Moms

I am not a mother.

Yet, last night at a baby shower, I had a wonderful time chatting with mothers of all sorts. I still feel new to my church community, even though I’ve been attending faithfully since moving about two years ago. I love how the community is adjusting to the changes – they celebrate births, baptisms, marriages, chrismations. And they mourn together and help when someone of the community has a physical or spiritual need.

I am so thankful for the opportunity last night to talk with those moms and women of my community.

I started the evening talking with a mom adjusting to her high school freshman daughter. She’s asking herself, “How do I help her find her way, but let her do it?” She recognizes the talents, brains, and abilities and is excited to see how her daughter will use them. But is also wondering how to let go and give her daughter room.

Mom B is lively with three college-age and beyond kids. One is planning a wedding, one seriously dating, and one still trying to figure out life.

Mom C has 3 children under the age of 8. Her baby has multiple food allergies, and since she’s nursing, she has to cut those foods out. Her other two are a lively handful and she’s homeschooling. She was so vulnerable in sharing that some of the negative behaviors she sees in her children, she knows they got from her. Thus, to have her children change and nurture their spirit, she has to change.

Mom D was the guest of honor and will be a new mom after only one year of marriage. I’ve loved getting to know her these months; she’s so chill and relaxed with the perfect amount of sarcasm.

In this period of my life where I’m engaged and preparing for marriage and the possibility of motherhood, I am always struck with how open these and other women have been with their lives. I’m honored that they want to know me and my struggles in this time as well.  Some have shared the worst parts of their engagements and marriages with me. They shared their children’s delights and joy; they shared their struggles, fears, and what is at the heart of their prayers. This is not as a “WARNING: RUN NOW!” but rather an encouragement to build the good foundation and habits in my marriage and (eventual) parenting.

I guess this is a “fluffy” post where I can pinpoint the exact “meaning” of my experience. It’s amazing how going through drastic changes in my life allows people to feel confident in sharing their joyful and difficult experiences. And maybe that is the “glue” of a community.

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Floating

Lately, several people have heard my lame joke, “I’m floating so much, I should be a duck!”

I started my student nursing adventures on a urology floor. I really wasn’t that picky when it came to this first job – I had heard from multiple advisers that getting on “a good med-surg floor” was the best introduction you could have to the world of nursing. Medical-Surgical floors (i.e. med-surg) is the basic care a patient needs in a hospital – they have some condition which needs attention through drugs (medical) or surgery. If anything else goes wrong, they can be transferred to a Progressive Care or Critical/Intensive Care unit.

So, I my first steps as a student nurse were spent tracking down a patient’s vital signs, making sure they get out of bed post-surgery, measuring urine and other fluid output (if you only knew how many forms this took other than pee and blood…), and my favorite – trying to keep track of how much they put in.

After 3 months on my home unit, I was eligible to float to others when my unit’s tech staff was overpopulated and/or the patient census was down. Thank goodness, I have been able to keep some of my working hours! At first, I heard from most techs and nurses “Ugh, I have to float!” Honestly, I don’t mind it.

Rather than being in the world of kidneys and bladders, I’m getting to see other medical-surgical and progressive care floors. I’ve been on liver, orthopedic, or digestive disorder units. One of my favorites to work at is the Organ Transplant unit. I’ve also been to an Oncology unit – that’s a post all on it’s own.

And it can not be said enough, ALL nursing is psych nursing. Some of my more interesting floats this summer were patients with alcohol withdraw or other substance withdraw issues. Definitely kept me awake on those 3 AM sitting/supervising shifts!!

My most memorable experience in floating happened in late June. I had settled in to a sitting shift with a patient, when my charge nurse appeared. She explained that one tech coming on could only float to sit and another unit needed a tech to work the floor. So, I pack my things and head to the new unit. I step off the elevator, introduce myself to the charge nurse, and am greeted with these words: “Do you speak Spanish?” Oh, dear.

Apparently, it was a sitting shift; my charge nurse was misinformed. The patient did not like the current sitter whom I was replacing, however, some quick thinking on my part got the patient to trust me. My two years of high school Spanish, one year of Latin, random study of words from my singing past, plus Google Translate helped me communicate to this freaked out patient. He/she went from unwilling to sleep, have vital signs taken, and allow blood glucose checks to resting comfortably in an non-paranoid state. All because I looked up, “Go to sleep. Everything is good. The nurses are taking good care of you.”

