please...

visit my new blog! I think I'm going to throw the towel in for this one. :) It's just too much work to maintain two...

Drumroll please...

www.pamirn.blogspot.com

Nurses still wear caps?

Did you know that in some parts of the world, registered nurses still wear those white caps? And they still wear white stockings? And they still wear white dresses or outfits? Yes, it's true! Yesterday I went with my dad to one of the major hospitals over here and I snuck a few pictures of the nurses (hence the lame shots). These hospitals are state-of-the-art, top-notch hospitals!!
Can you imagine what would happen if US nurses were still required to wear the caps? I'm glad I don't have to wear it, but it some ways it would be helpful for our patients to identify us as the RNs. With so many allied health professionals in the hospitals (nurses aids, doctors, occupational therapists, speech therapists, house-keeping, physical therapists, etc, etc, etc) all wearing scrubs, patients often get confused who the nurse is...the person ultimately in charge of their minute-by-minute care. Hmmmm...something to think about.

Been a While

I've turned into a horrid blogger! I was doing so well. But I refuse to give up and phase out. :)

Part of the reason for the long absence is because I've been scrambling to get ready for my trip to the Philippines in just two weeks! I've been sending out newsletters, applying to Action, working like crazy, moving to a new city, etc...

The big news in the blogospheric world is that I've started a NEW blog. No...I'm not giving up on this one, but this new blog is expressly for my missionary work. Hospital related stories will stay on this site. I may decide to merge them down the road, but I created the new site that has a shorter address so people can find it easier. So if you want to stay on top of that particular adventure, look for my other blogs or e-mail me for the address.

Giving

We've all heard the saying (it's Biblical!) that giving is better than receiving. And yet on Christmas morning as a kid, it was SO much better to receive! :-)

The other day I had an older gentleman for a patient. I had been warned by the day shift that he was quite the talker, which is pretty amazing considering he had just come out of surgery. Nonetheless, I realized what the day nurse meant as soon as I stepped in the room and introduced myself. He lamented that I hadn't been able to meet his dear wife as she had just left for the night. Then he got this undeniable twinkle in his eye as he said, "you know, I still bring her breakfast in bed every morning that I can!" He went on to say that he never used to buy the saying that giving was better than receiving, but ever since he started to really serve his wife, he had experienced a major change of heart. And this was no cold cereal and fruit. This was poached eggs, bacon, pancakes, smoothies...the whole nine yards. He said that ever since he'd gotten sick, there was now a fun war in their home as to whom could get breakfast for the other first! What a delightful man.

It made me realize that is what I want in life. Not just marriage, though I think service is key to a good and healthy marriage, but also life in general. Today's culture screams out at us that #1 is the most important person in the world: we don't love ourselves enough, we don't take care of ourselves, we're too self-sacrificing. The rate of prescribed anti-depressants has sky-rocketed. I don't just think that it's because it was previously underdiagnosed (though it HAS been underdiagnosed in some circumstances). I personally believe that some of it is because as the attention is turned inward rather than outward, people don't like what they see, but they don't know how to change it other than passing the buck to everyone else for all their problems. However, when we turn our attention outward, focusing on giving to others rather than constantly expecting to be on the receiving end, we find ourselves pleasantly surprised at how happy we become.

"In all things I have shown you that by working hard in this way we must help the weak and remember the words of the Lord Jesus, how he himself said, ‘It is more blessed to give than to receive.'" - Acts 20:35

Not just another holiday

Today is Memorial Day. CNN had a poll asking if "we" thought that Memorial Day had lost its meaning. Is it just another day to sleep in? Spend time with family? Throw a couple steaks on the grill? Or is really a day to remember the fallen heroes and those who serve our country to protect our rights and the rights of others...

Having grown up in a different culture, I remember always being awed when we would come back to the States. The clean roads, closed sewage systems, potable drinking water from the tap, no street kids... I never took that for granted. Now that I've lived here for 8 years, I find myself beginning to develop the calloused heart that I found so concerning in the average American on the street when I first came here.

So what is Memorial Day if it's not just another holiday? As a believer, I think it holds deeper meaning. Yes, it is a time to remember those who have given their lives and personal freedoms so that we can keep ours. I know several veterans who have lost their lives for my country. And I know so many more who carry both physical and emotional wounds from war. To them, I am grateful beyond words. I never want to make light of their sacrifice for us.

