Wrapping Up 2012

Last day of school!

Well...school nursing.

Spent my 2nd day alongside a high school nurse. Of the 2 student populations I've seen, they have their pros and cons:

PROS:

The High School Kid:

• Can explain what's wrong with them.
• Have cell phones and direct access to their parents.
• Better fashion sense.
• Better listeners.
• Less crying.

The Elementary Child:

• The cuteness factor.
• Terrible at faking. (In the biz, we call it "malingering").
• Catching disability / disease earlier means more years we may be able to positively impact their lives.

CONS:

The High School Kid:

• Can Google symptoms and recite them back. (See the next bullet).
• Accomplished fakers -- (although I was in a school of the arts...so mine may have been better actors).
• As big or bigger than you. (Depending on where you are, this could be potentially scary).

The Elementary Child:

• Wiggle. Wiggle. Wiggle. Wiggle. Wiggle. Yeah.
• They don't know what's wrong and often answer yes to any question. (Does your tummy hurt? Yes. Does your head ache? Yes. Do you have a third eye? Yes.)
• Poorer impulse control. One kid grabbed the mouse and started messing with the school health records while my nurse turned to grab something.

They all need you. Of course that's something I like about nursing in general, so its hard for me not to like some aspects of school nursing. However I find myself wondering if I'd be locked into a kind of Groundhog Day after a while: same flu, same bumps and bruises, same problem parents. It will likely be this way wherever I end up. (Perhaps less likely in the ER...I'll have to ask them). 

You can't argue that school nursing seems like a pretty cushy job: 180 work days per year on a full time salary. Set hours. No on-call. No weekends. Very nice pay. 

Hmmm. Maybe I could get used to kids.

It is also the end of the year!

Looking back to where I was last year I'm pretty amazed at everything. I was still adjusting to a new life in a new city. Still learning my nursing school survival skills. Getting to know everybody. Missing home.

Now I pretty much know what to do to survive this place...although I've learned to take nothing for granted. Beginning to see the weeks and months blurring past and knowing I'll be standing up in a ridiculous white nurse's dress, hat and hose ensemble soon (God willing). I have places I like to go, and people I like to see here, which takes the edge off being far from home. There are so many people I'll miss here once I leave. Overall I am thankful beyond words to be through everything I've endured and to still be holding my own. 

2013 will be another year of big changes: graduation, writing my boards, becoming licensed and finding that first job. Settling in wherever I'm planted and plotting my next moves.

Merry Christmas everyone!

Dear Little Kid...

I would have picked you up from school if I was your mom —with the skin on your upper body blistering up so much it looked like you were covered in bubble wrap. I saw your little self in the doorway to the school nurse's office covered in red bumps and wondered what dread disease I might be taking home with me today. I tried to keep you at arm's length as you hopped all around my office claiming it was "fleas."

Maybe it was fleas. Or maybe you are dreadfully allergic to something you ate. Or new laundry soap. How would YOU know? You are only 5.

My skin was crawling and I wanted to scratch some imaginary itches the whole time. And I really, really didn't want you touching me. But I remembered when I was a girl and I decided to suntan in a field of wild grasses by the sea -- and I ran screaming home to my mom covered in what looked like puffy red whip-marks all over me. (I don't sit on the grass anymore.) And my heart went out to you.

I must have told you a hundred times that the scale was not a toy. And please don't touch that. Or that! You hopped around so much it was like you had ants in your pants.

Hey...maybe you DID!

How could I expect you to hold still?

I named you "Itchy McScratchy" and told you I was going to frost you like a cake with hydrocortisone cream. You thought that was silly and giggled when the q-tip got you under the arms. Your poor little arms.

You leaned on me while we called your mom as I tried to enter a million data-points in the computer and simultaneously keep you from pulling all the shelves down. Then you had half yourself on my lap. Then all of you.

When your little brown arms went around my neck I stopped typing and held you--resigning myself to whatever pestilence I might catch.

I don't know if I would ever want to be a school nurse, but I am asking myself: what if I hadn't been there for you today?

I really wish your mom had come picked you up. I almost took you home with me!

Your student nurse.

Bugs and Home Health

First impressions...?

I don't know if I could be a Home Health nurse -- although I admire these people greatly. I consider them angels walking on earth after today. It may be too early to decide, since today was only my first experience with it, but this is how I feel so far. I spent the day in the hood, going in and out of rundown row houses, next to condemned buildings on either side, and in and out of the projects. This may be influencing my decision not to enter the home health side of nursing, or...

It could be because of what happened last night.

(If you are at all skittish about bugs, don't read any further. I know I wouldn't...)

My dorm room has a history. It has been known to have more complaints than average because of cockroaches. (Because I am right across the hall from the bathroom, the Environmental Services people tell me the bugs sometimes crawl out of the drain in the floor, where they have been poisoned, and then wander into my room to die a slow death.) I may have scrapped the Nursing School Idea if I had known this from the start. I had a couple run-ins last year. Last night topped those.

I was just getting off the phone, lounging on my bed and thinking about my big day ahead. Then, in my peripheral vision I noticed something dark and moving by my leg. Luckily my legs had jeans on them, because my brain stem registered it was a 2-inch long cockroach and had me flying out of bed before that thought even reached my conscious mind. I literally teleported myself into the hallway. (This probably would have happened whether I was wearing clothes or not. I was not in control of my body.)

Whenever I panic about a giant bug in my room, I have trained myself to keep my eyes on it even as I exit the premises, because the worst thing would be Not To Know Where It Is. That would make the place INHABITABLE. It must be vanquished before the place can be occupied once more. So as I was airborne I saw it run up my mattress and disappear behind the head of my bed into the darkness. Vanished. (I think it saw me freak out, and then it freaked out.)

Giant Cockroach = 1...Me = Zero.

I stood in the hall staring into the room already spending the $150 on a hotel for the night because there was NO WAY I would be able to share the room with him. A savvy RA dialed my buddy who lives on the men's floor downstairs and he came rushing to the rescue. The bug crawled out from under my door and there was a loud and noisy battle with a number of large objects used as weapons. It took a long time (probably just seconds) and there was much squealing (mine). The bug said nothing, but me and the girls made a big ruckus.

Giant Cockroach = Zero...Me = a million.

After this ordeal, I wasn't quite ready to re-enter my room and went downstairs to make a call. By now it was the middle of the night. An hour later I skittishly came back up. Wouldn't you know it, there was ANOTHER ROACH lying dead in the middle of the floor! After the initial shock, I squinted at him and just knew he was faking it. Playing possum. I stormed out to get the broom and sweep him out, and when I began -- he revived and began zig zagging around. I WAS READY FOR HIM. I got him out in the hall, and like an NHL player -- I made a big slap-shot and sent him flying to the end of the hall. He immediately flipped over onto his back again and resumed dying. (That had been his big finale.) He remained dead in the hall until another less squeamish student came home and killed him again...just to be sure.

2nd Cockroach = Zero. My nerves = Zero.

I calculated the odds of seeing more bugs in my room as being unlikely (since I only saw 3 of them all last year). I know that logic was faulty, but my brain was enacting protective measures, since I needed to sleep somehow. I decided to take a sleeping pill and consoled myself that at least I'd be unconscious if they decided to crawl all over me in my sleep. Somehow this worked and I got 4 hours sleep last night before clinicals today. (It was an effing miracle.)

(What I really should have done is set a match to this room and let it burn.)

Wouldn't you know it? Today my nurse's territory was in the slums! The odds of running into roaches and other vermin were high...as I was very aware. Some of the places were so skeevy I wanted to douse myself in clorhexidine upon exiting. The patients were all so sweet and my heart broke that they were alone in these awful places. The home health nurse is sometimes the only soul they see for days, so they love to chat. I sat, nodding politely to their ramblings, clutching my bag (since I was warned to Set Nothing on the Floor) and checked the surfaces for roaches -- which I imagined were everywhere. (Clearly I had developed PTSD from last night's events.) I was like a deep-cover CIA agent scanning the room for potential terrorists.

