Lunch break

The weather was beautiful today and after spending the morning catching glances through the windows, I went outside for my 30 minute lunch break from clinical. There's a staff lounge tucked away in a corner of the building and a door outside opens onto a couple of benches in a shady spot, well away from the bus stop and bird eating and crack deals and whatever other craziness is going on in the front of the building.

Side note: I got a few more details about the bird eater. He had come across a dead sparrow and decided to eat it because "it was bugging me."

Anyhow, I ate my sandwich and stretched out on one of the benches for a 20-minute snooze. Which was quickly interrupted when a man came and sat on the bench across from me.

"Hi there." Please please go away. "Having a nap?" Well, I WAS. "I used to work at nursing homes, but had to quit when I got dementia." Oh, waitasec, this is a patient here, not a volunteer or staff person. "Are you Asian?" No. "Have you lived here long? I used to live in California." Great, thanks for sharing. Can I go back to my nap now? "I had a doctor down there that I really liked. He was really great." That's precious. "Yeah, I told him, y'know. I told him I loved him." Sure, lots of people like their doctors. "He told me I had to stop saying that to him or I would have to find another doctor." Well that seems a little harsh. "He had a wife and kids, but I really loved him." Uh-oh. "And then they switched me to a female doctor. I felt like I had been dumped. It was the worst break-up I've been through." Oh my god, he's crying. And obviously very crazy. Poor doctor. "He had such beautiful eyes though. What color are your eyes?" I think my lunch break is over.

Little lost lark

Perhaps the most charming thing about my patients at clinical is the complete and utter unpredictability and wild fluctuations of their day to day lives.

Last week, I spent quite a bit of time chatting with one of my patients, J. He is quite pleasant and cooperative and seems to enjoy company so long as you don't ask him to take a bath or shower. (He hasn't bathed since he was admitted to the place.) All in all, normal guy. The end of my second shift, after 24 full hours of providing for his every nursing need, I wound up talking to a nurse who took care of him last week. "Oh, J?" She asked. "I guess that Haldol [an anti-psychotic med] is really working for him." I asked her what differences she noticed in him. "Well," the nurse replied, "last week he was throwing his poop at the walls."

So J left the facility yesterday at 3:30 pm which wasn't too surprising or concerning at the time. He'd been talking about going back to his old place, about 30 minutes or so from the clinic, to check it out and certainly isn't a prisoner. He never came back last night, which is concerning because the guy's so darn delusional he probably couldn't find his way out of a paper bag so the police were called and they put out a 'be on the lookout'. By the time I arrived this morning, we needed to file a missing persons report. We called the police and were waiting for them to arrive, when my preceptor (nurse) got a phone call from a nurse at the county jail. J had been arrested around 4 in the morning, 30 minutes away from clinic on a charge of public indecency. The jail wasn't too interested in keeping him and it seemed like he wasn't trying to be malicious in his indecency (more likely he couldn't get his pants back up after he peed than that he was flashing little old ladies). So they released him at 4:30 PM and took him to the bus stop that would get him back to the clinic. According to the bus schedule, he should have arrived before 5, but we didn't see hide nor hair of the guy by the time our shift was over at 7:30. The poor guy really is delusional and I'm worried he might have missed a couple doses of Haldol. I hope he finds his way back to the clinic tonight. Just in case though, I'm going to check the jail website again tomorrow - I wonder if he'll get himself arrested again.

The clinic has video cameras and monitors around and on our floor so we can see the front door of the clinic, elevators and so on. Mid-afternoon I noticed a small crowd of staff hovering around the monitor and went to check out the commotion. I saw paramedics wheeling a patient out. This isn't terribly uncommon. The clinic is a skilled nursing facility, not a full-blown hospital. We can provide a lot of care,. particularly for chronic conditions, infections, and so on, but more acute issues - sprained ankle, heart attack, collapse - warrant a trip to the hospital.

I got the full story from my nurse a while later. A patient who's known to be a little crazy came out of the bathroom and told some of the staff that he'd just eaten a live bird. The staff of course didn't believe him, but one went into the bathroom to find two little bird feet and nothing else. Paramedics were called to take the guy to a hospital (to do what? Pump his stomach for bird?) and the guy refused to go. So then the police were called and thus the tableau I witnessed on the security camera.

Population of choice

After a full year of little old ladies and dangerously cute children, my classmates may be a little worried (and not inappropriately) that I just don't like patients. I do. But like any drug addict knows, everyone gets their rocks off a bit differently and my patient population of choice is the one in my clinical this quarter. I have five patients, four of whom I'll probably have for the next month (the last will die before the week's out) and they're all lovely, smelly, wonderful people. They're using crack at the bus stop outside and cheeking their narcotics to sell later and are in and out of the building all day to smoke. They're each demented in their own special way (there's the guy who looks completely normal but tells crazy contradictory stories and has occasional word salad and the woman who's high as a kite all day and mad as hell that the nurses won't give her more narcotics for the pain she has because she fell two days ago when she was also high and snowed with narcotics). There's a woman on the floor who worked as a prostitute for years and years - today I saw an ex-john/pimp wheeling her out for a smoke. There's people who think they need a shower once every four months and people who think they need one every two hours. They're cranky and sweet and smart and dumb and irritating and lovable all at the same time. I can't quite imagine another group of people who would be more challenging to work with and I'm so glad that they'll be mine all summer.

God bless my immune system

I have my dream clinical this quarter - My patients are a party mix of buggies: tuberculosis, varicella zoster, tinea (fungus), osteomyelitis (bone infection), Clostridium dificile, herpes, and lord knows what else. I didn't have much of a chance today to do anything more than follow my nurse around, but I'm excited to start digging into their lab results and examining their scaly skin/fingernails/hair/etc. Whee!

Sometimes, the reality of getting what you want isn't quite so nice as it is in theory. It's awesome to see these infested patients....not so awesome to imagine all those little buggies hopping onto me, my clothes, my food, my hair. And so, as I sit here and type this entry I'm trying to remember if I cleaned my hands before or after I touched the elevator button and whether I need to mop the floor of the bathroom where my clinical clothes touched it. I notice that my arms are kind of itchy and my hand tingles and my throat is scratchy. I'm up for the 12 hour days and long lists of meds this clinical's going to take - I hope my immune system is too.

Day 1, a year later

Today is the first day of the last quarter of the first part of my MEPN program, which got off to a not very promising beginning. To start with, I dumped my freshly brewed shot of espresso into a cup full of coffee grounds instead of the clean mug. Then I fell off my bike on the way to class. The website for my class listed the wrong room - actually, there were three different rooms listed in three different places - so I was late and the class itself was boring and offensive (ironic for a cultural sensitivity class). By lunchtime at least two of my classmates were in tears and I was just about ready to join them when I discovered I had another three hour class in the afternoon. Which also had multiple wrong rooms listed and took a while to sort out. After class I ran to the gym and promptly pulled a muscle in my shoulder.

However. It's hard to believe that just a year ago I started this nursing program. There was a welcome dinner for the new class tonight - just like the one I attended last year - and meeting the incoming students was a great reminder of just how far I'd come. I was assigned a 'buddy' to be available for and check in with throughout the year and she was telling me about how she couldn't sleep the night before because she was worried she'd forget her stethoscope on the first day of class. It was great to be able to tell her that those feeling really would go away, she really would begin to feel like she knew what she was doing and that she could be a nurse someday. While delivering this little speech, I realized that I have just one more quarter, that I will manage to get through my gross classes and survive clinical and learn lots and be an RN this fall. And it didn't hurt to think that two months from today, I'll be on a plane en route to Kenya.