Saturday, April 21, 2012

I'm Sexy And I know It...

Babysitter + Hubbs and I + good friends + Urban beer hunt (think Amazing Race with costumes and booze...) + 80's aerobics wear = fantastic day of enjoying life and forgetting about the craziness ever so briefly. Needed that. Read more!

Monday, April 16, 2012

A birthday with nothing to celebrate...

Christmas 2011...
Today is my birthday... I remember celebrating last year, I was 8 months pregnant with Baby D and it was my baby shower day. I had a new dress, super cute shoes, it was a happy day. I was full of anticipation of my new little dude's arrival, wasn't sure if he'd be here early like his brother or right on time (turns out the latter of the two would prevail). I was anxious, physically exhausted, counting the minutes of each day, realizing how much I hadn't done that needed to be finished, I had a lump in my throat thinking about just how much our lives were going to change...

This year is eerily similar, but there is no baby arriving. Instead we've recently received the news that my Dad's cancer is back. It is now Stage 4. The doctors have given him 2-4 years best case scenario with intense chemo treatment.

So I sit here with a lump in my throat in shock over how quickly one's life can change, anxious, physically exhausted, counting the precious minutes and hours of each of these last memories together realizing how many things are unfinished.... I am not ready to live this life without my Dad around. I'm not ready to think about our last Christmas... our last hunting trip... our last conversation... my last birthday with him. I'm so not ready for this and I'm so angry. I want to throatpunch the doctors, HOW DID THEY MISS THIS?! I want to scream and kick and cry. And I want to curl up in a ball and hide away forever. I am physically ill just thinking about it and there isn't a

single.
thing.
I.
can.
do.
about it...

Devastation can't even come close. I feel like someone has ripped my heart right out of my chest. Like someone is suffocating me until I can't breathe.

How does one begin to live when they know their expiration date. To me it has done the opposite of what most would think.. instead of "over-living" and going out there and making the most of it I feel like it stops you from living. Stops you dead in your tracks. Everything in my world is depressing right now. A beautiful sunrise is tainted by the sickening feeling that there will only be so many more of these that my Dad will enjoy. A tender moment between my sons and Grampa is almost too much to watch anymore because I know that my children will never really get to know and remember him.

Every day right now is spent realizing how finite our time here is, how cruel and unfair life is, and instead of it being a gift as everyone would love to encourage you about. It isn't people. Death isn't a goddamn gift, it is crushing to all those left behind. Call it selfish... I didn't choose this and I don't want it.

People try to say the "right" thing... they try to tell you that at least you get to have this time, however short it may be, at least you get to say goodbye, now you can make the most of this time, etc. They try to say 'just think about everything you have to be thankful for, everything that is good in your life, focus on that.' Well let me saw off your arm, lay it on your kitchen table for you to gaze upon every hour of the day, and you go ahead and try to think of all the good things.... let me know how that goes for you. I realize they are trying to be helpful, it makes sense that saying something along those lines would help but it doesn't and that's not their fault, it's mine. I could choose to focus on the good of life rather than this crap but right now I can't. I suppose I'll get there.... I certainly hope so, for the sake of my husband and children... they deserve to have a mom and wife that relishes each day, not one that is shut down and flat and impatient. If it weren't for them I wouldn't get out of my bed. Ever. So I'm thankful they are in my life because I'm not sure what would be happening right now if they weren't.

My Dad is in pretty good spirits... as good as you could be I guess. He puts on a brave face but I know he is just as shocked as I am. When he called to tell me what the docs said I was literally dumbfounded... I said "so that's it????????" and he said "yep, that's it, kid" trying to compose himself. I hung up the phone and went outside and fell to my knees. I sat on my back porch bawling wanting so badly to just go away, to wake up from this dream. When I got to the hospital I fell into his arms and sobbed... all this time I've tried to be strong and I just couldn't fake it anymore... he held me and told me it was going to be ok and all I could say over and over again was "I'm so sorry Dad.......................... God I'm so sorry"

"It's ok honey.... It's going to be ok"

My heart breaks for him, I can't even begin to imagine this from his perspective. He is trying to be strong. "Well, looks like I'm going to retire early huh".... "We're just going to make the most of these next 4 years." "I'm gonna ride my bike 130 down the highway, if they pull me over, let them take my license, what else could they possibly take..." This is one of the things I'll miss most about my Dad. His humor and strength are second to none, thinking about that brightens my day. There could be the biggest of giant elephants sitting in the room and he'd find a way to make everyone comfortable about it. Or at least get a laugh.

