Unexpected sadness

I haven't written for a long while. Recently I did a pregnancy test on a young woman, freshly out of college, who found out she was pregnant. She isn't sure what she wants to do. Part of my options counseling involved providing her with the names and numbers of local abortion clinics, which she requested. I didn't expect this, but it made me really sad. I'm a very strong advocate of woman's right to choice. But I still had to say a little prayer before I gave her the information.

Kazakhstan!

Here's portions of a letter that became a diary entry:

I am in Taraz, Kazakhstan now. I keep thinking of you because I keep seeing different birds and wishing that I had a bird book of central Asia with me. It’s quite wonderfully different here. We spent a few days in Almaty, which is the most cosmopolitan city here. There were two cities in Kazkahstan in which the USSR exiled intellectuals to and Almaty was one of them. Therefore it has a great intellectual academic class here. Because Janara and Daniel are very involved with the arts, we have learned all about the current artistic situation, gone to galleries with shows that were extended just for us, and had dinner with two of the country’s leading artists. (Their work, which we saw, is amazing). We also met with the Soros Cultural Institute artistic director and also learned from her about what is going on with the art community here. Because of oil money, Almaty is currently undergoing a construction boom. Prices have skyrocketed for apartments and while they are still not Boston prices, they are not far behind with one bedrooms going for the equivalent of $150,000. Everywhere we look there are new sky rise apartment buildings; of course most people cannot afford to live in them and it is said that a person is hired to turn the lights on and off inside to make them seem occupied.

Because there is no concept of tenants rights, people can be evicted without any notice if they decide to tear down the apartment for a new building. The gentrification process is excruciatingly painful here as it is anywhere else; the artistic community is being decimated, being turned out of their homes and studios and having to relocate to the outskirts of the city.

I’ve been astonished at the multicultural nature of the city. It’s Russian, Kazakh, Uzbek and Korean. Daniel sometimes gets stopped and they ask if he is Uzbek, there must be an illegal Uzbek immigration ‘problem’ according to authorities here. But when he says he is Mexican, they become very excited. He is probably the only Latin American person here.

The city is very green, with lush tree-lined boulevards and wide pedestrian pathways. All the green areas are thick and overgrown, creating a wild air in the city. Everywhere there is a mix of the old and the new. At the airport, there were automatic machines to pay the parking fee, but they were broken so you had to pay someone at the gate who would then open the lot for you. The residents are very fashionable, closer to downtown Boston or NYC style than to my style. Apartment buildings are either the nice, new modern ones or are old Soviet style cement monstrosities; I have some great pictures of them.The buildings were originally unfinished concrete on the outside; now the individual apartment owners are renovating them one by one. So the outside of a large building contains a mix of unfinished concrete, scattered siding, tiles, and other finishing materials. It makes an interesting melange. To travel from place to place we have taken buses, where they push you off if you don’t disembark quickly enough, to ‘taxis’- private cars that you flag down and they take you where you want to go for $2 - $3. It’s very safe. The price would be 3-4x as much if we didn’t have Zhanara to bargain for us.

The modernity of the city has certainly impressed me. Parts of it remind me of Japan. There was one mall we walked into that could have been any mall in the US with Benetton and Adidas stores charging $100-$200 for items.

We took a train to Taraz. It is a ten hour ride and we went in a sleeper car. It had 2 bunk beds, the top ones folded up. The train is one beneficial aspect of soviet times; it was fairly comfortable and very quaint. Mom was reminded of old British murder mystery novels set on sleeper cars. Evidently the police visited us and checked our passports because we are unique as Western tourists, but were friendly. They even sat down to chat. I slept through the whole thing. As a matter of fact, the rocking of the train served as a wonderful soporific for me. I slept 8 out of the 10 hours.

difficult days at work

I worked the last two days as a PCA at my job; it was really the last two days that I will work there because once a PCA has her RN license, she isn't allowed to work on the floor as a PCA anymore. I don't know why as other floors allow it, but my floor does not. I actually passed the boards in March, but because I enjoyed my job, needed the money, and didn't have time to look for or orient in a new job during school, I didn't tell any of the RNs, just the other PCAs.

While I had signed up to work the past two days, as a per diem employee, I don't know why they had me come in. Generally Sunday and Monday day are the quietest days, no surgeries and lots of discharges over the weekend; most of the surgery patients on Monday go initially to the ICU before coming to our unit. By Monday night, the floor starts filling up and by Friday it is a dance for rooms.The patient census wasn't high enough. I was working as a respiratory walker and there were only 5 or 6 stepdown-ICU patients; all the rest were regular floor patients and only a couple of them needed the thoracic walker or a companion to walk with (if we are worried about falls). So I spent a lot of time over the twenty hours trying to look busy.

