ANXIETY!

Who doesn't have anxiety these days, right? But I have a new anxiety on the horizon and the endless surprise at the cause of my anxiety is giving me more anxiety.

My last day of school is less than one month from today. Good, right? Yes. And no. Yes, it's good that school is almost over. I'm very happy about this. But. Now this means that it's time to get that resume into shape and start applying for jobs. And this gives me anxiety because there are no jobs for new grads in California. Boo. Let me repeat that. There. Are. No. Jobs. For. New. Grads. In. California.

Seriously. This is not me be overly dramatic about an abysmal job market. It's for real. Everyone knows there's a nursing shortage, even here, but that doesn't change the fact that I'm looking outside of CA for job opportunities. And having to convince people that as a new grad I'm at the bottom of the applicant pool for jobs here grows wearisome. So! Carry on smartly, I must! Avoid typing in Yoda-speak, I must! I will be looking for new grad openings around the country, preferably on the West Coast but maybe somewhere near where you live. Didn't you say you wanted a roommate for a year?

For now, tho, I'm putting job stuff on the back burner. Until Dec. 20th, I still have school obligations so I'm not off the hook yet. Then I need to focus on the NCLEX. And theeeennnnnn, on jobs. In the meantime, all I want to do is bury my head in the sand and not come up until hospitals in this state realize that being penny-wise and pound-foolish is not a good long term strategy.

Beware the extra credit opportunity...

Because sometimes you sign on for extra credit projects and find out from the professor that your group has to make a music video. And the professor picks the song. And we can't back out. Oh, god, what have we done?

Trying to take some time to smell the roses...

I'm a planner. I like to plan things. In advance. Like, way in advance sometimes. And I don't often take the time to enjoy what I'm doing, when I'm doing it where ever it is that I'm at (noooooooooo, don't end a sentence with a prepositional phrase!!!!). And when I'm overwhelmed by the amount of stuff I need to do and feel stressed, I plan even more and enjoy the moment a lot less.

But today I tried to stop and enjoy what beautiful NorCal weather we're having and the wind sweeping the fallen leaves through the streets and the smell of clean laundry and coffee crunch bar cookies baking in the oven. Oh, and perhaps most importantly, the tickle-y feeling of my husband lightly rubbing my feet. Love that. My house is tidied up and the dog is asleep in the "doggie doughnut" position and Michael and I are yuppy-ing it up on our laptops. He's checking out ESPN and I'm cruising the 10 or so cooking blogs that I've bookmarked. Right now I'm in the moment and it feels good.

Nothing but backwash in my can of care...

For those of you familiar with the origin of the "can of care" thing, my apologies. I do, however, I feel that it's apropos of the way I'm feeling right now. I am really struggling with staying on top of schoolwork what with the insane workload, prep for my exit exam, 2 out-of-town trips scheduled 2 weeks apart and home/life maintenance that has got to be done. You can only outsource and/or ignore so much stuff, you know?

This apathy is hard on me. I got B's on exams for two separate classes and, folks, I am NOT a B student. But apparently I am now. It wasn't for lack of studying, I just didn't retain the information. Also, I committed the cardinal sin of changing my answer after I had selected an appropriate response to the question. And I did it more than once. What the hell is wrong with me? I stopped myself from doing that back in March. Blarg. Before you say anything about grades not being that important, grades do matter when you know you're going to be one of 1,000 applicants for 15 slots at the only hospital in the Bay Area that is continuing its new grad hiring program. Boo. Also, taking ACLS (advanced cardiac life support) classes help but that's a whole weekend of studying and doing of homework down the tubes b/c now I'll be in this class. Plus it cost $225 (a discounted rate at that). Like I'm made of money or something. Or Michael since he's the one with the job. (Thanks, honey!) I better get a job, that's all I'm saying.

I keep telling myself that I will adjust my attitude and try to work harder/longer/sleep less/whatever the hell it takes to get through this but, man, am I tired. All I want to do is sleep. And you know, I haven't even been doing that much cooking. I cook, but I'm not trying out new recipes and I'm doing the cooking out of necessity rather than enjoyment. And that makes me sad because cooking is one of my favorite things to do. Especially since I got some seriously awesome birthday gifts in the form of cookbooks, ice cream makers and an immersion blender. We're talking about some serious kitchen loot and I've hardly touched it because I haven't had time. But as with all other things and the use of laxatives, this, too, shall pass. Not that I'm taking laxatives. Or that anyone needs to be. In fact, there are no laxatives here. Just forget I mentioned that part. Anyway, the light is at the end of the tunnel and there will be suntanning and fruity umbrella drinks when I get there. I am counting down the days.

There are times...

When I'm so frustrated with the administration at school and feel so utterly disenfranchised that I think I just can't bring myself to go back to campus or pick up a textbook. And I still feel that way for the most part. One of the faculty recently said that all students feel this way once they get over the hump and are just a few months from graduation. I remember feeling like I couldn't wait to be done with school that last time and I just kept saying "...finally, I'm finally going to be done" and I said it so often my mom had it piped onto my graduation cake. Thankfully, the person at the bakery was able to spell it correctly (I'm alluding to the cake my MIL brought to our rehearsal dinner that said simply "Tomorrow!" but the girl at the bakery could NOT, for the life of her, spell "tomorrow" without misspelling it. Repeatedly.)

But, today, I find myself feeling excited for the curriculum and for having had some really interesting experiences as a student. Right now we're doing simultaneous mental health and community health rotations and I'm really enjoying the mental health clinical portion. I'm sure I'll enjoy community health (home health and hospice rotation) but I don't start until tomorrow. Anyway, we have a lot of assignments for extra-curricular projects one of which is observing 2 self-help groups. We're supposed to do AA for one and then anything we want for the second one.

And I have to tell you, dear internets, that attending an AA meeting has to be one of the most interesting things I have ever done. It was absolutely fascinating. And the member were so friendly and welcoming. And they really do introduce themselves by saying "I'm Bob and I'm an alcoholic." And they celebrate anniversaries of sobriety. One member has been sober for 50 years, another 18 years and one 7 months. But everybody applauded these efforts no matter the length of time spent sober. They spent the meeting reading from the Big Book and everyone took turns reading a paragraph and then talking about what that paragraph meant to them. Or to make any other comment and it was humbling. The desperation, the struggle, the rock bottom-ness of it all was sad, inspirational, fascinating and surreal all at the same time. I'm glad I went. Thank you, SMU faculty, for assigning this project. I can't promise to try but I'll try to try to keep this in mind the next time I feel like I can't bring myself to go to campus.

Resolution update...

Remember these?

1. Make bread from scratch (no cheating with a bread machine)
2. Donate blood at least 4 times this year (can't do more it more than every 8 wks)
3. Try 3 new recipes every month
4. Do some container gardening...maybe some tomatoes, a pepper plant and some herbs?
5. Meet more of our neighbors besides just the couple next door
6. Do some sort of exercise (besides walking the dog) a minimum of 3 times a week
7. Try at least 3 new restaurants on Murphy Street (there's at least 12 and we eat at the same one every time)
8. Work on being more consistent with my tennis game
9. Hang pictures on the walls that do not feature any member of our families
10. Spend Christmas in Hawaii
11. Make this blog more aesthetically appealing (gotta have a stretch goal)

Well, since I'm so boring a lame and hardly ever post these days, I'm going to pinch hit here and give you a little update on my progress. I still haven't done #1 but then, it's been hot and we don't have air conditioning. I've spied Ina's recipe for Irish soda bread which is not, by the way, the same as the Irish bread we make every year during the holidays and whose recipe I cannot ever share with anyone (Great-Nana Breen's family secret) but I don't think that counts anyway. I'm thinking more like a really good honey whole wheat. Anyway, I'll get there.

