My Midlife Nursing School Adventure

Oooooops!

2008-06-01T19:03:00.003-05:00

Boy is my face red.

Since graduating and starting my new job in acute dialysis, I haven't had much to say about being a middle-aged nursing student. Instead I've been blathering away about being a dialysis nurse....

....and I forgot to tell you. I'm so sorry!!

Anyway here is the link to my new home. If something comes up with regard to being a student, for example, if I run into a nursing student during my job, I'll come back and post about it here.

In the meantime come on over to the U No PP place and here more about patients who don't pee than you ever thought you need to know.

Toys In the Attic

2008-05-19T21:22:00.003-05:00

For those of you too young to remember Aerosmith before they got sober, toys in the attic is a euphamism for crazy.

I don't know what it is about dialysis patients. They can be so crazy and controlling sometimes. Maybe it's all the grief and loss. Maybe it's the metabolites building up in their brain. Whatever it is, it's never a dull momement in Dialysisland.

The other day I had a patient whose husband created drama as I was leaving one night. The patient was a little hypotensive after treatment, which is not all that uncommon, but when she got to her room she told her husband she had chest pain. He came roaring out of the room demanding to know what had happened to her, and later insisting that she was allergic to one of the meds I had given her. Before I was able to get to the bottom of it, word had already spread throughout the unit that "that dialysis nurse gave her a medication she's allergic to."

By the time I arrived at her bedside the charge nurse was there trying to damage control and was fuming. I stayed with the charge nurse, trying to get to the bottom of what had really happened. I wanted to make the charge nurse understand that I was there to clean up whatever problem I might have created and that I wasn't going to dump the situation in her lap and then leave. Together we looked at the patients' record. The med I gave was prescribed by the nephrologist and had been given to her before. We checked her list of allergies and the med I gave her was not one of them.

About an hour later as we began to unravel what had happened, we realized that we were the victims of a drama king and an attempt at staff splitting. By teaming up with the charge nurse to solve the problem, we stopped the patient's husband from performing a "divide and conquer" episode with us. I'm glad I made the decision to work with the nurse and function as her ally. As things calmed down she relaxed and we were able to talk through what had happened. I could tell she was relieved that I stuck by her against the evil one and worked as a united front against him. Everything was documented thoroughly. We could feel a lawsuit in motion and thought we'd better have things written down. The next time I saw her she gave me a big smile and a wave. That made me feel pretty darn good about how we got through that difficult situation together.

Today I had a problem with my dialysis machine and was doing what I could to keep it running. Meanwhile the patient noticed I was spending a lot of time punching buttons and began a running commentary about it. "How come the other nurses don't have this problem? You don't know what you're doing. They need to get someone up here who knows what's going on." Stuff like that. I mostly ignored him and went about my business. I learned long ago that dialysis patients have lots of time on their hands and use it to invent new games to try and rattle the nurse. I've learned to deal with the crazy.

Today it took me 12 hours to run 2 patients. That's really way to long but actually it's an improvement over what I was doing before. It's going to get better. Even with all the playground games I already love this job.

Time For A Cool Change

2008-05-12T21:35:00.004-05:00

Pinning was awewsome. Graduation was awesome. My family was awesome.

It is an interesting place to be; ending one kind of life and beginning another. In the past my life changes came on like a freight change. They were sudden and dramatic. This one is smooth and calm. It feels like moving in slow motion and it's very nice.

I have the uneasy feeling that I'm supposed to be doing something. People tell me this is normal after graduation. I still have this amazing feeling that whenever I do something fun I can keep doing it until I don't want to anymore. I can enjoy myself without guilt.

I still have to take the board exam. I had planned to spend an hour a day reviewing stuff to get ready for it. I can't quite get myself to do that yet. I just want to enjoy doing nothing for a little bit longer.

Then there's the unpleasantness of having to actually work.......full time. I haven't worked full time in 2 years. I'll be hating it for a while but eventually I'll adjust.

Meanwhile I am spending way too much time on YouTube and I Can Has Cheezburger, but what they heck. I worked hard for it.

I Feel Love

2008-05-07T18:33:00.002-05:00

This weeek is filled with graduation frenzy.

My family arrived yesterday and we have not stopped partying since they landed. Last night we went out with my classmates. I've never been out with them in the evening; just lunch here and there. It was a big deal because I rarely stay awake past 10 p.m. The ideal bar for me would be one that has last call at 8:30 p.m.

Today was the pinning rehearsal. The pinning committee had put together a couple of slide show presentations. They were trying it out to see how it would work and we were all mesmerized. Our instructors saw that they could not get our attention once the slide show started so let us watch the whole thing. There were lots of photos and video of us from the past two years of nursing school. Lots of smiles, hugs, busy moments, etc. Each student also created a couple of slides thanking friends, family and whomever for helping us get through. So, yeah, all of us were riveted, waiting for our slides to appear.

Tomorow is the actual pinning. There will be plenty of Kleenex for all.

Friday is graduation. I'm pretty excited because miraculously I was able to keep my grades up and I'm graduating with honors. Yay me!

I'll write more once all the celebrating is over. For now I'm having a great time with my family, soaking up the love from my classmates and marveling at having made it through in one piece.

Peace out.

Adapt......Or DIE

2008-05-01T19:22:00.005-05:00

Boy, the stuff they don't teach you in nursing school.

I spent a day working with another dialysis nurse. As she hooked up the dialysis machine to the shower she said "Oh by the way. Call the manager and tell her you need a special plumbing adapter for this."

Special adapter?

Okay so I called the manager and she said she'd have someone drop off a kit at the hospital the next time I was there. A kit? I expected to find a charming little kit, maybe with fur lining and rhinestones and it would play music when you opened the lid, and a teeny little adapter inside. Instead I found this.

Inside are no less than 20 different plumbing adapters.

That's a penny on the bottom row second from the left.

I'm calm today, but when I saw this thing I just about shit a brick. What the hell am I supposed to do with all these?

Apparently what I am to do is attach an adapter to the dialysis machine and another adapter to the faucet or shower and couple things together until I get a tight seal. The one I saw the nurse use was a perfect fit for the dialysis machine and the shower head so only one piece was needed. No coupling required.

Wait it gets better.

So the other day I decided to put on my big girl panties and run a couple of patients all by myself. I get to the patient's room, introduce myself and get him all warmed up in preparation for dialysis. He's a new patient, just started dialysis a couple of days before, and so was a little edgy and nervous about the whole process. I fire up the dialysis machine and drag the hoses into the bathroom. I get out my sparkly new kit and begin trying out different adapters.

None of them fit. Oh sure, I could get one to fit the shower hose and another to fit the dialysis machine, but could not get them to fit each other.

Oh boy.

I called my manager and she said to call the machine tech. The machine tech said he could send someone over with the correct part and it would only take about an hour or so.

AN HOUR OR SO!?!

I cooled my heels in the cafeteria and played games on my Blackberry to relieve the tension. I had to get out of the room because the anxious patient set to whining and saying "well, how come the other nurse came in and hooked me up right away?"

Because I'm a lame-ass buffoon and they sent me here as a joke. April Fool!!!

The machine tech arrived with the correct adapter and threw in a pipe wrench for good measure. Thanks Dude. Much hillarity ensued and about three hours later I ran the patient and all was well with the world.

I took a lunch break and went to run my second patient and things went even further awry, but I'll save that story for another day. I'll just tell you that I spent 20 hours running two patients and I'm still trying to recover from that disaster.

The really awesome part is even with all the time I spent there that day, I still made more per hour than I did as a medical transcriptionist.

It's going to be fine. I just have to get over the hump.

Post HESI Survivor's Guilt

2008-04-23T20:23:00.014-05:00

The past few days have been exhausting. After the elation of passing HESI wore off I have felt drained of energy. At first I thought maybe i was feeling a little guilty. I want to celebrate the fact that I passed, but 22 of 60 students didn't pass and I feel terrible about it. I feel traumatized by the whole experience, the preparation leading up to the test and the tension that had built up over time.

So much is at stake. If we don't pass, we can't graduate. We get several chances to try again, but only two chances before graduation and pinning. For a lot of people that means cancelling graduation plans, money wasted on plane tickets, the embarrassment of having to tell your family you didn't pass. To make matters worse some students have internships and jobs lined up that they won't be able to start if they don't graduate.

I didn't know what to do with these feelings. Fortunately another classmate who passed the test opened up to me and it turns out she feels the same way. We talked to other students and several others who passed are feeling the same strange funk.

At the beginning of the semester a classmate came up with a plan to help students succeed. She suggested that the students who pass HESI participate in tutoring sessions for the students who didn't pass.

It turned out to be a terrible idea for several reasons. The students who didn't pass are very embarrassed about it, and they feel humiliated to be in the same room with their classmates who passed. For those of us who passed, we're drained and exhausted. We feel that we just don't have anything left to give. I know that since the day of the test I have had this gnawing sense of responsibility for helping my classmates pass, and I resent it.

Then I have this classmate, the one who calls himself the class nerd, who has patronized me for every HESI I have passed. We have had three exams - one midcurricular exam, the LVN exam and now this one. I did well on all of them and he did not. He always says to me "well the reason you did so well is that you got a lot of questions on topics you're good at." Now I'd heard that the questions are random, but after talking to other classmates, I think we all had pretty much the same questions. I can safely say after taking the HESI three times and scoring more than 100 points beyond passing every time, it's not just the luck of the draw that got me through. It was hard work and staying on top of the material all the way through. There is no magic formula. It's not luck or fate. I hate it when he tries to minimize my accomplishment as a way of justifying his failure.

The other thing that bothers me is that that during our test review that was week before last, I listened to students asking questions and I realized that for many of them, this was not a review. For many of them, it was as if they were seeing the information for the first time.

As much as I would like to help my classmates succeed, I cannot teach them two years' worth of material in an afternoon study session. I'm sorry. Every once in a while during nursing school, a classmate would ask me to help him or her study, or I would be asked to join a study group. I would try and explain my study methods to them and they would always reject what I was trying to tell them or they would argue the information. I personally go straight to nursing interventions, then fill in the rest of the information later. That way if I run out of time to study before the test, I at least got the most critical information covered. I would try and convince them that, hey, you asked me how I do it, I'm telling you, you have to believe me. But okay. Have it your way. We'll go through the Powerpoints item by item if that is what you want to do.

So today in class the passers and failers eyed one another uneasily. The class nerd wouldn't even look at me, wouldn't talk to me. I take this as a sign that maybe somehow he finally gets it. I really did learn something in nursing school, and he's not really the class nerd after all. I know that the failing students have their own stories to tell. I know they have no sympathy for those of us who passed. They would trade places with us in a minute. Nevertheless, our feelings are real and we're doing our best to try and sort them out. We feel guilty as hell and we feel left alone to deal with the aftermath of this experience. We want to honor our committment to help our classmates succeed, but we're all too aware of what little we can actually do about it. I'm trying to choke down this ball of resentment mixed with guilt and it's not going down well at all.

I know the classmate who came up with the tutoring plan had her heart in the right place. I know she wanted us to bond as a class and help each other get through, but unfortunately it didn't turn out the way anybody had hoped. They say the road to hell is paved with good intentions. I never imagined the form of hell it would turn into.

But I'll be okay. It's just a weird place to be.

Acute Dialysis - Day One

2008-04-21T19:47:00.003-05:00

It sounds great. Patient nurse ratio 1:1. Bring something to read because you'll be sitting down for four hours.

Four hours? What nursing job lets you sit for four hours straight? Wow. This my dream job. And it pays a whole lot more than any other graduate nurse job I've heard of. Some of the nurses told me that they made six figures last year. Six figures. My first year out of school. Oh man!

I figured sooner or later there would be something about this job that makes is suck bad enough that no one would want to do it. Turns out all the things that are good about it are also the things that make it suck.

Nurse-patient ratio 1:1 means the patient interprets this as meaning you are their personal servant for the day, at their beck and call. "I'm cold. Give me a blanket. Turn off the air conditioner. Give me a drink of water. My oatmeal is too cold. I need another Sweet N Low for my tea." You get the idea.

This also means we have way too much personal time with each other. The following is a sample of the verbal abuse I was treated to by my patient today.

"You aren't taking care of me right. I hope they don't ever let you take care of me again because you are a terrible nurse. You can't do anything right. You aren't very good looking are you? You're pretty fat for a nurse. If I get pneumonia I'm going to sue you. If you don't take me off this machine right now I'm going to call my lawyer. You never listen to anybody. You're just hard-headed and stubborn."

Yeah, yeah, yeah. Here's the phone, you grumpy bastard. Call your lawyer. Bring it!

Luckily I've had about three years' experience dealing with similar bullshit working in a chronic dialysis unit. I found that the best response is act like you're schizophrenic or retarded.

