Back Again...

Being a nurse practitioner is a wonderful career! Here I sit at work, typing away on the iPad my employer has supplied--I can read a book, write a book, surf the WWW, watch Netflix...the list goes on. No, my employer won't get on to me for doing these things--as my co-worker and fellow NP said, "we don't get paid for what we do, we get paid for what we can potentially do." That's what my current locum tenens job is about. I'm waiting on a job to open up in a rural hospital--where I will work full time with a work seven 12 hour days and then be off for seven days. I took this temporary position as it offered more money than what I had been making (being honest--Medicare doesn't pay well) and I needed a little break before I started the 7/7 job. This job is 3/12 hour days a week rotating every 3 weeks so nobody is stuck always working the weekend (except Sunday--this office is closed on Sunday). See, a career in nursing (as a NP) is a great thing. The job market is wide open. The work is generally rewarding--it's a lot what you make it. The responsibility is awesome as a nurse practitioner--I remember when I first started I would lay awake at night or be jarred awake by the thought that I'd forgotten to check for allergies to certain medication or the dose of furosemide I ordered was gonna shoot their kidneys--or worse, what if that nurse didn't take the order off that I wrote or forgot to take the warfarin out of the med cart because I d/c'd it 5 days ago but the INR kept going up--only to find the night nurse HAD been giving it. There's a lot of what ifs. Eventually, you calm down and become a skilled, knowledgeable, overall "well seasoned" NP. Remembering to check for drug/drug interactions, allergies, noting of risk/benefit--all become second nature. For the time being, this job is a mini-break from the serious, chronic health challenges I had been faced with daily at my previous job. The worst thing here so far is poison ivy rashes otherwise it's DOT/CDL physicals, urine drug screens, breathalizer testing, occasional gluing someones skin back together, various injections for minor problems. We are prepared to suture if needed. Nothing REALLY life threatening, and for that I am thankful. Now don't get me wrong, I still love little frail old people and I'm sure the base population at the hospital will be these folks. I'm just being honest about the pay and getting a break from the stress of trying to keep old worn out bodies working and anxious and unrealistic family members breathing down your neck. I still say, there should be a law passed that declares it illegal to make a person with a "terminal illness" or in "end stage" disease a full code. Please, let them go with dignity. More later.

Thanksgiving

I worked yesterday and am off today. I follow many blogs and a few of the ones I follow are blogging on what things they are thankful for. I am thankful to finally have a position where I CAN be off on Thanksgiving...and the day after. I've got a great position, not to say that it's perfect, but it's pretty darn close. I still see geriatric patients and now I'm able to focus on prevention. I don't treat, I just review medications, the patient's social, family, medical and surgical history and perform a physical exam. Then I do a fall risk assessment and discuss all my findings with the patient. Sometimes, during the exam, I discover that the little elderly lady in front of me who's denying all problems has a temperature, or abnormal lung sounds--which require further investigation. That's when I either contact their primary provider (physician, Nurse Practitioner or PA) or their DPA (Durable Power of Attorney) and advise them of the findings. It's good to find out you've nipped something in the bud--preventing an hospital admission hopefully. It's so much better for the patient, if they aren't too sick, if they stay at home in their own environment. Hospitals are the WORST place for a sick person--sounds absurd doesn't it? There are so many germs there just waiting to hitch a ride on your body and it can wreak havoc on the elderly--especially the frail elderly.
Hey, did you hear? Tennessee ranks THIRD in the nation for over prescribing of antibiotics. I'm not surprised. In defense, when I was working in primary care (Family Practice Clinic) I had patients to chew me out and say they would go find another "doctor" to give them an antibiotic. People just don't want to hear it and don't believe that they don't need an antibiotic. I always say, "lets let your body try to fight it, I don't think you really need an antibiotic for this". Some listen, most don't. Onward...
I'm not cooking Thanksgiving dinner today. I'm thankful for that. Instead, I'm headed to my niece's home for the Thanksgiving meal. I was asked to bring "something chocolaty" and so, I will. It's called 'Lawson's Chocolate Psychosis', after my nephew Lawson who made this chocolate cake on Thanksgiving in 1998. It was a hit! He hasn't baked since. I wish I would have had the forethought to snap a few pictures during the process of mixing the batter, removing from cake pans, etc., but anyhow here's a picture with the "undercoating" of icing












Then, I took the cake over to the sink, where there is more light so you could see the finished product. (I'll try uploading pic later)

So, there you have it. Hoping above all that we all enjoy today's offerings what ever they may be and those that travel a safe going and return. Peace to all. Joyous Thanksgiving!

