Saturday Seriousness: for nursing students.

It's not often that I'm really, really serious, but today I think I might as well go 'head and be.

I got to thinking today about what five things I could tell nursing students that would make them feel better--or at least a little less bad--about clinical rotations and classes. Here, then, with a special shout out to my fellow Texan Rob, currently kickin' ass and diggin' shallow graves (see his blog in the listing to the right!), is my list of Five Things You Must Know About Nursing School:

1. Nobody Wants You To Fail. They Just Want You Not To Be Stupid.

Even the toughest professor I had (Pediatrics, booyah!) would forgive stupidity if it was followed by a fast "Oh, duh, I wasn't thinking." Trust me. I had plenty of those moments and still graduated. The professors who seem most intent on weeding out students are those who are also excited and stimulated by people who want to be challenged.

2. The Nurses You're Paired With During Rotations Don't Hate You; They're Just Nurses.

We say things once and expect you to get them. We want you to conform your schedule to ours; after all, you're usually leaving halfway through the shift, and we're there all day. We double- and triple-check everything that you do not just because you're newbies, but because we care about you not learning something wrong. But we (well, most of us; there are some toxic weirdos out there) really like nursing students. We want you to do well, and we like teaching.

3. That Said, Someday You Will Be Just Like Us.

I used to swear that I would never be the brash, outspoken, cynical, irreverent, bitter person that I saw over and over and over during rotations. I'm not as bitter as a lot of those nurses, but everything else, I am. I have become incredibly tough-minded and efficient, with a short-term and mid-term memory that would put most Mensa members to shame. You will be that person, too--it's part of becoming a nurse. Just make sure the bitterness comes last in the list rather than first and you'll do fine.

4. Doctors Don't Hate You Either; They're Just Busy.

Learn to say it in the fewest words possible. Never apologize for paging someone, or forget to thank them for returning your call. Have the chart with you before they call back. If you must interrupt rounds, be sure it's for something major, like the patient's stopped breathing and you can't intubate them. Doctors like efficiency, and they love nurses who are one step ahead of them.

If these skills don't come immediately, don't fret. They take practice.

5. Eventually, This Will Be Over.

Everybody has a breakdown in nursing school, and everybody has a crisis when they're a new nurse. It's okay. You're riding the steepest learning curve known to man. In time, it'll smooth out and you'll feel finally like you're swimming with the current rather than fighting to stay afloat.

In the meantime: sharp pencils, extra pens, and notecards never hurt anybody. And have some fun learning this stuff, okay? It's actually really, really cool to be a nurse.

Further Friday Foof. With Fluffitude.

This is Flashes. He's very proud of having unmade a corner of the bed.

I fear Notamus is under the bed, plotting my demise.

I got tired of having the same ol', same ol' fire extinguisher.

This is the dresser I painted white (from a weird light-pine color) and put green knobs on. It makes me very happy, like I'm living in an Anthropologie catalog but without the underfed stringy-haired people in ill-fitting clothing.

Friday Foof.

I loved these guys when I was a kid. I love them now. I'm considering making a blue Martian costume for Halloween.

Edited to add that the orange singing "Carmen" always scared the shit out of me when I was younger. I don't know why.

And speaking of dermatology,

I have an eight millimeter by eleven millimeter gouge in my face today. It took off a third of my left eyebrow and left behind an oddly colored (secondary to iodine) divot in my normally-lovely visage.

Such is the joy of being a freckled, fair-skinned redhead. You could trace the veins on my chest to their source and would be amazed at the transparency of the skin on my calves. And I'm prone to actinic keratoses, the precoursor of skin cancer, thanks to Dad. Thanks, Dad.

I got sunburned (true story!) in Copenhagen, Denmark. in JANUARY. It was sunny that day, between 9 am (when the sun got up) and 3 pm (when it went back to bed), and I got sunburned.

In Copenhagen. In Nyhavn, actually. In January. Which made my dermatologist crack up.

All told, getting a precancerous lesion cut off my face was better than what happened in Nyhavn that day, which involved a statue of Birgit and a drunken Swede and a lot of promiscuous kissing (not on my part) and beer horns you can't put down because they're curved or have big balls on the end, and isn't that a fun trick to play on the Americans? It was less painful to get lidocaine infused into my skin and a lesion scraped off than to deal with the fallout of getting Gammel Dansk'ed on a college field trip.

Which tells you something about my experience with dermatologists. It's a good thing when I'm told that whatever bump has popped up will probably take care of itself, unless I really, really want it cut off.

