NYE Thoughts from my iPad

I forgot that on NYE you were suppose to contemplate the past year and make future plans. I guess I should start with what my goals where last year: Do well in school (done I think with the help of Autum and some awesome preceptors that are helping my future as a Nurse Practitioner), be there for my family; for the family I call my family done as well. I can honestly say that my TRUE Family has tough me many life lessons and given me the opportunity to be a SISTER and Daughter with the true meanings of those words understood and expected. I said I wanted to be involved and join the board for Cuidando Los Ninos, I did that and worked to be on the executive committee, which means a little more responsibility but lots of rewards through mentor-ship. Have an Art Gayla at the film festival to raise money for Cuidando (done with amazing rewards of seeing involved youth increase awareness about the faces of homelessness and receive the wonderful support of my friends. I also decided I would "put myself out there" and start dating again. I completed that and was in the Albuquerque Magazine "Hot Singles" issue. With that hurdle jumped I also started dating an amazing man. What was not on my list, and came as an amazing surprise. These include the new friendships I have made this year. Also my trip to NYC with Beau which gave me the opportunity to meet Stella, Olga and Genevieve from American Women Veterans, you ladies are inspiring. Also important to me are my DIY projects at my home. Thank you dear roof for leaking, and teaching me more about my responsibilities as a homeowner. One thing I also learned is that friendship is a word often thrown around, worked for or even miss-used. We can often say that someone is our friend, but to be a friend you have to be "present" and not in the physical sense but definitely in the emotional sense.  We have the advent of FB that truely makes it appear as though you have hundreds of friends. But I often wonder if I was at the same coffee shop would they say hello? Probably I would, becuase I love saying hello. But like many social outlets (FB), it at times become a tedious chore rather than a true expression of friendships. So at the end of this thought, I would like to say, I have amazing friends whom inspire me in different but amazing ways and many acquainceces who will either stay aquantences or evolve to friends. What are my goals for next year: 1. Graduate with my Master's in Nursieng as a Family Nurse Practitioner. 2. Work more for Cuidando Los Ninos in developing out program, gaining my grants and raise more funds. 3. I can't wait to help more Veterans 4. Work to start a AWV Chapter in NM 5. Start working as a FNP in a great learning environment. 6. Build Assets, and probably the most important one: 7. Continue to love and cherish my Family and Friends. I would like to thank them for their support over my lifetime, appreciate the lessons they teach me and for each of my friends be "present".

Being Present

I have always known that it is important for nurses to be present, or should I say in the present? Life it seems can pass you by and decisions can be made that may not seem to have a huge impact, however like the "butter fly effect" not being present can have unknown consequences and impacts to the health of your society.

As many know, I believe that we are all more than "just a nurse". Our hard work impacts health care and the various jobs that we have chosen to peruse and develop. These accomplishments are just the tip of the ice berg in terms of our success. I love being a nurse and I believe it is that perspective that gives me insight on even the most random of subjects. Take for instance the "employee handbook".

In addition to being a veteran, an ED nurse, a full time graduate student, sister, daughter, girlfriend and friend, I am a board member for a wonderful non-profit that seeks to help children and their families that are experiencing homelessness. Check out: Cuidando Los Niños if you want more information: http://clnkids.org/

I usually work on advocacy and out-reach, and serve as a "connector" (read http://www.gladwell.com/tippingpoint/tp_excerpt2.html ). I give the elevator speech and work to get donations, sponsors and anything else I can for Cuidando, but in addition to being aboard me member I serve on the Executive Committee. Our task from the interim Executive Director was to review the employee handbook.  So in-between triage classes, an advanced EKG workshop and case studies I sat pen in hand and poured over the handbook. 

I have yet to write an employee handbook, however I am skilled in "the joint commission" , "OSHA", "preventive medicine” as well as "infection control" "Evacuation plans and Fire Drills" (thank you OIF and OEF).

As I started to pour over each section I found myself actually having input on several areas: credentialing, performance evaluations, reimbursements, holiday schedules, PTO, leaves of absence, property books, dress codes, attendance and illness. Not too bad, if I do say so myself.

I also took the liberty to change some verbiage from physician to provider. Yes it may seem small in terms of grammatical ways, however it terms of the education I am about to complete (at least at my Master’s Level)and  it is important to me that an employee be able to see a mid-level provider (NP or PA) in addition to a physician.  

