Taking the scenic drive

Lost memory

2012-01-26T22:30:00.000-06:00

I don't remember the last part of August, some memories of September exist and October was spent mostly wondering what I'm doing to do with my life. The rest of my life. Weird why it all of a sudden started to matter. November and most of December I spent down in the south with my mom. And upon my return back to the Midwest I finally felt better. My husband, having slept for 1.5 months straight was nice all of a sudden, but became his old self after 2 weeks, when my daughter would wake him up at night. So sleep training it was. The most excruciating 2 nights of screaming and then miraculously on the 3rd night, she slept through 1 am feeding. At 4 months of age, she did good.

This past Sunday we celebrated her 5 month birthday in a new outfit and pretty pink UGG booties. Making memories one day at a time.

The hardest part for me has been having to quit my job. I loved working in the PICU but my husband didn't want to baby sit at night. Day shift was not a possibility due to extremely low numbers at night so my manager despite her best efforts to stretch my maternity leave, offer me less hours, schedule me on weekends instead of week days, couldn't offer me anything more than a nice goodbye email, wishing me all the best. I still haven't turned in my badge and it's been a month. They usually ask for it, but it still sits on my dashboard, as if I'm still employed. I smile when I look at it, brings me happy memories.

Despite all that, I love spending time with my daughter. I try not to think of what is happening, but instead channel all of my energy toward doing the best for her. From birth, I have been trying to stimulate her intelligence with toys, talking, reading and playing. I iron her clothes, exclusively breastfeed her, now make home-made 100% organic food, and make sure she is warm, gets enough fresh air and has the best diapers and diaper creams. I give her all the love I have as there's no one else in the world I love more. I don't think about tomorrow, only today. One day she will grow up, not need me any more and then I will think about what I'll do next. Work can wait, work is always the same; this current life is different every day, as she will only be 5 months once.

2012-01-20T23:53:00.000-06:00

Every time I sit down to write something thinking I have this *great* idea, words just leave me. So I sit there with a blank page with the cursor staring at me. This blog used to be a source of relief, a chronological pathway of work, life and some family news. Now there seems to be a growing gap in posts, life events and I'm not sure of where to start.

Should this blog now be a stay-at-home-mommy chronicle of mommisms that I have since become? [but how many times can you really write about laundry and baby food?]

Or the beautiful ways my little girl is growing and changing? [but every parent thinks their kid is the most beautiful, funny and intelligent human being]

Or maybe I should just write for myself, whatever I want and whomever wants to read is welcome?

My life since

2011-10-25T23:44:00.000-05:00

My life since delivery has been ok. 7 days post partum we moved into a new apartment because the old place smelled like smoke so much, I was afraid that the baby would develop some type of lung issue. In retrospect, the move and the stress was probably not worth it (as the smoke dissipated and it wouldn't *truly* have been an issue), but we live and we learn, right?

My mom came from Mississippi 3 days after I had the baby. When I was discharged from the hospital, she came home with us and like any new parent, my husband and I kinda looked at each other thinking, "Now what? What am I supposed to do with this thing called baby?" My mom taught us how to swaddle the little girl, she gave her the first bath and showed me how to pump properly. 2 months later, I am so thankful for her help as without her, I would have been lost.

For me, baby blues took the turn for the worst around week 3 post partum. My husband was dysfunctional, helpful to the maximum for his capacity; and none at all for mine. Sleep deprived, stressed, bleeding from the delivery and with a sore bottom, for the first time in my life, I struggled to find my happy place. I hated the question constantly asked by my pediatrician, "Do you have thoughts of hurting your baby or yourself?" Because how can releasing yourself from the daily struggles be "hurtful to oneself?" How is leaving this world, escaping all problems by jumping off a bridge "hurtful"? As I sat there contemplating on THE plan, I realized that I don't plan on hurting myself but rather making myself feel better. For a fleeting moment, I thought I should probably call someone and tell them so they would stop me, but that thought left as quickly as it came.

I wanted to drop off my daughter at a nearby church and go to the famous, gigantic bridge in my city (popular for my type of need due to the fact that people are always successful) and forget that my problems ever existed. It was such a relief.

But then I thought of my new daughter. Cliche, I know. I thought how terrible it would be that she would never truly meet me or know me. How terrible it would be that all of her friends are going to label her as "that girl without a mom." Poor baby, how could I allow that? Since this issue was in my control, I reconsidered.

So I guess, if anyone ever asks me how it possible that a 3-week-old can save someone's life... I would say: "It is."

Sleep. Deprived.

2011-10-24T00:44:00.000-05:00

I read this article recently how every woman loves to talk about her labor. I guess it's true. It makes you feel accomplished. Like you did something great. I think some women see it a "rite of passage" or something like that. I see it as the baby has got to come out and it has 2 ways to do it.

Mine was the traditional way, although she didn't want to. I had a very long, 3-day induction that didn't go as great as planned, but my delivery day was great. After an uneventful first night with cervidil (a string they put on your cervix to thin it out) to a drawn out whole day on citotech (pills they put inside your cervix also to ripen it every 4 hours, I was still 1 cm dilated and 60% effaced and that was "generous" according to my OB. Not only was I was bedrest, I was tired, emotional with an emotionally detached husband. Add every 4 hour cervical checks and you have an emotional breakdown.

I wanted to go home. Even though I damn well knew I couldn't, shouldn't and they wouldn't let me. But I wanted to leave. Get out. Jump out the window if I had to. My clueless husband would sit there and eat in front of me, when I couldn't; and then slept and snored while I was breathing through contractions. Nevermind that I was emotionally in pain, too. Birthing class 2 weeks prior... what?

But I digress.

The last 2 weeks of my pregnancy were not the fun, uplifting, looking-forward-to-baby type weeks I imagined. Preparing for our 2nd move in 2 months was tough enough, not being able to "nest" because the place where we live now was occupied by someone else, and a husband who yelled at me on a constant basis was enough to drain me of whatever leftover energy I did have. I put myself in survival mode and moved on.

2 admissions to L&D before my induction introduced me to awesome nurses, pretty cool residents and very nice attendings. But of course, I really wanted MY doctor to deliver. It meant more to me than the actual physical delivery. It meant assurance that things would go well and if they didn't, I was certain I was in good hands. I KNEW my doctor, I became (unfortunately) dependent on his encouragement, praise for being strong, effective and wonderful medical care and most importantly I trusted his medical decisions. I didn't want someone I didn't know who was just "on call" to deliver the baby. That delivery was the epitome of a very long, sad, difficult journey that was complicated emotionally by my crazy husband and physically by high blood pressure at 35 weeks.

And being the natural stubborn child of her father's, she didn't want to come out the day my doctor was on call. And that was the end of the rope for me. I had my breakdown, begging my nurse to ask my doctor to stay, crying that I wasn't ready for this and worse, knowing my doctor wouldn't stay no matter how hard I asked. It would be a post-call day after a very busy day and night, 11 deliveries, 3 emergencies... would I even WANT someone so tired delivering my baby?

But it was so important to me.

Turns out he stayed. 36 hours of no sleep, he delivered my baby with a resident. He narrated the whole birth to them both and let the student deliver the placenta. I was so happy. Dr. L was there. Time stood still when they put the baby on my chest, with the nurse vigorously wiping her down. It really is a once-in-a-lifetime moment that I will never forget.

Let the sleep deprivation, feedings and endless crying sessions begin. That I hope to forget. Eventually.

Where to start?

2011-10-04T03:41:00.000-05:00

So where should I start?

Last time I posted, I had been put on bedrest and was coming to the clinic every 2-3 days for a blood pressure check with the nurse. Labetalol 600 mg in full swing, I was dizzy, drowsy, nauseated and loopy in addition to being overheated by the wonderful Wisconsin summer heat. About 3 days or so after the "nurse" post, I realized labetalol was working SO well, I couldn't really breathe. I could TELL my cardiac output was pretty low, my heart rate went down to the 40s at night, but yet my blood pressure was still high. High as in 140/100s.

I called the clinic hoping that maybe, perhaps, my doctor would lower my dose seeing how I was getting more side effects from it than effectiveness... I told the nurse my symptoms, yet she somehow skipped the whole thing and went straight to the "trouble breathing" part, called my doctor (who was in the middle of a c-section), told him I couldn't breathe and of course, naturally "freaked" him out (as he later told me). She calls me back within 5 minutes of me hanging up and says that Dr. L (my doctor) wants me to come emergently to L&D and if I am not able to drive myself, call an ambulance. Wha?

He thought I was having a PE (pulmonary embolism).

Right. Definitely. That's why I'm still walking, talking and gasp, breathing with a pulse ox of 98%. Stupid clinic nurse.

I get to L&D, trying to stay calm, wondering if they expect to be resuscitating me on the spot. A nurse, B, dressed in OR scrubs, with a big smile comes to the waiting room to get me. I walk into room 15, pee in a cup, get totally undressed, attending along with an ER resident walk in. While B is putting on a pulse ox, cardiac leads and takes my blood pressure, I get bombarded with questions.

What's going on? What are you feeling?
Do you have asthma? Can you describe your breathing to me?
- all asked by the OB attending, Dr. K. (love her!)

Do you have a rash? Do you take any rash medications? Do you have any STDs?
-obviously asked by a 1st year ER resident... totally irrelevant to the current situation (yet necessary for the H&P of course).

Dr. K glares at the resident, looks at me and gets closer to listen to my lungs. The resident jumps up and says "oh, I'll do that, too, all together." and let's out this horribly weird semi-nervous laugh. *sigh*

I didn't have a PE. Obviously. Everything was fine. In fact, so fine, they all left and my nurse took me off the pulse ox and said Dr. L (my doctor) will be in right after his c-section. I was left alone to comtemplate my life on a beautiful Wednesday afternoon by myself to watch whatever was on tv.

Dr. L came in swiftly and efficiently, as he always does. Love him. He said I scared him, but he was glad to know things were ok. He wasn't ok with my blood pressure, though. I had been quite nervous because it has been high, but the more nervous I got, the higher it went. With 180/100 he admitted me for an overnight stay.

Between all 3 admissions, this was the scariest for me. When he came in to talk that time, he told me that my BP is so high he's worried about the baby and even though I was on the monitor the whole time (and the baby looked great) he was worried the baby might not tolerate labor in the future or worse be growth restricted due to my pressures being so high. He was hoping to diagnose me with pre-eclampsia (for which you need protein in urine in addition to high blood pressure), but even with the 24 urine collection, I had none. Just high BP. Really high BP. All that on a max dose of labetalol. :(

Just as he was leaving home, he said he'd be back in the am to check on me, and if my BP stayed high told me that they would induce me that night per night attending's call. I was 36 weeks and 5 days at that point. Hence, NICU would get called to the delivery as the baby is technically premature (everything after 37 weeks is considered full term and NICU only gets called if there's meconium=baby poop in the amniotic fluid). I got the NICU talk from the nurses. Oh, boy, do I know that talk well. I've heard it myself multiple times but as the nurse to the baby, NOT the recipient mom.

To be honest, I was very calm and collected during the NICU talk. Partially, because I knew what NICU would entail and the fact that I liked the nurses and knew the place was the best in our state, but also because my baby would be 36 weeks. Not a big deal but any measures if you compare them to any baby under 30 weeks or even a little higher. We're looking at a small chance of major problems, although, of course, anything can happen at any time.

The next morning, Dr. L came back with a med student in toe happily noting that my BPs came down hence avoiding my induction overnight. He went with me to the maternal fetal care center and Dr. B (another super awesome perinatologist doctor who did my 20 week anatomy ultrasound [commonly known as the "gender ultrasound"]) checking for growth of the baby and a biophysical profile (that determines if the baby is getting enough oxygen by looking at how she moved and whether she "practiced breathing").

The results showed she was doing ok, but her weight was on the low side. They found 5 lbs 6 oz... small but not bad. Dr. B recommended delivery since my blood pressure was so high and I was feeling so crappy. He basically said that we would be ok to wait until 39 or 40 weeks, but it would be unlikely that the baby would grow significantly thereby reducing the risk that she would tolerate labor well, increasing the risk of a c-section for me.

That day Dr. L sent me home, pending 24-urine collection. The next day he called me back saying that it came back normal, but due to the growth of the baby slowing down that he still wanted to induce over the weekend since he's the attending on call Sunday. Hence, I was to come in on Saturday at 5 pm for my induction to L&D!

Excited I packed my bags and had my last full night of sleep at home... for a while.

Back from the dead... literally...

2011-09-26T23:20:00.000-05:00

Hello world,

I'm alive. Had my baby 5 weeks ago. Was admitted 3 times to L&D. 3rd time is charm after 3 days of labor post a looooongest induction of my life. My doctor is my hero and my husband is the asshole. Will definitely have to post more coherently soon.

Ah, when? In between feeds, diaper changes, arguments with husband and unpacking boxes for yet another move 7 days post partum, while wiggling in peri-pads and gigantic ice packs. Somehow I still have trouble understanding the question: "Should I be concerned that you would hurt yourself or the baby?" Who said that releasing yourself from this world of trouble, sleepless nights, abusive husbands and terrible life circumstances is "hurting" yourself? They are obviously dillusional.

"The nurse" - the patient's perspective

2011-08-16T12:29:00.000-05:00

Perhaps because I'm a nurse myself, I tend to hold other nurses to a higher standard. Or maybe my standards are high because I'm an ICU nurse, who knows. I definitely don't think I know everything, but when it comes to bedside manner, I think I know a few things.

Yesterday, I had one of my follow up appointments with a nurse from my OB doctor's office for a blood pressure check up. I check my BP at home of course, but he just wants an "official reading," so be it, I went.

My Labetalol of 600 mg is finally starting to kick in. I take it three times a day and around the 2-3 hour mark after I take each pill I feel the worst. I know it's supposed to lower my blood pressure (it doesn't - it's all the same as it was before), but I think my vascular resistance is SO high that my body just fights it. Just fights it and fights hard. If I walk for more than 10 minutes, or do any kind of exertion, I start to sweat, pant like a dog, my face gets flushed and my body just shuts down. I usually need to sit or lay down. You'd think it all sounds like a heart failure patient with poor perfusion... I guess maybe my perfusion is poor, but my BP is still sky rockedly high. :(

So, anyway. I finally made it to my appointment, sweating and panting like a CHF'er and sit down to wait for the nurse to call me. 15 minutes later. Then 30. Nobody is coming. Other patients are getting called in to see their doctors, I am still waiting for 'the nurse.' And then my medication trough hits that 2-3 hour mark. I wipe the beads of sweat off my face, trying not to be too obvious about forcing myself to take deeper breaths because my whole belly rises to exorbitant proportions, the TV blaring over my head is starting to give me a headache... I lean over the shoulder of the chair and close my eyes. People probably think I'm pretending, but I don't care at this point.

I wait another 15 minutes. I get up, try to walk over to the secretary's desk and ask to see if the nurse knows I'm there. 15 minutes later, nothing still.

Again, I walk over to the desk, angry, flushed and barely breathing and say (calmly, though), "Look, I'm on bedrest, I can't sit here any more, I'm going home if someone doesn't come out soon. Maybe a medical assistant can take my blood pressure?"

A few minutes later, an angry nurse walks out and in front of everyone says: "Excuse me, I was busy on the phone."
I'm thinking, "for a freakin' HOUR?!"
Ok, whatever. I'm just going to swallow it.

Forcing a smile, I get off the armchair to follow her. She takes me to a small room and does a manual BP. It's high (as usually). She gives me a puzzled look.
"My doctor wants you to do both manual and automatic, please." I said, without blinking.
"Well, it's probably because you've been getting your BPs done by medical assistants, and I'm an RN, so I don't need to do an automatic... but ok, if you want."

She does the automatic - BP still on the higher end, and close to her number. "Ah, it's close. Told you," she says with emphasis on the "told you" part.

Why does every nurse think that a patient is questioning her ability and skills when requesting something in addition to standard practice?

I guess maybe because everyone in healthcare gets picked on - technicians, nurses, residents, students and even attendings - I think people just kind of develop this defense mechanism against a patient. Or maybe it's just a patient's perspective?

She says she'll be right back to call my doc.

She comes back about 10 minutes later and says, "Oh, my, I didn't know your dose was that high... um, the doctor is stuck in L&D, he isn't calling back, I don't think he'll do anything with your BPs, so why don't you just head on home and we'll give you a call if something comes up. I'm so sorry this took so long." She proceeds to apologize and gives me this common look we give to patients when you know things aren't going well and you just feel sorry for them at this point because you know there's nothing you can do to help them.

"Cool, sounds good to me. I agree with you," I said leaving, stopping by the desk to thank the secretary for calling the nurse in sooner. I don't think I had any color left in my face at this point.

Barely making it to the couch at home, I passed out from 12 pm until 5 pm in delirious sleep, dreaming that I was at work taking a sick patient while having conflicting thoughts thinking I was supposed to have been on bedrest, yet forced to come into work.

I woke up to my husband home from work, standing above my head, wondering why I was laying in a pool of sweat looking like I had just run a marathon.

Chaos = my life

2011-08-12T11:40:00.000-05:00

It's been a rough ride to say the least, but I'm still here. And no, haven't written in a while not because I had the baby.

Lots has been running through my head lately. Moving, husband, work, life, etc. Last time I had written I was stressed at work, at home and quite frankly didn't know what to do with myself. This time, I'm unfortunately in a worse place. A week or so ago, I really wanted to crawl under a rock and hide from the world, but today even though I want to do the same, I don't think the world will let me. Or at least my doctor won't.

I have high blood pressure now. Almost 36 weeks pregnant and it sucks. No pre-eclampsia, though. Just yet. Doctors appointments up the wazooo and I'm sick of going to them. I don't want to go, but if I don't go, they'll admit me, like it happened 2 days ago. L & D is a modified prison with a huge window without bars. I'm hooked up to wires and the only thing I can do independently is pee below a yellow/neon sign that says "Call Before you Fall..." The meds make me drowsy and sleepy and even though they aren't working, they make me feel like someone is hammering me into the ground. My head feels heavy on my shoulders and even though I want to sleep, I can't.

I'm tired of seeing my doctor's tired, worried eyes. The nurses saying "take a deep breath, think positive thoughts, imagine you are on the beach" and when the BP comes back high, bite their lip, their smile fading and say, "let me go tell the doctor, I'll be right back."

I'm tired of thinking what could be. Will they take the baby early? How early? My doctor has proven to be so wonderful. He pushed and pushed for me to get out of L&D and I did. He is trying to stretch the time and give me and baby the benefit of the doubt and let me make it to 37 weeks. I only have 9 days left! I'm almost there, but I'm starting to lose hope.

Hope is the only thing I have left. Labetalol maximum dose is supposed to kick in within a day or two... no protein in the urine and all of my blood work (work up for pre-eclampsia) has come back normal. For now. But the BP is still very high. The baby is happy and healthy and the high risk consulting doctor says it all looks good. Yet, he was the one to admit me because of my high BP. As an isolated factor, the number by itself is not enough to induce labor... yet. It's a fine line, I know... but I'm so thankful that my regular doctor is trying to wait as long as possible.

My husband has gotten better. I made him stay with me the whole time I was admitted. He slept on the couch with his back to me, periodically reading the news on his iPhone, but at least he was there. My mom might come for the birth now although being as last minute as it might be, she might not make it precisely on time. Who cares, as long as she comes at some point in time.

So I'm off work until things get better. 40 weeks gestation has become a stretch of imagination, but 37 is a reasonable goal. I never thought I'd be here. How could I have these illusions of a cute, pretty baby, somewhat painless delivery and a happy family when in reality it might turn into an emergency c section with a late premature baby who is unable to breastfeed/latch? And a husband who wants to leave?

"Think happy thoughts" -> I should listen to my nurse.

I will try.

"What does this med student want?"

2011-07-22T20:03:00.000-05:00

I swear, I wondered this very thing this morning during my shift-to-shift report to another nurse. I wondered because this girl - a med student - was standing riiiiight next to us the entire time I was giving report (and another nurse in my Pod was, too) and waiting and writing something down while periodically looking up. I wanted to stop talking and just ask, "can I help you?" but I looked up a few times as if asking: "how can I can help you?" but she simply would smile back and say nothing. But still kept standing there. Then toward the end of my report, after the history and the basics, she let out a huge sigh and left angrily walking some place.

I really truly don't know what she needed. Did I not give her the info she needed? Did she need to ask me a question about my patient I had had overnight? Did she want the flow sheet I was using while giving report? Awkward silence. I'm not sure - and I think the other 3 nurses were also not sure.

I wish our attendings/residents somehow told us what the role of a med student is on our unit, what they need/want/may ask help with besides waking up our patients and wisking away our charts for hours at a time where no one can find them. I know our patients are super cool and interesting, but if I don't know what info they want from me, I can't help them. Standing there quietly expecting me to read her mind didn't help either. *sigh*

Wish someone could clue me in.

on stress

2011-07-20T15:14:00.000-05:00

The fact that I'm stressed is well, an understatement. I haven't been active on here as I was before partially because life has been getting the better of me. Thought I'd share my stress, spread the wealth!

