There are very few things in my life that I get to see through to completion. I see patients come and then leave (in better shape than when they arrived), yes. But let's face it - closure is really hard to come by in my line of business. So, I've been experimenting with different "hobbies" if you will, to see what keeps my attention and what doesn't.

First off, I work out on a consistent basis and have discovered that it is most definitely a chore, not a hobby. I do love to knit, but often I find that too long of a commitment and I do (gasp) get a little tired of my projects toward the end. I enjoy reading, and it does fairly often bring closure, but it isn't a social activity. So, I have found baking to be my time (and tummy) filler of choice. And, yes, there is a difference between baking and cooking... at least for me. And I love baking & enjoying the finished product with my friends the very most.

For a while I was on a cake kick... tunnel of fudge cake, angel food with a citrus twist, almond and walnut cakes. Oh my, I am in love! It was earlier this summer that I decided I needed to turn this baking experiment into more of a project: a MN state fair themed project, if you will. The original plan was to perfect the sugar cookie and submit that to the state fair for judging, but that was so labor intensive and making a batch of sugar cookies is really an all day commitment. So, I decided on the pie baking category because, really, what says "State Fair" more than an apple pie?! You got it - nothing.

My mom has been so helpful in the research phase of this project - collecting recipes, finding food blogs, giving me resources that discuss everything from gluten chains in the flour to the importance of keeping the pH of your crust between a 5 and 6 (ps. baking is science, people!), etc etc. I paid extra attention to the tips on crust making, as I felt this would be my greatest challenge and decided to use a recipe from Cooks Illustrated for my first go round. And it was 97% perfect. The filling has some work to be done, and I'd like the crust to have more of a butter flavor (because I lalalove butter!!)... But, for a first timer, I was pretty thrilled with how it all baked out.

So, the plan for apple pie 2.0: more butter, softer apples, more balanced spices, and as always... maintain flakiness!! I'll let you know how it goes!

Minnesota nurses are but a few days away from making history... again.

Maybe all ignorance is somewhat purposeful, but I've really tried to avoid learning much about the upcoming strike (why? Oh, I really dislike confrontation). But, while I am not a member of the Minnesota Nurses Association, June 10 is going to be a really big day in nursing history & I do feel somewhat a part of it. For those who might be out of the political loop - as it relates to nursing anyway - let me give you an update: after a long spring of contract negotiations, 12,000 Minnesota nurses will be participating in a 24-hr strike as a way of "defending their patients and their practice".

I'm not really interested in touching on the complexities of this issue (feel free to see the MNA website if this really "strikes" your fancy), but I am interested in reconnecting with the philosophy of nursing. Because when people get all excited about the issues, I find myself becoming more introspective than usual.

This may come as a shock to many, but the fundamentals of nursing theory is not the first thing I think about when I get to work. At least not in the organized manner in which it is presented in Nursing 301. But theory drives our practice, whether or not we recognize it, and most of our theory is based on our personal values. And, as a large majority of nurses will tell you, above all nurses value their patients.

I could go on and on about what nursing means to me. But, let me share with you part of a letter the nurses at my hospital received from our Chief of Staff during Nurses Week...

"Despite the rise of technology medicine remains a highly personal endeavor. And it must be so. I think that an unspoken question exists in the mind of every parent, and every child, when they come to us for care. The question we hear center on the mechanics of medicine: Where do I park?, where do I register?, how long must I wait?, what will be done?, will it hurt, will it help? and so on. The unspoken question is: Will you care about me? The answer to that question determines the worth of everything that follows. ... our patients and families value the physical presence of those who provide care. They treasure it! It is how they measure whether we care about them. And who is more present than a nurse?"

The rising voices of contract nurses in the Twin Cities have challenged me. Why did I pick nursing? What values influence how I approach my career and my patients? How do I find a place in this healthcare system that seems to be overwhelmed by tasks, efficiency, quantifying people's emotions and that pesky bottom line?

How do we maintain our presence?

this brought me some comfort.

