First Day of Community Health Clinical

We, the students, arrived at 8am. What time did our preceptor arrive?

9:20, all surprised that we were there. I was so frustrated. And then she tried to be sly and ask us what our understanding of what we were supposed to do on a daily basis was. Huh? We don't know, why don't you tell us! She was so unprepared. And then she said she would only see us for the first few days and then would be taking a vacation for the next couple weeks. I asked "So, you won't be here when we finish this rotation either?" Her reply? "No." She didn't even know the basics of our schedule.

How can this be?

Another nurse, an RN, who made a much better impression than she did, is going to help us. You know what I think? I think the RN should get the title of *Ivy* Instructor and the pay, too. This is an example of my school taking advantage of a nurse. They are paying our preceptor because she has the advanced degree - even though she is not going to be there at all...while the RN gets nothing for her time - not even the right to say she officially precepted students.

My classmates are all over the place, in the states, in South America, South Africa, and New Zealand to name a few. I am starting to wish I were, too.

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.

Biomed, In the Final Hour

The mornings of exams I used to listen to encouraging music while studying. I had my IPOD programmed to play 4 slower, encouraging Gospel songs (think, Yolanda Adams) followed by a Hip Hop anthem-style song (think "Survivor")...I actively study during the slow (20 mins) then take a break during the fast (5 mins) and keep going for about an hour or two. Well, since my IPOD was stolen last semester, I haven't been able to do this. But this morning I came to school and listened to Yahoo radio while I studied. A minute ago, a song called "The Struggle is Over" by Youth for Christ came on; there isn't a song more appropriate for how I feel this morning as I prepare to take this final BIOMED exam. I've reached that place where I can't even be anxious about it because I just want it to be over. No matter the outcome, the stress of it is now over. It's like the peace you get after making a decision.

Hearing the song was one of those "And this, too, shall pass" reminders, and we all need those.

Pscyh Clinical: Week Five

My fifth week of Psych clinical ended yesterday and, for the second time, my preceptor asked me, "Are you sure you don't want to go into Psych?" Followed with, "You'd be perfect for it." I kindly told her I was sure and we laughed, but later my groupmates said that I made this terrible face when she said it and that's what all the laughter was about. I really gotta work on my facial expressions! It's not that I can't see myself as a Psych APRN, it's just that I can't see myself as NOT being a midwife. This conversation happened after my conversation with a patient (another black woman on the unit who, like my last patient, is also addicted to cocaine) lasted an hour long - significant because she had refused to talk to staff and other students on the unit. This woman had had an "outburst" earlier in the week; she had called the social worker on staff a "racist bitch" and was screaming at her uncontrollably. Of course the staff just considered her to be very angry about something else, and requested that she apologize to the social worker after speaking to her about her feelings. Which is all fine and good (and necessary) but I also wanted to validate her feelings about the social worker, because angry or not, drug addicted or not, right now this patient is techinically clean (albeit only a month's worth, but still clean) and so she knows what she's saying and my guess was that she had a reason for saying it, so I asked her about it. Sure enough, the patient had an altercation with the social worker earlier in the month in which the social worker decided to interview another patient (a white patient) who had just got admitted that morning instead of her, despite the fact that she had been there 3 days already. I asked her why would the social worker do that...what would she get out of it? She said that she and the other black patients on the unit have all had negative experiences with the SW and the patient herself had had some negative experiences with the SW on her last stay on the unit some months ago, and that she felt like she just didn't like or wasn't comfortable interacting with them, and that maybe she was intimidated. So we talked for a while about all of that, and how to get what you came to get despite her or anyone else and then we moved on to other things. But later I followed up with other patients about their experiences on the unit, specifically as they pertained to racism (or not) and the same sentiments were expressed without my mentioning the SW or anyone else specifically. So it made for an interesting day, and when I questioned my preceptor about the SW, she said she thinks it has less to with race and more to do with the fact that the SW isn't very good at what she does, and some patients (I add: "especially the black patients who proabably have more experience because of socioeconomic differences on the unit") know more about the system than she does, which really irritates the patients. That sounds like it could be true. Anyway, I also spent a long time talking to this patient about books (she was thumbing through O mag while we were talking) and she happens to be very well read and *almost* (LOL) put me to shame! (now isn't that snobbish...elitist...ohhhh, someone like *her* could not possobly be more well read than *I*...mhmh) What a great Friday at clinical.

