Category Archives: Thoughts and Ideas

Update (6/12) weeks done

This past week, the jar of coconut oil in my cabinet went from solid to liquid.  The inside of my car read 114 degrees F (45C) and the steering wheel was hot to touch.  I never imaged I would contemplate buying one of those silver screens for the windshield to make it less hot in the car.

It’s about 78 degrees F (25C) and rising in my apartment.  I often escape to the school library for air conditioning.  The security guard is the only person who can confirm I study daily.  I like campus during the summer.  It’s fairly empty except for the young campers running around.  This semester, studying differently has helped, a little bit of pharm/patho each day.  Practice and repetition, like everything, are the keys to success.

My pharm professor meets with me weekly to check in for about 20 minutes.  She strikes fear in me a little because she is so smart, amazing and the busiest person I have ever met.  I want to make sure I am prepared for our weekly meetings, to show her I have learned something and not waste her time.  Often when meeting with her – her portable yellow hospital phone rings, followed by her Apple watch vibrating with an incoming message… she multitasks like no other, all while drinking the cup of coffee in her hand.  Last week she met me at a coffee shop before going on vacation, on her day off and she brought her son with her.  This is worth repeating – she made time for me – a whole hour before her vacation, on her personal day and with her child.  The generosity of the faculty and staff are incredible.  I am so grateful for their support.

It seems everyone who sees me knows my name and is keen to ask me how I’m doing.  I’m doing great, thank you.  There are plenty of other professors who make sure I feel involved and keeping up with my skills.  I spend an hour weekly in the lab – to review things like foley cath, med admin, physical assessments, etc.  I am kind of in shock when I practice physical assessments, then the instructor says, ok, do it again.  I think to myself, wasn’t that good enough?  She seemingly answers the question I was thinking and says I want you to get it perfect.  This coming week, I am helping in the Pediatrics class, brought on by the fact I ran into my Peds professor at Target.  I haven’t had to present to a full class in a long time.  But, like all things, it’s good practice.  Half way done with summer class, then back to reality of 3rd semester in the fall.

I’m trying to get back into archery.  It’s a 30 minute drive, and it’s an indoor range, but I think it’ll be good for my mental health.  I’m going to try it out next week.  I have also been going to meditation/mindfulness classes on Mondays.  I haven’t liked the type of meditation we have been taught, and much rather get back to my meditation of archery – focusing on the present and my breath while shooting arrows.  However, I have found some things useful from class.  I particularly like the write two things you are grateful for every day.  This feeling of gratitude helps center me and bring me to the present.  I also liked the exercise on reframing negative energy and stress.  For example, if you are at the grocery store, and you are definitely on the wrong check out line.  Everyone else around you is going faster than your line.  Rather than focusing on the negative, the slowness of your line, focus on the positive, like how fuzzy your sweater feels against your skin.  You have power and control to reframe your thinking and how you feel about the situation.

 

Mindful decisions

flow chart

This flow chart is from Cait Flanders’ book, “a year of less”.  The book wasn’t what I thought it would be about, so I don’t recommend it, but I liked the flow chart.  After coming back from Tanzania, I have been thinking about my resources.  I had this quandary with paper towels.  I was down to my last few sheets on the roll and I wondered if I needed it.  Could I use towels instead of being wasteful?  I don’t own cloth napkins.  Paper towels creates a lot of unnecessary waste and I need to rethink my use of them.  I waited two weeks before buying my resupply.  In the end, note to self, I think paper towels can be replaced if I had cloth napkins.

Here is a photo of me cutting cardboard in Tanzania.  They re-use cardboard from packaging as paper to write patient prescriptions, payment balances, and other critical information.  This experience of cutting cardboard into small pieces, reminds me to use all my available resources fully.

cutting cardboard

I am well – I have nothing to complain about except for want of a farm table and my shorts from last summer do not fit.  I must be watching too much Fixer Upper… because I really want a farm table. Not to entertain but I want a 8 ft. long table to study, like the tables at the school library.  I want to spread out my laptop, textbook, notebook, paper… all at home. This is what is missing from my life – a farm table and a bench.

As for my shorts, I was more active last summer leaving San Francisco to Durham. Can you believe that was just last summer?  I have been thinking of San Francisco lately, missing the fog and the bike ride through the Panhandle to Golden Gate Park on the way to archery practice.  I miss those experiences but have traded them in for much more.  In the first five months of this year, I have learned about maternity & pediatrics, observed births, and traveled to Guatemala and Tanzania for global health trips.

