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.

Confessions of A Mormon Boy

Last night, I went to see the play Confessions of a Mormon Boy. It is a one man show and the performer is also the author of the play; it is autobiographical. He describes his agonizing attempts for him to turn himself straight, the 'help' that he got from the Mormon Church, their referral to ex-gay therapists and help paying for them. He got married, having told his fiancee that he was struggling with homosexuality. Eventually his ability to 'remain straight' failed, he was excommunicated from the church, moved to NYC, became an escort (ie., prostitute), got involved with drugs, and eventually got clean of it all. The performance was phenomenal. Riveting the entire time. I think I can say that it was one of the best performances I've seen this year (I love student rush, when I have the time, I see as many plays as I can.)

I kept thinking the entire time about how much individual pain the Mormon Church and other conservative churches have caused. The amount of individual anguish that the belief that "homosexual acts are an abomination" has caused is overwhelming. When you are connected and have grown up within your church, synagogue, mosque, meeting, place of worship, and it is your entire life, having to reject it is heartbreaking. Thank God I grew up Quaker.

Another interview

This one is at a rehab hospital 20-40 minutes away from my house. No interview is set up yet, but I interviewed on the phone with human resources and she is getting some times and dates from the nurse manager. Cross your fingers. I'd really like the pediatric one I just wrote about, but they are hoping to find someone who can stay on fulltime. But there's a chance that they won't be able to, so then they would hire a few of us on part-time for the school year.

The rehab hospital sounds interesting. Three of their units I am interested in: cardiac rehab, spinal cord injury and brain injury. I think the SCI unit would be the toughest because the patients would be the youngest. This hospital pays $7-$9 differential for evenings, which is nice too. So cross your fingers that I get an interview before I leave for Kazakhstan.

Residential setting

Today I applied for a job at a residential crisis assessment, stabilization and treatment center for kids with serious emotional disturbances (ie., predominantly foster care and former foster care kids). The director, in my interview emphasized that the rewards are sometimes hard to see because the acuity level is so high and the kids are very disturbed from the physical, sexual and emotional abuse and neglect that they have undergone. She said that they have some children who are at the center whose parents were also treated here when they were children. Talk about a cycle that hasn't been broken.

Friendship dynamics

I had a friend who was a very good study buddy of mine. We dated briefly, it didn't work, and we returned to being friends. We were good study buddies and then the dynamics got weird. I found myself being uncomfortable in our conversations and get togethers, but I wouldn't be able to pinpoint why. I just knew that I was feeling uncomfortable about it. After a while, I realized that I was feeling bullied. Part of the problem is that it is lot of small interactions. If I think enough, I can pinpoint it, but when you talk about it, it often seems like trivial encounters.

For example, I was trying to figure out how I would work up an ALTE (acute life threatening event) in an infant. With an ALTE, an infant may while feeding or at some other time, suddenly turn blue, have trouble breathing, go limp, but with stimulation, promptly revives. In our conversation, he starts talking about what follow up he would do. I try to redirect to what we would do as our initial evaluation. But he keep talking about what we'd do as follow up. I get frustrated and say, can we talk about follow up after we've talked about the initial workup? He follows up with "I think you are just being too strict in your definition of follow up," rather than just saying "actually by follow up, I mean follow up to the ALTE not follow up after the initial visit."

It's those small types of interactions that make you feel silly if you pursue them. It's the overly intense reaction and adding in the attack, rather than just assuming that I wasn't following him, he assumes that I am being purposefully dense. It sounds so silly now as I try to write about it. But I do know that I am not comfortable around him now and I need to remember that and not make plans to get together and study. It's hard to accept that things are different.

Kudos

Talking to my psychiatrist today in a checkup on the strattera prescription, he told me that I shouldn't stop at an RN, but should become a nurse practitioner. I reminded him that that was my plan and he laughed, remembered, and asked if I was doing psych because he thought I'd be good at it. I told him no, I'm doing family and we talked a bit about it.

I'd thought a while about doing psych. For a time, I thought I might want to be a therapist. Finally I decided that I didn't because while I "get" a lot of things, I have trouble really getting some big issues that people come to therapy for. The judgemental side of me comes out and while listening about the troubles that a friend's roommate has with agoraphobia, I hear that little niggling whisper telling me that if she were to just try hard enough, just be with the anxiety when she went outside, it would get really bad and then start to decrease. If she just did that enough times, she'd "get over it."

This whisper knows that I know nothing about proper treatment of agoraphobia or its physiological basis. This whisper is also the same whisperer that that I hear when I think about cigarette addiction, drug abuse, alcoholism, etc. The judgemental side comes out. If I have personal knowledge of the struggle, I'm fine (no whisper). If I've observed really close friends struggling with it, then I'm fine. But without it, I judge and I hate it.

I don't know if I would judge if I were sitting in the room with someone. I don't think I would. In everyday life when I interact with people, I am almost not judgemental enough, too accepting.

There were a lot of other reasons why I chose not to become a psych np, I know I would have shut down the whisperer and been ok. But I'm glad I went with family.

Painful

But I still find myself hurt by it. As we've gotten closer and I've become interested, I do find myself hurt that it is not a real possibility. Please don't flirt with me if it's not, I need help to maintain appropriate friendship boundaries too.