The Bath
By Laura Gilpin

I stand here bathing her
while she sleeps
in a far place beyond my reaching.

I bathe her
as I have been taught to do:
first the eyes, then the forehead,
the face, the neck.

And as I work
I talk to her--in case she hears me
(believing that hearing is the last to go).

I tell her--I don't know why
but I tell her the time, the day,
the season, what the weather is doing,

lifting each arm to wash and dry it,
laying it down again at her side,
then the chest, the abdomen, each leg.

She offers no resistance,
except that of gravity,
the earth pulling her
down while I lift,
as though something between us
is being weighed.

Then I turn her to wash her back
talking to her about what seems to matter
in this life--though I make no promises.

Only this morning
the promise of spring was in the air
and I tell her that.

Some nights I am inspired to cook. And, yes, it takes inspiration (which is more than a growling stomach). Tonight, I was not inspired but I had to make a dessert for work. Living in Minnesota, I have found, requires you to prepare things for potlucks every now and then...

So, being on dessert duty, I took my crisp, hardly used copy of "Homemade Cakes" off my kitchen self and proceeded to get very excited about a yogurt and fruit cake. Simple enough, less than 10 ingredient, most of which I already had. It was after I returned from the grocery store with vanilla yogurt that I started my necessary pep talk: "Ashlee, baking is like chemistry lab. This recipe has been proven to work. All you have to do is follow the directions & measure things carefully. It will be fine." Turns out baking and chemistry lab are a lot more similar than I thought - I'm not a natural at either.

After I started to realize (er, accept) that this attempt will likely end in failure, I decided to start following my intuition. Move the cake down a rack, set the timer for 5 more minutes... Nope still a failure. It's bubbling with heat, but not forming into a cake. My plan to teach myself to cook has turned into a waste of resources.

I think it is time for Plan B. I'm calling in sick.

As you read my last few blogs, it might become obvious that I haven't been very inspired lately. I don't know why I write when I'm not really clear on all my thoughts - probably with the anticipation that writing will help sort them out?

Regardless, today I am feel inspired. Inspired and a little heartbroken. In the wake of Brown's Senate win yesterday, and the subsequent blow to the Healthcare Reform initiative, I stand completely dumbfounded. I don't even feel the need to comment on how irresponsible it is to elect a one-issue politician OR how ignorant it is to disregard healthcare reform when we are all one bad car accident or cancer diagnosis away from reaching our lifetime limit on our insurance policies (a limitation that will be revoked under Insurance Reforms), so I won't. Instead I will talk about why I still support federal healthcare reform. Because I whole-heartedly do.

I volunteer at a free clinic and I have noticed a new wave of clients in the past year. They remind me a lot of my dad - hard working men who were very well established in their careers, only to be laid off two or three years before they are eligible for retirement. Under healthcare reform, insurance coverage would be expanded for early retirees. Not only will this benefit the individuals, but the companies and our workforce in general, by opening up positions or preventing lay offs.

The state of Minnesota has the best "medical loss ratio" in the country. A "medical loss" is the money insurance companies pay to healthcare providers (yes, they count doing what they are supposed to do as a loss). Minnesota's insurance companies are required by law to use at least 91% of what you pay them to then pay the providers. Other states in our country don't "lose" even 60%. That means the patient is paying 40% more for healthcare than it actually costs!!! Under healthcare reform, minimum medical-loss ratios would be established, thus decreasing the insurance companies profit off of disease and disability.

95-98% of Americans would be provided with coverage & children will be covered until age 27. I think that one speaks for itself... especially when you consider how many new college graduates are unable to find jobs, let alone jobs with benefits.

Pre-existing condition clauses prevent people who have been diagnosed with cancer, and then go into remission, from being covered if the cancer should return. Healthcare reform would eliminate this entirely.

Increased affordability, through the institution of non-profit co-ops and the expansion of Medicaid, could be in our future. Instead, our country is choosing to continue down a road where 80% of all bankruptcies filed are due to high and unavoidable healthcare costs. Most of which have been accumulated by privately insured individuals (also part of my "lifetime limits" point).