It's amazing how much can change in a year. In one phone call. My birthday this year is less than happy. I don't feel like celebrating, in fact the word celebration is almost a sick joke to me right now.  My wish for my birthday is for peace, health, and strength for my Dad, myself, and my family as I try to mentally sort out the inevitable... Read more!

Thursday, April 12, 2012

CPNE Workshops and why I chose Sheri Taylor over Excelsior


I will be discussing my various contentions with Excelsior College in another post but to summarize I do not think the school has nor wants to work to have a good infrastructure for their nursing students. There are so many issues with the way the program is run and it culminates at the CPNE where you are expected to perform to perfection yet their own staff make the experience 100% subjective. You get 10 answers from 10 advisors and the only one who pays the price for ambiguity is the student. That's not right. On a variety of levels. Especially when your entire degree is riding on this.

When I was finally ready to apply to the CPNE I started to feel completely overwhelmed with HOW I was going to study for something that was so subjective despite the expectation to perform precisely. I just thought that I'd read the study guide and do my best to wrap my head around it and submit practice documenting to the school for feedback as was recommended by previous students. But I knew this wouldn't be enough the more I started reading the boards (I HIGHLY encourage people to get out there in social media land and talk to other students and those of us that have been through it, this is the ONLY real way to find out what to expect, what you're getting yourself into, and to learn some tricks of the trade that will be invaluable to you). SO I decided immediately that I was absolutely going to attend a workshop since this was the only chance I'd get at an actual look at what this CPNE looked like, my only hands on opportunity before the real deal.

I knew the school offered workshops along with allllll of their "online conferences"... I remember thinking when I first looked at this stuff wow that would add up quickly- a couple hundred here, a couple hundred for supplies, $700 for a live workshop, $150 for a skills conference or whatever, I mean damn if you really utilized all of the options they have to prepare for this thing you'd be DOUBLING your school costs! My opinion of all of this is that it's nonsense, if your students really need all of these things to even have a shot at passing the CPNE then it should be MANDATORY, it should be incorporated into the program and tuition. Otherwise your motivation is purely monetary.

This along with my personal experience of zero help or concern from the school over the past year cemented the idea in my head that the money uses this CPNE as a cash cow, and it is a highly effective cow folks! This process has been orchestrated to feed the cow and anyone that's gone through it can attest to that. As such, my theory was that I didn't want to spend ONE more dime at this place than I had to. To further my decision was the fact that the Excelsior pass rate sucks..... people doing the Excelsior workshops were still failing the CPNE left and right, but how could that be??? I mean they were getting their info right from the source, it should be a slam dunk..... Well the truth of the matter is this, in a normal scenario getting your info straight from the horse's mouth should give you the best possible chance to perform as the horse wants, in Excelsior's case the horse is schizophrenic.

For real.

Well what other options do you have then?? PRIVATE WORKSHOPS that are NOT affiliated with the school. I had heard of Sheri Taylor's workshop a million times, it kept popping up. It turns out I'd heard of it a LONG time ago when I signed up for her free video series for the CPNE right when I started taking my theory exams, I figured I'd save them for when I was done and ready to study for the CPNE. I'm so glad I did.

Everyone you ask raves about Sheri's workshop, and no we're not all on some cute groupie bandwagon, or because she pays us billions to send people her way (aha!!), we rave about her because her stuff works. She has nothing to do with the college (which in reality is probably why she is so good at it ha!) and she teaches you succinctly how to study, what to study, and how to dodge the curves they throw at you. She agrees that the way this exam is conducted is ridiculous, that it does not really evaluate how good of a nurse you are or will be, and that the info and exam requirements from the school are convoluted at best which adds to the ridiculousness.

After I realized that all of these people were obviously advocating for Sheri's workshop over any others and once I saw more and more people failing that were doing Excelsior workshops I decided ok there must be something to this. What sealed the deal? Pass rates. Sheri's collective pass rate is around 94-97% ish. Excelsior's........ well they don't give you a statistic on students who pass that have taken their workshops. Don't ask me why, because if it were good they should be shouting it from the rooftops, no? So you have to extrapolate some data...

