I have not fallen of the face of the earth (yet)

Phew, I managed to post befre a month passed. I don't know where to begin, but I guess I'll start at the most logical place...
where did September go? Furthermore, how are we already halfway through October?

I've given up any semblance of a normal life. Here's a recap of the previous week:
Monday- class 12-2;
Tuesday- class9-1:30, work the night shift
NO SLEEP
Wednesday- class, and meeting with my advisor, get home at 5pm and go to sleep after being awake for 36 hours.
Thursday- class ALL DAY till 9pm; biostatistics project due
Friday- class in the afternoon, work the night shift
NO SLEEP
Saturday- class 1-5; in bed at 6:30pm
Sunday- class 9-1, study for midterm on Monday

Ah yes, this is my life.

Today I took my first midterm, not too bad. Three hours to write type four essays; technology is so awesome.
I was't going to write about this, but I think it's important. Everyone is asking me if I like school; I tell them this: I'm still waiting for that "ah-ha!" moment when I realize how and when I will be able to use all of this information. Don't get me wrong, I like most of my class (Health Policy and Management Seminar, Policy Analysis, Epidemiology), with a few exceptions (Biostastics and Economics) but I don't find the administration very helpful or organized. Actually, they are so UN-organized. It's a 180 from PENN who was so organized that they sometimes anticipated my problems before I did....yeah, that was freaky.

However, one thing I must credit Columbia with is their impeccably clean bathrooms. I'm not kidding. Even at the end of the day, trash barrels are emptied, toilet paper is stocked and there is never any "tinkle sprinkle" on the seats. I know you know what I am talking about! So if nothing else, for my $55,000 a year, I am gaurenteed a clean bathroom.

But in all seriousness, life isn't that bad. I cannot compare my experience in graduate school to my experience undergrad. Back then, I lived on/near campus and school was my job. My weekends and weeknights were full of friends, going out, class board meetings, sorority events, drinking (sometimes too much), and making bad decisions gaining life experiences. Now, I'm a working professional, a real grown up. I have a beautiful apartment in a great neighborhood, brand new furniture, a fantastic employer, amazing friends (even if I never see them), things are shaping up. It will be pretty great to be 26 years old with two Ivy League degrees.

I can do this. I can do anything for 16 months. One day, one class, one paper, one test at a time.

because I've got nothing but time

Friday:Class 2-5,
Saturday: class 2-5,
Sunday: class 9-1, work 7:30p-8a
Monday: off work at 8a, class from 12-2.

That was my weekend. To top it all off, that night that I worked was horrible. I was in charge, plus had an intubated ICU patient, plus another patient coded and died (that's what happens when you have necrotizing fasciatis on 65% of your body), plus another patient who was crazy. And by crazy I mean, screaming at the top of his lungs that we should call him MARY and then screaming that he wanted to leave despite just having had a fasciotomy to one of his extremities. Psych had to come up to the floor and declare him incompetent and then every-time the patient threatened the nursing staff and/or tried to leave we had to call security. They came to the unit 7 times in 12 hours. By the time the morning rolled around, I couldn't wait to leave. I surely miss my night shift coworkers, but I DO NOT miss the insanity.

Now, I'm sitting on my couch watching Live with R & K waiting for my new furniture to arrive. No, not another new living room set, but a new bedroom set. You see, given the amount of school work that I have and the lack of table space I have (we don't even have a kitchen table) I needed to get a desk for my room. Problem: Where to put it? Solution: Thanks to a fabulous suggestion from O I purchased a loft bed for my bedroom. It comes with a built in desk underneath, so I maximize my space. Thankfully I have very high ceilings in my bedroom, so I can sit up without hitting my head on the ceiling.

I'm trying to think of more stuff to type, as I really don't want to start my economics homework, but I'm running out of ideas. Guess it's time to hit the books.

School Days

As of 8:31 am today, I am an official graduate student at Columbia University. I'm registered for classes, I'm ordering books, I'm meeting new people, and I'm scared shitless. Because I worked so much this summer, the reality of school starting didn't hit me. However, as I sat in the Alumni Auditorium surrounded by my 504 classmates, and listened to the Dean's welcome, I realized my life was about to get crazy, real crazy.

Classes Monday-Thursday//Work Friday and Saturday//Homework on Sunday. And just to spice things up, one weekend a month I have a class taught Executive style (i.e. Class on Friday and Saturday 2-5 and Sunday 9-1).

Are you tired yet? I am. The Director of Academic Affairs said that when they submit coursework to the curriculum committee, the expectation is that for every 3 hours spent in class, 9 hours should be spent out of class doing work. Here's how that math works out.

Class Hours: 15 hours
Work Time for those classes: [(15/3)= 5 (x9)]= 45 hours
Total Time needed for school related stuff each week: 60
Weeks per semester: 14
Number of Days off: 3 (72 hours)
Days spent at work: 2 (26 hours: 2x13 hour shift)
Free day (no work or class): 1 (24 hours)
Minimum sleep requirement: 4 hours

45-20= 25 hours work of work that I simply won't be able to do.

When I break it down financially:
15 credits per semester at $1248/credit= $18720/(14x60)
I'm paying $22.29 per hour to be in class and do work.


So just in case I disappear from the blog sphere, don't get worried. You, me, and my social life will reunite in 16 months.

730 Days of Being A Nurse (and counting)

I've now been a nurse for a little over two years. There were times when I wanted to quit, run away, and get a cushy job (like a M-F 9 to 5 gig) but Sucked it, put my big panties on, and stuck it out. I'm glad I did. As of late, my role is much more than "just a nurse"-some of which I like, others not so much.

1. I'm a preceptor . The nurse managers and the nurse educator approached me, and said that there was a particular new grad who was really struggling with time management and attention to details. They thought that I would be the perfect preceptor for her because I'm not only efficient and organized, but I'm also calm and patient. At first I was flattered, but once I met my little "project" I really wished I wasn't so anal retentive and organized. I struggle with how disorganized and flaky she acts, but I never raise my voice. I constantly have to focus her and prompt her to prioritize patient needs. She is making small strides, but progress none the less. If nothing else, I've learned a lot about my self.

2. I was recommended by my managers to become a senior staff nurse. My application, performance improvement project, committee involvement, and inservice lesson plans are being submitted on Tuesday.

3. I advocate for my patients no matter what.
I called for a palliative care consult on a patient with lung cancer that metastasized to the bone and brain who subsequently sustained 3rd burns to 65% of her body. The resident told me that I had no night to go over the burn services authority. I pulled up the policy on WHO can make a palliative care referral and under What grounds. Guess who was right? Me. The family thanked me and the attending said on rounds, this consult was a smart idea.

4. My coworkers asked me if I would be interested in being a permanent charge nurse. Dear friends,< that would have to be a big pay raise hell no!


Life may be crazy. but I wouldn't give it up for anything.

Informed Consent

So much of the healthcare world revolves around informed consent. Hospitals consider informed consent part of their best customer service, but essentially IC is a right. Patient and their families always need to be informed. But what about their health care providers? There was so much that nursing school didn't inform me about being a nurse. Sure nursing school taught me about anatomy, physiology, pharmacology, and ethics, but there's a lot that was never brought to my attention...

That patient's will test your patience.

That being able to identify a specific bateria by it's smell isn't a skil that makes you more attractive to the opposite sex.

That just because I'm comfortable talking about bodily functions, doesn't mean that it's appropraite dinner conversation

That Id both feel and hear ribs crack when I performed CPR but have to keep going

That I'd be so tired after a thirteen hour shift the thought of walking home five blocks makes me want to cry contemplate taking a cab

That my feet and ankles would swell so much flip flops are the only comfortable shoes to wear after work

That I'd have spider veins by the time I was 25

That I'd be verbally abused my patients and their families

That I wouldn't sleep more than 3 hours inbetween my 12+ hour night shifts

That Uncle Sam would take almost half my paycheck

That money in the bank is no good when you don't have the time to enjoy it.

That I'd only get to spend one holiday with my family over a two year period

That I'd be exposed to lethal infections on a daily basis

That prophylactic antiretrolvirals following a needlestick injury would keep me in the bathroom for the better part of a month.

That doctors and nurses don't have sex in the suppy room. They have it in the on call room (kidding)

That I'd have to fight with the doctors when advocating for my patients

Looking back, if they had shoved a paper in my face and told me everything that being a nurse entails, I think I would have paused, thought about and signed anyways. Becuase even though nursing school didn't teach me any of they above, they also din't teach me...

How amzing it is to deliver a baby on the side of the FDR highway while doing a shift with the paramedics.

