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!