But the deeper meaning lies in the ultimate sacrifice of the ultimate war. Christ gave up His life so that we could have freedom beyond our understanding. The war is for our eternity, the sacrifice is the cross. But the beauty of Christ's ultimate sacrifice is that we can rejoice in it. For by His stripes we are healed...For many Americans, it can be hard to equate the sacrifice of our servicemen when we don't see the suffering other parts of the world experience without the freedoms we have. But we all experience life without the greatest freedom of all. Christ's sacrifice is absolutely personal, worth appreciating, and worth accepting. For this, I am truly grateful.

Quite possibly the best invention ever!

Ever since I started working nights, I've tried to be creative with finding ways, nonpharmacologic ways, to help me sleep during the day. I tried draping dark blankets around my bed, cheap eye masks, etc... but I'm still suffering from "work-lag." This is the time between 3am-7am that I can't sleep, no matter what time I went to bed or what I have going on that day. While this waking up in the middle of the night isn't ideal, it is giving me time to have my devos in solitude and quietness. I've been praying that I'd be more motivated and I guess this is God's answer!

BUT, I have found a most excellent eye-mask. It's made of that memory foam stuff and lets in zero light...I mean ZERO light. It's a bit spendy: $35, but so worth it if you really want to sleep. It has little pockets inside that hold it away from the eyes so there's no pressure on the eyes. So lovely.

So while I think I should get some compensation for this little plug, if you want a good eye-mask, go to Brookstone and get it. Seriously amazing.

Hmmm...what to say...

It's been a while since I've posted. Not because there hasn't been much going on, quite the opposite. I cannot wait for this semester to be over with so that I can really focus on work. The timing is actually quite impeccable. The week school is over is the same week I start as an RN "on my own." (Anyone else have Les Mis running through their head now?) For the last 9 weeks I've had another RN shadowing me, helping precept me to the life of a new nurse.

One quick story: I had a south Asian patient the other day who didn't speak more than 5 words of English: NO!, yes, sank you, there, and fix. We struggled all night as she wanted her curtain, pillows, blankets, and gown JUST so. After going in to her room about 3-5 times an hour all night, we ended the shift with her morning meds. When I walked in, she motioned brushing her teeth. I finally put my foot down and said that the nursing aid would help her brush her teeth AFTER she took her meds. Every two minutes after that she was calling for us so she could brush her teeth. By now I was thoroughly frustrated. My aid was busy so I gave her a toothbrush and paste only to hear a resounding, "NO!" She wanted to walk to the sink. Alright, I know what it's like to be in the hospital, so I'll go with it. I got her to the sink when she suddenly grasped my arm in a death grip. These little old ladies are STRONG! She started motioning something about her tongue. Clueless I grabbed every supply I could think of, hearing only, "no!" every time. Finally I grabbed the basin with all her toiletries from beside her bed. She pounced on this curved, ornate silver object and proceeded to scrape her tongue. Of course, why didn't I think of a tongue scraper. grrrr...

I was so ready to pass this lady on to the day shift and warned them that she was very needy and used to being the matriarch. As we were walking out of the room, she grabbed my hand and said very clearly, "I love you!" Sigh...you just can't hate them for long.

<---her tongue scraper was much fancier than this...

love or pride?

My pastor quoted Richard Cecil today in church:

"To love to preach is one thing; to love those to whom we preach is quite another."

I am a born preacher. NO, I don't preach at a pulpit or even in a classroom. However, I am a pretty opinionated woman and really don't have a problem speaking my mind. It can be something like a little-known fact, how I think one should clean, what to do after surgery, when to take Tylenol for a headache, etc... (Is it a surprise I'm a nurse?) But when I "preach," what are my motives? Is it to justify my own opinions? Such as, if I can convince them I'm right, then I really must be right. Do I "preach" to make myself sound smart?

Now that I am considering a life of missions and nursing, both of which are apt to preaching of some sort, it's something I need to really think about. When I walk down the dirt path to the squatter shack to teach infant care, it MUST be love that drives me, not some sense of self-inflation, pride, or self-justification.

Because let's be honest: you can usually tell within seconds if someone loves to preach in order to hear themselves talk...we call it "hot air."

Holding Hands

I had to call in sick last night. Something I was loathe to do so new on the job, but the thought of starting an IV or inserting a foley while the room was spinning was enough to keep me home. I felt horribly guilty for hours afterwards...was I REALLY too sick to go to work? Would people think of me as a wuss? (stupid new grad!) Could I have pushed through?

