Primary Care Profiles

Camden, New Jersey. 

No one is ever on the right side of up here. “Rock bottom” is something people hit time and time again. 

If you watched ‘Stranger Things’ and struggle to picture the “upside down – Camden comes pretty close. There are entire blocks with vacant, abandos (abandoned properties) where my patients tell me they will go to get high. There are no grocery stores – just tiny bodega shops that feature snacks, soda, kitty litter, and Santeria candles but no fresh food. Trash is stirred up by passing cars and the wind. Glossy wrappers get tangled in bushes or create garish contrast against freshly fallen snow. A lone figure drops their pants to defecate in a vacant lot when they think the coast is clear.  

Yet, our oasis stands two stories tall admist the fray. Extraordinary things happen within our walls. I’ve been privileged to be introduced to an ever evolving cast of wonderful human beings. 

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Reggie* is exactly who you might imagine when you think of a chronically homeless individual. He has a long-standing mental illness that may or may not be schizophrenia. He is suspicious of me. He was last in for a doctor visit in 2012 – well before I was a provider there. He smells stale – of soil, of dried urine, and of the tang that develops from sweat never washed away. The fruity aroma that makes my nose twitch  is from the venous stasis ulcers on his legs that have swollen to 2-3 times their usual size. It is a smell that reminds me of my 5 years of hospital nursing. It’s the smell of things dying. I can see the pink-white layers of his skin. Reggie is a large man but he sits hunched in the wheelchair, observing my as I examine him. 

Reggie tells me that he only needs bandage supplies and pills to “make me pee”. He means Lasix – a rather strong diuretic we give to pull fluid from extracellular spaces back into the circulatory system so the kidneys can excrete the excess. I know that Reggie is chronically homeless but he spins me a yarn about having bought a 3 bedroom house behind one of the local hospitals. He goes into such detail about the property that I almost forget to question the verity of the whole thing. In all likelihood, he will go back to loitering around places like local food banks or the McDonald’s and get arrested for such because of the state of his skin but more so for the state of his mind. 

When caring for the homeless, the focus is on keeping the patient out of the ER, so I push the thought of IV antibiotics to the bottom of my list of therapies.  We clean and dress the wounds. I prescribe a strong oral antibiotic and a few days of Lasix. I beg him to let me draw his labs to check for signs of systemic infection and injury to his kidneys. He begrudgingly agrees. In a stern tone, one that I recognize as my mother’s voice, I tell him to return in a week for reevaluation. He leaves laden with a bag brimming full of bandage supplies, pedaling the wheelchair with his swollen feet. 

It has been two weeks, maybe three. No sign of Reggie. I search the streets for his face as I drive around the city on my way to and from work. I check the local news outlets for death notices. I imagine he’ll pop up again. Hopefully, I get to him before his infection does. 

*Name changed. 

Heirlooms

I can be overly sentimental about the things I love; collections or bits and bobs of things that evoke a certain memory or glimpse of a bygone era. I am especially fond of those things handed down or gifted to me by family members – pieces given out of love and the desire to pass along a good story or two.

I have written about my Aunt C before and her knack for choosing just the right gift for me. We share the same birthday and she seems to know this innate part of me that few others see. This year, for my birthday, she sent me the most dear ceramic spice shakers from her own kitchen. Also included was a compendium of recipes and stories from a local Philadelphia bakery called ‘Brown Betty’. Lastly, she included her own family recipe for old-fashioned lace cookies from her mother’s kitchen.

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I keep my spice shakers together with other special gifts from my Aunt C – a decorative light plate (Aunt C has small bits of whimsy like this throughout her California bungalow), a knob for a drawer to hold all those beloved bits and bobs, and a vase shaped like a bunch of radishes (to honor my passion for gardening).

I’ve made the “Plain Cake” recipe out of the cookbook several times now – a cake that was born from a Brown Betty family recipe shared at Sunday dinners and yearly birthday parties. The flavor of the cake, buttery and golden, tastes like home, like family. You feel sated and enfolded in warmth as it melts in your mouth.

