What is a Nurse Practitioner?

April, 1993

For some reason, I have been sick often this past winter with four colds, gastrointestinal virus, and bronchitis. I was only able to go skiing once in Vermont even though we had tons of snow. Things are going fairly well as a visiting nurse, although I have been assigned to three different districts, and had my office desk relocated five times in eight months. Finally, I’m the solo nurse in a beautiful rural area. I had to switch supervisors, which has been difficult because the two I have now complain constantly, but I’m trying to adjust.

I decided to take a music theory course at the local community college with three others from the church choir. I had fun writing four part harmony to a favorite poem called God of the Heights by Amy Carmichael, missionary to India, 1867-1951. Amy was an amazing single lady who the Lord used to rescue child prostitutes from the Hindu temples and start an orphanage for the rescued children. Even though she was disabled the last 20 years of her life, she wrote many books from her sick bed while in almost constant pain.

God of the heights, austere, inspiring, Thy Word hath come to me. Oh, let no selfish aims conspiring, Distract my soul from Thee. Loosen me from things of time; Strengthen me for steadfast climb.

The temporal would bind my spirit, Father be Thou my stay. Show me what flesh cannot inherit, Stored for another day, Be transparent things of time, Looking through you I would climb.

Now by Thy grace my spirit chooseth, Treasure that shall abide, The great Unseen I know endureth, My footsteps shall not slide, Not for me the things of time, God of mountains, I will climb!

May, 1994

During my annual evaluation with the director of the visiting nurses, she asked what career goal I had for the next year? I replied that I was considering getting a Master’s degree, but wasn’t sure what I should I get it in. I asked if she had any suggestions? She said, “I think you would make a wonderful Nurse Practitioner (NP).”  I never heard of a Nurse Practitioner, so I asked her to describe the role to me. She said a NP receives advanced training through a Master’s degree program and is taught how to diagnose and treat common conditions, much like a Family Practice physician does. NPs can also specialize in pediatrics, adults, geriatrics, critical care, psychiatry, gynecology, etc. She told me of several excellent NP programs in my state to investigate.

What is a Nurse Practitioner?

What is a Nurse Practitioner?

July, 1994

After much prayer, I have decided to go to graduate school for my Master’s of Science in Nursing (MSN) as an Adult Nurse Practitioner if I get accepted. I have spoken with several NPs who are currently employed and it sounds like a great career! My salary would also increase, so hopefully I won’t need to work two jobs to make ends meet. Many of them have private practices or work in MD offices. I can’t believe how motivated I feel about it!

I applied to the State University last week and received permission to take a 3 hour evening class in Nursing Issues this fall. I won’t learn if I am accepted into the program until April, 1995, but they will allow me to take 6 hours of credits prior to matriculating. The Visiting Nurse Association where I currently work will reimburse me the tuition up to two classes a semester as long as I get an A or B grade in the course. It will probably take me 4-5 years doing it this way part time while working full time during the day, so I’m trusting the Lord to give me strength.

For my spring semester course, I might be able to go to the Dominican Republic for two weeks in January and study trans-cultural nursing. The only holdup is that I am short three days of vacation time between Christmas and New Year’s. It is so good to leave it with the Lord and see if He opens the door or not.

Trust in the Lord with all thine heart; and lean not unto thine own understanding. In all thy ways acknowledge Him, and He shall direct thy paths. Proverbs 3:5-6

Reflection

And so I began to work on my MSN at the age of 39 after being out of school for 19 years! I was thankful there were others in my class who were older than me along with a few younger ones. It was a long hard pull over the next four years, and I nearly dropped out which I will tell more about in future posts. I am thankful I became a Family Nurse Practitioner (FNP) rather than an Adult NP as I originally planned. I was much more marketable as a FNP than ANP when I graduated since I could provide care for all ages of people from birth to death. I worked as a NP for the next 15 years. I recouped the cost of my graduate school education the first year out with my doubled salary, so it was a good decision financially also.

