Disclaimer

This site contains the highly fictionalized ramblings of a raconteur looking for a place in the medical world. The vignettes presented are cobbled together from various and sundry places.  Any resemblance to actual people, places, or events is purely coincidental.

And, I like to photograph things in lieu of words some days.

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Friday
Apr052013

Six Weeks

ACLS was like a cardio workout wrapped in a cardiology and neurology lecture with a healthy dose of stress and tense gluteal muscles. I learned a ton, which was, I suppose, the point.

We saved the coding patients. Well, most of them.

The shocker (pun intended) was how many RNs didn't attend the Day 1 class and refused to listen to the two nursing students that DID attend Day 1. We were told "That's not what we do" a few times by the "experienced" nurses. Then the coding patients died.

Funny that.

In the end everyone learned to trust everyone else. I suppose working in a true emergency setting that becomes the key.

I hope someday to know that firsthand. The trusting bit, not the coding patients dying bit.

Saw a ton of that in one of my former jobs on the tele unit...

---

My pediatrics rotation is over I wish it wasn't. I hope my final five weeks of Med Surg will bring everything into focus as the NCLEX draws nearer and nearer. Okay, maybe not focus. Maybe a blurry smudge. Certainly my noggin is a little more than foggy lately.

Nursing school is almost over.

I have way more exams in the next five weeks than I care to think about. Not really troubled by any of them, but there's a lot of ground to cover in our classes. There are papers to write, articles to review, chapters to read, and with the weather threatening to become nicer, my mind is wandering more toward the sunshine than the dinner table and endless piles of nursing books.

Good grief I have a lot of books.

And both Mad Men and Nurse Jackie are returning to TV. Eek.

Saturday
Mar232013

Seven Weeks

According to the ATI Comprehensive exam, there’s a 99% chance I’ll pass the NCLEX.  As awesome as that news is, I still need to get through the next seven weeks of school, which includes four more ATI exams; Peds, Med Surg, Pharm, and Leadership.  I also have five more class exams, a Peds, two Med Surg, another non-ATI Leadership, and a final math exit exam.  Oh, and I have an EKG presentation to prepare, resumes to draft, and a few other errata involved in school.

That’s a lot to do in seven weeks.  Oof.

I had ACLS Day 1 class yesterday.  We ran through the drugs, the algorithms, and a couple mock codes.  It was seriously no joke.  Playing leader really makes you realize how much teamwork is involved in running a code.  Combine that with my lack of experience in general and I was sweating buckets.  I suspect I’ll have to plan my outfit carefully for next week’s Day 2.

I’m officially on Spring Break.  But there’s not really much time for either Spring nor a break.  With all the exams looming, and ACLS, I’m basically going to be sitting around the house with my nose in a book, or an online exam for the entire week.

Maybe a glass or two of wine here and there with lots of home cooked meals.

All in all a good thing I think.

The other night I spent some time with a former instructor from my school.  He’s a pretty great guy that I met socially.  He was’nt working there while I was in the program, but we’ve become friendly and shared a few cocktails the other night while chatting.  He’s been an RN for many years and holds quite a few certifications across many different specialties.

He told me flat out I need to work in an ICU.  It’ll give me the full assessment and broad nursing skills that will open every door.

It makes sense.  I worry about going directly into Peds.  I love kids, especially the chronic kiddos.  I love the people that work in pediatrics.  But I also worry my options will be somewhat limited as a new grad with a two-year degree.

The remainder of school seems like it’ll be a breeze compared to entering the job market and finding a position.

It keeps me up at night.

Friday
Mar152013

Eight Weeks

Lest you think it a time warp, I realized that I was not counting my weeks properly.  There are eight weeks left until graduation.

!!!

---

My program has decided, in their infinite wisdom, to give us our final ATI Comprehensive exam TODAY.  It's pretty much a mystery to all of us why this is being done so early when we have eight weeks of school left.

The mysteries of nursing school.

