Crab Walk

I haven't worked in nine days and since I'm out of school that means lots of vacation. Lots of yoga, lots of spin. Ha. I read a NY Times article about teaching your cat to walk on a leash (http://www.nytimes.com/2011/12/29/garden/training-a-cat-to-walk-on-a-leash.html?_r=1&scp=1&sq=walk%20cat&st=cse) and decided that would be good for Crabby. So I have spent the last week on that process and I'm happy to say that her first real walk today, outside, went well. And yes, it took a week of prep work to make that happen. I ordered the little walking vest/harness that the Times article recommends and kitty treats are essential. It's completely different from walking a dog but I'm so encouraged by the results today. She is going to make a great walking cat. We did have a visit from Mitt Romney over the weekend (Holly's cat) and he didn't participate. Mr. Romney was an observer only.

It's a rainy day in Austin today and it's funny, Ken and I were out at Whole Foods and Performance Bicycle and at both places everyone says with a big smile - hey! It's raining! The drought has totally changed people's attitudes here about rain. A grey, rainy day is a very welcome thing. Instead of walking around Town Lake, a spin class was a much better idea. But eh - can I complain a little? - the gym is so crowded with the resolutioners. At 10:00 this morning, it was hard to find a parking space. I said, don't these people have jobs? (I mean, I certainly don't have one and that's why I'm here....ha). When we had lunch with Holly, she pointed out that many people have more flexible work arrangements now (like her) and can schedule in gym time in the middle of the day. OK, so I guess my 4:15 a.m. workouts aren't going to change any time soon. Not this month.

I just got an order of books in. $620 for nine books. Yep, you have to be rich to afford grad school nowadays. Kind of ridiculous. I thought I might be able to save money by ordering electronic versions but turns out those are almost the same price as the paper books. And illustrations are a problem. So I stuck with the real deal. Here's a list of the titles, I'm actually quite excited about reading some of them.

Diagnostic and Statistical Manual of Mental Disorders IV - Text Revision (this is the bible of the psych world)
Interview Guide for Evaluating DSM-IV Psychiatric Disorders
Drug Handbook for Psychiatry
Psychotherapy for the Advanced Practice Nurse
A Guide to Family Assessment and Intervention
Family Therapy - an Overview
Theory & Practice of Group Counseling
Essential Skills in Family Therapy, from First Interview to Termination
Synopsis of Psychiatry (this is the biggest, scariest one)

Now, you may be thinking what the heck's all this family therapy stuff? Aren't most people treated as individuals? Yes, they are, and that's where the primary focus of training will be. The family term just refers to the fact that I'll be trained and qualified (and licensed, once I pass boards) to treat all ages --  including kids, which scares me. And yes, certainly some families need therapy in an inclusive way, as do couples. But most people seek therapy as an individual and I expect that will be most of my client base.

This is my last free week before school. I am going to a continuing education seminar on Thursday called "Food, Stress, and the Brain". It's for medical professionals to get their credit hours for licensing, and doesn't that sound interesting? It's all about the latest research on appetite, hormones, weight loss/gain, and the impact of mood/stress. I'll have to post the pearls that I glean from the seminar.

Paranoia

Had a mini family vacation in Houston and then it was back to work on New Year's Day. You'd have thought that would be an easy day -- no discharges, everything is closed, docs stay home, right? I did. But I was wrong. I discharged a patient, accepted a transfer and then admitted one to the PICU. And the admission required me to do a full work-up. During the week, an admissions nurse does all that work but not on weekends/holidays. But it turned out to be interesting. (Again: details changed to protect confidentiality). The young woman I admitted was having a acute pyschotic break, her first. She was taking her cat to the vet with her boyfriend and basically did what we'd call "a freak out". She ended up pushing the vet tech to the floor (nobody was hurt) and ran into the woods behind the clinic. Boyfriend couldn't get her to come out. The police were called and brought her in to us. It seemed logical to her at the time because of paranoid delusions. Paranoia is actually pretty interesting to think about. It's such a common problem in psych, I would hazard a guess that it's the number one complaint. Most schizophrenics are "P.T." (paranoid type). People who aren't psychotic, what we might call normal (I word I don't like....I mean, who's normal?) have a little dash of paranoia, I guess we call it vigilance, skepticism, mistrust.

