a funny thing happened to me on my way to becoming a sleeper...

No Sleep 'til Brooklyn....again!

2009-09-08T05:16:00.001-07:00

Not sure if it's the time difference, or the fact that I had a list of "to do" things for today that kept running through my mind in that same pesky way a bag of marbles, dropped on the floor runs in every direction--I'm that tired...I've no idea what that sentence just said.

Basically, I fell asleep at around 3 am, and got up around 6, when my light timer was (evidently) set to go off. Either I did this to ensure I wouldn't miss my flight back in July, or, I have it all screwey since I unplugged it over the summer break. In any case, I slept another 3 hours last night.

Add that to the 3 I slept the night before, and you get 6! Almost enough for one night (sigh)

I'm off to my first class today--Pharmacology of Anesthetics. I'm nervous, anxious, and have a great need for sleep.

My best friend, Jean, is also in town and I want to see her since I didn't get to see her when I was home on break.

The good thing is that I don't have class again until Monday--but the bad thing is there are a million things to do and already tons to read and study before then.

I asked for it :)

Done and DONE!!!!

2009-07-29T09:59:00.001-07:00

Advanced Clinical Pharmacology Notes.
Somehow, I survived!

So it's the end of semester one.
I'm usually so amped up, and busy, that when the end comes I never know what to do with myself. So now, I've been washing the floors, doing laundry, washing the refridgerator, spring cleaning in general.

I leave for home Saturday--my driver, Jose picks me up at 6:30 am, and hopefully, there won't be a thunderstorm (though, it would be a first when I'm flying) and we won't get delayed and stuck on the tarmac for hours and hours (like last time!)

I'm so looking forward to going home and seeing my fellas :)
I've missed them so.

But I go home with a sense of relief and accomplishment; I was afraid about the chemo having ruined my chances to study, to learn to retain info, to go to school in general--I'm releived to know that I CAN do this. I can.

Not that it won't be tough, but it's not like I have mashed potatoes for brains, as I feared would happen after the chemo.

It's a balmy overcast day in New York. I don't mind it so much this time around--I guess cancer taught me to suffer through things that are temporary with a bit of patience.

Sunday morning I wake up at home, and all this will be like a dream.

Finals week

2009-07-22T08:58:00.000-07:00

How I study for pharmacology.
Each lecture is 4 hours long, each test covers two lectures: drugs, their mechanisms of action, reactions, side effects, pharmacodynamics, pharmacokinetics, special issues, considerations, contraindications and indications...this is just the drugs, and there's also the physiological issues she'll ask us about, and drug/drug interactions and dosing and what-not...

Final is Monday--pray for me :(

PS, sorry I look awful. It's about 99% humidity, and I'm not sleeping much/well.

CLIP0024.AVI

Still on West Coast time

2009-07-13T08:01:00.000-07:00

No matter what I do, I can't get to sleep at a "decent hour."

The other night, the fire alarms kept going off starting at 1:30 am and I think they might have gone off about another 20 or 30 times before morning. I went out for the first one, and the second one. We evacuate the building and stand on the wet sidewalk and watch the tall FDNY saunter into our building with gigantic axes.

Then they saunter out--they knew it was an alarm malfunction, and so did we.

The turn out for the second alarm was much smaller, and less than half an hour after coming in from the second one, the third one went off, then the fourth, fifth, etc.

By that point, I put the pillow over my head and kept sleeping.

It's amazing the things you learn to sleep through.

So, essentially, when I get back to the Bay Area, I won't have any time adjusting to do, since I wake up around 10:00 am here, and go to sleep between 1:00 and 3:00 am.

The weather's been holding out--not too unbearably hot just yet. I'm hoping it holds out for the real heat until the end of the semester, so I can miss most of it.

Anniversaries this week:
Tomorrow marks the one year anniversary of my first biopsy. I remember thinking to myself, "it's Bastille Day...nothing bad happens on Bastille Day."

Wednesday the 16th marks the one year anniversary of getting the phonecall saying the results of the biopsy was "a little bit of cancer, there." I remember thinking how this poor MD was trying to soften in, by saying it was a little bit--something we nurses are taught, clearly, is how not to do this sort of thing to patients--not to give them false hope, not to de-personalize it (it's not "the breast" it's "YOUR breast", etc) Physicians don't get this as part of their training, it seems. I don't hold it against him, I just remember the moment. Clearly.

I had all my hair.
I was in a tee shirt and underpants because the phone woke me--I was sleeping days and working nights. I was kneeling in the doorway to the kitchen, because I had called George on my cell phone to "be with me" while I got the results. He overheard everything.

That day was only just a year ago, yet it seems frozen in time...so long ago, yet only just yesterday. If I had known then just how hard the year ahead was going to be, I don't know if I'd have had the courage to go through with it.

Fortunately, we never have to do more than just one thing at a time, be present in more than just this one moment before us, so it was possible--however, looking back at the whole...makes me want to not look back, much.

I have classes until 8 pm toinght.

I did really badly on my first pharmacology test (got the lowest score in the class) because I didn't know we were having a test--the professors, who pride themselves on sneakiness buried the syllabus with the test dates in a folder called "class files" online, and so I didn't see it (I was looking under "Syllabus" Silly me.

I did significantly better on the midterm, studied my butt off, and now there's only the final to worry about.

Other classes to worry about now are Medical Genetics, in which I have to write a term paper on my pedigree (the tree you draw out from yourself to your great grandparents indicating life-span, illnesses, and death.) Obviously, I have been working with a geneticist at UCSF, and have the information at hand, but the actual writing of the paper is proving to be difficult. I really dislike writing, lately. Maybe it's the subject (cancer in my family genetics) or maybe it's just the APA style formatting that's killing me. I'm not sure.

In any case, I'm counting the days until I can go home!
(Nineteen!)

So this is Grad school...

2009-06-25T07:36:00.000-07:00

Well, so far it's been an interesting ride.

I was having a problem with my upstairs neighbor/wrestler/pro-bowler who was running around, crashing into things and so forth bdtween midnight and 6 am. The other night, I didn't get to sleep til 5:30 am, having to call the campus security people twice. I wrote an email to the campus housing coordinator and got a reply back that they wanted to talk to me, so I went in (rather than edit my paper, due that morning) and met with the director of student housing and the coordinator.

They were very sympathetic and nice, and the director said at the end "I'm going to personally go over there and have a talk with them" and they also posted, slid under the door, and mailed notices warning them that they were in violation of the housing contract, etc. Well, whatever she said, it worked. I slept like a baby that night and last night. Though I can still hear someone walking around, it's normal, not loud crashes and bangs and running around like an imbecile at 4:30 am.

Needless to say, my grades have suffered.

I did pretty badly on a test, though, it was mostly because it snuck up on me and I didn't know about it. Though I had been studying, there was not the level of pre-test study that would have normally gone on, so I did very badly.

Another problem I'm having is that I don't know how to write a scholarly paper.
I've received back an assignment and basically they minced it all up...as if I had been a 5 year old and tried to write something.

Partly, this was my fault for trusting the professor when she said it was just an opinion paper about an article we read. So, I found a news article regarding San Francisco's "Healthy SF" initiative, and how Kaiser hospital has just joined, and how great this is.

I got back something that basically said my paper had nothing to do with the article I ahd included. What the...

So, I have to step it up several notches. Lisa doesn't know the meaning of quit.

I'm off today to spend the day at a study cubicle of the library in preparation for my next Advanced Pharmacology exam, and to read about a thousand pages of journal articles that were assigned reading for Genetics and Health and Social Policy classes.

Outside, it's muggy. Overcast and hot--it will likely rain again today.
Only a few weeks now 'til I'm done and can go home!

was it a dream?

2009-06-14T19:30:00.001-07:00

Here I am, back in New York. A terrible flight home (more than 3 hours delayed) and an ok flight back, though both were middle seats and I hate those. I guess it's better than the window, though.

I've only been back about half an hour and already I miss George and Rutger so much I want to cry. It didn't seem this bad the first time I came (two weeks ago) but now, maybe because the novelty's worn off, I really just want to be done with this semester and go home for a long while.

My driver, Jose, asked me for advice regarding a friend who had had brain surgery and 4 or 5 days post op had a stroke...what can you say to that? I think people latch on to the fact that you're in health care and just have questions, you know.

I did lots of reading both at home and on the plane, but I bet it wasn't enough. I still don't feel buried but I guess that will come soon enough...tomorrow I have my 8 hour day and then tuesday is my friday. Then I'll hit the bricks running and knock out a few more assignments and so forth.

We have a great big group project/presentation and we chose emergency contraception as a topic...I hate group projects, I hope these guys are good at writing papers because I feel like my skills have waned considerably.

Ah well. Tomorrow is Monday.

It's hot and muggy in New York, but that's a given.

I miss home, too.

But, that's a given, too.

Uh oh

2009-06-10T14:48:00.001-07:00

So, I flew home yesterday.

I spent $700 on one of the last few seats left on a flight direct from JFK to SFO. I called my driver, Jose, and he said it was no problem to pick me up at 6 am, in front of my dorm.

The night before, I was in class. Mondays, my day is 8 solid hours of sitting in lecture, staring at powerpoint slides, as Pink Floyd said "ticking away the moments that make up the dull day..."

I went home, made flashcards of my pharmacology lecture, and had a little dinner. I took breaks to pack my bags (not much packing, really...just text books, and flash cards, and my laptop)

When 3 am rolled around, I knew I had to get some rest, but I was so worried that I would oversleep and miss Jose and my flight. I realized that though I had been there nearly 2 weeks, I had not yet used my alarm clock, a mild-mannered, weak little "tweet-tweet" sort of alarm. I set my phone alarms (all 5 or 6 of them) to buzz and ring as loud as I could make them, and I set the phone under my pillow. I drank a liter of water, ensuring I'd wake up at least a couple times,a nd I slept with the window shade all the way up--hoping light might wake me.

Between the ambulances baking up and the sirens, the thunderstorm that rolled through (WTF?) and my worry, I didn't get more than 20 minutes sleep.

Jose was on time, there was no traffic, and I was waiting at my gate with an hour to spare, relaxedly sipping coffee and having a blueberry scone (all bad carbs)

As soon as we get seated on the plane, the pilot's voice tells us there's a storm ahead of us, and all flights in New York have been grounded. Over the next 3 hours, they came over the intercom to tell us that flight had resumed, only to tell us they had re-halted take offs.

Finally, in the air, with a 6 hour flight in front of me, and a middle row seat, I made the most of it--I read my homework until my eyes gave out, then I napped for 15 minutes, then I started over.

I did all my genetics reading on that 9 hour flight.

I went to the bathroom, however, and discovered I had gotten what looked like my period. GREAT. I haven't had one since December of last year...and NOW??? I have to get one NOW???

So, I started to worry that the tamoxifen I have been taking every other day to start out with did some ovary stimulating (as 10 mg/day seem to do according to my drug book) and when I got home I took another 20 mg pill, though I had taken one the day before. So, now I'm taking it daily as they had intended, and I hope it won't make me sick. I only took it every other day for a little over a week, as my oncologist had recommended starting it.

So, with the delay, I was certain I would miss my dentist's appointment. When we got our first notice of delay, I called the office and let them know I was grounded, and they managed to switch my appointment with someone at 4. At the airport, George met me with my premedication (Amoxicillin mega dose for my Ventricular Septal Defect--to prevent endocarditis from having dental work done...my life sucks)

My dentist takes a look at it and agrees he's glad I came home to have him do the tooth, because now he knows what's under the filling. He said he thought I'd eventually need a crown in a year or so, but that he'd try to do a filling. I love this guy...I'm still walking around with a filling from when I was 16 yeras old, and my old dentist said I needed a root canal, but said, let's try this first, and put something into my tooth to numb it, put a temp filling in and let me walk around with it for a while, then filled it.

I ended up having that filling replaced (it was amalgam) and this dentist (who bought out the practice of my old dentist) said it was barely any tooth...all filling, and that he thought it was amazing it didn't end up needing a root canal. So, that filling has been with me (in two different forms) for 34 years already. I told him I bet the filling he did yesterday would last longer than he thinks it will.

I have to go back today and have another filling put in on the other side (I don't want to take a chance and break another tooth!)

These stupid cavities, I get because I go a long while between flossing--when iwas in ETP, I think I might have flossed 4 times. I get a small cavity between teeth and it goes unnoticed until I'm eating popcorn. I knew about these two, and was going to have them filled a month ago but then Rutger had his seizure and I had to cancel my appointment. I never got it rescheduled so I was planning on coming back in August to do it...little did I know I'd break a tooth and find myself back here emergency-style.

Not so lucky me...

2009-06-06T08:56:00.000-07:00

So, I've been doing great in my school work, academically, but I'm not the most lucky of people.

I was chillin' last night, watching an episode of "I'm a Celebrity, get me out of here" online and eating popcorn, when I broke a tooth. I guess I underestimated when the dentist said I had two cavities how bad they were.

So, it doesn't hurt, but I am worried about going to see a dentist here in New York--I've had issues with my VSD (ventricular septal defect) so they make me premedicate with a handfull of amoxicillin, and I have a low blood pressure and I'm usually tachycardic at baseline, so most dentists use Epinephrine in the shot they give you with the novocaine, because it speeds up the absorption, cutting down on your time in the chair, and making them able to move more people through the chair in one day. I can't have the Epi since it makes me so tachycardic that I pass out (no blood perfusion to the brain and I get short of breath, etc)

So, I called my dentist at home, and several other people...my friend Rebecca to ask if she's got a dentist, and the school's emergency health center.

My dentist told me going to an ER won't do it because they'll treat the pain, not fix the problem--so that's out.

