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.

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.

Magnesium and Bananas, Oh My.

It's the little victories that rock my world.

Today was awesome. NB, readers, I'm going to be writing more and more about my clinical experiences, and be assured that they all comply with HIPAA. Identifiers have been changed to protect patient privacy.

Okay, now to the good stuff:

Today I felt like a nurse. We (my nurse and I) had 4 patients, 3 of them a bit more intense than others, and the other one was being discharged (of course, we got one to replace her, a pre-operative transplant patient).

Our patient being discharged was a cancer survivor. I say survivor because that woman has moxie, and said to me, "Failure isn't an option. I've got way too much to do in my life." Rock on. When she refused a cocktail of electrolytes before she left the hospital because it would have kept her there another 2 hours (after she had been there almost a month), I saluted her. Her NP said, "Just make sure she knows to eat some bananas and chocolate."
No problem.
Her energy and enthusiasm made my morning. She'll be back for more treatment, but not for very much. Sweet. I'd go home asap too. Hospital food sucks, and having home around is sometimes the most healing thing to have.

Those little victories keep me going.

The short version of today: assessed a distended abdomen, caught diminished lung sounds, discovered people had been taking blood pressure on someone with a fistula on the lower arm, in a place where the cuff was too small... remedied that by taking it on a lower extremity, changed a central line dressing using sterile technique, rinsed a lot of commodes, talked with the rounding team of docs about getting better/different antidepressants for a pt who really needed them (and when I came back from lunch, psych was there! They rock!), took out a Foley, did a bladder scan, researched a 5 page MAR for another HIV+ transplant recipient, got a pt to laugh who hadn't laughed in 3 weeks. Oh yeah, and changed a colloidal dressing. Took a few blood glucose levels. Saw a patient with a pancreas transplant. How cool!

I took a very short lunch.

The long version of today? I gained people's trust, identified a female patient's discomfort with having male nurses deal with her perineal area and alerted the nursing staff to that - which they were happy to accommodate (which made me happy), hunted down the all-important lip balm, charted correctly (huge accomplishment), followed C. diff precautions (had an ET moment... Eliott), and got a very distant patient who has huge failure-to-thrive potential to be more engaged, aware, and tried to give her a goal.
She's the one I made laugh. I hope it works.
Sigh.
That's all you can do, you know?

It's interesting. I wrote about what an *honor* it is to participate in patient care. I mean, truly- think about it- you're helpless, you can't pee, you can't get to the bathroom in time, you're puking, you feel like crap... and you're vulnerable.
And there's this person there to help you out.
I'm that person.
I feel honored to be trusted with those: the most vulnerable moments. It's not about "cleaning poop" (although I certainly went through waterfalls of it today- not kidding), it's about knowing that the patient trusts me to be there in a pretty dark hour. And not judge.

If you've ever sat up with a friend who is 1) way too drunk or 2) way too high on whatever or 3) in the middle of a high-drama breakup, you can get some understanding.
It's sorta like all of that at once, and then add fear to it.

I feel so grateful to be able to sit here, sipping on a cocktail, writing my blog. I come away from my day with appreciation for the little things. No matter how tired I might be after a shift, I could still go back. We're only at 8 hours on the floor right now, but that's going to change in September.

For future MEPNs, and to myself 2 years from now: what I do daily is awesome. I like raw humanity. If you shy away from that, you run the risk of having a difficult time, no matter what nursing program you go into. Remember that honor. Always remember that honor. You have the opportunity to help someone in a way that nobody else can. As a MEPN, you might feel helpless, but you know what? Nobody else has spoken to that patient you just spent a half hour with, because nobody has time. Nobody else took the time to listen to fear, anxiety, to let that patient tell you about her dogs, his trip to a foreign country.
Or maybe you speak a language that the nurses don't speak, and because you speak Mandarin/Spanish/Russian/Thai/Swahili you can connect with that patient in a way that nobody else has time to, and you give them a glimmer of understanding of what the hell is happening.
I am taking full advantage of my student status. Look stuff up. Educate yourself. Ask questions.
Okay, that's my rant/rave.
I worked with an awesome nurse today, and I hope I get to work with him again. By far, a naturally easygoing person with infinite compassion and highly intelligent. Great combo.

Oh yeah, and learn to let go at the end of the day, if you can. And good luck with that.

Lessons Learned: Week 5

Not a lot of time right now, but I was reflecting on last week's dichotomy of humor and despair. That's kind of what it's always like: an emotional roller coaster, and you've just got to stay stable.

We're learning what honor it is to be a nurse. I mean, really. That's part of week 6's lessons, but it seriously hit home for me in week five.

