Tuesday, May 29, 2007

Pediatric Midterm

We got our grades back the same day (today), that was nice of her. I am suprised that I did so well, considering I hadn't read the lectures. I had been told by previous students that the exam would be pretty much common sense. That was true...but I think I used a lot of previous knowledge (from the days when I had a day care and took care of children all day long) and that those who don't have any experience with children would not have thought those questions were common sense. Anyway, I got a HP and I'm so friggin happy about it! It was also nice because I rarely go to that class, or I read articles while in class.

Another day, another test, on to the next headache.

Exhaustion before Midterm

We went down south for a family reunion over Memorial Day weekend and I am exhausted. I didn't study one ounce of material, and I have a midterm this morning in, oh, 30 minutes. Why would she schedule a midterm the morning after the holiday, when it was our first break since spring break in March? This isn't going to be good, between driving 10+ hours each way over the weekend and very little sleep, and no studying, it's not looking too good...

Sunday, May 20, 2007

Back on the Grind

Tomorrow I have class bright and early at 8am. Community Health, followed by Pediatrics, and then Issues in Nursing. I am not looking forward to it - it's too early in the morning. I'm losing steam because it's summer and I'm supposed to be out having so much fun, and not couped up in a windowless room for 7 hours a day. It's just tiring. So, let's have a few more moments of denial:

My neighbor (and good new friend since starting the program) is woman in my class, also in the midwifery specialty. Her husband is starting an accelerated nursing program at a nearby institution tomorrow morning. Isn't that amazing? They have similar backgrounds to my own (except they're Mexican American) and so I understand what this means for them to come from where they come from and be doing what they are doing, it's nothing short of miraculous. So, anyway, she had a surprise party for him tonight to celebrate his getting into the prestigious institution's nursing program and to wish him luck on his first day tomorrow by having all of their friends (both in and outside of nursing school) to come and offer support, encouragement and practical advice for succeeding in school. It was so beautiful, and he was totally surprised. I just kept thinking, love is a beautiful thing. Mexican American love exists, and it's beautiful, too. I hope I keep seeing these things happen around me, from people of all backgrounds; I think it does something for my soul each time, it's like having something greater than yourself to believe in...

She passed out a CD she made for all of the guests as we were leaving:

"Whatever Gets You Through Nursing School & Other Songs to Inspire"

1. Whatever Gets You Through the Night (John Lennon)
2. To Zion (Lauren Hill)
3. Feelin Alright (Joe Cocker)
4. Talk About the Passion (R.E.M.)
5. California Dreamin (The Mamas and The Papas)
6. Stayin Alive (Wyclef Jean)
7. Democracy (Leonard Cohen)
8. Wade in the Water (Various Artists)
9. My Own Two Hands (Ben Harper)
10. Crazy (Alanis Morissete)
11. Run On (Moby)
12. Talkin Bout a Revolution (Tracy Chapman)
13. Hope (Sweet Honey in the Rock)
14. Songs We Sing (Charlotte Gainsbourg)
15. Under Pressure (Queen)
16. September (Earth, Wind, and Fire)
17. Once in a Lifetime (Talking Heads)
18. Lizobuya (Amandala!)

Thank God for people who inspire and uplift you when you need it.

Thursday, May 17, 2007

May 17th


Today is our 7th wedding anniversary.
It's been a long road, but it's more than worth it.
Black love exists, and it's beautiful, too.

Wednesday, May 16, 2007

Integrity in Nursing School

Integrity in this environment is a tough thing to have. I remember one of my first posts of nursing school being about this very issue. Well here I am again, and I am really trying to figure out what the hell is going on. This place is like corporate America, people do whatever it is they feel they have to do in order to get the job done - even if it isn't right. So, same scenario as the first time, we had an online exam, but this time it was open note and open book. That's great, but the questions were tricky - everyone agrees on this point. My grade? 68. (FAILING) Class average? 90. (HIGH PASS) Now, I'm routinely a little bit below average - like 5-10 points give or take, but failing when everyone else almost hit the honor's range?!? Never. So, of course, I ask around town what the hell is going on. What happened? How did you know that answer? I couldn't find it anywhere, etc. (We were allowed 2 hours to take the exam - I answered the last question with like 1 minute remaining - I could NOT find the answers!) Here's what happened:

1) They made it a "group exam," meaning they all got out their laptops and took the exam together, dividing the questions among themselves, and figuring out the discrepancies as a group - which we were specifically told NOT to do - in fact, we were also required to take the exam in the school lab (which is under video surveillance). Some of the advantages of this are obvious, but one advantage that I think might not be so obvious is that because you have all those people, you can do a more thorough search of the internet - which is what you had to do to figure out some of the correct answers because his notes were not clear on some topics...so people had to read articles they found on Pub Med, etc. to find the answers, which is doable when you have four people helping you look for the answer, but not when you are taking the exam alone!

