Semen

Dani had a party. Here's some pictures. She invited mostly 16 to 18 y.o. girls and it was a pretty good time. Her NJ BFF Idil was here (that's them - the two little white-bread suburban princesses doing a gansta pose). Only one tiny hiccup -- one of the girls had an older brother come along - who showed up with 3 friends and proceeded to hide a 2-quart bottle of vodka behind the pool. Ken observed this and rectified things. Problem averted.

I bathed Morris, our old kitty. I had bathed a cat at the shelter with a blind woman (a fellow volunteer - she did most of the work) so I felt like I could handle this. He smells much better.

Summer school is half-way done. I've started the second session and it's not exactly what I expected. I'm in a class with a bunch of really young ones (all undergrads) and it's a little painful. This is the human sexuality class. Today we did an exercise on the scripts that we have for how sexual relationships progress and it was obvious that none of the volunteers for the exercise have ever been married -- or maybe that was my interpretation, it is possible they were presenting the "ideal" to the class. But seems like they had this fairy-tale expectation. Once you've lived through a few marriages (and especially had a few teenagers), you feel much more relaxed and nobody needs to follow a bunch of rules. I guess it rubbed me the wrong way. Judge for yourself -- here's what the group of class volunteers (about 10 students) produced.

Meet and agree to a date
Date 1 - kiss
Date 2 - fondle
Date 3 - fondle more and start conversation about sex, including contraception
Date 4 - oral sex
Date 5 - intercourse
After Date 5+ - say "I love you"
After Love - meet the parents
After Parents - get engaged
After Engaged - marriage

You know, when I look at that now, I think to myself, that can't be what these kids are actually doing. One of the guys had the energy to suggest that intercourse be moved to date 2 -- he was voted down. Hey, at least he's being honest about what he wants, right? But the outcome is so....predictable. I bet if it was a bunch of 50 y.o. women up there, we would've come up with a little different answer. I couldn't rubberstamp any specific timeline to be honest. People aren't like that - we rebel against that.

I've worked a few days. Friday I got to work with my favorite two guys - Curtis and Gilbert. We had a woman on the PICU that was very manic. You know, I'd never seen someone truly manic before I started working here. It takes some getting used to, you need to grow a thick skin for one thing, because they usually are saying a lot of things, and much of it isn't nice. I actually wrote down a sequence of what she said, just one interaction that I had with her. It was how we started the day together at about 7:30 am, I came out of the medication room and she was at the dutch door. Here's what she said. "I need a shirt and toothbrush. I came in last night and I can't find them. And don't try to give me that toothbrush you guys have - I need my special brush that I use with my organic toothpaste. Oh, but you can't give me that, can you (makes a face and slaps her hands down loudly). The class-action lawsuit that I've filed will take care of that, you will just see (voice is rising). You're looking at me like I'm dumb, but I'm not, my IQ is 1000 so we have a communication problem and it's on you, bitch! (I start to turn away at this point). Hey, when you come back, you need to wipe semen off me."

That's really what she said. About 10 minutes later, in the med room, Gilbert asks me, "Hey, did you get that semen wiped off yet?" And I did look into getting her a warmer shirt and her toothbrush. Just because she's manic doesn't mean that she doesn't have legitimate needs.

Really Crazy Side

We added someone to our family. Meet Morris. He is a forlorn 13 year old cat that we took home from the shelter. I'm already in love with him, Ken hates it when I say that (you can't love something you own!). But he's so sweet tempered, and so skinny and in need of good lovin' and a hot meal. When we first brought him home, he was vomiting and eating poorly and was incontinent. So we spent a lot of money at the vet to find out that a) he's not in kidney failure, and b) he doesn't have cancer. They ended up scratching their heads and giving him a whopping antibiotic shot and IV fluids over 2 days. And it worked. He's so much bettter, we think he'll make it. By the way, Crabby hates him. Really. Turns out she's not a meek, mild little girl after all. Why doesn't she hate Mitt, my sister's big ole boy kitty? I don't get it.

