newsflash from charm city:

It's Sunday afternoon, and I find myself reflecting on the past week while preparing for another to start.  I look at the items scattered around my desk... 3 saline IV syringe flushes, a bottle of hand sanitizer, 2 bottles of lotion, a pile of alcohol wipes, scattered papers that dictate current labs and medication orders for my last patient, various nursing textbooks... that basically describes my life in a nutshell right there.  I would say that this past week was more-or-less uneventful, but there is one quite important update that I have for you all...

I'm moving to Utah!

Although I had a feeling that I would eventually return, I didn't realize it would be so soon... I have decided, after much prayer and deliberation, that I will be returning this summer!  Many reasons factored into this decision... but now that I know I want to pursue my master's degree in midwifery at the University of Utah, it just seems silly to ruin my residency status by staying out here an extra year or so to work.  And, on top of that, I don't want to take my boards twice... getting licensed out here only to have to re-take the exam in Utah just seems like a huge inconvenience.  There were a few other factors that finally pushed me to make this decision, but I am at peace with this new turn that my life is taking.  I know that the Lord is guiding me, and that there is a reason I am meant to return.  Many people think I'm jumping ship, that I couldn't handle life out here on the East Coast.... but that's not the case!  I do love it out here, and I know that I will miss it once I am back in the Salt Lake Valley, but I feel like I've experienced what the Lord wanted me to while I was here, and now it's time for me to continue on to the next adventure.  So... after getting settled in the great city of Baltimore, it looks like I'll be packing up and making the trek out west.  But I still have a few more months to enjoy life out here, and I know that I will be making the most of it!!

SO.  Aside from that minor development... life has been pretty routine the past week.  School is quite time-consuming right now, and there isn't much of an end in sight... I have two exams this Tuesday, and then my first Care Plan for Adult Health due on Wednesday.  Needless to say, I'll be spending my "holiday" tomorrow at school.  This "Care Plan" that I speak of... it's not anything to be taken lightly.  Especially for Adult Health.  We take our patient from this past week in clinical, and we have to put together an entire plan of care for that patient based on their priority nursing diagnosis and problems that we are responsible for treating.  These "nursing diagnoses" include anything from pain management, ineffective coping, nonadherence to treatment directions, and so on.  In past clinicals, this diagnosis is usually quite straightforward... but for the unit that I am working on now, the "general medical-surgical" patients encompass a wide variety of problems.  For the first time, I had a female patient who was my age... she was suffering from spastic paresis (temporary periods of unexplained muscle spasms/paralysis of the legs) and gastroparesis (intractable nausea/vomiting), aside from a myriad of other medical diagnoses.  She is what the hospital terms a "frequent flyer" -- she is in and out of the hospital often, and comes to know nurses and doctors by name.  For the most part, this descriptive term is used to describe those who have multiple health issues and can't help but visit the hospital on a high frequency basis.  For some, however, they develop an apparent "addiction" to the hospital environment and the attention that they receive while there that they can't imagine life any where else.  So... they concoct these "symptoms" and find ways to return to the hospital.  I don't mean to say that they don't have these feelings of pain or sickness, but for many, their bodies are so closely intertwined with their psyche that they work themselves up into a state of illness.  It's quite fascinating, to a certain extent.  After spending two days with my patient, I watched her very closely and her pattern of behavior, and recognized a very deliberate and manipulative attitude regarding her care and what she wanted done for her while she was in the hospital.  I don't want to say that she was exaggerating her stated symptoms, but I have my theories... either way, I have to write up a plan of care for how I must care for her while she was in the hospital, and my priority problem for her was imbalanced nutrition -- she refused to take anything by mouth because it would make her sick, and all her medications were given through IV (which gave me great practice on administering meds via IV push).  She also complained of severe abdominal pain, and requested narcotics to treat her symptoms, as they were the only medications strong enough to cover the pain without causing her to be sick... but, after a lengthy course of narcs last year, she was weaned off due to a high tolerance build-up, and had severe withdrawal which caused her to be even more sick, so the physician did not want to go that route again.  She threw quite a fit when she couldn't get what she wanted... which made us slightly suspicious that she was drug-seeking.  That's the tough thing about pain -- it's completely subjective, and we have to treat it according to how the patient describes it to us.  You can have a patient in obvious excruciating pain, and they rate their pain at a 6/10 because they've been in worse pain in the past.  Then, you'll have a patient (like mine this past week) who is talking and laughing one second, then reporting her pain as a 10/10 -- the worst pain imaginable -- and requesting strong pain medications.  And for many pain medication orders, we are given a range: 2-4mg morphine Q3H, based on pain score.  If they are in more pain, we give them more pain medication.  There is no assessment that we, as nurses, can perform in order to definitively say how much pain the patient is actually in, so we must go by what they report to us.  Surprisingly, most patients under-report the amount of pain that they are experiencing, but there are the select few that, for whatever reason -- be it low-pain threshold or desire for stronger meds -- report higher pain scores in order to be treated.  Nurses are constantly put in this difficult position, to judge the situation and care for the patient as they see acceptable and appropriate.  This can be a difficult responsibility to have, but I much rather prefer to have this type of relationship with the patients and really understand what it is that they need versus what they want, or what their medical diagnosis may dictate that they may need.  In many situations, we are the patient advocates -- we recognize what the patient needs more than the physician, and we are able to relay this information to the appropriate provider.  Unfortunately, doctors are too focused on diagnosis and treatment plans that they forget to actually assess the individual from a holistic perspective and take outside factors into account for their current physical and psychological state.  Working as a nurse and learning more about the patient's history and lifestyle choices allows me to gain a greater understanding of the person behind the medical problems and usually helps to better serve the patient.  It's an interesting and complex dynamic, and I'm appreciating these opportunities to prepare myself for what lies ahead in my future career.  Aside from the complicated profile of my patient this week, I was able to attend two very interesting procedures with her: first was a gastric emptying study (which she was unable to complete because she couldn't keep the food down) and then second was an EGD - they put a scope down her esophagus and into her stomach to take a look and see what might be causing the irritation and constant vomiting.  In addition to looking around, they injected her pyloric sphincter with BoTox to prevent it from closing -- in essence, the BoTox prevents the muscle from contracting so that the food moves through her stomach more rapidly and has less chance to be regurgitated.  It's a newer, more experimental procedure, but she had it done last fall and it seemed to help so she was at Hopkins specifically to have this done again.  That's one thing about JHH -- we're able to witness procedures that are still being closely studied and investigated, as those patients who come through the doors of the hospital are usually at their last hope and will try (almost) anything to alleviate their ailments.  And I am grateful that it is a teaching hospital, as the physicians are much more willing to explain their procedures while they are performing them.  The two doctors (one attending and one resident) that did the EGD for my patient were more than happy to include me in their discussion throughout the procedure, and I appreciated that.  It was so fascinating... I was transfixed by the image on the monitor of what the small camera was viewing as it traveled down the GI tract... and once it was in the stomach, I could see the waves of peristalsis move through the muscle wall -- it was fascinating.  I am in constant awe of the complex systems that control our bodies and their function... have you ever stopped to really think about how perfectly our body systems must coordinate their efforts in order for us to live?  No matter how many times I learn about the various physiological processes that occur in our bodies, it never fails to amaze me... and only serves to further strengthen my testimony of the Lord and how perfectly He has organized this world.

