NOT SCHOOL

I was just looking over my posts and I have to marvel at how quickly school has taken over my life and interests. So in non-school related news...I dunno, what's going on?

I've been daydreaming more and more about my trip to Thailand, which is exactly 30 days away. I'm terrified of the heat, but otherwise can't wait for the good food, iced coffee, elephants, and beaches that are waiting for me there.

Hmm, that's about it. It's so sad when I'm around non-school people these days. If I have anything to contribute to the conversation, it's probably boring or gross or both, so I don't share much. I hope I can remember how to carry on a normal conversation after all this.

The home again

The theme for the day: poop and penises. I'm not sure how I've avoided the two in previous clinicals, but today I must've been making up for lost time. I followed a CNA around for most of the day and watched her replace a condom catheter (it's like a gluey condom ending in a hose which attaches to a bag) in room 663 and then we helped room 691A get onto a bedpan and room 667 needed to be moved onto the toilet and so on.

Poor Mr. 691A. After getting the bedpan all squared away, a crowd of people gathered around (2 CNAs, 3 students) to watch or assist in getting his suprapubic catheter attached to a leg bag so he could be transferred into his wheelchair. His new pants were around his ankles and his gown had been removed and as we all watched M try connecting the leg bag this way and that, Mr. 691A was lying naked on his back with a little erection. After 10 minutes of fiddling, a few people left to get more supplies and I asked the patient if he'd like me to pull his sheet up over him.

I knew that poop and urine weren't going to be all that fun or glamorous to deal with, but of course they're a natural and very healthy process and something important for nurses to deal with. Still, I wasn't quite prepared because I'd never really considered that the poop and pee in a hospital doesn't look or smell like anything natural. I think the urine was bugging me the most. In the several run-ins I had with the stuff today it was very cloudy, almost like a muddy brown and I swear it looked on the verge of having solid matter in there. The smell was also not so nice. Poop, same thing, although I won't go into detail on that one (see? I'm nicer!).

But you can't fault Mr. 691A or Mr. 663 or Mr. 667 who threw up on his gown and needed to be cleaned up. These poor guys are so incredibly dependent and are acutely aware of it. It's a pretty humbling responsibility to try to protect the dignity of the individuals you're caring for in the face of all of the indignities they suffer at the hospital.

Also today, I got to follow the NP into a patient's room to unroof a herpes lesion. Apparently the NP and the doc were having a disagreement as to whether the patient was experiencing an outbreak of varicella zoster (shingles) or of herpes. It had spread across one buttock and on the corresponding side of his penis and scrotum. Given the interesting pattern, I'd put my money on zoster...I'll have to check in a couple of weeks for the results. Anyhow, the NP was checking it out and demonstrating that it was causing pain to the patient. "Look, if I flick the unaffected side of his scrotum it's okay" flick. "But on the side with the outbreak, it's really quite painful" flick . "Aaaargh!" "See?" she asked flick. "Aaaaargh!"


note: all patient room numbers and names have been changed and purposely confused to protect privacy and all that. God bless HIPAA

The new superheroes

In pathophysiology today the instructor was giving us some case studies to get her points about oxygenation across. "What would happen to Vasoconstricted Man if XYZ were done?" "What will the pulse oximeter say about Carbon Monoxide Poisoned Man?" I'd love to see the superhero uniforms that went along with those monikers. Do you suppose they wear capes?

Nicer

When I first decided to take this nurse route, one of my biggest concerns was that I'm not nice enough to be a nurse. Nurses are all caring and compassionate and concerned and I'm...not so much. I hope I'm not out and out mean, but I do tend to be oblivious or at a loss of what to do in the face of other people's humanness. So imagine my surprise after a few short weeks of nursing school to discover that I am getting nicer! Not Mother Theresa, but a couple steps down the path to being a more compassionate person.

B and I entered the dog park last week to witness a jack russel trying to rip the cheek off of a King Charles spaniel. The owners were in the midst of it and when they finally pulled the dogs apart, I actually walked over to the spaniel's owner who had been bitten a few times. I helped her find a place to sit down and a tourniquet for her fingers. Isn't that nice? In my pre-nursing school days, I probably would have gone to the other side of the park and figured that someone else would help her out. Unfortunately, in all of my niceness I was surrounded by blood from her fingers and was trying my best to avoid it. I thought I managed okay, so I stood around at the dog park for another hour and then went to the U Village to run some errands (AKA shop for clothes) before I discovered that there was a very noticeable spot of blood on my behind - how embarrassing!

