the next week-ana-haf

It's not going to be pretty folks. Not pretty at all.

First off, tis the season to begin calculating what I'll have to get on my finals to maintain or improve my current grade in each course. And then, because there's still time left in the "fart around" block on my calendar, I can calculate exactly how far the 5 credit hours of a B in Peds is going to sink my GPA and if there's a way to recover. Since there's approximately 42.5* hours total left in my schedule for studying, and my other exam grades this semester have been 98, 85, and 84, it seems unlikely that I will score the 99% that I need on the final to make the cursed 92=A**. sigh.

today is a bust - but I did get the presentation for Thursday's genomics class done, and have about another hour or two to spend on my clinical worksheet for tomorrow, and then I'm taking my movie back to Blockbuster and getting something dumb like Fred Claus.

Wednesday 11-28 - up at 5:20a, leave home by 5:55a with lunch and hard boiled egg breakfast, drive thru coffee kiosk by 6:13a, park and ride lot by 6:22a, hospital by 6:42a, conference room with oatmeal ready for report by 6:46a. Twelve hours of 14 yo with idiopathic scoliosis s/p spinal fusion due to 41 degree curvature, logrolling q 2hr, monitoring morphine PCA and IVF, possibly d/c a foley and hopefully think of something to keep him from being bored out of his skull. I wonder if he plays chess? Catch the bus by 19:08, park and ride by 19:22, home by 19:51, feed cats, shower, eat something that doesn't require me to wash the dishes, make tea, finish worksheet, email genomics ppt to prof, trade out the laundry, scoop cat shit and collapse in bed by 23:28.

Thursday 11-29 - alarm at 6:12a, snooze til 6:32, leave house at 6:55, park at elementary school and feel slightly guilty for not saying good morning to child by 7:15, coffee from library coffeeshop at 7:38, sneak into lecture hall past man who yells about food and drinks by 7:51, Peds from 0800 to 1100, Genomics from 1100 to 1200. Get food from bookstore, take bus to elementary school, work on missed assignment from week before last in Research in school multipurpose room til 1330. Collect reading buddy, read Bear About Town and A Color of His Own, return buddy, collect new buddy, repeat. Return to MP room at 1430, refocus on Research assignment and lament the lack of reading completed for this class all semester. At 17:45, present self at Music Room for assistance with the Herding of the Parade of Children for the Multicultural Gala, in which child will be singing "Hello to All the Children of the World!" and cheesing it up as usual. Stay as short a time as possible, corner ex-husband to review end of semeter schedule, demanding a commitment for child care during next Saturday's scheduled final exam in Research, and dash home. Repeat Wednesday's evening activities at home, without the genomics email and with the added joy of supervising ready-for-bed activities of child.

Friday 11-30 - alarm, snooze, park at elementary school all as per Thursday's schedule. Present self at the library at 07:25 to work a shift at the Book Fair, collecting quarters for pencils and imprinting credit cards slips in an old ca-chunka credit card thing. Bus to campus, coffee from bookstore, lecture hall by 08:58 at which point all the good spots will be taken and I'll have to climb over five rolling bookbags and six laptop cords. Psych lecture from 0900 to 1100, and ATI test from 1100 to 1200 to heighten my anxiety about finals and my Lack of Mastery of the Material. Lunch with friends that I haven't seen in two weeks because of conference and then the holiday. Research at 1300, for which I will realize that I haven't prepared at 12:47. Prof will read her ppt, break us into small groups and then release us an hour before class is scheduled to end. Buy a 20oz Coke, and go to library for 1hr 15min to print out everything I can think of to use up my printing allowance for the semester. Bus to elementary school. Collect child from after school program, who will not want to be collected, and who has likely forgotten one of the following items: lunchbox, jacket, Gator Communicator, water bottle. Go to Food Lion for veggie chick'n nuggets, juice, bread, milk. Home. Cats. Dinner. Bed for kid. Write agenda for committee mtgs tomorrow, and reports for my position for November, and goals for the year for meeting tomorrow. Wish there was wine in the house. Bed for me.