If we are to accumulate “things” in this life, I am glad to have such a collection of things that lovingly speak to me of family and tradition and history when I use them.

28

28.

An age I never really imagined I’d see when I pictured myself as some fuzzy version of a “grown up”. When I was a child and in a hurry to grow up I definitely imagined myself at 16 – getting a driver’s license and having the time of my life in high school. I also imagined myself at 18 – going to the prom, starting college, making my own decisions. I don’t really recall any thoughts about life past that point. I’m sure that, at age 10, few kids are thinking about their future selves at 30. Of course, there were the traditional girlish fantasies about marriage and children that I acted out with dolls and my little girl friends, but the possibility of it seemed so remote that it was difficult to realistically picture it actually happening. And now that January 14th has come and gone, I feel that I have so many milestones behind me that I am rather unexcited about moving forward.

I still don’t feel like an adult because I have so many goals yet to achieve thanks to mistakes and detours I have made along the way.  I am still in school, working on a 3rd degree so that I can become licensed as a nurse practitioner in 2014. I can’t remember a time when school wasn’t a part of my life. Many of my coworkers, who took what I would consider a more traditional approach to life, are in long term relationships, have gotten married, and/or now have children. I don’t think I appreciated how much losing a parent in adolescence could stunt one’s progress in moving towards “the future”. Despite finishing a nursing program and starting work in a career that I am excited about, I have still felt a bit stuck and rooted to one spot by my desire to return to life before the absolute-worst-day-of-my-life  in 2009.

Grief, though it wanes over time, is fairly omnipresent. I mean, does one ever not grieve the loss of someone they love? Since my birthday, at least 5 people have told me that 28 is a good year. I don’t know where this consensus comes from or if there is even any truth to it. Several individuals have told me that 28 was their “best” year, that really good things happened to them. I hope to high heaven that they are right. I could use a dramatic twist or turn along this road I feel that I am traveling along at a plodding pace. I can feel all of that potential energy that has built up behind me over the last 4 years about to launch me into some great kinetic state where change happens and achievements are made.

Luckily, I started my new year off right with a hearty brunch at Terrain at Styer’s with some of those nearest and dearest to me. Nothing reminds you of what is most important in life than the important people with whom you surround yourself.

These ladies know me better than most.

These ladies know me better than most.

 

We survived nursing school together.

We survived nursing school together.

 

A Bit of Earth

 

It sounds ridiculous but…gardening saved me.

I have a fuzzy memory of my mother reading “A Secret Garden” to me as a child. She also took me to see the theater production and the movie. At some point, I read the story again, by myself. I had a quiet fascination with Mary and the way she brought that little piece of land back to life. Somewhere along the way, though, I grew up and tucked Mary in my back pocket with a whole lot of other childhood memories.

My father died in April of 2009. Just as spring was peeking it’s head around a cold winter corner. The day of his funeral was glorious – warm with lots of golden sunshine. We at thai takeout with family on our deck that overlooks a white Dogwood tree whose leaves were crisp and green. Later that spring, I joined my mother on her annual trip to the garden center for the usual annuals – pansies, petunias, marigolds. Besides volunteering to tend her tomato and pepper plants from my grammar school’s yearly plant sale, I never expressed much interest in spending my time with a garden. On a whim, I picked out several vegetable seedlings and flowers. It was a slippery slope downhill from there.

A fuschia plant with it’s pink and purple flowers

 

After watching cancer change the shape of our lives for 3 years, I needed to focus my attention elsewhere. I also wanted that spring to feature something more than death. I have since learned that it is quite a good idea to have something to do with your mind and body after a tragedy so that you don’t spend every waking moment replaying it in your brain.

