So I went into a PhD program this semester, and through a combination of luck and skill and the kindness of strangers was awarded a fellowship, funded by the NIH, to train as a life course scientist. Basically, they are paying me to be smart and work hard and it’s awesome.

It’s also quite a challenge. I’m taking roughly double the load most graduate schools consider full-time at this level, and driving 85 miles there and back for classes. Another instance of luck and the kindness of strangers has recently found me a place to stay near campus, so that I can drive up the night before and sometimes stay a couple days in a row and knock 3 hours of travel off my week. I feel exceptionally blessed.

I also feel about as stressed as I ever have been in my life, and that says a lot. Right after beginning the program, I started feeling a lot more negative, a lot more listless. Getting anything done (and I am the Queen of Getting Shit Done) became a challenge. People who love me started asking if I was depressed.


Depression is portrayed in the media as people who sit around, too worn out to get off the couch, with ratty hair and dirty, sad faces. They portray depression as listless weeping or angst or suicide attempts, but it isn’t always those things. Sometimes, it’s a subtle bastard that creeps up on you and sabotages your goals, your self-image, and your every waking thought. Sometimes it’s just a little distortion of the way you see the world, hard to notice.

I didn’t feel depressed, when my husband asked me if I was, but many of the symptoms were there. The negativity, the lack of energy, the absent sex drive, the avoidance of the things I once loved doing… I told myself it was just because I was busy and stressed, but the truth of the matter is, I’ve been busy and stressed through the best times of my life. I thrive on busy and stressed. And this time, I wasn’t thriving.

I was depressed, and not because of the PhD program. I was also cold all the time, and my skin was papery dry. Even my nails turned brittle, and that’s when I realized what the problem was. I went to my doctor and got my thyroid checked. Lo and behold, it was low. I tested positive for the antibodies that signal Hashimoto’s Thyroiditis, an autoimmune disease that attacks the thyroid gland in the same way that the pancreas is destroyed in juvenile diabetes. Now I’m on the replacement therapy and am starting to find my energy and my balance again (well, I was before I came down with the flu last weekend anyway).

Since then, I’ve been asked to prepare two papers for publication in scientific journals, I’ve found some really interesting things from data collected in a research study I’m helping with related to sleep quality in pregnant women and the risk for giving birth too early, and I’ve spent a lot of time reconnecting with my son, who just turned 15 last week. All in all, not a bad haul.

Oh, and I finished the revision cycle on Hunters. It now stands at 120,000 words and I love it. It’s as close as I can get it to perfect, and I want it out the door. Meanwhile, I’ve picked up Red Wolf Mountain again, found a plot, and am working on turning it into a story I can be proud of.


So what have you guys been up to?

Posted in life, Miscellany, Nursing, writing | Tagged , , , , | 2 Comments

UPDATE: IST and My Not-So-Broken Heart

Over the years since I was first diagnosed with IST, I have received many, many well wishes and kindly comments from folks who have found themselves in the same boat. I’ve also been asked for a lot of advice. I wanted to provide a brief update on my own path with IST and my later additional diagnosis of POTS, and to put my best advice somewhere folks can find it.

A bit of background – IST (Inappropriate Sinus Tachycardia) is just a fast heart rate at inappropriate times. POTS (Postural Orthostatic Tachycardia) is a fast heart rate in response to changes in position – like going from sitting to standing. Generally speaking, POTS is ruled out before a diagnosis of IST is made, but not always. In my case, I continued to have a fast heart rate even when sleeping, so my physician skipping the tilt-table test that detects POTS. Turns out, this was a mistake, as I had both disorders and they were ganging up to make my daily life much more affected than is usual with IST alone.

Once the diagnosis of POTS was made, I was referred to Dr. Grubb, a renowned specialist in POTS treatment at the University of Toledo. Unfortunately, he had a 9 month long waiting list for new patients. Well, being a nurse (and thus, making a terrible patient), I decided to do some digging. I found articles by Dr. Grubb discussing his non-medical management of POTS. I took them to my cardiologist (who had admitted by this point that he was at a loss for how to help me) and together we put a plan in place. I went off all the medications, because I learned that the elevated heart rate is actually an attempt by my body to compensate for a separate issue, so reducing my heart rate without fixing the underlying problem was causing me even more problems with fatigue. It turns out that my body was compensating for a low blood volume by increasing my heart rate and increasing the muscle tension in my arteries, to keep my blood pressure normal.