Home...at last. Did I tell you I was moving?

This place is me. It's got character and not easily shaken. We've had some pretty rough storms this spring, lost a few tree limbs off the newer trees (I now consider the Bradford Pear a "trash" tree) and like me, it is a work in progress. My motto is, "Rome was not built in a day" and I'm not trying to stress myself out over wallpaper I don't care for or paint colors I don't care for. All in good time.
While the weather is warm, I am spending a lot of time outside figuring out the gardens---there are still unidentified plants (yet to bloom) and doing lots of weeding. I have a small garden beside the garage where I am growing tomatoes and a few herbs.
As a nurse practitioner, I have to keep my knowledge up to date and so, I am heading to Cape Cod for a few days to do just that---attend a continuing education seminar. I am looking forward to the trip up and the return. On the way, I plan on stopping at a few places--namely the Greenwood Gourmet Grocery, The Inn at Little Washington, I plan on making a quick detour to Portland, Maine to see my Dad, pick up some Maine lobsters, Amato's Italian Sandwiches, canolli shells from Shaw's Supermarket and head back south---to my glorious retreat of a home. I was just thinking the other day, "how many people get to drive to work each day admiring the scenery on the commute?". I feel very blessed to have this place and call it my home.

Healthy Banana Bread

Happy and Healthy New Year to us all!
I haven't blogged in a while, no floods, just my daughter's wedding, putting my house on the market, and Christmas--all enough to keep me too tired to post.
Haven't heard much talk of resolutions this time around. Strange, usually that's all one hears around this time of year--"This year, I'm gonna..." and so it goes. I like what Nike says, "JUST DO IT".
And, that's what I did. I was reading over my favorite food blogs and came across this recipe for 'healthy' banana bread. As you can see by the picture, I had on hand some ready bananas. I like to say they are all freckled instead of 'over-ripe'. So, instead of oohing and aahing over the pictures I just made the bread.

See, I did it. and it looks just like hers! It really does taste very good and even better the next morning lightly toasted with a smear of butter.

I've attempted to give a link to her blog so that you too may try the recipe. (click on highlighted area for link).

Meatless Monday: Curried Pumpkin Soup

Meatless Monday: Curried Pumpkin Soup

It's fall y'all! This is the time of year I love to sit with a bowl of soup and savor each spoonful as I watch the leaves falling. I haven't tried this soup yet but The Wizard made dinner for me Thursday evening--Shrimp and Vegetable Curry. He served it over rice. I ate two helpings. I LOVE curry, coconut curry even more. So, I thought what better soup to make to usher in the cool fall days and nights than a pumpkin curry. Hope you try it.

Work Schedule

This week I'm starting a new work schedule--self imposed in an attempt to make better use of my time at the facility. Yesterday went fairly well, slow and easy pace. The lady with the labile blood sugars seems to have fared better on the new regimen I started for her--that's a relief.
I am happy to have a job where I have a flexible schedule, what a blessing! Sometimes I do miss working in an office environment where I have my own desk, computer, pictures and set hours. There are office pot lucks, birthdays, drug rep lunches not to mention someone who schedules who I see and when, no hunting around for someone to see because you're worried you won't make your quota for the month. Again, that's where I am fortunate in having a doc that is understanding. He knows you can't just go see a patient because they are sitting in front of you, there must be a medical necessity or it's considered fraud--Medicare fraud. That carries a HEFTY fine and I never want to commit that crime.
I have to mention that yesterday I wrote discharge orders on someone that I never thought I would. He was a patient that had come to our facility after a stroke. He was depressed. He was weak and had essentially given up his will to live. He was to the point that in order to survive he had to be fed liquid nutrition through a tube.
I've seen this done a lot and the outcome has never been good. Well, wonders never cease. He made a 360 and has gained almost 30 pounds, is eating on his own, talking, laughing, a happy man. Truly, he is a success story. It does my soul good to see him and know where he was 2 months ago and see where he is today. Today, he's going home! My best to you Mr.____, you've renewed my faith in PEG tubes!