I've worked a lot the last month, it's been been mostly routine. As much as a psych ward is routine. Very few emergency injections, I think I gave only two, and one of those was a big learning experience. We had a young 21 year old woman, very slight, she weighed about 90 lbs. and she had a little freak-out that involved pounding on walls and screaming. She clearly needed sedation. One of the docs (not her assigned doc) was there, so we quickly got an order and did it. Within minutes, we put her to bed. But later, she stumbles out and almost falls. She's very pale, we take her blood pressure and it's scary-low. We force her to sit up and drink fluids, she's able to respond to questions although she keeps asking to be put back in bed. We call the doc and he says to force more fluids and assign a watcher so she doesn't fall. And he was mad -- the thorazine dose was much too large for someone so small. We repeated this little event a few hours later. Important lesson-- dosing is important, and ask about the patient if you don't know them. Overall, this is a lesson I'm familiar with: Don't be in too much of a hurry. Check it out. We've had a lot of younger patients, many college students, who got in trouble with drugs. That stuff they're selling called Bath Salts or Spice (synthetic marijuana) is really lousy crap that needs to be illegal. You should see how kids behave after ODing on it. And how long it takes (ever?) to return to normal. I think they've permanently damaged their brains. Makes me mad.

Conversation overheard between two patients starting to make an acquaintance: "How long have you been here?" "Oh, three days, they just moved me over from the other side (meaning the PICU)" "Oh! Isn't that the really crazy side?"

Class is almost over, it ends July 5th and it feels like I just started. It's been shockingly easy, basically show up, do a little reading, write a few paragraphs each week and do one group project. That's it. Wish I could've knocked out two nursing classes like this. I start Human Sexuality after that. If that's not a fun-o-rama, I'm going to feel cheated.

My class is on Healthcare Policy, and it's actually quite interesting and I've learned a lot. It's inspired me to become politically active, so much about healthcare needs to change. I'm going to attend my first PAPNA meeting on Wednesday, that's the Psychiatric Advanced Practice Nurses of Austin. So next time, I'll talk a little about that.

And It Starts Again

Started summer school Thursday. Feels like nothing really ended, but that's OK. The class, on Healthcare Policy, appears to be very manageable. I'm even planning to work about one day a week. Enjoyed my review class in Boston, although I'm very angry at Expedia and will never, never use them again. I paid for my room, at $440 a night, at the Boston Sheraton because that's where the course was held. I paid for this 2 months in advance. Friday night before I leave on Monday, Expedia tells me that due to a "system error", they have to move me to a hotel 5 miles away. I talked to them for over an hour, spoke to the supervisor, to no avail. The hotel contact really wanted to help, but they were having a telecom conference at the same time and were completely booked. She said that Expedia does this all the time -- they oversell their rooms and then move people. So if you care about where you stay, don't use them. 

Nile and I have had some good times at the Austin Animal Center performing cat care duties. Here's Nile with "Noisy" as they named him. He is a tiny kitten who can't bear to be away from people & will cry and fling himself against the bars when left alone. Someone really lonely needs to adopt this little guy. We clean cages, talk to customers, feed cats, and of course, play with them a little. It's great. And they really need cat volunteers badly. Seems like everyone wants to work with the dogs. We are thinking about fostering some kittens, we got an email Friday that the shelter is "negative 8" for cat space -- meaning, eight cats are sitting in carriers because the cages are full. Look at these statistics (shocking): in May 2011, the shelter took in 750 cats. This year, we took in 1000. Something is terribly wrong with that and it points to a serious spay/neuter need in this community. I know that Austin offers this service free, but obviously people aren't utilizing it. I wonder what we could do to make it easier and more accessible? 

Dani graduated. Here we are at her graduation party. She has a summer of nothing ahead - well, nothing required, let's say. Idil will visit, she's going to Houston for a week, and we've talked about her taking a nurse's aide training class, but it's a lot of time relaxing. We bought tickets for the NYU delivery in August, we'll spend about 3 days in the city. (that's what they say up there in Jersey - "the city". I'm cool, I know the lingo. ha.)

