2 funny YouTubes because it's Monday, and tomorrow is clinical, and the semester is almost over!

aka, I'm busy and tired!  A lot of us are!  Funny YouTubes please?  Thank you.





I barely know who this Justin Beiber kid is - I can't even name a song he sings.  But this little girl is hilarious.  In the original video, you can watch a longer, much more drawn-out video about this toddler's love and devotion to teen pop idol, Justin Beiber.  My goodness...  Then of course who else but Jimmy Kimmel to save the day!  (Also note that Mom and I watched this the morning after I spent half the night crying with her, so that makes it even funnier.  Boys... they're all the same, always breaking their hearts, making them cry!)





My mom got this in her email.   Yes, we are all planning our trip to the Myrtle Beach Safari.  Nikki wants to get an orangutan for Riley.  I'm hoping that one never comes into fruition.

On that note, I was sick and missed clinical last week, so I've just been working on projects and papers and reading textbooks - our 1" thick syllabus tells us the endless pages we have to read...  Sometimes I wonder if you calculated average reading speed, words on pages, how many pages, etc. in some nursing school reading assignments... I really doubt one or two of these weeks it would have been humanly possible to read all of the required and sleep and eat.  Not even mention take a shower or go to lecture.  Insane!  Then we had some weekend fun I'll have to share about when I get a minute ... other than that, running around, going crazy.  Had to stop the med that saved me from my fibromyalgia so now I'm trying to keep up the pace I've gotten used to, realize it's probably not going to work out so well.  I'm going at the speed of light, and I feel like this fly is going to run into it HARD.  BAM!

4 MORE WEEKS!!!

(Up for air, then 6 weeks of nursing school torture, then a little more air until my REAL senior year!  So what if I'll be a 2nd or 3rd year senior? lol  The goal is to do it in a year.  We'll see.)

Here we go again :: N30040 :: Clinical Journal Entry #26

The Clinical Journal Entries started as a clinical assignment but then turned into tradition.  Unfortunately, we are back into the assignment mode, and that takes all of the fun out of it.  It will start out as a copy-paste from Word (the doc I emailed my professor) and now I get to tell you how the day really happened (or at least my uncensored and way-more-fun version of it)

This is our geriatric/rehabilitation rotation.  I signed up for the section closest to my home.  A solid 30 minute drive at 6:20am for an instructor who wants us there prior to 7am because "these patients are already awake anyways!"  Right.

Now, I love old people.  I'm a sucker for grandparents, and I even enjoyed working on the Acute Care of the Elderly unit for my first-ever clinical rotation.  Old people, the elderly, seniors... however it's politically correct to call them these days, are full of stories and have such varying personalities.  They're just like us twenty-somethings, only a whole lot smarter with many more lessons learned.  They're so easily stereotyped, while to them, we're probably just as easily stereotyped.  The more you're around the people who hit their '80s, '90s, or even 100s (101 - like one of our residents!) the more you realize that they're just people like you or me, only their bodies sometimes get worn out from this life and they need extra help.  That's all.  Alzheimer's and incontinence aside, forget about the hearing aids and teeth sitting on the counter...  Each and every old person in the world has a personality, interests, dislikes, memories, habits, values, and fears.  And, like everyone else, they just want to love and be loved.

Studying the process of what can go wrong in old age, however, is a different case.  We have clients, not patients.  They're here because they, the government, or their families are paying for their stay.  They're here to get better so they can go be good Grandmas again.  They're here to play games and sing songs until they go across the river.  They're here because they are a little forgetful and someone needs to help them know to take their medicine.  They might be here because their spouse died, their family couldn't take them, yet they couldn't quite live on their own.  And then some have colorful rooms filled with photos and banners and flowers and things from the home they will soon return to.  See, it's a different kind of place.  It has a distinct smell and sound, and yes, there are medicines and health problems, but it doesn't feel like a hospital.  Instead, nursing homes seem like big dorms for old people.  And I'm a nurse, just not that kind of nurse.   Just when I was getting proficient with tubes, needles, systems, IV pumps, intricate computer charts... I get dropped off on the doorstep of an old people dorm and am told to make myself useful and take assessments and give meds, charting it all in 4" 3-ring binders . Hand-charting aside, those things really don't take long.  But this does - this takes 10 hours on our feet, looking busy, and some weeks we will have alert patients, while some weeks we may not even have a patient who can talk back.  I'm the busy-busy-busy nurse, the one in the group who just doesn't slow down, so this might be a problem.  I foresee a lot of craft events and afternoons spent at the group "Dining Room Movie."  If I have to feed a few people or clean up after them, that's okay, too.  If I have to smile at a mean old lady or help him clean his dentures, that's okay, too.  And if I get to do a dressing change on a stage 3 pressure ulcer or get to go with a patient to see how dialysis works in our (rare in-nursing-home kidney dialysis) center, then it'll definitely be a good day!  I just don't like the smell of that place, especially at 7am, and I really, really, really don't like being bored.

Today was just orientation, see the unit, meet the staff, here's-all-the-assignments-and-final-paper-i-want-to-kill-you-with kind of day.  So next week, maybe something will change or I'll have some sort of different opinion.  Probably, yes, most likely.  :)

Oh yes, and because this is an assignment, I must state 3 personal goals, one with a clinical focus, one with a gerontological focus, and one with a rehabilitation focus.

Clinical: To increase my patient assessment skills (...Seeing how one of the only things we are doing here is, well, patient assessments, lol)

Gero: To be comfortable with dementia patients (Because let's face it - they're scary.  I had one when I student tech'ed at General and it was a BAD experience)

Rehab: To help a patient work on skills so he/she can return to home (Because we do have a few "acute" older people, and we all know that homes are soooo much better than nursing homes!)

My next journals will be on activities I did with residents or random things the syllabus wants us to do ("Make a list of stereotypes of older people"), citing a website that taught me more about my patient's condition, citing a journal regarding one of my patients... ya' know.... just the normal fabulous stuff the professors sit at home and make lists of because they have nothing better to do.  All while reading about 4-8 (50 page-ish) chapters of 2 textbooks a week.  (Well, technically 3 textbooks. The one was so big they had to make Vol. 1 and Vol. 2.  Not. even. kidding.)  Whoooo!!!

