When Nurses Harm Their Patients

I've had to deal with this head on in a couple of situations over the last week.

Scenario 1: (By word of mouth, but from a couple different sources that were highly corroborative.) Patient goes in to deliver baby, ends up heading to the OR for a C-section. Sometime after recovery, nurse draws up a dose of insulin, has a coworker cosign the dose, and administers it to the patient. The patient? Not a diabetic, and the wrong patient completely. The "dose"? 100 units, and the wrong dose. The patient's blood sugar? 3 mg/dl. Patient in a coma, nurses both fired.

Scenario 2: My patient at work. In for acute renal failure, 6.9 pH. Most likely septic shock--pressures 80s/50s while maxed on dobutamine, vasopressin, and norepinephrine, lactic acid over 13, anion gap 47, H&H was 7.2/24, zero bowel sounds, frank blood from the OG tube. Dead gut? Patient is vented. Past medical history reads like a patho textbook--100 year pack history, COPD, diabetes, CAD (s/p CABG), PAD, hypertension, hyperlipidemia, etc, etc. The patient was sick, sick, sick. Throughout my shift we'd managed to keep her stable enough. Minimal sedation, and minimal bucking of the vent--we were able to calm the patient by talking to her and repositioning. The night shift nurse comes on and receives report. Her first question is inquiring about what we've been using for sedation, and when she hears, "Nothing," she runs off muttering about how she wasn't going to have her patient bucking the vent all night.

Minutes later she comes back and says, "The patient has an order for propofol, I'm going to hang it."

My preceptor and I both freak out, saying, "With a pressure like that?"

She replies, "It's ok, I have pressors."

"But you're maxed out on all three of them!!"

I was actually planning on staying several more hours, but it wasn't very long before that nurse did indeed hang the propofol. I left, and went home.

I stopped in to work a couple days later and inquired about the patient. The patient coded and died that night. It seems her pressures bottomed out, and they couldn't get her back.

Scenario 1 just leaves me in awe. I hear she had to use two syringes to draw that dose--wouldn't that kind of trip the double-check-o-meter right there? And the nurse that "cosigned"? Oh my. I'm so going to be the un-cool nurse that demands to see the syringe and vial both when cosigning medications. I think that most people think that that procedure is in place to catch those newbie nurses with no experience that are bound to screw up. To me, those nurses aren't the ones to worry the most about. The really dangerous situations are when the nurse is experienced, and a level of trust has developed with coworkers. "I'm busy right now, but go ahead and give it and I'll cosign it later." And then some shift, just like any other shift, an experienced nurse makes a silly mistake and someone gets hurt, and the procedure has been worked around and failed. I believe the safety policies are most importantly in place to catch mistakes of that nature.

Scenario 2 frustrates me. The patient was clearly very sick, and quite probably was going to die. But I can't help but wonder if her death wasn't hastened on by the administration of a drug that is known to drop pressures, often precipitously. But what should one do when faced with such blatant disregard for critical thinking or patient safety? Who do you report things like that to? Do you report it? What happens when you have zero trust in the staff person you're handing a patient off to, or getting a patient from? How do you protect your patient and yourself in situations like that?

Any of you with more experience care to comment?

This and That

Several months ago our family lost a long time member and friend. Bo was as much a part of this family as any of us, and losing him so suddenly to an aggressive mast cell tumor was devastating. We miss him very, very much. It wasn't long before the kids started asking for a new dog, and I was surprised to realize that I was ready much sooner than I anticipated. And so we found ourselves on a hunt for new furry friend for our family.

Bo was huge, so walks in the neighborhood meant having to choose between the kids and the dog, and far too often he got left at home. Not to mention the sheer physical space a 95 lb dog occupies in the house. He was fantastic with the kids, but an inadvertent misstep was toe crushing. That in mind, this time we thought we'd like something a little smaller, but still sturdy. Not shedding a fur-baby every few days was another entry on the wish-list. Most of all, I just wasn't sure that any other Golden Retriever would ever live up to the memory of such a remarkable dog as Bo.

The breed that seems to fit all our criteria is the Scottish Terrier, and so I started reading about Scotties. As one of the oldest breeds in the AKC registry, it's even more important to buy from a reputable breeder to avoid congenital issues. I made some contacts and did some networking, and I'm happy to say that we have found our new puppy.

