coffee shop and the RN, or how to make anatomy approachable.

a patient once sarcastically remarked that being a barista was essential to finding me a husband and little else. (see: College Humor - a barista is the ultimate male fantasy) I jokingly retorted that a barista turned nursing student acts as more affordable, approachable psychiatric care, which is an essential service with healthcare costs so high.

but today in my physical assessment refresher course, we discussed how to assess the cranial nerves and their respective function. the instructor remarked that if a person can function in a coffee shop [as we from the bizz can tell you... there aren't many], we can effectively cite proper function in all twelve cranial nerves.

how, you ask? let me break it down.

CRANIAL NERVE I: OLFACTORY.

even if you don't particularly enjoy the taste of coffee, there are precious few who do not appreciate the smell of coffee. walk into the coffee shop and appreciate the smell of lovingly ground coffee, baking pastries, and toasting bagels or sandwiches; and you've got yourself a working first cranial nerve.

CRANIAL NERVE II: OPTIC.

if you can admire the pastries, read the menu, and notice JUST how attractive your barista is, congratulations! your second cranial nerve is hard at work.

CRANIAL NERVE III: OCULOMOTOR.

have you blinked? has the pleasurable smell of coffee impacted the size of your pupils? you've got a functional third cranial nerve, kid!

CRANIAL NERVE VI: TROCHLEAR.

look at you, moving your eyeballs up and down! whether it's to judge the outfit of the customer in front of you in line, read the menu without moving your entire neck, or dart between tempting treats in the bake case, it matters not. your fourth cranial nerve serves you well.

CRANIAL NERVE V: TRIGEMINAL.

once you've been handed your pastry of choice-- let's call it a chocolate croissant, you take that first bite... and sweet mastication! your fifth cranial nerve is in order.

CRANIAL NERVE VI: ABDUCENS.

with glee, you watch your marked cup or mug move laterally to the bar. cool story, bro. your sixth cranial nerve is totally intact.

CRANIAL NERVE VII: FACIAL.

has your pain de chocolat brought a smile to your face? has the anticipation of your latte caused you to weep with joy? more good news! your seventh cranial nerve is operational. (bad news? you're a little weird.)

CRANIAL NERVE VIII: VESTIBULOCOCHLEAR.

can you hear the whir of steaming milk, the crunch of freshly ground espresso beans, and the tinkling of smooth jazz? stay cool. your eighth cranial nerve is alright.

CRANIAL NERVE IX: GLOSSOPHARYNGEAL.

you take that first sip -- delicious! your ninth cranial nerve makes it taste oh, so good.

CRANIAL NERVE X: VAGUS.

your heart rate might increase a bit with the introduction of caffeine but before no time, your tenth cranial nerve is all like CHILL OUT and keeps your heart rate at a manageable level... you know, unless you drink espresso like a barista.

CRANIAL NERVE XI: SPINAL ACCESSORY.

you turn your neck to look for a seat. you swallow without choking or aspirating. "you're welcome," says your eleventh cranial nerve.

CRANIAL NERVE XII: HYPOGLOSSAL.

your friend kindly points out a bit of chocolate left on your lip. lick it off as seductively as you want, tiger. your twelfth cranial nerve's got you covered.

have any other anatomy questions you need answered with coffee?
lay 'em on me. 

hashtag, things that would only happen to you.

speaking of daddy issues, I unabashedly omitted information from my dad, concerning the details of my graduation from nursing school. I was simultaneously applying mascara in the mirror, prepping for my night out. I escaped without permanent blindness or a flat-out lie. I told him it was some Thursday in May [true]. He seemed to sense that this was not the whole story, so I conceded that I wasn't sure of the times and stuff because the administration at my school is guiltier of procrastination than I am [also a true statement]. This conversation rattled me, so what do I do? Call my straight, platonic man-friend (SPMF). Super healthy!

I laid out the dilemma: I am graduating - a big life event! My father should be present if he so wishes. But, he has no money for transportation or a place to say. I do not have the funds to front him. In addition, there is the distinct possibility that he will have a "bad Parkinsonian day" once he gets here and be unable to attend anyhow. Some days, the meds are not enough; and he experiences "freezing" and anxiety. Some days, it's too much; and he experiences exaggerated or squirming movements called dyskinesia. Also, there's a small part of me that just doesn't want to deal with the drama.