Re: #2. Oh, hell, that's a funny story. So, I have given blood 2x so far this year and I just realized I'm due to go back but that's not the funny part. The funny part is how on June 24th, the last time I donated blood, I got pulled over for an incomplete stop at a stop sign because I got lost while trying to find the donation place. And the officer asked me where I was going and I told him "I'm going to give blood." Yeah, I'm sure he believed that one. And he goes off to write my ticket because CA is in a massive budget crunch in case you hadn't heard and do you know how much it was? $212. $212!!!!! For an incomplete stop! Fck. Anyway, it's time to give blood again and I have made damned sure that I have stopped for a full 3 seconds at every stop sign since and you can bet I'll be extra careful when I drive to my next appointment.

Re: #3, I'm right on track. You can head over here to see some of the tasty things I've made as well as the other fabulous recipes we've tried.

Re: #4, I'm only moderately successful here. My herbs are fine although the basils are going south for some unknown reason and the cilantro died before I could transplant it. My cherry tomatoes are starting to come in but I've only seen a handful of the green zebras. The heirlooms, well, that plant hasn't produced a thing. Durr. As for the pepper plant, it said bell pepper on the marker but they sure look like little banana peppers or something besides bell pepper. Better luck next year, I suppose.

Re: #5, we met 2 more neighbors and continue to introduce ourselves to other neighbors while out for walks. Regrettably, we weren't able to participate in the national "Night Out" this summer so we missed an opportunity to meet more neighbors.

Re: #6, well, I have that one in spades. I work out 5 times a week and sometimes as many as 7 times a week depending on my schedule. I'm a big fan of the "Biggest Loser" DVDs and I have 3 Jillian DVDs. Love them. I don't love that I pulled my triceps muscles this weekend when I upped the handweights to 8lbs but I do love that I recently purchased pants and a skirt with a single-digit size tag. I haven't seen that number in years. Years, people. So long ago, in fact, that I can't even remember the last time I bought something in that size. 9th grade or 10th grade, maybe?

Re: #7, we recently tried the 3rd new restaurant and it was pretty tasty.

Re: #8, as always, my tennis game is a work in progress. I've developed a strategy for beating Michael but with his enormous wingspan and my remaining placement inconsistencies, I'm successful only about half the time. I'm also working on my serve and am constantly struggling against the bad habit of backing up while following through with my swing. That's never a good strategy.

As for the rest, well, you can see I haven't touched #11. #10 won't happen until December and I really have no excuse for #9. We just need to spend some time framing a few photos and putting them up. How hard is that, anyway? And yet, it's still not done. It's all a work in progress, right?

That sucked...

I just took my critical care comprehensive final and it was, by far, the worst exam I've ever taken. I know I've said that before but, seriously, this one was the worst. So, to cheer myself up, I'm embarking upon some baking therapy and then I'm going to work out and then I'm sitting down to a nice mixed drink of vodka and blood orange soda over ice. I'm going to sit in my backyard and read the NYT and relax. Can't wait.

A visit with an old friend...

A book friend, that is. So, like a lot people I know, I read in bed before falling asleep. And before Michael can make a comment about how I fall asleep before reading 3 pages of anything, I'll just out myself right now. Since I can't stay awake long enough to read more than 3 pages, I usually read books that I've read before like Harry Potter or Calvin & Hobbes. But this time as I was perusing the book shelf, my eyes fell upon "Are You There God, It's Me, Margaret." What fun to reread that book, a book I have read a hundred times since 4th grade. It's the original book I purchased from the Little Professor bookstore that used to be next to Giant but then became the pizza place which then got bought out by Giant when they expanded in the late 80's. Not that you care about the bookstore or Giant.

Anyway, the book has a huge cherry KoolAid stain on it and is a bit dog eared from being so loved. It was fun and silly and I'm so glad I picked it up. I just love rereading some books; it truly is like visiting with an old friend. I'm also rereading "Island of the Blue Dolphins" which Mr. Paone read to us in 6th grade. Scott will probably remember that. Before that it was HP and the Half-Blood Prince. I'm not sure which book will be next (I can guarantee it won't be a new book until the end of August when I'm on break)...maybe some Little House books. I just looooooove the Little House books. Like, love so much that when I commented to a boyfriend that I wished I had a new set and was bummed that my parents didn't get it for me for X-mas he bought me a set. And then I kept it when he tore out my heart and squished it flat. Normally, I would have burned and/or thrown away such a gift but not the Little House books. That would be sacrilege. Just thinking about it makes me want to wander over to the bookshelf and pick up a book. I think I'll start from the beginning. Do you have favorite books that you like to reread?

I win!

My first patient on my first day back on the ward was positive for C. diff and had scabies. Woo! I swear to Ogg that I would bathe in Lysol if I could.

On a completely unrelated note, Michael and I have been trying to take advantage of some of the many things that sunny Kali-for-nee-ya has to offer such as the San Diego Zoo, the SF MoMA and the garlic festival. Pictures of a baby cheetah out on a walk with a zoo keeper and warthogs and camels will be forthcoming. I rather enjoyed our time at the zoo but perhaps the July 4th weekend was not the best time to partake of its offerings. The MoMA was great; we saw the Ansel Adams & Georgia O'Keeffe exhibit and loved it. Usually I find the audio tour to be quite helpful but not so much this time. And the garlic festival? Well, I'm pretty sure I still reek of garlic but since Michael probably does too and neither one of us can truly smell the other, well, I wouldn't come visit us for a couple of days. I doused myself in perfume this morning before going to class. But it was so worth it. See what you're missing by not living out here? Or at least visiting? (hint, hint, nudge, wink)

Where have I been...?

Apparently not hanging around here sharing the mundane details of my life. Thank goodness for a little respite, huh? Well, as always, I have been up to my eyeballs in homework and weekly quizzes and/or exams. You know, the usual. I've since finished my pediatrics rotation and the nursing research class (evidence-based practice is your friend. So are librarians, by the way, so make nice with all the librarians in your life) and am now on to critical care. We're not on a critical care unit the whole 5 weeks but will rotate in a few students at a time/day plus hopefully we'll get to spend some time in the ED, OR and some of us will go to the wound care clinic. I'd like to do that but I have a weekend rotation and wound care is only open M-F. Boo. All I can say is that I better see some good stuff because if I get stiffed again like I did in maternity I'm going to be seriously pissed off.

To sum up peds, all in all it was a good rotation. The hospital was great (location was sucky but we can't have everything, now can we?), staff were awesome, clinical instructor was mostly good but sometimes weird and, well, weird, and my group of classmates was pretty solid. Peds is an interesting place because they try to make the floor feel inviting to kids and their families and parents (mostly moms, tho) are pretty much camped out for the duration of their child's stay. Sadly, some kids don't have parents who can or will come and stay with them. Some parents don't have employers who are understanding and will fire them if they don't come back to work, some parents don't have a partner or a spouse to help out and may have other kids and home to take care of and some parents are absent for some other reason. I saw a fair number of kids who were in foster care because of neglect. I had one patient last week whose parents give consent over the phone for procedures but have nothing more to do with their daughter. She has a rare syndrome that causes developmental delays and she requires total care. Her parents put her in a home and have no contact with her. Her only visitors at the hospital have been 2 of the caregivers at the group home where she lives and they come to see her twice a week.

You know, it's hard to keep an open mind sometimes when it comes to other people's behavior. If I've learned nothing else while in nursing school, I've learned that you don't really know what people's lives are like outside of the hospital and you don't know what is going on that may interfere with their care for themselves or a family member. As a result, you can't be too quick to judge. But this girl's situation broke my heart. It is an unfortunate fact that some parents can't deal with a child who is "atypical" and this won't be the last time I encounter a situation like this.

