Final Stretch

It’s hard to believe that there is only one more week in this semester! It really flew. I had a great experience shadowing an ortho doctor last clinical; his residents were funny. As a massage therapist I know a little more about bones, nerves, and muscles than the average nursing student and I was amused when I asked the doctor’s fellow a question about the ramifications of amputation on the origin and insertion of thigh muscles and the man tried (kindly) to dumb it down for me so I could understand! I disabused him of a few things and we got on famously after that:) The fellow was asking the residents questions about what nerve came out superior to the piriformis and what it innervated and what the leg actions relating to it were and I was able to answer before one resident could fumble his way through-and got it right!!

I did make a pretty stupid mistake however; the fellow had asked me to hold a patient’s arm while it was casted, which I did…WITHOUT GLOVES! Needless to say, I had sticky, gunky cast glue all over my fingers for hours until I got home and used WD-40 to scrub it off!

The other experience with the wound care nurses at another hospital I am much less enthusiastic about. These nurses were rude and careless, refused to explain procedures, and got their kicks out of making us feel inadequate. Oh well, bound to be a few rotten apples!


Class,Generation Gaps, and Apologies

Recently we had a large, rather messy blow-up in my family. Things were said and done that created a sizable, possibly irreparable rift between two family members. The problem is that the younger of the two involved, who married into this clan is not aware of what constitutes a formal, respectful apology. The older of the two is very proper and although a significant coolness and pointed politeness has accented his conversation when in the younger man’s presence, he is consistently courteous. The younger man seems to be unaware of his lack of proper apology. A few days after the incident, he telephoned the older man and said he needed to talk to him but didn’t want to do it over the phone and could the older man come over to his house. This upset the older man, who felt that he shouldn’t have to take a trip to recieve his apology so he declined with rather killing politeness. Since then, the younger man considers the subject closed. The fact that the older man is unfailingly polite when they meet apparently led him to believe that any past problem has been, if not resolved, at least swept under the rug, which is how the younger man’s family deals with blow-ups. The young man has done everything that his people do to make something up to someone; he thanks the older man profusely for any small assistance that would normally just warrant a casual “thanks”, he makes certain to speak to him politely each time they meet, and has tried to “show” that the incident will not reccur by his actions. The problem came up again because the younger man is expecting a substantial amount of money and wants to take the whole family out to an expensive dinner. The older man says he has yet to recieve an apology from the younger man and while he will not be rude when they meet, he is not willing to be treated to dinner by this man at this time.

My problem is this; how do you show a person how to properly apologize without rubbing his upbringing in his face?

The way I was raised dictates that I be polite and respectful to my elders, apologize promptly and face to face, as well as ask the offended person what I could do to rectify the situation.

I understand that some people were not raised this way, and on some level I feel that the older man, being aware of the differences in upbringing, should take into account that the young man lacks polish in some areas and that he should be held to a lower standard than someone  reared in polite society.

Reading my last sentence made me cringe because I hate class snobbery and elitism. That said, there is an undeniable difference in etiquette between cultures, races, classes, and generations that cannot be disregarded.

If anyone has suggestions or comments, I would greatly appreciate them as I am at a complete loss  in this situation.

Lunar Madness

I have come to the conclusion that yesterdays happenings were directly related to the fact that the moon is almost full. I’m back at my favorite study spot today, and so far I’ve been accosted with a request to look up whether Heinz Hall is hiring or not (by a little lady with multiple scarves and two knit caps), had the gentleman at the next table loudly discourse on the fact that the phrase “whatever works for you” doesn’t work for him, and finally, a man who came in, stood in front of the counter for about ten minutes laughing at absolutely nothing and then left abruptly. I shudder to think of what the Presby ED looks like right now and am extremely glad I have not yet graduated.

Healthcare Workers Chart The Darndest Things

The following statements are said to have been written by various health care professionals, and found on patient’s charts during a recent review of medical records.

“The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately.”

“The skin was moist and dry.”

“The patient had waffles for breakfast and anorexia for lunch.”

“I saw your patient today, who is still under our car for physical therapy.”

“The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.”

“The patient was to have a bowel resection. However, he took a job as stockbroker instead.”

“When she fainted, her eyes rolled around the room.”

“By the time he was admitted, his rapid heart had stopped and he was feeling better.”

“Patient has chest pain if she lies on her left side for over a year.”

“On the second day knee was better; on the third day it had completely disappeared.”

“Patient was released to outpatient department without dressing.”

“The patient is tearful and crying constantly. She also appears to be depressed.”

“Discharge status: Alive but without permission. Patient needs disposition; therefore we will get Dr. Blank to dispose of him.”

“Healthy-appearing, decrepit 69 year old male, mentally alert but forgetful.”

“The patient refused an autopsy.”

“The patient has no past history of suicides.”

“The patient expired on the floor uneventfully.”

“Patient has left his white blood cells at another hospital.”