And I need to rant just a little more to get "today" out of my system, because I'm tired and was up too early and am crabby from being bored and so stressed... I would have guessed a nursing home would be on the warm side, but this place was HOT.  We toured all 4 (or 5?) "units" and went on two different floors, all the different wings, and there was not one single cool spot beyond opening-wide a window or a door.  So next week, other than coming in swim-scrubs, I have no idea what I'm supposed to do.  I figured it would be rude to steal an "out of it" patient and turn on their room A/C.  Definitely rude.  And mean.  Neither of which I'm into being.  But it's like, we can put nice warm blankets and Snuggies and jackets on them, yet we are not allowed to take off any more clothing without violating some kind of rule or law.  Yes I have a tank top under my scrubs, but will they let me walk around in that?  No, because how un-professional!  Yeah, well then get a thermostat that works, set it where normal people set it, and try that for professional!

And to think if this was any other day, I'd have my reason for doing this, the hope of the ONLY one thing that I fought through this much school for already.  But it's funny... we humans are odd creatures.  I'm still fighting and even the faintest hope of my reason is gone.  So am I fighting for nothing?  Probably.  Uh-oh, I can't let my mind go that way.  K, turn this way...

5. More. Weeks. Of. This...  And I wish I could say I'm getting the summer off, but I'm NOT.  I will be spending 6 weeks taking what I should have taken January through last week but nervous breakdown'ed my way out of.

If I can keep going at this insane pace, I'll be done in 1 year, 1 1/2 months, making my grand total... 6 painful years.

And then what?  A nanny who just happens to have a nursing degree?  God help me!  All I wanted was a part-time job that I loved (which could be nursing, yes, could be this....) and to work because of want and not need, with the ultimate goal of staying home with my children.  Somehow all of my dreams got really mixed up into the life I have now.  Add a degree and a part time RN job, keep the nannying, and I have everything in the dream except the kids... The kids I pour so much into are kind of other people's kids.  Oh, and a husband... I think somewhere in there the dream was being married first.  Yeah, and that's a sore subject right now.  But yes, he would be present because I would be working because I want to, not because I have to, right?  Remember that part?   Not sure how this knot of "dreams" came to be, or how to untangle it, but we'll get there... look around, assess, reassess... intervene when necessary.   Follow the plan of the Divine, foremost.  Stay on for the ride, because it's sure going to be interesting how this one plays out!

(Sidenote - Nurses, did you know that after 2015, the MSN is no more?  The next step is the doctorate of nursing practice I think.  I'm not sure if they're moving CNS NP CRNA, etc. up to PhD level or what, but the masters will cease to exist.  The nursing board smartypants are doing the physical therapist thing where all existing MSNs will be "grandfathered in" but anyone wanting to be a grad student has to work to PhD.  So my plan is, you guessed it, to start my masters the latest day in my life possible before I can no longer get "grandfathered" in for my MSN.)

One of these days :: N30010 :: Clinical Journal Entry #25

There are no headlines
for everyday heroes
there is no tickertape
no standing ovation

sometimes it's all they can do
to set their feet on the floor
in the morning

they go through their days
the best they know how

no rainbow need arch
through the sky
to inspire them
they have a special courage
shining deep inside

they go through their days
the best they know how

Ted Hibbard

This came into my inbox today while I was at clinical. 

Today, I could not wake up.  My alarm went off, I took a shower, threw on my scrubs, ate a bowl of Cheerios in record time, and left for clinical.  We were supposed to be on OB today and next Friday, but our instructor said since everyone has seen births, we had an option of not going to clinical next week and going to campus instead.  It's December, and we're all dead.  Guess which option we chose.  So today was our last day in clinical for obstetrics.  We're done.  (Well, next Friday we have presentations, course evals, and an "educational" movie, but that doesn't  count.)

I begged to go to OB Triage today simply because our instructor was confused and assigned other people to Labor & Delivery and I sure was not going to do Postpartum again.  Plus, a lot of births were going on so I figured Triage would be a happening place  (Any pregnant patient who comes to the hospital is sent up to OB Triage.  They could have the flu, a broken bone, or be in labor - most of them know to come to OB Triage and the ones who go to the ER get sent up anyways.)

Not a single patient came in until probably about 11am.  It was all insane from there.  December 1st was a full moon, so don't ask why it all happened today, 3 days later, but it did.

We got a woman who had a stomach virus (and was vomiting so loudly that I almost wanted to do so myself) and we loaded her up with a cocktail of phenergan/benadryl/reglan.  Then we had a woman who had a scheduled C-section (4th baby, 4th C-section!) who needed prepped.  This was my favorite patient because I got to start her IV!  Now, rumor has it that no one teaches us IV insertion in nursing school.  Apparently it's the orientation responsibility of wherever we get a job.  That always sounded stupid to me, and thankfully my instructor isn't into going by all of the program rules.  (I love her for it though - she's smart about it, she just has a much more creative, free-spirited approach to nursing)  Everyone knows though that one of the meds I'm on make my hands shake.  As in a tremor kind of shake.  I'm a steller phelebotomist (or I was in my nurse technician days) but sometimes it freaks patients and instructors out.  So my instructor felt my hands to see if she wanted to "let" me try the IV.  Not even kidding.  Then she randomly puts her hand on my stomach and says, "Wow, your entire body tremors."  Yeah, welcome to the misery.  I told her I was comfortable doing it and thought I could, so after I told her what med I was on and she about attacked me to find out why the doctors make me take it (umm, because I'm allergic to every single aternative?) she finally agreed to let me attempt it.  She asked me what I'd need to start an IV and draw some blood (I voted for the 22 gauge, but the RN said I had to do an 18 - scary!), we reviewed the exact steps the process entailed, and I beautifully gathered all of the supplies in a Chux and carried them into the patient's room.  (Of course I know exactly what you need to start an IV - I've only had like 100 in my lifetime...)

