Showing posts with label ZebraARNP. Show all posts
Showing posts with label ZebraARNP. Show all posts

Saturday, May 20, 2017

Not everything that ends is a failure.

I’ve been gone for a while. A lot has changed in my life and some of the more peripheral activities within it (like writing for this blog) have necessarily been on pause. But I’m returning to this space now that I have the time and energy for it. In the past many months, our one family has morphed into two families --my marriage of 12 years ended. This was after a couple years of marital therapy, a trial separation (in which we lived in separate homes) a few years ago, and a lot of tears, gut wrenching atrocious fights, heart ache, issues within ourselves, issues between us, commitment, recommitment, more therapy and then…our marriage needed to be over. I truly feel that we turned over every rock looking for a solution to it all, and one could not be found.

We are recasting ourselves in our roles as co-parents only, and perhaps someday we will recast ourselves as friends. I firmly believe that a marriage that ends is not a failure, that the standard of “forever or failure” is just…ridiculous.  Does a marriage have to be life-long to be considered a success? No, it doesn’t.  We did not fail. We had a successful 12 year relationship in which we raised 3 awesome kids, bought a house, overall had a damn good time-- and I’m proud of all of that. And I'm grateful for the years we had together and I wouldn't change anything--life unfolded as it did.

But after much soul searching and countless tears, I realized that despite every good intention (on my part and on hers), and despite every effort (from us as individuals, as a couple, and by those in our families/community supporting us), I could no longer be the person that I wanted to be in my marriage any more—and even worse than that, I was becoming someone I did not want to be because I was so unhappy. This affected me more and more, and it was time for a change. I cannot speak to her unhappiness other than to say I think it was profound. And all of our combined unhappiness affected our children, without a doubt. And that was not tenable. 

In the meantime, she has moved out (and lives nearby), and the kids have started living in two homes. There have been bumps in the road, of various sizes—of course there have been. But I have every confidence that we will survive and we will all thrive, as we find a more peaceful existence. Families have survived far greater challenges than this, and our three children have two parents who love them immensely (and grandparents, and friends) and who will support them in whatever ways necessary. I am hopeful. 


ZebraARNP

Tuesday, August 23, 2016

Bits n' Bobs~ Parenting 8 year olds; a fine needle aspirate.


A biopsy (FNA, not core) of  some recent parenting moments.

I have three children, ages 8, 8, and 2. My 8 year olds (girl/boy twins) are about to start 3rd grade next month which makes me feel really old--how did this happen already?! I feel like I was just waddling around HUGELY pregnant, then swaddling them, nursing them, rinsing off binkies dropped on the floor for the millionth time, changing their diapers, having delirium from the sleep deprivation, and all of that goodness and badness. And now we're talking about Big Issues In The World like homelessness, what is a mortgage, why Donald Trump is "not a nice man" (ok, so we're not subtle in our liberal tendencies. We're a West coast gay multiracial family, duh!), why it's better to compost food waste than throw it away, and on..and on. And last week my daughter saw a license plate frame that said "Army Mom" and asked me "Mom, are there any wars going on in the world right now?". What a heartbreaking and innocent question. Cue a conversation about war and conflict in the world, presented at an 8 year old level.

When did parenting suddenly get so complicated for our home? Does anyone just want to read a board book? Sing a song? Wrestle? Be totally oblivious sometimes?! And with two elementary school students, we're now entering into questions about the human body. And these questions usually come up either at dinner or at bedtime (of course).

The other night as I was putting my son to bed I reminded him that he realllllly needed a bath the next day (man, boys can be so DIRTY! Summer boy feet, oh wow); I also asked him if he was still retracting his foreskin while in the tub, to make sure he was cleaning himself properly-such a mom question. It truly astounds me that an 8yo child can get out of the bathtub after having "bathed" as dirty as when s/he went IN. He asked me "Why do I have to pull it back?" and I explained that for boys with foreskins, it's important to retract/clean because blah blah blah. He then says, incredulously "You mean SOME BOYS DON'T HAVE FORESKINS?!". Oh. I guess we never really talked about that specifically--never had a need. So there we were at 9:00 at night discussing circumcision, why we didn't circumcise him, whether most boys are circumcised (around here I think it's 50/50 for new births), penis growth (he said he thought his was "fully grown" by now....um...no, honey...it's not. So we did a bit of teaching there) and so on. It was hysterically funny, all in all.