So I gardened. Not successfully at first. There were casualties from weather and my own inexperienced hand. There was one whole summer where I didn’t get any tomatoes at all! Bugs ravaged my squash one season and I have never been able to grow great cucumbers. I read dozens of books on gardening and my collection (from Barbara Damrosch to Alice Waters to Barbara Kingsolver) has failed to fit in the confines of my bookshelf. In the years since, I have learned to start things from seed, I joined a community garden, I taught myself new recipes to accommodate the abundance of produce filling the kitchen, I purchased more cubic feet of soil (I garden in containers) than I care to admit, I joined a CSA (Community Supported Agriculture) and I own an amazing Japanese knife called a Hori Hori which I wield quite impressively when slicing fruit off a vine. I poured a great deal of sweat and even more heart into each growing season.

Containers of flowers and vegetables on the patio

 

That first summer, gardening saved me from falling into perpetual grief. It brought new life. It deepened my sense of wonder for the majesty of nature. It brought food which meant meals savored with those closest to us. What my mother initially thought might be a phase has turned into a passion. A passion for: the earth – whole, organic, clean, seasonal food, cooking/baking/preserving, supporting local agriculture and farmers, picking my own fruit, and teaching others about the simple joys of a garden.

A garden is whatever you want it to be. For me (and maybe for Mary), it is a magical place where happiness springs from a single seed to bloom before your very eyes.

This anemone popped up from last season!

Post-Op Day 6

Being that I am a nurse, I am a terrible patient.

“What do you mean I can reset my own IV pump?!”

“Do you think you could have the doctor check x,y and z on my morning labs to make sure my kidneys are alright?”

“I’m pretty sure they could discontinue the heart monitor now.”

Yes. That was me.

I was blessed to have an amazing nurse overnight after surgery who withstood me freaking out about my low blood pressure and increase heart rate while in a morphine-induced phase. I’d be surprised if she got to see her other patients.

It’s hard not to micro-manage.

It’s hard to be a patient. I had an inkling of this having been the family member of a patient, but it’s hard to really know anything until you’ve lived the experience.

Truths about being a patient:

…sleeping for more than an few hours at a stretch is impossible.

…narcotic pain medications really do work wonders.

…it is possible for your lips to become so dry from lack of fluid intake than they cave into your mouth as if you forgot to put your dentures in.

…you will want to brush your teeth at least 4 times a day. See above.

…tape residue will remain with you for days. Maybe even weeks. You will find it in hard to reach places in the middle of your back.

…some doctor, without a doubt, will place an IV in a very awkward spot.

…you will, at some point, question your judgement about the decision to have surgery in the first place. Especially, if it is an elective procedure.

…you will definitely want your mom.

Overall, the procedure went smoothly. I remember being in the OR on the very narrow table with people flitting around me to prepare for the case. I could see the robot they use for laparascopic procedures as the scrub-tech prepared a variety of instruments that would soon be poking around my insides. I kept staring at those huge, bright lights that they would use to illuminate my nakedness and flaws in all their flourescent glory. I heard the anesthesiologist tell me she was administering propofol (MJ’s drug of choice) which left a big blank wall in my time-space continuum between sedation and consciousness several hours later when I awake mumbling about how I was going to climb Mt. Kilimanjaro once I have shed numerous pounds.

Six days after the procedure, I am sore and a bit cranky about the lack of fruits and vegetables I can consume while on a liquid diet. I really don’t have any regrets at this point about my choice to use a gastric band as tool for weight loss. If anything, I feel relieved – like “I think I can actually do this now!” I have never felt optimistic about my success before because I have so much weight to lose. The mountain was always looming before me in the distance and I could barely make it to base camp.

Bariatric surgery has its supporters and its detractors, but it is by no means a magic bullet or an “easy way out” of a life-long struggle. It does give me hope, though. And hope is a very powerful tool in and of itself. It is the “thing with feathers”.

The 1st of 1000 Miles

I tend to wince when I hear those hackneyed sayings like “The journey of 1000 miles begins with a single step” and “Today is the beginning of the rest of your life” or “It’s not about the destination, it’s about the journey”. I’ve sat through many a speech where someone, failing to find the words to communicate what they actually wanted to say, relied on a cliche.

