conversations in a hospital #10

this is, by far, one of my most favourite patients ever.
a horribly sad story, she was almost killed by her brother and his girlfriend...they attempted murder and left her with a closed head injury, subdural hematoma, a gash in her neck so big that i'm surprised she's still alive, and ultimately a traumatic brain injury...
she has improved dramatically in the few months she's been here, but has gone between our trauma unit and the trauma/neuro ICU multiple times, near death, battling multiple infections, and the deepest pressure sores i have ever seen...
she is now eating and talking and moving, but is moody, sometimes agitated, sometimes tearful, confused as to place and time and generally everything, but i am sure that she has brief moments of lucidity...and she's just funny as all hell sometimes...
~

on initial assessment, trying to locate the pt's feet under a gazillion blankets:

me: where are your feet?
pt: i usually like to find them at the bottom of my ankles.

on the afterlife...

me: do you still talk to your mom?
pt: well she's dead, so it's a little difficult...of course, i still do sometimes

on italian heritage...
(which, by the way, she is not...but i am...and she seemed to be using random memories as her own experiences to share with me...too funny)

pt: i mean, how many pictures of an italian horse do i really need?

leaving the room:

pt: be careful!
me: why?
pt: it's crazy out there.

you know you're a nurse when...

as i was sleeping off my night shift last night i began dreaming of intermittent catheters and giving myself an IMC...only to wake up and realize i had to pee like crazy.

the hipster reigns supreme

it was all mustaches and mohawks at the hip hop show

"do you think his one speed is in the tour van?" bob asks (re: eyedea of eyedea & abilities).

i believe the correct nomenclature is fixed gear.

~
Music to my ears: themselves - the free houdini

eulogy to my nonna

did you smile when you saw the light?
did you finally give in...or had you been waiting?
the bittersweet irony of choking on chicoria. oh irony, how i love you so.
you make life worth living (dying for?)

my sweet sweet nonna.
i cried.
but i'm not sure if it was because society tells us to cry at death.
because really, with any faith, should we not be celebrating life?

say hi to nonno.
R.I.P.

she says it better than i can

welcome, little one

to my dear little nephew, jackson philip, who entered this world on oct 29 at 4:45pm, weighing in at a hefty 5lbs 15oz (wee lil' guy):

welcome...i've been waiting to meet you

a conversation with mum

on days off, my ritual consists of sittin my ass on the couch with a coffee, reading email (well, if any of my 4 friends send me anything), catching up on my favourite blogs and sites, all the while on msn with mum, whose office life is anything but exciting...not that i'm any more exciting than her work environment, but we all need a little distraction in our lives...

so telling her about the lost ring and my thought of getting my wedding band tattooed on my finger (this isn't the first ring i've lost), she writes:

maybe you should hang them on a chain around your neck, you never lost your house key when you were a kid and it hung around your neck, lol

thanks, ma.

~
Music to my ears: Dead Confederate
In reality: this kid was my co-worker's brother's teammate and friend
(my rant on H1N1 is being formulated...more on that coming)

ttc weather

when the weather starts to turn, i start to wuss out of riding my bike for transportation. the only thing i like about riding the ttc is listening to my ipod, reading a book, and occasionally looking up to people watch and make up stories about my fellow passengers...

==
his eyes tell the truth.
he loves you.
and even if you see it, you'll treat him like shit for years.
and yet his love--it's relentless.
he won't care when you hate yourself for putting on a few extra pounds.
he'll love you even more.
he will always see you. on the inside.
and no matter how much that scares you, it's real.

