Travelling To Remote Locations

When you are planning a lengthy trip to a remote location (say you're going to spend a couple of months in Borneo) all of your guide books will instruct you to see a dentist in your own neighborhood first. Shoot, you'd hate to be stuck in the wilds of Bolivia and have a tooth go postal on your nerves in an unmistakable You-Need-A-Root-Canal-Stat! kind of way. You half think: Hm, perhaps I *should* have a prophylactic appendectomy, but then you remember that your insurance doesn't pay for that sort of thing.

The same goes for nursing school. Nagging medical problems need to be deferred until you have some time off. Heck, last year there was the gal who got mono and couldn't get out of bed for a week and she couldn't make up the time and - bam!- out she went. One of my clinical instructors broke a leg skiing during the time when she was a nursing student at Nursing School U and was fortunate that there was a spot for her the next year to pick up where she left off.

And, so, this lovely winter break I went to the dentist about the broken and painful crown in the back of my mouth. Turns out it broke because the tooth was rotting under the crown (and here I wont go into the evils of dentistry or the incompetence of the particular dentist who put the crown on originally....much) and the choice was 1) several appointments to get an *ALL NEW* (be the first on your block!) root canal, some sort of root scraping surgery and an *ALL NEW* (get out your checkbooks, kids!) crown and it might not work anyways or 2) pull it out. I took 2 and I've been in excruciating pain for days now. So much for having fun with my kids, shopping for Christmas, making candy for the neighbors and cleaning my house! Sigh.

OK. The other thing I'm putting off is this here Crap-And-Now-You-Know-How-Old-I-AM referral for mama's first mammogram [picture me here waving a pink referral slip around].

Above is my daughter's cake. Let me start by saying that, one year, my sister asked me if my daughter's cake was made out of sourdough bread. The kids, meanwhile, were snacking away on the cake w/ big frosting-smeared grins. It turns out, I'd left the sugar out of the cake. In my defense (and, yes, I know - I KNOW- it is indefensible to ruin your daughter's (or anyone else's) cake), I'd been out late at a play and made the cake at one AM. The kids didn't care because the frosting was FABULOUS and the mermaid I had rendered was pretty. This year I left the cream cheese out of the frosting. I wondered why the stuff wasn't spreading right and then someone opened the microwave and held up a plate with the perfectly softened cream cheese on it. So it was four (4) cups of powdered sugar to two sticks of butter. And the kids STILL didn't care! It was sweet as hell and they liked it that way! So there you have Hedgie Blasts Off rendered in cake form.

I See You

Finals are next week and, of course, I'm up late baking. My daughter wants a cake w/ an image from the children's book Hedgie Blasts Off on it. I'll let you know how it turns out.

I spent a day in ICU and I was standing in my patient's room when a loud woman's voice said "It looks like her blood pressure is dropping." Um, are you talking to me? I'm whirling around and the voice says, "Up at the end of the bed...the camera." And, yep, there it was zooming in on the scene in the room. "Your patient is really sick," the voice said. Um, yes. Septic shock will do that to a person: make 'em really sick. I said, "I'm just a student." And the voice told me that it belonged to a person named Mira (or something along those lines) and that she was watching a bank of hundreds of monitors from a city 25 miles away. I'm sure that the camera zoomed in on the scene several times throughout the day as the patient's blood pressure dropped to 60 over 40 and a dopamine drip and a flat head of the bed barely brought it up to 80 over 50. The funny thing is that all of the ICU nurses were really surprised that the camera had spoken to me. I guess they almost never do and I heard a story of a patient crashing and a lone nurse calling for help in the dead of night and the camera finally comes on and says, "Looks like you're doing the right thing." and that was it. And then there's the whole liability thing: see, we can show you on camera that we did all of the right things or, geez, here you are setting the drip rate wrong (or somesuch) which is fairly futuristic from the past 1984-like and all or is it Big Brother. It's a blur. Nursing texts have calcified my pop culture/literary reference bone.

The really amazing thing: another student took care of the same ICU patient today and she is as OK as she was before landing in the ICU. Hearing that made my week and I needed something to make my week because I didn't think I would make it this week.

I was in Disney World for Thanksgiving. It's a long story. I know, I should have been at home baking pies and perfecting The Dinner Roll, but I was riding the Dumbo ride instead. The picture is a bathroom sign in Tomorrowland (in The Magic Kingdom) which was the 50's version of the future. I love the past's view of the future especially when the past's view of the future is really of the past. It's so art deco.