"I'm not good looking on purpose. I get so tired of men asking me out all the time that this works better. Really? I'm fat. Oh, if my weight is interfering with your treatment somehow, let me know what I can do differently so it won't be such a problem for you. If I'm not doing anything right how about if I heat up these pancakes for you? I'm hard-headed. You sound just like my mother. Oh, I can't tell you how many times she has told me that. You know the two of you would have so much fun talking about me. How's that oatmeal? So I was wondering, if you already have pneumonia, how are you going to sue me for giving it to you? I've never heard of this before and I'm wondering how that works."

I finally figured out how to eeeeeeeeeaase my chair back little by little until the dialysis machine was between me and his line of sight. I could still monitor him but he couldn't see me and, well, it's sort of like dealing with a baby. If he can't see you, you don't exist anymore.

Pretty soon his wife came in. A lovely woman, very attractive, every hair in place, dressed beautifully and very attentive to him. And he was a complete bastard to her. She didn't speak English and so he felt free to say ugly things about her to me.

I forgot. People suck.

Then there is the "nurses eat their own" thing. Yep. It's true. Since it was my first day on this unit I had to figure out where things were, how to make unruly equipment do what it is supposed to do, you know, just figuring stuff out. Every time I came out of the room to ask a question, I was met with much eye rolling. Once I stepped out of the room and two nurses were at the nurses' station and I asked a question. Both of them ignored me. I know they heard me. I'm loud. My mother would tell you. Finally a tech walked by and asked if I needed anything. I said "Oh thank God. For a minute there I thought I was invisible since nobody seems to notice me."

Probably not the smartest thing to say, but I'm only working near them, not with them. I could see the nurses huddling up, talking about that "stupid dialysis nurse". Wow. Eighth grade all over again, only without acne and I can smoke in front of anybody I want. And I have a driver's license. And a paycheck. Neat.

But I took the high road. When I left the unit I gave the nurse report on my patient and was all professional and business like. I thanked her for everything and said "I look forward to seeing you next week. I really enjoyed my day." If she thinks I'm crazy maybe she won't poke a stick into my cage.

The other thing that could be a negative is the ominous rumbling of many long hours. Yeah the nurses earn six figures but they earn every single penny. I'm hoping that somehow I can balance those long hours doing things I would usually do with my down time - reading, crossword puzzles, surfing the net on my Blackberry. But I get the feeling that somehow it's not quite going to work out like that.

At any rate, I can't think of any other nursing job that would work for me at this stage in my life. I won't be running up and down the hall, patient to patient, juggling hundreds of life and death details. The next patient who asks me why I'm so incompetent and stupid I'll just say "would you like some fries with that?"

Nursing School Books

2008-04-20T12:32:00.007-05:00

With three weeks to go until the end of nursing school, I have found myself with more time on my hands and, well, more time to goof off. But this is creative goofing off.

I desperately want to purge my office of all nursing school detritus, but I still have an exam and a final to go, so I can't just yet. I have a butt-load of books and I'm sick of looking at them. So as I sit here staring at them, watching my bookshelf groan beneath their collective weight, I got to wondering how much they weigh. Unfortunately I don't have a scale.

I don't own a scale out of principle. I find out how much I weigh once a year when I go to the doctor. That's all I need to know. I don't need to watch myself lose and regain the same five pounds over and over again. I have better things to think about.

Still I have the urge to measure my books. Since I can't weigh them I decided to stack them up and see what that looks like.

Oh I also measured the height of the stack to fullfill my need to quantify my books. The stack is 42 inches high. To the right of the stack is a 16-ounce bottle of Dr. Pepper in case you need some sort of scale. Some fools drag these things to class in their backpacks on wheels. My approach was to find a spot in my house and claim that as my work/study area and leave them alone. This worked well for me. I didn't take a single book to class - maybe once or twice in the beginning. I quickly figured out that all I needed for class was the Powerpoint presentation du jour tucked into a nice plastic folder. Voila! No backache.

So in case you're dying to know what these books are, the following is a list of books that I used during the two years of nursing school. Some of these books were purchased during pre-regs but I used them during the course of nursing school even though they aren't nursing books per se. I have two or three other books that I bought but never used, so they weren't included in the photo.

So here is the list starting from the top of the stack.

1. RN Notes. Myers
2. Nurse's Med Deck - Tenth Edition. Deglin, Vallarand
3. Mosby's Pocket Guide to Basic Skills and Procedures - Sixth Edition. Potter, Perry
4. Mosby's Diagnostic and Laboratory Test Reference - Eighth Edition. Pagana and Pagana.
5. 2008 Edition Nurse's Drug Handbook
6. Stedman's Medical Dictionary for the Health Professional and Nursing - Sixth Edition. Lippincott, Williams, Wilkins
7. Laboratory and Diagnostic Tests with Nursing Implications - Seventh Edition. Kee
8. Success In Practical Vocational Nursing - Fifth edition. Hill, Howlett
9. Nursing Diagnosis Handbook - Seventh Edition. Ackley, Ladwig
10. Live Review Course for NCLEX-RN Examination. Elsevier
11. Advanced Cardiac Life Support Provider Manual. American Heart Association
12. NCLEX-RN Strategies for the RN Licensing Examination - Kaplan
13. Pharmacology and the Nursing Process - Third Edition. Lilley, Auker
14. Introduction to Microbiology - Third Edition. Ingraham, Ingraham
15. Contemporary Psychiatric-Mental Health Nursing. Kneisl, Wilson, Trigoboff.
16. Dosage Calculations - Seventh Edition. Pickar
17. Nutrition and Diet Therapy - Sixth Edition - Cataldo, DeBryne, Whitney
18. Human Anatomy and Physiology - Sixth Edition. Marieb
19. Wong's Essentials of Pediatric Nursing - Seventh Edition. Hockenberry, Wilson, Winkelstein.
20. Clinical Nursing Skills - Sixth Edition. Smith, Duell, Martin
21. Old's Maternal-Newborn Nursing and Women's Health Across the Lifespan - Eighth Edition. Davidson, London, Ladewig
22. Medical Surgical Nursing Volumes I and II - Fifth Edition. Ignatavicious, Workman
23. NCLEX-RN Review- HESI
24. Saunders Comprehensive Review for the NCLEX-RN Examination Fourth Edition - Silvestri
25. Understanding Pathophysiology Third Edition - Huether, McCance
26. Fundamentals of Nursing Sixth Edition - Potter, Perry

I also have the urge to calculate the cost of these books, but I'm all out of goofing off time for today. My rough estimate would be $3,000.

HESI Happiness

2008-04-18T18:31:00.006-05:00

I am pleased to report that I passed the HESI exam with flying colors. Passing score is 850. My score - 988.

I have mixed emotions. I'm elated that I was able to pass, but I am devastated that some of my classmates did not. They get another chance in 2 weeks, but it's difficult to try again once your confidence is shaken by not passing in the first place.

I wish I could tell all you future and present students what it takes to pass. I know what worked for me but everyone has to find their own way.

Okay. I'll tell you what I did.

* Stay on top of the material all the way through. If you learn it the first time around, getting ready for HESI is a review. It's not as if you are seeing the information for the first time.

* If you tank on a nursing school exam, be honest with yourself and go back and review the stuff you struggle with. Don't blame it on the test, the teacher, the weather, etc. If you aren't getting it, go back and get it.

* Stick to nursing process. Many of my classmates, even at the end, are still trying to approach the material as being able to define what something is. The test gives you a scenario with several right answers. You have to pick the BEST answer. For me the secret is this. If the question says "symptom, symptom, lab, lab, observation observation" - look for key words that tell you what the situation is. Is it heart failure? Renal failure? Pneumonia? Peripheral neuropathy? Once you establish what the disease in question is, think about what you AS A NURSE will do for this condition. In other words, go to INTERVENTIONS in your mind. Remember all those fugly care plans you had to do? HESI is the reason you had to do them.

* Know the normal labs. If the question gives you a lab result and you don't know if it's normal or not, you're dead in the water. If you know, for example, that the potassium is low, then you know what to do about it.

* Know the meds. Granted there were several medications on the test I'd never heard of, but the medication I had seen before, I knew what it was for, what the side effects are, and what a normal dose would be. So if you can't learn every med, at least know the meds you know backward and forward.

* Know medical tests. Know what an MRI is, an angiography, a barium enema, a CT scan, a hysterosalpinogram. Know if there is contrast dye involved. Know that if someone is allergic to shellfish or iodine, they can't have contrast.

* Have an understanding of the nurse practice act, delegation, legal responsibilities, therapeutic communication and cultural norms. It is tempting in the beginning of nursing school to want to skim over these topics and get to the "important stuff" like heart disease and stroke. Give these things your attention right from the start. It's not a lot of material, but you will see it over and over again. By the time you get to HESI you will have seen it so many times that it will be a no-brainer.

Many of us on the way to nursing school got really clever at figuring out to get the best grades for the least amount of effort. It got us into nursing school, but it hurt us in the long run. Some of us, and include myself, were in for a shock when we got to nursing school and found that there are no shortcuts. Those of us who made it accepted that early on and stopped looking for them.

Now that this ordeal is over I hope to gradually get my life back to what is seemingly normal. I don't have to drag a book with me everywhere I go. I can let go of some bad habits I picked up to cope with the stress. I can think about what I want to do in the abundant spare time I will now have.

And I'll blog some more. Twenty-one days from now when I graduate, I'll have to think of a new theme for my blog. It remains to be seen what direction it will take, but hopefully it will be something entertaining and maybe useful.

I don't know, but what I do know for sure is I'm going to have a spa day to celebrate my success.

HESI

2008-04-15T21:46:00.003-05:00

The HESI or exit exam is this Friday. I'm trying to look over anything that I'm not quite sure of with just a little bit of time left to do it. It's nerve wracking that we must pass this test to graduate. The good news is we get two tries. If after two tries and don't pass we can remediate over the summer and try again.

I'll write more after I take the test and let you know how it goes.

Twenty-two days to graduation. Hooo-ah.

Do You Believe in Life After.......Graduation?

2008-04-10T14:46:00.007-05:00

As the semester winds down and graduation draws near, I'm finding it more difficult to find things to blog about that are relevant to nursing school. When I began this blog I had an acute interest in things that matter to a nursing student. Now I really couldn't care less. I suppose with a little time and distance I'll feel like blogging about it again. For now though, my mind is filled with thoughts of life after school.

As I look around my messy office I'm already making plans to purge just about everything that relates to nursing school. Some of my classmates have talked about keeping their text books "as a reference", but hell, some of the information is already outdated. What's the point?

As an update to the internship scramble, most of my classmates are settled into one job or another. I myself have taken a new job doing inpatient acute dialysis. I still work for the same company, but instead of working in a clinic and caring for four patients at a time, I'll work in the hospital and drag the machine to the patient. But don't feel sorry for me. The nurse/patient ratio is 1:1 and I get to sit down for the treatment. And read. And do crossword puzzles. And surf the net on my Blackberry. I'm sure there are some miserable details about the job that I hadn't thought of yet, but for now I want to bask in the glow of delusion and marvel at what I feel is the perfect job for me.

My classmates have done such a good job securing jobs that I have to tell this hilarious story on the subject. Our college had a health fair that we were ~~forced~~ asked to volunteer for. As part of the health fair, local hospitals, rehabs and nursing homes set up booths as sort of a job fair - a job fair that was not announced to anyone. So naturally no one showed up with resumes or anything.

One of my classmates was cruising the booths and scamming complimentary pens, Frisbees and candy bars when someone behind a booth began complaining loudly to her about the nursing students. The complainer said "this group of nursing students has the worst attitude of any class of nursing students I've ever seen. Not one student has brought us a resume or asked for a business card." Without missing a beat my classmate said "That's because we all have jobs already."

Oooooh. Snap! Take that, you ornery recruiter.

Tune In, Turn On, Clean Out Your Backpack

2008-04-01T15:58:00.025-05:00

Remember time capsules? If you don't, I'll tell you it's part of some of the 60's stupidity that people thought would turn out to be the wave of the future, along with communal living and EST. But if you read the Wikipedia entry, there is mention of unintentional time capsules, and it turns out that I have one here in front of me.

Yesterday was my absolute last hospital clinical. I will celebrate this event by dismantling my clinical bag. Join me as I open this capsule and take a peek into 18 very interesting and stressful months of my life.

I remember putting it together thinking ever so carefully about what I might need when I would start hospital clinicals. I remember asking for advice at allnurses.com about what the well-prepared student should include in her pack. Now as I pull it out in reverse I'm laughing at what seemed like a good idea at the time, and nodding with self-knowing at what was really useful.