I have yet to hear from a single RN that didn't have lots of complaints about their nursing education.  Everyone has stories, everyone has good things to say about friendships and great teachers, but my informal survey of, say, 60 RNs, proves to me that they are all unhappy with their programs because of disorganization and communication problems.

Double-u Tee Eff?  Aren't we supposed to be nurses, a profession that should be at (or near) the top of the organization and communication heap?

How come it's such a nightmare, this nursing education thing?

---

Had the chance to do some observation at the child development lab at school.  It's basically a preschool focused on preparing the 3-5y set for kindergarten.  Lots of our peds work is focused on growth and development, so it was cool to see how on point the educational materials and toys were in the classroom.  Even cooler was a child-development student also doing observation, so she helped guide me through some of what was going on.

However, the impressive bit was the teachers.  Sixteen little kids, two teachers, and a whole lot of situational awareness.  They were multitasking every moment of the day.  Are there the right number of kids in each play area?  Is someone shouting and needs to be gently corrected to use their inside voice?  Did you wash your hands?  How many syllables in your name, let's put that on the name board.  How about you grab a smock so you can paint?

They were omnipresent in the room.  Blew my mind.

At one point we walked the kiddos over to the gym to have some time to run around and blow off a lot of energy, perfect for the age ranges.  They ran back and forth, played with balls, crawled in the pop-up tunnel, and then the teachers changed the pace a bit.

And then I almost cried.

The kids were told to line up at one end of the gym.  The teacher stood in the middle.  When she said "Go!" they were supposed to run from one side to the other.  At about the halfway point she shouted "Freeze!" and they had to lay down and stay absolutely still.

Most of them did it well.  But the kids that still squirmed or still had their heads up were scolded a bit harsher than I initially expected.  For a moment I thought it was just a game.  The teacher had them run some more and freeze some more, each time correcting the ones still moving a bit forcefully.

The child-dev student and I were watching the whole thing from the bleachers.  I leaned in to ask her if she thought the teacher was being too harsh.  She turned to me, looked me right in the eye, and told me that this wasn't a game.  It might have seemed like a game to me and the kids, but this was safety training.

"This is what they'd tell the kids to do if someone came in the school and started shooting."

The hair stood up on the back of my neck.  I could barely breathe.  I think I opened my mouth a few times but nothing came out.  Here was this group of adorable, healthy little ones running around giggling and laughing, and in reality they were training for the worst case scenario. 

I excused myself and went to the restroom to splash some cold water on my face.

---

I've seen people, old and very young, die.  Sometimes it's a good thing, sometimes it's bad.  I've had great people around me to teach me how to deal with it.  Guess I'm lucky in that respect.  It affected me every single time it happened, and I think it will continue to affect me, but in the moment I've been able to deal with it, move the emotion to the side, and get my part of the work done.

Never once did I ever think we'd have to teach kids what to do if a gunman came into their school.

Just the thought of that hit me in the chest like a ton of bricks and shut my brain down.

We need to pay our educators way more than we do.

Way more.

Thursday
Mar072013

Eleven Weeks

Last Friday I went to the opera.  I’m a big fan.  The costumes, the stagecraft, the orchestra, the voices, it’s all the top of the top at the opera.  Chicago is well known for the Lyric Opera company, and the Civic Opera House is a stunningly cavernous space.  Through a program that allows full time students insanely discounted tickets, I’ve had the chance to sit on the main floor twice, a treat I’d only experienced previously when a friend took me to see his wife performing in Die Zauberflöte.

Rigoletto by Verdi was on the bill.  I’d managed to get a matinee performance, which meant I found myself seriously bringing the mean age of the audience down.  My father likes to collectively refer to any group of senior citizens as “the blue hairs” and indeed, I was smack dab in a crowd of them.  That’s neither here nor there really, except to say that a more balanced crowd age-wise generally brings louder clapping.

My hands hurt just a moment into the curtain call.

