My first week on the job

This has been a very busy first week.  I started my job at CVS Minute Clinic.  Monday was my first day working independently.  For those of you who don't know about  Minute Clinics, I will tell you what they are.  There are over 600 Minute Clinics in America. They are independent clinics set up to treat common primary care complaints.  They hire both NP's and PA's.  They are somewhat limited in their scope of practice.    They are great because if you are unable to get a sick appointment with your PCP, you can always go to the nearest minute clinic.  They were designed to fill in the healthcare gaps and provide access to people who can't find a PCP.

I felt that my judgement was good but I still needed to look a lot of things up which slowed me down.  I have decided that even though there is a lot of pressure to produce high numbers, it is more important for me as a new NP to take my time and do the job right and avoid making mistakes.  There were times when I looked in the waiting room only to see 10 people waiting to be seen.  I managed to see everyone.

On Monday, I saw 35 patients alone.  I did all of the insurance verifications, treated patients, gave flu shots, ordered supplies, kept the books and cleaned.  Needless to say, I was so tired after the 12 hour day.  I work 8-7pm plus travel time which makes for a long day.  I work 30-35 hours/week.  Most weeks, it is only 3 days.   I do like working with the public.  Most people are so grateful for any help you give them.  I would like to share some of the stories from this week and the people who touches my life.

There was an old man who came in for a second visit because he still wasn't feeling well.  After doing his history and PE exam, he confined in me that he had lost both his wife and grand-daughter in the past 2 weeks.  He began to cry.  I held his hand as I fought my own tears.  I could feel his pain.  After giving him a new script, I gave him a hug.  Sometimes just validating someone's pain is all they need.  It was apparent that this man who had been married for 50 years was facing grave loneliness and was so grief stricken.

Then there was the young woman who came in for throat hoarseness.  She was receiving treatment for breast cancer at the tender age of 32.  Unfortunately, I had to refer her out because her condition was not in the scope of practice within the Minute Clinic guidelines.  She told me her plight and I listened.  Fortunately there was a lull in the schedule, so I could give her extra time.  She was the mother of 5 children.

There was the elderly couple who had been married for 62 years coming into the clinic, arm and arm getting their seasonal flu shots.  When I asked how long they had been married, the husband pipes up and said, "62 years."  I asked, "What is your secret?"  His reply in a very serious tone, "You have to always put the other person and their needs first and lots of laughter." 

Then there was the grumpy middle aged man who demanded antibiotics for a sinus infection.  It is so funny that people will self diagnose and then demand what they want or think they need.  When I informed him that he did not have a sinus infection  and that he had an upper respiratory infection/ allergic rhinitis caused by his allergies he got mad.  I told him what the s/s of a sinus infection are.   As I tried to explain to him that giving antibiotics for a virus/allergies can cause more harm than good, he stormed away dissatisfied.  I realized at that moment that you can't always please everyone and unfortunately he will go somewhere else and the next provider he sees will end up giving him the unneeded antibiotic.

When I was a student, we talked about the pressure health care providers are under to dispense antibiotics.  In some ways it would be just easier, but most primary care complaints are caused by viruses and not bacterias.  We need to prevent antibiotic resistance and stop prescribing them unnecessarily.

There will more stories, more lives that will touch mine.  I just hope that my dedication to this work will persevere.  My family has been so supportive especially Mark who has picked up the slack at home on the days I work.  My girls are so lucky to have him for their dad.  I am blessed to have a wonderful family and to be able to do this great work.

 
Ricky at age 5.  He was the happiest little boy.  I was honored to be his mother.  How I miss him and his angelic soul.  I have faith that if I live a righteous life, I will see him again.  My heart still aches for him.  On September 2oth, It was the 13 anniversary of his death.  I can't believe I haven't seen him in 13 years.  That is too long not to see your child.  Losing a child is comparable to losing a piece of yourself.  If only God would have taken me instead.  He was too young.  He lived 8 short years.

The family at Mary's sweet 16 party.

