My work schedule is pretty great-- I work Tuesdays, Thursdays, and Fridays. So Monday off helps to ease into the week, and Wednesday off helps to break up the "work week." It's pretty awesome. Can't complain. More about the actual work in a bit. But this morning, seeing the second snowfall in the past week coming down and highs expected only in the teens, I decided I probably wouldn't be going out for the day. Over a hot cocoa and toast breakfast, I settled in to read some local news on-line.
I grew up reading the Omaha World Herald-- it's the biggest paper in Nebraska, and we got it daily for most of my childhood. Claire and I were usually most interested in the "Living" section, particularly the comics. But as we matured we read other sections, too.
Aside from leafing through the paper at my grandparents when visiting, I haven't read the World Herald in years. This morning I was most struck by the stark contrast in tone from the manner the news is presented, but even the content of the news! from what we are used to. As if I didn't already know it, this just reaffirmed the dramatically different, conservative climate we now live in. It's surprising how different two areas of the country really can be. Here's two articles as prime examples:
http://www.omaha.com/news/nebraska/promote-meatless-monday-not-here-unl-says/article_ca6a4bb8-e044-5ad4-8c5b-57efeed8ac82.html
--(apparently, because "livelihoods are at stake," we cannot talk about the environment or our health here…)
http://www.omaha.com/news/legislature/i-think-we-just-recognized-gay-marriage-lawmaker-says-after/article_ec438da2-9d0f-54ff-a8cc-9491e4564730.html
--(as several commenters noted, how interesting that NE lawmakers find it more comfortable to acknowledge same-sex rights through gun possession rather than marriage)
And speaking of the climate… because that's what everyone's talking about here, the Midwest has been dumped on with snow. Saturday through Sunday we got about 8 inches of snow. It was a very pretty, wet, heavy snow which caused several school closings. Jon and Estrella both were fascinated with the snowfall, as it was the most significant snow they'd ever seen. Jon also got in on his first snow shoveling experience! Later, doing the boy-playing-in-snow thing driving/ sliding around the neighborhood in 4WD, he observed, "Now I see why most people are out with their snow blowers!" I'm not that used to driving in snow in my little car, either, so I was grateful to head to work on a day when most roads were plowed. Today again many schools are closed due to the new snowfall, and again conveniently and cozily, I get to sit inside and watch.
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| View from our front door on Sunday-- you can barely see my car in the driveway! |
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| These daffodils I dug up from our garden in Petaluma, as they were just starting to put forth sprouts in December. I brought them in a pot, anticipating they might bring needed brightness to our home in wintertime Nebraska. The first bloomed the day it started snowing! View from our kitchen window to the backyard (see the trellis from our wedding?) |
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| Estrella watching the snow, fascinated |
And speaking of work! So I've now been orienting for about 2 weeks. It's been a nice, slow orientation process-- as in, yesterday was the first day I saw patients on my own. And I'll still be shadowing patients at the other location at the end of this week! Tuesdays and Thursdays I am at Community Alliance, a wonderful organization which provides mostly social services for adults with mental illness. They have departments for homeless services, acute needs clients (those who have required significant inpatient stabilization), their own residential apartment units, and most significantly day programs. Every day during the week they serve breakfast and lunch, with an extensive schedule for groups (which of course warms my heart, as groups are where it's at!! no matter what the population, from "Group" in Residency to shared medical visits in clinic, the sharing of mutual experience is where we gain our sense of community and shed social isolation). Every hour there are 4-5 group offerings, with such diverse themes as "Understanding Your Diagnosis," "Art & Poetry," "Trust 101," "Science," "What's Up, Doc?" and, one of my favorites, "In Your Dreams." I sat in on "Schizophrenia & Schizoaffective Disorder," where they were finishing up on discussing delusions and moving on to hallucinations, and the next day "Attitudes of Hope," where the topic of the day was "using humor in times of darkness." The last half of that group was everyone sharing jokes which was, as you can imagine, in itself darkly humorous. It was great. I loved it.
