A few exciting things have happened in the past week or so.
1. I mailed my licensure application and registered to take the NCLEX. This means that after graduation I will be ready to take the exam as soon as possible and as soon as I pass the state can finish processing my application and send me my license. Yay! My goal is to have my license before my birthday.
2. I started my capstone. This is a slightly different kind of clinical. Instead of working in groups with an instructor, I'm working one on one with a nurse, her name is Amy and she's awesome, during her regular work schedule. Since Wednesday I've done 28 hours with her and I need to do a total of 88. I'm working again tonight from 3-7pm. Amy does a lot of day and evening shifts, 3 8's and 1 12 each week. I lucked out, a lot of people in my class are stuck doing all nights or all weekends. The best part is that Amy works on the BMT unit, so I'm doing exactly what I want to be doing and learning a ton of stuff, particularly the art of IV line management. When you've got several chemos, some antibiotics, a PCA pump and prenteral nutrition to give to someone with a double lumen central catheter it can be quite a juggling act. But I'm getting the hang of it, slowly. Amy is actually a graduate of my program and very patient and willing to teach. I really lucked out with her as a preceptor.
3. I'm on a registered team for the Race Across Oregon. It's a 527 mile race that I will do with a team of 4. Neil (my coach) is putting together teams at the college where he works, and he has invited me to join in. I'm ridiculously excited about this, but I've only got 3 months to train. Yesterday I went for a 50ish mile ride that took about 3.5 hours, which isn't bad for someone riding solo into lots of winds. Then I did a 3-11pm shift with Amy, so I was dead tired last night. Well worth it, though. I just hope the weather gets a little more consistently good so that I can get outside to ride a lot this spring.
4. Other people are getting stomach cramps and hives. This is not good news for them, but it is good news for me, because it strongly suggests that what I had was a virus and not actually an allergy. It's not definitive proof, but two people that I've had contact with have gotten sick in the last two weeks, whcih is pretty good evidence.
5. I booked my flight back to Portland. Only 36 days left in Rochester!
Monday, April 6, 2009
Thursday, March 26, 2009
Semi-coherent, drug-induced post
Hello everybody. I know I'm bad at blogging lately, but it's mostly because the things I've been doing have either been a) not interesting, b) not fun to write about, or c) way too interesting so I already shared with just about everybody and don't feel the need to also write about it. Therefore, if you want more details about spring break or clinicals I suggest you ask me and I'll try to answer.
This past week has been just the right amount of interesting for a blog post, since I'm currently incoherent enough to not know who knows what. Let's start with Saturday. I woke up and went to a class called Boot Camp at my new gym with Jess. It was really, really hard. We were starving so we stopped to get bagels before going to the market. While at the market my stomach started to feel funny. For those that hung out with me post-bike race last year, you may remember that eating after a really tough workout has always made my stomach do funny things, so I wasn't terribly concerned.
When we got home my stomach felt worse, so I went to lie down for a little while. Instead, I ended up throwing up. Not so fun, but I felt much better afterward. I didn't eat anything else except some grapes and ginger ale for the rest of the day. The next day I felt better, although my stomach still hurt and cramped after I ate, so I just didn't eat very much. I also didn't sleep very much because it kept me awake. This kept going on through Tuesday, getting progressively worse until I actually had to leave class on Tuesday afternoon because it hurt too much to stay seated. Some of you may remember that I've had cramps like this before associated with my period (TMI? too bad, I'm drugged and don't care), so I was concerned, but not freaking out about it yet.
Tuesday night/Wednesday morning I was up about every hour because it was so painful. Around 5 am I thought I would throw up again, so I just gave up trying to sleep (I had to be up at 7 anyway). I was starting to get much more concerned at this point because things had been getting progressively worse for so long. I was also starting to get itchy, but this didn't really register with me at first. After about a half hour I was getting really itchy, and noticed a rash on my sides. I then looked in a mirror and noticed the rash on my face. After a little while longer, my lip started to swell and go tingly. At this point I got worried. I started looking through the bathroom for any anthistamines because I knew I was having an allergic reaction. There was none. I didn't want to wake up my roommates, but the rash was spreading and I was getting raised hives, and my lip was swelling pretty fast. So I woke them up.
Jess had some Claritin that she gave me and it seemed to stop, but not reverse, the symptoms for a little while. Then I got a sudden wave of lightheadedness and the itching and swelling began to get worse again. We decided to go to the emergency department. They got me there, and Jordan stayed with me while Jess went to work. By now the hives were in two 6-inch wide strips down the side of my body and all the way up both forearms, as well as all over my scalp and neck. They couldn't even get an IV in the crook of my elbows because the hives were too thick and raised, so they had to go in the back of my hand. After it was in they dopes me up good with a corticosteroid (Solumedrol), benadryl, and Pepcid (which is actually a histamine blocker as well as heartburn drug). I promptly passed out.
At some point I woke up and had to pee (they'd also been giving me fluids becaue of my lightheadedness). Since I was doped and impatient, I just unhooked my own IV and went. They looked at me a little funny, but knew I was a nursing student so didn't argue. One of the advantages of being a nursing student :) Jordan was funny, he had never done anything with an IV before (he's a 2nd year med student). He was playing with the roller clamp that adjusts the drip rate and admiring the needleless screw on port system. I guess they don't show you real world stuff in med school. No wonder residents are famous for writing physically impossible orders.
After another nap, I woke up again and felt very awake. I also felt tightness in my chest and back of my throat, and my hives, which had faded nicely, were flaming red again. They weren't itchy, just bright red. The next time a nurse came by I let her know and after a little while she came back with an epinephrine shot (same as an epi-pen). Good lord, that stuff is powerful. Within about 5 minutes I couldn't stop twitching. I was like that for about 3 hours. But my hives faded and the tightness went away just as fast. So, they discharged me a little while after the epi and I got prescriptions for benadryl, pepcid, prednisone, and epi-pens. While that epi dose was still working, so I wouldn't pass out, I went to the pharmacy with Sarah to get them filled. Epi-pens are expensive when you don't have prescription coverage. Good thing everything else is either OTC or available as a $4 generic.
I got home, the epi was wearing off, and I took my next benadryl dose and promptly fell asleep for a nice long time. I'm taking benadryl until tomorrow morning, prednisone until Sunday. Should be a fun weekend. I did manage to get through clinical today without actually falling asleep, but it was a close call a couple of times. I think the prednisone takes full credit for the fact that I made it. Tomorrow I will be shadowing in the pediactric ED to make up for missed clinical time on Wednesday. I'm hoping I can stay awake for that too. I'm also kind of hoping that it's a slow day and they just send me home.
Oh, and since you're all probably wondering, I have no idea what I'm allergic to. It was most likely something that I came into contact with at the market and my body reacted first with the cramping and then, as I put more and more stress on it by not sleeping or eating, with the full blown allergic response. I will probably never know exactly what it was, but I sure hope I never encounter it again.
This past week has been just the right amount of interesting for a blog post, since I'm currently incoherent enough to not know who knows what. Let's start with Saturday. I woke up and went to a class called Boot Camp at my new gym with Jess. It was really, really hard. We were starving so we stopped to get bagels before going to the market. While at the market my stomach started to feel funny. For those that hung out with me post-bike race last year, you may remember that eating after a really tough workout has always made my stomach do funny things, so I wasn't terribly concerned.
When we got home my stomach felt worse, so I went to lie down for a little while. Instead, I ended up throwing up. Not so fun, but I felt much better afterward. I didn't eat anything else except some grapes and ginger ale for the rest of the day. The next day I felt better, although my stomach still hurt and cramped after I ate, so I just didn't eat very much. I also didn't sleep very much because it kept me awake. This kept going on through Tuesday, getting progressively worse until I actually had to leave class on Tuesday afternoon because it hurt too much to stay seated. Some of you may remember that I've had cramps like this before associated with my period (TMI? too bad, I'm drugged and don't care), so I was concerned, but not freaking out about it yet.
Tuesday night/Wednesday morning I was up about every hour because it was so painful. Around 5 am I thought I would throw up again, so I just gave up trying to sleep (I had to be up at 7 anyway). I was starting to get much more concerned at this point because things had been getting progressively worse for so long. I was also starting to get itchy, but this didn't really register with me at first. After about a half hour I was getting really itchy, and noticed a rash on my sides. I then looked in a mirror and noticed the rash on my face. After a little while longer, my lip started to swell and go tingly. At this point I got worried. I started looking through the bathroom for any anthistamines because I knew I was having an allergic reaction. There was none. I didn't want to wake up my roommates, but the rash was spreading and I was getting raised hives, and my lip was swelling pretty fast. So I woke them up.
Jess had some Claritin that she gave me and it seemed to stop, but not reverse, the symptoms for a little while. Then I got a sudden wave of lightheadedness and the itching and swelling began to get worse again. We decided to go to the emergency department. They got me there, and Jordan stayed with me while Jess went to work. By now the hives were in two 6-inch wide strips down the side of my body and all the way up both forearms, as well as all over my scalp and neck. They couldn't even get an IV in the crook of my elbows because the hives were too thick and raised, so they had to go in the back of my hand. After it was in they dopes me up good with a corticosteroid (Solumedrol), benadryl, and Pepcid (which is actually a histamine blocker as well as heartburn drug). I promptly passed out.
At some point I woke up and had to pee (they'd also been giving me fluids becaue of my lightheadedness). Since I was doped and impatient, I just unhooked my own IV and went. They looked at me a little funny, but knew I was a nursing student so didn't argue. One of the advantages of being a nursing student :) Jordan was funny, he had never done anything with an IV before (he's a 2nd year med student). He was playing with the roller clamp that adjusts the drip rate and admiring the needleless screw on port system. I guess they don't show you real world stuff in med school. No wonder residents are famous for writing physically impossible orders.
After another nap, I woke up again and felt very awake. I also felt tightness in my chest and back of my throat, and my hives, which had faded nicely, were flaming red again. They weren't itchy, just bright red. The next time a nurse came by I let her know and after a little while she came back with an epinephrine shot (same as an epi-pen). Good lord, that stuff is powerful. Within about 5 minutes I couldn't stop twitching. I was like that for about 3 hours. But my hives faded and the tightness went away just as fast. So, they discharged me a little while after the epi and I got prescriptions for benadryl, pepcid, prednisone, and epi-pens. While that epi dose was still working, so I wouldn't pass out, I went to the pharmacy with Sarah to get them filled. Epi-pens are expensive when you don't have prescription coverage. Good thing everything else is either OTC or available as a $4 generic.
I got home, the epi was wearing off, and I took my next benadryl dose and promptly fell asleep for a nice long time. I'm taking benadryl until tomorrow morning, prednisone until Sunday. Should be a fun weekend. I did manage to get through clinical today without actually falling asleep, but it was a close call a couple of times. I think the prednisone takes full credit for the fact that I made it. Tomorrow I will be shadowing in the pediactric ED to make up for missed clinical time on Wednesday. I'm hoping I can stay awake for that too. I'm also kind of hoping that it's a slow day and they just send me home.
Oh, and since you're all probably wondering, I have no idea what I'm allergic to. It was most likely something that I came into contact with at the market and my body reacted first with the cramping and then, as I put more and more stress on it by not sleeping or eating, with the full blown allergic response. I will probably never know exactly what it was, but I sure hope I never encounter it again.
Saturday, March 7, 2009
Friday, January 30, 2009
Baby!