Miss Maggie (a good sturdy Scottish name) is a black female Scottish Terrier bred from two American Major Champions, and is every bit as Scottie as they come. She'll be coming home on my birthday in a few weeks. We're super excited, and we're already planning a little brother for her, we'll name him Wallace (after none other than William Wallace of course), in a year or two.

In other less exciting news nurseXX and I have started a C25K program, and I'm really hoping it sticks. Because quite frankly I'm tired of being fat. It was a post by my friend Running Wildly that really motivated me to get off my duff and try this. I've only done the first workout of the first week, but it went much better than I expected which was nice for once. There seems to be much success around this particular program, so that's encouraging. Our best couple-friends have been running together for about a year now, and it will be fun to register for some races together.

Believe it or not, I was actually quite the runner in high school, running track and cross country. I was middle distance runner and wasn't too shabby. But now that I'm so flabby, things are looking a little different. You should hear the treadmill whine (and grumble, ha!)--not exactly what John Parr had in mind I'm sure--but I'm definitely a man in motion...

Roots...Alfalfa Roots That Is

Inspired by this post over at Call Me Nurse, I thought I'd do a post about where I grew up and where I learned my work ethic.

I grew up on an alfalfa farm in the high country of the great American Southwest. Most people, upon hearing where I'm from imagine barren desert with nothing but cactus and rattlesnakes, but that couldn't be farther from the truth.

I grew up in a valley where three rivers join together before finally contributing to the mighty Colorado River on its journey to the West coast. The rivers afford irrigation, and the soil is surprisingly fertile given the arid conditions offering excellent growing potential. Even though our family farm was in a valley, the elevation was still 5300 feet above sea level. Not terribly high for most mountain folk, but high enough to shorten the growing season, temper the summer heat, and put us firmly in the snow zone.

The town closest to the farm was originally founded for agricultural purposes, and it's as evident as its name. Apple orchards, wheat fields, and hay farms dotted the countryside, clustered around each of the three rivers. The county fair is the biggest in the area and has barn after barn of agricultural goods and livestock. But the economic focus of the town has shifted. Oil was discovered, coal, and natural gas in the coal seams. The town is now a dirty little oilfield town, and the tempestuous energy industry has left its ugly mark with its booms and busts. It's the reason I highly doubt I'll ever live there again.

The farm itself was homesteaded by my great-grandfather and great-grandmother. My grandfather grew up and died in the same room in the same house on the same land. The farm used to be quite large, but through selling pieces off in hard times and the highway right of way cutting the farm in half and making it difficult to get from one piece to the other, it's been whittled down to only about 60 acres.

It wasn't always an alfalfa farm. In the early days it was a working dairy farm, and there are still remnants of that former personality still on the property. A milk house with a trough down the center lengthwise cut into the concrete floor to water the cows while they were lined up to be milked. A stray milk can here and there. And a concrete block ice house to chill the milk while it waited to be transported to the local dairy.

My mother tells of drinking raw buttermilk from tin cups as a kid, and I have very distinct memories of the same brightly colored tin cups when I was a child. In fact, those tin cups are on my short list of things I want from the estate now that both my grandmother and grandfather have passed on. It was in this kitchen that I learned how to cook on a gas stove. I learned that you don't stick your bare hands into Grandma's dishwater for risk of scalding yourself. What you can't see in this picture is the vent over the stove that my grandmother crawled up to unscrew the cover from so that Santa would have a way to get inside for one of the earliest Christmases I remember at Grandma's house.

I was born in a Navy town in California, and that's the reason my parents were there to adopt me. My dad was in the Navy, and when he got out after 21 years, my family moved back to the family homestead. It was then my days turned from lounging about SoCal learning to ride my bike in the cul-de-sac to the harsh reality of life on a working farm.

During the summers we worked basically from sun-up to dark-thirty. School was a welcome respite. While my friends in town were having swim parties and sleepovers I was stuck out in the field setting water for irrigation or in the garden weeding. This isolation meant I had few no good friends outside of school. Even the people I hung out with during school were just superficial acquaintances. I think it's part of the reason my junior high and high school years were so awful for me socially. I was more at home with the shovels and hay bales than with people my own age. And it showed.

I resented having to work so hard all the time. It's definitely affected my work ethic. When things are slow, or it's my choice to start work or not, I often find myself unwilling to begin. I feel like I need time to do my own thing every day or I start to rankle against the workload. That's tough when you're in nursing school, working, and watching the kids while your wife is at work. I get fed up at times, and I know it sounds selfish, but I need my ME time. I never had any ME time growing up. In some ways I feel like my childhood was stolen from me. The flip side of that coin is my work ethic when things are really busy--and there I shine. I know how to work hard, been doing it for years, and it's ingrained in who I am.