*RN Notes. Not useful at the time, but very useful as a review for HESI.
*Drug book. If I had it to do over I'd use a Palm Pilot or Blackberry.
*Basic Skills and Procedure Manual that I bought this last semester. I wish I had it first semester because now I don't need it.
* A clinical binder. Somewhat useful. It has folders and pockets for keeping stuff organized.
* Stuff in the folders and pockets in the clinical binder.
-A table of IV compatible drugs. Never used.
-A list of NANDA approved nursing diagnoses. Glanced over once or twice.
-An EKG rhythm strip to practice identifying rhythms. Still can't identify it.
-Pulseless VTACH algorithm. Very useful when I was getting ready for ACLS. Now that I'm certified, who cares?
-A colorful chart of most commonly abused pharmaceutical substances. Never used but might come in handy if I don't pass HESI and need to find some street drugs of my own.
-A Powerpoint presentation given by one of my classmates on Marfan syndrome. Was I even there that day? I don't even remember this.
-Some hastily scribbled post-conference notes. Might come in handy if I could just read my own writing.
-A thick sheaf of looseleaf notebook paper that I thought would be more useful than a wire-bound notebook. What the hell am I going to do with all this looseleaf notebook paper?
-An ominous list of instructions for a community clinical from first semester. Oooo, have your clinical care form with you OR ELSE!!!
-A checklist for my instructor to use when I was checked off for Foley catheter insertion........first semester? Wow. Did I get checked off or not? Will the board of nursing find out?
-A Wong faces pain scale. Lest I ever forget how to use it or I can't remember that 1 is no pain and 10 is the worst.
-Step-by-step instructions for various procedures that if you held a gun to my head I couldn't do correctly and neither could anyone I spent any time in clinicals with.
-Ten photocopied patient care worksheets that I created for when I took care of more than one patient at a time. Those actually came in pretty darn handy. I'll keep those in case I ever work in a hospital again.

This is fun. What else is in here?

A cosmetic bag with two compartments that contain.....
*A penlight. Used, oh, five or six times. Pupils never moved on anyone I ever looked at.
*Bandage scissors. Very useful.
*Pens, pencils, erasers, a small rule, write-on page tabs. All very useful.
*Ear plugs. Very useful for studying in noisy libraries. Before you were born libraries used to be quiet places where people could read in peace, and someone would come from behind the counter and shush you if you didn't whisper. I swear I'm not making it up.
*Batteries for MP3 player. First year I recorded all our lectures. I think I listened to one or two of them. This year I didn't bother.
*Breath mints, travel-sized deodorant, anti-gas tablets - all stuff that shows I care enough about my classmates to not subject them to my BO, bad breath or noxious emissions. Trust me. You get so busy in nursing school that sometimes you forget to put on deodorant before leaving the house.
*Feminine hygiene products because menopause did not visit me this year as I had hoped.
*A stick of Carmex lip balm and a travel-sized bottle of hand lotion. Probably the most-used items in the bag.
*A beaded badge holder necklace that I made myself to match our school uniform. It was completely the wrong length so as when I was putting a Foley in a patient, the ID badge got caught in the bedrail and snapped off. But hey, the necklace didn't break! That's the important thing.
*Band-aids and alcohol prep packs that I probably emptied out of my pockets during post-conference.
*Hemostats. Never used. Now, if I just knew a pothead that could use them.
*Change. Hey! I could buy a candy bar for the pothead!

Also in the bag I find.......
*One blood pressure cuff. Bought that for an assignment the second week of school where I had to interview an elderly person and take their vital signs. I never used it again.
*Candy wrappers. Those aren't mine. I swear!
*Trauma shears. These were part of a lab pack that we used first year and I took them out and put them in my bag when I lost my first pair of bandage scissors. When I overhead some nurses laughing at my trauma shears behind my back, I went out and bought some new bandage scissors and threw those shears to the bottom of the bag.
*A small plastic retractable tape measure. I can't remember what I thought I would use this for. Never used.
*A stethoscope. Oh, I remember the first time we had lab and me and my classmates marching proudly into class with our stethoscopes around our necks, looking all nursey and legit. I remember how the stethoscope was an outward symbol of all the hard work and sacrifice that went into getting ready for nursing school. Yes, it's a powerful symbol and probably the second most-used item in my bag.

*A small spiral-bound notebook to write notes about my patients. Let's see what I have in here. Hmmmm.
-Clinical instructors' cell-phone numbers. I'll keep that for future drunk dialing. Just kidding!! I don't even drink.
-Door codes to the patient nutrition room. Might come in handy. Next time I'm in the hospital visiting a friend I can raid their snack drawer and help myself to coffee.
-Some vital signs. Some lab results.
-Phone numbers for people who might be able to put in a word for me in case I want to work on a certain unit. Naaah.
-A tiny drawing explaining osmosis. Not bad!
-Pick up gift for Tara's baby shower. Shit! That was last year! The kid's probably driving now.

Sure was fun exploring my nursing school time capsule. To summarize, the most useful things to pack in your nursing bag is anything that keeps you odor free, your skin soft and prevents chapped lips. Next is your stethoscope and a little notebook to write cryptic notes that you will laugh at later.

Thank you for attending this time capsule ceremony with me. Refreshments will be served in the back. One slice of cake per customer, please.

When A Nursing Student Is Not A Nursing Student

2008-03-30T20:26:00.003-05:00

I had another one of those conversations the other day.

Random Person: How are things going?
Me: I'm getting ready to graduate in a few weeks.
RP: Really? You know I'm going to nursing school too.
Me: Oh really? How much longer do you have?
RP: Um. Well. I haven't actually applied yet, so what, two years?

I hate to break it to you, my brother, but it's actually more like four to six years.

I can say this now because I've been through it. I made this mistake. I woke up one day and decided I wanted to go to nursing school. I thought I would waltz over to my local community college and sign up to start the next semester. Little did I know it would take four years before I was accepted.

It's not easy getting into nursing school. Every school has its own set of criteria for accepting students. If you are someone who is thinking about nursing school, get in touch with that school and find out what their criteria are. Pay very close attention to every detail and even closer attention to deadlines. For example every school will have some sort of admission packet that must be submitted. One year I missed the dealine by SIX HOURS and so had to wait another year to try again.

Pay close attention to what the criteria are and make sure you can meet them. For example, the school I am going to requires that one take an entrance exam as part of the admission criteria. Here's the rub. You can only take that exam once a year, so if your score isn't all that great, you have to wait another year before taking it again. Even if you have everything else in order and ready to go, that's another year of waiting to get in.

My sister-in-law decided she wanted to go nursing school about the same time I decided to go, but first she decided to try some other things and see how that worked. So about a year ago she finally decided to get serious about applying and working on pre-regs. She spent all of last year working on pre-regs. Meanwhile the school she applied to told her there was a two-year waiting list. She decided to pay $75,000 and go to a private school.

After finishing the her pre-regs the private school informed her that they were full and couldn't accept her application and were now using a lottery system. In other words, names are drawn at random. You could get right in or you could never get in. It's all chance. Meanwhile, you guessed it. She took her name off the waiting list for the other school because she was so sure she would get accepted by the other one. If she had left her name on the list she'd only have to wait another year, which isn't that long when you remember, or if you read my earlier post, we made the decision six years ago to go to nursing school. Now she has put her name back on the list and they tell her now the waiting list is 3 years.

So children, if you think you want to be a nurse, get busy NOW finding a school and working on getting accepted. No whining about the admission criteria, the wait time, the tuition, the entrance exam. All of us who are nursing students had to go through it. If you really want to go, you need to understand right now, up front, that it's time consuming and difficult to get in. Otherwise do something else and quit complaining.

Oh, and another thing. If you aren't currently attending nursing school, stop telling people that you are "going to nursing school". Yes, and I'm going to die. I don't mean right now, but someday I'm going to die. But imagine the different reaction if starting tomorrow I told everyone I met that I'm going to die. There's a big difference between going to nursing school now and going to nursing school.........someday. And shame on you for making people think otherwise.

Of Flash Cards and Powerpoints

2008-03-27T15:04:00.003-05:00

As we close in on the final 5 weeks of nursing school, I am struck with the irony that now, after all this time, I finally figured out how to study.

I bought this book and it has been a godsend. Every topic on everything we ever learned in nursing school is covered. All the information is formatted into nice outlines. That way you only see what you need to know about the topic at hand.

If you are a nursing student, your instructors will encourage you to buy some kind of NCLEX review book to practice test questions. That way you will have the chance to see the information given to you in a bizarre and obscure fashion so you can rattle those peas in your brain. Hopefully a couple of them knock together and shake the information loose, so it will float to the front of your brain and you can choose the right answer.

I wish I had bought this book a year ago. I could have saved myself hours of pointless studying, trying to learn stuff that I will never see on a test.

Then there is that 10-inch high (I measured it) stack of Powerpoint presentations we've been given throughout the program. I was commisserating with one of my classmates about this stack of dead trees and wasted ink and he pointed out something I hadn't thought of. He said "When we first started school I was thinking how lucky we were to have those Powerpoints and we could just read those instead of the book. Now that I see how much there is I figured out it's easier to just read the book."

No kidding.

This book is even easier than that. The information is in bulleted lists. No having to tease the information out of a paragraph or table. It's the facts whittled down to just what is needed.

The authors of this book has not paid me anything to say such nice things about the book. This is one of those "I coulda had a V8" moment.

With 5 weeks to go I'm also reminded of things I meant to do during nursing school and never did. And it's too late to start now. Things like,

1. Exercise regularly.
2. Make flash cards.
3. Take stress breaks.
4. Network with nursing organizations so maybe some mucky-muck would remember by name and face and possibly hire me.

I found a stack of flash cards I started the first week of the first semester of nursing school. I laugh now at the folly of thinking this would help.

Do The Hustle

2008-03-16T20:52:00.003-05:00

I haven't been feeling so great about nursing school lately.

In spite of studying harder than I ever have in my life, I have the worst grades I've ever had too. I have had this creeping dread that I couldn't name.

Then I read this thread and it made me smile.

It seems that during the last semester of nursing school, all order breaks down, that bonds with classmates begin to unravel and nerves begin to fray. This comes from the competition to get internships and jobs in the area. Whenever a classmate announces their accomplishment, the rest of us die inside a little bit.

It was getting to me for a minute, but then I read the open letter above and I felt a lot better. I suppose it happens to everyone their last semester of college in whatever field they hope to enter. A gaggle of graduates tries to squeeze into a small pool of available positions. It reminds me of a National Geographic special where increasingly desperate crocodiles are writhing around in a muddy lake that is shrinking by the day.

I decided to pull myself out of the pond and stay focused on what is in front of me. Yeah I should be shopping for shoes to match my slacks. And yeah, I should be schmoozing and networking to try and get a nice internship of my own. But frankly, I don't have the stomach for it right now.

I'm worried about passing the exit exam. If I can't do that, the nicest, cushiest internship in the world won't make a difference. Besides, I've gotten reassurance from all around, from friends, coworkers, my partner and online acquaintances that I'll be fine. I've been told to just chill out; that I won't have a problem finding a job no matter what. I'll be a nurse, and even without an internship, I'll get to work with a preceptor no matter where I go. They aren't going to let me drown my first day, or week, or month on the job. I'll have support and help, and even though it may be shorter than if I had an internship, I'll still have help just the same.

Even though I have to hustle to get through these last 70-odd days of school, I'm not going to worry so much. I'm going to stop eating my heart out and be genuinely happy for my classmates who score jobs and internships. I'll be okay.

If You Aren't Part of the Solution, You're Part of the Problem

2008-03-06T15:04:00.008-06:00

Doncha hate those catch phrases? I hate shiny, happy motivational-type messages. You know the ones. "What doesn't kill us makes us stronger." Yeah, yeah, yeah. Just give me more money and turn your stereo down.

Truth be told I could use a motivational kick in the pants now and again. I was just reading this blog post about a hospital that instituted a "no complaining" policy and how it helped with staff morale. Some people responded in the negative, saying that complaints are justified and nurses should be treated better and paid well, etc., etc.

Then I felt guilty. You see. I am a complainer. I'm whiny. I'm self-centered. I don't like conflict. I don't like to hear babies crying at the next table when I'm eating in a restaurant. In other words, I'm perpetually 4 years old and emotionally retarded.

But I'm working on it.

Pastor Will Bowen appeared on Oprah recently to talk about his anti-complaining campaign. I didn't see the show, but I can get behind this idea. I have been a complainer for years and I'm not sure when I first realized how bad I was about it. It was probably when my girlfriend called me "whiny-ass baby" to my face. Since then I've been putting serious effort into changing. I'm working on finding the line between valid complaint and emotional immaturity.

I never realized how badly a negative attitude affects other people until I started working with someone who complains more than me. I dread it when I see I'm on the schedule with her. I know that at some point during the day she's going to corner me and go on and on about her life. I can be a supportive, good listener if I'm having a pretty good day myself. What gets to me is that this person has been complaining about the same problems for the two years that we have worked together. I had heard of energy vampires, but didn't quite get the concept until I worked with this person. Once I read more about energy vampires, I was horrified to think that I might be an energy vampire too. I have been quilty of several energy vampire actions from time to time. But knowledge is power it. Naming it means I can change it.

Anyway I haven't figured out how to tell my co-worker that she needs to make some different choices. Well, actually I have told her, but it hasn't worked. She makes the same mistakes over and over then wants to whine about it. If I came in feeling good that day, it isn't long before I feel depressed from talking to her. The good thing is now that I know how it feels to be the victim of an energy vampire, I know that I don't want other people to feel emotionally drained by me. I'm insecure enough that I want other people to like me. There. I said it.