1) We have to move again. In a month. Moving is 3rd highest stressor after death and divorce and let me tell ya, I feel it! When we moved into our current apartment (current as of 3 weeks ago) we thought something was up but didn't know that the smoker who lived here for 3 years would leave the smoke smell behind her. The management didn't change the carpet, and poorly painted the walls. Not nearly enough to get rid of the smell and I was partially worried that these fumes would get to the baby. Allergies, etc. My throat hurt for the first week, but now I'm doing ok... As a result, we're moving again, into another apartment next month, like a few days before my due date! yikes!

This is a gigantic stressor in my life right now because we can't really set up anything for the baby. So, I bought the basics: diapers, wipes, clothes and a small bassinet (even though we have an awesome crib, still NOT put together because it will be harder to move it). Painting the nursery? Buying cute outfits? Yeah, totally not in my vocabulary right now. But I'm trying to stay positive in knowing that we are moving into a much better place, a larger apartment and a better location within the apartment complex.

My friends have been saints in helping me. From an unexpected birthday cake surprise to brownies at work for my birthday... let's just say, it's been fun. They listen to me, they call me and they do everything they can to help me. LOVE my girls.

2) The heat. It's been awfully hot here. Like 95F with a heat index of 116F!!!! Scary. Thank God for air conditioning! Physically this has been challenging for me. My legs are so swollen my doctor had to prescribe compression knee highs to make my legs swell less. My regular generic ones aren't really working that great any more. My blood pressure has been slowly rising, which for all of you who know a little bit about preeclampsia know that it's a dangerous pregnancy complication that can spin out of control any minute. At 32 weeks, they will take the baby if things get worse and I really really want to make it to 37 if possible. Praying, laying down and drinking lots of water as much as I can is about all I can do before my doctor calls it quits and puts me on bedrest and medications. :(

This has been stressful, too, but only in the last week or so. But now that things are really serious, my doctor has been SO wonderful, totally the opposite from before. He calls me at home and is super responsive to any questions I have. No wonder last year's med school class gave him an award for best teaching faculty of all faculty for the 2010 year.

3) Work. The physical demands of my job have been quite taxing, especially when my patients don't want to behave. "Behave" can have a two sided term on my unit. Our babies can be "naughty" because they are SO sick they try to decompensate all the time and this weekend was no exception. Lots of sick kids, full unit, stressed out attendings in house, additional attendings called in from home, etc, etc. My poor, poor fellows! I feel for them! The other "naughty" babies are those who are withdrawing, who won't sleep, won't eat, who cry ALL the time because they have a headache from opioid withdrawal and etc. I have been trying to take on easier assignments because of my growing belly, but it hasn't been as "easy" as I had hoped. Walking from one room to another has proven harder on my body than hourly chest tube checks on the floor, when I lean down and squish my belly.

4) My husband. This was a problem of the past somewhat... but he had asked me for a divorce because of the stress of the baby coming. He was having a really really hard time and he wasn't nice about it. He's gotten a little better, but not by much. I told my doctor about it who, of course, became very very worried... but it's slowly getting better. Either he's getting better or I am coping better with it or simply ignoring it because I have too much other stuff to worry about. As long as he helps me with things like moving and cleaning, I'll take it. Verbal abuse - not as much... more about that later.

5) MCAT. I got my scores back yesterday and although I wasn't happy, I did better than I thought. I raised my score a little bit. And most importantly it was in physical sciences which is notoriously been my hardest section. If I could take it 7 months pregnant and do better than not pregnant, people don't have any excuses! lol (just kidding) Applying this year won't happen probably, only because (I truly didn't expect to do better) I haven't even started AMCAS and it's already end of July. I'm also secretly hopeful to raise my other sections some more to have a chance at an even better school. We'll see how the baby is and then decide what I'll do. But this year's cycle is waaay under way and my score isn't a 40, so applying so late might not prove beneficial and financially hurtful given the fact that we already have a ton of expenses!

6) Night shift. I separate that from work because my work I love, night shift - I hate. It's been rough physically, let's just leave it at that. I can't even imagine how I am going to come home, take care of the baby all day (after having worked all night) and then leave again for work, while running on 3 hours of sleep and do that 2-3 days a week.

I've been applying for other jobs at other hospitals and within my own. I love PICU, but I have been on the day shift waiting list for almost 2 years and my manager said due to bad staffing, I have another 1 or 1.5 years to wait. My body won't be able to do it. I don't want to go to a clinic or a lower position, but as I have decided, it will be more conducive to my family and regardless of how I feel about my nursing competence skills, something has to give. And I guess my job is less important than my family.

Aside from that, I promised a friend and a co-worker to do her wedding shower in 3 weeks - so I'm working on that (thankfully 2 friends are more than willing to help me out, so again, yay for friends). I still have to buy a ton of baby stuff, have a doctor's appointment once a week at this point, have a birthing class and a breastfeeding class to attend and lots more! (plus working and house hold stuff).

If I can make it through this time and stay sane, I will be so very happy!

Moving

2011-07-06T14:14:00.000-05:00

After 3 years of living in the same apartment, I have forgotten how terrible moving really is. In fact, let me rephrase that, I HATE moving. And yet, we will have to do it again in almost a month and a half because the apartment we moved to.

It's been a few days, I've been trying to take it easy, but cheez, certainly didn't anticipate cleaning being such a major chore when there's a basketball tied around my belly!

But our new place has it's nice points:
1. Central air! Although having lived in the South and knowing that there is no way one can survive without central air, I am here to tell you that in the Midwest - you can, and I have, for the past 3 years. But you can't... while 8 months pregnant. Ya just can't! And even though it's only 80F outside, I'm truly enjoying my central air.

2. In-unit washer and dryer. I looooooove my washer and dryer. Even though it's not HE or high class LG or Whirlpool, I love not having to go to another building to wash my underwear and socks. And with the baby coming, this is a Godsend!

3. Sunshine in my windows. We used to live in an apartment that faced north and we never had sun, now we live in one that faces west and we get the afternoon sun! How wonderful! It makes our place hotter now, but in winter, this will be SO wonderful!

The not so good:
SMOKE smell. The person who lived here before us was a heavy chain smoker and man, can you tell! The carpet (that was washed, albeit not replaced), the walls (were re-painted, but probably not with the best paint), the kitchen cupboards ALL stunk like smoke. I've tired to wash them with clorine (in a mask non-the-less) but they still stink. Hence, we decided we're moving into another apartment down the street (same complex) because of the smell.

Being half-way-unpacked sucks. We decided not to unpack our books and all of the baby stuff because we don't want to repack it, so our place is half-way stacked with boxes - not pretty! Yet, I'm still trying my best to enjoy our place.

On this warm, sunny day, I wish you all happy Wednesday. Now off to unpack my closet before work tonight!

EH

2011-06-30T23:37:00.000-05:00

Not excited about this weekend... Moving to a new apartment, movers coming Saturday... and I'm 8.5 months pregnant, so let's just say I've totally underestimated how difficult it is to clean with a big belly that you can't squeeze because there's a little person in there squirming all the time!

Crazy day

2011-06-28T11:03:00.001-05:00

So my ultrasound went great! Wohoo! Everything on track and the baby is growing and doing well... and I love the maternal fetal medicine doctor! :))

My regular OB appointment didn't go as well as I had hoped, although given his track record, my doctor isn't one of the friendliest to say the least.

He walked through the door with the opening statement, "Young lady, you're in trouble!"
Thinking he's just joking, I (with a smile) say, "Oh, what did I do?"
"You know, I can't sign that paperwork for your FMLA, right?"*
(To backtrack, see below, I had some stomach pain over the weekend and called into work for 2 days, so one of my coworkers suggested I fill out this paperwork called Federal Medical Leave Act and since it's due to a medical condition (ie: being pregnant), it wouldn't count against me if I call into work for a certain number of hours).

My smile subsided, and with total seriousness and condescending comments he went on and on about how whatever/whomever gave me this advice wasn't correct, that they are wrong about these policies and etc. I said that I was sorry probably fifteen times because I was just following up on what I was told to do... retroactively. I didn't know this was going to be a problem even though it makes total sense that it's weird to ask a physician to sign for something that he didn't assess or see at the time of the problem.

Then, when he was done bitching about this, he started to complain about the perinatologist. I mean, seriously?! The maternal fetal medicine doctor (=perinatologist) wanted me to come back in another 2 weeks for a biophysical profile. I have a history of high blood pressure and although hypertension hasn't been an issue for a few years or during this pregnancy (I'm not on anything for it), he still says that it's a risk factor (because of the diagnosis) which by itself prompts for closer monitoring during the last trimester. Hence, he wants a biophysical profile or a non stress test done once a week starting 2 weeks from now.

Oh, my regular OB wanted NOTHING to do with it. He started bitching about how this wasn't appropriate and "who does he think he is for changing the plan without consulting me first?" and etc. On and On. Then he said, "It's not you, this has just been happening a lot lately and it's frustrating me."

Well, at least this time I'm glad it's not ME.

Let's just say, I have to see my regular OB every 2 weeks from now on. And I am NOT looking forward to it. At all. But due to the fact that I'm almost done... I figure, what the hell... my life can't get any worse anyways. This baby is like the bright light at the end of a deep dark tunnel called life.

Even though I'm not high risk, I kinda wish that perinatologist was my real, regular doctor.

Thanks!

2011-06-27T14:49:00.000-05:00

Thanks for liking my blog!

http://www.online-nursing-degree.org/nursing-students

36 hours

2011-06-27T13:40:00.000-05:00

Had to work this weekend. Supposed to have worked Friday night through tonight and ended up only making it through Friday and Saturday. Saturday barely. Stomach pain or epigastric pain - don't know what name to call it. White as a ghost, I could barely move at 9 pm and I still had 10+ hours to go. Luckily, my lovely co-workers understood. I really really didn't want to ship out to L&D... So I peed on a stick and one of the girls took my blood pressure... Both normal... maybe some trace protein and some trace leukocytes... but nothing major. Maybe it's the way the baby is sitting... maybe it's the lack of sleep or any kind of rest for 24+ hours. I have no clue.

One of the girls is an ER nurse at the hospital where I will be delivering, and where my doctor is, and she sort of "triaged" me... said what they *would* do and what L&D would say/do. One of our sweet attendings overheard my conversation. His wife just had had a baby a few months ago, so he chimed in. Called OB "the batman" meaning scratch all "classical" presentations of any kind. True that. He talked about appendicitis, cholicystitis and stuff like that. Or it could be a pre-eclampsia starting. Hence peeing on a stick helped. I guess the only thing we couldn't do was do labs: liver enzymes and a CBC.

My pain lasted for 36 hours and I still feel remnants of it, even though I have been laying down for the last 24+ hours pretty much. I hope it's GI or gas or something...

Tomorrow I go for an ultrasound with a perinatologist as scheduled before, so we'll see what he says.

Doesn't help that my roommate from college is hospitalized at 30 weeks gestation with epigastric pain and crappy labs... but she says they're getting better! Praying they won't deliver her baby just yet. She is a peds resident and man oh man... she knows better than anyone the dreaded "NICU" word.

Done. .... for now

2011-06-16T23:12:00.000-05:00

I finished!
I'm done!

For now.

I don't know how I did, don't know what scores I will get, don't know if I'll improve my scores, BUT I'm proud to say, I finished the MCAT fair and square without any special accommodations or requests in my 3rd trimester of pregnancy without any faux pas! :))) So happy it's over! Made it through with 1 yogurt, 2 granola bars, 1 L of water, 300 ml of orange juice and a smile on my face! I think the baby got SO tired of the quiet room and sitting for so long that she started kicking like CRAZY toward the end... I was sitting close to the door and even the proctor noticed because my fleece jumped at one point! That's how hard she kicked! :) LOL He even asked me if that was "painful." Hehe, nope, sitting was the "painful" part! But it's OVER!

For now.

Time for happy working through the weekend!!!

Brain freeze

2011-06-13T23:14:00.002-05:00

I have. a mental. block. Can't. study. any. more. :(

I'm out.

Who said doctors are anti social?

2011-06-10T22:41:00.000-05:00

Around 4 am last night, the girls and I were sitting around chatting during a small break. Evening rounds were long done and we had a few minutes. While chatting one of our fellows walks by doing this own mental rounds on our patients, deep in thought.

Me: "What's up Nate, how's it going?"
Nate: "Oh, fine, just finishing up, going for a nap."
Another nurse: "You know, we were just talking about how some doctors are SO anti social. They are so tired all the time, or they dress funny, like they don't have time to look at fashion magazines. And some are just plain boring... why is that?"

Without even a blink he moves toward the end of the long hallway of rooms, and from room 12 to room 1 starts doing somersaults. At 4 am.

He came back, redfaced, totally smiling, while we're all rolling on the floor laughing. "How's that for social ability?! Did you know I was a circus performer in high school? Despite me being fat and old now, I can still do it!"

Oh, Nate, we love you.

And then again, you have the resident we saw this morning... dressed in the ugliest khahi pants pulled up so high, she had a camel toe, hiking sandals (you know those super soft with the arch that you wear on a long hike?), dirty, oily hair pulled up in a long pony tail, what looked like Walmart turtleneck that almost looked like she was about to suffocate with no trace of makeup on her face. She came, sat down, like your typical student and starting rewriting every minute detail from the flowsheet, slowly, neatly, excrutiatingly carefully.

A friend looked at me and whispered: "Just wait will July comes, at least she's done with her first year already and knows not to steal the chart or wake up my kid. In July we'll get the new ones. They will steal the chart, wake up the kids and I'll rip my hair out!"

Every year, our attendings remind us to "be patient, to help teach our residents and new fellows" and that we don't "have to accept their orders if we don't want to." I'm cool, whatever, that stuff doesn't bother me, while my colleagues, especially those who do this every year for many many years... not so much.

It's great when someone new has a great attitude about a new place and doesn't act like a king/queen, but man, when they think they know it all...

"Previously healthy"

2011-06-08T12:53:00.002-05:00

Worked all weekend. Was so finally happy to come in for my last night shift of my 3-day stretch on Sunday night, hoping it'd go fast, looking forward to my OB appointment for the next day, finally enjoying the summer weather. With music going full force, I turned off the engine finishing the lyrics on my own.

Not 5 minutes after I got report from the day shift nurse, while verifying placement of my new patient's ETT, our charge nurse walks in.

"Hey, K, sooo, it would be you or Jess to take an admission... do you want it?"
"Um, well, whatever she wants to do. I'll take it if she doesn't want it."
"Well, Jess says she has had the same pair of patients all weekend and doesn't really want to give them up."
"Ok, then, no prob, I'll take it, who's going to take this kid [my current patient]?"

Literally, without pausing, or answering my question, she says: "You have room 4, it's not set up, the admission is stat, kid coming through transport, ETA 5 minutes, 8 days, sats are 20-30% they can't get them up, don't know what's wrong, ecmo standby. NOW!"

I think I dropped by measuring tape at this point.

Um, ok... sure.

I run to the room, leaving my current poor patient behind [she was ok]. :). Nothing is set up. At least the monitors are working. A few other nurses run in to bring equipment. No time to get a bed from distribution services, so we pull in some random bed hanging out in the hallway that's ecmo ready (meaning has certain adjustable controls that other normal warmers don't have). We wipe it off with cleaning cloths and as we're finishing tucking in the last layer of sheets on the bed, I hear over the PA system, "Bed 4 is on the way, bed 4 is on the way."

The blue transport jump suit appears from the side of the door, sweating, the transport nurse looks at me, while confirming that my pregnant self is the bedside nurse for the patient.

Sats are truly 30%, heart rate is a-ok, and cycling blood pressure cuff gives us a pretty good reading. Everything else sucks: head saturations, renal satuations, lines, everything. The kid just has a small PIV (peripheral intravenous line - your basic IV) and in it are prostaglandins (to keep the PDA open), epinephrine and through it they gave vecuronium (paralytic) boluses.

The transport nurse and transport respiratory therapist (RT) transfer the patient onto the bed (warmer), while RT is giving the patient breaths.


Warmer with a ventilator to the left. The red large tubes to the right are ECMO cannulas - we didn't have those.		Credit: http://nancyandbaby.blogspot.com/

One doctor after another listen to my grey, listless patient. I put my stethoscope down and hear good aeration, pretty decent pulses and feel a full diaper of warm pee. Truly, the best case scenario for someone on whom CPR was done for almost 1 hr and whose sats have been so low for a while. Pee = good because it means her kidneys are still perfusing and her peripheral organs and hands and feet are as well. :)

It took us all 4 hours to take care of this baby non stop. From a bedside echo by the attending and fellow cardiologists to putting in an art line, central line, another PIV, re-intubation (to change out the ETT tube due to an air leak since the other one was too small) and a chest xray, we were done. The patient was temporarily stable until the morning when the hospital hustle and bustle will pick up and the ORs and cath labs will open.

The patient's mom woke up around 5 am, came around to talk to her baby, touch her hands, rub her cold, clamped down feet, brush her fine, strawberry blond hair on her head with her finger and gently covering her own mouth, began to cry. "My poor baby, we were just swimming in the pool. So glad they brought you here, they know what they are doing, I love you." With tearful eyes, she looked at me, sitting in the corner, charting, and said "thank you." A moment frozen in time. I felt like I did nothing to help her baby, the most important is yet to come. I nod my head with a smile knowing she's thankful her baby is still alive.

------
It's scary for me to see a "previously healthy" baby [meaning, no medical diagnoses since birth] come in like this and discover a horrible issue with his or her heart and then have to get it fixed. You begin to think: "why didn't someone discover this earlier?" With our advanced technology (for which we all pay an arm and a leg) how can we prevent these crash code occurrences? And true, your average baby doesn't need advanced assessments or even a pulse ox at birth, but those who actually do, get missed that way.

my own internal

2011-06-03T01:27:00.000-05:00

ethical dilemma is growing and developing daily.

A patient near and dear to my heart whom I had taken care of for a loong, loong time, came in for an elective (albeit necessary) surgery to repair several congenital anomalies and is now super duper (like superdy duperdy) sick. Simply put, I am having trouble understanding why her parents knowing what they (and we all know) are still pushing for "everything." And I mean, there were 12 different specialists through her room this week and not one knows what's wrong. 12 - isn't that how many there are total sub-specialties in peds? (ok, I know more than that, but really, isn't 12 a huge number to not know what's wrong?)

Briefly, this patient has something wrong with every single organ system on multiple levels, had had all these issues since birth... and yet... "all" was encouraged to be repaired. So they are repairing, day after day, organ after organ and then play catch-up in the PICU when a system fails. It takes this pt months to recover after each induction, each surgery, each invasive maneuver and why? This patient will never be cognitively competent even have a slight ability for familiar recognition of a consistent caregiver... yet he is suffering profusely, in pain, edematous, septic, and sick, sick, sick.

And there I hit my usual pet peeve of the PICU and one of the biggest and I dare say, only reasons why I would change my job in a heart beat - ethics. I really truly struggle understanding sometimes the ultimate goal of the parent and quite frankly I blame our medical and nursing team for false reassurance of the parent at times. Perhaps it's legally driven, perhaps emotionally, perhaps, a physician doesn't want to recognize defeat?

Why does medicine fear death? Because it equals defeat in the eyes of modern medicine? Has my care as a nurse failed because I could not save the patient with my attending/fellow/resident at bedside? Does not being able to save a patient mean one is not a smart physician? Not a knowledgeable physician? A bad nurse?

Or a physician who cannot stand defeat? Who is afraid to "lose" to death?

But where does an innocent, suffering, delayed, needle pricked, artlined, PICClined and overscanned, ECMOed child get a say? What if he or she were could talk and say, "you lay here paralyzed, under-sedated, ECMOed, pricked and prodded, edematous and I'll see if you want me to do everything to you!" But a child can't say that. It's hardly impossible to believe that these patients feel no pain and they are "too paralyzed and sedated" for suffering.

As a nurse and a human being, this is by far the most difficult thing for me to watch and work with in the PICU. Trumps codes, disease and even meeting death while holding a patient's hand.

missing my mom

2011-06-01T19:44:00.000-05:00

My mind is in a whirlwind of emotions. So many things to do, not enough time to get it all done.

Just spent 5 days in the sunny San Antonio with my family. I love, love, love that city, but more than that, love my parents and my little brother. I left the sunny city still cradling hope that maybe, some day, my husband will find a job there and we could successfully move there. My dreamy, pregnant, emotional state was quickly interrupted by the announcement of our pilot that our plane was landing In-the-Middle-of-Nowhere, Illinois because something was wrong with the steering and the rotor.

