Peanut Butter Milkshake and a Walk in the Park

A peanut butter milkshake and walk in the park, those were my "self care" activities of choice following my phone interview for the WSU PhD program this morning. I had been dreading that interview for over a week, why couldn't I just drive to Spokane and do the interview in person. It doesn't matter now... at least it's over.
Since for some odd reason I don't have a phone in my office and the functionality of my cell in this building is rather dubious, I used the dean's office to make the call. I think in some ways sitting at his huge desk surrounded by all of his post-it notes to self and numerous degrees made the process more intimidating.
Now we wait...

Ineffective Individual Coping on Whose Part?

He came to us around Thanksgiving, he was on death's door. Mr. Jones (not his real name of course) had been dealing with a congenital heart abnormality all his life, and now at age 50 something it was catching up with him. I remember the evening he came us. With his breathing and circulation were controlled by machines, it appeared that his only hope was a heart transplant.
After several days in intensive care, Mr. Jones recovered enough to breath on his own. His prognosis was starting to look a little better. It wasn't long, however, before he experienced another setback, a massive stroke, a major risk for patients with ventricular assist devices. By Christmas his brain function was very minimal. Even so, his wife Sue, faithfully sat his bedside. Because she wouldn't "pull the plug," some of the nurses had her pegged as "in denial" and gave her a nursing diagnosis of "ineffective individual coping."
I found myself as his assigned nurse on several occassions. On the days I wasn't too incredibly busy I chatted with Sue as I changed dressings and IV lines. I found out that she was a high school language arts teacher, that she was a mother of 3 young women, that she had met Mr. Jones while they attented college in Canada... I found Mrs. Jones to be a very pleasant woman with a great head on her shoulders who just happened to be going through a very difficult time.
Last week I was assigned to a different hall. I was charting and watching monitors when Mrs. Jones walked by. We greeted one another in passing and I asked how she was doing. She told she that she had decided to see a counselor as a way of taking care of herself so she would have someone to talk to. "I'm doing it to be fair for my girls. They are already greaving enough over their father, they don't need to worry about me too..."
She told me about how when she went to meet with the counselor, she noticed that the counselor seemed uneasy. "So basically you're greaving over your husband before he's even dead?" Mrs. Jones was a little surprised by this unexpected response from a "mental health professional" so responded to this remark by asking, "You don't like me, do you? Am I making you uncomfortable."
The counselor responded with this: "I don't like myself when I can't help people."
Wow, that really hit the nail on the head. It isn't Mrs. Jones who has the "ineffective individual coping."
"I'm trying to keep at least one foot in real life. I want to do what's best for my girls and those I have left," she said as we finished the conversation and parted ways.

That's What Christmas is All About Charlie Brown...

Since all of my students are on Christmas break I have been working a lot more at the hospital. I have to admit that while I do generally enjoy my work, any sort shift in the schedule upsets the extremely delicate balance I have worked so hard to make it that way.
Last Wednesday was my random one day off in a long string and I was looking forward to spending it visiting with some good friends. My friends live about 40 miles south of me so I try to take advantage of making such a long trip by adding in other things I need to do in that direction. That morning it was taking the car in for service.
I left the house early as I had accepted the first appointment of the day. Traffic was a bit heavy so I was late by a few minutes. As I hoped out of the car and started inside I suddenly realized my keys were still in the car and the car was locked! Oy Vey!
Fortunately it was only about an hours walk to World Vision where my mom works. It was a cold morning but the walk gave me time to reflect. Of all of the days this could happen at least I had the time to deal with it today. Was it really that bad, more embarrassing that anything I guess. So I spent part of the morning praying as I walked.
I was able to borrow mom's car to drive all the way to my sister's place to get the key to my house and then to my house to get the spare keys. A few hours later I arrived back at World Vision to deliver mom's car to her. Of course with mom being mom, she didn't want me to walk back to the mechanic. "I get off early at 4 today, you can wait here for me." Ahhh... It was only 1 at that time.
So there I sat in the lobby of World Vision with my laptop half working, half people watching. Then I noticed a family outside looking at the statues of Jesus and the little children. As they entered, the children (a boy and girl about ages 8 and 1l) excitedly ran up to my mom's desk. They wanted to buy farm animals for people in Africa.
Of course mom is the receptionist and switch board operator, not the person who takes the donations. She tried to explain this to the family but the disappointment on the children's faces was just too much. As she called around to find a solution, the kids counted and recounted the precious money they had earned for this specific purpose.
They managed to create a elaborate plan to maximize their gift using every last dollar they had. Mom filled out the papers and gave them each a little receipt which their mom said she would hang on their Christmas tree.
"I hope you are rich when you grow up, you would just give it all away," said the mother to the little girl.
As I thought about that statement I thought about all the different ways we could be rich and all the different ways we could give it away. I'm hoping to take that as a challenge.