How gratifying it is when a patient says "Thank you for being you."

How satisfying it is to successfully run a code

How phenomenal it is to see some one survive after being burned on 90% of their body

How special it feels to be the first one a patient sees when they wake up from a coma

How nice it feels when a doctor says they are happy to have you caring for their patient

How awe inspiring it is to see a person walk on two prosthetic legs for the first time

How fulfilling it is to come home, exhausted after your shift, and know that you made a difference

a ramble

This post is going to ramble, so please bear with me. Over the last few weeks I've had several great ideas for posts; however, by the time I get home from work, my brain is mush and I choose a hot shower and my bed over my blog.

Work has been crazy lately. As the final weeks of summer approach, so many of the surgeons go into overdrive and book a million OR cases so they can go away on vacation. Makes sense, right? Wrong! What it means is that the OR's are overbooked, the PACU cannot absorb all the patients, and the ICU's end up absorbing the patients as "boarders". This past month, we have been getting a ton of ENT/Plastic patients with flaps. In the last week alone we got three of them fresh out of the OR (anywhere from 9-14 hour long surgeries). Aside from the regular tasks of recovering a patient, these patients come back on the ventilator and have q15min pulse checks It's agony. Last weekend I was in charge, had an intubated 75% burn, had an uncontrolled diabetic on an insulin gtt, and had to take a flap patient. Assignments were so horrendous I could do nothing but go home and drink wine, lots and lots of winelaugh. Okay, I drank some wine too! Later that same week, things got ugly. We only had 11 nurses for 36 patients; given that four of them needed 1:1 care and each had at least a two hour burn care/dressing change each shift, plus a pediatric ICU patient who on the verge of being intubated, we weren't in a good place for accepting these boarder patients. We got our managers involved and they talked to their managers. We were told that we can't refuse to accept a patient due to staffing. Which is funny, because we weren't refusing, but we were stating that accepting these patients is a huge safety issue. Oh well, guess they'd rather risk a lawsuit than give us an extra nurse or let us hire more nurses. Right, because that makes much more sense....

Other notable work related things-
1. Commenting to a family member of a patient with 75% burns and a 104 degree fever that "She's burning up."
Poor choice of words, and I felt like an ass.

2. Celebrating Danielle's birthday on Long Island.
After a terribly long work day, we all ventured out to Long Island for a night of drinks and celebrating. Getting chauffeured by our DD in her huge new Pathfinder, Leslie went ass of teakettle into the 3rd row seat while wearing a dress. We danced to cheesy coverband music that we proudly sang along with, we had cupcake/frosting fight in the bar, and then took shots of Jaugermeister and SoCo and Tequila. But by far, my favorite part of the night was when we returned back to the city and Alison was walking down the street yelling, "MB (aka Dr. Matt)? MB? Where do you live?" Then she and Leslie accompanied me to Paulas's apartment so we could feed her cats while she is away on her honeymoon. I think we probably freaked the cats out...three drunks girls, winded from climbing the five flights of stairs, whispering "here kitty kitty." Wonder what the security cameras thought of us that night.

Non-work related things-
My friends got married this weekend in Westchester. Of course it was an adventure getting there. I accidentally grabbed the directions to the reception, NOT the hotel where I was staying so when we got to the Country Club and tried calling the hotel for directions, we got so lost. The girl who answered the phone was quite a airhead who was clearly directionally challenged. She told us to go south the the CC Expressway and then head east on 119. However, we really needed to go north of the CC Expressway and then head west. After 2 hours of driving around Scarsdale, we finally made it to the hotel just in time to change and take the party bus BACK to the country club. Thank God it was 6 hours of open bar because my nerves were shot. Did I mention that the party bus was too wide to make one of the turns so we took out a few tree branches and then still couldn't; make the turn so we almost missed the ceremony! The dancing and DJ was awesome. So much so that I ruined my bargain silk dress with sweat and wine. Let's hope the dry cleaner can take away all my sins!

must accessorize

About a nine months ago I was in this same predicament. I have to go to a wedding in less than a week and I still have no shoes, no accessories, and no time to go shopping. Last time I needed a pair of black, peep toe pumps and green jewelry. This time I need silvery/taupe shoes and pearl jewelry. It's never a problem finding a dress, but finding the coordinating accessories on a budget kills me. I always find a great deal on a dress, but then end up spending more money than I saved trying to accessorize my bargain dress. Time's running out and if I don't get my act together I'm gonna have to go to this wedding in a moo-moo and sneakers.

Day At the Ball Park

I got this email last week:

Kelly,
I'm writing to see if you would like to join me at a Yankee Game next Saturday July 18 at 1:05.

You were picked because the staff identified you as someone who embodies our values at NYP .
I can't guarantee how the Yankees will play, but I can guarantee wonderful seats and refreshments in the luxury box that we have for this game.

Please let me know by Monday end of the day.

Thanks.
Laura

I read the email. I reread the email. I read the email for a third time. Yes, this was an email from the Vice President, Chief Medical Officer of the hospital. I was shocked and (obviously) flattered. Before I could write back, I realized that I was scheduled to work that Saturday. I called my bosses, who were thrilled to hear the news, and without hesitation they gave me the day off. I knew this must have been a big deal because staffing for Saturday was real crappy and to simply take me off without as much a hesitation meant a great deal.

As Saturday approached, I got nervous. What do I talk about? Is it going to be awkward? Who else will be there? I had to pick my ticket up at her office on Friday; I'd never been to the "executive offices" before. I received the ticket from her secretary and did a double take. It was twice the size of a normal ticket with shiny gold embossing. I felt like a kid who just found a Willy Wonka goledn ticket.

I took the 6 train to the Bronx on Saturday afternoon. It was a day I will not soon forget. Not only was it my first time at the new Yankee Stadium and my first time at a Yankee's game,

When I finally made m way into the stadium I was lost. I had no idea how to find my way to the luxury box...thats so not how I'm used to experiencing baseball games. However, after what seemed like an endless walk down carpeted, air conditioned hallways lined with plaques and giant mahogany doors, I arrived at luxury box 156. I opened the door.......fully stocked bar( beer, wine, hard liquor, soda, water), salads, paninis, hot dogs, hamburgers, chocolate covered fruit, popcorn, cookies, peanuts, pork chops, steak, grilled chicken, giant soft pretzels, a gastronomes delight! Once I got over the shock of it all, I realized that it was a rather intimate gathering. Maybe 20 or so people, a minute fraction of the ten thousand employees currently employed by NYP. I was greeted warmly by L (Dr. F). We chatted and I continued to mingle and meet the other people. There were a total of three nurses, myself included. The other two nurses were male- one worked in the PACU and the other in the Neuro ICU.

Although the game was rather slow, the Yankee's did pull out a 2:1 win over the Tigers. After the game, some people left,others lingered and chatted. Knowing that the train would be a zoo, I was in no rush to leave. I sat and talked to L some more. I was telling her about starting school at Columbia in the fall. She asked what nursing program I was doing; I told her that I wasn't enrolled in the school of nursing, but rather in the school of public health with a degree in policy and management. She stopped, put her hand on my shoulder and said, "Kelly! That's the program I did. You will love it, it's an amazing place and a fabulous credential." I smiled. We chatted a bit more, I thanked her, and then I left.

I couldn't stop grinning on the way home. I'd been quite nervous with my decision to go back to school, but suddenly I felt at ease. I realized that I'm not only happy and secure with my job, but also my future holds so much potential.

Who would have thought that a day at the ball park was all I needed to ease my mind.

The Good Life

After a wonderful tropical vacation, I worked a four day stretch, had one day off, then worked another four days. Had these been night shifts, I would have been exhausted and slept away of days off; however, now that my vampire days are over, I've been living the good life.

I can go out after work becuase other people are home! Have you ever tried to find a group of people who work M-F (9-5) who are free on a random weekday morning for dinner breakfast? Let me save you the trouble, it's impossible. Plus there's the whole issue of I'm craving a glass of wine to calm my nerves when the're focusing of a cup of caffeinated delight to perk them up!

I'm running. Long and steady, I'm thrilled!

I have plans to see my family more often than every six months!

I'm doing thing that I otherwise wouldnt do, just becuase I can!
Having picnics in the Park for breakfast! Good book + coffee + sunshine= bliss
Seeing the Philharmonic orchestra with my coworkers on a random weekday night.

I'm doing things that I love to do, but just didn't jive with my schedule before!
Cooking.
Baking.
Blogging.
Talking to people on the phone versus having to send them an email. No one appreciated a phone call at 3am just becuase it was convenient for me.

