Thursday, December 13, 2007

Multiply Life By the Power of Two

"The protocol for a continuous heparin drip is 25,000 units per 250 mL of D5W. A loading dose of 70 units per kilogram is ordered. What you have available is 10,000 units per mL. The patient weighs 154 pounds. The patient's aPTT is 90 and protocol is to reduce the dose by 100 units per hour. What is the drip rate of the new heparin dose?"

The above problem is an example of a question on our math final - the final that we have to pass with a 70 or better or get kicked out of the program. You cannot advance to next semester regardless of the rest of your grades. Even if you have an A in fundamentals, you are out of the program.

In a way I understand - pharmacology math is a big deal. But come on! Talk about pressure.

I have spent the past month practicing drug calculations for at least an hour a day. I wanted to make sure that I pass this thing no matter what. So I haven't exactly felt like blogging. I have been entirely focused on getting the hang of this.

And good news! I did! I'm still a nursing student - for now.

A few years ago I attended a Different Community College and didn't pass the pharmacology math exam. Coincidentally I got the same score on that test that I did on this test, but because the schools have different criteria, this time I got by. But I'm not bitter. Life is like that. I've learned to adapt to whatever is required of me wherever I am. I'm over trying to argue what works someplace else.

People ask why drug calculations are so difficult. I wish I could answer that. After all, the math itself isn't difficult. We do basic math functions - add, subtract, multiply and divide. But look at the problem above and you tell me why it's so hard. The first thing that comes to my mind is that you have to know what information in the problem is essential to the calculation and what information is just there to distract you.

The second problem is knowing what numbers calculate and where. Which number goes on top of the equation? Which goes on the bottom? What gets multiplied first and with what? What gets divided from what and when?

I don't feel bad because I showed this problem to my sweetie, who has a two degrees and thinks math is fun, and she couldn't figure it out at first. I had to explain which numbers go with what and only then could she do it. My classmates and I had gone to the tutoring center at the college to get help with this, and the tutors were scratching their heads too. Finally the nursing program chose one tutor and she is now the dedicated pharmacology math tutor. They sat her down and explained pharmacology equations to her so now she can explain it to us. She, too, was clueless at first. As absurd as this situation sounds, I'm just grateful that they have made this resource available to us.

Now the semester is over. I passed fundamentals. I passed math. Now if you'll excuse me I have some important sit-on-my-butt time I need to catch up on.

Oh, in case you're wondering, the answer is 10 mL/hour. If you're dying to know how I got that answer, you'll have to wait until tomorrow when my headache is gone and I can explain the problem adequately.

Thursday, November 29, 2007

It's My Turn To Shut Up

Thanksgiving break was a breath of fresh air - in more ways than one! A huge cold front moved in and dropped the temperature 40 degrees. Sweet! My down time was very much appreciated. There is a lot of talk about how we are so burned out with school, and now that graduation is a mere six months away, it is even harder to concentrate.

Now that I'm back in school, being around my classmates gives me stuff to talk about. For example, today's topic was How Nurses Don't Know What They're Doing And I'm Going To Be The Perfect Nurse Someday.

Nursing school teaches many things, but often what we’re taught doesn’t apply in practice. My favorite thing to do in nursing is procedures. I love doing dressing changes, fiddling around with catheters, and oh, the joy of putting a needle in someone’s arm. No, no, no. I don’t enjoy inflicting pain. What I enjoy is doing something with my hands and using my senses to do a job. As a cube-farm refugee, it is a breath of fresh air to do something with my hands besides type.

The problem with procedures is they can’t always be done the way it is taught to us in nursing school. When one is standing over a patient doing a procedure the reality is your pocket phone is ringing, a call bell is going off next door, you’re behind on checking on a patient who might be having a problem that is potentially life threatening, you’re trying to remember if the person you just talked to wants extra cream for their coffee or extra Ranch dressing for their salad, the person before that has shat himself and now he’s cleaned up, but there are no clean linens and you told the tech to see if they can get some from another floor but you haven’t seen or heard from her in about 45 minutes, and meanwhile he is sitting in a chair waiting for the clean linens so he can get back in bed.

What to do, what to do?

In that moment we prioritize. We decide what is the most critical thing we must do, and we go with that until the next critical thing happens and we have to rearrange the priorities and still keep track of the Ranch dressing issue.

In the next moment you begin to think about taking shortcuts. You know what the proper procedure is, but you realize that if you do this, you will be hours behind and the end of the shift is approaching. The nurse coming on to take your place will be highly irritated that you haven’t gone things done, so this creates tension between you and she most certainly won’t hesitate to vent this irritation to the other nurses on the unit. Next thing you know nobody will talk to you, and even worse, the story of your slackitude grows with every telling until everyone thinks you’re a pain in the ass to work with. Besides that, you haven’t done any charting and if you stay after your shift to work on it, before too long you will be invited to a meeting with your supervisor to discuss how you’re working too much overtime, and maybe a snarky comment or two about your time management skills.

So you begin to think of the steps you can eliminate from the procedure. You try it and it works great. You have cut 45 minutes off the time you would have spent taking care of the issue.

On good days you do all the steps you are supposed to, but the bad days are crowding closer together. More and more you use the shortcut until eventually you use it all the time. Nothing bad has ever come of it. The patients are happy. Your coworkers are happy. Your supervisor is happy.

Then one magical day, a nursing student appears on the unit. It’s an inconvenience, but it’s part of your job description and, hey, you remember what it was like to be a student and you made a promise to yourself to not be one of those nurses who is mean to students.

Off you go, the nursing student in tow, to do a procedure that you’ve done a million times. You are doing your thing when the student blurts out “aren’t you supposed to be doing it this way?” and she explains how she learned in lab that week.

I would like to treat that student to a mighty bitch-slap.

Nursing school is the soft, safe cocoon where everything happens the way it is supposed, hospitals aren’t hotels, we can focus all our attention on one thing at a time, and we have all the time in the world to listen to the patient talk about their concerns. Unfortunately reality is far different.

Because I have had experience with patient care, and now working as a nurse, I have noticed how people are dynamic and ever changing. They have moods. They have opinions. Sometimes they have body odor. What works one day won’t work the next. We always try to do the best we can, but we have a lot of things working against us. I have taken this understanding with me into my nursing school clinicals.

I stand back and watch. I get in there and help whenever I can within the scope of training I have to that point. I didn’t do a sterile dressing change until I was checked off in class. Then once I was checked off, if I see my patient needs a dressing change, I don’t wait to be asked. I tell the nurse I’ll do it since that’s what I’m there for.

Meanwhile I keep my mouth shut. If I have questions, I wait to ask it when things have calmed down. If I see the nurse doing something differently than what I was taught in school, I observe and learn from it. I might use that technique later when I’m a nurse. I just make sure I never say a word about it to the nurse. I may ask her about it later if I can sense she’s open to those kinds of questions. But I use tact and care with my question, and I never, EVER ask the question in front of the patient.

My goal is to make the world safer for student nurses who will come after me. I want the nurses to have a good experience with me so maybe they’ll be more willing to work with a student in the future. Nursing students who make themselves a pain make nurses not want to work with them. This is the only way we can learn is by watching and doing. If I see something I feel is unsafe or illegal, I take it to my instructor and let him handle it. I don’t feel it’s my place to address it. Chances are I’m wrong. If I open my mouth that nurse and I are going to have a bad day. Neither of us is thrilled to have to be together in the first place. I don’t want make the situation even more unbearable.

So I let my classmates talk about those terrible nurses and how they’ll NEVER do what they saw the nurse doing. I smile, keep my mouth shut and think “well, honey, wait until you’re a nurse.”

Tuesday, November 20, 2007

It Ain't Over 'Til It's Over

On this Eve of Thanksgiving Eve I thought I'd settle in for some quality time with my blog.

Let me just apologize for the terse mood of my last few posts. I'll spare you the details, but yeah, there's been stuff going on at my house that has been keeping me riled up. My *cough* in-laws *cough* will be leaving in the morning and I can go back to drinking coffee and eating chocolate in front of the Internet until I'm comatose. Of the many substances of abuse I have tried in my life, at least this addiction keeps me off the street, and I can still function at work and in school. If I am going to indulge an addiction, I don't appreciate non-relatives commenting on how I spend my free time.

