Teaching.

That photo is off my boat on the Grand Canyon, which was a sweet trip.

Full circle. Two years after starting the MEPN program, I'm now lucky enough and crazy enough to help teach new MEPNs. I'm river guiding rarely, working as a nurse in the Emergency Department a LOT, and teaching to really fill my soul.

I never knew how much I'd love teaching.

I also never knew how frightened I'd be to re-enter the Master's portion of this program.

So, I had to leave my Level 1 Trauma Center job in order to teach, so now I work at a Level 2 Trauma Center, hopefully going to be splitting a dual appointment with the Emergency Department and perhaps the PICC/IV team. Days, thankfully. I work DAYS. Sweet.

Night shift made me insane.
But that's not what I'm here to blog about.

I wanted to talk about teaching. It's been challenging, for sure. I watch the new students get so excited about the smallest part of nursing they get to experience. I watch their faces light up when they help a patient make a small achievement for the day- and for me, that's the real reward. Sometimes they get so lost in details that I could scream (oh, the questions), but I know it's part of their learning process and I want them to ask, ask, ask.

Their passion is amazing.

So we were talking about inserting nasogastric tubes the other day, and one student asked me, "What if they bleed? Or what if you hurt the person while you're doing this procedure?"
To which I replied, "Well, sometimes you do hurt people - I mean, it's not comfortable. Do you harm them? No. But you do hurt them. You aren't always doing something nice - sometimes you're doing something that is really uncomfortable."

She stated, "Wow. You must kinda lose some of that connection, you know? I mean, ER nurses must learn how to not care."

I blinked. And said, "No, you never stop caring. If you stop caring, you leave nursing. You just learn to differentiate between what's actually harmful and what's necessary for healing. I've refused to do things before. People have the right to say no. And you get used to how procedures go. Not every procedure goes perfectly every time. You just do your best."

And I realized I meant that. I could have told her about my patient the other day whose heart stopped mid sentence and was a DNR, and how even though I was still taking care of patients that day, I stepped into the room with the family and cried for 15 minutes with them. And that I still think about her.
I could tell her that I walked into a room with an intubated patient, noticed her BP was sky-high and titrated up her sedation and spoke to her in soothing tones, and watched her heart rate and BP drop to a more normal zone. I could tell her that I never say anything bad about my patient even if they're sedated, because I assume they can hear me, and my place isn't to judge.
I could tell her that sometimes I judge anyway, and I have to shove my judgment aside. I'm human, and people do stupid things, for sure- but how many times have I done something dumb? Nobody deserves to get hurt.
I could tell her that every time I feel like I hurt someone I cringe inside.
I could tell her that I give 110% to people while I'm there, because, well, that's my job and I love what I do.
I could relate the time I had a guy who learned he was probably never going to walk again, and how I held his hand and my friend Jen held his other hand because he wasn't sure if his child was alive, and how we both stood there and cried with him for an hour, because we had the time to give and we could be there and he said, "Please, please don't let me be alone." And dammit, we weren't going to let him be alone that night.

I couldn't do this job if I didn't care.

Bunnies have more fun.

No, really. That's me, at Symbiosis festival, doing medical work.
It was a pleasant relief from being in the ER everyday and having my ego shattered.
A lot has happened since I last blogged.
For one, I'm engaged. Awesomeness and love.
For two, I'm taking steps towards being less afraid of other things in my life. I can't elaborate here, but wow when you are open, life hands you some cool surprises. Some of those are worth waiting a long time for, and I am incredibly struck to the core by what can happen when we manifest our intentions.
For three, I feel like I suck as an ER nurse, it's okay. I've decided my work environment is destroying my soul, but I'm learning a lot, so I gotta suck it up and go with it.
Hopefully all will be well.

That's the news for now.
Aside from pushing Epi IV, which I'm sure I'll repeat.

Stay cool California. Or wherever you are.

Adventures in Big Emergencies.

Yesterday was actually pretty good, sorta. I missed a cardioversion which went on just after shift change (8:00pm), but I was exhausted. The ER is either going to kill all love and sympathy I have for humanity, or make it grow, or both.

The morning was pretty mellow, basic, a few definitely emergent-but-not-life-threatening things happening, and then all of a sudden, things heated up.
Within an hour of each other, we received a stroke patient, a patient having a bigtime cardiac arrhythmia, and then someone who was pretty septic with dangerously low blood pressure, out of it, and was pretty much circling the drain.
3 patients, three real emergencies. Ready, GO!

Sigh. When starting an IV on my cardiac patient, I didn't put the best pressure on his vein, so he bled a little bit (not a lot), but a little. His BP was really REALLY high, too. And he was scared.
And I will tell you this:
If you're a new nurse or a nursing student, listen to me carefully:
ALWAYS give the patient the call button before you leave the room. Even if they don't use it, they cannot be (as) upset with you if they have a way to get in touch with you.

Someone who was doing a test told him when he asked for one of us (literally 2 minutes after he had been stabilized and when we had just finished drawing blood and left the room to send it) that he would be lucky if someone actually came. First of all, that attitude is BULLSH*T, and secondly it's not true.
So he peed in the bed instead of calling and asking for a urinal or a bedside commode.
If he had the call light, he could have called for me or another nurse. So, that's the call light issue. Oh yeah, and this patient was relatively young.
I guess later he also figured out I was newer and was upset - apparently about the blood that leaked from his vein when we were getting his IV in. On the up side, I noticed that his O2 sat had dropped when he told me he felt confused, I figured out, "Oh hey, maybe it's because your oxygen is low and you need just a little bit. Sweet." On the down side, later that day, I also watched communication breakdown happen with him (and with me! I love it when people make major decisions about a patient and don't tell the nurses). It was a recipe for disaster, but the patient is okay, and that's what counts, right? Sigh.
Part of me felt like, "Wow, I totally understand how this person is frustrated," and the other part of me felt like, "Um, we just saved your life. We have 4 other super acute patients and I'm doing my best to chase down the doctor to make sure you're ok. Couldya throw a thank you in there somewhere?"

