Do you like the boobs?

That's become part of the Jersey Shore theme before every episode begins.  Deena asks the question.

I've always had the same answer about my own -- NO!

For 20+ years now I have micromanaged the extra weight in my chest looking for permanent solutions and find a way to accept what God had given me.  In High School I usually wore a sports bra and 2 when competing in sports.  I even inadvertently learned to stand with my shoulders rolled inwards to minimize the hugeness of the girls.  I tried a few nude, white and black "regular" bras that provided minimal support.  I even bought a strapless once (it was a complete waste of money and fell down).  I shyed away from swimming suits finiding them as supportive as a toothpick.  I searched websites to no avail through the years for the right option and finally opted to go with a super powered "over the shoulder boulder holder" and a secondary sports bra over the top.  It felt like my chest was being squeezed, but it was the best I could do to support them.  I suffered through sore neck and back muscles and sternum burns throughout my years as an athlete (and still do).

Until now...

I had been considering a breast reduction / mastopexy since pretty much the day the girls showed up.  My mother had scorned the idea saying "I needed to appreciate what God had given me."  Over and over I tried to accept them, but enough was enough.  I made an appointment in September with a plastic surgeon, went in for a consultation and scheduled an appointment to have them reduced.  It was unfortunate they would not be covered under insurance because he couldn't remove 1 pound from each and I didn't have any severe condition my breasts had caused (i.e. chronic back pain).  I was offered a 20% discount through my employer and only had to pay 38% up front, with the rest being deducted from my paycheck.  I took the deal and signed the paperwork.

On October 24th, after years of fighting to accept my body and change it through physical activity and fancy bras I have decided to go under the knife.  I'm a 34DD and have asked to be as 34B.  I worry about the pain and the risk for infection, but when it's all said and done I hope to say exactly what my doctor's NP told me "women leave all the time saying they should have done this 10 years ago and are extremely happy." 

Since the amount removed from each breast will be less than 1 pound it's considered a mastopexy.  Here is a video (minus removal of tissue) of pretty much what they will be doing to me incisions and nipple resetting --- ouch and barf!!

Mastopexy 1
Mastopexy 2

Rough Waters

Training is still rolling along.  I suffered through 19+ miles of running this morning after sleeping for about 20 hours after 3 straight days of work.  It seems inevitable that 3-4 days in a row at work is just a strain on my body.  Each day I get a little less sleep than the last, until I am nearly a zombie.  It seems so strange how the majority of the world works 5 days a week and deals, but I struggle with 3-4 in a row.

After 34+ years, I can't fool my body into thinking day is night, no matter what I do.  I've resolved to switching to days if I have more than one day in a row off (weekends) and hoping the boss puts this (3) 12 hour shifts/week into action soon.  It's funny how I work at a hospital and they preach "be healthy," yet I only get one meal for 30 minutes on a 12 hour shift (that I don't even get sometimes because I am too busy with patients), heck I only go to the bathroom when it's down to the wire and I'm not gonna get a choice in another minute or so.  I do however LOVE my job.  I can't imagine ever doing anything else.

The waves of difficulty come and go for me, just like Lake Erie's.  I'm definitely going through some "chop" right now after the loss of one of my favorite patient's about 2 weeks ago and then the GCT fatality.  Odd how I lost both of them to neuro issues.  I've stopped asking "why" but still go over and over stuff in my mind -- what I could have done differently, not that either would have made it for certain, but I can't stop.  The nightmares have started to subside (I always have them when I lose a patient I get close too).  I still cry discussing the beautiful memorial my patient's family had that I attended after work.  As for the other, it's still surreal and I go over and over the roll I played that day in my mind again and again, thinking about what could have been done differently.

I can only hope I've passed through this rough section and will hit some smooth waters for a bit.  It's crossed my mind that I have seen more dead people and watched way too many people literally die right in front of me all too often.  I have spent countless drives home crying and banging on the steering wheel in anger (no dent yet).

I often wonder how much death can a  person see, or more specifically me before it's too much.   

On the flipside, seeing how precious life really is daily, reminds me more often than most, it's the only one I have and it is not to be wasted. 

The Graveyard Shift and Sleeping Spells

My orientation for work was over about a week or two ago as my re-assessment went into the green --- duh!!  I know how to memorize answers and type it on a computer screen, if given the chance to study.  Believe me if you come in with fevers after chemotherapy, you can bet your a$$, I am gonna poke you with a needle (even you e-speed, not a big one though), draw some blood cultures, give you an IV and anticipate the doctor wants you on vancomycin and zosyn for the infection and tylenol for the fever, and then if you start pooping all over on me I'm gonna grab a poop sample too -- So look out and don't get sick or I'll be coming for you :)

Anyway, my orientation was thankfully extended another few weeks, because I somehow managed to avoid the graveyard shift and floating over to bone marrow transplant and leukemia to work.  BMT scares the crap out of me because those people have absolutely no white blood cells to fight infection and even family members can't kiss or hug them when they are in!!  Just sneezing on them could kill them.  I went up there for a few hours this past weekend and then they stuck me on nights all week this week and next week. 

Nights shift is 7p-7:30a.  It has it's benefits.  There a less orders going in and the patients usually go to sleep, so you just have to assess them and pass meds until about 10:00p then you can chart and read up on the notes to better understand each case.  There are a few that wake up in pain and need meds or have round the clock antibiotics, but it is definitely more my speed and I make more money working night shift, simply because it's night shift.  The only down side is I can't sleep!  I tried to stay up late on Sunday, but was out like a light before midnight.  I woke up at 8:00am on Monday and had some breakfast and then went back to bed until a little before noon.  The first night was fine for me.  I got home around 10:00a on Tuesday and was only able to sleep from 11am-2p.  I ate something and read a book until 4p and was able to sleep for another hour.  I had to shower at 5p and head to work and knew it was going to be ugly by 7:30a the next morning.  The shift went fairly smooth.  I picked up two patients at 11:30p, which I hate because they are already alseep and I have to wake them up to assess them unfortunatley or wait until early morning when lab comes around and cluster the care.  It can put me behind on my charting then and if something goes wrong I haven't assessed them and pin-pointing the problem becomes more difficult, so waking them up it is. 

I left around 8:15am, report took forever and before I was even half way home I could feel myself dozing off.  I called my dad and tried to call to him, but my hand was shaking as I held the phone.  Finally, I pulled into the JCC on S. Woodland.  I was about half way home and I knew it was too risky.  I pulled into a spot in the back, grabbed my Indians blanket and slept in my truck for an hour and a half, before some landscaper's mower hit my truck with some rocks and woke me up.  I drove home and went straight to bed around 11am and didn't wake up until 7:30pm.  I managed to eat something and stay awake until 9:30pm before going back to bed and not moving until 10:00am this morning.

I have to do it all over again this Saturday and Sunday, so I really have to get a game plan together.  I can't be driving home in rush hour traffic dead to the world, only to sleep for an entire day after!  I'm thinking until I figure this sleeping in the day time thing out (from 9am-5pm) I am going to have to take some sleeping pills to help me.  I can't afford to be unsafe at work or in my car.  Maybe I will be crashing at the A-train hotel more often than even he knows (also, feel free to leave a comment for him that he owes a post regarding his race at Taylorsville, if you have time!!)

