Warrior Mom

So many changes

2009-11-10T08:56:00.004-06:00

How has it been so long since I have written anything here???

Things have changed. I am teaching full time at the nursing school and working 10 hours a month as a NP. The family is busy and the boys are growing up so fast. Where does time go?

I am enjoying this new teaching role. It has been a great new challenge, especially since I have been writing lectures on subjects that I really don't have any expertise in. I love the opportunity to learn new things. I went to Philadelphia, PA at the end of September for the National League for Nursing annual meeting. It was a great place to connect with other nursing educators and learn more about what I have gotten myself into! The director of the program that I teach at was inducted as a fellow and it was nice to be there to support her. Our school has also been named one of the top 3 schools of nursing in Texas. So far I feel that this has been a good change for me and also for my family. It does put pressure on my husband to keep up the morning routine, but I am able to be more present in the evenings.

I was amazed yesterday when I received an email from my oldest son's science teacher that informed me that he got to class early to make sure he is on track. Is this really my kid? He just floats through life without even a backward glance and usually has no clue where he stands academically although he usually does quite well without much effort. He is in 7th grade now as does seem to be growing up. He has some good friends and is active in the art club and overall seems quite happy and comfortable with himself and life. My change in employment has allowed me to be home in the afternoons with him after school and he seems to enjoy having that time alone with me. I wonder how long that will last?

My middle son, in 5th grade and now 11 y/o, is having a difficult year. School is challenging from an organizational standpoint and he is struggling both academically and socially because of that. It is breaking my heart because I see him struggling with the same things that I did at his age. We have been trying to work on those executive function skills, but he is quite frustrated. I don't think that I really developed those skills until college and then it has remained a work in progress.

My youngest son is a shining star! He made the honor roll for the first 9 weeks at school with all A's. He does have a modified workload and is still significantly behind in reading and a little bit behind in math but is making great strides in catching up. We took him to SMU for evaluation of his reading and other learning disabilities over the summer and came away without any kind of definitive answers but we do have a 5 page list of recommended interventions. The resource teacher at his school has taken those recommendations and put together a program that is really working for him. He spends the majority of his day in the general-ed classroom and is making friends and is so happy this year.
We have decided to change plans from the traditional this Thanksgiving and will be going to the Texas Renaissance Festival this year. It is something new and the boys are excited. We have been watching Robin Hood on BBC America and they are looking forward to seeing the games and shows at the festival because of the introduction to some of it on the show.

I will make another effort to keep up with this blog again. Life just keeps moving on and it is good to stop and reflect.

And so...

2009-01-30T22:30:00.002-06:00

And so...
Our change in after school care has been very good for the two younger boys. My oldest son has only been home alone for a few days but that will be changing next week. He has handled himself fairly well. We have written down routines and rules and that helps him to stay safe. Now the biggest challenge is what about the summer. I am not ready for him to be home alone 3 days a week all alone.

I have started a new semester at the college. I love teaching. I have decided to pursue a full time faculty position at the college. I am hoping that this will work out and then I will have summers off to be with the boys and hopefully I will also be able to go back to work on a doctorate in nursing. The director of the nursing program has been very encouraging.

Looking Ahead

2009-01-03T11:01:00.007-06:00

What a year it has been. I taken a look back at the previous year and reflected on all that I have accomplished and then the things that I want to do in the new year. When I look back at the last year I feel quite satisfied that I got the most living packed into the short time and I am happy. This is my plan for the next year also.

Big changes are being forced on us with this new year. Our after school childcare has closed, unexpectedly and we are forced to look for new options. We have been quite content and comfortable with the arrangement that we had and this is a huge disappointment. We still don't have the whole story of what happened, only the owner does, and she is not talking to anyone right now. The center had been in business for almost 20 years and has enjoyed a very solid quality reputation. This has been quite devastating to many families.

The two younger boys will go back to the aftercare provided at the school. This may be a good option since they will get more homework help. It is safe and well run and they will not have to travel anywhere to get there.

The big worry is what about my oldest? He is no longer in elementary school and not eligible to attend the after school care there but I am nervous about having him home alone in the afternoons. He is also a little bit nervous about it. We will have to have transportation arrangements made and strict after school rules. I am still unsure of how to enforce some of the consequences if he breaks the rules. We are working with a "home trainer" from the Autism program through the school district and I am hoping that she will be able to help some with this new twist in after school routines. This will certainly force him to grow up quickly.

Old Friends and Aquaintances

2008-12-01T12:50:00.006-06:00

Old friends and acquaintances, wow what a thanksgiving surprise!

We went to MoRanch again this year for Thanksgiving. The weather was beautiful and we spent most of our time outside in the Hill Country sun. We did allot of walking, some fishing and the boys did some swimming in the Guadalupe River ( not me, too cold!).

My parents met us there and spent some nice time with the boys and my husband and I. We spent time visiting and walking and watching old movies of me as a young child. My boys really got a kick out of that. It is quite amazing how much my oldest son looks like I did at those ages. Especially when I was a pre-teen and early teenager. Unfortunately these movies are old and fading and my dad can't find many of the reels that he knows he took of me and my three sisters growing up. It was a great show for us and a great time to reminisce.

We also had the wonderful, but unexpected, opportunity to visit with some old friends. The pastor of the church that I attended throughout my youth was there with his wife and his 4 children and their families. I haven't seen any of them in at least 25 years! This man was an important influence in my life. He believed in me when I don't think I felt that anyone else did. He counseled me and reassured me and helped me to believe in myself. It was fun to meet up with his kids again. I was not close to any of them when I was younger. I am about 4 years older than his oldest son and they were closer to my younger sisters. Those years don't matter nearly as much as we grow into adulthood and have families of our own. It was good to catch up and hear what they are doing and make plans to keep in touch, I hope that we do.

I voted today

2008-10-20T10:22:00.002-05:00

I love the fact that we have early voting. I have to work on November 4th and I don't want to worry that I may not get to my polling place in time to cast my ballot.

There was a time in my life that I would not have even considered voting early. There was something so exciting about voting on election day and being a part of the whole voting process. I remember spending hours in line the first time I went to vote and feeling so excited about being able to really say something that mattered. I have always believed that to be able to argue politics you must first be willing to vote, otherwise you don't have a voice as far as I am concerned.

So today, on the first day of early voting, I went to cast my ballot. I was surprised that the line was long just to get into the parking lot and when I got inside the poll worker told me that the line wrapped around the building by the time the doors opened at 8AM! I only waited for about 10 minutes but there was a steady stream of folks lining up for their turn.

This election matters. But will my vote matter in the long run here in North Texas? I hear that question allot around here. YES it does count. We may not think it does in the Presidential election, but it matters, and in the local and state elections it matters allot.

I did my homework and really reserched the candidates before making my choices. I have engaged my boys in discussions and let them know what is at stake. I worked very hard to stay objective when talking with my boys, despite the fact that I have very definite opinions, and have definite choices. I think that my boys do understand that this is the most important thing that we as Americans do for our country and ourselves. They are listening and paying attention and looking at the issues.

So I voted today and now I will wait until November 4th to find out if my candidates win. My vote does count.

Still here...

2008-09-03T09:19:00.011-05:00

Has it really been almost nine months since I have posted anything here? I will say it has been quite a busy year!

I have received a few nudges to get busy and write about the family and how the boys are doing. Well, here goes. Hang on for the ride!

The school year ended on a very positive note last year. All three boys did very well and the oldest is now "all grown up" and in middle school. He seems to be doing very well. Of course it is only the second week of school. He seems to be handling changing classes and says that it is good and gives him time to move around and then he can stay focused during the class times. He has chosen to play the cello in the orchestra and is really excited about it. He also learned a little guitar in music class last year. I am planning to get him a guitar for Christmas with some lessons if he is still interested.

The two younger boys are now in 2nd and 4th grades and loving it. A thinks that his teacher is the most beautiful woman in the whole world. I guess I am just the mom now... J has S's former 4th grade teacher and feels very special about that. I am looking forward to an uneventful year for them.

I have just started my 4th semester teaching at the Nursing School and I am looking forward to that. Of course I still have my other two jobs also. Yes, I am tired.