I'm out, fully out

As Process pointed out, once you miss the chance to out yourself early in a relationship (platonic or romantic) with someone, it becomes more and more difficult to come out again. So with that in mind, I recently outed myself to M. We were talking about experiences having friends that we've had sexual chemistry with. I may lie by ommision, I won't lie by commision. So in my response, I acknowledged that the person I was talking about was a woman.

It was nice and we talked a bit about it. Later in the week we were out walking and I ended up mentioning the ADD (which I normally don't share with people who are or are potential work peers) and he asked me if I take meds for it, which I acknowledged I do. It's hard for me to be out to someone w/o ADD as an adult with it. Most of my friends have it; we do attract each other. But for those who don't, there is a serious lack of understanding. When I acknowledge that I take medication for it, I still feel some transient shame.

We keep spending large chunks of time together. I'm a little nervous because it is beginning to get the flavor of a potential relationship and I'm finding my feelings changing from brotherly/friendship to friendship/potential partner.

This isn't good for a couple different reasons. Reason #1: he's acknowledged having a pattern of sleeping with his female friends and having that mess up their friendship and of having a lot of unprotected sex in the past. To remedy this, he's cut back on his drinking a lot, started therapy (for reasons broader than this), and explicitly told me about this because he doesn't want to mess up our friendship.

Reason #2: He's two months post a breakup from a year long relationship. That one stands by itself.

Reason #3: He says that he has a habit of supporting a close friend or significant other emotionally for a long time and not getting his needs met and then he disappears suddenly and hurts them.

So he is not a good dating partner right now. But when there is that connection, I am so hesitant to let it go. There are so few guys who I really like and who are emotionally open. I am still averse to dating women right now (baggage) and now that I am becoming interested in him, I hate to lose it. All my friends are in relationships right now and it is really hard to be the only one that is not. Plus, we'd have really cute red headed children.

Pediatric vs Adult floors

Today I had an interview on a pediatric rehabilitation floor. The floor looks like a wonderful place to have kids. The floors are wood, the walls are painted. Their are stars on the ceiling, fish tanks and lots of color on the walls- a great mural that the kids have painted. All meals are eaten in a central dining room, all the kids together, and there are child life specialists whose job it is to make being a patient as a kid all a little easier.

My question is, why don't we do this on the adult floors? They are gloomy with white hard marble floors, white walls and beige or tan trim. All the rooms look alike, the flourescent ceiling lights make everybody look a little off and patients who are there on long stays are very isolated. I find it disorienting and I am young and healthy.

Now imagine that you are 68, in pain, on oxygen, trying to walk with a walker carrying your O2 tank and a chest tube. You generally wear glasses, but someone put them in the bedside table a few days ago and it seems like too much work to get them back. You've been in a room with three other patients for two days waiting to improve enough to move to a more private room. In the room you are in, their are 4 tvs going. Beeps every few minutes if an O2 monitor slips off a finger or if someone's heart rate is a little too high. Because of the noise, you haven't slept much and someone is taking your vital signs every couple hours anyway. A person you have never met before today is pushing your IV pole. You have walked in a circle between the four "pods" three times today to get your exercise; now you are circling back around in your pod to find your room. It's all white. You are confused, overwhelmed and you don't know where to go.

I've had patients only make it a few feet out of their room because the floor is so busy, so intense, and so disorienting.

Is a white wall any cleaner than a blue or purple or green wall? Can't there be pictures on the walls and non-flourescent lights? Can the hallways be wider? Can staff be alerted to codes via beepers rather than overhead announcements? Can their be a central dining room for patients without infectious diseases? What about a room with a few computers for adults to use? How come on the pediatric floor there is always room for a family member to sleep but not on the adult floor? Families are important for us too. Why is it that as adults we are expected to be immune to the physical environment? If I had a choice, I'd prefer to be on a pediatric floor. It's more humane.

Good news: ADD not NVLD

I got the final report back from the neuropsych testing. I found it pretty interesting. The results were substantially different from last time. They did find that I do still have ADD, that is consistent. But all the non-verbal test scores had gone way up. They explained that my abilities aren't as high as the test scores indicate although higher than the original scores indicated. My familiarity with testing made most of my scores go up. Also, I was moderately depressed at the time of the first testing. The areas that I was weakest in, the visuospatial abilities, became even weaker when I was depressed.

The components of the testing that indicated attentional difficulties however, I continued to have problems with. I knew that, one third of the way through the testing, Dr. B told me that she was almost positive that ADD would be a constant diagnosis. If I were NVLD, even with my testing experience and lack of current depression, I would still falter, same as I did with the attentional and planning components.

I am so happy to hear this. The research about "success" in adult life with NVLD is pretty bleak. I felt like I needed to know so that I could learn how to compensate for it.

The best advice I've gotten so far has been Dr. W's suggestion to go on Strattera rather than the stimulant medications. She says it is best for ADD without hyperactivity and also works very well in people who are weakest in non-verbal areas. I'm noticing consistently subtle changes every day. If I don't want to read anymore, if I don't want to lie in bed anymore, I can think about it, stop doing it and get up. It may sound weird, but I had immense difficulties doing so before. For 27 years, I would get into almost a trance state with books, tv, computer browsing and NOT be able to shake it even when I wanted to. It's something that I've even talked about in therapy because it was impairing my ability to manage my life and it isn't an obvious ADD sign. Lately though, I've been able to just stop, think about what I want to do and put down my book and do it. Phenomenal. I don't know why my psychiatrist had been so reluctant to try it. I'd brought it up a few times before; I really had to push it this time and emphasive the irritability that Adderal gave.