Sometimes, though, those cliches really do seem appropriate. Tomorrow is the day that I start a completely new way of existing on this planet. This change has involved two years of contemplation and research and 10 months of planning, testing, and therapy to completely change the way I think about food. In a sense, it will be the beginning of the rest of my life – the beginning of a life that I am really excited to start living. And while my preparative journey ends, I now have to start putting everything that I have learned into practice. One step at a time.

For the most part, I am a person who has enjoyed change. I like traveling to new places and not knowing a soul. I relish the challenge that comes with learning to adapt to a new school, a new job, a crowded room full of strangers. Sometimes the changes have been frought with sorrow and upheaval – like when my father died – and sometimes, they have felt like a breath of fresh air – starting nursing school. Be they tragic or not, each change I have weathered has led me to a good place where I have been able to derive joy from those who were along for the ride and pleasure at knowing I survived.

Changing my body has been a much harder challenge, though. It seems to have wanted to keep the same doughy shape since I was in grammar school. Even after changing many behaviors, I have still had a great deal of trouble seeing the results I want. Tomorrow, though, I’m going to receive a really fantastic tool to better help me make the change from a doughy frame to something that’s a bit more athletic and capable of doing some serious hiking.

This, below, is Point A. I’m excited about the journey to Point B.

 

Reverb 10 for December 29 – DEFINING MOMENT

December 29 – Defining moment. Describe a defining moment or series of events that has affected your life this year.

Those who have lost loved ones are probably familiar with the point in the grieving process where you realize that the person is never coming back. Obviously, you’ve known all along that death is pretty permanent, but it still takes quite some time before the less rational parts of your being accept the fact as well.

When my father’s portrait was placed in the lobby at the Hospital of the University of Pennsylvania, I realized that there was the end, right there, on the wall. The portrait “unveiling” was like a period at the end of a sentence of the last paragraph on the last page of a book. Full stop. “Well, that’s that”, I thought. It’s amazing how we are born, we live and carve a path on this planet, we die, and all that is physically left is a painting on a wall in a lobby of a busy urban hospital. Dare I say millions of people will come to pass that portrait? They will read the accompanying plaque and wonder about the man behind the spectacles. There is no more knowing him. I have avoided stopping and staring at the painting when I am in the hospital for fear that someone with “catch” me and wonder what the heck I’m doing with my nose practically pressed up to the thing. I think about my dad, bodiless, floating around somewhere, watching me watch him. I get an odd feeling in my gut – the same feeling I get when I misplace something. I know that I KNOW where the darn thing is, I just can’t find it, can’t grasp it. It drives me nuts. Just where could he be? Where on earth could I have put him? I usually have to open up the box I keep in my closet of “mom and dad” to find him. I guess in a way, he does come back. Just not in the way I would like.

The portrait is so life-like, so warm and golden in its tones, that you almost expect him to wink as you pass by. But Hogwarts, HUP is not and I don’t expect to see my father’s visage floating in and out of the frame any time soon. My auntie Jackie, who lives in Richmond, on the same street that she once padded down barefoot as a child when it was a dirt road, told me of how she regularly talks to her deceased husband. Sometimes, when she visits him at the cemetery, she even yells at him. “I just go and cuss him out when I’m mad at him for leaving. Nothing wrong with doing that once in a while.” And I think that’s ok. It’s ok to be angry with people about being left behind and all the things they didn’t say and the questions they didn’t answer.

The aunties, or Daisies as the elder matriarchs in our family have come to be known, remind me that my grandma ‘Ree – whom I seem to greatly take after at times – did things a whole lot crazier than talking to dead relatives, so there should be no shame in it. I’m guessing there may be some days when I take a chair in the lobby and look across the corridor and have a word or two with my father; maybe even yell a little bit.

Reverb 10 for December 28 – ACHIEVE

December 28 – Achieve. What’s the thing you most want to achieve next year? How do you imagine you’ll feel when you get it? Free? Happy? Complete? Blissful? Write that feeling down. Then, brainstorm 10 things you can do, or 10 new thoughts you can think, in order to experience that feeling today.

