The Unlikely RN

Likelier

2006-01-13T16:48:00.000-05:00

I'm writing 4 and a half months into my job as a pediatric nurse. I've conquered some steps of likely RN-ing: I passed the NCLEX in August (truly horrific, nasty exam but, apparently, passable), began work in September and finished my nursing orientation last week. I've also claimed some personal developments: Daniel and I are getting married in June and we got a dog, "Belly," the best dog in the world.

I'm still learning. I still make mistakes. Most of these mistakes would have been sort of cute in nursing school (Oh, look, I forgot to clamp my patient's PICC line, blood is oozing all over the sheets) are now just evidence of idiocy. Some patient's don't like me. I've only had one stuffed animal named after me (some nurses boast dozens of christenings). But things are mostly wonderful: I do truly love working with children and, better yet, sending them home. It's also immensely satisfying to see kids getting better (our patient's in DKA (diabetic ketoacidosis) can perk up over the course of a single shift). I like my co-workers, I like being autonomous, I like now knowing what my day will be like.

Nursing is a very strange profession: we're expected to teach families complicated home health care tasks and be able to pick up on the slightest changes in a child's condition but it's also my job to change my patient's sheets or to make sure my patient has the right size of diapers. Are there other professions like this? I honestly don't know.

The very good news is that I love my unit: endocrinology and neurology/neurosurgery are very clean, precise specialties with often certain outcomes (except the brain tumors, I hate the brain tumors). And I'm learning a ton. I definitely want to soak up as much nursing knowledge as I can and try my best to consider the nature of the profession so that I can begin to look at the bigger picture.

Finis!

2005-07-22T15:00:00.000-05:00

I graduated this morning and am now officially a "graduate nurse" (the "RN" only comes after passing the NCLEX). The graduation itself was lovely and so much more meaningful than the average graduation since it was only my 120 classmates and I. I am also the very proud recipient of the Edna Schoen prize for "excellence in clinical nursing." The prize was a total surprise and I was so pleased. I was flattered to be noticed for my nursing strengths (v. academic ones).

I had to say "good-bye" to my friends at the reception following graduation as Daniel and I are leaving to go back to Chicago tomorrow morning. Maybe I would have made it through the year without these friends but I don't think I'd have been half as happy or half as un-anxious without them.

PS: I lied about this being my last post - I'll write something a bit more conclusive when I'm back in Chicago and have been able to catch my breath and my thoughts.

Dictation

2005-07-19T16:57:00.000-05:00

The Unlikely RN is dictating this post to her handsome boyfriend, who is NOT editorializing as he is dictated to. The post is being dictated because the Unlikely RN is trying to pack up 13.5 months worth accumulated nursing school junk, which includes 22 hardcover nursing text books, totalling about 200lbs and a cool grand.

My last couple of shifts on the floor went very well. My primary preceptor was on vacation, so I worked with a different preceptor each day. This was a little nervous-making as everybody likes things done their own way (so much for standardization of healthcare). But it was obviously a great way to draw from different people's experiences.

As mentioned ad nauseum, my final hurdle is to write the licensing exam (the NCLEX), so Kathy and I have been doing practice questions. The questions run the gamut from depressingly obvious (I spent a year learning this?) to tear-producing difficulty (I only had a year to learn this?) to willfully obtuse. An example of the first would be something like:

1) A patient discloses their intention to commit suicide to the nurse and says that he has a handgun at home. The nurse's most therapeutic response would be:
a) "Please promise me to go home and throw away the gun."
b) "Doesn't your family love you?"
c) "What type of gun?"
d) "I am really concerned about you. We need to admit you to the hospital."

I'm not even going to bother telling you that the right answer is c).

An example of the second type (tear-producing difficulty):

2) Aluminum hydroxide gel (Amphogel) is prescribed for the client with chronic renal failure to take at home. Why will this patient receive this drug?
a) To relieve the pain of gastric hyperacidity.
b) To prevent curling's stress ulcers.
c) To bind phosphate in the intestine.
d) To reverse metabolic acidosis.

Amphogel? I have no idea what it is. Do we bathe in it? Do we stick it up our butts? Do we suck it down like so much Pepto-bismal? And what in god's name does it have to do with curling? These are things I do not know. Things are things I have never known. These are things I will not know when I am in a sweaty cubicle trying to write this damned exam in several weeks. As it happens (and this does make sense) Amphogel is used to help eliminate excess phosphorous. And it turns out that you drink it. I would like to see the compliance rates for this drug (Mmmm...yummy gel).

The worst sort of question is the one that makes no sense at all. For example:

3) A 30 year old patient is experiencing a spontaneous abortion (miscarriage) at 8 weeks. What do you expect the patient's primary emotion to be:
a) Anxiety
b) Guilt
c) Fear
d) Ambivilence

One thing nursing school did not teach me and, in fact, taught me NOT to do was to presume a patient's reactions to a difficult situation. I would be frightened if baby-parts were coming out of me; I would be anxious about my ability to conceive again; I would be guilty because maybe I did something to cause the miscarriage; and, depending on the circumstances, I might feel quite ambivilent, since I might not have wanted the baby in the first place. The answer is guilt.

So this is what I'm struggling with. To prepare me for questions like the last one, the Illinois liscensing board has been kind enough to make the application process an absurdist's wet dream: a charming combination of Ionesco, Beckett and the flippin' urinal on the gallery wall. It keeps me awake at night.

So all this brings me to this Friday when I graduate, which signals the end of both nursing school and the Unlikely RN. I think it's inaupicious to go into nursing with the epithet "Unlikely" and I plan to go about becoming a likely RN offline.

I'll be back on Friday for one last post. See you then. And boy my boyfriend is handsome.

2 Things

2005-07-11T07:42:00.000-05:00

Thing That Made Me Cry Happy:

There is a contingent of clowns that visit the Children's Center during the weekdays. They are specially trained Big Apple Circus "hospital clowns" that are meant to delight and amuse inpatient children. Working on an adolescent unit, I haven't seen these clowns once. Clearly, their training lets them know that their act would not be a hit on the floor. However, they came by the other day and asked if there was any one who could use a clown. I was taking care of a severely disabled teen-aged child (cerebral palsy with mental retardation) with a developmental level of 6 months or so. I had told them to come in an see this patient who can use all the stimulation she could get. The clowns came in a did a little song and dance and then blew bubbles popped them on the child's hands. The patient broke out into a huge grin, showing a dimple I hadn't seen before. The kid was so happy her whole body shook. I cried, the clowns cried, everybody to whom I've told the story has cried.

Thing That Made My Cry Sad:

It is a sad thing but I can no longer eat pudding, or at least vanilla pudding for the rest of my life. I had two patients yesterday who vomited the vanilla pudding that originally appeared on the lunch tray (the problem was clearly in the pudding). I was present for both "episodes of emesis" and one episode came dangerously close to my own pudding hole. It was an awful smell (sickly sweet) and I showered the moment I got home. The thing is, I really liked vanilla pudding.

A Couple More Things:
- Thanks for people's NCLEX advice - I can use all the advice I can get
- 15 down, 3 to go
- Last night was the first time I slept more than 5 hours straight in the last 14 days

Circadian Arrythmia

2005-07-06T13:58:00.000-05:00

I missed my shift on Monday night due to what's turning out to be a very nasty chest cold and the fact that I looked so sick I wouldn't want me coming within 3 feet of me. Well...that's actually impossible but you get my point.

So instead I'm trying to prepare to work three day shifts over the coming 4 days. As I've mentioned, it is so hard to go back to being awake during the day. Not even NyQuil (big "N", small "y", big "Q") and some Sleepy Time tea let me get any sleep last night. So I'm hoping exhaustion gives me some uninterrupted sleep tonight. You think my body would by dying for some sleep without ear plugs and a pillow squished over my eyes to mimic darkness.

But enough whining about my schedule. Let's whine about the NCLEX! The NCLEX is the national licensing examination I'll have to take before I begin my job in September. It is a test of "minimal competency." The good news is, then, that the test can't possibly be THAT hard if it's only showing you're not a complete nurse moron. On the other hand, how devastating would it be if you didn't pass it? I'm doing my best to start studying but it might have to wait until after graduation (in a mere 16 days!).

12 down, 6 to go & 8 notes

2005-07-03T17:26:00.000-05:00

I have six shifts left and I worked 4 of the past 5 days. All night shifts. And I'm tired. And physically sick. My lymph nodes resemble Volkswagons. But it's not that bad. Honest! I'm still enjoying the work and have had all sort of positive and negative experiences but even the bad ones have been worth it.

Several notes:
1. Teenagers can be real a-holes (again, I work on an adolescent-only unit). The full-out 100% lippy a-holes are fine and I can cope with them. The ones who are manipulative and whiny and boss their parents and nurses around make me want to throttle them. This is a worst-case patient scenario because you not only have an undesirable patient but you also have a cranky and pissed off family looking for someone other than their sick child to get angry at (hello student nurse!).

2. I have found the caregivers of my severely mentally and physically disabled patients to be shockingly caring, patient and good-humored.

3. I have tried to demonstrate initiative and sticktoitiveness becoming of a nursing student by offering to help the other nurses on the floor. This means I change 3-5 diapers a night. Remember, these are adolescent diapers.

4. I suctioned my first tracheostomy patient and it was not terrible. It was actually sort of satisfying to get all of the mucous out of the trache so that the patient could breathe easier.

5. I continue to be master of the urethra and successfully catheterized a young woman on the first try.

6. While the other nurses are scornful of the new residents who started on July 1st, it was wonderful for me because all of a sudden there was a crop of physicians who were pleasant and willing to answer my questions.

7. I am showing progress towards being a "likely" RN.

And one more thing:

8. I got a card from a patient thanking me for my "compassion" and "making [their] family's stay easier." Yeah, I cried.

Singapore

2005-06-28T16:14:00.000-05:00

I had a relatively long break from my placement (4 days) and go back tonight. It was pretty much impossible to re-adjust to sleeping during the night during this break. It was like going abroad and being jet lagged. However, I've never been more than 6 hours away from my home time zone and this time I'm 12 hours away. It's like the 5 blocks to the hospital has turned into a 14-hour flight to Singapore.

Of course, my friend Erin is actually doing her placement in Singapore so she technically could experience no jet lag at all. However, seeing as she might have travelled to Singapore to do something other than sleep during the day, I imagine it's been pretty tough. Also, they do 13 hour shifts on her floor! However, they also encourage their nurses to take a wee nap over the course of the night. I can't wait to hear how her experience has been so far. Hey Erin - wouldn't it be great if you could write a guest post? Wouldn't it?

At the end of my last entry, someone commented that they think it's all right for me to talk about patients. I'm not so sure. On a legal, privacy standpoint I'd be fine as I never reveal too much information about anyone. However, it wouldn't take brain surgeon (or even a mildly delayed child) to figure out where I go to school. Also, I try to put myself in a patient or parent's place: would I be happy if the nursing student who took care of me or my child today ran home and wrote about the experience so that hundreds of people could read about it? Probably not.

But it's a shame. Patients and their stories are more entertaining and/or tragic than anything I could come up with.

So so much.

2005-06-22T07:01:00.000-05:00

I have seen so so much over the past week but it feels wrong to write about patients. So I won't. Even though I'd really really like too. And I'd have so so much to say about how very awful, difficult, endearing, sad and sweet it can be.

I like being a nurse.

Last night I had a different preceptor who gave me some excellent constructive criticism about my charting (i.e. how I describe what is going on with my patients). Apparently, I am a bit too narrative in my charting style. Shocking to you all, I'm sure. In any case, I was glad to finally have someone not just say "Yeah, that's fine" which has generally been the case.

So tired. I worked back-to-back nights and have a class today from 12:30 - 2:30 so I can't even go home to sleep because it's just not worth it to return so quickly. So I'm at the public health school which is better endowed than the nursing school and falling asleep on their plush public health chairs. 'night.

Sleeping

2005-06-18T15:17:00.000-05:00

I'm weathering my night shifts all right simply because I seem to find myself sleeping all those hours I am not working. While this is fine for now, I don't see this as a long-term solution for night shifts. I also know that perhaps I am not as fine as I think I am: when I came home yesterday morning, I took my credit card out of my wallet in order to let myself into the house. I found the key worked better. This, I suppose, is how medication errors are made.

Night shifts do have their advantages: things are much quieter and there is definitely a feeling of camaraderie when you take a 2:00AM break for "lunch". There are also less medications to be given so I'm allowed to do a lot more. I've done some neat things like peritoneal dialysis, drawing bloods from central lines and hanging lipids (neat to me, thoroughly boring and routine for most).

So I'm heading up there now for my 4th shift in 6 days which brings me to 50 hours this week. We have 212 hours to do before graduation so it's satisfying to know I have made a good dent in that.

Tinfoil Helmets

2005-06-14T20:41:00.000-05:00

My first shift in my final rotation on Monday went very well. I think the unit is a perfect place for me to begin learning how one manages to take care of 4 patients over the course of 12 hours without causing grave harm to either nurse or patient. The only harm I suffered consisted of 2 very sore feet (whine) and knees (whine whine) after standing for so many hours. I also had to try to stay up late so I could start adjusting to night shifts (I have my first night shift tomorrow) and it was murder to do so (whine whine whine). No complaints, though (really!), I'm so happy to be working with younger people again.

Thanks so much for those people who had coping with night shfit suggestions for me. In order to darken my room to make it easier to manage daytime sleeping, I have placed towels over some windows and pulled the blinds on others are as tight as they can go. So looking around my room I look like some sort of deranged survivalist. If I make a tinfoil helmet for my head, I will fit right in.

I'd like to put a tinfoil helmet on Celine to celebrate her birthday on Wednesday!

Genuine Interest

2005-06-11T16:06:00.000-05:00

The first 12-hour shift of my 48-hour workweek begins on Monday morning at 6:45 AM. Since I have to work 1 day shift, 2 back-to-back nights and then 1 day shift after only a day-long break, I was feeling fairly sorry for myself. However, I reminded myself that residents and interns have to do something similar for years. If they can do it, I can do it. I am, after all in an "accelerated" program and should be prepared to carry myself in a speedy and sleepless way.

I've been preparing: I am re-reading my pediatrics textbook to review common adolescent conditions and surgeries, lab normals and age-appropriate vital signs. I read up on suggestions for working with adolescent patients but only found articles that discuss the relative hopelessness of the situation. The one bit of helpful advice I gleaned will be my mantra: "Adolescents will respond to those who show a genuine intrest in them." That's my game plan. Finally, I got a sensible, short haircut today so that I will be able to shave 30 seconds off my shower time.

Final Six Weeks or The Unlikely RN & Night Shifts

2005-06-08T18:24:00.000-05:00

This coming Monday I begin my "leadership" rotation where I work as a give-everything-but-medications nurse on a pediatric medical-surgical unit. When my preceptor (the nurse who will steer me through this experience) gave me my schedule, the first word she said was "Sorry."

Crap.