The best bit of the visit was when the dermatologist apologised for taking off a third of my eyebrow. I pointed out that a) my eyebrows are so fair I have to draw them in with a pencil; and b) that I'd already hacked off a portion of my right eyebrow with a pair of tweezers, so what was the problem? and she replied, "Well, at least you'll be even."

So now I look like Divine. With a divot. Which might be something I could parlay into a second job, so I'm not complaining.

Oh My God, You Fucking Idiots.

Neurology has three different subspecialties: stroke, general, and some other name that's been blasted out of my head by the Dalwhinnie.

If you call the Neurology rotating pager, your chances are good (ten out of ten) that you'll end up with a resident not on your patient's particular service, and with no clue what to do with that patient.

If you have a patient go bad at 1830, it's a sure bet that it's a Neurology patient.

So that's what happened to me the other night. And it's why I'm typing with one eye squinched shut and a half-empty (make that 3/4 empty) bottle of Scotch next to me.

Okay, not really. But still. It should not take me nine pages to find a resident willing to write the orders I need, and that resident willing only because I wrapped my bony paws around his scrawny neck. And squeezed.

WHY can you not have rotating residents on-call for more than a week? WHY must you keep the on-call pager a Deep National Secret? WHY on earth can you not brief the resident on call on the patients she or he is likely to encounter after 5 pip emma?

It's like the Neuro guys think they're Dermatology. Or that they actually get to sleep, post-call. In any event, the usual way of doing things brought me closer to actual physical violence, as in strangling the resident who decided to be a dick about things, than I've been in better than half a decade.

The best thing about moving to the CC unit? Is that neuro patients rarely get admitted to the intensive care service. And, if they do, it's the intensivist caring for them; not some jerk from the stroke service who knows nothing about myesthenia gravis.

PS: You're a moron.

Part I

Dr X: "Why hasn't the Argle-Bargle T380A test been run on my patient yet?"

Nurse Jo: "Because it's a timed test that has to be done by the lab. It can't be drawn through a central line."

Dr. X: "Why haven't you drawn it yet?"

NJ: "Because...it's...timed. As in, it shouldn't be drawn until a...specific time."

Dr. X, growing upset: "But you could draw it right now! Out of the central line!"

NJ: "No. I can't. It can't be drawn through a central line. The heparin lock we use will screw up the test results, and besides, it's a timed test. It's not due to be drawn until 1630."

Dr. X: (incoherent ranting about incompetence of nursing staff.)

NJ: (finds herself on the opposite end of the hall, unsure of how that bruise got on her forehead. Oh, wait. It was Head-Meet-Wall again.)

Part II

Dr. Y: "Why did you change my patient from calcium gluconate to a calcium citrate and magnesium supplement?"

Nurse Jo: "Because that's our protocol for people who have had gastric bypass surgery."

Dr. Y: "But this patient didn't have a gastric bypass! She had a parathyroidectomy!"

Nurse Jo: "Yes, I know. However, the patient's history shows that she had a bypass six years ago, and her blood calcium levels have been low enough to warrant IV repletion. Therefore, according to protocol, we changed her over to citrate and mag, and her calcium levels have come up."

Dr. Y: "Are you a doctor? I didn't write that order!"

NJ: "It's the standard hospital nutritional protocol for patients who have had bypass surgery. Here it is on the computer (clicks twice)."

Dr. Y: "I didn't write that order! You had no right to change that patient's medication!"

NJ: "Her calcium has been stable at 9.2 for three days, after being between 2 and 3.5 for the proceeding week. Is there a problem?"

Part III

Dr. Z: "Why didn't you replete this patient's magnesium and transfuse blood?"

Nurse Jo, looking worried: "Because I didn't see an order for it."

Dr. Z: "Her hemoglobin is ten! TEN!! Why didn't you transfuse her??"

NJ: "Um... ... ...because her hemoglobin is ten. And has been ten for the last four days. And her magnesium is 2.0 and has been for the last four days."

Dr. Z: "But I always transfuse patients with a hemoglobin less than twelve!"

NJ, taking chart in hand: "See this preprinted sheet? You filled out this preprinted sheet. It says right here that if hemoglobin is less than nine or crit is less than 25, we transfuse. It says we replete magnesium for mag levels of less than 1.7. Her crit and hemoglobin and mag have all been above those levels for four. days."

Dr. Z: "But that's not how I do it!"

NJ: Considers banging head on desk, then decides that the bruise that's already there is enough, and wonders why on EARTH the new docs in rotation aren't briefed on our protocols.

Super freak. (Composed Saturday night; posted Sunday morning.)

Oh God, oh God, oh God.

