By this time next year…

I am in my third semester in my MSN FNP program, and in my second clinical rotation. My preceptor is pretty awesome, and said something today to a patient that has had me thinking all day.

By this time next year, I will be practicing as an FNP.

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*cue jaw drop to the floor*

Yes. By this time next year, I should be a practicing FNP. There are those pesky board exams I have to pass, but my plan is to start preparing for those as soon as I wrap up this semester.

So much has happened. I couldn’t be more excited, but I still feel so unprepared for the amount of responsibility I am so close to having. I should probably mention I felt the same way when I was about to earn my RN license. And my preceptor would say a healthy dose of fear is what is going to keep me cautious, and caution will keep my patients safe, and hopefully healthy.

Still so many questions remain. Where will I be practicing? Will I be moving? Where to? Will I be part of a big practice, or a small office? Will I be serving the more rural parts of the state? Or will I find myself in a more metropolitan area?

I always thought I knew where I was going to be: with the Lyme doctor who got me well enough to go on this amazing journey. But that remains to be seen. Her office is small, and we would need to find a business model that could support both of our salaries. Also, she is taking her practice in a new direction, desiring to focus on cognitive decline instead of tick borne disease. I would still like to carry her torch, and help that population.

So many unanswered questions, but not really the time to address them either. I still have 8 weeks left in this semester, and one final semester to get through before graduation. Hopefully, things will get clearer in time.

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Changing Focus

Lyme disease and other tick borne infection started me down the path I am currently on. My hope was to finish my education, so that I may diagnose and treat sufferers like myself, in hopes they find some healing. But I may ultimately go in another direction.

Initially, I was rethinking my focus because I have recently become passionate about metabolic syndrome and all the associated diseases associated with it. Having fought weight problems on and off since high school, I knew, in my gut, something was wrong with the calories in-calories out (CICO) model. I knew metabolism was far more complicated than a simple mathematical equation. I knew from my very early biology classes that hormones were being ignored in the CICO approach. I just didn’t know how all the pieces of the puzzle fit together. Until now. Now, I have a better understanding, and I am applying that understanding to my own weight issues, and seeing results.

But I found something out recently. That other patients who are being treated by the same Lyme doc who helped me regain so much of my health, are visiting the EDs in the local area, looking for opioids to treat the pain associated with their illness. And when they bring up this doctor’s name to the MDs in the ED, eyes roll.

Now, I adore this Lyme doc. I think she is brilliant and I hope to learn all I can from her some day. However, I also don’t want to commit professional suicide before my career even takes off by potentially having patients that come to me for help, only to go to the ED looking for opioids, and then have my name associated with that. I do not believe opioids were ever designed to manage chronic pain. There is a law of diminishing returns with opioids, and I would rather focus on the root cause of the pain, fix it, rather than medicate it. To me, that feels like I failed somehow.

Now, this is NOT to discredit the patients who rely on these meds to treat intractable pain. If there are patients out there who manage to have a better quality of life because of them, I think that’s fantastic. But I will not be a practitioner who can manage those cases. I will not finish my education as an MD, and I would need to refer those patients to a doctor with whom I can collaborate with so that their pain is addressed appropriately, by the right professional, while I do what I hope to do to eliminate the root cause — the infection. I feel that pain on that scale would be out of my scope of expertise, and that would be unfair to me and my patient.

It’s upsetting because these ED docs do not know this Lyme doc like I do. They do not know of all her successes in returning patients to good health. They only know of those who come to the ED, looking for relief from their pain. And I dont want to be known among other professionals in that way either. I dont want eyes to roll when someone mentions my name to another medical professional.

When I first started down this path, I thought I knew my direction. It seems there are a few forks in the road coming my way, and I will need to make a decision on which path to take.

Beginning to feel the panic…

Clinical rotations start in a month for the FNP program I am attending. One thing I thought was a plus for the university I attend is that they assist with clinical placement, and have agreements with places all over the state. I knew it was going to be a hard road, so I started this process with emails to the coordinator February 1st. Emails go unanswered, and so, not wanting to be a pest, I waited until April 1st to call and get an update. NOTHING HAD BEEN DONE. I saw red.