It's been a rough night. After sleeping most of yesterday to prep for last night, I couldn't sleep a wink! It was miserable. My mind was constantly on the unit and what I could have (should have?) been doing. In the end I decided that I was more worried about my pride and reputation than my patients. Yes, I really was ill. And yes, that really warranted a sick call.

On a happier note, I've learned that nursing is really a vain profession. I've been complimented more times in the last 6 weeks than the last 6 years combined! Of course, 90% of my patients have poor vision, but still...

A couple of nights ago I helped admit a sweet old lady from the ER. She had been completely alert and oriented before going to sleep but when her IV started beeping in the middle of the night she became so confused. By the time I walked in she was trying to get out of bed and it took some time before I convinced her I was a nurse. She kept asking me where I was sleeping and apologizing for waking me up. I finally squatted down next to her bed, held her hand, and just talked with her about my job and how I was there to take care of her. She was quiet for about 30 seconds. I asked her if she was ok and she said, "I'm fine, honey. I'm just trying to find the words to thank you." Have I mentioned that I love my job?

Patients Say the Darndest Things

One of my patients this week was in isolation for testing positive to MRSA (a bacteria that has become resistant to some antibiotics). It's not that big of a deal, but we still have to wear this very trendy yellow gown and gloves whenever we enter the room.

I had to go in at 6am to give the patient a shot in the belly to prevent blood clots. I turned the dim lights on to save his eyes as he was sound asleep. After waking him up and doing all the normal procedural stuff, I walked up to his bedside, helped him pull up his gown and administered the injection. It wasn't until I'd stepped away that I realized in the dim light that I had been standing in a huge puddle of fluid. A quick glace at his IV bag showed it was still full, so I asked him if he knew why there was water on the floor.

With a big grin he said, "That there is 100% pure pee!"

Ahhhhh yes! gotta love it. Apparently he had tipped over his urinal after filling it during the night and I had the pleasure of stepping in it. You can be sure I took my shoes off outside my door and sprayed them REALLY well with Tilex. Yuck! His urine probably wasn't infected, but just the fact that it had come from an isolated patient made it even worse.

Patients Say the Darndest Things

The other day I had a very active patient who had just had major elective surgery. He was determined to get out under par, but one of the stipulations is all patients must have a BM before we let them leave as one of the side effects of pain meds and anesthesia is constipation. When I told him this he was in agreement but said it shouldn't be a problem because he's always "regular." When I took care of him the next day he was getting frustrated that he hadn't gone yet. The following is a sample of our conversation:

Patient: I can't understand why I haven't been able to go!
RN: Don't worry, that's normal. Patients normally don't go until their third day anyways. You should be able to go by tomorrow
Pt: But I go everyday without fail
RN: Yes, but your body just went through alot! You must be patient with it.
Pt: Is there anything I can take to make me go?
RN: You are already taking a stool softener. You can try prune juice or we can get an order for a suppository for you.
Pt: I hate prune juice. Does the suppository work?
RN: yes, but it's not pleasant.
Pt: I don't mind, just give it to me. I need to go so I can get out of here early!
RN: You do realize what a suppository is, right?
Pt: It's a pill.
RN: Well, it's kind of like a pill, but it will be put up your rectum.
Pt: (eyes get HUGE!) WHAT??? Nevermind, I'll wait until tomorrow.
RN: OK

The Reason Why...

...I'm a nurse. The reason why I am who I am.

The other day I was taking care of an older gentleman who was recovering from major surgery and his dear wife was sitting on the couch in his room. Since I believe the care we give should not only be directed at the patient, but to the family as well, I always try to engage the family and friends in what I do. After assessing the husband, I walked over to talk with the wife and noticed she was cross-stitching some sort of floral thing. On closer inspection, I saw that it read, "Christ Is Risen!" I immediately responded with, "He is risen indeed!" The wife looked up at me with shock on her face and her eyes started to water. "I haven't heard a young person say that in years. Thank you!"

Throughout the rest of my shift we talked about our faith, our priorities, our lives. The connection was immediate, all because of a simple response. When I left at the end of the day, she gave me a big hug and said, "I will probably forget your name, but I will never forget you. Thank you so much for all you've done and for who you are." I'm no extraordinary nurse, I'm just me... but this is why I love what I do. I'm new yet, and there will be hard days...but remembering stories like this one will help keep me going.

In other news, my first night shift is tomorrow night. I'm a little nervous, but I'm looking forward to guiltlessly sleeping in tomorrow! (After church tonight, of course!)

What I've been trying to say

For those of you who read this and haven't heard yet, this last trip to the Philippines was incredible and life-changing. I say life-changing because it really opened my eyes to the possibility of returning someday to work as a full-time missionary.

