Sep
26

10 Years

Dear Daddy,

10 years ago today, you took your last breath.

My world stopped turning.

I still recall vividly the day you called me from California, 6 months and 10 days beforehand. I had just gotten ready for bed. I was sitting in my papasan chair, replaying your voicemail asking me to call you as soon as I could. Something about the break in your voice. Something about the sigh after you said “Hey Tiney, it’s Dad”. Usually those words were followed by “Just checking in.” But this time? This time you just said you needed to talk. This time I needed to call you back. As soon as possible.

As soon as you picked up the phone and heard my voice, I could hear you catch your breath. The words came tumbling out before we could even exchange pleasantries. “I have lung cancer.” Knowing you, telling your children this news was likely the hardest part of this whole nightmare. I started weeping. All I could choke out was “Oh, Daddy.”

Then you told me you had had some scans. And it appeared that the cancer had already spread. “To my spine”. I knew what that meant. I was about to start nursing school. I knew what that meant.

I came home for one of your first chemotherapy treatments. It was a few days before Easter. I sat with you in your big recliner and watched the bag full of innocuous-looking fluid drip into your veins. When it was time to leave for the airport a few days later, I was getting into the car and saw you standing at the garage door, waving as we pulled away. I told Mom to stop, jumped out of the car and ran back to you. I wrapped my arms around your waist. I knew at that moment that I was moving home. I knew at that moment that each hug, each wave, each day with you was going to be a gift.

A few months later, my house in North Carolina was empty. My marriage was crumbling, but I didn’t care. I needed to get home. Kayley and I packed up the rental car with as much as we could fill and I sold or donated the rest of it, or gave it to my husband. I left him the car. I rented out the house. I didn’t look back. I didn’t cry.

We made the 3,000 mile drive. We unpacked and repacked and headed to Catalina to meet our friends and family. You and I drove the golf cart across the island. Riding beside you as I nursed an injured knee, I relished those private moments. You took me to the cliff where you had scattered some of your mom’s ashes. I saw you trying to hold back tears while you told me stories about your relationship with her, the grandma I had never known. About when she called you a few days before her death. About your memories and your regrets. I saw you struggle to pass along your own memories. To tell your own story. To carry forward the legacy you had received.

Those first few days in Catalina were the beginning of the end. Or the end of the beginning. You felt well initially but towards the end of the week you were too nauseous and too weak to do anything except sleep. You and mom took a helicopter back to the mainland ahead of the rest of us, and she rushed you to the infusion center for IV fluids. We spent much of the next month in and out of the hospital, watching your pain and nausea get worse and worse. Sighing with relief that you didn’t have brain mets. Weeping when your  oncologist reassured us he would tell us when it was time to have “the hospice talk” and that the time hadn’t come yet, while the same day he told mom that her dear husband was going to be dead in a matter of weeks.

Mom fought for you to get palliative care. It wasn’t easy. The hospital initially said no such programs existed. Until she saw a brochure about palliative care in the waiting room. We brought you home, got you a hospital bed. Pam walked into our home and into our family and gave us an anchor. Someone who knew what questions to ask and where to find the answers. Someone who could teach us how to care for you in the ways that you needed.

Over the next several days, you became more and more quiet. It was as if you were conserving your energy so that when you did speak, they were words that you needed to say. You pulled us aside for quiet conversations. You ate less and slept more. I would come home to find you and mom napping on the couch, snuggled as close as you could. You started to fear being away from her, begging her not to leave the room. As if each moment was too precious to waste.

Then one night we were watching TV in the living room when we heard mom scream for help. We ran to your room and found you on the floor, barely conscious. You had collapsed when trying to stand up. We couldn’t lift you. You didn’t seem to be in pain. So we pulled up a bean bag chair to cushion your head and covered you with blankets. Mom slept beside you on the floor. We slept in your bed, too afraid to leave you both. The next morning the fire department came and helped us lift you into bed. They wanted to take you to the hospital but you had made us promise. “No 911.” So we kept our promise.

You never woke up again. We held vigil for days. We gave you pain meds when your breathing sped up or became ragged. Dear friends who worked in health care stopped by and offered us support, assessed you for distress, advised us to raise the head of the bed a bit or tenderly washed your face. Pam helped us move you to the hospital bed that Papa Don had deconstructed in the living room and then reconstructed in the bedroom. We learned to reposition you, to bathe you gently. You didn’t like being moved.

We played music around-the-clock, old Harrington favorites. We held you and told you we would be okay, it was okay to let go. You didn’t listen (of course). It seemed that as long as we were by your side, you had to watch over us. Had to protect us from our grief.

Until one afternoon. September 26, 2007. We had been taking shifts around-the-clock. We were exhausted. Mom and Thom and Kayley had fallen asleep in your room. I had come to the kitchen with Pam as she called the doctors and discussed how to manage your worsening pain. Our friends Pam and Les came to see you – they had picked up more medications from the pharmacy. They came into the kitchen after peeking into your room. Les said “I think it’s over.”

“No”. The desperate cry.

I sprinted down to your room faster than I knew I could. I walked in and could feel that something had changed. Thom had woken up and seen you still. He had checked for a pulse. There was none. I took a position at the top of the bed, grasping your head in my hands, leaning my forehead to yours. Begging it not to be true.