Be good to your hearts, folks:



Our stroke patient had a whole 'nother story as well, but that one involved a good catch by me: "Wait a sec, we can't give this med- the blood pressure is sky high but the heart rate is under 60, we need a different one...." and some love towards the folks upstairs to get them to admit our patient with a super high BP.
The one circling the drain- well, when we get people that sick, our ER will drop nurses to 1:1 ratio, so that we function like a mini-ICU until people get stabilized. That works really well.

So, I still feel slow, my skills are slowly coming back to me, and for the most part, I'm getting it. It's week 4 for me in the ER, so I'd hope so. I'm glad I have another 20 to go before I'm considered a full nurse.

Some people are stronger than you think...

Every day is a new set of amazing stories. I see so many different people in a day, and I'm amazed at what I get to learn, see and do.

Today was a really good day. In fact, this week has been a lot better.
I actually have the ability to chart on patients, I know where stuff is in the Pyxis (the medication machine), and my IV start scorecard has improved drastically. Like I'm at 80% now - I'm just working on stopping the bleeding after I insert the catheter.

Tentatively, I'm starting to feel like a *real* nurse. Sorta.
I took on two patients on my own today (the standard is 3 to 4), and I'm getting the rhythm of it. The most awesome thing about the ER is that for the most part, the nurses and the docs really help each other out. The teamwork is stellar. I've learned which nurses will leave you 4 straight caths and bloodwork to do at the end of their shift, which ones spend more time freaking out than working, and which ones see that you have a new patient and will help your other ones to the bathroom or draw the blood or help with a procedure when you're swamped. There are more of the helpful than the selfish ones in the ER, and that makes me happy.

This week has also been full of good lessons.
A 90+ year old man attempted to break my thumb today. He was confused, ripping out lines, his oxygen levels were low, and we had inserted a Foley catheter. Poor guy. I think I'd try to break someone's thumb if someone came at me with a Foley, too.
In any case, of course it came at the time that 1) we were supposed to take him upstairs to his med-surge floor on a heart monitor (and he didn't want the lines on him), 2) I had 3 other things to do for a patient going to CT scan who was worried she had cancer, and 3) I had to pee really bad (number 3 being the least important).
What do you do with someone who does that?
Me: "Hey that is NOT okay. You are hurting me. Let me go NOW." I grabbed his wrist, bent it enough to loosen his grip. I am acutely aware that I cannot hurt my patient.
Him: "I don't care if I hurt you. I don't like being here."
He releases his grip.
I sigh. I don't blame him. He's a DNI/DNR, and his blood pressure is sky high, his heart is working at 30%, and half the time he doesn't know where he is, and when he does, he's frustrated because he can't move very well.
We still got an order for Ativan to calm him down. When he tried to pull out his Foley (which sits in the bladder with an inflated balloon keeping it from slipping out) and his IVs, we had to. He was hurting himself.
And my thumb still hurts. But both of us are intact.

Yesterday I had my first violent patient as well. He called me every name in the book - and I told him to stop, that he had no right to be abusive towards me, or anyone else when we're trying to help him.
He fired me as his nurse.
It all started over a lost glove. Apparently the glove was more important than anything else, including the pain he had reported on admission.
The clincher was when he called the very large, formidable African-American security guard a "stupid, fat, n****r." You could have heard a pin drop. I think the patients all gasped and stopped vomiting. All of our jaws dropped. He continued to be belligerent, and demanded to leave. The patient was escorted out by numerous security guards. He obviously had some other major psych issues, but he was threatening the nurses, threatening security, and he swore at another patient. It was nuts. And a good lesson. I tried really hard to talk him down, and so did other nurses, and so did the Doctors and you know what?
It just didn't work. He signed out AMA, cursing all of us for losing his glove. It's the first time I really felt a sense of "good riddance." I feel sorry for him, and if he came back I'd try to help him, but there's a point where you have to cut off the kindness. I reached it.
The funny thing is that I don't think he even had gloves to begin with. It was a surreal experience.

And today, I had so many different people with different issues, it was amazing. From vehicle trauma (trauma!) to heart problems to a possible aneurysm, to Lupus flare-ups, to gallbladder attacks, to insect bites to Septic Shock with some very special circumstances... holy crap.

Kind of like nursing school, except - holy shit - it's real. I'm responsible. For people.

You can bet your sweet ass I'm checking every single medication. Is Vanco compatible with NS 0.9%? Is Toradol? How about Diphenhydramine? How much Fentanyl do you want to give IVP - his pulse is only 58? Hey Doc, you wrote the order for Morphine IM. Did you want it IM or IVP like you told me? Can you change that order?
These are the questions I'm asking constantly. I'm super anal about the meds. The seasoned nurses think it's cute, and they also respect it.
The other thing I'm stoked on is the critical thinking skills we got from UCSF. I can look at labs and have some sense of what's going on with a patient. I know where to look for info on Up-To-Date. It helps me anticipate what's coming, and it really helps in the ED.
I'm really grateful for our assessment skills.

Emergency. My dream. I still can't believe I'm here.
And you know what my feeling is at the end of the day?
I *really* love my job.

All Thumbs

First of all, I am totally lovin' the Emergency Department (yes, it's a *department* not a *Room* - so when I say ED, you know what I mean).

I have seen so much cool stuff in the past two weeks, and I feel really fortunate to be where I'm at.
BUT
I also feel completely bass-ackwards. Somehow, between the end of nursing school and now, I lost all ability to start an IV. In fact, yesterday, I was the anti-IV starter. I blew the most perfect vein I've ever seen, and I have no idea why it was one of those days. It just was.
The nurses I work with have been super nice, "Oh, don't worry, it's ok, we miss too sometimes." Oh yeah? You guys miss on the 99 year old. I missed on the healthy person with an antecubital beauty the size of the Mississippi river.
Ack.

Sigh.
And with precepting, I kinda feel like I'm in nursing school again, except I can actually sign off on insulin, heparin, and narcotics. I *just* got my ability to chart yesterday, and I still don't have access to the Pyxis. I am about 70% able to help patients as far as logistics go. That's frustrating. And I still don't know where things are.

And I miss my MEPN friends. I am finally making some new ones here, but it's tough, you know?

Growing, growing, growing.

R.N.

It's official! I looked up my name on the CA BRN, and it was there, appearing like a little neon light in the morning.