And at the end of the conversation, my little man, being the budding biologist that he is (his obsession is mostly birds, so ornithology is actually his first love) also reminded me that foreskins are also important because they protect his penis from bad weather, bacteria, and insect bites. Oh right, but of course...

Until the next bedtime,

ZebraARNP

Monday, June 20, 2016

Witnessing sorrow and grief; taking trauma home.

About a week ago, I awoke to the news of the Orlando mass shooting-that 49 people had been murdered in the Pulse nightclub--for no other reason than that they were gay, and most were Latinx. The mass shooting du jour in America. You know the rest of the story, because unfortunately we've all heard these stories repeatedly. But it made me wonder about something else, tangentially related--but related to us in our work.

I came across a Facebook post by Dr. Joshua Korsa, an Orlando resident who described his experience caring for the surviving victims. Check out his story here (original post) or here (short news story)--. The "tangible reminder" he refers to below? His blood soaked Keens. He writes (about the survivors of the shooting):

"They've become a part of me. It's in me. I feel like I have to carry that reminder with me as long as [those patients] are still under my care. So this is a tangible reminder that the work's not done. That there's still a long way to go" 

Later I read the NY Times' "Orlando Medical Examiner: ‘Take a Typical Homicide Scene, Multiply It by 50" which was just amazing (for lack of a better word)--in less than 48 hours they were able to identify all 49 victims and in less than 72 hours autopsies were done on every single one of them. That's a logistical accomplishment and an emotional....quagmire. I cannot imagine being a part of that. I cannot imagine how hard that must have been. What exceptional work-- bringing confirmation to each of the 49 families and countless loved ones involved.

But wow, logistics aside--consider for a moment about the pathologists and technicians who did this work, who painstakingly photographed each victim, prepared them for transport to the morgue, the pathologist/assistants who later performed the autopsies, cleaned the bodies--these are the unrecognized people behind the scenes in such catastrophic events. How are they doing this week? How are the police officers? The crime scene technicians? Are they ok? How do people that witness such awful mass casualties cope? 

So that got me thinking (this is how my ADHD brain works, one topic to another, bouncing along)...WE deal with some really difficult stuff.  Not mass casualties (I don't think most of us do, anyway) but day to day casualties of life. Car accidents. People losing limbs. Diabetes, heart attacks, cancer, strokes. Kids dying. Homicides, suicides, accidents. Alcoholism. Lung cancer. New diagnoses of leukemia (surprise! you didn't just "have the flu"!). Homelessness. Stillbirths. Domestic violence. And so on. It's a lot to deal with.

How do you deal with the anger, death, violence, despair, stress, grief in your job? Sometimes it isn't even the death that's so hard, it's the sorrow, the daily witnessing of human distress. Death is a separate entity, and varies in it's impact on me--some deaths leave me with a sense of calm, some break my heart and I swear I never want to go back to work again (but I keep showing up.). Some don't seem to affect me emotionally much at all, and that's ok too. Every one is different.

As I walked around the oncology ICU recently, several rooms were empty-- and I realized as I walked around that I associate almost every room with a patient I have cared for in that room--and who has since died. I often think of them as I pass by (Oh, that's J's room...oh, that was D's room...etc).

As I walked down the long hallway to grab lunch, I thought:
  • M's room-she was my age--she died in that room over there, overlooking the water. She and her husband were avid skiers and mountaineers and he shared incredible pictures of their adventures together. I swallowed back tears during rounds that day; that was the second time I'd cried that day. M died of relapsed leukemia and candidemia. 
  • D's room-she coded suddenly, and died before her daughter could make it in. The chaplain put her daughter on speaker phone so she could say goodbye to her mom as her mom underwent CPR ("Tell her she was a good mom....tell her I love her....tell her she was a good grandma"). D died of advanced lung cancer.
  • M's room-an older woman with AML, the same age as my mom. Wonderful family, with a toddler grandchild who liked to sit on the bed and who was fascinated by the sat probe on grandma's finger. That boy lit up the room. M died of a disseminated fungal infection. 
And so on. I remember many. 

