laboring

i just left six hours of watching a first time mother labor. 2cm, 50% and -3 when I arrived. 3cm, 80%, -3 when I left, with membranes ruptured, epidural and foley cath in place. Foley so that when they 'went to the back' it would already be in place. fuck. just go on now, why not?

Pitocin running except when everyone in the nurses station decided those were late decels on the monitor and the nurse stopped the pit and then paged the doc who said start it up again, you can knock it down to 12 milliunits from 18. It wasn't until later that I understood that she had requested to be induced because she was in such misery, 2+ pitting edema, etc etc. and that that's why the pit was running in the first place.

what I don't know if she knows that, to them, to this doc, when she asked to be induced, she was asking for a section. I just don't know if she knows that. I didn't know that. but on my third week on the unit, it surely seems that way...

She was just lying there when I first got there. She was doing it. She was handling the contractions. She was resting between - I realized that I was still in my own stuff about not being able to rest in between, and perhaps more impressed by this than was warranted. But she was all still in the bed, only her face showing the contractions, and every once in a while, her feet would move around restlessly under the sheet.

I realized that I have a romantic, walk the halls idea of labor. The woman shuffles along, periodically stopping and grasping the railing or her support person's arm for 30 seconds and then off they go again. This doesn't happen in hospitals. Does it happen anywhere but in my head? Isn't the best place for a woman at 2cm who wants to keep labor moving to be in motion? In a world without continous monitoring, would I be out walking with this lady? Would we be laying down blankets for her knees and draping her across the birth balls that are all stacked up by the Pyxis mocking me.

On the bottom of last week's lecture notes, I scrawled: Why is the plan to tell the mother to wait as long as possible before coming into the hospital, instead of just NOT strapping her down to the bed on continuous monitoring as soon as she gets there, when we know that we'll end up putting in an IV and an epidural and a urinary cath and maybe narrowly avoiding a c-section? Doesn't this seem ironic when the community health prof defined empowerment as helping a patient or a community regain control of their life or environment? What was the process by which they lost control in the first place? Wouldn't that be a good place to begin with the empowerment interventions?

fuck this.

PICU + NICU + forgetting to pick the kid up from school = sobbing in shower

PICU kids were:
one month old boy with hypoplastic left heart, adorable smile, and hard swollen breasts (they were doing an MRI to find out if there was something on his pituitary?) Ventilator, central line in jugular vein, continuous infusion of fentanyl, methadone q6h. Mom and dad cannot come to visit often, and are a little checked out about this child. The nurse I was following (who I had really liked up to this point) described dad's tattoos and said "Some people should just be sterilized, you know."

five month old girl with metabolic disorder. ventilator, concern during the shift that her BP was rising, and that her end tidal volume of CO2 was getting too high. Continuous infusion of fentanyl. Attended a family meeting in which parents were informed that her problem was a mitochondrial defect, and that there was essentially no treatment available, and did they want to call and gather the family now or wait a day or two on the ventilator?

a boy with necrotic pneumonia in right lung, lots of staff in and out of his room all shift, trying to get a tube into his left lung to focus ventilation on that one. On an oscillating vent that was giving 400 breaths/minute.

a teenager who was paralyzed, wearing hand splints and Prafo boots, with a trach. She wanted to be moved up in bed, and so her nurse asked my nurse and me to help, and off we troop. Her nurse wanted our help to turn her, so that she could see her back and assess for skin breakdown. The nurse discovers stool in her brief and so we all help change her and clean her.
Then her nurse wants to change and clean the inner canula of her trach, and asks me to help. Sure, I say, desparately trying to remember the procedures from skills lab. That was the worst possible set-up for trach care I've ever experienced.
The bed was too low,
the patient didn't want us to take her pillow away, so her chin was down and resting on the vent tube,
the nurse didn't follow the inner to outer and throw away process that I'd been taught for cleaning around the stoma,
the patient is trying to communicate with me by eyeblinks and mouthing words,
there's clearish bloody stuff coming from around the stoma behind the trach, and
I can't get the velcro of the trach tie back in.

after the nurse puts the new inner canula in, the patient's sats start dropping after we get the vent tube back on. Like 98-to 87- to 74. She tells me to grab the bag behind me, and squeeze. Oh my god, I think. Squeeze. What am I doing, I think. Squeeze. Okay, back to 80, that's good. Squeeze. back to 94 and we put the vent tube back on, and she's looking at us again, and I'm not sure exactly what happened, but I feel like some sort of hero.