There was one old guy whose home smelled strongly of urine. (Turns out he pees in a bucket in the kitchen so he doesn't have to attempt the stairs to the bathroom). Regardless, he was the nicest fellow ever, and very chatty. I was on high alert in his place (for bugs) because of the condition of the place. I wanted to weep for him. Well into our visit, I had been lulled into some comfort, since my initial checks said there were no bugs in my immediate presence, and I was falling in love with this patient. Then out of nowhere he yelled and pointed at the coffee table! The nurse kind of glanced at him (she has known him for months) -- but me...? I jumped out of my skin thinking "ROACH" and my feet flew up off the ground, my hands kind of covered my head, like someone had yelled "BOMB!" (I am happy to report I did not squeal.) Turns out the guy had just forgotten to point out some paperwork the nurse needed to see, and that's how he decided to communicate.

In the meantime I developed an arrhythmia.

I told my nurse all about the roach incident the night before, and she laughed and laughed and then told me all sorts of horror stories about the big ones she's seen in the homes. This did nothing to comfort me as we continued our visits for the day I can tell you.

Otherwise...I enjoyed my day. And, I'm going back in tomorrow. I only wish I could bring my broom with me.

T-Boned

There’s that time in any action movie when things are going along nicely for our characters and then, in slow motion, a car crashes in on them from the side. Classic T-bone. Nursing school is hard enough without your personal life exploding in your face like mine did this fall.

Before my crisis happened I had seen examples of them in the lives of other nursing students around me. I had shaken my head, wondering how they were pulling through a tough program despite the challenges they faced— some just temporary bumps in the road, and others, life changing events. Maybe the unifying theme I’m uncovering is this: nurses are a gritty, determined lot. I think of nursing often in terms of warfare: bombs are going off all around, and there’s this soldier ignoring all of that to bandage a wound and make their patient safe for transport. Maybe the same person who can do that, can take a hit from life and still finish a nursing program.

At least that’s what I’ve observed so far.

Exhibit A: Vomiting up a Lung. It takes days to prepare to write a nursing exam, but of course the day before the exam is usually the most intensive. A friend of mine was missing from our study group that day, so I went looking for her. As I approached her room, the smell of vomit wafted through the hall. Turns out she had thrown up a dozen times that day and was dozing in between spells. No way she’d be able to study for the exam! Of course she could call in sick and the school would allow her to make it up the following week...but there was already an exam scheduled for that week too. Writing 2 exams in one week would be unthinkable. I didn’t see any other way, but clearly she did. She continued to be sick all night. Woke up in the morning. Threw up. Dragged herself to the exam. Passed it. And then ran and threw up some more.

I was astonished.

Exhibit B: That Baseball Knocked The Sense Right Outta You. Another exam, another study buddy came in with an impressive shiner. Into the evening he was falling asleep on his books and admitted he had been feeling nauseous and sleepy since a fastball connected with his eye socket. (Clearly he had a concussion.) The mother in me was alarmed...and I immediately offered to walk him across to the the emergency room and study with him there all night if he would just GO and get LOOKED AT. The tough bastard declined and with brute force he made it to the exam the next day.

I wanted to wring. his. stubborn. neck!

(You may have learned by now that nursing students would rather lose a LIMB than postpone an exam.)

It was my turn this fall when my personal life came crashing down around me. Suddenly I was on a plane home, missing school and our first exam to tend to a crisis. I won’t go into the sordid details because they are private, but I will say this is something I wouldn’t wish on anyone. Also, it had a ripple effect which followed me back to school and required hours of my attention and mental resources to help keep things on track. I failed the next 3 exams. Going into the final, I was only passing the class by 1 point. People around me and back home were praying along with me that I would somehow pull a high enough grade on the final to pass the course...which I was able to do.

It was a real nail-biter.

The emotional toll was high and I was reminded that there is NO WAY I could be doing this thing alone. Back in the wartime analogy, I felt like I had been shot and was bleeding out on the beach. Instead of letting me perish, my buddies came back at great risk to themselves and dragged me to safety.

God places people strategically around us and I have never believed that more than I do now.

And while I would never invite crisis, it did teach me something. How to ask for help. I have always liked to be the one to rally around someone and be the helper. I’m good in a jam and that’s probably why I am drawn to nursing. I’m not good at having the situation reversed. Being helpless. Powerless. Admitting that to others is so humbling. But letting people you love in, and trusting them to care for you is special too. My relationships are being redefined and reexamined because of what happened. I am thankful for that.

Its such a cliche but now its time to Pay It Forward. I got back to school after break and already there are opportunities to serve others all around me. Its so energizing to take the focus off of myself and do what I can for someone else. I look forward once again to seeing my patients. I miss them during every break.

Going into the new term I have a new theme! Recently, a friend posted a clip from a Rocky movie on Facebook and stated he recognized God in it. Ordinarily I would have cruised right past that but I was intrigued by his claim and had to watch it. I think my friend was right. What do you think?

“The world will beat you to your knees and keep you there permanently if you let it...Nobody is gonna hit as hard as life. It ain’t about how hard you hit, its about how hard you can get hit and keep moving forward. That’s how WINNING is done!”

I was never much for Stallone, but these words hit me right where I live right now.

So its a new term and a new beginning. I have fresh optimism and renewed energy for the fight. Only two more 10-week academic terms, followed by my preceptorship. I see the finish line and that keeps me going.

Who are we kidding? God is carrying me along. He has been the whole time.

First Week in the ER

First off...they call it the ED now. I wonder if they will rename the television show...?

Emergency personnel are my heroes. Hands down. Talk about a group of steely-eyed professionals. I was in a the emergency department big city hospital with a Level 1 shock trauma center and it has been such a great leap for me in terms of advancing my clinical skills. It was also terrifying to realize how on top of everything these nurses need to be and the enormous gap I have yet to traverse to get there. If there was ever a profession that epitomizes multi-tasking, it must be ER nursing.

Every student's experience on a given day will be different -- some of us will hop from patient to patient fairly quickly and see a good number of them during our shift. My first day, I really only saw 2 but that was because I was in the two rooms right next to the trauma bays and we had a couple of patients that needed a lot of care, and took a lot of time.

Codes don't happen in real life like they happen on TV or in the movies. Heck...probably because of this, I didn't even realize I was in one, until my instructor asked me about it later! All I knew, was we had about 15 people in our room for about an hour. Then somehow things turned and poof! -- it was back to just me and my nurse and our very sick patient. During the Code, people were hopping, but somehow it seemed like controlled chaos, this team knew all the dance steps and stayed out of each other's way as they all performed their own tasks. The doctor was so relaxed and no one was shouting, just quietly going about their business. Amazing.

Since I could do hardly anything but just stay out of their way, I had time to notice random things. Since my nurse and I had personally inspected the room and gone through every drawer with an inventory checklist -- I knew we were ready. And I could see why he took this step VERY seriously. As the Code ran it's course...the floor just got filled with debris. All the packaging for every supply was on the ground and they ran through supplies in a shockingly fast clip. I began to think about how, not having one critical item and that crucial moment could just make it or break it for my guy on the table, fighting for his life.

Then there was a whole nurse just standing off to one side documenting everything that happened, every drug given, dose and time. Every order. Procedure. She was like the court reporter. And...its because of today's law-suit happy society that we have her.

All of the "right ways" we learned to do things in class...many fall by the way-side when there is no luxury of time. And that's not a criticism.

Then I saw symptoms occurring in my patient that I wondered if I would ever see. It's called "Decorticate Posturing" and it's sad that I got to see this in real life, because it's never a good sign when the arms go really stiff and flex outward. But I saw it.

I also noticed veteran nurses who have done it a million times struggle with things that I would struggle with now, and that kind of comforted me. After a patient is given an artificial airway, they often need to get a tube down to decompress the stomach. Getting that tube down can be tricky. Even for the pros.

So we got through the Code and after a few hours, our patient was transferred up to the floor and we turned our attention to the next patient. She was thrashing around and confused, so when it came time to give her an IV, I had to wrestle to keep her arm still so my nurse could get a line. After a few failed attempts she had so much blood running down her arm and onto her hand that it looked much worse than it had to be. But she managed to work her arm free at one point and grab my white sleeve with her bloody hand and I looked like I had been finger-painted. It reminded me of old episodes of MASH and how Hawkeye was always awash in gore.