This summer, having only one class means I have time for many things like reading all about the royal wedding.  I loved that they donated the flowers from the ceremony to a local hospice.  Her bouquet, per tradition lies on the tomb of an unknown solider.  In lieu of gifts, they asked for donations to their favorite charities… the only foreign charity they choose was a non-profit in India providing menstruation pads to young girls.  This charity – the founder and director is a 2016 Duke undergraduate.  She’s 26 years old and going on to her PhD at Stanford in pubic health.  I’m not even invested in the wedding but I read all details avidly like it was my best friend’s wedding.

I go to the gym most days, working on being more active and healthy.  I have time to do  laundry, clean my house, meal prep & cook my weekly farm box share.  I’ve eaten a lot of lettuce in the last two weeks.  I read a non school related book and have been watching my Netflix queue.  If you haven’t seen the Ali Wong, Comedy Special – you need to watch it.  She’s a comic who is doing standup while pregnant – talking about all things motherhood related.  If you don’t have Netflix, you can watch her briefly on the Ellen show.

I have spent time catching up with friends (local and far), and made summer plans to see them.  I’m visiting Kris in Cleveland, meeting her fiance and seeing her home.  Marissa is visiting me for a week.  I’ll try to go up to NYC for July 4.  I’m traveling with Betty to Ireland mid-August for my first true vacation in a long time.

Class is going ok thus far, no exams yet to report back on.  I have tons of support from faculty and staff.  I meet with individual faculty twice a week, mostly for accountability.  I think everyone is afraid that I’m not going to have community or feel alone/isolated being between cohorts or forget everything, but secretly or not so secretly I am loving the downtime.  It’s really what I needed to refresh and recharge.

We are in week 3 of 12… 9 more weeks of summer class to go.  I interviewed for two summer jobs – one research oriented position and the other clinical with patients.  There was a recommendation that I needed to find community and do something in my spare time, but upon interviewing for these roles, they were full time positions and I wasn’t interested and/or able to devote 40+ hours a week to a job.  At most, I was willingly to work 2-3x/week.  The part time jobs posted were mostly admin and my time is more valuable than $10 of admin work to just fill time.  I was interested in some other clinical roles at the hospital but it would take too long for certification and the application process.  I was willingly to entertain a research or clinical position where I could practice my clinical skills.

I volunteered at an outpatient GYN clinic for women in a substance abuse recovery program last week and felt slightly traumatized by the experience.  I was expecting to triage, take vital signs, maybe observe a patient-NP exam.  I did triage, but I wasn’t expecting the hands on practice.  I was shown how to do a breast exam on a patient.  I was told you take the pads of 3 of your fingertips in a circular motion, then a press down again, in a deeper circular motion on each breast, traveling up and down the breast like a lawn mower.  I’ve never mowed a lawn before, but I think that means you press up and down systematically rather than go sideways.

I ran the speculum under warm water and put lube on the top and bottom of it for the pelvic exam.  I handed the NP other items too.  It was at this point that I felt most uncomfortable.  I was working with the NP, but I hadn’t built up any rapport with patient.  Here she was, on the scoot-scoot table, completely undressed and vulnerable and I felt so invasive.  I wish I had known that I would be going into the patient room and I would have spent more time with her before this point in the exam.  It’s not the experience I would have wanted for myself or anyone else.  I can’t do anything about this experience, but learn from it for the next time I volunteer next month.

It’ll be enough…

A week ago, on the drive back down to North Carolina, I listened to the Hamilton soundtrack because I ran out of podcasts.  That soundtrack carried me most of the drive.  The song, it’ll be enough…look around, look around at how lucky we are to be alive right now… rings through my ears and spirals around my head a week later.

Yesterday, I visited with the refugee family I volunteer with and they said to me, they have enough, that they do not need.  How can a family who uprooted themselves with nothing, need nothing?  I am floored by the fact, I want to go to the store to buy paper towels and Woolite and she needs nothing.  She said she needs nothing for her kids and she needs nothing.  How can she not want or need?  Is it an American custom to want vs. need?

