The Questions

I’m in an accelerated nursing program. It is geared specifically for people who already have a bachelor’s degree in another field and want to receive their bachelor’s in nursing rather than an associate’s degree. A common question in the first semester is, “What was your previous degree?”

But then, people decide they want to know you more. They now have two options:

1. “Why did you leave ______?”

2. “What lead you to nursing?”

I know that I’m having a bad month here in Ray of Sunshine Land, but for the love of God, these questions are getting on my nerves.

So, let me answer them for you –

1. I didn’t like teaching; I liked interacting with the students, and I liked singing. Teaching those concepts was draining the life out of me. Oh, might I mention a few colleagues made my life a living hell? Yes, teachers can eat their young as well. I found that I was selfish with music – I need it to be my relaxation. I don’t see music and arts as the first thing that people need for their lives. Public education bad days

2. I had a quarter-life crisis. Got tired of doors slamming in my face. Wiped the slate clean of my options, looked at my skill set. Thought about nursing, pursued it and doors opened. Loved the opportunities. Most every clinical I end thinking, “Maybe this career track is for me?” It fits my preferred M.O. as I like to be at a place and just go. I’m not an 8-5 for 5 days person.

And last thing while wrapping this up, I’m tired of hearing, “you’ll always have a job” from people who think they know healthcare because they had their immunizations. Kind of like the people who think they know education because they were students. Nurses are generally the biggest part of an organization’s budget. We are generally the first to feel budget cuts. Yes, there are always healthcare jobs. There are always teaching jobs. They just might not be what the person prefers to be doing in their career.

End rant. Back to studying.

Dating a Seminarian

I entered a new frontier the past summer – I’m “in a relationship.” But as this requires as much adjustment and introspection as being single, don’t think that my blog has suddenly lost its purpose.

Yep, you heard me, being single – a content single – requires as much introspection and processing as dating someone.

Anyway, my boyfriend is an Orthodox Seminary graduate. With my involvement over at Orthogals, it was suggested that I write an advice feature on dating a seminarian. Since this would involve his life, I ran the idea past him. The conversation:

Me: So, the Orthogals are wondering if I can write a feature on dating a seminarian. What do you think?
Him: Um, I don’t think that’s a good idea.
Me: (seeing his reticence and suddenly being aware of the personal nature of it) On second thought, maybe not.
Him: Actually, let me give you my advice for dating a seminarian – DON’T.
Me: Yeah, if people actually look at the demands life will have on that family, they wouldn’t seek it out.

Later, I was chatting with my priest about life and how mine was shaping up. In hearing that my relationship involved a seminarian, my priest offered his wife as a resource to me. Of note, Preoteasa is the Romanian equivalent to the Arabic Khouria and Russian Matushka – all are terms of respect for the priest’s wife. In my parish, it has been abbreviated to “P’sa.” The conversation as follows:

Me: Your husband volunteered you as a source of advice for me.
P’sa: Oh? For what?
Me: Dating a seminarian.
P’sa: Run. Run FAR away. 

So, ladies, there you have it from both the potential priest and the wife of one – don’t seek out that position and enter with caution if you do get called.

 

When The End Comes

Sorry that I’ve been absent for so long. There has been so much to juggle the past few months, and since I have a few people with whom I can verbally process my life, I guess blogging hasn’t been a top priority. I have plans to fill in some of my thoughts and experiences from the summer, but they will have to wait.

The reason for this entry, however, is that last night I received word from Stewie that The Brain finished his battle/war with ALS.

While I hate that a terrible disease has taken yet another person in such a cruel way, my emotion is not so much based on anger or depression or bitterness. I am actually relieved to know that he fought his battle in the only way he could and was able to let go. I am relieved to know that Stewie will have the opportunity to sleep through the night for the first time in over 2 years. I am relieved to know that The Brain was able to let go of this life and not give up hope.