I passed the NCLEX!

So, now I am DEFINITELY going hiking in Glacier.

85 degrees and 70% humidity.

Here's what the ranch looks like now. I was just caught on my bicycle in a lightning storm about two days ago in the same place I took this photo.

What did I do? I (fortunately) was on the stretch that had cell reception, and just 30 seconds before called for help from Will. I had looked up at the sky before I left- "oh, clouds, not bad - in fact, beautiful" but 30 minutes later on my ride, they were suddenly dark and had that this-looks-bad kinda edge to them. Black and thick, I decided, hmm, I might make it, but I'll call for a pickup just in case... That was the one smart decision I made.

When I saw the first bolt hit the field about a mile or so away from me, I have to tell you, it was pretty shocking (no pun intended).
There is nothing in the world like realizing you are the highest point in the field, sitting on a piece of aluminum.

I laid my bike down on the road and ran 100 feet away for the drainage ditch, where I squatted for the longest 10 minutes of my life. No, there was no water in it.
At least when it started hailing, the lightning stopped.
Will showed up with a truck like a knight on a white horse. I think I became a member of every religion for about 20 minutes that day.

So, humbled and more educated on Montana thunderstorms, not 10 minutes later it was sunny and 85 degrees again.

The saying here on the ranch is, "If you don't like our weather, wait 15 minutes."
Yeah, I guess so.

Ok, other fun pics from the trip so far.
Here's Idaho:




And here are my friends in Bozeman, during the pizza-and-champagne evening we had. It also included PBR, never fear:




So that's what I've been up to. We also went to an airshow in Helena, MT - where we watched the Air Force Thunderbirds perform, and got to check out some cool helicopters and planes. The focus on the military here in Montana isn't too surprising; it seems like a lot of folks are middle-America Apple Pie, and a lot of the kids go into the Reserves.

That's Montana for now. Off to Glacier soon.

Relaxation and a Roadtrip.

That's a photo of my ultimate destination, where my honey is, taken in March of this year (it's a lot greener and warmer now).

Since the MEPN year has finished, I've been a busy little bee.
It's almost unbelievable that the year is done.

What's also unbelievable is the fact that I'm discovering as I type just how well pepper jack cheese cures a hangover. Delicious.

I drove from Reno, NV to Bozeman, MT yesterday. Why Reno? I used to live in Truckee, CA and the night before I hung out in Reno, we had a little BBQ with friends at their house on Donner Lake. I'm on vacation, make no mistake. Truckee was fun - low-key and chill, beautiful weather. I also embarked upon my first bike ride in a year. I refused to ride my bike in SF after a few friends were hit or run off the road by cars, so that's one thing I've looked forward to in Santa Monica; however in Truckee I used to ride all the time, specifically the 35 mile round-trip from Truckee to Tahoe City on the bike trail. Beautiful.

Some of our Truckee friends, disenchanted with the smaller size of the quiet mountain town, moved to Reno, where you can still buy a house with a yard without paying half a million dollars. Yes, you can pay that much, but by and large it's much easier to be a homeowner. Not that they are, but hey, the option is there.
In any case, Reno was a fun adventure. Nope, no gambling, but we met near the Truckee River kayak play spot, then went off to my FAVORITE bar, the Roxy Bistro which is located in the El Dorado. The Roxy has over 102 martinis on the menu, and I am all about good martinis. Especially when they're made with vanilla vodka, chocolate liquor and have a rim of white chocolate on them. Yum.
From there we ventured out looking for sushi, but, alas, Reno is the red-headed stepchild of Vegas, so that was difficult to find at 11pm on a Tuesday. Instead, we went to get an Awful-Awful at the Little Nugget, which was the most awesome place EVAR because it combined a burger joint with a bar, and there was Karaoke Tuesday to boot. Perfect for a band of lost river guides in danger of being too drunk who need food and have to be functional the next morning. The burger was huge. My friend Shelley and I split it, and then I proceeded to karaoke Don't Stop Believin'.
That was awesome.
I got up early Wednesday and had a beautiful (albeit slow) drive from Reno to Bozeman, fraught with greenery, wildflowers, poofy little clouds, and people driving 10 miles under the speed limit. Sheesh.
When I arrived in Bozeman, my friend Heather greets me with, "Want a glass of champagne?"
Um, yes.
Then she looks at me, "Oh, it's Veuve. Is that okay?"
Hell yes.
Thus began the evening of drinking champagne, eating pizza, drinking more wine, and me passing out around 1 wondering if I drank enough water (I didn't).
Hence I'm still horizontal, nomming on pepper jack cheese wondering if my friend (who apparently drank more than I did) is okay, and wondering if I should go get breakfast makings for her. Hmm.

I'm gonna start driving to the ranch where Will is this afternoon, which is a short trip, but I have errands to run for him (he's in the middle of nowhere), so I gotta get movin!

I love chillin' out!

NCLEX done!

By the way, that's a photo of Mono Lake I took in December of 2008, which has nothing to do with my blog entry. It's just pretty.

So, I took the feared NCLEX-RN, which is the National Counsel Licensing Exam for Registered Nurses, and it's in the format of a computer-adaptive test.
What does this mean?
It means that the computer senses how well you are doing and gives you more difficult questions if you answer correctly. This feature would be all well and good, except that the minimum amount it takes to determine whether you can practice at entry-level competency is:
75 questions
The max? 265.
I think I would freak if I went to 265.
So you don't know when the computer determines your competency at 90% accuracy, you just know that it *could* shut off at 75, or the computer could decide that it doesn't know if you're competent at 75 and therefore you have to answer more questions. Yikes.
And it's not about getting questions right per se, it's about what level of question you get. Ugh.
Combine that with a bunch of over-achieving A students who like getting high scores, and you have a recipe for an anxiety disorder.
Around question 20, mine became insanely difficult, and the computer shut off at 75, which I was excited about at first, but also felt a little unnerved about.
"Did I pass? Or did I fail?"
I came to the point of not caring. It's done. I'll find out soon enough.

And bonus! Our transcripts aren't in yet, which means that we can't find out results with the Board of Registered Nursing in California. Yay. They won't release results until they know we've actually finished a nursing program.
Double bonus: California's not a "quick result" state anyways.

