Stories on the PICU

Been enjoying my time off. And I have worked a few shifts and some funny stuff happened. On one of my days off, I had a very Austin-centric day. It started with aerial yoga with my sister Holly. We bought a few classes off AmazonLocal, a Groupon competitor. It's this small studio in Hyde Park and proved to be great fun. Plus I'm sore in unusual places, a little bonus there. http://www.austinaerialyoga.com/

 

After hanging upside down and sideways for an hour, we went to Mother's Cafe and Garden (http://www.motherscafeaustin.com/) a few blocks away to eat a really good vegetarian lunch. And after that, we visited the Austin Faces AIDS photo exhibit. I've mentioned this already in my blog, one of my fellow volunteers is pictured in it, and surprise, surprise - I discovered someone else I know is also in the exhibit. It's beautifully done and it's free; you should check it out. Here's a link to the video work of the exhibit. http://vimeo.com/channels/austinfacesaids. It was a warm, sunny gorgeous December day.

So on to work the next day. (Again, I'm changing a few details to maintain confidentiality.) Not a bad shift, working with two of my favorite people, Curtis in charge and Gilbert. The PICU wasn't too riled up, we weren't in the med room sharpening our needles too often. I discharged four patients and part of the process is that we hand back their valuables that were locked in the safe. The patient goes over everything, verifies it's all there and signs for it. One of my discharges is thumbing through his wallet and I see a big "Registered Sex Offender" card. Interesting, because I didn't get any information about this in report and I realize that I was alone with him in the room at various times during the day -- and yes, I probably would've done that even if I'd known his history, but still....it's nice to know and plan how close your back needs to be to the door. Of course, the most likely explanation is that he didn't disclose any of that when he was admitted. That's a very big issue in mental health -- figuring out what is true from patient stories and surmising what gets left out. It's quite an important skill and one I know that I really don't have yet.

Amusing moments were provided by use of the phone on PICU. We have a phone for patients to use on each unit - but the PICU's (that's psych intensive care unit) wasn't working. So we pulled a phone across the nurse's desk and placed it at the dutch door for patients to use at various times. Normally we don't hear their phone conversations, but this day we heard them all. Several times I felt sorry for the government worker on the other end of the line as patients attempted to sort out some problem with SSI, their parole officer, or some kind of assistance. I wonder if they received special training on dealing with the mentally ill caller. Calls to family and friends sometimes offered insight. One caller was offering a long, rambling explanation of how she ended up with us. It involved her driving around the whole Austin metro area, trying to pay off all her parking tickets. Somehow that whole experience was too stressful for her, she ended up losing her cool with the friend taking her on this errand, and he deposited her at PES (Psych Emergency Services). As she recounted her frustration with this, her voice got louder and louder (apparently, the boyfriend didn't offer a sympathetic ear), "I said...I had to pay these parking tickets!" Then quickly, in the blink of an eye, she's calm, chuckles a little and says, oh it's snack time....I'll call you later. And it's over. I have new empathy for the patient, for I can only imagine the stress of driving through Austin traffic all day, and on such a depressing errand. Those of you not from here may not understand - Austin traffic is particularly bad, on many lists it's in the top 10 worst cities of the nation. The city council thought in the 1970's and 1980's that if they just didn't build a good highway infrastructure, people wouldn't move here. Austin has always had a thing about wanting to keep itself small & funky - which I totally appreciate - but look how that plan turned out.

I've been looking at the charts a little closer, especially at the forms and documents that I'll be responsible to fill out after I graduate. I noticed that a new term seems to be emerging, and I don't like it. Some of our patients are admitted after a confrontation with police where they make gestures that they hope will incite the police to shoot them and end their misery. In the past, we called this "suicide by cop". I noticed that the newer term (I guess more politically correct) is "police-assisted suicide". I really think that creates a false impression -- like, are they Dr. Kevorkian, standing there with a syringe? I think not. I'm going to stick with the old term.

In the rush of the morning, something absolutely funny happened. Mornings are busy because the majority of medication is given then, discharges are being prepared, and all the office personnel are at their desks. So at our nurse's station, we had two social workers, two doctors, three nurses, a unit coordinator, a rec therapist, and a mental health tech. Oh, and a pharmacist. Gilbert drops his pen while he's standing at the dutch door having a patient sign their discharge papers. After he picks it up, the patient says loudly "Hey, I saw your joker tattoo.". Gilbert looks startled, says, "What joker tattoo? I don't have any tattoos." "It's on your ass. I saw it when you bent over." Now everyone at the desk (me included) snaps around their head and is looking at Gilbert. He's blushing, starts to argue again with the patient....then realizes what he's doing and just shuts up. (note to self: don't argue with patients on PICU) Things move on and we get back to work. Later, Gilbert tells me he definitely does not have a joker tattoo on his ass, and I believe him. I remark that the only way he could've convinced all of us at the time, however, was to show us his ass. So where did the patient come up with that? If he was angry with Gilbert, that certainly was an effective way to get back at him. I bet half the people that witnessed that exchange now think Gilbert's a huge fan of Batman villains. That's the thing about mental illness....someone can be so intensely incapacitated yet still be one sharp cookie, capable of something so sneaky.

Overachiever

I'm done with the semester! And I definitely am an overachiever, I even got an A in my pass/fail class. Oh well. I learned Advanced Patho really well, sure that will come in handy. And here's something else that's cool -- I figured the skills I acquired in Advanced Health Assessment was just nice-to-know, but a classmate who currently works as the nurse-manager of a psych unit said that the NP's and psychiatrists also do full physical assessments on admission and bill for them. I need to get a fuller understanding of what my new role will entail & what I will be able to do. For example, I'm not even sure if the collaborating physician that I am required to work with has to be a psychiatrist or not. Over the break, this is something that I plan to investigate. Along with some fun - hey, never forget the fun - I went to see Ken in Houston last week and we took some wonderful long walks. He lives in the museum district, right by the zoo and Rice and the medical center. One morning we walked thru the medical center - that place is breath-taking for a medical professional. Ha. It's a beautiful park around the zoo - they have a pathway thru oak trees that I swear, is almost as beautiful as Oak Alley in Louisiana. Here's a few shots of that.

We also visited the King Tutankhamun exhibit at the Museum of Fine Arts - wow. http://www.mfah.org/ It's well worth the time and cost. They don't have every single item from the tomb, but what they have is lovely, including the iconic funerary mask that was placed over his mummy. I particularly liked the enormous statues that were in place around the tomb. We need to get Nile back to Houston to see this -- maybe interest in Egypt is genetic -- I mean, we did name him Nile for a reason. Ha. Speaking of my man/boy son, he had to go to school dressed as though for a job interview today. We went to Dillard's last night and bought him some dress clothes - that's right, he didn't own any. In the Men's Department, too. We bought this lovely deep-crimson (Roll Tide) dress shirt by Michael Kors and he looks great. I said, gee, you may find you enjoy dressing up. Nah. But it was worth a try. It did prompt me to have those predictable "gee, he is growing up" feelings. Don't have those for Dani. She's already a grown up -- just ask her.

I go back to work tomorrow. I'll be working two days a week on the break, exactly what I wanted to do (aren't they sweet to me?). So I should have some interesting thoughts and experiences for the blog while there. I definitely will be looking at the psych ward with different eyes - even though the focus of this semester wasn't yet on the nitty-gritty of psychiatric disorders (but we did cover the basics in Patho), I learned an enormous amount about the role of a "provider" as they say, which refers to the person making the care decisions & writing the scripts - whether that's a physician, a Nurse Practitioner, or a Physician's Assistant. NPs and PAs are often called "mid-level provider", which means we're between an RN and a physician. Recently I found out that some of us don't like that term -- thinking that mid-level means the care we provide is somehow reduced from that of a physician -- I can see that viewpoint, but I don't mind the term. I mean, graduate school for me is only 2 years, I just can't equate that with medical school and residency for a psychiatrist. Studies show that NPs provide equal-quality care, and that's what counts.