Just one this time. After two weeks of listening to everyone else in my group talk about the deliveries they've seen and how awesome a c-section is and all that cool stuff that I hadn't had the chance to see, I finally got assigned to a laboring mom.
First the history: This was her first baby and she had been in the hopsital for a very long time for a variety of reasons. Details withheld because of HIPAA, take it up with the government. She was supposed to be induced the following day, but her body decided induction didn't sound like much fun so it went into labor all by itself around 9am. When I showed up and got report she was at 3cm and had not received an pain medication. She had said that she did not want an epidural.
Shortly after I arrived, around 3pm, they did another internal check (that means the doc lubes up their fingers and sticks them in the patient's vagina to feel the cervix and the baby's head) and she was 4.5cm dilated, 90& effaced, and the baby was starting to descend into the pelvis. All good progress. Patient requested some pain meds, got an IV dose, felt much better. You could tell when the pain meds started to wear off again because the moaning got progressively louder and her grip got progressively tighter on the hand of whoever happened to be at the bedside when the contraction started.
The baby was in a posterior position, which means that its back was against the mom's back. Normally, the baby should be in an anterior position, facing mom's back, because that allows for the smallest part of the head to go through the pelvis first. When the baby is posterior, the labor pains tend to be concentrated in the lower back, all the way down to the tailbone. That's exactly what this mom was experiencing, and it didn't look like any fun. She did a really amazing job of concentrating on the breathing and rocking her hips and changing positions to try to keep the pain managable. We also tried a birthing ball, which I though looked great. It's just a regular exercise ball, but they put it in a chair-like frame, so there's a backrest. This mom didn't particularly like it , but I kinda want one for myself.
The nurse and I kept checking on her throughout the afternoon. At one point she and her husband kicked the rest of the family out of the room. Around 6pm they did another internal check and she'd progressed to 7cm dilated, 100% effaced. Fully dilated is 10cm. This was when my nurse told me that if I wanted to eat dinner I should do it now. So I did. Then came more monitoring and encouraging and checking vitals. Lots of encouragement for both the mom and the dad. She was still smiling between contractions, so that was a good sign.
Anoher internal check in a couple of hours showed her still at 7cm. The baby was starting to turn around to a more anterior position though, so something was happening. The mom was feeling more of the contraction toward the front and less in her tailbone. The contractions were also getting stronger and more frequent. Sometime around now the husband asked me if I was going to stay through the end. I told him I would if they were okay with that, and they both said, "Yes, please!" I was very happy to hear that they wanted me there. It was the first time for all of us.
Contractions continued, and the mom was obviously starting to get tired. The nurse mentioned that it was not too late to get an epidural, and discovered that the mom's reason for not wanting one was fear of a needle being put into her spine. But she was tired, and in a lot of pain, and said the anesthesiologist could come talk to her about it. So he did, and she decided that she wanted to go ahead with it. Now, having an epidural put in normally is not a whole lot of fun. Having an epidural put in when you're in labor with contractions every 3-4 minutes is downright miserable. We had her sitting on the edge of the bed propped up on both me and the nurse. The husband had to leave the room because he has a problem with needles. It took them four tries and nearly an hour to get the epidural in place and I think that was by far the worst hour of her entire labor.
When the placed the epidural the also gave her a spinal block for immediate relief. Unfortunately that also completely numbed her from the waist down. So we stuck her back into bed, covered her in warm blankets and left her alone to try to rest. She couldn't feel her contractions at all any more. They were happening, because we could see them with an external monitor, but she felt nothing.
More time passed, she was still numb, but the contractions were still going. Around 10pm, the doc did another internal check. This time she was fully dilated and there was already a head in the birth canal. We asked her if she felt like pushing and she said no, so we just left her alone. Contractions were still coming and we checked on her every 5 minutes or so. In about a half hour she said that she could feel some pressure, although no urge to push. So we had her push anyway. That nurses description of it was to, "Push like you're trying to poop out a watermelon." So she did, and it worked, even though she couldn't feel a thing.
After about 3 contractions worth of pushing I could see the baby's head. That's when we called for the docs to come in. They did, and set up all the stuff for delivery. I pulled out her foley, the docs got themselves ready, the husband was trying not to look, and the nurses were preparing the crib for the baby. It took less than a half hour of pushing for the head to come out and then one more push and the whole body followed. The baby was an adorable little girl (parents didn't know ahead of time), wrinkly and blue until she cried and magically turned bright pink. She was small, only about 5lbs, but she was a few weeks preterm, so it was to be expected.
As soon as she came out there was a flurry of activity. They cut the cord, handed the baby off to the NICU nurses, who did a quick assessment, Apgars, and got her warmed up. In the meantime the docs were massaging the mom's uterus to get the placenta out. It came out in about 5 minutes after the baby. The docs also saved the cord blood and the cord itself for research and the placenta looked a little funky so they saved it to be sent to pathology. It was about 15 minutes from the time of delivery until the mom actually got to see and hold her little girl. Then she got to hold her for only a few minutes before the baby got whisked off to the NICU. There wasn't anything wrong with her, she was just a little bit preterm so she had to go for observation for at least 6 hours. Mom couldn't go with her because she still couldn't move from the epidural.
There were many rounds of congratulations and hugs and then the docs left as quickly as they had arrived (I think they were in the room for less than an hour). I then helped get the mom more comfortable in bed and cleaned up. Both mom and dad thanked me again for staying, and I thanked them for letting me stay. It was quite an amazing experience. I got home about 2 hours later than usual from clinical, but it was well worth staying late.
First the history: This was her first baby and she had been in the hopsital for a very long time for a variety of reasons. Details withheld because of HIPAA, take it up with the government. She was supposed to be induced the following day, but her body decided induction didn't sound like much fun so it went into labor all by itself around 9am. When I showed up and got report she was at 3cm and had not received an pain medication. She had said that she did not want an epidural.
Shortly after I arrived, around 3pm, they did another internal check (that means the doc lubes up their fingers and sticks them in the patient's vagina to feel the cervix and the baby's head) and she was 4.5cm dilated, 90& effaced, and the baby was starting to descend into the pelvis. All good progress. Patient requested some pain meds, got an IV dose, felt much better. You could tell when the pain meds started to wear off again because the moaning got progressively louder and her grip got progressively tighter on the hand of whoever happened to be at the bedside when the contraction started.
The baby was in a posterior position, which means that its back was against the mom's back. Normally, the baby should be in an anterior position, facing mom's back, because that allows for the smallest part of the head to go through the pelvis first. When the baby is posterior, the labor pains tend to be concentrated in the lower back, all the way down to the tailbone. That's exactly what this mom was experiencing, and it didn't look like any fun. She did a really amazing job of concentrating on the breathing and rocking her hips and changing positions to try to keep the pain managable. We also tried a birthing ball, which I though looked great. It's just a regular exercise ball, but they put it in a chair-like frame, so there's a backrest. This mom didn't particularly like it , but I kinda want one for myself.
The nurse and I kept checking on her throughout the afternoon. At one point she and her husband kicked the rest of the family out of the room. Around 6pm they did another internal check and she'd progressed to 7cm dilated, 100% effaced. Fully dilated is 10cm. This was when my nurse told me that if I wanted to eat dinner I should do it now. So I did. Then came more monitoring and encouraging and checking vitals. Lots of encouragement for both the mom and the dad. She was still smiling between contractions, so that was a good sign.
Anoher internal check in a couple of hours showed her still at 7cm. The baby was starting to turn around to a more anterior position though, so something was happening. The mom was feeling more of the contraction toward the front and less in her tailbone. The contractions were also getting stronger and more frequent. Sometime around now the husband asked me if I was going to stay through the end. I told him I would if they were okay with that, and they both said, "Yes, please!" I was very happy to hear that they wanted me there. It was the first time for all of us.
Contractions continued, and the mom was obviously starting to get tired. The nurse mentioned that it was not too late to get an epidural, and discovered that the mom's reason for not wanting one was fear of a needle being put into her spine. But she was tired, and in a lot of pain, and said the anesthesiologist could come talk to her about it. So he did, and she decided that she wanted to go ahead with it. Now, having an epidural put in normally is not a whole lot of fun. Having an epidural put in when you're in labor with contractions every 3-4 minutes is downright miserable. We had her sitting on the edge of the bed propped up on both me and the nurse. The husband had to leave the room because he has a problem with needles. It took them four tries and nearly an hour to get the epidural in place and I think that was by far the worst hour of her entire labor.
When the placed the epidural the also gave her a spinal block for immediate relief. Unfortunately that also completely numbed her from the waist down. So we stuck her back into bed, covered her in warm blankets and left her alone to try to rest. She couldn't feel her contractions at all any more. They were happening, because we could see them with an external monitor, but she felt nothing.
More time passed, she was still numb, but the contractions were still going. Around 10pm, the doc did another internal check. This time she was fully dilated and there was already a head in the birth canal. We asked her if she felt like pushing and she said no, so we just left her alone. Contractions were still coming and we checked on her every 5 minutes or so. In about a half hour she said that she could feel some pressure, although no urge to push. So we had her push anyway. That nurses description of it was to, "Push like you're trying to poop out a watermelon." So she did, and it worked, even though she couldn't feel a thing.
After about 3 contractions worth of pushing I could see the baby's head. That's when we called for the docs to come in. They did, and set up all the stuff for delivery. I pulled out her foley, the docs got themselves ready, the husband was trying not to look, and the nurses were preparing the crib for the baby. It took less than a half hour of pushing for the head to come out and then one more push and the whole body followed. The baby was an adorable little girl (parents didn't know ahead of time), wrinkly and blue until she cried and magically turned bright pink. She was small, only about 5lbs, but she was a few weeks preterm, so it was to be expected.
As soon as she came out there was a flurry of activity. They cut the cord, handed the baby off to the NICU nurses, who did a quick assessment, Apgars, and got her warmed up. In the meantime the docs were massaging the mom's uterus to get the placenta out. It came out in about 5 minutes after the baby. The docs also saved the cord blood and the cord itself for research and the placenta looked a little funky so they saved it to be sent to pathology. It was about 15 minutes from the time of delivery until the mom actually got to see and hold her little girl. Then she got to hold her for only a few minutes before the baby got whisked off to the NICU. There wasn't anything wrong with her, she was just a little bit preterm so she had to go for observation for at least 6 hours. Mom couldn't go with her because she still couldn't move from the epidural.
There were many rounds of congratulations and hugs and then the docs left as quickly as they had arrived (I think they were in the room for less than an hour). I then helped get the mom more comfortable in bed and cleaned up. Both mom and dad thanked me again for staying, and I thanked them for letting me stay. It was quite an amazing experience. I got home about 2 hours later than usual from clinical, but it was well worth staying late.
Sunday, January 25, 2009
Babies, experiments, and running
And I'm still bored. Although there are stirrings of projects happening in my house. Oh yeah, and babies. Let's start with babies.
I got to hang out in the newborn nursery this week in clinical. Not a lot happens there, but when it does happen it all involves babies, so I'm cool with that. I got to feed babies, and swaddle babies, and do physical exams on babies, and take baby vital signs, etc. I also saw a baby with a huge conehead because she just wouldn't fit when on her way out the usual way, so they had to do a c-section and pull her back up and out. Fun, huh? There was another baby that looked like she was at a tanning salon because she got to lie underneath special lights that help reduce jaundice with a cute little face mask on. Oh, and there was a baby who was withdrawing from methadone because her mom is in the methadone treatment program. I felt really bad for this little girl, but she seemed like she's doing okay with it. Overall, babies are adorable and I love playing with them.