SPMF laughed and said, "well, then. I think you have your answer. I think you just need someone to say, 'you are making the right decision. you are not a bad person for thinking the way you do.' Allow me to be that person... Also, I can't make it tonight. I'm not feeling well. I think I'm just gonna stay in and be sick."

In the midst of my dilemma and his supportiveness, I forgot all about asking him out. (how could I? I even okay'd the move with my Man-conscience!) I wished him well in his recovery and promised to make time to see him soon, when he is well. I made my way to TD Bank to withdraw some cash. Then I visited work to get a good cup of coffee in me before an evening of dancing. I had already flirted with the idea of a nap but lacked the time. Coffee was a must.

Even though I work there, the menu still gives me order anxiety. Plus, it doesn't help that my coworkers are lovable nuts. We distract/tease/insult one another constantly. In my indecision, I failed to notice SPMF enter the line until he poked my shoulder. I... what? I greeted him amiably; we talked a bit in line. I ordered a sadness pastry and a cup of coffee. He bought his typical biker mag and a large tea because he had "this terrible sinus thing." During this time, Man-conscience spotted me from his department and sent me a series of text messages.
"Oh.My.GOD."
"And you come HERE? Awesome."

totally unaware of the fact that Man-conscience was even working, I paid for and received my coffee. I turned eight shades of red, I'm sure. I told the staff I would return for my pastry and power-walked to his department. Moments before I was about to accost him, a customer swept between our locked gaze and asked for assistance. I turned on my heel and fled the department, to the tune of the buzzer going off for my baked good. I returned to line to retrieve it and explain a bit of the situation to Bestie and the other staff on the clock.

"Oh, no. Caitlyn! I thought you two were meeting here and then going together!"
"No, this is me being stood up and then accidentally catching my stander-up in a lie in public!"

I excused myself to go explain to Man-conscience. I thanked everyone and headed to the back of the store. SPMF and Man-conscience were talking! Grumbling to myself, I pretended to be interested in a display table, keeping most of my focus on the back of the store. I grew more and more irritated by the time lapse, but hey. SPMF hadn't visited in months -- of COURSE they had a lot to say to one another. And before I knew it, I was sucked into a vortex of conversation with a very loud coworker. SPMF approached us and squeezed into the conversation with the coworker's totally subtle comment, "You're cute. Who are you?"

Lord, may you strike me down dead. Right here. Please. The coworker was caught in the act of avoiding her allotted department and excused herself. SPMF and I were free to discuss school, graduation, his job, and other stuff we hadn't shared in a while. My coworker escaped the section and sneaked back to our conversation and essentially forced out SPMF out. once he was barely out of earshot, she suggests, "he's cute. Ask him out."
"I did. This is actually me being stood up."

She laughed heartily, taking an uncomfortably long period of time to realize that I was not kidding. She sobered up fast, and said, "Well, geez, Caitlyn. I just don't get it. You're pretty. What's wrong with you?"
"Hah, thanks. If I knew the answer to that question, I wouldn't have these problems."

I eventually explained my plight to Man-conscience [who provided the comment that would later become the title to this blog entry] and had a fabulous night out of dancing. but for now, I give up.

thought digestion

Before beginning my community rotation down-Cape next week, our clinical group was together one last time to meet at Gosnold - a local organization that treats addiction as a chronic disease, instead of a series of character defects. Gosnold provides a continuum of services, from acute withdrawal care to community outreach programs designed to keep graduates of the detoxification program stay in a remission period, with abstinence as a goal. Today, we got a brief overview of their philosophies and the evidence they use to fuel their practice.

Most notably, our preceptor focused on emergent neurobiology that supports their thesis that addiction is an illness of a chronic sort, characterized by exacerbations and remissions. Addiction is believed to be the cause of a dysfunction of the mesolimbic-dopamine system, or the "pleasure center" of the brain. In times of pleasurable activity, naturally occurring opioids [you may have heard of endorphins or enkaphelins? those] are released, bind to mu receptors in this system, whose cells release dopamine which causes the "feel-good" feeling.