NICU: (nobody on pain meds here)
15 day old boy, 3180 gram born with sacral mengingocele, s/p repair. Two days ago, had a shunt placed from brain to belly to drain excess fluid. No IV access, foley cath from surgery that will be pulled later that day. He is the youngest of 6 kids, and has a 13yo brother who also has spina bifida. It was enough to make me want to take my folic acid right that second, even I never plan to get pregnant again. It wasn't until the end of the shift that I realized that his face really was all scrunched forward like that, it wasn't just because he was laying on his belly with his head turned to the right for the whole shift. Seven seconds into the shift, the nurse tells me to feel his head, and his fontanels. I'd call those full, but not bulging, she says. And here, these sutures, open wide is what I'd document for them. And when I say sutures, I mean the places where the bones of the skull should meet and knit together. I felt like I was touching his brain through his skin. He had never exhibited movement or tremors in lower extermities, no likelihood that he ever will. Mom is breastfeeding. Assisted nurse with cleaning and changing the stack of 4x4's under his butt that serve as diapers several times during the shift, positioning mom for feeding (which involves awareness of his foley tubing, ECG leads, incisions along his sacrum, incision on his head, no pressure on the shunt itself, no pressure on mom's c-section incision and 4x4s and pads under his anus to catch poop). He had a little plastic sheet (nurses called it a mud flap) stuck to his butt to prevent any feces from getting near incision site. I advocated for turning his head to the left, according to Neurosurgery's orders, because it seemed that his neck was starting to show some resistance and his opposite hand was cool and the pulse weak compared to the arm on the side he was facing.

33 week GA baby born 10 days ago, 1818 grams. She looked tiny, but so healthy. However, an echo had showed that she has no pulmonary artery, and the only way that blood is getting oxygenated is because the hole between her two atria hasn't closed yet. cardiology is deciding plan for surgical interventions. Currently on prostaglandin to keep ductus arteriosus patent. Some history of necrotizing enterocolitis. Pt has been NPO since last echo, and mom's questions are all focused on when she will be able to take a bottle again, without much insight into severity of cardiac condition. Observed bedside rounds while mom was present, holding baby, and realized how little of what was said would be comprehensible. Tried to translate after rounds were over. Even nurse greeted mom with news that she had only had 3 bradys overnight, so that was good. Mom indicated no understanding of what 'bradys' were, and I said to the nurse, Do you mean that her heart only dropped three times over night, and it was happening much more frequently? Nurse realized why I had asked when she looked at the relief on mom's face, and adjusted her language afterward. Come to think of it, though, her heart rate dropped to below 90 several times during our short shift and I don't remember seeing the nurse document. Fellow in rounds seemed to think that the apneic episodes and bradycardia were SE of the prostaglandin, and there was an order to cut the prostin in half by the time I left the unit.

Observed a PICC insertion performed on a 26 week premature infant. No pain meds on board, or any evidence of local anesthestic used. When needle was inserted, baby (who was completely covered by sterile towels except for her elbow) jerked and curled toward the arm. Nurse stated that she did have fentanyl PRN on her MAR, but that she's never had opioids before and you want to avoid them as long as possible because of her fragile state.

How do you care for a person that you don't think should be alive? How does it change your care to know that this person's lifespan will be only weeks long and contain no joy as you know it?
If you believe that some people shouldn't be alive, is it ethical for you to be a nurse?

So, yeah, sobbing while the kid did homework. I finally got in the shower so that I could feel like he couldn't hear me as loudly. He was all worried - I think he worries that I'm going to hurt myself and he's going to have to do something about it - and I just said that I had a really awful day, and that I needed to cry some of it out. I asked him if he would give me a hug in a minute when I caught my breath. I love that kid.

