A year at U of R

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Saturday, August 19, 2006

A thankless job?

I was chatting yesterday with one of the people I've worked with this summer at the HIP Teens research project as part of the Fuld Fellowship. I asked her, "would you ever consider being a nurse?"

"It's so thankless!" she said. "And you have to clean up messes, wash people. I don't think I'd want to do that."

I still get this response from many of my friends. Some of my classmates have realized that nursing, or at least working as a floor nurse, is not for them.

However, it's hard for me to verbalize how gratifying the experience is. By the nature of the job, the relationships with patients are intense and personal. You can't wash someone, listen to them cry, joke with them, shave them, and feed them breakfast without developing a personal connection. They make a deep impression on you, just as much as you make a difference to them as their nurse. It's a reciprocal relationship. You become, for a morning or afternoon, a small but important part of their life. If that isn't rewarding, what is?

Over the five weeks of summer clinicals, a number of the patients I've worked with have died, and more of them have terminal illnesses and won't be alive much longer. None have actually died while I was there. I wondered how I would handle that. To be honest, I've been happy for most of them, and felt that it was time. We have great technology for keeping people alive, and we have a culture doesn't accept aging and sickness. Yet sometimes it seems that death is the best treatment. At times, I'm glad I have some distance from the clients. Their families have known them when they were healthy, and they mourn the loss of the person they used to know. I only knew them when they were already confused, disabled or unresponsive.

I've also been challenged with patients whom I don't like. I worked with one client who, if I met on the street, I simply wouldn't like as a person. That was a challenge. At times, I could feel some empathy toward the client's condition. I could find one aspect of the person that I appreciated. However, sometimes, I just wanted to just leave the room. I guess there will always be a few cases like that. They seem to be a tiny minority, though.

Thus ends the summer semester!

I'm really amazed by how far we've come. After one summer, I already feel that giving an injection or giving meds is no big deal. I still feel a little awkward at times, but that's just a matter of time. I've worked with patients from age 18 to age 96, of all different backgrounds. Most of them have very compelling life stories. I wish I could write a novel about them all. I've seen kidney and liver transplant patients, AIDS patients and patients with strokes, epilepsy, diabetes and heart failure. I've suctioned a tracheostomy, given injections, written nursing notes in the client's files, and changed countless beds. I really never expected to be exposed to clients with this variety and severity of illnesses in just the first couple of weeks of clinicals.

By the end of our fifth week together, my clinical group of 8 students plus an instructor had really bonded. Our instructor actually works several nights a week in the same unit we were working in. She was really phenomenal with the amount she did for us. She was a great teacher, plus being very low-key. We all went out for margaritas and quesadillas to celebrate.

As a final close before the holidays, here's a photo I took on a bike ride. A farmer had planted a whole hillside with sunflowers. Very Van Gogh.

Friday, August 18, 2006


The real question in everyone's mind before classes began at the U of R was, "What will our uniforms be?" Forget about textbooks or syllabuses, we just wanted to know what color we'd be wearing.

Up until this year, the uniforms were white pants and white shirts. Thankfully, due to continued pressure, they changed this year's attire to navy pants and white shirts. I think they look pretty good. We had to sew the patches on ourselves. What they didn't tell us beforehand is that you don't have to buy the uniform at the bookstore, so you can get different styles of scrubs pants, as long as they are navy.

I actually love wearing scrubs. You never have to decide what to wear in the morning, which is a blessing when you've got clinicals beginning at 7am. I think that we've all come to like the uniforms.

Thursday, August 10, 2006

Around Rochester

In the midst of clinicals, I made it out for an evening bicycle ride. The countryside is beautiful at this time of year. The corn is maturing, and their are fields of sunflowers and hay.

I took some photos on an evening bike ride with the Rochester bicycling club (on a weeknight!) after a clinical session. A great way to wind down. The sun was getting low on the horizon, and the evenings are quickly getting shorter. Seasons change very quickly around here.

Wednesday, August 09, 2006

Giving injections

Today was my first day giving medications. We are closely supervised as students when giving meds. Each of my clinical group of 8 students is assigned to a different day to give meds. I was scheduled for the first day, along with one classmate.

Yesterday, I stopped by the the unit to pick up my patient assignment for the next day's clinicals. Low and behold, my patient was scheduled for no fewer than 12 different meds given every two hours, including a subcutaneous heparin injection. I read this and panicked. That same morning I had just attended the lab where we learned how to give injections. The next day, without any further practice, I was going to have to actually inject someone. To make matters worse, my patient was fully awake and alert. Couldn't they be comatose just this once???

I did not feel prepared. I'd read a chapter on injections, watched a 20 minute video on the subject, listened to an hour lecture, and given five injections of different types to a plastic dummy in lab. However injecting a piece of plastic didn't inspire confidence. Anyone can jab plastic. What about the real thing? What about flesh?

I dashed home, and spent the rest of the afternoon researching and writing notes on all of the 12 drugs I'd be giving. Then I reread the chapter on injections. I poked at myself with a ball-point pen periodically throughout the evening to practice technique. I went to bed with ink-dots all over my stomach.

In actuality the injection was very easy. It was over and done in a few seconds, and I'm happy to report I didn't feel any pain at all. Thankfully, my patient reported no pain either. However, it is the little things they don't mention in class that trip you up in clinicals.

What no one warned me about was packaging. Each individual pill comes from the pharmacy specially wrapped up in a little packet. For safety, these packets each get opened at the patient's bedside, and the pills are all dropped into one medicine cup.

