"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.

Trailin'

I barely have time to keep the last breath of life into this blog and wrtie about things I am doing and I find of interest.  That said there is just no way I am going to write a paper on the roles of the certified nurse midwife pretty much from start to finish in less than 8 hours.  I got nothing.  After, last weeks life sucking saga, I just had the wind knocked out of me.  It's like running a marathon on Sunday and then taking no time off to recover. 

Speaking of running, even with last weeks craziness, I managed to get out for 3 runs/week for the last 3 weeks.  Shocking, I know.  I have slowly been morphing into what feels like a large mass of blob.  I can literally feel my love handles, pulling on my skin as they hang off me, likethe way the last drop of maple syrup hangs on the bottle before you re-cap it.  Anyway, graduation is only 26 light-at-the-end-of-the-tunnel days away and then bring on normalcy. 

I had been part of the CRTR running group on FB for about 2 years now and never found the time or cared to check it out, but after digging myself out of the hell hole that is nursing research, I committed myself to meeting Solar Squirrel at lock 29 last night -- no backing out now. Studying had taken such a precedent and time-consuming necessity this last semester, that I started to look forward to urges to go pee, just to have a good reason to break away from it, if only for a few minutes. 

I had run the day before and hard, for me anyway and I had taken a 2.3 (per Garmin) trot around the neighbor hood earlier in the day with Bailey.  As you can see, this is how he spends the majority of the day guarding the house.

 I figured 5 easy miles on the trail with some good running people would be just what I needed to recharge for my research paper and nursing process recording.  It was completely dark, but with over 30 people, there were plenty of lights.  I was nervous about the pace, but JC, said even out of shape I wouldn't have any trouble with this group, but I found out the route was more like 8ish miles and that is almost a long run for me these days.  Solar and I started running together with Spiderman (her beau) and about 8-10 others ahead of us.  We did about 1.5 miles on the towpath and road before we started the ascent.  We had been chit-chatting and catching-up, but I could feel myself getting tired on the hill and made mention I was probably gonna have to slow.  Surprisingly, SS said "me too" (truthfully, I think she was just keeping me company).  The front of the group broke away and we couldn't see them and there was the majority behind us, so we ended up running in a group of about 8.  We never got lost for more than a 100 meters or so and I only fell once.  We ended up rolling through 8+ miles in no time and I was bummed it was over so soon, but excited to continue my fun night out at the Winking Lizard with old friends and new ones. 

I really want to try and attend this group again soon, but with another exam next Friday morning in critical care and Thanksgiving the following Thursday, it looks like I will have to wait a few weeks.

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.

Bowman Cup 5k - A Race Report???

Running had been a little bit better than non-existant for me the last few weeks, which was definitely helping me manage my anxiety over school.  I felt pretty slow and not at all light on my feet, course I am carrying around an extra 10lbs. right now. 

A few of my classmates were planning to run the Bowman Cup 5k this year and although I wanted to run it I was hesitant because I have absolutely no money and my leg and foot are so sketchy.  I was surpised when I received a confirmation email that said I was running a few days earlier.  One of my friends had secretly tried to sign me up -- he is too nice!  So a racin' I would go!!

The race had record numbers and it started later than scheduled.  I had to stand in line for about 10 minutes and ended up getting in absolutely no warm-up. 

My classmates and I all stood together at the start, but when the gun went off KS shot out so fast I lost her right away and MV was somewhere behind me.  I made it about a quarter mile out and realized I was way too fast.  I pulled up and did my best to stop pushing.  I regained my breathing and watched a lot of people run ahead of me.  I knew I wouldn't run anywhere close to my time last year.  I looked over to see MV had actually caught and passed me just a tad at the .5 mile mark.  Wow, had I slowed down that much? I caught him and we ran together to the first mile marker.  The timer shouted 7:26, 7:27, :28, I sighed because I was about where I thought I would be and also because last year I ran that first mile in 6:45. 

