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.
Thursday, December 27, 2007
Tuesday, December 18, 2007
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.
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.
Thursday, December 13, 2007
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!!!!!
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!!!!!
Sunday, December 09, 2007
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.
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.
Wednesday, December 05, 2007
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.
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.
Tuesday, December 04, 2007
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.
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.
Friday, November 30, 2007
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.
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.
Monday, November 26, 2007
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.
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.
Friday, November 16, 2007
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.
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.
Wednesday, November 14, 2007
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.
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.
Tuesday, November 06, 2007
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.
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.
Friday, November 02, 2007
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!
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!
Monday, October 22, 2007
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.
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.
Wednesday, October 17, 2007
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.
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.
Monday, October 08, 2007
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.
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.
Wednesday, October 03, 2007
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.
Monday, October 01, 2007
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/
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/
Saturday, September 22, 2007
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.
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.
Wednesday, September 19, 2007
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.
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.
Tuesday, September 18, 2007
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.
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.
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