Student Nurse

Morbid Curiosity

2005-12-05T12:14:00.000-08:00

This last week I did a one-day rotation with a Hospice Nurse. Hospice care is "any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease or slows its progress rather than providing a cure" (Wikipedia).

Our first visit of the day was to a patient who had passed on just one hour before our arrival.

I had never seen a dead person up close before.

She was in her 70's, a dignified looking woman who was clean and well-cared for. Her passing was peaceful, while she was sleeping, with her family nearby. Advanced breast cancer was the official cause of death.

In death her mouth slacked open like a trap door, as if her soul had escaped from that orifice.

After consoling the family, the Hospice nurse began the woman's post-mortem bath. I held up this woman's legs and turned her side-to-side while the nurse lovingly, gently washed her entire body.

She was still warm. A little air escaped her mouth when I turned her, making a groaning noise.

We dressed her in her favorite pajamas and the Nurse arranged her body just so: arms nestled in her lap, legs straight, head propped up on pillows. She looked as if she might be just resting, ready for someone to visit.

Then we waited with the family for the mortuary to arrive. They were eating fried chicken in the living room and some were crying while they ate. The smell of grease from the fried chicken mingled with images of this dead woman in her bed; it was surreal.

The mortuary workers came and took her away. Then we left.

I was impressed with the professionalism and respect that the Hospice Nurse had for this woman and her family. The family was grateful for her and for the gift of Hospice: A dignified, supported death at home.

To learn more about Hospice, Death and Dying visit Death Maiden.

I'm Alive

2005-11-28T19:07:00.000-08:00

Hello my Poor Dear Readers, who I have left stranded for over a month.

I want to assure you all that I am alive and well, as well as half-way through my 4th and last semester of nursing school.

I do not have an earth-shattering reason why I didn't post for you, I simply have been overwhelmed with the job of completing this last semester.

I wish you all well until the next post,

Student Nurse

Burnt

2005-10-18T18:54:00.000-07:00

This week I had a very needy patient who greatly tested my patience.

And as one of my friends said about me, "You have the patience of Job."

But something just snapped inside me this week. When she put on her call light "to get something for my dry lips," the 5th non-emergent call within that hour, a part of me wanted to tell her to shut the *%*!^ up and deal with it.

Of course I didn't. I got her petroleum jelly and she smiled this angelic, manipulating smile, saying, "Oh, Student Nurse, thank you so much."

I don't know exactly why I snapped this last week; chalk it up to the stomach-churning stress of a barbaric nursing school experience combined with less-than supportive hospital staff.

Whatever the reason, it bothers me. For a moment, I had that same look in my eyes that you see in badly burnt out nurses, those ones everyone hopes they never turn into.

I hope I can find a part of myself that is still idealistic and naive after this whole ordeal is over in February.

The Answer and Beach Time

2005-10-11T13:06:00.000-07:00

Yes indeed dear readers, my patient described in You're the Sleuth, Installment Two had a Cipro allergy. Props to those who guessed correctly.

Some nice pictures from a quick vacation to a misty beach in late September...

You're the Sleuth, Installment Two

2005-10-09T13:36:00.000-07:00

At clinical yesterday, my patient displayed interesting symptoms that left everybody guessing. Test your clinical knowledge with this scenario:

A 52 year old female has breast cancer and is 1 day post-masectomy of the left breast. Three lymph nodes were removed during the surgery. So far her recovery is uneventful except for complaints of "itching like crazy" on her left arm, right flank and head.

She asks you to check for a rash because "it feels so bad there must be something like a rash there." You see no rash, only redness where she has scratched the skin.

Her arms and hands are edematous (swollen) bilaterally, with the left side more swollen than the right.

This patient has not received any opiates (including morphine) for the past 24 hours. She is receiving Tylenol (Acetaminophen) PO for pain, Benadryl (Diphenhydramine) PO to relieve itching, and Cipro (Ciprofloxacin) PO to prevent a post-op infection.

What are your first impressions as to what could cause these symptoms?

Stop now to formulate your hypotheses.

Later in the shift the patient applies warm water to the itching area and states that this partially relieves the itching.

Thirty minutes later you observe a rash of fine papules on the patients hand and arm that looks like this:

What has caused these symptoms? What are the priority nursing interventions? What orders do you anticipate from the doctor?

Leave your comments and stay tuned to find out what happened. I will post the answer tomorrow!

The Meaning of Culture

2005-10-07T10:41:00.000-07:00

Our first lecture of 4th semester was on Nursing the Cultural Diverse Patient. Our class consists primarily of white Anglo-American women, as do most nursing classes, and the mood was slightly tense.

Everyone, students and teachers, was trying very hard to be politically correct.

Later that afternoon, while lecturing on a different topic, our teacher presented a case scenario. A white middle-aged homeless male presented to a free county clinic with coughing over the past month, night sweats, weight loss of 10 pounds, fatigue and malaise.

Then she asked the class, "So, what Nursing Interventions would you perform?"

After a few people answered, "Apply a mask," "Take vital signs" and "Ask about exposure to infectious persons," I piped up with "Take the culture."

"Umm, yea" she replied hesitantly, "You would need to be sensitive to this persons culture."

"No" I laughed, "Take a sputum culture!"

At that moment the racial tension and the white guilt dissolved like Alka-Seltzer, and the class burst into the release of laughter.

It's good to be back.

First Real Interview

2005-10-03T21:08:00.000-07:00

This past week I had my first real job interview as a Nurse. I don't graduate till February, but hospitals are already requesting interviews of those in our class.

You know you are in the right profession when Head Hunters are cold-calling you before you've even graduated!

Now, I've interviewed for a job at Taco Bell, and I did have to interview for my job as an Emergency Medical Tech, but this was a white-collar job on a whole new level.

First, the suit: pinstripe pants, black jacket, white undershirt, silver necklace, conservative makeup and hairstyle.

Then, the resume: after consulting with a few friends who are farther in the corporate world than I, the document was polished. I agonized over paper at the local office supply store. White or Ivory? Envelope or no envelope? Thicker or thinner?

Lastly, the research: the hospital and its philosophy, available departmental positions, comparable hourly wages.

And where, you ask, does Student Nurse want to work?

Adolescent Psychiatry. Hey, it takes a crazy to work in the looney bin, so I think I qualify for the job. Plus, I had a fabulous experience in this rotation, and I've always felt at ease with this age group.

Unfortunately, the Nursing Recruiter said that positions on the unit I requested usually require experience.

This is understandable. When the 347 pound high-school quarterback with Intermittent Explosive Disorder goes off, they don't really want the bran-new nurse crying and shakin' like a vibrator in the corner.

On the other hand, maybe they are so desperate for a warm body that they will hire me.

If not I can certainly pay my dues for a year in Med-Surg before I go on. Time will tell.

Vacation!

2005-09-29T15:21:00.000-07:00

Ahh, my dear readers, Student Nurse is on vacation after passing 3rd Semester.

Look for her to return the first week of October.

Happy Blogging!

Take Down! Psychiatric Restraint

2005-09-18T10:10:00.000-07:00

We've all seen the depictions of restraint of the psychiatric patient on some B-movie from the 70's or a low-budget sitcom:

The bestial patient throws chairs through the window, shattering glass and shreiking savagely. Six orderlies pounce simultaneously on the poor brute, whose struggles are fultile as the nurse jams a vial of sedatives into his jugular vein. His rigid body relaxes as the nurse coos, "Just another moment and this will all be over....."

I was expecting a toned-down version of this when I walked into my Psychiatric rotation, and was suprised by what actually happened when a patient had a major meltdown.

10 year-old Francisco was having a bad day, and loosing a Volleyball game sent him over the edge. He pushed down another kid and started running a very foul mouth.

Staff Intervention #1: Removed other children from the area and assigned a staff member to "talk him down." This involves calming words and setting limits verbally.

Francisco continued to swear at the staff member. Then, he picked up a chair as if to though it.

Staff Intervention #2: Placed Francisco in the Quiet Room (a padded room with a bed) with a staff member in the doorway. The staff member continued to talk him down.

Francisco continued to swear, and then spit at the staff member and on the walls.

Staff Intervention #3: Required that Francisco take a sedative, either in pill or shot form.

Francisco refused the pill, so a rapid takedown using as little force as possible to get the job done. He was then left to rest in the quiet room with a staff member watching from the doorway.

I was impressed that this team took every step possible to prevent a forced takedown and chemical restraint. I'ts not perfect, but three cheers for progress in Psychiatry care.

Self Mutilation

2005-09-15T20:51:00.000-07:00

picture source

I was surprised by how many adolescents in the Psyciatric Ward engaged in self-mutilation.

Jasmine had cuts in her hand deep enough to show muscle. Frank had fresh cuts and old cigarette burns. Tyler carved the name of his legal hold, "5150," into his arm.

They all have different reasons for self-mutilating.

Jasmine cuts to feel alive, to feel something. "I start cutting and I know that I'm still alive," she told me. A recent article confirmed this motivation:

"The shock of seeing blood helps some teenagers feel 'alive and real.'"

Frank cuts to dissociate, to cope with the stressors of his life. I found a poem that may touch on his motivation:

Painless Pain

Razor bladescan never hurt me
I've been hurt too often
I try to remember why

and then the guilt comes
blood on the bathroom floor
the sign of freedom soon to be gone
I am all
and I'll be gone

-Poem by a cutter

Tyler cuts for attention. This postcard, anonymously submitted to the site PostSecret, is a powerful message from another hurting young person with a similar motivation:

Persons who engage in self-mutilation need support and professional help.

Anyone who is thinking about harming themselves or can call a free hotline, 24 hours a day, 7 days a week, 365 days a year, at 1-800-784-2433 and talk to a supportive person.

Youth can also call the Youth America Hotline at 1-800- 968-8454 and talk to another Youth during business hours.

The Youth America Hotline also has a Website for those who want more information on Cutting and Self-Mutilation.

All Quiet on the Blogger Front

2005-09-14T16:27:00.000-07:00

I am remiss to admit that it has been over a week since Student Nurse has blogged.

I was emotionally overwhelmed, both with the human rights outrage in the gulf coast and with tying up the loose ends so I can pass 3rd semester.

Let me repeat that: I am going to pass 3rd semester! Lets get a big Shout Out for and everyone finishing up a semester!

Tommorow I will post another one of my tried-and-true stories from the Adolescent Inpatient Psyciatric Ward.

Stay Tuned!

Rubberneck

2005-09-05T12:38:00.000-07:00

Seeing and listening to the incalculable suffering and death in the wake of a natural disaster has been emotionally overwhelming.