Floating has allowed me to see what sort of nurse I might want to be and the sort I do not want to be. I have met patients, families, support staff, chaplains, and a host of others in the system. I have found units that I would consider working on as a nurse and those from which I will run far, far away. It can be frustrating, but as I’ve found out, also rewarding. Both in circumstances and the fact that I am getting paid.

Quack.

The Questions

I’m in an accelerated nursing program. It is geared specifically for people who already have a bachelor’s degree in another field and want to receive their bachelor’s in nursing rather than an associate’s degree. A common question in the first semester is, “What was your previous degree?”

But then, people decide they want to know you more. They now have two options:

1. “Why did you leave ______?”

2. “What lead you to nursing?”

I know that I’m having a bad month here in Ray of Sunshine Land, but for the love of God, these questions are getting on my nerves.

So, let me answer them for you –

1. I didn’t like teaching; I liked interacting with the students, and I liked singing. Teaching those concepts was draining the life out of me. Oh, might I mention a few colleagues made my life a living hell? Yes, teachers can eat their young as well. I found that I was selfish with music – I need it to be my relaxation. I don’t see music and arts as the first thing that people need for their lives. Public education bad days

2. I had a quarter-life crisis. Got tired of doors slamming in my face. Wiped the slate clean of my options, looked at my skill set. Thought about nursing, pursued it and doors opened. Loved the opportunities. Most every clinical I end thinking, “Maybe this career track is for me?” It fits my preferred M.O. as I like to be at a place and just go. I’m not an 8-5 for 5 days person.

And last thing while wrapping this up, I’m tired of hearing, “you’ll always have a job” from people who think they know healthcare because they had their immunizations. Kind of like the people who think they know education because they were students. Nurses are generally the biggest part of an organization’s budget. We are generally the first to feel budget cuts. Yes, there are always healthcare jobs. There are always teaching jobs. They just might not be what the person prefers to be doing in their career.

End rant. Back to studying.

Dating a Seminarian

I entered a new frontier the past summer – I’m “in a relationship.” But as this requires as much adjustment and introspection as being single, don’t think that my blog has suddenly lost its purpose.

Yep, you heard me, being single – a content single – requires as much introspection and processing as dating someone.

Anyway, my boyfriend is an Orthodox Seminary graduate. With my involvement over at Orthogals, it was suggested that I write an advice feature on dating a seminarian. Since this would involve his life, I ran the idea past him. The conversation:

Me: So, the Orthogals are wondering if I can write a feature on dating a seminarian. What do you think?
Him: Um, I don’t think that’s a good idea.
Me: (seeing his reticence and suddenly being aware of the personal nature of it) On second thought, maybe not.
Him: Actually, let me give you my advice for dating a seminarian – DON’T.
Me: Yeah, if people actually look at the demands life will have on that family, they wouldn’t seek it out.

Later, I was chatting with my priest about life and how mine was shaping up. In hearing that my relationship involved a seminarian, my priest offered his wife as a resource to me. Of note, Preoteasa is the Romanian equivalent to the Arabic Khouria and Russian Matushka – all are terms of respect for the priest’s wife. In my parish, it has been abbreviated to “P’sa.” The conversation as follows:

Me: Your husband volunteered you as a source of advice for me.
P’sa: Oh? For what?
Me: Dating a seminarian.
P’sa: Run. Run FAR away. 

So, ladies, there you have it from both the potential priest and the wife of one – don’t seek out that position and enter with caution if you do get called.

 

Complimenting the Choir

I have sung at the chanter’s stand and choir for about 5 years non-stop. In high school and college, my church and campus ministry had a rotation for people in the worship band or praise team, so there was no need for me to make a weekly commitment. Save August 2009, December 2011, and a few random Sundays of illness, I spend services as a choir member…or at some services, I AM the choir.

Yesterday, I got two lovely compliments that encouraged me more than any others combined. It was the Feast of the Dormition of The Mother of God, which is  the last major feast of the church year. Beautiful hymns encourage Christians to prayer. While in line to receive a blessing at the end, a woman approached me. “Your voice is so beautiful. It helped me to pray today. Thank you.

After the pitch-in breakfast, a man approached me as I got up to leave. “Thank you for singing today. It lifted us all up [to heaven].”

I had enjoyed Vigil the night before and Liturgy yesterday morning – the people I was singing with were on pitch and we could trade harmonizing ad lib. As a musician, those are the service moments you love. When you aren’t just singing but making music and able to have a few moments of prayer yourself.

