Sunday, December 20, 2009

I suppose it was a right of passage, though definitely one I could have done without.

I got splashed at work tonight - It's not even a good story. I was taking care of my patient and some of his blood splashed in my eye. So I had to go down to the Emergency Room, fill out some paperwork, pee in a cup, have some blood drawn, and have some of my patients blood drawn. An hour later (I was shocked it wasn't longer), I was back on the unit working.

I got a call later that everything was negative.

There are lots of risks we encounter everyday: HIV, Hep B, Hep C, MRSA, VRE, Nec Fasc, etc. The risks are low though. They were tonight anyway.

Thursday, December 17, 2009

Night Shift

So as I've said before I'm working the night shift.

For those of you who don't know me well, I am NOT a night person. I've always been a 10 o'clock bed time observer and have always adhered to that. In high school, if I went to a youth group lock-in I would always go home around 11. It was beyond me to think that people would stay up late "just for fun". Why is that fun? Why would one stay up late when they could be sleeping? The few times I have stayed up late, I try and sleep in the next day and then just feel like crap for the next few days. So why would one do that?

I don't even stay out late when I go on exciting vacations. In fact, I have left my group early to go back to the hotel and "crash" while vacationing in New York City, Chicago, Las Vegas, and London, England (just to name a few).

I studied a lot in all my years of college, but I never once pulled an all-nighter.

That's not to say that I've never stayed up past 10; I have even stayed up til midnight talking with friends at times, or watching a movie, or being involved with some other nonsense. But as a whole I am not a night owl, not a late nighter, not a night person.
So, I'm working the night shift.

I realized, when I got off from my first shift, that that was the first time, in my 30 years of life, that I had stayed up all night long. I quickly came home and completely crashed, only to wake up at 12 noon. It took me a few weeks to actually sleep a full nights worth during the day. I had bags under my eyes and found myself yawning all the time. Things are better now, I usually go to bed at 8 am and wake up around 4 pm. I don't always get out of bed till 5, but that's okay. So I'm doing a lot better on days that I'm working, but on days that I'm off I'm completely screwed up.

I've never been one to lay in bed all day. I suppose I have felt like that was lazy and that isn't a characteristic I ever cared to possess. Previously, the latest I've slept in was 9:00. Now, on any given non-working day, I don't wake up til around 10:00. I'm not able to go to sleep though until midnight or 2 in the morning. I never thought that I would have trouble sleeping or that I would stay in bed so late, but that's where it's at.

But overall, the night shift hasn't been too bad. I like the people I work with. I'm able to go to church on Sundays (at least once) when I work and if I worked the day shift I wouldn't be able to do that. I don't have to get up early. People are telling me I'm losing weight.

I'm committed to schedules. I love them, I always have. They give me structure, security, and expectations. I like that. So, I'll journey on with the night shift, but as soon as day shift is available, I'm jumping ship. After all, I'm a life long commited day person.

Monday, December 7, 2009

Traveling

I sit, as I type this, on an airplane flying between my home in Nashville and my life in Oklahoma.


Over the past 24 months my life has been made up of some of the most significant changes I have ever experienced. I quit my job, returned to school, moved, had 2 nieces and a nephew with 2 more on the way, moved again, I have turned my friends over to time and marriage and distance and slowly began making new ones, graduated, moved again and bought a home, started a new job, began making new friends again, and now find myself in the aftermath. The steady stream of constant significant changes are now beginning to subside and I’m finally beginning to find a new “normal”, a new routine, and a new way.

We associate grief only with death, but in truth, we all experience grief from various situations and circumstances throughout life. I know that the experiences over the last two years have resulted in times of grief for me. I wonder now as I am settling into my new “normal” and finding my way if my grief is beginning to subside and I am beginning to resurface as the strong-willed, independent, and powerful self I have always been. Yet, I know that as I resurface I am not the same person I have always been. These past months have changed me in ways that I am still learning and understanding and growing from.

In what ways have I changed?
  • I now acknowledge the uncertainty of life, relationships, earthly truths, and time. We never have stability no matter how stable we feel.
  • I would say that in some ways I am much more appreciative and needy of my family, though I would say they probably have not seen or know that. Despite death, I suppose family is the one stable aspect of life that cannot be taken away; there is an overwhelmingly significant comfort in that.
  • I am beginning to understand, in ways I never did before, the substantial value to friends. I would not say that I didn’t appreciate or value previous friends and friendships that I’ve had, I would just say that their impact on my life was not as underscored as it is now. Now I comprehend the value of friends in a different way than before. I also see those “casual” friendships I’ve always had to be much more significant than I had initially valued them and I am repentant of my lack of value. I suppose those casual friendships, those people that you may not divulge your deepest thoughts to, but those people who just know you; I suppose it is those people that help to make up the idea, the concept, and the feeling of home.
  • I am, for the first time, understanding what it means to be from somewhere and to have a place to call home. Maybe for the first time I am learning what it also means to be homesick.
  • As I discussed in my previous post, I have also become calloused. The past 12 months have afforded me the opportunity to see things that I had previously never dreamed of or could have imagined. And every day those visions are more prevalent and more normal. You do not see these things and walk away unaffected. I don’t dislike the person I’m becoming because of it, but I am very aware and try very dutifully to monitor the change these opportunities are having on me.
  • I now have a significant amount of self pride. I have always been proud of who I was and what I was, but the events of the past months have called me out. They demanded I show myself and prove myself in ways I had always feared and desired all at the same time. In the end I met every challenge and proved me to myself. These events demanded I respect myself and I am thankful for that. I always have, but now I do in a way that will always give me significant internal strength and resilience.
  • I have learned that suffering produces growth.
I frequently find myself feeling so very passionate about these past 24 months of my life. They have truly been a monumental time and cornerstone that has so deeply grounded me and proved so much to me. Yet when I really think about them, my challenges, my struggles, my time, it is not so much.

