not work related

Well work is still kicking my ass, I go through my night rotation this week and next so I'll be particularly logy but I'm not writing anything work related in this post. No I've been reading guilty pleasure books, my reward for stuffing so much oncology related information into my brain it will surely herniate from amount of information I'm trying to understand. So I decided to read Hunger Games, devoured that in a night, and then Catching Fire. I've got Mockingjay on my nightstand and started that but it's a bit slow going. And then I kept hearing about this Fifty Shades of Grey book. When I first heard about it I thought it was yet another young adult novel that had taken off with older adults. Oh how wrong I was. I finished it in a couple of days and I'm just so confused. I don't understand what all the hype is about (and there is a lot of hype, Newsweek has a cover basically related to the popularity of this book) because it's supposed to be a book about this guy being all into dominant/submissive relationships but, I don't know, it seemed really tame to me. And frankly insipid. I mean the writing is at that Danielle Steel level of perfect people although, to be fair, the author does make reference to Tess of the d'Urbervilles numerous times and I'm sure if you graded it on the Flesch-Kinkaid reading index it would be a level or two above Steel and Sidney Sheldon. But the protagonist in the book is named Anastasia Steele, honestly could you be more cliche you've got Danielle Steel's last name with an e added to it, why not pick a protagonist with a name like Ramona Lipschitz just to add some zing. And everyone is too perfect in this book, perfect looking, wealthy, oh and the really pushing the limits of suspension of disbelief, not only is Anastasia Steele a virgin, she has never touched herself. I think if I had read this in seventh grade it would have blown my mind with the sex stuff, but even back then I would have questioned the virgin who has never touched herself. And now I'm middle aged, divorced and I read Dan Savage every week. I guess I thought that this book would be racier, more of a book equivalent of a David Cronenberg film or the movie Secretary but for all the BDSM implied it's really pretty vanilla. I kept waiting for it to get to a really steamy passage and it never did and the main character is so fucking sanctimonious. The dominant lead, who is falling for her so he's falling short on his dominance and power play stuff, quickly doing these all these firsts for him, like sleeping, just sleeping with Anastasia, and letting her use his first name, blah blah blah. And this protagonist is such an annoying twenty two year old self righteous twit; she's all I can't take these first addition books that you're giving me, the audi, the clothes. Honestly this is like a completely unrealistic dream come true, you get a hot, young, insanely wealthy and powerful guy that's showering you with gifts, telling you how beautiful you are, that you bewitch him, plus he plays piano, speaks fluent French and can drive a helicopter. Oh yes, and he's great in bed?! I'd let him brand my ass if he wanted to. People settle for much much less. I guess this is what forty-three plus years and two kids turns me into, a pragmatist. If it's mind blowing sex I think I could very quickly become nonjudgmental about this fellow's kinks. Spoiler alert: The main character gets spanked, blindfolded and has her wrists tied (with a tie and cable ties) the climax of the story (oh my God reading about all this girl's many earth shattering orgasms I wanted to scream 'enough already', well that and her constant peppering of interior monologues consisting of 'holy crap' but the I don't know controversial/steamy end is when this girl is spanked with a belt and she ends the relationship because this fellow's way too fucked up for her if that's what he's into. Really? I mean I'm sure it hurt but um this is the shocking end? Okay, truth be told my sex life has been very vanilla so I don't have any idea what a truly dominant/submissive relationship is like. I've never been spanked (I think I would laugh if someone spanked me) or had my hands cabled tied or anything like what this female lead gets. But I'm like what's the big deal? I want to read about characters more flawed, more human and therefore infinitely more relatable and sympathetic. I'd prefer that this main guy was into something really dirty or weird aside from what I'm thinking are probably more pedestrian kinks, at least in the BDSM community. I mean I don't know I'm not a part of that community but I'm sort of curious what they make of the popularity of this book. I'm just confused by what shocks people (this book?) and what doesn't (how many people are unemployed/uninsured yet people watch the Kardashians?).

I tried to watch a porn film with a guy I was seeing once and we both had to stop it fifteen minutes in, it was that bad. There was nothing hot about it, at all. The people were unattractive and fake looking with teeth impossibly white, they were like Ross's teeth in the episode of Friends where he bleaches them and they're so bright they glow in the dark. And yes I get that it's odd that I would watch a porn film and focus on peoples teeth rather than their privates. I just don't find that stuff erotic at all. Nor this book. I find James McAvoy very erotic. And Hugh Laurie, mon dieu, House is ten times more erotic than this book. Oh how fucked am I that I think that? And watching Sigourney Weaver and Mel Gibson make out in The Year of Living Dangerously, that was insanely erotic to me as a teenager, not so much now that Mel Gibson became such a nutter. What else? the INXS video for 'The One Thing' that was a huge turn on to me as a middle schooler, it just seemed to epitomize debauchery. I guess reading the book made me long for those times when the blood courses so quickly through me it makes my whole body hum. For someone that makes me flush so readily (although I talk to anyone with MD after their name and I seem to blush- ugh!), who causes my breath to catch just by seeing them. I would love to have a relationship with someone who makes me physically feel like a teenager, who wouldn't? I think it's why there's so much infidelity, you meet someone who seems to notice and appreciate you and makes you feel young, that's heady stuff. Especially compared to the banalities of the everyday. I guess the real trick is to find someone who makes you feel that good but who you can share the banalities of everyday with. I haven't found that. In the interim, before I become a crazy spinster with cats, I'll lust after my guy at the gym, who I would readily let spank me. And if he bought me an Audi like Christian Grey does for Anastasia Steele (can you believe the names?) who knows what my hard limits would be, or if there would be any.

