Having neglected this space since summertime, I have a lot to catch up on, and I don’t expect to do that tonight. It’s been a long and complicated few months, with many transitions, lots of stress, growing-up galore, and some happy outcomes. While helping out my mom, who’s been struggling with health problems, I’ve also been supporting my kids as they move to new phases of life: Lily’s in a new job path, Ben is settling into college life, and Evan started high school this fall. My own work is expanding, and I will be taking on a new role as junior-class dean at my school beginning next week. Weaving this all together will be tough but, really, pretty fun. And for the first time in my teaching career, I’ve discovered this fall that while my beginning students assume that digital is the default starting-point for photography, their parents are coming back around to believing in film and “wet” photography as the authentic foundation for the medium. I continue to wonder where the expansion will lead and how I will forge a program–taught by just one person–that brings kids into photography no matter where their interests lie. Meantime, at least I can post a few pictures that perhaps will help tell the story of this fall.

One of the things I love about talking to my students and my own kids is that it keeps me thinking about the choices we all make. I believe that if we’re lucky, we never stop wondering about what we’re going to do “when we grow up”–we keep examining our sense of calling, and we continue to re-examine our personal vocations. Maybe the world isn’t changing any more rapidly than we are changing ourselves. What really matters is that we continue to ask the questions and to pay attention.

“But yield who will to their separation,

My object in living is to unite

My vocation and my avocation

As my two eyes make one in sight.

Only when love and need are one,

And the work is play for mortal stakes,

Is the deed ever really done

For Heaven and the future’s sakes.”

–Robert Frost, “Two Tramps in Mud Time”

Okay, I know that as a rookie blogger, I can ill-afford a lapse in updates, even if it’s only a whopping 12 readers that follow me. That being said, I’m in the middle of a family emergency of epic proportions. I hope to have something for you all on Thursday as it’s AFK Thursday and I’ve been learning quite a bit hanging out in the ICU waiting room this week. Please don’t be disappointed, though, if my absence is prolonged. I will return.

Everyone that knows me knows that i have been influenced by my Grandma.  She was my safe home.  She is my love.  I couldn’t thank God enough for placing her in my life.  One year and one week ago my Grandma accepted Jesus as Savior. She lived a good life…but the last year…she lived a great life.  We are telling her story today in my home town of Blythe.  At 3pm, the celebration of her life will begin. I was asked by her to do her remebrance…but I can’t…my heart will not allow me…so I will say a little something along with a cousin LJ to bring honor to her.  Here is what I will say…

Reflection:

The word “proud” is a powerful word. People are often proud of things…and people. Sometimes that proud is a mask that is hiding what is real. Sometimes it’s not.  If I could speak for ALL the grandkids, then I could say we are proud to have been influenced by grandma. Influence shapes a soul, and our souls have been shaped for the better.

My prayer today is that we would look at the clouds…they are breaking…the storm will always be there…but there IS a light shining through.  Its there to give you Hope.  We have a Hope.  Grandma had a Hope.  That Hope is the Christ…who is Jesus.  May we place our hope in Him today.

I know today is a funeral…a day of remembrance…a day of honoring.  It would not be complete if I didn’t tell you that God is near… In the past year when Grandma didn’t feel ok she would say, “ya know Shane I know God is going to take care of me…He hasn’t let be down yet…and I’ve been through a lot…shoot- we all have been through a lot.” And then, “Honey quit that!  You are worrying me.” (Grandaddy messing with something in front of her)

The Bible says, “He is near the broken hearted.” God mourns with you…meaning you’re not in this alone. Know that  God is still good.  And If He doesn’t do anything else for us in our lives, that doesn’t change God’s goodness.  He was good enough to let this great woman be apart of our lives…that is good.

There are reflections of my Grandma in many of you in this room.  That reflection will continue through the generations just as they reflected through the past.  Today her eyes no longer reflect pain, they reflect a Savior.

Over a year ago, She prayed to God and asked Him many things. One of those things was to make her well in the hospital so she could go home.  I can say…He did.

Part of the reason I blog is to jot down memories.  Someday I hope to print this out or send the boys the url and have them read what life what like as they grew up.  Today is lazy list day.  I am posting a few things I really want to remember.

1.  Little Boy A calls hand sanitizer, hanatizer. I love that.  I am not a big hand sanitizer person but Wildman’s school has it around and Little Boy A is enamored of anything having to do with the kindergarten classroom.

2.  Wildman constantly has paper and crayons in his hands.  He  draws almost every free moment. He wakes up before everyone else in the house and spends an hour drawing before we are up.  I love that he is getting more responsible, lately the only wall drawings have been in his room. He stupidly tags everything with his name and tries to deny it was him. I was like that at his age and I really am tickled he likes what I did because he looks NOTHING like me and is a clone of my husband.   I am in there somewhere.

3.  My husband bought himself a razor scooter that will hold him.  I  love looking out the window or driving up and all the kids in the neighborhood are scootering with my husband and the boys.  He is the pied piper of razor scooters.

4.  People tell me that eventually boys don’t want to play with girls or get choosy with who they will play with.  I love that my kids will play with anyone who is interested.  They don’t see race, sex, or challenges.  They see a kid and want to play.