Every person goes on a journey, not that mine is anywhere close to finished, but that has just been a part of mine. Other people encounter such greater challenges and struggles than I have. I have not lost a parent or a sibling. I have not overcome disability or physical limitations. I have not encountered material disaster and had to start from nothing. I have not encountered financial insecurity or done without. I have had everything I have needed from the beginning of my time until now. I have been surrounded by an encouraging family, strong friendships, important casual friends, a healthy body, financial stability, a good car, shelter, and all the amenities that one needs to succeed in life. I was not born speaking a different language or to parents who had no education. I was born into a family that gave me every opportunity that I could have needed. I was given love, encouragement, food, an elite spiritual training, comfort, and steadfast familial friendships that have conquered all things. My parents and sisters have always championed my causes. There were no disadvantages enrooted in my journey, there was never a reason why I shouldn’t or wouldn’t succeed.

I suppose the only struggles I have encountered over time have been the internal ones: confidence, diligence, endurance, determination, passion, etc. However, the innate resources given to me by my family and friends strengthened me to succeed on my journey and surpass the doubts within.

So as I travel on this plane, suspended in the air between home and my new life, I look to continue on my journey. I look to resiliently continue on as life demands. I look to continue building new friendships and casual friendships and look to maybe call this new foreign place home.

Saturday, December 5, 2009

The value and quality of life.

I have given so much thought to the value and the quality of life as of late. What is it that makes life worth holding on to, worth living, worth sharing?

I came on shift the other day and walked into my patient’s room to immediately begin chest compressions. We shocked him 3 times and finally regained that life sustaining rhythm that we were seeking. I proceeded to work harder than I ever have over the next 12 hours to maintain that life, and at the end of my shift the heart was still beating, the vent was still forcing oxygen into the lungs, and the four overly maxed out pressors were maintaining the blood pressure. It had been touch and go all night but we maintained the patient, the patient was alive.

The truth of the matter though is that that patient will die within the near future, hours if not days. The patient will die when the family finally stops their heroic fight and lets the patient go. I question their motives. Well, maybe not their motives, maybe their understanding. The patient will never regain the quality of life that was previously employed. The patient will never be the person they were prior to these events. Maybe it is the idea of the person, the memory, and the fear of loss that continues pushing the family forward to fight so hard. I see this situation often, I know the end of this story, they don’t. I know and have seen things that are worse than death. I have seen times when it would have been much better for one to die than to continue living in the state of physical torture, pain, disfigurement, and chaos that one’s body encounters in times and places of critical care. This patient’s family has not seen these things, they do not know, they do not understand, and so they hang on to this shell of a person who once was their companion, their parent, their partner, their friend. They keep fighting for an idea that by all reasonable standards is already lost.

So what is it that gives life value? What gives life quality? Is it found in our physical beings, in our bodies ability to move about and experience life and feel and know, to walk, to live independently of aid and physical support? Is it found in our relationships, in our family and friends, in our emotional experiences and encounters? Is value found in our spirituality in knowing that we are valuable and worthy and loved because of a higher being? Is value found from within, from the pride and love we have for ourselves and our abilities, our talents, the achievement of our goals, and the amount of our successes, in the way that one feels about himself/herself?

And what is the difference in the value and the quality of life? Does one trump the other? And how can one define the value and quality of life for another? How can a family know when to keep fighting or when to quit and give up?

I don’t know all the answers to these questions. I do know my thoughts and feelings and beliefs about such matters. I also know that over time I have become calloused. I am quick to give up the fight for human life. I suppose when you watch people day after day, in extremely critical situations, lose their fight, despite insanely heroic efforts employed, you become calloused. It is rare that one will triumph, it is rare that one will overcome their stay in a critical care unit. It is even rarer that a person will live a full 12 months if they should escape their stay. And yet, in the past 3 months I have encountered 2 individuals who had critical care stays >180 days who have lived more than 2 years after their event. They were not patients of mine, they were random people I encountered who thanked me for my work, who thanked me for doing my job.

My job. My job. My job is to save lives, to work to maintain lives, to keep families together. So why do I do what I do when so rarely the outcome is the one we are fighting for, the one we are seeking?

