it's the little things

typically, when you talk to a nurse about pee, he or she will automatically think about how 12 hour shifts and busy schedules and multiple patients with equally multiple and diverse needs often keep you from being able to pee. sometimes the few moments of peace and quiet in the restroom are ones that i relish, especially on the busiest of days. today, however, i started to think about pee in a different way.

for almost all of our postpartum moms, going to the bathroom is a little bit of a production. what with the pain of a possible abdominal incision or an extremely sore bottom that just let a baby pass through, whether its getting out of bed or sitting down on the toilet, it's never very easy. today i had a patient for whom it was virtually impossible. i got her as she was gearing up for her fourth attempt to pee independently. three times the foley catheter had been placed in her bladder, and three times it had been taken out followed by six torturous hours waiting, feeling the need to go but completely unable to do so.

and so it was a day of back and forth - watching and waiting, expectantly anticipating the most mundane of things, and celebrating the smallest of achievements. at the end of the day, i'm exhausted but so very thankful. i don't often think to name my own bodily functions among my list of blessings, and yet what a lovely gift for which to be truly thankful.

match up: RBC vs. dotting i's and crossing t's

i'm seven weeks into my new job, and i'm already amazed at how different each day of work is now, as compared to those first few weeks on my unit, wondering what the heck i was doing masquerading as an actual nurse. now my days have routines and i can stay more or less organized despite discharging two patients by eleven am and admitting another. charting is still, more than anything else, the bane of my existence. More than confidence in direct patient care, the electronic charting system somehow manages to trip me up more than anything else. i forget to chart a med or the urinary output of my postoperative patient or the feedings and diapers of one of my babies. sometimes i've recorded it in one place but forgot the other two places where you have to document the same information. more than anything else i forget to document my teaching.

in my nursing orientation class for all new employees be they new grads or experienced nurses, the instructor addressed us newly graduated nurses and said something along the lines of - our focus here at the hospital is to provide relationship-based care. we know you will be more task-oriented at first, but we look forward to when you can step away from the tasks and really focus on your relationships with your patients. my personal experience, on the other hand, is that what i do better than anything else is seek to build relationships with my patients. sometimes to the fault of my hospital-required "tasks." vital signs must be taken every 4 or 8 hours, depending on the patient's status. but what about that time my patient was in the neonatal intensive care unit, squeezing in every possible minute with her baby who has taken a surprising turn for the worse? or what about when, as i'm on my way to administered a timed antibiotic to one patient, i stop in one of my other patient's rooms, only to find her in tears about these new and unexpected stresses of motherhood? how do i advocate for my teenage patient, who has no real home to go to and a history of abuse in her relationship with the baby's father but loves her child to pieces and desperately wants to keep her, while still accomplishing the necessary steps of involving social work and the department of child and family services?

these are my new, daily quandries. i still puzzle over how quickly to push an IV med i've never given before and how to interpret certain lab values, but as these things - relatively black and white - become more familiar and more clear, it's the deeper shades of gray that continue to challenge me in my nursing practice. technically i'm on probation until the end of may at which time my performance will be reviewed and my employment extended or terminated, i guess. kind of an eerie feeling of big brother, or this case, big sister watching over you. i know my charting is being reviewed regularly, and i find it interesting that despite all of the emphasis on patient satisfaction and relationship-based care that ultimately, what i'm being graded on in large part are the tasks.



one last note: because hooking my computer into the internet isn't the easiest thing at my apartment, i've been writing more in my journal than online, but i hope to break that habit a bit and make more of an effort to share with you here more of my stories both from inside the hospital and from the outside as they unfold.

Finding Emmanuel

So last night was my first real night out in LA since I moved. I've been to happy hour once with my roommate and her friends and then out for dinner for my roommate's birthday, but definitely the first out-to-a-bar-solely-for-drinks-and-socialness since the big move and the start of my job. My coworker Lauren and I headed down to Manhattan Beach to meet up with a few people I had met at a holiday party last weekend.

