Odds & Ends

Firstly, because I am a huge noobnik, the link to the latest Change of Shift. I suck, I know. This is going up late.

Secondly, Mike from Scrubcap sent me a very nice email, asking if I'd link to his site. Sure, Mike! The only thing that bugs me about his caps is that he's only got two patterns for the caps that work for women with short hair. And it's not personal; I rarely wear the things myself. It's just a matter of principle.

The featured cap in that link is for the Oklahoma Sooners, which a quick Google informs me is a college football team. Boomer on, Sooners.

Thirdly, an answer to the nice email correspondent who asked me if I'd ever considered posting pictures of, say, my cat or my workplace. The answer on the cat is this: If ever she did anything interesting, I would be happy to start a Friday Cat Blogging feature. Unfortunately, she tends to lie in one position, either asleep or facing the camera with an "I'm going to rip your throat out, asshole" expression.

As for the workplace, same deal applies: If my coworkers ever did anything interesting, I'd take pictures. As it is, we're all drunk at work, lying around in attitudes of total dissipation while our patients hit the bell, so it's no go.

Fourthly, on a completely boring, girly, personal note, I got a "Well Done!" certificate from my personal trainer. I thought it was sweet, a child young enough to be my daughter giving me a fancy computer-printed certificate. The downside was that there were no gold stars on it. The upside is that she's impressed and a bit mystified by my strength and stability gains. Seems I've blown the top off the curve as far as building muscle mass goes. Wahoo me. Boomer on, Jo.

(You know, I may be snarky, but the fact that she printed up a certificate really touched me. It wasn't one-size-fits-all, as it had brains and cats on it. If she adds pictures of Robert Smith circa 1985 to the next one, I'll know we're getting along.)

Umm...what else? Oh, yes: the latest Change of Shift has an excellent post on "Communicating with the Doctor". I wish somebody had given it to me five years ago, just before I graduated. Instead, I had to figure all that stuff out myself, which led to me making a howling ass of myself on the phone more than once. All new nurses and nursing students should read that one.

Did I just mention the year 1985? Seems I did. Excuse me while I go take some Geritol. (Do kids these days even know what Geritol is/was?)

In other news, I have a product review for those of you who wear mascara. See, I had to replace all my eye makeup after that pinkeye thing, and I ended up buying some Maybelline waterproof Sky-High Curls mascara. Because it was on sale. Waterproof because I have to wear waterproof eye makeup for Beloved Sister's wedding, because I don't want to look like Robert Smith, circa 1985, by the end of the ceremony.

Anyway, it works well. Yes, it is waterproof, which means you'll have to use something oily to take it off. And yes, it does curl your lashes, in a weird process that involves you being able to feel your lashes curling. If I had done major drugs in college, that probably would've provoked a flashback. It does not clump, but it takes forever to dry, so don't sneeze after you've put it on. Overall, I give it a good rating, if you like waterproof mascara.

Ooooh. The best part of that mascara purchase? Was finding out that every-damn-thing at the local Target is on clearance. See, they're building a Super Target down the road, so the Non Super Target is moving. That means that all the cool stuff you never wanted to buy before, because $15 seemed like a lot to pay for a furry Sponge Bob pillow, is now 60% off. So I have all the cool eye makeup I could ever want (thanks, pinkeye!) and some other nifty stuff, as well. Boomer on, Target.

And finally, after swimming and dinner and champagne (ugh) at Friend Teresa's, I've decided that Borzois are my new favorite sighthound breed. She has three of them--one skinny, one fat, one shy. The shy one did the lean/nit/burrow thing that sighthounds are known for, plus she was furry enough to really cuddle. I'll always be a sucker for Greyhounds, but Borzois are now running a close second.

So You're Starting Nursing School...

Tips for student nurses of all ages, drawn from my own limited experience:

1. Put aside inviolable time to study every damn day. Even weekends, even holidays. Don't get into the habit of thinking that you'll do it later, or that you can catch up. Study every day. You'll be glad you did.

2. Put aside inviolable time to think about something other than nursing every damn day. That includes not thinking about nursing blogs, or blogging your own experience. If you don't keep some other interests alive, you'll turn into StudentNurseBot, and you'll go crazy.

3. Yes, you will have no social life. This will not bother you. There's plenty of time for a social life after you've passed the NCLEX; nurses are notoriously hard partiers.

