The Dark Side of Travel Nursing

So, I have been doing travel nursing again for essentially the past year. It has been mostly awesome. I spent 9 months in Houston, Texas, and most recently have come to St. Louis, MO. I have loved it. I have loved the freedom of working a contract and being able to take time off if needed, I have loved exploring new cities and meeting new people. It has been overall a wonderful experience!

Most recently (as in last week) though, the dark side of travel nursing reared it’s ugly head. Insecurity. Lack of benefits. No safety net. I had a “health incident”, which landed me in the hospital, on the other side of the rail so to speak. My shift started out as they usually do, getting report and developing my plan for the night. Midway through my shift though, I was having really bad chest pain. I had been feeling badly most of the week, increased heart palpitations, massive fluid retention, heartburn and fatigue. I had been chalking it up to overworking as I had been fairly consistently putting in 60+ hours per week for a while. As I stood there talking to the NP about my patient, I kept rubbing my chest unconsciously. She noticed and asked me about it, and proceeded to march me into an empty room. I took my blood pressure which prompted and “Oh my god Sarah, is that your pressure!?”. Needless to say it was a bit high. The long and short of it was, without me even being aware of it, she orchestrated someone to come in and take my patients and send me to the ER. I was furiously charting trying to catch up and they even snapped a photo of me with oxygen on refusing to get in the wheelchair until my assessment was completed.

I went to the ER, and went through the whole shebang. Because I have lupus, and I have been off my meds for 3 months, everyone started jumping up and down that I need to be admitted. Needless to say I was non-plussed. The first thing I thought of was “I can’t miss any work”. See, the dark side of travel nursing is, if you don’t work you don’t get paid. Additionally, if you opt for their housing, you can face penalties for missing your hours to supplement their expenses at maintaining your apartment. It is a very scary prospect to be a patient in the hospital, and even more so when you are facing financial issues to boot. After much foot dragging and arguing, I agreed to be admitted (have I mentioned I am a HORRIBLE patient?). My cardiac enzymes were negative, but based on my symptoms and my lupus, the doctors felt strongly that I needed a dobutamine stress echo. I will spare you the gory details, but suffice it to say, that was one of the worst experiences of my life. Nobody should ever have their heart go from 56 beats per minute to 176 beats per minute in the span of 2 minutes. I thought I was going to die. I cried.  A lot. And almost vomited on the tech, poor thing. By the time I got back up to my room, my blood pressure was so dangerously low I almost fainted in the wheelchair. Scared the poor CNA to death, but somehow managed to levitate my ass to the bed before collapsing. My blood pressure never came up to normal, and continued to be very abnormally low. I requested enzymes with my PM labs, because I truly felt like I had been having a heart attack during the stress test.

Needless to say, my stress echo was “abnormal”, much to the surprise of everyone. The cardiologists honestly thought they were just going through the paces and I would go home that day. I did not go home. They scheduled me for cardiac cath the following day, which absolutely terrified me. See, the problem with being a nurse, is you know too much. On one of my travel assignments , I sent a lovely lady to cath lab, and she never came back. I get report and transfer of all the patients with “complications” post cath. Scares the bejesus out of me. Later that night, about 1am, doctors came tiptoing in (always right when I need to go to the bathroom, like toddlers or cats), and went “ah well, tell us more about what happened during your stress test”. Suddenly everyone was interested to hear what I had tried to tell them before. Turned out I had a small MI during the test. By this point,  I felt like they were trying to kill me, to be honest. My enzymes had been negative up to that point, but their test suddenly has everyone going “um don’t get out of bed and here is a heparin drip”.  Through all of this though, my amazing friends and coworkers really saved the day. From listening to me freak out, visiting me at night when I couldn’t sleep, to making sure I was with the best interventional cardiologist for my cath, these nurses saved me. See, they didn’t see “a traveler”. They saw a fellow nurse, scared to death, and took care of me. Even my boss, went to cath lab to make sure everyone knew I worked there, came to see me, and hugged me when I was losing my shit before going to cath lab. All I wanted to do was go home….but these people kept me sane.

