Spring Awakening

It's early Saturday morning, and I'm sitting in my little loft, waiting for the sun to come streaming in through my windows and for my new little birdie friends to come visit me on my windowsill.  I almost feel like Cinderella... now if only I could get them to do my laundry... haha.  It promises to be another beautiful day here in Baltimore, and I am grateful for the change in season.  I used to think that summer was my favorite time of year, but after this winter and the recent shift in weather, I realize how much I LOVE spring.  Not just because it allows me to walk to school in the morning without the need for 5 layers of clothing, but rather for what it symbolizes: REBIRTH.  I've enjoyed walking through the city streets, admiring the budding and blossoming flowers, rejuvenated after a long winter hibernation.  Despite the 80+ inches of snow we had this winter, these marvelous works of nature are able to "come back to life" and share their beauty for us all to appreciate.  I know I personally appreciate the return of the sun, and the warmth that it brings with it, but I feel like I've reawakened - to life, to possibilities, to the wonder of this Earth, and to our individual significance as a member of humanity and one of God's children.  Easter is next weekend, and when you are able to look past the chocolate bunnies and see what the day really represents, it is humbling.  The most important and significant "rebirth" -- the true symbol of this time of year.  I feel so blessed... for many more things than I have time to share here.  But I am grateful for the knowledge that I have, the opportunities and experiences I have been given, and for the people that give my life meaning.

SO.  One thing that I struggle with is being present, in the moment, and recognizing and appreciating that which is right in front of me.  My mind likes to race forward, planning and preparing for the coming weeks and months, and before I know it, another day has passed me by.  Here I am, end of March... I only have one more full month in Baltimore, and then I'm OUT!  April will definitely be a busy one, so I know that it will be over in the blink of an eye... I have much to look forward to, but I'll get there soon enough.  So let me focus on what has happened the past couple weeks since I last posted...

I had the opportunity to return to the OR for another surgery... it was an incredible experience.  Watching the surgeons repair a thoracoabdominal aortic aneurysm was... awesome.  Not sure how else to describe it!  And let me just mention that the guy they were operating on was 6'5" and 450 pounds.  No joke.  Unfortunately, the surgery lasted much longer than I could stay for (I had tutoring with Ivan) but I do hope that he is doing well and making a full recovery to return home to his family and then to work as a middle school principal.  I will say... that is one thing I appreciate about bedside nursing -- the opportunity to develop a connection with the person behind the diagnosis.  It's not enough for me to understand the diagnosis and treatment plan; I need to know what events brought them to the hospital, and other factors that may be helpful pieces of information to improve the course of their care. 

After my second day in the OR, I was able to escape Charm City to enjoy a few days of my Spring Break in the Big Apple.  And I couldn't have asked for better weather!  The first day of spring in the city was well over 70 degrees, and I was thrilled.  New York can be one of the most miserable places to be when it's cold and windy... I was ecstatic when I was able to walk down Fifth Avenue with my sunglasses on :]  haha.  It's the little things that really do it for me!  The other highlights of my weekend included spending a sunny afternoon at the park relaxing on blankets with some new friends, , exploring the hidden beauty of Battery Park along the banks of the Hudson River, wandering through the halls of the impressive New York Public Library, and spending quality time with one of my favorites as we did yoga underneath a willow tree in Central Park.  Not a typical weekend in the city, by any means, but one of the most enjoyable and memorable ones to date. 

