Angles

I've been training, this past week, for "low angle rescue". While this might seem like an exceedingly easy task (especially if the low angle in question is 'flat'), what it really means is training for rescues on slopes that are a LITTLE too steep to want to walk down them with a rescue litter, but NOT steep enough that everyone is hanging off the ends of ropes. Essentially, it's any situation where, should something go drastically wrong, the people on the ropes would SLIDE, but not CRUNCH. It's fun, and I get to tie knots and use pulleys. Also, here in the Frozen Northland, the mountains have snow. And it's staying cold enough for the snow to STAY. I like this. There were even flurries this morning at home.

I have an interview in NYC for the USPHS on November 2nd. Right now I'm getting my recommendations/references in order from professors.

In Which I Rally

Sitting around wringing my hands, while extremely satisfying in a "woe is me" sort of way, is not terribly productive. So I have applied to the USPHS Commissioned Corps as a nurse. I mean, I'm QUALIFIED, and if they offer me a good posting/ take me at all, I'll probably take it. By "good posting" i mean either or both of the following: someplace nice and cold, and/or in an ED or somewhere else exciting, like doing epidemic work.

VIVA LA RESISTANCE!!!

Nope

The hospital where I had an ED application took someone else...didn't even get an interview. Everywhere else is looking for a year of experience. Question: if EVERYONE is requiring a year of experience...WHERE DO YOU GET A YEAR OF EXPERIENCE??? And this isn't for just critical care jobs, I was even looking at med/surg out of desperation. They want experience too.

Search and *maybe* rescue

I'm training for a search and rescue team (volunteer) to give me something to do until I'm employed, and also taking the ACLS, and probably PALS courses...hoping it will help. Heres the funny thing about SAR work- if it's a "search" as opposed to a "rescue", there's very little actual FINDING going on much of the time. Picture it this way- you have a missing person, a hiker, known to have been on a trail. Essentially, 20-30 people then walk all the trails nearby, yelling for the subject and blowing whistles, in teams of 3. ONE team will find the person, if they're LUCKY. For the most part, it's a lot of struggling through underbrush with blaze orange on. Not that it's not FUN, it's just not what I'm used to. I'm used to RESCUES more than SEARCHES. With a RESCUE, you KNOW where the victim/patient/subject IS, but they can't get out of the woods or off the mountain on their own. More medical stuff, lots more logistical stuff, and a lot more hands on.

On the other hand, you can't rescue them until you find them...

Alpine, BSN, RN

Took my boards yesterday. Checked, out of pure curiosity, on the state board website for my name. Found it. I passed. 40 minutes to take the NCLEX, minimum number of questions. HUGE SENSE OF RELIEF!!!

Texas

Apparently my mom has a contact who works as a bigshot for a big conglomerate of hospitals in Houston. I'm thinking about it, even though the air is supposed to be TERRIBLE there, and it's really hot. At least maybe i could be EMPLOYED.

The Job Search Continues

Ok. Two years ago they told us that when we graduated we would be able to work in a field that fascinated us. They told us that the days of "you must work in XYZ and be grateful for it" were over. Well...THEY'RE BACK. I've been told by THREE human resources people TODAY (Beth Israel Deaconess, Concord Hospital, Mass General) that "you should get experience wherever you can with this job market. How about working in a nursing home?"

This is a terrible idea on the industry's part. A LOT of us got into nursing because we thought, even though we HATED certain clinicals, it didnt matter because we wouldn't WORK in those specialties. I, for example get insanely bored in areas that don't move quickly. If i worked in a nursing home I'd probably go crazy within a week.

I wonder how everyone is going to feel in a year when many new nurses never work in nursing because they couldn't get jobs...then they'll be shrieking about a shortage all over again.

Sorry About Not Posting

The fact is, I've done virtually NOTHING nursing related in the last month and a half. I JUST got my Authorization To Test today (yay!!!) the problem: my test date is next wednesday...ON MY BIRTHDAY. Curses. On the other hand, afterwords I'll have a *REALLY* good excuse to party. Assuming I, you know, PASS IT.

Still job hunting. The market isn't great, and nobody's even called me back yet. Yes, this is apparently what I went to school and worked my butt off for TWO AND A HALF YEARS FOR- to be unemployed. If anyone knows any hospitals in the northeast or northwest hiring? DO let me know.

Anticlimax

Well, since we don't actually HAVE a real graduation ceremony...I'm just...DONE...except that I'm not QUITE done (yet again) because we have this NCLEX prep course weds, thurs, and friday.

This feels decidedly odd. I don't have any more classes before my boards. Verycatholic University actually considers me ready to take care of people.

Woah. That's a headrush.

One More Day

I feel like singing that song from "Les Miz"...but can't until tomorrow. I have taken my last exam, I have given my last presentation (rocked them both), and all I have left is my Last Day of Clinical, complete with my Last Performance Eval of School. I HATE evals. The profs always make it as scarily awkward as possible so that you always feel like you've failed until the last minute, and the feedback they give they try to deliver BEFORE letting you see your grade. Therefore, the "constructive criticism" aspect overshadows the "but you did great" part, so you're hearing them list and detail your failures for MINUTES before they say "oh and you got an A". It's like- couldn't you have LEAD with that???!! "You did great! You got an A! However, here are some things to work on as you move forward in nursing..." would be a lot less nausea-inducing.

Sometimes I think they just like to watch us squirm. :-p

I'm really ready to be done- picking up my CPR instructor card this week, getting ready for the move, looking for jobs.

Next stop: the mountains. But I really want to be working someplace I love before Christmas, if at all possible, ideally in an Emergency department. :-D

One more dawn, one more day, ONE DAY MOOOOOOOOORE!

What I'm Going To Do On My Summer "Vacation"

As of this afternoon, I've accepted a three-week position in the High Huts up in the White Mountains...a real gem of an opportunity to do some SERIOUS hiking for three weeks while studying for my NCLEX exam. Also, I'll be the most medically qualified (but least experienced) croo member on my team.

The oddest part? My hutmaster (think "supervisor" or "lord and master") will be none other than my BROTHER. I'm actually looking forward to this. Though I may call him a bit of an idiot, or (justifiably) think that he's a bit off sometimes, I do know that he's one of the finest people working in the mountains anywhere in the world, and I'm actually enjoying working with him...though we'll see how that lasts if he starts saying unkind things about my cooking...

I took my last test of nursing school today, and really enjoyed the questions on disaster triage and communicable diseases. The rest was less fun, but triage is like a puzzle- which patient first? Red, Green, Yellow or Black? It's really quite fun to do on paper (disaster triage sounds like much less fun when you're actually saying that you cannot do CPR on someone due to lack of resources).

So all I have left of school now is three clinical days, and one very immense presentation on community health interventions in a Philadelphia Suburb.

Patient Teaching

The problem with these last few weeks of class is that I don't get much to blog about- it's just sitting in a room. I WILL have something by tomorrow though- run in with a doc, my preceptor was MARVELOUS!

Dear GOD The HEAT!!!

Oh my lordie, it's STILL hot. Briefly today, I entertained high hopes of there being a real break in the weather, down to something normal, as it was pouring BUCKETS of rain. While this was a significant improvement in the fire weather warning, it's not been especially successful otherwise. The green is nice though, a big step up from the brown.

I was in NYC for two days, doing an interview with the Feds (USPHS) which was awesome and fun, and something I'm keeping in mind.

It's SO TOTALLY trauma weather- people go a little nuts in this heat...plus the cicadas are now out, and i've heard stories about the sound of cicadas driving people over the edge.

Looking forward to getting REALLY into job searching- i'm actually getting excited about this, unexpectedly!