~
Music to my ears: minus the bear - highly refined pirates
In reality: F**ks**t

mushin

as i prepare for my nidan level testing (2nd degree black belt) in Shotokan...a message from my hero:

gone. the ring is gone.

in a patient's bed linens? down the laundry chute?
in a latex glove, in the trash? down the garbage chute?
i may never know.
the ring that was given to me by the love of my life after 11 years of togetherness.
the ring that was so unexpected and wonderfully surprising and in such a beautiful place.
i haven't felt this terrible in a long long time.
"it's just a ring" he says.
what remains is a non-tanned strip of white skin on my ring finger and this photo:



i think i'm more upset with myself for 3 things.
1. for not getting the ring re-sized sooner, so it wouldn't fall off my finger.
2. for wearing it to work anyways.
3. for not noticing when and where it fell off.

i cried.

turkey on the campfire

Centennial Ridges trail, Algonquin Park


The Lookout trail, Algonquin Park


Centennial Ridges trail, Algonquin Park


Centennial Ridges trail, Algonquin Park


Mosley

apples, you tasty things

can't you just smell their apple-y goodness?

i need an apple dessert recipe that can double as a birthday type dessert and something easy to transport on a camping trip for thanksgiving dinner...something i can warm on the fire.
this will involve a little leg work.
i need something i can make ahead of time and possibly freeze, before leaving to go up north.
something that can make it until sunday in a cooler, and will go well with a bird cooked over hot coals.
something i could potentially stick a candle in.
something gillian gellybeans would enjoy for her birthday cake.
and something that really tastes like the apple-y goodness of fall.
i have a ton of tasty apples. ones that are perfect for a dessert.
but i want to taste fall.
i want the dessert to taste like tasty, delicious october apples...and possibly be gluten free...and vegan?
hmmmm.

my first ethical dilemma

...at my new fangled healthcare job that is...not in life...gawd no...in life, i've come across many, but as a freshie RN, recently released on my own sans preceptor/mentor, this was tough.

my first night of 3 in a row and i had 6 patients...4 of which were in a "high observation" room, meaning that a clinical assistant (CA) is always in the room as these 4 patients are prone to being agitated, pulling tubes out, at an extra high risk for falls, or some other reason that they need 24/7 watch.
as i walked in the room, one of these women is already quite agitated and insisting she leave at once. but you see, this woman has a brain injury, and her communication was a word salad at best.
funny thing is, i could totally understand what she was trying to say most times, just by her tone and intonation, and the odd word that came out correct (she hated me, that part was clear)...but for the most part, i can only imagine how frustrating it must be for her to not have the right articulation.
the CA was having trouble keeping watch over 4 patients and trying to keep this woman in the room, so two CAs got her in to bed and applied the wrist restraints.

wrist restraints already come with a whole not-so-nice-human rights-ish vibe to me, let alone the ethical issues...i have a fantastic team and there are a couple of charge nurses that i felt really comfortable talking to, despite my being new.
because not only did i have to restrain her for most of the weekend with physical restraints, but after coming back for saturday night and finding out that other staff was pissed that i didn't give her the haldol on saturday morning, which apparently then caused her to be "restless and agitated and exi-seeking all day" (like she wasn't already) on sunday morning 4 of us had to hold her down, give her the IM shot of haldol while putting on the wrist restraints...
so not just physical restraints, but medical restraint...straight out of a 1950s "insane asylum" movie.
it just doesn't feel right to me, but my charge's counter was that she was not safe in the outside world because of her lack of communication, and obvious brain injury.
point-counterpoint.
oh, and did i mention she was mrsa+?
uh, yeah.
that news came in on saturday, in the middle of the night.
so not only do we have to keep her on the unit, we have to keep her in her room, and not let her touch anything...
rrriiiigghht.

monday morning i decided not to give her the haldol.
she was redirectable to an extent. she was exit-seeking, but willing to stay sitting on her bed. she was under the CA's watch.
she was o.k.
so i mentioned it to the charge, then i mentioned it to the RN covering during report and shift change. all was fine. all was good.
3 nights of craziness and i went home to sleep like a log.
fast forward to dinner time, where my man had come home from work wanting to take me out to eat.
i was on the phone with fido, so bob turns on the 6 o'clock news while he's waiting.

