Wednesday, September 19, 2018

First two days of nursing. Update.

No photos from the hospital!  Imagine a landscape printed page with the list of 30 patients listed - they have their room numbers, what they are in the hospital for, how many days they've been there and a bunch more information that I can't remember right now and then they usually assign nurses to a block of 5 rooms.  So my name is listed next to five rooms.  My name with my cell extension number that I carry throughout the day.  This assignment sheet also tells you who: is on telemetry, has bed sores, is on a bed alarm, has a foley, has a central lines, has a patient control analgesia pump, is on isolation precautions, and needs total care.  It also lists the charge nurse and the two technicians who are working the floor.  The unit on a sheet of paper.

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So I'm on the other side of my first two days on the unit on my own.  Though I think I now have a slight cold (probably a rebound immune response - I think one often gets sick after a stressful time is over, your body can hold it together and fight off germs while you are doing the stressful thing, but once you relax into a regular thing, the germs take over.  This is not based in science.  It's only based my own experience), I made it through and I'm still standing.  I spent the weekend before in a state of controlled anticipatory anxiety which I was trying to suppress and hide (because I've come to the conclusion that anxiety over uncontrollable things should not ruin a good time and Sat and Sun were both good times and I was trying to relax and have fun), but both Vince and Jeremy could tell that I was anxious and were extra nice and supportive through the weekend.  Vince especially, who I dragged to orienteering on Sunday morning, did not protest the relatively early weekend wake up at 9 am and he played fun music and seat danced in the car on the way there and back making me laugh.

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It was the right time to go off orientation - there are things that are not learnable unless you are forced to do it by yourself and figure it out.   I had no truly demanding patients my first two shifts - even so, I didn't stop moving the entire time I was working.  I'm happy I get to form my own relationships with my patients which was harder to do when I'm deferring to my mentor.  I'm trying to figure out when to take breaks to make it all more manageable.  No matter what is happening, everyday around 5 pm I feel an incredible urge to cry.  Sometimes it's because I'm happy that I've almost made it another day, sometimes it's because I'm incredibly overwhelmed.  I wonder if it's some hormonal shift that happens in the early evening.  Old people with dementia have sun-downing where they get irritable at about 5 pm.  Maybe I have my own version.

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On of the reasons that I want to cry at 5 pm is because I've been nice since 6:45 am.  I mean, I'm almost always nice, but I mean, I'm nice in a particular customer service kind of way. There are many technical aspects to being a nurse which are important, but if you do your job right, no one notices and you can prevent problems before they happen.  Watching for a blood pressure that trends lower throughout the shift, watching for changes in mental status - you can figure out what you need to do before it all gets worse.  But this isn't what people care about. A lot of what people remember is how nice you were to them.  Did you listen to them?  Did you hear their complaints?  Did you get them a warm blanket when they asked?  So I'm nice to patients and try to listen.  They actually don't care that you were two hours late with the IV antibiotics because pharmacy didn't stock it in the floor medication machine and you had to call the pharmacist to verify the med and then they wouldn't send it in the tube system, or if they sent it, they sent it to the wrong floor - so you have to call again and then they said it would take another hour to have it delivered because the tech isn't scheduled to deliver until 6 pm, but you could come down to pharmacy to pick it up yourself.  So I'm also nice in the same way to all the pharmacists, techs, doctors, transporters, housekeepers, and various other staff throughout the day.  This level of sustained niceness is a kind of performance (and in a way it is a performance because cameras are everywhere and people are able to take video anytime they want to) that does take a lot of energy from me.  I pride myself in deescalation of tense situations, of making people feel calmer and more reassured and to feel like they are valued, but man, it makes me feel like crying at 5pm.

Sunday, September 16, 2018

Mr. Kent.