I've really had to work through some issues as I used to view missionary kids who return to the mission field in their adult years as weak or incapable of staying away. Those of us MKs who had a wonderful experience on the field often want to go back, and I thought those who did were doing so just because it was comfortable and familiar. Now that I am seriously considering a return, I'm having to rethink that and deal with some things within myself that aren't always pretty.

When I tell people that I want to go back most of them think, "Of course!" I know the people, understand the language and culture, and have a sincere love for them. It just makes sense. And yet, I don't want to take this too lightly. I know the challenges that returning MKs face are different than those faced by new missionaries with limited cross-cultural experience. For example, they often have to deal with over-sensitization while many of us MKs are desensitized.

During a meeting tonight, I was given a letter written by a missionary and what he wrote is exactly what I've been trying to say but haven't been able to clearly find the words for. Exodus 3 tells us of Moses and the burning bush. During this sacred encounter with God, he was given a commission to return to Egypt and rescue his people from oppression. "The fact that Moses was Jewish, a Levite, and a prince in Egypt counted nothing towards qualifying him as deliverer of a nation. However impressive the things he had were, he needed to be emptied of them in order to be qualified. It is a remarkable paradox, that in order to be sent of God, we have to be emptied first of our qualifications."

Just because I seem to have all the right qualifications, doesn't mean that my venture will be easy or even obvious. God must first strip me of them and work with an empty slate in order to commission me for any service He might have for me.

Patients Say the Darndest Things

I've decided to start a new "feature" to my blog... Whenever I hear something I find funny said by a patient, I will add a short blurb so you can share my humor. Hehe.

During my last shift, I helped take care of a white female who had just had major surgery. She was still groggy from the pain meds and anesthesia, but she still had enough cognitive functioning to crack a joke. While we were performing the skin assessment we have to do on any patient, she said,

"I wish I could have warned all my nurses to bring sunglassess to protect their eyes when they have to look at my white butt."

White Coat Syndrome

Today I worked another 12 hour shift and learned the definition of "white coat syndrome." I'd heard of this phenomenon that goes hand in hand with "black and white fever," but never witnessed it first hand.

I had a young male patient today who was scheduled for surgery ...let's call him Mike. He was a very sweet, cooperative guy who didn't want to cause any trouble or inconveniences for us, even if it meant his personal discomfort. I noticed that his blood pressure ran a bit high, not something you want to see in someone about to head down to surgery. The doc came in and assessed him, prescribed him a drug to lower his BP and instructed us to send him down to surgery. When we got him back he was on continuous pulse and oxygen saturation monitoring. His blood pressure was still above normal, but not as bad as it had been...chalk it up to pain. But his pulse was sky high! Why??? We didn't notice any bleeding and the EKG showed a normal, but fast heart rhythm. I later came back to check on him, multiple times, and always knocked on the door to announce myself. When I came in with an IV medication in a syringe, his pulse went even higher.

I decided to do a little experiment. His pulse/oxygen machine shows his continuous heart rate, so I started to peak into the room without announcing myself, and before he noticed me, his pulse was fully 40 beats per minute lower! This guy had a horrid case of White Coat Syndrome. I'd never seen it this bad...he was terrified of us!

I'm not sure if there's anything that can be done for it...most people don't even realize they have it. But at least it's nice to know there wasn't anything seriously wrong with Mike...he just didn't like white coats, just like some of us don't like seeing police cars. :)

Aching Feet

I had heard that nurses walk alot, and got to do some of this during nursing school without many problems, but I did not realize how much my feet would hurt after two straight days on the floor. I don't think the shoes I got are the best for the job...hmmm, might have to rethink that one. Anyone up for giving a good foot massage? :)

I've really enjoyed working with the staff as I get to know the routine and am given more and more responsibility. It is weird to have access to all the potent narcotics and give the patients meds with no supervision. I love not having someone constantly glancing over my shoulder. Many new nurses have a hard time not having this safety cushion of knowing that someone is watching to make sure they don't "mess-up," kind of like a security blanket. Not me! I love the freedom, the autonomy to make my own assessments and decisions. This doesn't mean that I don't ask for help or advice, but I love knowing that I don't have to check every little action with an instructor or the RN I'm shadowing.