If I had a dime...

Oh if I had a dime for every time I said I was going to be faithful and make a post daily or weekly I could...what? What would I do with all those dimes? Never mind, here I am again with the best of intentions.
As I looked at the last post with the picture of the broccoli, I saw there were no weeds in the garden. I need to take some pictures to show you just what it looks like now. I have had the best harvest ever, put up a freezer full of summer veggies. We've had lots of heat and rain and I've had little time or interest to weed in the hot humid garden. Ugh!
Yeah, I don't have enough time to fully engage in all my hobby delights and thus the weeds have grown tall, the insects are filling their little bellies on most of what's left in the garden. My friend CS, a.k.a. "The Wizard", has been too busy himself to come help out in the garden. I've even thought of renting out a room upstairs to someone if they would agree to be my "handy man" and help keep the house and garden in order. I sure could use the help.

'Pac Man', that's the name of the variety of broccoli growing in our garden. So, all that activity on Mother's Day is paying off. The garden is growing and thriving except for the eggplant. Ugh! I should consider myself fortunate as the bugs have not chosen to infest any of the other plants--so the eggplants are the sacrificial plants--well, two survived. I moved them down and into the row of parsley. I think I remember hearing that parsley was a natural insect repellent.
Lets see, there are 4 or 5 varieties of tomatoes, bell peppers, watermelon, muskmelon, bush beans, broccoli, red cabbage, okra, blue potatoes, 2 varieties of basil, parsley, yellow squash, zucchini squash, 5 varieties of sunflowers, cucumbers and 2 badly defoliated eggplant plants. I have yet to plant the zinnias. It's supposed to rain this weekend, maybe I'll have enough time to get out and scatter their seeds so we may enjoy fresh bouquets all summer.

Around The House...Bird House, that is!

Over the weekend I uncovered the old bird house that the ivy had overtaken. It was infested with insects and falling apart. No worry, The Wizard went to work and created a brand new one!
In the background, you can just see the edge of the garden. That's were I spent most of the day yesterday, Mother's Day.
Today when The Wizard had put the finishing touches on the new multifamily bird house, he mounted it to the tree pole that was remaining (still in good shape) and had no sooner walked a few steps away from it, when he turned back and saw a potential tenant checking it out. I hope they will like their new digs. I sure do!

The 2010 Flood in Nashville

Stayed home Monday due to the flooding. My house was fortunate, a lot of others, not so much. This picture was taken at the end of my driveway. There is a creek that runs under a bridge as you turn into my drive. A big part of that (the bridge) was washed away in the flood.
The picture below was taken after the water receded. As I said, our house was fortunate as there was no actual damage to the house only the driveway suffered. I was able to get out and go in to work yesterday.
As I drove past Nashville it was so surreal--seeing the city where I live and play under water. No, I don't work in Nashville but in an outlying community southeast of Nashville. The town I work in had some flooding too but not as bad as some other areas. Check out this video clip of the Nashville flood--no better song or singer to be the background for some pictures of the devastation. Keep us in your prayers!

