Are you our teacher?

The Pharm final was this morning. It was supposed to start at 8am. When I arrived in the parking lot at about 8:10, she was walking up to the school. She's always late (hence why I was late). However, she did not enter the classroom until 8:25, and when she did she looked confused...like crazy woman confused...looking under cabinets, walking around tables...crazy. Then she asked us if we knew where the exams were. I'm sure my facial expression spoke volumes, so it's good that I sit in the very, very back of the classroom. She left the room (presumably to look for the exams) and came back without them saying that they weren't where they were supposed to be, and did any of us know how or where she could make copies? The whole time I felt like I was in a time warp...the combination of sleepnights studying for finals (although I didn't really study for Pharm) and overall tiredness/frustration with this particular class just full cirlce and I was thinking "This is not happening. I am imagining this, I haven't woken up yet." I think the class was thinking the same thing. There was discussion of a walk out, but I knew no one would move. But we did fill out our evaluations right after the test and I don't think that helped her at all.

There's so much going on that I'm overwhelmed. And tired.

What Does One Say?

...when a major stressor in their life for the last 6+ months finally ends?

Nothing...yet. I have a Psych exam after lunch today and a Pharm exam in the morning. But by God, tomorrow afternoon. Tomorrow afternoon I will celebrate as though I've never passed a class in my life and then I will spend the weekend in a great city before going home.

Home. To my mama.

Now that I think about it, that's probably what I'll say.

Take me home, I want my mama.

Biomed, In the Final Hour

The mornings of exams I used to listen to encouraging music while studying. I had my IPOD programmed to play 4 slower, encouraging Gospel songs (think, Yolanda Adams) followed by a Hip Hop anthem-style song (think "Survivor")...I actively study during the slow (20 mins) then take a break during the fast (5 mins) and keep going for about an hour or two. Well, since my IPOD was stolen last semester, I haven't been able to do this. But this morning I came to school and listened to Yahoo radio while I studied. A minute ago, a song called "The Struggle is Over" by Youth for Christ came on; there isn't a song more appropriate for how I feel this morning as I prepare to take this final BIOMED exam. I've reached that place where I can't even be anxious about it because I just want it to be over. No matter the outcome, the stress of it is now over. It's like the peace you get after making a decision.

Hearing the song was one of those "And this, too, shall pass" reminders, and we all need those.

What Makes the NHSC Application Culturally Biased?

This was the question posed by an anonymous poster in the comments section of the related post. I will try to explain it here...

So. The point of the NHSC is to get med/pa/cnm/fnp students to work in economically depressed areas (which they call Health Professional Shortage Areas or HPSAs) which are in critical need of providers. The vast majority of professional students are middle to upper class non-minorities that do not come from these areas. Keeping that in mind, let's break down a question that is on this year's application/personality assessment:

Choose A or B:

A. "I would like to work in a community where the people and activities are different than those I grew up with."

B. "I would like to work in a community where the people and activities are the same as those I grew up with."

When advised about how to fill out this application (by people who were successfully awarded the scholarship) I was told "the answers they want to hear are obvious." I believe the answers are obvious to the majority of people filling out this questionnaire because the majority of people filling it out (students in professional schools) are NOT from HPSAs and they are supposed to be answering questions in a way that indicates that they are committed to working in these HPSAs...and therefore the "obvious" answer is "A" because if you want to work in the kind of community you (being the med student who's filling it out) grew up in, chances are that community doesn't qualify as an HPSA. Get it?

So, what happens if you happen to be one of the very, very few people who actually grew up in an HPSA? Technically, you should be circling "B" because the area you want to serve is actually the same kind of area you grew up in...but I don't think scantron-style reading of these bubble assessments will be taking that into consideration, which makes me wonder if someone in this situation shouldn't be answering as the typical professional school student, or themselves...and *this* is why I feel the assessment is culturally biased.

But anyway, I will tell you that I have already resolved all of this in my mind and am no longer really thinking about it. I am just going to fill out the form truthfully, and let the universe handle the rest.