Yesterday I was introduced to the world of nursing potlucks. Wow! So much food, so much JUNK food! Pizza, KFC, lasagna, chips, soda, cookies, cakes, brownies. It was one of the CNA's birthday and boy, do they know how to party. I have also heard that the night shift is notorious for potlucks and bringing food to party with. Yikes! I have to watch it. I haven't stressed too much about what I eat for years, but unless I want to buy a whole new wardrobe, I'd best be careful. hehe.

So I'm on day shifts for two more weeks, but I've survived my first week of working 12 hour shifts. I've already learned that I'd much rather have a busy day than a slow day, as the busy days go by so much faster. I also need to wear good shoes and bring lots of gum. Other than that...I'm loving this profession of nursing!

Orientation

It's been a bit since I've written, so a blog about orientation is due. I started on Monday and even though it's consisted of sitting in a classroom, SRH is an incredible organization. I have been so impressed by how friendly, encouraging, and empowering they have been. The first 2 days we were in a big pool of about 25 new orientees. Today it was just the patient care staff, including RNs, CNAs, PCTs, Radiology techs, and unit secretaries. I'm liking getting down to the more nitty-gritty details. I'll be on days for 3 weeks then switch over to nights. This is good, because it means I'll only have about a month and a half of doing school during the day and work at night. Whew!

Next week I will begin patient care with my preceptor. The 12 hour shifts are going to take a bit of getting used to, I'm sure. But thank goodness the employee break room has two full body massage chairs!!

Found It!

I was playing around on Youtube.com the other day and found this link! Yay!!! This is from when I performed on The Tonight Show with Jay Leno back in 2004. So happy!
Enjoy! The music is from The Passion of the Christ movie....

It's Official

I found out yesterday that in addition to being a real live Registered Nurse, I am now an EMPLOYED nurse! Praise God! I was offered a position at the prestigious Sunny Regional Hospital (name changed). To say I am excited is a huge understatement.

I was asked to go down to HR today to go through the preliminary paperwork and screening. This included a drug screen where I nearly had to be observed peeing in a cup (not really, but ALMOST!). This was followed by a TB test and this very interesting physical fitness test. Now most people think a physical fitness test includes running the mile, doing sit-ups, pull-ups, etc... Oh no. I had to walk 8 laps in a hallway to simulate walking on the unit where I will work, spend 60 seconds with my hands above my head (IV pole work), 10 compressions on a scale (CPR), lifting a bar, pulling a bar, pushing a bar (patient transfers), hold an 11 pound board for 2 minutes (lifting a limb for a dressing change) and 10 minutes of writing (documenting)... Very interesting.

So once this is all cleared and my background check is approved, I will begin orientation the week after next. I am still in shock. All this studying, sweat, blood, and tears will finally pay off! I'll actually be earning money instead of earning grades. And the best part??? NO tedious careplans! Ha!

Thanks for the prayers and encouragement from everyone and keep reading for the stories of a real nurse. :-)

Officially a Registered Nurse!!

Last Monday was the big day. I got up early and made my coffee, prayed, tried to relax and prepare myself for the big appointment at 8am. I stopped at McDonalds and got my favorite breakfast - a Sausage McMuffin, since a bowl a Cheerios just wasn't gonna cut it. Then it was on to the testing center.
After signing my life away and nearly being strip-searched, I was led to my little computer, complete with a video camera overhead to make sure I didn't cheat. With the exception of just a few questions, I was not 100% sure about the answers. Whenever I started to feel overwhelmed, I just took a few more deep breaths and prayed for peace and wisdom. It was pretty funny in retrospect. I started the exam all proper; both feet on the floor, back straight, staring straight ahead. By the end, I was slouching all over the place; head on the desk, feet on the chair, or leaning all the way back. I asked the proctor about it afterwards and we both laughed at watching people taking tests. It must make for an amusing job!
When I left the testing center, I truly had no idea how I did...or if I'd passed. I hear this is the norm for everyone. I wasn't sure how soon I'd get my results, but I knew that I would have them by Friday at the latest. I checked multiple times yesterday with no luck. I was pretty sure I'd know by this morning. When my roommate got up at 6am, I debated getting up and checking, but decided that if I hadn't passed, that I would rather sleep with blissful innocence for a bit longer. I kept having dreams about getting up and checking. When I finally did wake up, I was surprised those dreams hadn't been real! But sure enough, I checked and lo and behold, there is MY name with the oh-so-exciting initials, "RN" afterwards! Wow! I PASSED!
The glory be to God, not me. And He is so faithful. The amazing thing is that even if I hadn't passed, He is no less faithful, amazing, or great. My actions or inactions do not change His attributes. Praise God!
In closing, I'll repeat the words of Paul. "Now to Him who is able to do far more abundantly than all we ask or think, according to the power at work within us, to HIM be the glory in the church and in Christ Jesus throughout all generations, forever and ever. Amen." (Eph 3:20-21, ESV)

M O T I V A T I O N

What is motivation? I've been asking myself that a lot lately as I try to prepare for the nursing board exams... According to the know-it-all Mr. Webster, motivation is, "a motivating force, stimulus, or influence: incentive, drive."