My work as an NP

     When I was a little girl, I would  spend my days pretending that I was a doctor and that I was saving the world.  I owned my own toy stethoscope, thermometer and band aides.  I would pretend that my dolls were hurt.  I would try to make them feel better by putting bandages on their wounds and cool cloths on their fore heads.
     When I was 12 years old my maternal grandmother was diagnosed with a very aggressive form of lung cancer.  I was very close to her.  She was a second mother to me.  She cared for me in the summer while both of my parents worked.  She was my best friend.  She taught me so many things.  She taught me how to swim, bake, cook, clean, play the organ and play a mean game of scrabble.  She was an expert at doing crossword puzzles.  She was devoted to her family and was a career mom.  She stayed home and took good care of my grandfather, her children and her grandchildren.
     When she got sick, I watched her waste away to a mere 80 pounds.  In the early stages of the disease, I cared for her.  I would make her lunch, give her pills and did light house cleaning.  I was there for her every step of the way.  I was 121/2 when she died.  She only lasted 6 months.  My world was shattered.  Losing my mammie was my first taste of death.  The impact of her death had a lasting effect and her influence is still felt today.  You see my mammie was my first patient.  She was the first real life person I tried to make feel better.  The seed was planted.  My destiny was being staged.
     As I grew into adolescent, I became a little lost and discouraged.  I did not make the wisest choices and did not apply myself in school.  I was a smart kid but not the most motivated child.  My self esteem was pretty low as I did not think highly of myself until my junior year in high school.  I met a teacher who saw something in me, my true potential and he encouraged me to be and do anything I wanted to do.  That was a pivotal moment in my life because it was the first time a person outside of my family believed in me.  He taught me to believe in myself.   I did believe in myself enough to become the first college graduate in my family with both my undergraduate and graduate degrees.  My parents always encouraged me to get an education.  They saw the value and true importance of it.
     And then there was Ricky and Linsey.  My two eldest children who were born with a rare disease that shortened their life.  They were so precious, pure and happy.  I felt like I was in the presence of royalty from on high.  They were so Godlike.  I felt nearer to God when I was with them than I ever did before or since having them.   I would tease them and call then "your royal Heiness." They required so much care.  It was a 24 hour 7 day a week job.  It required getting up sometimes 4-5 times every night for years to turn them over, so they wouldn't get bed sores.  It required hundreds of trips to various medical appointments. It required wheelchairs, hospital beds, PT, OT, IEP's and handicap vans.  It was so much work and there were many sad days.  Days where I would just curl up in a ball and cry myself to sleep.  But I wouldn't trade any of those days in for a moment.  In fact, I would do anything just to have those fleeting moments back again.  I dream of just being able to get up for the 4th time, jumping into bed with Ricky,holding him and comforting him until he fell back asleep again.  I would love to hear their giggles and their laughter again.
     So, here I am 30 years later, a family nurse practitioner about to start to practice on my own.  For the past 3 years, I have been studying, reading and preparing for now. All of the hard work is paying off.  This past week in the clinic, we saw 24 patients.  We saw the very young and the very old.  We saw black, white, rich and poor.  All the while I couldn't help but to think of my Mammie, Ricky and Linsey who I was blessed to "try to make feel better" while they were in this life.  Being a nurse and caring for the sick is part of my destiny.  This is what God wanted me to do even in my infancy.  This has been confirmed to me over and over again in my life.  He sent me my grandmother, then my children and now countless others who I can't wait to make them feel a little better.

FNP

  APRN-BC

                                                               Mary and Linsey 2006

     20 years ago my SWEET LINSEY JEAN was born at the  Brockton Hospital, Brockton Massachusetts around noontime.  She was born crying and suffered from colic almost instantly.  Some babies develop that almost instantaneously.  She was a happy baby in between periods of colic but as long as one of her parents was holding her she was content.  At 9 months old, she started to have periods of normal development mingled with some apparent setbacks.  This is how we discovered that she suffered from an incurable brain disease called Leigh's disease.
     Leigh's disease is also considered a mitochondrial disease.  For all of you astute high school or college biology students you will remember that the mitochondria is the power house of the cell.  It is where energy metabolism takes place as well as the synthesis of ATP.  As a result of her body's inability to produce energy, her brain slowly deteriorated.  It was a slow progression which lasted 14 years.  She and her brother Ricky suffered the same rare fate.
     It has been 5 years since her death and I am still trying to make sense of it all.  Watching 2 of your children die is not only heart-wrenching but it put's one's whole faith and meaning of life into question. How could this have happened to our sweet children?  Why did God allow them to suffer such horrible, painful and slow deaths?  These were the questions I had and still have.  But, I have never ceased believing in my God.  I have felt his strength bare me up so many times.  I don't have all of the answers and some of the questions I have for God may never be answered in this life.  I just KNOW that having LInsey and Ricky led me to my career path in nursing and now as a Nurse Practitioner.  They were my greatest life teachers.  I learned from them about the true meaning of unconditional love, laughing at your own mistakes (They did a lot of laughing) and to give life everything you have by trying your absolute best.  Linsey and Ricky despite their physical limitations whether it was at home or school tried so hard at everything they were faced with and they did it with a smile on their face.  How many of us need to learn to smile adversity in the face and just keep trying.  Not a day goes by that I don't think of the both of them.  I feel them in the warm sunshine on a beautiful beach day or in the wind as I run through the fields.  Sometimes I imagine them running through the fields on either side of me yelling,"Go mom, faster, faster, you can do it."  I will do it.  I must do it.  I must carry on without them and keep them close to my heart and the life lessons they taught me.  I can still see their smiles.  Happy Birthday to  my LInsey Jean, the sweetest daughter a mom could ever have asked for.  Until we meet again my Cape Cod Queen, my hero.