This is what I call universal justice - something that you have done to other people comes back to visit you. Luckily I got the message and I'm working on staying positive and not drag other people into my misery and problems. But here's the thing - I have a great life. I have a lot of love and support from the people in my life. I'm lucky enough to have financial support so that I can go to nursing school full time. My children are happy and healthy. I have siblings who adore me. I attend the best nursing school hands down, and don't experience many of the horrible nursing school experiences other people have told me about. Why do I want to make myself miserable?

Because it's a bad habit. I would like to blame it on my mother, but she's not alive to defend herself. She was a miserable, unhappy person and I suppose I learned the art of complaining at her knee. But there is nothing that says I have to keep doing some 25 years since leaving home.

So I support people who are working to remind people to quit complaining. It doesn't hurt me to be reminded that complaining is a waste of energy and it drags other people down. If I want to complain that nursing pay and working conditions are wretched and we deserve better, I have options besides complaining. I can get involved politically and work on changing laws to make our job safer and our patient loads more sane. I can tell myself that it could be worse; I have worked harder for less money. I can even make the choice to not go into nursing at all.

I won't go so far as wearing the purple bracelet, but I vow to take other people into consideration before I start complaining. And thanks for reminding me. Now would you stop slurping your coffee and leaving your empty sugar packets on the counter? Thanks.

Two Roads Diverged In A Yellow Wood

2008-03-02T21:17:00.010-06:00

With 67 days to graduation, the push is on to find nursing internships.

I'm in a quandry. I can't decide if I want an internship or not.

Oh, an internship is sort of like a job orientation, but you get more one-on-one help with an experienced nurse preceptor, some extra classroom time, and also forgiveness if you don't get the hang of the job as quickly as one might expect.

You also have to commit to giving the hospital 18 months to 2 years of your life for this blessing.

I applied for an internship at a Hospital That Looks Like A Hotel. A couple of years ago I left my appendix there and, all things being equal, it was a great experience. As a patient it was great. As a nurse I'm not so sure. I'm spending my clinicals in this hospital my last semester of school. The halls are carpeted. I had no idea what a nightmare it was to try and push a bed down a carpeted hall until last week. I'm thinking if I had to do this on a regular basis, my poor old body won't make it to retirement.

I can't decide if this is what I want to do. I like the idea of having the equivalent of nursey training wheels. On the other hand, I want to be able to job hop for more money, or if the place I'm working is a hell hole I can't tolerate being there another day. Besides I already have the dialysis gig and it's pretty sweet. Once I get the RN license I will get a big pay bump. Plus I will be a little closer to my ultimate goal - travel nursing.

But there is that "med-surg or not med-surg" dillema. Some nurses feel that a stint in med-surg is essential for anyone starting his or her nursing career. Still others say that going right into your specialty is the way to go.

Dialysis is a specialty but I wouldn't say it's something I want to do the rest of my life. But if I am to think of it more deeply, I never set out to be a nurse in the first place. I found myself in middle age with a dwindling income, no retirement savings and a skill set that people on the other side of the world will do for half what I made. My goal is to ride this thing out to retirement and hope I arrive in one piece. Hopefully I won't be a physical wreck and I can actually enjoy my retirement. I've been in dialysis a few years now. As nursing goes it's a fairly easy job. I've already been through the fire and experienced the long learning curve.

I hear dialysis nurses are in huge demand among travel nurse specialties. Then I'm hearing more and more about nocturnal dialysis where patients come to the dialysis clinic and get their treatment overnight while they sleep. As people on dialysis are living longer, and as people are developing renal failure earlier all the time, nocturnal dialysis the way to go if you're young and want to keep your job. It's a pretty easy gig, I'm told.

For now I just need to focus on finishing. I'm getting the worst grades of my entire college career this semester.

And I don't even care.

I just want it to end.

Luck Be A Lady

2008-02-22T18:50:00.011-06:00

Here is a celebrity quiz.

Who is the perkiest celebrity?

A. Rachel Ray
B. Richard Simmons
C. Vanna White
D. Bindi Irwin

I think it's a toss-up between Rachel and Bindi. Imagine both of them on TV at the same time. I suppressed my nausea long enough to be horrified by this interview.

Bindi? The luckiest kid in the world? Didn't her father die a freakish death like a year and a half ago?

Poor kid.

This reminds me of a patient I know. She would not win a perky award. In fact she is surly, sullen, snarky and sarcastic. After a particularly unpleasant encounter I took off my sensitive, defensive, middle-aged woman hat and put on my empathetic, professional nurse hat and had a chat with her.

Using my best nursing school therapeutic communication I asked some open-ended questions about what was happening in her life. She shared with me that everyone around her keeps telling her how lucky she is. No one wants to hear her talk about how devastated she is that she has renal failure. No one will let her express her grief over what she has lost by being on diaysis - her career, her body image, her health, her faith in God.

No. Everyone tells her how lucky she is because she can still walk, that she has a nice house, that her husband is so nice, that her children are healthy. Those things are true but they don't take away the sting of all she has lost. Over time she was getting sick and tired of not one listening to her talk about her loss. No one wanted to let her wonder why God had abandoned her; why this happened to her. No one wanted to let her ponder what she had done to deserve this. Instead they all told her that it's all part of God's plan and she should focus on the good things in her life.

I'm all for positive thinking, and I know her loved ones mean well. It was painful to see this person having to swallow her feelings and deal with her grief alone.

I wish I could say the talk changed things. It didn't. She's still sarcastic and opinionated, but at least she got a few things off her chest.

I wonder when Bindi will be able to get things off her chest. I wonder when somebody will let Bindi say "I'm sick to death of these crocodiles. I want my Daddy back."

I suppose for some people keeping busy is a way of keeping your mind of your troubles. But I wonder whose troubles are being dealt with in this way. Bindi or Bindi's Mom? If it's Mom, okay. Mom, you go ahead and travel the world making the world safe for crocodiles. If this is Bindi's choice and she loves doing it, I'm okay with that.

But let's tone down the sugar-coating a few thousand watts. Crikey. She's giving me diabetes.

Who's Your Dialysis Daddy?

2008-02-15T07:00:00.012-06:00

Ahhh, dialysis. The life-saving procedure invented by a good doctor many decades ago, now perfected to the point where a patient can expect to live longer than ever. Not so long ago a person with renal failure was told to gather their family and say goodbye because there was nothing anyone can do.

So now, thanks to this 3-times-a-week treatment people can live for decades. Some of our patients have been on dialysis 20 years.

Unfortunately many dialysis patients are ungrateful and cranky. The majority of people with renal failure have diabetes or hypertension - a goodly portion of those have both. There is the occasional person who unfortunately blew their kidneys from a drug overdose or a reaction to contrast dye. Still others have problems with their immune system. For those with diabetes and hyperension, often they had been told YEARS AGO that they were heading down the path to renal failure. The problem with renal failure is that for a long time, the person feels fine. They figure that as long as they feel okay, that "stupid doctor" doesn't know what he's talking about. So they chose to ignore it until they woke up in ICU one day after an episode of uremic encephalopathy. In other words, their kidneys quit working, bodily waste built up in their brains, they went cuckoo and they scared the bejeepers out of their families.

Now that that's over, they have plenty of time - approximately 4 hours,3 times a week - to reflect on all the things they could have done to keep this from happening. They go through all the stages of grief - shock, denial, bargaining, anger - well, you know the stages. My two favorite stages are denial and acceptance. When the shit came down they were in shock, and everything they learned about their condition went over their heads. Now that the crisis has passed we can start educating them. I'm all for education, but in this case there seems to come a point of critical mass with education. They finally get enough information and it sinks in enough that now they're pissed.

I love it when they get past this stage and move on to acceptance. Some stay pissed though and those are the ones that I find challenging. They express their displeasure in some not-so-nice ways. Some do it by controlling the details of their treatment. "I must have 12 pieces of tape on my table. I can only have 3 x 3 gauze because the 2 x 2 gauze makes me sad. Stand on one foot, stick out your tongue and spin around twice before you cannulate me." Just kidding. I made the last one up.

Some express it by trying to manipulate their treatment time - often by constantly asking to stop treatment early. Oh, and the excuses they have for ending treatment early! Someday I'll write a book. "I have a flight to catch." Really, where would you be flying to that you have to be back day after tomorrow? "I have people coming over?" And you didn't mention to them that you have dialysis and that you don't get home until X o'clock in the afternoon? "I have a doctor's appointment?" Fascinating. So they only schedule appointments at precisely the same days and times you have dialysis. "I have to go to class." Uh huh. And you never mentioned to the clinic manager that you are taking a class so she could look into changing your appointment day, time or even find another clinic for you that has a chair time available that won't conflict with your schedule? Um hm.

Then we have the hurry-up-and-put-me-on folks. As soon as we open the door in the morning the patient's race to see who will be the first to their chair, because we put patients on in the order they come in. They practically knock each other down trying to be first. One day a patient passed out from low blood sugar on her way in the door. The other patients stepped over her prostrate body to get to their seats.

Some patients are in a hurry because they're smokers and they want to get back outside and smoke. Being a smoker, I symphasize - a little. I wear a nicotine patch during the day so I can wait until I get home to smoke. It takes the edge off. But what I've noticed is that the people who have the least going on in their lives are the most pushy about getting started on time. These patients are going to go home and sit on the couch in front of the TV. The patients who have jobs, children, errands or other activities are more willing to wait for us to get to them, and more tolerant of problems that keep them from getting started - for example machine failure or plumbing breaks. They will curl up in the chair, whip out a magazine or calmly watch television until things are okay again. Meanwhile the people who have absolutely nothing going on the rest of the day will yell at us to hurry up because they're going to miss The Price Is Right - even though they could watch it right there in their chairs.

Then a co-worker of mine told me something very disturbing. She told me that most of the male patients masturbate during treatment.

WHAT!!

I have known for a while that most men on dialysis suffer from erectile dysfunction - we can't call it impotence anymore. Usually the circulatory problems leading up to their renal failure also affected their ability to get an erection. It's all connected. So since it's all connected, when we start them on dialysis and their blood starts flowing at a faster rate, it starts flowing at a faster rate EVERYWHERE, including, you know, down there. Once they get on treatment they get the best boner of their lives.

No wonder those fools are pushing old ladies down to get to their chairs. They have a date with the dialysis goddess.

I am not naive but I guess I'm pretty dense. I've been working in this clinic for 2-1/2 years and had no idea this was going on. You might want to ask "License Pending, how dumb could you be that you couldn't see someone spankin' his monkey right in front of you?" Let me tell you why.

All these guys bring blankets with them. Dialysis makes a person cold. When their blood leaves their body and travels through tubing in room temperature air, it lowers their body temperature a bit. We can raise the temperature on the machine to warm their blood, but it only does so much. So most people bring blankets and pillows to make up for what we can't do. So while the guys are all snug and toasty under their blankets, their throbbing member right there begging for attention....well I guess, boys will be boys. I hadn't heard that women experience the same phenomenon. I suppose they do but, being that we are socialized differently, don't feel the need to, um, whatever it is women do to take care of themselves and darned if I can think of a decent euphemism for.

This information both fascinated me and traumatized me. I'm a sex positive person. I'm all for the freedom of sexual expression - in theory. I'm just a little skeeved by the sexual expression of some gnarly old men a few feet away from me. Ewwwww!
Part of me wants to be a looky-loo and see if I can catch them, but my rational side says "no, if you see that you'll ruin it for yourself and never have sex again." So I avert my eyes and go about my business as if nothing is happening.

So I'm in denial I guess. Next is bargaining. I wonder how I will eventually express my anger?

Papa Was A Rolling Stone

2008-02-14T07:56:00.005-06:00

In nursing school I've spent a lot of time learning how the brain and peripheral nervous system work. I've been doing this because, even though it was taught in anatomy, it usually came up towards the end of the semester, after weeks of the professor being bullied by students to push tests back because they weren't ready. So by the time the nervous system came up, we skimmed over it, barely discussing it. So I've spent the last week or so teaching myself about the nervous system.

I don't regret the time. I've learned so much. I was fascinated to learn that some nervous system disorders are not a problem with the brain, but a problem of communication. Either the brain doesn't communicate with the body, or the nerves in the body don't communicate with each other or with muscles.

I remember first becoming aware of cerebral palsy when my cousin had a child with the disorder. Like most people I didn't understand the condition. Like most people I lumped everyone with neurological disorders into the same category - retarded.

One cold winter day some 18 or so years ago, I began watching a movie that came on. The movie was My Left Foot. It is the story of Irish poet, artist and writer Christy Brown who was born with cerebral palsy. What struck me about this story is how devoted his family, especially his mother, was devoted to caring for him. He was 10 of 21 children, and yet his mother gave him the extra attention and care he needed to survive.

This made me ponder the point in human evolution when people looked down at one of their own who needed extra help to survive. Instead of moving on and allowing the person to die, someone decided to put forth the effort and care into making sure the person survived. To me, this is the first step to civilization - compassion.

