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.

randomly surfing at etsy.com

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?

why, White People, why?

My people are busy sucking again.

Listened to report the other day about how a patient was noncompliant with the Kwell shampoo. I perked up because this is the new admission that I saw coming in, a 30-something AfAm male with 5" dreads. What is Kwell shampoo, I wonder? And why are they trying to wash his head? And why are they confused that he would be noncompliant with this plan? The report on this patient ends with the fact that "pt did allow us to apply the Kwell lotion and understood that we would need to leave it on for 8 hours. He stated that he was offended by our original request and that he had psoriasis. After our conversation, he seemed less agitated and was less loud."

okay. let's get the bullets out:

• I don't know a thing about the situation, because my instructor wouldn't allow me to talk to the staff nurses about it.
  
• kwell shampoo is apparently used for lice, according to my clinical instructor.
• did the patient in fact have lice?
  
• does the staff have a clue that rules for washing and caring for white hair are totally different from the rules for black hair, and dreads have their own policies and procedures as well? Did anyone do a quick google search on whether kwell shampoo was the appropriate treatment for a patient with dreadlocks and lice?
  
• Yes, lice IS in fact a concern in this unit, as it would spread like wildfire and be very difficult to eradicate.
• However, did the patient in fact have flaky skin on his scalp that got mistaken for lice by the intake nurse?
  
• And, was this nurse the same one who left the report, because I've watched her and she has demonstrated a marked lack of social adeptness in a variety of situations. Including, but not limited to, responding to a patient's statement during community meeting that he doesn't know where his stuff is and didn't receive an itemized receipt for his belongings when he was admitted by saying that "you shouldn't bring things of value with you. I mean, when I go to the doctor, I don't bring all my cash and my jewelry and whatever with me!" Um. Hi. I have a comment. This patient was involuntarily committed and brought here in cuffs. What the fuck did you expect him to do?

so.

minority midwifery student has been writing of this bullshit this week.

and I'd like to add my offer of help to all my people. White folks, let me know if you need some help on this from one of your own. I'll be running a little workshop on Saturday in the park, come on by and we'll have graham crackers and talk it through.

Tagged!? Me?

I was soooo about to do my nursing note for the day's shift, practicing my SBAR format and then start to type some of my IPR (Interpersonal Process Recording - a word for word account of what he said/I said with notes about what I think he meant and whether I think I did a good job of responding/redirecting). I also planned on getting physically ill thinking about what in god's name I will talk about with my patient tomorrow and wondering how in god's greenest I managed to select the one man on the unit who looks 85% like my dead father. Well, other than the right BKA and left AKA. And the tweety bird tattooed on the side of his head and the CBR and the flaming eight ball on his hand.
But no.

*RULES - Post rules before giving the facts - Players start with eight random facts/habits about themselves - People who are tagged need to write their own blog about their eight things and post these rules - At the end of the your blog you need to tag six people and list their names - Leave them a comment on their blog, telling them they have been tagged and not to forget to read your blog.*


1. I feel weird saying I'm queer since I've never had a girlfriend. a sketchy sexual history, but never a sustained relationship. And I don't see that happening in the next 18 months either.

2. speaking of 18 months, I haven't had sex with another person in at least that long. Apparently, when I decided to stop sleeping with men for a while, I sent some sort of "No, thanks" to the universe.

3. I really enjoy picking the dead skin off my feet. I have become brave enough to get one of those horrid shaver-things recently, but I'm terrified to use it with the force needed, scared that it will slip and I'll slice off the end of my toe.

4. Speaking of toes, I can't feel the tips of my great toes. It happened about six months after I started waiting tables (HOLY BIRTHDAYS BATMAN, that was 12 years ago!), and I was still covered by my mom's insurance. The doc squeezed my toes and shrugged. They look sort of long-bath-prune-y all the time.

5. I haven't been to the dentist in 7 years. I overheard a woman that I was waiting on say, "Well, everyone goes to the dentist twice a year, I just don't understand how something like that could happen!" And until I left my husband, I know that I never considered the possibility that I might not be able to get my teeth cleaned q 6 months.