WOW.  Another soapbox moment for me!  I just get typing and don't realize how much I've written.  But I really need to get studying... I have so much to get done over the next 24 hours!  Goodness... pray for me. haha.  The only thing that keeps me sane is yoga -- my current goal is 30-straight days... I've hit 11 already (not including Sundays) and I feel FANTASTIC.  Seriously.  It really helps to keep my mind focused and helps reduce my stress. I have really developed a healthy addiction to the "hot yoga" craze out here -- 90 minutes in a 95-degree room... it's quite the workout, let me tell you!  I don't think I've ever been in this great of shape, and I absolutely LOVE it!  I could just continue on this trend for a while... why stop at 30 days?? :]  Anyways, have a great week all!  Until next time....

hopkins: behind the scenes....

Picture this:  It's 6 am, and the sun has not risen above the rooftops of the rowhouses quite yet... I open the door of my home, icy wind brushes my hair across my face - it's just another morning in Baltimore, and thankfully it has stopped snowing.  I step out onto Washington Street, and walk north toward the hospital.  The ice crunches under my fashionable Dansko clinical shoes, and I watch as my breath creates a white cloud in the brisk morning air.  I pull the hood of my down parka over my forehead and tighten the cord to keep my ears protected from the chill.  I force my hands down into my pockets and fumble for my iPhone, realizing that I hadn't started my standard morning music mix before putting my gloves on... number one drawback to having a touchscreen phone!  I pull my warmed fingers out of their cashmere and leather cocoon and scan for my current favorite artist: Carrie Underwood.  Perfect morning pick-me-up before clinical!  I look ahead and make my way toward campus, realizing that I have another 20 more minutes in the 10-degree weather before I can defrost in the computer lab of the SON building... maybe if I push it, I can make it in 15... that is, if I can keep my legs moving quickly enough to keep them from freezing.  I scan the sidewalk in front of me, ensuring that I don't step on a patch of ice that could lead to serious pain in my sacral area.  I have trained my brain to focus on the rhythm of the music, and coordinate my movements accordingly... keeping occupied doesn't allow me time to focus on the cold... that and wearing 5 layers of clothes.  My arms extend slightly out to the side, bringing to mind thoughts of "A Christmas Story" and that makes me smile.  Anything to keep warm!  I make my way up through Butcher's Hill and see the Hopkins Hospital looming on the horizon... my first day on Halstead 8: ADULT GENERAL MED-SURG.  Am I prepared?  Can I manage my patient and my time on the floor?  My mind races...  Hepatitis C. Cryoglobulinemia. Fungemia. C-Diff. Hemodialysis.  ESRD. GERD. I see the doctors and nurses flooding the front doors to the hospital, and I make one last stop in the SON building to review my notes and plan for the day, hoping that I can remember the skills and assessments I will need to perform and interpret.  As soon as the feeling starts returning to my fingers, I pull out my clipboard and scan over my patient's profile... I take a deep breath and accept that  it's going to be a long day...

That was a little insight into this past Friday morning.  Needless to say, I survived my first day on the general med-surg floor!  I was slightly overwhelmed and intimidated, but I greatly appreciate that we are given our patient's profile in advance, so that we can be adequately prepared for our duties and responsibilities in caring for our patient's specific needs.  My patient, bless him, kept me on my toes.  I was busy from 7 until 1, including following him to a procedure in the ECHO lab where they did a TEE - transesophageal echo - to scan his heart for any signs of infection with a probe that went down his esophagus.  Quite an interesting procedure to witness, especially when the machine wouldn't calibrate!  It's slightly funny... we rely on advanced computers and technology to perform these medical exams, and then get frustrated when they freeze up... they are computers after all!  I chuckled when the doctors tried to "turn it off and on" to see if it would restart itself... haha.  Unfortunately, they weren't able to fix the problem, so another machine from a different unit was brought in to use in the interim, and thankfully that machine worked.  After the delay, my patient received good news - despite all his other ailments and health issues, his heart was in great condition.  And believe me, he needed some good news.  His initial complaint of fluid overload, as brought on by end-stage renal disease and liver failure as a result of hepatitis C (which he contracted from a hospital blood transfusion) was exacerbated by hospital-acquired infection at an IV site and an allergic reaction to a medicine he received as treatment while in the hospital, causing severe itching over his entire body.  He was a bit withdrawn at first, and I wasn't surprised... I don't know how much patience I would have with the hospital staff after all that!  But at the end of the shift, I wished him well and thanked him for allowing me to work with him that day, and his reply made it all worth it... to hear appreciation for simply taking the time to listen and care -- that is why I am entering this field.  I know that my weeks ahead won't run as "smoothly" as that first day did (although it was far from smooth...) but it gives me hope that even with my "limited" experience and relative feeling of inadequacy, that I can come out the other side with a sense of accomplishment. 