For this lady I got to apply restraints. Something I haven't really had to do before. She was a really sweet little old lady who just needed a little help to keep her safe.

The next day was more excitement and I saw many more patients and got to do more things. Sunk my first IV, a nice big 16 gauge needle, which was awesome. There's this thrill when you see the flash of blood return in the catheter and know you got it I just can't really describe. I'm sure they would discourage cheering, but that's what I wanted to do.

One patient stands out and will likely change how I worry about people who live alone. She had gone down in her home for a week before she was found. She was in a very bad state by the time we got her, and she smelled wretched from having laid in her own filth for that long. Soooooo sad! My eyes would water any time I approached her room. The other nursing students hadn't gone in, but I finally wanted to help and went in and offered. It was just so great to take care of her and make her comfortable. I figured if the whole floor could smell her, surely she could too! We made it better and that's when the nurse I was helping looked up at me, laying across her and holding her arm in position for him to try and get a vein, and said, "Now there's a REAL nurse!" Meaning me! I asked him why he said that and he replied, "You see any other people in here offering to help? We're not that busy..." I floated on that compliment the rest of the day.

I do want to be a REAL nurse.

:)

Exorcisms and Lunatics

A report from this term studying Acute Care nursing, which includes time in the ICU, ER and the Psych unit. We are starting the last half of this term and it has been quite a ride both here at school and in my personal life. Since this blog is about nursing school, I'll focus on that.

First, the med-surg update, wherein I spent the first half of my clinical time taking care of VERY sick and dying patients in the step down critical care floors. I would describe this part of clinical as being thrown right into the deep end of the pool. Where previously I'd have the occasional challenge of more than one IV bag/ pump to deal with, the odd Foley bag or maybe an exciting deep wound dressing to change, usually it was just one of these things at a time to focus on. By contrast, with THESE patients, it was like the Nursing Gods said, "I'll SEE your bag of poop, your purulent wound, your bags of fluids....and I'll RAISE you a feeding tube, PLUS, three more pumps, AND a trach, a vent, heart monitor, an ART line, dialysis, and a couple of amputated limbs!"

The question was more like, "What WASN'T going on with my patient....?"

Like adrenalin? ...Become a critical care nurse.

You might recall my lingering fear of patients who have an artificial airway and the phlegm that is associated with it. Yeah...I'm pretty much over that. Each patient I had this term had this going on...sometimes to an alarming degree. My gag-o-meter did blip a couple times as I initially learned to suction, and I by no means relish this task, but because I did it so often, I became desensitized. I did have my nursing instructor's haunting words running through my mind as I dealt with the holes in the necks of my patients and tried to keep a reasonable distance from that opening. He said, "Make sure you keep your mouth closed when you suction...because a patient coughs and it will shoot straight in your mouth! So no talking!" I pray this never happens, and yet I can see how easy that foul outcome could occur. These folks generate a LOT of goop. Nuff said.

You might be wondering why I refer to exorcism in the title of this post. [Queasy people will want to skip ahead.]

Sadly, I was about to call a priest to fight the demons I thought must be inhabiting my poor patient one day. It was straight out of the movie. She needed just a crazy amount of medications that we needed to give into her feeding tube. It was a staggering number and I just kept thinking, any healthy person would feel sick after all this. [Foreshadowing.] There was also a decompression tube sticking out of her belly that emptied into a bag on the side of the bed filled with both stomach and bowel contents. It was a sick dark forest green / brown and I had to fight from walking in a circle around it just because I feared bumping it and somehow spilling the mess on the floor. The night nurse had changed it and had reported it was the most foul-smelling brew she had ever encountered. That was enough for me...and I was just grateful that the bag was not even close to full, meaning I wouldn't have to change it!

She also had a trach, so she breathed out of a tube in her neck. After a student and I had done our morning care, flipping her this way and that, tidying her bed up, we began raising the head of the bed back up and that became our exorcism nightmare. Suddenly noxious green-brown goop started gushing out of her mouth and down her chin! Terrified it was going to leak right into her trach airway and she would inhale it...I jammed my (gloved) hands under chin and began catching the stuff and my partner quickly tried to suction out her mouth! That's. When. The. SMELL. Came. And my eyes instantly began to water and my own stomach threatened to heave. Nothing could touch this...not a pus-filled necrotic wound, not poop, not vomit. This stuff made me want to run from the room and never return. And just as we would catch up with the suctioning, more would gurgle and froth from her mouth making me wonder just when her head going to start spinning around and she would levitate from the bed!

We eventually got her cleaned up and settled and I sent the trash far FAR from the room so the smell would fade. As much as I hated this, I just kept thinking how bad was it for HER?? This girl had so many things wrong with her I couldn't fit it all on my clinical paperwork, she couldn't talk, felt sick and then something as nasty as that had to happen. And she was MY age!!

Acute care has taught me that when things go wrong...sometimes they go very, very wrong. 

So far I got to see and do so many things in the first half of the term, that it was very exciting and terrifying. I am now in my psych rotation and that is like moving from one planet to another. I'll end my term with 2 weeks in the ER, which could get really interesting.

I'm back from my day with the crazies.

Actually, my 2nd day. A few weeks of psych lecture and all of the conditions and their lists of signs and symptoms began to merge together. Depression, bi-polar, schizophrenia, severe anxiety. And we haven't even covered them all. Then I got to go to the floor and saw the real stories and the real people whose lives are utterly destroyed by these conditions. Many of them will never be okay and lead a normal life. But they are not just a list of symptoms to me anymore.

I observed an advanced case of schizophrenia in a relatively young woman. She sat and rocked, carrying on conversations with people who weren't there. I thought to myself how strange to live in this age when if I saw her walking down the street talking out loud like that, I wouldn't even wonder. I'd just think she had a hands-free bluetooth device in her ear and I'd walk on by. In decades past, that behavior would stand right out.

I interviewed another schizophrenic, a pleasant enough guy who was happy to talk to me. I got through a number of questions when he casually mentioned he'd done time for killing a couple of people, like he was commenting on the fine weather we were having.

Another young guy looked like he should have his whole life in front of him is debilitated with bi-polar disorder and completely isolated from society. He was smart and funny, and didn't mind that I whooped his butt in a game of chess. Then I read his file and saw the downward spiral he has been on and I grieve for his future unless medications can help correct his condition.

So many psych patients isolated from society for something they can't help. I'm profoundly sad about this and my experience with these patients has given me a lot more understanding of just how derailed and lost they are. I know for sure I'll never want to be a psych nurse because the hands-on care is part of the job I really like and I'm not sure I have the mental stamina to deal with what psych nursing entails, but I also know that I'm looking at the whole issue in an entirely new light.

Old-Timers

Or...Alzheimers.

We spent time studying dementia this term. I have to say, I never really thought much about this patient population before then, which is weird because both grandmothers succumbed to it. And because of it, I have often joked that I'd rather go out in a fiery ball of flames while still in my prime than lose my mind slowly. When I saw on our clinical rotations for the term that we'd be spending time at an Alzheimer's facility, I quietly freaked a little bit.

Old people scared me as a kid. I thought they smelled off. They shook. They pinched my cheeks too hard. They cough and hack up big loogies. (During my childhood, a loogie expelled by an elderly person in our front seat unfortunately stuck to the inside of our windshield during some drive...and I was the only one to notice it there, dangling and suspended for the duration of the trip. This memory has unfortunately stuck with me...and launched my fear of both old people...and phlegm in a single incident.)

I grew out of that, and now I really enjoy the company of our older generation. But I do admit that sick, old people still kind of unsettled me prior to entering this profession. I don't like to see suffering of any kind, but I think seeing older folks sick in bed touches something primal in me which says, "that'll be you someday" -- and I'd spook.

Armed with our new knowledge of the disease process and nursing care associated with Alzheimer's, we began our time at the facility -- no ordinary home, the place is dedicated to this type of patient, and one whose family can afford the six grand a month it costs to live there. It was outside of the city in a very affluent community and I already wondered where they house the ones who can't afford to live there.