So I booked a flight to SFO for tuesday. I have to miss my health and social policies class (and we've got a big group project happening, not good) so I'm sure I will be hurt by going home, but what can I do? I can't wait for it to get impacted or infected.

For now, I am not having any pain and I'm eating soft foods and rinsing with salt water...

Why me?

First day of school

2009-06-01T06:25:00.000-07:00

This is the view from my window right now--it's 10:00, it looks hot outside, but at least the traffic is light.

As bad as last year was, I thought nothing could be worse--yet somehow, I'm scared of going back to school. Possibly intimidation from knowing these are some heavy courses I'm taking (Medical Genetics, Advanced Pharmacology, and Health and Social Policy.) I've got two days of classes, and Mondays will be my "long day" (classes starting at 1:00 and ending at 8:00 pm without a break for dinner.

I have to go straighten out my registration issues--Friday they confiscated my old ID badge and wouldn't give me a new one until I register. I can't register without the dean of anesthesia signing off on an add/drop slip for me, and I have to go down there and face her (she's a scary dragon) and get my form. Then it will likely be a day of walking around, from building to building, back and forth trying to find the right department and red tape and hoops to jump through.

New York, and specifically, Columbia University, is unlike anything I've ever experienced before.

But I'm here, and I'm alive, so I can't be sad about that (as much as I could be miserable, hating it here, and missing George and Rutger, like the first time around. Somehow, last year's experiences have hardened me--at least it's not cancer, I keep saying to myself.

Still, it's the gepographical equivalent of cancer--New York.

:)

Ok, I had to get one shot at New York in there, somewhere

Through the fire

2009-05-18T12:05:00.000-07:00

I'm coming back after a long absence.
I've been writing about the cancer on my tumblr blog, I guess I didn't want to mingle the two worlds, cancer and my normal life.

I'm now less than 10 days away from returning to school. I can't lie and say I'm not scared. I've tried to trace the fear to its origin--what is it I'm afraid of, exactly?

I guess I'm having flash backs to a year ago, when I was 2 weeks away from resigning and going back to school. I was at the same stage; beginning to pack and make lists.

I'm afraid I am still too tired or weak to do this.
I'm afraid I've forgotten everything and I won't be able to keep up with the lessons.
I'm afraid I've forgotten how to write a paper, study for tests, etc.
I'm afraid of being in a big city by myself again, though, this time, I have to say, I am not going as a complete stranger, but there are many dear friends there whom I am looking forward to seeing again, hugging and thanking them for all their support this last year. I know that if I had an emergency, someone would be there for me.

I'm nervous about taking this tamoxifen.
I'm afraid my elderly pooch will kick off while I'm in New York.

But, I'm hopeful, too--I think about shrinking back from this challenge, and I think "no way, I can't do that." My mind is programmed to rise to challenges, no matter how hard and insurmoutable they seem. I'm going to do this, damnit.

Back to student mode. It will be a welcome change to "cancer patient" mode.

what wreched luck

2008-08-06T14:47:00.000-07:00

I've been blogging about the cancer on my tumbler blog--for friends to read what the updates are, and I'm just overwhealmed at the reality of all this.

I've been cleaning the house, and sorting through boxes of things in the garage in an effort to clean. I've been fixing up my fixie and plan to ride the thing at least on the trainer it's sitting on for now, until I can rehab after the surgery.

There are times I think, and I think it's funny, because my mom used to say the same thing..."I feel so well, I think they made a mistake...I feel fine."

That's just what she used to say.

I've been depriving myself of nothing; I have pizza and beer if that's what I feel like having, and pounds be damned. I've never been one to deprive myself, but I do have a sense of timing when it comes to things...I don't usually eat out so often, and I avoid making huge purchases when I already owe a lot of money, etc.

So, I was online looking for a mattress topper, and ended up seeing these nice LCD tvs, and well...we needed one. So G ended up buying the TV, and I bought us a new mattress topper, mattress topper cover, sheets, and a few DVDs.

I have a feeling that after this is said and done, I won't want to go back to work, go back to school, go back to anything--I might want to sell it all and just enjoy what time I have and roam around the world with George.

I want to take him to Scotland, he'd love it there, and Indonesia...that was such a nice trip, and who knows where else I want to go...

There's so many things I want to do yet with my life. I wonder how much more of it there is.

Night lasts forever...

2008-07-21T05:58:00.000-07:00

From when George says "goodnight" to when he wakes up, the night is a miserably lonely, scary time for me. It was lonely before, but there wasn't the fear of cancer then. Now, I just sit here and think about dying of cancer. Not this time, but someday...when is anyone's guess.

I make new plans. I used to plan on things I needed to do, checks to send off in deposit for things at school, books to buy, kitchen items to pack, those types of things. Now, I think about other things--I research treatments, side effects, long-term survival rates based on different treatments.

Oddly enough, I've found that the Lance Armstrong "Livestrong" foundation has come a long way since 2004, when my mom died, in efforts to provide information to cancer patients. I filled out all sorts of questions regarding "the" cancer (I've learned you're not supposed to own it and call it "my" cancer) and it offers up the current treatment protocols for people with my type of cancer, tumor size, ER+/HER2 bullshit, and lymphatic involvement, etc.

It said there are three ways one could go: mastectomy, or lumpectomy PLUS radiation, and other adjuvant treatment is also ovarian ablation. I thought of all of these--only I wasn't thrilled about radiation--I was thinking about mastectomy as a prevention of it coming back, and/or obviating the need for radiation or chemo. I thought of a histerectomy in order to control estrogen, and thereby prevent another cancer from showing up.

I have a stress echo scheduled for today--I chose not to cancel the appointments because there are some cardiac changes that come with chemotherapy and I want to have a baseline measurement before starting any treatments.

You want to know something funny? In the paragraph above, when I tried to write "cancel" I wrote cancer. It's already become part of my life, the culture of cancer. This fucking sucks.

Cancercancercancercancercancercancercancer...

2008-07-19T03:14:00.000-07:00

it's all you hear, in your head.

You pull the covers over your head and say "fuck you! I need some SLEEP! Let me SLEEP!!!" but all you hear is '...cancercancercancercancercancercancer...'

You think you've made up your mind, based on something you've read, either for or against treatments, and then a few hours go by and you're leaning the other way.

I'm tired.

I'm tired of it already and it's been two days.

I wish this were a bad dream. This isn't how I wanted to go--not that anyone does want to go this way, but especially, having seen it first hand, it's not what I want to go through, nor what I want George to go through.

I have an appointment at UCSF friday--we'll see what they say, though I don't suspect they'll be "anti-treatment"

It's Cancer

2008-07-17T01:38:00.000-07:00

I'm sure I'm not alone in this: when one imagines what it might be like to be hearing these words, it's never accurate. You think think you're going to be in a clean doctor's office, and that you'll be ready. You never expect you'll be kneeling in the hallway, in your underwear, because your gorgeous MD (the one that looks like the love child of Richard Gere and Brad Pitt) called you as soon as he got the results.

"It's cancer."

The room spins, you wonder how someone could be sleeping one minute, and hearing "it's cancer" the next. You wonder if this could be another one of those moments in which you're only thinking of what it would be like; what your mom went through, first person (I mean, you SAW what it was like...)

So, the next thing you know, you're on the phone with the surgeon, and they're telling you to come in this afternoon, and you do, despite how you haven't slept since yesterday, and you wait forever because there was a booking error and they've accidentally booked post op patients as well as pre-op today--so she's only an hour late, but you sit there and hear the full news.

Ductal, invasive, moderately differentiated...

Lumpectomy, and "DEFINITELY chemo, DEFINITELY radiation" for someone of my age.

My age?

Do I have an age? I'm outside my body now, floating somewhere in the air--left of the dreams of going back to school, there goes the plane with me on it--I had tickets for August 28th...and look, down there...that's the horrible little studio apartment I was going to call home for the next two years...I paid the deposit already.

I keep thinking I'll wake up; that this is all some horrible dream. The surgeon said she had no doubts I'd "survive the cancer" but I said "Yes, and I know that when you say 'survive' you mean "five year survival rates."

Always the ticking time bomb now. Sure they'll cut it out, but when and where will it make its next appearance? Does anyone with cancer ever just die of anything else before a metastasis? Should I take up hang-gliding, or riding a motorcycle without a helmet?

My mother would yell at me. She had a 'never say die' attitude. And Lance Armstrong...how did he do it? So many more don't do it.

At least I don't have to worry about MS anymore.

Through all of this, it looks much worse through George's eyes. He's going to get sick himself from worrying about me if he doesn't take care of himself.

A Night Fraught with Fear

2008-07-14T01:49:00.001-07:00

Tonight, I'm laying here, trying to suppress a panic attack.

My stomach is full of butterflies.

I went to sleep and dreamed a few crazy dreams, I woke up and was telling G about it, and speculated that the reason he was wearing a goofy shearling hat (in the dream) was because it was similar to my friend, Eric's, who wore a kooky shearling hat.

15 minutes later, the phone rings, and it's my friend Eric. How ODD is THAT!? I haven't talked to him since we were both studying for the NCLEX and he had just passed it and was telling me via email how it was. Freaky coincidence? wow.

Anyway, he had some bad news. Sounds like Colubia screwed him over. With their idiotic disorganized way, they set him up to fail, sent him to several clinical placements where they "were expecting someone with experience." This poor guy is 90% done with the program, and they asked him to leave.

I started getting a choking feeling--oh God!! The disorganization, the way sticking out can put you on everyone's shit list and how they psycho-babble you into thinking you have turned in crap, when in reality, you did the best you could on bullshit instructions...the way one hand doesn't know what the other is doing...Brandon's words came back to me "I try to keep a low profile and not get noticed, not draw attention to myself" and I started wondering--my plan of keeping my mouth shut for two years, sitting in the back row and effectively teaching myself everything...would it work? Would they work me into a corner and make me run up the tuition and then ask me to leave?!

Oh god, the fear in the pit of my stomach is terrible.

I should be worrying about this biopsy tomorrow.

Science experiments: Beneficial Bacteria take over my kitchen

2008-07-11T13:26:00.000-07:00

After a recent unsuccessful attempt at bread, I purchased Peter Reinhart's Whole Grain Breads: New Techniques, Extraordinary Flavors.

I've been overtaken with the desire to develop a quick, easyish recipe for bread that I can throw together when at school (maybe a Saturday Morning ritual, while doing laundry.)

I'm also experimenting with yogurt. If my poor mom could see me now--all the things she struggled with trying to get me to like, simply because she knew it was good--whole grains, plain yogurt, plain tea...as I kid I couldn't appreciate.

Now, I think I'm eating better than I ever have, and I'm starting to feel better. Hopefully, this won't stop once I go back to New York and my standard of living drops dramatically.

So, though I've used my mom's yogurt maker at least a dozen times a year, I am perfecting the recipe so that I can get the same results every time. I'm now making a yogurt that is better than my favorite store bought brand (St. Benoit) but not consistently. I now have the perfect consistency of slight tartness, creaminess, and I can do it without the yogurt maker, too. I just made a batch in my slow cooker that turned out pretty well. Really, all it comes down to is giving the bacteria a chance to do their thing.

I was surprised to know all one needs is consistent temperatures between 105-110 degrees farenheit. I'm planning on trying this even more rustic approach--when the radiators are off and they STILL put out a constant bit of heat, setting up some mason jars near it may be the best use for the unwanted heat.

I also have been looking at the paltry pickin's with regard to organic food in NYC. I was ordering from Fresh Direct, but a recent check left me horrified at the decrease in selection. Brands I used to get are now gone, and instead of having ten different types of organic peanut butter, now they have one. Instead of 20 kinds of organic crackers, they have two...their produce section is pathetic--Where there were once hundreds of different fruits and veggies to chose from, there are now around ten (total!) to pick. I can't live on this.

So a quick Yelp search lead me to Urban Organic a strange type of organic grower coop that you sign up for, and receive, without the ability to pick and choose too much what's in your delivery box. In a socialist "you get what we give you" kind of way, I think it's kind of cool to take the burden off, to plan what I want, and what I can make during the week...to plan out my shopping and cooking schedule ahead of time...I'll use what I get, and maybe learn something about preparing the things I don't normally eat (like...what's a turnip? and how do you cook and eat it?) Don't get me wrong, you can change items out, but it gets expensive to do this, so to keep costs down, I may only eliminate things I don't eat (like potatoes and corn) and learn to eat like our ancestors did...eating what's in season.

The end is near

2008-07-10T01:13:00.001-07:00

I can't believe I'm now in the home stretch...I can see the forcasted schedule and I'm on it and I think--hah, I'm flying out to NYC that day! Or, That's the first day of school! I'm working up the nerve to write my letter of resignation--and what to say.

I'm off for three nights but I'm off to a bad start. The heat and my mind have conspired to keep me awake later and later every day, and this means I get less and less sleep, since I'm not sleeping in any longer. Today, I went to bed at two in the afternoon (like the last three days) but I got up at 4:00. I went out for a burger with G, and when I came home, I basically konked out on the couch until midnight, when G went to sleep. Such is the life of a night nurse. We ALL say this kind of stuff "went out for dinner, came home, konked out on the couch..." it's what we all say/do.

I can't wait for this night work experience to be over. The only thing that's kept me from utter desperation has been the thought that it is temporary. I like the sun, I like having friends, and doing things like shopping, and eating. I hate waking up long after everything has closed, and everyone has gone to bed for the night.

I'm extending my work (not making the 8th my last day) because I have only worked 32 hour weeks (not including overtime etc) and I'm not sure Columbia will count this as "full time" so I'm adding another week to my 50, in hopes they won't hassle me too much.