I encounter a great deal of disgusting things: suffocating smells, grotesque sites, nightmarish situations, perpetual alarming sounds, contagious bacteria, the constant feeling of my own dirtiness absorbed from those patients. Most of the really sick ones die. No matter that I worked harder than I ever have for 12 hours, they die. They will code again and we won’t be able to again find that life sustaining rhythm. The family will come in and we will watch time and again as they crowd around the bed with wet faces and weep and cry and comfort one another, only to walk away in the end without their loved one, without my patient.

So why do I do what I do?

Because there are times, though few and far between that the patient doesn’t die. Times when that patient does walk away in the end hand in hand with the family.

Because there is great value to helping one die in peace, in comfort. It is a beautiful thing to give someone a quality death.

Because someone has to talk to the family. Someone has to explain the step by step processes and actions we are performing for their loved one. I like to be that someone. I can talk to the family and help to bridge their previous state of reality to the new one.

Because I enjoy the critical situation, I handle it well. I enjoy the adrenaline rush of the code.

Because I enjoy the critical thinking, I enjoy the troubleshooting and the employment of algorithms to treat and “heal”.

Because that is what I was made for. Because God created me to be there and do what I’m doing. I know that more than I know any other thing. I feel most alive when I am there, amid those smells and sounds and situations.

Sometimes life isn’t so cut and dry. Sometimes we work to save only to lose days later. We wonder what was the point of our efforts only to lose in the end. The point was the knowledge that we did everything we could. Despite not always understanding what gives life value or quality, we still know that it does have value and quality. We fight to maintain that. We fight to honor life. We fight to honor our patients, their families, and ourselves. There is a great deal of personal validation in fighting such a noble fight day in and day out. It is a war that will never be lost just because a battle is not won. It is a war that is reaffirmed to each of us when we each go home to our own families, when we feel little arms around our necks, when we feel old eyes look at us with pride, when we acknowledge those we love. I suppose the fight for life in others is the acknowledgement of the value and quality of our own lives. So we fight for ourselves as we fight for the patient, because we are the patient in some twisted full circle way.

Life is all encompassing.

I have given so much thought to the value and quality of life as of late.

Thursday, November 19, 2009

Certified!!

So today I finally achieved my dream. I have finally become that which I have worked so hard to be. Today I became an Acute Care Nurse Practitioner. I took my test today. It was a 175 question test and I had 4 hours to take it. In the end I passed. In the end, that's really all that matters. And finally I'm at the end of my academic journey. I still have to work as an ACNP. Just becoming one doesn't mean I'm working as one and truly fulfilling my dream.

But for tonight I'm not worrying about any of that. Tonight I'm going to bed with my head held high, my heart full of pride, and finally finally finally able to relax. It's been a long time coming and for tonight, I'm so very happy to be here.

I am an Acute Care Nurse Practitioner.

Saturday, September 26, 2009

The Condo

So here are the long awaited pictures of my condo. I was supposed to close on October 8, but some stuff happened that delayed closing. So I will be closing around October 23 now.

It's small - 855 square feet. But it is enough for me and I'm really excited.


My Condo.


The Front Door



Living Room with Loft to the Left



The Loft



Living Room and Dining Room

Dining Room

Kitchen

Bathroom


Mater Bedroom (the only bedroom)

Closet

On Entering Into My 30's

Today is my 30th birthday. I'm excited to begin a "new" stage in my life. So many changes are occurring and new opportunities presenting. It is fun to experience change - sometimes. I'm doing my best to take it all in stride.

So this is how I entered my 30's: I woke up early (4:30) this morning and was awake for quite awhile. I finally went back to sleep and then had some crazy dreams that I won't elaborate on. I then started hearing voices in my dreams but was awake enough to say to myself, "Great, I'm having auditory hallucinations". So I think I'm going crazy. I eventually wake up and get up to shower, Chara and I decided to have breakfast for our birthday. When I went into the shower I tossed a dirty towel onto the bathroom floor, now I'm becoming a slob. After my shower when I'm blow drying my hair I see the towel out of the corner of my eye and I thought it was a snake and that it was moving. My heart was pounding. I started to stomp on it (I had cowboy boots on) and then realized that it was the towel. Now I know I'm going crazy, I'm not only having auditory hallucinations but visual hallucinations as well. Then Chara comes over and we go to breakfast. I normally eat fairly healthy, but today I had french toast with cream cheese, runny eggs, sausage links and bacon. I might as well stop up my heart if I'm going crazy.

Tuesday, September 22, 2009

Puppy

So I want a puppy. I've always wanted a puppy. It has never been the right time. I lived in an apartment and my landlord wouldn't allow it. I was a dietetic intern and would be gone alot. I was in my parent's house and I didn't want it to be their responsibility. I was in school and really did not have the time or money.

But now? I really still want a puppy. Haydn even said I should get one. She wants me to name it Polly (but that probably won't happen).