The Evil Plan

So...I'm a month from graduation...still no job offers, but then, we're in the middle of a TERRIBLE job market. Therefore, my parents (well, my dad, since he's some kind of evil reclusive genius) have come up with A Plan. This plan involves several aspects of my life: I will live at home with them-( yay! i get to cook! grr! i have no social life!), and spend 8 hours 5 days a week making contacts, and doing a real job search that will also gain me contacts within my profession. This is how dad got his job, and i KNOW it works. At the same time, I will be getting up at 0530 every morning, and exercising for 2-3 hours a day, 5-6 days a week, both going up the Mountain (its quite a small mountain) and doing pilates, and so forth, so as to be "as marketable as possible). With grudging acceptance, I have realized that he's probably right- though I'm not huge, i'm quite certain that if i were in STELLAR shape I would get away with more. :-p Dad calls it "stacking the deck in your favor".

One of the key factors in this plan is that Dad has consistently stressed that I should NOT just take "anyone who will hire me", because that will likely make me miserable. Instead, I should work all the contacts I can get, and hold out for a job I will LOVE, and be psyched about every single day. He has a point- why would I put in all this work and money to be miserable?

Therefore, as this plan goes forward, I will be blogging it. Think of it as Crash Course In Nursing, Part II- The Search for the Perfect Job...coming in Mid August to a monitor near you!

Nursing Skills- I have some of them

In nursing school one is expected to learn nursing skills. This should be self-evident. By graduation, there is an entire catalog of skills you are expected to have mastered. Now, nearing graduation, I feel compelled to make something of a list, both of those skills I actually HAVE, and ones I only have in THEORY. The reason for this dichotomy is that, shockingly, there is never a guarantee that you will be able to practice a skill in nursing school on a real patient while still in school. You have to be assigned a patient who NEEDS you to perform a given skill, and that's never a given. It does, however, keep you on your toes, as you never know if THIS will be the day you need to perform a skill you learned a year ago and performed once, on a dummy, in a lab. Also, most of these skills tend to be "sterile field" skills, just to make you even more sure you'll kill someone.

1. Catheters- The Theory- a nurse should be able to catheterize just about anything
In Reality- I am comfortable placing straight-caths for urine, in women. I have NEVER placed ANY catheter in a man, and I've never actually done a Foley. This is because the only patients available who NEEDED Foleys were men, chronic foley-users, who had some sort of obstruction or problem with said Foley, and no-one wanted me mucking around with it. Therefore, I live in fear.

2. Suctioning- The Theory- A nurse should be able to do oropharyngeal, nasopharyngeal, and, I assume, MAGIC suctioning with any kind of tube set up, through trachs, ET tubes, adjunct airways, etc.
In Reality- I can do non-emergent Yankauer suctioning and trach suctioning with one of those in-line setups relatively well, and have done it on many occasions. I have yet to do emergency-Yankauering outside the ambulance, and have NO idea if my technique is ok. I have never suctioned an ET tube, and still am convinced I'm going to cause a lung to collapse.

3. Wound Care- The Theory- Nurses, armed only with a set of vague orders "cover with dry sterile dressing (DSD)" should be able to come up with a spiffy dressing setup that prevents infection, decreases healing time, and makes the patient look like a rockstar. The nurse should also apparently be familiar with all sorts of epiffy expensive gear.
In Reality- I can actually do a dry sterile dressing job pretty well, if the wound is fresh (like a recently evacuated pilionidal (sp?) cyst, or on a patient whose wound has been previously dressed by someone competent, so I can just re-create their work of staggering genius. I have NO idea, however, how to choose which kind of dressing, aside from the general theory of "if it's wet, dry it. If it's dry, wet it", and "DONT EVER LET IT LEAK EVERYWHERE". Given the option, i will cover everything with 4-by-4s and tape. Lots of tape.

4. Assessment- The Theory- Nurses should be able to complete a physical assessment on just about anyone, note minor as well as major changes, bring all this to the attention of the proper physician, and catch tiny warning signs before the patient even knows they're sick. They should always be thinking 4 steps ahead to the implications behind each test result, and have plans in place for contingencies.
In Reality- I can do a pretty kickass physical, if I do say so myself. I'm good at details, and I've gotten REALLY good about asking history questions for clues to possible Very Bad Things. I cannot, however, think more than 1 step ahead, and still regard Real Nurses with superstitious awe.

So that's where I am!

Home Health Firsts

Home health, while NOT my favorite part of nursing, nor something in which I would like to make a career HAS given me a few "firsts". On Friday, I did my VERY first non-supervised wound dressing on something other than a fresh suture-job. On THREE pressure wounds on the same guy, who ALSO had a colostomy. And lived in an exceptionally bad neighborhood. In a house that was LITERALLY falling apart (wet carpet you were sinking into, as if the floor was giving out underfoot, ceilings and walls pulling apart, etc.)

I was proud of myself for doing it, but i was TERRIFIED the whole time. My partner and I got assigned to a nurse who works in BAAAAAAD parts of the city, and we, taking a few of her patients by ourselves, were therefore right in the thick of it. I'm a country girl (not in the southern twang sense, in the "oh look, bears and moose" sense) from an area where People Do Not Get Shot, except in the occasional hunting accident, or by shooting themselves. Nor are stabbings common. Carjackings are virtually unheard of. Therefore, even though statistically the likelihood of getting attacked personally is low, its still scary as hell. But I made it, my last day is tomorrow, and I'm following Hospice around, so its not like I can get into any trouble.

My Mistakes: Unfortunately, the VERY first day we had patients, our professor chose US as her group to supervise. I almost forgot to wash my hands (in FRONT of her, I'd purelled the heck out of them about 5 minutes earlier), and I forgot to make the patient sign for the visit, necessitating our driving around the block and coming back. I was SO embarrassed, and not a little annoyed, because I had given my PARTNER all HER cues so SHE wouldn't forget, then she COMPLETELY FAILED TO HELP ME AT ALL. She apologised afterwards, but said "i was just so relieved to be done with MY patient!" Grrr...i sort of think she just wanted to look better than me...which is a terrible thing to say, but there you have it. I didn't know her before this clinical, we were paired randomly. Grmph.

Hiking Safety

One of my very favorite non-nursing activities is hiking, and I'm training to do Wilderness Search and Rescue. I guess the love of the outdoors runs in the family, since my "little" brother actually has a JOB in the outdoors. We've been discussing people getting injured and putting themselves in danger for a while, and I thought, since it's summer, I'd just post some general tips for not making yourself into a statistic in the great outdoors.

1. Pack an Emergency Bivy. Emergency blankets suck. I've used them on car accident victims, and they blow off in even a light breeze. Invest in a "bivy sack" for emergencies. They're under 20 bucks, and TOTALLY worth it. It's basically a metallic sleeping bag-style sack that's orange with reflective stripes. If you were to be caught out or hurt you could climb in WITH all your gear, and survive the night, or wait for rescue. REALLY WORTH IT.

2. LOOK AT THE MAP BEFORE YOU GO. The main reason people call for rescue in MY favorite mountains (the Whites) is that they overestimate their abilities, and get "exhausted" before they make it back to the trailhead. If you've never done more than a mile or two, DON'T plan on going THREE miles to the pretty waterfall without remembering that it's ALSO three miles BACK. If you DO call for rescue, (and can GET a cell signal) it could be some hours before people can get to you. Rescuers are volunteer, and a crew may have to get out of work, pack their gear, and hike in from quite a distance, depending on where you are. Therefore, MAKE SURE YOU CAN SPEND A NIGHT OUTSIDE. If you're not critically hurt (fell off a rock wall climbing, stomped on by a moose, fell in a stream and broke your leg, etc) you should be prepared to spend a solid night outside before you could be rescued. If simple exhaustion is your problem, think about this- IF you could wait overnight, would you THEN have enough energy to hike out? If this is the case, DO IT.