One more thing that Dr. W said was that my social skills difficulties as a kid were all ADD related. She said that because I've grown out of them in my twenties. In fact, and I want to do some research to see if this is true, Dr. W said that people with ADD mature about 30% slower than people without it. So in a lot of ways I'm like a 19 year old. Not in terms of my drinking or stupid decisions, but in terms of taking control of my life, figuring out what I want to do, social skillwise and personal empowerment. I don't really think of myself as a 19 year old, but in a lot of ways, I've only recently, in the past year or so, felt myself to be more like other people in terms of social abilities, knowing what I want to do and how to arrange my life the way I want.

I have an interview!!

I'm very excited. It's on the pediatric inpatient rehabilitation floor at one of the best rehabilitation hospitals in the country! I did research there, (not pediatric research), my senior year of college. Don't want to jinx it, but this would be an acceptable job.

I found out the nurse manager's name at a major teaching hospital nearby for the Acute Respiratory Disorders floor. There they do ventilator weaning and other work with patients with major respiratory disorders and sent her my resume directly. That would be an absolutely ideal job. I'd be willing to go to school part-time for that job.

Cross your fingers.

Verizon remains evil.

Evil is too strong of a word. Incompetent is a more accurate word.

After spending two hours tonight trying to upgrade my phone, after talking to multiple Verizon customer service reps online and being told that I have a bad credit card and finally talking to someone over the phone, and being told that their ordering service is still down, I have just ordered a new phone from T Mobile.

Multiple friends rave about T Mobile's customer service. I found a plan that works a little differently, but will give me about the same number of minutes for the same price.
The entire checkout process with T Mobile- 4 minutes.
The process with Verizon- multiple attempts over 2 weeks, been insulted by a rep, been told I have a suspended credit card, probably spent 5-6 hours total with them trying to remain a paying customer.

Here's a hint to all companies. If you are changing your ordering system, FIRST inform ALL employees. SECOND, make it clear on the website. THIRD, don't allow customers to spend an hour figuring out which phone and which service works for them and then let them get to checkout and give them repeat error messages regarding their credit card. This isn't rocket science folks.

Centering

Today I had trouble centering in church. None of it felt like worship to me. I think that I am still trying to determine how much church attenddance is right for me and how much is too much. Some of it may also be that I haven't had a real day off or chance to sleep in for weeks. I fell asleep last night at eleven, but still woke up reluctantly today around 9 and barely made it into the shower and out of the house in time for 10 am service.

I wish that there were a programmed Quaker meeting around here. Maybe I'll start attending Quaker meeting one day a month and the rest of the time UCC. That may give me the quiet worship that I need in small amounts.

How much information to share?

At work today, I was a 1:1 sitter. My patient had gone through a very invasive surgery and developed delerium afterwards. The delerium is likely due to combination of her age, the invasiveness of the surgery, and the narcotic pain medicine she was given. As soon as it developed, the medication was stopped, but her sensorium didn't clear immediately (nor would it be expected to).

Her family had been reassured that this was because of the medication and the surgery and would only be temporary. Likely it will be. However, in some older adults, delerium from medication, surgery, UTI or pneumonia, can spark the long slide into dementia. For some, it may worsen a pre-existing unrecognized dementia and for others, it may spark a dementia that would otherwise not develop for a few more years. This certainly doesn't happen in all cases, but in a larger percentage of cases than we like, it does happen. Almost as bad, often delerium following hospitalization is a sign of impending dementia. She might be all right in a few days, but in a few years, she will likely not be.

All day I wondered about the ethics of not telling her family that this is a possibility. At what point should that information be shared? Right up front when the delerium is recognized? If it doesn't clear within 24 hours? 48 hours? If she's still not cognitively intact at discharge or in rehab? How much information is too much and overwhelming? At what point are we "protecting" the family the same way we used to protect terminally ill patients by not talking about death? One of nurses' main jobs is to translate medical information from medicalese to language that the rest of us can understand and that is pertinent to every day life.

I'm uncomfortable when I need to decide what information at what point needs to be shared. The family wasn't even told that she had developed delerium. Rather, they were told that it was a "medication reaction." I disagree with that as it may prevent her from using the opiod medication in the future when it may be needed and, without the stress of surgery, it may not trigger delerium. A medication reaction is like haldol causing tardive dyskinesia. Even more, if a family member wants to find out more information about what happened later, they won't find it if they don't have the accurate name for what happened to them. The final trigger may have been the medication, but I can guarantee you that if she were 40 years younger and going through the exact same operation, she would not have become delerious.

I closeted myself tonight.

I've become friends with someone in my grad program who is a year ahead of me in the program. We actually met in church, he started attending a few weeks after me and we saw each other across the aisle. He has very similar hair and skin coloring and when I looked at him initially, he reminded me of my father when he was younger. Walking past us on the street, I think many people might think that we were related, brother and sister because of our coloring. A lot of what he says, reminds me of myself. He talks about not being able to be alone and do activities by himself; I used to frequently wish that I were more independent. He is very easy to get along with (I love male nurses; I love men who talk about emotional intimacy and palliative care) and we've been getting to know each other.