Excelsior will tell you that the pass rate overall for the CPNE is 62% (which in my opinion is a lie, I can do math and I've watched the passing reports from students over several months, it's not 62% . Furthermore, that 62% includes people who have done these private workshops which skews their data upward and they don't disclose this detail). But let's give them their 62%, again this includes us passers from Sheri's workshop which bumps the average up, and it includes those who did not do any workshops (which may or may not lower the average) we'll just say that lowers it, so realistically their workshop average must be close to their stated 62% of overall passers in general.

Well what would you put your money on 62%.... or 94-97%.... it's a lot of money on the line folks especially if you have to repeat! So yah, I went with the better Vegas odds and I will tell you, like any good friend of yours should, you're STUPID if you don't do the same.

I found a way to budget in the cost of Sheri's workshop, the airfare, hotel, etc and made it work because this was my last chance to see what I was in for and in turn figure out how to study appropriately. I picked my workshop date for 2 weeks prior to my test date and figured that I would prepare at home as much as I could and then show up to the workshop as if I were showing up to the actual test and see what feedback I would get. Then I'd take the feedback and make the slight tweaks  for the next couple of weeks until my test.

I then signed up for Sheri's online workshop figuring that I'd get a head start on everything so I could go into the workshop as prepared as possible using it as somewhat a mock trial cpne. I started watching videos for a couple of weeks before I arrived at the in person workshop. This helped me tremendously! I was able to actually see what it looks like to perform the labs, what the assessments look like and how to incorporate all of those outrageous details and critical elements into what I was doing. It was like having someone standing with you saying "yep do that, ok now you want to do this like this, and NOPE you'd fail for that so make sure you don't do this". I was able to see what it sounded like to talk your way through your areas of care, what to say to the patient, tips and tricks on which order to do things in, things to look out for, the what-ifs. I was able to ask questions on anything I needed clarification for and read questions and answers from other students that helped broaden my understanding of what was expected for the exam.

I'll say it again, these videos were critical for me, I had been out of direct patient care for about 3 years so even doing simple assessments was not something I was used to doing and you forget things! The lab videos were equally as important because it gave me a visual on how to set up my own supplies, I had no clue where to put things or the most efficient way to practice, I learned this in the videos by observing and I learned even MORE in person.

At the actual workshop you have 3 days to cram it all in, I wouldn't advise going until you feel pretty confident in what you're doing because it'll all be over your head and you wont get as much out of it. That's my opinion, unless you're able to take the workshop twice, once at the beginning and one right before you test, I highly recommend going AFTER you think you know it all so that they can pick you apart and say "you're close but you need to do it like this" and that way you're just polishing the rough edges and getting the much needed confidence boost that you do have a grasp on it! Otherwise you're going to take the tough love the wrong way.

I love that Sheri and Greg are no nonsense, that's the way I am, I tend to be pretty straightforward not a lot of beating around the bush and as much as you may want someone to coddle you and hold your hand through this thing that will not help you. So they tell you where you're screwing up and tell you how to fix it. When they tell you to stop doing something a certain way don't try to argue and rationalize your point, just shut up and do it the way they tell you because the CE's on your exam day won't want to listen to your story either, they'll tell you too bad you failed. So don't be defensive about their critiques, it's like a mathematical formula 1 + 2 = 3 if you want to argue that it could be 4 you're going to fail your exam but go ahead and argue all you want, in the end it's 3. This is what Sheri and Greg will try to impress upon you throughout the weekend, just take it all in and adapt what you're doing.

The most valuable thing I got out of the workshop was careplanning, I really had a pretty decent grasp of it beforehand thanks to her weekly feedback on practice careplans (another bonus of the online workshop) but I was able to REALLY get down to the details in person. I learned how to write a bulletproof careplan that no one could argue with in a short amount of time. I learned to take a Kardex and glance at my assigned care areas and know what labels to go with in about 5 seconds. I finally learned how to pick a label based on my areas of care and what I was assigned to do so that I wasn't adding more work for myself. I learned to write those careplans with a limited amount of information so that I could write a careplan even EASIER when I had the whole chart at my disposal. These are the things that are invaluable, that you won't find in the study guide. Being able to hear "sure that nanda label will work, but I'd go with this one instead because of xyz" when you pick a label for a patient that you think would be great because the alternative label makes your experience in the patient's room easier and gives you a much better footing for evaluation. It's the whole start to finish thinking that she really brought home for me, instead of focusing right there on the planning labels you better be thinking about the eval statements and doing so may mean picking a different label that works just as well that will be easier in the end.

