Back in Richmond, I’ve had some time to realize that I have, much to my surprise and unintentionally, made New Year’s resolutions! Honestly, they more like guh-no-way-I’m-gonna-do-that-this-year solutions, but they’re nevertheless still holding (2 weeks into 2010; not bad, eh?) To make it brief, they all involve avoiding behaviors that do NOT promote a stress-free existence.

We’ll see how it goes when the school of nursing cranks the oven up… But for now the oven is only on preheat…we’re preparing for an interesting semester of Adults, more pathophysiology and pharmacology, and one particular subject I am not necessarily dreading, but already dubious of…psychiatric nursing. Psychiatry, in my eyes, is perhaps the most broken, or underdeveloped branch of “medicine.” To call it “mental health” is a misnomer; there is close to no focus on the actual health of a person’s psyche, and exponentially more emphasis placed on their pathology: the box they can fit into. Most of the psyche medications are the most mysterious of our pharmacology: we don’t know how they work…but sometimes…they do. Not to knock psychiatry in totality. Many people have benefitted from medication, from simple talk therapy, and in effect, arrived at an end to their treatment. But psychiatry has a bad reputation of not following through, of solving problems with bigger doses, more talk, and less compassionate company.

To recall back to Patch Adams, what we really need to be treating is the toxic pathology of loneliness. Isolation against one’s will is contraindicated for life: we have ample data from research that proves that lonely people die sooner of both acute and chronic conditions than those with (not even close supports networks) solely someone to talk to. My hope is that nursing, focused on the human response, will be able to provide some groundwork for more than just pushing meds and restraining patients.

But I suspect it will take an open mind…and perhaps less suspicion. So this is my self-determined goal this semester: an experiment in keeping people company: true company, to remain as present to them as I possibly can and see what happens. I’ll let you all know how it goes.

Paz,

B

The fall semester of 2009 was reputed to be the toughest…17 credits, 2 clinicals, and enough nursing process and diagnosis to kill the students faster than we could ever kill patients!

Though trying, the time was fruitful indeed. OB, again, astonished me, though I typically fulfill the stereotype of the dude: Glad to have the info…SO not interested in working in obstetrics or gynecology. I’ll feel alright if I have to catch some babies in my career, but I won’t go out of my way for it.

Pediatrics however, was even more delightful! As the days on acute care pediatrics progressed, I settled into being more comfortable with the level of acuity, and complexity of care. 

Why do I love pediatrics? #1) It is the only unit in the hospital where professional behavior includes acting silly and using ridiculous voices. #2) Nicknames are preferable for patients, i.e. “Mr. Noodle.” #3) The patients in pediatrics have one goal: getting back to normal. They just want to get on with their lives; play, jump, and have the energy to become themselves. #4) Every patient is allowed to get into at least a little bit of trouble…in fact, trouble improves outcomes. #5) The higher the level of acuity, the more important fun and distraction are.

 On one of my last clinical rotations, I snuck a handful of red noses into the PICU step down unit, determined to appropriately lighten whatever emotional loads I could. While I can’t provide details, my patient was an unfortunate combination of characteristics: cute, willing, and bearing a wretched prognosis: 10% likelihood of living another year. Mr. Giggles was due to have an invasive neurosurgery that day, and the family was both clearly nervous and sadly accustomed to the routine of not knowing. They had arranged his curtained quarters as domestically as they could: toys and pictures lined the windowsills, and devoted family members were passed to him via the blackberry to wish him good luck. He didn’t smile.

I arrived with my preceptor to begin morning assessment, bearing my nose, but saying nothing. The father and mother didn’t know what to make of the young, professional, upright, serious, and be-nosed student juggling lines around the bed. still I said nothing. My preceptor did most of the talking, in that whiney pretend-to-care but really don’t-give-a-shit voice that veteran nurses assume: always higher than there normal speaking voice. I don’t know about you, but on the worst day of my life, I feel soothed by neither Alvin nor the chipmunks.