The First Day

After nearly two full weeks of training and orientation I was finally scheduled to work on my unit.  It was a 12 hour shift (7a-7:30p), so when I got up at 5:00 am, I knew by the time I got home around 8:30 pm I was gonna be wiped.  It was so great to be back and see so many familiar faces.  It was a whirlwind of a day and of course, problems arose all at once rather than consecutively.  I spent a large part of the date observing IV drug administration and getting all my passwords set-up for the time clock, the computer, the pyxis machine (it's like a pop machine, but it dispenses drugs at no charge). 

I had my first up close and personal experience with an Indiana pouch.  I think those things are so cool!  Patients that have an ostomy bag on the outside of their body that can smell and must be emptied often suffer from self-image issues, but this internal pouch is pretty sweet for those who need new bladders.  The stoma itself just looked like a second belly button off to the left of my patient's abdomen.  The patient said catheterizing himself at regular intervals was pretty painless too.

We've added tele to our floor since I was there as an undergrad and reading EKG's has become more common.  I didn't care for them in my first undergrad and I still don't much enjoy counting the little boxes and trying not to go blind as I measure the PR interval or the QRS complex, but I am definitely better at it after spending two full eight hour days reviewing the material earlier in the week. 

Anyway, I was sitting at the nurse's station with about 45 minutes left of my day when I heard this strange noise that kind of sounded familiar to me, but I couldn't place it.  Out of the corner of my eye, around me, I saw a few nurses jump up quickly and call out a room number as they headed down the hall.  It registered at that point what it was.  "Oh sh*t!!"  A code blue really?  On my first freakin' day back, just when I was almost done!!!"  I jumped up and hauled ass down the hall to the patient's room.  It had been the tele monitor alarm indicating the patient's heart rythm was a flat line.  I was thinking two things, man I am not ready for this and if I was going to be in on this code, I definitely wanted to do compressions or bag the guy.  No way was I gonna put the central line in, if needed or push atropine, epinephrine, etc into said line. 

Luckily, when I got to the room, it turned out the patient was trying to get up to go the bathroom and had pulled a wire.  CHEESE AND RICE PEOPLE!!!  I was relieved, no code today for me.  I went back to my desk and prayed I would make it to 7:30 pm without any more codes or craziness.  The full moon was Saturday, not today.  I had a chance at normalcy and freedom still. 

Exhausted at 7:45pm I dropped off my time sheet and headed for the elevators.  I made it down to ground floor and had to get through the J building to get out by my car, but before I escaped I could see a couple looking a little confused.  I knew they were lost and I debated stopping.  I stopped.  They were lost and I ended up taking a ten minute detour into another building and up the elevators to escort them to the appropriate floor.  They told me their daughter was extremely sick and while I was exhausted, I wasn't sick and no one I loved was either.  The extra few minutes it took to help them were well spent. I left them in the waiting room of the unit their daughter was being transferred into and headed back out.  Finally, made it to my car a few minutes after 8:00 pm.  I was ready to head home.

Day 1: DONE

The Initiative

I had to backoff the blogging for a minute there, because I have found additional things to occupy all this free time I have so excitedly stumbled upon.  I also discovered I am not alone in my "what to do? what to do?" state.  Many of my classmates who have passed the boards are now searching for projects.  I spent over a year of my life living a fire drill, trying not to panic and get everything done and study enough (I realized I could never study enough) to arrive at this...

The ability to wake-up, stretch and just breathe.  I then plan out my day however I see fit for the most part.  If I wanna run, run, if I wanna watch TV I can do it, drink coffee and hang out on FB for half the morining, well go right ahead.  I even get to bed between 10pm and 11pm most nights and rise between 7am and 8:30am most days.  Never had a regular sleep schedule before, wasn't even sure if I could do it.  This nearly stress free zone I have been living in is fantastic and I know completely and whole heartedly that I earned it! 

It's only been a little over a week and I find myself excited for the next adventure!  Work starts on the 7th of March, and I have been going over new hire paperwork and scheduling appointments for exams and check-ups.  I have also started reading books again -- for fun!  No more text books addressing lab values and abnormalities of the human body.

I even started a private group on facebook for me and my classmates to share our knowledge about new nursing information, such as SB5 and collective bargaining (and to plan reunions, of course).  I have also reached out to a former professor of mine at school and have been mapping out some professional meetings and lunchs with some "superstars" in my profession.  I don't want to say too much yet, until it's set in stone, but there are about 3 million nurses in the US, however only about 20%  of them belong to a professional organization and are proponents of active nurse advocacy.  It is my hope to help that number increase in my own small and special way.  My last semester I made a promise to myself.  I wouldn't be that nurse that punched a clock and went home.  I would be professionally vested in my career, supportive of my colleagues and job, taking initiative to improve nursing care and patient outcomes. 

This is a really "BIG" step for me and I worry a bit I may have bitten off more than I can chew, but hey I wanna die trying..so I say "bring it on!!!" 

Results are in...

By 3:00 pm on Friday, the Ohio Board of Nursing still had the words "pending" by my name.  I was dying a slow death inside.  Most of my friends had found out by noon the day after their exams and I knew if mine weren't up by 5:00 pm I would have to wait until Monday!!!  I wouldn't survive that long with my anxiety.  I needed a straight jacket.  I needed Ativan.  I needed results.

I finally threw my running clothes on and texted A I was going out and gave him the information to check my status on-line if he wanted to while I was gone.  I swore to myself I would not return until after 5 pm.  The run turned out to be the best thing for me.  Mile by mile I slowly lost focus on the boards and just looked at the road ahead.  My IPOD wa turned up full volume, drowining out all my thoughts.  Peace of mind was filtering in and taking over, ahhhh thank goodness.

Eventually, I had no choice but to return to reality and at 5:05 pm I arrived back at my drive way.  I ran upstairs to see I had missed (2) phone calls, (2) text messages and (2) emails.  Oh man, something was going on, could it be, it had to be...my results were posted.

Sure enough, I went to the website and pulled up my name and there it was plain as day, my name with an active status and an RN number!!  It was over.  I had passed!!  I was officially an RN.

Hell Yeah!!!

The Next Chapter: See You Soon

When I last left my blog I was at the pinnacle of my stress level.  However, a canceled final with the option to take the average of your test scores and a few weeks of working like 35-40 hours after finals and I managed to

a) Graduate
b) Make the $450 (cash or money order only) for my review class

I felt it necessary to "get away" from the books and blogging to allow myself a re-load of some sorts before starting this promising new phase of my life.  I am still thinking "next semester" thoughts, only to remind myself a minute later -- there is no next semester, you are done, but that will fade. It seems so strange that I have been going to school since 2005 and in that time gotten (2) bachelors degrees and (1) masters and now that chapter has ended. 