“Patient was seen in consultation by Dr. Blank, who felt we should sit on the abdomen and I agree.”

“Patient has two teenage children, but no other abnormalities.”

“Patient’s history is insignificant with only a 40 pound weight gain in the past 3 days.”

“The patient left the hospital feeling much better except for her original complaints.”

“She is numb from her toes down.”

“While in the ER, she was examined, X-rated and sent home.”

“Occasional, constant, infrequent headaches.”

“Patient was alert and unresponsive.”

The Penny Trail

So, here I am once again at the 61c cafe, studying. Typically, nothing very interesting happens here. Customers come and go with their coffee and their textbooks and laptops in a steady stream of humanity. But tonight I saw something so intriguing that I had to stop and blog!

I had just gone out to stretch my legs and give my poor soggy brain some air when a man walked past with an enormous black garbage bag that jingled with each stride he took. And from a small hole somewhere in that bag, a slow trickle of pennies clinked out, rolling neatly down the sidewalk behind him. He would glance down occasionally but did not break his stride and eventually vanished from sight. I assume he was headed for the Coinstar machine in the Giant Eagle.

That was certainly strange, but ok, maybe he had so many pennies that he wasn’t concerned about a paltry few 2000 or so.

Then, up and down the street, I began to be aware of people stooping to pick up the errant pennies. People crossed the street, changed directions, and called to friends. People used their cell phones, transferred things to other pockets, all scurrying around bending and stooping…like pigeons after breadcrumbs. Business men with brief cases, ties loosened, hunted through the dusk for change. Mothers with children in tow were juggling grocery bags while they demurely dipped to secure a couple of extra cents. The children themselves ran shrieking gleefully after the “candymoney”. An older gentleman, scooping pennies up in the middle of the street where the pennyman had crossed used his cane to push a few toward the sidewalk where he could safely get them. Cars were slowing, puzzled drivers rolling down windows and gawping at the generally staid Squirrel Hillians scramble up and down the twilit street in search for change.

As for me, I was fervently wishing for my digital camera.

The pennyman did not come back and I finally made my way back into the cafe to hit the books but I will never forget the weirdity of tonight and the way the people moved, like a dance, after the loosed pennies.

Coffee Cram Number 2

Sitting at the 61C again on an absolutely gorgeous Sunday where the snow is noisily melting outside and the sun is blindingly glancing off the few remaining icicles decorating the Murray Avenue awnings. I have my second exam on Monday and I should be reviewing renal and thyroid function right now. George is at home with Sage and he called to tell me he was going to pack the baby in the backpack carrier and take him out for a walk. Sounds divine!

George was away at the cottage this weekend with his friends (all guy weekend trip) and just came back this morning. I’m glad he had a few days to decompress…boy could I use some! I miss him when he’s gone–the bed seems much too big, even though when he’s home I complain about how he sprawls and hogs the covers.

Back to the dreadful thyrotoxicosis and tubular necrosis flashcards! If I don’t post by Monday night, you may all assume that I had to retire from nursing school in disgrace, after recieving the lowest grade in history!

Wish me luck!

Sliding to Clinical

When I woke up this morning, the world was one enormous sheet of ice. Very pretty I thought, as I got ready for clinical. Twenty minutes later, as the car slithered and swerved down the third completely un-salted street, I was making futile bargains with the goddess: “I swear, if I could just get to the hospital in one piece, I’ll volunteer at the soup kitchen, I’ll compost this summer, I’ll only buy organic!”

Getting to the hospital, I breathed my thanks and staggered inside. Two people ended up calling off because of the ice. As for me, I spent all day squishing around in my soaking, icy nursey shoes, feeling my toes slowly prune up.

After clinical, I got soaking wet waiting for the shuttle to school and in desperation, went and bought some flannel sweat pants, an oversized tee shirt, and a pair of ridiculous rainbow socks that proclaimed that they were “My Lucky Socks”. None of these items even remotely went together and I got some extremely odd looks from the staff at school.

I’m finally at home now, just said good night to my little sister and her zoo (she has only two boys, but I swear they multiply when I’m not looking) and now have some space in which to breathe.

Today was one of those “shoulda stayed in bed” days

Unnatural Mother

I love my kids so much.

This may not sound like such a surprising thing until you know that I can’t stand kids.

When my daughters were 3 and 1, they were noisy, unattractive, demanding, time-consuming little people and it took everything I had in me not to smack their little heads together and run away from home. Their sticky hugs and kisses, which most mothers seem to find so endearing, set my teeth on edge. I had to force myself to be demonstrative and affectionate when I really felt exasperated and even repelled.

Thankfully, as they get older, the feeling is passing into respect and genuine “like” for the people they are becoming and I now know that I am capable of lying well enough to this new “bundle of joy” that he will never suspect (until he stumbles on this blog) what an absolutely unnatural mother I am. My secret is out to my eldest daughter though. She is thirteen now and sees everything. I was on the living room couch cuddling the baby and crooning nonsense at him while he drank his bottle when she came in, watched for a minute and said, “you don’t like babies much, huh mom?”.


