eye opener

First day of clinical today. I was so nervous I slept nearly a wink last night. Staff was wonderful and the facility is very nice. Its not Promises in Malibu, but its really nice. Preceptor was nice, I will spending more time than I thought with our class instructor which is actually a good thing. So incredibly knowledgeable. We saw a few patients together today, tomorrow I will be on my own with review after the fact.

The big drug down here is heroin. Heroin is to Bucks/Philadelphia counties as methamphetamine is to Bradford county. Addicts are plentiful and guess what they look like? They look like your nephew, your daughter, your sons, your lawyer, your banker. Mostly your sons, daughters, nieces,and nephews. They are bright, attractive, ridiculously young, and healthy. It breaks your heart into a million little pieces to see them. And I have only been there one day.

Drug use/abuse/addiction is not sexy. It's not cool or trendy. It's not provocative. It's pathetic, ugly, disgusting, destructive, and tragic.

I know we all "know" that. But sometimes we don't (can't) really grasp it. To know that the struggle is now life long after an addiction, relapse can be forever right around the corner. Seeing these beautiful people with their lives essentially taken from them is sobering. no pun intended. Never again will they be without this huge albatross. For those who can't get clean, mental and physical health will deteriorate and a slow and uncomfortable death follows for someone with drug abuse as their lifestyle. That is if you make it that far and don't get a bad bag, or unknowingly mix it with other bad junk like xanax or alcohol and just not wake up the next morning.

I know this is sensitive, those of you who might be or are dealing with it in your lives, I don't want to open up a sore, but please please please....talk to your kids, your family. Do what ever you have to do to keep them away from this stuff.

vags and bags

The META lab is over. Meaning- the pelvic and testicular exams are done. It was as bad as I anticipated, but in different and creepy ways that I did not anticipate. We split up into groups, then 6 at a time we went into an exam room to do the deed. The first was the testicle. 6 women in the room with one male instructor/model. He was the one telling us how to do it all the while holding up his gown- "more pressure when you squeeze the shaft" and "roll the testicle between your fingers". I swear. To make things even more gross, there was an air of inappropriateness because of the behavior of a few students. I am sure they were just nervous, but the instructor did little to maintain control/restore a clinical and professional atmosphere and it escalated the creepiness and made a couple of us extremely uncomfortable. It made doing the exam very difficult.

ok, so then we move on from that trauma to the pelvic. we have an instructor as well as the model/instructor and they were both women. A little better. But not much. I try to dissociate and complete the exam. Finally after almost 4 hours of hearing about sexual abuse, testicles, uteruses, trim pubic hair, and looking for lesions and wildlife, we are freed.

The last 2 days have been with our psych class and psych lectures. We have learned all about clinicals, the theory portion of the class, expectations..... Today a recent graduate visited us at lunch so we could ask her questions and she could tell us what it's really like.

"the worst year of my life" she emphatically declares.

I cry. (jk)

She echoes what the instructors are saying. We haven't seen nothin' yet.

I have often told the tale of the boy who cried wolf to my children, sometimes in subtle ways, sometimes not so subtle. I have always wanted to help them to discern what was important to be told and what wasn't, especially in terms of complaining, tattling, and the like. I just want to apologize for all the whining have done up to this point because I now feel that it has been premature. I was sort of hoping that once I got to this point it would become so interesting and exciting that I wouldn't even notice that I was doing work. The recent grad said "double it" in reference to our last class with this instructor and the difficulty level.

I have possibly "the worst year of my life" ahead of me.

So also let me apologize in advance for all the whining sure to come.

:)

I have 2 days left. It is sort of going fast; I am having a good time - learning a lot. But I can't wait to start heading up toward home. I am picking up the boys in Wyalusing on the way home on Friday. That will be so fun to see their faces when it is I, not their dad that shows up on their last day of daycare.

This is a picture of the psych class. The overall NP class is large, 100 or so, but there are just 8 of us. I guess there isn't that big of a draw for those who want to specialize in psych. I failed to get any pics of Jill and I at the Capital Grille last night. It was fun, and a great meal.