So, to avoid obsessive-compulsive searching for my name to pop up on the BRN site (it's our unofficial way of finding our license), I'm heading out, driving, to Montana where my honey is working as a producer for a show that's going to be aired next year.

The vacation has truly begun!

MEPN Reflections.

Those are my hands. We're doing a small art installation at our graduation ceremony and they will be part of them.

Today I finished my final hours of clinical instruction, and it still hasn't hit home:
I'm done.

Monday there is a class, but I'm headed to a wedding, and I was okayed to go early in the quarter.
So really, I'm done.

This year has been very short, but jam-packed. We were talking about some heavy stuff at lunch, and I thought I'd post some of the stuff I've experienced this year:

Poop is just not a big deal anymore. Period. Cleaned up a lot of it this year, and there's probably more to come.
Was present with a patient who watched her husband slip away more and more neurologically as cancer took over his body. And cried with her.
Learned that yes, I *can* take care of four patients at once on a med-surge floor, but it's hard and I can't do it and be doing a good job.
Learned I have a ton more to learn.
Started an IV on someone who was scared of needles, first try.
Missed on a few people who were scared of needles, first try. Didn't go for a second.
Watched one of my favorite patients go through acute rejection of a transplanted liver.
Watched the team of doctors and nurses pull for her to get a second transplant, and I watched her go home happy and healthy from that second surgery. That was a miracle.
Sat in the ICU with a woman who was too sick to be transplanted, and had been begging us to "let her go home." I held her hand as she was dying, intubated in the ICU, and she turned her head toward me for a moment when she was supposedly "unconscious." And the next day I held her daughter's hand.
Watched the acute distress of a young man who had his last bit of hope dashed when we learned he was in acute rejection of his lungs. I don't know the last outcome, but it was not looking good.
Sat with that memory intensely when my friend, Anne, died following acute rejection of her lungs at age 33.
Helped take care of a 3 year old boy who was dying in the PICU.
Helped care for an 11 year old developmentally delayed girl on dialysis with spina bifida who was in pain and spoke only Spanish. And helped her family get in touch with translators.
Laughed with an old woman who was incontinent after being in the ED for 3 hours (I had just showed up). Her remark, "Well, if you guys had actually checked on me, you might have noticed earlier. What do you expect? I'm old!" She watched us running around like busy bees.
Listened to a 12 year old with Lupus who had been in the hospital for a month, and who told me that all she wanted to do was go home and hang out with her brother and her cat. And have a piece of pizza, for once.
Charted with a 4 month old in my arms who would cry unless he was held by one of the nurses. He'd turn blue if he cried: Tetralogy of Fallot, and he would sleep if I sang to him.
Cried from anger while taking care of a pre-teen girl who had been hit by a bullet while playing, and was decerebrate. She would make noises that seemed like frustration or pain, and the reality of that situation broke my heart. I was overwhelmed by the love of her family, and still feel sick over the way violence destroyed her life. When I saw her picture from her soccer team, taken a week earlier, I nearly vomited because I was so angry, and the change in her was that drastic. I will never, EVER forget her.
Had a frank, genuine conversation with someone who was diagnosed as a paranoid schizophrenic, who told me, "Wow, you calmed me down!"
Had a patient tell me he loved me, in a really sweet way, and I could not tell him that I loved him back, because how do you explain platonic love to someone who is in a locked inpatient psych ward? I mean, really, how?
Held the hand of a spouse who discovered her husband had been rejected for a transplant, and has a year to live....
and still haven't emailed them.
Held my tongue when a precepting nurse chided me for holding the hand of a woman in labor.
Auscultated - and played with - a girl who had two hearts. Yes, two. Heterotopic heart transplant if you want to look it up. Imagine the ECG.
Failed on numerous attempts of trying to do something good. Fortunately it didn't hurt anyone.
Made a little girl cry by not taking out her IV fast enough (don't prolong the bandaid removal).
Faced some of my own prejudices, especially in psych.
Let go of some fear of TB.
Saw a multitude of vaginal births, and a few crash C-sections. And a few scheduled C-sections.
Relied on friends. Including professors, who were really supportive in all the loss I experienced this quarter. Sheila and Lynn and Pam, thank you. Seriously- thank you all.

And I made some great friends.

Keeping my Mouth Shut.

So, last Friday, I had an amazing moment.
Most of the nurses on the floor in the hospital I'm in for L&B, who discover the woman who wants to give birth without intervention, who wants to do "Natural Child Birth" (OMG!), she's automatically labeled as: crazy, insane, masochistic, f'ed up.
And you know what I said?

Nothing.
I'm a nursing student. I kept my mouth shut.

What I want to say?
When I first wrote this, I was really really angry, and I typed out what I wanted to say. But...
I was taught if I can't say something nice, then don't say anything at all. So I didn't. I want natural child birth too. I think I said that, but in a very even tone, so as not to rock the boat. And I clearly remember the shock in the voices around me, "Really? Are you kidding?"

I respect the mama who wants to scream, moan, blow out her pain with her breath.
I respect the mom who looks at the doctor with "crazy eyes" and says, "I can't do this, help me, pull this kid out of me," and the doctor says, "You're almost there, you CAN do this, I know it, breathe, focus" and then winks at me with all the love in her heart.

And I DO NOT respect the "nurse" who interferes with that beautiful, human connection that the patient and I have.

My patient:
She reached out to me, grabbed my hand while pushing, one of her most intimate moments in life that she will remember forever, she holds me, and I whisper to her, "I'm here for you, I'm right here, and I'm not gonna let you go."
And the nurse, with her degree, and her NCLEX, and her knowledge- she subtly reaches over and peels that womans' hand from mine,
and places it on a grip bar attached to the bed and says, "You might feel more comfortable here."

And the baby boy is so beautiful, and mom and baby are so happy when he is finally with us in the room, "crazy" mom and her little boy and dad who is super supportive...
and the nurse takes me aside,
"So, that birth went well, but um, DONT EVER let a LABORING woman GRAB your hand like she did, she'll break it. Protect yourself. You did really well except for that one thing. You're not aware of your safety."
And all I could do was nod.
"Okay. Thanks."