3. Backpacker.com has a good list of hiking essentials, but my top gear list would be the following:
NON COTTON clothing (cotton does not insulate when wet, and is heavy)- shorts and teeshirt
-raincoat and pants (dont need to be expensive, but need to keep water out)
-fleece jacket of some sort (the cheap ones work fine)
-iodine tablets (in case you have to be out there a while, to purify water)
-an EMERGENCY BIVY
-headlamp (seriously, dozens of people every year need rescue because "it got dark out"...BRING A LIGHT!)
-hat and gloves
-plenty of water

that's the minimum. hike in peace, and enjoy the outdoors!!!

For New Nursing Students (Some Advice)

So I've only got 2 more months (actually, slightly LESS at this point) of nursing school. I figure that this is an excellent opportunity to tell all you (theoretical) incoming nursing students a few things I've picked up in the past 2 years which I hope will help you.

1. PAY ATTENTION IN ANATOMY & PHYSIOLOGY!!! - I know you might hate it, I know it's occasionally boring, but dear lord, SO much of what we learn in nursing classes is predicated on the fact that you KNOW your A&P. For example: you have a patient with a heart condition like a-fib, and are giving a medication for it. You need to know your A&P to know HOW the heart works, WHICH parts are the atria, what a-fib IS, and why it is that a particular medication's action HELPS with this. If you snooze through A&P, it's going to SHOW when you take nursing classes.

2. PAY ATTENTION IN CLASS- I recommend NOT using your powerpoints on the computer. Either print them out and take notes on paper, THEN transcribe to computer, or just take written notes (which is what I do). This way you will have NO excuse for getting bored and going on facebook, looking at lolcats, or IMing your friends. Seriously, you're already SITTING THERE!!! Think of it as built-in study time, and pay attention! Worst case, it means you're bored, but have SEEN all the information AT LEAST ONCE!!! I cannot overstate how important this is. The kids who were on facebook the most in my class had the lowest GPAs. Just saying.

3. You are NOT alone- when you start out in nursing school, you have all these horrible visions in your head of killing your patients, of patients with their intestines coming out their surgical site, etc. Even if your patient DOES code, or dehisce (have their wound pop open), THERE ARE ACTUAL PROFESSIONALS AROUND! And fellow students! You can ALWAYS call for help.

4. You and your classmates are a team- deal with it. You're all in this together. And in clinical, you and your clinical-mates HAVE to work together. I had this one HUGE Patient, very complex, lots of work. SIX of my classmates teamed up with me to bathe, turn, change, and fluff his pillows. We were done in 10 minutes FLAT. Then we ganged up on the other patients. It made a VERY tough workload a piece of cake. DO NOT underestimate your classmates. Some of them might have picked up random skills that will really help you. They are also invaluable when you forget your stethoscope or drug guide.

5. There is ALWAYS time to pee- unless you are actually DOING COMPRESSIONS OR BAGGING A PATIENT, there is time to pee. Don't get into the habit of denying yourself basic physical needs like a quick bathroom break, or ducking behind the nurses station or into the breakroom for a bite of a powerbar or a drink of water. You wouldn't deny these things to a patient without a damn good reason, don't deny them to yourself. Masochism is SO counterproductive.

6. You will get through it. Really. Then you'll be panicking about job searching instead. :-p

Intro to Summer

When you're a cold-weather person like me, hot weather is The Devil- until this year I have rarely slept in weather where it stays above 70 at night. This just...doesn't...HAPPEN at home very often- even when we lived in the Big Scary Desert for a year the temperature would PLUMMET at night to a nice comfy 55 or so.

With the weather this hot, it's time to make sure everyone remembers that Summer Is TRAUMA season!!! Everyone is outside, even if just out on their porches, and the more people out and about, hot and cranky, the more assaults there are, on top of all the usual barbecue accidents, near-drownings in pools, dehydration/heat exhaustion/heat STROKE incidents, and just plain stupid decisions.

One of the big ones in this weather to remember is: If you know any elderly people, CHECK ON THEM FREQUENTLY. They may not sense temperature appropriately, and may forget to keep themselves hydrated and properly electrolyted...(is that a word? I'm going to say it is.) which, given that older people are frequently on electrolyte-sensitive heart medications, is a PROBLEM. Therefore, CHECK ON YOUR ELDERLY RELATIVES AND NEIGHBORS!!!

Also, make sure to REAPPLY your sunblock. My parents both have horror stories from the early '60s, when it was considered "not vacation yet" until they had sunburn-induced fevers. Let's just NOT repeat their mistakes, m'kay?

First day of home health tomorrow- orientation at the place (Way Catholic Home Care)

The Climate

This week has settled it. No warm climates for me, unless they come with a GUARANTEED constant sea breeze. Good lord, it's been HORRIBLY hot for the whole week here, and I feel like I'm melting. Really really melting.

As a result, and the temp being almost 90 all week (if not above), my brain isn't working. Coherent posting will resume when the weather breaks.

Home Health Intro

Okay, yesterday and today were my orientation for my VERY LAST nursing classes (of my BSN). Here's what I have learned so far about home health:

1. We may be going into Bad Neighborhoods, but, in the words of my professor, "I don't care how much you cry, or if your parents call the dean. You are GOING to your assigned locations, or you don't graduate. So deal."

2. Wound / ostomy care is SO not going to be my specialty. It's not very fast paced, and, frankly, it smells bad.

3. I am most definitely going to get lost trying to get to these people's houses

4. It is UNLIKELY (but in no way impossible) that people will have guns sitting out on tables. If they do, ask them politely to put them away. This has only happened once so far to my professor.

5. This is going to be a long three weeks if this heat doesn't break...its REALLY FREAKING HOT here.

Falls

So up here in the Not Currently Frozen Northlands (it's supposed to maybe hit 90 today...ew) trauma weather is in FULL swing. I do not have a problem with this, as trauma is something we can FIX (sometimes). Yesterday I was dressed nicely, for me, in a cute scoopneck and jeans with a great necklace coming home from doing chores with my mother when she spotted M, one of our EMTs going past with his lights on, back to the station, 200 yards away. I spun the car around, and hopped into the rig with M, and NO idea of what we were actually responding to...a FALL FROM A HORSE!!!

The woman's only complaints were pain at the costo-vertebral angle and both wrists. She hadn't really moved much, but we could clear her C-spine, and only short-board her. M and I were really only worried about her kidney...only time will tell!

In Which I Clean Up My Act

During the semester, my apartment (flat, for any Brits) often appears as if a small tactical nuke has detonated in the center. It's never DIRTY, but stacks of papers pile up, especially patient records that I keep so I can shred them properly. So now, with my parents coming into town tomorrow for "graduation" (I dont ACTUALLY graduate until August 2) I find myself having to dig through 3 months of accumulated debris...some of it hilarious.

Case 1. Patient notes I took on a post-partum patient before I actually knew what half of the abbreviated words MEANT. Therefore, there are statements like "she was induced for postdate and she's a TPAL 1122" with notations like "post what?" and "what does TPAL mean? How many kids is that?" Now i know that "postdate" means the docs started her labor because she was after her due date and hadn't given birth. TPAL is a way of noting Term (t) Preterm (p) Abortions (misscarriages or therapeutic) (a) and Live children (L). Sometimes, as I learned, the numbers DONT add up, then you have to go in and ask the patient to repeat HOW many children she has, how many times she's been pregnant, et cet. Very odd.

So now, as I move on to Home Health (shudder) and Health Promotion (postpartum unit, as it turns out) I realise just how much I learned in the past few months. Woah.

In Which I Have Seething Rage

Dear VeryCatholic University,

I understand that our health promotion and home health class begins June 2nd, and that we have VACATION until then. Therefore, to email me TODAY and tell me i need to research and write six pamphlets before MAY 24th to then EDIT AND FINISH THEM before June 2nd, and PRINT 50 COPIES OF EACH AT MY OWN EXPENSE all on my vacation

is not ok.