We also went over all of the areas of care one by one while Greg demonstrated and pointed out the critical elements of each one and how those related to the mnemonic for that AOC. This whole thing felt just like our lab time in actual nursing school, I loved it. After doing this distance program so isolated without any interaction with other other students, only having my non medical family to talk with about things while they looked at me like I had 3 heads, it was great to finally chat with other people I could relate to! To commiserate, to laugh, to bounce ideas off of one another. To mess with equipment that I hadn't touched in years. All of which provided amazing support and clarification that I needed. It was kind of like a pep rally for me and I had such a good time with all the other people there that I was ready to head to the hotel and have a bbq volleyball hang out session each night after we were done.... everyone was too busy studying and practicing unfortunately.... party poopers :) Perhaps I'll have to go back down another time to volunteer to help and I'll rally the troops for some de-stress fun time each night.

Labs were also great! I will admit I had purchased my own supplies at home, I had them sprawled all across the table and had messed around with drawing up meds and attempting the wound maybe a handful of times but I didn't really practice start to finish because I didn't have a clue how to set it up efficiently.... I mean I really wasn't sure how to do it so I would just stare at everything and pick up a syringe one night and then mess with the tubing another night, complete waste of time. At the workshop I got to see the 'right' way to set up each lab station, how to label the meds, how to fill out the paperwork, where to put your supplies, all of this stuff that I was half assing at home. So when I finally did get home I spent the next 2 days labeling my vials, printing off recording forms, and setting out each lab just as I had seen at the workshop so I could finally practice things! This is what I reference in my preparation post because I had no clue how to really do things logically until I saw it first hand as silly as that sounds.

My ONLY complaint, if you could call it a complaint, was that there wasn't enough time to do a full out mock trial of a PCS or lab check off start to finish so that I could truly be put to the test as if I were at the CPNE itself. I really wanted someone to just stand over my shoulder and give me that experience so that I could put my nerves to the test but we didn't have time to really do this. I did do this with other students and I would highly recommend others do the same early in the morning or during lunch, this really helps. If there were any way to add another day to the workshop I would've loved to do this!

Bottom line, it was worth every single cent I paid to get to that workshop, for my actual skills and also for my morale. I walked away knowing exactly what I needed to tweak to be 100% ready and felt like I finally had a pretty damn good shot at this thing. While I will tell you there was never a point that I felt completely sure of myself, not even going into day 3 at the cpne, this was the most confident I felt throughout the whole ordeal and I surely would not have passed unless some crazy intervention came about without doing this workshop. I even watched videos while I was AT my cpne, in the hotel room before our lab checkoffs and watched videos on the AOC's throughout the weekend to make sure they were still fresh in my brain.

I'm proud to be part of the 94-97% and because of that I continue to be a Sheri groupie. Given the choice of workshop options until Excelsior's pass rate can contend I don't see how you could argue with it.

And NO I do not get some sort of kick back for promoting for Sheri, there is no referral fee or any other compensation here just my opinion of the best resource to use to tackle this thing!


This is part of my post series on Excelsior College's ADN nursing program and the CPNE experience. See all related posts over here.  Read more!

CPNE: Evaluations and Rationales

This is Sheri doing her thing and breaking down evals.


Moving on to the final part of documentation, your evaluation form with rationales. Just thought I'd write out the ones that I used for my 3 PCS's and then a couple of the ones I used for practice care plans for reference. The main thing I focused on in careplans was to ensure that my evaluation would be a piece of cake, I never picked a diagnostic label that would or could possibly set me up for a challenge at eval because I figured if you made it that far the last thing you want to do is mess up the eval!I made sure, as best as I could, that I'd be able to check that "effective" box when I selected my interventions, I wanted to avoid the 'not effective' and 'unmet' options like the plague.

For evals you're basically restating what you did in reference to your label and whether or not the patient moved toward the outcome. I copied over my planning phase care plan verbatim for the applicable areas and went from there.  They will sound redundant, that's OK. Same for rationales, after you get a few under your belt you will use the same wording in all of them, don't try to reinvent the wheel if it works run with it!