MV continued to stay with me to the 1.5 mile marker and I couldn't help but be so impressed by his performance.  He usually runs in the 8:20 range or higher, but then it happened, he started to fade.  I made a decision right then to stop running my race.  I wasn't gonna PR, but MV had a great shot at it!  I also felt flat and was nervous about my leg.  I started talking to him about relaxing his form and joking that KS was only a little ahead of us and she was hurting and we could keep the gap to a minimum.  Initially, he tried to wave me off to go on without him, but my mind was made up.  I wasn't going without him.  We hit mile 2 at 8:06. 

The next mile wound up the bike and hike path back onto campus.  I remembered last year that I had been so shocked at how much harder the course had gotten for me at that point.  MV definitely, felt the inclines.  I told him to run the tangents and started swearing at him that for 8:00 measly minutes of his life all he had to do was run and then it would be over.  He was pushing himself so hard to get that PR.  We made back onto the road and I kept trying to pull him along, saying "4:00 minutes MV, 4:00 more f*ckin' minutes! Come on!!!"  We made the last climb and he hit his next gear.  I was yelling at him "Yeah, hell yeah, you got this, just get to the intersection."  The intersection was about 150 meters from the finish.  I kept thinking if he can just get to tthe intersection he'll be golden. 

We crossed the intersection and could see the finish balloons.  There was a young girl just ahead of us coming up on the finish.  I yelled at MV "come on you can get her!!"  He found his next gear, the girl ahead heard me and turned to look back at us.  We caught her, but she wasn't giving up, she hit her next gear too.  She pushed forward and I yelled "yeah, come with us, don't let him have it!!"  It was a great battle to the finish.  I was so pumped to see two people pushing themselves to the finish.  The girl ended up getting MV by one step.  His last 1.1 was 9:37.  He had fought so hard and he was rewarded with a new PR!!  I was so proud of him.  He finished in 25:17.  I crossed right behind him in 25:18. 

KS had won her age group with a 22:08 averaging 6 miles a week and also being 5lbs heavier -- the girl has so much potential! 

I finished feeling really good.  I didn't get a great gauge of my fitness, but the 8:09 pace definitely, didn't hurt me.  I never felt anywhere near tempo effort, so that was a good sign.  I went home and ran another 4 miles just to stretch out my legs after breakfast, since my feet and my hamstring were naggingly tight.  I am limping today thought (Maybe, it's time I go to the doctor). 

I know I was supposed to race, but sometimes being a member of a race team isn't always about racing for me.  Sometimes I feel it's about inspiring and swearing at someone, witnessing a new runner's PR and that is worth so much more than an age group/overall win or my own PR.

Electrified Mania

My favorite time of year has come, fall, when the leaves are so colorful, the temperature is perfect and I can eat lots of candy leading up to and after Halloween. The only problem is the pain in my left heel, just wont heal and the nagging pain that gets very sharp and painful if I overdue it in my hamstring, still lingers. Not being able to run anymore would probably cause me to commit a felony of some kind, so the last 3 weeks I have been gingerly trudging around my neighborhood for a half hour most days of the week with my favorite 7.5 mile jaunt on Sunday. I am completely avoiding hills since it aggravates the heel, but a few false flats here and there seem to be doable.

Today I started out extremely tentative and careful on what I hoped would be my longest run since Muncie. I made it out about 3 miles before that electrified feeling hit me. I was overjoyed as I had missed that second wind, tingling, ready to go get 'em sensation, I so often felt on my runs last year. I opened it up a little and felt awesome, a big smile on my face as I pressed on down Pettibone Road. I started thinking about psych class and how people with bipolar disorder loved their manic states because it was such a high and they felt so strong, even at times invincible -- that was how I felt in those next 5 miles today. My runner's high was my manic state and I loved every second of it. I made it home rolling though 9 gloriously kick ass mile, feeling great with only minor and completely manageable pain in my feet and no biting pain in the hamstring.