I feel really sad too as I recently learned the news of my friend, Don.  He has lost his battle with cancer and has moved to hospice care.  After a semester of practicing difficult conversations, I find it challenging to write the right words to him.  There are no right words to express my sorrow and emptiness of a life soon to be gone.  (For those of you reading, and also know Don – you can call or text him, or send letters to his home – no email.)  I know he’s not reading my blog anymore as he does not have internet but I am writing to the universe – I am thinking of him with all my strength and courage.  I hope he is surrounded by all that he loves, all that brings him joy, and each day his needs & wants are met.

A step back is a step forward

kili.jpeg

As Duke students we are competitive and strive for perfection.  Sometimes, we do not achieve these lofty goals but it isn’t talked about and imperfection is not seen or heard.

A few weeks ago, before the end of the semester, I had what would be later known as a panic attack.  I arrived to the hospital, a regular day at clinic, however, my heart was beating incredibly fast, so much that it hurt my chest.  I felt slightly nausea, and I had shortness of breath.  Imagine, sprinting at full speed, but you are standing still.   I tried my best to slow my breathing, but after 30 minutes, I asked my clinical instructor what I should do, and she promptly walked me down to the Emergency Room.  I didn’t want to go, and if left to my own means I would have just sat it out.  She was concerned that it had already been 30 minutes and I might have a heart problem.

In the ED, I was triaged, with an electrocardiogram (EKG) machine with 10 leads to check for electrical impulses at different areas of your heart.  The EKG checks for common heart problems and the results were normal.  My blood pressure was also within normal range, but my heart was still racing.

The provider was concerned I might have a pulmonary embolism or something blocking my heart/blood flow.  I received a chest x-ray, and a V/Q scan. The ventilation-perfusion scan (V/Q) is an image looks past the chest x-ray.  You put on a face mask nebulizer for 4 minutes, breath in the radioactive material and the tech takes an x-ray while you are breathing to examine airflow (ventilation).  Then the tech reverses the airflow for 4 minutes, removing the radioactive material from your lungs.  Next, inserted into your IV (which goes straight to your blood circulation) is a chemical dye to watch the blood flow (perfusion) in the lungs while you are under the CT scan.  Both scans came back clear with no evidence of a blood clot in my lungs.  I was tachycardiac for half a day.

I was asked to follow up with school provider and the school psychiatrist.  The school provider concluded it was a severe panic attack.  I had previously thought panic attacks were brought on by a specific incidence but I am told it is accumulated stress.  Your body in a last attempt to stop the stress sent me to the ED.  The Emergency Department bill is $9,000 USD, 10% of which I am responsible for as part of my student health insurance.

The school psychiatrist, coincidentally a graduate of this ABSN program, has knowledge of what I am going through.  She told me what you learn in nursing school is not what you do in real life as a nurse.  Whatever grades you get in school, does not foreshadow who you will be and does not at all imply what kind of nurse you will become.  She said to be kind to yourself and do not be hard on what you know and don’t know in school.

She also said, I need to manage anxiety and stress better. We always talk about stress and casually say, I am so stressed but never before did I recognize what stress really means to you and your body.  She prescribed anxiety meds and suggested I take them for the duration of nursing school.  I was surprised by this recommendation.  She said they will help and when nursing school is over, I can stop taking them.  There are side effects, but we’ll start with a low dose and see how it works for me.  She says meds and psychotherapy are the best ways together to manage anxiety.  She also suggested I take it easy and try to find ways to de-stress that have previously worked for me.  I am open to trying anything that will make me feel better.

Maybe related or not related, during the same time period, I failed the pharm/patho final, which means I am retaking this course and not continuing on with my cohort.  It means I get a time out for the summer to work on me, while focusing only on one subject.  In the fall, I will continue with the next cohort, on the regular schedule of Adult and Gerontology (caring for older adults).  Following in the 4th semester, finish with the preceptorship, graduating in May, spring 2019.

This is a setback in a time line, but does not change the fact I will graduate and still be a nurse.  If anything, the bright side, I will have more down time this summer to visit friends and have them visit me.  I will be part of a new cohort and meet 70 new friends.  It wasn’t until I shared my story, others told me they also have had panic attacks and they are also on meds to manage their anxiety due to nursing school.  Classmates also called to check in, considering I hadn’t been to their first week of classes.  I am usually ok sharing but I didn’t want to advertise this story.  Now, after talking to several people, I want people to know, others have difficulty managing nursing school, it’s not just you.