So here are the reasons why I shouldn't get a puppy. I'll be gone a lot working 12 hour shifts and it is not right to expect a puppy to be by itself for that long. When I am home in between those 12 hour shifts I will be sleeping and I really should be playing with my puppy during that time. I don't know how to house train a dog and I don't want my new condo to smell like urine, I'll smell that enough at work. After awhile the dog my get on my nerves and maybe I will resent her for taking all of my time. Getting a dog is a 10+ year commitment and I don't know my future well enough to commit to that.

So that is why I'm not going to get a puppy, even though I really really want one.

The Journey Continues

This is Oklahoma University Medical Center - my new place of employment.

I had to go in yesterday to the employee health clinic for a new employee evaluation. They needed my immunization records, took some blood, and gave me a TB test. I will go back on Wednesday to have my TB test read, get a flu shot, and then to go get my badge and fill out some paperwork. So after nearly a month of waiting, tomorrow I will become "official".

I started this blog when I went back to school as a way to document my journey. I titled the blog "Crossing the Bridge" because I was going through the bridge program at Vanderbilt. But now I find that I have crossed that bridge and that that journey is over. I had meant to blog more, to tell more stories, but my hectic schedule and occasional personal indifference prohibited me from doing so. I suppose I'm still on a journey to be an acute care nurse practitioner though, as I'm not one yet and I won't be working in that capacity as a few of my peers are. In some ways I view this next 1-2 years as a nurse as me furthering my education prior to becoming employed as an ACNP.

So I'm still on a journey and even after I'm employed as an ACNP I'll still be on a journey. Life itself is a journey and throughout life there are multiple bridges to cross and forks to chose and other travelers to meet.

Saturday, September 19, 2009

Here I Am

So here I am. Tomorrow will make 7 weeks since I graduated. So much has happened in those 7 weeks, yet very little has occurred.

I moved to Oklahoma, a place I always thought was home, but I realize now it's not. Moving (this time) taught me that my home is in Franklin, TN. From this point on when people ask me where I am from I will proudly and honestly tell them that I am from Franklin, TN.

I got a new job. I haven't started yet, but on Sept. 28, I will begin working as an ICU nurse at OU medical center in Oklahoma City. I have to work nights, I don't know how I'm going to do this, but it will be okay. I feel like this job was destined for me. I wanted to stay in Nashville, for months I applied and applied and applied - nothing. No one was hiring. Even if they were hiring it was for floor positions and I would have to work for at least 6 mo before they would let me move to the ICU. I didn't even apply for this job. I had applied for some other job at OU months ago and never even heard from them. Then while at another job interview (at a stupid hospital in Texas I didn't want to work at anyway) OU called me for an interview. They had 32 applicants for 4 positions, so why were they even looking at my resume when I didn't apply for the job? Before the interview was even over they offered me the job. I told them I would think about it - think about what, take the job!! I wasn't at that moment ready to move, I wasn't ready to leave Nashville, to leave Vanderbilt, to leave Concord Rd. But driving 12 hours the next day by myself I thought a lot about a lot and so I called them and made a verbal commitment to accept the job. What else was I going to do? I can always move back to Nashville. It's a great job though and I am excited about it.

I'm buying a condo. Why? 1. Because Oklahoma is cheap. It is cheaper to buy a condo (and make an investment) than to rent an apartment. I'm getting this condo for 1/2 the price I would in Nashville - crazy!! 2. Because I have a huge need to feel settled. I need to place some roots (even if they are temporary). When I move into my condo, it will be the 3rd time I have moved in 10 months. That is too much. I need some consistency, continuity, assurance, reliability, dependability, stability. It all happened really fast. I moved to OK on a Tuesday and called a realtor, looked at the place I wanted on Wednesday, made an offer on Thursday, and it was accepted on Friday. I will post pictures, but not today.

I'm trying to find a church. It's so extremely hard to find a church as a single person. I don't fit anywhere. People don't always know what to do with me. I just hope I can find what I need and where I can be used the most. I miss Concord Rd. I suppose that is really where my home is.

Like I said so much has happened so fast. I really don't believe all of it sometimes. There are times when I wake up and I'm not sure where I am or how I got here or what I'm doing. I've spent a lot of time doing nothing, not that I don't have things I need to do: write thank you notes, get a new car tag, get an OK RN license, study for my upcoming ACNP test, etc. I just don't have very much motivation to do anything lately. So, I've watched a lot of tv, played a lot on facebook, and slept a lot. I think when I start working I will feel real again, I hope so anyway.

I suppose I still feel really lost. I don't know what to do with myself a lot of the time. I'm questioning who I am and what I want. I miss being in school - I knew that I would. There is so much security in having tasks, expectations, and appointments. I appreciate structure so much. I miss my peers. We weren't super tight, but when you see people every day for two years and then you just don't, well it's just kind of funny.

Then there is Haydn. I don't love Haydn more than any of my other nieces and nephew (I wish there was a unisex plural word for this like cousins or siblings). I love them all equally, just differently. But Haydn is my little friend, we're "best buddies"as she says. I hurt her in leaving and I hate that. I just miss her. It has been good to be around Jonah though, to build my relationship with him.