Pam laid her hand on your chest. She nodded and started to sob. I remember whispering over and over “I’m so sorry, Daddy. I’m so sorry. I should have been here. I’m so sorry I wasn’t here.”

A chorus of choking and weeping. We held each other. We shook with grief.

We took turns lying next to you. Closing the door to the room so each of us could say what we wanted to say. I don’t remember what I told you. I only remember the tremendous loss. The sense that I would never be the same. The pain in my chest. It hurt to breathe. It hurt to think. It hurt to feel.

I have never known such pain. Even today, I can feel the searing, burning ache deep inside me.

But holding that pain is love. It hurt so bad to lose you because your love was everything I needed. You taught me how to live thoughtfully and prayerfully. You taught me how to love. And that love is as strong today as it was 10 years ago. Stronger than the pain. Stronger than the loss. It still sustains me. It still helps me live thoughtfully and prayerfully. It still gives me peace and calm in the midst of uncertainty.

It hurts for you not to be here.

I miss you.

I love you.

From the garage door to the living room wall, around the world. Times infinity.

You’re still here. Beside me. Every day.


Sep
11

On Vulnerability

Considering what I do for a living, you would think I would be an expert in vulnerability. After all, I get the privilege of being present with people during some of the worst, hardest days of their lives. I am a witness to their own vulnerability.

But alas, how little this gift makes its way into my own life. I am NOT GOOD at being vulnerable myself. I loathe crying in front of other people. Mostly because I know once it starts, it is unlikely to stop. This is made all the worse by the fact that I am emotionally an open book with the people who know me best. Hence why I don’t let many people get to know me.

Who knows from whence this facade comes? I could chalk it up to the fact that being vulnerable, getting real with my emotions, ultimately led to the undoing of my first marriage, when I had a husband who witnessed me disintegrate over a year when I lost a dear friend in a car accident, followed closely by losing my father to cancer. Or perhaps it was my own refusal to put myself in therapy after these losses and face my grief. Instead I threw myself into dating almost immediately after the divorce papers were filed. In many ways, I am thankful for that. It ultimately brought me to Steve, who has been my rock for the past 10 years.

But it also means I didn’t take some important time. To become my own rock. To fall in love with myself because I was too caught up in falling in love with someone else. To learn how to be alone without being lonely. To fill the silence with constructive and healthy practices rather than trying to drown out my own fears and anxieties with noise. To find contentment in the now without needing to search for the next best thing, the thing that would finally bring me peace. When all along I was missing the fact that peace was not an faraway need that I would track down if I just looked hard enough, but a force that I could find within myself.

So I’ve been trying, dear friends. Trying to make room for the silence. To welcome the alone-ness. I haven’t been extremely successful. When I start to feel vulnerable and alone, I get anxious. And the cycle continues.

But here and there, I catch glimpses of myself being still. Here and there, I am able to find myself and breathe. And celebrate being alive and present. Right here. Right now.

It starts by forgiving the anxious moments. It starts by recognizing when they come and saying “Here I am. I’m feeling open and scared.”

But at least it means I’m feeling. And if I can allow myself to do that, if I can sit with the discomfort, then I’m allowing myself to be vulnerable. I’m allowing myself to be open.

I am allowing myself to be me.


Sep
03

A New Day Coming

Hello, friends. I have missed you!

I have missed this.

Boy has it been a hell of a year (and counting).

Since I last posted, I found a new job as a palliative care nurse practitioner. I firmly believe that I am doing what I was built to do. It is beyond gratifying, even when it is exhausting. Steve has also graduated from nursing school and is studying for the NCLEX (ahh, memories). He starts his first job in October, in oncology critical care. There are no words for how proud I am. It warms me to see him doing what he was built to do also. We have figured out how to be a team and help each other become our best selves. That is a gift that I don’t take lightly.

We also have a new president. Don’t get me started. I can’t. Being an American these days is hard as shit. I alternate being ashamed and horrified. I have channeled my rage into some healthy and no-so-healthy habits. But one thing that I have noticed is how much I want to share, how much I want to connect. How much I have missed this blog.

So in the spirit of being constructive, in the spirit of pursuing a healthy, whole life in the midst of so much anxiety and angst, I am putting pen to paper (or fingers to keyboard, in this case). Writing has always been my way of reaching out and making connections. And I have a lot I want to say.

Very little of it will be related to nursing anymore. I am nine years into this journey and I feel like I have found my place. I feel like I am where I belong. I no longer wonder what brings me joy and meaning in my professional life.

No, friends. I’ve got the professional Me figured out. Now begins the harder stuff.

I’ve spent so much time and energy for the past 15 years trying to explore my sense of vocation. My sense of where I fit into the world. And I put my work at the center of that question. I figured that if I could do work that brought me meaning, that made me feel that I was part of something bigger than myself, then I was golden.

What I failed to recognize or remember was that vocation is not only about what brings home a paycheck. Am I gratified and thankful that my job gives me joy, that it makes me feel that I am contributing something important? Absolutely.

