Learn to prioritize, people, I beg you.

I don't know how many times I've written "In order to provide holistic care, a nurse must remember to consider the needs of the patient along with the current priorities of the healthcare providers." in all sorts of BS essays.

Oh I understand the point. I know that patients are not going to pay much attention to what you're saying if they're worrying about who's gonna pick up their kids from school while they're getting chemo. I get that. That's important.

I want to rant here, because I learned the other day that some people are so afraid of losing their hair during chemotherapy that they acquire certain ridiculous looking "cooling caps". The idea behind these cooling caps is that they shrink the capillaries in your scalp so that chemotherapy drugs can't reach the hair follicles and make your hair fall out. You have to put them on at least 40 minutes before the infusion begins and change the ice packs every 20 minutes to keep the scalp at the ideal temperature.

If that was all, I would just chalk it up to silly vanity and not bother writing about it. But do you know where tumour cells just LOVE to go? The scalp. Especially with breast cancer. They freaking love it. The cooling caps are basically preventing the chemotherapy from getting to the places where tumour cells want to hang out. This is such a problem that when we see these things in the chemo clinic, we have to check if the doctors know about it and notify them so they can talk some sense into the patient.

Sometimes, the patient decides that keeping her hair is more important than the terrible risk of scalp metastases. That's when the nurses are supposed to think back to that blee-blah-bloo sentence up there. It's kind of like Frank Costanza screaming "Serenity now!" , isn't it?

So I did my job. I asked if the doctor was aware that she was using that contraption. She replied that the doctor knew but she was going to use it anyway. My poker face was awesome. I charted. I hung up the meds. I stayed completely uninvolved in the massive ridonculousness of her relatives measuring the temperature of ice packs, figuring out how to put it all together and strapping that thing onto her head.

One nurse muttered in passing, "Her hair isn't even that nice." It was a catty comment trying to hide the genuine frustration that we were all feeling, I suppose. What a terrible waste of money, energy and resources.

Your hair? It's not as important as your health. I thought that was pretty much a common sense kind of thing. Obviously not.

Serenity now.

Huh, I've been an RN for more than a year now...

Yeah, I've started writing on this blog again so that maybe Robert will stop making fun of me for watching terrible television.

Clients always ask about what sort of things I see in community nursing. I guess since they're being treated at home, they're curious about whether there are other people who are equally unwell, if not more.

The other day, I was doing changing a dressing on someone's pilonidal cyst incision and she asked me, "Doesn't this gross you out?" It's a question I get quite often.

Believe me, incision wounds are a cakewalk. I LOVE pilonidal cysts. I could pack drained abscesses all day long.

Do you know what's surprisingly yucky? Tracheotomies. Oh sure, it's easy to think of it only as a tube in the throat to help you breathe. But people need them for a reason and that reason always leads to coughing and secretions. If one coughs hard enough, secretions can and will shoot out of the trachs like horrific projectiles of mucousy death. I will confess right here that when I used to suction trachs in the hospital, I had a silent scream frozen on my face under my mask every single time. Even disimpacting people's colons is less disturbing to the soul. Still, I've never actually dreaded doing trach care. I hid my face with a mask (and face shield, if I could get one) and got on with it. No one has to know that I did a little private shudder after it was over.

In the end, it comes down to the individual nurse's personal brand of heebie-jeebies. Eventually, you can get used to almost anything and will only feel a slight tingle running up and down your spine. The nightmares will only last a few weeks, tops. =P

The Summer of Judy

You know that Seinfeld episode where George loses his job at the Yankees and decides to spend the summer putzing around willy nilly?

Well, it's turning into a Summer of Judy for me. I had originally planned on having a nursing job by now and studying for the licensing exam in October, but due to some unfortunate circumstances (which I have droned on and on about to so many people that I can't even muster the energy to do it once more in writing), that ain't happenin'! The delay is so infuriating that I was getting flashbacks to the days of Science in Society class when I was threatening to bonk my brains out with the pointy end of a scanner while Linda laughed and laughed hysterically, both of our minds on the verge of crumbling like delicious cinnamon dusted graham crackers.

So I've been spending my energy taking Japanese classes and studying nursing stuff from time to time so that my brain doesn't completely rust. And, since I am a poor student and in need of money until a bunch of bureaucratic nitwits tell me when I can start working in my field, I've advertised myself as an English/French tutor on a Korean message board. Ahhh, it's like being back at U of T all over again. Except the fact that I refuse to teach chemistry and math now. Thank goodness.

Oh, and you know how in that same Seinfeld episode, George slips on an invitation and hurts his legs? Guess what I did last night. I slipped on Robert's floor and twisted my ankle. Yes, the same one that I always twist. Thanks to my nursing interventions, it is not as swollen as it would normally be. But yes, it hurt so much that I cried last night for 10 minutes or so. So we all know what's going first when I'm 70-something and have osteoporosis. Something to think about.

Cooking Attempt #48: Thumbprint Cookies

Two of my nursing buddies and I have been doing our clinical course in an Enfance-Famille program this past year, so when the time came to say good-bye to our preceptors, we decided that we would bake a little something for everyone in the program. I found the recipe for these cookies here, but had to adjust it because the dough was too crumbly during my test run. I added a bit more margarine like the random people on the internet suggested and it turned out better for the actual batch that I presented to the nurses.

I was actually worried a bit, because these cookies aren't very sweet. I wasn't sure if they were supposed to be sweet or not, you see. I mean, all the storebought cookies are disgustingly saccharine (Tim Horton's? Even worse.). I eat maybe two and then I've met my cookie quota for the next month or two until Robert shoves one into my mouth again. So how was I to know if these would satisfy a bunch of middle aged ladies who are probably more knowledgeable in cookie lore?

In any case, they liked them a lot. So much so that they asked me for the recipe. And being an obliging youngster, I promised to e-mail my nurse the recipe, which meant that I had to translate it in French. FANTASTIC.

