Networking

My wife and I attend a good sized church--about 10,000 members. It's big enough that we felt a little lost for awhile, and were torn about attending there at all. That is, until we got connected with a small group, and that made all the difference. But that's another post.

It turns out that our small group is led by the facilities director at the church, so we're often privy to a behind-the-curtain glimpse of what's going on. Considering the number of people on the church campus every Sunday, my friend decided it might be a good idea to have an emergency medical response team put together. In the process of recruiting volunteers for this team, he met a CRNA. Of course my friend mentioned that I was hoping to go to CRNA school in a few years, and the CRNA asked him to give me his email address.

I emailed the guy, we exchanged phone numbers, and I finally got to talk to him on Monday.

He spent about 30 minutes on the phone with me, answering all my questions about CRNA school, the CRNA job market, where he thinks the future for CRNAs will go, etc. Back when I was contemplating medical school, one of the biggest reasons I let go of that dream was the responses I got to the question I put to most of the physicians I'd interact with: "If you had it to do all over again, would you still choose to go to medical school?" Rarely did I get a physician tell me, "Yes, absolutely." And when they would say yes, it was always with qualifications or reservations. Mr. CRNA answered unequivocally that yes he'd do it again, no reservations. He loves his job.

I cannot even begin to tell you how much peace of mind this gives me. This is a running theme I've noticed with nearly every CRNA I've met. They're funny, engaging people that are a blast to be around. My guess is that it's because they're HAPPY. Nurse friends, tell me how many docs that you interact with, you can just tell they're HAPPY.

Anyway, back to the story. It turns out Mr. CRNA is not only a CRNA, but he owns a private practice that staffs two day surgery centers. But more than that, he is also a regular lecturer, at the school I want to attend. With. friends. on. the. admission. committee.

I have never met the guy, but he has already told me that if I do the work to get an interview (grades, work experience, GRE score) he'll sit down with me and help prepare me with actual questions the committee might will ask me. Then if he feels good about that, he'll call his admissions committee friends and drop my name.

Oh, and he wants to get together for lunch in the meantime.

God is good.

PS: No word from the externship hospital, yes, or no. Beginning to wonder if it was an organization I actually want to be a part of in the first place.

Disappointed

Things aren't looking good for getting into the pediatric externship. I was told that they take 2 applicants from each school, and 2 of my classmates have gotten phone calls. I called this morning and was told that there are only a few spots that haven't been offered yet, and that they were hoping to offer those to people out of the area. But she said she'd look at my file again.

I'm a little confused. I had a really great interview. I was told, "We really like our male externs, the patients respond really well to the males. We're extremely interested in you, so if you get an offer from another hospital before you hear from us, please give me a call before you accept, here's my direct number."

Of course, thinking about it now, the HR people aren't who make the final decisions anyway, so I imagine her words didn't hold as much water as I was hoping.

Everything seemed to be pointing that I was headed down the right path--the positive interview, an unsolicited yet amazing letter of recommendation from my pedi instructor.

I do know that the two girls from my school that got the externship both know someone there, so I'm sure that certainly didn't hurt their chances. I think it really does come down to relationships in the end, and I guess I just didn't have the right relationships in place.

This is a pretty major setback to my PICU dream--there's only two pediatric hospitals in town, my wife works in the PICU at one eliminating it from my choices, and I just got rejected by the other. It doesn't look good.

I guess I'm going to have to find a way to be ok with that.

Demented Curmudgeon

I first met Mr. Jones* several months ago when he was admitted to our unit from an Alzheimer's home with severe dehydration. His lytes were all over the place (along with accompanying dysrhythmias) and he was severely anemic. We patched him up and sent him up to the floor, but not before he earned a reputation here in the ICU.

There's pleasantly-confused dementia, and then there's the-world-is-out-to-get-me-and-I'm-taking-you-down-too dementia. Unfortunately, Mr. Jones fell into the latter group. Bad enough was his constant profanity-laced muttering under his breath. But he quickly earned a reputation for taking hostages by violently grabbing arms, hands, whatever was in reach, and not letting go. Sometimes his steely grip could be peeled back finger by finger, but more often it required getting on the call bell and pleading for reinforcements and rescue.

