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).