Ho ho halleluja!

My mother made Christmas a stellar event when my sister and I were young.  She purchased and/or made numerous gifts for us (and kept track of every cent she spent in order to be "fair"), decorated the house, cooked a delicious meal and made the day very, very special.  Rarely did anyone get drunk (unless it was me), and I don't remember even one nasty fight occurring on a December 25th.

If I shut my eyes today and follow my memory back to, say, Christmas of 1975, I feel warm, cozy, loved, safe, and happy.  I look around the memory room and see my father in his recliner (with a beer), my mother in the kitchen (with a gin and tonic), my sister and her first husband (they were trying to get pregnant and I can hear her squeal with glee upon opening a box containing a check that would pay for one infertility treatment), my first husband (whom I subsequently divorced about a year before he died desperately young at 23 years of age) and the family poodle, Trinka, preparing to beg at the table.  Trinka did love her turkey.  As a matter of fact, that year she managed to climb onto the kitchen counter after dinner and before the dishes were done to pick at the turkey carcass.

I remember this because that one year we happened to tape record "The Opening".  The opening was the lengthy process of  each person receiving one gift taken from under the tree while everyone else watched, and it was always fun. I could hear the Christmas carols playing in the background.  I had that tape and listened to it a number of times as an adult before losing it somewhere during the depths of my alcoholism (not surprising as I actually misplaced a clothes washer and dryer during the same period of time - I honestly cannot remember where those appliances went during one of my frequent moves).

Somewhere in my thirties it came to me that once I left home I was disappointed every Christmas.  My father was dead, my mother was involved with a man I despised, I had been married several times, had no children, my sister lived far away, and what was left of my family of origin rarely got together for Christmas.  When we did, Mom was difficult to deal with, her partner was a raging asshole and had to be the center of attention, and I was drunk or stoned (and disappointed).

Somewhere in my early forties I began exploring Buddhism.  I was sober by then and searching for a place where I fit spiritually.  I was also married to a man who doesn't remember birthdays or anniversaries (he just doesn't) and likes to hold on to his money (which is probably a good thing because I seem incapable of holding on to mine).  I always have a Christmas tree, though, because I love the lights and  inherited some gruesome family ornaments that remind me of Christmas of 1975.

This year, my husband was asked to play Santa at Walmart, where he works.  Walmart is a pretty big deal here in the town of Kenai, Alaska, and I try to be supportive of him in his workplace because he has always been supportive of me in mine.  On the Santa day, I actually put on some makeup, tried to tame my hair a bit, and donned a red scarf before grabbing my camera and making the icy drive to Walmart.  I got there shortly after the Santa event had begun and started taking photos.

As I watched my husband interact with children (he has perfect Santa facial hair - that bushy white beard that I'm always nagging at him to trim) I found myself smiling.  I took photo after photo.  The cute little Native Alaskan kids, the cute little black and white and Asian kids, the kids who cried, the kids who had to be coaxed, the kids who handed Santa crumpled, carefully (and illegibly) written gift lists.  Those kids looked at him like he was really Santa.  My heart warmed and warmed until it felt like I had Christmas music playing in the background, my mother in the kitchen, my father in his recliner, my sister, a turkey in the oven, Trinka begging for treats, and a big Christmas tree loaded with gifts around me.

This year, my husband gave me the best Christmas gift I have ever received, and one I could not have imagined possible.  Thank you to my dearest, long-bearded, thrifty, stubborn, funny, smart, supportive, genuine, honest, quirky husband Santa.  You returned to me the joy of Christmas.

A bundle of miracles

I took my last exam of my first semester of nursing school today.  I didn't do as well as I had hoped and ended up with a course average of 90.6%, which in this program is a "B".  I spent a few minutes mourning the loss of my straight "A" average, ate a bowl of ice cream, and started thinking.

Wake up, Nurse Ratched!  You're a recovering alcoholic/addict and drank/smoked/used drugs from age 14 to 38.  How many brain cells do you suppose you destroyed while you were out there having a "great time"?  It's a miracle you have any left at all - and you are disappointed that you had enough to learn 90.6% of the enormous amount of information presented in your first semester of nursing school.

You're 56.  This is an asset when it comes to life experience, however, let's be real here and admit that you don't have the stamina of a 30 year old anymore and frankly, those 40 or so extra pounds you're carrying around aren't helping any in the energy department either.  It's a miracle that you were able to keep up with your younger peers and rise at 5 am to attend clinicals (not to mention hustle up and down the halls of the hospital).