I don't know what I was worried about...because I can now say I enjoyed my time with these patients so much, I had a hard time leaving them. The place was as homey as it was possible to make it, the staff were loving and very skilled at communicating with patients in various stages of the disease. Our biggest objective wasn't to provide nursing care to these folks -- it was to learn how to communicate with them effectively. So we went there primarily just to observe and interact.

What did I do?

I fed a lady who was becoming too advanced, she was close to needing to be moved into a full-time nursing facility, because she was entering the final stage. She was non verbal, unable even to eat by herself, and wandered around vacantly the rest of the time. I would occasionally redirect her, or bring her to meal times. She also fell (so common) and I was first to her side, trying to keep her from attempting to get up until a staff member could be sure she was un-hurt. Other than a nasty goose-egg, she was okay. Still, during those minutes trying to keep her still, I saw shear terror and pain in her eyes, and it was all I could do to keep her from panicking. She nearly wrenched my arm off trying to rise -- which reminds me that caring for these folks can be very physical.

I danced. When the singer came to entertain everyone, we were encouraged to act as a pep-squad; handing out tambourines, bells and other instruments for audience participation. We clapped and sang along and I was amazed how even some of the more advanced patients could recall every word to the oldies! There were a few gentlemen who were willing to get up and once they did, still remembered how to lead me in a fox-trot. It's true that long-term memory can linger when short term memory is completely shot.

I took orders. Some of these patients are quite un-patient-like. They could be mistaken for staff. One younger lady was so convincing, she started ordering us around to tidy up. "Get these chairs put away!" "This place is a mess!" Thinking she worked there...I helped stack some chairs! Doh!...she was a resident. [This was amusing to the staff, and to my instructor.] Patients wear clothing, not gowns -- and because of "white coat syndrome" (a fear of medical professionals), the staff also wear street clothes. So, for a newcomer, it can be tough to tell them apart!

I rocked a baby. Another very advanced lady carried around a doll who had a name, and who was very real to her. (This is actually quite common...to bond with a favorite item.) In any case, during the music session, I watched her point to the singer and whisper things in her baby's ear. She would rock and mother her, and bring her everywhere. When it was time to get this lady into the bathroom, she was very unwilling to put the baby down in order to go do her business. The staff member saw me nearby and offered my help to "hold the baby" while she went. I swear this patient pinned me with her eye contact as if to silently warn me that this was a Big Deal, and handed the doll over. I effusively reassured her that I took this task seriously, as any mother would, and reflexively began bouncing and rocking the baby! Then...since toileting can take a while, the staff member went to a nearby counter and began folding laundry and asked if I'd like to help. I nervously glanced back and forth between her and the bathroom door -- what was I supposed to do with the baby?! I'd made this promise to look after her! I laid the baby down on the counter, kept one eye on the door, and helped out. The SECOND I saw that door handle jiggling, I swooped up the baby, resumed my stance and surrendered the it to my nervous mother when she emerged. She snatched her back and all was again right in her world.

I passed out snacks. We all rolled a cart around and became very popular as we handed out ice cream, asking vanilla or chocolate, and serving it up. Many times when we returned to our customers...they had forgotten what they ordered, but were still happy to see us. Then, when we had made one pass around the place, we still had many ice cream cups left -- as many patients had declined. One student asked me..."Shoot, what do we do now that we have so much left?" I said, "Let's go around again, they won't remember us being there the first time!" And it was true. Many that had declined before, took us up on it the second time around. And it is so important for these patients to keep weight on, or even to gain weight, that we didn't want to waste an opportunity.

I took a walk. One lady appeared quite standoffish, and was even referred to as snobby. She had this old-world, old-money feeling to her. Considering the zip-code, she very likely was! She kind of glared down her nose at everyone, and mostly wandered the hallways, looking at the driveway, as if expecting her chauffeur to arrive at any moment. None of the students had engaged her yet, so finally I mustered up courage to ignore her glares and offered to take her for a walk. One of the things we learned is that in those patients who were raised in higher social circles where manners and "social graces" were expected -- they can cover the onset of their disease in the early stages with meaningless pleasantries. In fact, on our walk, I relied on that and she graciously answered my remarks about our fine weather, these lovely roses, and other generally acceptable social ice-breakers with the expected replies. Anyone listening in on our conversation wouldn't really guess she had Alzheimers. This is because I didn't ask her any questions that required recall. However the answers were robotic, and yet allowed her some feeling of normalcy as we strolled.

When it was time to go, I had bonded with so many of these folks, and with the amazing people who cared for them, that I was a little sad to leave. On my way out, I approached the lady that I had fed, the one who was non-verbal. I said good-bye expecting no response and instead she reached out and hugged me and then, plain as day said, "Thank you. Good to see you." And all of the nursing students, and our instructor just stood amazed, grinning. They were the only words we ever heard her say!

Okay, I got a lump in my throat after that.

I have a whole new outlook on the subject of Alzheimer's now...and consider my time with these folks a gift. So many of them will end up in my hospital, and because they will be out of their environment, in crisis, and away from the caregivers who know them and their particular needs so well -- they will be frightened.


I'm so glad I got to practice how to reach them.

Shock of Re-Entry -- Summer Break

I've been so busy, I neglected to blog the whole last term! And now I've been home for three days. Time to catch up.

It would be too much to try to cover all of my impressions and experiences I had during this term in one blog post. I'll make it a summer project to reflect on all of that. Tonight I'll focus on current events.

Friday, on 48 hours with little to no sleep I wrote my final. My study group and I had to literally pull each other across the finish line because individually we had all hit our respective walls. Among us we had chain-smoking, endless fits of crying, incoherent babbling and fits of rage. Pure adrenalin pulled me through and then I clenched for the "rest of the story" -- because as much as we all wanted to celebrate in our usual fashion (corner bar at 11:00 am over beers), we knew we'd be saying goodbye to students who found out they failed out of the program. So far I know of 7 good people who won't be with us in the fall. It makes me profoundly sad to see some of them go. So the last day of any term is bittersweet.

On top of that we said goodbye to our graduating seniors that night. So after a couple of beers, I went back to the dorm for two hours of precious sleep, before rousing to attend the graduation ceremony. So...more tears, albeit happy ones. Still-- I'll be missing some of the good friends I made this year. The seniors did provide some great insights and encouragement in terms of getting through this first year. I can't wait to hear how they all do writing their boards this summer and landing their first jobs. They must know They Are Being Watched!

During finals week, students were succumbing to illness all around me, and I smugly boarded the plane home thinking I had avoided it for once. Don't know what I was thinking. I got sick my first day back and I may be getting sicker by the day. Bronchitis, rhinitis, laryngitis and otitis. You know another -itis? -- I probably have that too! This may be the universe's idea of a joke, because I was going to be without health insurance for only about a week and a half before I start back at work next Tuesday. So, of course, I'll probably get pneumonia the way this is going.

I feel out of sorts being back home.

At school, we literally have bars around us when we go out on the porches (to keep us from jumping off??) Of course, it feels like prison. Many jokes are made about this, and...like prisoners, we fondly start off many conversations during middle of the night with, "When I get outta here, I'm gonna...." (Fill in the blank.)

So now I'm out. I'm free!! At least for about 6 weeks. Maybe its the time zone change, maybe its illness, or...more likely, its Post Traumatic Stress Disorder -- but being on the outside feels very strange. Like I've forgotten something. Or I should be doing something. I just don't know quite what to do with myself. Reconnecting with friends and family is lovely, and I'd be enjoying that more if I wasn't coughing up a lung and without a voice. But, there's this nagging feeling, it's almost surreal. I walked down the steps to my home, for the first time since I left for nursing school last summer, and I thought..."Did I just wake up from a bad dream?" It all felt quasi-normal: heading back down to the cabin on the beach, walking the same steps, trailing behind my son who was carrying all the heavy stuff as usual. But this is only a brief interlude at the mid-point of this journey called nursing school. The friends and family here can't really know what it's like doing this...and my "fellow prisoners" are all enjoying their brief parole back east.

