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.

Search
Wednesday
Dec212011

Old Town Alley

Thursday
Dec152011

The Strength of My Pelvic Floor

And I’m back.

The first of four semesters of Nursing School officially came to a close ten days ago.  I sat for my 75 question final, worked my way through the exam, and left with a smile on my face and a spring in my step.  Having shaved my head early that morning, I was feeling good about life yet generally terrified about the next eighteen months ahead of me.

Sweet cheese’n’rice the semester F L E W by.  To quote Sondheim and Lapine from “Into The Woods”:

And I know things now, many valuable things, that I hadn't known before.
Do not put your faith in a cape and a hood, they will not protect you the way that they should.
And take extra care with strangers, even flowers have their dangers.
And though scary is exciting, nice is different than good.

C'mon Summer of 2013.  NCLEX, I'mma getchu!

Registration for the next semester of classes came and went.  This semester my classroom work was Mon/Wed day with a 7a-1p Tue clinical. Next go ‘round I’m in class Mon/Wed day with a 7a-1p Thu clinical.  Which means I spend six hours at one hospital, shower, nap, eat, and head to my hospital, Big Hospital for Kids, to work the first of three overnights.  I’m still working 7p-7a Thu/Fri/Sat. 

The weekly shift-flip remains, but I’ll gain a full Tuesday off.  Definitely a luxury I’m looking forward to.

So what did I learn in semester one of four?  Assess, assess, assess, and if you fail to spell ‘assess’ correctly in a nursing note, you’ve just written the word ‘asses’ in a patient chart.  Twice in my case.  As you cannot scribble out mistakes, somewhere there is a medical record with something close to the following entry:

“…with the assistance of Petit Filipina, R.N. (obviously not her real name…) and four other team members, rolled patient to the left side to asses asses ASSESS skin breakdown on the back, sacral and perineal area…” -Nosokomaniac S.N.

Joking aside, the goal of our program was to learn assessment and safety skills when caring for patients.  That covers a surprisingly large area of nursing, but overall I feel pretty confident about the things I’ve learned.  My psychomotor skills (to use their parlance) are absolutely lacking, but practice and repetition will hone them over time.

My CNA coursework and clinicals in early 2010 taught me good stuff.  There were ten students in my clinical section, three of us CNAs.  The contrast between us and the other students was remarkable.  I can’t fault my cohorts for their lack of experience, but you can guess who I asked for help when I needed it.

My Nursing School does not require incoming students to have their CNA, but I cannot recommend it enough for anyone considering nursing school.  We were miles ahead of everyone in both the clinical and classroom setting.  The language, the familiarity with equipment, body positioning, ADL care, isolation precautions, you name it, we surveyed in CNA class and it made a huge difference in Nursing 101.

It could be the case that in every vocational training there are people who bemoan the educational staff constantly, I’m not entirely sure.  What I do know is that there are some folks in my program who are so inconceivably rude and ignorant, I find myself doing kegels every time they speak. 

Let me sidetrack for a moment.

Back in my former life in Investment Banking, I had the good fortune to attend many classes on communication and management.  One of the teachers was lecturing us on how to deal with difficult people in several different scenarios.  He taught the text to the letter for a bit, then closed the book, sat on the table at the front of the class, and proceeded to blow our minds.

“Unless your life depends on it, whenever you encounter a difficult person, instead of spitting negativity back at them, do ten kegel exercises.  I guarantee when you consider what to say to them, it’ll come out a lot more effective that if you were simply reactionary.”

Trust me when I say it works.  In the face of negativity, tensing and relaxing the muscles in your pelvic floor will diffuse any snap judgements you might make.  Of course there are situations where it’s inappropriate.  Say for instance a person is threatening you with a knife with the intent to slice you to shreds.  I would NOT recommend pausing to tense your pubococcygeus muscle ten times.  However, when one of your cohorts is shit-talking like there is no tomorrow, ten quick squeezes down there isn’t gonna hurt the situation.  In fact, it’ll help keep you from perpetuating the negativity.

