I'm alive! And a new path...?

 What has it been, more than two years since I last wrote?  Yeah...life has been busy.

To give you the Readers' Digest version of what has happened in my life in the last two years:

• Adopted a puppy...who is no longer a puppy.  It's nice to have a new dog in the house.
• Had to take a break from moderating duties at the forum because graduate school was just too much work.
• Went to Spain to see family. It was my first time ever in Europe.  If I could move to Madrid, I would.
• Was transferred to a new home unit at work.  I was spending so much time on the psych ICU that they finally decided I should officially be assigned there.  So I was, and then the next day, immediately floated back to med-psych.
• Moved to an even smaller town in the mountains.  Smaller house but more land.  I love living in the middle of nowhere.  There's definitely a lot more space, a lot fewer people, a lot more livestock, and a lot more wildlife.
• Went through three advisors in graduate school.  The first was there only a couple of months before she decided to return to a job in the NICU.  The second was awesome!  We were together for most of my time there until she decided to take a job with the state Department of Public Health.  At this point, COVID-19 was still in its infancy, so she had no idea what she was getting into...
• Oh yeah, COVID-19.  Life upended.  Kids home constantly.  At least in my new small mountain town, I could go outside and not have to mask up like I was going to see a TB patient.
• COVID and I became intimately acquainted.  It was the 10-day headache.  Fortunately, the recovery was quick and full.  And fortunately, the family was spared.
• Graduated with my MSN-ED.  Did not leave my current job as it pays too well.  Plus, I never planned to immediately go into education...that's the long game, for when we leave the state and/or I decide to leave the bedside.
• Got through the strangest holiday season.  My mother decided to fly out from the east coast for two months, so every two weeks, she would shuffle between my home and my sister's home.  
• Meanwhile, our governor was busted violating his own health rules, so he threw a hissy fit and closed the state down through the holidays while she was here.  This meant we couldn't do much except go to the parks and the reservation casinos.
• Things started getting back to normal-ish after the holidays.  
• I was offered the COVID vaccine.  I declined it for now.  I'm waiting for the data on its long-term effects and possibly even on the final FDA approval for one of the variants.  Then I'll consider taking it.   Plus, I have bad allergies which make me very hesitant about taking experimental vaccines.

Which all brings me to now...

I received an interesting business proposition...which requires me to be a psychiatric nurse practitioner.  Since I wasn't rushing to go right into education, I decided to think about it.  

I have a MSN, so I'm already part of the way done.  I could afford school without having to take out a loan (though I'd fight like hell to get as many scholarships as I could!). I'd have a set spot for my clinical hours. I'd have a job when I graduated.  And even if the proposition fell through, having the NP would give me more career opportunities, especially if I am planning to leave the state. 

Overall, I think pursuing the NP might be worth it.  

So let's go apply and see what happens.  After all, I'm not committed to anything by applying, right?

No, the thyroid didn't leave. It even invited a friend over.

My birthday was nice.  I did my mourning the day before so I could make the best of the day.  Had a good day at the holiday party with my coworkers, had a good day at home with my family, had a good (sarcasm) time finishing up my performance assessment.  I turned that in the following day and found out yesterday that I passed.  So I am officially done with my first term.  Coming soon:  a post on WGU survival tips and must-haves.

The day after my birthday, I went to my PCP for the follow-up on my blood pressure medication and the investigation into my weight gain.  The new blood pressure medication is working fine.  As far as the weight gain...she agreed to check my thyroid, but she believes that 1700 calories a day may be too much for me.

"Even with being on my feet at work and exercising five days a week?" I ask.

Apparently so.  But she wants me stay at 1500 calories a week for at least two weeks.  If I don't lose some weight in that time (I'm not counting the water weight I'm bound to lose within the next couple of days, thanks to all the Chinese food I had on my birthday), she wants me to go down to 1200.  If that doesn't do it, then 1000.  Even 800 if I had to.

Of course, if I ever had to go below 1200, I'd ask for a referral to a nutritionist first.  No offense, doc, but let's talk to someone who specializes in this.