And now I am stuck between a rock and a hard place. Because it’s less that a month before the start of clinical, and I dont have placement and the panic is driving me to distraction. I should be studying for finals…

I gave the coordinator 4 places to start, and another 4 places this past Monday. I am also making phone calls to various practices including local health departments and college health centers. I even joined my local chapter of the council of NPs hoping to network, but as luck would have it, the meeting scheduled for this week was cancelled. No one is willing to precept a NP student. I get it. It’s expensive and time consuming, and unlike precepting med students, there is no government money to help offset the cost to providers.

I’m frustrated. I am also scared because I dont know what the ramifications are if I am not placed. It’s demoralizing to be shot down over and over, and so that is affecting me as well.

Keep your fingers crossed for me, folks. I appreciate it.

So my kid wants to be a nurse

And I really couldn’t be more proud. She has developed into quite a remarkable young woman, with a number of achievements already under her belt: she will be earning her Associates degree in liberal arts along with her high school degree, she has won her local regional science fair for her work on tarantula behavior and molting (and will be attending the international portion of the fair), and she has been accepted into all the BSN programs that she has applied to for this coming Fall semester, including one especially highly regarded in the country. It’s been her dream to attend this university since she was in grade school, and her father and I desperately want to make it happen for her, but financially, it would mean incurring a lot of debt.

There is a school, several hours away, in a major metropolitan area, that has offered her free tuition, and we would need to only cover room and board. We went to visit that school yesterday, and while they have a wonderful new facility for their nursing majors, my daughter isn’t thrilled with the school. It is a women’s college, it is small, and has a religious affiliation. Knowing my daughter, I realize she wont be happy spending 4 years of her life there. And despite her academic achievements, it is the only school that offered her a significant scholarship to attend. She has applied for many other scholarships, but they do not announce the awards until after we need to commit to a university.

This is hard. We’ve hit some major financial obstacles recently, and if it weren’t for those, our deposit would have already been made to “Dream School U.” She is being level headed about it, and realizing that incurring a huge amount of debt for her first degree isn’t the most fiscally responsible thing to do. But have you ever wanted to give something to your child so bad that it makes you ache inside?

She is going to be a phenomenal nurse. She comes home with stories from her volunteering time at the local ED, describing how she wants to jump into the fray and help the nurses, and she has already so much in the way of basic protocol for things like a patient presenting with chest pain. Of course, my bestie from nursing school works in that ED, and has helped nurture that in my daughter.

And this week, as we explored the nursing programs, and she toured the sim labs, she never hesitated to jump right in and become involved in any way the tour guides allowed. I am seriously, seriously, proud. I really cant wait to see where her nursing career takes her, because she is clearly going to make an impact in people’s lives.

How will we make this decision? Do we go for practicality for 4 years, despite me knowing she will not be happy at “Paid For U?” Or do we throw caution to the wind, let her get her education at “Dream School U,” let the debt mount, and hope for a future that allows us to help her pay down her debt?

Step away from the podium

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If you can’t communicate well, you shouldn’t be teaching. If you can’t compose a sentence clearly, you shouldn’t be teaching. If you grow frustrated when students ask questions, you shouldnt be teaching.

I am currently enrolled full time in an MSN FNP program. That means I am taking 4 classes. Two of those classes are being run by DNPs who have failed to learn how to communicate effectively. It is creating a special kind of hell for me, and with 10 more weeks to go, I am getting fed up of playing guessing games with my professors, wondering what their expectations are for each assignment.

Rubric? What rubric? Syllabus? The syllabus for both of these classes is an absolute joke. There is nothing specific about due dates, and it will elude to things like “group projects” but that’s it – no description, no due date…

It amazes me that people at their level of education have zero communication skills. Zero. In nursing, being able to communicate with others is of tantamount importance, and yet, these folks cant even explain their assignments clearly. Each assignment generates an entire class full of questions, and each answer only further muddies the waters. How does that happen?

Oh. And you dont get to be cranky about answering said questions. Be clear in your expectations, and maybe you wont be bombarded with emails asking for clarification. And when your clarifications require clarifications? Yeah. THAT is a problem.