Here is an interesting time line about how Nurse Practitioners began in 1965. https://www.aanp.org/about-aanp/historical-timeline The reason I had never heard of NPs was that the physicians in the midwestern state where I received my BSN blocked NP programs  for many years, because they did not want them taking away physician jobs from them. Since then, most physicians specialize  and so they welcome NPs, expecially in the Family Practice role.

The Grand Canyon – From the Top – Part 2

June, 2010

Ever since I rafted through the Grand Canyon in 1993, I have wanted to see it again from the rim and the comfort of a hotel with hot showers, flush toilets, and a real bed. (See previous post.) I was invited to visit dear friends who live in Utah near Bryce and Zion National Parks. After spending several days with them and touring these beautiful parks, I returned on the shuttle to the Las Vegas airport where I met my friend, Dee. We picked up a rental car and drove several hours to within two miles of the rim where we had reservations at a hotel. For the following two nights, I had booked a hotel right on the rim through the National Park Service months ago so we could see beautiful views from our room.

The next morning after breakfast, as we were waiting for the elevator, I became very lightheaded, weak, and started to black out. Thankfully, the elevator came then and I made it the lobby where I quickly sat down. I told Dee I needed to go to the closest emergency room (ER) as I had a headache also and was afraid I was going to faint from low blood pressure. I have done this several times in the past, so I knew the feeling. A few years ago, I had a concussion from fainting and hitting my head and was out of work for three months, so I certainly did not want to repeat that. The desk attendant told her to take me to the clinic inside the park since the closest ER was 80 miles away in Flagstaff. Dee quickly loaded our luggage in our rental car, drove through the park entrance to the clinic, and let me out at the door.

I walked in, told the desk person my symptoms, and weakly sat down to wait. Within 30 seconds, a male nurse came over to me, put me in a wheelchair, wheeled me into the triage room, and put me on a stretcher. He checked my vital signs, gave me three baby aspirin to chew and swallow, put me on the EKG monitor and oxygen in rapid succession. My blood pressure was high at 160/100 and my oxygen saturation was low at 85%. As I breathed the oxygen, I began to feel better. The MD came to see me next. When he heard that I had sleep apnea and a clotting disorder, he suspected that I was having a heart attack or developing a blood clot in my lungs. They began sticking me to try and get an IV in me, but couldn’t because my veins had collapsed. The doctor pulled Dee aside and said they might have to send me by helicopter to Flagstaff hospital. They brought one more nurse in, and she was finally able to get the IV in. They called the ambulance and loaded me in. I told Dee to go see the canyon from the rim and take some pictures for me, and then drive to the Flagstaff ER. I knew I would be in the ER for many hours, and I didn’t want both of us to miss seeing the canyon.

The ambulance attendants were very nice guys who told me all about the region as we began our 80 mile journey. At least I got to see the countryside through the rear window of the ambulance as we traveled. I was so grateful that they gave me IV Zofran prevent  motion sickness, which I’m prone to, especially riding backwards. We arrived after about an hour, and they wheeled me into the very modern huge ER. The ER doctor took over and immediately sent me for a CT scan and ran blood work. They also put another IV in me using the ultrasound machine. We were still at 7000 feet altitude. Dee then arrived, and reported she was able to take some nice photos of the canyon.

Thankfully, all the tests came back negative for a heart attack or a blood clot in my lungs. The doctor gave me copies of the tests and said I had altitude sickness. Since I live at sea level on the East coast, and have sleep apnea, my body could not adjust to this dramatic change. I used my CPAP machine the night before to prevent me from stopping breathing, but it was not enough. The only cure for altitude sickness is to go to a lower altitude as quickly as possible. Dee had already cancelled our room at the rim for the

Sedona Arizona where I recovered from altitude sickness.

Gorgeous red rocks of Sedona, Arizona where I recovered from altitude sickness.

