Nov 25 2007

Thanksgiving break

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p1040828.JPGSleet, rain, snow, and –6 degrees.

When I woke up yesterday morning and looked outside, the sight made me catch my breath. I hadn’t thought about snowfall in a long time. I touched the cold windowpane and remembered snowfalls when I was a kid on the east coast: how excited I was to wake up to the sound of the radiator whistling and clanking and see nothing but pristine whiteness outside; how I pressed my forehead to the window so that snowflakes filled my field of vision; and how the snow seemed to soundproof my neighborhood from the normal cacophony of people and traffic…

p1040864.JPGToday: stark, blustery, and still beautiful after some snow melted nearby. Reminds me of Poland in the Decalogue movies.

No, I’m not in San Francisco anymore. This past week I traveled far to see an aging grandma. I’ve had a little bit of time to reflect on my nursing school experience, but not as much as I’d like. I’ve finished with lecture and have only 4 more days of clinicals before a 3-week winter break, so essentially, I’ve already started my winter break. I’ll definitely write more about school and answer your questions over the next couple weeks. Happy winter to everyone.

This is what San Francisco looked like before I left for Thanksgiving last week; this is also my bike path to school:

p1040826.JPG

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Nov 13 2007

Updates

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FYI: My Burning questions? has updates.

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Nov 07 2007

Fall quarter is coming to a close

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Today was my last class of the fall quarter. For the next 4 weeks, except Thanksgiving, I will only have clinicals. Winter break will then be three weeks long. It’s still hard to believe that I won’t be back in lecture until Jan. 2.

The best thing about this quarter was the continuity between Intro to Nursing in the summer and Med Surg in the fall. Having these classes and clinicals back to back have been critical to helping build my confidence, skills and perspective as a student nurse. The continuity also has helped some of us strengthen our rapport with nurses on our units, so much so that many nurses now know us by our names and acknowledge our progress and contributions.

The downside is that some of the teaching continued to be shockingly bad and inappropriate. Since the beginning of MEPN I tried to keep a level head about one of our key instructors. I tried to understand that she simply has a different communication style, personality and background. Unfortunately, she proved time and time again that she truly doesn’t know how to teach nursing to 2nd and 3rd career changers like us and doesn’t know how to communicate with people like us who have had valuable life and work experiences that were not necessarily related to health care. Furthermore, she gave us no direction (or gave wrong direction) about her expectations for exams and assignments and focused on petty details instead of what was really key to our understanding of nursing.

During the summer quarter, many in the class tried to give constructive feedback about her teaching and communication skills, but still nothing changed this quarter. I understand change can take time, but some of us fear that the school might not take our instructor and course evaluations seriously.

It may seem petty of me to focus on one instructor, to let one person have such an impact on my experience, but it’s not something to be belittled. The MEPN curriculum is so compacted and the experience so new and intense that one person makes a bigger impact than in a more normal situation. My hope is for the faculty to listen to our feedback and believe that it comes from our desire to become good nurses and not because we don’t “get it” or because we want to be a pain in the ass.

That’s my venting and I’ll try to leave it at that. Life is good and vacation is coming soon!

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Nov 04 2007

Student luxuries

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I’m reminded time and time again that my life as a Student Nurse affords me the ultimate luxuries: the luxury of having only one or two patients to pour my energy into (i.e. Hello, let me check and empty your pee hat every single hour so I can track all your output) and the luxury of being able to ask stupid questions and make even stupider mistakes (i.e. disconnect an IV tube and fling the end of its sterile tip on to the bed like it was a telephone cord, or offer an NPO patient water and lunch, multiple times).

Because I know the day is quickly coming when I can’t fall back on student privilege, I’ve started keeping track of small successes after each clinical shift. I’m also trying to keep a list of details I missed during my shifts so that I can try to remember them next time.