The situation with the dishes and the house is not funny and quirky anymore. It's not sexy-messy. It's rolled right into calling Oprah for an intervention. When the kid was a baby and after my dad died, my mom would come over on the weekends a couple times a month and we'd clean my house. I wish that she still did that. I wish that I didn't wish that at 33yo.

still thinking...

Minority Midwifery Student's got me thinking again.

Our Research prof was talking last week about how she had this radical discovery after her first focus group in the Latino church. She wants to know if cardiovascular interventions for Latino folks like education on risk factors and exercise and whatnot are more effective if they are sponsored by the church. The church members interviewed said - We are glad that you are here and wanted to ask us questions and listen to what we say. And so we really feel that we have to tell you that we don't have time to talk to you about cardiovascular health and diet and exercise. We have enough other things to worry about - like when to buy food, keeping the car running or enough money for bus fare, and making sure that someone can always be home with the baby."

I'm getting all these messages lately that I'm not listening to what I am hearing. from newFNP, MMS, and my own District Health Action Committee that does not in fact want to talk about health disparities in the schools of my district, but would rather continue to advocate for compostable lunchtrays. I love the idea of corn-plastic cups, and composting lunch, and organic food for all school children. Get that Fast Food Nation guy in here right now for a sound bite. But also, there's shit going down that I would like to be working on, and instead I'm real busy jacking around.

I've been writing scholarship and election essays about how I want to work community health after I get my MSN, and after I spend a couple of semesters taking more conversational and health-care focused Spanish. But the more I edit those essays and really pay attention to what I'm saying, I realize that they are not reflected in my current day-to-day. In fact, I could be practicing my Spanish at the store up the street instead of driving past it to go the big chain store. I could be listening to Spanish on my mp3 player on the bus.

I wonder if I'm putting off the idea of working at the clinic until I am an FNP because I'm really scared to do that. Part of it is that I haven't had Community Health yet, but since when do I wait for the nursing school to come bring me the shit that I want to learn? I've trotted out to the workshops at the Pharmacy school on Plan B and over the library to meet up with the gay folks.

I guess I have this idea that once I go into the clinic as a practitioner, that I'll only be able to stay so long before my motivation/energy will be used up. Seems like that was my experience as a patient or the parent of a patient at the clinic - after a few visits, when I knew that being treated like shit was the norm, not the exception, I would go in with these high hopes, trying to muscle through as much bureaucracy before my momentum wore off, like that slow motion football player throwing off tackles left and right, and finally leaping over the goal line by inches... She finally... gets... the prescription... and she's clear.

Workshops on incontinence are important, yes. Seminars on the IRB process for the survey/honors project I want to do on nurses' cultural competency w/r/t LGBTQI folks, good. But following up on the shit that I said I was doing is also critical. And it's bugging me that I say I'm doing it for the people who will give me money, but I'm not doing it yet.

maybe that's why I'm still awake at 2am?

Frank Red Blood

Isn't frank red blood sort of redundant? Isn't the joy of using lingo that you don't have to explain what you mean within the lingo?

As of yesterday, I have spent exactly 21 hours providing patient care. I'm still terrified, and I'm amazed at how much I've learned in those 21 hours.

• Keep stethoscope with me at all times, unless my patient of the day is on contact precautions, then leave steth in bag and use the one draped over the cuff in his room.
• I am a lot better at taking manual blood pressures than I thought I was. I am 6000 times better than I was in January.
  
• Do not bring the linen hamper into the room with me - outside the door is fine! A linen hamper, two adults, an iv pole, a wide door, and a hospital bed in a five foot square area = disaster. It was like the Three Stooges in there while I was attempting to assist a patient out of the room to do a lap around the unit.
  
• Put on the gloves before you go in. You'll never regret having them, but you may regret not having them.
• I interacted with a lot of genitals on my first couple of days. This is normal. I will get better not staring or feeling embarrassed on the patient's behalf. Genitals are normal.
  