Praxis, Thesis, or Literature Review?

I have a decision to make. Maybe a week ago I mentioned that I woke up at 4 am with my praxis/thesis topic and emailed a potential advisor about it. Since then I have spoken to others about it and so far it seems to have legs, and I have been given an unofficial go-ahead. We have the choice of doing an aesthetic praxis (a kind of artistic project that demonstrates what you've learned about a topic, which includes some writing) or a thesis (you research a topic in your profession and write about it - but it's much harder than it sounds..see below) or a basic literature review.

At my school, people lean toward literature reviews because they're easier to do. A literature review is where you read up on all of the research that has been done on a vary narrow topic, say "smoking habits of Latino youth from 1980 to the present" and you write a summary of that research (based on the articles you find)...usually the point of this is to lead up to a reason for new research to be conducted, or to introduce your own new research that relates to that topic. This is usually the first step of any research project, whether or not you officially include the full review in your actual research article. (ie: you will do this informally when thinking about researching any topic, but you may not necessarily write up a formal review) One of the reasons this is the top choice for students here is because, unlike other grad programs, we are not given any "time off" (meaning a semester without classes) to do a thesis...whatever project you choose, you will be writing/working on it while you are taking about 5 or 6 classes, and a lit review is the choice most conducive to this situation. You can think of a lit review as the first step of a thesis.

Some people do opt to do a thesis. A thesis is usually written at the end of a masters program to qualify for the degree. Often times you finish writing it after course work is done, but some do it concurrently. It is one (big) step beyond a lit review in that you submit an original idea as the research. There is more than one way to go about this, but for the sake of ease (and my limited time) I'll just say you can do a research project that involves you actually going out an collecting qualitative or quantitative data clinically (ie: interviewing 20-somethings about their choice to have an abortion or keeping track of the number of 17 year olds who have abortions in a specific county over a 6 month period) or you can review data from sources like the US Census or Education Trust Foundation and draw new conclusions about the data they provide. The downside to this project is that it takes a LOT of work - and you still basically have to do a lit review before you get started! And also, we have to do this while we are in (hard) classes. But there are reasons I would choose this project, among them:

1. It's a great way to start your PhD dissertation (if you stick to the same topic, almost half the work is done).
2. It's a published bound work for which you are the sole author.
3. It's respected...serious scholars write theses, and I can't imagine applying to doctoral programs without having done it.

Let me add: Lit reviews are respected as well, and they, too, can be published in journals. But I do think there is a difference!

Lastly, there is the aesthetic praxis. This is what I woke up that morning thinking I would do. A student who is graduating this year did hers on pregnant women and dancing in which (I'm guessing) she reviewed the literature on dancing as exercise or therapeutic for pregnancy and she (I know) choreographed a dance to go with it. Another is doing something with pregnancy photography. I woke up at 4 am saying I'm doing a story quilt on the history of black midwives, a la Faith Ringgold. This would require me to narrow down a specific aspect of this history (ie: history of use of superstition or faith based protocols by black midwives) and review the literature about it (lit review) and then to construct a quilt that includes pictures/painting and the text that I write, especially the connection between quilting and black midwifery. The upside to this project is that I get to combine more than one of my interests and have fun while doing a something that could otherwise be very daunting. If I have to spend over a year of my life with this thing, I want to enjoy the process! But there are down sides, mainly there is the question of whether this is a "respectable" project for someone who is going to continue on to a doctoral program? Although I recognize the work that this project entails, is a doctoral admissions committee going to see it? Or is it going to look like I took an easy, fun way out? Further, is it going to be too black to be universally respected among an academic midwifery audience? In the grand scheme of things this is only one of many, many more research projects to come, but it also my first research project, and I want to be taken seriously.

