The sort of night firemen fear

It's at least -5 degrees Fahrenheit out there, with a sustained windspeed of 20-30mph...ice cold, clear night, with everyone in the whole state firing up their woodstoves to keep warm. This is the sort of night where improperly sealed chimneys have their seals freeze and crack, leading to housefires. And then the firemen get cold, slip and fall on ice, and wind up swearing like sailors.

I've got my BDU pants out, with long underwear, an extra warm coat, gloves, hat, boots, AND a thermos for hot cocoa if we get called out.

Last time we got a fire in this weather, it was a (thank god) uninhabited house, the propane tank blew up, and 10 firemen fell over like penguins on an iceflow from surprise. It was hilarious, but only because nobody was hurt. I was tucked up in the ambulance, watching from a "safe distance".

May I state again, for the record that it's EXTREMELY cold outside? It's also cold in my BEDROOM- 33 degrees F to be precise. I'm beginning to think that there's something wrong with the insulation. And possibly that, due to our wood stove being very efficient, they dont turn the heat on in the house, so it never reaches my bedroom.

It's not QUITE the backwoods, but dear god it's close

I'm home for break, I'm working on the ambulance squad, just as usual. The call we got most recently was complicated by a few things:
1. the temperature- it was about 10 degrees out.
2. the fact that we werent precisely sure where the hell the address WAS, as it was a made-up road, named only because 911 needed a road name.
3. the 'house' was actually a WAY sub-code former barn with holes in the floor
4. the patient couldn't stand up or walk, nor could he lie down, due to emphysema.

The patient was having an emphysema problem...but also probable H1N1. So he couldn't lie down, or face not breathing. On the other hand, since he had taken about 15 ampules of albuterol over the day to try to fix his breathing...he couldn't walk. So it took 4 firemen, plus our 4 person crew to get him out to the truck.

Just another nice "warm" day in the far far north.

MERRY CHRISTMAS!!!

Nightshift

Last night i worked the 18 hour overnight on the campus EMT squad again. We only had two calls, but they managed to keep us awake for most of the night. First call came in at 2 AM. We had tucked ourselves in around midnight, having remained up until then because we were anticipating a frat formal getting out around that time, and being dragged out of a bed you've JUST climbed into is awful.

Contestant Number 1 was a drunk young man, who consumed the traditional "two beers", prior to apparently CRAWLING up the stairs to his dorm. He wasn't THAT drunk, so I got a refusal from the doc at the LocalHospital, which allowed us to let him go off to bed...and probly get cited for drinking.

We got back to the squad room, only to find what one crewmate described as "a caterpillar as big as a mouse"- the woolly kind. This elicited everyone standing on chairs until somebody picked it up and put it outside. The giggling kept us all awake for about half an hour.

Contestant Number 2 was also drunk, and the call came in at about 315. THIS winner had somehow fallen and smacked his head on a curb, and got a quite impressive 10cm lac to his occipital region. We found him in his room, with his roommate holding a teeshirt to his head to stop the bleeding. My instincts said he was probly fine (aside from the lac- i swear i saw bone in there), but on exam I found horizontal nystagmus...and a three hour time lapse in his memory.

For these findings, plus the fact that the fall was unwitnessed, he won a middle-of-the-night trip to Downtown Philadelphia to a Trauma Center!! This would have been fine, except that on the way back, at 415 in the morning, we got lost. And I didn't get to sleep until 5 am, then got BACK up at 10 to do my reports.

I feel like i've been beaten with noodles.

When Things Go Badly

For ethics class I'm writing up a case study of a patient who is brain dead, but whose family does not believe in brain death as a criterion for determining "actual death". This is the sort of thing that is quite tricky in modern medicine- after all, "brain death" never used to happen: as soon as your brain lost control of your breathing center, YOU DIED. We never used to have the problem of a dead brain with a body kept more-or-less fresh with Science. While the part of me that LOVES a little Mad Science thinks that this is actually pretty nifty in a Frankenstein's Monster sort of way, the part of me that hates to see wasteful useless medicine practiced cringes at the thought that people are "maintained" on ventilators when they are actually corpses, all because the family simply does not believe that they are gone.

Plus- if they're DEAD, who is PAYING for all these interventions? Probably not insurance, as I'm fairly certain that they stop paying for procedures for deceased people.

Its not an easy decision though, because families may have valid religious reasoning behind their views on death, but that should never trump the fact that we CANNOT allow ONE person to be dead and ONE to be alive under the same conditions and circumstances. Death HAS to be universally applied, or things go downhill fast.

De-Escalation and Defense

Today we learned how to (WITHOUT hurting the poor "innocent" patient) get out of holds when people are trying to grab, choke, pull your hair, or bite you. Normally, I'd respond by doing whatever the hell is necessary to keep the person from killing me...but this is psych, where apparently pushing on somebody's jaw hinges to get them to release your ARM from their TEETH is "assault". Whiskey. Tango. Foxtrot. If somebody is BITING ME, I think I'm allowed to poke at them a little.

BTW...I RULE at making people stop, according to this class.

But you know what my number one self defense technique is? NOT LETTING PEOPLE GET BEHIND ME OR NEAR ME!

Things That Make Life Harder

I am not a large person. I am, in fact, rather short and curvy. This makes things like 1. lifting a stretcher with a 250 pound person up to its full height 2. reaching the turnout gear in the TOP compartment of the back panel of the ambulance 3. climbing into the driver's seat without hopping like I'm on a vaulting horse VERY challenging, and sometimes near-impossible.

What do you do? You put up with being laughed at by your fellow EMTs every time something like this is required, try to get somebody else to pick up the stretcher for you, and pretend NOBODY saw you almost catapult off the ambulance seat.

Tomorrow is psych clinical again, and lets hope I set my alarm properly. Last week I managed to set it to PM instead of AM- this clock doesn't do a 24 hour clock, which i use on EVERYTHING else, so I didn't notice- and wake up at 645, when I'm already supposed to BE at clinical. The only reason I am still breathing and did NOT get a nasty note in my file is that, by some grace of some deity, my instructor lost track of time, and was LATER THAN I WAS! Coincidences like this do not happen more than once to a student, so I'd better not screw up again!

You Know You're in EMS When...

You're out bowling with your entire squad, somebody's HOME pager goes off, and 20 people bounce to their feet, reaching for their hips, to see WHO is getting called out. Additionally, half the people look really disappointed that it wasn't us.

Then today was our Mock DUI demonstration, for which we had 7 fire/ambulance apparatus, and PENNSTAR!!!! We landed them right in the middle of campus, and the pilot buzzed us first, which is one of the single coolest things EVER. Just to make it look even COOLER, they let us climb inside, AND i'm going to get to do a fly-along!

God I love helicopters!!!

Special Olympics

This past weekend was...intense. So intense that posting has taken me a few days. I pulled Friday night 18 hour shift, and before that did Golfcart Standby crew for the beginning of the Olympics, as well as pulling for the Opening Ceremony. And as a result I am in love...or at least the victim of a massive crush on my overnight partner. It's been a LOOONG time since I dated anybody, but for this guy I'd make a serious exception. ~deep girly sigh~

So we had two Olympics-related calls in the evening, which resulted in me nearly getting into a fight- with the "Medical Coordinator", a nursing student a year behind me. The patient was post-ictal, known seizure disorder, but, you know, they CALLED THE EMTs, so I had to EXAMINE AND SPEAK TO THE PATIENT. This girl refused to let me speak to the patient, OR give me her written medical history. Why? Well she didn't want me to "upset" the patient by asking her questions, and as to the medical history? SHE WAS USING IT TO FILL OUT PAPERWORK.

After those two it was just drunks. And I'm only JUST recovering my energy.

Florid Psychosis

Yesterday my partner and I did the nursing intake assessment on a new patient to the adult unit. The nurse's advice? "Be CAREFUL girls! Don't let him get between you and the door, he's got a history of violent outbursts, isn't medicated, and is bigger than you".

Because that's going to make us feel REALLY comfortable.

So we sat down, carefully, and began our assessment. "You two are students?" he asked. "Yep!" I replied, knowing that Truthfulness Is Important, "GET OUT WHILE YOU STILL CAN" he said, admirably demonstrating pressured speech and delusional ideation. "THEY MAKE YOU KILL PEOPLE!!! AND THEY GIVE YOU MEDICATION THAT MAKES YOU NOT LIVE FOREVER WE CAN ALL LIVE FOREVER YOU KNOW" he said, at the top of his lungs.

A few minutes later, we were done, worried, and sent to keep the rest of the ward from hurting each other.

It's quite a rotation...

Over My Dead Body

Today we are learning, in Trends and Professional Nursing class, about how IMPORTANT it is that we practice "Consumer Centered Care", where the "client determines quality". Man, SCREW THAT. Ive had plenty of patients whose idea of "quality" would be higher thread-count sheets, perrier water, and me, running to cater to their every whim no matter how sick my fellow patients were. This should determine my practice? MY practice is based on providing safe and effective care to my patients, with their physical wellbeing placed FAR above any stupid ideas of customer satisfaction. You may hate me for not giving you water, but I dont care- if you're fluid restricted, you are not getting extra water. You may WANT it, you may DESIRE it, but you could go into a CHF crisis. The consumer is not always right, and pretending that the patient should run our units is dangerous and unsafe.

Just my student opinion, but it feels WRONG.

Its the Pandemic, Stupid!

Today I learned that a colleague on the campus EMT squad pulled an 18 hour shift last night with what is almost certainly an active case of H1N1. Without a mask. She was running a 103 degree fever this morning, according to her. She said "i didn't want to get people mad by calling out of my shift". Oh I'm mad as HELL now! She exposed another medic (one of our FIVE current drivers, due to how long our training program for driving is) AND her probie AND her observer/student to H1N1. If they catch it they'll ALL be unable to pull duty.

I am SO pissed at this! I'm stuck here with bronchitis, unable to think clearly for longer than 10 minutes at a time, and she's out there making people sick, and I can't STOP her without exposing MORE people to this bug! GAAAH!

Please people- if you're sick, dont hurt other people. Find an excuse to wear a mask if nothing else. Really. Just...wear a mask. This winter is going to be hellish enough for a HEALTHY squad- and we're dropping like flies here.

It's Bronchitis

I still don't feel terribly sick, but my mother (rather overprotective), convinced me to go over to the Health Services building to get checked out. As expected, it's bronchitis. As far as I'm concerned, it's probably viral (for chrissakes, most things ARE) but because of the asthma, they wanted me to take antibiotics, "so you dont wait too long to go to the ER, which you KNOW you will, while claiming it's "not really that bad". I guess they do have a point. It sounds like something I'd do.

So no Halloween for me. Trick or treat???

Hi, I'm Unresponsive!

Last night, in spite of (ok BECAUSE of) The Cough, I acted as a spare victim for the EMT class on campus. My friend Meg was assisting with teaching, and needed a person upon which to demonstrate a Rapid Trauma Assessment. As I cannot currently run away, that person was me.