I am glad that more research is being undertaken to better understand what happens when a person's mind and body are broken. They are helping understand what the parents knew all along - there's a person in there; a person with a mind and spirit, with thoughts and ideas trapped inside them. They just can't communicate them because their muscles won't obey what their brains are telling them.

Then yesterday our instructor shared with us the story of Dick and Ricky Hoyt - father and son team who compete in triathalons with Dick rolling Ricky the whole way. Read their story and watch the inspirational video below and see how Team Hoyt works together. I was very touched by how much this man loves his son. I only wish I could find the same discipline and devotion if it were my child with cerebral palsy.

Countdown to Graduation

2008-02-07T21:18:00.002-06:00

Countdown To

Oh yeah, babe.

I plan to play with it and make it look pretty, but I have to crawl off to bed.

One of my classmates drunk-dialed me earlier. At my age I thought I'd run out of virgin experiences. I so feel like a college student.

Lime Kool-Aid With Strips of Balony

2008-02-03T19:36:00.001-06:00

I don't know which came first - my interest in medicine or the TV series MASH. I don't know if it drew me in because I inately love medicine, or if watching it made me love medicine.

When I watch it now I realize that a lot of what passed as humor was blatent sexual harrassment. The guys were constantly propositioning any female in their vicinity. MASH the movie features or horrendous scene where the whole camp gathered to watch as the shower tent collapses revealing a nude Margaret Houlihan. It was supposed to be funny, but if I were to put myself in her place, the event would have been very traumatic.

But I don't mean to get up on my feminist soapbox. If I were to think it over, it depicts situations as they were in the 1950's when there was no such thing as sexual harrassment. Men could say and do whatever they wanted to women and it was supposed to be viewed as flattery.

What I liked best about the show was it had some of the best writing on television. I tried finding the actual dialogue for the episodes I liked best, but frankly I don't have that kind of time.

Below are some of my favorite lines from the show. They aren't verbatim but hopefully close enough for you to appreciate them.

The scene: Hawkeye and BJ are riding in a jeep. They turn too sharply and the jeep rolls over on it's side. BJ suggests that they could rock the jeep and turn it upright again. Hawkeye and BJ rock the jeep and it turns completely upside down. They both look at the jeep as the reality of their situation sinks in.
Hawkeye: So what are you waiting for? Get in.

The scene: Hawkeye and BJ are sitting together in the mess tent. Hawkeye is smelling the food and making suggestions about what it could be - smelly socks, old cheese. He offers the food for BJ to smell.
BJ: I don't want to smell your food. It's disgusting.
Hawkeye: This from a man who drinks lime Kool-Aid with strips of balony in it.

The scene: Colonel Flag has come to the camp looking for communist sympathizers. He is bragging about his ability to move about without being discovered.
Colonel Flag: I am the wind.
Hawkeye: I told you he was the wind. You said he was the moon.
BJ: You said he was the moon. I said he was the stars.

The scene:Trapper John and Hawkeye are lounging around The Swamp. An announcement comes over the PA announcing that cockroach races will be held later that evening.
Trapper: Are you going to the cockroach races?
Hawkeye: Are you kidding? People just go to those things to see a cockroach crash.

The scene:Radar and Colonel Potter are in the office making a phone call. Potter studies Radar for a moment.
Colonel Potter: How can you see anything through those filthy glasses?
Radar: I know where everything is, sir.

I Hope I Die Before I Get Old

2008-01-29T17:40:00.002-06:00

Only young people think that way. Now that I am getting old, I very much want to live.

So it turns out that middle age is depressing.

Indeed it is. There are good days and bad days, but for me the depression is realizing that someday I am truly going to die. There's no escaping it.

For many years I got away with not thinking about it - it seemed so far off. Now that I've been in nursing school and have seen people my age shuffle off the mortal coil, the reality is clear. I was really freaked out to see people my age unable to turn over in bed, suffering from dementia, having limbs amputated from complications of diabetes and unable to finish a complete sentence after years of smoking.

I can't get away with not taking care of myself. In the past I told myself I would eventually get around to eating right, exercising and not smoking. No longer.

My daughter and I started a pact this week. She went for her anual check-up and found that she had gained some 30 pounds over the previous year. She decided to change her eating habits and exercise more. I want to quit smoking and so will cut down gradually. Our pact is that we will check in with each other once a week and talk about our progress, our obstacles, any problems we're having, and to give each other moral support.

If I do nothing else, at least I can be an example. My hope is that I will get back to the state of health I was in before I started nursing school. It seems like an eternity. With the end in sight, it feels doable though. Watching my daily habits will help tick off the days to graduation.

And, no, I have no idea how many days it is. It's less than 100. That's all I know.

It's probably about the number in years that I would like to live to.

Take the Long Way Home

2008-01-14T11:52:00.001-06:00

Today begins the final stretch to finish nursing school. If I keep repeating myself either slap me or get over it because I'm getting old. But I can't believe how close I am to finishing. I spent 4 years getting into nursing school, plus 2 years actually being in nursing school. My mind is boggling about actually having a life once this is through.

It has been difficult but I know that I've grown a lot. And none of that "what doesn't kill us makes us strong" bullshit. I'm talking about how I've learned to prioritize and problem solve; how to communicate; how to work as a team. It has leaked over into other parts of my life and made me a better person. Well, not better. More effective maybe.

Still, I have noticed that now I can see the big picture where before I tended to get caught up in the mundane; the right now. Part of this has to do with actually having something to offer the world in the form of a service or a skill. It feels pretty good knowing that I can do something that makes a difference. I'm not just a body in a chair.

Maybe tomorrow I'll talk about dialysis hijinks. There have been many.

US Places Last on Preventable Death

2008-01-09T09:22:00.001-06:00

Okay yeah, blah blah blah. What are they going to do about it?

Dream A Little Dream

2008-01-07T11:10:00.001-06:00

As of tomorrow graduation is 4 months away.

Wow. After so many years of struggle it hardly seems possible. I spent years getting into nursing school. I'm trying to imagine a life where I just go to work and come home.

(thoughtful silence)

Oh, and enough money to pay bills and buy stuff just because I want it.

(more thoughtful silence)

Okay, so in no particular order, this is my wish list for after graduation

1. A laptop
2. Student loans paid off
3. A vacation - a REAL vacation where we go away for more than a weekend, stay in a hotel, eat in restaurants and go on interesting day trips and tours
4. Coming home after work, putting my feet up and watching TV until I'm in a coma - well for the first week or two anyway
5. Hobbies
6. A social life
7. A new bicycle - a nice bicycle - one that costs more than $50 and one that I can ride without feeling like I carried it the whole time
8. Laser hair removal
9. Dental care - specifically the crowns I have needed in the front for almost my whole adult life
10. Plane tickets for me and my family so we can see each other more often
11. Truck paid off
12. Swimming lessons
13. Personal trainer

There's more but that's a start.

WIBNI If E1 Would STFU During Class?

2008-01-01T14:53:00.002-06:00

I'm not in school at the moment there isn't much to talk about, so I thought I'd discuss issues about school that have come up in the past that gave me pause. Today I'm thinking about cell phones.

Last year our instructor had a rule that I loved. If a person's cell phone went off during class, the person had to bring snacks for the whole class the next time we had class. We only have 30 students in the class so it was doable. I don't think it would work in a class of 100 or so. If a phone rang a cheer went up in the class. There was no way we would let the person off the hook for bringing snacks. We were all over that.

Still, it helps to drive home the point that while cell phones are a technological marvel, people around you would appreciate if you would be considerate with regards to your cell phone.

1. Keep your cell phone off. Putting on vibrate is distracting.
2. If you have an emergency, the person will leave a message and you can call them back on break. Yes, you can wait a few minutes. Truly, what could you do in five minutes anyway? If your kid fell down and split his head open, whoever is responsible for him or her while you are in class can run him to the ER and you can meet them there. Five, ten minutes won't make that much difference.
3. If you feel it is absolutely necessary to answer the phone, please get up and leave the room.

I hate to sound like my grandmother, but I can't help it. When I was your age we didn't have cell phones. If there was an emergency, a person could call the school and someone could get the message to you. In my 20+ years in college this only happened once. I arrived in class and about 10 minutes into it, someone came in the room and handed the professor a slip of paper. She said "is License Pending in this class?" I said "Yeah, that's me." She said "Do you mind if we step outside for a second?" I thought I was in trouble but once we were out of the room, she told me my child was ill and I needed to go pick her up from day care. No need to announce the whole bloody affair in front of the class. We went back inside, I quietly gathered up my things and left. The next day a few ~~nosy~~ concerned classmates wanted to know what happened and I told them. Otherwise it was my business, I took care of it, and I didn't disrupt the whole class over my child's runny nose and fever.

I am delighted that more and more people use text messaging instead of talking. At first I didn't see the point. Why not just talk to the person and say whatever it is you want to say? After spending the holidays with my children, I see the beauty of it. While the family was having a conversation, my daughter could check her messages and send a text before it was her turn to talk again. No having to stand up and leave the room for a conversation. She could stay right where she was and enjoy our company all the while staying in touch with her friends.

I also noticed it when I was in the library. In the past cell phone conversation went something like this.

Bleep bleep bleep bleep bleep bleep (insert ringtone of choice).
Hello? Hey. What's up? Oh nothing, just sitting here studying. What? Who? Oh really? No way! Yeah. Uh huh. Well tell him I'll be here for another 10 minutes or so. Uh huh. Uh huh. Yeah. Blah blah blah blah blah blah. Blah blah blah blah blah blah. Blah blah blah blah blah blah.

Occasionally they would remember to get up and leave the room for the discussion, but mostly not.

Now I see people sitting quietly texting like mad, and I can study undisturbed by the ugly details of their lives.

Yay texting!

Multiply Life By the Power of Two

2007-12-13T13:01:00.002-06:00

"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.

A Blast From the Past

2007-12-02T07:46:00.002-06:00

It's My Turn To Shut Up

2007-11-29T20:48:00.002-06:00

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.”

It Ain't Over 'Til It's Over

2007-11-20T09:53:00.001-06:00

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.

I Said Shut Up - Part 2

2007-11-15T18:24:00.001-06:00

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.

Brain Damage

2007-11-13T19:49:00.003-06:00

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.

Hell Is For Children

2007-11-09T20:27:00.001-06:00

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.

Turn and Face the Strange

2007-11-08T13:53:00.000-06:00

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.

It's Only Words

2007-11-04T08:04:00.000-06:00

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?

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

2007-11-02T21:08:00.000-05:00

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.

Don't Have A Cow, Man

2007-11-01T22:39:00.000-05:00

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.

Always Look On the Bright Side of Life

2007-10-24T13:12:00.001-05:00

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.

That Smell

2007-10-18T18:52:00.000-05:00

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.

The Fire Down Below

2007-10-15T09:09:00.000-05:00

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.

I Keep Working My Way Back To You

2007-10-12T05:48:00.000-05:00

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.

Lay Down All Thoughts, Surrender To the Void

2007-10-09T17:26:00.000-05:00

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.

Wake Me Up When September Ends

2007-10-06T19:49:00.000-05:00

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.

Watch Out Boy, She'll Chew You Up

2007-10-05T20:53:00.000-05:00

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.

Are You Experienced?

2007-10-03T12:27:00.000-05:00

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.

The Long and Winding Road

2007-10-02T17:45:00.001-05:00

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.

I've Got A Bad Case of Lovin' You

2007-09-30T10:22:00.000-05:00

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 E-Harmony.com?

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?"

A Cute Abdomen

2007-09-29T23:33:00.000-05:00

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.

It's Not Brain Surgery

2007-09-28T18:24:00.000-05:00

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.

A Little Ditty About Jack and Diane*

2007-09-26T20:12:00.001-05:00

*not their real names

"I like doing things at the last minute. I like the challenge of having deadlines. That way it forces me to work harder." Diane said to me one day.

"It doesn't matter if I study 2 hours or 10 hours. I get the same result," says Jack "so I don't waste my time studying too long. I just do a couple of hours the night before the test."

Last year Jack and Diane were amongst my favorite classmates. We got along well and shared quite a few laughs. This year they're getting on my nerves.

Last year I was in on a group project with Jack. Diane was in a different group. Jack has great confidence, which is both his strength and his weakness. Jack decided he was the leader of the group and he was going to control everything. We had to choose a patient, research everything about the patient, create a care plan and do a presentation to the class. As we got down to analyzing the information about the patient and compared it to Jack's presentation, the other group members and I noticed a big, gaping omission on the project. I pointed it out to Jack. "Yeah, yeah, yeah, I got it, I got it." He said. Still the information didn't appear on the project. Another student tried. "I know, I know. I saw that but I don't think it's that important." he protests. I even went so far as finding a brochure that pointed out the very thing we were trying to make him understand. Still no luck. Finally when we got our grade for the project - we got the lowest grade in the class. You guessed it. We lost major points for not addressing the very thing we told Jack was missing from the project.