Saturday 12-1 - Plan to get up at 0700 and study for an hour, then at 0800 to go to farmer's market for eggs from the Happy Chicken guy. Sleep in, and wake kid up to go to whole foods with friends around 0945. Wake up friends. Go to Bank and deposit amazing Merry Christmas check from Generous Aunt which will make it possible to avoid working any shifts at the restaurant during finals week. Mentally thank Generous Aunt again. Sit around drinking coffee and eating overpriced underdone scrambled eggs for an hour. Leave child with friends, remember that I forgot my scrub top at home for group picture and go get it. Drive to nearby city for board of directors meeting of state nursing student association - struggle to find parking and arrive at bldg 12 minutes late. Meet until 2pm, avoid snapping at abrasive board members, and find a way to discuss grammatical errors without offending. Pick up kid, chat with friends, offer to take her child to park with us, go to park, knit while kids run. Drop off kid, offer to spend some of Generous Aunt's money on dinner for the four of us. Eat a lot of delicious breakfast food. Go home. Glare at the cats, their shit and the still-unwashed dishes. Also, on Saturday, I have 2hours worth of work to do on my clinical presentation due next Wednesday, which includes a 2page paper, 2 articles and a handout for my classmates on my interesting case study. Do this and then spend half an hour shopping for vibrators and dildos.

Sunday 12-2 - shit. I have no idea. schedule reads Peds from 09:00 to 12:00, county library with kid from 12:00 to 14:00, childrens museum from 14:00 to 16:00, grocery store from 16:00 to 17:00, dishes then dinner then dishes again from 17:00 to 19:00. There's a note that a chorus meeting is from 13:00 to 15:00 at the Friends Meeting House, but I don't know if I'm going. At some point, kids' father is sposed to pick him up for a roller derby match, but idk when. schedule also notes more Peds study time from 1900 to 2200, but that is unlikely. More likely that I will be on the computer until 0100, paying my bils with Generous Aunt's money and deciding on yarn for that afghan I'd like to start over break.

Monday - 12-3 get up at 06:18, leave house with kid (and whichever of the four essential items that made it home on Friday) and hardboiled Happy Chicken eggs and go cups of juice by 07:08 to be able to park at elementary school by 07:38, get kid inside before 07:40 bell. Buy the kid's stocking stuffers (with G.A.'s money of course) from the Book Fair. Collect reading buddy at 08:00, read for 20 min, collect another buddy, read, and then walk to bus stop for bus to campus. Coffee from coffeeshop, up to favorite nesting spot, plan to spend nine straight hours studying Peds and Psych. Fuck Genomics and Research. The finals are worth 40% in those classes? Oh. Spend an hour obsessing about grades in all four classes and filling in next semester's academic calendar. Spend another 30 minutes getting a latte, toasting a bagel and checking email. Wish that I still smoked and could take a smoke break. Force myself to go back to nest and sit down for another 3 hours. Take last bus to park and ride lot, forget that car is at the elementary school, take bus back to campus and then back to elementary school. Get home by 23:00. Glare at cats and their shit. Feed them, then go to bed.

Tuesday 12-4 - this morning is going to be hard. I don't have anything *scheduled* until 10:30 (which is my first dentist appt in SEVEN YEARS, and I'm a little Anxious About It) and it will be tempting to sleep in. I would like to get up at 0700, shower, make coffee and quick breakfast, then sit down to look at Peds for two hours before going to the dentists. After dentist, park and ride, campus, read Research in hospital lobby. At 15:00, go up to unit and get patient assignment for Wednesday, research chart for two hours for clinical worksheet. bus to park and ride, car to elementary school. home, cats, dinner, dishes, chess, kid = bed. clinical worksheet, set five alarms, self = bed. Remember to email clinical group my presentation and print multiple copies of handout and articles.

Wednesday 12-5 Okay, this morning will be harder than Tuesday's! The kid has to be at his father's workplace at 06:15 for me to have time to drive to parking deck and be ready for report at 06:48. I don't even want to think about when we have to get up. clinical until 19:00, parking deck, whole food buffet which had damn well better include some macaroni and cheese, home, cats, shower, type up clinical worksheet from a day's worth of scribbled notes. wait to email it until Thursday to allow for one more editing opportunity - I need every point I can get on these worksheets for that mythical 92! tea, email, check for an episode of house, fall asleep during it.