Okay, on to projects. Jess and I both want to lose weight. Not a ton of weight, but about 10 stubborn pounds that won't go away. Also, I seem to have developed some problems with glucose regulation. Evidence of this includes nearly passing out in clinical and while shadowing Dr. Meyers (I was fine after eating some food and I'm nearly positive that it was hypoglycemia and not blood-pressure related.) Further evidence is that fact that every time I go to the gym, unless I eat a LOT (way more than is reasonable for the kind of workouts I'm doing) immediately after getting home, I end up falling asleep for about 2 hours and then spend the res of the irritable and fatigued. This is annoying and inconvenient and I want to make it stop. So, with this in mind, we are going to change the way our house eats. Jordan is always excited for experiments and is willing to change how he eats to in order to study us :)
The plan is to switch to a low glycemic index diet. If you don't know about the glycemic index, read this. Basically, it means foods that provide a stable level of glucose in the blood instead of lots of peaks and valleys. Starting on February 1st we're going to take all the stuff in the house that does not qualify as low GI and stick them in a cupboard out of sight and then try to eat only low GI foods for the rest of the month and see what happens. I've also bought a glucose meter on eBay so me can get some real quantitative measures of how well this is working. I'm hoping it'll arrive sometime this week so we can all get a baseline reading of how we're doing and then see how it changes. Jess is having a fabulous time in the kitchen experimenting with low sugar and low GI recipes and so far they taste pretty good. The baseline rules are pretty simple: No foods with sugar (or high fructose corn syrup, or honey, or other sweeteners like that) in the ingredients list, and no white starches (basically no refined flour, white rice, or potatoes). This is going to be a very interesting experiment and I'm hoping it will have a good effect on both my mood and my energy level, since both have been pretty low lately.
Oh, and have I mentioned that Jordan eBayed an EEG machine? We're going to measure our brain waves. It's going to be awesome. You may be tempted to ask why, but the only answer you will get is that we think it's cool. Yeah, we're dorks.
I updated on my other blog about the Couch to 5K running plan I'm doing a while ago, but I think I'm just going to update more about it here, because I'm lazy and this isn't really cycling related at all. I've finished the first week and the first day of week 2. So far things are going well, and the workouts are getting progressively easier. The weird part is how my knee is reacting to all this new stress. I expected swelling, aching, soreness, all the usual stuff when I ask it to do something new. Instead, I'm getting this strange kind of soreness where the entire area around where the screws are feels like a gigantic bruise. It feels like someone hit that spot with a hammer, but there's no external sign of bruising except for some minor swelling. The actual joint is also mildly swollen, and a little bit achy, but not nearly as bad as I thought it would get. My theory about the bruised feeling is that I'm putting stress on the spot where the bits of bone are connected and the screws enter in a completely new way and so I'm temporarily weakening that connection and my body will respond by laying down more bone. But, in the meantime, that area is inflamed, and there is likely some internal bleeding from around the screw entry points since bone is a very vascular tissue. Which is unfortunate, since there is no way to reduce the pain and speed up the healing time except rest, and possibly alternating ice and heat. If I take NSAIDs for the inflammation that will actually slow my recovery so I'm not going to do that. And if I stop running, my body will lose the stimulus to lay down more bone and strengthen that area. So, I run slowly and carefully, take days off when I feel like I need to, and try to not put any more pressure on that connection than necessary (for example, avoid bending my knee more than 90 degress, something that my coach told me to do ages ago, which really helped, and I sort of forgot to keep doing). On the plus side, my kneecap has not done any wobbling out of place so far and I haven't had any problems with my leg collapsing under me yet. Fingers crossed that things will continue to go well.
I got to hang out in the newborn nursery this week in clinical. Not a lot happens there, but when it does happen it all involves babies, so I'm cool with that. I got to feed babies, and swaddle babies, and do physical exams on babies, and take baby vital signs, etc. I also saw a baby with a huge conehead because she just wouldn't fit when on her way out the usual way, so they had to do a c-section and pull her back up and out. Fun, huh? There was another baby that looked like she was at a tanning salon because she got to lie underneath special lights that help reduce jaundice with a cute little face mask on. Oh, and there was a baby who was withdrawing from methadone because her mom is in the methadone treatment program. I felt really bad for this little girl, but she seemed like she's doing okay with it. Overall, babies are adorable and I love playing with them.
Okay, on to projects. Jess and I both want to lose weight. Not a ton of weight, but about 10 stubborn pounds that won't go away. Also, I seem to have developed some problems with glucose regulation. Evidence of this includes nearly passing out in clinical and while shadowing Dr. Meyers (I was fine after eating some food and I'm nearly positive that it was hypoglycemia and not blood-pressure related.) Further evidence is that fact that every time I go to the gym, unless I eat a LOT (way more than is reasonable for the kind of workouts I'm doing) immediately after getting home, I end up falling asleep for about 2 hours and then spend the res of the irritable and fatigued. This is annoying and inconvenient and I want to make it stop. So, with this in mind, we are going to change the way our house eats. Jordan is always excited for experiments and is willing to change how he eats to in order to study us :)
The plan is to switch to a low glycemic index diet. If you don't know about the glycemic index, read this. Basically, it means foods that provide a stable level of glucose in the blood instead of lots of peaks and valleys. Starting on February 1st we're going to take all the stuff in the house that does not qualify as low GI and stick them in a cupboard out of sight and then try to eat only low GI foods for the rest of the month and see what happens. I've also bought a glucose meter on eBay so me can get some real quantitative measures of how well this is working. I'm hoping it'll arrive sometime this week so we can all get a baseline reading of how we're doing and then see how it changes. Jess is having a fabulous time in the kitchen experimenting with low sugar and low GI recipes and so far they taste pretty good. The baseline rules are pretty simple: No foods with sugar (or high fructose corn syrup, or honey, or other sweeteners like that) in the ingredients list, and no white starches (basically no refined flour, white rice, or potatoes). This is going to be a very interesting experiment and I'm hoping it will have a good effect on both my mood and my energy level, since both have been pretty low lately.
Oh, and have I mentioned that Jordan eBayed an EEG machine? We're going to measure our brain waves. It's going to be awesome. You may be tempted to ask why, but the only answer you will get is that we think it's cool. Yeah, we're dorks.
I updated on my other blog about the Couch to 5K running plan I'm doing a while ago, but I think I'm just going to update more about it here, because I'm lazy and this isn't really cycling related at all. I've finished the first week and the first day of week 2. So far things are going well, and the workouts are getting progressively easier. The weird part is how my knee is reacting to all this new stress. I expected swelling, aching, soreness, all the usual stuff when I ask it to do something new. Instead, I'm getting this strange kind of soreness where the entire area around where the screws are feels like a gigantic bruise. It feels like someone hit that spot with a hammer, but there's no external sign of bruising except for some minor swelling. The actual joint is also mildly swollen, and a little bit achy, but not nearly as bad as I thought it would get. My theory about the bruised feeling is that I'm putting stress on the spot where the bits of bone are connected and the screws enter in a completely new way and so I'm temporarily weakening that connection and my body will respond by laying down more bone. But, in the meantime, that area is inflamed, and there is likely some internal bleeding from around the screw entry points since bone is a very vascular tissue. Which is unfortunate, since there is no way to reduce the pain and speed up the healing time except rest, and possibly alternating ice and heat. If I take NSAIDs for the inflammation that will actually slow my recovery so I'm not going to do that. And if I stop running, my body will lose the stimulus to lay down more bone and strengthen that area. So, I run slowly and carefully, take days off when I feel like I need to, and try to not put any more pressure on that connection than necessary (for example, avoid bending my knee more than 90 degress, something that my coach told me to do ages ago, which really helped, and I sort of forgot to keep doing). On the plus side, my kneecap has not done any wobbling out of place so far and I haven't had any problems with my leg collapsing under me yet. Fingers crossed that things will continue to go well.
Tuesday, January 20, 2009
Ugh, winter
The worst thing about winter in Rochester is that I can't go outside. Well, I can, but it's extremely uncomfortable after about 15 minutes and there's nothing that I can do out there because the whole world is covered in snow and ice. Winter activities are too expensive, and building snowmen just isn't going to cut it. So, I'm stuck inside watching TV and pretending to study. Ugh.
Also, the comments I'm getting on my previous post are pretty hilarious. All these people that I've never met that clearly have a pretty strong agenda. Just so we're clear on this, I would not refuse to assist with a circumcision procedure. Even though I disagree with the practice, it is not my place to pass judgment on the choices of other families. I have pretty strong feelings about the law mentioned in one of the comments that allows healthcare providers to withhold services that they object to on moral grounds. But, since I have no plans to ever work as an OB or pediatric nurse, I imagine the issue will not come up during my career.
Now back to reading for the test that I have to take in about an hour. Yay.
Also, the comments I'm getting on my previous post are pretty hilarious. All these people that I've never met that clearly have a pretty strong agenda. Just so we're clear on this, I would not refuse to assist with a circumcision procedure. Even though I disagree with the practice, it is not my place to pass judgment on the choices of other families. I have pretty strong feelings about the law mentioned in one of the comments that allows healthcare providers to withhold services that they object to on moral grounds. But, since I have no plans to ever work as an OB or pediatric nurse, I imagine the issue will not come up during my career.
Now back to reading for the test that I have to take in about an hour. Yay.
Friday, January 16, 2009
I'm back
School started again on Tuesday. I'm taking only two classes at the moment: Women's Health and Management of Care. Management of Care is going to be boring and you probably won't hear me talk abou it much. Women's health, on the other hand, means I get to play with babies. Oh, and women, most of them pregnant. You'll hear about that a lot (disclaimer for the parents: Yes, I adore the little babies, and no, I do not plan on getting pregnant any time in the near future.)
I've had two clinical days so far on the OB floor. The first day we were jsut there to observe for a couple of hours, but I still got to hold a couple of newborns and see a bunch more. And their moms. Can you tell which I'm more interested in? The second day I go to use a doppler to find fetal heart beats in pregnant moms and watch two circumcisions. (Disclaimer #2: I'm going to go into detail about the circumcision procedure. Skip the next paragraph if you don't want to know.)
Before I start, I should say that I don't really like circumcision, because there is no proof that it has any benefit whatsoever. Recently a study came out about how circumcised men have a lower chance of contracting HIV during heterosexual sex, but the most current literature reviews say that there is no significant benefit (trust me, I just checked). That's how I felt about circumcision before I'd ever seen one. Now, what does an actual circumcision look like? First they give the baby some sugar water (which somehow calms them down) and then inject lidocaine into the nerves that run along the top of the penis. Then they let the lidocaine do it's thing for about 5 minutes so the area is numb. The baby is then put on a little tray thing with slots for his legs, which are held in place with velcro. A kicking baby would be a very bad thing during this procedure. One nurse holds down the baby's top end while the doctor takes some forceps and separates the foreskin from the glans of the penis. Naturally, the foreskin may not separate from the glans until he is 5 years old. Once the foreskin is separated, a cut is made so that it can be pulled back exposing the glans. Then they put a little plastic bell shaped thingy (called a plastibell, shockingly) over the glans to protect it. The doctor then ties a piece of string as tightly as possible around the base of the glans to cut off circulation to the foreskin. The foreskin is then cut off close to the string and the plastibell is removed, leaving a little plastic ring between the remaining bit of foreskin and the glans. Over the next 7-10 days the foreskin will become necrotic, turn black, and fall off, along with the string and plastic ring. For the most part, the baby doesn't feel anything during the procedure except for the initial lidocaine injection. The painful part is urination and diaper changes for the next week or so while he heals up.
