Content

I've been whittling away at my 8 12-hour Capstone night shifts on the Transplant ICU at Gargantuan hospital. As of this morning I've done 5 of the 8. I'm back again for the next 2 nights, and then a chaser shift on the 7th. At that point I will have completed all the requirements of my nursing school for graduation.

Transplant ICU has been interesting. I have a really great preceptor--so laid back--we fit perfectly. I've felt good about my contributions to the unit, and it's been great learning another aspect of ICU nursing.

In fact, this morning as I was leaving from shift #5, I found myself reflecting on the state of my life at this point, and a sense of well-being washed over me. The air was chilly, and the sun was just coming up. I was snuggled inside my college of nursing hoodie, and walking to the remote parking felt good.

I suddenly realized, I love my little ICU world. I love micro-managing my patient's care, and controlling every vital parameter. I love that the difference between doing well and crumping can be just a few mg/dL, or a few mmols. I love things as simple as writing vitals every hour, putting my mark on the chart stating, "I assessed this patient this hour, and things were good," or "things weren't so good so I..." I love that when patients go bad on the floor, they come down to me. I love the look of relief on the floor nurse's face when I take over responsibility for the patient's care. I love that docs ask me what I think the patient needs, and 9 times out of 10 they're on board with me. I love these things.

I love that I'm almost done with school. I love that the school and professors have thrown their worst at me, and I've met every challenge head on and succeeded. I love that I've excelled not only in classes, but in clinicals even more so.

I love that I have a job waiting for me. That I beat out 758 applicants that had been screened over the phone. I love the tone of respect in other people's voices when they hear which hospital I've been hired into, because it is truly a fantastic organization. I love the tone of respect in other nurse's voices when they talk about my home unit. I heard a Transplant ICU nurse say that on my home unit, "All the nurses are oddly intense."

I love that my wife truly gets what I'll be doing for a living. I love that I can complain about docs or nurses or lab or RTs and she understands why I'm frustrated. I love that I can throw out a set of vitals or lab values and she's appropriately shocked or mystified without me having to explain it.

Most of all, I love that my little, beautiful family is still gathered tightly around me despite the journey I've been on. I love that the kids still scream "DADDY!!!!" when I come home. I love that my wife kisses me and says, "Good job."

Life is good.

This? Is Not Good

My inaugural 5k race is coming up on Thursday.

I haven't been to the gym in 3 days and the way I feel makes tomorrow seem iffy also. I've come down with a cold that has settled comfortably in my chest. I'll spare you the gruesome details, but if my patients coughed up some of the funk I've hacked up recently, I'd be grabbing for a sterile specimen cup.

Lucky for us it's forecast to be 47* and rainy for the race.

In other news I've started my Capstone hours. I've been assigned to work nights on the Transplant ICU at Gargantuan Hospital. My preceptor rocks, so that takes away the sting of not getting to spend the time on my home unit.

Oh and today my wife and I are preparing Thanksgiving dinner for 53 people at a low income housing apartment complex.

Welp, back to the kitchen.

Honors and the Stink

I opened my school inbox last night to discover an email from Sigma Theta Tau with an invitation to join. It was an unexpected honor, and it lifted my spirits a bit after the Level II debacle. The induction ceremony is on December 15th, the day before graduation and pinning. At the very least, it's something to put in my resume and CRNA school application. It also may mean I'll be exempt from taking the GRE for CRNA school as well.

The dues are steeeep, and then I have to pay $12 for my purple honors cord for graduation. And another pin for $45. How is it that doing well in school is costing me more money? Doesn't seem right.

In fact, it just plain stinks.

But not as bad as my nursing school shoes.

Part of our strictly enforced dress code (the faculty will actually write us "tickets" that result in being put on contract if we break the code,) calls for 100% white shoes.

I hate white shoes.

But I have faithfully worn my solid white New Balance 622s for the last 2 years, and now they stink.

Nay, they REEK.

I noticed the stench got much worse after Hermine (that b*+ch,) soaked me from brow to toe. And it's quite embarrassing really, but I'll be danged if I'm going to buy another pair of $75 shoes for the next 2 months never to be worn again.

Maybe I'll try soaking them in bleach water. Or maybe that biological odor spray we save for the c-diff patients.

Anyway, that's the Honors and the Stink.

Community Health Clinical

One of the awesome classes they've saved for Senior II is Community Health. It's not that I don't think community health isn't terribly important, because frankly I really do. My sarcasm is rooted in two main ideas.

First, there is no way on God's green earth I'll ever do community nursing. It's just NOT for me. Trying to educate stupid people who don't even know they're stupid, and don't want to be educated anyway? My idea of personal hell.

Second, my all-knowing college of nursing's idea of community health clinical is to ship us off to the nurse's office at every elementary school in a 50 mile radius. Don't get me wrong, school nursing has a pretty sweet schedule--I mean, summers off? Sweet. But it's about the perfect antithesis to the kind of nursing I want to do, and the thought of sitting on my ass for the required 64 hours makes my legs go numb in anticipation. So, when an alternative was offered, I jumped at the chance. And that is how I came to be assigned to an investigative unit of Child Protective Services.