 

 

 

But of course, good times must always come to an end... and usually much quicker than you hope.  So Sunday night I returned to Baltimore, just in time to get a few hours of sleep before a painfully long and busy week of school.  Projects... assignments... exams... everything is piling on as we near the end of this semester -- only 3 more weeks to go!  At least I'm having an enjoyable time in clinical -- much less intense and stressful than Adult Med-Surg.  Thursday of this week, we spent the day at a catholic elementary school with the school nurse, and did some health education with a class of second graders.  Topic of discussion:  HEALTHY SNACKING!  Not just healthy eating... but what to reach for (or ask for) when they are hungry between meals.  I hope our activities at least got them to recognize that fruits and vegetables are better than chips and candy.  Gahhh -- don't even get me started on the obesity crisis that we are currently experiencing in the US!  That is definitely one of my interests when it comes to health promotion and education... here's a video that can better illustrate the nature of this problem that we must acknowledge and deal with:



 ... and here are some facts that I'll add on to that message:

• In 1990, ten states had a prevalence of obesity less than 10%, and no states had a prevalence greater than 15%.  By 1999, NO state had prevalence less than 10%, eighteen had prevalence between 20-24%, and no state had prevalence greater than 25%.  In 2008, only ONE state (Colorado) had a prevalence of obesity less than 20%.  Thirty-two states had a prevalence greater than 25%, and six of those states had a prevalence greater than 30%.  
• This is the first generation where the child's life expectancy is SHORTER than their parents.
• In 2000, obesity-related health care costs totaled an estimated $117 billion.

SO.  Take from that what you will... but this is more serious than people want to admit...!!  And after that educational moment on Thursday, I spent my day at clinical with a patient who is obese... spends 6-8 hours every day watching television, and refuses to participate in sports because she doesn't enjoy it.  It's a cycle -- kids aren't active, they get teased because they're overweight and unable to participate, and then they hide at home to escape the hurt and embarrassment they face at school.  It's terrible.  I tried to talk with the girl (13 years old) about her habits, but she wasn't really willing to listen.  I know it's tough for her... she comes from a broken home in East Baltimore, where it probably isn't very safe to be outside, with a mom who probably can't afford to buy healthier food (which is another community issue altogether), but hopefully she can find something to motivate her to be more actively involved in life.

Speaking of being active and eating healthy... I'm keeping up with my yoga practice, and I feel amazing.  I treated myself to some shopping in NYC at my favorite yoga store:  Lululemon Athletica.  I'm hoping to get a part-time job at one of the stores in Denver/SLC this summer.... keeping my fingers crossed!  I've also stuck with my "no sweets, no soda" pledge for the past 34 days -- SOOOO pleased with myself!  And what's even better, because I haven't had much sugar for the past month, it really doesn't sound appealing... maybe I should just keep this trend going... except for the dark chocolate of course (antioxidants, it's a healthy choice!) :]  Well, I have to get ready for my Saturday morning yoga session... Namaste!

springing ahead...

It's a GORGEOUS spring day here in Baltimore... I took a walk this afternoon through the city, appreciating the warm sunshine as I wandered along the banks of the harbor.  I love this time of year!!  As much as I enjoy winter, the shorter days and decreased sun exposure really affect my mood... I can already feel the shift, and look forward to sunny days that lie ahead!  And if that weren't enough, there are many other things that have brightened my outlook on life, and I'm excited to share that with you :]