We covered the H&P (history and physical) to the nth degree in class -- so I plan to make time to read over those in the charts for my patients and see how practice relates to theory.  I also want to talk to the psychiatrists more about what they do. And if I get a chance to talk to the single Psych NP that is employed where I work, I'll talk to her (they're not very progressive with that. Maybe that will change). I'm also going to look more at the meds - I take Pharmacology next semester, so my head will be crammed full of that data soon.

I just finished Jeffrey Eugenides' new novel The Marriage Plot. He wrote Middlesex, which my book club in NJ introduced me to & I loved it. It aggrieved me greatly that Mr. Eugenides came to Austin to give a talk on his new book and I couldn't attend because I was taking a mid-term exam right at that time. It was the time of the semester when I thought, good god, this is just too hard, what was I thinking? And I have no life, I can't even go see one of my favorite authors! Anyway, I survived and imagine my surprise about this book -- this wasn't even in any of the reviews I read -- it's basically about mental illness. Bipolar disorder, to be exact. And I found the portrayal realistic. One of the things I think he really "got" was how wonderful manic phases can be (and yes, eventually, how destructive). If  you talk to someone who's bipolar, you often see this expression come across their face when they talk about what it's like when they're manic -- you're so verbal, so energized, so positive, so up -- who wouldn't love that? The expression says Oh god, it was just the best thing in the world and I miss it terribly. The book really nails it.

I've been thinking about my post last week ranting about what people do wrong at the gym. Specifically, why does what other people do bug me so much? Who cares if they wear a visor and sing along to their ipod, right? I really am an open-minded, bed-wetting liberal type of person -- I actually had a conversation recently with my dad (ok, an argument) about why I like gay people so much -- it's because they are interesting, brave and different. I so admire that. So why am I intolerant of the people brave enough to wear their visor to the healthclub? I guess it's because I spent many years using only my home gym with workout DVDs from my guru/idol -- http://cathe.com/ -- going back to the gym is a relatively recent thing for me, and going back to school has enabled me to go there every morning. I'm having a social-adjustment thing, learning to share my toys and space. So please be tolerant of my intolerance. I'll get it eventually. Then you'll see me running barefoot on the treadmill, singing tunelessly to my ipod, with my bright-yellow visor on. Oh, and my muddy shoes by the side. Ha!

Books, Otoscopes, Visors

It's finals week. This is all I'm doing this week except for clinical hours. I have basically 3 finals - one is a physical demonstration of a head-to-toe examination and corresponding chart write-up, a Pathophysiology comprehensive final, and an Advanced Physical Assessment final that's also comprehensive. Oh it's fun, let me tell you. I don't know anyone that enjoys taking exams. I think the worst feeling is sitting in your little seat with your pencil in your hand as they start handing out the exams. Even worse is reading about the first 4 or 5 questions and thinking, oh god, I should've studied more. But anyway, it is all that I'm doing. My psychosocial class had no final exam (yay!) -- just a paper, and that is one thing that doesn't bother me, writing papers.

Interesting happening at clinical. I'm going to change some details in this to protect anonymity, but a child was brought into the office for a rash all over her body. We thought it was an antibiotic reaction, something called Stevens-Johnson Syndrome, which can be quite serious. When I walked in, they rushed me over to see the kid because the family was preparing to leave and go straight to the Emergency Department and the docs wanted me to see this. It was an incredible rash, covering the entire little body, very red. I noticed however, that there was a really big stretchy bandage (called Coban) on the child's antecubital, where blood was probably drawn. I thought, why on earth did they have to use that? I guess because I've worked in woundcare, I'm attuned to bandages and dressings. Anyway, later the Doc comes into the nurse's station and asks his aide to tell his 3 waiting appointments that he'll be late. It turns out the child didn't have Steven's-Johnson, she had leukemia. He had just gotten the lab results. The rash wasn't even a real rash, it was acute bleeding under the skin. Her platelets were only 40 (normal is 150 to 450). So the doc had to call over to the ED, where the parents were and tell them that their daughter has leukemia. Kind of ruined the rest of the day for everyone. But you know, I realized that a big goof was made -- that Coban was there because when the lab drew blood, she wouldn't stop bleeding. The doc should've been alerted and that should've raised alarm bells. I suspect they wouldn't have narrowed the diagnosis down to Stevens-Johnson quite so quickly.

My sister's cat is visiting with us for 10 days because she's in Goa, India (doesn't she lead an interesting life?). His name is Mitten, shortened to Mitt and so of course, we call him Mitt Romney. It's a hoot. The first night he was upset and mewed all night. The next morning, of course, we had to say many times "Mitt Romney is a cry-baby." Ha. But now he & Crabby are friends and play together a lot - they even eat off the same saucer together.

I managed to get sick about 10 days ago, and that's been awful. The worst part was that I missed 4 days at the gym, and when I did go back, the first few days I needed to go in later - not at my usual 4:15 am - and there were all these people there - like, what, people at my gym? To cope, I made a mental list of what I hate that other people do at the gym. (Skip the rest if you hate to read rants, that's really what's coming. And I saved this for the end for that reason.)

I hate:

- people who wear hats, especially visors at the gym. It looks silly - are the fluorescent lights too bright for you? And don't they know that most heat escapes thru your head, so that hat is why you're sweating like a pig?

- people who wear dirty shoes to the gym, and leave little trails of dirt or mud at the machines where they stop. Ditto people that wear inappropriate shoes - I've seen sandals and Crocs.

- people who crowd me at the free-weight areas. If I am working shoulders, do not sit on the bench close to me. I should not have to move and readjust just because you are either clueless about what kind of space people need for shoulder work or (& this is worse) - you are trying to strike up a conversation with me. That leads to the next one.

- people who do things to strike up conversation. Hey - notice I am wearing ear buds. Notice how hard I'm working. I am not there to chat. Sure, I'll say hello and/or smile if you're a crack of dawn regular like me - but darlin', that is all. And I don't feel guilty about that.

- people who stand directly in front of the rack of free weights to do their sets. This is always a clueless newbie -- how am I supposed to get my weights while you're standing in the way? I never say excuse me when this happens -- I say oh, excuse you -- funny, I don't think they get it.

- people who want to use 2 or 3 machines at one time to do super-sets. This is fine to attempt, and you'll probably succeed if it's 4:30 am, but do not say to someone, "hey I wasn't done with that machine" when you are busy on another one. I saw a ____ (insert derogatory term) actually say that to someone on the leg press -- a woman had removed three 45 lb plates from each side, then he finally sidles up to her and says, oh I wasn't done with that machine. Look, dickhead, I saw you busy on the hamstring curls over there. I wish he'd said that to me, because I would've said, "oh, show me where your name is stamped on the metal." And he did that when the gym was really busy, mid-morning day after Thanksgiving.

- people who tunelessly sing along or hum to their ipods.

- people who wear too little or too much. Please, I don't want to see up your tiny shorts when you're working abdominals. If you plan to do that, wear capri's or longer shorts. And I get nervous when I see idiots wearing thick sweatshirts in spin class. I think they are trying to sweat off weight - but dehydration is dangerous and doesn't make any fat go away. I know CPR but I really don't want to have to do that.

