8.26.2008

Another week, another interview...

The search for my first RN job continues.



This week I interviewed at the very first hospital I served at as a student. It's a small, private hospital about forty minutes from home. There are about 150 employees there. The med/surg unit I interviewed for was my first clinical assignment in nursing school. It has a little over forty beds, including a couple pediatric beds.

Revisiting this facility as an RN was strange...I hadn't been back there since my first semester of the RN program. Life was a lot different then. I was engaged to the girl of my dreams, and every day of patient care resonated with purpose and intimacy. It was a nice place to practice student nursing for the first time, the units were quiet, the pace was relatively slow, the Hospitalist was friendly and loved to test our knowledge with questions about patient's lab results and diagnostic imaging. The Nurse's aides were all older and experienced, many of them in school for Paramedic or RN. I spent more time learning from them than the RNs, at first. As a nursing neophyte I only had one patient to worry about at a time, a far cry from the hectic 4-patient assignments I took on as a senior student.

I still remember my first patient as a student, at that facility. A man in his 50s admitted for esophageal varices, diagnosed with hepatic encephalopathy. This was back when we received our assignments via a phone call from the clinical instructor the previous night, so I had plenty of time to pour over my med/surg and fundamentals texts and learn everything I could about the diagnoses.

The patient had stopped drinking well over a decade ago, but his liver function continued to decrease with age. The old damage caught up with him, and the decrease in portal circulation caused collateral circulation which distended the veins in his esophageal and hemorrhoidal plexuses. Ruptured esophageal varices are life-threatening, but since he was on our unit and not the ICU, he was probably through the worst. I did a ton of assessments on him. Asterixis, drawing simple shapes, hepatojugular reflux, you name it. He was on one-to-one care because of his altered mental status (the common wisdom as to why this happens is that liver failure leads to altered protein metabolism and increasing ammonia concentration in the blood, but I did a term paper a while back that cited research suggesting the ammonia may not actually be the culprit), so I spent most of the shift reminding him what his name was, where he was, and why he had to stay in bed.

I felt like I could take on anything after that assignment, even though it turned out to be a relatively easy evening.

Walking back onto the unit yesterday caused a flood of dormant associations to come flooding back. The first thing you see when you walk in is a wood-and-glass depiction of a tree in autumn. Each leaf is a plaque, inscribed with the names of each patient to die in the unit's hospice room. The entire unit, from the wallpaper in the bathrooms to the curtains in the rooms, is decorated with a falling leaves motif. At first I thought this was somewhat morbid, but I grew to appreciate the design choice over the course of the semester.

The Director of Nursing explained to me that very few codes occur on this unit, mostly due to the diligence and critical thinking skills of the RNs, as well as the availability of the rapid-response team for when someone deteriorates and we can't wait for an MD to return a page. She said the nurses there don't get paid as much as in other places, maybe 2-3 dollars an hour less than the other hospitals in my part of the state, but I don't mind that so much, and I told her so.

I think I talked a good game, but I'm never quite sure how well I've done after an interview. None of them have succeeded so far, anyway, and managerial types tend to clam up a bit when I ask for specific feedback about my interview performance. I did, however, hear that I had "passed" the interview for the state mental hospital (which is still in a hiring freeze, I've heard).

In the movie "True Stories", David Byrne reflects that someone (not him) once said that Highways, with their sprawling displays of engineering and stone construction, were the Cathedrals of our age.



I think a better candidate would be the Hospital. Not merely because of the religious funding of so many hospitals, and the resultant prominence of religious iconography in those hospitals, and not even because of the architecture and design of the buildings themselves (which is often impressive).



In the great stone edifices of ancient myth and religion, the great calling that they were wrapped around was regulation of human sexuality. At first by housing temple prostitutes, and later by establishing rules for how people procreate and structure their families.

In the Hospital (which I'm calling for sake of conversation the "modern cathedral"), some of the most intimate moments of their lives are played out, in the presence of the cutting-edge of medical technology and scientific training. People are born. People die. People are treated for life-changing illnesses and injuries. Through it all, the Nurses are there to educate, manage, and preside over these experiences. Approaching this task without an appreciation of it's sacred nature (independent of religiosity) is a commonly encountered source of failure of the therapeutic relationship.

Whether it's the small, modest community hospital or the sprawling inner-city hospital I'm walking in to, whether the particular place is associated with my own feelings of hope for a happy life or memories of desolation, betrayal and hopelessness, the place itself has it's own gravity, it's own purpose, it's own joys and sorrows that dwarf my own while still including me in them.