Earlier this week in class I was talking about a friend and her girlfriend, and he asked me if I had any straight friends. It was half in jest, but half real. Most of my friends are queer. Tonight we were talking about college and he asked me why I made the decision to attend an all-women's college. This would have been the perfect time for me to say that I chose it because I felt so comfortable there and the reason I felt so comfortable there was that they had a very visible queer group on campus. Then I could have launched into the explanation about how I date both women and men yadda yadda yadda...

But I didn't. I talked about all the other reasons I chose it. I talked about being a feminist and how wonderful it is to be in an arena where strong smart intellectual women are the norm and how you don't need to compete in class to be called on, to be listened to. How wonderful it was to be able to do the experiments in science class without having to force my lab partner to let me do some of it. All of it true, but not why I chose it. I chose it because I wanted to date women, to surround myself with women, and to explore this part of myself. But I didn't want him to know that. I wanted him to keep me in the "normal" category because I admire him. While I'm not particularly attracted to him, part of me wishes that I were.

Because I've felt out of sync with the rest of the world for a long time, part of me wants to be closeted and just step with everybody else. That, and lately I have been only minimally attracted to woman, I've been wanting to get away from my queerness. Or, to have it not be an issue at all. I enjoy the dynamic I have with him. I like the friendly flirtation we do. I don't want to change it. I also don't want an additional person in my life to try to define who I am attracted to. I've had too many friends tell me, "You can't be bi, you're even gayer than me." Or from people I don't know well, "I could never imagine you with a boy. You're so clearly oriented to women." And, occasionally from random people, "but you don't look gay."

But guess what, I am bi. I am attracted to men. I am attracted to women. At different times, I may be attracted to them with different intensity, but that does not preclude the fact that I have been intensely attracted to both men and women. So why didn't I tell him? I didn't want to open the conversation, I didn't want to be different, and I didn't want another person scrutinizing me for evidence of which way I "truly" lean. But, I'm still uncomfortable with my reticence and now, as I get to know him better and better, it will only be harder for me to open up that conversation.

It's working!

I really think the Strattera is working. Today I saw three complex patients and wrote up their notes and was done by 3:30. I could have done another patient. My patients are complex enough that my preceptor also only sees 5-7 patients a day. Even better than that, when I got home, I sat down and played online, but didn't stay glued to the computer, unable to move all night. I've made dinner too!

Nursing Home Education

Today, at the nursing home I am at for the semester, I watched one resident try very determinedly to teach another resident how to "walk" across the floor in his wheelchair. He was crawling along at about one inch an hour. So she tried explaining, repeatedly, how if you move your feet as if you were walking, but stayed seated, you'd move quickly. Unfortunately, every time she said the word "walk," he'd try to stand up to walk. Then she'd yell at him to sit down, which he would. The process would then start all over again. After about fifteen minutes, she gave up, but boy was it amusing.

I love the signs of life in the home. Many of the residents are so impaired that they cannot socialize, but the ones who do are active. The romances, hurt feelings and roommate quarrels aren't obvious at first, but now that I have been there three months, that world is becoming more transparent to me. I love this population.

Boundaries

When I went a week or so ago to be retested for ADD/NVLD, the neuropsychologist who tested me introduced herself as Dr. X. It felt very strange. The one who had tested me in college I also called Dr. W, but that didn't feel weird. Some of it I think is the age difference. Dr. W is 20+ years older than me; I met her when I was younger and she is an expert in her field. Dr. X is my age, could be a little older or a little younger.

I've spent several years doing psychology research since I graduated college and didn't call anybody except for two particular individuals by their title "Dr." and even then we'd often go by first names. It made me feel uncomfortable. I felt as if she were demarkating the differences between us with the title. Part of it is I am not comfortable in the patient role; I want to feel a working partnership between equals and my expertise to be respected. At the same time, I acknowledge that she is more of an expert in this area than I am. I just felt as if the title made the relationship hierarchical rather than, hmm, I'm not sure what the word is. Rather than non-hierarchical? Rather than a relationship between equals I guess. I felt as if we were unequal partners.

How much of this is guided by physical appearances I don't know. Dr. W inspires confidence. She has visible markings that separate her from me. We're not peers in any sense. Her "bedside," I guess "chairside" manner is better. She's a little warmer, D. X was a little more New Englandy. As part of it, I think that some of it is Dr. W's greater experience and knowledge allows her to focus more on her interactions with her patients and less on what she is doing. Dr. X is still more task oriented.

I'm going to keep a lot of this in mind when I have patients independently. I'm not sure how I'll use it, but I know it will be important.

Ok, no more complaining

I think I've been using this a bit too much as a griping board. Don't want to do that because a) it's not fun to read and b) I end up complaining/obsessing more than I should. So I will try to tone down the rants and stay focused on a few specific topics. Here's my current plan of topics to focus on:

1) Healthcare: My work as a PCA, RN and NP and my interactions with my patients, all nicely anonymized and changed of course.

2) Religion: After I go to church, I find myself mulling over what it meant and why I go for several days.

3) Mental health: My encounters with my therapist, my ADD, my questionable NVLD, medications, coping strategies, etc.