Oh and let me just insert here that Jen (my bestie) taught me how to do an IV (at my kitchen table - just like the time she taught me how to draw blood!) but I completely blew her vein.  She told me to try again, and I was too traumatized by creating a huge blood bruise to accept the offer.  I had just asked her this morning to come over this weekend so we could practice again.  Too late!

So the patient was African American and didn't have good veins at that.  So not only were her veins harder to see, but they just were crooked, deep, or way too "wiggly."  I put the tourniquet on and felt around.  I finally found a hand vein that curved back and forth but it was the best she had.  My instructor liked the site and told me to go for it.  I inserted the needle, bevel up, and there was no flash.  I was panicking when my instructor said, "Push it in just a little more."  Flash!!!  I pushed the button to retract the needle and threaded the catheter in.  Blood started spurting everywhere (that's a good thing!) so I quickly connected the adaptor and popped a blood vial in.  Full.  2nd vial.  Full.  I removed the adaptor and popped the IV tubing on.  Beautiful.  I got a warm rag to clean up the blood on her hand, and we covered it with a Tegaderm and taped the tubing securely.  I had primed the Lactated Ringers so I opened the line and let it go.  (I guess in Triage they just "eye" it and don't put it through a pump.)  Drop. Drop. Drop.  The LR were infusing perfectly in an IV that I had put in.  It was working!  Then later I piggybacked 2 bags of antibiotics, and they worked, too!  (Why they wouldn't, I have no idea.  But I was still on IV-high.)  I had an issue with the 2nd bag, but the RN said sometimes it's just the position of their hand, and sure enough, we had the patient place her hand a different way, and the med started infusing.  Good to know.

The day I performed my very first blood draw on a real patient (Jen doesn't count) I was teching and I called and texted pretty much everyone I knew (and Twittered!) and about died from excitement and pride and well, it was a little weird how excited I was.  Well, that was nothing compared to the IV.  The feeling of knowing I could successfully insert an IV made me feel almost like I'm a real nurse now - the IV is always the "big, scary" thing that everyone is petrified to do.  Well, I've done it, and I did it well.  So I can do it again.  And it feels sooooo good!  Major high.  Other than things involving my fiance like our engagement, first kiss, picking out the ring, blah blah blah, oh and maybe getting accepted into the nursing program, or the birth of my furbaby puppy, it was probably one of the most exciting moments of my life. (And if you're not a nurse or nursing student, you probably don't get it - that's okay.)

Wow, I use a lot of parentheses.  So many thoughts!

Anyways...

That was the highlight of my day, and I spent the rest of it helping check in new patients and then wasting time.  Not kidding.  The story...

We had this huge rush of new patients in Triage, all with what they called "contractions," one who said, "I'm not sure, but I think my water may be leaking.  I don't know," and then a couple women who both said their due dates were tomorrow so they were sure they were in labor.  Funny because most of the patients were in such early labor we couldn't even admit them.  Anyways, I went in with the nurses and helped put on the fetal and contraction monitors, get their urine samples, answer questions, get their data... etc.  After awhile, everyone was just chilling because that's what the Triage patients do - they sit there for a couple hours (unless they're obviously in active labor) so we can read a good amount of monitors to see what stage of labor (if any) the patient is in, and how the baby's heartrate is.  I think it's more like a "we know you're not in labor, but we need to legally cover our butts" kind of thing.  Not sure, but that's my theory because it's kind of monotonous.  And yes, most of them end up being sent home.  If you're contractions aren't under 5 minutes apart and completely regular, if you are in no obvious distress and have not had your water break, don't come to the hospital.  The nurses and doctors don't mind, but you will be very, very bored and miserable waiting and watching and then being sent home.

So Triage got quiet really fast.  Everyone just waiting to be sent home to walk around, have sex, do whatever they want to get their labor going faster.  Then they'll probably be back tomorrow in active labor.  It's crazy.

Our instructor said if we were bored, we could go study in the  conference room.  A lot of things happened in the morning and early afternoon, so there were a few of us who were bored out of our minds by 2:30/3.  We went to the conference room and rested, talked, went to the cafeteria (yes, just because we were bored and hungry), came back, talked some more, and just waited for postconference.  We were all completely absent from our brains by that time, one of us had a broken arm, another hurt her back when a patient attacked her this week at her tech job (seriously!), a few were hungover, I was in extreme fibromyalgia pain and had a migraine coming on, and of course we all knew it was the last day on the floor.  We were slaphappy and exhausted, and our instructor looked like death (she has fibro too and was having a bad day), so we all agreed to leave a little early.

And now I am typing this as I babysit (which is insane seeing how much pain I am in from this day) and will momentarily take a nap until Mom and Dad come home.  I'm with my nanny girls, and L Bug's grandma watched her today and let her talk her out of taking a nap.  I literally had to drag L Bug into bed as she's screaming, "I'M (sob) NOT (sob) SLEEPY (sob sob)!!!!!"  She's barely 2 so it was kind of cute, but also distressing at the same time.  She's never that bad.  All I could think was, "I feel like sobbing and yelling I AM SLEEPY!!!!" 

This nursing thing - although amazing and fulfulling and perfect- is going to physically take every last bit of me.  3 more semesters + a summer externship.  It seems impossible, but I don't know what else to do.

Oh and as a side note, Jen (my best friend, remember?) took her boards yesterday and PASSED!  She's an RN!  She was going to reschedule her test but failed to do so within 24 hours so either had to take it without studying at all or waste the money and pay to take it again.  She told me she knew she'd fail, but she figured she'd already paid for it and it would be good practice, so she went.  And passed.  Without studying.  That is so my best friend.  She texted me this AM and said "I know you're in clinical but I need you to call me ASAP."  I snuck into a hallway behind a door and called her.  We were both almost crying.  It was such a great moment.  Then she called me tonight.  She techs at a hospital and landed a job on her floor, which she loves.  Apparently she talked to the nurse recruiter this afternoon, and she's having Jen start orientation on Monday.   Tomorrow is her last day teching forever.  She's an RN, and she starts making an insane amount of money Monday morning.  She will be working on her favorite unit, loving every minute of it, and making the living she's worked so hard for.  Snaps for Jen.  I'm so proud of my amazing, crazy soul sister.  24 hours ago, she thought she was taking a practice NCLEX and she'd definitely fail it, and right now, she is an RN and starts work on Monday on her dream unit.  Absolutely insane.  God is pretty awesome.  Oh, and she has a new boyfriend too.  First "real" boyfriend ever.  It's so sweet when life is so good. 

