Sunday, November 30, 2008

Thanksgiving- I am thankful for not screwing up

Well, I'm back in the Mid Atlantic, after going home to the Great North Woods for Thanksgiving with the family. Technically there IS internet there, it just isn't fast, or reliable. Hence, no post for a bit.
I have clinical Monday and Wednesday, and then I'm done for the semester. I can't wait to start learning more skills, like EKG interpretation, actual med administration, pathophysiology and such. I know we work our way up, but I'm really looking forward to being put into a real HOSPITAL, and hopefully a situation where things move faster...on the other hand, if they'd moved much faster this semester, even at the Nursing Home, I'd have died, cried, or panicked. And that was just doing AM care and a basic physical assessment. I get nervous around stable patients.

Friday, November 21, 2008

Very First Clinical

I survived my first day of clinical, and so did my patient! I would have been quite surprised if he HAD died, as I have seldom seen a patient so stable in my earthly existence, but hey! I'm not used to people who STAY OK for the ENTIRE time I'm there. Usually they are either getting better or worse...this patient just sorta chilled.
The worst part about being assigned to a ~shudder~ nursing home ~shudder again~ is that I still have trouble thinking "like a nurse" as my instructor says. When I get nervous I automatically fall back on the ABCs. Airway, Breathing, Circulation. That doesn't WORK when your patient is stable as a rock, and their only problem is chronic orthostatic hypotension that causes them to fall over if they stand up quickly.
So the good part was my patient was delightful.
The BAD part is that I have to go back to that awful place THREE MORE TIMES. Why couldn't they have sent me to a hospital? Maybe a nice ER with patients coming in bleeding, or even drug seeking! I KNOW how to evaluate that!

Tuesday, November 18, 2008

11 Hours

Until I meet my very first patient. Well, my very first patient as a nursing student. My very first patient EVER was as an EMT, four an a half years ago. They say you never forget your first patient, and I'm sure I never will. After all, he died. My very first EMT call was a nasty car crash, which resulted in the rapid demise of my patient, about 30 seconds after we finally got him extricated.
In some ways, this makes me less nervous about tomorrow- after all, the odds are that THIS patient won't die on me. On the other hand, the odds of my getting a fatal car crash on my first day were pretty low too.
The professors told us that they expect us not to sleep tonight, to be worried about killing someone, and to obsessively study our texts. I'm not sure that's a healthy attitude, and I'm going to do my best now to get to bed.

Monday, November 17, 2008

36 hours

It's about 36 hours until my very first clinical day. To say that I'm nervous would be an understatement. I'm TERRIFIED of stable patients. I mean, give me a person whose oxygen sats are falling, who is gasping for air, and has some sort of critical problem, and I'll work my way through the ABCs, and work to get them back to stable. Once they're THERE, I run into problems. For one thing, I get bored. I mean, they're HEALING. They're doing FINE! There's nothing to fix! I'm certain I'll find some way to screw it all up, and leave them worse off than I found them.
I AM however looking forward to removing surgical staples. That sounds like fun, as does doing actual catheterizations. The facility we're being sent to "Doesn't Do Venous Access Onsite", so no IV training for me. ~sigh~ not fair. Why couldn't they have sent us to an ER?

Sunday, November 16, 2008

Med Dose Calculations

I'm procrastinating...or rather, I'm in the middle of my 4th of 8 "Meds Pub" modules to do today, all to do with medication administration. And the 4th of 8 tests. Blech.
I have been told that SOME people leading our clinical groups will test us on this WITHOUT ALLOWING CALCULATORS. I will hyperventilate and die if this includes me. I can't do division, and never HAVE been able to. I promise NEVER to calculate a patient's meds without a calculator, if they will only let me have one for the test. I'm not stupid, I KNOW not to let myself do it without a calculator.

Friday, November 14, 2008

Non-Medical post

What a treat! (for me, not for him) My dad got stuck in Philadelphia overnight, so I picked him up at the airport and he stayed overnight with me! And we had dinner, and it was lovely!

For the rest of the weekend, I'll be writing papers, working on a Care Plan, and studying up on GI and Mood-Altering Pharmacology.

Thursday, November 13, 2008

OB Observation

In other news, I'm still waiting to hear if my professor has gotten somebody to let me follow them around for a shift on the L&D floor of one of our (MANY) nearby hospitals. Being in the greater Philly area does have its blessings. OB/GYN is a complete mystery to me, so I'm terribly curious and would like to give it a shot. You never know till you try!

I'm Alive!

The Deathbug has migrated into the sinuses, where it is under tolerable control with Real Sudafed and cough syrup. Today in pharmacology we covered Antipsychotics. Three of us in the front row gave a "Shout Out To Haldol" and amused the professor. WONDERFUL drug, especially in the ED. One of our major focuses today was on "how benzos can mimic barbituates in CNS depression if you accidentally/on purpose mix them with antihistamines and alcohol. How this could happen accidentally eluded me, until I realized that if you were panicky AND had a cold, and happened to take Nyquil, you'd have all your ducks in a row right there. Oop.

We practiced catheters in the lab yesterday. I don't think the dummies were a very good approximation of human labia though. They were STIFF! I could barely get them to stay open, even wedging a knuckle between them (which would NOT be tolerated by a human, I have no doubt). Then the catheter balloon-syringe popped out of place and sprayed everyone with water. I'm praying it won't happen in clinical, making me look like a COMPLETE incompetent. At least with emergencies you just work your way down A-B-C. Stable people scare me.

