4th of July 2012

A recap of how I spent the 4th. Click the link to read more.

Summer Goals for Med Surg

I just started my Medical Surgical Nursing class today. Unlike the 3 previous classes I've had, this one will last 7 weeks and will be very, very content-dense. The basic schedule is class 2 days a week (9-5 or so) and 24 hours of clinical. I got assigned 12-hour shifts, so it might be more intense but I'm sure I will learn a lot.

This class will definitely require more study time, but I am continuing to focus my summer goals on my personal life. The times that school has become miserable for me have been when my personal life is overtaken by classwork and stress. Right now, I am focusing on eating well, working on my novel, and practicing my drawing.

Jeans Success

As I posted/ranted about last week, one of my summer challenges had been finding new jeans. The Ann Taylor petite skinny jeans that I wore about 3 times/week were veering dangerously close to the stage where they would get holes in embarrassing places, and one of my pairs of Chico's jeans had faded from dark navy to light/medium blue, gotten baggy-ish, and had paint stains.

Before I went to Macy's today, I had tried on jeans at Gap, Chico's, Sears (including Kardashian jeans), Old Navy, Nordstrom Rack, and even K-Mart.

At Macy's, I tried on stuff from Levi's, Not Your Daughter's Jeans, Else, and one other brand. For a while, I had avoided the NYDJ brand out of principle. Perhaps it was ageist of me, but since I'm too young to have a teenage daughter, the thought of owning NYDJ jeans was more embarrassing than having Kardashian jeans. But my mom thought that the NYDJ jeans would fit me, and since she is the sewing/clothing expert in the family, I decided to try them out.

Shopping as a Teen and as a 20-Something

I have many alternately fond and terrifying memories of experimenting with fashion and makeup as a teenager. My best friends in middle school, who were far ahead of me at this, were always letting me in on the unknown (to me) rules of Girl World. One of these rules was that you could not "preview" an outfit at school the day of a dance. Your dance outfits were apparently supposed to be kept secret until sundown. But they gave me these tidbits of advice, most of the time, in a supportive manner. At least as supportive as 13-year-old girls are capable of being.

Unpacking at the House

 By the time I arrived at the house on Friday, the movers were almost done loading the boxes in the house. This meant I got to help my sister-in-law unpack the kitchen stuff, so I organized the dishes and mugs on the table and let her decide where to put them. The house has a huge amount of cabinet space compared to the old apartment, so fortunately we weren’t worried about having enough space, just how to use it best.

            By the end of the evening, we were sitting around the table with a friend of my brother and SIL’s, drinking beer and alternately discussing the fate of the world and what show(s) Big Bro and SIL should start watching (Mad Men, and possibly Game of Thrones).

Halfway Through Class #3!

(Warning to the squeamish – includes my account of placing a catheter in a mannequin for the first time).

            Friday was a very big day for the family. My brother and SIL moved into the new house. They hired movers, which took away one of the most difficult pieces of moving, remarking that this was an important new level of adulthood: hiring movers instead of asking friends to help in exchange for pizza.

            While Big Bro and SIL oversaw the moving process, I took my first closed-book exam at Villanova. It was going to happen soon enough, but it ended up being a lot less stressful than I thought it would be.

            Right now I’m taking Nursing Process, which covers a lot of basic nursing skills, like giving medications, bed baths, transfers, and urinary catheters. Yes, catheters.

Physical Assessment Lab Final/Uniforms

This week was the second week of Physical Assessment. We spent Monday-Wednesday learning pulmonary and cardiovascular assessment, and musculoskeletal/neurological assessment. So far, so good. I keep reminding myself that listening to heart/lung sounds on a (very) healthy 20-something is very different from hearing them on a very large, or very old person. (The more tissue you have around your chest, the fainter your heart/lung sounds).

Today was the lab final, which went well in the end (got 48/50 points), even though I was nervous about it going in. The way it worked is that my lab partner and I went into an exam room, and I logged into the computer in the exam room. Our lab instructor, who was in another room, told us she was ready. Through a loudspeaker. Depending on your metaphor preference, it was like the G-d voice or Big Brother. Instead of watching over my shoulder, she watched me via two cameras in the ceiling. What was odd was that I didn't feel self-conscious about being watched during the exam itself; hearing the G-d voice was a little startling.