• However, scrotums the size of my head are not. Talk to someone about possible interventions. This kind of edema may be common with a man who is largely immobile and had massive abdominal crushing injuries (although I blithely flipped past the picture and description in my Health Assessment book, thinking that I would never see it!), but it's not okay. Get a sling! Be gentle, even though it's heavy! It's also normal to have recurring dreams about lifting a five pound scrotum. Not pleasant, but perfectly normal.
• It was wise to go to Eckerds and buy a Timex with a second hand at 9pm before clinicals at 6am. Very wise. It would have been wiser to get one when they recommended it in January.
  
• It was not so wise to check out a movie after leaving Eckerds and stay up until 2430 watching it. five hours of sleep is not adequate - I would like a stress-reduction/sleep aid that doesn't take so long.
• Bring cliff bars for snacks - one can eat them and maintain a sense of sterility. Picking up macadamia nuts from a gladware container with the same fingers that (although gloved) just wiped poop off the floor and handled a JP drain of blood and pus is not cool. Soap can't make me feel clean.
• Stop running. Take a deep breath. Go pee, even. Say, I'm concerned about... when it's clear that I am concerned. Those words aren't going to freak anyone out more than my wildly darting eyes and heaving resp rate and flailing arms.
  
• hardboiled eggs are 51 cents in the cafeteria, which opens at 0630. Go get one each morning.
• Cleaning up poop from patient and bathroom and sheets without getting any on my white scrubs is an excellent way to boost my confidence!
  

And another list of reminders that is going on a cheat sheet in my pocket.

• I am, at this point, support staff to the patient's caregivers.
  
• I am providing care directly to the patient and I am responsible for doing that competently. However, I am not responsible for the overall, eventual success of the patient's recovery.
  
• I am not expected, nor required, to bring all of the knowledge I have amassed into every interaction with a patient. It will flow more easily once I have figured out where to put my body, what to do with my hands, and what kinds of things are appropriate to say in certain situations. I am in a BSN program, in the very beginnings of a BSN program, but not a BSN prepared RN.
  
• I am responsible for making a plan, implementing my plan, and evaluating the success of my plan. My plan is limited to the things that I know I can do, and that my clinical instructor has told me I can do, and that the staff nurse responsible for that patient is okay with me doing.
  
• I can't make anyone get better. I can't even make them want to. I can pay attention to what they do want.
  
• I can try to keep myself calm and centered, open and aware, and empathetic.
  
• I will have varying levels of success with any plan, even the plan to take deep breaths and go pee, depending on a thousand variables.
  

Everything went pear-shaped for me at the end of the shift today. I had a good morning, overall, remembering to eat my snack and drink some water, and cleaned up loose stools on patient and bathroom expertly in my opinion. The patient I had last Wednesday, the guy about whom I spent most of the weekend consulting and debriefing with various expert nurse friends, was transported to a nursing home closer to his home. The music therapists were there with mandolin in hand as he was wheeled away and the combination sent me to the staff bathroom to cry.

My patient today and yesterday (post-Whipple two weeks ago, went home a few days ago, came back Tuesday morning because of a spiked fever and abd pain) had a JP drain* placed yesterday afternoon in the area that his surgeon noted as the most likely abscess** point. The bulb was filling with serosanguinous fluid when I came in at 7am. The nurse told me that it needs to be kept less than full or there's no suction and therefore no drainage. I watched her empty it and flush it at 0830. Document 50mL from JP drain on the intake and output form. At 1015, I emptied it with another student in the room. I learned that I should make sure I have a flat surface nearby to put the cup that I was pouring the fluid into since I had to hand it to the other student or try to grow a third arm. Document 90mL from JP drain for I&O.