As with most body systems, this is a negative feedback system -- think of this process as a thermostat. You set the suitable threshold, and once the desired temperature has been reached, the system shuts off. But say you've set the thermostat to 68 before leaving for work and the outside temperature reaches 89. The heating system shuts down its production altogether. Say this heat wave continues all week. The heating system lies dormant. This, too, is true of dopamine-producing cells in the brain in the presence of exogenous opioids [mind-altering substances]. The cells are quieted because the threshold of dopamine has been reached, and if the use continues, the system is overridden and becomes dormant.

Dr. Nora Volkow describes the effects of mind-altering substances in the addicted brain. Mind altering substances affect both reward and motivation centers, and cognitive processes. Using overactivates the reward and motivation centers, which hijack the cognitive processing [logic/decision-making/etc.] center. So next time you look at an addict and think, "DEAR LORD, DO YOU NOT REALIZE THAT YOU ARE RUINING YOUR LIFE," remember that perhaps they do not. The need to normalize/supplement their brain chemistry becomes a compulsion impossible to overcome without multiple intervention strategies -- just as the compulsion to, say, wash hands thirty times before eating is impossible to ignore for the obsessive-compulsive without multiple intervention strategies. For more information on her and her peers' work, she writes a fabulous blog for drugabuse.gov.

I must say, the more I learn, the more these findings put my heart at rest. When the news broke that my father was an addict, I was all, "you love cocaine more than you love me and my brothers, so fuck you and your phone calls." But viewing this problem in the framework of a chronic illness, it really takes the pressure off me. Uhm, his brain is hijacked. He wasn't standing in the doorway of our apartment, weighing his options. His compulsion was driving his decision-making. I am not to blame. I am not less than a substance. I am just an innocent bystander that he hurt in the acute phase of his illness.

What I cannot decouple from my mind is addiction and firsts. I am the direct descendent of an addict, which means I have a four-times greater likelihood of developing an addiction of my own than the next guy. But, like... that shit doesn't appeal to me in the slightest. And much like eating snails, I cannot begin to understand why it is appealing to anyone. So, sure, I may possess the phenotype that predisposes me to such things, but if I never take the first step, I never contract the disease. SO WTF!!!!

In the case of my father, I know this is also not mine. This. is. not. mine. The disease, in all likelihood, was given wings long before I was born. And I just so happened to be present for his periods of remission and reactivation of symptoms. It's a damn shame. But you know what? We approached him. We offered him options. We provided support. But he would not accept the help we were willing to give. So if I want to reunite with the man I remember as my father from my childhood, he will have to come to the conclusion that he needs help and wants to change all on his own.

Can I be angry about decisions he made before I existed? Sure. Will my anger accomplish anything? Apparently not. Slowly but surely, I am letting go. I will love him in the best way I know how. And if he ever approaches me for help, I will not refuse -- as long as the interventions are evidence-based. But until such time, THIS. IS. NOT. MINE.

phew, that feels so good to say.

vulnerability is not weakness and other disputed truths.

hi, all. I must apologize for falling off the face of the earth. I grew accustomed to writing about my personal growth (and completely foolish moments) on here, but for the last few weeks, I have been graded on these thoughts and feelings during my mental health rotations. I also just realized I stopped blogging right after I explored my thoughts and feelings on depression. LULZORZ, sorry if I scared the crap out of some of you. I have no suicidal ideations. In fact, I am completing crisis training for the Samaritans Group. Check out their story here.