Ha, I write with much bravado but in reality, I wouldn't even let a man, a very distinguished older gentleman, buy me strawberries when I was in the checkout line at the Giant Eagle and they were some ungodly price when I thought they were on sale and I started turning bright red (like said overpriced strawberries) as the checker took forever to remove the strawberries from my bill and the man was insisting he'd buy them for me, 'Come on, they're good for your health.' And I'm pretty sure he was flirting with me but I'm like Temple Grandin when it comes to flirting, an anthropologist on Mars, and I was mortified taking so much time in the express lane and I kept getting more and more nervous and could not look at this man, who was like sixty but very kind. I just said thank you after declining his many offers to pay for my strawberries and ran to my car.

april fool

So... I'm sort of going back and forth with ending this blog because I think the things I'm writing about most people don't relate to anymore. When I started this blog Oona was one and my Grandmother had just moved here from Cape Cod. I was still married and a stay at home Mom, doing the odd freelance photo retouching job at home. I'm sort of astounded at how much my life has changed since I put that first post up. I've gotten divorced, gone back to school, gotten my RN and am working on a unit where I'm regularly accessing central lines, that burrow into internal jugular veins, tracing a path through the vein to lie in the distal third of the superior vena cava, nestled right above the heart. I've gone from wondering how I could ever manage to give a person a shot to wondering if I'd like to be a nurse practitioner specializing in oncology, because then I would be able to perform bone marrow biopsies, not from a schadenfreude point of view because this sort of looks terrifyingly painful but I've heard in the right hands patients don't really feel a thing. I want hands that sure, attached to a body that feels equally confident in my skills. That will take time, probably a lifetime, but I don't mind passing the years on that quest. I started my ninth week of orientation today. Oh what a difference nine weeks makes. When I say what a difference nine weeks makes, we'll there was one specific episode today that comes to mind but I'm like how do I explain this in a way that those not in healthcare can understand. I'll try.

I had a patient recovering from a MUD transplant, this is a bone marrow transplant where the recipient gets stem cells from a matched unrelated donor. It's really such delicate balance when it comes to bone marrow transplant, when it comes to so much in medicine, weighing the benefits versus the risks. The risks for graft versus host disease are increased with a MUD but some doctors want to see a little bit of GVHD in order to ensure engraftment (that the patient's body has taken on the new stem cells, which decreases the risk of leukemia recurring). The patient had neutropenic fever (spiking a temp when your immune system has basically been obliterated to take on the donor stem cells) and, my God if you saw all the IV medications going in. I was using all three of the central lines, going from antiviral to antibiotic to antifungal. Potassium and magnesium replacements, immunosuppressive therapy. And there were contact precautions so I needed to wash gown and glove every time going in an out. I went in to get vitals at 4 this afternoon and brought along a dinamap (a machine to take vital signs). So I put a pulse oximeter on to get the patient's oxygen saturation and pulse and the dinamap registers the pulse at 250. On seeing that number I think my heart rate and blood pressure quickly spiked. I palpated the patient's pulse and tried to count it. It was quick, definitely tachy (meaning over 100, it was about 126) but I wouldn't be able to palpate 250. There was continuous pulse ox in the room and I turned that on to double check. It started high but then dropped to right around where I palpated it, high 120s. But there was an image going across the screen, it looked like a rhythm strip (which is an EKG reading you look at for heart function). I'd seen it the other day looking like sinus tach but this one kept looking like the patient was throwing PVC's (premature ventricular contractions) and a run of two (bigeminy) and then three in a row and then it looked like a run of V tach - all of these are very bad to see on a rhythm strip and my heart was still in my throat over seeing the heart rate at 250 even if it was erroneous. I ran out and told the resident I thought he should order an EKG and then started saying what I saw. My preceptor is like how do you know what a run of V tach and bigeminy look like? Not meanly, she was impressed but sort of chuckling at me. The resident ran into the room. And then the other nurses are like, you can't get a rhythm strip off the continuous pulse ox - and they were right. You need to be monitored, which entails having five leads (stickers) hooked up to your torso smoke over fire (red lower left quadrant, black upper left quadrant), clouds over grass (green lower right quadrant, white upper right quadrant) and chocolate close to your heart (self explanatory). I had fucked up. Sent the resident, who's first day it was (wonder how he'll view me now) careening into the room. I felt like such a complete idiot and asshole. I was so scared by that impossibly high number (250!) it clouded my thinking. Maybe it was my own heart that was still having trouble calming down. He came back in and canceled the EKG. I was confused. I've used pulse oximeters plenty of times but there was never a faux incredibly similar to EKG looking rhythm strip attached to them. But I was able to laugh at myself and that's where the pivotal difference is in the time that's passed on the floor. I probably would have bawled early on but now, well I made a fool of myself but no one got hurt. And my preceptor is always saying I'm an excellent nurse, I think she's too kind, but her heart's in the right place and I think she sees that mine is too, that I'm trying my hardest to stay on top of things and keep my patient's safe.

