Settling In

So I've unpacked and organized all of my stuff.  The apartment is small and technically a studio (though there's an alcove between the entryway and the kitchen- meant to be a dining area- I made it into a little bedroom.) It's clean with high ceilings, beautiful floors and tons of light.  I'm thrilled knowing that I'll have at least four years here. I finally have a home.

The last three years have been tumultuous for me.  I spent most of 2009 in a strange city, surfing the couches of friends of friends. My mom had had a bilat lung transplant and it hadn't gone well. Long story short: she spent 4 months post op in the ccu, graduated to the step-down vent rehab unit, crashed, back in ccu for 5 months, stabilized, transferred to another strange city to a LTACH for 3 months. SIRS -> MODS then she died.  The summer before her transplant, I arranged to finish my final undergrad requirements online and moved from Seattle to the east coast to take over as her caregiver, POA and medical proxy. After her death, we put the house on the market. I stayed there to keep it up and make necessary improvements but I continued to live out of my suitcase, not knowing when I'd have to up and move.

When we finally sold the house, I moved into a tiny studio knowing that I'd be moving for school in 8 months. So it never really became home.

Now... I can plan things like my window sill herb garden and the tomato plants I'll grow over the winter.  I grew these from seed- the far lower pot was the coriander that hadn't survived the 900 mile journey.

I also have a separate desk from my dining table! I'm so excited that in just a few weeks, I won't have to pack up all of my study materials to have a meal!

I'm living in a vibrant beautiful stimulating city. I have a home. I'm going back to school!  I'm on my toes with anticipation and happiness. Ironically, these are the times that I most acutely feel the absence of my parents. I so wish I could share the excitement of my future with them.

On another positive note: My cousin Becks, the crack addict, went through rehab a few months ago and has completely turned his life around. He's doing fabulously. He's out of a toxic relationship, has a new job and is really stepping up as a dad. I'm so proud of him!

Beginnings

So. I am sitting in a cute little coffee shop in my new hometown. School starts in 19 days.  My family 'helped' me move. I'm never never letting them again! This is my 5th move of >1000miles but it was more stressful than all the others combined. It's so much easier to a) hire strangers to help load/unload b) organize it without the input of those who think they know best. 

In hindsight, I can't help but laugh but in the midst of it all I had wanted to cry. 

I'm loving my new little apartment and all the things to do around here. I can't wait though to get my teeth back into academics.  I've been footloose for too long and want some structure again.

The school emailed me the MS1 booklist and I'm trying very hard not to jump the gun. I've been averaging a 'fun book' a day in an effort to cram in a year's worth of pleasure reading before school starts. I think that I've overdosed though.  I've reached the bottom of my 'to read' pile and can't drum up the interest to find anything else for the next couple of weeks. Any suggestions out there in cyberworld?

I'm off to the zoo now.

Oh Brother

Sometimes, my oldest brother has a way of making me feel as small as a flea. I love him desperately; he was even more excited about my first acceptance to school than I was. I can remember the look of thrilled shock on his face when I told him. Everyone should have someone to be so genuinely, unselfishly happy for them. I’m fortunate.

That said, he’s a freakin’ type A, control freak, micromanager with so-not-his-business. Argh. I called him today to chat. We take turns calling and so usually talk several times a week. I mentioned meeting an aunt for coffee and visiting our maternal grandmother in the afternoon.

Gram took great pleasure in reliving some of my “stubborn little pip” anecdotes. She and my aunt laughed at memories of me, a naked 4 year old interrupted from a fight with her brother, claiming that “Just because little girls are staying with their grandma, doesn’t mean that the grandma OWNS them.” Apparently, I was aware of my civil rights even at age four. I blame my mother.

I gave him quick updates on several of our cousins then mentioned finding sprigs of pussy willows on a walk. I have bouquets of willow shoots, winterberry and dried hydrangeas, pretty, easy to maintain and much much cheaper than fresh flowers. He’d always admired my displays when visiting.