Ingredients

• 3/4 cup margarine
• 1/2 cup brown sugar
• 1 egg
• 1 tsp vanilla extract
• 1 pinch salt
• 1 cup flour
• 1/4 cup raspberry jam

Method

• Cream margarine and brown sugar for about 3 minutes.
• Whip in egg and vanilla extract.
• Mix in salt and flour until formed into dough. Put in fridge for 30 minutes.
• Form small 1-inch diameter patties and lightly press with thumb to make a small well in the centre.
• Fill the well in the cookies with raspberry jam.
• Bake on parchment lined cookie sheet (I use wax paper, which works just as well) at 350F for 12 to 15 minutes.
• Let cool on cookie sheet for few minutes. It makes about 2 dozen small cookies.

These pictures are from my third time baking the cookies.

Brenda made the prettiest patties ever, don't you think?

And these are the cookies I actually presented to the nurses. I was still following the original recipe's instructions to make BALLS and then press your finger, so they have a cracked appearance. They were still yummy, I swear!

And now, the recipe in French that I translated for my preceptor nurse.

Biscuits “Empreinte de pouce”?

Ingrédients
• Beurre – ¾ tasse
• Sucre – ½ tasse
• Oeuf – 1
• Extrait de vanilla – 1 c. à t.
• Sel – 1 pincée
• Farine – 1 tasse
• Confiture – ¼ tasse
• Papier parchemin

Méthode
• Battez la beurre avec le sucre pour 3 minutes.
• Ajoutez l’oeuf et l’extrait de vanille et battez encore.
• Ajoutez la farine et le sel et mélangez. Mettez la pâte dans le frigo pendant 30 minutes.
• Roulez la pâte en boulette (?) et appuyez doucement avec une pouce.
• Remplissez le creux (?) avec la confiture. (J’ai utilise la confiture de framboise.)
• Arrangez les biscuits sur une tôle à biscuit. Mettez au four à 350 degrés Farenheit pendant 12-15 minutes.
• Laissez refroidir pour quelque minutes sur la tôle.

A declaration.

To: You people know who you are

Please, for the love of beans, stop over analysing stuff. Especially relationship-y stuff.
You make me oh so tired.

Yes, I am your friend. I consider myself a damn good empathetic willing-to-cry-with-you-if-something-bad-happens type of friend. But I am only willing to do so if there is truly something to empathize about.

If you believe that the guy you rejected but now have feelings for but he was seeing someone but then you have reason to believe from the oh so reliable evidence from Facebook stalking that he isn't seeing that girl anymore so maybe you have a chance again- You see? I can no longer form sentences to describe your situation. And I used to be excellent at forming seemingly run-on sentences that were actually quite sensible.

The point is, if you do this to me, I will sit there with my smile-that-isn't-quite-a-smile and say, "Ah."

Maybe in the process of becoming a nurse, I have learned to differentiate between "hard evidence" and "you are analysing the way someone waved at you across a dark room?" level of foolishness.

Do me a favour. If you are interested, ask the person out. Do it. And no, a text message asking if the person is "free" sometime in the future to do "something" is not good enough. SMART goals, people.

Specific-Measurable-Attainable-Relevant-Time-bound

If you didn't include all these components into your significant discussions for plan making with someone, then I can't be bothered to listen to you whine when it falls through. And I don't believe in coddling anyone. You can find someone else to help you cling to false hopes or any sort of delusions by saying, "Oh yes, she will totally come back to you one day. TOTALLY.", because I don't do that.

I. Don't. Do. That.

So don't call me heartless and unsympathetic and wah wah wah. Because it's not just one person who is filling a balloon with honey-coloured daydreams that aren't at all realistic. It's MANY people, each with their own individual balloons and it is SUFFOCATING me.

At one point, I had to resort to scream-praying to God, okay? I haven't prayed since grade 6, okay? I don't even believe in God. I did that because of you. And your yammering. And believe me, I'm not trying to burst your bubble. I'm trying to deflate it as gently as I can.

So please, help me preserve my sanity. By doing so, you will be helping to create a sarcastic and fun Judy. Someone you can truly rely on to congratulate or comfort you when something significant happens.

Help me help you.
Help me help you.

Love and hugs, your friend.

It's a work in progress.

I need somewhere to work out my course evaluation for a certain person at the end of this term. People seem to enjoy the bitterness and it never hurts to get feedback on one's compositions. This is only a draft. It will get updated as the bitterness accumulates and distills into the finest form of written cyanide. It's been awhile since I've written anything worth reading, so the purifying process may take awhile yet. But am I in a hurry? Not really. Whatever I have by December will be submitted. And then I have another 4 months to polish THAT draft and submit it again.

Subject: On the topic of course communication
The frequency of e-mails rivals that of the most virulent spambot in existence. The contents themselves, being so convoluted by length and pointless wordiness, are indecipherable to the point of making students shudder upon seeing the dreaded mail icon in WebCT. To actually understand the course itself, one must rely on those poor unfortunate souls who manage to navigate through the mazelike sentences through any combination of luck, sheer force of will and fear. If the tool that is supposed to enhance and facilitate understanding between individuals is simply ignored most of the time by the receiving party, then it is obviously not being used properly. One may be assured that after receiving up to five e-mails in one day that are marked as being important or urgent but say nothing, it should come as no surprise that students eventually end up ignoring them. Operant conditioning is a powerful thing.
A teacher must be professional at all times. If there are numerous questions on the WebCT discussion board regarding a certain issue, then there is a serious miscommunication from the teacher's end. As the provider of information, the teacher is responsible for answering questions in a manner that cannot be reproached for snarkiness or misdirected anger. If a question is answered directly, it must follow that students will be satisfied.

Subject: On the topic of a certain lecture
When one clearly loses one's voice and cannot be understood even with a microphone, it is an appropriate time to cancel class. Students learn nothing from a teacher who sounds as though she is on the threshold of death. It should be obvious that miming is not an effective communcation method. This is a university class and not a 3-hour game of charades.

Subject: On the topic of course organization
A syllabus should not be 50 pages long. The information within should be easy to find. The most important part of a syllabus is the list of assignments and their due dates. This should be the most prominent, instead of being buried under paragraphs of mindless text. This helps not only the students but also the preceptors, since one may be sure that clinical nurses will not read all 50 pages of the package, if they've opened it at all. If one wishes to publish a book, then one can easily do so online at various self-publishing websites and not foist their prose disguised as course material on defenseless students. If the faculty is confused about what the course entails, then this is an indication that the expectations of the course are too much. The blind leading the blind will not end well.