So.  Back on topic.  The naysayers who feel it necessary to belittle staff and many of their other cohorts are few in number, but they seem to be spreading misinformation like rot through the program.  I’m definitely not gullible enough to drink their poison koolaid, but a few people are.  And it’s worrying.

In the interim, my pelvic floor is getting stronger.

Friday
Oct142011

Fall

Sunday
Oct092011

Nursing The Chicago Marathon

 

 

Today I was a nurse.  A full fledged, steth-and-sphyg toting, head-to-toe assessing, comfort-giving, oh-shit-this-is-super-real, nurse.

It was amazing.

A few months back I was sitting at the ED desk chatting with my coworkers.  Many of them were describing their past medical missions to other places around the world.  Somehow we moved from that conversation to volunteering at the Chicago Marathon.  My ears perked up.

“Do they let student nurses participate?”

“Absolutely!  Let’s go to the website to see where you sign up…”

And so I did.

This morning I woke up at 3am.  Maybe I shouldn’t even call it waking up.  I got up out of bed at 3am, having had a restless set of naps.  I was way too excited.  Today was marathon day.

At 4am I was standing in front of a local 24-hour restaurant in the gayborhood.  Two of my RN friends were on their way to meet me to inhale a big breakfast before we’d spend the day as medical volunteers at the marathon.  I’d been to this place countless times, but usually at the end of a night of drinking.  It was in full swing, packed with folks fresh out of the clubs, dressed for the night out, their breath sweet with booze, temperaments slightly skewed to drunk.

I was wearing a pair of grey REI convertible cargos, my dusty worn-in New Balance, and a white Duo-dry tee with a stethoscope on my neck.  One of those nicer metal disposable ones.

Needless to say I stuck out.

A fay little lad sauntered up to me.  He asked me a few polite questions, told me I was cute, and asked if I’d like to join him for breakfast.  On any other night the answer would have been yes.  But this wasn’t my night.  It was the start of my day.  The cutie asked for a hug and I obliged.  He told me he’d like to see me around and maybe we could play doctor.

Note to self: wear a stethoscope out more often.

My RNs showed up.  We ate and caffienated, hopping on the train afterward to descend into the check-in chaos.  By the time the dust settled we were in a van heading back to our med tent at Mile 8.  Which just so happened to be right in the heart of the gayborhood again.

I swear that wasn’t planned.

Five MDs, six RNs, a couple medical students, and a PT made up our little group.  Four chairs, two cots, a table with various supplies and a kiddie pool of ice packs surrounded us.  We were ready.

During the check-in chaos earlier, since we were relatively close to the start of the race, we had to get through the line quickly.  Some folks corralled us up front and quickly checked us in.  Instead of a white medical student hat, I got a red one.  Red was for all med pros.  And as we were running to catch our van, someone handed me a blue RN bib.

Suddenly I was a nurse.

We saw the wheelchair marathoners first.  They sped by with their cyclist escorts.  So much power in their torsos, arms rippling with muscles, thick necks pitched forward in determination.  Some hand cycled their chairs forward, some directly drove their wheels.

It was the beginning of a very humbling day.

We had vaseline blobs on long pieces of outstretched cardboard for the marathoners to grab as they went by.  Apparently they slather it on whatever bits are chafing.  At first, everyone was out there offering it up to the masses as they ran by.  

Then we had our first patient.  Then two.  Then a steady stream began to trickle into our tent.  A cramped calf here, a seriously chafed pair of thighs there.  Tape this, ice that, mostly we saw ortho stuff.  Our PT was busy stretching, helping to knead, and manipulating parts.

We had clipboards with a pretty simple head to toe assessment sheet.  Get their flag number, name if possible, presenting complaint, any treatment, dispo, and they’re off.

Then I heard the magic words “we need vitals over here.”