My good friend Karen retired early from XOM so I'm going to Baton Rouge at the end of June for her party. I'll see some people I haven't seen since I left in 2005, should be interesting. My life is so radically different now. I'm a nurse! I'm a student! And I'm so lucky - I live in Austin!

I've worked a lot in May. I've had two patients with interesting cases - one has Renfield's syndrome, which if you look up, is clinical vampirism. Yes, he believes he's a vampire, namely he receives sexual stimulation from consuming blood from his partners. And he really looked the part, I must say that he put some effort into that, down to the blue nail polish. Won't say any more to preserve his anonymity, but this is the first case of this I've observed. The other patient was someone who we first believed to have squeaked in through the cracks - we are not a forensic unit, meaning we don't take patients who've committed crimes as part of their recent hospitalization, but we certainly have a gray area around that. For one thing, they can be under investigation but not charged. And we have many patients with a criminal history - every day I'm there, at least one patient has a tear-drop jail tattoo on their face. So this guy was under suspicion of killing his wife, then making a suicide attempt. Last year, I had a patient with this exact same scenario (who ended up being convicted) and both of these guys had a very similar affect -- they were wooden, dead, "flat" in our terms. How are you today? "fine". Are you feeling suicidal, as you were when admitted? "no". Have you attended group therapy and found that helpful? "no". Tell me why you haven't gone to that. "don't want to." And so it goes. Eventually you give up. Later, I was told that murder charges weren't going to be filed against him, just domestic violence ("just") although that could've caused the death. Not a good, solid endorsement.


I've been able to swim almost every day now - it's divine. Ken and I walked the Lakeway trail last night and the little streambeds are all full of water. Vastly different from last year. Cross my fingers that it continues.

May

The semester's over and I have a little time to do less and not be burdened with constant thoughts of "oh, this is great, but I should be studying...". I've worked a few shifts and will work some more. Friday I was on the   PICU, so the fun really started.

I was driving home from my last clinical day at the pediatric clinic and was listening to Fresh Air. You know, Terry Gross on NPR, station WHYY (that was my station in Jersey). She was doing an anniversary show, a "best of" and it was good. Nick Lowe sang his song, "What's so Funny about Peace, Love and Understanding", a song I've always liked, mostly the Elvis Costello version. And I had just read an article the week before -- Nick gave a concert in town, and he did an interview with the Statesman, talked about that song in particular. I think this all happened on the day that our President came out and stated his support for gay marriage. I thought, wow..... not a coincidence. I mean, that's what always, always pops in my head when people make bigoted remarks about the civil rights of the LGBTQ community -- tell me, exactly what's so funny about peace, love and understanding? Because make no mistake, that's what we're talking about here. You can stand behind your book all you want, but I notice you're not doing it for some of the other topics in that book, like trying to bring back stoning. So. Let's reelect this guy, alright?

I got sunflowers and chocolate-dipped strawberries for mother's day. And I got to eat some of them this year, Dani held off until I got home. Ha.

The last 3 weeks of school were hard. I found myself thinking, why does this feel worse than the stress of work? It usually does, I guess I can think of a few work-related times in my life where the stress was higher than school. Is it just all in our heads because it's such a discrete unit of time, a semester? I think that's a big part of it, but it's also the artificiality of test-taking. In the real world, you're tested every day, but it's not something that you can usually go home and cram for in advance. Now, I do expect to be looking things up and consulting others in my off-hours the first year (maybe years), but still. I wonder if nurses that sign time-limited contracts (a lot of travel nurses do that) have a similar experience. And I have to tell ya, I'm a little ticked off. I got an 89.9% in Pharm -- that's right, I squeaked out an A in my pass/fail class.