2) They used last year's midterm, which had the correct answers for 75% of the questions. A midterm we obviously weren't supposed to have access to - even considering it was open note, open book.

Here I am again, pondering the question of personal integrity versus survival in nursing school. What good is personal integrity if I do not pass the class and therefore do not finish the program? Can one be a person of integrity in an environment where integrity does not exist? Or is this like the "it is dangerous to be sincere with insincere people" thing? Is the cost to the individual worth it? Am I willing to take a chance on failing Nutrition in order to maintain my basic level of integrity? I have worked really hard not to let this place, this experience, turn me into someone I am not, someone I (and those who look up to me) will not be able to recognize. Repeatedly people defend themselves by saying, "it's just the way the game is played." I don't buy that. There has to be some level of self-responsibility. Pass at what cost? But I also understand this: do NOT pass, at what cost? There is a real opportunity to pass this class without using the final exam that is floating around campus...but there is also a real possibility of failing it by one question - which I just experienced. Where is the conversation that should be happening among the other folks who failed this exam because they did not cheat (there are at least 5 others who I know of) No one is going to tell, because we are not the moral police, right? But where does that leave us? Failing. And I find it so ironic that this is all happening in an environment where we all sign an "honor code."

Hmpf, honor code my ass.

Monday, May 14, 2007

Stand

I stumbled upon these lyrics right when I needed them.
Maybe you need them, too.

"Stand" by Rascal Flatts


You feel like a candle in a hurricane
Just like a picture with a broken frame
Alone and helpless
Like you've lost your fight
But you’ll be alright

You’ll be alright

Chorus:
Cause when push comes to shove
You taste what you're made of
You might bend, till you break
Cause its all you can take
On your knees you look up
Decide you’ve had enough
You get mad you get strong
Wipe your hands shake it off
Then you Stand,
Then you stand

Verse 2.
Life's like a novel
With the end ripped out
The edge of a canyon
With only one way down
Take what you're given before its gone
Start holding on, keep holding on

Chorus:
Cause when push comes to shove
You taste what you're made of
You might bend, till you break
Cause its all you can take
On your knees you look up
Decide you’ve had enough
You get mad you get strong
Wipe your hands shake it off
Then you Stand,
Yeah then you stand.

Bridge:
Everytime you get up
And get back in the race
One more small piece of you
Starts to fall into place
Ooohhh

Chorus:
Cause when push comes to shove
You taste what you're made of
You might bend, till you break
Cause its all you can take
On your knees you look up
Decide you’ve had enough
You get mad you get strong
Wipe your hands shake it off
Then you Stand,
Then you stand
Yeah then you stand.
Yeah then you stand.
ohhhhhhhhh
ohhhhhhhhh
ohhhhhhhhh
ooohhhhhhh
then you stand

Link to the video

Saturday, May 05, 2007

Maternal Newborn Clinical

It's so weird that I didn't blog about the Maternal Newborn clinical rotation...maybe because it went by so very fast. I had 4 weeks on a postpartum unit, and then 4 weeks on a labor and birth unit.

Postpartum: I liked the postpartum unit the best because it provided the most opportunity for education about breastfeeding, well woman care, and baby care. I took a lactation class, which was great and helped the lactation consultant on the floor with a mom who was having a really, really hard time (this was a two hour session with this mom and baby) and I learned more in those two hours than in all the lectures, classes and textbook material I've read about breastfeeding to date. The mom 1) could not recognize the baby's feeding cues early enough (by the time she noticed the baby was pretty much crying) which makes for a difficult latch (proper attachment/alignment of the baby's mouth onto the breast) 2)mom wasn't getting enough breast into the mouth, so baby was latching onto the nipple only = painful! and 3)because of the aforementioned, mom was exhausted from trying and baby was screaming. Eventually they got it together though, and I learned so much about positions and latching and how a frustrated mom can stop breastfeeding dead in its tracks. The basic organization of the rotation was that we took care of moms who had vaginal deliveries on Thursday and then moms who had cesareans on Friday, and we did head to toe assessments on their newborns everyday. It was the est rotation ever. My preceptor was phenomenal and very hands off (which I like...I don't like preceptors that hover) and she was very organized as far as what we could do alone and what we could not.