I clarified the emergency evacuation program, and to tip the entire butterfly effect off I asked for specific verbiage regarding employee health and vaccinations. Warning to all you who do not believe in vaccines I do (.) If we can prevent out breaks of pertussis and the flu (to name only a few) and save lives as well as prevent costly hospital stays, especially for children and infants (who when sick are not only high risk but incur potentially worse outcomes and health discrepancies) then not only will I take the Flu shot that I don’t like, but I will ensure my immunizations are up to date as well. (Wow that was a long run-on sentence…I will step off the box now…)

The thing is, in retrospect none of these items are huge by any means, however being present at the meeting, having that knowledge and insight is what is important. So to all my friends who are amazing nurses and think they are “just” anything, remember you  ARE Nurses and that is why they should always be present.

Windows

Windows can be the openings to your soul, or even just the space in which to let light reflect upon your heart. As of late I have traveled to various missions and Native American sites around New Mexico and Colorado and my mind has started to ponder. I spent my time enjoying some inner peace and reflecting upon the past. It made me think that all around us in life there are windows of opportunities.

I can remember as a little girl looking out the window of out small trailer and thinking of all the things I wanted to accomplish. The window served to inspire my dreams. I never had small dreams, or unattainable goals. In my dreams I wanted to help others, serve as a mentor and leader and ultimately one day move to a place where I could enjoy the calm breeze from the mountains. My window served as my inspiration, my dream builder, and my launching point for life.

A few weeks ago when I traveled to the Abo missions at the Salinas Pueblo Missions National Monument, I glimpsed at windows that over-looked tumbling hills. I sat and wondered if others used this window to look out and day dream. If I were at a mission as a Native American in 1629, what would I dream of? The sun good, the mother of life, of wild flowers and tumbling rain showers, possibly yes, but probably more.

The invention of windows can be linked to as early as the 13^th century and in various languages the word “window” has been described as the “wind eye”. I think that they were invented to open your inner soul, to allow for daydreams and to shed light on our hearts.

-m

The fear of suffering is worst than suffering itself (The Alchemist) Funny, but we fear many things in life. But, when we take action that fear can inspire us to do more. ♥

Sometimes you just need that solitary day to yourself for some inner reflection. Lately my plate has been so full that I have feared not accomplishing anything. But fear can be a funny thing. It can take hold of us and stop us from moving forward, or it can cause us to push farther and make plans for our next opportunities in life.

Last week was “The Faces of Homelessness” Donor Breakfast benefiting Cuidando Los Niños. I was anxious to make my guests feel comfortable and welcome, even fielding last minute invites form guests. I planned their seating arrangements and spent a few sleepless nights anxiously awaiting the breakfast event. Waking up early the morning of the event, I was ready and out the door eager to make sure everything was perfect. Fear of course stood next to me, waiting for me to get anxious and slip in with waited opportunity. I arrived, got the best gift ever (my name tag!) and found out that my planning was slightly lost as my seating arrangements were not perfect. I had a moment of impatient frustration: why not how I planned it? It took me only a moment to see that others had worked so hard, my need to perfection was seriously silly. I kicked fear in the shin and as it walked away from me I figured out that no matter what happened that morning, everything would work out.

The breakfast was wonderful, we had a articulate speaker Diana Sauceda and she kicked off our morning with style and grace. We heard life stories from two of our mothers, and an amazing video presentation about our children and families who work towards changing their homeless experience. My mom came and was able to see the organization I donate so much of my time for.  My friends all came to support Cuidando and that made me feel so proud of them. I didn’t see fear at the breakfast table; he must have decided to walk away.

I still have too many things on my plate. I do fear not getting everything accomplished: school work and case studies, clinical hours, and a very important Youth Creating Change Film Festival June 25^th, and of course some family events. I heard fear ringing my doorstep just now, ready to come hang out again, but I think I will use this time wisely and catch up on some projects to that I can hang out with my new friend: Wisdom 

Remember we are all more than JUST a nurse.

My birthday gift

Getting older actually does get easier. I honestly can say this year feels fabulous. I have celebrated all week, but last night I had a low key evening with a small group of friends. Everyone gave me amazing gifts. Mia drew me a picture (she's a talented pre-kindergarten gal) and then there is the wine, gift cards, and my favorite just spending time with amazing women who inspire me. Oh those beautiful qualities my friend (of over 23 years now OMG!) made a frame and a type of letter/reflection if you will. I can't stop thinking about it. I re-typed it so everyone can read it. Amazing Kellie. I love being a nurse, and I love that so many of us, help so many people everyday!