So here is a quick synopsis of things I have gleaned from my time in mental health, which I will call "Practicing What I Test Well In." [or perhaps, "How Did You Not Know That, Caitlyn? 'Cause It's More Difficult Than It Sounds, Rude."]
-- like the title of this blog posts suggests, vulnerability is not weakness. possessing the courage to reveal yourself to another is a strength that not everyone is capable of displaying, no matter how evolved the individual claims to be. vulnerability and bravery will not always pay in dividends. you may be disappointed, even heartbroken, but this should not be a deterrent.
-- primitive instincts are still very much alive. territoriality scares the shit out of me. I typically need three weeks to feel at ease with a person/place/thing, a luxury not afforded to an ADN student. my unease was always there, I just never had to journal about it and confront it before.
-- fake it till you feel it. the mind is a great and powerful force, capable of hurting and healing itself. I read an article online about the phenomenon in which acting in a certain way causes brain chemistry to adapt to your state of being. for example, the other night, I went in with the mindset that no matter how paralyzed by fear I was, I would force myself to walk in confidence. and you know what? it worked. I didn't stick to the strict script we are taught in lecture. I cursed myself for initiating a handshake, but all the client wanted to know was that I cared about them. and all that self-doubt and worrying and other silliness just didn't matter because all I need is empathy. I don't need a task to hide behind, like I did in Med-Surg. I just need to walk in heart-first, and I'll be fine.

And if I may share another story with you, I'll include no identifying information, just that information which I feel is essential for everyone to realize. A client who could easily say he or she had "The American Dream" in his or her pocket was admitted to the unit. On paper, everything was great: a happy marriage, a high-power position, a beautiful family, home ownership in the suburbs, good friends, etc. And yet, one day, the client booked an appointment with the family primary care physician and expressed feelings of depression. During the conversation, the PCP explained that in order to diagnose the client with depression, the client would have to exhibit at least five signs. The client demonstrated eleven. The client entered a crisis intervention program, and 4/5 of the way through the program, the insurance company pulled the plug on coverage. Finding no closure, the client returned home. About two weeks later, the client was home babysitting while the client's partner was out with friends and kissed the children for "what felt like the last time." When the partner returned home, the client shared these feelings with the partner, who called in backup to ensure the client's safety until a plan could be set in motion.

I feel this story is important for everyone to hear because the client's physician and family modeled excellent strategies to deal with depression. The partner did not take the client's feelings personally; instead, the partner reached out to their shared social support system in time of need and got the client the help the client needed. The physician did not dismiss or overlook the concerns of the client. Some terrifying fraction like one third of all people who attempt and succeed suicide see their primary care physicians within a week of the attempt. The number of individuals grows even larger, to something like three-fourths,who see their primary cares within a month of suicide. Every day, those with burdened hearts cry out for help and go entirely unnoticed. As a future nurse and citizen of humanity, I seek to keep an open mind and open heart to make fewer of those voices slip through our fingers.

AND IF YOU READ NO OTHER PART OF THIS BLOG ENTRY, LET IT BE THIS:

Sometimes, depression isn’t “caused.” It lies. It grows. It destroys. But mostly, depression just is. Outside things, other people, and accolades cannot make you happy. You have to make you happy. And sometimes, your brain chemistry makes it impossible to do so without drug therapy. Hearing this story – I think – made me really understand that mental illness is not a choice. It is not a product of your environment. It is not an unfortunate side effect of your life, decisions, and circumstances. It is a chemical process. Can depression be influenced by these things? Absolutely. But are these factors always a mean to the same end? no.

So walk in love, equipped with this knowledge, as I plan to do. 

and if by some crazy happenstance, dear client, you find my blog, I wish to thank you for the pleasure of getting to know you. I wish to thank you for the positive role modeling of compassion and understanding for others you demonstrated for us. I hope you realize how large an impact you had on me and my classmates. You are a kind, old soul. And again, I thank you.

on being brave

I'll keep this brief.

I must extend my deepest thanks to all of you who read my last post. also, I feel obligated to respond to the most popular response to it: some mention of my bravery. see, perhaps this is indicative of my line of thinking, I do not think of what I did as brave. in fact, I still sometimes look back at those two parts of my life with embarrassment. yea verily, I feel as though my depressive episodes were composed entirely of selfishness.

intellectually, I know this is not true. some days are fantastic, when I wake up invigorated and encouraged. other times, my self-talk pep talk can last as long as thirty minutes, followed by listening to "Push It" on repeat while doing jumping jacks -- in order to synthesize some feel-good hormones. a little mindfulness, a little effort, and I am whole. also, I am aware that I am lucky, very lucky. not everyone can compensate for their brain chemistry imbalances with a change of pace, with positive messaging, with love, with exercise and exercising gratefulness.