After the lab final, I went into another room in the lab/clinical practice floor to buy my student uniform. The pictures of nursing students on my school's website featured people in pinstripe oxford shirts and navy slacks. I was less than thrilled. I didn't want to press slacks or wear a button-down shirt tucked into slacks. Button-down shirts, especially unisex ones, just don't work for my body type.

But the uniform has apparently been updated. Now we wear navy scrub pants, a navy t-shirt with our school's seal on the sleeve, and a white short-sleeved jacket with the school seal that looks like a less formal lab coat. I was pleased, once I finally found pieces in my size to try on. The uniform people brought a range of sizes (XS-XXXL), but most of the girls who came from the morning lab section were sizes XS-M, and some were XXS, so trying to find a small in anything was chaotic. But I ordered two elastic-waist cargo scrub pants (I have a drawstring pair of scrub pants from Brandeis Chabad, and think the elastic waist fit me better), two t-shirts, the white jacket, and two name pins (in case one gets lost/broken. And in a few weeks, I'll be signing my name with VUSN (Villanova U. Student Nurse) after it, which is pretty exciting.

House Weekend

In terms of nursing school news, my Physical Assessment class is going very smoothly. My lab partner and I aced our vitals midterm (we had to take each other's vitals - temperature, blood pressure, pulse, and respirations). The next day, I aced my lecture midterm and then had lunch with a dear aunt. Brother and I had dinner at a charming bar a few hundred feet away from the apartment. I was told that Magners cider is a "girly" drink. I reminded Big Bro of one of my favorite mixed drinks, Cranberry Vodkas, which I think are clearly in the top five of girly drinks.

Moving day is fast approaching, so I helped my brother with some packing Friday night, and Saturday we put down primer in my future room (he did the tape and tarp). Brother, SIL, and I went to Lowe's to get some more painting supplies and pick window treatments (there are lots of windows in the house, and many of them are very tall). My favorite quote of the evening: "we will keep the blinds [in the basement windows] closed FOREVER." (Emphasis added).

This morning through this afternoon, the three of us primed the guest room (on the same floor as my future room), and then painted my room and the guest room.* The paint for my room looked light, light blue on the chip, but ended up a darker cooler than expected. But it was a beautiful color, so I don't care. Likewise, the light green for the guest room looks more yellow on the walls than on the chip, but not in a bad way, so we are considering both paint jobs done.

Tonight, we're getting falafel and frozen yogurt for dinner, and then watching Coming to America at the apartment. I'm excited.

* = To be accurate, Bro and I painted my room; Bro and SIL painted the guest room while I ran out to get my groceries.

Week 2 of Nursing School: Keep Calm and Carry On

When I started nursing school, I certainly expected long class hours and to go through the material very quickly, and prepared myself for an increased level of stress from my event coordinator job at a church. But I also make a conscious effort to focus on what I am learning in the present, and to not overthink future events, such as exams.
This does not mean that I slack off on my readings or studying. Rather, I try to focus on what I am learning each day, and not to worry about the exact composition of each exam. When I get a written assignment, I read the question and the paper's requirements, and proceed.

What bugs me about my program is the amount of class time in which people ask professors about what they need to study for each exam, what the exam questions are like, and how they should write a paper whose grade counts for 5% of the total class grade. As a detail-oriented person, I understand where these questions are coming from. I have always been very picky about my writing. What I don't get is why 30 minutes of class time is spent on these questions. Listening to people agonize over these things puts me on edge, and makes it harder to keep myself cool and collected.

When I go home, I look over my task list for the day, and sit down in the living room to do my work. Today, I punched out my 1-2 page assignment on patient learning while watching Parks & Recreation with my sister-in-law. It was incredible how much easier it felt to write that paper in a relaxed environment than when I was listening to people analyzing the rubric letter by letter. Likewise, I practice doing my blood pressure at home so that I'm not distracted by other people talking about how stressed they are about taking vitals.