I see the picture of the dehydrated, sobbing baby, and I want to bathe him, hold his bottle and sing him lullabies.

I see the picture of the distraught, frail woman and I want to give her a hug, tuck her into a warm bed, and feed her soup.

But I can't. The only thing I can do is open my wallet and give anything I have to spare.

I see my Brothers and Sisters hurting and dying and I can do nothing but rubberneck.

I feel so helpless.

Slightly Used Toilet Paper

2005-09-02T08:10:00.000-07:00

This is quite the unique advertisement from South Africa. Toilet rolls that are slightly used?

Please, tell me someone didn't actually unfold the dirty paper and roll it up after wiping their backside.

What is even more disturbing is the small script at the bottom: 'still in good condition.' Honestly, how good of a condition is any used TP? Yikes.

I'm Sorry Frank

2005-08-28T14:13:00.000-07:00

Frank, the 16 year old kid who clocked in at over 6 feet and over 350 pounds that I told y'all about on my last post, was well behaved this week. A little too well behaved.

I worry about kids like Frank. He has a history of serious problems, and the scars to prove it: fresh, deep, self-inflicted cuts on his limbs. A suicide attempt two months ago, a yellow-grey faded bruise on his mom's jaw from a punch two weeks ago.

On his face you could see sadness, anger and loneliness.

But he couldn't open up to anyone on the unit. He withdrew from his peers. He couldn't even act out or act in. He was just frozen: attending groups, taking his meds, complying docilely.

How do you reach a kid like Frank during a short-term (2-14 day) hospitalization? Sure, we can get his medication regimen stabilized. We can hopefully prevent suicide or self-mutilation for the short time that he is hospitalized.

But what happens when we shove him out the door and back into his very dysfunctional family?

So dysfunctional, in fact, that his mother saw 'no problem' with Frank taking an entire bottle of Aspirin to kill himself. Then he started cutting deep into his flesh with a steak knife and she saw 'no need for hospitalization.'

To be fair, she has now agreed that 'hospitalization was probably best' during the last week that Frank's been with us. But I just don't think that the underlying family dynamics have changed in this short time.

The social workers do the best they can: they arrange family therapy, medication follow-up with a psychiatrist, and referrals to community support groups.

But Franks family structure is broken and sick. His mother is not likely to follow up diligently with the things that can really produce personal change: therapy and support groups.

I wonder where he'll be in a few years.

Good luck Frank, I'm sorry we couldn't do more to help you.

Linebackers on the Pediatrics Unit

2005-08-24T23:55:00.000-07:00

While looking over the list of patients in the psyc adolescent unit today I had many interesting cases to choose from.

A 12 year old male with intermittent explosive disorder who had been in Juvenile Hall 5 times in the past month, with 3 take-downs this week. Too high-maintenance.

A 14 year old female with major depression on suicide watch. Boring.

Then there was Frank, A 16 year old male with bipolar disorder with psychotic episodes, social anxiety disorder and a history of cutting. Interesting.

I read further: He socked his mom within the past month and takes more medications than an organ transplant recipient. I think I picked a winner.

Oh my. The intake sheet says Frank's over six feet tall and over 350 pounds? In the Pediatric Unit?

Just then I looked up and realized that the hefty line-backer of a man with the full beard sitting in the corner is indeed 16 years old, and he is indeed my patient.

"Hi, I'm Student Nurse, and I'm going to be chillin' with ya' tomorrow and Friday. How are you feeling?"

Underneath the curly locks of facial hair is a cute, pimply face and frightened eyes.

"Um, I guess I'm OK."

The kid was shy, but personable.

After some smalltalk, I started with what I thought was an icebreaker question: "So, what do you want to be when you grow up?" I got an unexpectedly frank response.

"Well, first I need to be a functioning member of society," said Frank bluntly.

"So, like get stabilized on you medications and get out of here?"

"Yeah, and not be sedated all the time."

"So your medications make you sedated alot?"

"All the time. Like right now I'm sedated, I'm sedated all the time." His eyelids sagged halfway closed, determined to follow the course of gravity.

"OK Frank." (Notice my lame, non-therapeutic response. Be patient, I'm new at this.)

He got up to clear his dishes.

"Well, I'm gonna go make some photocopies. I'll see you tomorrow!"

"OK."

It will be interesting to see what happens with Frank. Stay tuned.

Model Parents

2005-08-19T22:56:00.000-07:00

Setting: Inpatient Acute Psychiatric hospital, adolescent unit.

Players:

-Joel, a 12 year old male with a history of multiple foster and group home placements, ADHD, intermittent explosive disorder, sexual and physical abuse.

-Many Staff Members

History:

Joel's only earthly possession is a plastic container full of toys. The doctor wrote an order allowing Joel to play with 4 individual toys during breaks and quiet time. A change was made on am shift that allowed Joel to bring the entire box of toys in his room, however am shift did not tell pm shift about this change.

PM shift only let Joel bring 4 toys into his room at a time. Due to this lack of continuity Joel had a meltdown, which included climbing onto the nurses station desk and stomping. He ended up in seclusion and restraints.

Act 1: By the time I arrived, the incident was over, the restraints were gone and Joel was calm. He interacted well with staff and peers during and after dinner.

However at bedtime, instead of sleeping Joel kept coming out of his room with attention-seeking requests:

"I just wanted to see what time it was."

"I noticed there is no light above my bed. Why is there no light above my bed?"

"When will I get visitors next?"

Each time Joel came out, a staff member said, "Joel, get back into your room or tomorrow night you'll have an early bedtime!"

The fourth time Joel came out, he had a Patient's Rights Manual in his hands.

"This states that I can have my TOYS in my ROOM! See, it's my right to have my toys!"

"Actually Joel, that pamphlet is for those age 14 to 17. You are 12, so we keep your toys until quiet time."

"That's not fair! I have rights, and I have a right to my toys! Show me a pamphlet that talks about my rights!"

"We don't have a pamphlet for you Joel."

Then another staff member started talking to Joel. Joel argued with her as he did with the first staff. Another took him aside and the discussion proceeded along the same lines.

Joel was dramatic and vociferous, his muscles were clenched, beginning to pace. The staff were pacifying, some patronizing.

But Joel had won this battle already. He had succeeded in engaging the entire staff on the Unit in a rousing conversation and extending his bed time by 15 minutes so far.

For kids like Joel who have nothing to loose, power struggles like these are the only things they can win.

And get this: The staff let the argument go to the point that the nurse picked up the phone and questioned the Doctor about changing the order about the toys.

The Doc said, "Oh, fine, give him his toys and there won't be a fuss tonight."

Inadequate parenting and early trauma are what's landed Joel in the situation he's in. And tonight, the place that is supposed to set boundaries and model appropriate parenting has failed him too.

Off-Duty Code Trauma

2005-08-14T18:15:00.000-07:00

It's been a trying week for Student Nurse.

In the last seven days I've spent over $1000 in repairs on my well-maintained car.

There have been challenges at school that I will save for a later post.

And I had promised the folks I would watch my two youngest brothers on Saturday while they were out of town.

Ah well, It would be fun spending time with the boys. I needed a break from the real world anyway.

One of my brothers, Chris, has Cerebral Palsy and uses and electric wheelchair (read about his background here). We've got a wheelchair-accessible converted van that gets him around.

On Saturday afternoon we had just got back from a trip to the supermarket and it was time to get him out of the van. I started lifting up the wheelchair lift and unlocked his wheels.

At this point in our routine he usually inches out a bit and waits for the lift to come to the top to the van.

But I watched in horror as his hand tightened in a spasm against the joystick and his 300 pound wheelchair lurched forward off the edge of the van, crashing onto the lift 4 feet below.

Too quiet.

I found him pinned between his wheelchair and the lift, blanched pale and wide-eyed, with a pool of blood forming under him.

My other brother lifted the mangled wheelchair up a few inches, and supporting his head and neck, I carefully slipped all 70 pounds of him out from the wreckage.

Airway. Check. Breathing. Check. Circulation. Check. And he's conscious. Extra fabulous wonderful check. The EMT in me kicked in and I performed a rapid trauma assessment.

He had a gaping 3 inch gash on his elbow, excessive tenderness above the site of the flesh wound, and was complaining of difficulty breathing.

In nursing school we haul our equipment everywhere with us to practice on manikins and hardly ever use the stuff, but where is a stethoscope when you actually need one??!?!

The Ambulance with the Medics arrived, and they said his lungs sounded OK. That was a blessing because a punctured lung can go bad quickly and we were a long ways from the closest trauma facility.

At the hospital, they completely ruled out pulmonary injury. Chris refused IV pain medication because he's phobic about needles and didn't want an IV.

Another great bit of news: X-Rays ruled out a fracture. That was surprising to everybody given the mechanism of injury, the large laceration on his arm, and the severe pain in an area that showed no major flesh damage.

15 stitches later, we went home.

Mom and Dad, who were on the flight home from their vacation when the accident occurred, made it home 30 minutes after we did.

In those 30 minutes, Chris' oral Vicodin had finally kicked in, his friends had come over to chill with him, and the dried blood on the garage floor was scrubbed off.

Things looked almost normal.

And I needed a Valium.

Flying Emotional Caca in the Peds ICU

2005-08-11T23:55:00.000-07:00

I was looking forward to my rotation today in the Pediatric Intensive Care Unit.

Even better, a baby fresh from open heart surgery was in the room the Charge Nurse directed me to.

But the mood changed very quickly when the Nurse at the bedside saw me walk in and barked fiercely,

"You! Stand out of the way on that wall!"

The physician looked at her and whispered something to the tune of "Hey, lighten up a little."

Lets just say she didn't lighten up a little.

The day ended up with me sobbing in the bathroom.

However, note the interesting role switch. Twenty years ago it was the doctors who were notorious for unloading emotional caca on everyone in their path. Today a doctor reminded a nurse to mind her manners.

You Are What You Eat?

2005-08-10T19:15:00.000-07:00

A hungry European traveler might pass by this Cafe in Prague and be tempted to stop in for a bite:

But watch out! If they truly live up to their name "Strep," this is what your mouth will look like by the time you make it to France or Russia!

Why I Could Never Work In Pediatrics

2005-08-06T11:45:00.000-07:00

A mother strode into the Pediatrics unit clutching her 3-month old baby tightly to her breasts. The mom had an expression of strained sanity on her face, old spit-up on her shirt, and an air of hysteria about her. Shell-shocked Dad was close behind, carrying the diaper bag and looking like he had forgot his balls at home.

I knew I had an admit coming in, and if this was it I knew my night was shot.