I grabbed her wrist while someone was getting her oral temp.  Shouted the pulse and respirations to the recorder. I cuffed her arm and did my first BP in the field despite the racket around me.  Temp was good, pulse high, bp a bit high for her, breathing fast.  Suddenly there was another body on the cot behind me.  “Need vitals!” said one of the docs.  I looked down at that first patient, looked her straight in the eye, and told her we were here to help and she was in good hands but I needed to work on the other person next to her.  She squeezed my wrist and thanked me.

And so it began.

Sometimes I took vitals.  Sometimes I started and finished the H to T, sometimes I passed it along to the MDs who recorded.  I tried to chat with all the patients, offer Gatorade, a bag of ice, an Ace wrap, whatever they wanted.  About an hour or so in, I could tell what they needed just by the way they walked over to the tent.  For the most part, we fixed them up in ten to fifteen minutes.

The saddest cases were the people who had to drop out and leave via EMS.  The hollow look in their eyes broke my heart.  I held quite a few hands.

Three hours later we started to pack up.  We headed back to the main medical tent.  Little did I know it was about to get more intense.

When we arrived in main medical it was pretty slow.  Our doc said we should relax, have a bite to eat, and stick around. The four hour mark is where things would start to heat up.

In the interim, we walked over to the finish line.

I’ve written this paragraph three times now, trying to describe what it felt like to see them cross.  Since I cannot seem to put it into words, I’ll just say I teared up a bunch of times and tell you what I saw.

There was an older gentleman who ran the final with his family hand in hand.  The way they all embraced in a big pile on the other side of the finish hit me hard.

Scores of people with shirts in memoriam of someone they lost.

Two older women in pink, crying as they crossed.  I’m not sure they were tears of joy.

The looks of exhaustion and exhilaration on faces as they raised both arms up to cross.

Two RNs on either side of a limping runner, his face contorted in pain, helped him across the finish.  He collapsed as they went through the gate.

So many tears.

By the time we returned to main medical, it was much more serious.  We were by the ambulance entrance.  If they didn’t need the ICU tent and we had a free bed, they stopped at us.

The massage therapists and PTs hovered close for the scores of extreme cramping.  Transporters from the finish were bringing people in who needed attention.  MDs were all consulting the RNs and each other.  The lab techs were busy in front of their machines.  

A lot of our patients needed IV access.  My RNs rocked the angiocaths.  There were iStat draws for lytes and gasses.  Frequent vitals and assessments.  I saw many liters boluses run wide-open, pouring into the dehydrated marathoners.  Didn’t realize how fast an 18ga can pump it in to a person.

I watched people go from very confused, shivering, pale, and diaphoretic to warm, pink, and smiling.  I also saw some people on monitors not getting better, whisked off to the nearest ER.

Intense.

As I was on the train heading home, I realized I helped bring people back to health today.  It didn’t happen in a vacuum either.

It wasn’t just spiking bags and priming tubing.  Not just vitals and hand-holding.  Not simply chatting in Spanish or offering more Gatorade.

It was working as a part of a team to bring patients back to health.  It was nursing.

And damn it, I was doing it.

Wednesday
Sep282011

Eyedrops

 

She has no hair and the biggest blue eyes you’ll ever see.  Their intensity is magnified by the yellow mask that I always see her wearing when she’s in the ED.  She’s been to see us far too often.

The visits seems to be getting more frequent.

There are a string of baseball-stitch type scars across her little head.

She just turned seven years old and has been recovering from the excision of an anaplastic astrocytoma.  On a scale of one to bad, that kind of tumor is nearly the worst kind.

Everyone looks tired.  She looks tired.  Her parents look tired.  The family that joins them, usually about twenty minutes after they arrive in triage, looks tired.

The angels are near.  They may take her soon.

The attendings spoke the words ‘palliative care’ the last time I saw her.  Immediately I told charge I needed to step out of the unit for a bit.