Tomorrow is my lab midterm (doing vitals) and learning how to do an abdominal exam. Hopefully I can follow my stress-reduction mindset tomorrow morning and ignore other people's pre-midterm jitters.

Summer 2012 Resolutions - Food

As part of my pre-nursing school physical and lab work (CBC, titers for measles, mumps, and rubella, etc), my doctor had my cholesterol checked. The total (non-fasting) was high, so she had me do a fasting lipids test. My good cholesterol was very high, but my bad cholesterol was also high, so I saw a nutritionist before moving to Philadelphia.

Since I only ate meat about 1-2 times a week in Boston (because I only eat kosher meat) and I will only rarely eat meat in Philly (my SIL is vegetarian so there is never meat in the house), the main things I have to cut down on are cheese and eggs. In addition, I am trying to eat more fruits and vegetables, as well as "good" fats, such as olive oil.

To help keep myself on track, I am going to make myself a list of foods to stock up on:

Friday Night at the Appliance Store

My first "official" day in the nursing school building, and my brother and SIL's adventures in home improvement. 

First Day in Philly

Tuesday morning, I somehow woke up at 6 AM, which startled my brother. For years he made fun of me for sleeping in on non-school/work days, and apparently expected me not to be up until much later. But I think the thrill of being in a new city and the large amount of sunlight that comes through my window gave me the inspiration to get out and explore. I had spent a week in Philly during February break my senior year at Brandeis, so I had already seen the Liberty Bell, Independence Hall, the Franklin Institute, and the new American Jewish history museum. It seemed appropriate to go to a place off the "standard" list.
Having read Swallow by Mary Cappello, which discusses the life of Dr. Chevalier Jackson, who developed nonsurgical techniques for extracting swallowed objects, I filed the Mütter Museum away as a potential destination. The Mütter has a set of drawers with all of the objects Jackson extracted, along with shelves of skulls, wax models of organs, and skeletons highlighting the effects of disease and trauma. For a nursing student who spent hours skimming Wikipedia pages on surgeries and diseases while working in a preoperative clinic, I had to see the Mütter.

The first takeaway I had from the museum was how much has changed in medicine and health (in the U.S.). Most of the full skeletons on display, which had been prepared in the mid-to-late 1800s were around my height (5' 2"). There were also a remarkable number of people in their 20s (and much younger) who died from now treatable infections, such as TB, and also several disturbing examples of rickets and osteomalacia (bone diseases caused by lack of vitamin D). At the same time, there was a display of spines curved abnormally from osteoporosis, and an exhibit on gunshot wounds during the Civil War. Though we have better treatments for gunshot wounds (particularly to prevent infection), there are still obviously many people who are permanently disabled or killed by guns, and the guns we have now are more destructive than those in the Civil War. My reflections at the museum, though, were lightened by the middle school group that was present. It was difficult to think too long about current medical and societal issues when there were fifteen preteen girls periodically commenting, "EW, GROSS" at the tissue samples and wax models.

After the museum, I had sushi for lunch, treating myself to some Philly rolls. Authentic Japanese sushi? Of course not. But cream cheese and smoked salmon with wasabi and soy sauce is a pleasant mixture of flavors and textures. On the way back to my brother's apartment, I stopped at the Superfresh in Society Hill to stock up on groceries. I was surprised to find that a lot of the produce was not fresh, to the point where I could detect the smell of turning lettuce, and stuck to non-produce. During my time at Brandeis, I used to complain to my mother that the produce section at the Waltham Hannaford was inadequate compared to the farmstand/grocery where she got our fruits and vegetables. Now I see that Hannaford was just fine, but there is hope in the form of a Whole Foods that is also within reasonable walking distance.

 I am surprised at how quickly I am starting to feel settled in, but I think a large part of it was this walking adventure - it was a good 1.5 miles or so walk each way, long enough to see changes from neighborhood to neighborhood but short enough that it didn't feel like something from Oregon Trail.

Today, I slept in, hung out with the cats*, and was introduced to Parks and Recreation by my SIL. Tomorrow, I get to familiarize myself with SEPTA by taking my first trip on the regional rail to Villanova. Classes haven't started yet, but tomorrow is Laptop Distribution day. I am not super excited about the computer itself (it's going to be a Dell, and I'm a Mac person), but I think it will be useful to have a school computer and a fun computer. As long as it stays alive, it'll be fine.