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Mr. Kent! I went to see my 7th grade science teacher this afternoon.  Mr. Kent is one of my favorite teachers - I have a handful of special teachers that I lug around in my heart and Mr. Kent is one of them.  I learned so much science when I was 12.  We learned about cells and used microscopes and made our own slides of onion cells, water plants, cheek cells.  We dissected chicken wings.  We typed our own blood (!).   He took us on field trips to Assateague Island and Calvert Cliffs to find fossils.  He was the person, besides my parents, who laid the first brick in the foundation for my science career.  He's turning 80 this month.  I just happened to see the invitation go out on Facebook a few weeks ago in Rockville Town Center, I'm glad to have had the weekend off to say hello again to him.  So good to see him.  Honestly, I just wanted to know if he remembered me and he said that he did.  I think towards the end of his 40-year old career with MCPS, he chafed at various changes in the county.  I know now the county has a standardized curriculum for each class in every school in the county, I'm not sure how much variation the teachers get in teaching the subject matter - I suspect that it isn't much.  I know Mr. Kent would have hated it.  He wanted to teach science in his own way.  And I loved it so much!  He basically went through the whole cheek cell lesson again with me this afternoon and when I close my eyes, I can see the younger him in the front of the classroom scraping the spoon against the inside of his cheek showing us how he wanted us to get our own cells and I can remember where I was sitting in his classroom and I see the fish tanks and snake tanks all around me and it makes me so happy.  I don't like telling people where I went to school, but here I made an exception and told him I ended up going to MIT & Caltech and to thank him for being there at the beginning and for showing me how much fun science can be. 

Friday, September 14, 2018

46!

I am 46 today!  I feel lucky and fortunate and happy.  My hospital gig celebrated all September birthdays in a unit meeting on Thursday and I fully claimed my birthday day and my birthday age in the group meeting.  None of this - I'm turning 29. I'm 46.  I also fully claimed my birthday day by insisting on having this weekend off, I've worked at least one day every weekend for the past 4-5 weeks and I'm not happy about it.  You know what a nurse needs?  A union.  But that's another story for another day.  On this, my 46th birthday, I think of my senior thesis advisor Anne who died when she was this age - she was just 7 years older than I was.  She was the first woman tenured in my department and I was one of her very first students and I joined when her lab was just an empty room and I saw her in her office late at night many times and I'd see her again in the morning after having slept on a bunch of chairs that she had shoved together to make a makeshift bed. 

I missed Vince's back to school night on Thursday.  Jeremy went and made a pinch pot in ceramics class.  He met all the other teachers, including the physics teacher named Ms. Vincent who went to MIT in Course 16 (an actual rocket scientist) and then Berkeley.  It'll be a good year.

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I had ramen twice today.  I went to lunch with Adriana (ramen #1) where we talked about our parallel nursing experiences.  She's on a neuro ICU unit and I asked about her assessments, she says that the hallmark of a neuro ICU nurse is waking everyone up every hour and asking - WHAT IS YOUR NAME?  DO YOU KNOW WHERE YOU ARE? and then if they can't answer those questions, then pinching them to see if they flinch from pain.  There is a lot of pinching.  And she's watched a bunch of med students/residents use a hand drill to drill holes into people's head. OMG.  Can you imagine some 23 year old try to drill a hole in your head?  I guess everyone has their first day.  My first day will be Monday - the day that I'm going to "fly" on my own and have my own load of patients.  I would be scared shitless if not for the fact that I can see ahead of me the two people who went on the floor by themselves a few weeks/months ago and seem to still be alive and I can see behind me the two other people who started a few weeks after me.  And I lean into the 10,000 times that people have assured me that I'll be fine (including my preceptor who has taught many, many new nurses) - that the first month or so will be overwhelming and then I'll fall into a rhythm.  The unit is very nice, everyone is open to teaching me, it's where I'm supposed to be right now.  Some days I feel like a veritable drug dealer: dilaudid, morphine, percocet, vicodin, tramadol.  Any opioid you want, I've given it away.  At least I don't do fentanyl.  I'm working out my feelings about it all.

