Thursday, November 15, 2018

Monday, November 12, 2018

Baby, Harvard, Spanish.

Baby is home!

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We are trying to figure out a new look for Edda.  For her whole life, we've bought her Hanna Andersson clothing which are beautiful, but really trap her in the early elementary school look.  Not a terrible thing, for sure, but now we are looking for an older, more grown up look.  I think we are skipping all the teen stores and going straight to Uniqlo.  We ordered a bunch of camisoles with the built in bras and some stretchy turtlenecks. For a little while I tried to walk into the popular teen stores and buy outfits for Edda, but I generally disapprove of those stores and I can't bear to spend $ there, so there is that.

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The first quarter of junior year is done for Vince.  He did well, but he did not get straight As - this included a B in AP Physics.  My plan for letting Vince live his own life is working well, I spent only 45 minutes fretting about his physics grade since September (ok, maybe 90 minutes).  If I wasn't learning to be a nurse, I'm sure I would have spent days obsessed about this and tried to make him cram physics into his head in various unpleasant ways.   We were driving home from school one day last week talking about his physics grade and I told him I was less busy now for the next quarter (in the sense that I don't feel like throwing up everyday I go to the hospital) and I more available to helping him with it and that Jeremy was always open to helping him out, but he said - well while you both arrive at the same correct answer there are pros and cons to asking either of you. Dad is always very nice about helping out, but he explains it in a convoluted and confusing way and you are always initially judg-y about it, but your explanations are clear and to the point.  I sighed and said, you ever use Kahn Academy?  They are pretty clear without the judg-y part.  And then I said I'd work on being less judg-y (Which I'm always working on.  Always,  Not just to Vince, but to the whole world).  I'm not sure Jeremy could work on being less complicated.  This Harvard/Asian-American case has also helped me let go of a lot of college admissions angst.  While I'm staunchly pro-affirmative action, Harvard's admissions procedures have really felt like a personal attack on me, so I often feel like - screw Harvard and all those fancy private schools.  There will be no private school going for any of my offspring.  They can have all the Squis that they want, they obviously don't want me and I don't need them.  There is a lot of work to do and none of it requires a degree from Harvard.  Then I tell Jeremy - Vince is going to a large, publicly funded state school and then Jeremy looks at me and is like, huh?  What is going on? (I can swing wildly on this topic.  It is shameful for me to admit that of all the crappy things that have happened, #metoo, children ripped from their family, etc, etc, I'm can focus on this Harvard case a lot and then I berate myself, because really?  am I going to feel bad about who is going to drive the Porsche when everyone has rusty tricycles to go to work/school?)  Maybe it's all sour grapes as Vince is obviously not as obsessed about school as I was and I often I think more power to him (though just as often, I'm like why are you not studying every minute you are awake?).  Unlike me at 16, I'm sure I could drop him in the middle of a foreign country, not speaking the language and with no money or phone and I'm sure within 24 hours, he'd find a nice, non-freaky friend and a non-freaky place to sleep and a way to call us/text us and tell us that he's OK and if he can travel for a bit with his friend and don't worry about the $, he'll figure out a way to find a job to pay for the travel.  (As an aside, I loved the affirmative action episode of Patriot Act with Hasan Minhaj where the best quote was "Our entire live we get shat on — oh, you guys have small dicks; you're bad drivers; you're the color of poop; you smell like curry and kimchi. Nothing. We say nothing. The moment we can't get into Harvard, we're like, 'I'll see you in court, motherfucker!'").

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To be really excellent at my hospital gig, I think I'd need to become fluent in Spanish.  I took French in high school and I often wish that I had taken Spanish instead because at least I'd have that to hang my hat on now.  I spent some time today watching TV shows in both Spanish (Cable Girls) and French (Blind Date) on Netflix with the English subtitles to kind of gauge how much of an advantage taking HS French was and I think any advantage is erase by thirty years of not thinking about anything more complicated than a croissant.  I consider my Chinese to be pretty poor (I tell people I speak like a toddler because that is pretty much when I stopped trying to learn any more), I still can't get tenses correct.  I've been in situations where my spoken Chinese seems good enough and the person gets really excited (because it's always nice to speak in your native language when you haven't been able to communicate easily and quickly in days/weeks/whatever) and then starts speaking really quickly and then I don't know the word for blood pressure and then I'm confused if they have taken their blood pressure medication already or if they are going to take it later or if they are asking if they should take their blood pressure medication.  I watched another Netflix TV show in Chinese (Meteor Garden) to see how fluent my Chinese is and it's not terrible, but it's not great either.  I think I could kind of manage without the subtitles.  If I could get my Spanish to be as good as my Chinese, I think that would be wonderful.  Actually, I'm lowering the bar, I would love to have good command of receptive language.  I would love to understand my patients.

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IV score:

Doris: 1 Patient: 1

Thursday, November 8, 2018

too much, andy, ning.

