Monday, August 29, 2011

Tripping Down the Stairs of Higher Education

I have heard that the college experience transcends generations, that Powerpoint is the main difference between a Harvard freshman class in 1900 and a Harvard class today. My parents and I bonded over similar experiences. As a non-traditional (read: older) student though, I have always been acutely aware that in many ways my academic experience has been profoundly different than even that of those my own age.

Students now deal with the enormous lectures halls and the reviled clicker questions. The body of knowledge to learn and the competition for top grades seem to grow exponentially before our eyes.

Each generation, each class, seems to develop radical ideas that change the world and the way we learn. When our parents had few resources outside their professors and material libraries, we have virtual access to libraries and scholars across the world as well as instant access through sites like Pubmed and Biomed Central (among countless others) to cutting edge research. We can clarify any confusion we may have about lecture material from almost infinite sources during the lecture. There is a beauty in the changes that America has witnessed in higher education. It is incredibly exciting to be right there and witness new developments unfold.

For example, Einstein fundamentally changed the world of physics for future students like Richard Feynman who, in turn, amended it for the new generations. Lisa Randall is continuing this evolution for current and future scholars. The biochemistry that I learned last year is radically different that that I would have learned had I studied it with my high school classmates. When they were studying advanced biochemistry lab techniques, the human genome had not been completely mapped. Certain technologies, like gene sequencing, that were cost-prohibitive to even postgraduate research centers then are now common in undergraduate laboratories. I was able to witness the development of new approaches like the development and use of homing endonucleases to cut HIV DNA that already been inserted into the host chromosome. But despite seemingly vast differences, the feel of college is the same.

Students are taught in essentially the same manner. Though we see a growing trend of non-traditional early learning philosophies (e.g. Montessori), at the collegiate level, the lecture method grips the undergraduate world just as we see in favorite stories like Tom Brown’s Schooldays or Tales of St. Austin’s. We suffer the same 500 seat lecture halls that our parents did as freshman, and at the graduate level, the fierce defense of one’s dissertation to a critical examining panel echoes softly in the memories of Cambridge’s fierce Wrangler mathematical examinations. Both parents and children relate to and laugh at the antics of Rodney Dangerfield in Back to School.

The students themselves are essentially the same. Roger Ashcam who wrote The Schoolmaster, a treatise on proper teaching in the 1560s, claimed “Some wits, moderate enough by nature, be many times marred by overmuch study and the use of some sciences, namely, Music, Arithmetic, and Geometry. These sciences, as they sharpen men’s wits overmuch, so they change men’s manners oversore… Mark all mathematical heads, which be only and wholly bent to those sciences, how solitary they be themselves, how unfit to live with others…” We can assume had he known the future evolution of chemistry & physics, he would have also securely included their scholars. We can all see this truth today. Everyone, regardless of her age, can remember growing up with a Milhouse, Urkel or Screech.

We see in the structures of universities, their classic Georgian or Gothic architecture, a lingering look to the past. The traditions of Greek Life, though on the wane, still exist. Students are still proud of being a multi-generational legacy. Memories of college shared between generations are that of a place out of time: days that start late and nights that never end.

The substance of academia is in constant transformation but the experience of being there is fundamentally the same. Though some of those newly found ideas shake the foundations of our world, our experiences, those joys found in intellectual awakening and the contribution of ideas to the great body of knowledge, may be shared trans-generationally.

As Ronald J. Daniels told the most recent freshman class of John Hopkins University “So although universities are in one sense symbols of permanence, they are – owing to their devotion to ideas -- paradoxically incredible engines of change. They change science and art, history and philosophy – even our understanding of what it means to be human – by the ideas they generate.”

Why am I waxing poetic over the college experience? Having dined at the smorgasbord of learning delights, having been able to choose to study something in depth under the guidance of great scholars, I have recognized how important it was in the development, the maturation of my character. The pleasure I feel when I can go to an art museum with an (somewhat) educated eye or read something, understand and appreciate some of its underlying social, economic historical forces is indescribable. But it is more than that. I was a full-fledged adult with strong opinions and curiosity before I pursued my college education. Post-college, I can look back and recognize that my full-fledged status did not mean fully formed. I know that my thinking and opinion formation now is deeper and more critical than before and I hope (and expect) that as I continue on in my education, that I will grow keener and more thoughtful.

On a greater scale, education is the driving strength of the development of our culture and nation. We would not be able to compete in the global market without the innovation an educated population develops. Those symbols of permanence and engines of change are undeniably some of the greatest sources of the innovation required to keep our country one of the most enlightened and innovative nations in the world.

