Tuesday, July 2, 2013

2 more semesters!

I'm almost finished with summer semester. I'm doing my "Adult 2" clinicals at a Family practice, but we don't really see anyone under 18.
I have to say, I'm really coming into my own. I am loving primary care, especially when you get to see people back. I have much more confidence this semester with seeing patients on my own, and coming up with a plan.

Finally, I can see the light at the end of the tunnel.
In August, I start peds/women rotations, and in the spring, I will start m FINAL SEMESTER of grad school.

Two more semesters.
I'm being proactive in my studying. I've bought Margaret Fitzgerald review CDs. At first, when I began listening, I thought...oh geez, her voice is seriously monotone and drab (it still is), but she's growing on me. And I love that she was an ICU nurse. Her comments at the beginning cracked me up.

I'm going to truly miss the ICU, my coworkers, the closeness with patients on a different level, just "being a critical care nurse," BUT...I AM SO SO SO SO happy with the direction my career is going. I'm not sure how pediatrics will go, but the new setting will be challenging and rewarding, I'm sure.
I'd love to start in a great Family practice. I'd love to see all walks of life, from the newborn to the elderly and everything in between.

How amazing to think that I began this blog in 2006, before I even started undergraduate nursing school. The enthusiasm is still there.
I've come such a long, long way.
FNP, here I come!!!

ICU

Over a year ago, I took care of a man in this late 30's who had been diagnosed with aggressive lung cancer. He had a wife, and two children under the age of 5. His diagnosis was quick, he was receiving chemo and radiation, but within one month, he found himself in room 291 in the ICU, on the ventilator fighting for his life...for the life of his wife, kids, siblings, and parents.

I took care of him on a Friday, no plans to wean him as he simply wasn't ready. I kept him sedated, comfortable.

The next day, we did a weaning trial, but he was breathing too fast, tachycardic, etc.

By Sunday, I spoke to the intensivist, and we both felt like perhaps we should forgo the spontaneous breathing trial (SBT) and just extubate...perhaps he will fly? We just didn't think he would pass the SBT. The family was agreeable, and if he didn't  look good, we would reintubate, but he would be a DNR.

His wife was sweet. She worked as a new medical assistant in primary care, from what I remember anyway. She laughed and smiled a lot; to the point that I felt she was probably in a bit of denial. But she kept mentioning his death and how she was realistic and understood it was highly possible he would not survive this. She could only think of her two young boys.

We had the family leave, extubated him, but he was not doing well within minutes. His family all came into the room, hugs and kisses. He was gasping for air. We would reintubate in the interim.
After a long discussion over hours, the decision was made. He would be extubated, and made comfort measures only (CMO).

This scenario has played out countless times for me. I've sat with lots of people as they take their last breath, but for some reason, I lost it that day.
He required a lot of pain and anxiety medication. His father decided he would be in the room. When he came to the door, I was still trying to get his gasping under control. His father took one look from the door, like a scared puppy. I motioned for him to come in, that it was okay. He said sorry, he couldn't handle it, and quickly walked back to the waiting room. Finally, I got him comfortable.
In the end, I believe it was his brother, wife, and sister-in-law in the room when he passed. His parents could not handle it. His mother was a nurse, she was a wreck.
I was dying. I was crying, I kept having to leave the room because I was so distraught. I honestly don't know why this particular situation had struck such a cord with me.
When he finally passed, I hugged his mom, both of us in tears.
Part of me felt like a horrible nurse. I'm supposed to be professional, keep it together!
I thought about him and his family for a long time, and still to this day.
But recently I was reminded of them.

A coworker had been to her doctor's office, and apparently she met the MA, who was his wife. My coworker said his wife said I was one of the best nurses, and she still thinks of me to this day.



Tuesday, January 8, 2013

Demand More!

 Not much updating of the blog these days. I accidentally forgot to renew my domain name, so I lost raspberrystethoscope.com and I have no idea what I'm doing or how to get it back. Oh well.

The end of 2012 and into 2013 have been wonderful...



We just returned from our 7 day cruise belated honeymoon...


We stayed pretty active during our cruise...

Tubing.

Zip-Lining!



 The palest person in all of Jamaica!


Climbing a water fall...



You know you're a CrossFitter when you visit a box during your honeymoon!
No time for a WOD, but it was awesome nonetheless!


We're still hitting CrossFit hard and loving every minute of it. New PRs and getting stronger everyday!!