*The photo above is of Africans Americans at Spring Grove Hospital Center. When (if) you go the page to read about this place, look in the right hand column of topics and you'll find "African American Patients at Spring Grove." It's probably the first Psych hospital to accept free or enslaved African Americans.

Psych Mid-clinical Evaluation

I have a Pathophysiology exam in a week, then my Pharmacology final, Biomed final, and Psych final all in the span of two days...a hellish Monday and Tuesday.

I've started reading 72 Hour Hold because it's over 300 pages and my paper is due in three weeks, but I want to turn it in in two weeks because there's a lot going on the week it's due...

Thursday I have to present a case report on my chosen psych patient...and do a skills check off to prove I haven't forgotten the skills I learned last semester - eventhough I have.

I never talk about my psych rotation...here's the patient I'm presenting this week...which should give you some clue to what I'm going through:

In a few weeks, the day before my birthday, she will turn 36. She has five children ranging in age from 5 months to 19 years. She has a history of marijuana, alcohol and cocaine cocaine abuse, starting at age 13. She does not have custody of any of her children, they all live with her grandmother. She has been hospitalized twice for post traumatic stress disorder, depression, and substance abuse. Her mother was addicted to cocaine when the patient was born...when she gave birth to the patient, she went outside the hospital on a smoke break and never returned, and later died of AIDS. The patient supports herself via prostitution. The patient has been raped and her perp is serving time in prison. She is on our unit for a "treatment seeking" substance abuse study - a cocaine stress test. Because she is treatment seeking, they are not allowed to inject pharmaceutical grade cocaine into her veins, which makes my heart happy because there are others who are NOT "treatment-seeking" and therefore their version of the stress test is to have pharmaceutical cocaine injected intravenously to study the effects of the drug. But her study is a little different: when she came on the unit, she told (and they recorded) her worst experiences with using cocaine...now (for the study) she listens (via headphones) to these stories and they record her body movements, affect, etc.

This is why I chose her to present on:

When the patients are given a mental exam, they are asked to write a sentence. She wrote, "I am sombody productive in society." Her answer to the question "Why did you come here today?" was "I don't know who I am. I just want to know who I am." One moment in time when she was happy? "Journalism class in high school. I want to be a writer." And guess what? She can write. I also chose her because no one else is interested. Because I have been standing up for her and her experiences since I got there, because no one else will.

I had my psych mid-clinical evaluation last week. My preceptor said (after you are so wonderful, brilliant, yada yada yada) "I always give students something to improve on. I don't know what it is, but you've got it. I want to tell you that you can't take this stuff home with you, that you can't feel it the way you do because it's not healthy for you. I don't know if you can turn it off. Your heart is big. You shouldn't take all of this in. I don't know what makes you do it..." I know how it sounds cheezy, but I promise it's true.

I wanted to ask if it was really that hard to understand. All of these black patients. No black practitioners. No practitioners who come from the very environments that they criticize on a daily basis. No understanding of how much work it takes to coordinate section 8, food stamps, and utility assistance. No idea what is to stand outside in below zero windchills waiting on a public bus to come to get to those appointments. No understanding of what is to be a black girl in room full of entitled professional white people talking trash about black people and their lives...as if I'm invisible...or maybe they just don't give a damn that I'm sitting there...or maybe I've reached that "different kind of black person" status.

She's right, I'm taking it in - isn't that what we're supposed to do? Or was this supposed to be a game? A way to say "I've served the poor, the disadvantaged. See, I care." She's right, I take it home with me and digest it to the best of my ability because until I take it home and digest it - make some sense of it, I can't move on. I can't not feel it. I can't turn it off, believe me I've tried for so long.

"I don't know what makes you do it."

My heart is big. My heart is big. My heart is big.

Psych Clinical

I realize I haven't said much about my psych rotation. Last night I talked to my friend and I realized that this is because I don't have the language for what is happening on the unit at this facility. In my "Psych Clinical Orientation" post (just look down a few posts) I talked about how glad I was that the unit is a voluntary research unit. I am still glad to be on the unit because 1)I think it's better than the alternative, which would be inpatient involuntary, which isn't really my speed, and 2)Because I think I needed to see what I'm seeing...even though I don't quite know why.

