A Psych Nurse's Shift

So here's something new for the blog. I thought I would go over the details of my most recent shift at my psych job. Everyone raises their eyebrows when I mention that I'm a psychiatric nurse - and I think it's because of the stereotype of Nurse Ratched or some other inaccurate notions. So maybe this will dispel them. Or bore you (in that case, feel free to stop when that sets in). I have omitted personal details about patients to maintain privacy.


First some background. I work at a private psychiatric hospital. Most patients have insurance paying for their stay, but about 30% of our patients are indigent and their treatment is paid for by the county under a special program called "healthcare district". Many of those are homeless, frequent flyers (they visit us often). It provides for an interesting mix. We are a short-term facility, most length-0f-stays are less than 2 weeks. Our goal is to stabilize patients in crisis and get them into either an outpatient treatment program or another in-patient facility that is designed for long-term. We have a very high turnover; during one shift I once had 6 discharges and 2 admissions. But that's part of why I love this job: I see many different patients, many different diagnoses. So here's how my most recent shift unfolded.


I start the morning at 6:45, doing the narcotic count on the automated machine with one of the night nurses. I am working on my favorite unit that includes the PICU (Psychiatric Intensive Care Unit) where patients are the sickest. After we count together & verify everything is there that should be, we go into the lounge and do report. The night nurses go over each patient with us, giving a brief run-down on the patient's diagnosis, what crisis brought them to us, their treatment and their medications. Patients may have special precautions as well: suicide, aggression, detox, seizures, SIB (self-injurious behavior) etc. This takes about 45 minutes. I am responsible for 10 patients today (my typical number). After report, I head to the med room and start pulling meds for all my patients using the Medication Administration Record. I use the automated machine to dispense each drug and put them into labeled cups. This takes at least 30 minutes, sometimes longer. Part of my responsibilities as I pull each drug is to confirm that it's an appropriate dose, verify last dose given, check patient allergies, and verify drug packaging that it's the right medication. Once the pharmacy tech loaded the wrong dose of morphine into the pocket and 3 patients were given 10x the correct dose. Really. So it is important to check.

A word about diagnosis. Most of our patients fall into one of 3 categories; MDD (major depressive disorder), schizophrenia, and bipolar. Sometimes we also get personality disorders like borderline. Borderlines, in fact, are the patients I have the most trouble dealing with. They are highly manipulative, extremely needy, childish and emotional people. They delight in playing staff off against each other; "you're the best nurse I ever had, not like that rotten bitch last night that wouldn't give me a blanket and stole my meds. And you should've heard what she said about you..." The diagnosis du jour seems to be schizoaffective disorder, I think because it incorporates elements of both schizophrenia and mood disorder. Of course, psychiatric diagnosis is a difficult thing. It's not like you can take a blood sample and measure the "insane" level.

Patients start eating breakfast at 8:30. I have two diabetics that need to have their blood sugar tested before this time and insulin administered. I find the techs and ask for these values, then give the appropriate dose of insulin. As the patients start eating, I bring the medications into the dining room, only two patients at a time to minimize confusion and reduce errors. Before I give meds, I check patient arm bands to make sure I've got the right person. Since I don't work full-time, I usually have a brand-new slate of 10 patients every time & I don't recognize any of them. I am walking among them to give these, since I'm on the open side. On the PICU side, we sometimes have to give meds from the dutch door for safety. But often we walk among patients there, too. You have to use your judgement and trust your aides to protect you. A good aide is your most valuable resource as a nurse.

About 9:00, the charge nurse sits down with the psychiatrists (we have 3) and goes over each patient's status and treatment plan for the day. I'm not in charge today so I get to skip this meeting, which often takes an hour.


As I'm making my way down the hall with some meds on one of my trips, one of the patients stops me. He's wrapped in a blanket, naked underneath, heavily tattooed and with a shaved head. I recognize him from report; we are all on high alert about him. He's on the open side & really needs to be in PICU, but he was admitted last night & there was only an open bed available. (We stay full almost 100% of the time.) He takes my elbow and tries to steer me into one of the rooms, stating that he desperately needs to talk to me. Um....no. I insist we talk in the hall. He's acutely psychotic and paranoid, hyperverbal and angry. He frightens me & that doesn't happen often. I know from report that he is an athlete and was arrested with a firearm. I use all my therapeutic skills to talk down his anxiety but still feel pretty unsuccessful. After I manage to seat him for breakfast, I tell the other nurses that we must move him over to the PICU side with a higher level of observation and security. We move him, and within ten minutes, his behavior escalates. He's angry at being moved & his paranoid delusions are intensifying. He accuses the other patients of things. He begins shouting and making aggressive motions and statements. We get a syringe ready of a medication to calm him. The psychiatrist (thank goodness he was there), 3 of us nurses and an aide walk him down to his room. After about 15 minutes of negotiation and some hands-on, we administer the shot. (I think the only reason we were successful is because of the presence of the doctor. It's interesting to me how often patients completely defer to him.) Once he's sleepy, the aides get him to put on some pajamas and crawl into bed. The doctor writes orders for more medication once he's awake.

I go back to finishing my medications. Once that's done, I have two discharges to process. The social worker hands off the chart to me. I detail the patient's medications on their form, make copies of certain things for the patients and ask the aides to ready all their belongings. If they brought in valuables, I get these out of the safe. When all this is ready, I sit down with the patient and go over their discharge instructions and ask for their signature. Sometimes this is smooth, sometimes not. Once a while, patients are unhappy with what the doctor chose to prescribe for their discharge & they refuse to leave (usually, they want Xanax. Xanax is probably the most-abused prescription drug that we see). Once in while, we can't locate a belonging. But eventually, the patient is either picked up by a family member or another agency and they are discharged.

During all this time, about three patients have asked me for what we call "PRN" medications. These are medications that are only given based on need, and the patient has to ask for them. Things such as pain and anxiety medications. For each one, I have to verify what I can give them, whether enough time has elapsed since last dose, and then pull the medication out of the machine and administer it.


The psychiatrists are busy making rounds and writing new orders on each of their patients. It's my job to "take off" those orders; I read the order and then either update or add to the medication record. If it's a non-medication order, such as "patient's family may visit during non-visiting hours today" or "vital signs must be taken every 4 hours", I alert the techs and update the white board. If lab tests are ordered, I fill out the lab request sheets and file them. The doctors see each patient once a day; often I have new orders on all 10 of my patients. Usually a newly-admitted patient will have multiple items ordered.