Like I said, this is but a beginning draft. You can expect much more from me if I start having blood-drenched nightmares again.

Okay, so clinical placement this year...

There was a lot of confusion over my clinical placement this year. Honestly, I get a little jolt of fear running through me whenever I open my school e-mail and see a new message waiting for me.

First, the prof who is in charge of the course had some difficulty finding placements for people, because of all the health institutions trying to prepare for the possible resurgence of H1N1 pandemic in the fall. Which meant that instead of getting our placement information sometime in July as promised, we got them in late August.
When she did e-mail/call me, it was to ask if I'd had a psychiatry placement already. Because she'd asked for our résumés back in April, I hadn't included my fascinating experience from May (of which you know). She had wanted to put me BACK at the psychiatric institution. O_O

At that point, I was just worried about having a damn place to work during the year. I told her that it was not my first choice, since I'd already done psych and I'm sure there were many students who hadn't had that wonderful experience. (It's kind of mandatory to have psych before you graduate.) She said okay, that psych placement wasn't even a sure thing anyway.

O_o Why would you even offer it to me unless it was a sure thing?

She got back to me a few days later and said that I'd been placed at community clinic. Okay, it's sort of on the opposite side of Montreal, but hell, I commuted to Maimonides, which is like 2 bus stops down from there for a term. I wasn't particularly picky about it. The placement was described as "Services Généraux", which I assume to be regular check-ups and such. I contacted the preceptor listed on the professor's ginormous Excel file and sent my résumé.

I was so relieved at having found a place that was not psych (again) and was not exclusively geriatric (again).

Oh, this is not the end of the story. Last Friday, I got an e-mail from the prof, telling me that my placement was "lost". I was confused, because I'd already talked to my preceptor and he hadn't said anything about changing jobs. Apparently, I had talked to the wrong person, because the prof couldn't figure out how to line up my name properly in the Excel file.

Yeah. She couldn't figure out how to move my name down 3 rows in an Excel file.

-_____________________-

That's a severely disgruntled face.

She wrote that she was trying to find another spot for me somewhere else and that I shouldn't panic, because there was still a whole week left before our first week at the clinics.

I did not take this well. It was more of a panic than anger. There are clinical hours that I need to fulfill to graduate. How could they lose a placement in the span of a week? Also, why wasn't the prof telling me the possible consequences of not finding a place for me at all? Why the terrible lack of organization?

Okay, so there was a teeny bit of frustration in there. Just a tiny bit. That's when I decided, screw it, I'm not going to let it keep me from relaxing the Labour Day weekend away. So I did the Buddhist ritual of 108 bows, meditated and generally felt better.

Finally after badgering her in class and via e-mail, I received word that I would be placed in an Enfance-Famille program on the southwest corner of Montreal. I was really happy about it. It's easier to get to (on the green métro line) and babies! On Friday, my newly assigned preceptor called me back.

The first thing she said after we'd said hello was, "Do you want to talk to your prof about finding another preceptor for you?"

I think when she heard the voicemail I left in English (because duh, I'm anglophone), she thought she wouldn't be able to communicate well enough with me. I wasn't about to give up three bloody days before the start of our clinical duties. Unless she was going to move out of the city, get pregnant or fake her death, she was going to teach me and I was going to learn from her, goddammit.

Her: I use French mostly and I'm afraid I won't be know how to explain some things in English. I only use English with my anglophone clients.
Me: That's okay. I've been studying French since elementary school and I feel comfortable with it.
Her: Could you say something in French for me?
[Rest of the phone conversation was in French]
Her: You see, we write our charts here in French.
Me: I was at the Douglas in May and all the nurses there were francophone, most of the patients spoke French and reports were done in French and I had no problems. I took courses at McGill for both conversational French and written French.
Her: Hmmmm....
Me: Sometimes I might get confused if someone talks really fast, but I can look things up and I have no problems asking for clarification.
Her: Okay, which day would you prefer to meet?

If she had asked for a writing sample, I would have totally composed a damn essay right then and there in my zeal to keep this placement.

So hopefully, this year will go well. If another thing goes wrong with this, I don't know what will happen to my already fragile sanity.

Click the photo to see the detailed contents.

My last day as a summer extern

Today was my last day working at the Children's Hospital as a nursing extern. While I might not have learned much about new ailments, medications and procedures, I learned lots of other things. Working in a small unit also meant that I got to see the same patients for a long period of time and follow their progress and development. When I first arrived back in June, none of the three toddlers could walk on their own, but now they're zipping down the hallway as soon as your back is turned and you have to chase them down before they lick the wheels of a baby carriage or something. There's a routine there and sometimes it did get a bit tedious, but it helps you become super efficient.

Anyway, you know how I love lists. So here we go...

Things that I learned

1) How to feed toddlers: I learned distraction methods, ways to disguise certain foods in other foods, hiding dessert until the main meal had been consumed, techniques to maneuver the spoon around scrambling hands to the mouth and ever so much more. Got a kid who likes to spit stuff out in order to see your reaction? Oh, my "I'm ignoring you for the next 30 seconds" face is positively stony.

2) How to stop tantrums: My brother used to fling himself backwards onto the floor from a sitting position when he was a toddler. I was about 7, but I learned to strike my hand out lightning fast to cushion his head centimetres above the floor. Oh he would continue to whine, but at least there was no danger of a head injury. I found that the best method to deal with a tantrum is to pay attention but don't. One kid likes to fling herself backwards (from a standing position, no less). Of course I grab her arms so she doesn't get hurt, but then I lower her onto the floor gently and she can writhe around all she wants. Meanwhile, I stand above her with my arms crossed. "What drama for nothing at all. Let's stop the nonsense, " I say in a bored voice. She cries and wriggles for a minute or so and when she gets up and stops sniffling, then she gets properly comforted with a hug.

3) How to give report: Report is passing pertinent information to the nurse who is taking over for during your break or the next shift. I still need some work on this. Usually my thoughts are so jumbled at the end of the day that I need a minute just to figure out where to get started. Of course, everything is charted, but it's faster for the nurse to hear the info directly from you and be able to ask questions. Lately, I've been writing down a short list of issues I want to mention as I write the chart, like "Sprint, Splints, Genetics, Nystatin" and these help jog my memory when it's fried from a 12-hour shift.