******************************************************************************

I didn’t get much of an update from NY today.  My Mom and Dad have been at the hospital everyday and they live about 45 minutes away.  When I saw my Mom on Friday she was gaunt and pale from being 76 years old and traveling to see my sister everyday for the better part of a month.  I convinced her that it was not such a good idea for her to be there everyday and she needed to take one or two days a week off the hospital.  My sister although still in ICU, is not as critical and if things were going badly my Mom could  easily get to the hospital.   I am glad she listened to me.

3015836    การดูแลรักษาผู้ป่วยวิกฤตหลังการผ่าตัดหัวใจ 1    Cardiac Surgery ICU Care I

วิธีการดูแลรักษาผู้ป่วยในไอ ซี ยู เน้นการดูแลภายหลังการผ่าตัดหัวใจ ได้แก่ การดูแลในด้านการทำงานของหัวใจ การทำงานขงปอด และการแก้ไขภาวะแทรกซ้อนที่อาจเกิดขึ้น

(Methods for the treatment of patients in an intensive care unit with emphasis on post-operative care : patient care with regard to the functions of the heart and lungs, and management of complications.)

(3015836 จุฬาลงกรณ์มหาวิทยาลัย)

3015843    การดูแลผู้ป่วยวิกฤตหลังการผ่าตัดหัวใจ 2    Cardiac Surgery ICU Care II

การตัดสินใจในการรักษาผู้ป่วยหนักหลังการผ่าตัดหัวใจ แก้ไขภาวะแทรกซ้อนของการผ่าตัดหัวใจขั้นตอนและวิการผ่าตัดเปิดแผลทรวงอกฉุกเฉินในไอ ซี ยู กรณีเร่งด่วย ประเมินและเฝ้าติดตามสถานะของระบบไหลเวียนโลหิต การใช้เครื่องช่วยหายใจชนิดต่าง ๆ

(Decision making in management of post-operative cardiac patients. Pevention and treatment of post- operative complications; process and skills in emergency open chest procedures in an intensive care unit; assessment and follow-up hemodynamic monitoring and ventrilator machines.)

(3015843 จุฬาลงกรณ์มหาวิทยาลัย)

I love me a good road trip but these solo road trips to Long Island are killing me.  The radio sucks and I don’t have an IPOD.  Can’t chat on the phone because I don’t have bluetooth and it is illegal to talk on the phone in New Jersey and New York.  It is just  a little too much alone time.

My journey started at 4:30 am. As soon as I hit the Pennsylvania Turnpike I passed a caravan of about 15 big rigs carrying Christmas Trees.  Nothing says “Black Friday” than 15 semi’s toting what looked like thousands  of murdered trees.  It truly smelled great though.

I got to my sister at about 8 am.  She is still in ICU and not breathing on her own but her doctors told me she is better everyday.  They said she is taking little steps forward and they were more positive.  I only spoke to the resident. The other doctors were visibly absent.  I guess because of the holiday weekend and her improvements the medical staff are not as on her constantly. Her kidneys are doing better and there was no blood in her urine which is good.  She is on the vent but it is out of her mouth and it is now connected to a hole in her throat.  They were concerned about her right side.  She has not been moving it for a few days now.  While I was there she pushed on the nurse with both hands and feet strongly.  The nurse was excited and said that this was much improved.  She had just about equal strength on both sides. They took the oxygen monitor off her right hand and she moved it more, the oxygen monitor had a short cord.

She is a PISTOL. She cannot speak but she can mouth words.  She told me she wanted to GO HOME NOW, just like that. The doctor told her that she would go home but not for a while.  She also was asking me for something I could not make out. I was really thinking about it as I drove home.   I figured it out on the Jersey Turnpike.  She wanted her GLASSES.  She was mouthing the words and putting her hand to her eyes.   We are both extremely nearsighted and she chose me to try to get through to. Her best friend from high school,  J was there when I was visiting and she gave me her number.  I called J from the car and told her what I figured out.  J got very excited and was so happy I thought of it.  P also kept asking for a drink she cannot do that but they came and put a little water in her mouth to help.  Her lips were dry and they let me put some water based lubricant on them.  I told her she looked beautiful with her eyes open and she wrinkled her nose and shook her head no and made a face that she thought she stunk.  Which I thought was funny.  After a while she grew tired and she slept.

It was a good visit and I hope her glasses help her feel more in control.  I know if  I were that tied to a bed I would want my glasses so that I could see.  I find it very frustrating when I can’t see.  She gets so frustrated when she can’t get her ideas out.

It was a good visit and I look forward to seeing her progress next time.  She is so mad right now which means she has plenty of fight. Fight on, P.

I thought that title had a nice ring to it…

Monday to Friday of this week has been like night and day for me.  After realizing I needed to pick up the pace in my clinical patient workups, I re-vamped my systematic approach and since then I have gone from feeling totally lost to finally finding a comfort zone in the ICU. As well, Gabe and I have had many discussions of the big ICU literature, mainly this week around activated Protein C and Corticosteroids in sepsis, and next week we will be talking about glycemic control and DVT and stress ulcer prophylaxis in the ICU setting.