Thursday 12-6 I would like to get up at 07:00, be at the library at 07:45, get coffee and a study room, and spend all day on Peds, with short study breaks of Psych and Research thrown in. Maybe meet with study partners from last two semesters, but I'm feeling like it's a bad idea to study with them for the first time this semester the day before the final. I really hope that next semester will allow for some more regular study times when we're all on campus. This semester, it's been scattered all over for clinicals M T W, and in class from 8-4 Th and F. Rescheduled Reading Buddies to another time, maybe Monday morning. Eat a good dinner, take a bath, lay out my clothes, and set five alarms before I get my 8 hours of sleep.

Friday 12-7 Peds final exam 09:00 to 12:00 Get to campus early enough to get coffee and a bottle of water. Sharpen pencils. Layer clothing. Read each question three times, underline key phrases, circle any negatives, check each answer backwards - does the answer make perfect with the question? I will plan to be there until noon. I will not dash out of the room to be the first one done because I'm nervous. I will also spend 5 hours on Research Friday afternoon, and repeat the whole Twas the Night Before a Final routine Friday night.

Saturday - 12-8 Research final 09:00 to 12:00. I am too exhausted to even think about this.

Sunday - 12-9 Write Genomics paper on asking my family about their medical history over the holiday

Monday 12-10 Psych Final 09:00 to 12:00 Write Genomics paper on Case Study Project. Read all Genomics powerpoint slides

Tuesday 12-11 Genomics Final 09:00 to 12:00 Collapse into small quivering pile.

Wednesday 12-13 I've decided that this would be a good day to donate platelets. I don't know WHY I decided this. I've also scheduled myself to work a lunch shift on this day. I think I'll keep the platelet appt and release the shift - I deserve a day on the couch with a season of Scrubs, a big bag of Grandma Utz's potato chips, some sour cream dip and a two liter of coke. mmmm.



* Oops, make that 41.5. I just spent 30 minutes catching up on Google Reader and I'll spend at least 20 constructing ridiculously long sentences here.
**It's not even a real 7 point scale. 100-92 = 8. Dammit! It's annoying enough to make 92 the lowest A, but don't call it a 7 point scale if you do so!

more emo - who can get enough?!

Peds is still kicking my affective ass. After the shower-sobbing reaction to my shifts in the PICU and NICU, I then had a series of less intense but recurrent crying jags last week after my first 12 hour shift on the unit. I am SO good at dissociating that I can't even really tell you what triggered them - but it was akin to the med-surg crying, based loosely around the idea that during those 12 hours, I could have done something or not done something to hurt someone and would never ever know it.

Therapeutic interventions recently employed:

• massage. wow. I said to the nice LMBT, "I feel like I can't breathe a full deep breath, like there's a little ball of silly putty right *there* in my spine and if I could just bend the right way, it would crack open and I'd be able to breathe again. I've also been doing a lot of crying, and I don't want any of that sadness to get stuck in any crevices of fascia and fester". She said, "I can handle that." And she did. She did something under the edge of my rib cage that made me think of my ribs as completely detachable. And she did a controlled version of a sternal rub that warmed me up for hours. No surprise, I cried on the table. But not out of control, not like I wouldn't be able to stop crying - more like the way you might cry when someone you love tells you a very sad story and you hold their hand while they talk. It was good. I felt so guilty picking up my backpack after she'd just spent an hour integrating my upper body bilaterally.
  
• tea. I don't know why, but I seem to only think of tea when it's chilly outside. I can drink hot coffee through the summer - though with admittedly less enjoyment, I do have to shoulder through it. But it's been a journey through the Stash Herbal Tea Sampler Box lately. The colors of the little packages are almost as soothing to me as the tea itself. And I had enough honey and didn't feel like I had to skimp or be judicious.
  
• art. went walking around a historic neighborhood with an artist friend yesterday, looking at amazing pieces of art. It was a Winnie-the-Pooh sort of sky and blustery wind, I woke up in a good mood and so did the kid, it was good all over.
• a productive-feeling new notecard system for Psych and Peds exams upcoming this week. I'll sign off in about five minutes to do more of these. I'm really hopeful that they will help me turn around the Bs from the second exams back to the As from the first exams of the semester.
  