4) I don't like 12-hour shifts: They have 12-hour shifts at this hospital, because they say that it's less hectic and confusing for the patients to have 2 different nurses throughout the day than 3. But it's very tiring and rather unfair, as the day nurses pretty much do a huge chunk of the paperwork and follow-ups while the night nurses are doing vitals or something. I hope that my hopeful working place when I'm a nurse (Sick Kids? Pretty please?) has 8-hour shifts. During the summer, I would start work at 7am, take a 30-minute break around 11am, take an hour lunch around 3pm and then go home at 7pm. I had lunch when most people would be going home. Guh. From now on, I shall never feel that 8 hours is a long time to work. NUH UH.

5) How to be patient: Let's face it. People are dumb. Children can be frustrating as heck. For heaven's sake, I'm trying to give you banana-flavoured medicine. BANANA-FLAVOURED MEDICINE! Do you really want something up your bum instead? Because that's the alternative: suppository up the bum. But no, you must never lose your composure. If you can't manage a smile, at least have a really good placid mask. It'll keep the patient from being startled at the sudden murderous flash in your eyes when she bites your arm. Which actually happened once, I'm sorry to say.

6) Never get married to a relative: I of course knew this long before I started working at the hospital, but this summer, it's been pretty much hammered into my brain. If you can trace a common ancestor somewhere in your family records, then it's too close. Even if they're your fourth cousin twice removed (whatever that means), it's too close. Don't bother arguing with me. IT'S JUST TOO CLOSE. Now stop it. *shudder*

7) I'm okay with all bodily fluids except for mucous (from nose, mouth, trach) and earwax: Feces? Fine. Urine? Fine. Blood? I LOVE blood. Blood is the best thing on this list. Snot? It's not fine. It's especially not fine when you're suctioning the nose and your Yankauer just keeps sucking out an enormous amount of [stuff] (edited for sake of reader comfort). And have you seen the way peroxide solution fizzes when it meets earwax? *deep breath in and out*

8) But even when you're disgusted, don't show it: You're a professional, goddammit. If you need to silently scream because of the [stuff] that's shooting out from the trach when your patient coughs, put on a damn mask.


All in all, it was a very good learning experience, wouldn't you say?

It's all for the children... *shifty eyes*

As a gift to the unit in my last days as a nursing extern, I've made a CD of cutesy songs from the Katamari Damacy video game series for the children here. They're here for so long, they might as well have something new to listen once in awhile.

It has nothing to do with the fact that I just want to listen to the awesome music while I'm changing diapers and feeding formula. No...how ridiculous would that be? I mean, it's not like I've snuck Korean hip hop in ther-

Well, alright, I did do that. But it's a mellow song that blends in seemlessly with Katamari's funky melodies. The lyrics are about breaking up, but how many people know Korean nowadays, right? I also put in an anime song and some clips from Viva Pinata. It's totally kid friendly!

So no one accuse me when I appear to enjoy the CDs just as much as the children, if not more. I'm moments away from singing along to the Katamari Que Sera Sera.

It's FRIGGING SWEET.

Live blog: Overnight shift at the hospital

Believe me when I say that this will probably be more interesting due to my various antics to stay awake and keep busy than it will be for the things that go on at the hospital during the night. Especially, since I'm back on the chronic care unit. I was on the surgical unit unexpectedly last night and it was so drag-yourself-on-the-floor fatiguing.

8:45pm - Patients 1 and 2 are asleep in their cribs. They will stay asleep until I leave at 7:00am tomorrow morning (my gods willing). Patient 3 has a personal caregiver 24/7, so all I have to do is give him his feeds and his meds. I am now starting my Japanese exercises. Having mastered hiragana, I will now practice katakana. Kanji that's more complicated than "person", "big" and "I" can go straight to hell.

9:10pm - Okay, I lied. I actually haven't started studying Japanese yet. First I had to eat my delicious sammich (egg bread and spicy sausage slices - hell yes!) while browsing websites about terrible celebrity fashion. Now that my delicious sammich is all gone, I worry that I will be hypoglycemic later in the night. Thankfully, I also have a peach. But I'm no good at picking out peaches and fear that it won't be ripe enough and that I will be sorely disappointed as I have been so many times before with this particular fruit. Alas. Also, I have just tried out an anime site. It isn't blocked, BUT! this computer doesn't have flash player which pretty much makes it impossible to watch any videos on it. Victory snatched away!

9:15pm - But apparently it has a DVD player. Fate is kicking me in the butt, because of course, I don't HAVE any DVDs with me. Unless I want to watch Dora the Explorer or other kiddy stuff we have on the unit. And that's a no. What will I do when I have kids and I have to buy them crappy DVDs? Will I have to actually WATCH with them? I'd much rather read books with them or play with toys or make up imaginary play. Maybe it will be a "Mommy's naptime" activity. "Here kids, go watch this blue dog count to five ad nauseam while mommy honkshus for 2 hours. ZZZZZZZZ." Oh yeah, that will totally work. *thumbs up*

10:40pm - Slowly getting through the different types of verbs and how to conjugate them. It's easy enough once you have the rules down, but it's a matter of knowing enough verbs. Ever so slowly getting there.

11:30pm - There are sleep studies being performed in the room opposite ours. Which means the alarm rings whenever the heart rate, respiration rate or oxygen saturation drops below a certain limit. The alarm's so loud that I thought it was a fire alarm or something. One kid keeps ringing so often that it's waking up the other kid who's getting the study done. Which means that the other kid will probably have to do the study again tomorrow night, since the results from tonight won't be accurate. Finally, we've put tape over the speaker portion of the monitor and it's been quiet ever since.