As we were driving down from the hospital (oh yes, we worked a 12 that day) to the south bay area, everything seemed perfectly natural. And yet, as I was sitting there sipping my fat tire, looking across the table at Lauren and next to me at Josh, our local guide to the dive bars of Manhattan Beach and my connect person from the weekend before who had graciously invited us out, I couldn't help but feel a little...whelmed by the situation. I say "whelmed" because I wasn't overwhelmed - struck down by the situation or paralyzed by any particular emotion - but definitely impacted.

Huh, I thought. I guess this is what the social part of life looks like now. And it's not a negative or really even a positive statement. It just is. For all intents and purposes, I pretty much avoided the college drinking/social scene until my senior year.

You see, I'm a collector of good conversations. I love stories. Human connections are what keeps me going from day to day. It's part of why I love being a nurse. I love hearing about my patients, their lives, their hopes and fears. I'm not opposed to alcohol. I love a good beer or a great glass of wine and i'll never turn down champagne, but while bars are great places to chill out, have a few laughs, and generally unwind, I crave the intimacy of a few close friends over for dinner.

Perhaps what I'm really trying to say is that I'm getting tired of small talk. When you're always the new person, when you're constantly meeting people and not meeting up with people, the same information - the interesting facts and important details - get recycled over and over like stale air in a plane. And when everything stays on a surface level, there's a heartbeat of intensity that is missing, leaving me feeling slightly dried out and those human connections - such a force of life - slightly dead.

From my childhood, from my years in college and my summers in various places, I should understand by now that community-building takes time. In fact, the larger the group, the longer it takes. The five or six of us volunteering in Sierra Leone fell into community quickly - the intensity of our experiences as well as the shared life and ample free time when we were restricted to our house easily facilitated strong bonds of friendship. In a city like LA, where you many only see any given person once a week at most, community is harder to construct. It feels rather like trying to cling to a handful of sand in the shallows of a beach while the tide whips in and out around you, prying the small grains from between your fingers. Let up at all, and everything's gone in an instant.

It seems a bit dramatic to throw in a line like "it's times like these that define our lives," but I can't help but feel the little bit of a challenge, the push to hold on tighter despite the pull of the sea - these tides of work, material culture, comfort. How much do I really care about community, deep and enriching? How long and how hard am I willing to fight for it? How far am I willing to go for it? How much traffic will I wait in to get to it?

Good questions all, and as I sit here on my couch, meditating on Sufjan Stevens' christmas albums, I ultimately find a core of inner peace, a center of perfect community that is forever closer than my breath and stronger to hold me together than fingers made of steel. Emmanuel, God with us.

coming to christmas

it's a rainy day in the city of angels. after a week of work (more about that later), i was all ready for a day off. plans for an afternoon in the park, maybe an outdoor cup of coffee or stroll on the beach. and now rain. it's funny how quickly i've adjusted to the general sunniness of southern california. i didn't even look out my window this morning and was absolutely shocked when i stepped out of my apartment to find wet. very, very wet.

but as it turned out, a rainy day was exactly what i needed. after a walk to trader joe's which left me thoroughly wet, i warmed up with hot tea and a warm oven, baking up a batch of christmas cookies - ginger oatmeal with fresh cranberries. yum. let's just say my apartment smells heavenly right about now. with over the rhine's snow angel record playing on permanent repeat, i feel a little closer to christmas, despite the distance from anything i am used to around the holidays. when i was away from home in boston, it was still easy to get into the holiday spirit with snow on the ground and huge decorations in store windows downtown. not to mention enough garland and holly on the campus buildings to dress a whole neighborhood. but here, it's been a bit different. very few homes are decorated, very few christmas trees make their way into shop windows. at work, we have one lone, artificial tree at the end of the hallway.

work, by the way, is going well. really well, actually. i am consistently floored by the warmth, encouragement, and support i have received as a new employee and a newly graduated nurse from the other staff members. my patients have all been lovely - all with their own quirks, of course. i find more than anything else, though, that the authority, decisiveness, and responsibility of the nurse that at first was so overwhelming and seemingly far off is becoming more and more a part of who i am at work, and i'm enjoying this new role quite a bit.

