Thursday, October 29, 2009

I am struggling this week with closing one chapter here in Nashville, and beginning a new one in Paducah. I have been one giant slug this week, only accomplishing what is absolutely necessary to get by! Not a feeling I am familiar or comfortable with! I am scheduled to load the U-Haul next Wednesday and head to KY.

I joined the Kentucky group of Nurse Practitioners and Nurse MIdwives this week. They have been so welcoming to me and am getting excited about meeting other NPs in the area. I must say, I am thrilled and surprised to have such a strong group of NP/CNM's in KY!! Looking forward to getting involved in the organization and promoting the discipline of advance practice nurses to the community.


Wednesday, October 28, 2009

Another Journey, Another Challenge, and Another Opportunity to See What I am Made Of!!

Since I last wrote a blog, my journey I had planned (obviously my plan is NOT God’s plan, you would think I would have learned that by now) out meticulously has been once again derailed!! I graduated in August from the NP program all of you have read about during my last 3 ½ years in Nashville. No small feat in itself since I began this adventure with a MS in Fashion Design/Merchandising and not the least bit of science background the majority of my classmates had. A challenge to say the least, but one that I loved! In the last 3 years I went from having no experience (except a wide variety of LIFE EXPERIENCE, and 50+ deliveries as a doula) in the medical field. The journey began in Paducah at the community college taking A &P, microbiology (from a teacher that wrote every single note in long hand on the board… chemistry, statistics and nutrition with one of my best friends in the world. (Thanks Trish for being my study partner and cat-dissecting partner). During my RN clinical I learned to put in Foley Catheter’s, NG Tubes, bathe patients, run IV’s, put in IV’s (on my classmates/instructors and real patients), learning the pharmacokinetics of medications, the classes of medications, the path physiology of diseases, taught an impromptu childbirth class in the middle of the project’s to one of my community health patient’s (baby, fake pelvis and all), much to the horror of my very young and brilliant nursing school partner, helped orchestrate the first wedding on 4E at Vandy for a woman dying of gyn cancer, and felt the horror as my clinical group and I went to lunch only to return to find out one of our patients had died while we were gone (5 students, bathing, and preparing a patient who had died alone with only a plastic bag of belongings to her name. No one said a word as we realized the reality of our job), to passing my RN exam (after 75 questions, yes I am proud of that!!), to immediately be thrown into the MSN portion of the program and learning to suture a vagina in a million different ways (not easy for a left handed gal), delivered 43 babies, learned what to do in most any OB emergency, had my arm up to my elbow in a woman’s vagina attempting to remove a retained placenta from her uterus, got a tsunami of amniotic fluid in may face, mouth, down my scrubs etc. from my first standing delivery (the patient, not me), learned the true art of pitocin management, cut my very first episiotomy in order to assist a baby make that final journey into this amazing world, became an excellent stripper (membrane stripper that is…), can put Cervidil in with the best of the them, learned how to put in IUD’s (thanks Lisa) many times over, met my Somalian sister during her journey of breast cancer and childbirth (Read the Listen to Women blog for that story), learned that even if I don’t speak Somalian, Kurdish, Swahili, French, Spanish or any of the other languages my patients spoke, I could still offer good healthcare simply by “being present” and attempting to make the effort to communicate, I was blessed to be a part of a Centering Pregnancy group that had a treasure trove of different women from different backgrounds and nationalities in it. And was saddened beyond belief when one of my patients from the group was suddenly killed along with her 6 week old infant daughter during a tornado. I sat in sadness with the group back at the clinic as they gathered to honor her life, share stories, pictures and their feelings of one of their friends that they had experienced their pregnancy journey with was so suddenly taken away. I treated patient’s who were transgendered, gay/lesbian, unemployed, famous, students, immigrants, black, white, Hispanic and learned that we all just want the same thing in life, to support our family, and be treated with dignity. I froze off plantar’s warts, warts on the hands, anal warts, as well as injected steroids into a tennis elbow (thank you Dr Bullock for allowing me to do that), I stapled wounds, found an enlarged liver on a patient (seems simple, but I was proud), had to tell (the MD did the talking actually, as I listened in horror) that he is HIV positive and most likely had AIDS, I missed a case of facial shingles (one time only), but nailed it the next two times! I took I waited with a patient while we got her transportation to be immediately transported to a psych. Unit from the office, I spent 5 weeks in a psychiatric hospital (behind double locked doors, as a student, not a patient) learning the difference between being a functional human being one day and snapping the next and wondering everyday, just how close any of us are to the mental state I witnessed PhD graduates, former executives’, housewives, entrepreneurs’, students, etc. attempt to regain their mental abilities while living in an institution. I realized that pscyh is not my calling because I was drawn into everyone’s stories (some true, some completely fabricated, yet real to the patient). I realized that each and every one of us just might be one step away from crossing that line from sanity to insanity! I spent 14 weeks at Ft. Campbell serving the men and women who are serving this great country we live in, I cried as a pregnant patient told me her story of watching her husband killed in the car in front of her as they were driving home one night. He had just arrived back from Iraq the week before and heard the baby’s heartbeat for the first time right before he was killed. I felt my first cervix with Ms. Lindsey beside me as I examined a pregnant patient. I will never forget the light bulb that went off, as I knew exactly what I was feeling for the first time after many missed attempts on other patients. I practiced suturing and tying knots on placentas as Major Brown so patiently worked me on her own time day after day! I went to Tullahoma once a week to a health department and gave prenatal care to mainly Hispanic women with no other means of healthcare. I learned how to draw blood with my eyes closed, give injections (thanks Lisa for letting me give you my first flu injection)! My experiences the past 4 years have been too many to mention. Peppered with comedy, tragedy, tears, laughter and a treasure trove of emotions!