And the schedule IS something awful (2 days then 3 nights then 1 day then 2 night...). However, I did say I wanted to experience both day and night shifts and I will indeed have about equal parts day and night. Also, I don't have anything else going on for the next 6 weeks (we only have to attend a weekly discussion group and our online class) so I might as well undertake a gruelling schedule of ill-timed 12-hour shifts. Right? The very good news, however, is that I like my preceptor very much. I'm her first preceptoree which I think is a good thing as she won't be comparing me to other students and we can work out a situation that will work for both of us. Additionally, my preceptor is being trained to be a charge nurse so I get to go with her to her training shifts and I'm looking forward to this taste of management. Also, my two best friends are working nights so we'll be able to see each other.

Does anyone have night shift survival tips? Sleep schedule suggestions? Painless ways to put yourself out of your misery? I'm very green when it comes to shift work and can use all the advice you can give.

Nursing Moments II & Virtual Class

2005-06-06T10:29:00.000-05:00

This morning I had my "virtual class," which is my new on-line class on nursing informatics. My computer would crash and start smoking if I actually asked it to run any of the software that is required to participate in a virtual class so I have to go to the school's computer lab which obviously compromises the whole "the world is your classroom" aspect of on-line courses. About two thirds of my class also have lousy computers so we all end up at the computer lab talking to each other over the Internet and across the room. Cool! Virtual!

We also are obliged to wear headphone/microphone combinations telemarketer-style.

Oh brave new world!

More in the spirit of the World Wide Web, the latest edition of Nursing Moments is up at www.codeblog.com (can't get the link to work, have no idea why). And by latest I mean the second... but you have to start somewhere. "Nursing Moments" is a compendium of different nursing-related stories from blogs submitted to an editor who weaves them together and posts them on his or her blog. This type of thing is called a "Carnival." Thinking Nurse put the first Carnival together a couple of weeks ago and Geena at Code Blog is carrying on the task. It's really neat to read the different postings and read new blogs. These people are very clever to get their links to work.

FYI: when Thinking Nurse was asking for suggestions to name the nursing Carnival, I suggested CaRNival but it was rejected. *I* think it's sort of catchy.

Press Conference

2005-06-03T15:26:00.000-05:00

A friend in my program was part of a group that arranged a press conference with medical and nursing students to calling for a gubernatorial override of the "Fair Share Health Care Bill". The Bill would require large companies (>10,000 employees) to spend a minimum of 8% of their payroll on health care benefits for their employees. It's been nicknamed the "Wal-Mart Bill" and you can probably guess why. The Governor decided the Fair Share Bill was bad for business within weeks of vetoing a bill that would have freed funding for stem cell research. Health care equity? Bad for business. No funding for biotechnology? Ummm... something other than bad for business, apparently.

In any case, I went to the press conference and it was fun and I got to wear scrubs and look concerned and pissed off in front of cameras so that was a thrill.

In other, decidedly different news: is anyone looking for registered nurse thong panties? Because I can hook you up. This should also delight you (click on "recent discoveries").

What Can I Do To Harm My Patient Today?

2005-06-01T18:05:00.000-05:00

In my transition-to-practice/leadership course, we had another patient safety lecture today. Our instructor encouraged us to start of each shift by asking ourselves: "What can I do to harm my patient today?". The class laughed when she first said this but our professor wasn't deadpanning, she was dead serious. She wants us to look for all potential systems and personal failures that can lead to adverse events. It's good advice but, like all of her advice, terrifying truly.

We also talked about sound alike/look alike drug names (e.g. hydralazine v. hydroxyine, cerebryx v. celebrex, vinblastine v. vincristine). Do you know that paragraph, usually sent as an mass e-mail trick, about how we only read the first and last letters of a word: "aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it deosn't mttae in waht oredr the ltteers in a wrod are, the olny iprmoetnt tihng is taht the frist and lsat ltteer be at the rghit pclae..."? When I used to receive this email in my inbox, I'd think: "Hey, what a neat trick" (or Hey, waht a naet tirck). Now, I think "Great, I'm going to kill someone!" But, again, this is all sound and necessary advice. Avdcie.

My Chicago trip was great - we moved in seamlessly with the help of 7 very kind and very much owed friends. It feels so strange to move out of our old neighborhood but we're excited to live in a more urban area. I think. Here in Baltimore, they're showing my apartment/room to potential renters. Also, the new incoming students came today so it's been exactly a year since I started the program.

Time flying, blink and you miss, where did it go and all that.

Chicago

2005-05-26T19:49:00.000-05:00

I'm in Chicago for the long weekend as D. and I are moving into our new apartment in the Lakeview/Roscoe Village area, which is decidedly hip and cafe and restaurant-laden and safe. I'm not sure how much I will miss living in Southeast Baltimore. While waiting in line for the plane, Southwest Air Cattle-style, I chatted with a nursing grad student who attends my school and lives in my neighborhood as well. She's been working in the ER and decided to move out of the area exactly 1 week after starting her placement there. She's seen dozens of injuries related to violent crimes committed just blocks away from our homes and just can't stomach the walk home anymore.

Other acts of violence are taking place in my lymph nodes and throat: I have strep throat and it's been a real pain. Luckily, however, my packing and moving duties have been adjusted accordingly. Moving is a breeze.

National Nurse

2005-05-23T17:24:00.000-05:00

America's Nurse

The above is an op-ed piece from the NY Times that advocates the appointment of a "National Nurse" a la Surgeon General who would have biweekly press releases and radio or TV spots to highlight healthy living and prevention activities. Great idea, no? The author believes that the National Nurse should replace the Surgeon General which probably went a long way in alienating many potential supporters and I'm not sure why one would have to replace the other. There's room at the top, I suspect.

Today in our community health class we had a "Bioterrorism" lecture where we had the pleasure of distinguishing bubos (the lymph welts that show up when you have bubonic plague) from smallpox lesions and Tularemia eccyhmoses (where blood fills the entire layer under your skin) and leprosy discoloration. I'm having my own attack of something decidedly infectious which involves a headache and fever so horrible and high I've been doped up on codeine the last 2 days. I indulged in some nursing student hysteria and diagnosed myself with meningitis for about 2 minutes (I interviewed a man last week with HIV who was recovering from viral meningitis) but remembered that I am not immunocompromised and happen to not have multiple open lesions on my person.

Final Placements & El Jefe Double Speak

2005-05-20T15:42:00.000-05:00

We got our assignments for our final placements on Wednesday. These "leadership" placements involve working as a can-do-everything-but-give-medications nurse for 6 weeks. We were all very nervous and excited to find out where we would be placed. Imagine my thrill when I was placed at a pediatric emergency room in northern Baltimore County. Imagine my disappointment when I remember I live in Southeast Baltimore City and don't have a car. I was able to switch placements with a girl who does have a car and I will now be working on an adolescent medical-surgical floor instead. It's certainly not the most glamorous placement but it will help me develop my clinical skills and since the floor is organized by age instead of disease group, I will get to see lots of different types of patients. It's also a 10-minute walk from my house which will make my first 12-hour night shifts slightly more bearable.

Kathy (our defenseless young woman whose victimization is described in a recent entry) says "thank you" to everyone who got all riled up about people's inaction. She's doing fine and the lump on her head now approximates a pea instead of its former impressive egg-like size.

Speaking of defenseless little things and big bullies, the President has spoken out on South Korea's recent stem cell cloning accomplishments (BTW: Way to go, SK!). He has stated that "I am a strong supporter of stem cell research, but I've made very clear to Congress that the use of federal taxpayer money to promote science that destroys life in order to save life, I am against this," said Mr. Bush, speaking in the Oval Office during a brief joint appearance with the Danish prime minister, Anders Rasmussen. "Therefore, if the bill does that, I will veto it."

Which is to say "supports" means "not support at all."

Sigh.

Blue Pads & Dead Birds

2005-05-17T18:18:00.000-05:00

Blue pads (or "chucks") are disposable 2 foot square pads with a soft, cotton-y top and lined plastic blue botton. I've used them throughout nursing school: beneath the bottom of a woman giving birth, across a vomiting child's chest, under a patient's side during a wound change and to wipe up urine dribbling from underneath the quiet room's door on my psych floor. Several blue pads were included in our community health nurse bags which we take to our home visits. Since we tend to do fairly psycho-social interventions in this rotation, I was doubtful (and hopefully so) that we'd have a need for the pads.

Today, however, the blue pads came in handy. I accompanied my peer to her client's house and while we were talking, the client's cat waltzed in with a small, yellow-throated bird in its mouth and shot upstairs. The client is very elderly and is in no position to clean up whatever becomes of a bird after a cat mauls it.

Therefore, I was sent upstairs to try to separate the cat from its prey. With the help of the blue pad I first tried to distract the cat, bullfighter style (ole). This doesn't work. At all. However, I managed to use a section of a headboard to hustle the cat under a bed while I wrapped up the poor little bird in a blue pad. Of course, I only managed to get the bird out of the cat's mouth after the bird was good and dead and had made all sort of pitiful dying bird noises.

So blue pads are eminently handy but now they'll always be tinged with a little aviary sadness for me.

Moral Turpitude

2005-05-16T19:50:00.000-05:00

My friend Kathy got mugged and punched in the head on Friday coming home from school. She didn't even have a dollar bill on her and her cell phone was deemed low-tech by her assailant so she did keep her belongings but was left with a significant egg on the head and some road rash on her hip where the guy dragged her along the sidewalk. Kathy's a tough girl and weathered the situation very well.

The most terrible thing (this coming from the girl without a head injury) was that the assault took place at 3:00 pm on a fairly busy corner in my neighborhood. It's a four-way intersection with traffic lights and Kathy said there were people in cars waiting at the light and watching her while she was being mugged and then punched.

I hope none of those people have slept a wink since Friday afternoon. I don't expect people to run out of their cars and attack the guy (although that would have been nice and he was only a youth - Kathy thinks middle-school-aged) but I do expect them to honk their horns, scream and shout and call the police ASAP.

Unbelievable.

One bright spot was the Baltimore police (and I say this as 2 officers have just been arrested for selling confiscated drugs of their arrestees). The officer who took care of Kathy was very kind: he drove her to my house and I sat in the back of the cruiser with her. The officer got out of the front seat and came around the back to give us a group hug. Yeah, it was a little bizarre but nice. They also sent out the helicopter to look for her attacker which impressed us very much.

Lately, we've been spending hours in class learning about our responsibilities as nurses and how our licenses will be revoked if we commit any act of "moral turpitude". Spending so much time thinking about accountability and duty makes it hard to imagine how any citizen can feel so little responsibility to a young woman walking home. I think it's true depravity.

The Unlikely RN Goes to Washington

2005-05-13T13:05:00.000-05:00

Our class went to D.C. yesterday to meet with our representatives and also hear from the American Nurses Association, the American Association of Colleges of Nursing and a representative from Sen. Mikulski's office who is a nurse. Senators Obama and Durbin (from Illinois) have an open session for consituents on Thursday mornings so myself and another girl from Chicago went. While answering a question, Sen. Durbin mentioned something about "Doctors...even Nurses...could manage these [community health] clinics." After the session, my friend and I went up and asked Sen. Durbin to acknowledge that doctors and **especially** nurses should be running community health clinics. So I have now officially done 5 seconds of lobbying for the nursing profession.

After the session, we walked upstairs and decided to check out the Bolton committee hearings and waltzed right into the 5-hour debate where Voinivic defected. Pretty exciting. If you want to know what I look like, you should have been watching C-SPAN last night. I was the girl in the front row trying not to spend every moment considering John Kerry's chin.

Oy.

2005-05-10T20:28:00.000-05:00

Some schools celebrate Nurse's Week with cookies and feel-good posters, our school celebrates it with giving its students ulcers:

This week it has been especially hard for my class and I to keep our eyes on the prize. We're now just 10 weeks from graduation but we've got an obscene amount of work to do and even more is coming up. On Monday we began our final course that deals with "nursing leadership" and "transitioning to practice" which sounds very helpful and it is. But it is also TERRIFYING and our professor would like us to go home with that thought (it is terrifying) and wake up with that thought (very very terrifying) every day from now until July 22nd and, if she succeeds, every day after that for the rest of our careers.

This is perfectly fair as nursing responsibilities *are* terrifying. It is horrifying to contemplate what my active errors or simple neglect can cause. We watched a video put out by the Institute of Medicine called "Do No Harm" which is a true (composite) story of a series of nursing errors which led to a brain dead mom and a brain damaged infant. I think I ulcerated about 70% of my entire digestive track during the 10-minute movie and, all around me, I could hear people whispering "I don't want to be a nurse anymore." It's not as if this idea is new to us but it's rare that we do nothing for 4 hours but contemplate it and, perhaps more importantly, the reality of our responsibility has never been closer.

So this course will, I hope, help us incorporate this sense of dread into simple responsible nursing practice. Our professor is wonderfully competent and firm and intelligent so I can't imagine a better person to help us accomplish this. Because, really, I didn't want to be a nurse anymore either.

Nurse's Day

2005-05-06T14:21:00.000-05:00

Apparently it is Nurse's Day. Unfortunately, no one sent me this card or this one (I'm actually pretty glad no one sent me that one).
I've also found out that May 8th is National Student Nurse's Day . I don't feel entitled to be celebrated as a nurse yet. There is an advertisement on television with multicultural, multigenerational individuals in soft focus saying things like "Thanks for not judging me," "Thanks for telling me the truth," "Thanks for giving me hope," etc. and ends with "Thank you for being a nurse."

It makes me cry.

But I don't think I deserve to be thanked yet, I'm still in the thanking stage. On May 8th, however, bring it on.

Debutante Nurse

2005-05-04T08:23:00.000-05:00

Thanks to Head Nurse for discovering the absolutely fabulous site Tiny Pineapple's Collection of Nurse Fiction or "Career Romances for the Young Moderns".

This is more or less the most wonderful thing that I have ever seen on the internet. Tiny Pinapple has collected 256 nurse novels and posted their covers and a sentence or two from each one capturing the book's...uhmmm...feel. Apparently, the collection has been valued at ~$100,000 by the Antiques Roadshow.

Some of my favorites:
Debutante Nurse (1958): "As Dana Gordon put on her new mink coat, she remembered the quizzical eyes of the young intern. To him she was nothing but an ornament — beautiful but useless. At that moment she made her decision to show him that she had the courage and will to win a place in his hard, dedicated world of medicine — even if it meant giving up her soft, glittering social world."

Do you think her useless ornament self will come into soft, glittering contact with his hard dedication by the end of the novel?

Hood River Nurse (1982): "Young Roxanna Blake, dedicated coronary care nurse, was sure that handsome Eric Newberg returned the love she felt for him. So when the magnetic skier left California for Mount Hood in Oregon to pursue his skiing career, Roxanna followed him. But her idyllic dream of a life with Eric seemed to hit snags as soon as she arrived.

The first problem was Jody Averill, a women’s competition skier who was also determined to compete for Eric’s affections. Then there was Devon Roberts, who had a maddening habit of popping up when the young nurse least expected him. Worst of all, there was Eric’s determination to sacrifice everything — even Roxanna — to become a skiing champion."