12:30am - My preceptor's gone for her 2.5 hour nap. I usually sleep later than her, because 1) I have trouble falling asleep during work unless I'm tired out and 2) the later I take my nap, the less hours I have left to work when I wake up. Plus, I'm really into my studies now. 2 more chapters in this book and I should have the means to say basic sentences in Japanese. I think, I will now take a short break, however, to do some charting. Since I love making lists and crossing stuff off...
- do charting [done]
- finish off 2 more chapters [done]
- turn off the feeding pump and flush the gastric tube for patient 3 [done]
- take nap [done]
- wake up [done]
- do meds and more feedings [done]
- read Aishiteruze Baby online

4:15am - Back from my own nap. I've been taking my night shift naps on a spare cot that I drag into the conference room just next door. I put my eye mask on, zip up my hoody and huddle under the blankets. Even then, it takes me a good while to fall asleep. Tonight, I had an anime theme song running through my head. I have my cellphone alarm to wake me up, but I forgot to tell that to the PCA who scared the crap out of me by knocking on the door just ahead of the alarm. Ahhhh well.

5:00am - Well, I'm done everything on my list except reading Aishiteruze Baby and I don't feel like doing that just now. 2 hours left and I'm stuck for what to do? Should I study more? Read the news?

5:10am - What's this, what's this? I've been snooping around the computer, trying to see if anyone has copied a video worth watching onto it and found "Midnight Sun - partial draft", a PDF file. That sounds familiar, I thought. So I opened it up. And got through the middle of the second page and said, "Waaaaaaaaaait a minute." Title based on astronomical phenomenon? Character names taken from a smutty book in the 18th century, like Rosalie and Emmett? Pointless drivel that kept me completely uninterested? The name "Edward" hogging a whole line by itself AND italicized? This is a Twilight book! I closed the file with the speed of a hypochondriac shoving away a leper. (Digression: What a curious sentence.) But I find myself wondering, who was reading this at 6:30am on May 12th, 2009? Well, I do know that there were McGill students doing shifts here during that time. Bwahahahaha~
I don't know why I find this so amusing. A sense of gleeful superiority, I guess. I've been careful to avoid anything Twilight-related and am determined to keep it that way. Forever. Well! This has given me a second wind. I will fetch a glass of water and find something else to do!

5:40am - Found some tea biscuits in the kitchen. Sweeeeeeet. One of the sleep study kids are awake, thanks to the freaking alarm of the other kid. Now she's wandering up and down the hallway, practicing her recently acquired support-free ambulation. She's walking without holding onto anything, I mean. My kids better sleep until 6:50am at least. I mean it!

6:56am - Everyone woke up around 6:15am, just when I was trying to chart and tiptoeing around. Ah well. Kids are in playpens or walking around. It's great that some of these toddlers have started walking by themselves, but it makes it so tiring to chase them around and stop them from shoving electric plugs up their noses. No more night shifts until the end of the summer! Yatta!

What a day...

I worked 12 hour shifts on Wednesday and Thursday. Wednesday was alright, even though it WAS Canada Day. Thursday was admittedly more difficult. When you've been out of the house for 13.5 hours only to drag yourself back out early the next day, your brain is going to falter a bit.

I was okay until about 3:30pm on Thursday. That's when I got back from my lunch. I work in the tech-dependent unit, which is a room with 3 patients and a nurse's desk in the corner. The kids there are mostly toddlers with tracheostomies and require constant supervision and oxygen monitoring. One baby was out on day pass with his parents and the other two toddlers were napping. So I was free to drift along in my Elvish sleep. The 3.5 hours passed without incident and my shift was over.

There's a mini bus schedule that I made on a cue-card that has all the important times (when my shifts start and end) for the bus that conveniently connects the hospital and my apartment along a road without much traffic. I love that bus.

Yesterday, however, I left the building and realized that the bus wouldn't come for another 15 minutes. No problem, the hospital is right next to a subway station. What I didn't account for was the half-zombified state of my brain.

I went to Atwater métro station, paid my fare and went down to the platform. I remember looking across the tracks to the opposite platform and noting that it was heading towards Honoré-Beaugrand (which is kind of like Kennedy station on the Bloor-Danforth line). What I didn't note was that THAT was the direction I was supposed to be heading in. Believe me when I tell you that I am well acquainted with this particular station. Last fall, I did my clinical placement at this same hospital. I go down there to shop at the Korean market which is nearby. I know Atwater station damn well, is my point. Now why, on this particular day, I decided to go down the staircase on the left instead of the right is a mystery. Maybe my brain was angry with me for subjecting it to the smell of chlorhexidine all day, I don't know. But there I was, placidly looking up at the TV screen and wondering what the weather would be like in the evening for 5 minutes straight without even thinking about whether I was on the right platform or not.

The train arrived and I got on. Now, my station, Place des Arts, is 5 stops east from Atwater. So one doesn't want to zonk out completely during the subway ride. Zonking out partially is okay, though. While I was in this haze, I heard the announcement, "Attention. Attention. Charlevoix station is closed. Buses are available from..." I thought to myself, "That's strange. They don't do that announcement unless you're going west on the green line." Then came the announcement, "Next station, Lionel-Groulx." It took 2 seconds to sink in. That's right. I was heading west. Thankfully, it was only one station in the wrong direction, so I got off.

Lionel-Groulx is like Bloor, where you can transfer between the green and orange lines. But unlike Bloor where you change floors to change lines, here you change floor to change your direction. Nonsense, you cry! I tell you, it's true. My brain apparently wasn't done screwing with me, so I mindlessly walked across the platform and got on the train, thinking that my misadventures were at an end.

I wouldn't be posting this if that was the end. Oh no. Being squishy of brain, I had changed to the orange line. When they announced, "Next station, Place St. Henri", I actually said aloud, "Bloody hell!" By this time, I would have been better off just sitting on the bench in front of the hospital and waiting for the damn bus. With a supreme burst of effort, I forced myself to stay alert and made it back to Place des Arts without making any more blunders.

All that was left was to take a bus for a short distance to my apartment. Imagine what I discovered when I exited the station! It's Internation Jazz Festival time here in Montreal and all the streets in the area were closed off for the concerts. This was the last straw. I was hungry, I was tired, it was bloody hot and sticky. If I were a child of less principles, I would have thrown a screaming tantrum right then and there. (Fact: My parents swear that I have never thrown tantrums, just death glares which is infinitely more endurable.)