Labs were done.  My TSH is normal.  But my chloride is 10 points high.  Total protein is a bit low.  Everything else is normal.

Chloride, high?  Odd.

She said she's not worried about it, but I do need to make sure I'm eating enough protein.  Should I do the Atkins diet?

As far as the chloride...I looked it up.  Causes of high chloride include:

• Dehydration (possible)
• Hypernatremia (high blood sodium) (nope, that was normal)
• Cushing syndrome (not likely)
• Kidney disease (kidney-related labs were just fine)
• Metabolic acidosis (nope, those levels were normal)
• Respiratory alkalosis (ditto)

So my best guess is that I need to drink more water.

I'm disappointed yet relieved that my thyroid test came back normal.  Disappointed because hypothyroidism would have explained a hell of a lot of what's been going on with me besides just the weight gain.   Relieved because it's better to have the working thyroid in the long run.

It's going to be tough to keep track of the calories when my mom is here...mostly because I don't want her to know I'm trying to lose weight.  She's always been critical of my weight all my life, even when I wasn't overweight to begin with.  Yeah, I know.  And she tends to believe she knows best about everything...she'll be there, giving me all the diet and exercise advice she has.  Meanwhile, she very overweight, doesn't exercise, and her diet is anything but balanced.  Or she is trying the latest fad diet or quick fix, such as drinking apple cider vinegar in water and expecting it take off 35 lbs. 

Spoiler alert:  it didn't work.

*sigh*

In which Meriwhen wonders if her thyroid went on holiday

My weight loss had stalled, so my psychiatrist started me on a low dose of topiramate which is used off-label for weight loss.  They're not sure how it works, but apparently for a lot of people, it does.  Considering that I've been tracking my diet for a while now with no results, I figured I'd give it a go.

I had downloaded an app (Lose It), and have been pretty faithful about sticking to my calorie allotment.  It helped me calculate my BMR and an allotment to allow me to lose weight at a safe rate, which we (the app and I) decided was a pound a week.  So this translates to about 1700 calories a day.  Of course, this still fits in with intermittent fasting, but I do the fasting more because I find that if I eat at work, I want to fall asleep.  So I don't eat at work, I fall asleep after work, and when I wake up, 16 hours are gone.  1700 calories for 8 hours is no problem.

After I finished my half-marathon almost a month ago, I've also been exercising about 5-6 days a week.  I've been alternating between the treadmill and the recumbent bicycle.  I've also added in some resistance/strength training on the treadmill days, since I tend to spend more time pedaling than walking.  I give myself one day of total rest, usually on the last day of my work week as I adjust back to a daytime schedule. I may do a second day if I feel too tired or achy, as I did the other day when I felt sore and exhausted.

So you think with all of this, I'd have made some mad progress, right?

My scale says No.  My scale had me lose 5 lbs, but then gain 8 lbs.  So I'm up 3 lbs. overall.

Mind you, my psychiatrist's scale has me down 3 lbs. since I started the topiramate.  He (and I) were hoping for more than that, but in his words, "between losing 3 lbs. and gaining 3 lbs., I'll take the loss."  He tweaked the dose a bit more.

But that isn't what got me thinking that it might be my thyroid.  It's the cold.

Being from the Northeast, I'm used to cold.  I love cold.  I dream about snow and rain.  I get excited whenever I see clouds in the sky.  Hell, I consider it a beautiful day if I can't see my shadow.

Except that as of late, I feel like I'm freezing.  It's only 60 degrees, but I'm freezing.  I'm turning on the heat, to the other half's surprise.  I'm wearing my coat at work, to everyone's surprise.

The other half says, "it's not so bad out."

"I'm taking your sweatshirt then."

This is not like me, to be stealing sweatshirts and wanting to go around with a space heater.

I have an appointment next week with my PCP to have my blood pressure medication follow up.  I already messaged about having my thyroid tested.  My PCP is away until the end of the week, but hopefully she'll agree we should rule out any problems.

And if it's not the thyroid, then I guess I finally acclimated to the Southern California climate.

And so it begins...