Meanwhile Diane's group was grumbling to us about her penchant for last-minute work. She didn't turn in her portion of the project until 11 p.m. the night before the project was due. This meant that the other group members had to stay up all night incorporating her information into the project.

Oh, in case I didn't mention it, I hate group projects with a purple passion.

Meanwhile we took our midcurricular HESI exam. Jack and Diane both failed. I knocked it over the fence. Jack said "well I think the reason you did so well was because you happened to get questions in areas you're good at." Huh? Wouldn't be because I spent more than 2 hours studying each subject, would it? Naw, that couldn't be it.

Three weeks ago we were assigned our first group project of the year. I wasn't in class that morning (I have a really good excuse; honest!)and I guess there was a little tiff between Jack and some other folks who wanted me in their group. Jack cornered me later and told me he drafted me into his group and just knew I'd be thrilled, and oh by the way, Diane is in the group too. My heart sank. I went to the other group and said "I don't want to be in his group. Help me out!" Their eyes lit up. "Please be in our group with us. We were so mad at him for saying you would be in his group without even asking you." Somehow I managed to convince Jack that the other group asked me first and I thought I told him. He was furious but I stayed calm, keeping in mind that I really do like him as a friend, but don't want to work with him on anything of any importance. I kept it friendly and acted as if nothing changed, and pretty soon he got over it.

Every week we have lab homework. We are given a certain number of questions we have to answer before class, and if we show up without them we get a zero for the day. I always start on homework the minute it's in my hand because I'm old and it takes me longer to do stuff. Besides, it always ends up being more difficult than I thought, and I like having extra time to look stuff up if I can't find the answer in my book, or online, or in the notes, or some other god forsaken place that they have cleverly hidden the answer. Week before last, I overheard Diane telling someone that she didn't do her questions and got a zero. "I guess I learned my lesson, huh? Gigglegigglegiggle."

We have lab after class once a week with an hour break for lunch in between. Last week fter class I was heading to my car to get my lab stuff when I bumped into Jack walking back from his car. He was waving his homework paper around in the air and said "Hey, did you get all the answers to the homework? I can't find them all. Oh well, I guess we'll sit down in the cafeteria before lab and swap answers."

Uh, I think not.

I hid out in the library during lunch, then snuck up the back stairs to the lab. As I rounded the corner I see Diane furiously copying Jack's crap-ass homework answers that he pulled out of his ass at the last minute.

Wait until the last minute? Only spend 2 hours studying? My ass! I'm going to have to hide from these two the rest of the year

We Want You As the New Recruit

2007-09-25T14:17:00.001-05:00

A big surprise you get when you go to nursing school is that there are rules......lots of them. They are given to you in orientation and they're as long as your arm. Sometimes it feels like we've been drafted into the military. For adult learners, um, non-traditional students, er, okay old farts like me, it has been a long time since anyone has told us what to wear, how to behave, where to stand or how to talk. The good news is that for those of us who have been on this planet awhile, we have learned that rules are a part of life. Some are good. Some are worthless. The trick is finding out which rules can be gotten around without a problem, and which ones can be violated at your own peril.

There is a level of discipline needed in nursing school that is a bit overwhelming. For example, for clinicals there is a dress code.
I'm philosophical about the rule. Maybe I'm just too old to waste energy on rebellion, but more than that, I understand why they have this rule. I figure that reason they have the rule in the first place is because someone somewhere doesn't have the sense enough to know how to do the right thing. One day, many years before I got into school, someone showed up for clinicals not wearing the right uniform, wearing purple polka-dot undewear under white pants, popping their gum, reeking of cigarettes and B.O., sporting a tattoo down their arm that says "Born to Be Wild". This won't do much to put a patient at ease or to develop trust. I don't know about you, but if this person was coming at me ready to shove a Foley catheter in my wee-wee, I'd have a heart attack.

The path to nursing school is paved with pre-regs. We spend lots of time in classes in the sciences, math, English and so on. Some classes have attendance policies and some don't. Most of the time when we're mixed in with the wet-behind-the-ears youngsters, the rules for turning in assignments are pretty relaxed. I suppose this is to keep the helicopter parents out of the professor's hair. "Trevor can't turn in his homework because his alarm didn't go off today? No problem. He can turn it tomorrow. Oh, he can't turn it in tomorrow because he's going on vacation and won't be back until next week? Okay, well just have him turn it in whenever he gets around to it."

This won't fly in nursing school. It requires a different level of discipline that some students are acustomed to - and not just generation Y. People of all ages, if they've never undergone a challenge this intense, sometimes fall down and never get back up. See the point is to get us to make the transition from "employee" to "professional." Nursing school isn't just job training. It's a transformation. Sometimes students don't understand that the way you do things in high school and community college won't go over well in nursing school or in the hospital. There are deadlines. There is pressure.
There are tired, hungry cranky nurses waiting to go home and they need you to show up on time so they can. Turning in homework on time is a way of driving the point home that things need to be done on time, and if they aren't; there are consequences. The point is to get you to develop some integrity; to be able to do the right thing because you're supposed to without someone standing over you to make sure you do it.

As nurses we will be taking care of people who are vulnerable. The people we take care of, their families the agencies that employees us and the state board of nursing need to know that you can be trusted to not cause harm to this person. They need to trust that we won't steal from them, molest them, refuse care because of differences in opinion or take advantage of them somehow when no one is watching. How can they trust you to hold yourself to that high standard if you can't get your homework done on time? If you cheated your way through pre-regs - fuhgedaboutit! You won't last long in nursing school. First of all, your classmates will be working their butts off too hard to let you scam their work. Secondly if you never learned how to think, you'll be lost very quickly.

At first I was frustrated with students who couldn't step up and do what was asked. This problem took care of itself fast enough. Students who can't conform to the rules don't make if far. The rules aren't there to irritate you. The rules are to get you ready for what's ahead. There are greater expectations and bigger responsibilities. A person's life is in your hands.

Doctor, Lawyer, Indian Chief

2007-09-23T20:18:00.000-05:00

When you were a kid, did you want to be a nurse when you grew up?

Me neither.

I've noticed that most people think that a person is born to be a nurse. I suppose there are some people who have an innate need to nurture and care for others. These people are co-dependent, not nurses.

When I talk to people and they find out I'm a nursing student, several things happen.

A. They want to talk about their last hospital experience - in vivid detail.
B. They ask for medical advice - then promptly argue about it.
C. If they're nurses they tell me I'm crazy.
D. If they want to go to nursing school, they first tell me they're in nursing school, then later confess they're working on pre-regs. Trying to go to nursing school and actually going to nursing school are two completely different things.
E. They tell me I'm an angel.

The last one really amuses me. In my entire life no one has ever said I'm an angel. Oh, I've been called many descriptive and off-color things, but never an angel. I'm not a person who is all-giving, all-loving and concerned about the welfare of others. I'm not known for committing random acts of kindness. Not that I don't care about people at all; just not that much.

I would like to put the idea out there that nursing is a career choice; that people can make an intellectual decision to go into nursing. If you didn't want to be a nurse ever since you were a little girl (or boy) that doesn't mean you can't change your mind later.

There are lots of careers out there that people don't even know about until they get into college, or get into a job and find out there are other things to do in their field. No one thinks it odd that a computer programmer or a widget welder didn't dream about that profession from the time they were little kids. Why not nursing?

My view is that if a person goes into nursing because they want to take care of people, they are trying to get their own caregiving needs met and the focus isn't on the patient. They're looking for a pat on the back or other emotional reward. Another downside to this view is that the person who has a need to take care of others is going to get their hearts broken. Patient's are a very ungrateful lot, and it's getting worse as hospitals are trying to market themselves as hotels. In the short time I've dealt with patients, they couldn't care less that they've been yanked from the brink of death. All they want is their meals hot and on time, fuzz-free cable and someone to make them a fresh pot of coffee. Do you want me to pull the car around for you too?

Even though I didn't go into nursing looking to fullfill a need, I was still shocked by this attitude. Fortunately I was able to keep going and stay focused on my reason for going into nursing - because I love medicine. It doesn't mean that only one kind of person can be a nurse. It doesn't mean that only people who can suffer inwardly and silentely can do the job - although it helps.

For the people who don't get past the shock, I'm disappointed and sad. Nursing is such an all-encompassing field that anyone can find a good fit somewhere. Depending on your personality, there is a nursing job that will be a good fit. Some of my classmates got disillusioned during clinicals and quit. I wish they could have held on long enough to see that nursing isn't just what we do in clinicals. If they held on they would see that the places we spend time in clinicals got more and more interesting. They would have found out that what you thought you'd like to do, you really actually hate, and thing you thought you'd never do end up being the thing that you love.

There are lots of places a person can work. There are different specialities, patient populations, age groups, working environments, and so on. The job can vary a great deal from one hospital to another, and even one unit to another. There are nursing jobs where you don't have to work with people at all if you don't want to. Don't like kids? Work in orthopedics. Can't stand the sight of blood? Work in hospice. Hate wearing scrubs and prefer heels and hose? Become a drug rep.

I'm sizing up jobs based on the working conditions. For example, I always thought I'd like working in the OR best because I'm fascinated by it, but even more than that I don't have to deal with providing concierge service all day because the patients are asleep. Then I went to NICU and fell in love with that too because of the practicality of the job. No running back and forth down the hall. My patients are no more than a few feet away, and I won't be acting as concierge because they can't talk. I can't imagine quitting after all the time and effort I put into my education. If I don't like what I'm doing, I can easily go someplace else.

I wouldn't have all those choices available to me if I had chosen to become an Indian chief.

A Student-itis

2007-09-22T17:47:00.000-05:00

Yesterday during our clinical conference our instructor discussed our assisgnments that we turned in the week before. Some of my classmates didn't do very well. One person confided in me that she got a C on hers and she felt so bad she went into the ladies room and cried.

This is an example of what I call "A Student-itis." That is a student with straight A's and gets a B and feels like she is a complete failure.

This phenomenon happens because nursing school is so competitive now that people who get accepted usually have the best grades and highest test scores of the huge pool of people competing to get in. If you are an average person, like me, getting accepted means you have to knuckle down and work extra super hard to get your grades up and do well on the entrance exam. At any rate the majority of my classmates have a 4.0 GPA. I don't, but I managed to make it in because our school has a point system, and I put my effort into getting high grades and test scores in areas that would get me the most points.

Another part of the phenomenon is the nature of nursing school. It's not like anything else a person could do. I've had debates with people who insist that nursing school is just like any other kind of college. It's not. One of my instructors worked as a legal nurse. She has a law degree and said that nursing school was much harder than law school. All our faculty have master's degrees, and many of them have said that going to graduate school was a breeze compared to nursing school.

A lot of nursing students start nursing school with plans of keeping their 4.0 GPA. Then comes the first test and they quickly find out that it's next to impossible. I said NEXT TO impossible; some students manage to do it, but they are serious freaks of nature. The average student is doing well if they can keep a C average. The super-achievers wind up getting their hearts broken and their confidence shaken when they don't do as well as they expected. Even though the faculty tells them that this is okay, many of them beat themselves up - hard - because their grades slip.

Some recover and manage to either get their grades back up, or learn to accept the lower grade. I think the ones who accept it go on to succeed because they've learned to ease up on themselves. They suck it up and move on to the next thing. Dwelling on the bad grade, wondering where you went wrong, arguing with the instructor about the test takes precious time and energy away from studying for the next test. It helps to talk to actual nurses who've been there. They say that no one will ever check out your GPA when you look for a job. The fact that you graduated and got your license is enough for the hospital to know that you are smart enough and safe enough to be a nurse. If a person can focus on just getting through and letting go of the goal of having straight A's, then nursing school isn't quite so harrowing.

A couple of years ago I started nursing school at a different school than the one I'm in now. I was quickly bounced out by a bad math grade, and it was devastating. Somehow I managed to find the courage and keep trying. It took another 3 years before I got in to a different school, but I got in and lived to tell the tale. I was pretty stressed out at first, wondering if I would go through that again. Eventually I settled down and learned to put my energy where it would do the most good.

The bonus for me having this experience is that I got comfortable with failure. I still stress out from time to time, and I feel a little down when I don't do well, but that's only when I know I didn't try hard enough. If I know I did everything I possibly could to get ready for the test; that I read the material, took good notes, reviewed the material before the test, then I let up on myself. I know that there isn't anything more I could possibly do.

Even if I don't know everything on the test, there is one thing I know for sure. Now that I am in nursing school I know there is no such thing as a stupid nurse.

Nursing school 101

2007-09-21T20:36:00.001-05:00

I'm going to tell you something about nursing school you may or may not know. Nursing school has three parts to it. The first part is fundamentals which is reading a text, listening to a lecture, taking notes and being tested on the material. The second portion is lab where we practice sticking needles and tubes into orifices on a dummy. That way we can fumble, giggle and drop things in front of our classmates first instead of in front of a real person. The third portion is clinicals where the idea is to combine what we learned in class with what we practiced in lab and do it in the hospital on real people. The idea is to find a patient who has the disease you talked about in class, and needs to have an orifice poked that you practiced in class that week.