I’m sure there will be more writings and musings of my grieving. But they will be dampened as I do not feel my life will make as much of an adjustment compared with others.

I have been struck the past few months in how complete the prayers of Orthodoxy are for the human experience. When we let go of our pride that says only extemporaneous or spontaneous prayers are best, we find a vast wealth of wisdom. So, I leave you with several of the prayers available in the Orthodox Prayer Book published by Holy Protection Monastery in Colorado (aka “The Blue Romanian Prayer Book”)

Oh good Lord, remember Your servant(s) _______ and forgive them all in which they have transgressed in their lives, for only You are without sin and can grant rest to the departed. In Your divine wisdom and love for mankind, You bestow all things and provide for all the needs of man. O Creator, rest the souls of Your servants _____ who have placed their hope in You, O Lord, the Fashioner, the Creator and our God. Amont the saints, O Christ, rest the souls of Your servants where there is neither pain nor grief nor sighing, but life everlasting.

In one of my conversations with The Brain before I left for nursing school, he expressed to me his fear of being forgotten after his death. So, I now can pray the words I reassured to him that day: Memory eternal.

 

How to Be a Good Patient

nurse-meme-grumpy-cat

While I understand this picture of Grumpy Cat is more the patient’s view, I would like to point out the power/authority that a nurse has and that maybe, just maybe, we have some ideas that you know, deep down, are good for you.

I don’t want to be Nurse Kratchet/Ratched. The summer was long and hard to schedule work around class and being cancelled due to low hospital census. I had some delightful patients and good learning experiences. This is a compilation of not-so-great experiences. A rant, if you will. It DOES NOT mean that I do not value a patient’s opinion or experience. It only means that some patients annoyed me with their similarities of crappy attitudes towards those of us lower on the hospital totem pole (the CNA/Student Nurse).

1. Don’t talk or move excessively during vital signs. Health care workers and providers need to listen and watch for various things, such as your breathing. Movements in the arm while taking a blood pressure can make the final pressure appear too high. Your talking and yammering about how this doctor or that nurse from previous experiences is of no concern to me, especially at 3 AM when all I need to do is count how many breath cycles you have in a 30 second time span.

2. Hospitals hate falls. Hate them. We don’t want your stay extended because someone was unable to standby and ensure your safety. That being said, just because you know who you are, where you are and where the bathroom is in your room, does not mean that you are not a fall risk. We don’t put people as a fall risk because we want to imprison them to a bed, it’s because we don’t want you to get injured from your own stupidity or because you tripped over your own IV.

3. Having been a CNA does not mean you know my job or the entirety of the medical field. Taking Psych 101 and Abnormal Psych doesn’t make you a therapist. Giving a meal or a few dollars to a homeless person doesn’t make you a social worker. Answer our questions truthfully, ask questions (write them down when no one is in the room). The person there to take your temperature is not the person who orders your discharge.

4. Don’t complain that your beeping IV hasn’t been taken care of for 3 hours when I can prove by the time stamp on a monitor and through the electronic tracking system that I was in your room 45 minutes ago and nothing was abnormal. Also, these situations are when you use the call light.

5. Most units I have observed or worked on are post-operative, and most people are focused on one thing: leaving. As one of my nurse preceptors told me, “All patients need to poop, pee, walk, and eat before they can go home.” The faster you do these things, the faster you go home. Cooperate.

6. Don’t assume we are out to get you or that we intend to forget you. Unless you are an ICU patient or labor and delivery, your nurse has other patients. We might have been answering their questions.

Yes, everyone has their personal horror story or has heard of someone who experienced a series of complications only rivaled by a House episode. We know you don’t like the hospital, and our goal is to get you out of here as fast as possible.

Let the barrage of comments begin…

Complimenting the Choir

I have sung at the chanter’s stand and choir for about 5 years non-stop. In high school and college, my church and campus ministry had a rotation for people in the worship band or praise team, so there was no need for me to make a weekly commitment. Save August 2009, December 2011, and a few random Sundays of illness, I spend services as a choir member…or at some services, I AM the choir.

