AMS

In other mental health news, I seem to have a sixth sense for neuro changes with my patients. I'm now 3 for 3 on knowing that my patient was suffering from altered mental status(AMS). The most recent patient was three weeks ago. I told my co-assigned I thought the patient was suffering from delirium and she said, try to hear this in the most patronizing tone a nurse in their mid-twenties, with their wealth of experience, could manage, 'That's not delirium. I know what delirium looks like and that's not it.' Well, lo and behold, two days later the patient got a psych consult and guess what? They said the patient was suffering from delirium. I'm not Sherlock fucking Holmes, if a patient doesn't seem altogether there what I usually do is ask a family member if this is the patient's baseline. If they say no then I keep telling those above me (which is everyone when you’re a student) that something is wrong. It's sad because what I do, which is pathetically simple and unskilled, just is not done or it’s not prioritized.

Wednesday was quite a day in the ICU for me. New location, new ICU, longer drive, meaning I need to get up even earlier. The hospital is in a depressed area so things seem very different in terms of the patient population than the suburban more homogenous hospital where I've done all my other clinicals at so far. My patient from Tuesday was stable enough to be transferred to another part of the hospital so I came in bright and early Wednesday (6:30) and got a new patient. Now getting a new patient is very hard for me because I'm someone that likes to know what I'm getting into. As one instructor mentioned, I have a comfort zone. So as much as I loathe the mountain of preclinical paperwork I'm thankful for it because I spend at least five hours, usually closer to eight, the night before clinicals learning as much as I can about my patient. That way I can try and be on top of things, and try and calm my nerves, when I come in first thing in the morning. But I couldn't do that Wednesday. I also cannot do that in real life, there isn't time, so it was a good experience, if also somewhat terrifying. My patient on Wednesday was someone very young who attempted suicide. It was sad on so many different levels; the patient's age, the spouse at the bedside, who was so unbelievably kind to me, even in the midst what's happened to them, the kindness of other family members. These are the times when I get really close to crying (okay, if you've read any of my blog you realize that I get really close to crying or actually cry quite easily) because the whole situation is, obviously, quite emotional and the patient so young. There's a problem that I keep coming up against in nursing school. It's not so much caring for the patients, although I worry, pretty much constantly, that I'm not doing a good enough job helping them. But I can deal with beating myself up in that area because I want to help them. The thing I can't handle is the lack of sympathy, emotional hardening or downright meanness that I see in some of the other nurses. I do not work in an ICU and I have heard from numerous sources (a good percentage being those who have worked in critical care) that nurses in critical care can comes across as arrogant, in part, because the job is incredibly stressful. People say you have to emotionally distance yourself or you won't really survive in that field. But that does not make the nasty, demeaning comments that this one very seasoned nurse said about my patient right. I don't care if it was meant to be funny (it wasn't) or if it's how that nurse deals with working in the ICU. It was so fucking judgmental and small and outright mean and the patient might have been sedated and vented but that doesn't mean they can't hear you or understand what your saying. For a patient to have so much negativity directed towards them, by the person that's supposed to be caring for them, is unconscionable. Mental illness is so stigmatized and I guess I naively hoped that it would be different in a healthcare setting. From my brief experience it seems that it isn't,different unless you're at a psychiatric hospital, then they're very compassionate towards those with mental illness. And if mental illness is stigmatized, suicide is like the illegitimate child of mental illness that no one wants to talk about. And it's so wrong because for those who attempt suicide (or succeed) and the family members of these victims the grieving process can be far more difficult than for other people that get critically ill or die. There's so much shame, guilt and anger that can be attached to suicide, if anything the patient (and their family) need more care directed towards them, definitely more compassion, not judgment and jokes about 'these kids don’t know how to do it (kill yourself) the right way.' And that was one of the more tame comments. The things I heard just make me seethe. And then I start wondering where can I be nurse where I can make the biggest impact? Should I become an ICU nurse and do my miniscule part to put a compassionate, hand holding, if also very nervous, nurse in that field. I see so many problems within healthcare (and, to me, having a nurse that makes fun of a patient they're caring for is a HUGE problem) but I really want to try and help fix them. I just don’t know how.