I don't like that I have to ask these questions. I don't like knowing that if I choose the aesthetic project I am going to have to fight to prove its value (even though this is the whole point of these projects) to a whole bunch of people who won't see it. I don't like feeling like I have to do the hardest project just to prove that I'm supposed to be here. I don't like that we value quantitative or qualitative, sciences over humanities. I don't like how we don't really value art in this country and the resulting obligation I feel to do something more "academic" because of it.

NHSC is Not Doing Interviews for 2007

The National Health Service Corps is not conducting interviews for its 2007-2008 scholarship cycle...it just never ends with this program.

Let me start from the beginning. When I was applying to grad school, I found out that there really isn't any good financial aid for programs like mine (direct-entry/grad-entry programs in nursing, also called bridge programs) nor for graduate professional school in general. Everyone speaks of one or two programs when considering aid: the National Health Service Corp Scholarship & Loan Repayment Program, and the Scholarships for Disadvantaged Students Program. (The Nursing Scholarship Program is mostly for undergrads)

NHSC does not accept students in bridge programs, so we apply after the first year when, technically, we are no longer in a bridge program. You can see a snipet of the history of NHSC here, pay specific attention to the "NHSC milestones." Over the years, the program has been reducing its scholarship offerings in favor of the loan repayment program, which costs them less to provide, and in the '80's there was a severe decline in aid because the country expected a physician surplus. At this point, the program is almost all loan repayment, and I predict that in the next few years the scholarship will no longer be offered. I believe this will directly impact the number of minority physicians and APRNs because I have read articles stating that at times the number of minority students in this program exceeds 50% of the total of participants. (I will try to find a public link to one of these articles or at least tell you the name of it so you can look it up!)

The problem this year is that they all of a sudden decided not to conduct interviews for this program! Instead, they will select awardees based solely on their application...an application that has no essay, no place to indicate involvement in the community or any other volunteer experiences, no way to indicate who you are! How do you select people like this? The application is basically a personality assessment...and it happens to be culturally biased. I think the interviews were crucial to the selection process, and that in the absence of these interviews the demographics of their awardees will change significantly...that is unless they use the demographic section of the application to select a specific percentage of minority and non-minority applicants...is that still legal?

Anyway, all of this is just to say my number one plan for funding the next two years of school looks like it just fell through. I'm still applying, but interviews are a strength of mine, and with only the application it doesn't look good. The positive is that I can just stay and go straight to the doctoral program (maybe part time, I'm tired of school).

Oh! And the problem with the Schlarships for Disadvantaged Students Program is that none of the schools I applied to participate. You must apply through the financial aid office of your school. When I asked about this, they said that they don't meet the requirements for the program - mainly, they don't have enough minority students enrolled to qualify for the program, which seems backwards to me...

Pscyh Clinical: Week Five

My fifth week of Psych clinical ended yesterday and, for the second time, my preceptor asked me, "Are you sure you don't want to go into Psych?" Followed with, "You'd be perfect for it." I kindly told her I was sure and we laughed, but later my groupmates said that I made this terrible face when she said it and that's what all the laughter was about. I really gotta work on my facial expressions! It's not that I can't see myself as a Psych APRN, it's just that I can't see myself as NOT being a midwife. This conversation happened after my conversation with a patient (another black woman on the unit who, like my last patient, is also addicted to cocaine) lasted an hour long - significant because she had refused to talk to staff and other students on the unit. This woman had had an "outburst" earlier in the week; she had called the social worker on staff a "racist bitch" and was screaming at her uncontrollably. Of course the staff just considered her to be very angry about something else, and requested that she apologize to the social worker after speaking to her about her feelings. Which is all fine and good (and necessary) but I also wanted to validate her feelings about the social worker, because angry or not, drug addicted or not, right now this patient is techinically clean (albeit only a month's worth, but still clean) and so she knows what she's saying and my guess was that she had a reason for saying it, so I asked her about it. Sure enough, the patient had an altercation with the social worker earlier in the month in which the social worker decided to interview another patient (a white patient) who had just got admitted that morning instead of her, despite the fact that she had been there 3 days already. I asked her why would the social worker do that...what would she get out of it? She said that she and the other black patients on the unit have all had negative experiences with the SW and the patient herself had had some negative experiences with the SW on her last stay on the unit some months ago, and that she felt like she just didn't like or wasn't comfortable interacting with them, and that maybe she was intimidated. So we talked for a while about all of that, and how to get what you came to get despite her or anyone else and then we moved on to other things. But later I followed up with other patients about their experiences on the unit, specifically as they pertained to racism (or not) and the same sentiments were expressed without my mentioning the SW or anyone else specifically. So it made for an interesting day, and when I questioned my preceptor about the SW, she said she thinks it has less to with race and more to do with the fact that the SW isn't very good at what she does, and some patients (I add: "especially the black patients who proabably have more experience because of socioeconomic differences on the unit") know more about the system than she does, which really irritates the patients. That sounds like it could be true. Anyway, I also spent a long time talking to this patient about books (she was thumbing through O mag while we were talking) and she happens to be very well read and *almost* (LOL) put me to shame! (now isn't that snobbish...elitist...ohhhh, someone like *her* could not possobly be more well read than *I*...mhmh) What a great Friday at clinical.