I say all of this as I passed my FNP boards yesterday and have been preparing to move back to Paducah, KY to begin a career in the ER. A move I am absolutely scared to death about! I invite you to join me on the journey I am embarking on!

Listen to Women...Update

As a postscript to the first Listen to Women, my new "Somalian Sister" is healing well after her mastectomy. She has had 2 rounds of chemotherapy and in good spirits. The children and I took gifts for her two children and donations that were sent over the holidays to her apartment last month. She was shocked and so appreciative of the money. This woman who has breast cancer, a port in her chest for the chemotherapy was gracious enough to cook my children and I an authentic African dinner. I have never been more proud of my children as I was watching them eat goat meat, greens, rice with amazing spices and vegetable etc.....I was horrified at what might come our of my daughters mouth when she was told that is "goat meat" in the greens!! To hear Ella Kate ask "can I have more goat meat" almost made me choke! Those are 6 words I never expected my 11 year old to say. On the ride home, she and Jackson decided that when their family comes to visit us, we have to cook an American dinner of spaghetti and meatballs for them! If she thinks spaghetti is American, so be it....she had just eaten goat meat and collard greens with a family from Africa and I was thrilled!

As great as my rotation was last semester, this family practice year is equally as amazing on a totally different level. It much harder academically than I had imagined. I have the most amazing MD for a preceptor and his practice is booming and extremely diverse. Newborn exams to my oldest patient thus far has been an extremely young 86 year old woman. I had no idea how broad family practice is....I never know what to expect once I get into the room with the patient. Talk about feeling inadequate!! I will be starting week 4 on Monday and just beginning to have some idea of what to expect. I was thrilled to have discovered a very very soft 1/6 systolic murmur on a 1 year old this week, as well as rhonchi over the lower lobes of a 12 year old with a bad cough. Hearing Dr. Bullock tell me "good job today on clinical skills Dani" was just what I needed to hear to continue onward. Now if I could simply commit to memory all of the medications we prescribe for hypertension, diabetes, skin disorder etc....I present every patient to Dr. Bullock in front of the patient after I have taken the history, done the exam and made a list of possible diagnosis and a about nerve wrecking! I was doing an exam on a man Wednesday and out of my mouth flew the words "Gosh you have a huge uvula"....well crap, I was horrified as he started laughing. Dr. Bullock and I decided that that is definately on the list of "Things you probably should never say to a patient" As well as "Wow, you are so open in here" while doing a pap smear......nevermind how I know about that one!!

My first born turned 13 last Sunday. He was 10 when we moved here all alone to start over not having any idea what I had gotten myself into. He has transitioned from a little boy to a 6 ft 2in size 14 shoe half man/half boy who has helped raise his sister while his mom was overwhelmed, over worked, stressed out, on the verge of tears and way to short tempered while attempting to pay the bills, clean the house, cook the food and keep us clothed. My little man mowed yards one Saturday last summer to buy the expensive shoes he wanted, he made 60.00 one Saturday so he could have new shoes on about a proud mom...and sick at the same time that he had to go out at age 12 and hustle up business to help buy his own shoes because his mom was unemployeed and back in graduate school.

I received my Certified Nurse Midwife certification certificate in the mail yesterday!! What a feeling to see it in writing! Proof that I really have been working hard the past 3 -4 years....



Listen to Women....a Lesson Learned from a Student Nurse Midwife

October 29, 2008

Today is a day that changed my life in a profound way. I called my preceptor this am at 5:45 as usual, and she told me that no one was in labor and we had 2 PP rounds to make, so I would meet her there at 8:30. We made our rounds and as I went back to the call room she told me that the induction we had scheduled for 12:00 pm had just come from the Oncologist and her biopsy of a lump in her right breast had come back as invasive breast cancer………..