Finally: the crossover coronary care nurse-pro skier novel! It was worth waiting until 1982.

Second-Chance Nurse (1961): "CRISIS! The young doctor’s face was etched with bitter hope and desperate strength. Karen Reese looked from him to the small form stretched on the hospital bed and knew that Dr. Mark Corman needed her at last; needed her skill, her devotion, even her silent, unspoken love. For only love’s valiant faith could win this struggle. Death was groping for the child with cold fingers, but they would not, could not, let him die…

A dedicated doctor and nurse are united in a heart-gripping battle for the life of a child, while a fierce love grows between them as they thwart death with all the courage of their calling."

Yeah. That's happened to me about two or three times. Silent, unspoken love saves lives.

I haven't had this much fun since the Weight Watcher's Cards from the 70s.

Name That Disease

2005-05-02T16:57:00.000-05:00

Today we had a lecture in our community health class on epidemiology: incidence (number of new cases) v. prevalence (number of existing cases, specificity (the degree to which a screening test can eliminate people who *don't* have the disease) v. sensitivity (the degree to which the screening test can pick up people who *do* have the disease) etc. Phew.

We also examined trends of infectious and chronic disease over time and played an informal, pick-up game of "Name That Disease." This consisted of our instructor putting up a line graph showing the dips and spikes of a mystery disease. For example, disease X spiked in the late '40s, mid to late 50s then went way down until the late 60s and early 70s when it came back with a vengeance.

Any guesses?

The disease was Malaria that was brought back by soldiers in the Pacific theater during WWII, Korea and then Vietnam. We also played this with Polio, measles, TB and HIV (easy one).

I'm up to my neck in group projects and one of these groups presented our project to our class today. The project was on researching methods to reduce pain for children receiving an IV or undergoing venipuncture i.e. how to make a big scary needle slightly less so. One of our group members has an 8-year-old daughter and she was the showpiece of our presentation, answering questions about how much needles hurt and so on. She was coy and adorable; every endearing word that came out of her mouth was followed by over 100 young men and women (mostly women) positively gushing. We joked that we were saving the puppies and kittens for next time.

Long Week

2005-04-29T11:09:00.000-05:00

It's been a long week. I'm smack in the middle of far too many projects which makes sitting in front of the computer for any longer than absolutely necessary absolutely unbearable. However, there's been a lot of exciting personal news this week including a new apartment in Chicago and Daniel getting his superstar grant from Canada.

I had my first home visit with my new patient and it took a lot of "assertive" behavior on my part to get in the door and negotiate a second appointment. There's a fine line between bullying and nursing sometimes.

In our community health course, we're having a series of lectures on environmental health with an emphasis on lead poisoning. We read one study that found for every 10 microgram increase in lead levels, a child's IQ drops 5.8 points. Permanently. It is not uncommon for children who live in houses with lead paint to have lead levels of over 30 micrograms (normal is under 5 micrograms).

The Patient RN

2005-04-25T13:04:00.000-05:00

I was a patient today for the first time since starting nursing school . I went to a nurse practitioner at the student health center for my yearly GYN check-up and it was so strange to be palpated and prodded and the like.

For two years, I had a deaf nurse practitioner. I didn't like her much. Since she couldn't hear, every time she asked me a question mid-pelvic-exam, she'd have to pop up from in between my legs to read my lips while I answered her question. It was mortifying and totally comic all at once. The first time I saw this NP, she commented "My my you're sweaty down here [yes, there], are you nervous?" and then popped up to hear my answer (which, unfortunately, was not "Really? Nervous? With 6 inches of cold metal jammed into me? Not at all! I've been looking forward to this for the past 11 months and 30 days").

During a check-up a year later, she said exactly the same thing to me. I wonder if she is still out there ... somewhere ... letting her patients know that they're nervous.

And sweaty.

And mortified.

I promise to do better.

HIV

2005-04-21T14:42:00.000-05:00

I am placed at an AIDS services organization for my community health rotation. It's a great place and provides legal services, meals, laundry, medical care, case management, temporary housing and cash assistance to HIV+ people. My clinical instructor is also wonderful and is a board member of the Center for Nursing Advocacy (see link at right). I'm too embarassed to tell her that I want to make love to the organization and have written cranky letters to "Grey's Anatomy" and "ER" at their behest. I'll work up to it.

We were assigned patients today and we begin our home visits next week. I was assigned a "difficult" and "noncompliant" patient who has a really outrageous history that, sadly, cannot be shared. Essentially, I've been warned not to give in to any requests or to give into anything, for that matter.

Our day started with a faculty member showing us a giant, plastic, basketball-sized CD4 cell (T-cell) and how HIV attaches, replicates and lets loose from the cell.

Bad news: this faculty member had just returned from an HIV conference and told us that there's little hope for the sort of AIDS vaccine we all want i.e. a one-shot deal we can give anyone. Instead, a new AIDS vaccine will likely have to be developed every year or so to keep up with the virus mutations and would be more like the flu shot than the polio vaccine.

Good news: There is some success with one-time vaccines given to existing HIV+ people to slow the progression of the disease. G

Community Health Nursing

2005-04-19T15:24:00.000-05:00

Today was our orientation to the clinical component of our community health course. It's pretty daunting as we'll be making home visits on our own. It's our last clinical since, ideally, we'll be able to synthesize all of our assessment and planning skills to date and provide comprehensive, knowledgeable services to our patients/clients. Oh sure. No problem.

The good news is that we get toys and a snappier uniform. We've been given a visiting nurse tote bag with thermometers, BP cuffs, flashlights, wound dressing supplies and the lot. We also are given to opportunity to replace our rather law-enforcement-ish uniforms with plain navy pants and a white blouse. We're told not to wear coats so that people can see our public health nurse uniform clearly and this should prevent misunderstandings i.e. we're not there to arrest you or take their children away.

For fellow nurse-type blogger people, the "Thinking Nurse" is holding a "blog carnival" (I didn't know what it was, either).

Being Dick

2005-04-18T14:04:00.000-05:00

For the next two weeks, my research fellowship requires that I audit how well a unit's nurses are using a new screening tool. I'm not allowed to actually be on the floor during the audit because the nurses haven't been told they're being evaluated. Therefore, I have to perform the audit in an undisclosed location so it will be fun pretending to be Dick Cheney for two weeks.

Today was the first day of our Community Health Nursing course and it is wonderful so far. It's amazing just how healthy people can be when you bring good nursing care *to* them. Tomorrow we have a day-long boot camp to learn how to do home visits and ways to be safe and smart while touring East and West Baltimore. We've been told to bring a map. I have a bad feeling we're going to be asked to take a black marker and designate certain areas as "no go" zones. I hope not.

Mentor Corporation

2005-04-14T12:33:00.000-05:00

I think it is very funny that the company whose breast implants have newly been approved by the FDA for use in cosmetic breast augmentation surgeries is called "Mentor Corporation"? Just who, and how, are they "mentoring"?

Yesterday I had final exams for both of my psych classes. I apologize for the lull in writing but I've been trying to study how to be therapeutic in every crisis, psychotic break, suicidal episode/attempt, delusion and domestic abuse scenario. Generally, I don't think you'd want me around in most of these cases but I've at least gained basic competence in handling these types of situations. I am so happy that they're done and I'm 7 credits closer to graduation. Our Community Health Nursing course starts Monday.

One Year Of The Unlikely RN

2005-04-08T08:42:00.000-05:00

It's been one year since I first started posting with a rather serious, long-winded introduction.

To mark the event I've decided to pull together my favorite entries:

1. A photographer visits the nursing class during a rectal exam video
2. The first thing in nursing school that made me want to throw up and then, 5 months later, actually doing the vomit-inducing task
3. Saying "Oh Shit" while taking care of a patient
4. Mastering the urethra
5. Killing SimKid (it's a wonder I've chosen to work in pediatrics)
6. The entry that explains why my site comes up for the search terms "smallest boobs in the world"
7. Body fluids and the foods they resemble
8. Why psych probably isn't my thing - an explanation of the GAF
9. My first bedpan
10. Ten questions that won't be on the exam that were

Enjoy!

In less self-indulgent news, we've received our placements for our community health rotation that starts in a week. I've been placed at a clinic and social services agency for HIV+ people. It was my first choice so I'm pleased. We'll be doing a lot of health teaching and I'll have to wrap my head around the dozens of medications that these people must take.

This weekend will be dedicated to studying for 2 (!) psych exams next week (psychopathology and psych nursing). I fully expect to have a psychotic break by the end of this which, I guess, will enhance my knowledge first-hand. Tomorrow, though, I am working on a community serivce projects with students from the medical and public health schools. I can't remember the first time I haven't been with the same 127 other nursing students at all times so I'm looking forward to this.

Nice Touch

2005-04-06T17:29:00.000-05:00

Our nursing school has a lovely courtyard and small garden surrounding its exterior. The exterior garden is planted with a thick bed of flowering purple-pink vinca (Vinca rosea), a type of periwinkle. The vinca is lovely to look at and is also the key ingredient in the commonly used chemotherapy drugs vincristine and vinorelbine. Nice touch, no?

So the sun is out, the vinca and magnolia are in bloom and there are suntanning nursing students in the courtyard. Sort of. The courtyard seems to be split between sunbathers and students interested in things other than vanity and skin cancer. I guess the vinca gives them hope that when the melanoma comes, the chemo will be there.

Full disclosure: I spend about an equal amount of time in the sun as not. I'm 50% dumb and vain.

The Boring RN

2005-04-05T11:43:00.000-05:00

I'm now beginning the first steps of actually becoming a registered nurse. I feel as if graduating, writing and passing the licensing exam (NCLEX-RN) are all difficult but certainly surmountable tasks. Actually becoming licensed and registered is not. I'm not the dullest knife in the proverbial nursing drawer (?) and it took me 2 hours of staring at forms to figure out how this licensing process works. And I'm still not sure if I'm right. I have an impression of how I might go about it but there isn't any room for "impressions" in this business. It wouldn't be so much of a problem but I don't have a lot of leeway in between graduating and starting my job and I can't afford any glitches.

So that's an extremely boring, cliche- and mixed metaphor-ridden account of the situation but it's all very nervous-making.

I had a short talk with my delusional chronic schizophrenic patient today and the patient is doing so much better. It is truly amazing to watch someone turn into a person after being so disturbingly ill. However, the patient still has no insight into the the illness (i.e. believes the delusions were real, only that the voices have decided to stop their torturing for a while). Obviously that's what the chronic business is all about.

Any day we'll receive news about our next clinical placements. Our final rotation is in community health and will involve making home visits and working with community health nurses. We also do a brief stint of school nursing. This rotation should be great and will continue my grand tour of Baltimore housing projects.

Viagra For All

2005-04-02T16:27:00.000-05:00

So now we have legislation in Illinois to force pharmacists to fill prescriptions. For everything. Even - GASP - birth control pills. The American Pharmacists Association, however, is outraged that pharmacists be compelled to fill all prescriptions. They believe pharmacists should have the option to "step away" in cases where they feel uncomfortable about giving a certain drug.

Their inevitable slippery slope argument? Here it is: "Ms. Winckler [representative of the APA] worried that Governor Blagojevich's new rule might reach beyond the question of a pharmacist's own moral sensibilities, and require pharmacists to dispense all prescriptions, even those that were 'clinically inappropriate' for patients." Yes, that's certainly around the corner. Viagra for everyone! Children too! Every day! Two pills a day for pregnant women! Dispense or die, pharmacists!

It's very hard for me to imagine feeling uncomfortable about meeting the needs of women trying to lead responsible sex lives.

Slouching Towards Likelihood

2005-04-01T13:48:00.000-05:00

Today is "Accepted Students Day" for incoming accelerated students. I cannot, cannot believe that it was only a year ago that I was attending this event. During the panel discussion, one (very bright) new student asked us if we had any advice for her: "Is there anything you know now that you wished you had known when you were in our shoes?". Tough question. I guess I just wished I knew that things would turn out so well and that I would fall in love with nursing. I thought this was too schmaltzy to relate to 150 people but wished I had said something to that effect i.e. they will come and they will love it.

Unfortunately, there wasn't any opportunity for me to tell my perv-y stories . Because really this is what I live for and I've been informed that my blog now has a sufficient number of swear words and/or sexual references that it's blocked in some libraries. Nice.

Yesterday on the unit I had the same patient as last week with the troubling and absurd delusions. The patient's medication was beginning to work, though, and the patient was far more responsive and easy to talk to. We played tic-tac-toe and hangman and talked about whether dogs went to heaven or not. Of course, once in a while during a lull in the tic-tac-toe action, my patient would say "They're trying to cut off my hand," or "Why do they let dogs [fornicate] in my room?". I was very careful to choose words for hangman that were totally neutral and would not encourage delusions. Neutral words are hard. Apple? Yes. Television. No: "Why is the television showing fornicating dogs who want to kill me...."

Race in Baltimore City

2005-03-31T12:59:00.000-05:00

The presentation on youth violence in East Baltimore yesterday turned into a free-for-all discussion on race and was a total disaster. It ended with an African American women telling the audience that Africans are cursed descendents of Noah's (of ark fame) son Ham (not of pork fame) and their American cousins are victims of the same curse. That went over well. The other highlight of the presentation was a police officer telling the audience that homicide has overtaken all other causes of death (suicide, drugs etc.) for young black men in Baltimore.

On another note, the Center for Nursing Advocacy (a media watchdog) is asking its members to write emails to the producers of the new TV show "Grey's Anatomy" to ask them to reconsider their pretty lousy portrayal of nurses. I wrote the following email last night:

March 30, 2005

Dear "Grey's Anatomy",
I am a nursing student at ----------- in Baltimore, MD. I am very sorry that your new show has decided to show nurses as helpless, uneducated individuals whose profession serves as an insult ("you're calling me a nurse?").
I have worked with surgeon-resident-nurse practitioner-nurse teams who provide excellent and seamless care to surgical patients at -----------. This care is based on each of these profession's respect for each other and appreciation of each profession's unique skills and focus.
Please reconsider your portrayal of nursing.
Sincerely,
-------------

No doubt this earth shattering missive will change the course of the nursing shortage. I am aware that it will do crap all but it is sad to see another show make nurses look so pathetic. The show has gone to such lengths to make the surgeons multicultural and include positive female characters. It's such a shame they've forgotten to extend that sort of forward-thinking to nurses.

Not A Dry Eye.

2005-03-30T13:14:00.000-05:00

The tears don’t stop this week.

Today in my psych class we watched a film that followed the disease process of a 70-year-old woman with Alzheimer’s over the course of 7 years. Her husband was a retired physicist and took over care for her and the household. He took every new blow (losing her ability to speak, losing her ability to recognize him, losing the ability to walk etc) with acceptance and was remarkably patient, loving and hopeful throughout the years. She died at home. He told the interviewer that operating his HAM radio and going to church kept him sane. I can’t think of any things, much less two things, that would/could keep me patient and loving throughout a process like this.

