turned a corner?

I did MUCH better than I had hoped or expected on my midterm. And the nurse I'm working with in the ICU was super nice to me today. So can I just recant on my previous post. I don't know. The ICU is definitely interesting and an incredible learning experience. It's just so unfuckingbelievably overwhelming at the same time, all the meds to know, the hourly charting on vitals, hemodynamics, intake and output, the fancy pants monitor for reading central venous pressure and mean arterial pressure, the pressure bag, the tubing going all over the place and needing to keep on top of orders (for new meds, tests, procedures, yada yada yada). I feel like I could actually get my groove and learn to enjoy ICU nursing if I ever had the chance to get my bearings without feeling like an idiot and/or asshole (disclaimer: this could entirely be me misreading people's shortness, not wanting to be in my presence, comments on my anxiety ad nauseam and taking it personally). One thing I do like is that the doctors actually ask you things, like how your patient is doing. And what you say matters. And if I can manage to keep my shit together I might one day come across like I know what I'm talking about. Like to the very handsome vascular surgeon (like Atul Gawande but much hotter), surely much much younger than me, but very friendly, he patted my shoulder when I made an idiotic mistake trying to let him access the computer to place an order (I was logged on and as a mere student of nursing, obviously they aren't going to allow me to make any orders). Oh well, live and learn. With all this learning I should be 120 (in nursing student years) by April.

I'm not stressed - beyond the stress induced by your telling me how stressed I am

For some curious reason I thought that Adult I, the term I endured last fall with my father's death three weeks into the term, would be my toughest one. The tests were hard, the midterm brutal, a quarter of my class didn't pass the term, but somehow I got through on emotional fumes and managed to get high honors. Well this term, which is my critical care expereince, is kicking my ass and making me long for the seemingly easier pains of fall. I don't know what has gone wrong for me mentally, emotionally but I'm doing so poorly this term and it's killing me. Okay, now I'm not failing but my grade it's nowhere close to that high honors zone I usually shoot for. And I do that for a reason I need a huge cushion from being near the failing zone so by my final I can be like, I can miss 60 questions out of 120 and still pass. And the thing is, having solid footing with the academic, testing part of the schooling, well it made clinicals (which fill me with panic) bearable. Like I didn't worry quite so much because at least I had the 'I'm doing well with my tests' in my back pocket. Now I have nothing. I have cried way too many times at clinical already this term. All my clinical instructors keep talking about is how I need to relax which brings to mind the house quote I titled this post with. I've cried too many times in front of too many different instructors. I feel like I have no reserves to put forth in terms of getting through this term. I have a midterm tomorrow which I've been studying for but part of me wonders if I should back off on the studying because I usually get many a question wrong by completely over thinking the answer. Going above and beyond the black and white type in front of me. I don't know where my head is lately, just know I want to successfully complete this term and have it behind me already. And the ICU experience, it's killing me. I feel like an alien with all the nurses there. Almost all of them are in their early to mid twenties and have the type of personality, well I doubt I would have fit in even at their age but now it's painful how different I am personality-wise from everyone else and then there's the 15 + year age gap on top of it. I just don't think the same way. I don't find the ICU thrilling, I think it's terrifying and dehumanizing. My patient would have painful things done to her (procedures, nothing intentionally painful) and no one even looked at her or really talked to her, aside to make a joke like 'oh that must have hurt, like a bikini wax.' I held her hand and would look in her eyes and squeeze her hand gently when I could see that she was scared or in pain because God knows I'd want someone to do that for me if I was in the ICU and my family wasn't around at the time. And why do I wind up feeling like I'm the only one who thinks that stuff matters. I'm good at hand holding and listening, not so good at the other stuff. It's so fucking lonely. Like being an outsider in high school without a friend to commiserate with over how fucked up things are. All the other students are just loving this term, I guess when you're young it's sort of an adrenaline rush. And yes ICU is a great place to be in terms of increasing your critical thinking and the skills attached to reacting quickly to crisis situations. But all of that completely enervates me. I just want to help the geriatric (or possibly pediatric) community with mental illness. For whatever reason the psych stuff doesn't scare me and I understand the information I learn very easily, I just get it. Fortunately there are instructors who look out for me, one in particular helps me feel better when I'm teary and overwhelmed with not fitting in. I'm sure she thinks I'm neurotic as all hell but she's very nice to me and helps me out. Keep your fingers crossed. Seven weeks down, seven more to go.