Our summer was a busy one!

S spent a week at Mo Ranch this summer for camp. I think he really grew up emotionally at that time and he is already asking to go back next summer. Of course I was a nervous wreck but all was well and he thrived. He spent the rest of the summer hanging out with his friends at the activity center that the boys attend after school during the school year. They had weekly field trips, swimming three times a week and time to be with other kids. All said it was a good time.

We did take some family time away and went to the hill country for a brief vacation. On the way to pick up S from camp we stopped at Inks Lake State Park and went swimming at the Devils Waterhole. The two younger boys had the chance to jump off the cliffs into the lake and float around in the water before heading into Kerville to spend the night.

We spent the next day swimming in the Guadalupe river and playing in the rapids and going down the big slide at Mo Ranch.

Finally we headed over to New Braunfels and spent Sunday at Natural Bridge Caverns, touring the caves and the boys climbed the Watchtower.

the next day we went to Schlitterbaun

and then finally went into San Antonio and saw the Alamo. The boys were surprised and a bit disappointed that it is so small!

The highlight of the trip was probably Schlitterbaun. What a water park! We spent the whole day on Monday there. We do plan to go back next summer. I think that next time we will get a two day pass so we can do everything!

We also spent time with friends boating out on the lake. My three had never been in a boat before but you would never know it by how well they did. We got them out on the knee board and by the time we left they were being pulled all over the lake and all three were almost able to do 360's on the board. Now the question has been when we will go back.

So all in all it has been a good 9 months. This is certainly an abbreviated, just hit the highlights version. I will make a real effort to keep up with things here more often this year.

Time will tell...

Vice President of Guatemala

2008-01-16T14:41:00.000-06:00

As I pulled in to my parking space at work on Monday morning, listening to to the local PBS radio station as usual, and just as I reached to turn off the engine and pull out my keys I heard something being said about a former cardiothoracic surgeon from Houston's Methodist Hospital. So of course I stopped to listen, was this something being said about any of the surgeons that I used to work with? The news went on about how this former surgeon was being inaugurated as the vice president of Guatemala. I missed the name... So of course I went into my office and immediately googled the news. It was good news!
The man that I have respected and admired for twenty two years is now the VP of his home country. This gentleman that I spent many a night in the operating room in the late eighties doing heart transplants with is now VP of Guatemala. This gentleman with a charismatic personality and a very quick engaging smile has given up surgery to try to heal his country.
I have not seen Dr. Rafael Espada for a few years, well actually about 15 years, but I can still hear his voice and see his smile and I remember his great "bedside" manner and his commitment to his patients and his respect for all of us that worked with him.
Dr. Espada, I congratulate you and wish you well in this new and exciting, and I imagine grueling role that you have taken on. Your country is fortunate to have you.

reflecting...

2007-12-28T14:15:00.001-06:00

I cannot believe that the year 2007 is almost gone. This has been quite a year and full of new challenges for me. I think it has been a good year.

I have been thinking back to this time last year and I was preparing to begin teaching, that was a big step for me and I am so happy to say that I really enjoy it and I think that I am good at it. I am looking forward to the next semester and getting to know a new group of students.

I have continued to do women's health care and feel that what I do at that job is filling an important need in the community. I am still driving to Paris one Tuesday a month to do colposcopy and will admit that I don't always enjoy the drive but I do enjoy the clinic. I spend the other Tuesdays at a clinic in Dallas providing colposcopy services.

Although it only was for a short time I learned allot while working for the family practice. I wish that things had worked out differently there but I try hard to never look back and stay focused on today and the future.

I have really been enjoying my new position with the Child and Adolescent Psychiatrist. I am learning many new things and meeting new people. I think I make a difference in the office there and I know that the Dr. is happy that I am there to help lighten his load a bit. I am focusing allot of CEU's on mental health management and find that I am really fascinated by it all. I just never even considered this as a career path for myself in the past.

My family is doing well. The boys are turning into such nice young men. I am learning to appreciate that more each day as I watch them grow. S will be 11 years old in February,when did I get so old? A is now nine and J will be 7 in March. In November we had a photographer do portraits of the family just hanging out at the park. I am stunned at how handsome my boys are. The photographer thinks that my oldest should get into modeling, I asked S what he thought and he is considering his options for now. He thinks it would be fun to a point but not if they make him wear weird clothes...

As I look forward to the new year I have a few goals. The first is to enjoy my family and make sure to have more family time. I need to learn how to carve out special time with each one of my boys as well as my husband. Second, I think I also need to look at my career goals and decide what I really want to do. Three jobs is getting to be allot to keep up with even though they are only part time and I love each one. Third, I really want to get back to TKD regularly and work on my 2ND degree black belt. I have spent the last year poking along with out really devoting the time and effort to achieving that next milestone. Not lofty goals but ones that have significant meaning to me. I suppose I could set a goal to write more too, probably the hardest goal to meet.

Distractions...

2007-12-04T13:08:00.000-06:00

I really should be finishing grades for the semester. I have many things that I should make priorities other than writing her. It is so easy to put that off. It is a beautiful fall day here.

I was out running a few errands this morning and was struck by the colors on the trees. North Texas is not known for its colorful fall foliage but this year I am certainly enjoying many shades of red, orange, yellow and green, everywhere I look!

I had to get out the camera and catch a few leaves while in their brilliant display. These are in my backyard, a few roses thrown in for good measure today. My "Old Blush" is still blooming and is full of buds. The weather is predicted to hold. I may have roses for Christmas!

Stretching is good....

2007-10-26T08:42:00.000-05:00

I have had a great week! I think that I will really enjoy my new job. I worked independently yesterday and saw 11 patients. It was a very satisfying day. The patients are very accepting of a nurse practitioner as a provider and actually one patient was relieved that she was seeing me. She said that NP's have a much different approach and she is much more comfortable with that. I think that having a primary care background is also very helpful.

The boys do not have school today but are going on a field trip at the daycare to see dinosaurs at

The Heard Museum . They would rather do that with friends then hang out with mom. I plan to spend the day working in the yard and getting it finished for fall/winter. My sister is coming over to help. We only live 25 miles apart and just really never make the time to get together. This is our sister time.

I do have a parent/teacher conference with S.'s teacher today. I think it should go fairly well. He has had a hard time getting back into the swing of things since his camping trip, but I think he is coming around. He has really come so far socially and emotionally and has learned to recognize when he is feeling frustrated and/or angry and can turn it around or ask for a few minutes. This is a huge step for him. his grades have been good, he has a reduced workload but he is learning what he needs to learn. We are really working with him for transitioning to middle school next year.

I start the advanced digital photography class tomorrow. I have really enjoyed the introduction to digital photography class and have had such a good time learning to use my camera.

We had a contest last Saturday in class. We were to take two photos during the week and then bring them in as 8x10's for a contest, mine did well, this one came in 4th,

and this is my other. Not bad for an absolute novice!

We are renovating the Sanctuary at church and I took before pictures, and then also played around a bit. I actually love the second one, it has so much of the detail of the wood, I learned to use the manual focus with that one! Who knows where the next class will take me. I am already thinking about a digital SLR camera.

Learning to stretch

2007-10-21T17:28:00.000-05:00

It is Sunday afternoon and I have been out working in the yard all day. I hope that my body can move in the morning! It has been warm and sunny and perfect weather for yard work.

My oldest son went on his 5th grade camping trip last week. He was so hesitant to go but finally, the day before the money was due decided he would go. He came home dirty and tired and very happy. He was quite successful at camp and slept away from family for two nights, made new friends and showed what an outdoorsman he is. He came home wishing that he could do it again. There is only one 5th grade camping trip, hopefully he will feel that it went well enought to go to a sleep away summer camp.

I have parent/teacher conferences in the morning with A and J's teachers. I always look forward to these meetings. I just really like to be in touch with the teachers to know what is really going on. I am hoping that A's teacher can help me out with his organizational skills at school. I will meet with S's teacher on Friday morning.

I also will start a new job tomorrow. I have accepted a position with a child psychiatrist. This was a very difficult decision for me and I have taken about 7 months to make it.