 

Pediatrics

One of my pediatric patients had said to me after witnessing another family, “when is my mom going to pick me up?”  I could not answer her question, instead I witnessed a nurse provide this patient with the upmost love and support in hugs and kisses, as if this nurse was their caregiver.  The nurse gave the patient unconditional support to feel safe and nurtured while no one else was with them.  I do not have the emotional bandwidth for this type of nursing.  I cannot go to work every day and feel sad because a child looks to not be loved, or maybe they are loved, but I can’t see it.

Pediatrics was a difficult clinical rotation, more challenging than all the other rotations to date.  I did not enjoy working on the floor due to the psycho-social component of care.  I could not understand the circumstances that would leave a child to be alone in a hospital without family support or to have family support but to not have it be great.

Tomorrow, we go to UK-Kenya-Tanzania, where I will giving health assessments to 100-200 orphans, all should be mostly healthy.

Malaria and mosquito nets

Many years ago, I read an article in the New York Times about organizations doing good work – places to donate to during the holidays.  I remember reading, it takes less than $5 to buy a mosquito net to prevent malaria in Africa.  I remember telling, myself, that’s amazing, only $5 to help save someone’s life.  I’ll donate to this cause and tell everyone about it.

Some time in the recent past, in class, we watched a TED talk about malaria.  The talk equated malaria in Africa to how we, in North America deal with the flu during flu season.  It’s just something you might get, and need to get over.  The speaker said, in Africa, malaria is thought of in the same way to the local people, it’s something you might get, and have to deal with.  Local people don’t consider it a big deal, in the same way, many of us might think of colds or the flu.

Imagine, you get the flu, and someone says to you, to fight the flu, you should put a heavy bed net over your bed that does not allow for any cool air to circulate while you sleep.  You accept the net, but decide it might serve a better purpose by using it to fish in the lake to make money at the market.  But, the net is covered in a toxic bug repellent and makes all the fish die.  Instead of helping these people, with your great ideas of how they should improve their lives, you instead have created an environmental problem.

I am guilt of this thinking – and years ago, I donated money to this idea of buying mosquito nets for people in Africa.  I failed to realize the idea of malaria had to be resolved by their own people in a way they think is effective.  They need the motivation themselves.  Just like, I cannot convince anyone to go to the gym if they don’t want to go.

I leave for Africa in 11 days and will remember, my purpose is not to bring interventions to a community but instead help serve in ways that support their independence.

Pakistan, my refugee family

My refugee family is from Pakistan.  When I think about it, I’m not sure if I’ve ever met anyone from Pakistan.  Pakistan is bordered by Afghanistan (west), India (east), Iran (southwest) and China (far northeast).  The official language is Urdu and English, but many people speak Arabic, Punjabi, Hindi and other languages.  In 1947, Pakistan became an independent country for Indian Muslims.  (FYI: Islam refers to the religion or faith, and Muslim is someone who follows or practices Islam.)  In 1956, Pakistan became an Islamic republic, with many cultural identities adopted from the British.  The school system is modeled after the one in the UK and Pakistan students must pass A-levels to enter university.  At my refugee families home, the mom served us British tea and cake.

An ethnic civil war in 1971 resulted with East Pakistan, seceding to a new country Bangladesh.  This is all I know of Pakistan – and I vaguely remember reading a book about Benzair Bhutto a long time ago, the former Prime Minister who championed women’s rights.  This is a sad state of my knowledge gap when all I know about another country is a paragraph.

I don’t know about the political instability that led my family to leave their country but I would guess that it might have been related to Taliban rule, as was the case of Malala (the young girl who won the Nobel Peace Prize for championing girls education).  Malala is now 20 years old and recently made the news for returning for a visit to Pakistan this week for the first time since she fled.  My family, like many refugees relocated to other countries, before arriving in the US and also has been unable to return, leaving behind family members.

The plan for me and my team is to work with this family every week – on whatever needs they have relating to becoming U.S. citizens and assimilating to the U.S.  I think of how challenging it must be to find a new community and flee under such difficult circumstances as to leave your family behind.  Our immediate goals are to work with the mom on passing her driver’s learning permit exam and then finding resources for her to learn to drive.  For the children it is to work with finding them resources such as a playground, after school activities and getting a library card.

I continue to be surprised as to what it means to be a nurse.  Working with this family, brings me an unexpected education.