4. Make the effort to look as nicely pressed and crisp and clean and starched as you can during clinicals. Really and truly, it makes a difference. You'll not only feel more confident, but your patients will feel better about having you in the room. And if you have a crappy day, at least you looked good.

5. A word about your patients: on the whole, patients don't mind having student nurses. Some of them love it. Think about it: they get individualized attention from someone who's detail-oriented. They want you to succeed.

6. A word about nurses: on the whole, nurses want you to succeed as well. In four years, I've only seen one group of students that I felt couldn't hack it as even marginal nurses. The other students I've seen I have wanted to help, encourage, and see do well. Yes, there is the occasional wackjob or sadist who hates students. You'll be able to pick that person out of a group in no time and avoid them.

7. Another word about nurses: on the whole, nurses do not eat their young. The ones that do (and I work with one) bite everybody, not just the new nurses. And nobody likes them. Their colleagues avoid them, the doctors try to do end-runs around 'em, and management knows their tricks. Do not let the Nurse From Hell ruin your day.

8. Look around at the class you're in. Two thirds of the people in the introductory courses will probably wash out. Support them, study with them, and lean on them anyway. The relationships you form in nursing school last for about five minutes after pinning, but they're the most important relationships you'll have during school.

9. Some of your professors hate nursing. Some of them will try to discourage you, or will show favoritism to particular students for unfathomable reasons, or will be nasty without cause. Ignore those professors. Cultivate respectful relationships with the instructors who love what they do.

10. Pay attention in A&P. Learn enough skills to pass your skills lab, but don't fret about starting a zillion IVs. Know your drug book backwards, but remember that you'll have a set formulary in your hospital--you won't have to remember everything forever. Care plans suck, but they're useful in figuring out disease processes and really do come in handy sometimes. Never use "Potential For" as a nursing diagnosis more than once in a care plan. Make sure you have good pens. Always carry an extra scrub jacket.

And get out there and kick some ass. Being a nurse is infinitely more pleasant and much, much easier than being a student. Soon you'll be done with school. While you're doing it, remember that those of us who've been there are pulling for you.

Sung to the tune of "Heartbreak Hotel"

*strumming guitar*

I woke up at one this morning
And didn't know what to do
My eyes were welded shut with
This nasty yellow goo

Oh, I've got the pinkeye, baby
Yeah, I've got the pinkeye, baby
And don't'cha know I
Wanna diiiieeeee

I went to see the doctor
And all she said was "Wow...
"You sure 'nuff got the pinkeye
"Go fill this scrip right now"

'Cause I got the pinkeye, baby,
Yeah, I got the pinkeye baby,
And I got this burning
In my eeeeyyyyeeeeessss

I went on to the drugstore
And there the folks all screamed
They'd never seen the pinkeye
Be quite this bad, it seemed

And oh, I say
I got the pinkeye, baby
Yeah, I got the pinkeye, baby
And I am so bummed that I could cry.

Downside: I have to throw away all my eye makeup. Upside: I get to buy new stuff, which means I could conceivably change my image from Competent Nurse to Crazy Punk Rocker.

Downside: I have seven days of truly disgusting eyedrops. Upside: The drops kill even C. perfringens, so I won't get gas gangrene in my eyeballs.

Why I love students and GNs, and why you should too.

This past week, I was at the fifty-seventh minute of the eleventh hour of my shift when a GN I hadn't met before approached me and introduced herself. Turns out she wasn't looking for me, but we had a nice chat anyhow.

I asked her if she was getting a thrill from signing "RN" rather than "GN" after her name, and something amazing happened. I don't think she realized it, but she stood up a little straighter, her face glowed, and she said, "Yes. I'm really proud."

Turns out Dad and Mom had both been working three jobs to put her through school. She did very, very well and passed the NCLEX first shot, and now got to sign "RN" after a name composed mostly of consonants. You bet she was proud. Her whole family is proud of her, and rightly so.

And *that* is why I love new RNs. It's not just that they keep me on my toes during preceptoring with questions I've never thought of. It's not that they're seemingly inexhaustable and willing to work hard, because everything is so fresh and interesting. It's not just that they come up with questions about procedures and policies that make me go, "Buh?" and realize that there's a better way to do things. It's that they are so damn *proud*.

They've worked very, very hard for two or three or four years, often while mastering English as a second language or relearning algebra that they'd gladly forgotten twenty years before. They've busted ass through difficult courses with instructors who were, at best, flaky and at worst, actively discouraging about nursing as a career. Some of them turned their backs on lucrative jobs doing something else in order to answer a calling they'd ignored for too long.