Today I sent the girls off to their first day of school. Summer always goes by so fast.  It is a rainy day today.  Mary is excited to enter her junior year.  She had a pile of books and school supplies.  Elizabeth was full of enthusiasm and excitement.  They carefully picked out their outfits for their first day.  My mom and their grandmother each year brings the girls school shopping and out to dinner. It has been a nice tradition.  Last night after they came home from their shopping trip, they each tried on various outfits.  It was fun to watch.  I will miss them.  Their childhood seems to be fleeting before my eyes.  I am trying to enjoy each moment because I know one day the house will be too quiet without their laughter and little voices.  I cherish these school days.

Mary's first day of 11th grade. Elizabeth first day of 4th grade.

Summer of 2012

     September is here with her crisp mornings, dry air and brilliant blue skies.   Now that I have finished graduate school, I have more time to spend on writing updates for family and friends on the happenings, the comings and goings of the Rosbach Family.  Summer is just about over while Mary and Elizabeth anxiously prepare to start school on September 4, 2012.  Mary will be entering her junior year and from what we have heard is going to be academically intense.  Mary is returning to Falmouth Academy which is a small, private and very rigorous school.  She has already had a few captains soccer practices and is working on getting back into top shape.  She spent the summer working a part time job at the Holy Cow, where she spent her days scooping ice cream.  She went to the beach when she could and did a little running.  I encouraged her to continue to practice the classical guitar.  She manage to practice guitar while trying to fit in driving hours for driver's ed.  She will be going for her license in October.  I must confess this made me rather nervous.  Thinking about her behind the wheel terrifies me as a mother but I know that I must let her drive.  I have tried to give her as many experiences as possible behind the wheel.  She drove over the Bourne bridge which I survived. Mary has been a bit sad because her best friend Lydia moved to Italy for the school year and her other great friend went off to college.  I promised her that she would survive and make new friends.  She has been dating and doing well at choosing wisely.  Mary got to attend girl's camp with the teens from church in New Hampshire.  She had the great opportunity to go to Oregon on a white water rafting trip with her best friend Lydia who is now In Italy.  She enjoyed camping.  I must confess, I am not a great fan of camping.  I like day hikes, kayaking, canoeing and trail running but I hate sleeping on the ground.  My idea of a nice vacation is a resort on the beach anywhere, really.  I will camp because I know how much my husband and family like it.

Liz has been attached to both Mark and I all summer.  She and her dad took an awesome trip to the White Mts. where Liz make her first ascent and reached the summit of Mt. Washington.  She went to Whales Tale water park.  She did other lighter hikes and even received 2 pocket knives from her dad.  She played a little soccer with the travel team at the beginning of the summer, went to the library and has discovered comic books.  She does wear dresses and looks pretty on Sundays when we attend church.  This is the only day of the week that I can convince her to wear a dress.  She refuses any other day.  I will take what I can get at this point.  She enjoyed going to the beach and jumping off the dock at Megansett beach while spending time with some of her favorite classmates.  I tried to get her to practice the piano a little too.  Bot girls will resume their music lessons at the Cape Cod Conservatory in September.  One of the things LIz likes to do is bake.  She successfully and on her own made her first batch of chocolate chip cookies.  She wants to be a baker when she grows up.  She likes to watch the cake boss on TV.  However, when I think about Elizabeth with her big heart, I can see her in a human service field like nursing or medicine.