Anyhoo, I also mentioned that when I went to the market I noticed that sashimi grade tuna was on sale for 7.99/lb and splurged on a filet ($5.28). I was excited to indulge myself on this weekend off.

His temper exploded and he ranted. How I can’t expect to pay for school, our shared mortgage etc, if I can’t budget my income… blah blah blah.

Now. I. Am. A. Freakin’. Penny. Pincher. I can satisfyingly squeeze a week’s worth of meals on a $30 budget with some creative use of spices and inexpensive staples (quinoa, eggplant, cauliflower etc.). I am also a master of the free/cheap entertainment: volunteering with the zoomobile for a free season pass to the zoo, free city wifi and no cable TV, forgoing downhill skiing for cross-country in open parks. I haven’t seen a movie in the theatre in years. Other than a few pairs of (clearance-no grey’s anatomy for me) scrubs and my interviewing suit, the only clothing I’ve purchased in the last 2 years has been socks and underwear.
I don’t mind. I’ve always been pretty low maintenance, but hell if, at 31, I’m going to be explaining every little purchase to anyone. I told him so. It escalated. Dammit. He’s just like our father; careful, loving and thoughtful but rigid, old-fashioned and by-the-book.

I remember being a teenager and chafing against my father’s restrictions. It was the primary motivation for my moving thousands of miles at eighteen to work for national parks. Every time that I jumped out of a plane, hitchhiked to the rodeo, climbed a difficult mountain or pushed myself past things that scared me, I thought “so there!” to my father.

Right now, I’m garnishing my tuna in a lemon wasabi remoulade (less than $1.50 to make- even with locally raised free range and hormone free eggs) sipping a glass of prosecco ($2.25) and thinking “so there!” at my brother.

Addendum: My brother, bless his soul, sent me an apologetic message a few minutes ago. He and my (favorite) sister-in-law have been under unrelated stresses and he didn’t mean to take it out on me. * sigh * How can I maintain my rebellious angst (damn you! Camus and Morrissey) when my family is so bleeping awesome?

Thursday Interview

My first (and thus far, only) medical school interview is this Thursday. I had hoped that I would have heard from another school by now. I'm incredibly stressed that this may be my one and only chance.

I decided to splurge and spend $30 more on a hotel room within walking distance to the campus.

My aunt- the crazy (in a fun way) one who took me on my first trip abroad (Turkey) wants to go with me. My youngest uncle lives nearby in an institution for developmentally disabled and she wants to visit him while I'm on campus.

I'm torn. It'll be nice to have someone there afterwards to talk about the experience but I'm afraid that she'll be critical of my weirdness beforehand (you know- waking up 4 hours early to obsess over my hair, clothes, review possible questions/answers etc). Besides, she doesn't really sleep. I learned that early during our Turkish adventure. I'm working the night shift all this week and will probably want to rest most of the day before the interview.

One of my favorite patients died yesterday. I found out through the hospital grapevine that he had been readmitted at the other hospital in our system for pneumonia and quickly crashed. He had been a quadriplegic who just conquered all obstacles. He ran his own business, drove and just celebrated life. It breaks my heart that someone so strong and inspirational is gone. RIP Dwayne. You'll be missed.

Book

I spent hours and hours writing my med school applications. Now that they're done, I'm at loose ends and am trying very hard not to obsess over my statuses. Watched pot and all that...

So I've spent the last few weeks maintaining that creative momentum and focusing it into a story.

I am writing an FBI/armed forces thriller. Ha ha ha ha! It's absolutely ridiculous but I'm having so much fun. I've done a lot of research and am surprised at how much I've learned.

I was never really interested in military history before. Now I have a new appreciation for what my grandfather must have experienced as a ranger in the 6th Battalion during WW2. How I wish now that I had the knowledge/interest to talk to him about his experiences before he died. I didn't even realize before the significance of his being a ranger, a member of the special forces. It's thrilling to have have a personal connection to something that is so romanticized now. I'm trying to balance the romance with reality in my story.

I've fleshed out the plot and have composed about 60 pages but the more I research, the more I have to add to my story. I know that I'll probably never finish it but the process is, so far, fantastic.