Today, her day, almost makes me forget how far away from nursing I feel after remember what I realize at the end of each clinical day  - my body cannot do this job for more than a couple hours.  My heart can, just not my body.  Everything starts aching and throbbing and crushing and burning.  My energy dips steeply at about noon, and then I drag.  I come home and load up on percocet, a muscle relaxer, a pain patch, sometimes a zofran... and I sleep for 2 solid days.  Then during the week, I forget how hard it was and look forward to the next clinical.  Then it nearly kills me, and it happens all over again.  I think it hurts my soul more than it hurts my body. 

One of these days, life will be okay.  One of these days...

Thanksgiving shouldn't end

Since Thanksgiving shouldn't ever end, I guess it's not too late to share a post of Angie Smith's I found in the (In)Courage blog.  It really inspired me on Thanksgiving - click here to read it.

An excerpt:

I've felt called to spend some time studying gratitude in an effort to work on my own negative tendencies and the Lord recently gave me an amazing glimpse into Scripture.

In Luke Chapter 17, Jesus is traveling to Jerusalem when He hears ten men with leprosy calling out to Him in desperation. Most likely, they didn't expect a response, but they were used to announcing their ailment whenever anyone walked by.

Jesus did respond, and He instructed them to show themselves to the priests. It says that as they walked, they were cleansed.

The Greek word for cleansed in this passage is "katharizo," and it means "to cleanse by curing."

After they are healed, one of them recognizes that he is not leprous anymore (the Greek for healed in this passage is "iaomai" which means to be cured) and goes back to thank Jesus.

So all of them are not leprous anymore but only one has returned to thank the Lord.

Upon falling at Christ's feet, Jesus tells him to "Rise and go; your faith has made you well." (Luke 17:19)

I was intrigued by the fact that while the rest of the Greek words refer to healing of a sickness, only the leper who returns is told that he has been made well.

So what is the difference?

Actually, quite a bit.

The original meaning of the word "well" in this passage is "sozo," and it means more than a physical healing.

It means that in the Biblical sense, the man was saved.

It seems gratitude is an intimate part of our salvation. This doesn't mean that our salvation is earned by it. But it does challenge us to think about how we are living it out that gift every day.

I want to encourage all of us to fall at His feet in gratitude, if for no other reason than that we are "sozo." Loved from before the beginning of time.

Let's be like the leper who returns in shameless gratitude, spilling out our thanks as we lay at His feet.

After all, He has made us well.

Speaking of Angie, her book is coming.  Have you preordered it yet?  I have.  It's called I Will Carry You: The Sacred Dance of Grief and Joy.  So. Excited!

And one last thing... her latest blog post brought me to tears...  Permission to Hope.  Start from the beginning of her story over at her blog if you're unfamiliar.  In a nutshell, she has three beautiful little girls and when she was pregnant with the fourth, they found out she might not live until birth.  She ended up living for a couple of hours and they named her and loved her and then lost her.  Angie is pregnant again, and here's the highlights of what inspired me and quite honestly, resounded in my heart and soul because I've been there... I hope her words can touch you too.

It has been really difficult to go through this again, and I really covet your prayers as we face our fears. I know that the Lord is trustworthy and that I can believe in His goodness but it's not easy. Yesterday I spent a long while crying on my closet floor as I processed the fact that I need to pull out my maternity clothes again. I think I am reliving things in a new way as I sort through the things I wore with Audrey, tucked away in a corner I haven't really faced. I have the kind of memory that can smell perfume across the room and remember sitting next to my third grade piano teacher while pounding out a horrific version of the love theme from Romeo and Juliet. She said I was really good.

She lied.

Turns out she was in love with my father (yes, we let her go shortly after gifts starting arriving for him...my mom was not about to eat the cake she sent). That was my last attempt at piano, and I assure you that the human race is better for it.

I remember little things people have said, the way hospital soap fills a room with anxiety, the exact expression Todd had on his face when he told me he loved me for the first time. It's locked away in a little vault that opens with trigger points in my life.

Unfortunately, trigonometry, driving directions, and Spanish never made it into the vault.

I honestly feel like that's one of the reasons I love to write so much. It can get all tangled out and if I can just get it on paper it unravels a little and helps me connect the dots. The hard part about that is that I can't run from it when it's right in front of me. I have to dig around in my closet, past the wedding dress, past the girl's linen dresses, and into the corner I have not wanted to face. I opened a vacuum-sealed bag of maternity clothes yesterday and I could feel her again. I screamed at God because I wanted her back so badly I ached. Todd came and found me there, face-down in my pain, clothes spilled all around me.

"This is the sweater I was wearing when we found out. This is the shirt I almost returned because we got her diagnosis and I knew I wouldn't ever be big enough to wear it. This is a nursing gown I never got to wear, this is the dress I bought for the photography session..."

They are just clothes, I know.

But they were a part of my life with her.

I needed to have a little meltdown. I've been moving along as if I could get through it without feeling this, and I can't. I'm just not going to bother to try anymore because it isn't going away. I really want you all to know that I have struggled in my walk recently. It isn't that I don't believe or trust in the Lord. I do. I just haven't been as disciplined as I should be with my quiet times and spending time in the Word. It isn't like me to retreat so much, and I finally realized yesterday that there was a part of me that just felt like going it alone because the last time He let me down.