Giuseppe Filianoti was everything the duke should be.  Sexually driven, a touch heartless, and a soaring tenor.  As he strode around in the first scene, his open robe billowing in the breeze, his legs should also get some credit.  Le woof.  Andrzej Dobber’s Rigoletto was filled with disgust for his position in court one minute only to change on a dime and sweetly proclaim his fatherly love for his daughter Gilda.

Gilda.  Albina Shagimuratova.  A crescendo performance.  I know Rigoletto.  My love of opera began with the works of the the Italian compositori, and Verdi is close at heart.  Shagimuratova took us on a journey, THE real journey of Rigoletto in my opinion, that I won’t soon forget.  I’ll spoil it now, she dies at the end.  But before she does, we hear her move through many grand emotional journeys; innocence, love of family, love of another, betrayal, the fear that the love of her life will be killed, and her swan song.

Coloratura sopranos in general amaze me.  Not that the mezzos, contraltos, or even the men are boring.  Hardly.  But the coloratura soprano has some of the richest musical passages ever written.  They can soar through the skies with musical ornamentation, drift sweetly back down to earth, or dig deeply with rage and fury when called upon.  I constantly find myself gasping and holding my breath when they sing.  Theirs is the highest, purest form that steals me away to that land of opera.

Shagimuratova truly took me to that place every time she was on stage.  At the close of the final scene my face was damp with tears.

One month to Mad Men.

Two months to graduation.

Three months to NCLEX.

Hell of a ride ahead.

Wednesday
Feb272013

Twelve Weeks

Let me tell y'all, peds ain't no joke.

Or to say it another way: Holy Mother Of All That Is Holy there's a lot of ground to cover.

My teacher is the kind that insists on the class writing case studies and presenting them.  I'm not opposed to that style of class, just offended that I have to listen to a bunch of people uncomfortable with public speaking.

Which, if you are going to be an RN, is a Bad Thing, but not a Very Bad Thing.

I'm not a shy guy.  I did live radio in Chicago.  I've spoken in front of thousands in a stadium before.  I've hosted public events.  I'll keep bragging until you realize that public speaking gives me mental wood.

HOWEVER, there are many people who are deathly afraid of an audience larger than three.  I get it.  I hope they'll get over it, but I get it.

I'm not sitting in a Communications 210 class.  I'm sitting in my final semester of nursing and have to deal with awkward speakers.

It's just not the time for it.

/End Rant

 

---

Our first clinical day at the peds chronic intermediate care facility was yesterday. 

During pre-conference, as our instructor warned us about how very ill the children we were about to meet would be, I could see the looks of dismay and sadness on some of my friends faces.  We were told some of the kids can't respond.  Most of them aren't vocal.  Many are trached and vented.  There is little to no hope of recovery for many of their conditions.

Yet truly, moments after we arrived in the nursery, every single one of us was smiling, holding a baby, or off playing with one of the older children.  In the blink of an eye, we were all loving the kids with everything we had. 

I, too, fell in love with every single kiddo.

We suctioned trachs.  We re-attached vents when the adorable babies pulled them off.  We held the little ones, we watched movies with the teenagers, we passed g-tube meds, and we helped wash, position, and care for the  children.

But none of it was care.  It was Care.  We Cared for them.

Chronic kiddos are magic.  Theirs is a world of tubes, procedures, a life in a clinical setting, and more physician visits than the elderly, yet their families are larger than ours.  Way larger.  And, dare I say, full of people who love them.

Every single person who worked at the facility considered the kids members of their family.  The love was limitless.  And the kiddos loved us right back in whatever way they could.

It's odd to say that.  It's odd to speak about love in healthcare as part of the client relationship.  But the children I met yesterday were so obviously loved by everyone around them I can't choose a different word for it.

There was no time for sadness the entire day.

In fact, in a quiet moment when I was in the med room with one of the staff RNs, I mentioned how happy the entire place was.  She put down her clipboard and looked me dead in the eye.  "The only time it's sad is when they leave."

I didn't dare ask what she meant, but I understood.

I think I found out where I want to work. 