In the last week, I have grown more comfortable in working up patients and making recommendations. These are some of the interventions I have been able to make and things I have been able to observe:

1) Many interventions involving antibiotic dosages based on renal function

2) Changing antibiotics (antibiotic stewardship) based on cultures and sensitivities as they came in

3)  Re-starting PTA medications based on medication reconciliation after patients have recovered from septic shock

4) Watched a CVC line insertion this afternoon on an intubated 

5) Watched a patient get intubated as they arrived to the ICU

6) Contributed to the tailoring of sedative medications as patients stabilize and require less sedation

and the clincher….

7) Watched surgeons remove what looked like a twig from a patient’s urethra

Next week is my last week, and it is chock-full with therapeutic discussions with Gabe, Academic Halfday on Wednesday, and my case presentation on Friday.

Kesehatan kita SEBESAR  ASET ! Barangkali ungkapan diatas sangat tepat, terutama bagi kita yang pernah merasakan bagaimana mahalnya biaya kesehatan akhir-akhir ini. Hal yang kelihatannya sepele, namun setiap orang akan memiliki “waktunya” untuk sakit. Apa jadinya bila kita tidak memiliki dana “sewaktu-waktu” yang bisa memporakporandakan keuangan keluarga kita? Nah, untuk hal semacam inilah produk-produk asuransi dapat membantu kita “mengantisipasi” kondisi yang tidak diinginkan banyak orang ini. Beraneka manfaat dapat Anda dapatkan melalui program ini diantaranya Manfaat Rawat Inap dan Rawat Jalan. Manfaat rawat inap biasanya meliputi Biaya kamar dan akomodasi, biaya ICU/UGD, dan Biaya Pembedahan. Sedangkan Manfaat rawat jalan biasanya meliputi Perawatan kanker, rawat jalan darurat kecelakaan,cuci darah dan sebagainya. Menariknya lagi, untuk manfaat Rawat Inap dibeberapa perusahaan tertentu menawarkan sistem paket tambahan yang mengcover biaya-biaya misalnya: ambulance, suster/penjaga, aneka perawatan rumah sakit (jarum infus,perban,obat-obatan,dll),biaya perawatan sebelum dan sesudah rawat inap, biaya dokter umum,biaya dokter spesialis, dan sebagainya. Berdasarkan cara pembayaran klaimnya pun dapat berbeda. Ada 2 sistem yang populer yaitu: sistem reimbursement dan sistem kartu. Pada sistem reimbursement, nasabah mengeluarkan uang terlebih dahulu untuk biaya RS dan selanjutnya perusahaan asuransi akan menggantinya. Sedangkan pada sistem kartu, nasabah dilengkapi oleh kartu khusus dimana dengan menggunakan kartu tersebut nasabah cukup menunjukkannya kepada RS yang bekerja sama dengan perusahaan asuransi. Tentu saja ada premi yang dikenakan lebih jika nasabah ingin memiliki fasilitas kartu ini. Kini pilihan ada ditangan Anda. Selamat mencoba!

Last year, I made a Christmas list too. And I get to review it today…and realized that most of it was just a “wish”.

My Grown Up Christmas List—>2009

This is actually the first Christmas List I ever made. Of course as a kid, I had wishes but I never get to write them. So, to make things unique this Christmas and to add a little spice in my life I’ll have to write this wish list and look at it after a year if I ever got those wishes come true. J

• Job. This has been one of my wishes last year, to finally have a job. I had a job but it lasted for less than three months and I had to quit that early. This year, it is gonna be on top of my list again. Out of the thousands of nurses the Philippines’ produced bi-annually, where can I find myself? Though one.

Number One has been really hard. It was more like swimming in a big ocean looking for an island. And I’m lucky enough to have a job as a PEDIA ICU nurse for six months. A job I can truly enjoyed.:) Number one—>done!  But I’m really hoping for a permanent job on 2010.:)

• Travel Business. Travelling has been one of my passions. If had lots of money I’d love to travel around the Philippines and the world as well. And ever since Chester had proposed to me to start a travel business, although the girls and I were planning to start it even before Chester told me, we didn’t have enough knowledge, skills and time to talk about it. I hope I can really start one first quarter this year with the help of my friends.

Travelling Flipflops is what we called it and our first ever Ilocos tour was last May 1-3, 2009. It was a success for a first timer although there had been problems, it was good enough for a start. The sad part was, in travel biz you have a lot of competitors (other travel agencies, weather, road blocks, etc). We suppossedly have our first foreign clients last October but due to the typhoon and some other internal problems, the tour was cancelled. We are resuming the biz this November and hopefully everything else will go on smoothly.:)

• Go to Singapore in November. The girls and I have been planning to go on a trip to any Asian country this November. When we have earned enough for our plane ticket and pocket money it would be really nice to spend time and relax with the girls.

• Go to Coron in summer or before June. I’ve been really loving photos of Palawan lately especially Coron. And if I only have money, I’d love to go there now. I wish number one and two will come true so I can support myself financially.

Numbers 3 and 4 were merely wishes for 2009 but I do hope we can make them come true on 2010.:)

• Climb at least three mountains before 2009 ends. I just recently joined Encircle Mountaineering Club for  new hobby but I haven’t climbed a mountain since the Basic Mountaineering Course with Mr. Cabotage. I’m planning to climb at least one every quarter with Chester and the rest of the club of course.

