Week 8: 23 hours, 50 minutes

Week 8 – we have 4 more weeks of the semester and then one week of finals.  In our course work, we have transferred from learning the basics to moving into our introduction to the lifespan. I was impressed to learn newborns and infants exhibit signals of distress and there are ways to manage it to calm their over-stimulation.  Some of the steps are as simple as swaying them, tucking their arms to their chests, or putting them skin to skin with baby/mama/dad.  This week’s highlights were working at Blind Industries and my first day at clinical in the oncology unit. Continue reading →

Support Liane’s Guatemala midwifery trip

I have been hesitant to post this message because I am conflicted with the many causes you could donate and support: the Myanmar refugee crisis, the hurricanes in Puerto Rico and the south, the California fires and really anything going on in the world today.

However, with all the chaos, I am asking for your personal support to help me work towards creating positive change. I would not ask if I did not have to ask. Our program did not tell us of this opportunity when I requested my loans for the year. Our program does not allow the time to work and so I am asking you, my dear friends and readers to consider supporting my alternative spring break to learn about midwifery.

Did you know every year, 5.9 million mothers and children die from treatable and preventable causes? (Curamericas Global statistic)

I would like the opportunity to travel to a remote mountain village in Guatemala to work with midwives at a maternal health clinic.  The clinic supports pregnant women, a labor and delivery unit, and postpartum care for women and children.  As students, we also visit households to support well baby/child visits.

I invite you to join me in my educational endeavors, please consider a donation to this midwifery educational experience.  I hope to learn about treating preventable conditions and serving the under-served.

Thank you for your generosity and support.

Please click here to donate.

Week 7 – “5 wishes”

In the bathroom, one of my classmates looked in the mirror and said, “guys, I look destroyed.”  She said, “normally I don’t look like this” (…dark circles under her eyes). I told her, don’t feel bad, I have to wait until I go to New York to get my hair cut, so until December, I’m going to look like a puff-ball.  She said, same with me, I have to wait until I go back home to Venezuela to get my hair cut too.  That made me feel a sense of camaraderie, someone who travels a greater distance than me to go home to get their hair cut.  It’s not that I can’t get my hair cut in other places, but my go to person in New York is the best.  She makes you feel great, look great, and you don’t need a explanation.  She is also a practitioner of reiki – which if you don’t know is a healing art.  It works with energy.

School was only 3 days this week but just the same level of intensity as a full week and it is non stop again for 6 more weeks than with a small break of 4 days off (Thanksgiving).  Thurs/Fri/Sat/Sun. This appears to be the pattern, 6 intense weeks, 4 days off and go again.

This week’s palliative workshop was on Advance Directives and I thought it was amazing.  It was the first workshop were I felt like I learned tools to use in my future practice.  The facilitator had a powerpoint presentation of all visuals.  I loved that it had no words and I could for the first time just listen instead of read/write/learn.  For example, she had a compass as a slide and that cued her to say, sometimes we do need to guide our patients… followed by the strategy she shared.  I’m meeting with her in a few weeks to talk about how she came to the hospice field in her nursing career.  Every day, I am so humbled to be surrounded by brilliant supportive professors who want to share their knowledge.  I am grateful to be at Duke.  I am also excited to meet in a few weeks with one of our guest lecturers in our wellness class.  She is the Program Director of nutrition services at Duke.  She had great things to say too.

Some things to remember to put in my box of words:  “I wish things were different.”  “I worry… her kidney function is not getting better.”  “If time becomes short, what is most important to you?”  And, once again, we were taught to remember the power of silence.

We were given a bunch of different articles to review, but I liked the 5 wishes the best.  You can also look at Engage with Grace to begin these conversations with loved ones.  Or a game to spark this conversation, called Go Wish.

My update on my ethics paper will be on interpreter services.  If everyone has a right to universal health care, how do we overcome the barriers of language and patients with limited English speaking abilities.  Translation services are in theory great, but in practice they have limitations.

I went to the gym 3 times this week as part of my wellness plan… just 3 more weeks of that.  This coming week – two exciting events – spend the day at Blind Industries (working with visually impaired people doing health assessments/health education) and I start my first clinical assignment at the hospital with oncology patients.

