Olympics

Number of days the games have been on: 14
Number of people I saw today wearing one of those stooooopid Roots berets: 4

The Triscuit

Our class of 21 students dropped to 20 by week two of the program. Aside from a few strange stories about sex with strangers and pharmacology homework on peyote, our departed classmate left her legacy in P's nickname, when she turned to P one day and remarked, appropos of nothing: "well aren't you a tasty little triscuit."

The lecture on COPD was off to a slow start this morning and while trying to get the technology on line, our instructor told us all to stand up. Put your arms above your head. Now bring them down to the side. Now above your head. And bring your hands down in front of your face in a wai. Repeat after me: Namaste. "Blow me" said the Triscuit.

Broken heart

Our second midterm caught me a bit behind and I spent last week in coffee shops, cramming cardiovascular bits and pieces into my brain. I was with a study group for four hours on Thursday, drilling through cardiac pathologies - coarctation of the aorta, atrial septal defect, tetrology of fallot, pulmonary hypertension. At clinical on Saturday our conference involved two hours of pouring over ECG strips trying to find paroxysmal supraventricular tachycardia and ventricular fibrillation.

We were let off of clinical an hour early and a group of us were on our way to sushi when my own heart skipped a beat. A weird sensation started in my chest: pressure, pounding, an extra beat. I was still at the hospital so I checked my oxygen sat (normal) and my pulse (normal) and headed off to dinner. And it didn't stop. The next morning the pressure and pounding woke me up at six - early even for me. It continued the rest of the day and I pulled out my stethescope and noted extra heart sounds; some sort of arrythmia for sure.

After two days of this with no relief, I got it checked out, ECG and all. There's nothing quite as stupid as having to tell a health care provider that you have some strange problem, oh and by the way, I'm a nursing student and have been studying this disease process for the last week. Hello crazy!

The triage nurse, physician and ECG all confirmed that something was in fact going on, premature atrial complexes to be exact. Oddly enough, PAC's were on our midterm. They're probably related to anxiety (although I'm not particularly anxious) and not hypochondria or a heart attack. They should go away and my cardiovascular system will go back to normal in time for me to develop asbestosis or bronchiectasis or one of the other lung pathologies we're studying next.

Death wish

I was concerned about B's frame of mind during the 26 straight days of rain. She was gloomy and appeared depressed (for a dog anyway) and couldn't get out to the dog park or other fun places. The sun's been out lately though and we've returned to all of our usual haunts - Greenlake, dog parks, Discovery - and she appears to be happier.

Still, I'm worried. Twice now I've come home to discover her trying to off herself. One evening she pulled a butcher knife out of the kitchen sink and into the middle of the living room. I returned home before she had a chance to slit her wrists. And last weekend while I was out, she pulled a bag full of aspirin off of my desk and pulled it apart. I must have interrupted her - there were still 50 or so pills in the bag when I opened the door.

Not to mention the whole 'running in front of a car' thing. Seriously, I'm taking away her shoelaces and putting her on suicide watch.

Demise

My OB clinical has finished and I'm a little relieved. Not just that I get an extra day off and don't have to be anywhere at 6:45 in the morning - although that's nice too. And witnessing labor and birth, participating in patient care, teaching new parents how to care for the kid was all amazing. OB is just too emotionally draining.

One day at clinical there were three separate fetal demises, including two term pregnancies that just ended for no apparent reason. The patients in each case had to come into the hospital and go through labor to deliver the dead baby. In one heartbreaking case, the couple had conceived via in vitro fertilization and to imagine how excited they must have been - all the effort and money, the wait and anticipation - on their way to the hospital, thinking that it had all finally paid off and they were about to have a baby. Instead, they were faced with the choice of spending money out of pocket for an autopsy and chromosomal study versus spending it on mortuary services.

There's a symbol they put on patient doors when a demise occurs to alert other providers and I learned that the symbol is also put on the clean utility room so you're not surprised to walk in on the dead baby. The one I saw looked perfect - perfectly formed, all the fingers and toes. But said fingers and toes were white, totally drained of the blood that had pooled in her head in the hours after her death, suspended head down in mom's uterus.

I attended another labor with a family that already had a child. Their second pregnancy was diagnosed with down's syndrome and they made the decision to abort. The woman delivered the third pregnancy - one with a normal karyotype (no down's) - the day I was there and we noticed immediately that the baby had some congenital malformations. I looked up the deformities once I got home and gather (though I'm not the pediatrician and this could be totally wrong) that the child is in for a long tough haul with a disfiguring condition that may also cause other physical and mental problems. Imagine what those parents are going through now.

And my professor reminded me again that I need to document what I saw the day those twins were born, in the event.

My classmate M is going to be a midwife and she's been really beside herself at all of these bad outcomes. "Pregnancy and birth is normal. It's healthy and normal and normally there are no problems," she keeps reminding us. During her report, another classmate remarked that after seeing a vaginal delivery that day she's "still not scared to get pregnant." I think that sums up all of our feelings (hopes?) at the end of our clinical on the labor and delivery floor.