disclaimer

I am not as noisy as I appear to be in the pictures below. That's one place I'll draw the line at picking myself apart about. I'm not nearly that spotty. I don't know why the pictures saved that way, when I open them in photoshop they're fine. But I'm beyond hitting the gaussian blur a couple of times to soften them up for this blog. Although I sometimes wish I could hit gaussian blur on my real life face a few times. Imagine. Okay I'm done with the solipsistic self loathing though. The next post with be free of that. Promise.

continuum

They say you can never be too rich or too thin. But I'm becoming the latter, at least in my face, and this is where my problem arises. I've got a twenty pound continuum. When I'm at my thinnest I look horrible pretty much everywhere, except my legs. At my heaviest my legs look horrible but I have a pretty good set of tits then. When I'm in the lower quartile of my weight, any semblance of breasts is all smoke and mirrors, thanks to american eagle and their paige bras, which can put my 34 A minus amply into B territory. When I'm ten pounds heavier than I am now my face usually looks best. Unfortunately I'm not able to cut, parcel out and repackage a me with my lowest weight legs, heaviest weight tits and 3rd quartile face. So what's a girl to do? I'm currently five pounds away from my lowest weight (I don't want to put numbers or sizes in because that just seems too horribly fucked up and, really, I'm just aiming for minimally fucked up with this post) and my face looks horrible. My chest is also rather ghastly. My intercostal spaces are clearly visible, and at times it looks my sternum is about to break through my skin, from the nipple line up I look a wee bit like I'm starving? I'm on Survivor? I don't know I never watched that show but I'm assuming they get rather gaunt. In other words I can sort of understand why that doctor thought me wan. But I'm actually not underweight, my BMI is on the low end of normal but it falls firmly within normal territory. And the way I carry weight, I'm more pear shaped than apple, so it's no suprise that I'm very thin in the chest and thicker in the hips and thighs. The first picture is of me four and a half years ago when I was, obviously, younger but also a bit heavier. I miss how much softer my face looks in the earlier photo but I don't think it's just the extra weight. Age plays a big, I don't want to think how big, part in it. I never thought I'd say it, because God knows I found plenty to pick apart about my face back then, but I miss my younger face. I'm sure stress plays a part on ravaging my face too and nursing school has sucked any remnant of happy, healthy plumpness right out of my face. So I currently avoid mirrors and other reflective surfaces in public to come home and furiously scrutinize my shortcomings in the privacy of my own bathroom. I sound like Greta Garbo without the fame. I know how vain this all sounds, but I don't want to look sick and I think that my face sort of makes me look like I'm terminally ill with something. Fatal fortysomething dysmorphia.

Okay, now this might sound like I stretch but I'm also wondering if any of my facial gauntness could be due to my ongoing headache issues. I've had a headache more often than not since October. I finally kicked that 3 month sinus infection in January but my headache hasn't really gone away and I think I'm suffering from pretty much daily tension headaches, which pain relievers don't do anything to alleviate the pain of. I wake up every morning to the top of my head hurting. By midmorning my cheekbones and everything north of them kick in with the pain. By dinner I have a helmet of pain, my head hurts everywhere except for my mouth, nose and ears. Don't even get me started on my forehead and how it feels like I'm frowning all the time, even when I'm not. That might not sound painful but when those muscles feel pulled in that position all day, it hurts a lot and creates this heaviness, it makes my eyes ache. So couldn't all this pain possibly result in a deleterious effect on my face? I know it probably makes me look even more stressed and tired. And it's sort of exhausting to have facial pain almost constantly. The only good thing I can think of is that at least I'm not suffering from trigeminal neuralgia which is a type of facial pain that is so bad it's nicknamed the suicide disease. There you go, I found the silver lining in my face hurting and becoming more gaunt by the day, at least I don't have trigeminal neuralgia. I'm off to pop some ineffectual NSAIDs.