* = Brother and SIL have two cats, a compact, rounded tabby and a black cat. Both have taken to me pretty quickly, perhaps because my room has one of their food dishes.
More info on Swallow: http://www.swallowthebook.com/book.html

In My New Home City

After the drive to Philly, dinner with my brother and parents, and (starting to) unpack, I am too tired to write much. But so far things are going very well.

1) The textbooks I ordered online, which were originally sent to the wrong address, arrived at my brother's apartment last week.
2) Even though my guest room in the apartment is very small and lacks a dresser, I found places for my everyday clothes and office supplies. I accepted that many of the things I thought I would need for the first month can be left in their boxes until my brother moves to his new house (also in Philly).
3) My room in the new house (see above), which I move into next month, is spacious, has nice views, and has lots of closets. Also, I have my own bathroom for the first time ever, which is more exciting than I would have thought.
4) My brother and sister-in-law's two cats have accepted me and did not interfere with my unpacking at all. Other than sniffing the boxes (probably because they smelled like my cats), they didn't push anything off a table or try to play with fragile things.

And, number 5) my wonderful SIL put clean sheets on the bed in my room, so I didn't have to make the bed. All I did was lay my wool crocheted blanket on top of it.

I hope that I will find the time to write about my new city some more before classes start, and/or to get a little more work done on The Fiennes. If that doesn't happen, I'll just be happy to enjoy my last lazy days before the summer semester starts.

Dark Shadows and Final Moving Preparation

Today, Dad took me to see Dark Shadows, which I was hoping would be quirky, a little dark, and richly entertaining, after seeing many of the previous Tim Burton and Johnny Depp in Pale Makeup movies.*

Sadly, while the visuals were riveting, the story and mood seemed to be all over the place. The movie seemed to go from quirky and fun to horribly depressing way too quickly at many points. I am not averse to movies having a balance of funny, scary, joyful, and sad, especially darker movies like Tim Burton's works. But it is annoying for the mood to switch from scene to scene, without any sense or rhythm. The lack of a cohesive storyline made this feel worse.

At times, the plot seemed to serve visual show-offs (explosions! blood flowing from paintings!), rather than the visuals serving the plot. This was also an issue in Repo! The Genetic Opera, which uses a lot of unnecessary blood and gore, but in Repo the strawberry red blood, even in excess, still serves some purpose. The organ repossession scenes in Repo highlight the brutality of GeneCo, the company which orders them. But the visual effects in the Collins mansion in the final scenes just seemed over the top for the sake of being over the top. I was hoping for a neater resolution towards the end of the film, and instead got bleeding paintings and later splashing waves, without little more tying it back to the introduction than Depp's moody narration. Oh well. There were some good lines, most of which were in the theatrical trailers, and Depp does look surprisingly good in the Moody and Pale look.

The other main highlight of the day was finishing my packing. Dad managed to fit all of my boxes into the back of the new family car (it's a hatchback; the previous car was a very petite sedan). This means we don't have to rent a monster car or van, which is wonderful because now my parents can entertain themselves by playing around with the new car's audio features (including connecting to Dad's iPhone's music library). And I can listen to them go on about how they should probably read the manual for the audio features, but let's try this button and see what happens.

It will be a fun trip to Philadelphia.

* Edward Scissorhands, Sweeney Todd, Corpse Bride (even if it was technically a clay representation of Depp). If you haven't watched them, the basic look was a powder white face with dark eye circles (done with dark brown and black eyeshadow), sometimes accented with blood or scars, and dark clothes.

She's Leaving Home

Despite spending my last two years at Brandeis (plus the year after graduation) planning and preparing for nursing school, I had come to a point where I was unconscious of the new step I was about to take. In addition to starting the classes and clinical rotations that will prepare me for nursing, something I had never imagined choosing when I applied to college, I will be leaving my home state for the first time.

Last Week in MA

My master plan for moving from MA to Philadelphia had been to finish my church job and my volunteering gig at Brigham and Women's in early May, take my Pathophysiology final, and give myself a week to pack/say goodbye to my friends. But plans have a way of being interrupted.