But is there more to me than this? Yes. And in pursuit of a life of the mind, I neglected the life of the spirit. And of the body.

A few weeks before my beloved father passed away (probably right about this time ten years ago), I was sitting at his bedside while he rested, studying my pathophysiology notes. I had thrown myself furiously into studying for nursing prerequisites while I was home helping care for him. He opened his eyes from dozing and saw me poring over my flash cards and said “You know, Teeny, sometimes I think that you work so hard because you are afraid to face or deal with your other needs. I worry that you use school and work to escape from the ongoing work you need to do on yourself.”

Okay, Daddy. Ten years later, I finally get it.

Message received.


May
15

Nurse Practitioner-Ish

My transition from registered nurse to nurse practitioner has been somewhat long and drawn out, but I am realizing via conversations with my peers that this is nothing new. What I hadn’t realized when I started this experience is that there are multiple steps to actually practicing:

  1. Pass the national certification exam.
  2. Become licensed in the state where you plan to practice.
  3. Obtain authorization to prescribe controlled substances at the state and federal levels.
  4. Become credentialed as a provider at the institution where you will be practicing, so that the services you provide can be correctly billed to insurance.

This last credentialing piece is the biggest hurdle. It involves so.much.paperwork. They dig deep into your professional history and your history as a provider (which I didn’t really have since this was my first NP job). They want CVs, copies of liability insurance, proof of license/certification/ability to prescribe, educational transcripts, and the like. I must have scanned and submitted 100+ pages.

And you can’t really fully practice until credentialing is approved. So far I have been approved by two separate committees, with one more vote to come from the general board of directors. Assuming there are no unexpected hiccups, I’ll be credentialed next week.

In the meantime, I’ve basically been working an infusion nurse. The medical oncology practice has its own infusion center and mixes its own chemo, and there are three registered nurses working full time to administer chemo, fluids, and other infusions to our patients. One of the nurses happens to be out on medical leave (originally until mid-May), so I was asked to take her spot. It actually turned out to be a great way to get to know the staff and patients, show the medical staff and physicians that I know what I am doing, and start familiarizing myself with our protocols. And boy do I have a whole new level of respect for infusion nurses. I thought floor nursing was exhausting, but managing care for 10+ patients at once, handling crises, taking triage calls from patients AND mixing/administering serious amounts of chemo is no joke. I end

But this is the challenge in being the first NP to join the practice… They don’t really have a concrete orientation plan for me. And now the nurse out on leave won’t be back until July, at the earliest. So they’ve asked me to continue helping out the nurses in the morning, when they are busiest, and shadow the physicians in the afternoon. While I’m happy to be a team player, this plan makes me a bit nervous because I don’t want to become the default pitch hitter for the RNs when I am supposed to be learning how to be an NP. Not to mention I have that whole DNP project that I’m supposed to be working on for school, which I can’t do if I’m spending half of my days running around like a chicken with my head cut off. It’s also a bit schizophrenic-feeling. It’s hard to transition between roles when I’m trying to do them both at the same time.

So I’m working on my professional self-advocacy skills, while trying to take advantage of the benefits to this plan. Like setting my DNP project up for success by convincing the nurses that it will help them too. And reminding myself that nurse practitioners are nurses first – we think differently than medical providers, and getting to know the patients in this setting will hopefully help make me a trusted member of the team when I am wearing a different hat.

The good news is, I’m in a place that is supportive and nurturing and all about teamwork. The practice staff consider themselves a family. And that is a huge relief. The learning curve for this new role is already steep enough. I am joining a team that wants me to be successful and wants me to love what I do. I really couldn’t ask for anything more.


May
10

Surgiversary

So now that you’ve hopefully recovered from reading about the craziness that was my life since August, as promised I’m going to attempt catching you up on key changes that have been happening ’round here.

Starting with the biggest change…literally. My first year as a postop bariatric patient. Oh boy, brace yourselves.

Stats-wise, as of my April 23 “surgiversary” I had lost exactly 130 pounds since Surgery Day and 148 from my highest recorded weight. Looking at those numbers, it’s pretty astounding. I have literally lost more than half of myself, weightwise. My BMI at the start of this journey was 47 (AKA morbidly obese). My BMI today is 20.6. Zoinks.

One month before surgery in April of 2015, this was me…

Not my cute baby...

Not my cute baby…

And this is me (with the hubby) on an April 2016 trip to D.C. …

washington_monument

*Interesting observation: I am still camera shy and prefer not to have full body photos taken…*

Last time I posted about my postop experience, I was only two months in and feeling…well…mixed up. Guys, there are SO MANY emotions tied to this experience, and it doesn’t help that as you lose weight, your shrinking adipose tissue releases stored hormones back into your circulation. All.the.feelings. All.the.time.

In the interest of avoiding a novel, I thought I’d write up sort of a “Frequently Asked Questions”-style list, based on conversations I’ve had in person and via online support groups, of the most common issues that inquiring minds want to know about. If you have additional questions, please leave them in the comments section and I’m happy to tackle them in a future post and/or one-on-one. Feel free to use the Contact Me link as well if you have a more personal question you don’t want to share.