PCS #1 Evalution: (Choices were Impaired Gas Exchange & Activity Intolerance)

Nursing Diagnostic Label: (copied exactly from my planning phase)
Impaired Gas Exchange

Related Factor:
Ventilation perfusion imbalance-COPD


Signs & Symptoms:

Patient complains of dyspnea and fatigue.

Outcome:
Patient will have a capillary refill of less than 3 seconds in both hands during PCS

Patient's progress toward the expected outcome:

MET
Patient had a capillary refill of less than 3 seconds during PCS.

Intervention #1:
Nurse will continue to administer oxygen as ordered via nasal canula during PCS
 
Evaluation of effectiveness of interventions in moving the patient toward the expected outcome:
Effective
Oxygen was administered as ordered via nasal canula and patient had a capillary refill of less than 3 seconds in both hands during PCS.

Intervention #2:
Nurse will offer rest periods during ambulation during PCS.

Evaluation of effectiveness of interventions in moving the patient toward the expected outcome:

This one was a little tricky since my patient went crazy, I debated about checking the effective box because I DID offer the rest periods and the outcome was achieved, I probably could've gotten away with that but I opted to include a little detail about what actually happened just to be on the safe side.
Effective (I did check effective)

Rest periods were offered throughout ambulation and although the patient declined the need to rest his capillary refill remained less than 3 seconds in both hands during PCS. Continuing to encourage rest with activity will improve oxygenation.



Rationale explaining whey this nursing label is a priority diagnosis for this patient during the PCS.
Effective oxygenation is a basic physiological need in order to deliver oxygen to the tissues for vital functioning. By continuing to administer oxygen and encouraging rest during activity the patient will be able to maintain a higher level of oxygen perfusion which will aid in recovery and decrease the chance of further complications.


PCS #2 Evaluation: (Choices were Acute Pain & Activity Intolerance)



Nursing diagnostic label:


Acute Pain


Related Factor:




Tissue Trauma- abdominal surgery


Signs & Symptoms:


Patient states pain level 4 on 0-10 scale.


Expected Outcome:
Patient will rate pain level 3 or less on 0-10 scale during PCS
Patient's progress toward the expected outcome:
MET
Patient rated pain at a level "0 to 1" on a 0-10 scale after implementing interventions during the PCS and states that she feels "wonderful" and can't believe the difference in how she feels in just 1 day.


Intervention #1:


Encourage patient to use PCA pump at regular intervals to better manage pain during PCS.


Evaluation of effectiveness of interventions in moving the patient toward the expected outcome:
Effective

Patient was encouraged to use the PCA pump regularly to better manage pain and reports feeling "wonderful" with pain at a level "0-1" on a 0-10 scale.



Intervention #2:
Reposition patient out of bed to chair x 1 during PCS.
Evaluation of effectiveness of interventions in moving the patient toward the expected outcome:
Effective

Patient repositioned out of bed to chair during PCS and reports feeling "wonderful" with a pain at a level "0-1" on a 0-10 scale.

Rationale explaining whey this nursing label is a priority diagnosis for this patient during the PCS.
Freedom from pain is a basic human right and physiological need in order for the body to maintain a state of homeostasis. If pain is not managed at an acceptable level the patient is at risk for further complications including prolonged immobility that can lead to dvt's, pneumonia, and atelactasis which will delay recovery and prolong hospitalization.



PCS #3 Evaluation (Choices were Impaired Gas Exchange & Activity Intolerance, again)

Nursing diagnostic label:


Impaired Gas Exchange


Related Factor:




Ventilation perfusion imbalance- COPD

Signs & Symptoms:


Patient complaints of severe dyspnea.

Expected Outcome:
Patient will have an oxygen saturation of 92% or higher on oxygen during PCS
Patient's progress toward the expected outcome:
MET
Patient had an oxygen saturation of 92% on oxygen during PCS.


Intervention #1:


Continue to administer oxygen as ordered via NC during PCS.


Evaluation of effectiveness of interventions in moving the patient toward the expected outcome:
Effective

Oxygen was administered via nasal canula at 1.5L/min as ordered and patient had an oxygen saturation of 92% during PCS.



Intervention #2:
Nurse will position patient upright out of bed to chair x1 to facilitate oxygenation during PCSEvaluation of effectiveness of interventions in moving the patient toward the expected outcome:
Effective

Patient repositioned out of bed to chair during PCS and had a oxygen saturation of 92%.

