First Day of Freedom

Yesterday was my last day of nursing school and today was my first day of...nothing. Oh yes, it was grand. So in honor of the first day of no nursing school, here are my five favorite nursing t-shirts from cafepress.com.

#5- Polyuria Rocks!
#4- Annie's in V-tach#3- Oh I wish I were a ninja...

#2- Florence Nightingale is my idol!
#1- My all time favorite

Reproductive Outsourcing

A few weeks ago, I happened to be flipping through the channels and for some reason settled on Oprah. The show was about infertility and the segment that happened to be on was on a very new kind of outsourcing: wombs. Apparently, as the cost of fertility treatments and surrogacy continues to rise in the West, more and more couples are turning to India for the answer. I already find surrogacy to be a dubious ethical practice and I was honestly even more repulsed at the thought of paying Indian women to do it for us. Obviously, it's difficult to find people and costs a lot here for a reason. And obviously the reason we're going to India is because it's cheaper and less regulated. Dubious to the second power. What bothered me the most, perhaps, was that Lisa Ling (who did the investigative work for Oprah) worked very hard to paint this practice as empowering to women every where. She talked about how it was women helping women with American women providing economic empowerment for Indian women and Indian women providing babies for American women. In my opinion, it boils down to Americans using their economic edge to exploit those who live in poverty to do something they probably never would otherwise do: rent their wombs. No women should ever have to be forced to rent her womb to provide food and education for her children.

After a little more research, I found out a few important things about surrogacy in India. The industry is worth $449 million in India. Surrogate mothers are typically paid $2500 with the total cost around $6000 in India in contrast with $15,000 in America plus about $30,000 in agency fees. What else makes India attractive? First, there is ready access to high quality health care in private hospitals at a low cost. Second, it has a high percentage of English speaking doctors. Third, India's laws favor what has been dubbed "reproductive tourism." Indian women sign away their rights to the baby as soon as it is delivered and up to 5 embryos can be implanted. (Much looser laws then say Great Britain). Finally, perhaps the most sinister reason of all, there are plenty of lower-middle class women willing to do it. The lure of earning $2500 in a country where the average per capita income is $500 and 35% live on $1 a day or less is just too much.

Despite the many ways that the media and industry try to spin this as a win-win situation, one surrogate mother summed it best when she said, "How else will us uneducated women earn this kind of money, without doing anything immoral?" Other aspects to consider are that Indian women have fewer rights and are often forced to do the bidding of their husbands and in-laws. The potential for women to be forced into surrogacy is great. It cannot be assured that the money made will go toward the education of that woman's children or the betterment of her living situation, as so many claim. There is also tremendous social stigma. One couple interviewed for an article in the Christian Science Monitor moved to a different town in order to avoid becoming social pariahs after the delivery. An article from the Asia Times Online pointed out that in addition to turning to India to answer out customer service calls, the West is now turning to them to have our babies.

As infertility continues to grow, so do ways to get that all important baby. Money is being thrown around desperately. Anytime there is desperation and money to be had, it reeks of corruption. Now that corruption has the potential to be spread to other people around the world. This practice raises so many ethical questions, I can't even begin to wrap my mind around them. A few examples: what if too many fetuses implant and the woman is unwilling to abort and the biological parents are unwilling to take the additional children? who takes the child if the couple is unable or unwilling to do so, such as in the event of death or divorce (which has happened 65 times in the history of surrogacy in contrast to the surrogate trying to keep the baby only 20 times)? who is spared if there is a condition where only mother or baby can be saved? Obviously, all these situations favor the biological parents because well, they're paying good money for the baby and the women is just another poor Indian. While some may be motivated at least in part by altruism, the motivating factor here is clearly financial. No one should have to sell or rent their body to provide a decent lifestyle for their family. How can we be so selfish and short-sighted? Children are important and special, but at what price? There are already so many children in this world without people to love them, so do we really need to go to such great expense and risk just to have our own biological offspring? Renting your womb is not exactly like micro loans here people. Get a grip.