Labor and birth: of course I enjoyed it...but it's frustrating to be a nursing student when you want to be a midwife because there's so much you want to do and say but can't because it's not your role yet. You have to take a lot of orders that you may not believe in, and that's hard. It's also hard to watch women be shackled to monitors all day, unable to move and without an ounce of food. But I did see healthy babies born vaginally and by C-section and it was great. It was so amazing to be standing in the OR and watching what I've watched on TV for so many years. I mean really amazing. My last patient made my experience on L&B very memorable:


N.K. Podo (not her real name) showed up to the hospital on Wednesday for a nonstress test. They admitted her because she had lost her mucous plug and was spotting, and because she had SO MUCH going on that they didn't want her to go back home. They started to induce her instead (don't ask). What did she have going on? She was high risk because
a)she had gestational diabetes
b)pre-ecclampsia
c)isoimmunization with sensitization (I made the term a link, but it's complicated...in the most basic terms I can think of, the mom's immune system attacks the baby's blood while she's pregnant)
d)she had tested positive for the Cystic Fibrosis gene, and the father had not been tested
e)polyhydraminos (too much amniotic fluid)
f)measuring macrosomic (baby estimated to be 10lbs)
g)she was obese at 5'7" and 365 pounds, which makes monitoring the baby on a heart monitor much harder, and posed some increased risk in the the operating room
h)she had no support system present but myself

They (the attendings, residents, anesthesiologists, etc) "allowed" her to labor for three days...mostly because no one want to be the one to have to perform her C-section (they said as much) because of the excess adipose tissue and the risk factors with anesthesia (she was demanding general anesthesia because of her fear of epidurals). She labored until Friday afternoon without any food or drink or pain medicine because they would not give her narcotics by IV and she was afraid of the epidural. The reason they would not give her narcotics is because the baby's heart rate was not looking very good.

So what does this mean to a nursing student/future midwifery student? It means that instead of getting a new patient on Friday, after spending all day Thursday with her, my preceptor sent me back to her, which I was so grateful for because she was all alone. It means that a lot of labor support was needed because she was so tired and in pain and hungry and all alone and very, very scared. It means that I had to fight for the patent's right to refuse the epidural even in the face of serious bullying from the docs and her obvious pain. It means that I had to deal with the consequences of "talking back" to a doctor (because I said that maybe it would be better if only *one* of them spoke to her at a time and maybe, just maybe, we could wait until the peak of this contraction had passed?!?) This moment made me realize that I would never, ever, have a baby at a teaching hospital...to many people coming in to "consult" and "check" and "advise" and "teach" Just imagine two or three of every role, all in the room at once, trying to convince her that she wants an epidural (never mind that she's had 3 children, up to 9lbs 14oz without ever having had an epidural), trying to explain the risks and outcomes of all of these complications she has going on and an overall fat bias present from most of them on top of everything. It was a circus and I was trying to help create some calm because she was in tears and almost irate at the situation (as I would be).
There were no consequence from asserting my patients rights, other than the silent treatment form the docs, which I can live with until they get over it, besides...it will be a long time before I am on that unit again. I rarely left the patients side, but when I did it was because the nurse made me. She said the patient was "too attached" to me, and that it wasn't healthy. This really p'd me off. I mean, she had no support system...why wouldn't we want someone to help her through each contraction if it was feasible? And, she was my only patient...let me get this right, I am supposed to sit in the break room for two hours doing absolutely nothing instead of helping her? It goes against everything I believe in, and I told her so. The patient eventually went to the OR for C-section because the baby's heart rate was flattening, she wasn't making any progress at all as far as cervical dilation or station, and her water had been broken for a long time (it didn't help that everybody had there fingers up there all the time). I went to the OR with her but wasn't part of the care team (as we usually are by helping out when they need something or charting or whatever else the nurse is doing), instead I only had to sit at her head and keep her company and calm. Again, the nurse tried to make me leave because I was "off" (meaning, I was off work for the day) and again I said I was just fine where I was and would leave after we wheeled her into the recovery room, just as I had promised the patient (she had an epidural, not general anesthesia). Her baby was born, wailing! It was a beautiful sound. And she felt like 10 pounds to me. It was so great to see the baby, and to have the mom awake for it, after all she had been through. She said "I will never forget you and all you have done for me." I said "And I will never forget you and all you have allowed me to learn. I will never forget how strong you were, how strong you are." And I meant it. I will never forget this patient.

From my preceptors (1 for L&B and 1 for PP) final evaluation comments:
"If I were having a baby, I would come find you, even at the level you are right now. You're going to be a wonderful midwife...you're so intelligent...you know when to stand back at let be, and you know when to jump in and you don't hesitate when that time comes...seriously, you're great, and I can't wait to see you back on the floor as a midwifery student."

I almost cried. I struggle in class so much that I really wonder about all of this...it seems like it shouldn't be this hard. But I do not generally struggle in clinical when it comes to relating to people, especially women which really keeps me going. You never really know how your preceptor thinks you're doing in clinical until the evaluation comes... It wasn't a validation per se, but rather it was I know I am supposed to be a midwife...now other people know it too...and they know it not because I told them, but because they witnessed it.