"My Angels on earth…

When my great grandmother was ailing and suffering from dementia and Alzheimer’s, it was a nurse who would come to the house and care for her, making her last few months on earth comfortable.

When my little sister was born with Down syndrome, it was a nurse who comforted my family after they rushed our new baby to the NICU.

When my brother was in the hospital after a tragic event, it was a nurse who reassured my family that he was going to recover.

When I was in the hospital having my own babies, it was a nurse who held my hand, reminded me to breath and helped me deal with the aftermath of a C-section. It was a nurse who wiped my post-partum tears and told me it was normal to feel anxiety. I felt so comforted and never alone.

When I was worried about my son’s pneumonia, it was a nurse who gave me piece of mind and told me everything was going to be alright.

When I visit many families through my charity work, its nurses who give the kids and families the hope, strength, and motivation to overcome obstacles.

I think God put angles on earth to take care of all of us throughout different times in our lives. These angels are called nurses, Throughout my life I have been touched by nurses and I am so blessed and proud to have a friend who is one.

Love, your friend,

Kellie"

Kellie is an amazing woman who inspires me daily. Truly a great moment in my life. Thank you!

Emerging from the white coat

This semester is coming to an end. Today is my final day at women’s health clinic. I have to say I entered in to this semester with some trepidation. Evaluating my own health I would give myself a B+ on the good ‘ole score card, but does that give me the right to advise other women on her health?  Headed into a patients exam rooms I hesitantly started each day the same: notebook (check), white coat (check), pen (check), ROS card and screening sheet (double check) and off I went.

My preceptor, being the beautiful soul she is, set aside one hour per patient. This in itself is wonderful fore thought on her part. Even thinking about it now I have to laugh, the first 25 minutes I would ask every single past medical history, family medical history and review of systems question under the sun. Then came an intently focused physical exam, final “assessment” and detailed plan of care. 

For each patient I was concerned about the same aspects: LMP, last pap, partners, safe relationships, type of birth control, satisfaction with birth control, vitamins/ exercise, diet, last pap, etc. I perfected answering my patient’s questions in a manor that made them feel normal. However, none of us are “normal” and who even had the audacity to event such a word should probably consult with their own “specialist”.

Somewhere in the middle of my rotation I lost my precious white coat. It served as my shield and protection against unknown answers to all my patients’ questions. To say they varied across many spectrums would be an understatement and at times I wondered how I had the tenacity and tact to answer them. However, I did believe they were due the respect and courage to ask any question they wanted.

As the white coat became part of my history, so did the need to wear it. When the lab coat went away, so did my imaginary barrier between my patients and I.  I took on a feeling of being more “humanistic”, in deed more myself. I want to be Michelle the FNP student that cares. I want them to feel comfortable calling me for test results or for advice. Their appointment should make them feel relived and informed. I can’t tell them everything about being healthy, nor are there such things as the magical “normal” in the realm of women’s health. However, at least now they know to check their Vitamin D, take a daily mutli-vitamin, exercise at least three days a week for thirty min, and that open conversations about their health are all important aspects of their care.

In the end this rotation has thought me many important lessons; some learned by chance, others on a daily basis. I couldn’t have asked for a better learning environment. I have two hopes: 1. that I can cultivate a caring environment for my patients in the future, 2. that my next preceptors and staff are just as amazing at my next clinical rotation.

Who raises a child?

     It’s late at night and my day is winding down. The funny thing is; my heart and my mind are all wound up. My never ending whirl wind of school, work and family/friend commitments couldn’t be piled any higher. However, today was the accumulation of a six month process to become a board member for Cuidando Los Niños (a.k.a. CLN). 

  

It should be explained that this board has some requirements. Attendance at events, participation in committees, volunteer time at the center, involvement in advocacy and outreach as well as a back ground check. There are other points too, but by no means can you show up and expect to be appointed membership. 