Later today I’m attending a presentation on controlling youth violence in East Baltimore. And they’ll be a video as well.

This video & depressing topic business has to end.

Bioethics Blog

2005-03-29T10:29:00.000-05:00

My friend Celine reads the American Journal of Bioethics Blog. Who knew journals had blogs? Celine did.

The blog is very interesting and it also has a link to a clip of John Stewart hosting a Q & A on Terri Schiavo.

Does everyone know that Terri Schiavo's cardiac arrest originated from an eating disorder? In our class on anorexia and bulimia yesterday, we learned that this is the most common cause of death in patients with eating disorders (electrolyte imbalance related to vomiting or starvation -> heart attack). My friend pointed out that if, indeed, Ms. Schiavo is "locked in" or conscious at all, she's possibly quite happy that the feeding tube has been removed. She'll be thin after all.

Intimate Partner Violence, Forensic Nursing & The Harrowing Day

2005-03-28T17:10:00.000-05:00

Today was a harrowing day. Our first class dealt with developing and interpreting statistical tables. Wait, that's not harrowing (I guess it can be if you fear the Pearson's R, which some people undoubtedly do). No, it was the two-hour lecture on domestic violence and sexual abuse that made it so. Our lecturer began the class with a short movie that opened with as actual recorded 9-1-1 call from a 6-year-old girl who reported that her mother's boyfriend was "trying to hurt [her] mommy and kicking her in the stomach." The child's mother was killed while the child was talking on the phone and we all heard the thump as the mother fell down the stairs. Ugh. And there are so many people who are killed/abused: 4.4 million women in the US report being abused, 52% are physically injured and they figure only about 38% of violence is reported at all.

Our class focused on vigilance in detecting assault and abuse because these women frequently show up in the hospital: women who are abused are four times more likely than the average woman to have urinary tract infections and pelvic pain (from forced sex); three times more likely to have irritable bowel syndrome (from the stress), STDs and bulimia, two times more likely to have seizures.... A lot of my classmates are interested in forensic nursing to help address this issue.

Forensic nursing applies to any nurse role that involves the legal system. The most common type is a SANE (sexual assault nurse examiner) nurse (a nurse is likely to be far more experienced and comfortable performing this exam than the medical resident who would otherwise perform it in the ER). Also, a lot of cities are now hiring nurses to be crime scene examiners. Nurses excel in this role because they're accustomed to interviewing people, examining/assessing bodies (usually the bodies are alive but, hey) and knowing the health status of people e.g. what drugs the deceased used to overdose. Alberta (that trailblazing province) was the first place to use nurses as examiners.

So after a short break for lunch my class trotted off to psychopathology class where we had a lecture on anorexia and bulimia. Again: ugh. Not the cheeriest day. Also, Baltimore seems to be in some permanent storm system so I haven't seen the sun since before March break.

Delusions & Plans

2005-03-24T19:22:00.000-05:00

I had a patient today with the most horrifying, absurd and imaginative delusions I've come across. They involved male genitalia, a Western European ethnic group, canine excreta and an unusual substitute for water. We're taught to "redirect" patients having delusions and focus them on other, less inflammatory ideas. Also, we're supposed to reassure the patient that they are safe and that the delusions are a symptom of their illness. This is really hard to do and my patient wasn't responding to any of this redirection business. The only way I found to distract the patient was to have the patient help me fill out a survey that itemized just how depressed the patient was. The patient loved the survey. I decided talking about depression was slightly more therapeutic than talking about the maligned ethnic group and what they do to male genitalia.

However, one of the questions concerned killing yourself and my patient admitted having "suicidal ideations" and had a plan to carry them out. Having a plan is considered to be the #1 warning sign as it suggests the patient is serious and not just enjoying the idea of no longer existing.

"OK," I said. "Hmmm. Well. Could you just hold on? I'll be right back" [nursing student flees and returns moments later with a real live psych nurse] "Ummm, could you just repeat to Nurse X what we were talking about." The patient did tell the nurse what the patient told me (to my relief) and it was duly noted. So that was my first suicidal patient. Pretty awful.

My best friend in the program worked in psych before coming to the program and is accustomed to leading group therapy sessions and implementing "cognitive behavioral therapy" (helping people adjust their thinking/processing methods to be more positive and adaptive). Today, our clinical instructor actually let my friend lead a session and she was amazing. I couldn't believe how well she managed a group of about 15 people including about equal parts of dementia, schizophrenia, depression and substance abuse. She had them read cards with positive thinking statements ("I can learn to be peaceful!") and say how these statements related to their lives. If they said they couldn't relate to the statement, the rest of the group was encouraged to help the person figure out that at least in some small way, they did embody the positive statement.

You would think this would be a total disaster, no? It wasn't. It was great! The patients (especially the subtance abuse patients) spend so much time focusing on how miserable they've been and how miserable they are, that they're not used to saying nice things about themselves and others. I was really surprised and so proud of my friend.

Official

2005-03-22T17:03:00.000-05:00

Yesterday I got back from Chicago and finally met my birth companions client. This involved visiting my first roach-infested, fetid and generally heart-breaking public housing project apartment. I went to my client's apartment with the public health nurse who was as unflappable as ever. The TV was on throughout the interview but the nurse just talked over it and I followed her lead. I suppose that the nurse only makes requests that are absolutely necessary ("Please don't have the baby in the kitchen this time) instead of merely for her convenience ("Please turn the TV down so I could have a chance of saving my voice"). It will be very interesting for me to see how what it's like to give birth in this country if you are impoverished, illiterate, uninsured and inner city.

The Monday hospital officially offered me the job today and I officially accepted. I start September 12th and have my physical (and drug test) on August 25th. Amazing. The other good news is that I will be working 3 months of days then 1 month of nights and every third weekend. This is considered a primo shift as I will be able to have a fairly regular schedule and not have my sleep totally out of whack every week. Also, all of the other Chicago hospitals would have had me working every other weekend. New nurses usually start on permanent nights so I am very lucky. I get paid $3.00/hour extra on nights so every fourth month I promise to take everyone out for dinner.

In other news, I continue to get about 1 or 2 hits for "rectal exam videos" each day. What's going on? Somebody has to make this video and quick.

It will not be me.

In Which The Unlikely RN is (tentatively) Offered The Job She Wants

2005-03-18T10:53:00.000-05:00

I received an email from the unit director of the Monday children's hospital (this hospital shall now be known as the day I had my interview there) and it looks like we're good to go there. Lots of formal things like reference checking and credit checking and fingerprint checking has to happen first although I can't imagine that will be a problem. The offer didn't come a moment too soon: the Thursday hospital was a nightmare and the nurse manager was WAY too honest with me and scared me right off. Shiver.

So I'm quite over the moon and so pleased. I think that I will learn how to be a good nurse on this floor and really enjoy working there. I'll start the second week in September. Hooray! To add to the wonderful-ness of this job offer, it looks like another girl in my program will start working at the hospital in the pediatric ICU there.

I head back to school on Monday morning. Ouch.

3 down, 1 to go

2005-03-17T10:41:00.000-05:00

So my Tuesday interviews made me want to run screaming from that hospital. On each floor, about 30% of the nurses were non-staff i.e. from nurse staffing agencies, the nurse managers had just been hired and both of their clinical educators (the nurse in charge of training new nurses) had just quit. Wow! Where do I sign up? Also, the orientation at that hospital is only 6 weeks. For me, that seems dangerously short. At the Monday hospital, minimum orientation is 4 months.

So yesterday I had a "share day" at the Monday hospital (a children's-only hospital) and it was wonderful. So wonderful, in fact, I can't bear to think about it because I'll be so sad if I don't get a job offer there. The floor was friendly, clean, well-designed and the environment seemed extremely supportive. 3 nurses there came as new graduates over 5 years ago! Wonderful.

Today I have an adult oncology interview at a hospital that has the potential to be very good. I'm definitely excited but pretty exhausted after the impress everyone marathon March break.

1st Interview

2005-03-14T21:23:00.000-05:00

The first interview went well and I really like the hospital and unit. In fact, I'm going back on Wednesday for a "shadow day" where I'll follow a nurse around and ask all sorts of questions one can't ask a nurse manager. But I *did* really like the nurse manager and the floor looks lovely. The patient population is children with neuromuscular and endocrine-related illnesses so it's a mix of chronically ill kids (cerebral palsy, brain damage), briefly ill kids (head injuries) and newly-diagnosed diabetics. Therefore, there'd be a lot of working with families and teaching which are all things I like. The good news is that there is a 3:1 patient:nurse ratio and that the hospital is so in-demand that they only have a 1% vacancy rate - pretty impressive, no? So hopefully I'll know if I definitely want to work there and in a couple of weeks I'll know if they want me!

I didn't bring my (one pair of) scrubs so Dan and I dashed out to "Uniform City" and I bought my first pair of scrubs (the first were a gift from friends). Scrubs are terrible and ill-fitting. I decided on kelly green pants, a black v-neck shit and I'll wear a hot pink t-shirt under the black for a festive, aren't-I-a-great-pediatric-nurse touch.

Tomorrow I have an interview at the hospital I used to work at in pediatric oncology, general pediatrics and adult oncology. Pheush.

Interviews Begin

2005-03-13T14:23:00.000-05:00

Tomorrow I have my first interview. It's at a children's hospital and it's currently my first choice. I can't tell you how nervous I am. I've written two cheat sheets, typed up interview questions and considered about 5 trillion anecdotes to answer the "tell me about a time when..." question.

Oy.

Wish me luck.

(Stereo)typed for Life

2005-03-10T12:09:00.000-05:00

On Wednesday, myself and fellow students proudly wore our "Typed for Life" stickers showing that we had signed up to be part of the national marrow registry. Great. Well, not so great. As it happens, if you are gay you are ineligible to donate marrow. I know being gay precludes you from donating blood but so does having lived outside of the US for more than 6 months, having a fever, being an IV drug user, being anemic etc. With marrow registration, however, it's more or less the only factor that will preclude you from registering: you could be an IV drug user with track marks up and down, have a fever of 103 degrees and sucking back zithromycin and they'd still take you and give you a sticker.

So it was galling to see super cheery, near-manic medical and public health students in our lobby accosting people and asking them to be typed for the registry. You couldn't avoid them. Not an easy situation to navigate if, in fact, you are a man or have had sex with a man who has had sex with a man since 1980. Perhaps they should have been giving out "Don't ask me, I'm Gay!" or "(Stereo)typed for life" stickers, too. Of couse, the sticker I'd like to see is "There wasn't a match for my child's tissue type but boy am I glad that thousands of willing donors were cut out of being typed due to a non-sensical restriction as everybody's donations are routinely and thoroughly tested for hepatitis and HIV". I'd totally wear that one.

In other news, I spent the morning with a public health nurse who visits pregnant women in Baltimore housing projects to provide pre-natal care and counseling. She was wonderful. She meets many of her clients in her car because they have no other safe place to meet. She also encourages many of these women to request students from my school to act as a doula/birth companion for their births. I accompanied the nurse to meet my future client but my client was "at the welfare," according to her mother and wasn't home (we'll go back in two weeks).

Have you ever seen pictures of videos of the United States Public Health Service nurses who travelled around their precincts on horseback, braving the elements, delivering babies in woodsheds etc? Well they still exist but they wear navy blue pant suits, drive beat up old cars and help the absolute neediest of inner city people.

Typed for Life

2005-03-08T18:07:00.000-05:00

Today I did something a bit rash. I signed up to be part of the national bone marrow registry which involved donating a blood sample and filling out a questionnaire about my background. If my tissue sample matches someone who is looking for a bone marrow donation, I will be contacted and will have the option of undergoing further tests to see if I qualify as a donor. Since I've actually seen a bone marrow aspiration, I'm horrifingly well-informed about what it would involve. However, I'd probably get a choose-your-own-adventure narcotics prescription and there's the whole saving someone's life bit, too. You should check it out and consider signing up: http://www.marrow.org/.

Speaking of selfless committments, please read the third comment under yesterday's post (my Mac OS <9-age computer doesn't let me insert links into posts...sorry). The person who typed in "Caregiver hating patients" came forward and told his or her story and the rather compelling reason for the search term. The brief rationale is pretty moving and reminds me that nurses are often caregivers in the hospital only. So much more caring goes on at home and I should never forget this.

As for the first two comments on that same post, I have no idea what my friends are trying to say. I think they are trying to out-geek each other but that's where my comprehension ends. Could either of you translate for the rest of us?

Search Terms II

2005-03-07T16:42:00.000-05:00

I forgot to mention the least funny (to me) search term that people use to find my blog: "smallest boobs." This is actually my second most popular search term after "unlikely RN." Why are people looking for the smallEST boobs? Do they want a picture? Do they think there is someone out there with the smallest boobs and they want to know who that is? Do lesser superlatives turn them on? Let me tell you, you won't find the answer here or in my perfectly well-proportioned chest.

Now, though, I think someone might just must be messing with me. After my post yesterday, I got hits from people who used the search terms "Caregiver hating patient" and (this is my favorite) "Men who are desperate to pee themselves." You read right: I am the third hit for "men who are desperate to pee themselves" using the AOL search engine. As for my apparent relevance to caregivers hating their patients, I can only say I'm working on it.

My first exam went fine and there's only 2 clinic days and 1 exam until March break. I'm excited for my break and becoming more excited for my interviews. I learned more about a unit I'm interviewing for next week and it really appeals to me - you work half time in an outpatient clinic and half time in the hospital. I think that sounds wonderful.

Megacolons & Swollen Urethras (Reprise)

2005-03-06T21:34:00.000-05:00

I can see the search words that people use to find my blog. Poor people. Quite a few type in "Toxic Megacolon" and reach my post about how ridiculously funny those words sound together. I'm sure if you're looking for information about a toxic megacolon you're not in a joking mood. Who would be?

"Swollen urethra" is also a very popular search term and those people interested in learning more about swollen urethras get to read about me desperately trying to shove something into one (a catheter). I once had someone type in "sexy proctologists" and find me. I swear this is true. And I have no idea why my blog pops up for this search term; I don't think I've ever used the words "sexy" or "proctologist" until now. I also get a lot of "rectal exam videos" which refers to a post I wrote about a photographer showing up while my class watched a video of a rectal exam.

Clearly there is a need in cyberspace for more information about toxic megacolons, swollen urethras, sexy proctologists and rectal exam videos. If you're forced to click on something called "The *UNLIKELY* RN" to learn more about these topics, I can't imagine there is much competition.

I've spent the weekend preparing for two exams this week and getting my interview groove on. Nursing interviews are "behavioral" which means the nurse manager will ask me a question like "Tell me about a time when..." and I poop my pants.

Simple as that.

Delusions

2005-03-03T19:04:00.000-05:00

Delusions are fixed, false beliefs as compared to hallucinations which are false sensations ("My tea cozy tells me things") and illusions which are misperceptions of reality ("There's a monster [IV pole] by my bed"). My patient had a hell of a delusion today: the patient believed that feces and urine were soaking the patient's big toe. Therefore, the only sensible thing to do is rip off your toe nail. Yikes. I've never seen a nail-less big toe before and let me tell you it is a sore, oozing, unnatural-looking thing.