This Dr. first called me last spring to ask me if I would consider a position with him. He wanted to talk to me because he likes the way that I interact with patients/parents and I have allot of practical as well as proffessional knowlege about ADHD and ASD. Despite that fact that I needed something closer to home or with hours that allowed me to be home earlier in the evenings, I said no. I wasn't ready for the big step in that direction. He elected to put the position on hold until after the summer and rethink things then. I talked to him about a month ago and he again asked me if I was interested. I told him no since I had just started to work for the family practice. He called me again after I had resigned my position with the family practice. He had an applicant that was possibly a good fit but wanted to talk to me one more time. I sat and thought it over, listed pros and cons and accepted the position for 16 hours a week. He has guaranteed that I will be home between 5:15 and 5:30 and if not my schedule will change to make sure. He even put this in writing! He is paying me very well, and I will have a nice office and very helpful staff.

I have to admit that this is not what I thought that I would be doing at this point in my career. But, it is good to stretch and try new things and grow.

I am looking forward to tomorrow.

Good Friends

2007-10-13T14:01:00.000-05:00

Last night as I was settling in for a quiet evening, at least as quiet as it can be with three boys, my good friend and neighbor came over with a glass of wine for me. We went a few doors down to sit on another neighbor's porch and relax and have a nice "kid free" few moments. We talked and laughed and shared for hours. Some days you just need some good friends, especially girlfriends, to have a glass of wine with and relax and remember what makes each one of us special.

Here is a toast to good friends!

...hmmm

2007-10-11T15:56:00.001-05:00

Well, in evaluating the binder and routine system, S and J are doing great with it. A, on the other hand, is still struggling with getting it to and from school/daycare and using the checklists and guidelines to help. I think that it is probably the best system that we have used so far though so we will keep at it.

On the other hand, what is not working is my new job. I am a bit anxious right now, I will be going in to talk to them this evening to resign. They need someone who can commit to them much more than I can, I need to be more available for my family. I was really hopeful and excited about this opportunity, it is so close to home and seemed to be just what I wanted and needed. It is not to be.

Routines and Systems

2007-10-08T07:37:00.000-05:00

Homework and organization do not seem to go together at my house as I wrote about in my last post. I spent allot of time thinking and talking to teachers and talking to A and we have a system that we will try out. I bought a small binder (actually 3, one for each boy) and put pocket dividers into it. Each divider has a label and then I made a list that I put in the clear pocket on the front of the binder. A seems to think this is a great way to keep track of everything and even used it over the weekend to get his things ready for the week.

A's Binder

Nightly Homework

Reading and Math Log
Fill in every day, at least 10 minutes of math and at least 20 minutes of reading (due each Friday)

Week long assignments
Spelling Packet, divide # of pages by 4 and do that many pages each night Monday through Thursday (Due each Friday)

Spelling and vocabulary lists
Review each night for at least 5 minutes

Ideas for Science Project and timeline

Forms to turn in, orders to make, papers for mom or dad to sign

We also really worked on our evening routine and I am planning to show my new employer what has to happen to keep my family on track each evening.

Evening Routine

Home from daycare and backpacks and lunchboxes unpacked

Homework out for review by mom or dad and/or finishing it

Dinner/clean-up

Weather check, calendar check

Backpacks ready for morning

Lunches ready for morning

Clothes ready for morning

Baths
Spelling/vocabulary (5 minutes each with mom or dad)

Math Drills (10 minutes each with mom or dad)

Reading (20 minutes each, S and A on their own, J reads for 10 minutes with mom or dad)

Bedtime at 8:00 PM

Lights-out at 8:30 PM

Monday: A and Mom - Karate
Wednesday: Mom works late and Dad on his own with the boys (teachers aware), Mom to Karate after work
Thursday: A to Karate

We will reevaluate how things are going every few days and tweak as needed.

...life in general

2007-10-04T14:56:00.000-05:00

I am trying very hard to be more consistent with posting. I always have things going on and therefore no lack of things to say. I just have to commit to getting on here and putting them down.

I am really struggling with how to help A. get organized. He is now in third grade and he is a organizational nightmare! He would loose his feet if he wasn't walking on them.

We have tried checklists, we have tried time and task lists, we have worked with him to plan out his evening to get his homework done and still have leisure time.I have tried to get his input on everything since this has to work for him. We are at a complete loss. I want to meet with his teacher, I sent an email to her, to really want to try to get some good pointers for this at home and to see how she can work with him at school.

On to other things, I decided to start a knitting blog, I haven't posted anything there yet, but it is ready! Check out the link in the sidebar.

I am also taking a photography class at the community college. It is not for credit and purely for fun. This week we are experimenting with lighting. This is my willing and cooperative model "Fritz".Now I need to figure out some creative ways to show off my knitting projects. Off to look for something else to photograph.....

September, must be balloons!

2007-09-27T12:25:00.000-05:00

Despite my good intentions and real willingness to sit down and write, time seems to get away.

It is now Autumn, it doesn't feel like it outside here in North Texas but I am hopeful that we will have an early morning crispness in the air soon.The boys are all in school and the year has been going very well so far. I have started my new job, more about that later, and classes have started at the college and I am really enjoying being back in the teacher mode.

We had the local balloon festival here last weekend. We took the boys on Friday night and had a nice time. The picture above is from the balloon glow that is held at sunset and is quite spectacular. Those are just a few of the balloons that filled the fields. We look forward to this every year and in the mornings we also enjoy watching the balloons float over our backyard. We go out and wave and they wave back.

My oldest son has earned a hot air balloon ride. Several years ago he made a contract with one of the resource teachers that if he met certain goals, both behavior and academic, and once he was 10 years old, he could go on a hot air balloon ride in her balloon. He is next on the list, he has made it! He is so excited. We are hoping he will be able to go up sometime in October. He wants another teacher to go with him so both mom and dad get left on the ground waving. I guess you have to let go at some point. But I would really like to go on a ride too! He has been working hard to take good pictures on his digital camera so that he can come back and show them to everyone afterwards.

I have been knitting like a fiend lately and have made several shawls and baby sweaters and blankets. I have a sweater for me on the needles as well as some beautiful yarn for another. I have so rarely knit for myself and I need to. I have so many other project though that I have been asked to do for other people and I seem to always put those first. I will have to get some good photos of some of my projects and post them. I would start a craft blog but I can't seem to keep up with this one!

I am teaching a 12 hour clinical as a pilot program for the college this semester. We start at 6:30AM and leave the hospital at 6:30PM. I have a great group of students from very diverse backgrounds and we have an excellent clinical site. I come home energized and feeling so excited to be able to this every Wednesday. I think in many ways it is the highlight of my week lately. It feels like such a privilege to work with these future nurses and influence their career choice in a positive way.

I am still doing colposcopy most Tuesdays. I still love doing that and I was in Paris the other day. I love going there to work, I just wish the drive were easier. There has been allot of construction on the highways lately and what has usually been a hour and a half drive is now over two hours. I am finding it to be quite tiring. I think it may feel more so since I am worried about the hours at the my new job.

And about my new job, I am wondering if now was the time to change jobs. I am really excited to be back to a more holistic approach to health care but I am worried about the hours at this point. My main reason for changing jobs was to be home earlier in the evenings but I am getting home later and later each week. The MD that I am working with is great, the staff is wonderful and I am getting up to speed on general medicine again fairly quickly. So why is it that I feel that I am robbing my family of my time and attention as much as I was before? I had been hoping that this would give me that extra time in the evening to help with homework, spend time reading with the boys and actually have dinner together again. I find that we are rushing as much if not more than we were a month ago when I was working 35 miles from home, not less than a mile. I have ended up getting home even later than before! One of the things that I thought that I had made very clear when I accepted the position is that I need to be home by 5:30 each evening and that was something that they seemed to agree with. The clinic is open until 6PM and they accept walk ins until they lock the door at 6. They have set it up that my last scheduled patient is at 5:15 but that doesn't mean that I will be done by 5:30, by the time the patient is checked in and then weighed and vital signs done and ready for me it is already after 5:30. I am frustrated. I am hoping to make a time to sit and discuss this with the office administrator and the doctor tomorrow. I need them to understand that my family has to come first.
OK, enough about work...