On the other hand, there are some parents who are total rock stars and stay with their child for the duration of the treatment (sometimes for months at a time), who learn all about the diagnosis and treatments, who rally behind their child and support her/him all the while trying to hold their own shit together. It's an amazing thing to see and I think it's what I'll miss most about pediatrics. But for now, it's back to adults and all the challenges that come with treating them. I'm hopeful that this will be a good rotation.

Hater...part II

Wow, straight off of the whole financial aid pain-in-the-ass-ness and here I am being subjected to automated call center hell just so I can make an effing doctor's appt. Whatever happened to just calling the doctor's office and making an appt. with a human being and being off the phone in, at most, 2 minutes? Gah. I hate everything.

8 minutes and 37 seconds later I have made an appt. It seems like sometimes advancing technology creates more work and takes more time to complete a task than just putting a schedule book in the hand of a single human being at the other end of the line. Durr.

Tomorrow I'll find something nice and wholesome to say about, I don't know...something.

Hater...

I hate you, FAFSA. Hate. You.

The end.

Procrastination nation...

More like procrastination household but I love me some Stphn C0lbert. There are a million things I should be doing right now but I'd rather sit here with my coffee and the internets instead. I should be making appts with the dentist and GP, calling the stupid FAFSA office about my pin, calling financial aid at school, sorting mail, shredding credit card offers we don't need, running the weed whacker, buying some tomato stakes from Lowe's Depot, doing a hundred things for school, call for an appt to get the oil changed and the tires rotated on the car...you get the picture. Serious life maintenance + school work = a crapload of things to do. And now it would appear that I may be coming down with a sinus infection which will throw a monkey wrench into my plans to get it all done. Durr.

In other news, the pediatrics rotation is coming along. I absolutely hated it the first day because I didn't feel in the least bit competent to do my job but it's gotten better. It's just a very overwhelming rotation. Not because you're taking care of sick kids (let's face it, the only healthy hospital stay involves maternity) but because their ages vary, their parents may or may not be present, their parents may or may not be really involved with the kids' care, vital signs are different at different ages, med dosages have to be calculated and at this hospital, the place is overrun by residents and their attendings so there isn't much elbow room. You have patients who have been on the ward for weeks and months and some who just pop in every now and again. There are a lot of congenital disorders and chronic diseases and it's a lot to remember. Honestly, I just don't know how MD's do this. So many signs and symptoms can be indicative of so many disease processes and they all manifest differently in kids. Hell, vomiting and diarrhea alone can indicate umpteen conditions.

For now, tho, I'll spare you the sad stories. You can go over to 6YearMed for that. There are some uplifting ones as well but I need to hang on to those for myself. As with any hospital experience, uplifting and happy moments are like gold.

It's a shame...

That we don't treat our adult patients the way we treat our pediatrics patients. The pediatrics floors are brightly decorated and there are murals and pictures and scales that look like rockets and giraffes and there's so much effort put in to making a stay at the hospital seem less scary and more fun. And yet, we don't do that for adults. There are far more adults in a hospital setting with bland, boring walls that blend into white tiled floors and seemingly little effort put into making an adult floor more appealing. I think it's wonderful that the peds floors are so nice but what about the adults?

That was a fast 5 weeks...

Well, my maternity rotation is over and now it's on to pediatrics. Tomorrow is my first day on a new ward at a new hospital at a new time and at a place where there is no street parking on weekdays and a parking garage that costs $24/day. On the other hand, it only slightly interferes with my tennis schedule but leaves me free to worship at the church of Kelly on Sundays. Why, hello, leisurely breakfast with Michael and the Sunday Times and a trip to the market followed by tennis and the remainder of the afternoon spent in my backyard. How I've missed you.

Anyway, maternity. There are lots of good things to be said about my rotation but seeing the birthing process from start to finish was not one of them. Durr. It was a great hospital and the labor and delivery nurses were awesome. The midwives were awesome. There just weren't any women in stage 2 labor while we were there. The darned babies would always come out at like, 3 am or 5 am or something. You know, when we weren't there. Seriously, I was about to stand on the street corner shouting to pregnant women about eating some indian food for dinner, having sex with their partners and then coming to us in labor. I don't even know if eating indian food works, but whatever.

Overall, it was good. It was a really different experience to work with women and their families and the fact that there is a constant rotation of patients is nice. There were always new moms and babies when we were there unlike in med-surg where we saw patients who were there before we started the rotation and were still there when we left 10 weeks later. And while there was poop, it was meconium and it came out of the behinds of tiny babies. And let me tell you, it's a lot easier to wipe poop off of a baby than an adult. But that meconium? Yeah, it sticks like crazy to skin. That stuff is like wallpaper paste.

But it isn't always sunshine and rainbows. There are lots of ethical dilemmas and internal conflicts to deal with. Like the 16 yo who already has a 2 yo and encouraging her to breast feed even though she doesn't want to. Internally, you're thinking "dear god, put that girl on Depo, stat!" and you're also thinking "breast feed!" Here's the thing: studies support the "breast is best" idea but it's not for everyone. But just trying it is so important even if it's only for a few weeks. My job is to support mom in whatever her plan is but it's also my job to educate mom and encourage her to breast feed. If she's got her mind made up to bottle feed, well, so be it. If she's on the fence, it's my job to help her decide what will work best for her and the baby. But it doesn't always work out and formula is a nutritionally-adequate substitution. Did I mention the support thing? That's always the most important part.

Then there are the other issues: sending a baby home with parents who may or may not be fit to parent (CPS and the hospital social workers make these decisions but the nurses and MDs alert them based on certain evidence); adolescent moms; moms with histories of spousal abuse. Those things are hard to deal with but all we can do is act within our capacity, alert the authorities when abuse is suspected or evidenced, be supportive and keep our mouths shut re: everything else.

In L&D, you have those issues but also the labor and delivery part. The hospital where I was stationed is great if you want the natural childbirth experience. Laboring women are not on a time clock and the staff are super supportive and let you do your labor thing. But sometimes birth plans have to be pushed aside because of fetal intolerance and moms suddenly find themselves having an emergency c-section. And, man, those moms are pissed. This hospital has a 3% c-section rate and they're only performed if it really is necessary (not just b/c the doc wants to go hit a few rounds of golf on the way home). It's not like in the documentary that R. Lake produced (which was really good, btw). But there was a mom who came in 3 times during labor and 3 times checked herself out against medical advice because she really wanted to have a home birth and did not want the emergency c-section she needed and...ultimately her baby died. She finally agreed to the c-section but the baby had been in distress for so long that she died 3 days later. It's really, really sad. But it goes to show you hard this can be sometimes. You really want moms to have the childbirth experience they want and deserve but sometimes it can't be the experience they planned and hoped for.

But I don't want you to think that maternity is a huge downer experience because it's not. It's a wonderful and beautiful thing to watch families get to know their newest additions and to help moms prepare for going home to raise their babies. And those babies are just precious. It's a privilege to be a part of that experience and maybe someday I'll be back as a maternity nurse. For now, onward to pediatrics.

Feeling irrational...

When I tell you why I'm feeling irrational, you'll undoubtedly laugh but this is something about which I am very upset. I got a B+ in maternity. A B+. In my book, a B+ is practically an F. An F- at that. Effe menos. This is the lowest grade I've gotten in nursing school and it kills me that I didn't get an A. This sucks. I'm going to go stew in my irrationality and have something with alcohol in it. Boo.

I need a break from the internets...

Because if I see one more effing headline about J0n & K@te I am going to throw my laptop and myself off the roof of my house. Okay, maybe just the laptop. See, the roof isn't that high up and I'd probably just break an arm or a leg and that would be unfortunate. But, seriously, I can't take it anymore. Even my beloved Salon has featured stupid headlines about these people. So, if you don't see me on the internets you'll know it's because I boxed up my laptop and buried it in a closet. Someone please call me when it's over and it's safe to surf once more.