- people who grunt or moan loudly while they work. Please, unless you are a world-class power-lifter, that is just ridiculous. You really can't hold that in?

So I could go on but I won't. I guess I'm a curmudgeon. But I'm trying to become more tolerant. Yesterday I was getting a drink of water right before spin and I notice that the floor is shaking. So I look behind me and a very large guy is running on a treadmill with absolutely terrible form - massive foot falls, thud thud thud. He's wearing too little, I see way too much skin, and he's even barefoot. And he's singing to his ipod. It's a trifecta. But I smiled and went into spin. I thought to myself, that is absolutely great that he is working out and he's so happy that he's singing. I'm happy for him. Hope he doesn't break an ankle and need CPR.

Austin Faces AIDS

No pictures today (awwwwww). Got a 97 on my second Psychosocial test....yeah, baby. And a 92 in Patho again. Hey, that's fine, if every grade I get is a 92, I'll just smile. The semester is winding down. And you know, I get to have so many varied experiences, even if none of it really applies to what I'll be doing professionally when I graduate. Well, "none" is a big extreme, but it's at a big, big remove shall we say. For example, Friday I did newborn assessments. I spent 4 hours at an Austin hospital's newborn nursery examining newborn babies. It was fun (obviously, huh?) but will I ever do that when I graduate? Absolutely not, newborns don't have psychological problems yet. We have to give their parents time to do that. Ha. No, if a newborn has a brain-related problem, they call the neurologist. Probably the only time in life when psycho-social issues do not apply.

I love my volunteering gig. I mentioned Tina (not her real name), the gorgeous transsexual chick that works on the same days with me. I really like her. I think it's because she's completely out - she lives with AIDS, she is a transsexual, she likes sex, she has a hot boyfriend, she likes to read....you get the idea. If it's on her mind, she's saying it. She is so completely comfortable in her skin and let me tell you, what a skin. I mean, most women only wish they look that good. And she has to be about my age because she's been volunteering there for 20 years. I see the grey roots - ha. Last week I met her boyfriend -- a really nice, average kind of guy, brought pizza for lunch, easy to talk to. And the other folks I work with are all interesting -- from different parts of the country, different walks of life. It's like gee...I get so much back by being there. And here's something neat. Tina and lots of other Austin folks are in this great photojournalism display that's going up for World AIDS Day - December 1st. Here's a link to the photog's web site, but it won't be posted until that date. http://www.joannsantangelo.com/
The exhibit is called Austin Faces AIDS - Portraits of People Living with HIV/AIDS. I can't wait to see it. It was fabulous listening to Tina describe how the photographer interviewed and photographed her at her home.

I learn so much in school. This Patho class I'm taking is really an overview of everything that can go wrong in the body. What advice do I have for you, dear readers? Take a vitamin D supplement every single day. 1000 units. That's the first thing. Then the obvious stuff: don't smoke, drink a little alcohol (1 drink per day for gals, 2 for guys), exercise and eat right, meditate, drive carefully. Last week I learned how to do this cool screening test for kids under age 6 called a "Denver". It's actually a pretty complicated, skilled assessment that I wouldn't dare try to do without much more training. But it tells you if a kid has any developmental problems. So this is funny -- after being in class and listening to the endocrine lecture, I was convinced that I have a thyroid problem. It runs in my family. I had blood drawn and of course....thyroid is perfectly normal. I mean, TSH level of 0.69. That's great, nowhere near hypothyroid. My doc thinks it's just perimenopause. Yes. Ick. The joys of being a certain age. Oh well, at least I don't have to look my age. Westlake Dermatology (and the gym) takes care of that -- ha.

Tests, Foodbank, and Condoms

It's mid-October. I got an 85 on my psychosocial test, which I am rather amused by. You'd think that would be my strongest class, huh? And I wouldn't do so hot in the more FNP-oriented classes, where we're learning to do things like pelvics on women and differentiate between lung diseases (things I'll never do in practice). Ah, but no, that's not how it works. I'm cool with it, though because an 85 is passing and that means I don't have to repeat it. Enough said.

I volunteered at the food bank Thursday and enjoyed it. AIDS Services of Austin operates a food bank out of their office on alternate Tuesdays and Thursdays. I filled orders and helped carry bags to cars. Yes, a glorified bag boy -- ha. But the fun part was meeting my fellow volunteers and talking with them. I met a truly cool chick who's been there (she says) 20 years. I think she's a transsexual (don't know her well enough yet to ask) but I must say, she is gorgeous and so full of personality. Made the time fly by. And the social worker that worked the counter, checking clients in and handling issues, had the coolest modified flock-of-seagulls hair style and various piercings. I definitely need to wear my bright-green Anthro capri's next time to keep up with this crowd! One of my fellow bag boys was this hot young Hispanic UT student who - get this - is getting his social work degree and then he wants to become a doctor. Don't think I've ever met someone with that particular combo but doesn't it make great sense? We had a lot to talk about. Ah Austin, that's what I love about you.

And today was Austin's AIDS Walk. We went as a family - well, not with Nile, of course. He's married to his PC and I respect that relationship. It was a bit hot today, but it's a pretty short walk - a 5K - and this was, shall we say, a stroll. Definitely not race-walking. Greg Louganis was the celebrity who led the walkers. Fox News was interviewing walkers while we were all getting ready and I said a few words about how condoms are so much easier and cheaper than the drug regimen for AIDS -- kind of doubt they'll run that, but you never know. I'll certainly never know since I'm not exactly a Fox News kind of girl, KWIM?

Friday I had drinks with Holly at Hula Hut. Such a completely perfect afternoon to do that, and such a completely perfect Austin thing to indulge in. Ken met us for dinner after we had thrown back a few. And as I said on the drive home through gorgeous Westlake Hills -- ah, I love it here.

Somehow I'm finding time to still do the fun stuff like that, but I have a lot of work to do and the next 6 weeks will be hard. I did get a mani/pedi Friday and they are doing this new process called SNS - they actually dipped my nails into this micro-fine powder for the color -- really. And it looks great. See?

And More About School

I started clinicals last week and it was a eye-opener. This is for my Advanced Health Assessment class. I'm paired with a Family Nurse Practitioner (FNP -- yes, it's a bit of giggle when you say it like this: "you dirty effin' P") and she sees patients in a practice with 4 MDs and a Physician's Assistant. I liked Pam right away -- she is a fit, rocking, over-40 woman, with a brain and lots of confidence. All I did was observe, but boy....as I told her at the end of the day, she has a fascinating job. To be honest, I had felt as a future FPMHNP (Psych NP) that FNPs see the boring, routine cases - the colds, the earaches, the routine physicals. That's how the day of her appointments looked on paper: 48 y.o. woman for thyroid check, 28 y.o. woman for back pain, 45 y.o. man for physical, 52 y.o. woman for cold/flu/earache, 40 y.o. GYN checkup with pap, 72 y.o. woman for physical. We were also supposed to see a 5 year old - she sees the whole lifespan - but they cancelled. But that's what the day looked like on paper at 8:00. I thought, ok, all of that is routine. Maybe the kid will be interesting since my experience with Peds has been limited.

Here's the deal about confidentiality. I'm not going to give details about where I'm working, Pam's real name (it's not Pam) or any patient identifiers other than age and gender. So it would be impossible for anyone reading this to know who I'm talking about.