Meanwhile, another patient on the open side begins to have a meltdown. He's obviously cognitively-impaired, beyond being in a psych crisis. From reading his chart, I know that he's brain-damaged from a lifetime of drug abuse, starting when his parents shared their drugs with him as a small child. If you ever want a good cry, just open one of our patient's charts and read the history. He is demanding to be discharged immediately, in his child-like way, and won't listen when we explain that the doctor must examine him and ensure he's not going to walk out the door and run into traffic. He is pacing and his voice is getting louder. Attempts to talk him down fail, and he refuses the medication offered. The aides start to stand closer to him and we ask him to walk through the doors with us to PICU. He refuses and we spend about 10 minutes negotiating, which fails. He must be restrained and carried over to the PICU side and by that point, he is getting physical with the staff and yelling non-stop. Two of these in one morning feels like too much, but it's not the first time. Once he's on PICU, his behavior doesn't lessen and again, we must inject him with anti-anxiety medication. He is crying because he doesn't like needles; this really gets to me, but I understand the necessity for his safety and I do my job. But I feel an intense sadness when I think about how he got here & where he's going. Because he was restrained, I have to fill out a special form documenting exactly what we did, why, and for how long.


Unfortunately, I have a new admission that was just walked onto the unit and witnessed all this. It's her first psych admission and she's only here for MDD (major depressive disorder). Her eyes are wide, watching this unfold and I have to quickly explain what's going on & reassure her that she's in a safe place and this won't happen every day. Probably. I take report from the admissions nurse and then review her paperwork that documents exactly why she was admitted and what her history is. The techs take her vital signs and examine her belongings, confiscating things like razors and scissors. We document her valuables and lock them up. I sit down with her and do a full assessment and history and answer her questions about what's going to happen. As part of my assessment, I have to take her in a private room and have her strip for a search. For the safety of all the patients and staff, we have to make sure that nobody comes in hiding drugs or a weapon (both of which have happened).


Sometime during the morning, I review vital signs taken on all my patients by the techs. If something's amiss, I address it. If a patient's blood pressure is too high, I call the doctor and get an order for new medication. Many of our patients are detoxing from drugs/alcohol (about 30%), and based on their vital signs, we administer extra medications because elevations suggest withdrawal complications, which can lead to seizures if untreated. I also spend a few minutes asking each patient key questions. I do these in a conversational way, starting with "how are you today?", but eventually I find out if they are suicidal and/or if they have auditory or visual hallucinations.


Meanwhile, our aggressive athlete in PICU has woken up and is pacing amongst the other patients. He's still psychotic but is not threatening. The aides watch him carefully. He has about 4 medications in him, each one alone would put me to sleep for all day. But he's still hyperverbal and paranoid.




Pretty soon it's lunchtime and again, I am checking blood sugars on my diabetics. After that's done & I give a few medications due at noon and some PRN's, I can finally take my 30 minute lunch. It's 12:45.


After lunch, I have 3 patients with 13:00 medications that I give. Then I finally start my nursing notes. I will work on these off & on the whole afternoon. It's required for each patient, and it's a synopsis of their care and behavior during my shift. It details things like their mood and affect, their attendance at group therapy, their sleeping and eating, and their medication compliance. I also assess their suicidality and their aggression risk. It's a form with checkboxes but also a narrative paragraph is required. I also take another admission during the afternoon so that both of my two discharges are replaced.


The afternoon from about 2:00 to 5:00 is the slowest part of the day. Most nurses eat their lunch then, but I can't wait that long. I work really hard to get things done in the morning so that I can eat earlier. During the afternoon, I sit down with the aides and go over each of my patients, asking about their behavior and participation in unit activities. Again, I give requested PRN's as patients come up to the nurse's station. As the afternoon progresses, issues come up and I handle it. One patient was found eating toilet paper in the bathroom; this is a known problem for him. Patients that eat unusual things are called "pica". Some patients, as a result of brain injury, will eat almost anything. Others eat particular things because it distracts them from their internal anxiety; that's the case for this guy. I redirected him verbally (that means talking to him about what's bugging him & asking him to stop), gave him an anti-anxiety med and kept him out of the bathroom. A patient threw up in her bed & needed some anti-nausea medication. A patient was found in tears, curled on the floor; I ended up spending over 30 minutes talking to her about her treatment plan and her medication orders and finally got her off the floor.

A word here about what we call "drug seekers". Many of our patients have a history of drug abuse and like their PRN's. Some will readily ask for anti-anxiety medication right after a rousing card game in the day room. Some nurses are stingy with the meds, but I simply follow the doctor's orders. If it's allowed every 6 hours, then I give what the patient asks for and record it. It's there for the doc to review and address as needed. But I also always ask why the patient thinks they are anxious and offer them conversation. Some take it, some don't.


A process server comes by and serves court papers to one of my patients, admitted involuntarily. When patients are brought in by the police, they have a court hearing at ASH (Austin State Hospital) after their admission to decide what to do next. We bring them over to ASH for that. The social worker appears with them to report on the patient's treatment and discharge expectations.

One of the social workers tells me a funny story. In group therapy that morning, the patients were asked which animal they were most similar to, and why. One of my patients said "a bear". When asked why, he simply stood up and started taking off his clothes. He's very hairy.


At 5:00, things usually pick up and get busy. The patients eat dinner at 5:30 and some medications are given before dinner. Visiting hour starts at 6:00. Our head psychiatrist makes rounds again at this time, and often the medical doctor will make his rounds then. If I patient has a medical problem (like a sore toe), the psychiatrist will write a consult for the medical doctor to examine him. The psychiatrists try to confine their treatment to only the psych needs. But in a pinch, they do both. If someone needs something simple, such as a laxative, they'll write the order. Of course, doctors making rounds at this time means that new orders are written and have to be taken off. During all this, I'm trying to get ready for shift change; get my notes ready for report and finish all my nursing notes on each patient for their chart. If I have time, I squeeze in dinner. I hate to arrive home at 8 pm hungry and I never go to bed on a full stomach. So I bring my little Kashi frozen dinner and eat it as fast as I can.