I promised myself, I would study diligently for my state boards and build up my mileage again in preparation for my 5th marathon, but both are not quite where I had planned them to be.  Although, I told my employer I would be leaving him here in the next few weeks, he seems to have decided to get as many hours out of me as possible, thwarting my efforts to study and run in favor of asking how a guest would like their steak cooked and refraining from walking out because as a whole our restaurant lacks accountability from the management on down (which completely frustrates and annoys me, as a person with a self-diagnosed obsessive-compulsive personality disorder). My sanity clings to the thought of, "a few more weeks and then I am done with this."

As for my review class it is exceptionally informative and funny.  My instructor is 110% NO BS.  She tells the most ridiculous stories to help us remember drugs, diseases and treatments we will need to not necessarily be a good nurse, but to pass the NCLEX exam.  My homework includes 530 questions every week with stacks of handouts, which will put me pretty near the recommended 3,000 that should be done before taking the boards. 

As for my board exam, well of course KSU's administration who set unrealistic goals and deadlines for us dragged their feet "because of snow days" and submitted our graduation work to the state late (Uuggghh, one last thing to add to the pile of things KSU did to piss us off).  I am very excited to be done with that place.  If and when I go back for my masters in nursing, it certainly will not be there.  I did however, sign up for my test and am keeping it a secret from the world, so don't ask. 
 

Running has been slow, but progressive and my weight has come down about 3lbs.  My aunt even came out on New Years and was able to run 8 miles with me and my running club, followed by some mimosas and a kick ass runner's breakfast at FDs.  The weekly mileage is only hanging in the 30s, but on a positive note I have found new uses for a golf ball that has minimized the discomfort in my left hamstring, calf and foot.  Mornings are always a test the first few steps as I walk gingerly until I can assess the damage from the day before. 

Boston is less than 100 days away and I very excited to go with the e-speed, BB and JP.  My team (mom and aunt) will be traveling separately, but will be there nonetheless.  My mom has been at the starting line of every one of my marathons.  The first one (Akron) she was not quite at the level of a hot mess, but she was a bit teary eyed and emotional, right before I left.  I told her I would "see her soon" to try and calm her down and although she is much more composed and focused on getting me focused now-a-days, I still always say it before I cross the starting line. It's funny how I used to give her a 20 minute window of when and where I would be at a certain mile and she would just watch expectantly.  Now, she gets updates on her cell and knows my splits almost better than me.  It's my hope one day that I am the one standing with the cell phone watching her splits and trying to not to pull my hair out as she leaves the starting line and tells me "I will see you soon."

Ice Road Trucker

It seems my third degree is gonna take a little longer than I had hoped (bummer).  It would figure that of the three final exams I have scheduled this week they would be at the beginning of the week when all snow, had broken loose!  I prayed they wouldn't be canceled since KSU's contingency plan was to reschedule them for the week of Christmas -- What kind of present is that??!! 

I left for my first final around 9:00 am and drove at most 30 mph, since the "snow governor" on my truck wouldn't go any faster. Oh and did I tell you the doors were all frozen shut and my dad  had to jimmy the door open with a crow bar.  It wasn't too bad, except when I would try to get going from a dead stop, then the back end would just fish tail left and right with only a little forward momentum, until I gassed it a bit.  Kent was a disaster.  The snow was coming down so hard it looked like white rain and two of the main roads onto campus were closed.  I detoured over to the northeast end of campus only to find a car in the ditch and myself going down a hilll in the middle of a traffic jam.  Impatient, young and not so bright college students were pulling into a nearby parking lot to turn around.  I left space in front of my truck so they could pull back out, but cars started going around me thinking they were just gonna cut in front of me and wait in traffic.  I was completely irritated and ready to get out of my truck and hit the a-holes in the face with a snowball or take my truck and tap their back ends into the ditch, but people are idiots and even worse in bad weather, so I just honked hoping they would realize they had cut me off and blocked people from being able to pull out.  Thankfully, they all got the picture and pulled into the parking lot themselves so cars could get out.  It took me about 15 minutes to go 1 stupid mile, but I made it for my first final -- Whew!! 

My final went off without a hitch and as I was leaving I got an email stating all classes were canceled for the remainder of the day.  I hurried to my truck thinking..."I gotta get the hell out of here!!"  I took the main roads home (i.e. 261N and 43N), but when I got into Streetsboro I could see a line of cars slowly going up a hill.  Great, my truck doesn't do slow uphills in the snow.  I slowed as much as I could at the base of the hill before trying to rush up it, but no dice.  My truck was succumbing to the snowy kryptonite.  As I slowed, my back end started sliding toward the ditch and no matter what I did it just kept going the wrong way.  Arrrrggghhh!!!!  This was the most frustrating drive in all the years I have had my truck. Usually, I can handle my truck in the snow, but I was losing ground -- literally.  I hit the brakes and stopped trying to fight the slide for a second when this crazy broad in a van decided while I was trying to avoid and accident and getting stuck she would go around me.  Enter full on slaught of Road Rage:  I yelled "WTF are you doing, you dumb broad?"  She of course couldn't hear me, but she did smile and wave as she passed.  All I could do was mutter the words "complete idiot" under my breathe. 

I pulled my foot off the brake and hammered the gas.  It went straight, but I was diagonal and went toward oncoming traffic. I managed to get the truck back in the appropriate direction after a second and minus having to pull over to clean the ice off my windshield at the next gas station, I made it home without further mishap. 

I had a final tomorrow, but thankfully KSU smartened up and canceled it, until either Thursday or Tuesday of next week.  While I am not happy my last day at Henderson Hall wont be this Wednesday, I am quite glad I wont have to drive in this snow tomorrow.  The bright side of this extended, unfinished business is I get at least one extra day to study for psych.

The Big News

Well, if you haven't guessed my beyond exciting news from my other post by now, you obviously don't care about my life in any way, but I got a job!!!!

If you read through my prior posts this fall, you will see I worked in oncology, solid tumor to be exact and I can't express enough how much I loved the work and the team of healthcare professionals I worked with, nurses, doctors, physicians assistants, case managers and PCNAs.  My preceptors had asked me what I thought of the unit while I was there and I of course told her it was really well run and such a great atmosphere.  She then asked me "would you wanna work here?"  I thought "HELL YEAH," but responded with "absolutely, this is a great place." 

I was fortunate enough to spend a shift shadowing the nurse manager (the boss) and getting to know her (she is very direct, no non-sense and super cool).  I went to a staff meeting and they covered important topics that I can't disuss here, but they also covered small things too.  I remember her asking where was the coffee machine for her staff?  Although, silly and miniscual she cared about here staff and wanted her staff's needs met big and small.  This woman was my kind of boss!!  As my practicum progressed, I had short encounters with her and she even asked for help with drip calculations on the new pumps and what I thought of her unit as a nursing student.  I told her I loved it and if a position ever opened, I would be more than excited to work for her. 