Well, I have allot to do on my day off today, I still need to shop and finish the laundry, try and do a little cleaning, you know, daily life!

I will try to not be absent so long next time.

Days of Summer

2007-08-08T08:29:00.000-05:00

This has been quite a summer. It is longer than usual since the boys will not go back to school for another few weeks. Last year they started back this week. It has been a very good summer.

During the last week of July I had several girlfriends in town, they came from far and wide, what a time we had! We shopped, ate, traveled to Van, TX for breakfast (90 miles each way) and talked and talked wore tiaras. We marveled at the strange Texas weather and amazed our friend from Western Washington with our spectacular thunderstorms. My family enjoyed the extra attention and I am mourning the fact that it had to end so soon. We will try to get together again at another home next summer.

I have found what I think is my dream job. I knew if i held out long enough that I would find the perfect fit. I will be working part time for a small family medicine clinic that is only 9/10 of a mile from my home! I will be working with a family practitioner that actually sees families! I have learned throughout my professional life that I am not a geriatric health care provider. I will start on September 6. I will continue to teach and i will continue to do colposcopy for my current employer on Tuesdays. Yes I will have 3 jobs.... but it will actually give me about 6-9 hours a week more with my family since I will not have the extended drive times!

When I interviewed with the Dr. I was quite honest of my wants and needs in a position. I told her about my family and the need to be more available to them in the evening, she said "of course you must be". I said that I really enjoy teaching and wished to continue, she stated that it is an asset to her practice to have me continue in that role. When I told her that I would like to continue doing colposcopy for my current employer she said that it is such a specialized skill and that I would lose my expertise if I stopped, so I should continue to stay up on that, she does quite a bit of women's health care but doesn't have the volume of abnormal Pap Smears to even consider offering that service.

I had a working interview to see how the clinic runs. I felt right at home and comfortable with the staff and the patients were quite accepting of having a Nurse Practitioner as a provider in the clinic. I have allot to learn since I have done exclusively women's health for ten years but the she is quite willing to teach me what I need to learn.

The boys are gearing up for the school year. We are working to get back to the school day routines, evenings have been a bit of a free for all since we have had company and no real pressure to be too alert first thing in the morning. The daycare has been a good time for all three and they have made good friends and grown up so much. They will continue there during the school year.

S. will be in 5th grade. This is the last year of elementary school for him. I really hope that this year is his turn around year so that he is better prepared for middle school and all the stresses of that. A. will be in 3rd grade, first year for actual grades in our school district, and then the TAKS tests are another stress. We are still struggling with handwriting, it is improving but is still not at a 3rd grade level. J. will be a first grader, my baby is growing up. We will see how things go, I anticipate more problems this year because of more demands in school now for him. He is still really struggling with communication and allot of sensory issues.

I hope that your summer has been a good one. Thanks for reading!

Already Summer!

2007-06-30T15:46:00.001-05:00

I am not very good at keeping up with this blog. Life keeps me busy. Thank you Big Mama for the nudge.

So much has been going on since my last post in March. I finished my first semester teaching nursing school and I can't wait for next semester. I love teaching and hope to be able to continue for quite some time.

The boys all finished the school year and it is on the next grade level for them all. This summer they are hanging out at daycare and loving every minute. When I gave them the option of being home with me on my days off, they said no thanks! They spend their days playing on the indoor playground, swimming at the local pool, doing crafts and going on field trips to some really cool spots!

I have S and A working with an occupational therapist for handwriting, this is an area that they both really struggle in. We are seeing quite a bit of improvement. I also have J working with an OT for sensory integration therapy. He loves it and we talk about going to the gym when he goes for therapy, he is also working with the SLP from the school over the summer. His speech is improving dramatically with the one on one support that she can give over the summer.

I am working three days a week, two days in my clinic and one day doing colposcopy. I just can't leave what I do. Despite a few other offers that were attractive, I really feel that what I do is important and I am not ready to leave it. I need to feel that I make a difference, working where I do I know that I make a difference.
We spent a few days camping (in a tent) at Caprock Canyons in early June. The boys want to go back again and again. It is beautiful and I thin we may plan a trip after Christmas this year. The Park Ranger said there is often snow at that time. I think we may rent a pop-up trailer for that one though. Heat is always nice in the winter! It did take a few weeks to get the red dirt out of everything.

We have been dealing with quite a bit of rain lately. We did have to cut our camping trip short by a few days because of severe weather. I didn't want to try to sit out a severe thunderstorms with hail and possible tornadoes in a tent. We drove home about a half hour ahead of the baseball size hail and 70 - 100 mph winds. The rain was so heavy that we had to drive a good part of the way going only about 30MPH. It is a long drive!

It is hard to believe that last year at this time we were in a severe draught and this year we are dealing with flooding. I think this is now the wettest June on record in the DFW area. I do worry that it will stop and then we will have hot and dry weather for the rest of the summer. Unfortunately my roses are not happy with wet feet and are looking quite stressed. They will rally though since they are all old garden roses and grow on their own roots, none are grafted. Most of my garden is loving it though.

Well time to get a few things done on this soggy Saturday afternoon. I will try to post a bit more often. Time seems to get away from me these days!

Is it spring?

2007-03-13T10:46:00.000-05:00

Time seems to be flying by! My spring daffodils and grape hyacinths are in bloom and there is a certain freshness in the air. I have planted my two tomato plants and my youngest son added a few marigolds, "for color". It is spring break anyway!

I have been busy with many different things over the last two months. I have started my teaching job. I love teaching. The small hospital where my students are doing clinical has been an ideal experience, the staff is welcoming and very helpful, the patient load is just right for second semester students and I think I am a pretty good instructor!

I have a very diverse group of students. Most are second career students and take this very seriously, they are used to everything being perfect and strive for only the best. Unfortunately the realities of clinical practice is that humans are not perfect and not everything goes exactly as the textbook says that it should. It has been good to see the evolution of my students from absolute novice to a more accomplished novice. I am seeing that in myself also as an instructor.

One of my passions is knitting. I have been knitting for many years and have found myself doing quite a bit of charity knitting. The problem is, I feel that knitting is a social craft and I was mostly knitting alone. Several years ago I became aware of The Shawl Ministry. I was immediately interested in joining a group such as this one but soon realized that if I wanted to join one I would need to start it. Beginning last summer I started to bring it up at church to get an idea if it would interest anyone else. Soon I was given some seed money and a time and place to present the idea to the Women of the Church gathering. Soon another opportunity to make it very real came about. On January 23, 2007 I wrote this on a Shawl Ministry Message board.

We dedicated our first item last night.
I have a 5 year old son, his kindergarten teacher was pregnant and had her baby too early at only 25 weeks just before Christmas. My son has been very concerned about his teacher and her baby. I showed him a picture of the baby in the NICU and he was very concerned that she was cold since she was only wearing a diaper. He asked me to knit her a blanket to keep her warm.
This story is very important to me because my son is autistic. He was able to articulate his concern for his teacher and her baby and come up with a way to help. I made the blanket and a small hat over the weekend and took it to the meeting last night and told the story to this group of amazing women, many who know my son. We said a prayer for the baby and her family and everyone signed their first name on the back of the shawl card.

We have since distributed 3 shawls and I have a current request for a matching shawl and baby blanket. The interest has far exceeded my hopes and expectations.
Well the sun is shining and the dog is barking and I think that I need to spend a little time enjoying the day. I hope that you are enjoying yours.

Life is full...

2007-01-12T10:54:00.000-06:00

I can't believe it has been more than 2 months since I last updated! I have to admit that the Internet has not been at the top of my list of priorities during this time. Things around here have been running in high gear.

To do a brief rundown of our life...

We had a good Thanksgiving at Mo Ranch. There is so much for the boys to do and the hill country is full of color in November.

We have been enjoying Zoe, our little beagle dog. She has certainly added to the energy and noise around here! You have to admit she is cute..

I did test for my 1st degree Black Belt! What a challenge and I am happy to say that I did pass testing!

I have started all the prep work for teaching. I am very excited about teaching Nursing School. I love being a nurse and I hope that I can help my students to find that same joy and fulfilment in the Nursing profession.

Things are changing!