Shift change is often a time for patients to become anxious, unfortunately. There is extra activity at the nurse's station and it's visiting hour. So often there is a mini-crisis (or major, once in a while). The worst I've ever witnessed was when a young male patient jumped over the dutch door of the PICU, grabbed a pen and tried to stab an aide in the throat with it. Luckily, his aim was bad and he only grazed him. As often happens, the patient had fixated on the aide and it became part of his delusion that the aide was a bad person, or out to get him. The most amusing fixation that's happened to me so far was when a patient wanted me to leave with him as he was discharged and get married. Really. Unfortunately, I'm just not into bipolar, hyperverbal guys. But seriously, I don't want to give the impression that I view myself as above the patients in any way. All of us have issues, I like to say that all of us are crazy. Some just are in crisis and need a hand. The patients are truly not different from me, they are just in a temporary state with some limitations for their own protection. Many of us are drawn to psych because we've been there. If you talk to the nurses and staff, you'll find things in our pasts that led us down this path; it's usually not accidental.


Finally at 6:45 the night shift appears, we do the narcotic count again and then sit down to report. Hopefully we're not interrupted during that, because all the nurses are in that one room and if something happens with a patient, one of us is going to have to come out and address it. If all goes well, I'm able to walk out and go home after my 12 hours.

TX Back to NJ

Dani and I spent Thanksgiving week in NYC and Jersey having a grand old time. We first saw my sister Holly, who lives in Hoboken. And boy, we did it right. One of the first things we did was go to the Rice Pudding shop on her street - yes, that is all they sell. 12 flavors. I got Mocha Canolli. Holly took me to dinner at Palma, a wonderful Italian restaurant in the West Village. http://www.palmanyc.com/ The artichoke appetizer was one of the best things I've ever eaten. The next day, we spent the whole thing in the city. We shopped along Fifth Avenue, went to Rockefeller Center, and went to the Museum of Modern Art -- incredible; 5 floors of stuff that you've seen pictures of in books your whole life. Here's a picture of my favorite exhibit; it's a mobile that looks like a cloud of stars. Gorgeous. It's cool that they have some exhibits where they encourage photographs; this is one.
The Anthro store is to die for; I bought some great new clothes and shoes of course. The next day we went to the Macy's parade. Holly actually purchased grandstand seat tickets for us. Macy's gives them out free to special customers/vendors/friends but there is a hot secondary market for them. So get this: she paid $250 for each ticket. Really. And she bought 4 of them, and resold one the next day for $340. So hey, guess she got a deal. We were sitting along an aisle with a wall behind the seats that backs to Central Park. Shortly after the parade started, people started trying to come over the wall...without tickets, obviously....and stand in front of us. You should've seen my little sister! She gets right in this mook's face, telling him that he doesn't have a ticket and he's not going to ruin her parade! He has the nerve to call her a bitch and Holly has to fetch New York's finest over to tell him to get his butt back over the wall. And all those New York men just sat there. Would've been a little different in Texas, I think. No Texas man would sit still while a guy talked to a lady like that. Anyway, here's a couple of parade pics. It was very cool to be right there; not sure it was worth the money.

That evening we went to the Peewee Herman show on Broadway. OMG, it was just amazing. Some of the original cast was in the show, like Miss Yvonne and Jambi. I laughed so hard I cried. The funniest running joke through the whole show was Peewee's abstinence ring - you know, like the Jonas Brothers wear - which he threw out to the audience when we gave him a standing ovation. Guess he doesn't need it any more. HA.

Holly and her new husband Ryan (well, married a year...that's new to me) cooked us Thanksgiving dinner and that evening we drove to Jersey. "Home" as Dani kept calling it (made me a little teary the way she said that).

I stayed with Jackie, who is a fantastic cook and make me scrumptious curried scallops. I drank way too much white wine and had to trot off to bed when I couldn't keep my eyes open. Dani stayed with her BFF Idil. Here's a pic of them together - inseparable - they Skype each other every single night - it's that teenage girl thing.

Jersey was absolutely fabulous. Dani hung with Idil & they went to downtown Clinton, their favorite hangout. I went back to my old gym - love it! - Hunterdon Health & Fitness Center on Hwy 31. I actually did 4 classes back-to-back on Saturday morning. Yoga, Kickbox, BodyPump, then Zumba. It was a great morning, let me tell you. And I got to see Christy, my best work friend from 3 West at Hunterdon Medical Center. Her little toddler daughter, Ryleigh, is too, too cute. Here's a picture. And one of Jackie, cooking dinner for me (yes, that's asparagus, one of my favorite things). And Holly & me on the subway, just for fun.

It snowed in Jersey the day we arrived but had melted off by the time we got there. Too bad. Dani really misses the snow. I do too, because no snow = no ski. Oh well, we're going to New Mexico for a Xmas ski trip. But somehow it's not the same as skiing every Friday night at Camelback, Pennsylvania. Talk about fun.

Of course, our flight back to Texas was snarled. Let me just say this: I will never, never, never fly on United/Continental again. I will fly Southwest even if it costs more and is more inconvenient. That's all I'm saying.

Hoboken, by the way, is pretty neat. We spent time along the waterfront, and I'll close with a few pictures from that. Can't wait to go back....when is Spring Break?

It's All Good

A miracle happened on Astoria Drive in little Bee Cave, Texas. Well, really the miracle happened at the DMV office up in Northwest Austin. They....ready for it?....allowed Dani to take her road test without turning in her New Jersey permit (which she lost). Yep, I'm telling the truth. With some last minute maneuvers, Grandma was able to take Dani for her test on Friday. She passed (easily, I hear). So yesterday we bought her a car, a new silver Prius which is actually an incredibly cool car. Here's just one neat thing about it: we don't have to use a gate or garage door remote control because the car will "learn" the frequency of such things and assign it to buttons built-in. I think Dani would have slept in it last night if we'd have let her.


Everything else is going swimmingly too. Work is going well for me, I am getting as many days as I can handle and finding interesting patients every single day. I learn from the minute I arrive. I have stopped wearing scrubs to my psych job; about half the nurses there wear them & half don't -- I have switched sides. So (awwwww) I need a new work wardrobe from Anthro. Making weekly visits there to scoop up what's on sale & I'm loving it. The woundcare job is also looking up, I'm there two days this week.