Okay, so that's how it's done. Why is it done? We got a little history lesson from the doctor who did the ones we watched. She was Norwegian, where almost no one gets circumcised, so she went and looked up the history of it when she arrived here. Apparently it gained popularity in America after WW1 when many men developed infections because they were unable to clean themselves properly underneath their foreskin while in the trenches. I don't know if that's true or not, but that's definitely the time period when circumcision took off in the US. Now 80% of American men are circumcised. In the rest of the world, the cultures that circumcise are mainly Muslims and Jews and only 30% of the total male population is circumcised. None of the national medical associations in the US recommend circumcision and most families say that they do it because they, "want him to look like his father." Anyway, I'll get off my soapbox now and go back to my usual blogging.
I haven't really been doing anything since I got back except school and sleep. It's been freezing cold here for the past couple of days, about -10 and frequently snowing. I'm mostly hiding out inside and trying to stay warm. I did manage to get to a blood drive yesterday, which was good. My hemoglobin is still nice and high (12.9!), which I love to see, and they only had to poke me once. I even got a free movie ticket and coupon for coffee. Also, I discovered that hospitals that use blood from the red cross get charged based on how much blood is donated at their facilities, so support your local hospitals by going to their blood drives! I may be going with a couple of other students to donate platelets sometime in the near future too. I haven't done that yet, but I've been wanting to give it a try.
That's about all for now. I'm sure there will be more to write about soon. A lot of the next 5 weeks is going to be OMG BABIES!!!!! so consider yourself warned.
I've had two clinical days so far on the OB floor. The first day we were jsut there to observe for a couple of hours, but I still got to hold a couple of newborns and see a bunch more. And their moms. Can you tell which I'm more interested in? The second day I go to use a doppler to find fetal heart beats in pregnant moms and watch two circumcisions. (Disclaimer #2: I'm going to go into detail about the circumcision procedure. Skip the next paragraph if you don't want to know.)
Before I start, I should say that I don't really like circumcision, because there is no proof that it has any benefit whatsoever. Recently a study came out about how circumcised men have a lower chance of contracting HIV during heterosexual sex, but the most current literature reviews say that there is no significant benefit (trust me, I just checked). That's how I felt about circumcision before I'd ever seen one. Now, what does an actual circumcision look like? First they give the baby some sugar water (which somehow calms them down) and then inject lidocaine into the nerves that run along the top of the penis. Then they let the lidocaine do it's thing for about 5 minutes so the area is numb. The baby is then put on a little tray thing with slots for his legs, which are held in place with velcro. A kicking baby would be a very bad thing during this procedure. One nurse holds down the baby's top end while the doctor takes some forceps and separates the foreskin from the glans of the penis. Naturally, the foreskin may not separate from the glans until he is 5 years old. Once the foreskin is separated, a cut is made so that it can be pulled back exposing the glans. Then they put a little plastic bell shaped thingy (called a plastibell, shockingly) over the glans to protect it. The doctor then ties a piece of string as tightly as possible around the base of the glans to cut off circulation to the foreskin. The foreskin is then cut off close to the string and the plastibell is removed, leaving a little plastic ring between the remaining bit of foreskin and the glans. Over the next 7-10 days the foreskin will become necrotic, turn black, and fall off, along with the string and plastic ring. For the most part, the baby doesn't feel anything during the procedure except for the initial lidocaine injection. The painful part is urination and diaper changes for the next week or so while he heals up.
Okay, so that's how it's done. Why is it done? We got a little history lesson from the doctor who did the ones we watched. She was Norwegian, where almost no one gets circumcised, so she went and looked up the history of it when she arrived here. Apparently it gained popularity in America after WW1 when many men developed infections because they were unable to clean themselves properly underneath their foreskin while in the trenches. I don't know if that's true or not, but that's definitely the time period when circumcision took off in the US. Now 80% of American men are circumcised. In the rest of the world, the cultures that circumcise are mainly Muslims and Jews and only 30% of the total male population is circumcised. None of the national medical associations in the US recommend circumcision and most families say that they do it because they, "want him to look like his father." Anyway, I'll get off my soapbox now and go back to my usual blogging.
I haven't really been doing anything since I got back except school and sleep. It's been freezing cold here for the past couple of days, about -10 and frequently snowing. I'm mostly hiding out inside and trying to stay warm. I did manage to get to a blood drive yesterday, which was good. My hemoglobin is still nice and high (12.9!), which I love to see, and they only had to poke me once. I even got a free movie ticket and coupon for coffee. Also, I discovered that hospitals that use blood from the red cross get charged based on how much blood is donated at their facilities, so support your local hospitals by going to their blood drives! I may be going with a couple of other students to donate platelets sometime in the near future too. I haven't done that yet, but I've been wanting to give it a try.
That's about all for now. I'm sure there will be more to write about soon. A lot of the next 5 weeks is going to be OMG BABIES!!!!! so consider yourself warned.
Saturday, December 20, 2008
Snow
I made a quick video for all you people in Portland that think you've been having blizzards. I'm not sure if the sound will work, but if it doesn't I didn't say anything interesting anyway. All the snow that you see fell in an 8 hour period the day before.
In other news, I go home tomorrow! Yay! I just hope the weather allows it...
In other news, I go home tomorrow! Yay! I just hope the weather allows it...
Wednesday, December 3, 2008
Exhaustion and headaches
I've found a couple of different types of exhaustion in the past few weeks. There was the pre-Thanksgiving exhaustion that involved a complete lack of motivation to do anything at all. This included schoolwork, clinicals, exercise, cleaning, laundry, shopping, interacting with people, or any other activity that didn't involve eating or my computer. Thankfully I'm done with that now.
Then there was the post-Thanksgiving exhaustion, which involved a flight being canceled and getting almost no sleep while trying to figure out how to travel from Toronto to Rochester in the shortest period of time. Thankfully that is now over with as well.
Today I got another kind of exhaustion. This kind comes from having an 8 hour clinical day in which only 30 minutes is spent off of my feet (that was lunch) and then choosing to spend an hour in the gym. Granted an hour is not a long time, but my workouts are fairly streamlined by now and I can do a good job of beating my legs into a pulp in an hour. 25 minutes of hard intervals on an elliptical, followed by leg presses, dead lifts, squats, and extensions. Add in warm up and stretching time, and that takes an hour. I walked home with a shuffling gait that you usually see on Parkinson's patients. But when I got home, I wasn't sleepy, just exhausted. So I showered, ate, and sat around for a while avoiding homework. Which is not all that different than my usual evenings, but I did it with much less energy.
At some point this evening my headache started. I've been getting more of these headaches in the past few months than ever before. If I don't get rid of them quickly they turn into migraines, which is a very bad thing. Being the clever nursing student that I am, I tried to find a pattern to the headaches. Lo and behold, I did. They always happened after I work out. Not after every workout, but every headache that feels like this comes after a workout. So, still being a clever nursing student, I turn to Google. Google (and the Mayo Clinic) informs me that exercise-induced headaches are very common among people that are prone to migraines. I honestly can't believe that this never occurred to me before. Exercise dilates blood vessels, migraines are caused by excess blood vessel dilation in the brain... duh. So, I know now to expect a headache after a hard workout, and that I can even prevent a headache by taking an NSAID pre- or immediately post-workout. Unfortunately, NSAIDs slow muscle healing and recovery... hmmm... Luckily, Google and the Mayo Clinic also informed me that the headaches should go away, or at least lessen, if exercise is done regularly. Yet another incentive for me to get myself to the gym.
In unrelated news, my clinical instructor adores me. This is very good because I will be using her for recommendation letters in the near future. At one point today, after telling me how awesome I am at this nursing thing, she asked me what I used to do. I told her that I did bench research in a neuromuscular development lab. She took a moment to absorb this, with an incredulous look on her face, and said, "I am so glad that you're not doing that any more." I agree with her completely.
Then there was the post-Thanksgiving exhaustion, which involved a flight being canceled and getting almost no sleep while trying to figure out how to travel from Toronto to Rochester in the shortest period of time. Thankfully that is now over with as well.
Today I got another kind of exhaustion. This kind comes from having an 8 hour clinical day in which only 30 minutes is spent off of my feet (that was lunch) and then choosing to spend an hour in the gym. Granted an hour is not a long time, but my workouts are fairly streamlined by now and I can do a good job of beating my legs into a pulp in an hour. 25 minutes of hard intervals on an elliptical, followed by leg presses, dead lifts, squats, and extensions. Add in warm up and stretching time, and that takes an hour. I walked home with a shuffling gait that you usually see on Parkinson's patients. But when I got home, I wasn't sleepy, just exhausted. So I showered, ate, and sat around for a while avoiding homework. Which is not all that different than my usual evenings, but I did it with much less energy.
At some point this evening my headache started. I've been getting more of these headaches in the past few months than ever before. If I don't get rid of them quickly they turn into migraines, which is a very bad thing. Being the clever nursing student that I am, I tried to find a pattern to the headaches. Lo and behold, I did. They always happened after I work out. Not after every workout, but every headache that feels like this comes after a workout. So, still being a clever nursing student, I turn to Google. Google (and the Mayo Clinic) informs me that exercise-induced headaches are very common among people that are prone to migraines. I honestly can't believe that this never occurred to me before. Exercise dilates blood vessels, migraines are caused by excess blood vessel dilation in the brain... duh. So, I know now to expect a headache after a hard workout, and that I can even prevent a headache by taking an NSAID pre- or immediately post-workout. Unfortunately, NSAIDs slow muscle healing and recovery... hmmm... Luckily, Google and the Mayo Clinic also informed me that the headaches should go away, or at least lessen, if exercise is done regularly. Yet another incentive for me to get myself to the gym.
In unrelated news, my clinical instructor adores me. This is very good because I will be using her for recommendation letters in the near future. At one point today, after telling me how awesome I am at this nursing thing, she asked me what I used to do. I told her that I did bench research in a neuromuscular development lab. She took a moment to absorb this, with an incredulous look on her face, and said, "I am so glad that you're not doing that any more." I agree with her completely.
Tuesday, November 18, 2008
Snow
There was an inch of snow on the ground when I woke up this morning. It stuck around all day, and more is going to be coming down throughout the week. Let winter begin.
How did I respond to this snow? First with a lot of impolite words, mostly under my breath, and then by turning my singlespeed bike into a fixed gear. See, I'm not going to ride my race bike in the snow because not only would it be dangerous on skinny slick tires, but I'd end up ruining the bike once they start putting down salt and I start crashing because of ice. So, in order to continue riding as often as possible this winter, I need to ride my steel-framed clunky commuter bike. But that's no fun. At least until now.
A fixed gear bike does not let you coast. Any time the wheels are turning the pedals turn too. It's how all bikes used to be before the invention of the freewheel. The benefits of riding a fixed gear bike are that you get stronger (zero rest = strength + endurance), pedaling technique improves, and you learn how to pedal at a really high cadence, because that's just what happens when you going to go downhill. And, it's a whole lot of fun, mostly because it's a new challenge. The challenge is simple, if you attempt to stop pedaling while the bike is moving forward you do one of two things: If you're in control you skid to a stop and feel lucky, if you're out of control the bike flips you over the handlebars. I rode it around the block a couple times today, but it was getting dark fast, so I'll need to do a real test ride as soon as I get the chance. With luck I won't be doing any flips.