I had ramen #2 with the family.  We just had a quiet dinner together tonight. Fun at the asian market and asian dessert store.  Now i'm going to give Edda a shower and go to bed early.  Fingers crossed for a good 46th year.

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Monday, September 10, 2018

updating.

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The kids are home today, causing a slight bump in the tight logistical ship we are running here in Maryland.  It is the Jewish new year, but MCPS marks it on the calendar as simply a non-instructional day for teachers and students.  When I was a kid, they just straight up called it Rosh Hashanah leading me to be confused as to what exactly was happening that day, but I'm sure I was happy with a day off from school.

I'm feeling behind on a lot of things including this blog, but I'm trying to not let it bother me, we just keep on going.  Everyone is well, we are all doing our things. 

Jeremy's weekends have been transformed.  I'm not home a lot of weekends now, so he's managing the family and errand running.  And a lot of alone-ish time, that's new for him.   It's a complicated thing we had going on the weekends even before this nursing thing, we usually alternated going out of the house so at least one of us could mind Edda, we are very rarely out of the house together without Edda. We have some Edda-care on the weekends, but Vince helps out a bunch so Jeremy can go grocery shopping without having to take Edda and her wheelchair.  Jeremy booked his first business trip in October, hopefully we'll be able to swing that without too much trouble.

Vince hosted parties on both Friday night and Saturday night in the house.  It was lively both nights when I was trying to go to sleep early.  He's gearing up for a busy year.  I still haven't figured out how to log into the grade-checking system.  He says his dream school is Carnegie Mellon, he told me his whole plan of what he needs to do to get in, and I think if he pulls it off, it would be a pretty good application.  He has a good friend who also wants to go, they are going to go to the information session in Bethesda together later in the month.  I'm such a pessimist, I can tell I'm not doing this parenting part right.  There is going to be probably one kid from RM from his class going to Carnegie Mellon that, to me, is a long shot.  Jeremy asks me why it can't be Vince, and I shrug. 

As for Edda, it took me until today to think about her high school situation and back to school night when I was telling Vickey about it on the phone.  Emotionally, it's a bummer for me that she's in high school.  She's in a school community based program which means that they are prepping them, not a high school diploma, rather for work in the community.  I just can't imagine Edda ever working anywhere, but I'm getting this idea that Edda has to have a job from various sources and it's upsetting to me.  The jobs that the kids are doing are things like collecting recycling in the school or going to a job site to shred paper or sort items.  I think some of the kids in Edda's program can do this and when I first understood that Edda was delayed in some major way but I didn't know yet that it was Rett Syndrome, I remember thinking of her being a housekeeper somewhere and thinking that that was a terrible thing, but now I wish she could use her body well enough to be a housekeeper or to stock shelves or to mow a lawn.  How nice would that be?  To be able to go to work and do a useful thing.  Anyways, I'm sure this is coming out all garbled, but it's hard for me to think of Edda as an adult, but now that she's in high school, we all are focused on her adult-ness when on the day she turns 21 and ages out of the school system into adult programs.  Also, the program expanded from two classrooms with two teachers to three classrooms and three teachers.  Edda rotates throughout the day among the three classrooms.  But to accommodate the expansion, one of the classrooms (the one manned by our main point of contact and Edda's teacher/case manager) was a storage room last year with no windows.  Vickey was like - Edda's classroom is an old storage room?!  I was like - huh, I didn't really think about it that way.  I was just telling Vickey about it because they had to empty the storage room just last week and it's not yet decorated or equipped with a Promethean board.  So that is hard, to move from a newly built middle school where there was a whole special needs wing in the front of the school with kitchen and laundry and bathroom facilities to, um, a repurposed storage room?  I know not everything is in the fanciness of the building, for example, the teachers made it a point to let us know that, at lunch, instead of grouping the kids at the edge of the room to have their lunch, they are all seated in the center of the cafeteria with the typical kids bustling around them.  There was a plan to demolish the school and rebuild it, but the funds got re-allocated at the last minute to building a new high school not far from here where there is a huge expansion of housing.  So that is that.  Edda, of course, is fine with it all. 