Grumbling, I walked to my apartment. It was only a 10 minute walk, but I let myself wear the cranky pants that had been collecting dust in the closet of mind. Once I was home though, a shower and some food fixed EVERYTHING. Ahhhh~ Then I passed out on the bed and slept the night away. ^_^

Later in the month, I have to work three 12-hour NIGHT shifts in a row. I'll be happy if I don't somehow end up in Ottawa after that.

At long last, overview of the psych placement.

I've been neglecting this blog a little bit. I could say it's because I was working pretty much full-time in May, but since then I've had a blessed break of 10 days. And although I am working full-time again (more on that later), it's in 12-hour shifts, which gives me lots of days off. So I hope to begin writing again more regularly during the summer.

I think I'll begin with a description of my 3.5 weeks clinical placement at the largest psychiatric hospital in Montreal, as a sort of catharsis. Oh...what can I say. The whole thing was poorly organized to begin with. For instance, no one could really tell me the goal of my particular unit until I actually got there and talked to my preceptor. And on the orientation day, me and three other students wandered around for 2 hours because no one told us where we were supposed to meet the prof, which led us to assume that we were expected to be in the main lobby. A rather obvious supposition, no? Unfortunately, the institute is composed of many buildings like a university campus and there's a special administration building where all such orientations take place. We would have known this if we had actually made it to the orientation!

My first day on the unit was fairly uneventful. I had expected patients to be confined to their rooms and was surprised to find that they were walking around so freely when I stepped off the elevator. Then I found out that they were mostly schizophrenic patients who were in programs to be moved back into the community eventually. Some never make it, most move out and then return in a matter of weeks and very few actually live outside for a longer period of time. It was a very lax environment compared to the medical/surgical units I'd been on. Staff breaks lasted 90 minutes or so. Most afternoons were spent gossiping or in the case of a student like myself, pretending to be busy reading articles while surreptitiously playing sudoku.

I hated it at first. The giant gap under the door of the smoking room made the whole unit smell like smoke and gave me throbbing headaches. Patients thought they could take advantage of me and push me around because I was new. The very first day, I went outside to wait for my friends so that we could have lunch bitch session in the sunshine. A man who was obviously an alcoholic sat down next to me and a very awkward half an hour followed during which I tried my best to use my therapeutic conversation techniques and he somehow took that as flirting. When he finally walked away, I bolted back to the main door, fumbling with my key like the clumsy main character in a horror movie. I vowed never to go outside by myself again.

It did eventually get better. I was allowed to participate more in the unit activities. I took over medications for all of my preceptor's patients in my first week, including bi-weekly IM injections. I conducted interviews with several patients on the unit even though I wasn't officially responsible for them. I took part in rounds and called hospitals and family members to get medical records that were missing. It was a hell of a lot better than what my friends were doing down in the Memory Clinic: MMSE day in, day out, some tai chi (YEAH) and computer programs designed to stimulate memory and learning. I shadowed in the memory clinic for one hour and it was deadly dull. They do mostly paperwork down there. I do want to have a clinic eventually, but I doubt my paperwork will be as absurdly pointless as theirs.

I also got more comfortable being around patients who could potentially have a psychotic episode at any given moment. The trick, I think, is being calm and firm. Most patients were on their medications, which meant that they were very unlikely to try and choke you out of the blue. Due to a panic button shortage, I ended up not having one for most of my stay there, which was admittedly dangerous when I think about it. But I was never very far from the nursing station and there was always a staff member nearby to step in or go get help.

There were two memorable incidents, which would have escalated into something very unpleasant if I hadn't gotten help immediately. The first involved a young male patient with a history of sexual harrassment and assault, which actually landed him in the unit via a court order. I was trying to get a patient to take her morning meds when I felt something brush past my butt. I looked up and the man was walking away from me. I couldn't decide if he was just walking by and accidentally touched me, but then why wouldn't he choose to walk between the other tables where there was a lot of space? I told my preceptor as soon as the patient took her medications and he brought it to everyone's attention during the morning report. Then there was a patient meeting with my preceptor, the unit coordinator, me and the patient in a smaller office. My preceptor basically came out and told the patient that he knew the patient did it on purpose. The patient didn't try to deny it and simply left the room.
My initial reaction was perturbation, I think. I was really hoping that the patient didn't do it on purpose, because the fact that someone could deliberately do that to me was very upsetting. And I couldn't retaliate in any other way, because he is sick (and mentally retarded). The court found him not responsible for his actions because of his illness and I completely understand that, but it still took a couple of days before I could give him his medication without feeling an underlying sense of dread. In a way, it was good that I had this kind of experience early on, because now I know to be more vigilant and I know what to do.

The second incident upset me much more. It was my second last day on the unit and I was giving morning medications to the same patient I was trying to convince in the first episode. She is a really sick lady. She's completely paranoid, delusional, irrational and sarcastic. She was apparently much better when she was on lithium, but it had to be stopped because she started having kidney problems. Anyway, there was nothing new that morning. She was mocking the way I spoke and was extremely annoyed that I was interrupting her breakfast, but I was used to her insults by that point. Then she started breaking one of her many many pills in half. I asked her what she was doing and she started screaming that she always took half the pill. I reminded her that she'd been taking the same pill every morning for a long time. That's when she showed me her fist and asked if I would like being punched in the face. Thankfully, a nurse stepped in at that point and I was allowed to leave the unit to regain my composure. I sat outside on a bench and cried. It was ridiculous. I shouldn't have taken it so personally because she was...well, there's no other word than "insane" really, but in that split second when she threatened to punch me, I was shocked. Angry, too. I have a terrible temper when pushed and if I hadn't been in a mental hospital, I probably would have screamed something like "What the fuck did you just say to me?" and flipped over a table or two. When I came back, there was a patient meeting with my preceptor, the nurse who helped me and the patient. After 10 minutes of reining in her absurd tangents and digressions, they finally got her to apologize to me with much reluctance. I doubt it actually got through to her that aggression is unacceptable towards anyone, because she's in such a haze of paranoid and persecutory delusions, but she did apologize. That was an improvement enough for me.