We landed within 5-hour driving distance from our final destination. After sitting 1 hour and 45 minutes in the plane awaiting the promise that it will be "fixed promptly" we were escorted out at 11 pm and promised a bus to take us all home. A 5-hour limo bus ride. Without a bathroom. For me, that's like a death sentence.

There were 68 passengers. Each bus held 30. The first load is only 30 people: women, children and people with a medical condition. Yeah, that included me as well. The other 30+ were left with their coats waiving in the wind as we drove off into darkness. I heard they were going to be 1.5 hours behind.

At 4 am we arrived to our airport. By a limo bus. No food, no water, and with me being the only person who wanted to use the restroom bad enough to pee in the middle of a grass field next to the freeway at 3 am.

Emotionally torn between missing my family, and especially my mom, taking the MCAT in mere 2 weeks, not being able to breathe, getting kicked in the ribs by the baby at random hours of the day and night, half of my stuff still left to be unpacked, mountains of laundry to be done and of course constant night shift-day shift switching for work, I'm really hopeful I won't lose my mind.

My friends tell me I will "miss" being pregnant. I hope so, because although I shouldn't be complaining because overall, I have nothing to complain about but the usual stuff that every pregnant person goes through, I have plenty that I won't miss. I won't miss the indigestion, the constant doctor appointments that seems to happen all the time, even though right now they are "only" every 4 weeks, the blood tests, the measuring of my belly, the slight leg edema at the end of the day (not to mention a 13-hour flight from Texas) and people's comments on my belly ranging from "wow, what a cute belly!" to "you don't even look pregnant" or "man, you're gonna get so big!"

Not to mention the fact that even though I don't look like a mini elephant, I certainly feel like one. The not-being-able to take in a full breath part without sitting up totally straight is certainly a deterrent to sitting next to the computer or studying for a long time.

Speaking of which, with another kick in the ribs, I will adjourn for dinner.

Life is fragile, cherish it

2011-05-18T19:39:00.000-05:00

My Pediatric Advanced Life Support (PALS) re-certification class always makes me feel like a hero. I walk out of there, head high, proud of "what I do", what I'm capable of doing and yet... the infallibility of human life hits me as soon I walk through the sliding doors of my unit in my nursing uniform.

House of God

2011-05-17T13:53:00.000-05:00

I'm currently reading "The House of God" and I LOVE it. Soaking the rays of wisdom, mockery and the bitter truth about one man's experiences as a intern in medicine. Gives me flash backs of my student rotations in the adult hospitals, personal experiences at work, and the nurse-doctor relationships. Sometimes I become sick to my stomach reading. Not because of a graphically described situation, but rather a situation described for how it truly is - it's nude, sickeningly factual, ugly face that leaves you empty inside. How true, how sad, happy, satisfying and sickening at times. So glad someone out there put this bitter yet satisfying truth out there. That is if you truly understand what he writes. I wouldn't have the courage to write that book.

Sensitive

2011-05-13T16:24:00.000-05:00

When FB first came out, it was great. The concept behind it was awesome, keeping in touch with my college friends was grand since at the time, only a person going to college was able to sign up with his/her university account.

And then it went to the general public. Which was good, too, but along with it came consequences.

A friend of mine almost got fired over posting a You Tube video that a patient's family put together about their child. The only reason why she didn't was because You Tube was a "public domain" and "technically" available to all. Yet, she was told by her putting that video on FB, she identified the pt's location, time, place, etc - huge HIPPA violation.

Around that time, people were also sitting on FB constantly while at work. Patients' parents noticed - complained (and rightly so) the hospital blocked many sites - You Tube, Facebook, My Space, Twitter - and put out a new policy. If a family asks if they can take pictures, they can only include their child in them - no pumps, no staff, no monitoring equipment, NOTHING. Furthermore, if they want a pic with anyone from their healthcare team, they have to ask written permission and if they put it on FB they can't tag the staff member due to again, HIPPA protection for the staff member.

Cheez.

But even those rules didn't stop my coworkers from posting some very sensitive information a few days ago.

One of my colleague's newborn was diagnosed with a major heart defect, emergently brought to our ER and operated on right away. How could a nurse from a peds cardiac ICU miss his own child's defect? Scary, right? Missed by maternal fetal medicine, missed by the pediatrician - twice. This was a cyanotic defect as well - hard to miss with a pox, but as my OB confirmed, pulse ox is not part of a routine neonatal heart exam.

My colleague came out of the room after his child rolled in back from the OR and with great sadness walked a few rooms down in his so-oh-familiar unit that his own child now has to call home for a few weeks. He stopped by to say hello and when approached me, stopped.

Sadly, he told me that his and his wife's family found out through Facebook that their child was sick. They had not had time nor energy to call because it all happened to fast . His mom called frantically asking "what's wrong" when she happened to glance at FB where people from work were posting stories online, asking for prayers, naming his family and his child. This also forced his wife to "clear the air" and explain what had happened when neither parent was yet ready.

Oh Facebook. As great of a tool as it is, when misused, as with anything, can really hurt some people and bring some unsolicited attention. I just wish people had a little bit more sense and respect for other people's privacy.

And for those of you in healthcare, beware, you never know who's watching.

To do or not to do?

2011-05-05T09:52:00.000-05:00

Interesting discussion the other night at work.

A fellow colleague (doc or nurse, I won't mention) and I were talking about "what we do." As in, we work in critical care and specifically pediatric cardiac intensive care unit, which basically translates into taking care of children and adults with congenital cardiac anomalies (there are like 1001 out there), children who come in with cardiomyopathies for a variety of reasons, heart transplants, children with arrythmias of a weird/unknown/known origin, etc. Basically, anything and everything heart related.

So, we were talking, as usually, late at night, philosophisizing (as I like to say) about what's right and what may be not. The conversation was triggered by a paper a former fellow had done on Hypoplastic Left Heart Syndrome (HLHS) Ethics for his Masters in Ethics while doing a critical care fellowship at our hospital a few years back. His thesis basically focused on the root of all origins of our unit, "should we play God and "fix" these kids who aren't intended to survive from the start?" He didn't phrase it like this, obviously, but you get the point.

His main point was that physicians do not provide parents whose children are prenatally diagnosed with the toughest defect of all, HLHS, with enough information to make informed decisions. That is, they are given an explanation of palliative surgical interventions a CV surgeon can do in great detail, but are given the choice to abort or do nothing upon birth, under their breath, as if it's a bad thing. While in reality it's not a bad thing and equal weight should be placed on both options. His point was, just because we can doesn't mean we should. Yet, 99.9% of parents he works with, without a doubt or further questions chose to repair.

Of course, imagine a scared parent looking up at the doctor for advice, information, support and the doctor says that there are all these "great" things we can do. No one wants to hear the words "termination of pregnancy" or "abortion" or "pass away after birth" but those are all options. And what I don't understand is why are they wrong?

However, upon interviewing physicians and specifically physician cardiologists in various hospitals (which he cites), he came to an astounding, yet not surprising conclusion, that 90% of physicians, and 85+% of nurses and other healthcare personnel would NOT chose to go through with the palliative procedures our healthcare system offers and instead choose to take the baby home.

Not really, if you live in Philadelphia. A hospital out there (during the years when he did the research) set strict rules on what they do if a prenatal diagnosis of HLHS is made. A parent either 1) signs a form saying you will do nothing, request nothing and take the baby home upon birth to die or 2) signs a form saying you will go through the palliative procedures and one cannot change their mind after birth. Period. End of discussion.

You can't change your mind?

Wow.

What have we come to?

So what, if a parents wants to change their mind the Ethics Committee will get involved? Or is the parent supposed to go to a coat-hanger doctor/veterinarian to get the baby out? Or give birth in the forest where no one can see?

At least that's what this person told me a parent needs to do to avoid the wrath of consequences of the money making machine our unit is...

I guess, what bothers me about this whole thing isn't necessarily "are we playing God?" or "who are we to decide?" Each case is different, each unique and quite frankly medicine isn't as advance as we all pride ourselves to believe to truly make a good decision (sorry to burst anyone's bubbles here).

But, as I am on a brink of becoming a parent myself, it really bothers me to see that many people can overstep a parent's decision when it comes to taking care of a child. The Ethics Committee can get involved, the DA, accusations pour from left and right, an accidental bruise already equals an investigation in the ER. People who have never been a parent put their noses into parental issues that they have never had to deal with themselves.

I am in agreement with questioning parental decisions when a parent is delayed or has obviously been presumed incompetent due to whatever issue in court, but what about parents who come from the street who get accused of abuse after their child has suffered a concussion after falling off a trampoline? And yes, I have seen real cases of child abuse, where comatose, beaten half-to-death children are dying while the family's attorney is fighting to avoid taking the child off life support. I've seen it, and the horrible aftermath and police and security and pain. But those are obvious. Most of these aren't as obvious.

Case in point, I saw a parent once get accused of abuse. Her son passed out at home, had a seizure and she brought him in to our ER. Of course, a CT was ordered and they found, low and behold, small hemorrhagic foci throughout his brain. Classic sign of child abuse due to blows on the head. The doctor said nothing to the parent, and instead contacted the Child Protection Services. The next thing you know, parental rights were taken away, the child was admitted to the hospital "for further testing" while the counselor was looking for a foster family.

His mom was baffled? She couldn't understand. She is losing her son. Any day now. And for what? For bringing him to the ER. Her husband was in tears. Why? A week later (at this point, I had the patient), mom finally decided to help her child and after her insistence for several days, they did an MRI. And guess what? Found that he had a neurological disorder classic signs of which are those precise hemorrhagic innocent foci that sometimes progress to seizures.

Miraculously, the charges were lifted in one day and he was discharged home a week later on meds.

And now you explain to me. Where is our focus here? What do you think?

Smelly t-shirt

2011-04-26T00:02:00.000-05:00

My friend J is having an adoption party for her daughter on Friday. Meaning, her second husband has officially adopted her 10-year-old from a previous marriage. Aside from her husband being a fantastic father to three kids of their own (youngest being 2 months), he has chosen to take upon himself the great task of being a father to a little girl; although I'm sure if you ask her, she could hardly tell the difference in treatment between her brothers and her up until this point anyway.

So I wanted to get her a gift. One she really wanted. And according to J, she's been begging for a "smelly t-shirt" like all the popular girls at school. She heard they sell them at Justice.

You know, the first thing that hit me when I walked through the front door of that store was, "did I really enjoy all this stuff when I was in middle school?" Calling the clothes tacky would be an understatement.

And then it hit me. This is going to be what my own daughter might like years down the road...

Then the sales lady pointed to the huge table of stacks of t-shirts of all sort of colors.There were many that smelled, including this one. For 4th of July.

I got her the cutest 4th of July t-shirt with a cupcake and confetti on it, that smelled like a cupcake (and confetti). Well, my pregnant nose smelled old glue mixed in with some brown sugar, but to a 10-year-old the popularity smell of this item probably smells like my Chanel perfume.

As long as she is happy!

Happy Easter!

2011-04-24T12:15:00.000-05:00

Source

Happy Easter, everyone! :)

2011-04-23T19:20:00.000-05:00

Yay!

I'm not a huge fan of pink, I have to say, and I haven't even started looking for anything for baby - 20 weeks is too early, I think - but man, couldn't help by notice how much more stuff is out there for girls than for boys. It seems like boys' clothing ends with blue. Girls can do purple, pink, stripes, dresses, sun dresses, suits, pants, t-shirts, overalls, rainbow, yellow, green, everything! And the ruffles and the cute hats (I think those bows they take pictures with are SO underrated). So I'm pretty excited to start shopping. :)

On another note, I absolutely LOVED maternal fetal medicine clinic. LOVED what maternal fetal medicine doctor does and how much more he has to know than a regular OB! What a night-and-day difference from my regular OB! :))) I couldn't stand my OB rotations, deliveries and c-sections as a nursing student, but I looooved this! So complex and SO interesting!!! :) Hm... maybe I gained a renewed appreciation for obstetrics...

However, MCAT awaits. Back to reality.

Empty

2011-04-20T13:01:00.000-05:00

I feel empty.

I wake up at 11 am daily, unable to separate my eye lids any earlier despite going to bed before midnight. I try to get comfortable on my body pillow,

I so much wanted for a while and one I am still learning to appreciate. I toss and turn at night.

I can't go to the gym because my favorite ever elliptical and treadmill are painful to use. And swimming takes 2 hours out of my time that I don't want to waste.

Pages of notes, problems and information are spread around my study table. I love organic, it's easy for me, but the thought of getting it done seems repulsive.

The remembrance of yesterday's class on EKG's by our unit advance practice nurse, and her brave attempts at explaining the action potential and Na/K pump made me cringe. I used to LOVE classes. I would use to listen to everyone and everything - soaking up knowledge like it was the last piece of information I would learn before I die. And now, it seems stale, like yesterday's bagel from Einstein's Bagels.

I try to cheer myself up about Friday - that's when my husband and I will find out the baby's gender. Isn't that exciting?! But in reality, I am slightly nervous because besides knowing what's in between its legs (or not), we'll know whether it's healthy or not.

And then again, my husband works endless hours because his project needs him, so he'll have to go to work right from the doctor's office. He can't work from home. It's lonely in these 4 walls without any sun, with wailing wind between the slightly opened windows and the neighbor's dog barking - he's alone, too.

And now, I felt the baby kick as if saying, "it's all gonna be ok, mama, you're not alone, I'm here."

my mini breakdown

2011-04-14T13:51:00.000-05:00

"mini" is an understatement...

Had my regular appointment with my OB doctor today. Here's roughly how it went.

He rushes into the room 2 hours behind schedule... quickly appologizes with a smile, "where is the day going, seriously? I'm sorry I'm so late."

I'm barely awake because I work nights and this time for the morning, ahem, now almost early afternoon, is sleeping time for me. Of course I say "it's ok, the break from life in a quiet room is welcomed." [minus the super uncomfortable chairs for pregnant people, but that's besides the point.]

He smiles, and then I ask my dreaded question, one I had been contemplating on since my last appointment 4 weeks ago:
"So, I know my delivery is far away, but I heard that whoever is on-call that day delivers, right?" And then I start crying. I can't hold my tears. I sit there, trying not to sob like I did this morning before my appointment. I don't know why I'm crying. Probably because I never really wanted to know the answer to my question, or maybe because I already know what it will be.

He knods his head and says, "Yes, that's right. Whoever is on call delivers. My partner will deliver."

And that would have been enough.

But he goes on all of a sudden. "Do you want me to have a divorce? I mean, I have a life, too. I'm not going to come in at 2 am in the morning for your delivery. If my daughter has something going on or rather, I'm not going to be able to come. I don't want to be divorced."

I think my jaw dropped, I was dumbfounded. I felt like I dropped 100-pound weight on his pinky toe. what are you so upset about all of a sudden? seirously?

He goes on: "You know, if you want to see me any more that's fine, you can switch to another doctor. We have a few single doctors in the practice, who will come in for every patient. I just can't do that. I mean, my partner will deliver my patients and there have been patients who were my patients who switch after he delivers them and visa versa. But I cannot come in for every delivery."

And on: "See, like next week I have 10 patients delivering and I'm going on vacation. I'm NOT coming in for those patients. I have a family, I don't want a divorce. I wouldn't plan on me doing your delivery, I can't promise you and I wouldn't expect it."

I think he said something more, but I was so scared to look him in the eye, I hadn't followed his gaze for a few minutes at that point.

Really? All that triggered by my single question? (that I'm sure he gets all the time)

I told him I understood and respected his decisions and it was totally fine and I didn't want to switch to anyone else. Period.

BUT.

I also told him that I realize all physicians want a life, there's nothing wrong about it. I'm a product of a family where the word "on call" brings goose bumps at the Christmas dinner table and fun trips get put on the back-burner because mom's on call or dad's on call. Whatever.

BUT.

I have never heard my parents tell their patient(s) or their coworkers that they didn't want to take care of them because they "wanted a life" or because they "didn't want a divorce." Wow. Of course, I get it, nobody wants a divorce or to come in at 2 am for something. But I would never have the nerve to tell my patient that. I've come in on my own time for more than one patient before. And I know my parents have come in outside of their schedule at times for someone.

I guess he was preaching to the choir. And I guess my parents practice medicine differently from him. But that's yet another example and lesson in life I've learned. Albeit a hard one.

BUT.

I do have to say I respect him for striving to make time for his family outside of work. That's something both my parents, my grandparents and my father-in-law do not do. And my hat goes down for him and his wife and daughter.

Diaper Cake Adventure

2011-04-07T13:56:00.000-05:00

Even though I am not going to get an Oscar for this cake, I want to thank profusely Best Baby Shower Ideas and their wonderful directions without which my cake wouldn't have happened!

Our little favorite baby is finally going home!!! And since her mother never had a baby shower, we as primary nurses decided to throw her one!

And then this idea crawled into my head one Saturday night... I have always wondered how people made it and now I made it myself!

According to the directions I had to get:
- 50 diapers (I ended up using around 60-65)
- rubber bands
- double sided tape
- a serving tray for the bottom
- some toys to insert once the cake is done
- flowers for decorations

my diapers*

*I have to note that using size 4 diapers (for a bigger baby) kind of screwed up my colors. Normally, newborn diapers are plain white and don't mess up the color scheme, but these have little blue clouds on them, so I had to find colors that meshed well with this. If using just plain white ones... rainbow colors are your guide!

You roll up the diaper and then tie it with a rubber band

(on the right)

like so

I ended up buying 2 ribbons (never used the wire), so

make a dual color, this was obviously for a girl :)

the toys and flowers, I ended up not using all the flowers

but it was fun anyways!

it helped to have a sturdy, hard surface underneath to

prevent the diapers from collapsing. The rubber bands

also helped a lot with structure :)

this is how I made my ribbon, putting on the pink

on top of the thick magenta one with double-sided

sticky glue tape

sorta pre-final version

1 of 3

2 of 3

3 of 3

my absolute favorite side - love the flowers!

A Day in the Life of a PICU nurse, Part II

2011-04-06T22:40:00.000-05:00

01:40 - I come back from lunch. The nurse watching my kid tells me that she did great. Nothing happened. Good! :)

02:00 - write down numbers, strip some chest tubes, clear pumps, etc, etc, etc.

02:20 - my patient starts moving around a little. While on a paralytic. Not good. Obviously, she isn't paralyzed, she's in pain, agitated, etc. How would you like to have your chest open, chest tubed all over, with stickers all over your body, a Foley catheter in your urethra and being poked and prodded all the time and feeling all of it? Not so much?

02:30 - I give her another round of sedation: morphine, ativan, hoping it will help. Nope. Her sats now dip a little, her back sats (the renals) also dip, all means, she's poorly sedated (my opinion) or could be something else. She is basically using too much oxygen to accomplish something.

02:40 - Call the fellow on my Vocera: "Hey, my friend in 10 is moving quite a bit. I just gave her some morphine and ativan, but still not helping. Can we maybe do a fentanyl (sedative/pain) bolus or maybe a vecuronium (paralytic) bolus since we're on a cooling mat and moving?" Everyone knows in our ICU is that it's cruel to have someone on a cooling mat and not paralyzed and sedated. Just cruel. The fact that this little one can move, means, she can feel things and is obviously isn't paralyzed or comfortable.

Fellow walks in: "Ok, let's do fentanyl and vec." I call the pharmacist and in a few mins he brings both. Given.

03:00 - time for numbers, the patient is better, sats are back up, she isn't moving around and renals have returned to baseline. "Great," I thought.

04:00 - an hour passes by, I do my numbers, empty chest tubes, sit around munching on some candy and then see that sats are slowly creeping down again. This time, she's not moving around, seems pretty well sedated. Hm...

Usually, if the problem isn't sedation, then it's physiological. One of the "biggies" of fresh post op Norwoods is the shunt closing off, meaning, the heart can no longer circulate blood. Children generally tend to compensate for almost anything a lot longer than adults, so once they crash, they crash fast and hard.

04:10 - watching the monitors, checking pulses. The trends are still in the wrong direction - lower sats, higher heart rate, lower blood pressure, lower renals... I am now wondering about the worst.

04:11 - I call the fellow again. Poor guy will never get to sleep tonight. "Hey, my numbers are trending downward and my filling pressures are going up, my heart rate is junctional, I still have a murmur, my renals are worth crap... can you swing by?" Almost immediately he's at the door, rubbing his hands with hand sanitizer.

"Let's see what we can do here." He listens to the heart, the lungs, looks at my numbers. "Definitely a trend in the oppsie direction. But the murmur is still there." [absent murmur is a sign that the shunt is closed or pretty much closed = not good.]

Calls the attending.

04:20 - stat beside echo. Possible reasons: shunt clotting off/closing.

04:22 - cardiology fellow at bedside with his huge massively unattractive machine. In the middle of his procedure the overhead goes off:

"Attention all hospital personnel, code blue, room 682, North Tower. Attention all hospital personnel, code blue, room 682, North Tower."