and for those individuals, I am going to fight. I am going to serve.

and what do I think is brave?
being honest with oneself and others. loving oneself and others. being your most authentic self. being.
so maybe, just maybe, I'm a little braver for being honest. and again, I thank you for your support and your love. I am better for knowing all of you.

and now, I must go. instead of using one homemade anti-blemish face mask recipe I found online like a normal person, I decided to COMBINE ALL THE RECIPES AND APPLY DIRECTLY TO FACE! so I should go to sleep before I lose my nerve and towel off my concoction. if it's a disaster, I'll post pictures. and if it's a miracle sludge, I'm taking it to the bank.

goodnight, loves. and like I said, many thanks.

it's, like, meta-homework.

mental health lectures always make me squirm a little.

it is said that in the grieving process, the number and nature of past grief experiences, the importance of the lost object or idea, the perceived number and nature of existing relationships, the degree of ambivalence toward the loss, the degree of preparation for the loss, and the age of the lost person all play a role in just how complicated the grieving process may be.

in my case, I had lost two mother figures in six years -- and in so doing, I lost two extended families, lost the father I knew to unsavory habits -- the nature of which I would later find out, gained the thought that I would lose two little brothers in the divorce, transferred schools, moved out of the first home in which we had settled for more than three months since my mother's sudden, premature passing... I felt like the world-rug was being pulled out from underneath me. Complicating matters, my father's second marriage was far from a happy and healthy and safe one. We all hadn't slept for years, and the suspicion was slowly encroaching upon our happiness. So both grief and elation washed over me, accompanied with guilt for feeling elation during a traumatic life-event.

Moving into the new house and hitting a plateau of relative peace for the first time, I finally had time to move from preservation-mode to grief mode. and it hit me in the form of a major depressive episode. it was tenth grade. I missed three months of school, in segments. I experienced what I now understand is somatoform pain, that pain which is real and terrifying to the affected; but baffling to a healthcare provider because there is no clinical reasoning for it. mine manifested itself in my head and neck, so I tried multiple migraine medications. I used the very real pain as an excuse to hide from school and other forms of reality in the darkness of pulled shades for weeks at a time. My parkinsonian father had to drag me out of bed and into doctor's offices. luckily for him, I've never been fat.

finally, my primary care provider suggested that I try taking antidepressants and seek out a therapist to work through my emotional turmoil. I also juggled a few depression medication regimens and talked to two different child psychiatrists. I didn't feel like myself when I took the medication, so I stopped taking them and stopped filling prescriptions. My dad didn't push me. Day by day, I decided that I would not be consumed by my dark cloud any more. And more than any other factor, my unfairly placed hate for my advisor pushed me to complete my coursework on time. I returned to school my junior year, invigorated and encouraged, ready to kill it. And for whatever reason, I was triggered again. after about a week, I retreated to my room, wedged myself between my bookcase and chest of drawers, and cried all afternoon. I did not leave that spot for an entire week.

Exasperated, my dad sought out my aunt for help. I needed a shock to the system. I pleaded not to be sent away -- the stigma of my inability to cope already weighing heavily on my heart. the solution? a return to the tiny school at which I had started my academic career, Cheswick Christian Academy. I sat my four best friends down at dinner after my week-long absence from school and explained my situation as best I could. In the middle of a busy Max and Erma's, we cried and laughed and shared. only half of them even knew what I had been struggling with, and even without my extensive explanation, they supported my decision to transfer schools and promised unconditional long-distance love. I knew then that I had been foolish to think I was alone. sometimes the best family is the family you choose, not the family awarded to you at birth.

At CCA, I felt I could make a relatively fresh start, revealing myself to only a select few. I remained largely misunderstood, but at least I was renewed and forgiven. and the benefit of a new venue was that I could talk about my struggle in the past tense. I used to be this way. I used to think that. it was freeing, but at the same time, I didn't really deal with it in a healthy way. I just pushed it away from who I felt I was in the present -- Caitlyn the Survivor.