Many a dissertation is written on Orthodox services, and I have a very simple understanding of them. I can say, however, that the reason Orthodox Christians gather is to pray. Liturgy is a prayer. Vespers, Vigil, and all other daily services are for prayer. Everything in an Orthodox church is a call to prayer and to see as best we can with earthly eyes and hearts the Glory of God.

Yet, when you sing in the choir, you give up that freedom to pray. I have experienced so many, Orthodox or not, who view the choir or worship leaders as “untouchables” or that the work of a musician is so much more honorable than they in the crowd. My voice being audible during the service in NO WAY makes me amazing and you liturgical dust.

Complimenting your choir member or director with a “woe is me” or “Gosh, you’re important” tone is flawed. Please stop doing that.

The choir members have given up their freedom to pray because we have to think about other things – like staying in tune. This also goes for the opposite – to “mentally check-out” during a service is disastrous. And because Orthodoxy involves the body, we also give up the freedom to prostrate, bow, or even bless ourselves without whacking our hand or forehead on a music stand.

God has given us a gift. We are to use it, and most of us do with glad hearts! But it does not come without sacrifice. Knowing that you were able to pray makes my sacrifice worth it.

I have had people compliment my voice after it has sung both the sacred and secular. Very few have gone to say how it has moved them to better prayer. That sufficiently humbled me to know they were praying as I was singing yet thinking about whether or not I chose the most comfortable shoes for a 3-hour service.

Infiltrating

I began my pediatrics clinical rotation last week along with Pediatrics and Obstetrics lecture. Thankfully, I was able to get the type of rotation where each student is assigned one preceptor and follows that nurse for an entire 12-hour shift one day per week rather than two shorter days per week. I would rather have one day that is super busy and tiring and one day off than two days that are busy and tiring. I always collapse after clinical, whether it has been 4 hours or 12 hours.

My unit has medical-surgical patients with various GI, neuro, and some renal patients. Basically, a smattering of low-acuity kids who either need to be diagnosed or are coming back for a few maintenance visits/procedures.

Lesson of this week: pediatric IVs.

I had been warned in both clinical orientation and in lecture, pediatric IVs infiltrate fast. FAST. Also, little people do not or are unable to tell you that something is wrong. A nurse must look at an IV site for redness and swelling every hour and before attaching new fluids or medicines, flush a small amount of normal (isotonic) saline so we can see and feel that the catheter is  still in the vein and not poking through into the tissue. Infiltration is a BAD thing with your isotonic fluids, let alone medications.

In my clinical, I was beginning my assessment of an IV in preparing to administer an IV antibiotic that is a known vesicant.* It didn’t have a blood return (not bad) and flushed rather easily. I let my nurse know that there was no blood return, but continued to set things up. My nurse also assessed the site and compared his IV hand with the non-IV hand; some edema was present. She flushed a little more saline through and asked the patient if it hurt.

“Ow, yes!” (Patient is a younger adolescent).

Nurse, “Yeah, we should probably start another IV then.”

Patient: “That’s okay, I’ll just live through it.”

Nope! It doesn’t work like that kid. On pediatric patients, especially those younger than 16, we just call IV team because veins are not as visible the younger the patient. The IV woman came within an hour, used her awesome ultrasound and placed a new IV in the patient so the antibiotic could be given safely.

The experience didn’t scare me, rather helped me see what else goes into an assessment and better techniques for assessing the pediatric IV. Some catheters are tiny; some only need 3 cells to occlude and clot. It was a reminder that early adolescents need to know the risks of their medications and why nurses check things that seem insignificant.

My next clinical is tomorrow. Hopefully I can remember all the assessment techniques for pediatrics and focus on other important things. Like playing Candyland with a patient.

When The End is Near

The past two weeks The Brain has been in rapid decline. I am thankful I was able to see him over Memorial Day when an hour-long conversation did not take all his energy for the day. Besides, since last Thanksgiving, I try to do most of the talking. He has recently consented to swapping out his usual king-sized mattress for a hospital bed and does not balk at any medication interventions to control secretions or pain. From what I read in updates, he is not uncomfortable but there is a huge battle with peripheral edema that refuses to go down. Edema, or swelling, is a sign that the kidneys are not motivated to keep filtering the extra water and usual waste products out of the body.

We talked about ALS our last day of lecture in Med-Surg 2 along with other “chronic neurological disorders.” I had to work hard to not dominate the discussion. The question was posed to the class, “What do you tell a patient who asks you if there is a cure for ALS?”