Nile is back to 3x/week karate now that their tournament is over, so his progress should increase towards black belt. I get the first batch of report cards soon & the kids both tell me it will be good news. More on that later. Ken has furnished his little apartment more in Houston; my parents even found him some....interesting....original art to hang.

The Texas fall weather is divine. It's warm, not too humid, with cool evenings and nights. I miss the leaves in Jersey, but this is fair compensation. On my off days, I sit on the patio outside to eat lunch in the beautiful sun.

Joy and Strangulation (not really)

I went to the Cathe Road Trip in Houston this weekend and loved it, loved it, loved it. I got to workout with my idol 4 times. It would have been 5, but my bum shoulder acted up that last morning & I had to skip the class. She is such an inspiration to me (check out www.Cathe.com). I've been doing her workouts for 11 years, and I completely owe my body, my health, and (actually, most importantly) my sanity to her. It's also such a relief to be among like-minded women who are just as obsessed as I am and not get strange looks when I reveal that on workdays I get up at 4:00 am to squeeze in a workout with her first.

Another interesting aspect of the trip was that I stayed in Ken's apartment in the museum district. And it's quite cool; great location, great security, great pool. We walked to the Houston Museum of Fine Arts and saw their German Impressionist exhibit - very good (http://www.mfah.org). I ate at an Indian restaurant where I finally (finally!) got a meal that was spicy-hot enough. It did say "for only the brave" and they weren't kidding. Excellent.

The only problem was that when I returned home, I found out that Dani LOST her New Jersey driver's permit. Now, if you've read my previous posts, you know the ungodly rigmarole I've had to go through to get her to the point of almost getting her Texas license. In fact, on Wednesday she is supposed to be taking her road test and turning in that permit (lost, I think forever). What the hell do you suppose we do now? (oops, anger leaking out, just can't help it -- sorry) You think New Jersey will gladly replace this permit for a driver who's no longer a resident? You think we can just tell the Texas DMV "oops, we can't turn it in - it's gone!" No, obviously. I think we're basically screwed and now she really has to start all over to get her Texas permit. And yes, I dearly wanted to strangle her but I did not. I did cry because I was really looking forward to her being able to driver herself and Nile to some activities. Now Mom still has to be the taxi.

So one bright spot: my favorite cable show is getting ready to start its new season. It's In Treatment on HBO, staring the very hot Gabriel Byrne (something about dark, handsome & with an Irish accent that I can't resist). Debra Winger is in this season. Each episode is one of 4 clients' actual therapy sessions and it's really ground-breaking. It's amazing to see what unfolds. You should check it out, it starts October 25th (see http://www.hbo.com/in-treatment.) Some of the best writing and acting I've ever seen. A dream show for a psych nurse!

Ode to Fonda San Miguel

We went to one of my favorite restaurants, Fonda San Miguel for their Sunday brunch. It is to die for. Interior Mexican food, known as some of the best in the country. Here's a link if you'd like to check it out: http://www.fondasanmiguel.com/

My favorite dish is a cactus-based salad but anything with their mole sauce is a close second. It's also located really close to my parents' house, so it makes for a wonderful Sunday afternoon. Eat a little and then visit.

Austin is simply full of great ethnic restaurants, it's not just barbecue and Tex-mex (although there are some phenomenal places that have that). I have eaten good Vietnamese pho (Blue Bamboo in Bee Cave, no less), some excellent Greek food downtown (Athenian Grill). It's a refreshing change from Hunterdon county where the choices were largely Italian and Italian. Of course there were great things in the city, but that was quite a drive. Here it's all 20 to 30 minutes away. Maybe I can put back on that 5 lbs I lost due to all the moving/new job stress. But I probably need to cut back on the workouts too & that's just not going to happen. Oh well, guess I need to go to Anthro and buy some new pants (how terrible! Dani will be crushed!).

NAMI Walk

Today we had the NAMI walk. NAMI is the National Alliance on Mental Illness. It is a great organization that offers information to the public and also helps friends and family of those with mental illness. I can't say enough good things about it, we always tell families struggling with a loved one to look into help from NAMI.

The Austin Lakers had the best team -- we actually raised more money than anyone, even our rival private psych hospital that has 3x our staff was far behind us. I was proud to walk with my do-workers. What's cool is that I saw a few former patients there too.

It was the perfect day for this - lovely Texas October day, crisp and mildly cool but sunny. Talk about a blue sky. We got to see the rowers on Lady Bird Lake and there was a high school band taking pictures at the capital, in full concert dress. I walked most of the way with three of my co-workers and the conversation was terrific - nothing at all about work. One woman lived in France for seven years, so we talked about the cultural differences between France and the U.S. Another coworker retired from the Austin State Hospital, so we talked about working in state hospitals and how different that is from what we do now.

A lot of walkers brought their dogs. Pets are a wonderful mental health booster.

Socialization Update

We're starting to establish networks and routines. Dani has gone out with girls twice now on the weekends, and she's not eating her sandwich in the bathroom stall by herself any more. I have some pretty good work friends that I get all jazzed when I see we're on the schedule together. One of my co-workers is expecting a baby & I went to her shower yesterday. It was fun. I realize now that a big reason that they hired me is the expectation that I will fill in for her when she's on maternity leave for 12 weeks -- the bad part is that she works full time & I really don't want that. Kind of wishing they'd been up-front about that expectation, but I am per diem & the beauty of that is I am completely entitled to say "no". And I plan to.

Nile was caught snoozing in class and I had to go up & talk to his teacher. A little bump on this new road of me being a single mom during the week: I go to bed before the kids (that's what happens when you have to leave your house at 6:00 to be on time for work). And Nile was staying up pretty late, apparently. World of Warcraft is addictive and should be a schedule II drug. I hope I've fixed that problem but not sure at this point. And Nile still says "fine" to every question, no matter how ridiculous. (how was lunch? did you like math class? what do you think of the teacher's purple mohawk?)

No full license for Dani yet, but she's driving again and doing fine. She even drove in some of the downpours we've had lately and came through like a champ. She actually is driving with more confidence here than in NJ; maybe it's because the roads are not all windy little two-lanes up and down mountainsides.