They have every right to be proud. And seeing a new nurse's face light up when you ask about the "RN" thing is marvelous. It reminds me why I do this.

Nursing students do everything that a GN does, but more so.

I remember coming on to the floor on the first day of clinicals my first semester. I was so frightened I thought I'd throw up, and seriously considered running away. As the semesters wore on, I got less nervous, but I got much, much more tired. I see that process now with students.

The nursing students we get are excellent. The one exception that I complained about bitterly last year was just that--an exception. The SNs ask questions about anatomy and physiology that require that you keep your chops up. They cheerfully volunteer for tasks that seasoned nurses hate, because it gives them experience. Inserting a rectal tube is a brand-new, shiny job when you're just starting out, after all.

And they're cheerful. On very little sleep. I had classes Monday through Wednesday, starting at seven in the morning and going until three in the afternoon, after which I would spend at least a couple of hours in the lab or the library. Thursday and Friday, clinicals started at 6 am and often didn't end until after 4 pm.

The students I work with have schedules at least as harrowing, and some of them drive two hours or more to our hospital, but you never hear complaints. Maybe a wan smile or two, or somebody might crash and burn for a day or so toward the end of the semester, and have to be revived with coffee and chocolate, but they show up smiling, work their butts off, learn new stuff every day, and graduate.

What with the shortage of nursing instructors and the lack of places in programs, you have to be exceedingly bright to even get into a nursing school. Where I am, two-year programs produce most of the bedside nurses, and the entrance exams are very, very tough. The programs are competative--perhaps thirty people will finish from a starting group of over a hundred and fifty. The women and men who graduate with an associate's degree should be proud of themselves.

And I'm proud to work with them, both as students and as new graduates. I hope I'm as good to them and for them as they have been for me.

Thanks, guys. I'll see you next semester.

The Conga Line

Today I slept.

It's been a long week. We've had a number of folks with undiagnosable whatevers--things that we either have to wait for the disease to progress to be able to diagnose, or for the patient to die so we can diagnose whatever hit them on autopsy--and that always is hard.

So I got up this evening, after sleeping most of the day, and cooked. I had a bottle of wine, three different kinds of cheeses, and a selection of fun vegetables, so I cooked.

And just after ten o'clock, I was suddenly the head of the conga line.

Every nurse has a conga line. It's made up of the patients who die--the ones whose names you remember, whose various afflictions you remember--the ones you might've known even before you were a nurse.

Unexpectedly, I felt Darlene's hands on my shoulders. I kept washing dishes until I knew that Velva was behind her, kicking in rhythm to whatever four-beat polka they play where she is. Curt joined in, his wool sweater as scratchy as it ever was before herpes took his sight and hearing, and made his sister take over the coffee shop. Last in line came Astin, dead of metastatic breast cancer that we caught too late. She and Darlene kicked in perfect rhythm, while Velva and Curt had a good time making up new steps to the music.

I conga'ed around the apartment, macaroni and cheese and zucchini cakes forgotten.

Some of my patients pray to Saint Therese. I pray to the people that I loved--and who hasn't fallen in love with a patient, wished they had been friends with them before--for help, and guidance, and compassion.

And sometimes we dance with them, in a silent conga, grinning, as the music only we can hear and the hands only we can feel guide us.

An Open Apology to My Filipino Colleagues

Guys, I'm sorry.

I know you do better for my patients overnight than I can during the day. Gerb, I appreciate your attempts to teach me to talk dirty in Tagalog. Michelle, thanks for the custard cakes and the joke about the sausage and bread and fish. Ester, you rock my world when you start IVs for me. Jay, you've pulled more folks back from the brink down in post-op than I can count. None of you complains about the schedule, or about the bigots you have to work with, or about the assholes that pepper your day. Along with the Indian and African immigrants and the occasional Slav or Russian, you make my hospital a fun, interesting place to work. I love you all.

But I cannot, cannot eat pork adobo.

I have tried. I like fried eggplant and little squiddy-squids for breakfast. I rock the lumpia whenever you decide to bring some extra. I'll eat anything that you put in front of me, really.

Except pork adobo.

Kill a chicken, pluck a parakeet, slay a sturgeon. Put it into adobo sauce or dry it and fry it and serve it up cold; I don't care. Just don't put pork in front of me, please, with or without that delicious white rice that I can't seem to cook myself.