I’m wishing I can climb one before the year ends. With my cakes.:)

• Buy a Nikon digital SLR. Since SLR’s are bit pricey, I bought myself a Cybershot this Christmas. And by the end of the year or before November I wish I can buy an SLR for myself too.

Photography has been one of my passions since high school. (Go ask PJ about it.) And if there is one thing I want to do for the rest of my life, it would be capturing life’s moments and hoping I can pass them on to whoever is in line on the next generation.:) I hope I can buy one after passing the NCLEX.

• More movie dates, dinners and coffee afternoons with my brother. I always go out with my brother just to drink coffee at Starbucks or watch a movie together. I wish we can do this more often and we get to talk a lot more about what’s been happening to our lives.

I guess I really succeeded in making this part come true.:) And I’d love to do more activities (why not try extreme sports?) next year.:)

• Finish the scrapbooks. First things first, I have to print the pictures first before I can finish the scrapbooks. I’m supposed to make three now (CEU days, 2007 and 2008 events). That’s a lot of work.

This, as I’ve said entails a lot of work. And I haven’t started one….sad…:(

• Have a better fashion sense. Since my metabolism has been great for the last six months, I’ve lost a lot fat. And since slim people can basically wear anything, I’d love to try the girly fashion sense this year. More of the dresses, shoes, accessories and prints. I’ll clean my closet and shop for new clothes this year.

And this one is still in the process. Since I was busy in the hospital, I didn’t get enough time to shop but then I’m loving dresses and they love my yellow bag.:)

I am stunning in my scrub suit.:)

• Improve on writing, cooking and photography. My three greatest dreams: to be a writer, chef and photographer. I wish I could improve things, make it better next year. I have friends who have been good influences and inspirations as well, they really are a good help in my hobbies. And I’m planning to cook a different meal every week and watch more of Chef Rob’s show so I can improve the cooking part.

Busy as always, I don’t get enough telly moments except lately for the Pinoy Big Brother really rocks, I didn’t get to watch Chef Rob for the most part, I did enjoy Chef Rose Bud and Iron Chef shows though. My photography skills? Quite improving I guess. And I read a lot from the internet lately, I’m planning to take a photography class next year when I get my SLR.:) Writing? Oh well, you be the judge.

• Pay the bills. When I get a job, this has been my first promise to myself. I WILL PAY THE BILLS. (water, electricity, internet and cable –when I get to apply for one.) I want to buy new things for the house and buy groceries using my money again. I really pray I’d get the job.

I did pay the bills…with dad’s money.lol Maybe next year *crosses fingers*.

So those were what was on my Christmas list this year. I do have one last wish though (but I won’t post, its kind of personal when I finally get to make it come true I’ll post it too.) I think I get to make half of the wishes come true and another half just wishes…. This year I have a new Christmas wish list. And it will be a more grown up wish list. For the next 30 days I will write my wishes and at the end of 2010 I will make the same “review” or evaluation. (I hope I do get better every year.:)

Just Me. For Now.

-katt

While traditional hospitals seem to slow down around the holiday season, this year they are moving full steam ahead.  There are new jobs opening and interviews taking place while we’re eating our turkey.  If you’re on vacation for the holiday, don’t forget to have your phone with you so that you don’t miss any new travel nurse positions that might be just right for what you’re looking for.  Also, as we talked about last week, you don’t want to miss that phone call from the nurse manager!

This Week’s New Positions Include:

ICU in Fort Worth, TX

Peds in Miami, FL

ER in Wynnewood, PA

ICU in Gainesville, FL

L&D in Orangeburg, SC

PICU in Mesa, AZ

MS/Tele in Conroe, TX

L&D in Modesto, CA

ER in Chinle, AZ

ICU in Sebring, FL

MS in Billings, MT

NP in Columbia, SC

ER in Tampa, FL

ICU in Grants, NM

OR in Ketchikan, AK

I am tired from working till 3am and getting up at 7:30 am.  It’s that good feeling time of day.  The kids are clean and happily sleeping in their soft beds in cozy pajamas.  The lunches are made for tomorrow, the kitchen is cleaned up, and the dishwasher is making its watery washing noises.  Next I will fold laundry and fall into bed.  Such is the life of a former rock star Mom.

As I put Wildman to bed we talked about how many days till Thanksgiving. He also wanted to know about our plans for the holiday again.  As I tucked him in he asked me if I wanted to hear what he was thankful for.  Of course I said sure. He told me that he was grateful for me.  That made all the lack of glamor and glitz of my life post kids ok.  He is the best audience I ever played to.

The news from NY is more of the same. They were doing a lot of tests this afternoon and we should hear more by the morning. They are holding off doing her tracheotomy surgery to install the ventilator in her neck.  They want her to be more stable and they are hoping to wean her off the ventilator but so far all attempts have failed.  I hope she can breath on her own soon. Today is day 14 in the ICU.  It feels like forever.

We can divide rule infringement into 2 kinds. Serious and Not Serious. When we count an Infringement as 1 unit, then 3 infringements is 3 units. Assuming that the school has placed all the rules into the 2 categories, then if a student has infringed 1 serious Rule and 2 Not Serious Rules, he will have 3 ICUs; 1 Serious and 2 Not so serious. For graphic purposes we assign color codes of Red and White. If we put up a bar chart, it will be showing 1 Red and 2 White units. This makes it very convenient for the viewer.