"Oh, lovely. K, hope you aren't carrying the code beeper!" the critical care fellow tells me with the smirk.

"Nah, I decided one was enough today." Half praying that my patient was ok, and half wondering how I would run up several flights of stairs pregnant.

The patient's shunt ended up ok. Luckily for me and everyone else involved.

"How does the bleeding look?" I asked the fellow. "Is there enough for a nice tamponade?" Not that I wanted to throw it out there, but it was certainly a real possibility.

"A lot of blood. Still oozie, I see it..." said the cardiology fellow quietly studying the echo in the dark. His hand still on the chest of the patient, he muttered: "Blood and lots of it. OR in the am for sure."

05:00, 06:00 passed by unnoticed. Busy between chest tubes, drips, vent alarms and suctioning, I didn't realize 07:00 was almost here and I needed to prepare paperwork for OR.

07:00 - a ray of sun light streamed into my patient's room hitting the pre-op checklist the OR nurse was diligently filling out. By the time 07:15 rolled around, my patient was getting rolled into the hallway, on the way back to the sterile blue-green haven of drapes, machines and bright lights.

And I went to finally sit down and recap the night to the oncoming day shift nurse.

08:00 - walk into my apartment, half-dazed, half-awake, wondering if there's some food in the fridge or something. A yogurt would do.

08:10 - take a warm shower, almost afraid to close my eyes, wondering if falling asleep right here was a possibility.

08:30 - crawl into my soft 400-count Egyptian cotton bed sheets, blinds drawn and although it's not complete darkness in the room, it's still ok with me. I love my bed, my sheets and my sleep. I breathe in the shea butter body butter I had just put on my chapped hands and doze off to dream land.

Wondering what would happen the following night.

Registered (interlude)

2011-03-29T10:31:00.000-05:00

for the MCAT. For June.

Again.

Hopefully this time is the last.

Granted. I'll be 27 weeks pregnant. I can picture my stomach walking in the room before me, the pre-meds snickering "who got you knocked up?" or something like "you are never gonna get in like that."

I wonder if they'll let me sit by the door to save time on bathroom breaks? Hm...

But unfortunately, in my all-famously-cheese-country-rural state, whose Governor's new bill is taken to the Supreme Court, no dates are available in May. None. None even in my neighbor city of Chi-town. I could go to San Antonio and take it any time in May... but I figure it's kind of a long trip, plus we're going there for Memorial Day anyway. Probably.

I consider it a personal challenge to conquer this test not only out of school for many years, but also pregnant. Think it crazy, think it stupid, but I'm biting the bullet and doing it. With a smile. :) Kinda like I do most things. :)

A Day in the Life of a PICU nurse, Part I

2011-03-27T14:23:00.003-05:00

Well, a pediatric cardiac ICU nurse to be exact.

Flippinsweetgear.com

I "stole" this idea from Mothers in Medicine blog because I thought it would be fun to write about my work.

*I work night shift... so my "day" starts at night! hehe.

16:30 - phone rings. I roll over to see who, barely awake, my eyes trying to render an image of my cell phone. An "all call" in a robotic voice from the hospital asking for "help tonight", "all night" because we're short staffed. What else is new?
17:00 - I slowly get up, shower, eat, talk to my husband...
18:30 - get out of the house, down into the garage, turn on some music, say a quick prayer for my patients tonight and cruise into work.
18:45 - drive into the parking lot, drive up to the 1st level, park. Take the stairs to 2nd floor skywalk.
18:50 - walking through the skywalk, greet a doc or two who's going home (lucky!) and maybe a pt's family.
18:53 - clock in. Put my Columbia jacket in the locker. Bathroom. Water break. Report room.
18:57 - make small talk with the girls, who is getting married, having a baby, who is sad, happy, annoyed, didn't sleep, or slept too well until charge nurse walks in.
19:01 - our supervisor walks in (who is charge tonight), everyone is quiet, report begins.
19:03 - charge nurse reads off report sheet: "... room 2 is empty, room 3 got extubated today, doing well, room 4 needs to ECMO techs ... room 10 is rolling in from the OR in 10 mins, fresh Norwood, open chest, a [million] drips, bleeding, needs cryo, FFP... doing allright, room 11 nothing new, room 12 going home tomorrow ... room 20 doing well, room 23 coming from transport, don't know what is yet... ok everyone ready?"
19:05 - everyone divies up their patients. I take room 10.

Go to my room.

19:10 - nurse is still in room, writing stuff down on our ginormous 8-pg-fold-out flow sheet [we still have the archaic paper charting]... pt's BP doesn't look so hot, as I see from the monitor, well and the towering tree of drips, too, but it will be alright. I have 12 hours ahead. :)

19:15 - I get report: 2 wk old Norwood, came from the NICU, was on prostaglandins [to keep the PDA open], in the OR had 3 pump runs [means was put on bypass 3 times = not good, means they had issues], lots of bleeding, left chest open, patch is sort of bulging, but last time I talked to N [our day attending] they weren't going to wash out yet, maybe tonight. Alright, systems.
Neuro: vecuronium [a paralytic], fentanyl, versed drips [both sedation]. You have PRN ativan, morphine, versed, vec and fentanyl boluses [nice buffet of sedation and paralytic meds - makes PICU patients and nurses happy to have!] I gave morphine last at 16:00 and ativan at 17:20.
Cardiac: paced DDD [means both atria and ventricles are paced by an external pace maker], went into SVT, we override-paced for a while, ice, did fine. None since (that was when he first came back), otherwise, BPs ok, on epi of 0.2 [pretty hefty dose for the 4 kg pt], norepi, milrinone, epi dwindle at bedside, loading dose of amiodarone there, too, didn't give it. Renals in the 60s, cerebral sats in the 80s, doing ok. Has a muffled but obvious murmur, chest tube output has been 20cc/hr from mediastinals, about 30 cc/hr from pleurals [that's a pretty hefty amount of blood for a baby], cryo is going in at 20cc/hr, FFP is running into your PIV at 20cc/hr as well. Should be done in 2.5 hrs, ask them if they want whole blood. Your RA, LA and CVP has been ok, hovering around 7-8 [good, because all of those are filling pressures in the heart detected by small lines the CV surgeon puts in, we use these numbers to determine if the pt is fluid overloaded, dehydrated or if bleeding is so severe inside the chest that we need a quick wash out. We also generally look for trends or just a specific number, but it's good when they all stay below 10].
Repiratory: you have a 3.0 ETT, not-cuffed, 12 cm at the nare, retaped after OR, not a lot of suctioning, your settings are 25/5, pressure support of 10, respiratory rate of 15, latest gasses were good. Not a lot of suctioning, although they said in the OR they suctioned a lot.
GI/GU: NPO [not eating], ok urine output, 3 cc/kg/hr[you want at least 1cc/kg, which this kid is 4 kg, so your immediate calc says it's a little on the low side, probably due to poor end-organ, aka: kidney perfusion, fresh OR stress and 3 pump runs, :(], they know about it, they want to know if it falls below 2 cc/hr.
Skin: I got the die off, but it might be nice to get his back a little. I haven't had time, sorry.
Lines: you have a right IJ, double lumen, your TPN and drips are in 1, CVP and medline. He has a R hand PIV where your cryo is running, a L hand PIV where your FFP is running, a L foot PIV that flushes well, where I sometimes gave morphine when the CVL is taken. Your R foot PIV has your Lipids and Lasix drip. Questions?

19:20 - got report, checked orders, sort of. Before the nurse leaves, I enter the room to check drips.

19:30 - concentrations, rates, doses and PRNs all match the orders, all is well. Dayshift nurse can go home (she was a good nurse, too, which helps my speedy report and all things matching).

source for both of the above: Children's Hospital Boston

Johns Hopkins

19:40 - listen to my patient, look at him. I million things run through my head pulses are good, lung sounds clear to slightly coarse, murmur is loud, good, ETT checked, correct placement, CT gauses are still occlusive, the patch looks alright, but bulging just a slight tad on the right side, urine straw-colored, scant, but he's still peeing. I strip some chest tubes before doing labs at 20:00. Chest tube stripping is important because those tube evacuate blood from the chest cavity and most importantly from around the pleural space of both lungs. It's the nurse's job to make sure they are draining well, consistently (obviously the less the better), but you don't want them to clot, especially since we're giving clotting factors to stop the bleeding. If a chest tube clots off prematurely, you risk blood backing up into the chest/pericardial/pleural spaces and can cause compression, poor ventilation of the lungs, or contraction of the heart and the patient may code (you'd notice it before then, but just giving an example).

19:50 - prepare all my labels, do labs at 20:00 off my art line. CBC, auto differential, metabolic panel, clotting times, blood gasses, mixed venous oxygen saturation, etc.

20:00 - labs sent off, hourly numbers written, drips cleared, urine dumped, chest tubes stripped, time to chart my assessment and wait for evening rounds.

20:15 - evening rounds. attending. critical care fellow. cardiology fellow. hospitalist. Looked at the flow sheet. Fellow: "um... urine output still sucks... how bout we go up on the lasix drip to 0.5? ABGs from 20:00 look good, BP is ok. how's the bleeding?" he asks.
"Slower, but still a lot," I say.
"How fast is our cryo and FFP going?"
"like 40 cc/hr total for both"
"Let's give a unit of whole blood once one of your lines is free, he's losing a lot."
"How does that patch look?" asks the attending.
"eh, kinda crappy on the right side... but it's holding on"
Attending enters the room, looks at the patch, sorta pokes around. "let's call surgery to look at it, looks a little bulging."
"Sure, let me page the PA on call," says the fellow.

20:40 - they leave. I put a "transport order" for my ordered whole blood, change the lasix order on the behalf of the fellow and go on with my numbers.

21:00 - write down my numbers, clear my drips, etc. Surgery PA comes in. "Hey, K, how's it going?"
"Hey P, fine, just hanging out, doing my thang."
"So what's up with this patch of ours. Hm... looks kinda big to me... let's see, maybe we should wash out, how does our PTT look like?"
"Um, shitty."
"Did you guys give Factor 7 yet?"
"Well, I thought they gave it in the OR... but I think our team hesitate because of the shunt... don't want that thing to get a clot in it... hoping the bleeding with subside with the cryo and Platelets."
"Um, ok. Let me call Dr. E to see if he wants to wash out."

21:30 - PA comes back, tells me they are gonna set up for a wash out, meaning mini-OR (as we call it on the ICU). They will remove the patch and suction out all the excess blood, or sometimes they will put in a pig tail chest tube (very very tiny) and have it drain outside of the patch if the pt is bleeding really bad.

22:00 - drapes all set up, the OR nurse puts the OR hat on me on the back, surgery PA is here, CV surgery attending is here, he'll operate, PA will be the first assist, OR nurse at bedside, anesthesiology attending and fellow at bedside managing the vent and drips, cooling blanket out of the way, I put up procedure curtains outside the room, they get started.

22:40 - they are all done, I'm catching up on orders. The unit secretary brings me my whole blood. I double check it with another nurse, drawn up with all the necessary filters, give to anesthesia, they put it on the pump where FFP used to be. The fellow comes up to me, puts a hand on my shoulder, says he put in another order of Platelets after whole blood is done. "Let's tank him up, shall we?" with a grin he leaves.

22:50 - I get a call for a critical potassium level. Call pharmacy to give me a replacement. 1 mEq per kg stat.

23:00 - I write my numbers, start my potassium replacement that our lovely efficient pharmacist already brought to me (even though I called only 10 minutes ago!).
Anesthesia gives me an update. "Kid is all washed out, I gave him vecuronium [paralytic] and some morphine beforehand, lost some blood (sorry, we made a mess on your floor), I pushed the rest of my whole blood, so that's done, patch is better, we suctioned out 100 cc of blood from around the patch, added a pig tail chest tube, hopefully that will help till morning. We will probably take him back to the OR in the morning to cauterize the bleeder. Hopefully the patch will hold for ya. See ya."
"Don't worry, man, won't call ya again tonight... hopefully!" I thought for a moment...

23:30 - my blood pressure goes from 60/40s, to like 40/30s and hits some 20s some time. I call the fellow. "Hey my pressures are goin' down in 10, can you come by?"
"Sure, be right there."
He comes in, my renal saturations are low 40s, high 30s (from 60-65s), my arterial sats (pulse ox) is still ok, in the 80%s [Norwoods have mixed venous and arterial blood, hence sats are normally 80s].
He quickly changes the epi dose from 0.2 to 0.25, norepi goes up, too. Pressures are a little better.
"I have epi dwindle if you need it, S."
"Ok, we're fine for now."

He takes a seat in my room, watching my pt, while I take care of business. My pressures seem to have returned to 60s/40s, my renals improved.
"I'm gonna give him his ativan and morphine, if you don't mind. Maybe this is sedation related," I tell the fellow.
"Good idea."

23:45 - sedation given. Renal sats even better! yay! Fellow leaves. Attending swings by.
"So, what's happening?"
"Oh, fine. Went up on the epi, giving platelets, they washed him out."
"Um, ok, sounds good."

00:00 - I'm tired. I'm running around the room, between this and that, I'm already kind of drained. I have another 1 or so before lunch time. Dahgit. I want to go now. I'm HUNGRY. I peek outside my room, "Hey, JP, can you watch my kid while I get some water?" "Sure, dude." My friend, another nurse, comes into the room. "What's going on here?"
I tell him about the kid: "Norwood, fresh post op, just gave a boat load of sedation, should be good for another 15-30 mins." I just need just a min to get water, but with these kiddos, anything can happen at any time.

00:10 - I take huge, large sips of water. I'm sooo thirsty! The hospital dries me out. I don't know how patients live here for days and months. Horrible, germ infested place! I grab a few pieces of almonds from my bag. Even dried out old almonds are better than nothing right now. JP is still sitting in there, watching the monitor.
He sighs "Dang, poor kid..." as he exists the room.

00:30 - keep pulling blood through my chest tubes, keep making sure they're patent. Keeping up with urine output, drips calculations and making sure it's all tit-for-tat. Then my vocera goes off, "Can you talk to A?" "Yes" I say while writing down my latest numbers. "Hey, when do you want to go for lunch?" A asks.
"Um, whenever, like soon though... I'm starving."
"Ok, well, my kid's alright now, wanna go after our 1 o'clock's?" [meaning after we write down all of our numbers respectively? lol - my life revolves around paperwork!]
"Sure, I'll meet you in the back 5 mins after."
"Cool, see ya."

My friend A read my mind, as always. She knows when I'm hungry!

01:00 - I write down my numbers and go to lunch!

Initial worries

2011-03-21T13:29:00.000-05:00

When I first found out I was pregnant, I got worried. Who wouldn't?

I didn't want to jinx myself to I didn't buy any books prior to being pregnant. Plus, how is reading about nausea and vomiting while 4 months pregnant helpful to someone in the middle of their period? Not at all meaningful.

But once I took that pregnancy test... a rush of emotions and thoughts rushed into my head. Now what?

There are SO many books out there on pregnancy, SO many websites with tips, tricks and advice, that initially it was really hard for me to put it all together. I still wish there was one go-to place for just the simplest run-down of what to expect, what to do when you have a question about ___ and when to call the doc. Of course, when in doubt, call your OB's/midwife's office.

But the thing is, there is no source out there, unfortunately, that's uniform that will answer all of your questions. Every person is different and, of course, every pregnancy (even in the same person) is different. There are age, race, medical differences and it's impossible to find a book for it all.

It was really hard for me (with a little bit of science and nursing background) to find something I liked. After all, in nursing school and I had a whole semester clinical in OB (labor and delivery and post-postpartum only, no clinic) and I was tested on normal through high risk pregnancies and I tell you, that didn't prepare me for the questions I had either.

As my wits end, 6 weeks pregnant, I came to my mom. Now, my mom is not an OB doctor. She's in peds anesthesia! Totally far away! She kind of stared at me and gave me her old OB text for the USMLE. Ok. I flipped through it. Embryonic development, menstrual cycles, ovulation, blah. Nothing helpful to my immediate questions about slight cramping, small pulling pain... Crap.

But it was informative... if I wanted to take the USMLE.

However, I didn't. I just needed some peace of mind.

So I opened my nursing notes: preeclampsia, 1st semester ambivalence, gestational diabetes, triple screen, ultrasound, amniocentesis. Ok, waaaay out of my question range.

There is Google, right? Wrong. All kinds of scary assumptions by uneducated people. That thought when out the window.

Should I call my doctor? No, they'll think I'm stupid.

So, I called my friend who was pregnant 2 years ago. She recommended the "Bible" What to Expect When You are Expecting. Not a Bible for me. Definitely far from it. Gave me horrible flashbacks of nursing textbooks. It is written by a nurse (or two)...

*sigh* Amazon here I come. I started putting in search words, one after another. I think I hit 1001 books on the topic. Mixed reviews. Hm...

And then I found THE ONE I liked. Mayo Clinic Guide to Healthy Pregnancy. The reviews speak for themselves, but since I already had the What to Expect Book, I was seriously comparing and I loved this one and never touched the What to Expect after that. The Mayo Guide is written by a physician (not going to lie, was a factor for me) and organized completely differently and answered my questions in a compact, efficient, organized method. But even this one lacked some specific details I wanted to know.

So then I found this book: Pregnancy, Childbirth and Newborn. Definitely a great supplement of more detailed information than the Mayo Clinic Guide. This book covers a lot more than just pregnancy and goes into grave detail but again, I don't like how it's organized. Just a little too scattered for me.

I am happy to say I have found my method of reading about being pregnant. When I hit a new week, over breakfast or lunch, I open the Mayo Guide first, read about that week, that month and go through the reference chapter about upcoming tests, what to expect at appointments and symptoms that I will experience. It's a really good, quick 15-20 min read.

Then, I open the Pregnancy, Childbirth and Newborn book to correlate and 9 times out of 10 I fill in the gaps that the Mayo book doesn't give me. I do feel satisfied after reading both and I have to say it makes me so happy and fulfilled that I know what's going on in my uterus and my body.

Probably I sound obsessive, but I am content and happy, and my OB's favorite quote:

"Anything, anyone, any situation that makes you unhappy, worried and most importantly stressed, needs to be eliminated (if possible) from your life."

And I try to live by that. :)

Challenges of a Pediatric Nurse

2011-03-20T12:57:00.000-05:00

1. Communication. When I rotated through adult units that was the biggest difference for me. I mean, really, if babies could tell you what's wrong with them, right? To meet the nursing "standard of practice" (rules that have to follow regardless of whether it's a pediatric or an adult patient) most of the time I have to use some "tricks" to elicit the same information from a baby, that I could simply ask an adult. Naturally, parents are a big help. Unless the child is abused and then what?

2. Which brings me to the next point. Parents. They can be my biggest asset or my biggest pain. They can be so helpful - my problem is solved; or they can be so difficult that the physician and I will be breaking our head for hours as to what can be done.

3. Pain. Obviously you can't explain the 0-10 scale to a baby! Instead we have this chart where we look for certain signs and cues that a baby may be in pain (or a delayed child). For older kids (toddlers) we use these faces. We point and say, "Do you feel like this face? or do you feel like that face?"

4. Medications. A whole another ball game. With adults there are standard doses, with kids it all per kilogram! Even during an emergency. For Pediatric Advanced Life Support (PALS), a certification all critical care nurses and doctors (those who work in the ER, ICUs, Transport, Urgent Care, "emergency type" places) have to have, we learn algorithms on which medications to give, per kilo, and for what. It's quite intense when you first do it, especially if one is coming from an adult background, but it's definitely something you get used to!

5. How to talk to some kids about medications. So I had this kid once in the ER. This poor 3-year-old broke his elbow, bellowing over in pain while waiting for orthopedics to come down to fix it. I asked, "Want some pain medicine for your ouwy?" Ohhh, big mistake! He scwormed in pain, and started to cry.

What I didn't know is that many kids associate "pain medicine" with a shot? Little did I know all I had to say was, "can I give you something that will make you feel better? No ouwies?" He smiled and said "ok." He truly thought I was going to give him a shot!

6. Taking care of an IV. Another fancy way of naming a Peripheral IntraVenious access at the hospital is simply a PIV or IV. Standard of care dictates that I have to flush a PIV, meaning just put some saline through it once to make sure it's open at least once per day or once every 12 hours. On my unit, it's especially important because it's a place for me to give all kinds of medications, especially emergent drugs.

Normally I look for signs of infiltration (meaning the IV doesn't work any more, gets clogged, plugged by a blood clot, etc). PIVs can turn from a simplest tiny plastic catheter in a child's arm to a necrotic wrist in a neonate if not taken care of properly. A nurse's job is to look at the site of insertion and see is it red? Is there a bruise? Does it flush easily? If I flush do I see a bubble above the skin (meaning, it's no longer in the vein, but in one of the layers of the skin)? And lastly, is the child/baby crying (aka: pain) with flushing?