There was a young patient that I wrote of earlier. I really liked her and her Mom. I came in one night having had her just the night before and I knew she was off. I can't explain it, it was just a gut feeling I had. I called the resident on call that night, twice. I kept trying to get her help because her heart rate seemed too high and she was breathing too quickly and she just looked bad too me. The resident blew me off, both times. Chalked up the high heart rate to anxiety. Even when I said 'But she got something for sleep and has been sleeping for four hours and just woke up and she's in the 130s?'. The resident walked in, walked out, did no more than an eyeball assessment then left. But I couldn't put the bad feeling away and went in shortly after the resident left, with the dinamap in tow, just to check her vitals again, to reassure myself. Her heart rate was 165 and her pulse ox was 88% (not good for someone who normally was around 97-98%). She was transferred to the ICU and died a week later. It had been the last day of my night shift. I picked up my children after school that day, it was so beautiful and warm, that we went to the park. A nurse anesthetist I know, our sons are friends, came up to me and asked how work was going and I was talking her about my week and I just wound up crying and talking to her and crying, I just couldn't stop crying, for well over an hour, in the center of the other parents, knitting and eating snacks, and the children running around. Angel, that's her name, truly, and she was an angel to me that day, listened. And she gets it because she's a nurse and it was so unbelievably helpful talking to her.

Angel told me to journal about my days on the job because then I can look back and things and see what I've done right and not beat myself up when I feel like I've fucked up. So I'm writing this post from my new macbook air (13 inches and light as a feather). Once I get Word on this I think I'm just going to puzzle this stuff out on my own. My dream is be to be the nurse equivalent of Atul Gawande, to be able to write that well about medicine, but from a nursing perspective. But I don't know that I can write this way on this blog anymore, it hurts my heart too much. I feel displaced in most every role I inhabit; mother, nurse, friend, other. Maybe I'll switch to pictures if I get around to getting an iphone.

If I was really clever I would have shouted, "April Fool's!" once the resident came back to the nursing station after running to the patient's room for the stat EKG I was recommending but I'm too flipping earnest to be a tease.

7p

7p is what many in the field call the night shift. Brevity being key in healthcare, as evidenced by the many acronyms of medicine that I now get all excited about when I actually know them. I've worked nights this week, my last 3 days are tomorrow through monday night. Back to back to back darkness. If all goes well I'll emerge, like a mole, into the sunlight tuesday morning around 8:00 give or take, to go home, pass out and pray that I can avoid ever working the night shift again. I will gladly work weekends, holidays, hell I'll even skip lunch if I have to, I do it most days anyway, in order to not work the dreaded night shift. Because I am a lady whose circadian rhythms are firmly entrenched in being up at daylight and I do not like abusing my body and psychological well being this way. There is a $1/hr shift differential for working nights, meaning, woohoo you get all of $12-$13 extra for submitting your body to the abuse of a probable carcinogen. I don't know, maybe $10/hr extra would make it worth it for some, but even then I'd choose not to work nights because it makes me mental.


I'm still trying to figure out where I fit in in the world and sometimes it just doesn't seem like there's anyplace for me. I am an admitted control freak and there are so many things at work, little frustrations that take up time and so much energy. The veteran nurses agree that it's a pain in the ass but say you just have to ignore it or get past it. But I'm like why can't we fix this so it works properly? I just see the waste when you let things go, even little seemingly insignificant things. Like what you ask? Well there's a small frig that locks, it stores medications that need to be refrigerated and when I shut the door it doesn't catch, meaning lock, so I hear this insistent beepbeepbeep and try to shut it again. And again and again and still beepbeepbeep. The heat rises to my face and I start getting flop sweat (with the actor that made me love Broadcast News demonstrating it so well below). I ask other nurses what to do. Oh you have to really slam it, is their reply. So I do that, to the point that the frig moves and still beepbeepbeep. Do you know how fucking annoying that is when you have to give a patient vancomycin 3 times in a shift?! And because I am new and I am ssslow and the beepbeepbeep of the frig is just the tip of the iceberg in terms of the obstacles I run into daily. Don't even get me started on how unintuitive and time consuming the computer charting is. Oh my. Hopefully I'll speed up in a year or two but this profession it's like, you're hired and then you're tossed into the deep end. I'm on orientation but it's so busy sometimes (all the time?) that my orientee doesn't really have time to sit and answer all my questions. It's like triage with the questions I can get answers to in a shift. And then I go home thinking, but I still don't know what to do about that or this and did I forget to chart that. It's maddening. I'm doing alright but there are such huge gaps in my knowledge and I am not okay with that. It terrifies me. Now, to be fair, I tend to see every goddamn thing I do wrong and very little that I do right and when I fuck up, even in a very minor, pretty insignificant way, it haunts me.