1145 - go into my guy's room to do vitals and a noon assessment. Realize that the bulb should be emptied. Empty it, alone, but competently. Note 85mL from JP for I&O charting. Continue with vitals and assessment - point your toes, what's your name, what day is it, shine a light in your eyes, listen to your chest and belly, make my dumb joke about how you still have heart and lungs, worry a bit when patient responds that he doesn't have a gall bladder anymore, recover quickly with a comment that gall bladders don't usually make much noise anyway. Nervous laughter. Fine.
1155 - I'm done with vitals and assessment. I dumped the cup with drainage from JP drain, rinsed out cup with showerhead thing on the toilet and congratulated myself on not splashing myself. I was standing outside room charting and the wife says he's having some pain and wants to get out of bed but the bed's too high. Oh shit, I think, how many times did we say and hear that you always leave the client's bed low and locked, side rails up x2, call bell in reach?! I come in, lower the bed, and place myself in a wide stance at bedside ready to assist him to the bathroom. We've done this a couple of times already, I feel okay. My guy is pretty mobile, but I like to know that I'm there because of the fear that I'll think he's fine to ambulate around the room, and he yanks out a line, or gets lightheaded and falls.
I look down, and that JP bulb that was empty 10 minutes ago is full of frank red blood. I start mentally gasping and phrases like "bleeding out" and "surgical placement sutures dislodged" start spinning in my head. I ask the wife to call the staff nurse I'm working under, because I don't want to leave the bedside to go get her***. I get patient to toilet, because he was having lower abd pain and thought it might be gas and wanted to sit and try to pass it. He reports no lightheadedness but some nausea. I explain to the staff nurse about the bulb filling in 10 minutes and the change in color and the pain and she is nonchalant. She says she'll look when he comes out of bathroom. I don't know if I should wait outside of bathroom or what. I am trying to be clear in my description, without showing that I'm freaked out. I realized later that what I was doing was trying to scare the staff nurse into doing something, but not scare the patient or his wife. She responds as if she didn't really understand that the type of drainage has changed to bright red blood, and the rate of filling has increased from 80mL in two hours to 100 mL in 10 minutes.

1200-It seems like I should be pushing the Code button, like I could say the right combination of words and she would just leap into action. This is not true. She moseys away, and I go find clinical instructor to explain situation. Clinical instructor agrees with me that it's important, and has me stand with staff nurse while she calls and tries to get a physician to come look at patient. I can tell within10 seconds that whoever the nurse is talking to is not coming, she's weaseling around, trying to sneak up on the problem. I did this even when talking to her, but I thought it was because the patient and wife could hear me. Where does this sliding around language come from?

1210 - resident told staff nurse that he was in clinic, and to call the PA. PA is also not available. Staff nurse gets charge nurse to come look. By this time, bulb is filling again, with a big gelatinous clot taking up much of the bulb. Staff nurse shows charge nurse, patient looks green to see all this blood, and discussion of clots. Charge nurse says, yes call the house officer. I get a chance to offer my line that I emptied the bulb at 1145 and it was full of this type of drainage at 1155. I wonder what a House Officer is.

1215 - Apparently, house officer means someone who struts, makes zero eye contact and doesn't speak to nurses. I'm standing the room, having delivered ice water, when he marches in and starts talking. He picks up the bulb, and starts talking immediately about "old blood" and "pancreatic juices" before he's even really looked at the the thing. I start to say, "But I emptied this bulb at 1145 and it was full ten minutes later". and then i start to really worry - what if I'm responsible for this problem because of how I emptied the drain? I also get all stage-fight-y and worry that he's going to spin on me, and not listen, or be snotty because I'm speaking to him. Shit! Didn't I swear that I wouldn't buy into this idea that even as students, we are not to be cowed by the idea of speaking to physicians?! I left the room, but stood in the hallway and looked terrified. The charge nurse made eye contact with me, and said, get back in there, you can totally be there! I stood in the door and started to speak and then froze again. The patient and his wife were clearly confused and I didn't want my questions to make things worse for them. Also, the staff nurse for this patient was in the nurses' station, seemingly unconcerned by the consult with the House Officer, and I thought that meant that I should be unconcerned as well.
He spoke in phrases that seemed to have no linkage - like a two year old talks in telegraphic speech and you have to fill in all the grammatical cement. He said something about leakage from the pancreas because of the whipple, and that the fact that my guy had had radiation and chemo before the whipple made this more likely, and that the "old blood" was from the surgery (but did he mean the whipple, because that was two-three weeks ago, and is it still supposed to be bleeding like this?) He said that he's going to give a drug to stop the activity of the pancreas (which my clinical instructor referred to as "challenging the pancreas" when I talked to her later. He wrapped up with something about "we'll get this emptied out, you know the whole bulb just comes off and we'll get it the clot out of there" and patted him on the knee and was gone.
As if we hadn't just tried to empty it. As if this was just the accumulation since 8am, not since ten minutes ago. As if there was no indication that anything was wrong - when what I was concerned about was an emergent situation, like in the last twenty minutes, not since breakfast.
House Officer never communicated directly with Staff Nurse. WHY? Why didn't he ask her to clarify what was concerning to her if he was soooo obviously unconcerned? Was I concerned only because this is the first JP that I've seen/cared for? Is it normal for them to suddenly begin filling in 10 minutes, when they've been filling in two hours since they were implanted 12 hours ago?