Here are two small successes:

1) Advocating for a 68-year-old man with a tracheostomy tubedal_240a_lg.jpg

A tracheostomy can be a scary thing when you see—and hear–it the first time. I mean, to put it simply to my non-nurse readers, it’s a hole in a person’s neck (windpipe) with a tube coming out of it to make breathing easier. Hole, tube, neck (and blood because the hole was fresh) are what my mind latched on to when I first saw a “trach” last quarter. When the person breathes you can hear mucus rattling in his throat. When he coughs, the mucus gets squirted out of the tube that is sitting in the hole in his neck.

Last week, with fingers trembling just a little, I inspected my patient’s tracheostomy site. I could tell that the site would need thorough care and cleaning and I noticed that one edge of the neck plate (which holds the tube to the neck) was digging into his skin, causing a red sore on his neck. My nurse and I tried to clean the trach site but she then had to rush off, leaving me feeling mightily unsatisfied about the work we had done.

Throughout the day I kept bugging her about the sore on the patient’s neck, until she suggested that I call the Respiratory Therapist for advice. I called him twice. When he finally came around, he taught me how to properly clean the trach, take out the cannula, and how to reposition the neck plate. He recommended that Aquaphor cream be applied all around the site to protect the skin. When we were done, I was elated! I felt like I had made a tiny difference in this person’s care – and I didn’t even mind that he showed zero appreciation. That’s love, isn’t it?

2) The same patient: a pressure-sore discovery

It was reported to me that the patient had a Stage 1 pressure sore on his sacrum due to his immobility. Depressed, he lies in bed all day with very little movement, which is no good for his skin. (For my non-nurse readers, a pressure sore, also commonly called a bed sore, can go from being red and non-blanchable (stage 1) to total skin and tissue breakdown (stage 4) if it’s not taken care of).

As someone who has been terribly negligent about checking patients’ skin carefully, this time I was determined to do a thorough assessment. With my instructor’s guidance, lo and behold, I found a tiny spot on his butt that was no longer covered with skin. It was the beginning of a Stage 2 sore. If left untreated, and if the patient were to continue to lie on his back, that tiny sore would get worse.

I covered this Stage 2 with cream and a duoderm dressing, diligently turned him in different positions every 2 hours, and hoped for the best for him, because he’d need it: He was going to a nursing home the next day and sad to say, nursing homes = land of bed sores.

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Oct 30 2007

Autumn musings

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1. Fall is here, and it’s beautiful and makes me smile to myself.

2. We’ve hit a mid point: There are only 5 weeks left to the quarter.

3. I’ve been treating MEPN as a break or pause in my real life, as though after I’ve completed the program, I will go back to my regular life. This is a detrimental way to look at my next few years, because I end up looking to the future instead of living in the present. What I need to do is embrace my everyday life now. I need to see MEPN as part of my real life. This means not thinking too far, not rushing or feeling rushed to get my NP license or Master’s, not forsaking time with my friends, and not forgetting my other interests and creative pursuits.

4. It’s going to be weird when I’m working and not surrounded by classmates. It’s even going to be sad and bittersweet. It’s going to feel a little lonely walking amidst strangers again and not running into a familiar face for days at a time.

5. When I’m an RN, Med-Surg is going to be tough without having peers who understand exactly how I’m feeling.

6. The days move so fast that it’s hard to feel like I’m really getting to know anyone, or that anyone’s getting to know me. I hope I’ll have a few close friends who will be a part of my life after MEPN.

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Oct 23 2007

Observation Days: OR, ED, and ICC

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This quarter I have most Tuesdays off from school, except 3 days when I go to a different department in the hospital to shadow a nurse to see just how different each unit is. My placements have been extremely valuable for assessing my options and interests:

Week 1: Operating Room
I have a relative who works in the OR and she said the nurses there love it and would never leave, so I went to this observation with great interest.

Oh, is that it? I was fully underwhelmed.

I stood in a cold room and watched one nurse hand tools to the surgeon and watched the “circulating” nurse keep an eye out for problems, remind an MD to put on his mask, and play Solitaire on the computer.

The operation was interesting, of course, but since I’m not trying to be a surgeon, it was kinda moot. (I did, however, like to see how I’d react to blood, flesh and guts! Blood and guts? OK; Cauterized flesh with a little smoke arising from it? Not so OK.)

