Laissez les bons temps rouler

I've been trying to take a more laid back attitude towards things at work.  There's been some changes I'm dealing with, as well as other possible changes coming down the pike that may or may not affect me.  Now, regular readers (all 2 of you) know I have major anxiety issues that I'm been working on for years.  My regular medications have helped considerably.  I've been using a lot of mental tricks that I've learned to try to relax and deal.  Writing about what is making me anxious also helps.  So does the occasional alprazolam, though I save that for when the tricks and writing fail me.

For the most part, the anxiety issues have improved, but I have weak moments when the anxiety can and does overwhelm me. 

So instead of working myself up into a worried frenzy over what might happen--especially when it might not--I decided that I am just going to roll with things the best that I can.  For the most part, work has been good times, so may they continue to roll and I roll along with it.

I guess it's a modified Serenity Prayer, Cajun style. Le Bon Dieu would approve.

I am finally able to use that treadmill I purchased.  I'm making an effort to put in at least 30 minutes on it before work each day.  It's still mostly walking with some occasional running, but I'm improving.

I've been lurking on a couple of WGU support groups online, one for the general school and one for BSN/MSN students.   I see people in both groups complaining (maybe not the best word but it'll do) about how hard some of the assignments are and how tough the instructors are being on said assignments.  It's reassuring to see this.  At least I know that I'm going to have to work for my MSN kibble.

Albeit 3.0 kibble.  I'm still adjusting to that.  Remember that my lowest nursing school GPA was 3.93.  So to go from that to knowing I'm going to get a 3.0 no matter how hard I work is a bit of a paradigm shift.  But then again, at this point in the game, does the GPA really matter anymore?  It only does is I decide to pursue a PhD or post-masters.  And even then, lots of WGU students go on to get even higher degrees than a MSN.

Red hair, don't care

Having red hair, even subtler red/brown hair such as what I'm sporting, is hard work.  It's a lot of maintenance because of all the hair dyes out there, red hair dye fades the fastest and the most.  So monthly maintenance is a must, unless you like faded red tones and/or visible roots.  I use demi-permanent dye so the fading means my hair gradually gets closer to its natural color and the roots aren't quiet as obvious...well, in theory, anyway.  In reality, demi-permanent dye never goes completely away.  

Having long hair doesn't make it any easier.  It's not at its longest length, but it's gotten to the point that I've had to move up to using 3 boxes of hair color, as 2 is no longer enough.  I'm not using the entire 3rd bottle...yet.  My hair being long means that dye gets everywhere, so it's a messy process.  Then is the washing out of all that dye:  that alone takes as long as it takes to let the dye sit in my hair to color it.  And the washing out is even messier than the application.

For the best results, one should wait as long as possible before that first hair shampooing:  at least 24 hours.  I color my hair right after my last shift of the work week, so this occurs on my days off.  Then for the next three days, my hair will bleed dye every time I shampoo.  I wear a lot of black during that time.

Overall, I think the results are worth it.  I'm left with a nice plum/burgundy-brown shade that looks stunning in sunlight.  But I don't know how much longer I want to keep all this work up.  I'm thinking about going back to black-brown.  The coloring process is still a lot of work--see second paragraph--but at least I can go more than a month between coloring sessions.

After my "Technology" post, I logged off and logged into the WGU student portal to find that transcript #5--the only one coming hard copy via mail--had arrived.  I thought about updating the post, but then I had the whole chest pain thing.  By the way, the pain is gone so it's likely GERD.

I called my enrollment advisor today to introduce myself, talk about the program and my goals, and to see what my next steps are. 

I learned my materials have been reviewed and I have been officially admitted.   I didn't expect to be rejected, but it's always nice to have things official.

We discussed the education program and why I wanted to pursue a MSN in education.  I admit, a lot of it has to do with my own experiences in ADN school.  Not that it was horrible--not in the least.  But there was some things in the classroom that I felt could have been improved on.  I also felt that the staff/CIs could have been more supportive of us during clinical experiences.  I frequently felt like we were left to fend for ourselves for a lot of it, with support hard to come by as criticism flowed easily.

That's why I have a soft spot for students doing clinicals:  I want them to have a better experience than I had.

The competency-based way of doing things seems to be interesting.  It's going to be quite the shift adjusting from the "must get an A" mindset.  I was concerned about having access to resources should I not already have some competence in an area, but they do provide the, as well as access to instructors to help me. 

She explained that they have redone the program to make it more competitive, including the field experiences and the capstone.  I was reassured to hear that they have contacts in the Southern California area who will help me in establishing a site and the projects.  So I'm not entirely on my own trying to find a school/facility in which to do the projects, designing and setting up the projects, etc.