*The photo above is of Africans Americans at Spring Grove Hospital Center. When (if) you go the page to read about this place, look in the right hand column of topics and you'll find "African American Patients at Spring Grove." It's probably the first Psych hospital to accept free or enslaved African Americans.

Psych Mid-clinical Evaluation

I have a Pathophysiology exam in a week, then my Pharmacology final, Biomed final, and Psych final all in the span of two days...a hellish Monday and Tuesday.

I've started reading 72 Hour Hold because it's over 300 pages and my paper is due in three weeks, but I want to turn it in in two weeks because there's a lot going on the week it's due...

Thursday I have to present a case report on my chosen psych patient...and do a skills check off to prove I haven't forgotten the skills I learned last semester - eventhough I have.

I never talk about my psych rotation...here's the patient I'm presenting this week...which should give you some clue to what I'm going through:

In a few weeks, the day before my birthday, she will turn 36. She has five children ranging in age from 5 months to 19 years. She has a history of marijuana, alcohol and cocaine cocaine abuse, starting at age 13. She does not have custody of any of her children, they all live with her grandmother. She has been hospitalized twice for post traumatic stress disorder, depression, and substance abuse. Her mother was addicted to cocaine when the patient was born...when she gave birth to the patient, she went outside the hospital on a smoke break and never returned, and later died of AIDS. The patient supports herself via prostitution. The patient has been raped and her perp is serving time in prison. She is on our unit for a "treatment seeking" substance abuse study - a cocaine stress test. Because she is treatment seeking, they are not allowed to inject pharmaceutical grade cocaine into her veins, which makes my heart happy because there are others who are NOT "treatment-seeking" and therefore their version of the stress test is to have pharmaceutical cocaine injected intravenously to study the effects of the drug. But her study is a little different: when she came on the unit, she told (and they recorded) her worst experiences with using cocaine...now (for the study) she listens (via headphones) to these stories and they record her body movements, affect, etc.

This is why I chose her to present on:

When the patients are given a mental exam, they are asked to write a sentence. She wrote, "I am sombody productive in society." Her answer to the question "Why did you come here today?" was "I don't know who I am. I just want to know who I am." One moment in time when she was happy? "Journalism class in high school. I want to be a writer." And guess what? She can write. I also chose her because no one else is interested. Because I have been standing up for her and her experiences since I got there, because no one else will.

I had my psych mid-clinical evaluation last week. My preceptor said (after you are so wonderful, brilliant, yada yada yada) "I always give students something to improve on. I don't know what it is, but you've got it. I want to tell you that you can't take this stuff home with you, that you can't feel it the way you do because it's not healthy for you. I don't know if you can turn it off. Your heart is big. You shouldn't take all of this in. I don't know what makes you do it..." I know how it sounds cheezy, but I promise it's true.