As Mr. Giggle awakened, he stared with bewilderment up at the red bulb on the face of his otherwise serious nurse-for-the-day. He glanced between his parents and me, back and forth, neither party quite understanding the dynamic. I waited for it…

As the stethoscope moved along his back he took his well-practiced automatic breaths, and still I said nothing. I pulled out my penlight, he automatically opened his mouth, but instead of asking him to say “ahh” I shone the light up his nose and laughed. “HEY!” he exclaimed. I broke my silence…

“Ohh! saawie! Mah’ dose is a liddle pluggered up…I just had a dose job. waddya thingk?” I said with an occluded nose. A smile cracked. The parents lost it laughing. “You just wouldn’t believe wad I sawr up der…” I said

“What?” he said…smile gone

“Same thing I hab in ‘by dose…” I handed him the penlight…

he hesitantly approached my face with the glowing stick and looked up the red nose…

“There isn’t anything up there!”

“NOTHING?!” I squeaked…”Nothing? Oh, NO! I had better call the doctor…” I picked up a cafeteria delivered banana and pretended to page Dr. Smelly. I pocketed the banana. “Phew…hopefully he’ll call bag’ sood.” He looked at me as his parents snickered, paused, and then as if deliberately, he laughed. A percolated, bubbly giggle. His parents froze! His mom teared up.  I followed him into the OR and out into the PACU, and ended the day by thanking his folks, who in turn thanked me.

That was one of the best days of my life in healthcare, and I provided almost no actual healthcare. It got me thinking. REALLY thinking, and after one of the most grueling semesters of my academic life, I was surprisingly smacked upside the head by my original inspiration, in the most unlikely of situations. He kept the nose.

Finals tested the memory of every cell in my brain, which I hope have recovered sufficiently for the upcoming term. My academic muscular atrophy is slowly improving (my once 60 push-ups have been reduced to a painful 20), and sanity crept back into my life slowly.

 The worst (hopefully) semester ended with an unexpected visit with one of my biggest heroes. Dr. Hunter “Patch” Adams, a graduate of MCV, madman, and social radical (in the good way) delivered a talk to a small group of attendees at the Byrd Theatre on “living a life of joy,” and “refusing to have another bad day.” Front row, the tower of a dude almost glowed with his 35 year old inspiration, still as potent as the day it was realized, and honed by the challenges he has faced and the lessons he was so generous to share with us.

 Interestingly, Patch clarified that he never was credited with the idea that “laughter is the best medicine.” Instead, he advocates true and authentic friendship offered to each patient. “We can cure a person’s hypertension or cancer, but their life might still SUCK, they might still be lonely, and if this is the case, we have failed as providers.” The question and answer session was brilliant. I got to visit with him for some time after the talk, about surviving MCV, and how to prioritize human contact in a medical education that emphasizes technology, professional distance, and anonymity. His advice was excellent and hilarious. We spoke about his visiting our school of nursing as soon as possible, and he seemed stoked. I will contact his assistant next week.

 My flight to New Mexico lifted me out of the east coast before a week long mass of heavy clouds dumped a record blizzard on Virginia, to begin a tour de friend of the west on this well-earned break!–

The academic summer ended with a screeching halt, and a whole month of vacation! I had the pleasure of seeing some of you, but missed many dear folks. After successfully navigating my withdrawal from the medical world (twas hard…), I booked it up to Greenfield, Massachusetts to be with Zoë and associates, and assumed a strange alter ego, one known to have time to meditate, fly fish, cook, and go for…get this…walks! Zoë and I planned and (dare I say) rocked our trip to Maine, which went something like this: AmazingBlueberryAddledRoadTripThroughRelativelyTouronFreeLovelyWith

JustEnoughPieAndBeautifulWeather

AsWeKayakedOutToOurOwnIslandsAndEnjoyedTheFogAndSunHerbsAndEagles.

Big thanks to Beth and Daryl who hooked us up with amazing kayak gear, to the CS friends who provided amazing puke-worthy-cute cabin, and all Mainers who tolerated our driving. It was a sad return to Richmond, but lately punctuated by many welcome visits. <3

Though I promised I would write when my head was again above water, I am, hilariously posting this when I am yet again submerged. This semester is known as the toughest, with 17 credits, 2 clinicals, 3 didactic lectures, and all together too many assignments. My excuses for not having a life include the classes Nursing of Children, Nursing of Women, Pathophysiology and Pharmacology, Principles of Research, Pediatric rotation (in acute care peds), and OB/GYN rotation. In nursing school we celebrate fascinating, engrossing clinical experience with dreadfully dry and boring papers.