See....life is good.
Continnuing on with things that fit back into my life....

I finally made it back to Philadelphia this weekend, and boy was it a long overdue trip! I got to see the L's. R and J are getting SO big. I can't believe it has been six months since I'd see them. It was the longest stretch of time I'd gone without seeing them. Highlights of my 24 hour visit were: eating with a group of people around a table, baking with the boys, playing flashlight tag, snuggling up in the big cumfy chair to read books before bed, coming downstaris in the morning to: "Good morning Nurse Miss Kelly. Did you have a nice sweep?", pancake breakfasts, and spending a lovey afternoon at the pool. My trip was over much too soon, but I already feel revived.

When I was living in Philadelphia, I escaped the city at least once a week and spent time in the suburbs; my longing for greenery and quiet was always fulfilled. I'd forgotten how much I enjoyed my urban escapes.

I've got six more weeks of bliss, before life gets crazy, (again) school starts. I realize two things. First, I need to enjoy the rest of the summer and do whatever it is that makes me happy. Second, I simply cannot go another six months without seeing my family and without seeing the L's!

Where are all my posts? I wrote a bunch of short posts to autopublish over the last few weeks, but it looks as though they never published and now they are gone. Hmmm....guess I'll try and recap:

1. NO MORE NIGHT SHIFTS! I'm officially working full time days.

2. My Aruba vacation was amazing! It was so great to see my family after six months.

3. It's been 13 months since I fractured my pelvis and I'm finally back in action.

4. The Pink Panther sofa is GONE. The new furniture is beautiful and I am very satisfied.

As I get my life back in order, I'll write more. Please be patient. =)

FFoF #79

Here are this week’s four questions. If you want to play go here!
Oh hey, that's my question as #1! Yay.

#1, Kelly’s question. What is your favorite memory associated with the smell of a certain food? As in, you smell it, close your eyes and are instantly drawn back to a magical moment in time….
Pumpkin and apple pie baking in the oven. Immediately draws me back to the fall season in New England and spending holidays with my family...something that hasn't happened in two years.

#2. Name something red that is in your cabinets.
The cover of my PAM spray.

#3. Ice. Do you have an ice maker, use ice cube trays or buy by the bag?
Buy it in the bag. It's a habit of my roommate.

#4. Pepper. What kind do you use most often? Is it in a grinder or a shaker?
Black, from the grinder. Love that grit!

When Futility Wins

We got a notification at 9am on Thursday morning that a Jane Doe, approximately 60 years old, found down at the scene with 90% TBSA burns was being transferred. We set up the room, the ventilator, the pumps, etc, and then we waited. Four hours passed before we heard anything else. We assumed that the patient didn't make it, as it was reported that the other person in the fire was pronounced dead on the scene. However, at 1pm, EMS called and said they would be there in 15 minutes. We gowned up and organized ourselves.

As the trauma elevators opened, the smell of charred flesh filled the corridor. We listened intently as the paramedics gave us report. Turns out the patient had been identified by neighbors and was not 60 years old, but rather in her late 20's. The dead person at the scene was her mother. To make matters worse, the patient had Cerebral Palsy (CP) , an uncontrolled seizure disorder, and the cognitive function of a middle schooler. Her mother was her primary caretaker. It's always hard to deal with breaking the news of loved one's death, but when there is a cognitive delay and/or deficit it's even harder. Thankfully, as crass it it sounds, this patient was unconscious and we didn't need to tell her yet.

Upon arrival her vital signs were stable, but she quickly decompensated. We placed an arterial line to monitor her blood pressure, a central line with cordis for venous access, and a SWAN to monitor her hemodyamic stability. Her blood pressures plummeted, despite liters of fluid. Her oxygenation dropped due to an inhalation injury. She was cold, 34.0 Celsius, despite fluid warmers, a heat shield, and a bair hugger. Her coags were out of control, INR = 2.6, and we were pretty sure she was in DIC. We lost pulses in her bilateral upper extremities and performed escharotomies at the bedside. She became anuric (stopped making urine), her bladder pressure soared to 35, and we opened up her belly at the bedside.

The first 24 hours were tenuous. Administer blood products- give fluids- check labs, check ABG's-adjust the ventilator. We were fighting a loosing battle. We were able to contact the family, maternal aunt, uncle, cousins, etc. They sat vigil at the bedside, but knew were this was going. They made the patient DNR. Many people not in the health care field are scared of DNR's. They think that's the equivalent of "puling the plug" or removing life support, but they are wrong. DNR- on a already intubated patient, simply means that if the heart should stop, no CPR would be given.

By Saturday afternoon, the patients' prognosis was dismal at best. Given her % burn, her lung injury, her preexisting conditions, and hemodynamic status her survival rate was less than one percent. The family listened as the doctors and nurses talked. When I came on shift that night, the aunt pulled me aside and said, "It's not good, is it? I just want her to be comfortable. She wouldn't want to live like this..."

I hate these moments. I looked at her and said, "She's sick, very sick. Even if she were to survive the next day or so, she'll never be the same. She has no skin and will likely develop an infection. We don't know how much damage her brain suffered when she was unconscious at the scene. She is currently maxed out on medications to sustain her blood pressure. We have no other options."

And then she made the toughest decision of her life. She decided that she wanted to withdraw care. However, it was not quite that simple. She wasn't the patient's health care proxy, so we needed to have two attending physicians write notes of medical futility and get approval from the administrator on call. There was nothing we could do but wait. Until that paper was approved, signed, and placed in the chart, we had to keep treating her. Around 5:30 am as the sun was rising and the sunlight was streaming into her room, her heart rate slowly began to drop; her blood pressure soon followed. When she didn't respond to any medication, a few of us nurses went in and sat with the patient at her bedside. She had no family there, but we talked to her offering words of comfort. We told her it was okay to go, that her mom was waiting for her. We talked, and talked, and talked. I swear she heard us. At 6:05 am she passed away.

As hard as it is to see someone so young die, it's even harder to think about ethics behind medical futility .

A Bond Unbroken

We are both female.
We both have blue eyes and brown hair.
We have the same parents.
We grew up under the same roof.
We went to the same high school.
We both love dogs.
The similarities end there.

I'm the serene intellectual; she's the social know-it-all.
She's the jock; I'm the recreational athlete.
I'm a planner, she's spontaneous.
She thrives on chaos;I like cleanliness and order.
I'm an endorphin junkie; she likes her sleep.
She'll hold her ground and never back down;I hate conflict.


I've always been fascinated at the differences between my sister and I. Same sex siblings tend to fall into one of two categories: best friends or arch enemies. My sister and I are neither. We grew up differently, and we have a unique relationship.

I'm seven years older than her. I was in first grade when she was born. By the time she was in first grade, I was in Junior High. When my college friends hosted their siblings for the weekend, I stood by and watched- my heart aching that my sister couldn't be there too. Twelve year old + fraternity party+ alcohol+ boys= lawsuit waiting to happen.

My friends would always ask what it was like to have a sister so much younger than myself, but I never knew anything different. We didn't have much in common; we weren't into the same things. We existed in different worlds. She was playing dress up and I was going to formals. Don't get me wrong, I love her to death, but I always felt more like a mom than a sister to her. But then something happened- I didn't come home from college in between my junior and Senior year. And suddenly, our relationship changed.

She called me one Thursday afternoon in late June. She was giddy with excitement. "Kel. I think he likes me! He told J, who told A, who told me! Isn't that cool?" My heart melted. Her first crush. And she called me. Instantly, she grew up. She was no longer that little girl, she was a teenager. Despite our separation that summer, our relationship grew. We talked on the phone, she became my friend on facebook (yeah, that was weird), she asked me advice, etc.

That September she started high school. I vividly remember talking to her on the phone the night before school started and telling her that it would all work out. She wouldn't be late to class, she wouldn't get shoved into a locker, and she wouldn't sit alone in the cafeteria. I recalled my first day of high school and I remembered her sitting in the living room bay window waving as I walked down the driveway. Suddenly, my heart ached and I realized that I wouldn't be there to see her off.

When I was in high school, I used to go to all her soccer games. I enjoyed spending a few hours each weekend at the soccer fields watching her evolve from a amateur to jock; however, I only made one of her JV soccer games freshman year. The weekend that I graduated was the weekend of her Freshman Dinner Dance. She skipped the after party so my family could dive down to Philly fr my graduation festivities.