In other news, school is still insane, but I'm still enjoying it. I will be observing in the operating room all day tomorrow, which I'm really looking forward to. I have no idea what kind of surgery I'll be able to see, or if I'll see multiple, that will be decided when I show up.
My housemate, Jess, and I spent an entire day baking this weekend. We're coming up with winter survival plans and a lot of them involve food. This plan was specifically to get a weird food at the public market every week and make something with it. This weekend was persimmons. I'd never had one before, but it turns out they're really delicious. We made persimmon tarts and persimmon cookies. And then just for fun we made some hummus. Next week I think we're going to try making bread, and something with our mystery market food. This is a fun game.
How did I respond to this snow? First with a lot of impolite words, mostly under my breath, and then by turning my singlespeed bike into a fixed gear. See, I'm not going to ride my race bike in the snow because not only would it be dangerous on skinny slick tires, but I'd end up ruining the bike once they start putting down salt and I start crashing because of ice. So, in order to continue riding as often as possible this winter, I need to ride my steel-framed clunky commuter bike. But that's no fun. At least until now.
A fixed gear bike does not let you coast. Any time the wheels are turning the pedals turn too. It's how all bikes used to be before the invention of the freewheel. The benefits of riding a fixed gear bike are that you get stronger (zero rest = strength + endurance), pedaling technique improves, and you learn how to pedal at a really high cadence, because that's just what happens when you going to go downhill. And, it's a whole lot of fun, mostly because it's a new challenge. The challenge is simple, if you attempt to stop pedaling while the bike is moving forward you do one of two things: If you're in control you skid to a stop and feel lucky, if you're out of control the bike flips you over the handlebars. I rode it around the block a couple times today, but it was getting dark fast, so I'll need to do a real test ride as soon as I get the chance. With luck I won't be doing any flips.
In other news, school is still insane, but I'm still enjoying it. I will be observing in the operating room all day tomorrow, which I'm really looking forward to. I have no idea what kind of surgery I'll be able to see, or if I'll see multiple, that will be decided when I show up.
My housemate, Jess, and I spent an entire day baking this weekend. We're coming up with winter survival plans and a lot of them involve food. This plan was specifically to get a weird food at the public market every week and make something with it. This weekend was persimmons. I'd never had one before, but it turns out they're really delicious. We made persimmon tarts and persimmon cookies. And then just for fun we made some hummus. Next week I think we're going to try making bread, and something with our mystery market food. This is a fun game.
Thursday, November 6, 2008
A sorta, maybe good day
I think today was a good day in clinical. Why? Because I was busy pretty much the entire time and I felt like I really did something good for my patient. Unfortunately, the situation that allowed me to be busy and contribute was my patient having a stroke. Does that make today a bad day? It was definitely bad for him, and it was very stressful for me, but I got to learn a lot and while we were rushing down to get a CT scan, I was the one providing the neurology docs with his pertinent history and current medications. I was capable of answering all of their questions, I explained what was going on to my patient, I worked with the team of nurses and docs to get him where he needed to be as quickly as possible. In that sense it was a very good day.
I guess I'm feeling a little bit guilty for being happy with what happened today. I'm glad I got the chance to help with an emergency situation, but I shouldn't be too glad because it means that my patient's health is declining. On top of that, today was my last day on 7-14 and I will probably never find out what happens with him. That part of school bothers me a lot. I want to see my patients' outcomes, I want to know whether they will be okay. Sadly, there is nothing I can do to change that part of the system.
My major frustration today was with the neurology resident. After forcing my patient to get up out of bed, despite being warned that he was very unsteady and barely able to walk, he left me there with a medical student and my patient sort of half sitting on the edge of the bed. This was incredibly unsafe for several reasons. First, my patient weighs about 350lbs. If he falls on the floor (which has happened) it takes about 6 people to lift him back up. Second, he is very weak at the best of times and understandably exhausted from everything he was put through that afternoon, he barely had the strength to help us move him back to bed. So, this doctor finished his exam and just walked away, leaving me and a med student with an incredibly large, exhausted, and weak man who we can barely keep from falling onto the floor. Thank god my clinical instructor was walking by the room and grabbed a few people to help us. I understand that docs are busy and very focused on their specialty and figuring out what's wrong, but the primary focus of every health care worker in the hospital should be patient safety. There is no excuse for what he did.
I have had other bad experiences with providers (doctors and nurse practitioners) lately. They get too focused on diagnoses and orders and forget about the basics, like safety and comfort. I do not expect to ever see a doc giving a patient a bath, but I do expect them to make sure that if they cause a huge mess (such as a patient vomiting all over himself during an NG tube insertion) that the nurses and techs cleaning up that patient are okay and have all the resources and information they need before the doc leaves the room. That way we don't have to go harass the doc while he's writing his orders or seeing another patient.
All of that being said, I am going to miss 7-14. It was a good floor with (mostly) good staff. I've heard very contrasting reports of what my next floor will be like, so I'm keeping my fingers crossed.
I guess I'm feeling a little bit guilty for being happy with what happened today. I'm glad I got the chance to help with an emergency situation, but I shouldn't be too glad because it means that my patient's health is declining. On top of that, today was my last day on 7-14 and I will probably never find out what happens with him. That part of school bothers me a lot. I want to see my patients' outcomes, I want to know whether they will be okay. Sadly, there is nothing I can do to change that part of the system.
My major frustration today was with the neurology resident. After forcing my patient to get up out of bed, despite being warned that he was very unsteady and barely able to walk, he left me there with a medical student and my patient sort of half sitting on the edge of the bed. This was incredibly unsafe for several reasons. First, my patient weighs about 350lbs. If he falls on the floor (which has happened) it takes about 6 people to lift him back up. Second, he is very weak at the best of times and understandably exhausted from everything he was put through that afternoon, he barely had the strength to help us move him back to bed. So, this doctor finished his exam and just walked away, leaving me and a med student with an incredibly large, exhausted, and weak man who we can barely keep from falling onto the floor. Thank god my clinical instructor was walking by the room and grabbed a few people to help us. I understand that docs are busy and very focused on their specialty and figuring out what's wrong, but the primary focus of every health care worker in the hospital should be patient safety. There is no excuse for what he did.
I have had other bad experiences with providers (doctors and nurse practitioners) lately. They get too focused on diagnoses and orders and forget about the basics, like safety and comfort. I do not expect to ever see a doc giving a patient a bath, but I do expect them to make sure that if they cause a huge mess (such as a patient vomiting all over himself during an NG tube insertion) that the nurses and techs cleaning up that patient are okay and have all the resources and information they need before the doc leaves the room. That way we don't have to go harass the doc while he's writing his orders or seeing another patient.
All of that being said, I am going to miss 7-14. It was a good floor with (mostly) good staff. I've heard very contrasting reports of what my next floor will be like, so I'm keeping my fingers crossed.
Saturday, November 1, 2008
I must be procrastinating or bored
Yeah, yeah, I'm bad at updating. At least I'm not as bad as some people I could name... ;)
It came as quite a shock when I realized that it's officially November now. Halloween is over, I get to vote on Tuesday, as usual I will feel weird without a poppy on the 11th, and Thanksgiving will arrive before I even get a chance to breathe.
I'm sick right now. I started feeling yucky on Monday, but nothing too bad, just achy and tired. Then on Wednesday I was at clinical in a patient's room and I suddenly became very dizzy, nauseous, and felt like I was going to black out. Luckily, I was surrounded by nurses and they sat me down, got me some food and juice, and refused to let me get up for almost an hour. I was feeling pretty much okay after I'd eaten a little and rested, but my instructor let me take the rest of the day off, for which I am grateful. I went home thinking that maybe I'll catch up on some work, but ended up just falling asleep for 3 hours.
When I woke up, I had just had time to get dressed and get bored enough to call home to tell all about my fainting fit when a prospective medical student knocked on my door. Jordan had volunteered to put him up for a couple of nights while he interviewed at the med school. He was a nice guy, very geeky, from MIT, and a former Google intern. He was clearly not a medical student yet because he still had this bright-eyed optimism and excessive amount of energy. Jordan and I tried not to dampen his spirits too much with reality during the dinner conversation. Poor guy, he thinks he knows what's coming but he really has no idea.
Jordan and I had an interesting conversation about med school applicants after our prospie left. Apparently current students get to interview applicants and their comments are pretty highly valued during the admissions process. Jordan said that the majority of students have a canned answer for, "Why do you want to be a doctor?" which I would expect. The surprising thing is that if you rephrase the question to include a little more reality, such as, "You are volunteering to give up the next 8-10 years of your life to intense school, no sleep, and harder work than you've ever experienced. What makes that sacrifice worthwhile for you?" they have no idea what to say. It makes me wonder whether these people really know how brutal and pointless a lot of medical school can be, or if they were just not aware or willing to consider other options in health care.
I got to skip my second clinical day on Thursday in lieu of shadowing a home health nurse around on Friday. Thursday was instead spent in a combination of resting and shopping. I got myself a Zipcar and did all the things that I had been avoiding because I didn't have time. I even bought myself some snow boots and a tuque. Bring it on, winter, I'm ready for you. I also stocked up on soup to keep my cold-ridden self going.
Friday was my home health shadow. Sarah was very kind and drove me out to the agency office because I was in no shape to bike. I then followed my nurse around as sh met with a couple of little old ladies with minor wounds and caught up on some documentation. She couldn't get in touch with her other patients for the day, so just dropped me off at home around 1pm. I called Sarah to let her know she wouldn't need to give me a ride back home, and she asked me to come over and give costume help. She had a truly fabulous big floppy hat with ribbons and flowers on it and a long shiny purple dress that matched perfectly. I did what little I could to help her curl her hair in big bouncy ringlets and then went home to sleep for a while. At about 5:30 we got our first trick-or-treaters, Sarah and co. as well as another family with a pair of 2 year old blond twin boys. More trick-or-treaters followed pretty quickly after that, and we sadly ran out of candy before they stopped. I hadn't expected so many, but it turns out that a lot of kids get driven in to our neighborhood from the more dangerous areas of town. A lot of them didn't have costumes and were using their backpacks for bags. My guess is that was for financial reasons rather than the usual "we're too cool to get dressed up" reasons.
After candy dispensing, I started to get dressed to go to a Halloween party hosted by some classmates. I've stopped attempting to go to most of the class parties because they have devolved into loud and obnoxious groups of very drunk people, but this one was hosted by a different house and was advertised as being pretty quiet. Plus it was within walking distance and Sarah was coming with me. I had borrowed an amazing coat from the 70's and some equally amazing boots from Sarah, combined with a loud and obnoxious thrift store shirt and a miniskirt turned into something approximating a girl from the 70's. I made a valiant attempt at straightening my hair but it just wasn't going to happen. The party was fun, and not full of obnoxious drunk people. Although my favorite costume by far was the girl that came in a patient gown, covered in bandages, and with a foley catheter bag filled with tequila. I got home around midnight exhausted and immediately fell asleep.
Today has been lazy, I've just been cleaning up around the house, occasionally hacking up globs of green goo, and trying to get some rest. Probably should have done my homework, but it's Saturday and that somehow seems wrong. I'll probably still be trying to rest and recover tomorrow, so I can do homework then.