4) Relationships/Queerness/Bisexuality: There's a lot for me to say in this arena. I have a post gestating right now.

5) All else: I have ADD after all. You can't expect me to stay on topic all the time after all...

Fixed my phone

I've temporarily fixed my phone. Thank god. Time for a new one now. Finally fixed it enough so I could call Verizon and find out what was going on. Turns out they are changing their computer system and can't do online upgrades for another week. Why they didn't put this as part of their error message I don't know. They keep telling me to go to a store, but the store is more expensive and they acknowledge that it will cost more. I hate technology so much sometimes. I just like to be able to do things seamlessly. I'd be one of those people who buys a phone and doesn't change it for 15 years if possible. Once I have a system down and it works, I don't see the reason for change. I wish they built cells to last longer. My is considered ancient as it is 3 or 4 years old now.

Way to go Verizon

Verizon pisses me off to no end. I've been with them for several years now because they genuinely have the best coverage where I live. But I don't care now. Their customer service person was just extremely rude to me; I'm not a difficult customer and I'm not one of those awful people who yell at, harass and expect to have my *ss kissed by customer service people. I expect a basic level of politeness.

I'm trying to figure out why I can't upgrade my phone online and if there is a work around. The customer service chat appears and I ask her about my problem. After a few back and forths, she tells me I have to contact Customer Cares. I ask her how I can do it online, she tells me how, then tells me that won't solve my problem. I then ask her why not (cause I really do want this thing solved and she just told me to contact them) and she ends the conversation. I'm sorry, that's as rude as hanging up on someone in the middle of a conversation.

I don't want to put up with this. I did some online research, looks like T mobile has the best comparable deals around here.

Cell Phones woes in the midst of a job hunt

Today I got my first call back for a possible position. Of course it happened during class when I couldn't answer and after class, my cell phone managed to break. It gave me the same error message once before and I managed to fix it, but now I think this is the end. This time it says the same error message and it won't stay on for more than 45 seconds.

I am years overdue for a new cell phone with Verizon, but now their website won't let me do it online. It is giving me a 1-800 # to call. My cell phone is my only phone, so that won't work. I sent them an e-mail to find out if that was the only option. If it is, I don't care, I'm switching services. Verizon has been hounding me to upgrade for a couple years because the service plan I have isn't one they offer anymore. If they get me to fundamentally change plans, they don't have to offer me as much money toward a new phone as this plan has. I hate it when companies make your life more difficult to get more money out of you.

The only way that they can get me to switch is by confusing me on the phone. I don't want to upgrade by phone. I need to see all my options laid out in front of me. Every time I've upgraded on the phone it has turned into a giant mess and I end up without a service that I want or with one that I don't. Why make it so difficult?? Two months ago I could upgrade online no problem. ARGH! And I need to do this fast so I can continue my job search.

Surprise Placement

At school, we have one on one placements with a preceptor. This semester, I have a placement with a geriatric nurse practitioner. We had the option to sign up for a summer placement, but I did not as I had unclear summer plans.

Last night I got an e-mail from the placement coordinator that she had a summer placement for me, one with an OB and one with a pediatrician. OB and pediatric placements are DIFFICULT to get around here. If I turn this down, I may not have another chance to get one. Placements in general are hard to get around here. There are around 1,000 NPs in the state and maybe 300 NP students graduating every year. So many of our placements are with MDs or PAs. The pediatric placement is with a NP, which I prefer.

As I just turned down a summer camp job that I did not feel qualified for, I do have the chance to take the placement. The one problem is that I am flying to Kazakhstan in May for 2 weeks to visit a friend and that means that I will have to make up 32 hours of clinical; my preceptors may find that they are slowed down too much by having me there extra time every week. So I'm in crossing my fingers and toes and hoping that this can all get worked out.

What a change it will be, nursing home to OB and pediatric; I'm going to have to review a lot!

An unusual presentation

At a birthday party on Saturday, one of my friends left early because she didn't feel well. I asked her what was wrong, and she said she didn't know, she was exhausted and had been fainting a lot lately. Although my friend has a tendency to be rather melodramatic (going to the ED because the back of her throat looked funny; she didn't feel ill) and she also faints every time she sees blood or has blood taken, this sounded a little strange even for her.

My wise nursing skills came into play and I strongly encouraged her to go see a provider or at least call a doctor. She kept asking me what could be causing it and why I was worried. However, as I was at a party, I didn't feel like playing let's list and explain the differentials. My strong nursing and NCLEX pass skills came into play and my first thought and reason for going to her provider was "safety." Regardless of the cause, it is dangerous to be randomly losing consciousness. You can hit your head, crash your car, etc.

Leaving the restaurant, my friend evidently fainted again outside her car. Finally she went to the ED either that night or Sunday. What was her diagnosis? Pneumonia. I never would have guessed. Her only other sign was "not feeling right." She had no fever, chills, cough, shortness of breath or chest pain. Today, she wasn't able to keep down her antibiotics and started coughing up bloody mucus, so she went back. I'm still waiting to hear if anything has changed.

Great reminder that diseases often don't present classically and that it is much more likely to be an uncommon presentation of a common illness than a common presentation of an uncommon illness.

Strattera

This is not a product placement, I promise. I don't do those. I've just been thinking a lot about taking Strattera.