OR

I can cross OR nurse off of my list of possible career options. All my fellow student nurses have been so jazzed to witness a surgery and for me it was just boring and exhausting. The patient had a cervical laminectomy - the removal of a bulging disc from one of the neck vertebrae. The patient was given an iv milk-looking induction med by an incredibly high strung anaesthesiologist. The circulating nurse whispered something about sweet dreams to the patient and out went the patient. The patient was put on the table face down after this vice grip was placed around the patient's head to hold it in place. And then drapes were put everywhere until just a little square at the back of the neck was exposed and even that was covered in a membrane so the entire focus of instruments, doctor and assistant, three nurses, an x-ray tech and me was on a four inch square of plastic wrapped flesh. I watched the whole thing in close-up on a monitor. The hard part wasn't the smell of cauterized flesh or the ten million tedious/shiny instruments or the cold of the OR (the thermometer said 50 and I didn't mind at all) or the bloody gauze that was counted over and over (don't want to leave one inside!). It was the standing there wearing 40 pounds of lead to protect from the x-ray. I had a neck do-dad, an apron and a skirt and, I tell you, my back was *killing* me after 1/2 an hour and the surgery went on for two or so hours.

Sorry. No Thanksgiving recipes this year.

The Caramel Season

My last day in adolescent psych was on Halloween. I thought: Gee whiz, the last thing you'd wanna do is wear a costume on a psych unit on Halloween, but the entire staff was dressed up. The charge nurse was wearing a bizarre paper maché animal head atop his own. The thing is, you want to normalize things as much as possible and Halloween = dressing up for kids. But everyone was glum to be in the hospital on Halloween. They all got little Halloween place mats and stickers with their lunches, but with half of the kids in for eating disorders that somehow made the meal seem like a grimmer thing to choke down under the clock. I was sad to say goodbye. Sad, too, to get a poor grade on my psych final and face my first B in a class since returning to school almost three years ago.

And today was the first day since spring that I had to put on my white scrubs. They'd been in the drawer so long that they had little yellowing patches on them that I didn't even notice until I was under the bright hospital lights of my peri-op (surgical) clinical.

But I know what you're thinking. You're thinking: The caramel season has arrived! And then, perhaps, the dread sets in. Have you ever messed up caramel? If you haven't you haven't made enough caramel, I say. OK. Here's an absolutely foolproof caramel recipe. My mom's friend, T., passed it on to me and it works every single time! Top your ice cream, dip your apples, slice and wrap in waxed paper: you can't go wrong.

Can't Fail Caramel

1 cup heavy cream
4 oz unsalted butter (heck, use salted if you're making candies: makes' em sweeter and more complex)
1 vanilla bean split and scraped (or 1 tsp regular vanilla)
1/4 cup light corn syrup
2 cups sugar

Heat cream and butter and vanilla in a saucepan until the butter melts and the mixture is hot.

In a deep 3 quart saucepan heat the corn syrup until it bubbles sprinkle sugar over the top until the surface is entirely coated (about 1/3 of a cup) then stir with a wooden spoon until the sugar incorporates into the syrup.

Add the rest of the sugar in batches until it's gone. The mixture will be stiff. Stir vigorously until the mixture is runny and straw-colored (you'll know, the mixture will seem to "give" for you).

Remove from heat immediately.

Add the cream/ butter mixture in four portions stirring well after each addition. Use CAUTION as the mixture will splatter and it is very hot.

Return mixture to high heat and boil 2 to 3 minutes, stirring gently until sugar is completely dissolved and caramel reduces and becomes thicker and stickier.

Pour into a heat-proof container and stir a few times to release the heat and stop it from further cooking. Resist the temptation to put any of the caramel-y spoons in your mouth right away. Ooof, no tongue burn worse than hot candy burn!

When refrigerated the heated caramel will be stiff. If you want to use it as a sauce, reheat it in a double boiler over gently simmering water. Add 1/4 to 1/2 cup of cream to make a sauce.

Shock

This has been a tiring week. I have a test coming up in my nursing theory class which is called something like "Patients w/ Complex Needs" but really is another stew of random lectures by several different instructors some of whom are confused and/or really dull. I'm thrilled about the test, though, because it means that I won't have to sit through a lecture for one class. But the thrill doesn't mean that I've studied. Studying for one of these stew-y class tests takes too much work: you have to download various outlines and notes and some confusing randomness called objectives and then suss out the reading that needs to be done. I bribed my pal to send me a list of the reading and it's scattered in 10 different books seven pages here and two pages there and the tedium is too much for me.