We carry our patients in our hearts and in our minds--they are with us/in us, year after year. And sometimes memories of them/their deaths are comforting while at times they are heart breaking and hard to revisit--even years later. Some patients/deaths I look back on and I feel peace, and I smile at the memories that surface. Some patients/deaths I think back on and tears still come to my eyes-and the deaths were years ago. Some I look back on and my heart rate increases--because their deaths were so awful that I still have an emotional/visceral response. 

So I wonder. I wonder how the nurses, doctors, EMTs, police, pathologists-how everyone that helped victims of the Orlando massacres is doing. And I hope they're ok. And I'm grateful they were there to face such horror, to run into a scene that hopefully none of us will ever have to face. And I hope now that they've taken care of so many others, that others are taking care of them.

And last but most certainly not least, may we never forget these 49 people, almost entirely queer people of color, murdered en masse for being...themselves. 

ZebraARNP. 

*****************************************************************************


In Memory.
June 12, 2016.


Stanley Almodovar III, 23 years old
Amanda Alvear, 25 years old
Oscar A Aracena-Montero, 26 years old
Rodolfo Ayala-Ayala, 33 years old
Antonio Davon Brown, 29 years old
Darryl Roman Burt II, 29 years old
Angel L. Candelario-Padro, 28 years old
Juan Chevez-Martinez, 25 years old
Luis Daniel Conde, 39 years old
Cory James Connell, 21 years old
Tevin Eugene Crosby, 25 years old
Deonka Deidra Drayton, 32 years old
Simon Adrian Carrillo Fernandez, 31 years old
Leroy Valentin Fernandez, 25 years old
Mercedez Marisol Flores, 26 years old
Peter O. Gonzalez-Cruz, 22 years old
Juan Ramon Guerrero, 22 years old
Paul Terrell Henry, 41 years old
Frank Hernandez, 27 years old
Miguel Angel Honorato, 30 years old
Javier Jorge-Reyes, 40 years old
Jason Benjamin Josaphat, 19 years old
Eddie Jamoldroy Justice, 30 years old
Anthony Luis Laureanodisla, 25 years old
Christopher Andrew Leinonen, 32 years old
Alejandro Barrios Martinez, 21 years old
Brenda Lee Marquez McCool, 49 years old
Gilberto Ramon Silva Menendez, 25 years old
Kimberly Morris, 37 years old
Akyra Monet Murray, 18 years old
Luis Omar Ocasio-Capo, 20 years old
Geraldo A. Ortiz-Jimenez, 25 years old
Eric Ivan Ortiz-Rivera, 36 years old
Joel Rayon Paniagua, 32 years old
Jean Carlos Mendez Perez, 35 years old
Enrique L. Rios, Jr., 25 years old
Jean C. Nives Rodriguez, 27 years old
Xavier Emmanuel Serrano Rosado, 35 years old
Christopher Joseph Sanfeliz, 24 years old
Yilmary Rodriguez Solivan, 24 years old
Edward Sotomayor Jr., 34 years old
Shane Evan Tomlinson, 33 years old
Martin Benitez Torres, 33 years old
Jonathan Antonio Camuy Vega, 24 years old
Juan P. Rivera Velazquez, 37 years old
Luis S. Vielma, 22 years old
Franky Jimmy Dejesus Velazquez, 50 years old
Luis Daniel Wilson-Leon, 37 years old
Jerald Arthur Wright, 31 years old





Wednesday, June 8, 2016

"Why didn't you just go to medical school?"

I'm guessing this is a common question posed to ARNPs/PAs, and one I figured I'd take a moment to answer personally, because I find it irksome. Well, I didn't go (or even apply) because....I didn't want to be a doctor!  I don't think it's a compliment to ask an RN/NP/PA that question, but I'm thinking it's meant to be one (i.e. you're really smart, you could've learned more/done more). But the question presumes that becoming a doctor is The Best Option for those interested in a professional graduate level healthcare career (and that the smartest people in medicine are always the doctors).  But becoming a doctor is one of several medical career options out there, and it's not always The Best One for everyone. So for this post I'm going to recount how I got to ARNPLand, given other possible paths-and how a key factor in going to ARNPLand was motherhood. Doctors are awesome (duh), but not all of us are destined for DoctorLand--for a variety of reasons.