I started Strattera on Wednesday. It's a selective norepinephrine reuptake inhibitor and is the only non-stimulant medication approved for ADD/ADHD (other non-stimulant drugs are prescribed off label). Over the past 9 years, I have worked my way through all the different permutations of Ritalin (ritalin, metadate, concerta), Adderal and Dexedrine. None have worked particularly well for me; I'm very sensitive. For adderal, most people use 20 or 30 mg over the course of a day; I use 2.5 mg - 5 mg over a day.

All of them make it difficult for me to socialize and talk to people. I feel on edge. Adderal, which has worked the best of all of them, makes me very short tempered and irritable. Dexedrine makes me this bizarre combination of spacy and overly focused and alert. Ritalin made me overly focused and alert.

Strattera so far seems like a miracle. I can sleep and eat on it. I'm not overly irritable (yet). This morning on my way in to school, I remembered to bring in a dermatology book for a friend to look at and my check for the Nursing Honor Society. Two days ago, as I was walking through the kitchen, I stopped and put away some glasses and tidied. Small things, but things that I would never have remembered or noticed to do.

Most people start at 40 mg for a while and then go up to 80, but because I've been so sensitive to the other medications, I was hesitant to do it. We decided to start at 25 mg for 5 days and then go up to 25 mg twice a day.

The geriatric psych drug axiom is to "start low, go slow." It's an axiom that I was eager to follow for this particular drug, although I am at the other end of the age spectrum. One of my friends was on it, and it gave her terrible mood swings-- she ended up throwing things at her gf during a fight. She's now on Adderal without that problem. Other horror stories are easily available on the net, so I've been hesitant. It's also a relatively new drug. The FDA approved it at the end of 2002. I like waiting several years before I put a new medication in my body, then it has a good chance to get recalled before I take it. So it is a little early for me to take it, but I think that I have exhausted the stimulant options and I really would like to have a little extra help.

Today was the first day I took 50 mg. I'm hoping that I won't start experiencing any of the serious side effects. It makes me nervous. As I'm seeing some beneficial effects now at 25 and minimal side effects, should I really go up? I did go up, but am not sure I feel like it was a great idea. Guess I'll find out.

It makes me sick

"If Jesus was here tonight, I can guarantee you he'd want him terminated," said Pastor Ron Saunders of Largo's Lighthouse Baptist Church. "Make no mistake about it."

from http://www.boston.com/news/education/higher/articles/2007/03/01/fla_official_fired_over_sex_change_plan/


This is why I have difficulties with so much of Christianity. Jesus who said to turn the other cheek, Jesus who walked with prostitutes and lepers, who sought out the lowest of the low in society at the time. I can guarantee you that Jesus would not want her "terminated." What is so scary about a transgendered person transitioning? Does the pastor who said that worry that he too will start questioning his gender? I wish I knew how to contact the person in Florida. I'd love to send a supportive e-mail.

My plan was to write about what a feeling of relief I had when, during church this morning, Molly the minister talked about miracles. We had heard the reading of Mark in which the woman come to his tomb to annoint his body and he is not there. Then it ends. She talked of how Mark is the biblical book written first and in that one, we don't see Christ resurrected in a physical body. That came later. She talked a lot more about miracles and the movement of the rock and how a miracle doesn't have to be God reaching out to move the rock away, but it could be an acceleration of a natural process, the ground thawing and shifting, a small earthquake. It felt so nice to be in a church where I don't have to give up my intellect to be a part of it.

Easter

So it's Easter Eve. Tomorrow will be only the second time I've gone to Easter services in a church. I once went to a Catholic Easter Service with my best friend, but otherwise I've gone to meeting or not gone at all.

I've been trying to understand what I can about Jesus and accept what I can. After a lot of struggling, I've accepted that faiths outside my cultural tradition aren't right for me. I can conceptualize Jesus as fully human. And with that knowledge I can understand how he allowed himself to be taken and crucified. It almost seems as if it is something a teenager would do. The willful disregard that one's very life is at stake. Something will save me at the end.
It's a human fault- to conceptualize of a God that will interfere in day to day lives and that will change the world.

The second part is what I have trouble with. I accept that he is as divine as I am divine and most others are as well. Is he fully divine, more divine, separate from us, from the people living then? I don't know. He was certainly a better healer than I was, although I consider my family values better (leave your mother and father and follow me? I think not.)

Did he rise from the dead? No, he did not. But I know, after I've had a major loss, how I keep seeing that person across a crowded street or in every store window. Could the same thing have happened to the disciples? Certainly.

Rules for Patients

Say you are in the hospital and recovering from surgery. Here are some general rules that will make everybody much happier if you follow them.

1. Don't flirt with the nurses and patient care assistants unless you are exactly our age, the attraction is reciprocated (and let me tell you, you don't smell too good and there's nothing attractive about a Foley) and we start it. Or you can be severely demented and then we don't mind. Otherwise, the last thing we want to do in hour 10 of a 12 hour shift is to have to start setting real clear boundaries. See your idea of flirtation, is our idea of not fun cause we still have to deal with you. And it's best if we just don't go there.

2. Your nurse is not your maid. If you brought six bags to the hospital, no I will not pack and repack and find things for you. Your family and friends can and I will look for occasional items as necessary, but that's all I can do, I'm sorry. What should you bring to the hospital?