Rationale explaining whey this nursing label is a priority diagnosis for this patient during the PCS.
Effective gas exchange is a basic physiological need necessary to perfuse oxygen throughout the body for cellular functioning. Without adequate oxygenation the patient is at risk for extensive complications including cellular death and decreased cardiac output which is further complicated by the patients COPD and CHF.



Some other rationales for reference: See how they all start to sound the same??




Ineffective Airway Clearance:
A patent airway is a basic physiological need in order to deliver oxygen to the body for cellular functioning. Continuing to perform respiratory hygiene activities and positioning the patient upright will further loosen secretions and facilitate proper oxygenation of the tissues which will increase recovery and prevent further complications including pneumonia and atelactasis.
 
Ineffective Peripheral Tissue Perfusion:
Adequate circulation is a fundamental biological need for the body to deliver nutrients and oxygen to the tissues for cellular functioning. Without appropriate distribution of circulation to the peripheries the patient is at risk for further complications including tissue necrosis and thrombi formation that will delay recovery and prolong the hospital stay

Imbalanced Nutrition Less Than Body Requirements:
Adequate nutrition is a basic physiological need in order to meet body requirements for cellular growth and homeostasis. Keeping intracranial pressure within normal limits with the use of ordered medications and proper positioning will stabilize the patient’s internal regulatory mechanisms and encourage the patient to resume a normal appetite. By continuing to offer the patient formula at regular intervals the patient will have the ability to ingest adequate nutrition to promote healing and prevent further complications.

Acute Pain (another version):
Freedom from pain is a basic human right and important physiological need. Failure to manage pain appropriately can delay patient recovery, worsen mobility impairments and lead to serious complications such as deep vein thrombosis and pneumoni

This is part of my post series on Excelsior College's ADN nursing program and the CPNE experience. See all related posts over here. 





Read more!

Tuesday, April 3, 2012

Cancer: An evil condition that spreads destructively


If you look up cancer in the dictionary it states: any evil condition or thing that spreads destructively; blight. Well isn't that putting it mildly... destruction is an understatement.

I've been wanting to do a post about what cancer has meant to me.. how this diagnosis, albeit my Father's and not even mine, has literally churned my insides and flipped my life upside down. I joke about therapy, which is ironic because my mom is a psychotherapist, yet I am the type of person that subscribes to the theory of "get over it, shut up, put up, and move on!" (thanks for that, Dad) It's a running joke in the family that there's a reason I'm a nurse and not a therapist because I'd make a HORRIBLE therapist! That's just my personality, I'm not usually one to loathe in self pity and problems and quite honestly have a limited amount of patience for others that do. If that offends anyone... sorry... that's me, like it or leave it. I mean it's like my latest tattoo... "Get up and fight another round"... suck it up and roll with the punches folks, life can suck that's for sure, the goal is to realize the greatness you can experience along with the bad. That being said, I process things differently, I work things out in my own mind.

Part of me working it out in my own head means that I tend to shut down when emotional experiences arise, at least to the outside world. I don't like to talk about my problems, my anxieties, my fear, my anything. I go inward and figure it out on my own and then I come back to "earth". This has been quite an interesting challenge as of lately... more on this later. So here's to processing... in my own head... but outloud on this blog so that I can make some sense of what I'm going through.

The past year has been hell, I'll be honest. I have struggled with complex emotions from the joy of a new baby alongside the devastation of cancer. Losing my uncle to cancer the day after Baby D's birth and my Dad's diagnosis shortly after. This diagnosis has literally effected every single facet of my life inadvertently. I struggle with finding the words to really express just how crazy and awful this has been for me. It has hardened me as a human being, forced me into being "cold" to the outside world all the while being far from "cold" inside. And because of this it has created a rift in my marriage. Exact words out of my husbands mouth one evening were "you know I always figured if something like this was to happen it would bring us closer... and it hasn't... at all".... and he's right. Rather than confiding in my best friend and partner in life I have gone inward to deal with this on my own. I've alienated him and shut him out. A part of me thinks that he could not possibly understand what I'm going through, unless it was his Dad, so there's no point in trying to lean on him for support. But my heart breaks knowing how hard he's trying and I'm just shutting him out. Not to mention my pride... I stand tall no matter what I go through, no one and I mean NO one in my life has ever known the real hardships I've experienced because I always put a brave face on and I do it well. It has been an immense challenge for us, an unwanted challenge mind you and this is just a hint of the "destruction" cancer causes.