Picture time...

We finally got a new camera and we finally uploaded the photos taken thus far. Not that we take very many. That's bad. And we really do need to branch out beyond pics of the dog. Just how many photos of the dog do we need anyway?



Isn't she cute?



Cherries! In my backyard! Now, how am I going to reach those?



Crazy-looking plant from the backyard. Anyone know what this thing is?



Tree? (Come on, I had to. Even if I didn't want to, you all would make me do this for the rest of my life. Also, I don't know what the hell that baby head thing is--there are 2 at the front entrance of Boston's MFA.)

No babies!

There were no babies to be born on Saturday night and I'll admit to being disappointed. There was one mom in L&D but she wasn't in labor; she was being treated for a kidney stone. There was one baby in the nursery and only one post-partum mom would allow a student to provide her care. Durr. A wasted evening at clinical.

That being said, there is no schedule for babies and it's either feast or famine, as they say. Unfortunately the famine seems to occur during our clinical hours and the feasts occur at 3 am after we're gone. Also, it's unusual for a patient to refuse student care so there we were doing a big group study session in the family waiting room because there was nothing to do. Maybe this coming weekend?

That's all that's exciting in my life. Hoping to see a birth, studying for exams and the usual life maintenance. And tennis. Lots of tennis. Did I mention that I beat Michael twice?

You know what's funny...?

Being asked to address "sexual activity of the pregnant woman and her partner" (male in this case) on an exam and having to list sexual activities on the test. Yes, that's right, I had to write down sex positions on an exam. How many people can say they've done that?

The other funny thing is that our maternity book provides little pink and blue figurines in sex positions to provide a visualization of the position. Hi-larious. Even better than that is in our geriatrics book there are color illustrations of the elderly getting it on (this is in the coping with the aftereffects of cardiac events chapter). It's like it's straight out of the J0y of Sex. Full on nudity, I tell you. They're really funny, too, b/c the man always has his hand on the woman's breast no matter what position they are in and both their eyes are always closed; they look like they're asleep. Older people have active sex lives, as do pregnant women and their partners, but it's just so amusing to have it laid out there so explicitly in a text book. It's like the kama sutra issue from C0sm0 but for pregnant women.

Springtime explosion...

It's very much springtime here and headed quickly toward summer. The trees are green, roses are blooming and grasses are starting to turn "golden" as the state motto goes.

The produce at the market is once again bountiful and delicious but my daily allotment of time to spend in the kitchen has been overtaken by school as usual. Still, I'm finding time to try new recipes per my "try 3 new recipes a month" goal. So far this month I made caramel chocolate matzah crackle and mock spanish rice. Next up will be this yummy quiche. What's not to love about hashbrowns and a cheesy quiche all in one dish?

As for gardening, I have purchased a bit of everything in the herb department and will be transplanting everything later this week into a large pot. I also have some tomatoes and a pepper plant to transplant. Unfortunately I already killed the cilantro. Don't even ask me how I managed to do that. Unlike Alissa, we don't have bunnies around here to eat our veg but we do have a rotten brat of a dog who likes to tear around the yard like a maniac and I swear to Ogg if she touches my potted plants I'm going to sell her to the monkey house.

I'm excited to note that our cherry tree has actual cherries on it and I can't wait to pick them. Most of them are out of reach so I'll have to enlist Michael to do the picking. Our landlord told us that peach trees only bear fruit every other year so we should get peaches this year. I'm not so sure about that since the tree looks a bit sickly but who knows? I'm no expert on fruit trees so we'll see what happens. I'm been thinking about buying a citrus sapling but haven't decided which would be best. They're not cheap and I don't want to buy more than one at this time. What do you think: lemon or lime? Lemon is good for fish, garnishes, lemonade, yummy desserts like these lemon bars, hummus and well, almost anything but limes are good too. Limes for guac or spritzing over mexican dishes or limeade. Maybe the lemons would be better?

First day on the maternity ward...

Admit it. You're here to find out about the babies, aren't you? I must tell you: they are cute. Precious, in fact. Wee bitty things that you want to munch on and smell their little baby smell. It's true. Those tiny feet and that hair that reminds me of the baby ducks Judy used to hatch in her kindergarten classes. OMG, total cuteness.

But first, the hospital. It's a small facility in the Mission but has free parking in the garage on weekends (score) but the cafeteria is closed on weekends (which is either good or bad depending on how good their food is). The nice thing about weekend night clinicals is that the traffic is generally pretty good unless there's a Giants game. What's especially nice is that this hospital tries to avoid medical interventions during L&D as much as possible and has a 3% c-section rate (c/s). 3%. That's totally unheard of. They do c/s if they need to but they don't permit scheduled c/s which I think is great. They have mostly nurse-midwives on staff but there are OB-GYNs around, too.

It's a nice facility and the post-partum rooms are relatively roomy and have a pull out couch for family. They do "couplet" care so the baby rooms with mom and the nurses care for mom and baby simultaneously. The NICU is a level 2 so really premature babies and really sick babies get transported across town to the other facility which is a level 5. There were 2 babies in the NICU this weekend and they were tiny. The nurses are nice and our clinical instructor is great. Also, this part of the hospital feels less contaminated by MRSA and C. diff than med-surg floors which was nice. I came home Sat. night and didn't even take a shower before going to bed. Normally, I'm in the shower within 3 minutes of walking in the door. Still, I never wear my scrubs in the house.

So, my assignment for the evening was to do the well-baby assessments. I assessed every newborn on the ward and changed diapers and talked to moms about feeding. Newborns are funny little things. They really don't like to be messed with and absolutely hate having their temperature taken. All but one of the babies was eating well and I changed some very wet diapers. I got a rather full meconium one just 2 hours after birth. Good lord, that stuff is sticky. And I managed to avoid being sprayed in the face. Did you know that diapers come with little lines on them that change color when the baby wets in them? What a brilliant idea! Except when the pee just runs up their backs it's kind of useless but still. I'd be remiss if I didn't mention that some of the adult diapers have the same thing. Which is nice for the same reason and allows you to preserve their dignity a little more.

This weekend I'm on post-partum duty so I'll be assessing moms for lochia and breast stuff. The week after I'll be doing a turn in L&D and NICU. I hope someone gives birth while I'm there but I have no control over that. Chances are I won't see a c/s birth but maybe. Either way, it's all really neat. They want us to do the teaching with the moms but for all the reading and classroom discussion on breast feeding, I still feel like I don't know what the hell to say. I know what I'm supposed to say but it seems so weird to teach someone how to do something I've never done before. Then again, I've had to teach someone how to clean his colostomy bag and I sure as hell don't ever plan to have one of those.

All in all, it was a good weekend and I'm looking forward to going back on Saturday. Stay tuned.

Back to the grind...

Spring break is officially over and it's back to school for me and my classmates. This session starts with 5 weeks of maternity followed by 5 weeks of peds and 10 weeks of research class concurrent with maternity and peds. My first clinical rotation starts this weekend (Sat and Sun 3-11pm - blarg, it's not the Sat night I care about, it's Sun. At least it's only 5 wks) so by Monday there will be an update on all those moms and babies I'll be seeing over the 2 days. At least the only diapers I'll be changing are those of the neonates.

I really am looking forward to a little change in curriculum. It'll be so nice to do a rotation where (almost) everyone is healthy and excited to be there. But seriously, this class is going to kick my butt. The amount of information we need is massive (I can hear the collective "duh" from all the moms already) and we are cramming a 15 wk course into 5 weeks. Jesus. Let's hope I can remember it all. Stay tuned.

Hefk, I'll be cognizant of where my badge is hanging at all times.

I've been tagged, too!