I got to be very psych-nurse-y in my approach: "I see you've ripped off your toenail. Can you tell me about that?" (Probing, non-confrontational question). "I understand: you feel as if your toenail is impregnanted with feces, is there anything else you think it's important for me to know?" (reflection, which continued probing). "How do you feel about not having a toenail anymore?" (internalizing question).

I felt a bit better being on the floor today and a tad more confident. In some ways, it's easier to act confident and take charge in this setting as noone will challenge you if you do but they certainly will if you don't. I also got to treat multiple lesions of unknown origin on my patient's hands, face and legs which was unpleasant but it was grounding to perform nursing tasks to which I'm more accustomed.

First- and Second-Hand Violence

2005-03-01T18:30:00.000-05:00

Second-Hand Violence:
I saw my first act of violence against a nurse today. A patient became very agitated after receiving the wrong meal tray and decided to wack the nurse in frustration, screaming all the while. My heart nearly jumped right out of my rib cage and I was pretty terrified. The nurse, on the other hand, was wonderful: she was so calm and put her face right in the patient's face and talked him down in a marvelously soothing, quiet voice. She was also smart and pinned his hands down and told me to go get help.

It was not a great day on the floor - 7 patients were on "CO," constant observation. The nurse manager had to call a staffing agency in order to call in extra nursing assistants who could provide the one-on-one care being CO entails. Luckily, nursing students cannot act as observers otherwise we'd probably all have been conscripted. One act of violence a day is quite enough (see below)

First-Hand:
I tried to be a good citizen and went to give blood. The phlebotomist poked the 16 guage needle (think big) right through my vein and caused some pretty impressive bleeding. I soaked 4 guaze pads with blood in 1 minute and gave everyone a fright. I was fine but they didn't want to stick me again so that was that. They gave me a "Be nice to me, I gave blood today" sticker but it felt disingenuous (and needy).

March comes in like a lion and all that.

The Runs - Not Not Funny

2005-02-28T18:59:00.000-05:00

Well this is a little (a very little bit) funny:
(The following results are from an internet quiz - click on the link below to finally find out which human waste you are)

You scored as Diarrhea. You are diarrhea... I mean come on you like RUNNING AND MUD
Diarrhea: 67%
Pee: 58%
Throw-up: 50%
Turds: 33%
Snot: 33%

What human waste are you?
Created with Quizfarm.com

Not Funny

2005-02-28T16:50:00.000-05:00

I feel as if I've neglected to be even somewhat entertaining lately. I blame psych. There's nothing funny or even amusing about psych - it's sad, draining, deeply personal and bathroom humour doesn't enter into the mix. I'm left with nothing.

So I'm afraid for the next 6 weeks you'll have to bear with me as I try to make the most of this rotation. Maybe things will pick up or (at the very least) I'll stop being so serious but otherwise it's tardive dyskenisia, the isolation room, eloping in the milieu and a brooding, boring unlikely RN.

Psychotropics

2005-02-27T17:42:00.000-05:00

I am studying for a psych medication quiz tomorrow. We have to learn all of the adverse effects and nursing considerations of the most commonly used psych drugs. The most horrible adverse effect is called "tardive dyskenisia" and occurs in patients who have been taking "typical neuroleptics" - antipsychotic medications given to people with psychoses usually related to schizophrenia. I'm sure you've heard of these drugs (Haldol and Thorazine are the most common).

Tardive dyskenisia refers to a grouping of bizarre symptoms where the patient has constant tremors in their limbs and strange mouth and tongue movements: lip smacking, tongue tremors, tongue rolling. Once you develop tardive dyskenisia, the symptoms cannot be reversed and you'll suffer from these symptoms for the rest of your life.

Today, psychiatrists and psych nurses can pick up on symptoms of tardive dyskenisia pretty quickly and will lower the dose or stop a patient taking these drugs altogether. However, when these drugs came on the scene in the 50s and 60s, no one figured that these symptoms would persevere after a patient stopped taking the drug. Therefore, there are whole generations of people who have the symptoms their entire lives. On the unit last week, we saw an older woman who had pretty severe tardive dyskenisia and the lip smacking and shakes are unmistakable. Pretty terrible, no?

If I were a psych nurse, a patient would only have to lick his lips and I would swat away the medicine cup of Haldol in his hands. Which is to say, I don't think I could be a psych nurse.

Snow Day

2005-02-24T18:54:00.000-05:00

Wonderful things happened today: I had my first snow day since I was 9 (there are no snow days in Canada) and I also scheduled two more job interviews for my March break.

Tomorrow I am working with a psychiatric nurse practitioner who specializes in oncology. We are going to screen oncology patients for delirium. What fun! Actually, I am excited because I'll get to spend more time on an oncology floor and see how things work. I'll also get to play the is-it-delirium-or-dementia-or-are-you-just-wierd game over and over again.

Part of the delirium screening involves asking patients to perform a "Mini Mental Status Exam," the MMSE. The MMSE is a brief series of questions and tasks that measure how on the ball an individual is e.g. counting back from 100 in 7s, drawing two intersection pentagrams, writing a complete sentence. I sometimes have problems with the 7s.

Some nurses have to perform the MMSE on a patient up to 4 times a day. I think this must be extremely exhausting and frustrating for patient and nurse alike: "OK, here we go again, draw the pentagrams (again), count backwards (again) yada yada yada...". I think my own score on the exam would drop after the 3rd test in the same day until I would be considered demented, delirious and just wierd.

Isolation

2005-02-23T17:04:00.000-05:00

I wanted to tell people more about the isolation room they have on the psych unit. It's about 6 X 9 with linoleum tile, a plastic-covered matress, linens and a locked door with a plexiglass window covered by a hand towel that's duct-taped to the door. The room is not sound-proofed so you can hear the patient raging and swearing (there is also a 1" space between the floor and the door through which patients can pee and nursing students have to clean it up (that was me)). All in all, it's pretty squalid.

The odd thing is that the room itself is located within the nurse's station. This makes some sense since the nurses can keep an eye on the closed-circuit monitors as they chart, make phone calls and deal with medicines. However, patients are put into isolation because they're psychotic and cannot handle any stimulation in addition to the raging thoughts and/or voices that are already occupying their minds. I'm surprised, then, that the room isn't soundproofed. How would you like to be psychotic and having hallucinations AND hearing muffled voices and laughter not knowing, of course, that these noises are the benign comings-and-goings of the nurse's station.

Another strange thing about the floor is the combination of patients: substance abusers (most of whom have "comorbidities" i.e. psychiatric diagnoses), schizophrenics, people receiving electroconvulsive therapy (mostly depressed people) and a smattering of demented elderly. And they all are on the same floor. Together. All day. I asked a nurse on the floor about this combination and she cannot offer any explanation whatsoever except this group includes the patients no one wants to deal with.

Elopement

2005-02-22T17:20:00.000-05:00

On our psych unit, the elevator spits you out into a vestibule where you must hover and look uncomfortable until someone decides to buzz you in. There is a large sign in the vestibule that says "ELOPEMENT RISK." In psychiatry, "elopement" refers to a patient escape. I didn't know that at first and had *no* idea what the sign was getting at unless there were some extremely impulsive and commitment-loving patients on the floor.

Another odd term of art in psych is "milieu". The term encompasses the day room, hallways or anywhere else where a patient might interact with others. It's funny to see notes in the medical record that says "patient masturbating in milieu" or similar. The most bizarre term I came across today is the name given to substance abuse on my floor: "motivated behavior". To me, "motivated behavior" is, at worst, Type A, go-getter behavior and not spending $200 on heroin each day. Of course, procuring $200 worth of drugs each day does speak to some serious motivation which is, I suppose, where the term comes from.

Overall, it was a bizarre day. I spent an hour or so with a nurse watching a psychotic patient in an isolation room on closed-circuit TV. I attended a substance abuse group therapy session as well as a "movement'" group which was stretching in the day room with anyone who wandered by.

Moving On

2005-02-21T21:21:00.000-05:00

Today we started "Nursing for Adult Emotional Health" known to the non-ridiculous world as psychiatric nursing. It's pretty exciting. Our textbook is full of thematic diagrams, samples of "therapeutic dialogue", goal checklists for positive nurse-patient relationships etc. There's not a single picture of the human body in the whole book and it's really a nice change. There are some pictures of patient restraints, though.

Speaking of our textbook, it has a batik print illustration of the Maine coastline on the cover. Please - can anyone suggest a relationship between ethnic silkscreening, the Maine shoreline and psychiatric nursing? For the life of me I cannot cannot make the connection.

Tomorrow is my first day on the unit. We will not be wearing our nursing uniforms but are asked to wear professional dress and our lab coats instead. This strikes me as somewhat odd - doesn't this v. doctorish ensemble seems far more threatening to patients than our normal nursing-uniformed selves? I'm sure the substance abusers and agitated schizophrenics just *love* people in white coats.

Note to Ms. or Mr. Thinkingaboutnursing: I would, without hesitation, recommend nursing school. I have no reservations about my choice and am truly thrilled with my program,the profession and my prospects. If you'd like, leave you email adress and I'd be happy to answer any other questions you might have.

Again - thanks to everyone in Chicago for the lovely weekend. It's so nice to be home.

Suprises & Toxic Megacolon

2005-02-17T17:14:00.000-05:00

I'm amazed and shocked to report that two of the questions on my previous post titled "Questions that won't be on the exam" were on the exam. There was a question about bone marrow transplant patients and standing water (avoid it) and conscious sedation (demand it). One of my favorite questions on the exam had to do with digestive diseases and one of the (wrong) multiple choice responses was "Toxic Megacolon".

I didn't know there was such a thing as a toxic megacolon but there is. And it is horrible. I was hoping that it was a made up condition because I find the words "toxic," "mega" and "colon" wildly funny when put together. It sounds like a character from a 1970s comic book whose magic power is...never mind. I really *have* to stop making these sorts of jokes. Too easy.

Today was my penultimate day of medical-surgical nursing. I had a really lovely patient and got to do a lot of teaching which I like. I made a real ass of myself, though, when I referred to a resident as an intern and a nurse chided me by saying "After their 4th year [of intense, gruelling surgical residency], they tend to resent that".

To give you all an idea of the small pleasures of a nursing student, I have been saving something very special for my last day of med-surg. My mother put a Coffee Crisp (a chocolate bar only available in Canada) in my Christmas stocking and I've delayed the pleasure of eating its nice-light-mocha-crispness until the last day of med-surg.

I'm a mere 20 hours or so away from CC-day.

Questions That Won't Be On The Exam

2005-02-15T17:45:00.000-05:00

I have a final exam in medical-surgical nursing tomorrow and the following are the only items that one could possibly consider worthy of sharing and, as you'll see, that's not saying much:

1) If you know someone who has just had a bone marrow transplant or is severely immunocompromised in some other way, don't send them flowers before asking to see their latest lab results. At my hospital, you may only receive flowers if your absolute neutrophil count (germ-fighting white blood cells) is above 500. The general idea is that standing water and flowers can play host to countless germs that will get someone killed. Go with the balloons (but not latex balloons because that will kill someone too).

2) There is such a word as "hematochezia" and it means bloody stools.

3) Besides sounding like a lovely girl's name, the word "Melena" (or melena, really) means black, tarry stools.

4) If you have colo-rectal cancer and you must have your rectum excised, some clever surgeons will build you a new rectum out of a bit of your small intestine. You can't use your new rectum for about 6 months to a year because your body needs a while to get used to having a small intestine for a rectum. In the meantime, the surgeons will fill your new rectum with *glue* to help it keep its new shape.

5) There is such a word as poiklothermia and it means "cold" but has 5 syllables.

6) If someone has had a cardiac catheterization for an angioplasty or angiogram, the nurse is responsible for placing a 5-10 pound sandbag over the insertion site for a couple of hours after the procedure is over. Who makes these sandbags? Are they made of special, hospital sand? Do frantic civilians raid the cardiac units when hurricanes come and they're low on sandbags? This whole thing mystifies me.

7) Nurses should request that their patients receive "conscious sedation" for bone marrow biopsies because this may not be standard practice. Conscious sedation, or "Versed" (the name of the drug), is a type of anesthetia that kills the pain and makes you forget the procedure but allows you to follow simple instructions and breathe on your own). Ummm, why would anyone have to do without this? My book says that bone marrow biopsies can be "quite painful" and you know that when a textbook admits something can hurt, it must be mind-blowingly horrific. After all, these are the same textbooks that talk about "discomfort" while giving birth.

In addition to the above, we've technically covered all you need to know to care for hospitalized adults in 7 weeks. I don't buy it. However, the process of becoming a likely RN is really picking up the pace: I have a job interview scheduled in March and will hopefully have another interview set up by the end of the week. One interview is for general pediatrics and the other is for adult oncology.

Happy Valentines Day Unlikely RN!

2005-02-14T10:31:00.000-05:00

You've been hacked for a not-so-nefarious purpose:
Happy Valentine's Day - You're the best (and cutest) nurse out there.
Love...
????

Worries

2005-02-13T22:51:00.000-05:00

Two of my friends have kindly listed the top ten things about which they worry under my "Panic" (02/07) post and so it's only fair I confess my own:

1. Somehow becoming a "likely" RN (see all)
2. Schizophrenics, drug abusers and patients receiving electroconvulsive therapy (see "Panic", 02/07)
3. Being overly scatalogical (see all)
4. Not being able to find a bedside commode next time (see 02/11)
5. That my tea cozy doesn't like me (see 02/04)
6. Being suctioned (see 02/04)
7. Having more than 2 patients (see all)
8. Being sat on by a patient (see 01/26)
9. Thinking cognitive distortions aren't distorted (01/12)
10. Being self-referential (see 1 - 9)

Nursing Intervention: Bedside Commode

2005-02-11T18:52:00.000-05:00

As nursing students, we're taught that our profession is comprised of treating human responses to medical conditions. and our "nursing interventions" are targeted towards increasing our patient's autonomy, comfort and security. I took this very seriously today and moved heaven and earth to have what must have been the only remaining "bedside commode" left in the hospital delivered to one of my patient's (see 02/10/05) room.

A bedside commode is a sort of toilet seat on wheels that can be positioned next to a patient's bed so that patients whose activity level is limited to OOBTC (out of bed to chair) can use a toilet-type-thing instead of a bedpan (again, see 02/10/05). Using a bedside commode is much more comfortable as it is far easier to poop sitting down, it definitely promotes autonomy and anyone feels more secure wiping themselves than letting a maniacally smiling nursing student do it (please, see 02/10/05).

Unfortunately, I am not the only caregiver in the hospital interested in promoting my patient's interests so all of the commodes seemed to have been taken. It took about half a dozen phone calls for me to track one down. I had the receptionist page me the moment the commode appeared so I could grab it before anyone pilfered it. The students in my clinic group all lived vicariously through my bedpan experience yesterday and whooped and hollered when they saw me wheeling the commode down the hall, triumphantly.