These last few days have been brutal. Because I spent a month in the Philippines, I didn't take the traditional NCLEX review course that my fellow classmates took, which consisted of sitting in a classroom for four 8-hour days. Instead, I opted for the online course which consists of watching the same 24 hours of lecture online. The very professional word that comes to mind is, "UGH!" It's been torture! Now don't get me wrong, I love to learn and the information truly is interesting, but watching it online for so long is brutal.

So what's motivating me? (this is for my own benefit!) Well, I need to pass the Boards...that's number one. If I don't pass, then I won't get a job, I throw away the $200 I paid to sit for the exam, and I have to do this review all over again until I can pass. On top of that, it will be very embarrassing and discouraging.

But perhaps the greatest motivating factor is not related to pride, but responsibility. As a believer in Jesus Christ, I am of the conviction that " whether you eat or drink, or whatever you do, do all to the glory of God." (1 Cor. 10:31, ESV) Of course I fall WAY short of this mark and perform half-heartedly all too often, but my goal and desire is that the more I walk this life, the more I reflect this truth. No matter what I do... change a dressing, empty a foley bag, hang an antibiotic, change a diaper, take a really big exam, take a super boring research class, or even something as mundane as scrubbing my own toilet, that I do it 100%, with a cheerful attitude, to the glory of God. He doesn't just deserve it, He demands it!

Daddy

One can always tell when I'm procrastinating, because I suddenly find lots of time to write letters and blog. :-)

Last night I was watching my first American newscast since being back and was annoyed as usual by the inane reporting. It's sad what people find newsworthy, especially to someone like me who has more of a global perspective. But the last part of the newscast really touched my heart. I don't typically see myself as an overly emotional person, but I nearly had tears in my eyes as Jenna and Barbara Bush read a letter they had written to Sasha and Malia Obama. The letter is quite long as the girls have 12 years of advice to give (from the presidencies of their grandfather and father), but it's worth reading here. However, I've copied the best parts here:

Sasha and Malia, we were seven when our beloved grandfather was sworn in as the 41st President of the United States. We stood proudly on the platform, our tiny hands icicles, as we lived history. We listened intently to the words spoken on Inauguration Day service, duty, honor. But being seven, we didn't quite understand the gravity of the position our Grandfather was committing to. We watched as the bands marched by -- the red, white, and blue streamers welcoming us to a new role: the family members of a President.

We also first saw the White House through the innocent, optimistic eyes of children. We stood on the North Lawn gazing with wonder at her grand portico. The White House was alive with devoted and loving people, many of whom had worked in her halls for decades. Three of the White House ushers, Buddy, Ramsey, and "Smiley", greeted us when we stepped into her intimidating hallway. Their laughter and embraces made us feel welcome right away. Sasha and Malia, here is some advice to you from two sisters who have stood where you will stand and who have lived where you will live:

-- Surround yourself with loyal friends. They'll protect and calm you and join in on some of the fun, and appreciate the history.

-- If you're traveling with your parents over Halloween, don't let it stop you from doing what you would normally do. Dress up in some imaginative, elaborate costume (if you are like us a pack of Juicy Fruit and a Vampiress) and trick-or-treat down the plane aisle.

-- If you ever need a hug, go find Ramsey. If you want to talk football, look for Buddy. And, if you just need a smile, look for "Smiley."

-- And, a note on White House puppies--our sweet puppy Spot was nursed on the lawn of the White House. And then of course, there's Barney, who most recently bit a reporter. Cherish your animals because sometimes you'll need the quiet comfort that only animals can provide.

-- Slide down the banister of the solarium, go to T-ball games, have swimming parties, and play Sardines on the White House lawn. Have fun and enjoy your childhood in such a magical place to live and play.

-- When your dad throws out the first pitch for the Yankees, go to the game.

-- In fact, go to anything and everything you possibly can: the Kennedy Center for theater, State Dinners, Christmas parties (the White House staff party is our favorite!), museum openings, arrival ceremonies, and walks around the monuments. Just go. Four years goes by so fast, so absorb it all, enjoy it all!