She turned sixteen that September. I had to work. I missed Christmas that December. I had to work. She called to tell me that it didn't feel Christmas without me. I wasn't there to hold her hand as we walked the steps to see what "Santa" left us. I wasn't there to sit next to her at church and giggle as the cantor reached a note that would break glass. I started to cry. Although I made it home the next day to celebrate, it wasn't the same. I thought she would be okay without me on a holiday (I hadn't been home for Easter in four years), but I was wrong.

Over the next two years, we grew closer and closer. The age gap seemed to narrow and although i still harbored motherly feelings, I felt more and more like a sister. I gave advice, I spoke from experience, I didn't judge. The first time she came to visit me in New York, without my parents, I showed her city life. She told me that she felt "so grown up", I told her, "Because you are."

Tonight is her first prom and no I won't be there. The date was changed, no one informed me, and I couldn't get the night off. I want her to know that I don't value my job more than my relationship with her. I want her to know that there's a piece of my heart there with her tonight, as always. We may be separated by distance, but the love is there and stronger than ever.

Colleen- You've become such a smart, wonderful, loving young woman...I'm so proud to call you my sister. I love you.

Out With The Old

I've got spring fever. I'm cleaning out closets, organizing cabinets, and rearranging, obsessively. You all know about the ugly couch, aka "The Pink Panther" .... And yes, unfortunately, it's still with us.


Despite numerous hours spent searching for the perfect chocolate leather sofa and matching love seat, I haven't found "the one." I'm skeptical to buy something online, because I want to be give it the "but test" before purchasing. Also, because my roommate and I are both short, we don't want any furniture that when we sit down , our feet won't touch the floor.

This past weekend, Memorial Day sales GALORE, would have been the perfect time to purchase furniture; however, A was out of town and she didn't trust me I didn't want to make the decision myself. So what did I do instead? I redid our bathroom. It went from a sleek and modern black and white powder room to a page out of the Pottery Barn catalog. Yes, I know that store is overpriced and I could buy knock offs at Tarzhay, but the Manhattanite in me took over. I bought a shower curtain, towels, rugs, baskets, and decorative soaps. Yes, you read that correctly- decorative soaps. Ahh, what was I thinking?

Although redoing the bathroom was fun, if not a drain on my wallet, I just need to buy a couch. It will be much cheaper than redoing every other room in the aparment to compensate for the ugly "Pink Panther."

Any suggestions on buying furniture??

Four Foods-Memorial Day Edition

It's been way too long since I last played! But with summer coming, I'm hoping to get back on track! If you want to play FFoF, go here!

#1. Do you celebrate Memorial Day with a picnic, cookout, road trip or some other way?
Growing up, we always went to our neighbors house for a pool party and cookout. But as of late, I'm usually working. Exciting, right? haha.

#2. What are staples at your summer time cookouts?
Big watermelon slices and icy cold beer.

#3. What drink do you find most refreshing on a hot summer day?
Ice cold water with fresh lemon slices.

#4. Share a recipe for a picnic side dish.
Chocolate Covered Strawberries
Ingredients
4 ounces (about 3/4 cup) Chocolate Chips- I like to do 1/2 white and 1/2 semi-sweet
12 strawberries

Method
Line a plate with wax paper or parchment. Place chocolate chips in a glass bowl or measuring cup and microwave on high, 1 to 2 minutes, or until melted and very smooth, stopping to stir about every 20 seconds. One at a time, dip strawberries into melted chocolate and place on the prepared plate. Refrigerate about 10 minutes to harden. Store covered and refrigerated up to 1 day.
To pack: place in flat bottom container with fat lid r and place a bag of ice on top and below)

Changes

Dear loyal readers few people who follow this blog-

Please excuse the lack of posts lately, life's been happening. Guess I'll catch you up on what's been going on.
1. Grad School
I'm going to Columbia! Classes start the end of August.

2. Work
I'm going to full time days starting June 21st! Two years of hell, holy hell nights will finally be over.
I'm going to stay working full time while I go to school. I'm banking all my vacation and holiday time to use September through December. It works out that I'll get paid for a full time work week, but only actually working part-time. The way I see it, my life won't suck any more than it has the past two years.

3. Vacations
I'm joining the family in Aruba for six days. Because I have no vacation time to use, I will be working the four days prior and three days after. Oh well, it will be worth it to get rid f this pasty white goodness otherwise known as my skin.

4. Dating
I'm still single. Dating still sucks in NYC. Please send any intellectual, tall, dark, and handsome men with a great sense of humor remotely good looking men my way.

5. Health
I'm still chronically exhausted but I found out that I'm quite anemic. My TIBC (total iron binding capacity) is very elevated compared to my actual iron level indicating that my body isn't properly utilizing/absorbing the iron. Now I'm taking iron pills. Hello constipation! Sorry if thats TMI. But it's all worth it, if it will boost my energy.
Regarding my fractured pelvis, I've had no further complications (knock on wood). I won't have another bone scan until next year, but I've finally gotten back to running just about year since my injury. After a five month wait, I saw the endocrinologist and found out that my vitamin D level is low. Now I'm taking additional vitamin D pills.
Yes, I've turned into the vitamin popping princess.

I'm sure that a lot more has transpired over the last month, but those are the highlights.
Thanks for checking in!!!

i've heard it all

No big surprise, our ICU census was full last night- all 20 beds occupied. Our step-down unit was only 3/4 full- 15 beds occupied. So when we got the EMS phone call at 3 am that we were getting three smoke inhalations, guess what?!?!, our three "stable" ICU patients (non vented/demented/etc) needed to head to the step-down unit.

Our prospcects were grim..
- two vneted patients over the age of 90
-two patients on CCVHD, also vented-duh!
-one fresh 30% degloving injury with history of dementia
-one 60% deglving injury, vented, in DIC
-new purpura syndrome admission with GI bleed
-fresh post op of STSG to bilateral legs on heparin gtt for a PE
-fresh extubation with signs of anoxic brain injury from initial carboxy hemoglobin > 50
-quadriplegic wound management patient with a 12% ejection fraction (systolic heart failure, ya think?!?!?)
-etc, etc,


And just who were the lucky three???

1. Thitry something year old man who refused to leave his room stating that it was Passover and that he had hired a cleaning service to come in and purify the room and it's air. Nope, under no circumstance would he leave his room to be sent to a "dirty and unholy hell hole" -direct quote.

2. Middle aged man with severe MR that likes to streak in the hallways and jump up and down naked when moaning and screaming when we do his burn care. Oh yeah, you can forget going near him with a needle for labs, let alone for IV placement...too bad he is going to the OR today for surgery.

3. Older woman with extensive history of ETOH, only 6 hours past the threshold for severe DT's. Did I mention she's obese and refuses to wear bipap so she essentially goes apnec every two minutes.

So glad that shift is over! Never a dull moment.

update

Update on this post....

The dumb shit resident that I saw never called back with my lab results. I got annoyed after trying to call her back for a week and just looked them up myself. Maybe I wasn't supposed to do that? eh, oh well.

Called 11 times to get an appointment with an attending: hold, transfer, hold, hold, ANSWER, nope transfer, click.......fuck!

Called on the 12th time this past Friday from work in the same hospital where the practice is located:
One ring....
Secretary: Hello? what department are you calling from? What can I do for you?

Me: Hi this is Nurse Miss Kelly from the burn unit, I'm a former patient of Dr. W's, I need to make an appointment with Dr. C?

Secretary: Oh do you work here in the hospital?

Me: Umm, yes?

Secretary: Marvelous. How's this Tuesday at 10:30am?

Me: Seriously? That's great.

Secretary: Would you like us to call you if we can an earlier cancellation?

Me: I'd love that! (thinking am I dreaming?)

Secretary: Okay, I can reach you at this number?

Me: Actually my cell is better xxx-xxx-xxxx. thanks.

Secretary: Oh, okay. Well then I'll note that. Bye bye.

lesson learned: make an internal phone call, work the system!

FFoF #72

#1. Suggest a question for FFOF. Something fun is in store for the one whose question is chosen.
What is your favorite memory associated with the smell of a certain food? As in, you smell it, close your eyes and are instantly drawn back to a magical moment in time....

#2. Share instructions on how to make your favorite smoothee or shake.
Breakfast in a Glass~my banana mango smoothie

2 frozen, ripe bananas (freeze WITHOUT the peel!!)
1 mango, peeled and sliced
1 cup orange juice (any kind will do- I prefer tropicana light plus calcium or fresh squuezed)
1 cup fat free vanilla yogurt
*1 tsp of vaniila extract and a dash of cinamon can be added to enhance the flavors*

Cut banana into chunks. In a blender, combine all ingredients and blend until smooth.
If the smoothie is too thick, thin with a little more orange juice. Pour into 4 glasses.

