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.