More freaky-deaky stuff at the house. I came home last week to find that the guest bathroom had flooded several rooms. Not badly & all on the stained concrete so no true damage, but still a pain. I called a plumber. He looked really hard but couldn't definitively find the source of the problem. Finally settled on this: one of the kids had plugged the toilet in the morning as we were frantically trying to get out the door (is there any other way to start the weekday? not at our house). Ummm....OK. So we clean up and I lecture the children. But then it happens again, days later: water appears (same area) and it's hard to find a source. It was not the toilet this time, so now I'm questioning whether it even was that to begin with. Anyway, everything clean and working and no water today. Hope it stays that way.

I'm having lunch with Cecilia this week, the woman from Michigan that I met online. We didn't realize we were both nurses (although she hasn't practiced in more than ten years) until she came over with her girls. But we have a lot in common and it's great to have a non-work, non-family friend. I found a good pediatrician, whom I had to call on this morning when Dani had her first Texas migraine (last night was loads of fun, but - hey - we stayed out of the ED so it's all good.)

I haven't been able to swim in the pool for a while. This tropical storm has made it either too rainy or too cool almost every day. Except of course, the days I work 12 hours and get home at 8:00 or 9:00 pm. Those are the nice, hot sunny days; I'm indoors and never even look out a window. Getting worried that the lap-swimming days are over unless I get used to having blue lips.

Zilker Botanical Gardens

The Zilker Botanical Gardens in Austin are gorgeous ("gorg" as Dani would say). And it's free this time of year. The recent rains have made all the plantings lush and colorful. Just watch out for the mosquitoes - they are vicious. In fact, they drove me away early from my picture-taking. But here's some looks at how lovely it truly is.

So, if you need an activity, go to the gardens. Check out the info at http://www.zilkergarden.org/. The best time to go is early in the day, it's cooler and not as crowded and no parking hassles. Austin is full of little gems like this, another planned activity (soon to be seen here) is a tour of the local museums. Tours of all the Anthro stores (there are 2!) has already happened of course, no pictures needed. Well, I could show pics of all the clothes I've bought, but you probably don't need that.

Red Alert -- Another Stab at the DMV!

Dani and I made our third trip to the DMV today. I did actually find the small card issued by the state of New Jersey stating that she passed Driver's Ed. So we took our thick folder of documents up there for another attempt to get a Texas Graduated Driver's License (what we used to call a learner's permit) for her. Here's a list of what I had to bring (no kidding): birth certificate, social security card, NJ GDL permit, NJ commercial driving school certificate, verification of enrollment from Lake Travis High, state of NJ Driver's Ed card, and North Hunterdon High's driver's ed certificate. Whew.

Here she is at the window. Will we get it this time? Or will they tell us again that we are missing a piece of paper? Let's recap what happened on visit one in East Austin. After consulting 3 different supervisors, they tell us that she needs to both repeat her commercial driving school (because Texas requires 7 hours, not 6 as in NJ) and she needs a "verification of enrollment" from Lake Travis High. The nice fellow also tells us that we "should have stayed in New Jersey" if she wanted her license. So I grit my teeth and contact the school & they say they won't issue the form until the first day of class. When Dani gets that on day 1 (two months later, incidentally), we decide to drive all the way to Marble Falls to a DMV office a little friendlier than East Austin. The woman there tells us that we need the state of NJ driver's ed certificate, and makes up some other stuff about needing even MORE hours in a commercial course. I decide to ignore the bit about the course & just find the darn card. And I found it.

So we decide to try the Northwest Austin DMV office this time. It's open late on Wednesdays, and that's when we go. It's a long line of people as we arrive at 4:30. When we get up to the counter (this is just to get the paperwork to start filling out), the woman looks at us blankly and says, "What's a GDL?" I'm sorry, I couldn't resist elbowing Dani. Here we go again! She has to go ask a co-worker what to do, and makes a show of looking at each of our papers although it's obvious she is clueless and isn't really making any kind of judgement. She hands us two forms to fill out. Dani and I sit down and fill them out.

They call our number and we go up to a window and hand over everything. Again, for the sixth time, I explain what each item is, although I sense right away that the young woman behind the counter knows what to do and is familiar with the process. Her name is Rebecca & you'll see why I bothered to ask her name in a bit. She looks at things carefully and looks up some information on her computer, asks us a few questions about dates on the forms. A woman with a clipboard behind her chimes in at this point that if all the documents are correct, Dani will get a Texas GDL and repeat her six months training. Dani starts to protest and the woman says, "Oh, but this is a Texas GDL, not New Jersey." I have to shush Dani as her voice escalates. Good god, if I hear something like that one more time, I will get violent. This doesn't ruffle Rebecca, however, as she calmly excuses herself to confer with her supervisor. When she returns, she says...you know what it is, right?...we need another document. The certificate from the NJ driving school just isn't official-looking enough. So I start begging. Really. With tears in my voice, I beg her to just give us a permit; this is our third trip, we have done everything they've said, we just need a permit, we don't even care that we have to repeat the six months. The sad thing is, I wasn't acting. I meant every word.

Rebecca and I look at the documents again and I point out that the state of NJ permit has the driving school data written on it. Obviously, the certificate was good enough for them. She agrees, and goes back to the supervisor. We wait anxiously.

When she returns, she is smiling. She tells Dani, "You're going to get your license. You've had a permit for over six months, all you need is a driving test." That's right, not just a permit, but a real, drive-by-herself license. We look at each other and almost cry. After a few more minutes, we pay the fee, take the picture and we're out the door. She has 90 days to go back for the driving test. Before we leave, I get Rebecca's name. You better believe I'm writing a letter to her boss about what a great thing she did for us. Here's Dani with her new temporary license. I'm still a little in shock. Dani's already looking at cars on Craig's List. Boy, life's going to change! Thank you, Rebecca.

School Started

We started the school year and it was an interesting first day for us all. I had a fender bender after experiencing such ferocious traffic that both kids were late on their first day. Surely arriving 30 minutes in advance would be enough, I foolishly thought. But no. I was so perturbed that I hit the woman in front of me -- who happens to live two streets down from us in our subdivision and was also dropping her kids off (she was very nice about it). She warned me that the first few weeks is a madhouse. Their carpool system is not ideal and since the kids bring a truckload of supplies the first day, I guess all parents want to drive. This one did but next year will be different, even if they have to strap on double backpacks.


