Post Christmas/Pre-New Year

I have meant to put together a brief update since finishing up with school last week, but haven't found the time or energy until now. It has been an expedient week since that point in time and it scares me a bit to think that I am already one week more proximate to school and one week more distal from the onset of my vacation (had to use proximate and distal after hearing it so much in physical descriptions in school).

School finished with a flourish. Though they would have preferred I not missed any time from my unit (and I would have preferred not vomiting for a few days) it was determined that, though there existed a make-up day on the calendar, no one was willing to proctor it for me. Hence, Thursday was my last day. My final evaluation was quite good actually, with some room for growth of course. The comment I thought most intriguing was related mostly to my personality as a whole. To paraphrase the comment (since I am too lazy to look for it amongst the mess of our apartment; residuals of our recent move), my clinical instructor essentially said that I was somewhat enigmatic until she observed me in simulations because, on the floor, I often just did my own thing without being a 'squeaky wheel.' I took that as a compliment because it is just who I am. I don't ask for help for every little detail or I ask for help from whomever I can grab that might know rather than seeking my clinical instructor out constantly. I also just do what needs to be done with my patient and try to do so professionally and efficiently. So, all to the good.

As for classes, I finally broke through the barrier and got and A. Two actually. The other two grades were of the A- variety which I am still quite proud of. Does that mean anything? Not really......but it is nice to do well.

As I stated previously, the move is a memory (a lingering one, but a memory nonetheless). The house finally closed today after a few small snafus (The garbage situation has been the most laughable as they cannot seem to bring themselves to actually pick up the trash though Tia has repeatedly contacted them and has paid for the final pick-up service. Despite not picking it up, they have taken our trash can and sent a driver and a supervisor at this point to 'inspect' the remaining trash which, though bagged and set upon the end of the drive, is deemed somehow too 'trash-like' to pick up. We have also been informed that it needs to be in a can which is a problem since they collected the can and told us to just put the garbage on the curb. I cannot wait to have a patient that I need to clean up and then, instead of doing so, just observing them and telling a supervisor that they are too messy to clean up. Does this line of thinking work in ANY other job?). We are now officially apartment dwellers. I really hope we are able to sell a majority of our remaining belongings before we move again. I hate moving and have reason to having participated in not one, but two transcontinental moves and a total of 4 additional local moves in the span of three years.

Christmas was pleasant, though somewhat bare. We spent the eve of at Tia's friend Sherri's home. Her husband Kevin made mussels, risottos, Maine lobster with drawn butter and lava cakes amongst other dishes. Altogether fabulous. In contrast, we went out to eat on Christmas but only found a few asian restaurants open to accommodate us. We ended up at a mediocre Chinese restaurant with the fastest service this side of a restaurant with a drive through. I would bet even money that our harried waiter suffered a heart attack by the end of the evening. It will be nice to be near friends and family next holiday season.

I am certain that this update misses much, but that is to be expected of any posting. I hope anyone who reads this had a wonderful holiday season and has a happy and safe New Year's celebration.

Almost there

Just one more day now. I would say a couple more days, but there still exists the possibility that there will be only the 1 day without a make-up day. Even if I have to do a makeup day, it hardly dampens my excitement that it is almost over. I will be thrilled beyond imagining when I don't have another bed bath to perform for three weeks!

Today I spent out with VNS (visiting nurse service). As I thought, it was interesting going out into the community and into people's homes to provide care. As I also suspected, it is wholly incongruent with my personal interests. I worked with a pediatric nurse today. I give the nurses who work with the population I saw a lot of credit. Part of me feels so badly for these children knowing what hurdles they face because of their surroundings and the disadvantages that lie in their path coming from single teenage mothers. However, another part of me feels angry at the parent (or parents) who continue to make poor decision upon poor decision, which likely stems from their own parents making the same bad choices. One household was littered with beer cans as the 1 year old wandered around playing with whatever she picked up off the floor while the mother tended to the 1 year old (and the father watched TV in the other room). The really interesting thing to me was that, even though these people lacked much furniture, had beaten up vehicles, and often had mainly WIC appropriated food, they still had big screen televisions and cable. How badly out of whack priorities are.

Thursday marks the final day on the adult floor, which is mercifully shortened to go over our evaluation (and then the aforementioned possibility of Friday as a makeup). All in all, things haven't gone too badly when I look back and consider all the things we (Tia has shared the burden) have had to get through to make it to this point. The whole thing seems very unreal at the moment........as though the dean of the nursing school might crawl out of her office, see her shadow, and determine that there will be three more weeks of clinical (it is hard to type with a shiver crawling up your spine).

I am still awaiting one more grade to trickle in. The grade in question was a paper that encompasses a fifth of our grade in the course however so it is not nearly complete, but, unless I butchered it horribly, I don't see how I could get less than an A-. Could end up being a highly successful term. Looks like I won't know for certain for some time though........at least until Thursday when they are obligated to post them.

Looks like I just got a delivery from my roommate of a list of meds I need to look up for tomorrow......and it is doosy. I hope I am never in the position to require 13 medications at 8am every day (and more than that throughout the remainder of the day). I don't know how you would even manage the side effects of such treatment. Wish me luck that there is no required makeup.....I will do it if I have to, but I definitely don't want to.

Interventional Radiology

I spent the past two days in Interventional Radiology working with a number of patients ranging from age 2 to 72 and seeing procedures such as catheter embolizations, angiographies, and biopsies. Pretty interesting stuff by my account anyway and, best of all, not an ADL amongst them. No bed baths! No ass wiping! No bed changes! Just medications, assessments, and assisting with procedures........or ACTUAL nursing. How very novel indeed. I am quite happy I chose to observe there. Another possibility on the plus side of the column is always a good thing.

Other than that, things are still a complete mess at the house (well, not complete, but comparably it is) with unpacked boxes cluttering up the apartment. I dont think the apartment will look normal until AFTER school is done.....or until I decide the boxes are just part of the decor.

The weather has turned once again as well with 4 inches already on the ground and more to come today and this Sunday. No temptation to do any outdoorsy stuff when I should be studying I guess. Thank goodness for an apartment with free heat.

Speaking of studying.....the end is nigh! One more test to go! Two more clinical days! One more simulation! I can't stop using exclamations I am so damned happy to type this!!!!!

Moving Day

Yesterday was officially moving day, though moving is never a process accomplished in so short a time. It will be another week at least before the house is empty and another week beyond that before the apartment isn't full of cardboard boxes.

So far, the apartment is pretty nice. The rooms are spacious, we have free cable TV (and the channels come in clearly), free heat (and heat in the bathroom), copious hot water, and we are a lot closer to school and the local strip of shopping and restaurants. The downside, is that the apartment, like all apartments, has thin walls (which is painfully evident since our downstairs neighbor evidently doesn't like quiet time without the TV on......consequently we feel asleep with its murmur and I awoke to it this morning around 7:15), we have to go back to paying to do laundry, and there is this odd double door security system to get in and out. On the whole, I think it will all work out....especially with the short span of time we have left here. In two weeks, I am 2/3 done and that is followed by three weeks of holiday before the home stretch starts in January. I am giddy just thinking about it!

There is much to do and not much more to say at the moment. Back to the move.

Sick sick sick

I hate being sick!

Not the best turn of events today. Arrived at clinical feeling nauseas which quickly evolved into me puking like a sorority girl after her first kegger. Suffice to say, with a neutropenic patient you have to concern yourself with passing any kind of bugs along in their compromised immune state, let alone hocking up breakfast on them, so I ended up being picked up by Tia in the early AM and have spent the remains of the day alternately reading, sleeping, and dry heaving. Guess which one is my least favorite?

My main concern at the moment is trying to make up the days......or if I will have to. Who knows? This was obviously unplanned, but the schedule doesn't permit much in the way of catch up. I guess I will find out soon enough. In the meantime eat something savory for me. I think I will be on the BRAT (banana, rice, applesauce, toast...........though I wish it stood for bacon, red meat, apple crisp and tuna rolls) diet today and, most likely, tomorrow since my clinical instructor has already advised I stay home then as well.

Almost made it the term without illness. Almost, but not quite.

From burnt to scorched

Not sure when I will next have the time to post so, in my efforts not to fall asleep and take a 5:00 pm nap (which is like fast food, gratifying at first, but generally unpleasant afterwards) I thought I would post a quick blog.

There is too much happening at the moment to fully take in. I honestly feel pushed to the edge yet again, but will muddle through it with Tia helping to nudge me along. Right now I am just exhausted mentally and physically after a few days of sleep deprivation. Two exams to study for and a few papers to write over the weekend will do that. Now the two tests and papers are done and turned in and I just have to get my patient prep together and try to make it through yet another 2 days of clinical. I have a bad feeling that I am going to get very sick as soon as the stress stops. My body is beginning to feel the weight of it, but there is little that can be done. After clinical is over on Thursday early evening, I have another patient care plan to write, a simulation and a move to a new apartment on Friday/Saturday followed by writing up another critical appraisal on Sunday. I swear I will have one proper Sunday where all I do is read the paper and watch some football. It HAS to happen. I am really missing life of late. I am sure Tia couldn't feel less like she was living with someone presently.

The weather has turned recently for the worse, just before our move. I guess it is early for snow accumulations such as this, but mother nature rarely follows a tight schedule. Anyway, it has been windy and snowing for the past few days.....more than I have seen since I was too think about measuring such things in Ohio. I shoveled my first driveway. Hopefully we will move soon enough I will have shoveled my last driveway as well. On the plus side, the snow was so bad they sent us home early from class on Monday evening.