So let’s get to it…

What surgery did you have again? My surgeon refers to it as the SIPS (Stomach/Intestine Pylorus-Sparing surgery). It’s also been called a SADI-S (by the surgeons in Spain who originally came up with the idea) and the Loop-DS. Since it is still in clinical trials, it’s pretty unfamiliar to most folks, even other health professionals. For those who are familiar with weight loss surgeries, I often explain it as a combination of a vertical sleeve gastrectomy and a very modified duodenal switch. If that previous sentence makes no sense to you, don’t worry, you’re not alone. See this post for more details about the SIPS/SADI-S/Loop-DS (plus a gnarly video). And one of the surgeons who performs this surgery has developed a helpful description as well as a handy comparison chart. There is limited data out there since it’s a new(er) procedure, but early nutritional outcomes are pretty promising.

What was the most surprising thing about your first year? I’d say it’s a tie between the sheer amount of weight I lost so quickly and the emotional ups and downs that I didn’t expect to be quite so extreme. Which are related to each other. I’m 0.6 BMI points away from being technically “underweight”. This causes its own share of stress, as I start to wonder when things are going to level out. I’ll reach an even weight for a few weeks and then drop 3-4 more pounds. I’m ready to stop dropping and maybe even take a few pounds back.

What has been the best part about your first year? Hands down, feeling like I can participate in my life again. There were so many occasions pre-op when I turned down opportunities to hang out with friends because I literally didn’t think I could keep up with them. I’d be worried about walking too much, or sweating, or chafing, or not being able to breathe if we were going dancing or headed to a concert. I chose parking spots based on the minimum distance needed to walk and dreaded anything that involved stairs. So to not worry about these things is very liberating.

What has been the most distressing thing about your first year? Definitely the unpredictability tied to eating. I can eat the exact same food two days in a row and tolerate it fine on Day One, while I’m running for the bathroom on Day Two. It’s annoying and sometimes inconvenient. My rule of thumb is never to try a brand new food in a public venue (if I can help it). Plus I’ve had to get over my fear of using public restrooms. A necessity. (TMI: This handy little product has been a lifesaver.)

Can you drink alcohol? Yes, but I’ve become quite the cheap date. 😉 It doesn’t take much to give me a good buzz and most of my favorite cocktails from pre-surgery are way too sugary now. I’ll take a small pour of wine with dinner and I’m golden. (Bonus: My migraines have been largely absent since surgery, a not uncommon and quite desirable outcome of weight loss procedures. So I can drink red wine again! This makes me very happy).

Does food taste different now? Yes and no. My palate has definitely changed. Sweets tend to turn me off completely – if it’s a really special occasion and it’s a really high-quality goodie, I’ll have a bite or two to enjoy the flavor but that’s about all I want. Which is a huge change from my days of inhaling Skittles and Pretzel Flipz in massive quantities. I tend to prefer saltier foods and umami flavors. Sushi is still my favorite food but I tend to eat the fish and veggies and leave the rice for Steve (seriously, I should take a photo sometime. It’s massive sushi roll carnage on my plate). My sense of smell is still very strong and doesn’t always agree with my sense of taste. And my eyes are still bigger than my stomach. But I also have a lot of food anxiety that I didn’t have before, so I’ll over-order for fear that I can’t find something I’ll like and then just eat bits and pieces of something.

My cousin’s sister’s aunt’s brother had gastric bypass five years ago and has gained all the weight back and then some. Aren’t you worried this will all be for naught? (Or some variant of this question….) First of all, I know the statistics, thank you. I know regain is a major concern in this community. The jury is still out on how it will affect SIPS patients because it’s a newer surgery, so we don’t have long-term data. But I know it’s easy to get complacent, especially when you are literally melting off the fat without even trying during your first year postop. It doesn’t come so easy in year two or three or ten. So thank you for sharing the regain horror story – I’ll take it as well-intentioned and move on.

Can you eat anything you want? Can I? Sure. Should I? Nope. Will I pay the consequences with my GI system? Often. This is supposed to be a tool, not a crutch. I’m learning portion control and paying better attention to nutritional information (especially sugar content). I’m certainly at the point where I can physically consume pretty much anything (in MUCH smaller quantities). Certain foods still don’t sit well and cause uncomfortable gas and bloating. I don’t technically get “dumping syndrome” the way that RNY-ers do because I still have an intact pylorus controlling gastric emptying from my stomach to my intestines. But sugar moves through me FAST and does not absorb well, and often leads to great discomfort.

So tell me more about this food anxiety? Let me paint you a picture: during a recent road trip, I called up Steve sobbing because I couldn’t figure out where to stop for lunch. Although I still consider myself a “foodie” and love to try new restaurants, this experience also causes me some distress because I don’t know how I will tolerate new-to-me dishes anymore. I tend to try splitting plates and unfortunately have had several episodes of feeling awful and crampy after a nice evening out. When it’s just me and I’m in a situation where I need to order take-out, I try to stick with foods and restaurants that I have tolerated before. But it’s no guarantee (see above re: unpredictability)

What have you done to help you recover mentally/emotionally/spiritually? This is key, folks. If you make this leap, be sure you surround yourself with people who will be there no matter what the outcome is. There is no place for negativity … this is MAJOR surgery with major physical and emotional fall-out. You need support and you need to find outlets for when it gets hard. Because it will get hard. Personally, I can’t recommend ongoing therapy enough. Most surgeons will require a pre-op psych eval. But it doesn’t stop there, and the issues that caused weight gain in the first place don’t get surgically resected with your stomach. So find a good therapist and keep going back. Plus, find a support group if you can. Most bariatric centers have a support group for their patients (I’m fortunate that I found a local one that is going to let me start coming even though I had my surgery elsewhere). At the very least, search online for supportive communities. Some of the online message boards can be downright toxic, so choose wisely (and let me know privately if you need recommendations).