Adventure nurse

We made it through week 6, which is the half way point of our fall semester.  I canceled my participation in the fall break canoe trip because I felt I could not devote 4 days (Sat-Tues) and needed to focus on my catching up with my studies.  I’m sure that means I will not be a participating as a future guide with the outdoor program.  However, I have other things to look forward to in the spring.  I was selected for the Tanzania Global Clinical Immersion program.  In April, for our clinical assignment, I will be going to Tanzania for two weeks.

A classmate asked me what type of nurse would I like to be?  I answered, I would like to be on a mountain search and rescue team, or as a flight nurse on a mountain like in Jackson Hole/Grand Teton, Wyoming or work in Alaska and fly in to rural communities to provide care.  She said it sounded like an adventure nurse.  It made me think a little about post graduation plans.  I will need to work one year as a registered nurse before I am eligible to apply to graduate school.  I am thinking about living in Philadelphia (Penn), Baltimore/DC (Hopkins), and Duke/Durham.  I could see myself going to all those schools and I think if you work at their hospital you are eligible for some tuition reimbursement.  I’d like to get my Nurse Practitioner license/degree so I can provide further care to communities in need.  It made me also think a little that I would like to have somewhere, someplace in the world to call my own.  A place where I have a bed and address that is not a storage unit.  I can continually travel but it would be nice to not have to buy pots and pans every time I move.  I think Philadelphia/DC/Denver might be affordable places, but I hold out hope for the dream of living in Vancouver/Canada, with a big home in Whistler/Squamish, British Columbia/Canada – with a home large enough for guest bedrooms, skis, bikes, and a 4×4 off-road car.

Photos – bathroom in 21C – cool historic hotel in downtown Durham, that has a bank vault – the bank vault is used as a lounge.  The glass doors in the bathrooms at this hotel are transparent, but when locked become opaque.  The sign was interesting to me, because North Carolina is home of the HB2 legislation/”bathroom bill” that mandates transgender people use the bathrooms corresponding to the sex on their birth certificates.  Other photo – Duke Gardens – not as wonderful as I hoped.  It’s 5 miles of green space on campus, but it made me miss the Golden Gate Park, where I would visit the Botanical Gardens any time, ride my bike past the bison on my way to the archery range.

This week’s highlights:

1. workshop on inclusion – I liked how the facilitator reminded us to move back/move up – instead of step up/step down – and wait 7 seconds before speaking again to allow time for someone else to speak.

2. spirituality and dying patients – I will not answer the hard questions, but ask “what can I do for you today?” or “what is important to you when you make decisions?”  Stay humble and curious.

3. Diet and Diet plan – I don’t think I learned anything from this workshop, but I loved the free dinner of soba noodles/green beans/tomatoes/tofu.  I shared with the group of soon to be health professionals my eating habits are focused on the principles of eating locally and sustainable.  I meal plan every week so my fridge looks like a Tupperware take out container fest and I have nutritious meals and won’t be hungry.  I made a rule of not spending money on take out food unless it was a social activity with a friend.  (i.e. you cannot buy a pumpkin scone unless it is an activity with a friend.)  I felt everyone looked at me like I was strange, and a girl in the group said I should mentor her.

We have to write a paper soon about ethical dilemmas and our future practice.  I am thinking about writing about the difficulty of providing objective standard of care to all patients, regardless of your thoughts/values on (for example, addiction).

Next week, I have my head to toe assessment, then the following week, I am assessed on this skill in clinical with my a oncology patient.  I’m a little scared as we have only 6 weeks of school/training.  I am not yet ready to take small responsibilities away from a nurse, with a real patient.  Our professors say we are ready, and maybe that is enough.

Nutrition in Medicine – holistic care

I should be excited that I was selected for yet another workshop series that I applied for, but I’m kind of exhausted.  I’ve had two 12 hour days on campus this week.  Monday, I arrived at school at 7:30 am, and then left at 6 pm, went home for a quick dinner then back for kayak skills class for 2 hours in the pool, back home at 9:45 pm.  Today, I was in the library at 9 am, left school at 8:30 pm.  Adding one more thing to my calendar, even though it’s only for 4 weeks, 2 hour sessions still uses a lot of mental energy.  I should feel like I won the lottery.  Not everyone was selected for the workshop series and I do not want to pass up on another great learning opportunity with my colleagues from the other health schools.