I've come to the conclusion that I'm working too much.  I don't think I'll do anything about it for another 2.5 months though.  That's when I hit the 6 month mark at the hospital gig.  I'm still learning way too much each shift, I'm not yet fluent in the ways of the unit.  I feel like I need to wait until I feel that competency before I back off from full time.  Everyone assures me that it happens - that I will feel so comfortable, it'll come.  Just wait for it.  The question is will I feel it at 6 months?  Or will it take me a whole year?  That seems to be the range.  But it means I'm tired, I'm not doing many things that I love to do and I had the space to do before. 

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I had to head to Alexandria today for training.  Usually training is online, but somehow I missed the first rounds of notification email and by the time I could find a date that worked for me, the only spots I could attend were in-person at the office.  Actually, training in-person is so much nicer than training online. Even though the online training still has a live-person giving the training, it's so much easier to ask questions and interact etc, in person.  I used my office presence to have lunch with Andy which was lovely.  (I was surprise to learn that even though Andy is 100% at the office, he still does all the training online!) We spoke a bit about Catholicism.  He's grew up Catholic and still goes to church but now identifies as an atheist.  I grew up without religion and also consider myself an atheist and now work at a Catholic hospital and stop by at the chapel before each shift to pray (to who, exactly? dunno.) for the well being and safety of my patients, their families, my coworkers and finally myself.  (When I'm anxious and feeling bad for myself, I will reverse the order of the prayer.)

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Ning had her baby this morning!  On the way home from Alexandria, I stopped by the hospital (not mine!) to visit.  I walked in quietly to find them all sleeping soundly.  I couldn't bear to wake any of them up - I'm sure they were exhausted.  So I tiptoed out of the room and I was driving home when I got a text that they were awake and ready to see me.  I looped back to the hospital.  Noah is beautiful and perfect.  I'm going to be a little selfish here and say that I'm so excited that there is a baby in the house.  Ning is our morning caregiver for Edda, but she (and family) also rent our basement apartment.  There is going to be a baby in the house!  Our house is going to be full, makes me happy :)  I hope I get to babysit sometime. 

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Wednesday, November 7, 2018

Misc.

I actually wore this outfit out into the community where people could see me.  I'm dressed by two Asian mothers: Soojung's mom gave her the plaid purple pants which she then gave to me and I wear them all the time to the gym and my mom gave me the striped sweatshirt.  I had to stop by the hospital today to do some administrivia and I thought I could sneak in/out wearing these pants, but I now know too many people at the hospital and even though I was tunneling through the basement belly of the hospital, somehow the hospitalist who, yesterday, I was just getting to know in a professional-type manner was walking straight down the hall towards me, spied me in my plaid leggings and kind of smiled in a wow-those-are-some-pants kind of way and said hello to me.  I cringed a bit.

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Speaking of yesterday's shift, I started my first IV on a real-live patient.  I'm writing this only so I can remember it later on:  I had a nursing student with me (they show up on random days and get randomly assigned to various nurses - the last time I had one assigned to me, I was on my 2nd shift on my own and I implored the instructor to please take the student away from me because I was anxious enough on my own).  This time, I was like - what the hell, we'll just go for it. I understand it's part of the gig, I was a nursing student who tagged along another nurse, I need to do the same to pay it forward.  This particular nursing student was an asset because she added calmness to me instead of anxiety and I was happy to have her around.  I had a very friendly, very appreciative patient whose IV was infiltrated and needed to be replaced. I pulled the student aside in the medication room and told her that I was going to start my first IV and asked if she would she help me out.  It's, of course, possible to start an IV on one's own, but it's also very nice to have someone handing you supplies as you need them.  She immediately said yes and then told me that she was hiding from her clinical instructor because she did not want to give any injections today.  I said, OK, I'm like 6 weeks ahead of you in that feeling.  We walked into the patient's room with twice as many supplies as is technically necessary and it did take me three jabs to get it right, I was going to stop after two which is the general rule of thumb on our unit, but my patient was like - no, it's fine, just keep going.  And then there it was: I got the flash of blood in the cartridge, I advanced the catheter, I got the blood return, I didn't let the blood spill out like I did with me own self-IV, the student handed me all the supplies one by one as I needed it, the hep-lock, the saline flush, the transparent tegaderm dressing.  Beautiful.  And then I hung that damn bag of IV antibiotics.