I most want to achieve physical wellness. I imagine that I will feel pretty darn elated when the scale hits a healthy number and I get to try on anything I want off the rack and my back no longer hurts and I have energy to burn.

I can experience that feeling today by…

– going to the gym (which I already did!) to get myself in motion

– eating breakfast (which I already did!) to start my day with a happy tummy

– creating a manifestation board to better visualize my goals

– to compliment myself about one thing I did really well

– remind myself that I have an adorable nose and awesome hair

– choose a recipe to try from my new Jamie Oliver cookbook

– write one paragraph in my journal before bed

– put aside my worry about my kidneys until my next doctor appointment in two weeks

– try the LA Fitness Aqua Fit class and keep in mind that just about everyone looks bad in a bathing suit

– spend less time at my computer

– sew more, knit more, be with friends more

Reverb 10 for December 27 – ORDINARY JOY

December 27 -Ordinary joy. Our most profound joy is often experienced during ordinary moments. What was one of your most joyful ordinary moments this year?

Nursing brings me more joy than I had thought. Yes, it is messy and complicated and patients can be infernally frustrating, but I still feel that it is such a privilege to be able to care for people when they are at their most vulnerable. The best moments in nursing for me aren’t in the critical moments when I’m making tough decisions about patient care or trying to keep a patient from the brink of medical disaster. The best moments for me come when I’m taking a patient history, helping someone with their medication, rocking a scared child. I feel joy when I know a connection has been made between myself and a patient. Despite the fact that nursing is such an intimate profession, it’s not very common to make a profound connection with patients because there is just so much to do in a shift. Most of my time is usually focused on just maintaining the status quo. Sometimes, though, I recognize a kindred spirit, or someone opens themselves up enough to trust in my care, or I get a “thank you” and that sustains me.

My mot joyful ordinary moment this year occurred during the days I got to care for infant A. at The Children’s Hospital of Philadelphia. He arrived on our unit at about 9 days of age – so new to the world. I took such delight in seeing him grow and achieve developmental milestones over the months that I cared for him that the other nurses teased me. There is just something so magical about seeing a human being develop that it is hard not to be mystified. I knew that I wasn’t his mother but I felt such elation the first time he made purposeful eye-contact with me. I enjoyed being his cheerleader – encouraging him during feedings, quieting him after procedures, updating the medical team on his progress. I never once saw or met his parents in the 14 weeks I was on that unit. Their absence – complicated reasons I won’t go into – ignited a little fire within me that kept my anger on a low boil for weeks. I eventually got tired of wondering who these individuals were and speculating about their parenting abilities. Instead I focused on providing A. with lots of positive energy in the time I could give him. Just because I wasn’t his mother didn’t mean that I couldn’t love him in a way, too. My nursing care improved when I focused on communicating to this little babe that he was loved and cared for and going to do just fine in the world. Once I let go of the anger, I found there was certainly a whole lot more room for the joy.

Reverb 10 for December 25 – PHOTO

December 25 – Photo – a present to yourself. Sift through all the photos of you from the past year. Choose one that best captures you; either who you are, or who you strive to be. Find the shot of you that is worth a thousand words. Share the image, who shot it, where, and what it best reveals about you.

Well, this is a tough-y since I am usually taking the photos and not having them taken.

Disneyland, California

This photo was taken a smidge before 2010 when I spent Christmas in LA in 2009. My uncle took the photo with my camera while we were waiting in an interminable line for Space Mountain at Disneyland the day after Christmas. I think it captures a good deal of what people tend to notice about me. Despite having what I consider “horse teeth”, I’ve always liked my smile because it’s genuine and lights up my entire face. If I’m happy, you will know it! I also like the way my eyes light up when I smile. I tend to wear my heart on my sleeve. I am a vibrant, happy, outgoing, boisterous person who gets excited about the silliest things because it’s the littlest things that are most important: waiting in line with family during a day of fun, creating and sharing memories, laughing together.