 

Thursday
Feb212013

Thirteen Weeks


I'm on the road to getting my ACLS certification with a friend from school. The prerequisite for sitting for the two day class is an EKG overview, which we both took last week.

In the short span of eight hours, the little and big bumps and squiggles on pink checkered paper went from a mystery to a somewhat less than mystical. It was a pretty amazing class and I'm happy to have it under my belt. After briefly peeking in the ACLS book I realize just how much prep I'm going to need to do for it.

But first things first.

My gero rotation has come to a close and I aced the exam. I find it strange that we have a gero section of the program because the entire first year we had only gero patients. But hey, I didn't design the curriculum.

We've now moved into peds. Cue blood-curdling scream.

I'm not sure what it is but the growth and development stages just aren't sticking in my head. Rote memorization is where it's at, which I'm not a fan of. But hey, this too shall pass right? Our first eighty page (yes, eighty) homework is due on Monday and I'm fairly terrified. But I shall triumph with a combination of green tea and chocolate at my side.

My peds clinical will be set at a chronic care facility in the city. Vents, trachs, and g-tubes. Some folks have already expressed a distaste for such things, but I honestly love chronic kids and their families. The limited experiences I had with them at my previous job were always magical. Those parents are angels on earth. Truly.

---

As graduation comes to a close, I'm trying to do as many practice NCLEX questions as possible. The biggest and best resources I've found so far are the Reviews and Rationals series by Mary Ann Hogan. They offer the books on a wide variety of subjects and the rationals are magically educational.

Book content is pretty dry. It's a list of bullet points and key terms. More of a review of what you may have learned instead of a learning tool. Of course there are bits and bobs along the way I've picked up from them, but really it's more like helping me recall what was covered.

The other brilliant learning tool, as silly as it seems, is a series of three cartoon books by JoAnn Zerwekh called "Memory Notebook of Nursing" Volumes 1&2, plus a Pharmacology and Diagnostics book. They are cartoons that, for whatever reason, seem to help me remember concepts. A number of them are based on mnemonics e.g. ROME for ABG interpretation (Respiratory Opposite, Metabolic Equal) but some are full maps of a disease process, nursing assessment, diagnostic tests, nursing interventions, and expected outcomes. A great investment if books are your thing.

---

Thirteen weeks. Geez.

Sunday
Feb102013

Fourteen Weeks


Over the course of the next fourteen weeks I'll be taking more exams than I care to mention. My peds rotation is just around the corner, followed by my final five weeks in med-surg.

Then I graduate.

Then I take the NCLEX.

Ohholyshit.

So many of the RNs I've spoken with tell me that time flies in nursing school. I didn't think much of it at the time but they are so spot on it's scary. It feels like I've literally flown through school at light speed. Perhaps the most amazing part is how much I've actually learned. I'm not trying to toot my own horn, although if I could I'd never leave the house *rimshot*.

The odd sensation of knowing how much I don't know keeps creeping into my head. I'm convinced it's part of the process of learning how to become a nurse. Maybe that's just the safety stuff they drill into our heads all the time. Or maybe it's just my personality. But I know what I don't know. And I know what I know.

The other day I was getting report on a patient typical for our gero rotation. Lots of comorbidities, on dialysis three times a week, not medication compliant. The RN was rattling off the details as I was trying to put together a picture of the patient in my mind. Not a physical picture (although sometimes details like that are relevant) but more of a head to toe systems assessment. I like to arrange it sort of like this:

CC, Vitals, Neuro, Resp, CV, GI, GU, Skin, IVs, the admitting DX, and any timed meds/procedures etc.

I walked in, met the patient, and started to do my head-to-toe when suddenly it all clicked. The "picture" I'd built up in my mind was actually right there in front of me. There were also a couple things I'd never seen before and didn't know much about. So I assessed what I could, grabbed my teacher a few minutes later, and learned a couple new assessments.

A year ago I was worried about vitals and lab values and med dosages. I still think about those things, but that person laying there, that complex mix of systems that all work together, that's what I think about most now.