Believing is seeing

Why is it that as nurses we are so quick to label people? The Frequent Flyer. The Drug Seeker. The Whiner. When you see a patient do you see them, or do you see what the previous shifts nurse saw? Did he/she see the patient, or did someone else or the patient’s chart tell them what to see? Let’s look at these “problem patients” one at a time.

The Frequent Flyer

O.K. So the frail older lady down the hall has been admitted to this floor 15 times in the last year. Maybe she has a complicated disease process, maybe she likes the decor, or maybe she lives alone, is a widow with no grown kids and no friends and the hospital is just where she gets a little TLC. Whether it’s one of the above or something else entirely, she doesn’t deserve to be ignored or have her complaints of pain shunted aside. And before some exhausted full time RN jumps down my throat….yes, I do, to some extent “know how it is”. I’ve been a CNA for over 10 years and have seen my share of all of the above. It IS frustrating if you let it be. Sometimes you have people that “really” need the care and this lady is “just taking up space”. Here’s my ten cents: loneliness, neglect, and depression can make you sick. Staring at the same walls for months on end can make you want to end your life. I’m not saying we should spend tons of extra time on this patient, just equal time. Every patient deserves equal care…and if this patient gets treated warmly and compassionately, she’ll probably be less likely to blow up the nurses station with her call bell!


The Drug Seeker

That guy that asks for his dose of pain meds at least an hour before they’re due. It could be breakthrough pain, but you know better because he looked homeless when they brought him in, because he said he used to do drugs but not anymore, because his wound isn’t really that bad and can’t hurt as much as he says, right? Yeah, sure, it could be one of those. Who cares!? How is it any skin off a nurses nose to administer what’s prescribed, for a patient who says he hurts? So he wants you to push it fast…sorry buddy, have to do it this way…but why worry about his addiction, real or imagined. Addicts have pain too, it’ll keep him from calling you every 2 minutes if he can’t feel it, if he builds a tolerance…wait, will he really be here long enough for that to happen?…and if he is, can’t he be weaned off slowly once the pain gets better?

The Whiner

We all know and love this last one. It’ll usually be the biggest, toughest-looking guy on the unit but he sobs for his mother if you even look crosseyed at his sutures. Don’t we all get a perverse satisfaction from lurking in the hall outside his door so we can hear everything while the poor resident debrides his wound! Pain tolerance is a funny thing, isn’t it? The tiny old lady that won’t call for pain meds no matter how much it hurts and the big biker-dude who wants them for a hangnail and faints at the sight of his own blood!

Each of these patients has come into my life in one form  or another. Sometimes the personality diagnosis was right on, and just as often it was completely off base. I’ve learned to take each patient as they come, without the stigma of what their chart says or even what the night shift thinks. Yes, I listen to the report…and then I forget it, go say hello to the patient, and let them show me who they are.

Clinical Woes

This  morning, I entered the clinical unit confidently, listened to report, alerted my nurse that I would be providing care for one of his patients, and jaunted off to introduce myself to my patient….The day went quickly South from there.

My guy was 70 years old with about a hundred tattoos. He had returned to the floor after an I&D for a pretty stinky incision that didn’t do well after his cervical spine surgery. He was a pleasant guy and we got on just fine. I held his hand as he got his PICC placed and when they ended up having to retract it. I provided all the AM care and got his meds ready and everything was ok until I had to hang a bag of vanco. Now, I’ve had that Alaris training and have even hung a few bags before but it seemed that over my recent Yule break I had lost whatever minor skill I possessed with the stupid machine and fumbled my way through the entire process, with my clinical instructor standing behind me very patiently indeed and calmly walking me through the bits I was screwing up. First, I didn’t spike the bag fast enough and there were tons of air bubbles all through the line. Then the damn dolphin (an electronic, supposedly time saving, safer way of documenting meds, which hardly ever works properly, even after you wait for it to boot up—can you feel the love?) wouldn’t register the med and I pressed the little buttons until my instructor took pity on me and punched the right one for me. I breathed a sigh of relief and resolved not to let it bring me down. A few hours later, my patient’s pump started screeching. Air in the line (silence…restart), occluded something or other (straighten patient’s arm, silence, restart), BIG BUBBLE over an inch long followed by two more…YIKES (clamp line and yammer incoherently to my nurse until he followed me into the patient’s room to see what I was on about)…and so on. Then I tried to empty a wound vac that was not designed to be emptied and to ice the clinical cake I forgot how to chart a couple of things. When is it that you lose the inept feeling and really start to get it?! At the end of every semester I’m bored and certain that NOW I’ve gotten confident enough that even in my mistakes I will gracefully and calmly ask for help and not repeat retarded moves from previous terms….and at the start of every semester, I feel…well…retarded!

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