bob (poking me and pointing to the tv): uh, uh, hey babe?
me (finger over lips, mouthing): shhh. i'm on the phone
bob: but, um, hey...look
me (giving the angry eyes, mouthing shut up)...
bob: you might want to see this
at which point i turned to the tv to see a fuzzy security camera pic of my crazy lady (!!) exiting the hospital entrance in her gown, sunglasses, lei around her neck, purse slung on her shoulder...
me: holy crap! hang on (i yell to the poor fido rep)
bob: i kinda had a feeling that's who you were talking about
(note: even though i tell him random stuff, i still keep a certain standard of confidentiality...yes, yes, i do)
me: that's her! that's my girl! oh my god! what did they say? did they say when she escaped? what's the story?
bob: i don't know. i couldn't hear because someone was on the phone. (smart-ass -ed.)

i freaked out a little, thinking because i didn't give her the haldol that morning, she had escaped during the changeover when there is way less staff on the floor...but no, she left in the late morning, when the CA had let her walk out and not called security.
so she got free.
(they found her later in the afternoon, at a friend's house in the east end. how the taxi driver knew where to take her is beyond me. what does that say about our city's taxi drivers? wow)
i must say, i am so impressed by her determinism.
scary, but she is just so damn resilient.
it's amazing, really.

i have had her as a patient since then. just yesterday, in fact.
still as exit-seeking as ever.
on 1:1 constant observation.
even in 4 point leather lockable wrist restraints.
they discontinued the haldol, because really, what's the point? it didn't even work for her.

when i came in yesterday she only had one restraint on, her left wrist.
and she managed to contort out of it by mid-morning.
if you can believe it.
it didn't really surprise me.
security was called twice.
first time, we gave her ativan.
didn't work (surprise!)
second time, we held her down to put her in restraints.
and she cried.
and i almost did too.

dreaming of turkey weekend

can't wait to see this in a different colour...


overlooking Cache Lake, Algonquin Park

conversations with T

bob and i often find ourselves walking around a book store after a dinner out.
yes, our dates end with book shopping...we are serious nerds.
bob saw me take an interest in this book, that he promptly bought for me as Book City was closing its lights for the night.

i told T this and added "do you think he thinks i have an eating disorder?"
"do you?" was her reply

it made me think.
i've never been anorexic (love food way too much)
i've never had the guts (so to speak) to purge, so bulimia is not a label for me.
but i do binge eat.
probably emotional. usually anger. most often because i get so frustrated that i care so much about what i eat.
because i get so frustrated that the whole idea of "healthy" eating and body image consumes my thoughts.
and then i eat to say "fuck it!"
does that even make sense?

i have an unhealthy relationship with food, and yet, on a whole, i eat really, really "healthy".
but i don't always want to.
and when i don't i feel guilt. horrible, horrible guilt. and i don't want to do that either.
and that gets me so angry.
it's a vicious cycle.

unfortunately, binge eating disorder isn't really classified as a disorder in the DSM-IV without the purge to go along with it.
so does this count?
the author of the book so far is arguing that yes, these unhealthy relationships with eating and self-image are forms of eating disorders that largely go unnoticed--and they affect much older women than the public thinks "classic" eating disorders usually affect, like teen girls.
but these days, doesn't that mean that every woman would have some sort of eating disorder?
our society is so caught up in dieting and thinness that i feel no woman can escape this.
and it's makes me angry because i never used to be like this.

i used to be 30 lbs heavier...and happier (once i left the house and didn't have to listen to my dad's unhealthy "teasing" anymore)
it took some menstruation and hormone issues and one trip to an endocrinologist to finally see that i wasn't at a "healthy" weight...so i began to eat better, bought a bike, started training in karate...
but then i ran a marathon, got really thin and the issues started.
to put weight back on seems like the biggest issue in the world and i hate that.
i never cared about body image, i never cared for falling in with societal norms...i only always wanted to be happy and healthy...but by what definition? it seems so muddled now.
so it is SO goddamn annoying for this to be in my thoughts and contributing to me being unhappy with myself.
it seems so complicated.
and i just want to be able to celebrate the fact that with a 15lb weight gain i also quit smoking, finished 4 years of university, and have more time to hang out and have a beer and nachos with my man.
the obsession has to stop.