We can add up all the ICUs in a class, convert into bar charts and we will see the relative Reds and Whites. We will have instant feedback on where to start of we want to take some action.

Since I last wrote in my blog, many things have happened.

I got over my swine flu, but ended up missing the last week of lessons and the week of exams. I was so tired due to my upside-down sleeping patterns. Not to say I slept upside down, but rather if I went to bed it was at 5am-6am in the morning and I would get up at 3pm-4pm. Occasionally I didn’t sleep at all for periods of over 24 hours.
So I met with my teacher, Kanayama-sensei,  on the Friday at 4pm which was the last day of the exams. She tried to convince me to just resit the semester rather than take the exams, since I wasn’t doing very well in class anyway. Considering I was homesick, injured, depressed and tired for pretty much the entire semester ensured I couldn’t do better than scrape a pass.
Anyways, just after the meeting she mentioned that there was a party to celebrate the end of the semester, so I went along since my headache wasn’t too bad and I figured it would make me sleepy enough to sleep early.
It was a really fun party and I got to see my friends again. It was pretty cheap considering it was all you can drink and they gave us some nice-ish food. Best thing was socialising with the teachers (Song-sensei and Kanayama-sensei both sat at our table in the izakaya) and seeing Chanelle mix drinks while trying not to get caught by the izakaya staff, having brought her own selection in with the intention of mixing mojitos and pina coladas for the teachers. For some reason they had never tried them before.

I went home afterwards, having to wait half an hour for the bus (bought some cakes from the Little Mermaid bakery before it closed. They make really nice apple pies. Though maybe not as good as my nana Margaret or my little brother. Their apple pies are amazing.

I revised my butt off for the exams. Was in the library as much as I had been before I had the internet, though it was crowded a lot and I couldn’t get a good desk. I spent 6 hours there drumming causative and passive verbs into my head and writing out kanji after kanji. I even practiced speed reading, which came in so useful in my final exam, since I mistimed it and ended up having 10 minutes to finish the reading section.

I think, despite my mountains of revision, that I failed. Mostly due to my abismal performance in the speaking test. I’d just finished the 2 hour final exam and due to mistiming it I had been forced to miss out some grammar questions I would have otherwise been ablw to answer, and then had 10 minutes to read a 2 page spread of text and answer 2 pages of questions on it. I answered all the questions though, with the exception on the extended writing answer. It shook me up though, realising I had probably failed despite the fact I actually thought I did ok on the kanji and grammar until that point. I ended up with no break and went straight in to the speaking exam. My mind blanked, and the kanji readings in the text that I memorised that morning left me struggling. I made so many mistakes that I knew it was going to be a failure. I ended up getting upset and could hardly continue. I got to the interview part and got through that ok, except half way through I realised I was supposed to be using polite and humble forms and I wasn’t. So I failed again. Then I got to the roleplay. I had written out and practiced 2 of the 3 roleplays. I was better at the one on my experiences in Japan though, and knew I would do well if I got that one. But I was given the letter of reccommendation role play which I wasn’t as good at, and ended up forgetting how to speak any Japanese at all. So I gave up and didn’t finish it.

Kanayama-sensei said I only had around 50% before these exams and I need 60% to pass, so I doubt I will pass.
But she says I will be better off resitting JLP3, but it ruins my plans. I wanted to do JLP3 this semester, JLP4 next semester and intensive JLP5 and 6 in my final semester. If I have to resit, then JLP4 is the highest I can get, and it isn’t good enough to get fluent for my final year in Japanese at Newcastle University.
Also if I fail this semester, I may get my scholarship taken off me, and have to repay the 100,000yen I have already recieved. Though I can’t exactly help the fact I had influenza…

I have been pretty lonely whilst in Japan, but I am starting to get out more and make more friends. I went to Tokyo Disney Sea with the Soul Run people. I could only afford to go after 6pm (which is 3,100yen as opposed to 6,500yen for the whole day) but it was still amazing. I got to ride some fun rides and see a 3D Aladdin live show, and I bought some Minnie Mouse ears (they were 1,050yen though :S ) The fireworks were amazing. Everything was so Christmassy even though it is onlt November!
On December 2nd we are all going to Disney Land for the day. I hope I can afford it, since I am running low on money. I’m going to transfer more over this evening when the UK is up and running. I think it will be faster than last time, mostly because I actually know I need to go convert it from pounds to yen myself rather than waiting for it to happen itself. Maybe I will get a good exchange rate this time?

I went out with Gary and the guys from Canada House the other day. We went to a festival at the Tokyo University of Foreign Studies not too far from ICU’s campus. We rode our bikes there, which was good because I needed the exercise. I hadn’t eaten all day but I didn’t like how small the food portion sizes were for the money they were charging. I gave in and bought some ゆず茶(Yuzu Tea) from the Korean food stall. Yuzu are a sweet citrus fruit that is very popular in Japan. It reminded me of how Lemsip would taste if it was actually yummy. Very sweet and tangy.
After the festival, some of us went off to Higashi-Koganei station’s side streets and got some Gyoza from this really nice restaurant. It only cost 500yen for 2 rows of gyoza (10 gyoza in totally I think. either 10 or 12) plus a bowl of rice, some pickles and some soup. There was free water on the table too. I had a really fun time and made new friends – some American, some Japanese.