Anyway, I broke the blogger code of ethics and went back to change some of the wording of my posts. Some of my meaning wasn't clear, and some of what I said came out sounding meaner than I intended. Even though I'm not all that fond of people, I really don't want all of humanity to be vaporized into a pile of dust. I have been auditioning some blogs to see if I want to add them to my blog roll. I don't know if this is how its done, but it's how I have chosen to build my blog roll. I want to see if the blog is one that is 1) active, 2) interesting, 3) entertaining, 4) has content that I identify or agree with, and if not 5) challenges my assumptions with solid science.

My blog intentions when we first met were to have a good time and to grow together. I feel like I have failed you in spite of all my good intentions. I still care about you and I want you to blog-love me and not turn me into a blog-ex. I'm insecure enough to want your attention and not go to some other blog to get your needs met. I had thought up some interesting blog topics but just can't spare the mental juice to blog them in a way that would keep you entertained. This doesnt mean our blog honeymoon is over. Even though this is the blog equivalent of sitting around in sweat pants for days without taking a shower, I hope you understand that I'm going through a difficult time.

Thank you for your patience. I know we're just getting to know each other, but I guarantee you that I'm worth the wait.

Winter break is coming up. I promise to get off this virtual couch, pick up those empty ice cream cartons, empty the ash trays, open some windows and run the vacuum. I will cook up some blog goodness that will keep you coming back for more. I will take a shower, shave my legs, do my hair, throw on some make-up and take you on an interesting blog adventure that will make you realize how truly special you are to me.

Thursday, November 15, 2007

I Said Shut Up - Part 2

I grew up in a large family and my social skills suck. A lot people think that growing up with lots of siblings makes you a better adjusted, sociable person. Far from being outgoing and sociable, I'm very much a loner and very snarky. I don't like being around other people for very long.....unless I'm paid to be. I can be sociable when forced, and I am polite enough to get invited back to things, but it's not my true nature. I can only do it for so long, and then I want to get back to my books, my CDs, the Internet, my MP3 or whatever amuses me currently. I guess my point is that wherever you fall on the aloneness-togetherness scale has more to do with the personality you're born with and very little do with whether or not you have siblings.

It's not just the presence of people, but all the goddam noise they make when they are around. My MP3 player gives me some relief. If I'm standing in line and someone starts complaining about how slow the line is, I slap those babies on and disappear into my own world. About 10 years ago I noticed this tendency for people to have to have some kind of freakin' noise going on all the time. Too often I get stuck in a situation where I am forced to endure what some people feel is their right to enjoy music at ear-splitting levels and just assume that I like their music as much as they do. For years I lived in apartments, and too often the neighbor's stereo would vibrate the pictures off the walls. I can't tell you how many times people have threatened to kill me because I asked them to turn their music down. I asked politely - I promise. Is there some connection between listening to loud music and being a homicidal maniac? I'm beginning to think there is.

Apparently I'm not alone. I found this article in Wired magazine where someone says that Hell is Other People's Music and I feel as though someone has heard my distress call. For years I have been complaining about the rise of personal noise that seems to get worse all the time. I have said for years that I would like to find the person who invented the subwoofer and subject him to a few hours of waterboarding.

Part of the problem is I think I have ADD. Back when I was a kid ADD wasn't invented yet. We were just "bad kids" and were made to sit down and our homework. I'm not just being flip - I really do think I have trouble concentrating. I've learned to adapt to it by sitting in the front row in class so I'm not as distracted. I have also adapted by keeping my environment quiet.

What is it with everyone else that there has to be some kind of noise going on all the time? Are your thoughts so distrubing that you have to drown them out?

And what happened to the rule about being quiet in the library? The other day I went to the library to study - because I've been invaded by nattering in-laws - and the other patrons talked to each other, and talked....and talked......and talked, as if they were hanging out at a party. Meaningful looks didn't work. Dirty looks worked no better. I finally went over to them and said "I'm sorry but could you keep it down I'm trying to study." They rolled their eyes, looked at each other and said "God! What's HER problem?" I settled back down to study when another disturbance erupted - this time it was the LIBRARY STAFF carrying on and laughing behind the desk. What the hell?

Just how bad is this phenomenon going to get? Maybe I'm the problem but I just can't get used to having constant noise going on all the time. Studies have shown that the effects of too much noise is detrimental to health - but nobody cares. They want what they want right now and don't care how their behavior affects others. I guess this is the result of a society that values youth - eternal adolescence; people seeing the world from their own perspective and having no clue about what other people might think.

Thankfully I only have less than six months of nursing school left and won't have to concentrate so fiercely. That will help. Meanwhile I hope people read the article and it introduces them to the idea that not everyone likes the same music you do. Maybe you should turn it down a little, or better yet, turn it off altogther and find out what you really think. You might be surprised.

In the words of the philosopher Jean-Paul Sartre, Hell is other people.

Tuesday, November 13, 2007

Brain Damage

Ahhhh. Much better! I took my neuro exam today and got an A. I feel like I turned that failing grade around in spades. I won't get an A for the semester, but at this point I'm just happy that I'm passing. This time I made sure I was all over that material waaaay before the test.

Pardon me while I get this off my chest. Remember my classmate, Jack? He is ENRAGED that he only got an 80. He calls himself the class nerd. He meets with a group of students who have formed a study group - one I've never been invited to join - and some of the students in the group got better grades than he. He had the audacity to say "I taught them everything they know about this subject and they still did better than me." Hmmm. Wouldn't be the text, the lecture, or the Powerpoint presentation? Nope it was all him.

He has these tirades whenever he doesn't get an A on a test; and lately that means he has a hissy fit after every test. The problem, as he sees it, is "the questions aren't worded right."

Nursing school exams aren't knowledge based. They give us the knowledge in the text and in the lecture, and then we are expected to apply the knowledge in a practical way. I can't give you an example of one of these questions because it is unethical, and I could lose my sparkly new LVN license. Let me see if I can think up a non-medical question to demonstrate this logic.

The first year of nursing school our instructors started feeding us questions that were worded more like what we'll see on our exit exam and, if we graduate, the board exam. They were trying to get us used to the idea that it's not a knowledge dump format. I struggled with this mightily. I went to public school, where the method of teaching is memorize and regurgitate with no real logic involved. I've had to overcome quite a bit, but after 3 or 4 tests I figured it out and got with the program. Many of my classmates fought this and kept arguing that "they were trick questions" or "you didn't teach us that in class". I didn't fight it because I'm too old and tired to fight authority anymore. I am too self-centered and lazy to try and bring the whole nursing education system around to my point of view.

Now in our second year most of us have gotten on board with this kind of logic. Somehow though, Jack is still stuck on memorize/regurgitate. He says that tomorrow he is going to complain to the faculty because these aren't fair questions. He claims that this test is not an accurate reflection of his knowledge; that he knows all this stuff and they are just trying to trip him up. A few tests ago when he bombed big-time, he swore that the computer "didn't save his answers right." He grumbled and complained loudly enough that a few other students soon claimed that the computer didn't save their answers right either. So two of the faculty sat through all the lectures and took the same test we did. Lo and behold, all of their answers were saved correctly. Everything that was on the test had been covered in the lecture. Most interesting of all, now that the faculty was looking at it closely, everyone else's answers were saved correctly too. It's a miracle!

I feel for the guy. I wish I could tell him that the sooner he stops trying to fight this, and does his best to adapt to this kind of logic, the better off he will be overall. I want to tell him that, really dude, you are not important enough for them to try and trip you up. You are a body in a seat that they are trying to get to graduation. It is not in their best interest for you to fail.

Mostly I just wish he'd get off this ego trip and let go of his view of himself as the class nerd. Yeah, maybe he does know a lot of data, but if you can't apply the logic, it doesn't matter how much you know. It just so happens that some of my classmates who maybe aren't that great at memorizing data, are geniuses at applying the information they do have. That means they will have a better chance at passing the board exam, and probably make some damn fine nurses.

It is important to know that if a patient is twitchy, has only peed 30 mL in 6 hours, their urine specific gravity is 1.045 and their serum sodium is 125 there is a problem. More importantly is knowing what the problem is and what to do about it.....and what to do about it FIRST.