How I became a Nurse Practitioner

I'm a late bloomer, a testament to "it can be done". Due to my stubbornness (and divorce at 37), 3 children and no real work experience, a love of science (biology) and undergraduate major in Biology, I became a nurse practitioner at the age of 41. Since I had a college education the judge decided I should find work. I had been a stay at home mom since I married in 1981. I never worked before I was married. Yes, I was somewhat spoiled by my parents (they were divorced). My mother told me as I went away to college, "You go to college to be well rounded in certain subjects and to meet a husband--not have a career. Women are supposed to stay at home, have children and throw memorable dinner parties for their successful husbands, look at Jackie Kennedy!" My mother was always comparing us to the Kennedy's--? I remember my sister fussing about eating at McDonald's and my mother retorted, "If its good enough for the Kennedy's its good enough for us."
Anyhow...I wasn’t encouraged to pursue my dream of becoming a Marine Biologist or maybe even practicing medicine, instead my dreams turned to homemaking and raising 2 daughters and a son. I was married to a successful and very handsome man who gave me a monthly allowance which I used to buy groceries and whatever else I wanted to buy. I never knew how much the household bills were, my husband took care of all that. He even took care of having all his clothes (with the exception of under garments) dry-cleaned. We lived on an estate sized lot with 5 bedrooms, an in-ground swimming pool, a garage full of cars including a new Suburban and a darling little white BMW 325i convertible—both of which were my cars to drive, we had a boat, 2 SeaDoos, not one but two country club memberships. Needless to say, most would think I had it made. Money can buy a lot, but it cannot buy happiness.
Tried to make it work but it wouldn’t. I will spare you the sordid details. Divorce.
As I think I mentioned earlier, I had never had a job. So, I went back to my Alma Mater for career counseling since I had been told that I would need to get a job to help support myself and the children. The psychologist administered different tests that would give me insight into my personality and which careers would be best suited for me. Number one on the list: Administrative law judge. So, off I went to begin training as a paralegal as I didn’t want to start law school right off the bat. There were other options, Physician, University Professor; they were all requiring no less than a doctoral degree. To find a job with my own major required me working on a doctoral degree. I mean, what’s a degree in biology going to get you—not even teaching? Nope. That requires a minor in education—more school. So, I opted for the paralegal program. It was nine months and they offered job placement.
My first job was with the Attorney General’s Office, Criminal Justice Division. I was on “the Death Team”. It was serious work, the “worst of the worst” crime against another human—murder. Pictures. After a while you get used to it, not so shocked by the photographs of the victims. I remember the point where I knew I was hardened. It was a gruesome photograph where I made the comment, “Oh wow, they’ll never get the blood out of that rug, what a shame.” I remember the rug was exceptionally beautiful, it was needlepoint or something and it was totally ruined. I had not even thought about the victim as another human, a daughter, a mother, a wife, a sister. An emotional defense mechanism—block out the victim?
More money lured me away from the AG’s office. I was moving up. Up the hill to a high rise and to the ultimate demise of my law career—boredom. After about a year of working at “the department”, I was totally bored. I had often daydreamed about a career in medicine. I was a biology major after all. Most of my fellow (and I say fellow because they were mostly guys) biology majors were pre-med. It had crossed my mind but that was about it, remembering what my mother told me about girls and careers. Wish I had not lived a good part of my adult life being totally irresponsible and dependent upon a man (my husband). I was determined that I wasn’t going to be a victim of this. I grabbed my gumption and boot straps and got on-line and checked into a program at a local university where I could “bridge” into the nursing program to become a master’s prepared nurse practitioner in just 6 semesters. A friend of mine had mentioned this to me, she was a nurse and thought this would be a good way for me fulfill my dream of practicing medicine and they had a geriatric program which is the specialty that I wanted to go in to. I found out that I was missing some of the prerequisites to be admitted into the program and that I would have to take the Graduate Record Exam (GRE). I got busy getting into the local state university for the classes I needed, and never thought to take prep courses for the GRE, and signed up to take that also. When I got to the test taking office, so many people were talking about the prep class they took and how hard this was going to be. I said a prayer in my head and thought, if the Lord wants me to do this I will score well enough on the GRE to be accepted into the Bridge Program, if not, He will open a window (if He closes a door, he will open a window).
I graduated the Bridge Program in May of 2002.

I'm Back...I think.

Yesterday I hit the ground running. Nurse J met me at the door and said, "I need you to come up here and see about Ms. G, she is talking out of her head." Just as I rounded the corner at the South Nurses Station, nurse P says, "Hey, you need to see about her, as she pointed to Ms. L, she's got a cough and then go down and take a look at Mr. F, his eye, well, go down there and you'll see." Then nurse J reports another case I need to see as the family is concerned. Then another nurse from the 400 hall reports that, "Ms. C is not doing well. She's more congested and is getting anxious because she's having a hard time breathing and the granddaughter (who is a hospice nurse) is requesting that we increase the frequency of her Roxanol dosing."

Roxanol--it's immediate release morphine generally used in end-of-life to keep the patient relatively free of pain or help calm them when they are struggling with breathing. "Air hunger" is what we sometimes call it.