Computer took a recent dump on me thanks to Windows Updates. I have expended zero time on my blog bitching about Microsoft Vista because it is so low on the priority list at present, but it really sucks. I am wishing the school wasn't so opposed to Macs, because I know Krista is very happy with hers. One day I will have one too. The result of repeated calls overseas was that I can no longer accept Windows updates but must instead only get updates from the HP website that have been vetted prior to downloading. In the meantime, I lost pretty much everything again........except the important files I transferred to my jump drive (which thankfully wasn't much). I sometimes wish I could just go back to handwriting things.

On the positive side, classes are going well. I think I will do better academically than last term, which is mildly surprising. I still have a few walls to climb to get there, but at least the dogs aren't snapping at my dangling feet. Evidently, risk of failure notices went out to about 1/3 of the adult and home class.....Krista and I evaded that. Small kudos to us both.

Well, it looks like its once again time to slip on my cardigan and head out the door like Mr. Rodgers. Wish me luck on the apartment move and holding on to my health and sanity.

Mentally flagging

I have determined, at this moment, that I cannot stare at my care plan one more microsecond without a protracted breather and, since it is 12 degrees outside (or feels that way to this Florida boy) and is pitch black at 5:15 leaving no outdoor options, I thought it was an opportune time for a quick posting.

Another week on oncology has come and gone. Still not sure what to think about it. On one hand, it is interesting and makes you really think about blood labs. On the other hand, it can be one hell of a depressing place. A fellow student had a patient she worked with just prior to Thanksgiving pass away. I worked with a patient in end stage renal disease with lymphoma who stated her desire to do the same. These are people with severe, and often multi-faceted problems with recovery rates ranging from pretty good to nearly hopeless. It hammers home ever further what my friend went through and how fortunate he was to come out the other side of it. On a side note, I did get to observe a hemodialysis treatment which was quite fascinating, especially the science behind how they can quickly alter electrolytes, urea, and all sorts of other things within the blood.

The picture is clarifying some in regards to where I want to fit in within the profession. No epitomes, but at least I am thinning the theoretical herd. I am learning what facets of the profession I dislike (bed baths, assisting with activities of daily living, and feces) and what I do like (patient teaching, faster work pace with higher patient turnover, opportunities to work with a collaborative health care team and not solely the provision of direct care). It is hard to be clear when each door you close leads to other opportunities you had not previously considered. I am quite literally learning of another new opportunity each and every week in clinicals. Very exciting.

In far less exciting news, life is still chaotic and school will be a big part of that chaos until the 21st of December (though the bulk of school work will be completed by the end of next week). There is still no close date for the house sale, leaving Tia frustrated and all of us up in the air about move dates. The apartment is officially ours tomorrow, but we have not found a reasonably priced mover as yet and neither of us know enough people in this area to ask to help us move it on our own. That needs to be figured out either this coming weekend or, failing that, probably not until the 21st after Tia returns from a trip out west. Wedding plans continue to be complicated even though we were striving for simple and there is little more to say than that presently because I have been able to dedicate precious little time to it as yet. On top of that there are but the usual nagging concerns of daily life to contend which always seem more overwhelming when so much else occupies your time.

Speaking of time, I am once again running afoul of it. As always, time to get back to work.

M.O.W.

Another blink of the eye and another 10 days gone. I genuinely hope that remains the case for the upcoming 2 dozen. There is a part of me that feels like I should be taking in these experiences and trying to wring all that I can out of them, but there really isn't much time for that kind of reflection in this program......so I try to settle for just making it through by staring directly ahead at all times.

The Thanksgiving holiday was fast but enjoyable in its own small way. Tia and I ended up having our own turkey day after being ostensibly uninvited to our erstwhile friend's home. That is a long and convoluted story, but the moral is don't mix friends with business. We were invited to two other Thanksgiving events, but declined both and opted instead to make a meal at home and watch football. Tia is a mean cook and we ate particularly well. It was pleasant enough, but it was a bit solitary (and the fact that it did not stop raining throughout the day did not help matters). I suppose thats why we opted for an overnight trip to Niagara Falls the next evening. The trip to the Falls was really enjoyable and, in the area we were near, just as tacky as we both recalled. We lost a little bit of money at the casino, an equal amount at an arcade, and saw a gorgeous fireworks a light display in temperatures reaching into the low 20s. All in all, a nice way to close out a brief, but refreshing, holiday.

In addition to the usual holiday stuff, Tia has been trying to get me to love thy neighbor a bit more and volunteer around the holidays. I don't mind doing it, but without her I lack the motivation. Thankfully, she does not. We have volunteered with very positive results in Portland, so we ended up delivering food for Meals on Wheels (MOW) here in Rochester on Friday. We actually ended up delivering food in the downtown region, taking 10 meals to people in 2 separate high rise tenement buildings. The buildings made me thankful for what I have to be sure. Between the flickering dim lighting, the general disrepair, and the smell of decaying food I realized how very good I have things. I hope that I, nor anyone I know, ends up in such a situation.

We also adopted a family for the holidays. It seems a far better thing to do than buy gifts for people who don't have any needs and few wants that cannot be immediately gratified (or if not gratified by them, would be far beyond me to afford either). So the thought went anyway. We both still feel pretty good about it, but it is hard to want to shop for a person who requests things like a Baby Phat jacket and gold hoop earrings (suffice to say we did not pick the family we adopted. Also, no one in this family will be receiving a Baby Phat jacket). It is much easier to shop for her kids which need all the basic kid stuff and some toys to boot.

In both situations, I really wanted to feel that warmth the spirit of giving is supposed to give you way down deep, but all I really felt was sadness for the people getting MOW food for their paucity of options and a bit offended by the fact that a teenage mom would want more than the basics for herself with two kids to contend with. Not that it is fair to blame anyone for asking, but I suppose I always expect one to sublimate their own wishes for the benefit of their kids. I guess I also don't expect a teenage mom twice over, so people don't always make the best decisions.

I guess it is about that time again, time to load up the backpack and get geared up for another day sitting in an auditorium listening to endless hours of lecture and hoping that some of it sticks. Four weeks and counting until I can sling that aforementioned backpack into the deepest region of the closet to moulder for the better part of a month. I can hardly wait.

At risk for impaired religiosity

I was looking over my blogs and realizing that, well, the shine is off the proverbial apple. I had wanted a light touch, but it has evolved into a kind of banality that I blame entirely on the limitations placed upon the most precious of all commodities, personal free time. Nothing that can be done about it I suppose. Thanks for the continued patronage in spite of.

At this moment I am staring into the teeth of what will likely end up being another unmemorable weekend of more work than play. Although who would want to play in the scrotum clenching chill that has recently enveloped this region. It strongly dissuades one from going out except to collect only the most vital of necessities. And to think it isn't even really winter yet here. It will be some momentous task to make it through the coldest parts of the year, and I presume harder still to make it through the dark and frosty early morns that await me come January. So, me thinks its prime time for a rant.

As a nurse, one is expected to know a little bit about a lot of things from the jump. Once in the profession, your knowledge base specializes and is honed to a fine edge. You might not be able to diagnose like a doctor, but it appears you can eventually understand them and offer some input. In fact, there are a lot of things that doctors can do that we cannot. I dont begrudge them this right since they did go to school for a long time. However, somewhere along the line, nurses collectively determined that we ought to have our own diagnoses as well. The fact that they border on the ridiculous and flirt frequently with the inane is what truly ruffles me. We cannot say, for instance, that you have a breathing disorder, but we can say you are at risk for impaired breathing. We cannot say that you are anorexic, but can say that you are at risk for impaired nutrition. Some new ones I have come upon, and I shit you not as to there authenticity, are: energy field disturbance, risk for dysfunctional grieving, risk for impaired religiosity, risk for enhanced religiosity, and readiness for enhanced religiosity (where the readiness for impaired religiosity or the risk for dysfunctional religiosity (that one would be prevalent) is I dont know...........maybe the next NANDA update). How or why I would care about levels of religiosity or energy fields is beyond me, but I think it can be agreed upon that you cannot hope to be taken seriously if these are approved diagnoses. I might as well start reading patients' tea leaves or try to discern their aura to determine care. But maybe I am just at risk for impaired intellect from reading them in the first place.

To top off the enhanced ridiculosity (or risk of as the case may be) we are now supposed to incorporate 'cultural considerations' when writing up our care plans. What this means is that, based upon our discussions in class and with our clinical instructor, instead of walking into the room and assessing the patient based on their illness and various co-morbidities, we should assess them on their ethnic heritage as well. So, in essence, we focus not on the 98% of them that is primarily the same as everyone else and the fact that they are in a western hospital seeking medicine, but rather on the fact that the 2% of them that may be different. It is infuriating........but thats probably just my angry German/slavic heritage talking!

Off to grab some sour kraut and a beer before shuffling off to get some sleep so I am not at risk for impaired awakeness tomorrow.

A half-assed entry

I haven't had much time to post lately and it looks like that will continue to be the case until Thanksgiving day or thereabouts.

Not much new of note. Finished up with neuro (big hell yeah!) and began in oncology (looks to be more interesting but, just the same, I would like a break prior to initiating this new and highly incongruent adventure). Day 1 went well at least. Lets hope that remains the case throughout.