The next day I went for my cath. I asked for a radial approach, to have faster healing time. The cardiologist didn’t want to do it because of my Reynaud’s, but he did anyways (I begged). Turned out he was right and I should have listened to him, it hurt like a son of a bitch and still does. The long and the short of it was I apparently had a 68% blockage midway down my LAD. the put a stent in, and now I am on plavix and aspirin, with the lovely diagnosis of Coronary Artery Disease and Non Stemi Myocardial Infarction. There are no other lesions anywhere, and most likely the pain I have been having for a long, long time has been vasospasms. See, I never paid attention to my “chest pain” because it wasn’t like what I thought of as chest pain. I could point to where it hurt. Apparently that spotI could point to was halfway down my LAD. The doctor said it was a little hidden, but that I was extremely lucky considering this was in the main artery of my heart.

All of this has been overwhelming to say the least. I can’t wrap my head around the idea that at 44, with no family history, normal blood pressure, perfect cholesterol that I am a cardiac patient. Yes I am fat- have always been so. But being fat in and of itself doesn’t clog your arteries. Turns out, the pesky Lupus does. For some unknown reasons, the near constant inflammation I experience from my Lupus is worse on my arteries then having bad cholesterol. This coupled with chronic arterial vasospasms led to me needing a stent. It is possible the “benign” heart arrhythmia I have had all these years was in fact this lesion developing. Being off the meds that reduce inflammation levels in my blood exacerbated all of this. Luckily, statins also help with inflammation, also for unknown reasons. So if I take my meds like a good girl I should be fine. Mind you, I stopped them because they were making me fat. Because we live in a society where it is better to be dead than fat. That is a blog post for another day, however.

They say that experiencing a profound health crisis changes you. I don’t know that it has changed me per se, but it is definitely giving me pause to rethink things. While I love travel nursing, it is a bit like playing Russian Roulette. Unless you are smart and have 6 months of salary saved up (and face it, who among us does?), you run the risk of losing everything if you can’t work. There is no safety, no backup, no net. None of us are immune, no matter how indestructible we think we are. This experience has taught me that it is ok to be a little selfish. To think about my needs first before others. I need to get back to classes and finish school (I am going for my RN to MSN, then NP). I need to have a less stressful job. I need to make more money so I can work smarter instead of harder. The days of “well I will just pick up an extra shift” as the answer to all the financial woes must stop. I cannot be this workhorse anymore. I need some safety and security in my life, as much as is possible in this crazy world to have.

I also realized I have been afraid to share what has been going on, because of the stigma associated with CAD. I know, that people assume by looking at me that I “ate myself” into a heart attack. I also know that the people who love and care for me know that is not true. I probably have better eating habits than most of the people I know. I avoid meat, fat, eat lots of veggies etc. I loathe cheeseburgers and mayo, and usually get chased after to eat something. Obesity is a complicated thing, and not easy to deal with. I had been losing weight fairly consistently after getting off the steroids, until the new Lupus meds- then over 9 months I gained 45 pounds back.  No matter what I did, how I restricted my diet, what exercise I did, I gained. According to my fitbit  I would hit my 10K steps in the first 4 hours of work.  I gained in weird places, not normal to me. So I went off my meds. In my mind, I could be ouchy and fat, or ouchy with Lupus, what was the difference? What I didn’t stop to think about was the hidden effect the Lupus was having on my body. The insidious inflammation and destruction of the unseen parts of my body. Sure, I started to lose weight again, slowly, but at what price?

So now, I am going back to work tonight. Nervous, only with a week recovery. Could I use more time off? Sure! Who couldn’t? But the sad truth is I can’t afford it. One week without pay was all I could do. While I adore travel nursing, and part of me wants to continue jetting around the world to exciting locals, meeting new people and seeing new places- I realize that I need to slow down and reconsider. The sad truth is I can’t “afford” to do travel nursing anymore. I need to seriously investigate a permanent position until I am finished with school. I need to get back on that bandwagon ASAP so I can finally have some viable financial options that offer nursing away from the bedside, but not in administration which I loathe with all my soul. Luckily, I love it here in St. Louis. I adore the people I work with, the unit, my boss, the hospital, the city. I am lucky I have support here and the backup to take a perm position. Hopefully that will work itself out by the end of this contract. I am still waiting to hear from HR, apparently they move glacially slow. But hopefully this will turn into something even better for me then I have had before. Meanwhile, it’s back to the grind, albeit at a little slower pace.