No, in fact it is WORSE than not ok, it is unethical. The university isn't actually OPEN, and we need to have our site approved, which might take another day or two. This means we actually have more like a week and a half to do OUR ONLY PROJECT for a semester that DOESNT START YET and for which I will not be GRADED until August 2nd.

Furthermore, I have WORK lined up for the next few weeks, AND i'm TRYING to...um...GET A JOB! Plus, my financial aid still hasn't come through. Again.

So yeah, VeryCatholic University. Just TRY calling me again for a "class gift". I think I'll just go cry now.

Enjoy Your Stay

Over my past few shifts in Mid-Size Non-Trauma Center, I have noticed a few common questions and requests from patients that I would like to address:

1. "Can I have something to eat/drink?" - This is a perfectly reasonable question if you've been in the ED for a few hours, and haven't been allowed anything pending test results or some such. It's going to SERIOUSLY PISS ME OFF if it's the first thing out of your mouth when you walk into the ED. Here's why: if you've WALKED into the ED, you got yourself to the hospital. On your way, you passed LOTS of places to get a drink of water/juice, or a snack. If you're sick enough to be here, your snack should really NOT be your primary concern.

On the other hand, i make plenty of exceptions for: people brought in by ambulance, especially for fainting- maybe hunger or dehydration MADE them faint, so I'll do my best; Pregnant women- snacking helps with morning sickness, i get it; The Elderly- sometimes they have been brought in without much input on their part, and havent eaten in AGES.

2. "When will the doctor be here?"- Another question that sounds perfectly reasonable, except when whined repeatedly by someone who came in for narcotics over FOUR HOURS. The doctor (nominated for sainthood) had checked on him EVERY TWENTY MINUTES, but he still felt it was unreasonable that the doctor "wouldn't really help"- the doc exhausted like, 7 DIFFERENT pain management techniques INCLUDING a lidocaine patch, toradol (allergic, but not to codeine with tylenol, or to vicodin), pain management referral, etc. I was sorry that he was in pain, but...we cannot just keep giving him narcotics for his complaint of "the last doctor pushed REALLY HARD on my abdomen and it hurts". Seriously, try a heat pack. The doctor even went in and explained "i think you have a problem with narcotic addiction, and I would like to refer you to somewhere for help". The patient spat at him and left.

3."Can't you just look it up?"- with regard to medications the patient is taking. The emergency departments of the world do not, as a rule, have access to magic 8 balls, or necromancy to divine patient records from world war 2, other states, other hospital systems, or other planets. While this DOES put the burden on patients to know what they've taken, what they're allergic to, and if they still have an appendix, until we get a centralized national system patients are just going to have to try to help us out. Again, free passes are given for people too sick to remember anything, 90 year olds taking 40 meds with memory problems, or anyone unconscious.

Death 2, Alpine, 0

Today was another fine day in Mid-Size Non Trauma Center's ED. Coffee in had, I stepped bravely into the department following a TERRIBLE night, waking up every hour with a recurring nightmare that I had overslept and gotten thrown out of clinical for tardiness. Auspicious start to the day, I must add.

Upon arrival my coffee and I were shoved into the doctor's dictation closet, because JHACO/TJC were expected to do an inspection of Stroke Center Procedures, and Coffee In Public Areas is not permitted when inspectors are present. Seriously, I think that medical and nursing professionals without ready access to coffee are a FAR bigger danger to their patients than coffee cups on the nurses stations. I mean, we're talking about alertness here, people!

Death's first victory was an elderly woman, past 80, who came in with mild stomach pain and more serious back and flank pain, presenting with an inability to get up off the couch. COPD? No. CHF? No. Diabetes? WRONG AGAIN!!!

AAA. Yes, an abdominal aortic aneurysm (never seen one before!) of 7cm, already popped. According to the (VERY excited) doc, she was currently stable because a clot had formed over the popped bit, rendering her sort-of hemodynamically stable-ish. No problem. We know JUST what to do with her- a quick-as-HELL trip up to the OR! Or...not. See, she was a Jehovah's Witness, and they cannot accept blood products, which obviously sort of limits the operating rooms that are willing to take a shot at an operation that ALREADY has a greater than 50% death rate. Half an hour of frantic phone calls later and one of the Large Impressive City Hospitals agreed to try a "bloodless" surgery on her. We managed to keep her alive out the door, and she actually survived the surgery, much to our surprise. Unfortunately, she suffocated 10 minutes later from a hemoglobin of .8- she literally had NO blood cells left, and was circulating saline. Even though I don't necessarily understand her beliefs, I have to admire how she and her family stuck to their beliefs in the face of death.

Death number 2 was much less exotic- a code that really had died at home, with paramedics working him on scene for HALF AN HOUR without ever getting a rhythm back. His family refused to let the paramedics pronounce him, and insisted on a hospital transport. I'm not really sure how that works, legally, but they were still coding him when he arrived, and were getting a VERY nice waveform on the monitor, complete with femoral pulses with compressions. On the other hand, his skin was mottled and grey-green. While part of me grieves for the family, and can understand that "letting" the paramedics call time of death would make it all "real", the rest of me wonders how they could have thought that he was anything other than dead. Live people don't look like this man did. I've seen living people, dead people, and dying people- even the woman with NO BLOOD LEFT, for all her pallor, still was unmistakably alive. This man was, just as unmistakably, quite dead.

I just hope that someday soon I will actually see a SUCCESSFUL code. Death, next time I'M cheating.

That's Just Unsanitary!

Friday was another 12 hour shift in Midsize Non-Trauma Center's ED, and while there were only two people I would actually be able to label "True Emergencies" all shift, there were some VERY interesting cases in other ways, which was impressive given that when I walked in at 645, there were NO PATIENTS IN THE DEPARTMENT. I curled up on one of the swivelly chairs and DIDNT SAY ANYTHING for fear of jinxing it, but as predicted, the "quiet" (oh no! i typed it!) only lasted about half an hour.

The first truly bizarre/awful case of the day was a 500 some-odd pound man, brought in for, ironically "failure to thrive". This MUST only be a social designation, since in neonates "failure to thrive" means they're LITTLE...not this particular gentleman's problem. His problem was bilateral cellulitis of the lower legs. REALLY GROSS cellulitis of the lower legs. They were wrapped in biohazard bags by the medics, who promptly ran outside and started shaking their clothes off on arrival...which is NEVER a good sign. Apparently this gentleman had ROACHES LIVING IN HIS SKIN FOLDS.

The truly odd thing about this large man was that he was COMPLETELY LUCID, and convinced that we were "making a big deal out of nothing!". He was caked in dirt, apparently from "pulling himself across the floor" which he didn't seem to think was a problem in and of itself, and was FURIOUS that he'd been taken out of his house. It took us (me, my partner and three Real Nurses) almost an hour to get him all cleaned up. He was really quite polite, and seemed lucid, albiet with a HUGE blind spot about how bad his house and hygeine really were. He was admitted to med-surg, for placement in assisted living, and may lose both his legs to gangrene.

I learned that the smell of gangrene actually does not upset me nearly as much as I had originally thought. Good to know! On the other hand, I have also learned that I will be itching for the rest of any day when a patient has bugs.

Its tough to know how to feel about a patient like this- on one hand, you KNOW they cannot take care of themselves, because...well...he was dragging himself across the FLOOR in a filthy house! But on the other hand, now we're taking away all his perceived independence. Tough call.

Finals

In senior year at Very Catholic University, finals are EARLY. Today i had both my Ob-Gyn test (the FINAL for OB/Peds is TUESDAY) and my FINAL in Leadership/Management. This is because MOST people have their leadership clinicals next week...unlike me, and I'll be FINISHED for the WHOLE SEMESTER on the 30th of April. Yeah. Next week. Then all I have is Home Health / Community Health this summer.

So I'll be (NCLEX willing) A NURSE at the end of July. Yes, JULY. THREE MONTHS AWAY.