I'm relieved that the suspense is over for the kids starting a new school, but the hard work (in terms of socialization) has begun. So far, Dani has only gotten into my car and burst into tears twice at pickup. Well...actually, one of those days was yesterday. This is certainly not easy. And Nile just says "fine" to every question (how was your day? how was lunch? did you slay any dragons at recess?). The schoolwork does not appear to be harder than NJ -- in fact, Nile is repeating his semester of studying the Holocaust, and I'm not sure that's such a good thing. Surely one semester of that is enough for a 14 year old to deal with. Dani's classes that are not AP are, as she states, "so easy". Better than too hard. Nile's pre-AP science is proving interesting, they are looking at hurricanes right now, which seems appropriate given Earl's action.


I started my second per-diem nursing job this week. This one is in a south Austin woundcare clinic and oh my goodness, folks, I've never worked in a clinic before but let me tell you something.....this is INCREDIBLY easy compared to hospital work. You get a lunch break! When you want it! You can pee when you need to! The doctor knows your name and he USES it to address you! The patients remember you from last week! They are happy to see you! Alright, you get the gist of it. Even better, this job pays as well as hospital positions because it's affiliated with a hospital and there's a single per-diem RN rate. All I can say is after 3 years of med-surg on 3 West, I deserve it. The only downer is I have to wear dowdy navy scrubs; here's a picture.


But you know, I definitely want to keep my psych job going too. It's just too much fun there. In a single shift last week, a patient wanted me to leave with him as I discharged him and get married. Really. He was serious. Why, how did you know that I really dig hyperverbal bipolar narcissists? And then a few hours later, another patient fired me as his nurse because I'm just too much of a bitch. Yes, he used that word. Here's the deal: I wouldn't discharge him without a doctor's order (that pesky little detail). You can't just let unstable psychiatric patients run out the door, for obvious reasons. Oh, but I'm a bitch. Good thing I didn't marry that first guy, he'd have been sorry.


We had another family gathering Sunday and (can you stand it?) here's more pool pictures. Someone at work said that if we turn on the heater, we can use this baby into November. Music to my ears. And my dearest brother Roy, who has a booth at Room Service (a very cool Austin store, check it out), took away some of the junk in our garage with the promise of more to be removed. The bedrooms and office were painted, so Nile is no longer in a pink room with fairies on the coffered ceiling looking down at him. It's a manly blue.


One sour note...still no progress with the DMV. The NJ high school told us they issued a completion card to Dani for driver's ed. She has no memory of this & if we can't find it, the state will have to reissue. Yep, that's the one and only state of NJ, in the middle of one of the worst fiscal crises in the nation. I'm sure some sweet civil servant will gladly issue us a new card. Maybe if I can figure out which agency, how to contact them, and who to ask. Alright, I'm tired just thinking of that. I'm going to swim laps in my new best friend.

OMG...More DMV Hell

The DMV has a special place in my stomach right now (it's turning). Our quest to get poor little Dani her driver's permit continues. Dani & I finally got her "verification of enrollment" form on the first day of school (we waited all summer for this), and we drove to Marble Falls, TX to the little friendly DMV office there. Not a quick trip, took 45 minutes. But after our delightful (NOT!) experience at the East Austin DMV, I thought this would be better. Well, darlin', the DMV is nothing if not consistent. This time, the woman told us we need 14 hours of behind-the-wheel training. Yep, don't know where she pulled that number from because I know that it's 7 hours based on our last DMV trip and the official web site. But I digress. She then fixated on the report card showing Dani completed Driver's Ed at school with a grade of A. "We need to know exactly how many classroom hours this was." I point out to her it's 2.5 credit hours (1/2 semester). Nope, not good enough. We must have an official letter from North Hunterdon High School. Each time we visit, it's something new and they are obviously making this up as they go along. Makes me wonder what's really going on -- are they just trying to keep us awful Jersey people off their precious Texas roads?

So here's hoping my nightly laps in the pool can cure this massive headache I've got after this experience. And the glass of wine too. I am already mentally composing my letter to the editor of the Statesman. As if moving across country wasn't traumatic enough, now my plans for dealing with work/transporting kids are basically all changed. OK, I'll stop whining now.

New Online Friends

You can meet real people online. A woman that just moved her family here from Michigan has been corresponding with me since February 2010. We met on the Austin forum of http://www.city-data.com/, which is a great resource for people facing a move to a new city. Cecilia moved here this summer with her husband and 3 daughters (all close to Dani's age). They were actually planning a move to the Lakeway community (where we live), but they ended up in Steiner Ranch. It's close but a different school district.




As you can see, the girls really hit it off and enjoyed an afternoon in the pool. It was interesting to hear Cecilia's perspectives on Austin. Since it's not truly a new city to me, quirks like the way streets are arranged (& how the names change so often) don't really bug me. The fact that I-35 is unusable (except as a parking lot) is just something I accepted a long time ago. These things bug her. I also didn't hear a lot of gushing about the "weird" Austin, most-cool city thing from her. And that's in spite of the fact that she's already enjoyed the easy availability of live local music. Maybe all that really doesn't matter to newcomers that aren't in their 20's.

It's funny how things turn out differently than you planned. We are truly enjoying the pool, much more than expected. We have my family over every other Sunday and basically have a big party. It's a nice draw to invite kids over to meet Dani and Nile. And I am finding I can actually get some exercise out of it and use it to relax in the evening. We looked at a lot of houses that didn't have pools & it wasn't high on our list. Now I would list it as a "must have". I figured I would not be able to tolerate working at a hospital that wasn't in South Austin, but I've found the commute up to 32nd street not bad at all. Saturday was especially sweet, only 25 minutes. And this is corny, but I love driving through downtown between the high rises and then skirting along the edge of UT. I love being back in the city.

The kids start school tomorrow, so soon everything will change drastically. I have most of the week off so that I can help ease the transition. The painters come on Tuesday to paint much of the interior of our house. I start orientation for my second job the next week. Ken's been invited to play a big poker game in Houston one weekend in September. Dani & I are planning a Thanksgiving trip to NYC to visit Holly. I was concerned Nile would never replace his beloved Clinton TaeKwonDo studio, but in some ways I think he found an even-better school (smaller, more of a family).

