October, overwhelming.

Healthy or paralyzing fear?

Depends on the day. This program is a huge step up in everything that we're doing, and I really love what I'm learning. The stark realization of responsibility hits me every 15 minutes or so and I find myself nearly panicking - then I remind myself that there are two years left and I'm just beginning this program, and somehow I head back into studying.

Yeah, it's exciting. Sometimes I look around while at UCSF and I can't believe I'm there. It's everything I've ever worked for, and I'm doing it.

So many changes in life- it's amazing what a mere 8 weeks will teach someone. Burning Man was pivotal for me in so many aspects; I loved being a med supervisor and really connected with a group of EMS personnel who are just as goofy and fun-loving as I am. They were people who listen to each others' stories, understand one another. I felt more at home than I have in a while. And the gifts that the Playa provided! I can't even begin to articulate my experiences from this year, because they were so profound. Returning home from Black Rock City, I felt as though my lessons continued, and I felt ready to embrace life in a way I haven't for a very long time. I felt alive again. I still feel that. And I knew some changes had to occur. Which brings me to: Will is most likely moving to LA, where his world, life, work exists. He travels all the time for work, which is great- he's awesome at what he does. But leaves me alone. A lot. I think he's been home at the most 10 days in a row this year. Yes, what does that mean? I'll deal with that later. I can't even begin with that one.

All I can say is that in this past year, I've been lonelier than ever. But that's about to change.

Suffice to say I'm glad I'm in school, where I can get lost in learning.

Here we go.

Learning.

Every day I learn, I am humbled by how much more there is to know.
Here's a sample:

I've learned that fake seizures are indeed, obnoxious.

I've learned that asking a parent, "How are you doing?" when their child is sick and in your care goes a really long way.

I've learned that more people should speak Spanish in California.

I've learned not to trust other peoples' charting and to make my own assessment.

I've learned to try for the "tough stick."

I've learned that no matter your religion, there's a special place in hell for people who hit-and-run 80 year old grandma crossing the street to go to church.

I've learned to go to the doctor, even if he's a jerk, because the time you go to him and it's really a big deal, you earn more respect than you ever imagined.

I've learned to never let it go to your head.

I've learned that I will have days where I seriously screw up, and am grateful that nobody is hurt. (Knock on wood).

I've learned that I love what I do.

I've watched other people sit on their asses and not help out when push comes to shove, and I will never be like that.

I've learned that if you tell me the exact amount of pain medication you need, where to start your IV, and that you're allergic to all meds except ativan and dilaudid, then I consider you a GOMER (Get. Out. Of. My. ER.), and I never thought I'd ever feel that way towards anyone. And if you ask me for a meal tray and then tell me you're suicidal after I refuse because I'm waiting for your lab tests? Then you have incurred my wrath and I resent paying taxes for your visit. And I especially resent you if your ring the call light 40 times while I'm in a pediatric code next door.
See this youtube video, it is so illustrative of the crap I deal with: http://www.youtube.com/watch?v=_m64cy1MMPg&feature=related

I've learned that you cannot, no matter what, give more than 10mEq of Potassium per hour or you will cause a dysrythmia. And I have not done so, thankfully.

I've learned that if you call a nurse "honey," s/he will cringe. And will lag at getting what you need.

I've learned that a good charge nurse is really awesome.

I've learned that even a jerk of a doc can be a really awesome diagnostician.

I've learned that when the doctor says stop CPR, you stop. And you realize that you've done all you can.

I've learned that when you start an IV on a kid, you had better damn well get it the first time, but sometimes you don't, and that's okay.

I've learned that really, everyone who is sick and in the ER is afraid, and if you honor that, then you have a way better chance of connecting and understanding what's going on with your patients.

I've learned that the little things really go a long way.

I've learned that I have a helluva lot more to learn.

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.

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.