Again, see 02/10/05.

Code Brown or The Unlikely RN's First Bedpan

2005-02-10T19:25:00.000-05:00

It was conceivable I could get through nursing school without having anything to do with bedpans. Many people get through my program without it and many people can even get through nursing without bedpan duty by politely requesting the nursing assistant to, well, assist.

But that won't be me.

Instead, I had an old-fashioned, code brown, #2, 4-days-worth-of-feces bedpan experience. Guess what? Bedpans are too small for 4 days worth! My poor patient was very unhappy but I tried to be as therapeutic and jovial as possible and said "Well we weren't built at all to poop lying down so you and I will just have to try to cope". Cope we did with about 3 packs of wet-wipes, a sponge bath and a half and a sort-of-smile.

So I have never been more intimate with adult poop in my life. To be honest, I get a little nauseous thinking about it and I have developed a minor psychosis where I think I can still smell it on me although I showered (just once, I promise - a *very* minor psychosis). In any case, the bedpan seal is broken.

Panic

2005-02-07T17:49:00.000-05:00

Psychopathology sometimes gets a little ridiculous. Today we learned about "Generalized Anxiety Disorder" which, according to the DSM-IV (of GAF fame - see below), refers to being worried about 2 or more things for 6 or more months. Our professor gave the example of a mother who worries about her children and finances.

Oh yeah, that's pathological.

We also learned about panic attacks which account for 11% of all emergency room visits. The symptoms of a panic attack are shortness of breath, difficulty swallowing, chest pain and dizziness which are some of the symptoms of a heart attack. It must take a lot of experience and chutzpah to say to someone who is grabbing their chest and gasping that they ought to breathe into a paper bag and refer them to a therapist.

We got our psych nursing assignments: I will be on a floor that has schizophrenic patients, patients who have received electroconvulsive therapy and patients with substance abuse problems. What a mix!

Taking Your Breath Away: The Unlikely RN on Suctioning Tracheotomies

2005-02-04T17:38:00.000-05:00

Today I had a patient with a "fresh trache" i.e. had a tracheotomy yesterday. A tracheotomy is the procedure wherein a surgeon cuts a hole in your neck and inserts a plastic tube that lets you breath when your mouth/larynx/pharynx region is obstructed, usually by a tumor. Your lungs continue to expand and contract normally but the air comes in and out of the hole in your neck. When I describe a trache, most people think of "those people who smoke out of that hole thingy in their necks." Exactly.

There are several problems that the nurse has to watch out for when caring for someone with a tracheostomy (tracheOStomy is the name of the hole, tracheOtomy is the name of the surgical procedure). First of all, the darn plastic thing might pop out of the hole and the hole will close up and the patient will die. Therefore, trache patients have Kelly clamps (scissor/clamp-type-thingies) taped to their bed rails so the nurse can hold open the hole and scream for help (or that's what I would do - I suppose other people (nurses, say) might be able to remember to press the panic button also at the bedside). Also, it's difficult for people with tracheostomies to cough up mucous or anything else that ends up in their lungs. Therefore, you have to "suction" them. This involves putting a plastic suction tube down their airway until it hits their lungs and then withdrawing the tube while applying suction to remove mucous plugs and any blood left over from the trauma of putting a hole in someone's neck.

For the patient, suctioning is pure hell. Babies turn blue when suctioned, children fight the nurse, cry and vomit and adults just gag and panic. It's so horrible because when the nurse suctions, s/he is taking away all of the air in your lungs and scraping a tube along your tender airway that goes into spasms when even a drop of water "goes down the wrong tube". My patient's eyes bulged, then the patient gagged and sputtered and coughed up about 3 tablespoons of bloody mucous. Terrible.

Also, patients with new trachestomies are susceptible to choking since it's difficult to swallow with a plastic tube jammed down your throat. Therefore, nurses sit with patients while they're drinking to ensure the patient doesn't choke and die. I sat at my patient's bedside and with every sip all of my muscles tensed and I was ready to untape those clamps and use them, suction out the offending liquid and then pass out.

Finally, patients with new traches can't talk (once they've had them in for a while, you can have a special one that allows you to talk or you can learn to whisper with a normal one). Therefore, you have to remember to ask "yes" or "no" questions ONLY. I have to be very careful about this as I will ask "You don't have any nausea, do you?" and then I get a "no" nodding response and then I'm not quite sure what I asked so I have to rephrase "Do you have any nausea" and luckily I get a "no" nod and probably an inward eye roll from the patient thinking "Who is this clown?".

Relationships

2005-02-03T18:17:00.000-05:00

Although there should be at least one person who disagrees with me, perhaps I shouldn't be in a relationship as it seem I greatly undervalue them. I did well on my psychopathology test but got the following question wrong:

1. Which of the following are considered protective factors for suicide (select all that apply):
A) Relationships
B) Religious conviction
C) Dependent children
D) First year after birth

I selected B), C) and D) but figured that "relationships" was too vague. You could have a lousy relationship or you could have a relationship with your tea cozy and neither of those relationships would be considered healthy much less make you likely to kill yourself. But, according to my professor, relationships of all kinds are indeed correlated with lower suicide rates.

So introduce yourself to your tea cozy.

Global Assessment of Functioning

2005-02-01T16:57:00.000-05:00

I have a psychopathology exam tomorrow and am learning about the Global Assessment of Functioning (GAF) scale. This is a scale used in the diagnostic and statistical manual of mental disorders (the DSM-IV, the psych bible) in order to rate an individual's psychological, social and occupational functioning on a scale of 1 - 100. It's hilarious.

Are you an 80? If so, your psychological symptoms are transient and expectable reactions to psychosocial stressors and have no more than slight impairment in social, occupational or school functioning. Maybe you're feeling more like 60: moderate symptoms with or without moderate difficulty in functioning. God forbid you're a 20 where you have some danger of hurting yourself or others or you occasionally fail to maintain minimal personal hygiene. If you're lucky, you migh reach 100 where you have "superior functioning in a wide range of activities, life's problems never seem to get out of hand, you are sought out by other because of [your] many positive qualities".

Obviously the point of this scale is for a mental health professional to assign some value to your level of functioning so that they may chart your progress or lack thereof. However, I still think it's pretty funny. I mean, what does it mean to be a 98? Does that mean life's problems never seem to get out of hand but you are frustrated that you can't figure out your VCR? If you are a 97 maybe you have problems with your VCR *and* your child-proof vitamin bottles. Who can say...

I think it would be neat if we could all wear little wristbands that could report our GAF on an hourly basis: "I was 92 this morning but then I forgot my gas cap at the filling station and cursed in the car so I'm down to 89" or "I was 97 last week but then I stopped bathing and tried to throw myself out of a moving vehicle so I'm running a 3".

What are you?

Being Nice

2005-01-29T15:29:00.000-05:00

I'm slowly learning how to be therapeutic, polite and kind while hating my patient's guts. It's extremely difficult. One of my patients this week drove me absolutely crazy and half a dozen times I really would have rather stuck things in other places and omitted certain parts of my interventions (pain medicine, for example...).

Sometimes I wonder if you can see it on my face. I'll have to start practicing unfurrowing the brow, relaxing the lips, lowering my middle finger etc.

It's hard to know how not to let things get to you. A lot of people in medicine and nursing jut turn off all of their patients-are-people neuropathways and treat everyone brusquely or in that over-friendly, dehumanizing and familiar manner that drives me crazy ("And how is our new mommy doing today?"). I know that some hospitals (and one of our textbooks) refer to patients as "clients," in order to emphasize the service-orientation of health care. That has its advantages but when I'm washing a cancer patient's feet because they cannot do it on their own, I feel very differently towards that person than I imagine I would if I were giving them a pedicure for $40.00.

There's obviously a balance to strike but I think it will take years and years before I can even find the fulcrum.

National Body Fluid on the Uniform Day

2005-01-27T19:08:00.000-05:00

I had my first body-fluid-on-the-uniform day. What fun! Luckily, I was able to remove my blood-stained turtleneck from under my uniform shirt which meant I didn't have to borrow a pair of paper scrubs from the unit and sound like a newspaper for the rest of the day.

And so this brings up an important question: What would *YOU* like to have on your shirt? My clinical group seems evenly divided between crap, pee and blood. I'm a blood girl myself (doesn't smell but could give you a terminal disease and doesn't come out easy in the wash) although there are equally good and bad reasons to prefer crap (comes out of the wash, generally has non-lethal germs in it but definitely smells) or pee (no germs, only some smell (depends) but stigma of being "pissed on" and likelyhood of pee seeping through shirt onto your skin).

And the thing is it is a good idea for nurses to wear white or light colors: I probably would have no idea my sleeve was covered in blood if I were wearing a dark-colored top. And then, god forbid, I probably would have wiped my nose with my sleeve as I'm wont to do or something similarly unsanitary.

Prioritizing

2005-01-26T17:21:00.000-05:00

I had my first case study-based exam today. Essentially, the questions would include a clinical scenario and then ask you what you would do first. It's harder than it sounds i.e. one of the options isn't "B) Check back with patient after lunch break." Instead, all of the options seems equally important and critical and I am always convinced you could do two at once i.e. listen to breath sounds at the same time as you ask someone else (like a hapless nearby nursing student) to collect a sputum culture. Unfortunately, there's only ever one answer. In this case? Listen to breath sounds. Luckily, I got that one.

Today was an exciting day because I was assigned to a project for the research and leadership training fellowship I'm doing. It looks as if I'll be developing a screening tool for delirium in oncology patients. This is actually a plum assignment because the other projects all seemed to be about medication errors or whether or not to put bed rails up. And I'm pleased to be working in oncology.

Tomorrow I'm back at the hospital with real-live patients (as opposed to case studies). I won't say more than this but while looking up information about the patients I would take care of, I wrote down a patient's weight. "My my my that's a heavy one," I thought and wrote down a weight in pounds. I was wrong. The patient's weight was actually written in kilograms and is therefore 2.2 times as big as I originally thought.

Oh dear.

J Crew Mania

2005-01-24T17:08:00.000-05:00

We learned about bipolar disorder/manic depression in our psychopathology class today. The lecturer, a psychiatrist, talked about one woman who, in a manic state, ordered one of every thing from the J Crew catalogue.

She also talked about the fact that people are most likely to kill themselves within 3 months of being hospitalized for depression. This, of course, is mostly due to "severity bias" i.e. people who were depressed enough to require hospitalization are the people most likely to commit suicide. However, if must make it extremely difficult on the staff who took care of the individual - I would never want to discharge anyone.

The Unlikely RN Keeps Her Lunch

2005-01-21T18:31:00.000-05:00

I did it! I neither gagged nor vomited; I didn't even bat an eyelash while aspirating stomach contents from my patient's nasogastric tube. When I removed a mucous plug the size of a centipede from the tubing, I simply raised an eyebrow at it in a seasoned nurse-ish way as if to say "What else have you got to show me?" I got so confident that after I left my patient's bedside once, he called after me: "Aren't you supposed to turn the suction back on?"

Oh yeah, I am.

All things considered, it wasn't too bad and I got to learn a lot about the veritable palette of green our stomachs are capable of producing. Anywhere from sage to neon - I swear.

I also performed (wait for it): foreskin care. When it's there, you have to take care of it and that is that. I went for the warm, soapy water but others prefer simple normal saline. Someone even recommended a mix of peroxide with tap water.

The only time I felt queasy today was when I watched an IV therapy nurse look for a vein. These nurses are amazing and spend all day going around and starting up new IVs for people. They are vein hunters par excellence and an inspiration to someone like me who can't even take blood yet. However, today I saw what happens when these exceptional nurses can't find a vein. They essentially get the needle under the skin and take about a dozen or so blind stabs into the flesh hoping to draw blood. It was awful to watch and very lightheaded-making. I told my patient if he were any younger he would get all the stickers and prizes in the sticker and prize basket for undergoing such a thing but instead all I could offer was some chapstick.

The First Thing in Nursing School That Made Me Want to Vomit (reprise)

2005-01-19T19:10:00.000-05:00

Back in July we learned all about nasogastric tubes and how the good nurse aspirates for stomach contents before flushing or delivering medication through the tube. In order to do this, you have to use a giant syringe to draw up a couple of tablespoons of stomach contents (vomit, blood and bile, oh my) via the tube, squirt out the contents into a basin, dip a pH stick into the sludge and then draw the sludge back into a syringe and instill it back in the patients stomach via the tube. This is decidedly vomit-inducing. I had 2 patients in pediatrics with NG tubes but the protocols are different and we didn't have to do this for kids.

No such luck for adults.

So tomorrow I have my first adult patient with an NG tube and will likely be performing the above procedure every 4 hours. I think I will wear a mask for two reasons: 1) If I vomit, there will be some barrier between myself and the patient and 2) If I manage to keep my breakfast down, the mask will slightly obscure the horrible expression on my face.

The forms are in for our next rotation which will be coming up in a month: Psychiatry. Our choices include the schizophrenia floor, the mood disorder floor, the eating disorder floor, the general psychiatry floor, the geriatric psychiatry floor (please oh gosh not this one), the pain floor etc. How many floors can this horrible hospital possible have? My carpool friends and I chose mood disorders but who knows if we'll get our first choice. It might turn out I'm force feeding 90-pound adolescents this spring. I certainly hope not.

Lab Normals

2005-01-18T16:28:00.000-05:00

My nursing school celebrates Martin Luther King Jr. Day, which made for a lovely long weekend. However, I had to write a "care plan" on last week's patient which mostly consisted of saying "make him stop smoking" in 14,000 different ways with research to support my outlandish claim.

I am currently torturing myself by committing "lab normals" to memory. Lab normals are the acceptable ranges for various tests e.g. your potassium blood level should be 3.5 to 5.0 millequivalents per decileter. You will never, ever (ever x 14,000) receive a lab report that doesn't include normal values in addition to whatever a patient's actual results are. However, everyone must make a show of memorizing these values only to forget them the day after the licensing exams. There are about 25 or so and they're damned difficult to remember. I have brightly colored flashcards but not even these snappy neon colors are making the process any easier or fun.

Like The Unlikely RN? Candid thoughts on (actual) nursing can be found at Code Brown by Nurse C (no relation).

Operating Room, Peristalsis & Agony

2005-01-13T18:49:00.000-05:00

Today was my operating room experience. Every member of the surgical team conformed to (stereo)type: the surgeon was abusive and short-tempered, the nurse was meek and bumbling and the anaesthesiologist seemed clinically depressed. I just tried desperately not to get in the way (and therefore conformed to the nursing student stereotype).

I saw two GI surgeries where the surgeon wasn't sure what he would find i.e. cancer or no cancer. Luckily, both patients had noncanerous tumors. One tumor was a lipoma (fat tumor); I went with the pathologist to cut open the tumor the surgeon resected from the patient's duodenum (the middle portion of your small intestines) and, sure enough, it was filled with fat. It was exciting, though, cutting the thing open because the pathologists really had no idea what they'd find. Surprises every day in the pathology department!