Reading material and music if you like it. Pen and paper if you want to write. Your wallet, cell phone.

You probably don't want to wear your clothes in bed. 90% of the time, they will get bloodied, shit stained, sweated through, urine soaked, or some other nastiness on them. There's a reason you are here. If you are not doing any of the above, you are probably almost ready to go home. If you want to wear it, go for it, but don't say I didn't warn you. And your clothes can't go in our laundry, so whatever it is dirty with, it is going to fester.

Your own robe is a wonderful idea for walks. And yes we do have robes here so you don't need to worry about showing the world your backside and if you are really lucky, we even have pajama pants. Bring underwear for once some of the tubes come out; we have some disposable mesh ones, but really, it's quite funny looking. Otherwise, a change of clothes for going home. That's it. We have soap and toothpaste and toothbrushes and socks and shampoo.

3. We are not your waiter or waitress. If you didn't get enough sugar with your meal, then that does not mean that you should start calling at me for more sugar while I am trying to take your roommate for a walk. Ring your call bell. Call the PCA and he/she will get it when they are done with vital signs. See when I work as a walker, like today, I have 22 step-down ICU patients to walk with; each needs at least three walks a day to prevent pneumonia with the types of surgery we do. While I am trying to disentangle the wires and tubes, the last thing you want me to do is to be distracted by your calling me frantically and for me to trip and break your roommate's arterial line. Then I will be so busy that you will NEVER get that sugar.

Moods

Yesterday I was down all day. I didn't leave my house until 7 pm, when I was meeting my ex to study. I am realizing quite how upsetting getting retested was for me. There were such mixed feelings. I want to test well. I want to perform really well. But I also want to have a validation that there was a specific reason that I have the challenges I have. Otherwise I fall back into self-criticism, which isn't useful. Will this testing be useful? I hope so. The more I think about it, the more I wish I were diagnosed at a young age. I have some vivid painful memories of teachers telling me to try harder, that I could make it neat, make it pretty, put it together right, and I just couldn't.

There was one particular chemistry teacher I had who pulled me aside after class to ream me out for having turned in messy work. This was work that I had stayed up until two painfully typing (this was before typing was the norm) so it would be readable and I redid the graphs so many times so it would be neat. But it just wasn't able, no matter how many times I tried. I remember leaving class and trying not to cry.

There were other episodes, in other classes. People just don't get that while you can be smart in many ways, it may be beyond their capabilities to figure out how to center something on a page and plan it out. To hear again and again that I wasn't trying, that I could fit in if I wanted to, that they didn't understand why I wouldn't bring papers home, start projects earlier, just do my math homework, etc. You start doubting yourself, you label yourself, it's not healthy. Honestly, it has been really hard. I try, so hard, all the time, and it isn't seen because what I have to try at is what comes naturally to others and what they have to try at, comes easily to me.

So because I was so down yesterday (and let me tell you that job hunting in a tough market is adding to it. Any nurse managers out there looking for someone? Especially someone with a fair amount of experience in thoracic surgery/pulmonary medicine? Drop me a comment.) I called my therapist and made an extra appointment. I've been going every two weeks, but the past couple of weeks I've gone every week. This week I was going to go back to every two weeks, but I don't think it is such a good idea.

Good Friday

I've started going to a United Church of Christ near me. My criteria for a place of worship was that it must be actively gay friendly (not just tolerant), feminist, and not too centered around Jesus. This is the best I've found so far. I tried a UU church near me for a while, but I couldn't get around the lack of a God as the centerpiece. It felt weird/off. I often don't know if I believe in God, I think I'm more of an atheist/agnostic, but I still find comfort and insight from participating.

Growing up, I was raised Quaker. At my heart, I am Quaker. All the Quaker values and beliefs resonate strongly with me. But, the mode of worship does not. Part of me hopes that in later years I will be able to gain more from going to meeting, but right now it does not work.

The UCC church I am currently attending is mostly good; the congregation is incredibly friendly, the minister is funny and engaging and she makes me think. Looking around in the congregation I see young and old people, lots of babies, same and opposite sex couples, it feels right. But the emphasis on Jesus is still a little too strong for me. I'm hoping that that is partly because it has been Lent and now Easter.

The Good Friday Service was dramatic and moving. But still at the end of it I come down to my constant question. How can there be a good God who demands/requires/allows a crucifixation of his son in order for us to be saved? (Let's leave aside the matter that I don't believe in Heaven or Hell, salvation or damnation). I wonder, is it something that one must have grown up with to fully accept?

At times I don't even know what I get out of going to church. I don't identify as a Christian, although I am culturally. Part of it for me is the fact that I am constantly striving in my life to "do right." To make the right decision, to act properly, to think of others before myself. Trying to keep everything together feels overwhelming often. The idea that we cannot act right all the time, that we all fall short, that we are all together in this, is comforting. Being in a social community where a relatively diverse set of people come together every week makes me feel part of something larger than myself. And for now, I guess that is sufficient.

Job Hunting

Currently I am job hunting. My goal right now is to find an inpatient RN new grad job at a major teaching hospital. I prefer working with surgical patients, but I am mostly applying to medical floors because I think that experience with medical patients will be more important for my future career as a family nurse practitioner. To my surprise, I have found that I actually enjoy working inpatient. Before I started school, I have to admit that I expected the RN portion of school to be a joke and my time inpatient to be hellish, full of wiping butts and bed baths.