So, Gwen tagged me and she already tagged most of the people I would have tagged so I'm with Alissa and I won't bother tagging anyone.

"List 7 things that you love, and then pass the award on to 7 bloggers that you love! Be sure to tag them and let them know that they have won. You can copy the picture of the award and paste it on your sideboard letting the whole world know...you are Kreativ."

1. The way dogs look when they're asleep
2. Flannel sheets
3. The yummy way the house smells when I'm baking
4. Beating Michael at anything
5. Harry Potter
6. Reading a new cookbook
7. Fleece pants and fuzzy socks

Adventures in container gardening...

This weekend the local community garden had a plant sale and I availed myself of the opportunity to do a little gardening. I always meant to do this while we lived in Ohio but we had a problem with raccoons and feral cats so I never got around to it. Now we've got a yard but it belongs to the landlord so I won't be digging up the grass for a real garden. That leaves me with container gardening.

I got 3 types of tomato (green zebra, cherry and regular), 2 types of basil (broad leaf and lemon), parsley, cilantro and an aloe plant. Everything has to stay put for another week or so to mature a bit more (well, not the aloe) and then I'll transplant it all to bigger pots. I'd post a picture of the teeny plants I brought home but our camera is broken but hopefully by transplantation day we'll have a new one. Here's hoping I don't kill everything.

Heartbreaking...

I just cannot focus on the enormous amount of studying I have to do because I can't stop thinking about the patient I had last night. I was a assigned a 17 y.o. HIV positive male who was admitted for cryptococcal meningitis. He was no longer under contact precautions so I was able to go in his room without a mask, etc. (hallelujah for that one--I always have a pt with contact precautions of some sort). He's been in the hospital for about 2 weeks now and is expected to go home sometime next week.

When I first introduced myself he ignored me and the other nurses; he just played videogames until I needed to put a BP cuff and a pulse oximeter on him. He has a history of refusing his medication. Today it was one of the antibiotics he needs to take by mouth--2 of the 4 doses he needs to take in a day. He's depressed (and taking bupropion), stuck in the hospital and bored. And both of his parents are HIV positive as well.

I spent almost and hour and a half with him while he ate some of his dinner and took his meds. He was scheduled to take 9 pills at dinner and an IV injection of an anti-nausea medication. He says that the pills make him nauseous and he doesn't like to take them. He takes a lot of pills. A lot. He's on about 5 anti-retroviral drugs plus the other meds he takes. He said his mom takes her pills 4 at a time. He takes his one at a time over a long period of time. I got him to take 6 of them over the course of an hour and was waiting for the nausea to pass to give him the last 3.

We hung out and watched Mythbusters and the stupid show with the guy who shouts about laundry detergent. You know who I'm talking about. Anyway, we talked about school and videogames and tv shows and why he doesn't like vegetables. He's a nice kid, a good kid, and sometimes he acts like a pissy teenager because...he's a teenager. And maybe, if I were him, I might refuse my meds, too. He tells me just looking at them sometimes makes him gag. But he also knows what happens if he doesn't take all of his ART meds. We talked about the importance of that. And the nurses on the ward have 4 other patients to take care of and can't spend 1.5 hours hanging out trying to cajole him into taking his meds the way a student nurse can.

I got him to take 2 more ARTs before I left last night. I tried to get him to take the last one, the biggest one, the one that can't be cut in half or crushed and put into applesauce, but he was sleepy and didn't want it. But he took the antibiotcs and most of his ARTs so I'm pleased with that. It's hard to do this job sometimes. You want your patients to get better and often times that means just taking all of their medications. And a lot of them take a lot of meds. They're like walking pharmacies, these patients. But they have every right to refuse even if they're minors. But if they don't take their meds, you can't keep the disease in check and/or cure them. In this case, as we know, there is no cure. And he's walking a very fine line between HIV and progression to AIDS by not following the prescribed regimen. He's only 17.

I think I'm ready for a break...

From med-surg nursing at least. This school was a total pain in the arse to get into (b/c nobody returns phone calls or emails) but once you're in they really do take our feedback under consideration. Previous cohorts have done 20 weeks of med-surg nursing, 10 of which are spent on an ICU step-down unit (we won't be doing any work on the ICU--there's too many of us and not enough space and, good lord, those people have tubes and wires coming out of them like crazy). 20 weeks is a lot without a break. So our cohort is doing 10 weeks of med-surg and then we move on to maternity for 5 wks and pediatrics for 5 wks before going back to med-surg. It'll be nice to have a little break.

We're starting week 9 of med-surg and we've learned a lot to date. There's still more to learn but it's very difficult to get exposed and/or try all the skills we learn in lab for many reasons. For example, foley catheters (the ones that go in your bladder and stay there) have to be changed every 3 days. There are 10 students and maybe a total of 25 patients, some of whom may have a foley but many may not. Of those who do, they may not need a new one. And in some cases, it's okay to do something that's just been done for the benefit of learning but many times it's not feasible. For one thing, the waste involved is enormous. For another, the patients are not guinea pigs. But I would love to put in a foley. Maybe in maternity.

Last week I had my first colostomy patient. For all the joking about colostomies they're not funny to the patient. The bags look like those little bags of air that are used to prevent breakage during shipment of the goodies you ordered from amaz0n.c0m. Except these fill up with poop and gas and you have to go in and empty them out and, whew, it does not smell pretty (did I not tell you it was always about poop?). Still, it was cool to see. And you have to be cool about it b/c the patient is not happy to have one. I know I wouldn't be happy about it.

I also had my first experience with a combative patient. The doctors were trying to figure out what was wrong with her and in the meantime she became very combative. For a pretty small 88-year-old, she was strong and fiesty. It took 4 nurses to hold her down so they could give her a sedative before going for an MRI. She was kicking, yelling, biting and hitting; talk about surreal. And this behavior can occur as a side effect of a number of disease processes but it can be hard to deal with while you're waiting for the docs figure out the underlying issue. The pts have no idea what they're doing and if they did, they would be so embarrassed.

Anyway, this patient grabbed some papers the nurse laid on the bed and flung them (yes, she really flung them) right in the nurse's face and then while I held her down so the nurse could flush her IV, she looked right at us and just yelled right in our faces. And then she took a deep breath and telled some more. And...it's not funny. At all. But I mean to tell you that I was about to start shaking with laughter b/c of the un-funniness of it all. It's sort of like laughing at a funeral. Michael will remember how, at my aunt's funeral last year, I started shaking from head to toe from repressed laughter. The cause? My cousin doing a less than stellar version of "In the Arms of an Angel." I thought I was going to die from lack of oxygen. But, see? Not really funny. Except that it is. In a very inappropriate way. Ah, trench humor. This is how we're able to do what we do without losing our sanity.

Another first...

Today I experienced my first earthquake. It wasn't a big one--4.3 to be exact--and the epicenter was in the south Bay. I was at school when it happened. I heard a loud noise and the building shook a little and I thought "geez, someone must have dropped something really heavy on the second floor to make the building shake." Duh. Actually, I did wonder if it might be a quake but then I assumed it wasn't.

Anyway, no harm done but it's kind of surreal. My mom has been worrying about earthquakes since Michael accepted the job offer out here. That and wildfires, bears, cougars and, get this, tsunamis. We had to reassure her (multiple times) that there are mountains between us and the ocean so there won't be any tsunamis. You just can't reason with a mother who is looking for any reason to worry. You can believe I'm not going to tell her about this. Thank goodness she doesn't read my blog.

A new first...

I successfully put in a new IV last night--on the first try! I realize this probably doesn't seem like a big deal (maybe it does if you've ever had an IV put in) but this a huge deal for the nursing students. And I did it on a little old lady with tiny little old lady veins that roll around. Yay me!

Some resolutions. Ish...