Of course, in a place like that, the bad stuff is always more memorable. But I like to think I have some nice memories to make up for them. The nurses and other staff are very nice, for one thing. They're no Nurse Ratchet, that's for sure. They get frustrated too, because some patients are so resistant to helping themselves and psychiatry isn't exactly known for its "cures", but they genuinely like working at the hospital and they try their best to help their patients. I'll remember all the advice they gave me for the rest of my career.

Important things I learned about psych:
1) Get a damn panic button and wear it.
2) Don't assume that the patients can think as rationally as you. But try to reorient them in the real world as much as possible.
3) They're really like children. They're either extremely well-behaved or frustrating like the devil.
4) Be nice, but let them know that you're not to be trifled with when they overstep boundaries.
5) Don't take anything personally and leave everything behind when you're done for the day.


Hmm...now that I've written it, it's a bit lacking in humour, no?

When you give blood, don't tell your nurse that you're a nursing student.

On a whim, I decided to go with a friend to a Hema-Québec clinic at school. I haven't donated blood in awhile, because they always ask at the Canadian Blood Society if you've donated in Quebec and it makes me paranoid somehow that they won't let me donate if I have. Plus, I have my super favourite CBS clinic at Hillcrest. Clean, bright, not too crowded and the best cookie selections. Having been multiple times to clinics at Westmount, U of T, TD Centre, College Street and Sheppard, I consider myself something of a connoisseur.

They do things a bit differently here. Instead of checking your blood for hemoglobin levels right after they ask about your address and phone number (so that they can tell you immediately whether you're eligible or not), they make you wait for ages until you're in the booth with a nurse. For someone who tends to have hemoglobin levels *just* below the required level from time to time, this is worth nitpicking.

I was watching my nurse as she was about to insert the needle into my vein. She said, "You're going to watch?" I said, "Yes, I'm a nursing student, so I want to learn." This made her, a nurse with 10 years of experience, nervous enough that she went through the vein to the other side. Perhaps at this point, I should have looked away, but I couldn't. I watched as she pulled the needle out ever so slowly back into the vein. Even then, it took awhile for the blood to flow properly and they'd only gotten 250mL (out of 450mL) by the time the vein stopped being good. This has happened only once before and that time, the only thing left to do was getting blood cultures, so they used a smaller needle on my other arm.

My point is, this is a nurse with 10 years of experience who gets nervous just because I'm watching her. What's going to happen to me when I have to do this with my patients while my teacher watches? Anyone who's seen me play video games knows that I get very squealy when monsters/zombies/enemy soldiers/a particularly difficult section in Rock Band appear. But I like to think that when it comes to something really serious, I'm steady under pressure.

God, I hope so.

I am a professional. Do not try this at home.

I did a sternal rub on myself. OUCH. OW, dammit.

Since I am going to be working at the Neuro, I've been reviewing neurovital signs and level of consciousness (LOC) assessments. If a client can't be aroused by calling their name softly, shouting or even shaking, the next step is to cause pain. A sternal rub is when you take your fist and knead your knuckles firmly into one's sternum for 15 to 30 seconds. This causes severe pain and may result in bruising. Don't try it. I know you want to, but don't do it.

Why did I do a sternal rub on myself? Because I wanted to know if it really hurt. Why I couldn't just trust the various textbooks, videos and lectures that all tell me that it's painful and causes the maximum response in everyone, I'll never know. I am, after all, the same person who headbutted my brother to see if it would hurt. But I've learned my lesson now, so I won't be trying a trapezius pinch or periorbital pressure on myself.

By the way, I totally wrote the sternal rub instructions up there so that you would all try it on yourselves. MOOAHAHAHAHAHAHA! Oh, the delicious evility!

I'm not yet in my late 20s!

Birthdays are not a big deal with my family. I mean, look at my parents. They left for Panama early this morning for two weeks. Yes, they called last night to wish me a happy birthday and then they were off to warmer climes! Lucky lucky bums.

My 26th birthday began with the alarm ringing at 7 in the morning to wake me up for my first day at the Montreal Neurological Institute. Awesome. I must say that I'm feeling very lucky in all of my clinical placements so far (well, except for Maimonides). They're always easy to access (again, except for Maimonides) and they're very pleasant places to work once you become familiar with the environment. The MNI is about a 15-minute walk from my apartment, which is SO nice. It's a bit uphill, but it means I can sleep in a bit more on these cold cold mornings.

Do you remember the Heritage Minute commercials on TV? I don't think they play them on TV much anymore, but I loved watching them. Especially the one about the first female doctors in Canada. Mrs. Trout (what a name!) ripping the piece of paper from the anatomical drawing of naked male and throwing it to the ground.
Anyway, I mention them, because Dr. Penfield, who built the MNI, has his own Heritage Minute.

I was able to watch a brain surgery for 45 minutes in the very same operating room theatre where Dr. Penfield did his seizure surgeries. Hundreds of doctors from all over the world watched him work in that theatre! It was great. We arrived in the OR theatre just as they were pulling off the scalp after a bifrontal incision (from ear to ear above the forehead). We could see the skull! The surgeon started drilling two holes down to the dura layer. Bits of bone started flying everywhere and the surgeon started putting something called bone wax into the holes using his fingers. This is when I started to clutch my face in awe. I'm not very squeamish and then only time I ever felt faint was when I cut my finger with a serrated knife. Then the surgeon started using a punch to chip away at the hole to make it bigger. Hooah.

I'll be starting my clinical course on the surgical floor on Wednesday and I'll get a chance later in the term to see a surgery from start to finish in the OR. I'm very excited.

The nursing girls in my group kept asking what I was going to do for my birthday, which was kind of embarrassing, considering that I don't like to make a big deal out of it. It's not because I am no longer 22 (what I have randomly decided to be the best age in young adulthood) and slowly feel the grip of adult responsibilities on my shoulder. It's just a day! I have also just remembered that Koreans turn a year older automatically on New Year's. So when Koreans ask each other how old they are, the age they give is usually one more than their real age. Then they also give their real age ("mahn"). So right now, my New Year age and my real age match up. But my brother is 22 and mahn 21. Get it? That was a bit of digression.

So what did I do on my birthday?

I came home, took a nap, had some lovely mangoes to celebrate and got nice phone calls from friends and Facebook congratulations. ^_^

Also, happy 26th birthday to my Birthday Buddy, Brenda!