6. Secretly, I love the abbreviations of medical terminology. It makes me feel proud to be able to remember what the NOS in a psych diagnosis stands for. (not otherwise specified, when something's not *quite* in the diagnostic criteria)

7. I'm a know-it-all. Always have been. I can remember being aware of this in kindergarten and chasing around the girls that had told me they didn't like me, asking them if "it was me, or my big mouth" that they didn't like. cringe.

8. I have given myself a series of mouth ulcers this summer from eating tomatoes from my mom's garden, and I'm getting ready to go make another tomato sandwich!

I love newFNP

She refers to herself in the third person in a very not-annoying way. She is not afraid of the well-placed f-bomb. She provides excellent insight into the aspects of practice that my lecture professors are not even hinting at.

Go read. Really.

She reminded me of the importance of diction when talking with patients -

It took me the entire med-surg rotation to recognize that the reason that I was getting frustrated when trying to assess my patient's pain was related to my own diction...

On a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain you can imagine, where would you say your pain is right now?

My belly.

Oh. I see. Yes, ma'am, I see here that you have multiple abscess caths and even a PBD* or two, so I imagine that your pain is centered in your belly. What with the bile duct cancer and all. But how bad is it? Because, as the staff nurse who sent me in here to ask you so kindly pointed out, you won't be getting a single speck of your potential 15 mg of PRN oxycodone until you give me a number.


*It took me forever to find out that PBD stands for Percutaneous Biliary Drain, and then an equally long time to realize that I would actually be draining plastic bags of bile hanging off of this woman 3x/day. Doesn't bile digest its way through plastic? Shouldn't these things be glass or silicon or something?

It's a Big Big World

I was up till 4am reading at Obama's site, watching his YouTubes and typing a letter to him (which was embarrassingly autobiographical, and will need heavy editing before anyone but me and my cats see it). I finally got my copy of The Audacity of Hope from a long hold list at the library, and the library clerk told me that Obama is on her friends list on MySpace. How bizarre. It reminds me a bit of Clinton's sax playing on Saturday Night Live.

More than the intricacies of the internet, I'm a little shocked that politicians have time to write books. As I skim Audacity, I'm feeling grateful that this politician has written a book. It seems like a remedy for the sound bite. The idea of a sound bite offends me in part because I worry that someone (ie the politician) will think that I choose to get my information about a topic in that manner. I'd like the book, instead of the movie trailer. (Unless the trailer is for a two-hour documentary by Al Gore in which he sums up his life work thus far with heart-rending animation of floundering polar bears, in which case the movie will be an acceptable substitute, and the trailer a good teaser.)
An excerpt from The Audacity of Hope that caught me where I stood yesterday:

I understand the frustration of these activists. The ability of Republicans to repeatedly win on the basis of polarizing campaigns is indeed impressive. I recognize the dangers of subtlety and nuance in the face of the conservative movement's passionate intensity. And in my mind, at least, there are a host of Bush Administration policies that justify righteous indignation.
Ultimately, though, I believe any attempt by Democrats to pursue a more sharply partisan and ideological strategy misapprehends the moment we're in. I am convinced that whenever we exaggerate or demonize, oversimplify or overstate our case, we lose. Whenever we dumb down the political debate, we lose. For it's precisely the pursuit of ideological purity, the rigid orthodoxy and the sheer predictability of our current political debate, that keeps us from finding new ways to meet the challenges we face as a country. It's what keeps us locked in "either/or" thinking; the notion that we can have only big government or no government, the assumption that we must either tolerate forty-six million without health insurance or embrace "socialized medicine."
It is such doctrinaire thinking and stark partisanship that have turned Americans off of politics. This is not a problem for the right; a polarized electorate - or one that easily dismisses both parties because of the nasty dishonest tone of the debate - works perfectly well for those who seek to chip away at the very idea of government. After all, a cynical electorate is a self-centered electorate.