Yes, I know it's the end of March. Like, 3 months too late for some resolutions. But, hey, this is about the time everyone else abandons the ones they made 3 months ago so it's not such a bad thing to start now, right?

This is a big year. A challenging year, if you will. I wasn't planning on any resolutions per se and I never got around to my own 31 for 31 list (I didn't do a 30 for 30 either but then 30 kind of sucked) but there were a few things I wanted to do and the only way to hold myself accountable was to publish them in a public-type place. Like the internets. Not the refrigerator door, not the bathroom mirror--the internets. So, here they are, in no particular order.

1. Make bread from scratch (no cheating with a bread machine)
2. Donate blood at least 4 times this year (can't do more it more than every 8 wks)
3. Try 3 new recipes every month
4. Do some container gardening...maybe some tomatoes, a pepper plant and some herbs?
5. Meet more of our neighbors besides just the couple next door
6. Do some sort of exercise (besides walking the dog) a minimum of 3 times a week
7. Try at least 3 new restaurants on Murphy Street (there's at least 12 and we eat at the same one every time)
8. Work on being more consistent with my tennis game
9. Hang pictures on the walls that do not feature any member of our families
10. Spend Christmas in Hawaii
11. Make this blog more aesthetically appealing (gotta have a stretch goal)

So far, I've given blood once (this morning, in fact) and I tried one of the Thai places on Murphy St. last week for Michael's birthday. Also, I met 2 other neighbors on Friday (Rick who lives across the street and 3 doors down) and Saturday (Paz who lives across the street). Next weekend I hope to buy some plants and begin my container garden. Any recommendations from the gardener extraordinaire? Also, suggestions for recipes and breads are always welcome as are travel tips re: Hawaii.

To my husband on his 37th birthday...


Happy birthday to my:

• biggest supporter

• honey do-er of everything that even remotely involves engineering or any other science or the use of his leatherman

• walker of the dog while I sleep in after a late night studying

• fetch-er of Chipotle when I just can't bear to cook dinner

• giver of awesome foot rubs

• total geek hotness husband

I love you. You're the best.

p.s. you smell like a monkey and you look like one too:>

Try not to lose...

That's commonly heard at my weekly tennis clinic when Mark has us doing drills. He'll put half the class on one side of the net and the other half on the other side and he'll tell us to play competitively and then he'll tell us try not to lose. Which is a different way of saying try to win. And while "try not to lose" and "try to win" are essentially the same thing, you want to win and not losing means winning, it's still a different mindset.

It's actually pretty easy to beat yourself by trying to overpower your opponent and then missing the final shot and giving away the win. Trying not to lose is something I need to work on.

Not really a big deal...

School, school, school. Blah, blah, blah. All the time, right? Yeah, boring. So I won't bore you with the latest and greatest in the land of incontinent older adults, many of whom have dementia and tell you they need to "go bim" even when they're already on the commode and have already gone "bim."

It's about grades and performance this time. This is a highly competitive program and none of us who are in it are "paying customers." You had to have seriously good grades to get in and you have to get better than a C in every class to stay in the program. And the curriculum is difficult not the least of which is due to the fact that this is an accelerated program not an abbreviated one. Yet, I find the work ethic of many of the students appalling.

Every week we have an exam or a quiz or some such thing do and a lot of the students whine about not wanting to study (hey, it's not like I live for studying or anything myself) and then they don't do as well on the exams as they would have liked. And then they commiserate about their grades and inevitably they ask what your grade was and my grade? Almost always an A. Which is good, I know. But, man, have I come to dread the day after the scores are posted and they look at me and my grade is only one of 3 A's in the class and they all got B's and C's. See? Not a big deal but it gets on my nerves after a while.

And on top of that we're doing med administration during our clinicals and that includes everything by mouth, nasogastric tube, topical application and injection (no IV meds until after we graduate) and all the people at my clinical site seem to want to do is jab people with needles. Yes, it's exciting and a little scary especially when you are administering something like heparin or insulin and it requires the signature of 2 RNs before you can give it but, sheesh, there's more to it than that.

There is just so much information to learn and so many things to be on the look out for and I always worry that I'll miss something. Sometimes I worry that my classmates aren't worried enough. Maybe it'll be different in another couple of months after we've all given loads of injections and it starts to become routine. It's like that saying about: what do you call the guy(or gal) who graduates at the bottom of his (or her) medical school class? Doctor. It's the same for us. And I don't know about you, but I want the goddamned valedictorian taking care of me when I'm the hospital.

Why my dog is an asshole...

Most of you have had the distinct pleasure of knowing me when I adopted Shana (maysherestinpeace - that, by the way, is on purpose and anyone up to date on the Terry Pratchett witch series will know that, right?) and will remember that she did horrible, unspeakable things like eat shoes and underwear; steal Thanksgiving turkeys; eat birth control pills; get in the trash (a lot); eat a tube of citrus face wash; eat fireworks and she got sprayed right in the face by a skunk. Oh, and she puked on a boyfriend once. Hee hee!

Normally Esme doesn't give us this kind of trouble but she seems to be channeling Shana's spirit these days and I'm seriously about to ship her off to the monkey house. She's been counter surfing and has pulled down a big loaf of irish bread, eaten half a bag of pizza cheese and one half of a ball of raw pizza dough (that one there cost us $325 in emergency vet bills, god) and on Friday we came home to discover she had managed to open the cabinets where the trash is kept and pulled out the trash can and all of it's contents and spread it throughout the kitchen and living room. She had gone after some chicken fat leftover from cooking off chicken for her behavioral training (might I add that this dog gets to eat organic chicken. Little rotter) that I wrapped in paper towels, wrapped in a plastic bag and placed in the bottom of the trash can. Not only did she eat the chicken fat-covered paper towels but she ate that little absorbent pad thingy from the bottom of the chicken packaging. That thing is wrapped in plastic and I'm pretty sure she ate some of it in the process.

I can't even begin to describe how pissed I was at this dog. Instead of having a date night with my dear husband, we spent the evening mopping the kitchen floor and steam cleaning our living room rug. Then we locked the little bugger in her crate and went out for Indian food and a trip to T@rget. So far she's passed the paper towels and we're keeping a close eye on her for any obstruction but I have to say: it's a good thing she's so cute or I swear I'd have FedEx-ed her back to Sarah, her foster person in Ohio.

'Til death do us part...

A lot of us have said those words as part of our marriage vow and even if you didn't say the actual words, you probably said something like that. And if you haven't said anything resembling those words to another human being yet you're probably planning to at some point.

In the state of CA, it is mandatory that a healthy aging class be taught as part of the nursing school curriculum. One our assignments in this class is to conduct 3 interviews with a community-dwelling older adult, so, someone aged 65+ who still lives in the community (but not in a nursing home). I interviewed Michael's tennis partner who is 69 and let me just tell you that Bob regularly kicks Michael's butt on the court. Also, they're playing at the 3.5 level which is relatively advanced.

During the course of my interview I asked Bob about whether he was married, widowed, divorced, etc. I knew he was living with one of the lady's who is in my tennis clinic and that they reconnected at their 45th high school reunion a while back but that's all I knew. But during the interview I got the scoop and discovered that Bob decided to divorce his wife of 42 years because he felt that he still had too many good years on this earth and wanted to be happy. The details of what precipitated this decision are few but he did mention that they had changed too much and didn't share enough of the same interests anymore.

Just out of curiousity I asked him if, given how long our life expectancy is now, if he thinks it's feasible to be married to the same person for the rest of your life. And he said no. And if it does happen, great, but what a rarity it will be. Being married for more than 10-15 yrs to the same person seems like a rarity these days. But it got me thinking about things. I said those very vows to Michael 3 years ago and I meant them then and I mean them now. But will we feel differently in 40 years? 60 years? We could easily live to be in our 90s and beyond and that is a long, long time of being with the same person.