There is value in my childhood though. I learned to cook, because cooking dinner meant you got to go inside an hour earlier. I have great amount of physical strength for my size, even now, years later. I imagine it had to do with having to learn to toss 200 lb hay bales when I only weighed 140-150. I've been driving farm trucks and tractors since I was 9, so drivers ed was a cinch. I know an enormous amount of information about a myriad of things because reading was my escape from the isolation of the farm. I have the knowledge and skills to be completely self sufficient if need be--so bring on the zombies.

So much of our past is who we are today, and I guess my past is a mixed bag. The high country is a harsh place. It can literally kill you if you're not careful. But there is so much beauty there too.

Don't think there aren't days that I don't close my eyes and think about the feasibility of moving out to the country and becoming a farmer again. The thing about dirt is it gets in your blood, and no amount of city living or education can wash it out. This much I have come to understand.

I think it might be a very real option after I graduate. I mean, we only have to work 3 days a week, right? What am I going to do with the other 4?

On Margaritas, Ceremonies, and Fine Fancies

The ceremony for my Clinical Excellence Award by some cruel joke was the evening after my last final. It's been tradition that immediately following finals each semester we all pile on at the nearest BAR & Grill for some appropriately "ineffective coping". This year, the last final was on Wednesday afternoon at 1300, and so not everyone was finished until after 1500. So we didn't really get to the restaurant until 1530, and I had to be at the ceremony at 1830--dressed up.

Whoever got to the restaurant first decided we were going to sit on the patio, despite the 20-30 mph and gusting wind, the ridiculous humidity, and the spring sun. But hey, at least they had $2 double-size margaritas. The first one I ordered was so weak it may as well have been (probably was) Koolaid, so I quickly ordered another. It came out with an honest to goodness brown tint from the tequila--did I mention I hadn't eaten since breakfast? As I was happily sucking down my brown margarita (served in a styrofoam cup no less), I realized my legs were going numb and I decided I better get some food. The service was so ridiculously slow it took me half an hour to get a plate of nachos. Here I am, margarita happy, and nacho poor.

Note how messy my hair is and the 3 days of final exams beard growth.

Lucky for me I have a large liver, and I was able to safely drive home with enough time to spare for me to shower, shave, and dress up. I originally thought that it was just my wife and I going to the ceremony while her sister stayed with the kids, but when I got home I discovered that everyone was getting ready to go--even her sister. I had to be there about 30 minutes early, so we all packed into the trusty Expedition and drove up to school.

I had to sit up front in the reserved section while my wife and kids and SIL sat further back in the audience. Of course my award was quite nearly the last to be given, and the kids were restless. In fact, just as I was about to go on stage to get mine, littleXX announced she needed to go potty. So, she actually missed me getting my award, but was back in time to see me still up on stage. Ah well.

There was a small reception after the ceremony, and my wife got to meet my pediatrics instructors. During that conversation it came up that I did not get the summer externship at the pediatric hospital. Of course it turns out that my instructor worked there for years, and she told me to let her know when I apply for the internship for after graduation and that she'd do her absolute best to get me hired. So very sweet of her. I'm a little scared to get my hopes up, but there is a the squirrel of excitement at the thought. It felt good to have my wife see that (some of) the instructors actually appear to like me--she's convinced that with all my prior education and often unbridled mouth that I must be a nightmare student for them.

After the ceremony, we took the kids and SIL home where she got them ready and into bed so my wife and I could have a little date night. She had a Cosmopolitan and I had a Tanq & Tonic, and we ate appetizers and dessert while we talked like two young people in love.

It was a fine fancy.

NTI

The AACN NTI conference is this week in Washington DC. It doesn't get much bigger or better as far as critical care nursing conferences go. I would love to be there. What a great conference, what a great city!

Lucky-butt nurseXX is there with 3 coworkers, on her hospital's dime, mostly.

They even flew up a couple days early to traipse around DC taking in all the sights of our nation's capitol. Saturday afternoon alone they saw the Capitol building, the Mall, Washington Monument, WWII memorial, the (empty) reflection pool, Lincoln memorial, Vietnam War memorial, and Arlington National Cemetery. Whew! She even sent me a picture of the statue of FDR's dog--a Scottish Terrier of course. (We're in the process of finding a Scottie pup, but that's another post altogether.)