Sorry bud. Being the class nerd won't save your ass when your patient who fell on his noggin yesterday is now circling the drain with SIADH. You can stand there and look at those numbers and impress people with your fancy book learnin', but you'd better cut that IV off and get on the phone and notify the doctor. Save the bullshit for later.

Friday, November 9, 2007

Hell Is For Children

I think parents take the blame too much for what happens to children. Mothers are especially picked on. Every mother has had the experience of unsolicited advice, comments on her choices and warnings that what she is doing will damage her children for life. Letting your child have a piece of candy before dinner once in a while is not going to hurt them. Letting them sit too close to the television won't hurt their eyes. Eating Pop Rocks and drinking Coke won't make their stomachs explode. If they cross their eyes they won't get stuck that way.

I've had experiences during nursing school where I was initially shocked by something but eventually became desensitized. I don't know if I'll ever get over what I saw today. I'm still haunted by it. I need to put it somewhere and process it. This seemed like as good a place as any.

Our clinical rotation was in an acute care hospital for children. Some of the children were there because of an accident; a child pushed down by a playmate and hits his head on the ground; a child with Down's syndrome; still another who suffered from a bacterial illness with a high fever that caused inflammation and swelling. These things happen and my heart goes out to the parents whom I am sure are suffering a great deal.

What I can't get over is the number of children who are there because the parents didn't take 5 minutes to make sure their child was buckled into a car seat. A large percentage of the children in this hospital were in this category. It is so senseless to me that these children will never wake up, never be off a ventilator, never run and play, never say their first words, or if they said them they are forever silenced. For some it is a cultural belief that car seats are an unneccesary expense. When your religion says you have to have all the babies God intended you to have, a car seat does seem like an extravagance. Does your religion intend for your baby to be forever broken and smashed? Your religion doesn't want you to use artificial means to avoid pregnancy, yet when your child cannot breath on his own you insist we use every artificial means invented by humans to keep the child alive.

Yet another child is there because she found her parents'crack stash and ate it. A beautiful baby with the biggest eyes and the longest lashes is forever brain damaged because her parents addiction meant more to them then their child's well-being. Long ago I learned to accept that for addicts their addiction is always first. It is heartbreaking but easier to get on with life once you know that. Today though, I am having a hard time accepting it. An adult can make the choice whether or not they want to have an addict in his or her life. This baby had no choice. This baby came into the world helpless and dependent on the people around her to make the right choices to keep her safe. She didn't get to choose. She couldn't leave her home and find some new parents who were better equipped to keep her safe and to put her needs before their own.

I am not so concerned about my tax dollars paying to care for them for years on end. Part of being a civilized culture means we care for people and do what we can to keep them alive. It's what separates us from animals. I am not so concerned that we have the technology to keep people alive beyond what is practical or useful. Those are ethical concerns that I am willing to let other people fuss over and evaluate. If I wanted to make it my business to worry about tax dollars or who gets to live or die, I would have run for office or joined the clergy. No. I am in the business of giving patient care to the best of my ability.

Nursing students have to go through the process of learning to put their personal feelings aside when it comes to patient care. We deal with people of different races, classes and sexual orientations than our own. If we are to be effective at what we do, we learn to put our feelings aside, at least temporarily, or come to some understanding of these strange, new people we may never encounter in our lives otherwise. If we never travel outside our own small circle, it comes as a shock when we find that some people would rather buy cigarettes than food if they can't afford to have both. We may have never met a person who doesn't go to their doctor's appointments are pick up their prescriptions because they don't have transportation - and no one in their circle does either. If we don't know people like that, it's easy to judge them from our cozy, comfortable perspective.

But I don't know if I could ever deal with the constant tragedy of parents who put their children's lives in danger. I might eventually learn to deal with it, just the same way I learned to be okay with the sight of blood and the smell of feces. This challenge is one I don't feel ready to take on just yet. I'm too heartbroken and angry today.

Thursday, November 8, 2007

Turn and Face the Strange

Today in class we learned a new term. It's "brain attack." Many of you know this as a stroke. Medical people have been calling this a cerebrovascular accident, or CVA, for years. Then someone decided that since most things that cause a stroke are things a patient can control, then it's really not an accident.

The problem is getting used to the new term. Our instructor even struggled through the lecture trying to say "brain attack" instead of CVA. I, too, am struggling to try and adapt to the new terminology. I ask myself "why can't they just keep saying CVA and leave it at that?"

We live in a world where technology changes rapidly, new things are being discovered and what we used to think was absolute is now shaky. It can be unnerving to try and adapt to the new knowledge. It is my belief that as humans, we would like to trust that the information we have is the final word. As we get older, it becomes more difficult to take in new information and rearrange what we already know.

This is frustrating when trying to educate a patient about their medical problems. For years diabetics were told that they can't have sugar of any kind at all. Now it has been shown that by allowing diabetics to have a little sugar now and then, they are more likely to stick to their diets. If you talk to someone who has been a diabetic for, say, 20 or 30 years, they can't wrap their brain around this new idea.

I've noticed that a person's age can give me a snapshot of what the popular medical beliefs were at some period on their lives, usually young adulthood. Once I understood this I realized that I am experiencing the same thing. The most recent example I know of is when low-carb diets were all the rage the past 10 years or so. When I was a young adult HIGH-carb diets were recommended. The thinking was that carbs are instant energy and we burn them more quickly. Fats are bad because our bodies have to process them into a form that can be more easily used for energy.....and this was bad. I was convinced I was right and refused to cave in to the low-carb diet fad and kept on eating the same way I always have.

Nowadays more and more experts are confirming what I thought; low-carb diets aren't a magic bullet after all. One great flaw in the diet is that it's one that is almost impossible to stick with. Not only that, but we need carbs, and most foods that are sources of carbs also have lots of B vitamins that our bodies need as well. The important thing is all things in moderation; that message has not changed. Eat a little bit of everything. I feel vindicated in a small way.

Where do we go from here? How do we educate patients and get them to accept the new information? I do my best to try and win them over. Like me, they've been on this planet long enough to realize that what I am telling them today will change again in a few years. How can they trust that the information I am giving them is accurate? How long do they have to remember this bit of information before exchanging it for a new bit of information? It's exhausting to keep up with.

I don't have the answer to these questions. I cope by focusing on results. I say go with what works. I am a fan of research. If research shows that a certain treatment has good results, then that's what I feel is best. I don't think we even have to understand why or how it works. The important thing to know is that it works, consistently, and that it causes no harm.

I fall back on the oath we take as nurses and our purpose for being here.......first, do no harm.

I would add keep up on medical research and keep an open mind.

Sunday, November 4, 2007

It's Only Words

In my long and winding post I mentioned setting off on my career path by taking medical terminology. This one class has done more to open up my world than just about anything else I've done.

I hear people complain about medical professionals using medical terminology to communicate, and feel that we do this as a way of making it hard for them to understand what we're talking about. Well, yeah, that is one benefit. We can discuss some scary issues that need discussing immediately without alarming the patient. But understand we aren't doing it to hide things from you. It's a shortcut; sort of like verbal shorthand, and unfortunately we get so used to doing it that sometimes we forget to revert to layman's terms when we talk to patients.

But that isn't the main purpose for the use of medical terms. The practice of medicine has been around for thousands of years. It has only been a couple of thousand or so years that someone put any thought to describing what is they're looking at and what it's doing. Without getting into too detailed a history of the medical field, it was in Rome that the art of medicine really took off. So naturally most things anatomical were given Latin names. For example "osteo" for bone, "cyte" for cell and "atrium" for, uh, a little room but is used to describe a chamber in the body, usually the heart.

Lately there has been a big fuss in the scientific community about naming conventions. Throughout much of history body parts were named according to their structure, location or function. More and more there is a trend toward naming things for people. For example the area in the brain that controls speech is called "Broca's area" for the fella who spent a lot of time in there.

Personally I'd rather like naming things for their structure, location and function. When I see a medical word,for example "suprarenal arteriogram" (and I just made that up; I don't even know if there is such a thing). I can figure out what the heck it is by analyzing the word. "Supra" means above or over something. "Renal" means kidney so I know that there is something above the kidney. "Arterio" is a combining form of "artery" so okay, I know that the thing in question over the kidney is an artery. Then "gram" is a diagnostic study. So AHA - this is a diagnostic study of an artery that is over the kidney.