And then there's the psych rotation. My patient is bright and cheery and just a young teenager and says "I'm fine. Nothing's wrong. I won't do it again. Can I go home now?" and still has bruises around the neck from the rope that hung from tree a couple of weeks ago. And I won't even talk about the graphic stories I heard from the psychotic kid who has an angel on one shoulder and a devil on the other who flatly talked about the graphic ways he killed some people. On the sunny side, though, he was the only one in a group discussion of about eight kids who hadn't tried to kill himself recently.


So, did you know they still do shock therapy? It's ECT or electroconvulsive therapy and people are jolted with electricity through electrodes attached to the head until they have a grand mal seizure. The nervous-making thing for me is that they aren't exactly sure how it works, but it seems to be helpful for people suffering from major depression who haven't responded to medication. I got to see someone get a treatment. The person is put out under general anaesthesia and a wrist is tied off. They are given succinylcholine to paralyze their muscles (except for the ones in the tied-off hand). They are jolted and seize for around 45 seconds which is judged by the un-succinylchined hand. The hard thing to watch, for me, was seeing this person I'd just been chatting with get put under and then seem to deflate with the succinylcholine. I've never seen someone anaesthatized before and the succinylcholinealso means that the person is not breathing on their own. It seemed like the anaesthesiologist was rarely putting the bag on the patient and squeezing air into the lungs. I was feeling woozy about the whole thing even knowing that her blood oxygen was being monitored and was fine and knowing that the patient's body needed to have the breathing instinct ("Hello? HELLO!! Too much CO2 here in the brain: breathe, BREATHE!!!") kick in. And then , yes, there's the feeling I can't kick about shocking people. I know it works for lots of people, but it seems so dramatic and primitive.

A Tale of Two Brownies

So I came back to the adolescent psych floor after lunch and was told to start loading snacks into a paper bag because "this is a closed unit". Uh, what? Apparently, the whole wing was moving across the hall so that they could do repairs. Surprise! And the patients seemed even more surprised. We got to go with one patient at a time to help them gather their stuff, load it into grocery bags, stack it onto office chairs and wheel it through no less than 4 security doors requiring some combination of keys and swipings of magnetic-strips on id cards to open. There should have been circus music playing except that it was not amusing and all the kids were complaining about how prison-like their new home looked. And in the process of moving it was discovered that my patient had been vomiting into the pages of her books and "cheeking" and hiding her meds. This is a gal with a standing heart rate of 160 bpm (beats per minute) which is only not scary if you're measuring the heart rate in a hummingbird. I sat with her for more than an hour while she tried to drink two cans of formula earlier that day. She cried the whole time.

And everyone says that psych is the easiest of our clinical rotations.

OK.

What we need here is TWO brownie recipes! I love a good cake-y brownie and you like the dense and fudge-y ones, right? Here's one of each. The first one is the fudge-y one. I stole it from Gourmet magazine.

Peanut Butter Brownies of the Gods

for brownies:

2 sticks of butter, softened
1 3/4 cups of sugar
1 cup creamy peanut butter (add a little salt to recipe if the peanut butter is unsalted)
2 large eggs plus one large yolk
2 tsp vanilla
2 cups AP flour
1 1/2 cups semisweet chocolate chips (9 oz)

for ganache:

1 1/2 cups (9 oz) semisweet choc chips
1/2 cup heavy cream
1 TBsp butter, softened

Preheat oven to 350 F. Butter a 13 X 9 X 2 inch pan and line bottom with parchment paper(my new bumper sticker says: I [heart] parchment paper). Butter parchment.

Beat together butter and sugar until light and fluffy. Add peanut butter and beat until incorporated. Beat in the eggs and yolk plus vanilla. With mixer on low add flour.

Mix in chocolate chips. Spread in baking pan and smooth top.

Bake until golden and puffed and a toothpick comes out with just a few crumbs.

Cool completely in the pan on a rack.

Ganache:

Put chocolate chips in a heat proof bowl. Bring cream to a boil then pour over chocolate chips and let stand for one minute. Whisk in butter until incorporated and chocolate is smooth. Spread on completely cooled brownies and let stand fpr 15 minutes or so before slicing. Makes 32 bars unless you're me and you make 'em really big which was a mistake becaus ethey are rich and should be treated like fudge and eaten in small quantities. They are pictured above.