New Digs

I'm settling into my new apartment. It's a tiny studio in an old Victorian house with ceilings higher than the room is wide...

I'm using an old refurbished library study table for dining.

I last rented a mother-in-law basement apartment, draped in grapevines and filled with books, that I christened the li-burrow. I haven't yet thought of a clever name for this new place. I'll post some more photos when I finally organize the living/bedroom. It's filled with boxes now and not very inspirational.

We have a patient at work. I'm not able to express the turmoil that this patient throws the hospital into when (s)he is here. I've been on the unit for over a year an this is the second visit. It's an incredibly stressful time for nursing staff, manager and hospital administration. This patient only comes to our floor for reasons that I can't go into without violating HIPAA. I can only say that they're unique and awful. I'm not experienced or clever enough to adequately change the details and still portray the magnitude of this person's effect on us. We get extra staff and the nursing supervisor relocates her center of command to our floor for the duration of the patient's stay. It doesn't help with the stress levels of the nursing staff. My manager hand selects the staff assigned to the room. Though he picks his most reliable, most patient and most experienced, it's not an honor.

The last time, the patient stayed 2 months. I'm not looking forward to another two months of complete anxiety before every shift. Bah.

I received my first med school interview offer. I'm thrilled but my loneliness yesterday was amplified in my hunt for someone to share my excitement. I mentioned it to my coworkers but they were more concerned that this means I may not be there next year. My brother disapproves of my ambition (I'm too old) and my west coast friends couldn't talk last night.

I'm still excited though!!

Libraries

I love books. I adore books. I hoard books. When I moved to Seattle, I culled my library from almost 1000 volumes to 200. Four years later, I moved again and culled 500 more from my collection. When I came back to the east coast 3 years ago, I sent 15 boxes ahead. 2 were clothes, one was packed with keepsakes and 12 were full of my favorite volumes.

I have no problem throwing out anything else. My great grandmother's cake pan? Bah, it's rusted and unusable. The faded notebook that she painstakingly copied recipes into? A treasure! Don't ever ask me to give up my copy of The Quiet American that I read while sipping 'white coffee' next to Hoan Kiem Lake in the sultry Viet Nam mornings.

I would rather lose a finger than the tattered A Tree Grows in Brooklyn that my grandmother read to my mother and then to me when I was a child. I was Francie. Knowing that my niece will pick up the same pages next year (when I pass it on) that 3 other generations have caressed thrills me.

I can't do libraries. I try. Over the years, I've moved a lot. I have a system: move stuff, contact PO, contact banks, get new driver's license and car registration and obtain library card. But I have never returned a library book on time. Not once. While packing yesterday, I came across 3 library books, the only books that I've checked out from the local library since moving here.

I can leave my childhood home without a backward glance (stupid albatross) but returning those books brought tears to my eyes. The one was the last book that I read to my mother before she died.

I drove home and cried. Then, I drove back, paid my $82.15 fine and checked the book out again.

Isolation

All five of our isolation rooms are sequestered in one hallway on our unit. I was walking back from helping woundvac dressing change and found myself stopping in each room to chat with the patients. I knew them all well. I chatted with Dean* (MRSA) about his kids; Ira* (VRE) shared his news about his UNOS status; Frances* (MRSA) asked me for a cigarette and we laughed together at the inside joke; and for a few minutes, Robert* (CDIFF and MRSA)and I competed to see who could get the most Jeopardy questions right. He won. Stupid "Sports Venues".

I headed back to the desk and, out of curiosity, checked to see how long my friends on the I-ward had been here. At July 7th, Ira was the newest admission. Three months. Like the others, he's settled in. He has his favorite snacks in the kitchen fridge, a mountain of pillows to burrow into, piles of linens, dressing changes and unopened Nepro spilling out of cupboards and closet. Photos of his dog are on the wall and an extension cord keeps his cellphone and nook within reach.