#3. What’s in your favorite panini?
Eggplant, portabella, zucchini, roasted red pepper, and goat cheese

image

#4. Share a recipe for potato salad.
For all those of us who aren't big on mayo!
Roasted New Potato Salad
Ingredients
2 pounds new potatoes, cut into chunks
6 tablespoons plus 1 teaspoon extra virgin olive oil
Salt and pepper to taste
1/4 pound green beans, stemmed and sliced
2 tablespoons red wine vinegar
1/2 cup basil
1 garlic clove, finely chopped
2 medium tomatoes, chopped
1 cup salad greens
12 pitted Kalamata olives

Method
Preheat oven to 400°F. Toss potatoes with 1 teaspoon of the oil, salt and pepper and transfer to a roasting pan. Cover and roast until tender, 35 to 40 minutes. Set aside to let cool.

Meanwhile, bring a large pot of water to a boil. Add green beans and cook until just tender, 3 to 4 minutes. Rinse in cold water and set aside.

Put vinegar, remaining 6 tablespoons oil, basil, salt, and garlic into a blender and purée until smooth to make a vinaigrette. Toss potatoes, beans, tomatoes with vinaigrette together in a large bowl, then spoon mixture onto a plate arranged with salad greens. Garnish with olives and serve.

tah dah!

I must make this quick, I'm on my way to work (night 4 of 5), but I just got the final word.....

Grad School Acceptance:
YALE: yes
HARVARD: yes
COLUMBIA: yes
EMORY: yes

Now onto the million dollar question: Where do I want to go?

Four Foods 69

#1. Olive oil. What kind do you prefer to use?
Extra Virgin. I don't use much oil., so I splurge and buy the expensive aged stuff. You use less, when it's more flavorful!

#2. Meatballs. Do you make them from scratch, buy premade cooked or buy premade frozen?
I make meatballs from scratch for others and use frozen "meat-less ball" for myself

#3. Do you use napkins at home? Paper or cloth?
I use papertowels. I know, please don't send the green police after me.

#4. Share a recipe for a white sauce.
Heat 3 TB milk in a saucepan, add 8 oz of cream cheese. Stir, stir, stir, add seasonings to taste, stir, stir, stir. As soon as smooth, turn heat down to lowest setting.
*add in seasoned and cooked chicken or fish
* toss with pasta

Go here to join in on this meme.

A Little Appetizer

Looking through my refrigerator and cabinets with only thirty minutes until my friends arrived, here's what I came up with!

Goat Cheese Stuffed Dates with Rosemary Balsamic Reduction

50 Large Dried Organic Pitted Dates

4 oz Goat Cheese, room temperature

2 teaspoons freshly ground black pepper
1 tablespoon olive oil
2 tablespoons minced shallots
1 teaspoon minced garlic
1 cup balsamic vinegar
1 large or 2 small rosemary sprigs

Reduction
Set a 1-quart saucepan over medium heat and add the remaining 1 1/2 teaspoons of olive oil. Once the oil is hot, add the shallots to the pan and sweat until translucent, about 1 minute. Add the garlic to the pan and sweat for 30 seconds. Pour the balsamic vinegar into the pan and bring to a boil. Add the rosemary and allow the balsamic to gently boil and reduce until only about 1/4 cup of balsamic remains, about 10 minutes. Season with 1 teaspoon of salt and 1/2 teaspoon of black pepper. Remove from the heat. Remove the rosemary sprigs before using.

Assembly
-Place dates on large platter or cookie sheet.
-Fill a medium size tipped pastry bag with soft goat cheese.
-Place tip of bag into each date and fill until goat cheese starts to peek through the other end of the date.
-Once all dates are filled, lightly drizzle balsamic reduction over the top.
*tip: use a large spoon to easily drizzle the reduction.

I Dream Of....

School?

I had the strangest dream last night. I found myself running across the junior high school parking lot frantic that I'd be late for the first day of my senior year,, only to reach the sidewalk as the homeroom bell rang. I walked into the school, up to the office window and said, "I'm sorry I'm late, I was picking up my parents at the airport. Can they send in a note later?" I think the office clerk mumbled something about needing it now. Next thing I know I'm wandering the hall of the junior high looking for room 3005. When I finally find it, its filled with kids from my graduating class, and they are starring at me. Matt came up to me and said, "Yeah, you freaked us out in high school and that's why we wanted to ruin your prom." Before I could open my mouth, our elementary school librarian was handing out locks and schedules telling us that our lockers would be located here in the Junior high, but that all of our classes would be at the actual high school. Right because that makes so much sense..... Before I could retort such an insane proposal, I found myself amidst w whirlwind of people in a multilevel maze trying to navigate my way to my classes. I walked into the library and cut through to the gym only to find that I had no gym clothes. Then I was sitting in math class realizing that I hadn't been to a math class in over a semester and I freaked out. I asked to be transferred to another class, but my teacher only spanked my hand with a ruler and said get out and go back to community college. Then I was sitting in the principals office and he told me that he was disappointed in my choice to be fifth in my graduating class, he said I'd never go anywhere in life...

And then I woke up.

I think the anxiety of waiting for schools is killing me.

Dear Nurse Miss Kelly

If you aren't in the mood to read a rant, than I suggest you file this post under "to be read at a later date."

I work in healthcare. I'm going to graduate school for public health. I understand the healthcare crisis. I have money taken out of my paycheck every cycle to pay for my health insurance. I don't have complex medical issues. SO WHY CAN'T I GET A DOCTORS APPOINTMENT?!?!?!?!

Last year I found a GREAT internist/gynecologist. I also found a great dermatologist. After much angst I did find a dentist, but after my visit, I decided that I wouldn't be going back there ever again. In December, amongst holiday cards and holiday bills, I get a letter from the dermatologist:

Dear Nurse Miss Kelly,

It is with deep regret that we tell you that as of Jan. 1, 2009 Dr. N will no longer be with the practice. She has decided to relocate to Florida. Please call xxx-xxx-xxxx to book an appointment with the doctor who will be taking over her patient load.

Noted. Due for my annual checkup at the end of January, I called to book an appointment "with the doctor who will be taking over her patient load." What does the secretary tell me? Our conversation went something like this:

"Hi. This is Nurse Miss Kelly. I'm a patient of Dr. N's. I'm aware that she has left the practice, so I was hoping to book an appointment with whoever took over her patient load."

"Oh, well you see, you are going to have to wait. It's a four month wait to be seen as a new patient."

"But I'm not a new patient, I've been to the office before! I have records there. I just need to change doctors."

"Yes. But you are new to the replacement doctor and she will need to do a workup. What do you need an appointment for?"

"Just my annual skin check. I'm sorry, I'm confused. All patients of a doctor who left must now wait to be seen as new patients?"

"Correct. You can be seen in four months. How does April 29th sound?"

I concluded our call with, "Let me check my schedule and I'll call you back."


I was pissed. Not only did that not make any sense, but also this lady was clearly very misinformed. What did I do? First I looked to see the names of the other physicians in the practice to book an appointment with them. Then I called back, spoke with a muffled voice, what if the same wacko picked up, and booked an appointment with another doctor. Yes the wait was two months, but that was much more reasonable.

Crisis averted.

Not even two days later, I get another letter in the mail.

Dear Nurse Miss Kelly:

As of January 1, 2009, Dr. JW will be leaving WCIMA and joining a private practice. She will continue to admit her patients to xx hospital. Dr. PC will join WCIMA in February 2009 and will be responsible for your care. It is expected that she will participate in the same insurance plans that Dr. JW has participated in. Please contact us at xxx-xxx-xxxx to arrange to see our new physician.
If you wish to continue your care with Dr. JW here information is listed below..


Great, I'll call and book an appointment with her new practice. I mean, I never thought that she wouldn't take my insurance, after al it's expensive to be in private practice, so the more patients the merrier, right? WRONG.

Since I fractured my pelvis last summer, my lifestyle has been chaotic, at best. I broke up with a boyfriend, was studying for the GRE's, worked ALL the holidays, had a fight with my best friend, applied to grad school, etc. Through it all, I continue to work nights, sleeping less than four hours a night. My energy levels have bottomed out. It takes all my will power to get out of bed. I have no stamina and my workouts, once my sanity saver and favorite pastime, are awful and I hate the thought of the gym. My runs have dwindled down to nothing. I haven't run in over three weeks.

I've continued to eat my vegetarian, almost vegan diet and be very conscious of what and how much food I put in my body. So I was concerned that I started gaining weight and more and some more. I don't weigh myself, I go by how my clothes fit, but I'd estimate that I've gained 15 pounds since I graduated from college. And that freaks me the hell out!