After I see all the "acute" cases the nurses have told me about or written a note to me in my book (a spiral notebook just for nurses to communicate problems or potential problems to me), I go back up to the nurses station and pull out the charts (hooray!! they are all here!!--that's another story) and begin my progress note and write the accompanying orders. Before that's done nurse J comes up and says, "Oh, did you see the UAs yet?". So, I pull out Dr. H's folder and pull out the labs and unsigned orders. It's enough to make your head spin sometimes but I begin sorting it all out and before I know it, the patients on this side of the building have been seen, the orders have been written and it's time for me to move to the other side and start the process over again. You see, there is a North and a South Nurses Station. This is what I do daily. Every day presents a new challenge and that's what I love. Monday is my "like a box of chocolates" day--I never know what I'm gonna walk through the door and get. Over the weekend "stuff" happens. Residents get sent out to the hospital because of an acute illness, or a fall, or they start developing symptoms of a problem and need to be seen so that the potential problem may be "nipped in the bud". Tuesday is "lab day" and blood work drawn in the early morning usually returns with some abnormal results that need to be addressed, and Wednesday is "day off", Thursday is "catch up" day for all that may have happened on Wednesday when I wasn't there, and Friday is "Regulatory and lab" day. I usually perform my required visits per medicare guidelines, that is every patient or resident of the facility is seen at least one time a month for management of chronic health problems such as hypertension (HTN), diabetes (DM either I or II), kidney disease (CKD), chronic obstructive pulmonary disease (COPD) and others. It entails a physical assessment of the patient, reviewing their labs, medications, vitals, weights, bowel and bladder, and activities of daily living and determining if their current medical regimen is working to keep them healthy. In addition to the monthly visits, I also see the "acute" problems that pop up. Like the ones mentioned above where the nursing staff is reporting that a resident is "talking out of their head" or having "burning" when they urinate. Some acute problems are fairly easy to figure out, others not so much.

October already!

Ah, it's already October and I've missed blogging about a lot of water under the bridge. Sorry. Well, we had a great birthday party at my house for my grandson's 3rd birthday--lots of kids, parents, a few grandparents and a grandparent to be--my dear friend Jody as her daughter Shyanne is with child and, God willing, will give birth in due time to a healthy, happy bundle of baby. She and Alex will have a bond that will never be broken because of this child. That's the thing about babies that I don't think anyone understands until they have one, or two, or five. I think women get this. Once you've had a man's babies you will forever be honored in that man's mind--even if he doesn't show it. Believe me, it's there. When push comes to shove, you are still the mother of his child(ren).

Life. It's a circle isn't it? It's eternal. As one comes, one goes.

I am a little miffed right now at a certain GI doc that sent away an elderly patient of mine who had anorexia and abdominal pain. He said the only thing left to do because of her anorexia (said she didn't complain of abdominal pain!!) is to put in a feeding tube, and he didn't recommend doing that. The daughter stood at the nurses station this past Friday--lost look on her face. I mean, that's her mother. The doc said essentially no hope. I don't know if he didn't look at the whole picture, ask questions, or simply didn't care to delve any deeper for answers because of her advanced age. Yesterday when I got to work, my very inquisitive and dependable LPN on the skilled wing came to me and told me about Mrs. _______. She said that she had been hollering all weekend and asked if I could give her something to help calm her. I had spoken with the daughter on Friday and said that I would order an abdominal x-ray to see if anything showed up. I remembered this and then my LPN reported the upper abdominal symptoms and wondered if it could be her gallbladder. We giggled at this because another elderly resident had just had an ultrasound that showed up gallstones and this LPN had recently had surgery for this condition. So, an x-ray and an ultrasound ("US") were ordered. Guess what, my LPN was dead on the money. The US showed her gallbladder was full of stones. This is why she was in such pain, poor creature! We sent her to the ED and I trust they've taken her for surgery by now. I wonder what Mrs. ____'s daughter is thinking? I wonder if she wants to call the GI and give him a piece of her mind? It's sad but all too common that the elderly are often overlooked and every complaint they have is chalked up to a UTI, fecal impaction or dehydration. I just want to ask these young doctors, is this how you want to be treated or how you want your mother to be treated?