Life is good and I'm living in Austin, where I always wanted to come back to. It's great.

Employment

I am now employed in the fine state state of Texas. In fact, I have two jobs, which is the way I like it. Both are per diem, so I only work when they need me & I want to. One is at a private psychiatric hospital that is actually two floors within a larger acute-care hospital. I completed my orientation week there yesterday. I was quite worried about the commute - I actually drive through downtown - but it was not bad, and that was for arriving at 8:30. It took me 35 minutes from our house in Bee Cave, and (again), it's a pleasant scenic drive along Bee Cave road. And I actually like driving through downtown -- a part of me loves being back in a city. Should be less than 30 minutes when I am arriving at 6:45 am for regular work. Look, I even have a badge.

I see good signs that I will like this job. The employees seem capable and friendly and the patient population is more interesting to me -- these are people with acute psychiatric needs and with insurance. I am hopeful that with many of them, I will feel like I'm actually making a difference in their lives -- helping them through a crisis and getting them back on their feet. Hagedorn was a different situation, one that I grew to appreciate, but very few patients did I ever feel like I was making a difference in their outcome.

I also signed all the papers yesterday for my other job - it's as a woundcare nurse at a wound clinic in south Austin. This is very cool, can you believe I was able to find jobs in my two specialty areas? And dayshift? Woo hoo! This employer is part of a large system, there are 6 hospitals in the metro area with a total of 1088 beds. It's big. I also see signs that it's a good place to work. I start that orientation on the 30th of August.

The kids went to their "round ups" at school, got their schedules and books. Dani met two girls that just moved here and I am hopeful friendships will develop. Nile is fitting right in at Tae Kwon Do. The school bus stops only a block away at 8:00. Ken has a good apartment in Houston during the week and finds his new job interesting. He says it's much less stress than Clinton, so hey - that's really all I care about. It's all good. Summer is winding down, one week left for playtime. But the nice hot weather & the enjoyment of the pool continues. I'm getting in the habit of getting in there every evening. It is so relaxing and pleasant, especially if I spent the day working indoors. I have figured out that I can swim laps if I do the breast stroke and that's not too annoying. Trying to do freestyle is just too much turning, too fast. Here's another pool pic -- can't take enough of these I guess. I can't believe we even looked at houses without pools. What was I thinking?

TX to Philly

I went to Philly last week for my annual pilgrimage to my workout goddess's shrine in Glassboro, New Jersey. That's Cathe Friedrich's gym and filming studio. This was my fourth trip and I enjoyed it just as much as the first time in 2005. I'm getting so I know the routine so well, I don't even bother to bring the agenda with me. I took a total of 6 classes from Friday evening to Sunday morning. That's me with Cathe in the pic. Yes, she really sat at our table to eat. Not your typical idol.

On Saturday, Cathe did her one minute of fame with us, where small groups got to workout on the set with Cathe and take pictures for a minute. My cool camera even does video, so I got a video of it and it's posted on Facebook. For a minute, I could pretend I was one of Cathe's cast working on a video with her. And yes, the lights are really hot. I am amazed that they all aren't dripping with sweat on the videos. Must really have the hair and makeup shellacked on.

I love to go to these Road Trips because it really gives me a shot of inspiration and enthusiasm to get up at dark-thirty every morning I'm working and sweat for an hour and a half. It can be lonely to workout at home and it's also weird. I spend that time with Cathe every day & start to feel like I know her -- she releases a new set of workouts about once a year & I've been collecting them since 1999, so if anyone knows her little jokes and how she thinks, it's her loyal fans like me. But when you meet her in person, you realize how one-sided the relationship is, although she is very warm and real. No diva.

And New Jersey/Philly was lovely. The weather really cooperated and was so much cooler than it has been in Austin. Not that I saw much of it starting Friday night, but the days before were nice.

I got to see Jackie and Christy and many of my 3 West pals, which was nice. I worked out at my old gym in Clinton and took a terrific Zumba class - better than the Zumba here in Austin, in fact. I miss New Jersey, especially now that the temps here are over 100 degrees every day (& I really feel it)!

The bad luck of this house continues though....when I returned home I discovered that my Mom had backed into the neighbor's mailbox with her car while she was babysitting my kids during my trip. She leveled it, and it was one of those big brick things. Oh well, it's fixed now. I just have to laugh.

The View

As of Friday, we've been here a month. One of the things we notice here is the view. It's gorgeous. Dani & I went to eat sushi today at a restaurant here in Lakeway that is perched on the side of a cliff. And we took pictures so you can see how much we liked it (the food was good too).

We are living on the edge of the Texas hill country and it sure is pretty. We drive into town along Bee Cave Road and it's quite a scenic drive. Check out the rock formations along the side of the road.

I always equated Austin with the weather in Baton Rouge, but it's actually quite a bit less humid, which makes it more tolerable. Of course, next month it will start getting over 100 degrees, and it almost never does that in Baton Rouge. I may eat my words. But along with those words I'll be having a frozen Margarita or frosty Corona, so hey...it's not all bad.

We've gotten into more of a routine and that's great. I am still job hunting. I am going to force Dani to write an email inviting over the two 11th grade girls that we know of in the neighborhood. General nebulous invitations thru the realtor have failed so far, so it's time for mean momma to step in. She met a cute, nice 10th grade boy (!) during her first volunteer session at the library but we need more than that. Nile is making friends at Taekwondo.

Wednesday I leave for Philly for my annual Cathe Friedrich convention. Yes, I am paying money to work out 3 times a day with my idol. But I'm not the only one - there are 110 of us from all over the country & the Road Trip (as it's called) sold out in about 10 minutes so there is a widespread craziness when it comes to Cathe. I can hardly wait!

Sunday we ate brunch at another old Austin haunt - the Omelettry. First time I ever went there was in 1982 after a really special night...and that's all I'm going to say. Same deja vu experience at Waterloo Records and Amy's Ice Cream. It's weird to be revisiting all these places that I was so intimately familiar with more than 20 years ago. Austin has changed, it's gigantic now, but it's kept some of its character in these places. It's great to be part of it again.