And yes, we did a routine physical but it was a real challenge -- this patient was an older woman with a loooooong list of meds to treat chronic conditions -- heart failure, hypertension, anxiety, chronic pain, and diabetes. That visit actually took the longest. Just going over her list of medications, making sure she's still taking them, all her specialists are aware of the meds, none of them conflict....wow, that took some time. And besides that, it's important to actually perform a physical exam and assess how she's doing. Stakes are high if something gets missed. One thing I like about Pam is that she did a skin check on every single patient. Hiked up the gown, looked at all their moles, the whole deal.

And here's the truth about psych -- you see it everywhere. We saw 5 patients (one of the 6 scheduled refused to let me observe -- the only guy -- interesting, huh? maybe that reveals psych issues right there, ha!) Two of the five (in my opinion) displayed emotional issues that needed to be addressed. One of them was the young woman with back pain, who ended up crying on the exam table. It was an uncomfortable minute, I so badly wanted to have a mini-therapy moment with her. (And she wasn't crying about the back pain, it was being told "Oh, by the way, your labs from last visit reveal that you have an STI."), but I couldn't step out of my role as the observer. Honestly, it was excruciating. Pam did her best to address the issue in a methodical, task-oriented way, but it wasn't the way I would've done it. My way would've taken more time, so I guess that's why it didn't get done. What I settled for, finally, was handing the patient a tissue.

Next week I'll get to do more - they've already told me I'll get to seat the patient in the room, do vitals and a quick intake assessment to prep them for Pam. I'm ready to feel useful. And thank goodness for those 3 years of med-surg -- none of this intimidates me, and I know that's not true for some of my classmates who've been exclusively in pysch for years. The wound clinic work has helped too - I'm quite comfortable in a clinic setting and understand the workflow issues.

Another cool thing that happened was that I had a few of my cultural encounters for my pyscho-social class. Yes, the stuff I was complaining about, where I have to talk to multi-cultural people about their healthcare experiences. Holly had a party Friday and I was able to talk to an Indian woman and my sister-in-law, who is from Taiwan. And here's the cool thing -- I enjoyed it. It's quite something to meet someone for the first time, ask probing questions about their intimate lives for an hour and then go away with a new set of thoughts and feelings. I liked it. (Now as a psych nurse, why should that have surprised me? After all, I'm used to asking patients I've just met if they have any suicidal thoughts right now. And I like that too.) One of the reasons I love psych is that it's such a challenge - it's a mystery, a puzzle. You can't tell from a physical exam or labs what's really going on with them. Those are clues - a disheveled, rambling person who can't sit still is telling me all kinds of data non-verbally - but you have to figure out what's underneath the behavior and what they say. And yes, you must by definition doubt what the patient tells you. Because they may believe absolutely in what they say -- after all, we're all pretty skilled at deceiving even ourselves -- but it may not be the truth. So, thank you, Dr. Fredland, for giving me this assignment that I initially hated. My lab partner, Maggie and I are going to pool our resources and do some of our encounters together. We have two lined up for the next few days already.

So more on all that next week. I took two tests yesterday - things are moving along in the semester. So far, I've been really happy with all my grades. It's funny though - I had a very specific goal in nursing school to graduate with a 4.0, and I did. That is not my goal this time.

Yippee

I took my first Advanced Pathophysiology exam, and I got a 92. I'm surprised - boy, did I make some bonehead mistakes. I was very relieved though - the exam was fair and the questions were clear. I left feeling confident. Maybe I should take this for a grade instead of pass/fail - ha -- nah! No way! Like I need more pressure in my life! Here's the stupid stuff I did on this test. One of the questions was which heart valve makes the S1 sound and what is it doing - opening or closing? And yes, I actually had to throw the dart on that one. But here's the type of question I got right: Your patient presents with fever of 100.4, respiratory rate of 18, heart rate of 120, his lymphocytes are 80% and his WBC is 12.8. His Bili is 1.2 and is ALT is > than AST. Which of the following differential diagnoses is most likely? And which diagnostic test do you order to confirm that? I put a lot of time into being able to know exactly what the lab test values mean and which diagnostics to order. And there was a whole lot of other stuff to memorize, like what is the SOC (standard of care) for heart failure medications with left-sided systolic failure vs. right, vs. complete right-sided failure. You can see why I was so worried about this test. But it's all over now....and I'm happy.

And the weekend before my test was Austin City Limits Music Festival. And yes, we got tickets for Sunday and went. We heard some good music, here's who we saw: Broken Social Scene, Death From Above 1979, Fleet Foxes, Empire of the Sun, and then Arcade Fire. We were walking over to see Randy Newman and saw Empire of the Sun playing. Man, it was contagious. We had to see them - it was like Las Vegas, their show was so good and honestly, I really like their beats too. Like your hips have to move (kind of like Zumba, but in an Aztec sacrifice ceremony kind of way -- ha!) Really, I mean these guys are totally insane & unique and I now love them. You've probably heard their one hit: Walking on a Dream. (If you listen to Alt Nation, that is.) Anyway, here's a link to them. Way cool. They had an incredible stage show (cool video, freaky dancers, wild Aztec costumes, charismatic front man) - and this is at ACL, an outdoor festival. This is not the Erwin Center. Anyway, sorry Randy.

http://www.walkingonadream.com/

So yes, I studied for a few hours before we went, and then we left early when Arcade Fire played -- they sounded good, but not exactly energetic. But I'm glad we went. It's such an Austin thing to do and you know me....I loooooooove Austin. Which disgusts Dani, all she wants now is to move to NYC. She's too cool for Texas as she tells me. Tonight she said she's going out to meet friends, I ask her where and this is amusing: she blushed, embarrassed, and said "well....we're going to the football game...." Yes, my precious 17 y.o. daughter thinks football is silly and beneath her. Not sure how her friends talked her into it, but they did.

Anyway, I've got a backlog of work to do this weekend because all I did this week was study for Patho. It paid off, but here comes the price. I have two write-ups to do for Advanced Health Assessment, basically my examination of my lab partner's skin and EENT (eyes, ears, nose and throat). And yes, my favorite class: Psychosocial Nursing - I have to turn in a plan for a paper with references, etc. My topic is healthcare for the gay community and how their different needs/concerns get addressed. Seeing that "Don't Ask, Don't Tell" finally came to an end this week gave me the idea.

Oh! And guess who's playing here on December 29th! Better Than Ezra! Can my life get any better?

My Life Now

I am settling into the life of a student. I have class 3 days a week and Monday is a killer - from 9:00 am to 7:30 at night. I will be adding a day of clinical next week. My Patho class, as feared, is the hard one but I think I will be able to handle it. There are two instructors, and one I seem to click with more. I bet I can get most of her test questions right. The other one is the question mark, but I plan to go see her next week to get a feel for her philosophy on test questions -- is it lots of patient scenarios, asking us what to do next? or is it more along the lines of left-sided heart failure causes which of the following symptoms? A little discussion won't hurt.

It's a lot of material. Here's a shot of my notes. Yes, that's Crabby's paw. She likes to "help" me study. I think I spend more time moving her off my books than reading some days.

I can see that I've let some other parts of my life slide. I haven't been in the pool in a week. I haven't made some appointments that I need to make. I haven't been good about returning calls (if that's to you as you read this -- sorry!). But the good news is that things feel quite manageable. My Advanced Health Assessment class has no exams -- unless you count them critiquing our physical exams as we perform them on a guinea pig. We have a quiz every Monday on the readings that we should have done, and I'm happy to say I got a 93 on the first one. And here's the thing -- it was, by far, the easiest test I've ever taken in a nursing class. It was basically a check to make sure you'd done the reading - nothing tricky, a little basic memory things. One of the two things I missed was where on your hand do you check for vibrations in a patient's body (where do you apply your hand to the patient's body part). The answer is the ulnar portion. This is the flat part alongside your pinky. I'm sure it was in the book. I think the ease of the exam is the correct approach -- this is a class on learning how to PERFORM skills and that's where we'll be graded.