I wanted to ask if it was really that hard to understand. All of these black patients. No black practitioners. No practitioners who come from the very environments that they criticize on a daily basis. No understanding of how much work it takes to coordinate section 8, food stamps, and utility assistance. No idea what is to stand outside in below zero windchills waiting on a public bus to come to get to those appointments. No understanding of what is to be a black girl in room full of entitled professional white people talking trash about black people and their lives...as if I'm invisible...or maybe they just don't give a damn that I'm sitting there...or maybe I've reached that "different kind of black person" status.

She's right, I'm taking it in - isn't that what we're supposed to do? Or was this supposed to be a game? A way to say "I've served the poor, the disadvantaged. See, I care." She's right, I take it home with me and digest it to the best of my ability because until I take it home and digest it - make some sense of it, I can't move on. I can't not feel it. I can't turn it off, believe me I've tried for so long.

"I don't know what makes you do it."

My heart is big. My heart is big. My heart is big.

I had this long post typed out just now and it crashed. Man.

I had this strange experience where I missed my own blog. Meaning, I sat down to read my blog...as in "I haven't read so-n-so's blog in a while, let me see if she has a new post" like it isn't my own blog...it was strange.

Anyway, I guess I am sitting here to write (rewrite) the post I wanted to read...

I didn't make the things to do before I die list yet, but I did visit a new place on campus! I went to a pregnancy photography talk that was about how society has shaped the images of pregnant women we see (or don't see) and about the evolution of the photographing of pregnant bellies. It was great.

Per one of my goals, I took note of some meaningful things I did over the week, including talk to a girl in my class about health disparities until 1am one night, and unofficially submitting a praxis idea to an advisor after waking up at 4 am one morning with it on my mind.

I also took note of watching the superbowl, which turned out to be so much more emotional than I thought it would be...it was the commercial that did it! I realized that when I'm old and some youngins are talking about the year when two black men went to the superbowl as coaches, I would be able to say "I remember that."

The brown people have officially decided to get together *regularly* (finally) for something one of us coined Brown Folks Brown Bag...I guess we're going to be meeting over lunch. I can't wait.

And then there's this:

I’M GOING HOME!

A New Month, A New Outlook

January flew by. One of the things I realize is that I missed it! One of my goals for the year was to be in the moment more often, which for me starts with being in the month, instead of constantly thinking about the 1/5/10 year projection of my life. It is so easy to live lecture to lecture, test to test in nursing school. In a way, that is living day to day, in the moment, but it is also a very narrow view because school is always the focus. Some would say, "but oh that is the life of the student" but what I realize is that my life in general has been a bit heavy on the waiting...when was an undergrad, I couldn't wait to finish and get the hell away from that institution, now I can't wait to be done with this RN-heavy year of my grad program and get on to things I'm actually interested in, and as I looked at my pitiful W2, I can't wait to finish all this education and actually get a job...I am not a career student (contrary to what my family probably thinks!) My point is that I spend a lot of my life "waiting" for it to really start, instead of being grounded in the reality that it has very much started in the here and now, and as I wait for it, it is passing me by. That's so cliche. I've read the million emails that tell you to live each day like it's your last, but I just don't have the guts I guess. But what I can do is write down more than just my work/school/clinical/social schedule in my planner. I can write down a goal for the week and a confirmation that I successfully achieved it. I can write down something out of the ordinary that I did that day before I go to bed. The whole idea is to be able to look back on the month and feel like I did something other than take 3 exams, work 50 hours, log 65+ hours of clinical, or meet a classmate to study. Maybe if I have a written record that I've helped my brother with his math homework, or me and my husband went to dinner, or I read a book in a beautiful library for two hours, or I went to a coffee house and journaled about my life on Maple Street, I would be less likely to feel like my whole life is passing me by while I'm in this program...

My goal for next week is to make a list of 25 things I want to do before I die, and to visit a new place on campus.