I start the CC internship in a month. A month. What was I thinking? What the hell am I doing, leaving what I'm used to? What happens if I hate it?

What happens if I can't do EKGs? I've never been good at EKGs. And all that other CV stuff; I haven't done that in years. I can't remember what Vfib looks like. Blocks...blocks...I can't remember blocks. What's the normal for mag? I can't remember. I've been off work for too long. I'm only back for a few weeks, and then I start the internship.

Holy crap. What if I hate it? What if they hate me? I'm going to have to work nights. I've never worked a night in my life. What if I can't stay awake? What if I can't sleep the day before my first night? Oh, God, oh, God. Nights. What am I going to do about feeding the dog? How long will I have to work nights? When will I start? What if I hate it?

Seven years. I've worked on the same unit for seven years. Why did I have to go and make a change now? I wonder if it's too late to back out. It probably is. What if I hate it? I'm going to feel like a complete idiot for at least a month, and pretty stupid for at least six months after that. Ventrics. I haven't dealt with a ventric in...what? Four years? Five? I've forgotten how to level them. I mean, I know this is what an internship is for, but they'll expect me to remember this stuff.

Oh, geez, and ventilators. I wonder how much ventilator stuff we'll have to do. RT is right there, but will I have to troubleshoot? What about extubation? What about intubation? What about code team? When do you use bicarb, again? Isn't bicarb, like, your last resort? Shit. And open bellies. Open. Bellies. Covered with plastic wrap. That's insane. What am I doing, changing units?

We're gonna see a lot of flu cases this year. Probably some of 'em'll be on vents. I hope I don't get the flu. What'll I do about vents? What if I have to go to Holy Kamole and work on vents there? And what about all that damn CV stuff? Geez, I hate counting out rhythms. I need to get a better stethoscope. I need a set of calipers. My feet hurt. It's the last night of my vacation, and my fucking feet hurt. I can't sleep. What about EKGs? I wonder when they'll have flu shots for us. I wonder *if* they'll have flu shots for us. Maybe I can tell 'em I'm pregnant, and get a flu shot that way. But then I'd have to produce a baby.

Which would probably be easier than starting this damn internship.

*toss*

*turn*

Eternal Questions: Friday at 4:30 a.m. edition:

1. Why is it so hard to plug in equipment with batteries that have to recharge? Is there some anti-plug-in gene that only I am missing? It's frustrating to have every. single. pump. start screaming "LOW BATT" the minute you turn your back.

2. What the heck are they using now to mop the floors? Superglue? 'Cause that's what it feels like.

3. Why does my sweet curly lamb of a resident insist on writing floor orders on preprinted critical care order sheets? It doesn't work like that, dear. For the fifth time.

4. How is it that a hospital can make such uniformly bad vegetables? Is there a special pre-over-cooked form of veggies that are only available to large institutions?

5. Why are there six boxes of gloves in this room, but none of them are my size?

6. How many family members does it take to see one person off to surgery? My record so far is 35, all in one small room. It was...humid. And crowded.

7. Do I have a sign over my head that says "Crazies: Talk to Me! I Like It!"?

8. Where do all these college students keep getting all this Adderall? And Ritalin? And Abilify?

9. Why do I have so many pockets and so little memory?

10. Why do my patients keep bringing up health care reform to me? I don't talk politics to patients, and you won't like what I have to say anyhow.

Yeah, I love this. I'm a nerd.

"The discovery of the gastroliths associated with this plesiosaur specimen were particularly exciting because most plesiosaur gastroliths are found associated with the long-neck morphotype", Dr. Schmeisser explained.

(Long-neck morphotype shown.)

You gotta know when to hold 'em.

Back in the saddle again!

A conversation I had over vacation brought to mind a patient I had a couple years ago. He told me, quite seriously, that he tended to throw punches when he got a shot.

"You won't this time" I said calmly.

"You don't understand!" he insisted. "It's like, this reaction I can't control. You gotta get a couple big guys to hold me down before you give me that shot!"

I went on filling the syringe (I can't recall what, exactly, I had to give him, but it was one of those drugs that requires a glute shot and a Z-track) and said, again, "You won't this time."

(Query: Why is it always young, healthy guys in the military who tell me this? Dude, you spend your days *getting shot at by bad men with big guns*.)

He looked at me. I said, "Roll over onto your stomach."

He did. I said, "Okay, now grab your crotch with both hands."

A sidelong glance over the shoulder. "Why?"

"Because if you try to make a fist, your balls are in the way. And by the time you get your arms out from under you, I'll be across the room."

I did not need two big guys to hold him down.