I didn't even have to look at them to feel the vibes radiating off them: "Drama Alert! Drama Alert! Parents need the Valium more than the Kid!"

Today their local pediatrician had felt a large mass in the infant's belly. (That could potentially be really bad. Think advanced cancer.) However, a subsequent CT scan had showed a greatly enlarged ovarian cyst.

Yea! This was comparatively great news. The baby would need emergency surgery to remove the cyst, and may loose one ovary, but she did not have cancer.

After hearing this news, the mother said, "Oh, that's great but.." and rambled non-stop for 5 minutes about not the lost ovary, not the emergency surgery, but how hard it would be to start an IV.

You just got news that your kid is cancer-free and the most important thing on your mind is the pain of a needle poke?

~~~
Sometimes in Pediatrics the parents need more hand-holding and babying than the actual patients.

Heck, if I was a parent I might act that same way if I had little knowledge about medicine and my kid was facing a serious illness.

But there is a part of me that wants to say, "Stand up and be there for your kid! Be emotionally present and supportive. She needs a parent, not an adult child snivelling in the corner!"

I never would actually say that to a parent, but I often think that.

This is why I would not make a good Pediatrics nurse. The family needs a cheerleader too.

You're Not Welcome Here

2005-08-03T22:06:00.000-07:00

Being a Student Nurse is difficult. No Duh.

But there is an aspect of Student Nursing that creates a difficulty that I hadn't anticipated, and that people don't talk about much.

It is a sometimes vaguely and sometimes bluntly enforced rule that as a Student Nurse, I am not a valued, welcome member of the Health Care Team.

I am in the way.

I am a pest.

I am a distraction from real patient care.

I am literally underfoot.

I even heard one RN say, "Make way for the real nurse." Yikes.

Compounding this problem is the fact that Student Nurses have very little patient care that they can do completely independently. Even in 3rd semester, I've stood around waiting for my teacher to show up to watch me give PO (oral) Tylenol.

Our near complete dependence frustrates the staff RN's. It delays medications and procedures; it disrupts their 'flow.' This just feeds that feeling of 'you are in the way.'

If this lasted just for one rotation, or just with a few people, it wouldn't be a big deal. And some rotations are better than others. But it is a persistent, unnerving and demoralizing attitude.

On a lighter note, I think the students could extract an appropriate revenge on the most grievous offenders:

RN, at end of shift: "So, you finished all the charting? How did it go?"

Student: "Charting? Oh, that. I know you said you had to leave right after work for that date with Frank, but I just didn't get time to chart, and I figured you could do it.

RN: "What the %(@*? I thought we agreed you...."

Student: "Oh, my post-conference meeting is starting in like 2 minutes, gotta go! Have a great night!"

A Beginning and a Premature End

2005-07-30T23:52:00.000-07:00

This last week I cared for a young man with Medulloblastoma (brain cancer) that had metastasized to his spine.

Like most adolescents he tried to be macho; he was also respectful, well-spoken and kind. These are attributes that you rarely find in kids who have much less to be angry about.

I did some research on his disease prognosis. The National Institutes of Health say this of his cancer: "although response (to chemotherapy) is seen in more than 50% of patients, long-term disease control is rare."

'Long-term disease control' is a nice, sterile phrase for 'cure'. For him there really is no cure.

He was in the hospital for another round of Chemotherapy, just to help him live as long as possible. We have potent drugs that reduce the horrible nausea, vomiting and pain, but Chemo is still so hard on the body.

He was cooped up in his room all day while the poison dripped into his veins. Late that night I asked him if he wanted to walk around.

There aren't many places in a hospital that a teenage guy would think were cool, but I lamely listed the best ones: the patio with nice landscaping, the coffee shack, or the garden out front with the funky sculptures.

"Actually, I would really like to see the newborn babies," he said.

We went to the Newborn Nursery, and I cried a little as I watched this big, macho adolescent press his bald head to the glass and admire the babies.

"Oh, that one is really cute!" he said, pulling his IV pole behing him.

~~~
I believe there is a part of him that knows his time here is short. He wanted to connect to the beginning, to the very start of this thing we call life: the innocence of a new babe. I hope it will help him be at peace with the end.

Patient Updates

2005-07-27T23:20:00.000-07:00

I wonder if I'll get a hat when I graduate. I've never seen a nurse actually wear a hat; I think it would be fun to wear one as a joke.

An update on some of the patients whose stores I've shared:

First, the 4 month old baby from the post World Hunger Comes Home. Even with aggressive treatment, TPN and lipids (IV fats, sugars and amino acids), she has dropped her weight again from 6.5 pounds to 6 pounds, and has been transferred to the Pediatric ICU. It's sad, she is such an alert, angelic child.

Next, the elderly Asian man from Student Nurse Has Super Powers. I ran into his family in the cafeteria last week. They said that he was not doing well and that a pacemaker had been implanted. I checked in on him, and his time was coming.

Last, the lady from You're the Sleuth. Last time I peaked in on her, 2 months post op, she was still alive! This was particularly suprising considering her advanced age (mid 90's), aggressive cardiac surgery complicated by a GI bleed, and no desire to rehabilitate. When I asked how she was, she said, "Oh, you know, the same." Amazing.

I would not have predicted these outcomes. Life has a funny way of happening...

The Worldwide Scope of the STD Problem

2005-07-24T10:47:00.000-07:00

I wonder about this French Village named Herpes. If I was a traveler I would go out of my way just to see the place and snicker.

And this street is interesting also:

I wonder, is this street located in the French Village? With a name like Herpes, maybe they've developed a whole tourist industry out of it.

An Untimely Deposit

2005-07-21T22:34:00.000-07:00

Student Nurse usually avoids discussing personal topics on the blog to protect her identity, but a recent incident is just too funny to avoid mention.

I recently bought a firm, thick slab of salmon. It was sure to be toothsome- Fresh Wild Alaskan, not the bland farmed type. This was a rare treat, considering the steep price.

Unfortunately, I was unable to eat the fish for a few days as I was overwhelmed at the hospital. When I finally unwrapped the butcher paper to partake of the Pink Goddess, it had a slightly odd odor and a patch of sliminess.

Oh, the disappointment! Being the penny-pincher I am, I decided to rinse the fish, cook it completely and happily consume.

And how fabulous it was! It truly was worth every penny.

With a full belly and a smile on my face, I went out to do errands. Upon finishing I drove home and neared my apartment complex. This is about 2 hours post-fish consumption.

Then, I felt a sudden and uncontrollable need to propulsively empty my bowels. I knew I had about 15 seconds till this urge would become involuntary.

I planted my foot on the accelerator, racing towards the automated safety gate that surrounds the complex. I pushed on the electric gate activator- it wouldn't open the gate!

It had just worked just 2 hours ago! Why wouldn't it open the gate now, in my moment of desperate need? I broke out into a cold sweat. 8 seconds to go.

Looking frantically around, I spotted paper towels. OK, but now the ultimate question: where do I make the untimely deposit?

I could just go in my car. It's an older car, but the seats are cloth and would be really hard to clean.

Or I could go in the bushes. But I really like the maintenance people at my apartment; they are so friendly and hardworking. 3 seconds to go....

Ultimately, I made the selfish decision.

And I brought the maintenance people a plate of cupcakes the next day. I didn't say what it was for.

World Hunger Comes Home

2005-07-18T18:48:00.000-07:00

My pediatrics rotation started this week, and the tiny, sick infant above looked much like my first patient.

Only my patient looked more emaciated and weighed 6.5 pounds at 4 months of age, 1/2 pound less than her birth weight. Healthy 4 month old babies weigh 15 pounds.

As you can see from the picture, the skin is loose and flabby, like a coat a size too large. The fontanel (soft spot) is depressed. The eyes are dull and sunk deep in their sockets.

It is sad to see babies like this, but we see them all the time: on the news and on the solicitations from organizations like Doctors Without Borders and Save The Children. Sometimes I just get numb when looking at pictures of sick children.

It's not that I don't care about these poorest of the poor. But to be really emotionally present when you are looking at those pictures, to imagine the her suffering and the suffering of all other starving children is so devastating, so draining.

So usually I mentally check-out when I see these sort of pictures.

But I couldn't check out with my patient last week. There she was, 6.5 pounds, 4 months of age, looking like a civil-war refugee camp survivor.

She grasped my pinkie finger, smiled and babbled. It startled me.

The poorest nations are so far away, the need is so unfathomable: this can make the problem easy to objectify. It isn't so easy when she is clutching your hand and cooing at you.

Cinema Confusion

2005-07-13T19:01:00.000-07:00

This is an oddly named theater in South Africa, and I am left wondering:

If I walked in, would I be more likely to see "Raunchy Raven Gets Rough" or "The Sound of Music"?

Student Nurse has Super Powers

2005-07-11T22:47:00.000-07:00

I cared for a frail 90-something Chinese man this week whose wife was in her 40's. She lovingly held his hand, fed him spoonfuls of applesauce and wiped the drool from his chin.

She had lived most of her life in China, and she derived great pride and esteem from her family for the care she rendered to her geriatric husband.

For reasons no one understood, the man slipped into unconsciousness early in the morning.

The woman wept quietly at the bedside, her shiny raven locks buried in the soft blankets and his withered thighs.

The man had been strong and fertile in his younger years. People gathered, and every time I walked towards the room I heard several concerned family members speaking in hushed Cantonese. Concern and heartache clenched their shoulders and lined their brows.

At dinnertime the man woke up as unexpectedly as he as slipped away, and said in his native tongue, "What are you all doing here?"

The wife yelped and clutched him and scolded him for scaring them, and a small celebration began.

She gifted the nurses with candied nuts, gushing our virtues in broken English.

When I walked in the room she said, "He awake! You so good nursie, now he awake! You give me you name, I write it down, I tell people now he awake!"

I think she was attributing his surprising recovery to my work as his Student Nurse, but frankly I did nothing but palliative care for this man.

She believed that I had some power over sickness and death in our completely random universe, and this helped her feel more secure in this end-of-life situation.

Does our profession perpetuate this myth? How?

Basic Protection, Please

2005-07-09T12:12:00.000-07:00

I chortled when I saw this picture of a storefront in Shrewsbury, United Kingdom.

Really, though, I shouldn't have laughed at their ignorance and suffering. Someone should go in there and offer these poor folks some basic protection. Condoms aren't that expensive.

Mystery Solved

2005-07-04T11:09:00.000-07:00

So, what happened to my lady in the post "You're the Sleuth"?

One of the side effects of Droperidol (Inapsine) is excessive sedation and mental depression. Another common side effect is hypotension.

These side effects can be especially pronounced in the elderly.