This Christmas, with the enchanting smell of the holidays encompassing her halls, we will again be saying our good-byes to the White House. Sasha and Malia, it is your turn now to fill the White House with laughter.

And finally, although it's an honor and full of so many extraordinary opportunities, it isn't always easy being a member of the club you are about to join. Our dad, like yours, is a man of great integrity and love; a man who always put us first. We still see him now as we did when we were seven: as our loving daddy. Our Dad, who read to us nightly, taught us how to score tedious baseball games. He is our father, not the sketch in a paper or part of a skit on TV. Many people will think they know him, but they have no idea how he felt the day you were born, the pride he felt on your first day of school, or how much you both love being his daughters. So here is our most important piece of advice: remember who your dad really is.

I truly respect the grace and dignity of Bush's daughters. Undoubtedly they disagree with Obama's politics, but they understand and respect him for the important person he is to his daughters, and that is "Daddy."

Whether you are a missionary, a teacher, a nurse, or the president of the United States of America, there is no greater title a man can have than just "Dad." And to MY Dad, a girl could have no greater earthly father than the one I have!

I love you, Dad!

Back to Reality

The vacation is now officially over. I had an incredibly blessed month in the Philippines with just the right mix of ministry and vacation.

The flight over was filled with surprises. I got bumped up to Business class on my leg from Manila to Tokyo, sat next to 20 refugees from Burma on my flight from Tokyo to LA, and met a couple of very interesting people in the process. I love traveling; it's always filled with adventures.

But now I am back. I checked the weather tonight and found it hilarious that we are under a severe weather alert, "first showers of the year expected." Folks, this isn't even real rain...it's showers! Since when are showers considered severe?? Now I just hope that it really does rain.

I'll sign off with one of my favorite pictures of the trip. I took it under a pier on the island of Corregidor, an old World War 2 island. You can see the original pier posts beside the current ones. The original pier was bombed out during the war. You can also see a reflection of the beach in my sunglasses. :-)

Another clinic

It's been a while since I've posted... I spent a week on a gorgeous beach, soaking up the rays and doing lots of relaxing: massages, dirt-biking, scuba diving, frisbee, good food, shopping, long walks, night swims... total bliss.
Today I went up by my alma mater to help out at a free medical clinic run by two missionary doctors. I spent most of the day taking vital signs and initial assessments, but have a couple of interesting stories.

I called in a lady who looked to be very full term...and too old to be pregnant: 49. She weighed quite a bit for her stature and physical appearance. All of her vital signs were normal except for her blood pressure which was about 190/150!!! VERY high. I followed her over to the doctor because I wanted to know what was the issue with this lady. She was so sweet and didn't act like she felt ill...but her stomach was very hard and she said she wasn't pregnant. Turns out she'd been to the clinic 6 months prior with minor hemorrhage. She appeared at that time to be 5 months pregnant. When she went to the restroom to give a urine sample, she started hemorrhaging all over the floor! She was rushed to the hospital and was given 6 units of blood with orders to get a ultrasound. Of course she is very poor and couldn't afford an ultrasound. Now she's back with what appears to be a huge tumor. So very sad. The doctor said we can treat the hypertension, but the tumor will probably kill her before the hypertension does. However, they are going to get her an ultrasound and see what exactly the mass is. It might not be malignant, but in all likelihood it is.

The second story is sad also. It was a 35 y/o mother who brought in two of her seven kids. One has rubella and the other has TB. Those can be treated. But the mother cannot. She doesn't appear to be sick...and physically may not be so, but her heart is very sick. She lives with a married man and keeps getting herself pregnant because her cramps are so bad. She prefers to be pregnant. I'm sure there's also the thought that as long as she's having this guy's babies, she has some sense of security. The clinic has given her free birth control pills, but she refuses because she wants to have more babies. The kids are then sent to beg in the streets because the married man spends all his money on alcohol. The abject poverty is so sad and yet there is only so much we can do. All the medical services and medications are free and paid for by the missionary doctors' US financial donors or actual donations of products (as in a centrifuge, ultrasound machine, meds, etc...).

Each patient is prayed for before they are sent home...the lives touched are countless. The people who go to the clinic have an obvious, genuine love and affection for the doctors. It's not just a matter of gratefulness for the freebies. God is faithful, God is good.

A few more pictures

Every Tuesday, Wednesday, and Friday, a clinic is held at the birthing home for pre-natal and postpartum check-ups. Here are a few pictures from the clinics. :-)

Every mom gets her BP checked...