And that's just it. They usually cry. But that doesn't make an otherwise "fine-looking" PIV bad. They cry because the saline is cold and they feel it enter into their tiny hand, so they start to squirm. I learned a trick that if I flush it slowly and warm up the saline in my hands prior to flushing that it helps a little bit. Plus, a hard flush might "blow it" meaning ruin it.

7. And lastly, the art of pediatrics: distraction! Try distracting an adult who is asking you a question and you're probably going to get the middle finger. But putting a TV in front of a fussy child, turning on some lullabies or making a facial grimace while looking straight at the baby might do the trick. Their focus will totally shift and you have yourself a temporarily happy baby.

toddlers. is. a. whole. another. post.

"jealosy"

2011-03-18T17:35:00.001-05:00

Last night my friend Kiera flopped down on a seat in my pod at work and pretended like she had business to do on the computer. Immediately turned around and says,
"You know, it's just not fair."
"What's not fair?" I asked in between charting.

She goes on to tell me a story about a luncheon she went on Wednesday for the co-worker who lost her babies. Kiera is pregnant herself, almost 21 weeks, and is a really sweet girl.

"You know what she told me? In front of everyone, K?"
"What?"
"She said that she's jealous of 'all those pregnant people at work'."
"Ok, so what did you expect her to say, be happy for us?" I sort of laughed nervously thinking: 'It's not all that great when someone has open hatred toward you.'
"No, I just expected her to be a little more respectful, it's not my [our] fault this happened and she can't be so angry with me? She just looked so mad, with this big wrinkle in the middle of her forehead, like she was about to jump up at me and strangle me."

I shrugged. At first, I just kind of sat there, not knowing what to say. Of course, a death of a child, let alone two is devastating and the grieving process takes time and comes in stages, and perhaps our mutual grieving co-worker is in the angry stage... but at the same time... we're both pregnant and yeah, in the "emotional" stage for like 9 months. Who's gonna feel sorry for us for witnessing the horrible incident of a co-worker?

It's easy to chalk it all off to anger and emotions and feel sorry for her, but it's totally another thing when that person attacks you verbally and makes you feel like crap for being pregnant, when in reality you had nothing to do with her situation, you just happen to be in her life at an unlucky moment. I'm beginning to regret sending flowers and donations to her only because I feel like I was a sore thumb that stood out because apparently now she's 'jealous' of me and Kiera.

Great.

Should I stop talking to her? Should I just see what happens?

Kiera is upset, angry and told me that by the looks of our co-worker's face, she thought she was going to stand up and stab her with a steak knife!

Night shift

2011-03-17T13:48:00.000-05:00

Not sure how many more nights I will have to toss and turn until 2 am to sneak a few hours of quality sleep before 5 am rolls around and I wake up yet again. Staring into space. Wondering, how long am I gonna have to work night shift?

Talked with my manager last week. It's hopeless. The waiting list from night-shift to day-shift is like ohh.... 15 people in front of me. Some people have been on the list since 2007. Scary to think I might be doing this dark side thing for another year or two. Unless, of course, half of day shift retires and the other half quits! Ha!

But laying there awake at night rushes so many thoughts into my head... My husband always growls when I turn the light one... Maybe he'll just have to get used to a low light in the middle of night so I can read. I think reading will be my salvation!

It's getting tougher to sleep on my back. My belly is hardly showing, but when I lay on my back, I feel like cantelope just sitting on top of my bowels. Kinda uncomfortable. So I turn to my side and it "rolls" off. My doctor asked me today if I felt the baby kick. It was the most unexpected, but sweetest question ever. I just felt all warm and fuzzy inside... but no kicks felt yet... and he says I have some time.

The other night I turned on my side and watched my husband sleep, thinking how lovely it must be to be able to sleep soundly, quietly at 4 am in the morning. And then it dawned on me. He was in the same exact pose as the baby was on the ultrasound! With his right hand over his head, kind of propped.

and that's exactly how he slept

*sign* genetics, the mother of it all...

To go or not to go

2011-03-06T14:02:00.000-06:00

My friend's funeral for her babies in tomorrow.

I don't know if I can muster up the courage to go.

I just can't do it.

My stomach churns and starts cramping with pain, sorrow and anguish. And it seems all that much more worse when you're pregnant, constantly on an emotional roller coaster, can't sleep (or sleep all the time) and live on bread and lots of water.

So my coping strategy is that I'm not going. My husband and I decided already. I don't know if I would handle this well. In the traditional thinking, I should be seeking closure... but... could I be instead opening a can of worms for myself?

I think it would be one thing if I wasn't pregnant or already had healthy baby(ies). We were the only two girls on night shift pregnant and now it's -1. Just gives me a reality check how quickly a "normal" pregnancy can turn into a "not-so-much."

When I was in nursing school, studying OB, doing my rotation and diligently memorizing the placenta privias, abruptio placenta, multiple births, high risks, differentiating this symptom vs another, I was fully certain if I was pregnant I would want to know what to do, why wouldn't I? But the reality is, I don't. I am always one of those people who wants to be in the "know" sort of speak, anticipate what's coming, be prepared for what "could be" (after all, it is my job description) but now that I'm pregnant, I do understand why people always steer clear of not maybe knowing as much.

It's simple: you get stressed out. When it's a theory out there for "some" pregnant person, it's ok to know. But when it's YOU, you get stressed out thinking. All of the "what ifs" and "maybies" and "nots" scare you. Your blood pressure goes up, your nausea increases, your heart rates goes through the roof and then what? Whom did you do a service by knowing?

That said, I'm not saying one should live in denial.

My OB doctor of 6 years gave me some awesome advice, "Anyone, any thing, any situation that stresses you out - remove yourself, forget it, move on, leave it, don't dwell on it. You cause yourself harm thinking about it and your developing fetus." Well, said. I'm sticking to it.

Conclusively, I can easily identify the funeral as "stressful situation" hence I'm not going. I don't know how to cope with it right now as much as I wish I could be there for my friend. I am hopeful she will understand and not call me selfish... but I just can't handle such sadness right now.

:(

Exactly a week ago

2011-03-04T11:10:00.000-06:00

Exactly a week ago a co-worker friend of mine and I were eating pancakes at breakfast with a few other friends from work. Just earlier that night, she was showing me her new baby cribs, bedding and we were debating which color scheme to put on the walls of the bedroom. The very bedroom upstairs she and her husband were preparing for their two unborn twin boys.

"This one is light green and darker green... but L likes this one more, what do you think, K?"
"Um, I like this one more... I think with your blue turtoise bedding the lighter green would work."

And so on.

She was 23 weeks along and the happiest pregnant girlfriend I've ever met.

Sunday morning came. She was rushed to the hospital early in the morning by L, her husband, who said she was fully dilated and contracting. They transferred her to the university hospital where one of the membranes was ruptured. The delivery was eminent... but by the time they were done, her cervix contracted back to 2 cm and eventually closed. The storm seemed to have passed.

Monday afternoon she delivered the first baby. 1 lb 3 oz.

And I didn't know. I thought it was all better, so I called Monday night from work, quietly wondering how it was going. She couldn't stop crying, barely being able to tell me that she lost the first baby. Devastated I couldn't help but cry. But she said, her voice half-way breaking, that he's in a better place and although all the interventions were offered, "you and I know better," she said, and "his quality of life would suffer, so we chose to just hold him."

Just Friday morning before breakfast - 3 days prior - she was talking about her fears of losing one of them, or having them stay in the NICU. And now it happened.

I hung up the phone, my own belly was cramping... I felt dizzy and couldn't see a thing from tears running down my face. I needed to tell someone... I needed a friend. But our shift had recently started, people still still busy checking drips, getting updates. Instead I ran into one of our fellows on the way to the bathroom. I told her the news. She gasped and put her hand to her mouth, gave me a hug and told me to tell our mutual friend hello next time I call.

I didn't get to call.

On Wednesday night, she lost the other baby.

They couldn't stop her contractions. They are still in the L&D room as I type this, with both babies at their side. A mutual friend and co-worker is collecting for a fund for the March of Dimes and flowers for the funeral.

My heart goes out to her and her family. They are just devastated. So for all those who read this, I ask that you please pray for their healing.

Her babies are in a better place, with angel wings attached, they are probably helping God make the most important decisions up there.

A little secret

2011-02-28T13:29:00.000-06:00

So, I've been hiding a little secret. Well, a big one, actually.

I'm pregnant!

I just wonder how many dirty-raised-eye-browed premeds are going to give me the stare down when I walk into that test center in April. I'll be 5 months pregnant. Can't wait for the bathroom competition, but I have to say I'll have to train myself for the peeing schedule as much as I'm training for the timing on the various sections.

As exciting as it is to finally be part of my long-awaited dream [of having a baby], I find myself scared, happy, nervous, excited and calm all at the same time. And I'm still pretty much hanging out at the end of my first trimester, so it's not the most happy and comfortable of times, I tell ya! I am also lucky this didn't hamper my studying one bit. Minus a few extra naps here and there!

I'm lucky that my forgetfulness spreads to literally all things outside of my MCAT. I usually forget what I came in the room for or return to the grocery store twice to get "that thing" that I've forgotten, aka an essential ingredient for dinner. My morning sickness isn't so bad (never was, luckily) and ends up usually tied to the time I take my prenatal pills. The being-sleepy-all-the-time part, definitely blends my day time and night times together, but who said I have to do this for a long time?

Hopefully, I'll have much more updates in the future.

Blizzard, part 2

2011-02-03T14:00:00.000-06:00

I lived through the biggest blizzard ever! And here are the pics!

the snow hurricane outside!

The pizza guy still delivered to us!

Me outside next to the snow pile!

In the morning after the blizzard on my way home

Snow plow vs the snow pile

Some serious snow plowing

our back door of our apt

I SO couldn't get into my apt from the back unless of course I tried to dig a tunnel

Not goin' anywhere...

the frog exhibit

2011-02-01T15:15:00.000-06:00

A friend of mine from work is moving to San Diego in California. She originally moved here for med school from California, ended up not liking med school (actually she hated it) and started nursing school after 1.5 years of negativity in med school. Now, she is a successful, married woman who is an outstanding nurse and will probably be an outstanding nurse practitioner one day. She loves her job and decided to start a family and a new life back home in California. So, blizzard and all, they are starting out their drive tomorrow in all this snow!

So us girls decided to throw her a surprise birthday party/going away party and went to the Frog exhibit at our local museum. We had so much fun. Here are some pics of the toads, froggies and such!

Some creepy-looking, yet innocent frogies

My friends

This frog lives in this leaf and hides that way from the predators (I'd say the fact that it's "hiding" and where it's "hiding" is pretty obvious!

These are poisonous frogs... this thing was running toward my camera (hence blurry) because I guess it was trying to pose for me!

A cutie

This thing was seriously huge!

My friend's husband trying to play with the sea lion (who was actually behind glass & he was a stuffed, aka: not alive)

a Thank you

2011-02-01T14:57:00.000-06:00

I am so excited to announce that my blog was included into "60 Excellent Nursing Blogs for Exploring Other Specialties!"

From NursingSchools.net

I think I should write more about my work, but honestly my biggest impediment has been HIPAA. I try to adhere to all the rules and many of the patients we have at work and I get to take care of are SO unique and brought from various corners of the country that it's hard to write a good story without some of the unique identifiers because it wouldn't be exciting or fun to read (or as interesting). I will try to improvise and write more as I'm sure people would find peds cardiology ICU interesting if I shine the "right" light on it.

Blizzard

2011-02-01T14:50:00.000-06:00

Wherever you live in US if you haven't heard that the Midwest is getting blown over by a blizzard, then you probably live in a cave or never turn on the TV or the radio.

We have had snow before, we have had lots of snow before, but it has certainly been a while since we've had THIS much snow. I dare say, I haven't ventured outside yet only because the wind is howling and the snow is blowing... but I did manage to snap a few pics from our apartment, behind closed doors and no wind blowing in my face. :) I think right now we "only" have 10 inches out of the promised 20". I pray and hope this is my last winter in the Midwest!

Hanging off the top of our roof!

Snow bank - see the inches!

Zoomed out

One giant thing!

And yes, ladies and gentlemen, I have to drive in this to work tonight. And no, we don't have the "snow days" concept at my job. Obviously.

The Bachelor recap

2011-01-24T22:35:00.000-06:00

I find myself hooked to the show "The Bachelor" on ABC. I mean, really, a bunch of cute girls and a guy (whom I honestly don't find all that attractive but he's ok). They are all SO into him and are fighting their way in like cats and dogs, or excuse me, clawing their way.

Brad Womack - the Bachelor

I first got hooked on this string of shows when a friend told me that Alli Fedotowski (on "The Bachelorette") went to Turkey for one of her dates.

Alli Fedotowski - the former Bachelorette

Since my husband is Turkish, I had to watch the episode to see where they went and what they had done. Since then I have been hooked! My husband, too! We sat down one night and watched like 5 episodes online and then were religiously following the show until the end! It's so addicting... The gap between her 2 front teeth was slightly bothersome, but since I had my guy favorites, I managed to look past it. She had a good TV personality, though, which is everything when you have your own show!

Anyway, back to Brad Womack, the current bachelor. If you do follow the show, what do you think of these ladies? Any opinions?! Would LOVE to hear it!

Alli - she seems pretty cool, calm, not psycho like *some* people (later on that!)

Ashley H. the dentist - she seems a little psycho-possible obsessing over every detail, but maybe she really likes him... or is she just obsessed because she is used to being successful and this is just another challenge that she has to win?

Ashley S. - I really like her, she seems like a nice girl. She really reminds of one of the girls I went to high school with when I lived down in Arkansas - so down to Earth and just cool as can be. I like her!

Britt - I hope Brad knows this girl better than I do but I haven't really seen much about her... so don't have an opinion, but she's pretty...

Chantal - I like this girl a lot. She is my #2 or #3. She seems sexy, fun and just interesting. She doesn't fight with people and from what I can see genuinely cares about winning Brad's heart.

Emily - I LOVE, LOVE, LOVE this girl. I loved her from the day she walked out of that Limo. There is just something so classy, calm, nurturing about this girl that makes you want to picture her baking cooking for the kids in the afternoon and making a giant, delicious dinner every night for her husband. I loove her southern accent and I think she would be a great wife to anyone! She is my #1!

Jackie - eh, I think she's ok. Nothin' special.

Marissa - my good friend's name is Marissa. That's all I can think of when I see this girl. She seems nice, but doesn't say much...

Michelle - this girl is NUTS. Absolutely, undeniably, clinically, physically, emotionally, publically, INSANE. I really hope Brad reviews the private videos shot of her before he makes his final decision. I mean, she's crazy. She is obsessive, like I-am-gonna-kill-you-if-you-take-brad-from-me kind of gal. She is very unstable. Very. Watch out world. I think he's keeping her on the show for drama purposes. Totally.

Shawntel - I think she's kinda pretty, the deep set eyes with curvy eyebrows kinda throw me off... But she seems to like Brad and she seems pretty cool... But in the eh kind of way.

Lisa M - I like her sponky personality but I feel like I don't know her...

So what's your verdict? Who do you like/not like?! :)))

Packers won!

2011-01-23T23:20:00.000-06:00

Despite the cheese hats and the big beer & cheese bellies! Yay! And they even beat the rival team Chi-town Bears! woohooo!

2011-01-22T12:18:00.000-06:00

In case you don't live in Cheese Country, you might want to know that the Green Bay Packers are playing tomorrow at 2 pm Central Time (who I'm not sure!). I went to the mall yesterday and saw the most interested outfits on people showing their Packer spirit. I mean how can anyone by proud of wearing a big piece of cheese on their head? I mean, really? (For the record, my vocab for "football" is "soccer" in most other people's).

from Google

After being invited to 4 game-watching parties, I decided I'm staying home after all. With a big cold, a stuffy nose - I don't know anyone wants what I've got, even if it means sharing some cheese and bratwurst while screaming "Go! Pack! Go!"

Missing my family

2011-01-07T13:02:00.000-06:00

My posts have been scarce to say the least. MCAT studying is on full force, so are the terrible blues in missing my family, my warm, sunny San Antonio home and my husband.

For new year (after I finished a marathon of working all of Christmas) I went to visit my parents in San Antonio, Texas. I don't know why but for some reason I miss them SO much more than usually. I also absolutely fell in love (more than before) with San Antonio and many of the surrounding areas. My mom and I took road trips to a couple of places around the city, in the city and I even interviewed for a nursing position. I looooved hanging out with my mom who has a lot more time now and for the first time we really got along the entire time. She looks sooo good! She is rested, not tired, not overworked and not running on a few hours of sleep. She feels sooo good and I am SO thankful and happy for her.

I absolutely loooooved the weather, despite being slightly "cold" for the locals. Loved the shopping and feel like I live in the village right now. Bought my first Texas Longhorns hoodie and my first set of cowboy boots. After returning yesterday night to this freezing cold weather, snow, gloomy days and no sun. It's been 12 hours and I STILL cannot get warm.

Today is Eastern Orthodox Christmas (the church is still on the old Gregorian callendar) but the concept of our Christmas is just like the traditional Catholic/Methodist/Protestant/Baptist, etc Christmas, just on a different day. Eastern Orthodox are usually people from Russia, some Armenians, Serbians and Greeks. So for Christmas Eve (yesterday) my mom and I went to the Greek church yesterday (we were there at this time yesterday!) and got some holy bread, holy water and a blessing from the priest. I prayed so hard for my MCAT and that 2011 would bring good things for my family.

2011 is here and my resolutions are simple yet so complex (for me anyway)
- Finish with the MCAT (aka: finally get a good score)
- reunite with my family in Texas

For right now, I'm totally alone at home until early February. My husband is doing his Turkish military service in a southern city. They don't have hot water, no heat and he can only call me when he has a few minutes early in the morning (between 5 am and 6 am his time). At least the food is good. I am so hopeful that he'll make it out of there ok, safe and with minor problems if any.

Sorry for the sour post...

"The Christmas Shoes"

2010-12-22T13:09:00.002-06:00

"The Christmas Shoes" by Newsong is my Christmas favorite. Of all times.

It was almost Christmas time
There I stood in another line
Trying to buy that last gift or two
Not really in the Christmas mood.
Standing right in front of me
Was a little boy waiting anxiously
Pacing around like little boys do
And in his hands he had a pair of shoes.
And his clothes were worn and old
He was dirty from head to toe
And when it came his time to pay
I couldn't believe what I heard him say.

Sir, I want to buy these shoes, for my Momma please
It's Christmas Eve and these shoes are just her style
Could you hurry Sir? Daddy says there's not much time
You see, she's been sick for quite a while.
I know these shoes will make her smile
And I want her to look beautiful
If Momma meets Jesus tonight.
They counted pennies for what seemed like years
And the cashier said, Son there's not enough here
He searched his pockets franticly
Then he turned and he looked at me.
He said, Momma made Christmas good at our house
Though most years she just did without
Tell me Sir, what am I gonna do?
Some how I gotta buy her these Christmas shoes.

So I laid the money down, I just had to help him out
And I'll never forget the look on his face
When he said, "Momma's gonna look so great."
Sir, I want to buy these shoes for my Momma please
It's Christmas Eve and these shoes are just her style
Could you hurry Sir? Daddy says there's not much time
You see, she's been sick for quite a while.
And I know these shoes will make her smile
I want her to look beautiful
If Momma meets Jesus tonight.
I knew I caught a breathe of heaven's love
As he thanked me and ran out
I knew that God had sent that little boy to remind me
What Christmas is all about.

Sir, I want to buy these shoes for my Momma please
It's Christmas Eve and these shoes are just her style
Could you hurry Sir? Daddy says there's not much time
You see, she's been sick for quite a while.
And I know these shoes will make her smile
And I want her to look beautiful
If Momma meets Jesus tonight.
I want her to look beautiful
If Momma meets Jesus tonight.

"Christmas Shoes" on YouTube.

dreaming

2010-12-17T12:23:00.001-06:00

"In life, there's nothing more valuable than family time. And no better place to spend it than Texas."

My thoughts precisely.

Dreaming of my warm, sunny vacation at my parents'.

Photo courtesy of an email from who I'm not sure.

"Pregnant Chicken"

2010-12-14T14:13:00.002-06:00

A friend sent me this link on FB for a good laugh. Passing it on to you.

I think these pregnant photos take things to the next level. Seriously.

Holiday cards dilemma

2010-12-14T14:05:00.000-06:00

So I've been getting holiday cards in the mail from a bunch of my friends. Already. It's not even the week of Christmas! Some cards are really pretty - with people's pictures, some are hand-crafted, one card was in the shape of Santa's head. I mean, pretty cool stuff.