Touring the Microbiology Lab

This is my second post about shadowing general medical residents, and talks about our tour of the Microbiology lab.

If you don't like reading about blood, feces, or dissections, you might not enjoy this post.

In addition to seeing patients and attending a lecture on kidney development, the residents I shadowed went on a tour of the Microbiology lab to learn how they did blood cultures. Blood cultures are run when a clinician suspects sepsis (blood bacterial infection). The first step is to find if the blood has anything growing in it. The lab does this using an automated machine which incubates the blood samples and lights up if one of them reaches a certain level of growth (the blood sample bottle has an indicator of some sort). This way, only the blood which has detectable bacterial growth is put on culture plates, saving the lab time, money, and labor.

If a blood sample sets off the alarm, the lab tech disinfects the bottle top with iodine and then extracts a small sample, putting a drop of blood on each culture plate. The plates have different varieties of agar (a gel made from algae), including blood agar (which has sheep blood added to show bacteria that can break down blood cells) and chocolate agar (in which the blood cells are heated to break them up - these plates show bacteria that cannot break down blood cells - there is no actual chocolate). I wish I had taken pictures of the plates; they were oddly beautiful. Even though some of them had nasty bugs growing on them, seeing the different shapes of the bacterial colonies (some looked like snowflakes) against the red and brown agar was fascinating.

For those who are curious:
http://en.wikipedia.org/wiki/Agar_plate
http://en.wikipedia.org/wiki/Chocolate_agar

The most amusing takeaway from the lab was hearing which type of sample the lab techs despised most. I thought there would be widespread detest for fecal samples, given the smell factor. Acknowledging that working in a lab may desensitize one to strong smells (they used acetone to do Gram stains), I also wondered if there was a diversity of opinions about body fluids. After all, many of the nurses I have worked with admitted that even though they could deal with (name a list of body fluids) pretty well, there was still one fluid that made them nauseous or uneasy.

I know that I am much more tolerant of blood than of fecal matter. Watching an open prostatectomy during my tour of the surgical wing (through a window to an OR) did not phase me. Oh, look at all those red sponges, I thought. They almost looked pretty in the periwinkle blue organizer that had individual pockets for each used sponge.  I attribute my comfort with blood to watching my dad do fingersticks (for blood sugar tests) for 23+ years and being a blood donor for 6 years.

When I did a fetal pig dissection in anatomy and we had to examine a portion of the large intestine, though, I stepped back after feeling the intestine between my fingers.  I can't explain why cutting into a sheep brain or looking at a cow heart didn't phase me, but fetal pig intestinal contents did. It is mostly the smell, I think. There are definitely serious pathogens that are transmitted in both blood and feces, but my automatic reaction to the latter is that it is dirty and nauseating. While a stranger's blood is a disease risk, I don't look at it as an inherently dirty substance.

But the most hated sample category among the lab techs was not blood or stool. It wasn't urine, either, which they process a lot of as well. It was foot wound samples (i.e. diabetics with infected foot sores), simply because of the number of organisms in each sample. One tech's quote was: "where do people put their feet?"

On that lovely note, enjoy the rest of the weekend and cover your foot blisters!

Outside of Seattle Grace…

… medical residents see patients who actually look sick, and not just actors with slightly pale complexions and overly dramatic spouses. For the last day of my most recent hospital volunteering gig, I shadowed a group of general medical residents on their morning rounds. As much as I suppressed the images of rounds I had from Grey's Anatomy and St. Elsewhere, I still pictured a semi-orderly series of patient visits, interspersed with questions about what conditions the residents would consider with certain findings. Though my Pathophysiology course this spring only covered the most common diseases, and skipped over some key systems (the GI system and reproductive system), it was rewarding to be able to follow some of the residents' discussions and to see a variety of non-surgical patients. (I had spent months seeing all sorts of hernias, hearing about colonoscopy preparations, and learning about hysterectomies - it was good to have some new sights).