There is a bathroom near the unit that is a great place to cry.

Is it wrong to want to see a child pass away?

I bring eyedrops to work. None of the other parents need to see that you’ve been crying.

Social Services tried in vain to find a place that would accept her.  Four hours later, there were no institutions in the city and surrounding suburbs that would accept.  The family had given up years ago.  They were disengaged in the care of their child.  She wasn’t even their child anymore.  She was a ward of the state.

How do you give up your child?  It must be an awful feeling.

Behavioral problems are often the most tragic things I see.

The devils of the mind are indeed wicked.

Aside from the occasional meal outside my apartment and work, I’m eating, drinking, breathing, and excreting Nursing School.

Once a dream, now a reality.

Where are those eyedrops…

Tuesday
Sep272011

Church Windows

Sunday
Sep182011

Fullerton Stop

Wednesday
Sep142011

Of Livescribe and Mental Case

Four weeks.  I’ve been in Nursing School for four weeks.  Let’s rundown what’s happened:

 

  • Read twenty-two chapters in our three main books and about a hundred pages scattered across a half-dozen more books, articles, and webpages.
  • Watched approximately ninety minutes of instructional videos.
  • Captured eight hours of lectures with my Livescribe pen.
  • Oriented to two computer labs, two mocks hospitals, our clinical unit, our library resources, and four major publishers websites.
  • Answered around three-hundred NCLEX questions.  Even got a few right.

 

Holysheeyat.

On Monday morning, I’ll be tested on all of the above.  All. Of. The. Above.

Oh holysheeyat.

To be fair, I knew it’d be like this.  What I didn’t know is just how much I’d actually be retaining.  There is absolutely no doubt in my mind that my recent work history has helped socialize (our buzzword in class) to the world of Nursing.  I speak a lot of the lingua franca because I work with it every shift.  It makes a huge difference.

Our clinical orientation was pretty interesting.  The unit is what I expected.  Post-op surgical, mostly gero, compact, full of the dichotomy of old vs. new equipment.  Sparkly EMR terminals and beds from the last century.  Abandoned sphyg faces in every room, rolling cart with the fancy pOx/BP machines.  Staff was full of smiles when we walked in.  Tiny breakroom, tiny cafeteria, slow elevators, friendly people.  All the pieces of a community hospital I'd expected.

A couple of my fellow students seemed bored but I found it useful.  And I can’t lie, it felt good to walk to the hospital in my scrubs.  Dorky perhaps, but it feels right to be in uniform, ready to work.  It’ll be a couple weeks until we actually work with patients because there’s a lot of computer training we’ll need on site.  But I’m ready.

My clinical section has six men out of eight students.  Which means, unlike my CNA training, when there is an obese patient, I won't be the only one they're calling to help turn/transfer/reposition.

Win.

There are a few students in my class with the foulest attitude I’ve ever seen.  Thank god they aren’t in my clinical section.  Two gals in particular, let’s call one the moaner and the other the bitcher, have made up their minds that we’re in the worst program ever and it’s completely beneath them.  Of course, whenever the teacher calls on them in class, they both are struck with that priceless deer-in-the-headlights look.

The moaner commented that she doesn’t even know if she wants to be a nurse.  The bitcher can’t stop complaining about what she perceives as the lack of organization in our program.  In tandem, they seem to feed off each other, wallowing in some sort of cesspool of bitter.  Normally negative people wouldn’t appear on my radar, but when I look around my class at how hungry for knowledge some of us are, it angers me that two idiots made it into the program while some very eager people didn’t.

Then again, seeing how much they complain only makes me realize that I really am exactly where I want to be, learning what I want, chasing the goal of slapping the letters R.N. after my name.

Nosokomaniac, R.N.  That's the goal.  You better believe I have that written out and taped to my iMac screen.

All hail the Livescribe pen!