What I am seeing is a disproportionate number of black people involved in clinical trials for drugs that both have and have not been tested before, including pharmaceutical-grade cocaine (which is a drug that "has" been tested, vs drugs that are not yet FDA approved), and patients in experimental treatments that involve brain manipulation and a form of electric shock therapy. YES, there is "informed consent" on the unit - meaning the patients signed that they agree to participate. But repeatedly I am hearing from patients that they really didn't understand what they were signing (and the staff/researchers on the unit consider this to be a delusional moment related to their illness, ie: they understood, but they just don't remember that they understood!) Now, I am questioning exactly what informed consent really means...especially when someone is going through withdrawal or has an 8th grade level of education...according to Wikipedia, "The individual needs to be in possession of all of his faculties, such as not being mentally retarded or mentally ill and without an impairment of judgment at the time of consenting. Such impairments might include illness, intoxication, drunkenness, using drugs, insufficient sleep, and other health problems." A lot of what I see is troubling...

My friend asked me something about processing it all or coping or something (I don't remember what the exact question was) but now I'm thinking about it...

I know what I feel and why I feel it, but I have yet been able to articulate it, meaning I don't have the academic language for the problem that I am seeing. I have put up my reading list for 2007 and includes the book "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present." I think this book will help give me the language and a way to process this BS in a way that allows me to recover mentally and spiritually from what I am witnessing, especially in the absence of some much needed ongoing conversation about it.

In the mean time, when talking to my husband about my theory of not having the academic language to express my psych experience, he, with his knack for bringing me back to reality, asked me "why do you have to explain it in academic language, what's wrong with regular ol' language?!" I laughed so hard! But it's true. What's wrong the way I've been explaining it to him? Or the way I (half) explained to it to my friend? Really there's nothing wrong with it...and if I could get away with it - using an unimaginable number expletives (as I do with him) and my animated way of talking fast in half sentences, all breathless and sometimes hopeless (as I do with my friends)- the truth is, I would. But that just doesn't cut it in the classroom. After all, their is that pesky double consciousness to deal with; I rarely speak in class unless I have completely formulated the thought and have the appropriate (ie, acceptable) language to present my comment. Fair? NO. Necessary? ABSOLUTELY.

So, I am going to dive into "Medical Apartheid" slowly, and I hope that the history presented is accurate and that the language of the author gives me a way to voice what I'm feeling and recover from the trauma caused to my psyche from this rotation.

Psych Clinical Orientation

I oriented to my new Psych clinical rotation on Friday. I wondered why my clinical group only had 3 people in it, including myself. (That's less than half the normal size of a group) Turns out my placement is on a very small unit - only about 8 patients - inpatient, locked unit. The patients have severe OCD, Schizophrenia, and substance addictions. The best thing about our unit is that it's a research unit, which means that the patients are inpatient voluntarily and that they get paid to participate. The worst is that facility is state funded, which we all know means that they're broke. The facilty has inpatient, outpatient, and walk-up services.

I was the first one there for the orientation and had to sit in the lobby by myself for 30 minutes because everyone else was late. It was...interesting. Many, many black folks, and consequently many, many young men trying to "get to know me." I met two black men who rapped out loud to themselves the whole time. They weren't paying any attention to me, but I was listening to them. I have always been fascinated by what I presume to be a very thin line between psychosis and sanity. Everything they said made sense, and that was my worse fear for this rotation. What does it mean if psychotic people make perfectly good sense to me? There was a lot of conspiracy theory in their rhymes, but I believe in a few so-called conspiracy theories myself. I'm not saying that I can't recognize the difference between me, a non-psychotic person, and them. However, I think we have gravely underestimated the psychological trauma related to racism in this country and so I can't help but wonder how many of these people used to be just fine (or borderline, like we all are) and then they just snapped under the reality of this life?

Our professor gave an example of an African American married man who had to work two full time jobs to make ends meet for his family; one day he woke up and decided that he just couldn't do it anymore and he went into a severely depressive & suicidal state and had to be instituionalized. I must say I CAN imagine. The goal is to get the person to remove their stressor, to put things into perspective, to change. How do you tell someone not to work as much? Are you going to supplement his income? How does a person without very many marketable skills find a job that pays so well that he will be able to work one job? If he could find it, wouldn't he already have it? Who chooses to work two full time jobs for their entire life? The point is, what if the event that leads to psychosis is just life. What if you are being crushed under the weight of a circumstance that isn't going to change?

There were many other examples, and a good friend of mine asked about the intersection of race and mental health. (We're getting much better at taking turns!) The professor referred anyone who was interested to the works of another person. Now, I am all for providing students with the resources that allow them to investigate something for themselves, but why is it that the impact of race on the psyche is not also a topic that up for discussion in the classroom? If we aren't going to discuss it, then what is the relevance of including the race of the person in the case study examples? And I find it wholly inappropriate to spout statistics that help to set up the minority/unhealthy vs. non-minority/healthy/normal dichotomy without dicussing race at all.