Community Alliance: http://www.community-alliance.org
So Community Alliance (CA) is full of amazing people who have been drawn to do amazing work. And tucked to the right, just past the front door, is our little clinic. Two years ago CA received a grant to fund a primary care clinic for their client population. While all of their clients have a psychiatrist (it's a requirement for the program), few had regular primary care. Recognizing the need to help with out of control hypertension, diabetes, and so much more, the clinic was born. They approached One World, the community health center which is my actual employer, to fill this need. I've been brought in as an MD, as prior it was only staffed by an NP. When I am there I am the only primary care provider, surrounded by support staff: an MA, RN, 3 health navigators, a wellness coordinator, the program director AND a full time psychiatrist. Six patients per half day is the max scheduled. While granted there are more complexities in helping with this population, with such an army of support, it feels amazing. The patients aren't so different from those we all have seen in community health centers.
One World: http://www.oneworldomaha.org
I work at One World on Fridays. I'll start out prior to maternity leave with a full day of regular clinic, and on my return do half a day regular clinic and half a day of acupuncture. I'm anticipating this may expand to a full day-- if demand/ referrals are what they should be. One World is indeed impressive in their mission and what they offer. Fully dedicated to improving health in their community, the largely Latino South Omaha, they operate three low-cost housing units (one for adults, two for seniors) and, my favorite, own the Community Learning Center, which among other programs provides low-cost ESL classes with free childcare. They've expanded to several new sites in the past decade in West Omaha, 4 schools, and are now discussing rural sites.
The clinic environment is… well, it seems a lot like any community health center. Fortunately or unfortunately. Chaotic, rushed, but with friendly staff all around to help. Instead of Vocera they use Walkie Talkies (a bit humorous) between patients to communicate their patient's needs prior to moving to the next. The EMR here is NextGen which has left me really missing ECW and all of the work Danielle Oryn did to make it user friendly and streamlined (e.g. there is nowhere to free text PMHx or Social Hx. I can't see meds on the main screen, but must go to a different module to order meds, then enter again if I want that to show up in my note. No templates! No stored physical exam findings! And the screen is all black, white, and blue).
And, having shadowed 3 physicians there with very different styles, there is a consistent use of medication for this, that, and everything. Which is not that different from the entire country's health system mode of operation, but… it only takes a few times to see someone on adderall, valium, risperidone, and morphine to get an idea of what is (and is not) happening here. I'm sure I'll get used to things. And make my own way. Already I've had different staff members voice some sort of excitement that I do acupuncture and "holistic medicine." I had a patient yesterday at Community Alliance who'd gotten herself off all psych meds and was doing great (seeing on her own that the depression diagnosis and meds that started at 15yo were more the result of the trauma she'd experienced than a chemical imbalance) who said, very hesitantly when I asked about her diet, "Um… I do paleo?" As if I wouldn't recognize it or would ridicule it.
And then I have to laugh at myself a bit, comparing these experiences to my friend Nicki's experiences in Rwanda as she works to establish an ER residency program there (she has a blog, too, where I partially got the idea!). These cultural differences are minute compared to those she sees everyday.
And then… a little baby talk. Baby boy is kicking and growing. I had been freaking out or… we'll say "hyper focusing" on his position, as our first midwife appointment two weeks ago he was transverse. Reading online, especially the very detailed information on the website spinning babies.com, I started to get nervous about him not being head down by 32 weeks. So every night I was trying to check his position (w/ an anterior placenta, a little harder… and it's hard to be objective when it's your own belly and baby), and doing all these inversions and pelvic balancing exercises. Last night was our second midwife appointment, and I was happy to be reassured his head's in the right place. So. Yay. :) There's still apparently a lot of exercises I can do to help him not be OP, but maybe I can relax a little…
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| Estrella is such a sweet cat, cuddling up w/ my belly. (Don't fret, that IS a bio-dot mat you can sort-of see under my shirt, protecting baby from the computer's electromagnetic frequencies!! :) |
Now I'm going to go bundle up like I used to on wintry days on the farm, head outside, enjoy the crisp weather, and try my own hand at snow shoveling… it's been awhile for me, too!