The neatest thing I saw during the surgery was peristalsis. Peristalsis is what your small intestines are doing right now: regular, muscular waves that crunch the mashed-up food in your intestines and move it down towards your colon. The motion almost reminded me of a lava lamp: v. transfixing.

Seeing another surgery makes me desperately want to avoid ever being on the table myself. I'd also like to avoid ever working in an operating room: people are on their feet all day. One of the surgeons was in his mid 30s and had massive vericose veins around his ankles; presumably from standing so much. I was on my feet for 6 hours without a break and it's not really becoming for a nursing student to do squate or stretch or move about during a surgery so I had to stand stock still for all of this time. I was almost crying from the pain in my back towards the end.

Agony. Of course, I'm not the one waking up with a 10" abdominal incision.

Cognitive Distortions

2005-01-12T17:26:00.000-05:00

I was looking forward to my psychopathology course to learn new ways to describe the people around me i.e. learn words slightly more sophisticated than "psycho". Unfortunately, so far I've only learned new words to apply to myself. Today we learned about "cognitive disortions," which are common ways badly adjusted people react to the world around them. There are 10 of them and they include overgeneralizations (everyone hates me), all-or-nothing thinking (since Mary doesn't like me, everyone hates me), disqualifying the positive (my mother likes me but she doesn't count because she has to), magnification (Mary didn't sit next to me today so she hates me), etc. I would say I use at least one of these a day. Some days I probably make it all the way down the list and go 10 for 10.

Seriously, who doesn't pepper their version of reality with these mechanisms.

Right?

(I'm currently house sitting (great, great gig) and have a computer that was built this century so I'm actually able to do fancy things like add links to my entries - very exciting).

Electrolytes

2005-01-11T13:49:00.000-05:00

I'm stuggling with electrolytes this week. The only science I studied in university involved plant reproduction and I'm quite behind in the worlds of potassium and hydrogen and their cation and anion friends, extracellular and intracellular fluids and other basics of biochemistry that everyone else seems to absorb with ease. So I have to slog through it and it's no fun at all. In the fall I mastered metabolic and respiratory acidosis/alkalosis (too boring/complicated to explain but essentially when you have too much acids or bases in your body because you're in some sort of physical distress) so I have the confidence that one day I, too, will be able to calculate an anion gap with ease and let you know why, exactly, we want to avoid hyperkalemia. Or not.

This Thursday I will be in the operating room all day. A friend of mine saw a below-the-knee amputation, inguinal hernia repair and a ERCP (gall bladder exploratory surgery) last week. I'm not sure if I'm excited or not but I think it's in everybody's best interest if I skip any amputations. Our professors' advice: eat breakfast.

Savant Servant

2005-01-09T17:23:00.000-05:00

I have just finished my weekend of doula training (see below) and it was wonderful. I spent the greater part of the last 48 hours in a Baltimore basement with the same 15 classmates and instructor learning and practicing all sorts of comfort measures, positions for childbirth, techniques for encouragement and concentration and taking in heaps of information about birthing and the postpartum period.

The weekend was decidedly interactive: we all bounced on birth balls, squeezed each other's sacral areas, gave backrubs, tried out dozens of pushing positions (including the supported dangle, toilet squat, cow/cat rock...), "vocalized" (lots and lots of grunting), did "roving body checks" (lots of lots of stroking - all kosher) and other creative and slightly boundary-expanding and personal-space-invading activities.

We were also shown about a dozen videos of different types of birth - the water birth, the vaginal birth after c-section, the home birth, the unmedicated birth, the sorta medicated birth, the super medicated birth and the hypnobirth (v. strange). We also saw a video of one woman birthing twins where the first baby was born breech (bum first) with NO medication. Unebelievable. Our instructor was obviously a proponent of less-invasive births but was extremely careful to support all birthing choices (possibly excepting c-sections on demand) and to make sure we behave in the same manner.

Our instructor knows, of course, that it's unusual for doulas to be young women without children but assured us that a sincere desire to help is sufficient to, well, help! I liked this much better than the pretty glib response our professor in our childbearing class: "One doesn't need to have cancer to nurse cancer patients and the same goes for labour and delivery." Frankly, I think it would be quite inspiring to have a nurse who survived cancer if I were a cancer patient.

So the next step in my doula-hood is to pick up a client. On Tuesday, we'll be paired up with another student and assigned a pregnant woman who has requested our services. Exciting, no?

Stumbling Towards Surgery

2005-01-09T17:11:00.000-05:00

My first day as a full-fledged med-surg student nurse on Friday was actually not so bad. Our instructor gave us a wonderful gift - a day of observation. In other words, we were allowed to watch a real live nurse do real live nursing things before we stumble through the procedures ourself. We were also allowed to perform the tasks we were comfortable with so it was a nice balance of learning new things and having the chance to get back into the swing of things.

This was a last minute gift: our instructor led us to believe that we would be responsible for all nursing interventions on Friday and suggested we go home and review the procedures we'd be expected to perform. This is actually quite terrifying and I spent half the night in a cold sweat worrying about my patient's bile stents; specifically - where are they? I kept running over a nightmare situation where I'm fumbling around my patient's gown trying not to reveal that I have absolutely no idea where one finds a bile stent, much less two. I read all about how to empty and flush bile stents and how often and with how much saline but no one seems to bother telling you where they actually are. I know where a gallbladder (where bile stents go) is, of course, but stents can come out anywhere. When I came in the next morning, our instructor had "reconsidered" (perhaps she had some cold sweats of her own) and decided she'd let us tag along with a nurse. Thank goodness.

FYI: Bile stents come out below your 8-9th rib halfway between your nipples and armpit.

Surgery. Crap.

2005-01-06T20:46:00.000-05:00

I've been posted on a surgical floor for this rotation (we didn't really find out until 7 o'clock this morning - my group and I all thought we were lucky and placed on a medical oncology floor). Ninety percent of the patients have GI cancers and have had some sort of awful surgery involving pancreases (my favorite), bile ducts, gallbladders, intestines and livers. Therefore, the next seven weeks will be filled with drains of all kinds, stents, colostomies/ileostomies (plastic poop bags), nasogastric tubes, incisions and wounds. Crap. Literally. So more or less this placement is an everything-I-really-really-really-really-don't-like one. However, there will be one important challenge here: most of these patients have liver or pancreatic cancer which generally have low survival rates. A great many of the surgeries are palliative only and meant to improve the quality of life for these patients before they die in a year or so. I'm looking forward to see how patients, families, nurses, doctors and I cope with this.

If people are interested, there is an interesting debate concerning the state of modern psychiatry on the "comments" section of my posting on Tuesday. I have only had one class in the subject and can't properly contribute but, essentially, I believe I will neither burn my DSM-IV nor worship it.

Prevalence & Some Insane History

2005-01-05T17:27:00.000-05:00

Do you know just how crazy the country is? And how much that matters?
Please note:
1) ~21% of the US population over 18 has had a diagnosable mental disorder in any given year. That's about 44 million Americans
2) 4 of the 10 leading causes of disability in the US and other developed countries are mental disorders
3) Mental illness, including suicide, accounts for over 15% of the burden of disease. That's more than all cancers combined.
4) Direct treatment (i.e. MDs, RNs, social workers, drugs and NOT lost productivity, sick days etc.) of mental illness, substance abuse and Alzheimer's disease costs $99 billion dollars a year.
5) The prevalence of suicide in the US population is 1% i.e. every year, one percent of the population kills themselves successfully.
I had some idea of the magnitude of mental illness and suicide but I had no idea tens of thousands of people were killing themselves each year or that almost a quarter of the population looses it in some diagnosable way. In my psychopathology course, we'll spend the next semester learning all about the varieties, management, medications and other facts surrounding tmental illness.

Our next class will be on the stigma of mental illness so this might be the last time I use the word "crazy." Or "nutty". Or "loony tunes" or "out to lunch" or "mad as a hatter" or "------- in the head" or "cookoo" or "nut job" ...

Over the break, I started reading a great book called "History of Psychiatry" which is, well, what is sounds like. The author, Edward Shorter, presents an argument which argues against Foucault's idea of a "grand confinement" that took place in the 19th century i.e. the nasty capitalist society shipped their non-comformist or eccentric relatives off to insane asylums and this explains the large increases in asylum populations of the mid to late 19th century. Shorter argues that this simply was not the case and the bourgeois were not so petty (hahahaha!) as all that but, simply, there were more mentally ill people at this time. He blames this increase on syphilis (which leads to neurosyphilis which will make you extremely, uhh, eccentric), alcoholism, DTs (alcohol withdrawal-related insanity) and schizophrenia (he doesn't quite explain how schizophrenia suddenly popped up). I like the idea of all of a sudden people going crazy over the span of 50 years or so. It's easy to see how Foucault tried to link it up with capitalism!

Woman Servant

2005-01-04T14:41:00.000-05:00

Monday was my first day back at school. This semester seems as if it is going to be quite different from the last: all of my courses are at least somewhat discussion-based and deal with slightly more squishy things than pharmacology or pathophysiology. So my new courses include the research process in nursing, psychopathology and nursing for adult physical health (this is a lecture + clinical course - the 1st in a series of 3 clinical courses I'll take this semester). I'm really looking forward to psychopathology as I've never taken any psychology before but have been diagnosing people I know for many years so will finally learn just how right (or wrong) I've been.

I'm also taking a course to learn how to be a doula also known as a childbirth assistant. Doula comes from the ancient Greek "woman servant" and it is a woman who is trained to help a mother during birth. The tagphrase from DONA (the doula association of North America) is to train women to "mother the mother". Therefore, the sort of things I'll learn is different positions for different types of labor, non-pharmocologic pain relief (rubs, baths, distraction etc.) and more about the natural course of labor so you can assure woman that what or when they're experiencing is normal. It's a bit hippie and I feel a bit odd learning how to do this since I have never given birth myself but I'm really looking forward to it. After I take the course (which runs 18 hours over this weekend and some extra meetings), I'll be assigned to someone who requested a doula from my school and go ahead and provide the labor support. If I do enough births, I can apply for certification from DONA. I get paid through the school for the births I attend, too, so it's hard to say no.

I've been placed in an oncology floor for my clinical work for adult physical health (I know the name's a mouthful but what else can I call it?) and that's excellent. I'll start on Thursday.

Vacation

2004-12-27T15:51:00.000-05:00

I'm now in Canada enjoying my two and a half weeks off. Sadly, there's only 6 days left of my vacation. There'll be much more to write when I'm back at school.

My last exam went well enough but unfortunately I couldn't use any of my food-related knowledge as the exam tested things other than repulsive food comparisons.

See you on Monday.

Christmas Disease & More Offputting Food Comparisons

2004-12-14T18:40:00.001-05:00

One exam left: pediatrics. This is a cumulative exam and involves countless conditions, diseases, symptoms, lab values, nursing management and more. I can barely bring myself to write about any of these things as I am so sick of studying them. The only barely entertaining fact that I can come up with is that the rarer type of haemophilia is called "Christmas Disease." That's festive, at least.

Oh wait. There *IS* more . . . more disgusting food comparisons to share:

If a child has an intestinal intussusception (happens to kids from 3 months to 3 years where their small intestine telescopes into their large intestine and shuts the whole works down), you will pass "CURRENT JELLY stools." And if that's not enough, you'll also be able to palpate a SAUSAGE-shaped mass in their abdomen.

If a child has a pyloric stenosis (a narrowing of the sphincter that lets food from your stomach into your intestine), you can palpate an OLIVE-shaped mass in just above their belly button on the right. Don't you find the olive comparison suspiciously specific? Why couldn't they just say "small lump" or "oval lump"? Why does it have to be an olive? The child would also have projectile vomiting which would probably discourage you from looking for that damned olive anyway.

Diverticulosis, Gallstones, Hepatitis and Osteoporosis Explained

2004-12-12T19:19:00.000-05:00

Am busy studying for my final pathophysiology exam tomorrow. Have learned I am somewhat at risk for gallstones: fat, flatulent, forty, female and fair. Am neither fat nor forty but firmly meet the other three criteria.

I have also learned about diverticulosis. North Americans and Western Europeans are the only people dumb enough on the planet to suffer from diverticulosis (a condition where bits of your large intestine pouch out and can become infected). Apparently, the other 6 or so billion people in the world manage to a) eat enough fiber and b) do not hold poop in too long. North Americans and Western Europeans are apparently neglecting to do these things in droves so almost 60% of people over 60 will suffer from diverticulosis. Diverticulosis isn't so bad but if it turns into diverticulitis you can contract peritonitis, go into shock and die. So lets all go to the bathroom OK?

I have also had to learn about each type of Hepatitis (A, B, C, D and E) which has been boring but helpful because I've always had no clue about what differentiated one from the other. Essentially, A and E are generally short-term illnesses that are spread by water and poop (see a theme?). B, C and D are spread by blood and other body fluids and can covert into chronic hepatitis. C is the one you really want to watch out for as it can raise your chances of having liver cancer. However, most people get C from doing IV drugs so I hope my readership is out of the running. B can be very nasty but luckily we have a vaccine. So there you have it: the A,B,C,D and Es of Hepatitis.

We also learned about Osteoporosis last week and I have been eating dairy products like a madwoman. Apparently, we've laid down all of our bone mass by the age of 30 and lose 0.7% per year thereafter. I've looked at the nutrition labels of all the foods in my fridge and have been downing mozarella cheese, soy milk and spinach. Yoghurt has a disappointingly small amount of calcium (only about 10-15% of your daily requirement compared with 30% in a cheese stick or soy milk).

So while I may not ace the exam tomorrow I've clearly internalized all sorts of information and am keen to share. Watch out family and friends! I'm coming home armed with so much "information" and "advice" that you might just want to send me right back.

Flu Goo

2004-12-10T19:31:00.000-05:00

I had the "Flu Mist" today which is anything but. Have you had this? I had imagined that the Flu Mist was, well, a mist. Instead, it's a syrupy goo in a syringe that a nurse shoves way up each nostril and squirts. The goo is sweet and it trickles down the back of your throat : "Mmmmmm" I thought, "live attenuated influenza virus." I think having something shoved up your nose is far more invasive and painful than a shot. Such is the plight of the nursing student in the year of the vaccine shortage.

It was great fun, though, watching other people react to the "mist". Everyone looks shocked and pissed off that someone would dare put something so far up their noses and afterwards everyone tears up and wipes their nose with great vigor.

Today was my last day of pediatrics. I did enjoy it and I am definitely thinking about working in pediatrics. Working with kids required a lot of adjustment on my part i.e. learning what they can and cannot understand, the difference between pain and anxiety, working with parents. Once I got used to dealing with these facets of peds, I really liked it.

It's agony waiting out this weekend before my 3 final exams next week. All I want to do is write the exams and split. 5 days until I'm halfway done nursing school!