Then, it's time for us to leave the unit for our conference and math test on medication dosage and IV drip rates. I check in with nurse and patient to say goodbye, feeling like not everything that could be done has been done, but completely unprepared to do anything more myself. The nurse is more annoyed that I didn't get the man a bath this morning, though I did get the sheets changed.
I explain situation once again to Clinical Instructor, in a final attempt to get some closure. CI says that I did a good thing in immediately noticing, and that as long as I told the staff nurse everything I did and noticed, I'm good, and since I witnessed her take action on the situation, I'm clear. "But!" ,I want to whine, "it's not Fixed! I don't know what they're going to do! The guy in the blue scrubs was talking about how it's not serious because his heart rate and blood pressure aren't dropping, and I didn't check his pulse after it started filling like that. What if it's something serious, and they don't catch it? What if something bad happens after I leave? "

What if something bad happens after I leave? This is the thought that I leave with. Is this the thought I will leave with at the end of every shift? Does my clinical instructor have this same fear? I won't be back tomorrow. I want to know - want to call up to the unit later tonight. It's not my place. I've taken on too much of a sense of control or responsibility, I guess. But where's the line, then? What is the point that I'm NOT responsible for anymore. The thing that I can think of that I could have done better or differently is speak directly to the guy in the blue scrubs, explain in as few words as possible what I observed and why it concerned me. I have been composing those few words over and over and over again in my head. I wanted to be able to say it right so that he would do something - wanted to keep re-phrasing it so that he would leap into action. It's a horrible feeling to feel like leaping up to do something, but not having the authority or the experience or the knowledge to know what to do.

I thought I would be so exhausted that I'd fall right asleep but I ended up having to put myself to sleep last night with my art history textbook, desperate for images and words to replace today's.

*I just learned that I've been misspelling abcess all day in charting!
**A Jackson-Pratt drain looks like a little plastic turkey baster, attached to a clear tube that has been surgically placed within the body. There's a little port on the bulb like the thing that you use to blow up an inflatable pool toy and this is how you get the fluid that's drained into the bulb out. Open the port, let the fluid drip into a cup or whatever, squeeze the last bit out if you need to, maintain squoze-ness of the bulb, and close the port. The vacuum continues to suck the exudate out of wherever the other end of the tube is.
***Note to me, hit the call button and ask the unit coordinator to get my clinical instructor sent to me as well. As she says, "We'll all go to jail together since you're working under MY license."

What are you going to be when you grow up? Jesus said, God.

The kid and I have been having this lovely conversation about God the past few days. It started as a bit of a stand-off about diety gender, when he said He and I said She, and he said god's not a girl, and I said, God is both and neither. There's nothing you can think of, or see, or feel that's not god. The kid chewed on that and agreed and that's where we've been for days, pulling out the most random things we can and testing if we believe they're god - they always are. :-)

So, last night, he says, I can't go to sleep because what if the world ends tomorrow?

hmm. That's a show-stopper, dude. I take a deep breath. I begin, "Well, I can see how that would be really worrying to think about. but there's times, baby, when you can think of a thing (and even think it over and over) that doesn't make you happy or healthy or doesn't help you at all. there's times when you need to let go of the thought, put in a box or a balloon or whatever, and let it drift off. Thinking something over and over doesn't mean that you have to pay attention to it over and over; sometimes it means you have let go of it over and over."