I'm sort of scared now.

Cootie Shot

So I've now spent 3 fridays at Mid-Size Suburban Hospital's ER/ED, and there are two patients, very much alike, who have me wondering one simple thing:

Is it REALLY that hard to avoid getting Syphilis?

I mean, although it's an EXCELLENT learning opportunity for ME to give large IM injections of painful antibiotics into the butts of young men, it CANT be a good sign that this many of them are presenting with "testicular pain", burning on urination, or REALLY REALLY OBVIOUS SYPHILIS CHANCRES. One of these young men (23 or so) BROUGHT HIS MOTHER WITH HIM. That must have been one interesting conversation...and makes me really wonder- if he's that big a mamma's boy, why didn't she teach him how to avoid these things?

The OTHER unfortunate young man had his syph shots and promptly went into anyphylactic shock. The intern LOUDLY says, at the nurses station, "well that's ONE way to teach someone about the dangers of STDS!"

So really, people, WEAR A CONDOM. Because as much as I appreciate the practice, your butt is going to be sore for a week.

The Month From Hell

More accurately, the week from hell. First, for most of this month my blog keeps trying to send me to another website when i try to view it, and i'm HOPING that it has been fixed so i can start posting again.

Just THIS week, i have been through the following: During my Leadership Clinical in the ER i had to pick up a miscarried placenta from the FLOOR (it done fell out) while comforting the poor woman it fell out of, find a jar with formaldehyde to put it in, then got yelled at by the woman's nurse who WENT MISSING FOR AN HOUR while this was going on, but was upset that the charge nurse had had ME take care of it, since it was "her patient". Sorry, wasn't going to leave the placenta on the bathroom floor. Seemed unsanitary.

Then, THREE WEEKS after my observation day in the NICU, a nurse said i told her i did something REDICULOUSLY stupid, which i didn't do. Like, never get my nursing license and possibly get sued stupid. And i didn't do it. So yeah...i'm still panicked that i'll get thrown under the bus for this, even though it was just a miscommunication where the nurse thought i said i did it, and i was ASKING if one would do it, and i hope my instructor irons this all out. Of course, at THIS point, i dont REMEMBER what exactly i said, because IT WAS THREE WEEKS AGO.

THEN, now that i'm completely emotionally a DISASTER AREA, i decided to get my hair trimmed, so i could pamper myself a bit, and feel better. Besides, my hair hasn't been cut in 4 months.

She ruined it. It was a simple, slightly layered shoulder-blade-length cut, and now she cut MOST of the hair short, but left a FEW long pieces...basically the OPPOSITE of what i asked for. My hair has a SHELF. I'm now in tears AGAIN, and have to wait to drive home to my parents to have my MOM'S lady try to fix it, which will probably involve trying to make it look like Ginnifer Goodwin's in "He's Just Not That Into You", because it's too short to do anything else.

I think i need a hug...and for this to be fixed. I'm afraid they wont let me be a nurse...AND i have bad hair!

OB-STOP BEING DISCOURAGING, DAMMIT!!!

Yes, I'm pretty psyched to be doing my OB rotation and Major Urban Medical Center...but boy are they ever INVASIVE with their patients! I did TWO straight-caths on one woman in labor (to be honest, the pt. asked me to, since she couldn't feel her bladder what with the epidural turned up so high)...and every time I have spoken to about half the nurses about natural childbirth, they laugh and tell me "oh sweetie, you don't know what you're talking about. The pain is like NOTHING you can imagine! Don't get your hopes up when you have kids someday! You WILL get the epidural!"

This is why patients come in panicked, at 2 centimeters, with the baby floating high, begging for an epidural "before it gets bad". Because we get told we CANNOT POSSIBLY deal with a natural childbirth.

My mom did TWO- myself and my brother. She says yes, it DOES hurt like hell, but being tied down would be WORSE, and anyway, it went faster since she could walk around.

Seriously, what's with tying all the women to the bed with the heart monitors? They're healthy, they're young, WHY DO THEY HAVE TO LIE THERE? Is the world going to END because we cannot see everything for 10 minutes? Is it?

Although I'm gaining a LOT of experience fast, this place makes me NEVER want to have kids- it seems a lot like they torture women for the hell of it.

Time Flies When You're Up To Your Eyeballs in Work!

So spring break FLEW by! I have an interview for the Job Of My Dreams next thursday, it's an ER internship up in Vermont (i really really really want it).

I also had my first day at Really Big Philadelphia Urban Medical Center for OB. It was pretty cool, but I have a strong (STRONG) feeling I'm going to spend a lot of time biting my tongue about unnecessary interventions into uncomplicated labor.

On the bright side, we apparently get lots of really "interesting" cases, and when I said that ED was my dream job, she said "well by all means, if someone codes, or we get a hemorrhage, jump right in and work them!". This is the very first time an instructor has given me blanket permission to assist in an emergency beyond "push the help button". I mean, a hemorrhage, as far as we students are concerned, mostly means "push the help button with one hand, massage the uterus with the other"...but its still a step up.

We did a newborn exam on a baby in the nursery...rather a suprise when we unwrapped him- POLYDACTYLY!!! (SURPRISE! EXTRA FINGERS!) They looked like tiny little cat-toys dangling by skin tags off the distal side of each pinky. VERY cool. This bodes well for the rest of the semester.

OH! and yesterday I found out that i got an EMERGENCY DEPARTMENT PLACEMENT FOR MY LEADERSHIP CLINICAL!!!! WHEEE!!! It's not a trauma center (none were available for placements), but i got one of only 3 spots for the whole year. GO ME!!! The downside: its 12 hours every friday until may. Yeah. My workload just went up again.

Something Every Man Fears

Today I pulled at the Campus EMT squad, for lack of a car. I slept there last night, so as not to miss my 0830 midterm this morning due to inability to get there on time...and just stayed, because we're kind of having another snowstorm, and why not.

Our first call of the day was both wince-inducing and possibly a real emergency. It was called in to us from the student health center as an "abdominal pain" which turned out, when we got upstairs and got accosted by the questionably skilled nurses, to be TESTICULAR pain, possibly a torsion. A testicular torsion is A Bad Thing. In fact, it's a surgical emergency that has to be corrected pretty damn quick, or you lose the testicle involved to ischemia. The poor kid was really scared, and I don't blame him. I DO blame the nurse, who kept us outside the room for a minute, telling us "dont ask him any questions or examine him, just take him to the hospital. He's embarrassed".

No. If you want a TAXI, you call a TAXI. If you call an AMBULANCE, you get asked questions, vital signs taken, and assessed for any immediate problems. Can you imagine if an ambulance pulled up at the ER, and just unloaded the patient to the ER nurse saying "well, we dont actually KNOW what happened, because we didn't want to embarrass the patient. No, we didn't look at it either, cause the nurses at school said not to!"

The patient himself was quite cooperative, although he did refuse a physical genital exam- two women on the crew, i'm not sure I blame him, it's only a 5 minute hospital transport. i DID manage to elicit a possibly important history though- when he was a baby he had an inguinal hernia repair on the OTHER side...maybe this is just a hernia, not a torsion! I do feel sorry that he was embarrassed, our driver S is a guy, and he was practically wincing the whole way to the hospital, in sympathy. Still, better a little embarrassment NOW than a bigger problem later.

So there you have it. EMTs DO try to assess their patients. If you want to just get a ride, call a friend or a taxi. We're better than that. We'll try to help save your life if you give us a chance.

When it rains...

Yesterday afternoon my car decided to stop working. I was planning on being home by now, up in the Frozen Northlands, but I decided to make a food run for road supplies, and my car stopped shifting gears. I drove my poor little Civic straight to the dealership down here, and they diagnosed my brave little car with having her wires chewed through by mice. It's going to be 500 dollars to fix. Dammit. I really don't have the money to spend on it, but no choice. I need my car to work, so...there you have it. Really hoping I can pull some calls as soon as i get home, to earn some money to make up for it. Grr...