The Cakey brownies now. My favorite and a family recipe. These are so wonderful!

My Grandma Mary Ellen's Brownies:

1/2 cup softened butter
cup sugar
2 eggs

2 ounces unsweetened chocolate; melted (I really recommend Scharffen Berger and I've used semi/bittersweet w/ no problem)
1/2 cup flour
1/4 tsp salt
1 tsp vanilla

optional: small handful of choc. chips and/or nuts (let's say a 1/4 cup of cc's or nuts or combo - too many and the brownies fall apart)

preheat oven to 350
grease and flour a 9X9 pan
whisk dry ingredients
cream butter and sugar
add eggs one at a time until combined
add vanilla
add melted chocolate and combine
mix in dry ingredients until just combined
smooth into pan
bake for 30 minutes until toothpick comes out clean
Cool completely in pan before serving

Dinner With the Anorexics

Back on the adolescent psych floor and I got to have dinner with the anorexics. It's a tense scene at best. First I had to serve dinner to the gals. They each had a list of the specific quantities of stuff they had to eat. I gave them a choice of small or large tortilla which made on of them laugh and say, "You're giving me a *choice* of a large tortilla...?" They watched me dole out a half a cup of this ("Hey, that looks like more than half a cup!") and three ounces of that and turned down the optional tomatoes and sour cream. Back to the table, timers were set (they have a certain amount of time to finish their meal otherwise they'd eat tiny mice bites and shove the food around on the plate until midnight) and the gals went to work. Forks moved to mouths and chewing occurred in a precise and mechanical fashion. When (well, ok, if) they finished I had to investigate under napkins and plates, I had to pick up the milk box and assess whether or not it was really empty. Later, I got a lecture from my instructor because I left a gal at the table with a closed can of formula when I went to get ice. And the instructor mentioned that the anorexics aren't supposed to wear long sleeves at dinner. Ooops. My patient had a big baggy sweatshirt. Now I wonder if she tucked bits of cheese or grains of rice in there. The "fun" part of the meal was that I got to eat dinner, too! MMMMM, hospital food and delightful dinner companions. Now you're talkin'!

On the other side of the coin or maybe it's really the same side, I went to a meeting of a group of compulsive overeaters. One of them said that if they were addicted to alcohol at least they could just not buy it or avoid going to places where alcohol exists, but food? Food is everywhere. And here's where the overeaters and the anorexics join hands: they are both obsessed with food.

Geez. Maybe I'm a little obsessed with food. One of the nice things about taking a summer off from blogging is that I baked up a storm and now I get to share with you! Have you ever made homemade bagels? You should. It's a bit of a hassle, but it's fun for the kids and they are just the best bagels you'll ever have. I topped mine with poppy seeds and a few with sunflower seeds, but you can pick your own favorite toppings. This recipe is from Bernard Clayton's New Complete Book of Breads.

Bagels

3 1/2 cups of AP flour, perhaps more
2 packages dry yeast
3 TBsp sugar
1 TBsp salt
1 1/2 cups hot water
3 quarts water
1 1/2 TBsp malt syrup or sugar
1 egg white and 1 tsp water, beaten
Toppings

Baking sheet greased (or with parchment) and sprinkled lightly with cornmeal

In your mixing bowl, combine and stir the dry ingredients (uh, not the toppings), pour in the cup and a half of hot water and stir vigorously with a wooden spoon for 2 minutes. Now mix with mixer using your dough hook. Mix at medium low speed, add flour to the sides if it sticks to the side of the bowl. Mix for 10 minutes. Dough should not be wet and sticky. If it is, add more floor.

Put dough in a greased bowl and cover it tightly with plastic wrap. Let rise until doubled (about an hour). Meanwhile, bring three quarts of water to boil and add sugar or malt syrup. You, ultimately, want the water to be simmering lightly ("giggling").

Turn dough out onto a floured surface and divide dough into 10 pieces. Shape each into a ball. Flatten them in your palm. Press into the center of the bagel and tear a hole, pull it down over a finger and smooth the rough edges. The book sez: "It should look like a bagel!"

Cover bagels with waxed paper and let rise slightly for 10 minutes.

Preheat oven to 400 F.

Lift one bagel at a time into the giggling water. There should be no more than 3 bagels in the water at once. (I do 2 at a time) Simmer for one minute, turning over once. Scoop bage out and drain on a towel then place on the baking sheet.