The house is still a disaster--boxes are starting to be made, and piles of stuff I need to ship to myself seem to be in every room.

I have a million things I need to be doing, including studying the $500 worth of critical care lectures on computer DVDs, but I can't seem to get my energy level up in order to get stuff ready, clean the house, organize my stuff--being awake at night sucks.

Next week is my needle biopsy, and the week after I have echocardiograms and stress-echocardiograms...I still need to get the car tuned up, and go to the dentist, and see my neurologist.

(sigh)
So what am I doing blogging?!

Counting down...

2008-07-05T17:40:00.000-07:00

Little more than a month now left before I quit.

Bought my ticket to NYC (one way) on Jet Blue, paid $30 for extra leg room...we'll see.

Sent my deposit off for my apartment on campus, a studio with seperate kitchen and a bathtub in the bathroom! It's a block over from where my classes will be held, but who knows where my clinical sites will be.

I'm working up the nerve to write my letter of resignation (any hints out there?)

It's bittersweet to know that I'll likely never hear from or communicate with many of the people I work with, except for one, who's on myspace...but I have to move on. I can't do this forever, and even this next month will be tough with my back and fatigue like they are.

Last night's Epic SUCK.

2008-06-30T17:11:00.000-07:00

It was slowish, we only had four patients and there were three of us. Those of us that came on at 11 pm had one each, and Clarissa, our new hire, had two.

Around 2:30, we got a call from admitting to tell us that we were getting a patient from the ED, who was R/O MI (rule out Myocardial Infarction--in other words, "see if he hasn't had a heart attack")

He had.

His cardiac enzymes were through the roof, and it was surprising, because he admittedly "only smoked 3 or 4 packs a day."

You see what I have to deal with?

He was nice enough, but he didn't come up from the ED until around 4:30, and he was going to Mills-Penninsula for cath, so I was filling out admit AND discharge/transfer paperwork simultaneously. On top of that...I never discharge anyone, so I wasn't sure what the procedure was. (people just die on night shift, they don't check out of the hospital in the middle of the night--they wait for day.)

So, it was a little crazier than normal--not to mention that my other patient, whom I had bathed and changed her sheets around 4, decided to wet the bed and needed another bed-bath, with new linens at 6:45.

I still managed to get out of there with only a half hour of overtime.

As I drove home, I was trying to remember how many days there are until I give notice. My boss is nice enough, she took this patient that was transfering out, and she didn't find and harp on every little thing I had missed on the paperwork. To boot, she fixed a confusion with the ambulance transfer who wanted to be paid up front before they'd schedule picking him up to take him to Mills...

Then I came home and tried to schedule the needle biopsy of the lump in my breast, and I'm getting the run around...I finally told the person on the phone "you know...it's a disgusting commentary on the state of our health care system, when I--An ICU nurse!-- come home from a long night and try to take care of my own self, and I'm having trouble navigating the system, and I'm falling thru the cracks...I just want to have this looked at...can you please tell me who I'm supposed to talk to in order to schedule this?"

She agreeed it was bad, and told me she'd look into it and call me back. I went to bed, and now I'll go check and see if the left me a message on the answering machine.

Our health care system is broken! I see patients all night long who are victims of having no care, no insurance, and then I come home, a well-paid health care worker, and cant even find out who the hell I call to schedule this biopsy?! Disgusting, I tell ya.

My Patient population

2008-06-29T16:46:00.000-07:00

I'm kind of stoked about ONE thing about this job.
The diversity of cases I see.

I have had patients with Neuroleptic Malignant Syndrome, post MI, Post surgical procedures ranging from Craniotomies, hip replacement, duodenal resetions, below the knee amputations...you name it.

Last night I had a patient that was relapsing (? possibly) from Myesthenia Gravis, and the other guy had a ruptured appendix and was status post Laproscopic procedure...his peritonitis was crazy. You can imagine having a peritoneum full of shit--ugh.

Still, I know anesthesia is for me, because I get so stoked when I see a PCA pump...I want to know everything about it!!

On the bad side, my friends back in New York are posting complaints about the Policy class I have to take either this fall or spring of next year, on TOP of advanced Pharm and another class... NOT looking forward to this!

preparations...

2008-06-27T15:18:00.000-07:00

I'm doing things like getting all my doctor's appointments out of the way, and check ups done, etc. I'm also looking for ways to adapt to lving in New York again (if you can call it that!)

I haven't bought a plane ticket yet...the prices are sky high (no pun intended!) and maybe it's approach/avoidance behavior...I dunno. I know too much psych stuff for my own good.

I'm going to have to adapt to walking my ass off again, and the bad food, the horrible weather, the horrible air quality. Grocery delivery--I'm looking at Amazon and Fresh Direct (FD was about 80% of my food source last year) and I'm bracing myself for the sky-high prices of food, and the invonvenience of buyng groceries and carting them home in canvas bags on the fucking subway again. (God, how much that SUCKED)

I was talking to our new Orientee, Cara, who is also trying to get into CRNA (who isn't?) and she was telling me that Sam Merritt's enrollment seems down and that's why they're trying to get everyone to apply...That makes sense.

She was telling me about an interview she went to at one ANES school in Michigan, and how the interview panel was grilling people to the panic/breaking point to see how well they responded to pressure. She said she almost left crying.

Bullshit...why do they do this? Because it's a high-stress job? She said "ah, you're already IN at Columbia, you should GO...it's too hard to get into, don't waste the opportunity." I agree with her.

This year has taught me how to keep my mouth shut, just get thru my day without standing up for every damned thing I believe in, not to stir shit up...in short--it's BROKEN me. Working with women is the hardest thing I'd ever had to do. I can't wait to be done with this part of my life and move on to the next.

And I'm sure I'll regret quiting once I arrive in NY and say "Fuck! I had a good paying job and I left it for THIS?!"

I know...I know.
I'm like a cat--on the wrong side of every door. In the long run, it is for the best.

Mamm-OOOOHH!!!-gram

2008-06-25T16:42:00.000-07:00

So, I don't ever want to hear about how much it hurts to get kicked in the nuts.

I just had my first mammogram today. It's been a long time coming, and I should have had one years ago since my mother died of breast cancer. But last year I started having breast pain before my period and since returning home I discovered a breast lump. This isn't abnormal; many women have caffeine-related or smoking-related lumps that are not cancer, so I didn't worry.

I worried more about the pain of the mammogram, than the results of the mammogram.

They also scheduled me for an ultrasound, which I did after the mammogram.

The Radiologist came in to see me and suggested a biopsy, and because they know I'm in health care, the conversation goes deeper--Lidocaine, 14 gauge meedle (14!? that's a PENCIL!) and so on. How scary is this for women, for my mom, who have NO background in medicine; for whom hospitals themselves are scary places? I come in and I see a world of technicians, and size them up by the looks on their faces--good, lazy, lost, waiting to retire, looking for a better job, etc. I see people at work, who'd rather be somewhere else, usually.

Cancer?

What if?

School in September? Would I still get to go? If it's cancer? Chemo? Radiation?

The mind boggles.

Then, I realize there's a slim chance of it being cancer.

I flash back to my oncology lectures and how interesting cancer is as a subject. It's insidious--the perfect organism. Its whole purpose, design and function is to spread. Its structure is fragile; the cells are shaped to break off and swim downstream somewhere in the warm, loving tide of your blood (the world's best connective tissue!) and seed some new area--depending on where the cancer originates, the downstreem (metastatsis) will be some new, interesting place.

From the breast, it could be the lungs, the brain, or the bones (among other places the circulation goes.)

I'm more worried about what it could be if it's not cancer, I think. On the one hand, it could be just a stupid lump--something that annoys me for the rest of my medium-to-long life (Whatever Multiple Sclerosis lets me have.)

It could be that even my one espresso per diem, my occasional-to-increasing in occasion- vodka tonics, it could be residual karma from all the cigarettes I smoked.

It could also be a lymph node; I think this scares me more than cancer. If it is a lymph node, it could be a form of cancer that spreads so quickly, and is so fatal I could be gone in a year. Lymphoma has a 3 to 6 month sentence attached to it.

What if?

I guess the "what if's" will have to wait until I get a biopsy scheduled.
Getting old sucks.
But it beats the alternative.

Live long, and prosper, peeps.

Son of a...

2008-06-24T08:39:00.000-07:00

So, last night was my first night back after throwing my back out and having to call in sick for a couple nights for two weeks in a row.

I wrenched my back because our piece of shit orderly, who's a very sweet and nice guy, but a lazy fuck, never comes when we page him, so we end up bathing our patients by ourselves, and turning them, and the more my back was hurting, the harder it was to sleep; the more exhausted I got, the more the back hurt, etc.

I'd have one day off and rest it, go back to work and wreck it.

Last night, when I paged him at 03:45, then again at 04:00, and again at 04:15, I gave up and paged the nurse supervisor and told her we'd been paging and paging him and he's not responding. She tried, she walked around to all his usual secret sleep areas and didn't find him, she even went outside to see if he was out there...nothing.

She said "I bet he went home."

What the !?

So, the guy was missing for at least 3.5 hours, and maybe even as much as 5.5 because really, the last time I saw him was around 12:30 or 1:00 when he helped me turn my patient. For all I know he left right after that.

Carolyn asked us to write something up, about patients that were not going to get bathed, not xrayed because he wasn't there, and so, as charge, I had to write it up and the other nurses and the xray tech also signed it.

He finally had the balls to show up around 06:40, looking all dazed. I said "There you are...where've you been?"

He couldn't even answer me. He couldn't even look at me. He just looked away, shaking his head. I could see the wheels turning: do I lie? do I tell the truth?

He at least told the truth--"I fell asleep."

"You'd better talk to Carolyn, she's been looking for you."
He turned and left.

I have no idea what to expect tonight when I go to work, but this guy, as sweet and nice as he is, has got to go--it's not right that with our need (nurses) we are becoming disabled because some no-education having lazy fuck wants to sleep. For his barely over minimum wage job, do you mean to tell me that the hospital won't fire him and will instead risk the health of all it's night nursing staff?

I had to lay on the floor on a blanket for 5 minutes, because my back started cramping up from bathing my patient by myself.

I hope they fire this guy...or put him on a shift where he can't fall asleep, like days. We need Jericho, or Tim or Sean back on nights--those kids worked their young butts off for us and we adored them for it. This guy might as well be bigfoot for as much as we have "Angelo Sightings."

And the best part?
It's in our contract that we have lift teams.
Lift teams!!!
I can't even imagine that sort of luxury.

On the plus side, my boss made me sign transfer papers for evenings...so maybe this will happen.

On the negative side, Tony is retiring this Friday and I wanted him to fill out my Columbia paperwork. (DAMNIT)

Oh well.

funkopolis

2008-06-19T14:53:00.000-07:00

I'm not sure why I'm in a funk.
I think it might be that my brain is shooting forward and backward all the time, and never in the present, lately. It might also be that I'm in sort of a double limbo. I'm off work until the 23rd, resting my back, which I've thrown out because we're staffed down to bare minimum and there's no one to help me with turning the patients.

I looked at the form to verify clinical placemeobnt, it says "full time/part time" and I just came to realize that I'm not considered full time at my work...I'm considered .8 ("{point eight") which is part time. This sucks, because now Columbia is going to hem and haw and try to keep me from the program, OR they'll make my life a living hell, trying to prove to me how the extra 4 hours per week (x 50 so ~ 200) would make a difference in my critical care knowledge. Since I do still have trouble with this, it wouldn't be hard to wrong-foot me and stump me.

Fucking fuck.

On top of that, I seem to be thinking about the remote future, when I'm done with school, and I can gut the house and fix it up the way I want to...and of course, this is against Buddhist thought...I should be present in the NOW and not living in some fictitious tomorrow that hasn't and may not ever arrive.

Look at Laura, she's my hero--she left just before I did, in 2006, and she's been at it ever since and she's almost done. I guess it IS possible...there IS an end to all this, a light at the end of this tunnel (and it's not an oncoming train?!)

I just feel in a deep funk right now,
I miss my friends, especially the ones that I've had fallings out with (Jean, Steve, the other Steve, the distant Steve) and I'm sick of the struggle to push forward all the time.

I just want to arrive.
Do we ever arrive?
Is arriving the same as stagnation or dying?
I wonder.

Relapse

2008-06-17T20:03:00.000-07:00

So much for the positive spin--this one's gonna sting.

I am usually off Monday nights, so, when I worked the weekend, I didn't call in sick despite the broken back, because I was thinking "it's just one more day, see how it goes, then you have a day off...just get thru it."

I haven't slept because my back hurts so bad--why? you ask...because I work at a hospital where the nurses are shortstaffed, there's no extra help (no PRN nurse) and we have one orderly to share throughout the whole hospital and when you page him, he doesn't come (usually because he's fast asleep in the OR.) So, I wrench my back bathing and turning patients by myself.

So, last night, when I fell aslepp out of complete exhaustion, at around 10 pm, because I've slept about two hours each night for the last week, imagine my surprise when the nursing supervisor called me to ask where I was.

Apparently, my schedule has been changed, and I didn't know it/notice it, whatever (my fault for assuming) and I shook off the fatigue, the pain, and went to work.

Andrea (you'll remember her...she's the one that's about to quit, so she's using up her sick leave before going off to get married and have vacation for a month) has called in sick for two nights in a row, so the odds of finding someone to replace BOTH of us was nil.

ANYWAY....I'm off tonight.
And though I thought I saw that I was off tomorrow night too, my photocopy of the schedule says I work (so this means my charge nurse posted it, then changed it after I made my copy--still...she'll say that's my fault)

It's an interesting dichotomy to work somewhere where they're so damned hard up for you, they hate you, yet they can't fire you because they can't replace you any time soon...