After her transplant, my mother lived in the hospital for 11 months. We settled her in as best we could with soft throws, poster-sized photos of family on the wall, homemade hospital gowns, radio, magazines, toys, anything that we could think of to make it more comfortable. She hated it. She had no interest in anything but getting home.

I don't see that with my I-ward friends. Both Robert and Frances have been on the verge of going home several times over the months but they got stressed, become enraged and argued with the discharge planners. Then they had relapses, Robert became septic and Frances' tissue flap reopened.

Over the weeks, I've learned bits and pieces about my patients lives. Ironically, the time they spend in the I-ward is less isolating than their home lives. They each have a different story but, without exception, they are lonely and enjoy the 'perks' of living in a hospital: constant company, all the food they can eat, any need/desire filled by just pressing a call bell button.

Over the last year, I've noticed a steady increase of 'social admissions' to our unit. I think it's due to the aging local population, the depressed economy and the cutbacks at the nearby psychiatric hospital. A lot of its inpatients have been reevaluated to outpatient status. The recent flooding also destroyed 2 nearby nursing homes and countless homes.

It's scary and sad to me, that the awfulness of being in a hospital is actually preferential to what awaits outside.

Though my mom never made it out of her hospital stay, she had something better to look forward to, to work for. We all, up until the very end, had hope and desire that she'd make it home. In that way, we were fortunate.

No news on the med school application front.

Panegyric

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.

Coming Home

After spending over a decade away from the itsy bitsy town in which I grew up, I'm still not accustomed to the small world that it is.

I still get a fleeting thrill when I see a local license plate before I remember that I'm actually home and they're more than common.

Last night, a nurse floated to our unit and, because it was relatively quiet, we got to chatting. She had just moved from Atlanta but, like me, grew up here. Oh, we went to the same high school! 84?, I graduated in 96. Did you know ___? What's your last name? Howe?!!! You're Franny's granddaughter?! Kathy's daughter!???

It turns out her father was a close friend of my grandpa's and my mom used to babysit her. We both, in our giddy, not-used-to-small-town-relations way, laughed and shared anecdotes all night until, like a pin in our bubble, two of the other nurses related how they discovered that they were cousins in an amazing story of medical drama and common relatives.

Humphh. Small towns.

Neighbors

My mother died last year and I've been trying to sell her house. It's a pain; the housing market in this area is incredibly depressed and mine is one of a dozen for sale in this neighborhood. I do what I can on a nursing assistant salary to maintain it. Spending hours weekly landscaping in the yard and tinkering in the house, I've become very handy. I've taught myself how to put up drywall, repair cupboards, fix burst pipes and paint/stain with the masters.

My neighbors are the same as when I was a child. I grew up with Krissy. We caught critters, played softball together and fantasized about pooling our money for a horse. The horse was to go in my backyard which I mistakenly convinced myself was zoned for farm animals. I think my father let me believe that, hoping that I would save money instead of spending it.

Krissy had a baby when she was a teenager and her parents, who live next door, often watch over him while she's at work. Over the years, particularly through my mom's extensive illness, Jack, Krissy's dad, has helped us tremendously. He mowed my mom's lawn, shoveled her drive, carried her groceries and brought in her mail when she was too weak to stand.

He was the very best neighbor anyone could have. Now he'll yell at me to be careful when I'm on the roof replacing shingles or painting ducts. He's always available in a pinch if I run out of gas or need an extra pair of hands.

His grandson, though, is a punk. Jerome is 12 now and the most disrespectful, destructive little brat I've ever had the misfortune to meet. We used to have a basketball hoop over our garage. I took it down after Jerome and his friends broke windows and cracked and shattered the vinyl siding along the garage wall.

I've come home to find shingles missing from the garage roof where they dive into the ground pool. The deck/pool is surrounded by lattice. I spent days painstakingly staining it only to find my efforts damaged from their rambunctious antics in the pool.

I've told Jack that I prefer the boys not come over without supervision. I've mentioned the damage but it has had no affect on curbing more wreckage.