Adaptation to this situation is never easy, and it's a transition that changes you. It's a process that never ends, just as getting a black-belt in a modern martial art is really a sign that you're finally a "beginner", graduation from nursing school is the event that marks the beginning, not the end, of the journey. To react with grace to the extremes of the human experience is something that seems simple at first, but can take a heavy, hidden toll.

I wish so often that I could have made it this far with everything I started out with, maybe if I handled the transition a little better I could have.

Even if the happiness I imagined for my own life never comes to pass, I'll always have the patients. They have enough sorrow and happiness to last me whatever is left of my life.

Not enough to forget about you, though.

8.13.2008

The Way People Live in Stories / Fly Honeys wear Hakamas




This past saturday, the two Ushi-Deshi and I drove to PA for a seminar at Buck's County Aikido. None of us were expecting what we found there.







The Dojo sits on top of a hill overlooking a field of lavender, on the second story of the barn pictured above. There's a segment of the wall facing the fields that folds away so the dojo is mostly open-to-air.







Caroline and Tom were my companions for this little adventure. Caroline is moving to mexico so practice tonight will be my last chance to hang out with her. Tom's moving out west in november. I'll miss training with these guys, they're a lot of fun. Caroline was teaching me Yoga, she lived in an ashram for a while. Tom's from out west, and did some farming in Belize.




The Senseis for the seminar were George Lyons (Left) and Juba Nour (Right). George runs the farm along with his wife, and Juba is a relatively famous sensei from the brooklyn dojo. I've heard him described as a "ronin", since he doesn't belong to any of the national aikido organizations.



We trained....and trained, and trained.






For more than five hours. I was exhausted by the end of it. 2 hours was pushing me to the limit before!





She was fun to talk to, she's from another dojo in my state, the students where I train go down there every friday. Looks like I'll have to switch off between go club and aikido!







Some advice for shoulder throws....always pick someone shorter than you! I hurt my back doing this and had to sit out for a few minutes (I was the one being thrown in the picture above. You can see with my hand I'm kinda tapping him on the side saying "hey, im not so sure about this!"). I did some spine stretches caroline taught me and I was back in the action in no time, though.



Seeing the Senseis demonstrate the techniques was surreal. No wasted movement, they barely seemed to move at all, while the person having the technique applied on them moved -a lot-.









This technique involved so much running around and rolling and such that we had to split up into groups and take turns.



Juba demonstrating a technique.



All of us at the end.



BEEES! I walked past these in the dark a few times late that night, hoping I didn't stumble head-first into them.



We stayed up late and sat by a nearby lake, talking and enjoying wine.



George offered caroline the use of his study (pictured far above with the picture of the two sensei) so she wouldn't have to sleep in the same room as us. The dojo was unlocked all night! Hanging out up there in the dark was surreal.



It was pitch black, and the only sounds were caroline practicing ukemi on the mats. I tried to roll in the dark, too, and the sounds of bodies hitting, slapping, and rolling across the mat were more or less the only sensory input.



At the end of the night, the couple that runs the farm sat around the fire with the three of us and told us stories about their 10 years in the farming business, how they got there, and places they stopped along the way. Before they switched to a single-crop farm (lavender), they spent some time doing community assisted agriculture and farmer's markets. They used to be in to "co-creative" farming, where they would deal with pests by -planting gardens for them- instead of trying to eradicate them, making peace with the spirits of the rabbit and the groundhog and that kind of thing.

Everyone there was really friendly, so I'm going to ANOTHER seminar this Saturday, this time in Northampton Mass.

8.08.2008

Drivin to Doylestown

...Doylestown, PA, that is.

I'm getting up at 6AM and driving all the way over there for an aikido seminar.

http://www.buckscountyaikido.com/

*warning* some of the pages on that site link to some kind of thing that tries to trick you into installing anti-spyware software (which is most likely spyware..I'll have a little chat with them about that when I get there).

It'll just be me and the two Ushi Deshi from the farm, driving out of state and then training together.

I get a lot out of training with the two of them. They train much more frequently than the rest of us (since they live there), and even though they're only about half of a rank ahead of me I get almost as much out of it as I do training with the 1st Dan in the class.

I think part of the fun is being comfortable enough with them to counter the techniques when I sense one of them is off balance. The techniques almost evolve their own taxonomy of jokes or pranks. There was this one time when the resident Yogi applied Sankyo, forcing me to step backwards around her because of torque applied to my wrist. She held my hand near her head and not her chest, however, so I was able to arc my hand over her head, sending her tumbling backwards with it.

I'll make sure to take pictures tomorrow, I just spent 60 dollars getting a new battery charger for my phone (ugh), so stay tuned for photos of aikido-y goodness and the ushi deshi.

When I come back, some more trombonin', and a long overdue night in my backyard with some friends.