This has been one of the worst years of my life. Seriously. I think I had to travel into the bowels of hell in order to truely appreciate coming out the other side in two years with an MSN in anesthesia. I understand that it's going to be an ass-kicker; very demanding, and it might kill me...it's the ultimate challenge and on TOP of how hard it is normally, I have to cram two extra courses on top of my heavy load when I get back for the next two semesters, the classes I'm missing now.

Still, I'll be thinking back to this year: the broken back, the dirty disgusting work, the shit, the C-diff, the obtunded or sedated patients, the psych patients, the jail patients in shackles, the shitty attitude I get from the day staff for whatever I happened to do wrong, not be able to do, or not be able to answer, will all serve to motivate me during those tough times up ahead.

At least I have this year to think about and say "at least I'm not THERE, doing THAT."

Though I bitched about it, I really miss school--at least there's a payoff at the end of it, and this (I swear!!) is the last round of education for me.

Unless, I pursue that PhD.
Dr. Lisa...
Hah.
No.

why do they ALLLLWAYYYS code at shift change?!

2008-06-16T15:19:00.000-07:00

Another busy night (but I'm still trying to be positive, so I will try to filter this thru positivity, versus "what's fucked up with my hospital" spin...mmmm-kay?)

So my back is still fubar, but I went to work anyway and (YAY!) we had TWO orderlies on that night...so maybe, I'd actually not break my back bathing patients by myself.

Besides Angelo (who has a secret sleeping place in the OR and never answers his pages) we had Boni, who rocks it like my Philipino homies do. Here's stuff you'll never say about my Philipino peeps in healthcare "They don't know what they're doing" (bullshit, they know it better than you, up down and sideways but they're too modest to tell you to your face--this comment is for a bigot nurse I hate who actually said "too many philipinos around here" out loud in our ICU. Ugh, she's from Iran, anyway. Draw your own conclusions.)

Here's another thing you'll never say "Those guys sure are lazy." NEVER. I've come to respect Philipinos as some of the hard-workingest, self-motivatingest people I have ever worked with. If they're sitting still, it's because they've already done 8 hours worth of work in a two hour period and they're BORED. They have some time management skillz, y'all.

How did I get on this track? Maybe it's that comment Rita made about Philipinos when in my experience, they've been the coolest folks I've ever worked with.

So, despite having two orderlies, we were swamped again--an admit came up from the ED at 4 or 5 am and she was lovely--yelling at us, telling her nurse to be nice to her, to take care of her, all while she was getting mad at her and screaming "OWWW!!! You're HURTING ME!!!"

I had two patients (one on contact isolation for C-diff so gowning up and down going in and out of her room) and a guy on a vent with psych history, thankfully--sedated.

I was just starting to catch up on my charting and help Maria with admitting a new patient (like the night before, man there are a ton of orders to check off and paperwork to check and file, and stamp and fill out, etc etc) when Joni walks into her patients room, and before going in looks up at the monitor and says "guys? he's coding!"

We all run in, Maria ran to get the crash cart, and before you know it, the orderlies are there, two ER nurses and the ER doc are up there, the house doc is awake and heading toward us.

I guarantee this guy didn't last the day--or certainly, if he's still alive, he won't make it past the night.

We started CPR, gave him one amp of Epi and he went from Asystole to V-Tach for the rest of the morning (never saw anyone respond so well to one epi.)
As I left, he was still alive.

I'm off tonight, and I'm so happy for a night's rest.

I just did a load of laundry in the Euro washer/dryer we've had for a about 2 years now...I wonder if the "sanitize" cycle really handles C-diff and Psudomonas? What does it do with MRSA and ORSA? Wash it all down the drain, I guess?

Somewhere, there are bacteria exchanging drug resistant genes, and stories about my ass...

a whole bunch of frigging lies

2008-06-15T16:25:00.000-07:00

because I swore I'd be more positive :|
Last night I had one of the suckiest nights...from 4 am til I left, and my back was acting up too, so add that to the mix.

BUT, I promised I'd be more positive--so I'm making a concerted effort to do that.
Here's the things that are going well.
(I'm positive it's a short list)

;)

(sorry--old habits die hard!)

I have a new, kick ass guitar that G bought me. It's NIIIiiiiIIIICE. I've started playing again, though I suck and all I know are strumming chords, I'm looking up songs online and printing the tabs and practicing them (I have all the time in the world, right? Nothing to study or get ready for...house is spic and span---NOT!)

I will be gone from this back-breaking, suck-ass job in 51 days or so. Yay!

What else is good now?

I talked to Laura, who is rockin' that Nurse Practitioner program at U-Penn (go sister!) andshe's going to be an awesome, awesome NP come this December. Why is this good? Because I love my friends, and I like to see them doing well for themselves, and it also means that it's possible, through hard work and dedication to finish the MSN!!! I look forward to getting down to MY last six months--what sort of feelings will I have then?

I found Sarah, Chris, Pablito and they all look like they're doing well for themselves, have happiness in their lives, and I can't be more pleased.

I am loving my Prius--auto-dimming rear-view mirror, map havin', gas-savin', quiet, electric-bus soundin', silver egg lookin' MP3 playin' THANG. It's so nice to have something that's not the hooptie Syncro.

Anyway...that's my positive post.
Don't get used to it, eh?
;)

Is it better?

2008-06-13T02:46:00.000-07:00

Some times, relationships come to a quick, nasty end, and you THINK it's the end, but maybe it's just that enough time hasn't elapsed. Is it better to just let it be and let it go? Better to allow those things to pass into the misty haze of memory and get on with your life, eyes forward, never looking back? Perhaps.

I'm a bit melancholic right now. Happy and sad all rolled into one--it's a complex feeling, and I've said often--I'm a man brain trapped in a woman body, so this complexity is working me. I don't have the advanced skills to deal with this emotional stuff.

I've been finding everyone on facebook. Almost Everyone.
I found almost everyone from Cal Poly; from my studio, almost 100%.
I found Sarah Wettling and her brother Sam; I grew so close to them on my second trip to Italy--and lost contact with them in 1998.
I found Chris, my best friend from junior college, who had a massive, embarrassing blow out with me on the Charles Bridge in Prague...ugly, ugly--and all these years have gone by and there these people are again, by my doing. So strange. Is it a good idea?

What is it about me that's making me do this? What perverse need am I looking to fill? It feels good, to find people, and find out that though you stood nose to nose, screaming at each other in a foreign country, with people standing around watching your relationship supernova, there is as much guilt and sadness on their part as there has been on yours about what happend, and the loss of such a close friendship.

I dunno. Perhaps, the more I get to know people, or rather--the more people I meet, the more I appreciate the sanity of people I used to know, over the flakes, and screwballs I seem to have around me at times.

Remember when friends used to have your back? When you confided shit to them and they were there for you even if they thought you were making a mistake, they were there for ya. People seem eager to point out where you're going to fail, or "I told you so" or give you the "I flaked" (ie--you don't matter) bullshit without any remorse or shame.

This isn't the case with a handful of good friends I am blessed to have now--they know who they are...but it seems like the flake:genuine ratio is tipping lately.

Forgive my pessimism. I'm merely venting.

I swear this next post will be something uplifing, and happy, full of puppies and sunshine....(yeah, right!)

Nothing intelligent to say tonight

2008-06-12T02:32:00.000-07:00

(like THAT'S gonna stop me)

I'm off for three nights and I've got so much to do, yet I'm totatlly unmotivated to do any of it.

When I first started working nights, I did so much on my nights off, just to stay awake, I suppose. I baked so much that it must have been like being married to a Keebler elf...every day, scones, cookies, bread, you name it. I've lost motivation to mess up the kitchen, or perhaps it's not winter and I don't feel the need to stand next to the warm oven as I once did. I should be at the very least, studying my critical care stuff--again, unmotivated.

I've come to grips about a couple of very close friendships that came to a screeching halt--Jean, over 25 years of big-sistering me, who suddenly pulled her support away and (reading my old blog) was planning well-timed emails when my self-doubt was highest ("you're not ready, you're going to fuck up" etc)Although, I probably will patch things up with her, once I finish the anesthesia thing and can prove myself to her. I dunno, should you have to prove yourself to your friends?

Then there's Steve, with whom I was having Thursday morning coffee, who suddenly went a little emotionally haywire. Some of it may be that he was once my physics professor, but most of it, I think, is the state of his marriage, currently (Hiroshima, anyone?) I can understand when someone has stuff going on in their lives, but whatever--it's like being aboard a sinking ship; sometimes the only thing you can do is swim away as fast as you can, because otherwise, you'll just get pulled down with the force of its sinking.

I can hear my bro, Dave, yelling "Paddle!paddle!paddle!paddle!" at me here.

Dave is another one, he happened to chime in at one of the worst possible times for me, and I snapped back at him and though he said it was not a big deal, I bet I've hurt our friendship, too--it was a really bad month last month. Now he's moving to So Cal and I'll probably never see him again, which blows.

Anyway, one thing I should really do is back up what I need from this laptop and reformat the drive--I don't know what the hell glitch/virus/worm/corruption I have going on, but this shit ain't swingin' it anymore and it's got to be resolved by the time I go back to New York--what a pain.

So, if it's a while before I update anything here, you'll know my reformatting attempts were failures.

Any day now

2008-06-10T08:41:00.000-07:00

According to my boss, I'll be going on evenings any day now. Chris is going on paternity leave, Michele is out on maternity leave, Jocylyn is still out on leave, Laura O. is leaving, and Laura D is moving to days, Ron is retiring, Robbie our secretary has just finished her Associates in Nursing and has to pass the NCLEX, yadda yadda...and then I get to go to Evenings. The funny thing is, this probably wouldn't be until September and I'll be history by then.

If they got their shizzle together and it could happen in June or July, that would be one thing...as it is, I have 58 days left and I'm out of there.

After last night, I welcome the thought. This whole year has been a nightmare. I almost wish I'd stayed in New York, but I had to come home. I absolutely hated New York with every fiber of my being, but going back means leaving this ICU, and I can't wait to leave this job behind me.

Losing sight of shore

2008-06-05T19:27:00.000-07:00

"Man cannot discover new oceans unless he has the courage to lose sight of the shore." attributed to Andre Gide.

As a kid, I once heard that saying and it must have affected my psyche deeply. I thought of my father, who left the motherland on a ship to some unknown land, in order to make his fortune. Then again, he uprooted my mother and brother in order to come here, to the US, with nothing more than they could fit in two suitcases, and the money he could carry in his pocket.

I am feeling this quote quite deeply these days.
I feel as though I've lost sight of shore, or I'm about to, and soon, land will only be a memory. I'll search the horizon for two years, looking for signs of it.

When I step on land again, what will I be? Who will I be? What will I think, know, feel?

I'm boarding ship.
And the wind is in my sails.

you'll get a kick out of this:

2008-06-05T09:19:00.001-07:00

So, last night, it was a low census again, and it was just me and Andrea on with three patients (I had to admit one later at five a.m.)

Andrea, you might remember, is the one that was screaming at me on the floor, in the middle of an intubation "YOU KNOW WHAT YOUR PROBLEM IS? YOU DON'T LISTEN!! THAT'S YOUR PROBLEM! YOU NEED TO JUST SHUT UP AND LISTEN!!"

You may also remember that later that morning, she went to Phyllis, my boss, and told her that I was looking for another job, that I was unhappy, that I was planning on going back to school, etc...

So, last night (a mere six months, how soon they forget) she starts telling me how she's started looking for a day shift anywhere else, how she'd never work days at our hospital for the bitches that work that shift, how she's dying to leave, etc. She spent all night faxing her resume and sending emails and looking up places online and then she has the NERVE To tell me not to tell anyone.

Bitch. Do you remember stabbing me in the back when I asked you the same fucking thing you whore? How you went RIGHT to our boss and told her?!

Are you kidding?!

I wanted to laugh, and point this shit out to her, but I left it alone.
I'm like a guy that way--if I were a girl, I'd seize my revenge, cold and sweet, and rat her out.

What a bitch.

Yay!

2008-06-04T11:57:00.000-07:00

Last night, I woke up after having had a bad day's sleep, and headed off for a hot bath to try to wake up.

G and I were talking about dinner--what do YOU want? I dunno, what do YOU want, when the phone rang. A thick African accent came over the machine, leaving a message. After a few minutes, I said "oh hey, that's the new night nurse supervisor, probably calling me to tell me not to come in, the patient census is low, or if I want to come in at 7 pm and pick up overtime."

I toweled off, listened to the message and called her back.

Sho' nuff, she was calling me off.

"So, how would you like a night off?"

I laughed and said "I'd like it pretty well"

Dried my hair and went to enjoy burgers at the Embarcadero. Awesome. I love when that happens!

Back to work

2008-06-03T11:07:00.000-07:00

I haven't been able so sleep correctly for a few months now. My sleep should be during the morning hours, waking in the late afternoon and then working all night.

Lately, I fall asleep around 3 or 4 am, sleep until around 9 am, then I'm up all day, needing a nap before work, when I wake up at 10 and get ready and leave for the hell-hole I call a job.

It's been so painfully boring, that I can't even bring myself to read at work...I sit and fold origami cranes...in an ICU! This is disgusting.

I'm looking forward to just moving on and getting past this period in my life. So much tumult and anguish this year. Maybe I should have stayed in New York...but, my health is definitely better here on the west coast, so I don't know.

I'm in communication with the Housing office and Office of Students with disabilities and they've managed to get me a studio in the Georgian Building (hopefully, they won't get funded for renovations and force us to move in the next 24 months!) I'll have my own bathroom, and a kitchenette, which will be nice since part of my problem last year was cooking for myself and finding decent enough food.