Mark and I went to Spain in July.  WE loved Spain, the people, their way of life especially siestas and meal time.  Mealtime in Spain is an event, an art not just something you do to get it over with.  They serve green olives with every meal which I loved.  We stayed in Madrid Hotel Ritz for 2 nights and took a tour of the palace of Madrid as well as the Cathedral.  The highlight for me was going to the Prado art museo.  It was spectacular.  We saw art by Rubin, Valasquez, Goya and many more.  The climate in Madrid was hot and dry.  Many people who lived there smoked a lot.  The people were very friendly and welcoming of us.  While we were there, we took a 30 minute train ride to Toledo which was the former Capital of Spain 500 years ago.  It was built in the 12 century.  When we arrived, I felt like we went back to that time period of history.  The city sits up on a hill with a huge cathedral on the top.  The city is surrounded by a wall and all of the narrow streets lead up to the cathedral.  It had a large central square, shops and small cafes.  The people of Toledo have a deep sense of tradition and many generations might live in the same home and own the same restaurant and businesses.  It was a must see.  

After we left Madrid, we took a 3 hour train ride to Valencia, yes Valencia oranges,  We met my friend from high school Cesar and his wife Ana who so graciously were our tour guides.. We went to their house in a town called El Saler which was a lovely gated orange tree farm with 2 properties situated on it.  One of the properties is owned by Ana and the other by her sister.  Ana and her siblings inherited the farm from their grandparents which is over 100 years old.  The oranges are ready for the picking in December and January.  They took us to a town about 2 hours south called Moraira.  This was a quaint seaside town with spanish villas perched in the hillsides.  Cesar's parents have a lovely home with views of the Mediterranean sea.  We stayed there for 2 nights, spent time on Cesar's dads' boat and swam in the sea.  It was simply beautiful.  The beaches there were lovely and the water was crystal clear and very salty.  We ate a lovely dinner with them which was served to us by their maid.  I loved that.  The Spanish hospitality was superb.  Everything was clean and neat.  Even the public bathrooms were clean.  While we were in Moraira we went to Altea, which was one of the most romantic places I have ever seen.  It was happily situated on a side of the cliff with a smaller cathedral on top of the hill overlooking the ocean.  It had whitewashed homes, narrow streets and you could hear the bells of the church ring every hour.  There was a man playing classical spanish guitar.  We ate at an outside cafe where we enjoyed seafood and tapas.  The unfortunate part about the trip was that I was stricken with an awful virus that  lingered all summer.  I still am not 100%.  

After leaving Moraira and saying goodbye to Cesar and his parents, we returned to Valencia and stayed in his house for 2 nights.  He took us to his yacht club which had a wonderful restaurant and pool.  He showed us his sail boat called the Amarillo.  Cesar loves to sail.  In the evening we wemt into the city of Valencia and he and Ana took us on a history tour.  What a clean and gorgeous city.  The next day we went to the central market of Valencia where we shopped for our lunch.  It was this huge market with individual stations where they sell fresh foods of all sorts.  They eat a lot fish and cured meats.  They serve bread and olives with every meal.  Ana and Cesar cooked us a delicious meal of tuna, salad, spanish omelets (one of our personal favorites).  I had a nice time in Ana's kitchen while I looked through some of her cookbooks.  Ana went to school to become a chef, so I enjoyed watching her in action with her various kitchen tools.  I love to cook too , so she showed me how to make her version of pesto.  It was a lot of fun.  Once we said goodbye to the Baronas, we boarded the train and headed for Barcelona.  

This was a huge and beautiful city.  We took a tour bus and we saw most of the city. We enjoyed the architecture by A. Gaudi.  We saw the Familia Sacrada, Geulle park and took a walk down the Ramblas. We saw the Cathedral of Barcelona and we ate at a seaside cafe.  I have never seen more beautiful people in my life.  It was the most diverse place I have ever been.  It is a cruise port which unloads people from all over the world everyday.  It was a more intimidating city than the other places we visited.  All in all, besides being sick the entire trip, we had a wonderful time.  I want to go back to Altea.  That was my favorite place.

I start my new job next week at the CVS minute clinic as a family NP.  It requires travel and some weekends but the pay and benefit package are excellent.  I  will work 3 10 hour days, which will give me days off during the week.  At this point in life this is ideal because I will be able to going to soccer and lacrosse games.  Most of the other jobs I applied for were 8-5 or 6pm 5 days a week.  I would have missed out on the games of my children and it didn't feel right.  CVS provided a more flexible schedule.  I am nervous but excited to get started.

Mark starts teaching tomorrow.  He is excited because he is teaching advanced science classes this year.  He has started trail running again and has been getting ready to play the bagpipes in the Highland games in NH.  He loves the bagpipes.  Sometimes I feel like they are the other woman.  

We feel blessed and love our family and friends.

Meeting my friend Cesar after 26 years at the train station

Moraira, Spain

Altea, Mi Amiga

With the Barona Family, Altea, Spain