I called the hospital the next day to see how she was doing. It turns out she experienced this sudden deterioration in condition for a few hours, and then was back to her normal self when the drug wore off.
~~~

Was that what you suspected? It sure wasn't what I thought; I was sure she had a brain bleed, neurothrombus or another acute neurological pathology. Thank heavens it was the R.N. and not me who pushed the Inapsine...

You're the Sleuth!

2005-07-02T18:23:00.000-07:00

Thursday night I had given report to the oncoming shift and was ready to leave the hospital when I saw a mass of people run into one of my patients rooms.

Her eyes were pinpoint, she had slow, gasping breathing with expiratory grunts, was completely flaccid and did not respond even to a corneal stimuli. BP was 78/38.

Thirty minutes ago this woman had been conversing appropriately with me with stable vital signs.

For Student Nurse on a hum-drum Thursday night, this was some serious action!

I wedged myself in between the head of the bed and the wall; I was both out of the way of the scrambling team and I could manage the patient's airway.

The charge nurse barked orders, and the team worked smooth and hot: "Get another BP! Whose got the blood sugar machine? Someone get a 100mL normal saline bolus running. Call the ICU for a transfer. Order Chest X-ray, blood ABG's STAT. Someone write this stuff down. And whose calling her doctor?"

A specialized team of ICU and hospital staff rushed in to help us stabilize the patient and figure out why she had suddenly collapsed.

I was trying to formulate hypothesis as to why this patient had gone so bad so quick.

She was in her 90's, had cardiac surgery less than a month ago with a slow recovery, a recent GI bleed, a history of CVA, a recent moderate drop in her hemoglobin/hematocrit as well as a recent moderate increase in her white blood cell count.

In the last few hours she had gotten Acetaminophen (Tylenol) for neck pain 4/10, Droperidol (Inapsine) for chronic stomach pain 8/10, and Pantoprazole (Protonix) to protect her stomach from ulceration and further GI bleeding.

Any ideas yet? Check back tomorrow for the answer and a patient update!

If Life is a Stage....

2005-06-27T23:44:00.000-07:00

The Scene: Patient's bedside.

The Plot: Crushing one Norco-5 (Hydrocodone/APAP) and mixing with water to inject into PEG Tube.

The Players:

Student Nurse, Ever vulnerable to the sin of hubris
The Patient, Barely responsive, pain mild to moderate, death will still her breast soon.

And now the Narrator begins in a hushed yet excited voice:

"And now, we see Student Nurse at this patient's bedside, adding the crushed pill to a plastic cup. She picks up a syringe, fills the syringe with water, and squirts the water into the plastic cu....

"Ladies and Gentlement, we have a critical error on our hands! The force of the water stream from the syringe has blown the pill powder all over Student Nurse's face, shirt and the bedside table!"

(Foreboding melodramatic music begins)

"Worse yet, she has ruined a Schedule II Narcotic, and may be suspected of stealing or consuming pills if she asks for another. For gosh sakes, the pill powder is all over her face and shirt!"

"Oh, the conflict! What is our hero to do?"

Nic Fix

2005-06-25T23:06:00.000-07:00

It was 10:30 last night, an hour past the time when I should have been cruising the asphalt on my way to home sweet home, and I was at the nurses station charting.

A faint whiff of cigarette smell came to my nose, but this was not unusual because one of the night staffperson is a heavy smoker. She must have just walked past me after her fix.

Then the smell got a little stronger, and I noticed the resident smoker was nowhere in sight.

One of our particularly spastic nurses leapt out of her chair like it was scorching her cheeks and shrieked, "Who's smoking!"

Three more nurses got up, and with the seriousness of a manhunt they went to find the offender.

30 seconds later they found a patient with an impish grin, sitting on a toilet with a smoldering cigarette butt in her hand, in utter nicotine bliss.

Good thing they found her quickly. If the smoke alarm is activated, the Fire Department would have charged $3,000 to respond.

Are We Compatible?

2005-06-24T23:44:00.000-07:00

Tonight I was hanging two IV antibiotics, Vancomycin and Cefepime. The order said to administer them at the same time to the same patient.

I assumed this order meant that they were compatible.

I then prepared to administer the antibiotics, a procedure I have repeated many a time:

I reconstituted the antibiotics and primed them into the same tubing.

I called my instructor and walked into the patients room.

I hung up the med on the IV pole and cleaned the PICC (central IV) with alcohol.

"So, these antibiotics are compatible, right?" said my instructor. It sounded like an afterthought, something she was slightly hesitant to ask because it was so obvious.

My hand holding the IV tubing connection stopped abruptly, inches before it connected to the port.

"Hmm, actually I haven't checked."

It turns out they were NOT compatible.

Dang, I got lucky tonight.

Flesh-Eating Bacteria

2005-06-21T21:53:00.000-07:00

Ever heard of Necrotizing Fasciitis, the so-called "Flesh-Eating Bacteria"?

Well, it's a rare potent variety of Group A Strep or other combinations of bacteria that consumes the fascia, the layer of connective tissue between subcutaneous fat and muscle.

Want to learn more about this pathology? Read below. Want to see the cool pictures? I thought you did!

This man, Dan Morsette, contracted a severe case of Necrotizing Fasciitis of unknown cause. The following picture shows the rapid spread of the bacteria:

Do you know what the treatment is for Nec Fac? Surgical Debriedment of the fascia. Because subcutaneous fat and skin covers the fascia, this skin must be removed also.

The following are links to the pictures of Dan's trunk after his debriedment surgery. WARNING- these are graphic pictures of open wounds! For those age 18 and older please:

After Surgical Debriedment

Another View, After Surgical Debriedment

Fresh Skin Grafts

Healed Skin Grafts

Dan, I award you the Badge of Perpetual Endurance for surviving that ordeal. To read more about Dan and other survivors of NecFac, visit the National Necrotizing Fasciitis Foundation online.

More about the Pathology:

The bacteria can enter the body through a very minor trauma such as a pin prick, or a major trauma such as surgery.

The CDC estimates 500-1500 cases per year with a 20% mortality rate.

To learn more about Necrotizing Fasciitis, visit the National Necrotizing Fasciitis Foundation on the web at www.nnff.org.

Beautiful Smokers

2005-06-19T20:58:00.000-07:00

Smokers are beautiful people.

Youthful and sexy, rebellious and curvy. Smoke wafts from their voluptuous lips like steam from a hidden hot springs.

Until the carcinogenic smoke fatally mutates their cells.

I took care of a smoker last week. At the fossilized age of 57, she gave up a productive career to treat her lung cancer with chemo and radiation. They thought they got it all.

I was with her on Friday when the Doctor told her the cancer had spread to multiple areas of her brain.

She would pass soon.

"I can deal with what the Doc's saying," she said. "I just don't know how my oldest daughter's going to cope with this."

Smokers are beautiful people.

Direct Rapture Plan

2005-06-18T23:56:00.000-07:00

Student Nurse has been busy. The hospital census is high.

But I have an idea of how we can dramatically reduce our patient admissions, as well as relieve the patient load in hospice and the skilled nursing facilities.

It's called the "Direct Rapture Plan."

The Royal Adelaide Hospital in South Australia has used this method for some time with great success.

Maybe we should try the same thing here.

We Have Crabs

2005-06-15T23:05:00.000-07:00

This sign was seen at a seafood shop. I think it would have been just as appropriate to hang it at the public clinic.

The Irony of the Student Psyc Nurse

2005-06-14T21:44:00.000-07:00

Whoever thought Student Nurses were emotionally and physically capable of treating psyciatric patients was a daft meatheat.

Months upon months of obsessive studying has left us catatonic.

No time to cook. Instead, a constant fast-food diet has added a layer of marshmellow pudge to our figures.

The mere sight of our sadistic Maternity Instructor sends us into full-fledged panic attacks.

Endless hours at the computer typing careplans have induced visual hallucinations of Maslow Hierarchy of Needs.

I swear I'm gonna introduce myself to my first psyc patient and get a reply of, "Well, you can have my bed. You look like you need it more than I do."

Candida Toothpaste

2005-06-13T23:52:00.000-07:00

When I think of toothpaste, I think of minty fresh breath. Slick smooth white teeth. Pink firm healthy membranes. A genuine smile.

So I was suprised to see this French toothpaste with the brand name "Candida."

Hmm, that's a wierd name for a toothpaste.

The picture of a raging Candida infection bombarded my senses:

I just I don't think I would be able to use that toothpaste without gagging.

Supine, Vulnerable, Disinfected

2005-06-12T23:53:00.000-07:00

So in the previous post I described Electromagnetic Therapy (ECT) and my compulsory rotation in this treatment modality.

However, I could not understand why thinking about this rotation would create such anxiety, as well as involuntary puckering of all orifices of my body.

Today I may be able to write a coherent explanation. Here is a fictional narrative of how someone who thinks like I do would respond to the option of ECT:

"Imagine you are a person who is severely depressed and anxious. You are locked up in a psychiatric facility.

It greatly bothers you that you are locked up in a facility, but you understand that this is to help keep you safe.

You feel worse than any healthy person could imagine- your wretched soul is tormented by feelings of shame, guilt and worthlessness. Your life is a living nightmare.

You just wanted it to end. You had tried to end it at home- that's why you're here.

You've lost so much in your life, the only thing you've really got left is your mind. You're a smart person, and you rely on your mind to help you out of tough situations like this.

They can lock up your body, but they can't take away your mind.

Now the doctor suggests a new treatment. But it involves putting you to sleep? A side effect of likely memory loss?

Your consciousness and your memories are the only things you've got left!"

This is why ECT terrifies me so- It takes away that last bit of control from the patient. It leaves them supine, vulnerable and disinfected.

I imagine myself that way- supine, vulnerable, disinfected- and I am horror stricken.

Shock Them Sane

2005-06-11T16:15:00.000-07:00

Electroconvulsive Therapy Today

Electroconvulsive Therapy (ECT) has a shamefully barbaric history in our country, right up there with frontal lobotomies.

It involves passing electrical shock through a depressed patient's brain to induce seizures, hopefully relieving the severe depression.

The technique is still in use today, but with many different adaptations to decrease the harm to the patient.

In the past, the patient would be fully awake for the procedure, awake as jolts of electricity were pumped through their head. Today they are under anesthesia and completely unaware.

In prior years the induced seizure would cause a body to thrash forcefully, sometimes to the point of breaking bones. Today muscle relaxants are used and the body lies still.

Sometimes patients would receive ETC for punishment, for acting out, or at the staff's whims. Today, the patient must consent to the procedure.*

Electroconvulsive Therapy In The Past

Student Nurses in my program are required to assist with this procedure for an entire day during our psych rotation.

I am terrified of assisting with this procedure, and I don't quite know why.

As we toured the Electroconvulsive Therapy Suite yesterday it was as if a cold, metallic vise was compressing my chest, preventing the exchange of air.