My organic preferences, and whole grain desires were not met well. Frequently, I found myself ordering food to be delivered, and when I came home and was able to feed myself the way I'm accustomed, I started feeling much better.

Anyway--I'm looking forward to just starting this and getting it overwith. It's going to be like two years of boot camp, but so be it.

...and so help me god

2008-06-02T04:12:00.000-07:00

if she calls me one more time, I'm going to wrap the call bell light around her neck and strangle her.

I went to the kitchen, and when I came back there was a note on my book "Hi Lisa, I just had blood labs done, and was wondering what my T-3, T-4 and TSH levels were."

She's fucking killing me.
Go to SLEEEEEEEP!!!!

Some nights are like this

2008-06-02T01:15:00.000-07:00

Again, it's just me and Maria tonight.
We have three patients.
She took two, and I got the crazy I had last night.
She's possibly an attempted suicide, but using the excuse that she doesn't remember having taken her anti-depressants, so she kept taking them all in one sitting.

Super needy.
On the call light every couple of minutes.
This is an ICU?

Gah.
67 days until I'm out of here.
on the funny side, I asked my charge to set up a time to talk to her about switching to PM shift (3 to 11 pm) and though we haven't talked, she's telling people I'm going to switch to PMs. This would likely be in July, so I wonder about ethically taking that position if I'm only going to give notice after a week or two.

Still, it would be nice to sleep normally for a month before heading back to New York.

is it me? or has the whole world gone crazy?

2008-05-29T13:57:00.000-07:00

I don't know about you, but I don't normally believe in this astrology stuff. Oh sure, I fit the description of "Taurus" to a T, but I know people who say their horoscopes say nothing to them, that it's not even similar.

My mom was a firm believer in this mercury retrograde shit. She was fond of saying "don't buy anything hi-tech...mercury is in retrograde."

And everytime something broke, she'd say "mercury must be in retrograde."

I've come to understand that there are coincidences, and then there are so many simultaneously occuring things, that you can't help but believe.

My hi-tech prius went tits up a while ago (just before the retrograde) and the key wouldn't sense, the car wouldn't start, and it sat overnight while I worried about how much this was going to cost to fix.

With Mercury in retrograde, communications also fall apart. In the last few weeks, I've had fall outs/misunderstandings with the people at the Columbia Anesthesia office, with UCSF about a job, with my friend Dave, with the orderly at work, and Andrea had a massive communication breakdown with her fiance, followed by me having another severing of yet another frienship, while he's having a massive communication/emotional melt-down with his wife.

It's all too much.
Is it merely coincidence? It could be, but I can't remember so many fights/arguements/differences of opinion with so many people at one time in my life ever. It was getting to be so much that I decided to look up the dates of the next retrograde, and sure enough, we were dangerously close to one. I need to mark these on my calendar and go on silent retreats when they occur.

MOST of these relationships can/will be fixed...one of these I'm sure is not going to recover.

C'est la vie.

Stanford

2008-05-23T16:05:00.000-07:00

Wow, what a place!
like being a poor kid and going to Disneyworld for the first time.
They have these cool coffee machines everywhere, I couldn't figure out how to use it. You press what you're going to make, select a pouch from a bin with several little packets of different stuff, like every flavor coffee you can imagine, every type of tea or hot chocolate...insert packet in machine, and it fresh brews a cup of coffee for you! Wow...it was cool! I must have had about 6 cups.

Within 30 seconds of being there, the lecturer came up to me while she was preparing and asked me where she knew me from, and began trying to recruit me when I told her I went to Columbia, and I wasn't a Stanford nurse. She asked me where I work and I told her, and she asked me if I like it there...my slow reply, "Wellllllll....." made her try to scoop me up for their hospital.

Hah, if I weren't going back to Columbia now.
I am pretty sure that's how I've got to go.
As much as airfares are starting to cost, it's worrying me that I won't be able to come home as much as I want to...especially if they continue to climb.

Anyway, today's hemodynamics class was AWESOME and I can't understand why other institutions can't put it together like this. It was worth every penny I paid. (I paid 13,500 pennies.)

I'm going to look at the rest of their classes and see if I can afford to take another course or better yet, see if I can sign up for it early enough to get my JOB to pay for it!

And, there are only 76 days left at this crap heap of a job (yay!)
Now, to switch my sleep back to days so I can go back to work!
I'm exhausted (despite the thousand milligrams of caffeine!)

a couple of bad nights

2008-05-22T11:14:00.001-07:00

in a row.

Patient in end-stage liver failure, (want that? drink LOTS) with a platelet count of like...12, bleeding from everywhere, and going through ETOH withdrawl decided to go into DTs on me. Ended up intubating her, but not before she kicked and flailed, and bought herself 4 point restraints. The ED doc took forever to come up to the ICU thinking we were exaggerating, and later appologized.

Last night, I was just busy with bullshit. Paperwork, etc. Got 1.5 hours of overtime just trying to chart.

Andrea and her fiance were fighting on the phone, she was crying, and in general it was a sucky night.

I'm glad I'm off for a couple days.
I'm looking forward to that hemodynamics class at Stanford.
I'm looking forward to going to New York again.
I hate it here, hate these people, hate this job, hate bathing patients, hate our orderly who dicks off for the whole morning and shows up at 6:30 so we can all three nurses bathe six patients with him in twenty minutes left before the day staff comes on.

Fucker.

I feel lucky to have at least met a couple cool anesthesiologists who agreed to let me scrub in for some procedures when I told them I was in the CRNA program at Columbia. The one said "wow! Congratulations!)

BLOW this popstand.

Blow it with 400 tons of plastique!!

Bitches

2008-05-17T13:10:00.000-07:00

I got a call from someone at Sequoia hospital ICU.
She left a message about coming in for an interview.

I called her and she kept trying to get me down there on a day off, or the afternoon, so finally I agreed to see her on some day off morning. I went down there yesterday, a forty-five minute drive. I was there early, and walked around the hospital for about an hour; it was nice. Reminded me of CPMC CCU that I was in during my integration.

I was intimidated, but I thought it was ironic that I would have been MORE comfortable there straight out of school. They do CVVH, have balloon pumps, and I dealt with those at CPMC. I also had patients on LVADs, pre and post orthotopic heart transplant, and almost everyone had a PA line.

Now, this last year, I've been dealing with post surgical patients, the GI bleeders, the DKAs, the Pancreatitis secondary to Alcohol abuse, the drug addicted, the elderly and the septic. When people die in my ICU they're usually end-stage organ failure and so we don't code them.

So, now, I'm sitting in this bitch's office, and after about 60 seconds it becomes clear this isn't an interview, it's a sermon about how I am not ready for "her" ICU and how I need to go to their step down (a four patient ratio) and or stay where I'm at, that nurses from my unit have come to work there and failed because my unit is basically like a step down, etc.

The whole time, I was thinking "you made me miss sleep...my fucking SLEEP...to drive down here for 45 minutes in one direction, to tell me no...you fucking whore."

And then it became clear that no matter what, I've got to go back to New York. I'll never (not only NOT get another ICU job, but) get into another program.

This is it.
My one shot on goal.
And, I'm so not ready for it.

I hope somehow I can fake it, but I'm doubting it.
I just don't want to go back, accrue all this debt and fail.
Come home with nothing but outrageous debt and no way to pay it back.

The only thing possible is to return to New York, put my head down for two years, and see if I can make it thru to the other side.

It's a longshot, but it's the only shot I've got.

spoke to a friend today

2008-05-15T18:01:00.000-07:00

I meet a friend every Thursday morning for coffee (well, he drinks the coffee, I am coming home to bed so I drink herbal tea) and today he had some insightful things to say that I have to mull over.

He said that he thinks I'm self-sabotaging. Me? really? Huh...maybe, I have to think about this.

He said he thought I went off on a few people due to my distress about Columbia and UCSF and all the things going on; that's very possible.

he also had some advice that may serve me in future--he told me to just go on avoidance when I start feeling like that, in order to not shoot myself in the foot and burn bridges...he's right.

He also said he thought the best thing would be for me to suck it up and go back to New York and be done in two years. Bad program or no, I'll have a degree and be eligible to sit for boards.

It's nice to talk to someone who's objective, and will give you their honest opinion and listen to a very long story and let it be all about you when it needs to be.

I guess that's the meaning of friendship.

two weeks; no answers

2008-05-11T01:50:00.001-07:00

I've been going around and around with all of this in my head.

At times, I think I could get into another Nurse Anesthesia program...then I start thinking "well, this one is out, because they require this, and that one is out, because to be competative they say you have to have this many year's experience, or that certification, or do these extra curricular activities..."

Then, before I know it, I'm thinking "fuck it, just lower your head and go back to Columbia, get it over with, god damn it."

The more I delve into how I could get into one of the California programs, the more I think it will take me at least three years to get ready to apply...then, the two years of the work...I could just be done with all of this May, 2010. Instead of applying in November 2011, and graduating June 2015 at the age of 50.

Woe.
Is.
me.

They say...

2008-05-06T03:00:00.000-07:00

They say it's always darkest before the dawn.
I guess I should know this, intuitively, since I see the sun come up every day.

It is darkest, then it's miserable and grey, everything a spooky, undefined, outline, bleek, black and blacker, shadows and outlines, giving way to blue, then some drab colors.

Then it's blinding. The sun piercing your head like a spear. Your eyes ache with the blinding sharp light.

I tried to call UCSF to talk to them about talking to my nurse manager/nursing supervisor. Instead of getting a call-back, I got an email saying basically "fuck off"

It went something like this:

Lisa,

Our administrative assistant told me that you called today; again expressing concern regarding our contacting your current employer. I am concerned about your persistent hesitancy regarding this matter. It is standard procedure for UCSF to contact an employer to obtain any current information about a job applicant within labor law guidelines.

Your ongoing concerns have led me to believe that perhaps this is not a good time for us to pursue potential hiring for the Critical Care Training Program.

I wish you the best with your future nursing career pursuits.

Best Wishes,

So, I guess it's a common thing to have someone call your current employer and let them know you're trying to find another job BEFORE making you an offer?

They're making me feel like I'm wrong about this--but I've NEVER been in such a rock/hard place before.

On the one hand, I'd love to go to UCSF...especially their cardiac ICU. It's the sort of environment I'd thrive in...but I've never had someone want to talk to my BOSS before offering me the job!

Yowza.

So, now I'm looking at my options.
Honestly, it doesn't look good.
I think I'm just going to have to quit my current job, and then start looking around, I guess. Seton Hospital (near my house) would be good, and Stanford has a couple of good training programs.

I'm so low tonight, I just can't even stand it.
To make matters worse, it's my one day off in six days, and I'm on a handful of hour's sleep...I can't get a break and get a damned 8 hours sleep at once for anything.

Go back to Columbia?
try to find another job for a year and chance getting into another program?
Stanford has an OR nurse training...that might be fun, but it's not truely what I want to be doing.

No ideas.
Nothing but waiting for the piercing bright light to get rid of the blackness.
I'm tired of all this.
I really am.

2008-05-01T23:30:00.000-07:00

I'm so mad, frustrated, confused, demoralized, that I don't know what to think.

1. I received an email from Columbia, informing us that we'd be getting valuable info we'd need to register "at orientation" and no dates given. I replied back that dates would be helpful, since I'm on the other coast. I received a snotty reply from the director of the anesthesia program to watch my tone. What the fuck? My email was forwarded around and scrutinized for sarcasm? Why don't they do this with their own emails to check if they have included information we frigging NEED in it?!

2. I'm so mad, that I really would like to tell them in which orifice to cram it.

3. doing so would be to bow out of not only Columbia, but anesthesia in general since my ICU is filled with similar passive/aggressives from whom it would be nearly miraculous to get a good refernce from. A very experienced nurse with a few years of dedicated service to them has just given notice, and the nurse manager's response is "no big loss there." What hopes have I got for a good reference?

3. Speaking of references, the people at UCSF that I met last week want me to provide them with my nurse manager's/charge nurse's numbers and contact info, so that they may contact them before considering me. If I give it to them and it ends up in a job offer...great. But if it doesn't lead to a job offer (such as, my nurse manager says something like "no big loss") my life would become a living hell there. Oh the power they'd have over me. They're losing two nurses this month, two next month, one is out on maternity leave, one is out on leave of absence, the unit secretary is on permanent disability (work related psyche issues, no less) and one person is retiring in September. And they'd give ME a positive reference? Hah...I can hear it now "You're stuck here, under my power...you'll never get away, etc." They'd be thinking it, anyway.

4. if this happens, I'd have to quit. period.
I would find myself in August, jobless, and with no academic program to return to.

5. Anyone have a loaded pistol?

remind me not to get sick

2008-04-28T08:40:00.000-07:00

at least, not to go to this POS hospital I work at.

I was off for two days, and in that time, the patient I had had on Thursday has had a severe change in mental status, can't identify his wife, tried to use a drinking straw to write what he wanted to say, and in short, has no idea what time/day it is, where he is, etc.

Of course, the nurse I got him from said he was A&Ox3, but when was the last time she checked? The morning nurse reported "confused" but failed to follow up on it.

I called the house doc, he came down and did the same neuro tests I had done, ordered a CT of his head, and it came back "acute ischemic accident"

No shit, Sherlock.

So, had they caught it earlier, he might not have much deficit, but now...it might have been who knows when that he had this stroke. I caught it right away, but no one else had.

Nice nursing there, gals. You sure know your shit.