I was accepted to Allegheny College with a sizable scholarship and began what proved to be the best and worst year of my life. I experienced another major depressive episode, during which I purposefully sabotaged relationships; so I could remain in my "safe" haven. I kept my friends abreast of the day-to-day triggers, but not about how it was affecting me. I attended only the classes I shared with them and cried every moment they weren't around. I had to be reminded to eat, to leave my bed in the morning.

the dangerous thing about depression is that it's easy to confuse with laziness and self-absorption if you're good at hiding it. the behaviors that perpetuate the problem are insurmountably simpler to carry out than attacking your problem head-on. it's easy to ignore a phone call. it's easy to close the drapes. it's easy to just say nothing about how your heart is breaking. it's easy to lash out at people who care for you to keep from confronting what is really going on. it's easy to assume that other's actions are steeped in contempt for you, when all you can do is imagine how much contempt you have for yourself. it's easy to attribute a headache or neck ache with a problematic pillow. it is not easy to admit to yourself or others that you are experiencing a major depressive episode, and all that which you thought you had overcome has come back to eat you alive.

it took another large shock to my pattern and lots of lying on the floor, crying, but I eventually was able to work through pieces of my grief with my aunt's help. I have made some great friends up here. I have begun on a path that will facilitate my transition to functional adult life. but I never forget who I was. and sometimes, I hurt people unintentionally because I am afraid of who that person is and her potential return. and sometimes, I throw myself into projects or relationships that cannot fulfill me because I have a need to make up for "lost time." and then I quit them because it would be easier than hurting others with my darker self.

I like to think that as I age with grace, my shame slowly dissipates, and my self-worth returns. I know what I want. I know what I need. I know who I can trust with these concerns. and sure, maybe I don't have everything I ever wanted at my age, but shit. who does?

I have my health. I have a family, both adopted and hereditary, whom I love dearly. I have a career path. I have a bright future. I have self-capabilities the likes of which astonish me. I have a very forgiving metabolism. I have lovely teeth -- and a reason or seven to smile. I have seen the monster in the shadow and shined a light in its face. But I do not forget.

HOW DID I FORGET NO-PANTS LANCE?

Thursday was an odd day, to be sure. But I forgot the most glaring example of how bizarre it was. Ambition is a lovely thing in nursing school. I firmly believe that you get every bit out of it as you put in, and if you ask, you shall receive. However, ambition isn't always practical with us newbs. Newbs are slow; newbs are crazy thorough. Newbs are a bag of nerves. And this particular newb is way smarter after ten am.

Ambition is pushing eight o'clock meds with three different newbs. I admire my professor for her patience and steadfastness. I, however, don't always exude the same qualities. whilst waiting on another classmate's more extensive med list, the third woman and I chatted in the hallway. But again, it was before ten am, so my creativity came to a standstill. so we just kept silent company while we waited. My eyes began to glaze over when a white blur passed through my field of vision.

I snapped out of my partially conscious state. A man in a white lab coat and bare legs turned the corner and out of sight. I consulted my classmate's eyes for confirmation that I did indeed just see what I thought I saw. Our eyes met, and the giggles began. Like the professionals we are, we ducked into the resource room to dull the sound of laughter. Another classmate was using the resource room for its expressed purpose, researching a client's condition, so we shared with her why we were laughing.

The classmate laughed and told us it must be the same man who arrived in man-leggings. He must have ditched them sometime between the then and now. He walked past the resource room just when we had gotten ourselves together. On further inspection, he was wearing an ID signifying that he is an MD... and it appeared as though he was wearing no shorts or undergarments, as white cotton is hardly a forgiving or opaque fabric choice. That was the final straw! He was a doctor!

Imagine yourself in the hospital, desperately ill, when a man wearing no pants waltzes into your room to evaluate you! I would question my sanity. I would wonder what medication was causing me to experience psychotropic side effects.

P.S. Rudy told me today that I look like one of the residents, a man-resident. why? because we're both slender redheads. I'm telling you, I will be on the lookout for this guy. If he doesn't have blue and golden brown eyes, crazy long eyelashes, a straight nose, a girly waist, and shoulder-length hair, Rudy will be on the receiving end of a vicious punch to the arm. I guarantee it.