I think it's time for self-care just now. I better bite the bullet and go in for a throat culture before this pestilence in my throat turns into full-blown pneumonia -- which will waste too much of my precious time. In a few more days, and with the help of some really good drugs, I'll finally ease into my summer and enjoy it!

I'm Pretty Sure the O.R. Made Me Shorter

I loved my two OR experiences. LOVED them! I know for sure I don't want to work in one...at least, not right now. But the experience was so rewarding.

Last week I got to see a surgeon hunting for a bullet that had been lodged for 2 years in the guts of my dear, sweet patient. The doc hunted for that thing like an easter egg before giving up and repairing the damage it had done to his parts so he could look forward to a "normal life." I met the patient before the surgery, watched his insides get rebuilt for several hours, and then stayed with him in the PACU for a couple more hours since he had nobody there to hold his hand, except his two prison guards. We had a good talk about his hopes and dreams and I didn't leave his side until I was made to go.

Did I mention he was a prisoner?

I wish I could share how much this case touched my heart and reminded me of why I wanted to be a nurse in the first place, but...there are privacy laws. Let me just say that I hope I never forget him. The other students watched as I fed him his ice chips and stayed close so he wouldn't be afraid and declared that if they are ever in the hospital, they want ME as their nurse!

Aw...shucks. 

Today was my final day in the O.R. rotation and I faced another fear. The fear of watching the gore that is an orthopedic joint surgery. Why is this my fear? Because I had four surgeries to rebuild my humpty-dumpty left arm not so long ago, and have some titanium in there to prove it. Since I'll be facing more of such surgeries in the future (for maintenance) -- I just wasn't sure I was up to seeing up and bloody close just what goes on in there!

Meh. No big deal. I was glued to the procedure the whole time. I orbited all around the table to make sure I saw every drill, wire and bolt. It was disgusting and fascinating. I loved it.

What I do NOT love about the O.R....

The fashion. Really, the only way to express oneself is by way of eye makeup. (Designers like to express themselves.) It's kind of like a Burka-Situation. The puffy blue hats are as far away from sexy as possible. And you can think some guy could be good looking under all the layers of blue...and yet be disappointed when the patient is rolled away and the guy lowers his mask.... I'm just saying. 

It's a meat locker. If you are perpetually cold, like me, this environment is unacepptably frigid. Good for patients because bacteria like warm places to grow. Bad for me. The menopausal ones around me LOVE it.

The lead. If you are going to work in an orthopedic OR, they will ask you if you are wearing lead. You may think about the uncomfortable underwire bra for a second, and then say no. And then they will wrap you in an apron of lead down to your knees and you'll stagger away under its weight. They take lots of x-rays while they drill holes in bones. You will consider your pre-osteoporotic bones, and of the discs of your spine crushing in on themselves under the weight of this new torture device. You will wonder why you didn't drink more milk and if you will be two inches shorter by the end of the day. Bad enough that you will be standing on your feet for four hours in a meat locker, but now you are also shrinking.

And then the surgery will be over and you will take off the lead...

And you will float away!!!

Friday...Glorious Friday

It isn't uncommon for me to feel like I "crash land" into Friday at the end of every week while in nursing school - however this week is more like a meteor plummeting from space. This is because last night marked the first night that I (among a small group of hearty souls) pulled an all-nighter before our exam this morning.

Now I remember why I don't do that anymore.

The grades aren't where I'd like them to be this term. I had anticipated this coming into it because of the heavier class load, however, I'm not thrilled that I was proven right. I don't mind the grades dipping, since I never started out with the idea of being an A student. I want to be a balanced student. However I'm especially displeased that I'm missing points this term simply due to Operator Error! I failed my first exam in my life this term -- which was extremely puzzling since I knew I had prepared at LEAST enough to PASS. Well in the post-mortem, it turns out I marked an answer on the answer sheet on the wrong line, and that made the subsequent five (correct) answers, also wrong! Doh! I don't mind missing points for answers I had no clue about, but it does chap my hide to miss them because I didn't bother to go back and check that I'd filled them out correctly!

Still, the poor grade is a black mark on this term's grade-book for me, and is in part why I decided to cram all night for today's exam, on which I did admirably - but still not up to my usual standard.

I think I've just identified the theme for this term: Not Up To My Usual Standard.

How very underwhelming.

We are two weeks away from finishing term 3 and yes, that theme just about sums it up. As promised, the term was incredibly hard academically (and the beatings are far from over). I found myself hitting new lows in every area: emotionally, academically, endurance, nutrition, exercise...and personal hygiene.

An older gentleman stopped me as I was leaving my favorite diner/study spot this weekend, put his hand on my arm and said, "good luck in nursing school -- it's the hardest thing you'll ever do." (I was wearing my school sweatshirt.) I said, "You a nurse?" He smiled and said yes. I wanted to throw myself into his arms and cry, but instead I gave him a wobbly smile and said, "It IS hard, in fact...it's kicking my ass!" And we both laughed.

It has been kicking my ass, I'm not going to lie.

And in the middle of the "fog of war" -- I'm amazed at the things that can occupy my mind and interrupt my thoughts. All of them seem oriented around the bottom of Maslow's Hierarchy of Needs. The following list are random thoughts I have had during lectures about gangrene, osteoporosis, amputations, etc:

[I am estimating I will fall a few points in terms of your respect for me now...]

"I wonder when I last washed my hair?" 

"Did I wear these clothes yesterday?"

"When did I last eat?"

"I wonder if I have any money."

"I wonder if the cafeteria has pie."


"Mmm...I put clean sheets on my bed. Man, I want to be in my bed right now." {I actually yearn for my bed like a lover on most days.}


"How can I write this Care Map and still watch Idol tonight?"


"Did I go pee yet?"


"OMG -- am I out of BUTTER? How can I make popcorn and study all night without BUTTER?!"

Yes -- lofty thoughts, those. Oh sure, other stuff breaks through now and then. Things like world peace and the fallen state of man, n' such. But don't be surprised if you call me one day and say...what about those elections? And I say...what elections?

It's that bad.

Gag-O-Meter

I have rejoined the living after the busy day at clinicals, thanks to my three hour power nap. I still have much to do and its already rounding on midnight, so instead of getting started on all that...of course I'll blog.

First of all, I kind of smirk when I type: "busy day at clinicals." At this point, I really think the words "busy day at" should just be implied. I think I have a really high tolerance for change on the fly. Heck, I ran a design studio for years, full of creative and brilliant lunatics. There existed no linear process of A to B. I honestly don't know how folks could enter the medical profession if they were wired to expect to make a "plan" and then "follow it" to the letter. Still, even I am constantly adjusting to the whole new world of crazy that is the hospital floor.  As we are learning in school, there is the "ideal outcome" for any given situation, and then...there's what really happens. Reconciling how far apart those two things really are is always surprising for me. And I'm a Type B! Lord help all those Type A nurses out there!

One incident today (among several less interesting things) shot my best laid plans all to hell. It also makes for an interesting story, although those of you with a delicate constitution may like to skip it and go back to whatever it was you were doing.

THE HEMOVAC.

Sometimes when you have surgery you'll wake up attached to a circular accordion-like vessel which is about the size of a saucer. The surgeon will squish down this plastic device, which is attached to a tube inside your surgical site, and which will then provide a bit of suction and a place for that nasty stuff to collect outside your body. This is a Hemovac, and today my knee-surgery patient had that snaking out of his tidy full-leg bandages on his first morning post-op. Of course I was excited to see it, since it would be something new for me to experience. He also had a couple of wires sticking out of his tush, a nerve block that kept his whole leg blessedly numb. In other words, he had a lot of lines which could potentially detach from him and ruin both of our days.

Of course that's exactly what happened...and how I discovered the presence of my Gag-O-Meter.

Man, we were SO close to the end of my time with him and everything before that had gone swimmingly well. I even got to give him his mid-day IV push medication. Afterwards my instructor had gone over how I would empty his drain, as it was now expanded about two inches full of blood, and courtesy suggests we don't leave these messy tasks for the next shift...we take care of them before we go. She trustingly left me to do this solo and went to deal with another patient. However, for moral support, I snagged another student who had just completed this task and was willing to talk me through it. Since it was essentially a bag of blood, I figured a mistake could easily ruin both my stark white outfit, AND my reputation!