Crazy and New

Little bit crazy, little bit new. We had a mini-crisis Friday when we discovered that a) we had no hot water and b) our garbage can was gone. Little detective work by Dr. House (that's my husband, for those not in the know. They are twins, separated at birth, or so it seems to me and his minions at work) revealed that the pool guy probably turned off the gas when he did some work (after experiencing the pandemonium on Monday when the gas line was cut by the yard guys) and then turned it back on, not realizing that the pilot lights needed to be re-lit. As far as the garbage can, I do not know. It was full of trash and it was gone at 3:30 when I returned home. Quizzing the neighbors revealed nothing. But the garbage company is happy to bring us another one, so I guess it'll be OK. Might want to lock up the can, somehow when I put it out next time, although not sure exactly how. (Who wants a smelly can full of garbage? and we live in a gated neighborhood. It's just screwy.)

Then Monday, Dani and I went to pick up our new breakfast-nook dining set at Pier One. It took 3 trips in my little CR-V and it took all 3 of us (me, Dani, Nile) to carry in the table's box, but we did it! And it looks great, check it out.

Today we are getting new carpet in the bedrooms and the study. You'd think that would be a relatively minor thing, but it's major. The former owners apparently had big dogs that they allowed to swim in the pool and then lay in the master bedroom, wet and smelly. The carpet absolutely reeks in that room. I bent down with my nose near the floor shortly after move-in and gagged. When the pool guy first came, he cheerfully asked, "Do you have some big dogs?" (notice, he said dogs, plural). Why no, we don't. "Well, the filter's completely clogged with dog hair and that's partially why your pool is green." The new carpet looks great, and I know some folks complain about new carpet smell, but I'm not.

Some good stuff happened: We got Dani registered at school and she is taking a lot of challenging classes, including 2 AP, but I think it will be fine. We found a Taekwondo school for Nile after a little trial and error. It's a smaller school than the Clinton one, but I was impressed with the quality of teaching. The twice-a-week teen class will help him make friends. Dani starts volunteering at the teeny-tiny Lakeway Library tomorrow too, and I think she'll meet other teens there. It's a popular place for them to get their service hours.

And we love the pool. Have I mentioned that enough? The water is so warm, it's like bath water. I could spend every evening out there.

DMV Hell

It's been a jam-packed couple of weeks. It is a lot of work to move somewhere. And let me tell you, I've been spending way too much time just on the issue of driver's licenses. Texas has this fun thing that requires you to make visits at 4 different places to get all that done. First, you see your insurance agent, then get your car inspected (at a mechanic shop, not at a state facility as in NJ), then go to the tax assessor to get your title, then (finally) you go to the DMV and get the license. I am having a hell of a time getting Dani's driver's permit or "GDL" as they call it now (graduated driver's license). Now I know Texas is a big state with a big ego, and I heard that the governor even mentioned secession recently, but last I checked it's still part of the United States of America. Not so when it comes to this GDL business. Texas flat-out doesn't recognize anything Dani has done in NJ -- she has to repeat her expensive driver training (cost me $365) and she has to start the clock all over again for the 6 months that I have to be in the car beside her. The wonderful DMV employee that explained this to me added with a flourish (when we said "but we already did all this in NJ!"), "Guess you should have stayed in New Jersey." As we say in Jersey, no he didn't. But sadly, yes, he really did. And here's the kicker folks: we still don't have it. The DMV wants a piece of paper from her new school saying she's enrolled and today they told us that they won't give it to her until the first day of class.

A few days later, I arrive home right behind the fire truck. Now, that's a scary feeling. When I drive up, the truck is pulling to a stop and I'm watching the firemen (and one firewoman) get out of the truck. My heart is pounding.....are they going to my house? They are. Turns out the yard guys cut a gas line while doing a massive clean-up effort on our neglected yard. It all got fixed that same day, it was actually not a big deal. Just my near-heart attack was a big deal. Here's a pic of Dani that shows off the yard.

So I have my driver's license (too bad Dani), the yard looks great, the pool's been cleaned, and one more good thing...I love my new gym. It's bigger and it has many more toys for me. I did legs today and there are so many machines that I didn't even get to them all because I only had an hour for weights! I'm in heaven. Guess it's not all bad.

I Ate Chicken Feet

Mmmmm.....chicken feet.

We've been here a week. The moving van left, many boxes have been unpacked (not all), and we've starting doing some of the necessary things that residents do. The paper arrives each morning. I applied for my nursing license. We've gotten together with family 3 times so far, and it's been fun. It's a lot of people, even when a few don't show up. Two of my siblings and their significant others didn't come to Dim Sum this morning and we still had 12 people. It's so different.

So the van was here 3 days unloading us. The guys did a great job, not a single thing was broken. I am missing a knob to the buffet in my dining room, but I can deal with that.

I know I already mentioned the plane trip here in my last entry, but I just have to show a picture of what Gary, our cat, had to stay in for a total of 12 hours on this trip. It's a pretty small box, but it had to be according to airline regs. This is at the Philly airport.

Hurricane Alex made it rain for 4 straight days, but the sun came out today and yes, a trip to the grocery store results in significant sweating. But it's all good. You just surrender to it & smile. It's good for the skin!

I have to mention the one item of weirdness. The people that we bought the house from are going through a very nasty divorce. So bad that that they refused to be in the same room together for the closing. The wife had actually been living in the house (with the 3 kids) and turned over the keys to us, which included an electronic device to open the neighborhood gate (like a garage door opener). Well, it didn't work. (got a separate device from the husband & worked fine.) Ken opened it to find that the dip switches had all been flipped to render it inoperable. Hmmmm. Then when we started moving furniture into the dining room, we discovered that the curtains had been soaked in animal urine. At first, we assumed Gary did it, but the volume of urine was just too much for his little kitty bladder. Also, the curtains had a uniform line of the urine, not in a spray pattern. The other thing was that we shut Gary up in the house the day before we actually started moving in, but when we returned to the house the next day we couldn't find him. Finally found him in a drawer, closed, in one of the closets. Hmmmm. Somebody obviously did this, it was intentional, and we think they shut away our cat while it happened. We got the locks changed that night. Here's a pic of the curtains. Draw your own conclusions.

I ate the chicken feet at Dim Sum. Yes, real chicken feet. Probably won't do that again but I'm enjoying the huge variety of restaurants so close to us. We didn't have that in Hunterdon county.