The Geek years...

Ok so not only was I a geek to be a volunteen...I became more of a geek in high school...I was determined to do well in school so I could go on to be a nurse...Let me back up a little and tell you about my scholar skills prior to going to high school...As I mentioned before, I was shy and clumsy and some would say not have much common sense...I didn't apply myself in school as much as I should..My school career didn't really get a good jump start...My parents sent me to parochial school...Let me first preface by saying ..parochial schools are very good and one could get a very good education..however, in the 1960's the class size was was over 50 kids in a class. Each class had the kids sit in alphabetical order. There were no teacher aides. Nuns taught the majority of classes and there wasn't any room for individualizing student needs....So my parents sent me from 1st grad to 3rd grade...Oh and did I mention there wasn't any kindergarten when I was little. So...it was up to Mom to teach you what would normally learn in kidergarten...Already that put me at a disadvantage...so needless to say.....my parents finally got the jist that I wasn't really learning well and they decided to put me in public school in 4th grade....I was really behind in math,reading and spelling and struggled to keep up with the rest of my class. I managed to improve in my learning through grade school....middle school got better but still was average...then I had a revelation...I need to be more organized in my studies...I need to study every night...and I need to read and comprehend every assignment..... I was very disciplined in highschool...wanting to keep up with my studies I would study my notes everynight...Read and re read my reading assignment....I would even study on the weekends....I did try to expand beyond my studies and get involved with Marching band in high school...but I pretty much limited my social scene to Marching band in the fall and concentrate on my studies pretty much the rest of them time....well by junior year it paid off...I got inducted into the National Honor Society and was ranked 6th in a class of 400 kids....I was able to take advanced science classes in my junior and senior year to preprare me for my nursing curriculum in college....I will never forget my chemistry teacher..he was the best and I did really well in chemistry.....I got an A ...and when it was time to take college chemistry I...believe it or not it was a review of my high school chemistry class....all the kids in my college chemistry class were struggling and I was brezzing through it....Needless to say my social lfe sucked in high school...I was a geek...everyone knew who I was but didn't want me to be in their "in" group....I didn't go to any proms or dances or wild parties....I couldn't wait to graduate from high school...I did make an impression on the school nurse... She helped my apply for a couple lf scholarships...I did manage to get one for 3 years of college....Oh did I say college...yes .....when I declared to my parents I wanted to go to college and not a 3 year nursing school they looked at me as if I had 3 heads...This was something new...going to college to be a nurse... I think it was as early as 1972 when the first college prepared program was developed. I graduated high school in 1976. My parents didn't know much about the college route...but I made sure they quickly learned... I was accepted to 2 different colleges ( not many were around) and was so excited when I got accepted to West Chester State College.... this was going to be my ticket to being a nurse...Alleluha...