Life is just hard. I feel these last two years have been so up and down. So many extreme changes. I often look back to September of 2006 as such an extreme high point in life, when I was on top of the world, and wish life would be like that again. But it won't and if I were to go back I would lose all that I have gained since then.

One week from today I will be 30. I wonder how that happened. I still feel like such a little kid. But I appreciate my 30 years. I appreciate all that I have gained and lost. I appreciate all the amazing opportunities I have had. I appreciate all the family and friends I have known and loved.

Here I am.

Wednesday, August 5, 2009

Post August 2nd

So, on Sunday I graduated. It wasn't a true graduation as we did not dress in all the regalia usually worn in graduation ceremonies. Vanderbilt only has one formal graduation ceremony each year and it is in May. This was actually a pinning ceremony in which they gave us a pin. But I graduated none the less. I haven't seen my diploma yet, it's coming in the mail sometime next month.

Pinning was somewhat disappointing. It was very anticlimatic. I had expected something much more exciting or grander. It lasted an hour. Then the past two years were over. I saw most of my friends in the lobby and we congratulated one another, gave each other well wishes, and before I knew it, I was back in the parking garage pulling out for the last time.

So what am I going to do now? That is the million dollar question I have been asked numerous times over the past few months. The answer is, I don't know. I have to move in two days, I don't know where I'm moving to. I've applied for nearly 100 jobs and I really haven't heard anything unless it was to say they weren't interested. I've applied for anything from graduate RN jobs to full fledge critical care ACNP jobs. Something will come up - I know that. But I had wanted to have it all settled so that I could move where ever I needed to go. Needless to say, I've been a little stressed.

I had wondered a great deal how I was going to feel on August the 3rd. I suppose that since graduation I have felt shocked, it was all so fast and furious I can't believe it's over. Mostly what I have felt though is lost. I'm not sure what to do with myself now that I have nothing to do. I don't know where I'm headed. I don't know where I'm going. I don't like waking up without an agenda. I don't know how to relax. Having such an intense schedule the past 2 years has created a constant underlying level of anxiety. That anxiety haunts me througout each day. I suppose it will eventually subside. It's funny because I want to relax for awhile, but I want to start life right now too. I suppose I'm always going to have somewhat of an internal conflict.

I graduated from Vanderbilt University on August the 2nd with a Master's of Science in Nursing as an Acute Care Nurse Practitioner.

I am Tara Sanders, MSN, RN, ACNP-BC (still have to test for this one), MA, RD, LDN.

Wednesday, July 22, 2009

The Final Exam

School does not come naturally to me. You might think that having been enrolled in 5 different colleges for the past 10 years and nearing the end of my 2nd Master's degree that school would come naturally to me, but it doesn't. It never has. I've always struggled. I'm not an A student. This doesn't mean I don't get A's, but I have maintained more of a B average throughout life than an A average. I suppose I've always been afraid that someday someone would find out that I'm not really as smart as I try to be or that I'm not really what I appear. I've always been afraid that someone would find me out and expose me for a fraud.

So, in order to graduate, I had to take a comprehensive final exam. In order to pass the exam, you had to make an 80. Last year's ACNP class only had to make a 70 to pass, the average was a 75. So this year we had to make an 80. It was a 163 questions. We had 3 1/2 hours to take it. Half the class didn't pass, didn't make an 80. So all day we moaned and groaned and wondered what would happen. If we didn't pass, we could take the same test again. If we still didn't pass, then we had to wait 45 days and take it again. The problem with waiting 45 days means you don't graduate. You repeat this class next year, next summer.

So, like I said, 50% of the class didn't pass. The faculty gathered that day for five hours and evaluated the test. They ended up throwing out 11 questions, giving us 7 points back. With the additional points all but 6 out ~80 passed. I was one of the 6, I needed another point.

I came up short. I guess I'm always afraid that I will come up short. I suppose that is my greatest fear. I felt as though I had finally exposed myself to my peers and my faculty as not knowing, as not being where I needed to be, as not being that which I had portrayed. I failed. I did not pass the exam. There is a great deal of shame in failure, a great deal of embarrassment, a great deal of disappointment.

I bare my emotions so very close. So I took not passing in stride. Gathered with a few others and studied. We were taking the same test, so we just needed to research the questions and find their correct answers. But how do you remember 163 questions? I didn't remember them, luckily others did. We studied for days, sent e-mails and texts, and spent a lot of time on the phone coaching and consoling one another. It's funny to think that the fate of two years of hard work and stress and heartache could fall on the results of 163 question test. Yet it did.

So today I retook that test. I was scheduled to take it at 11:00. I woke up this morning and I tried to be calm. The problem with getting up at 4:30 half the time though, makes one wake up very early most days. So, I tried to be calm but 11:00 was never going to get here. I ate a good breakfast. I took a long shower. I studied over my notes twice. And at 8:45 I couldn't wait any long and I left for the 30 minute drive to school. I went up there in hopes of taking it early. All of our tests are on the computer. I feel indifferent about this. Thankfully, the lady, I don't know her name - she wasn't our usual lady, let me take it early. Luckily I was the only one in the computer lab because I had to stand some from anxiety and I kept flailing my arms around about me to let go of some of the fear that was erupting within me.