Finally for the last hour I replaced another PCA who was sitting with a confused patient. This patient's case gave me the heebie-jeebies. She'd been at another elite hospital for more than a month, had gone home to die and had been home only a few short weeks before her family heard about the amazing surgeon here and decided that this surgeon would save the life of their beloved older family member. One family member even told me that he couldn't wait for the surgery. I knew at this point from Rounds that surgery was not an option. The cancer was too far advanced and the patient was too weak. A family meeting was called for more than 5 days later (time for all family members to arrive) where the news would be broken that surgery is not an option.

The patient, whose mental state was cloudy due to all the pain medication, has now been in the hospital for almost two months straight. Now, this is projection on my part, but if I were her, if my options were going to be palliative care or hospice, I'd want to know right away. I'd want to go home. I found it very difficult to sit there with her and not ask her if she wanted to go home or what she wanted. I get impatient with time lags. Hospitals are deadening places. I don't want to die in one unless it were the only way my symptoms could be controlled. Part of me does think that the way I want to die, if I have to die slowly, should be with a morphine and ativan drip. Morphine to control my pain and breathlessness. Ativan because, and I haven't seen this yet, but another nurse friend tells me, dying is anxiety producing and psychologically unpleasant. My ideal way to die would be with chronic renal failure when I am old enough to know that I don't want dialysis; then I will just drift off.

Temper Tantrum

First of all, sorry for not writing for a while. We had our pinning ceremony at school, my family came up to visit, and then to top it all off, I got really sick for two days. But I'm starting to feel better. As part of feeling better, I was puttering around my apartment and tidying it up. Now I live with 4 other roommates. We have a very large place. As I've been in school, I've felt the need to save money. Hence 4 roommates and I live in a very run down place.

But run down or not, there's no need to live in filth. Our kitchen today qualified as living in filth. There were so many dirty dishes in the sink that no one else could wash. There was mail scattered all over the place. The trash had been emptied, but no bag put in and someone had left two bags of groceries sitting out.

So I had a small kitchen temper tantrum. Groceries went in front of one roommates room. Any unidentifiable random crap, in the trash. All the plastic cups, tupperware, vases, beer and wine glasses that had been sitting there waiting to be washed for a month are now in the trash. Mail that has been out for a week is now in the trash. I washed anything that isconceivably mine or that I want to keep. I even tossed out some mugs that I don't particularly like and that have been sitting there for a month. It was disgusting. Absolutely disgusting. There's a pile of dishes left that belong to one particular roommate that are in one area. I felt like the parent who gets frustrated when the kids don't pick up and throws out the toys instead.

I am counting down the days until our gas gets turned off. We all contribute equally and each take a bill. For some reason, the gas bill keeps going in increasingly late and it hasn't been fully paid in three months. It's not my name on it, so I don't mind. I can't wait to get a job so that I can move. When I move, I am buying a cat. I can't wait. At least then I will be living in my own filth.

Homeless Volunteering

I had my first night volunteering with a group that does homeless youth (< 25 yrs) outreach. They have a medical van that goes out and actually serves people of any age, not just youth. The medical services provided are another draw for the kids to come by and for the outreach workers to connect with them. I really enjoyed myself.

It'll be an intense learning experience as I will have to start really relying on my own assessments and plans; I won't have another person to double check it with (Usually it's one medical person, RN, NP, MD or PA volunteering at a time). Tonight I was working with a NP. I think with what I saw today, I'll be ok. If it's a true emergency, we'll call 911, which they've had to do a few times in the past. One guy I would have been nervous with as he was on heroin and coke and he was really twitchy. But I think I'll get better at gauging it.

I've been surprised at how honest the patients were. One pt. told me in the same sentence about her daughter and her heroin addiction. This will be a good exercise in learning patience and acceptance. The knowledge of her daughter makes me even more uncomfortable with her addiction. But lectures of any kind will NOT work and are completely inappropriate. I did get her info about the community health center close to where she lives and she promised to make an appointment tomorrow (CA-MRSA with two abscesses). The more connected she gets to the community and the more resources she has to depend on, the better she will be. I tell myself and I believe that it is about building support for individuals and through engagement change can occur.

Current Favorite Music

I'm always looking for new music to listen to. Here is what I'm listening to now as I work on my pharm project. If you like any of these and think that I might like someone who you listen to, please let me know.

Richard Shindell: http://www.richardshindell.com/
Patty Larkin: http://pattylarkin.com/
Peter Mulvey: http://petermulvey.com/
Naomi Sommers: http://www.naomisommers.com/

Trauma

I still can't stop thinking about the kids at the residential crisis center I interviewed at. Most are aged 4 - 12, a few 3 year olds and a few 13 years olds with developmental disabilities; they are primarily foster care kids or former foster care kids (now adopted) who had been so severely physically or sexually abused that they are in need of a crisis placement out of a home to stabilize their behavior.

I haven't worked around kids in a long time. I had forgotten how young 12 is. When I read cases of horrific abuse and the young ages of the kids, I hadn't been able to make that translation to reality. I keep seeing the babies and cannot imagine the abuse that has been done. These kids are just babies is all I can think. They are so young, so small.