Inside, what I wanted to say, "What. The. Fuck."

I had one of the most intimate moments I could ever have with a patient- she reached for me, gently, to support her, and that nurse, so afraid of intimacy, took it from both of us.

I think that moment really topped off a very disheartening day with this particular nurse, who seemed very disconnected from her patients even though she was young and fairly new. She liked hanging out with the monitors rather than being present with the patients, and I heard the charge nurse asking, "Please, can you help and be a team player? I really need you here." And this particular nurse, sighed, rolled her eyes, and stomped off like a toddler, not even introducing herself when she came in the room with the woman she labeled as crazy for just wanting to trust her body.



Even my Clinical Instructor: "wow, what a beautiful moment..." then I continued with my story... her comment, "how sad. How sad for that nurse that she didn't feel comfortable being present with her patient at a very vulnerable moment. What a sad, reserved, afraid human that nurse must be to be so unavailable at the moment her patient needed her more than anything..."

Exactly what I thought.
How sad.
And how sad that I kept my mouth shut.
I hope that young nurse changes specialties. L&B is not for her - sheesh, maybe not even nursing. But that's not my call.

And what a blessing to be present with my patient.
What a blessing.
How beautiful.
I support a woman's right to choose, and that includes the conditions surrounding her labor and birth. What a beautiful thing.
The MD asked if I wanted a job on the floor. If emergency weren't my thing and L&B were (ok, so it is, but emergency more so), I might consider it.
More to be discussed.

SANE/SAFE

People ask what my ultimate goal is within nursing.
I have a few.

I want to be a Sexual Assault Nurse Examiner/Sexual Assault Forensic Examiner (SANE/SAFE) because we need them, and we need them to be helpful, caring, respectful, and good at what they do.
And they should work in emergency.
And in a perfect world, we would never need them.

Here's another story, besides ones from my friends that motivates me. Read at your own risk. I kid you not. If you can't stomach these things, don't read.
I cried for an hour after I read this story.

It is absolutely horrible but there are some good souls left in the world.

And having the tools to help someone in this situation is most certainly my motivation.
Let's stop this violence before it starts, people.

Let's Talk About Organ Donation, for a moment.

I just lost a friend who was given extra years of her life due to someone's gift. She received lungs about a decade ago from a man who had the courage to donate, and recently, at the age of 33, went into an episode of acute rejection, aspergillis infection, and had also developed cancer in her abdomen.

I miss her terribly, and am in shell shock.
I can't even imagine what your family is feeling.

Please, if you haven't, register yourself as an organ donor. If nothing else, I got more years of knowing my friend. She was a beautiful soul, a real fighter, and will be missed by many.
Anne James Ferrari, you have touched the lives of so many. I am so lucky to have known you. Spread your wings my friend, and remember us here. We'll see each other again.

Please, donate life.

And for those of you still here, live every day. Carpe goddam diem.

Here's a photo of her and her beautiful sister (who is also becoming a nurse. I love you, Beth):

The Cycle Continues

I'm backdating this blog entry, mostly because I like having Anne's sunshine smile at the top of my blog.

Friday, the 10th, I spent my first rotation in Labor and Delivery. Here's a summary of the experience:

My brand-new clinical instructor is moving very quickly towards us, somewhat breathless.
"Okay, Nicole, you and (male MEPN) are in the delivery rooms, and everyone else is in Post-Partum. Go change into these scrubs. And the women in those two rooms are pushing. Hurry!"

My cohort and I look at each other, high-five, and nod. Neither of us even had time to register nervousness- I mean, I had never seen a vaginal birth, only a C-section, and we have had about three lectures on pregnancy. New scrubs on, we stepped out, ready for the day.
For about ten minutes the nurses we were working with hemmed and hawed about the number of students allowed in one room, and I told him to go ahead- as a male, I know it's more difficult for him to be accepted into a delivery room. Not today. He merged right in to the room, needed and accepted. He had only been in there two minutes, when I hear a call for, "Hey can I get another person in here?!"
So I stepped in.
"Um, I'm a student, what can I do?"

A nurse looks at me, "Grab that towel and go hold her leg so I can hand tools to the doc."

The patient is in a traditional hospital-birth supine position, her husband is at her side. They are super cool, and very calm, all things considered.
"Hi, nice to meet you. I'm Nicole." Contraction.... "Okay, breathe deep with me, ready?"
And that was it. Off and running. It's 7:15 am, and I am helping hold this woman's legs open for a difficult birth, trying to remember what I can about fetal heart rate decelerations, next to her husband (who is also totally rad), watching the doctor work, realizing that this baby is in a little bit of trouble. And I'm watching the baby's head crown.

Holy Shit.

And I thought, silly me, that the head would be way smaller than it was.
The OB was very calm, and grabs the vacuum to help get this baby out. I see the FHR (fetal heart rate) is about 70.
Not so good.
Doc, very slowly but firmly. "Get Peds in here. Now."

A team of 3 superhero nurses emerge from the ICN, ready. They're setting up oxygen support, and the warmer.
The woman pushes again.
"Call Dr. XXXX. Get him in here." I realize that she's calling for the attending.
"Okay, now push. Hard. We need him out of there."
Attending arrives, steps back close to the ICN nurses.
Our laboring mama listens. Another nurse is pouring mineral oil and olive oil on the crown of the baby and on mama's perineum.
And all of a sudden, I realize just how huge that head is, because it's coming. Fast.
And just like that, there's another person in the room.
"Floppy baby."
Not a good thing.
He's blue and floppy, and the cord was wrapped around his neck, twice. Not 2 seconds into the world, this little guy is under a warmer, being rubbed down, suctioned, and bagged with oxygen.
The trio of superheros is working, hard.

It's almost too much to absorb. I look at mama, I look over at baby, and then I look down at mama and she asks me (and the doc), "Did I tear?"
It took every ounce of my consciousness not to look incredibly shocked.
Um, yes.
The OB: "It's not that bad."

Apparently, it's not that bad, but I have never seen a vaginal birth and I could not believe what a "not-that-bad" tear looked like. And the amount of blood that was associated with this process I was NOT prepared for.