Rewind several weeks….my new friend’s right breast starting “itching” in a strange way. She was unable to palpate any lumps but felt that something was not right. She came to the clinic and still no lump was found on the first visit, but the next ROB a lump was present.

She was referred to a doctor at Baptist Hospital who, after a biopsy this week diagnosed her today with cancer, the day she was scheduled to be induced at 39.1 weeks due to a prior term IUFD in Kenya…..

I said all of this to set up for the life changing day I spent with one of the most amazing, strong, powerful, graceful and determined women I have ever met in my 42 years of life. I was granted the rare opportunity to share my day with this woman who was left alone at the hospital to begin her labor journey only 3 hours after receiving heartbreaking news about her health.

We laughed, cried, shared hair conditioning tips, talked politics, watched the Obama 30 minute commercial, and watched Deal or No Deal during the emotional rollercoaster course of our day. Her husband had to be at home with their 4 year old son and would not be coming to the hospital until tomorrow morning after the baby is born. With no family or friends in Nashville, I quickly became her “sister” as she stated. We were both under the impression that I was to offer her support and company during the day, when in reality, she gave me much more than I could have possibly given her.

My new friends’ story began in Somalia, where she was born into the family of her Somalian father and mother. At the age of 8 she was one of many little girls who lined up to take part in the generations old tradition of Female Genital Mutilation. She told me heartbreaking stories of infection from razor blades used on more than one little girl, stories of family and friends who bled so much on their wedding night they would have to be transfused to save their lives. Stories of nothing but a “pin hole” left from the FGM in some women that they are unable to have penetration with their husbands, stories of women who died from renal failure due to the fact that they have chronic UTI’s after FGM.

As a teenager she was forced to leave her country of Somalia with her family when civil war broke out. She and her family lived in a refugee camp in the country of Kenya for 16 years. She built a good life in a country not her own, all the while knowing that eventually the government would require her to leave Kenya.

Her father was a practicing polygamist who had 3 wives and many children (as is the custom in Africa, one can have up to 4 wives). We laughed and wondered out loud how any woman could share her husband with other wives. She told me how it works for her culture; and that she told her husband before they married, “If you want more than one wife, marry someone else, I don’t share”. She told me that in Africa adulterous affairs are rare….having 4 wives should be plenty for any man!! Her father was an educated man and saw to it that she and her sisters all had college degrees. She told me that the greatest gift we can give our children is a good education. She was an “assistant physician” in Kenya. Similar to physician assistants in our country. She saw anywhere from 30-50 patients a day in the government clinic she worked in. She met her husband (an Ethiopian refugee) while she was working with Doctor’s Without Borders. He is an accountant and owned his own business in Kenya. The heartbreak of 2 professionals in one country, and not being able to find work in another country.

She told me the story of her courtship with her husband, wedding celebration and the traditional customs involved with an African wedding. The heartbreak of delivering their first child in Kenya after he died in the womb during labor. The agony of her breast milk coming in after she went home from the hospital empty handed and heartbroken. The joy of delivering their 4 year old son and breastfeeding him. We cried together as she realized that she won’t be breastfeeding the baby currently in her womb. She has battled TB and hypothyroidism. She had never used a washing machine in Africa, a luxury we take for granted in the US. She told me of the loneliness of living in Kenya with their infant son for over a year while her husband had been moved to Jacksonville, FL first then to their current apartment in Nashville. The heartbreak of her mother and father both dying in 2006 within 7 months of each other while she was waiting to move to Nashville. The feelings of being torn between leaving her family in the refugee camp in the country of Kenya and the anticipation of being reunited with her husband in yet another country not her own. She told me of the 24 hour journey from Africa to the United States to begin life over once again in a country she had never even visited. The struggles of being given one months rent, $200.00, food stamps and no family or friends to communicate with. And now, the long road ahead of her with the diagnosis of breast cancer just hours before.

She asked me about my family and we cried together as we both shared our stories of once having financial security and the heartbreak of standing in line at the DHS and putting your pride aside to ask for food stamps and TennCare to feed and have medical insurance for our children. We laughed together at the realization that it just might be possible that I am one of the few at Vanderbilt on food stamps and Medicaid while attempting to put myself back through school for a second chance at financial security for myself and my children….we are from two different worlds, with two very different stories. She believes as I do that I was sent to Vine Hill Community Clinic for integration this semester for a reason, one I may never know. Even though I can’t even begin to fathom the heartbreak, and loneliness my patients have experienced; I can relate to losing everything and having two choices, to either stay down or begin the long, grueling, hopefully rewarding journey of “starting over” and making a better life for me and the children.