Aside from clinical, school has definitely kept me busy!  I'm really excited about my class that focuses on nursing for newborns... we went over neonate assessments and what to expect, and how to recognize any abnormal signs or unexpected symptoms... SO much information.  But this is the first class where I am excited to read and actually WANT to purchase the textbook for my own library to have as a reference... I know this is where I need to be!  Spending an extra 10 hours a week in class for an elective... that has to mean something, right?  haha.  Aside from that class, my Adult Health class is focusing on major health issues that plague our society.  First on the agenda: OBESITY.  Not sure you want me going into that, I could be on my soapbox for a while!  Let's just say that over 1/3 of our country is considered obese, and it's not getting any better... for the first time in our modernized world, this current generation of kids has a shorter life expectancy than that of their parents.  Main culprit: TV and video games.  GET OUT OF THE HOUSE AND GET ACTIVE!  And while you're at it, throw out the CheezIts and Oreos.... goodness people.  But enough of that (for now at least).... it's time for me to get my study on, SO.... I will leave you all until next week!  And here is a parting quote that I heard in one of my classes, that I thought was so appropriate and I just have to share:

"You make a living by what you get, but you make a LIFE by what you give." - Sir Winston Churchill

*TWENTY-TEN*

 H A P P Y  N E W  Y E A R ! !

 As much as I love the feeling of a fresh start at the beginning of a new year, I always feel a let down after the end of the holidays...  Christmas brings with it such joy and spirit, and just as quickly as it begins, it's over... and the focus shifts back to maximizing productivity, with an increased emphasis on overhauling our lives.  Granted, "New Year's Resolutions" can be motivating, but unless it's practical, more often than not they are forgotten before the end of January.  I'm not the biggest supporter of the "Resolution" movement, only because I like to think that I can make changes to my life and follow through with them - no matter the time of year.  It's amazing - I've found a way to make the most of change... I now thrive on it; it gives me more purpose and direction in my life.  Speaking of... I have made a huge decision regarding my future, and taking a different direction: I have decided to forgo the Nurse Practitioner program at Hopkins, and instead will work toward acceptance into the Midwifery program at the University of Utah.  It has been a very drawn-out and prayerful decision, but I know now where my passion lies, and I feel that it would benefit me (in many ways) to pursue the rest of my education at the U.  It is a very reputable program, and the environment there would provide me with a great deal of experience and a variety of patients.  Prior to starting that program, however, I plan to work for at least 2 years, in order to have a stronger foundation and understanding of the field.  That leaves me with another huge decision... where shall I work?  I have been pondering this difficult decision and praying about it, and I will keep you updated as soon as I figure out where I am meant to be.... whether that be here in Baltimore or back in Salt Lake, I'm not sure.  I know the Lord will give me direction as He sees fit.  Seems slightly funny that I travel all the way out to Baltimore to return to Salt Lake, but the Lord has His way of handling things... I recognize the many reasons I was meant to be out here in Baltimore, and I am grateful for the opportunities I have been given and the experiences I've had, but I've learned not to argue or question the path the Lord has prepared for me, no matter how convoluted it may appear.  But I still have another 2 full semesters of school ahead of me, so I have to stay on track and focus on the task at hand!  And they aren't wasting any time... I start classes tomorrow, and I already feel the pressure of the course work that will be required.  I'm excited to start again, I just hope that I am prepared adequately for clinical this week... I have been placed at Hopkins Hospital, on a general Adult Health floor, and we will be expected to be on top of all our patient's assessments and meds... I keep reminding myself that it will be overwhelming at first, but with time and exposure, it will become easier.  At least coming out of this rotation I will feel much more like a nurse!  And I'm excited to finally be working at Hopkins... finally I'll be able to learn what all the hype is about....

But today is still technically Winter Break.  So, although I am mentally preparing for school to start, I am still trying to enjoy a bit of my freedom!  And I want to fill you all in on the holiday happenings in my life... it's been a busy past couple weeks!  I already told you about the snowstorm that we survived 2 weeks ago (really? only 2 weeks? wow...) that shortened my trip to California, where I stayed with one of my dearest and oldest friends, Brenn (we go waay back to 4th grade!) for a few days.  It was so good to see her, after having her out here for our historical exploration of the Chesapeake region back in September.   I hadn't been back to California in over a year, so more than anything, it felt great to be "home" again.  We ventured back to our old stomping ground, Westwood (Brenn and I were roommates while at UCLA together) and then traveled to Malibu to visit my mom's beautiful residence (with Pacific Ocean views, no less) and visit with the monkeys that her friend Monique owns.  There are 7 in total... and we had a wonderful time getting to know them all!

A majority of our time was spent in Hermosa Beach, near Brenn's lovely little home... we treated ourselves to a Bikram session, massages, and shop therapy.  Much needed, and deserved (I think), let me tell you!!