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Return to Travel Nursing

So I’m super excited I finally get to be a travel nurse again! I have missed travel nursing immensely and am looking forward to the new adventures. I’m going to start out with some local travel to San Antonio hopefully and just work like a beast between my current job and a travel assignment in hopes of preparing for longer distance travel. I’m starting the “dating” process again with agencies and will see what happens. I’m in a great position to be selective and wait for the right opportunity so that’s awesome. 

Of course if I get Hawaii then I’m just gonna shout “IM OUT, BITCHES!” and send everyone postcards 😉 here’s to new adventures!! 

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I got this

Another 45 minutes of exercise in. I can’t believe what a difference a couple of weeks can make. I got the ps4 Just Dance 2014 game, and it is fabulous. There are exercise routines, sweat mode, and calorie tracking. It is a game, one that gives you stars and trophies and instant feedback. Silly that, it took something like a game with instant gratification to get me moving again. I finally feel like I have broken through the barrier that was holding me back. I am determined to get a minimum of 30 minutes a day in, up to 1 hour. This seems to be working, both on the days that I go to work and the ones I don’t. This coupled with my food changes is radically altering my energy level, my weight loss and my overall fitness. 

I have not felt so motivated to be fit in a long time. It never ceases to amaze me how simply “acting as if” can have such a transformation on my life. That by starting small, with something as simple as a “game” every day, is making me feel happier, more confident and more at peace. I finally feel like I got this.  

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“The Edge… there is no honest way to explain it because the only people who really know where it is are the ones who have gone over.” Hunter S. Thompson

Very honest, lovely blog post. My sister struggles with depression, it is so hard to see her go through it, powerless to do anything to alleviate her suffering. It is a comfort to know there are other such wonderfully talented, literate, thoughtful people also struggling, but surviving.

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Perhaps to Travel Again

So, the hunt begins. Finally, we are at the home stretch to be able to travel again. It has been a long process, working this past year towards getting my husband’s papers permit so he can travel too.

I am approaching our 1 year wedding anniversary. I can’t believe everything that has changed. We finally have his bio-metric appointment, and should have his permit to work and travel shortly after that. There will still be a final interview, but at least he will be able to move about freely in the US.

It is more than that though. This has been a journey and process for him as well, leaving his country, his friends, his family. acclimation to the US. Having his web-based business become successful. But mostly a journey of the spirit for him and us. Before, I did the traveling. I took assignments and worked in the US while he stayed at home in Mexico. Then everything changed and we moved here. Still, we live on the border, and it is much like being half in Mexico and half in the US. I continued as agency, and PRN at 2 jobs. I then took a full-time position for benefits, and continue PRN agency at the other hospital.

It was a wake up call for me as well with taking the permanent position. The first one I have had in several years. I don’t like it. I don’t like the politics, the crap, the people. I am so tired of the stagnate medicine, the ongoing issues that never seem to resolve. My heart yearns to travel again, to explore new places, meet new people. I have the soul of a travel nurse. I never want to stop learning.

I also am battling personal illness. Which is another reason I took this position, so I could have health benefits. All the years of playing fast and loose with my health, working 80 hours a week, have caught up with me finally. I can’t anymore. So in the end right now its better that I am stuck. It is forcing me to take care of myself for the first time in years.

I have learned something important about my husband though with this. After coming home from a particularly vile experience with work, with nasty awful hateful backstabbing people, I was heart-sick. I didn’t want to be here anymore, working in such an untenable place. I told him I just don’t want to be here anymore. he turned to me and said “that is ok honey, WE don’t have to be, we aren’t going to be here forever”. This was revolutionary for him. He had reached the point where he is ok with leaving the border, leaving his comfort zone, exploring new cities, going further into the US. Leaving his family. This is huge. He is with me, completely, whole heartedly, now and forever. To travel with me, as he only needs internet to work. This was so freeing for me. Took a huge weight off my chest, and made everything bearable again. A light at the end of the tunnel so to speak. To know that my love is with me, at my back, to go where I go, be where I am, together.