My undergrad education was in liberal arts, which was interesting but frankly not very useful at all (a classic tale). I worked in social work right after I got my degree, and worked in social work/corrections for a while...but I wanted a job where I could DO things, and PROBLEM solve and really FIX things. And not be stuck at a desk all day long shoving paper around.

I knew that I wanted a job where I could do the following:

  • Be a big nerd, and be in an environment where nerdiness was celebrated 
    What a cute ARNP!
  • Fix things or people (or both)
  • Make a good living, i.e. to support a family of at least two kids. Oh crap, we have three now; we've debated selling one but the kid market is in a slump. And yes, the third pregnancy was planned. And yes, we had an OB ask us this. We changed doctors. Think about that question for a moment...Anyway, my goal wasn't to be rich but to have enough. Comfortable enough to be like the Cleavers (well, the interracial lesbian family suburban version). Ah, but "enough" is so subjective, isn't it?
The Cleavers, "then"..

The Cleavers, "now"
  • Be a mom who could go to choir performances, be home for dinner most nights, have dinner with my mom, go out to dinner with my wife, walk my kids to school sometimes,  have time to email my twins' teacher about schoolwork (and kvetch about common core math, that is a whole different post...), cook dinner on my off days, and so on. 
  • Be able to have kids closer to 30, not 35 or 40 (I had twins at 29--overachiever!!). 
  • Completely gross out my kids and wife with graphic descriptions of medical procedures, bodily fluids, and so on. 
  • I wanted to be able to say nonchalantly, "It's just a flesh wound!" (please click HERE if you understand that allusion...you're welcome!)
  • Pay $800 in student loans per month. Actually, this is a heck of a deal-ask a physician (or a lawyer). Gotta pay to play, right?
  • Crap my pants as I mumble  confidently say the the words "Call a FREAKING code !!!" as I run to the room, after the RN calls me and I hear the words "EKG changes" and I see the heart rate go from 120--100--90--70--50 in 5 seconds on the tele monitor, while my amygdala fires repeatedly and my brain says "ARGHHHHH!! You totally know what to do, breathe...". Begin CPR....
  • Have an unlimited supply of graham crackers to sneak from the nutrition room when the charge nurses aren't around to notice (and peanut butter, oh MAN, that stuff is good).

I also took into consideration how much I'd be able to see my kids, day to day--it was important to me to be around as much as possible...consistency. In some subspecialties (that involve years upon years of fellowship), fellows put in so many hours that it's a real challenge to balance the demands of motherhood and work--and year after year they face these dueling demands--and hats off to these women for taking it on! I see fellows in particular who FaceTime their kids nightly, because they're rarely home in time to say goodnight--especially those with young preschoolers. And sure, it's temporary--because kids grow up, stay up later, and so on--and fellows finish their programs. And fellows do have days off, of course, during which they can love their kids (in person) to pieces. But for me, I wanted more of the day to day mom stuff. The stuff that makes me crazy and the stuff I love.

My point is---to each her own. I have as much respect for the mother who is a general surgeon as I do for the mother who stays home full time. And really, it's great that those of us in medicine can FaceTime now to say goodnight to our kids so that we can maintain the daily connection despite our wacky schedules; I used to do it frequently when my twins were toddlers--I'd leave for work before they were up and get home after they were asleep. It was hard, we missed each other a lot. And it was a lot of extra work for my wife when I was gone, as she'd get through multiple 13-14 hr days on her own. So for any woman who is embarking on a medical career it's incredibly important to consider how one's choice of career will affect one's ability to parent in a way that works best for you, for years.  It's a huge, huge consideration. It's a years long balancing act--how on earth are you going to mix these two awesome things (motherhood and medicine) together successfully and keep your kids alive (and your patients)?! 

I needed the work:life balance that I thought an ARNP career could best provide, and I was concerned that I wouldn't have been able to find had I chosen medical school. Or, I suppose that I could have found it eventually, but I would have had to put off having kids for several years--and I didn't want to do that, for many reasons. I couldn't be the kind of mom that I want/wanted to be had I chosen a different career path. And what about the difference in salary, you might ask? The money is great, I think. The starting ARNP salary in outpatient oncology around here is about 100k. Inpatient oncology at private hospitals around here? Around 130k. That's enough for me, enough for my family to live well. So I'll never be The Boss, I'll never be famous, but it's enough--I'm home over half the month (I work 10-12 12hr days a month), I often pick up the kids from school, I have the time to make dinner frequently (and lunches for school, ugh), I have a challenging/brain stretching/ emotionally taxing job and it's all enough. Score.