As for me, I'm still slightly drowning with my new schedule.  I'm almost on my own with my own patients, I think that'll be next week.  It's become clear to me that I will not know everything I need to know when I go off orientation, but I'm OK with that.  So many things I don't know: how to change a wound vac, how to take blood from a medi-port, how to compensate for fluid overload when you are transfusing blood, how to follow up on a delayed midline insertion, how to speak Spanish.  There is never a dull moment at work, the hours pass extremely quickly.  On Saturday, I had a nursing student following me around for 3 hours which seemed incredibly ridiculous to me because it implied that I was capable of teaching her something.  I actually had to apologize to her and tell her I wasn't ignoring her and I wanted to talk small talk with her about her big nursing dreams, but at that moment, I was using all of my brain cells to manage the 9 am morning shift report / vitals / assessments / morning medications and I couldn't spare any extra for diversion for small talk.  Once I start doing small talk, I can't fully concentrate on the task at hand.  I'm getting used to having many "Sunday" nights.  You know, the night before you have to go to work for the first time after having a day off.  I used to always insist on having a quiet Sunday night, but I can't have that anymore.  I'm also trying pretty hard to protect some "down" days.  I'm working a lot and I could work everyday if I wanted to, but I'm trying to insist on myself having some protected time off - which, to me, means no socializing past the family members, no catching up on housekeeping or bills or various errands and no working (obvs.).  Just watching tv or reading, blogging, or crafting.  I think if I threw a load of laundry in there somewhere, it would be OK.

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Friday, September 7, 2018

Fifty!

Jeremy is 50 today!  A big day.  I went downtown to meet him at his office where he hosted a happy hour-type birthday party.  Cookies and beer.

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It was very lively.  I spoke to his coworkers about: Michigan, summer camp for kids, universal basic income, moving into a condo, grocery meal services, rowing.  That's a pretty good showing for me.

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Thanks Nat for picking Edda up from aftercare and hanging out with her until we got home at around 7:15 ish.  Thank you Vince for making spaghetti dinner.

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Vince is downstairs hosting a Magic card evening with a bunch of friends.

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Jeremy had made some biking goals this year.  He wanted to do fifty 50-mile rides during this birthday year and he did do that - he did 53.

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He also hit 10,000 miles on this bike (2.5 years old).  Here are the stats:  since his last birthday, he's ridden 5,220 outdoors and 3,211 miles indoors.  So how many hours is that?  Hold on...he's doing the math...ok.  We aren't doing the math.  Maybe next time.

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Thursday, September 6, 2018

No school supplies, bus routing, back to school night.

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I might have gone a little too far in the letting go of paying attention to Vince & Edda's schooling because I was at the hospital on Sunday thinking - oh crap!  I've been so busy, I'd not bought a single school supply for either child.  And I knew at the rate I was going, I wasn't going to be able to get any shopping done (either virtually or in the real world).  And then I got home late Sunday night and Vince comes and finds me and says, hey mom!  can you log into myMCPS? All of my friends' parents have logged in and they all know their schedules and I want to know if I'm in their classes.  I looked around the website and tried to sign up for the account and realized that they physically mailed a password to the house mid-summer and I must have thrown the notice away.  Then I apologized to Vince that I couldn't do it, and he says - no worries, it's actually kind of nice that you aren't super concerned about checking up on my grades like the other parents.

Edda's bus came on time the first day of school, but in the afternoon, the bus routed her back home and not to her aftercare.  Luckily I was home that day.  Our street is being repaved and there was a bunch of construction going on and it was incredibly hot and the bus coming home was going the wrong direction on our street so I scampered across the street to get her off the wheelchair lift and then I put her in the car and drove her to aftercare.  Which is just as well, because I forgot to tell them that Edda was in high school now and no longer on the middle school bus.