• journalling. Psych instructor, who I have a complete identity crush on (I love her hair, her shoes, her style of speaking, her humor) mentioned it the other day in class, and I have meaning to get started again. I stopped at some point around the time I left my husband, catastrophisizing about supeonas and whatnot. It was intensely helpful Saturday night when all of a sudden, I was going to turn myself inside out with feeling alone and sad and completely helpless to fix either of those things.
  
• write-ups. I know, it's counter-intuitive that school-work would help me feel less overwhelmed. But what's happened is that I'm less afraid to include this emotional response in my weekly reflections. I think that my experience in Psych a few weeks ago (jesus, it seems like a year ago) helped me get a point of comfort, that yes, I am usually able to judge what's appropriate to disclose, and what's inappropriate. And yes, when I say something, and someone looks uncomfortable, it doesn't necessarily mean that I shouldn't have said it - it may mean that they are simply uncomfortable. And no, I shouldn't avoid writing the story about how the nurse said that some parents should be sterilized to me in the break room because I'm scared of getting her in trouble. It's good information for my instructor to have that this is the kind of thing that I'm trying to integrate on a weekly basis. This is an accurate reflection of the level of emotional processing that I am personally doing. Sure, not everyone is having this reaction; who would expect them to? But I am, and that's okay, and I want the prof to know it.
  

The other thing that's been really helping me this week is reading and re-reading the Love Letter to Nursing Students at Head Nurse. I can see myself in some of the things that she is excited about, and I am vicariously proud. A Love Letter to Nurse Preceptors will be forthcoming posthaste.

Smitten Kitchen is feeding me lately with images of amazing food, and reminders that food is something that I love, not just something that means dirty dishes and rotten potatoes. (though rotten potatoes are hands down the most disgusting thing that can happen in a kitchen, I think. You reach in and it looks okay and then you pull it back and it's... not okay. not not not okay.) I've purchased pumpkin and french bread. I cooked a mini pumpkin for dessert last night for the love of pete! I'm considering stuffing some onions! Come on!

speaking of amazing images, these pictures at deputydog are broadening my horizons and making me sit up and drop my shoulders. love love love them. We already talked about the 7 amazing holes list that he has, right?! wow.

Things that are not getting written about this morning - the upcoming parent-principal meeting regarding the kid and his second grade class (still not going well), the fact that I hurt myself with my menstrual cup and feel really annoyed about it, my continual brokeness and the recent crisis proportions, the chance to do an hourlong interview with a grad student doing research on single moms who went to community college and then a four year school, and the upcoming trip for the ANS Mid-Year Convention.

later, tater.

grumble.

I've been working hard to drag myself out of a trip to the sucking thought-spiral of despair for the past couple weeks. I had been feeling sad and lonely, and sort of on the verge of tears - the kid wouldn't go to sleep, I was being a raving angry shrew anytime we were together, and then teared up when he told me he wanted to go spend the night with his dad. That's the first time he's said that, and though I knew it would happen at some point, I just figured that point would be in five years when I wouldn't let him go bungee jumping or something. All my free time had been taken up with writing essays about how super super great of a student and a human being I am so that nameless bureaucrats would award me some money, which other nameless bureaucrats in the Fin Aid office would then process in such a way that I couldn't get my hands on and pay my cell phone bill, which somehow was doubled this month because of usage charges since I was out of class for three weeks and everyday was a holiday!