I remember being struck by the juxtaposition of his violent tendencies and the tender devotion of his wife. She was there every single day for morning, afternoon, and evening visiting hours. Knowing full well he must have been a good and decent man to deserve such loyalty, I remember thinking how unbearable it must be for her to sit by day after day and bear witness to the slow corruption of his mind and character. There were moments of crystal clear lucidity, and honestly I think they were worse than the dementia--because she had her husband back for one brief instant. She never knew for how long--sometimes long enough to reminisce. Sometimes only for the breadth of an "I love you."

After he was transferred upstairs, I'm not sure if he was ever discharged from our hospital or not. But I do know at some point he came down with pneumonia, ended up intubated, and right back in our unit. He's trached now, and vented. He can't talk, and his mentation has deteriorated to the point that he's mostly unresponsive, constantly agitated, and generally belligerant.

Today was a super busy day on the unit. We're full, and with sick, sick patients. From hepatic encephalopathy to CVVHD on a post-op CABG patient to a 232 kg woman bouncing between Mobitz type 2 and 3rd degree heart block.

As shift change approached, I was making my rounds helping reposition patients one last time. The last bed on my tour happened to be Mr. Jones, and as we got him turned he opened his eyes, looked me square in the face, and grabbed my arm. He's much weaker now and I had little trouble pulling free of his grip. When I did, I noticed he was more agitated after I let go. Putting my hand in his to hold onto seemed to calm him.

I sat down in the chair next to his bed and held his hand. He drifted off to sleep fairly quickly, much to our surprise. But each time I'd try to extricate my hand, he'd wake up and become agitated again.

And so I sat, holding his hand, letting him sleep. My shift was supposed to be done at 1915, but I stayed until 2000 when his wife returned for evening visiting hours.

It was just 45 minutes, but it was more than long enough for this indelible truth to reveal itself--that even in the midst of a completely demented hell, the human soul reaches out, grasping, searching, yearning to know. To know simply that we are not alone.

Thank you Mr. Jones for taking time out of your day to teach me this profound truth.

*Of course Mr. Jones isn't really named Mr. Jones.

Nursing Self-Dx

Overwhelming anxiety r/t waiting to hear about a pediatric summer externship program AEB short temper, excessive flatulence, and clumps of hair falling out.

They SAID they'd make a decision on April 15. They SAID if we got into the program we'd find out the 3rd week in April. They SAID if we weren't selected we'd get the obligatory up yours courtesy email by the end of the month.

It's definitely past April 15th. And we're almost done with the 3rd week of April. And the end of the month is approaching with all the delicacy and grace of a speeding 18-wheeler...

My phone simply refuses to ring. Every text message that vibrates sends me scrambling for my phone. I've nearly caused 2 wrecks on the highway trying to get the damn thing out of my pocket.

Don't think I haven't been obsessively checking for celebratory announcements on the Facebook pages of people I know who have also applied for the program.

This program is such a huge stepping stone, I can't even begin to explain. This is THE hospital I want to work in, and this is my chance to impress the unit I want to work on, the staff and managers. It's practically the only way to get hired into this fabulous hospital as a graduate nurse. Especially to the unit I want to work on.

The wait is literally giving me an ulcer.

No Report

I am a nurse extern at a medium size regional medical center just a few miles from my house. My home unit is the ICU, and I love it. The hospital is only 3 years old so everything is new, and it is in fact a beautiful building--gourmet chef to boot. The ICU is only 16 beds, but we do get our fair share of cool stuff. There are several heart surgeons who do surgeries, and our cath lab is super busy. About the only thing we don't see is major traumas--which in all reality is just fine by me.

One Saturday we got notified by the house supervisor we'd be getting a transfer from the floor. The patient was hypotensive (70s/30s), bradycardiac (low 40s), and her last blood sugar had been 28. My preceptor was the nurse open for the next admission, so the patient would be ours. I began setting up the room for an incoming patient and my preceptor did a quick look-in on our other patient while waiting for the floor nurse to call report.

No sooner had we turned our backs, then guess who came rolling through the door--without calling report. The floor nurse was in a dead panic, you could see the shell shock in the glazed look in her eyes. Even the transporter was sweating.

And the patient?

Well this sweet woman in her 80s smiled sweetly back at me from her comfortable hospital bed, and gave me a little half wave.

"Uh...how are you m'am?" I ask, more than a little incredulously, turning to look at the floor nurse.

"Fine!" is the response I got.

Now, I'm just a nurse extern, but super critically hypotensive, hypoglycemic, bradycardic 80-something-year-olds don't grin and say "Fine!"