You had me until squid axon

I was especially groggy this morning which is why I accidentally used my roommate's toothbrush. Pathophys started at 8:30 and I still wasn't fully awake and having trouble following what seemed to be an especially circuitous and convoluted and confusing and torturous lecture about membrane potentials and depolarizations. I wasn't alone - looking around the classroom it seemed that everyone had glassy eyes. The professor was wizzing through the overheads and she finally put up a graph to demonstrate an action potential in a nerve which was labeled "squid axon" and it was just too much for the class. M spoke up and said "excuse me, what's a squid axon?" It's a crazy question when you look at it independent of context, but imagine a roomful of weekend-spent students trying to follow a confusing lecture that's presumably about potassium imbalances and suddenly there's a fish thrown in for fun... The professor explained that it was indeed the axon from a squid and another classmate said "oh, you had me until squid axon."

Red reflex

My motto for clinical is "make the most of it" which is why I was wandering from patient room to patient room with my checked out opthalmoscope and blood pressure cuff (or technically, my sphygmomonennemonenanoometer) looking for victims to practice my assessment skills on. Towards the end of the day, C and I decided to find someone with cataracts so that we could assess their red reflex by shining a light in their eyes with the opthalmoscope. I remembered seeing that Mr. V had cataracts charted, so we went into his room and obtained permission and I looked for the red reflex in his right eye and saw it. C looked in his left and couldn't see it. She checked on me to make sure she was looking for the right thing and saw mine, but when she tried again on Mr. V, still nada. I checked it out as well and didn't see anything. How exciting - my first abnormality!

Afterwards, I was wandering through the hallways and came across the instructor with a clump of students. Looking to review my assessment knowledge for the midterm next week, I asked the group what conditions would cause an absent red reflex. The instructor responded "you probably just don't have the skills to look for it."

How many drams in a grain of vanco?

This week's been all pharmacology all the time it seems. I had a lot of memorization to do for the Tuesday quiz and was able to tell a muscarinic agonist from a muscarinic antagonist (that's all gone now) but forgot to memorize the @#$$*!@ conversions between grains and grams and mLs and ounces and so on. So I missed a bunch of very simple questions on the quiz and was so frazzled that I managed to convert milligrams into micrograms instead of the other way around, thus missing the one conversion question that I DID know the answer to.

Our lectures this week have been on antibiotics and antifungals, which I find to be a welcome change from the beta blockers and MAOIs we looked at before. I was meant for a career in infectious diseases...now I just hope I can find a job when I finish school.

I did better on the quiz today, mainly because I got those conversions down. As we were sitting down, I heard G mention the conversion between F and C - which I had totally forgotten to include in my flashcards - and asked her to repeat it. Sure enough, there was a question about it. Thank god for classmates!

Clinical low-down

I talked to a MEPN1 student about my awful clinical and learned that it's not terribly uncommon. The previous class overall was pretty disappointed by their clinicals, she reported. Her worst clinical was at an outpatient facility where she spent a lot of time in the cafeteria and breakroom. Another student is stuck on the graveyard shift at a hospital. She sympathized, but it sounds like there's not a lot that can be done about it.

I'm really surprised that my school, with its great reputation would have such terrible clinical experiences. How can they boast about the great education if the hands-on portion routinely sucks?

On the plus side, knowing that clinicals are usually bad makes me feel a lot better about my lot. If there's nothing that can be done about it, I just need to get through it. And I can do that. I sure wish someone had warned me about this before I entered the program though. It may have affected my decision to come here and also would have prevented me from having such high expectations.

The nursing home

My clinical really blows this quarter. It's in a nursing home where people are either not sick enough to be in the hospital (read: don't need vitals done, no acute illness) or are in hospice waiting to die. After spending a day there I've realized that the type of nursing that goes on there is exactly what I never want to do: babysitting or providing pain meds prn. That's not to say I don't like the individual nurses, I just wouldn't take their jobs.

But back to the beginning. My carpool pulled up in front of my house and my classmates and I talked about our purples (scrubs), purple people, grapes, barney and grimace all the way to the site. On the walk inside we talked about how our pants fit weird, our shirts were strange, the jackets, the shoes, etc. After all this talk about our uniforms, the clinical instructor greeted the ten of us by noticing that one girl didn't have her jacket (and was concerned that the girl's midriff would show if she leaned over in her t-shirt...not sure how that would work) and another had shoes that were the wrong color. "What do I have to do to make you get here on time and in uniform!"

We weren't introduced to the staff on the floor and got to know their names throughout the day as we got in their way or shared rumors with other students. The instructor had told us to answer call lights but the nurses didn't know that, so my introduction happened when trying to communicate with a nonverbal patient about whether he could get his hair cut and two nurses rushed in, told me to leave to they could talk to the patient, and then told me that they really didn't have the time to help this guy get his hair cut and I shouldn't let him think that they did. Yikes.

There wasn't a lot to do. You could see people in purple walking in circles around the unit all day. A couple were assigned by the instructor to play checkers with the residents. Another couple practiced taking vital signs on each other. We were told to go into the rooms, but around 1100 a rumor circulated that some of the residents didn't want to have anything to do with us. Not knowing which ones, we went back to wandering in circles. R reorganized the little nutrition closet and seperated the sugar packets from the creamer packets. I fed one guy. It was a really long day.