Is it false thinking? Absolutely. No question Satan wants me to be convinced that I am better off on my own, trusting that doctors and logic will sustain me. I confessed this to the Lord, and I confess it to you all. Many times I have shared about my spiritual life, urging you all to be disciplined and faithful, and I owe it to you to tell you that I have just not been there in the last several weeks.

Truthfully, I have not felt permission from the Lord to write on the blog because I knew there was a disconnect between what I wanted to say to you and what I felt. I know He wanted me to focus on Him, and sometimes that means stepping away to get my priorities in check. I don't want a ministry if I'm being hypocritical or false. So, all that to say, I am working to get back in my groove... :)

I want to believe that this time is different, and I do feel a peace about everything. The night before my first appointment (I even switched doctors because it was so hard to think about going back to mine) I started letting my thoughts get away from me. I pictured the room, the gel, the screen. My heart was pounding and I pleaded with the Lord to give me a sign of hope. Lord, you don't have to tell me the baby will be fine, and I don't expect you to. But would you just let me know You are there? That you haven't let go of me?

There was a time of great hope during my pregnancy with Audrey, when an ultrasound seemed to conflict with her diagnosis. A few weeks after we learned she wouldn't survive we were surprised to see that many of her original diagnoses were not what they thought. That evening we went out to dinner for my nephew's birthday and I photographed Kate asleep with a balloon in her hand. I posted the picture and said that when I saw her I knew that we were doing the same thing; against all odds, we were holding on to hope. I actually wrote about this event in my book because it was such a pivotal moment for me, and the picture of Kate is featured in that chapter. It was a symbol that the Lord used to remind me that He was with us and that we had permission to hope.

When the sweet technician did my scan a few weeks ago, she had the screen turned away from me. Todd could see it and he was trying to make out what was happening. We knew it might be a little early to see a heartbeat so I had prepared myself that we might not get that reassurance. Just after she started, she said "148 beats a minute!"

Oh, Jesus. Thank you. Thank you.

She continued to look at the screen while I looked at Todd. All of a sudden she giggled a little under her breath.

"Well I can't say I've ever seen that before! That is so funny. Look at this, Angie."

She started to turn the monitor as her words filled the gap in the room. She shook her head warmly and continued, having no idea how it would bless me.

"It looks like the baby is holding a balloon."

I stared at her and then I took a look for myself and indeed, it was uncanny. I felt a peace come over me when I saw it because I knew He had done it for me. He hasn't forgotten how much it hurt me and He knew I would understand Him. I felt my eyes get hot as I thanked Him for letting me sense Him so strongly in a moment I needed to believe He was there.

She repeated herself and I nodded.

He isn't so big that He can't find His way into an exam room. I couldn't wipe the smile off my face as I agreed with her.

"It does look like the baby is holding a balloon."

I let out a 2 years-long sigh and finished the sentence in my head.

And so are we, Lord...

So are we.

Amazing, no?  These words touched my heart because I, too, get attached to smells and items and anything.  The smell of certain plastics immediately take me to the operating room.  Putting on a hospital gown for an MRI sends my mind to laying in a hopsital bed, 9 years old, watching the rain fall out the window.   I can't wear certain items of clothing because of the grief I felt in that shirt or with that bag.  I can't drive by certain places without chills shuddering up and down my spine.  Certain songs take me to the times I have been laying on the floor screaming at God or curled up in a ball in my closet, sobbing into a pile of clothes, struggling to catch my breath.  I have meltdowns all the time... usually in a longing dispair for what isn't, what cannot be.  But you know what? God has been there every single day through all of it, and He's been beside me through every hard time, to see each tear fall.

He was there about a month ago when I had just failed a nursing paper, I was in over my head in school and life, and Jonathan was taking a class that made him only come over a couple times a week.  (He's usually here every day.)  Then, I had a day of appointments.  A new pain psychologist helped me realize some things.  The appointment was a good three hours long and just emotionally draining.  I need to get my life down to a quota, not stress my tolerance.  She told me that my pain - physical and emotional - is always going to be there.  If I do less to handle it, if I am deconditioned, the painful thing or the physical pain is just going to hurt more.  She told me to take pain out of the equation and no longer make pain the determinant of what I do or don't do.  She told me life is like an airplane and said my life is turbulant, and the plane is coming down.  She asked me what to do when the life masks pop down from the plane ceiling.  All of a sudden the light bulb went on.  I remember exactly the soft tone of voice I had when I slowly said, "I put mine on first before I help others."  That was it.  I'm killing myself trying to save the world when my own "life mask" isn't on.  And then I saw my liver doctor, which is usually emotionally painful.  She's told me in the past that she had a patient with my condition, and after she got pregnant, she advised her to abort the fetus because the pregnancy and birth would kill her.  That has always stuck with me, but this particular day, we discussed the genetics of my disease and how it's thought - although no one knows to what extent or how - to be somehow genetically composed.  She said my children would have a small chance of having liver problems, and even my sister's children or if my mom would to have more children, were to be slightly at risk.  So then of course, I immediately feel guilty for tainting my entire family's offspring (even though no such offspring exist), and I also start getting sick to my stomach because although I'd risk my life to carry a baby and bring her into the world, even a small chance of passing on this hell I've lived through is without question just not going to happen.  I would never, ever wish this on anyone, God forbid my own children.

So an hour long drive home got my mind in a mess of stress and fear and exhaustion and something set me off later that evening (no idea what...) and I literally went into a crying hysteria that lasted about 3 hours.  It went into a full blown nervous breakdown.  My mom came into my room twice to try to calm me down, and I know it upset her to see me like that, but I guess that's what moms do best.  Eventually I texted Jonathan who was in his class and told him to come over ASAP because it was an emergency.  I'd never in a million years ask him to do that, but I knew if I didn't get my strength to me soon, if I couldn't sob in the only arms who could stop the tears, I wouldn't get out of this fit that was suffocating me and stabbing knives in my stomach.  I'm not even sure I should type these next words because it makes me look so lame and pathetic, but when I'm at my absolute worst and cannot find the words to talk to God, his arms are just a little longer to reach God and bring Him to me.  Jonathan connects me to my hope, and until I'm strong enough to hope on my own and learn to trust God just a little better... until my crippled legs straighten and my broken hands heal, he's the only one who can pick up my broken pieces and place them in God's hands.