Fast forward to about three weeks ago: My semester was coming to a close and I was excited to be done with step 1: get the degree.  Step 2 & Step 3 would commence at the same time, i.e. pass boards, get licensed and find a job.  I had applied for  position in leukemia, bone marrow transplant and cardiovascular units, but got the response "thanks, but no thanks."  It appeared nobody wanted to hire an ulicensed nurse with no experience, but then I got an email from my old nurse manager that a positioin had opened up and I should post for it.  Immediately I did and I got a call for a phone interview a few days later.  I was excited and nervous.  I went through questions on the internet on how to best answers questions about your weaknesses, why you feel you are qualified and why you want to work on a unit and had nearly two pages of single spaced 11 inch font answers all ready for the the phone interview and no, I am not a worrier, or neurotic, or a perfectionist ;)

I got the call and it took all of ten minutes.  I breezed through it and felt really good about my answers.  I was told I would get a call back in about a week if they were interested.  Okay, here we go witht the waiting game.  I thanked HR and hung up, but then my phone rang not an hour later and I was shaking -- CRAP!!  They had forgotten to ask me something or I was that bad they knew immediately how much I sucked.  I answer (Gulp) "Hello." 

"Hi, E, We have your results and you did really well and we are calling to set up a two hour working interview with the nurse manager."  Oh my God, you are, I thought!!  "Oh that's awesome!" I said.  We discussed times scheduled it at 9:00 am on the following Wednesday.  I would then have to haul ass down to KSU by 1:00pm, since Psych class takes attendance -- blah!!

December 1st, I dressed in my scrubs and headed down to my old stomping ground (or to what felt like it anyway).  I got there about 15 minutes early and ended up hugging lots of nurses and saying "hi." Everybody seemed pretty glad to see me.  My preceptor was there and I got a huge hug from her, have I mentioned how great she is?  I waited until about 8:55 am to head down to KD's (the nurse manager) office.  We chatted for not even an hour about everything.  We were then supposed to commence with the shadowing but the resonse I received was "you already know the floor, the nurses and how the unit works.  I am not going to make you shadow.  You can leave or you can go visit with the nurses, or just hang out, whatever you like, just don't pass any medications."  I laughed, this was so awesome, even a little fun.  She told me she would know within a week, who she would be hiring, but HR is slow so if I didn't get a call in a week, then don't to panic.  I left her office and helped my preceptor care for a patient who was vomiting, changed some sheets, helped a guy arrange for his dinner and said my good-byes, hopefully not for the last time. 

One week later, I had received no phone call and I was devastated.  I had sent a thank you letter and worried and worried and -- nothing.  Some of my classmatesknew about the interview and would ask me everyday "did you get the call yet?" "No, they don't want me.  I am not gonna get it"  I said.  "Yes, you will!  They love you" they said.  I hadn't really told anybody for fear of cursing myself, but maybe the few who did know were enough to curse me anyway.

This Thursday, I had stayed up until about 2:00 am working on my last project and so I heard my phone at 9:30 am on Friday morning I was a little groggy, until I saw the number. It was THEM!!!  I sat up quickiy and had a huge head rush.  My heart was pounding in my chest.  I felt like I was under water.  I was losing my hearing.  Oh, Sh*t!!!!  I am gonna pass out.

Me: (heart rate is well above 100 bpm) "Hello."
Them: "Hi is E. there."
Me: (Of course, it's me!!  This is my cell, who else would it be?) "Yes, this is she."
Them: "This is so and so from the so and so."
Me: (I know who it is!!  I have been waiting for you to call all freakin' week!!) "Yes, hi, how are you?"
Them: "Oh, great.  Thank you. And yourself"
Me: (my heart is about to explode and I am ready to puke, how do you think I am feeling) "I am doing really well. Thanks."
Them: "Well, I am calling on behalf of KD, about the RN position on such and such a unit."
Me: (of course, I know what you are calling on behalf of!!) "Oh yes?!?!"
Them: "Well we would like to offer you the position (goes over shift, pay, details etc...)  "Would you like to accept?  Oh wait do you have any questions?"
Me: (Yeah, why did you wait so long to call and Hell No, go back to your question!!!!) "No, I have no questions."
Them: "Well, would you like to accept the offer or would you like time to think about it?"
Me:  (that's all I have thought about for a week and a half, how much more time do I need?!?!?!) "Um, no I don't need time to think about it.  I WOULD LOVE TO ACCEPT THE POSITION." 
Them: "Great!"  then she goes over more details and requirements for start date and hangs up.

I sat there for a good two minutes just staring at my door and smiling and then I jumped off my bed and yelled "I DID IT!!! I GOT A JOB!!!!!"  I am an idiot, but an excited one nonetheless.  I found a job in nursing before graduation and on the unit I wanted to boot.  I had heard horror stories about kids who had graduated in August still looking for jobs, but not me.  I was on top of the world, now to pass my finals and my boards.  (HELL YEAH!!!!!!!!!!!!!!!!!!!!!)

Last Days

It hasn't set in at all that today was my last clinical ever, before I become an RN, barring failing any exams (actually I could fail and still pass, unless it was an extremely low grade).  Every patinet I had in critical care with the exception of one was intubated and none had made it off the vents when I cared for them.  I had a patient a few weeks ago that respiratory therapy attempted a wean test with (usually lasts about 30 minutes), but she failed within 10 minutes.  Today, my patient for the first time in my critical care history ... PASSED!  I took that as a good sign for not only him, but for me. too.  He had been taking quite a bit of the Michael Jackson juice (Propafol/Dipravan) as I have so fondly been calling it and when I stopped the pump, called out his name and gave him a firm sternal rub he could barely open his eyes.  However, when I reported off a little before 1pm he was extubated, had a venti mask on and was turning his head to the left and right.  What a fighter!!!  Hell Yeah!!

Tomorrow, I have my very last class from 9-1p and testing from 1-3p, but you can bet your candy canes I wont be going down until noon or so.  I have one final project due by midnight tomorrow that's pretty much all wrapped up.  I look back now at all I have learned and I still feel like I don't know anything.  It's rumored it can take up to 2 years to feel  comfortable on the floor -- yikes! 

In other related news, I nominated my precpetor for an excellence award as a leader in nursing and lo' and behold I received an email stating ..... "thanks for nominating so and so.  Your nominnee passed all the necessary criteria and will be honored at a semiformal dinner celebration."  She hands-down deserved the award and so much more in my opinion.  I don't think I could ever thank my preceptor enough for all she did to guide me as a soon-to-be new nurse. 

The entire nursing school experience was much more difficult than I had ever thought it would have been.  I generally am not an overconfident person, and when it came to academics I never worried.  This program has really knocked me down a notch or ten, but it's also opened my eyes to critical thinking and application on a whole new level. 

This program has afforded me the opportunity to meet twenty-nine peopleI will never forget and miss dearly.  We have worked together, studied together, and even cried together, but all those times don't even come close to how much we have laughed together.  I know they will all be very successful in their nursing careers.

 On Wednesday, if I haven't said it before I am scheduled for my last exam.  It ends at 12:30pm and when I walk out of Henderson Hall it will be for the last time. 

I will have victoriously crossed another finish line.

Holy Hibernation Batman!