As the stress (and excuses to bitch) mount, healthcare and it’s aspiring students are beginning to raise our ugly heads. Perhaps it is our increased clinical hours, but this semester has portrayed the darker side of hospitalist care: Jaded and negligent nurses, inconsiderate or arrogant doctors, frustrated families, burnt-out clinical faculty, and lots of people who just don’t listen. Add a culture of catty gossip, a pinch of insecurity, and deadlines, and you have a recipe for self-perpetuating unhappiness. The good news is that this provides awesome opportunities for practice, not just for personal survival, but also for patient well-being. It takes only one person in the OR (out of 9) to provide presence and a few minutes of real listening in the middle of an emergency C-section, in which everyone else is arguably more anxious than the patient!

MCV hosted a recent study designed to monitor whether patient communication in palliative care (death or dying) improved with mindfulness practice. Did it? …duh. We’re not hopeless here, things are improving. In fact, during the study, I met a wonderful Buddhist Chaplain (I know…MCV has one!), who provided incredible insight and support for staying centered and inspired when your entire workplace isn’t. “You gotta’ outlast the bastards,” he said bluntly. Prioritizing practice has been crucial, and it’s impact is indispensable.

Clinically, it has been an amazing semester so far. OB is something that ALL MEN need to take. Period. (Geek Alert) Birthing is the most alien, incredible thing I have ever witnessed. It doesn’t matter how many times you’ve seen it televised or heard it explained; being there is mind-blowing. At St. Mary’s off site clinical, we are exposed to tons of deliveries, and invited into the OR often for C-sections and procedures. Last Saturday, I watched 2 twins delivered C-section by a wonderful OB/GYN, who taught through the entire procedure.

I am most surprised by my time in pediatrics. I was wary of the impact seeing so many ill children would have on me, but it is their resilience and genuineness that is so striking. I am finding myself serendipitously drawn to the field, and not out of any arrogance, but relatively natural at it. I will say though, that the cases themselves are not inspiring. Sorry to be crass, but unfortunately, the reasons for admission on our floor often leave you considering the cause of illness to be utterly F*$@ed up. It has done several things for me: 1) made me value Social Services even more and wonder why they don’t have a hotline, 2) provided a whole new set of potential dangers to children, including football cleats and icecicles, 3) exponentially increased my admiration of (most) parents. So for peds, I offer a shout-out to the late Dr. Woodard, kiddo extraordinaire.

Speaking of both shout-outs and Woodards, this last month brought a sad opportunity to remember the ephemeral nature of our world. Jane Cahalane Woodard, better known as Namie, passed away after an unfortunate CVA. My schedule and the combined will of airlines prevented me from returning home to her memorial.

Namie was my last remaining grandmother, to whom I was very close. I think my dad got his affinity for nostalgic tradition and regularity from his mother. My memories of her are marked by these annual opportunities for interaction. She loved when the summer cooled off, and she could begin preparing, for Thanksgiving, Halloween, and that mack-daddy of nostalgia, Christmas. She had a sweater, costume, recipe, and tradition for each. Any Woodard family member will attest to amount of lard and nutmeg she loaded in her secret donuts, and delivered in oversize freezer bags. I never spent more anticipatory time in front of a microwave as when I was waiting for those lob-sided pastries. On Christmas eve, she and I would load up into my station wagon and drive around Old Town, watching the lit Farolitos and tourists. This was our tradition.

Yet it was her stories that made her a Namie. To my friends who have heard my stories repeated over and over (me forgetting to whom I told them), I argue that it is genetic. At least I heard them enough to remember them, most often at her kitchen table. Buying the Ranch, Kid falling out of the car on the 1 over the Big Sur cliffs, Japanese soldiers filming in Hawaii (and her thinking it was WWII all over again), Bill and Doc’s med school scuffle, etc. She meticulously documented our Irish heritage, which she handwrote out for me on yellow-pad paper. Namie passed on to me, with the lovingly hoarse voice and laugh of a 60-year-smoker, my paternal lineage of storytelling. We all miss her dearly, but it is only suiting that it is as Christmas-time that we grandchildren will gather to remember her.

I’m off to Greenfield to celebrate with wonderful loving folks, and hope to write soon. No really, I want to! Here is wishing all of you a quiet moment by a tree, enjoying the fire of autumn.

Paz,

B

The program began with a jackrabbit start and has increased it “acceleration” each week, but I love it. The learning curve is astounding; acclimating to a new group of amazing students (ALL ages), school policies, the ins-and-outs of the MEGALOhospital, and trying to meeting the basic biological needs conducive to learning critical skills.