When I worked in the preoperative clinic, I found that one of the anesthesia residents was fond of pointing out "interesting" details in a patient's history or showing me what physical findings were abnormal (such as a loud systolic murmur whose "whoosh do whoosh do" I can now distinguish from the moderate, even "lub dub lub dub" of a normal heartbeat). During rounds, I noticed that some of the general medical residents made a point of talking to me about cases that to them illustrated a major clinical issue. One such case was a person who had a serious allergic reaction to a prescription drug. The resident mentioned this case not only as an example of a serious immune reaction, but also to make a point about how unnecessary prescriptions of antibiotics can raise the risk of an allergic reaction.

While the practice of pointing out clinical curiosities may seem like it reduces people to abnormalities, seeing the manifestations of a disease (or a combination of conditions) in a real person broadens the sometimes narrow image of an illness that one gets from a textbook description. Even reading a person's lab values does not always give a complete picture. One resident noted that a sick person "looks sick." That may sound obvious, but it does highlight the importance of looking at the patient and talking to him/her. We can learn a lot from lab values and vital signs, but every person's body responds differently, and some people do not follow "textbook" patterns or our preconceived expectations. One of the preoperative patients I remember best was a man in his 80s who I assumed (based on his medical history and age) led a fairly quiet, less active life than in his youth. He proudly announced that he still did household renovation work. That certainly taught me the value of a thorough physical activity and occupational history!

Nursing School Fashionista

For most people my age who work the year after graduating college, the transition is marked by a dramatic change in self-image. Gone are the days of sleeping in until 9, 10, or even noon, and shuffling to class in yoga pants or sweats. Those lucky enough to land a professional job start to accumulate trousers, crisp shirts, and smart blazers. One of my best friends, who spent 90% of her time in yoga pants or jeans and a hoodie at Brandeis, now looks like she walked out of a Banana Republic ad. Even her going-out jeans are darker, more polished.

I knew for a long time that the dress code for nursing is based primarily on functionality. My nursing student uniform, navy slacks and a white button-down with our school's seal, also serves a symbolic function by marking us as student nurses. Sadly, it was one of the less aesthetically pleasing uniforms I had seen. I decided that I definitely wanted to have some cute summer clothes to wear to class, and stocked up on bright tees and a floral wrap top.

While I had been trying to find a new pair of jeans, I got an email from my Health Process and Assessment instructor with the course syllabus. Realizing that the lab portion of the class involved performing (and receiving) thorough physical exams, a new pair of yoga pants began to look much more practical than a new pair of jeans. This was how I ended up getting stretch capri pants at Target.

In a month, I can picture my friend sailing into work in a few weeks with her elegant Longchamp bag over her shoulder, while I show up to class with a stethescope and sneakers. But at least my stethescope and blood pressure cuff will match.

Fiennes Character Designs

One of the biggest challenges, after figuring out a mental picture of a character, is translating that onto paper. 

Helen always had thick, curly brown hair and an expressive face. Her dramatic eye rolls and stubborn questioning were accented by big, round eyes and well-shaped (but not thin) eyebrows. When I tweaked her face shape a bit, I turned to a website on hairstyles for different face shapes. For more complicated expressions/poses I use stock photos, but my basic picture of her has been pretty consistent for the past six years.

Perhaps because he's a quieter character, Reuben did not have many distinguishing features for a while. When I started writing the book, I thought of him as a tall, but otherwise unremarkable middle-aged white guy. A few extra pounds, some chemo-induced hair loss later on, but nothing memorable. 

When I tried drawing his face, though, I ended up modeling him after a younger Paul Sorvino. I realized that a round face and somewhat prominent nose helped make Reuben look more similar to Helen, but dissimilar enough that she could still share some of her mother's features.

Donna Bianci (the labor and delivery nurse who delivered Helen and later becomes an oncology nurse) was also a challenge. My mental picture of her is a pediatric nurse from Children's Hospital Boston in Waltham. But in terms of personality, she has elements from three different nurses I've worked with (all of them were named Donna). Since she reminds me of four very real people, I wanted to make her visual design from scratch. It's still in progress.

Katie and Chloe Green (two sisters who appear much later in the book), like Reuben, seemed to come alive in the drawing process. They were written as short, blonde, and petite, but their faces were unclear. Looking at my current sketches of both of them, I was most satisfied with how much they resembled each other, and with how their expressions came out. Sometimes that can be the hardest thing to nail in a picture.