She seems to be having a good time. Well, as good of a time as can be had living in close quarters, 4 to a hotel room with 3 people she's only worked with before.

But here on the home front, if you do the math:

(nurseXY - nurseXX) = nurseXY + (bigXX + littleXX + babyXY)

Which is a very complicated equation, fraught with linear regressions, multifactorial derivatives, and some operations failures.

Mostly though, we're doing surprisingly well. NurseXX doesn't return until Thursday afternoon however...

On top of that I hosted 20+ people at our home on Saturday night unexpectedly. My clinical group was having an end of semester BBQ at our OB clinical instructor's farm. Unfortunately as is bound to happen in Spring in my state, a torrential downpour turned everything into a mud bog, and her house simply isn't big enough for that many people.

That's about the number of people we host at holidays due to nurseXX's ridiculously large family (6 sisters and 1 brother + spouses and kids!) so I obliged. My clinical instructor was concerned as to whether it was OK with my wife, but I told her nurseXX was in DC, and I wasn't saving any BBQ chicken for her.

I suppose I ought to include a picture of the XY+XX children so you, my faithful readers, may ooh and aah over how cute they are.


Lucky for them they are genuinely cute, so the occasional stranger has taken pity on us.

We may survive the week yet.

Finally, Fin, Finals

School is done, it's officially summer.

My OB class went very well, ended up with one of the highest A's I've gotten to date.

In Critical Care, I was cruising along in my normal grade range, 93ish, and only needed an 84 on the final to keep an A. It was a comprehensive final, and I actually spent a great deal of time studying for it, much more than I normally spend preparing for exams. When I sat down to take the exam I felt about as confident as I usually do, but then the unthinkable happened. I had a bad day.

A really bad day.

Bad day like reading an answer that clearly said "hypervolemia" as "hypovolemia", you know, the polar opposite. Just really, really boneheaded mistakes like that.

A lot of boneheaded mistakes.

I scored an 83 on the final, and ended up with an 89.83 in the class, which my friends is a B. No rounding of grades in the ###CON, the cards lay where they fall. So yes, in the class that I've been eagerly anticipating only my entire nursing school career, I came up 0.17 short. I have no explanation. Maybe some sort of exam-tile dysfunction, or premature exaculation if you will. Stupid. ONE exam question would have made the difference.

Stupid, stupid, stupid.

I went to see my professor about it on the off chance there was something anything that could be done. Did I mention she's retired military? You can guess how that went.

Way to fumble the 5 credit hour class...

My instructor felt horrible about it. She said she went over all my test scantrons from the entire course looking for stray marks or mis-marked questions. She hand calculated my grade to make sure I was getting the benefit of all possible decimal places.

She did say that she knows of two past students that are currently in CRNA school, and received B's in her class. She said as far as jobs are concerned, A or B doesn't matter so much. C matters, but not A or B.

But it matters to me.

A post about, what else, Mother's Day

I am not a Mother. Never will be. No matter if I tried, I would never attain the coveted lofty title of Mom.

I am a father however. And sometimes it seems that's not enough in this world. The title Father bears with it the tiniest hint of incompetence.

Don't believe me?

Take a gander at any random commercial on TV that depicts a father. How are they portrayed? The bumbling idiot dad is one of the most recognizable advertising ploys in use today--second only to sex appeal itself. Most people don't even notice it's so ingrained in our culture.

It makes me crazy.

My wife works every Saturday night--she's on weekend plan at her hospital. Since she needs to come home and sleep, I take the kids to church every Sunday by myself. You would not believe the amount of comments I get "in support" of my actions.

"That's great!", I'm told, "Good for you!"

"Got the kids here all on your own? That's fantastic!"

Positive words for sure, and certainly better than negative. But why are people compelled to applaud my efforts?

There is a couple in our church small group--the husband is employed by the church and he's heavily involved in the technical aspects of the church service. He arrives quite early Sunday mornings and is busy throughout the morning with every part of the service. His wife is essentially there with their 3 children by herself. We all sit together as a small group, and not once have I heard her being congratulated for making it to church on her own with their 3 children.

Why is that?