I keep myself together, "Yeah, not that bad. How are you doing?"
And then I look at dad. "How are *you* doing?"

We start bantering, like we had known each other for a while. I glance over at the busy trio and the once-blue baby. He looks pink, to my relief. It's been almost 10 minutes.
Then we hear it... He cries!
I sighed, audibly. Everyone in the room noticeably relaxes.

They bring the little guy over to mom and dad, and let them say hi, but he was on his way to the ICN to be watched for a little bit. Both mom and dad are medically savvy, and they nod. Mom looks tired. Baby looks pink, warm and dry. He looks a little mad after being suctioned, and he's probably a little dazed.
"How long were you in labor?"
She looks at me. "31 hours."
My male MEPN companion and I look at each other and our jaws drop.
"Um, can I get you some juice?"
She laughs, and nods. "Yeah, that'd be great."
The OB is busily sewing up the tear. This mama had an epidural, which she relates is what helped her make it through. It's not even 8am yet.

And that was the beginning of the day. Literally, 2 hours later, I'm watching a C-section, then an hour after that, I'm holding the legs of another woman who didn't get an epidural because her baby was on the fasttrack into life. First baby, and she only pushed about 5 times. She tore, too. And let me repeat, NO epidural. Her baby came out with a loud cry, pink, and feisty. Good sign. The doc was trying to numb her up to sew her back together. Again, not a bad tear, but on my first day, it was pretty shocking.

At that point, I thought to myself, "Is there a third option?"
If I invent anything, it's gonna be a baby transporter beam, a la Startrek.
And I had a hell of a lot more respect for all the women I know who have gone through this process.

I then spoke to my Godsister, who is a NICU (ICN) nurse, and she relayed to me that usually women with epidurals tend to tear more often because they can't feel pain, so they don't allow themselves to stretch enough. Makes sense, naturally, when it gets too painful, you stop, take a breath, relax, let yourself stretch, and then begin pushing again. Huh. I am going to ask my prof about this (not that I don't trust my godsister, I just want to ask my professor).

L&D started with a rush of emotion.

So on the same day that I was there for 3 new people coming into the world, someone I really loved transitioned to another one.

Which is a wild head trip for me.

In the past few weeks I've lost a lot of people I've known. See my prior post about one group, but I also lost Shane McConkey, who was a trick skier filming in Italy, and fell. One of his skis didn't pop off, which screwed up his balance and from what I understand, his parachute was tangled in his ski. So he fell. 400 feet. He was only 39, and he was the most bitchin' landlord I ever had- he used to come over and drink beers with us, and his wife Sherry used to come visit as well. I remember how excited she was when she told us she was pregnant. Shane was awesome- he knew I was trying to improve my skiing and offered to ski with me, which floored me. Shane was a legend- he was Squaw's guy, and he was a friend to so many, and so down to earth yet nutty and fun. Total prankster, and totally loveable. He leaves behind his wife, Sherry, and Ayla, his daughter.

Too much.

It's a cycle. I haven't confronted death in a long time, and I've never seen birth like what I saw on Friday, so I guess it's time for reflection.

Love of Doing Nothing.

Six glorious weeks off. It's 11:20am and I have done nothing today so far, except heat up some soup my mom made me. My boyfriend and I are heading to the Hangar One tasting room in Alameda with a few other MEPNs today, just for fun.

Realizing that there's nothing due, that I can read for fun, and that I don't have to get up at 5:00am for any purpose is a fabulous thing.

Done with Med-surge quarter. Now: enjoyment. The big questions: To work or not to work, to ski, to travel, to sleep.

Ahhh, vacation.

For a Patient.

Because I could not stop for Death,
He kindly stopped for me;
The carriage held but just ourselves
And Immortality.

We slowly drove, he knew no haste,
And I had put away
My labor, and my leisure too,
For his civility.

We passed the school, where children strove
At recess, in the ring;
We passed the fields of gazing grain,
We passed the setting sun.

Or rather, he passed us;
The dews grew quivering and chill,
For only gossamer my gown,
My tippet only tulle.

We paused before a house that seemed
A swelling of the ground;
The roof was scarcely visible,
The cornice but a mound.

Since then 'tis centuries, and yet each
Feels shorter than the day
I first surmised the horses' heads
Were toward eternity.

-Emily Dickinson


Morpheus

Oh, Morpheus, give me joy till morning
For my forever painful love:
Just blow out candles' burning
And let my dreams in blessing move.
Let from my soul disappear
The separation's sharp rebuke!
And let me see that dear look,
And let me hear voice that dear.
And when will vanish dark of night
And you will free my eyes at leaving,
Oh, if my heart would have a right
To lose its love till dark of evening!

Alexander Sergeyevich Pushkin


"There's no place like home."
-Dorothy Gale, from Kansas.

Honoring one of my favorite patients, who will probably not make it 48 hours.
I think she recognized me for a second today. She smiled, for just a moment in her confusion and pain.
And then she simply said, "I want to go home."

Maybe I'll see her tomorrow. Maybe not.

Whatever happens, I am grateful to her and her family for allowing me to help them. I am grateful for their love, which teaches me to love in kind.
And I hope that when she does go home, she finds peace.
Sometimes, holding someone's hand is all you can do.

Namaste.

Turning Seasons.

When you are in clinicals, or are working in an acute care setting, you will understand why I love that LOL cat.

Fall is here. It's getting colder, we're getting a little bit busier, although there are only four weeks left of this quarter.
Papers are due soon. The last time I wrote a paper? About 9 years ago, so the foray back into APA format has been somewhat like a jog down memory lane after gaining about 85 lbs. I feel out of brain breath. Make sense?

Someone said that MEPN is like running a marathon. Nah, running marathons involves sleep. A lot of people take "mental health days" here and there, and I have to say I wholeheartedly agree.
This last weekend I went over to the eastern Sierras with my best friend, and we camped out in Jeffery pines and Aspen trees that were golden with the sunset. We hiked around at 7000 feet at the same place my headlining photo is from, and there was no water in the creek. It was awesome, to say the least. I was reminded why I chose nursing as a career path- it fulfills my love for patient care and (hopefully) allows for having a life. I have to live outside. Have to. Non-negotiable. My boyfriend and I are already planning some backpacking trips once I'm out of school.