We signed on with a new place to live.....a better than marginal, although not spectacular, 2/2 nearer to school. It comes with 72 channels of cable which trumps our current fuzzy four and all the heat and hot water we can handle. Downside is the same with all apartments: thin walls and a motley hodgepodge of neighbors.

Classes are settling down a bit, though not much. I hope my mind will continue to bend and not break. I'll try to expend more effort on the next entry.......no promises.

Gotta run off and do some damn assignment or another I am sure.

Til next time.

While I have a moment

Having just finished a 15 minute assignment for research and evaluation (which is a rarity, of late, most assignments for that course have run into the 8-12 hour range) and having stuff I can do, but don't really feel like doing as my brain is presently having a harder time latching onto the readings than GW has latching onto words longer than two syllables, I thought I would post a quick note.

The usual school = shit continues unabated. It is part stress related from too much to do and not enough time to accomplish it all and part related to validity issues in testing. To illustrate:

Our adult and home health rotation, which encompasses 8 credit hours, is comprised of many facets that make up the whole of our experience. We spend 18 hours a week in clinical (16 on the floor and 2 in post conference), 6 hours a week in lecture, 2-3 hours a week in simulation or home health, and countless hours doing the readings, weekly write ups, journals, and taking exams outside of class time every other Monday. All told, I would say it takes up 35-40 hours of every given week without the class readings included. Maybe another 5-8 hours weekly for the readings. That is possibly a conservative estimate as well because I skim the readings generally, if I have time to do that much. (As a sidebar, the class grade is composed of 70% exams, 20% clinical papers, and 10% home health presentation, with 0% allotted to simulations. What that says to me is that the classroom/book information is far more important than the clinical experience and that the simulation isn't worth concerning myself over. So, the two facets that would help us most in practice upon graduation are the two facets that are given the least credence in grading.......just found that interesting since I won't be able to perform a lot of patient care on paper in the future.)

Research and Evaluation is an ebb and flow type of class where the work varies widely week to week. The class is once a week (Monday evening from 4-7, which follows the adult and home health 3 hour block lecture that afternoon and, every other Monday follows a 90 minute exam as well.......so it is very common to see nearly half the class leave during the break) and thankfully requires little outside reading (a misnomer as well, it is just that nobody ever seems to read the articles we discuss in class for lack of time). All classes include a 4th hour assignment (because the class is supposed to be a 4 hour block lecture) which ranges from 10-15 minutes to 8-12 hours in length. It takes up, on average, about 8 hours a week of our time.

The therapeutics lab is a pretty big cake walk. You have 2 hours a week you have to be there and about an hour a week to prep for it (maybe two if you read the assigned articles, 3 if there are videos to watch). Lets call it 4 hours on average.

All told, for 13 credit hours, there are conservatively 52-60 hours a week spoken for between classes, labs, and clinicals without taking into account any additional time for studying. Some weeks there are less and some more. I dont know how people with children or who are working part time (though they often don't have the research class to deal with) manage. Even in the face of this, sometimes you just say to hell with it and write a blog.

The testing validity issue is the other major stressor. We frequently spend significant time studying for our tests only to have material brought in from other courses, questions about medications that we couldn't possibly know, or an endless number of multiple multiple questions (which are choose all that apply) where if you miss one of the five possible right answers out of eight options you miss the question entirely. No one complains about how hard the class is (Pathophysiology was much more arduous), but we do complain vociferously about how what we learn isn't what we are tested on. Hence, the class average is precipitously low.

I have simple tried to adapt as best as I can. I aspire to do well, but i am learning to accept that passing is all that is important and that much I can and will do, even if I am kicking and screaming the entire way. In the end, the result is the same.....cap, gown, and new career.
Just don't ask me about the renin-angiotensin system......I haven't had a chance to read that yet.

50 days

That's what it comes down to at this point......50 days (well i was fifty days when I started this post anyway. Unfortunately, I have been too busy to finish it until today. Might be 47 days give or take now. A shame really, 50 seemed much more imposing). Not all of them are class days, but that is the sum total that stands between this moment and the day I walk out of my last clinical experience for this semester. Fifty days isn't much, but lately I feel every one of them. I have heard, though who knows if it remains true since this program goes through more changes than an adolescent during puberty, that the next term is somewhat less taxing. I hope so at this point......or at the very least that the break provides/restores some semblance of balance and sanity. In the meantime, I am just trying to make it to the next holiday (16 days for those who are counting).

A lot has gone on since my last post, foremost amongst the group is my recent engagement to Tia. I ended up carving it into a pumpkin, which she thankfully deemed creative enough to acquiesce to my proposal. I am pretty excited about it....or at least I will be pretty excited about it as soon as I have the time to be. Seems like we are both on board for an inexpensive wedding and an eventual more lavish honeymoon. Assuming I ever make an income again that is.

Tia's parents came to visit for a brief, but enjoyable, weekend. Had an opportunity to go out to see the museum of glass which was far more interesting than I thought it would prove to be. I would recommend anyone who ends up in the frigid climes of western NY to visit it. We had intended to go to the Bodies exhibit as well, but her parents ended up helping tie up a few house projects and I ended up typing a single study review and carving the aforementioned pumpkin.

I finally got to visit the OR on Thursday. The procedure I witnessed didn't lend itself overmuch to ogling and there were more people in the surgical room than there were F-bombs in Scarface, but it was fascinating nonetheless. The procedure was a Laproscopic Cholectystectomy & Laproscopic Myotomy with partial fundiplication. It was done to repair a motility problem in the esophagus (severe GERD and swallowing problems) and to remove the gall bladder. They essentially punched 4 holes in the patient's belly (which they filled with a gas to distend), put plastic reservoirs in the holes to keep them open, and then stuck an endless stream of cameras, clamps, harmonic blades, flushes, and suction tubes through the holes. It was beyond interesting. I have no idea how the surgeons master these tools and the extremely fine motor control required to use them to cut through layers of adipose tissue, connective fibers, and arteries to remove the gall bladder and then stitch up wounds inside the body with use of cameras, the aforementioned clamps, and a small curved needle and thread which they have to be meticulously careful with to avoid puncturing anything else. Just prior to stitching up the patient, they yanked his gall bladder through one of the small holes, like a macabre magic trick with human organs. Very cool.

Tia's house is through most of the required processes for sale. The last issue is approval from the govt for the house loan for the buyer. Tia's parents, Tia and I cleared up what issues we could including fixing some windows to slide easier, removing the pool (done by someone who got a free pool out of it), and locating and removing two dead birds from the attic (I swear this was a request). The next step will be finding a new place to live and then relocating our belongings to it in the middle of winter. The party doesn't stop up here.

I need to get back to writing up a care plan and doing innumerable other school related tasks.
16 days until Thanksgiving!
16 days!
16 days!

Tia sold the house............er, maybe

I had to include this in my blog because it went down in a way that my mother would be proud of. Without getting into the entirety of numbers, it came down to me, according to Tia, "bitching out the Realtor." The situation revolves around a bit of unpleasantness which, in the most base terms, involved the Realtor in question lying to Tia about cutting her commission in order to make a deal happen so that Tia wouldn't bear the entire brunt of any lost monies on the sale. It was agreed upon prior to a contract being signed. A potential buyer came, numbers were exchanged, and the deal was dying on the vine over less than a grand. When Tia spoke with the Realtor to make the deal happen by cutting her commission, the response was, "That's not how I do business." Interesting considering that: A. She technically works for us and B. She stood to make $0 if the house didn't sell at all. Tia was upset, but didn't want to confront her about it, preferring instead to just wait until Monday (today) to fire her and talk to her manager. I was more concerned that she would lose the potential buyer unless the Realtor was pushed immediately.......so, I called.

I admit, I was pretty excited about it. With school being an utter, for lack of a better term, shitfest, I was ready to vent and cut loose on someone. I told her calmly, and then emphatically, that if she insisted on maintaining her full commission and letting the deal fall through because of it, she would shit canned and her boss would be notified of her duplicitous dealings (of which we had email record). She wasn't happy to speak to me, maybe because I kept calling her a liar, though I did refrain from peppering my diatribe with profanity as tempting as it was, and insisted she speak with Tia who reiterated my tirade in a more subdued fashion. The result, she caved and the deal is moving forward pending the inspection. It sucks that you have to be a complete tool to get your way anymore, but evidently that is the nature of business anymore. Evidently the Realtor is now being an aloof bitch to Tia, which is infuriating, but hopefully we won't be dealing with her much longer. In the end, the Realtor is getting far less than she hoped, though I wish she would get nothing at all. Now, hopefully the inspection comes out clean.

I got to speak with some of my fellow students and generally bitch about the state of affairs in the school at present and, with utter unanimity, the feeling is that things pretty much suck. I am very disappointed and am clinging to the residual effects of my psych rotation like 'stars' on the surreal life are clinging to the last vestiges of fame. The classes are uninteresting and poorly taught, the simulation is in its infancy and clearly we are operating as the guinea pigs, the home health portion is ludicrous if only because its as fleshed out as Kate Moss after a purging episode, and the clinical rotation is frustrating and is crammed with more bullshit than your average Republican primary debate. Meanwhile, I am often left feeling like the guy who just put a new transmission in his 15 year old car only to have the engine take a dump: too much money in the hole to not keep going.

Off to cobble together enough hours to call it sleep instead of a nap (which is what I am acclimating to on my clinical days). On the upside, at least the Atenolol seems to be working its mojo and the headaches, as well as the nasty initial side effects, are dissipating.

