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.

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.

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.

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.

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.

And we had lots of fun taking the family picture.

Good times were had by all.

SICU Crew

Yesterday was the last day of clinicals. I was placed in the Surgical Intensive Care Unit this semester.

The purpose of lab and clincials this semester was to become proficient at the physical exam. The first part of the semester we practiced conducting physical exams on our lab partners until it became a habit. The second part of the semester we conducted actual physical examsd on real patients. It was much harder to do physical exams on my patients than my lab partner. My lab partner (third from the left) was responsive, agreeable, helpful, and not sick. Most of my patients this semster have been intubated, had numerous IV lines and EKG leads to maneuver around, had restraints on, and were sedated. The few I had that weren't sedated had ICU induced psychosis and were absolutely crazy. Every exam had to be modified and I learned a lot.

I enjoyed my time there. I learned so much everyday and I left wishing we could stay longer. I look forward to the day when I can.

Thoughts

I suppose I feel like I have been burning the candle at both ends for quite some time now. Prior to Thanksgiving break, I had adapted so that I could function at a very high level of stress. Then I had the week off at Thanksgiving, which has thrown me completely off. I'm having trouble regaining my momentum and even though the end is in sight, I feel I will never make it to next Thursday. I have always been amazed by people who would work so hard and then quit right before they accomplished their goal, but I think I can understand now. It would make perfect sense to me if someone were to drop out on July 31st, despite pending graduation on August 2nd. Sometimes you just don't have it in you anymore.

My break will start next Thursday and will last until the 5th of January. I look forward to the time off from school, but overall I'm not excited by the events which the break will bring. I'll be moving, my parents will be moving, much of life, as I have grown accustomed to it, will change dramatically. I'm not one for changes.

Growth is often a product of change and I hope that that is what the upcoming changes will yield for me. Fear is often a byproduct of change and I know that that resides within me; however that which I fear is not well defined and is somewhat obscure. Change often presents new opportunities, new beginnings, and new challenges - each of these can offer both positive and negative aspects to one's life.

I wonder a lot about my future job - where I will work, and what exactly I will be doing. I wonder about my future place of residency - where on this great big Earth I will live. I wonder about so many things and that wonder at times leaves me feeling so unsettled and lost. I wonder where my place is and what my purpose is. I know that I am in the process of doing what I am supposed to be doing, I feel that as I have never felt that, but there are so many contingent factors associated with that that I do not know. I do not know what is best for me or for my future or for my family. I suppose something that saddens me a great deal, is that I do not have a home. I've lived a nomadic life. I had begun to think I did, but in coming days that is passing away. It is difficult to step outside of one's self and establish yourself and allow yourself to become, especially when you must do it alone.

I've never in my life been under the level of stress that I have been under the last few months for a prolonged period of time. I've learned what it means to take it one day at a time. I've been unable to look more than two weeks in advance without becoming disabling overwhelmed. Yet, I am surviving. I look back over the last few months and I see my growth and I am able to identify my progress. But there is so much I do not know. There is so much I will never know. I try to learn and to grasp it all, but it is not possible, there is simply too much.

There have been so many events that have occurred over the past few months and their stories reside within me desiring to be let out and told. I do not know that they will make it out, but I do hope they do. If for no other reason than I do not want time to elapse and awake one morning to find those events have left me. Birthday Curse #2, Male Surrogate exams, Female Surrogate exams, Lost Dogs, Liver/Kidney Transplant, the cursed 20 page paper........

Second Year

Second year started with me sitting in a large auditorium for orientation. As I sat there I couldn't believe that I was where I was and that that day had finally come. All of my life I have been anticipating and seeking a challenge. Desperately wanting to be put to the test so that I can have the opportunity to prove myself, to prove me to myself. As I sat there in that auditorium that challenge I have always desired was staring me in the face. It was a very surreal feeling.

In the eight weeks that have passed since that orientation day, I have encountered and met my challenge on nearly an hourly basis. It has been hard. I have sat in countless lectures and thought many times that I can't do this. Most days I have left class and questioned if I really have it in me. I've studies these past eight weeks as I have never studied before. I've found that no matter how hard I study there is still so much I don't even begin to comprehend. And as much as I study my test grades usually fall just below my goal. This has been incredibly disheartening at times. Studying so hard and yet feeling as though I still didn't do enough, that I didn't quite make it. The concepts are daunting and yet when I look back to the first weeks of lecture I feel as though I understand them and have integrated them into my knowledge base.

This week marked the middle of the semester. I left school last Friday and thought to myself, for the first time, maybe I can do this. Then I laughed at myself. Tara, I said, you are doing it.

The weeks and months to come continue to promise of the challenge I have so desperately desired. The opportunities, adventures, and events of the near future are daunting and yet so exciting. I'm living the dream I've dreamed a thousand times, but have always been to afraid to embrace. In the past fear of failure and fear of living has stopped me short, shot me in another direction, or humbled me to nonexistence. Today I am acknowledging, accepting, and embarking.

It is hard, horribly hard. I can't wait for August the 2nd - I think about it every day. But I know when August the 2nd does arrive a part of me will mourn the end of this unparalleled experience.