I have also tremendously benefited from acupuncture. Not everyone is a believer (you know I am) and the scientific jury is still out, but when we moved to Maryland in January I found a local place and started going weekly. We focus on digestion and also talk a lot about nutrition. It has done wonders … I’ve only gone once this month due to budget constraints and I can feel a real difference when I don’t go regularly. Luckily my new employee insurance covers acupuncture, so as of June 1 I’ll be golden. (And in the meantime, I re-budgeted to go at least twice for the rest of May…it’s too important not to.)

How are you feeling today? Sigh, such a complicated question. Unfortunately I am still dealing with quite a bit of fatigue. If I don’t eat on a fairly strict schedule I get lightheaded and develop symptoms reminiscent of hypoglycemia. This makes working as a nurse/nurse practitioner quite tricky sometimes. I’m also struggling with exercise tolerance related to my fatigue, as well as some orthostatic hypotension. We’re trying to figure out if it’s just the result of massive and rapid weight loss to which my body is having a hard time adjusting, or if there is something slightly more sinister at play. My endocrinologist has had to make significant changes to my thyroid meds with the weight loss, so that could be part of the problem. And I’ve had multiple people ask me if I’m anemic because I’m so pale (I was pale to begin with but apparently these days I can come across as downright peaked.) Previous labs have never revealed severe problems, but we are re-doing a CBC this week just in case.

So all in all, it’s still a struggle. I imagine that in some ways it always will be. My relationship with my body and with food is complicated and has been for as long as I can remember. That relationship doesn’t get fixed by having my insides rearranged.

And yet, and yet …. this will always be one of the best decisions I ever made for myself. I was headed down the path of serious health complications that would likely have shortened my life and would almost certainly have led to profound disability. My overall quality of life was at an all-time low. I needed this, not because I wanted to be a certain clothing size or weight. In fact, I’ve really struggled with what it means to be a feminist who is attempting to be body-positive and yet intentionally lose a person by undergoing drastic surgery. It’s complicated. Another post for another day.

I guess the best word I’d use to describe myself today is … grateful. We all have our battles. Mine have changed as my body has changed. But I’m in a far better place now.

More than anything, I’m grateful for the most important lesson learned from this experience: Take care of yourself. Whatever that means to you, take care of yourself.


Apr
12

Whirlwind!

Helloooooooooo friends!

I’ve missed you! Where to even begin with the last six-ish months of life happenings?!?

I think what I plan/intend to do is give you a quick synopsis – with more detailed posts to come – in the hopes that 1) it will keep you coming back after my unplanned hiatus and 2) hold me accountable to actually posting more often! I can’t make any promises, but my life is about to get a lot less unpredictable and harried, so maybe that bodes well for this little blog ‘o mine as well.

So since posting about my accident last August, the following chaos ensued…

August/September 2015:

My car was officially declared totaled and we had to get a new one. We settled on this beauty.

And now I understand why people become Subaru owners for life...

And now I understand why people become Subaru owners for life…

I started physical therapy for accident-related injuries (which set back my postop recovery as well). Back pain is the worst. Took three months, but I survived! Now if only I could get the insurance company to settle my injury claim. Sheesh.

In the meantime, I managed to make it through clinicals and, by some miracle, graduate from my NP program!

September/October 2015:

My husband got HUGE news that he was admitted to nursing school…in Maryland. He was also admitted to schools in Montana and North Carolina too, but this was a no-brainer decision. *Commence panic about moving AGAIN.* Started looking for NP jobs from out-of-state. No easy feat for a new grad!

At some point over the summer, we had gotten a wild hair and decided to adopt a THIRD dog. Because it’s a brilliant idea to do so while you’re finishing school, recovering from surgery, and now planning a 500-mile move. But when we first met this little one in August we were smitten…

Wouldn't you be?

Wouldn’t you be?

This time we decided on a Golden Retriever – only the dog I’ve wanted for as long as I can remember! So we brought her home in September..and we’ve been in love ever since!

Internet, meet Lorelai. The world's sweetest, most loving dog. Now prepare yourself for gratuitous numbers of adorable photos.

Internet, meet Lorelai. The world’s sweetest, most loving dog. Now prepare yourself for gratuitous numbers of adorable photos.

October/November 2015:

Took and PASSED my NP boards! Woot woot! I’m officially an Adult-Gerontology Primary Care Nurse Practitioner!

Got frustrated by the job search and decided instead to sign up for a travel nursing contract in our new city to see us through the first few months. Accepted an inpatient oncology position. Back to my roots!