other things are coming slowly, a church community, a few choice hang-out spots. i am still exploring, and in a city like LA, there's quite a lot of exploring to do. :)

in case i don't happen to write again before the holidays, merry christmas! i really love this time of year, and while it might look a bit different this year, i still believe there is plenty of light, love, and laughter to be had and shared. many holiday blessings for your christmas and new year - i've got some twinkle lights to hang!

thanks.

tomorrow will mark one week in la-la land (as my mother calls it). i’d like to say that i have fit into this city like a hand into a glove, but that would be glossing everything over a little too much. actually, when you think about it, i’ve never had a pair of gloves that really fit all that well, so maybe that cliché is relatively close to the truth. because, you see, the reality is that there are many things i love – my apartment is in a great neighborhood, i can walk to trader joe’s, my roommate and her friends have been more than welcoming, and my job promises to be everything i could hope for and more. but there are also a lot of things that take getting used to. some things, like the way of driving and general direction-sense, i will have to adjust to. other things, like the ever-present emphasis on image and external appearances, i feel creeping in to my train of thought and will have to work extra hard to stay comfortably un-l.a.

as we near thanksgiving, i am absolutely floored with gratitude. my job, my apartment, a roommate who is pleasant and helpful, parents who take off two weeks of work to come with me, who have provided so indescribably much for me in not only the past few days and months, but in my whole lifetime as well.

i’m always a little uncomfortable with the idea of thinking of those “less fortunate” in order to bolster your attitude of gratitude. it feels like i'm taking advantage of those who are caught under systems of oppression, recognizing their need but then sitting back and saying something along the lines of “thank thee, o god, that i am not like other men.” if i’m not mistaken that jewish priest wasn’t exactly the hero of that particular parable. i suppose, then, that true thanksgiving should lead us to recognize that what we have is actually a gift – one that wasn’t necessarily meant to stay in our sole possession. if everything we have is god’s, then everything we have – down to our time, energy, and ideas – really belong to everyone around us, god’s children.

of course, this quickly gets more complicated, especially in a city like l.a. where the homeless population is significant and omnipresent. extend that out to those individuals who make conscious choices to do drugs, abstain from psychiatric medications, willfully commit crimes. are they god’s children, too? there’s a fear that if i open my arms too wide, i’ll lose myself in the process. but isn’t that exactly what christ did?

after all, what's box unpacking and picture hanging without a healthy dose of soul-challenging theology. :)

what we do with them

jet lag isn't completely gone. but each day is filled with its little victories - this morning i woke up at 6:30 am. definitely a bit improvement on the 5:15 am-on-the-dot wake up i've been living with for the past few days. i'm still tired earlier than normal, but my days have been steady enough to also play a part in my exhaustion.

i'm moving to california. i imagine this doesn't come as a shock to anybody in particular, and i of all people should know this. but i think perhaps there are many layers of realization and many levels of knowledge. mentally, i've been organizing this whole cross-country shenanigan since i graduated in may. first it was to be a month early and now, finally, four months later, it's really happening. plans, details, little bits and pieces of information flow freely from my mouth with an ease and confidence that don't betray the moments of sheer panic that periodically stab through my heart.

you see, it's not just that i'm moving to california. i moved to boston four years ago to attend bc, and i've moved for summers to various locations around the country and the world. my whole life has been a grand sequence of moves. it's what this particular move means. it means my bed comes with me, and my room for the last six years that was always my haven, my sure sign that i was home from the stresses of school, will change. it means i live somewhere else and come home to visit my parents, not the other way around. it means i have responsibility, a job with expectations of me, an apartment, an income, a budget.

in those moments of breathless terror, it's much easier to hunker down and simply wait for the feeling to pass - much easier than looking up and seeing the harsh and gaunt realities we lump together under the ambiguous name of "life." loneliness, isolation, frustration, embarrassment, steep learning curves, and awkward moments stand before me. the cousins of transition, they try to hide among their brighter and more exciting siblings - exhilaration, discovery, adventure, surprise - yet their negative energy casts a pall over everything creating an atmosphere of dread, worry, and concern.