~
In reality (and related news): the effects of our surroundings on body weight

conversations with T

i only see my best friend once every few months.
we make all these grandiose plans and they never pan out.
instead, we end up meeting at a second cup halfway between my place and hers to chat over my soy latte and her skinny chocolate chiller.

you see, my best friend has been battling addiction, depression and anxiety issues for more than 4 years now....although it could be argued for the better part of her life.
being clean for the last year has put her in a position to examine her life and find the things that make her happiest, but has also kept her from holding down a steady job (or have one that she has been on leave from for 4 months), leave the house regularly, or engage in social activities.
she wants to live her life and enjoy her life, not be bogged down with mental health issues.
so our conversations are usually pretty heavy
(albeit peppered with bits of comic relief due to T's obsession over celebrity lives...which would normally turn me off, but in T's case i know it is such a sense of enjoyment for her to be a part of the cult of celebrity just to laugh her ass off at the idiocy of it all)
but our meetings and chats are generally mirrored and whether T knows this or not, they are just as therapeutic for me as they are for her.
hence this new, somewhat sporadic, feature: conversations with T

conversations in a hospital #9

during bathing

patient: how old are you?
me: 32
patient: why do you look 17?
me: genes, i guess
patient: what are your friends going to say when you tell them you bathe old men?

~
on dating

(me, wearing glasses)
patient: men don't make passes at girls with glasses

~
on hospital food

me: aren't you hungry?
patient: let me put it this way, the food here is less than desirable.

day 14 - all good things come to an end

whirling dervish, Sirceki train station

tried to sleep in...didn't work.
so we packed up, showered and ate a crappy breakfast
(remember to write shitty review for Istanbul Hostel).

we left our bags to wander the bazaar district streets. we picked up boxes of lokum (turkish delight) for gifts, as well as çay and kahve from the grocery store.


mint lokum from the oldest turkish delight confectioner in istanbul


delicious dried apricots

we had a wonderful and relaxing lunch in Gülhane Park on the grounds of Topkapi Palace.


Gülhane Park on a Sunday afternoon






fortune telling rabbit

bought some knock off Chuck Taylors ("Harlem All-Stars") and a shoulder bag handmade with some Turkish musician silk screened on the side.
walked over the bridge to Karaköy Güllüoglu for the best.baklava.EVAR
(we went back for seconds!...even bob, who is not as big a fan of sweets as me).


they opened a shop in NYC at Coney Island...yikes, that's almost close enough!


2nd helping of baklava...this time with dondurma!

feeling sluggish and full of sugar, walked backe and had a beer under the bridge...


pier on the Bosphorous River, beside the Galata Bridge

sat and people watched in the mosque square for a bit before going to see the dervishes whirl...which was quite incredible, really.


Sufi musicians of the Mevlevi order











picked up some food and beer and went back to the hostel to relax...we met some dude from Chile who was on his way to Cappadocia, so naturally we sent him to Rock Valley.
drank some beers to kill time until our 3am shuttle to the airport.


finally...the doner kebap


pistachio is the new almond

and that was Turkey.

ps...worst. gum. ever...

day 13 - an adventure in the Turkish army HQ

got to Istanbul early and had the rare treat of walking around the streets of Sultanhamet without getting hassled
(read: free from the constant barrage of "yes, please, spend your money here, please")


breakfast borek feast


kahve (pre)


the post kahve sludge

popped in to a small bakery/cafe and had a wonderful array of tasty pastries (where i learned that borek refers to any phyllo pastry, no matter what kind of filling) and a couple of Turkish coffees...which inevitably leads to wanting to brush your teeth immediately thereafter...so we went to find the Istanbul Hostel, which we had booked the day before while at Rock Valley (we had really wanted to stay in Beyoglu this time, but everything was booked...everywhere...so we decided to book a day ahead to avoid leaving us stranded on our last night in Turkey)


the old Yerebatan Saray Sarnici cistern



so we dropped our bags off and went to the old byzantine cistern, which we had deliberately missed on our Istanbul sight seeing days almost 2 weeks ago (!!) because of the price and the line up...but bob decided he really didn't want to miss this because of his fascination of both the underground and water...so glad we didn't--it was phenomenal.