I think tomorrow I will know why this therapy leaves me so panic-stricken.

Check back then.

*Unless the patient is declared mentally incompetent, and a judge and medical professionals concur that ECT is indicated for this patient.

Into to Psyc

2005-06-09T22:37:00.000-07:00

One of our psyc lecturers is an interesting dame.

Last semester tape recorders were common and accepted. In the middle of her first lecture of the semester, this lady spotted a tape recorder and spat upruptly,

"Turn that off! It's a crutch. People don't listen to it anyway. Just listen and you'll understand."

Hmm. So, auditory learners who listen to lectures again on tape use "crutches," while people who re-read textbooks are studious? OK.

It will be interesting to see how the semester plays out.

First Day of 3rd Semester

2005-06-08T16:38:00.000-07:00

Tuesday was the first days back to school after a short break, and I am now in 3rd semester! Whoopee!

A choice moment:

Our class was introducing ourselves to the new instructors on day 1. Many people in out class had recently had babies and were talking about their new additions.

Eric, the archetypical joker of the the program introduced himself with, "I just had my 22nd child during our break!"

Uproarious laughter.

"And I carried two of those babies," I piped up.

The class howled.

"Well, but that was before I decided I was a lesbian."

By this time some of my fellow students were doubled over in delight. The new teachers were chuckling softly, looking at each other with slight puzzlement.

Butt Paste and Teenage Growing Pains

2005-06-07T09:17:00.000-07:00

Last week I took my brother Chris (read about his background here) to a doctors appointment. Having moderate/severe Cerebral Palsy, he requires total physical care, including diapering.

However, he can communicate with a special computer and has normal intelligence. I love the kid.

Although the appointment was to monitor his healing from a recent orthopedic surgery, I asked the doctor check out a groin/scrotal rash that had developed over the last 4 days.

As I took the diaper off his adolescent frame, I remember when I was a teenager and had to visit the doctor for a GYN exam.

I was mortified to be seen naked, scared that I would be told I was somehow defective, and dreaded any questions my mom would ask about the visit.

After hearing me ask the M.D. to check out his rash, Chris looked at me, rolled his eyes and pursed his lips. I could see that he was about as excited about this as I was at his age.

The doc said the rash was no big deal, just irritation from the diaper, and recommended Boudreaux's Butt Paste. Then he left the room so I could apply the ointment and put back on the diaper.

As I applied the butt paste with all the professionalism of a Student Nurse, my brother's manhood quickly stood at attention.

What do you say then? How about, "Oh, hey bro, sorry I gave you a woody." Yeah right.

I settled for, "Alright, almost done."

He looked down, and then looked away. I was suffocating on time, on the protracted seconds that refused to erase his red-faced embarrassment.

Then his diaper was on and we were done.

Some people feel sorry that my brother can't walk. Others are sad that he can't talk.

I mourn that he can't care for his most personal needs.

Morality, Grief and Unwritten Rules

2005-06-06T10:53:00.000-07:00

I had a patient had Calciphylaxis, a rare and often fatal disorder. He was mentally competent, had many probing questions and wretched symptoms.

He was in the hospital recovering from a surgery to temporarily alleviate some of the symptoms of the disorder.

The doctor wouldn't answer the patient's questions or describe the terrible morbidity and high mortality associated with Calciphylaxis.

The staff nurses couldn't answer the patient's questions due to lack of knowledge of this uncommon pathology.

The patient was both frustrated and terrified.

I faced a dilemma: What were the institutional rules, both written and unwritten, about who tells the patient about a poor diagnosis and prognosis? What happens when communication between doctor and patient fails?

More specifically, could I tell this patient about his diagnosis and disease process?

I wanted to ask my clinical instructor for guidance, but I had a foreboding feeling that she might issue a "gag order" with this patient. I could not have abided by this, I am a staunch believer patient's rights.

Putting my education on the line, I went into the patients room with printouts about his condition. I answered all his questions, even the hard ones.

He had been talking about going on a vacation with his girlfriend, and he asked, "So, you think this stuff will be better in a few years so I can go on that vacation?"

"Maybe sooner would be better than later for that vacation," I said.

His eyes, which had been moving smoothly from the door to the window, caught sharply like a fishes mouth on a hook.

He swallowed conspicuously, rearranged the covers over his ulcerated legs, and sat up a little straighter.

"Oh," he whispered. We both started crying.

He understood.

Ode to the Student Nurse

2005-06-05T00:48:00.000-07:00

A Student Nurse throws up when the patient does. An experienced nurse calls housekeeping when a patient throws up.

A Student Nurse charts too much. An experienced nurse doesn't chart enough.

A Student Nurse loves to run to codes. An experienced nurse makes graduate nurses run to codes.

A Student Nurse wants everyone to know they are a nurse. An experienced nurse doesn't want anyone to know they are a nurse.

A Student Nurse will spend all day trying to reorient a patient. An experienced nurse will chart the patient is disoriented and restrain them.

A Student Nurse thinks people respect Nurses. An experienced nurse knows everybody blames everything on the nurse.

A Student Nurse looks for blood on a bandage hoping they will get to change it. An experienced nurse knows a little blood never hurt anybody.

A Student Nurse expects meds and supplies to be delivered on time. An experienced nurse expects them to never be delivered at all.

A Student Nurse thinks psych patients are interesting. An experienced nurse thinks psych patients are crazy.

A Student Nurse doesn't find this funny. An experienced nurse does.

Thanks Michael for the Wonder Bread Nurse Picture, and thanks to Nursing Student Nemo for this cute jingle.

Student Nurse Works Off-Duty

2005-06-03T19:12:00.000-07:00

This picture is of a person who looks similar to my brother.

One of my brothers is a teenager who has Cerebral Palsy. CP is organic brain damage that is often sustained at birth or in utero.

My little bro Chris* has moderate/severe CP: he sits in a wheelchair, can't talk, is incontinent of stool and urine, has to be assisted with feeding and has very little movement in his arms and legs.

However, he is mentally totally with it and communicates by holding a pointer in his mouth and using this pointer to spell words on a keyboard. He has a fantastic personality and a great sense of humor.

As you can imagine, he requires an inordinate amount of care.

For the last three days I have been caring for Chris and my two other siblings who are still at home while my Mom went on a much needed Vacation.

Just imagine, for one moment, your life with a total-care family member like Chris. Here is the night time routine:

Take off his diaper. Physically lift him (75lbs) into a padded shower chair. Shower him. Get wet in the process. Imagine washing and rinsing your family member- everywhere. You shave his adolescent whiskers, brush his teeth, apply acne medicine, apply groin ointment, lift him onto his bed, put back on his diaper, put on pajamas, give him a drink of milk, tuck him into bed, and prop pillows around his contracted arms and legs.

It is physically demanding to lift him and care for him, to stoop over his bed, and his strong tone makes it hard to bend his limbs.

By the end you are wet, he has drooled on you, and you have to clean up the bathroom. The process takes about an hour.

You don't get paid. There is no "next shift" coming in to relieve you.

You want to go out for the night? Just catch some drinks with some friends, or see a show?

Too bad. Chris needs to be showered and to go to bed.

FOR EVERY SINGLE NIGHT OF EVERY SINGLE WEEK FOR THE REST OF YOUR LIFE.

Just contemplate that for one moment.

for the rest of your life....

* Name Changed to protect my brothers privacy

The Circumference of a Grapefruit

2005-05-31T09:40:00.000-07:00

At the beginning of this year I had a patient with multiple medical challenges.

She was suffering through a poorly healed chronically painful tibia/fibula fracture, Chronic Obstructive Pulmonary Disorder, Congestive Heart Failure, Diabetes, many pressure ulcers, blindness, etc. She was in her early 60's.

You know what bothered her most?

She hadn't crapped in a week, and this caused her severe physical discomfort. She couldn't eat, was vomiting, and had belly pain of 9/10. Enemas and suppositories brought no relief.

Huh? Never had I thought that something as "small" as constipation could compete with the "big" stuff like fractures, heart and lung problems.

The trick was to assist her in defecating without having her stoke out or drop her heart rate dangerously low from the effort of pushing.

I put on a plastic gown, two pairs of gloves, mask and eyewear, then rolled her on her side.

We began "coached pushing." Someone standing outside the door must have thought I was delivering a baby:

"OK, Three Big Pushes! One! Two! Three! Nicely done, now rest, take a big breath. You're doing fine, it's coming out nicely. Good job. Now I want two more strong pushes! Ready...

Holly Hanna, this thing coming out had the circumference of a grapefruit! Her perennial skin was stretched so thin it was taunt and blanched white. I prayed she wouldn't tear.

Finally a single gargantuan, petrified lump of poop emerged.

She was pale and exhausted from 45 minutes of pushing. With sweat beading on her brow, closed eyes and a cracking voice, she whispered, "Just clean me up and let me rest."

Dough-coo-saw-teah!

2005-05-30T13:38:00.000-07:00

In the hospital there is one medication that is given out like free samples at the grocery store: Docusate. Also known as Colace, this med is a stool softener.

Why would a patient need a stool softener?

All that lying around in bed, plus the pain medications we give, really stop people up.

Plus, who really wants to take a crap in one of those plastic bed pan thingies?

The result is constipation. Sometimes severe constipation.

For a blow-by-blow of how bad constipation really is, check out my previous post The Enema is your Enemy.

A month ago a was getting yet another Docusate out for my constipated patient. Another student in out program, Eric*, was getting out the same stuff.

"After we graduate, we should open a Sushi restaurant," he mused.

"Oh really, Eric?"

"Yes. The name of the chophouse should be Docusate, but it would be pronounced Dough-coo-saw-teah! Sounds Japanese, right?"

He said Dough-coo-saw-teah with the low, rumbling voice of a Sumo Wrestler, enunciating each syllable. The effect was hilarious.

"So, will we specialize in getting our patrons bowels moving again?" I bantered

He snickered while priming his IV.

Eric continued, "You know how they always bid farewell with a unanimous 'Arigatou!' when you leave sushi joints? Well, we could send everyone off with a heartfelt Dough-coo-saw-teah!"

*Eric- Name changed

A Near-Lethal Case of Mistaken Identity

2005-05-29T20:56:00.000-07:00

Another great story from my Ambulance days:

It was a very ordinary afternoon in this part of the country, quite warm and dry at the end of summer. My partner and I were driving the Ambulance to a town 50 miles south to pick up a patient.

We came upon a messy car crash on the highway, treated the patients, Cops and Medics showed up, and everything got taken care of. "Nice Work, Guys."

Then, out of the blue, a Cop yelled "Get Down! Get Down and Stay Down!"

We crouched behind the ambulance. What the $%)# was going on?

A helicopter circled overhead.