Oh, and before I go I should explain my decision from the last post. I've thought about going straight into graduate school and come to the conclusion that I'm not ready for that. This program is too fast to give us time to really apply all the things we are learning, we only get little tastes of applied nursing during clinical. I want to have the opportunity to be a bedside nurse for a while to figure out how it really works and have a better chance of focusing my graduate work on real life problems and potential solutions. Also, I've been a poor starving student for almost 6 years straight, I want a real job and some time to do the things I'm missing this year, like racing, dancing, and painting. And if I don't go to graduate school, that's okay too, since I'll likely make a better salary as a staff nurse than as nursing faculty. The main reasons that this decision makes my life easier are that I don't have to start working on grad school applications and I am much more likely to just come back to Portland in May. There's still a chance I'll stay in Rochester, but it's not real high.
It came as quite a shock when I realized that it's officially November now. Halloween is over, I get to vote on Tuesday, as usual I will feel weird without a poppy on the 11th, and Thanksgiving will arrive before I even get a chance to breathe.
I'm sick right now. I started feeling yucky on Monday, but nothing too bad, just achy and tired. Then on Wednesday I was at clinical in a patient's room and I suddenly became very dizzy, nauseous, and felt like I was going to black out. Luckily, I was surrounded by nurses and they sat me down, got me some food and juice, and refused to let me get up for almost an hour. I was feeling pretty much okay after I'd eaten a little and rested, but my instructor let me take the rest of the day off, for which I am grateful. I went home thinking that maybe I'll catch up on some work, but ended up just falling asleep for 3 hours.
When I woke up, I had just had time to get dressed and get bored enough to call home to tell all about my fainting fit when a prospective medical student knocked on my door. Jordan had volunteered to put him up for a couple of nights while he interviewed at the med school. He was a nice guy, very geeky, from MIT, and a former Google intern. He was clearly not a medical student yet because he still had this bright-eyed optimism and excessive amount of energy. Jordan and I tried not to dampen his spirits too much with reality during the dinner conversation. Poor guy, he thinks he knows what's coming but he really has no idea.
Jordan and I had an interesting conversation about med school applicants after our prospie left. Apparently current students get to interview applicants and their comments are pretty highly valued during the admissions process. Jordan said that the majority of students have a canned answer for, "Why do you want to be a doctor?" which I would expect. The surprising thing is that if you rephrase the question to include a little more reality, such as, "You are volunteering to give up the next 8-10 years of your life to intense school, no sleep, and harder work than you've ever experienced. What makes that sacrifice worthwhile for you?" they have no idea what to say. It makes me wonder whether these people really know how brutal and pointless a lot of medical school can be, or if they were just not aware or willing to consider other options in health care.
I got to skip my second clinical day on Thursday in lieu of shadowing a home health nurse around on Friday. Thursday was instead spent in a combination of resting and shopping. I got myself a Zipcar and did all the things that I had been avoiding because I didn't have time. I even bought myself some snow boots and a tuque. Bring it on, winter, I'm ready for you. I also stocked up on soup to keep my cold-ridden self going.
Friday was my home health shadow. Sarah was very kind and drove me out to the agency office because I was in no shape to bike. I then followed my nurse around as sh met with a couple of little old ladies with minor wounds and caught up on some documentation. She couldn't get in touch with her other patients for the day, so just dropped me off at home around 1pm. I called Sarah to let her know she wouldn't need to give me a ride back home, and she asked me to come over and give costume help. She had a truly fabulous big floppy hat with ribbons and flowers on it and a long shiny purple dress that matched perfectly. I did what little I could to help her curl her hair in big bouncy ringlets and then went home to sleep for a while. At about 5:30 we got our first trick-or-treaters, Sarah and co. as well as another family with a pair of 2 year old blond twin boys. More trick-or-treaters followed pretty quickly after that, and we sadly ran out of candy before they stopped. I hadn't expected so many, but it turns out that a lot of kids get driven in to our neighborhood from the more dangerous areas of town. A lot of them didn't have costumes and were using their backpacks for bags. My guess is that was for financial reasons rather than the usual "we're too cool to get dressed up" reasons.
After candy dispensing, I started to get dressed to go to a Halloween party hosted by some classmates. I've stopped attempting to go to most of the class parties because they have devolved into loud and obnoxious groups of very drunk people, but this one was hosted by a different house and was advertised as being pretty quiet. Plus it was within walking distance and Sarah was coming with me. I had borrowed an amazing coat from the 70's and some equally amazing boots from Sarah, combined with a loud and obnoxious thrift store shirt and a miniskirt turned into something approximating a girl from the 70's. I made a valiant attempt at straightening my hair but it just wasn't going to happen. The party was fun, and not full of obnoxious drunk people. Although my favorite costume by far was the girl that came in a patient gown, covered in bandages, and with a foley catheter bag filled with tequila. I got home around midnight exhausted and immediately fell asleep.
Today has been lazy, I've just been cleaning up around the house, occasionally hacking up globs of green goo, and trying to get some rest. Probably should have done my homework, but it's Saturday and that somehow seems wrong. I'll probably still be trying to rest and recover tomorrow, so I can do homework then.
Oh, and before I go I should explain my decision from the last post. I've thought about going straight into graduate school and come to the conclusion that I'm not ready for that. This program is too fast to give us time to really apply all the things we are learning, we only get little tastes of applied nursing during clinical. I want to have the opportunity to be a bedside nurse for a while to figure out how it really works and have a better chance of focusing my graduate work on real life problems and potential solutions. Also, I've been a poor starving student for almost 6 years straight, I want a real job and some time to do the things I'm missing this year, like racing, dancing, and painting. And if I don't go to graduate school, that's okay too, since I'll likely make a better salary as a staff nurse than as nursing faculty. The main reasons that this decision makes my life easier are that I don't have to start working on grad school applications and I am much more likely to just come back to Portland in May. There's still a chance I'll stay in Rochester, but it's not real high.
Sunday, October 19, 2008
One decision made
I'm going to work for at least a year before entering grad school. Suddenly life seems a lot less complicated.
Monday, October 13, 2008
Clinicals
I started my adult health rotation last week. I'll spend 5 weeks on a cardiovascular surgery floor, then 5 weeks on a short stay medical floor. Here's a quick rundown on what my weeks are going to look like from now until Christmas:
Mon: Lecture noon-8pm
Tues: Lecture 8am-3pm, go to clinical unit and copy patient information, write up a report on patient including primary diagnosis with pathophysiology, up to 6 comorbid diagnoses, explain their pathophysiology and effect on primary diagnosis, past medical history, drug cards for medications (up to 12), and a priority nursing diagnosis.
Wed: Clinical 7am-4pm, write up a report that includes assessment of patient, and nursing care plan with daignoses, interventions, expected outcomes, and method of evaluation.
Thurs: Clinical 7am-4pm, implement the care plan, write up an evaluation of whether it worked.
Fri: Simulation or Community Health (alternating Fridays). For simulation days, write SBAR report, critique partner's SBAR, blog, and comment on blog.
That's the summary for this class alone. I guess that's what happens when you take a single class worth 8 credits.
Other than the crazy workload, I think I'll really enjoy this clinical rotation. My instructor is great, gets really involved while we're on the floor. And the patient population is mostly interesting. I say mostly because I'm interested in cardiac surgery patients, but not vascular surgery patients. Vascular surgery is a lot of, "Oh, you had uncontrolled diabetes for your entire life, we're going to cut your gangrenous leg off now." I'm hoping to be assigned a cardiac patient for this week.
Also, our nurse manager had breakfast there for us on the first day. How cool is that?
I'll write more about clinicals when I start to get interesting stories to tell.
Mon: Lecture noon-8pm
Tues: Lecture 8am-3pm, go to clinical unit and copy patient information, write up a report on patient including primary diagnosis with pathophysiology, up to 6 comorbid diagnoses, explain their pathophysiology and effect on primary diagnosis, past medical history, drug cards for medications (up to 12), and a priority nursing diagnosis.
Wed: Clinical 7am-4pm, write up a report that includes assessment of patient, and nursing care plan with daignoses, interventions, expected outcomes, and method of evaluation.
Thurs: Clinical 7am-4pm, implement the care plan, write up an evaluation of whether it worked.
Fri: Simulation or Community Health (alternating Fridays). For simulation days, write SBAR report, critique partner's SBAR, blog, and comment on blog.
That's the summary for this class alone. I guess that's what happens when you take a single class worth 8 credits.
Other than the crazy workload, I think I'll really enjoy this clinical rotation. My instructor is great, gets really involved while we're on the floor. And the patient population is mostly interesting. I say mostly because I'm interested in cardiac surgery patients, but not vascular surgery patients. Vascular surgery is a lot of, "Oh, you had uncontrolled diabetes for your entire life, we're going to cut your gangrenous leg off now." I'm hoping to be assigned a cardiac patient for this week.
Also, our nurse manager had breakfast there for us on the first day. How cool is that?
I'll write more about clinicals when I start to get interesting stories to tell.
Sunday, October 12, 2008
Grad school hunting
There are basically four schools and two degrees that I'm interested in. A master's degree (aka nurse practitioner license) and a PhD (aka license to do lots of research and teach). So I narrowed down my list of schools by finding ones that would a)be in places I'm willing to live b)have some way for me to work on both degrees at the same time and c)help me pay for those degrees. The list ended up being University of Rochester, Boston College, University of Pennsylvania, and OHSU. OHSU is sort of an honorable mention for reasons I'll explain later. Let's go through the pros and cons of each:
1. University of Rochester
Pros: I'm already here. MS/PhD dual degree program. Fully paid tuition for said program. Associated with a really high quality teaching hospital.
Cons: Staying in Rochester for 5 more years.
2. Boston College
Pros: 4 year MS/PhD program. Boston looks cool.
Cons: Boston's expensive. Not sure about the funding for this one. Reputation of not liking people from outside the area. Jesuit school, which may or may not matter.
3. University of Pennsylvania
Pros: Ivy league. Associated with nationally recognized hospital. Fully funded for PhD portion of program, plus $20K stipend. Philadelphia looks cool.
Cons: Have to fund the Master's degree myself (only one year). Moving to a new city.
4. OHSU
Pros: Portland! Faculty with my exact research interests. Associated with really good hospital. But mostly, Portland!
Cons: No dual degree program. No Adult Nurse Practitioner program (only Family). Bureaucracy.
So, based on this list Penn and UR are looking pretty good. But then I have to take into account what I actually want to do, which changes frequently. Right now I'm kinda liking the idea of bedside nursing, which I give up if I get my NP. But, I could still do if I just got my PhD. In which case, OHSU jumps to the top of the list. So, I think my plan right now is to apply for all of these things and then decide based on what I want to do when the decision has to be made. Usually there's an option to defer admission for a year, or start out part-time, which I could do while working a full-time job as an RN. Although I'm open to any suggestions for alternatives or additions to this plan.
1. University of Rochester
Pros: I'm already here. MS/PhD dual degree program. Fully paid tuition for said program. Associated with a really high quality teaching hospital.
Cons: Staying in Rochester for 5 more years.
2. Boston College
Pros: 4 year MS/PhD program. Boston looks cool.
Cons: Boston's expensive. Not sure about the funding for this one. Reputation of not liking people from outside the area. Jesuit school, which may or may not matter.
3. University of Pennsylvania
Pros: Ivy league. Associated with nationally recognized hospital. Fully funded for PhD portion of program, plus $20K stipend. Philadelphia looks cool.
Cons: Have to fund the Master's degree myself (only one year). Moving to a new city.
4. OHSU
Pros: Portland! Faculty with my exact research interests. Associated with really good hospital. But mostly, Portland!