Atenolol

I guess part of having a blog is having the freedom to spill the beans on whatever is on your mind, even if what is on your mind is exactly whats wrong with it. I have long had problems with headaches. Middling annoyances, like gnats at a picnic. They didn't make me feel wonderful, but at least they were as infrequent as good ideas from W's camp. Of late, they have gone from pesky to persistent, making lectures even more difficult to follow then they usually are (for boredom this term, not their intellectual difficulties). Finally, largely at Tia's insistence, I made an appointment to see a doctor. This was two weeks ago.

The doctor performed a neuro exam and was thorough with her inquiries. The determination was some sort of low grade migraines that, on occasion, flare up to be somewhat worse (though not the incapacitating migraines that some suffer). She gave me a few choices, and I decided to just wait and see if the symptoms receded, but they worsened instead. For the headaches, I was prescribed a beta-blocker, Atenolol, which I began taking for the first time today (and here a thank you to Tia must be inserted for tending to me in a manner far better than I would ever tend to myself). First impressions of the medication were not positive. Instead of a low grade hum, I found myself ambling about like a stiff-legged drunk. I don't mean literally reeling through the unit, but mentally I was less steady than Dick Cheney's EKG. I drifted from focus to stupor and back again in rapid succession. I tuned in and out of conversations and had little time hiccups where you are staring at someone and they are clearly talking and, as you are staring at them you presume it is likely you, but when they stop talking and begin looking at you for some kind of response, you quickly realize that staring at the shape of their mouth did not confer upon you any sense of the conversation. (As an aside, if anyone knows a better way to extricate themselves from these situations than wetting their pants, giving an embarrassed shrug, and then shuffling off please let me know. I only have two sets of scrub bottoms.) Suffice to say, it wasn't my best day.

So, since I have the attention span of a tv-raised latchkey kid on a Pixie Stix bender, I think I will cut this short and say that it is hard, based on one day's evidence, to determine if this is any better than the headaches. Kind of like trading a punch in the face for a punch in the kidneys. hopefully I adjust, cause I certainly dont want to try to give meds feeling like this.

How about them Maple Leafs, eh

I am not sure what I expected Toronto to be like. I have partaken of only a scant few forays into Canada and those were both on the West Coast. I can see why Toronto, not Vancouver, is called the "New York City" of Canada. It larger, dirtier, and more expensive than Vancouver. The trip was a pleasant diversion save the traffic on the way up (with which I deal with the aplomb of a mental patient) and the odd weather which was exceedingly gorgeous upon our arrival and fairly inhospitable (especially since I didn't pack to accommodate such a shift) upon our departure. In the middle, we got to see the sites from the CN tower (and had a delicious and expensive dinner), visit a thriving Chinatown, and window shop for days (since we couldn't actually afford anything there due to a combination of the weakening American dollar, the ridiculous prices than Canadians seem to pay for goods, and a tax rate on goods that seems to hover around 90% or so).


School is now back into full swing. The steady torpor of Psych has become the cranked up amphetamine rush of med surg. I am not really sure what to think of it. I feel about as comfortable as Britney Spears in underwear when performing adult care, but I fake it well enough. Largely, for me anyway, the problem is that we have little enough training to start with and that is compounded by an utter unfamiliarity with the unit. So, not only can i not help patients make their Alaris pump stop its constant beeping, but I also cannot find a way to get a patient a cup of hot water for tea without begging anyone for a pass card to get into the break room. On our new floor, even the clean linens room requires a pass card. Evidently pillow case theft is on the rise.

The above noted, it is at least a far more interesting unit. It is a step-down unit (where people go after surgery) for neurology. My patient had a Pterional craniotomy clinoidal meningioma which is the removal of a brain tumor in the meninges (the fluid surrounding the brain) that involves cutting open a flap on the skull. Needless to say, she didn't look great after the surgery, but she was doing well. The tumor had been sitting on her ocular nerve impairing her vision severely on the left side. She now has a shaved head with a curving row of staples along its left side and 6 weeks of radiation to follow. Hopefully things will turn out okay for her. It is a rough thing to have to go through in your mid 40s. A lot of the patients on the unit are even younger. We will be spending the next month on the neuro floor before relocating to an Oncology floor for the remainder of the term. Along the way, we will also visit the OR, spend a day with the visiting nurse service and spend two days shadowing a nurse on a unit that, hopefully, interests us. Should be much to write about on that side of things.

Classes are still kind of dull, though they will be busy. There are a slew of papers due and biweekly exams to contend with as well as write-ups covering every experience we partake of. It pains me the way that tests on books used to in high school. When you read a book, you read to enjoy it and discuss it with others who have similarly enjoyed the book. You immerse yourself in it. When you read a book for a test, you try to focus on the little things like the address of the main character, the colors the author uses to describe the rivers, and how frequently the author uses metaphors. What you don't do, however, is enjoy the experience of reading the book. Just occasionally, I wish we were afforded the opportunity to just be in the experiences and learn from them with the guidance of our instructors without then having to turn around and document everything. Sometimes it is useful I understand.......but often, it is just a pain in the ass.

Still no sale on the house and winter is coming. Looks like a long drive in the snow for me. Keep em crossed that global warming is real if only for this year and that little more than a dusting befalls us. I cannot imagine trying to wake up and make it to clinicals by 6:45 in the morning (to allow time to change from winter gear to scrubs) while trying to navigate 13 miles of snowy roads and freezing temps. I predict I will be openly weeping for a trip to Florida by mid February at the latest.

Going back to Portland............er, maybe

So, today was the end of clinical in psych. It ended very well actually. The rotation itself was great, though the class was utter trash. I had a meeting with my clinical instructor (the one with closed eyes in the picture) and she was extremely complimentary in my review. It was a really nice (by far the most glowingly positive review I have ever received) and, with the rotation coming next, much needed ego massage. It is a place that I finally felt like I fit and understood the rhythms of the facility (perhaps the fact that it happened to be a psychiatric hospital might bear some examination, but for my own sanity I wont look too closely). Anyway, I thought I would get with the Joneses and actually post a pic for one. This is my psych group. The white t-shirts that my classmate and I adorned for the photo is something of an inside joke and not a cry for assistance with fashion (though I would not oppose that notion considering my lack of imagination regarding apparel).

Tia is edging ever near the precipice of her decision on our next destination. I am not without a say in the matter, but we ultimately are making the decision based on whether or not she wants to pursue a PhD in the near future or put it off a bit. If she wants to pursue it, we need to find a place we can both exist happily and, if not, then we head to Portland (or surrounding regions). We should have some semblance of a plan by December.......if she can sell this house that it.

Off to bed. Its been a LONG day.

Ennui

The combo of the coming fall is a real mixed bag here. I remember it being exciting in Florida because it finally meant it was going to cool down. In Portland, it meant the rainy season was nigh and, here in Rochester, it has a very foreboding air. Immediately though, it is fairly pleasant except that it comes bearing my personal Kryptonite, a flurry of new allergens floating through the atmosphere. So, between my meds and the allergies, I get the choose between low grade headaches and general malaise or constant draining. not sure which is the lesser of the two evils. All I know is that it royally sucks.

Classes still leave me wanting. I feel quite disengaged. I would be more concerned about this fact (especially considering that there is much that lies ahead yet) but the malaise is fairly uniform. I wonder when these things occur if they haven't occurred before, because it seems likely that it would have. I wonder why, if that is the case, there isn't something that could be done or changed to reduce such instances. I wonder these things, but in truth I little care because, ultimately, I am here for the destination. A pleasant ride along the way would be a bonus yes, but if i don't walk across the stage at year's end it won't have been worth the time and money. Classes will change soon enough and hopefully my indifference will change with them. If not, there is always the OB/peds rotation in January.

There are so many interesting things that are part of the profession and could be experienced, which is genuine shame. What we are left with is only a cursory knowledge of what we can choose to do upon graduation. It is a little disheartening to imagine the next 10 weeks will be spent wiping ass instead of seeing a research facility, home nursing, community outreach, clinics and the list goes on. Even within the hospital, I wont have the opportunity to see more than my neuro floor. I guess on the bright side, at least I will have a lot of things I will want to potentially shadow to experience.

Off to do some research. Final in Psych by Wednesday and the last clinical day in Psych as well. Then off for some fun in Toronto! I am so excited and have to say that Hotwire rocks (should there be no problems with the reservation that is). The hotel we got for incredibly cheap is gorgeous and right on Front near Yonge: http://www.torontocentre.intercontinental.com/

ECT etc.

For those of you wondering what happened on Thursday after Wednesday's fiasco........well, it was another peculiar day. We arrived at our usual time and went through our usual meetings, only the second meeting, the one with the entire staff, was performed with the truly disruptive patient (we'll call him the assclown or AC for short) was up to his antics. AC danced around, practiced his karate moves, banged on the windows, screamed profanities and was his usual AC self. We ended up not leaving the conference room for the next few hours and, ultimately, leaving the floor entirely at 11am. The lunatics do run the asylum evidently, at least at RPC. The attitude on the floor remained that of the neglectful parent better off ignoring the problems than dealing with them. Moving on.

Our new floor is one that deals with long term care patients. Patients who have been in the institution for better than 25 years in some cases. My patient had been in and out of RPC 40 times since he was 16 (61 at present). Some may wonder why you would let a person out again after their 10th, 15th or 20th admission. I do. Especially after talking to him.