Done With Pediatrics

Today was the last shift of pediatric rotation. I learned a lot about human development, I played with some cute kids, and World's Greatest Children's Hospital was MARVELOUS as a placement- the equipment all worked, the kitchen was stocked, the staff was top-notch- but I'm glad to be done with it. Floor nursing just isn't for me.

Today I had a mixed bag- one GREAT patient, one Exorcist patient. The great patient was a 10 year old girl, one day post-op for a splenectomy, who let me get her out of bed (in spite of some serious pain) to help her to the bathroom, let me take her to the play room (she needed to sit up straight for a while to prevent Acute Chest Syndrome), and basically coped pretty well with her treatment, said please and thank you, the whole bit.

Her roommate, a 10 year old girl, needed FIVE NURSES to restrain her to take ONE ORAL DOSE of a not-bad-tasting medication. she simply did not wish to take it. she took it yesterday, without a problem, said it didn't taste bad, but today she was clearly possessed by DEMONS. she spat at the nurses, tried to bite, and basically was AWFUL. her mother just stood by the bed saying "she likes to play". Clearly this is where she gets her fabulous attitude. I asked the mother to either help us get the meds in, or leave the room. She refused to do EITHER, and just stood there laughing as I got spat on and kicked, and the doctor got punched in the chest. He had shown up when the kid started screaming, to lend a hand.

Next is OB. Hopefully less kicking.

Conversion Disorder

Conversion disorder is when someone (usually an adolescent, and female) takes some sort of outside stimulus (school bullying, or puberty, or nerves, or whatever) and manifests it as physical symptoms.
ALL nursing students suffer from a bit of this, when we worry ourselves sick, or we give ourselves headaches, convinced we're failing a course. This is not a disorder.

A patient today DID have the disorder. Breaking the odds, he was male, 13 years old, good student, all that. And he was dizzy. REALLY dizzy, especially when he stood up, or was made to do anything he didn't want. Suprisingly, even sitting up or standing or walking, he had NO problems, as long as he was goofing off, or talking on his cell, or looking for snacks. Assess him, or let anyone in a white coat enter the room, and suddenly he was "super dizzy, weak, and unable to stand on his own".

I feel bad for the kid. If he had an organic problem, there'd be an easier fix...with this, he's got to use meditation and biofeedback, and possibly wait to grow out of it.

Modern medicine mostly sucks at behavioral conditioning...except when it involves training people to take medications...

Age Differences

The strangest thing about pediatrics is the developmental difference between our patients. In adult medicine, even if two patients have ages 15 years apart, their care remains pretty much the same. A 65 and and 80 year old heart attack patient are treated with the same drugs, in the same approximate amounts, with predictable effects.

In pediatrics, on the other hand, it is possible to have EXTREMELY different patients. Today, mine were 2 years old, and 18 years old. One pulled at my earrings, and tried to RUN AWAY from the blood pressure cuff, the other was worried about missing his chemistry class.

It's actually kind of amusing, once you get past the shock of going room to room and adjusting speech patterns and priorities by age. For the teenagers, you need to emphasize (against the express dictates of Very Catholic University) sex education, good decision making, and independence. For the toddlers you focus on SIMPLE choices: "do you want the BP cuff on your ARM or LEG?" or "temperature BEFORE or AFTER I count your pulse?"

All in all, I like pediatrics, except for the teens in Status Dramaticus. They drive me NUTS! After all, if your pain level doesn't CHANGE after you've received a MASSIVE dose of painkillers that makes you REAAAAAALLY high, and you STILL rate your pain level as "the same! 10!", what would the point be of me giving you any MORE pain meds? If you're breathing at 6 when you sleep, due to the sheer amount of narcs, we CANNOT give you more! Plus, don't think I didn't notice that when I was not within view, you were giggling, laughing, eating a FULL lunch, and chatting with your friends about how you were SO getting "the whole week" off from school. Yeah. I told your doctor. :-p

My So-Called Snowpocalypse

I spent an unintended 24 hours on call yesterday afternoon into today at the ambulance. I left my car at the squad building Tuesday night, intending to pick it up Wednesday and return it to my apartment building after we were plowed out, walked the mile from my apartment to campus yesterday afternoon aaaaaand...promptly got told NOT to walk back, as it was quite windy and snowy out.

Since I only had half a change of clothes (so that I'd be dry after I got there), I had to run upstairs to the student health center and borrow a set of scrubs from the nurses (they keep a supply for sick students to wear) to wear as pjs. Then we realized that the ambulance was grounded (only allowed to move in an emergency) which meant WE were stuck in the building too...except for me, as I wasn't officially ON duty...so I wound up tramping across campus to a dining hall, and scrounging food for the whole crew. They were WONDERFUL, and gave me about 5 POUNDS of chili-mac and cheese...plus apples, crusty bread, and dessert. FABULOUS.

We only had one patient, in spite of the massive amount of partying expected on campus, due to classes being canceled for today as well. We attribute the LACK of mayhem to the fact that everyone drank heavily TUESDAY night, in anticipation of having classes canceled WEDNESDAY....except that YESTERDAY, the liquor stores were closed. This meant no-one could restock on alcohol, so, being an intemperent bunch, most of the students were OUT OF ALCOHOL! OH NO!

A Guide for College Drunks

Hi, drunk college students! In the interests of making all our lives easier, here's a little advice:

1. When you decide to go out in the middle of the week, go EARLY in the evening, so that you can get wasted, stumble back onto campus, get picked up by public safety and taken to the hospital in time for the rest of us to get some sleep.

2. If an EMT tells your slightly LESS drunk friend to "please just stand over there and put on a coat, it's freezing", cussing the EMT out and muttering snarky things under your breath will NOT endear you to either Public Safety officers, or the other EMTs. Hint: either you dont mutter as quietly as you think, or you might want to remember that when you're drunk, you tend to lose inhibitions. I hope you enjoy the 500 dollar fine.

3. If you're going to lie and give us the birthdate from your fake ID, show a little spine and give your fake AGE too. If you give us a REAL under-age age, and a FAKE birthday, a little simple math makes you look even MORE like an idiot.

4. I know it's a cliche that you should wear clean underwear in case you get into an accident, but really, EMTs dont WANT to look at your underwear, so a skirt that is wider than your average belt would be great

5. If you're worried about a friend who cant hold their liquor, don't worry. We WILL come out and get you in the middle of the night, and do whatever it takes to keep them safe. Just...try not to let it get that bad. You guys might swear at us, and hate us, and think we're all out to get you busted, but really, we just want to make sure that all of you who go to bed get to wake up tomorrow, hangovers and all.

Entitlement

Yes, I know I've already posted today, but this was getting to me.
This evening, Very Catholic University (VCU) was playing a home game against Some Other University (SOU). This meant that the parking lot next to the Student Health building was PRIME parking real estate. Now at Collegiate EMS, we dont actually HAVE our own garage, we have a lovely set up with a massive parking space on the lower level of this covered garage, which we have marked off by cones as well as flourescent parking lines saying "NO PARKING- AMBULANCE" all over them.

Needless to say, as we are near the Home Stadium, the Health Services lot becomes "The VIP lot" during games, and VIPs tend to be...well...asshats. I spent AN HOUR AND A HALF this evening kicking people out of the CLEARLY LABELED ambulance spot. Once, I even had to go yell at a guy who made his 10 year old kid get out and start MOVING OUR CONES so he could park in the spot. I bounced out the door, ran over, and knocked on his window: "Sir! You can't move the cones! They're there to help you notice the 'NO PARKING- AMBULANCE' sign!"

"But..." says he, irritably, "all the other spots HERE are TAKEN!"