Hey, remember that couldn't hear anything through a stethoscope three months ago.  Today you identified specific abnormal lung sounds and a heart murmur in the simulation lab and a couple of weeks ago in clinical rotation you heard what emphysema sounds like in a human being.

Now let's talk about the husband.  He's working full time (because you asked him to) and bringing home the health insurance too (because you asked him to) while you go to school.  He takes care of the house and your four cats while you live half-time in Anchorage and never complains that you're gone too much.

You know you were afraid that you'd get the clinical setting and be afraid of "blood and guts".  You were sure you wanted to be a psychiatric nurse (partially because you're a bit nuts yourself) and were very worried about barfing when you saw open wounds.  Turns out you love open wounds....seeing the healing process and the way the body works to fix itself.  That day you got to see a skin graft was the best day of your life.

So you didn't get an "A".  Look at all you got instead.  A bundle of miracles.

So far

Today was the best day of my life.

None of my wedding days (there have been five), my 10th sobriety birthday (a very big deal), the day I realized that I had truly been a good daughter to my dying mother,  the day I left California after 35 years of wanting to leave California,  the day (night) I first saw the aurora borealis, the day I saw Michelangelo's David at the Accademia Galleria in Florence or the day I heard that I had been admitted to the nursing program are any longer in the running for the best day of my life, because it was today.

I spent six hours with my patient today.  In those six hours I used skills I've learned during my first semester to listen to his heart and lungs, assess his neurological status, and take his vital signs.  These are important skills to be sure, but they were only a portion of what I used today to help my patient.  I drew on 17 years of sobriety to understand, accept and support his concerns regarding how alcohol use contributed to the terrible burns he suffered, nearly ended his life, and landed him in the hospital.   I used the strength I've found by changing careers in my mid fifties to reassure him that he too can find a new professional path now that his extensive injuries dictate that he no longer earn his living by manual labor.  I used my laptop to show him that he really can use a computer - he had confided that he was worried about finding an office job because he has always been afraid of computers (we spent an hour on the basics in his hospital room).

I helped him, but he helped me more.  Although I have always wanted to be a nurse, a small part of me was very very worried that I would recoil at the sight of human mutilation.  That "blood and guts" might make me dizzy and weak and nauseated.  That when push came to shove I would run away.  That didn't happen.  Instead I examined with fascination third degree burns.  I saw deep tissue damage.  And because the gods were smiling upon me, I got to see a three day old skin graft.  It was a miraculous thing, the way that skin harvested from one part of his body was growing on another, and I told his surgeon that it was the most beautiful thing I have ever seen (that really made the surgeon smile).

When I left the hospital today to drive home I wept a bit.  I wept for my good fortune - in having the opportunity to live my lifelong dream of becoming a nurse (thank you Mom), for my patient who has taking a long hard look at his life and is choosing change and personal growth instead of despair, for the surgeon who is a skilled artist and can move living skin from one place to another, for my sister who talks me down from the ledge, my husband who works to support us while I am in school, for my sponsor who has stuck with me through thick and thin, for my cousin who has become such a wonderful blessing in my life, for the college friends and educators who have encouraged me to continue when I have struggled.

I was born to do this, and today was the best day of my life.  So far, anyway.  I know there will be more.  And that is the greatest gift of all.

The light at the end of the enema

Tomorrow afternoon I will be asked to administer either an enema or a tube feeding to one of the plastic mannikins in our skills lab, and that will be the last "hands on" test of the semester.  Two weeks from today I will take my final written exam, dust myself off, and leave the first semester of nursing school behind me.

Tonight after class I drove to an unfamiliar corner of Anchorage to look at a "snow bike" a man named Doug had posted for sale on craigslist.  I've been riding my bike indoors on a "trainer" since the first snow fell, but that doesn't quite cut it for me.  I'm like a dog riding in a car with the window rolled down.  I want that wind blowing in my face and bugs in my teeth.  Having found myself green with envy whenever I saw a hardy Anchorage resident pedaling through the snow and ice I started trying to figure out a way to get a bike with studded tires and join the group of lunatics who ride bicycles outdoors during Alaskan winters.