I know that certain medias’ portray ‘the educated elite’ as unnecessary and even threatening to ‘normal people’; I see the fundamentalists try to disparage and discredit scientists in their attempt to sell creationism over evolution and I always laughed at the silliness. I mean, all of the comforts in our life, the luxuries (food, clean water, electricity, medicine etc) that allow us to focus on things other than physical survival, are due to the innovations by the very people that are being discredited.

But there are increasing unhappy trends in our status as the innovative and educated nation that make it more difficult to laugh off silliness. For the first time, we are looking into a future whose children will be less educated than their parents. They'll be less educated in a world of growing education opportunities. As a population, we need more, not less, education to compete on the global stage. We need more education to evolve as a society. Last year, the United States fell to an international rank of eighteenth in secondary education. That is almost as low as an developed nation can fall. We seem to be losing our drive to become the strongest or we're using a warped meter stick to measure our progress. Whatever the cause of this educational downturn, I’m just saying that I probably won’t be dismissing any silly attitudes anymore.

*The statistics I cited are from the Organisation for Economic Co-operation and Development.

Saturday, August 27, 2011

Hurricane Savior

So... tonight wasn't as awful as I had feared. Vile Princess is terrified of the hurricane Irene. She lives on the river and "just knew" that her apartment was going to be flooded. I explained that we're several hundred miles from the coast and will probably have nothing more than some big winds.

She shook her head frantically and pointed to the satellite image. "It's headed right to us!" I grabbed her Mountain Dew bottle and blew, waving my hand behind it. See... wind felt here but stopped by the hills. Hooray for the Appalachians!

Now I'm her new BFF and she was positively sweet to me for the rest of the night. I hope her memory lasts. Wish me luck tomorrow!!

Working Blues

I went to work yesterday refreshed and determined to maintain my good humour but the moods of some of my coworkers were just awful. I was running the desk and so was forced to be the central communicator for nurses, physicians, aides, and patients.

Usually, I get anxious when Dr. Pita* comes to the unit. Her mercurial temperament can be scary to work with. She can go from friendliness to dragon in three breaths. But yesterday, I was so happy that she decided to do all her dictating at our nurses' station. She was there for almost 3 hours which gave me a reprieve from the snipping and snarling of my coworkers. They're always more polite when a physician or supervisor is within earshot.

The girl who cried is one of the greatest culprits of nastiness. A significant responsibility of mine is to answer call bells and then call the nurse or aide needed to the room. I heard "Jesus Christ" (with accompanying eyeroll), "take them yourself-I'm done", "fine-FINE!"(with hand up, palm toward me) and other 'tude responses throughout the entire night.

One of the nurses commiserated with me after a particularly vile comment: "she's like that with me too." Argh. That almost makes it worse; I could almost rationalize her behavior if it was animosity solely directed toward me but that she just indiscriminately spews obnoxiousness...

Well, we're not allowed to police each other and I need to be more 'tolerant' of my coworkers. Bah. Think happy thoughts, think happy thoughts, think happy thoughts.

Tonight I'm scheduled to work with the vile princess and another moody grumpy aide. I'm absolutely dreading going in. (think happy thoughts think happy thoughts think happy thoughts.. )

Thursday, August 25, 2011


I'm back from the cabin. It was a lovely interlude from the daily grind. I received a call during the trip from my brother... "we're here to celebrate with you... our car broke down... will you pick up your cake and some groceries..."

My brother is the most responsible person in the world (seriously!) and spend the entire weekend peering into the hood of his minivan with all the neighborhood men (beer in hand), trying to diagnose the issue.

In the end, his family borrowed my car while his was being repaired and today, I drove several hours south, and he several hours north, to exchange our vehicles.

Oh, I also dropped my phone into a local lake and so was without transport and communication for the entire week. It was a true vacation!

Saturday, August 20, 2011

"Now Comes Good Sailing"

I'm heading deep into the woods to my family's little cabin. This next week, I'm vacationing from people a la Thoreau; major break but with the occasional visitor. Here's hoping I can use this time to finish the rest of my school applications. I'm only halfway done and it's already late August!

Today is my birthday. When I blow out my candles, I'll wish for my parents back.