He said, I can't put in a box or a balloon. I just can't. It's too scary to ignore. (and also, he wants to keep talking and keep not sleeping!)

hmmm. more deep breaths. (I'm mentally working through The Work at this point and wondering how to frame it up without a lecture.)

Kid, do you think that that thought is god?

Yes.

I do too baby.

silence.

sleep.

'night, baby.

hmmph.

so. still awake. now, instead of blaming the quart of coffee I had today, I'm staying up to keep an ear out on the kid. (he is breathing much more regularly and quietly now. regular is good but quiet is not, since it makes it harder to know if it's regular, for fuck's sake.)

the mania i was whining about a week or so ago - thinking I was signing up for too many things, setting myself up to fail, stretching myself thin, the cliches are endless and all boring - well, it looks different to me now. Calling it mania seemed histrionic, even at the time.

there was a whiff of inauthenticity about it. even in my own head. i'm not really scared that i'm going to sign up for too many things and not be able to do them. that's possible. fine. that's even happened before. cool. i'm scared that I will say out loud in a crowd of some sort - I can do this thing! and screrch the music stops and everyone looks and waits for me to do the thing. well.

this is true of any role I have ever taken on or currently hold. mother, student, queer person, writer, smart person, sarcastic bitch, teenager, spiritual woman, aware to the immensity of the horror and the beauty of the world. i sense that there's a right way to do that, to be that, and the fear and the judgment starts immediately that i'm not doing it well.

and the moment that the music stops is the moment that i lose the connection with the present moment. you know, like literally, i'm bopping along to the music, really feeling it, and rip - gone. bereft. The Void.

So, I think that I was calling the lack of presence, the lack of attention, being in the costume but not in the moment, going along acting like my heart isn't broken open, trying to say that I can't do but so much, trying to call out of work in advance of even being scheduled the shift - calling that mania. because it feels all fast and scary, like i've done a thing that is too much, said a thing that can't be unsaid, actually articulated a desire or some shit like that.

and my last web-based expedition this evening led me to inga's site. and this excerpt from her book, which really synthesizes a lot of what i've been reading, thinking, hearing , singing and seeing lately:

An acquaintance and I were talking about this just the other day. He was telling me that he hunkers down into his daily life scheme of things because he cannot deal with all the horror in this world. I told him that I cannot live like that. He thought I was full of shit. “You can’t take in all that stuff,” he insisted. “It will drive you insane.”

But I disagreed. I hear this sentiment often, in a variety of forms.

Your average pissed-off citizen in the U.S. is willing to fight for three or four “causes,” maybe, but the line’s gotta be drawn somewhere.

When you’re present in the world you don’t just see one or the other. The horror and beauty go hand in hand. Even as this environment breaks your heart, the world fuels, protects, instructs, inspires, guides, and gently humors you.

So things balance out.

The whole excerpt is worth the read. seriously. This is deeper, bigger and wider to me than 'we're all desensitized to the horror and destruction around us and it's perfectly normal to feel hopeless' idea that i have held for many years. I have thought many times that the reason I was all of a sudden feeling so overwhelmed, tired, full of despair, was that I was taking on too much that wasn't mine. that i would go insane if I tried. that it was good self-care not to take stuff in. (and i do believe deep in my heart that is good self-care not to take in the medical emergencies on Discovery Health and the random tragedies that the folks at work want to wring their hands about for entertainment. that's self-serving melodrama.)

