Wednesday, August 23, 2017

The Day Our Whole World Changed

We've been having a lot of difficulty with Dovid over the last few months, and after blaming so many things for his issues, we've finally figured out what was really going on...

Since about June, Dovid has been drinking as though he could never get enough water. He would sneak down in the middle of the night, parched, and get himself water, even though we told him a thousand times not to. He would also sneak down for snacks. Then the pee accidents started. During the day, over night, you could never trust him not to pee. He was soaking everything, too - his bed, the couch... We blamed his medication, we blamed him just being lazy, we blamed the water before bed causing accidents (technically true, but there's more to it than just that). He also fell off the growth chart. Not that he's ever really been on it, but his plateaued, and his pediatrician was worried enough that she was going to send us to see a gastrointestinal doctor. In the meanwhile, I was going to take him to the child development clinic to see someone about his pee accidents.

Fast forward to last Sunday evening. We had a delightful party of sorts at our next door neighbor's house as a birthday celebration for our friend, Ron, whose birthday is this week. Dovid went to the bathroom (after having no less than 4 glasses of water) and stepped on their bathroom scale. He came out and proudly announced he weighed 39 lbs. *record screech* 39 lbs...he had been over 40 lbs at some point. He was not only not gaining weight, but now losing? And I know he's eating. As I said, he was sneaking snacks even! And he'd eat plenty at dinner. There was no excuse for him losing weight.

When I got home and sat down at my computer and really started thinking about it, my nursing brain kicked in. What else could make a kid drink, pee, eat, and lose weight? I got on Facebook and asked around for a glucose meter, and luckily a friend of mine down the street had a spare. I immediately went to get it, hoping I was being a hypochondriac nurse mother. She tested it in front of me, so I knew how to work it and that it actually worked properly. I took it home and tested Dovid while he was still asleep. The screen said "high glucose > 600". My hands shook. My heart sank. I ran down the stairs, screaming for Shmuel. I showed him the meter, because I couldn't actually say it out loud. He suggested I retest, even though I knew in my heart it would show no different. I went back up and used a different finger...same result. Crap. I asked my friend if she ever got a result that high. The answer was no. Double crap. We called the pediatrician, though I knew this was an automatic straight to the ER glucose result. Shmuel carried Dovid down to the car, and I took him to a local hospital (Newton-Wellesley).


At the ER, of course Dovid feels totally fine, just thirsty as all heck and asking every living being if he could have a glass of ice water. Don't let looks fool you, of course. They tested his glucose again...same result as at home. Well done, mom. They sent his sample to the lab to get an actual value...851. Triple crap. Luckily, somehow Dovid with all of his energy and water drinking managed to keep himself out of DKA (diabetic ketoacidosis) for months with high sugars. He still had high ketones, but his blood pH was decent - just obviously compensated. After a bag of fluids and, yes, a nice glass of ice water, they gave him insulin and we were transferred via ambulance to Children's Hospital.



 One last note about Newton-Wellesley is that they have child life specialists for pediatric patients who help when any procedures are done and give them activities to do (coloring, iPad, etc). She helped to educate him and calm him, and Dovid is a kid who HATED needles. He caused a major scene at CVS getting his flu shot last year. She also gave him a REALLY nice Lego set (for keeps). They really know how to treat children there, and I was very impressed with the way they handled everything.


These two pictures above are of Dovid in the ambulance. He was entirely enthralled, as this was his first time in one. Hopefully he will never need to see the inside of one strapped to a stretcher again.


At Children's, they repeated Dovid's blood sugar and labs, and of course it was all still high. Then he was admitted, but unfortunately they didn't have any "legit" rooms, so we got put into a treatment room. :( By this time I was so exhausted I was almost not coherent. Once we were settled, Dovid, who had at least gotten a few hours sleep, enjoyed time on the iPad while I was passed out in the bed. Once the day started in earnest, all manner of doctors, nurses, educators, and dietitians came to talk to us about diabetes care and treatment. We were lucky enough to be offered a chance to participate in their day program, so we could be discharged that night (Monday) and come back the next day (Tuesday) for education for the latter part of the day.

