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.

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!

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?

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!

"Is it...gonorrhea?"

The thing that excited me the most about going into the nursing program was the standardized patients. I'm not gonna lie. You know what a big Seinfeld geek I am and one of my favourite episodes is "The Burning" where Kramer and his friend, Mickey, are standardized patients acting out symptoms for med students to diagnose.
Of course, as a nurse, I can't diagnose anything, but the main thing was to do a physical assessment and get enough information to recommend further action, like a triage nurse.

Anyhoo, I got a tip-off before my turn that I would be doing a cardiovascular assessment. I felt ready. I had all my questions prepped and a mental schedule and everything.

The Plan
0:00 - Introduction of self; ask for client's name and age; questions about chief concern (PQRSTUIA)
0:04 - Past health history (surgeries, hospitalizations, injuries, allergies, meds); Social history; Health maintenance activities (sleep, diet, exercise, stress reduction)
0:06 - vital signs
0:09 - cardio assessment
0:15 - end of session

Now, to be quite honest, I thought that it would be sufficient to get far enough into the assessment by the end of the 15 minutes. After all, it was only practice and if you want to be a nurse who follows the McGill model of health, you want to be holistic, man! That means asking a whole ton of questions that, believe you me, my family doctor has NEVER asked me. I can only assume he has either a magic crystal ball or a private investigator at his disposal.

So there I was, being all professional and interested in what he had to say and good grief, how much he did have to say! It turns out that my standardized patient was actually a cardiologist on his day off who had made up an intricate and compelling background story to his character and was determined to say all of it, damn you and everything else.

It was like that episode of Frasier when they were trying to do the radio play.
Frasier: A gun! A gun is what he's got. When the lights came back
up, a smoking gun lay on the table. The maid lay dead,
unable to name her killer. Nigel Fairservice lay mortally
wounded.
Gil: I'm dying!
Frasier: Poor man was gone.
Gil: Never again to visit the scene of my boyhood in Surrey,
romping with my school chums in the fens and spinneys...
Frasier: Just then the lights went out again. [gun sound] Nigel
Fairservice was shot again.
Gil: Only grazed me. When the twilight bathed the hedgerows like
a lambent...
Frasier: [creates another shot] The final bullet, blew his head clean
off his shoulders. All right people, let's try to keep calm
although it's hard when the killer is among us.
Gil: [walks over and makes the door sound effect] Hi-ho, I'm
Nigel's brother Cedric, who I haven't seen since my boyhood...
Frasier: [creates yet another shot] And so died the last surviving
member of the Fairservice family.

[In Frasier's apartment, Martin and Daphne are still listening in
disbelief.]

Martin: Boy, I sure didn't see that one coming!
Gil: [radio:] Hello, I'm the ice cream man. Years ago I went to
school with Nigel Fairservice. We used to romp in the fens
and spinnies... [gun shot]

Not that I blame the cardiologist. I myself have a tendency to create intricate storylines for trivial roleplaying and lab reports (the journalist who went to Russia for 6 months and caught tuberculosis while dallying with a consumptive hooker, hello?). What if his secret passion was acting and the only way he could let it out was to volunteer himself for these sessions with student nurses and doctors lest he die of never being able to fulfill his dreams? Oh the tragedy!

See what I did there? It's like I can't stop.

I came out of this revery when the voice came over the PA system telling me that I had FIVE minutes left and the standardized patient had JUST finished answering all my questions. So I washed my hands, did the vital signs as quickly as I could and started palpating the precordium (5 landmarks of the chest used for the assessment). The final obstacle, which just made me want to laugh and cry at the same time, was that the man was too muscular. I couldn't feel the intercostal spaces! So I just imagined in my head where they would be and palpated the chest anyway. Like I could feel anything through at least 4cm of pectoral muscles, really.

It was awkward, feeling this man's chest without saying anything, so...