Being alone as a father with my children in public carries a great deal of pressure as well. I feel like the kids need to be impeccably dressed. If something doesn't match, or someone is wearing 2 different socks, or pants are too small, I get that knowing look. Like I'm being given grace because I'm the dad. If my wife has my kids out and about and something is askew, it's because maybe she's having a bad day.

Or, how about if a child is upset, and inconsolable. Why of course, they "just need their mother." Yet, how is a child typically behaving when they "just need their father"? Usually a behavior problem, the result of not having a strong male role model.

I could go on about this for an entire post, or six, but that's not the point of this post.

My wife knows these arguments well. She hears my diatribe nearly every time we watch TV. She listens to me gripe when someone says something particularly insensitive about fathers, or men in general. She puts up with my fierce independence and pride in my ability to do things for my children myself.

And yet, she is a mother. She calms crying children with a sweet caress to the face. She dresses our kids in stylish attractive clothing. She balances her career and her role at home with grace and dignity. She grew my children, stitched them together in her womb while I merely looked on from the outside.

Being a mother is a special thing, have no doubt. And my wife is a special mother to be certain.

And I think know in all my righteous indignation, I forget to tell her that enough.

So, sweetie, thanks for being such a great mother to our children. They we all are better for it.

Perspective

She was young. Oh so young. And slender, graceful, and quiet. She was uncompromisingly polite, with a soft slow smile. Her long dark hair, smooth skin, and high cheekbones spoke of her Hispanic heritage. 17 years old, 26+3 weeks.

Her equally young boyfriend was there in a show of support, although he was more like a boisterous puppy to be herded about--completely immune to the gravity of the situation. Even though it was the first truly warm day of Spring hinting at the heat of summer, he wore his chic ski cap with his bangs painstakingly crafted to carelessly sweep across his forehead.

After checking in at the desk for their genetic screening and perinatologist high resolution sonogram appointment, they sat on the hospital grade vinyl couch in the waiting area together. He laid his head on her shoulder.

The reason they were in the office to begin with had to do with an abnormally high AFP level during her Quadscreen. Really high--as in if she hadn't been pregnant, they'd be looking for a tumor.

As soon as the young couple was in the office with the genetic counselor, the next patient and her boyfriend careened into the waiting area to check in. High risk because of her morbid obesity, she was so large it was difficult to tell she was pregnant at all. It was also immediately clear that her personality was as large as she was. In fact, much of her behavior bordered on inebriated. Waves of tittering were punctuated by peals of laughter that repeatedly caused all activity in the office to come to a screeching halt in distraction. Her boyfriend was with her, and we all knew it was her boyfriend because they made the best use of their time waiting by making out on the couches in the waiting area.

After the genetic screening, the teenage couple was escorted to the ultrasound suite. The young mother clambered up on the table and shyly exposed her growing belly. Because of her small frame and slender stature the ultrasound images were simply beautiful. As the tech expertly moved the transducer around scoping out the fetus, mom smiled at the sight of her baby on the monitor. The US tech did a few quick biometric measurements, confirmed that the baby was indeed a boy, and then started to look more closely for any sign that the AFP levels were more than just worrisome. It was quickly apparent by the US tech's quietness that things were not going well. Mom could tell something wasn't right, and the look of sadness on her face was haunting. No tears, just profound sadness.

Mom's sadness was well founded. The ultrasound clearly showed a laundry list of abnormalities: Placentamegaly (it was occupying a full half of the uterus), amniotic banding, a 2 vessel cord, agenesis of the left kidney, echogenic bowel, ventriculomegaly, and a neural tube defect at the level of the cerebellum.

The US tech gave a short report to the physician who then went in to confirm the findings and to talk with the young parents.

Meanwhile, the loud couple was escorted to the other US suite. Picture quality was terribly grainy due in part to mom's obesity. Biometric measurements were completed, with baby proving to be SGA, which wasn't unanticipated. The mood was downright festive as the US tech asked mom if she wanted to find out the sex of the baby.

"It's a boy, I've already decided, but you can look if you want to," she stated matter-of-factly.

"Oh, did they tell you it was a boy at your last ultrasound?" the tech inquired.

"No, I just really, really want a boy, so..."

When the baby's peri-area came up on screen, it was very clear that she was indeed, carrying a slightly small for her age, but nevertheless healthy baby girl.

The mood in the room visibly deflated like a birthday balloon. Mom began to cry. Big wracking ugly sobs. Hysterics and histrionics enough to go around.