I'm explaining this because many of my classmates said they didn't really understand how nursing school works. I had a loose idea, but I confess I didn't know either. We were surprised to find out that it was more than just readin', writin' and taking tests. I had a classmate last year who is a real brain. She had a 4.0 GPA, could get 100 on any test you put in front of her. Once we got to the hospital She lost it. A few weeks later she dropped out of nursing school.

Today was clinicals. I'm always stressed out on clinical day. It's nerve wracking because, as a classmate put it, "it's like starting a new job every day for two years." You have to hit the floor running - picking a patient or three, looking up the medication you'll be giving them, getting report from the nurse who took care of the patient during the night, and planning what kind of care you will be doing that day - even though you don't really know what you're doing.

What makes it so stressful is that we can't just jump in and start working. We have to collaborate with the nurse, figure who is going to do what, and then dealing with the insecurity of not knowing what you're doing. Even harder than that is not letting the patient see that you are nervous and unsure. It takes almost as much effort to pretend you know how to do something you've never done before as it does to actually DO the new thing you've never done before. When a student does something for the first time - say, a dressing change - the instructor has to be there to observe.

Waiting for the instructor to show up on the unit is another layer of stress. Care has to be done in a certain time frame. Once we figure out what we're going to do for the day we have to call the instructor to come watch. Sometimes they're too busy and can't get to you, and the stress ratches up a notch as you wait for the instructor. Then if the instructor doesn't make it, you then have to tell the nurse you can't do the care after all and they have to do it. This is stressful for the nurse, finding time to do something she thought the student was going to do.

Fortunately I have an instructor who is a real sweetheart. It also helps that now, in my second year of school, it is expected that we already have enough experience to work on our own, and the instructor doesn't hover as much.

First year was worse. Since we had never done anything ever, the instructor put us through a little gauntlet I like to call "stand and deliver". The instructor comes to the floor and starts asking questions. What meds is she taking? What's it for? How does it work? What are the side effects? What do you need to know to give the med safely? What are the labs? If the lab is abnormal, why is it abnormal? At the time I hated it, but looking back on it I realize it taught me a lot. Getting ready to stand and deliver means spending a couple of hours looking up everything - the meds, the labs, the disease, any tests that are being done, how they're done and why.

Eventually I got pretty good at knowing what the instructor would ask and being ready for her when she got there. I noticed that once I had that covered the instructor wouldn't hover as much and would leave me alone. I guess she figured that I had a grip on what I was supposed to be doing and didn't need to be watched as carefully. That meant she would go and put pressure on someone else who wasn't getting it. Since then I've noticed that if an instructor is riding someone pretty hard, there's usually a good reason.

It also was a huge help that I spent the summer in the LVN program. I got 12 extra weeks of clinical experience and got the hang of handling several things at once, and that was the most difficult thing I've ever done in nursing school. I also got better at thinking on my feet and prioritizing my day. I learned to be efficient about getting and giving information. I learned to comb through information, pick out the most important facts, and reporting the most critical stuff to my instructor or the nurse I work with.

The stress still lingers though. I had a good day today and almost got to start an IV. But I'm exhausted and my brain hurts. Tomorrow is dialysis day. It's a relief to go to work, doing skills I'm good at, working with people with whom I am familiar, and patients that I've seen over and over for the past 2 years.

I never thought I would hear myself say that.

Gonna Dress You Up In My Love

2007-09-20T16:12:00.000-05:00

"I don't know what I did to deserve this. I must have done something really terrible in my past life. Maybe I invented culottes." Murphy Brown

Like a lot of people my age, I carry a forward head posture. When I think about it, which is about once every 5 years, I'll try and sit up straight, pull my shoulders back and pull my stomach in. The result of this posture means my stomach sticks out......a lot. And it's not just the posture doing it; I'm fat. I have a big basketball sitting where my waistline used to be.

I can't conceal it very well but I do what I can to not draw attention to it. I try to choose clothing that is cut wider in the shoulders and hips to make it look like I have some kind of shape. I do this out of consideration for my classmates so that my great basketball in full bloom won't block their view of the 22-year-old hotties walking around campus.

I have a doppelganger in my class. People say we look exactly alike. Experience has borne this out. One day my professor handed me something and went back to lecturing. About 10 minutes later she walked over to my doppelganger and asked for the thing back that she had given to me. So it's real. Our personalities, however, are nothing alike. She is more of the homeroom mother, second grade teacher, Vacation Bible school volunteer type. She bakes cookies for the nurses at our clinical sites. When it's a classmate's birthday she passes around birthday cards for everyone to sign. Me, I'm the bitchy, cynical, sarcastic, wise-cracking, gossipy, self-centered type. If I bake cookies it's because I have a craving for cookies.

She is a very nice person; a pillar of virtue even, thoughtful and sweet. But she does something that I hope makes it easy for someone to tell us apart from miles away. She wears elastic-waist pants......with a T-shirt......tucked into the elastic-waist pants.

Remember, she is my doppelganger, which is not really a twin, but we look exactly alike. That means she has forward head posture and a big basketball in front too. Tucking a white T-shirt into dark green pants with an elastic waistband is saying HEY! LOOK AT MY BASTKETBALL. YOO HOO. RIGHT HERE!

I won't even go into the culottes and skorts that she wears with running shoes and footies.

Then I noticed that the phenomenon is spreading. Yesterday I saw 3 other middle-aged women with forward head posture and basketballs in front wearing their shirts tucked into their pants. Over the past few weeks I've seen, I don't know, 5 women over 40 wearing culottes with Birkenstocks and socks to match their shirt. Okay, fashion faux pax. One should wear socks to match their slacks, not their shirts. Oh dear.

Did I miss fashion day in 1977 or something? When was it ever okay for anyone from my generation to wear shirts tucked into an elastic waist? I remember during the 80's when oxford shirts tucked into slacks were big, and I have to admit I'm a huge fan of that look. If it ever comes back I might even consider losing 50 pounds so I could pull it off.

Nevermind. No I won't.

Long ago I made the decision to grow old gracefully. I promised myself that I would not attempt to wear clothes that are meant for people 20 years younger than me. So far it's not a problem. This abomination that is the the babydoll, that makes one look like you're walking around in your nightgown is easy enough for me to avoid.

I'm no sex kitten, I don't have a strong sense of style and I haven't shopped for anything new in a while, but culottes? Skorts? T-shirts tucked into elastic waists? What happened? When does a person wake up one day and say "I'm going to go out and buy the ugliest thing I can find and make myself look 20 years older?"

I hope that if I ever get the urge to wear a skort, or if I tuck my shirt into my elastic waistband, that someone who cares about me will pull me aside and say ever so gently..........

"You're not wearing THAT are you?"

Glossary

2007-09-20T15:37:00.001-05:00

ADN - associate degree nursing; usually a two-year program that meets the requirements for taking the RN licensing exam.
ACLS - Advanced cardiac life support. Providing rescue care beyond basic CPR that includes starting IVs, giving medication and using a cardioverter to shock the patient. Certification is good for 2 years. The class has to be repeated to become certified again.
ATT - authority to test; awarded to a student who has graduated from an accredited vocational nursing program. This allows the student to work as a graduate nurse while waiting to take (or pass) a licensing board examination
BSN - bachelor of science in nursing, usually a four-year program that meets the requirements for taking the RN licensing exam.
dialysis - artificial removal of waste products from the blood when the kidneys fail.
fistula - an abnormal connection or passageway between organs or vessels that normally do not connect. An AV fistula is a vein and artery sewn together which makes blood flow faster through the vein making it thicker. Dialysis is then given through this passageway.
Foley catheter - a thin sterile tube inserted through the urether and into the bladder that is left in place to drain urine from the body and collects the urine in a bag. Different from a straight catheter which is inserted into the bladder to drain and then immediately removed.
HESI - Health Education Systems Inc; a test given by nursing schools to evaluate a student's strengths and weaknesses, and to assess their preparedness to take the NCLEX, or a way of keeping a student from graduating and thereby inflating the schools' graduates' NCLEX pass rate; depending on how you look at it.
LVN - licensed vocational nurse; often known as an LPN or licensed practical nurse; a graduate of a diploma or certificate program of 9 months to a year that meets the requirements for taking the LPN/LVN licensing exam.
MSN - master of science in nursing; an advanced degree of usually two years beyond a bachelor's degree; one whom must be addressed as "master" at all times -NAH! Just kidding.
NCLEX - National Council Licensure Examination, formerly known as the state board examination. The exam a graduate nurse must take, and pass, before being issued a license to practice nursing.
OB - Obstetrics; dealing pregnant mothers and unborn babies.
RN - registered nurse; one who has holds a license to practice nursing

It's Here

2007-09-19T21:38:00.001-05:00

I got it today! My ATT is here.

I take my board exam on October 8, 2007. Some two weeks after that I will no longer be license pending.

My employer is even more excited about this than me.

I mentioned before that I work as a dialysis technician. Most dialysis patients begin their life on dialysis with a central venous catheter. Eventually they'll have surgery to put another kind of access in their arm, either a graft or a fistula. Some never have the surgery and have their catheters forever.

Lately our clinic has gotten a lot of new patients.....so that means lots, oodles, tons, an embarrassment of catheters. On the days when we have catheter patients the 2 or 3 nurses we have in the clinic run themselves ragged hooking up all the catheter patients while we techs stand helplessly nearby and wait. Once I have my license I can join in the fun, and help out with the catheter patients.

For now the cake ban has been suspended.

I Always Feel Like Somebody's Watching Me

2007-09-19T07:58:00.000-05:00

The mental health unit of school is winding down. Boy I thought I knew everything there was to know about crazy people. Turns out the crazy people I know personally aren't really crazy; they're just assholes

Now that I think it over, a good many of the people I know probably suffer from some kind or other personality disorder. Just about every geek I know could be fit the description of a schizoid personality - detached from social relationships, uncomfortable in social situations, and more involved with things than with people. Wow, that would even describe me except I'm really not into "things" all that much, unless one considers useless information one of those "things".

This description sort of jumped out at me. This is a passage from my psych nursing book about paranoid personality disorder. It reads as follows. "A person with this disorder possesses shallow emotions, and shows a pattern of disregard for and the violation of the rights of others. They exploit relationships for their own gain and don't give regard to the needs of their partner, but only care about what they get from the relationship and how it will serve them. Those of the paranoid type constantly analyze the actions of others. They are rigid in their view of the world and think others are plotting against them. They have frequent conflicts with authority and are quick to attack. They are deeply suspicioius of their life partner and want to remain in control at all times.

They can pretend a role to suit their needs and can be very charming in order to get what they want. They show a tendency toward impulsivity and are unable to consider the ethical and legal consequences of their behavior."

I didn't jump to conclusions. The conclusion rose up and swallowed me.

What Did Tornadoes Sound Like Before Freight Trains Were Invented?

2007-09-17T20:22:00.000-05:00

About 20 or so years ago I had a friend who, every time I saw her, had something else wrong with her. There was always some physical malady bothering her and keeping her from enjoying life to the fullest. She had gone through an entire list of stuff happening to her from bowel problems, to gallbladder trouble, to endometriosis until one day she told me she had TMJ

She was speaking about the diease tempormandibular joint syndrome, which would actually be TMJS, but I'm saving annoying English and grammar for another post. In medical terminology TMJ refers to just the joint, hence the J.

But I digress.

At that time I had never heard of TMJ. I was, and always have been, interested in medicine, so I was instantly fascinated and wanted to know more. Since the Internet wasn't around much, or not to the typical person like me, I had to find out more on my own. I hadn't even made it to the library before I saw an article about TMJ in a ladies magazine - Redbook, Ladies Home Journal, something like that. Turns out it is fairly common and lots of people have it and the treatment is fairly simple.

What is interesting to me now about this malady is that this was the first time I experienced a phenomenon that I now see all the time. There is a new disease discovered or brought to the public's attention and suddenly everyone has it. I remember when everyone had hypoglycemia, then it was carpal tunnel syndrome, then chronic fatigue syndrome, then dysautonomia, then sleep apnea, and now restless leg syndrome.

I know there are people who really do suffer from these conditions, and for those people I have a great deal of compassion. It just seems to me that there are a lot of people who have these complaints and really don't have anything wrong with them, but want to use the disease a way of drawing attention to themselves or to get out doing stuff they don't want to do.

In nursing school we are talking about mental illness. This week we talked about somatoform disorders. These are disorders for which there is no physical evidence of illness. Some of the disorders cause actual physical pain and other symptoms for the patient. Others are completely manufactured by the patient to get out of having to do things they don't want to do, to get money via lawsuits or disability, or because they enjoy the sick role and want attention. This called malingering and it's different from other disorders in that the patient knows they don't have anything wrong with them, and the goal of being "sick" is personal gain.