When presented the opportunity, I made the time. Moved my working days to weekends, started putting feelers out into the community, donated my time, submitted my back ground check, and during the process become even more excited to join this community. I say community because that is what this is. It is a community of people dedicated to helping children who are experiencing homelessness. CLN helps them meet their developmental milestones so that they can continue to grow, develop and become contributing members of society. Studies have shown that without this, the cycle of homelessness will continue. But CLN doesn’t stop there. They take the whole family and build a plan end the homeless cycle through partnerships within the community.

It makes my heart sing to be involved in something that is bigger than me.  I think that is what deep down my heart wants: contribution to others in a meaningful way.  So as I sit here and ponder tonight I wonder…

Who raises a child?

 Is the role limited to a mother, a father, a grandparent or aunt? What about the sister who raises her siblings or the son who steps forward in the role as provider. There is no one entity that raises a child.  When you think of raising a child as a single individual’s role you fail to see the influences that act upon that child and that family unit.  

Take for instance the school. The school has the principle that provides leadership and fosters diversity which is passed to the teachers. Teachers provide education, nurture, and fosters growth within children often inspiring and encouraging them to grow into their community.

 The school is one part of the community but there are also businesses and other community centers at which children frequent. Imagine the possibilities of influence. For instance camp counselors who inspire imagination and exploration or the business owner who donates his time as a part time league coach. It is the scientist who donates her  time tutoring, or even the  church group who through fund-raising helps to provide shelter, food and clothing to families in need.

Each single individual who enters a community has the ability to influence and sponsor growth within that community.  The ability to donate is not defined by the wallet from which checks can be written. It is defined by the quality of time and mentor ship that is put in to the development of the community that in turn fosters true financial growth and lasting development.

Our communities are not defined by white picket fences or cars polished to pristine shine on the weekends.  Our communities are what we build, through the relationships we develop and the growth we provide.   We all have communities, can you find yours?

Being honored with a position on the board is the green flag to forge ahead in a new civic role full of responsibility, challenges and opportunities. It is by no means a finish line of accomplishment but rather a spark that ignites the personal drive to do more, and be more.  I am more than just a role. I am a role model, a worker and a leader within the community. And at the end of the day, it is the community that raised the family. 

"Yes" moments

Sometimes a long day opens up the mind for contemplation.  I am officially knee deep in my second half of my woman’s health clinical rotation.  I never thought I would enjoy woman’s health, but at times I do. Take this week for example I had the opportunity to call a patient regarding her labs and let her know that her results where normal. I re-enforced the need to eat a well balanced diet and to exercise (something everyone should do) and during the call you could hear the relief in the woman’s voice.  That is when you have that “yes” moment. Helping, giving reassurance, educating and being “there” for your patients, that is what is important. 

In addition to school and working I had the opportunity to attend United Way of NM’s Breakfast event.  Another "yes" moment given to me by my friend Maren. She invited me to the event, and although I thought I was going to hang out and eat breakfast with her, I did enjoy meeting a wealth of individuals in the non-profit community.  You never know who you are going to meet.  It was a great morning, and taught me a lot.  The event ended with a wonderful opportunity and a brief chat with Mayor Berry. 

Now, you may ask why I care to meet Mayor Richard J. Berry?  Well, you see the mayor has an initiative to end homelessness. As some people know I volunteer (and hopefully soon serve on the board) for a non-profit that works towards helping children who are experiencing homelessness. I had to do a quick meet and greet with the Mayor to remind him of the wonderful organization I serve.  Hopefully we can partner to expand and help even more people. But it should be said, in my opinion in order to help someone you should give them the tools for success trough education or opportunities. But what they do with those skills is their own choice. I akin it to the Chinese proverb “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime”.   

So just a small blog today, but long thoughts surround my synapses. I will write more soon…and remember my peers and I are more than JUST any one dimension, one job, or one definition. We ARE nurses.

And now to listen to my new favorite:

Infant Motrin? I think Not

This week I read an article by Novak and Allen: “Prescribing Medications in Pediatrics: Concerns regarding FDA approval and Pharmacokinetics”. The pediatric population is one that I am familiar with and enjoy working with the most. That being said this weekend I was exposed to some other than stellar medical care which made me think about what I would do if the tables where changed.