To start, I had the great opportunity to observe 2 surgeries yesterday in the cardiac/vascular OR, a result of meeting Dr. Julie Freischlag a couple weeks ago.  It was an awesome experience.  First, I watched her resect the first rib of a woman suffering from thoracic outlet syndrome -- pinching of the nerve/artery/vein that run through that narrow region of the shoulder.  It was a relatively short procedure, and one that Dr. Freischlag is well-known for.  After that procedure, she whisked me off to observe a surgery that had already begun -- CABGx2 (coronary artery bypass graft) with an aortic valve replacement.  WOW.  I walked into an open-heart surgery!  I stood at the head of the patient for 3 hours, transfixed on the scene playing out in front of me... I could see the heart of this man, and watched the surgeons as they meticulously grafted on an artery cut from his leg onto the outside of his heart.  For those who are not famliar, CABG procedures are required for patients who have diminished blood flow to the heart itself, because without that blood support, the heart cannot function to pump blood to the rest of the body.  Usually the coronary arteries are occluded by fat deposits, result of long-standing diet and exercise habits.  (Prevention, people!)  The aortic valve, also a vital part of the heart, functions to keep blood from flowing back into the heart as it is pumped out of the left ventricle.  If not working efficiently, blood can flow back into the heart, decreasing the amount of oxygenated blood that is delivered to the various tissues of the body.  Replacement valves are synthetic -- created in a lab -- that are designed for maximal efficiency in patients that have weaker hearts.  Medicine never ceases to amaze me... even though I've learned about these types of procedures in class, it's something completely different to see it in person.  Anatomy and physiology is somewhat completely predictable, and although there is still much to be learned, it's fascinating to really understand and appreciate all that we DO know.  One of the aspects of Adult Med-Surg that I appreciated most was connecting all the patient data to understand the much larger picture... one that includes not only physiological factors, but also emotional, psychological, environmental, and social factors.  For example, my one patient who was suffering from congestive heart failure and renal failure -- she came into the hospital for fluid overload due to the complications of those two chronic diseases, but with further investigation, I learned that her meals included easy-to-make foods such as canned soup, which are known to be high in sodium... which would further exacerbate her fluid retention.  Interesting what health care providers can learn when they take the time to talk with their patients and learn more about their lives outside the hospital...... which can help us better care for them while they are inside the hospital.

In my last post, I mentioned my upcoming trip to St. Croix... I met with my group and instructor last week to learn more about what we should expect from our clinical experience on the small island in the USVI chain.  Our responsibility focus will be on health screening and health promotion.  The big diseases we will be faced with include diabetes, obesity, CHF, and... HIV.  We have a lot to prepare before we head down there, and I'm excited to research ways to better educate people on the prevention and management of these health complications that plague our modern society.

I'm nearly half-way done with my pediatrics rotation (really??) and this past week, I was fortunate enough to have a charming 13-year-old boy recovering from a sickle cell crisis as my patient.  For a kid who is familiar with the inside walls of hospitals, he was handling his most recent hospitalization with a great sense of positivity.  Maybe it was because he was missing school.... haha.  But he was a great patient.  In order to better manage his pain, we played Clue, wii, and Operation.... all completely nursing-related interventions, of course.  :]  It was a great day, laughing as we chatted and played games.  We even worked on some of his math homework!  He was not excited about that, but I made a deal that we would play Mario Kart after he finished a page of problems.  Kids truly do amaze me... his resilience and optimism was inspiring, and I was grateful for that short amount of time that I was able to spend with him.  He has such lofty ambitions for his future (he wants to be an engineer) and I hope that he finds motivation and support to pursue his dreams!  It reminds me of my younger years... wanting nothing more than to be a doctor.  I've definitely grown since then, and I'm grateful that I've found my calling as a Nurse Midwife. 

It's now Spring Break, and I'm enjoying the time I have to take care of my looong "To Do" list that has been haunting me for the past few weeks!  But of course, I'm taking advantage of this free time to escape to my favorite city -- NYC, of course!  I'll be heading up there this Thursday and staying until Sunday to do some therapeutic shopping :]  Then it's back to the grind... next week is going to be quite busy with school assignments and projects and what not, so I'm trying to stay mentally engaged with that reality.  Having days in the OR is actually helping... I'm returning tomorrow for a very serious and extensive thoracic surgery -- repairing an aortic aneurysm, and also placing femoral shunts.  I'll have more details next week... but I'm looking at multiple hours in the OR tomorrow!  What an opportunity and experience.... I'm quite excited, to say the least!

I'm looking out the window of my room, and it's still bright and sunny outside.. at 5:30pm!  I love DST.  Looking forward to the blooming cherry blossoms this spring.... only a few more days of "winter" -- I survived. haha. Until next time, take care all!

... could spring finally be here??