Under my breath I muttered, “You tell them to plan their last vacation.”

When going over some of the collaborative care for ALS, a group recommended Physical Therapy along with some other options. I spoke up and said that physical therapy is good, but the patient is not going to improve over time. Rather, massage therapy might be better as it had been beneficial for The Brain. Unused muscles cramp up and become rigid; if the patient will allow a massage therapist to work with the muscles early on, the later neuropathy due to muscle atrophy is greatly reduced. Having helped multiple people move or even roll in bed, those with loose muscles are MUCH easier than those with rigid and spastic muscles.

As I said earlier, hospice nursing is different. You know that your patient will not beat their disease or win the battle with their body. I knew when I first started working for The Brain and Stewie that there would be an end; I just didn’t know if I would be working for them when it came.

My prayer has not changed nor has my view of reality to the situation. Reality is merely coming into focus more clearly, along with the true reality that we are all given the gift of our lives, and we get to share those with others. I am continually thankful for Stewie and The Brain sharing theirs with me, even as ALS is sneaking around the back for its last hurrah.

Thus, as always, Lord have mercy.

Patient Simulations: Medical Student Edition

Thanks to technology, student in medicine, nursing, and other patient care roles can be put thought simulations with patient mannequins. “Mission control” is behind a two-way mirror and can “talk” for the patient, monitors are “connected” to give real-time data, and a lot of sterile saline is used as various medications.

Last Friday, rather than work the floor in my clinical rotation, I volunteered to be a nurse during medical student simulations. These students just entered their 4th year of med school and were beginning their month of ER rotations. The role of the nursing student was to act as the nurse for the simulation: assess, advocate for the patient, collaborate with the physicians, and administer medications while the doctors continued to formulate a care plan. We were not being graded or evaluated, the med students were.

It. Was. Awesome!

My fellow nurses and I got one other benefit over the doctors: we were able to go through the simulations twice. Group 1 rotated from 8-10 and Group 2 rotated 10-12. The first simulation was a practice for all of us – what was I to ask the doctor? The patient? Focus on in regards to care? What information did I need to assist the doctors and the patient? Because of the nature of simulations and how much students should not know before participation, I will refrain from specifics of the scenarios. All three were common emergencies, and one involved pediatrics. I was thankful for two semesters of Med-Surg, so I was way more comfortable with these scenarios than I would have been in January.

I felt as though I hit a stride as a nurse that second time around – the other nurse and I knew the outcomes and what to watch for while the med students were new to the situation. Also, the group the second time around had a GREAT sense of humor. I was asking for more clarity in orders: how much oxygen do you want? What drug and what dosage? Is that an order or an idea? Do you really want to give that heparin sub-Q when the patient already has IV access? By the way, your patient has below 85% Oxygen saturation for the last minute.

At the end of the day, one area stood out: patient advocacy. During one simulation, the benefits of morphine were being debated. Yes, the patient could have been given it, but it doesn’t improve mortality. Thus to a doctor’s mind, there was not convincing enough evidence to warrant a morphine administration. With Group 1, I didn’t push back on the students to order a pain killer. With the second group, I questioned.

“He’s in a lot of pain. Could we give him something for that?”

“Nah. Morphine doesn’t help long term.”

“What about Fentanyl or something else.”

(Voice from speaker) “The simulation is over.”

In post-conference, we talked about the simulation, when drugs were given, and the plan of care. We were about ready to leave when I stated my point. “Just one thing from the nurses. When it came to whether or not to give morphine, I know it does not solve the root cause of this patient’s problem, but to that patient, his pain is why he’s here. Giving half to 1 mil of morphine will ease anxiety, knock the pain down, and to that patient, you are doing something. As nurses, we’re trained to assess and we’ll hear a lot about a patient’s pain. Again, it’s not solving the root issue, but you are doing something. And that will get you far with them.”

My point was not ignored. Instead, the medical school instructor VALIDATED my point.

“That is a good point. As medical students, you need to know that by the time the nurse has time to call you to change or up the pain meds, she’s heard about it at least 12 times.”

I could have kissed that man.

Bullied: Part 1

Do you remember the first time you saw yourself in the mirror and finally had a shred of hope that you just might be physically attractive and desirable? That you were not the despicable and horrible human that others kept saying you were for so long?