Personally, I can recall a time in my life where I said to myself, "gee, I feel paranoid." I was working as a aerobics instructor at a gym where the ownership changed hands from  the husband to wife following a divorce. The wife then started dating one of my fellow instructors (a guy, BTW). I noticed that there seemed to be this strange little clique develop that consisted of the wife, her boyfriend, and two of the other instructors. They worked out together, went out to eat, socialized. I wasn't part of it, but I was such a gym rat that I was around these people a lot and ended up feeling very separate. I didn't particularly like them and didn't want to be included, but I also felt at times that they looked down on me and didn't like me. My instruction style was always based on safety and effectiveness - I didn't include exercises for abs, say, that I was taught weren't effective or could strain your back. I noticed that this "clique" seemed to be more about what looked cool -- for example, make your oblique exercises with big arm movements because it looks like you're doing a lot, when actually it is easier than forcing your core to do the work. Do 50 hops on one leg - nevermind that could injure your achilles. It's more imporant to feel like a badass & scream "Alright, do FIFTY!". I got the impression that they talked about my style being uncool and boring. Did I ever hear them say that? No. I think it was more when I would enter the leg room where they were all doing squats together, they'd look over at me and get quiet. It was more expression and affect, not words. Now if I had thought I heard them whispering about me, following me, and that they wanted to kill me & take my classes, well, then I guess I'd have been a psych patient. As it was, it just made me uncomfortable and I quit. But right before I quit, they reduced my schedule of classes, and I wasn't surprised. See, my paranoia had prepared me to expect that.

We went to the Better Than Ezra show at ACL Live (Moody Theatre) the night before we drove to Houston. Good show, excellent seats, but I had a very drunk and horny youngster next to me. I had to keep out of the way of her flailing limbs. She and her date would periodically make out, his hands all over her ass, tottering next to me, I just knew I would have to catch them. And to be honest, I didn't really want to touch them. A paranoid schizophrenic I'll touch, certainly, but not some obnoxious drunk strangers with no boundaries. Ha. She did kick me once. It didn't hurt.

We had a laugh at work - as I mentioned the most common type of schizophrenia is paranoid type. The unit secretary that entered my new admit's diagnosis into the system, however, didn't quite grasp that and typed it as "paranormal type". So we had a discussion about how that could make for an interesting patient. Could they move objects? Hear our thoughts? See ghosts?

I was reminded at work of the value of just listening. I had a patient, one of the read-the-chart-and-weep variety. When he was a teenager, his abusive father gave him a head injury that rendered him mentally retarded, with a significant seizure disorder, and with mental illess. He was upset because my discharge was his roommate and he really wanted to be discharged too. He started making threats about "causing trouble". I judged that he's been in the system enough to know how to create a problem and get what he wanted. But what did he want? Anxiety medication? a shot (some patients like those)? to force someone to pay attention? So I started a conversation with him, letting him take the lead and the charge nurse (someone I normally like and respect greatly) horns in to state that he won't be discharged and why. Apparently she was assigned this patient yesterday and felt the need to remind him that his discharge was delayed. Now this just served to make him more angry. I could see it in his body language and face. He started arguing back with her, and incredibly, she just got louder. She clearly wanted to be right. (and duh - of course, she's right, but who cares?) I had to give her a look (a "shut up" look) and lead him away to talk to him privately. All I did was listen, say "uh huh" a lot. He wanted to vent. We talked ten minutes and then he was fine, didn't even need a pill.

I see this often, it's got to be the most frequent staff error. People want to be right. But you just don't argue with the mentally ill. You really can't convince them that their paranoid delusions are wrong. Sometimes they are asking for information and don't like the answer - like, how long can I be held here on a protective order? Really, 72 freaking hours?! But I know basically not to get into it with them -- let them talk. Listen more than anything. Ask them about their feelings, their behavior but don't lecture, for god's sake, about why they're wrong. It's not therapeutic! Look, I'm not a genius and I'm definitely not the best nurse there, but I did figure out early on who were the best nurses (Kathy, Curtis, and Gilbert if you want to know). I noticed they all shared this trait of letting the patient talk more -- you'll never see them making long-winded speeches to patients, showing irritation, or being insistent, unless it's insistence about delivering an emergency injection (but even then, very little needs to be said).

Yeah - paranoia, the destroyer. (apologies to the Kinks)

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?