End of Spring Semester

Spring semester ended yesterday, finally. With it, Maternal Newborn and Pathophysiology ended as well. What would be nice is a break between the spring and summer semesters, but of course we aren't getting one. Summer semester starts on Monday. Nutrition and Issues in Nursing continue on, and we pick up Community Health and Pediatrics. So my new clinical starting next week will be Peds. Oh joy.

Right now, on this non-break of a weekend, I am trying to write my paper for Issues class, which is worth 70% of my grade. It's been a long time since I could sound off about anything I want in a paper! It's due on Monday. I also have to get my stuff together to take the Nutrition midterm...no cramming necessary because it's online, open note and book, and I have two hours, so I just have to organize the notes.

I went to the mall today by myself because the man's away visiting his hometown. It was a very relaxed day of shopping, manicure, massage (I tried that Aqua massage thing at the mall...it was only ok) and eating out with only Sister Outsider to keep me company. I planned to see a movie, but there was nothing good except Spider Man which I promised to see with the man, and Disturbia which is a group outing scheduled for next week.

PS: I saw "The Namesake" last week and it was really, really good - and this is coming from someone who sees a LOT of movies! It was so refreshing to see a movie with brown characters, living real lives and dealing with real issues like assimilation.

Tuesday, May 01, 2007

An Exhausting Day

The following post was typed over a week ago, and I never posted it because I wanted to walk away from it and come back and see if I felt the same way or if I was simply whining...I still feel the same way, so here it is:

This time, it is not really about the physical demands, although it was 12 hour day in which I left my house at 8 this morning and won't get home until after 10 tonight (class, work study, and work today!) Today left me mentally exhausted. I feel like I think about my life ten times more than other people, and I'm not sure that's a good thing. Everyone seems so detached from life while in nursing school. I try to focus on only what's in front me this moment, but I just don't think that way I guess. I ask about the PhD program, about research, about job experiences, about clinical competance, about writing a lit review, and a million other things that other people don't seem to be worried about, or even thinking about, at all. It's only about the classes...day in and day out...but I will lose my mind if I have to really concentrate on only the classes, especially since so many of the classes really make me nuts! I also think I might talk to much, ask too many questions (but NOT in that "OMG I know she's not asking another question, can't we just get on with class" kind of way) and make too many people in positions of power uncomfortable. I know that I am articulate (can I have that moment of arrogance?) but I will say that I had no idea just how articulate other people perceive me to be (H, you don't count ;o) and how threatened that makes them feel.

The Agony of THE WAIT

I took my two finals today, dutifully. Patho went (seemingly) well enough, but Maternal Newborn, on the other hand, felt disastrous. I hate studying so hard to still have to wonder if I passed a test. We covered a semester class in 6 weeks. I think that's beyond accelerated. And what's worse is that the objectives that are supposed to help you study for the exam are useless because they simply outline every bold heading in the textbook...it's unreasonable to expect that kind of memorization. But I'm not going to get up on my soap box today. I'm just going to say that I am worried....even after having started studying for this exam well over two weeks ago (right after the midterm!) Only 65 questions for all that material...I took the full two hours, and still wasn't really sure of my answers...I said I was going to stop, and I am, because what can I do about it now? Nothing.

Anyway.

I added two new blogs to my roster. I added Battle Axe because I realized I've been reading her lately, and I enjoy her sense of humor, her frankness and her willingness to post about being in nursing school and a (single?) mother. Here's a post of hers if you wanna chek her out. And also "Brown Graduate Student" which is not the real title of the blog...the real blog is by a girl named Cathryn Blue who is earning a PhD at St. Louis University (she says all this in her blog). I have been reading this blog since it first began months ago. I learned about it from some online article about the "first minority graduate student blog" which I thought was interesting because so many of us have been bloggin for such a long time...but anyway, she is in the humanities(?) if I remember correctly, so it's a different kind of graduate school experience from another brown (black?) girl in the world for you non-nursing folks considering graduate school. Her blog is quite good because she sticks to the topic, is insightful, and consistent. This first page of posts is a good example, I think.

This is the last week of Maternal newborn clinical also...which I somehow neglected to ever comment about. A pre-midwifery student's first maternity rotation deserves its own post, so I will give it that respect later...

We have been assigned our community health rotations for the summer and I will be staying local and working at a primary health care clinic. I asked for, begged for, Planned Parenthood, but of course I didn't get it...I still think there was some non-randomness to the whole selection process...I ended up at a site with two other brown people...can somebody get back to me on the probablity of 3 out of about 10 available brown folks (out of a class of 80+) all getting placed at the same clinic? I mean, really, what are the odds? Whatever. It's a 3 week rotation, and I can do just about anything for 3 weeks. But before this rotation starts, I have Pediatrics.

I hope it's better than I am imagining it will be.