The next workshop series is Nutrition in Medicine and students were selected across health schools from nursing, PA (physician’s assistants) and MD’s.  We have four sessions, two hours each week, with the first hour – a demo of culinary techniques and healthy meal prep, the second hour devoted to a discussion about nutrition topics by an expert.  Topics include: macronutrients and the diet interview; eating for hypertension (high blood pressure); diet and diabetes and food and cancer.   The sessions take place at Duke Integrative Health and the building is phenomenal.  They have a labryinth, meditation room, quiet room, a library and courtyard.  I can’t wait to visit.

For the other workshop series, the one on end of life care – today was our first workshop.  It was called medical improv.  It was about communicating, listening and speaking to someone very different from yourself.  My favorite activity of the evening was to pretend one person is Rip Van Winkle (from 1776) transported to today and the other person is from today trying to describe what is email.  It was a fun and challenging activity.  We had a brief discussion about how this activity can be applied to patients, especially about difficult topics like cancer.  What are the important topics to get across?  What is valuable for the patient?  More learning… every day.

Highlights in our lessons this week – we gave each other partial baths, brushed someone’s teeth, learned to listen to heart and lung sounds and learned about different types of neurotransmitters.  It’s only Wednesday.

Grateful, breath awareness

The last three days of practicing ten minute meditation through breath awareness has been very challenging.  My professor said we can break it up to five minutes, and another five minutes, if we can’t find the time.  I know I should be able to find at least ten minutes in my day to sit still, but it’s hard to sit for ten minutes while bringing your awareness back to your breath.  I do feel better though after the ten minutes, more focused and calmer.  My professor recommended downloading the app/podcast: Meditation Oasis.  (The app cost a few dollars but the podcast is free).  Click here, Meditation Oasis if you want to try the meditation with me.

Our hw was also to write two statements every day: “I am grateful for…”  I enjoy the “I am grateful for…” exercise for bringing back the awareness to the present.  Today, I am grateful for not being 18 years old and I am grateful for my safety.  As part of Duke staff (for the outdoor program), I had to sit through a mandatory training about safety.  Safety about the buildings – if there is suspicious activity, or a tornado, or an active shooter.  The active shooter video was really eye-opening.  Did you know if there is an active shooter – your first action should be to get away – evacuate?  I didn’t actually know that you should run away.  If there is an active shooter, you should try to run away rather than lie down or hide.  Second step, if you can’t evacuate, you should hide, and lock the doors.  Third, your last resort if you are in immediate danger is to take down the active shooter.  The first officers to arrive at the scene are responsible to stop the shooter, then the next group of officers attend to the wounded.  The video seemed very timely.  The beginning of the video was post office workers who were shot by an angry employee.  This tragic incident happened in San Francisco, this past June.  The video also showed scenes from a shooting at a school, and it reminded me about a podcast I listened to a few months ago about forgiveness.  The podcast was by the mother of the boy who killed other students in Columbine, Colorado.  She was speaking about the meaning of forgiveness.

My second grateful statement is – I am grateful for not being 18 years old.  In this safety workshop, I sat next to a colleague, who is also working in the same outdoor program as me.  She is 18 years old and we were chatting about her classes, life and she had some basic “adulting questions”, one of which was what is direct deposit and how do you enroll?  I said, she could text me or email if she had other “adulting” questions and I would help her answer them.

Below – for your amusement is my color coded schedule for the work week, 8am-8pm.  It does not include homework time.

schedule

Week 4

Finishing 4 weeks, means there are 2 more weeks until fall break.  Fall break isn’t really much of a break but more like a long weekend.  For fall break, I am shadowing a kayak/canoe trip for 4 days with Duke’s outdoor program.  The shadowing is a requirement if I want to be considered to lead trips next semester.  I haven’t been on the water in a long time, so before I can shadow this trip, I need to take a pre-req and take a 2 hour refresher course in the pool in a kayak.