If they had named this test or this artery for someone I'd be lost. Let's say Dr. Slim Goodbody spent his career studying arteries above the kidney and he figured out a way of looking at the artery with some cool instruments he had lying around, they could have called this a Goodbody Study or a Slimogram. Then I'd be forced to have to look up the word then make the effort to remember that a Goodbody Study is a way of checking the renal arteries. It's a lot easier for me to be able to analyze the word when I see it and not have to commit it to memory.

But that's just me.

The other thing I like about medical terminology is it's a great way of concatenating a whole sentence into one word. Orthostatic hypotension is a way of saying "when-the-patient-stands-up-his-blood-pressure-drops-and-he-passes-out." See? Isn't orthostatic hypotension so much better?

No? Okay. For your amusement I have created a list of medical words that describe everyday events and situations.

alopecia - I am bald
bezoar - I have a hair ball
borborygami - My stomach is growling
coryza - I have a cold
diplopia - I'm seeing double
dypnea - I can't breath
dysgeusia - everything tastes funny
dysmenorrhea - My periods are horrible
dysuria - It hurts when I pee
echolalia - Hey! Stop repeating everything I say.
epistaxis - My nose is bleeding. AAAAHHH! MY NOSE IS BLEEDING!!
eructation - Erp! Excuse me
flatulence - Okay, who floated the air biscuit?
hematuria - there's blood in my pee
hemoptysis - I'm coughing up blood
hirsutism - I am a woman with a moustache
masticate - I am chewing
melena - There's blood in my poo
menometrorrhagia - I bleed like a stockyard hog
orthopnea - I can't breath if I lie down flat
pectus excavatum - I'm a dude who's chest is caved in instead of out and therefore I never take my shirt off in public
piloerection - I'm so scared that my hair is standing on end
polyuria - I pee all the time
presbyopia - I need reading glasses now that I'm 40
priapism - I have a boner that won't quit
pyrexia - I have a fever
pseudocyesis - I have all the symptoms of pregnancy but I'm not pregnant
somnambulism - I walk in my sleep
syncope - I passed out
tinnitus - my ears are ringing
vertigo - I'm dizzy

Who knew that a four-hour erection could have such an interesting name?

Friday, November 2, 2007

Hush, Hush, Keep It Down Now.......

My classmates would like for me to shut up.

I read a blog somewhere but gosh darn didn't save it. The blogger told the story of a middle-aged female know-it-all in her class who never stopped talking and never missed an opportunity to tell stories.

She could have been talking about me, but I'm not sure. I do answer a lot of questions in class, but as far as I know I don't launch into long-winded stories about my personal experience and how it relates to the lecture. At least not on purpose. I, too, am annoyed by over-sharing in the classroom. I want to get the relevant information nailed down to what will be on the test and nothing more. I, too, want to get the heck out of the class just as badly as my bar-hopping, mini-van drivin', second-shift working, pick-the-kids-up-from-school classmates. Even if all I'm going to do is go home, take a nap and watch Oprah, I'm just as eager to get to that as they are to get back to their lives.

For the first part of the semester I was sitting next to someone who has a really bad habit of asking questions during class. Unfortunately she doesn't ask the instructor these questions. She asks the person sitting next to her.

It goes something like this.

This is what the instructor said.

"Gliomas are malignant brain tumors that are classified by their cell types or their location. For example astrocytomas arise from neuroglolial cells. And if you'll recall there are two kinds of nerve cells which are neurons and neuroglolial cells. Anyway, astrocytes are a kind of neuroglial cell. But what is important to remember is that astrocytomas can form anywhere in the cerebral hemispheres. Then there are oligodendrogliomas are usually only located in the frontal lobes, and they are distinguishable from other gliomas because they are usually calcified."

This is what I heard:

Instructor: Gliomas are malignant brain tumors that are classified by their cell types or their location. For example astrocytomas...
Classmate: What?
Me: Astrocytoma.
Classmate: What?
Me: Astrocytoma.
Classmate: How do you spell that?
Me: Um....(initially trying to motion that is in the powerpoint up on the screen four feet high in front of the classroom.....then giving up) A-S-T-R-O....
Classmate: Oh yeah. Okay. I see it now. Is that an A or an O?
Me: It's an A.
Instructor:.......because they are usually calcified.

I would like for my classmate to shut up.

Every time she asks a question and I turn to answer her, I miss the next four things the instructor says.

I tried body language.

Classmate: What?
Me: (Looking fixedly to the front.)
Classmate: (Nudging me) WHAT?
Me: I'm sorry, I'm trying to listen.
Classmate: Oh. Well. It's a good thing I know you cause I know you're really not a bitch.

I tried talking to her before lecture.

Me: I know there are lots of things you miss during the lecture, but could you raise your hand and ask the instructor? When you ask me a question and I stop to answer you I miss the next thing she says. Okay?
Classmate: Okay. Yeah. Cool.
Later during lecture........
Classmate: What?
Me: (Putting finger to lips and pointing to the instructor.)
Classmate: What?
Me: (smacking self in forehead)

Since I couldn't get my wish that she would shut up, I resorted to looking for another empty seat in the class. I found one probably six seats away from where we were sitting and moved myself to that seat about two weeks ago.

One day I bumped into my questioning classmate during break and we had this conversation.

Classmate: I noticed you moved and I bet I know why.
Me: I know. I'm sorry. I really hated to move. I asked you to ask the teacher questions instead of me. I really need to concentrate or I get lost during the lecture.
Classmate: (Look of horror on her face) YOU MOVED BECAUSE OF ME?!?!

I don't know what she meant when she said "I bet I know why." I figured we were thinking the same thing. I was terribly, terribly wrong.

She hasn't spoken to me since.

Thursday, November 1, 2007

Don't Have A Cow, Man

My poor blog. It's so empty lately.

I failed an exam this week and so today I was sent to the principal's office.

Actually it's called "remediation". We review our exam with the professor and figure out what went wrong. I've never failed a test before so this was a devastating experience. But not being one to wallow, I have put it behind me so I can focus on the next test.

The professor didn't get on my case too much. She told me "I know you know this material. You just made some silly mistakes." And boy did I! I made two silly mistakes on math problems by switching what the prescribed medication was with what was on hand, basically quadrupling the dose and killing the patient.

Let me just pause a moment and tell you that I love my professor. She was in the military for years and don't take no mess off nobody. A few tests ago when some of the students were protesting their lousy grades, she reviewed the test scores and said "the grades stand. End of story." Last week she was lecturing and told us that she was giving us some information for our benefit but that it wouldn't be on the test. As she talked a student raised her hand and said "would you repeat that?" The professor said "why are you writing this down? I told you I'm just giving you this information for your benefit and it won't be on the test. We're already behind on the lecture and I can't stop to repeat things. You just have to write faster."

I wanted to marry her on the spot. I love bossy women.

My personal life has been a gauntlet of stress and I haven't been able to study as much as I would like. But I've made some changes. I asked my boss to schedule me one less day a week and see how that goes.

I promise to come back to enlighten and entertain you with some fun medical words I've learned. Honest.

Wednesday, October 24, 2007

Always Look On the Bright Side of Life

Last year my classmates and I kept hearing about how third semester was the most difficult semester in nursing school. "Difficult", we snorted. Nursing school is already difficult. I can't imagine it being more difficult than it is now.

I'm reminded of the stoning scene in Monty Python's Life of Brian. The dialogue went something like this.....

OFFICIAL: You're only making it worse for yourself!
MATTHIAS: Making it worse?! How could it be worse?! Jehovah! Jehovah! Jehovah!

Matthias has no idea what he was talking about. It can ALWAYS get worse. If you ask how it could be worse, you will find out soon enough.

I haven't been blogging much because this semster has been a special kind of hell. I'm doing okay but I feel like I'm treading water most of the time. Last year I settled into a routine quickly, got myself organized early on and stayed that way the rest of the year. This year has been completely different. I constantly lose/misplace things. I forget assignments. I'm scrambling to do things at the last minute. There are people who function well this way. I'm not that person.

I will spend the rest of the day in front of my computer working on some assignments with serious deadlines. Since I'm here anyway I thought I'd sneak in and vent a little.

Don't you find it annoying when people ask the same question over and over? If you happen to have the name of a famous person; say your name is James Bond. Don't you get sick and tired of people saying "hey double oh seven"?