Another thing that haunts me. I get links from some nursing website through my email and one recently was an article about lucrative second jobs for nurses, because being a nurse doesn't always pay enough. Something I was unaware of in school but see on now that I'm working, I have met many a nurse working two jobs, which usually accounts for five or six 12 hour shifts, in order to make ends meet. And these nurses are older than me and I am flipping exhausted after my three 12 hour (really 13 hour) shifts. Good to know now that my student loans will be kicking in come May. And I still need to get a BSN and then hopefully an MSN, so I won't need a 'lucrative second job'. It's exhausting. The last time I went on vacation was in August of 1998. I went to Italy for a poetry workshop and had to come home early because I was sick- spiking fevers at night, I had no appetite (in Italy of all places!) and lost weight, had a rash and migrating arthritis. It wound up being lyme disease. Closing in on fourteen years without a proper vacation. Sure I've gone out of state for weddings or across the state to Kennett Square for the weekend of my 40th birthday but I'd like a week of mindless idleness under a warm sun where my raynaud's disease is kept in check and I can wear some sandals, take pictures of a different landscape, play with my kids and buy some souvenirs.


All that's missing is my pale body, plenty of sunscreen and a good book.

in the mind of oona

Lucky Oona got puked on yesterday. While getting ready to leave for the day the boy whose locker is next to hers puked and it sounds like Oona and her backpack bore the brunt of the vomit. Driving the kids home I tried to breathe through my mouth to avoid the smell. But although gross, this is also somewhat exciting for Oona because it's a story to be told, where she has a starring role. I put her in the tub for an early evening shower, due to the puke, I figured it best to wash everything including her as soon as I got her home, out of the blue Oona said, "I love Grandma Cat. I ask her questions and she answers them for me." apropos nothing. I could be biased being her mom, but she'll come out with these little gems sometimes. Sure they're a bit off grammatically or round about, archaic perhaps? but that's part of their charm. Or she comes up with an entirely new and ultimately more fitting word, like booby trap for bra. She frequently says things in such a way that I'm hitting myself for not running around with pen and paper to quote her and then I'm mad I'm not a good enough writer to write a novel and pepper it with her dialogue because she is a memorable character. After she was all squeaky clean and in her favorite pj's, fleece pants that are covered in all varieties frosted and and sprinkled donuts and a purple top saying something about loving cupcakes, she hopped onto my lap while I was paying bills online, wanting to do the photo booth. She's a sucker for the effects and mirror is her favorite, which caused her to rhapsodize about how she would love to have a twin because then she would always have someone that wanted to play with her because I'm usually too busy working (ooh, little guilt dagger) and Owen doesn't like to play with her. Then she wondered aloud if her soon to be Stepmom might give her this longed for twin. I told her that twins usually come about the same time that you're born but Oona has a mind that's quick to push aside such pesky details as logic.

What a difference a week makes. This past Sunday at work was infinitely better than the last one. I'm getting better with coordinating my care, managing my tasks and charting ad nauseam in the computer. I'm hanging platelets like it's an ordinary occurrence, which is good because on that floor hanging platelets, blood and electrolyte replacements is routine. I reaccessed and changed the dressing on someone's port yesterday, I'm a slut when it comes to acquiring new nursing skills. I'm slowly finding my groove with having three patients, becoming more familiar with where to find what I need and dealing better with the disorganization that's inherent everywhere. I realistically fantasize that I would be a horrible chief nursing officer when it comes to schmoozing but I would kick ass at the organization part. The highlight of my day was at the very end when a younger patient asked when I'd working again. The mother came out in the hallway a few minutes later and said that the patient told her she was going to miss me until Friday. It brought tears to my eyes and makes every other experience that brings me to tears in a not so rewarding way worth it. It's why I wanted to become a nurse.

So with those kind thoughts in my heart I floated out of the hospital after working thirteen hours Sunday night, totally forgot the Oscars were on and wound up renting Drive, which was horrible. It was cheesy, overly reliant on silence to show it was arty and weirdly anachronistic in an eighties sort of way. Albert Brooks cannot play a bad guy to save his life, his voice just doesn't work that way, it belies his sweetness, even when he's cursing. He'll forever be Marlin, Nemo's dad, in my mind. Or I'll think of how much I loved him in Broadcast News and Defending Your Life. He's meant to play lovably, self-deprecating, funny men. His DNA has typecast him. Ryan Gosling might be hot but his voice reminds me of a weasel. He sounds like trouble. Owen Wilson is a hot mess but that man's voice is like honey, his voice could make you overlook how deeply troubled he is. I'd rather listen to him than the weasel any day. But if I had my druthers the voice I'd be listening to daily would be British. Hugh Laurie, Ralph Fiennes, Tim Roth - I'd take any or all of them to listen to. The one real bummer in my quotidian exercise routine is the man at the gym who made me goofy is MIA. He hasn't been there since November. I can't tell you how sad it makes me every time I note his absence. It's not like I knew him but damn he gave me a nice visual reprieve during the hour and a half of torture I put my body through. Hopefully he's hibernating and will be back come April, he'd still be nice to steal glances at ten or twenty pounds heavier. Just come back to the gym hot Tim Roth/Eddie Munster man.

unblock me

I don't have a smart phone, an ipad or anything else that would let me play unblock me at the addictive level I'd like, which would be where every need except those basic physiological ones gets shelved, and even those can be put on hold. There's no moderation for me with unblock me. So it's probably for the best that I lack fancy new gadgets that would let me download this 99 cent version of spatial relations crack. It's such a simple game, just move the yellowish blocks around until you clear a path for the red block to go through the opening on the right, and when that red block passes through there's a little trill of victory music that gives you just the dopamine squirt you need to get hooked. It's like a Pavlovian response for geeks. You can't stop with just one game, or ten. At least I can't.