Sure, this will take awhile. Best case scenario, it is up and running in 2014. And, I understand the hesitation of investing in an initially very expensive program. That's why the billions this reform will save our country over the next 10 years is important to keep in mind (if you are on the more money-conscious side of the argument).

The worst part of healthcare reform is that hospitals will be seeing less reimbursement for services rendered. That is why many institutions (the smart ones anyway) are preparing for this by evaluating costs and looking to high efficiency industries to get pointers on eliminating waste, increasing efficiency and ensuring that the quality of care provided does not suffer. Providers may need to run cheaper and less invasive tests when a patient initially presents with a headache instead of immediately rushing them down to the MRI room. But, is that really a bad change?

There are so many reasons I support Federal Healthcare Reform and I've really tried to show how it is not just a "theory" but something that is happening to people. Please see this as a part of discussion - I'm aware of all the other sides that exist. I just wanted to say my peace (/piece) about this particular side. I hope it's helpful....

twenty five in twenty ten. has a nice ring to it, don't you think?

I have no idea what I should (want to) do with this year. I am tempted to make a resolution... my way of saying, "I have control!! I'm going to rock this year (instead of it rocking me... again)". Hm, not sure if that's actually how it works. But, how can decide to "roll with the tide" without sounding a bit apathetic about my life?

I am in a better place (whatever that means) this Jan 2 than I was last. Significantly better. There are reasons for this - mainly good decisions and a lot of love and support from my people. But, also I think a lot of this happiness has been sustained through a focus on my reaction to life rather than getting so distracted by the desire to control it. Because, as it turns out, control is quite impossible. And incredibly agonizing.

I am looking forward to discovering a new year... I have no idea what it holds, which is really exciting! Mostly because I know that I will be in good company, and that is all I need.

very merry.

Christmas at the hospital is hard to figure out. On one hand, there is some excitement. The night nurses take on some Santa-like qualities and distribute the gifts from our Child Life dept in the patient rooms, the popcorn tins and bags of chocolate bells pile high, and everyone (and I mean everyone) is wearing some outrageous combination of red and green. On the other hand, no one wants to be in the hospital on Christmas - staff or patients! Grief comes out at funny, unexpected times, but I think it is safe to say that Christmas is not really an unexpected time.

Holidays, by nature it seems, cause us to crave the securities in life. It seems as if humanity is especially in need of comfort & community during the holiday season. As it turns out, finding yourself in a very unfamiliar life experience is not comforting. And while the emotional needs of our patients run high, the desire to be at work runs low for the caretakers. It is an important inequality to realize, I think. Tragically ironic how the opportunities to really impact a person in a positive way happen to also be a time when I might not be "in the mood" for it. (For the record, I believe caretakers have to be in the right place to "be present". People who say they are ready to take on all the severe emotional needs of other people all the time are not very aware - or they have reached an incredible emotional maturity that I merely dream of. That's my opinion at least. The problem with that, I will admit, is that people don't always have time for you to get in the right emotional/spiritual place, but that's a topic for another blog).

Anyway, Christmas at the hospital is tricky. It's not a time that people want to outline in their holiday letters. But, it's not automatically a time that people will be inconsolable. I believe in the significance of faith & I am often in awe of how some are able to genuinely stand in the face of real tragedy and remain committed to things like life and love. I'm certain that there are always going to be times when you would have to fight for that kind of peace, though. The idea that peace washes over us is nice and probably true to some extent but, I also think there is some kind of battle involved - a reclaiming of the good and a rejection of all that enslaves us.

Redemption composes all that is good about Christmas, which by definition means there is something from which we need to be redeemed. No life is immune to grief - some grief will be manifested in small ways, other grief will take hold of us and never seems to release it's grip. No matter the experience, pain is always significant - but, may our spirits be moved to remain open to living in freedom and love.

Receive and give, my friends. Merry Christmas.