 In fact, my ONE YEAR CrossFit Anniversary is coming up this Friday. I'd like to do a post on this because CrossFit is a huge part of our lives...

Today is the first day of the semester for me. I begin my first clinical rotation on Wednesday and I'd be lying if I told you that I didn't have butterflies.
This is the meat of my program and I'll be busy with work, school, and clinicals SIX DAYS PER WEEK.
You better believe I'll be making the time for CROSSFIT at all costs. It keeps me sane.

On that note, I've been living with the following...

Tuesday, November 20, 2012

You can cook just like Mom...

Last night I got the best Thanksgiving and Christmas gift of my life.

I had taken a nap earlier in the day and had sad dreams about my Mom. I missed her so much afterwards.
I had been thinking about her earlier in the day after volunteering as an RN at the free clinic. I thought about how proud she would have been because she loved to help people, and was always so proud of everything I ever did in life. I thought about how she would have loved to volunteer, and probably would have asked if there was something she could do, too.

At the clinic, they began closing off the parking lot for handing out turkey and other food for Thanksgiving to homeless and others unable to purchase. I suppose the holidays are all-around a hard time because we devote them around our family, and when they're gone, you feel lost...



Later in the evening, after cooking and thinking of the upcoming holidays, my thoughts turned to her recipes. You see, after her death in January 2011, due to family dynamics and drama better left unsaid, I was unable to retrieve some of her belongings from the house. Over the past year and a half, I've always been completely heartbroken that I've lost her handwritten recipes, notes, and books.
My Mother read the newspaper every single day from front to back (very proudly, I might add!), and she would often cut out little articles or recipes that she liked. She was a wonderful cook and had many of her "Nancy's" famous ___ (fill in the blank!).

Nothing compares to your Mom's homecookin', even the simplest of meals. Every time I put a knife to a celery stalk, open a can of tomatoes, or make a batch of banana bread, I think of her cooking, the aroma of smells wafting through our house on any night of the week, and I regret all of the missed opportunities to learn from her!

And I regret not having her famous recipes.

The one thing that I did have, however, was a tin recipe box with handwritten recipes from my Grampa (her father, who raised her and 6 other kids when she died of complications from a car accident; my Mom was 6). However, after dreaming of my Mom so vividly and thinking of her food, I could not remember where I stored my Grampa's box!
My Grampa, and Mom's mom who died at age 36.


Since my Mom's death, I've been putting off going through the boxes and boxes of photos and small mementos hidden in my closet.  It's been a daunting and depressing task that I've "put off for a rainy day" that has yet to manifest in busy life.

So, last night around 9pm, I went through a box and came across a large green plastic box with the words, "Important Recipes" haphazardly written in sharpie across the sides...in my Mother's handwriting.

I opened the box to discover hundreds and hundreds of recipe cards in her handwriting, yellowed with age and splattered with sauces and crumbs from past times in the kitchen. In addition, tons of articles, recipes from newspapers and magazines that caught her eye and prompted her to cut them out and store them in this box. She wasn't very organized.

They were all there...chicken ala king, cheeseburger pie, Nancy's famous sauce, her chinese chicken wings, angel chicken...the classics from my childhood. Here they were!!!!!

I brought the box out into the living room with tears in my eyes. I opened a manilla envelope full of newspaper clippings.
The first article that I pulled out nearly took my breath away...
It's like she was smirking in her mischievous grin trying to speak to me...

Thanks, Mom!!!!! I'm certainly going to try...

Sunday, October 28, 2012

Happiest Day of my Life!


10.20.2012.

Married the love of my life...
A beautiful garden in the evening with 30 family members and friends...

Sneak peek photo from our photographer...


"First look" candid via our amazing photographer...


 First kiss as husband and wife...(rest of the photos are not the professional shots! waiting on those and so excited to see them).
Married!


 Macarons made by MY HUSBAND's mother...


Top of our cake...


Mirza jammin' out with the jazz band...screw tradition and first dances. My husband entertained...


Beautiful centerpieces, taken via iPhone,which sat in my POCKET:)


Updates when I have better photos to share.

Friday, September 28, 2012

My hot spot

Lately, I feel overwhelmed that I either:

 A., have nothing to blog about
or
B., have so much to say, and no idea where to start.

In the end, I write nothing, and as a result, I have not posted in months, as you all can see.

Let me break it down for my own (in)sanity:

We'll make this post about school and nursing:
Last month I began  a new semester taking, "Advanced Diagnostics and Procedures," and "Organizational and Professional Dimensions of Nurse Practice."