I read with great interest Atul Gawande's article in the New Yorker about electronic health records.  I have so many of the same feelings as the providers cited in the article.  I always, always feel defeated at the end of every shift by the documentation system that I'm required to use.  I feel like I'm a smart person, generally above average when it comes to computer systems, but it just kills me every day.  Each day, I make handwritten grid where the room numbers are across the top and the fields I need to document go down the side and I swear, the list is like 18 lines long now.  Each line doesn't just mean one block like a block on Excel, each line is a complete section that might require 10-25 entries.  Some days I have 7 patients, so that is 18x7 things I'm suppose to remember to document.  The computer system gives me no indication which patients I've completed charting or which sections are done, so the handwritten grid is to prevent me from going back to each chart to remember what exactly I have filled out because I have to fit charting into the five minutes chunks of time I have between tasks and interruptions.  The charge nurse saw me write my handwritten list to-chart-list at 6:55 am and said, you know, you don't have to handwrite it every time, you can xerox it and use it over and over again, but I told her, it changes every shift, I find out more things I'm supposed to chart each shift. I feel like I can do all the work I'm tasked to do, I can keep my patients safe, I can notify the docs on critical things, but I feel like I can absolutely document none of it in a timely manner.  I'm suppose to document each time I go into a patient's room.  I'm suppose to note what they are doing, what I did, what they asked for, if I asked that they are pooping/peeing/eating.  I'm suppose to document that I taught them all about each of their medications, the scheduling of the meds, the mode of action, the side-effects.  I'm suppose to document every conversation I had with the doctors.  I'm suppose to document what their pain is now, what they would like their pain to be, if we have come up with a pain management system.  I'm suppose to fill out four screening questionnaires for each patient every shift: fall risk, bed sore risk, are they ready to learn, sepsis screen.  I had to use an interpreter (via phone) 4-5 times on Friday to explain a complicated all day hydration plan.  I had to document each phone conversation with the ID number of the interpreter.  While I'm documenting all this, I find it incredibly difficult to find out like why are we sending this patient to X-ray?  No one told me anything, I can't find it in the doctor's notes, the patient seems surprised.  It's a mystery.  Even with all the documentation, I feel like it doesn't pull together the feeling I have about the patient from the 12 hours I spent with them.  It doesn't highlight the biggest issues. 

Jeremy bought more reflective gear.

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Sunday, November 4, 2018

Friend, dinner, dinner.

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It was an entirely lovely day on Saturday.  Jeremy's canvassing worked well.  Who knows if he got any votes, but he got to spend many hours in the car with this new-ish friend.  He said the car ride itself was worth the entire day because he got to spend four hours talking about transit planning with this guy who is an expert at planning.  When he got home, Jeremy was all excited from the conversation and I was like - oh! you have a new friend!  That's great!  I think it can be hard for Jeremy to find pals.  For leisure, he does really, really want to talk about transit or autonomous vehicles - something most guys aren't interested in talking about.  I try very hard (or mostly hard) to listen to him when these conversations spill out from him and I do/can hold up my end of the conversation when I'm not tired, but mostly I'm not interested and Jeremy knows I'm not interested.  (Don't worry, it's the same when I tell him all my hospital stories, he's interested because I'm talking, but he's not interested in any other way).

We went out to dinner with my parents at Owen's Ordinary where the service was lovely and the food was also good.  Though really, there were only 10 things on the menu and 100 different types of beer.  I think we ate all the food there was to try.  Edda ate some salad which she seemed to enjoy.  We don't often feed her salad because it's hard to put lettuce on a spoon.

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Today was less wonderful.  You can't have two wonderful days in a row, I think.  We couldn't get into a groove.  We made it through and had Sunday night dinner at Eric's house.

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Which was funny in its own way.

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Saturday, November 3, 2018

Canvassing & mud.

Jeremy is in Pennsylvania today getting out the vote.  He got the email from a friend earlier this week and groaned - I hate canvassing so much.  I don't want to go.  But he likes the friend who sent him the email (they would go around together) and of course, the question is, if not now, then when.  So he's in PA.  I'm not sure where...York?  Hold on, let me check my google locater - yes, it's he's in York.  I met his pal at pickup this morning and the pal asked me - do you know anything about the race in York?  I said that I had no idea what was going on, but I thanked him for going and doing this.  He said it was kind of a stretch goal for our team, but maaaybe we could pull it off.  Jeremy and I put our ballots in the mail today.  Let's see how this turns out.  Fingers crossed.

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I got myself out into the woods today.  Such a beautiful day. 

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The mud suctioned my shoe off my foot today and I had to go backwards and find the shoe in the deep mud and pry it from the ground while trying to keep my socked foot from getting too mucked up in the mud. 

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Wednesday, October 31, 2018

Happy Halloween!

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Took a few hours off of work to manage a logistical thing-y for a Twenty One Pilots concert.  Ben and Vince went to see them Jan 2017 and Vince wanted to go again to see them.  Thank goodness they are playing downtown and not 3 hours away like last time.  I got Vince after school and then drove north to pick up Ben, then back south to Jeremy's office.  We found a parking spot right in front of Jeremy's building and walked to Shake Shack for dinner. 

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Then the boys took the metro to Galleryplace, I took the Metro back to Rockville where Jeremy had left the van in the lot in the morning and Jeremy went back to work to revise a report that needs revising.  He'll pick up the kids in front of the Portrait Gallery after the concert.

Jeremy won 2nd funniest costume at his work Halloween party.  Although he feels like he doesn't deserve it because he was basically told to dress up like Waluigi and all he did was buy a purple shirt and hat (he borrowed Vince's overalls and the Halloween mastermind gave him his mustache).  He thinks he won because all of his coworkers are like 22 years old and were genuinely surprised that Jeremy would dress up in this get up.  Jeremy is actually a pretty good sport and goofy guy hidden underneath a layer of kind of seriousness.

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The scene from the concert!

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