Then another friend posted this extravagant post on Shutterfly's holiday post cards. I went to the website and was seriously overwhelmed by all the choices! (and prices) Should I get the big cards, the folding ones, the one-page ones, make them myself or buy the 100-card set from Sams or Target and send them to anyone, everyone?

What are you doing this year?

Long overdue... our Christmas tree.

Hug a Stressed College Student Day

2010-12-13T11:24:00.000-06:00

My brother got this really cool email from their health professions office assistant today.

Obviously, college is super stressful. With finals and stuff, things can be even worse. It is my understanding that Monday, December 13th is the National Hug a Stressed College Student Day.

In honor of this day, next Monday, beginning at 9:00am and continuing until 4:00pm, I will be giving out free hugs to any Vanderbilt student that feels that one of my hugs may help .... Also, while they last, cookies will be given out.

All those of you who are college/graduate students reading this, feel yourself hugged!

When my eyes met his...

2010-12-09T12:13:00.001-06:00

I was expecting to see sheer horror, instead I saw deep, profound sadness. For the rest of my life, I will never forget: a father's eyes meeting mine while I was doing compressions on his child. I don't think I will ever forget this for my entire life. Ever.

His baby coded, for the third time in 2 days. First the blood pressure went into the tubes, then the heart rate. I think our number of code dose of epinephrine exceeded 10 or 11... I think there was enough calcium and bicarb in the pt to save a small elephant. Yet nothing was working. We hooked up the defibrillator pads.

"1-2-3... stop, let the machine do its thing" said my attending. I let go of the patient to allow the machine to calculate a rhythm. The monitor alarms on the bedside monitor started beeping heart rate of 30, a non-existent blood pressure and sats of 90%.

"Connect electrodes..." says the machine and displays the same on the screen.

Machine won't shock unless there's an underlying rhythm and there was none. The kid had nothin'. Nothin'. I kept going with compressions. Mom and dad were within arms reach watching their baby's chest being caved in with every push. They watched the fellow fumble with the machine. He started pushing all the buttons he could in frustration, in sadness, anger and disbelief. The ONE time you want this thing to work and it won't because it's too smart. Because there IS nothing to shock. Period.

Since my compressions were effective, the machine detected a rhythm of some sort. Since the fellow kept pressing the red "Charge" button constantly and raised the jewels on the machine to an exorbitant amount, the machine finally started calculating what it was going to do with the shock. I felt the little thingies move under my arms like worms... It was a weird feeling... I knew he was playing with it... and so did my attending. I looked up at her and she looked at me and then the machine in silence.

All I could think was: "Please don't shock me. I have to do this. This kid needs me. I have to give all I've got. If I am tired, I have to give this to someone else because my compressions won't be effective. I can do this." I pushed harder, stronger, better. So the monitor said. I couldn't look at the baby's face and felt the parents' stares. Sweat was dripping off my back, the isolation mask sticking to my face, hair sticking to the sides of my face.

And then the bedside nurse saved my life and the baby's life. In a way. While I was in "the zone" of thought, the machine found my compressions rhythm and was about to deliver the shock. While I was listening for it and waiting for the "shock advised, stand clear" mechanical request, what I didn't hear was the bedside nurse pulling out the cords from the machine socket because the fellow's nervousness ramped up the jewels to 10x the amount needed and the machine was about to shock us all together. As the attending later told me "we woulda been scrapin' you off the ceiling!"

With the machine aside, ECMO team in the room, we were finished within an hour. Blood checked, circuit primed, bolus after bolus of various meds given. ECMO initiated. We have a heart rate, we're circulating, perfusing, oxygenating.

The chaos in our lives is over, it had just started in the patient's parents'.

---------------------------------

When I returned to my pt's room, my patient's parent asked me: "I saw that mom... how do you do this every day?"

You know, this isn't the first time I heard that question.

First of all, my job is not all codes, it's not all ECMO and it's not all bad and gory (as my blog probably portrays). I work with very sick children who do get better (and I have the pleasure of seeing that) and those who don't, I know that our medical and nursing teams did their best to try to save them. I work in the cardiac ICU, so mostly we have babies with congenital heart defects. But often, I get to see toddlers, pre-school and high school children (at times adults, too) come in intubated, on dialysis, in distress, with a pacemaker and a horrible prognosis, and then they turn around, get extubated, off the dialysis no longer needing a pacer, off all sedation and pain medications and on their way home. Even though my part in the whole thing is so small, I still feel like what I had done was worth my time, efforts and efforts of the whole team.

Plus there is that "professional" part. I've been in a critical care hospital setting for almost 4 years. This is my job, and if I am not calm and collected during majority of the situations I find myself in as a bedside nurse, who will be responsible for making sure my patient is receiving the care he or she needs? The doctors and other nurses are not with me all the time. It's just me, my patient and sometimes the parents.

As someone once said: "A contented heart is an even sea in the midst of all storms."

first real snow

2010-12-05T17:03:00.000-06:00

Excited or not, snow is here, so is the freezing cold weather.

But I am truly excited that I get to see my parents and my brother for new year's! San Antonio, I love you, here I come!!!!! I am SUPER excited for 80-weather, hanging out with my mom and perhaps scouting out a job in my dad's hospital! Woohooo! ;)

But, for now, for all of you who live in those nice balmy climates, here are some snow pics from yesterday.

I call this dude, the "Wisconsin style snowman" who has a huge beer belly, a black eye and rolled in the dirt after drinking...

So what snow beats this?

Google Images

My thoughts exactly!

Pretty cool :)))

2010-12-03T22:53:00.000-06:00

My Dear Blog,

Thank you for being presentable enough and apparently interesting to be voted #41 for the "50 Up and Coming Nursing Blogs Worth Reading" I guess you and I are working it up towards the top! :) And we find ourselves in good company. So honored to be among people like MedRNinja and Wife.Mom.Nurse.

2010-12-03T09:45:00.001-06:00

Seriously awesome for dry hands after work!

I want Kate's coat...

I found a new blog that I really like FreshMD. What a great writer!

2010-12-03T09:17:00.002-06:00

For a moment there yesterday I thought I wouldn't have anything exciting to write. For a while. Because my life revolves full circle around studying and working and other minutely boring life-details like cleaning, cooking and taking out the trash. But yesterday a friend of mine called and said her boyfriend was going to propose finally this weekend. But, hold on, I know what you're thinking: "How does she know beforehand?!"

Let me explain.

August 2009

My friend and colleague, A, is one of the most heartfelt people you'll meet. She and I met at work pretty much both fresh off orientation while I was scared to death to take on a sick patient and she was "bravely -foolish" enough to close her eyes and just do it. She called me to help her a few times, and before I knew it, she taught me a certain comfort zone I resort to even these days.

A is not like the other girls. She's special to me because 1) we are both second degree nursing students (Bio and Chem being our first degrees), 2) we're both "older" than our average co-worker on nights because we're sort of "late bloomers," 3) we're both in a committed relationship, hence no clubbing till 4 am like during our single college days and 4) we don't call nursing school "college." Oh, and our birthdays are 3 days apart and several days apart from Princess Diana's whom we both adore.

With great success at work, A's personal life was also on a rise. Her boyfriend had just proposed, they moved to Wisconsin from Chicago where they both went to school, she got this new job at our hospital - #3 in the country (yeah!) - and they were calmly settling into their new lifestyle.

That's when it all happened.

Her then fiancee's father became very ill, kidney failure, heart attack, hospitalized for months at a time... emotions ran high, problems ensued and A's fiancee moved back to Chicago and long days without him strained the already deteriorating relationship. The engagement was off. So was the already-in-the-planning beautiful wedding.

January 2010

2 months into a non-talking ex-relationship, he called her one Sunday morning as we were leaving the hospital and entering the parking structure. As unpredictably as the relationship ended, just as quickly it started again. 11 years in the making.

April 2010

"He wants to move back, K!" A told me excitedly one afternoon out shopping.

Good friends by then I hesitated to answer. I knew she loved him, but I also knew knew their issues were not resolved. I actually care for her and seeing what she went through mere 5 months ago was devastating. But of course, I was also excited to see her excited. Hoping for the best, I offered my congratulations.

"I know what you're thinking," she said. "You think he's going to hurt me again, you don't think things changed." She read my mind.

But things did change. And for the better.

September 2010

He was looking for a job in town. He visits often. A is happy.

December 2010

He found a job last month. He starts before New Year's. He's moving back in any time. THIS weekend is THE weekend, if you know what I mean.

Trying not to get too excited for her. I think I'm going to cry when it happens. Hopefully our girly trip to get hair cuts, nails, pedicures and nice dresses will be fruitful. :)

TGIF! :)

Edit: So yeah, he didn't exactly propose that weekend, it was this past weekend Dec. 11th So she still had that "surprise" element. :) It was exciting none the less. Congrats, A!

yum!

2010-11-24T17:37:00.000-06:00

If you haven't tried these, you're missin' out!

Hershey's Kisses in Candy Cane & Cherry!

Happy Sunday

2010-11-21T14:03:00.001-06:00

Some random things on my mind.....

1. I have to say I'm on the fence about one of the shows on TLC... "The Sister Wives."

TLC.com

This guy, Kody, is "married" to 4 people. I think the show started back in September, but it plays every Sunday evening during prime time. They have 17 kids together between the 3 current wives (pictured above) and tonight Kody and his 4th "wife" are going on a honeymoon. Ok, so legally he's married to only 1 (second from the left in the picture), but he lives and has kids from all of these women. I'm not sure what kind of message TLC is trying to send to the general public.

TLC.com

Is TLC trying to say that it's ok to go outside your legal marriage and be with several women?

I guess TLC thinks it's interesting to see what a life of a woman/man is in a multiple-marriage. Ok, I get it. Reality TV. I watched the show once, too. But, I think it sends a mixed message and some people can interpret it as it's "ok" to have more than one wife/partner because "look this guy is doing it and people love it!" I wouldn't want my kids to think it was ok to do this... I would much rather watch the real lives and struggles of a gay/lesbian couple and how they adopt kids because our conservative society needs to be more accepting of homosexual couples.

2. And then there's "Sarah Palin's Alaska."

TLC.com

At first I wasn't so thrilled that my favorite TV channel was filming my least favorite person... Mostly due to this rap video she did during her campaign. Really? that lady could have been the VP? yikes! BUT Sarah Palin actually "grew" on me a little bit. She doesn't seem as crazy in her normal day-to-day life as I thought she was during her campaign in 2008. Seeing her daily life makes me appreciate her a little bit. Just a little bit, though.

And I absolutely LOVE her hair. Even in the trenches of Alaska with bears fighting by her side in the river, her hair is still rocking awesome!

And, of course, that's exactly what she's doing right now with this show: campaigning for 2012 elections for president. Mark my words, peeps, she's gonna run!

Um, and no, for the record, ladies & gentlemen, you can't see Russia from Alaska... (despite what Sarah says). Not to burst anyone's bubble or anything...

Google.com/images

3. Thanksgiving is next week! So excited! My husband and I normally spend the holiday with some family friends who live out in the country and I looove it! Um.... turkey.... um... stuffing! My favorite. I remember my first Thanksgiving in US. We lived in Southern Cali at the time (no snow there!) and an American family invited us over for the dinner. It was SO different and there was SO much food, it was nuts! This is my favorite time of the year. But normally here in the Midwest is snows on Thanksgiving. Kind of fun, too, because I snuggle up with some yummy coffee, put up the Christmas tree and read a book next to the window while watching the snow flakes come down! Priceless!

4. Pot Roast. My husband is making pot roast for tonight's dinner. The whole apartment smells like it! Hard to study... but so worth the wait!

Google.com/images

5. Thunderstorms. I read on one of the blogs that it helps some people focus when they listen to calming thunderstorm music. Hm. Normally I study in a quiet room/library, but this person said that you don't lose your concentration as easily and your mind doesn't drift away. And if it does, it stops when it hears the thunderstorm, which is a cue to 'study' in your mind. Double hm. Interesting. I'm gonna try it.

Do you do something while studying to keep your focus?

I didn't know doctors could get laid off

2010-11-19T14:46:00.001-06:00

So, here goes nothing. It's been bothering me since yesterday and as much as I've tried to block the worry out of my mind with Starbucks drinks and fresh hair product smells, it has hit me: my mom has been laid off as of yesterday.

This is a real struggle... I didn't know doctors could get laid off. Like how?! In her group, there is a pregnant lady who just came back from a maternity leave after TWINS (!) and she is going to get laid off, too. Next week. How UNFAIR?! WHY? What there aren't any sick kids any more who need an anesthesiologist?! What the hospital is downsizing?! What are my parents going to do?

Please pray for my family. My dad is working, thank God, but for the same health system. :( I hope she finds a good job soon. Hopefully one with better hours, better pay and a better lifestyle.

On a happy note, I have to say that this may be a small blessing in a big disguise. My mom worked a lot for this group. A LOT. What I mean is, she had no post-call days (as in, you don't get to go home if you've worked all night), she had no sick days, only 1 week of vacation per year and of course a ton of required CMEs (cont. medical education) credits to get on her own time (ie: during her vacation) because Texas is super duper stringent on those. In addition, her case load was so high, she averaged 60 hours, if not more per week. If someone was sick or on maternity leave, she had to split the coverage between the members of her group - hardly fair when you're already averaging a 13 hour day.

But I am happy because she can finally rest, get some much needed sleep and eat healthy food, not the crap they sell at the hospital. She will finally have time for gardening, cooking and some R&R with my dad. She can go to the gym now during the day and maybe pick up a favorite show or to. Health is more important and now it's "me time" for her.

Love you, Mama.

my latest "struggles"

2010-11-19T14:23:00.001-06:00

"Struggle" 1. I know this is going to sound lame... but having frizzy hair that looks like I might have stuck my fingers into an electric socket is what I've had to deal with for a while now. Let's face it - many people have worse problems, but this is my blog and my current ordeal.

Then on Tuesday my hairstylist recommended this. I LOVE it. Moroccan Oil "Curl Control Cream." It's awesome, smells awesome, feels awesome and you need a teeeny-tiny bit. [and for those obsessed with advertisements, for the record, I didn't get anything to advertise this] I did get a heavenly, teeny-tiny sample box of this from my hairstylist, though! Hello, my new hair!!!

"Struggle" 2. Venturing out to Starbucks. So, the other night on TLC (my fav! channel ever) they said from Nov. 18 through Nov. 21 from 2 pm until 5 pm, if you buy 1 holiday drink, you get another one FREE! Um, hello Eggnog Latte for my husband and I this weekend! YUM!

"Struggle" 3. I want a new Starbucks Rewards Card. Now. Today. :)

So I admit...

2010-11-16T13:43:00.001-06:00

"Our main business is not to see what lies dimly at a distance, but to do what lies clearly at the hand." Thomas Carlyle

... this blog is turning into something I had originally not intended at all. I started this blog to write about my work, my struggles of getting into med school and most importantly, of course, how could I forget? About MCAT and how seemingly impossible this test is (at this point, for me, anyway).

Maslow's Hierarchy of Needs

But that's just it - after posting all these wonderful wedding and traveling pictures, ordering Christmas cards and mailing out the last CD to Turkey, reality has hit. What now? The MCAT is still here and as much as I don't like it, it's here to stay, until I take care of it, that is. The thought is honestly so daunting that I want to throw up. I know in the grand scheme of things it's "just a test" and there are people out there with *real* problems like lacking food and lodging, but the truth is, THIS is MY reality. This test is MY current obstacle in life and in order for me to achieve the commonly known psychological Maslow's Hierarchy of Needs, I need to do well on it to climb that pyramid.

After Googling "motivation to study MCAT" I found numerous blogs, Student Doctor Network posts, question and answer sessions at medical schools posted online, pre-med forums and bazillion med students lecturing pre-meds on how to "suck it up" and "face the problem" and some even elaborating on how I should be "loving" this time of MCAT study because I will be "wishing" that I was studying for MCAT and not boards later. Ok, I get it. It's not as difficult as USMLE, no argument there, BUT. It is THE most difficult test in my life thus far. Hands down, so for me, right now, this IS the USMLE. THIS is the test I have to pass and it is just as difficult for me now that USMLE is for your average med student and final board certification for a resident. And all those condescending remarks were so far from helpful that I sunk into my chair and really wanted to call my husband.

But I didn't. I gave it one last shot to find encouragement within me, when I found this blog. This was just about the only truly helpful post I read. And read that quotation. And it sort of hit me. This IS my task at hand and there is no use dreaming about "what if" and "what could be" because there is no "what kind of doctor you want to be?" until I pass the MCAT.

I knew that before, but somehow reading that very phrase and in that context turned things in a new direction in my mind.

Hawaii

2010-11-16T13:15:00.000-06:00

Finally coming full circle, I'm posting some pics from Hawaii. I can definitely say it's a heavenly place with hardly any people, 1-lane-1-way highway and some awesome Asian food. :) But pictures tell more than words.

Heaven on Earth - our beach and hotel in Big Island Kona

Talking on the phone to people on the "mainland" while laying in this thing was an awesome experience ;)

Me with the hibiscus flower

Interesting factoid: Did you know that in Hawaii they do not observe Day Light Savings Time?
Bummer for us - we could have "gained" an hour!

2010-11-15T22:40:00.000-06:00

My current secret addictions!

1. Dior Addict Ultra-Gloss lip gloss (color TBA)

2. NARS Blush in "Orgasm"

Hope Santa is good to me this year! ;)

more Istanbul

2010-11-14T14:57:00.001-06:00

Istanbul Streets on European Side

Typical of Turkey - among pretty buildings you get something like this...

a mixture of almonds, hazelnuts and cranberries glued together by fig jelly with sugar, caramel and more sugar. Basically like a miniature energy bomb!

Spice Bazaar!

The famous Turkish Evil Eye - like an amulet/bracelet/charm that people use to ward off bad people

Part of Dolmabace Palace where M. K. Ataturk lived and passed away in Istanbul

Maiden Tower - a historical (now restaurant and museum) light house on the water where the European and Asian continents meet!

We sailed on the boat there from the European side for dinner

View from the top of the Maiden Tower

Another view from the top

A special day

2010-11-14T13:57:00.001-06:00

Today is a special day for my husband and I.

On November 12, 1999, Turkey and the municipality of Duzce, where his parents resided in 1999, was struck by a massive Earthquake. More than 17,000 people passed away and 50,000 were injured. 2 very special people passed away that day: my parents-in-law. My mother-in-law was in their apartment and my father-in-law was in his clinic next door.

Source for all pictures

Today my husband, his brother and I are hosting anyone and everyone who comes for a prayer for his parents at the Turkish Cultural Center in our city. We are hoping people will come and pray (I'm not Muslim, but I will pray anyway in their remembrance) with us in hopes to remember them and all those people who passed away that day.

When we were in Duzce last month, we visited the area where they lived and passed away. It is still rubble that's been guarded off by fences because the municipality doesn't have enough money to rebuild everything. As you walk around the town you see many houses (like these pictured above) that have yet to be cleaned up, rebuilt and redone. Although there are many that have been rebuilt with better concrete and safer, with the earthquake-in-mind strategies. I hope this doesn't happen again... but since the city is on the fault line, usually there is a bid earthquake every 30 years. We have tried telling our family members (the few that still live there) to move, but it's their "home town" so they won't move. It's where they have lived all their lives and they say "if we're meant to die then, then be it."

I guess then everyone would have to move out of some areas in Cali since they have earthquakes there, too. I felt one when I lived there, not a huge one, but enough to knock me off my feet. Let's just say it's not something I want to experience again. But I guess I somewhat see my husband's relatives' point.

Read my Duzce Today post

Still needs rebuilding - a house next door to our uncle's house

the wedding

2010-11-11T11:32:00.000-06:00

So after all of our Istanbul trips, which I will post soon, we went to Antalya (southern part of Turkey) for our wedding. The lovely thing (and so special!) is that my husband and I didn't do anything to make it happen. We tried, let me tell you, but his family wouldn't let us. So, we just enjoyed the ride. It was such a wonderful event for us - people came from mostly Istanbul, some from Ankara and some were already vacationing in Antalya. Everyone danced and had a wonderful time (I think).

One of the most special things was my friend from Ljubljana, Slovenia came with her boyfriend. We became friends back in the day when my family still lived in Moscow, Russia. We frequently vacationed in Croatia (at the time it was still part of Yugoslavia) and I met her when I was 10 and she was 12. We instantly became friends, dining together, hanging out with our families and swimming in the Adriatic Sea. Now, 16 years later, she came to Turkey for my wedding. I had not seen her since I was 12. She gave me the most unforgettable wedding gift: a "Friendship Book" with our pictures when we were 10 in Croatia and my letters in broken English from 4th grade. I cried. It was so special. I will scan the book in and post it here.

My Slovenian friend and her boyfriend!!!! The red coins are the traditional golden coins that one can trade in for money after the wedding

Dancing, dancing and more dancing

with my father-in-law

this girl was such a good dancer!

the cake - we only had 100 people - but cake was HUGE!