Both of them are going well, and although it is a lot of work, I am certain that when I graduate, it will all be worth it!

Yesterday, we learned to suture, so that was certainly something I looked forward to doing. At the beginning of grad school, we take a lot of theory-type courses, so to delve into the hands-on, and nitty-gritty aspects of being a Family Nurse Practitioner has been quite rewarding and exciting.


 We practice our suturing on pig's feet.  I practiced tying the knot and over and over until my hands just moved fluidly without thinking. In all honesty, as an RN, I've never been all that enthusiastic about little procedures/tasks, like IV insertions, phlebotomy, insertion of small bowel feeding tubes, etc., so I was kind of nervous about how I would do. I suppose you could say that my confidence was low! But, I believe that I did great and with practice I could even love suturing. It was definitely fun!


Next semester I begin clinicals, and I am nervous!!!

I know that once I'm with a patient that I am fine, calm, and natural, but the anticipation is killing me. In addition, just talking to classmates ahead of me, I know it will be a ton of time consuming work, especially with a full-time position. In fact, I may need to cut down my hours in the ICU, but it would only be to one less day per pay period. I can probably swing the minor pay-cut if it will save my mind and body the extra stress.


^^ Prior to my OSCE head-to-toe...attempting to "look like" an Advanced Practice Nurse. I did great, by the way, and my actor-patient dude told me that I did excellent, and he said that although he did not know how long I've been a nurse, that I seemed "very comfortable," like I knew what I was doing! Score.

The other day at work I was joking around with the pharmacist after he told me how much they make right out of school ($$$), and I said I might need to switch careers. Immediately, the ARNP in our ICU said something along the lines of, "No way, you love the bedside. I see how you interact and talk to your patients--you love it! Don't try to deny it otherwise." I smiled on the inside because it made me happy to think this is how I portray myself inadvertently to the world. I do like my job and I do have a passion for helping me, but oftentimes, during a long, 12 hour shift in the ICU, you don't necessarily feel all lovey-dovey towards everyone, or that you're actually even making a difference. However, he genuinely meant what he said, and that makes me happy. It also gives me the drive to continue on with school because it is a lot of work.

During this political season, I'm feeling especially fiery towards certain topics in healthcare, and I feel like I want to take action and be involved in organizations and legislation.

I am currently obsessed with what Jeffrey Brenner, MD has done in Camden, NJ with "hot spotting."  If you haven't heard about the Camden Coalition or Dr. Brenner then you definitely need to check out a few sources because I suspect that these types of programs/organizations will be popping up all over the country. Or at least I hope!

First, this video from Frontline 



and this piece by Atul Guwande from the New Yorker, "The Hot Spotters: Can we Lower Medical Costs by Giving the Neediest Patients Better Care?" 

When I read these articles, and watch these videos about the Camden Coalition, I feel a huge spark! I want to tell everyone what they're doing because I think it's the wave of the future. I seriously feel excited about what is going on, and this to me shows that I am in the right field...or should I say, I've found my own "hot spot." I LOVE being an ICU nurse. Just telling people you work in the ICU sounds cool in and of itself, I have to admit. But there's something calling from within me and that is primary care. I just know that I'm going to be doing some awesome work!!

Saturday, July 7, 2012

"Angie" and 6 months CrossFit

This morning we did a partner "Angie."
-100 pull ups
-100 push ups
-100 sit ups
-100 squats

That's not all, though...while one person is doing the work, the other has to hold a 95lb/65lb barbell in the deadlift hand position. If you drop the bar at any time, 3 burpees, both of you.

 We chose 85lb to compromise because Mirza and I wanted to work together...what. the. heck. was. I. THINKING????????

It was horrible.
The entire thing.
Halfway through we had to switch to 65lbs. There was no rest for either of us. Ever.
It was worse than running...

My muscles...all of them...screaming right now.


The pull ups are the worst. We used a blue band. I ripped my callus and it hurts like hell!!
I honestly did not think this would be so bad, but it was. CrossFit is definitely not pretty at times.

However, I killed it during the squats. I did not want anything to do with that barbell.

In 4 days, it will be my "6 month CrossFit anniversary." I can't believe I'm going to share this, but I'm proud of my results, so here it goes.

When I first started CrossFit, I took a before photo. And then a 3 month photo. I wanted to see if I could notice any results from this whole CrossFit thing.

The final picture is now. 6 months into CrossFit..