My patient claims the following things: he is the wealthiest man in the world (trillions); he has located more than a half dozen nuclear weapons in and around Rochester; he is a psychic who has used his ESP to assist in the arrests of hundreds of criminals; his psychic ability makes him immortal; he is being poisoned by the staff (who work for the mafia), but has an antidote he takes daily; etc. The litany is interesting but also continues uninterrupted for long stretches. Other patients tell similar tales of oddness including the need to do abdominal exercises to "strengthen your testicles and strengthen your seed." It is so peculiar I dont think I can adequately describe it. That said, it is much much better than the other floor because they are all well medicated, have a strong rapport with staff, and the staff seems to work very well together.

ECT (electro convulsive therapy) was interesting to say the least. First off, I had no clue that they still shocked people. The second "shocking" (get it? :) thing about it was how short the duration of the actual therapy is. It encompasses all of 10 seconds of the hour the patients come in. There is no way to describe how it feels to be sitting and talking with someone and then, 20 minutes, later they are laying on a gurney, paralyzed and unconscious, getting pumped with alternating current. Within 20 minutes of this experience, they are up and walking out the door with the only caveats on their behavior being abstinence from alcohol and signing contracts. The therapy evidently works by directly stimulating your brain and, in this manner, helping to cure symptoms of depression. Interestingly, it also causes memory loss. Perhaps it just makes the patients forget what it was that was depressing them in the first place.

There is little else to add at the moment. Classes are still stupendously dull (we are having an entire 2-3 hour lecture on APA style in the research class......I expect to be admitted to RPC shortly thereafter) and there is little else to remark upon. Another week begins.....hopefully it is quick.

sofa king crazy

Be careful what you wish for. Today there was definitely some excitement on the floor. Unfortunately, it wasn't like finding a $20 bill in your jacket pocket exciting. It was more like, "is that a bee in my car?" exciting.

To being the story, I should state that I had only slept 4 hours last night. I have no explanations as to why my body inexplicably determined that 2am was an appropriate bedtime, but it did. So, as I ambled into the rotation today, I will in a less than stupendous mood. We went through the usual morning progression of meetings and then things got weird. The new patient, a young muslim male in his early 20s, appeared outside of our conference room. The conference room in question is behind the nurses station and, oddly, located next to one of the quiet rooms that patients use when too much stimulus exists for them to maintain functionality. Odder still, the rooms are separated by windows that lack any mechanism to shield the persons in one room for those in the other. The patient was evidently sent to the quiet room to chill out, but that isnt what he did.

What he did do was begin to yell invectives and hop about like his ass was aflame. He also began to tap maniacally on the glass. He then spotted a classmate of mine which he believed he knew and then began to direct his vitriol towards her directly. Exclamations about where he would stick his "hairy muslim dick" (with a creative use of adjectives) leapt from his tongue with the alacrity of lies from the lips of Alberto Gonzalez. This scared my classmate to no end and awoke in me the big brother protective instinct. While we were instructed to keep our eyes averted from his antics and ignore his entreaties, I could not help but want to leave the room, wrench his scrawny arm behind his back and drag him into the room to offer formal apologies. But we arent allowed to so much as speak to him at risk of our academics, so we gathered our things and relocated. He followed to our new room and we eventually spent the remainder of our day on an outdoor patio without much interaction at all with our patients.

Why we should be put in such an awkward position is the first big question. The second might be why nothing was done to remove this patient from the floor. A litany of others might follow. But, despite any of these things we will be back there tomorrow. I hope we arent asked to endure the day again.

On a sidebar, another patient on the floor apparently came out of his room, penis hanging loosely from the front of his boxer shorts covered in what the social worker described as 'semen' telling that same social worker to come over and 'suck his dick' the evening prior. Maybe psych isnt quite the place for me......or anyone for that matter.

trying to stay motivated....in spite of school

As my blog attests, the last few weeks have not provided much fodder. What I had hoped would be an experience replete with wild stories and interesting people has instead devolved into 16 hours a week in a clinical that leaves much to be desired. Instead of being involved in any nursing activities, we spend our hours playing Sorry and Uno with the patients and try to eat big chunks out of our days. We spend the first two hours of each day in meetings, the first hour with our group and the second hour with the staff on the floor. We then meander out onto the floor around 9:15 or thereabouts and, at 9:30 the patients have their first group. We can attend or not at our discretion, but if we dont attend we have to go sit in the back conference room and, ostensibly, read their chart for the 100th time. The group lets out at a quarter past 10 with the next commencing a half hour later. They lunch at noon and we often leave. When we return to the floor we try to soak up the last remaining hours chatting with our patients or writing our daily SOAP note (not worth explaining). Sure, there are a few colorful characters, but none on our floor.

Unfortunately, the classes are no better. The psych class is just as dull as the rotation, only it only takes up 6 hours (though it seems like so much more). The instructor is very fond of the sound of her own voice. It is unfortunate that I do not share her interest in it. Unlike some classes where you find the instructor reading from the powerpoint slides, she reads around them. Both kinds of instructors have their disadvantages, but neither imparts much knowledge.

The research course, which I had been looking forward to, has been a BIG disappointment thus far as well. It has been more focused on how to look up an article than how to read and evaluate research. I evidently mistook the title. I thought we would learn not how to understand research and better evaluate it......instead we are learning little more than how to use the library's computer system. To quote my roommate Krista, "Boo."

We also have a lab course that has proven, thus far, to be quite disjointed and uneven. We spent an hour today learning about ABG lab values and then the second hour practicing sterile technique while we removed a bandage around a PICC (peripherally inserted central catheter) line on a dummy. Think changing a bandage only with sterile gloving and a mask.

I am sure this whole blog post will come off negative.....and that wouldn't be inaccurate. The reality is that this will change in the coming weeks. I have another 2 1/2 in psych and then it is back to acute care (which will be another round of wiping ass and changing bed linens, but at least it will be a bit more medical than anything we are doing presently). In spring, we get into OBGYN and pediatrics, which will likely prove much more interesting. Until then, I will keep slogging along and keeping the end goal in mind.

Vacate is the word

I have officially completed week #2 of my psych rotation. That and a hill of beans of course get me nowhere. It reinforces just how quickly time passes and how queerly short-lived these courses are. I have my midterm on Tuesday after a sum total of three actual class lectures. A big fat whatever.

As far as the classes go thus far, they are very disappointing. the psych lecture is kind of like watching a Jerry Bruckheimer movie.........except that it costs exponentially more and is far less entertaining. The class, like the movie, lasts about 3 hours and, after its over, you immediately forget what you saw. I thought I had contracted a terminal case of ADHD, but it turns out in surveying other members of the class that I am not alone. Ah well, hopefully the tests arent difficult.

The rotation continues to be interesting. The amalgam of disorders clustered together on the floor is quite arresting. there is one patient with a facial tattoo (among many other tattoos.......I think I can safely assume that NO ONE makes a facial tattoo their first), another that has bouts of mania expressed by singing and dancing, and yet another that claims millions in the bank if he can just get out. The sad thing is that once these patients do get out, where do they go? They either go to group homes or are sent to temporary housing (essentially a half-step up from living on the streets) and in most cases they relapse and end up in trouble with the law and return. In no way can you 'cure' any of these people. Thats what makes it really interesting though.....and probably incredibly frustrating too.

Speaking of temporary housing, my own situation is now tenuous. Tia and I are not nearly homeless, but we are also not really that far from needing another place to live. In the past week, the condo has fallen through (much to our delight considering what a massive tool the seller has been and Tia's desire to return to school somewhere other than ROC in the fall), there are now possible house renters (that it too much a story to detail here), and the possibility remains that it could be put back on the market..........or we could stay here. God knows what is going to happen. Hopefully we will soon too.

I need to go write my journal and catch up on assignments.

Camelot

When I think of Camelot, I used to imagine King Aurthur and the Knights of the Round Table......now I think some mentally imbalanced person is probably whipping a chair at someone. Its all contextual I guess. Spending time with people you would actively avoid on a city bus is a different context to be sure. When they say Camelot on the loudspeaker, you just hope it isn't occurring on your floor as that means something has gone awry and the calvary had to be called. So long images of Merlin, hello images of violent psychotics.

I dont mean to paint an overly dreary picture. Truth be told, we have heard the call of 4 Camelots in the 2 days we have been on the floor, but none have been in our unit. The unit I am working on is comprised of the shorter term 'consumers' whose length of stay rarely extends beyond a season. The hospital does house longer tenured residents on other floors (one gentleman just passed away who spent 44 years, the latter 2/3 of the entirety of his earthly existence, in psychiatric care), but we are not privy to their units. The floor I work on is coed, with adults ranging from 18-64 years of age, and with varied levels of mental impairment. We are each assigned a patient and my own is in his late 30s and presents asymptomatically, which is good because it is easier and bad because it may not present much of any interest. He has a very short history medically and seems wholly in denial that he has any problems to contend with. It will be interesting following him from the snapshot view I got from today on through the weeks to see if he begins to accept that he has some issues to work out (which he assuredly does even if they aren't outwardly manifesting at all times) or continues to assert that all problems and issues in his life manifest largely in those around him leaving him blameless. We shall see. Other classmates have patients that display somewhat more readily their impairments. I was anxious about this rotation, but I am now just excited to see what happens. At the very least, the likelihood that I will be cleaning up poop in the next month seems nearly nonexistent :)

I am off to seek out textbooks online for which I will pay an exorbitant amount for up front, enjoy reading little or not at all, and then sell, recouping very little monetarily because, in those few scant months, the newest edition will have been released with such earth altering changes as a new font in the preface, a superfluous rewording to page 346 and a flashy new cover photo. Admit it, no one misses that part of college.