Do I think Bob is right? Kind of. Marriage takes work and commitment no matter how long you're married but the thought of being divorced in 40 years is mind boggling. Clearly, this is not an issue we need to concern ourselves with right now but it's been on my mind since Saturday. Frankly, the whole thing makes me feel sad. And it's a reminder that you have to take care of your marriage and not let it languish like some half-rotted plant in the yard. But what say you, dear internets? In this age of longevity, is it feasible to be married to the same person until death parts you?

You're just dying to find out...

about the crazy things people stick up their butts, aren't you? We won't be doing a rotation in the ER anytime soon, and that's where those stories originate, but here's another example of something you don't stick up your rear: a dowel rod.

One of today lectures (well, both actually) talked about bowels (yes, again) and disease, etc., and our professor shared a story from his days as an ER nurse. A man came walking into the ER looking as if he just got off a horse, you know, crab walking. That's your first sign that something is not right. So, they do an xray and discover that he put a wax-coated dowel rod up his bum and it got sucked up into his large intestine. When that happens it often requires surgical removal. This is very much like the guy many of you heard about who stuck a big vibrator (including the testicle part) up his bum and he used a fork (yes, a fork) up there to dislodge it. In case you were wondering, the distal end of your GI tract has 2 sphincters and once you get something past your internal anal sphincter, well, it's gone. It's called the point of no return, people, so you better be damned sure that you don't stick anything up there that you can't get out. This also goes back to my own personal theory that your rectum/anus is in "out" hole not an "in" hole but that's just me. If you don't subscribe to that theory, that's cool, just practice good hygiene and never, ever use analeeze. You can hurt yourself without realizing it due to it's anesthetic effects.

Anyway, both patients required surgery and a temporary colectomy while the bowel healed. That means that they close off part of your bowel and then create a new anus by connecting the bowel to a hole in your abdomen thus giving you a place for excrement to, um, excrete. You attach a colostomy bag to the stoma (that's what the artificial anus thing is called) to collect your excrement until your bowel is healed and is then surgically sewn back together. Often this is a temporary arrangement but sometimes it is permanent in cases like colon cancer, etc.

So, my other theory is that no one wants a colectomy and there are ways to prevent needing one unless you get cancer but, hey, that's what sigmoidoscopies are for, right? And lots of fiber, but I digress. I think it should be a requirement that there should be a brief lecture during high school health class on sticking things up your bum. If you do it and something gets "lost", you should just take yourself to the ER right away and not try dislodging the item with a fork and, really, if you're going to stick something up your bum, make sure you can get it back out. Then there needs to be a talk about thorough cleanliness and hand washing. Hee, you can bet that parents don't want me running for school board...

How was it?

Well, the first day on the ward was brief but good. I'll spare you the gory details but the patients we saw included:

1. An agitated bi-polar woman with a tertiary wound and hemovac drain. She was in pain and unhappy and not very nice. But then, if I were in pain, I might not be very nice either. She was mean to all the nurses including the wound specialist. Unfortunately, we didn't get to see her wound.

2. A homeless man with a femur and tibial fracture who didn't smell so good. Also, he was still in his clothes and not a hospital gown. He wasn't wearing underwear. Don't ask me how I know that. I asked the nurse how he hurt himself but she didn't know. She says that when the homeless come to the hospital they've usually been hit by a car. That makes me sad.

3. An older gentleman who had recently had a laparoscopic cholecystectomy (gallbladder removal). We almost got to observe the insertion of a foley cath on him but then he went and voided 4 oz of urine and the nurse decided he didn't need one inserted just then. Good for the patient but unfortunate for us.

4. Another older gentleman who was post-op for the removal of a melanoma and a partial parotidectomy. He was vomiting a bit and still fuzzy from anesthesia. Melanoma, ewww.

On Monday we got to hear about the experiences that some of the other students had. Some of them were on an oncology ward and most of their patients were not long for this world. A number of the students were caring for dementia patients. 2 students were working with a patient who died during their shift so they did post-mortem care (they wash the deceased's face and hands, do a quick shave of the face--basically they make them presentable for family). All in all, lots of different things to see and experience.

Also, there was more paperwork. Big surprise, I know. And the handwashing thing? Well, some were more lax about it than others. All I can tell you is that when you are in a clinical setting, your provider, be it nurse, doc, respiratory therapist, etc., should wash with soap and water or use alcohol gel when she comes into the room and leaves the room. If you are ever at the doctor's office or the hospital and they don't wash please, for your own sake, ask them to do so.

More soon!

First day! On the ward!

There have been many times that I've thought about taking down this blog. I usually don't have anything important to say and when I look back thru the archives (not often because, well, I sound like an idiot which brings me back to my point) I am amazed at how ridiculous I sound. I'm certainly not trying to find a cure for cancer or bring about world peace here. But I also know that if I take it down I'll never write in a journal either. I had a number of empty journals laying around because I could't bring myself to write in them. They have since gone to Goodwill where someone else can buy them and keep them around the house to gather dust. But somehow this blog seems like a reasonable medium to jot down some thoughts because sometimes people come over here to read what I have to say. And by people I mean Michael.

But I digress. Today is one of those days where I think it's important to make a note of what I was thinking. Today is going to be our first day of our first clinical rotation. Yesterday doesn't count because we filled out about a million pages of paperwork and took a tour of our new home for the next 9 weeks. But today. Today. Today is the day. And can I just tell you that I am scared out of my mind? They are going to let us do things to people and we are going to try not to kill them. I imagine that med students feel a little like this, too.

Of course we'll start of easy with checking of vital signs and all that but still. What if I look at someone wrong and he keels over? It's not like we're left on the ward by ourselves, certainly not. Our supervisor will be with us the whole time and yet it's scary. Our instructors have spent the last 6 weeks drilling ethics and protocol and liability into our heads because those things are very important but now we're about to put that stuff plus actual nursing skills into practice. This is scary. Very sick people are going to let us take their vitals, help them ambulate, help them use the bathroom, give them bed baths, give them meds and, just maybe, put in a few foley catheters and nasogastric tubes. !!!!!!!!!

So, dear internets, I tell you how scared shitless I am right now but when I go to the hospital today I will exude total confidence to the patients in my care. I will be friendly and will try not to let my hands shake nervously. I will wash my hands a lot and will hope they won't feel too clammy and cold. I will be careful and deliberate in my movements and will strive to be gentle when I have to adjust equipment or parts of the body. I already cut and filed my fingernails and removed my wedding rings and I'll remember not to wear perfume. Okay, deep breath. Wish me luck.

Justice?

Lately, you've heard about poop and shipping unused-but-in-perfectly-good-condition medical supplies so you've got the warm fuzzies right about now, right? Prepare yourself for a little downer...

The drunk driver who killed my aunt last year just 2 weeks after her 58th birthday was supposed to go to trial this week. Since then, the prosecutor, victim's advocate and my 3 cousins agreed to accept a plea bargain involving 10 years in prison and charges of DUI blah-dee blah but nothing about involuntary manslaughter. The judge has approved this so I guess this man, Travis Day is his name, is headed back to prison to serve out his 10 years.

No one asked me for my opinion, and it's irrelevant really, but it feels like justice has not been properly served here. I don't know all the reasons for accepting this proposal and I am not close with my cousins (regrettably) so I'm not in regular contact enough to find out what they're thinking but I'm thinking that this is not right. This man, by his own reckless actions, killed an innocent woman and he gets 10 years in jail and that's it? How is that okay?