In short, I am amazed at the nursing profession, and convinced that karmically, this is my path. Any school that spends the same amount of time teaching it’s students compassionate communication and holistic care as it does technical skills has my vote. The week was filled with listening exercises, intake skills, empathy in clinical practice, as well as IV’s and pumps,  venipuncture, foley catheters, and all the other fun stuff that you wish nurses didn’t have to do to you. The professors are top notch (and quirky!), the facilities are some the best in the country, and our opportunities for learning in 15 months surpassing those of most 4 year nursing schools. But it is certainly demanding.

School of Nursing

The Hospital (MCV, or VCU Medical Center), is freaking ginormous, with close to 800 beds, more than 80,000 emergency admits annually, and about 31,000 inpatient discharges a year. My clinical is on the Women’s Surgical floor, with perhaps the most maternal, loving, and no bullshit veteran RN as my clinical instructor. Our time spent on the floor is time as an RN, under the umbrella of the Hospital, much like medical internships. Our advantage is that we get to work the hospital in nursing capacities before we graduate, so we hit the ground running.

MCV Hospital, Critical Care Center

Yet even in the most advanced facilities, in one of the best teaching hospitals on the east coast, it is evident that system is broken. As a budding liberation theologist, and health-care activist, my gears are loudly turning, tuning to a system that is so counter-intuitive to the care I aspire to provide. But it is grist for the mill; in becoming a critical care RN, I hope to use an in-depth knowledge of emergent care to treat it’s opposite: health promotion and preventative care as a rural Family Nurse Practitioner.

The activism is leaking out into the school…in running for class director I hope to restart grand rounds for nurses, with diverse faculty and guest speaker, hopefully attracting leaders in compassionate, integrated care. We shall see…

But it’s not work, fortunately. Richmond in summer is stunning, fun, and well…hot. I have been tuning my tracker mind to the woods here, slowly learning and meeting the new plant friends, and taking sufficient time for silence.

The highlight of the last month, however, was the celebrated visit of the Zoe. In sparing you all my typical mush onslaught, I will simply say that we shared a week of the most surprisingly kind, delightful, loving, and silly time ever. <3

Missing the Boulder crunch, the New Mexico weather, the Z, the friends, and the company, but loving it. WIshing you all the very best of my best, talk to you soon, and post when my head is again above the water.

Some of you know my uncanny love of nesting. Though most of the definitions involve mud, twigs, and twine, I like this one best: 2. To create and settle into a warm and secure refuge.” To warm the refuge even more, I christened the Nest with the ceremonial baking of Don Bread, which turned out quite well.

Anywho, I thought I would post some pics, including the requested pics of my bathtub (?!). 

Finished the BLS Healthcare provider training today: CPR, defibrillation and codes.

Hmmm…first thing they teach you in naturopathy: The body is a living miracle of nature that heals itself.

The first they teach you in allopathy: How to bring someone back from almost dying.

Hope all is well,

B

The Bumbleducks, Jesse & Meredith

I can safely say, without a doubt in my mind, that the Bumbleducks (Meredith and Jesse) are the best road-trip team ever. so there.

We arrived safely in Greenfield at midnight, greeted by an elated and sleepy Zoe (of whom I was very happy to see).

The days have been filled with garden tours, meeting elusive and long-awaited botanicals, delighting in roadside botany, debauchery potlucks with more-than-tolerable new friends (friends by osmosis are the BEST!), AMAZING old-time and bluegrass jams, singing, and my favorite, Zoe.

Z & B

I am sure it is easy to fall in love with New England when it is spring, and one is introduced only to the kindest, more fun people who live there, but I would rather not think about winter, and commuting, and grumps, and instead revel in the fiesta (a word not too common to these parts). Incredible medicines I have studied for years are introducing themselves (with a little help) in full un-abashed regalia, friends offer music whenever, snuggles are warm, long, and late, the local food dee-lish, and the cozy rain-days are the best in their class. 

Zoe and I met up with the gaggle of new friends on Sunday morning in Montague, for the much-anticipated May Day celebration. It was complete with Morris Dancing, the May pole, adorable dorklet’s raised with the tradition and dancing as though it were an annual chore, and my favorite, the fool, played by the one-and-only Big Billy Bart Bayles.