2006-11-07T11:19:00.000-06:00

I was formally offered and have accepted an associate professor position in the School of Nursing at the local college. I will start on January 17, 2007. I will be teaching second semester clinical nursing. The hours are very family friendly and I will be home in the afternoon by 3PM! It is a part time position, but I will have the opportunity to see if this is what I want to do without making a huge permanent commitment yet. If I want to consider a full time position in the future it is easy to move into that since I will already be there. I am hoping to continue with my current employer doing colposcopy clinics and also picking up about 3-4 days a week in the summer since I will not be teaching during the break. I am very excited about this opportunity! Of course I do have to pass a criminal background check and a drug screen. Those will not pose a problem. I am hoping that this will open up enough time for me to return to school to get my doctorate! That has been my goal for quite some time, unfortunately it has been sidelined for a while since having the boys.

Our other big news is that we have adopted a dog!
(Blogger won't let me post a picture...)
She is a 4 y/o Beagle, tricolor and absolutely in love with the boys. She is tolerant of all their antics and enjoys just being with them. We have had her for 5 days and she is right at home now. She loves to chase the rabbits that wander into our yard and has managed to terrorize a few armadillos that roam the neighborhood while out on late night walks. I have been a bit hesitant to get a larger pet for a while, after discussing it with a few experts, we decided now was the time. Then as soon as we made the decision, a friend of mine told me that a beagle was posted at her Vets office as free to a good home. I spoke with the previous owner at length, she is up to date on all of her shots and parasite treatment, she is spayed and has an ID chip and is used to being around an active family. They cannot keep her and wanted to find a good home. That is us! We had a visit with our new Vet and he has verified that she is in excellent health and free from any diseases or problems.

I am very interested in training her to be a Therapy Dog, the vet said that she is cleared from a health standpoint. Now I will get her enrolled in a Canine Good Citizen training program and then take it from there. Once S. turns 10 y/o he can also be involved with this. I want my children to understand the value of volunteering their time and talents for others.

Today is election day here is in the USA, I need to get out and vote!

Still busy...

2006-10-31T07:30:00.000-06:00

I haven't been around much to update here. It has been quite a month! Trying to keep up with work and the boys (all four of them) has been quite a chore. I have today off from my job but I will be spending part of the morning at the elementary school at a meeting with the campus assessment team to address the difficulties that A. is having with severe distractability and boredom in the classroom. After that I have an interview for a part time faculty position at the local Community College in the Nursing School.

I am excited about the interview, I have always loved to teach and they actually called me from a recommendation from a former NP student that is faculty there. The other nice thing about this potential position is that the college is about a 10 minute drive from home and has a reputation of being a family friendly employer.

Tonight is Halloween and our neighborhood will be teaming with little ghosts and goblins. I have the candy and trinkets set and we will be joining in the fun. My oldest has put together his costume as a fly fisherman, A. will be Darth Vadar and my youngest is a Ninja. I will put on my Queen of Heart's card costume and hand out the treats.

I hope you all have a fun and safe evening!

Busy....

2006-09-26T09:08:00.000-05:00

The Balloon Festival was last weekend. Unfortunately the weather didn't cooperate and we did not see the masses of balloons take off as usual. Most years the balloons will float right over our house and we can go out and wave at them. The boys enjoyed the festival and the many activities there anyway.

We have made our Thanksgiving plans and will be going to Mo Ranch this year. This has made the boys quite happy. We love our family time at this place and Thanksgiving is quite special there.

I have asked for some changes at work. I love my job, but I love my family more. I am a part time employee, should be working 24 hours a week, I have been away from home about 36 hours a week since school started and it is starting to really put a strain on things at home. The boys are in the afterschool program and are doing well, but they are often the last ones picked up and then dinner is rushed and we have very limited time in the evenings to just be a family. We have mostly given up any extracurricular activities. We do go to TKD on Monday evenings if I get home in time, otherwise it is dinner, bath and bed.

Anyway, I have asked that my clinic hours be changed to 8:30 to 4:30. I have one evening a week, Wednesday until 7PM, I will leave that alone. If I am able to leave my clinic before 5 in the evening I can usually be home in 45 minutes, if I leave after 5 it is usually closer to 1 1/2 hour, I live 27 miles from the clinic, on some of the busiest roads in the metroplex. I haven't been given any type of response to this request. I would stay where I am at if I could be home more for my boys.

Last week I updated my resume, I have given it to a few Family Practice Docs in the area and one group that does Adolescent GYN (Girls to Women Health and Wellness). That is the job that I would love, but even though they are really interested in me they are a new practice and don't have the volume to support a NP at this time. I will work to keep my name at the top of the list with them. I am also considering looking at some pediatrician offices in the area, I am mostly interested in the older kids and adolescents, that is where my talents are. Around this area most NP jobs are by word of mouth or by knowing someone. I have been with the same employer for 9 years, I haven't done allot of networking since I have been so busy with family issues and I have been content up until recently.

We did have parent teacher conferences last Friday for my two younger boys. A. is struggling with distractions but is still way ahead of the game since he is bright enough to keep up by hearing about 25% of what is said in class. He is reading at a 5.3 grade level and is in the second moth of 2nd grade. We are wondering how much of the issue is boredom so his teacher is working to get him involved in more advanced work. I am very worried that his ability to keep up this way will not last as the work gets harder.

J. is exceeding all the expectations. He has integrated into the classroom, he has made friends and is finally starting to realize that written letters have meanings and sounds and has been working very hard. He is finally able to write his name and is very proud to put it on everything. He is being pulled for about 30 - 45 minutes daily for speach and language arts and will receive even more support in fine motor skills. But I am very happy with his progress and from a behavior standpoint, he is doing outstanding. He has had no issues with any behavior problems at all at school, and very few at home. He is one tired boy when he gets home in the evenings though.

My oldest son S. has been doing very well also. He and a neighbor worked on a poster for fire prevention week at school, it won 3rd place for the 3rd and 4th grades at his school. (Blogger won't let me download a picture of it....) We will have a conference with his general ed teacher as well as the resource team in a few weeks.

This is long, if you made it this far, thanks for reading. If you know of any good part time Family NP job prospects in North Texas, please let me know.

Former Texas Governer, The Late Ann Richards

2006-09-14T21:48:00.000-05:00

"I have very strong feelings about how you lead your life. You always look ahead, you never look back."

Ann W. Richards (September 1, 1933 – September 13, 2006) was an American politician from Texas. She first came to national attention as the keynote speaker at the 1988 Democratic National Convention (detailed below). Considered the first woman elected Governor of Texas in her own right, she served in that post from 1991 to 1995; she was defeated for re-election in 1994 by George W. Bush, current President of the United States. Born during the Depression, Ann Richards died in Austin, Texas from esophageal cancer at the age of 73.
http://en.wikipedia.org/wiki/Ann_Richards

Tomatoes for Fall.......

2006-09-03T17:34:00.000-05:00

In Texas we have two growing seasons, spring and fall. I was worried that the heat and dry weather had taken its toll on my fall tomato plant but with the cooler temperatures and rain last week it is finally blooming.

Dr. Charles, this is my final submission for the tomato contest for 2006, should have tomatoes by October.

Celebrating!

2006-08-17T22:43:00.000-05:00

I have been taking Taekwondo for 2 years. I started because my 2 older sons were taking it and parents had a chance to train free for a month. I thought I would give it a try. Tonight I was recommended for black belt. I never imagined that I would be preparing to test for my 1st degree black belt in November. This has been an incredible experience for me.

Tonight I was required to do my form, spar and demonstrate competence in self defense techniques. I was also required to break two boards using an arm technique, a back elbow strike, and a kick technique, a #2 jump round kick (a very difficult technique for me). I felt confident about everything but the board breaks, I plowed right through them. I think it was all the adrenaline that gave me the power to do that.

My boys are very proud of me. That makes it even more special.

Time for Change of Shift

2006-08-11T07:44:00.000-05:00

Change of Shift is up. Take a walk around the college campus with Intelinurse2B!