Right now I could care less about overcrowded jails and long court proceedings and what would have happened if the jury let him off anyway--I care about justice and I just not feeling any right now. It's not like this reckless, drunk, repeat offender is someone who slid through an icy intersection and just, by accident, killed someone. No, he got drunk, drove on a suspended license and then rear-ended my aunt pushing her car into the way of oncoming traffic. The volunteer fire personnel on the scene told my mom that they were sure she died instantly. Small comfort, tho, for my mom, my grandmother, my other aunt and uncle, my cousins, their children and my aunt's significant other. Did I mention that her dog that was with her in the car was also killed?

Accidents happen, I get it. But while I'm sure he didn't wake up on December 27, 2007 intending to kill someone, he nevertheless got drunk and got behind the wheel. He caused an accident that could have been avoided. 10 years doesn't seem like a long enough time to pay for his crime. Is this guy sitting in jail feeling remorse for what he did? Does he even care that he killed someone?

Waste not, want not...

I don't know about you, but I really don't like to waste things. I try to recycle or repurpose stuff as much as possible and that means bringing home banana peels and plastic clamshell takeout containers to compost and recycle. I scrape out every last bit of peanut butter out of the jar and I will save 1 Tbs of milk just to use it the next day in my coffee. Yes, I am that person. I hate wasting things. And on occasion when I do I feel horribly guilty about it.

During the last 5 weeks, we have talked a lot about medical and surgical asepsis (clean vs. sterile) and that means going thru a lot of single-use products like gloves, syringes, cannulas, dressings, IV tubing, catheters, etc. In America, the land of plenty, there are often plenty of health care supplies around and manufacturers are getting rich off of the single-use products they supply because we want everything to be as clean and/or sterile as much as possible. And asepis is very important, I don't want to diminish that (some of you will recall that I sprayed Lys0l on the dishes before eating off them during a vacation to OCMD), but that approach to asepsis comes at a cost to our environment and our wallets.

Meanwhile, in underdeveloped countries and even some very rural portions of our own country, there are people who are reusing syringes and tubing by boiling them in water and sharpening the needles on a strap. Gloves are washed and reused until they're riddled with holes and then the fingertips are cut off and they're used for wound drainage in lieu of tubing. Often there aren't enough dressings to go around and wounds are left open to the air. In America, once a prepackaged sterile surgical set is opened it is no longer sterile so any remaining unused items are discarded in the trash. The wastefulness is outrageous.

Today, in lieu of going to lab, we went to MedShare. MedShare specializes in collecting medical supplies and equipment from area hospitals in GA and CA and ships them to underdeveloped countries all over the world. They also fund medical missions. An online database of the supplies they have on hand is kept and governments, aid groups, etc. can request a shipping container of the items they need for the discounted price of about $20K-22K, supplies which are worth hundreds of thousands of dollars. They only collect usable items that work (it's not a dumping ground for broken equipment) and their warehouse is full of hospital beds, walkers, crutches, lights, drapes, dressings, syringes, respiratory equipment, etc. You name it, they probably have it. They get so much stuff and this is from only a very small number of hospitals. I think they told us that in the 10 years of their existence they have kept over 1 million cubic feet of medical waste out of landfills. Really, it is amazing. Their overhead is very low; they are getting more support from health organizations by the day; they're being good stewards to those in developing countries while being good stewards to the environment.

So, for those of you who have made charitable giving and/or involvement a goal for the year, I invite you to send a little something to MedShare. I plan to give a little money and a little time. At the very least I hope you'll visit their website.

It seems like it's all about feces...

If you can't tell by the title that this post is about to err on the side of gross, well, you've been warned.

Ah, yes, poop. My favorite topic of conversation. So, for the benefit of those of you who are doomed to listen to me bitch about how tough this program is (you know, the one I so desperately wanted to get into) and for the rest of you who might be interested in what goes on in a nursing program, well, it can be summed up in one word: poop. Or feces. Or excrement. You decide which word you prefer.

So much of what I'm learning is about poop. It's about other things too like liability (scary!), teaching (fun!) , administering medication (also scary!), bathing (sometimes I'll get to delegate that one), assessment and diagnosis (nursing not medical) and, yes, toileting. And, yes, the poop.

The poop tells you so many things about a person's health status but also about their level of mobility. Even a perfectly innocuous discussion about pressure ulcers ends up with some chit chat about wanting to clean up diarrhea before it gets near the wound dressings. See? Poop. (Also, exudate and other perfectly nasty stuff involving pressure ulcers). Or, narcotics for post-surgical patients slows peristalsis and frequently results in constipation. Let's talk about how we treat constipation (also, you don't even want to know about fecal impaction and digital removal). During a health assessment, auscultate, palpate and percuss the abdomen and be sure to ask about the frequency and quality of bowel movements. Truly, we talk about poop at least 3 times a day 5 days a week.

Clinical rotations are going to be assigned next week. We'll be spending 10 weeks in a post-acute setting and will be spending a lot of time helping patients ambulate and assisting with self-care, toileting, etc. and I understand that poop will play a prominent role during this assignment. I assure you there will be more to share than just poop talk so stay tuned.

I know I talk a lot about poop but please know that nursing is so much more than bodily functions. Consider this:

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.

-Virginia Henderson, 1966

Procrastination...

I'm supposed to be editing my 3-page paper written in APA format that absolutely cannot be more than 3 pages but requires ridiculous requests of 1.5 left and right margins, paragraph headers and Times New Roman 12 pt font (which I hate, by the way) and cannot get myself motivated to do it. I wrote it on Sunday...and I think I'm just tired of looking at it but I know my professor is going to ding me if it isn't perfect (duh). I can't bring myself to care.

This has not been a good week so far and it's only Tuesday. The dog is being a pain in the ass and refusing to pee (she's also counter surfing and required a $300 visit to the emergency vet for x-rays to make sure everything she ate came back up), Michael and I are in the Land of Miscommunication, I have a ton of reading to do and I'm not getting enough sleep at night. So instead of finishing the essay, reading any of my books, calling Pam for an appointment to deal with Esme's misbehavior or sleeping, I'm surfing the internets and am in total denial about everything. Also, even tho it's not as cold as where all of you are, it's cold enough that my hands are too cold to type without making a million typos. I feel like I need something to help me clear my head and get back on track. I've tried exercise and yoga. I've baked cookies. I've had a beer. Nothing works. Maybe a bubble bath? A vacation? A million dollars? A game of Sn00d?

Ausculation, Palpation and Percussion, oh, my!

As Michael likes to point out I am 4% closer to my BSN as of last Friday. As you can see by the title of this post I am up to my eyeballs in all things health assessment related. It's exciting, fun, scary and amazing all at once.

I know it's been ages since I last posted but I've been busy, blah, blah, blah, right? Aren't we all busy? And depressed about the economy. But happy about the inauguration. And needing more sleep. But trying out yummy new recipes.

So, I'm 2 weeks into my nursing program and it is BUSY. Lots of reading, lots of time spent in class and lab, lots of time at home reading some more. It's really interesting and it's all stuff I need to know (duh) but it comes at you at such a rapid fire pace that it's hard to stay on top of it. We'll start our hospital rotations in 3 weeks. No word yet on where we'll be placed for the first one. I hope it's somewhere a little closer to home.

Michael and I are settling in to the new routine. I think the dog is just glad when we leave the house in the morning so she can go sleep on our bed all day. My scrubs arrived as have my shoes. My loan finally got processed just in time to do taxes and submit a 2009/2010 FAFSA. My stethi arrived and I've managed to avoid spilling coffee all over my white scrubs. Did I mention that they are white? As in head-to-toe white?

That's about it. If any of you lived closer I would force you to let me practice health assessments on you and ask about your bowel movements and whether or not you wear sunscreen on a regular basis. Then I would check your pulse and listen to your lungs. See what you're missing?!? That and some 68 degree weather (which is warmer than normal at this time of year but I'll take it).

Hope you're all staying warm and have your glasses raised in honor of our new president. Cheers!