The RTA involves touching just about everywhere quite rapidly on a person, palpating and skimming to look for "DCAP-BTLS"- deformitites, contusions, abrasions, punctures, burns, tenderness, lacerations, swelling. Essentially, it's summed up as "well THATS not good". Meg is a rockstar, and was demonstrating to these VERY nervous students how you can do a complete assessment without your victim feeling sexually harassed. It helps that they dont make the students strip the mock victims, although one girl was HORRIFIED to learn that we strip ALL trauma patients. He he he he he!

I only vaguely remember being that green. The problem with those of us who are nursing students as well as EMTs is that we keep adding to our field assessments- no longer is it "lungs clear and equal bilaterally", its "lungs CTA, decreased at the bases, suspect atalectasis from stasis"

I Dont *YET* Have The Flu

But I do have some sort of violent cough- mild, almost unnoticable congestion in the nose, just mostly a VIOLENT (sounds much worse than it is) cough. For the past three days. At this point I'm pretty damn sure it's NOT the flu, but the looks people are giving me are pretty awful. I mean, ive been asked 5-6 times if i have "The Flu", though i'm not actually that sick. Two people bucked the trend, and notified me that I could have walking Pneumonia.

It's getting to the point where I'm almost tempted to go to the Student Health Center so that they can TELL me I dont have anything wrong with me, and write it on a slip of paper...last year people would have asked me if I had a cold. This year they think I'm Typhoid Mary.

Go figure.

Dear God The Exhaustion (Part 2)

Last night I worked as Standby Crew for a campus event to kick off the basketball season, and that is always followed by a brief musical performance (usually by someone we've never heard of). "Oh! This will be easy!" I thought. After all, the event started at 7pm, and would be over by 10! What could POSSIBLY go wrong???

We were there for FIVE MINUTES before we had TWO patients, both found in the bathrooms puking their guts up (thank heaven for small favors- they made it to the bathrooms) because THESE geniuses thought that aggressive drinking was the best way to attend a basketball event. The irony is, they were so sick, and so drunk within the first FIVE MINUTES (ie. before anything had HAPPENED at the event) that they missed the whole thing. Local Hospital was being EVIL and on full diversion (we're not sure why...we think it's because they dont like us) so our Duty Crew (the people who were on the actual night shift) were taking two patients at a time to a farther hospital, which turned the whole thing into a Mass Casualty Incident.

The thing about MCIs is that you have one as soon as your number of patients overwhelms your resources and personnel. We were at that point about 15 minutes into the event- public safety officers were scouring the building for sick or drunk people, and kept calling us. We had 7 EMTS, working in 3 teams (3 on the rig, two pairs with a jump-kit each)...there WAS another crew, a paid professional squad, but they were technically on call only for the athletes and the entertainment, NOT for the students. As a result, they wouldn't transport for us, leaving us at several points with patients stacked up waiting for rides to the hospital.

By 10 pm we had upward of 12 patients, and 7 VERY testy EMTs. I'm exhausted, and I just slept for 8 hours. Ugh. I hate hate HATE drunk students.

Dear God The Exhaustion (Part 1)

Last night I pulled an overnight for the campus EMT squad- it was a Thursday, so I expected SOME drinking, but to get some sleep. Apparently the gods of EMS did not favor us. Our first call came in at 1230, after we were all tucked into bed- me, one of my favorite girls on the squad, our HILARIOUS driver for the evening, and R, the best looking guy in the whole nursing school, who also happens to be hilarious. We were paged to UPSTAIRS, in the student health center, for a kid who "hurt his ankle" and was in 9/10 pain...while munching crackers and sipping gatorade. "9/10 you say?" I asked sweetly "Oh that must be SOOO awful for you- I'm SURE you have no appetite with pain like THAT!"
"Oh no- I'm STARVING!" my patient replied happily. That's -2 pain scale points for you, plus ANOTHER two dropped for making coherent conversation without wincing when we moved you. 5/10 sounds about right.

2nd call came in about 220, once we were all BACK asleep, the first of the inevitable Intox Evaluations- a bunch of frat parties at bars off campus had gotten out, and two prize human beings had decided to pee in the parking lot...in front of both campus security and the local PD. Yeah. Bad idea. Took the one who looked worse off to the hospital, left the other one to be arrested, then BACK to campus for ANOTHER drunk, discharged because he wasn't THAT drunk, then back into bed by 310...only to be awakened at 530 for ANOTHER drunk, stumbling around shoeless. By this point we were all so punch-drunk that L started giggling at the patient and couldn't ask him any questions.

I've had 4 hours of sleep...and I'm working a standby tonight.

I am going to DIE!

PSYCH!!!

Wednesday was our first day of psych clinical at Hospital Nobody's Ever Heard Of. For the first few weeks I have been assigned to the adolescent unit...which seems to be entirely populated with kids committed for 1. violence and/or 2. sexually inappropriate behavior.

I was propositioned in the first 5 minutes, but apparently I have the Icy Glare of Doom that makes most of the guys back the hell off. I dont really like being touched, so the "stay an arms length away from the patients so they cannot attack you" rule is just fine by me.

I'm already wondering what the hell we're supposed to be doing here...aside from the one REALLY COOL thing we get to do, which is Crisis Descalation class, which involves both verbal AND physical de-escalation, which sounds fun.

What I Did On Fall Break

Up in the Frozen Northlands we had a bit of an early cold snap, which allowed for some early snow-frolicking...which I LOVED, as I am, in demeanor as well as in appearance, pretty much a cross between one of santa's elves (height, and love of winter holidays) and the White Witch of Narnia (demeanor before 8 am, when awoken at night, ok...i can be a bit irritable). I LOVE snow. I love it to an almost unreasonable extent. For one thing, it makes driving WAAAAY easier. This may seem odd, but clearly you are not from the Frozen Northlands. Snow makes reflections on BOTH sides of the road. You simply drive down the dark bit in the middle! This is a serious improvement, as we have no streetlights.

I GOT TO DRIVE THE AMBULANCES!!! both of them! M, my training lieutenant, took me out and let me drive around at high speeds, yelling "STOP!" at random, to get me used to being startled. It was awesome.

We had two calls: 1. MVA of a motorcycle on a notoriously dangerous stretch of a state road that has already claimed 5 critical injuries THIS YEAR. Naturally, we went REALLY fast to get there, only to find a perfectly lucid man, lying on his back NOT MOVING. He was NOT MOVING because his brother, a rather large gentleman, had threatened him with death should he move before the arrival of the EMTs. I LOVE people like this. They make my job easy. We cleared is C-spine, and took him in for evaluation, because he had a crash at 30-40mph off a motorcycle, but he was FINE. Wear a helmet, kids, it really DOES help.

2. Chest pain and epistaxis in a 20 y/o male: AKA cold dry air leads to nosebleed, young man panics because his mother is CRAYZEE, and thinks he's having a heart attack. We explain that "family history" of heart problems (AT 80!!!) is NOT the same as a "previous history" of heart problems, and that he is fine. Really. FINE, and to please go to bed.

other than that, i did TONS of chores, and got to see my beloved Bella, my evil Devon Rex cat. Pretty good. Then an 8 hour drive back down here, because of the GW bridge being designed by Satan himself.

Medsurg is done!

No more med-surg for the Little D! Finished today by running around doing moderately useful tasks, like finding coffee for a terminal cancer patient, and getting a doc to order nicotine gum. He said she needs a quit smoking consult. I pointed out that with metastatic lung cancer, it's a little late at this point to tell her "i told you so", and just to please order the damn gum. I really think she GETS that smoking is bad for you, what with all the surgery, the radiation, the chemo, and the DYING.

On the bright side, I got an A. ~insert happydance here~

AND I NEVER have to go back to Bob's Hospital again!

After break I'll be going to Psych Hospital Nobody's Ever Heard Of, outside Philly.

Midterms

Thursday afternoon I'll be leaving for the Frozen Northlands for a week of running around in an ambulance, hopefully punctuated with a nice hike up Mt. Washington with the Little Brother and his buddies. This should be an excellent test-run of our winter gear, and we're hoping for snow.

I MAY be able to post (especially if I get any good traumas) but in the Frozen Northlands the internets are quite temperamental (especially if the weather gets interesting...power, running water, and internets are apparently some things for which my area is simply NOT a priority)

Hopefully tomorrow (last clinical day at Bob's Hospital) will pass without anything icky happening, and with a decent grade...wish me luck!

Patient Assessment WIN!!!

Today I WON at patient assessment- Moaning Dood was an intractable pain patient- essentially, we pumped him full of more pain meds than I've ever seen given, and he would mutter "it's still an 8"...and then go to sleep.
On one of these visits, the nurse was pushing the IV meds (we DO NOT do IV push, it's apparently a legal risk) and I decided to take advantage of Dood's distraction to do a reassessment of his pulses, dont ask me why. I laid the backs of my hands on his calves and...um...hummmmmm....
One leg was noticeably cooler than the other one! I'd read about it, and been lectured on it, but it was REALLY obvious. So I tried to get a pedal pulse, and couldn't find one, so I ran to the ICU and stole their Doppler...which ALSO failed to find a pulse. At this point I dragged the nurse back into the room to check my findings AGAIN, and when she couldn't get anything with the doppler, we decided it was time to call in the doctors.

It turns out he had been scheduled for a doppler scan of all limbs back on friday...but then it was the weekend and it was never done. He's hypercoagulable. I hope we saved his leg- since it still had capillary refill, some blood must have been getting through, hopefully enough to hold it for a while.

Help Is On The Way

I've always loved to watch firetrucks and ambulances go past, probably because when I was a baby, and would startle at the noise, my mother would bounce me up and down and say "Help Is On the Way!!!"

I think maybe EMS would be better off all around if everyone thought of it that way- not "oh no! something has gone terribly wrong" but "Help is on the way!"

Two more clinical days at Bob's Hospital- and if we're REALLY lucky (ha ha) the nurses will be going on strike either tomorrow or Tuesday...which will mean we CANT go to clinical, and Will Have To Be Flexible. Because if there's ONE BLOODY THING we learn in nursing school...Nurses Are Flexible!

I am disappointed that I cannot put my feet behind my ears. Apparently flexibility has limits.

ICU FTW!