they say misery loves company, and i'm hoping that will prove to be true. if i square my shoulders, stare these clinging fears in the face and consciously choose against them, do you think they might just leave in order to find someone else who might join their un-merry band? one thing i think i've sorted out about life (from what i've known of it so far) is that they never stray too far. i used to think there was one perfect serendipity, one ultimate destination for each person where these morose fellows were banned once and for all by the infinite positivity born out of total fulfillment. well, when put in those terms, i guess that would be my best working definition of heaven...

but for now, for this life and this earth and this set of broken people, i imagine life sort of like one of the last scenes from a beautiful mind. In answer to a question as to whether or not his psychotic hallucinations persist despite the many years since his diagnosis and multiple forms of treatment, john nash, played by russell crowe, answers that they are always there, he has simply learned to ignore them. meanwhile behind him, you see the man and child - his consistent hallucinations - standing. silent. these feelings of overwhelming despair are with us every day, in the ebb and flow of emotions that float beneath the surface of our seemingly rational minds. they, like nash's illusory friends, will always be there. it's about what we chose to do with them.

there and back again, a traveling story

i'm back in oegstgeest once again. crazy to think that the in-between has held nijmegen, frankfurt, prague, brussels, aalst, ghent, brugges, and antwerp. but, the beauty of it all is that nothing has felt rushed or contrived, and it has been a joy to discover once again the natural rhythm that traveling is for me. the dynamic of arriving, discovery, and learning that manifests itself in the exponential growth in familiarity with the city streets, transportation, language, and people.

in brussels, oom ad, tante mareijke, oma, and myself met up in one of the central parking garages before filling our afternoon with the royal museum of art, the grote markt, and mannekin pis with a healthy dose of walking around and picture-taking sprinkled in. then it was off to our hotel in aalst, about a half hour drive away. we were treated to an elaborate dinner in the hotel restaurant as a part of our booking package, and while i enjoyed it, the late hour left much to be desired. one thing i really haven't adjusted to is the generally late hour of eating here in holland, and europe as a whole. five on the dot goverened so much of my life while on board ship, and while i recognize that's a bit too early, eating your main course at nine is just a bit too late. :)

still, we all survived (obviously), and were up and ready to take on brugges the next day. and take it on we did. parking near the center once again, we roamed through the streets despite the misty rain and managed to squeeze in the grote markt (there seems to be one in every belgian city), the belfry, nearly every chocolate or lace shop, the stadshuis, and the beguinage, which i learned is a place for elder, unmarried women to live in community in a consecrated life something like a step lower than full consecration as a nun. good to see there's hope for community living at every age :)

the next day was ghent and while the weather was much lovelier, the day itself seemed to drag on. maybe it was another heavy meal the evening before or the late hour of sleep, but i started the day somewhere hanging narrowly above exhausted. that plus the fact that over 70% of the historic city is covered in tarpaulins and under restoration kind of marred the fairytale like atmosphere the city normally has. still, we had a fine time walking about and spent quite a lot of time admiring the polyptych by hubert and jan van eyck that sits in st. bavo's church on the (surprise, surprise) grote markt.

the last morning, we parted ways at the hotel and birgit, merlijn, oma, and myself headed back to oegstgeest via a short stop in antwerp while oom ad and tante mareijke spent some time in aalst and also stopped over in leeuwen on their way back to nijmegen.

all in all, plenty of coffee drunk and cobblestones walked and history learned to satisfy even the hardest of history buffs, and for me it was quite, quite satisfactory. back in oegstgeest, though, i'm already missing oom ad's precise english and slow rhythm of speech that easily marks him for a teacher.

back in oegstgeest, we have a few more items on the agenda including a trip today in the car with birgit and merlijn as well as some last minute shopping for the essential dutch food groups: cheese and stroopwafels. tomorrow is oma's birthday and we will have a small get-together here at birgit's house for some of oma's friends and family before going out to dinner with the boys as a happy birthday/tot ziens treat. then thursday morning early will find oma and myself in schiphol, boarding a plane for the us-of-a.

definitely enough left to be done and experienced, but my traveling eyes are turning homeward once again...