I still need to take care of business first. I need to get my health together, and then plan smart to travel again. We will keep our house here, perhaps take short-term assignments with a company that offers benefits for sure. My dream is to work just 3 days a week, take online classes, and travel to exotic locals for short assignments. Come home, work PRN  a day or two here and there, then back out to travel again. Heaven! The exciting thing is it looks like it really will happen. Now I just need to decide where to first! the sky is the limit!

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Nursing is a War Zone

I have not posted anything for a while. I have stopped doing travel nursing, due to personal circumstances that are not allowing me to do it at the moment. I recently got married, and until we get everything sorted out with his immigration papers, it is easier to just stay in one place here. So, I have been renewing my agency contract at the local hospital here. I also recently applied to the LTAC facility here for a secondary PRN job. I desperately need a change. I have been experiencing maximum frustration with medicine and nursing in general, particularly here in this area.

Lately, moral has been in the dumps. And for good reason. It seems as though the hospital wants to eek out more and more from us, until we are wearied to the bone. I recently floated to the medical unit. I started out with 6 patients. discharged three of them and admitted 2. I felt like all I had time to do was run down the hall chucking meds down people’s throats and keep moving. Everyone wanted a piece of me. There was no time to do anything. I could see why nurses get so frustrated and short tempered. You feel like a pill and paper pusher. This is not why I got into nursing. I got into nursing to care for people. to educate them, to help them, to provide compassionate care.

The next day I was back in the ICU, large and in charge. I started out with 2 patients, and quickly was tripled. We ended up moving out 4 admitting and transferring 4 in. I transferred a patient out to another hospital with an OB team. It was chaos. Hell really. Flash pulmonary edema, drips, codes, just…hell. I did not leave until 10:30 that night. It occurred to me that day, that I was in a war zone. We barely have the equipment needed to do our jobs properly. Doctors scream at us, curse at us, even hit us at times. Administration piles it on higher and deeper. I often feel like I am barely keeping my head above water. I have nightmares about work. Administration does not back us, doctors belittle us, and everyone exists in a state of fear. You never know when you will be written up again, who will be fired on a whim, and most people do not know that a better way exists.

So, you ask, why do I stay? I adore the people I work with. My coworkers are lovely. They make me happy to go to work. I love being a nurse, and I feel like I make a difference almost everyday, even in some small way. And right now, I am not in a position to go anywhere else. At least not until things are more settled at home. I am just afraid that this place is stripping me of my passion for nursing. I do not want to become bitter and jaded. I do not want to become cowed into not speaking when things are wrong. If it is shit, it is shit. candy coating it, just makes it candy coated shit. You cannot change what you do not acknowledge.

I am also frustrated by some of my younger coworkers, who have never worked anywhere else. I feel that they have unrealistic expectations. It is always up to the mysterious “they” to fix everything. “They should give us more help” “They should treat us differently” “They should fix these problems”. It is what it is. When the shit is hitting the fan, screaming about it and having a temper tantrum refusing to accept an assignment is not going to solve a thing. Demanding more help when it just is not available won’t make a difference. Yes, it sucks where we work. No question about it. So what are you going to do about it?

These same nurses, do not seem to get involved. I do not see them going to staffing meetings, or nursing congress, or doing anything to try and make things better. In my humble opinion, the only way we will ever have things better, is to be more self directed. For the nurses in the trenches to set the standard and the goals. We need to come together and come up with creative solutions to fix our problems, and present them to administration. This will give us back a sense of control, and in the end be a lot more effective then temper tantrums. Perhaps we will even be able to solve some of our issues. But you know what? If we don’t try, we will never know.

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What a Week

So this week has been overwhelming to say the least. I have felt pulled and torn in multiple directions on a daily basis. It has seemed as though everyone has had a criticism of me this week. I have felt at times as though my very character is being questioned. This is demoralizing beyond belief.