I realize I'm ranting at 2 am Eastern and no one's listening. But the other day I realized that I pay over $1,000 PER WEEK to this place! I refuse to pay AND be invisible. We are reading a novel for this course in order to write a paper on mental health. We write all about the character's mental disease, so it's stuff like The Bell Jar (Plath)(deals with depression) and She's Come Undone (Lamb)(deals with Obesity, PTSD, and depression). I submitted a proposal to read a novel by a black woman because I have reached the point where I refuse to pay and not get what I want. I learned this from my colleagues. These people are vicious climbers, demanders of what they came for - and the only way to not fall victim to getting what's left over because they didn't want it, is to be right there fighting for what you want. It's the game in every sense of the word. I chose 72 Hour Hold by Bebe Moore Campbell (Bipolar mania). What does this have to do with the whole "grad school is a game" theory? It occured to me that the only reason they get what they want is because they have the audacity to demand it.

Pharm Exam/Clinical Week 7

The Pharm exam went well enough. It takes a couple weeks to get the scores, but I'm not at all worried about it, I finished quickly and easily enough, but this week of memorization was no punk.

This was the first week of my new clinical assignment. The commute was about 30 minutes on the way there, but only 15 on the way back (traffice differences). It sucks to be holed up in the car with folks you don't really know. That, and the interstate we have to take is notoriously bad and so the whole time my eyes are closed. It was an interesting first day. We got lost (as required) which ticked me off because people would not listen to me. We just drove around in circles for 30 minutes before they finally listened to what the hell I had to say. My suggestion was to start from our school since the only directions we had started from the school. But, no, they decided they "knew" of another way to get on the interstate, so we drove around looking for it. After 30 minutes, we were right back at my house, and after I pointed this out, someone *else* had the "bright idea" that we should just go back to school and start from there. Did I mention the school is probably all of two miles from my house? Arrgh. Then, when we arrived at the hospital I informed the group that my friend had told me that we needed to get our parking ticket validated as soon as we walked into the hospital so we could pay the flat rate; otherwise, we would have to pay the hourly rate because the desk closes at 7 and we aren't done until 10. Do you think they listend to me? No. For whatever reason, they thought that it wasn't really important. And she told me "oh, don't worry about it" as we walked right pass the desk where we could have done it. Ok. Whatever.

In the mean time, we go through our first day of clinical, which does not involve taking care of a patient. We do scavenger hunt type activities to locate where everything on the floor is, we go over hospital procedures and regulations (ie How to call a CODE) and we get to know eachother. We found out that we will be doing concept maps instead of careplans for this rotation. Our preceptor is also a teacher at a diploma program. A concept map is basically a visual careplan that you can draw, color, or whatever. Fine with me. The nurses on the new floor are nice and they were excited to meet us. The patients on the floor are very sick. Many of the rooms double as hospice rooms and it has a very sad feeling to it. The exception is the outpatient room which is actually on the floor. I dont' know why they would want to have an outpatient area (where patients get chemo) on the same unit as hospice - that seems really eerie and inappropriate to me??!! There is also a notable difference in presence of clergy on this floor. I never saw any on our last floor; I saw two on this floor within the first hour.

So, to continue the previous rant, clinical ended and we started to leave when the driver realized that not only should we have gotten the ticket validated, but we needed to at least bring it IN the hospital because you actually pay for parking before you leave the building. She went to get the ticket and brought it in. We put it into the automated machine. It cost more than three times the daily rate. So everyone is forking over the cash, but I forked over less. I refused to pay the difference between how much it *should* have cost us and how much it actually cost us. Not to be the difficult one, but I don't have money to waste, and when she decided (on her own) that we didn't need to pay the daily rate, as far as I'm concerned she took responsibility for the difference in cost. Then, we got back to the car and started giving her the gas money. Earlier this week I said we should meet for second and figure out how much we should pay to whoever was driving. Again, no one thought we needed to do that. So last night when it's time to fork over the money, everyone is paying five or ten bucks. Now, this is not a problem, but I at least need to know if this is just for today, or for tomorrow, too? Why is this so hard to discuss? People probably want me to just roll with the flow. I hear that all the time. But that's not the kind of budget I'm on. You can tell me how much you expect per week, or I can make the decision for you and you will just get what I give you, but I must know how much to plan for.