It looks like winter has hit.  I am usually not excited for the snow, but I had such a great winter of running last year with the snow falling, the slush slushing my shoes and lets not forget the cold butt cheeks that I can't be anything but excited for this year!  Except for one problem, I can't stop sleeping!!!  I have been so drowsy since last Thursday.  I still have 6 days left of school too before running season can commence. Everyday I have been getting a little bit more pumped about the nice quiet days that lay ahead for me.  The days that will only require me getting out of bed and lacing up my shoes for the next few weeks and coming home to a nice hot cup off coffee with Baileys in it...mmmmmmmmm!

I just need to stay awake long enough to wrap up two more projects and four exams!!  I did my professional issue yesterday and it got a few laughs and an A....WOOT!!  I am learning to become googledocs savier-ish.  I like powerpoint and attaching documents to emails, but KSU is so up to date on technological advances it was unavoidable and I had to submit to there "linky" ways. 

I am hoping to have some beyond exciting news here in the next few days (or some super sucking news), but I don't deal in patience.  I deal in patients :)  I have noticed I have acquired this urge to make up new words or transform them from verbs to nouns or adjectives too (weird, I know). 

Running has been about 3 times a week.  This week I have 0 in and probably wont do any, just not in the cards, nor do I want to.  It's gonna be a long road back, but no sense worrying about that now -- at least my weight isn't going up, so maybe I am not really ready to hibernate yet.

"Hey Man, Nice Shot"

Is just not an acceptable thought in my head right now as I have 11 measly days of school left until graduation!!!  The long road within the never ending tunnel of darkness has come to an end.  I can see the light. 

I finally got out for a few runs to counteract my sluggish, defeatest attitude the last few weeks.  I am moving at the speed of a true turtle, especially with the additional poundage nursing school afforded me, but it's better than sitting on my bed with my laptop for countless hours trying to do, well you know, all that stuff that has kept me from triathlon and running and stressed me the heck out for the last 15 months!!

I feel very removed from my friends and the endurance world right now.  Everyone is talking of big dreams and goals for the upcoming year.  I am starting to enjoy my runs here and there again, but the idea of racing and "training" is so much for me.  I feel like Maverick from "Top Gun" right now.  I have lost the edge.  My motivation to run is there, but to compete and all that jazz, yuck!  I just pushed myself through nursing school and realized I am ready to decompress not re-compress with a new stressors.  Hopefully, my racing motivation will return by April 18, 2011.

Over the last few weeks, I have really cut back on my studying, tried to go to bed earlier and myabe even sneak in a few extra minutes of fun.  I have slowly started to realize somethings in my life must change.  I am so excited to become a nurse and get a job, hopefully in oncology.  I still have my work cut out for me with finals in 2 weeks and the infamous NCLEX exam for licensure, before it's official but I am definitely ready for this challenge!!  I just can't see myself failing, so I say bring it!!  I worked too hard for this one and I know I can do this :)

Results are in -- It's da' bomb

I pulled out all B's on my exams.  The first line defense was SSRIs, but because they take 4-6 weeks to work benzodiazepines are given immediately.  I got it right, but personally I think that question is bull.  What am I saying, I think they are all bull.  The question about the patient having the acute myocardial infarction, should not try to pull himself up in bed.  It could make his heart explode.  He should just lay there and wait for help.  Finally, the math answer is 8.4 or rounded is 8 ml/hr.  Thankfully, I have not missed any of the math.

However, this week included another critical care exam that I nearly failed.  I have been so tired and unmotivated to do anything the past two weeks.  I came home from clinicals and finally got in a run, only to fall asleep and get in no studying for the exam.  I also received my paper grade that my instructor had said not to put too much effort into with a really terrible grade on it.  I was mad at myself for putting so little effort into it, but I was a little pissed at him to for saying not to worry about it!  What the heck does he want?  I am just so frustrated and tired of nursing school.  I am contemplating quitting every other minute.  I am burned out and after the last test, which hopefully I didn't miss any math on, I am done.  It's like the last few miles of the marathon for me.  I just want it over.  I don't care anymore.  I hate worrying that every time I have a test I will ruin my grade and fail.  December 15th can't come soon enough.

Hell Week

It's over.  I had known this week was coming for 10 weeks, but couldn't even think about it for fear I might break down crying, quit or just start screaming and pulling at my hair.  I know it seems like it's just school and school is easy right, but nursing school is unlike any other.  You can study, study, study and still NOT get it.  It is absolutely imperative you train your brain to think in a critical manner, based on the over abundant information they try to smash into your brain.  An example of a critical thinking question that I missed on my last exam was ...

The patient is having an acute myocardial infarction, which of the following would be the worst thing for him to be doing...

a. Sitting in a chair for 30 minutes
b. Getting up out of Bed
c. Eating
d. Bathing

Go ahead, post your answers (heck include your ratioionale for why if you like) and I will let ya know in my next post, or post nothing and just wait for the answer. 

Monday I had my first exam in Leadership which was fairly easy to pass.  It's not a matter of understanding the material, it's a matter of finding time to look it over.  Tuesday, I spent the morning with the crazies at Metro on the 6th floor dealing with a patient who tried to kill himself by swallowing a bottle of seroquil and a fifth of vodka because he felt he was useless and couldn't do anything right (had to laugh at the thought that he couldn't even kill himself right -- I know terrible thought, but I had it nonetheless).  Wednesday, I took my second exam in psych, which I studied the hardest for and did the worst on.  I think the class has too many instructors with different points of view and criteria and we are all just a little lost.  A prime example is a powerpoint slide in our notes looks like this...

BIOLOGICAL INTERVENTIONS FOR ANXIETY

SSRIs (Selective Serotonin Reuptake Inhibitors)
- produce anxiolytic effects by increasing the transmission of serotonin by blocking serotonin reuptake at the presynaptic cleft; take about 2-4 weeks to work
Benzodiazepines
-the most commonly used medications for panic disorder even though SSRIs are recommended for first-line treatment; they are fast acting and usually given first

THE QUESTION
Which of the following drugs is used as a first line intervention for anxiety?
a. Benzodiazepines
b. SNRIs
c. SSRIs
d. Alcohol

We find out the answer on Wednesday, and I picked SSRI's, but half the people picked Benzos because that is what is given right away and most often.  So, the real question is what the heck does "first line intervention mean?"