Typing this out made me read much more carefully! I hadn't seen how skillfully he enumerates the tactics of the Republican party, while ostensibly discussing the habits that thoughtful citizens should avoid. And on my first and second reading of this passage, I kept thinking of that study about how narcissistic college students these days are.
But on this reading, I'm struck by how he has captured the feeling that I have when I hear Cheney say things like "The American people won't tolerate a policy of retreat." Actually, that's exactly what I'd like to request, sir, and furthermore, it makes me feel hopeless, excluded, and insulted to hear my exact sentiments negated. Yes, I feel Cheney is still dangerous. He's certainly dangerous in a foreign policy sort of way, but he's also psychologically dangerous to Americans, when he reinforces ideas that are not held by the majority, with that nasty sneering tone that dares anyone to countermand him. It's bullying, and it makes me feel useless.

I've used up my blog time getting all these links (why can't research papers be written with links instead of those pesky citations!), and I haven't got time to wax poetic about political crushes. I need to think that one through anyway before I post it - it may be a bit heterocentric.

And I need to remember to add Suzette Haden Elgin's LJ to my links, as she is certainly one of my Favorites. Check out the entry on March 4th. Good stuff. She makes me want to make new words.

three things I love about the internets this week

One - Cut a hole in the box. (Come on, you know this isn't work safe!)

Two - Put your junk in that box. (Gay Love Rocks My Sea Goat Testes)

Three - Make her open the box. (found at Bitch, Ph.D.)

Seriously, this computer (and more importantly, the wireless connection I seem to be able to find everywhere) have been blowing my mind lately. I racked up a huge bill on my DSL account - didn't pay the bill for months to teach those bastards at Verizon a lesson - and when I finally did pay the balance to get my interweb turned back on, they said thanks for the $286 but now you'll need a credit card to reinstate your account. I don't, of course, have a credit card. So, for about a year now, I've been on dial-up. Dial-up means no big downloads (so no Youtube), and a lot of instability connection-wise (so I avoid getting on the computer when I didn't have a lot of time to devote to babysitting whatever I was trying to do). It also meant, for me, no pdf documents, because every time I'd try to open one, Adobe would jump in and try to do a lot of fancy updates, and my poor computer would freeze right the fuck up. So. It's been a whole new world for this big girl lately. blogs, youtube, time wasting games, in the recliner, in the bed, in the library! Whee!

I've been feeling a little manic lately. It's a shift from feeling like I can't do anything, I have no time and less energy. And I like coming from a place of "sure, that sounds great. let me see if i can work it in!" rather than being so eeyore about the world. But I'm scared of a crash, honestly. I'm also wondering if I'm trying to tie together too many things that are interesting to me, but not nec. related. I'm trying to yoke social justice stuff (with that US Social Forum event this summer and with a drive to finally get involved in war stuff) with health education/parity/accessibility stuff. I'm looking at my ANS chapter and the state board of ANS for opportunities to get good shit on my resume and applications, wanting to stay active in my kid's school (so bring ANS functions to that population), but also remembering that for the most part the kid's school has a lot of well-meaning rich white folks to help out already, and so looking at the city I live in and how to work there (but avoid being a well-meaning white girl trying soothe my own guilt about sending my kid to the neighboring richer, whiter, "better" school district). I'm also looking ahead to my senior year and potential Honors projects, wanting to lay the groundwork and do something I'm actually passionate about, instead of just enough to get the yellow cords at graduation. Ay. And did i tell y'all about finding about the group that trains health care providers (they have contracts for local SONs, PA schools and MD schools) to provide pelvic and breast exams!?! It sounds like the perfect action opportunity for any woman who has seen the Vagina Monologues and hooted and cheered about the cold ducklips. Wow!

had fun in skills lab this morning - we slung each other around in the lifts. It was such a weird experience to be dangling in a fabric sling from a big purple machine.

test today in LifeSpan Development, which I'm assuming will be pretty much a gimme - helping my mom through a master's in psych in eighth grade and listening to her teach as an adjunct for the years since are a major advantage.

test tomorrow in Patho, which I feel less confident about, but I've done a great job of acting nonchalant about it for the bulk of the weekend. taking a nap, dragging letters around and watching The Facts of Life, Season One.

In other news, I have a $50 gift card to target and I have no idea what I'll spend it on! Jeans? Tennis shoes? A rolling bookbag? Hell, I've spent down my fin aid nest egg for this semester to the point that I may need it for groceries!