Maybe if there'd been a counselor. Or a psychiatrist.
Or anyone with training and resources to help her through the terrible and sudden loss of her 7-year-old son.
Then maybe Murlene Osburn could have gotten some sleep that first year. And maybe her first marriage wouldn't have fallen apart.
Maybe she wouldn't have wound up in a bad second marriage. Or left the family farm in Montana to come to Nebraska.
If anyone knows firsthand about the dire need for mental health care in rural areas and the shortage of providers, it's Murlene.
And if anyone is now equipped to do something about it, at least in the Sand Hills' Cherry County, it's Murlene.
The 52-year-old cattle rancher is among the latest graduates of a UNMC program that aims to reverse the trend of an aging, shrinking psychiatric workforce in Nebraska.
The University of Nebraska Medical Center launched its psychiatric nursing program in late 2009. The goal was to capture motivated graduate students who could study online and stay put, bringing vital psychiatric care to their communities.
Murlene already had a bachelor's degree in nursing. And she lives in a fairly remote part of Nebraska. Her 3,700-acre cattle ranch is about 14 miles (seven of them dirt) from the nearest Sand Hills town, Wood Lake (population 63).
From there, it's a half-hour drive to her two youngest children's elementary school, 2˝ hours to the closest Walmart and four to North Platte and Hastings, where Murlene completed hundreds of hours of clinical work to get her nurse practitioner's degree.
The med center got a $1.2 million federal grant to launch the program, which has drawn three dozen students from rural places across the state since it started.
By helping Murlene bump up her nursing degree to the nurse practitioner level, the university is helping address a huge social need.
As of last count in 2010, Nebraska had 161 actively practicing psychiatrists, and half of them were over age 50.
Most of them live and work in Omaha or Lincoln, leaving most other Nebraskans with a long drive to find that kind of expertise. The med center estimates that some 247,000 Nebraska adults have diagnosable mental illnesses and need treatment.
Psychiatric nurse practitioners have less training than psychiatrists, who go to medical school, but enough to prescribe medication and serve as counselors. These specialists now practice in 13 Nebraska counties. In five of the counties, they are the only psychiatric prescribers available.
An ad about the UNMC program three years ago in the Hooker County newspaper caught Murlene's eye.
Skeptical, thinking the earn-a-master's-degree-from-home pitch sounded like a scam, she was still curious, and intrigued enough to call the university two days before the deadline.
She emailed her application and made the long drive to Omaha for a three-hour, face-to-face interview.
Thrilled that she made the cut — 29 applied for 18 spots, and it's gotten more competitive since — Murlene bought computer software to enable her to “show up” virtually for the lecture classes held on the midtown Omaha campus. Which she did after milking her cow. With manure on her boots.
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Murlene could raise her hand by logging into a computer program and typing in real-time questions or comments. She wrote papers on her own time.
Clinicals, in which she had actual contact with patients, were another story. The two-year program required 540 hours, or the equivalent of 13˝ full-time weeks, of clinicals.
Murlene would leave her house at 3 in the morning on a Monday, drive to North Platte or Hastings for hospital and clinic visits, book motels for two nights and be home by Wednesday evening.
She did this while juggling a hectic home life: two elementary-school-age children, an adult daughter and her child who had moved back home, a second divorce. But when an adult son was diagnosed with brain cancer, she had to scale back. She postponed a class. She got two incompletes but was allowed to turn in her work later to get the grades.
The strain nearly caused Murlene to drop out of school halfway through.
She thought of her kids, who needed her. Of her cows, who needed tending.
Then Murlene thought of her son Ben, who died in 1997 at the age of 7, after being struck by a backhoe on the family's Montana sugar beet farm. She thought of the deep depression she fell into afterward.
“I felt like I slept all the time after Ben died,” she said, “yet again felt like I needed to sleep and could not. I had trouble sleeping and would jar awake, sobbing. My chest hurt so bad when I lay in bed — the physical pain of grief was so shocking to me. It literally hurt to breathe.”
Eight months later, she went to see her physician about a urinary tract infection, sores all over her body and weight loss. Her doctor said her immune system was breaking down and prescribed an antibiotic. And an antidepressant.
The Prozac helped her sleep. But it didn't remove the depression, and it felt like a crutch that a tough farm woman shouldn't need. So she quit taking it and fell deeper into depression.
In hindsight, Murlene says, she wishes she would have also had therapy.
The grief over her son's tragic death upended her first marriage.
“It devastated us,” she said. “If we would have gotten the help we needed ... . We were best friends.”
So she thought of all that.
Murlene also thought of two women her age who had died recently. One was a Wyoming friend, who killed herself.
The other was a neighbor, who died after years of struggling with what Murlene thinks was undiagnosed schizophrenia.
“There was no option of giving up,” Murlene said of her studies. “Did I cry a lot? Yes.”
Family, friends and neighbors, especially Danny, a widower, pitched in to cover the ranch and child-care duties so she could study and get her clinical hours.
“You will land on your feet,” Danny told her. “Failure is not an option. And we will not let you fail.”
In August, Danny proposed. In December the couple married, and Murlene graduated.
She donned her cap and gown in the basement of Joslyn Art Museum alongside classmates young enough to be her children. Two hospitals were bidding for her, and other job options beckoned.
She had earned a perfect grade-point average and was named by UNMC “outstanding graduate.”
“I'm so excited, I'm really happy,” she said. “I just want to impart hope.”
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