kiss kiss

Oh this week at the hospital was a blur. I had a very very sick patient. Sorting through my preclinical paperwork on Monday night, rumor has it our nursing school is the most exacting in terms of the sheer amount of paperwork we must have prepared for our clinicals the next two days, the school also requires the most clinical hours out of all the other in this area. I worked from 1 to 8 making sense of all the infomation, then went to the gym for an hour and a half to burn off my anxiety. I was really concerned that my patient might already have died when I came in Tuesday morning, because a diagnosis a severe septic shock is one you never want to have. But the patient was still there with a pulse and clear lungs, even if everything else was going to hell. The patient was scheduled for wound closure surgery which I got to go to. Down in the PACU, prior to surgery, the transport nurse started relaying information about the patient to the anesthesiologist but he had the wrong information and I was able to sound like I knew what I was talking about and tell the anesthesiologist the patient's story, so I'm actually quite grateful for all that grueling preclinical paperwork because I was prepared. The transport nurse was super gracious and thanked me, which was very nice of him but I get the feeling that transport nurse is never not nice, a very chatty and up fellow. So to the OR. I absolutely love watching surgeries, it's completely fascinating to me, the more open and exploratory the better. But I couldn't be an OR nurse. For one thing the idea of standing in place for longer than fifteen minutes sort of drives me crazy. Like I need a nursing position where I can walk, usually very quickly, and move around a bunch because I'm a bit of a physical spaz. If I decided to became a nurse anesthetist I'd probably need to do jumping jacks or something because it tends to be COLD in those ORs too. But watching the surgeons do their work is pretty incredible. Plus my favorite vascular surgical resident, who is most likely a few years shy of thirty, was there, making me rue that I'm not fifteen years younger. At one point he called me muscles because I had trouble snapping off something which is ridiculously easy to do. But he'd pat my shoulder and he thanked me a few times for my help, which honestly was minimal at best. Sigh. That attention creates those teenaged heart thumpingly good feelings until I'm like, 'Are you insane? You're 42! He's just being nice.' And he is nice. To everyone. He'll pat anyone, male or female, on the shoulder. Still that boy makes me goofy, like my Tim Roth/Eddie Munster man at the gym. But I digress... Unfortunately they started the surgery but couldn't finish the way it was originally planned, the patient's condition started deteriorating too much. But when your body goes into severe septic shock the choices are between bad and worse. What choice can you make? The patient was closed up and brought back to the ICU, it was touch and go as to whether they would live through the night. I had gone back to the hospital later that afternoon to catch up on paperwork because I was so busy watching what was unfolding during the day that I wrote down nothing. I stayed up until 9:30 last night doing my paperwork and got back to the hospital at 6:30 and, thankfully, the patient survived the night. I talked to their family and my heart goes out to them. It is hard to know what to say in a situation so grave, but I just try to be an empathetic ear more than anything. I don't have answers but I do care for how incredibly difficult a period it is for them emotionally, hopefully that caring is felt. The patient aroused more through the day (the previous day the patient was sedated the whole time) and got restless a few times. This might sound weird, but I find that I bond with the patient more then. I mean I guess it makes sense and it's not like I didn't care whether they died or not before I had that response. But the interaction, even if it's brief, it brings the reality of this person, you see them, and their struggle for life, home to you. I think that's another reason why I wouldn't like OR nursing, I want to interact with the patient more. I think there's a delicate balance maintained between caring for the patient and being able to do your job thinking critically. I know I care, I know I can think critically but I don't feel incredibly skilled doing them at the same time. Do I get too emotional. Oh yeah. Does my anxiety cloud my judgement. Definitely. But my hope is that it's on the smaller things (shaky hands, little fumbles like that) that I can calm down about when I do it often enough. So I really struggle with this balance. Especially since this is a person who probably is going to die, unless some miracle occurs. And what can you do? The surgeon can't operate on them again, their condition is too grave. They've got more drips going than I could have imagined possible. Tuesday I was shellshocked by the amount of care the patient needed. But today I was actually able to help a bit, and even if it is in my awkward student nurse way, it still felt good. And when the patient roused and was anxious I'd hold a hand or stroke them along the forehead and tell them it's alright. I'm almost certain that it won't be alright but you can't let them lose hope. The patient and their family will be in my prayers.