Cons: No dual degree program. No Adult Nurse Practitioner program (only Family). Bureaucracy.
So, based on this list Penn and UR are looking pretty good. But then I have to take into account what I actually want to do, which changes frequently. Right now I'm kinda liking the idea of bedside nursing, which I give up if I get my NP. But, I could still do if I just got my PhD. In which case, OHSU jumps to the top of the list. So, I think my plan right now is to apply for all of these things and then decide based on what I want to do when the decision has to be made. Usually there's an option to defer admission for a year, or start out part-time, which I could do while working a full-time job as an RN. Although I'm open to any suggestions for alternatives or additions to this plan.
Saturday, October 11, 2008
Job hunting
This isn't so much hunting for jobs as deciding which ones I'm interested in. I love my chosen career already.
My first step was to shadow at Strong Memorial Hospital here in Rochester. They require you to shadow on the unit you're interested in before you can apply for the job. So I scheduled two shadows for last Monday, first on general oncology from 7am-11am and then on the bone marrow transplant floor from 11:30 to 3:30pm. I walked over in the dark early morning with Sarah, since she was shadowing on labor and delivery, and we got shuttled off to our respective units by the nursing recruiters.
I was introduced to my nurse, and she whisked me off to meet her first patient for the day. She was assigned 4 patients, 3 of whom had blood cancers. As I followed her around throughout the morning I just got more and more amazed at how efficient she was. She never stopped moving the entire 4 hours that I was shadowing with her. She saw and assessed patients, administered medications, hung a platelet transfusion, prepared a patient for discharge, prepares a patient for a surgery, reassured family members, fed a man who couldn't use his hands, and still somehow found the time to help out anyone that asked her for anything. The most amazing thing was how she managed to go from looking completely frazzled to looking completely composed the moment she stepped into a patient's room. I want to be like her someday. At 11 I realized that I hadn't been able to ask her any questions about the unit, but there was nothign that could be done about it, so I ran off to get lunch.
After lunch I was taken up to the bone marrow transplant unit. I was met by the charge nurse and the nurse manager (aka the people that hire people) and they were both very welcoming and eager to talk to me. First the charge nurse sent me into a team treatment planning meeting. It was very interesting, especially since they discussed the 3 patients I had met that morning on the oncology unit. When I got out of the meeting I had a long list of questions for the charge nurse, and she answered them all. Then I got a quick tour and description of the unit. They have 12 beds, all in private rooms. They take all kinds of patients, including pediatric patients, with every imagine disease that might need a bone marrow transplant. They do both autologous and allogeneic transplants, and they even have 4 outpatient infusion chairs. After my tour, I followed a couple of the nurses around for most of the day, just doing standard nursing stuff. Then I got to watch and help with an autologous transplant, and that was really cool. I actualy like the vibe and atmosphere better on the this floor than the oncology floor, but I still can't identify exactly why. I just felt more at home, probably because it's so similar to 5C at OHSU.
I got to talk to the nurse manager about the hiring and orientation process a little bit. They usually take 1-2 new graduates each year, and spend 12 weeks doing orientation (most units do 6-8 weeks). Orientation means working 1 on 1 with another nurse and learning how to do the day-to-day job. After orientation they let you loose to work on the unit as a regular nurse for a while. At some point during the next year, they send new hires to the ICU for a while to get critical care training. They also slowly introduce new hires to working with the pediatric patients during their first year. What this means is that nurses from this floor are the best trained in the hospital, but they also want you to commit to a year of full time work at the time of hire.
The next step for me at Strong would be to submit an application and get an interview set up. I will do that soon, but want to get to know my current clinical instructor better first so she can write me a recommendation. Based on the feedback I got from both the recruiter and the nurses on the unit I'm pretty confident that I would be offered a job on at least one, if not both of those units if I apply.
Job hunting in Portland has also progressed a little. I contacted OHSU a while ago to ask about working on the BMT floor as a new graduate. They said that yes, they do hire new grads, but I should just apply online when I'm about 6 weeks away from taking my NCLEX. I don't like that answer for a couple of reasons. First, I'd like to shadow on the floor. Second, I hate the OHSU online application process and have never had any luck with it. It sucks. I got my last job there through the Willamette Career Center after submitting dozens of applications online. Third, I don't know when I'll be able to take my NCLEX because I can't do it until UR gets some paperwork to whoever administers the exam. It might be delayed by a month or more after graduation. At Strong, I can work as a graduate nurse until I get my RN, it doesn't sound like that's a possibility at OHSU.
Based on all of the above, my mom contacted Dr. Meyers, who knows me fairly well and has always been very supportive of my nursing career plans. She kindly offered to get me in touch with the appropriate people to help get me a job on the BMT floor at OHSU. I haven't heard back from her yet, but I only emailed her on Thursday, so I need to give her some time. I lov having inside connections.
I haven't looked at jobs elseewhere yet. I'm betting that I'll either be in Rochester or Portland for graduate school though, so there isn't a whole lot of motivation to look elsewhere. I might check out the hiring process at some hospitals in Philadelphia (more on that in the grad school post) but that's probably it for now. It is pretty exciting knowing that wherever I go I will be able to get work, but I'd like to know that I can get the kind of work that I want.
My first step was to shadow at Strong Memorial Hospital here in Rochester. They require you to shadow on the unit you're interested in before you can apply for the job. So I scheduled two shadows for last Monday, first on general oncology from 7am-11am and then on the bone marrow transplant floor from 11:30 to 3:30pm. I walked over in the dark early morning with Sarah, since she was shadowing on labor and delivery, and we got shuttled off to our respective units by the nursing recruiters.
I was introduced to my nurse, and she whisked me off to meet her first patient for the day. She was assigned 4 patients, 3 of whom had blood cancers. As I followed her around throughout the morning I just got more and more amazed at how efficient she was. She never stopped moving the entire 4 hours that I was shadowing with her. She saw and assessed patients, administered medications, hung a platelet transfusion, prepared a patient for discharge, prepares a patient for a surgery, reassured family members, fed a man who couldn't use his hands, and still somehow found the time to help out anyone that asked her for anything. The most amazing thing was how she managed to go from looking completely frazzled to looking completely composed the moment she stepped into a patient's room. I want to be like her someday. At 11 I realized that I hadn't been able to ask her any questions about the unit, but there was nothign that could be done about it, so I ran off to get lunch.
After lunch I was taken up to the bone marrow transplant unit. I was met by the charge nurse and the nurse manager (aka the people that hire people) and they were both very welcoming and eager to talk to me. First the charge nurse sent me into a team treatment planning meeting. It was very interesting, especially since they discussed the 3 patients I had met that morning on the oncology unit. When I got out of the meeting I had a long list of questions for the charge nurse, and she answered them all. Then I got a quick tour and description of the unit. They have 12 beds, all in private rooms. They take all kinds of patients, including pediatric patients, with every imagine disease that might need a bone marrow transplant. They do both autologous and allogeneic transplants, and they even have 4 outpatient infusion chairs. After my tour, I followed a couple of the nurses around for most of the day, just doing standard nursing stuff. Then I got to watch and help with an autologous transplant, and that was really cool. I actualy like the vibe and atmosphere better on the this floor than the oncology floor, but I still can't identify exactly why. I just felt more at home, probably because it's so similar to 5C at OHSU.
I got to talk to the nurse manager about the hiring and orientation process a little bit. They usually take 1-2 new graduates each year, and spend 12 weeks doing orientation (most units do 6-8 weeks). Orientation means working 1 on 1 with another nurse and learning how to do the day-to-day job. After orientation they let you loose to work on the unit as a regular nurse for a while. At some point during the next year, they send new hires to the ICU for a while to get critical care training. They also slowly introduce new hires to working with the pediatric patients during their first year. What this means is that nurses from this floor are the best trained in the hospital, but they also want you to commit to a year of full time work at the time of hire.
The next step for me at Strong would be to submit an application and get an interview set up. I will do that soon, but want to get to know my current clinical instructor better first so she can write me a recommendation. Based on the feedback I got from both the recruiter and the nurses on the unit I'm pretty confident that I would be offered a job on at least one, if not both of those units if I apply.
Job hunting in Portland has also progressed a little. I contacted OHSU a while ago to ask about working on the BMT floor as a new graduate. They said that yes, they do hire new grads, but I should just apply online when I'm about 6 weeks away from taking my NCLEX. I don't like that answer for a couple of reasons. First, I'd like to shadow on the floor. Second, I hate the OHSU online application process and have never had any luck with it. It sucks. I got my last job there through the Willamette Career Center after submitting dozens of applications online. Third, I don't know when I'll be able to take my NCLEX because I can't do it until UR gets some paperwork to whoever administers the exam. It might be delayed by a month or more after graduation. At Strong, I can work as a graduate nurse until I get my RN, it doesn't sound like that's a possibility at OHSU.
Based on all of the above, my mom contacted Dr. Meyers, who knows me fairly well and has always been very supportive of my nursing career plans. She kindly offered to get me in touch with the appropriate people to help get me a job on the BMT floor at OHSU. I haven't heard back from her yet, but I only emailed her on Thursday, so I need to give her some time. I lov having inside connections.
I haven't looked at jobs elseewhere yet. I'm betting that I'll either be in Rochester or Portland for graduate school though, so there isn't a whole lot of motivation to look elsewhere. I might check out the hiring process at some hospitals in Philadelphia (more on that in the grad school post) but that's probably it for now. It is pretty exciting knowing that wherever I go I will be able to get work, but I'd like to know that I can get the kind of work that I want.
Don't even know where to start...
A lot has happened in the past couple of weeks. So, I'll follow Matthew and Leah's lead and give a list of things to catch up on:
1. Job hunting
2. Graduate school hunting
3. Clinicals
4. Classes
5. Everything else
I'm going to try to write about most of that over this weekend, since once the week starts I have zero free time. I'm beginning to understand the true meaning of "accelerated program" and I'm loving it.
1. Job hunting
2. Graduate school hunting
3. Clinicals
4. Classes
5. Everything else
I'm going to try to write about most of that over this weekend, since once the week starts I have zero free time. I'm beginning to understand the true meaning of "accelerated program" and I'm loving it.
Tuesday, September 30, 2008
Recruitment
We're being seriously recruited. It's time to start thinking about where I'm going to apply for jobs and what kind of jobs those are going to be. Of course, my first choice of job would be to work on the BMT floor at OHSU. Since that is unlikely to mesh with my graduate school plans, I need to expand my search a little. Like, to the BMT floor at Strong Memorial Hospital in Rochester. Which, by the way, offers full tuition reimbursement for any classes at UofR for anyone that has a) worked at SMH for a year or b) worked in a university setting for a year. I believe I fall into category b. Pretty sweet deal, huh?
Then again, if I get into the MSN/PhD program, tuition is covered anyway. But, this would be a good backup in case I don't get accepted and end up doing just the MSN or something. Speaking of MSN/PhD programs, I've requested more information about the program at University of Pennsylvania (Ivy League, on my!) in Philadelphia. I hear good things about Philly from my housemates (they've both lived there) and Sarah and Ronen might consider following me there if I go, since they have an exceptional nurse midwifery program as well. Haven't discussed the whole moving thing much with Paul yet, I need to have a talk with him soon though.