The most difficult thing, I learned, is not to watch someone die or even lay there and suffer.
The most difficult thing for me, I've discovered, is to watch the eyes of someone who loves that patient, and who has loved that patient for decades, as that patient is treated, tested, writhing in pain, out of it.
When you see the partner of a patient- and that partner is so alive, so intelligent, and so present, and then you look over at the patient helpless in bed, struggling to remember his name...
And then you see the way that partner looks at your patient, as the doctors and nurses place the ECG electrodes on that patient's body - you see that partner's eyes, and you look at their wedding rings, and you realize that the sweating, hyperventilating *person* in the hospital bed who can't even tell you his/her name at that moment because they're so out of it is *everything* to this person in the room, who stands in the corner, out of the way, strong, keeping it together, letting us do our work, stabilize, extend life another minute, hour, day.

I lost it for both of us. I had to leave the room and duck into the closet. Trauma has never bothered me, but that look in her eyes cut me right to the soul.
I fought tears, and lost.

A fellow MEPN (and good friend) asked me, "Did you see her eyes?"
"Yes. That's why I had to leave."
He nods. "I had to leave, too."

We just stood there, hugged each other for a bit, sighed, and went back to taking vitals.

Later that day, I found out that another patient had received a final cancer diagnosis, and that it was not only extremely early, the prognosis was very good, AND it was treatable. She hugged me and we jumped for joy together.

A nurse practitioner friend of mine told me that not a day goes by that she doesn't give bad news, good news, cries, laughs or hugs a patient. And she says if you can't feel, it's time to leave the profession.
I think I understand why.

Remember: there's a life in front of you. There's a person in that bed. We are so much more than the sum of our diagnoses.

Ambling along.

An early Sunday morning. You know you're in school when 8:00am feels like sleeping in.
The infamous parrots woke me up this morning. Yes, parrots. In San Francisco. Apparently they like to summer in the Parnassus/Cole Valley area, and this morning I discovered that they love apple trees.
That was actually a novel alarm clock.

In any case, we're done with our 4th week, and into the 5th. By the end of this week, we're halfway through the first quarter. It's pretty amazing to see how much we are learning. Tomorrow we have another pathophysiology test (yay) and we have some relatively difficult homework in Pharmacology where we have to investigate a toxicology report for Ms. Vickie Lynn Marshall.
Then there's the usual reading, heaps of it.

The patient care is awesome - Friday was by far the most interesting day I've had as far as variety of problems, and alertness/communicativeness of patients. I saw my first pressure ulcers, which the wound nurse confirmed as stage I and stage II. The nurse I was shadowing is AWESOME, lots of experience, moves fast, and is by far one of my favorites to learn from. We got that patient taken care of, dressed the wound properly, and started ambulating the patient. I can see why it's such a problem though- when you have thin skin, a recent MAJOR surgery, and someone in pain, it's hard to turn the patient every 2 hours. Somehow, though, we did get the patient moving, which also got the lungs to clear.
Sigh.

Someone called a code that I got to cancel. Incidentally, someone decided that the code team members should wear all black. Not kidding. How morbid is that? Hmm, the "death angels" or the "pirate-ninjas"? I guess the person in arrest isn't gonna know one way or another, but I thought the decision was pretty morbid.

Friday was also a day of A-Fib (wild to listen to), learning more meds, checking vitals, learning about HIV, catching an infiltrated IV - Me: "I think it looks swollen, and the patient says it stings." Nurse: "Well, Medicine can sting sometimes." Nurse looks at the arm, and says, "It looks okay."
5 minutes later, Nurse: "You were right, good eye, it was infiltrated. Here's how we deal with it."
I thought that was really cool of her- for one, any praise we get we thrive on- and of course I'm going to defer to the judgment of a 20+ year nurse. What really got me was that even though she's been a nurse for two decades, she listened to my observations and took the time to double-check things- she didn't have to, but she values anyone's observation, including a brand-new student. I really respect that, and I told her so, "thanks for listening to me." Her reply, "when you stop listening, you stop growing and learning. Everyone's input is valuable, and when it comes to patients, it's better to double check then to let it be. Remember that."
I nodded.

That's probably the best advice I've had so far.

I also shook a patient's hand good-bye - she thanked me for helping her out, which made me want to help her more. When I left, she was just about to undergo a very very painful procedure, and I wanted to be there to hold her hand for it, but time didn't allow.
The conversations I had with that patient were some of the most intriguing I've had, but I have to save that story for another time.

MEPN is a constant balance of emotion, work, schoolwork, and time for self. The latter gets lost, so I'm determined to do a bit of that today.