Thursday, July 29, 2010

Blood Work

I had quite a headache all day at clinicals, but managed to not let it distract me from one of the most hands-on clinicals I have had thus far.  It started off rough with my grandma dying in the first week and having 3 case studies, a nursing profile for a client having a pulmonary embolism and a concept map on a patient with lymphangitis cellulitis and 2 quizzes to make-up, but it all worked out. 

Our rotation was only 6 weeks.  I missed week one, but week two had my first patient refuse medication and got to pull out a central line.  The central line is just insane.  Its basically an IV that runs directly into your subclavian vein, which feeds directly into the vena cave, which feeds into the right atrium of the heart!  Crazy to be that clos to it! The patient had been unable to eat due to stomach cancer and we were running total parenteral nutrition (TPN) right into his blood vessels.  Removing it is quite simple, the patient turns his ahead away from the line, he holds his breath and you just pull it out -- it's a rush for a nursing student.

**This is not my patient, just a pic I found**

Week 2, they sent me off to "convenient care" which is like outpatient oncology, but that day all my patients were anything but.  My first two patients had kidney failure and needed bi-weekly injections of procrit or aricept, which is just two different brands of erythropoetin.  The kidney also have the responsibility of making RBCs and obviously when they quit working RBC production becomes inhibited.  I was able to give both shots in the deltoid -- thankfully, most IM's are given in the deltoid or the vastus lateralis.  The butt is usually a last resort (whewww!).  Then I had 2 patients with peripherally inserted central lines (PICC), which start somewhere in the upper arm and are threaded up and through to the subclavian again and into the heart.

These people had IV antibiotics for a few months, so they needed to be cleaned and have a dressing change.  A peripheral IV is only good for 72 hours and having to be re-stuck every couple days would just suck.  These were much more realistic.  A patient with an insanely low blood count came in for 2 units of PRBC and so I watched a blood draw (or 3 for that matter as this patient's veins just ran away from the needle every time it seemed).  We finally got it and it was cross-typed and matched and for the next couple hours I monitored her VS (specifically for hypertension) as that is a common side effect of the transfusions, not to mention she was hypertensive anyway.  After that, a patient managed to rip a saline locked IV out of his upper arm while eating and got blood everywhere before we finally managed to re-dressed and cleaned it up. 

Week 3, was dealing with all the other bodily fluids as my patient was end-stage alzheimer's and had lost the ability to swallow.  Eating had become impossible and with a hiatal hernia, successful placement of a g-tube or peg tube was impossible, so she ended up with a j-tube, which I found out you do NOT check the residual on.  I was worried about running too much isosource as the pump was 35ml/hour continuous, but was told I would know if it wasn't being tolerated because, well everyone knows what happens when you eat too many oreos or corn right? 

Needless to say, I will never be a GI nurse of any kind.  I spend half my time trying not to vomit and the other half of the time holding my breath when dealing with patients who are inconinent, but I know I am a super hero because I willingly do that stuff!!  I had also willingly volunteered to take on a second patient that was MRDD and had to take about 8 oral meds.  I ended up doing one at a time hidden in small bites of his breakfast tray, starting with the smallest and working my way up to the horse pill sized ones.  My instructor actually gave me 4's for the day, which is above satisfactory, so YEAH!!!  She even stated she only gives \3's (satisfactory) unless something very exceptional occurs, so BOOOOYAAAHHHH for me!! 

Today, was my last day there on the floor and we were told it was exceptionally, slow and there weren't enough patients for all of us.  I volunteered to go back to convenient care and work and as a result she told me since I worked with two patients last week to go on down to the heart failure clinic.  SWEET!!!  I hate standing around at clinicals, even if there is absolutely nothing to do, I still feel guilty.  Heart failure was definitely different.  My first patient needed Lasix IV push (4ml over 2 minutes) and then 2ml and hour for 4 hours on an IV pump.  It was nothing knew, but each pump is different and it's always nice to brush up on skills to clear the lines and access the ports correctly.  They were having a slow day too, but it was still more action packed than upstairs as I had 4 patients coming in needing blood draws for BMPs, PTs, BNPs you name it.  I had only started an IV and accessed a med-port one time, so using a butterfly needle and finding veins, followed by doing a blood draw was exciting and new!  It may not seem like it, but sticking a needle in a teeny-tiny vein, without missing and miniminzing the discomfort of the patient is very nerve racking for me.  Not to mention when every patient you have says "I have really hard veins to get blood out of" it definitely makes me a little doubtful of my skills.  My first patient I was told to go for a little vein on the dorsal side of the hand.  I know I hit the damn thing, but it ran away from me and I got no flash.  I was disappointed, but my instructor told me not to worry that patient was indeed a hard stick.  None of my patients had pretty veins just popping up in there antecubes for me, but I successfully nailed the rest on the first try.  My confidence with blood and needles was definitely boosted after today's handy work. 