I've been missing Portland a lot this week. Maybe because the weather has been so quintessentially Portland-like. About 65 degrees and misting rain. I love it, but it makes me homesick. Rochester is an okay place, but I would never choose to stay here because of the city itself, it would take something like getting into a fully-funded dual degree program to keep me here. I don't know if I would like Philadelphia any better, but I could at least visit there before moving. One definite perk of Philadelphia would be more access to the things I love to do, like cycling and dancing. There is no such thing as a women's cycling team in Rochester, the city is just too small to support it. And dancing is extremely limited and doesn't seem worth the effort to get out on a weeknight. Then again, if none of my friends came with me to Philadelphia, I'd have to start all over again.
Basically, I'm back to the waiting game, not sure if I'm hoping for my decision to be made for me by admissions committees or if I'd rather have all my options open and have to choose myself. So far my decision to come out here has proven to be a good one, but right now I"m really unsure if I want to stay for 5 more years.
Then again, if I get into the MSN/PhD program, tuition is covered anyway. But, this would be a good backup in case I don't get accepted and end up doing just the MSN or something. Speaking of MSN/PhD programs, I've requested more information about the program at University of Pennsylvania (Ivy League, on my!) in Philadelphia. I hear good things about Philly from my housemates (they've both lived there) and Sarah and Ronen might consider following me there if I go, since they have an exceptional nurse midwifery program as well. Haven't discussed the whole moving thing much with Paul yet, I need to have a talk with him soon though.
I've been missing Portland a lot this week. Maybe because the weather has been so quintessentially Portland-like. About 65 degrees and misting rain. I love it, but it makes me homesick. Rochester is an okay place, but I would never choose to stay here because of the city itself, it would take something like getting into a fully-funded dual degree program to keep me here. I don't know if I would like Philadelphia any better, but I could at least visit there before moving. One definite perk of Philadelphia would be more access to the things I love to do, like cycling and dancing. There is no such thing as a women's cycling team in Rochester, the city is just too small to support it. And dancing is extremely limited and doesn't seem worth the effort to get out on a weeknight. Then again, if none of my friends came with me to Philadelphia, I'd have to start all over again.
Basically, I'm back to the waiting game, not sure if I'm hoping for my decision to be made for me by admissions committees or if I'd rather have all my options open and have to choose myself. So far my decision to come out here has proven to be a good one, but right now I"m really unsure if I want to stay for 5 more years.
Saturday, September 27, 2008
A little more about the psychiatric hospital
People have asked me why I hate my psych rotation so much. It's not because I'm not interested in psychiatry, or because I don't get to be involved in patient care, although those would be reasons enough. It's because I come home angry and depressed every single day. So, here's a quick summary of the things that I have seen that make me so angry. I honestly hope it makes you angry too, because unless a whole lot of people get very upset about it, nothing is going to change.
First, there is one nurse for every 30 patients. That is simply not enough. The nurse spends his/her day filling out paperwork, not even giving medications (an LPN does that). Zero patient contact, unless a patient becomes disruptive or dangerous.
Second, the unit feels like a prison. There are locks on all the doors, and I understand that is out of necessity and cannot be changed. What could be changed are the institutional rooms, fluorescent lights, warnings posted on the walls, and complete lack of individualization of patient rooms. Several patients have said that they feel much happier and more stable when they're at the regular hospital or doing outpatient treatment, just because that place makes them depressed. Honestly, I would probably become suicidal after being locked in that unit for a month.
Third, there is nothing for the patients to do. The nurse is too busy to interact with them. The mental health techs don't seem to give a damn. The LPN just does medications. Who's left? Other patients. And they do okay together, but any time you put a group of 30 people together with no available form of distraction besides the one television there will be problems. Then do it with 30 mentally ill people, many of whom have impulse control problems or histories of violence, and you've just got a ticking bomb.
Fourth, the patients get medication, not treatment. Medication is not the same as treatment. The doctors don't seem to realize this, and the nurse and social workers are either too busy or too jaded to do anything about it. Medications help. They calm symptoms, like command hallucinations and extreme depression or mania, and make it possible for various types of therapy to be successful. There are several kinds of therapies available, and many of them are effective. But, they need to be implemented with consistency and expertise. One group therapy session each week is not going to make a difference in these patients' lives. So, instead of getting treatment, they get medicated to the point where they are "safe" (read: unable to feel or think straight) and then medicated some more to deal with the side effects of the original meds.
Fifth, the patients believe that nobody cares about them, with the possible exception of the social workers. And who can blame them, I've seen very little evidence to prove the patients wrong. Almost all of the staff are unapproachable and impatient. I don't blame them either, they are overworked, underpaid, and buried in paperwork.
So, who's to blame? Everybody. Why? Because none of us care enough to fix these problems. What's the fix, you ask? Easy, money. Mental health funding has been cut significantly in the past 10 years. They are now so broke at this place that they don't even have snacks or drinks other than water available between meal times. They have a full kitchen and used to bake cookies with patients. Now they can't afford the ingredients, so the appliances have been disconnected and the kitchen is locked. They used to get $200/month for the entire hospital (less than $1 per patient) for recreational therapy. That is going to disappear by the end of this year. They won't even be allowed to buy a deck of cards or a soccer ball, unless it comes out of the pocket of a staff member. This isn't a unique situation, this is standard for psychiatric hospitals around the country.
Where does the small amount of money that they do get end up? Paying staff to do paperwork. The amount of paperwork they have to do is beyond belief. Double, if not triple, anything I've seen at a regular hospital. That's why the nurses can't spend time with their patients, and the therapists don't have time to do more than one session per week. The intense overregulation of mental health care is preventing any actual care from being given.
So that's why I hate psych, because it's a broken system and there is nothing I can do about it, except be angry and try to care.
First, there is one nurse for every 30 patients. That is simply not enough. The nurse spends his/her day filling out paperwork, not even giving medications (an LPN does that). Zero patient contact, unless a patient becomes disruptive or dangerous.
Second, the unit feels like a prison. There are locks on all the doors, and I understand that is out of necessity and cannot be changed. What could be changed are the institutional rooms, fluorescent lights, warnings posted on the walls, and complete lack of individualization of patient rooms. Several patients have said that they feel much happier and more stable when they're at the regular hospital or doing outpatient treatment, just because that place makes them depressed. Honestly, I would probably become suicidal after being locked in that unit for a month.
Third, there is nothing for the patients to do. The nurse is too busy to interact with them. The mental health techs don't seem to give a damn. The LPN just does medications. Who's left? Other patients. And they do okay together, but any time you put a group of 30 people together with no available form of distraction besides the one television there will be problems. Then do it with 30 mentally ill people, many of whom have impulse control problems or histories of violence, and you've just got a ticking bomb.
Fourth, the patients get medication, not treatment. Medication is not the same as treatment. The doctors don't seem to realize this, and the nurse and social workers are either too busy or too jaded to do anything about it. Medications help. They calm symptoms, like command hallucinations and extreme depression or mania, and make it possible for various types of therapy to be successful. There are several kinds of therapies available, and many of them are effective. But, they need to be implemented with consistency and expertise. One group therapy session each week is not going to make a difference in these patients' lives. So, instead of getting treatment, they get medicated to the point where they are "safe" (read: unable to feel or think straight) and then medicated some more to deal with the side effects of the original meds.
Fifth, the patients believe that nobody cares about them, with the possible exception of the social workers. And who can blame them, I've seen very little evidence to prove the patients wrong. Almost all of the staff are unapproachable and impatient. I don't blame them either, they are overworked, underpaid, and buried in paperwork.
So, who's to blame? Everybody. Why? Because none of us care enough to fix these problems. What's the fix, you ask? Easy, money. Mental health funding has been cut significantly in the past 10 years. They are now so broke at this place that they don't even have snacks or drinks other than water available between meal times. They have a full kitchen and used to bake cookies with patients. Now they can't afford the ingredients, so the appliances have been disconnected and the kitchen is locked. They used to get $200/month for the entire hospital (less than $1 per patient) for recreational therapy. That is going to disappear by the end of this year. They won't even be allowed to buy a deck of cards or a soccer ball, unless it comes out of the pocket of a staff member. This isn't a unique situation, this is standard for psychiatric hospitals around the country.
Where does the small amount of money that they do get end up? Paying staff to do paperwork. The amount of paperwork they have to do is beyond belief. Double, if not triple, anything I've seen at a regular hospital. That's why the nurses can't spend time with their patients, and the therapists don't have time to do more than one session per week. The intense overregulation of mental health care is preventing any actual care from being given.
So that's why I hate psych, because it's a broken system and there is nothing I can do about it, except be angry and try to care.
What's wrong with this picture?
There's a young man on my unit, let's call him Jim, who's a paranoid schizophrenic. He's in his early twenties and has a past history of violence, badly beating several patients, but nothing recently. Jim believes that people are trying to kill him, have already killed his father, and that he should be in the witness protection program. He is afraid of leaving the hospital because there will be an attempt on his life. He has constant and persistent hallucinations and delusions, despite the medication he is on. He's also one of the most thoughtful, soft-spoken, and caring gentlemen that I have ever met.
Today Jim came to the staff and told them that there was a wire in his leg and he had to go to the hospital. They explained to him that he is in the hospital already, he responded by turning around and punching the wall. Based on his history, staff called a "Camelot," meaning security came running and Jim was medicated and then isolated for the rest of the day. Had Jim punched a staff member instead, it says in his treatment plan that he would immediately be taken back to prison.
Compare Jim's story with another young man on my unit, let's call him Tom. Tom is also a schizophrenic and hears voices frequently, probably command hallucinations. He has attacked three people in the past four weeks, twice stating that he was trying to kill them. First he tried to choke another patient with headphone cables, then he tried to break someone's neck, finally he punched a lawyer in the face. Tom also has a history of imprisonment, and has been moved off of every regular unit at my hospital because he was a danger to the other patients. My unit was the last option, and so he's stuck there. After each incident, he was medicated and isolated, arrested briefly, and then returned to the unit because his actions did not qualify as severe enough to actually imprison him. Note that there is a forensic unit at this hospital specifically for criminals that have been found guilty by reason of insanity.
So, to sum up: Tom has a history of attempted murders. Jim gets frustrated and punches a wall. They both get the same treatment, except now if Tom punches somebody nothing different will happen. If Jim punches a person, he'll get taken to jail, setting back all the progress that has been made.
Anyone else have a problem with this?
Today Jim came to the staff and told them that there was a wire in his leg and he had to go to the hospital. They explained to him that he is in the hospital already, he responded by turning around and punching the wall. Based on his history, staff called a "Camelot," meaning security came running and Jim was medicated and then isolated for the rest of the day. Had Jim punched a staff member instead, it says in his treatment plan that he would immediately be taken back to prison.
Compare Jim's story with another young man on my unit, let's call him Tom. Tom is also a schizophrenic and hears voices frequently, probably command hallucinations. He has attacked three people in the past four weeks, twice stating that he was trying to kill them. First he tried to choke another patient with headphone cables, then he tried to break someone's neck, finally he punched a lawyer in the face. Tom also has a history of imprisonment, and has been moved off of every regular unit at my hospital because he was a danger to the other patients. My unit was the last option, and so he's stuck there. After each incident, he was medicated and isolated, arrested briefly, and then returned to the unit because his actions did not qualify as severe enough to actually imprison him. Note that there is a forensic unit at this hospital specifically for criminals that have been found guilty by reason of insanity.
So, to sum up: Tom has a history of attempted murders. Jim gets frustrated and punches a wall. They both get the same treatment, except now if Tom punches somebody nothing different will happen. If Jim punches a person, he'll get taken to jail, setting back all the progress that has been made.
Anyone else have a problem with this?
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