Stents, Fruit Punch and Coffee

2004-12-09T16:44:00.000-05:00

I had my first surgical patient today. I was a little nervous at first because these are the sorts of patients that are connected to countless tubes, drains, stents, on a hefty number of narcotics and in too much pain to move. Did I mention all the tubes? However, I went very slow and prepared enough so that I was able to remember what was what and what to do with what (did you get that?).

Part of caring for this patient involved emptying all sorts of receptacles and charting the amount and quality of the fluids this child's body was producing. The theme? Food. I asked my instructor how nurses generally describe the discharge from a LCS nasogastric tube (a tube that is attached to suction machine that removes all of the blood and bile from the child's stomach) - I was thinking about describing it as "dark brown with black granules" but my instructor took one look at my specimen and said "coffee grinds." When I described some other fluid as "pinkish," she corrected me and said that "fruit-punch colored" was really the better term to use. The terms are bang-on. However, I will no longer be able to look upon either of these substances again without feeling just a little bit like vomiting.

I also, of course, have my running list of dingbat nursing student things I did over the course of 8 hours. Today, this consisted of trying to insert medicine through an air port instead of the needle port, incorrectly closing a drainage bag that subsequently leaked all over the floor, being unable to multiply 1.7 times 2 without a calculator (!?!?!?!?) and getting myself locked into the medicine room. One good thing about making mistakes is that I will (I hope) never make them again and reminds me there is so much to learn. Also, these mistakes were fairly minor since I caught them before they adversely affected anything other than my ego. I can't say anything positive about me being unable to perform the most basic mathematical operation. That just makes me stupid.

Keeping Patients in Line & Things We Do For Children With Cancer

2004-12-08T19:11:00.000-05:00

I know I dwell on the uniform but it really is a large part of the nursing student experience. I swear. For example, I was taking care of a 5-year-old patient the other day who asked me why I was dressed like a police officer (our uniforms have all sorts of patches and pockets). The kid asked me this after I had been taking care of him for a day and a half already. He had finally worked up the courage to ask why his caretaker was in costume. Goodness knows what other misunderstandings the uniform engenders. Personally, I think I look like a deranged paramedic. The worst part is that other schools in the area get to wear uniforms that actually make them look like nurses. Therefore, I always wonder if the hospital staff feel as if we're somehow different from the others; that we're "special" nursing students.

For one of my "enrichment" experiences in my peds course, I spent 2 days at a pediatric oncology clinic. A lot of children who are going to have long-term chemotherapy will have a device implanted in their chests which is connected to a central vessel. The nurse accesses the device by poking a needle through the patient's skin into the main chamber of the device which will route the chemo drug into a vein. The device has the rather jaunty name "port-a-cath".

A nurse was showing me how these port-a-caths worked on a teen-aged girl. Her device was located just below the left breast so that it would be hidden with low-cut shirts or bikinis (talk about paying attention to quality of life...). The nurse told me that girls who have larger breasts need the port-a-cath implanted aboved the breasts - v. unisightly. Therefore, the nurse essentially told the patient she had small boobs. I picked up on the slight and assured the girl that I shared her dilemma and that I had the smallest boobs in my family and my rather mediocre endowment hasn't done me too much harm nor will it her. The nurse, the patient, the patient's mother and another patient (teenage boy - oh great) all shifted their gaze to my chest and laughed. Cheer the cancer patients up by poking fun at my boobs! All right!

I have my last two days of clinical this week and today was the last day of classes. Three final exams next week then off for two and a half weeks!

Back Up

2004-12-07T23:12:00.000-05:00

I'm back up and the definitive article once more: THE one and only unlikely RN. I'm working on putting up my archives but it is very boring so I am going to bed in order to be bright eyed and perky to learn about cancer in children tomorrow morning.

Boo-ya, as Demi Moore might say (see below).

Hiatus

2004-12-06T14:43:00.000-05:00

I apologize for the Unlikely RN's hiatus. I had some technical concerns and some other issues which you can ask me about off-blog. However, I'm making it up to everyone by now relieving you from having to type "The" into my URL. I am now merely an Unlikely RN, no longer the. I am no longer the definitive article. Sigh. I'll be able to post my archives again but I have sadly lost my comments, which is a shame because I have some funny friends. Please make up for this by commenting avidly over the next couple of days.

The last several weeks have been more of the same. However, a great number of humiliating, entertaining and obscene things have also happened in this time period so I'll try to remember them all until I am caught up and bore you to tears.

Have you seen the movie GI Jane? It's the one where Demi Moore is trying to become a Navy SEAL which, apparently, is extremely difficult. The sadistic commanders put a bell in the middle of the recruits' training ground and when the devastatingly buff actor-marines give up and want to leave the program, they're supposed to ring the bell. All of my friends have had at least one "bell moment" and my number came up just before Thanksgiving. I was in a small group of students who were assigned to attend a "Sim Kid" workshop. Sim Kid is Sim Man's pediatric equivalent - a child-sized plastic dummy who can do amazing things like have a heartbeat, make retching sounds, and emit breath sounds.

I killed him.

It was my job to administer a nebulizer treatment (asthma meds) to Sim Kid and I didn't properly evaluate his lung function and the damn dummy coded on me. So he died and it was my fault. This happened while the following people looked on: 6 fellow students, 2 professors (one who teaches my pharmacology and the other one pediatrics - that's 2 out of my 4 classes) and a TELEVISION CAMERA! The professors decided it would be a great idea if they videotaped us working with the dummy so we would be able to critique our bedside manner (or negligent homicide, in my case). I went to the gym afterwards, found a dark and sweaty corner and cried my little murdererous eyes out. It was a disaster and I wanted to ring the bell. Looking back, it's a little more funny now but I'm still a little scarred.

In any case, that's the worst thing that happened since THE Unlikely RN went out of business. The best thing is that I won a fellowship to conduct research at the Hospital next semester. It's part of a nursing research training program and I'm v. excited about it. More details to follow.

SUVs

2004-11-15T22:45:00.000-05:00

We learned an interesting fact about common injuries children sustain today. Motor vehicle accidents (where the child is a pedestrian or passenger) are the most common cause of accidents in children under 18. Children who were hit or run over by a car used to come to the hospital with fractured femurs, arms, skulls and a lot other bone-related damage that could generally heal well with time and care. However, with the advent of SUVs, children are now coming to hospital with lacerated livers, burst spleens and other internal organ damage that is a lot more difficult to manage. SUVs hit their little bodies higher up and do far more harm than a sedan ever could.

Who knew we'd long for the days when only sedans ran over kids?

The Mouth on That Kid...

2004-11-11T22:48:00.000-05:00

I was sworn at by a very young child today. I also avoided fists, sharp little baby teeth, ragged little nails and flying feet. It's not so bad, really, because kids are small and easy to hold down but I do feel like an orderly in some '70s mental asylum movie. My patient was (obviously) extremely agitated, anxious and combative and used the S, F and B words describe me. The father was so embarassed and urged me not to take it personally. Who could take swear words from a preschooler seriously? Especially when the worst thing I'm doing is taking the kid's temperature.
I've decided to take it as a compliment that my instructor assigned me this "noncompliant" patient.

IV Drug Users, Medicare and Pancreases

2004-11-08T22:49:00.000-05:00

We learned an interesting quirk about your kidneys, heroin and health policy today. Using IV drugs i.e. shooting up heroin causes your nephrons (the functional unit of your kidneys that filters your blood) to shrink and seize up which will eventually lead to kidney failure. People with kidney failure are eligible for Medicare. For my Canuck readers, Medicare is the nationalized (*gasp*) health plan in the US for those who are 65 and over and, as it turns out, for people with end stage renal (kidney) disease.

Therefore, if you fry your kidneys using drugs you'll be covered for dialysis and the majority of your health care expenses. However, Medicare doesn't pay for any type of rehab for these users. Essentially, they'll pay thousands of dollars a month for dialysis but not a penny on any programs aimed at getting you off drugs. Brilliant, no?

In other news, I have come up with a topic for my patient education project which is a good thing seeing as how it's due on Friday. I've decided to teach 4/5th graders about diabetes and their pancreases. I've designed a "Pancreas Pledge" which children sign after promising to eat healthy, pancreas-friendly food and to exercise every day, thereby making good use of all the energy that our pancreases gave us by producing all of that handy insulin.
It's hard to find pancreas clip art.

Kids, Flu Shots and Show & Tell

2004-11-05T22:50:00.000-05:00

I've come off my second round of caring for pediatric patients and this week endeared me a little more to pediatrics. I had an extremely sick but appealing patient. It wasn't that the patient was particularly sweet or special, it was just that I was able to interact with the patient . And I liked it! Even though most of our conversations consisted of talking about Wrestlemania or Dora the Explorer, it was still rewarding somehow.

I really had to get my nursing chops up to prepare to take care of this patient: 15 medicines (and I have to know the actions, side effects, dosage and other parameters for each of these), 2 IVs (one in each arm), strict I&Os (Input and outputs - self explanatory), continuous monitoring (heart rate, respiratory, pulse ox) and research the pathophysiology of my patient's illnesses. It was fairly stressful and every moment of my day was taken up caring for the child. It's hard to imagine how a real nurse cares for 2 or more. Although this type of patient takes so much work and the type of unit I work on is full of similar children, it is a perfect learning opportunity. If I ever have someone with something as uncomplicated as a tonsilectomy or pneumonia, it will be no big deal at all.

Side note I:
Believe it or not, nursing students (even those working with pediatric patients) are not eligible to receive the flu shot. 've noticed, however, that some doctors are walking around with an "I've Had A Flu Shot" sticker on their lab coats. Do they expect us to read the sticker and think: "Oh, good for them, they've had their flu shot. Well done! Good show!" Goodness knows, though, we'd all like a flu shot very much. I have no idea what the thinking behind the stickers is this year. Ridiculous.

Side note II:
The election has put me a little on edge and I've done some bizarre things since Wednesday. First, I broke down into tears while watching the Kerry conseccion speech while on the treadmill at the gym. Everyone else was watching the speech, too, but no one else decided it merited tears and sobs. Later that night I had a little boy (only 3 years old or so) from my child abuse prevention group come up to me to ask for a tissue. When I brought him a tissue he extended his finger to show me a giant booger, clearly pleased with it (and it was truly magnificent in size and consistency). I cracked up, choked on my popsicle and had a coughing fit.

On Being Canadian

2004-11-03T22:52:00.000-05:00

Some parents give their child the gift of a second language, others a talent for the arts or mathematics. My parents didn't give me any of these. However, they had the good sense to be Canadians. Greeting this morning's news knowing that I have a second, less dreadful home makes it easier to deal with.

Some people wore black to school today. Others couldn't care less and still others were thrilled. My first lecture this morning was on children's experiences of pain. Our professor began with "I have personally entered a world of pain after yesterday..."

I promise to sponsor you all in the immigration process. Diverse, cosmopolitan Toronto? Gorgeous and temperate Vancouver? Urbane, funky Montreal?

Take your pick.

Abcess

2004-10-31T22:53:00.000-05:00

I have a pathophysiology exam tomorrow and wanted to share a fact I just learned about brain abcesses. Brain abcesses occur when an infection (usually staph or strep) is "seeded" in your brain i.e blood takes it there to roost. The infection causes a little pocket of pus to develop in your brain and leads to swelling which increases your intracranial pressure. You will have a headache, some neck pain and general malaise and you'll come to the emergency room. It could occur to your fresh-out-of-medical-school doctor to do a lumbar puncture to see if you have meningitis (s/he should take an X-ray or CT scan of your head first to rule out an abcess). Once the needle hits your spine, your brain might well herniate through the base of your skull down your spine due to the pressure.

Happy Halloween.

Someone please please help me

2004-10-29T21:54:00.000-05:00

Today was my first pediatric clinical day. The child was a good first patient as the patient wasn't too, too sick and my main challenge was simply communicating and understanding the child.

The child didn't speak in complete sentences but could quote from movies or TV shows perfectly. When I had to take my second set of vital signs, the mother helped me uncover her child's chest and the child started screaming "please stop...oh please help me...someone please please help me....ohhhhhh" in this eerie, extremely articulate voice straight out of some made-for-TV neglected child movie. Of course, a nurse rushed in to see what was going on. "Just a blood pressure," I told her, "nothing going on, nope, nothing." She probably would never ever have believed me if my patient's mother wasn't there, a witness to the fact that I wasn't abusing anyone.

Working with children seems to be one part nursing and equal parts simply dealing with children and parents. It's very different from OB and I'll see how it works out. I feel somewhat guilty because most people's reactions to pediatric patients is "Oh how can you stand to see a child suffering?" and all I am thinking is "oh please just let me listen to your damned chest."

Thanks for everybody's patient education suggestions. I haven't come up with a definitive idea yet but I'll keep you posted.

Uniform note:
Halloween celebrations were held on the floor today. My instructor allowed us to wear something a little more celebratory/scary than our uniforms and I wore a scrub top with smiling candy corns I received for my birthday. All of a sudden, I didn't look like a student. It was wonderful! People smiled at me instead of grinning or shaking their heads (nursing students always seem to inspire either one of these reactions), people didn't have to stare at my boob to see which school I was with and instead just passed me by, people assumed I knew things. Finally, people didn't giggle when my classmates and I are all crowded into the same elevator (and I suppose it is a funny sight to see identically-dressed young women with white shoes in a small space; white shoes are always funny).

Little People?

2004-10-27T21:55:00.000-05:00

"Children are not little people," the frontispiece of my 1,994-page pediatric nursing textbook reminds us. It's a shame, really, because I was just starting to get the hang of people. And the thing is, children aren't just children, either: they're infants, toddlers, pre-school age... you get the idea. Each type of child comes with its own set of vital signs, appropriate interventions, warning signs and treatments.

I've worked with sick children before (one summer at a camp for children with cancer and another at the ridiculously named Toronto Hospital for Sick Children). However, when I came in the hospital room no one asked to me to do anything other than bust out the crayons or distract a child with silly faces. This time, things will be different. We had a speaker in my pharmacology exam the other day who said she came to nursing school confident that she wanted to be a pediatric nurse practitioner until she met her first parent. Which, I suppose, is the greatest challenge with pediatrics: 2 patients or even 3 if both mother and father are there (or mother and mother and father and father (take that, Florida! (http://www.lethimstay.com/)).

I have my first clinical day tomorrow so I will find out soon enough.

The hospital that I have been placed in groups its children according to their age and not disease (except cancer). It's a neat concept and I'm looking forward to see how it works out for the staff and patients.

**Soliciting help**
I have to come up with a topic for a pediatric patient education presentation i.e. teach a kid how to do something health related (preventative or disease/treatment-related). Do any of you wish you had learned something about your body as a kid? Were any of you sick as a child and wish you knew more about why you were sick and if you would get better? I'm having trouble coming up with something interesting. All I had as a kid was an ugly hemangioma (blood tumor) on my middle finger and I didn't need any nursing student to tell me it was ugly and needed to be sliced off ASAP.
You can press the "comment on this" button below and leave any ideas. Please?!