We finished off that celebration with a good introduction and following roll in the biggest Bloodroot patch I have ever seen (Sanguinaria canadensis, super endangered, but amazing medicine).

porching...and singing

Today, I toured University of Massachusetts Amherst campus, investigating the graduate nursing programs, and getting a window into the wonderful work that Ms. Gardner lives and loves. Sad to think that Wednesday will bring my departure (SO SOON!)  but we are already mapping out the various routes between Greenfield and Richmond, and hoping for synchronized long weekends and vacations. hooray!

morris dancing

Tomorrow brings the UMASS Herbfest, sponsored by the future Dr. Gardner’s department and a group of Guest Herbal Presentation judges…ahem. I am looking forward to it.

I’ll take a train to Jersey to visit with the sister, Joss, and her wonderful family for 3 days, before returning to Richmond to finish my nesting, and begin classes, including hospital orientations, CPR classes (bleh…fo real?), and NURSING SCHOOL! I am sure that the advice provided to me by VCU MCV female grads will assist me in surviving as one of the ONLY dudes in our class. sigh… we shall see!

I’m pushing the wire as far as move in time. The flakey landlord keeps pushing back the move-in date…which is now the day I will be leaving. great. But, I am grateful for a place after all the hullaballoo. Mostly, I just need to unload the girthy load Sasha little-Subaru-that-could is bearing…she seems like she might break under the weight. I’ll post pictures as soon as it’s nested!

One of the blessings of all this house-searching has been that I now THOROUGHLY know Richmond. In looking, I tracked down a great local foods market, Elwood Thompson. After reading Omnivore’s Dilemma, and Animal, Vegetable, Miracle, it is a treat to live in a state that produces so much…produce! Hopefully, I can properly food-out healthily as I crunch through the gauntlet of nursing school. 

As a thank you, I cooked a dinner for Becca and Perry last night of predominantly local food. , and we finished off with an amazing documentary about Annie Leibovitz…ya’ll gotta see it. 

Anyway, hasta la proxima vez!

So I went back to the drawing board. I have lived on craigslist for the last 4 days. Saturday, I looked at 8 places in one day, and 6 the next day, and have come to the conclusion that I should not live in the Fan, aka student ghetto. It tough. Amidst this stress, Becca and Perry have been gracious hosts, and more couchsurfers have arrived; some hilarious Brits who make excellent company. 

I forget exactly where Maslow placed “shelter” on his heirarchy of needs, but in meeting this requirement I have unfortunately not had a lot of time to check out Richmond’s cool spots. The original plan was to arrive, move in, and chill for at least three days before heading up to Massachusetts to see Zoe and New Jersey to see my sister Joss. Oh well, I have two days when I return…Just gotta find a house before then. sigh…

Finally!

Holy Lord…If you’re going to drive through the center strip of Americana, I recommend doing it with a friend. Yes, a cross-country-road-trip virgin I was, but no more. I feel like I deserve a certificate until I remember all of my friends that have done it 10 times.

part of my view

It took three days, averaging 11 hours of driving a day, 15 hours of books on tape, and uncountable mix CDs from friends (you all saved me from madness). The trip started in Boulder, heading out on the 80 through Nebraska, landing at sunset in Henderson, NE, home of my lovely step sister, her husband Mark, and their son Carlon. I was greeted by a lovely meal, a tour of their inspiring farm, and a cozy bed.

The Farm in Henderson

Day 2 was started early, cutting across the southwest corner of Iowa in Missouri, through Kansas City and across to Louisville. Ha! 4 states in one day. I rock.

Day 3 brought me over the coal-country of Kentucky and West Virginia, right into Richmond. Wow.

Sunrise in the plains

I have been staying with a phenomenal couple I met through the networking site Couchsurfing.com. Couchsurfing is an international online community committed to provided couches, futons, floors and guest-bedrooms to travellers interested in meeting interesting people, sharing, and networking. 

I arrived to Becca’s and Perry’s home as the sun started to set on the balmy Richmond. Becca is an RN, and Perry  Pharmacist. And what a colorful home! Yellow, green, purple. They have been nothing but kind, hospitable, and insightful, showing me some of the ropes of Richmond and giving me the skinny on the place. We shall see!

yellow

B

playin da tunes..

Mr. Chekovsky and Myself

different states

gamblin early...