The OR rotation reinforced for me my love for patient interaction and my aversion to boring, sterile work, therefore, the OR is out.

Week 2: Emergency Department
Now this is more like it! Hustling, bustling, adapting, flying, running, communicating… I could tell my preceptors were loving their job, and better yet, didn’t mind taking me along for the ride. In my 12 hours in the ED my nurse dealt with: a woman trying to come off crack, a woman in respiratory distress, a 10-year-old bipolar boy, and a young woman with multiple personality disorder.

I asked three fairly young nurses how they chose the ED and what they liked about it. They all said they knew they wanted to work in the ED as soon as rotated through it during nursing school. They like seeing a lot of different patients and conditions throughout their day, they get bored by med-surg’s chronic care patients, and they like the fast pace. I also noticed that communication between nurses and MDs in the ED were very different than on the Floor. Somehow more collaborative and respectful. I also found it highly amusing that some of the ER docs reminded me of George Clooney’s character on “ER.” I guess that show got it right on the money.

Man, after this observation I so wanted to be able to imagine myself as an ER nurse! I think there’s definitely a coolness factor with being an ER nurse: It is badass to be able to handle anything that comes your way.

But, alas, this department didn’t click with me 100% either. The ED remains an option, but I’m still searching for the ‘one.’

Week 3: Intensive Cardiac Care
Hmm … The ICC is probably the most disconcerting place I’ve been to so far. The acuity of the patients and their multiple tubes and IV drips were quite intimidating. Each nurse is responsible for 2, maybe 3 patients (vs. 4 or 5 on a med-surg floor)–that’s how critically ill each patient is. But my charming, Irish preceptor quickly put me at ease. She said she likes the ICC because the team works wonderfully together and the management is extremely supportive. A few MEPN new grads have done their step-out year in the ICC, but generally, an intensive care unit is challenging for new grads.

There is an amazing special feature that follows a new grad in the ICU for six months, by the Boston Globe. It is fascinating. It’s the first feature of this kind in the mainstream public media. Its intent was to give the public a really deep, insightful look into the work of nurses. It also scared the crap out of me in a thrilling I-hate-scary-movies-but-I-have-to-watch kind of way. It could inspire you, too. Check it out at: http://boston.com/news/special/nursing/top/

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Oct 18 2007

Mind vs. body

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6:17 a.m. Some mornings I wake up and wish I had a regular job. So that I can call in sick. It’s a herculean battle between mind and body.

Yikes!! I’ve missed my pledge to blog once a week. I’ve got to leave for clinicals in 5 minutes, but very quickly these are the two important entries I’ve been crafting in my head:

- The public image of nursing and how nurses are working to change it for the better. I’m on board for this. I’m proud to be a nursing student and nurses are the most hardworking, undervalued professionals I’ve seen.

- The face of nursing school and nursing. Both seem to be dismally underrepresented by ‘minorities,’ while the face of our patients is increasingly diverse. Are schools retaining students of color? (No.) Why aren’t there more professors and nurse leaders of color? What’s being done about this?

Ok, gotta run. Have a good week!

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Oct 06 2007

Scatology!

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I learn something new every day. For instance, I didn’t know that there’s an aerosol bottle in every patient’s room that can be sprayed to help mask foul smells. When a patient poops into the waterless commode, I have to stand near him/her to make sure s/he doesn’t fall off. For the past two months I just stood there each time, suppressing the urge to run and silently begging for a reprieve. (I’ve got willpower like you’ve never seen before, unless you’re a nurse.) Then one day a nursing assistant took that little spray out of my patient’s closet and turned my life around.

Some laughs:

Morning report
Night nurse to morning nurse: …so Mr. X had xyz and abc, and he had explosive diarrhea this morning.
Me: Ha ha ha!
[Morning & Night nurse: faces blank]
Me: Sorry.

Changing soaked bedsheets with overweight patient in bed
Nurse [whispers]: She has the biggest bladder I’ve ever seen.
Me [feeling the cold urine through my gloves]: Mmhm. Wow.
[Patient farts in our faces while I hold her on her side]
Nurse to patient: Are you done?
[Patient nods]
Me: [Ha ha!]