Christmas Greetings

Greetings everyone and a Merry Christmas!
The last few years have been full of blessings and new adventures for me.
In May of 2008 I traveled to Rwanda as a part of my master’s thesis to teach a class in basic trauma nursing. I had the pleasure of working with my friend Julie Yerger at Kibogora Mission Hospital. The experience was nothing short of amazing, I am sure I learned much more than I have ever taught.
In June 2008 I successfully defended my thesis and presented the work I did in Rwanda completing my work and officially becoming April Morgenroth RN, MN. It is much more exciting than it sounds however, as all it meant was a change in offices and an increase in responsibility. I suppose I could add to that eligibility for a PhD program, but that of course means many more years of work (and hopefully more trips to Rwanda).
In September 2008 I officially became the Northwest University Medical Surgical clinical instructor at Overlake Hospital in Bellevue. I have truly enjoyed the experience and have been blessed two years in a row with the “Best Clinical Group Ever.” We have had so much fun learning, laughing and growing together and I feel so incredibly blessed by them.
June of 2009 was the first year in 13 that I wasn’t in Mexicali, Mexico on the MOP mission’s trip with the high school students. The trip was canceled this year due to violence in the border cities. I must say there were a lot of disappointed high school students but we’re hoping to resume this year.
Of course I couldn’t let summer go by without any international travels… July found me in Cambodia with a medical team from New Life Foursquare Church. We served the Province of Ratanakiri by setting up a free clinic at a local orphanage. Thirteen practitioners saw over 1600 patients in only three days! We saw everything from Malaria to heart disease and everything in between. The clinic was actually cut short by some political activity but God has His hand on us and everything turned out for the best, even better than we had planned in fact.
Two weeks after returning to the U.S. from Cambodia I left for Mexico City with four students, one nurse and one nurse practitioner. This was part of a pilot program for a summer nursing elective travel course. The class was on trauma nursing and we partnered with the Mexican Red Cross. Fortunately I was able to modify the same curriculum I had developed for Rwanda for the work became a little more manageable.
The trip was amazing and we all made many wonderful new friends. Each team member was also able to bring in an extra suit case packed full of much precious donated medical supplies. An ambulance crew received their very first and only bag valve mask, a clinic was outfitted with a nebulizer machine and oxygen equipment and most of all, everyone was encouraged. The new curriculum has officially been approved by the office of the Provost and we are all looking forward to next summer.
These last few months since the beginning of the school year I have been dividing my time between University of Washington in the intensive care unit and Northwest University with my “9 kids.” The year is going by so quickly, I’m excited to see what the next year will bring.
Merry Christmas Everyone!

A Happy Thanksgiving

This year for Thanksgiving I had four nursing students with me who lived far away and were unable to go home. Two are sisters from India and two are roommates, both from out of state. We started out at my house baking bread and making delicious curry. In the afternoon we headed over to my sister's house to enjoy the Thanksgiving meal with the rest of my family and some other friends.
The food was delicious and everyone seemed to be enjoying themselves and eachother. Lisa and even broke out the Wii. It was a kick in the pants to watch my students play Wii bowling with my mom. Everyone seemed to be getting into it to extent of making sound effects.
After most of the guests had left, we got Priya and Reena to play Guitar Hero; what a hoot! I am so thankful for all the fun loving people in my life!

Celebrating Life's Little Victories

At the end of the long term care rotation I asked my students to write down three goals they hoped to achieve during the acute care rotation. One student (who can sometimes be especially "giggly") stated that she wanted to work on maturity. This goal came from a conversation she had with another nurse about the skills they had learned in skills lab. Apparently she couldn't say she learned about enema administration without laughing.
One day at clinical a nurse asked her to administer a fleets enema to an extremely constipated patient recovering from a hip surgery. With hip precautions a extra person is needed to help turn the patient in such a manner as to protect the joint. I went into the room to help her. In attempt to put the patient at ease we made small talk with her and found out she was from the Olympic Peninsula. We discussed the elk crossing signs in Sequim and the enema was administered without even a smirk! Sometimes it's the little things...

Patient Hand Off to Eternity

Over the last few weeks of teaching I have encountered two repeating themes, patient hand off and end of life issues. The Joint Commission (the accrediting body for hospitals) has put a lot of emphasis on patient hand off recently in an attempt to improve continuity of care for patients during the transition between care providers. I have been thinking of ways to discuss this with my students and provide them opportunities to practice patient reports.
A few weeks ago I found myself standing with a student at the bedside of a patient as he passed. Only days later one of my students found herself caring for an extremely ill developmentally delayed young man who was on deaths door. She did a wonderful job providing competent and compassionate care for the boy but unfortunately he died just a few days later.
I fell asleep Monday night reflecting on the last weeks events and wondering how best to respond to the students difficult questions about death. I awoke at 2:30 am from a very vivid dream. One of my junior students was with me at work in the ICU. We where standing at the foot of that same young man's bed. We had come to the place where we could do no more for this boy. We remained at his bedside as he took his last breath. Then we did something very strange, we clapped. It was a long hard fight coming to a gracious end. As we where clapping the boy took flight right out of the bed. I know; odd, cheesy, disturbing, call it what you will...
After thinking about it for a bit I finally realized what it was all about. As nurses we naturally desire to cure our patients, to make them well. We often take on too much responsibility for them, forgetting that in perspective we really have little offer them. While we must carry out our duties as nurses, we must also remember to daily "hand off" our patients to The Great Physician. Our job is to help help set the stage for God's grace in the forms (likely and unlikely) in which it manifests.