Wow, four weeks left in this quarter.
Four.
Then we're halfway done.

Today I looked around at everyone and just had this moment where I realized how much everyone has learned- people were so nervous, so unsure of themselves when it came to talking about patient care, not to mention actually doing it - and now everyone trades information and speaks to each other like, well, like nurses.
It's really really cool.

Since my last time in, I spent some time in the ED (emergency department to those of you who don't speak medicine), which completely re-lit a fire under my ass. I loved it. Working in emergency always ignites me, and I even got to do some charting under the auspices of my nurse preceptor. She challenged me to do an assessment on an ortho patient (yes!- easy, what I *always* used to do while patrolling), who had a bad bicycle accident. I did a full assessment, checking my patient's neuro function, asking if she could remember what happened, did she lose consciousness, etc. I assessed her breathing/ribs and cardiac function. I checked all peripheral pulses and cap refills, paying special attention to the one distal to her injured forearm. Very carefully, I wrote down my findings, scared shitless - I mean, it was on real ED charting paper from a major hospital, and my words become legal. After sweating for a few minutes, I figured, well, hell, if the RN I'm working with doesn't like what I'm charting, she can shred this and start over.
I got praise. I was stoked.
I also got to hold traction later, working with a doctor who had a gentleman with an obvious shoulder dislocation. We didn't get it back in. I've reduced a few of those in the field, and when I saw this one, I thought to myself, "Ooo. That's bad..." so when it didn't go I wasn't surprised.
We had such an amazing variety of patients: people with liver dysfunction, people in withdrawal, abdominal pain, an Acute MI (heart attack), that I saw only briefly on my way out when my shift was over- there were so many people in the room that I wasn't able to be a part of anything anyway.
I also inserted a Foley on a guy who was having a rough night. I'm sure that didn't help. The night was busy.
I'm not a night person, but I was completely awake. Our observations are only 3pm-11pm, but I stayed until midnight, ecstatic to be back "at home."

Other than that, I think the program has been relatively manageable this quarter. The final papers are kind of a pain, but they're almost done.
Back to back 12 hour clinical shifts are tough, and for each student they're tough for a different reason.

I'm thinking about doing a quick advice column for things I've learned with the MEPN year so far.

Sorry this posting is so disjointed but one reason I haven't written in a while is lack of sleep and personal time. I got personal time this weekend, but sleep is yet to come...
Oh yes, and Halloween is coming. No we don't get out early from clinicals.

Love, Bluegrass, and Tears.

Ah yes, 5th week of "schedule A's" quarter, and I'm deep in Med-Surg nursing. Still on the transplant floor. Still doin' my thing.

Last weekend I rode on a float in the LOVEfest parade down Market St in SF. If I could find a photo of me on the Spundae/Skills float, I would, but alas, I was in my EMT pants and a T-shirt, although I had my hidden orange fur and sparkley pants in my bag. I was supposed to volunteer from 11am until 4:30, and ended up staying until 6pm. We had so many calls- lots of overly intoxicated people on various substances, and I was running around with oxygen on my back trying to help them. Doing the quick assessments was actually kind of fun, because it brought back my EMT skills and I was surprised at how comfortable I felt in that environment. A lot of people thanked us. Afterwards, I found some friends and danced until about 7, went home, and drank a margarita. Sweet.
Sunday I went to Hardly Strictly Bluegrass since it was only a mile or so from the house, and had a fantastic time just chillin' with close friends. Listening to Iron and Wine play was magical, as was dancing with the girls to Greg Brown. Awesome day.

Today was a tough one at the hospital. Last week, I took care of a patient who was hoping for a good diagnosis. He didn't get one. He has an inoperable state, and at this point, he has been referred to Hospice care. He'll be here for a few more days, and I'm going to try to be with him tomorrow. His wife is phenomenal, and I cried with her for about 20 minutes this afternoon. There's not much time to give, but what I have, I will.
I can't go more in depth, but that still makes me tear up. Knowing that your parter is going to pass, knowing that you are going to pass- given "time" to do what you need to do... Is it a blessing? He has the opportunity to say what he needs/wants to the people he loves, yet it's limited.
His wife looked at me and asked, "Why is it that we only find out who truly loves us when we're sick or dying? Life is so short- time goes by so fast and we keep promising each other that we'll get together, and it takes something like *this* to make it happen. Why?" She paused, looked at me, and said, "Enjoy every moment you can. If you learn nothing else as a student, enjoy every moment you can."
That's when I started crying.
I hugged her.
In the middle of the hug, my stupid cell phone started vibrating, and we both laughed and laughed. Perfectly ludicrous.
They've been married for 40 years. I've been with my boyfriend for 2.
My heart aches for them.

And then there is that question: how *do* you go back into the hall and help your patients after that? How? My heart was heavy, but I got elbow-deep into poop (literally- and discovered a pressure ulcer and worked to prevent skin breakdown) and tended to the needs of someone else who is, very literally, dying.

Inoperable.
Bad word on our floor, but seemed to be the word of the day.
Sigh.

All we can do is love openly, celebrate the time we have, and be here for each other.
Those words from my NP friend echo through my head: "There's not a day that goes by where I don't hug a patient or am there for a patient. I give good news and bad news. When I've lost my ability to emote, then it's time to move on from this."

I'm just getting into it, and it's heartbreaking and beautiful all at the same time.

This weekend I'm at a wedding. A beginning. I think I need it.

Firsts, Escapes, and Anniversaries.

First of all, if any of you readers are applying to MEPN right now, congratulations on finishing. Tonight at midnight is the deadline, and I remember all to well scrambling to get it all in.
In fact, the GRE made sure that I was late by a week, but somehow it all worked out. Have faith that yes, indeed, it will work out for you.

Non-MEPN stuff: I went to my first same-sex wedding in the beautiful Genessee Valley area of California. My friends Julie and Abigail tied the knot in the best ceremony I've ever been to, out in the middle of nowhere on their property past the North Fork Feather river.