Brief story: I was working as an agency nurse this weekend in an ED and was asked to give a 10 week old Motrin (weight based dose 5o mg po) due to fever. Motrin is a drug that I have been taught not to give under 6 months of age. So I decided to one assess the patient myself then make a decision on the order. I went into the triage area to find a 10 wk old baby wrapped in numerous blankets. I asked the parents to unwrap the child and have only a light blanket to hold the infant with. I then passed by the triage nurse (engrossed in her computer, charting I am sure) and spoke with the ED MD who had written the order without assessing the child. I asked if he knew that the patient was a 10 wk old child. And he said yes and he felt comfortable giving the medication. I handed him the drug and asked if he wanted to administer it. To which he replied he never does. I explained that the child was wrapped in many blankets and suggested rechecking the temp after being unwrapped and doing a physical assessment and history. I then informed the busy triage engrossed in the computer (still charting I am sure, although she had no patients to triage) that I was not comfortable giving the drug nor would I. I then tried to pull up information regarding Motrin use and infants. As I suspected the FDA has not approved its use for those under age 6 months.

Fast forward to this article. Several key points where discussed. One of the first statements included that “Off-label” use of medications still required rationale scientific theory, sound medical judgment or data from controlled trails. This is of key importance to me. I highly doubt a nurse who is engrossed in her computer did a sound history enough to understand when the patient actually last had Tylenol or thought to unwrap the infant from the many blankets before urging the MD to give her a verbal order, to which she felt too busy to administer herself.

Novak and Allen also point out that although the Harriet Lane book is often differed to for appropriate children dosing, although  some medications described are also not approved by the FDA.

I reviewed my own pediatric dosage handbook by Lexi-comp and again it stated the safety and efficacy had not been established for infants younger than 6 months. Not that this information alone would stop me, but say the infant had an undiagnosed Patent Ductous Arteriousus. The lack of assessment and random administration of a drug without complete history and assessment puts the patient at risk.
At the end of the article this simple statement was made: "prescribing medication to children is one of the most complex and potentially dangerous functions pediatric advance practice nurses perform” (Novak& Allen, 2007, pp.69). I realize that my time on the ED floor is coming to an end, and that I will eventually be on the other side of care. But what seems most important to me is actually assessing the patient and determining the efficacy of treatment. In addition I think referring to professional colleges who have more sage knowledge in specific areas is also important. Never forget your resources. As far as my role currently as an ED nurse, I will continue to question orders I feel where written without precedence and hope that I can teach other nurses who may not be as vocal as I to also use sound judgment and assessment.


Novak, E. & Allen, P.J. (2007). Primary care approaches: prescribing medications in pediatrics: concerns    regarding FDA approval and pharmacokinetics. Pediatric Nursing, 33 (1), 64-70.

Taketomo, C., Hodding, J. & Kraus, D. (2009) Ibuprofen . In Taketomo, C., Hodding, J. & Kraus, D. (Eds.), Pediatric Dosage Handbook (pp. 899-902) Hudson OH: Lexi-comp.

Did I win the hearts and minds?

I wrote this while preparing to leave Iraq after a long year. I re-read it today.

On March 7th 2005 I volunteered to deploy to Iraq. I felt in my heart that it was what I was called to do. It wasn’t my job to defend our country or help another country re-build. My heart called out to me that I need to be in Iraq to take care of soldiers. You see that’s what I do. I am a Nurse. A long time ago I found my profession, which allowed me to care for others, which in turn gave my heart a personal reward of fulfillment. My mind and heart’s only wish was as any Army nurse, to care for and protect soldiers. So for me, my choice did not feel like a heavy burden or pain. I felt excitement and pride, a sense of fulfillment because I had made a choice to be in the Army. A choice I made because I wanted to care for soldiers.


Soldiers, brothers, sisters, family.


In June 2005 a rumor was spread that I would deploy. My excitement was met with mixed trepidation. My family, although proud of all I accomplished, was scared. Fear…I had not felt that emotion until the moment I caught my mother’s eyes. I was immediately torn…serve in what I felt was my duty, but with a strain upon those I loved.


In September 2005 I deployed to New Orleans to help with the Hurricane Katrina aftermath. I had the opportunity to have a taste of what life would be like. I worked in the EMT (Emergency Room) built from a tent at the convention center. I grew to understand and appreciate my co-workers, while having the opportunity to give back to my country and community in some of the most challenging experiences. With that growth and knowledge a glimpse of what was to become the for bearer came..."Politics”.