thigh envy

I would kill to have thighs that looked like this! Good lord to be 43 and able to wear a skirt that high? Although there's another couple photos of her straight on and her thighs are so thin I think you could throw a baseball between her legs without hitting them,. Honestly. And with her feet together. She's got the body of a teenager with nary the littlest dimple of cellulite. On top of that this CD is very good. I got hooked with the song, Lonely Love, that has Richard Butler singing backup. I had her first two CDs, well copies of them from an old boyfriend, and I'd sort of forgotten about her until a friend picked this up and I've been listening to it ever since. I'm on a nostalgic music kick. Listening to psychadelic furs, love spit love, well anything with Richard Butler and the Fixx on my shuffle for the gym. Okay, I've got to go back to studying. Had my presentation on Friday, I wish I didn't get nervous speaking in front of people. Test tomorrow, then the hospital and then my midterm next Monday. So please, send prayers, cross fingers and/or toes, good vibes, anything positive my way that I get through this term without failing, or succumbing to heart failure from the stress.

My Grandma died yesterday morning. My Mom called me at 5:20 before I went to the hospital for the day. Not the best time to let me know but I guess there's never a good time for learning someone you love has died. She had just been transferred from the assisted living facility she had been living at for over four years (over two of them while on hospice) to Forbes regional hospice located within West Penn hospital. At least her last hours were in a facility that provided her peace. Unlike the assisted living facility where she would get agitated at night and no one would give her medication to alleviate her pain or anxiety because there was no LPN or RN on staff at that time. So she stayed up all night and suffered, we found out last week. I know it's a looong way off but please think of your parents, your loved ones, yourself. Consider a skilled nursing facility before you go to an assisted living center. Over the past week my grandma would keep repeating 'please don't hurt me.' it's not a memory you want, worrying about who might have hurt her or what exactly happened to scare her so. And hospice, be careful which one you choose, more than that, ask for another nurse if you get some religious whack job taking care of you or your loved one who doesn't believe in being liberal with the morphine or thinking it's premature to put someone on continuous care, because when a person is actively dying they are in a lot of pain and agitation and for God's sake be a wee bit compassionate and give them the morphine and ativan they require. My Grandma was under 80 pounds and a month shy of 96, that her life was dragged out to literally dying bit by bit is a travesty and something I hope no one else ever suffers through or watches a loved one suffer through. I love you Grandma. I hope you're finally at peace now. You were so darn nervous but such a dear sweet, smart beautiful lady. I truly hope you realize the gift you were now.