So my patient was tucked neatly into the freshly made bed (which I had just finished making up while he was at PT) and was starting on his lunch of rubber turkey and powdered mashed potatoes when we approached to deal with the Hemovac. I flipped back the crisp white covers and instead of the cleanly bandaged leg resting on clean white sheets -- he was laying in a bed of gore! Bright red blood was leaking through his thick bandages, beneath him on the bed pad and all over the covers! (My bed!) His drain, and its now detached tube were lying impotently beside him. Since his leg was fully numb, he couldn't even sense the wetness he was lying on.

Rather calmly, the other student and I began to deal with the situation. She went to get a nurse, while I remained with the patient. The male nurse came in, glanced at the bed full of gore and diagnosed blandly, "Drain's out."  (Clearly this was a "no-DUH" moment, but I repressed it.) The patient stated that he felt a little tug about 30 minutes ago, and we deduced that shifting around in bed had pulled the tube out. (I realize this isn't exactly rocket science.)

The nurse and I then emptied the drain out of the patient's line of sight, thankfully. I held the measuring cup and he squeezed. The thing is, it's blood. It doesn't just drain right out when you open the valve (say, like urine would.) I hadn't really thought about that fact ahead of time and I was already somewhat steeled to participate in this gross task. (You just never know what event is going to cause you to toss your cookies.)

If you can picture me on a television screen this whole time, down at the bottom of my screen would pop an animated meter - my Gag-O-Meter, which goes from zero to ten.

It was at zero when I entered the room. And I am proud to report that it didn't really twitch when we flipped back the covers to see the bloody mess. When I held the cup and felt the warmth of the blood filling it, the meter moved up to a 1. No big deal. But it wasn't until the nurse began to squeeze the drain, and this long, dark clot just hung there suspended, and then slowly began to snake, quiver and coil its way into my warm cup that the Gag-O-Meter moved up a couple more points. I realized that if I had been: pregnant, hungover, or was just getting a stomach flu, I probably would have hurled. I couldn't tear my eyes off of the seemingly endless clot, and kept worrying that the nurse would squeeze a bit too hard to force it through and maybe spray us both, thereby soiling my outfit -- (at which point, I very well may have soiled the floor.)

I think the Gag-O-Meter got to about a 3 today. I'm betting at a 5, I would actually gag. At a 10, that's when somebody would be holding back my hair. I periodically wonder when/if these events will happen for me personally. Perhaps it will be in a couple of weeks during my OR rotation. If not, I have a sneaking suspicion that another body fluid may send me over the edge when I start to suction tracheal tubes in the ICU...

Phlegm.

How to Look Like a Dumbass in Nursing School

I'm sitting in a coffee shop this sunny Saturday afternoon on Walnut street after a week of exams that left me haggard and drained by Friday. Pretty sure I just failed my first test ever - the drug exam. Easy to do when failing means missing two out of 14 questions. I hate drug exams, so many data points to memorize...and admit I only gave it a half-assed effort on Thursday night prepping for it. I was already seeing double from long nights of study for the big nursing exam we also had this week.

In any case, instead of studying for the microbiology exam and lab midterm, I thought I'd blog about how stupid I felt this week during clincals. I can't wait until I know everything and will stop sticking my foot in it on the floor! First I'll share just a couple ways I made myself look like an idiot, and will end with a story one of the seniors shared with me, that makes my little faux-pas look minuscule in comparison.

THE LITTLE RED CAP:

When you disconnect an IV temporarily, you need a Little Red Cap to put on the end of the tube, to keep it clean.

I needed to send my knee-replacement patient to physical therapy on Tuesday, and knew she needed to be disconnected in order to go there. I'll admit, I'm still intimidated by IV's...even though we've been trained. The main priority I was given: (since post-op joint replacements are loathe to do this)...Get. Your. Patient. To. PT. Don't put up with their whines. It is BEST for them to be UP and MOVING. (Of course...if you attempt to do this by yourself, without help, we will knock your block off...)

So, I was stressed, since she'd been hinting all morning that getting out of bed would be, impossible. I hunted down my co-assigned nurse and told her we were all ready to go, except for disconnecting the IV. She raised her brows and said, "you up for it?" In my head I freaked and said NO WAY! But, robotically I answered, "Hell yeah!" (Because I'm a junkie for all new experiences.) She smiled like I had given the right answer, and handed me the packet which contained the Little Red Cap. (This is lucky, because I never would have remembered I needed it.) She reviewed what I was to do, and then sent me on my way. The PT assistant was in the room already, and he wasn't going to disconnect it. Not his job. But he, and the patient, were waiting for me. More stress.

I fumbled around with everything. Stopped the IV pump. Closed the clamps everywhere to make sure we weren't all about to get very wet. Wiggled, and strained to get the danged tube out of her IV port without actually pulling it out of her hand. Finally, got it! I popped that little red cap on the end coming out of her hand, and hung the end of the tube connected to the pump back up on the pole, always afraid the end would touch the floor, or anything else, and become contaminated. Since I had nothing to cover it up with, I used a clean glove, as my previous clinical instructor said would work in a pinch. It hung up there like a deflated, blue UDDER. But my patient was free, and together, the aid and I got her OOB and to PT, without any calamities and despite her protests.

SO proud of myself, I asked my clinical instructor to come in and show me how to shut off my beeping IV pump, which knew it was no longer connected to a person and was beeping it's complaints. She walked in and stopped short when she saw my blue udder hanging up there.

"Kristine...what's that?"

"Uh...I didn't want it to get dirty."

Smiling now, "That's good, but why didn't you use a cap?"

"I only had one, so it's on the patient's hand."

"You don't need one on the patient. Their end is has a valve that closes and keeps it clean. The red cap goes on THIS end." (Pointing to my blue udder.) Instantly, I remembered that detail from our training.

FAIL!

I spent the rest of the morning wondering how I could get that red cap off my patient's hand before my co-assigned nurse saw it and realized what a dumbass I am. It was just this bright red thing in the wrong place that vibrantly announced that the student nurse didn't know jack to the whole world! Turns out I didn't get to it in time. Instead I confessed as my lead nurse looked puzzled up at the blue udder. She just smiled and said she'd beat me later for it, but we had other things to do...

(I love her!)

THE BLADDER SCAN:

Later that day, with the same awesome nurse, I proved, yet again, how much of a newbie I am. She allowed me to do the bladder scan on the same patient - now back from PT and exhausted, but who also hadn't pee'd since her catheter had been removed that morning. That can be bad, so she needed a scan, and I was going to do it! After my nurse reviewed the procedure, I bared the patient's belly, got the gel on my instrument and placed it over the bladder area, gently rotating it around a bit.

"Just hold it still and point it at the bladder hon...we ain't having a baby here!" 

Groan. The nurse and the patient both got a kick out of the look on my face.

In any case, these stories are helpful because I PROMISE YOU, I will never swirl the bladder scanner or misuse the Little Red Cap ever again! :)

And hopefully, any student nurses reading this never will either!

I was relaying this story to a few seniors on the porch late one night and they loved them, but one of them blew mine out of the water as she relayed what she had done in her first year on the floor:

THE ICE CHIPS:

This student nurse went to her busy clinical instructor and asked what else she could do that day, her patient was settled and resting comfortably. The instructor waved her off, busy with another student, "just go fill up the ice for every patient on the unit."

So she did.

Then she entered the room of a patient who had just passed away. She looked like she was sleeping, and the student nurse had no idea she was deceased. To the daughter who was quietly weeping, she said "would your mom like some ice chips?"

"She's GONE!" the daughter howled at her!

The student scrammed from the room.

And that's how she encountered her first dead person. She offered them ice chips!

I tell you, I think there's a book here. In nursing school, as punishing as it is, sometimes if you don't laugh...you'll cry.

Enjoy!

Pit Crew

It's Saturday and I'm in lazy mode. Slept in, made a late breakfast (around lunch time) and my goal is to remain in jammies all day. In other words, it's like any other Saturday!