The copper pulled out his Automatic Rifle and aimed at a car coming down the freeway.

A beat-up old Cadillac pulled up followed by four more cops with searing lights and screaming sirens. A young man was driving the jalopy, and a baby was in the front seat.

"Oh man, whatever this is, this is really bad," I whispered to my partner.

"Yeah, no Shit," said my usually affable mate.

The man driving the beater car opened the door and lifted his hands high, yelling, "Don't shoot me! Don't shoot me!"

The muzzles of six cop rifles and pistols were trained on this guy, and they were all shouting at him, "Get down! Get down!"

The man slowly got down on the ground and I noticed blood on his shirt. Blood? I didn't hear any shots fired. How did he get shot?

The police shouted, "We need a medic NOW!"

We ran over, and sure enough the guy had two holes in his chest. By the time we had him bandaged and packaged up on a backboard, Paramedics showed up and took him to the local Trauma center.

Only later did we find out what happened: There had been a gang shoot out in a town 5 miles up the road at the same time that we pulled up to the car accident. The victim of the shooting had thrown his baby in the car and driven away to escape the shooters. With 2 bullets in his chest and 4 coppers on his back, he made it 5 miles down the freeway until he ran into us.

The police had made a mistake. They thought he was the shooter.

It wasn't until they saw the bullets in his chest that they realized he was the victim.

And I wouldn't have believed this story unless I had seen it myself.

Another Reason for the "No Cell Phones" Hospital Policy

2005-05-28T12:55:00.000-07:00

Anybody whose ever been in a hospital has seen the "No Cell Phones Allowed" signs, and the nice nurse explains that the policy is enforced because electronics can interfere with the life support equipment.

But I think that it this goes much deeper than just looking out for that poor guy down the hall on the external pacemaker.

I hypothesize that cell phone usage is directly related to an immediate loss of rational decision making and prioritizing.

For Example:

As an EMT on an ambulance, we came upon a young Motorcyclist who had gone down on the freeway. He had no obvious injuries, but they don't call them "donor bikes" for nothing. He was at very high risk for a hidden lethal injury.

"Hello, I am an EMT, may I help you?"

Shaken up and unable to decide whether to let me help him or not, he pulled out his cell phone and called his mother.

"Uhh, mom, I just crashed my bike on the freeway. Should I let this EMT help me?"

His mother was equally confused, and explained the details of the crash to her, wasting precious minutes while he could be bleeding internally. He eventually refused care because his mother said he "sounded fine."

This is a perfect example of what happens when someone who could have made a competent decision about medical care decided to pick up the cell phone. His IQ careened like a roller coaster off that first plunge.

Sure, we have patient courtesy phones in the hospital, but I don't thing that they have the same neuron-stunning power that is wielded in the tiny cell phone.

Imagine the craziness:

"Mrs. Martinez, two of your coronary arteries are 95% blocked, and one is completely blocked. You need immediate emergency cardiac bypass surgery or your heart attack will worsen to certain death within a few hours."

Ring Ring Ring! La La La! Ring Ring La La! Oh no.

Mrs. Martinez picks up that insidious electronic menace, "Oh hi Maria! Yeah, about our Family Reunion in three years, oh you know you want to be on the food planning committee honey! You always make the best enchiladas...

Queers in the Hospital

2005-05-27T18:53:00.000-07:00

Now, I have not taken an official poll or read any statistics, but it seems like there are a large number of homosexual/bisexual persons working as in semi-skilled and skilled positions in the hospital.

There's always been the "gay male nurse" stereotype and the joke about big butch "Helga" who is going to give you a bath.

But beyond stereotypes, just looking around at the hospitals I rotate there are quite a few persons who register a bleep on my gaydar. (Being queer myself I usually have a fairly accurate gaydar).

Maybe the hospital environment, with its traditionally feminine, nurturing nursing environment, has been safer than other job sites for persons to come out of the closet.

Any ideas from my dear readers?

My favorite queer is an Asian man in his early 20's. This man defines the word flaming. He is also gorgeous, six feet tall, broad chest, tiny waist, tight bubble butt and a handsome face.

He was hot and he knows it. And he lets all of us know he knows it.

Flamer doesn't walk around the unit- he prances. I love the guy.

One time my teacher and I passed him in the hall, prancing his best and sashaying his hiney. After we walked by, my instructor giggled, "He reminds me of a Prize Rooster, just strutting his stuff!"

We stifled out laughs in our jackets until we could make it to the elevator.

Hubris

2005-05-26T00:45:00.000-07:00

Hubris: Overbearing pride or presumption; Arrogance

One day I was working with a nurse who frankly looked a bit shell-shocked. She must have been either very new or completely overwhelmed by her caseload.

At the beginning of a shift, I told her that I had done some charting on the patient's chart. Students are expected to chart, so this was very normal.

In a slightly snobby tone she said, "Well, you can chart for yourself on a separate piece of paper, but I will do the real charting."

The Student Nurse's ego takes many blows through the learning process. But to be denied grunt work because I was considered inadequate for even this job?

From a place of hurt and resentment swelled the Learner's greatest enemy: Hubris.

While locking her into my fiery glare I tore up my charting, slowly, piece by piece. I wanted her to know I was angry about this snub.

I put the chart back where it belonged and went on with my day.

Later in the day while I was reviewing that same chart for a medicine order, I realized that I had torn up not my carefully detailed notes, but the notes that she had spent all night charting.

How could I have done this? I wanted to tape a "Kick Me" sign to my back. Maybe self-flagellation would avoid some of the reign of fire that would inevitably come from the nurse and (oh no) my instructor.

Although the nurse didn't seem very angry at me personally, a visible wave of hysteria rose up her body as she found out about the the missing charting.

Her voice shook as she said, "Well, OK, we can just get the tore up pieces and tape them together, and it will be alright. Which wastebasket did you through the little pieces?"

"In the shredder."

(In response to comments, it was completely accidental that her charting was put in the shredder. I thought I was putting my charting in the shredder. And yes, this story is completely true.)

Continuation of "The Devil Incarnate": Will Student Nurse be Devoured by the Demon Instructor?

2005-05-24T17:19:00.000-07:00

This is a Continuation of the Edge-Of-Your-Seat Post The Devil Incarnate:

She stood there with that same slight smile on her face. I felt like the junior-high shrimp running the mile in in P.E.: stumbling, heaving, trying so hard to catch up, catch up to the reality of what had just happened.

Some shard of clearness pulled through my head and I managed, "Well, I think I will stay to finish the day, to take care of my patients and just see what happens." Her face was unreadable again.

Flatly she murmered, "OK."

Two hours later she approached me and said, "Student Nurse, come with me to a private room."

A private room? What, was she going to solicit sexual favors in exchange for a passing grade?

She then said that she had "collaborated with her colleagues" (yapped with her friends) and "found it in the goodness of her heart to not flunk me."

The lecture continued for well over 30 minutes: "But just watch your back young lady, because you are this close to flunking out of this whole program!" She held out her hand, pinching an imaginary spaghetti noodle between her thumb and 2nd finger to indicate how "close" I was.

Talk about manipulation! Was this lady just playin' with me or what?

For some reason she passed me. I still to this day don't know why.

But she made her exit in style: She arranged a meeting with the Class Director, my next Clinical Instructor and Myself where she fabricated stories about mistakes I didn't make, and exagerated the small mistakes that I did make.

Oh, my dear friends, but revenge is sweet. All of the other teachers dislike her and thought she "went overboard" with our group. I'm sure they said more pointed things about her in private. She will not be teaching at our school again.

Downtime

2005-05-24T11:07:00.000-07:00

This site was down parts of the last few days for maitenance. Sorry for the inconvenience, you may now notice faster loading and a better interface. Please bear with me as I finish maintenence on the graphics, the result may please you.

Happy Blogging, and Stay Tuned for the Continuation of "The Devil Incarnate" to be published later today!

Student Nurse

"A Student Nurse spends 2 hours giving a patient a bath. An experienced nurse expects the CNA give the patient a bath."

The Devil Incarnate

2005-05-23T00:40:00.000-07:00

Yet more proof that my Nazi Maternity Instructor was the Devil Incarnate:

It was the last week of my rotation with her and the air was thick with emotional gunpowder. My entire back was knotted up like an ancient, gnarled tree from the tension.

She walked around the corner and said flatly "Julie, I need to talk to you," then escorted me down the hall.

I nearly lost control of the sphincters below my belly button.

"So, do you have your papers that were due on Tuesday?" Oh no. It was Wednesday and I hadn't finished one of the two papers that were due. This was the first real mistake I had made with this lady all semester.

(The reason I didn't complete the papers: My severely disabled brother got pneumonia while I was babysitting him and my other little siblings for the weekend. Also, my cat needed emergency surgery because a rapidly-growing mass had occluded her esophagus. Also, my car broke down. Weird but true. All on that weekend.)

"Umm, I have one of the papers but not the other. I can get it to you by Friday though, and I understand that I will get no points for the paper."

Class rules state: If its late, you loose points. Understandable.

Nazi Sergeant looked at me with an unreadable face, "So, you understand what the consequence of this will be?"

"Yes. I will loose some points." No big deal. I've got plenty of points.

A faint smile flashed across her lips, "Actually you have failed. You have failed this clinical rotation, and thus you have failed out of Nursing School. You can go home now, because you're done."

What? Failed me out of the whole school over one late paper? I didn't read this anywhere in the class rules. Is this a joke?

She stood there with that same slight smile on her face. I felt like the junior-high shrimp running the mile in in P.E.: stumbling, heaving, trying so hard to catch up, catch up to the reality of what had just happened.

To Be Continued...Check back tomorrow for the conclusion of this Edge-Of-Your-Seat Story!

Adult Protective Services

2005-05-22T21:35:00.000-07:00

He was brought back to the ER one month after hospital discharge. This Man was in his 50's, fully alert, and severely physically disabled due to Cerebral Palsy and a Stroke.

His hair and face had a thick build-up of dirt, oil, and old skin, causing sores on the skin underneath.

His foley catheter was clogged full of sediment, unable to drain. His bladder was distended, and when we finally got urine out, it was bloddy and teeming with bacteria.

His back was covered with painful stage II and III bed sores from laying in one position constantly, the flesh was red and oozing in places.

His buttocks and genitals were caked with old feces.

He cried as he told me how his caregiver would call him "no good" and "worthless."