We have ACL (Austin City Limits music festival) this weekend and we'll be attending on Sunday. I probably won't be in spin class as usual on Monday at 5:30 am, but other than that, I expect to do everything on Monday at school as usual. It's up to me to spend the next 3 days preparing and making that happen. And guess how many chapters I need to read? It's 8. Kind of ridiculous, but nursing is nothing if not an overwhelming amount of information. I mean, the education time stays the same in spite of all the medical advances being made, so guess what.....they just cram it in there. Because it's all important.

My psycho-social class has an interesting real-life experience component. It's on culturally competent nursing; being able to work with people of many different cultures. A good thing to know, and a good goal for someone in the helping professions. The professor decided that she didn't want to keep us so late at school (the class should be 3 hours, it's the last one of the day) so she lets us go after two hours. Which is a big relief on long Mondays, but here's the kicker....we have to make up those hours in "cultural contacts" with people different from us and then write a paper about it. Again, a good goal - let's make it real - but we have to go out and find those people ourselves and we're not allowed to use our workplaces or classmates. I'm wondering how to line this up. It's quite a stretch - get waaaaay out of my comfort zone. (that probably is the point, right? ha) I have no idea how to line this up. I thought about utilizing the place where I volunteer - AIDS Services of Austin. I'm sure I'll find this a valuable experience when it's over, but getting started is proving hard. More to come.

Anyway, I'm going to go study some Patho.

First Week of School

I've finished the first week of classes and so far, it's close to expectations. I can see that I'm going to get to know this corner of the UT campus very, very well. And it is a corner (southeast) - the nursing building is pretty new, right across from the Erwin Center (pic below). There's a nice parking garage behind it, convenient but pricey. So different from when I was a student. UT seems to have invested quite a bit in parking garages in the intervening 30 years -- well, just in buildings, period. I haven't been to palatial Gregory Gym yet, but I hear it's better than Lake Austin Spa.

I actually spent a lot of time in the basement of Gregory back in the 1980's. I was just learning how to lift weights and they had a decent weight room and a pool. But I'd never call it palatial - I think some of us called it dirty. It was. The summer that Shawna came to Austin & we lived together (1983), we would routinely walk from our little west campus apartment over to Gregory, lift weights together then hit the pool. I can remember vividly that we were singing together some of the songs off The Police's Synchronicity album as we walked some days. When I went to get my official UT ID card, I actually parked on the spot where our apartment used to be (yep, it's a parking garage now), walked along the drag, then crossed over to the Academic Center and stood in line with 18 year olds to get my card. And the ID looks awful (but my school of nursing ID looks great - and that's one I'll wear every day in clinicals). It was an intense deja vu experience - I had not repeated that walk, one I did countless times, since 1984 when I first graduated. I expect to feel that way again.

My Advanced Pathophysiology class is the hard one. Some say it's the very hardest class of the entire 2 years. I am taking it pass/fail, but it's still going to require lots of study. I feel a bit disadvantaged in that I've only been a nurse for 4 years, and then pretty much out of the med/surg milieu for over a year, but wah, wah! -- some people haven't been in school in decades and some folks (the "Alternate Entry" students, accelerated second-degree) haven't even practiced as nurses yet. So I'm not feeling sorry for myself. I liked the professor, she displayed a little humor and personality and seems to be smart. I just hope her test questions are fair. Yes, I know that's an entirely subjective evaluation, but I found in the first go-round of nursing school that was a critical item. Is your purpose to see if we can apply knowledge or just to show how tricky and clever you think you are? Anyway, I'll find out in a couple of weeks. And typical of a nursing class, the assigned readings for the first day included 5 chapters and some extra pages beyond that, too. And there were 5 powerpoints to go with them, but she only covered two of them. We just have to know the other three. Good thing I like to read. And yes, about diseases, especially gross ones. You should see some of the pictures in this book.

The other two classes feel more do-able. One class is really a two-fer, it's Advanced Health Assessment with a large clinical component. I'll be doing 4 hours of lab and 4 hours of clinical per week for that class, and have separate written work for the labs. But this is so cool - I got my 3/4 length white lab coat. I feel soooo much like an APN now (Advanced Practice Nurse). In healthcare, only docs and APN's wear this distinguished looking lab coat. I was fearing they would expect us to wear scrubs to clinical - something I really don't like - but no, we get to wear the lab coat over "professional dress". This will be a time-consuming, important class that basically teaches us to take in a patient off the street, perform a thorough history and exam and then do a differential diagnosis. Now think about that. People come in with a wide mix of issues - and even though I'll be a psych nurse, they will present with medical as well as psych problems. I have to parse those out and refer them to another provider when it's necessary. And it's my decision about whether it's necessary (& I can hear the other nurses chime in....."and it's your license on the line").

The last class is Intro Psychosocial Nursing, focusing on cultural diversity. It will be interesting, certainly a topic I've been exposed to before, and I don't expect this class to kill me. A gift from the professor - we don't have a textbook. She posts PDF's of articles for us to read for each week. Also, she's a New Yorker. I could listen to her all day, just reminds me fondly of Jersey.

Something cool that coincided with the first week of class was Austin Fashion Week. Dani and I were invited to a show at Anthropologie and it was really pretty neat. We saw about 20 new outfits on the models and then we were let loose to shop. I liked that they used "real" models -- many of them were saleswomen from the store. It's easier to judge how something will really look when a woman is not a size 00. Dani bought some J Brand jeans that she has decided she is in love with. They served cookies and champagne. And yes, we're decked out head to toe in Anthro, even bought our purses and shoes there. See why we were invited? ha.

Dallas Weekend

We spent the weekend in Dallas. Saturday night we saw Death Cab for Cutie and it was excellent. The band sounded so good. Our seats weren't the best, but they were close to the exit and we were able to get out of there quickly -- basically get back to the hotel in 15 minutes -- so it was worth it. Especially when it's after 11:00 and waaaaaaay past my bedtime. They opened with "I Will Possess Your Heart" -- one of my favorites and it was all good from that point on. Some other high points were "Kath" and "Soul Meets Body" (of course). I really wanted to hear Marching Bands of Manhattan - that's my favorite song of theirs - but no dice. They did play a lot from Narrow Stairs, one of my favorite albums. The opening act wasn't bad either, silly name: Frightened Rabbit. And yes, we were some of the real oldies there - their audience is quite a bit younger than the band - every concert of theirs may not be like that, could be it's just the proximity of UT-Arlington to the venue. But hey, I'd rather be mentally younger than older. You won't see me at a Crosby, Stills and Nash revival. Although, I must say that some of the rock acts from the 1960's are really timeless. I mean, who wouldn't have wanted to see the Beatles or the Stones back then?

On Sunday, we went to the Kimbell museum. They have a Picasso and Braque exhibit on their collaboration and creation of cubism in about 1910 and I was impressed with it. Well put-together and informative. They displayed lots of prints first and then a separate room of oils. It was a nice way to do it, like the warm-up and then the full flowering. I learned a lot more about the artists and about cubism. One of the sad things to me was that Braque sustained a severe head wound in WWI after all this creativity and he was never the same again, as an artist or a man. Fits with my experience of head-wound patients, it's one of the things that you basically never want to see happen.