November/December 2015:

Wrapped up my jobs as a clinical instructor and inpatient hospice nurse. What a bittersweet transition!

Spent Thanksgiving weekend house hunting in our new home city. Decided we love it here. Debated the pros and cons of several gems and finally settled on one we love. Exposed brick walls, stainless steel appliances, amazing views, and a JACUZZI BATHTUB, people. Yes, please.

Went home for almost 10 days over Christmas and loved on my family! One of my favorite holidays in recent memory. Steve and I cooked up a Christmas Eve feast to be remembered … ironically eating less myself has translated into wanting to feed others more!

IMG_0526

January 2016:

Sold Steve’s car (we’re city folk now – only need one!), loaded up the moving van and headed north. Where it was 19 degrees on the day we move in to our new place. And we were greeted a few weeks later by Winter Storm Jonas.

At least the dogs loved it...

At least the dogs loved it…

Eli and his winter coat.

Eli and his winter coat.

See above re: gratuitous puppy photos...

See above re: gratuitous puppy photos…

Started my travel job and decided I don’t like travel nursing. It’s so discombobulating. Luckily the unit I signed on with is full of amazing nurses and I end up having a great experience.

Steve started NURSING SCHOOL, folks! I feel like he should take over this blog now.

As soon as we arrived at our new address, all of the NP positions I had previously applied for suddenly appeared to be interested in me and I started lining up interviews.

February/March:

Continued the interview process for a number of exciting options. Got an official offer from one and implicit offers from a couple others before I had to make a decision. After creating the most complicated, convulated pro/con list ever, I decided to go with the place that jumped first. Too many reasons to say yes and not enough reasons to hold out for the other ones.

Decided to get a little wild and dye my hair red. Apparently I was born to be a ginger because now no one believes me when I say I used to have dirty blond hair.

Signed up for my first 5K ever! Here we come, Color Run!

April:

Wrapped up my travel contract and said farewell…kicking and screaming, I might add. Suddenly the idea of being a newbie NP is quite disconcerting and the idea of staying in my comfort zone as an oncology nurse is not so bad. Funny how that happens. 😉 Especially when you’ve settled in and actually really love your job at the bedside. Ugh, adulting.

…Which brings me to today. I arranged to take a week off in between the end of my travel job and the start of my nurse practitioner position. So that begins on Monday. *She types with great trepidation.*

I plan to post much more about the job I accepted, but in a nutshell, it is an outpatient NP position with an medical oncology clinic/cancer center at a suburban community hospital. They have never had an NP there before, so the kicker is that I kind of get to mold it and make it my own. Both an exciting and terrifying prospect. I chose it for a number of reasons, but the most important was that I think it will allow me to practice better work-life balance as I learn my new role.

And if there’s anything I’ve learned over the past year, it’s that taking care of myself is non-negotiable.

So this is me these days…

IMG_0548

April 23 will be my one-year “surgiversary”. As of this week, I have lost 155 pounds from my highest recorded weight and 137 pounds from my surgery weight. Yeah, I know – it shocks me too to see those numbers. I’ll post much more about my recovery, but suffice it to say, as hard as the moments have been, the overall outcome of a healthier Nurse Teeny has been totally worth it. Did it fix my life? No, but it wasn’t supposed to. It’s a tool and one that I plan to use well.

So cheers to a roller coaster of a year. I’ve learned to enjoy the ride!

I hope you’ll stick with me for the next one…


Aug
24

Impact

Sorry the blog has been so quiet lately. The rest of the summer was a flurry of teaching, clinical and classes (not to mention continued recovery). I’ll have more news on all fronts very soon, I promise.

But the big news of the week is that I was in a very serious car accident last Wednesday. I was waiting at an intersection to turn onto a highway when someone decided it would be a good idea to turn left right in the path of oncoming traffic. They collided with said oncoming car so hard that they slid across the road, right into me, causing my car to spin and roll into a roadside ditch. It wasn’t pretty. I’ve been rear ended a couple times in my life, but nothing like this. It was terrifying and there was definitely a moment when I thought “This is it. This is how I’m going to die”.

Considering the damage that was done, I’m amazed everyone involved was not more seriously injured. I honestly believe that my side air bags saved me from a head injury. But the impact was pretty stunning. I was transported to the ER (in a C-collar … as soon as I said “My neck hurts”, the paramedics had that thing on me faster than you can snap your fingers), scanned and released the same night. I was told the next few days I’d feel like I was recovering from a really hard workout…they weren’t kidding. Ice and heat have become my best friends (not to mention pain meds and muscle relaxants). Fun fact: NSAIDs are often the medication of choice to take for musculoskeletal pain (no duh, right?), but guess what? As a bariatric post-op patient, I’m not allowed to take NSAIDs! Boo. Since the stronger stuff knocks me out and I can only take it at night, I’ve had to grin and bear it for the most part.

Unfortunately since I was hit on the driver’s side, the impact did some damage to my back and flank and the pain hasn’t dissipated with the the rest of my generalized aches and soreness. So tomorrow I meet with my PCP to talk about what’s next.