Sedona Arizona where I recovered from altitude sickness.

next two nights. We quickly climbed into the car and Dee began driving us to Sedona, Arizona which is only at 4300 feet in altitude. Initially I was short of breath without the oxygen, but as we winded our way down the curvy road through the beautiful red rocks, I began to breathe more easily. By the time we arrived at our hotel in picturesque Sedona, I was so relieved to feel normal again! We enjoyed a lovely dinner that night at one of the many restaurants there. The hot apple pie sure hit the spot.

How I thank the Lord for the excellent rapid medical care I received at the Grand Canyon clinic, from the ambulance staff, and the staff at the Flagstaff hospital. I also thank the Lord for the peace He gave me in the midst of feeling so poorly from the lack of oxygen.

He shall call upon Me, and I will answer him. I will be with him in trouble; I will deliver him, and honor him. Psalm 91:15

We enjoyed seeing the sights in Sedona over the next few days, and then I attended a two day violin seminar which was the original reason I chose this time of year to come West. I met another lady at the seminar who was a professional violinist in our local symphony. When I returned to New England, she became my new violin teacher!

Reflection

After I returned home, I did some research on altitude sickness. The experts advise sleeping at lower altitudes, going up high during the day, and then returning to the lower altitude. In retrospect, I should have acclimated in Sedona for a few days, made a day trip to the rim, and then returned to Sedona at night. But I will always have trouble with altitude because of my sleep apnea.

Later that year, I attended a medical seminar and met two Nurse Practitioners from Colorado. I asked if they had any suggestions to prevent altitude sickness? They said to take ibuprofen an hour before going up high, and every four hours while up high. It is a  non-steroidal anti-inflammatory medication and decreases swelling in the lungs.

So in May, 2011, I tried it out in the White Mountains of New Hampshire. I took ibuprofen and then took the ski lift to 4000 feet at the top of Cannon Mountain. I strolled around for an hour and felt fine. I came back down and drove to Mount Washington. I enjoyed the van ride to the top where it was cool and windy at 6300 feet. I stayed 30 minutes and caught all the views and then rode back down. I was elated that I felt fine, so now I know that ibuprofen helps me short term.

Altitude 6288 ft at Mt. Washington, New Hampshire

Altitude of 6288 ft at Mt. Washington, New Hampshire

mtwashingtonsummit view

When I flew to Ecuador two years ago, I had to carefully plan my flight so I didn’t land in Quito (10,000 ft) or La Paz, Bolivia (13,000 ft). I flew through El Salvador and landed on the coast in Guayaquil. I also had to forego seeing Cuenca, Ecuador in the Andes Mountains because it is at 8000 feet. So I am even more thankful now that I rafted through the Grand Canyon while in my thirties before I developed sleep apnea and needed electricity to run my CPAP machine!

The Grand Canyon – from the Bottom – Part I

The Grand Canyon – from the Bottom – Part I

May, 1993

A couple years ago when I went white water rafting with some friends in the mountains of the state of Washington, I fell overboard and nearly drowned when I was caught in a whirlpool. Even though I am an excellent swimmer and was a lifeguard when I was in high school, it was a terrifying experience to feel helpless in the grip of the powerful water.

After much research, I decided to spend a week rafting on the Colorado River rafting through the Grand Canyon to overcome my fear. It is also one of the most beautiful sites in the world, so I figured now is the time to do it before I become any older.

aerial view

Flying into the Canyon in the small plane

I used to do primitive camping when I was a Girl Scout growing up, but haven’t done any in years. One of the men at church went on this rafting trip a few years ago, so he let me borrow his “solar shower”. It’s a two gallon clear plastic bag with a hose and clamp on the end. Since the river is a chilly 50 degrees, you fill up the bag with river water in the morning and throw it on top of the baggage on the raft to be warmed by the sun during the day. When you pull over at night, you find someone to hold the bag over you while you take a quick shower with the warmer water while standing in your swimsuit in the river.