In Jan of 2006 my close friends and I knew that we would indeed be deploying to Iraq. Our mission was not as we had hoped for; instead we would be taking care of soldiers and Detainees at Abu Ghraib. We were to win the hearts and minds of the masses and reclaim our countries good name, after the negligence of others had tarnished it. I remember leaving my mom at the airport, tears in her eyes. I had caused her pain and now I was to have a mission I dreaded.


A thousand questions pass through your mind and your heart. The “what ifs”, came to life in my dreams. Two wounded...one a US soldier, another a detainee…who do you care for? What if they both have serve wounds? What if you can care for only one? What if one will die? How do you decide? “Remember your ethics training” the empty voice repeats over and over again. “Remember the Geneva Convention, remember the rules of triage” the voice continues. But what about my heart? What if? What if it is me? What if I can’t make that choice? What if I do make that choice? Who will know but me? The truth lies deep inside.

Politics, media, mis-representation, smiles, nods, handshakes, thank you for… yes thank you. We came here to win the hearts and minds. Did we? Twenty four hours into our new lives, “Two marines IED”, my medics voice...breathe in Michelle…breathe out, “you have four inbound, detainees”, breathe in, “Ma’am we have four waiting for sick-call”...breathe out... “Ma’am there’s a call”…breathe Michelle.


I slept the first night with exhaustion. I awoke only once to the sound of Chinooks…more patients I thought. My days seemed to mix. Busy...slow…there was a fair amount of US solider trauma, detainee trauma, aches and pains. No tough choices.


“Smile”, a whisper went into my ear. “Hello Sir”, “Yes”, “We’re good Sir”. Politics, reviews, tours. We closed the infamous Abu Gharib. We moved from one small FOB to a smaller fishbowl, straight in the heart of politics and garrison life. The day we separated from our small home, I felt saddened with the knowledge that I would see fewer and fewer soldiers and more and more politics. It wasn’t just me that felt the change. Almost instantaneously people’s lives were surrounded by “evaluations” and “accomplishments”. With this came a strain of confinement. Winning the hearts and minds became more painful.


Can you give 100% of compassion and care to someone who may have hurt your brother, your sister? Can you do it for one day? How about two days? Ten? How about 150? My friend did. Day in and day out she gave. While I was sheltered in the Emergency Room, I watched as my friend gave and cared. She did it and it hurt. My momentary emergency room triage, evaluation, patch work, was nothing compared to her work. That work changed all of us. We all grew apart and together like an enigma. Pulled at two polar extremes. Our defense at times was to lash out against ourselves. We did it for the anguish, pain, frustration and fatigue we felt. The confusion and strain of our jobs caused a roller coaster of emotions, upsets, and heart aches.

In a job like ours it would be easy to allow the weight of the world, of “politics” to weigh your heart and mind down. “They” say that under stress people band together. We did, my friends and I. We made a mafia of friends. We gave each other strength and encouragement. We found ways to laugh and have fun despite our fishbowl.

The fishbowl, you see, is we now lived. The eyes of the world were on us, even though our neighbors to our left and right had no idea who we were, or what we did. It was this fishbowl that proved to magnify the “politics” that surrounded our job.

Our year is almost complete. Although it sounded like a jail sentence, it was a life experience. We as a collective group watched as mortars flew over our heads and landed 75 meters from our hearts. We felt the sting of “CS” gas, and the scare of M9 rounds clamoring around us. But with that there was more. We learned about the culture in which we were submerged. Both US forces and Iraqi alike. We cared when others might not have. I know now more than my peers will ever learn in their “school books’ and spoon fed educations. A fact that to this day causes me to pause while I listen to them make claims of knowledge and understanding.

I learned also about something others may never truly understand. I learned about Philia, a love for my friends. I love my friends as my brothers and sisters. I understand now, how our lives will forever be intertwined. I also learned how to listen to my own heart and soul. I lived and experienced, I made history. And with all this is the knowledge that by no means did I do any more or any less than my peers. I just simply did.

What lies next in the chapters of my life? The next “what if” to ponder. If there was a word that meant more than a simple “thank-you”, more than gratitude, above the simple and equal to the gratefulness that overfills my heart. I would give it. First to my family, then to my friends. To my co-workers, fellow soldiers, to my brothers and sisters.

It has been five years since that point in my life, and so much has changed. I am forever grateful for my journey. My life constantly gives me the tools to succeed. God, my family, my friends, my mentors and even random

patients teach me every day. And for that I say from my soul, Thank you
~m