That's what true love is, and that is what the grace of God means to me.

How thankful are we for the love of God, the grace of God, the mercy He has for His broken ones.  He wants us to hope in Him.  Even if we don't feel like hoping anymore, even if we can't see the hope.  It's there.  Hope is a powerful, powerful thing.

Persisting (or trying at least)

The softest things in the world
May be harder than the hardest.
Soft water can go through the strongest wall.
Knowing this, I know the value of calm.
Knowing this, I know the value of patience.
Knowing ths, I know the value of persistence. 
. . . . . . . . . . . .Lao Tzu . . . . . . . . . . . .

Most days, I'm trying to practice the calm, while every day, I pray to God for patience and watch as it takes me through, and every day I wake up with persistence - a firm belief that I will do a anything in my power to make this a great day, to make healthy choices, and accept the things I cannot change.

This persisting thing can get pretty tricky, but if you want to keep your soul, heart, mind, or body, you have to keep your guard up and fight to protect it all.  Do whatever it takes, you know?

Life's been rough lately.  Finals just ended (I think I got an A in all 3 classes!  Awesome for the GPA!)  And now, everything in the world is going on plus now, big news, the possibility of starting clinicals in the fall (after a year long hiatus!)

Today I'm going to see Dr. Mazanec, a new doctor (just what I need, right?) who is supposedly the best doctor up at Cleveland Clinic for my specific back problems.  Yes, I have my pain management doctor, but over time, it seems to be getting worse.  I'd like to just get it better so "pain management" (muscle relaxers and opiods, trying to schedule physical therapy in around school) isn't needed AS much, because right now, it's out of control.  My doctor does a great job at giving me the tools to manage the pain, but how about just getting rid of the pain?  Well we'll see what the doctor says tomorrow.  Then I have an ultrasound because of a big spot on my kidney that they "accidentally" found while doing liver scans.  My specialist thinks it's a shadow, but we're going to check to make sure.  Then I'm secretly hoping inside we'll have time between the two appointments to get lunch at the cafeteria!  Cleveland Clinic has great food, or at least as far as I'm concerned.  Oh, and their cookies are to die for!!  (Make a mental note in case you're ever there!)

Looking ahead, especially if the clinicals work out, I have not the faintest clue of how I'm going to keep seeing all of my doctors since for one, they're all an hour away, and for two, I'll be in classes, clinicals, and nannying the other days.  Plus add in things like massotherapy, physical therapy, and - starting on Friday - acupuncture.  I know MY health comes first if I ever want to be a nurse, so I'm determined to take the best care of me while still being up to taking my nursing courses.  I think that's easier said than done, but I miss my patients all the time so my heart knows where it needs to be.  I just need practicality and logic to catch up with that heart. :)  I have big dreams, people, and just because I have more diseases than you have fingers, that doesn't mean I won't achieve them.  Might take me longer, and I might work harder than most, but I'll get there.  You watch.

This week is a ton of crammed-in plans and events and appointments and then Monday evening begins my Genetics course and 2 online courses (am I trying to kill myself again?) plus whatever nursing I can squeeze into my schedule at this point.  (But for sure, for sure clinical for 2nd half of semester.)  But back to Genetics... I've been putting it off so long that I decided to make myself take it.  I'm not excited about it at all, especially since it's an evening class.  Yuck.  All by Monday, I'm getting books for Nikki and I, organizing parking, schedules, all that fun stuff, AND I'm trying (semi-successfully) to remember to take my meds, get my rest, and try not to get stressed.  (Stress = muscles tighten = back hurts BAD.  I currently have something in my neck and haven't been able to move it to the left for 3 days now!)

Craaaaaziness!  Thankfully my mom is awesome and is so excited about me going back to clinicals.  She promised she'd help me with anything I need which helps so much because right now my room is a disaster, I've needed to do laundry for a few weeks now, I need to change the sheets on my bed.... you know, just little stuff that busy people can't seem to ever fit in.

So I'm busy, but blessed.

God give us patience today.  Give us calm.  Give us persistence.  We'll keep on going even though the path looks cloudy up ahead.

Be blessed.

The state of your life

I love my quote-a-day emails, and this one came to me last week:

The state of your life is nothing more than a reflection of your state of mind.
Dr. Wayne Dyer

It kind of stopped me dead in my tracks.  My state of mind has been less than ideal lately and these words helped me realize how badly my stressful mind has been disrupting my life.

Then in my Medical Sociology course, we were presented with this article in the New York Times addressing chronic stress.  I'd read all of these things before in my various courses, but the truth is so easy to forget about when caught up in the hustle of everyday life.  Here is the article, The Heavy Cost of Chronic Stress, by Erica Goode.  You can read it here.  I'm pasting it on my blog because we all need to read it, and I want to be reminded of it.  Here it is.  You'll probably be surprised at what you read.

 

In this season of bickering relatives and whining children, of overcrowded department stores and unwritten Christmas cards, it is instructive to consider the plight of the Pacific salmon.

As the fish leap, flop and struggle upstream to spawn, their levels of cortisol, a potent stress hormone, surge, providing energy to fight the current. But the hormone also leads the salmon to stop eating. Their digestive tracts wither away. Their immune systems break down. And after laying their eggs, they die of exhaustion and infection, their bodies worn out by the journey.

Salmon cannot help being stressed out. They are programmed to die, their systems propelled into overdrive by evolutionary design.

Humans, on the other hand, are usually subject to stresses of their own making, the chronic, primarily psychological, pressures of modern life. Yet they also suffer consequences when the body's biological mechanisms for handling stress go awry.

Prolonged or severe stress has been shown to weaken the immune system, strain the heart, damage memory cells in the brain and deposit fat at the waist rather than the hips and buttocks (a risk factor for heart disease, cancer and other illnesses), said Dr. Bruce S. McEwen, director of the neuroendocrinology laboratory at the Rockefeller University and the author of a new book, ''The End of Stress as We Know It.'' Stress has been implicated in aging, depression, heart disease, rheumatoid arthritis and diabetes, among other illnesses.