The trip is six days long and all inclusive with a small plane flight from Las Vegas to the beginning of the trip at Lake Mead ending with a helicopter ride out at the end. There were enough of us to fill two large rafts including our four tour guides (a mother and son, and a married couple). After we stowed our things in water proof bags, donned our waterproof rain suit and life jacket and shoved off, the guide gave us the “bathroom orientation”. I’ll leave it to your imagination! They told us to drink lots of water so we wouldn’t become dehydrated. We were hot while in the sun and cool after being drenched by the rapids and when in the shade which continually shifted throughout the day.

loading raft

Loading the huge rafts

After a couple hours, we pulled over for the night and set up camp. The guides set up a couple small tents for us to change clothes in and put the porta potty at the end of a path. Then each person grabbed his duffle bag, sleeping bag, and picked out a place on the sand to sleep under the stars while the guides made us a delicious dinner. After eating, we washed our camp dishes in buckets as instructed. One of the guides brought out his guitar and sang us a few songs.

campsite at dusk

Campsite at dusk

chow line

Delicious chow line!

handwash demo

Washing hands in the designated buckets.

I’m afraid I drank too much water so that I was up all night trotting off to the women’s “pee tent”. I think I washed my electrolytes out and became very weak and dizzy. So after that, I added lots of salt to my food and didn’t drink so much water. I tend to have low blood pressure, so if it goes too low, I faint.

womens pee tent

The very familiar women’s “pee tent”

One day, I was chatting with Mary, one of the guides, and found out she is also a believer in Jesus Christ! We marveled at the beauty of the canyon which is the result of the flood recorded in Genesis. It was wonderful to share some Bible verses and pray together. That night as I lay in my sleeping bag gazing up at the stars, I started humming softly to the Lord,

Amazing grace, how sweet the sound, that saved a wretch like me! I once was lost, but now am found, Was blind, but now I see.

The next morning, Nicole, one of the ladies sleeping nearby, said she enjoyed hearing me hum the song and asked me to do it again that night!

The following days were very exciting when we went through the rapids while hanging on tightly. Thankfully, this time I didn’t go overboard! We got drenched several times a day and then the sun dried us off until the next rapids. We pulled over several times to hike, see waterfalls, and climb up for more of a view. I kept wishing I could stand on the rim and look down since you don’t get much of a view from the bottom looking up.

waterfall 4

Our guide fills our water bags at the falls with fresh clean mountain water.

waterfall 1

Pretty water falls

running the rapids 2 (1)

rapids run

Hang on tight!

post rapids

After being drenched in the exciting rapids!

blue water

Brilliant blue water!

helicoptered out

My helicopter flight out.

On the final day, I was the first to climb in the helicopter and fly out. It was an exciting five minute ride!

Reflection

I am thankful I went on this trip when I was in my thirties and didn’t wait any longer. It was a little more rugged than I anticipated between sleeping on the ground,  “showering” in the cold river, climbing up on to the three foot high rafts, and then jumping down several times a day. I enjoyed the rugged beauty of the Canyon, realizing it was the result of the worldwide flood recorded in Genesis.

If you have never read The Genesis Flood by Dr Henry Morris and Dr John Whitcomb, I highly recommend it. Here is the link for it from The Institute of Creation Research.  http://store.icr.org/The-Genesis-Flood-50th-Anniversary-Edition

And God remembered Noah, and every living thing, and all the cattle that was with him in the ark: and God made a wind to pass over the earth, and the waters subsided; The fountains also of the deep and the windows of heaven were stopped, and the rain from heaven was restrained; And the waters returned from off the earth continually: and after the end of the hundred and fifty days the waters were abated. Genesis 8:1-3

After I became a nurse practitioner, I learned there is such a thing called water intoxication from drinking too much water. I think I came close to that with my weakness and low blood pressure. It would have been difficult to get me out of the canyon if I would have fainted, so I thank God for His mercy to me. The next post, I will tell how I tried to see the Canyon from the rim with nearly disastrous results!

Throw That Carriage!