In essence, I hate group dynamics. Also, as I get to know folks, I think a lot of people are here because they didn't want to work yet. For example, people are getting their THIRD master's degrees in succession. Hmmm. You're 30+ and you've yet to have a real job? Or people who have an undergrad in one thing, a master's in something else, did the peace corps for two years, taught for one year, and now they're doing this and they aren't even 30 yet??!! What's really going on? And when I hear them talking about their undergrad and grad loans from previous programs, and I remember what schools they're coming from (all Ivies), I can't help but add that up...and I realize that they are adding yet another $100,000 in loans to the loans they already racked up in undergrad and previous grad school...we're talking $200,000 easily. That's a lot of money. But it ain't my business.

Clinical Week 6/Last Clinical of 1st Rotation

I survived my first clinical rotation! And it ended with a difficult patient...

My patient this week had a whole host issues - which was, of course, sad for him, but good for me because I actually started administering meds this week. (I passed the med math exam on the second try). He was on 23 different meds, so I got a lot of practice, including some injections (insulin and heparin) but his main issue was bilateral foot amputations. He was diabetic and had periperal vascular disease which resulted in his not being able to feel his toes. And because he is also blind, he could not see that his toes were black and blue. So, they had to cut off all of his toes a few months ago. Then, he went home and was bedridden, without proper home care, so his wounds from the amputations did not heal. In fact, his feet became necrotic (all the tissue died) ---> this is also sometimes called gangrene, and so he is now scheduled for both of his feet to be amputated at the ankle, or maybe even below the knee. I had to change his wound dressings, and this was no small feat because they were "packed" wounds. Packed wounds are like holes in the body that are stuffed with gauze and then wrapped. My job was to pull all of that gauze out, inspect the hole and clean it, then repack and wrap it. It is not something you ever want to see. But, what's worse is the smell. It is the smell of necrotic (rotting) flesh. If you ever smell it, you will NEVER, EVER forget it. My preceptor coached me through the whole thing, telling me to open my mouth to breath, but I couldn't because I just didn't want to taste that smell...if that makes sense? We were low to the floor at the foot of the bed when doing the dressing change, and she told me to actually get down on my knees (as she had done) as an attempt to stay steady and not fall back, away from the wound, which is what your body wants to do. She reminded me to take a second to look at the floor to keep from showing the patient all those rude faces one makes when a smell assaults your nostrils. It was also the first time I had to practice sterile technique, so it took a very long time to complete the task because the first time you do it, it's hard to maintain a sterile field!

If you want to see what I was looking at (or as close a picture I can find), click below. The differences were that my patient had no toes, and the wound was a little deeper/more of a hole.

Big picture
or Webpage (see middle picture)

Week 4/ Day 2

Nuthin but s-h-i-t. All day. My patient was incontinent, with diarrhea. Can you imagine? It started even before my day technically started. I walked into the room to find him laying there, covered. Bedding covered. Everything covered. And the smell. Grown man strong. The smell. God, the smell. Three times I had to leave the room as I silently gagged. And it just happened over and over again allllllll day long. Now I swear the smell is coming out of my pores. I smell s-h-i-t all up in my nostrils. I wasn't prepared. I didn't have anything to sniff to hold my gag reflex at bay. No strong cinnamon gum to chew. Nothing.

I think this means I'm officially a student nurse?

Clinical Week 4, Day 1

First of all, YEP, I failed the biomed exam. Nuff said.

Now, today started clinical week 4. Guess what my patient said?

"Yeah, I like you too, but I want that other girl."

I think I smiled in clinical today for the first time ever. Why? Because *I* am "that other girl." His nurse and I were both in his room, but he can only see shadows of figures and ironically his nurse for the day also happened to be black. So as shadows of figures we look the same, but our voices, of course, are different. So when he asked for someone she stepped forward first to see what he needed and he started talking, but when she responded he said "oh, no I thought you were the other girl." And of course she laughed and made some funny comment about not feeling loved anymore (she's great and new and still happy and fresh as a RN) and that's when he gave her the consolation line before turning to follow my voice. You can't imagine. Here he is 80+ years old, been in the hospital for over two weeks for a heartattack because he's homeless and we can't find a nursing home placement. His girlfriend ended up in another hospital right after he came to ours, and they have been evicted from their apartment in the mean time, but he doesn't know that yet. All day he swears it's 1966...must've been a good year for him. None of his daughters visit because he has a history of violence driven by alcoholism. He apparently tried to kill their mother. Oh, and of course he, too, was restrained. Why do I always get the restrained ones? Anyway, I took his restraints off today because he wasn't threatenting to me, but it's always different at night. Patients who are combative usually become that way at night. He also is in chronic pain because of his gout and is used to numbing his pain with alcohol and percocet(oxycodone), but in the hospital he only gets Tylenol. But believe it or not they have given him beer at the hospital the first few days to help his withdrawal! (I'm shocked by this) But whatever, all that matters was that I didn't kick and scream all the way thru clinical today and that my shave, homemade heating pads, and thorough cleansing of his dentures gave me a leg up. Finally.