It's funny though, how much unblock me mirrors my life. Puzzling out how to get through nursing school, then boards, then finding a job. I'd get the dopamine rush of success, I wish I could hear the accompanying music trill when I accomplished these goals, but then I'm faced with another puzzle to get through. I mean I love brainteasers so I guess in some ways I should be glad that this is what life throws my way. But another part of me, the rather sizable middle aged, single mom of two in a very new and stressful job part of me, just wants the path to be easier. It's exhausting trying so hard, all the time. And I feel so fucking alone at times.


So is it any wonder that after 13 hours at work, where I've sat down and relaxed for oh, all of fifteen minutes, my mind is focused on eating something, anything, everything to obliterate the day and then succumb to a food coma until I have to get up at 5:00 and start the day again. I need balance in my life and I've got to puzzle out a way to find some on the days I'm not working, and put little bits and pieces of kindness into my life on the days I am working. At it's worst, floor nursing seems like a career that's focused on subverting your basic physiological needs and that just doesn't seem good to me. Is it good for anyone to do that to themselves?

Can I say that Sunday was a horrible day at work for me. I'd been doing so well. The other nurses have gone out of their way to say just how well I've been doing, which honestly made me feel like they're going over the top with their praise because I find fault in every little misstep I do, I'm so slow and awkward with my skills, and magnify to alarming proportions. But the charge nurse joked 'are you going to be done with orientation in a couple weeks?' because I seem to be picking things up so quickly. To be fair, my patients have all been very easy and my schooling helped enormously in picking up the computer documentation system, even if I find way too many problems with it. But Sunday I had a patient from Hell. I usually can do a good job at not taking things personally. And I had asked for a patient that was more of a challenge, but I wanted one where I could increase my nursing skills (hanging blood, platelets, coordinating lots of different medications) this patient was a psychosocial nightmare and that was not the challenge I was looking for. The patient had nothing good to say about what I did, in fact the patient did an ongoing passive aggressive dialogue whenever I was in there about just how incompetent I was. Any confidence I had in how I was doing was gone by five o'clock Sunday when I left the patient's room after getting vitals. I said nothing the whole time I was in the patient's room and being told of my many failings, but as soon as I left and walked down the hall I wound up bawling. The other nurses were extraordinarily nice, telling me not to take it personally and stressing how hard this floor is to work on, and the charge nurse that day told me she thought I was experienced because I've been doing such a good job. I know they meant well, I just felt horrible, like I couldn't do anything right. It was a day that made me question my deciding to get into the field.

I keep having dreams where my house is a terrible mess, all my time and money spent on something that's falling apart on me. The walls are crumbling, the foundation sagging. In lieu of the nursing nightmares and forgetting my kids somewhere this is my reprieve, a house of usher collapsing under the weight of my worries. I just want something solid that I can count on but more and more I think it's foolish to assume that such a thing exists. And this puts me in a very uncomfortable position, it's similar to where somebody does something that makes you very mad at them, but you're clearly aware that that anger is more self directed because they've done something that you hate in yourself. I don't like being in this space. Well February is almost over with, hopefully the self discontent will abate and I'll feel more in control moving around the blocks in this latest puzzle I'm faced with.

week 1

Hello. I will try to post more than monthly in the future. I've been hunkered down since Christmas because I don't like winter, even when it's a mild winter that sees my gas bill at an astoundingly low rate. And February is my least favorite month of the year, thank God it's the shortest one even if we get an extra day this year. January through early April is usually a hellish stretch for me. I just try to keep my head down, indulge in chocolate at an alarming rate, exercise and hopefully get out on the other side by May.

So I started work, last week was my first week on the floor at the Bone Marrow/Transplant unit. And I made it through the week without causing a sentinel event. I'm only partially joking about this. Becoming a nurse has put my borderline OCD into a most likely diagnosable OCD, at least when it comes to medications and making sure I don't make a mistake. I have nightmares about this stuff. Troubling dreams with syringes and me not following aseptic technique, with me doing stuff I'd never do in reality. It's the sister nightmare to my parenting nightmares where I forget the children at malls, I wake up from those dreams wanting to scrub the memories away a la Silkwood. This might seem crazy to those not in the profession. Hell I'm sure it might seem crazy to plenty of those in healthcare. But there is so much in the real world of healthcare that falls way outside the realm of what I was taught, and the utopian healthcare world that you come across on the NCLEX exam. And it's hard for me bridging that divide. Knowing what I don't need to worry about and what I cannot put aside. I am a cautious person, anyone that knows me well would attest to this. Having children put my cautious nature into overdrive and nursing school, I didn't realize I could become more of a cautious freak but I did.

