are you my mother?

Just one last week of clinicals in the ICU for me and I have to tell you I sort of love the ICU we're at currently. It's in a bad neighborhood, a number patients of patients come in with substance abuse issues, and the hospital might very well close in a few years time. It's a longish commute, 25 minutes instead of 5, but this ICU is scrappy. I have always been a fan of the underdog, so it's only natural that it would extend to a hospital and patient population that I think many people would like to ignore. A HUGE part of my liking this ICU is that, with a couple exceptions, the nursing staff is exceedingly nice and helpful. I've had one particular co-assigned (nurse I work with for the day) twice now and she's great. She's so young but very cool, incredibly easy to talk to, helpful but quick to say 'let me know if you want help or if you need me to back off' and she actually seemed to appreciate my help at the end of the day. Most co-assigneds that I've had basically ignore me so the few that interact with me are worth their weight in gold. But this girl in particular, if I worked somewhere where most of the nursing staff was like her I'd be happy as a clam. After lunch one of the doctors stopped me and said, You look like you're the nursing instructor. And I sort of laughed, saying, No I'm just a student. So he stops me and asks, Do you know why I thought you're the instructor? Because I look so old? He smiled and said, No, you look like you know where you're going. Now this doctor wasn't your typical looking doctor, he was like 6''5", not wearing a lab coat but instead a polo shirt with a very large white flower in his chest pocket. And I just love eccentrics like that and this hospital, it sort of has an island of misfit toys vibe to it. It's more than capable medically, I'm not saying it's deficient in that respect at all. It's just that it's not snobby in the least and I really like that. Plus the boutonniere doctor wished me luck when he left the floor. I know that when it comes right down to it the environment I'm working in will determine whether I'm happy with my job or not. Sounds like a no brainer right? I think it takes on a new level of importance in extremely high stress jobs where it could quickly devolve into lord of the flies if the environment isn't supportive. And that sort of aggressive, backstabbing bullshit would ruin me, even if I stayed out of it, which I would, because I tend to strenuously avoid office politics and just do my work and be friendly but not get involved. So this will sound odd, but lately, when I go through each clinical rotation, that book 'Are you my mother?' pops into my head. I don't want a snort for a job. I want a nice place, the medical equivalent of that sweet worm seeking bird mom in the kerchief. And it's a bird in a kerchief so there is a bit of goofiness there and I want a place where people want their work to speak for them, not the way they look, or their car or that other status related crap. So if I can find that after graduation, and successfully pass my boards, then I'll be set. But first things first, one more week of clinical and passing this course. I'm done April 13th. My word, the past 13 weeks have been a blur.

Reasons I hate my car? The list is endless. The city MPG that is thirty percent less than what was the original estimate, the highway mileage is even worse, it's close to 40% below the estimate but I'm not on highways daily (well I'm on one daily but only for less than a mile). The tan cloth interior that takes every drop of water spilled on it and turns it into an ugly magnified stain? Water staining a car's interior, how unpractical is that? The loosey goosey chassis that makes me long for my old Civic, the list goes on. But this morning when I hit my turn signal to go right and the tempo was stepped up to the fast paced beat that let me know yet another turn light has short circuited I was ready to drive right past school and drive the car right through the front window of the dealer I got it from. This is the third time that a turn signal light has died on me in the four and half years that I've owned the car. I never had that happen to me on any of the other cars I've owned. EVER! And this is the third time and the people at the Ford shop insist that this doesn't indicate a problem with the Freestyle, and it's not covered under my warrantee and I'm not paying another $200 to get this fucking turn light fixed. Although I know that every time I inadvertently hit that directional and hear the tick tock'ing on speed or every time I don't hit it because I know I'll hear that is just going to make my anger at this car rise again. Grrrrrr... I loathe people who fail to use turn signals but I refuse to fix this problem. As soon as this albatross of gas guzzling is paid off in full I'm trading it in for a used civic or jetta. I will never buy a Ford again, this car, which I got for (#1) safety reasons and (#2) the gas mileage it was purported to get, is a fucking piece of crap.

mathlete?

My son is many things, smart, belovedly goofy, kind, curious, very sensitive but athletic, no. Last month his grade and two above him went to Romp n’ Roll, apparently a roller skating rink that’s been a fixture of the Pittsburgh suburbs for ages. Owen spent the majority of his time at Romp n’ Roll skating on the carpet. He didn’t actually skate in the roller rink the whole time he was there. And he mentioned having to hang onto railings for most of his time there. But he had fun. He was especially thrilled that I gave him $10, he had mentioned wanting to buy a plastic sword, apparently those were all the rage at Romp n’ Roll last year when he was a second grader watching the cool older kids go there while he had to go to the Science center. This year the thing to have was the glasses you see him wearing. It was a set that also included a quasi bite guard mouth piece which also blinks in those different colors (I took many photos but couldn’t capture the mouth blinking bling on digital, you’ll just have to trust me on this one it’s in there.) Mmmm, a battery encased in plastic sitting in my child’s mouth. What do you think the chances are of a recall on that type of toy? Possible choking hazard? And they were a bargain at $5 so he spent the remaining money on little plastic parachute ninjas. I think he got over twenty of them.

In other adventures of inathleticism, this past week his school has been taking the PSSA tests (don't even get me started on how much attention is put on this test) and in the morning the principal has the classes taking the test run around the front of the school a couple times to get that blood flowing up to the cerebral cortex and invigorate them for test taking. Well Owen fell and did a total face plant the first day. He wound up with an abrasion on his nose, knee and hand. I am still trying to work out the physics behind the nose abrasion but am eternally grateful that he didn’t mess up his teeth at all. Between his falls running and Oona's predilection for head trauma given her being too top heavy it's no wonder I hover as a parent and quickly envision worst case scenarios (the nursing school lectures on head trauma have done nothing to help with this) when I watch them play.

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.