Yes, they are a part of it, but I don't mind. The rest of it is very fulfilling. More so than I thought. My ego aches every time I see an intern or resident my age rounding on my patients. That could have been me. (This is why parents it's important to have kids get a comprehensive evaluation if they are struggling as kids, even if not academically struggling. My parents had me go to a child psychologist, didn't help the cause, although I did have someone to play with. My problems weren't with depression or anxiety, they were due to a learning difference. Please get a neuropsych evaluation, especially if there is nothing traumatic in the history.)

My hunt is disheartening. The students ahead of us passed the word on that it was very tough to find a job; I didn't quite believe them. But now that I am hunting, I am finding it to be true. Why would a hospital be interested in us? Spend three to four months training us and then we work part time for 9 months and we are gone.

I applied for a job today with the proviso that I will work full time for at least a year. It seems to be the only way for me to get the experience that I want. Once you have that year or two of inpatient experience behind you, doors open. And, I really do want to feel competent as an inpatient nurse. At my old job, I felt as if I were posing; I could present very well, but felt I never produced well. I want to know how to respond automatically in an emergency and be able to tell the difference just by looking between someone who is "sick" and someone who is sick.


Nota bene: No one believes me today when I say that I struggled socially as a kid; we learn to compensate. Thank goodness, a lot of us socially awkward kids grow out of it.

LD testing

I got tested today. While I have to go back in a few weeks for the report, it is sounding as if I do have ADD (without the H) and probably NVLD as well. I don't need accomodations in school, most of my visuospatial skills fell within the range of normal or low normal, but my verbal skills are so high that it is a huge discrepancy.
I was nervous doing the testing. I wanted to do well. I also wanted them to find something, so I could stop blaming myself, for being lazy, unmotivated, disorganized, scattered, lost. I could tell on the tests that I had improved in some ways from before. But there were still problems.
One suggestion they have is for me to use a 'cognitive coach.' There's a neuropsychologist who works with a lot of the NVLD kids at the local ivy league school and Dr. D thinks that will be a big help. I am willing to try it. It'll be interesting to read the full report. It's funny, I got tested initially in college, but never really dealt with any of it. Now it's as if I've grown up enough to really figure out what it means to me and how it affects me. 9 years later. How do kids who are diagnosed at age six ever make sense of it? Is it any easier or do they grow up feeling as if there is something wrong with them? I've felt that way a lot, although I'm moving beyond it now.

Therapy

I've been in therapy for about a year and a half now. This post is inspired from a post of Process's in which she talks about therapy.

Therapy has been a struggle for me. I have some very well hidden, very concealed, learning issues that I struggle with. One thing that I have problems with because of these learning issues is figuring out how to start a project, how to organize it and how to follow through as well as a lot of difficulty with visuospatial skills. It's not a traditional learning disability like dyslexia, but it has a lot of the characteristics of ADD and NVLD. I'm actually getting retested tomorrow to elucidate more of what's going on. But these issues made therapy difficult for me because unless I have been explicitly told how something is supposed to happen or what I'm supposed to do, I falter.

So in therapy, the first time I went in college, I didn't know what to do, so I didn't get a lot out of it. My therapist was very good, she was able to get me to talk a little bit, but without my knowing what to do, it mostly provided me with some support and structure. I was struggling with a depression and she helped me with some very basic plans and needs. Two years ago I had a bad breakup from a tough relationship that shook me to the core. I started therapy. I knew the therapist I had was going to be right for me when I asked her what her philosophy was and she said that she was known at the Happy LGBTA Health Center I go to as the "Gentlest Therapist."

Therapy was painful. Not because of what we were talking about, which was painful too, but because I had no road map. I needed guidance. Being part of the queer community, all my friends are in or have been in therapy. I think it's a prerequisite before you get your Q Card. So I asked my friends about what they talked about and how they get started. It didn't really help me though. I guess I just needed a lot of practice. One point I should add though is that I don't trust easily. About a year into therapy, one day I woke up and the thought crossed my mind maybe I can trust her. Since then therapy has been even more productive.

I'm glad I stuck it out through the painful sessions in the beginning where I'd have so much bottled up and not be able to mention any of it to her. I am glad that I had the economic resources, even though it was almost entirely student loans, that allowed me to see her for the whole year and beyond. I can't imagine only having 8 sessions. I don't go every week, but it probably took me 30+ sessions to decide that I can trust her. Was I getting something out of therapy that whole first year? Yes. But there's a difference. Now therapy is easier. I am able to focus on what I want to and not have to struggle so much with how to do it.

So after lurking for a long time on other's blogs, I'm thinking maybe I should start blogging some of my own. An online diary of sorts. I've got a lot that goes on in my head, so maybe here I will have a chance to lay it out. I've never been much of a writer, more of a reader.

I'm calling my blog the Foot Necklace because I have one necklace that I've been wearing lately. My aunt gave it to me and it is a quirky little happy foot on a silver chain. It's been making me happy lately and it matches my only other piece of jewelry, which is a silver ring. It looks like interwoven tree branches and has a very organic feel. What makes the ring fit just right is that I didn't buy it, I found it in a big cardboard box filled with junk that was labeled free on someone's lawn after a yard sale.