So this is my corner in the medical world, and I'm happy in it. And frankly, ALL of us are awesome for making our lives work-however we get it done. So here's a toast to getting by with FaceTime, nannies, dads, moms, friends, support groups, childcare centers, vodka martinis, grandparents, Munchery/Pizza Hut/Whole Foods/Amazon Fresh--we're getting it done--mothering AND medicine.


Later,

ZebraARNP

Friday, May 27, 2016

think zebras, not horses

Hi MiM aficionados,

I'm ZebraARNP, and I'm so pleased to be the first non-physician contributor here! I'm a nurse practitioner in a big hospital in a big city. I've been an ARNP for about 8 years now, and I've spent all of those years in oncology. I can't imagine doing anything else, to be honest. I live in the 'burbs with my wife, to be known here as The Wife, and our three kids, to be known here as Jaybird, Hedgehog, and Egret. More about the family in my next post.

The other day on rounds, as my team was heading out to see our first patient, we encountered a large group of petite Filipina women, dressed in the green environmental services uniform provided by the hospital. Our team greeted the group then as we passed them my (tall, white) attending said to me "They're so cute, they're all so short!" At the same time in my mind I was thinking "Dammit, they're all people of color..." and I felt a wave of...disappointment? Sadness? Irritation? Hard to find a word to describe the exact feeling. I'm not even sure that the two (white) MDs with me even noticed that the ENTIRE group of custodial staff we encountered was Filipina. All that my attending appeared to notice was that they were "cute." Sigh.

The flip side of the above experience is when I see another African-American/multiracial ARNP/PA/MD in the hospital. In those moments, time slows down, music starts to play...(Chariots of Fire, in case you're wondering. It's ok to click on it..) I want to run up to them to see if they're actually real!! Should we hi-five? Cheer? OK, no. Maybe next time...

For such a big city (although <10% African-American), and such a big hospital (>300 beds), there is a dearth of African-American professional staff. Over the years I have been mistaken for kitchen staff, janitorial staff, nursing staff, but more than that people have often looked genuinely surprised when I explain my role on their healthcare team and what I actually do on our team (admissions, write orders, take first calls from the RNs re patient issues, etc). And my point is not that any of the above mentioned jobs lack importance at all; my point is that no one assumes that I have the job that I have and mostly that they express surprise at my actual position. Food for thought. That surprise? It doesn't feel very good on my end.

Always check your assumptions....because we all have 'em. Women as surgeons. Men as nurses. Someday I hope that female surgeons, African-American physicians, male nurses, etc--I hope none of that even raises an eyebrow.



More about me, since I'm a newbie-->
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ZebraARNP is an oncology ICU ARNP with three children- school aged twins (girl, boy) and a preschooler (girl). That brief sentence vastly oversimplifies the amount of joy/pain/money /insanity/Band-Aids/love/maniacal laughter it requires to raise three human beings; it’s a doozy sometimes. Anyway, this is ZebraARNP's first public/non-academic/not Facebook writing experience, or writing that isn’t a daily progress note of a critically ill oncology patient. ZebraARNP is married to a pediatric SLP who isn’t in fact really that interested in oncology but who has acquiesced to the fact that she will indeed continue to learn about it (or at least listen to random factoids) year after year simply out of love for Zebra. Dinner time conversation in our demographically complicated yet still shockingly quotidian suburban home (interracial lesbian marriage, anyone? Can someone say “intersectionality” ten times fast?!) may or may not include how much CPR was done that day, palliative care conferences, cdiff vs VRE, who did well on his/her math test (or who did not), who will go grocery shopping next, what MRSA is, what exactly IS pus made of, what actually happens when you die, arguing over who gets the last muffin/cookie/etc, reviewing hematopoiesis, and questioning whether kid # 1, 2, or 3 really did wash their hands after using the bathroom. When ZebraARNP isn’t at work or with kids, she enjoys gardening, chicken keeping, reading books (or the NY Times), and wasting time on her iPhone (oh the Amazon app…)…and not being at work or with the kids.