"The ambulance needs to plug in to this plug here, sir, or the epinephrine we keep on board freezes, and the next kid with a nut allergy dies in agony" I replied. Entitlement to VIP parking is one thing. Believing that you have a god-given right to park in an emergency vehicles zone? That's a whole NEW level of evil. Next time I'm not going to warn him, I'm going to tow his car WITH THE AMBULANCE...into the dumpster.

My Kingdom For An Accurate Dispatch!

Today was another episode of Fun And Games with the collegiate EMS dispatcher! This time, I was OVERJOYED to have a call for a -gasp- actual medical complaint! "College EMS, please respond to On Campus Nursing Home for a Really Old Dude with a witnessed syncopal episode!" 'WHEE!' I thought, 'an actual call! where I might be able to perform interventions! And help fix someone!'

No such luck. Upon arriving at On Campus Nursing Home (seriously. It's a nursing home, on campus.), we find Really Old Dude (ROD for short) sitting up in a chair, looking really lousy. "Hi, ROD!" I said with my best jaunty EMT grin, "I'm Little D, and I'll be your EMT today! When did you faint?" And that's pretty much when it all went pear shaped.

"Oh no, he never FAINTED!" Piped up the nurse at his side, "ROD got sick last night, and hasn't gotten better!" "Define 'sick' for me" I asked, warily. "Oh he's been vomiting, and having diarreha, isn't that right ROD?"

Oh great. Here we go AGAIN. "Ho ho ho!" Replied ROD, perking up a little bit. "Sir, how are you feeling?" I tried again, "You've been a good little girl! I'm feeling fine! Merry Christmas!"

Yes, ROD thinks he's Santa Claus. "ALTERED MENTAL STATUS" I wrote. "Um...ROD always thinks he's Santa Claus" interjected my partner. Peachy I thought to myself- nausea, vomiting, NO syncope, AND he think's he's Father Xmas. This is SO my day.

We dropped ROD off at the hospital as requested. This may be his last visit, as people with "Alphabet Soup" rarely do well. A SMALL sample of his PMH revealed the following: BPH, COPD, HTN, CHF, NIDDM, GERD, and PEs, and multiple DVTs, as well as at least one CVA.

This time the dispatch mixup was not all the dispatcher's fault. Apparently the nurses called in for a "Sick Episode". Seriously? A SICK EPISODE? What's next? A HUNGRY episode? This has to stop.

In other news, my morning at the Greatest Pediatric Facility In the Galaxy went extremely well.

The Importance of "Why"

Yesterday I was informed, by someone on my school EMT squad, that I should focus less on "why the patient has symptoms" and more on "just getting their vital signs and getting rid of them. It's not our job to care about WHY they have them". At first, I was only mad because of the implication that I wasn't doing my job well.

And then I started thinking- I'm angry for a deeper reason. I CARE ABOUT "WHY"!!! (not to mention, my blood boils every time someone tells me something "isn't my job" or "isn't my place"- it's like saying "don't you worry your pretty little head about it. just take his blood pressure, and we'll do the rest")

"Why?" MATTERS. Ok, a 24 year old woman calls 911 for chest pain and "palpitations". You COULD just treat the chest pain per protocol with aspirin, take her BP, run the vitals, but it matters WHY her chest hurts! Maybe her boyfriend beats her up, and punched her in the chest! Maybe she has Marfan's Syndrome, and her aorta is tearing open! Maybe she just had a fight with her mother, and is having a panic attack! Maybe she has a congenital heart defect! The symptoms themselves are just that - SYMPTOMS. Of some underlying PROBLEM. If we content ourselves as health care providers with putting bandaids on the symptoms, we are doing a massive disservice, both to our own intelligence and to our patients.

Take back the "why"! Ask questions! Join the resistance!

Babies

Yesterday I had a 34 day old patient. The problem with babies is, they're adorable, and make great patients. I was SO spoiled. Her mother changed her, cuddled her, and all I had to do was assess her, take her vital signs, and do actual LEARNING. It was wonderful. The poor little thing had mastitis. Yes, an infected BREAST. This is highly unusual, as...um...she was 34 DAYS old, not 34 YEARS, and breast infections are really really rare in people who don't even know where their feet are yet.

A little clindomycin seemed to clear it right up.

I'm still unsure if i want any of my own, but babies make delightful patients.

Cultural Competency

Today at Worlds Greatest Childrens Hospital I had my very first patient, an adorable 5 year old who only a spoke chinese dialect, and whose parents didn't speak english either. This may have contributed to the fact that this was her THIRD trip to said hospital in the past three weeks for asthma. THIS time, someone actually admitted her, and did a screening. She has RSV (its a virus that causes flulike and chest-cold symptoms in little kids. pretty much everyone gets it at some point or another, 80 percent of us before age 2) as well as her asthma. THIS time, REAL translators were brought in (hard to get them down in the ED on short notice for her dialect of chinese). Her parents were painstakingly taught about how to care for her asthma, and it was impressed upon her father that he MUST stop smoking in the house. Hope he takes THAT one to heart.

She was a BEAUTIFUL little girl, and HATED it when people used stethoscopes on her without her help. To "help" she would grab the bell end of the stethoscope, and move it across her chest. Thing is, she did it RIGHT, unerringly moving it to the exact spot I wanted. What a pro. I had the interpreter tell her she should study hard to be a nurse or doctor herself someday.

I hope life treats her well, she's due to be released tonight.

Student "Health" Services

I give up. I really TRIED to like our student health services nurses. Really. I'm still a nursing STUDENT, and it kills me to think badly of members of my profession-to-be...

But they're idiots. Over the past week we have transported no fewer than SEVEN students from the health center to the LOCAL EMERGENCY ROOM for complaints so non-emergent as to be head-against-wall laughable. These have included: 1 cut finger, three weeks ago, scab removed by the genius student, so it started bleeding again. (yes, but why do you need AN AMBULANCE?) 4 students with upset stomachs that the health center felt "needed further evaluation"- just a tip: THEY HAVE A STOMACH BUG, and a few other random things like "arm pain".

This is par for the course. We just assumed that, for liability reasons, they HAD to get cleared by the ER, and we had resigned ourselves to this state, until yesterday. Yesterday we were called up to the health center for a young female, fell three days ago playing soccer, and since then had been suffering MEMORY LOSS, VISUAL DISTURBANCE, an inability to focus on anything, sleeping 20 hours a day, and "when I close my eyes i forget i have hands".

The problem is, this girl had ALREADY been to the health center, the day of her head injury...and after taking one set of vital signs, they LET HER GO. Without even a friend to make sure she woke up frequently during the night.

My faith in their clinical judgment is shot, and now I feel like I have to keep even more on my toes so these idiots dont kill someone.

On another annoying note, someone has to have a chat with our dispatcher. For the last week, EVERYONE has been dispatched either as a "transport to the ER" (no, you cant dispatch us for that, you need to tell us WHY they need to go) or as a "sick person" (C'mon! HOW sick? Stomach? Head injury? Boo-boo?)

This ends now.

It was a LONG day

Yesterday started out "bright" and early at 520AM, as I blearily stumbled out the door to the school parking lot to meet my carpool. Then FIVE of us jammed into a compact car, miraculously surviving the Schuykill Expressway and getting to 5 East JUST in time. Since yesterday was Shadow Day, we were each assigned to a nurse, to "get a feel for what they're doing". My nurse was a new grad, and really wonderful. She was willing to teach me (my non-emergent pediatric knowledge is LIMITED) and fun to work with.

We had 3 patients, ages 6, 13, 17, ALL with sickle cell. Woah. The hardest part of taking care of the OLDER two patients was the persistent desire to smack both of them upside the head. They seemed totally uninterested in the world, but avidly watched the clock waiting for the magic q3hr mark, when they could get their beloved M.orphine bolus. Now I understand that this disease is RIDICULOUSLY painful. I understand that a vaso-occulsive crisis is actually causing ischemic damage, and is totally uncool. I do. I get it. But the parents wouldnt' even help us kick them out of bed! And they KNOW better. You see, if a sickle cell patient (or really, ANYONE) just lies in bed, Bad Things Happen. Bad things like blood pooling (which, yanno, makes the clotting worse), lung problems, pneumonia, Bad Things.