As we left the suite to go give report to the physician, it took everything in me not to turn and say, "You know, there's a couple next door who are having a little boy, but they'd be absolutely over the moon if they were having a baby girl instead, as long as she was healthy. So suck it up and quit your crying."

Perspective people. Perspective.

Clinically Excellent

Today I got an official looking envelope from ###CON in the mail. We're a CON now, instead of SON. They tell me it's a big honor. My tuition dollars hard at work--changing every bit of ###SON letterhead to ###CON.

But I digress.

Inside the envelope was an official looking letter informing me I'd been selected for a Clinical Excellence Award for my work in my Pediatrics clinical. It isn't some huge fantastic honor--I'll only get an official-looking cheesy certificate--but it is very nice to be recognized by the faculty for my hard work.

I was chosen last semester for the Clinical Excellence Award for my Psych clinical, but I didn't get the letter/invitation to the reception until the morning of, too late to arrange childcare. But not this semester. The reception is a week from tonight. I wonder if they'll be serving martinis now that we're the sophisticated ###CON?

I got shut out my Jr I semester because my clinical instructor couldn't decide between two of us. So she just told us both we *would* have won...

It's appropriate to send a shout-out to my wife who won a Clinical Excellence Award every semester she was in nursing school--the suck up. ;)

Of course when she went to our nursing school, it was still a SON, not a CON, so I think I've got her in the end.

Labored, and Delivered

This past OB clinical was the one I was truly dreading. Labor and Delivery.

The thing about babies is that they come out of va-jay-jays. (Or at least they're supposed to.)

This is just the awkwardness I could really do without. My wife was as unthrilled with the va-jay-jay parade as I was.

My day did not begin well. The entire L&D staff dresses in hospital provided scrubs while they are on the floor--even the unit secretary. Presumably in case they get sprayed with va-jay-jay juice. Have no doubt, there is only one locker room on the floor, a woman's locker room. Thank goodness the staff restroom was separate, and had a lock on the door. After much pomp and circumstance to make sure there was nobody in a state of undress in the locker room, I was escorted in to make my selection of scrubs. XL is what I usually wear, so I grabbed a set and scurried off to the staff restroom to change. I tried the top first, and got it on easily, but when I spied myself in the mirror...

Two front pockets, and a crossover neck. It was then that I realized my hands were slowing going numb and tingly because the sleeves cut deeply into my biceps. (You should have seen the IV access popping up though.)

Next up, pants. Pretty, shapely woman pants, with an elastic waistband panel across the backside. I got them up to mid thigh before my apparently XL-woman's-hips sized legs arrested all upward progress.

I redressed in my uniform. Found an escort, obtained an official Act of Congress, and returned to the locker room to try the XXL's. The tops were the same as the XLs, except with darting in the bust. The XXL pants were so huge, the drawstring literally wouldn't draw enough to tighten around my waist.

I redressed in my unifrom. Again.

And then I was rescued by Lacey, my preceptor for the day. Lacey has been a nurse for only 2 years, but she's sharp as a tack. And lovely, and nice. And merciful. She escorted me to the hospital-wide OR, (where other boys work and they have two locker rooms, one for girls, and one for boys) to get me scrubs.

After I dressed, she whisked me off to the OB/GYN OR to witness my first C-section, and placed me in the care of a CRNA. A fun, crusty old CRNA who kept asking me questions trying to stump me. And I LOVE that! I like the challenge.

I ended up seeing 2 C-sections, and 3 epidural placements. I basically spent the day with the CRNA. In between procedures, Lacey had me palpate a fundus so I could feel what a properly contracted uterus feels like. But other than that, she summarily excused me from all vaginal checks, even lochia checks. Bless her. The only va-jay-jay's I witnessed were when I placed the foleys for the the C-section patients. And I don't know why, but foley va-jay-jay is way different than root-of-life va-jay-jay.

Maybe that makes me, *gasp*, a boy.

I'm glad it's over. My instructor is disappointed I didn't get to see a vaginal birth.

I told her, "I've seen my own 3. I'm good."

She said, "It's different when it's not your own."

I said, "You're right--it would be way more awkward."

Smartassery

So far in my OB clinical I have spent time in nursery, NICU, and post partum. Nursery and NICU were right up my alley since I want to do pediatrics. Post partum was a bust--like I was going to have an awesome experience checking fundi, and teaching the multiple underage new moms how to breastfeed.