And then it was time to head up to Utah... and Brenn decided, on a very spontaneous decision, to join me for a few days in the winter wonderland of Salt Lake after Christmas weekend!  I was so happy to have her up to visit.  Christmas came and went, and I was grateful for the time I had to spend with my family.  Especially when we all made the trip up the canyon to Snowbird for some time on the slopes!  It was (albeit windy) a gorgeous day on the mountain, and we had a great time exploring the runs off the tram.  The rest of the weekend was relaxing, and it was great to visit with family and friends in the Salt Lake area.  Brenn arrived on Monday afternoon, and I had such fun introducing her to life in the snow.  We went to Brighton on Tuesday, her very first time snowboarding, and I was impressed with how well she managed on the mountain!  She was determined and motivated, despite spending a majority of her time on her back.... haha.  Greg came along with us, and we were all pleased with the conditions... light snow fall, making for smooth runs down, but also adding to the picturesque scene of the frosted mountainside.  We were definitely happy to return home that evening and put our feet up in front of the fireplace... such a wonderful way to defrost.  We had intended to head up to Park City on Wednesday, but a snowstorm prevented us from making the trip... our little shoebox of a car wouldn't have made it up the canyon!  A bit disappointing, but we made the most of our time in the valley.  She was so excited about the fresh snow that coated the ground outside our house, and I was surprised at how much I missed that climate!  Snow in Utah is idyllic... in Baltimore, it's just depressing.  haha.  After Brenn left on New Year's Eve, I was feeling a bit sick, so I spent that night in bed!  So sad.  But I know that if I had tried to go out, it would have been miserable.  I know I'll have plenty more NYE's to enjoy.  The rest of my time in Utah was spent relaxing around the house, enjoying time with Greg, as I took advantage of my remaining freedom before returning to "Charm City" - which is currently under "weather watch" for gale-force winds, which I can hear whipping around our house!  I don't even want to know how cold it is outside...  currently, accuweather.com says that it is "27" degrees outside, but with the windchill, it's about 7 degrees.  GAHHH.  When I arrived back in town last night, it was 0 degrees. ZERO.  Really?!?  What I would give for the "freezing" temperatures of Salt Lake right about now... save me! haha. But I signed up for this... so I'll grin and bear it!  Even if that grin is frozen across my face... and with that, I'll leave you until next weekend -- I'll have plenty to discuss after this first week of classes is over!  Here are a few parting shots from the past few weeks:

[Rockefeller Center tree]

[Mary Poppins on Broadway]

[Snowstorm on Washington Street]

[Snowbird]

[sibling love]

[Brighton]

[Snowfall on 1500 East]

'twas the night before Christmas...

I'm sitting in the living room of our quaint Salt Lake City home, fire blazing just a few feet from my toasted feet, keeping me warm on this wintery Christmas Eve.  What a wonderful holiday season this has been - time spent with family and friends, and that is what makes it truly special.  And I have managed to stay quite busy over the past few weeks!  But I have finally arrived at my last destination, and I am ready to be still and enjoy time here at home, and up on the slopes of the Rocky Mountains.  Snowboarding on Christmas Day with the family... couldn't ask for a better way to celebrate.  But before Santa arrives, I want to fill you in on the happenings as of late...

SO.  I left you during the final few days of my semester, with one final to go - PHARM.  I had a busy weekend preparing, and I was proud of my preparation and the effort I put into studying... and it definitely paid off!  What was definitely the hardest exam of the semester became more manageable, and I finished the semester with solid grades.  One more classroom-intensive semester of school and then its on to my transitional semester in preparation for me to become a licensed nurse!  And what a intense semester it will be... I'm overloading the first month with a course, Nursing the Neonate, that will prepare me to care for newborn infants - particularly those in emergency situations.  It will be an added 10-hours of class per week for that first month, but I am eager to learn the information so I am willing to sacrifice my free time for this elective course.  Having this wealth of knowledge will only serve to increase my knowledge base and level of confidence as I enter the workforce as a nurse, and I want to be as prepared as I possibly can!  And aside from that, the course is led by the instructor I had for my Faith & Health course and I absolutely love her, so I was even more willing to spend those hours with her.  But in addition to that course... I will be starting my Adult Health rotation - not sure where I will end up quite yet, but I am crossing my fingers for the HIV/AIDS unit at JHH!  That will be my hardest, most comprehensive clinical course... as overwhelmed as I might be at the thought, I know that my experiences will only prepare me for what lies ahead, so I look forward to the challenge it will undoubtedly be.  I'm also taking a research-based course, to educate us on the importance of implementing evidence from current research into our practice (something that is crucially important, as a multitude of new evidence for medical practice is presented every day!), and then a course on information technology and its place in the hospital.  During the second half of the semester I will be doing my Pediatrics clinical rotation and my Public Health-focused clinical rotation, and I will go into further detail about that as that draws closer.  So I know I won't be bored next semester, that is for sure!  But now is time to relax and enjoy the peace and quiet that the holidays bring.... although looking back at the past few weeks, I really haven't experienced much peace or quiet! 

After school finished, I had a few days to collect my thoughts and strength, in preparation for the busy days that lie ahead of me.  That following weekend, Amanda and I made the trip up to New York City to take in the sights and sounds of the city during the holidays.  We wandered along Fifth Avenue to view the spectacular window displays of Bergdorf Goodman, listen to the "Carol of the Bells" play in coordination with the snowflake light show on the outside of Saks, take in the beauty of the giant Christmas tree in Rockefeller Center overlooking the menagerie of people skating on the ice rink below... I love New York during the holidays.  Nothing compares  - the spirit of Christmas has filled each and every street as a constant reminder of this glorious time of year.  Only wish that some of the people there would feel that spirit and remember what this season is really about... but hey, it is New York.  Blaring horns and disgruntled shoppers are part of the package.  We were able to escape the chaos of the shopping frenzy for one night, though, as we went to see "The Nutcracker" performed by the New York City Ballet.  I have never appreciated the grace and utter strength of ballet until that show.  Words cannot adequately describe their perfect poise as the Sugar Plum fairy danced with her Prince on stage... it appeared effortless.  I was in pure awe... so grateful for the opportunity to witness the beauty of their talent.  We stayed until Monday, enjoying some time to relax with friends and relish in the Christmas spirit of the city.