later we bought tickets for the dervish show at Sirceki train station...the tourism agent selling the tickets at the station was quite an interesting fellow with whom we spoke with at great length...he had strong opinions about his own people ("beautiful country, but the people are shit")


fish fry on the pier



we sat on the pier and split a fish sandwich before heading to Üsküdar by ferry

once there, we set out for the Turkish first army military barracks "Selimye Kislasi" which houses the Florence Nightingale museum...seeing as this was my official nursing post-grad, pre-work trip, it only seemed natural to check out the site our founding mother set up to decrease mortality rates among soldiers in the Crimean War

okay, let me explain the crazy security around this place...2 weeks prior i read about the Florence Nightingale museum in lonely planet...it had said that you needed to make an appointment so while exploring Istanbul on the other side of the Bosphorus, i spotted a sign for the museum. figuring it would be easier to just go in and make an appointment, we found our way to an entrance, walking past 20 foot high barbed wire fences with periodic soldiers in army fatigues and rifles (!!)
the soldier at the gate house didn't speak english, and our turkish at that point didn't really extend beyond "merhaba", so he radioed up and sent us along to the entrance, past the stares of random military personnel...we got through the metal detectors at the door, and they made us wait for someone who could speak our language...
finally a lieutenant came out and after taking our passports, began quizzing us about why we were there and why we wanted to see the museum...after explaining i was a nurse from Canada, he returned our passports and gave us a fax number and name of a superior, telling us that we needed to write for permission and get it ok'd, and then recieve a fax back with a time/date.
thinking it was a lost cause--not only were we not sure when we'd be back in Istanbul but where were we going to be able to receive a return fax?--i assumed i would not be seeing the beginning of the origins of nursing as we know it...

fast forward to our time in Rock Valley pension...explaining this story to Ilhami & Miriam one day, Miriam suggested Ilhami translate a letter for me and they'd fax it for me...so i wrote the letter, it was sent, and we waited...and 4 days later we left, without getting a reply...
except on the bus back i got the call from Miriam with a time and a date...

and so, without the official fax, we returned to the barracks only to go through the same rigamarole...without that fax that was sitting in Miriam's office back in Göreme, they had to scan us, take our passports, find the person who approved the meeting...it took a while, but we got in...they made us give up all our baggage and camera gear (no pictures!...i was even afraid to take pics outside!), gave us "visitor" badges, and then we waited for our ride and chaperon...a soldier in fatigues picked us up in a van, then brought us to another building, where we waited for this man in a suit to tour us around...he must have been someone really important as our fatigued soldier gave him the military salute when he approached and said he'd wait for us...everyone who came into contact with us stopped and gave the salute (i guess we should have dressed more appropriately instead of jeans and muddy sneakers, heh)

the museum was totally awesome...the barracks themselves were incredible...the man even gave us a book with the history of the barracks themselves...they then escorted us out, and watched us leave...no doubt had scanned our passports in the meantime, perhaps called the Canadian embassy? who knows...what an experience...i turned to bob and said something to the effect of "what the hell? did all that just happen?" and he said "you do realize we were just in the headquarters for the first Turkish army, right?"
huh.


grand bazaar

on the ferry back to Sultanhamet we realized the Grand Bazaar was not open on sundays, so change of plans...we went to haggle for gifts today.
bob got a saz and the guy even put in an electric pick up.


putting the pick up in bob's saz


in the music shop

we got another belly dancing outfit for Cath...and a few other things.
what a crazy place.