I also wanted to notify her of my planned start date:  July.  The deciding factor was that if I were start in June, I'd have to fill out two FAFSA forms.  Filling out one was bad enough because I had to dig up old tax forms.  To go back and do it again but with digging enough another year's old tax forms...that was a bit too much.

So my next step is to get a background check done.  Because July is still a bit out, there's not much more I can do right now.  Once May hits, I can start applying for scholarships and checking off other things that need to be done.  

In which Meriwhen gets a good scare

No story build-up here, I'll just say it:  chest pain.

I had it for about 3 or 4 days.  It wasn't (isn't, as it's still kind of here) aching or stabbing, it's more of an uncomfortable pressure.  It's not radiating.  It doesn't get worse with exertion.  It doesn't get better with rest.  It did wake me up one night.  The only other symptom I have is a little tachycardia one morning, but it was gone by the evening.

Now, if this was someone asking me for advice, I'd say, "get thee to an ED today."  If if was a patient, I'd be seeking advanced counsel and probably calling the MD as well.  But of course, I don't tell myself that.  I'm a nurse and let's face it:  nurses are the world's worst patients.  So I schedule a next-day sick appointment after work.  What's one more day, right?  Let's just ignore the fact that I have cardiac issues on both sides of my family.  And let's ignore the Lisinopril in my medicine cabinet that I take daily.

That night, I was kept busy enough at work that it didn't bother me too much...it was when it was slow, that I noticed it was still there.   Not stressing over it, because I know that in a few hours,  I'll be at my doctor's getting checked out.

But it's not until I'm actually there in the clinic, getting an EKG and cardiac lab work done that I realize that this could be really serious.  Especially when my PCP orders a D-Dimer test for the presence of clots and tells me that if it comes back positive, that I need to drop everything and get myself to the ED for a CT scan.

I'm not young:  according to Erikson, I'm entering Generativity vs. Stagnation.  People my age die from cardiac issues.   I see it in the ED all the time. 

I gave up smoking 20 years ago.  I don't drink alcohol anymore.  I don't do drugs, legal or otherwise.  I'm in decent shape.  II'm physically active, though not as consistently as I should be.  I could stand to drop that 30 pounds I recently regained.   I have hypertension, though well controlled.  I have cardiac issues all over my family tree, including heart attacks and deaths from stroke.

And heart disease is the #1 cause of death in women.   And heart attacks in women don't always present with the typical "clutch the chest and feel the left arm go numb" symptoms.  It presents like indigestion, like heaviness.  Like how I felt.

Yes, I already knew all of this.  But again, nurses make the worst patients.

So I spent the morning being tested 10 ways from tomorrow.  My EKG is beautiful.  Exertion test is great--I actually wore out the LVN that was monitoring me because she couldn't keep up with my speed.  Lab work is beautiful.   Then I get to go home and wait, anxious as hell, for the D-Dimer results.  Because I can't go to sleep until I get this test result, in case I need to call out of work and find a good book to take with me to the hospital.

Fortunately, it was negative.  Unfortunately, I couldn't sleep even after getting that news.  So work that night was challenging, to say the least.

My PCP decided to start off my treating me for GERD, since he thinks it could be an atypical presentation.  So now I'm on omeprazole for a couple of weeks to see if that helps.  It's been two days on the medication, and the discomfort seems to be lessening, which is positive.  It might just be atypical GERD after all...I hope.

All of this was quite the scare for me, as well as quite the reminder that I could still improve my health.  I'm waiting until the discomfort is fully gone before I try out the treadmill we bought with the tax refund.  It wasn't a large refund so it's not a large treadmill.   But it's another way to exercise.

Technology is grand.

So I as mentioned last time, I applied to WGU.  In less than 24 hours, I was able to have my application in as well as all but one of my transcripts (there were a few) securely in their possession.

The remaining transcript is for one course that I took at a small community college in southern Texas.  They did not accept online transcript transfers, so I had to submit a faxed request, which was sent out the same day I requested--and received--the other transcripts.  Its receipt at WGU is still pending.   I couldn't skip this transcript as it was for a pre-requisite course for both the ADN and BSN.

So I have been granted provisional acceptance into the MSN-Education program.  Of course, transcript #5 has to make it, plus I have to do a whole slew of other things, including two interviews.  Given that this was a holiday week, I didn't press my counselor for contact.  But now that the holidays and accompanying spring breaks are almost over, I'll be dropping her a note to set up the first interview for sometime next week.

There is also the question of when to start the program.  I can start on the first of any month...well, the first of any month after I have submitted and done everything I needed to, which would need to be done by the first of the prior month.  So if I wanted to start June 1, I have to have everything tied up by May 1 so I could start orientation on May 15. 