One of my closest friends from my college days at UCLA, Meghan, came out to visit me for a few days after she finished her semester of business school in Denver.  We stayed Monday night in Baltimore before making our way back up to New York for a few days of a holiday shopping spree!  Over the course of three days, we traveled from Harlem all the way downtown, visiting every major shopping district you can think of... and thankfully my bank account did not suffer too much!  I was able to get all my Christmas shopping done, and then treat myself to a few gifts as well... including a trip to a Broadway show!  We felt the need to relive our childhood - singing along to "Spoonful of Sugar" and "Let's Go Fly a Kite" with the cast of Mary Poppins.  It was a fabulous show!  Our whirlwind adventure in the concrete jungle of New York ended as quickly as it began, and we found ourselves back in Baltimore on Friday to pack and prepare for our Saturday afternoon departure.  Goodness, that makes me chuckle now... because when we arrived back in Baltimore, Meghan and I went to the grocery store and were surprised by the masses that were crowding the aisles, until we heard the reason for the mad rush to the market - a huge "Nor-easter" storm was on target to hit Baltimore that night, bringing with it about 20-32 inches of snow!  We had absolutely no idea that a huge blizzard was heading our way, and we rushed home to find out that all flights out of BWI for the next day had been cancelled.  Including ours, of course.  So... we were left to fend for ourselves,  situating ourselves next to the fireplace and renting about 6 movies to keep us entertained for the day.  We ventured out into the biting wind for brunch at my favorite breakfast spot (it was actually open!) but that was our only excursion out that day.  With an average yearly snowfall of 20 inches, the city of Baltimore is not equipped to deal with any huge snowfall - namely, no snowplows.  Even when we left on Monday, many of the streets were still blanketed in snow.  A bit ridiculous... to get 22 inches over the course of 24 hours... but it was a fun experience.  Unfortunately, snow in Baltimore doesn't really amount to much... at least in Utah, we have mountains to enjoy and activities to participate in.  In Charm City, everyone goes into hibernation... it just causes miserable travel conditions!  But after a couple days of hiding inside, we were lucky enough to find seats on planes out to our final destinations (California for me, Colorado for Meghan) - thankfully BWI is not the busiest  airport... canceling flights the week of Christmas is only asking for chaos!  And apparently it did wreak havoc on certain airports... bless those people who work in the customer service departments of airlines.  I don't know how they do it! 

Well... so that I don't take up any more of your time, I'll leave the rest of my holiday story for another day... now it's off to a movie with Greg!  Love this time to spend with family and enjoy the splendor of the season.  Wishing you and your families all the best on this glorious Christmas Day!

*DISCE PATI*

"To live is to suffer, to survive is to find meaning in the suffering. If there is a purpose in life at all, there must be a purpose in suffering and in dying."  - Dr. Victor Frankl

I SURVIVED.

I just finished my last day of clinical at my OB site... on 2 hours sleep.  Thank you care plan!  I was up until 2:30 AM scrutinizing every last detail so that I could prove (to MYSELF) that I was a competent student.  And I feel so proud of the effort that I made and the work I accomplished.  I feel that it adequately represents ME and the type of student I am and reflects the type of nurse that I hope to become.  Which I am now one more semester closer to... half-way there!  Hard to believe... another 7 weeks of clinical - OVER and DONE. 

So. Now to discuss this past rotation... one which led me to realize my passion in the medical field - L&D!  Can't tell you how excited I am about that discovery.  It just FEELS right, on so many different levels.  As for this clinical experience...  my feelings are quite mixed.  On the one hand, I'm a tad bit frustrated with some of the communication (or lack thereof) between the course coordinator and the clinical faculty.  Our site instructor had much higher expectations of our preparation and knowledge base, when we all understood that we were going to learn a majority of the material and skills as we gained experience on the floor.  We were taught the information in the classroom, but over the course of the 7 weeks, so it didn't quite translate over to the timeline of our clinical rotation.  I don't normally complain about the workload of classes, but when it isn't clear to the students what is expected of them (and I wasn't the only one) then maybe it needs to be addressed across the board.  HOWEVER... because of the high expectations that were placed on us, I was forced to push myself out of my comfort zone and I chose to challenge myself, to prove that I was capable of meeting those expectations.  I know that I am a competent student, and I have a strong desire to be a confident and attentive nurse, and that eagerness is what fuels me to take on the obstacles that are thrown in front of me as I make my way through this program.  My clinical instructor gave me feedback that I am quite grateful for, and complemented me in the best way possible - by telling me that I am motivated to challenge my weaknesses in order to overcome a complacency with mediocrity.  Thankfully she noticed my committment to the unit and to my responsibilities after my midterm evaluation, and was impressed with how I took her comments and implemented them into my practice.  So.. despite the frustrations, I am grateful for the lessons I learned and the experiences I had while I was on that unit - it has prepared me well for my next rotation!  Adult Health.... oiy.  I requested to be on the HIV/AIDS floor of Johns Hopkins Hospital -- that is my number one choice, and especially because it's at JHH!  I've heard great things about the staff on that unit, and I really hope that I am placed there.  I haven't been at a clinical site at JHH yet, and this would be an incredible opportunity!  I'm crossing my fingers...

As the semester draws to a close, I've been reflecting on all that I've learned this semester... so much more than just nursing-related information.  I've really delved deeper and gained a greater understanding of myself, and I am so excited to take this with me as I continue on!  I read "Man's Search for Meaning" by Dr. Victor Frankl for my Faith & Health class (a fantastic book, if anyone wants to pick it up this holiday break) and I found some great insight within its pages.  I started off this blog entry with a quote, one that I have drawn strength and inspiration from.  In his book, Dr. Frankl describes his experiences as a prisoner of the Nazi concentration camps, and how those who were forced into such great, unavoidable suffering had to change their perspective and outlook on life in order to survive.  His theories form the framework for "Logotherapy," which focuses on man's intent to find meaning in life, which gives motivation and reason to survive.  This meaning can come from many different places, and sometimes we must be willing to swallow our pride and humble ourselves to give ourselves over to a greater purpose.  Life is not meant to be an easy roadtrip... there are going to be struggles and sacrifices that we will have to make in order to reach our eventual goal, and as I have learned to accept this, it makes the process much more manageable.  Sometimes I might not understand why I am chosen to suffer, in whatever context that might entail, but I know that in the end, it will all be worth it.  And that is what gives me hope and strength to press forward.