I am hoping that I will spend the holidays going places with friends, but everyone seems busy going outside Tokyo. I can’t afford that yet. Maybe I can’t afford it until after Christmas, or perhaps not at all.

I am looking forward to Soul Run Video Night #2 (I was unaware #1 had even happened) and I really hope I have the money for Disney Land on the 2nd.

The last few pages of my ‘medical life’ story…

Time flies. lallalalalaaa… I’m finishing medical. 12 days to go..yippie!!! I need to make sure I didn’t make a single mistake in my last few days. Otherwise 1 month extension. no no no no!!

How am i feeling now? Great. It is a hard and complicated posting. But i’ve learnt how to be a good, competent, SAFE doctor in medical posting then in other posting. In medicine everything has a reason. For example, a patient got a temperature spike and you’ll crack your head to find the source ..is it infection? inflammation? antibiotic fever? something is definitely wrong somewhere… the MO will stand next to me during our morning round and ask  ”ur patient is having fever, y huh? tell me.. y? ”  and as usual, i’ll give him this look jeng jeng jeng…

..donno....don't be angry..

I still remember not so long ago where i would be complaining and cursing on how i hate long working hours, sleepless night, the scolding, the pressure, the dying patients, the fussy relatives.. but now i see all of these from a different point of view. These are the like peppers you sprinkle on roast beef. Medicine means nothing without those hardship. The more difficult it is, the sweeter is the end result. The more difficult the case is, the more satisfaction i get in the future. Weird it is, but it’s the truth

Currently i’m taking care of the ICU and the H1N1 isolation ward. Dem the second wave is coming. My patients are getting more and more and everyone is coughing!!! I’m behind the mask all the time. And you know what, I don’t even care to put on my lip gloss or blusher. Pakai pun saper nampak :p hehehehe….

As i’m writing this blog, i feel like i’m more confident then ever to face the rest of my medical career. It’s sad to think that I have another year to wait before i can go back to medical. Not as a HO but as a MO  :). Wish me luck peeps~!

I was a real mess yesterday.  For the first time since Wildman was in the hospital I just plain felt bad, and wanted to hide under the covers and watch bad TV alone.  I was having a pity party for one. Those with responsibilities can understand that this was impossible.  This year has been full of drama, change, and hospitals starting with my husbands heart surgery in February. It was all starting to feel all too much.  With a very heavy heart I arrived at work.  Everyone of my regulars and co-workers were hugging me telling me they were sorry.  I was enjoying all the hugs but was unsure why they were all sorry.

Finally,  my bartending partner for the evening, F grabbed me by the arms and in a very serious tone told me that I should go home.  I looked at him with a what are you talking about look on my face and told him that I wanted to stay.  He was shocked and said but your sister died.  I replied, “WHAT!!?!?!?!  Can’t be, I was on the phone with my Mom as I walked in”.  I turned to all my co-workers and regulars who were so concerned for me, and told them that yes she was in very bad shape but she was fighting with all she had and was in fact, very alive.

Everyone wiped the worried looks off their faces.  It seems like the story of my sister dying was a miscommunication between my boss and the daytime bartender A.   I appreciated all the hugs but this event really shook me out of my funk and I had a great  night.

People always can tell you things can be worse but it is hard to fathom worse sometimes because it is all words. I felt and saw in my co-workers faces what worse could be last night and I am happy at where we are now. I was comforted that she was fighting and still very much alive.

The update today was more encouraging.  Her jaundice has lessened and she is becoming more and more awake.  They have had to sedate her because she was fighting the tubes in her mouth. They sedated her with morphine and my Mom says she is more awake but goofy.  My Mom and my sisters friend have been massaging her arms and moving her limbs for her.  This evening after such a session my sister raised her arm for the first time which is also good.  She is still on the ventilator and they are talking about putting in a tracheotomy so that the tube is not down her throat. They won’t perform this till Tuesday.  They are giving her some time to become more stable before performing surgery.  The doctors say she is still a very sick woman who is close to death.  My Mom sounded more upbeat.  I am bearing down for the marathon.

I am now 2 weeks deep in my ICU rotation, and I have learned a great deal in that time… probably by the time I finish my rotation, I will finally start feeling comfortable treating this kind of population!  The medications used in this population, and the acuity and complexity of the patients on this ward is quite intimidating, but Gabe has been a great preceptor, and I am easing my way into it. My routine for the last 2 weeks has been the following: I get in around 7:30, and work up my patients until about 9, when we start X-Ray rounds.  X-Ray rounds have been quite interesting, and I have learned how to recognize some parts of thoracic pathology on X-Rays, such as pleural effusions, atelactasis, and consolidations.  We then go on medical rounds with the team, which usually goes from 10-2.  Rounds are great, because I learn a lot of interesting things about medical pathophysiology.  After rounds, I grab a quick lunch, and then my afternoons usually consist of catching up on patient issues, and/or a therapeutic discussion.  I have had therapeutic discussions with Gabe about acute respiratory failure, pain, anxiety, delirium and sedation, and arterial blood gases.  I also had a discussion with Kate, the ICU dietician, today about nutrition and the different feeding routes and supplements (ie. Isosource, Resource, Novasource Renal) that are commonly used in the ICU.  I was also able to do a Journal Club discussion on a recent study from the Netherlands about digestive tract decontamination in the ICU.  And today, I found a patient case for my case presentation which I will be presenting in 2 weeks time.