Being in the medical field means you are endowed with information that most people don't have. Since you have this knowledge people continually ask questions, and often it is the same question over and over again. Or they repeat some really bad piece of information. For example when people talk about something that runs in the family, like twins or cancer of some kind. Sooner or later that person will say "but it skips a generation." Yesterday I heard someone refer to a really limber person as "double jointed." Aaaaaaaargh!

I am struggling to not get annoyed by it. I'll get there eventually, but today I'm annoyed and I felt like getting it off my chest. I found this discussion a while back. Reading it made me feel not so alone.

This past week I heard a couple of whoppers that I just can't shake. I was talking to a patient about my career goals. I mentioned that I like the OR because the atmosphere is laid back and sort of fun. She said "well if I'm the one having surgery I would insist that everyone in there refrain from having any conversations while I'm asleep because it would affect my healing." I'm sorry. I couldn't help laughing. I know I should have kept my composure and used it as a teachable moment. I could have said that the media blows things out of proportion by telling stories about people saying nasty things about patients while they are under anesthesia. I'm sure it happens, but believe me when I tell you that you aren't interesting enough for us to talk about. I could have told her that most people in the OR are professional enough not to do that even if there was something interesting about you that we want to comment on. Just like there are no rules about farting in the OR, no one does it because it's not polite. The same is true of saying unkind things about unconscious patients who are under our care. We could do it, but we would look really foolish if we did.

But I was tired and not in my right mind. Certainly the medical field could use more compassion and practice some alternative healing methods, but not this day and age of managed care hassles. Go ahead and tell an OR full of people who will be on their feet all day, working on one case after another, that you would like for them to be quiet because of some freaky New Age belief you have. Go on. I dare you. I think I managed to say "I'm sorry but I disagree." Nevertheless I'm sure I alienated her for life. She's a dialysis patient so I see her on a fairly regular basis. My bad.

Then last week while I was in ER clinicals a patient got angry with me about her blood pressure reading. She said "There has to be something wrong with that blood pressure cuff. My diastolic is always the same as my IQ."

This time I was better. I blinked a time or two, made sure there was a pregnant pause and said "I'm speechless."

What a jerk! First of all she was trying to dazzle me with the fact that she knows what a diastolic blood pressure is. Second, she was trying to dazzle me with what she feels is a high IQ. I wanted to tell her that if her diastolic were to reach what some might consider a decent IQ, she'd probably better get herself to the ICU because she would fixin' to have a stroke.

People! I swear!

I don't want to get into how the health care system has brought us to the point that we have to interact with mentally unstable folks on a regular basis because they have nowhere else to go. I don't want to talk about how we could, if things were better, take time to grant the patient's every wish and do things exactly as they want them done; at least not today. For now I am taking my cranky self off the Internet to work on my clinical log and power point presentation.

Hopefully when I return I'll have adjusted my attitude and have a brighter outlook. Until then....

Life's a piece of shit, when you look at it.

Thursday, October 18, 2007

That Smell

I wasn't sure how much longer I could go without discussing the scatological. I suppose that it was inevitable that the subject would come up eventually.

One of the most important things a nurse does is take care of a patient's basic needs - oxygen, temperature control, food, fluids, safety, pain management and elimination. The last one weirds out students and potential students. Many a nursing student has learned to his or her horror that we have to manage poop.

When we learn basic care, it was a shock to us all that we had to evaluate poop. That means we had to look at it and notice the color, size, consistency and, yep, the odor. We have to be able to tell if the odor is normal or if there might possibly be blood or infection in there.

I have to admit I wasn't sure how I would hold up under the unpleasantness myself.
And really it's not a big deal. I got over it when I had to do stool cultures on a patient, and to make it more interesting she was given a laxative that morning. I was in her poo every 15 minutes for the rest of the day. After that many excursions there really isn't any room left for feeling disgusted. It became as normal to me as doing just about any other kind of work.

Having cleaned up lots of poop over time, I began to see things more from the patient's perspective. If I were to put myself in their place, and someday I just might be there, I think I would be very grateful to have someone willing to clean me up and put me back together with a smile. I would appreciate knowing that my normal bodily function is not a source of disgust, but accepted as a normal human function. When I clean up a mishap, I try my best to make keep my facial expression neutral, get a conversation going about anything other than what is happening, and contain the aftermath quickly to keep the smell down. I know that given the choice, they would rather I not have to do that for them. But since I do, I try and make it better for both of us.

The question I hear frequently is "do you ever get used to the smell?" The answer is yes you do. Just like you get used to an unpleasant part of any job, whether it's lousy coffee, a tempermental copier, office politics or micromanaging bosses, you adapt to dealing with the smell. Some people suggest putting Vick's or a piece of gum in a surgical mask and covering your face with it before dealing with poop. My best advice is to let yourself get through it. After a couple of whiffs you don't notice it so much anymore.

Given the choice I'd rather deal with bad smells than I would a chatty co-worker who wants to share every detail of his life from the time we said goodbye yesterday until he showed up this morning; from what he had for dinner, to what he watched on television to the dead squirrel he saw on the way to work. At least the former is over rather quickly if you can manage it well.

Just please remember to wash your hands before you leave the room.

Monday, October 15, 2007

The Fire Down Below

I love nursing school. You get to have some of the best conversations on topics that are completely taboo other places.

The topic last week was cancer. The instructor was talking about how chemotherapy works on rapidly-dividing cells including cells that line the GI tract, skin cells and hair follicles. Because of that, as most people are aware, a person who gets chemotherapy loses her hair. What most people don't know is that patients lose ALL their hair including eyebrows, eyelashes and pubic hair. Nobody blinked. We're used to hearing information about woo-woos and wee-wees by now. We've seen lots of naked people and had our hands in poop too many times to count.

The kicker was what she said next. She told of a woman who lost her pubic hair and then had trouble controlling the direction of her urine. She said that every time she peed she got it all over the toilet seat now that she didn't have her pubic hair there to direct it to the right place. I saw many female heads turn to each other and mouth "what the........"

During break I talked to some of the women whom I saw squirming when they heard the pubic hair story. What I found was that a very large number of women in my class have a grooming practice that was unheard of when I was in my 20s. Many young woman shave their pubic hair. Not only do they shave but they can direct their urine to the toilet just fine.

I'm not talking about the sideburn-variety bikini wax that was common in my younger years. They shave further and more completely than anything I'd heard of before. Until recently I thought shaving pubic hair meant shaving it all. No, I'm talking about what is known as a Brazilian. Shaving the whole thing to make you look 6 years old again is called a Sphinx, and from what I've been told is fairly uncommon outside the porn industry.

The knot of people gathered around the vending machine got other people curious to find out what all the fuss was, and I was able to do a rather scientific poll of the women, and men, about their attitudes toward shaving pubic hair. Of course, the men were enthusiastic fans of the practice. What I found was that the line between women who shave and women who don't is somewhere in women in their 40s. Everyone I polled said that there was no way their mothers would consider doing such a thing. I didn't get to ask any women in their 40s if they shave their pubic hair because, once they heard what we were talking about they scampered back into the class and said nothing. I won't talk about my shaving practices because I'm sure anyone who knows me doesn't care to know me that well. I will say that my daughter told me of this nifty electric shaver about the size of an electric toothbrush that saves me tons of money on getting waxed.

So why the difference? There is definitely a shift in opinion from one generation to the next, but why? Is it possible that the 40-somethings shave but don't talk about it, or they just don't shave and also don't want to talk about it? Could it be that swimwear has changed enough to make it necessary to shave more? Is it because the Internet has made pornography more accessible and women or imitating porn stars?

When I was a child we were given "the talk" in fifth grade about babies and feminine hygiene, but the message was loud and clear; it's dirty and nasty and you don't talk about it. You ignored your genitals and pretended you didn't have any. I grew up in the so-called "sexual revolution" but that just meant that your body was even more available to be exploited by men. There was Playboy and Penthouse, but that sent the message that your genitals are for the enjoyment of men, and not yours to touch or take care of. In other words, the sexual revolution was for men. Women were still expected to keep those genitals locked away in a secret place until marriage. Until then you pretended you didn't have any and you only spoke about it in euphemisms . After all, we had Barbie as our example. Everyone who has a Barbie has taken off her clothes, examined her stem to stern, and found a smooth, plastic mound where the genitals ought to be. Yep. If we are to be like Barbie we must imagine our genitals into non-existence.