Do this with all of the bagels.

Brush with egg white mixture and sprinkle with your toppings! Hey, if you want to make raisin bagels (maybe with cinnamon?) or chocolate chip bagels (ok, just make cookies!) you'd mix 'em in when making the dough.

Bake in the middle of the oven for 25 to 30 minutes. During this time, watch for the bagel tops to appear light brown and flip the bagels over to prevent a flattened bagel.

Cool on a rack.

Me...Now In Cupcake

I went from Student Nurse to Busy Mom this summer and I forgot all about this place. And so have you. But I'm back now and I have my student nurse cap on though nurses stopped wearing caps a few decades ago because they were found to be reservoirs of disease and, well, ridiculous looking.

School started again last week in a flurry of syllabi printing and several phone conversations with friends entitled What is Conservative Street-Wear Anyways? See, I'm doing my psych rotation now and we don't wear our marshmallow-colored scrubs for that. We wear "conservative street clothes". I figured it was kind of casual Fridays but with more comfortable (albeit closed-toe shoes). Nothing low cut, nothing with logos. If you lift up your arms and bend over and any midriff is showing: you're outta here. We're told, "Don't do anything that makes you stand out." and "Don't show any weakness." and "Be just scared enough." and "Don't touch anyone."

So, how can you tell the patients from the staff? The patients are wearing socks and the staff wears jeans and t-shirts. Except for us students. We're wearing button up shirts and flat shoes. "Wear shoes that you can run in." And I'm on the wing with adolescent girls. Most of them have eating disorders and that made me show weakness and want to touch shoulders and the one time on my first day I forgot and touched an arm gently the tiny gal cringed and looked scared. I think I was put with the adolescent girls because I was one of the only students in our group to raise my hand when the instructor asked "Is anyone scared?" But it's scary to hear "I'm huge...I'm soooooo fat." from someone who barely makes 90 pounds. But, funny thing, maybe I could be a psych nurse. I'll let you know next week, ok?

That picture is of me in cupcake form. My sister concocted a cupcake competition between myself, herself and my mom for my birthday this summer and those are my sister's cupcakes.

More Pie

I'm trying to get over my last week of my first year of nursing school. It was not the happiest week. My horrible group paper got one of the lowest grades in the class which is leaving me hovering at 0.8 points below an A, so while all of my nursing school friends are basking in the summer sun and singing out joyfully about making it through their first year and "oh, what a relief" I'm just feeling grumpy, bitter and completely burned out. My house still looks like finals week (and it's been over for a week) with dishes stacked everywhere and books fanned out on random horizontal surfaces with notes sticking out here and there. I have three months to get over it and then I'm back.

So what are we going to do here for three months? Bake? OK. Let's do it. Take this pie and skip the bananas. Make the crust using chocolate graham crackers, if you'd like. Add 3/4 cup of unsweetened coconut and an extra 1/4 cup of sugar when you add the butter to the pastry cream/ pudding after you've removed it from the heat. Toast another handful of coconut in a 325 degree oven for less than ten minutes until golden and sprinkle that on the whipped cream topping at then end. This was the husband's Father's Day pie. Hey, it might have been tasty to leave the bananas in and have a banana-coconut cream pie. Hm. Next time...

Hand Pies 'Til The End

Today was my last clinical until the end of September. Whoo Hoo! I can tuck my uniform into the bottom drawer of my dresser and stop waking up before 6 AM until then.

You can tell the quarter's end is on hand because the oven here in the Student Nurse household has had very little rest. Why, just in the last 24 hours I've baked two separate batches of chocolate chip cookies and two pans of biscuits. There's plans to make homemade graham crackers and I'll be exploring the Wonderful World of Hand Pies (more on that later) for Pie Month (I'm sure there's an official Pie Month, but June is Fathers Day and my husband's birthday and he is all about pie, so, well, that's what it is, ok?). Finals week = lots of baking.

So, nursing school year in review:

We started off with 64 students and are down to 60 (though, really, five people left, another one joined us mid-year after almost failing out the previous year). Only two people were actually thrown out of the program for failing to make the cut.

