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.