I hadn't been to the Kimbell in about 30 years and this was interesting: I had one of those childhood-remembrance things. It was so much smaller than I remembered. The last time I was there, I went with a college boyfriend who was (& I hope still is) an artist and I was seeing it through his eyes and under his tutelage. The gorgeous lighting is still there; they have such an impressive, innovative system of natural lighting though out the entire gallery. Here's a shot of how that system looks up on the ceiling. But it certainly was quite different than all my memories.

We saw the strangest mix of the sacred and profane on the billboards between Austin and Dallas. There was one that said "Suicidal? Call Jesus." With no phone number; helpful. And then one with a big busty gal in a bikini advertising truck alignment. Hmmm, wonder if she's crawling under the rigs in that get-up. A big picture of Obama with the word "Socialist" in huge red letters. And then the weirdest one of all....a nervous-looking sweating cucumber, big words that said Stop Vegetable Abuse and in much smaller letters at the bottom, a recommendation to use condoms. Um......OK there.....message received. I still can't quite believe I really saw that last one, but Ken saw it too. Really. I'm not kidding. No, really, I mean it.

Two other things I'll mention quickly and certainly elaborate on in subsequent posts. We got a new kitten to keep Gary company. We got her at the Town Lake Animal Shelter and she is 3 months old. We've named her Mrs. Crabs (goes with Gary - get it?) but we call her Crabby. She is the opposite of that name however - super affectionate and sweet, basically Gary's opposite. So far they are getting along well.

The tone of this blog will change in the next week. I am going back to school to become a psychiatric nurse practitioner and it's going to be a really interesting two years. I'm returning to my alma mater almost exactly 30 years later and what could be more interesting than psych...I mean you should see some of the names of the classes I'll be taking...well, you will because I will certainly be talking about them. I'm not changing my blog's name, but the focus will definitely be different. So dear reader, you are forewarned.

Way Cool and Way Hot

I had an absolutely great three days. I went to Cathe Friedrich's shrine in Glassboro, NJ (my workout guru -- I've been doing her home exercise DVDs since 1999) for her annual road trip weekend and then on Monday I received word that I have been accepted into graduate school. I'll be going to the "the university" as they say here in Texas (UT) to become an FPMHNP. What a mouthful. That stands for Family Psychiatric Mental Health Nurse Practitioner. It's an advanced practice nurse that works with a psychiatrist but performs many of the same functions that the doctor does - I will assess patients, manage their treatment, do brief therapy, and (ta dah)....I have prescriptive power. The psychiatrist I work with may want a pretty close working relationship where he/she is involved in a lot of decisions or it may be very hands-off -- just a resource that I use when needed. Well, I couldn't be more excited. Yes, and very scared. It's a two year program, very intense, many clinical hours. But I love this field - it's truly my life's work - and I'm ready. I realized I'm going back to UT almost exactly 30 years after I was first there and got my business degree -- is that weird or what? How many people can say that? And ...gulp.... I start August 24th. Yes, in 3 weeks. WOW.



The Cathe trip was actually a tad disappointing. She had just finished filming a new series and I could tell she was fatigued. She skipped some of the interactions that usually took place and all the events started late. Now, if you know me, that's a pet peeve of mine. Standing in the workout room under those big-ass fans, shivering for ten minutes or more just wasn't fun. I also took time to talk to Chris, her business manager, like I do every year and he sounded tired as well. I asked what were the next road trips planned (she did one in Texas last October) and he basically said none....they're too darned expensive. And I asked what was next for productions and his response was "oh, nothing special, more of the same". Not what he usually says. Anyway, it's all OK - I've bought every series she's made since 1999 and don't plan to stop that -- she's absolutely the gold standard of home workout queens. Maybe too, I'm just jaded. This is my sixth road trip, after all. But Cathe still inspires me and I greatly admire her. She's so warm & real, a true anti-diva. Here's a pic of us together.



The kids are happy and having a good summer. Nile is the camping fool. He's done sculpture, ceramics and dog camp (2 weeks with the dog). Karate camp is next week. Whew. Dani is back from New York and is out with her friends or with my parents, it seems like all the time (which is fine -- she is 17, after all). Last night she went to the Kesha concert. She said, "goodness what can I wear?" I looked at her like she had three heads....I mean, we shop together at Anthro and you could arguably say that we both have a clothes-buying problem. I mean, her closet is full. Ah, but I'm such an old lady....apparently one must dress just like Kesha to attend her concert. And Kesha dresses rather, um, interestingly. Let me give you idea -- here's how they looked at they left (ha). You can't see her nails but they alone took an hour to do -- three different ghetto-fab colors with the crackle effect. It did look pretty cool, I must admit. Dani is such a girly-girl, she loves that stuff. Hmmmm, wonder where that came from?





And next weekend, Ken and I go see Death Cab for Cutie in Dallas. I'm really excited about that. Their video You Are a Tourist is nominated for an MTV award this year. A lot of their songs really speak to me, I think it's the existentialist thing. It was interesting to hear them explain where that comes from on "Storytellers" on VH1 (a great show, BTW, and yes it's still around after all these years) -- it's from Catholic school. Yes, even when one grows up and learns to reject dogma and superstition, there are remnants. And interesting ones, too. Who'd have thunk it? We're going to stay in Dallas an extra day and visit the Kimbell. I haven't been there since the 80's -- which is kind of embarrassing. I think it has the best natural lighting display of artwork that I've ever seen. And this hot, bright Texas sun should really be good for that now. Good lord, I like it hot but 107? I was out in that heat and it just takes your breath away. But you know what's good about that -- pretty soon I can wear shorts and flip-flops every single day! Cause I'm a student! HA!

Better Than Ezra in Tulsa

Ken and I went to see Better Than Ezra in Tulsa. Yep, we flew to Tulsa for one night just to see my favorite band. At a casino, none the less, with cheap tickets. It was a marvelous show. The band played really well, made lots of jokes with the crowd and seemed to honestly have a good time. The other part I liked was that it finished by 10:00, so my bedtime didn't get screwed up too much -- ha.

Kevin Grifin, the lead singer, has an incredibly expressive voice and not only did he sing the songs I love, he played around a little with silly stuff, like imitating Rush. It was kind of like being in on a practice gig, with the guys just goofing around, but with an awesome sound system. They even made a big cowbell joke with their new drummer. I need more cowbell.

They did one of their biggest hits for the last song - In the Blood. It was a great way to go out. They only played 3 songs off their newest album, and to be honest I wanted to hear more. They told the crowd that they'll start recording a new one in November, which will be excellent since it's been 2 years now.

And Tulsa was interesting. We looked up a Lebanese restaurant online and found something called Eddy's Steakhouse. It was the oddest little place. A tiny, dirty, old windowless dark room. We knew something was up when we saw it - just a really old sign that said "Eddy's". Nothing else. The door to go in was around the side, unmarked and a little confusing. There's a guy sitting right beside it as you go in - like an usher - and it's so incredibly dark, he needed to guide us to the table. So the menu is quite simple - every entree (which aren't Lebanese), comes with an array of Lebanese appetizers. Tabbouleh, hummus, salad, and cabbage rolls. Which was all tasty, in fact their version of tabbouleh gave me ideas on how to improve mine. But the entrees were really so-so. I think the steaks would've been good, but we ordered fish.

We stayed in this old hotel, the Mayo. Art Deco, very beautiful. And deserted. Downtown Tulsa on the weekends is very quiet. Sunday morning, we went to the Philbrook museum. It was a gorgeous mansion built by the Phillips oil company family. Breathtaking grounds and quite a variety of art to look at. They have a Rauschenberg exhibit, native American works, photographs and even impressionists. It made for a nice afternoon.