I passed. I passed the test. I was going to graduate.

Funny, the way I handle my emotions. I often ignore them, bottle them up, and wait until an opportune time to acknowledge them. Some emotions I never acknowledge, other emotions wait until the must acknowledge me. Today my emotions acknowledged me. When I finished the test, realizing that I had passed, that I would graduate, and that essentially the past two years were done, I finally felt the extreme stress that I had been harboring. As the moments passed the stress slowly dissipated from my being, yet even now as I sit here hours later, it is still slowly dissipating from me.

After the test I spoke briefly with my advisor. And as I talked my emotions, after a week and a half, finally acknowledged me and the tears began to roll down my face. My advisor told me that people have different skills. Some are skilled as excellent test takers, other are skilled at the bed side. She said she's seen my skills at the bedside and I have nothing to worry about. I suppose after this year I won't have to take that many more tests, but I will have to be at the bedside everyday.

I feel so very exhausted - emotionally. These past two years have been the hardest, most intersting, most enjoyable, most encouraging and discouraging two years of my life. I grieve their end. I warrant their end. Mostly though I just want to rest, so that I can discover my next great adventure and pursue it.

Tuesday, June 23, 2009

Living in the Shadow.

So I'm in the thick of it all. I'm finally getting to do that which I have dreamed of since August of 2006 when I returned to school.

I dreamed of doing more. I dreamed of being more involved in patient care. I dreamed of playing an active role in the health care decisions of others. I dreamed of doing, of being, of making an impact, of making a difference. I find myself right now in that place I have dreamed of. I'm working right now in the SICU, the Surgical Intensive Care Unit, at Vanderbilt University Medical Center. I will spend 9 weeks there before I graduate. I'm in the middle of my 4th week, so I have 5 1/2 weeks left. I am learning so much and I am enjoying it everyday. I'm living MY dream. I'm still mostly just shadowing the ACNP right now. I make very few decisions on my own and still have very little autonomy, but I have more now than I ever have. My day starts on the floor at 05:30 and ends at 18:30, but it flies by. Most days are half over before I even realize what time it is. So much is going on and there is so much to learn and see. I want so much to grow and to truly become that which I have so desired for so long. The truth though, is that I still have so much to learn. The learning curve is huge and I am simply attempting to learn and grow as much as I can. I have so very far to go.

In the short time I have been there I have seen so much. Events occurred on the floor a few weeks ago that are not common. I observed those events for most of a shift. I have never seen so much blood. I experienced so many things that day that overwhelmed me. I constantly carried those experiences of sights, smells, and sounds with me for hours. When I layed down to sleep and closed my eyes that night, I found that I was still there in that room - seeing those things, smelling those smells. I can understand how men go to war and experience post traumatic stress disorder. Some things aren't meant to be seen. I am so thankful for that day though. I learned so much.

Every day these past two years has been made up of experiences that have slowly brought me to this point. Those experiences have built me up and helped to develop me into the person that I am. God built me for this though, this is why I am here. To share in the tough difficult experiences of those in need. So I'm thankful for that day and every coming day. It helps me to grow, to learn, to see.

I am amazed at the trauma that we can overcome. I am amazed at how quickly and suddenly life can be taken away. I am amazed at families and their various responses to difficult situations. I am amazed at people and their ability to change and grow with various situations placed in front of them. I am amazed at the various people that come to work everyday and the attitudes they chose to wear (or not to wear). I am amazed at the expansive technology we have and the things that we can do and at the things we shouldn't do. I am amazed by how fast a patient can decompensate while in septic shock. I am amazed how a simple cigarette can destroy a whole body. I am amazed that people make the choices they do. I am truly amazed.

There are so many stories that I had intended to tell, so many stories that I needed to tell. Yet they, as I feared, have been lost to time or HIPPA or to wherever the recesses of my soul lie. I did so good last year telling my stories, releasing this adventure of mine. This year I have not done as well relinquishing the experiences that have made up my daily life. I have never been so proud of myself, in all that I have accomplished, as I am in these days. And as excited as I am to finish school and be done with this initial journey, I am so very sad for it to end. Vanderbilt has presented the challenge that I have always dreamed of and desired. The challenge that I have deeply longed for. Vanderbilt has provided me with a true test of my abilities, my knowledge, my skill. I suppose that challenge has been one of the greatest gifts I have ever given myself and while there have been times when I feared that challenge had beaten me (not that I have won yet) there have been times that this challenge has so deeply empowered me. That challenge has become a friend of sorts, an empowering friend and I will miss it. I have within me a deep resilience that has been shown and proven to me in a way that I didn't know could be. I know that I can accomplish and strive and be the person I have always been afraid I wasn't. I am the star of my being and all I have to do is let myself shine - my friend taught me that.