Popping off the top of my esophagus

I cant believe it has been two weeks since my last posting. Which means I have spent a solid two weeks dealing with only my own concerns and not those of some poor bedridden individual. I also cant believe that the holiday is winding down.

It was a pretty wonderful, though overly rapid, break. I definitely feel like I needed a few weeks to recuperate mentally from the grind of the summer. Tia and I spent the first week in Florida with my parents and, despite the inhospitable heat and humidity that greeted us, the trip was really great. We spent a good portion of the break poring over the sands of Venice beach on the gulf coast trying to locate the now elusive prehistoric shark teeth that I spent many summers searching for with my family growing up. Unfortunately, they had recently pumped some new sand on the beach and effectively buried most of what you could locate. They were harder to find than Lindsay Lohan's dignity.

The trip to Florida, as busy at it was and as much as I enjoyed seeing my parents, sped by furiously. It still seems as if a week's time could not have transpired between our arrival and departure. The extra 5lbs of girth about my middle section reminds me that it was no mere figment however. If you are reading this, I love you mom and dad and thank you for a wonderful holiday.

The second week has been spent largely reading leisurely, trying to return to routines, and dealing with the vagaries of life that so often try all of our patience. I wont recount any of the details of the mundane aspects of it other than to say that I abhor dealing with car insurance, buying a house/condo FSBO is maddening when you are dealing with the most obtuse seller in the history of realty, and financial aid and associated monetary school concerns remain enigmatic and frustrating.

I would love to attest to my readiness and willingness to return to school, but I am not one opposed in any way to idle time. Sure, there are times where I have yearned for activity and, lacking the money to find many to occupy my time, have bemoaned my financial situation and longed for the days when I will return to school if only to finish and begin accruing money instead of hemorrhaging it, but a few deep breaths and the feeling comfortably passes. I have really tried to enjoy this week something that I think we, as American people, often take for granted.......spending our time off doing little or nothing of import or note and, quite simply, just relaxing.

Speaking of relaxing, I am off to do a little more before school begins anew and I will be afforded almost none until the winter holidays. The next term starts on Tuesday with Psychiatric nursing to begin it all. I am sure there will be plentiful stories then.

My Christening

Just thought I would write a quick blurb and let everyone know that I was christened today. I was taking care of a patient who was unable to speak or understand more than a child's handful of English and was also in a state of moderate dementia. He was on one-on-one care (meaning someone was sitting in the room watching him all day so they didnt have to put him in restraints because the restraints 'agitated' him) because he had ripped out 3 catheters (1 for sure before the balloon holding it in his bladder was deflated......make my bits and pieces ache just writing about it) and numerous IVs. So, the person watching him needed a break and, while I was watching him for a bit, he began to flail about. Thinking he was having some problems, I ran to the bedside only to find out he had undone his adult diaper. He peed all over the floor and on my arm. At least pee is sterile.......though it did NOT make me feel awfully clean.

On the upside the person doing the one-on-one care did most of the cleaning up during the day as my patient had been prescribed Colace (a laxative) the evening before. I helped out a few times but lets just say that Colace is HIGHLY effective and leave it at that.

1 to go until Florida beckons!!!

With deference to Margie from Fargo, "I think I'm gonna barf!"

Do not read this if you are of a delicate constitution as it will likely prove a mistake. You are warned :)

I have seen quite a few things that would make anyone, myself included, squeamish since I have started school. I have walked with bags filled with human offal, I have cleansed the genitals of the more corpulent amongst us (and the more malodorous), and I have observed a welling pool of urine more blood than urea and more solid than liquid. I will not pretend (even though it is my blog and I am well within my rights to augment myself both mentally and physically) that I have dealt with any or all of it with a smile, but I certainly have tried. Today was a different breed of animal......eh, like a liger or a tigon if they were repellent.

I had the option of working with another student today and, since I am mentally on vacation already I thought why the hell not. She thought the same. Turns out we did not know what we were getting into.

The patient has been on the floor for about a month now. I am learning that acute care spans the time frame between a day and somewhere just south of a year evidently. She was admitted looking something like a burn victim having succumb to some ill effects from a medication she was on. Her husband is a medical doctor, but evidently thought better of taking her in to attend to her problems until two weeks later, hence the severity of her ailments. Her co-morbidities are plentiful and I doubt I will cover them fully here. She has 100 pack years of smoking, severe COPD, she is on oxygen therapy, she has lost better than 60lbs in the past 6 months, she is diabetic, she experiences bouts of psychosis, she is unable to ambulate, she is fed through a peg tube in her stomach, and she is on contact precautions because of ORSA (Oxacillin Resistant Staph aureus). She is presently bedridden and in restraints to keep her from pulling out her feeding tube and/or IV lines. She is also shedding skin.

When I say she is shedding skin I dont mean the kind you see sheaf off your body after too much sunbathing. I mean the type of shedding that you really would have to see to believe. It comes off in sheets and sloughs off constantly. Her skin, despite this, has the tacky texture of a linoleum floor with a three day old soda spill dried upon it's surface. Bathing her yielded a bucket of wrinkled human detritus and putting lotion on her afterward necessitated changing gloves as they gathered up more flecks of skin than a rake would leaves on a fall day. It is probably beyond my words to explain it as vividly as I would like (though it will likely spare you the images I will have for some time). The smell I will leave to your imagination as typing this has proven enough for me.

The counselor told us when seeking employment not to make a list of what we like, but rather to make one of what we do not like. This has shot to damn near the top of that list. Were the profession limited in scope in such a way that this rotation was representative of the whole, I would have removed myself from it by now, but it is no more than merest of fractions of what can yet be. I cannot wait to move on. 2 days until that happy event occurs.

Consuming booze and gut fuel

What a bummer weekend. It went downhill faster than Britney's career. It actually wasn't altogether horrid, so you will have to excuse any hyperbole, but the condo situation is deteriorating rapidly. This could be a good thing in the long run because there is a lot less incentive to stick around ROC if we dont have inexpensive digs within spitting distance of campus. The main issues are twofold (three if you count the owner being a complete tool): there is asbestos tape on a small piece of piping coming out of the furnace that needs to be professionally removed and the piping repaired properly and one of the breakers kept shutting off and heating up whenever you turned on anything upstairs. The first problem will cost about $375 to repair and the second could range anywhere from replacing the breaker to all the wiring in the house being aluminum, bringing with it the whole 'fiery inferno' potential that, aside from those of us with an arson bend, is not appealing. So, we feel he needs to get that stuff fixed and he is the kind of guy that keeps bills in his wallet so long that the Lincoln is getting an ingrown beard. It sucks. No more looking at FSBO (for sale buy owner) homes.

In an effort to check out the other fish in the sea real-estate wise, we popped into a condo community today for a gander. The place itself is nice if a bit dated. The rooms were large (as were the taxes) and the real estate agent pretty much said outright that the owner was extremely motivated to sell. What we fell in love with was the community which includes an Olympic-sized indoor heated pool, two indoor raquetball courts, an indoor basketball court, a fitness center and the nicest people I have met. It was pretty sweet. It is closer than this house, but not as close as the other place. The downside is that it is not altogether that much less expensive. A head scratcher at the moment.

As for school......it goes. I was so nervous and excited to get to clinical, and now I can't wait to move along. I, as well as most people I have spoken with, have our eyes on the vacation ahead and have pretty much had our fill of cleaning up feces and wiping ass. We got to give meds, injections, put info in charts, and attend to other types of patient care........and that was good, but having one patient also makes for a LONG day once you have the general care down. Much like having one table as a server or one customer in retail......they will keep you moderately busy, but only for so long. The rest of the day is spent trying to busy ourselves with whatever is, or at least appears to be, productive. I am glad I feel that way though, because it beats the hell out of feeling overwhelmed.

Also, as a post script to my usual rants, check out Scott Baio is 45 and single if you get a chance. Compelling stuff.

Off to learn about the Alaris pump.

A poo free day!

There haven't been many and there may not be many up ahead, but today was finally poo free. It was touch and go all shift though because my patient did wear adult briefs........but today the fates smiled upon me clearly (my patient is also morbidly obese, so it could have gotten ugly quick!) I do have the same patient tomorrow, so who knows if my luck will hold that long, but here is hoping that he chooses to do so in the care of the evening or early morning crew.

I also gave my first injections today (my mom will likely cringe just reading about it). It wasnt as bad as I thought it would be, although honestly I hadn't given it too much thought altogether. I just kind of assumed we would have to do it and I hoped that I wouldn't cause the patient too much grief. Mission accomplished. Injected some heparin (an anticoagulant) into his stomach and some insulin into his arm. I can now say this much, though I didnt really enjoy giving shots, it is both a hell of a lot better than getting them and, as you can imagine, infinitely better than the whole cleaning up poo thing that I love oh-so-well.

So far, the techs seem to love us because we do the grunt work that they no longer have to (at least for some patients in our care) and the nurse's like us because they have one less patient to tend to. i am sure the hospital digs all the free help too.

Off to read and relax. Two more days and a write-up to get to before the last pre-vacation weekend. I cant wait to have some time off, see my parents, and enjoy a real beach.