Recently, I've began having some other symptoms:
-dry scalp and skin
-swelling of the hands and face
-gas and bloating
-thinning hair
-increased exhaustion

When I woke up the other morning and my hands were so swollen I couldn't get my rings off, and I also didn’t fit into any of my pants, I knew I had to go to the doctor. Something isn't right.


I pulled the letter out of my files and dialed the number of my old doctors new private practice. After explaining that I had been a former patient of Dr. JW's, I asked the secretary if she was taking my insurance plan.
"Um, No. I'm sorry. She's not accepting any managed care. But she will gladly see you for a physical. Would you like to come in today?"

"Hmm, well. How much is a physical? I would like to continue my care with her if possible."

"A physical would be $1000. And lab work is about $400."
I cough and scoop my jaw off the floor

"I think I'll pass. Thanks though."

No way in hell was I going to pay $1400 out-of-pocket when I have insurance! Guess I'll call the old office. After being hung up on twice, transferred twice, and then on hold for 15 minutes I finally managed to speak with someone. I told her that I needed to make an appointment with Dr. PC. And then, like something out of a sitcom, she tells me, "Well. Right now we don't have a doctor covering. Dr. PC's joining the practice has been delayed, twice. In the meantime you can be seen by a resident until we get an attending on staff."

A resident? A resident?!?! No way, lady. I get that this is a teaching hospital, and I'm all about higher learning, but this is serious. It's my health we are talking about and I want an attending!

Frustrated beyond belief, I agreed to see a resident at 2:30 that day; nevertheless, I did insist on the name of the resident's attending to have for reference.

Two hours and four vials of blood later, I walked out.

Hopefully they can figure out what's wrong with me.

Hopefully I can figure out what's wrong with our healthcare system.

Four Foods- Salty!

Another week of late posting. Bad me! Check out everyone else's timely posts here.

#1. Potato chips. Flavored? Regular, ridged or stacked?
Baked, anyway they come.

#2. Cheese doodles. Yellow or white? Puffed or crunchy?
Pirate Booty, so white and puffy.

#3. Pretzels? Your favorite shape? Favorite flavor?
Honey Wheat Rods

#4. Share a recipe for salsa or dip.

Chipotle Chickpea Dip

1 large clove garlic, peeled
15 ounces (1 1/2 cups) chickpeas, drained and liquid reserved
2 tbsp. lime juice
1/2-1 tbsp. chopped canned chipotle peppers (adjust according to how spicy you like it)
1 tbsp. chopped red onion
1 tbsp. tomato paste
1/4 tsp. chili powder
1/4 tsp. cumin
salt to taste
more red onion for garnish

With the food processor running, drop in the garlic and process until chopped. Add the chickpeas and lime juice and begin processing. If it's too dry, add 1-2 tablespoons of cooking liquid from chickpeas or, if you're using canned, just use water. Add the remaining ingredients and process until smooth. Adjust salt to taste. Serve garnished with chopped red onions.

Oops

I must admit, I enjoyed a glorious four days/nights off. I did laundry, polished china, cleaned out my closet, filed for financial aid for grad school, caught up on t.v. (oh how I <3 DVR!), and slept. However, yesterday was a blah weather day. Gray skies, cold and windy, with bouts of sleetish (sleetesque?) precipitation and I had a headache. I took a power nap before leaving for work, but my head was still a pounding.

I'm not one to take much medicine, so my "medicine" cabinet is mostly hairproducts, toothpaste, and only two bottles of pills-Tylenol and Tylenol PM. After my powernap, I rushed into the bathroom to grab something to kick my headache before what was sure to be a busy night at work.

I popped open the bottle, grabbed two pills and swallowed them with my water. As I was putting the bottle back in the cabinet I froze... "Tylenol PM". Uh, oh.
Not really sure what to do (I've never been very good at making myself throw up), I sighed, walked out of my apartment, and walked into the first coffee shop I passed on my way to work

6:45 pm......triple shot of espresso
I'm going to tell you all something now, a valuable lesson if you will, espresso does not negate the effects of Tylenol PM.

8:30pm.....cup of coffee from the overpriced starbucks in the hospital lobby

9:30pm.....2 cups of green tea

10:30pm....bottle of diet pepsi (uck, I haven't drank soda in over 2 years!)

11:30pm....diet red bull (man, that stuff is gross)

12:30pm....at this point in the night, my bladder is ready to explode, my heart is racing, and my eyes are so heavy that I need life preservers to keep them open!

With each hour that passed at work, my eyes got heavier and heavier. Thank God my patient was sick and VERY busy becuse if I had one moment to sit down, I would have been out cold.

Waiting on His Steps

A moment.
A bad accident.
A very tragic injury.
A young life changed forever.
A broken family grasping for hope.

But what can we do for them?
Will faith conquer impending death?
Does modern medicine prevail?
Believe in God?
They do.

To trust.
They must believe.
We will try everything.
It is a long road.
One that many do not survive.

But they sit at bedside vigil.
And sing against the tune
Of the musical alarms.
She will live.
They pray.

We hope.
Our actions suffice
And instincts are wrong
But fear lingers ever present.
Each day brings a new change.

But no more can be done.
We join in their prayer.
Medicine is not God.
We know this.
Trust him.

-KS 2009
I'm not an overly religious person, but lately I've been rocked back into my faith. Life is precious.

Four Foods on Friday 65

Here are this week’s four questions. Check out the FFoF meme for yourself.
Let’s talk about foods that sound funny.

#1. What’s the funniest sounding food or ingredient you know of?
Maybe I'm immature, but I still chuckle when people order the "Pu Pu Platter"

#2. How do you pronounce “cavatelli”?
(cah)-(va)-(tel)-(lee)

#3. How do you pronounce “gnocchi”?
(know) (key)

#4. Share a recipe that calls for mozzarella cheese.
Mozzarella Salad
Ingredients
4 ears sweet corn, in the husk
1/4 cup extra virgin olive oil
2 tablespoons sherry vinegar
1 teaspoon Dijon mustard
1 clove garlic, finely chopped
2 tablespoons finely chopped fresh chives
Sea salt, to taste
Freshly ground pepper, to taste
1/2 pound fresh mozzarella, cut into 1/4-inch cubes
2 ripe avocados, halved, peeled and cut into 1/4-inch cubes
1/2 pint grape tomatoes, halved
1/2 cup cooked black beans
10 large fresh basil leaves cut into thin strips
5 cups baby arugula, spinach or romaine lettuce for serving

Method
Preheat oven to 400°F. Soak corn in the sink or a bowl filled with cold water for 10 to 15 minutes.

Meanwhile, prepare vinaigrette by whisking together oil, vinegar, mustard, garlic, chives, salt and pepper. Set aside.

Once corn has soaked, place on a rimmed baking sheet lined with parchment paper. Roast for 25 minutes, until kernels are tender. Cool to room temperature, then discard husks and silks. Cut the kernels off the cobs and put them in a large bowl. Add mozzarella, avocados, tomatoes, black beans and basil.

Drizzle the dressing over the salad. Toss gently to combine. Season with salt and pepper and serve over a bed of greens.

I've worked the last six nights straight.
i had to stay 5 hours late on my last morning becuase a nurse didn't show.
two nights with sickest patient on the unit, four nights as charge nurse
bed census: full! (40 patients)
toal work hours = 82
total sleep hours =24
work to sleep ratio: > 3:1


my eyes are puffy
my ankles are swollen
i have no clean underwear
my refrigerator contents: ketchup, soy sauce, applesauce, soymilk, beer
number of unanswered emails: 35
number of times I've seen my roomate in the last week: 1
my neighbors upon seeing me in the elevator: "Ouh, rough night?"

what I want to do most? sleep
what am I going to do? sleep
why am I still typing this? who knows, goodnight!

ZzZZzzZZZzzzZZZZzzzzZZZZZzzzzzZZZZzzzzZZZzzzZZzzZz

"I got no strings to hold me down"

Two weeks ago I got an email from Columbia…

Dear Kelly,

Happy New Year. I hope this email finds you well. The admissions committee is in the process of reviewing your application file and I was asked to see if you would be willing to take the biostatistics placement exam. It will help the committee in their decision-making process…

I nearly shat myself. My heart started racing. Biostatistics? Test? Now? Are you kidding me? It didn’t help that I read this email at 8 in the morning after a four night stretch at work. As tempted as I was to just shoot back and email saying, “NO!.” I knew that was essentially writing my own rejection letter. I did the next best thing and called the woman who sent me this email. Of course she wasn’t in the office, so I left a voicemail. Boy do I wish that she had the option to delete and re-record because I rambled and babbled and stumbled. I managed to leave her my number and the best times to reach me, but I hung up with a pit in my stomach.