I have to give a presentation on Friday about noxious stimuli and maximizing stimulus response. If you don't know what I'm talking about don't worry, I didn't either until yesterday in class during my neuro assesment lecture. It's basically about eliciting a response in an unresponsive patient with the last resort, pain. And the instructor kept stressing how we should be creative with our presentations. And me and my sick mind I instantly went to Marathon Man with the dental torture scene and then to the whole S&M scene. Especially since one of the pain responses I remember seeing, and actually blurted out in class, was pinching the nipples. Which I think caused more than a few of the nine other students in my class to raise an eyebrow, my instructor somehow managed to keep a straight face. But when she mentioned it again I said that I remembered that from an episode of House and then, everyone was like 'oh, of course' and went off on how House makes all these medical gaffes, like I've mentioned before. But the thing is I'm trying to look up these various methods of arousing a response. And a lot of people say never do the nipple twist (apparently it's a twist, not a pinch, and that is what Foreman did to House when he was found not breathing) but then these online forums say that's the one things that elicits a response when all else fails. What are the other methods of noxious stimulus you ask? pressing down on the nailbed with the side of a pencil or pen (one commenter recommended a tongue depressor instead of a pen to avoid cross contamination), sternal rubs where you press (some say use your knuckles, others the palm of your hand) along a patient's sternum and firmly rub (this is supposed to be unbearably painful), pinching the trapezius muscle (not easy to do with a petite nurse and a larger patient), pinching an ear, pressing a finger firmly on the supraorbital bone (which can give a nasty headache but you can't do with a suspected face, skull fracture), and ... the Liverpool health service policy says 'genital pain may be used when other forms of recognised painful stimulus have failed to elicit a response from the patient. It is not to be used as a first line assessment of patient response to stimulus by staff.' How in the world am I to give this presentation with a straight face? I mean it would be 'creative' if I dressed up as a dominatrix but then we get graded on wearing appropriate attire for the presentation so I think that's out. The odd thing is why is the nipple twist so vilified when the other methods can also cause pain and bruising, the sternal rub is just as painful if not more so. It's like the parent that is vehemently against spanking but has no problem pinching their child or digging their nails in the child's arm hard enough to leave a mark. Now I'm not advocating spanking, pinching, nipple twists, any of this stuff! And God knows I'm not looking to have my nipples twisted if I was a patient in the ICU. Why couldn't I have gotten a cranial nerve for my presentation. WHY?

Soo i have had these bags under my eyes since i was riddled with a sinus infection that lasted two months back in the fall. It took 3 rounds of antibiotics plus a steroid to finally kick. And yes I did wind up getting a cold two weeks after kicking that lingering infection. Go immune system! It's down the tubes thanks to stress, school, going to the hospital and caring for sick people... Anyhoo, these darn bags will not go away. It could be age, it could be stress or it could be allergies, which might have precipitated the sinus infection. And since you can treat allergies I met with an allergist today to see if that might be the reason behind my bags and annoying annual sinus infections. I wound up being there close to two hours because they put serum on my back, then pricked it and I waited around reading an old copy of Time which has me really wanting to run out and rent The Social Network until it was time for them to come back to see if I reacted to anything (one type of mold and one type of dust mite). I can go back in a month and get shots, which are stronger dosages, and I might come up positive on more. But... I saw my chart and what the doctor wrote under general appearance. Wan. My heart sank so low when I saw that. And to drive the nail a little deeper into the coffin of any remnant of self esteem I had left I looked it up on merriam webster so I could get the exact definition and commit it to memory. wan - a : suggestive of poor health : sickly, pallid b : lacking vitality : feeble. Okay, now it's not ugly, but that wouldn't be a medically appropriate adjective. Having any confidence about my appearance. Poof, and it's gone. With that one wee word. I won't even fill you in on the mortifying clinical week I had aside from telling you that I bawled on leaving the hospital Tuesday and wound up crying twice while at the hospital yesterday. And wound up crying again this morning when I ran into one of the instructors that I saw at the hospital yesterday. She's very kind to me and sometimes seeing that little door of kindness open when it feels like everything around me is going to hell, it's all I need to start the tears. Because this program is so fucking hard and it's not exactly like I have a partner to talk me off the cliff when it's all overwhelming. I come home to a cold, empty house, and one thing or another falling apart in it. And when the kids are here it's even worse because the weight of the guilt at how unavailable I am to them, while trying to keep from drowning in this program. Oh my. And I went to visit my grandmother with my mom after class today. My grandma is under 80 pounds, she looks like she's dying (now she looks wan) she could barely open her eyes, yet she keeps on going. It's like she's someone who actually might cheat death. Not really, but it's maddening to witness because her appearance alone can bring you to tears. She is literally dying piece by piece, she's been on hospice for over two years, which must be some kind of record. It's horrific. I think I'm ready to go to bed and just have this day be over. I'll dream about having enough money to shoot stuff in my face and plump the wanness right out of it.