I can now: take vital signs, make a bed -occupied and not-, give injections (I got to do a stint at The Injection Clinic - I'm not kidding - I did a tuberculin PPD, a handful of Sub-Q shots and a ton of intramuscular (IM) shots. Our clinical group was the envy of the class until we heard about the student in another clinical group who witnessed a hip replacement surgery: "The noise when they displaced the hip..."). I can clean wounds, insert and remove a foley catheter, feed and give meds via nasogastric tube, give a bed bath (people say I can give a good bed shampoo- you've gotta love the rinse free cleanser!). I can do Therapeutic Communication. I can chart, um, sort of. I can do a head-to-toe assessment. Dang. I should be able to do more than this! I'm sure I'm missing something.

I've made a ton of friends and maybe an enemy or two (hey, it happens when you're outspoken and fatigued at the same time). I've written two group papers and have probably answered 1000 questions via scantron. I've only missed about 5 classes (though I've not missed an entire day of classes; I always went to at least one class) and only one of those was due to illness.

I've written my fair share of care plans and I have a list of medications that my patients have taken. It's nine pages long, 10 point font.

I've only stayed up past 2 AM to study twice this year. And both times it was to write papers that I kept putting off.

I have maintained straight A's, but I'm only saying that now. This quarter might be different - you know, The Group Paper From Hades and the fatigue and all.

But you want to hear about the hand pies. My husband loved those Hostess hand pies and a cheaper ("Hey, they're only a quarter each!"), creepier version called Home Run Pies. It's pie you can throw in a lunch sack and eat with one hand. So, here, make this crust:

2 1/2 cups AP flour
1 tsp salt
1 tsp sugar
2 stick o' cold and unsalted butter: cut into pieces
1/4 to 1/2 cup ice water

combine dry stuff in food processor and pulse 'til combined (maybe 6 one-second pulses). Add butter bits and pulse 10 times for one second per or until the flour looks coarse. Add the ice water slowly while the machine is running (um, take the ice out of it or add it through a sieve) until the dough holds together (my machine starts sounding a little different when this happens, maybe yours does, too). Don't do this for more than 30 seconds. Divide dough into 2 pieces and wrap each in plastic wrap and refrigerate for at least an hour before using.

OK, that recipe was paraphrased from Martha Stewart.

The pictured hand pies have strawberries in 'em. I cooked up a good two cups of 'berries with a half cup or so of sugar and a bit of cornstarch, flour and lemon juice for about 5 minutes. I chilled it after having cooked it. I rolled out the dough on a floured surface and cut it with the largest circular biscuit cutter I have and filled each circle with a small scoop of the 'berry goop. I folded the circles (darnit! I always overfill the things and sticky goo is oozing everywhere) and pressed the edge with a fork. I did the filling and pressing on a cookie sheet covered with parchment. I brushed the handpies with egg wash (one egg mixed up with a splash of milk) and sprinkled them with sugar and baked on 350 until the looked golden (sorry, lost track of time. It might have been 20 minutes. It might have been 45 minutes: bad scientist! Oh, god, the imprecision of it all). Yum! If I want to be "authentic" I'd probably make a powdered sugar glaze and paint the things with it when they cooled after baking. I'll try blueberries next: just uncooked blueberries mixed with a little sugar and cornstarch. I'll let you know how it goes.

tickticktickticktick

boom! I'm ready to collapse or explode from the stress this quarter. Only three more weeks -I have to say it again - only three more weeks. The only thing I'm enjoying this quarter is the clinicals and actually working with patients. The class that used to be fun -Skills Lab - is a grim combo plate of petrified students, confusing military instructor who doesn't like me (No, I'm not paranoid. People have been asking me, "So, why doesn't MilitaryNurseTeacher like you?"), and check off after check off. Wound dressing, IM injections, cleansing enemas, giving meds. It's all blending together. Oh, yeah. I like my yoga class.

And then there's the group paper. I am in the group best described as The Island og Misfit Toys. There are a few borderline personality disorders in there and maybe I'm one of 'em. Every time I give my opinion I'm accused of "insulting" everyone in the group. And there's that sinking feeling that my group members don't care about each other (um, there was the email from one member that actually said, after I relayed my personal struggles with having minimal time to get things done, "We don't care about your personal business."), and don't care about getting a good grade. Zeep. Who was it that said it's the BS that justifies the BS (N).

The patients..I think the hardest ones are the confused ones. There's just something deeply sad and often frustrating about people who are not in their right mind. Watching my last patient struggle to make a phone call to his family - to operate the phone, to try to remember and fail to remember the number, to look at the phone like it was a foreign device - was hard. I did what I could to organize his things. I did what I could to tidy him up. I parted his hair on the side when I combed it. I wondered- has he always been slightly confused? Is some of it the drugs? When I came back someone has cut his hair badly. Someone had attempted to remove his hospital-grown facial hair. He seemed to recognize me, but maybe he just recognized the theme of me: person there to help. I don't know.