First Philly

Friday was a very successful day for me! I got a job offer (I'll give more details once it's official) and Kim and I signed the lease on our new apartment. It's official! We're beginning our lives in Philly! Click the picture below to enjoy the photos of our new apartment.

New Apartment

I Think She's Commenting on the Weather

Overheard at the hospital today.

Nurse: I think that Al Gore is on to something.

The Many Countdowns

This update is, as everything has been lately, sadly tardy. Much has been happening lately! I thought I'd give you a little picture of the things I'm looking forward to in the near future.

1) 5 days till my first nursing job interview at Thomas Jefferson University Hospital
2) 9 days till my last day of nursing school!!
3) 11 days till Kim and I sign the lease on our new apartment in Philadelphia
4) 24 days till commencement activities a.k.a. freedom from Seton Hall
5) 30 days till I am completely and officially moved out of my present apartment :(

As you can see the next month is rather busy indeed. Since I missed posting this when it happened, I'll give you the update on the new apartment in Philly, because that's really the most interesting thing anyway.

On Friday October 12th I had the day off from class for "Fall Break." Whoot, one whole day. Despite what looked like a pitiful showing on Craigslist, Kim and I decided to schedule some appointments to go look at apartments in Philadelphia. We managed to schedule to see 6 apartments in various locations though out the city. The one with the most promise by far was one in Old City. But we'll get there. So we drove into Philly for out first showing at 9:30am. The apartment was ok but a loft and small and in Chinatown which smells. The next apartment we saw the old guy was randomly mean to us and the kitchen was from the 70's. Really. The next apartment was a bargain price and was actually a little better then we expected but by no means what we were looking for. The next apartment was the one in Old City.

It's over a fabulous used book store and just blocks from the major Old City attractions (think Independence Hall, Liberty Bell, Betsy Ross House, etc.). The location is more fabulous then we ever thought we could afford. The first apartment we looked at was a nice size, had hardwood floors, but one bedroom was significantly smaller and had no windows. Bummer. Then the landlord mentions that there is actually another apartment and he just find out the guys deposit check bounced, so why don't we take a look? We agree and trot upstairs. This apartment is bi-level. Dream come true. It has a skylight and two big windows in the living area. The kitchen has a bar/pass-through into the living/dining area with cool pendent lighting that hands over it. The bathroom is large and has a lovely large mirror over the sink. The bedrooms are relatively equal in size with nice, equally large closets. And the rooms are not plain boxes but have interesting alcoves and angled walls as one might expect from a 200 year old building. There is a washer/dryer in the bathroom. The living area is on the top floor so neighbors cannot be upset about late night games of Wii tennis or DDR. Dogs are permitted and there is a nice fenced in park nearby to walk them. Each apartment has a 10x10 lockable storage closet in the basement. The only downside? The yucky navy blue industrial looking carpet. Oh well, we can buy area rugs. We leave the apartment, in love with both the building and the landlord.

We went to look at our last apartment and while it is perfectly fine, even nice, it just does not compare to the beautiful bi-level in size, amenities, location, or price. We immediately call the lovable landlord who e-mails us applications and after filling them out and dropping off our deposit, the apartment it being held for us. Unfortunately, the lovable landlord has given Mr. Slacker Bounced Check until 5:30pm to get his money in. We put our deposit in for either apartment with our first choice being the bi-level. Everything must be rushed because he is showing the apartment again at 6:30. We frantically exchange e-mails and calls until finally...we have the bi-level! Yay! The other apartment is also rented that evening. The following week we get e-mails saying that our applications (with the help of our parents as co-signers) have been approved and we can sign the lease November 1st. I am overwhelmed with excitement.

I'm helping Kim move the majority of her stuff in on Nov. 3rd. Which is also the day she takes her math GRE. Will someone else please tell her how crazy this is? I will probably be gradually moving my stuff in starting then with the majority being moved on Nov. 17th. Anyone in the area is more then welcome to lend a hand!