Nowadays women are much more comfortable with their bodies. They are comfortable with the fact that they have genitals, and they don't exist just for the pleasure of men, but are a part of their bodies like noses, hands and feet. Shaving their pubic hair is just another part of their regular grooming, as normal to them as washing their hair and cutting their toenails. To me, the fact that they are paying attention to their pubic hair says that they value their bodies, their WHOLE bodies, enough to pay attention and take care of them.

I even found this discussion among some nurses when a patient asked a nurse to shave her pubic hair, and the nurse was just sure the woman was trying something sexual on her. I'll save the discussion about how lesbians are not men for another day. It's not all that uncommon for men to ask for certain hygiene assistance because it turns them on, but it's rare for a woman to do this, especially from another woman, and let me put a finer point on it by saying why would you even think this when both women in question are straight?

I mean, really. Who among us would ask another woman to do something sexual to us when we are lying on our backs, not having bathed for a few days, feeling stubbly and grungy, people are constantly walking in and out so there is no privacy, you are likely in a lot of pain and scared to death of losing some body parts? That is probably the least sexy scenario I could imagine. All the candlelight and soft music in the world can't cancel it out. I don't care who you are.

Friday, October 12, 2007

I Keep Working My Way Back To You

Sorry folks. Life has kept me away from my blog this week, and I'm trying my level best to not be cranky. My SO had shoulder surgery, the fourth surgery since January, and I've been playing nurse in my personal life. It's been very time consuming, and while I don't mind doing it, it has taken me away from doing other things.

Then yesterday I had a meeting to go to at my job. As I was leaving the building at 6:00 p.m., my boss stopped me and told me I had to get recertified in water treatment (I'll explain later). Long story short, I ended up staying until 8:00 p.m. last night. It would have been nice if I had a head's up that this was happening. I would have eaten dinner BEFORE I went to the meeting.

So instead my SO and I raced to get dinner before everything closed, snarfed down our food, and now I have a tummy ache today. Today and tomorrow are my two busiest days of the week, sort of the beginning of a horrible gauntlet, and going into these two days tired before I start, does not bode well for how I'm going to feel on Sunday.

Anyway, on Sunday I'll come back and share a conversation I had with my classmates about pubic hair. I've been cogitating on the topic for days, and it's really driving me nuts that I can't get back to my computer and finish it.

Oh, I am no longer license pending. I got word yesterday that I passed my board exam and I am now a nurse.

*bowing deeply*

I have to think of a new blog name. I'm not feeling especially creative so I have no idea what to call myself.

Tuesday, October 9, 2007

Lay Down All Thoughts, Surrender To the Void

I took the LVN board exam yesterday. Here are some observations made during my experience.

1. It helps to drive to the testing center some time before the test to you know exactly where you're going.

2. Taking a dry run to the testing center doesn't help if you don't get up early enough.

3. Everyone who has a white car drives really slow in the fast lane. As I was racing to the testing center every idiot that was driving slowly in the left lane and wouldn't let me pass was driving a white car.

4. I hate white cars.

5. If you react to stress by getting a case of the trots, take some over-the-counter medication for diarrhea.

6. Taking the anti-diarrheal medication after you get to the testing center doesn't help.

7. When you take the test, you will not recognize about 75% of the information as having anything to do with what you've studied.

8. No amount of studying in the world will prepare you for this.

9. When you freak out about not understanding 75% of the test, you will not notice that there is a calculator button in the lower right corner of the test screen, and you will do all the math by hand.

10. When you stop at the convenience store to buy a pack of smokes to self-medicate following your disappointing testing experience, the clerk will humor you and ask to see your ID.

Saturday, October 6, 2007

Wake Me Up When September Ends

Holy smokes, I saw somebody die today.

I was working at my dialysis job and things happened so fast that I can't remember what made me realize something was wrong. Next thing I knew a few of us were standing around a patient shaking him, calling his name and getting no response. His eyes were wide open, mouth gaping open and he was having agonal respirations. I felt his neck for a pulse and felt nothing.

The nurse brought the crash cart and had the foresight to tell someone to put privacy screens around the chair so the other patients couldn't see what was going on. The clinic I work in has three rows of five chairs about two feet apart. Everyone can see everything that's going on.

The downside of working in dialysis is that death is frequent. It's different from other specialities because we have long-term relationships with our patients. We see them three times a week for years, sometimes decades. When someone dies it's a terrible loss for us and we grieve every time. In the hospital, especially in the ER, there isn't time to get to know someone, and if you do become acquainted with them, it's for a shorter time. That's not to say it's not difficult. Death is always sad for health care workers. For dialysis professionals it's different. These people are like our family.

We're not the only ones affected. The other patients are affected too. Whenever someone dies a wave of fear goes through the clinic. Patients with end-stage renal disease are very, very ill and usually in a long, downhill slide. They never know when they'll reach the bottom. It's especially bad if a youngish patient in seemingly fair health dies without warning. They are terrified that they might be next. Having a patient die in the chair next to them is even more horrific.

This is the first time someone has coded while I was in the clinic. I cannot imagine what the other patients were going through while this guy was coding. I applaud the nurse for putting up the privacy screen. Even though it didn't completely block the sights, and none of the sounds, anything to soften the effect was worthwhile.

When it was over my adrenaline was pumping. I understand now why people are drawn to working trauma care. It was an unbelievable high. That's something I didn't know about myself.

Later on I learned that they managed to revive the patient in the ER, but he coded twice more. Even though he was alive last I heard, I don't think he'll survive for long, and if he does he'll probably be on life support until someone makes the decision to withdraw it.

It's funny that after more than a year of nursing school, I'm just now really getting into the thick of it. For all the times I wondered if a career in nursing was the best choice for me, on days like today I have no doubt. I definitely made the right decision.

Friday, October 5, 2007

Watch Out Boy, She'll Chew You Up

It's that time of year again. There's a chill in the air, restless creatures are stirring and ghouls with murderous fangs and dangerous claws are lurking in the shadows.

Yes, it's time to start nursing school clinicals.

Nurses have this ugly reputation that has an even uglier slogan - "THEY EAT THEIR YOUNG".

Many's the time I've been warned by nurses that once I get my first nursing job, I have to watch out for the older, more experienced nurses. I've heard they are mean, nasty, unsupportive and bitchy.

You know, it doesn't sound all that different from any place I've ever worked.

Still, I wish those nurses would cut it out. They're scaring the nurslings who are still in school. Having been in clinicals for over a year now, I haven't found nurses to be all that scary. Most of the time the nurses are patient with me and enjoy teaching. That's not to say I haven't had my share of nurses who weren't very easy to get along with. From what I've seen, it's usually a personality quirk. Once in a while the nurse I'm working with and I don't get along all that well because our personalities clash. All of us can think of someone we don't like and we can't put a finger on why. We just don't like them, period. But I'm there to learn, not make friends. If the nurse and I like each other it's a bonus. It's not a requirement.

I try and put myself in her shoes. I think about how I would feel if I'm having an off day; the alarm didn't go off, the neighbors fought all night and I didn't sleep, I'm behind on my bills, the dog crapped on the floor in the middle of the night and I'm PMSing to hell and back. I get to work and here is an eager, fresh-faced nursing student brimming with enthusiams and ready to save the world. Not only do I have to struggle to put on a game face for my patients, I also have to manage a nursing student. I have to slow down and explain everything. I have to coordinate my care around what the student does. I have to figure out which patient would be the best choice for them to care for. Then I have to go behind the student and make sure they did what they were supposed to and be ready to step up and take over if they don't. Forgive me if I'm not all teddy bears and rainbows.

To make the experience better for everyone, we can do what we were taught from the time we were in grade school. Be nice. Be polite. Be helpful. Keep your snarky comments to yourself. Say please and thank you. And students, suck it up and do what you're there to do. Pay attention. Do what your instructor tells you to do. Learn.

And whatever you do, pull in your claws and give those fangs a rest. We've got work to do.

Wednesday, October 3, 2007

Are You Experienced?

Last week we took our exam on the topic of high risk OB. For a lot of people, including me, it is our worst subject. When I took the mid-curricular HESI last spring, I missed every single question on the OB portion of the exam. A lot of guys don't do well because almost every male nursing student I know hates OB.