I might mention, here, that we've all had to pass an online quiz about the national Stroke standards, too. Most of these cows had to take it multiple times, until they finally got a passing grade. Surprised?

Me either.

Busy night

2008-04-25T09:42:00.000-07:00

due to hippa, I can't say much, but I will say that I had a tough night with lots of busy work.

One of my two patients was a GI Bleeder, waiting for endoscopy in the morning, who was also showing inverted T waves on his EKG (not surprising, since he was bleeding and his Hgb/Hct was dropping) but to top that cake, his blood sugars were in the high three hundreds so I started him on an insulin drip and had to monitor his blood sugar every hour and titrate the drip. I also had to give this guy 4 units of blood, but because of his heart failure, I couldn't give it to him too fast (though, he needed it) because it would send him over the edge, so he only got two units of packed red blood cells.

My other patient isn't making any progress, but is in a presistent vegitative state. He opens his eyes, but he's not tracking...it's so sad.

Anyway, I'm out of this unit in 105 days and counting.

I'm stoked to have recently found a bunch of old friends on Facebook and reconnected with them. It's been so long since I left architecture that it seems like a foreign world, a dream almost. I used to have big ideas, once, didn't I? Now, I just run around an ICU and deal with the critically ill. I like it, enough I guess...it's just that I do miss those intelligent conversations we used to have (and the not so intelligent ones, too.)

Now, we puzzle over treatment plans, and rule-out diagnoses...health care is so different. Granted, I'm making double what I was in architecture, and working about half the hours, but there's that lure (like a bad first marriage...one that was a train-wreck, but was full of passion) that is undeniable.

I haven't heard back from the Cardiac Intensive Care unit at UCSF, but I just only inteviewed a few days ago (two) so it would be a bit soon...still, I'm interested in knowing if they'd really want me (nevermind that I can't go because I'm going back to Columbia!)

I'm sick of working nights, though. It's hard to come home every morning and go to bed. (sigh)

People die...

2008-04-16T09:25:00.000-07:00

and their discompassionate nurses don't even go into the room with them when they die.

And the younger nurses look at each other, and raise eyebrows, and think "wow."

Some nights are like that.
Some places are like that.

At least a few folks are making some money at it.

Have I mentioned how I can't wait to quit working at this shit-hole?

Yeah.

it all sucks

2008-04-13T23:49:00.001-07:00

I don't get it.

WHen I'm at work, all I want is a few days off.
Then, I have a few days off and I don't really enjoy it.

I'm alseep when G is awake, then I get up early, he heads off for a nap, I am awake until he wakes up then I fall alseep because I got up early to see him, and so forth.

Because I'm up all night, I have to be quiet so it's not like I'm getting anything done. Pretty much just spend my time on the laptop, with Adult Swim on.

I can't take much more of this--on top of that, pretty much every day off, I get a call to come in because they're shorthanded. I'm planning on calling in sick on my birthday and the day after (I have tickets to see Midnight Juggernauts) and I will probably get written up for it.

Do I care? Not much, since I will be there for another couple months.
How great would it be if I could work it out at UCSF and give notice now?
I could maybe learn some hemodynamics, at least, patients with PA lines, and I'd be oriented on days, at least.

This place is killing me.

119

2008-04-11T09:41:00.000-07:00

Not that I'm counting.

My nights are so bad.
We work like fiends, never once stopping. Not a lunch, no breaks, nothing.

Just 8.5, 9, sometimes 13 hours straight with barely a pee break.

I can NOT WAIT to hand in my notice.

To make matters worse, everyone else is talking about leaving. They're saying that they put up with the low pay (county hospital) because it's mellow, but now that it's not mellow, people are like "why? I can make way more money elsewhere if I wanted to deal with this crap"

AND...to make it extra bad, I got a call back from UCSF (from, when...last summer?) to interview at their ICC (cardiac ICU.)

Don't laugh, but I'm going to call them back!! Why? it's good experience, and I want to know more about different hospitals, and it's practice at the very least in interviewing :)

I hope the money isn't much better, and they don't offer to put me on days for three months, because the commute would be easier, and the type of work would be more interesting (my unit seems like long term ventilator care some nights)

Ahhh, it's nice to be just getting called back at all!

I'm slowly gathering up the stuff I'm bringing back to New York...clothes shopping (can't show up to classes in the same damned clothes I wore last year, can I damnit?)
and all my text books for the first few semesters (thank you ebay!)

I am so absolutely ready to quit this bullshit and head back to school.

Even Laura's phone message about the bullshit in gradschool (hope that's cleared up a bit for you, sister!) TWO WEEKS!? before she's done with her master's...even THAT doesn't scare me.

The payoff, sister...think of the PAYOFF!!! You can do it!
TWO WEEKS LEFT LAURA!!!

:)

in case you didn't know this already...

2008-04-08T02:29:00.000-07:00

my job sucks.

I worked a 12 hour shift (as a favor, becaue no one else would have done it) and I have one day off in a row of six days on, (three on, one off, three on).

I made a mistake (didn't give a medication) and basically came home feeling like shit--what a sucky thing to do...I'm so inept, etc.

Then I realized, the nurse who's fault it really was really did a great job of making me take the blame. She buried what she didn't do and made it so that I would have had to do lots of digging to find out what she did and didn't do, catch it and administer this med. Then she came in and right away asked me if I'd given this med...so she knew. How hard would it have been to day "hey, there's this order for this, but I didn't get to it. Can you do it?" But what she really wants it to make herself look good, and me look bad. This is why the other day she confronted me in front of everyone and said "this is why DAYSTAFF has to FIX ALL THE PROBLEMS."

I really hate women.

On the positive side, all this leave of absence crap with Columbia has been resolved. I spoke to the director of the anesthesia program and she seems much nicer (either she really is, or my perception of women is altered and in comparison to the hags I work with, she's not so bad.)

She was very helpful and there doesn't seem like there's going to be a problem. I think I was overly worried about my readiness--I think it's going to be much more laid-back than I initially thought.

125 days now.
All I have to do is survive them, and get my stuff ready to ship.

I'm feeling like a weight has been lifted.

my head is a disaster

2008-04-04T13:51:00.000-07:00

Someone call FEMA.
Or better yet, don't.

My brain is on fire these days and it feels as though my brains were liquifying and boiiling. I'm so unhappy. Mainly, it's a lot of back and fourth with the thinking about things. Like a tennis match between what I want and should, can and can't do.

I'm meeting lots of difficulty in heading back to NY. The state hasn't been too bad with my RN license, the campus has been great with housing and so forth, but the anesthesia office is like a Chinese Firedrill. All chaos, all the time. No one ever seems to have the answer, all you get is steered into a wall.

Should I go back there?

There's the money issue--it's expensive. And right now, it would be harder to find a job in nursing than when I graduated. The economic slow-down (what the rest of us have been calling a cataclysmic economic disaster, the Hindenburg of recessions) has made its way to the hospital and there's not only a hiring freeze, but a cur back of hours, and overtime, and supplies and everything else you can imagine.

Especially at County Hospitals; a tightening of the fiscal belts, and doing without for now. If I leave my job, there won't be one to come back to. If I fail at school, or decide I can't do it, then there's nothing to come back to.

Communication seems to be my worst suit right now, as well. The people I want to be hearing from, I'm not, and the few people that are talking to me, I feel like I'm just screwing everything up, so I should just say as little as possible.

In some ways, it feels like I've already left.

What memories of San Francisco? What images to take back to New York with me? Everything is night time, and dark always. I just took Rutger (my dog) outside to pee, since I'm not sleeping, anyway--I might as well get up and see what I'm missing sleeping days.

The lilacs have bloomed. My garden is overgrown. There are weeds sticking out of every brick and some of them are miniature trees--three feet tall...good luck ever getting rid of those; the roots probably are a foot thick and travel down several miles to the earth's fucking core.

So what...my life has been, this year, a miserable, pleasureless year of staring at the ceiling, wishing for sleep, or, on few occasions, sleeping, or working. I've been out to dinner a couple times, had a couple sincere laughs (maybe two or three) and done nothing.

I leave for New York in under 125 days, now. I might have been better off had I never left it. At least, I might have found a job right off, and been able to go back to school in the summer, and gotten these classes out of the way.

I'm trying to be present in the moment, but it's hard when the moments are all so lonely, miserable, and all I want is out. There's so much to do, I don't know where to begin, and sometimes I wonder if it's worth the effort.

Why am I doing this, anyway?

meh

2008-04-04T00:47:00.000-07:00

I'm feeling sort of...I dunno what.

I'm pissed off at Columbia (and I'm not even THERE yet!)

I have to file an extension for my leave of absence, if I go back in the fall, instead of summer. So, I contacted the anesthesia office, they said to contact student affairs. I contacted student affairs, they said "not Columbia student affairs, the student affairs at the school of nursing. (Click.)" So I contacted the School of Nursing Student affairs, they had no idea what I was talking about, but I finally got someone on the phone that said they'd email me in a few days.

I got an email, and it was a form to fill out, and telling me I had to write a letter stating why I'd be extending my leave (easy, right?) but also, to include my proposed NEW SCHEDULE as I see it, if I come back in the fall (to make sure there are no schedule conflicts.)

Do you have any idea what I've been thru, trying to find the schedule of classes? What the classes are I'd be missing, and when they're offered in the following semesters?

I emailed the anesthesia office again asking for their help.
Got an email back "call the office"
Emailed back "I'll call you tomorrow around noon your time, since I work nights and don't make it back home until 8:30"

The email that followed, from a blackberry, said "we're out of town at a conference, you need to talk to the director, call her"

looked up her number on the website--it's wrong.
Called the school of nursing "can you give me the RIGHT number?"
"They're all at a faculty conference"
"CAN. YOU. GIVE. ME. THE. NUMBER!?"

For fuckake, they're really making me nuts.

I left a message, I'm sure I'll get no call back, and for now, I'm done with that (before I die of an embolic stroke!)

THEN...
I get an email about reading two books before returning. Some piece of shit work about nurses in WWII (yeah, yeah...whatever) and another book we're to write a 3 page essay on due the first day of class, September 2nd.

AH HAH!!! September 2nd is the first day of school!!! EUREKA!!!! I have ONE PIECE OF INFORMATION!!!

Looked up the book...it's out of print.
Ebay--one copy, buy it now $135.
on another book seller's site: $100.

The copies are hard to find, and I'm guessing I might have to put in some state-wide search through the library system.

Fucksake.

Can they be any worse?

Seriously. CAN THEY!!?

Reflections on New York

2008-03-31T10:00:00.000-07:00

I was surprised last year, when I landed at La Guardia, and took a cab to Washington Heights, my new home for the next year. I had chosen Columbia thinking "it'll be just like San Francisco, only hotter, and colder, and bigger."

Hah.

I wanted New York to be the New York I grew up watching on television.
The New York of the 70s, as in Rhoda, the Jeffersons, Taxi. I wanted the New York that I saw on Sex in the City, a vibrant, exciting city, full of variety, and opportunity.

I thought I'd be able to find more things like we have available here in San Francisco. Organic groceries, used book stores, healthy restaurants...I pretty much thought that if we had 4 or 5, New York should have 10 or 20. In truth, I couldn't even find one.

Sure, there's a Whole Foods--but they don't sell bulk grain, cereal, and so forth--everything is in packages, and scarcely anything is organic. If it is, brace yourself, because you're going to get charged organic prices for it.

I wanted to have myriad choices for art galleries, and hip hang outs, small clubs playing cool music, what I got instead was a schedule so busy that I could barely ever go out, even for groceries. And when I did have time, I couldn't afford (or justify the expense of doing) some of those things. NOTHING is cheap, or underground.

The few people who kmow about that scene are the people that "make the scene" and spend all their time doing it.

I'm worried now that I'm not going to be able to survive the first semester. How awful to have not only the core classes, which are terribly hard, but to add three more classes...that might just kill me.

Anyway, I hope I get to see any little piece of New York this time, and that I won't hate it and resent it as much as I did the first time.

this year

2008-03-30T05:49:00.000-07:00

Last year, I was so homesick.
While being overworked, and torqued beyond my breaking point, my mind would wander and invariably, take me to my happy place (San Francisco!)

I would count the days until I could wear a light jacket, walk around the slighty moist night air, arm in arm with my hubby, doing something fun, anything. I envisioned art galleries, dance clubs, DJs, drinks, night lights, restaurants, laughter, good times.

The reality of this year has been basically my working my ass off, sleeping during the day, waking up at night, and laying on this couch, with the TV on, while bad movies you'd never watch during the day are on.

I went to a New Year's eve party, and I think I've tried about three new restaurants. Maybe.

My year here is drawing to an end, and come the start of September I'm going to have done next to nothing in the way of entertainment and enjoying myself. I will return to not only the hectic schedule of an impacted program, but three additional classes that I would have been taking this summer, if I had been able. So, pretty much, I guess...this IS my fun.

Let's see what's on AMC.
(sigh)

what makes your job...

2008-03-29T03:46:00.000-07:00

is the people around you. Your co-workers make the difference when you're there for 8 or 12 hours.

Last night, I worked with Maria and Bindu, and we were ok.

It's nights when I have to work with A. (YOU DON'T LISTEN!) or P. my charge (HAVE SOME COMMON SENSE!) or M. (YOU'RE EITHER A BITCH, OR A DUMBASS, WHICH IS IT?) (this is the same M. that said "Who's that slut?!" in the parking lot when I was approaching, because I had taken my bun down, and let my hair down, because it was cold and my neck and ears were cold.

From one night to the next, it's like a whole different hospital.

The weird thing is that my patients are really jacked up, but stable, and when other nurses get them, they become unstable, or highly agitated, like when A. gets them, they almost always need restraints, or sedation.