One of the most exciting parts of our new apartment is the fabulous location! Every month Old City hosts First Friday which is an open house for the many art galleries in the area. Music, wine, and cheese abound and with at least 2 art galleries on our block, it's sure to be hopping. It's also conveniently on our move in day this month! What a way to be welcomed into the neighborhood. According to Lonely Planet, Old City also has the densest concentration of liquor licenses anywhere in the U.S. besides New Orleans. See, you really do want to come help us move.

Some Deep Thoughts

Happy Fall! Things have been a little hectic lately, but I'll start with the good news. I passed my comprehensive exam in the 99th percentile! That means that I can in fact graduate in 27 days. It also makes it very tempting not to study any more. Now that this test is finished, I've been doing a lot of thinking and reflecting on the last few weeks. I get pretty fired up about a lot of things. I'm a notorious ranter. Hey, that's why I have a blog. But recently it's gone beyond just rants.

As I handle progressively more acute patients, I often find my head spinning. There is so much wrong in our health care system. Staff are over-worked and unable to perform some of the most basic, important things that every student learns (like checking medication orders). Nurses spend less time at the bedside, providing direct care and more time supervising, charting, and giving medications. It breaks my heart to see the way some people are treated in the hospital. There is no one to blame though. It's not as though the staff sit and around the nurse's station and polish their nails. Every one's working as hard as they can, but you just can't do everything. Health care in our country is politically motivated, it's financially motivated, it's so far from ideal it sometimes hurts me.

On the other hand, there are my classmates, the future shining stars of nursing. I don't want to say too much, however, some seem to have a skewed view of what nursing is. As nurse, you do sometimes have to do things that are disgusting and you do have to do things that could pose a risk to your health. You always watch out for your own health first, however, we learn infection control in order to have a correct and appropriate understanding or infectious diseases and how to prevent them. But no matter what you do, if you choose health care as your profession there is the chance that you will be exposed. It's slight, but it's there. Every profession comes with its own job risks. The risk in nursing is largely to your health. Accept it or move on. No matter what one's view of nursing, whether it's a calling, a job, or a profession, we touch patients. It should be our goal, as human beings, to touch them and treat them in a way that is respectful and dignified. Sometimes, that requires me to change a diaper. Sometimes that requires me to ignore things like dirt, flaking skin, or bad breath. But I do it because that human being I am treating has a right to dignity and compassion. I try to treat every patient like I would want to be treated in their situation, or like I would want my family and friends to be treated. Sometimes that means challenging my patient or encouraging them to do something they don't want to, but it is always with their best interest in mind. I question that motivation in some of my classmates. When we fail to see the humanity in the people that we encounter, we commit the greatest injustice of all.

My recent patients have also been challenging my beliefs about euthanasia and in some ways the very meaning of life. It is so hard to see the value in preserving a heavily medicated, slowly deteriorating life. I almost hate to admit that I ever had such thoughts. I know that every human life has value, that no life is a mistake, and that there is a purpose to everything. It's so hard to watch some one's life break down. To see someone who was once a vibrant person become a completely dependent, helpless thing. To literally watch someone slowly, pitifully, helplessly march to their death all the while expending energy and resources to prevent their body from shutting down becomes so exhausting. I cannot imagine the physical and mental anguish. You don't have to walk a mile in those shoes to know that they just don't want to walk anymore. But for whatever reason or whatever circumstances, I have to do everything in my power to prolong that walk, to slow the march, and, in many ways, slowly torture them. I'm just not sure I can keep doing it. I know I have to and while I think euthanasia is a slippery slope, I wish that we were more willing to challenge families and doctors and institutes that prolong what is inevitable. In the last 10 months I have faced more death then ever in my life and while it is so hard and so painful, it is something we must accept. We can make it comfortable and dignified or we can make it long and painful. Why do we keep insisting on the latter?

Whatever the current climate in health care is and whatever my classmates may due, I am so glad that I know where I want to be and that I can keep challenging the status quo. The only thing scarier then facing these thoughts is reaching the point of acceptance and tolerance of the way things are.