OKAY now I'll get off my tiny soapbox... I guess that I'm just feeling the love in my life right now - holidays tend to do that!  I had an incredible time with my family and friends while I was in Utah for Thanksgiving, and feel so grateful to have such an amazing support system in my life.  It was just what I needed - time to let go of the world for a few days and just appreciate my numerous blessings.  It was also nice to see SNOW - the first time I've ever actually missed living in that climate!  It's starting to get icy out here... but with this humidity comes sleet and freezing rain.  No powder-white snowflakes to catch on my tongue as I ride the chairlift up a mountain... something to look forward to this winter!  But not before my trip back to California... it's been over a year since I've been back, and I cannot wait to return!  Many things to do, places to see, and people to visit. It will be a much-needed mini-vacation.  I also plan to head up to New York City... again... haha.  Next weekend, Amanda and I are making our way up to see the NYC Ballet perform the Nutcracker - SO EXCITED!  And then the week after, a close friend from UCLA (Meghan!) will be out to visit... and, surprise!  I'm heading up to NYC again. haha.  Can't keep myself away.  Love that city!  Just waiting for a couple other people in particular to make their way out here to show them the wonders of the Big Apple... *ahem* GREG *ahem* :]

So.  It's Friday afternoon... and I'm at school.  Maybe because this place is my second home... I feel oddly comfortable here.  I had to drop by and finish an assignment and pick up some notes, and then I sat down at the computer and haven't had motivation to get up and walk home yet.  I should probably head back soon... it's almost 5:30!  Yikes.  One more final to go... can't forget PHARM on Monday.. goodness.  So close, I can almost taste it... mmm a cup of hot apple cider seems so perfect right about now....



(SIDE NOTE: for those who don't want to take the time to look up the meaning of the latin phrase in my title, it means "LEARN TO ENDURE". Quite fitting, if I do say so myself...)

reality. check.

SO.  I wouldn't normally blog about the negative things that happen in my life, but what is life without a few set-backs?  I can't paint a rosy picture for you all and pretend that I haven't encountered a few bumps (or ditches) along the way, and I feel like it's semi-therapeutic to share my experiences.  Helps me to learn and grow.  And most importantly, to move forward.  Nothing worse than over-thinking situations and letting them stew... it only compounds the issue and prevents progression.  Which is why I feel it necessary to get this out, and then I can hold myself more accountable and motivate myself to press on....

Last week in my clinical rotation, we started on a new unit - Postpartum.  Most people immediately think "Postpartum = depressed patients" but this is not the case!  Postpartum is the term used to describe the unit that cares for moms and their babies after they have delivered.  Most patients are on the unit for 2-4 days, depending on the type of delivery (vaginal vs c-section) and related complications or concerns.  This is a much different environment than L&D... slower paced, more monitoring and basic nursing care (comfort measures) and routine assessments.   It was a big adjustment, both in activity level and what we were focusing our attention on.  I was assigned a patient who was stable and fairly knowledgeable with the expectations in postpartum following her c-section, and her husband was a great support - he was an RN so he was also watching for any concerning signs or symptoms to alert us.  It made my first couple days a little more relaxed, but looking back, that probably wasn't the ideal first postpartum patient experience for me.  I've figured out how I learn best - hands on, in the moment, addressing issues as they are presented and processing through their implications.  It's much harder for me to take information from the book or lecture and apply it without prior exposure to the situation.  So.. on Friday, I had my midterm evaluation with my clinical instructor, and she brought up some concerns she had with my prioritizing and care of my patient, mostly related to my ability to assess my patient as a whole and think critically regarding any and all issues that might be of concern to us while she is under our care in the hospital.  In my defense, it was only my first couple days and I hadn't had any prior experience in postpartum so I wasn't well-versed on the major concerns and issues of that unit, but she did have a point.  And it really knocked some sense into me.  Yes, I finally had my break-down and a good cry in the nurse's lounge, it was bound to happen, but most of all I was grateful.  My instructor took the time to point out areas where I need to improve, and if I have any desire to be the best nurse I can be, I must be willing to hear feedback and then (most importantly) apply it to my practice.  It wasn't so much a smack in the face as it was a wake-up call.  I have been doing quite well in this program, and I haven't had anyone challenge me to work harder to reach my potential.  My last rotation in Psych was not a great indicator of what is to be expected of us as nursing students - I lowered my expectations of myself and my work ethic suffered.  I sunk back into old habits and wasn't focused on the bigger picture - that what I am learning here and how I choose to practice will translate into my work as a nurse.  If I don't learn how to effectively care for my patients in this environment, how can I expect myself to perform with confidence as an RN?  So I made that clear to my instructor - we may only have 2 weeks left of clinical in postpartum, but I have committed to myself and to her to extend myself beyond my comfort zone and push myself to think outside the box and care for my patients accordingly.  I also explained to her how I can learn best in the clinical environment and asked her to help me by challenging me to look past what is in front of me and consider alternative explanations for any values or assessments that I might come across.  So although I might have been disappointed in myself and the level of effort I had been putting forth, I was grateful that I had this chance to take a very critical look at my performance in order to make necessary adjustments.  It's so much harder (near impossible, I believe) to grow and progress if you don't have someone pointing out areas where you can improve.  Self-evaluation can only go so far.... outside input is what really drives change.  Yeah, it was hard to hear... but now I am motivated to live up to my potential, because I know I am capable of so much more than this!!  And with that said... only a few more weeks left in this semester to finish strong, then it's holiday break!  THEN will be my time to relax and breathe.    Hard to believe that Thanksgiving is next week... ahh don't even get me started! 