Call it an epiphany, call it a milestone, call it whatever you want, I'm different now.

And this is just the beginning.

Saturday
Jan052013

Sixteen Weeks

Sixteen weeks stand between me and finally graduating nursing school.  I honestly haven’t felt the need to write about it because every time I tried all that came out were complaints and sadness.  Not complaining about the program, which I love, complaining about healthcare and the horribly wretched sadness that tends to descend upon the elderly and those in desperate need of quality mental health.

It’s really bad out there.

But let me bring you up to speed.

I’ve quit my job.  I actually quit working at Big Hospital for Kids a while back because I knew my second year of school was going to be brutal.  It was.  I studied damn near all the time.  The little bits of free time I had were spent with my family or my friends, decompressing from all the classroom and clinical setting overload of information.

There really is a hell of a lot to learn in nursing school.  And a lot of hell involved in learning.  Especially in your mid-thirties.

Five weeks each of Med-Surg, Psych, and OB taught me a lot.  I’m scoring well on my NCLEX prep software in those areas, but there’s still so much more to go.

Psych was interesting.  I don’t think I can say for certain I never want to be a psych nurse, but I’m pretty sure that’s not the field I’d like to go into.   I hated being locked in the unit as a student nurse with no keys of my own.  Nothing terrible happened and indeed some fun stories came out of the rotation.  It’s just not my thing.

OB was, well, I got to flex my Spanish speaking skills quite a bit more than I’d ever done before.  Doing a full postpartum assessment in Spanish pushed me right to the edge of everything I’ve known medically and linguistically.  By the third time it was easier and I wasn’t sweating nearly as much.  But it still took some really tricky focusing on my part.  I know my future in this city will include lots of Spanish speaking patients.  Better to practice now.  

However.  I was not a fan of all the waiting.  OB and LD are feast or famine.  Either everything is peachy keen or it’s hitting the fan.  Not to mention the medicalization of birth is a pretty extreme reaction to such a natural process.  Humans have been birthin’ babies for a long time.  It’s pretty twisted what we do in the hospital these days.  It’s not the kind of nursing I’m interested in, but I’d choose it before I’d choose Psych.

Med-Surg handed me a ton of CHF and dialysis patients.  My assessment skills are sharpening, but they’re still rather dull.  Sort of like I know what I’m supposed to look for but I’m having the damnedest time figuring out if what’s right in front of my nose, under my hands, or in my stethoscope, is actually the right or the wrong thing.  Time will cure that but I know I have a long way to go.

And what’s the deal with absolutely everyone having a radically different definition of 1+ 2+ 3+ etc. pitting edema?  The only thing I know for sure is giant legs are giant legs.

My Med-Surg teacher was perhaps the most amazing lecturer I’ve ever had.  She was funny and engaging, smart as a whip, and a long time Emergency Department nurse.  I genuinely like ED nurses.  Scratch that, I LOVE ED nurses.  Assessment, intervention, result.  Boom.  They have some pretty amazing autonomy as part of their toolkit.  They think like that as people too.  They teach like that.  It’s pretty rockin’.

Inspiring.  That’s probably the best word to describe her.  I want to be like her.  I want to know the things she knows.  I want to understand medicine and the body the way she understands it.  I want to be able to answer questions the way she does; concisely and directly to the level of the questioner.  And she does it all with a smile and a joke every now and again.

We covered a ton of material in her class yet I feel like I retained more from her than anyone else.  In fact I have listened to her lectures quite a few times since class ended.  It’s good stuff.  Looking forward to having her again this coming semester.

So that’s school in a few paragraphs.  Ahead of me is another Med-Surg rotation, a Gerontology rotation, and a peds rotation.  A huge handful of exams every couple weeks, some performance exams, and a Leadership class.  All in sixteen weeks.  Then I take my NCLEX.

And if I pass, I try to get a job as a nurse.

And thus the great question looms in my head…

What kind of nurse do I want to be?

Thursday
Sep062012

Jefferson Park

Tuesday
Jul242012

Marina City