Giving report to my class
Me: My patient is an 85-year-old male, status post diarrhea. He developed…
Teacher: No, you wouldn’t say status post diarrhea.
Class: Ha ha!

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Oct 04 2007

First cry on the job. A hundred more to go?

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I finally have some time to journal…last week was the toughest week for me since school started. I had my first back-to-back 12-hour shifts that went something like this:

Wednesday: Went to hospital to “pre-lab” a patient, meaning pick a patient to work with during your shift on Thursday. I chose an elderly man admitted for dehydration and a UTI. Upon being treated for dehydration, he became overloaded with fluid and developed acute renal failure. I asked his current nurse if the patient was very complex or was he someone that I could take care of on my own. She said, “Oh, he’s fine. He’s really easy!” Went home and researched everything about the patient’s condition and all his medications.

Thursday: Woke up at 5:30 a.m., biked to the hospital, and had a busy morning putting together all the meds and assessments my patient needed. I thoroughly understood his condition and had pieced together his whole history, complete with lab values to back up the history. At 7 p.m. I reported about the patient to the on-coming night nurse, and left the hospital feeling light as air because I thought I had done my job as well as I could.

Friday: Woke up at 5:30 a.m., biked to the hospital, and started preparing my meds again.

8:00 a.m.: My nurse and I helped the pt. avert a diarrhea disaster in his bed.

8:30 a.m.: I asked my clinical instructor to watch me give the medications. She said: “Sure! Now, tell me about this one. And this one. And what kind of anti-hypertensive drug is this? And is that the right dose? What’s the therapeutic range? What blood pressure is considered hypertension? What are the side effects of this one? And that one? And this one?”

Yesterday I had the details, today I had only the general idea. It wasn’t good enough.

“You’re not ready to give these meds.”

My confidence imploded. She was right. Shame flooded over me. If only she knew how many hours I spent preparing for this patient. If only she saw how prepared I was…yesterday—but that doesn’t matter. What mattered was that I had gotten sloppy already.

I sniffed back tears while I assessed my patient. When I noticed how sick he was–sicker than the day before–my shame grew. When I couldn’t choke back the tears, I snuck into his bathroom to talk myself down.

12 noon: My patient is looking worse. My nurse gives me no guidance, takes no initiative.

3 p.m.: The doctors order an EKG stat because his potassium level is too high.

5 p.m.: He may be transferred to palliative care. We tell his family. They burst out crying. I try to console them.

7 p.m.: I go home mentally and physically exhausted. It boggles my mind how nurses can take care of 4 to 6 patients at a time. I go home and make all sorts of worksheets to help me organize and learn my medications.

I found out later that my patient died the following day.

Lessons Learned: Don’t rely on busy RNs to see things from your perspective. Don’t get overconfident. Don’t be too hard on yourself.

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Sep 20 2007

Teaching shortage => Nursing shortage

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The first week of the fall quarter has been mellow, great for getting us back into the right mindset. Again, our class of 84 has been split into two groups, Schedule A and B. The exciting aspect of my group, Schedule A, is the two 12-hour back to back Med-Surg days at the hospital, which is from 7 a.m. to 7:30 p.m. We’re supposed to take on more responsibility–instead of ‘helping’ a nurse, we’re going to start off with total care of one patient, then two, then three–and maybe four by December. Holy moley. Very cool.

Aside from the Med-Surg clinicals, we only have class 1-1/2 days and are free the rest of the week.

Schedule B folks reportedly have more relaxed clinicals, because they are doing Pediatrics, Labor & Delivery and Community Health. Many of the students are glad to see other units of the hospital and of nursing, instead of Med-Surg. I’m personally glad to be doing Med-Surg now, because I can continue to build on my relationship with the nursing unit I’d been working at over the summer. It seems like most people are happy with their group and can see the pros and cons of both schedules.

So, the eye-opener of the week is the fact that the illustrious UCSF MEPN program was scrambling to find and hire enough faculty/clinical instructors to accommodate everyone for the fall! Two clinical instructors were out of commission this week, so Schedule A’s clinicals had to be cut down to one day instead of the normal two (this week only). A clinical instructor had to be pulled in last minute as a favor to our full-time instructor! The teaching shortage is very real. Without faculty, schools can’t accept or train all the people that want to be nurses.