I still work with amazing people. But management and the doctors have been just difficult as hell to work with lately. I am finding that the things I value the most about my nursing are being questioned and criticized. I am a person who gives a crap. I can’t help it. I try to not at times, but it is just contrary to my nature. This week, I was questioned for my dedication to my job- that I shouldn’t be helping people so much that I have to clock out on time. I also shouldn’t speak when the work situation is intolerable.
Later this week, I was told I was too emotionally attached to my patients. This was for trying to report issues going on to the doctor. The long and the short of it, is I realized today that this patient was being discriminated against for being unfunded. Apparently we are only aggressive and proactive with 90 year old people with insurance. If you are young but critically ill without money, you are screwed. Sometimes I feel so impotent at work I want to scream.

At least there is balance of good and bad. I saw some truly amazing and beautiful moments. I was blessed enough to witness a wife holding her husband and saying goodbye. She let him go, even when it was hard. To see the amount of love in that room, was a profound experience. The best that we can hope for in this life, is that someone loves us enough to do that. To be both on the giving and receiving end of that. To love and be loved, to draw our last breaths on this earth while resting in the arms of our loved ones. How someone cannot be moved by that, escapes me.

Yet, I find myself being criticized for being filled with wonder at what an amazing and fragile world we live in. How often to we circle one another, never truly connecting? How often do we hold back, not expressing our love and gratitude for the experiences we have on this earth? Why do we take this all for granted?
I am a sentimental person. I cannot help this. It is who and what I am. But perhaps I need to explore another direction in my life. I feel like I am spinning my wheels and getting nowhere. Life is too short for this.

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Nursing the Computer

So, we are experiencing a number of changes going on at work. We have a new CNO, and she is wanting to implement new procedures and policies. Additionally, our manager is currently out, and someone else is covering her. We have been under a tremendous amount of pressure, with these new changes, to make it work. We have recently hired a spate of new grads into the ICU, as well as new agency nurses. Recently our interim director had a “come to Jesus” talk with us. I found it to be quite punitive in nature, and completely unrealistic.

Concern has been voiced over the slacking in documentation within the ICU. We utilize an antiquated computer documentation system that is neither user friendly nor time saving. It is bulky, unwieldy, and a challenge for even the most computer savvy people to use. We do primary care nursing in the ICU, which includes all personal care, medication, monitoring, etc. We often do not have a secretary and must enter all our own orders. We answer the phones, draw labs, turn and reposition, document, coordinate care with families, transfer patients, call doctors and implement the plan of care. We are responsible for several aspects of cleaning of equipment and rooms, and must do everything FAST. It is not uncommon to completely turn your patient assignment around several times during your “12” hour shift. I say 12 hours in quotations because nobody I know ever leaves on time.

Unlike the medical units, we do not have CNA’s. We do not have a free charge nurse. If you are charge nurse, you have a full patient load, and sometimes the sickest ones at that. During the day there are additional meetings, rounding and responsibilities as charge nurse. Most of us despise being charge nurse, because basically in the words of my dear coworker “you are everyone’s bitch”. The people I work with, however, are amazing. They are truly some of the best people I have ever had the honor to be in the trenches with. They maintain an awesome sense of humor despite being in a war zone everyday. 99.% of them truly care about their patients and their job. Yes,  .5% are clueless, and .5% just totally annoying. but all in all, pretty darn good odds for a hospital full of strong personalities.

In addition to new constraints being placed on us to increase our speed of transfers, we are being asked to increase our documentation. we already document 2 shift assessments, hourly vital signs, hourly I&O’s, any interventions, meds, critical labs and need to contact the doctor. we transport our patients to all procedures and document on this. We are now being asked to document focus assessments every 2 hours on every system that is not within normal limits. That would be every system on our patient. Now, most nurses are constantly assessing their patients. we assess and intervene and evaluate continuously. The difference is to now go into the horribly time consuming computer system and document this, even if nothing has changed and we are doing no interventions. This is the complete opposite of the idea of “charting by exception”.