The ICU today was FANTASTIC! We were all basically thrown at the unit, and with a 10 bed unit, 8 of us, plus ANOTHER student from another school, pretty much all the nurses had students to do the heavy lifting, which they seemed to really enjoy. MY nurse was totally AWESOME. Our patient was really honestly an ICU patient- she was really truly unstable, with resps in the 30s, HR in the 120s-140s, BP all over the place.
And end-stage MS. Really tragic. She was REALLY young for it- in her 30s, and her "admitting complaint" was MASSIVE pneumonia. She realised upon admission that she was probably terminal, and made herself a DNI...but NOT a DNR. This put us all in a bit of a quandry- we needed to suction her, we could hear the ronchi from the nursing station- but she would fight tooth and nail against the NG suctioning, which would bring up little bits of THICK mucus, but it didn't feel as if we were doing much good. For REAL help, she would need something about the size of a garden hose, which would have to be put down her throat through her MOUTH, but she couldn't tolerate it. She would need to be tubed for us to reach her lungs, which we couldn't do. So...we did our best, rolled her side to side, restrained her arms by tucking them inside the covers (she would rip off her NRB mask in panic, which would make her de-sat into the 70s, even when I would HOLD it there, and remind her that she NEEDED the mask.) The hardest part was that she was mouthing "help! I cant breathe!"
But it was both challenging, and really DIFFERENT...I loved it.

Oh God the Crazy!!!

For the past week or so, my life has been MADE of crazy. On Monday I had a woman who really REALLY should have been allowed to be a DNR. Unfortunately for her, her family did not have the time to visit grandma, so she was a full code. And I spent the ENTIRE day running to her room as her vent alarmed, jumped into the Iso gown and gloves, and checked the vent, which inevitably was only alarming because of LOL's silent coughing and agonal resps. Of course, the nurse didn't go in ALL MORNING, and only spoke to me insofar as she had new orders for me- i did all her discharge work. Yeah. All of it, except for WRITING DOWN the progress note, which she had me dictate, so it would be in her handwriting. Not fun.
Yesterday was my BIRTHDAY!!! Except I had classes from 8-1, and then I went and got cake to bring down to the EMT building, because eating cake alone is sad, pathetic, and very VERY fattening...except there was an executive board meeting they forgot to tell me about...so I sat outside from 2-530 and studied...and got quite chilled. Then had 20 minutes to bolt down some cake before running to my developmental psych class...then straight off to bed for clinicals this morning.
Today the CPU was actually CLOSED, due to low census, so we ALL went to the ICU, which was half CPU patients, half ICU...and that really should be it's own post...

100th Post, EMS Overnight Shift

Last night at 6 I went onshift for the 18 hour overnight. Since it's parent's weekend at college, I was thinking SURELY it would be a quiet night. I mean...who would go out to get drunk with everyone's PARENTS there?

Well, as it turns out, quite a few idiots.

First call of the night was the only REAL call- anaphylaxis in progress. The poor guy was on his SECOND life threatening reaction of the day, having had one yesterday MORNING, and only been released from the ED about 6 hours before we got called out again. He still has no idea what he's allergic to, but my god I've never seen hives like that. He was really intelligent though, and had already taken a BUNCH of benedryl before we got there. I'm convinced that it's the only reason I didn't have to hit him with the Epi-Pen. I prefer NOT to do that to people who have just gotten their own Epi Pen prescriptions, because I don't want them scared if they need to inject themselves someday.

Third was a simple cooperative post-vomiting drunk who we promptly sent off to bed after a stable set of vitals.

Second and fourth were the "fun" ones. They were the ones who make you want to smack them a little bit- the drunks who were combative, verbally abusive, and whiny all at once. Number 2 was worse from the "whiny" and "combative" standpoints- engaging in a LOVELY combo of invading our personal spaces and trying to run away, while she sobbed loudly that "now she was gonna be in trouble and it was all our faults". Um...this was going to be her FOURTH write-up. Shes a freshman. That means an average of a write-up per week. In contrast, I didn't get written up AT ALL in FOUR YEARS of college, not counting THIS degree. That means not only does she drink more-or-less constantly, but she isn't very good at staying out of trouble.

Number 4 was actually not all THAT drunk. We were planning on releasing her into the custody of a sibling, but then she said the magic words "It doesn't matter what you do, i'm going to kill myself anyway". Whoop! That, combined with absolutely obvious alcohol intake equals a trip to the hospital. Sorry sweetie, saying "i dont consent! i'll sue you!" is NOT going to get you out of this one. Once you voice a wish to kill yourself, you become legally incompetent as far as we're concerned. Since you're drunk you CANNOT consent or deny treatment, and since you're voicing suicidal ideations we cannot release you to the custody of ANYBODY without a doc's evaluation.
Plus, you called me the c-word. Now I'm not sympathetic anymore. In addition, this being the FOURTH call of the night, it's 4 am and I havent SLEPT YET.

I understand depressed patients, and even suicidal ideations. I've been there myself...but I lose all my warm fuzzies when you start abusing me. Hell...i'm VOLUNTEERING here. I'm staying up ALL NIGHT WITHOUT PAY to make sure you're ok. The least you can do is NOT insult me.

And now...i'm exhausted.

I See JHACO People

Today JHACO descended upon Awful Hospital (aka Bobs Hospital)...and chaos did reign. The very first thing we were assigned to do (since we figured we had an hour or two before they got all the way up to our floor) was CLEAN UP THE UNIT. Now...I have no problems cleaning, but it was pretty damn clear that nobody gave a damn about making our lives any easier- leaving things for us to collect instead of picking up behind themselves. Once the unit looked pretty good, I was promptly yelled at by Overstressed Clinical Instructor for asking what the combination was to a cabinet, as I had found a PILE of unused saline flushes, and wanted to put them away properly. "DONT SAY 'they just locked the cabinet'! THEY'LL KNOW WE DONT LOCK THEM!!!!"

Look. I'm a student. I DONT know where everything is yet. I DONT have a password to the COMPUTER, much less the combinations to all the cabinets. So...I ask questions! Yelling at me that I'm not supposed to ask questions because the sheer fact that there IS a question reveals incompetence on the part of the unit is SO not my problem.

After the inevitable conflagration over ALL of us having "inadequate" charting (I wasn't DONE yet, I was IN THE ROOM, doing NURSING CARE on my PATIENT), she then continued to panic...and panic. It's not her unit. She doesn't even work there anymore, and hasn't in years, and yet she's going around putting up the JHACO mandated signage in the rooms instead of helping US. My school is paying her to teach US, not to help Bob's Hospital look good.

On the bright side, my pillow-fluffer patient was looking much better today, and actually managed to be cheerful, in spite of pissing me off by pressing THE CALL BELL for "a drink of water" despite said water being approximately 8 inches from his bed, in a cup, with a straw, and plenty of ice. He didn't want to take his arms out from under the covers to reach it...BUT HE HAD TO DO THAT TO REACH THE BELL!!!!

Headbanging on walls commenced. NLN CONFERENCE TOMORROW! HUZZAH!

Pillow Fluffing

Today we had TWO patients, and i was paired with a different partner. This was ok...we differ on a lot of points of opinion, (she thinks vaccines are scary and evil, I love them) but we work okay together. One patient was a lovely man with lung cancer, admitted for a cardizem drip for new onset A-fib. He and his wife were REALLY with it, asked great questions, took notes on everything the docs said, so that when the NEXT service came by the docs didn't have to go over the same things again and again.

Our other patient wasn't nearly as easy. He weighed at least 250-300 pounds, and was paralyzed from the waist down, according to him. He could, however, feel everything down to the tips of his toes, and i'm not sure how much was paralysis, and how much was deconditioning due to bedrest and pure LAZINESS. Now, I'm a student. I like to give my patients the benefit of the doubt, but this man had two working arms. I know this, because he had the remote control in one hand, and the telephone in the other, and he was holding the phone up to his ear PERFECTLY, and clicking channels...and yet he continually asked to be spoon-fed, and to have his juice held gently to his lips while he sipped.
My answer was simple "oh sir, we're trying to encourage self-care behaviors! Can you please do these range of motion exercises for me? No, I will not wipe your chin for you. Here's a tissue".

And then the call light started going off, while I was helping do the med-pass for my other patient, who needed a blood draw. WHY was the call light going off you might ask?

He wanted his pillow fluffed. And then another DIFFERENT pillow. And then THAT one needed to be fluffed. I understand that patients get lonely. I understand that human contact is important. I am not a candy striper, and taking advantage of the fact that, as a student I HAVE to RUN to answer call lights is just a dick move. No points awarded, sir!

PS- I DID fluff the pillow, btw...I'm not irresponsible! (That and my instructor already wants to kill and eat me)

Advocacy

From the very first day of nursing school...the very first HOUR, actually, they tell you that you MUST be your patient's advocate- you are the ONLY THING BETWEEN YOUR PATIENT AND A MESSY DEMISE...or at the very least a hospital acquired infection, mental anguish, whatever.

And then, after this indoctrination, you're sent out, bright and shiny and optimistic, into a clinical setting. Where, at least at THIS clinical, you get chewed out if you ever dare to DO any patient advocacy. In this case, it was trying to get everyone to actually glove and gown before coming into the room with someone infected with ESBL...which is a NASTY little bug, version of E. coli...this is in addition to the standard MRSA. I just politely asked a doctor to please put on a gown over his lab coat (which i doubt he ever washes), and was told by my instructor that it was not my place to tell doctors what to do. MY place as a patient advocate is apparently to "Advocate By Setting A Good Example".

So...how are we training our nurses of the future if we start silencing them before they even graduate?

Stopcocks

I fear the stopcock. Its one tiny bit of plastic, not much longer than a fingernail, and yet it's the bit responsible for keeping a patient's body fluids on the INSIDE of the body. If it's on a PEG tube, it keeps stomach fluids and gastric acid where they belong. If it's on an A-Line, well then it's holding back the flow of arterial blood.
We need to be able to zero an arterial line on a regular basis, to keep the pressure readings as accurate as possible. To do this, one needs to flip the stopcock so that it is OPEN to atmospheric air, but CLOSED to the patient. If, however, someone has turned OVER the stopcock system because they prefer it that way, and you dont check EXTREMELY carefully...you open the stopcock to atmospheric air, and the patient's arterial blood comes spraying out all over the place. OOPS!!!

It would also be terribly TERRIBLY obvious to everyone concerned what had just happened. As nursing students we take a lot of mocking from hospital staff...I dont like to give them any help.

And this is why I fear the stopcock.

Poor LOL

My LOL from last week was due to be discharged that same day, and, indeed, she was. Back to the Sketchy Nursing Home. She was BACK to the unit this morning, however, once again Uroseptic, with abnormal ABGs. Apparently somebody messed with her vent settings, and her pH was something like 7.22. For those of you who don't know body pH yet, 7.22 is QUITE acidotic. Normal is 7.35-7.45, and you really don't have much leeway. Also, it looked as if nobody had really thoroughly bathed her during that time, as her skin was sloughing off in the most alarming way. It took me about half an hour to bathe her, which is impressive, considering she only has THREE limbs. I STILL didn't get HALF the dead skin off, and then my partner and I put an entire TUBE of aloe cream on her, to help with the itching.
Poor thing is quite heavy too, which makes turning her...tricky. The doctor says that she probably won't get better, and he would very much like to get an End Of Life plan for her, but that her family is dead set against a DNR of any kind, so she remains a Full Code.
Oh! and somebody else coded TWICE today, down the hall in the ICU. They remain alive-ish.
Kudos all 'round.