Smells like poo

Ah clinicals, what is it about you that I love so well. Is it the early mornings? No, I hate that. Is it the white uniforms that breathe like Hefty bags? No, not a fan of that either. Must be the poo. As the song in Scrubs says, everything comes down to poo. (http://www.gibbleguts.com/scrubs-poo-song.html)

How many days does it take to get the smell out of your nose? God only knows, but I can tell you it isnt an easy thing to forget. Here is how Friday went: Our patient on Friday must have had 4-5 BMs and, instead of putting her in an adult undergarment, they seem to think that a pink pad is appropriate. Suffice to say, that can get messy........kind of like pooping directly onto your sheets. Clean up involves a lot of wet washcloths and, since the patient is largely bedridden, quite a bit of rolling her to and fro as we attempt to clean her linens (you have to roll up the dirty linens and roll the patient over top of them and onto the clean linens......not as easy as you think it might be. Next time you are extremely bored try making the bed while someone lies in it). The attending MD wanted her in her chair so, our fellow nurses (the nurse for our patient and the GN she was working with) decided we should move her with just the linens (it did not go smoothly) and then, once in the chair, the RN did not securely attach the feeding tube so the pt ended up with chocolate all over her. When we moved her to clean up, she had had another BM, so they thought we should move her back to the bed. Instead of using proper technique yet again, they opted to stand her up and pivot her, smearing poo all over her newly changed sheets (meaning we had to change them again). The patient is on contact precautions also, so while cleaning her we have to wear protective garments that are made of plastic......so now we are sweating hot on top of the smell and poo pretty much everywhere. Suffice to say, it wasnt the worlds greatest day, but mostly because the RN and GN we were working with were not pleasant (and when our NP notified the head nurse about our experience the head nurse just said, "without assigning blame, lets just say it isnt your students' fault whatsoever). We had worked directly with the head nurse and a different GN the day prior, so they knew that we did a good job. Moral of the story is that nurses (or GN in this case) with a tramp stamp are complete tools (not sure if that is a moral that can be applied elsewhere, so mold it as you see fit).

Does any of this make me want to give up? Not whatsoever......but I think we are getting to experience the worst of it for sure. I do not envy the techs and CNAs at all, but I appreciate the hell out of them. Hopefully I always remember to let them know how much I appreciate the work they have to do when I am a nurse.

On an aside rant, Tia and I went to Wegmans grocery tonite and they have the most inane alcohol policy that I have yet heard of. Tia neglected to bring her driver's license so they wouldnt sell me the beer even though I had my ID. Tia tried to argue that it was a good means to stop the sale of beer to the underaged, but that would really only prevent the sale to the truly stupid. All I would have had to do is to have Tia not be near me when I bought it and there would be no issue. Same goes for if I were 21 and was buying it for the underaged. So, all the policy really does is piss people like me off and prevents NO ONE whatsoever with a valid ID from buying beer for the underaged unless they are standing directly next to them. Kudos Wegmans!

On the other side of that coin Tia, being the overly sweet super-GF she is, went out to pick up some beer later that night. yeah for Tia and yeah for a cold Sunday night beer.

Condo inspection tomorrow. Hope everything comes our all right........or if not the inspector at least finds it. The inspector Tia had for this house couldnt have found water in the ocean.

Off to finish Potter. I am having a hard time finishing it because it will be sad that it is all over.

2 weeks til vacation!!!

A quick blurb

I havent a lot of time or energy tonite, so this will likely be shorter than Tom Cruise standing in a pothole. I just wanted to write how exciting it is (though wickedly tiring) to be on the floor doing actual nursing work. Sure, we also still do a lot of CNA/tech work, but we also get to distribute meds (oral and peg....which is through a parenteral feeding tube), take vitals, and clean wounds. Today I even put in a Foley catheter (which was actually less nerve wracking than I thought it would be, but largely because the patient has dementia). We are going to learn to give IV meds next week. I wont hide my terror at practicing injections on an orange and then trying to do it on a real person. Hopefully that patient will have dementia as well (so she/he can forget my feeble attempts at putting a needle in their arm). My only wish, and a longstanding wish at that, is that the days didnt start so bloody early. I am not now, and will likely never be, that agreeable in the early AM hours.

Off to finish Potter and then sleep. I have to know what happens.

Sundays are for bemused reflection

This program, as I have noted numerous times, is incredibly rapid and oftentimes confusing because of the speed. I have no idea what it is we are going to be doing throughout next week. I state that as there is something exciting in having no set routine or expectation of what is to come.....and also because there is certainly something to be said for the opposite of that entirely. I sometimes miss knowing what Monday will be like and the likely trajectory through the end of day Friday. I miss the confidence that comes with knowing what the hell you are doing and the comfort of working with people that come to you because of that knowledge. This program is oftentimes like the first day of a new job......except that it continues every day. Always meeting new people and being put in new situations and, on top of that, with real patients who have real problems and aren't always terribly excited to have you around. There persists a constant low-level anxiety.

Because of the nature of the program, the labs only introduce you to most concepts, and then tersely at best. Truly, the lab mannequins, while anatomically accurate, are nonetheless not animate and therefore never the least bit begrudging when you fail at one skill or another, such as repeatedly shoving catheters into their nether regions, and have to try it again. This will undoubtedly not be the case when a real patient is involved unless they are amiable beyond comprehension or seriously sadistic. I can say with no hesitation that the bath we gave the mannequin did not compare very favorably with the one I gave my patient, that diapering a mannequin was significantly less unpleasant than diapering a person (especially when you have real feces involved), and that practicing needle sticks on an orange will leave me less than confident that I will find a vein on a person. Often, the labs approximate the real settings about as well as running three miles on a treadmill approximates a marathon under the summer sun or as well as using a calculator prepares you to use a computer, which is to say not at all.

I understand the limitations however, I just miss being confident about any aspect of what I do. It is a weird lost feeling I hadnt truly felt since the first day I walked into a classroom to teach. That surreal sense of knowing you look the part, but now being expected to act it.

I hope that everyone is doing well. I had better get back to my patient write-up. Lord knows what I would do if I actually had a free weekend anymore :)

Day 3 - embiggening the common man

What a way to wrap up your week. It actually ended on a very positive note. I have a completely new level of respect for what a CNA has to do on a daily basis.......it definitely isn't a cakewalk. Some of the students I was working on the floor with lamented how much break time the CNAs seemed to take, but I wouldn't begrudge them a minute of it. I spent the last few days hauling around plastic bags full of human excrement, changing diapers, washing bedridden patients (including in their nether regions......and then applying salves to said places) and generally seeing a lot of people with only the prospect of continuing deterioration ahead of them. And yet, as I was walking down the haul with one of the aforementioned bags filled with the waste products of a freshly changed colostomy bag, I couldnt help but feel a little giddy. Not because I was thrilled at that moment to be doing something that, 3 months ago I wouldnt have imagined myself doing in my wildest, and most displeasing, dreams, but because it didnt make my body shudder in revulsion......in fact it didnt bother me at all. I was much MUCH more discomfited by the thought of dragging my bleary behind out of bed before the sun chose to. Not only did the whole process not bother me, I actually felt good to have helped out. Over the long term, I think working at a place like a long term care facility would grind you down, but in the short term it was really a good way to get our feet wet.

On to acute care next week.

Sidebar: still no condo and now renters for the house. Might have to look at RVs.

Clinical Day 1

I think it will always be a memorable day if only because it most assuredly had some very surreal moments, the kind that will definitely stick with me.

The clinical is more a sampling of what is to come and the first taste was a long term care facility. We had to arrive at the facility at 7 in the morning which might as well be 2am to me. Not a morning person now or ever. Looks like I will have to adjust in the near future anyway. We began by participating in a brief orientation and then went up to our assigned floor in two groups of 8. My group went off to get our patient's charts. I had always thought of a chart as a compact bit of information distilled into a few scant pages in a manilla folder. These were 2" binders packed more tightly than Wal-Mart on Christmas Eve. It was interesting because I could actually understand a fair amount of what I was reading which made me somewhat happy. Unfortunately, what I was reading was mildly disturbing. My patient is morbidly obese, has a trach (and therefore isnt very communicative), a colostomy bag, is not ambulatory, has uncontrolled diabetes and an unpleasant demeanor known on the floor. It is only a three day gig, but I definitely got the prize. Should make for an interesting assessment.

I also had the pleasure (?) to witness not one but two colostomy bags being changed. It was a different experience to be sure, and not because of the odor. The strange thing was that the stoma was protruding, in both patients, a few inches. The stoma is part of the intestine outside of the body. It is a strange thing to see on the outside of the body. I had no idea it protruded to such an extent either.......like 2 or 3 inches. It was truly strange watching the nurse remove the bag and then wash the intestine. I also saw a suppository inserted and a trach cleansed. All in all, a big day. I dont know if long term care is something I would ever be interested in, but it definitely has knocked down some barriers.

Off to relax and sleep. Another early morning awaits.

the weekend ends

Another week gone by the boards. This one was especially long because I didnt get my two 'sleep-in until you wake up' days because of a Saturday lab. I feel a bit cheated. The way the labs stacked up, my roomie ended up having to stay longer on days we had class, but had no school on Wednesday and none this weekend and, just prior to the start of our clinical rotations, she has Tuesday off as well. Truly we are in school the same amount of hours, but it is the time of those hours that really gets you (as those of you that know me know that mornings are not my preferred time of day).