I joked with my preceptor (a nurse on the floor that I shadow for 12 weeks during my orientation to the unit, she's amazing) that the patient population on this floor is like the NCLEX come to life. Almost every patient I've had has a central line, most are on neutropenic diets and due to their being so immunosuppressed precautions are instituted to prevent them from acquiring an infection, which means I can't use my kick ass littman stethoscope but, instead must rely on the fisher price equivalent that's placed in every patient's room and absolutely sucks when it comes to auscultation. Hanging platelets and blood is an everyday occurrence and once I receive training in March and April I'll be able to hang chemo. The learning curve from nursing student into actually being a practicing nurse, especially in this unit, is sort of astronomical. But that's okay because the two main reasons I got into nursing are that I wanted to help people and that I wanted to be in a job where I was constantly learning and this field more than meets both of those reasons. I just tend to read up a lot on my days off trying to familiarize myself more with leukemia and lymphoma, the medicines, pertinent lab tests and complications for these patients.

There are two roadblocks I've noticed this first week, and it's not job specific, it's endemic to healthcare. The first is gossip. I don't know if nursing is more gossipy than other professions but I just don't have any interest in participating in it. I don't want to act sanctimonious about it I just want to be nice and professional with everyone and not get involved with the griping about certain patients or other nurses, it's just not my thing. I get that many people do this to relieve stress in a field that is incredibly stressful but to me it's enervating so I want to glide past it without seeming bitchy. The second roadblock is the computer system, which is a travesty. I'm all for a computerized documentation system that is easy, efficient and helps healthcare workers do their job better. But I've yet to come across a system where I don't find problems that I think can result in errors and could potentially harm the patient. In addition to my worrying, becoming a nurse has put my compulsion to fix things into overdrive as well. I always look at things on the floor and find all the problems and think there must be an easier, intuitive way to make the nurse's job at dispensing medication and documenting assessments idiot proof. And I don't say this because nurses are idiots and need to take it easy. More that they're overwhelmed with tasks throughout their shift and if you can make the documentation and medication administration easy you just might free up the registered nurse to do what she's been trained for, use her critical thinking to keep on top of the patients care. Some nurses can balance all of this but I can't help but think that others sort of put the critical thinking on hold and become excellent task managers but then don't have the time to notice the early signs of a patient decompensating until it's too late.

I'll try to post about non nursing things in the future or maybe I can fill you in on something more vapid related to nursing, like my quest for fashionable scrubs. I know this is stuff that will probably put most people to sleep, or at least make them promptly click their back arrow button. But I'm pretty passionate about medicine. And I have hope that I can get to a position where I can make things better.

friggatriskaidekaphobia

There are so many things that scare me but friday the 13th isn't one of them. Although it scares my children. My children are scared to even go upstairs and use the bathroom by themselves, or get socks, or be left alone upstairs. Or maybe they're just really good at working the guilt angle with me until I feel compelled to send them up in tandem or get the socks myself. I really need to work on making the gutted half bath downstairs into a usable bathroom rather than a storage catchall. But 2012 is bringing a lot of new, and somewhat scary, things my way. And I already botched my New Year's resolution to eat better after one ill-fated spinning class where I neglected to bring water and thought I was experiencing an asthma attack during - I wasn't I just needed a drink, desperately. I've been hired for a new job as a bone marrow transplant nurse, that will start the end of this month.

And today I received my decree of divorce on fancy tan paper with a raised gold seal. I'm officially an ex. Sigh. I can't encapsulate the separation and divorce into a sound byte. I'm not good at that and it just wouldn't seem respectful. Maybe I'm slow to come to this realization but I understand now that you can love someone deeply and still not be right for each other. I think being in a long term loving relationship can take work, but it shouldn't be difficult, it's one of those delicate balances that are only teased out by the two people in the relationship ultimately. My ex will be remarried soon and he's with the right person for him. And she's wonderful with our children. What more could I ask for really? I'm seeing someone too. I don't know what our future will bring but I do know that he can make me laugh out loud over the simplest, silliest things. He can drive me crazy at times, but, when I look at everything that truly matters to me, he is a very easy person to love. My children ask every day if he's coming over, not in an eye rolling annoyed way, they both look forward to seeing him. Owen and Oona are so different. Owen is too much like me, a people pleaser who tends to avoid the difficult talks by circling around an issue, trying to think of the right thing to say. While Oona cuts right to the chase, 'Is he sleeping over?' I want to be like Oona when I grow up.

I had saved a turkey wishbone from the Christmas turkey we had and Owen and Oona broke it last night. I've never seen this happen before but it split completely down the middle in two equal pieces. Oona told me she wished that I would never die. I try to tell her that everything dies and that that's okay but then she gives me her sad puppy dog face and I just hug her. Owen told me his wish was to have a regular life and be happy. It sounded pretty wonderful to me. So I leave you with what I saw on my walk today, although I had to drive to get to these pretty locations. I hope the few that stop on this blog are well and wish you all a most wonderful 2012.

I've never seen sap icicles before but there were some hanging on most of the felled trees I spied during my walk through Beechwood Farms.