So as for the kiss kiss title. The nurse I was working with today, an instructive co-assigned who also did this as a career change, was trying to squeeze the patient's two JP drains to close to suction properly and when he popped open the cap on the one a tiny spray of serosanguineous fluid hit me across the mouth (which was thankfully closed) and bottom part of my face. You couldn't even see it, it was like when someone accidently spits on you when they talk. Except this wasn't spit. It was a septic cesspool positive for Klebsiella and God knows what else, that has the patient literally at death's door. Needless to say when I got a chance to leave the room I went straight to the bathroom and scrubbed my face, especially my lips with the antibacterial soap. Ugh, I wanted to drink the soap. Sort of ironic this would happen when my last post made mention of my kick ass physical health. Let's hope it stays that way.

dark alley

The corner I turned just led me into another dark alley, something that seems to be happening a lot lately. Like pretty much since this fall. It makes me question what I'm doing in nursing school? What am I going to do with my life? Can I get a job and health insurance before my divorce is finalized? Because the idea of being without health insurance in my forties could, in itself, push me into a breakdown and how would I ever afford that, you know, without health insurance? So another Sunday creeps up on me, sticking it's tongue out at me from the moment I raised my blind to find snow falling. Another test that I'm studying for. And every Sunday my belly is filled with this acidic stomach churning panic of a new round of clinicals to face for Monday, Tuesday, Wednesday. How am I ever going to work in a hospital if this is what 'play work' at the hospital does to me? Five more weeks of critical care to go. Our instructor talked to us about workarounds at post conference (the end of clinicals) last week and asked about workarounds we have we noticed. And why is it I see, not workarounds, but outright errors, lies, stuff that makes me thank God for my kick ass physical health and hope that I never have to spend time as a patient in a hospital. I can't say that I entirely blame the nurses I see doing these mistakes, although I see some things, and as a student I am in a position of no power, that make me feel very uncomfortable. Like come home and bawl uncomfortable. The hospital healthcare system doesn't work. Neither for the patients or the employees of the system. And I want to hop up and down and point it out and try to make a difference. But my instructor, the very first week she met with me after clinicals said, 'You are a very kind person but you have this attitude like you want to save the world.' She didn't see it as a good thing. More as something that was going to make me depressed and cause me get burnt out early and she was sort of like 'you have to accept that you can't make changes in that way.' But I don't think it takes genius, the biggest impact can be made with simple stuff. And the biggest thing I see, that leads to the most problems, is the lack of time. Being rushed to multitask to the point of mistakes and decreased productivity and getting a sort of tunnel vision so you can't even see the patient in front of you for the person they are and not just what's on their medical chart (which is on a computer, which just makes me think that Paris, Texas is one of the most prescient films about technology and isolation). Ugh. Guess, I'll hop off my soapbox of despair and get back to studying.

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.

finally finished nightstand

Because I am CHEAP one of the Christmas present Oona got from me was a nightstand that I finally got around to refinish, one year later. I got the piece for $10 at a yard sale, unfortunately when I stripped it the wood wasn't in good enough shape to stain so I had to repaint it. I love working on furniture, aside from the paranoia of inhaling lead paint fumes which I'm really hoping my green stripper that I use sort of neutralizes. See during my breaks from school is when I start fantasizing about owning a store where I sell furniture I redo and jewelry I make and crafty items I find. I just love crafty stuff and maybe this fantasizing is a good way to handle my stress with school. Good lord we have a test next monday where a good third of the test is understanding various heart arrhythmias (atrial and ventricular) and being able to figure them out from EKG readings and it is a lot to digest, not to mention knowing the medical conditions that correspond to said arrhythmias AND the medications you then use to treat them. My mind just doesn't latch onto this information the way it does other medical stuff, it just feels too abstract to me right now and if I can't contextualize my information I'm sort of a goner AND (once again, the panic inducing all caps and) it's twenty-five different rhythms! So... here's hoping I can make it gel this week. Wish me luck. Just in case you want to try you hand at understanding EKG rhythms you can go here and learn more, I'm sure you're all just dying to check out this site.

I was walking through Highland Park around dinnertime the other day and just liked the way the dormant hydrangea looked next to these puplish black pods thingies. Yes, obviously I am no master gardener. I have no idea what type of plant this is but I liked the contrast of the colors and that it was dark it made the contrast even more vibrant.

Off on running with school. Have had two full days learning to read EKG rhythms. Oh my it all makes sense until we go on to the next section of abnormal rhythms and then I'm like, wait I still have to remember all those ones before that I just learned. Gotta make space in my brain for this stuff to sink in. On the plus side Monday, after our lecture I caught a House episode where the patient went into super ventricular tachycardia and they need to cardiovert her and I understood what they were talking about. If nothing else, it makes my House viewing that much more enjoyable. Oh and one helpful bit of meaningless house gaffe trivia, they almost always put their stethoscopes on backwards on that show.