The new grad postings for my healthcare organization are up.  Yes, it's that time of year when the new grads finish up their residency and start jockeying for the spots.  No guarantees...though of course, if you're aiming for a particular spot, it helps if you have an "in" somewhere in that department.  Then the department manager has a name to ask for when they submit the posting to HR.

We have a new grad coming our way next month.  Their "in" was that they were a per-diem CNA/tech for us.  And now they're a nurse for us.

We're actually doing pretty well in the new grad front.  We've had quite a few of them over the last couple of years, and so far almost all of them have stuck around.  It's nice to see that there's new nurses who are really interested in psych, and not just using it as a way-station to get their golden first year of experience before moving on to another specialty.

In which Meriwhen cries at work

I've only gone misty at work a few times in my career.

First time was as a new grad.  The powers that be decided I should be in charge of the ICU that day.  Well, I had never been in charge of the ICU--it wasn't even my home unit.  Up until that point, I was primarily a detox nurse.  And it was a day full of discharges, court hearings, and everything administrative. I can deal with psychotic patients until the cows come home, but administrative stuff and court hearings...yeah, not yet familiar territory.   My other nurse (we were short, so there were only two of us) was also a float.  She was also a LVN so what she could do to help me was limited in scope.

I did my best to make a go of it, but after an hour and a half, I was so overwhelmed, I had to call the DON for reinforcements.  She was able to get the supervisor down there, as well as one of the regular ICU nurses to come in on his day off and help me out.  God bless him.  He helped me get through the shift and gave me a crash course in all the legal ins and outs.  He remains a good friend to this day.  We both have the same taste in firearms.

I managed to keep the water works in until after the shift, when I went by the DON's office.  She invited me to stop by to see how I was.  I got there, sat down, and promptly started bawling.

The second time was many years later, on the first Father's Day after my father died.  I went to work four days after he passed and didn't cry.  I didn't cry for a long time.  But that first Father's Day...I was on the open unit, so fortunately I got to be alone in my misery.  Patients slept all night and it was so slow that my partner was chatting with some other nurses.  I sat in the corner with a COW (computer on wheels), quietly, with the tears streaming down my face.  I think that was the first time I had cried since he died. 

I haven't really cried for him since...I do get misty at times, especially on my birthday.  But brief tears since my father would have never liked to see me get upset on my birthday, especially about him.  And I've never really cried over him since...but I know he understands.

Third time was due to stress over my mother.  I love my mother but she can drive me to tears.  I don't remember exactly what it was that got me upset, but with my mother, it could be lots of things.  And while my crying wasn't outright hysterics, it was enough to get people worried.

Which brings us to the fourth time, today.

I generally have a good relationship with my coworkers, especially the ones I work with the most often.  You need to have it, it's part of surviving.  But work has been very stressful as of late--unfortunately things have happened and I can't go into details.  It's getting to a lot of us.  At least, it's getting to me and a few who have confided in me.  We're doing our best to support each other in this.  Anyhow, one of my coworkers--normally a decent guy--has been acting kind of like a jerk lately.   He said something to me and it actually hurt.  I asked for help with something and I got this instead.  I'm not entirely sure if it was meant as a joke--I'm kind of thinking/hoping that it was, but it still hurt nonetheless.

I know, Meriwhen, sensitive?   Not usually.  But like I said, things have been stressful lately.  So the remark got to me more than I'd like to have.  I didn't quite know what to say, or even if I wanted to say anything about it, so I have just been keeping my distance from said coworker.  Not really talking to him other than what I had to say while I thought it over.

I did end up talking about it with another coworker--the topic just kind of came up.  He was also there and heard the remark, and agreed that it was rather insensitive, especially since I never ask for help (and yes, I'm working on improving that) and didn't get why the coworker said it, even if it was supposed to be a joke.  He's also been a bit frustrated with this first coworker as of late.  We both concluded that he (first coworker) probably hasn't even noticed that he upset me and so it might be pointless to even bring it up, just to let it pass.

So while an apology might be nice, my second coworker has a point.  As far as remarks go, yes, it hurt...it wasn't the worst thing I've ever had anything ever said to me.  Still, it was nice to know that perhaps it just wasn't me being overly sensitive. 