I'm approaching the mid-point of Term 3 and it is everything I feared it would be: extremely rigorous and challenging. The weeks start out with a bang, Monday's being the absolute worst -- a full day of classes ending around 2:00. A quick change into assessment clothing, and bolting down some food before the mad dash to the hospital for pre-planning. Several hours later we return home to eat and dig in for the LONG night of paperwork.

I have yet to get more than two hours of sleep on any given Monday and this continues to frustrate me; not only because I'd like to get more rest, but primarily because I worry that it endangers my patients to have a "zombie-nurse" caring for them the next day. I keep thinking about pilots (since I was married to one) and how the FAA requires them to only work so many hours before they give them a mandatory-grounding to go get some sleep. After all, hundreds of lives are at stake and sleepy pilots are a bad thing. Same goes for nursing in my mind. So, I have begun picking the brains of the seniors around here on the subject of clinical paper work, hoping to pick up some time-saving pointers in order to get a little more rest for my clinicals on Tuesdays. Every Monday is a new chance to learn better time management, prioritization and efficiency -- and I'm determined to streamline. Somehow.

Especially since clinical days are my favorite! I love being in the hospital and I keep winning the "patient lottery" -- each one this term has been a gem. I have just finished my stint in a Telemetry unit -- mostly heart patients and now will spend several weeks back on the Orthopedics floor (which is where I was for my first term). Considering I have a titanium elbow and have had FIVE (yep, five) ortho surgeries myself; I have a great affinity for the ortho patients and can't wait to get back there to see them. Don't get me wrong, my time with the heart patients was fantastic. We actually had a pretty great happy ending there this term. Week 1 we got to listen to a man's chest who had no heart beat -- he was on a VAD (Ventricular Assistive Device), so a machine was circulating the blood continuously through his body. It was eerie feeling for his pulses and finding none, listening to his chest and only hearing a whirring sound. In any case, this young man (in his 30's) had been in the hospital for a month, waiting for a transplant and was getting pretty down, having had a couple of close calls. Well, my last day on the floor, I heard he had finally gotten a match and was at that moment in surgery and hopefully on his way to a new lease on life!

I'll spend several weeks in Ortho before finally getting my OR rotation during the last two weeks of term. I am anxiously awaiting my time in the OR, and wondering if I'll be up for the experience - the gore, the smells, and the hours and hours of standing. It will definitely be a break from the very active clinical days I have had so far.

I was discussing nursing in general with my mom and told her that I feel like I'm being trained to be on the Pit Crew for the human body. We all cruise our way down the road of life, but every once in a while, something goes wrong with our body - the human machine, with all it's electrical wiring, it's circulatory and digestive plumbing, the ambulating pieces and parts. That's where I come in. You'll pull off the road and into my hospital where we will swarm all over you; like the pit crew does for a race car.

And hopefully you'll get back out there on the highway of life, no more worse for wear.

Your welcome.

:)

Snowed in with Cabin Fever

I wonder how cold it has to get before PIttsburgers consider it cold? 

I'm at the diner now and chose to drive instead of walk this morning, considering it's well below freezing outside. Cold enough for me! I trudged the few blocks to the parking lot where my car is located, walked right by it and into the lot, racking my brain to remember where I parked it last. (I drive so rarely now, it takes a minute to recall.) No wonder I walked right by and missed it. It looked like every other car--buried in 5 inches in snow! I finally found mine and unburied it for the short drive to the diner. I figured it was a good idea to get the snow off today, since it's supposed to snow even more tonight and I actually have to drive to the hospital tomorrow, may as well get some of it dealt with today.

In any case, I passed the corner park thinking it would surely be deserted this morning, but of course it wasn't. The hail and hearty deck-hockey guys were out there playing in the frigid cold. It made me smile. How cold before they cancel the game?

I had a severe case of cabin fever this Sunday morning, after having been in the near-empty dorms all weekend and missed my usual friday night out when plans fell through. I consoled myself with Rom-Coms on the telly, catching up on my notes and cross-stitch. Luckily I did make it out Thursday night, unexpectedly. I was invited to karaoke night with a friend and a group of her friends from the hospital in which she works. Got to visit a cute new neighborhood and discover a nice old tavern--The Apple. Her friends were clearly all about karaoke--and I swear they were good enough singers to go professional. I love watching karaoke and singing along! Too bad I can't sing!  :)

There are clear downsides to living in this old building...the fire drills being the most annoying right now. Last year they had something like 36 false alarms, but it still means we all need to leave the building and wait in the park across the street for the 3 fire trucks to come and give us the all clear. The only up-side to this exercise is gawking at the gang of cute firefighters that swarm the building! Nonetheless, I have tallied it up so far, and of the 6 or so drills we've had, I have been pretty much naked when the alarm went off for most of them; just getting out of the shower or already in bed. (I have started getting a little skittish when in the buff, thinking that I will surely hear that blasted bell at any moment.) I'm beginning to take it personally, as if it just waits for the worst moment (for me) to go off. What the alarm doesn't seem to do is go off during the daylight hours, or when I'm fully clothed, or when I'm not even home. Why?

Last night was the worst yet. I had just showered and crawled into bed at midnight when the alarm went off. I glanced at the temperature and, seeing that it was 16 degrees out and snowing, I got myself fully dressed in tall boots and warm coat among much cursing and gnashing of teeth. Other girls chose to dash right out in what they were wearing, choosing the expedient (and undoubtably safer) option, especially had it been a real fire. They later regretted it as they fought hypothermia in the park in shorts and a tee-shirt.

I'm blogging from my counter seat at the diner now that my friends (the old duffers) have finally gone. I love to discuss old cars, the golden age of big band music, the work-ethic of today's young people and various other topics with them. But when they finally go, I get to put on my head phones, dial up some Perry Como (in homage to my vintage diner and vintage friends) and get my work done. Headphones are necessary to drown out the buzz; clanging dishes, shouts of "order up!" from the kitchen, and the gabbing of the waitresses. Headphones also discourage friendly conversation from my neighbors...so I can actually get my work accomplished. Of course, the diner doesn't have WiFi, as I discovered this morning, but I guess I really didn't think it would. It's okay, I brought plenty to do.

This week we went into the Sim Lab and learned all about IV therapy. How to hook them up, the ways to hang medications, give bolus doses through the ports, how to change the tubing. How to draw blood. I was so excited about all this until my clinical instructor told me that students are restricted from putting in IV's at my particular clinical site to which I've been assigned this term! Boo! How am I supposed to practice? By the time I'm actually faced with a real patient it will have been weeks/months since I was trained! I pity my poor first patient for this reason. Because of this, I'm determined to actually take advantage of the open lab sessions they have after class every Friday, so I can at least go practice sticking rubber people...until a real human subject is made available to me. Grrr....

I'll head to Whole Foods later and plan the meal I'll make for friends tonight. Something comfort food, since it's cold outside. I'm thinking a cheesy garlic scalloped potato dish with ham. And maybe pie. Something to stick to the ribs, fill our bellies and fortify us for the coming week. Calories be damned. I really miss cooking and entertaining friends over a meal. Glad to have a friend with a kitchen so I can do so once in a while!

Like a prisoner in a cell...I like to mark off the time remaining in the term on my white board, counting down the weeks until the end, and break. Happy that one week is already behind me, and girding my loins for the remaining nine. Oh well..."It Had to be You" is playing on Pandora, and I have notes to type. 

...Until We Meet Again!

Reflections from Gate B8

Parked by the window at Seatac airport awaiting my flight back to PIT by way of Chicago. Hoping the weather all along my route will cooperate and get me back on schedule.

It's a gorgeous northwest day...blue sky acting the backdrop to our stunning Olympic Mountains in the distance. Finding it very hard to leave home...again. Clearly, my homesick blues have already set in and I haven't even squeezed myself into my teensy coach seat. (What would it be like to fly everywhere first class?!)

Tomorrow kicks off Term 3. I am dreading it entirely. Not sure one week in between terms was enough to refresh my batteries before the hard work begins again. Plus, we will all be returning to the lecture hall, minus a couple of students who didn't make it. It's a bittersweet beginning. I realize we may lose a few now at the end of every term, but saying goodbye is still hard. These are folks we go through tough things with...all-night cramming for exams, scary encounters on the clinical units, and even just the mundane sharing of crappy cafeteria food together. Inevitably...we bond.