It was really dark out there tonight (and this afternoon and morning, for that matter) and few lights were lit while I searched for Doug's address.  I shuffled through snow and knocked on the garage door at the right address.  It opened and one of Doug's employees motioned in the direction of a small room off the garage. There it was.  It was sturdy and studded and powerful looking.  I rolled it outside and rode it up and down a snowpacked street.  The tires crunched through that snow, the wind was in my face and I felt the warm, syrupy flow of the only healthy addiction I've ever experienced return.

Can I afford it?  Define "afford" for me.  I'm paying for nursing school and not working, so do I have extra money lying around?  No.  That said, how can you put a price on rolling down a bike path in Alaska in the dead of winter, the hood of your coat covering your helmet, Thinsulate gloved hands gripping the handlebars, blowing by trees covered with ice and remembering that you lived in the sweltering heat of southern California for 35 years dreaming of a climate more to your liking?  How can you say no to exercise that fills you with excitement?  I can't.

So, I bought it.  I have my alarm set for sunrise (no sacrifice - that'll be about 10 am tomorrow) and I'll suit up and hop aboard my wicked snow bike and take a frosty ride to celebrate the light at the end of the enema.

Two weeks out

When I started nursing school, I counted "weeks in".  As in, "I'm three weeks in!".  Now I am "two weeks out".  This first semester is almost over.  BNS (before nursing school) I was told that I would learn a great deal about myself as I made my way through the four semesters required of any poor soul whose sights are set on an Associate's Degree in Nursing.

Here's what I've learned so far.

1. Fairness counts to me.  Very much.   We just took our third exam yesterday and it contained numerous questions that were just plain unfair.  Either our instructors had told us that we wouldn't be tested on that information, or it was "taught" by an instructor who informed us that class would be short on that day because she wanted to get home in time to take her children trick or treating, or it just wasn't covered either in class or our book.  I got a 79.8 on that exam (which destroyed my chances of getting an A in the course) and most of my fellow students did worse than I did.  None of us are happy about that exam.  It wasn't fair.
2. I have a massive ego.  Why was that A so important to me?  I try to justify that burning desire by explaining that the airline I use to get back and forth from home to classes gives me a 25% discount on airfare for a 4.0 GPA and only a 15% discount for a 3.8 (which is about what I'll have after this class), but as my sister pointed out, that represents approximately $6 per flight.  Who but an egomaniac whips themselves into a frenzy over $6?
3. I was born to be a nurse.  I love staring at wounds and dead tissue and think bowel sounds are absolutely fascinating.  The smell of poop doesn't make me gag.  I can find the good in every patient with whom I interact - even the really cranky ones.  And, when I come in contact with a nurse (a real one, not a student) who doesn't put patient care first I find myself wanting to take her "out back" and show her "what for".
4. I'm really, truly NOT a morning person.  Our clinical experience in the hospital starts bright and early (0630) every Thursday and when the alarm goes off at 5 am I've gotten maybe 4 hours of sleep.  I just can't nod off at 9 pm.  My clinical hours for next semester will be from 2:30 through 8:30 pm on Wednesdays and Thursdays.  Ahhh.

A few more tidbits:

• One can never have too many individually sealed alcohol wipes;
• It is easier to learn to use a stethoscope if you don't have too much wax in your ears;
• First semester nursing students should buy scrub pants with elastic waists (ice cream is an excellent coping mechanism) and
• If your instructor is having a bad day, chances are that you will too.

Happy Thanksgiving to all.  What am I grateful for?  I'M TWO WEEKS OUT!

E ticket

My cousin's husband calls the small planes that fly the 60 miles between Anchorage and Kenai the "vomit comets".  Most of the flight is over the flat land on the Kenai Peninsula, but the 20 miles southwest of Anchorage are over water:  Cook Inlet as it curves to become "Turnagain Arm". 

It takes 30 minutes in the air on a 10-seater to get from point A to point B.  The drive, however, is 150 miles and takes 3 hours IF you obey the speed limit.  The highway winds through mountainous terrain and there are miles and miles of nothing but spectacular scenery.   I'm making a round trip once per week for school.   The drive was wonderful as summer wound down - I got to watch fall in all its glory along the route.  Now the leaves are gone and winter has arrived in the form of snow through the passes.