Oh yes, this is the kind of stuff I do at home.

I wrenched the proximal interphalangeal joint of the middle finger of my right hand after my pharmacology exam this afternoon. How did I do this? It's snowing today and my joints must be acting up. That's a fun thing to happen at 25 years of age.

Anyhoo, I fashioned a homemade finger brace out of a Trident package and masking tape. And then I realized what I'd done. Here's a pic. You can laugh but it works super awesome!

These aren't the droids you're looking for...

Being a nurse means having to maneuver yourself around many people, each with different interests and priorities. It's a lot of reading moods, figuring out personalities, probing emotions and gentle nudging. It would be draining if I didn't thrive on such delicate interactions. My clinical teacher said that I was manipulative, which sounds bad if you take it at face value. But consider what I've been learning in class for the past year and a half about eliciting information that you want, figuring out people's wants and needs, urging them to see things in a different light (your way) to get them to do what you want. Officially, these techniques are supposed to be for clients, but why not for all the other people you have to work with? Nurses, technicians, clerks, doctors, orderlies, housekeeping staff, client's families, volunteers...the list goes on and on.

If I can manipulate a student doctor into seeing a client's family immediately, is that wrong? If I can get a resident to change a prescription right now so that it's easier for the client to take his medication, is that so bad? Or am I simply Alec Guiness guiding a doofusy-haired kid and two droids through a checkpoint? No one thinks he's a conniving schemer.

So until I somehow grow some damn midichlorians in my blood (or simply learn The Force, according to purists), I will be refining my techniques of "manipulation". After all, you can be sure that I won't use it for evil. Right?

Right?

Excellent.

What's the level of your pain on a scale of 0 to 10 after I've bonked you with my juicebox?

I'm sick to death of classes, conferences, discussions, case studies about pain management. Yes yes, it's a crucial component of health care, blah blah blah here's some morphine.

But are we going to be having conferences at every single clinical location and classes on it every term in one course or another? I'm not kidding.

First year:
Therapeutic relationship - class on pain
Health and physical assessment - assessment of pain (actually useful)
Geriatrics clinical - pain conference
Obstetrics clinical - pain conference

Second year:
Acute stress and coping - 5 insufferable classes on pain
Pediatrics clinical - pain conference

It's not like there's new information, people. Regurgitating the same drivel about why the OUCHER scale doesn't work as well as FACES is not going to help me pay attention. Tell me how to administer analgesics, then. Tell me how to deal with a child that's kicking and screaming, because he doesn't understand what the medication is for. Tell me something that I can use instead of telling me for the sixth bloody time that pain is the fifth bloody vital sign and should bloody be assessed whenever you bloody go talk to the bloody patient.

I was going to insert a joke in here somewhere about classes on pain giving ME pain, but I can't. And the word "bloody" is starting to look weird to me. Like it's spelled wrong but I know it isn't.

Look what you've done now! Are you happy, McGill?

An Open Letter: Help yourself and avoid the stompage of my boot on your face.

Dear Professor Bok-bok,

Would you mind not being so damn inconsistent in your notes? Listen, I know that each hospital and lab has various standards for blood counts and whatnot, but people working at those places have the luxury of having the normal ranges listed RIGHT NEXT to the results.

*claw face*

You can't list normal serum osmolarity as being 280~300mmol/L in a table of important values we should know and then turn around and list 275~295mmol/L in your lecture slides.

Just like how you listed normal arterial bicarbonate as 22~26mmol/L in your lecture slides and 20~30mmmol/L in your module. That's a BIG difference, lady. I don't have the time to sit here and dig out everything that's wrong with your notes, okay? I also can't go buy a whole thing of juice cartons to go on a Rampage of Sweet Righteousness. Throw me a fricking bone, as Dr. Evil would say.

I swear to all that is holy to an agnostic, if I calculate serum osmolarity in one of your questions and the value happens to be something like 277.5mmol/L, I will be writing the following as my answer:
"This client's osmolarity is WNL according to your lecture notes and below normal limits according to Appendix A.3. SUCK ON IT. If you deduct marks, I will throw such a fit that you will think it is the Second Coming of Shoshannah. My foot, your face. Depend on it."

Too much?

I'm mere minutes away from sitting in my chair with drool running down my face.

When I first started this blog, I thought I would be writing a lot about my experiences as a student nurse, making her way into the exciting world of healing people and kicking ass, which oddly makes me sound like a strange video game character who goes around alternatively healing people in a benevolent Mother-Theresa-with-a-health-professional-degree fashion and stomping people's faces into the dirt while cackling with glee.

Like a ninja nurse.

O_O!!!

Ninja nurse! That's even better than Judero Hirabayashi, a former voice actress from Japan who became tragically addicted to cough syrup and was forced to make her way to Toronto in order to tear herself away from the terrible memories of her past life. Will we ever do an actual enactment of Untitled?

Anyway, back to my nursing adventures. They're not so much adventures as they are, shall we say, episodes that occur as I happen to pass by. It's not so much the confidentiality issue that stops me from writing about them. Goodness knows that I talk about my clinicals all the time and I'm always careful not to reveal any identifying features. "So my client was a man with green hair and lazy eye with one rainbow-coloured toe sock hanging off his left ear..."

My mind is too full of details, most of which I probably won't forget for the rest of my life. If you were to ask me about the very first client I ever had in the postpartum unit 30 years from now, I'd probably remember. I don't really feel the need to record every single thing that happens as I did during all those years in Westmount. If you begged me to write a Crazy E-mail now, then I couldn't, because those e-mails were for all of us. The funny things that happened when we formed our own TAG group in the third floor stairwell are important to me as they were to you, which is why I tried to record them as faithfully as I did all those years ago. One day, THE book will be finished when most of you will have forgotten what we did together. And hopefully you'll read it and all the memories will come whooshing back. And hopefully I'll finish it before we're all sitting in a WSS retirement community someplace. I picture a nice cul-de-sac with all of our houses arranged in a row. That is the dream, neh?

I don't know where I'm going with this, really. The nap in the evening really doesn't help with coherent thought process.

NINJA NURSE!