EKG Interpretation

I have chosen to do EKG interpretation for my class presentation on Monday, along with Know Your Arrhythmias and Dysrrhythmias. This is because, for some unknown reason, I LOVE EKGs. I find reading EKGs to be both highly entertaining, and fun, especially when I can find even the smallest, most benign abnormality. Maybe this is because I'm new-ish at it, because as an EMT I knew basically two things about EKGs- "this is probably ok", and "OH MY GOD DEFIBRILLATE!". I appreciate the more subtle problems a bit better now, and will happily perch on any available surface to peer over somebody more qualified's shoulder to see new and interesting things.

Things I can now reliably identify:
V-Tach
V-Fib (if you CANT identify V-Fib, you're going to be in trouble)
A-Fib
A-Flutter
PVCs

Things I can Sometimes Identify:
Multifocal vs. Unifocal PVCs
Complete Heart Block

Things I Barely Understand At This Point:
Mobitz
Junctional ANYTHING
Various Types Of Heart Block
apparently none of these will be on the test, but i'm still going to look them up.

The Hard Part

They say (our all-knowing instructors) that the hardest part of nursing school is learning to THINK like a nurse- to assess WHILE performing all the other tasks set to you, and keep assessing at all times. To prioritize ALL of the things you have to do, and re-organize your priorities on the fly.

I am only just BARELY beginning to get a handle on this. When I'm on the ambulance, my priorities as an EMT-B are pretty straightforward- Airway, Breathing, Circulation, Get the patient to the hospital in a timely fashion. If all of these things are being accomplished, it's considered OK to actually just sit and look at the patient for a minute or two (40 minute transport times, yo). In nursing, (floor nursing at least) sometimes it seems as if you never FINISH doing ANYTHING, even while your basic priorities (Airway, Breathing, Circulation) remain the same. The difference is that there are innumerable other things to do, even for a rock-stable patient. Today was assessment during bathing and changing the patients bedlinens, interrupted several times to suction the patient's trach tube, and once to help save the patient in the other bed, followed by putting her tube feeding on hold, helping give meds, restarting the tube feeding, changing the patient's gown, changing all the wound dressings, MORE suctioning, several bedpans, et cetera. And I only had that ONE patient. AND I had a partner.
I think this is why I like the Emergency Department/Room so much- patients come and go, and I always feel more accomplished after doing a stint in the ED.

Maybe this will change as I gain my time management and mental listmaking skills...on the bright side, once again I made it through a clinical day WITHOUT killing anyone!

Full Code

Today was our first day with a patient of our own. We doubled up into pairs, since these patients are WAAAAY more complex than last semester. For example, most people last semester could...like...TALK. And breathe on their own.
Ms. E (SO not her real name) reminded me of my Grandmama- tiny, frail and old as rocks. She had what the docs called "alphabet soup"- you name it, she had it: Type 1 diabeetus, CHF, VDRF (vent-dependent resp. fail), COPD, previous history of CVA, seizure disorder, previous GI bleed, liver failure with jaundice, previous UTI, et cet. Oh and ALL FOR STAGES of pressure ulcer, on various parts of her body. Essentially, Ms. E was a mess. A MRSA-positive mess.
Still, she would grin at us as we assessed her, occasionally pointing imperiously to her trach for us to suction it. Then she'd wink. It was kind of a riot. She had just had one leg amputated above the knee, due to gangrene, and I'm pretty sure the other one is going to have to come off soon, if her nursing home doesnt learn how to treat bedsores.
Ms. E was a full code, due to her family wanting to give her "all the chances they could".
Her roommate was ALSO a full code, with agonal breathing on another vent. Both alarms were constantly going off as the two women shifted their heads, or coughed. That's why, since the curtains were pulled around the other bed, I didn't realize that the OTHER alarm was going off. Ms. E's roommate had pulled off her vent, satting in the 40s. I heard ANOTHER alarm go off, with a different tone (the BP alarm) and checked, and then suddenly the room was FULL of people.

"Quick! Grab the AMBU bag, and bag her!" A nurse yelled, so I grabbed the bag, attached it, and began bagging...against very little resistance. It took a minute for my instructor to run into the room...she blinked, and said "What's going on?" I explained that I didn't know that the vent alarm was going off, and so this all was probably my fault.
Everyone laughed. "It's not even your PATIENT, and it's your first day! How were you supposed to know which alarms were for which patient? Next time just run around and check ALL the patients in a room."

She stabilized, and all was well...but I will NEVER let that happen again.

Labor Day

So the apartment is finally in order! 3 hours of cleaning and organizing, another hour of getting Teh Interwebs installed, and i've got a place to live again! I am SO happy about it, because it means not inconveniencing someone when i come in late from classes.
The downside is that, as I live alone, and am not terribly close with most of my classmates, and the ones with whom I AM are working...I went this whole weekend mostly without talking at ALL.
I did make about 35 drug cards.

Some interesting nursing observations:
Cardiogenic shock is a very nasty thing to get- it basically means that your heart is no longer pumping in a fashion that lets it get blood into all the rest of your body...or at least not enough to get it into all the fiddling little places like does, noses, etc.

Ventilators: Bubbling in the FIRST chamber means an air leak- either its air coming down the pt.'s throat, through a hole in the lung tissue, and out the chest tube, or the tube has a hole. Check BOTH. If it's the lung, this should stop when the lung heals itself. DO NOT PULL ON THE TUBE.

Stopcocks: They are the DEVIL. Make sure they're closed the way you want them to be closed, or SOME nasty liquid is going to get all over the place. If you're LUCKY it'll only be the foul-smelling enteral nutrition junk. Couldn't they make it smell better? Please? (this one wasn't me...my instructor was so busy telling us how to work a stopcock that she turned it the wrong way)

Codes: hospitals have so MANY kinds of codes now (Pink, Blue, Black, Grey, Red, Yellow, Orange, etc) that NO ONE knows what several of them mean...for instance, apparently orange means "patient surge" which i ASSUME means "we're getting swamped, call for more help for staffing" but COULD mean "omg, somebody got accidentally defibbed!" Code pink means "baby abduction". This means IN ALL SERIOUSNESS that they lock the hospital down, and you're supposed to ask people if you can check their purses for hidden babies. Seriously. Hidden babies. I think there's PROBABLY some leeway in saying "ma'am, i think your purse is too small to hide a baby in"...but you never know.

Effing Clinical

This hospital (Suburban Stupid Hospital With A Staffing Problem) sucks. There were THREE nurses for the whole ICU-stepdown unit. THREE. Which meant each nurse had 4-5 pts, at least half of whom were on a vent, or at LEAST totally immobile. That's totally unsafe. And the nurses were really angry when we showed up, because if they had KNOWN that we were going to be there, they wouldn't have done ANYTHING for the patients we were going to take. Except that we weren't doing patient care today, we were orienting to the unit.

They don't even have an aide, or an CNA. So...that's why they have us come there apparently. It's because they want to use us as free grunt work. That's NOT why we're there. I don't mind doing work. I like to pitch in, but we're there TO LEARN primarily. We are PAYING to be in nursing school, not to be unpaid aides doing tasks we learned how to do LAST YEAR. We're supposed to be learning NEW things, not just doing bedbaths. Assessments? Sure! Foleys? Glad to! Suctioning? Bring it on! Spending ALL MORNING cleaning patients, WITHOUT getting to do any of our new skills? NOT COOL.

And everything is either broken or absent.

And there are PLENTY of other clinical groups at ACTUAL TEACHING HOSPITALS, with staff who WANT to teach them, with doctors who show them things, with LEARNING to accomplish, which just makes this all feel dreadfully unfair.

Straws! Ventilated Straws!

Apartment is getting the cabinets ripped out and replaced today! This SHOULD fix the mold problem by eliminating all the damaged wood.

We're learning all about ventilators this week. They're scary. The idea that i could personally blow out somebody's lungs? very scary. Especially since half the settings appear to be specifically designed to prevent venous return, especially PEEP settings, which nonetheless sound exceptionally useful for somebody in severe resp. distress.

Besides, our professor is an old ER nurse, and LOVES her trauma. A few of us got in trouble for laughing at her photo of a guy with "BMW" impressed backwards into his chest from hitting the steering wheel.

what? i thought it was funny!

Back to school: actual nursing stuff

I've been assigned to a hospital for Advanced Med-Surg that i will refer to as "Crappy Suburban Hospital with a Staffing Shortage" or CSHSS...if i remember. we will be in the CPU- cardiopulmonary unit, or stepdown from ICU. i am afraid of ventilators. This may be interesting. The one thing I'm NOT afraid of is a code. Because, well, if they survive, they'll be my first successful code. If they dont, my record is unchanged.

Back to school

Yay! i'm at school! Unfortunately not back in my apartment yet, as there was a serious flood this summer while i was in NH, the place is full of mold and my apt. company is trying to do NOTHING for me. not amused. i'm exhausted, cranky, moody, and feel like taking scalps.

Three Days in the Mountains

I just got back from a 3-day 30something mile hike in the Whites. It kicked SERIOUS amounts of ass. I carried minimal weight (20lb pack, with clothes, including winter gear, water, gorp, etc) and stayed the nights in the AMC huts, where my brother works. Amazingly good weather, great company, filling food. And I made it up the Valley Way up Mt. Madison in 2 hours flat. Booyah. That's pretty good time, considering I also made it from Mizpah Springs hut to Zealand Falls hut in 4 hours, leaving me plenty of time for a swim in the waterfall. God i love hiking.
For my readers who have no idea what the White Mountains are, this means i did a very nice traverse of the Presidential Range, which boasts the Worst Weather In The World. While our mountains may not be as big as those out west, we have lots of elevation gain, and we have truly FOUL weather that shifts at a moments notice, often leading to summer snowstorms, sudden whiteout fogs, and all kinds of other delights. I got 100 mile views and a nasty sunburn in spite of SPF 70 sunblock.

Why I should Never Let My EMT Cert Lapse

Years (something like 5-6) ago, when I first became an EMT my first call was a fatality. I just got my cert finished (yes, I passed my computer test, go me) so, just to keep things tragically symmetrical, so was my first call as a RE-certed EMT. At first when we were toned to a "male, unresponsive, no pulse" I assumed the bystander just didnt know how to take a pulse. Happens ALL the time, and if he was RIGHT, we'd be doing about 45 minutes of CPR. Instead, upon arrival, it was clear that there was nothing we could do. The patient had been crushed by the weight of his stupid toy, and was beyond help.
That was bad enough when I thought he was an adult. It got WAY worse when I was informed that he was only a kid, not even a teenager. Just HUGE. And then the police notified his mother, who was just down the hillside, in her house. And the day got MUCH worse from there.
I've never been to a death notification at somebody's house, only been there incidentally in the ER, and by the time people make it into the ER after being told "there's been an accident", they're sort of prepared for it to not be good. This woman was COMPLETELY blindsided by the fact that her son, whom she'd just seen an hour before, was not coming home again.