I feel *so bad* for not liking what is supposed to be the summit of Filipino cuisine, at least according to my coworkers, who can debate for hours the relative merits of various recipes for it, all the while switching into and out of English at baffling speed.

I had a big bowl of the stuff yesterday for lunch. Don't get me wrong; I love the way it tastes. But after? Oh, my stars and garters, it was like trying to work out with a hangover today.

So no more delicious, soft, tender, perfectly-cooked, meltingly wonderful bits of pork in a tasty sauce for me.

I think I'll go on a four-day juice fast now.

Progress.

The chocolate cake for Thursday is made. For those interested, it's the recipe off the back of the Hershey's cocoa box, which even Chef Boy says is the best he's ever tasted. It stays moist for *days*.

The salad for the next two days is made. Artichoke hearts, cabbage, romaine lettuce, baby corn chopped up, red pepper, cucumber, tomato.

My laundry is mostly done.

The patient with the weird collection of symptoms turns out to have both a demyelinating process of some sort and a bizarre, very rare form of bone tumor. "I've...uh...never heard of that" I said to Doctor Number One. "Neither had we." he replied. Doctor Number Two points out that this is not the time for that patient to be playing the lottery. Patient says that's fine with him, just as long as the state doesn't come after him for the amount of the jackpot next week. Mayo says they're not entirely certain that the tumor is what they say it is, but what they say it is is the closest match. We may have something entirely new here.

After five sessions with Der Trainer, I've encountered a new embarrassing reaction at work. Previously, people used to ask when my baby is due. Now, they say "Oh! You had your baby!" Friend Pens, in her wisdom, told me I should reply, "Yep. And as I get stronger and more fit, I will be able to kick your couthless ass more thoroughly."

More reason to think that Just Because You're A Doctor Doesn't Mean You Know Everything: a patient, a doctor, decided to manage her own Parkinson's medication. No problem there, as most Parki patients prefer to continue the routine that's kept them functional for years. But! If you try to "wean" yourself prior to your brain stimulator being turned on, you will indeed fall over and freeze, and we'll have to pick your rigid body up off the floor. Note to all concerned: This is not as easy as it looks. Six people and a bedsheet later, we got her back to bed.

"House" is on tonight. It'll be the first chance I've had in months to watch an episode. I hope it's a good, snarky one. My record is still good: I've only missed two diagnoses in all the time I've been watching--the first was the pregnant teenager with autoimmune weirdness, and the second was the guy with the stuff that's transmitted through pigeon poop. I even got the nun with the IUD.

On a completely serious note: If you work crazy hours, can't motivate yourself to exercise, and hate your life, please consider dropping the dough to hire a trainer. Yes, it's expensive. Yes, it's embarrassing to realize how out-of-shape you really are. But damn; this is the second-best money I've ever spent on anything (the first being the clams to get away from The Ex Husband). No really noticable changes in my body yet, but my stamina is improving, and I feel wonderful.

And I'm not even tempted by the cake.

Why do you come here when you know I've got trouble enough?

I finally got to say it.

"Are you shitheads gonna do the same thing to me this time that you did last time?" he demanded.

"He told me that nobody would help him with his bath last time. And that the doctor wouldn't come see him. He told me he was in here ten days without a bath." she concurred.

"Ma'am, Sir," I replied, "let me be straight with you. You weren't given bed baths last time because when the aides came in, you would curse and throw things at them.

"Then you'd get up and shower.

"The doctor stopped coming in after you threatened to kill him and his family. You've been fired by every nurse on the floor except me.

"The aides have been instructed, for their own safety, not to enter your room.

"I am the only person here who is willing to take care of you. And if your behavior is anything like it was the last time you were here--any cursing, any throwing things, any threats--I have instructions to discharge you immediately. If you assault anyone, I'm going to call the police."

There was a brief silence.

"Where am I supposed to go if you discharge me?" he asked.

"You may go to any other hospital of your choice. We will assist in your transfer." I said.

"No place else will accept him," his wife said, "They've all got do-not-readmit on his chart."

Another brief silence.

Then I gave him twenty of immediate-release oxycodone, four of dilaudid, and a milligram of Xanax and went away. That was all he really wanted anyhow.

Damn. Mention poutine, and the world beats a path to your blog.

I'm not much in the mood for IMAGE WARZZ today, sorry, SS and Bob, because I had that dadratted physically and verbally abusive patient come back in AGAIN. If he hates us so much, why does he keep coming back?

Anyway. I see your naturalistic images and raise you...

this.

He looks like he would love some poutine.