I recently read an article regarding some new legislation pending in 2 different states regarding mandating advance nursing degrees for all RN’s. This is the path leading to reimbursement, they say. I see a striking similarity to these pending legislations and the conversations being held in my job. It is all about justifying a reimbursement rate. Core Measures are mandated by regulatory committees, which failure to adhere to leads to financial consequences for the institution. Many diagnosis if acquired while in the hospital, will result in non payment for their treatment if the documentation is not there for its preexistence prior to hospitalization. The bottom line is, while higher standards of care for less money are being demanded, nurses are no longer taking care of the patients, but instead being asked to nurse the computer. We are wanted for our documentation in order to secure payment for the hospitals. We are asked to police the doctors, not to ensure safe care, but to make them document and order the required products and tests to ensure financial reimbursement. The very skills that make nurses invaluable- the eyes and ears present at the bedside, are being pushed further and further away.

I wish I knew what the answer was. I understand where this is coming from, and I do not fault them. Medicine in this country is still a business, and it needs to be financially stable in order to keep functioning. Health care costs are spiraling out of control, and the drain on our society is climbing. People want access to affordable, quality health care, and nurses want to give this. Administrators are responding to pressure from all sides to somehow make it work. I do however, think that everyone is running like chickens “the sky is falling the sky is falling”, and rather than calmly taking things back to basics, are standing with a finger in the dyke while the tsunami washes over the top. Nurses need to take back control of nursing. We need to be setting the standards, writing the requirements, and holding each other accountable to a higher level of care. We need to remember what we came into nursing for, and find a way to stop making things so freaking hard. Otherwise, who will be left to care for us?

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To Staff, or not to Staff, That is the Question

So, when do you know if you should take a staff position or not? At what point do you decide to stop traveling? This is a question I am pondering, as my life has started to go in different directions. Travel nursing is a bit like dating- you  meet someone, go through the introductions, decide to hook up. Sometimes there is an instant click, and a honeymoon phase commences. Things seem all sunshine and roses, and then the frustrations start. You start to annoy each other. Little things bother you, until you are ready to blow up and say screw it. As an  agency nurse, you have the ability to get up and leave, that a staff position does not have. You can decline to renew your contract, or if it is just intolerable you can give notice and quit.

Other times as an agency nurse, you find yourself renewing your contract over and over. You feel connected to the place, the people, and ponder staying permanently. The thought of leaving causes anxiety. You see the flaws in the system, but you think you can change them. You think, maybe, if I work really hard and invest in this, I can make a difference. The bad boy hospital really wants to change I know it. It is suffering inside and we can make it work! So you keep renewing, and the marriage dance begins. Will they propose? will the offer be enough to accept? Should I go ahead and commit? What if it sucks? Do I really want to be committed to a sign on bonus that I have to refund if I leave?

Neither path is truly realistic. There is no “perfect hospital” or “perfect job”. No hospital administrator in shining armor on her JACHO accredited white horse to save the day. Ultimately one has to decide based on what your goals are, what you are looking for, and what needs you have. Now that I am married, and we have other things to be committed to, I am contemplating taking a staff position. Ultimately, my goal is to have a house and hopefully a baby. This requires a certain amount of permanence. Yes, there still is part of me that very much wants to just put it all in storage and travel from city to city. I would love to go to far away and exotic locations, to have hospitals talk to me with a sultry accent and woo me with new procedures and policies. To have that thrill of exploring a new city, not knowing what is around the next corner.

However, now I have someone else to consider. The truth is, its not fun traveling without your loved ones. It sucks and is very very hard. He is not in a position to travel right now, so I need to consider what will work for both of us. There are other benefits to a staff position. mainly…. benefits. As an agency nurse you can usually get at least a 401K and health insurance, though it is very expensive. The problem is the other benefits- PTO, ELB, short term disability. those are not offered as a travel nurse. If you do not work, you do not get paid. So you have to plan for time off, and save for it. That is all fine and well if everything goes according to plan, but sometimes it does not. Additionally, if I am lucky enough to get pregnant, there is no promise I can work through all of it. There are risks associated and a good chance I could end up not able to work. I need to take that into consideration.

So, at this juncture, I am contemplating my options. Continue the sexy, slightly risky path of travel nursing, or take the committed path of staff nurse. Not sure what I will do, but I will keep you all posted.

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Sub blog

I have not posted anything here for a while. I actually have started another blog, to kinda separate my ooey gooey spirituality stuff from my nursing things. They do overlap quite a bit, as I realized from a post I made on my other blog. If you are interested in reading it, the site is findingmybuddha.wordpress.com

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