Now, I have 4 more days of school and the "Dog Days" of summer finally begin for me after 7 long, intense months of school.  I only need a 59 on my final exam to pass, so you can only imagine how confident I am.  I feel like a senior in high school again, just itching for the end of school.  Although, it's only 3 weeks off.  I plan on enjoying every minute before I start my last semester of school.  It's so crazy I am almost 3/4 done.  It seemed like just yesterday, I was sitting in orientation wondering what I was getting myself into.  I know the hardest is yet to come, but hopefully, these few weeks off will allow me to re-charge and hang in there until December 17th.

Sunday, July 25, 2010

Johnny Cake 5 mile

This is the 4th time I have run this race (I think).  I ran my 2nd fastest time unintentionally on the course, which sounds good but the truth is the other times were when my anemia was in full effect.

It had only been one week since the half ironman and my workouts consisted of 6 miles of running in 2 days.  I was super excited and stoked I would undoubtedly PR (NOT!).  I had worked late like usual Friday and Saturday night, so draggin my ass out of bed at 6:30am to drive to Mentor/Painesville was almost as hard as the 5th mile of the race that day, but this was a big race for my team and I felt obligated to participate.  I love Achilles, the owners are personal friends and wonderful runners themselves. 

I arrived at 8:00am with only 30 minutes to grab my packet and go to the bathroom (OF COURSE!), but the line was huge.  I was out and on my way to the start line by about 8:25.  The weather was way too hot for me.  I had no intention of doing a warm-up.  Five miles would be plenty for me.  I felt run down and knew I had a fun, fun day of studying ahead of me.  I did see BD and E-speed right before the start and got to wish them both luck.  It seemed we all new the weather was going to make this race a little more miserable than usual. 

When the race started, everyone took off...FAST!  I got passed and passed.  My main goal was to negative split every mile (except for 2, which has the hill).  I figured starting off at a slower than normal effort would ensure my plan. 

Mile 1 was tight with all the construction barrels and I heard the timer yell out "8:12!!"  Eeeeekkkk!!!  I could only laugh at my suckiness.  Between the heat, my lack of training and my poopedness -- I was literally a "hot mess."

Mile 2 has the only climb in the race and I took it nice and easy.  Some people around me charged up the hill like angry bulls and others were breathing like they were in labor.  I wasn't doing either so I took that as a sign that I was right where I needed to be.  The timer called out "16:30"  Sweet 8:18 for that mile.  I was only 6 seconds slower with the hill, but wait no, no, no that split sucks too. 

I kept thinking I did 20 milers at these paces in the spring (course it was in the 30s and 40s and I was 8 lbs lighter and I was running 50 mpw -- excuses, excuses, excuses).

Mile 3 was flat and slightly downhill with some shade (two of my favorite things).  I saw some of the Mentor cross country girls and one of the parents and I waved and yelled "You guys should be running and suffering too!!"  They replied with lots of cheers and smiles for me.  Mile 3 I think was 24:35, so my split was 8:05, the time was coming down just as planned. 

Mile 4 was forgetable and in the sun and where you begin the long deadly, hot run down Mentor Avenue to the finish and can only think "one more to go after this."  Timer number 4 shouts "32:33", doing the math in my head I realized that was a 7:58.  Finally a sub-8:00.  I was wondering if there were any in my legs today. 

The last mile was the least painful 5th mile I have ever run on this course.  I was running people down one at a time and using that to help stay focused.  I forgot to mention how I had poured water on myself twice during the race to keep cool.  My mom was out of town and not home to remind me that morning to put body glide along my chest where my sports bra rubs and I could feel a burning pain where I had already chafed that morning.  I could see the banner in the distance and passed the 880 marker and then the 440 marker.  I was almost done when a kid next to me started dry heaving.  It was absolutely repulsive and after dealing with vomit, urine and feces at clinicals I wasn't up for it today, so I picked up the pace and purposefully pulled away from the pukemeister. I saw the clock going just passed 40 minutes as I was closing in and I saw 40:20 when I crossed but official time showed 40:24, so that makes my last mile 7:51.  Not to mention, if you look back up at the picture at the top I am CLEARLY way past the finish clock and it only reads 40:22, so how I got moved to 40:24 I don't have a clue, but a crappy time is a crappy time right?