He begged me not to send him home.

One of his caregivers was a hired person. One of his caregivers was his Sister. And one of his caregivers was his Mother.

We called Adult Protective Services.

Nazi Drill Sergeant

2005-05-21T21:56:00.000-07:00

My Maternity Instructor was a Nazi Drill Sergeant. The Teacher from Hell. The Devil Incarnate. (And she was in Maternity? Babies and Nursing Mammas and stuff? Go figure.)

She began her introduction to us Students by barking, "I have a background in Military Training! And I expect you all to perform as well as in the Military! Consider this Boot Camp for Nurses!"

Her appearance only added to her personality. Her ears were as large as cup handles and jutted perpendicularly from her head. Her lips were thin, slightly purplish and often pursed. Her jaw was angular, meeting at a prominent, poking chin.

But her eyes were the worst: I swear they were the eyes of the devil. Bulging slightly from their sockets, the pupils were constricted and searching, penetrating as gamma rays.

She could summon glares of rage that would melt steel if even a small detail was not to her liking. This was the "look."

In a typical exchange with her, she would give me the "look," ask me what I was doing, tell me why I was wrong, give me another "look," threaten to fail me if I didn't "shape up," and walk away.

Afterwards, typically the staff nurse would give me a look of sympathy and say, "Oh my. I thought you were doing fine. I am so sorry hon."

It's been 2 months since I've finished with her, and I still feel waves of panic just thinking about her.

Sheer terror.

Spankings: A Valid Patient Control Technique?

2005-05-20T10:40:00.000-07:00

I had the opportunity to observe a cardiac procedure a few weeks ago. The patient was scrubbed and draped, gloves were donned and a call came down from the floor.

A nurse wanted to speak to the cardiologist about one of his recovering patients.

Known for his brusque manner, the surgeon punched the "speaker" button on the phone with his elbow and barked "What!"

"Your patient in 456-B is saying he's gonna walk out," said the nurse evenly.

Dr. Arrogance retorted in a loud, demanding tone, "Tell him if he does, I'm calling the Police!"

The Police? What, are they gonna arrest the patient and charge him with Not Following Doctor's Orders? Last time I checked, we were running an institution of treatment, not incarceration.

"I'll do what I can," said the nurse on the other end, with a hint of exasperation in her voice.

Now, I've got an idea that will avoid the messiness of calling police every time a patient leaves the hospital against medical advice: Spanking.

Get wooden paddle boards like the ones in Catholic schools and put one in every patient room. Make it required equipment, like suction and oxygen.

Then, every time a patient looks at the door, or talks about how they long to go home, pick up the paddle board.

I'm sure that just the visual threat will deter most folks from ever crossing our power again. 100% compliance guaranteed.

Of course, there will be those few who will take those paddlings the wrong way, if you know what I mean. These pervs just might just like being spanked. I'm sure we'll find a way to deal with them.

Do YOU have Health Coverage?

2005-05-19T11:59:00.000-07:00

Right now I'm paying $281.80 per month for mediocre HMO health coverage with $20 office vitits. And I consider myself incredibly lucky that I get this coverage through my old job.

But this coverage will run out before school ends, and so will my ability to pay the $250/month.

Now, I've always thought that truly poor people could get free health insurance from the government. That's what Medicaid/Medicare is all about, right?

Wrong.

Even though I will have zero assets and an annual income of less than $2000 by the end of this year, I will not qualify for Californias Medicare. To qualify, I would have to have children, be pregnant or disabled.

WHAT??????? Now, I agree that kids and pregnant women should get priority in getting the health care resources.

But there is something SERIOUSLY wrong in this country when someone with absolutely no financial resources cannot get some assistance with health care needs.

And I'm sure you have your own story of health insurance problems to share. Please share your story.

Sick

2005-05-17T14:59:00.000-07:00

Student Nurse is sick. Will post within the next day or two!

The Enema is your Enemy

2005-05-15T11:33:00.000-07:00

Nurses love Students because we perform grunt work. Lots of it. But it is a reciprocal relationship, because we are required to perform these grunt work procedures or we don't pass.

Thus, students are drawn to grunt work like mosquitoes to bare flesh on a humid July evening.

One grunt procedure that Nurses most want to pass onto a Student is the administration of an Enema.

This is also the procedure that the experienced Student will never volunteer to perform.

The first part of the enema is a bit embarrassing for the patient, but not that bad for either party. A plastic tube or the tip of a squirt bottle is inserted into the rectum. Fluid is instilled into the GI tract.

The patient is then asked to hold the fluid in for as long as possible. Yeah, right.

The deluge hits.

The large quantities of fluid that was dumped into the bowels, sometimes over a liter, comes out forcefully and often uncontrollably, accompanied by the week's worth of crap that had been stuck in the intestines.

If the patient doesn't make it to the toilet in time, this concoction is sprayed on the bed, floor, chair, wall, equipment, and especially me.

I always wear a plastic body suit, two pairs of gloves and a mask, but the smell penetrates the protective gear and sticks on my skin.

And this, my dear friends, is why the Enema is your Enemy.

Explanations of Medical Terms, Part II

2005-05-14T10:03:00.000-07:00

Barium - what's done if a patient dies
Cauterize - made eye contact with her
D & C - where Washington is
Enema - not a friend
Fibula - a small lie
Impotent - distinguished and well known
Medical Staff - a doctors cane
Nitrates - better than day rates
Outpatient - when a patient faints
Post Operative - delivers the mail to the ward
Rectum - Damn near killed 'em
Seizure - a Roman emperor
Ultrasound - very good music
Varicose - nearby

Thanks again Kathy for the funny definitions, and Michael for the Minnie Mouse Picture.

Seeing Strangers Naked and Washing Private Parts

2005-05-13T21:38:00.000-07:00

One thing I hadn't really pondered as I applied for nursing school was the frequency that you have to see and touch strangers private parts.

Not just nice, clean, healthy private parts. Sick ones and old ones. Yikes.

And then you have to wash them. Clean them. Put medicine on them, tubes into them, sometimes when the patient is fully aware of what you are doing.

As a woman, washing another woman wasn't a huge deal to me. But washing another man who was too sick to wash himself? Hmm. And how do you state your intentions as you are preparing to wash the guy?

So, for all those uncomfortable moments at the bedside, I have crafted a few choice phrases:

For the Very Affluent Rich Snob: "Very good sir, now I will retract the foreskin and clean around the preupice."

For the Nasty Old Man who Keeps Hitting On You and Won't Take a Hint: "All right now, I'm just going to clean your pen....where is it? Oh, sorry, I couldn't find it. It was hiding behind your finger!"

For the gang banger: "Yo shit stink, bro. Hommie gotta wipe the smack off, and no, we 'aint gettin' on the down low."

For the Hormonal Young Man: "Hey man, what up? Here's a bucket of warm water, soap and a washcloth are on the bedside table. Your girlfriend will be here in a few minutes, and I'll leave you two alone for an hour or so. Make sure she gets you nice and clean!"

Explanations of Medical Terms, Part I

2005-05-12T12:17:00.000-07:00

And now I will provide a few translations for those readers of this blog who may be confused by some of the medical terminology I use:

Artery - the study of paintings
Cat Scan - searching for kitty
Coma - a punctuation mark
Dilate - to live a long time
Fester - quicker
Labour Pain - getting hurt at work
Morbid - a higher offer
Node - was aware of
Recovery Room - a place to do upholstery
Secretion - hiding something
Tablet - a small table
Urine - the opposite of "you're out"
Vein - conceited

Used with the permission of Kathy, another Nursing Student.

Elderly Woman Without Uterus Gives Birth!

2005-05-11T11:20:00.000-07:00

It's not every day that you see a baby's head protruding from a 70-something year old woman's vagina.

Especially if this elderly woman has already had her uterus removed.

I had been caring for this lady for two days and was cleaning her up after a trip to the commode. I stooped over to get a good view of her rear-end to make sure it was really clean and.......

I jumped a few inches when I saw what looked to be a large baby's head crowning at her vagina. It was light pink and had a few tiny blood vessels visible under the surface of the skin. At least there was no hair on it, whew.

I touched it gingerly, and it was firm, but there was no skull bone underneath.

Thank the Lord His Son was not coming as a Babe to a Grandmother this time!

It turns out that this was a part of the woman's bladder protruding through her vagina, as illustrated in the picture above.

In fact, her bladder was hanging even lower than in the illustration: it was suspended between her legs.

As women age, the ligaments the hold the bladder in place loosen and wear-out, allowing the bladder to drop. This can cause bladder infections, retained urine and impaired sexual function.

This prolapsed bladder sure gave me a shock!

Want to see a real-life picture of a Uterine Prolapse that resembles what I saw? ONLY IF YOU ARE OVER 18 YEARS OF AGE, click here. (This picture is fairly graphic, no blood but you do get a full waist-down nude picture of the patient).

Queer Female Nurse Teaches Breastfeeding. Huh?

2005-05-09T22:12:00.000-07:00

I am fascinated with breastfeeding. Yes, I know that sounds a bit odd, but it's true.

Sidenote: Student Nurse is also queer.

No, I am not fascinated with the breasts of the Mothers per se, or with the Mothers as sexual potential. I am fascinated with the miracle of breastfeeding and the connection between mother/baby.

Still, I wonder how a mother feels when I walk in the room. She may suspect that I am lesbian: I have a stereotypical gay haircut, wear an aids bracelet, and no wedding ring.

Heck, I don't wear birkenstocks like I do outside the hospital, but I'm sure some of them suspect.

There they are, sitting in their hospital beds, lovingly holding and feeding their baby. When I walk in, do they wonder, "Is she looking at my breasts because she's interested?" Actually, we are taught to look at the mother's breasts for signs of infection, sores, engorgement, etc. But do they wonder? When I help them get the baby latched on and sucking, are they uncomfortable?

I know there are plenty of queer Maternity Nurses and Breastfeeding Educators out there. I wonder how their patients respond.

The guys in our program had the same dilemma: They were required to care for maternity patients, just like us ladies. Only for them, they often had more difficulty because patients sometimes refused to have a male caregiver

None of my patients refused to have me as their student nurse. I hope none of them wanted to but didn't.

Why Nursing? (Shameless Endorsement)

2005-05-08T10:27:00.000-07:00

The following it shameless endorsement describing a few of the reasons why this profession ROCKS:

1. School is Short and Accessible. Getting your Associates in Nursing with an RN takes 2 years, plus pre-requisites. You can space out the pre-reqs, and some colleges offer part-time nursing programs. Many Community Colleges have a Nursing program (read: cheap tuition).

2. We make BANK $$$! In this area, Nurses fresh out of school start around $30/hour with incredible benefits at the local hospital, plus $4/hour if you work night shifts or weekends. And they are always begging you to stay overtime.