Thursday, I had to get to Marymount for critical care by 6:45am, so I was exhausted from only 4 hours of sleep and I had to do six medicaiton sheets on drugs and their effects and things the nurse needs to watch so she doesn't kill her patient like labs for blood, liver and kidney toxicity, urine output.  An example, lopressor is a beta-blocker, usually given to patients who have hypertension, but if at 0900 you are scheduled to give the guy his meds and his heartrate is less than 55 beats per minute and his BP is 120/80, if you give it you will probably just put the poor guy into cardiogenic shock or damn near close, so as a nurse pay attention!!  My first week my patient had coded twice, once less than 24 hours before I was assigned to her and had a transvenous pacer and a transcutaneous pacer keeping her going along with a nice little endotracheal tube and a ventilator to help her breathe with vasopressors and propafol.  The code cart was in front of my door and I can't say I wasn't scared shitless my patient was gonna punch her ticket on my shift and freak me the hell out.  Thankfully, she made it through and so did I.  This week my patient was cake compared to her.  He was even awake and could talk to me a little, so I was able to take some time to actually learn how to do central venous monitoring, using the phlebostatic axis.  The poor guy had some bad scrotal edema (BEWARE!) and kept telling me "my balls hurt!" so every 2 hours I was pushing 3 mg of morpine in  his IV and telling him to "stop touching your balls then."  He was too funny.  We managed to get out on time at 5:30 pm on the dot.  I hurried home, already exhausted and managed to force myself to listen to audio lectures and cram for my critical care exam until 2:00 am before I couldn't keep my eyes open.  I set my alarm for 6:30 am and managed to drag myself out of bed for another hour and a half of studying before heading out for the last of my three exams.  I wasn't even panicked at this point.  I was just exhasuted and knew by 10:30 am, pass or fail it would be over.  The last test I took this week consisted of 50 questions 5 med math that you must work out yourself with no choices.  There are 5 on each of the 3 exams and you can only miss 2 or you fail and you have to take the "Save My Ass Exam" immediately after the final exam which is 15 quesitons that you get 30 minutes to do.  If you fail again, you fail the class.  Two weeks ago my classmate told me how she had to take it and another girl in the traditional program sitting next to her had failed for the second time.  She just broke down crying in class, knowing she had just failed the class and would have to take it all over again because of 15 math questions.  An example question looks like this...

Your patient is in CHF (congestive heart failure) and is place on a nesiritide (Natrecor) drip.  Nesiritude 1.5 mg is mixed in 250 ml of normal saline.  A continuous infusion is ordered to run at 0.01 mcg/kg/min.  The patient weighs 185 lbs.  At what infusion rate should you set the IV pump?  Answer will be in ml/hr. 

Now, these are really just means extremes problems once you get everything into kg. or mcg. or mg. what ever you are using, but all the stress of failing builds up on you.  I never did the math to figure out how many I needed right to maintain a passing grade in a class until nursing school.  Needless to say, I passed and by 1:00 pm me and 10 of my classmates trekked to the bar to celebrate living through hell week.  I have no more exams until finals now, one big paper and about 8 small ones and then it's done.  It's really done.  I will be through the hardest academic challenge of my life.  I don't really believe graduation is only 5 weeks away, but it is.  It was way harder than any marathon I ever had to do and at times felt quite comparable to a some distorted version of hell, but my classmates and I (most of us anyway) survived it.

We did as Winston Churchill had advised..."When you are going through hell, keep going!!!"

Exit Externship :(

Well, it's over and it hasn't even been a week and I miss it already. I feel like I learned more in 120 hours of my externship than I did in all of nursing school. I am sure the truth is it just all finally started to come together for me.

I feel my preceptors were wonderful. They always provided feedback good and bad, but never in a condescending way and kept pushing me to take on more patients and nursing skills, even though at times I felt unprepared. I enjoyed the one on one experience much more with my nurse as she was there initially to guide me and help me get into good habits.

This rotation finally removed some of the doubts I had about my abilities as a competent nurse and replaced it with some confidence. I learned even if I don't know something, I have become independent enough to find the solution. My last 40 hours I was pretty much on my own, unless I needed medications out of the pixis or chemotherapy or blood were needed. My preceptor had thought I was proficient enough at pushing Zofran in an IV and I felt confident too. My last day I went to push some in a patient's IV and noticed it was D5 and not normal saline. I was quite unsure of the compatibility and did as I was instructed since day one. I was honest. I told the patient I was unsure of the compatibility and I wanted to check before I killed him. He laughed and thanked me for thinking of him. I left and checked -- they were not compatible. I was so glad I had trusted myself and admitted I didn't know! I went back stopped the pump, clamped the line flushed it with normal saline, pushed the Zofran and flushed it again with normal saline before starting the pump back up. I was so elated, I had not hurt my patient, maybe I could do this.

My second to last day had been very hectic. I got behind on my medications and my documenting, even one of my assessments wasn't done until 11:00am because the patient had been off the unit for a few hours. I tried to manage my time wisely, but every time I went to document, someone needed a medication or an IV was beeping or people wanted discharge. I didn't get frazzled, just realized I couldn't keep up. My two main priorities became getting a patient discharged and getting a sent tray for a patient that had one meal in two days due to NPO status that had been waiting for it for 4 hours! Needless to say the secretary had put in the tray for dinner and although we had ordered it at 2:30 pm and called four times it didn't arrive until I finally went upstairs to the pantry to personally pick it up. I left wondering why I had such a hard time taking care of my three patients. My only plan was, if I was waiting for chemo to be checked or hung or something else I couldn't participate in, I would be documenting, instead of standing and watching.

Friday, my last day, I went in and had two of the same patients and one new admit. It was by far, undoubtedly my best day of time management ever. I had everything done and nearly all my documenting with the exception of one patient note before noon. I couldn't believe it! I stayed past my 120th hour. I wanted to discharge a 57 year old woman with brain cancer and metastasis to the liver that had just signed a DNR the night before and was going home to brother-in-laws and sister's house with hospice care. The doctors explained to her that because her radiation was so recent another dose. It would undoubtedly cause necrosis of her brain tissue and the treatment would be as disabling as the disease. She and her sister gave me and my preceptor so many hugs as they left. They thanked us for all the wonderful care and support and all I could think was "that's it, that's all I can do and it's not enough." It was very hard to watch her get on the elevator and leave knowing that she was not going to beat her cancer.

My drive home was full of reflection about how much I had enjoyed the patient's, the nurses, everything about G-70, about how much I had learned and how much better I felt about maybe calling myself a nurse soon. I had had an awesome experience and could only hope to be lucky enough to go back as an employee after graduation.

The Blog Is NOT Dead

Good grief where have the last few weeks of my life gone?  Every semester, I had hoped it would get easier and every semester it gets crazier.  The tests are the same, but now we have so many self-reflection projects to incorporate into our analysis of the nursing process and research articles utilizing evidence based practice, not to mention trying to remember how long I can leave a peripheral line in a patients arm, all the while hoping for an order to extend and STOP!!  JUST STOP, I keep telling myself, but I can't.  Every time I turn around it is another new assignment. 

School has now incorporated mandatory attendance for classes that talk about the most exciting things like malpractice and managment theories.  It is like being at the superbowl.  Very exciting!!  NOT!! 

My psych rotation completely blows ass!  I feel most of the patient's are a bunch of sissy bitches that just want to utilize the fact that they drink or beat their families because they can't HTFU and make the necessary choices not to be an asshole.  We have a ton of patients who are "suicidal," but yet they are full codes.  Really?  Do you wanna die or not?  I had one patient who has tried to kill himself more than ten times, yet he refuses to take depacot because his lab results have shown liver toxicity in the past.  Again really?  You can't live without a liver, you wanna die, so why do you care?  In my non-psychiatric opinion, I feel he just wants attention.  I bet if someone were to stick him in the electric chair and threaten to throw the switch he would change his mind about dying.  Needless to say I have little tolerance for this rotation as we don't actually cure or fix these patients.  We take care of them for a few days and try to get them to at least pretend they are sane and then send them back out there until they come back again in a few months.  We also had a disgruntled HIV black male patient who was racist and they wanted one of us to take him.  Hell No!!  All that guy has to do is get pissed off and bite me and then I have HIV too.  As a lowly nursing student, I definitely have the right to refuse to provide care to some people -- him being one of them!