I'm torn between starting in June or in July.  On one hand, I'm rather eager to jump in and get things started...because the sooner I start, the sooner I'll finish.  It'll be nice to be back in school again.  On the other hand, my mother is visiting for two weeks in June and I don't want to have to worry about schoolwork while she's here.  I was fortunate enough to get one of the two weeks off work, and she is very excited about that.

Financially,  I could start in June as I have enough to cover the first session's tuition stashed in my school savings account, plus there's a couple of scholarships I'm going to apply for.  They're merit/category-based, because I do not qualify for any need-based funds.  That reminds me, I need to complete the FASFA (FAFSA?) this week.  On the other hand, waiting until July just puts extra money in the kitty, plus lets me look for more scholarships.

And I do have tuition reimbursement available...which actually will cover a half-year of tuition each year.  So while I may not be able to get this MSN at no-cost (though I'm certainly going to try!), it's going to be rather affordable.

I have not told anyone at work about the MSN.  Well, some of them know that one day I want to get a MSN, but I've not told anyone that I have actually applied to a program.   I'm not sure why I'm playing this close to my vest.  It's nothing to be embarrassed about.  And I wouldn't be the first one in grad school, though I'll be the only one not going for nurse practitioner.  Maybe I want to get a feel for school first before I let the masses in on it.   Who knows?

When I apply for tuition reimbursement, it will definitely be out of the bag because I'll need my manager's signature on the application.   But that won't be until towards the end of the year.

Sticks and stones

Happy Easter.  Or Passover.  Or April Fool's Day.  Or Sunday.  Whichever holiday(s) you celebrate.

Just the other day, there was a patient who was unhappy that I had set firm limits.  So for the entire shift, I was yelled at, berated, harassed, taunted, made fun of, you name it.  The patient kept doing it because they thought they could get a reaction out of me, so they trotted out the worst verbal barrage they could short of physically threatening me--which they were wise enough not to do.

For almost 10 years, I've worked on the worst of the worst psych units, so the bar is set really high if you want to use your words to upset me. 

So, for all their efforts at getting that rise, the best the patient got was a smile or a neutral expression followed with a laconic "OK."  Or "I know."  Or "Whatever you say."  Or whatever other noncommittal benign remark comes to mind, followed by as-needed reiteration of whatever limit was being challenged.   And naturally, complete documentation of their behavior which is then discussed with staff and the MD so we were all on the same page, because attempts at staff-splitting usually go hand-in-hand with such behavior.

I can usually talk a patient into dialing their behavior back once they see it won't get what they want.  Sometimes they figure out on their own that it's not working and give up.  But occasionally, I get a persistent one that is hell bent on leather, and no matter what I would say, it will be ineffective.  I can usually figure out that they're one of those pretty quickly.  Most psych nurses can--it's an essential skill that we must develop in order to survive. 

I don't engage any more than necessary as then it would become a power struggle, and some things on the unit just aren't and can't be open to negotiation.  Sometimes I think I should just not say anything and ignore whatever is being said, not even give that "OK" or whatever laconic response.  I decide not to as that may give the impression that a. I didn't hear them, b. I'm ignoring them and/or c.  what they are saying is getting to me...and any one of them just feeds the fire even more.  If they think you didn't hear them or are ignoring them, they'll just keep going on until they do get a response.  If a patient--especially someone with an Axis II diagnosis--thinks they've found a weak spot of yours, they will go after it like a bloodhound.  Show them that something they said upsets or otherwise gets to you, and they'll latch onto it and keep launching barbs.

Caveat:  if they are acting out, then as long as they're not hurting themselves or anyone else, the temper tantrum is ignored until it is completed.  It's the same as Toddler 101.

I try to avoid getting assigned to such patients once I know they have it in for me...in fact, they often weren't my assigned patent in the first place!  After all, there's a fine line between standing your ground and rattling one's cage.  For me to willingly assume care of a patient who considers me Public Enemy #1 for whatever reason is not very therapeutic for them, nor would having to deal with me as their nursing contact "teach them a lesson."  If anything, I think it comes across as antagonistic:  "gee, you don't really like me, do you...well, guess who's your nurse today!  Ta da!"

I have to admit that over the years, I've had some very creative insults and names hurled in my direction.  I would love to share some of them, but I prefer not to run afoul of privacy laws or my organization's management.   Oh well.  Perhaps many many many years down the road, I'll publish a book that'll be released after my death:  The Meriwhen Diaries:  Detailed Adventures in Psych Nursing.  And it'll be full of all the stuff that I wish I could have shared now but can't due to privacy concerns...but which in 40 years or so, would be impossible to tie back to specific people.