So there I found myself, nervous as anything at the patient's bedside, with eight tiny packets to open. My instructor, the patient, and the patient's whole family were watching me expectantly. I picked up the first plastic packet, and tried to tear it. It wouldn't give. It was like your worst nightmare of trying to open an unyeilding bag of Doritos, and knowing that if you use too much force, the Doritos will end up all over the floor. I wasn't about to try using my teeth. Finally, my instructor gingerly took the packet from me, and tore it easily in the other direction. How humiliating. Instead of practicing injections tonight, I'm going to get some candy and lipton's instant soup, and work on opening packets.

Friday, August 04, 2006

Clinical week 2

I'm still running an adrenalin after today, caring for a kidney transplant patient. It was really non-stop. It is amazingly exciting, I still feel very unprepared for it. Last March I was a graphic artist, and six months later, I'm caring for patients with serious conditions. I thought we'd start out on easy patients, with, say, sprained ankles or pink-eye. There's no adjustment period in this program. Half the time, I feel like a bumbling idiot in patient's rooms. I can barely find a pen in my pocket, much less locate the dorsalis pedis pulse. Then there are rare and glorious moments when I actually do something right, and feel confident and in control. Why are those never the moments when the instructor is looking in?

Today I had one of those beautiful text-book moments. I was taking some vital signs, and listening to the patient's heart sounds with my stethoscope. Low and behold, I heard a swoosh. I did a double-take. Is this right? I listened again, and with every heartbeat, there was a definite, very loud swoosh. It sounded exactly like the tapes we listened to in lab. I couldn't believe my ears. Had I identified a heart murmur? It is sad to admit, since it is a person's heart, but I felt like I'd discovered gold. I called the instructor over, and asked her to listen. She confirmed it ... systolic murmur. WOW.

Clinicals are developing a little bit of a pattern. In the morning, we go in and read out patient's charts (we are each usually assigned to one patient). We then meet briefly to talk about what we will do that day. There are eight students and one instructor in our clinical group. Then we go to see our patient. At this point, after six days of clinicals, we are responsible for independently doing all of the morning care. This includes giving a bed bath, shaving, teeth brushing, changing the bedsheets, changing adult diapers where needed, dressing the patient, feeding them, and recording vital signs. This can take just 15-30 minutes if the patient is ambulatory, or the entire morning if they are hooked up to tracheostomies, feeding tubes, IV's, etc.

There is actually alot of down time. For those who have "easier" clients, they then read charts, or help out with patients who need more care. However, we all spend alot of time waiting. Starting next week, though, we will be responsible for keeping track of the patient's medications as well. It is a crazy fast pace!

A second shave

I did my second shave of a client's beard today, and happily it went far better than the first (see my entry from last week). I spent the past week grilling every guy I know about the male shaving experience. If you are a guy, and have anything to add on the subject, please feel free to post!

This time, I looked at it as a spa treatment rather than a medical procedure. I remembered about the hot, damp towel to soften the stubble. I was careful to note the direction of the hair BEFORE applying the shaving cream, and I applied the cream lightly with artistic finesse. It was an improvement over the first shave which was more like slapping huge gobs of mortar on a brick. I had about 10 disposable razors on hand, so that I could dump one as soon as it became dull. I wasn't taking chances this time.

The shaving was great ... nice long strokes with no repeats. Some areas were a little patchy, but I was working with about 4 days worth of stubble. I even got the upper lip. That was no small feat. And I did this all without clogging his nostrils with shaving cream.

Who needs to be a nurse? I'm opening a male spa!

Thanks to all of the men who offered advice and contributed to my success!

Subclavian line or lunch?

I continued to be amazed by how involved I am already (on my sixth day of clinicals). Today was a busy day to say the least. I was on my feet from 7am to 3pm, with about a 15 minute lunch to sit down. Normally, I'd join everyone down in the cafeteria for a 45 minute lunch. Today, I took a short lunch to watch a subclavian line that was being inserted into a client's vein. Yesterday I took a short lunch to attend an epilepsy group meeting that is evaluating patients who are monitored in rooms 24/7 for up to 10 days while they deprive them of food, sleep, and submit them to strobe lights to try to induce a seizure. But more on that later.

Inserting the subclavian line sounds like a lot of drama. The doctors donned sterile gowns, gloves and caps, and there is some blood spurting. They use a needle and syringe initially to go underneath the clavicle to get to the subclavian vein. They know they have hit the vein when the syringe easily fills with blood. They then remove the syringe, and they put a guide wire through the needle into the vein. Then a plastic spreader and the actual line (a plastic tube), go onto the guide wire.

I stood by and tried not to get in the way. Occasionally I fetched some supplies that were needed, or helped re-attach an MD's gown. I talked to the client, and tried to give the client a hand-massage to keep the hand out of the sterile field. The MD's were particularly worried about this, because the sterile field was essentially the patient's entire draped body. So I held the patient's hand, and chatted when I could.

I would not want these doctor's jobs, though. Two of them spent about an hour and a half stabbing away, trying to insert the line. Finally, they called in another physician, who also couldn't get the line in. He then tried for the jugular vein, but was unsuccessful there as well. It wasn't exactly made-for-TV drama. Just lots of uncomfortable poking. Still, I found it fascinating to watch. It was the first bloody procedure I'd seen. I was a little worried that I wouldn't be able to handle blood, but it wasn't a problem. I was mopping up clots from the client's hand, thinking about how hungry I was for lunch.