Tuesday, November 11, 2008

Blood from a Stone

So I checked into the student health center for a few hours yesterday, because of a fever/sorethroat/painful cough. The WONDERFUL nurses, after tucking me into an in-patient bed with three blankets, in semi-Fowlers, call light within reach (as per protocol- no, I DID NOT use it) decided they needed a CBC and Mono blood test. Well fine! I always like watching nurses work, it gives me valuable tips for the eventual time when that will be ME. So on went the tourniquet, in went the needle and...nothing. Try again? Sure! Nothing. So she called in a colleague, who tried a back-of-the-hand. Nothing, apparently the veins are not only tiny, they roll. So a THIRD colleague, an NP tried the vein in my thumb, hit a nerve and STILL didn't get any blood. At this point, noting that I had been drinking NON STOP in an effort to give them something to work with, and all the previous sites hadn't actually bled at all, these poor souls decided that my body didn't want blood work done. Apparently I'm either the walking dead, or just the WORST set of veins in somebody my age ever seen. The irony is my skin is pale enough to look like a ROADMAP with the veins perfectly visible underneath.

Monday, November 10, 2008

Sore Throat

Spent today "admitted" to the Health Services clinic, getting high-test painkillers for the worlds WORST sore throat. Am now at home, still on high-test painkillers, awaiting the results of the mono test and throat cultures...bacterial or viral? ONLY TIME WILL TELL!
Other than the throat, fever is holding at 101.7, grossly swollen cervical lymph nodes. blech.

Wednesday, November 5, 2008


Well in the past 24 hours I took three midterm exams and voted in the general election. I am all KINDS of exhausted.
I found out where I'll be going for my first clinical rotation which (thankfully) only will consist of the four sessions before Christmas break. Next semester we get a new assignment (and I hope and pray for a BETTER one). I'll be going to the local "skilled care facility". Now I know that these places are necessary, can be fulfilling places to work, and that many of their patients are perfectly wonderful individuals. But, honestly, I can't think of a posting that feels more like a circle of hell for me. I like trauma, blood, fast moving departments, and babies. But still, it's something you've got to do to get through this program.

Monday, November 3, 2008

Bathing Your Patient

Today was "Hygiene and Mobility" day, also known as giving bed-baths, changing occupied AND unoccupied beds (with mitered corners, no less) and learning how to use all sorts of spiffy lift-assists that we are assured will NEVER be there when we need them. It was hilarious. Bathing a fully conscious, morally outraged classmate is a unique experience I hope never to have to repeat, and the water really DOES go cold faster than you'd think. Highlights included the lecture by one VERY straightlaced catholic professor on the importance of "putting the foreskin of the penis BACK after washing". It never occurred to me that this would actually be a HAZARD of receiving a sponge bath. I wonder if it will be declared a "never event".

Tomorrow is the dreaded Pharmacology exam. I WOULD simply quake in fear, but NOW thanks to my rapidly progressing education, I know that I am instead experiencing an activation of my sympathetic nervous system, and that an appropriate antidote to my rise in blood pressure would be propanolol, except that its successor metaprolol has fewer side effects.

I WOULD fear for my sanity, but that would only get me started on drugs that can cross the blood-brain barrier and interact with my dopaminergic pathways. I'm screwed.

Saturday, November 1, 2008

Wear A Helmet

Now, I'm from the frozen northlands, and I volunteered as an EMT up there for four years, prior to this little relocation-for-school thing. My home state has no helmet laws, preferring to rely on Darwinism-In-Action. While this may work really really well from a "Live Free or Die" standpoint (literally), it works LESS well from the point of those who are scraping you off the pavement. A few years ago we had a DOZEN fatalities in ONE TEN DAY PERIOD during Bike Week. That averages to over a death EVERY DAY. And that's just DEATHS, not taking into account permanent coma, serious brain damage, and all that sort of thing. If the first time we meet is while I'm in full trauma gear, and I'm struggling to even VISUALIZE YOUR THROAT, we are not going to be good friends. If you are breathing three times a minute, and decerebrate, this is not a good day for you. So put on a helmet, please.
While I'm at it, please also refrain from mixing marijuana, alcohol, and your desire to ride your awesome motorcycle at night. Because your reflexes just aren't up to it. We have lots of beautiful roads, but they get awfully dark at night, there aren't many people to find you, and it's going to be a LONG TIME until we can get you to a hospital. If there isn't DHART (air ambulance. love them.) available, it's going to be AT LEAST a half-hour transport. Your depressed skull fracture is not going to be pleased. So just...don't do it. Or if you MUST do it, please have the decency to ride in a populated area where somebody MIGHT come across your mangled body in UNDER an hour? We don't start CPR if you're in rigor.

So please, be sensible. Wear a helmet, don't play chicken with our forests (they're going to win), avoid the moose, don't pet the bears, and for the love of God buckle your seatbelt!


I love my pharmacology class. It's amazing, really. It has, however, lead to a certain amount of understandable paranoia among my class- we're all convinced that somehow, probably on our very first day of med administration, we will all kill somebody. This is understandable, once you realise that our only actual practice in administering parenteral medications was ONE SHOT for practice in both IM and SubQ injections. ONCE. I was really picturing a bit more practice than that before being set free on an unsuspecting sick population. I mean, I can barely flick the inevitable air bubbles from my syringe, much less competently hold the thing "like a dart" and wince when it goes in!
Aside from the fear that we might kill somebody through sheer incompetence in med delivery, there are so many drug interactions that we're being taught that it seems a miracle that ANYBODY makes it out alive! I feel I've started to reach that critical nursing student point where I know JUST enough to be REALLY dangerous.