I was off for one night, and the patient that had been awake and talking went down to CT and coded while there...they're really messed up now, and I'm guessing since I'm off for three days, that she'll be gone when I get back.

I'm studying as much as I can before September. I really want to be ready.

It begins...

2008-03-24T21:48:00.000-07:00

The Columbia Screw.

The latest: I have to contact Student Affairs to get an extension on my leave of absence in order to return in the Fall because I should be going back in the Summer.

For a second, I thought about having to contact the FAFSA people about my loans, and getting covered for Summer, and the housing people about moving my date up three months, and I saw this whole cluster-fuck happening.

I'm going to make some calls tomorrow morning to New York to see if there's anything else I need to do--I can't show up three months shy of my fifty weeks, but I have some official crap I have to do in order to get the "extended" leave in order to complete those fifty weeks.

Red tape, rock, hard place. It's the Columbia way, it seems.
For a moment there, the happy thought was the sudden resignation I was going to have to tender, sooner than expected.

I'm so ready to end this ICU experience, Stat!

that was 4 nights off, just there?

2008-03-17T03:57:00.000-07:00

Gah!

I can't believe it! I could swear it was only like two days, plus the day I called in sick...why is it that when you work nights your time off seems at least 50% less than it actually is--days always feel like days, but nights somehow shrink time.

I had been having some trouble getting to sleep for a few weeks. It seems I'd be up "late" reading until about 11:30 or so (read 6 am for those of you that live in the daytime and would like to imagine how late that would be for you.) I tried to get up early this weekend and go run some errands, but I did NOTHING. The whole weekend seemed to just slip by and I was either too tired, or it was too late to go do stuff.

It also sucks that in 162 days, more or less, (who's counting?) I'll be leaving for NYC and I will have barely seen my hubby and pooch all this year--while I've decided to try to be more positive and less bitter about being in New York (I swear...I will) I think it's going to be super hard being away from home, which only makes me sad and bitter about being in New York.

I was thinking that somehow, when it gets really bad, I can always think back and say "Hey, at least I'm not cleaning shit in the middle of the night, or getting yelled at by my nursing supervisor." This should help.

I'm thinking a lot lately about how many times I've left home. I left for Los Angeles when I decided to get my first Bachelor's degree. Then I left for Italy when I decided that spending a year in Italy was preferable to spending it in Los Angeles :D Then, New York. It's funny how much I love San Francisco yet I can't seem to do anything here. Why is it that other people (so many other people) can come out here and go to school, and then they never leave...why can't I seem to go to school here? I guess it's because the education I'm seeking is better elsewhere. Berkeley was the only architecture school nearby, and they only offered a B.S. in Architecture; I have a B. Arch (5 year degree which allowed me to sit for the exams without going for a master's degree like the BS would have.) This time, the only Nurse Anesthesia school around is Samuel Merritt and they take about a dozen students per year, and with much experience. I think about my friend, and her friend (the associate director of that program) and how much they disapproved of me doing what I'm doing...I'd almost certainly be guaranteed to NOT get in. Why bother applying?

So, I'm sitting up, late at night, thinking a lot about what New York was like. Was it really that bad? (yes...I think I remember it being pretty bad.) But, like most bad memories, we don't store them, so I've thankfully forgotten just how bad it was, and this enables me to even think about going back.

This time, it looks like I'll get into a studio apartment, and this will have a kitchen and my own bathroom. The thing that sucks is the elevators are always breaking down. The rule for living in an old building, or going to classes in an old building:

1)Make sure you always pee first, before getting in the elevator (because, you never know when you're going to be stuck for two hours when the elevator breaks. This happened to friends of mine.)

2) Make sure you always have something to do, or read in the elevator when you get on...never travel empty handed because that's when you'll get stuck and die of boredom.

3) Always carry a flashlight...you never know when the power will go out in NYC and leave you in the dark, and for this reason...

4) Always make sure your cell phone is charged.

5) carry a snack, because there's never anything good to eat anywhere nearby and, again, you may be stuck in the elevator for a while.

I'm hoping I don't jinx myself, as last year I never got stuck but it was close a couple of times...just after I had used it, it stalled for 45 minutes and some friends of mine were late to class.

New York. So inconvenient.
162 days...I miss home already :(

Hell

2008-03-13T20:28:00.000-07:00

A few weeks ago, I admitted a patient, and, during nights the pharmacy is closed, so we stamp all the orders "must be verified" in our medication administration system in the morning when the pharmacy opens and puts all the meds in the system.

As a joke, the nurse taking my patient in the morning told me I had to stay to verify the orders with her. So, the other night--it was actually the end of my shift so it was morning, I asked another nurse about this--there's nothing I want more than to make sure I have done everything I need to do with the patient before I hand him over to the next shift.

Nursing is a 24 hour job, they all say, but they really hate it when you haven't done something and you hand them off with something like magnesium or potassium that hasn't been replaced...nevermind that the lab has taken two hours to get you your lab results back and they just came back 5 minutes ago and you haven't had time to act on it.

So I'm always trying to get everything done. I admitted another patient a couple nights ago, and I wanted to make sure that I had done everything, so I asked another nurse if it was true that I had to stay and verify the orders because T had said so the other day. My charge nurse, who was coming on that morning and had been checking the crash cart, came RUNNING around the corner, YELLING at me, in a full rage, POINTING and saying things like "THAT'S not TRUE, and you KNOW IT. She WOULDN'T have SAID that, now...USE some COMMON SENSE.." blah blah blah.

I was dumbfounded.

In front of EVERYONE! And as I was sitting there, SEETHING! I thought about taking her by the throat and pinning her up the wall...I thought about talking calmly to her about being nearly 42 years old, and how in my entire life, no one had EVER spoken to me that way. I thought about just calmly, quietly, quitting. I thought about just putting my name badge down and walking out.

The next day I went in and everyone said "What the fuck was THAT?!" and told people who weren't there the story. Everyone, EVERYONE without fail said "don't take it personally, she does that to EVERYONE!"

How sad.

She's been yelling at me every morning, without fail, for about a week now, and I've just come to expect it, but this was too much, and over the top. I think, being in her late fifties, she's just under some hormonal shit, or under some job stress, or whatever, but she's definitely looking for a reason to jump down my throat and unleash this wrath that has been building up, on me. What a misearble bitch. I calmly ended up telling her I was sorry to have offended her, but that I sincerely didn't know if she had been kidding, or whether it was true that I had to stay with her and do the verifications...I'm new and don't know the protocols.

So, tonight I called in sick because my back is bothering me. And I have three days off after that, so I get four days to just rest my back. And not pin her up the wall by her throat. That would probably be bad, and not go over well. It IS a county job, and it IS hard to get fired...but they might make an exception in this case.

It's funny how my nurse manager is such a bitch, that everyone comes together and really bonds as a team. I've been working with A, who went off like a psycho ("You know you're problem?! You don't listen!!") and M, and the three of us have done a fine job of helping each other out, and working cohesively as a team. We have to. I had to--I can't let it get back to the nurse manager that we couldn't work together.

I know that our schedule is delicately made out so that certain people don't have to work with certain other people--I never want to have to ask for that, though, it sure would be nice to avoid certain jerks.

I've said it before--working with women is hard.

I'm counting the days now.
One hundred seventy until September 1st.
And then I'll be back in New York, hating life.
But at least, I won't have this bitch up my ass 24/7.

A better schedule

2008-03-09T01:10:00.000-08:00

So, all it took was an email to my supervisor, telling her I can't keep working three days with one day off, and then two days with one day off, I need some days off in a row to rest. She scheduled me three on, three off, two on, two off, and it's PERFECT! Of course, now everyone else is mad because their schedule is screwed.

So, psycho bitch gets every weekend off...because she's planning a wedding, I guess, and I said "so, what, the rest of us are screwed until June?" and the other nurses said "thank you!"

The blame was laid directly on another nurse who's going back to school now and so she's doing something oddball with her weekends...whatever.

5 months and they can have my schedule, for all I care.

I've got lists going on in my head of all the things I need to pack, and bring, and do...ay caramba. It's getting close.

Tired, tired tired

2008-03-07T09:32:00.000-08:00

SICK and tired.

We're supposed to get every other weekend off. Since I finished up with this school thing, I've had to work EVERY weekend, but on my "off" weekend, I only have to work one of the two days. THAT's fucked up enough so that Sunday night, it's not REALLY weekend pay, (because it's really monday morning) and I've been doing this now for a month. I'm pretty fed up.

I'm so counting the days until I can give notice. I absolutely hate this job. Not the job itself, or most of the people, really, I hate the treatment.

They recently decided that no matter what, we couldn't afford to have more than 3 nurses on at once. This means that if you have 6 patients, no one can go to the bathroom because technically, that leaves more than two patients per nurse. The day staff was almost incited to riot--two of them saying they almost quit. Breaks? I don't think I've ever taken one here.

That's, YES--ILLEGAL. I work it straight thru, sometimes without even stopping to pee. This place is an absolute sweatshop and I can't WAIT to leave.

School starts up in September. August is 5 months away.

Grace under pressure?

2008-03-03T09:26:00.000-08:00

So, I went to work, and when I got there, the nurse that was taking care of my patient was in his room. Pumps were beeping, the monitor alarms were going off...the crash cart was in front of his room, so I knew I was in for a tough night.

The nurse, M, wasn't really talking a lot and when I looked there were two bags of Neosynephrine hanging, and both the pumps were paused (hence, the beeping) and my patient's MAP (mean arterial pressure) was 41 (very, very bad...you want it up at least around 65.) So I ran to the med-room, mixed up some levophed, which he had an order for, and set the pump at dose mode and calculated the mcg/minute dosing, and set him up at max. Two pressors running at max.

She couldn't get anything beyond "this is...this is....this is..." out of her mouth.
To make matters worse, the patient next door was doing the same thing, but with arryhythmias, and we were getting a patient from the OR that had coded on the operating table. They had called in another nurse for the night. Also, M is a diabetic, and as it turns out, she was hypoglycemic and her blood sugar was down to 30 when someone caught her and sat her in a chair and eventually she was sent to the ER.

I wouldn't have minded so much if she had done anything since 7 pm. I guess the night had started off crazy, so none of her orders were taken off, not much had been done in the way of labs, and I had to go backwards and recreate the day from when I left yesterday morning. To make matters worse, she hadn't charted much, and had not given me report.

Eventually, she came back upstairs at 4 am and gave me report, but it was more about what she could remember at that point.

All night, I ran back and forth between either my own patient's needs, or helping W, M--a different M, or L the other nurses with their highly accute patients. I was mixing drips, and running glucose checks, and titrating drips all night. I had my patient's feet up in the air, his head and torso flat, and his pressors all the way at max, so I was glad to be able to titrate them down at all, and not shut off all perfusion to his extremities (Did I ever tell you about the lady in NY who had had so many pressors that her fingers became necrotic and had to be amputated? Fingers and toes, ALL gone, and all because there were too many pressors on board.)

Anyway, last night was like I remember an ICU being--crazy, nonstop and acute. As I was taking over with little direction or help, I was realizing: I AM ready to go back to NYC...maybe I don't know a few things yet, but I think this is what they wanted us to be able to do--handle a crisis.

I did that, and then some, I think.
I got my charting done, and left only 15 minutes late.
Who knew...I actually CAN do this!
:)

Everyone seems to be crazy.

2008-02-29T08:58:00.000-08:00

Except for my dog. He's sane.

My work is nuts, my friends have either gone nutty or have jumped ship, and I'm beginning to believe in this astrological stuff, because it's the only thing that could explain it. The moon must be in the fifth house of crazy or some shit.

I got another email from my friend, who now is pushing the oncology nursing, or hospice nursing (Is this her way of saying I shouldn't be taking care of patients that have any hope of living?) God, I try to not be offended, but really, when you read between the lines it's downright insulting. If she had changed careers and decided to go into architecture, would I have told her that it's a big responsibility, and to stick to model building? Or to maybe go into designing grain cylos, because those are so rewarding, and you can't kill many people with those? I don't think I would. The more I read what she says, the more it screams out "you can't get where I did without paying your dues first!"

Some friends you just have to cut loose, I guess, when it becomes evident that they're not really there for you. I have no problems doing this, usually, it's just that like I keep saying--she's like a big sister, and it sucks.
Anyway.

It's leap year, and I was hoping there'd be all sorts of cool club events tonight (being a Friday, too) but nope...haven't found anything interesting yet. Maybe after I get some sleep, I'll check the Bay Guradian.

Peace out, peeps.

The To-Do list grows

2008-02-25T15:18:00.000-08:00

There comes a time when planning must become implementation. I can spin mental circles and make lists all I want, but the time when I have to leave is drawing near. The Summer session consists of 3 classes that I will have to miss and add on to the fall semester in order to get all 50 weeks ICU experience I need. I started working at the end of August, so, Mid August is when my 50 weeeks would be up.

Here's the list of things I have piling up:

1) Apply for New York state licensure
I can't attend clinicals if I'm not registered in the state of New York. New York is not the most organized city in the world, so I'm sure the form I send them will get lost, and then they need to send a form to California to verify my license, then California needs to get on the ball and send the form back to NY...and I remember the state board of registered nursing in California being a lovely place, too--they're backlogged at least 3 or 4 months themselves. I passed the NCLEX some time in August and didn't get my actual license until the end of the year.