The last 2 weeks have been daunting, but very rewarding, and I am hoping that the next 2 weeks will be even more educational and rewarding.

Every year about this time, some travel nurses head home for the holidays saying they will return in January to start another journey.  What this means is that the first Monday of the New Year has the highest starts for agencies and hospitals.  If you wait until December, it may be too late to grab one of these assignments and then you may have to wait until February for the next one to come around.  While you’re home with family and friends don’t forget to keep in touch with your Recruiter for new January needs.  What better present than the peace of mind knowing where you’re headed to in January? Areas like Florida and California are known to open their January positions in November while some other states open at the beginning of December.   Enjoy your holidays but remember to keep the communication line open with your recruiter so that you get the best pick of January assignments.

ER for Las Vegas, NV

PICU for Amarillo, TX

L&D for Honolulu, HI

Tele for Hudson, FL

Peds for Tulsa, OK

PICU for Englewood, CO

ICU for San Jose, CA

Peds for Amarillo, TX

ER for Oakland, CA

CVICU for Aventura, FL

PICU for Salt Lake City, UT

“Reflect upon your present blessings, of which every man has plenty; not on your past misfortunes, of which all men have some.” ~ Charles Dickens

The holidays are upon us, and I’m not going to pretend that school is kind of preventing my excitement at the moment. Next week is Thanksgiving, and I’m excited to be going to Texas again to see a lot of family I don’t get to see but once a year, but not excited that I’ll be studying for 2 exams and writing at least one 5 page paper, if not two. Sense my irritation?

Clinicals have been going well. We had to make up our snow day by working an extra long shift, but it really wasn’t too big of a deal. I had the opportunity to work one day in the ER and one day in the ICU. So far in nursing school, I haven’t had any opportunities to start any IV’s, believe it or not, because of the floors that we work on for clinicals. If you think about it, you get IV’s placed before you hit the med/surg unit because you’ve either gotten it before surgery or if you came through the ER, you got it placed there. But, while in the ER, I took every opportunity I could with the hope of not making the patients my pincushions. I successfully placed 6 of the 7 IV’s I did on the first poke!! I was very happy about this. To be honest, I was slightly worried that I would graduate nursing school without having practiced this skill, which is one that all my family and friends complain about being stuck multiple times. I still can’t convince any of them to let me practice on them. Haha.

I’m not an ER nurse. I really enjoy my time in the ER; it’s very different – in and out – like a drive-thru of healthcare. I’m much more of a relational person, and part of the reason I really love nursing and the bedside care of it is because I love developing relationships with my patients and their families. Working a day in the ICU – I could see myself possibly doing that in the pediatric setting. I liked that the nurses have only two patients at a time (whereas on the med/surg floor I’ve seen them take on as many as six or seven), and you can really tend to your patient’s every need when you aren’t spreading your time amongst so many. Of course, it is absolutely necessary to only have two or so patients at a time in the ICU because the care they require is much more intense. One of the patients I had in the ICU was on a mechanical ventilator when I walked in that morning, and by the time I left, he had been extubated (the ventilator was removed), and he was beginning to talk and wake up more often. He still had a ways to go to being discharged from the hospital, but it was encouraging to see the progressive healing that had taken place.

I went with another nurse in the ICU to a “mock core” which is where the hospital calls a “code blue” which indicates that someone’s heart or breathing has stopped and they need resuscitation. This “mock” one was performed on a dummy so that the staff can practice what to do when a real person flat lines. Well, not five minutes after we got back from that, her patient actually did code and his wife came out screaming as his heart monitor was displaying a flat line. They were able to revive him by placing an external pacemaker, but it was a very scary situation.

I feel like I am learning a lot this year in clinicals about the kind of nurse I want to be. I saw a similar situation this week in two different places with two different responses by two different nurses. One patient in the ICU who tried to commit suicide. The nurse said that she is not a psych nurse and is not responsible for tending to that part of the patient’s care. She said she was there to do the “medical” care and would stick to the point of what needed to be done. Did I make it sound like she was lacking some compassion? – because that’s the point I was intending to make. The second situation was in the ER with a patient who also tried to commit suicide and ended up completely mutilating his arm in the process. The nurses and plastic surgeons who were basically putting his arm back together spoke gently and lovingly to him, made sure he was comfortable and in as little pain as possible, and did not judge him but, rather, instead explained that he must have been in an absolutely horrible place in life to come to this point where he felt his only way out was to die. They said they didn’t know his situation, but understood that he was human who clearly needed love and compassion.