I suppose the challenges of life never truly leave us though. When we conquer one another comes along. When I finish school in the coming weeks, I will have to find a place to live (wherever on this big green earth that is), I will have to find a place to work. Those choices will come as challenges in their own right. I will once again have to push myself to meet them, to embrance them, and to own them. Even when we finish we are never done. Life truly is a marathon and not a sprint. We have so far to go. We worry about so much and there is no reason for it. I say that though as I stress and worry a great deal about August 3rd. I wonder how I will feel and what I will do when I wake up on that day.

The patient of the uncommon events eventually left the hospital and that was good. Somethings work out for the best. But then that is my opinion.

I am afraid to graduate. I have lived a great deal of my life in fear of my future, in fear of failing. I am afraid that I won't be that which I hope to be. But one day, years from now, I will wake up and know that I haven't failed but that I am doing that which I hope to do, being that which I had hoped to be. I will have hurdled the learning curve, I will be writing orders, I'll be doing procedures. I'll be living the full dream and not just living in the shadow.

Saturday, March 14, 2009

Being the Patient

So in the past month I have been sick with the stomach bug two different times. Both times I was vomiting and having diarrhea for like 4 days. It has caused me to miss clinical days - which is a big deal and has really messed me up. It put me in the bed for like four days. It got me behind on my homework and study schedule. And it caused me to have a sore rectum.

This last time was much worse than the first time. I lost a lot of fluids. It got to a point when I wondered if I even had anymore fluids in my body to lose. It was bad.

The problem though with having medical knowledge and being sick is that you know too much. Case in point. I had gone to bed this past Sunday evening around 9:30 with the hope of sleeping all night and feeling revived in the morning. Around 11:00 I woke up with horrible stomach pains and quickly found my way to the bathroom. I was in their for a while. I was sitting there and began thinking about my plight. My train of thought was as follows:

I've lost a lot of fluid the last few days. I know I'm dehydrated. I haven't eaten in like 3 days. Plus my electrolytes must be way out of whack. I know that I must be hyponatremic and hypokalemic. Those are cations. Losing cations leads to a state of metabolic acidosis. I bet I'm getting ready to start hyperventilating in order for my respiratory compensatory mechanisms to kick in. I wonder if my hemoglobin in low? If my hemoglobin is low and I start hyperventilating then I will become hypoxic. Hypoxemia could lead to confusion and coma. I wonder if I go back to sleep if I will just go into a coma. Plus my current state of hyponatremia can lead to confusion. That's not as bad as my state of hypokalemia. That can lead to muscle cramps and heart attacks. I bet I'm going to have a heart attack. This is how I'm going to die: sitting on the toilet in a dehydrated state. It would kind of be embarrassing if I died and my pants were pulled down. Oh well, I guess I'll get back in bed. It would be better to have a heart attack there anyway. I'll probably start having muscle cramps soon. That will be annoying and painful. Ideally I can go to sleep before the muscle cramps start, then I will go into the coma and have the heart attack. I am begining to become short of breath and I can't get comfortable. I know this is because I'm getting agitated due to hypoxemia (Actually it was because my sports bra got twisted when I got back in bed and I couldn't breath, I never sleep in a sports bra, but I was to sick to take it off when I went to bed earlier.). I'm so exhausted. I feel the coma coming on.

So I fell asleep. I woke up the next morning. I had no muscle cramps, no heart attack, and I don't believe I was in a coma. My stomach bug resolved within 36 hours. I never get sick. I don't like to get sick. But looking back, it sure was funny.

FCCS

Today was day 1 of 2 of my FCCS course. FCCS stands for Fundamental Critical Care Support Course. It started at 7:30 this morning, so that meant that I needed to be up by 5:30 a.m. Whenever I have to get up early, I don't sleep well - I worry in my sleep. This has resulted in me waking up many times in the middle of the night, in the shower about to turn the water on to begin my day. Fortunately 75% of the time I wake up before I turn the water on. (I tend to go back to sleep better if I'm dry.) Last night I was having dreams about patients with subarachnoid hemorrhages and was up at 1:30 this morning trying to get ready for the day. I woke up thinking my alarm had gone off and then I turned it off. I realized it was the middle of the night reset my clock and went back to sleep. So I reset my clock, but I didn't turn the alarm on. So I needed to get up at 5:30 and leave my house no later than 6:40. I woke up at 6:49. I got to school at 7:25 - class started at 7:30. I was freaking out. If we were more than 10 minutes late to the class, then we got kicked out - so I barely made it. It took me a while to settle down.

So the FCCS course was fast and furious - what else is new?? From 7:30 until 1:00 we had 10 30 min lectures straight. We covered a lot of topics very quickly. The afternoon was comprised of 4 labs. The labs were a lot of fun. Two were simlabs with patient scenarios. So we had manequins and they both crashed and we had to save them and give them drugs and intubate them and everything. It was fun and they both lived and so it was good stuff. The other two labs focused on mechanical ventilation. We talked about vent settings and played with some of the ventillators. One of the two labs we had a pair of pig lungs in a jar hooked to a ventillator. We turned them up and down and watched the pig lungs inflate and deflate. It was really neat and I enjoyed it a lot. the instructor for the lab station was an Indian doctor from the SICU and he was hillarious. We had a really good time with that.