School Days

2006-08-09T10:45:00.000-05:00

Today is the first day of the 2006-2007 school year in our district. This is the last year that school will be starting this early, beginning next year the Texas Legistlators have decided that school cannot start before the 4th Monday in August. I am not very enthusiastic about this new law, August is the hottest month of the year, it is dangerous to send my boys out to play and keeping them entertained inside is a challenge. My childcare costs will increase dramatically and then there is my concern about retention of what has been learned the previous year. But that is the way it will be.

My three boys are finally all in the same school. I am very happy with the teachers that they have and I am optimistic that we will have a good year.

S., my nine year old (seen getting on the bus in the above picture), has matured quite a bit over the summer and has expanded his areas of interest to include some topics that more kids are interested in, he will be involved in a group at school that is called "STOP" Students Taking care Of their Peers. This group makes welcome packets for new students and shows them around and helps them find their class and the cafeteria and other areas of the school. They also hold a Teddy Bear Drive to donate to the local children's advocacy center. He loves things like this and I think this will give him an avenue to let his peers see him in a different setting than just the classroom where he really struggles. He is actually very happy about school starting and was very excited about meeting his teacher yesterday.

A. has continued to struggle through the summer with depression and anxiety, I am hoping that the routine and structure of school will help him. He asked me last Friday if it was too late to change schools. I told him that I would take him to school for the first week so that he wouldn't have to ride the bus. He seemed relieved and once we met his teacher yesterday he seemed much less anxious. His teacher is new to the school but has taught Special Ed in the past and I think that is a good thing for A. this year. I filled her in on what is going on with him and the counselor is also aware and will start meeting with him next week for support and she is putting together a group of boys for a friendship group, she wants A. to become somewhat of a leader in the group, he has been a leader in the past and she is hoping that this will be a confidence booster for him.

Speaking of A., we spent a good part of yesterday in the local ER. He fell off the monkey bars at day care and split his chin open. Our Family Doc was not available and his partners were not able to get us in either. I am not a fan of going to the ER with something I feel should and could have been handled in the office, but that is where we were sent. Many hours later we left with 4 sutures, a shot of antibiotics and a prescription for more. A. is feeling quite excited to start school this year with a "busted up chin" that he can show off, he was disappointed when I told his teacher that it has to stay covered. The ER doc did a beautiful job suturing it up and I don't think it will leave much of a scar.

J. started Kindergarten today. He was up at 5:30 AM and dressed and eating breakfast shortly after. He didn't want to miss the bus. Of course the bus doesn't come until 7:15 AM so he had quite a wait. I did peek in on him when I dropped A. off and he was sitting at his table with 3 other kids doing his "morning work". He has an aid with him and she was just standing back and watching since he was engaged and chatting with the other kids. I am pleased with the teacher that he has, she was at his ARD meeting in the spring and knows what he can do. She is taking the team approach to his education and I am very happy with that.

Well, now that the before school rush is over, I am hoping for a bit of a lull in the action. I have belt testing next week at TKD and am hoping to get in as many classes as possible before then. I will be testing for recommended black belt. I never dreamt two years ago that I would be testing for this belt or decided first degree black belt in November (if all goes well next week). Taking TKD is one of the best things I have done for myself in a long time. After all, where else can I go and hit and kick, and break things and yell and then be rewarded for it! I think every mother needs an outlet like that.

And we never did any rain on Monday.....

Rain?

2006-08-07T14:03:00.000-05:00

This is what the sky looks like outside right now. It looked like this yesterday and we got about 2 minutes of rain, unfortunately we need about 2 months worth. Our lake that we get water from is now 13 feet below normal and things are very grim for any real relief.

Maybe we will get more today. The local radar shows rain to the north and to the south of us. We have discussed this among neighbors, we think that we have an umbrella over our area! We are taking the issue quite seriously and have really worked hard at conservation measures as recommended by our local water district.

Grand Rounds

2006-08-01T08:18:00.000-05:00

It is Tuesday and Grand Rounds is posted at Inside Surgery. Please visit and enjoy the great collection of posts. Thank you Dr. Marcucci for hosting.

Empathy

2006-07-27T10:52:00.000-05:00

Empathy is a very important to me. I feel that to be a competent caregiver both professionally and personally I must have empathy. To be a wife I must have empathy. To be mother to three boys with challenges, I must have empathy.

I want the people involved in the care and education of my boys to have empathy. My children are happy boys and are leading full lives; they are creative, funny, active and engaging. They do have difficulties with various issues and situations, some things are beyond their capabilities. Some things they will never master, but with the correct leadership and education I expect they will conquer their own world and continue to lead full and joyful lives. They don’t need sympathy or pity.

As a Nurse Practitioner I encounter many situations that require empathy. There are very few professions outside of the health care professions that are as intimate and invasive of the individual as our professions are. People come to us and trust that we will preserve their dignity and integrity. We are strangers and they often trust us with some of the most important and private issues in their lives. We have usually entered a care giving profession because we really do want to help people, the work is too hard and the hours are too long to want to be there for any other reason.

I am a Family Nurse Practitioner, I have for the last 9 years done Women’s Health Care. I have a varied professional background. I never dreamt I would do Women’s Health Care and OB. I was more interested in fast paced, adrenaline producing situations and complicated multiple diagnoses. My professional history includes time working in a Pediatric Burn ICU, Coronary ICU, Cardiovascular Surgery ICU and working as the Inpatient Coordinator for Heart and Lung Transplant programs at three different large transplant hospitals. Now I do pap smears and STD testing and colposcopy. How did I end up here? How did I end up loving this position as much if not more then the ones I have had in the past?

One thing that all my various positions have required of me is empathy. The ability to look at the patient’s situation and understand it. I don’t need to feel it to recognize what they are going through; I don’t even have to agree with it. I just have to understand it.

When a woman comes to me for her well woman exam or a problem she trusts me, a stranger, to invade her body and perform procedures that are quite foreign to her. I will be touching her in intimate and private areas, I will be asking her embarrassing questions and expecting her to answer with honesty. I will be bombarding her with information in a very short amount of time and I will be doing what is routine to me. If I am able to show empathy to her and acknowledge her fear and anxiety in my actions and words and gain her trust she will be more likely to be forthcoming with answers to questions that I am asking, she will be more receptive to information that I am giving her. She will have an uncomfortable exam instead of a painful and embarrassing one and she will trust me enough to come back. Maybe then the information that I have given her on health and safety issues will actually mean something to her.

I saw a woman in her mid forties; she had not had any kind of healthcare since her last child was born, 11 years ago. At that time she had a Bilateral Tubal Ligation and felt no need to continue routine exams since she didn’t need any birth control. She originally came in to the clinic that day at the insistence of her husband and daughter because of severe low back pain and bleeding from her vagina after intercourse for about two years but had now been constant for a few months. She was there with her sister because the pain in her low back was so severe that she couldn’t drive.

She was terrified. Her last pregnancy was a difficult one and her delivery was complicated and the whole experience had her convinced that she had no need to ever seek health care again. She filled out our medical history form and I felt that she had been quite honest in her responses to the probing questions. One thing that put up a red flag was that she had an abnormal pap smear 11 years ago. She never returned for follow-up. She had lost trust in the caregiver that performed the Pap smear and never went back.

With this information all before me, prior to even meeting this woman I knew it would be a challenge. She was the last patient on a day that had been long and was already running over an hour late. I was tired. In my mind I was asking the rhetorical question, why do they always wait until problems become so bad and then they are the last patient of the day?

I knocked and went in and introduced myself to the patient. She sat at the end of the exam table a tall, elegant and poised woman. She sat with at straight back and stiff limbs and when I offered my hand to her to shake, she gripped it firmly. She promptly told me that she didn’t want to be there. She then introduced me to her sister who brought her and wouldn’t let her leave. From there she proceeded to tell me that she had avoided healthcare professionals and she didn’t trust us and would rather die of blood loss that let anyone touch her again. What? Why was she here then? She came at the insistence of her family; she still had the ability to say no. Tension enveloped the room and I wanted to run, to go home and be with my family and spend the evening doing family things. I knew right then that my family would be having dinner without me that night.