Nile and I are volunteering at the Austin Animal Center and had our first working shift last week. I picked him up from school and headed over. We were in the cat house. The day before, they were all over the media because the shelter was way past capacity and appealed to the public to please come adopt a pet. They stayed open til almost 10:00 that night, and I heard that over 100 animals were taken from the shelter - at first I was excited, that's a huge number of adoptions, but then read the fine print and about half were foster families. So those animals are coming back. So, if you're reading this and you live in Austin, think about adopting a new pet. They've slashed the prices, all animals over 1 year old are free -- and they come neutered, microchipped and fully vaccinated. Such a deal. That's where we got our sweet Crabby, about one year ago. Here's a link: GetAPetNow

My sister was invited to the White House and was there on May 7th. She's worked at Texas School for the Blind and Visually Impaired almost her entire career, she currently teaches math there. (yes, she really teaches math to blind kids.) She nominated a blind chemist for an award and got to attend the ceremony. Here's a link: STEM Innovators

So here's my interesting experience from work on Friday (details withheld/changed to protect confidentiality). One of my patients was a young woman who's had schizophrenia for about 7 years. She periodically goes off her meds -- she starts feeling normal, starts thinking she doesn't like the side effects (which are significant) and stops with the pills. (I always think of Billy in Six Feet Under, when his relationship started with Claire, and how he started doing the same thing. Throwing his pills in the toilet because...well...he was in love and just felt so good. Who needs drugs?) And of course, the delusions start intensifying, she stops paying attention to things in life like job, friends, eating, etc. and then she's back with us at the hospital. She's a frequent flyer, as we say. Her delusions this time were quite specific -- the weather is causing her schizophrenia, so she was focused on getting all her medical records since diagnosis and getting weather pattern records and carefully correlating them. I asked her -- then what? And I guess that was a mistake, because she absolutely crumpled. She became so tearful, so hopeless, so lucid  -- she suddenly realized the futility, that no matter what she can prove, she'll still have schizophrenia and she's never getting better. That's exactly what she said. I tried to talk to her about getting back on meds, how she'll feel better, things aren't hopeless, but since she's off the meds now, none of that sunk in. And to be honest, she's right. She's not going to get better. Schizophrenia is always a decline. And the meds are horrible. They're better than schizophrenia - but the personal price is terribly, terribly high. Tears ran down her face and I just stood there telling her I was sorry. And she wouldn't take the medication in my hand either. I think we talked for 30 minutes before I gave up and asked Gilbert, the charge nurse, to take over. He was a little more directive (and he's a rather imposing man, that counts for something) and she took the med from him. But I have a lot to learn. And these are my peeps -- the chronic mentally ill. I prefer working with them, because any little bit of help you offer to move an inch forward means so much. So I just hope that a year from now, I feel better equipped to deal with them.

Cinco de Mayo

Last week of classes. And I've been sick for two weeks. Started with a rather bad URI (upper respitatory infection--a cold) and then turned into a sinus infection. I waited too long to see the doc, I had to leave school and go to an urgent-care clinic on Thursday. It was a good reminder to me of how bad "just a cold" can feel, and how absolutely lousy it is when you get a secondary infection. (Never again will I scoff at all the UT students who run to the clinic two days after they get a cold.) Also I really should've paid attention to the day count -- I know that if you're still sick on day 10, it's turned bacterial. But I needed a lesson. And one lesson is that antibiotics are the best stuff on earth when you need them.

My darling daughter is graduating if she can tamp down on the senioritis for one more month. I put together some pictures for a slide show at her party, here's one from Baton Rouge and another from winter formal. She's a big girl now. And next year both of us will be in college. The past 3 weeks have been really challenging, on one day I turned in 2 papers, gave a presentation, and took an exam. Glad that's not the norm. This week I just have 3 exams and 2 presentations. Ha. Really, no kidding.

I'm working some in May as an RN at the psych hospital, so interesting things will happen and I'll have some musings to report. I tell you, I can't wait to get my hands on those MARS and look at the meds with my newly-educated eyes. And talk to the psychiatrists about med choice, like take Risperdal. That is one dirty drug. It's top of the list for nasty side effects in every category -- why is it prescribed so much? Is it cheap? Super effective? That wasn't obvious to me from my lectures.