To fix this, I started doing exercise to strengthen my calves and thighs with a tightly controlled regimen that involved gradually building stamina from a couple of minutes to over an hour of peddling while lying flat on my back to keep my POTS in check, and never letting my heart rate go over 130 while exercising. I also began drinking 3-4L of water a day and eating a VERY high salt diet. Now, as I’m not the sort to put salt on anything, this was actually pretty difficult for me. I was expected to eat 4-11grams of salt a day (which is 2-4 times higher than the average American high-sodium diet). I usually managed 3-4grams, but eventually I started seeing the results of increasing my blood volume.  I also pursued a mindfulness about my body that I had never had before, learning and respecting my body’s limits despite my desire to overdo it. Over time, my heart rate decreased, my exercise tolerance increased, and eventually I was able to return to work as a nurse. It took me over a year to completely recover from the year of disability I suffered before trying out the high-salt diet, exercise, and body-mindfulness management plan I created, and I never got to see Dr. Grubb because the solutions I learned from him in the literature corrected my condition before I ever made it off the wait-list.

Today, I am pursing my PhD in nursing science at The Ohio State University under a National Institutes of Health-sponsored training grant for promising scientists, which would not have remotely been possible if my condition had continued to languish in the land of beta blockers and ablations. With no medication and no ablation, my resting heart rate is in the mid-70’s, and while I still occasionally experience a pounding heart and the rapid rates of old, I am competent at managing the symptoms and the underlying causes.

All that said, PLEASE do not try to copy my success without the advice of a physician. Even though I found my own solution, I stayed in close touch with my cardiologist and did nothing without his agreement. If your cardiologist isn’t willing to listen or shrugs your concerns aside, as several of mine did, find a new doctor. If all else fails, request a referral and get on the list for Dr. Grubb, who really does know his stuff, if his publication record is any indication.

My best advice for you is this: if you have a person in your life who knows how to research the medical and nursing literature for a condition like this, enlist them as your advocate and constant companion in medical situations, if you can. For what it’s worth, the cardiologist who eventually did test me for POTS misinterpreted the test as negative initially, and only my own knowledge of the diagnostic criteria made him reconsider and recognize that I did in fact have the condition, as there are two different forms, and I have the rarer variety.

Finally, I completely understand the desperation that this sort of rare and debilitating condition produces, but please don’t fall prey to “miracle cures.” The methods I utilized were not pseudoscience nonsense involving crystals and magnets and energy fields. They were evidence-based treatments described in medical literature that was produced by a recognized expert in the very narrow field of POTS and IST research. They also required no money other than the purchase of a free-standing exercise peddler ($56 on Amazon).

Posted in Broken Heart | 8 Comments

Countdown to BSN


That’s how long I’ve got to finish up everything for my Bachelor’s of Science in Nursing.

The list of things to do by then:

Major assignments:

  • CLAS assignment (2-3 pages, single-spaced, referenced)
  • Human Relations Final Paper (4-5 pages, single-spaced)
  • Scheduling Paper (2-5 pages, referenced)
  • Patient Advocacy Letter (2 pages, single-spaced)
  • Indirect Clinical Project Final Paper (5 pages, abstract, referenced)
  • Cultural Assessment Paper (4-5 pages, referenced, plus interview)
  • Case Study assignment (2-4 pages, referenced)
  • Final essay exam for Nursing Leadership
Discussion Boards (these are 1-2 page essays on a topic with references, followed by 1/2 to 1 page responses to 2 other essays)
  • CLAS & Hatian Americans
  • Civil Rights Amendement and Health Care
  • Current Issues in Health Care
  • Indirect Clinical Project discussion
  • Nursing Management + interview
  • Sigma Theta Tau
  • Health Care Disparities

In addition, I have roughly 15 12 10 4 chapters of dense textbook reading to finish between now and then. It’s an insane course load, and I still have work, 15 10 hours of indirect clinical experience, and a meeting with a professor from my proposed PhD program to go between now and Done-Day.

And this is how long until my actual commencement ceremony. I’m walking because my mom, who is 76 years old and suffering from Alzheimer’s disease, wants me to. She even bought a dress *gasp*.


I’ll update this with progress as I go along.

Wish me luck, ’cause I’mma gonna need it.

Posted in life, Nursing, School | Leave a comment

Empathy and Authenticity

I work in an environment where people fear for the lives of their children. 