More recently, I had another patient like that. Only this guy told me that he'd kick me in the gut if I tried to start an IV on him.

"Not this time you won't," I said, calmly unpacking the IV supplies.

"No, seriously!" he insisted. I sensed a trend. "You gotta get a couple..."

"Big guys to hold you down?" I asked. "Yeah, except this time, I won't."

"Why not?" he asked, chin jutting out.

"Because I'm going to stick you once with two hands. If you kick at me, I'll stick you the second time with one hand." I tied the tourniquet around his upper arm.

"What'll you be doing with the other hand?" he asked.

"It'll be wrapped around your balls, ready to squeeze." I smiled sweetly.

One stick, no kick.

Monday Mush

Sunday Meditation

...And if it was all to do again, would I do otherwise than I have done? No, I would do the same. A thousand times over, I would do the same. And it would still be sin.

In our various degrees, we are all sinners. To acknowledge and accept that load is good. Perhaps even to acknowledge and accept it and not entertain either shame or regret may also be required of us. If we find we must still say: Yes, I would do the same again, we are making a judgement others may condemn. But how do we know that God will condemn us? His judgements are inscrutable....In the end there is nothing to be done but to state clearly what has been done, without shame or regret, and say: Here I am, and this is what I am. Now deal with me as you see fit. That is your right. Mine is to stand by the act, and pay the price.

You do what you must do, and pay for it. So in the end all things are simple.

--Ellis Peters, Brother Cadfael's Penance

I wanna party with these guys.

Extreme Pool Jump - Click here for more home videos

I am bummed.

Severely, severely bummed.

Intolerably bummed.

Listening-to-Sugarland-and-sobbing-even-at-the-happy-songs bummed.

Friend Pens the Lotion Slut will not be joining me for a week of debauchery after all.

Friend Pens has the worst boss in the world. The day before she's supposed to come see me for a week of champagne, IKEA, and swimming in spring-fed pools, he swanned into town without warning. Worse, his minions passed out a pre-arranged itinerary that had entries on it that said, in burning letters that would do J.K. Rowlings proud, "LOTION SLUT'S PRESENCE REQUIRED OR SHE WILL BE FED TO THE WOMBATS."

Pens, being an intelligent woman with a good grasp of the essentials, decided that not being fed to wombats trumped champagne and strawberry trifle. I don't blame her; I believe wombats are vegetarian (or, at the very least, have kind of dull teeth), so being nommed repeatedly by a cage-ful of them would certainly suck.

*sigh*

On the upside, it's still the week during which my pal Suz the Rat Wrangler will be liberated from the crazy man she had the bad fortune to marry lo those many years ago. So the champagne and strawberry trifle will still happen; it'll just happen without the L.S.

And, as a result, I am bummed.

Stolen from Shakespeare's Sister

Yeah I know that you wanna be Canadian, please
Even if in winter things tend to freeze
We've got the world monopoly on trees
And our country's bordered by three different seas

Yeah I know that you wanna be Canadian, please
We invented the zipper, we've got expertise
We made insulin to combat disease
Yeah I know that you wanna be Canadian, please

CHORUS
Brits have got the monarchy
The US has the money
But I know that you wanna be Canadian

The French have got the wine and cheese
Koalas chill with the Aussies
But I know that you wanna be Canadian

Et si ce n'était pas assez
On a deux langues officielles:
L'anglais et le français
Ooh la la

Yeah I know that you wanna be Canadian, please
Where else do you find mounted police
Or go to the hospital and not pay fees
Yeah I know that you wanna be Canadian, please

And when freshwater is in high demand
We've got the world's largest supply on hand
So you know that we could make a pretty good friend
But it's even better if you can be...

CHORUS

So you're thinking to yourself,
"How do I live in this beautiful country?"
Well we've got some steps for you to follow...

STEP 1: Lose the gun
STEP 2: Buy a canoe
STEP 3: Live multiculturally
STEP 4: You're ready, there is no more!

We got beavers, cariboo and moose
We got buffalos, bears, and Canadian goose
And we're sorry about Celine Dion
But she did do that good song for James Cameron...

CHORUS
Brits have got the monarchy
The US has the money
But I know that you wanna be Canadian

The French have got the wine and cheese
Koalas chill with the Aussies
But I know that you wanna be Canadian

The Greek chilled out with Socrates
Can't build a wall like the Chinese
But I know that you wanna be Canadian

In Kenya they have safaris
We've missed lots of other countries
But I know that you wanna be Canadian

Live, from the dusty plains of Central Texas, it's Head Nurse!

I had no idea my eyes slant downward like that.