So far we are all hanging in. Dovid is a real trooper and has given us no problems with the finger sticks and insulin shots. I am incredibly proud of him and his maturity with all of this. He doesn't really seem perturbed, even when I have to keep him from eating long enough to count his carbs and give insulin. And he doesn't mind needles now...at least not the teeny insulin ones. I also felt so loved at the outpouring of support from everyone on Facebook and especially those (like Ron, our nanny (Melissa), my amazing neighbors, and the mom of one of Dovid's friends) who visited in person, brought me food, helped with the kids, and drove us home.

I never thought I would ever need to know about diabetes at all (aside from obvious nursing/midwifery related things), let alone get a crash course in type 1. Life is going to be a whole lot different, but we'll get through as we usually do. Now we just have to get Dovid onto a regimen where his sugars are controlled and hopefully get him a continuous glucose monitor and insulin pump. That at least will take some of the weight off. Until then, I better get to sleep. 2am is finger stick time.

Sunday, May 14, 2017

Night At The Museum x3

Costco had a really great deal on the Night at the Museum trilogy - $13 for all three in a DVD set. I could not pass that up, considering I've really wanted to see them and figured the kids would enjoy. So we may have binge watched them a bit.

The kids ADORED the movies. They've been deciding which of them is which character. So far Gavriella is Sacajawea, Tzipora is Jedediah, Chana is Octavius, and Dovid is King Akhmenrah. Which, of course, leaves me to be Teddy Roosevelt. I could have done much worse. haha

Each movie has is really great points, but I have to tell you the little Jewish pieces in the third one made me smile. There's a reference to Nicky's Bar Mitzvah and an entire (little) conversation between Larry and King Merenkahre (played by the amazing Ben Kingsley) that made me crack up. Speaking of Ben Kingsley, I just about freaked out when I saw him in the Egyptian pharaoh get up. Anyone who knew me well as a child would know I had a small (huge) obsession with the biblical Joseph. It started with Joseph and the Amazing Technicolor Dreamcoat and wafted over to a made-for-TV movie called Joseph, where Ben Kingsley plays Potiphar. As I've watched him as Potiphar probably a hundred times, seeing him play the pharaoh was pretty awesome and made my teenage heart flutter.

But Ben Kingsley wasn't even the best part of the third movie. That was Dan Stevens, of course, who played Sir Lancelot. They made just enough "Dan Stevens is hot" jokes to suit me. He did a fabulous job making Lancelot believable even when I can't not picture him as Matthew Crawley.

If you haven't watched the trilogy, definitely do it. Rent them or see if your local Costco has them. You're in for a good laugh (and a good cry).

Saturday, May 13, 2017

Answers

Since at least one person expressed interest, at some point I will tell you about my interesting genealogical findings. As for now, I'll give the answers to the questions I got in comments:

First off, Dovid. He has ADHD and is a challenge all around. He still has accidents because he gets so engrossed in things that he does so he doesn't make it to the bathroom on time. He also talks a lot and has difficulty with social interaction. So he doesn't realize that the other person wants him to be quiet or just isn't interested in what he's talking about. He doesn't talk about the other kids at school much (except for one boy who I don't think is a mutual friend), so I don't know if he really has any friends. I hate thinking about how lonely he must be. But B"H he is very smart, so academically he does quite well. I'm always impressed with the things that he knows.

Right now not TTC and not planning on any more kids in the near future. I am quite content (and overwhelmed) with 4. Maybe once these guys get older and less of a handful I might have a change of heart, but I am too busy to think otherwise at this point.

As for work, I cannot get into a midwifery practice because no one wants a new graduate midwife (especially one without many years of labor & delivery experience). So I'm a bit stuck unless I want to go into a home birth practice or private practice, neither of which is a viable option for me.

I'm getting my doctor of nursing practice degree in midwifery, though at this point I'm not sure what I'm going to do with it. My end goal was to be a midwife, and now I just feel so worn out by it that I think retirement is my end point. haha

Friday, May 12, 2017

Finger Surgery

I had a small cyst removed from my finger last Tuesday, and it HURTS. I was expecting to go in, have it removed, and be sent home with a bandaid, but no... It has stitches and a HUGE dressing. Doctor also said I can't lift heavy things with that hand. So now I'm out of work for at least a week and a half. I'm not happy. My boss is not happy. And my finger hurts because this dressing is cumbersome and tight. I am seriously contemplating having one of my coworkers take out the stitches before the family reunion next week if I can't get in to see the doctor before then. It's a good thing I'm a righty.

Thursday, May 11, 2017

You Miss Me?