Yesterday, I got two lovely compliments that encouraged me more than any others combined. It was the Feast of the Dormition of The Mother of God, which is  the last major feast of the church year. Beautiful hymns encourage Christians to prayer. While in line to receive a blessing at the end, a woman approached me. “Your voice is so beautiful. It helped me to pray today. Thank you.

After the pitch-in breakfast, a man approached me as I got up to leave. “Thank you for singing today. It lifted us all up [to heaven].”

I had enjoyed Vigil the night before and Liturgy yesterday morning – the people I was singing with were on pitch and we could trade harmonizing ad lib. As a musician, those are the service moments you love. When you aren’t just singing but making music and able to have a few moments of prayer yourself.

Many a dissertation is written on Orthodox services, and I have a very simple understanding of them. I can say, however, that the reason Orthodox Christians gather is to pray. Liturgy is a prayer. Vespers, Vigil, and all other daily services are for prayer. Everything in an Orthodox church is a call to prayer and to see as best we can with earthly eyes and hearts the Glory of God.

Yet, when you sing in the choir, you give up that freedom to pray. I have experienced so many, Orthodox or not, who view the choir or worship leaders as “untouchables” or that the work of a musician is so much more honorable than they in the crowd. My voice being audible during the service in NO WAY makes me amazing and you liturgical dust.

Complimenting your choir member or director with a “woe is me” or “Gosh, you’re important” tone is flawed. Please stop doing that.

The choir members have given up their freedom to pray because we have to think about other things – like staying in tune. This also goes for the opposite – to “mentally check-out” during a service is disastrous. And because Orthodoxy involves the body, we also give up the freedom to prostrate, bow, or even bless ourselves without whacking our hand or forehead on a music stand.

God has given us a gift. We are to use it, and most of us do with glad hearts! But it does not come without sacrifice. Knowing that you were able to pray makes my sacrifice worth it.

I have had people compliment my voice after it has sung both the sacred and secular. Very few have gone to say how it has moved them to better prayer. That sufficiently humbled me to know they were praying as I was singing yet thinking about whether or not I chose the most comfortable shoes for a 3-hour service.

To The Babies I Held on My Birthday

Obstetrics clinical rotations began this past week. Day 2 was Wednesday, July 17 – my 31st birthday. Here’s what I was thinking that day.

Dear Little Ones,

Welcome to the outside world. The past week was filled with a lot of change for you. You are still dependent on your mother for nutrition and warmth, but you are now breathing on your own. And this time it’s air, not amniotic fluid. Your heart and lungs have gone through intense change and you are still causing your mom hormone and physical changes in this post-partum period. Your dad, while not new to this, is still in awe and thankful that the both of you are safe.

You didn’t know it and probably never will, but I took care of you on my birthday. 31 years ago, I was the new bundle of joy. I’ve seen pictures but time fades colors in the pre-digital photography era. I have to wonder if my face looked like a model for a porcelain doll and if my lips were perfect cherry red as yours are. As I held you, I didn’t mourn that I have yet to push a new human out of my abdomen. I was overwhelmed with a distinct sense of hope for you and wonder.

What delights will you bring your parents? How will you and that big brother I saw earlier get along? Will you color on the walls or play in the mud? Will you break hearts or have your heart broken? What will you be so passionate about that could help your corner of the world?

I hope sincerely that you will not disappoint others, but you are human, therefore you will. Thus, I hope more that you learn to ask for forgiveness and extend it. I hope you are able to see Truth and want it for you and others.

As I hear the news of what the world is throwing us – the suffering isn’t new but you are. May your eyes be opened gently so you don’t see too much at once, yet just enough that you are able to have compassion and help as you can.

It is wonderful to look upon you just being you. Content that your needs are met.

Thank you for that gift of seeing life simply when it is complex. My only regret is that I can’t tell you this for when you’ll remember nor can I leave your parents a note – that would just be creepy.