On the flip side oncology is just beyond rockin' right now for me.  I don't care for the 4:50 am wake up calls 2-3 days a week, but the work itself is very rewarding.  My preceptor is awesome.  At first she gave me the most difficult patient (the one with the most problems or needed the most care), but now I am up to two paitents, so she lets me pick which cases I want to deal with.  I usually take the hardest patient and an easy one.  I have definitely had to learn to manage my care on the floor or I would never be able to care for more than one patient at a time.  I felt strange being only a nursing student and delegating to a paid patient care nursing assistant things such as vital signs, intakes and outputs, mobility and feeding instructions, but that is supposedly one of the pitfalls of a new grad -- trying to do everything themselves and not knowing how to delegate, thus resulting in less quality care for the patient, so bossy it is :)  While I feel it is not my job to do those things, it is my responsibility to make sure they are done.  I had a hard time trying to figure out how to tie in all this leadership and management with my patients at first because I was so busy worrying about tasks, such as a head-to-toe assessment and what to look for (e.g. edematous patient, check for crackles in lungs, JVD, capillary refill, tingling or numbness in extremities or immobile, does he have DVT's, is he on heparin, does he use incentive spirometry is he using the deep breath and cough method...oh the list goes on and yet there are probably tons of things I am missing), grabbing a refill of water for a patient, or just plain old utilizing my therapeutic communication skills to listen to the patient's concerns, I had no time to reflect of even sit down to eat lunch on the first two shifts. 

The chemotherapy regiments are about 4-5 days with bags being hung consecutively every 12 hours.  Some require two IV lines such as, Fluoracil and CISplatin because they are incompatible while others need administration of a rescue after, such as Leucovoren, which acts as a toxicity prophylaxis for those given methotrexate.  Cancer is not just cancer on this floor.  It is accompanied by complications such as neutropenic fever, imbalanced nutrition, especially if the cancer is esophageal.  Some of the patients have a corpak because they have dyspahgia and are at a high risk for aspiration.  One patient had radiation on his throat and had very visible blue radiation marks along with what looked like the worst sun burn ever.  He was prescribed aquaphor for his neck and a warm soak to maintain the skin integrity and minimize discomfort. 

My second week we moved from one unit to another.  The nurse manager on our floor is no doubt a leader in a management position.  I was able to observe her interactions with directors, nurses and construction workers as to what the most effective and time saving way to safely move patients who could walk, needed a wheelchair or were completely bedridden.  The nursing managner and the assistant nurse manager spent about thirty minutes developing a floor plan on which patients to move first and which room to assign them to. They split the nursing staff up into teams of those who would be sending the patients and those who would be receiving patients.  I was on the receiving end.  I escorted patients to their new room and plugged in their IVs, put the bed in lowest position and made sure some, but not all the side rails were up, as that is a restraint, unless they do it.  As time wore on our nurse manager felt it wise to take a "time out" and confirm all patients were safe and in their assigned rooms and continuity of care was being maintained.  It was very organized. 

Unfortunately, with all this nursing there is just not enough time to jump on the "train" wagon.  Hopefully, once I get some of these crazy projects off my plate and meetings out of the way I will be able to do a few things in the upcoming weeks.  Either way this is all gonna end in 12 weeks.  I can't believe it.  It seemed just yesterday I started this and to think it's almost over, at least the school part will be.  It looks like I wont be able to take my boards until late January or early February and then I can get a big person job!!!!!!!!!!!!  Holy cow, I am so close I can taste it....mmmmmmmmmm, mmmmmmm, mmmmmmmm :)

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.

Bleeding Hearts

Boy did I hit a nerve today at clinicals. 

It is inevitable that working in the healthcare field is going to bring up the problem of healthcare reform.  While I usually try to play devil's advocate or take an opposing side just for the sake of argument, today it happened because I can't stand the sympathetic, pity party for sooooooo  many who don't deserve it. 

It seems the majority of my classmates believe that ALL people in the United States should get equal healthcare.  I don't quite feel that way.  I believe that since healthcare is tied to income, those who have jobs and pay for it should be allotted healthcare and those who are unemployed, having unprotected sex and having unplanned pregnancies are shit out of luck.  I am a firm believer in Darwinism.  If it comes down to providing food clothing and money for my kid or giving it to someone else's kid because they can't too freakin' bad.  If all these bleeding hearts want to adopt a person without healthcare or a family fine, but don't force me to follow the rules, pay for my healthcare and then charge me money for those who don't. 

I would be all for healthcare for all people if it wasn't a "throw money at the problem" solution.  I believe education, health promotion and disease prevention are key, but not an allowance. (hence my decision to work in the field of nursing -- perhaps I will move to Oregon and do assisted suicide --LOL) 

I see healthcare as a priviledge, not a right.  Why should a smoker or a person that goes to McDonald's everyday and makes poor food choices be given the same healthcare as me?  Both are risk factors for higher inicidences of many diseases.  Why should some homeless bum who spends her life doing drugs and drinking receive healthcare when she gets pregnant?  It is her mistake hence, her problem!  Abortion is a couple hundred bucks.  I would much rather give her the money for the abortion, than pay for her and her kid.  Lets face it, the kid will probably not be that special one that does anything with his or her life anyway (Birds of a Feather...).  And don't give me that "the Lord wanted me to have a baby" garbage, because I didn't get the message from Him that said I had to pay for it!!  Survival of the fittest, if you can't protect yourself and your young...SEE YOU! 

If two kids were dying and both needed a heart transplant, but there was only one heart and you paid into the healthcare system for you and your child all your life and some ghetto-ass, drug addicted mom brought in her baby for the same heart, do you really think that is fair?  I know it's not the child's fault but I refuse to allow the government to make me responsible for a mistake (having unprotected sex), that was followed by another mistake (having the baby) because these people don't believe in birth control or abortion. 

Our society is irresponsible and indulgent.  Americans, can't control money, can't control their diet and they can't control their sexual urges it seems.  We need to teach people discipline, refrain and control while educating them and empowering them to take responsibility for their lives and the lives of their children, not say "oh, it's okay, somebody out there worked really hard and can throw money at the problem for you!  Don't worry, you can continue to be a total fucking loser and never be held accountable.  It's not your fault." 
(I know there are a exceptions to the rule and some people who lose their jobs and are trying.  A system that helps them would be awesome to be in place, but these other people = Be Gone!

Cardiac rehab showed me the unwillingness of so many to change their diet (high fat, high salt, obesity) and lifestyle habits (stress, smoking, inactivity).  I work with a bunch of single moms who worry more about where they are going out after work ends then getting home to their kids.  They all know better, but they don't care and I am suppose to care?

Give me a fucking break!!  Take some responsibility!! Grow up!! 

Our healthcare system is the Titanic. We are sinking and we do not have enough life boats. We are not all gonna make it.

Lost

It's the running theme in my life the last few weeks.  All the work along with the bumper schedule I am on is constantly pressuring what few brain cells I have left to keep me in line as to the when and where of each day.