Pictures below.

Ordination Punch Recipe

In addition to my volunteer work, I have been doing events support at a large Protestant church in Boston. Most weeks, I do basic housekeeping around the church kitchens (a commercial-size kitchen and two small kitchens) and organize the coffee hour supplies. The holidays obviously bring special events on Sundays and during the week, from the Christmas pageant to a lenten adult study series. I have also had the pleasure of setting up the receptions for two ordinations.

Both of these events were marked by large amounts of fancy finger food and non-alcoholic punch. The original punch recipe, which was used for several years at coffee hour, consisted of a 2-liter bottle of ginger ale, 1 bottle of fruit punch (64 oz), 1 can of pineapple juice (46 oz), and a package of rainbow sherbet (1 quart). My preference is to use 1/2 a bottle of fruit punch and 1/2 a bottle of cranberry juice cocktail to give the punch a little more tartness, since it is basically sugar water.

Directions:
1) Mix fruit punch (32 oz), cranberry juice (32 oz), and pineapple juice (46 oz) in large punch bowl.
2) 5-10 minutes before serving, take sherbet out of freezer to thaw.
3) Five minutes before serving, add ginger ale (2 liters).
4) Add sherbet to punch. Mix well so that it is well distributed through the punch.

A Playlist for The Fiennes

One of my favorite resources for writing, besides Wikipedia (a great source of moderately-detailed information on drugs and diseases), is well-chosen music. Having a song in the background that reflects the mood of the section or a character's personality I'm working on helps me visualize the scene, intensifying the actions and dialogue.

Often, I turn to my bookmarks in Firefox for a "mood" song not in my iTunes library (mainly instrumentals from James Horner and late 90's/early-to-mid 00's pop, depending on the scene).

I also have an iTunes playlist, mostly of 90's and 00's pop and alternative, for this very purpose. Most of the songs I think direct relate to Helen's stubbornness and passion ("Fighter" and "Beautiful" being two of the main ones), while others voice her envy of her peers' less stressful lives ("Could be Anything" and "Where Does the Good Go"). There are also "triumph" songs for the high points when Reuben and Helen manage not just to survive, but to come out stronger than before.

To see the full playlist, click on "read more."

January 2007

As you may have noticed, the excerpts from The Fiennes are not back-to-back. This piece is set during Reuben's second bout with leukemia. It has been the hardest section to write on an emotional level, but I also felt like I got closer to understanding my characters. Comments are welcome.

How "The Fiennes" Evolved

I started the first version of The Fiennes in my senior year of high school, inspired by my rabbi's description of serving a very small congregation that met in a YMCA. The small town setting of the first version (and the current one) was primarily based on my parents' hometown in central PA. In both versions, Helen is the epitome of the fiery, rebellious teenager, rarely shy about voicing her feelings.

In Version One, Reuben was a widowed rabbi who had a habit of sermonizing in the grocery store, especially about the ideas perpetuated about femininity by women's magazines, while Helen happily read Seventeen and Cosmo. Through Reuben, and the (tiny) Jewish community in Zion, I showed the challenge, as best as possible, of maintaining one's Jewishness in the context of a non-Jewish society. Meanwhile, Helen and her friends (Lydia and Cassie) showed the everyday challenges of adolescence and young womanhood. I had started writing about how an unexpected diagnosis with chronic leukemia changed both Reuben and Helen's lives towards the end of my senior year of high school.

Throughout my college years, I wrote small story fragments designed to go with Version One, but did not take the time to integrate them into the larger whole. As I drifted further and further from the big picture, though, I took more and more time away from the story.

But Helen and Reuben lingered in my imagination. The summer before my junior year of college, I started doodling comics about Helen as a college student. Reuben was no longer a rabbi, but a cook. I decided that Helen's hometown was too small to believably support a synagogue, even though I really liked the image of Reuben as a rabbi who lead prayer services at the Y.