I'm really not good at the "comfort the parents" part. My way of dealing with other people's grief is to feed them. Not an option here, so i was a bit out of my depth. RIP kid. Motorized toys for children are SO not a good idea.

Cervical Spine Traction

So I'm still here! Long time no blog! Tuesday I spent in VT, checking out a hospital that I might want to apply to next year when i'm All Growed Up. I spent 6 hours following a TERRIFIC nurse around the ER. Only by "following around" i mean "hanging out in the trauma room" because his patient in there was pretty much a full time job in and of itself. Middle aged man, status post motorcycle ditching. Estimated blood alcohol was probably about .35. Yeah. POINT THREE FIVE.

For comparison, if I, a small-ish sized female were to have a BAC that high, I'd probably be comatose. This dude went DRIVING. Briefly. He managed to smash up quite a few ribs, lacerating both liver and spleen, but that wasn't his main problem. The MAIN problem was that he dislocated his C-spine. Oh, but he still had viable use of all 4 limbs, and no urinary retention. Lucky bastard.

So it was TRACTION TIME! 15 x-rays and 155 lbs of traction pulling from bolts screwed into his skull (which is one of the COOLEST things I've EVER seen) he could feel everything, which didnt make him happy. Also, his vocabulary consisted mostly of explatives aimed at those of us "punishing him" by not letting him move to get more comfortable. As the Orthopod said "sir, if you even NOD you'll never see your penis again. HOLD STILL."

By the end of the shift we packed this prize human being off to the OR for a spinal fusion, and said goodbye to the cops, the patient's last comment still ringing in my ears- "Do you think this violates my parole?"

Take THAT Theology!

WOOHOOOOOO!!! Today I got an email from the Dean, saying that she was accepting (at long last) my previous medieval courses from my Anthro/Arch degree for BOTH my theology requirements. That means I dont have to over-load classes in the spring, just take the Developmental Psych class this fall. CAN I GET AN AMEN?

In other news, other than the self inflicted shotgun GSW to the head, things have been pretty quiet around here, patientwise. Which probably means everyone is saving up for the warmer weather that should descend soon.

Summer reminds all of us that "Live Free Or Die" would be better put "Live Free AND Die". Helmet laws? Please? Or mandatory health insurance/ DNR / Organ donor cards for people who wont wear a helmet?

This Summer's First Call: Hilarity Ensues

So last saturday I passed my practical! YAY ME! (only, i HAVE done all this before, so it was mostly nerves threatening to throw me off) Which means I got my pager and radio re-issued from the FAST squad (that's Volunteer EMT squad to all of you NOT in the Frozen Northlands). AAAAnd we got my first call of the summer 20 minutes later. While I was putting groceries away, naturally. I performed my USUAL "run to the car in a bra, pull on squad shirt en route" maneuver, which works as there are no neighbors, get to the ambulance, they pull away AS i'm closing the doors, (thanks Mike, I missed taking my life in my hands with your driving) and get to the call- "Male, LOC change, laceration to forehead" which turns out to be EPIC.

This young dood, 28 or so, was mowing his mom's lawn. He's not the brightest bulb in the kitchen, and he's holding the hood of the ride-on mower in place with bungee cords. Not in itself dangerous. Except he decides to CHECK them. While leaning nice and close. One particularly vindictive bungee jumped off, smacked him square between the eyes, and KNOCKED HIM OUT. He woke up, and called 911, because he didnt know how long he'd been out. Yes, his mother was standing right there, yes he IS a volunteer firefighter, but hey. Gotta get that nasty bungee-shaped welt checked.

And, in the process, let the ENTIRE FIRE DEPARTMENT KNOW YOU GOT KNOCKED OUT BY A BUNGEE CORD. Because let's face it- HIPPA doesn't mean ANYTHING in a town where everyone knows which addresses go with which people. We get toned out and EVERYONE in the entire REGION knows who's in trouble.

God i love being up here.

Unemployment Sucks

It really does. Still job-searching, but the Local Big Spiffy Medical Center is actually HIRING, so i applied for ALL their patient care positions. I'm overqualified, having a BA, but that's ok. I'll do pretty much anything.

In MEDICAL news, I've been down at the EMT squad a lot this week, preparing to test tomorrow and get my license back. (Let it expire while taking nursing prereqs- oops!) I LOVE living in a small town- excellent gossip. Last week was apparently an absolute nightmare. TONS of calls. And I learned that we have a New Local Batshit Crazy Dirtbag. LBCD is living in a falling apart-at-the-seams trailer which cannot be condemned, because of the state Live Freeze and Die attitude, which precludes condemnation for health reasons without a REDICULOUSLY long process. On the bright side, people dont lose their homes. On the downside, this "domicile" is being inhabited by 2 people (LCBD and wife) 2 dogs, a goat, and some chickens. None of whom apparently know how to use sanitary measures for their bathroom habits. So there's excrement EVERYWHERE, no electricity inside, and the whole structure is percariously perched on a hillside.

The net result of this is that EMS is PROHIBITED from entering, no matter HOW crazy he is when they call us. We stage down the hill, and FIRE has to go in IN FULL HAZMAT GEAR with breathing masks to get him out. Which they wont do, for fear that the hovel will tip over, and kill them. So we have to wait until he comes out. Ew. And the police are worried, because he's CRAYZEE. As in, we're currently trying to get him shipped off to the state hospital. The problem is, his wife (just as crazyee) keeps bailing him out and taking him home.

Good to be home.

Speed Record

Happy Memorial Day! As a result of it being the holiday weekend, nobody is calling back. Hrmph. Holding pattern until Tuesday.

Went up the mountain today, and set a personal best time- 36 minutes ascent time! Woot! Thats about 3 minutes faster than my previous best. Admittedly, I was wheezing audibly enough to worry pretty much everyone else on the mountain, but I sort of enjoy wheezing and STILL passing everyone. I figure that I'm in considerably more danger from TAKING my Albuterol than from my airways closing down on the mountain. If I SLIP on that mountain once I start shaking, I'm DEFINATELY going to get hurt. So i just drink water, put my arms over my head, and deal.

Good weather. Also cleaned the house, did 3 loads of laundry, and read a murder mystery.

Still Unemployed

Getting VERY bored, and beginning to go quietly insane. I vividly remember why I like living on my own. I'm about 2 days away from applying to work shifts as a waitress at my old restaurant. Tomorrow I'll be calling everyone again, and CROSSING FINGERS that somebody (anybody) with a hospital, or a clinic, or something will take me.

Surely SOMEONE needs a tech!

Spring Redux

The interesting thing about journeying to the Frozen Northlands (currently not frozen, at least during the day) is that spring resets itself. You go from irritatingly summer-like conditions in April, and suddenly find that you've jumped backward about three weeks as judged by plants. Its rather fun, since you get to see some of the prettiest foliage TWICE.

On the nursing front, filling out applications, more applications, still MORE applications, including to a freestanding Dialysis clinic, the Big Spiffy Academic Hospital (ee!) the Smaller Local Hospital, and, of course, the Public Health Service. That's the one I REALLY want to come through. The best POSSIBLE outcome would be to go with them for the summer. I just called the recruiter, to ask if they need anything else from me, and am waiting for her to call me back. Fingers, toes, and all other appendages crossed!

In the meantime, I will be helping serve at the festivities marking Commencement at the Law School where my mother works. Good food, and they pay. Could be worse!

Also, recertifying my EMT on May 30! Then I'll be able to get some decent trauma!

Wrap Up: 2008-2009 School Year

Well! It's actually that time already! I'm spending the entire day packing all my things that I might conceivably need for the next three months or so, returning books/DVDs to the library, emptying out the freezer (taking the food to the volunteer EMTS, who WILL eat just about anything) returning the school-sponsored laptop to tech support, hopefully hitting the gym one last time, putting everything in the civic.
Tomorrow morning throw the sheets into the laundry bag, make the bed, close all the windows, unplug EVERYTHING, get IN the civic, and head North. North, where the leaves are just beginning to THINK of coming out, where the grass may or may not be green yet. You know, like early May is SUPPOSED to be...if you live in the Frozen Northlands.

On the way home I'm making one more attempt to have lunch with one of my oldest and best friends on earth. He helped me through a nasty depression, through high school, and he himself survived 4 deployments to Parts Classified. For the last couple of years EVERY ONE of our plans has fallen through due to circumstances beyond our control. Still trying to break the trend, this time with a picnic.

Then, because the universe is funny like that, I get to meet up with the Former-Fiance, to hand off a textbook that he's buying from me. Its funny to think of him getting his EMT license, since he used to put his hands over his ears and hum to himself when I described trauma. Who knows, maybe (if fate is feeling especially nasty) I'll be working with him a lot in the future. I'll deal the way I always have- crack a few jokes, and pull faces when he's not looking. Its Terribly Mature.

Armed Forces Physical on friday for the public health service. Cross your fingers and hope they take me!!!! If they do, i'm strongly considering accepting a commission after graduation.

Finals

One more test, one more paper to go. Needless to say, i'm SWAMPED with work. Also managing to fit in some time at the gym. I'm really stepping it up! Hopefully by summer in the Frozen Northlands, I'll actually be in good enough shape to wear a bathing suit in public.

2 grades in so far, both A. I'll take it!

In Which I Do NOT Have Swine Flu

Ok people. I know you've heard on the news about the Impending Piggy Doom that hovers over us, the "Swine Flu Possible Pandemic". But really, there is something very important that needs to be said:

OH MY GOD, STOP PANICKING!!!!

It's the flu. For the GREAT majority of people, even if you DO get it, you'll feel under the weather for a few days. Maybe a fever, chills, cough, muscle aches. You've had it before. Seriously, you have. This time it just has a scary name. Unless you like pigs. Mostly you can avoid getting it by WASHING YOUR HANDS, and not letting people cough in your face. Really. Not only am I NOT worried about this, but I'm actually planning on calling the Public Health Department first thing tomorrow to ask if they can put me on the front lines with the Epidemic Intelligence Service for the summer. That's how not worried I am, and I'm an asthmatic. Yes, one of the people who qualifies for "special circumstances that would warrent prophylaxis". Which I'm not going to take. EVEN if you get the nasty form, which is cytokine storm, where your immune system overheats a bit and makes your organs shut down, we can treat that before it gets you killed in the vast majority of cases.

In other words: YOU WILL BE OK. STOP WORRYING!!!

In Which I am almost Half Done

I can hardly believe I've been a nursing student for almost a full year. Looking back I feel so DIFFERENT. Even though I had four years of EMT experience before heading to nursing school, it still feels like I started out as a civilian, and have started to think as a Nurse sometime during this semester. I look at people on the street, and I've started to see CHF, fluid overload, cor pulmonale, various genetic defects. I look at the man next to me on the train, and my first thought isn't "oh I wonder where he works" but "oh I wonder if he knows he needs a little Lasix!"