This picture is sort of like a trick of logic. The pine tree looks like it's falling but it's suspended in that position, for now, at least until the spring thaw.

I found four cairns like this in the stream that wraps along Squaw Run Road in Fox Chapel. I want to know who's making this loveliness.

hope everyone had a lovely holiday

and that you're able to relax and enjoy this time until the new year.

looted

Oona made graham cracker houses in class this past week. I guess graham crackers are a lot easier to manage architecturally with a classroom than gingerbread. Thing is when I picked up Oona the day she made it she looked at me with these very large, very sad, very manipulative eyes and said that kids kept asking her if they could have the candy from her house and she readily obliged. Hmm. Kids. So when I saw her there was one lonely candy cane shingle that she plopped off with her fingers and popped in her mouth. She continued to drag her nail through the frosting remaining on the rooftop, the better to get her sugar fix. By the time we got home the orange jelly ring wreath that hung over a door that was gone long before I picked her up was also in Oona's stomach. So I've got the pilfered remains of her graham cracker house hanging out on top of our bookshelf. I think the only thing that's stopped her from the graham cracker structure is 1. it's hot glue gunned onto a milk carton and 2. it's probably not as sweet, and therefore not nearly as valuable, as the other parts of the house that are now long gone.

pass

I took my NCLEX on Monday. 12/12 and I was supposed to take it at noon but I got there early so they let me start at 11:30 and spoiled my 12 cubed thing. I was shaking when I got there. Literally hands, body shaking. But after being fingerprinted and having my palm scanned. Being told that I'd be videotaped while taking my test and ushered into the testing room I got in my seat in front of the computer, put the earplugs in, took my boots off and sat cross legged in the chair. I went through the tutorial and then started the test in earnest, my heart thundering through my earplugged ears. But the first question was easy, and the one after that and the next. I was focused and doing what I do best (it is so sad that I'm such a good little test taker but I am. On paper, in theory, I excel). I wasn't focusing on how far I was in the test. There were a couple questions I didn't know but I didn't get hung up on them. There were a lot of 'select all that apply' questions, which I hate, because I'm always torn between adding one answer or not. But I was ruthless with myself and got through those. At 72 I started noticing what number question I was on because with NCLEX it's a computer adapted test and you can have anywhere from 75 to 265 questions (and any number in between). The screen just goes blue and your test ends when you have either passed or failed. And you can't find out whether you pass or fail until two business days later. It's a huge mind game. My worry had been how bad will my anxiety kick in after 75 if the test keeps going because you know then that you haven't failed but that you're also not in the successful pass zone yet. What a horrible way to fuck with a person's confidence. But I was feeling really good during the test, after so many weeks depressed and relentlessly studying, things were going well. I clicked my answer to 75 hit next and it went blue. I cannot tell you how happy I felt. I did the test in under an hour's time. I came out into a beautiful sunny day. I felt wonderful.

healthcare is a human right

I'm down to the wire with my last week of studying before NCLEX. Still worried that reason will completely leave me the day of the big test and I'll draw a blank on everything or forget how to read or will be so nervous my blood pressure will put me into the hypertensive crisis range (which would be impressive considering my normal BP is like 80/50 when I wake up in the morning). Anyhow I was taking a study break and drove my recycling to a local place (because they do curbside recycling every other week here but there's one truck that collects everything and tosses it together and somehow I just question whether everything is actually being recycled or if this is some half-assed fabrication to keep Ravenstahl in office). But while driving I was listening to NPR and they had the former Medicare & Medicaid Chief Donald Berwick on discussing Obama's healthcare reform. Now I don't understand why people shake their heads and tsk tsk healthcare reform. I think they're either misinformed, because they get their news from FOX, or they're inhumane. It just doesn't really make sense to me. A friend of mine had to read the bill for work and she said if you're the head of Aetna or some other insurance company I understand you being against the bill but otherwise, no. The bill forces hospitals and doctors to be accountable, rewards preventative care, stops insurers from fucking over those with preexisting conditions by denying them coverage, seniors get more money for medications, young people can remain on their parents insurance until their 26. The only potential problem that I could see is nurses and nursing aids getting screwed because the focus on reducing infections and pressure ulcers in hospitals is wonderful yet there are many non-profit (yet highly profitable hospitals) that will put the burden of achieving that success on the nurses and aids, yet not hire enough nurses and aides to do that (and at the same time admonish those same nurses and aides for not using good body mechanics but not give them the time to be able to do that). But but but, sorry I tend to go off on my soapbox tangents, the thing that made me want to drive my car into a wall, was during this interview they played an excerpt from the Teaparty Republican presidential debate in Florida back in September where Wolf Blitzer posed a hypothetical question to Ron Paul asking what he would do if a healthy 30 year old who opted out of health insurance was gravely injured and fell into a coma, should the people not pay for his care. And he responds 'That's what freedom is all about, taking your own risks.' to which the audience erupts in applause, and Blitzer counters, 'So are you saying society should just let him die?' and at least three members of the crowd shout out yes. There are many things that I read or hear or see on the news at a local, national and global level that make me think things are very end of days lately - not that I'm particularly religious but things are just dire (although if you spend a weekend in NYC you would never know it). And when I hear people say shout out someone should just die because they opt out of health insurance, which I would think would be because they cannot afford it, how can any human being be against someone being treated if they're ill? It isn't humane and therefore I don't think the person against treating the gravely injured person is human. At least I view them as far less than human. I need to make a tee shirt, get a bumpersticker, wear a blinking hat that says 'healthcare is a human right' because it is and I'm more than willing to shout it from the rooftops, hop up and down and fight anyone who thinks otherwise.