I took a seat on the stool and asked her to just talk to me and let me know what was going on. I sat as she started and stopped a few times, I didn’t rush, and I didn’t interrupt except with a few utterances to let her know I really was listening. She finished her story and I sat a few more minutes, acknowledged how really hard it must have been for her to be in the clinic that evening and how scary it must be to know something is wrong and to have to rely on someone else to figure it all out. I let her know that I was very concerned, I asked her to allow me to examine her. She was not sure she could manage an exam that evening. I offered her the opportunity to make another appointment in the next few days to return after she had thought about what I had said and what my concerns were. I did tell her I would call her and check on her the next day and we would set up her appointment at that time. She agreed that that may be the best.

I left the room, started writing my note about our interaction and the plan when her sister came out and asked if there was still time to do her exam. By now it was an hour and forty minutes since the clinic had closed. I went in to find the patient a bit tearful and yet stoic and ready to do the exam. She has decided that if I was able to take the time to listen to her and allow her to make a few decisions that she was able to make the decision to be examined at that time.

It was a very difficult exam. It was painful and there was significant bleeding and I knew as soon as I put in the speculum that my news to her would not be good. I found a large lesion on her cervix and her cervix was hard and fixed in place and her pain increased dramatically with the exam. I finished what I was able to do and had her get dressed and then went back to talk to her.

I told her that I was certain that the lesion that I saw was an invasive cervical cancer. I offered at that point to work on securing grant money to do a colposcopy to rule in the cancer and then she would be able to obtain emergency Medicaid for treatment and I could then refer her to a Gyn Oncology clinic. Reluctantly she agreed to come the next week to my dysplasia clinic. I was very concerned that she wouldn’t show up and had the manager of the clinic call and assure her she had funding for her and to set up and then confirm her appointment.

The next Thursday as I was driving in to the clinic I felt quite anxious that she wouldn’t be there. I suddenly felt very invested in the well being of this patient. As I walked in the back door the assistant was walking with this woman to the counseling room. She was there and was the first patient of the day.

We did diagnose invasive squamous cell carcinoma of the cervix in the biopsies that I did that day. We were able to get her emergency Medicaid and she did get treatment and is now home and doing well and enjoying her family.

She sent me a card the other day. She thanked me and said that her family thanked me. She then added that the time I took to really understand what she felt was what changed her mind. She called it my “gift of empathy”.

Last of the spring tomatoes...

2006-07-25T16:58:00.000-05:00

I picked tomatoes this morning to have in a salad this evening. It is the last of the tomatoes from this plant. No more blossoms. Time for this poor plant to hit the compost pile.

It is time to plant my fall tomatoes. We should have tomatoes well into November if the weather will cooperate.

Grand Rounds

2006-07-25T12:56:00.000-05:00

Grand Rounds Volume 2, Number 44: The Garden is up at Medical Humanities , please take the time to walk through the garden, it is a really nice collection along the path.

The Drought

2006-07-22T10:40:00.000-05:00

We are still on stage 3 water restrictions here in our city. We are able to water once a week, one inch. Some of the neighboring communities have moved to stage 4, no outdoor watering. The lake that we get out water from is very low and what was once water is now a meadow. This bridge usually spans the lake. This picture is from the City of Allen website. I think it must have been taken a few weeks ago, when I drove over this bridge today, it is all overgrown with weeds in this area.

The restrictions are anticipated to continue thru the end of 2007. We are expecting that we will be moved to stage 4 restrictions in our city soon. Even if we were to get allot of rain it will take a long time to replenish the reserves and the North Texas Municipal Water District is working on alternate sources.

This is our first casualty to the drought. This was a River Birch that we planted in a rather soggy area of the yard to help with the drainage issue. The drought has alleviated the soggy area and also this wonderful shade tree. The rest of the yard is holding up so far...

My lone tomato plant is hanging in there but I think this will be the last of the tomatoes for this season, time to get some planted for the fall.

Paris

2006-07-20T21:36:00.000-05:00

For the last 2 1/2 years, one day a month I travel to Paris to staff a colposcopy clinic. Paris, Texas that is. I look forward to this day each month. It offers me a change of pace and I enjoy working with the staff at the clinic. It is a 90 minute drive each way on most days. The WHCNP that is the clinician at the clinic was a student that I was able to mentor/precept five years ago and it is nice to watch her as she matures in her role. I enjoy the patient population and the role I fill in this community. This is what I really think I was meant to do when I became a FNP.

One thing that strikes me each time I go is the different expectations of the patients that I see. I am a big city girl, have always lived in or on the fringe of a large metropolitan area and have had easy access to all that I may want or need. The clinic is across the street from a feed store and next door to a car repair shop. The stockyards are a few blocks away and I can often hear as well as smell them. The patients that I see are medically indigent hard working people. Many haven't ever had adequate healthcare. Many haven't ever been anywhere but in Paris and the neighboring communities.

When patients come in to see me they are scared and feel overwhelmed by the whole process and the diagnosis that brought them to me. I will often be seeing women that haven't had any healthcare for years and they came in for an exam because of problems and were found to have an abnormal Pap Smear. The women that I see at this clinic have few resources and I rely on private, state or federal grants to pay for the colposcopy, unfortunately the grants don't pay for treatment. When the colposcopy and biopsies reveal a high grade dysplasia or an invasive cervical cancer I can usually get them emergency Medicaid if I was able to get them on a grant for the diagnostic procedures in the first place. Unfortunately the struggle doesn't stop there. It is difficult to find a physician that takes Medicaid for Gyn Oncology in Paris Texas, it is difficult to arrange transportation to Dallas if they need to go there for treatment and it is difficult to explain the urgency of obtaining care when they have the more pressing immediate concern of feeding their families and keeping a roof over their heads.

I feel good about what I do there, I feel frustrated by the situations I encounter and I feel angry that we make it so difficult for these hard working folks to get the basic care that they need. I will keep making that drive each month, I will keep on working to get the care that these women need and I will keep being frustrated. I will keep on loving my job!

It is so hot....

2006-07-18T12:49:00.000-05:00

We are definitely in the dog days of summer here in North Texas. It is already 101 degrees today and it is just after noon. It was 85 degrees when I got up this morning at 6AM.
On the way home from work yesterday there were cars stalled on the sides of the freeway and you could see the waves of heat rising from the cars ahead of me. We have been under heat advisories for several days and a high temperature of 98 sounds like a cool breeze. We are still suffering a severe draught and have water restrictions in place. I feel like I am living in a cave since we are keeping all the shutters and blinds closed to try to keep out the heat. We have had hotter summers here, but this is still a miserable time.
The boys are tired of indoor activities and it is too hot to just send them out to play, I load them up with water bottles and sunblock and we have lots of shade, but they wilt after about 10 minutes and come in panting and red and miserable. I think I am ready for winter, but if it is anything like last winter, it never really cooled off.
But please don't misunderstand, I do love living in Texas!

Riding Horses

2006-07-15T20:01:00.000-05:00

Today was A.'s second horseback riding lesson. He was so excited on the way to the stables and talked nonstop about "his" horse Prancer that he rode last week. He will keep the same horse for the 6 classes that he is signed up for.
We got there a bit early and spent some time talking and grooming Prancer. Then he learned how to saddle her.

I have one very excited 7 y/o. He is doing something that his brothers aren't involved in and it is something we can share. He is cautiously confident at this point. I think that is good.

Getting ready for the new school year...

2006-07-13T10:30:00.000-05:00

In just a few short weeks, on August 9th, my boys will be heading back to school. It is an anxious time for me. I worry how they will do.

Will my youngest be able to transition into a full day classroom. Will life be easier for him with the security of a highly structured day or will he find the classroom to stimulating and have difficulty with that. He did so well in PPCD, with a small class and so much support. (This is a photo of him getting on the bus when he was 3 y/o.) So many what-ifs....

I am also concerned about my oldest, the pressures of 4th grade, the fact that he is dysgraphic and 4th grade is when writing becomes so important in the curriculum. Will he find friends that he can relate to now that he has found that joy over the summer, or will he feel like the outsider again.

My middle son is already worrying about the bus. We have taken steps to protect him on the bus this year but in his 7 y/o mind it is terrifying. He is doing very well on his medication and is laughing and active again, enjoying the things that little boys should enjoy, making silly noises, riding his bike, running around and making messes. Unfortunately both appointments we have had with the counselor have been cancelled at the last minute due to illness of her child. We will try again on Tuesday.