Talkin' 'Bout Stomas

So, I got to follow the wound ostomy nurse this week and had my first real moment of queasiness as an SN (student nurse). The wound care nurse taught two patients about taking care of their ostomies. The first stoma we saw was for draining urine. The patient had a bladder cystectomy and the stoma was little and-despite its neighbor on the abdomen being a long surgical scar-was kind of cute. It looked like a small pink scrunchy. The patient asked, "Do people name their stomas?" I was the only one who laughed. The next stoma was for a transverse colostomy. It was of a size somewhere between baseball and infant's head. It mushroomed out from a smaller base. It was (despite all my book larnin' on the issue) not pink, but a veritable rainbow of, sorry, icky colors: bleeding red, necrotic gray, black and a brown that wouldn't have been unpleasant were it not surrounded by the other colors. This stoma needed a name. It took a trek all over the hospital to find a flange that would fit around The Stoma.

It's been a tough week. My strep throat came back and now I'm on scary antibiotics. The kind that says on the warning label "Take only in case of SERIOUS infection." with implied skull and crossbones peppering the container. Crud.

Bananas

I wonder how many other professions have to take a class about that profession's history...Is it just a funny nursing thing? I already did history and women's studies in my first go-round through school twenty years back. I thought I was done with it, but now I'm stuck with in this class with a lazy instructor who just spews random viewpoint for two hours (Oh, it's History and Trends in Nursing, and, well, trends... Trends could be anything, right? But nowadays most classes are taken up with students doing presentations about trends in nursing and reading in monotone from Powerpoint slides in a cavernous and bowl-shaped room that is decorated like a 70's-era rumpus room (brick walls w/ odd carpet-y panels hanging on 'em in regular intervals). I'm not actually going to stab my eye out w/ a fork, but it's almost as bad as the first quarter's theory class in terms of This Is A Waste Of My Time. And, don't get me wrong, I love history. And, um, I'm all for empowering future nurses with the story of nurses, but this class is so random, unfocused, dreary, and insulting to anyone who loves history. I'm worried less history-knowing students will think history is dreary, unfocused...flake-y. We had our midterm in the class today and we were allowed to have two pages (both sides) covered in notes to help us. Mine looked like an insane person's manifesto: no paragraphs, tiny writing. At some point I got tired and taped some random scraps of paper to one side. I couldn't even read the things it was such a mess.

OK. Here it is. Make this pie now. It is so fabulous! I don't even like pie and am only just ok with bananas (they have their place, I'll give 'em that), but this is REALLY GOOD. If you make this for someone you love they will know, upon first bite, that you, indeed, do love them. It's from the New York Times magazine of a couple of months back. I stole it almost word for word.

AMAZING Banana Cream Pie

For the crust:

1 ¼ cup graham-cracker crumbs, about 10 or 11 whole crackers

1 tsp sugar

4 Tbs butter, melted

For the interior:

1 2/3 cups milk

¼ cup plus 3 tablespoons sugar

½ vanilla bean, seeds scraped out and reserved

3 Tbsp cornstarch

1 egg

2 egg yolks

1 ½ Tbsp butter

For topping:

1 ½ cups heavy cream

¼ cup crème fraîche

3 ½ medium bananas, sliced into 3/8-inch-thick rounds, ripe but not too ripe

1. Crust: Preheat oven to 325 degrees. In a bowl, combine the crumbs and sugar. Add the butter and mix, first with a fork, then with your fingers, until the crumbs are moistened. Pour the mixture into a 9-inch pie pan, using a flat-bottomed cup to press the crumbs evenly. The edges of the shell will be crumbly. Bake until lightly browned, 9 or 10 minutes. Cool completely.

2. Prepare the interior: In a medium saucepan over medium heat, combine the milk, 1/4 cup of the sugar and the vanilla bean and seeds and bring to a simmer. Over a small bowl, sift the remaining 3 tablespoons sugar with the cornstarch. In a large bowl, whisk together the egg and yolks.

3. When the milk comes to a simmer, discard the vanilla bean. Add the cornstarch mixture to the eggs and whisk until well combined.