Speaking of early and of clinical rotations, they start on Wednesday. I would say they crept up, but the truth is that nothing creeps up in this program.......at its slowest it would be fairer to say it lightly jogs up or ambles up (amble is a great word to describe movement by the way, much like gamble and saunter. Admit it, sauntering somewhere sounds a lot more interesting that walking there). The rotations are from 7-4. Meaning, I will be up prior to the sun. I am not sure if there is some cruel and unusual clause in the school's operating manual, but this would be a poor omission were it not. I would almost prefer it to be from 7pm to 4am.......its honestly a coin flip. At least I would be mostly awake for the first half of the rotation. I really hope I dont have to stick someone with a needle first thing in the AM. I can scarcely tie my shoes that early.

the labs have gotten more interesting as they have gotten more preparatory. We have spent the past week not taking vitals and percussing the hell out of each other which has been a turn for the better. Instead, we changed dressings, learned how to (on a dummy) insert a catheter, diapered each other, put on restraints, practiced a Hoyer lift, learned about respiratory treatments, practiced bed making with someone in it, and learned all about sterile technique. I am missing a lot I am sure........it was a thoroughly busy week. We have 4 weeks of class/lab/clinical and then a nice long holiday.

I am already dreaming of what I might do on the holiday, but since I have little money and two long weeks, I am thinking it will be a great time to read some books (like the Brothers K and the new Potter book) and watch movies and otherwise let my mind vegetate. Hopefully arrange for a few days driving trip to Canada or up into Vermont and Maine. Who knows. One month more and we are a full third through. Freaks me out just typing it. In the meantime, I have the next month to get through first.

I hope everyone is doing well. I am working on trying to keep up on the emails.

Until next week when I should have a lot to say about my first rotation.

Without deadlines, you wouldnt be able to procrastinate

I am not sure if I got the quote quite right, but the gist of the quote that Krista told me is the same. I am just having a hell of a time getting my head together to write this final paper for Genetics. I have scads of information, a rubric to go by and still am finding it taxing to get the words organized in a cohesive manner. Plus, with Tia gone this weekend and the house on the market, I have been spending a lot of time scooping cat boxes, tidying up, and doing whatever I can think to do to get the pool from a pea-soup green color to something resembling blue. The house is listed in the paper today, so our Realtor seems o think we ought to be getting a few more people to come through and look at it. It is such a difficult situation considering that we have only a roughly formalized but yet to be signed contract on a new home (that will be much less expensive to maintain). So, if all goes well, we will end up selling this house soon and buying the new one within the next month. If not, I dont know what will happen because I know it is an expense that Tia is having a hard time bearing even with Krista paying rent and me giving Tia money as well.

I need to try to get myself motivated with some food and some caffeine. As always, wish me luck. It has been slow going thus far and, while the paper isnt due until next Friday, I have a feeling the new class wont leave a lot of time to do much of anything else.

Got three grades in:
Patho: B (1 point from a B+, I wont go into how poorly everyone seemed to do on the final paper, myself included)
Nursing Science: A- (just barely got it.......win some, lose some I guess)
Assessment: didnt do stellar on the last exam, but did enough to hold onto my B+

mursiful heavens

We have almost surmounted our first hill. Unfortunately, cresting the first hill only shows you all the other hills to follow. In this case at least, it is better to look back than look ahead.

In looking back, i still cannot believe that we are nearing the end of 4 out of our 5 summer courses. There is still the matter of another exam tomorrow and a paper due by next Friday, but for the most part, its all but finished. My overall impressions are mixed thus far. There still seems to be a certain sense that the program is still in the process of finding a groove. There are too many incidents of paperwork getting to us just prior to deadlines and some classes feel superfluous. My thoughts in review:
Pathophysiology: An amazing class and one that I wish everyone could take, though much more slowly. Great instructor. (expected grade - B+, A-)
Nursing Science: Superfluous waste of time. Assignments were poorly explained and capriciously graded. (expected grade - B, B+, A-)
Genetics: Interesting, but not in depth enough to really garner much information. Spectacular instructor. (expected grade - A, A-)
Assessment: I have mixed feelings. The lab instructors were pretty sterling, but the class itself was middling. No consistency to the exams or papers. (expected grade - B, B+)

Overall, I think that there is definitely room to improve the program, but there are also some really strong points to build from.

The new course looks like it will teach us everything we could possibly imagine needing to know out in the field.......and once again in an incredibly short span of time. Most lessons are an hour or less with focuses of catheter insertion, bathing, and injections. Makes me fear doing it out in the field with so little practice time. Hope all the skills are easier to pick up than I presume they will be.

Not much else to report. Heard of a few students who have already dropped out/failed out of the program. A bit scary really, but the silver lining is that it is no one I know at least which would be more impacting since most people seem very competent and capable. Wish me luck on tomorrow's test. I may need it.

Murcenary

There are some days and weeks that are just harder than others to navigate. Not sure why that is, what cyclical issues are at play or what phases of the moon or tide may be involved, but they happen and i am in the midst of one right now. Part of it may be allergies (which have been nearly incapacitating some days), but I am sure most of it is stress related. I feel like I am in that period of time when the brain and body really want you to shut it down for a bit, but there isnt time for that. Every stressful event (my final demo) is followed by another task of some kind or another (a paper). The nature of the program is definitely not one of ebb and flow......but rather just flow. To keep up with that, you have to be on top of your game at all times. I have already had days here and there that arent my sharpest or best. Times where I would, and may have chosen to be, anywhere but studying. I think this program wont be so much about ability (as presumably all people who got in are capable), but it will be more about stamina and focus. It is a year, but it will likely feel a whole lot more than one.

In better news, the final demo went well. I am thinking with the write-up an 'A-' is likely in the cards. I of course forgot a lot of things I should have remembered, but it is done and I am quite pleased. In order to pass it you had to know how to do a 5 minute head to toe assessment (vitals, check for edema, bowels sounds, auscultate, etc) and know the 6 system exams thoroughly enough that you could do them all if you pulled them (you draw a name from a hat when you arrive to the examination). i pulled Abdominal which was rather short (thank goodness) and obviously did pretty well. Tia is happy I passed as well since I had to poke and prod her for days on end. i have heard that, thus far, three people have failed. I cant imagine how that would erode your confidence. But, that is why I study as much as I do.

I dont really have a lot to add. I am still doing pretty well in all my classes. There is one week to go before we move on to the next round of them. There are a lot of things to do between now and then as well. Speaking of things to do, I have work I need to get back to......then I am going to do something fun dammit! :)

My so called life

Truly, without Tia's insistence, I probably would have nothing near a life. At least she tries to make sure we do something non-school related, even if I sometimes feel guilty at this point for doing anything besides studying, writing papers, or practicing technique. She will be the reason I wont be institutionalized before the winter hits.

I dont have a lot to add in the way of school other than it is really coming up on crunch time. In the next 8 hours, I have a clinical paper due in Pathophysiology and within the next roughly 24 I have a final demo to do (because I misunderstood the instructions and hence signed up late......which is my MO of late, never seeming to get things together on time). The upside is that the demo will be done well before most other people have done their demo, the downside is that I had to (have to) learn 6 system examinations over the past few days and commit them largely to memory. As always, keep em crossed for me.

Outside of school, Tia celebrated her 26th, we went to a new fondue bar called Chocolate (you can imagine the food), and Tia and I are strongly considering the purchase of a new condo (well, new to us). It is another stressor, but will ultimately save a lot of money (mostly because you can buy a condo here for under $74,000) and time (no more lawn work, etc).

I would love to fill in more details, but school beckons.

Whew!

So the week that was is finally a 'was' instead of an 'is'. It included three exams and two write-ups and a CPR class for me. The score at the end of the week, I did well on the two Patho tests (though the second one was truly just recognition), but feel about as comfortable as a pair of tighty whiteys about the one today. Ah well, you cant win them all, and, as Garth Algar would say "live in the now man." Indeed.

Got back the scores from a bizarre test we took way back in week one: The NET (Nurse Entrance Exam). Theoretically, this exam would assess whether or not we possessed the skills necessary to make it in school and the profession. Of course, the point of giving it to us after we were already admitted is lost on me. I have doubts that if someone couldn't do math or write that they would kick them out now. The test yielded some surprising and entirely unsurprising results. First off, evidently I can do math. Yeah for me. I was in the 98% percentile. I am EXTREMELY curious to know what I missed (I missed one percentage operation), but I will be happy with how I did. I can also read fairly rapidly. However, my reading comprehension is just only above average and my knowledge of punctuation is below average?!,. (cant even figure out how to end the last sentence). Evidently I also dont have very good test taking skills (a skill they can test for apparently, though unrelated to math I would guess). However, it should be noted that my scores, as well as those of my classmates, ought to be curved somehow. We were given this test on our first Friday after all new classes, overwhelming lectures, and bustling about trying to dot every 'i'. Overall I ended up in the 88th percentile. Too bad that doesnt directly translate to school where I remain entrenched in my 55th percentile niche (it is a cozy place and I am quite comfortable).

Tia's birthday is this weekend. I got her a new bike (a surprise I cannot ruin since she already has ridden it). I am hoping to be able to clear out some time for us to do something fun on Sunday since her birthday and school match up about as poorly as Lindsay Lohan and rehab. I have a test that morning from 8-11 and classes that run until 7pm.

Off to bed. One more day to go before the weekend.