Jet lag

2010-11-10T23:13:00.000-06:00

Dear Jet Lag,

I can't stand you. I am tired, but I can't sleep. Yesterday I tried taking a shower, counting sheep, pretending like I was back in Hawaii sleeping on the beach, yeah no, didn't quite work. I was tossing and turning for an hour and finally fell asleep. I woke up at 6 am with my husband, have been awake since, but can't seem to fall asleep again. Jet lag, you are not liked in my house.

Oh, how I miss you! :'(

Turkey Travels, continued

2010-11-10T14:43:00.000-06:00

Of course, my last post was about Ankara... this one is about Istanbul.
After flying from the capital back to one of my favorite places in Turkey, Istanbul, we moved into our hotel, Villa Sphendone, we went back to the airport to greet my husband's boss and his colleague who had just flown in from America. They were, of course, coming for the wedding, but had decided to come a week early to travel around the city.

Our Hotel Villa Sphendone

Sultan Ahmet Mosque, otherwise known as Blue Mosque because of the blue tiles inside the mosque

Inside the Blue Mosque


St. Sophia (Hagia Sophia) which was at first a Greek Church, then reconstructed into a Mosque during the Ottoman Empire and now serves as neither and stands as a Museum

Inside St. Sophia Museum

As you can see construction is underway. The workers are trying to uncover the ancient Greek mosaics with saints and angels painted over by the Muslims during the Ottoman rule when the church was converted to a mosque.

The dome of St. Sophia - do you see the uncovered angels?

The ancient water storage cistern or modernly called The Basilica Cistern, do you remember the last season of the Bachelorette? Ali Fedotowski had one of her dates here!

A lady making a Turkish carpet from silk threads at Punto Carpet Store in Istanbul

Bliss! Turkish lamps at the Grand Bazaar!!! I really really want one in my house! (I just need a house, hehe)

A really awesome belly dancer at Istanbul Inn where we went for dinner

the last belly dancer inviting a guest to join her :)) (the video of her is below)

2010-11-10T14:03:00.000-06:00

So, let's see, where should I start?!
In the last 4 weeks I have been essentially across the globe, minus the whole Asia side...

I was unpacking quite happily 14 days ago after our exhausting yet fun trip to Turkey, when my cell phone rang and my mom was on the other line.
"Hey, welcome back!" long pause
"So, what's up?" I asked.
"Nothing, are you busy next week?"
"Well, just unpacking, studying... you know the drill. Why, mom?"
"I feel bad saying this so last minute, but dad can't come with me to my California Society of Anesthesiologists meeting in Hawaii, so wanna come with? The room is paid and everything. Plus I haven't seen you in a while."
I sat down for a minute.
"Huh? HAWAII?! You're inviting me to HAWAII?!" Woa. "YEAH I'M COMIN'!"

So, last week, just like that I went with my mom to Hawaii. My husband was working, of course, and I felt really bad leaving him. But it's not like you can party with a bunch of 60-year-old anesthesiologists on the beach. Ok, maybe not 60-year-olds, but definitely not in my generation. Plus they were all from California, quite farther away than my zip code.

But, Big Island Kona was heaven. Very pretty, peaceful, nice, sunny, warm, friendly people and many more words that I'm probably forgetting. A truly nice relaxing vacation while doing absolutely nothing.

Now I'm back. I feel more energized to study. We met up with some of my mom's friends who also came to the meeting and they had a nice "talking to" to me about my med school plans. I feel embarrassed that I have to study so much for the M-kitty, but they totally made me feel like everything I was doing was right, that it is not only a hard test and it is hard for many people, not just me (their kids are struggling, too!). And that not only this test, but once that's done, the path through medical school and beyond is not any easier. But if it is what I want (which it is) and I have the right reasons for it (which I do and they concurred), it's worth the hard work.

For a moment there, I had a viola moment, here are 5 attendings and their spouses all talking about me at the moment, saying that "I will try" isn't good enough, that "I WILL DO" is what I should be saying... and the determination in their eyes made me realize these people are all genuinely rooting for me. And they genuinely want me to be successful.

So out of the dumps of MCAT disappointment I go into the world of I WILL beat the M-kitty and I WILL get into medical school.

Who knew it would take a trip to freaggin' Hawaii to come to THAT realization.

our beach

2010-10-29T12:36:00.000-05:00

Pretty cool belly dancer :)

Ankara

2010-10-28T10:03:00.001-05:00

Being the political capital that it is, Ankara has the most important Mausoleum in Turkey: the Mustafa Kemal Ataturk Mausoleum. It is vast, big and beautiful.

Mustafa Kemal Atatürk was a man who changed Turkey. He was a man whom the current Republic of Turkey thanks for being what it is. It's impossible to give him credit in one paragraph, but basically, he, as one man, broke the Islamic regime of the Ottoman Empire and "drew" the borders of the modern Republic of Turkey. He changed the alphabet and language from Arabic to Turkish, re-wrote the history books, changed the education system, government system, judicial system and made the country secular, meaning, prevented the religious influence on government and judicial decisions. He essentially separated Turkey from the Middle East. And all in between 1923 and 1938 when he passed away.

Atatürk is very much respected in Turkey. His face can be seen in every government building, in every office and on every military and professional man's suit in the form of a pin. His picture hangs in every classroom and his voice can be heard on a recording in almost every museum. He represents what Turkey is today.

I was so touched and proud to have visited his Mausoleum. I gained so much respect for him and the Republic of Turkey. I hope the government continues to support his vision and continue to push Turkey into the western world.

View from the museum onto the city of Ankara

The Mausoleum

To the left of the front entrance

View of Ankara

Turkish flag at the front entrance

Turkish soldier at the front entrance

It is what it is

2010-10-28T09:32:00.000-05:00

So we arrived.

Ankara is awesome. I mean, awesome. It's the capital of Turkey, and unlike Istanbul lacks large tourist groups. Many government offices are here, municipalities, but not many historical attractions and touristic places. The traffic is much better and surprisingly, I could breathe in this city.

We came here because my husband's sister lives here with her family. She works in a private Turkish-American hospital, affiliated with a medical university as an OB/GYN. Last time I was in a non-American hospital, was when I was a teenager in Moscow, having to go there because of my parents. And this hospital was a nice mix in familiarity of my current work hospital in US and my childhood memories.

the hospital

I also had a chance to see Turkish healthcare with my own eyes. My husband had some problems with his knee after playing soccer, so he needed an MRI. In US, after meeting with the sports medicine physician (flat fee $386, but with co-pay only $30), his MRI would cost $2000 (flat fee) and $500 with my health-care worker insurance. We could afford it, but it's not emergent, so we went in Turkey.

When we walked into her hospital, his sister flagged an orthopedic surgeon in the hallway (lucky us, right?!) who immediately took my husband (with me in tow) to his office right down the hall. He did range of motion, asked a million and one questions in Turkish and said his knee was fine, but since O wanted an MRI, he ordered it. Went for an MRI almost immediately, I waited maybe 30 minutes and he got a CD in almost same exact folder as we have at work here in US.

Guess how much?

$40 for doctor's appointment, $80 for MRI (or 50 Turkish Lira for appointment and 100 Lira for the MRI).

The waiting room may not have had computers and wi-fi access as our hospitals. It had a regular tv, not flat screen, the arm chairs were not as comfortable and they were not fake-leather like in our hospital, but fabric covered, but the overall concept was pretty much the same. At 1/100th of the price of our services.

I think the biggest difference in healthcare (I dare say) in US and in Turkey is not material. It's not the machine or the technician or the color of seat cushions in the doctor's office, but is the quality of physicians. So perhaps I'm biased because of my parents and their friends and because I am in healthcare, but I dare say, that US doctors are taught to *think* on a different scale than other doctors in the world. Maybe not in every country, but I'd say 90% of other countries.

So in US we must be paying for the "know how" then?

Maybe if a radiologist in my sister-in-law's hospital (whom we met, too) would look at a straightforward case and say something very similar to a radiologist here. Sure. But what about those non-straightforward cases where you truly need thorough knowledge? I guess that's where the difference lies.

Bus Station

2010-10-28T09:09:00.000-05:00

After 3 days in Istanbul, 3 days in Duzce, my husband and I took the bus to Ankara. It was so fun! At first, when my husband said "bus" I cringed at the thought because I remembered my high school yellow school bus: hitting every bump, the distinct smell of fuel and hard-cushioned seats. And to be on a bus like that for almost 5 hours - just the thought made me nauseated. But he reassured me that it was going to be "fine."

Bolu is where "A" is and Duzce is the left of the road and Ankara is toward the bottom right.

Indeed, it was. The bus was air conditioned and heated, the seats were beautifully soft and instead of smelling gasoline, we smelled the steaming tea and coffee with chocolate cakes served every 2 hours. And all for $10 per person. It was actually one of my favorite experiences in Turkey. Minus one thing.

The rest stop.

We were boarding the bus after a brief tea-and-bathroom break near Bolu, a city in between Duzce and Ankara. After I made myself comfortable on my front-row-seat, put away my coat and camera, I saw this through the front window.

A man with a little girl

Do you see the trash? Do you see the little girl's dirty hair? Do you know that that girl never lifted up hear head or moved while they were sitting there?

"Do you think she is ok?" I turned to my husband.
"Yeah, she's ok. Why?" he asked me.
"Well, she's just sitting there, on his lap, not moving. It's just seems odd."
"Do you think she's sick?" he asked, now starting to get worried.
"I don't know... but she seems awfully still, not moving, it's around lunch time and she doesn't seem to be in such deep sleep." The most awful thoughts came running through my head at that moment. What if she is sick and this poor man doesn't have any money to take her to the doctor? What if he doesn't have any money for food and she is hungry? I mean, he is sitting next to a bunch of trash. What if they can't afford medication?

I digress, and maybe this isn't my place to talk... but all of a sudden I became very angry with our medical system in US. Very. We spend SO much money on (pardon my bluntness here) "sometimes" useless procedures, save children and adults who ask not to be saved, but we do anyway because well, "it's a liability for the hospital." And then there are real people like this little girl who want and need care, but can't afford to go to the doctor because they have the flu or don't have food or can't afford a simple antibiotic. It breaks my heart to see the parents at our hospital bickering with physicians about stupid stuff that ends up costing Medicare millions (literally!) and this little girl who could be running around if only $100 was spent on a doctor's visit (and in Turkey probably even half that price!).

I definitely am not saying that some human beings are not "worth" the care, everyone has worth. What I'm saying is the allocation of funds and where they go and that "sometimes" they go toward treatment that is well in advance known as not useful, but it "covers the bases." It just makes me so heartbroken.

You know, at our engagement party last year, we had several family members and their children come to see my husband and congratulate him. People he didn't really remember... Very poor people. And you know why? For my husband's father.

My husband's father was a pediatrician in a relatively medium-sized town Duzce close to Istanbul. Educated in the best medical school in Turkey, trained in Germany, fluent in 3 languages, he wanted to give back to the people of the town where his brother lived, so he and his family moved there. He had his own clinic and never refused a patient. He examined children of all ages, unrelated to their parents' ability to pay. My husband remembers he would accept chickens as a form of payment from the families, just so that they wouldn't feel an obligation to the doctor. He would ask the drug companies to give him extra samples for the poor. He accepted calls from patients in the middle of the night and he treated everyone with respect, regardless of education level. He was truly a good man and a good doctor.

At our engagement ceremony last year, many parents of those kids came. Many cried, many hugged me, saying how proud he would be of his son, how healthy their children are (who are now adults like us, whom I met, too) and how sad they are that they lost such a good man and doctor.

I really wish I could some day become a doctor like him. Many years from now, if ever. But it would be an honor. For now, I will try my best to be a kind and caring nurse. One my children would be proud of.

one sincere hug from a parent at our wedding

And all that was triggered by a little girl at a bus station.

Duzce, week 1, part 2

2010-10-27T11:17:00.001-05:00

Honestly, I can't breathe in Istanbul. The pollution results from factories, chronically poorly maintained car exhausts, the super populated areas and most of all from smoking. Everyone smokes. EVERYONE. Even I felt compelled to smoke while I was there. But didn't. 98% of my husband's family smokes. From teenagers to the most elderly into their 90s, lighting a cigarette is a social requirement of sorts. Turkey has a law that prohibits smoking inside restaurants, public places and government buildings, but that doesn't prevent many people from smoking right outside. And, of course, they smoke at home, sometimes without opening any windows.

All of that, didn't help me with my cold. I started coughing in no time and constantly felt like there was something stuck deep down in my throat and I couldn't seem to cough it out. Yick. Even my husband started coughing and he hasn't pick up a "sigara" as they call cigarettes in almost 4 years!

On Sunday evening, we traveled by car from Istanbul to Duzce, where the oldest and most important family member lives: my husband's uncle.

Duzce is to the right of the photo, where "A' is, and Istanbul is on the very left. Above is the Black Sea and at the left bottom is the Sea of Marmara.

O's, my husband, parents passed away tragically in 1999 in an earthquake that killed 15,000 people around Istanbul area. And now, his father's brother, Amca [pronounced ah-m-cha] (or father's brother in Turkish) is like his father, or my father-in-law. We always come to see him because he's not only the eldest and wisest and most respected, but also because we love him and we miss him.

Duzce streets

A retired Jandarma General, he is tough, strong and has the willpower of a lion. At 73-years-old, he walks with a strong, has an unshaken gaze and speaks un-interrupted. But has a heart bigger than this world. His wife calls him Pasa-Amca [pa-sha ah-m-ca], meaning General Uncle in Turkish. I don't know what my husband's siblings would do without him.

Amca's House (right)

Flowers in the backyard of the house

While there, my cold progressed from ok to pretty bad. I took some "Day Time" with me, thinking I wouldn't use it and ran out after 2 days. I felt so weak I couldn't go places with Amca and my husband. I would have loved to see the city, but my knees were weak, my head was spinning and my face was red and I was freezing cold. It rained both days that we were in Duzce, so Amca's house was humid, moist and with the heat running, the windows all had condensation (were "sweaty" as we like to say in Russian). I tried to be social and once again fell asleep on the couch in the living room. Amca's wife covered me with a wool blanket, and in and out of sleep between lunch and dinner, I sweated my flu away in delirium.

When O came home, I asked to go to the pharmacy, or call his sister in Ankara (another major city in Turkey and also the capital) for some medication. She is a physician and I thought she could recommend a medication similar to our American "Day Time." They have an equivalent, but it's prescription only. Thinking she could "call it in" as physicians do here, I was bitterly disappointed when she said I had to go to a doctor as they don't have the same system in Turkey.

We went to the pharmacy anyway. O translated to the pharmacist that I had the flu and needed something. I wanted to see the ingredients as I'm not one of those people who takes what I'm told blindly. I couldn't figure out what the medications were because they were all in a different language. They were all in English-Latin letters, but acetamenophen (for example) is parasetamol in Turkey, pseudoephedrine also has a different name, but the root "ephedr" is the same. The pharmacist showed me 5 boxes of different medications and all had different compositions and doses. Since I didn't know which was which (at that point), I tried asking my husband to explain my symptoms and ask the pharmacist to give me the medication based on my symptoms: sore throat and lethargy. My sinuses were fine at that time.
My husband got really frustrated.
"There are too many people here, all are talking and you're asking too many questions, can't you just get this and let's go home?!" he yelled.
"Honey, but I want to know what I'm taking," I said half-crying.

Weak, tired, cold, not able to breathe because of the polluted air, standing there in a crowded pharmacy that smelled like a hospital, getting pushed by people from all sides, I broke down crying. I looked up at the absent minded pharmacist who also seemed frustrated with my inability to talk to him and my husband's lack of vocabulary to explain what I needed, I felt lost in translation. I turned around and left the pharmacy, crying, almost sobbing, thinking, "I just want to go home, I wanna go home."

My husband came outside, angry (still) that I was embarrassing him in front of other people. Frustrated he said, "Stop crying, you're embarrassing me, what do you want?! Just take the medications!"
Obviously, what he said didn't help any. I couldn't stop myself from crying, I wanted to fly away home, into my warm bed, take my Night Time and forget everything. But instead, I was sitting there on a cold street in the rain, leaning on a dirty wall behind me trying to digest the reality.

But in the end, my husband was correct: I needed something. So I gave up, bought what the pharmacist recommended, ended up being overdosed with an anti-histamine and fell asleep at 8 pm that night.

Istanbul begins, week 1, part 1

2010-10-27T11:16:00.001-05:00

And here begins the saga of our trip to Turkey. We went for almost 3 weeks, so here is week 1.

We arrived in Istanbul on Friday, Sept 30. Just in time for a huge dinner at my husband's cousin E's place. It was soo yummy after a 10 hour flight and a 1 hour drive through the city traffic.


Istanbul on the map (where "A" is). To the left is Bulgaria and Greece and to the right and below is all Turkey

A zoomed out version

Istanbul streets

We spent the weekend in Istanbul, visiting the Golden Horn, spending much time cooking yummy Turkish food that I missed and just hanging around the house watching TV and sleeping.

The Golden Horn of Istanbul

My husband's beautiful cousin E

My husband got to watch his favorite team soccer team Galatasaray play their rival Fenerbahce in a Derby game that weekend. Priceless.

Fenerbahce Stadium that we passed by on the train

On Sunday I woke up with a sore throat. Someone must have sneezed on me at the airport or on the street. The weather was also much colder than we anticipated. Sometimes it rained, the clouds covered the sky and even during the day it was dark sometimes. I felt weak, cold and tired. But my husband's whole family was SO excited to see us, how could I curl up in a ball and sleep in a bedroom? Instead I drifted away into sleep on a living room couch, with bright lights, blaring TV and afternoon Ezan calling to prayer in the distance.

My adventures

2010-10-27T08:09:00.000-05:00

And we're back from Turkey. We were so busy visiting with family in Istanbul, Duzce, Ankara and Antalya that we forgot to take a vacation. ;) As I finish cleaning, doing laundry, ironing, stocking the fridge with groceries, shopping for winter clothing and paying the bills, I promise to put some cool pictures and tell our "fairytale" story of going to Turkey and getting married there. :) Even though we're pooped tired, it was fun, nonetheless. :)

T - 2 days!

2010-09-27T16:41:00.000-05:00

Flying to Turkey Wednesday night!!!! WOoo hooo! My life has been filled with packing, cleaning, stocking up on tiny body wash bottles, toothpaste, socks, underwear and learning about my camera (to take better pictures!). I really hope I can update my blog from Turkey. :)))) Mostly we'll be staying with my husband's family in Istanbul! :))) Can't wait to show everyone how beautiful that country is!!! (and how awesome the people are!) There are 3 of like hundreds of pictures I took there last year around this time.

Our hotel last year in Antalya, on the Mediterranean Sea

Turkish Flag while on a tour of the Bosphorus Straight around Istanbul

St. Sophia Museum that was originally a Greek Church that the Ottoman Empire sultans turned into a mosque, but when Turkey became secular, the Republic decided to make it a museum, so there is a little bit of each there

Congrats!

2010-09-22T12:09:00.000-05:00

So happy, but so sad. My little brother is graduating from college in May. He is my little brother nonetheless. The university chancellor sent out an email making sure that parents and siblings make arrangements. I can't believe it's time! Can't wait to see him walk across that stage!

Congrats to everyone graduating as Class of 2011!

It's a big deal!!! :)))) You made it!!!

(Photos curtesy of www.vanderbilt.edu/campustour)

Medicaid?

2010-09-19T12:42:00.000-05:00

I copy-and-pasted this from Facebook, so some of you may have already seen this. Would love to hear opinions!

Pictured is a young physician by the name of Dr. Roger Starner Jones. His short two-paragraph letter to the White House accurately puts the blame on a "Culture Crisis" instead of a "Health Care Crisis."

It's worth a quick read:

Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture" a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me". Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

Respectfully,
ROGER STARNER JONES, MD

If you agree...pass it on.

2010-09-14T17:44:00.000-05:00

So excited!

Bought tickets to see "Eay, Pray, Love" on Friday!

Have been wanting to see it for a while now. :)

(source

Remembering

2010-09-11T14:28:00.000-05:00

my weekend

2010-09-10T12:55:00.000-05:00

At my place not much happens on the weekends. Well, except for this weekend, I guess.

(source)

For the first time of my life I was asked to take the code pager. I usually volunteer for it only when I'm up for a challenge and I want to do it that night... but this weekend I was asked to take it because my primary patient is feeling better and others either didn't want it or had too sick of a patient to leave if "code 7" is called. So I took it. Usually it hardly goes off and when it does it's a nothing. Usually. But not this weekend. Present for me, I know.

Around midnight, I heard the loud man over the PA system say: "Code 7, Center Tower, __ floor, Room ___. Attention all hospital personnel, code 7, center tower, ___ floor, room ____." I tell my pod buddy to keep an eye on my kid and run to the elevators, swap my badge to stop all elevators on my floor and go up. Once on the floor, I see our CC fellow already running down the hall as I join her in stride to the room.