And here's something way cool....we're flying up there, on Southwest of course, and I notice the guys in the seats in front of me are too cool for school, or at least for air travel. They are wearing their shades on the plane. I take a closer look and OMG....it's THEM! It's the band! Tom, the bassist was sitting directly in front of me. I was too shy to say anything, but luckily my husband wasn't. Ken leans up to them and says "Hey, does BTE mean something to you guys?". They laugh & say yeah, we tell them we're coming in just for the concert & it's a little Hallmark moment. Tom gives us an inside tip when we say we're from Austin -- they just signed on to play at Austin City Limits in September. Man, I sure hope it's on Sunday since that's the day we have tickets. So I just have to say this -- even rock stars fly on Southwest (if you've read my blog in the past, you know I love Southwest).

Meet Racer

Nile is in dog camp this week, and he is working with a dog from the pound (or a "rescue dog" in more politically-correct terms). His dog is named Racer (an inside joke, more on that later) and is a 3 year old black Labrador retriever. Here he is.

We went to the camp location Sunday, for them to talk to Nile and try to match him to a dog. But when we walked in, they already (apparently) had decided that he would take Racer's foster-brother (I know, funny, huh?), another black lab named Cyrus. Now Cyrus is a pretty big, powerful-sounding moniker, isn't it? Yes, Cyrus was a really big, wild boy. Nile tried to be a sport about it, but Cyrus was dragging him all over that room. I could see that he wasn't digging it. And Racer (who is smaller and much, much calmer) was just watching. Pretty soon the camp staff offered Nile to have Racer as his dog instead. We took him outside and in my very non-dog-expert opinion, Racer was a good dog. Easy-going. His only character flaw seems to be that he likes to slobber. But he doesn't jump on you or bark a lot, and doesn't yank you around by the leash.

Well, it's day 4 of camp and I would call it a success. Here's a picture of Nile with Racer. He looks pretty OK with it all, huh? (I mean Nile, ha.)

Today they were supposed to bathe the dogs and tomorrow they have a little showcase where the dogs do tricks that the kids have taught them all week. My mom will go to that, because since it's Friday I'll be at work. That's a bummer, but Fridays I work with Bethany and Curtis, so we'll be having an enormously good time. It's wonderful to have co-workers that you not only respect and learn from, but also enjoy and laugh with. And they are both that.

It remains to be seen if Racer will join our family. Nile has another week of dog camp, so we are delaying the decision until then. Nile is worried about how Racer will affect Gary, our cat. So we'll have to talk about it and figure out what to do. And the assumption of responsibility is significant.

Dani is loving NYC. Got a text from her -- guess what? She needs cash. And she went to see Spiderman on Broadway -- loved it. Oh, and the class at Columbia is hard. What? Classes are hard there? Gee.

Diagnosis, Families (Sigh) and Stuff

Interesting things are always happening at work. When I take report from the night nurses in the morning, we usually have a few things to chuckle about, but Tuesday absolutely took the cake on this. I had three patients with different delusions that were, shall we say, unusual. The first had the delusion that a Doritos truck is following her. Yes, it was that specific. I can see why that would upset someone, especially if you are interested in keeping your slim figure. The second patient believed that a vibrator was stuck in her vagina, in spite of the fact that she was thoroughly examined in the ER by a doctor and there was no contraband in there. This delusion was part of a complicated set of beliefs she had about an ex-boyfriend; he was stalking her, he had put the vibrator in her, and he was living in her attic. The last patient thought that there was a little (very little) two-year-old child in his pocket. Isn't psych interesting? Really, it truly is. Most delusions involve some degree of paranoia (you can see that in the first two), and the most common focuses are religiosity, sex, and persecution (often by the government).

Most people think delusions only occur with schizophrenia, but nothing in psych is that clear-cut. The brain is so stunningly complex, most disorders are actually pretty unique to that single person. Disorders often overlap in symptoms. The field of psychiatry is fairly new so it's evolving (there was an article in Newsweek this week about the explosion of bipolar diagnosis in children -- the author thinks it's being overused). And since you can't diagnose with a blood test, communication with the patient is key. If that's limited, your diagostic task is going to be pretty tough.

At the end of my shift Tuesday, one of the techs told me that a family member wants to talk to me about one of my PICU patients (incidentally, she was one of the three patients I mentioned above). Now, it's 15 minutes before I go into report and I could have handed off this task to the next shift. But I know that I would not want that done to me, so I talk to the family member when we finish report. I have seen the patient all day, so I am in a better spot to respond to questions with knowledge. Unfortunately, I can tell right off the bat that this family member is very pissed off. She states that she thinks the patient hasn't made enough progress -- which is amusing, since she was admitted less than 24 hours ago. Does she think we give them one pill and they're cured? She asks numerous questions about things outside my scope of practice -- things that only the psychiatrist can answer. But I know that if I curtly refuse to answer, it won't go well so I shift the focus to what I can talk about -- how the patient coped that day, what activities she did, what medications she is on, how she responded to staff. That goes pretty well.

But her last question is when it falls apart -- she wants to know what's the diagnosis. (By the way, all of this is discussed with the patient standing there, listening. Which is actually better, as being open and direct is my preferred way to do this.) I tell her that the diagnosis is bipolar with psychotic features. Her nostrils flare. "Oh, that can't be right," she exclaims. "She has delusions! She is imaging things! That's not bipolar. That's schizophrenia." So I have someone who read an article once about mental illness and is now an expert, I think to myself. Oh boy. How to encapsulate a complete course in mental health in five minutes to educate her? I try, but I can tell that I've failed when she says "Well, that's all interesting, but I want to talk to the doctor." Unspoken, of course, is that I'm just a stupid pill-pushing nurse. Oh well, I tried. And all that effort just made me 30 minutes late getting home.

Dani is loving New Jersey, and I can see why from the pictures she's posted on Facebook. It's so green and lush there now, compared to Austin. Jersey has beautiful summers, I miss that. She also got good news on her SAT -- can I brag? She got a 2010. Exactly what she predicted, by the way. The airlines have found a way to extract more cash from parents of spoiled little princesses, by the way. When we put her on the plane to Newark, the bag was 8 lbs overweight and we had to pay $100 for that. And guess what....she'll have to pay another $100 on the way home. I'm sure it will be much more than 8 lbs overweight then.

One last thought. Dani and I went to Victoria's Secret right before she left, and they had a specially-trained bra-fitter there. So we both got fitted and boy....we were wearing the totally wrong size (especially her). We bought new ones in the correct size and WOW, huge difference in both comfort and appearance. Every woman should do this! And VS must be really happy, because I have five new bras now. Ha.

Pool Party

We had a great pool party with our friends, Jeff & Therese DeMouy and Robert, Laura, and Thomas.

The weather was perfect for it, and we had barbecue from County Line to enjoy. The splash attack was in full swing with six kids to take part (I guess the teenagers still count as "kids").

The night before, Nile and I joined them at Dart Bowl for a little bowling party. This is a great Austin place, it's got a serious 1970's bowling alley atmosphere going on. We'll definitely be going back, especially since Nile really enjoyed it. It helped that they had sour skittles in the vending machine.

Ken came down from Houston for the party and was able to seamlessly work from home on Friday. Hopefully he'll be able to start doing this once a week and have a regular 4-day week in Houston. Things are looking good for that.

Nile has his "dog camp" interview next week. They will try to pair him with a dog where their personalities mesh well. And today, Dani and Idil left for New Jersey and for their summer program at Columbia University. It feels a little strange to send your child off for 5 weeks but we did it without tears. I'm working every day this week, so that'll keep my mind off her. (She's fine this week, she's back in Clinton with Idil. It's next week when I'll start to worry, as that's when they'll be at Columbia.)