It happened again the other day. When I was at the psych hospital an adorable, tow-headed, blue-eyed lad of 19 years told me he didn't sleep the other night because he had restless leg syndrome. Restless leg syndrome? Son, you are all of 19. Most people with this disorder develop it in middle age, so go sit down and do your homeowrk. Five years ago nobody had restless leg syndrome because it hadn't been invented yet. Now everyone has it.

My question is what did you have before there was TMJ? Did you just have a headache or an odd clicking noise in your jaw? Before there was restless leg syndrome were you just amped up on Red Bull or going through the manic phase of your bipolar disorder?

It's not just malingering that motivates people into having sexy new diseases. I blame TV as well. Now that it has become legal for pharmaceutical companies to advertise on television, it has done so much to make people believe they are ill and must have the sexy new drug they saw on TV. It works the way advertising works - create a need, tell people they are flawed in some way and then sell them the solution to their problem. The transition for using this technique to sell drugs is seamless.

There was an episode of Scrubs recently where two of the characters are sitting on the couch watching television. The dialog pauses and the newscaster is telling of an outbreak of a new bacteria in the city. The two doctors sit upright and scream NOOOOOOOOOOOOOOO!!! In the next scene the hospital is being overrun by people who think they have this new bacteria.

People are already overly hysterical about everything anyway. Again, I blame the media for this. The media takes a simple fact and presents it with earnestness and anxiety to make it seem like it's a horrible problem, when it's something normal and natural. For example, giardia. Now that is one unattractive parasite and what it does to you will make you feel not at all sexy. You will have cramps, bloating, gas and frequent, watery diarrhea and there is simply no way to sex that up. So let's say in your part of the country there are typically 10 cases of giardia a year. It's not such a big deal. That might be a pretty good number now that we have sanitation and water treatment plants. The number was probably much higher 100 years ago, but we don't know because maybe statistics weren't kept in your part of the country 100 years ago.

So the media gets hold of this number and screams OH MY GOD!!!!!! THERE WERE 10 CASES OF GIARDIA REPORTED LAST YEAR!!!!!! IS THE HEALTH DEPARTMENT DOING ENOUGH TO PROTECT YOUR FAMILY!!!!!?

I never hear of anyone using giardia as an excuse for getting out doing things they don't want to do. No one ever claims they have West Nile virus, or luekemia, or multiple sclerosis. No. Those are not sexy diseases.

And what of all the sexy diseases of the past? Why doesn't anyone have the dropsy anymore? Or the ague? Or the consumption? Because now they have edema, fever and chills, and tuberculosis and it doesn't sound nearly as exotic or interesting. All of these old disease aren't as sexy anymore, or maybe the newer diseases are sexier, easier to have, harder to diagnose, and just bad enough to get you out of going to work or school but not bad enough to disfigure you are cause you horrible discomfort.

What horrible disease lurk on the horizon? I can't write about it anymore because I've developed a terrible case of texting thumb and I have to go lie down on the couch for the rest of evening. I might even have to take a few days off work until I feel better.

Why My License is Pending

2007-09-15T20:54:00.000-05:00

Over the summer I took a course that would allow me to sit for the board exam to get my LVN license.

It was hell on a half shell, but worth it. I learned a lot. It gave me the chance to see how it feels to do actual nursing. By that I mean I had several patients at a time and did all their care. I learned to multi-task and prioritize. These are things we don't get to do in the ADN program. In the summer program I did all the care AND the procedures as well as giving meds. In the ADN clinicals the focus seems to be more about learning individual tasks and not as much learning how to deal with multiple things at once....or at least not yet.

Before I start meandering onto other points and musings about this experience, I want to talk about why I bring this up.

The last day of class as we were eating our graduation cake, someone put her name and phone number on the board for us to copy down in case we are not able to get our authority to test, or ATT. For some reason I had a dumb-ass attack and didn't write the number down. Now some 6 weeks later my classmates have all gotten their ATTs and I have not gotten mine. The simple solution would be to call the person who wrote her name and number on the board. Naw, that would be too much like being responsible. I have a real jones for cake and I think I got sidetracked. That's the best excuse I can come up with.

This week has been a nightmare trying to figure out who that person is and how to contact her. I've left several messages for the secretary, er, administrative assistant for the nursing program asking her to call me back with this person's name and phone number. She hasn't called. I had to deal with this person when I signed up for the summer program and, to put it mildly, she has the social skills of a doorknob. I don't expect to get anywhere with her.

I resorted to calling a few names in the staff directory and seeing what happens. Finally someone called me Friday evening. She said she had a pretty good idea who I was supposed to talk to and would send her an e-mail for me. That was a relief.

This has been bugging me to the point of distraction. I have been losing stuff; important stuff. I lost an assignment last week. This week I went to lab on the wrong day. Today at work a co-worker asked me to take care of something for her while she want to lunch and I totally spaced about it and didn't do it. I'm not usually like this. I'm pretty good at handling details and multi-tasking. I'm fairly responsible with the occasional lapse in judgment, but overall I can be trusted to handle important things.

I just want to get this over with so I can get on with life. I want to get the LVN perspective out of my head so I can continue on with the RN perspective. It's harrowing to try and juggle them both. Ever since I got the call back last night I have felt slightly less moody than before so that's a positive. I was able to settle down and look over some math stuff that I have to know before I take the our first test for the semester. Still, I plan to drive over to the college on Monday and find some actual people to talk to, but not the doorknob if I can help it. Hopefully I'll see a familiar face and we'll find a solution to my problem.

Meanwhile I made a promise to myself that if I have something important to take care, I'll make sure I'm not within 10 feet of a cake.

Got to Keep the Loonies On the Path

2007-09-14T17:05:00.001-05:00

Today was our psych rotation. We did this last year and I was a little nervous, mostly because I didn't know what to expect. This year I wasn't nervous at all since I'd already been there and seen some actual psych patients before.

Our society treats mental illness as something to be feared or laughed at. I tend to look at it as any other medical condition. It is treatable and the patient has the potential to be able to function well enough to work, have relationships and take care of themselves. I think the public's view of mental illness is that these people are doing it to themselves somehow. Their behavior is judged as being bad or scary. I see it as this is how the disease presents itself and the person who has it is not to be blamed for it.

I also find it interesting that most people are looking for a reason for a person to have a mental illness. There are many theories about why people develop mental illness, but I think for the most part looking into the source isn't very productive. I think time is better spent figuring out what to do about the disease once it's here. We can't change the past. It is good to have information about a person's past to better understand things, but from what I've seen so far it really doesn't do much to plan the patient's care. Leave the naval gazing to the scientists. As practitioners we should do as much as we can to treat people with the tools and knowledge we have available to us now.

This attitude carries over into how the insurance industry and government pay for mental health services - which is to say very poorly or not at all. If society took this situation more seriously and realized that many things are treatable, the patient's would be so much better off. Instead, mental health is still the red-headed stepchild of health care and it's a horrible, horrible oversight.

It's a vicious cycle. A person becomes unstable for whatever reason and winds up in the psych unit or hospital. They get on meds and their behavior levels out. Then because they can only stay a little while, often before their meds start showing any signs of working, the person is released from the hospital and don't get the support they need to keep getting their treatment. They go off their meds for many reasons; finances, side effects, the belief that they aren't doing them any good, then their abnormal behavior returns and they're back in the hospital.

But I don't want to get off on a tangent about our crippled health care system. That would take forever. I also can't educate the public as much as I would like. All I can do is educate people one at a time.

Maybe I'm still in the throes of nursing school hubris and I believe we can fix anything, but I don't think so. I try to look at things realistically, or at the very least scientifically. I'm old enough to be jaded about almost everything anyway, so I don't feel that I am indulging in magical thinking. What I really believe is that I am living in an interesting time in history where we have the potential to do so much, but beaurocracy and short-sightedness have us in a bind. I wonder if we will look back this time 20 or 30 years from now and wonder why we didn't do more with what we have?

Could I work as a psych nurse? It wouldn't be my first choice, but I could easily do that. The worse part of the job for me would be to have to constantly confront my own issues and keep from having my buttons pushed. It would be exhausting to constantly ward off the manipulation, verbal abuse and possible violence from the patients. Over time it would take its toll I suppose. I would also feel constantly frustrated knowing that we could do more for these people than we actually do.

If I couldn't find a job in a hospital, in an OR, in a NICU or some other area that interests me more, I would consider a stint in a psych hospital.

I'm tired and need a nap. I have to work tomorrow and 4 a.m. is such a sucky time to have to get up in the morning, not to metion the 10 hours of being on my feet. For now though I need the money and I want to keep my dialysis skills up. Oh, for those of you who don't know me, I work as a dialysis technician to pay bills while I'm in nursing school.

More musings about nursing school will follow. I just need to chill for a while.

Pros and Cons of Nursing School in Midlife

2007-09-13T11:25:00.000-05:00

Pros
1. We take school more seriously, so we turn in our assigments on time, arrive to class prepared, and have no excuses for not getting things done.
2. We're closer to death so we're more focused on the goal of finishing and don't want to waste time changing majors.
3. Many of us have already been to college or have degrees. We know the drill.
4. We've had several relationships in the past. If someone delivers the ultimatum that comes in the form of "it's me or nursing school", the choice is easy.
5. We're closer to our professors' ages and so we get their jokes.
6. We've seen lots of people naked so we're not as freaked out at seeing our patients naked.
7. We can pass a drug test. If we're still alive it means we gave up drugs years ago.
8. If we have children, they are probably grown and out of the house. If they aren't out of the house we're not responsible for their daily care and feeding. They can pour their milk over their own cereal just fine.
9. This is probably not our first career, so we have an idea about adapting to a new culture. We don't expect that nursing will be our dream job. We recognize that it won't be perfect and are less likely to have our hearts broken once we get our first nursing job.
10. We have a thicker skin. Mean nurses don't bother us. We can ignore snarky comments and rolling eyeballs and focus on why we're here - to learn.
11. We don't care how Britney Spears bombed at the VMA awards. Well, maybe a litte.
12. We don't get out much and there isn't anything to watch on TV anyway, so studying isn't a problem.
13. We're better at handling money. There might be a bank account or retirement fund that we use for school. If we have to get student loans we won't squander it on beer and pot. Advil, maybe. Preparation H, maybe. But not street drugs.
14. We do well on the psych portion of our class because the longer you're in the world, the better your chances of meeting people who have issues. Who knew that the manipulative, deadbeat, clingy lover from your past would serve as a test case for your group project?

Cons
1. It is difficult to be a beginner at this age. We're used to being experts or at the very least adequate at what we do. It's difficult and sometimes devastating when we try something new and mess up. Hopefully we get over it.
2. We may be older than our professors and don't cotton well to autocratic leadership from people who are the same age as our children.
3. We don't have as much energy and so have to plan our activities carefully to avoid getting overly tired. If we over do it, we have to allow ourselves time to recover.
4. We have to work harder to learn new information so have to devote more to time to studying. This is not a problem because there's nothing on TV and we are way over trying to keep on the latest music group or fashion trend.
5. It's a bitch being on your feet for several hours at a time during clinicals. Fortunately this prepares us for being on our feet when we're nurses.
6. Reading glasses and bifocals are a must for reading teeny tiny drug labels. We just have to make sure we remember to have them with us when we leave the house.
7. We're set in our ways. We have a hard time adapting to new ways of thinking and doing. Sometimes we are presented with information that contradicts what we learned 20 or so years ago. The challenge is keeping an open mind and realize that the world is always changing, and remember to answer the test question with the new information and not the old.
8. We have to sit in front because we can't hear the lecture.
9. Many of us have spent our lives trying to avoid learning computers. Now that everything is computerized we have to figure things out at the busiest time in our lives. Our younger classmates grew up with computers and it's not a big deal for them. For older students, learning new technology is one other task to add to our already overloaded schedule.
10. It's easier to forget things - assignments, watches, keys, stethoscope, eyeglasses.
11. There is no way we can skimp on sleep. No pulling all-night study sessions.

Welcome to my Blog

2007-09-13T10:48:00.000-05:00

Here we stand at the middle of life wondering what the hell happened.

Nobody told me that at 22 my life would disappear and I would wake up at 46 wondering where my life went.

I woke up at 46 and found myself beginning my second year of nursing school.

So I'm 50 pounds heavier than when I fell asleep. So what if my face is saggier, my teeth aren't as white and I have to wear reading glasses to make toast? I like myself a whole lot more than I did when I was 22. I don't have the same self-conscious feeling about myself. Mostly I realize I don't have a lot of time left. I can't mess around. I need to finish my education so I can enjoy a few years of having enough money to make life bearable before I have to retire.

There are lots of blogs for nursing students. This theme of this blog is the challenges of nursing school that are unique to those of us in middle age. Fortunately there aren't a lot, but they're funny. I would venture to say we have an edge over those youngsters. But the issues are different and complex, and only another middle aged nursing student would understand.

So welcome to my blog. I hope you enjoy what I have to say. I hope it will bring you comfort when you feel no one understands what you're going through. I hope it makes you laugh on those days when all you want to do is cry. I hope you will see yourself in my experiences and know that you're not the only one crazy enough to do this.