My very first day I went on 5 visits, from a hospital, to schools, to a home visit in a residential hotel. The cases ranged from a mom who admitted to using marijuana before she realized she was pregnant, to a kid that was so dirty I had to hold my breath that claimed to have been beaten with a dog leash.

It's been interesting watching the dynamics in all these situations, and so far I haven't personally seen anything just gut-wrenchingly sad.

So much better than sitting in a nurse's office.

That Hermine, What a B&%#@

Orientation for my Management & Leadership clinical was this past Wednesday. I've been looking forward to this particular clinical because somehow I managed to score a Level I trauma center, the ONLY Level I center offered as a clinical site for this class (of the 3 Level I centers in my metro area). Now that doesn't seem terribly important for a management clinical, except for the fact it's also the site for our Capstone--basically a 96 hour clinical that is supposed to transition us into the real world of nursing. This particular hospital is known to hire people directly out of Capstone. So, if I manage to maneuver myself onto an ICU for Capstone, and then manage to impress someone important, it could lead to yet another great job option. I know, that's a whole truckload of "ifs", but such is the life of a near new grad nursing student.

Regardless, I've been looking forward to this clinical since I found out I was assigned there.

Until that b##%& Hermine showed up.

It all started off with a beautiful Labor Day weekend, so nice in fact that I had the top off the Jeep for nearly a week. The kids love it, and having the balmy Fall breeze in your face makes the rough ride, the wind noise, and the crappy fuel mileage all worth it.

I was aware that Hermine was lurking in the Gulf, and that she'd probably end up in our area after she made landfall, so I was keeping an eye on the radars on Monday. All the forecasts clearly said she wouldn't arrive in my area until Tuesday night. So in my Labor Day induced lazy stupor on Monday evening, I elected to wait until the next morning to put the top up.

Guess who wakes me up at 5 am drooling all over my eaves, splattering all over the back patio and driveway, and slobbering all over the interior of my Jeep.

That's right, the b*(@# was early.

By the time I yanked on a pair of jeans and a t-shirt and got outside to get the top up, it was clear it had been raining for a couple of hours. The Jeep was soaked. Which is not a big deal, it dries out.

Eventually.

My wife was kind enough to shuttle me to school that day, which turned out to be a blessing since it rained all day. Not hard, just steady. Enough to saturate the ground.

Enter Wednesday morning. The morning of my orientation for Management Clinical, at the hospital, 31 miles away in downtown big city. I get up at 7 to wake up my oldest daughter for school, and look out the window. It's pouring.

POURING.

Now, I've been in this area long enough to know that when it rains, traffic does not pass Go, does not collect $200, it goes directly to hell. So even though my orientation doesn't start until 9, I immediately got dressed in my trusty blue scrubs with iron-on nursing school patch, grabbed my umbrella and hit the door.

It normally takes me about 10 minutes to get from my house to the nearest highway. This morning it took 35. The water was above the curbs on the left and the right, effectively turning a 4 lane boulevard into 2. In places the water was above the door sills on the smaller cars, in the middle of the road!

Once I got on the highway, it wasn't any better. Traffic was stop and go the entire way. Water was ponding out over the highway. Exit ramps led into lakes. Overpasses became bridges over rivers.

An hour and 50 minutes after I left, I was pulling into the remote parking lot on the campus of the hospital. Oh yeah, Level I trauma center also means really big campus, and don't think that students don't get the shaft with remote parking about 1/2 a mile from the actual hospital. Luckily there's a shuttle service. Too bad it only runs every 20 minutes, the first one didn't wait for me to get out of the Jeep, and I was already 5 minutes late.

So I decided to walk. Within minutes of being outside, it was clear that my umbrella was only going to be useful enough to keep my forehead dry. My trusty blue scrubs were soaked through, clinging to me like a 3 year old being dropped off at daycare. From about T-4 down, (that's nipple line folks), I was completely drenched. Water was up to my ankles on the sidewalks. I was making good progress though trudging onward.

Until I turned the corner of a building and discovered that there's a commuter train that runs through the middle of the hospital campus. With a 8 foot high, wrought iron fencing on both sides of the tracks.

When I turned around to back track to the remote parking lot, don't think I didn't consider just getting back in the Jeep and driving the hour and 50 minutes home. Lucky for me I got back to the remote lot in time to stand in the rain another 10 minutes before the next shuttle showed up.

I was about 30 minutes late to my clinical orientation. I was completely drenched, even my underwear was wet. Water squished out of my shoes when I walked. And I sat there like that, learning yet again that you R.A.C.E in response to a fire, you P.A.S.S. to use a fire extinguisher, and code pink means someone's trying to steal a baby.

What a miserable day.

All told, the weather station near my house measured over 11 inches of rain in about 6 hours. For contrast, where I grew up receives an average of 8.39" of rain...a year.

And Hermine wasn't done either, she later spawned 4 tornadoes on top of all the flooding.

What a b#*&^.

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.