Needless to say, a job where people genuinely (and sometimes rightly) are afraid for the lives and well-being of their children, can sometimes be emotionally exhausting. It also allows me to see the full spectrum of human response to situations of unparalleled intensity. As you might imagine, that can come in handy when writing fiction, and since it might also come in handy for the three people who read this blog, I’m going to share a detail-stripped, time-aged story about a young mother.


I worked a night shift a while back, starting at 7pm and ending sometime in the vicinity of 8am, during which a particular parent called me on the phone every three hours to yell at me about something. And I mean yelling. Angry, aggressive, and sometimes downright mean yelling, with not too subtle implications that I was stupid and bad at my job.  

This is not the woman in question. No hair was harmed in the making of this story.

The thing she was yelling about? Her premie wasn’t strong enough to eat all his formula by bottle. In other words, it was nothing anybody (including the baby, me, the doctors, or the mom) had a lick of control over. Premies are small and weak, without the musculature and stamina they need to complete complicated tasks like eating. It just takes time, and there’s nothing to be done about it but have a little patience and keep on doing the things that will support the baby to get stronger.

Now, I could have taken her comments personally, gotten angry, acted passive aggressively, or used my authority to have her put into a position of trouble. Instead, I chose to empathize with her. To realize that she was still a child herself, with few coping skills, no support system, and little experience with the world. To understand that she was anxious about her child and that his failure to eat was making her feel like an incompetent mother, which likely compounded feelings of guilt that she didn’t carry him to term to start with. In other words, I chose to care about her and her situation. 


My writing pals often say to me that their characters do things that don’t make sense, or that they react in unexpected ways. This, I believe, is an expression of creativity. It is also a symptom of our unconscious understanding that people are much, much more complex than their actions may reveal on the surface. Motivation is an underlying process that drives our actions and character actions, but it helps to remember that not every motivation is going to be transparent to the other characters. What looks to one person like a display of anger might actually be an expression of fear. It isn’t logical, but it is authentic.

People misinterpret each other’s motivations and goals all the damned time.

Really. It’s a wonder we accomplish anything.

This is one of those things I try to remember when writing, because characters who always guess right about each other, or who display too much empathy (or too little) come off as authorial insertions. They seem to dance to strings rather than genuine motivations. On the other hand, creating that sense of empathy within a reader is the foundation for emotional connection. This is why motivation must be crystal clear to the author, so that we can share it with the reader. Empathy is what makes us care about the characters and the story. As with most of the emotions in a really well written story, this is a battle for the subtext, but it is one well worth fighting, in my (not so) humble opine.

How do you create empathy for your characters among readers, while still making them authentic?

Posted in Nursing, writing | Tagged , , , , | Leave a comment

Loci, not Loki

I’ve been reading a lot lately about a psychological phenomenon called locus of control. Locus of control is a term that indicates where you, consciously or unconsciously, think the control over your life originates. This simple characteristic can have profound effects on a person’s behavior.

Someone with an external locus of control might not get a breast exam because they figure they’ll get cancer if they’re meant to, because their lives are controlled by destiny, fate, genetics, or God. This allows them to abdicate responsibility for their decisions, to just throw their hands in the air and mutter rather than doing things to help themselves. Meanwhile the untreated cancer grows to the point of being incurable, rather than being detected and treated early, and the person is left to ask “Why me, God?”

Someone with an internal locus of control might feel guilty for things going wrong, even if the cause was genuinely outside of their control – someone else’s bad behavior, the weather, an unavoidable accident, etc.. A lot of people in the extreme end of this locus end up being chronic victims, martyrs who flog themselves for every bit of wrong in the world, as if they are personally responsible for the state of North Korea or the Middle East.

At the extremes, both of these loci have their own benefits and pitfalls, though the external locus of control tends to end in more serious consequences. Most people, I think, fall somewhere in between. The trick, I guess, is to maintain balance. Few events in life are completely outside our control, but some absolutely are. 
In fiction, few things frustrate a reader than feeling that the protagonist is abdicating control of his or her life to fate, chance, or luck. Still, without an element of divine (or antagonistic) intervention, you end up with the infallible Mary Sue. Like most things in life, locus of control requires a deft hand and a fine sense of balance.

Who controls your life? Who do your characters tend to think controls theirs? How do you maintain balance?

Posted in MuseMed, writing | Leave a comment