How surprised was I today to see that someone was looking for an update and that I hadn't posted anything since last August when I became a CNM. I'm not really sure why I don't update more. I am busy - doing my DNP, working, kids - but not so busy that I can't take a few minutes to say hello to anyone who is still reading. *waves to all of my "fans"*

The nine months have not been particularly eventful. The twins are in 2nd grade and doing fairly well. Dovid is on a medication that has made him much easier to handle at school, though he still struggles with anything related to social interaction. Chana is progressing steadily and hopefully will be able to continue on to 3rd grade with Dovid next year. Tzipora has whizzed her way through kindergarten and can read! She's got a lot of sight words down, and we are all super proud of her. She also is friends with basically her entire class. Gavriella is also having fun in her first year at "school" in the 3-year-old class. She's an adorable gem, and I love it when her teachers send me photos of all of the fun things she is doing in class.

As for me, I /finally/ got a job, but not as a midwife. I was hired to work as a labor and delivery nurse (part-time nights). This is not ideal, but it is work. Meanwhile, I am plugging along with my doctoral studies and will hopefully finish in September. At that point you can all call me doc. :D

In about a week, we're going to be attending a family reunion with my grandfather and people from that side of the family that none of us have met. My mom, Uncle Ron, my sister and brother-in-law will also be there. It's going to be very exciting, and I promise to take lots of pictures and actually post about it. Maybe I'll get back into a groove or something... Feel free to leave a comment if you want me to post about something in particular. I feel as though I don't know what to talk about. I've made some pretty interesting genealogical discoveries over the past few months, but I doubt they would be interesting to anyone outside of my family.

Wednesday, August 17, 2016

Certified Nurse Midwife

I know I do not post here very often, but exciting things don't happen very often, and I have no idea if anyone even comes to look at my blog any more. My day to day life seems pretty dull to me, especially because I have been in school for so long (seems like forever). None of my kids remember a time when I wasn't in school studying for something. They have no idea who Mommy is when she doesn't have her nose in a book. I started my pre-requisites for nursing school in January 2010, when my twins were not even a year old. My now 5-year-old was conceived during my first semester of pre-requisites, and my almost 3-year-old was born about two months after becoming an RN. My goal from day one was to become a midwife, even though it seemed like that day would never come.

It took six and a half years of blood, sweat, and many tears. These last few semesters of midwifery clinicals nearly broke me entirely. There were times when I wondered if I really should be doing this. I was beaten down so hard that I thought I would never graduate, even after spending all of that time and money. But, after eight months of clinicals, I did graduate (finally!). I got my congratulatory email from my school the day after my birthday last week. But even though that gave me my master's in nursing, I still could not call myself a midwife. Not until today...

Today I passed the AMCB (American Midwifery Certification Board) exam which makes me a CNM (Certified Nurse Midwife).

I took this selfie right after getting into my car after passing the exam. I studied my brains out over the last week, and it paid off.

I wish I could tell you that I'm done with school, but there is one piece left for me to accomplish. I am going to do my school's 9-month DNP program for my doctorate. Once that is finished I will be 100% done with school, and then you'll be able to call me Dr. Kahn. (I've always wanted to be called that. See 90's Nickelodeon TV show Salute Your Shorts if you don't know why.)

My next step is to find a midwifery position in my area, though that is proving to be somewhat difficult. I have interviewed at several hospitals, but most (if not all) places want someone with at least some midwifery experience or at least some labor and delivery RN experience. I have neither. In the meanwhile, I will be working at Roxbury Community College as a maternity clinical instructor for their nursing students and hopefully will pick up some doula clients to keep improving birth on a small scale even if I'm not working as a midwife (yet).

Sunday, August 9, 2015

An Open Letter to Every Hospital in Boston (and the Rest of the USA)

Dear Hospital Administrators,


As a hospital, you provide an essential service to the communities where you are located. Your staff saves lives daily. They care for people when they are sick and help them heal so they can return home. This is probably one of the most valuable services in existence, and you have a difficult job. You need to make sure your staff are the best so you can be the best, which is why I understand why hiring experienced doctors and nurses is appealing. Unfortunately, this is causing huge problems for new graduates.