May the Lord have mercy on you daily.

Your Student Nurse

And in case you, the reader, are wondering, here’s from 31 years ago:

laurababy

Infiltrating

I began my pediatrics clinical rotation last week along with Pediatrics and Obstetrics lecture. Thankfully, I was able to get the type of rotation where each student is assigned one preceptor and follows that nurse for an entire 12-hour shift one day per week rather than two shorter days per week. I would rather have one day that is super busy and tiring and one day off than two days that are busy and tiring. I always collapse after clinical, whether it has been 4 hours or 12 hours.

My unit has medical-surgical patients with various GI, neuro, and some renal patients. Basically, a smattering of low-acuity kids who either need to be diagnosed or are coming back for a few maintenance visits/procedures.

Lesson of this week: pediatric IVs.

I had been warned in both clinical orientation and in lecture, pediatric IVs infiltrate fast. FAST. Also, little people do not or are unable to tell you that something is wrong. A nurse must look at an IV site for redness and swelling every hour and before attaching new fluids or medicines, flush a small amount of normal (isotonic) saline so we can see and feel that the catheter is  still in the vein and not poking through into the tissue. Infiltration is a BAD thing with your isotonic fluids, let alone medications.

In my clinical, I was beginning my assessment of an IV in preparing to administer an IV antibiotic that is a known vesicant.* It didn’t have a blood return (not bad) and flushed rather easily. I let my nurse know that there was no blood return, but continued to set things up. My nurse also assessed the site and compared his IV hand with the non-IV hand; some edema was present. She flushed a little more saline through and asked the patient if it hurt.

“Ow, yes!” (Patient is a younger adolescent).

Nurse, “Yeah, we should probably start another IV then.”

Patient: “That’s okay, I’ll just live through it.”

Nope! It doesn’t work like that kid. On pediatric patients, especially those younger than 16, we just call IV team because veins are not as visible the younger the patient. The IV woman came within an hour, used her awesome ultrasound and placed a new IV in the patient so the antibiotic could be given safely.

The experience didn’t scare me, rather helped me see what else goes into an assessment and better techniques for assessing the pediatric IV. Some catheters are tiny; some only need 3 cells to occlude and clot. It was a reminder that early adolescents need to know the risks of their medications and why nurses check things that seem insignificant.

My next clinical is tomorrow. Hopefully I can remember all the assessment techniques for pediatrics and focus on other important things. Like playing Candyland with a patient.

Linkage

I’ve been writing some over at Orthogals, which is taking time away from posts here.

As you can tell, something has to give between nursing school, blogging, and cleaning the kitchen and bathroom. For now, it’s blogging. When I can hire a cleaning lady – watch out!!

Anyway, here is my most recent post on dating life.

Blessed All Saints Day, Orthodox folks. And to those on the Old/Julian Calendar, enjoy a shortened Apostles’ Fast since those of us Newbies don’t have one.

When The End is Near

The past two weeks The Brain has been in rapid decline. I am thankful I was able to see him over Memorial Day when an hour-long conversation did not take all his energy for the day. Besides, since last Thanksgiving, I try to do most of the talking. He has recently consented to swapping out his usual king-sized mattress for a hospital bed and does not balk at any medication interventions to control secretions or pain. From what I read in updates, he is not uncomfortable but there is a huge battle with peripheral edema that refuses to go down. Edema, or swelling, is a sign that the kidneys are not motivated to keep filtering the extra water and usual waste products out of the body.

We talked about ALS our last day of lecture in Med-Surg 2 along with other “chronic neurological disorders.” I had to work hard to not dominate the discussion. The question was posed to the class, “What do you tell a patient who asks you if there is a cure for ALS?”

Under my breath I muttered, “You tell them to plan their last vacation.”