Trip description: 4 days, 3 nights: Hammocks Beach State Park & Croatan National Forest, NC: Start off Fall break by canoeing 2.5 miles out to Bear Island to camp for two nights. While on the island enjoy beautiful views of the Atlantic Ocean, long walks on the beach, and the variety of wildlife. Then head over to the Croatan National Forest to camp and canoe through the wetlands.

I am excited to report back, I was accepted to the program I applied for – it is a year-long program aimed towards health professional students to gain experience working with seriously ill patients and become comfortable with end of life care discussions.  Program includes students who are PA’s (physician assistants), MD’s (med students) and nursing students.  I have two-hour workshops every Wednesday covering topics such as financial toxicity, spirituality, advance directives, etc.  Each seminar is led by leaders in the field.  Once, I’ve finished all the topics, I shadow an oncologist mentor several times this fall.  I sit in on chemotherapy appointments with patients.  My first clinical placement, starting in October (Thursday’s from 7 am – 3 pm), is on the oncology floor too.

I started a mindfulness workshop that meets 1 hour once a week for 4 weeks to learn mindfulness-based skills and mediation to manage stress and improve general quality of life.  The workshop is based on Jon Kabat-Zinn’s, Koru Meditation practices.  I’m excited to learn new strategies as I feel very sad about losing my weekly archery practice – which to me was like mindful meditation.  Weekly, I would bike to the archery range in Golden Gate Park, and work on stillness, breath, being outside and focused attention on a singular task of hitting a target.  There is some reading and hw for this class.  Our first week’s assignment is to every day for 10 minutes, practice our first learned meditation breathing exercise and be mindful about one repetitive activity every day – like brushing your teeth.  Be aware of the action of brushing your teeth, feeling the toothbrush on your tongue, on your gums, on the roof of your mouth, etc.  We are to hold that attention actively for 2-3 minutes.

In November, I signed up for a Doula workshop.  For 3 weekends, I learn birthing terminology and techniques to support a child-bearing woman.  After this workshop series, I will be able to sit for an exam for Doula certification.  I am taking this workshop out of general interest and to prepare me for the spring semester course, on maternity and peds.  Then, for spring break, I will spend a week working with midwives in the mountains of Guatemala.  I heard of this amazing experience where a few students went with a midwife for a house visit and the woman they checked on, lost her baby the night before, but the placenta was still very much in her body.  The students, directed by the midwife, assisted for two hours in the woman’s hut, until the woman pushed out the retained placenta.  They used skills learned in class and applied it to the real world.

These workshops are all voluntary, in addition to my intense coursework and offered for mostly for free, depending on how you think of it.  I am doing my best to take advantage of my very expensive Duke Education without overcommitment.  The spring break trip is $2,500 which I will likely have to fundraise for since I had not allocated it during my personal student loan request.

During the Nursing Students Without Borders info session, I was interested in a project that they call Nurse Mentors.  We, nursing students go to a middle school, after school program and teach kids lessons.  I would love to teach sex ed and considering it for the spring semester.  I would also like to work with refugees, and they had a previous workshop on that.  This is a voluntary club, you know with all that extra time we have to spend on the community.  In the spring, we have a class called Community Health and we spend much more time in the community.

In lab, I passed my first check off – which was taking vital signs.  I am now cleared to go to clinical assignments and practice taking blood pressure, temperature, heart rate and measuring respiration rate on real people.  In two more weeks, we have our next check off which is Head to Toe assessments and that one is much scarier – if you don’t pass this check off, you don’t pass the class.   In the Head to Toe assessment, I think the most difficult part is the pulmonary/respiratory system.  Click this website to listen to lung sounds and commit them to memory.

I still haven’t made it to the gym in 4 weeks, but I keep thinking about it, putting it in my color coded calendar and then pushing it off to the next week in favor of other priorities like eating, sleeping and studying.  I think for the second part of my wellness plan (hw) – I will probably have to put exercise on it to increase my wellness.  The hw will hold me more accountable since a grade will be tied to completion of the task.