I don't agree with feeding tubes just for the sake of prolonging the inevitable. Hospice is a wonderful service, helping to keep your loved one's dignity intact and gently and lovingly caring for them during the transition and journey to death. Death. Humph. It's just a transformation from one form to another, like the ship leaving port headed for a distant land with our loved one on board. This is a journey we all must take, and take alone. It makes me remember a poem that my sister told me about that she found on a grave stone while walking around in a local cemetery in Portland, Maine. It goes, "All earthly friends as you pass by, so now you are, so once was I. So now I am, you soon must be, so prepare for death and follow me."

Life and death--that's life.

09/09/09 the 252th day of the year

Yesterday was 09/09/09 and it was also the 252th day of the year which when you add up 252 it = 9. Remember School House Rock? "Nine, nine, nine, distinctive number nine, times any number you can find, it always comes back to nine", someone even added, "Well, Wednesday has nine letters, right?" We all thought it should be considered a lucky day. Anyhow, it was just another day to me. I don't consider myself lucky, I consider myself blessed.
Today I've pretty much got my day laid out for me. First I go to my facility and see the 10 people I've already got on my list and then over to the clinic for 3 hours. My work day will end around 3:30 today. The 10 on my list are what we call "regulatory visits". These are required visits according to Medicare guidelines and some are just courtesy visits as a resident of the facility. It's a good thing because everyone in the facility is there because they are essentially unable to care for themselves and thus unable to manage their chronic or acute health problems on their own. I tell you, their condition can change in a matter of minutes. That's why any long term care facility (skilled nursing facility--"SNF") that has a nurse practitioner on staff or the facility medical director has his NP there should be a good choice for anyone looking to place a family member.
I have seen residents condition change in a matter of minutes, right before my eyes. Just recently a long time resident of the facility who had been just earlier in the day wheeling about without a care made her way back down to the nurses station and settled herself along the back wall, like so many others in their wheel chairs do. She sat and spoke to a man on her left and the woman on her right. I looked up and saw her several times as I sat studying the chart of a resident I had just seen for symptoms of a urinary tract infection ("UTI). All at once she began to cough, and cough, and cough. She turned pale and then light blue. We quickly came around from the desk area and assessed her ABC's on the spot. We wheeled her back to her room. Her O2 saturation was 76%. I called for a face mask for oxygen because she was fish mouth breathing, she didn't respond much to that and I could hear no air moving in her lower lung fields. So I called for a nebulizer solution (albuterol) to hopefully open her airway, as she was taking shallow breaths, gasps really. That did the trick, her sats started coming up and she pinked up fairly quickly but was still struggling with sats hovering in the low to mid 80's. During the time we were trying to stabilize her, the nursing supervisor had called 911. The EMTs arrived, we related to them what had just happened, her medical history, her vitals. They took over her care as we stood by and watched. I kept hold of her hand and looked her in the face and said, "Your going to be okay. They are going to take you to the hospital to get checked out." They left with her. She returned a week and a half later very much changed. Pneumonia had struck her and taken her down that quickly. She rallied after a couple days at the facility and then slipped back into that place between here and there and died about a week later. Let me add too that she had several chronic problems and this was not the first time she had pneumonia. She was a smoker, had a history of hypertension, COPD and diabetes, she was overweight and had mild dementia. She had been living at the facility for a few years and the staff had come to know her and adore her. That's the hard part about working with long term care patients. They often endear themselves to you and when they go, it hurts a little. I think all of us in long term care know in the back of our mind, kind of like the foreknowledge of going to a movie that a friend has already warned us to "bring tissues". We go ahead and allow ourselves to become involved knowing that we are setting ourselves up for heart ache. It is a pleasure to be with these people in the last years, days, hours and minutes of their life--a privilege really.

His Peace,

Stephanie

Lovely heirloom tomatoes

Went to the Nashville Farmer's Market this past weekend just to get some heirloom tomatoes before they are gone. There's a great little stand down there that I count on each year for these beauties. I love the market and now i know where I can get that extra basil for my end of the year stash of pesto--it has to hold us over for the winter. I think I've mentioned that one of my passions in life is cooking. I subscribe to a lot of foodie magazines ( I'm not going to say how many) and get inspiration from some of the great food blogs I follow such as TravelersLunchbox and 101 Cookbooks - Recipe Journal just to name a couple.