It was the summer I turned 15; my family had moved back to Kansas the previous year after 6 ½ in South Dakota. While I had a minor disappointment with a boy the past year, I had been getting some attention from others and had successes in extra-curricular activities about my confidence. I was uncertain on what to do with compliments. If I said “Thank you,” I feared I would look like a snob, but if I ignored them, it would be rude. I think I usually stammered or tried to shrug things off.

It was a day I had very little planned. I was still in my PJs at the breakfast table when my brother came from the basement. He thought I was wearing a casual sundress for the day and is a pretty cool guy when it comes to his sisters. He asked, “Where did you get that dress?” in the way that men from my family say with uncertainty on how to word a compliment, yet in a way that the women know the men noticed.

“Um, Jeff, these are my PJs.”

Him: “Oh.”

After that comment and finishing breakfast, I walked back to my room to change into my real clothes for the day. At the end of the short, narrow hallway was an oval mirror. I caught a glimpse I had never considered before. It wasn’t an imaginary catwalk to my room, or a trial run of how I would saunter through The Mall. Just enough of a second glance to where I could say, “Maybe I’m not fat and ugly.” My self-esteem and self-perception were still hovering above empty, but there was something about those 10 feet down the hall that gave me hope. Not everyone was out to be better than me. My obvious features of height and hips were not necessarily a negative. And maybe my acne-prone face and shoulders weren’t as horrible as others made it seem.

I still had plenty of emotional breakdowns between that moment and now. I still considered shopping a war and personal assault. The number on the size was all-important as to how I felt about myself for the next month or so.  Some hurts have scabbed over, yet I’m reminded of their scars at the most random times. Just when I think that I’ve answered all the questions and satiated the emotional holes left from my middle school years, the emptiness slinks in the cracks on bad days.

The mid-90s seemed more concerned with sexual harassment and whether or not kids knew about HIV transmission. The line between “kids being kids” and bullying had not gotten the attention of the past 10 years. Sometimes I wonder how I would feel if I could have stood up for myself in the schoolyard. What if one day I would have just punched someone in the face? What if I could sue for the therapy bills not covered by insurance? What if I had taken a few more sick days or convinced my parents to get me out of that school?

What happened cannot be changed. But I have hope. Not because I saw myself as pretty one summer day, half my life ago.

Because I’m learning to forgive people that I will never see again and who will never know how deeply their words cut to my heart. Because I can look at the world around and know that God created things that are good. Because I am to look and myself and say that I am the chief of sinners and forgive others’ trespasses, debts, and sins.

It is not easy, nor should anyone be demanded to produce these results overnight. Be filled with Truth to combat the lies. That is the first step. The other steps will follow, but always seek Truth.

Hospice Nursing

We knew the discussion was coming based on our pre-class preparation videos.

My group was having a discussion on end-of-life care and how hospice nursing is different than other kinds of nursing. We delved into the ethics of giving morphine or other comfort measures that may or may not drop our patient’s O2 saturation lower. I was of the few students who had experience with hospice care and nursing. Caring for The Brain had been most of my formative hospice experience, however, I have had other family members in hospice care and a good friend described her experience with hospice in relation to her mother’s illness.

Hospice nursing is different.

Your patient will not get better. He/She will not walk out of the facility or their home cured and on the path to wellness. “Wellness”, for a hospice patient, is more based on their comfort and whether or not there is peace at the end of life. You meet amazing people with interesting lives, yet you are usually meeting them at the end of their life’s journey.

In describing the above, and using almost the exact words, I teared and choked up in front of my colleagues. I thought of The Brain and my aunt and my grandma.

It’s easy to feel defeated on the floors as a nurse – I didn’t get patient medications on time, I failed to call the nurse or someone about the patient, the patient did not get to walk exactly when s/he called for me, the patient bathed 2 hours after s/he asked for a set up because I was held up in other patient rooms or needing to get vital signs on everyone before the next rounds.

But how does a hospice nurse not feel defeated? Every patient is choosing to stop life-prolonging measures and has, to some degree, accepted death as the resolution to their disease. It is a different form of nursing to know that you have helped your patient live well and provided them with comfort and anxiety relief. You have given the patient utmost consideration, care, dignity and security. You assure them that their body will be treated respectfully when they pass away.

And until those final moments, you share memories. You swap recipes for favorite meals. You hear about the patient’s life, passion, and wishes for care. You look at their choice for a casket or urn. You ask what they need and what the family and caregivers need. You are a nurse that stares death in the face and tells it that just because it is lingering does not mean there is fear.

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