I really want to look this calm and pretty when accessing the defibrillator (although ours are already on the code carts...) (source)

We walk into sort of a disastrous mess (surely both hoping it was a "nothing" code). A tiny baby went into respiratory arrest due to aspiration and pneumonia.

Every person on the code team has a role. In our hospital, our cardiac PICU nurses (me) document on the code sheet (vitals, pressures, meds, dosage of meds, etc) and the medical PICU nurses manage the code cart. RTs help at the head of the bed managing airway and fellows (critical care, surgery and anesthesia (sometimes)) so whatever the attending running the code says. This time it was a mess. A total disaster. The medical PICU nurse didn't know anything about the code cart (and they were truly using it this time) so she asked me if she could record and I would manage the cart. Sure. Whatever. There were hardly any supplies in the room, since the floor nurse "didn't expect" her kid to code. Right, and we all come into work *expecting* our kids to code.

In peds, unlike in adults, we go by weight on everything. There is no "standard" dose like in adults. So I flip open the weight book to the kid's kilos and go off of that. Pharmacy usually draws up the meds and I help out with handing out supplies. There is a method to the madness. Promise. :)

So, anyway, long story short, we got there and the kid is satting 50% with bag and mask and had JUST puked for the 3rd time a massive amount of formula, all over the mask and all over the ICU attending (and all over the pulse ox cord). [We were one of the first people to get there, so the floor's attending was bagging while waiting for RT and the attending running the code.]
"How big is the kid?" she asked the floor nurse.
"4 kgs"
"How old?"
"3 months"
"I need a 3.0 ETT"
I grabbed the tube out of the drawer and handed it to the attending. Her hands were shaking (I feel for her... her baby is the same age and looks awfully similar to the kid we were coding), she tried to reposition the tube in her hand and dropped it on the floor.
"Need another one." I grabbed her another one thinking, "S**t, she's nervous, please don't intubate in the stomach." She did.
After she redid it, the Critical Care fellow listed to lung sounds.
"Right mainstem, can you pull it out a little."
While they were intubating, simultaneously, other people were checking for pulses. She bradied to 40 (her normal HR should be around 120s). shit
All of a sudden her pulse ox went from 50 to X on the monitor. Hm, she either lost her pulse and the machine doesn't work, or the probe is off. I check the probe - fine. Except there's puke all over the electric probe and the bed.
"I need another pox probe please!" I yell out. I put another sticker on a different finger and toe just in case while waiting for someone to tap me on the shoulder and hand me the electrical cord. Nothing. I turn around and see this parade of gaukers: nurses, parents, nursing assistants just standing there talking loudly, discussing what was going on.
"People, where is my pulse ox!" the attending yells out.
I look at him and say, "he puked on the probe I need a new cord. I need someone to get it now!"
All of a sudden the attending yells, "PEOPLE SHUT UP. Hear me SHUT UP! QUIET! If you are NOT helping, get out of here!"
Thank you, Dr. Awesome.
No one still got me the probe and I couldn't leave. Oh well. I started blowing into the probe and finally within 30 seconds we had a reading. 60%. She wasn't any better, but we did have a reading.
"We still have a pulse" someone yelled out.

At this point, she was successful aerating, intubated and still had a pulse. Phew. Someone started an IV, I pushed some meds throughout some time, checking pulses. She was gray and lifeless still. Her HR was around 110, which with all the epinephrine, bicarb and calcium we gave her was ok. Should be better. Pressures were still on the low side 50s over 30s. Could be better as well.

I was trying to feel for pulses since it was sort of my turn and couldn't feel any in her groin, tried again in her brachial - nothing. "I don't have a pulse!" I didn't want to believe my own words.

"Someone start compressions" yelled out the attending. As he said that, someone had leaned on the light switch. "Where are the lights, people?!"as they went back on again.

Her sats went to 30% , her HR was a mumbo jumbo on the monitor from so many people touching her. We started compressions, "1, 2, 3...30" Breath by the RT. "1, 2, 3...30" Breath by RT.

Stop. Look. See.

We have a rhythm. Only 4 minutes of compressions and we were ok again. I was sweating. There were waaay too many people there and it wreaked of formula vomit and people's BO... thank God the attending running the code was awesome and controlled the situation.

She got transferred to the Medical PICU since she coded because of respiratory issues.

Upon entering my unit, my charge nurse is running down the hall yelling: "Can you run up to __ floor PICU, they are coding another kid and need help. I will watch your patient." SHIT, WhAT?

I run upstairs... to the PICU... thinking it's probably that kid again we just coded. NOPE. A totally different kid - well a teenager to be exact - who went into liver transplant rejection, septic and coded.

(source)

When I got there they were actively coding him and we were called because our unit is the only unit in the hospital where we have enough staff to do ECMO and this guy was about to be a candidate. Shit x2. So I help out, whatever, I don't even remember what I did there. It was all a blur. We began the process for ECMO cannulation in their PICU but trialed him off and he soft of tolerated. Sort of. Still came down to our unit and they placed two techs in the room just in case we were going to have do this all over again.

I swear to you, people, not moments later that I came back to my unit, my beeper goes off AGAIN. Now it's AGAIN the medical PICU charge nurse paging wanting me upstairs for ANOTHER (3rd!!!) kid who is about to go on a osccilator who is also an ECMO candidate.

This is unbelieveable. I was very tired at this point. Hungry, thirsty and tired. I couldn't think any more. But shucks, I've already been there twice tonight... might as well go back to the "shitfest" as the cardiology fellow eloquently put it.

This kid was different. A hematology oncology patient whose lungs just "sort of" collapsed. Ascites, sepsis, anemia, low white count, lots and lots of meds, you see the picture. Prognosis doesn't look good at all. For some reason, of ALL patients out there, my heart goes out the most to hem onc kids. I don't know why. Those kids have hearts of fire and are some of my favorite patients when they are coherent enough to talk. No matter how old, these kids are incredibly mature (life sort of makes them more mature than they should be) and so gentle and kind yet spunky and spoiled at the same time.

I grab my mouth about to cry. This night's emotions are truly building up at this point. Luckily, I know the bedside nurses well. (I used to work in that PICU). "Hun, are you ok?" one of them asked me. "Yeah, I'm fine. No worries." I put on my isolation garb, mask - at least no one can see my facial expression.

So much needed to be done, his sats were 39% on the oscilator, blood was swoshing in his ET tube. He needed suctioning, but then his sats would go to null. I don't want to remember the rest: he coded again, we did compressions, he wasn't stable enough for ecmo, they waited and waited and waited and missed the "window of opportunity." After a night of meds, compressions, spewing blood, he passed Monday morning.

And that was one night out of my weekend. Thankfully not every night is like this.

See why I try to take the code pager only when I want to...

Love it

2010-09-05T18:05:00.000-05:00

Found a dress!

2010-09-02T12:28:00.000-05:00

I took a day off yesterday to hunt down my wedding gown. One day. 4 stores. 1 dress!

The dress fits very well... now. But if I gain any weight, I won't be able to breathe.
The corset is pretty tight, but the seamstress said that I shouldn't let it out because it will lose the shape and fall down, but instead get used to the tightness. I can breathe... but if even 1 pound creeps onto my waist, I will pass out.

Dilemma: should I have it let out a little (I have 25 days!) or... lose some weight (the cheaper yet risque method to fix the problem)? Hmm....

Moscow Today ~ where I lived Yesterday

2010-08-27T23:45:00.000-05:00

OR Lovin'

2010-08-26T15:22:00.001-05:00

So, there, I said it in public. I job shadowed for an OR nurse job! Soooo excited. But... hardly so for another reason.

source

I had my interview yesterday. It was awesome. Typical questions and apparently somehow I had the right answers. I was so excited to talk to my husband, I felt like the sun was coming behind the MCAT clouds... when the phone rang. My excitement to tell my mom that I am shadowing tomorrow (today that is) was curbed by a long pause on the other end. "What?" I got that feeling. "Grandma died last night," she said.

Huh? What? Can't be? Granted she was 89... this can't be.
I was hoping she was kidding. "Yeah, honey. She did. But she passed without pain."

I don't remember the rest of the conversation. It was like as if we never had it. Right now, I'm in the denial phase. It hasn't just hit me yet. And that's good... I guess because I went to my OR job-shadow this morning.

6:30 am here! Running on automatic, 5 hours after I talked to my mom, I was up and running on coffee into the OR. I felt like the world was spinning around me. From a bronchscopy to abscesses to a burn debredement (sp?), I felt like I was running like an Energizer bunny. Lucky for me, because once it stopped, I realized how horrible my reality really is. I felt like I was taken away for a blissful 6 hours into a world where I could function without thinking about my real life. I felt removed, taken away into a world, where emotions were not necessary and my work was automatic. It was blissful. I was in such a trance that when talking to the manager and supervisor at the end didn't even allow me a breakdown. I was like a machine. My mom calls it professionalism, I think I just might have found the job of my life.

Once in the parking lot, I balled my eyes out. I probably scared a few people. Everything just came down at once. How am I going to start this job? How am I going to keep studying for the MCAT? How can I go back to my job? What am I going to do? Personal leave? Paid vacation? Quitting all together? Why does this have to happen now?

I sat in my car, staring into the gray, blank wall in front of me. What to do? What to do?

Teary-eye, starving, probably grey-colored like that wall, I went back to Human Resources Office (HR). I need to talk to someone. I'm scared. Neither HR people I needed were there. My luck. I called, left messages, knocked on doors. Nothing. No one.

And that was 2 hours ago.

2010-08-25T17:34:00.000-05:00

My blog needs a makeover. Stat.

It's over... illusively speaking...

2010-08-25T17:32:00.000-05:00

Took the dreaded test on Friday afternoon... and though it was only 4 days ago, I feel like it was 4 months ago. I feel weird not studying, not going to the library... but hey, I'm pretty certain I'll have to re-take it. As my fave surgeon at work likes to say, "I'm not being not optimistic, I'm being realistic." But while waiting for my scores, I have this illusion that I did well and things will be "ok." I'll soak in the blissful feeling until I have to face reality!

Things I've done since then:
1. Bought and returned a new set of Urbane Scrub pants. love them!
2. Went shopping. No, I mean SHOPPING. Finally, freedom to browse through endless shelves of clothes without glaring at my watch, being afraid the minute hand will move forward too fast! Bliss!
3. Bought baby clothes for a friend's baby shower. and realized my own biological clock was ticking
4. Bought a wedding gift for another friend's wedding.
5. Bought my Turkish sister-in-law her annually requested HUGE bag of makeup from Lancome.
6. Went to a baby shower.
7. Worked 40 hours.
8. Slept for 24 hours.
9. Cooked dinners and lunches.
10. Met with a friend for dinner.
11. Went to an outdoor concert.
12. Got stood up by a friend for lunch. had a better lunch anyways!
12. Spent 3 hours looking for a recipe for kohlrabi. And ended up not finding one.
13. Went to Office Max to rejuvenate my studying abilities by buying a new set of highlighters, pens and pencils. Those will stay in their box... ahem, for now.
14. Got a new backpack.
15. Interviewed for a job.
16. Fell in love with my new Victoria's Secret pair of jeans that I got on Tuesday.
and finally... 17. Don't feel guilty sitting here writing about all of the above because I'm taking some time off to enjoy my life. Really. Finally.

Inept socialites

2010-08-14T17:10:00.001-05:00

Our extremely hot and humid weather and lack of air conditioning in our apartment (I know, sucks x2!) pushed me out of my apt to study at the closest library to my house. And you guessed right... it's the one by my work, at the med school. I study, eat lunch there and of course observe and watch everything around me. So the other day, while eating lunch, I overheard the following conversation of a couple of 1st year-I-just-arrived-and-forgot-to-unpack-my-maturity med students.

I believe they were discussing their first night's outing into the city.

Girl #1: "So, like, get this!!!! [as she frantically throws her hands up in the air with excitement] this guy comes up to me last night and like, we start talking... You know. Just having a conversation."
Girl #2: "Was he hot at least?"
Girl #3: "For real, wow, you're fast!"
Girl #1: "Yeah, no listen, listen. So we start talking and then he goes... 'so you aren't from around here, right? That's cool, man. So like where are you from?' So I tell him. He asked me what I was doing in town, and I said I was starting med school. Then he says this thing, that like, I'm TOTALLY digging!!! Oh, my God, you're not going to believe it?!"
Girl #3: "What, what did he say!?!!"
Girl #1: " So then he goes: 'Oh, wow. You know, you're so gorgeous I think I might be having a heart attack... where is your stethoscope? Can you listen to my heart?'
Girl #2: "awww, really, he said that? How sweet! I'm jealous, you're so lucky."
Girl #1: "I KNOW!!! Isn't that adorable?"

I think I snorted my Diet Coke at that point. I didn't dare to look in their direction, being deathly afraid they had heard me. Oh, MCAT, the places you take me.

And worst part of it all, ironically, is that this "guy" they were talking about ended up being a 3rd year med student. Yeah, yikes. Luckily, at least, he wasn't from the same school.

Define YOUR success

2010-08-08T18:30:00.001-05:00

I've always felt the need to defend my career goals (ie: becoming a physician). At first it was to my parents, then my distant siblings and now my every day friends. My personality is such, as I may weakly add, is that I want to appeal to my friends and family. I want to be friends with everyone, make everyone happy... and as my husband pointed out once, tend to leave myself unhappy sometimes at the expense of others.

And that's just it. For years, especially once I started nursing school, my medical school plans went from hush-hush to lies, all the way to complete secrecy. My worries range from judgmental remarks from my friends who are nurses to not being accepted at work as a "nurse," but a "doctor wanna-be." I try to play down the quantity of time I study because people observe that I've been studying too much "for that easy GRE" - that's how I have dubbed 'MCAT' so my friends don't find out. I did tell a few people... hence they have chosen to distance themselves from me. I don't get texts to hang out any more, I don't get party invites, birthday bashes and even a wedding invite left unanswered. It hurts... but maybe they were never really "my friends."

Today I was chatting with a friend who's a new 3rd year. A long time friend, obviously non-trad student like me. I needed a pick me up from test anxiety of the upcoming Big Day. From relaxation tips, we went on to talk about goals and then putting things into perspective. She said something that I think will stick with me forever. As obvious as it is, until she said it out loud, I was never so confident that what I want to do is mine.

"...You know, the question is what defines better success. higher MCATs have been statistically shown to later have higher grades and boards scores. but again, what do you want to do in the end? ....... Success is achieving YOUR goals, not other peoples standards."

How Sweet

2010-08-07T19:40:00.000-05:00

Thank you, Shawn, for such a good post. :)

Beef jerky

2010-08-05T15:06:00.000-05:00

I read an interesting post on Tex's blog and thought of something somewhat similar. Someone-talking-without-common-sense similar.

Last night my little patient wasn't doing too hot. Her sedation was inadequate, her pain probably, too. After giving her enough sedatives and pain meds to knock out an elephant, I was still struggling. Her withdrawal after her surgery also seemed to step up a notch, so I called our critical care fellow (CC Fellow) to assess her. After a few "ums" and "ohs" she left the room asking me wait a few mins until evening rounds to come back. Not 2 seconds later, my favorite attending in the world comes in.

"What's happening?" she said with a smile.
Me: "well, we're a little uncomfortable, withdrawing and in pain. Her O2 sats are lower, she's febrile and her belly seems to be larger. I gave her her scheduled dose of ativan, methadone, PRN ativan, morphine and was wondering if we could go up on her Fentanyl drip because I think we weaned it too fast [ahem, YOU weaned it too fast]."
Attending: "yeah, sure why don't you also give her another PRN dose of morphine and some ketamine and why don't we go up on Fentanyl."

A few seconds later, I asked her to look at the area of my pt's surgery. Her abdomen seemed much more distended, the skin turgor was shiny, taught, but abdomen was soft... The redness around the periphery was concerning and the pt's mom said, it seemed to her the pt's belly was getting bigger. She looked at me and didn't need to say, "Could you page surgery for me?" After my "I'd love to." 10 minutes later the dishevelled surgery fellow/resident/someone with a white coat walked in.

I have the upmost respect for surgeons, their schedules and desire to fix people (after all, several members of my family are ones), BUT their lack of respect for non-sedated people and ability to explain to a parent without medical mumbo-jumbo what they need/want/did baffles me.

This was only 9:30 pm, mind you.

He walks in, starts poking and prodding at the abdomen, with my attending standing by. She tries to ask what he sees, what he doesn't see, what his concerns may be. The surgeon is quiet. At this point, the baby is about to jump off her bed - the narcotics and sedatives can no longer control her pain.

Surgeon: "Um... you know... I wasn't on the case when they did the surgery. She seems distended, but ok, she's soft. Um... you know... she looks good to me. We could be worried about illeal prolapse, some air leakage into her abdominal cavity, perhaps a fistula, or worse some intraabdominal bleeding. And then there was a lot of "I'm unsure" and a lot of "medical blah, blah." Let me call my attending [who luckily happens to be the surgeon who did the surgery.]"
Me thinking: "Ok, after scaring the crap out of mom, talking a ton of medical talk, now, really, the pt definitely looks 'GOOD'. Let's quad her sedation, pump her up on meds and then you touch her once and she wants to leave this planet. Really, definitely, she's FINE!"

My attending rolls her eyes at me as the surgeon is leaving...

The pt's mom's eyes were the size of saucers at this point. I'm pretty sure the only word she heard was "bleeding." Turns out, she thought her daughter was bleeding out, dying and better yet was about to be rushed to the OR.

Thanks, Jerk. How about an abdominal xray and some labs, huh?

15 minutes later. "Can you get a CBC, Lytes, Blood cultures, venous blood gasses and a BUN?" Also, I just ordered an abdominal xray. Thanks."

He sat there in the little cubby where all the docs hang out, looking at xray and finally familiarizing myself with the pt's complex medical history. He didn't even come in until I asked him to explain to mom that her baby wasn't dying or bleeding to death. When he finally came, he flooded her with xray terminology and a ton of lab numbers, told her an illeus wasn't a possibility, blood was possible but unlikely either. He said, "you can't really see blood on xray anyway, so unless her belly gets REALLY big, then we know she's bleeding out."
I chimed in: "Would you like me to pull up her xray for you so you can show it to mom?"
Surgeon: "Oh, I've already looked at the xray, plus, mom wouldn't get it anyway."

Huh, did you just say THAT in front of a parent?

Then, mom started asking about signs and symptoms of bleeding and "how big is too big" etc. Her questions about the redness ("erythema", as he so gently corrected her) and sedation and pain were diverted into a direction even I didn't understand where he was going. Satisfied, he left.

Mom looked at me, "Well, I guess, she's ok... I just wish he could just tell me that he didn't know what the "erythema" was and why she was so distended. He didn't have to make up stuff. What do you think he meant?"

And that's just it. This mom has been at her daughter's bedside for so many months now, hadn't missed a day since birth, she knows when doctors talk bs and when they know what they're saying. I think his rudeness didn't even phase her. She told me that many doctors talk to her like she doesn't know anything, like she sees her daughter for the first time, like them...

Needless to say, I apologized for him on his behalf.

Taking the scenic drive

Lost memory

My life since

Sleep. Deprived.

Where to start?

Back from the dead... literally...

"The nurse" - the patient's perspective

Chaos = my life

"What does this med student want?"

on stress

Moving

EH

Crazy day

Thanks!

36 hours

Done. .... for now

Brain freeze

Who said doctors are anti social?

"Previously healthy"

my own internal

missing my mom

Life is fragile, cherish it

House of God

Sensitive

To do or not to do?

Smelly t-shirt

Happy Easter!

Empty

my mini breakdown

Diaper Cake Adventure

A Day in the Life of a PICU nurse, Part II

Registered (interlude)

A Day in the Life of a PICU nurse, Part I

Initial worries

Challenges of a Pediatric Nurse

"jealosy"

Night shift

To go or not to go

Exactly a week ago

A little secret

Blizzard, part 2

the frog exhibit

a Thank you

Blizzard

The Bachelor recap

Packers won!

Missing my family

"The Christmas Shoes"

dreaming

"Pregnant Chicken"

Holiday cards dilemma

Hug a Stressed College Student Day

When my eyes met his...

first *real* snow

Pretty cool :)))

yum!

Happy Sunday

I didn't know doctors could get laid off

my latest "struggles"

So I admit...

Hawaii

more Istanbul

A special day

the wedding

Jet lag

Turkey Travels, continued

Ankara

It is what it is

Bus Station

Duzce, week 1, part 2

Istanbul begins, week 1, part 1

My adventures

T - 2 days!

Congrats!

Medicaid?

Remembering

my weekend

Love it

Found a dress!

Moscow Today ~ where I lived Yesterday

first real snow