The Revelation

So I am getting a little sentimental in my old age and want to share as much possible with the younger generation to help them put into perspective how things have developed into what they are now. I would like to share my story and my life with all of you. I want start at the very beginning because I still want to keep the Nurse thing in my theme ...So I will start where it all began...when I realized I wanted to be a nurse. I never thought of being anything else but a nurse...I can't remember when or how this thought came into my mind. I can't remember any particular event that made me want to be a nurse...I think I was just born realizing I wanted to be a nurse...No one in my family had any job related to the health care field. As far back as I can think, I always rationalized and did things differently than the rest of my family. I was clumsy, absent minded and shy...Unlike my siblings who were atheletic, percise and spoke their mind. Since I made my mind up about wanting to be a nurse, I thought it would be a good idea to be a candystripper. The hospital where I volunteered called us Volunteens and we didn't wear the pin-stripped uniforms as one would thinks. We wore a yellow apron instead. We would record our volunteer hours and at the end of the year receive awards for the amount of hours we volunteered.. I remember my oldest brother jeering at me says,"why would you want to volunteer instead of working somewhere and making money instead?" I would always brush him off. I knew deep inside that this is what I wanted. Money was not what I was interested in, the exposure was most important. So I would go in every Saturday from 1-3 and do my duty as a Volunteen. I would report to the unit I was assigned to shyly asking the nurses what they would want me to do. They always saved the water pitchers for me. Now, you need to know that the water pitcher were metal. They had a metal tray and the glasses were real glass. So I was incharge of collecting all of the water pitchers,trays and glasses. Then I would take them to the kitchenette and wash them with them with dish soap and water. Refill with water and ice. Then make sure everyone got a clean water pitcher,tray and glass. My next chore was to pass out the mail, water flowers. I would also help make beds every once and awhile. Do you know what was different about making beds back then. They used rubbber pad under the pull sheet. Imagine how hot that was for the patient.
I would volunteer on Saturday afternoons during school year. During the summer, I would volunteer several 1/2 days during the week. The most exciting assignment one summer was volunteering in the Emergency room. My biggist job in the ER was washing and wrapping instruments to be sterilized. Yes, no disposable suture kits, etc. All re useable. Even there syringes were glass. I was also incharge of stipping the liters and washing /clean them down after a patient was discharged from the ER....washing off dried blood from the litter frames were the toughest. The ER doctor would call me in to watch him suture...I was devasted the one time when I almost fainted. The staff took care of me but I was so upset that this meant I would never be able to be a nurse.....the staff assured me that this didn't mean anything and I would certainly be able to pursue my career goals.
The other place I liked to volunteer was Maternity....I loved taking the babies back to the nursery after their Mothers fed them....I never really spent anytime in the labor room...but got really good at making beds in postpartum unit and watching the babies in the nursery.....
I did get a lot of exposure during these years as a volunteen...The experience definitely confirmed my desire to be a nurse......So the journey began .....the next step was to do good in school and take the right classes so I could be accepted in nursing school...

Teaching...helping my mind and soul

So sorry that another month has gone by and not writing...again my personnal life has taken precedent in caring for my parents....My Mom had a small CVA last month and Dad was in the hospital shortly thereafter with CHF ...I believe it isn't going to stop from here on in...the struggles of caring for your parents with declining health ontop on my family and job get a little overwhelming...but I do try to put things into perspective...my husband is the best and helps with house and yard stuff...and usually has a meal ready when I get home...I have my faith that keeps me strong and focus..
My work has also been a saving grace lately...I have a new challenge of precepting an NP student this semester...Usually I find this to be a negative challenge and frustration due to past experiences...but I am enjoying this student. She is mature and experienced and very knowledgeable and willing to learn and help as much as possible...She is even willing to take on complicated patients...wow...So I oblige and set her loose...I think the most memorable experience for her thus far was to watch my interaction and discussion with a patient who was diagnosed with infiltrative hepatic cellular carcinoma...this one day the patient had a rough weekend and was accepting the fact that he wouldn't be able to go home on hospice and would have to be transferred to our inpatient hospice unit...My discussion with him went well and very smoothly...we discussed his wishes of transfer ....At this time I needed to discuss the fact that being a Full Code, as he had currently was designated ,would be futile upon transfer to hospice...he agreed and accepted to be a DNR...I actually looked at this scenerio and wonder how the student took this in ..the conversation that I have had with other patients in the past ...once found it to be a difficult conversation...is now part of my demeanour of being an NP now....This in itself makes me realize how far I have come and able to mentour those who are learing to be an NP preform such and heartful and emotionally discussion such as end of life wishes...
We have had several complicated patients thus far ...it keeps me on my toes and my mind straight and narrow...she has asked some good questions and I have been able to provide her with excellent resources for her upcoming projects and presentations.... I can hosestly say this has been good medicine for my mind and soul...keeps me focused on the days tasks and goals...
I hope I can write in a more timely fashion from here on in..but not promising anything...I do enjoy writing and sharing my experiences....hopefully you are still enjoying as well...thanks for your patience.