In the meantime, I wait for the insurance adjuster to tell me whether my poor car is totaled or not. I am praying it is fixable but I am not holding out hope…

The fallout

The fallout

Airbags may have saved my life...

Airbags may have saved my life…

The worst part of this whole thing is feeling like it’s a giant step backward. I was just starting to feel like I had a handle on things. At almost four months postop, my energy levels were better, I was able to eat more, and I had just signed up back at my gym to create a long-term workout plan. I felt like I was moving forward. Then some yahoo decides to turn into oncoming traffic and it all changes in the blink of an eye. Not to sound whiny because I know it could be MUCH worse (and I could have been much more seriously injured), but the past few months have been such a roller coaster that I was really looking forward to the idea of progress.

For now I guess it’s back to one day at a time.


Jun
24

Two Months Out: Ambivalence

Last week I celebrated my eight week postop-aversary. This is usually the point at which we are cleared to eat regular foods and swallow pills whole. For many bariatric patients this is quite a milestone when you are supposed to start feeling “normal” again. I have to say I feel anything but.

My postop life continues to be a roller coaster. I continue to struggle getting my protein in, have no appetite and with the heat and humidity raging in NC, it’s even harder to eat. This has resulted in some days where I have just dragged. I definitely notice that when I do reach my protein goal (80 g/day), or even get really close, I feel MUCH better. But my boss pulled me aside a couple weeks ago and said she was really worried that I might be anemic since I was so pale. Of course I panicked, called my doctor’s office and begged for my labs to be checked. The results? Everything was beautiful. Everything. I’m not anemic or vitamin-deficient or hypothyroid. My labs literally couldn’t be better.

It really is all about the protein, folks.

I had my two month post op last week with the PA, who was wonderful and helpful. I think my surgeon is great at what he does, but he’s not super warm and fuzzy and I needed some affirmation and support (especially after my practice’s triage nurse verbally berated me over the phone a few days prior…I was feeling pretty vulnerable).  My PA reassured me that with SIPS patients, the “magic number” seems to be more like 3 months instead of 2 and that as long as I took care of myself, I should start to feel normal again soon.

The good news? I was cleared for regular food, with the caveat of always getting my protein first. The bad? Advancing my diet has done nothing for my appetite. I’ll try something new, think it tastes decent, and then loathe it with the next portion. Poor Steve is getting stuck with tons of leftovers. The only flavors that seem to really resonate with me are Asian foods and fish…I still love miso soup and now that I can have (some) vegetables, have become enamored with lettuce wraps. Scallops are my new best friend and I could eat white fish all day.

I’m still discovering what foods sit well with my new stomach. Granted, a lot of the foods that felt like lead (i.e. shrimp) haven’t been attempted for a few weeks – when my stomach was still in the healing phase – so I’m trying to convince myself that it’s worth another try. But beef just does not agree with me at all. The “head hungry” side of me is mourning the idea that even if I wanted to, I could no longer eat a cheeseburger because it would make me sick as a dog. But I know that’s actually a good thing.

The two hardest adjustments have been fear and mental exhaustion. I fear trying new foods outside of my home because I don’t know how they will affect me and I don’t like to get sick in public (nor do I have time…more on that later). I may just have to get over this but my anxiety makes it even harder to eat because I’m not very willing to experiment.

The mental exhaustion is in knowing that for the rest of my life, every morsel that I put in my mouth will require focus and mindfulness. Not that mindless binge eating was any healthier, but bariatric surgery does not fix the delicate and tenuous relationship that many of us have had with food for most of our lives. I could see how the constant attention to what we eat could go to the opposite extreme and become pathologic in itself. It will be a delicate balance and I think it will be a different kind of struggle. I have had moments of sincere regret about having this surgery and its consequences for my lifestyle.

Then again, I have lost over 50 pounds from my highest weight and almost 40 pounds since surgery. I can walk without my legs chafing and climb the stairs without having to catch my breath. I look forward to vacations because I can start keeping up with the rest of my family (and even fit in airplane seats)! I enjoy shopping again and rediscovering old clothes in the closet that now fit…or are too big! I feel like I am starting to get my life back.

I may be exhausted and beat up but I did undergo major abdominal surgery and my body is still healing. During my harder moments, I need only to remember how far I have already come.


May
27

One Month Post-Op

Last Thursday, I hit the 4-week mark and Saturday was my official one-month postop-aversary. I can honestly say there have been moments when I doubted if I would ever make it this far. (Especially during Week 2 of liquids…cream-based soups still make me want to gag.)

Overall I am doing well. My energy levels are just not where I want them to be, but I haven’t reached my protein goals yet. I also aim to get 600-800 calories (no more than 1000) daily and it is an effort to reach 500 most days. Says the girl who used to down an entire plate of loaded nachos in one sitting (by herself).

My how times have changed. 😉

I know it can take up to eight weeks to really start “feeling normal” so I am doing my best in the meantime. I’ve been walking as much as I can (and as much as this blasted Southern humidity will let me).