I also have a little bit of an update: I've expressed how interested I have become in L&D, but it has become a recent decision to pursue a career in that field.  I haven't been so sure of a decision for a while... I know the Lord is guiding me and nudging me along, and He has helped me to realize how passionate I am about this specific environment in medicine.  Yes, I love working with teenagers, and maybe I can adapt my work to include care for teenagers in the future, but I feel like I have found my calling - as a nurse midwife!  It's going to be a long process, but I am eager and excited about the road ahead of me.  It's been a long time since I've really been excited about what I am working towards... reminds me of when I first started nursing school.  Now that I realize what I want to pursue, it makes preparation so much more enjoyable.  I love studying about the aspects of women's health related to pregnancy, so much that I am slightly overwhelming my schedule next semester so that I can take a class to learn about caring for the neonate.  I know my life outside school is going to be non-existent come January, but it will be worth it!  I am actually much more productive when I have a busy schedule... pressure to get things done, and helps me keep school at the front of my mind.  Besides, winter in Baltimore probably won't be so pleasant... I'll be stuck inside anyways, might make the most of it right?  haha.  Not so excited about that.  But this will be my last classroom-intensive semester of school!  How did it go by so quickly...?  I'm almost half-way there! Yikes. With that said, I need to go get my study on... had a wonderful past weekend escape to New York City with Amanda, just relaxing and enjoying our time together with our friends up there.  Much-needed time to refocus and get back on track.  So let's start this week off right.... and if I don't get on here before next Thursday, HAPPY TURKEY DAY!!  Wish all of you an enjoyable holiday with your families, and of course, enjoy the pumpkin pie....

season of change...

It has truly shifted to fall here in Baltimore... green trees have given way to beautiful shades of amber, gold, and crimson dotting the surrounding mountains.  I have loved driving the winding back roads of the Maryland country side just to take advantage of the natural beauty of this region.  I feel so blessed.. I love seasons!  Not sure how prepared I am for the winter that is sure to follow this mediocre fall weather, but it's coming whether or not I am ready for it!  So I am trying to enjoy all that this season has to offer, including the start of the holiday season.  Yesterday was Halloween, and it was (albeit rainy and cold) an enjoyable evening and celebration in Charm City (aka B-more).  Amanda and I were able to make our way out to the cobblestone streets of Fells Point (my neighborhood) for the festivities last night, and it drew out quite the eclectic crowd!  We mainly enjoyed the opportunity to people-watch, as there were plenty of costumes to gawk at.... people never cease to amaze me!  I dressed up as a ladybug and Amanda as a bumble bee - we were quite the twosome, and were proud of how classy and cute our costumes turned out to be!  My high heels were not the most favorable shoes for the cobblestone streets however... I was grateful that I didn't injure myself as a result of walking the streets - I'm positive that there was some unfortunate girl who woke up with an ankle swollen two sizes this morning.  We called it an early night, after a very long week and I was very appreciative of the extra time to sleep - the only reason I like the end of Daylight Savings Time!  Now I have early darkness to look forward too... it's only 5 pm as I am writing this, and it's already dark outside!  Oh winter, how I loathe thee.....  at least I have holidays to look forward to!  Only a few more weeks and I'll be on a plane back to Utah for Thanksgiving... I can't wait!!  Maybe get some snowboarding in if I'm lucky.... but until then, I have plenty to focus on and worry about with school, which has been keeping me very busy over the past couple weeks!  I'm sure you're eager to hear about my recent adventures, so without any further adieu....