When going over some of the collaborative care for ALS, a group recommended Physical Therapy along with some other options. I spoke up and said that physical therapy is good, but the patient is not going to improve over time. Rather, massage therapy might be better as it had been beneficial for The Brain. Unused muscles cramp up and become rigid; if the patient will allow a massage therapist to work with the muscles early on, the later neuropathy due to muscle atrophy is greatly reduced. Having helped multiple people move or even roll in bed, those with loose muscles are MUCH easier than those with rigid and spastic muscles.

As I said earlier, hospice nursing is different. You know that your patient will not beat their disease or win the battle with their body. I knew when I first started working for The Brain and Stewie that there would be an end; I just didn’t know if I would be working for them when it came.

My prayer has not changed nor has my view of reality to the situation. Reality is merely coming into focus more clearly, along with the true reality that we are all given the gift of our lives, and we get to share those with others. I am continually thankful for Stewie and The Brain sharing theirs with me, even as ALS is sneaking around the back for its last hurrah.

Thus, as always, Lord have mercy.

Patient Simulations: Medical Student Edition

Thanks to technology, student in medicine, nursing, and other patient care roles can be put thought simulations with patient mannequins. “Mission control” is behind a two-way mirror and can “talk” for the patient, monitors are “connected” to give real-time data, and a lot of sterile saline is used as various medications.

Last Friday, rather than work the floor in my clinical rotation, I volunteered to be a nurse during medical student simulations. These students just entered their 4th year of med school and were beginning their month of ER rotations. The role of the nursing student was to act as the nurse for the simulation: assess, advocate for the patient, collaborate with the physicians, and administer medications while the doctors continued to formulate a care plan. We were not being graded or evaluated, the med students were.

It. Was. Awesome!

My fellow nurses and I got one other benefit over the doctors: we were able to go through the simulations twice. Group 1 rotated from 8-10 and Group 2 rotated 10-12. The first simulation was a practice for all of us – what was I to ask the doctor? The patient? Focus on in regards to care? What information did I need to assist the doctors and the patient? Because of the nature of simulations and how much students should not know before participation, I will refrain from specifics of the scenarios. All three were common emergencies, and one involved pediatrics. I was thankful for two semesters of Med-Surg, so I was way more comfortable with these scenarios than I would have been in January.

I felt as though I hit a stride as a nurse that second time around – the other nurse and I knew the outcomes and what to watch for while the med students were new to the situation. Also, the group the second time around had a GREAT sense of humor. I was asking for more clarity in orders: how much oxygen do you want? What drug and what dosage? Is that an order or an idea? Do you really want to give that heparin sub-Q when the patient already has IV access? By the way, your patient has below 85% Oxygen saturation for the last minute.

At the end of the day, one area stood out: patient advocacy. During one simulation, the benefits of morphine were being debated. Yes, the patient could have been given it, but it doesn’t improve mortality. Thus to a doctor’s mind, there was not convincing enough evidence to warrant a morphine administration. With Group 1, I didn’t push back on the students to order a pain killer. With the second group, I questioned.

“He’s in a lot of pain. Could we give him something for that?”

“Nah. Morphine doesn’t help long term.”

“What about Fentanyl or something else.”

(Voice from speaker) “The simulation is over.”

In post-conference, we talked about the simulation, when drugs were given, and the plan of care. We were about ready to leave when I stated my point. “Just one thing from the nurses. When it came to whether or not to give morphine, I know it does not solve the root cause of this patient’s problem, but to that patient, his pain is why he’s here. Giving half to 1 mil of morphine will ease anxiety, knock the pain down, and to that patient, you are doing something. As nurses, we’re trained to assess and we’ll hear a lot about a patient’s pain. Again, it’s not solving the root issue, but you are doing something. And that will get you far with them.”

My point was not ignored. Instead, the medical school instructor VALIDATED my point.

“That is a good point. As medical students, you need to know that by the time the nurse has time to call you to change or up the pain meds, she’s heard about it at least 12 times.”

I could have kissed that man.

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