dutch

kind of crazy to be blogging twice in one day, but seeing that i will definitely be away from the computer while we're in belgium, i figured i could load all of you family and friends up with an extra comment or two on my adventures thus far.

today - just to give a quick update - oom ad and tante mareijke returned from their friend's party around noon, and we hopped in the car around one, headed toward appeldorn (obviously something to do with apples at one point in history or another). there we met up with andor, monique, and their two children ivo and annika for some honest-to-goodness dutch pannekoeken. some people eat pannekoeken and say they are just like french crepes. it is the closest thing one might compare them to, but for the dutch it's a dish all its own (mine, if you're curious, was kaas, tomaaten, en ui and i'm still full full nearly six hours later).

which brings me to the theme of this particular entry: dutch.

every evening, around nine pm or so, i am absolutely exhausted. as i reflect on my days, there's no stupendous expenditure of energy that would warrant such tiredness, and a comment from marte, on our trip, made it all so clear to me. she asked if being around dutch all the time made me tired, and suddenly, i realized it did!

i find myself in a very unique situation. commonly, as most dutch people speak english, an english-speaker making painful attempts at dutch is quickly rescued by the gracious conversation partner(s), and english becomes the language of choice. it is not uncommon for expats to live years within the country and never learn a word of dutch beyond the basics of ''hello,'' ''goodbye,'' and ''thank you.'' i, on the other hand, find myself surrounded by family that have somehow come under the impression that i speak dutch. interesting. before leaving, oma swore up and down that it would be only english and that she herself would personally intervene in any and every conversation necessary to be sure that i was included. i'm not sure what is more surprising, her promise or that i believed her.

but, of course, that's not practical in the least, especially with shakier english-speakers like tante mareijke. so? so i have been spending a very quiet trip. :)

a friend once dared me that i could not be silent for ten minutes straight, and while that was many, many years ago, and i have since come to value the merits of quiet observation, these past weeks have taken it to a whole new level. i find myself appreciating, once again, the powerful communication inherent to body language, tone of voice, facial expressions, and gesticulations. also, i am amazed at the incredible language-learning potential in complete immersion. with dutch swirling around me almost constantly, i find myself noticing sentence patterns and commonly used words that then become intuitively understood by mere repetition.

like the word maar which is the conjunction ''but.'' from hearing time and time again that drawing out of the word and emphasis unique to the introduction of a contradiction in the voices of birgit and oma in the first days here, i taught it to myself (and confirmed it later on, of course). now oma and i have a pattern - i listen throughout the day and then mentally hold onto a few words i think i have figured out or some that completely mystify me and we go over them in the evening. as i write them all down in my moleskin journal, i realize how much my vocabulary has grown.

five year old annika still has me beat (she can count all the way to thirty!), but slowly but surely i'm getting a little closer every day. and here is the pinch - in view of my mental energy, i'm quite looking forward to englespraten but in light of the progress i've made in just a few weeks, i'm already missing those words i might have learned in the months to come. misschien een dag...

more on prague

oom ad and tante mareijke are off to a small birthday party for a friend in their athletic club, and oma is comfortably sorting through clothes for belgium with all of her hairs neatly dried and combed into place. here in the little garret office that has become my home, i have a few minutes to myself for some further writing on prague, as promised.

first, our host kate. always ready for a laugh and a huge conversationalist, both marte and myself felt right at home the moment we walked up to the looming mass of grey concrete and brick that is her apartment building and she popped her head out of her window to shout a ''hello'' to us down below. with convertible couches, a designated storage space, room in the refrigerator, and our own copy of the house key, it was challenging to not feel instantly at home, and of course we did. sheets, blankets, pillows - everything was provided, and with a cup of tea in hand we sat down for a long, get-to-know-you chat. she works for an it company, and had recently been to the us for a conference. we chatted about boston, new york, san diego, jon stewart, and stephen colbert for the large part of that first night.

in the following days, we say kate at least once or twice. usually she was just getting up when we were heading out the door (since her company is based in the us, she has a large amount of flexibility with her hours, usually working some from home and going into work after lunch) but we also often caught her in the evenings as well. she was always interested to hear how our days were turning out and quick to offer us advice and guidance as well as her wonderfully outspoken opinions!