I have never been good at recognizing the signals God puts in front of me to pay attention, be still and listen. My life changed in profound ways today as I “listened to women” (a woman) with an open mind, allowing myself to feel her pain, while embracing the very personal pain of my journey the past 4 years as we shared our life stories with each other. Two strangers, who in ordinary circumstances would have never crossed paths. But this is no ordinary circumstance, and we have chosen no ordinary profession. WE are soon to be nurse midwives in a country that values volume over quality. We speed through life, fast food drive through windows, we are double booked in our clinics with the assumption that someone won’t show up for their appointment; having to mindfully make the attempt to “listen” to our patients when no one “no shows” and we have every room filled with patients wanting to share with us their fears, concerns, joys etc. of their pregnancy. Had I not been a student this week, I wouldn't have been able to spend and entire day with this amazing woman who made a lifelong impression on this single mother of two. We had two patients in labor, and I was fortunate enough to be able to dedicate my day to this woman while my preceptor took over the other patient. A gift I am grateful for, one that I hope I can return to another student someday.

My day was long, and my heart broken when at 9:30 pm she was only 5 cm and I had to make a decision to relieve the babysitter at my house, who was keeping my children that I had not seen in over 24 hours; or stay with this woman that had no one with her to welcome her baby boy into this world. We hugged, cried and said goodbye as I left the hospital with a heavy heart; torn between the needs of my family and my patient….

October 30, 2008

She delivered 2 hours after I left her bedside. As I made post-partum rounds today she relived the birth experience with me. I met her husband who for the first time got to hold his newborn son. I took pictures with my camera so that they could send them to family in Kenya. Last night my daughter and I took the pictures and a card to her room. She was sleeping peacefully. As I was putting her gifts on her table, I noticed that beside her was a book on “Surviving Breast Cancer”. A stark reminder of the journey this woman has in front of her. And a true testament to the WILL of this woman to live. A true survivor in every sense of the word. She told me that she knew October was breast cancer awareness month; she just wasn't prepared to be “joining the numbers”!

My phone rang at 10:00 PM last night (the first patient I have ever given my number to) and it was her in tears over the pictures I had left for her and her husband. She talked about the book on her table, and how exhausted it made her to read it and contemplate her options. She is considering a double mastectomy, radiation, chemotherapy and whatever else she must to do survive and raise her sons. Her appointment is November 10 with the oncologist. She asked me to pray for her and her family. I am asking you to do the same. She shared with me that in her religion they believe that God gives you trials to test your faith, and even though it isn’t easy ~we must believe that everything is for a reason. I know that whatever the reason, God put a Southern Baptist girl from Gilbertsville, KY (a town still to this day without one single African American living in it) in the path of a Somalian refugee with a lifetime of tragedy in her 33 years of life. And together we will face the challenges of our very diverse life. I have a new “sister” whom I will forever be grateful to for giving me a wake up call in this whirlwind of a life I have been living the past 2 ½ years of my CNM/FNP education.

I have shared only a portion of all that we have discussed over the past two days (for those of you that know me, know I have never been short on words, so the time I spent with my new friend has been filled with many more stories than I can ever begin to put onto paper). When I walk into Vine Hill on Monday, I will be a changed person. I will still be overbooked, still too little time allotted for translators, there will still be angry patients that somehow had their appointments mixed up, triage patients to sort through~but this future CNM/FNP will be radically aware of and in tune with the needs of my extremely diverse population of patients I am blessed to serve every day I am there. And when I catch myself frustrated, wanting to just ask only the necessary questions to fill in the flow sheet~I will breathe, relax and attempt to refocus on why I am on this journey that encourages us today, tomorrow and for a lifetime to “listen to women".


A new day, a new journey, a new challenge.....

This is my first attempt at officially blogging. As I am preparing to move back to my home state of KY for my first job out of Nurse Practitioner school, I have decided that this journey my possibly be inspirational to someone down the road.

I made a midlife career change 4 years ago, and have recently graduated as a CNM/FNP. Certified Nurse Midwife and Family Nurse Practitioner. Unfortunately, I was unable to find a job working as a CNM in W. KY. So, as goes most things in my life, I was offered a job in the ER as an NP! I figure my chances of delivering a baby are better in the ER than they are working for any MD in town!!

With that said....I will detail my journey as a single mother of two, at the age of 43 beginning a new career in an environment that is both intellectually stimulating and overwhelming at the same time! I hope you enjoy the blog!

Integrative Family Medicine