I'll leave you with a list:

1. The Crawling Eye
2. Jodhaa Akbar
3. Wit
4. Down by Law
5. Office Space
6. Guru (the one with Aish and Abhishek)
7. Starship Troopers
8. Stand by Me
9. Guess Who's Coming to Dinner
10. The Treasure of the Sierra Madre

*honorable mentions..
Dhoom 2 -but only because I'm totally in love w/ Hrithik Roshan
Dead Man -because Jim Jarmusch is a GENIUS
Indiana Jones & the Last Crusade- do I really need to explain this one?
Shawshank Redemption- this was actually on my top 10 until I thought about Sierra Madre, which won out by a hair

Fun Fact of the day: Katharine Hepburn's mother, Katharine Martha Houghton was the cofounder of Planned Parenthood with Margaret Sanger.

Thursday, August 18, 2011

Chicken Pox

One of the new nurses on the unit has a moderate case of the chicken pox. Policy here is that anyone who had contact with the infected needs to demonstrate either a recent immunization or an adequate varicella titer.

When I was hired last year, my titer was low. When I was six, I had had a severe case of chicken pox; if you closely examine my cheek and shoulders, you can still see the pockmarks. Because I've read that those who actually have had the disease demonstrate lower measured titers than those who are vaccinated, I declined to get a booster shot when I went through orientation. The clinic was across town and I didn't want to take an entire afternoon to get a shot I didn't need.

I am now presented with a choice: either take 28 days of unpaid medical leave or get the booster shot. I, of course, am getting the vaccination - I would need to for school next year anyway. It's just one more irritating errand in my already insanely busy life.

The irony is that the new nurse's infection is due to a booster shot she received during her orientation.

Monday, August 15, 2011


Today, my mother's birthday, I walked, reflected, found a tiny sparrow's nest, and ate ice cream with fresh picked blackberries.


The weather this weekend has been misty and gray. The trees quiver with the weight of the moisture on their leaves. With every gust of wind, the dew patters to the ground to echo the footsteps of my ghosts as they run through the woods.

One year ago yesterday, I decided to change my mother's care to palliative. It was the day before her 55th birthday. After some contemplation, I had decided not to wait until after her birthday to sign the paperwork. Though it had felt like I was giving up just when I should have been celebrating her life, I had finally recognized that she had given up long before and I just wanted her pain to ease. I didn't want her to have to struggle through her birthday.

Over the last year, that decision, all the decisions over the course of her care haunt me. I question if I should have waited, if I should have made the decision weeks earlier. I wonder if my self-interrogation stems from the melancholy that I feel right now, struggling with the convergence of her birthday, her death, my birthday (the 20th) and the anniversary of her funeral. I probably won't ever know if I made the right choice for her and that abrades me. I hope that as time passes, the erosion resembles less the calving of glaciers, monstrous pieces felled in a swoop, and more the gentle tumbling of sea stones.

Last night, a husband, surrounded by his family, decided to transfer his wife to hospice. The time spent in her room with her family was like a crampon squeezing my heart but they seemed desperate to have someone they trusted, who had cared for their wife, there to reassure them of their decision. I stayed because her daughter wouldn't let go of my hand and I couldn't bring myself to extract it.

The staff lounge was awash with comments like "it's about time" and judgments about the family's decision, a typical occurrence during these transitions. I completed her paperwork and then took a 5 minute bathroom break to rinse my grief from my eyes.

My sadness for her family and their coming sorrow, my sadness for the other six patients that I've transferred to hospice, particularly those who had no loving family to take on the burden of loss, and my memories of my beautiful vibrant charismatic mother sit like lead in my chest.

It's ironic that those who are most vocally critical of the choices that families make are those who have had the least experience dealing with any major decision, loss or grief and the least experience with the patient and her medical history. There were nurses who had never worked with the patient, never read her chart, never met her or her family who felt comfortable deriding the family and what they perceived as an unnecessary delay of the inevitable.

With a few questions carefully chosen to prick holes in their balloons of certainty, I made my point that this was a complex situation that could not be boiled down to an imprecise diagnosis and that making these types of decisions isn't easy or simple for clinicians who've been in the field for decades, let alone the families who are newcomers.

I started this post intending it to be a panegyric for my mother and the incredible staff at the Kindred LTACH in Wilkes-Barre, PA. Throughout the last months of her life, they nurtured the joy that she felt being around people- not an easy thing to do working in a hospital. Despite their many responsibilities and her inability to respond, they took time to visit with her and amuse her. They also supported me completely as I tried to navigate the bayou of treatment options. When my mom reached her limits and began to withdraw, I requested and they unhesitatingly joined me, her physicians and an ethical committee to discuss withdrawing treatment.