Thankfully, I managed to fall asleep for a few hours that morning. I got up and went about my day (gym, grocery shopping, post office, shower, date with the firefighter). After a late night, I didn’t wake up until the 11 the next day. What’s waiting for me? A voicemail from the admissions woman. I had only missed her by twenty minutes; I quickly called her back. She picked right up. She sounded so happy and perky; I, on the other hand, sounded like a hoarse, stuffy nosed sick person. I apologized for my rambling message and she said, “ Well after reading your application it sounds like you have a very intense and exhausting job. No excuses necessary.” Phew! That made me feel better. I told her that I was glad we were able to speak in person. I had a few questions and felt that speaking was much more personal than email (bonus points?)

But onto the real issue at hand. What I wanted to know was if they wanted me to take the test because of a shortcoming on my transcript/performance, or if it was something they were asking all candidates to take? She quickly summarized why she had contacted me. She was a member of the admissions committee and they were in the middle of reviewing my application. They were very impressed with my undergraduate transcript (Ivy League, Magna Cum Laude), my letters of recommendation (two PhD’s well known researchers & the worlds best nurse- BSN, CCRN, MSW, NC, Reverend –I forget all of his other credentials), and my personal statement. However, what they were rather concerned about was my quantitative GRE score. My scores just didn’t match up with my other credentials. That being the case, they felt that they needed me to take a placement test to determine my quantitative (math) capabilities.

I took in a deep breath and said, “Sure. When would you like me to take the exam.” She said, “Great! Here’s the name of the woman you need to contact about the test. Best of luck, Kelly.”

I hung up and sat motionless in my bed. I hadn’t taken a statistics class since my sophomore year of college, but I did get an (A). When I contacted the exam woman in the afternoon, she said that the sooner the better. I looked at my calendar. This was a Wednesday, that Friday I was beginning a 5 night stretch. I told her that due to my work schedule the earliest I could take the exam was the following Thursday. And that was that. Thursday at 10am. I no sooner hung up from her and ran out to the store to buy a review book.

Over the next week I did nothing but work (and study), work-out (and study. I’m sure the other gym members were like who’s the nut on the treadmill reading a statistics book?), and “sleep”/have nightmares of linear regression models, T-scores, and Z-scores.

Before I knew it, Thursday had arrived. I got up early that morning and was at the gym by 5 (sans review book). After a good sweat and steamy shower I set out for 168th and Riverside Drive. Oh yeah, WAYYYY up there across town. Knowing that public transportation would take almost an hour, I opted for the cab (gasp!). What I didn’t account for was morning rush hour traffic. I left my apartment at 8:50. I caught a cab at 9:20. Absurd! My stomach was in knots, my heart racing. The cab driver asked me if I was okay- I guess my voice was shaking as I told him where I needed to go. He was sweet and dropped me off right at the door, wishing me good luck as pulled away. I made my way to the sixth floor, knocked on the door, and then- test time!

The woman’s chipper personality made me more at ease. She led me to a barren room, I said a quick Our Father and Hail Mary and began. Forty minutes later I emerged and handed in my exam. She asked me to sit outside as she graded it. I could hear her turning the pages, it seemed like an eternity. She emerged from her office, paused, then said, “Congratulations, Kelly! 20 out of 21.” My stomach flopped, my head buzzed, I felt all warm and tingly. It may have been just a test, but it was a sweet victory for me.

And now all I have to do is wait for their decision….

Four Foods on Friday 64

Here are this week’s four questions.
Let’s talk about things that might not be quite the usual fare.

#1. What’s the oddest thing you’ve ever made with bread?
A gingerbread house. We didn't have any graham cracker, nor molds to make gingerbread so I improvised. I toasted it, then sprayed it with shilack (did I spell that right?)

#2. What’s the oddest thing you’ve ever done with mac and cheese or pasta?
Dried Pasta Jewelry. Go here for instructions

#3. Is there a food you eat other then it is intended?
Sometimes I take boxed cake mix and add it to some canned pumpkin, stir and eat. It's (almost) guilt free. May I suggest you try it with Namaste brand spice variety


#4. What’s the weirdest food you’ve ever seen?
It's not weird, but my phobia is. You know those "eyes" on overripe potaotes- they freak me out.

(photo credit Food Boom)


Do you want to play? Check out Valmg's FFoF blog feature!

Four Foods on Friday 63

Here are this week’s four questions.

Let’s talk about Chinese food.

#1. Do you prefer to eat Chinese food in the restaurant or to have it delivered?
Delivered. Chinese restaunratns scare me. Cat foo yong.. any one?

#2. Do you prefer wonton or egg drop soup?
Neither, too much salt.

#3. What flavor fried rice is your favorite?
I'd say vegetable.

#4. Describe your favorite item on the Chinese food menu.
This is so lame, but my favorite is steamed veggies. Since I don't eat meat and the tofu isn't recognizable in most dishes, I stick to the green stuff (and the occasional carrot). =)

What about you? Go and check ou Valmg's FFoF blog feature.

One Final Prayer

My last two shifts were non stop, but they are two shifts that I will never forgot.

X was accepted as in international transfer five weeks post burn. Although I've seen many patients with his % burn survive, the fact that at five weeks out none of his wounds were closed was not favorable. When X finally arrived in New York at the beginning of December, he was in renal failure, maxed on dopamine and norepinepherine for his blood pressure, thrombocytopenic, in respiratory failure and ventilator dependent, and in septic shock. Additionally a MRI of his brain revealed an acute cerebellar infarct. He had six surgeries for debridment and skin grafting but none of them took as his body was invaded with fungus and bacteria. I took care of him the better half of the last two weeks and grew to know his family well. They halted their lives abroad and moved here to keep vigil at his side. They waited and prayed and waited and prayed and waited and waited and waited and prayed.

In the last two weeks, X grew sicker and sicker. He had showed some signs of improvement early on (return of some kidney function with oliguric output, improved ABG's, improved coagulation, fewer bacteria invading his wounds) but he took a turn for the worst...

Pseudomonas in the sputum, blood, and urine.
Acetinobacter in the sputum.
Candida on the skin and in the blood.
Thrombocytopenia
ARDS
Pulmonary Edema
Acute Renal Failure
Collapsed Lung
Sepsis
Acidosis
20 kilos of fluid overload with edema making him unrecognizable

In those 25 hours of work I administered 8 units of blood, 8 units of FFP, 10 units of platelets but he remained thrombocytopenic.
The ventilator was on 100%FiO2 and he was still lethally acidotic.
He required continuous deep lavage suctioning that involved removing him from the ventilator and breaking PEEP causing his blood pressure to plummet.
He was so unstable we couldn't turn him to put him on dry sheets, yet he was putting out 11 liters a day in bed drainage (yes, we suction and measure this).
He was two days overdue for day #5 post-operative dressing (POD) change.
His eyes were dilated and minimally responsive.
He was maxed out on Dopamine, Levophed, Neosenepherine, and Epinephrine.

I arrived at work on Monday and was partially surprised to find X still alive. The three hours prior to my arrival his blood pressure was resting around 68/40, his heart rate tachycardic in the 110's, and his O2 sat around 73%. The attending physicians held a discussion with the family during the day and I thought they were leading in favor of DNR, but in a desperate twist of fate the father disagreed and said he wanted "every thing possible" to be done.

During the day, the family had kept vigil at the bedside, never more than three visitors at a time. In the middle of report from the day nurse, Xs alarms sounded, his O2 sat was 65%, he needed to suctioned. The day nurse (J) and I went in and prepared to suction. We no sooner finished when his heart rate began to plummet: 110-90-80-75-70-60-55......

J yelled to get some atropine began bagging the patient. I hopped up to begin compressions. In rolled the code cart and so began the code. His venous access lines ( a right internal jugular TLC, a left femoral TLC, and left femoral Aline) were a mass of "spaghetti" coming from the 13 pumps running on either side of his bed; however, when the atropine arrived J started pushing meds, I continued compressions ,and the fellow took over bagging. I felt ribs snap, I saw my artificial compression "V-tach" heart rate on the monitor, my triceps and deltoids tightening with every blow. And then it happened. The mother came running down the hall, stopped in the doorway, and yelled, "Stop! NO More! I'm his mother." We all looked up- all hands off the patient. At this point the attending physician was also in the doorway and he and the fellow clarified with the mother what stopping CPR would mean and verified that this indeed was her wish. With tears streaming down her face, she sobbed, "Yes. Yes." And with that we turned off the pumps and stepped back. I stood there holding the mother as we watched the agonal heart rhythm on the monitor...28, 23, 10, asystole. We checked- no pulse. And he was gone.