So, that's the update. A full day day of psych lectures today, I hope a half-day tomorrow, then home.

relax

this day has been exhausting, relieving, fun, nostalgic, and exciting. I started off with the most stressful exam that I have taken since boards. The dreaded head to toe demo. i passed. then the standardized patient. the old lady that was my patient couldn't have been nicer. it was so intimidating at first. you go into the room like ou are entering an exam room with a patient ready to be examined. you interview them, figure out what to examine, what tests to order, and then diagnose. NOT graded or pass/fail=little stress. then we leave and go back in after 20min or so and they tell you what you did poorly at, what you did right, and what you failed to do at all. she was like my grandma! "oh teresa, you did a great job...but you didn't ask about my marriage..." "you have such a comforting face (lol) and are such a good listener, you didn't act shocked at all when I told you about how much I drank." I loved her! the other girls didn't fare as well, at least with the kindness and approval of their SP's.

Then we were done! My lab partner and I had the same schedule so we were both done (and we are both psych) at the same time. she was stuck in the city so we decided to celebrate. Then Jill was on her way and met us at the pub. We sat outside and had beers, cosmos, and laughs. It was great. Vicki (lab partner, and cute as a button) was waiting for her husband to get off work, then we walked her down to Merrill Lynch, then Jill and I had a great Thai dinner.


Overall, it was a great day to get that awful exam over, not have to be "remediated", to be moving on with the fun parts of school this week, and to see Jill again (and to have another dinner date on Wed!). I love it here.

Friday

picking strawberries. jeep ride without the top. all four of us together for the entire day. a clean garage. freshly bathed children. an early bedtime. bliss.

iLust

A Good Day

Will graduated from Preschool yesterday. It was very cute, and he was very proud. My dad ended up coming, which made me happy, but made Will extra happy and proud. Dad spent some time with Nate on the train tracks while we mingled and got refreshments. Then he took Nate home with him. We headed over later with Will. It was exceptionally low-key, doing just a few simple things...taking the two old jeeps through the woods, a go-kart ride and the boys oogling their promised treasures (an old Jeep truck for Nate, and the yellow '48 Willy's Jeep for Will). We spent some time just shooting the breeze with Dad in the garage, then it was time for Al to head to the stable for chores and we were off for home.

It was so simple, sort of your average, quasi-nondescript day....almost.

Whine post

I am in deep....very very deep cover. I am playing the part of a dedicated and thoughtful NP student.

Seriously, I have gone underground and will remain there until about the end of the 3rd week of June. So, no I haven't fallen off the flat end of the earth, I am not ingoring you, I am not depressed (wait, yes I am...jk), I am just consumed. I know I complain and whine about my classes, specifically this one, more than I should, it is just that I feel like it has taken custody of my life and if I don't behave it will punish me severely. So I bend to it's will, that I spend every minute of my procrastinated day either in a book, at the computer, or running around ensuring my clinical sites and my health compliance are all in order.

I miss everybody, I miss being able to do things, to plan things, to have carefree or not so carefree talks on the phone...lots of stuff. I forget my kids school programs and dates for camp, I have abdicated cleaning and supper making (that's right Housewife...S.U.P.P.E.R) So please don't hold it against me, feel that I am a bad friend, that I don't try hard enough or that I don't like you enough, or even that I am just a self-absorbed pseudofriend. I think about all of you more than you know and wistfully pine for the days that I can interact guilt-free.

This is the hardest thing I have ever done, and some days I really regret ever having any ambition whatsoever. I feel a lot of responsibility to get this stuff right, like it's do-or-die (the patients, not me of course). And although it sucks almost every single day of my life, there are times when I get a vision of what I can do, what changes I might be able to implement, that will bring relief and comfort to individuals, families, and hopefully to communities.

I will be leaving for Philly on June 14 and will be home June 21. I will be home for 2 weeks, then will go back down for 2-3 weeks. Then I hope to be doing clinical at NTC for a bit. Prayer please!

A quickie

So, things have been relatively ok. Things are looking up, I think. Nate seems to be doing ok, (ghost post). I have really been stressed over this latest class, not only because of the content (you know what I'm talkin about) but also because there are two visits to campus to demo our skills. Skills I think have gone the way of the dinosaur for me. I really need some practice, so if anyone wants a free head to thorax exam, let me know. (Thorax is to the chest, not below!)

This summer I am scheduled to spend most of my time in Philadelphia for clinical, however I was able to speak to my advisor and she was very supportive of changing if I could. It will take some negotiating, but I might be able to spend only a few weeks in Philly, and the rest locally. That has been such a huge weight off my shoulders. I told Nate the other day that I wouldn't be here for his field trip, that I was going away for a few days, and the kid broke out in tears and said "I don't want you to go, why can't daddy go?!" So I guess he doesn't dislike me all that much.