But now, the first coworker for some reason is now not really talking to me.  We have somehow entered a cold war...maybe.  Or maybe not.  I haven't asked him.

It hasn't impaired our working together, but it was tense.  And got tenser as the night wore on.

Finally, towards, the end of the shift, I couldn't take the tension anymore and started crying in front of three psychotic patients.  Two of them--long-term patients--were very concerned about me.  The third said he would get us an apartment to live in together and buy me a sports car.

Uh, no, thank you.

I excused myself and left the floor.  I'm a firm believer in presenting a united front when it comes to patients, and any issues among staff is not patient business.

A third coworker (I have to number them now so you're not confused) found me and consoled me.  I didn't really say why I was upset.  I'm not sure if anyone else knew I was upset because I did have the waterworks under decent control.  Others including the first coworker were going past us in the nurses' station, so maybe they noticed.  Or possibly not.  No one else said anything, and I was too upset to care who saw at this point.

I pretty much ran out of Dodge after that.

And that, ladies and gentlemen, was the fourth time I ever cried at work.  I'm sure they'll be a fifth, but hopefully not for a long time.

As far as the first coworker...I don't know what to do about that situation.  It's inevitable that we will be working together again. He really is a good guy and I genuinely enjoy working with him.  I'd like to think that his remark was a poor joke made at a horrible time, and which I for some reason am having a hard time getting over.  Things are stressful at work for all of us, and the holidays are just going to make it worse.  And December is a horrible enough month for me as it is.  Maybe it may just be better for me to let it go and try to get out relationship back to normal.  If he asks about it, I'll tell him how I felt.  Though I don't think he will.  I think it's just like my second coworker and I think:  he probably hasn't noticed anything was/is wrong.

Though I'll be honest:  part of me never wants to ask him for help with anything again if I can help it, in case it wasn't a joke.

The half-marathon went well.  No PR, but I wasn't last either.  It was my first time on the course and I enjoyed it so much that I'm signing up for next year's race as soon as they post it.

The registry (a.k.a. Job #2) called to see if I was working and whether I was interested in picking up work with them again.  It's nice to know I'm still thought of well by them...but between work and graduate school, I don't really have the time to spare for a registry position.  So I'm going to decline but ask them to keep in touch.  It never hurts to have contacts wherever you can.

A few of my coworkers asked me if I was going to go for that administrative position.  I didn't directly answer (at the time, it was not yet posted), but stated that it would be nice to have someone consistently there for those of us on nights and that if it had to be me to deliver that consistency, then so be it.  It was nice to hear that I still have the vote of confidence from some of my peers if I had decided to pursue it.  But as I mentioned, it's already off the table of consideration due to its hours.

In other news...the other half's father passed away this spring.  I don't thing I had mentioned it here because it blindsided us.  He went into hospital for a lung issue that turned into a cardiac issue that turned into a ICU stay that turned into the end.  The reason we were blindsided was that he and other half's mom didn't want us to know how bad things really were.  So whenever we spoke to his mom, she made it sound like things were better than they actually were.   Then one day his mom calls and says, "oh, your dad passed away."  No preamble.  Just boom.  Said it as though she was discussing the day's random activities.

Side note:  she's also a psychiatric nurse, which is probably why she had such great emotional control when talking to us.

In a way, I can't fault her.  The other half has never been good with anything medical, so much so that even I no longer disclose any of my own medical issues to him unless I'm certain I have to.  He'd spazz endlessly with worry over every single little thing.  So the family tells him only when he really needs to know.

But at the same time, if his mom knew that his dad was likely not going to make it, she should have been honest about that part so other half would have had a chance to say goodbye to him.  At least I had that chance with my dad.  Other half never got that chance. Neither did I.

I do miss my other half dad.  He was a good guy and you could always count on him for a bad pun.  And he considered me the daughter he never had.

Tomorrow is his birthday, which happens to be the same day as the half-marathon I am running walking.  I was going to wear my one of my usual running shirts (turtles or sorority runners) but found one that he'd love.  It has this printed on it:

Which is totally something my other dad would say to me as I'm slogging along.