Even so, the mother of the 17 year old boy wondered if we could give him a BED BATH, because he "didn't feel like getting up". This is a boy who was scheduled for discharge today or tomorrow. And he wont get up and move, even though it is the ONLY thing that will actually help his recovery. His mother glares at the nurses, and wants TWO to be present for everything, including connecting saline to his IV. According to the nursing staff, this patient is a frequent flyer, and doesn't WANT to be discharged- home is lacking in room service, unlimited cable tv, and m.orphine. Go figure.

The bright spot in my day was my youngest patient. This little boy had a VERY low hemoglobin- low enough to need a blood transfusion. What was his reaction? "I had breakfast. I ate it ALL. I don't WANT to stay in my room, the other kid (the 17 year old) is BORING. Can we go play?" My reaction: "Lead me to the playroom!"
We made mutant Mr. Potatohead dolls, with airplanes for arms, AND invented obstacle courses to navigate one-handed (his other arm was wrapped in an IV-protector, much to his annoyance). This kid was unstoppable. AND totally hilarious. His attitude was "there's a giant playroom here, and my mom is here. Whatever you people need to do is ok, as long as I get to to play afterwards". He's awesome.

AFTER clinical, I ran home, showered, threw my stuff into a duffle, and went back over to campus for my overnight VEMS shift.

THREE BLOODY CALLS on a Wednesday night! First one was simple: fairly obvious tib-fib fracture, kid was in a LOT of pain, but still apologized for swearing when we picked him up (they're cute when they're polite). Second AND third calls: one young freshman girl, food poisoning. We took her from her dorm to the health services building, per the request of public safety, who were afraid she would puke in their car. THEN 15 minutes later, the health services nurses (we really need to have a chat with them) CALLED US BACK to say they "couldn't care for her" and we should take her TO THE HOSPITAL. Seriously. She'd vomited FOUR TIMES...and had admittedly painful abdominal cramping, but clearly epigastric, and she was currently menstruating, so that would rule out most appendicitis AND tubal pregnancy...so I don't really know WHY our nurses refused to keep her- except to wake us up TWICE in the middle of the night.

So I'm tired, and cranky...but feel VERY accomplished.

I was THAT kind of little kid

Over this past break, I got to perform TWO (TWO!) whole medical procedures BY MYSELF. Why? you might ask, would ANYONE let an unlicensed nursing student perform a medical procedure on them? Well, because my father hates going to doctors (45 minutes each way in travel time, and he claims they "never do him any good anyway").

When I got home for winter break, dad was complaining of severe ear pain, with loss of hearing, consistent with cerumen impaction. In other words, his habit of wearing wax earplugs at night had jammed lots of earwax together, and it was stuck deep in his ear. I knew this, HE knew this, and the doctor to whom he reluctantly dragged himself could see it with the otoscope. But this VERY new doctor had never actually TREATED a cerumen impaction by himself before, and didn't have the cool little wire tool used to dig them out of ears...but he did try. He told dad to get some Debrox, use if for 4 days, then come back and he'd try again.

It's really hard to put Debrox in your own ears though, due to head tilting, and the severe vertigo that can come from putting water in your ear...so I did it for him for two days. On the second day I was curious about something: Debrox is really diluted hydrogen peroxide, which is a liquid that bubbles. The ear canal can be straightened, by manipulating the pinna (outer ear)...ergo...I started playing with the ear, while instilling the Debrox, and squirting the ear canal with the bulb syringe (WARM water, thankyouverymuch)...when lo and behold...

THE BIGGEST MOST DISGUSTING THING I HAVE EVER SEEN IN AN EAR SURFACED!

Seriously, it was huge, like the size of several cashews. I have no idea how it fit down there. "EW!" I yelled, rather triumphantly, immediately hiding the thing from dad, who gets REALLY grossed out. "I GOT IT!" Dad cancelled his follow-up appointment, and has been telling everyone that I "might make a decent nurse practitioner someday".

I also got to give him his flu shot, the first he has ever consented to receive. My parents are so supportive they let me practice on THEM. :-D

Child and Family Nursing

Okay, I get it. Patient-centered care in pediatrics includes the parents. Really. I DO get it. The problem I have is when HALF of the slides on yesterdays powerpoint for class said that it was important to do "whatever the parents want"- namely, if the parents want you to change their child? you do it. If the parents dont want to feed their child because they are tired, you do it. If they want you to page the doctor, change the bedsheets, or give their child pain medication, apparently we just "do it".

I understand that the number one concern of parents for their hospitalized children is pain control. Except "pain control" isn't what most parents want. They want pain RELIEF for their child. As in, NO pain. And as medical providers, we've kind of sucked at explaining that, in many cases, total pain relief is impossible, due to the danger of, say, respiratory depression. Or death. I just wish they taught us more about using our clinical judgement, and a LITTLE less about how we should do whatever parents tell us to. I'm all for working with families, and feeding and changing kids doesnt bother me, but please...teach me to respect that I have knowledge that is valuable, beyond the fact that i have two working hands to change bedding.

Pediatric Clinical Placement

You want karate? Sorry. I don't have any. But I DID get my clinical placement for my pediatric rotation this morning: World's Greatest Children's Hospital! ~insert squeels of glee~ it's the best Children's Hospital in the country, POSSIBLY the world, and I GET TO LEARN THERE!! WHEEE!!!

I'll be on 5E (i think) which is hematology/general peds. I'm not sure how i'll like it, being more of a critical-care girl, and I REALLY don't know how i'll like dealing with parents- most of my experience in that line has been "oh your child is sick? we'll take him/her/it to the hospital. You can ride in front."

Here, the parents are PART OF THE CARE PLAN or some such. I have visions of parents going "you missed a spot cleaning behind little Johnny's ear" or "are you sure you're feeding him right? have you ever done this before? where's his REAL nurse?"

My plan is to smile brightly, and inform them that they're WELCOME to wait for the "real nurse" to get to them. When said nurse has a minute. Which might take a while.

Portland

So I spent the beginning of this week in Portland, ME, looking at a pair of hospitals, and shadowing an Emergency attending (friend of the family) on an evening shift, to get a feel for the department. LOVE their ED. I have a SERIOUS case of emergency department envy. It's brand new, cavernous, but extremely well laid out, with WINDOWS. Doesn't feel claustrophobic at all (thanks to the aforementioned windows and nice high ceilings), and manages traffic very very well.

The attending I followed is wonderful, and has a good relationship with and respect for nurses. She even let me yell at her residents for saying "oh we'll just do this here, and let the nurses clean it up"...including one bright young doctor who said an elderly patient could just defecate in the bed if he didn't get around to telling a tech to bring a bedpan, and that then the nursing staff could "just clean it all up". My response? "Um...do you REALLY want to be the most hated resident in the department? REALLY?" His attending started laughing, and said she'd make HIM clean up, since the nurses had plenty of THEIR OWN WORK to do. (Have I mentioned that she's awesome?)

Saw some really interesting cases, including an exceptionally elderly gentleman who presented with what looked like TERRIBLE pneumonia, like, die in an hour or two pneumonia, resps in the 40s, BP crashing, HR 160s...a mess. And HIS brilliant resident discovered a massive bowel obstruction, that was causing his abdominal contents to compress his lungs, so they DEcompressed him, his abdomen shrank by a good 4 inches, and his vital signs stabilized so that he could wake up and recognize his wife. He may WALK out of the hospital in a few days. How cool is that?

All in all, one of the Portland hospitals and one Vermont hospital are the top of my list.