I hung out for about 40 minutes catching up with lots of running buddies and was really happy to hear most of my girlfriends JO, Campy, E-speed and BB had all but cleaned up.  Congrats to all my Female Fasties.  That took a lot of pressure off me to have to win the race that day knowing they had been there ;-)  HA!  I managed to snag some pizza and was on my way back home for a fun filled day of renal diseases.

Saturday, July 24, 2010

Mucnie Endurathon

JP and I woke up at 4:00am on race morning and were loaded up and on the way to the race site by 5:15am. This would be my first HIM, but I wasn't nervous and I really wasn't too excited. I knew I would more than likely finish, but my time wasn't going to put me in a good overall position at the finish.

I went to the bathroom about 5 times before the race, like usual and thought I was in the clear and might only have to go once after the swim, maybe twice at most.

JP and I lined up for the wave 6 start. BH had gone off in the wave before us and EG, AH and BS would be coming right behind us in wave 7. My goal was to not drown. The water temperature was over 78 degrees and going sans wetsuit was not the option I had hoped for. This was only my 5th swim this year and I had only swam one time with my wetsuit off all year for 25 minutes. JP and I wished each other luck and the horn sounded. I walked deeper into the water and just started stroking away, like I was out for a nice easy swim. Swimming is so intense. You always have to check to make sure your hips are up, your feet aren't dragging, your entering the water with your hand straight and not crossing over, your not dropping your shoulder, your head is in a neutral position and then you have to make sure you swim in a straight line and avoid as much body contact with other swimmers as possible. It is always something, much more technical than running. I tried to get into a rhythm and relax. I used the swimmers around me to sight and after finally checking my position to the far buoy discovered I had swam far on the inside. Damn!! It seemed so had a bunch of other people. Perhaps the buoy's initial position was an optical illusion. I wanted to get out of the water in under 45 minutes and I didn't want to put myself in oxygen debt, however, when I made it to the far buoy to swim the backside my watch said about 18:xx minutes (UGLY). It was going to be close. The backside was easy and I was on my way back a lot quicker than I had thought. I finally settled in, but my hip flexors and my back started aching from holding my legs and body up in the water. I was fatiguing already and I still had over 69 miles to go today. When I was almost out of the water, I stopped kicking to allow myself to pee one more time. I was happy to have gotten it out of the way so I wouldn't have to pee in T1 and could just go straight out on the bike course.

I hit the shore in 43:xx and hit T1 at 44:43. No wetsuit and no drowning, I'll take it.

T1 was slow for me, but uneventful in 2:10.

The bike started off on the greenway, which was sick fast. I could coast at 20mph easily. I spent the first 15-20 minutes spinning easy to get my heart rate down and figure out where the heck my body was at with all this. My lower back and my hip flexors were pretty tight from the swim and my neck and shoulders were a little achy. A little over 10 miles in I felt the urge to pee and by mile 15 it was unbearable. I debated trying to pee while cycling because there wasn't a porta-john anywhere. I couldn't do it, to uptight I guess. Indiana is all fields and no forests, so when I finally found a wooded spot I jumped off my bike and ran into the woods. I tried to hurry, but my bladder was full and I wanted to get it all out, so I wouldn't have to pee again, or so I thought. I jumped back onto my bike feeling so much better and started making up ground, but another 15 miles later and it happened again! Again, I jumped off and ran for cover. I wasn't too frustrated, just a little annoyed. I was trying to stay focused catching people that had passed me while I was peeing. I would check behind me pull out to the left and pass then check again to make sure I was a few bike lengths in front of the biker before pulling back to the right side. I was following my routine and as I pulled left and checked behind me I saw a guy coming so I made sure to pull back right as soon as possible to get out of his way. Now, when I pulled right, I pulled far right, just to give him extra clearance, but this asshole and I mean asshole pulled far right, right behind me. I veered back left thinking he was going to pass me on the right, but when I checked he had pulled back left on my wheel. I completely lost my cool and yelled "get the fuck off my wheel!!" The guy gave me a nasty look and yelled "I was just using your slipstream for a minute!" To which I replied "That's illegal!!" He mumbled something I couldn't quite hear and pulled away. I was so pissed. I hate cheaters. I tried to focus on my pedal stroke, but I had to pee again...damn!! I pulled over for the 3rd time and jumped off, but this time my foot slipped on the gravel and I went down on my right knee. I managed to rip the skin off and blood started trickling down my shin. I just kept running for the woods. As I was peeing I noticed some plants that perhaps could have been poison ivy and as I tried to move away I almost fell back in it. Thankfully, I grapped a tree and kept my balance. Jumped back on my bike and with about 12 miles to go, but one more mishap awaited me. I was less than 7 miles away and I heard a soft humming. People were flying by me. I looked down and my speed had gone from 20+mph to 14mph and I was working HARD. Great! My front brake was rubbing. I reached down and tried to pull on the calipers, but that didn't work. I began pumping the brakes trying to get them to open up a little bit. Finally, after about 2 miles I got my bike working again. I had had enough I wanted to get off the bike before I flatted or wrecked. My luck was running out. All the mishaps put me at 2:56:43 for the bike.