I have spent over two years looking for a permanent job. I have spoken with countless nursing recruitment agencies only to have each one turn me away because I didn't have experience. Well, of course I don't have experience; no one will hire me! I have submitted my resume numerous times to every hospital within an hour's drive of Boston (and sometimes more), yet I can count on one hand how many interviews I've had, and I still do not have a permanent position. Every time I am brought in somewhere, I hear the same refrain: "Oh, we really need to hire someone with experience." Well, I'm very pleased that you brought me in for an interview, but why did you bother when you knew from my resume that I don't have the experience you are looking for?


I became a nurse for the sole purpose of working in women's health, most preferably in labor and delivery. This has been my passion since I was a child, and it is the only type of nursing that I want to do. But for two years I have only been able to give flu shots, work per diem on med/surg, and assist in procedures to combat hair loss. I have not treated a single pregnant woman in the entire two years since I received my nursing license. I am forced to work in fields that I don't enjoy or feel comfortable in, because I need to feed my family, and being out of work entirely for two years (or more) just wasn't an option. If you look poorly on my resume now, can you imagine what a two year gap would look like? "So...how come you haven't been working for the last two years?" "Well, so far no one has given me the chance to work in the field that I am dedicating my life to, so I'm still looking..."


And I am not even close to the only person having this problem. Any beginning nurse who wants to work in a hospital specialty will face the same thing. He or she may need to begin by working in a nursing home, and at some point she may be lucky enough to get a job on med/surg and possibly someone in that hospital will allow her to switch to a specialty after a few years. A few years of doing something you don't enjoy or want to do just for the possibility that eventually someone will take pity on you and let you work in the specialty you joined nursing for! That's unacceptable.


I've been working my brain off in school to become a midwife. I finished an entire 18 month BSN program in 6 months so I could apply to midwifery school. I have a 4.0 GPA in a full-time midwifery MSN program even though I'm working part to full time for an agency. But that means nothing to recruiters who are looking for 2, 3, 5, 10 years of experience when they are hiring nurses for their maternity floors. I would be an absolutely incredible maternity nurse, and I am stuck caring for everyone except pregnant women. I start clinicals for my midwifery program in about 3 months. I will be catching babies myself...managing labors...treating women in the office...diagnosing illness...all under the watchful eye of my preceptor. And when I finish that, I can graduate and become a licensed CNM. Then what?


I am faced with the fear of being unable to find a job even once I have an MSN in midwifery and am licensed to practice as a CNM. Why? Because I have no experience working on L&D or postpartum. New graduate CNMs do not appear to be as discriminated against as new graduate nurses, but hiring administrators still would prefer someone with some type of maternity experience. Great... And once I have my CNM license will someone want to hire me as an L&D nurse now that I'll have about 6 months of experience? No. Because they would know that isn't what I want to do with my life, and they would believe I would take a job as a midwife if one became available.


I am horribly stuck with no foreseeable end. This type of discrimination against new graduate nurses and nurses without direct specialty experience needs to stop. You want someone with experience? Give someone a chance to prove themselves and give them the gift of experience. In some ways, hiring a new graduate is a GOOD thing. She's fresh, not worn out or jaded. She wants to learn and do a great job. She'll learn how to do things YOUR way rather than stick with what she's been doing for the last ten years whether it's evidence-based or not. New grads are up to date on the latest nursing practices, too.


How can we fix this? Have nurse residency programs like the ones for doctors. Teach nurses how to be excellent in a specialty. If you want them to get some med/surg experience first, then put them on a med/surg floor for 6 months or a year before transitioning them to the specialty floor. But that transfer needs to be a guarantee, and they need to be properly trained. Make a commitment to giving jobs to new graduates and nurses without specialty experience. Be a part of the solution. Every time I see a job description that says "2 years L&D or postpartum experience required" I die a little inside. You hospital administrators have no idea how painful it is to be turned away before even applying for a position. And it happens daily, because I check your postings daily for the one that slips by and doesn't have that line added. Had one of you hired me straight out of nursing school, by now I would have two years of experience.


Rather than throwing those "inexperienced" resumes into the trash, I implore you to read through and see if that nurse would be a good fit for your floor, regardless. You might be throwing away the opportunity to shape someone into a fantastic specialty nurse. You could be missing out on having the most energetic, caring, thoughtful, safe, and passionate nurse you could find for that job (i.e. me). Experience isn't everything, though it is definitely valuable. Yesterday was my birthday, so perhaps this year could you give me the gift of experience in a job I would excel at?


Sincerely,


Elana Kahn, RN