The past couple weeks have been quite the whirlwind, to say the least!  I'm sure you're eager to hear about how my transition has been into the Labor & Delivery clinical... I really don't even know where to begin!  We started our new rotation last Thursday, and I remember the feelings of anxiousness and nervousness as I walked onto the unit for the first time... I had been in Psych for 7 weeks, never seeing an IV stand or Foley catheter, so imagine my nervousness when our instructor informed us that we needed to be prepared for these skills when we were assigned patients on Friday!  I was hoping that I would remember the steps and how to maintain a sterile field... just picturing opening up a catheter kit and then having my patient kick it off the bed in the middle of a contraction.  Okay, so I knew that probably wouldn't happen, but I was still picturing the worst.  The field of L&D seems so unknown to me, and I was unsure of how my presence in the room would affect the experience for the new mother and her family, and I felt a load of pressure on me!  Our instructor gave us clear instructions on what to expect and how we needed to prepare in order to participate in nursing care of our laboring patients, and I was a tad bit overwhelmed.  I think not having a clear understanding of the labor process really affected my outlook, so I made sure to study that night in order to better prepare for what was to come on Friday morning.  Unfortunately... nothing in a book can adequately depict the environment that you're thrown into as a nurse for a laboring patient!  So, as we walked into the unit on Friday, I was caught a bit off-guard as our instructor threw a few of us into our patient's rooms first thing!  No orientation?  No warm-up period?  I got report on my patient - gravida 1, parity 0000 (her first pregnancy) who had gone into labor the day before and had an epidural started early that morning so she was resting comfortably.  I walked into the darkened room and introduced myself... the girl was sleeping with her mother sitting at her side and the baby's father sleeping on the couch.  I sat off to the side, quietly observing the monitors and the patterns of contractions and the fetal heart rate (FHR) on the print-out strip, trying to apply the material I had looked at the night before to the real-life scenario playing out right in front of me.  For a while, I sat in pure awe - medical technology never ceases to amaze me.  I could watch a computer monitor and follow the tracing of contractions and how it affected the baby's heart rate.  Incredible.  Such simple things... but it made me realize how grateful I am to live in a country where such technology is so standard.  I spent the morning monitoring my patient and her baby, and was grateful that the nurse had time to share some insight into the foreign language of L&D.  Thankfully (for me) my patient was progressing through her labor quite slowly, and so there weren't many changes to her status other than the constant progression of her cervical dilation and effacement.  I was hoping for a delivery, but was a tad grateful that I had another week to better prepare myself for the delivery atmosphere.  One of the girls in my group was able to participate in a delivery that day, and hearing about her experience gave me a better understanding of what to expect and how to be of assistance in that situation.  However, as much as I read up and prepared for the scenario in which I would undoubtedly be witness to, nothing can prepare better than first-hand experience.  With that said, I'm sure you can guess where this is going... :]  This past Thursday, I was put into my patient's room, her third pregnancy and she was 6 cm dilated, 80% effaced.  Her husband and mother were in the room, and I introduced myself and learned that they were an Orthodox Jewish family, which I was completely unfamiliar with, when it comes to traditional expectations.  I tried to be as supportive as possible, but gave them their privacy to prepare for the arrival of their son/daughter - they had left it as a surprise!  I stood outside at the nurse's station, monitoring the FHR and contraction pattern from the screens, and had the opportunity to observe the staff as they busied themselves about the unit.  As I stood there, amidst the flurry of nurses and anesthesiologists and OB physicians, I started to picture myself in that environment - and I really felt a sense of belonging.  I really enjoy the atmosphere of L&D, and the role that the nurse plays in the patient care, so much so that I am giving it serious consideration as a possible field to work in!  Getting a master's degree and becoming a Certified Nurse Midwife... I could really enjoy that position and responsibility.  I'm still keeping my eyes and options open, but that is one path I NEVER expected to consider pursuing.  So I'll keep you updated on that!  But back to my patient... unfortunately, my patient's husband was a bit on the over-involved side, and every time I came in the room he pressured me for information about ever flashing light and beeping monitor, wondering if there was anything wrong with his wife or the baby.  I kept reassuring him that everything was progressing as it should and that there was no reason to be concerned, and he was grateful for that.  I found out later that one of the physicians had told him that the baby should be delivered by 5 or 6 in the morning, and now it was closing in on 11, so he was worried that the labor was taking longer than it should.  Thankfully my instructor was there to provide some reassurance and inform him that he had no reason to worry, that baby and mom were doing just fine.  I was grateful for that!  Because her labor was not progressing as they would like, the doctors started her on Pitocin and hoped that her contractions would develop into a more regular pattern (they were only 5-7 minutes apart, lasting 50-90 seconds) and decided to grab some food while I was waiting.  I didn't have much time to wait... I heard that there was some commotion coming from my room, and I rushed back to my patient's side (literally - her husband was waiting outside) and helped her through the (relatively) quick delivery of her son!  It was a "beautiful" experience... it all happened so quickly (she delivered about 20 minutes after she reached full dilation) and I was there, a part of the entire process.  Her baby was delivered, 8 lbs 8 oz with a full head of hair and some mighty powerful lungs!  He wouldn't stop wailing for about 45 minutes after he was delivered, and he made it very difficult for us to clean him up and administer his medications.  But I did it - I gave my first shot and took his vitals and was able to do a quick assessment before handing him back over to mom.  It was a rush - it took me a while to really process the entire experience, but I felt so grateful to have been a part of it.  Words can't adequately describe the emotion and feeling of being present for the delivery of a new spirit into this world... I can't imagine what it will be like when I have children of my own!  All in all, it was a fantastic first birthing experience, and I am really interested in the option of becoming a nurse midwife... we'll see how things go over the next few weeks!  As for Friday, without going into a long, detailed description of my clinical day, I will say that the OB wing of the hospital is never boring... I spent the morning in the NICU, assisting with the care of the premature infants and those with congenital problems - I have definitely ruled that unit out!  The little babies, as cute as they were, frighten me.. any little change in their status or care can have such dramatic effects on their health.  It is a very quiet and controlled environment... I like the action of the L&D unit.  Speaking of... as I was returning to the unit from the NICU, I was rushed into the first room to help care for a woman who had delivered her baby in the hallway after arriving on the ambulance!  The paramedics stood by in a state of shock after what they had just witnessed, and I pushed through to help care for the baby.  The doctors and nurses worked to treat the mom, and I focused on baby.  Thankfully the little baby girl was healthy and happy - 8lbs 10oz!  I guess she was just ready to see the world... couldn't wait until her due date in a couple weeks!  Mom said it was her fourth child, and she had just started labor a few hours earlier.  Wouldn't that be nice... one minute you're waking up for the day, next you're arriving at the hospital for the delivery of your daughter!  It was an exciting mash of people in and out of the room, everything in order and treated as need be treated.  I was able to give the baby girl her meds and assess her vitals before handing her back over to a somewhat disillusioned mom... I think she was still in a state of shock.  haha.  In the end, mom and baby were just fine, and I left them to rest after a very exhausting morning.  What a couple days!  Never a truly dull moment... even in the quiet, the constant FHR monitor sounds of the baby's heart beat remind you of what you're caring for, and it is a special role to play.  We'll see how the coming weeks turn out...  I feel lucky to have been a part of two deliveries, as some girls in my group haven't seen one yet!  I'm hoping to be able to follow a patient to the OR for a C-section, but I don't know if that will happen... we haven't had a patient go into the OR yet during our clinical hours.  I still have some time left though!  It may be November, but we are only a couple weeks into our 6-week OB rotation (three of which will be spent in postpartum).  I can only imagine what the coming weeks have in store for me...

Wow.  This has been quite the entry!  I guess I am just really excited about the experiences that I've had over the past couple weeks... I feel like I'm still processing what I was a part of.  So much left to learn!  I feel like I've only reached the tip of the iceberg...  but I'm loving the progression and acquisition of knowledge.  It is a fascinating environment, and I'm realizing more and more how much I enjoy being a part of a specialized focus, so I'm trying to learn more about this field and my available options and opportunities.  I will make sure to keep you updated!  But for now, I have to get back to my Pharm studying... test #3 this week, and then I have to write up my L&D care plan for my patient... it's going to be a LONG and busy week... but I can't begin to tell you how grateful I am that I am not dreading the work I will have to contribute!  How pleasantly reassuring it is to find my niche, and discover my individuality and independence in this oftentimes overwhelming environment.  I am just grateful that I have been blessed with a passion for this type of service, and look forward to my future... it won't be long now... 9 more months and I'll be an RN!  And with that, I'll leave you until next time.. happy start of the holiday season to you all!!

[New York City]

[Central Park]

[Yankee Stadium - after they beat the Angels to advance to the World Series!]

[Halloween bugs]