This experience has made me question everything about life. It's made me angry. It's made me feel helpless, which pisses me off. And it's made me feel extremely guilty... while I've been focused on my Dad's cancer and treatment I've neglected myself,  my husband, my kids... my BRAND NEW BABY. I feel like I have an almost one year old that I've never truly been able to appreciate, a one year old that hasn't gotten the best of his mommy... a family that's been put on the backburner while I focus on the patriarch, a man who means more to me than I could ever express. Guilt.... overwhelming guilt... tears, that I only cry in the middle of the night into my pillow quietly by myself. Aggghh this feeling is gutwrenching. It's like clawing for your life as you hang from a cliff with one arm slipping farther and farther away.

But oddly enough it hasn't all been bad, which makes it even more overwhelming. This experience has made me realize that I need to appreciate the everyday things. That I need to strive to be a better mom, a better wife, a better student, a better nurse, a better ME. It's really been an eye opener on enjoying the present. Not constantly fighting for the future, for the next step, the next house, the next kid, but stopping and enjoying the NOW. Stepping back I see that there have been good things from this experience, real things that actually have happened to change me, rather than getting caught up in the cute cliche of "appreciate your life, be thankful what you have" I can honestly say I really and truly am experiencing that concept. And it's been subconscious, I haven't had to force myself to adapt these ideas, they've just come about... I take a look around and go, wow for once I'm content with my current surroundings and it feels GOOD! For once in my life I truly feel a sense of calmness and peace about where I am in life. I don't feel like I am on a perpetual stepping stone to the next phase of life. I am happy with where I am and who I am. Honestly for once in my life I am really starting to feel this... surreal to say the least. It is a feeling that no on one the planet can understand unless they have lived it, I mean really they just can't possibly come close to understanding the gravity that this experience carries with it.

As I type I sit here cautiously optimistic after my Dad has been re-admitted to the hospital this morning. His kidneys have stopped functioning, most likely due to scar tissue blocking off the plumbing. So he's laying in a hospital bed with tubes coming out of his back, doped up on pain meds, waiting in limbo.... this goddamn limbo I feel like we've been entrapped in for nearly 12 LONG months. Every doctor gives a different story... the primary care resident talking about "soft tissue masses" and "lytic bone lesions" appearing on the CT scan this morning.... aka- cancer. More FUCKING CANCER. I HATE YOU.

I HATE YOU

I HATE YOU

I just want to scream and hit someone in the face... can we ever catch our breath here... ever or is the rest of my life (or moreso my Dad's life) going to involve this constant walking on eggshells feeling... this anxiety and helplessness. What the hell did HE or the rest of us do to deserve this. Here we are sitting in the same shitty hospital 2 rooms away from where we were when this fucking nightmare began a year earlier and yet we're STILL going through this crap. My Dad even has the same nurse.... it's like a twisted deja vu and it makes me angry, so angry... I'm very good at angry.... And as I begin scanning my nursing knowledge of bone cancer, metastatic processes, myeloma, etc and I'm ready to break down. I want to jump out of this 8th floor window. Then the urologist walks in, who I really like and know well (we've been seeing him regularly this whole year), and he says he is very confident that this acute problem is not related to cancer. Long story short, he doesn't think there is any recurrent cancer that is causing this problem, he thinks it's moreso a "plumbing problem" He thinks that the interpretation of the CT results by the radiologist this morning are wrong to put it simply.

So I breathe a sigh of relief... but only briefly because at this point we really just don't know... once I hear the interpretation by the oncologist I will feel more confident in what we're dealing with, until then I continue to hold my breath. Are we about to embark on another nightmare.... or is this just an unwanted bump in the road. I dont have the answers. Limbo... once again. All I know is that I feel at peace about things right now, my intution is saying that everything is fine this time around rather than what it was telling me the last time we were in this godforsaken hospital on this godforsaken 8th floor, 2 rooms away. That time I knew it was BAD news, I knew something was very wrong.... this time I don't feel that way.

And thus we continue our ride on the cancer rollercoaster, it's a bitch folks, not for the faint of heart. And the destruction caused along the way is unimaginable for the great majority....  "sickness, evil, plague, scourge" couldn't even touch this experience... I wouldn't wish it on my worst enemy.

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