I wonder if I will ever start a school year without this anxiety that I feel for my children. I talk to other moms and they express much different feelings from mine. They worry about getting new clothes and shoes, new haircuts and backpacks. I am worrying about before school appointments with Doctors and therapists and filling out forms for the school nurse and resource team. I am scheduling meetings with the special ed bus driver, the school counselor and the resource teachers to give my boys a chance to meet these people that will be so important to their success in the coming year. By the time school starts each year, I am exhausted. I need a vacation.... unfortunatly the schedule just won't allow for that.

Ramblings...

2006-07-08T19:13:00.000-05:00

I had lunch today with a long time friend. We met at a local eatery and settled in for our usual 3 hours. Soon a very familiar looking woman sat down at a table nearby. It only took a few seconds to realize who she was. It was a good day!

Just a little background on me. In my 20 years as a nurse I have had many different roles. While in school I worked in a pediatric burn hospital, first as a unit secretary and then as a burn tech. When I graduated I worked on a surgical floor where we had patients following reconstructive plastic surgery. That was a good start since it taught me time management and organization and compassion and empathy.

After six months I wanted more excitement and moved to Houston to work in a big Hospital in the Texas Medical Center. There I learned how to be an ICU nurse. I felt that this was my true calling in life and thrived in the role. I did a 6 month comprehensive nursing residency and took a position in the "Cardiac Critical Care Unit". This was a busy place that only admitted the sickest of the medical heart patients, we never had a patient admitted to our unit to "rule out" an MI, these patients were on several IV meds to keep their heart rates up or down, their blood pressures up or down and we always had a few balloon pumps and occasionally a patient on "fem to fem bypass". It was an exciting time, it was the mid 80's and many research protocols were being done in our unit. It was also a time of the resurgence of heart transplantation, and the realization that it was no longer an experimental procedure.

In 1987 I decided to return to school to earn my MSN, I chose to follow the Clinical Nurse Specialist tract in Critical Care. I focused on heart and lung transplant nursing. Soon I was offered a job at the hospital on the heart transplant team. I still remember the first patient whose transplant I coordinated, I had actually taken care of him in the ICU when he had decompensated a few times. He was a 24 y/o man who had a viral induced cardiomyopathy. He was a big guy and finding a heart to fit was proving to be a difficult task. On December 10th 1988 I spent the late evening and night in the operating room making sure that everything went well as we performed a heterotopic heart transplant, otherwise know as a piggyback transplant, the donor heart was attached to his failing heart. He thrived with the transplant and was out of the hospital in record time for the late 80's, he went home 6 days after transplant! I stayed in touch throughout the years and was even in his wedding in South Dakota in 1990. I received a call from his wife in January of this year. He passed away peacefully. He had lived a good life and was ready. I cried, I felt like an era of my life was over.

In 1990 I moved on to Minnesota and worked as a transplant coordinator there. Unfortunately it was just not the move I had hoped for and I missed home. I moved back to Texas a year later but this time to North Texas to open and run a new heart transplant program at one of the major hospitals in North Texas.

It was at this time that I met this incredible woman. She was one of the patients that put her trust in a very competent but new team to give her a chance at living when her heart was failing rapidly. She is really a lovely woman with a smile that lights up a room. We became friends.

I left the job in 1994, once it was up and running and growing and I was burning out, I wanted to start my family and felt that it was too much for me to this job and have children.

We stayed in touch and I was honored to be invited to the 10 year anniversary celebration of her transplant. It has now been 15 years. She is healthy and active and has just returned to school to get her Master's degree in counseling.

I am in awe of her and all the folks that put their trust and lives in our hands. I am in awe of the families that so unselfishly give at their time of grief. I am very honored to have been a part of that and have the chance to be touched by so many lives.

When I left that job I tried my hand at administration for a large home health agency, soon to realize that this was not for me, I missed my patients, I applied and then was accepted into a Family Nurse Practitioner program as a non degree seeking student, I finished in the spring of 1997.

I have never had one moment of regret. I love my work, I love my role. I am still a nurse but can now provide more comprehensive care for my patients. Life is good.

Rain!

2006-07-05T21:00:00.000-05:00

We have had a very dry year here in North Texas. The lake that is the local water supply is down almost 12 feet. We have outdoor water restrictions in place, we can water our lawn one day a week and that is on Tuesdays. When driving through the neighborhood, we see allot of brown lawns.

Yesterday it rained! Not a drizzle, not a soft gentle rain, but an all out bold and beautiful soaking. You can see the joy that this has brought us! We were out in the street dancing in the rain, a soaking wet, joyful dance. I would be happy to have it rain like this for a week. But today the sun came out and dried up all the rain again...

Tomatoes!

2006-07-04T09:16:00.000-05:00

I haven't been very successful in years past growing tomatoes. I love to have fresh from the garden tomatoes to eat but living in North Texas it was hard to keep the plants contained in the spring and fall and they were often destroyed by the local wildlife that enjoy frequenting my gardens. Summers are impossible to grow anything because of the heat. So rarely would we enjoy many fruits of the vine.

This year my boys wanted to try again so off we went to look for a "patio variety". We planted it in early April, just a few leaves on a small stem, in a pot on the patio, since it is a "patio variety". We have been eating tomatoes every day now for about 6 weeks and it keeps on producing! A fresh tomato for the 4th of July salad today!

Life in the fast lane!

2006-07-03T09:11:00.000-05:00

Has it really been this long since I decided to start this blog? I had thought I would post a bit more frequently but it is already July and here I am. We have essentially unplugged for the summer and I am turning on the computer at home only a few times a week to check email or to do a bit of research or shop. We have also turned off the TV for the most part. Amazing how quiet it is these days! Things are rarely quiet with three boys in tow!

One of my biggest concerns for the summer had been childcare for my guys. It is challenging to find a good and convenient place for all three. I found a place not too far from home that is a school age specific "Activity Center". I spent time with the owner/director explaining the issues with my oldest (S. who is 9) and youngest (J. who is 5) sons and gave her information on Asperger's Syndrome and Autism. So far two of my guys are having a really good summer. I think for the first time ever my oldest feels like he is accepted for who he is and has made a few friends, he is excited about going everyday. My youngest has the structure he needs and the ability to move and be active and despite a few wetting accidents has done well. His speach has hampered a few things but since he is verbal they are working it out.

Unfortunatly, my middle son (A.) is having a very rough summer. Actually this started during the school year when he was being bullied on the bus on the way to school. Of course he wouldn't tell us about the bullying, I had to do a bit of detective work to find out what was going on. A nieghbor's daughter revealed to her that he was being both verbally and physically bullied and didn't want it to get worse so he was keeping quiet. I took it to the school and they did act on it but it started again about two months later. I had A. start weekly counseling with the school counselor. He is an avid reader so we found some books on bullying and those seemed to help him know what to do and he seemed to have some increased confidence.

Once school was out I really thought he would find some joy in all the new summer activity and would really do much better. He is a very athletic boy and this activity center has an indoor playground, gymnastics and karate classes and organized noncompetitive soccer and kickball, as well as swimming three times a week. He has chosen to sit inside the TV and video game room and watch others play video games, he doesn't even want to play them himself...he loves games, and he panics if he misses the daily afternoon movie that is shown for those that are not going swimming or doing the other activities. He never smiles and at home he is in tears more than half the time. He told me that he feels like crying all the time and "just can't keep a smile on his face". We went to see the Child Psychiatrist that manages his ADHD meds on Friday and he was put on Lexapro. My heart is breaking for my little boy, he is only 7 years old, this should be a carefree time for him. Hopefully we will see improvement by the time we return to the doctor in two weeks. I have also arranged for him to start counseling with a child psychologist who has experience working with siblings of children on the autism spectrum.

Blogging...

2006-05-19T10:10:00.000-05:00

I have read many blogs and have thought of blogging for myself many times, I just feel that I never really have the time. This will be my attempt to put into real words what it is like to be a mom raising three boys with significant challenges. I may post often, I may post occassionally. Life is very full, we will see what it brings next.