Sunday Sweetness

This blog is lovely; one little girl is lucky to have the mother she does.

You undoubtedly heard about this on NPR. It's still a good read.

Something tells me my nephew might be getting a really cool Christmas present this year.

Drive-by vacation posting

ONE:

Please. I have told you and your coworkers four times this week that Maria Wenschel does not live at this number. I have had this number for (counting on fingers) uh...five? No, *six* years now. Maria Wenschel has never lived here. Neither has Joyce Ngabe or Matthew Watkins or any of those other folks who owe you money.

TWO:

Bra. Buy one. Wear it. Please. Unless you are the adorable, bone-thin, dancer-bodied hippie chick from across the street, you need one. And she has no boobs anyhow, so she's good.

THREE:

Leash. Buy one. Put it on your dog. Otherwise, my dog will get very upset when your bait canine* comes over to the fence and starts acting all tough, because Max won't know whether to bark or be calm or run away. This is sort of an existential crisis for him, because he believes in protecting the small and weak, and your particular small and weak is begging for a beat-down.

FOUR:

Call. Before you come over. Unless you are the UPS man with new shoes, in which case you can come over any time you like without calling first. Especially if the shoes are free.

FIVE:

Bad: The idea you had to come knock-knock-a-knockin' on my door this morning at four a.m. Not only am I awake then, but I am awake with an anodized pink practice bat filled with Quikcrete** in one hand and my very large dog's collar in the other. And I do not know you, so either the bat or the dog is going to move toward you fairly soon. No, you may not use my phone.***

*"Bait Canine": any dog under six pounds who has no other obvious function than to act as bait for real dogs.

**For a while I considered buying a shotgun, because the sound of a round being chambered in a sawed-off double-barrelled shotgun is the single best deterrent to violent crime ever. However, I've now discovered that the sound of a concrete-filled bat tapping against a doorframe combined with the subterranean rumble of a Good Boy (yes, he's a good boy! Yes, yes he is!) is almost as good.

***And no, I would not have normally opened the door at all, but the knocking was getting insistent and distracting me from Go Fug Yourself.

In Which Jo Reveals Her Blog-Crushes (aka link roundup)

Since I don't have anybody in the meatworld to crush on, here are a list of my current blog crushes:

Design/Homewrecking

Door Sixteen. In my social group, "D16" has become shorthand for "anything you obsess about and work on with perfectionistic tendencies showing, because you know it'll be gorgeous in the end". This woman probably wipes her ass with $100 bills, and has more patience than I do, but it's a crush....so it's aspirational, right? Right?

The Daily Danny. Yes, it's all about consumption, which doesn't seem very green to me, but he does find some pretty things. And, when you really need to replace your coffee mug collection/end tables/whatever, he undoubtedly has a post about whatever it is you need a new one of. (What a sentence.)

Screamprinting. You've seen those "Keep Calm And Carry On" repro posters? Well, these folks have some that say "Bloody Hell, We're Buggered Now." I'm thinking of getting one of each and gluing them together, then hanging them on the wall so I can turn them whichever way I'm feeling that day.

News You Can Use

The New York Times. The original and still the best.

Jezebel. Not only do the brave souls of Jezebel offer commentary on this week's "Big Brother" episode, they do thoughtful analysis of news stories you won't get anywhere else.

Advertising For Love. The project of a woman doing her dissertation on old personal ads. Maybe it's not "news", but it sure is interesting, and it shows us plus ca la change, plus ca la meme chose, or wevs.

Girly Shit, Like Lipstick and Shopping

Apocalypstick Now. Not only does she have the best blog name ever, she's hilarious.

Outblush. I must admit that I read this blog only to see what the authors consider to be reasonable purchases. The average price of a dress exceeds my mortgage payment.

The Beauty Brains. Science and beauty in one tidy package! Don't buy a new shampoo without checking here first.

Esteemed Colleagues

Grunt Doc. Right up there with Sid Schwab, in my opinion (who's no longer medblogging, and what a loss that is), I always find something interesting going on with The Grunter.

March of the Platypi. Still one of my favorites, lo these many years later. It was the Platypus who showed me both that it could be done and how to do it.

Your Pharmacist May Hate You. Total blog-crush material: he likes Scotch, he's grouchy, he's overworked. What more could a woman with her own tools ask for? Plus, he writes amusingly and is politically active.

WANT.

All the way down at the bottom of the page. 1940's girl's bike.

It's blue. It has a headlight. It looks cool. I wonder if it's fixupable?

I wonder if Friend E. would mind a houseguest while I go browse?

HA!!!