this is a way to re-think the idea that i can't work on all the causes I want to because i'm so busy paying the bills or going to class or raising the kid. that feels like a cop-out and it is. If I'm truly present in paying the bills, going to class and raising the kid, I may not be able to show up at a committee meeting for some non-profit. But being fully present (in the world, not the environment, is the HUGE distinction that inga is making here) IS working on the causes/issues that are important to me.
it's true that I'm interested in more things than I'm passionate about, and sometimes i latch onto the interest, and subsequent lack of follow-thru, as a nice-n-sneaky way to say i'm not good enough. Add it to the list of things I haven't done adequately or haven't done at all. oh, me. i can take in that star that was twinkling directly at me last night. the world, not the environment.

i swear, next week, i won't have a single deep thought. i'll watch wallace and grommit all weekend and expunge all of the cathartic self-examination* from my communication, web-based or verbal. no no. i can't mean that. i can't start talking about how this is all because of my impending period, or whathaveyou. it IS true for me that I'm full of this stuff lately, and it IS true that that's embarrassing to say out loud, and it IS true that I'm honored when others are willing to say shit like this. perhaps it should be a little more internal dialog and a little less internet rambling in the wee hours of the morning. shrug. if this was livejournal, i'd throw it behind the cut so noone had to scroll thru it. and this is all very rough draft, stream of consciousness. (what isn't at 2am?)

it's important to talk about love and imagination and what it feels like when your heart breaks open. look away if you're embarrassed by it; that's what I always did when my mom embarrassed me.



* from rob brezny's free will astrology

Leo Horoscope for week of February 22, 2007

You're strong medicine these days, Leo. You're 100-proof mojo. You might want to consider pinning a warning label to your shirt or jacket. It could say something like "Caution: Contents are hot, slippery, and under pressure. Use at your own risk." It's not that you're evil or neurotic. It's just that as you revisit and revision your deepest psychosexual questions, you have so much cathartic potency that you're likely to transform everything you touch into a more authentic version of itself. People with weak egos will be afraid of that, while those with strong constitutions will love it.

When Things Settle Down

Dear Mom,
Remember how hard I cried the first week after I went away to college fifteen years ago? Remember how I said that I never would have come if I had known how hard it was going to be? Shouldn't fifteen years which encompassed an entire life span of a marriage, the birth of a child, the death of a father, and countless years of accumulated successes and failures have mitigated some of that emotion?

I've survived the first week of nursing school at BigSounthernSchool. After attending lecture last week, I made the following to-do list:
Be a Good Person.

According to my professors and textbooks, nurses are caring, attentive, selfless, open to new ideas, creative, calm and professional. They are reseveroirs of knowledge, advocates and teachers. They use good communication skills, show flawless emotional control and time management skills and are devoted to the health of their patients above all else. I begin to wonder how I will acheive this in only two years.

The first two days felt like one big blur of faking-it-til-I'm-making-it. With no clue, a thousand wishes and a million fears, we all dashed around to find classrooms (or not), see people that we recognize (or not) and collectively we waited for Things to Settle Down. Hopefully, I won't be too far behind in the reading when this finally happens.
For weeks before the semester started, I've been busy at home, shopping for books and looking at campus maps and bus schedules. Apparently, that was all for comfort only, because I never actually bought the books (everyone's already read the first chapters of everything), am lost immediately upon stepping onto campus and take the wrong bus for three days in a row (oddly enough, three different wrong buses). I was also busy constructing a thousand assumptions. No wonder I'm lost. How can I come to this open? How can I dive through the fear and get to the thing that needs doing? I sit in the library and wonder what needs doing. With each breath, I know. With each breath, I can open and dive. But this moment's breath seems caught somewhere small.

I'm lost. There's something in the feeling itself that can allow me to string together the times I have felt small and sad in a long heavy chain. But the the beads of all the days that I have grown larger and brighter scatter and roll under furniture. The joy is finding those beads in a dresser drawer somewhere. with love, kati

P.S - Things are Settling Down a bit. The doc from Counseling and Wellness who addressed us at Orientation had a slide that showed a much higher rate of grad students than undergrads come to the office for counseling. She said that grad students see the value of free psych services when they see it. I'm not a grad student, but I'm old enough and poor enough to perk up when I hear the words "free service". I've got an appt next week - let's see how good your free services are, nice lady.