Judy: You're very muscular.
Client: Oh really? I've been reading the Men's Health magazine [indicates one sitting on the table next to him] and I look nothing like those guys.
Judy: Well, they probably spend 4 to 6 hours working out everyday.
Client: The women in it are extremely buff.
PA System: END OF SESSION. BEGIN DEBRIEFING.

The comments I got were that I was very methodical and thorough in my questioning, but that I needed to be more aware of the time. I was very good with taking the vital signs, but that if they were normal, I could reassure the client with the results instead of just moving onto the next procedure.

In brief, I listen a little too well, it seems, which makes me an awesome McGill nurse, but it's not very practical in the real world. Hmm. Do you know what I say to that? If you're going to teach me to be a holistic nurse, give me more than 15 minutes to do an assessment. 5 more minutes would have been a huge help, in my case. Anyway, I learned a lot from my first standardized patient encounter and definitely have some things to work on, but I'm getting more confident day by day.

Oh yeah, I should be getting my scrubs in a few weeks. They're not as ugly as I thought they would be, which is a comfort. I must get back to work on a family interview report that rivals Alexandre Dumas novels in their intricacy and drama!

While studying for the Therapeutic Relationships exam...

I came across a lecture slide which states, "A nurse shall not use physical, verbal or psychological abuse against the client."

Judy: I. Am. Flabbergasted. So you can't slap them upside the head?
Josh: Where's the fun in that?
Judy: It was gonna be my signature move! "Hey, Billy!" *smack* "Did you take your medicine?" *slug*
Josh: I'm thinking Three Stooges style motions.
Judy: "Did you have your lunch yet?" *uppercut*
Josh: Just a few light slams here and there.
Judy: "The doctor will come and see you in an hour or so, okay?" *HADOUKEN!*
Josh: FINISH HIM!

That's from a different game, but you get the basic idea. Oh god, I'm so glad that course is over. I gleefully threw the coursepack into my recycling basket. Gleefully!

L'endoctrinement continue.

La fin de semaine passée, j'ai regardé Le Seigneur d'Anneaux en français. Pendant le troisième film, il y avait une scène qui me faisait avoir peur pour ma santé mentale.

Eowyn: Courage, Merry. Ce sera bientôt fini.
Merry: Dame Eowyn, vous êtes belle et courageuse. Vous avez tant de raisons de vivre et de gens qui vous aiment.
Judy: Merry a utilisé une intervention de la modèle McGill! Il a rappelé à Eowyn qu'elle a des forces qui la donne un sentiment de contrôle. C'est tellement important pour sa santé!

Vous saviez déjà que je suis folle. Maintenant, vous avez plus de la preuve.

McGill Cultural Revolution!

I always thought I'd be the one doing the brainwashing in pursuit of world domination. Who would have guessed that I'd be the one getting indoctrinated? I wouldn't have noticed that anything was happening were it not for this conversation.

Josh: Why "client"? Isn't it "patient"?
Judy: The McGill stand is that people don't have to be ill to receive nursing care, so it's more appropriate to call them "clients".
Josh: Why are they getting treatment otherwise?
Judy: A new mother doesn't have to be sick to get information about her newborn. It's a more holistic way of looking at health. "Client" can refer to an individual, a family or a community.
Josh: Ah. Do you have a little red book written by Chairman McGill?
Judy: Well, I do have a red book. It's not very little though.

And look at this quote from Mao Tse Tung's Little Red Book:
"This army is powerful because all its members have a conscious discipline; they have come together and they fight not for the private interests of a few individuals or a narrow clique, but for the interests of the broad masses and of the whole nation. The sole purpose of this army is to stand firmly with the Chinese people and to serve them whole-heartedly."

If you replace "this army" with "McGill" and "Chinese people" with "clients", you have the basic gist of McGill model of nursing. Scary.

Join me, comrades, in the McGill Cultural Revolution (or is it Nursing Revolution?)! If you see me dressed in drab grey clothing, ominously muttering about the human condition and "transformation of the profession", please take me away to a deprogramming farm. Just don't bonk me on the head with a baseball bat.