Challenges

My personal life has been a little crazy so I haven't been able to keep up with my blog the way I would like to..so sorry for those who are following me...I usually don't like to divulge into my private life but since it has to do with being on the other side of being an NP I am allowing myself this one time to do so....My parents are in their 80's and have been in good health up until a couple of years ago...my Dad was the first to have medical problems...he was diagnosed with CML a few years ago but is in remission now...However, he has other medical problems that have been making his good days of feeling well fewer and fewer...He has an array of heart, lung and renal problems..His has more days of not breathing well than good days...he can't even help my Mom with light housekeeping chores without fatiguing and getting dyspnic.....he has been to more specialist than I can count on my 2 hands and they come up with the same conclusions...Multi factorial causes to his declining quality of life...My Mom has been the rock for him during this time...making sure he takes he medications;getting him to the doctors; and providing love and emotional support....today my Mother ended up in the ER with TIA....I went to visit her at the hospital tonight and she is devastated that she can't be there for my Father and take care of him....she is his rock...with tears in my eyes I told her it will be ok..that is why you have us ...as much as my parents don't want to be a burden and face the reality that the day is here..they need us to help them...it breaks my heart I see this everyday as a Nurse Practitioner caring for my patients...families that are faced with the challenges of elder parents and providing for their elders...I am there I am one of them ...I am wearing the other shoe..I am on the other side of the fence...I am in a fog right now to tell you how I am feeling..reality hasn't set in quite yet..but I know from experience it is creeping up on me...As I sat in the hospital room listening to my Mom telling me how she is so concern for my Dad...I told my self this is my time to be the rock for my parents.....they deserve it...they have given me a good life and lots of love in their own way..right now I just want to be a daughter and not a health care provider....

The TOP memorable patients in my career

Ok I am sure Jay Leno is known to all especially with his Top 10 whatever...so this gave me an idea to post the Top most memorable patients that I have come across thus far in my career:

16 year old female who was raped by her father became pregnant and is raising the child..

20+ year old female who complained have not having her menses for 6months and claimed she never was sexually active in her life....guess what...yep she was 6 months pregnant

26 year old healthy male who came to the office thinking he had a cold...chest xray revealed empyema

80 year old women never wanted a hernia repair ....it literally hung down to her knees

Elderly female who thought she had the virus came in with nausea vomiting back pain...ekg showed inferior MI...to the hospital with you!!!

Amish male came to office with nail from a nail gun through his leg

Schizophrenic young adult male came in for his depokote shot and closed the exam room door and cornered me and was irate...then he runs out of the office building onto a busy highway

Homeless man complaining of foot pain...unwrapped the soil dressing he had covering the painful area to find and foul smelling magot infested wound

so it is only 8 but I am sure I will have many more found memories to be added to this list

Delirium and awful place to be

So I have to say my 2nd week of the year at work proved to be very eventful...The 3.0FTE provider positions are now 2.5. ..myself and attending and 0.5 PA who unfortunately was not on the floor all week because he was covering another PA who is out sick...best laid plans...and the day this went into effect our census jumped from 16 patients up to 26 patients and still going...yep...another best laid plan...so 2 days into this I found myself attempting to convince an 87 year old delirious patient to have his vitals taken and his pulse ox...He refused saying we poisoned him and we aren't doing for him...I pulled him into a very very quite room and tried to reason with him that we were helping him and not hurting him...he started to get a little agitated and I had asked the nurse to give him haldol...despite all efforts we needed to bring in more troops to get this accomplished....at this point his anger became directed at me saying I poisoned him and he didn't want me to take care of him...I also took away his dentures and broke them as well as his hearing aide....he became a little loud and started to take swings at me...we finally calmed him down and gave him his haldol...he slept for a good 1/2 hour...by lunch time he was up and eating his lunch...he was a little more cordial to me but still believed I was no good and against him...my feelings were hurt because he and I were really getting along very well prior to the earlier incident...thankfully the psychiatrist came in to help sort this out for me and we changed some of his medications...this proved to be a positive thing...he finally got a good night sleep( he had his days and nights mixed up) I went in early this morning to find him back to his old self...he was smiling and was very apologetic to me and told me he would never hate me and loved me and my smile...now that was a good moment and one to cherish...