For the women a different dynamic come into play. I would say the majority of female nursing students are mothers or have been through labor. For some of us it was as long as 20 or 30 years ago. This is a problem because what happened to us then is different then what happens to patients now. Our experience in labor and delivery is probably very different from what we need to know for the test.

This is true of nursing in general. What happens in nursing school is very different from what happens on the job. I don't have very much experience in actual patient care. The small amount of experience I do have has proven to me that there often is no direct application of what we learned in school to actual hands-on patient care.

I had written in a previous post about the pros and cons of going to nursing school at middle age. One of the problems we encounter is what we learned a long time ago may have changed. The medical field is constantly changing. New research is being done all the time. What used to be the gold standard for a certain kind of care, is later found to be either ineffective, dangerous or it doesn't matter one way or the other.

For example, pre-eclampsia. Years ago this used to be called toxemia. The treatment is still the same but the name has changed. What has changed is the treatment for preterm labor. In the past a woman who was having contractions before she was due was ordered strict bedrest. Studies have shown that there is no conclusive evidence that bedrest makes it any better or worse. In fact studies point to evidence that bedrest is actually slightly more harmful, not so much to the unborn baby, but to the mother and her quality of life. If a mother is ordered to bedrest and has other children, she needs to find someone to help her care for the other children. Nowadays most women work outside the home. If a Mom is placed on bedrest, she has to quit working which creates financial difficulty for the family. Then there is evidence that putting Mom on bedrest can cause her muscles to weaken and lose their function. This can be a problem during labor when Mom needs those muscles to help push the baby into the world.

So in weighing out the pros and the cons, the experts have figured out that the slight benefit, if any, of bedrest does not outweight the downside of being in bed. What I love about this is that more and more often medical care is focused on not just the physical aspect of a medical condition, but all the parts of a person's life that can affect their condition; their quality of life.

The problem is if you are a middle-aged woman who experienced preterm labor decades ago, you may apply your experience to the test question and not what was in the book or the lecture. The challenge is paying attention to what the information is today. When I'm taking a test I have to ask myself "okay, is what I'm thinking what I just learned, or is this something I remember from way back when?"

For the guys I have no idea how this information affects you. I cannot think of anything in urology that has come along in the past decade or so that can affect what you learned 30 years ago.

Oh wait. I just thought of something.

Think about what I talked about before. Your health problems and your choice of treatment don't just affect you, but other people in your life.

And remember, get help if your erection lasts longer than 4 hours. Not only will it be a test question, but it'll seriously cut into your action if you don't apply it to real life.

Tuesday, October 2, 2007

The Long and Winding Road

I am acquainted with someone who has been back and forth about going to nursing school. First she was working on pre-regs, then decided to start an ambulance company, then pre-regs again. Now, six weeks into the semester, I heard her say she's thinking about not going to nursing school but might go to PA school instead.

For a minute I was all smug and self-righteous. I kept thinking, "How are you ever going to finish nursing school if you keep changing your mind?" It's very difficult to get in and the only way you can get through it is to stick to the plan, keep your eyes on the prize and take one step at a time.

But then I began to think about my own circuitious path to nursing school and I simmered down. I like to tell people that it took me four years to get in. This always brings a gasp and a look of horror. Why did it take so long? When I think about it more deeply my own past is littered with near misses and coulda, shoulda, woulda moments, and my path to nursing school actually took 25 years. That's right. Twenty-five years.

So for your amazement and amusement, here is the timeline for my path to nursing school. See if you can spot the times I should have gone to nursing school but chose another path instead.

1982 - Began work in a nursing home as an activities director. Got the job because my husband at the time knew some people there. Looking through the patient's charts I was mesmerized by what I found. I found out that I love medicine.

1984 - Took a medical terminology class with the loose idea of becoming a medical secretary - "somewhere" but no real plan.

1985 - Got a job at Planned Parenthood, again because of someone my husband knew. Was hired to do community outreach but mostly worked as a medical assistant. Decided to start college.

March 1986 - Enrolled in my first college class - basic math. Dropped after 3 weeks because "it was too hard."

August 1986 - Applied for a job doing patient transport at a local hospital. Was offered a job in medical records because my work at Planned Parenthood introduced me to the concept of confidentiality, my class in medical terminology, and because I know how to type.

Early 1987 - Became a coder when my boss said "Come here and let me show you how to do this." Now coders need 2 years of college and have to pass an acreditation exam.

September 1987 - Job has benefits that include tuition assistance. Decide to enroll in a corespondence course to become an accredited records technician. I sell my car and ride my bike to work so I can afford the class.

April 1988 - Discover that 30 hours of college credit are required before a person can take the accreditation exam for medical records. Drop out of the course with plans to get the college credit classes needed, and then restart the program later.

June 1988 - Enroll in college classes. Actually finish 3 classes in one year taking one class per semester.

1989 - Move to another part of the state. Get a job in a hospital as a file clerk on weekends. Learn how to do medical transcription when my boss says "Come here and let me show you how to do this."

1990 - Discover that the local Small Town College offers an associate degree in medical records. Get financial aid and enroll full time.

1991 - Move again, this time to a large city with lots of opportunity. I look for a transcription job. The classifieds has 7 columns of transcription jobs. I find one easily.

1992 - Begin the process of enrolling in the medical records program at the Big City University only to find that the Small Town College was not accredited, and none of my credits will transfer to the University. A whole year of college down the drain.

1993-1994 - Various medical transcription jobs. Each one sucks more than the last.

1995 - Sick and tired of sucky transcription jobs, decide to get an education in something, ANYTHING, and take an algebra class.

1996 - 1999 - Life circumstances require me to work two jobs to survive. College not an option. More sucky transcription jobs. Oh well, Y2K will wipe out civilization as we know it and it won't matter.

2000 - Civilization intact. A friend tells me she can teach me to be a programmer and I can make a bazillion dollars.

Early 2001 - Friend was wrong as I am highly unteachable. Decide to pay good money and go to college to learn programming.

August 2001 - Take a class in logic required to start programming classes. I get an A. Wow!

March 2002 - Begin classes in Visual Basic. Everyone in the class has a programming background but me. I am quickly lost.

May 2002 - Get a Visual Basic certificate by the skin of my teeth. After crying for 2 hours because I can't understand my homework, in frustration I decide to go to nursing school. Hey, how hard could it be? I could start in the fall right?

September 2002 - Wrong. There are many prerequisites needed for nursing school. I look into every nursing program I can find and begin jumping through their hoops. Retake the ACT that I took back in 1977 to raise my score to what is required for school-A. Enroll in classes required for school-B as a back-up.

October 2002 - Look for a job doing Visual Basic as a way to pay for my education. All programming jobs move overseas. No jobs to be found. Continue sucky transcription jobs.

January 2003 - Register for more classes to meet requirements for what is required for school-B. Get word that my mother is terminally ill.

February 2003 - Drop all classes to be with my mother while she is dying.

June 2003 - Take 2 classes during the summer to meet requirements for school-B. Pay off student loan taken out to attend Small Town College. If you do the math, that's 13 years.

September 2003 - Take pharmacology as required to get into school-A.

December 2003 - Failed spectacularly in pharmacology. School-A says "thanks but no thanks."

January 2004 - School-A says "Awww, we were just kidding! You're in." Hastily quit job and make arrangements to start at school-A.

February 2004 - Dropped from school A because I cannot pass math. Lose my grant and have to pay for a whole semester of classes even though I was only there a month, and now I don't have a job. Apply to school-B.

March 2004 - Found a transcription job from the ever dwindling supply that haven't been sent overseas. Continue working on preregs at school-B.

April 2004 - School-B sends a letter saying "Thanks but no thanks." Spend rest of the year on preregs anyway.

January 2005 - Apply to school-B. Take entrance HESI.

April 2005 - School-B says that I have been placed on an alternate list in case a student who has been accepted doesn't attend school, I can take their place.

July 2005 - Getting close to time for school to start. Decide to find out how far on the list of alternates I am. I am number 63. Sixty-two nursing students have to die before I can get in.

August 2005 - Retake some classes to improve my chances of getting accepted. Meanwhile left transcription for good and began work as a dialysis technician to get some patient care experience. Basically took classes full time while learning a completely new career.