Tomorrow, on day 2, I have to take a test at the end of the day. I have to pass with a certain percentage in order to become FCCS certified. I really hope that I do well, but the pre-test I had to turn in by 7:30 on day 1 was very hard. It was 15 multiple choice questions and took me about 2 hours to answer. Tomorrow I have an hour for 60 questions. I'm hoping to be faster and do well. If I don't get certified though, then it'll be okay.

So overall I really learned a lot today and had a really good time. I look forward to tomorrow and really hope that I don't turn my alarm off in the morning.

Monday, February 23, 2009

School

So I really haven't said much about school in a long time. I could really say that I have been too busy to write, but the truth is I just haven't felt the desire. Sometimes I have found writing to be very therapeutic and helpful in dealing with patients or various overwhelming circumstances in life. Sometimes I compose blogs in my head for days prior to writing them and sometimes those compositions never make it to the big screen.

So a lot changed before the semester even got started. I moved. I live in Brentwood now. I sleep in a different bed in a different room in a different house. I drive a different route to school and have to park in a different area of the same level in the same parking garage. I walk the same walk to class.

Classes have been very different this semester though. Last semester I carried 16 graduate hours. They were heavily didactic. In 14 weeks I had 20 tests, wrote a 20 page paper, a 10 page paper, completed 3 case studies, completed a complete head to toe physical exam, and spent five weeks in the SICU. Last semester was by far the hardest semester in my entire life. I humbly learned what it means to live day by day. I was under so much stress that I was brought to tears in ways I never have before. I spent 5 months studying in my "naughty chair". I didn't make a lot of A's but I also didn't end up on Academic probation like 40% of my cohorts did.

This semester has been very different. Classes have been much slower. I've only taken 2 tests. I've already spent 5 weeks in the ICU and loved nearly every minute. I had a patient whose carotid artery exploded. I learned a lot about arterial lines, CVVHD, life sustaining drugs, the importance of breast tape, the importance of bubble tape, etc., etc., etc. I love love love love it.

Last week I started a new 8 week rotation in Manchester, TN. I'm in an internal medicine rotation. So basically I'm in a doctor's office all day. We get to see everything from tick bites (yes, in the coldest February ever), to neck/back/leg/foot/hip/chest pain, to possible CVA's, to sore throats and headaches. We get to see it all. I got to write my first drug prescription today. Yes, it was cosigned, but I got to order drugs. I fumbled through it and was completely taken off guard, but I did it. Amoxil 875 mg 1 po BID.

Do I want to work in a doctor's office? I don't know - never really thought about it.

One thing I learned from the ICU is that nearly all really sick people smoke.
One thing I have learned from the doctor's office is that all people who smoke smell.
One thing I do know is that smoking is stupid. I have learned that beyond measure in the past year. And it infuriates me beyond words.

Laura tagged Chara. Chara tagged Me.

So you have to go to your pictures. Look in your 4th folder and post your 4th picture. But I prefer the number 5. So I looked in my 5th folder and I am going to post the 5th picture.


So when I graduated from my Internship I woke up one morning and found my car like this. I later sent an e-mail out to a lot of people with a lot more pictures of the car which read:

To all of you whom I called this morning and to those of you I didn’t, I just wanted to let you know what all the fuss was about. Last night, in the middle of the night and to my parents knowledge, my car was molested.
Two unnamed friends shrouded my car in such a manner so that I could not even open my car doors.
They littered the inside with a gargantuan amount of toilet paper, feathers, beads, and little fluffy balls. Additionally, they sprayed silly string around the perimeter, and know it is dried up like dead worms.
And if that wasn’t bad enough they placed signs all over the car and on my mailbox.
I was absolutely shocked when I went outside.

I eventually found out the two who did it.

I tag Tia Coffee.

Saturday, January 24, 2009

Sanders Family Christmas Extravaganza 2008

The Sanders Family Christmas schedule was a hit again this year. We again did not follow the schedule exactly as perscribed, but we had a blast and made plenty of memories all the same.

Sanders Family Christmas 2008

Thursday (12/25)
5:00 Pasta Bar
6:30 Ornamentation
8:00 Family Singing

Friday (12/26)
12:00 Sandwiches
1:00 Cookie Creations
5:30 Pizza Pizza
6:30 Imagine IF
8:00 Christmas Cheer

Saturday (12/27)
9:00 Family Breakfast
10:00 Time for Christmas Presents
11:30 Family Picture
1:30 Family Lunch
2:30 Mystery Gift
3:30 Bunco
5:30 Dinner (whatever you can find)
6:30 Apples to Apples
8:00 Family Singing

Sunday (12/28)
9:00 Church
11:00 Lasagna Lunch
1:00 (Family Picture 2 if Family Picture 1 doesn't turn out)
Wii Bowling Tournament (Have you been practicing?)

Most everyone participated in every activity. We especially had fun with our ornamentation and cookie creations.

video

And we had lots of fun taking the family picture.

video

Good times were had by all.