I can't remember if I am coming or going as I only sleep about 4 hours at a time and when I wake up I am not certain if it is to rise for class, clinical or work.  Just a week ago I drove a few extra miles in the wrong direction to the wrong clinical before realizing what day it was.  I have also locked my keys in the car twice in the last 3 weeks (thank goodness for the hide-a-key).  Not a day goes by that I don't wish for June 25th to get here, so I can be done with this awful schedule.  It is so non-compliant with my life, not to mention with my parents away for two weeks I worry that "The Bails" will be home just a bit too long and try to eat a hole through the wall like he once did as a puppy to punish me for being an absentee owner!  I try to make it up to him by taking him running with me, but training is sporadic at best.

I did get out for a nice bike ride two weeks ago when it was in the 90's.  I meant to go to a family picnic, but had my days wrong and I went to the wrong park.  On my way back I went a new route and got lost for a bit, so with only one water bottle I had to detour to a park to find more fluid before going home.  My lack of seat time reared it's ugly "head" or is it "ass" in this case when my not-so crotch of steal started to become painfully sore after an hour and a half.  Luckily, it was only thrity minutes home. 

I had another midterm this Monday, but felt extremely rebellious as racing season is in full swing and decided after only a few hours of studying on Sunday to go for another bike ride.  Again, I got lost and my hopes of riding about 35-40 miles translated into 49.  I ended up in Mantua riding the Potato Stomp course and then some.  It was the perfect day for a ride and I loved every minute of it, even the minutes after my butt time buzzer for comfort had expired. 

I didn't learn much gerontology that day, but I did learn a long painful ride is still better than any type of studying (especially in the summer!).  Oh, to find my way back to a schedule that is either days or nights with no bumper shift will be glorious.

Just Around the Corner

This semester, I have 6 weeks of community nursing and gerontology for rehab and it is intense.  I finally broke down and bought some Unisom to help me sleep and it's working, but the problem now is it is lingering and I am exhausted 24/7.  I fell asleep at the my gerontology clincial watching a video on dementia and alzheimers the first day and have been napping in my car on my lunch breaks.  I am so over the top intense and stressed all the time through nursing school I don't know what to do, except keep going until December when it's over.  If I take the pills I am tired.  If I don't take them I am tired.  If I quit the program, well that is not an option.  It is worse than it's ever been.  I have 35.5 hours of clinical and class time, combined with 12-15 hours of work and 14 hours of drive time, putting me at 60+  hours not counting all the time I need for projects and studying for tests. 

I feel tightness in my chest and my throat all the time. I don't feel like I am learning the material because it is so fast and I am just guessing at everything I do in class.  I am not doing anything I don't already know how to do at clinicals.  I am just killing time.  I am completing my degree to be an RN, not an LPN or an aide, yet at my gero clinical I spend my time bathing my patient, teaching her how to wipe herself correctly and washing her hair, because that is what my patient needs the most. 

I can't stand the smell of old people, but the thing is old people only smell because the people that are supposed to be taking care of them are doing a half ass job!!  Old people get fucked up feet to if you don't apply lotion and wash them appropriately they smell!  I don't want to change bedpans or wipe asses, but I absolutely refuse to have a stinky patient.  Needless to say, it seems healthcare professionals get lazy or burnt out and become a little calloused to caring for patients and when I gave my patient a foot bath and massage she ended up crying and telling me no one cares enough to do that for her and she was glad someone still did.  I left the room and told my instructor I couldn't deal with that and needed this rotation over.  She was proud of me, but I just felt sick.  I vowed that day I would take time off work to care for a family member before I let some half-ass healthcare people do it.  I guess what I am saying is there are shitty people working everywhere.  It's not the first rotation where I saw a lazy healthcare worker.

Community is overwhelming with the amount of paperwork.  I have a midterm on Tuesday and haven't studied yet, because I had to prepare for a population teaching project.  ML and I were told we had to each do an hour presentation on puberty to about a hundred 4th graders.  The words "oh shit!!" were flashing through my mind.  I hated going through puberty.  I hate my breasts.  I hate menstruating.  I hate having to shave.  I hate not being 50 lbs and being able to do an unlimited amount of pull-ups.  How am I suppose to explain to all these girls that becoming a woman isn't too bad?  Oh, and not cover the topic of sex, fertilization, STDs or pregnancy?  We were told the kids were too young and to tell them to defer to their parents with questions in those areas.

I am not a presenter.  I get nervous and shaky.  I would rather write a 50 page report.  We over prepped with our outline, transparencies of female anatomy, a powerpoint with topics to cover and I re-read all the basics of puberty just to make sure I hadn't miss anything in my three degrees.  It was definitely overkill, but I was armed.  I started off by asking the girls if they knew what puberty was.  I got some really strange answers like "red" and "hair" and "your hands and feet get bigger."  All of them were in a sense right, but they were avoiding the BIG answers, so I said "Come on guys.  What's the difference between you and me?" To which I got the response "you're old!" WTF!!!!  Ahhh, I should have known that would happen.  It did lead into breasts and growth eventually, but damn really, old? 

I introduced a video called "Just Around the Corner" which covered the growth changes, menstruation, ovulation and the importance of good hygeine.  I had two choices when the video was over.  I could re-lecture on the topics or I could do a more interactive Q & A.  I wanted to do the Q & A because the girls were nervous and had not been excited about this lecture today.  My outline had my objectives for my instructor to grade me on such as know the definition of puberty, identify the changes, understand the process of menstruation, understand what things good hygeine involves etc... But I had my own underlying objects to make the girls more comfortable with what was to come so they would make the best choices or at least be able to identify a trusted adult in their lives they could go to in the future for questions.  The only problem was if I did the Q & A I might lose control of the group, or miss covering an objective both which would lower my presentation grade.  I ended up choosing the Q & A.  I couldn't give the talk based on my grade.  I want to be a nurse.  I want to help people, even if my grades suck.  The girls started off asking about tampons.  I was told to cover pads and pass some around but to avoid tampons, because of toxic shock syndrome and that they had to discuss that with their parents.  I tried but their were too many questions...

"How do you know you put it in the right hole?"
"What if it goes to far in and gets lost?"
"How do you get it out?"
"Can you feel it and does it hurt?"

I finally gave in and pulled out a transparency of the female anatomy and explained how a tampon works.  They were way too curious to not cover the topic.  We had a few good laughs and I got more and more questions.  I would see 5 hands up and answer 1 and then 4 more would go up.  It was crazy.  I had won them group over and they were interested in my lecture!!  I had to defer a few questions regarding sex to the parents, but for the most part I was able to explain a lot and I concluded the conversation by explaining it was okay not to be embarassed and no one should make fun of someone regarding puberty.  When I was done I asked "how many of you feel much better now about puberty than you did when we started this?"  Every single hand went up!!!!  It was a victory.  I had done it.  I was super nervous and a hot mess by the end, but my instructor said I was getting no less than a  98%.   YES!!!!!!!!!!!!!  Perhaps, I would survive this semester afterall.  Four more weeks is just around the corner.