I am grateful that they demonstrated the power of empathy in softening the uncertainty and distress a family feels in these circumstances. Though, as an aide, I have no medical authority to ease the doubt and fear someone has in making a decision, I can follow the example set by the folks at Kindred. I hope that I made the family's trauma easier last night. I hope that I will always remember as vividly as I do now what it felt like grieving, frightened, unsure and dependent on the guidance and understanding of doctors and nurses.

Friday, August 12, 2011


Finishing my stint on third shift this morning, I stepped into the clear cool air and watched the beautiful blushing sunrise. It was a serene moment after a long night and a tense early morning.

One of our patients had left AMA just after morning labs. Last week, high on cocaine, Russell** started a bar fight and injured his shoulder. Dr. Joe told him that the surgery would be delayed for several days to allow his body to metabolize the cocaine. Russ was not happy to be stuck in the hospital for a week and recompensed by abusing the nursing staff: dumping his urinal over his sheets and the floor, barking at us when we walked by and spitting at anyone who came into the room.

We, of course, avoided him as much as possible. Well, Dr. Joe neglected to mention to Russ that he would have to have another drug screen before the surgery. Apparently his visiting friends had decided to bring him more drugs instead of flowers. When the lab tech went in to draw his blood, he went a little nutso, pulled out his IV and, blood dripping down his elbow, stormed out of the room toward the nurses' station screaming about bovine stool and ordering us to procreate with ourselves. Thinking he was going to attack us, we called a security code.

After the grey coats wrestled him back to his room, Dr. Joe came up and told him that the surgery was, yet again, delayed. Russ decided that he didn't want the surgery and demanded to be allowed to leave. Dr. Joe, quite angry and quite willing, retrieved the AMA paperwork and Russ left.

I stopped by the grocery store for cat food on my way home. I settled in the express line as a heavyset young woman unloaded her cart of items with the corresponding WIC vouchers on the counter. I had the rest of the day off and so buried my natural impatience with a magazine.

I soon found myself eavesdropping on the transaction ahead of me. The woman, refusing to pay the 58c difference for a bunch of grapes, told the cashier to take some grapes out of the bunch. I watched as the scan was voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided and then grapes added one by one until the weight matched the amount allowed by the WIC voucher. *sigh*.. "day off.. day off.. day off.. breathe.."

The cheese came next without issue. The juice wasn't juice but punch and not allowed under the rules of the program. Argument. Huffing. Return with Lemonade. Argument. Huffing. Apple Juice.

Finally, the cashier began scanning the non WIC items: HungryMan dinners, bagels, jars of baby food and beer. Total $21.53. Oh, only have $18.37.. Big eyes look at the cashier then move to me. I bury my face in the magazine. Hummm... Ok, take the baby food off.

I drove home judging her. I drank my black coffee and judged her. I thought about the choices that she could have made but didn't. I began to reflect on the decisions that I have made that could be better and I felt guilty. I could have had something other than that blueberry muffin this morning. I could have had tea instead of wine last weekend. I make awful decisions all the time: too much cheese, not enough greens, not enough water, reading trashy novels instead of literature, watching True Blood. I have a degree in chemistry and a passion for studying nutrition. I still make crappy lifestyle choices. I think most people do.

Lady, you're doing alright. Keep going to your classes at WIC and keep fighting for every grape. Please just don't do it in the express line. And don't date anyone with a gimpy shoulder; he's bad news.

Wednesday, August 10, 2011

Night Shift Vacation

I've been working third shift this week. It's amazing how tranquil the small hours of the morning can be on the unit. The lights dim and, as we walk down the hall, the only sounds are those of our footfalls and the occluded IVs chirping like birds chattering in the woods.

Patient interactions are softer, quieter. They raise bleary eyes when I wake them for vitals or glucose testing and immediately nod off afterwards.

During the day, my job is hectic, a continual scramble to stay atop of the endless tasks and requests. At night, I mostly mitigate patient squabbles: she won't turn her TV off, He snores-I want a different room.. etc.

The staff, too, is more seasoned, less gossip-girl petty and fun to work with. The team in general has a perverse sense of humor- befitting a group that works the 'graveyard shift'. Last night, one of the nurses taped little devil horns and paper pitchforks to all of the office supplies (staplers, pencil sharpeners, computer mice) at the nurse's station just to annoy the morning secretary, Anna. Anna's celebrity doppelganger is Dwight from The Office. She's incredibly pedantic. This is great for dealing with time clock issues but she gets worked up over the craziest details.

The nurses on the night shift have developed an art to annoying Anna. It was so much fun to watch her huff around this morning tearing down little paper horns. After about ten minutes, she settled down to organize her desk. She then went to fax new orders to pharmacy. When she lifted up the scanner only to find more horns, she bellowed, bellowed, "Okay, who did this? Paper costs money people! No wonder we're always overbudget! This is ridiculous, Who did this?" She then glared at everyone in the nurses' station as though someone had stolen her purse. It was awesome.