We return to find out what clinical rotations we'll have and where. I'm looking forward to that information...very much hoping to be placed at my 1st choice...the big city hospital located nearby, and NOT the smaller, suburban hospital that's a half an hour away. I'm living on borrowed time with the little beater-car I brought here, and hoping to stretch that time by keeping long commutes to a minimum.

I'm not sure of everything we'll be learning clinically this term, but I do know we'll be getting our IV training. I am VERY excited about that! Another skill that will make us more useful on the floor. Also -- I know we'll be getting a rotation into the OR. I'm looking forward to that, but with some trepidation...hoping the experience is interesting, AND that I don't disgrace myself by wussing out when things get gross. Which they will.

Finally, I do dread how busy I will be over the next 10 weeks. Selfishly, I'm hoping my new exercise regime I began when I moved here doesn't get sidelined when the schedule gets full. Taking my runs (nearly) every day is such a mental-health break. I don't like slogging along on the elliptical in the gym when it's too cold or snowy outside, but even that is better than no movement at all. Exercise has been such a de-stressor, and a welcome escape from the dorms.

In any case -- it looks like time to pack up and board the plane. To everyone I was able to see, and to those I missed this time -- know that I love you and will see you soon.

Win Some, Lose Some

For many, today was the low point of nursing school so far. I shall now refer to it as Black Tuesday.

Its the last week of Term 2 and we took a brutal unit test which covered (among other things) acid-base balances, fluids and electrolytes. Hello, SCIENCE! This test wasn't just going to be about concepts, it was about the details. And if you didn't spend time on memorizing a bunch of data, you weren't going to be able to reason your way to the answer. Most of that material was along the lines of, "you either know it or you don't." Many didn't.

Unfortunately, right after that we had our first Drug Exam. I had heard these were brutal, and preparing for it sure was. Again -- it was about a bunch of data; long unrecognizable drug names attached to lists —why would it be prescribed, what action does it take in the body, what contraindications might there be, what signs and symptoms would be associated with those, what nursing care is required? Lists...lists...LISTS!

Even recalling these hazy days of studying, cursing, and suffering that lead up to these two exams gives me PTSD.

For me it's the worst kind of studying. I'm terrible at it. I have a hard time concentrating because it's dry. I embark on mini-acts of rebellion and self-harm. (Like writing curse words on my notes or eating pizza both for dinner at 1:30 a.m....AND for breakfast.) Still, I've learned that I always do better than I think I will, because I have a somewhat dubious gift--I can cram through a bunch of material and the next day go write a test on it and end up with a fairly decent grade. This does NOT comfort me, although many would be happy to have this skill. All this means is I can hold the information in my head for only so long as it takes to pass an exam. Ask me next week...and I promise you, it's gone. Long gone.

I'm also a fairly decent guesser.

When taking a multiple choice test, any time I don't know the answer, I'll pick one, but I'll write a question mark next to the question. At the end of the exam...I'll know how many question marks I had and can sometimes get a pretty good idea of what my score might be. Today was the first day I had an ALARMING number of question marks at the end, and I truly thought it would the first exam I would have EVER failed. (Here at nursing school, and also in my whole life.)

I ended up passing the unit exam with a good grade, but as we went through the test, I realized that I was getting a number of my question-marked questions correct. I still don't know the material, and had no rationale behind why I picked one over the other...truly I thought I was throwing a dart and randomly just selected any answer. They just happened to be the right answers.

The drug exam was a squeaker. Two more questions wrong and I would have bombed it. Failed. 

I don't like how close I came to failing that exam. It was too close for comfort. I also don't like how quite a few lucky guesses got me that decent grade on material I will admit I still don't really know or understand. We'll also be covering this same stuff for the final exam this Friday -- and I'm going into it wondering how I'll study differently so I may end up with more answers I'm certain about, and fewer question marks.

I really don't want to bank on the fact that I'm a fairly decent guesser.

Pretty sure my future patients won't want to bank on that either.

I have one last complaint before I collapse in a boozy heap and conk out from pure exhaustion. (Because NOT going out for several beers today after the blood-bath just seemed wrong!) The timing of those tests stinks. Why both on one day? Especially because of the type of material it was, they could have spread them out. Why wasn't one tomorrow? We've got nothing going on tomorrow. In fact, we didn't even have our FIRST exam this term until week 4...surely by the end of week 2 we could have gotten one exam out of the way and pushed the whole schedule up.

From my perspective, overall organization of the schedule this term needlessly left us with a bottleneck of exams at the end. I've never been one to whine...I know that at times, things will just be hard. However, I do feel that the school didn't really get to see how well this cohort would be able to perform academically had the schedule been more spread out. I raise this complaint because I heard of so many students today who either failed one or both of those exams. I had a little wiggle room in my grade to be able to afford a hit. Too many students did not. I can't help but wonder if we'd all have done markedly better if given a day or two in between such difficult exams.

I know many are taking a hard look right now and asking some tough questions. Am I up to the academic standards needed to get through nursing school? ...Can I continue to hold down one or two jobs and still do it? ...Do I need to make adjustments in my life? ...Do I need a back up plan? ...A safety net?

We all need a break!

Good thing it's a week off coming up. Time to recharge and refocus.

Onward!

Buzzing 'Round Here

You can tell its a test week (luckily not for me) -- the seniors have one this week. Blessedly this week my cohort doesn't have one. Then we have something like 5 tests in the next 3 weeks. You won't be hearing a peep from me after this post. Yes--it's test week. Girls in sweats and messy pony tails flopped over every couch and comfy chair on every floor of the residence. Sprawled in the halls. Smudges under their eyes.

My class was back in clinicals this week. We go on Tuesdays to take care of our assigned patient. That means we do pre-planning on Mondays. The ratio of hours spent planning to take care of our patient, to hours spent actually caring for our patient seems to be about 1:1. Mondays we throw on our "assessment clothing" (career wear) under our lab coats and invade the ward -- looking for information about our patient, usually from the chart. We need to collect about a zillion data points in order to complete our paperwork, which will be due by end of day Tuesday. By the next morning we should be very familiar with what our patient has, how to care for them, what meds they are on (and what they do, what the side effects are, etc) and anything else relevant to their care--even though we have never met them. (We are welcome to meet them and even get our head to toe assessment done the night before...but who has the time?! --Actually it has more to do with interrupting their dinner and their sleep. Plus many of them are coming back from surgery and too groggy to put up with us.)

A person could go blind reading the charts. They are easily 4 inches thick and range from handwritten gibberish, nonsensical (to me) lab results, graphs, charts, and piles and piles of forms. I expect if we laid each page of a single chart end to end, we'd easily travel to the moon. The only good thing is that after weeks of hunting through them looking for the same information, I'm getting quite familiar with where to look. I'm getting faster. But it seems just as I get comfortable with something...they ask us for even more paperwork. So the ratio never really seems to change. One hour of pre-planning for every hour of care. At least for me. But I'm old and slow.  :)

The graphic designer in me is chafing at the poorly designed forms I'm forced to work with. Information design is one of my favorite topics. Its both a science and an art. The healthcare industry could truly benefit by investing in good design. Productivity and comprehension would increase. Error and eye-strain...reduced. Everybody wins! Lord, even the user interface on the "new" computerized charting systems seems pulled right from the early 90's. Nightmare!

Don't even get me started on the signage and wayfinding systems. Cringe!

Tonight I'm studying for a vocabulary quiz on elimination. There are more latin-derived words to describe pee and poo than I ever could have imagined. Speaking of poo -- I encountered my first (and long feared) diarrhea adult diaper change this week, and conquered it. Man...somebody else in my class got to insert their first catheter, while another had a wound vac...how cool is that?! (A wound vac is a machine that basically shrink-wraps draining wounds and applies suction.) And all I got this week was lousy loose stool. I was recently exposed to some pretty gnarly wounds and I just can't wait for more so I can practice my newly acquired wound-care skills.

It is really weird what nursing students think is exciting.