Summer school starts May 31. I'm taking Healthcare Policy first, then Human Sexuality. Gotta have a little fun. Crabby is no longer a kitten - she turned 1 on May Day. It was wet food all day long. And Ken and I have 23 years together on Cinco de Mayo, so some margaritas will be consumed. Nile and I are volunteering at the Austin animal shelter, we orient on Saturday. Tomorrow night is the Roger Waters concert of the entire album of "The Wall". Typical busy May.

I mentioned in my last post that I heard on NPR that 1/3 of the people in Who's Who have lied about their military honors - that is, claimed those honors and actually were not awarded them. Some did not even serve in the forces. I was astounded at that - seems patently ridiculous, does it not, that someone would put on display in a database/book (whatever it is now) such a bold-faced lie that can be easily checked out. In my line of work, I often think about the line between truth and lie, between fantasy and reality, between what we wish and what's real. Dani and I recently talked about how we lie to ourselves when we want something badly. In class, this came up in lecture last week, and my professor (who is really good at therapy - I mean, I could sit at her feet and just watch for days) said it in an interesting way. She said that you take the truth that the patient chooses to give you at that time. But their truth will change as they open up to you. Be willing to see the change. Here's a link to an interesting NPR story about this, a different story - more specifically about fraud.
NPR fraud story

The gym is still fun-o-rama. We're doing a new "release" in spin and the lead-off song is that awful infectious thing about moves like Jagger...ick, I have to hear it every morning at 5:30 am. I am about to punch someone. Let's see Jagger do that move. One good thing (the absolutely only thing) about being so sick was that I missed 4 days at the gym so my hip now does not hurt.

Not G-Rated

Warning: If you're prudish, you should stop reading now. Ken and I went to AIDS Services of Austin's Art Erotica fund raiser. This is an annual event, very Austin, where erotic art is displaying and bid on. All the money goes to the Kirby Fund at ASA, which provides funds to people with AIDS that are in a financial crisis. It's such a worthy cause, and let me tell you....so fun.

I've displayed some pictures here. But here's the scene: a large empty warehouse, dark, techno throbbing beat, with fences all along at different angles, art hanging on them. There's dancers up on catwalks and the cutest young gay guys serving drinks on platters -- all they're wearing is tight little briefs. Big bar in the middle, your ticket gives you unlimited libations. The art is so wide ranging....some of it quite amateurish, some so sophisticated, some absolutely filthy, others abstract and refined. It's a treat to dive in visually. And -oh- there's some aural stimulation as well. There's a big booth on one side where you put on headphones and listen to someone's erotic experience as a performance piece. At the end, you get a little card that explains what was really happening as you listened. It's designed to allow you to experience erotica without visual input, which is not what we usually do. I enjoyed that. I think ASA's young people's group (called Q? or something like that) put that on. There was also live art taking place - three tableaus of models posing, with an artist painting or drawing their likeness on canvas. No pics allowed of that - too bad, cause it was pretty arresting - but one thing did rather irritate me. So the women are nude, right? But the men - nope, they've got their business covered up in a teeny-tiny g-string. This struck me as sexist, but then later I thought, you know it may a legal issue. You know how it is - the authorities are soooooo fearful of women's sexuality. We see a penis and we totally lose control.

I was thinking about how much of my life is not G-rated. As a nurse, and especially as a psych nurse, I am privy to the most personal parts of people, the parts that we hide from everyone else. Things as simple as showing me that rash on your groin that is really bugging you, to talking about the funny uncle that touched you inappropriately and now you keep having nightmares about him. It's so interesting. What I was born to do. I can speculate about why, but the core is that I've felt different than everyone else my whole life and finally, I truly appreciate it and embrace it.

I have more to talk about, I will do that when I get this week done at school. I am so busy my brain hurts and I feel guilty about writing this post but didn't want to wait. I read a super-interesting article about how 8 mentally-ill people in Austin accounted for 2700 ER visits over a span of 6 years. Can you imagine the cost of that? That's no typo -- only EIGHT people. It's incredible and points to a severely broken system. Also, weeks ago I heard on NPR that 1/3 of the people in Who's Who had lied about their military honors. So I thought I would write a bit about both of those topics.....so much there to ponder on. But next time.