It's so much nursing condensed into such a short period of time that I wonder how I've suddenly become an impending medical professional. Next week I'll be HALF DONE. Hopefully I'll be sub-letting the apartment for the summer, and either serving as an Ensign in the Public Health Corps, or teching at some hospital Up North.

Tomorrow: THE CATH LAB!

In Which The Universe Evens Out

The last two days almost made up for Monday's wretchedness. On Tuesday I recieved news that I, so far, am at the top of my class, and my research professor wants me to go to grad school ASAP. I was flattered, but will be much calmer once I pass all my finals. And get a summer job. Still no word on that.
Wednesday was even BETTER: I went to Interventional Radiology, where they let me put in my very first IV on a real person. And it went PERFECTLY- no bruising, slid right in, LOVELY. It was fun. I think i'd like to do it again. One of the patients was a lovely spry 80 year old, in for placement of a chemo port, for her SECOND type of cancer. She was able to hop right up onto the stretcher in a way that I seldom see my 55 year old patients manage. She pulled me over, and whispered "I'm only doing this for my son. He's too scared of cancer to let me die like a normal old lady". I was saddened for her, but the twinkle in her eyes gave me hope- I feel fairly confident that she's got a fighting chance to see 90. I just hope it isn't too painful for her.

Once I got home, I found out that my pathophysiology professor had nominated me for an award as the one student of the semester who displayed "aptitude and love for the subject". I regressed to a mental age of 6, and did a little happy-dance around my apartment. At least the universe is evened out a bit...

Tomorrow is the Relative Invasion- my mother and two aunts are coming to stay with me. In a studio apartment. I have no idea how we will fit.

In Which I Am Reduced to Tears

They say that every nursing student encounters something that makes them question their motivation to be a nurse. Mine came today.
At first he seemed like any other patient- a little younger than some, in his mid-50s, with no acute cardiac problems, or anything critical. A few days ago he suffered a dizzy spell and collapsed on the toilet, after seeing blood in it. So he went to the ER at Spiffy Teaching Hospital. They, being reasonable people, decided that while they were transfusing him, they should probably see WHERE the blood was coming from. So they CT scanned him and found...Cancer. LOTS of cancer. Somewhere upward of 15 distinct metastases, on at least 4 organs, including BOTH lungs, the liver, one kidney, and a mass in the bowels. Some of the metastases were bigger than a fist.

So, because he had a prior cardiac history of some sort (HTN, high cholesterol, cocaine abuse) they sent him up to telemetry. Then a Gastroenterologist got involved. You see, he decided that it was important that this patient be given a colonoscopy. After all, the medical team wanted to see what KIND of cancer was in the bowel (even though, by his own admission, the patient was almost certainly inoperable, and with all the metasteses there would be no way of ridding him of ALL the tumors without a minor miracle). So they ordered a gallon of Go-Lytely.

And that is where I came in, at 7 in the morning. He didn't want to be assessed, only "left ALONE". The nurse overheard this, and my quick check of his bodily systems (lungs, bowels, neuovascular, vitals) and told me to "just come back around 10 to finish up with him after giving his meds". So I gave the meds, left the Go-Lytely in reach, and went to go keep an eye on my OTHER patient, a 90-something, delightfully confused gentleman who kept trying to sneak off the floor, because his dead wife was telling him to come home. After all, Cancer Patient was fully self-care, not even on fall precautions.

So, around 10, I came back into the room. After all, I'm a student, and I have to get my assessing done. The Worst Smell In The World greeted me. I gloved up, and lifted the blankets to find a SEA of feces, from his chest to his knees. "What HAPPENED????" I was devastated- had I left the call-bell out of reach? Was he conscious?

Oh yes. He was fully A+O. He "just hadn't WANTED to get out of bed. It had "Seemed pointless, since I'd be sitting there for so long". Why no call bell? "Didn't feel like it" Why keep telling me NOT to come in? "Didn't want people around". So, frantic, I ran and fetched the nurse to help me clean him up. It was NOT a one-person job. So we double-gloved, gowned, and masked, and went in to clean him. I was apprehensive (ok, terrified) but determined to prove I could handle this. After all, I want to work in Emergency medicine. And then the smell, coupled with the patients flat refusal to help us in any way (including refusing to turn to his side) hit me, and the sound of it, and the sight, and I started gagging as I tried to contain it all. Fortunately I made it out of the room, to an unoccupied one across the hall, where I was violently ill, and promptly started to cry.

But I couldn't leave the poor nurse alone in there with all that...so I wiped my eyes, rinsed my mouth out at the sink, regloved, and went back in. Where it took the next half hour to get all the feces up, and off the patient, and sanitize everything afterwards.

I felt like a failure- after all, nursing school taught us that we MUST simply "get over it" and do the job at hand, that "maybe you aren't cut out for nursing if this bothers you", and that "you can NEVER show disgust, because the patient will feel worse", and "this is just part of the job". All of it implying that we have to somehow be super-nurse from the very first day of clinical.

And that, after removing gloves, masks, and gowns, and washing our hands up to the SHOULDERS, is when the nurse hugged me. "THAT," she said, "is as bad as it can get in my opinion...and you came back in. You'll do fine".

I still want to be a nurse...but maybe not on a GI floor.

Update: The patient was sent up to the GI floor, and did eventually get his colonoscopy. I have no idea what they found.

Ambulance Drivers

Yes, i know this term is now frowned upon, but in the four years I spent working as an EMT, and now almost a year trying to get my cert BACK after letting it lapse while doing nursing prereqs I have NEVER been allowed to drive the ambulance farther than the edge of the parking lot. The insurance won't let anyone under 25 drive it, unless they have special licensing or what have you.

THAT ENDS TODAY! Today I finished my two-day EVOC class, and can now drive the ambulance. I made it through the ENTIRE slalom course, and the parallel parking, and EVERYTHING without hitting a single cone. I win!!! I can drive the ambulance!!!

Report

Today's exercise in clinical was in Giving Report. I had a bit of an ace up my sleeve here, in that I, unlike my clinical classmates, have actually DONE this before as an EMT. Not in the same depth, but I'm used to saying things like "Mrs. Diabetique is an 82 y/o caucasian female, who presented at home with an altered LOC, whereupon EMS was called. She was placed on 4lpm O2 by nasal cannula, and restrained after trying to kill us all. Her blood glucose was 23, so we gave her an amp of D-50, which quickly restored her to complete sanity. She's A+O x 3, resting comfortably, and has a past medical history of every diagnosis in the book. Here ya go, please sign right here."

I enjoyed getting my patient, doing his workup and then reporting. Didn't hurt that he was conscious, and going home later today.

On the other hand, his family are all christian scientists, which made getting a "family history" next to impossible. "I dont KNOW what they have!" he said. "They dont go to doctors!'

Oh...hmm...

Spring?

Arrived back in The Mid Atlantic yesterday evening after a HELLISH 8.5 hour drive. It SHOULD take more like 6.75, or 7 hrs. WITH stops. I hate the Jersey Turnpike...well...ALL of I-95 was clearly designed and built by Lucifer himself.
Aaaand I'm not feeling well. Vague GI complaints, and THIS time I KNOW it's not giardia. Nowhere I could have been exposed, so it must just be one of those things. Lots of Pepto Bismol and hot tea should fix it. AND not dressing for class- sweats head to toe today. It feels almost naughty, and i KNOW it's "not attractive", but it's raining, and I feel gross, so sweats it is.

Tomorrow we're doing a "special project" in clinical. Stay tuned...

Easter

Tomorrow is the dreaded Lab Day with blood transfusions and PACU patients. Wheee...
Immediately following that, I'll be heading home to the Frozen Northlands again until Tuesday. Hopefully the traffic on the GW bridge wont make me cry THIS time.

Back to OB

Good news! I just found out that I get to go back to do a second OB floor observation! This time I'm going in for a Friday dayshift, so that hopefully I can see an induction and/or C-section...or just a plain old BIRTH! I'm a little unusual for my classmates...I'm a natural birthing advocate ALREADY, thanks to my Mama. She was adamant about her own natural childbirths (me and Younger Brother), and it really rubbed off on me. I even went up until surgery with my appendicitis because i knew that childbirth HAD to be worse, and if Mama could do it, so could I (turned out to be a great choice, as I was lucid enough to refuse full anesthesia, and got a spinal instead, which worked MARVELOUSLLY well).

Still...a C-section would be really good to see, since I'm sure we'll see them on our OB rotation, and I'd like to see one before i have to be knowledgable and competent as an assistant.

For Patients and Others: Why you WANT a student nurse

Sometimes we find, on our clinical days, that a patient may want nothing whatsoever to do with us. This is rare. MUCH more frequently, it is their RELATIVES who want us out of the room, and out of their lives. This is, for the most part, A MISTAKE. Yes, I know that we aren't "Real Nurses" yet. Yes, I also know that our questions may worry you, as we are probably young enough to be your grandchildren. You still want us to care for you.
Why? For many VERY good reasons.
1. Your call bell will be answered INSTANTLY. We have (usually) no more than 2-3 fairly stable patients. Odds are, if we see your call bell, we're in there RIGHT AWAY. You see, unlike the staff nurses, we are being GRADED every day. If you are unhappy with us, and tell our instructor that we ignored you, and it was TRUE, we're in Very Big Trouble. So chances are, you WONT be waiting half an hour to go to the bathroom, or get some reglan, or a juice box.

2. We're REALLY (most of us) still idealistic. We tend to really want to help you, and all of our therapeutic techniques are still shiny and new. We still think giving backrubs is entertaining AND we've got the time to TRY all those "non-pharmacologic analgesic techniques".

3. We're terrified of screwing up. We're going to double and TRIPLE check everything we do, and we're paying COMPLETE ATTENTION to the whole procedure.

4. Many of us (especially from MY school) are cute. While I know this has no direct bearing on your patient care, it never hurts.

So please, be kind to your student nurses. We ARE trying our best here, and if you just give us a chance, we'll get you your hot tea in just a minute. After we finish tucking you in with warm blankets.

Floor Code

Yesterday I spent the day watching 3 colonoscopies, and hanging out with a VERY cool nurse anesthetist. I never realised how FAST they are- average scope time was about 10 minutes.
On the ortho floor, where the other half of the group is stationed, there was FAR more excitement. A woman, a few days post-op for a spinal surgery, went into trigeminy. No big deal according to the telemetry guys. Then bigeminy. Slightly more worried, especially when it continued for a few minutes. After about 5 minutes, the telemetry guys called up to the floor, and informed the nurse to maybe go check her patient. Upon entering the room, she immediately yelled "IM GOING TO NEED SOME HELP IN HERE!!!" within 30 seconds, the patient stopped breathing. They coded her for 45 minutes, and technically got her back, rushing her off to the ICU.
The problem is what CAUSED the code- probably either a PE or a stroke, according to my instructor. Probably lots of brain already dead. Who knows if she'll ever wake up.
Two of my classmates were traumatised. They had never seen a code, and NEVER a young person dying.
Slowly but surely, we're beginning to think less as laypeople, and more as nurses.