Sometimes I think when you see situations like people attempting suicide or overdosing on drugs, you can become numb to it or so discouraged that the only coping mechanism for yourself is to just not tend to that part of the patient’s care. Where is the holistic care they teach us about? A person is not just a diagnosis or an injury. A person is a human with basic needs, with desires, with discouragement, with hopes, with families, with friends, with a life outside of this hospital room that they can’t wait to get back to. A patient is a whole person who needs tender, loving care. I hope to never become hardened to situations such as these that I see nurses becoming hardened to. People will do things to themselves that I will never understand, but while they are in my care, they deserve the same amount of love and attention as the next person regardless of their situation. I’m not here to judge. I’m here to care.

I feel like I’m hanging on this semester by the skin of my teeth. Some junior nursing students were asking me the other day if it ever gets easier. I can’t say that it is easier. I think you just learn to adapt to the crazy and constantly busy schedule that nursing school gives you. But, it probably actually gets a little harder because with graduation just around the corner…senioritis really kicks in. The main symptoms of senioritis consist of anticipation, excitement, some apathy, and definite procrastination. You start feeling like free labor around the hospital and can’t wait until you start getting paid to do all of this work. Of course, have no fear – we are all super Type A personalities where crossing things off of a to-do list releases just as many endorphins as a piece of chocolate, so we will still put great effort into what we do, but getting the motivation to do so has to come from a deeper place than a brand new nursing student.

Happy Thanksgiving, everyone! It’s such a special time of year. Enjoy it as much as possible.

Heather and friend sledding in Colorado

I love this idea being tested by the officers at Imperial College Students Union to keep their Union Councillors on their toes.
Although I worry that the news website Live have rather let the goat out of the bag by running the story before the Council Meeting.

Sadly Coucil would never have been caught out at Sheffield, as I’m sure the Student Broad Left types at least read every word, and eagerly appraised every agenda and picked over every paper.

It is one step forward, two steps back in the ICU.  P is bleeding internally and has had two bags of blood today.  I am at work now and thinking of driving to Long Island for another visit on Wednesday.  If anyone needs a ride to Brooklyn or LI on Wednesday or just needs a road trip I would love the company on the stupid long trip there and back.  I am not too teary and love sing-a-longs.

Keep the prayers and good thoughts coming.  They are getting me through the days.

Tonight I was driving through the city.  Little Boy A was asleep and Wildman was playing his Leapster 2.  We were on our way to pick up my husband so I could go to work.  On the radio, Cecilia by Simon and Garfunkel came on.  I almost cried, then I laughed.  Why you ask?  When my sister P was a tween and I was a kid she had the BEST 45 lp collection in the world.  It was 1973.  She had the best songs.  I still think about that collection

Cecilia was one of our favorites.  My father confiscated  the single  because it had the line,”Making love in the afternoon with Cecilia up in my bedroom.”    I used steal the 45 out of my parents dresser and listen to it, almost daily.   I have always been the child to defy them and their idea’s.   I went off to work, P in my mind.

This has got to be one of the best birthdays I have ever had, especially as a month ago I expected to be training to be a truck driver without my family or even Joe.  With his brother in ICU I really expected nothing and didn’t care to celebrate.

My birthday began around midnight yesterday. Joe was staying in his brother’s ICU room overnight but decided to stop by the house for a little while to help me eat a plate of cookies. He told me not to eat breakfast and call him as soon as I wake up. I probably slept for five hours and barely opened my eyes to text Joe “I’m awake.”

It was a beautiful morning. Orange, yellow and red leaves were floating from the trees as we drove to Dixie House for breakfast. It was so sweet. It was all I wanted. Afterwards Joe took a nap before heading back to the hospital to help his brother go home. Yes, the most fantastic part of the day was knowing his brother, who had just lingered at death’s feet for weeks, was on his road to recovery and heading home.

Joe returned home after several hours with a bag behind his back. “Sorry I took so long. I couldn’t afford much. Happy birthday,” he said with a kiss. I pulled out a bottle of vodka and white russian mix. I was thrilled since those were my favorite! He immediately made a giant glass of white russian for me and a small one for himself.

I drank two of these while he got ready to take me to dinner. It was not an easy feat! About halfway through the first glass I was already giggly and trying to figure out if I would even have room for dinner. Dinner was a secret. He said he’d been dropping hints all day about where we were going. I couldn’t think of a single clue. As we drove he told me if anyone tries to buy drinks for me I can go ahead and accept them and have a good time but I should not ask for anyone to buy them. I told him I’m not that sort of girl, no matter how much I like to party.

As we drove I started catching on that we must be going to Riscky’s. He passed it as he was busy texting. “Joe, you passed it!” I drunkenly pointed out and nearly panicked. “We’re really far off course, baby.”

He turned around and pulled into a parking lot, still texting. “Oh hey, this is Edel Weiss.” I started catching on even though he was trying to suggest we just “look around” and then we’d head back to Riscky’s. As soon as we got inside I saw his dad and was excited that he threw me a surprise party. My sister Wendy, my niece, his mom and brother, his dad and his wife were all there. A man in German garb and an accordian sang to me, I had an awesome authentic German dinner (though the weinerschnitzel is no longer veal… a real shame because that used to be my favorite dish) and a cake and gifts. I was expecting none of this! Joe is the man!

Thank you to all those who made this birthday special, for all the comments on myspace and facebook from family and friends, for God granting Joe’s brother life and most of all to my mom and dad who planned my birth and brought me into this world.

11:11, Mama. I love you.