I’m a week into my “soft diet” phase, which will last until week eight. So far it’s not bad … it’s a relief to actually eat things with texture. I’m just beginning to figure out what works and what doesn’t work for my body. So far I can handle meat if it is sliced thin or in a soup. I adore fish of all kinds but shrimp makes me feel like I’ve got a rock in my stomach. As does ground beef or ground chicken. It’s kind of amazing how individualized our food tolerances become after bariatric surgery. I’m still not craving sweets or junk food. I’ll walk down the grocery store and see a shelf full of Cheez-It’s (my #1 preop vice) and think “Huh, I remember really liking those.” And it stops there. Thank goodness.

My sense of smell, however, is very much intact, if not sharper than before. This is really annoying. Over Memorial Day weekend when Steve and I would take walks around the neighborhood, I could smell our neighbors grilling all kinds of goodies and it actually made me hungry. But when I actually had food in front of me, the hunger went away. Occasionally I’ll “crave” a particular type of food – ironically it’s usually soup. The other day I desperately wanted to try a Panera Quinoa Broth Bowl (my favorite) but when we got there, they were fresh out. Wop wop. Tonight I’m curiously interested in trying egg drop soup with wontons.

I continue to be amazed at how much my taste buds have changed. Foods that are traditionally salty (but tolerable to my palate before) are overpowering for me now…I tried prosciutto rolled up with some Laughing Cow cheese the other day and could barely finish a slice. Sweets of all kinds make me nauseous (particularly artificial sweeteners). And cheese is my new favorite condiment. I put it on everything. Small amounts of part-skim cheese, mind you, but I eat such small volumes and struggle to get my calories anyway, so I figure if it makes food more palatable then I am willing to go there. Especially for the added protein.

Some other curious changes… My stomach is starting to act more “normal”. It is much less talkative, except when it is empty…just like old times. My incisions are healing really nicely. I weirdly hate hot showers now – I used to be able to stand in the steam until the water ran cold. Now I get dizzy if I’m in there too long. Not sure how I will do with jacuzzis or baths once I’m allowed to use them.

Probably the most satisfying outcome so far has been the utter lack of migraines. They were pretty well-controlled before surgery, especially once I started sleeping with a CPAP, but I had heard that bariatric surgery often improves headaches, sometimes to the point of eliminating them completely. I saw my neurologist today for a post-op followup and he couldn’t have been more pleased. He didn’t see a need to put me back on a prophylactic medication (my surgeon discontinued my propranolol because my BP was running low). We slightly tweaked my rescue meds to remove any trace of NSAIDS or caffeine from my regimen. He said as long as I feel this good I don’t have to come back for six months! If I can get rid of these damn headaches for good, that alone would make this experience well worth it.


May
15

Walking the Tightrope

If I could describe my first month of recovery, it would be akin to walking a tightrope on a roller coaster. How’s that for an image? 😉

In all seriousness, I am actually thankful that recovery has been fairly smooth. I’m keeping food down, have minimal reflux problems, and although my stomach is still quite vocal (seriously, stomach, shut the eff up), have been pain free for weeks and am generally doing okay.

The main challenge has been staying hydrated and getting my protein. Which is harder than it sounds. In fact, the only (slightly) major hiccup in this whole experience so far has been doing what I swore I wouldn’t do: I got majorly dehydrated over the weekend.

The challenge is that now that I’m actually eating (huzzah!), I can’t drink fluids for 30 minutes before or after a meal or snack. And I’m supposed to eat 4-6 times a day. And get in 80 grams of protein and 64 oz of water. You do the math. It’s not easy. Oh, and add on the fact that I’m supposed to be getting about 600-800 calories a day … y’know, to sustain life and all. I’m barely getting 400, if I’m lucky. Sigh.

So this weekend after I advanced my diet to semisolids/pureed, I had trouble balancing the fluid versus food equation and got behind on my sips. So behind that when I woke up Monday morning I felt like pure hell. I knew I wasn’t going to catch up on my own and I knew that if I didn’t catch up I was in trouble. So poor Steve got woken up at 6:30 am by a pitiful little voice begging him to take me to the ER. Two boluses of normal saline later and although I was still tired, I at least no longer felt like I was going to die.

The other difficulty has been protein. Ah, protein, you are an elusive bugger. I know 80 grams daily is a goal and I’m not expected to be there yet, but I also know how important it is to my healing and energy levels (and continued weight loss, so my body eats fat and not muscle). I was WAY behind on the liquids because I was just so sick of …. liquids. The PA at my postop appointment gave me some helpful pointers that I will share with you in a future post, and that has helped, as has advancing my diet.

Speaking of which, I advanced to soft foods yesterday! Woohoo! It’s been a fun adventure re-experiencing new (old) foods and new combinations. It’s funny because whenever I reintroduce something into my diet, Steve gets a text from me proclaiming that what I just ate was the “best thing ever”. But seriously…to put actual, real food into my mouth, and taste it (and then chew the hell out of it). It’s just a divine experience. I have 4-5 weeks of soft foods and then I can slowly add “normal” food back into my diet. As I’m able to eat more volume, I’ll also be able to add back in more cooked veggies and complex carbs (gasp). Once I’m further into this soft diet phase, I’ll share with you some of my favorite combinations.

So onward we go… I go back to work next week, start my final (!) semester of NP clinicals, and generally resume a “normal” life again. Whatever that means.

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