If I didn't know that I would be bored within a week by the routine, I would request a permanent transfer to third shift.

Friday, August 5, 2011

Poison Ivy

I went hunting blackberries yesterday before work in the hills beyond my house. Through the misty rain, the sun had cast a mauve glimmer on gray shale and the birds' loud chatter drowned out any stray noises from civilization.

It was a much needed diversion into serenity. My hamster wheel had been spinning furiously and stepping off reminded me of the bigger picture. Attitudes at work drive me mad but it's only a brief interlude. It will only be at most 10 more months until I'm back to school (fingers crossed!).

So I walked in the woods with dew soaking my sneakers and breathed in the absence of people. Coming up over a knoll, the sun beamed through the trees and from across the meadow. There, I saw the bush. Enormous, succulent and inky berries glinted in the light.

I made my way forward and noticed the wide jade green leaves that surrounded the fruit. Poison Ivy. I stopped a moment and thought about the symbolism, the correlation with my work dissatisfaction and my ultimate goals. I couldn't help but laugh aloud, startling a small flock of goldfinches into flight.

I continued to the bush, thankful in many ways, that I don't react to urushiol and I picked the berries.

And I made a blackberry, ginger compote for my salmon.

Monday, August 1, 2011

Crying at Work

In Floating, I alluded to the reality that staff on my floor don't always do their jobs thoroughly. It's a major frustration; the onus of work usually falls on the shoulders of only a handful of people.

I get particularly fed up when our manager seems to coddle the biggest transgressors. He does have his favorites. Usually leaving before our shift starts, he's not much of a presence and I've always attributed his lack of enforcing job responsibility to his ignorance of what really happens during the evening.

When I first started, I really liked my manager. He was welcoming and warm and seemed to really try to create a happy work environment. As the first months past, he seemed really receptive to all of my little ideas for the unit, posting bed phone numbers over the information board in each room, changing the location of the linen carts to be more generally accessible etc. I reorganized the way that the medical teams, patients and nurses were listed on our charge board, color coding them to make the information much easier to read. You should have seen the way they did it before, it would take minutes to figure out who the doctor and lead nurse was for each patient! I was allowed to join the unit council (their first aide!) and I thought, despite my lowly status as a grunt, my thoughts, ideas and concerns were being heard. I took on all the training of new PCAs and attended workshops to improve my clinical mentoring skills.

Last month, another aide, ignoring an imminently dangerous situation for the patient, neglected to do something important. I stepped in and performed the required task, then followed the her to the nurses station. I confronted the aide and told her that she could not disregard those types of situations.

Well, she started to cry and complained that she was having a really bad day. Her brother was having oral surgery to have his wisdom teeth removed and she was so anxious about it. She became hysterical,(seriously!) and needed a twenty minute smoke break to regain her composure. Of course, I was rolling my mental eyes the entire time.

The next day, I was called into the NM's office and scolded. He informed me that it was not my place to police my coworkers(!) and that, and I quote, "not everyone has your work ethic". I told him that I was indeed having trouble adjusting to lack of my* work ethic in my coworkers and that my actions stemmed purely from my concern for the patient. He nodded sympathetically and asked me to work on my tolerance.

Of course, I've thought that maybe I was out of line or too harsh with the other aide. I talked it over with one of the nurses who had been present though. She reassured me that it happened as I remembered: 10 seconds of me getting the aide's attention, telling her to do her job and her becoming histrionic. She confessed that she too has been scolded for scolding someone else.

I'm currently looking for a new job** but I'm saddened and frustrated by the entire scenario. I absolutely love the work that my job entails (but not the poop part) and I hate that I'm leaving with such sourness. All that I've read about the evolution of healthcare shows that the culture is one of increasing openness to policing each other in the effort to generate fewer mistakes. To be slapped in the face with the very antithesis was shocking.

*my work ethic being that I actually do my job!
**I did call the 'anonymous' hotline two weeks later for an incident that I wasn't directly involved in. I haven't seen nor heard any outcomes but I hope that someone is looking into the mess that is my unit.

Salmon Again

Salmon poached in white cooking wine with garlic, capers, roasted red bell peppers and green olives

Cabbage Salad
shredded with jalapeno, currants and raisins, tomato, green pepper, onion, apple cider vinegar, sugar, cayenne pepper, lime juice and lots of ginger.