Palpating baby's position

An old-school fetal scope!

The birthing mats hanging out to dry

Midwife scheduling the next appointment

When It Rains, It Pours

Dec. 29

There’s a saying I’m sure you’re all familiar with: when it rains, it POURS. We had 8 more deliveries today. One of the midwives accused me of praying that I’d see a lot of deliveries. I didn’t! I promise!
We had three more post-partum hemorrhages, which meant three more IVs. I hate starting IVs over here! They are just straight needles…no plastic catheter. Which means the needle stays in the whole time, which means it’s painful and infiltrates very easily! But, I got all three started first try and they stayed it until I took them out. Whew!
The first PPH was with a mom’s five baby. The dad asked me what the sex was and was extremely disappointed it was a girl. They have a boy but he wanted another one. When he came back 6 hours later to check on his wife, he was raging drunk. So sad.
The second PPH was secondary from horrible clots. Once we got those out, the mom was fine. BUT, this was her first baby and it was breech! They got it delivered no problems, but it sure made for another adrenaline rush. Unfortunately, I was napping during the delivery and missed it.
The last PPH of the day was with another primip. (First baby) When we went to check her, we thought she’d be 3cm because she was walking around, smiling, and silent. WRONG! She was complete and crowning. Then all the fun started. Whenever we told her to push, she started crying and trying to crawl up the table…she was terrified! She kept yelling, “Hindi ko kaya!, Hindi ko kaya!” (“I can’t do it!”) In between one of her contractions I grabbed her hand, stared her down, and said, “Kaya ko” (“I can”). I had her repeat it over and over throughout her contractions. We finally got her baby out, but she tore terribly and bled 800cc’s. In these little Filipina women, that’s a pretty big deal. Her blood pressure dipped to 60/40. As soon as I got the IV started and fluids running, she was fine.
And I can’t write about today without mentioning the cephalhematoma I saw. It was textbook. It’s all a blur now, but I think it was with the mom who was afraid to push. Because the baby was engaged for so long and was pushed against ineffectively, the skull was subjected to a lot of trauma, which caused massive swelling and bleeding between the skin and skull. Fortunately, this usually isn’t serious and goes down within a week or so.

Meconium Happens

Dec. 28
Meconium Happens

This day started out just as crazy. We had 8 total deliveries today…a near record. We had 5 moms on the floor in cots, two on beds, and more laboring outside. We got all the moms home except for the laboring ones of course. Poor Marilou had seen all these mom come and go and she was still laboring with poor progress. We knew they had no money to transfer them to the hospital and the baby’s heart-rate was fine. At around noon we put her up in stirrups to find her fully dilated. The midwife broke her membranes to find copious amounts of thick, smelly, meconium-filled amniotic fluid. (FYI: Meconium is a baby’s first BM) Terrible! We needed to get this one out pretty fast…nice thought, but it didn’t happen. The midwife tried everything: lithotomy, left side, birthing stool, all of it to no avail. (Left is the midwife playing the waiting game. Even Ming-Ming, the cat, got in on the action! see below) It just wasn’t coming. It looked like it should be a problem but for some reason Marilou just couldn’t push it out! We transferred her back to the table and into stirrups for an episiotomy. (A controlled slice to make sure the mom doesn’t tear where she shouldn’t.) Finally the baby slipped out at 1:30pm. It was extremely yellow with peeling skin from all the meconium. I suctioned it’s mouth and got out extremely thick brown mucous…meaning it had swallowed and inhaled the fluid, a very bad thing. Then it went from bad to worse. The mom continued to hemorrhage. She lost nearly 1 liter of blood. The midwife started an IV and we got fluids running in. After she was somewhat stable, we transferred her to a bed. To make a longer story short, the little boy had rapid respirations so we called out a missionary doctor and got it started on Gentamicin and Ampicillin. It threw up everything but this isn’t that unusual considering it was trying to get rip of all the goop. The mom stabilized and was able to go home the next day. The little guy now comes back twice a day for injections and check-ups. He looks great! He’s eating and keeping it down.

On a side note, I must say that for this being the father’s mistress, he was super attentive. He stayed by her side through her whole labor doing whatever she needed. He’s come to the clinic twice a day with the baby for the injections…not just sent it with someone else. He has asked lots of questions. It’s sad that he has five other kids with his wife and that this son is with a mistress, but as of now, it looks like he’ll be a good daddy. (below is mec baby cleaned up)