The monitor no sooner read asystole and the sister came running back in. She threw herself over her brother and let out a blood curdling scream. The crowds started to dissipate from the room and the fellow, J, and I began to comfort the family. After turning off the monitors and stocking the room with tissues, we all left and let the family grieve. I called the priest. It broke my heart as I watched the father pace frantically outside the room, refusing to set foot inside. After the priest left, I heard a noise coming from the room. I looked up from my paperwork and started walking towards the room...

Oh Dios de quién Único Hijo nos ha otorgado los beneficios de la vida eterna, concédenos la gracia que te pedimos mientras meditamos los Misterios del Mas Santo Rosario de la Bienaventurada Virgen María, debemos imitar lo que contienen y obtener lo que prometen, a través del mismo Cristo Nuestro Señor. Amen.

Over the last two weeks I'd listened to X's family chant prayers at his bedside, but suddenly I was moved. Not overly religious, but still connected to my Catholic roots, I stopped to think about what they were saying.

Let us pray. O God, whose only begotten Son, by His life, death, and resurrection, has purchased for us the rewards of eternal life, grant, we beseech Thee, that meditating upon these mysteries of the Most Holy Rosary of the Blessed Virgin Mary, we may imitate what they contain and obtain what they promise, through the same Christ Our Lord. Amen.

Jesus died at 33, their son didn't even make it to 30.

The post mortem care that followed was grueling. It took over 3 hours. Removing the dressings churned my stomach. X's skin was green with infection and textured with fungus. When all was said and done, I called the family in one last time to say good bye. As they kissed him their final goodbyes, I stopped the mother in the doorway and took her hand. I opened her clenched fist and placed something in it. She brought her hand closer to her face and opened her fingers--an ID band. She threw her hands up around my neck and sobbed, "Thank You. Thank You." I may not have been able to save her son, but I sure hope I can preserve his memory.

WEEK 62: Four Foods On Friday

And I've been out of the loop for over a month. Life has been quite busy and work, well, overwhelminng. But it's a new year and I'm trying to get back on track. Valmg's been in a funk too, so hop ov over to here meme, check it out, and leave her some love.

Here are this week’s four questions.
#1. Waffles. Do you usually eat frozen or homemade?
What do you consider waffles made at a restaurant? I guess they are "restauarnt" made- but those are the only times I eat waffles

#2. Eggs. Do you buy brown, white, or it doesn’t matter?
Whatever is on sale, but I always buy organic, cage free eggs.

#3. Oatmeal. Do you usually make instant or cooked?
Cooked. Call me a snob, but I'll forgo the oatmeal if I dont have time to cook it. Cooking tip- Old Fashioned Cooking oats are MUCH Better in cookies.

#4. Bacon. Share instructions or a recipe that you use bacon in.
PASTA WITH SPINACH, BACON AND MUSHROOMS
1/2 lb. thick sliced bacon
2 tbsp. butter
1 c. onion, chopped
1/2 c. sweet red pepper, diced
1 c. sliced fresh mushrooms
1 bouillon cube in 1 cup hot water
Salt and pepper to taste
1 lb. pasta
10 oz. fresh, washed spinach (about 4 c.)
1 c. grated fresh Parmesan cheese
Cook bacon until crisp in skillet. Discard fat. Place bacon on paper towels. Add butter to same skillet (do not wash). Saute onions and peppers for 2 to 3 minutes. Add mushrooms, saute for 1 minute.
Over high heat, stir in broth. Bring to a boil. Lower heat and simmer for 2 minutes. Taste and add salt and pepper. In a large pot, cook, then drain pasta well. Return pasta to pasta pot.

Add the vegetable sauce and spinach. Toss over medium heat until spinach is wilted and most of the sauce is absorbed. Divide onto 6 plates. Top with crumbled bacon and Parmesan cheese.

2k9 MEME

I got this MEME from O, who got it from All & Sundry. It's my last day off for the next five, so I figured what the hell-let's waste some time on the computer.

1. What did you do in 2008 that you’d never done before?
took the GRE's

2. Did you keep your new year’s resolutions, and will you make more for next year?
Is it a bad sign that I can't remember if I made one last year?

3. Did anyone close to you give birth?
two of the nurses that I work with, two of the girls I went to highschool with, and Anjali

4. Did anyone close to you die?
yes, one of my coworkers. RIP Tara. Miss you.

5. What countries did you visit?
St. Martin, St. Barts

6. What would you like to have in 2009 that you lacked in 2008?
Sleep and a social life; weird combination I know.

7. What dates from 2008 will remain etched upon your memory, and why?
December 19th- best Christmas party ever!
December 1st- I dischared the first pediatric trauma that I ever admitted
June 14th- I fractured my pelvis

8. What was your biggest achievement of the year?
Staying healthy

9. What was your biggest failure?
Not staying in touch with my friends becuase of my crazy schedule

10. Did you suffer illness or injury?
Fractured Pelvis

11. What was the best thing you bought?
My blackberry

12. Whose behavior merited celebration?
Amy: new job as a VP= all grown up

13. Whose behavior made you appalled and depressed?
The parents of my patient who pressed their child's face against the radiator. It made my blood boil.

14. Where did most of your money go?
Rent, rent, rent. Did I say rent?

15. What did you get really, really, really excited about?
The prospect of getting a permenant day position (too bad it was only a prospect).

16. What song will always remind you of 2008?
I don't know.

17. Compared to this time last year, are you:

a) happier or sadder? neither, I'm content
b) thinner or fatter? fatter and it's really stressing me out
c) richer or poorer?Richer. That's what happens when all you do is work and have no time to play!

18. What do you wish you’d done more of?
Stayed in touch with my friends, gone to church, slept (in no particular order)

19. What do you wish you’d done less of?
Stressing over the future

20. How did you spend Christmas?
At work. Hospitals never close.

21. Did you fall in love in 2008?
Someone won my heart over, but then broke it.

22. What was your favorite TV program?
The Biggest Looser (a guilty pleasure, I know).

23. Do you hate anyone now that you didn’t hate this time last year?
No.

24. What was the best book you read?
Quantum Wellness

25. What was your greatest musical discovery?
Our tiny little bathroom has great acoustics for shower singining

26. What did you want and get?
a complement

27. What did you want and not get?
a permenant day position

28. What was your favorite film of this year?
Rachel at the Wedding

29. What did you do on your birthday, and how old were you?
I worked, but at least Dr. MAtt was there *cue the dreamy music*! I turned 24.

30. What one thing would have made your year immeasurably more satisfying?
Working days so I could see more of my friends and family, sleep more, and make dating easier

31. How would you describe your personal fashion concept in 2008?
Hospital issued 50/50 Cotton, Poly scrubs; gym clothes; a conglommerate of J.Crew, Gap, and Bloomingdales

32. What kept you sane?
Escapes to the suburbs to see the L's or my family, late night talks with Natasha or AMy, and Wednesday Night Dinner Club

33. Which celebrity/public figure did you fancy the most?
I can't decide if the numerous adoptions and procreations of Jolie-Pitts is admirable or insane

34. What political issue stirred you the most?
The shit show otherwise known as our health care system

35. Who did you miss?
My family, my sorority sisters, Sarah, Memegrl and family, Shestartedit and family

36. Who was the best new person you met?
Cheryl. I'd be lost without her friendship

37. Tell us a valuable life lesson you learned in 2008.
Life is best lived with a little spontaneity.

38. Quote a song lyric that sums up your year.
Don't get all worried but if you remember this post, I'd say these lyrics just about sum it up:

What's wrong with me?
Why do I feel like this?
I'm going crazy now

No more gas, in the red, can't even get it started
Nothing heard, nothing said, can't even speak about it
On my life, on my head, don't wanna think about it
Feels like I'm going insane, yeah
-Rihanna, Disturbia

9 things About Me for 2009

1. I like green grapes but red wine
2. I can't fall asleep with dirty dishes in the sink
3. I can wiggle my ears
4. I don't play any musical instruments
5. I haven't eaten meat in 8 1/2 years
6. When applying to college I was torn between architecture and nursing
7. I floss after I brush
8. I prefer flats to heels
9. I'd rather go to bed at 10pm and be up at 5am, than go to bed at 1am and sleep till noon.