Enjoy the pics. (Not you, Dani).

Downhill

Mid-semester has passed, I can feel the momentum of racing downhill. And yes, did a little of that Sunday at the Capitol 10K, the 35th annual event & the fourth largest 10k in the US. It was fun, kind of hot, but no complaints. Ken and I cheated a little and actually veered to Lady Bird Lake trails near the end. It was just so shady and nobody on them. We weren't timed anyway. After that, we had a big family lunch (excellent Thai food) at Holly's house, my aunt Pam was in town.

I've got two big projects left, well I guess it's actually three. Two are papers and the other is being videotaped while I do a psychiatric assessment of a "patient" (really a classmate). Tricia and I are doing this together, we take turns playing the role of the patient. We read a secret script of a patient with a particular disorder and we get to impersonate them. It's not strictly scripted, we choose how to respond, and we have to demonstrate an understanding of the disorder and its manifestations. But ick...who likes being videotaped? I have managed to settle my nerves by thinking through how much of this I've done in real life as a floor nurse on a psych unit. It's a standard routine for new admissions, and that actually was one of my favorite tasks.

The other projects are a health assessment of a family, which was quite complicated, it involved interviewing someone, drawing diagrams of her family health history and analyzing the psychosocial functioning of their family unit. Plus identifying a health problem that they are willing to address and developing a plan. Anyway, it's 20 pages long (really), with 3 attachments. The last thing is a paper and presentation (with a partner) on the new cervical cancer screening guidelines and how best to explain them to patients. The new guidelines actually decrease most women's screening to less than annually, and I've seen some patient reactions in clinical - most aren't very happy about the idea. So the assignment could have some validity - it's a difficult thing to explain the science behind it, and takes some finesse.

And there's the day-to-day fun. A pharmacology test every Thursday, other tests sprinkled in, yes like jimmies on an ice-cream cone. I actually ....gasp.... got a 100 on a pharm test. I really had decided that he just didn't give that as a grade. But I'm still taking it pass/fail. And there's the big group presentation in my research class. The topic my group chose is pain management in post-cesarean section women and an association with post-partum depression. Let me just scream now --- I hate group projects. I don't mind things with a single partner, but our freaking group has seven people. Yes, that's not a typo.

Clinicals are still the most fun on the block. I just wish they didn't take 14 hours a week to do. I have Peds now on Fridays, and I'm paired with a Pediatrician (a physician, not an NP). I have to say, she's great. She's young, just graduated last year, couldn't be more helpful. At the end of our first day, I hugged her and said I wanted to give her a best preceptor award. (yes, I hugged a doc -- ha) We see patients at a community clinic, most have no insurance and are covered under Medicaid. I got to see coxsackie virus on the first day. And it was an amusing day at the University Health Center after Spring Break - literally two days after the kids returned - they were all sick as dogs. I mean, no sleep, too much sun, too much beer... I think I saw Sherry hand out antibiotics to every single one and she never does that. It was highly instructional -- like, this is what happens when you're stressed, you compromise your immune system, you have a tickle in your throat but you go out all night anyway...yep, this is what you get. A monster sinus infection, strep throat, a terrible exacerbation of asthma, etc.

I've got my summer lined out. I'm taking a required nursing class first, Health Policy. Then I get to take my elective, and I am still researching that. So many choices, it's just way cool. Things like the psychology of health in AIDS patients, human sexuality, deviant behavior, the advertising of health promotion, etc. But before all that starts, I'm going to Boston for two days for a review course for my board exam. I know, it's a year early, but it gives me a heads-up on what's important this last year. And what's really valuable is the manual - I can then study that whenever I want to start, I'm not dependent on scheduling of a live class.

So I'm going to leave with a cool quote I got from a fellow nurse at a lecture.

Philosophy of Sharing Ideas (K. Kirksey)
A large group = culture
A small group = cult
2 people = love
1 person = psychosis

ha!