Researchers have known for many decades that physical stress takes a toll on the body. But only relatively recently have the profound effects of psychological stress on health been widely acknowledged. Two decades ago, many basic scientists scoffed at the notion that mental state could affect illness. The link between mind and body was considered murky territory, best left to psychiatrists.

But in the last decade, researchers have convincingly demonstrated that psychological stress can increase vulnerability to disease and have begun to understand how that might occur.

''If you would have said to me back in 1982 that stress could modulate how the immune system worked, I would have said, 'Forget about it,' '' said Dr. Ronald Glaser, an immunologist at Ohio State University.

The more researchers have learned, the clearer it has become that stress may be a thread tying together many illnesses that were previously thought to be unrelated.

''What used to be thought of as pathways that led pretty explicitly to one particular disease outcome can now be seen as leading to a whole lot of different outcomes,'' said Dr. Robert M. Sapolsky, a professor of neurology at Stanford.

Central to this new understanding is a novel conception of stress, developed by Dr. McEwen, who has been studying the subject for more than three decades. According to his model, it is not stress per se that is harmful. Rather, the problems associated with stress result from a complicated interaction between the demands of the outside world and the body's capacity to manage potential threats.

That capacity can be influenced by heredity and childhood experience; by diet, exercise and sleep patterns; by the presence or absence of close personal relationships; by income level and social status; and by the piling on of normal stresses to the point that they overload the system.

In moderate amounts, the scientists argue, stress can be benign, even beneficial, and most people are equipped to deal with it.

Preparing to give a speech, take a test or avoid a speeding car, the body undergoes an elaborate series of adjustments. Physiological processes essential in mobilizing a response -- the cardiovascular system, the immune system, the endocrine glands and brain regions involved in emotion and memory -- are recruited into action. Nonessential functions like reproduction and digestion are put off till later.

Adrenaline, and later cortisol, both stress hormones secreted by the adrenal glands, flood the body. Heart rate and blood pressure rise, respiration quickens, oxygen flows to the muscles, and immune cells prepare to rush to the site of an injury.

When the speech is delivered, the test taken or the car avoided, another complex set of adjustments calms things down, returning the body to normal.

This process of ''equilibrium through change'' is called allostasis, and it is essential for survival. But it was developed, Dr. McEwen and Dr. Sapolsky point out, for the dangers humans might have encountered in a typical day on the savannah, the sudden appearance of a lion, for example, or a temporary shortage of antelope meat.

Blaring car alarms, controlling bosses, two-career marriages, six-mile traffic jams and rude salesclerks were simply not part of the plan.

When stress persists for too long or becomes too severe, Dr. McEwen said, the normally protective mechanisms become overburdened, a condition that he refers to as allostatic load. The finely tuned feedback system is disrupted, and over time it runs amok, causing damage.

Work that Dr. McEwen and his colleagues have conducted with rats nicely illustrates this wear-and-tear effect. In the studies, the rats were placed in a small compartment, their movement restricted for six hours a day during their normal resting time. The first time the rats were restrained, Dr. McEwen said, their cortisol levels rose as their stress response moved into full gear. But after that, their cortisol production switched off earlier each day as they became accustomed to the restraint.

That might have been the end of the story. But the researchers also found that at 21 days, the rats began to show the effects of chronic stress. They grew anxious and aggressive. Their immune systems became slower to fight off invaders. Nerve cells in the hippocampus, a brain region involved in memory, atrophied. The production of new hippocampal neurons stopped.

Dr. Sheldon Cohen, a professor of psychology at Carnegie Mellon University, has found that people respond much the same way. Among volunteers inoculated with a cold virus, those who reported life stresses that continued for more than one month like unemployment or family problems were more likely to develop colds than those who reported stress lasting less than a month. The longer the stress persisted, the greater the risk of illness.

Allostatic load is often made worse, Dr. McEwen said, by how people respond to stress, eating fatty foods, staying late at work, avoiding the treadmill or drinking to excess. ''The fact is that we're now living in a world where our systems are not allowed a chance to rest, to go back to base line,'' he said. ''They're being driven by excess calories, by inadequate sleep, by lack of exercise, by smoking, by isolation or frenzied competition.''

The Chemistry

Shrinking Cells, Turned-Off Responses

Doctors sometimes dismiss stress-related complaints as ''all in the patient's head.'' In a sense, they are right. The brain, specifically the amygdala, detects the first signs of danger, as demonstrated in now-classic studies by Dr. Joseph LeDoux of New York University. Other brain areas evaluate the threat's importance, decide how to respond and remember when and where the danger occurred, increasing the chances of avoiding it next time.

So it is not surprising that when the stress system is derailed, the brain is a target for damage. A decade of research has demonstrated that sustained stress and the resulting overproduction of cortisol can have chilling effects on the hippocampus, a horseshoe-shaped brain structure intimately involved in memory formation.

Scientists say they believe that the hippocampus plays an active role in registering not only events, but also their context, an important task in the face of danger. In stressful situations, the hippocampus also helps turn off the stress response after the threat has subsided.

But high levels of cortisol, studies have shown, can shrink nerve cells in the hippocampus and halt the creation of new hippocampal neurons. These changes are associated with aging and memory problems. Some evidence also links a smaller hippocampus with post-traumatic stress disorder, depression and sexual abuse in childhood, though the meaning of this size difference is still being debated.

Like other hormones, cortisol normally rises and falls with daily rhythms, its production higher in the morning and lower in the evening. Prolonged or severe stress appears to disrupt the cycle. Chronically stressed people sometimes have higher base line cortisol levels and produce too much or too little of it at the wrong times.