AND, the patient I took care of last week is still on the floor. Remember he couldn't speak and I had to ask a million questions so I could do a big careplan. Well I went to visit him and his wife and he was truly happy to see me. With his voicebox in working order again, he said "where were you? I've been looking for you." And he actually told me some of the things I had joked about. His wife had told me he had a wicked sense of humor, so I had made lots of jokes while I was giving him his bath - things like how great it must feel to have two women washing you from head to toe, and how I didn't care for his favorite topic (he is an American History PhD) because I didn't think history had been to kind to people like me and what's up with that? etc. So he finally got to talk and tell me about his life. Interesting. Anyway, my clinical day just got better and better with every word.

Then my preceptor told us we can lighten our careplans now which means less work and fewer hours! (This mainly means we only have to do 3 diagnosis for each patient instead of 5, with 4 interventions for each diagnosis instead of 6, and we only have to report abnormal labs instead of ALL labs.) I know it doesn't seem like a lot, but believe me, that's at least an hour less than we normally spend.

What a great day. Not even an F in biomed could bring me down off this high.

Clinical Week 3/Exams

I got honors on the first Pharm exam, but I think I failed the first Biomed exam. But word around the school is that everyone failed it, so I don't feel bad.

Clinic for Week 3:

I pretty much broke down. I swear I hate clinical. It was my week to do a full interview (5 pages of questions) to complete a "big" careplan (more detailed than the usual weekly one) and my preceptor assigned me to a patient that could not speak. (Laryngectomy with disfunctional voice prosthetic due to anesthesia). He also had no gag reflex, but no one had checked that before assigning him to a "normal" diet. So he was eating his french toast and sausage , which wasn't really going down, but he was so numb he didn't know it wasn't going down, and I noticed him choking. I came over just in time to catch every ounce of puke he threw up. French toast, sausage, orange juice, and coffee. Eww. Then I gagged and almost lost it. All of this tunred into my first full bed bath, which I was dreading.

In other news, I am wondering about how midwifery fits into the nursing model. I am going to have to do some reading about this, because the fit doesn't seem to be a good one so far...

Weekend Thoughts

I'm glad the pharm exam is over. Just to have the first one out of the way is nice. I am now studying for biomed which I went to a review session for today. The review session was helpful, but probably would have been more helpful if I had of read before hand, but where's the time. Last night my normal happy hour group went out for our routine Friday evening happy hour, but about 15 more nursing students ended up joing us. Did I mention we went yesterday, too? Lot's of drinking going on. One of my dearest friends (optometry student) started drinking more when she started her program, and now I understand why. There's so much tension, there's gotta be a release. At least the drinks are only $2.50 and there's free food to soak it all up. That, and we can walk to our place if need be. Once a week can't hurt!

We are going to finally furnish our apartment this week. Ikea here we come! I think I am going to try to do something fun and post a before and after of our living room makeover. I've always wanted to do this! I love HGTV design shows!

I remember that I was suppsed to tell you about Week 2 clinical:

Week two was better than week one in some ways, mainly because I had women patients, and I found them much easier to deal with. On the other had, I also had two patients this week because my first patient went home the first evening, which gave me a new patient for day 2 of this week. This was a huge headache. Twice the work. And, I got called out to give report (basically you sum up a whole careplan in 5 minutes or less) and I had only known the patient for a few hours. But I'm glad I got it over with and I don't have to do it again for at least 6 weeks. This weeks patients both had triple bypass surgeries and heart valve replacements. I learned a lot about the heart this week, including that you can live without a tricuspid valve! (The tricuspid valve separates the right side of the heart into a right atrium and right ventricle).
I did get somewhat frustrated with one of my patients' insistence on calling blacks people "colored" and her mixed nieces and nephews "mulattos." Sometimes you just have to look 'em dead in the eye and say, "for real?" And then they say "no offense." Well, if you must add no offense after it...it's probably offensive.