I don't know what to do. Jack has been an amazing friend and neighbor over the years and I want to be able to extend open invitations to my parents' amenities. I just can't afford repairing all the destruction his grandson causes though. I've hinted that Jerome isn't welcome but it doesn't make any difference to his indulgent, doting grandparents.

This situation sucks. Any ideas out in blogland?

Real Men Eat Quiche

Quiche is an awesome dish. Simple to make, easy to experiment with and impressive to serve. My burly manly-men cousins love quiche unabashedly, without exception, and will always stop by to help around the house if I have snacks handy. This quiche helped me get my refrigerator repaired in record time!
This is my twist on the classic Italian salad.

3 eggs
1.5 cups shredded cheddar
1/4 cup mozzarella (perline)
lots of fresh basil chopped
3 Roma tomatoes diced
1 jalapeno minced
1 cup milk
1 pie crust
1/2 cup whole wheat flour
salt/pepper to taste

Bake at 375* (until firm) and let sit 1/2 hour before serving. Garnish with fresh basil.

Fragile Flower Syndrome

My grandmother has what she has denominated 'FFS'. It's a delicate balance to treat her hypertension, hyponatremia and Meniere's disease (for which she takes hydrochlorothiazide, a diuretic) and she'll often call me over to check her blood pressure.

The heat wave has hit her hard but she giggled today when I told her as I wrapped her arm with the cuff that she looked like a wilted daisy with her white hair and dark eyes.

Temples

I have a cousin who is addicted to crack. Our family has struggled to understand how he could have made the choices that forced his life into a downward spiral. We discuss what approaches to take, limitations to set, anything to help Beck come back. But he doesn't want to. He lies, manipulates and steals, neglecting his children and watching his debt grow.

It's heartbreaking to see my aunt weep, grieving at the loss of her son and fearing for the welfare of her grandchildren. Their mother died of an overdose two years ago and Beck has sole custody. Though his house could be featured on an episode of Hoarders and his electricity and water are periodically shut off, he doesn't fall below the threshold of what is unacceptable to Social Services and so his children remain with him.

I see his jittery hyperactivity and the tracks on his arms when he comes to ask me for money; his electricity, water, phone etc are about to be shut off. I see the boy I played with as a child, catching snakes and salamanders, climbing trees and building forts.

My patient tonight, a woman with liver failure, is febrile and having seizures from alcohol withdrawal. Sedated, she didn't move when I took her vitals and washed her up. I was tender, reverent when I rolled her to her side to clean stool from her bottom and salve with protective ointment. Though she was alone, I could see the child that she was and the people who love her despite the abuse she gave to her own body. I hoped that my cousin would be treated gently when he crashes and is brought to a hospital unit like mine.

I swam tonight, alone in a crook of the river. I could feel the water against my body and the freedom of my limbs. I flew, buoyed by the water, unhindered by gravity. I love my body. It is the only house that the essence of me will have. I am amazed sometimes when I look at my arm, think about its function and then raise it purposefully, only to demonstrate to myself that my mind has control of it. I'm telekinetic with my own body. It does what my mind tells it to.

I could wax poetic, citing Descartes and his mind-body dichotomy, but I'm a Spinoza girl. I see the physical connection, calcium released and synapses firing, between my thoughts and the movement of my arm. It works beautifully and I don't want to mess it up.

I'll have a glass of wine with dinner and a scotch on special occasions. I love the taste, the dimension, the artistry that can be found with alcoholic beverages. I've even been happily intoxicated on occasion.

There's a turning point, a threshold that people pass when they immerse themselves completely into habits that destroy the function of their body.

I wash bodies for a living. Every day, I help someone to eat, walk, communicate or clean themselves. I hold reverence for their bodies and the function those bodies have in housing the special being that makes the individual. I'm gentle even when the patient is not. It's a gift to be there cushioning the body, encouraging someone to respect the majesty of their own body when they don't see it themselves.

I treat the open wounds of my patient tonight. I hope that she wakes from her sedation and recrosses that threshold into a place where she respects the gift of her body. I hope that my cousin rediscovers his own gift before he destroys it completely .