One result, recent studies indicate, is that fat is deposited at the abdomen rather than the hips or the buttocks. One of cortisol's primary functions is to help mobilize energy in times of acute stress by releasing glucose into the blood. But when cortisol remains chronically elevated, it acts, along with high insulin levels, to send fat into storage at the waist. This makes sense if a famine looms. But it is bad news for anyone who wants to minimize the risk of heart disease, cancer and other illnesses.

Studies have shown that excess cortisol secretion in animals increases visceral fat. And Dr. Elissa S. Epel at the University of California at San Francisco has found that even in slender women, stress, cortisol and belly fat seem to go together.

The notion that being stressed makes people sick is a popular one, and most people subscribe to some version of it. Come down with the flu in the midst of a messy divorce or a frantic period at the office, and someone is bound to blame stress.

But it was not until the 1980's and early 90's that scientists began to discover the mechanisms that might lie behind the mind and body link. Investigators uncovered nerves that connect the brain with the spleen and thymus, organs important in immune responses, and they established that nerve cells could affect the activity of infection-fighting white blood cells.

Scientists also found that cytokines, proteins produced by immune cells, could influence brain processes. Among other things, the proteins appeared able to activate the second major phase of the stress response, the so-called hypothalamic-pituitary-adrenal, or H.P.A., axis. In this chemical sequence, the hypothalamus, situated in the forebrain, dispatches chemical signals to the pituitary, which in turn secretes the stress hormone ACTH, prompting the adrenal glands to produce cortisol.

Much remains unknown about how the brain, the endocrine system and the immune system interact, and some of what is known is not well understood. For example, high levels of cortisol have long been known to shut off the production and action of cytokines, which initiate the immune response. At normal levels, cortisol can enhance immunity by increasing the production of inflammation-fighting cytokines. Yet in some cases, it seems, cortisol does not properly shut down the immune system under stress, allowing the continued production of cytokines that promote inflammation. These cytokines have been linked to heart disease, depression, stroke and other illnesses.

Still, scientists can watch stress hammer away at the immune system in the laboratory. Dr. Glaser of Ohio State and his wife, Dr. Janice Kiecolt-Glaser, found that small wounds took an average of nine days longer to heal in women who cared for patients with Alzheimer's disease than in women who were not under similar stress. In another study, arguments between husbands and wives were accompanied by increases in stress hormones and immunological changes over a 24-hour period.

Stress also seems to make people more likely to contract some infectious illnesses. Dr. Cohen of Carnegie Mellon has spent years inoculating intrepid volunteers with cold and influenza viruses, and his findings offer strong evidence that stressed people are more likely to become infected and had more severe symptoms after becoming ill.

A direct link between stress and more serious diseases, however, has been more difficult to establish, Dr. Cohen said. Recent studies have provided increased support for the notion that stress contributes to heart disease, and researchers have tied psychological stress, directly or indirectly, to diabetes, rheumatoid arthritis, fibromyalgia, severe depression and other mental disorders. But the influence of chronic stress on other diseases like cancer remains controversial. All the same, Dr. Cohen said, ''The evidence that stress puts people at risk for disease is a lot better than it was 10 years ago.''

The Risks

From an Early Start, Lifelong Effects

Why do some people seem more vulnerable to life's pressures than others? Personality and health habits play a role. And severe stress in early life appears to cast a long shadow.

Dr. Michael Meaney of McGill University and his colleagues have found that rat pups intensively licked and groomed by their mothers were bolder and secreted lower levels of the stress hormone ACTH in stressful situations than rats lacking such attention -- an equanimity that lasted throughout their lives. (Cuddled pups, the researchers found in another study, were also smarter than their neglected peers.)

In humans, physical and sexual abuse and other traumas in childhood have been associated with a more pronounced response to stress later in life. In one study, Dr. Charles Nemeroff, a psychiatrist at Emory University, and his colleagues found that women who were physically or sexually abused as children secreted more of two stress hormones in response to a mildly stressful situation than women who had not been abused.

Yet perhaps the best indicator of how people are likely to be affected by stress is their position in the social hierarchy. In subordinate male monkeys, for example, the stress of being servile to their alpha counterparts causes damage in the hippocampus. And dominant monkeys who are repeatedly moved from social group to social group, forcing them to constantly re-establish their position, also exhibit severe stress and are more likely to develop atherosclerosis, according to studies by Dr. Jay Kaplan of Wake Forest University School of Medicine.

Being low in the hierarchy also affects reproduction, presumably because evolution dictated that in times of stress, other factors were more pressing than procreation. In a recent study, Dr. Kaplan found that the constant low-level harassment by dominant female monkeys shut down reproductive function in subordinate females and built up fat deposits in their arteries.

It would be nice to think that humans are less chained to their social rankings. But alas, researchers have found this not to be the case. A wealth of studies shows that the risk for many diseases increases with every step down the socioeconomic scale, even when factors like smoking and access to health care are taken into account.

A real estate mogul living in a Park Avenue penthouse has a better health prognosis than the head of a small company in an upscale condo a few blocks away. And a renter in a one-bedroom apartment on the Upper West Side of Manhattan will be a tier or two lower still in health expectations.

Even people's perceptions of their relative standings in society affect their disease risk. In one study, led by Dr. Nancy E. Adler, also at the University of California at San Francisco, women who placed themselves higher on the social ladder reported better physical health and had lower resting cortisol levels and less abdominal fat than women who placed themselves on lower rungs.

No matter what one's circumstances, of course, some stress in life is inevitable. But illness is not, Dr. McEwen said. A variety of strategies can help reduce disease risk.

Reaching for a gallon of ice cream to soothe the tension of a family argument is not one of them, however, nor is forgoing exercise in favor of curling up on the sofa for an eight-hour marathon of ''Law and Order.''

The best ways to cope, Dr. McEwen said, turn out to be the time-honored ones: eat sensibly, get plenty of sleep, exercise regularly, stop at one martini and stay away from cigarettes. ''It's a matter of making choices in your life,'' he said.

Maybe think a little harder next time you feel like you're going to crack.  What are you worrying about?  What is the root of the problem?  Where will your anxiety get you?  Re-center.  It's hard - trust me - but it's worth it when you can get there.