I was truly bored...until they admitted a 2 week status post hysterectomy patient who was in SVT. Considering the post partum floor isn't a monitored floor, that little gem of an admit by the house supervisor left us all scratching our heads. The patient had already failed adenosine in the ED, but IV push metoprolol brought her down from the 210s to the 160s by the second dose. Clearly stable (WTF!?) they shipped her up to post partum(???) before giving the 3rd dose. The nurses I was working with were clearly excellent OB nurses, with years of experience between them. But when faced with a CV patient, it was clear I knew about as much about OB as they did about abnormal heart rhythms.

The nurse was about to just push the metoprolol (without knowing what it was!?!) when I said, "Umm...I don't know if it's a real world practice or not, but our books say the patient has to be on a monitor to give this drug IV." So she got the pulse-ox and clipped on the patient's finger. "Ummm...I think we need an ECG monitor to watch for dysrhythmias, not just monitor the heart rate." At this point the nurse gave me her best Vulcan Mind-Crush Death Stare, so I politely excused myself from the room and made my way out to a quiet corner of the nurses station.

Now I've been known to come off more than a little "know-it-all"-ish, mostly because I do know a lot of stuff--I can't help it, I just remember stuff. I don't mean to come across in an arrogant manner--in fact I hate being around people like that. I really, really have been working hard to just keep my mouth shut, but sometimes I pop off before I have the chance to reign myself in. I'm sure my preceptors each week just shudder when they meet me. I am so, so aware that I have sooo much to learn yet, and I try so hard to exude this, rather than the other.

Anyway, it wasn't 2 minutes later that I overheard the nurse around the corner talking to the house supervisor on the phone, telling her she wasn't comfortable giving the medication without having the patient on a monitor, etc. I was glad she didn't just push the medication, and I actually felt pretty bad for her. She was having a rough day. It wasn't 5 minutes later she got her head bitten off by the admitting physician for paging him about the patient while he was in the middle of a C-section. I would have liked to apologize, but I doubted it would have been well-received. I just let things lie.

So you experienced nurses out there, any advice on how a newbie can "know stuff" without coming off like a know-it-all smart ass?

Because I'm not sure I'm going to be a popular guy come internship time.

Abstract Thinking

One of the requirements for admission into the externship was writing a single page abstract answering the following two questions:

1. What do you hope to bring to this experience?

2. What do you hope to take away from this experience?

I wrote mine dutifully, with much thought and planning. I was pretty proud of it, but it wasn't mentioned in my phone interview.

So I thought I'd post it here--at least get a blog post out of my hard work.

Bring, Give, & Take Away—Children’s Medical Center Summer Extern Program

I bring a thirst for knowledge and excellence—the desire to learn and to be better. I still have so much to learn, and I believe the best way to gain that knowledge will be to live it.

I bring a multi-disciplinary point of view that has always centered about pediatrics and holism. As an older student I bring life experience, world experience, parenting experience. I have seen things, done things, experienced things that help me to meet people where they are; to respect, if not understand different points of view. My previous clinical doctorate affords me the essential basic skills of assessment, diagnosis, and perhaps most importantly, critical thinking.

I hope to give my time. As a husband and parent of three children, my time is quite valuable to me. There are few things that I deem important enough to take time from my family. This is.

I hope to give love, warmth, and respect to those I encounter. I will bring compassion, integrity, and professionalism in the hope I can give a part of myself to the patients, families, and staff that I come in contact with throughout the program. As I look back through my life, the people that have affected me in the most positive ways have embodied each of those traits. I hope that I too can affect people in a positive way—to make a difference.

I hope to give patient care that actually contributes to each patient’s recovery. I am so ready to begin making an impact as a nurse. I can hardly bear the wait until graduation, licensure, and practice.

I hope to take away a sense of ownership in pediatric nursing. My wife is a pediatric ICU nurse with 8 years experience, and I’ve consistently and actively sought out new experiences during nursing school clinicals—I feel I’ve seen the true face of pediatric nursing, but I want to own it.

I hope to take away 10 weeks of all-important, real-world experience. My clinical experiences through nursing school have been fantastic—but they always leave me wanting more.

I hope to take away a sense of pride in a job well done; a sense of accomplishment from a program that selects so few from so many. Being selected for the extern program would be an honor and a privilege.

I hope to discover my new job home, to take away long term plans and a view of my future. I hope to become a part of a well respected organization, and by that association become better for my experience. I do not deny my desire to work for Children’s Medical Center after graduation.