I’m really curious about how nursing programs are run at other schools, whether they are also scrambling for faculty, and whether the accelerated ones are just as hectic and crazy as UCSF’s. If there are any readers out there who are in a nursing program, please, please chime in!

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Sep 18 2007

Worst fear or deepest desire

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Of all the questions/issues that my MEPN friends and I lost sleep over during the first quarter, two of the most disheartening might have been: Is an accelerated nursing program really for me? And, am I crazy, stupid or lazy for feeling this overwhelmed?

Question 1: Is an accelerated nursing program really for me?
I learned over the break that a classmate is dropping out. She wrote an email to the whole class, explaining that she decided a traditional BSN was more suitable for her. I know her email resonated with many of us, either because it was our worst fear or our deepest desire.

Normally a pre-licensure program occurs over two years; MEPN is one year. In creating the one year curriculum, an administrator told us, the school took a hard look at all the types of courses in a normal nursing program and whittled them down to the knowledge and experiences they thought were vital to being a nurse. They also whittled the credits down to the minimum number required by the Board of Registered Nursing. Apparently we’re taking only one credit more than what the BRN requires.

This compressed, bare bones curriculum can be a dream come true for people who want to become a nurse but who are short on time and money for a long program and/or who have already demonstrated their academic competence and maturity in college and on the job. Most of us were probably good students and hard workers in the past, so, in theory, a lot of reading and weekly quizzes are not outside the realm of impossible. I went into the program prepared for the workload and at peace with the fact that I wasn’t going to read everything or get an ‘A’ on every test.

But what I hadn’t anticipated was how we would be skimming the surface of subjects like Pathophysiology and Pharmacology, and how fast… The Pathophysiology class, for instance, was offered in the summer for a mere 10 weeks. It’s a critical piece to understanding our patients’ illnesses but there was no time to do it justice.

Many of us came to realize one or more of the following:

  • Either we want a deep understanding of concepts, or we don’t mind skimming the surface.
  • Either we like didactic class work, or we live for clinicals.
  • Either we find it exciting to run around like headless chickens, or that scares us shitless.
  • We can find the time we need for studying, but there’s no time left to process how our identity, language and outlook are changing.

The last point is the most salient for me. Within weeks I was expected to think and talk like a nurse, but after bending time to fit in classes, clinicals, studying and new people, there was nothing left over for processing and bringing everything together. This is a piece of the accelerated program that threw me for a loop. I felt like a whirling dervish–spinning into a nurse but not able to stop to really feel like one.

Within weeks it also became apparent that the way in which pieces of a person’s life come together can make MEPN either wonderful or stressful. I realized that I’ve got it pretty easy:

  • My man is 100% behind me, and is keeping me fed and housed.
  • I have a 10-minute commute to school.
  • I have no responsibilities to kids or parents.
  • I don’t have to take out loans, thanks to my dad’s modest pension. He labored for the City of New York Parks & Recreation for 18 years before dying unexpectedly three years ago. Thank you, Ah Ba.

But others are in the opposite situation. I didn’t have a chance to get to know the woman who dropped out, but I know she faced a very long commute to school, which would be enough to make me think twice.

She was also an older woman and a person of color.

I can’t say for sure whether her background had a bearing on her leaving the program, but as a woman of color from a working class family and the first person in my family to go to college and graduate school, I know color, class and culture most definitely inform my experience in MEPN and as a MEPN, as they do in any school and setting. No one seems to want to talk about the color, class and culture of the MEPN class, so I’ll post about this in the near future.

I give the woman props for making her decision. If her situation was like other people’s, she most certainly felt caught in a bind: What are you to do if you arrive at a place after months, maybe years, of dreaming, hard work and agony, and only want to run the other way but feel stuck because you don’t want to have wasted your hard work and/or because you can’t imagine what else you’d do?