During my "gap" year between college and nursing school, I wanted to revisit the storyline of Helen taking care of her father while he has leukemia. After skimming the hundreds (I hate to think how many) pages of old drafts and story fragments, I ended up starting from scratch. It was a little strange to see how much some characters had changed, but even more so to see how much Helen had stayed the same. She is still talking back to her peers and adults, and sometimes getting into trouble for it, but her honesty and loyalty still pull her through. I hope that after I finish this novel (whenever that happens) that I can keep telling her story.

Putting Google to Work

For the past six months, I have been shadowing nurse practitioners (NPs), RNs, and anesthesiology residents at the preoperative clinic of a Boston hospital. 

During one of the appointments I sat in on today, the patient and his son had come from outside the U.S.. The son acted as an interpreter, and gave me and the NP a list of his father's medicines. While some of the medicines' names corresponded to the generic names used in the U.S., several of them did not. The software used by my hospital to make patient medication lists only knows U.S. generic and brand names.

What began as a challenging, but less than productive guessing game ("What's Losec?"/"It's for his stomach") changed with Google. With the NP at the computer, I fed the medication names to Google, and translated the foreign generic names to something we could use. While Losec happened to sound very close to its American trade name, Prilosec, the rest of the American drug names bore absolutely no resemblance to the foreign drug names. There was one drug name which looked (to the NP) like the generic name for a prescription medication, but turned out to be acetaminophen (Tylenol).

Using this information, we were able to write the patient's medication list for the day of surgery so that it had the American and foreign drug names side by side.

In the my hospital's operating rooms, we have a number of tools for "smarter" health care delivery, from sponges with bar codes (so we don't lose them in a patient) to robotic instruments.

Before today, I wouldn't have thought that the phone I use to read Dear Prudence on the bus could be used to make a bilingual medication list.

The Fiennes: Biopsy/Diagnosis

The following takes place after Reuben's visit to the Emergency Department.

The Fiennes - October-November 2006

After we learn more about the oncology nurses' thoughts on Helen, we return to the Fiennes house. Helen and Sam's relationship takes a new turn, while Reuben struggles with what to tell his daughter about love and sex.

The Fiennes - September 2006

In between the January 2006 chapter and this one, Helen and Reuben each have a number of ups and downs (which I'm still writing out). One of the main "ups" is Helen and Summer's junior prom, and the girls trying to figure out college plans.

Helen's first day of her senior year turns out to be a lot crazier than she thought.

Featuring Helen, Reuben, Pete, Summer, and Principal Klein.

The Fiennes (January 2006)

In between this excerpt and the previous one, Reuben explained to Helen's English teacher what was going on in their family. Helen "downsized" their Christmas decorations from a full-size tree to a table-top tree, and Reuben gives her the set of ornaments he originally gave her mother for their first Christmas. (Helen's mother died in labor, which is discussed in the prologue).

The settings: January 2006; Westwood Hospital, Fiennes house, Pleasant Valley High. 

The Fiennes (pages 38-42)

 In between this excerpt and the preceding one, Helen's English teacher noticed that her academic performance is declining, Helen started donating platelets (cells that help the blood clot), and Helen started to show signs of caregiver stress. This section is set in December 2005.

The Fiennes (pages 27-32)

 This excerpt immediately follows the previous one, and includes most of the November 2005 chapter. The scene with Ballpoint Lady was one of the most fun for me to write, even though, like Helen, I'd probably want to run away from her in real life.

FYI: Fludarabine and Chlorambucil are chemotherapy drugs commonly used to treat CLL (the type of leukemia Reuben has).

The Fiennes (pages 23-27)

In the previous excerpt, Helen Fiennes and Jess Baker were suspended for fighting on school grounds. When they came back to school, Jess was embraced by her peers but Helen and her friend Lydia were no longer welcome, and found a new table in the cafeteria.

The following excerpt takes place in October 2005, shortly after Helen's return to school. Helen and her father (Reuben) are the main characters.

The Fiennes: Aftershocks (pages 15-18)

The following is an excerpt from the beginning of my novel The Fiennes. The scene: Pleasant Valley High School, fall 2005. Helen Fiennes is the protagonist. Jess, one of Helen's fellow cheerleaders, may have intentionally let Helen fall during cheer practice the preceding day.