DAMN!!!

Rejected from the externship.
Now need to find a summer position. In this economy. ~insert stream of profanity, and tears~

ITS NOT FAIR!!!!

CALL ME!!!

Today is the day we're supposed to find out if we got externships at CHOP. No phone call yet. Practically TWITCHING with impatience. GAAAAAAAAAAAH!

O No! Meme Attack!!!

Meme: What does your stethoscope look like?

I've been tagged by undergrad RN!

Here are the rules:

1) Post a picture of your stethoscope

2) Tell what you love about it

3) Tell what you hate about it

4) Tell me what your dream stethoscope would be

5) Does it have a name?

6) Tag all your nursing friends (Including the one that tagged you) and dont forget to leave a comment on their blog telling them that you tagged them!


1. It looks like THIS (see above), only in what they claim is Caribbean blue, but actually looks more like hunter green.

2. I love that it's considerably better than my old EMT scope, in that you can actually HEAR THINGS that are subtle with it. I have really good hearing anyway, so I dont know what I'd DO with a fancier scope. Maybe I'll upgrade someday, but my basic Littman is good enough for now.

3. I hate that it occasionally shifts around my neck, which is actually a function of having a stupid chest pocket on my uniform that gets in the way. Also, the rubber occasionally catches my hair. Other than that, not a problem.

4. My dream stethoscope? Didn't know I had one, but one that would magically home in on abnormal sounds :-p

5. No...no name, except "my scope" which doesn't sound terribly original.

6. Ok...I'm only going to tag back undergrad RN, and wardbunny, because I dont want to bug people. :-p

The COOLEST clinical day EVER!!!

So guess what I did today?

I WATCHED OPEN HEART SURGERY!!!! (yes, i know many people do this all day, every day, but this was my first time, and i was impressed, dammit). I even got to help, as the circulating nurse got stuck holding a cellphone for the surgeon, so the PA didn't have anyone to fetch her suturing supplies and staples, so I volunteered. The circulating nurse said she was only half kidding when she offered me a job. :-p

The human heart freaking RULES. I mean...there it is! And it doesn't move like you'd think it would, it sort of torques around, and you can see the lungs inflate and deflate, and the shine of the diaphragm below them, and it's just...AWESOME. The nurse anesthetist showed me what sort of things you can do with airway management and surgical anesthetics, and the PA let me poke around at an extra piece of artery she wound up not needing. Its TOUGH.

All in all? BEST FREAKING DAY EVER!!!

Hospital Air

The air, at least at Spiffy Teaching Hospital, is absolutely DRY. The weather here is ALSO absolutely dry right now. The combination has my skin stretched tight and painful. Ouch. Also, microcuts all over my hands. For this, I wear gloves for ALL patient contact.

For extra giggles, Ive started seeing flu cases on our unit. It could be a very late flu outbreak...the fun just doesn't stop!

I KNEW It didn't look right!!!

I have finally figured out what looked wrong about my hospital ID-badge, having finally looked at it while fully awake and caffeinated:

Instead of saying "ScaryCatholic University", it says "ScaryCatholic Universeity".

This is going to bother me for the rest of the semester. I just KNOW it.

Meh

No word from CHOP yet, clinical was pretty standard: two patients, lots of running back and forth, about 40 meds between them, and only one injection (Heparin, 5000 units, as usual. I hear it stings like ANYTHING).

One pt. was a lovely 80something year old woman, just told that her heart problem was inoperable, due to her emphysema-secondary-to-controlled TB-that-shes-had-forever. Thus, her option was Plavix, and hope. Her response was charmingly refreshing: "Fine, lets do that, I'll go home. I'm 80, i'm a widow, i have LOVELY great-grandchildren and have lived a good life! Whatever is going to happen is fine with me!"

I liked her.

Spring

Dear Spring,

If you are going to be sunny and warm, could you green up the grass, and put some leaves on the trees? Otherwise I'm uncomfortably reminded of a certain desert that I don't like. (Well...ANY desert. I don't like deserts.)

That will be all. Kthnxbai.

Wednesday Clinical

Guess what? I HATE ORTHO!!!! I was an "exchange student" from telemetry up to ortho yesterday, and immediately decided that it's pretty much my idea of hell. It suuuucks. The patients are all in (understandable) pain, but dont want to help with ANYTHING, including getting to the commode. They're ALLLLL about the bedpans. I, on the other hand, am NOT all about bedpan duty, given the option. I especially dislike the fact that the nurses and aides don't lift a damn hand when there are students on the floor. They'll be sitting there, hanging out, while the students panic, and pray they arent hurting the poor patients.
WILL NOT WORK THERE!!!

3 Patients

So today, instead of one patient, I had three. Yes, THREE, bypassing the 2-patient rule from the beginning. I thought I would choke on my coffee, especially when I heard that I was going to have the shyest person from the orthopedics floor group following me for the day to "see what the tele unit is like". Surprisingly, the only part that actually stressed me out was the "being followed" part. I poked my head in and said hi to each patient, to make sure that none of them desperately needed to use the commode or something, then did vital signs for all three, then medications for all three, with assessments fit in between putting the medications in cups, and waiting for my instructor to come and watch me give them.

All three of my patients were interesting in their own ways. One was a not-terribly-old guy, HIV positive, new onset hyperthyroidism, chest pain relieved by nitro, three stents placed, etc. REALLY nice guy. Anemic all his life. Guess how he got HIV? Yeah. That's right. Transfusion in the 80s. How much does THAT suck? But he was awesome. Helped me with all my assessments, wanted to know if he should encourage his kids to go to my school for nursing, LOVED it when I found a way to make coffee for him strong enough to kill the taste of the HIV cocktail.
Did you know that one of the HIV meds looks (and apparently tastes) like yellow paint? I think he's terribly brave to put up with it all (including us).

My second patient was a TINY little 90+ year old woman who looked MAYBE 70. Completely stable, except for that little 5-second PAUSE on her EKG this morning. That she didn't notice. Apparently, since she FELT fine, it's cool, and we didn't need to worry. All she wanted was to be quickly checked over, and we made her DELIRIOUSLY happy when she came out of her bathroom from a shower to find that we'd remade her bed, with proper Nursing School Corners. Yay! I love it when I can make patients happy just by the little things. Actually, my first patient was pretty psyched when HE came back from the bathroom to find everything all pretty too. AND I chased down a doc to get him a scrip for some high-test cough medicine. He had a nasty cough from Pneumocystis pneumonia, and he felt better pretty fast.

My third patient just wanted to sleep, and had a gangrenous foot. Which I never saw, because podietry came round early this morning and REALLY did a BEAUTIFUL job wrapping it. Very nice. We gave him his meds, hung his antibiotics, flushed his PIC line, and voila.

I didn't sleep well last night, so now i'm WIPED OUT. Early bed I think. Like...8 pm early.

Interview

So I had my interview at CHOP this morning. Last year they took 71 externs out of 500 applicants. This year they'll be taking 38 externs out of 550. They only INTERVIEWED about 150, but still. Seriously scary odds.
So i'll be applying to DHMC tomorrow, as a backup, in the hope that THEY will be taking externs. This is so fucked up. I mean, we're in the middle of a "NURSING SHORTAGE", but nurses aren't finding jobs because hospitals don't want to/ cant hire anybody until the economy starts moving again. ::Ahem:: FIX IT!!!!

FOR THE LOVE OF GOD, SOMEBODY FIX THE FREAKING ECONOMY RIGHT THIS MINUTE!!!

As for the interview, I think it went well, but I really can't tell. I mean, i have top grades, a previous degree cum laude, et cet, but...there were 550something applicants...those that were interviewed with me must be pretty nifty themselves!

I should know if i got it by the 23. Fingers AND toes crossed!

PACU

Today I got to go observe in the PACU. Before going there though, we (my counterpart and I) followed a patient from admission through a short procedure, and then into the PACU, to get the patient's experience. She was in for a D+C to take out some polyps, and came through it like a champ. We watched the surgery (which worried the nurses, once they figured out it was my first time in an OR...I think they were afraid I'd faint) and it went swimmingly. We helped settle the pt. in the PACU, where she woke up almost immediately, and smiled at us. I was amazed. Here this woman was- just barely out of surgery, and smiling at us, asking if we learned anything important from her surgery. I just wanted to give her a hug.

Next to her was a woman about my age, just had a lung resection for cancer. She's never smoked, no risk factors. Just lung cancer. She looked so scared, and kept getting cold. I ran warm blankets to her until she looked like the michelin man...but at least she was warm, and cuddled in blankets.

The patients who made me grit my teeth were a pair of VERY overweight women just post knee replacement, who were unwilling to accept ANY pain, and called the nurses "bitches" for not giving more morphine for a reported pain level of 3-4. "But i'm still FEELING PAIN!!!" They moaned, like a greek chorus. Well...um...your KNEE got taken out, and now you have a FAKE ONE!!! There's NO way that you're going to be consious and not be in a bit of pain!

Then I went to the gym, had a nice long workout, ate dinner (mmm..chicken!), and am sitting with my feet elevated, on my futon. OOOF.

Impending RIP

Today's patient was all SORTS of dying. 70something years old, long time smoker, the inevitable lung cancer with scary bone metastases. He came to us from some nursing home because of a fever, but the REAL problem was Hypercalcemia of Malignancy. Which is pretty much the definition of "make this guy comfort-measures only"...except the family only got there today to make the decision. Essentially, once you HAVE Hypercalcemia of malignancy, your chances of making it a MONTH are 50/50. That is, if you also dont die of massive fluid loss from electrolyte imbalance, or one of the other nasty side effects.
The guy was more or less out of it, rousable only by a bit of shaking, a loud voice, or me, trying to give him his shots. He was unimpressed. Also, he had a lot of trouble swallowing, the result of an old brain aneurysm that ruptured, so getting him his medications required creativity. The hospitalist dropped in, to say that a PEG tube would be torture, and to call him when the patient's family got in, so that he could convince them that there was nothing more modern medicine could do but make him comfy-ish.
Once they pull the calcitonin shots, he'll maybe have 3 days to live. RIP, cancerdood.

Northlands Update

It's chilly, windy, snowy, but the food's good.

My interview is on the 13th at 10 am. Woot!

The Frozen Northlands

I leave today, after my second midterm for The Frozen Northlands. Sometimes there is internet access in the Northlands, sometimes not. But we do have snow. Lots and lots and LOTS of snow.

I won't be doing any nursing stuff for the next week or so though, so the chances of any interesting blog entries is somewhat lessened.

Happy "Spring" Break! (there are no leaves on trees, no green grass, no flowers, and at home there's 3 feet of snow. It's not spring.)


Just remember kids: YOU CAN'T SHOCK ASYSTOLE!!

