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.