It's a beautiful Sunday afternoon here in Bal'mer... I just arrived home after a trip down to DC for church with a friend.  It was a much-needed break from the city -- sad to say that I was excited to be in a car driving on a freeway!  That says a lot about my life lately... Aside from my recent trip to New York with Greg, I haven't left the city of Baltimore for 2 months now.  I've forgotten what the world is like outside of my little bubble of Fells Point... thankfully the weather is finally starting to shift -- the sun is shining brilliantly on the harbor water today, with a bright blue sky overhead... could Spring finally be here??  I'm crossing my fingers, but definitely not holding my breath... Baltimore has found a way to disappoint me on more than one occasion in the past.  But I do have one thing to look forward to, that will happen whether Mother Nature wants it to or not -- DAYLIGHT SAVINGS TIME!  My favorite time of year... I don't care that I lose an hour of sleep, all that matters is that the sun will set after 7pm... I am so excited to walk home with some natural sun lighting up the sky! 

Well.  Because I have loads of studying and work to catch up on this evening, I'll try to keep this (somewhat) brief.  I've finished my second week in pediatrics, and it has been an interesting transition from Adult Health.  I've been assigned to work on the general med-surg floor for adolescents, and at Hopkins, "general" doesn't really encompass the breadth of medical cases that we see on our floor.  While I was working on the adult med-surg unit, we saw many local patients with common chronic diseases that they had been managing for many years -- namely COPD (chronic obstructive pulmonary disease), CHF (congestive heart failure), CKD (chronic kidney disease), DM (diabetes mellitus) and so on.  With the adolescent population, we are seeing families from all over the country, here at Hopkins as a "last resort" -- the hospitals back home are at a loss trying to diagnose and treat their ailments, so Hopkins is their only hope.  It can be a depressing situation, in that sense, because many patients do not know what is causing their problems, or if they do, it might not be something that can be treated at any regular hospital.  My first patient was from New Mexico, here to treat symptoms and complications from a rare genetic disorder that was only recently discovered (by her physician at Hopkins, no less) only 5 years ago.  She had spinal fusion surgery to correct her severe scoliosis, and had growing rods inserted to stabilize her back.  Her parents were present, and I cared for her over the course of my 12-hour shift.  We were happy to see her walking a bit by the time I was leaving, and she was such a trooper.  Thankfully her parents were very supportive and willing to assist with her rehabilitation, encouraging her to push through and do the activities that she did not want to do.  I think that's one of the most crucial factors in the health care of a child, whether the parents are willing to accept the diagnosis and comply with the course of treatment that their child needs, especially if it means pushing and challenging the child to do what he/she does not want to do.  As a nurse, my responsibility is to care for the child, but I am also "treating" the parents, by educating them and including them in the care of their child in preparation for discharge back home.  It's a delicate balance, and it will be interesting to see where the next 5 weeks take me....

And now for some exciting news:  This past Wednesday, I was fortunate enough to attend a lunch presentation by the Chief of Surgery for Johns Hopkins Hospital, Dr. Julie Freischlag.  Yes, a female Chief of Surgery.  It's an unfortunate rarity in this country, but she is managing the department quite successfully and spoke to us about taking on challenges when others say it isn't possible to succeed.  She was a fantastic speaker, and made some really interesting points that I greatly appreciated.  I was surprised to learn that she had completed her residency at UCLA, and that she had returned as the Director of Vascular Surgery at UCLA Medical Center for a few years before she moved to Baltimore.  I approached her after the presentation and thanked her for words of encouragement and inspiration, and to make a complicated story short, I asked her if it would be possible to observe one of her surgeries... and she was more than happy to arrange it!  So, next Monday over Spring Break, I will be in the OR... I'll be excited to report back details of my experience.

So, yes, Spring Break is next week... with the amount of school work I have looming on the horizon (between exams, assignments, projects, and presentations) I'm somewhat relieved that I won't be traveling anywhere.  It will give me some time to (hopefully) relax and check a few things off of my "To Do List."  I'm trying to plan a trip up to the Big Apple, at least for a few days... I don't mind the idea of traveling alone, and besides, I have friends to visit there and work that I can get done while I'm in the city.  And I will definitely appreciate the change of scenery!

With that, I'm going to leave you all... look forward to exciting updates on my next blog entry!!