T2 was a blessing. I was so glad to be off the bike, but as I ran into the fenced area I felt the urge to pee again. Uuuuugggghhhh!!! I transitioned like the flash and ran to the porta-john, let loose like the Hoover Dam and got out in 2:01. Had I not had to pee, I would have been out in under a minute darn it!!!

The run started off fine for the first 2 miles. My legs felt really good, which surprised me because my longest work out had been just shy of 3.5 hours and I was beyond that by this point. I was not running hard and I was passing person after person from the get-go. They had aid stations every mile, which I thought was a bit much, but as I got to the first one I greatfully accepted ice and gatorade. The temperature had been fine for the bike but by mile 2 I was warmer than I would have like and there was no shade. I took more gatorade and water at mile 2 and by mile 3 I realized I was not going to make it the 13.1 miles unless, I could cool myself off. I was overheating so fast. I started to see more and more of the leaders coming back and some were running, some were hobbling and some were walking. This was a bad sign. I had to cool my core. I grabbed to cups of ice and jammed them down in my sports bra. Almost immediately, I felt a little better. I continued to stuff ice down my top, grab fluid and then added an ice water soaked towel to my neck. Every aid station became like a buffet table. Ice for the sports bra, get a new cold towel, or re-soak the one I had, grab some flat coke. I couldn't do all that on the run so I had to stop at the table for a few seconds. I hated to lose the time, but it was the smartest move I could make. After mile 4, runners were everywhere walking and hobbling. I was still passing a lot of people. I don't think one person passed me the entire race and I knew I was running the worst half marathon time I had run in 3 years! I made it to mile 10 and my body finally gave out on me. My legs became extremely heavy and it felt like my throat was the size of a straw. I was really glad my body had held up this long, but I knew with an average of 40 miles a week biking and 15 miles of week running I'd be lucky to finish. I started thinking about my grandma a lot at that moment and how she was the one who had died and I was the one who was still alive, about how this past year has been about doing a lot of things that I didn't think I could do. I started to get a little emotional and I did what I ALWAYS do... I just kept going.... one foot in front of the other, thinking about her and how I was doing this for her. About how even if this is my only half ironman ever, at least I did one.

I made the final turn at the church knowing I had a little less than 2.5 miles to go and I started to cry a little because I knew I wouldn't give up. I knew I was gonna finish and I was gonna finish in plenty of time to break 6 hours. The last 2 miles were all uphill and a few people were just too beaten to run, but I kept going. I could see the finish tents at the top of the last hill and people were on both sides of the streets clapping and cheering. I was almost done. I was smiling and tearing up at the same time as I ran up the last hill and as I crossed the finish line I threw up my fists in victory. I had done it. I had gotten in enough training to do swim 1.2 miles, bike 56 and run 10. My determination and my grandma had brought me the last 3.1 miles in 5:47:37.

It was a great day and I loved the race, the course, the volunteers, everything. If things work out I definitely want to go back next year and crush my time.

Monday, July 5, 2010

Still Standing

I am still here. Spending a lot of time trying to gather my thoughts and keep my head above water. I can't bring myself to talk/blog about things yet. It is just too much for me right now. I know I have a lot on my mind, but I have put myself on autopilot for the next 5 weeks. The idea of throwing in the towel and giving up has been coming at me full force this past week, but I just keep thinking "hang in there" and "don't be a pussy" but sometimes it just fucking sucks right now and I can't help but hang my head and let a few tears go....

but as of right now... I am still standing...