And then my clinical instructor wrote "Very interesting! Let's discuss!" on the top of my write-up for Psych, and I cried on her when we had our midterm conference. I figured she meant interesting like "I'm speechless with how poorly you have completed this assignment! Let's talk about how you can get some points for this by re-doing it entirely! You actually have no empathy and should consider a new professional track immediately. " I cried, and stammered that it seemed like she was telling me that I didn't listen to my patient, and of course I listened to my patient, I had just written 500 words about how I want to be a nurse because my inherent capacity for empathy and attentive listening that I will provide my patients from traditionally underserved groups.
She suggested that I seek counseling, because as I had shared with the group, these patients and their PTSD and alcohol abuse issues were obviously close to some emotional issues I hadn't yet resolved with my own father. She didn't say anything that I hadn't said in post-conference to the whole group, honestly - she just linked all that I had said to the fact that "I was moved to tears by feedback on my first paper" and said that "my reaction suggested that I have a bit more anxiety about this rotation than I thought I did". She was calm and compassionate. My reaction to her suggestion that I seek counseling, when I had, in fact, sought counseling in the past, and was currently medicating my way through a bout of depression/anxiety, was to instantly feel like I am much crazier than I thought, and that I had embarrassed myself in revealing what it was like to grow up with a father who had PTSD.

In fact, it turns out she wrote that on everyone's paper, because it was the first time any of us had done an IPR (interpersonal recording - patient said, nurse said, was nurse therapeutic, how is patient's diagnosis exhibited?).

What I'm really proud of is how I handled it. Not initially, of course. For three days or so, I mucked around in a shallow pond of self-doubt and pity. I had imaginary conversations with her, and started arguments with my ex-husband about the cell phone bill and our custody arrangement. I told the story of our conversation to any friend that would listen, and filled in any boring places with sarcasm and dramatic analogies. I felt betrayed by this professor, who I had for a class my first semester and for whom I had much respect.

But then, I went for a long walk in the woods on the cross country trail near my house. I took my mp3 player and listened to the Non-Violent Communication files I have saved. I realized how far removed from reality and the present moment I had become lately. I sweated and swang my arms and stomped along the hills of the trail. I ate an entire huge slice of chocolate cake and checked out two discs of Scrubs to watch back to back. I made notecards for the house to remind me to say "I feel --------- because I -------." instead of "You made me really mad!" and "It's none of my business what anyone else thinks of me." and last but not least, "You can't MAKE anyone do anything. You can only make them regret it." And I decided that I had shared my experiences appropriately at the time, and that my embarrassment was about exposing my tears and emotions to my instructor. And that my sense of betrayal was based on an assumption that because I already had a level of comfort with her, that she wouldn't push me at all during this rotation, when I explained that there was some real potential to get sad while talking to veterans that reminded me a lot of my dead father.

I also remembered that each semester so far has had its own teary day. Remember when I burst into tears because of I couldn't inject saline into the hotdog! How much fun was that?! I realized that I thought that the Wellbutrin was going to protect me from emotional outbursts - and decided that I had experienced the emotional equivalent of breakthrough bleedings. I'm actually grateful to know that I can still have super sad experiences while taking the meds; it would be scary to think of never experiencing strong emotions again.

And that when one, who shall nameless, walks around looking for things to mock and deride, then she will get really really good at mocking and derision. And one who is really really good at mocking and derision will be tempted, nay, compelled to occasionally mock and deride herself.

And then I was not an asshole to the kid for one whole afternoon, and made oatmeal cookies with him, which he pronounced "surprisingly delicious".

All is well.

Duck Rice and Croup

the kid celebrated his birthday, not with a hippy ritual in the gazebo of the rose garden walking around the sun and talking about what he's learned in his seven years on earth and hearing good things from whomsoever had gathered, but hanging out in the bedroom with me, watching movies with the humidifier running non-stop. The good news is that we only had one episode of really scary barking coughing gagging dash to the bathroom and crank up the hot shower and sit on my lap while i sit on the toilet and try to tell him that it's going to be okay and he should just relax and not worry so much about how he can't breathe. After approximately seven minutes of that hell, his coughing had stopped, and his breathing has certainly eased, and I left him in the bathroom to get my best diagnostic tool. My fancy new red Littman? Nay. My fancy new black laptop. While the screen got all foggy, and I started to wonder how long we could all spend in the bathroom without meltdown, I confirmed my diagnosis of croup (remembered from an incidence during infancy) and called the advice nurse. Because, of course, I am not the advice nurse. I am simply in the very first semester of nursing school. We haven't covered auscultating for abnormal breath sounds yet in Health Assessment. Hell, i'm just as likely to use the bell as diaphragm on that thing, or put the (very uncomfortable) ear buds in pointing to the back of my head rather than my nose. The advice nurse was quite helpful, very calm and my new best friend. She told me that no, I don't nec. need to make a Saturday appt for the kid, and that since croup is viral, the most common medication would be steroids to open the airway if the steamy bathroom (or head in the freezer, which seems rather cruel and not very infectious-control-smart) doesn't work in 15 minutes (which seems like an eternity when your kid is looking at you like 'Aren't you in nursing school? Can't you fix this shit, mommy?').