Almost all of my river friends were attending, and I had a weekend of margaritas, sleeping bags and dust boogers that made my fall happy. This weekend, I'm volunteering in the med tent at the LOVEfest, hosting a few women at my house who are going to Hardly Strictly Bluegrass, and just unwinding. The Gourds are playing, and they play the best version of Gin and Juice (which, incidentally, Will plays on his banjo). So will Emmylou, Iron and Wine, and Poor Man's Whiskey. Sweet.

I miss Will. He's in Houston, doing hurricane relief, still. Probably there until December.

MEPN stuff:
Last week we had rapid response on our floor 4 times, once for someone with 10/10 chest pain and shortness of breath with a low O2 sat- ended up that patient didn't have an MI (heart attack- or "myocardial infarction," an "infarct" being an area of dead tissue due to lack of oxygen). And then another patient had Atrial Fibrulation alternating with Sinus Tachycardia. It was a chance for me to be the EMT on the floor; when the docs said, "get oxygen tubing" I already had it and the christmas tree (the attachment that allows us to connect tubing to oxygen). I also ended up printing out the ECGs for them. Yay! That was exciting.

Also firsts, some not so good: first long-term patient death. Sigh. Remember, yes, my info is changed due to HIPAA, so I don't always get to tell you everything that's happened. I will say this, the patient's room always smelled wonderful, due to aromatherapy, and I loved being in that room, regardless of how good or bad the day was for him. I took care of this patient about 3 days. He was waiting for a miracle, was young, needed more than one organ. He died waiting in the ICU from a massive internal bleed. His platelets were always low, and the clotting factors were always at critical values. And there were reasons for that, but it doesn't make it any less sad.
I haven't cried yet. I need to share this info with another MEPN who cared for him even more intensively than I did. The info I'm giving you, public, is different than what really happened, but it affects me nonetheless. I spent last Friday thinking about this person and remembering interacting with his family.
My heart felt heavy.
It's different, you know, when it's someone you've met briefly, than when it's someone you've helped out with on a day-to-day basis. Someone you've advocated for, watched the doctors go in and talk to, watched the discussion by the teams as to whether they're going to get what they need or not.

I started my first IV, a 20G on someone who's a "hard stick" and I nailed it. Proud? No: Glowing. I hate needles, and I faint when people come near me with them, so I'm uber aware of how I treat people with them, and I'm all about being a phlebotomy pro. I always used to get the hard sticks at Planned Parenthood, and now I feel like I did well with someone in the acute care setting, and I'm willing to go further.

A MEPN saved someone's life last week. She noticed a fever, and essentially caught early sepsis on someone. It wasn't someone who had had a ton of patient care experience; she was just very observant and very dedicated. And she's smart.
One small light, a small flickering flame that glows just enough for one person to see can change the world.
I hope that if I ever get sick I'm lucky enough to have this person as my nurse. She's awesome.

It's that time of year when we're getting sick, sore throats, tired - even though our schedule has eased up. Our first test is tomorrow.
MEPN is tough. Many of us have gained weight, lost partners, lost sleep.
There's a lot I'm editing, but more will come to light later, when I'm done with this program.

For now, it's all about the basics, the day to day stuff, the hopeful living and breathing and learning that we all do together.

For you applicants, think about nursing, and imagine yourself with someone at they're most vulnerable moments. Yeah, you'll hear a lot of jokes about "wiping ass," - which incidentally I do a lot- but think about being with someone when they're vulnerable and need that help. What an honor it is.
If you can't see it as an honor to be with someone when they're so sick they can barely take care of themselves, then this pathway is not for you.
If you feel that you have enough love for the entire world, with a little left over for yourself at the end of the day, then by all means, walk through the fire and do it, because it's worth it.
What a fucking honor. Every day.
The light in me honors the light in you. Namaste.
Whatever your reason is, let is shine forth in your essay, and best of luck.

Holding Each Other Up.

What a beautiful day.
The sun was out, it wasn't too hot, and we got into some people.
What a beautiful day.

The above image is a painting by Susan Seddon Boulet, and I believe it's entitled "Isis and Osiris," a myth I've loved since I was a child.
It ties into healing; how Isis loves her brother so much that she hunts down his body parts and puts him back together. The image of her cradling him in her wings is a very powerful one- he seems to float in this peaceful space even though he was just recently utterly destroyed. It's what love can do: make us whole.

Today was amazing: we had good news; we had bad news. One woman in our clinical group described the honor she had in spending what she knew (and her patient knew) were the last moments/hours in his life together. She was there with the patient and the chaplain, and was able to be a part of an in-depth conversation about death/dying and fear, and ways to live even in death. She teared up as she described this experience, and wondered how the hell one walks out of the room, into the beeping, the lights, the rush of the rest of the floor- so *alive* and bustling- while still keeping it together.
I don't have an answer for her, except that I don't keep it together all the time.
Her story made my heart ache, and even now, even when I should be going to bed, my thoughts are with my classmate, because I have no idea how the hell I'd deal with that situation either. How beautiful to be a part of someone's death, to be wanted in one of the most intimate lonely times in our lives, yet to feel so helpless-
As our new clinical instructor said, "You can't just say 'I know how you feel,' because, well, you haven't died."
Good point.
Speaking of, someone who I thought *was* going to die is alive and well and back on my floor. A patient I had 4 weeks in a row, I was ecstatic to see her doing so incredibly well, better than I've ever seen. She received a new organ, and it shows. We were able to talk today about her favorite pesto recipe- I swear that sometimes, patients just need to be reminded about life outside the hospital, and they often instantly perk up or become a bit "better" just by thinking about not being sick.
I had an ecstatic day. I learned a lot, worked with one of my favorite nurses (a guy who totally rocks), really helped out the patient that I had- I actually *felt* like a patient advocate, AND I got to see a rockstar ICU nurse/CCRN whom I adore in the ICU. Which I buzzed through for a moment to see if she was there.
Stellar. Day.

I also got to hang out in radiology/ultrasound for a bit, and saw a kidney, about 6 hours post-transplant, that was functional. It made me overjoyed for my patient, and it was an excellent learning experience as I asked the resident to teach me how to read what was on the screen. Awesome.

Okay, not much, and everything, and I'm exhausted. 12 hours tomorrow too.
This quarter is a bit easier, but I can't tell if it's a time thing or just the fact that we're used to school.