Nephro: An Introduction

Today's pt. was NOT cardiac, though he'd had the obligatory CABG some years ago. He has had prostate and bladder cancer, and a resected bowel, and god knows what else. He was on our floor because...well...I'm not really sure. Medical floor overflow I suppose. CHARMING man, he was really fantastic, great storyteller.

The Interesting Part: He had a nephrostomy. It LOOKS like a colostomy- pink stoma, bag attached, but instead of draining feces, it drains urine, directly from the ureter, because his bladder was obstructed by tumor, and removed. Two days ago they added a shunt to ANOTHER bag, draining his kidney directly because of an infection. Kind of painful looking, actually, and draining bloody, cloudy stuff. He didn't wince when I did the dressing changes, LOVED having a student, and regaled me with stories of the old WW2 comics he used to read, about brave army medics and pretty nurses. He agrees that the cape SHOULD make a comeback.

Also got to hang out with the telemetry techs again, and learned the finer points of paced rhythms, so I no longer look at them and say "uh oh! wide complexes! DANGER!!"

I am NOT poison control!

But nevertheless, a friend from college just called to ask if swallowing a bottle of codeine syrup would kill/ seriously maim you. Some chick she knows just did it.

Me:"Call the ER, and ask them if they want you to bring her in, or just give her ipecac"

Her, 5 minutes later: "Ok. ER says ipecac. And I dont even LIKE this chick!"

Better her than me...I wouldn't have gone over there when she called to say she'd taken it, I'd have just sent 911 over there to haul her to the psych ward.

I Spied Three Things

Three things I've never seen before while doing an observation day with the Wound Care Nurse, all of them vaguely horrifying.

1. The fattest man I have ever seen. I'm not prejudiced against large people, but this guy weighed in, on admission yesterday, at 904 pounds. Yes, NINE HUNDRED AND FOUR. He is scheduled to have some sort of pannus-removal surgery. The docs are pretty sure he has a heart condition, but he's too big for ANY nuclear medicine studies (the tables aren't big enough, and he wouldn't fit inside the machine, and too big for the cath table, the OR table, and pretty much everywhere else. They're planning to do the surgery IN HIS HOSPITAL BED because they can't move him. It took 7 of us to roll him to assess his skin integrity.

2. Somebody's tendon. No, not in surgery, he had a pressure ulcer from where another hospital put pressure ulcer preventing (o irony) boots on him. The inside of said boots were hard plastic, so the skin over his achilles tendon broke down. Voila! Tendon! He was really out of it, and on a vent, but it was still horrifying. I mean, insides are supposed to be on the INSIDE. Also, his big toe was BLACK and about to fall off. I don't think he'll be walking again.

On the other hand, I doubt he's going to be CONSCIOUS ever again either. Sad, either way. He just took really lousy care of himself (smoker, alcoholic, morbidly obese, no exercise, diabetic, dialated cardiomyopathy, cardiogenic shock, etc.)

3. A wound-vac. They're gross. I'm sorry, but I don't know how the floor nurses can deal with that. I mean draining normal stuff like blood or serum? Fine. This was draining...infectious goo. NOT fine. Gross.
And she had the inevitable NON EXISTANT pain tolerance. She screamed when the nurse POINTED at her, and demanded more "mo'phine", because we were "torturing" her. Without touching her. When she said she was comfortable when we walked into the room. Oy.

Care plans suck

They really do. It takes me forever to write it all out, and I can rattle it off verbally in about a minute and a half.

Fortunately, my clinical instructor thinks they're annoying too. She MAKES us do verbal care plans on every patient every day. Which is BRILLIANT. She has a formula for it too: First start with all the assessments you need to make, then all the labs you would check, then all the interventions you can do WITHOUT calling ANYBODY, then the interventions you can do WITH other services (pt, ot, nutrition, et cet) THEN the medications, THEN things you have to call the docs for.

She says that this way we'll get into the habit of always looking for our independent actions FIRST, and in many cases we won't HAVE to wake a doctor up, which will make EVERYONE happier.

Have I mentioned that my clinical instructor rocks? She still works PRN on the floor where she teaches, and knows EVERYONE. This floor is awesome, and the aides kick some major ass.

CHOP INTERVIEW!!!

I HAS ONE!

Specifically, I managed to at least land an interview for Children's Hospital of Pennsylvania's summer externship program. My first choice of placement? ER of course. If i can learn to put an IV in a tiny little arm, I can sure as hell put one in a BIG arm.

Fingers crossed that I get a spot!!!

Comprehensive Care Plan

Today was our designated day to create a "comprehensive care plan" for any patient on the tele floor. I picked a sweet LOL going in for a mitral valve replacement tomorrow. She let me do a complete workup on her, including history, complete physical exam, patient teaching, nursing diagnoses, et cetera. She said that she was "bored, so why the heck not!?" I love patients like that. You get to learn SO much from them.

I even got to do something helpful for her- I was with her in the Echo lab when her REAL nurse called in- her APTT was over 150, meaning DISCONTINUE THE HEPARIN!!! IN A HURRY! So I did so, and felt, for about a tenth of a second, like a Real Nurse. Then it passed.

We've started learning about EKG interpretation in class, which is totally and completely awesome. I used to be able to only read Very Bad Things, like Torsades des pointes, v-fib, v-tach, and of course, asystole. Now I can read PVCs, a very few kinds of bundle branch blocks (assuming NO other complicating factors), and junctional rhythms. Very Very Cool.

What I DONT understand is one of my fellow students. I asked the professor if I could go hang out in the telemetry room once all my charting was done, and before she could answer, Fellow Student says "WHY would you want to do THAT?"
Me:"Um...because they show you lots of neat things about cardiac rhythms"
FellowStudent: "Who CARES? Its not on the TEST!!!"

It boggles the mind. I want to know, because i DONT KNOW IT. That's actually reason enough for me to want to learn about it, setting aside altogether the fact that I want to work in an ER, and they dont HAVE telemetry techs to read all the monitors down there. Grrr. She has NO curiosity whatsoever. And she's lazy. I wouldn't want her taking care of ME.

How To Look Pretty For Clinical

It isn't easy, I'll tell you that. Nobody really looks their best rolling out of bed at 5 AM, pulling on our godawful uniform, and hightailing it to the hospital, but I do make an effort. I'm vain, and I'm single, and dammit I want to look my best, insofar as it is possible. It doesn't help that I have a DIFFICULT skintone. I am SERIOUSLY pale (like, porcelain pale) but without pink undertones in my skin. I'm the world's palest olive tone, the sort that LITERALLY turn green when they're sick. You can see most of my veins through my skin.

On the other hand, you do NOT want to be that girl who shows up with a ton of makeup on- you'll look silly, and you probably did your makeup under different lighting. Hospital lighting is NOT forgiving of makeup errors. There is a girl in my clinical group who seems to think that she cannot go out without bronzer. You can TELL. She looks muddy.

On that note, here's what I've found can be done in a relative haze, and still make you look human without making it obvious that you're wearing makeup.

1. MOISTURIZE. Hospitals are dry, you will be dry, invest in some good moisturizer with an SPF (for when you DO go outside), use it liberally.

2. CONCEALER, for spottiness. Make sure you test it on yourself in NATURAL light, AND under nasty halogens. This will help prevent it suddenly becoming scarily visible at the hospital, and ruining all your work.

3. FOUNDATION- if you wear it, wear as little as possible, mix it with moisturizer, and for God's sake, make damn sure it really matches your skintone.

4. BLUSH!!!!! I cannot stress how much I love blush. I recommend a very light pink for people as pale as me. Something NATURAL looking. Brush it with a really big brush over the apples of your cheeks, then dust a TINY bit on your chin and brow bones. This part might not be necessary for people who actually have color in their skin, but I find it does WONDERS for me. Makes me look human, refreshed, happy. It is also far easier to use than bronzer. DO NOT USE BRONZER. It doesn't look right under hospital lights, I don't know why. Blush is much more forgiving, and gives you color without that "i swear i was just in cancun" fakeness.

5. MASCARA- if you can use it this early in the morning. I usually go for a brown color, and use just one coat of something that will not clump. Rimmel is good. It opens up your eyes, helping you look alert.

6. Clear Eyes solution. Seriously. If you were up late writing your care plan, use this so your patient's dont know.

And that's basically my morning routine, give or take a few products depending on how alert I am. I can't help my uniform, but dammit at least I look awake!

Short post

I am spectacularly unmotivated today, and have the day off from clinical due to my instructor not having a babysitter for President's Day. I think I'll go to the gym so I don't sit around doing NOTHING.

Also, I should finish this care plan on pain.

The Drunkest Guy Yet

Last night was an interesting shift. 18 hours, two calls, which isn't bad. The first one was no big deal, (moderate concussion, easy transport, cooperative patient).
The SECOND patient was a whole different story. 3 am is never a good time to be hauled out of bed, and we knew it wasn't going to be an easy call when we could smell the alcohol from OUTSIDE the room. The patient was (sorta) conscious, but he thought it was Halloween, he kept giggling, and he repeatedly climbed out of the stairchair because "seatbelts dont belong on chairs!!!" He hadn't vomited at all, which was a blessing from a messiness standpoint, but I have no idea how he managed to drink so much and not get sick. His friends estimated that he'd had 10-15 shots in the preceeding hour, and must have JUST stopped drinking before the campus cops found him.
Once on the ambulance, he repeatedly attempted to grab my breasts while I took his blood pressure. Who knew that "no, these aren't for you" actually WORKS as a deterrant? Then he passed out, which made things easier.
Hope he's ok...KNOW he won't know better.

Hyacinth

I would just like to state, for the record, that hyacinths smell AMAZING...and that I got some at Trader Joes for 2 bucks. WHEEEEE!!!

Unexpectedly Emergent

Today I had a lovely pt. on contact precautions for MRSA colonization (no active infection), and got to follow her to the lab where they were testing her brand new internal defibrillator. What this involves is quite nerve-wracking. They sedate the patient, pace her on the T-wave, which sends her into V-fib, and then WAIT and see if the defibrillator can kick her back out of it into sinus. This was the SECOND test. The day before the test had failed, and they had to use the external paddles. This time, after ten heart-stopping seconds, she cardioverted, and all was well.
The second drama in the day unfolded about 4 minutes after I left the lab: one of my classmates came running up to say that a girl in my carpool had collapsed in the hallway, unconsious, and was being taken to the ER. Needless to say, the two of us in the carpool with her ran down to the ER, and stayed there until her discharge 4 hours later. Diagnosis? Vaso-vagal syncopy, with mild bump on the head. Basically, she stood still in a freezing room for four hours, and hadn't eaten in 6. When she walked OUT of the cath lab into the hallway, which was VERY warm, and her blood started moving again, she passed out and bumped her head. All is well, but it made for QUITE an exciting day. The best part was taking the EKG electrodes off her every 20 minutes so that she could go to the bathroom, because they had her IV running in so fast.