Had a very interesting conversation with the mom of one of the kids I invited to his birthday party (note to me: never invite more people than you are willing to un-invite the day before the event.) everyone followed the script: I'm so sorry he's feeling bad, please tell him that we hope he feels better soon, when will the party be rescheduled? But one mom added that her son was out with a bad bad cough several days last week. I casually asked if it got worse at night and came with a fever, which it did, and did he sound like a seal, which he did. Well, there's that mystery solved then - and I managed to not be an asshole (I hope) when I said that I knew it must have been circulating in the classroom, but that we wouldn't have the party so that it didn't go any farther. The kid's got one grandparent undergoing chemo for breast cancer that's moved to bone marrow and one recovering from outpatient biopsy of the tongue. not a good equation.

So, this weekend was a great chance to practice my study skills at home with kid. I have studying in the quiet room of the library down pretty well, but can't seem to get over the hump to reading or doing note cards at home. I whine about how I don't have a table to sit at and spread out my books - in 500 sq. ft of living space, I literally don't have a table. I whine about how the kid and I seem to always be on top of each other, how my usual distracted-ness (which I have learned will take up about the first 20 minutes of any study session) gets exacerbated by the cats or requests to play Thomas the Train on my computer or urges to get up and make a cup of tea or watch just a few minutes of whatever the kid is watching (hey, I like Wallace and Gromit!), ad infinitum. It was a little ridiculous this weekend because I have two tests and three quizzes this week - and have not spent a lot of time keeping up with the reading in either class. the tests I thought that I aced last week with minimal studying came back with good solid B's. damn this seven point grading scale!

Also got to figure out what would happen if I couldn't make it to lab - email the TA and pray the skills can somehow be made up. The kid's dad ended up taking him this morning, and then bringing him to campus after lab so the kid could see my classrooms and the library and then ride the bus back to the park and ride lot. I told the kid that we usually go to the library after class and he asked if we had to walk single-file. it took me a second to figure out what the hell he was talking about!

I'm a little sad that I missed my psych appt and my med eval to get some Wellbutrin answers. I hope that I don't chicken out on rescheduling those.

Last week at work, the chef made fried rice for the end of shift family meal. This has been a bit of a challenge since I decided to stop eating even the small amounts of meat that I used to consume at the beginning of the year. Usually fried rice is made with strips of various meat - and I can feel relatively comfortable that I can scoop around the meat and still get free food. But last week, we apparently had a couple of ducks coming up for expiration soon, and so the chef made duck fried rice. I scooped out a small bowl and started my search and avoid mission in the corner of the kitchen. Sam walked by and said, how's family meal? I shrugged and said it was a little hard to avoid the shreds of duck, but the rice was good. He was all - You're eating family meal tonight?! But you're a vegetarian now! and then his face softened and he got all calm and objective and says 'wow. you must be really hungry to eat that duck rice.' Sheesh - the guilt! I ended up eating brown rice with potsticker sauce and fried wonton noodles. I hope there will be a point that I will have cycled through all the times that I was accustomed to eating meat and worked out acceptable substitutes. Last Tuesday at Golden Corral, I realized that the brown gravy beside the mashed potatoes was probably verboten now, along with all the soups, and that delicious broccoli salad with the raisins and the bacon bits. I'm good with the meat analogues, and the overall concepts of nutrition within a vegetarian dietary pattern. I'm still a little leery of being 'difficult' to hosts - but had good practice last weekend, when i had to speak up at a conference with free lunch that consisted of a big bowl of pork barbecue, buns, apples, and bags of chips.

In other news, got to practice administering meds via NG tube today and gave a plastic butt an enema this morning. nice.