I'm down to just working on my personal statement for graduate school. Oh, it's so much fun. I think I'd rather have my toenails ripped out with pliers, and that would truly bug me because - wow - talk about ruining a pedicure. Ha.

Couple of Things...

Couple of things that I forgot to post. Nile turned 15 yesterday and Dani and her friend Idil are going to Columbia University this summer for a high-school science program. It's a great opportunity for her and she is terribly excited to be going back to the northeast, especially to the city.

We had a little party for Nile at my parents' house yesterday. Here he is by the cake. He starts dog camp in a couple of weeks, and he finished sculpture camp last week. Dog camp will be interesting -- he will train a dog from the pound. Learn about how to do that, learn about dogs in general. We've never had a dog, only Gary the cat. So lots of new things there. My brother Colin gave Nile a dog toy for his birthday - ha. Colin has always had a dog. Sculpture camp was interesting, but it turned out it was in far East Austin. It took 45 minutes to get there, on a good day. The last day with the ROT Rally going on, it took even longer. Not sure I want to repeat that. He has ceramics camp in August & that's at Laguna Gloria, a much better drive.

We picked Idil up at the airport on Friday. She and Dani are experiencing Austin intensely. Saturday they went to the Co-op to buy Keep Austin Weird shirts and then they went to the Matt & Kim concert at Stubb's. We will visit Fonda San Miguel, Barton Springs (or maybe Deep Eddy) and the Salt Lick sometime this week. They leave for New York on Sunday.

I wish it would rain. The weather report is amazingly, boringly the same, every single day. High of 99 or 100, low of about 75. Not a cloud in the sky. No rain. Everything is starting to get a terrible brown.

The DeMouys are visiting from Baton Rouge this week & we'll have them over for a big pool party on Thursday. Ken is able to come home early for that.

Settling In

It's been six months since an update -- too long, but indicative of how settled in we are in Austin. We've been here almost a year. I have absolutely no doubt in my mind that I will ever leave here, it just feels like me. I'm as funky and freaky as Austin (yes, you can't tell when you first meet me, but it's there).

I bought a new car, it was past time when I needed the mom-mobile and time to return to my sports car roots. I got an Infiniti G37S with a stick shift. It is so much fun to drive, it's genuinely mood-altering, especially with the sunroof open and the new Cars CD playing. After a long 12 hour shift, I so enjoy driving that baby home along Bee Caves Road into the sunset.

Dani and I went to Houston and stayed with Ken. We went to the butterfly exhibit at the museum and it reminded me so much of the rain forest exhibit at the New Orleans aquarium. Of course, everything there died during Katrina (terrible). I've never seen so many butterflies in one place, and of so many different types too. I'm going back to Houston this summer for a "grown-up" trip. And Ken and I are going to see both Better Than Ezra (in Tulsa) and Death Cab (in Dallas). We have serious fun planned for this summer.

Some big things are coming up/happening now. My sister Holly has moved back to Austin. We're so happy she's here. She's a serious Austin-fun maven and I am so looking forward to getting the 411 from her and going out with her. We are 20 years apart and I never lived in the same house with her -- and we're the most alike of the kids (go figure). So this is a great opportunity. Here's a picture of us on the bat cruise on Town Lake (yes, I know the correct term is Lady Bird Lake). We look like mother & daughter, don't we? But we're the oldest and youngest of five.

The other thing is that I'm applying to graduate school at UT to be a psychiatric nurse practitioner. Normally I would've had to wait until December to apply to get in the following fall but they extended the deadline. The school received some special funding for psychiatric training (there's a crying need for it in Texas) and they also needed more applicants. So I'm going to go for it. No idea what my chances are, but I am going to take the plunge. I took the GRE a few weeks ago & did good enough. Now I'm collecting materials to send it (writing an essay, getting recommendations, transcripts). If I get in, I'll start school in late August.

Oh, and I lasted exactly 3 days at my new PRN job at (ahem) a competing private psych hospital. My god, those fools were so disorganized and they were pressuring me to work like a fricking dog. I'm sorry, but I am NOT willing to work 6 days a week! And they are (in my opinion) over-controlling and don't trust professional nurses to behave as such. Every single order a nurse takes off has to be checked and counter-signed by another nurse -- is that ridiculous or what? I would spend all my time running down a nurse to sign my damn papers. OK, guess it shows how exasperated I was with them -- enough said. I completely appreciate my present job now. I got to take a full load of PICU patients Tuesday because Kathy was on vacation and it was challenging and interesting. Too many wild young guys (as usual, think it's because ASH is on diversion), but we cracked the nursing whip and handled them. As Gilbert used to say, I'm not a nurse sometimes, I'm a zookeeper. It was like that. But in a good way (ha).

So life in Austin rolls along. Oh, did I mention the pool? Sigh......99 degrees....I'm in love. That's all I need to say.

Ski Week!

We went to Angel Fire, New Mexico the week after Xmas to ski. It was a good trip: no broken bones and some good skiing. We first drove to Ken's Houston digs and then took an early direct flight to Albuquerque. This is a good way to do it. Our flights were on time and only 90 minutes. In Albuquerque, we had a little surprise: Holly! My sister Holly was stranded there, unable to return to New Jersey because of the massive storm that shut down all the Northeast airports. So we flew in, picked her up & took the road to Santa Fe. In Santa Fe, we ate, drank, bought some art and jewelry and just had fun in general. Here's a family pic of us in Santa Fe.

Santa Fe was chilly but sunny and delightful. We enjoyed our morning on Canyon Road, browsing the galleries. We really only needed to buy one painting but when Ken saw Robert Taylor's new works, he had to have one. Not sure where we'll put it, maybe his Houston apartment? Anyway, it's a wonderful work, it's titled When Magic Becomes Medicine, it's the top left painting that you'll see in this link.

http://www.gallery822.com/artists/taylor/taylor_main.html

I have to tell you, the best margaritas I've ever had are at the Ore House on the square in Santa Fe. They are small but pack a punch. Holly, Dani and I ate and drank (Dani had the virgin one, of course) all afternoon.

After that, Holly caught the train back to Albuquerque and we took the high road to Taos and then on to Angel Fire. We had a condo right on the slopes - walk to the lift. We skied the next morning but a storm was coming in and they closed the lifts mid-day due to high winds. So we went to Taos and spent the afternoon shopping (a tragedy....ha). Here's a picture of Dani in the snow.

We woke up the next morning to a beautiful blanket of powder and had a great day on the slopes. I really felt proud of myself in my skiing ability -- no falls. I exclaimed to Nile: "I didn't fall on the steep part!" and of course, his reply (totally serious): "What steep part?" Sigh.

The following day, however, was just too cold. It snowed again, all night, and the powder was incredibly thick. It was zero degrees, the news said -15 with the wind chill factor. So fools that we were, there was no line at the lifts first thing in the morning and we went up the mountain. It was bone-chilling cold. All my fingers and toes were numb at the top. And this is with the silk liners and the little warmers in my boots and gloves. I had to say to myself "just keep going" to get down the mountain. Nile & I decided not to do any more runs, but Dani and Ken did two more. They are ski champs.

The trip back was uneventful (the best kind) but we did eat at this fantastic Turkish restaurant in Houston on our return. Honestly, they served the best tabbouleh that I've ever eaten and I like to think I'm a tabbouleh snob. Here's a link to the place, I'll definitely be returning there.

http://www.istanbulgrill.com/

OK, so I rate that vacation at an 8. Would've been more if we could've skied a little more. But it still was great fun.