2) Apply for Student Housing
Student housing isn't the best, but it's about 1/3 to 1/4 the cost of an apartment in a good neighborhood (near shops and walking distance to the subway and major bus lines) PLUS, the utilities are included so things like the air conditioner won't be an issue. I can't see paying utility bills and so forth and remembering to pay my rent on time when I'm in school. I can barely handle paying things on time now, and I'm not under the stress of school deadlines and assignments...I turn into an absolute mindless spaz when I'm in school, and on campus housing is the only way to go, though it is usually louder and not as nice--it's a sacrifice. I'm not there to live my life, I'm there to go to school. I don't care where I live so long as it's safe and a shelter from the weather (my friends have all moved to the upper west side, it's a status thing. But, I'd be less than a block away from the building our classes would be at, so getting up on lecture days would be a cinch...just a 2 minute walk to class.)

3) Pre-departure check ups
There's no way I'm going to go to NY to find out I have something wrong with me. Dentist, Gynecologist, Neurologist, GP and maybe a Cardiologist referral, too--I haven't seen anyone for my VSD (ventricular septal defect) since I was about ten years old, and now that I know how to read a 12 lead EKG, well, naturally I want to see what my heart looks like, and what's going on there...no sense if falling down dead in the New York subway from a condition that could have been spotted by echocardiogram or EKG. I should add here also, "get a haircut!"

4) Clean out the garage
This sounds silly, but my car will have to be put up when not used. And, on the days when my hubby has to deal with street cleaning, and no parking on this side of the street or the other, it's one less thing for him to deal with if he can just drive my car and park it in the garage when he needs. Though, he does have this crazy effect on the electronics of a car; he drives things for a while and when you get the car back, some indicator light is on and won't shut off. When I went to Italy, it was the brake sensor in my jeep, and in his car it's been the check engine light, the oil light, and a few other mysterious lights that the mechanics say are just the light sensor themselves, and not a problem with the engines. So, when I get back from New York, my Prius (all sensors) should be lighting up like the Las Vegas strip.

5) the Packing
The ever growing list of things I need to bring; two laptops, a rice cooker, maybe my little air oven for roasting the occasional chicken, or should I buy a microwave? Does the studio apartment they'll put me in have a fridge since it's got a kitchen? will I even get into the studio apartment or will they cram me back into Bard hall, where I was lucky enough to have my own bathroom, but no kitchen. Just an 8x10 room with a phone booth sized closet and drawers under the bed. Towels, sheets, winter clothes and coats and boots, summer clothes and shorts, something nice in case of interviews, and evening wear in case we go out to celebrate people's birthdays and such...then there's all my scrubs, and clinical garb--shoes, clogs, and my books and stuff...ugh, Stuff stuff stuff...so much stuff.

6) Financial Aid
This stupid Ivy League tuition isn't something I can just pay out of pocket. We're talking nearly six figures to attend just last year. I hear the Graduate portion will be cheaper, but who knows how much cheaper. In any case, it's all about loans, and grants in order to get through it. I have to submit all that stuff too. I'm off to find the online applications now :(

that's all I can think of right now, but the list is bound to grow as these 6 months creep forward.

I have arrived

2008-02-23T16:08:00.000-08:00

I finally feel like a nurse.

Oh, I still have to double check stuff with my co-workers, but they do it too. No one pretends to know everying. Doses, interactions, compatabilities...we question everything.

Last night the census was low--only 4 patients in a 7 bed ICU. There were 3 of us plus one orientee, who's a long time nurse, but new to our unit.

Marie, acting as charge, gave me two assignments, and they were the two hardest. I knew the patient she took for herself, a young man with end-stage liver failure. I had taken care of him last week. There was one other patient, given to the other nurse and orientee. This patient had just come back from the floor, where I guess we'd transferred her to for less than a day, and she came back in Acute Respiratory Distress, so they intubated her just moments before I walked in for the night. She was a little riled up, so the sedation wasn't yet kicking in too well.

Both my patients were difficult, and busy. One was kicking and flailing up a storm, and was not on a ventilator, (though, should have been) so I couldn't sedate him too much, but he was definitely agitated so it was an hourly dose of 4 mg Ativan to keep him calm enough to clear his congested airway, suctioning him via a thin nasal canula. I suspect when I go in tonight they will have intubated him too, which would have been appropriate...his lungs sounded terrible.

My other patient had had a thyroidectomy, and immediately I salivated and did a mental dry hand wash. "Danger of a thyroid storm!" I thought. I've only read about it in books. All night long the poor thing was vomiting and nauseated, her abnormal heart rate and rhythm would jump from the 120s to 150s, then back down to the 130s. From SVTs (supraventricular tachycardia) to A-Fib (atrial fibrilation) with frequent PVCs (premature ventricular contractions) She was everywhere.

It seems she'd had an acute event in the OR during her surgery (hey, anesthesia...how did you react? were you ready? Did you get enough experience?) and her heart rate went up into the 190s and they did all the standard stuff to get it back down to normal sinus rhythm but nothing worked (cardioversion, amiodarone, atropine, etc)

At some point in my shift, she converted back from Atrial Fibrilation to Normal Sinus rhythm, and the sage nurses said "HEY! your heart rate! what did you do? You FIXED her!" So it's nice they are accepting of me in that way. They must see I work hard because what they do is talk about the nurses who just sit on their butts all shift and do nothing.

I never once complained to Marie about the assignment, about me getting two, let alone the two hardest patients, and I did ok. I was busy. So busy, I never got caught up with the charting until around 7 am, just as the day shift was walking on.

I had managed to get my labs in, written the results on the chart, replaced the electrolytes that needed replacing, given all the meds that were charted on time, bathed both patients, administered PRN (as needed) meds, and documented everything.

I walked out of there thinking "maybe I can handle it afterall." For the next six months, I really hone the critical care knowledge I need to get back into the program. No stopping me now.

The Principle of Equivalent Exchange

2008-02-22T14:45:00.001-08:00

I was watching "Full Metal Alchemist" last night, and thought it was a relevant term: The principle of equivalent exchange.

The show hinges around alchemy, and the lesson is that you can't make something from nothing. Beyond the base minerals you need to make something, you need to exchange, or sacrifice something, in order to create something new. The protagonists learn this the hard way when they end up crippling themselves in a failed attempt to bring their mother back from the dead.

The parallel to what's happened between me and my best friend of 25 years, didn't go unnoticed by me. In order to get the career I've set out for, over 5 years ago, I now have to lose the oldest friend I have. It seems the cosmos never wants to throw you anything without taking something away.

She's still oblivious to this, since she thinks I've quit, and forwarded me an email between her and a mutual friend of ours, who asked about me, to which she replied that I was disappointed in my nursing career.

Disappointed? I hope I haven't given that impression. I love what I do, but I also am aware that it's easy to love something you know you'll be leaving in 6 months. I don't like thinking about being stuck here, in my late 40s, or early 50s, one of those burn out nurses.

People have told me my hospital is good for people starting out their career, or ending it. Damned if that doesn't describe each and every person I work with. There are those that tollerate a bad situation because some days are better than others, and they know if they were to leave, it would be to a bigger hospital, where they'd get more work to do for the same amount of money. If they're big fish in a little pond now, they're not willing to try the sea; it's too scary. I seem to enjoy shaking up the status quo and going boldly into the unknown...I dunno--I'm not scared. I believe I can do anything I set my mind to, most times.

Again, I find myself unable to reply to her email. This doubt in me, this pulling her support away, or maybe it was never there to begin with--maybe she thought I'd fail--has really left me with a bad taste.

The bad thing is that anesthesia is a small world. Everyone seems to know everyone and when I come back and look for a job, how the hell am I going to go unnoticed? She's said she's going to retire as soon as she can, but that's still a few years off...maybe if I concentrate on the penninsula and south bay, I'd be alright.

Still, I can't believe it's come to this.
She's never going to change her mind about me, and I'm never not going to be hurt by her doubts. It seems like it's the end of a good, long friendship. I think about when she came visit me in San Francisco, and liked it so much she moved out here. And when I went to study in Italy, how she changed her vacation plans to include Florence for a week, so we could hang out. Or how we went to Indonesia and spent two weeks in Bali together...how we were planning on doing a reunion tour of that trip someday.

I can't help but be sad. If ever I had something resembling a sister, she was it.

I feel better

2008-02-21T14:46:00.000-08:00

I heard from B, a student at Columbia that the ETP office set me up with contact info for. He answered some questions and though he was at Cornell's CCU (what I consider to be an infinitely better ICU than the little county hospital I'm at) he felt unready and unsure about patients with other disease processes. That's soemthing I'm quite comfortable with, since I've managed the gammut when it comes to patients. Everything from overdoses, to end stage liver diesase, cancer, cardiac problems, pulmonary problems, diabetics in acute distress...you name it.

He made some suggestions about drugs and dosings, so I'm adding that to my repetoir of study materials, and darnit--I'm so motivated now!

I'm wondering if this whole thing has cost me a friend, or for how long I can pull off the lie when people ask, and say "I'm a nurse" telling only the half truth around her, since I'll be a nurse anesthetist.

B also mentioned his plan was to keep quiet about being an ETP student, and therefore letting everyone know how limited his experience truely is. This sounds like a fine plan, and I think I'm going to adopt it as well.

I've done ok, so far, in that I don't talk much any more at work. Ever since Andrea's psycho-bitch crazy moment of screaming at me that I don't listen. I just do my job and read my books when I can, trying to learn as much as I can.

I feel like I've so much to prove to the world...I'm going to make it thru this program if it kills me.

I'm not surprised

2008-02-20T13:18:00.000-08:00

The email I got from my best friend said the following:

Lis,

I know I've preached about this over & over & I will continue to preach because I cannot over emphasize the importance of clinical experience for this job. I am working with a 1st year (1st rotation) resident today who has had tons of ICU experience & she is having a difficult time processing & thinking. It's too overwhelming to come only out of a year's experience of ICU. I've said it before & I'll say it again YOU NEED MORE EXPERIENCE! Your mind is getting used to the day to day of just being a nurse, let alone being an ICU nurse. What we do here is serious business & for the students, even with a lot of ICU experience, is very very stressful...I know, because I'm stressed when I work with the first year students! Just trying to help you out & prevent you from fucking up....Many of the programs now are requiring 2 years of ICU experience for a reason....

Again, think about it...
Love ya,
J

I thought about it.

I wondered how Columbia could be pumping out graduate after graduate if their program didn't work. I wondered what she had against me doing it. I wondered why she'd written me a glowing recommendation letter and now was sounding like she didn't believe in me.

I wrote my friends, the other 3 people in the program.
They seemed to come back, unanimously with the same sentiments I have been expressing: I hate my ICU, I'm counting the days til I go back and finish up the degree, I'm worried I won't be ready, but I have faith that others have come before us, and have succeeded in doing what we're doing. Maybe this first year resident has been out of school for a long time, and it's the school part that's doing her in, and not the acute care itself.

I felt better after musing it over with them.

To reply to her email, I had to take a few days. I decided to stop telegraphing my every thought to her via the blog (hence, the new blog) and if she asks, I'll pretend like nothing has changed, like I'm working and getting experience.Meanwhile, I'm going back to school as scheduled. Hopefully, I'll prove her wrong--it's going to be my secret for the next few years. I don't see her that often, so it won't be that hard to fake like I'm not in school.

I wrote her back, saying she was right, that I appreciated her input, and that I would think about what else I could do, because at my age, with my MS, I wasn't sure how long I could pull off the physical ICU job, and delaying school wasn't a good idea. I wanted to see if she thought I should even be a nurse, so I said that I was regretful of having left architecture at all. She was always dead set against me leaving architecture, even when I lost my job and no one was hiring...when I couldn't pay the bills. It was the sinking ship she wanted me to stay on board.

She wrote back the following:

You can do both. Get an architecture gig & work per diem as a nurse. Take the focus off of anesthesia & ICU & do something that means something to YOU....oncology clinic or other clinic type work where it's not so strenuous, research, home health, teaching....the beauty of nursing....bigger picture...anesthesia doesn't have to be the be all end all. All this stress could be contributing to how you feel physically as you know! Keep your head up!
Love you,
J

What contributes more is the stress of friends pulling the rug out from under one.

What does she think? Like architecture is some job you can do for a couple hours a day or week? Does she realize how much drumming up of business one has to do, and making contacts and polishing one's professional image. As if it's some sort of hobby one can pick up like knitting, whenever the whim strikes. My god.

And what does "do something that means something to YOU" mean? It sounds like "This is MINE...go find something that is YOURS and leave MINE alone."
What the hell?

So there it is, she's happy I've given up on the anesthesia and even the ICU. As far as she'd be concerned, I should go work oncology (the last form of nursing I would do, in fact--too much baggage there for me with the loss of my mother and brother, and way too dangerous, that chemo is toxic and causes cancer in people who don't have it) and...hey...didn't SHE leave oncology? Because it burned her out?
What kind of advice is she giving me?!

Unbelievable.
You think you know who your friends are, who's in your corner, and then this.
I'm trying not to be bummed out over this, but I've known her over 25 years, longer than my husband. She's like a sister to me and this whole thing has me a bit surprised.

Forgive my going on and on.
I'll try to keep this blog a lot less wind-baggy. This super long post was required to explain the "why the new blog."

That's right...

2008-02-17T19:11:00.000-08:00

It was all a ploy.
You knew I couldn't keep my mouth shut for long.

It's a long story, but I'll tell you the short version: I have been getting a lot of discouragement from my best friend about the Columbia program, and how ready I'm going to be, and how I need more experience, etc.

I'll go into it a bit more later, I have to work tonight, but for now, I didn't want you all to freak out when you logged in and saw my farewell.

My plans are to continue on, blogging, and getting ready to return to Columbia (damnit) and as for her, well, I won't tell her...I'll just agree and by the time she figures out I'm not an ICU nurse, but I'm back in school, I'll be ready to graduate probably.