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!