We got her into the room, got a set of vitals and a blood sugar. Her pressure was 100s/60s, her HR was low 50s, and her sugar was 88. As I'm entering them into the computer I notice that these values are pretty much consistent with where she'd been running since she'd been admitted a few days ago. I also noticed that if the scary findings had been retested to verify, they certainly hadn't been put into the computer. Even more importantly, nothing had been done! No volume, no atropine, no D-50. Nothing.

Not sure why the floor nurse panicked quite so badly, but needless to say she was more than a little sheepish as she was finally giving report to my preceptor, and then quite defensive once she realized how silly she looked.

Meanwhile, the patient was prattling on about her 3 kids and 246 grandchildren, happy as a lark.

She got transferred back upstairs by the end of the shift.

10 Things I've Learned In Nursing School

I stole the idea for this post from my friend Tiffany.

1. Flexiseals rarely, if ever actually seal.

2. Propofol, Ativan, Zofran, and Levophed are amazing drugs. Digoxin isn't nearly as scary as instructors say. And Tylenol may just be one of the scariest drugs on the market.

3. Boobs are just boobs. Everyone has them. Even a lot of men.

4. Genital warts can look a lot like smegma, and most patients don't enjoy having them scrubbed off.

5. The number of letters behind a name is a poor predictor of intelligence or empathy.

6. The real psych nursing doesn't happen on the psych floors.

7. It's truly amazing how much clean linens and organized lines and tubes will improve a patient's condition.

8. Nurses rarely eat their young if you always look them square in the eye. And ask them what you can do to help them on a regular basis.

9. Sometimes 90 minutes of chest compressions isn't enough, and sometimes a single chest compression is too many.

10. It is an utter privilege to be present for first and last breaths. It's during the breaths in between that you hope to make a difference.

Yes m'am, I am a boy...

This semester, Senior 1, is the semester I've been anticipating from the day I stepped into orientation. In this semester we have both pediatrics and critical care classes and clinicals. Since I want to be a pediatric critical care nurse, perhaps you can see how this semester might just float my dinghy.

Peds class and clinical was during the first half of the semester, and critical care is all semester. My clinical instructor for peds usually had to drag me kicking and screaming from the floor when it was time for post conference. And the day I got to spend in the pediatric ICU? Don't think I didn't skip lunch and show up to post conference 20 minutes late. Critical care? From day one it's been pure greatness. I was lucky enough to be assigned to a CVICU in a large hospital in a large metro area. My first 15 minutes of my first day of CC clinical went a little like this: "Here's some towels, a sterile dressing kit, and a suture removal kit. The doc is in room 6 waiting for you to assist him in removing the patient's chest tubes." And it hasn't really slowed down since.

All this to say that even if I sparked out today, I'd go a happy and fulfilled nursing student.

But...

Remember how I said peds was the first half of the semester? That implies a second half of the semester (see, critical thinking skills--where would a nursing student be without them?!). And in that second half lurks...

OB.

Oh let me count the reasons why I dread this class and clinical.

First, it's more likely I'll sprout wings and fly off to Neverland than ever become an OB nurse. Ever.

Secondly, I've already experienced the miracle of birth. Live. In person. Three times. Once with each of my children (eh, more critical thinking skills!)

Thirdly, I happen to have some pretty strong opinions about what a low-risk birth should look like, and those opinions don't really mesh well with traditional nursing school OB practices.

Fourth(ly?) even being (or especially?) nurseXY I am actually fairly comfortable with the female anatomy, all extra plumbing aside.

But the very number... er... Five... reason I hate this class? My female classmates think it's just the funniest thing in the world that we're talking about breasts. And nipples. And, *gasp*, vaginas. And I'm, *giggle*, a BOY. I mean, they are literally giddy with the supposed hilarity of the situation. And it drives me UP. THE. WALL.

3 weeks, and done.

Seriously, this must be what a 37 week gestational mom must feel like. How's that for empathy.

The Beginning

Well, this is the beginning.

It occurred to me today that in exactly 8 months from this day I will be graduating from nursing school. It feels so far away, like a distant mirage shimmering on the horizon, but the road behind me is far longer, and more treacherous. So many hours of class, days of clinical. So much worry, stress, fear. So many new experiences, successes, and confirmations.

My experiences as a male in a vastly female dominated profession range from silly to downright scary, with the full spectrum in between.

For the most part I think I'm better for the journey.