The last semester I used my iPad to take notes via SoundNote.  It’s an amazing program that allows you to record a lecture as you type notes.  Then, while reviewing your notes, you touch a word, and the app fast-forwards the audio to the exact moment you typed the note.  It’s nifty technology and was useful for my micro and A&P lectures.  I knew I’d need something far more compact for my Nursing 101 lectures.  Enter Livescribe.

It’s a pen.  Kinda fat, but comfortable.  It requires special paper to exploit all its functions.  It records your lecture in real time, and synchronizes your written notes.  If you only have the notebook and the pen, when you are playing back a lecture, you tap on a word on the page and it’ll scrub the audio captured while you were writing that word.  If you have the desktop software, it’ll replay the whole thing on your computer.  If you have an iPad, you can upload the entire thing, called a Pencast, and use it to review your lectures.

Fan-frickin’-tastic study tool.

It has some downsides.  The microphone isn’t awesome and it’ll capture some physical sounds while you are writing.  There are binaural mics to get around that, but I can’t be bothered.  You also cannot add to an existing audio recording.  The pen will always create a new session when you stop/start it.  That sucks for breaks and whatnot.  You can pause it, but I’d prefer to keep one long session for a day in class.  But it works like a charm and so far I love using it.

I hate flashcards.  They are just not my thing.  I hate writing them, I hate carrying them, and inevitably I manage to grab a stack and slice open either my little or ring finger.  Paper cuts are no fun.

So I dropped a tiny bit of dough and purchased Mental Case.

Mental Case is an OSX app that you use to build flash cards digitally, then upload to your iPhone/iPad for review.  It has bells and whistles for making picture flashcards, audio flashcards, and a lot of other nifty things.  So far I’ve only made text cards which I love having with me everywhere I go.  I always have my iPhone, so I always have stuff to study in my pocket.

The desktop app is $14.99 at the moment, and the iPhone/iPad app is $2.99.  Worth every penny.

Okay, time to hit the books again.

Wednesday
Sep142011

Wilson & Sheridan

 

Tuesday
Aug302011

And so it begins...

 

I’m currently sipping a hot cup of homemade chai tea (none of that Starfcuksery for me) and listening to soft classical music.  That’s pretty much been my m.o. since starting school last Monday.  That mass of dead trees drenching almost half my dining room table is a significant financial investment in my future.

I’m really, truly, honest to goodnessly a Nursing Student.  I’ve got the books and the shocking receipts to prove it.

Without waisting any time, we kicked off last week reviewing NCLEX questions on ethics, morals, and legal issues.  From day one.  Seriously.

My teacher will also be my clinical instructor.  I’m fortunate to have classroom on Mon & Wed, clinicals on Tues.  Then, aside from copious reading and a ninety minute trip to our mock hospital, I don’t need to be on campus.

When I say copious reading, I am not joking.  We have reading assignments in almost three-quarters of those books on the table.  Some will be used in the coming semesters, and some are pure reference manuals if we need to research things.  It’s i n t e n s e.  I haven’t spent this much time with my nose in a book since the last two Charlane Harris Southern Vampire Mysteries novels.

Yep.  I like Sookie & Co.

Just today we started to sink our teeth into some of the more interesting topics of infection control.  It’s not that I dislike discussions on morality, legality, and ethics in healthcare.  I’d love to take further classes as my career unfolds.  It’s obvious there are lots of issues at play when you are caring for someone.  But it’s dry material, less than stimulating.

There are lots of guys in my class.  Perhaps half in my thirty person classroom.  That was a bit of a shock and a bit of a relief.  Thankfully I’m not the only one.

The only other thing I’ll share before I get back to studying is this:  School has much more of an online component than I’ve ever experienced.  Most, if not all, of my books have online access to the text and supplemental learning resources.  Videos, interactive quizzes, and amazing review guides.  We’re required to communicate outside of class via an online message board system and e-mail.

Truly, it’s a 2011 education.

This feels like college.

It feels amazing.