I won't drive that road in the dark.  I am afraid of hitting a moose, careening on black ice, and getting caught in a whiteout.  There are stretches with no cell phone coverage up there.  I'm too old for that s$x*(.  The sun is setting earlier and earlier these days, with our shortest day (December 21st) fast approaching.  On that day we will have no more than six hours of twilighty daylight.

I took my first flight home about 10 days ago.  I was nervous - I'm always nervous about plane travel, but this was my first trip on a plane that small.  At the airport in Anchorage I started a conversation with a young woman in the ladies' room near my boarding gate.  She said, "MAN that was a bumpy flight".  I asked her where she had flown in from and she replied that she had come from Kenai.

I took a tranquilizer.

The flight was not too bad.  It was bumpy in stretches, but I was sufficiently medicated and just glad to be home when we landed.

The day of my return flight I noted with smug satisfaction that the winds were calm.  No tranquilizer for me - I was "experienced" by then and had class later that day.  The first 15 minutes of the flight were smooth as glass.  Then, we flew out over the inlet.

I won't say all hell broke loose, because that would be an exaggeration.  I will say that it got very bumpy.  The up-down-sideways stuff.   I figured I could handle anything for the 10 remaining minutes of the flight, but noted that we weren't heading straight for Anchorage.  We bumped and twisted and bounced north of the usual route and flew over some mud flats, making two huge circles.  I could see Anchorage off to my left, and from a number of different angles as the plane tipped and jerked I longingly eyed the runway.  The seat belts on these planes are very strong and very restrictive.  One strap crosses from back to front at an angle over your shoulder, and another crosses you at the waist.  I wear mine fairly tight, and I needed it.

After what seemed like days, we made our approach to Anchorage and landed.  I smiled at the pilot and made a reference to the winds as I left the plane;  she looked at me and said, "Oh, was it bumpy?"

That afternoon NOAA posted a high wind warning for the Anchorage area.  85 mile per hour winds.

"Oh, was it bumpy?"  Yeah, it was bumpy.  Like, way bumpy. 

Just part of living the dream in Alaska.

The list

I've never been much of a list maker.  My life has been more of a "fly by the seat of your pants" experience, and I'm beginning to realize that if I'm going to make a good nurse, some change may be required on my part.

I'm building a list. The list consists of mistakes I've made in lab class and involve the dummies (lifelike mannikins) we use for training.  It is my wholehearted wish that I do not make these same mistakes when I am allowed to reposition, catheterize, drive needles into or provide bedpans for real people.

Today we were tested on our ability to administer medications - both the oral and inject-able kind.   You'd think that giving the oral kind would be pretty much pop one out of the bottle and hand it to the patient, but instead it is an incredibly complex process including things like checking for contraindications, cross checking the medication with the patient's medication administration record at least three times, educating the patient regarding what the drug does and knowing when, as the nurse, to wear gloves, wash hands, or call the doctor.  Medications to be injected include the same activities, however, they are further complicated by choosing needle and syringe size, figuring out which anatomical site to jab, and learning all the tricks by which nurses avoid needle sticks (and therefore avoid bloodborne diseases nobody wants).  The next time you get a flu shot, look at the person who is about to skewer you and realize that he or she is using about 7,000 snippets of information in order to administer that vaccine.

I got through most of my skill checkoff today and felt pretty good about things.  As a matter of fact, I was taking a last look at my plastic patient when I realized in horror that even though I had carried my new stethoscope into the room with me just in case my instructor wanted me to administer a particular heart medication, I had failed to use it.  I was not supposed to administer the medication if the patient's heart rate was less than 60 beats per minute and I had absolutely no earthly idea if that was the case because I had skipped that crucial step.  My eyes grew wide and I gasped while I advised my instructor that I had made a terrible mistake.  She already knew it, of course.  I said, "Is there an antidote?".  Very stupid question.  This patient is in no danger from this drug because she is plastic and therefore unable to swallow the pill in the first place.  I felt awful. 

My instructor passed me on the skill because I realized my mistake before leaving the patient's bedside, but she cautioned me to pay closer attention.  I left the college and drove to a grocery store where for the first time in my life I bought one of those gizmos they advertise on late night tv: some kind of magical chopper thing.  I felt as though I had failed the exercise, even though I had passed, and retail therapy usually works for me.

I still feel like crying.  If that had been a real patient I could have caused her complications.  This nursing thing is serious, serious business and tonight a tiny part of me is questioning whether or not I have what it takes.

One more for the list.  And tomorrow is another day.