And then there’s that feeling that you should feel lucky and privileged and even grateful to have been accepted to UCSF MEPN, because by god, it’s one of the top nursing schools in the country and there were hundreds of other applicants who didn’t get in, so what are you complaining about…&#!$&@?

Again, the decision could have been a piece of cake for this woman, but the agony about whether an accelerated nursing program–and UCSF MEPN–is really the right choice is very real to some students.

The question that bugged me in the beginning was whether I really could be a nurse and whether I really wanted to be a nurse. Fortunately, after a few challenging, life-changing clinical days, I felt I had made the right decision. UCSF MEPN, with all its problems, is the best route for me at this point in my life. But I know that if my circumstances were just a little different, if like in Jenga, one little piece was out of whack, things could easily crumble.

Question 2: Am I crazy, stupid or lazy for feeling this overwhelmed?
I’m going to have to finish this part another time…

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Sep 16 2007

The price of a phat vacation

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Update: Yes, I’m not alone! A classmate just called me and said: “I just got back from L.A., I’m totally out of it and I don’t remember anything. Help!” Tomorrow’s going to be interesting…

The two weeks have flown by and I quite unexpectedly failed to write for NursingZen. I’m sorry. To my utter surprise, when it came to thoughts about MEPN and even nursing, my brain completely, 100 percent, checked out this vacation.

When I tried to reflect on the first quarter of nursing school, especially because I wanted to share the experiences with you, I found to my horror that some memories were fuzzy, like the picture on an old TV, and some felt unreal, like a dream, but on the whole, my mind went blank. I might as well have had amnesia. I felt like the world of MEPN and of the journey to becoming a nurse belonged to someone else entirely.

Fortunately, it has started to come back to me, though not in the best way: The other day I dreamed I was at the hospital and was completely and totally mismanaging the care of all my patients. It was 7 a.m., and I hadn’t a clue who my preceptor was. Then it was 8 a.m., and I was letting a patient walk all over me. Then it was 9 a.m., and I still didn’t know who my patients were. No one would help me. I sensed doom. Then I woke up. Hmm, so those are my deep fears; that’s the real life that I’ve got to get back to. Tomorrow. Joy!

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Sep 16 2007

I like to play

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Biking to Sausalito I’ve got one word for the San Francisco Bay area in September: Spectacular. I didn’t want to be any place else for my break. I love how the bay dazzles with sunlight all day, how weeks of 80 degree weather turned my skin the color of caramel, how the winds from the Pacific ocean make my bike rides a breeze and how the colors at the farmers’ markets remind me that it’s actually fall, not summer. My connection to the Bay area is getting stronger!

In the beginning of the break I had a list of goals and projects (nursing school/nursing= obsession with time management), but thankfully, I think, the list flew out the window by day 2. Suddenly I had the kind of summer vacation I wished I had when I was growing up: carefree, with an abundance of new experiences and new people.

(A digression: Summer vacations when I was little were boring and dreary: While my friends went to camp or played on the streets, my evil stepmother kept me captive in my dark railroad apartment and loomed over me, ruler slapping in her hand, as I practiced math problems and was forced to teach her English. Later, summer vacations during college were fraught with stress about making money to support myself =(.)

This time, I had no worries. Every day I secretly thanked the universe–and my man–for the gifts of unemployment and student life (amazing!).

Highlights:

  • 12-mile bike ride to Sausalito
    Biking to Sausalito
  • Family weekend at the Russian River
    Russian River house
  • Hiking from Mt. Tamalpais to Stinson Beach
  • Rock climbing at Mission Cliffs
  • Farmers’ market Farmer’s market
    Farmers’ market

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Sep 03 2007

Burning questions?

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I’ve created a new Burning questions? page. Feel free to send questions and I’ll try to answer or incorporate them in my posts.

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Sep 03 2007

Vacation!!!

Published by nurseSF under Uncategorized

I never thought vacation would be so sweet. I’ve got two weeks of chilling and reflecting. My goals this vacation:

    Call friends
    Bike
    Hike
    Meditate
    Go to yoga
    Take out library books
    Blog
    Craft presents for friends
    Go rock climbing
    Swim
    Bake

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