Autumn, 1968 – Ninth Grade

“Class, place your fingers on the keys under the paper towel and keep your eyes on the document holder on your left while you type. As soon as you hear the bell ring, that means the typewriter carriage is at the end of the line. Quickly place your hand on the carriage lever and throw the carriage to the right as quickly as possible. Immediately place your hand back on the keys by feel. Don’t look at your hands!” said my typing teacher.

So that is how I learned to type. At the end of the ninth grade, I had progressed to 60 words per minute during our daily timings. When I became a senior in high school, I took one semester of advanced typing for college and one semester of college bound shorthand. At the end of the typing semester, I had progressed to 100 words per minute.

Smith Corona Manual Typewriter like I used in College

Smith Corona Manual Typewriter like I used in College

I received some money for high school graduation and used $50 to buy a solid steel Smith-Corona manual typewriter in a steel carrying case. I think it weighed about 20 pounds! I used it all through college to type my papers since the college would not accept any handwritten papers. It was quite a chore to correct my mistakes before I handed in my paper to the professor. I usually chose erasable paper and an eraser pencil. Liquid white-out or white-out papers were other options. Then after I erased the mistake, it was a challenge to roll the paper around the cylinder and align the paper perfectly in the typewriter to type the correct letter. I also had to change the typewriter ribbon when it came to the end of the roll.

Summer, 1974

“…this we commanded you, that if any would not work, neither should he eat.” 

II Thessalonians 3:10

At the end of my freshman year of college, I asked my parents if I could remain on campus for the summer because I was enjoying attending the Bible church so much. They said I could remain if I could figure out a way to support myself to pay for rent and food. I went to my boss at the main library and asked if I could work full time during the summer, and she said “Yes!” I found a room at a rooming house a few blocks from campus for $50 per month where I shared a bathroom and kitchen with six other women. I rode my bicycle about one mile to the grocery store and loaded my food into my backpack to bring it home.

My job at the library was to type 3″ X 5″ cards of the title, author, and subject of new books and then file them in the huge card catalog alphabetically. It was the most boring job I ever had and the hours dragged. To make it more interesting, whenever I came across the name of a country in a title, I would start praying for the people of that country to receive Christ as their Savior and for the Christians there to be encouraged. The fellowship with the other believers that summer who also remained on campus was very uplifting and encouraging. I taught a Bible class weekly to Dee who was a new believer. The last week of the summer, Dee and I held a 5 day Bible club for the inner city children.

I kept a budget book and recorded that I earned $856.34 that summer, spent $547.34 and was able to save $309. I was thrilled to be able to support myself for the first time in my life with a little left over. Truly God always provides!

“But my God shall supply all your need according to His riches in glory by Christ Jesus.” Philippians 4:19

Main Library where I was a typist for the summer.

Main Library where I was a typist for the summer.

Reflection

My typing skills have continued to be very beneficial throughout my nursing career. From the manual typewriter, I progressed to an electric one. It was so much easier to strike the keys and no longer have to throw the carriage! Then I bought a word processor which allowed me to see four words at a time on a minuscule screen just before they were typed.

When I entered graduate school in 1994, I broke down and bought my first computer and took a course on how to use “Word” at an adult education class. I started asking people at church who are computer experts to explain things to me which I continue to do to this day! I thank the Lord for their kindness and patience with me….  I was able to type all my own papers in graduate school, including my thesis, rather than hire a typist as most grad students did.

In my current government nursing job, I am required to type all my progress notes into the patient’s electronic medical record. In the private sector, I had dictation, but I’m afraid the government is way behind. I pity my colleagues who have to use the “hunt and peck” one finger method to type. They work many hours of unpaid overtime to complete their notes. I am so thankful that I took those two typing courses in high school, and I would advise any young person to learn to type as fast as possible!

I recently spoke with Dee on the phone. It was a blessing to hear how she and her husband are serving the Lord among the Navajo Native Americans during their retirement years. I praise God that she has faithfully walked with the Lord all these years since we had that little Bible class together the summer of 1974.