nclex study update

Still losing my mind studying for NCLEX. The thing that's really throwing me is that I keep arguing with the study guides and honestly how far am I going to get yelling at a book? But it really chaps my ass when I come across huge typos, like Parkland and modified Parkland formulas being the exact same formula (meaning someone got lazy with the cut and paste). One of my books had 6 comprehensive tests at the end and it was like they completely gave up on the last one. They'd have a question about sickle cell disease but then the answer would relate to cystic fibrosis. Two questions were supposed to contain rhythm strips to look at and they were missing. But the questions I save the most wrath for are the psychiatric nursing questions, which really make me wonder whether the 'clients' that flip out and get placed in seclusion might be the saner people there. Because when I come across a question where a man is suffering from depression and feels like a worthless father and husband and the correct answer IS NOT pointing out that his wife said he's a wonderful father and husband (no no no because that's too logical and therefore ineffective). No the book said the correct answer was to 'state that "you were able to shower and dress without any help this morning," points out a visible, realistic accomplishment and strength to the cient with self-deprecatory statements, thereby helping to increase the client's self-worth.' I would be ready to punch the nurse in the face that offered this gem of therapeutic communication. I can't think of answer more likely to increase my self hatred and push me further along the suicidal ideation path if I was this depressed man. Oh my. Please send out good wishes, cross your fingers, pray to God if you believe that I make it through this test without succumbing to hysterical blindness from the stress and that I pass the first time I take it. Pleasepleasepleasepleaseplease. With questions and answers like that I have my work cut out for me.

grainy blues

Oh Lordy. I graduated almost two weeks ago and I've already spun into a spiral of depression and anxiety about the uncertain future in front of me. The high of graduation was getting an award for third highest academic achievement, for which I got a check for $150 that I still need to cash. But by the next day I was starting to feel the dark panic nipping at my insides about needing to study for NCLEX. On the night of graduation the president of our class joked 'Who here did their 60 questions today?' and, of course, I was the only one who had. And I continue to do at least 90 questions each day, like I was told. Because I'm very task oriented and good at sticking to rules that way. But every time I score poorly on a test it takes so much out of me. And I'm like, how can I know all this information? I've never even heard of vanillymandelic acid test but am supposed to be able to figure out the foods one should avoid before taking such test. I can't get over how much the test name resembles Milly Vanilly and how many mnemonics can I make and keep straight in my head? Christ. The importance of this test, yes my future, my paycheck, rides on my passing and becoming an RN are not lost on me. Nor is the director of the nursing program having told our class at the graduation luncheon, we've had a 100% pass rate with the last three classes. To my perfectionistic mind, the implicit 'don't fuck things up!' was added and it's all I can do to keep my heart rate below 100 (60-100 being the adult norm). So I've got five different books that I can study from but when I look at the tear out 'cheat sheet' on one that lists common lab values but they don't jive with the lab values I've already committed to memory it just sends my anxiety through the roof (maybe I can blame my profuse hair shedding on that). As does every question I get wrong and can't puzzle the logic out of, like a lot of the psychiatric related questions and yet I've thought of getting involved in that field? Goddamnit. Yes, panic brings sacrilegious profanity to such a high point in me you'd think I suffered from coprolalia. I've got to get down the dirty dozen that will most likely be on my test- anything related to renal issues, diabetes, COPD, cardiac disease, cranial nerves and functions, TURP, hip/knee replacement surgery, sickle cell crisis, Diabetes insipidus vs SIADH, therapeutic levels of digoxin, lithium, aminophylline and theophylline as well as potential interactions with each. And what you want your PT and PPT times to be in relation to the control. That's over a dozen. It seems easy enough when I type it out but with each subject it's real easy to go down the rabbit hole and get lost to the point you can't see the easy answer for what it is. And can I tell you how badly I want to take the baddest, brightest red pen to the study guides and copy edit every extra 'and' or 'an' or 'as well' but I don't because I hope to sell them once I've passed. I have all these free days until I test (I'm still awaiting my 'approval to test' because everything nursing school & NCLEX related seems to be a fucking mind game, I guess this is how they weed out those that will go crazy on difficult patients from those that will handle it -Me, I'll just beat myself up in the privacy of my own home and vent under a pseudonym). But it's not like I can really enjoy this time off because I need a job and health insurance by January and that's all dependent on passing NCLEX. So as much as instructors stress how important this test is yet, in the same breath, say don't lose sight of NCLEX just being a test, well it winds up being a lot more than that for me. I'll be so glad when I've successfully jumped through this hoop and can get a job. Really. I promise to stop my complaining. Okay, truth be told, I'll keep griping about my increasingly painful lower back and hip that are making me feel like my late grandmother, at least until they stop hurting all the time.