we found her through the couchsurfing online community, and it was an awesome experience. everyone who doesn't yet know about it should check it out at www.couchsurfing.org

one of the biggest advantages was her insight into the culture of the county and the aftermath of communism, which i mentioned before. i realized, as kate was talking one morning, that the czech republic was the first post-communist country i had visited, and i was at times surprised and at other times not to see how prominent the fingerprints of that time still exist, exactly twenty years later. for one, there seemed to be very little nationalism, in terms of pride in the country's history and even awareness of the sort of stories we heard on walking tours and in the guide books. kate explained that soviet education was more about the greater soviet union with an emphasis on communist themes rather than the individualism of then czechoslovakia versus romania, ukraine, bulgaria, etc. similarly, people themselves rarely speak out in public, often avert their eyes on streets and in trams, and only the younger generation, born after the fall of communism really display that gregarious impudence characteristic of youth.

another thing quite shocking to hear is that, growing up, kate was taught in school that jews did not exist. under a completely areligious government policy, judaism and other faiths were taught as sort of relics of the past rather than active influences. she knew about franz kafka, the famous czech writer, but only recently learned he was jewish. when we made a point to visit the memorial of the czechoslovak jews who died in world war ii, she sort of regarded us with a look of quizzical bemusement.

no facet of life has been unaffected, it seems. while people got married very early under communism because having a family moved you higher on the housing list, now most people delay marriage until their late twenties or early thirties because there is greater access to other things like traveling, work, university, etc. the first mortgages are appearing and many people cannot afford to buy homes or flats because their salaries haven't changed that much but the prices set by private industry have. so many fascinating tidbits that cracked open a whole new aspect of czech life and culture.

i definitely didn't see everything - sometimes because of the weather, other times because we didn't want to pay the cost of admission, and in the end, because four days really isn't enough. still, as i said to both marte and kate, i think we both saw enough to know that we would very much like to come back...

op de fiets redux

just back from a looong (read: 2.5 hr) bicycle ride with my great uncle, Ad. i love that when dutch people talk about bicycles, it's always by the full name or just "cycle" - it kind of highlights the quaintness of dutch "cycling." bike somehow always brings to mind harleys and the like, and you have to sort out for yourself which one, based on the surrounding details in the story. but with cycling you kind of know right away there are no overweight men with doo-rags and leather jackets involved.

dutch bicycles are different from the general american ones, anyways. they are usually more relaxed but with narrow tires, sort of a cross between a beach cruiser and a road bike. my old red bicycle from my time at bc would fit in just perfectly on the dutch fietspad. i have yet to see a bicycle with more than three gears, and with 60% of the country reclaimed from the sea, you rarely need to shift at all.

in any case, it was an absolutely wonderful ride as we passed along the dike off the vaal river and in between the little family farms and country homes.

yesterday was quite lovely also. we went first to the museum in nijmegen and saw an exhibit of some illuminated manuscripts from the mid 15th century. they belonged to catherine of kleve who resided in nijmegen at that time. the various pages normally live in new york and london, but they were specially reunited on home turf for the celebration of the city's anniversary. i have read a few different novels recently that involved medieval manuscripts and their illuminators, but i realized i had never really seen one in person. the miniatures were absolutely incredible to behold in person, and i'm very glad we went. you do go a bit bug-eyed, however, after several rooms of squinting in the dim light used to preserve the pages.

after that we did a bit of shopping in nijmegen center before hopping on a bus to bring us back to the house. for dinner, we hopped in a car and went to ''oriental palace'' where there was a chinese buffet and a rijstafel especially for oma. she hit up one of the young men working there as an entertainer, hoping to brush up on her indonesian, but unfortunately he was from the philippines and happened to only speak english and dutch.

when we arrived back at the house, i was able to show off my pictures of prague via oom ad's computer cable. i already miss the city and our wonderful host.

today is already half done, and i have very little idea of anything else on the agenda, but the sun is shining and the high is 15 degrees celsius, which is a lovely jump up from the 2 degree weather in prague, so i'm as happy as can be! for the meantime, i believe lunch is calling my name.