I must not fail to mention www.closetcooking.blogspot.com/ I just recently discovered his blog and have subscribed to it, I haven't been disappointed yet in what he's been preparing, check out his blog if you're a foodie.
I enjoy cooking for my family and friends, having parties and the occasional catering gig. Its been a while since I've done any catering and I surely miss it. I mostly did small gatherings and one time a wedding for over 100 guests--it was held at my home and I coordinated EVERYTHING down to the music. The only thing I didn't make was the wedding cake. The groom's cake was a flourless chocolate cake topped with real sweetened whipped heavy cream (yes, I whipped it myself) with Chambord and raspberry sauce. This was in the early 90's and I was so sure Martha Stewart would have been so proud of me. I was proud of myself to have pulled that one off by myself. I am also happy to report the couple is still married to each other.
Tonight I came home after work (got home about 4:30) and put 2 good sized pieces from a head of broccoli and 3 carrots through the food processor grater attachment, added a heaping handful each of raisins and broken walnut pieces and tossed in some Vidallia Onion salad dressing (I picked up at Sam's Wholesale), mixed it together and let chill until dinner. Dinner was leftover barbeque ribs from last Friday and my stove top cooked "baked" beans. This is a picture from last Friday. They were still good and smoky five days later (I'm glad my husband likes leftovers!!). . The sweet from the "slaw" mix went well with the heat of the ribs. My husband Joe is heat sensitive--the cayenne pepper really gets to him, so I have to go light handed with it. I got the recipe for the rub off of Epicurious.com and it was pretty good. I used one of my cast iron skillets as the "smoker" and put about a bag (4-5 cups) Hickory wood chips in it. I remove one of the metal grills from our gas grill and place the skillet directly on the part where the flames come out. I also turn the remaining burners on low and watch the temperature so that it stays at about 350 degrees F. After about 20 minutes the skillet starts smoking and it really does impart a nice smoky flavor to the ribs. This is my first time to try this and it works. I had rubbed the ribs and they had marinated for a day and a half--I'd use more garlic and more dark brown sugar next time. Then placed the ribs on the grill racks and made sure the flame was on low or turned it off if it flared up, which it did only one time. I am going to try to find someone selling hickory wood and get some larger pieces, the wood chips burned quickly and didn't produce as much smoke as I'd would have liked.
Anyhow, this is part of my life. My next endeavor is planning a birthday party for my grandson who will soon turn three with his Mom (my middle daughter, Abby--who is BTW studying to become a nurse!). Will keep you posted on these plans as they materialize. Good night to all.
His Peace,
Stephanie

Hey, I realize it's been a few days--maybe even a week since I last signed in. What can I say? I've been either too busy, too tired or just simply forgot. This whole blog thing is new to me and it's a little dissapointing when you see that no one is interested in what you've got to say--at least at this point.
Well, I got my professional cards today. They are really pretty. This is the first tiny step I am taking towards starting my own practice. I am seriously considering starting my own (part time) house call practice limited to adult and geriatrics--particularly the frail elderly. I've recently entertained the idea, met with a couple of NPs from down in Chattanooga (this is the meeting that I mentioned in my first blog) and reluctantly accepted an offer to do just that but it would be working with them--which is essentially for someone else. Not sure of all the details, that's what I don't like. I am hoping that in the coming weeks the details will be presented to me where I have it all laid out in black and white. I am still reluctant. I am just happy that I have options.

Getting Started

This is my first blog on A Day in the Life of a Geriatric NP. If you are here to gain insight into the life of a NP--welcome. I will do my best to enter daily about my work. I love what I do. What a blessing to be able to make a living while doing something you really enjoy. I have other interests and first loves (as in cooking, gardening and daydreaming). More on those topics later.

I must leave for work soon but I will be back to post about my day. It should be an interesting day---I'm going to meet a few fellow NPs to discuss a new business opportunity. Yes, geriatrics is a specialty that not many care to do. It's not as "sexy" or lucrative as the day in a life of a critical care, cardiac or hospital based NP but but the patient population is growing (hey, we are all aging if we're not dead, right?) and with growth opportunities abound. My nursing career started out in the long term care setting, many years ago when I was searching for my life's work. I will write all about that soon. For now, I must get busy about my day--in the life of a geriatric NP.