Tonight was Edda's back to school night.  We met the special ed team that'll be working with Edda - it's going to be a good year!  The school is showing her age.  Edda's middle school was a brand new school with beautiful natural light, a rock climbing wall, and wide hallways.  My old high school, on the other hand, is a little rough around the edges.  It's had a couple renovations since I've gone, so it's not entirely familiar, but I enjoy walking through the hallways. 

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Monday, September 3, 2018

School starts!

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Jeremy, me and Edda went to see Crazy Rich Asians to end the summer.  I wanted Vince to go, but he wanted to stay home and enjoy the empty house to himself.  I cried again!  Even the 2nd time.  Jeremy liked the movie too.  Edda was a little bit noisy, but Jeremy managed her and fed her popcorn the whole time, hopefully we didn't bother too many people.

Tomorrow school starts.  Jeremy went last Thursday to see Edda's teachers at Wootton.  I had gotten an email saying that there would be a freshman half day orientation that day, including the whole bus schedule and I emailed the special ed teachers and asked if that general freshman announcement included Edda - if her bus would run and if teachers would be expecting her.  They didn't quite know if the bus would run for Edda, but they extended a personal invitation to visit the classroom.  I was at the hospital, so Jeremy and Kitachi went on their own.  A bunch of her friends are there - from elementary school and middle school, it'll be nice to see them again.  We have a full roster of childcare providers - Ning in the mornings, Kitachi in the afternoons/evenings and Eliana on the weekends.  We have Vince for backup and even better backup when he is able to drive in the late fall so he'll be able to pick up or drop off Edda as needed.  It's going to be challenging as the summer lull comes to an end and Jeremy starts travelling again for work.  It remains unclear how the scheduling will work for me at the hospital over the next few months. Theoretically, we should be able to swing any weekday travel and I think our caregivers + Vince would be able to throw together something for weekend work travel, but it's not a relaxing thing to think about. This nursing gig is pretty crappy for anyone who is trying to arrange childcare.   A lot of my coworkers have their mothers taking care of their babies.

Vince is going to be a junior, a big year for him.  After a particularly angst ridden spring sophomore year (for me, not for Vince) where I fretted constantly about where Vince was going to get into college, how he was going to get into college, what we could possibly do to improve his chances to go to particular colleges, I decided that instead of fretting, I would let it go.  I'm forcing myself to pay less attention to Vince's college application process by paying attention to other things.  He'll be fine, he's making good choices, learning what I think he needs to learn to grow up and be on his own.  It's easy for me to be caught up in all the hubbub, I've had people tell me I need (right now! right now!) to hire not only SAT prep tutors, but also Vince's own personal college application coach.  I've had people tell me that even with a heavy load of AP classes, a 4.0 average and 1550 on the SATs, their kid got rejected from every "desirable" school.  The absolute worst case in our situation would be if I pushed and pushed Vince to attain whatever level of performance I thought was necessary to get into a name-brand school and he got rejected from all of them and then I would have ruined the very fond and happy relationship that I have with him (which I'm super grateful for, I love my teenagers, they are both a joy to hang out with.  Right now they are both sleeping right next to me in Edda's twin-sized crib squished together like two peas in a pod while sponge bob square pants plays on TV.  They might both be snoring a little).  So I'm doing my favorite parenting thing which is nothing.  No SAT prep, no college coaches, no crafting experiences and/or extracurricular activities.  There is only living a full and interesting life - which I believe Vince is doing fine on his own.  We'll see how long that philosophy lasts, I'm sure I'll eat my words and hire someone to write his college essays.  I guess why hire anyone?  I'll just write them myself.  In the female middle-age voice?  That would be weird.   Who am I kidding, I just want to go to college myself again. 

And finally it means that I will have a few hours tomorrow during the day when no one is home at the house and I can finally do all the things that I want to do when no one is home like listen to how quiet the house is and also to put something down on the counter and find it in the same place three hours later.  I'm very excited!