Growing Pains...journey of a career path

I am writing this blog before I title it so hopeful once I am finished I can come up with a suitable title...I am having a writer's block on what to write anymore...this is bad news since I have only had this blog for a couple years...So I was doing some deep soul searching this morning on what I can write about...actually I was in church while I was doing this...call this my morning meditation....as I was thinking an looking around at the people surrounded me I got this overwhelming felling I have really grown into myself...I am saying this not only personnally, spiritually and also professionally....Personally I look who I have become....not the same person I would have pictured in my early 20's ...at that point all I wanted to do was be a med surg nurse, marry young and have a family...not that I didn't do that ...but I took some detours on the way...I did become a nurse(working part time), I did marry...and I did have a family...the glitch and first detour was when I was 25....the happy ever life as I knew it ended...horrified when my husband told me that he didn't want to be married anymore...and leaving me with a brand new house and an 18month old daughter...I had no idea what I was going to do...needless to say...the part time nurse idea was out the door...I had to work full time to support myself and my daughter...hopes of living in the brand new house was also out the door and I was back living in an apartment...my self esteem hit rock bottom...It took several years to pick my ego out of the basement and wipe myself off and realize it was all up to me of how the rest of my life was going to pan out...this is when I did my double challenge take on a new job as a nurse educator and go to school part time for my Masters in Nursing...still a single Mom this was a challenge. By the grace of God and the help of my parents and 5 years later I had a MSN next to my last name and to add to my credentials...during this time I met my best friend and husband...He has proven to be a rock to me ...He made my family true family and we married in 1992...I continued to work in the hospital setting as a nurse educator...but something still didn't seem right to me...I was bored...can you imagine...bored with a family and full time job...plus hospitals were re organizing and the nurse educators were the first on the chopping block...so that is when I decided to go back to school again for my NP and post masters...2 1/2 years of working full time and keeping a house and family I succeded...jobs were not plentiful or were well known at this time for NP's I literally sent out letters with my CV to all the family doctors in the area...I got that one bite and I was on my way to my current career...granted it wasn't all sweet and nice in the beginning...I actually worked a full time job as a Disease Manager in a hospital and part time in the evenings as an NP for the first 6 months...then another family practice approached me to work in their office...so I was able to quit the hospital job and work the two family practices at the same time for a full time job....the first year I worked 60 hour weeks..ugh..and the pay was lousy...after a year I quit the first job I landed and worked the second job ...was lucky to add hours to this job to make it a full time job....During my first 2years as an NP I had a lot of growing pains....fears of not knowing a lot and of possilbly making an error...I wouldn't sleep at night...was constantly reading and looking things up ...I would wake up in the night and think about a case I had during the day doubting myself...it was awful...plus office practice was not the end all and be all for me...the pay was lousy and benfits were nothing...and the docs just didn't get us...that is when I started looking for something different and even 2nd guessing if I made the right choice to be an NP....that is when I ran into a fellow NP collegue at a conference who introduced me to her boss...they were looking for a new NP at the nearby VA....I got an interview the next week and the rest is history...almost 11 years I have been there...they do get it..and I am very happy there...I can honestly say.. I don't feel bored ...I learn something everyday...the docs I work with get me and me them...and I love the patients...working for the VA gives me a sense of security with my practice and with my ohm....I doubt I will ever return to the private sector...the VA has come a long way...it works very hard to provide quality care...it is built in to every providers work day...we are constantly provided tools to provide this for our vets...I can honestly say that I am where I want to be now...I wouldn't even know where else to go nor do I have a desire to go...I do get up everyday and dread getting up only because I can't sleep in but I do look forward to going to work...it is always a new adventure and a great opportunity to help those who otherwise would not be able to get good health care in the private sectore...plus it is my way to give back to those who gave to our country...so now that I wrote this what should I call it?

Happy New Year

Well in looking back to last year I kept my promise to write more...so I am going to try to live up to it again this year...I have already promised myself to organize my closets and kitchen cabinets...done and checked off the list..trying to exercise more...shall be a challenge ..and eat healthier....OK now what should I do for my career...hmmmm...this is always a struggle...I have found myself to be in such a routine anymore...I don't want to go back to school...I have had enough of that...I don't want to change my job...I love what I do...so maybe I can promise myself to read more...educate myself more...maybe I can stick to doing a couple CME's once a week...I think I can do that.....
I always like to self reflect on how my year was in the past with caring for my patients...I have had some real challenging cases in this past year...Some of my challenges were with those patients who lost their battle with life...suffering from chronic diseases, cancer, cirrhosis...Some patients I was able to help and turn their life around...like giving them another chance in life...others remain in the cycle of no return with their poor health and addictions...these are the ones I wish I could make a difference and hope that someday the light will go off and they will get it....Hopefully 2012 will bring more challenges that I can face head on and make a difference in more lives...in a good way...I hope that you too have a very Happy New Year and may it be blessed with good health