One thing that is really exciting for me, and has I think, helped to ease some of the stress is spending some time with my dear friend Jen, and as we say, "gettin our God on" (for me, gettin it back on).

I have been dry for sooooooooo long. Dry, dry, dry. And it feels so good to just put my feet back in. And to not have someone telling me to just jump in, you get used to it faster that way. Or worse yet, some crazyass trying to push me in, ya know?

So in a nutshell, that is the latest. Nothing dramatic, nothing unusual. Just the persistent stressors, but some bright spots that I didn't see before.

tragedy of the commons

This started out as a reply to Amy, but got too lengthy for a comment. I also thought a new thread would be better for opening it up for discussion.

Disclaimer: I do not have the answer to this problem, and I find myself vacillating between two ideals. But I am going to put his out there for your consideration.

[regarding "Sicko"]
Yes, michael moore is too dramatic, and slants his work to the nth degree. He also oversimplifies the solutions. Canada works, but he didn't look at the other costs. You lose a good deal of your healthcare autonomy, the gov't makes the tough decisions for you, like if you are going to get the dialysis you need, or that cholycystectomy that would make your life so much more bearable. There is a reason that those who can afford it come from all over the world to get their healthcare here in the US. Is the current system troubled and probably going to implode? Yes.

But is socialized medicine ethical?

I suppose it depends on if you think healthcare is a right or a privilege. Most of us in the trenches of healthcare go with the former, rather than the latter, but this presents a dilemma. the tragedy of the commons is a metaphor that has been applied to biology, economics, evolutionary psychology, sociology, and now healthcare. It goes something like this:

There is a finite amount of pasture. Everyone in the village has equal access to it and allows their cattle to graze.The downside is that the resource is exhaustible. Rationally, it makes sense to each individual herdsman to maximize his gain, that is to add to his herd. He asks what the gain would be to him. The positives of adding to his herd are realized by him only, the negatives of overgrazing the land are shared by all the herdsman and so each experiences just a fraction of it. So the logical thing for each individual to do is to increase his herd. But every herdsman does it. Therein is the tragedy, that each man is locked into a system that compels him to increase his herd without limit, in a world that is limited.

Ruin is the destination toward which all the herdsman push by each pursuing his own best interest in a society that believes in the freedom of the commons. Freedom in a commons brings ruin to all.

So, is everyone entitled to unlimited healthcare? Or is socialized the way to go. Do you subscribe to a utilitarian view or a deontological one?

Moore does his best to piss off the population and fuel the rancor towards the current government. I think he is very effective at that. But you have to take him for what he is, a movie maker. He exposes many of the injustices our current system employs, and that is not at all bad. I just don't like it that he thinks he has all the answers.

Our healthcare system is jacked up, and sooner or later, change will occur. And I doubt it will matter what philosophical stance you have. It scares me nonetheless.

<3

This made my day.

what to do...what to do....

I have neglected my blog. I miss it, but I have been keeping up pretty well reading all of yours, even if the comments are few. I am a bit obsessed right now with my new macbook and the new photo equip I have acquired over the past few weeks. It is so exciting! I can barely do my FLYlady (and sadly, my house shows it). Also, classes have started back up. Diagnostics and assessment this term. It is sort of the final didactic training for checking someone out, head.to.toe. There is also a lab component, to which I say, crap.

Now, it only stands to reason that you should have to demonstrate your ability and hopefully proficiency at assessing and diagnosing someone. What I am worried about is that female internals and paps are a part of the curriculum. This could be a deal breaker people. I have no interest whatsoever in either simply doing a onetime demo to prove I can do one, nor do I ever want to incorporate it into any type of healthcare I practice in the future.

Moreover, I do not wish to be the "mannequin" for my lab partner.

Good thing I am interested in learning photoshop. Maybe I could do some freelance graphic design, or *gasp* maybe even some photography. Heck, I would rather do just about anything than look at, "inspect", palpate, or culture someone's crotch.

I know, I know....we all need comprehensive healthcare. I am all for that. I just want someone else doing that part.

I am in psych for crying out loud.

Well, I suppose I will find out what my fate is soon.

Other than that, I am immersed in my tech, and gearing up for the rest of the class. I am thinking about learning a new language too, I just can't decide which one. Spanish is most practical and I have a bilingual friend who is fluent. She could talk to me in Spanish and help it along. The only thing is, I would much rather learn French or Italian. hmmm, decisions, decisions.....