You can enlarge if you like, but there is a noticeable difference in my mid section. This isn't a post about looks because that is NOT why I do CrossFit or why I even started. I do CrossFit because I love it! It's a ton of work, but a lot of fun. Like I mentioned in my last post, it is the one thing I look forward to most in my day. CrossFit helps me feel stronger and enables me to do things I never thought possible.



CrossFit makes me an overall better person. And I love it.





Saturday, June 30, 2012

Busy Bee

Work, school, and life are kicking my ass!


Nurse Practitioner school is no-joke and I'm not even doing clinicals yet. Right now I'm in Advanced Assessment and Advanced Pharmacology. I wish I could tell you some good things about Pharm, but I was forced to take it online for the summer semester, and it is absolutely horrible. I'm honestly not learning much. In fact, it gives me severe anxiety knowing I am teaching this to myself from reading a stupid book. I'm worried about how I will fair when clinicals begin--will I be prepared?


Assessment is just a ton of work. In a few weeks, we are doing something called an OSCE (observed structured clinical exam). Basically, we go into a mock outpatient office with an actor/patient, and we will be observed behind a two-way mirror (like in the cop shows!) by our instructor. We'll also be videotaped. The patient will have "something wrong with them," and basically we go through a health history and focused exam. They are "professional patients." We will do this again at the end of the semester, but it will be a "well-visit" and we'll do a complete head-to-toe assessment. Just the thought of it is scary! However, I have to keep reminding myself that I've been a RN for 4 years and every single day, I walk into a patient's room and I ask them questions and do an assessment. They are not scary. Except now? I have to figure out what is wrong with them and order meds, labs, diagnostic tests, etc. I'm freaking out, but also proud of how far I have come. I definitely do not know how people with no nursing background could ever go through a program like mine. My clinical experience and background has been the only clutch I have to lean on, especially when writing case studies.




This is pretty much my life right now: work full-time (bla!), school "part-time," which is not part time because every hour that I am not at work, I am focused on school. The other bits of time I focus on staying healthy, which is of course with CROSSFIT. It's pretty much the only awesome part of my day. Oh, and wedding planning.


I'm a busy woman!


CrossFit has been nothing short of awesome. I am getting stronger everyday. I look and feel it! We also did a 6 week paleo challenge at the box. Mirza lost 3 inches from his belly! I lost 1.5 inches. I did it mostly to kick the sugar habit, and it has definitely helped my mood, performance, etc. Like I said, CrossFit has been a lifesaver for my crazy, hectic life. It's what I look forward to most in my days.
Mirza has made huge gains in CrossFit, as well. I'm so happy that we've both found something to be passionate about together. It's so much fun! 
Taken on May 24th--Mirza's birthday


This morning we did a Team WOD together.

The Saturday WOD
Team WOD:  Partners pair up according to experience.  We want each team mate to be close to partner’s abilities in time and work capacity.


  • 30 HSPU’s
  • 400 Meter  overhead plate carry 45/35lbs
  • 100 Hand release push ups.
  • 100 m. Walking lunge (to the first speed bump)
  • 100 m.Burpee broad jump(from the first bump to the second bump)
  • 200 m. Sprint (back to the “box”) both teammates must be at the box before starting the pull-ups.
  • 100 pull ups


For this WOD each member will share the work.  ONE works while the other counts.  At no time can both athletes work at the same time other than the runs, but that is because one is no good without the other.  During any run or the plate carry, the work cannot resume until both are in attendance.

 It took us 30:11! The coolest part of the day for me was during the warm-up when I did 2 unassisted, strict pull-ups!! I've come such a long way. My knees came up a bit, but I know I'm getting stronger everyday. 
box jumps during CrossFit for Hope


A couple of weekends ago, I climbed the rope!! Of course, Mirza got a crappy photo of me at the top, so it's impossible to see if it's me, but I swear, I climbed the rope. On my SECOND attempt, I tired out and ALMOST got to the top. He took a video.



Of course, I have no technique and need to work on my feet, but yay!! rope climbs rock.





Other than CrossFit, one excellent aspect to life is this:

That right there is me holding a receipt for final payment of my CAR LOAN! I PAID IT OFF. I officially OWN.MY.CAR. What a great feeling!

Until next time!


Hope I still have a few straggler readers out there!
I'd like to start a conversation: What is the one thing you look forward to most during your day? As said, mine is CrossFit (when I'm able to go!!!). Oh, and of course, the nice, hot long lavender bubble bath after a rough day. I think I'll go take one right...about...now!