outside the bazaar


stall at the spice bazaar

we then rushed over to the Spice Bazaar thinking it too was closed on sundays (later figured out it wasn't)...but we definitely needed some supplies from there to bring home!
we got some chiles and apple tea vacuum packed to transport overseas, and stocked up on dried apricots, pistachios and by far, the best dried figs i've ever eaten.


delicious dried figs


veg kebap


iskender kebap

all bazaar-ed out, we went back to the hostel to shower and get ready for some dinner.
after dinner we took the tram to Beyoglu to find some live music.
it was nuts over there.


istiklal caddesi

thousands of people just walking up and down the main street (Istiklal Caddesi) with a bazillion bars and clubs on the side streets.
walked in to a bar to hear a crappy rock band and pay $7.5o YTL a beer (!!) so we left to wander more...ears open for sounds of anything good, we heard some dub-reggae coming from up high.
followed the sound up 5 flights of stairs to catch the end of an unknown (to us, but not to the people in the place) great band...good vibe all around and didn't have to pay to get in seeing as it was the end of their set...still 5 YTL for a 1/2 pint though. craziness.


bar in Beyoglu

after the band was done, we moved on and found an alt-rock band--the door guy let us in for free after determining via our broken english-turkish conversation that we were foreigners looking for local Turkish music--loads of fun!
and the second cover of the Cure's Love Song in one night...

we walked all the way back to Sultanhamet, over the Galata bridge that was packed with fishermen at 2am.

day 12 - living in the fairy chimney

woke up feeling the many glasses of wine and beer from the previous evening's celebratory nature.
not to let a little dehydration get in our way, we guzzled some water, had a delicious breakfast at the pension, then set out for Pigeon Valley.


Rock Valley french toast deliciousness

Pigeon Valley:










we walked the valley about 4 km into Uçhisar--whose castle we had been admiring from afar...the hill looms in the distance if you look north from Göreme...


a loud cow blocking the path up to the castle


woman and her donkey

we climbed to the top of the castle and visited more surreal empty cave homes...


view from a cave home








Bob waving on a path in Uçhisar amidst the fairy chimney homes


storm coming in


storm over Göreme, as seen from Uçhisar castle


lunch on the castle grounds


dried apricot snacks from man outside castle


the rooster at #7

but before that we followed a sign for "traditional Türkish home" and toured ourselves through an awesome home in a fairy chimney...


work room


bedroom


balcony

we had a çay in the sitting room with a man who was actually born in the house...he now runs his family home as a guesthouse (2 rooms in a fairy chimney!)...while we sat in the cozy carpet filled room with him and his 2 cats lounging in the sun, Bob plucked away at a Saz...a wonderful sound (will have to look for one back in Istanbul for him)


sitting room


view to the yard


property for sale in Uçhisar

we took the dolmus back to Rock Valley to shower and relax with a couple of beers before catching our bus....
and then the stone fell out of my new ring.
sadly, i could not find it...i was in tears. Bob is convinced he can get another but i think there's no way they'll size and reset it without the original stone--i'd hate for him to have to pay for another (the designer reset it when we got back--no problem -m.)
"it's just a ring" he says. this is why i love him.

grabbed some awesome pide from Firin Express before getting on the bus.
sadly it was the first meal i didn't take a photo of, and consequently one of the most delicious.
i wouldn't have minded missing the photo otherwise, but it was a veg version of the traditional egg pide...hard to come by!

so later, sitting on the bus, the driver comes up the aisle with his cell phone:
"amanda? amanda?"
it couldn't possibly be me...oh but it was for me.
turns out the military barracks with the Florence Nightingale museum sent a reply to my fax to Rock Valley pension after we had left...Miriam went through the trouble of tracking us down on the bust (!!) to tell us of our appointment at the barracks for tomorrow.
incredible.
if you're ever in Göreme, stay with the amazing Miriam and Ilhami at Rock Valley Pension.