I am paying big bucks to attend school. I am not taking out any loans, so instead we are tightening out belts and going without to make the financial commitment work. I want the most for my money, and this, quite frankly, is a disappointing return on my investment.

I feel angry and powerless to do anything about it. I feel like I have to keep my head low and plow through. But this is painful. And stressful. And I frequently find myself wasting my most valuable resource – time- because what I *think* the assignment is and what it *actually* is are two different things, only to become evident after I already spent hours on said assignment.

I’m going to have a glass of wine.

Diet Changes

Since I left the hospital, I have not only started graduate coursework, but also have worked to get a handle on the remaining obstacles to good health. My weight became a real impediment to my job and my daily functioning, and between Lyme Disease, nursing school, and night shift, I put on a record amount of weight.

A friend told me about the Ketogenic diet, a high fat, moderate protein, and low carb diet, that is meant to control the hormones that direct weight gain and weight loss. During that time, I have become a huge fan of Dr. Jason Fung, a nephrologist out of Toronto, who treats his diabetic patients with this eating plan, along with fasting. He has two books that I highly recommend if you’re curious: The Obesity Code and The Complete Guide to Fasting. That said, he has plenty of free videos on Youtube that are incredibly educational, and completely intuitive. He doesn’t talk above the listener or below them, and I like his delivery style.

About 3 months in, not only was I losing weight steadily, I was noticing that my hunger had really bottomed out. The next logical thing to do was to include fasting. I had already been intermittent fasting on a 16/8 schedule at the suggestion of my Lyme doc, so I moved on to a 36 hour fast once weekly, and then progressed to the alternate day fasting when I had some experience under my belt.

At first, it was easy. And I was dropping a good deal of weight. But it didnt remain easy. My second semester of grad school started, and the alternate day fasting was beginning to take it’s toll. I was hungry and tired on fasting days, and I was unable to focus on my homework. So I decided to switch to a 5:2 fasting plan, where you fast for 2 nonconsecutive days in a week. This plan has been in place for the past two weeks, and I am struggling with it. I was unable to get as much homework as I wanted to today because I was unable to focus, and I am tired, hungry, and cold.

I think it’s time to return to basics. Time to go back to just intermittent fasting, either on a 16/8 schedule or an 18/6 eating window. Time to tighten up my food choices, and pay attention to those sneaky carbs. I need to remind myself that this isn’t a race, the weight will come off, and that it will take some time to undo the metabolic damage my body suffers from. This is a permanent change for me, and I need to do the things that will bring me success in the long run. And if that means adapting my fasting to a more reasonable approach, then that is what it means. I still need to be able to focus on school, and my other family obligations.

In the end, I will still meet my goals.

In case anyone is curious about ketogenics, here is a link  to an article in JAMA.

Things that bring me comfort

A warm cup of tea.

A hot, lavender scented bath.

My sweet, feline companion.

Talking with a friend.

Reruns of my favorite sitcoms.

Browsing in a book store.

Journaling.

Currently, I am finding myself dragged into the chaos that is my extended family, and I wanted to take a moment and remind myself of things that I can turn to that will help calm the storm, quiet the frustration, and help me to return to a more productive state of mind.

Classes are open, and my phone has been lit up from group texts from classmates, as we all try to get started on the right foot. I’m too distracted and frustrated to focus, so I need to mindfully do something that will at least quiet my mind enough to get myself organized so that tomorrow will be a more productive day.

The syllabus for each class needs to be printed, and I need to go through each and write down important due dates in my planner. Last semester, my planner was a huge part of my success, as each week was laid out with all my tasks, and if I got them completed early, I was able to socialize a bit more, or take some time to work ahead. If I can accomplish at least that much, then tomorrow I can begin taking each class individually and focus on the work due this week.

This past winter break, I made great strides in clearing out room for extra textbooks, discarding unnecessary paperwork, and clearing off my work space so that I can be most efficient in my studies. My study is a place I like to come to. It’s *my* space, with a big, cushy club chair in the corner, and my books neatly arranged on a new shelf, rather than my desk, giving me a little extra work space.

So tonight, I will have my tea, watch some reruns of Frasier, and go from there.