January 2006 - Decide to see if I can get accepted into the LVN program then maybe take a transition program later. Drop by the school to find the deadline for admission is the next day. Spend the rest of the day getting everything together that they require for my application. I make it.

February 2006 - Apply for the RN program. What the hell. Retake HESI for a better score.

March 2006 - I get accepted into the LVN program.

March 2006, one week later - Get word that I have been accepted into the ADN program. Give up my seat in the LVN program to another deserving candidate - who probably has her LVN license today.

August 2006 - Begin actual classes in nursing school.

Sunday, September 30, 2007

I've Got A Bad Case of Lovin' You

Here is some nursing school gossip that you didn't hear from me, okay?

One of my classmates is getting a divorce because her husband is pressuring her to quit nursing school because, get this: he is afraid that once she's a nurse, she'll dump him and marry a doctor.

Holy 1953, Batman. You mean, once she gets out of the house, has her own money and *GASP* unchaperoned access to men she won't be able to control herself? There's no time to waste! Take away her credit cards, her driver's license, her right to vote, her brain, put a skirt on her and wipe that make-up off her face. What's that? A packet of birth control pills! Here, get rid of 'em, quick. If we let this woman control if and when she gets pregnant she'll be screwing everyone left and right. All birth control pills do is turn women into whores.*

*My very own grandmother said this to me.

We're a long way from Seneca Falls and I don't mean to get up on my feminist soapbox, but WTF? If I wanted to marry a doctor, why would I bother with nursing school? Couldn't I just join a country club or a medical society? Couldn't I ask my friends and family to introduce me around? Couldn't I go to

I usually have an issue with medical TV shows, not because of the accuracy or lack of it, but the unreality of being able to stand around and BS with my peeps. That and I cannot fathom a hospital being okay with already overburdended staff taking care of dogs, chimps and Bambi. But lately I've noticed they've got one thing right. Doctors don't date nurses; they date other doctors. So really, if I want to improve my chances of hooking up with McDreamy, wouldn't it better if I went to medical school? "Ah my darling, listen closely and you'll hear my heart; even closer and you'll hear the Kreb's cycle."

Obviously the issue is more about him and how his own insecurities about himself. He thinks he isn't good enough for her, and makes her suffer for it. It doesn't matter what she does; he'll always try keeping her one step behind him, one level below him. I think she should dump him for being a Neanderthal. Everyone knows that they shouldn't interbreed with Cro-Magnons anyway.

I suppose it still happens that women do try and snag a doctor. I guess it's the money and all; but nowadays most women have their own money. They don't have to marry a doctor to get it. As I see it, the benefit of marrying a doctor for his money is that he's never home. While he's out on-call I could watch whatever I want on television and have a cold hot dog and some Tang for dinner. You have to work on Christmas AGAIN! That's okay. I can sit around in my pajamas all day and watch movies. Besides I can't stand your parents anyway.

But by far the best reason I heard for this being a ridiculous idea came from our clinical instructor. She listened to my classmate's frustration and obvious pain over being accused of wanting to marry a doctor. She let out a small chuckle and said "has he SEEN some of these doctors?"

Saturday, September 29, 2007

A Cute Abdomen

This is exactly why I want to work in surgery.

Oh sure, there's the sit-down-once-in-a-while appeal, but the suspense of trying to figure out what is going on with a sick person gets my juices flowing.

I can't get enough of this stuff.

Friday, September 28, 2007

It's Not Brain Surgery

But today it was.

I got to spend my clinical day in the operating room and got to see an actual brain surgery. The doctor was good enough to hold the brain hemispheres apart enough for me to see the optic nerve and communicating arteries. Oh yeah. That completely rocked!

It was a day of relying in communicating with mostly eye contact, since everything from the nose down was covered. Good thing I did my eyebrows before I left for clinicals this morning.

Ever since I have entertained the notion of being a nurse, I thought I would like to work in the OR. Working in the OR has several characteristics that I like.

1. The circulating nurse spends a lot of time on the computer and on the phone. For an office refugee like me, that's a natural transition.
2. It's freezing in there. I'm hot all the time, so the frigid atmosphere agrees with me.
3. Doctors like to listen to music while they operate. I like to listen to music while they operate. That's a win-win.
4. There are cool instruments to play with.
5. The patient is asleep.
6. The patient's family is in the waiting room.

The nurse plays two basic roles in the OR - scrub nurse and circulating nurse. The scrub nurse works in the sterile area with the doctor, sets up the table with all the instruments the doctor will need for a case, and then passes instruments back and forth and deals with used equipment that the doctor no longer needs. Nurses don't get to be in the scrub role very much anymore. Hospitals have found it cheaper to hire scrub techs for the job instead.

The circulating nurse sets up the room, tests the equipment to make sure it's working, monitors the room to make sure no one breaks into the sterile field, and basically runs errands so that people who are already in the sterile field can stay there. So after anywhere from a few minutes to an hour before the case, there is lots of frenzied activity getting things ready for the operation. Once the surgery starts, things quiet down and everyone gets down to business.

Notice that she's sitting down.

I love it.

I'm very much taken with the work environment, and I think work environment has a lot to do with how well you like your job. I'm trying to be realistic. I don't want to wind up quitting nursing after I've put so much time and effort into my education. Every time I ever go to the OR, it feels like such a good fit for me. This feeling never changes no matter how many times I go.

As for the patient being asleep and the family in the waiting room, I don't want to sound mean, but in my short time in nursing school I have found the most difficult thing to deal with in the nursing role is patient's families. There are difficult patients from time to time, but difficult family members outnumber difficult patients 10 to 1. Many times the patient and I are getting along just fine. He or she is clean, fed, medicated and comfortable. Next thing I know a family member comes in demanding that we "DO SOMETHING" for their family member who was perfectly content last time I checked.

Inside I feel myself screaming "let me do my freakin' job, okay?" I can do a fine job taking care of someone, making sure they are safe, that they are getting the right medication in the right dose at the right time, that they are clean, dry and pain free all without you giving me the hairy eyeball, telling me stories about how you got someone fired for not doing something the way you wanted it done. What is going through a person's mind when they threaten a nurse or student like that? If you're trying to impress me or earn my respect, you're failing in a spectactular fashion.

Over the summer I was taking care of a man who had knee surgery. I did my usual thing - check him top to toe, bathed him, made sure he was not in pain, made sure he was eating okay, had enough blankets, had fresh ice water in his pitcher and had everything he needed within reach. About an hour later I went in to check on him and half a dozen family members were swarming around the bed. One of them snarled at me "turn down the thermostat. It's too hot in here." There was no polite request, for example "can you please turn down the thermostat." No. This was an ugly demand. To top it off, she was standing within arm's reach of the thermostat. She could have turned it down herself if she would just bend at the waist. After being struck (momentarily) speechless I said "Oh, didn't the thermostat worked when you tried turning it down?" Her mouth feel open and an "uh" was uttered. Then I turned to the patient and asked "Is it too hot in here for you?" The patient said "No, I'm fine." So I said "let me know if there is anything I can do for YOU." and left the room.

Again, the media doesn't help. They regurgitate stories about how x-number of people were killed by medication errors, or how hospital infections are spread by unwashed hands. True and true, I don't deny it. What the media doesn't talk about is how nurses are given too many patients to take care of safely, and then they're pressured to not work any overtime. Naturally people compensate by taking shortcuts and unfornately this also leads to mistakes. I can appreciate you being there to make sure your family gets good care. But jeez. Can you at least be polite while you're there?

In the OR I can knuckle down and work. I like the role that OR nurses play - patient advocate. We are there to be the advocate for the patient when they are the most vulnerable of all - unconscious. In the OR it would be my job to make sure everything is correct - that they are doing the right surgery, that he is given the right medication, that he is positioned in such a way that his circulation won't be cut off, that no one who hasn't properly scrubbed goes near him. I like the feeling of responsibility that comes with that. But I feel better knowing I can do whatever I can for the person in that state without someone standing over me, making unreasonable demands over nit-picky details - like making sure the sun doesn't get in their eyes.

If your family member is in my care in the OR, I guarantee they will get the best possible care.I will do everything in my power to make sure they are safe and they'll come back to you pretty much all in one piece, even though a piece or two might be missing.

Everything will be fine as long as you don't ask me to turn down the thermostat.