3. Job Security. I am 10 months away from graduating and I am already getting job offers. In case you've had your head in the sand for the last few years, there is a huge Nursing Shortage that will only grow over the next 15 years.

4. We aren't treated like they show on TV. We think critically and work as a team member with the doctor to plan care for the patient. Sure, there are a few fossilized docs who think they can treat you like crap, but that is SO going out of style.

If this piques your interest, check out my links "Discover Nursing" and "Futures in Nursing" at the right for more info about Nursing as a Career.

Liquid Sludge Power

2005-05-07T08:33:00.000-07:00

Although I have already recounted the story of the worst smell ever (Rotten Vagina Flower), there are still other smells that singe the nose hairs of even the crustiest nurse.

Take the GI Bleed.

The patient with GastroIntestinal Bleeding experiences bleeding from the lining of their esophagus, stomach or intestines. If this blood sits around in the digestive tract for any period of time, it gets digested and looks like coffee grounds.

And the smell is unique: blood has a sticky-sweet smell, and after being processed by the intestines, it has a distinct sweet/shit odor.

A few months ago my patient had a Rectal GI bleed. About 3 times an hour, he would hobble over to the bedside commode and empty about 1 Quart (1 Liter) of black, tarry Liquid Sludge from his bowels. The stench of old, digested blood and feces mixed, penetrating everything in the room, overpowering people in the hallway.

The aid drenched a washcloth with cinnamon mouthwash and put it next to the fan, allowing the air currents of cinnamon-freshness to mingle with the power of the Liquid Sludge.

I slathered my upper lip with Vic's Vap-O-Rub and ate Altoids Mints like jellybeans.

And then I asked the nice housekeeping people to bring up another carton of toilet paper.

A Very Brief History of Student Nurses' Life

2005-05-06T08:10:00.000-07:00

So, how did I end up in Nursing School?

Originally the plan was for an M.D.
Half-way finnished Chemistry degree at the State College.
Had no friends, no time to relax, was developing an ulcer.
Quit School
Got my Emergency Medical Technician-I license
Worked as an Emergency Medical Technician for 3 years, driving ambulances and taking care of patients who called 911. Learned lots about medicine and life.
Liked the field, but EMT's make crappy money.
Then I stumbled into Nursing.

Stay Tuned: A Shameless Plug extolling the virtues of the Nursing Profession. (Hint: Virtue Number One, Wage= $30+/hr starting in this area)

My Best Question So Far

2005-05-05T07:31:00.000-07:00

We have lecuture one day a week for 6 hours. That doesn't sound like much, but some days I would rather set red fire ants loose upon my flesh than go to lecture.

Sometimes in those eternal lectures, I ask a question. Sometimes my questions are probing and intelligent, and sometimes they are simply to lighten the mood and give everyone a good chuckle.

My all-time best question was last semester when the teacher was lecturing on the proper insertion of Foley Catheters in Men (the tube that is inserted in the penis to drain the bladder). The standard Foley catheter is about a foot and a half long.

I calmly raised my hand, and with a very sober look on my face said, "Now, have you ever come across the situation where the tube was not long enough to fit in the organ in question?"

The instructor fell silent for about 5 seconds, pondering my question.

Then realizing the joke, she jumped up and sputtered out amid many laughs from the class, "No, I have NOT ever had a man who was longer than the catheter!"

Flashback to Segregation

2005-05-04T09:19:00.000-07:00

I live in a liberal, large city in blue-state California in 2005. Covert racism always happens in America, but it is a rare instance that I observe instances of overt racism here.

I was listening to the television a few weeks ago with a patient and her cousin as I was emptying the patient's foley catheter. The patient was an elderly woman who had very light colored skin. Her cousin, Mrs. Segregation, stayed devotedly at her bedside, and also had light colored skin.

The television announcer said, "This afternoon, two young African American men robbed the Convenience Store at the Corner of X and Y at...." which was interrupted by the raised voise of Mrs. Segregation, "People are always complaining about how many Black people are in jail. Well, it's because they just do more bad things!"

I turned to her as she finished her sentence, the words striking my face like glass shards. I must have misunderstood her, didn't I?

The announcer continued, "The men made their getaway in a '95 Ford..." Mrs. Segregation stiffened in her seat, "Well!" she yelped, "If we just took away all their cars, that would just solve the problem, don't you think?"

She blinked, waiting for someone to answer her. I had a stunned-fish look: wide eyes, gaping mouth. The patient was too ill to respond. More earnestly now, Mrs. Segregation tilted her neck towards me and said, "Well, don't you think?"

Outside of the hospital, my response would have bordered on verbal assault. But I am a student in a very conservative nursing program, and I have already drawn too much attention to myself in the past for bucking the system.

I looked back down at the catheter and continued my work.

Mrs. Segregation started mumbling to herself, justifying why she was right, nervously twisting the fringe of her jacket.

My cheeks burned a deep scarlet, shame for not having the cojones to say something.

A Child's Child

2005-05-03T07:57:00.000-07:00

During my rotation in the Neonatal Intensive Care Unit, I cared for a tiny baby who was born with a serious heart defect called Tetralogy of Fallot. This defect consists of four heart abnormalities that lead to poor circulation of oxygenated blood to the body tissues. In short, the baby turns blue and stays blue.

The treatment for this condition, which includes constant monitoring and many open heart surgeries, would be overwhelming for any parent. But the parent of this baby was a 16 year old developmentally-delayed teenager.

This teenaged mother's family were not involved in her life at all. She was living with the 17 year old father of the baby in the home of the father's father. Both the baby's father and his father were on parole for sexual crimes. None of them had jobs, and they lived in an economically depressed rural town without transportation. Could it get any worse?

The 16 year old mother came in to visit her fragile little infant one day, who weighed all of 4 pounds. The mom was mentally delayed to the point that she couldn't remember watching me tube-fed the baby the day before. In fact, she couldn't remember anything from the last time she visited.

But I smiled as I watched the love in her eyes as she cooed to her baby. She lovingly cupped her hands around this fragile infant and intuitively cradled her close to her skin.

This baby may grow up sick and lack adequate health care. She may end up in limbo in the foster system. She may die early due to her broken heart.

But at least for today, she was safe as her mother held her tenderly.

Ambulance on the Scene

2005-05-02T20:18:00.000-07:00

A quick story from my ambulance days:

We were driving down the highway and heard over the EMS radio that one of our rigs had crashed in a multi-car pileup on a highway innerchange. All crews and dispatchers breathed a simultaneous sigh of relief when the crashed crew came over the EMS radio saying they were uninjured.

It took only a few minutes for the news of the crash to hit the radio traffic reports. "There are several cars piled up on Highway XYZ," said the radio announcer, "But not to worry, an ambulance is already at the scene."

Rotten Vagina Flower

2005-05-01T08:25:00.000-07:00

One time I was assigned to care for a very large woman in her 40's who had been experiencing profuse vaginal bleeding for months before seeking medical help. All this bleeding had left her anemic and weak- to the point that she could not clean the constant discharge from the flabby folds of her legs and belly. The poor lady would just lie helplessly in the bed, spraying a can of floral air freshener every few minutes in hopes of masking the smell.

No words could adequately describe this smell. I had been an Emergency Medical Technician on an Ambulance for 3 years and a Student Nurse for several months by this point, and I have never smelled anything worse. Ever. Three words come to mind: Rotten Vagina Flower.

The only way we could manage the odor was to clean her well (this took 2 assistants to hold the folds of fat back while a third person cleaned), put on a large absorbent diaper, and wrap her in several sheets to contain the smell.

Unfortunately this poor woman likely had a terminal uterine or ovarian cancer. She needed an MRI to get a diagnosis, but she was too large to fit in the normal MRI machines, so we had to take her to an "open" MRI unit.

Well, just as we were moving her to the table of the open MRI unit, the carefully wrapped sheets came loose and the absorbent diaper fell off. A thick, potent mass of "rotten vagina flower" smell wafted up and hit our noses. The assistant across from me blanched deathly pale and literally began to dry heave while tears started welling up in his eyes.

At this most inopportune time, I got a severe case of the giggles. I tried to suppress it, but I soon was laughing so hard I had to run to the bathroom before I soiled myself.

And this whole time, our patient is a younger, intelligent woman who is completely aware of her situation and our response. After the scan, she looked at me somberly and said, "I heard you."

Sometimes, amidst all the smells and messiness and noise, it is hard to remember that our patients are always listening.

Mrs. England and the Beastlies

2005-04-30T16:03:00.000-07:00

This week I took care of an elderly woman who has been through quite alot in the past month: a stroke in the beginning of April, a heart bypass and aortic valve replacement in the middle of the month, and finally the placement of a pacemaker in the end of the month. Despite these assaults on her body, she is recovering quite well, and I am convinced that it is due to her firey English temper and determination.

On Thursday I angered to the point that she broke out into, "well I will BOPP you on the HEAD if you EVER TRY TO PULL THAT AGAIN!" What was my insult that triggerd her wrath? Well, she had about 15 pills to take that morning, and 7 of them were Potassium. Anyone who has ever had to take oral potassium suppliments knows that they are large pills that upset the stomach.

Mrs. England particularly detested these pills and called them Beastlies. She took about 20 minutes to take each pill- first wet the mouth with water, begin telling me a story, place the pill in the mouth, take a bite of pudding, swallow, tell more of the story, eat a cracker, and finish the story. She insisted that if she took the pills quicker they would "get all mixed up and [her] body wouldn't know where to send them."

Well, I was setting out the "Beastlies" one at a time for Mrs. England, and she would get into her story, thinking that she had already taken the pill that was in front of her, when in fact she had forgotten to take the pill, and had only taken a bite of pudding. She looked down at the table and thought that I had tricked her by slipping another pill in it's place!

Then she broke out into her very animated exclamation: "well I will BOPP you on the HEAD if you EVER TRY TO PULL THAT AGAIN!" I tried to explain that I had not slipped her another pill, but that she haddn't taken it in the first place, but the was too angry to believe me. She eyed me suspiciously for the next hour as she took the rest of the Beastlies.

2 Hours later, the aid brought me a curious suprise: a crumpled kleenex from Mrs. England's room with a Beastily Potassium pill tucked carefully inside. Even under my constant watch, the clever old broad had palmed her pill.