While whisking the egg mixture, slowly pour in about 1/4 of the milk. Transfer this mixture into the saucepan, set over low heat and simmer, whisking constantly, until it reaches the consistency of thick pudding. (Be careful not to curdle the eggs.) Remove from the heat and stir in the butter until incorporated. Pour into a shallow bowl, place plastic wrap directly on the surface and chill.

4. To assemble: Using an electric mixer or a whisk, whip the heavy cream and crème fraîche into peaks. Transfer the interior pudding to a large bowl and whisk until smooth. Fold in 1/2 cup of the whipped cream. Line the bottom of the cooled pie shell with a layer of bananas. Fold the remaining bananas into the interior, then spoon it evenly into the shell. Mound the remaining whipped cream on top, swirling it decoratively. Chill and serve within 24 hours. Serves 8.

grumblegrumble

It started happening this quarter. The comparisons between nurse training and military training. First, it was my Skills instructor. Trained in the army she runs the class like a drill sargeant: "Draw that medication faster! Hey, checking back after giving a medication is what makes you different from the janitor, maggot!" (ok, no one was actually called a maggot, but you could almost hear it in the tone of her voice). I muttered to my neighbor, at one point, "You're in the army now." Rumor has it we're not allowed to wear sweatshirts to class. Suddenly A students are getting less than A's on the skills. And, um, yep, that's me. I couldn't draw up the medication from the teeny, tiny ampule using the gigantic syringe and I touched the edge of the needle with my glove and that = didn't pass the skill.

The other military comparisons keep springing up in the dreaded History of Nursing Class (oh, come on: History of Nursing!?). The caps and uniforms, the civil war nurses, the discipline, etc. Is it summer yet?

The thing that I have been enjoying is the clinicals. My last two patients have been so grateful to me for the little help I provide them. I don't know how much of it had to do with the heavy amounts of morphine they were on (both had itsy-bitsy pupils and morphine pumps. One kept the little button in his hand at all times.) and how much of it had to do with the lavish amounts of attention I'm able to focus on them as my sole patient for the day. I'm able to wash their hair and rub their backs and chat while most of the RNs are flying in to give medications and ask for vitals and then whirling out.

OK. Recipes. Have I mentioned the banana cream pie from the NY Times magazine a couple of months back? It was the most delicious pie I've ever made and I don't even like banana cream pie. I'll get back to you on it.

Large

So my clinical is at a busy city hospital on an acute care floor. Half the patients are telemetry patients (on heart monitors) and the other half are...just real sick. They say no one is in the hospital unless they're real (sic) sick these days, but I mean coughing up blood, gasping for air, moaning real sick. So it's...exciting and interesting and-can I admit?- a little scary. I'm always nervous when I'm driving to the hospital and then I get there and I feel oddly competent (um, not that I am) and calm for the most part.

This week, after Easter, things were not so busy and a whole group of five nursing students were told to make ourselves useful, but the nursing assistant wanted to do patients' vitals so all five of us gave a woman a bed bath. It actually took all five of us, though, and, an hour later, we still could have been working on it. The patient weighed at least 400 pounds and maybe lots more. She was so large she was barely able to move. It was hard work and many of us were sweating from moving her body parts to clean under them. And it really took all five of us to one, two, three HEAVE the patient a couple of inches back to the top of the bed. I've always kind of looked at very obese people and thought that they look kind of, um, fluffy, like, if you poked them a little you'd make a dent (and I mean no offense, I just had no idea), but this woman was substantial, solid. Each breast took all of my strength to lift and her legs were literally elephantine down to the thickened rough skin. Her feet didn't look anything like feet except that there were sort of five toes and toenails on each of them. This woman had had heart attacks by my age. Our bodies can do interesting things.

Back To School Fun

It's back to school after my very short spring break. It took a lot of energy to "relax" during my break. I had a HUGE list of things I wanted to accomplish: paint my bedroom, prepare a veggie garden for the kids, finish the kids' quilts, de-clutter the house, finish pruning the Ugly Tree in my parking strip and the baking projects, oh lord, The Baking Projects! No. Not a one. I didn't get any of them done. I did pick up the soil for the veggie garden and it is now killing a huge spot of "grass" (read: weeds that we try to mow into a grass-like height) in the backyard. I spent the whole time trying to catch up on books, movies and magazines that I'd been putting off. I stayed up late every night reading. I spent a lot of time each day not doing the things I'd planned. And then school started.

And now I'm in school or clinicals five days/week. I have to keep telling myself: It's just ten weeks, it's just ten weeks, it's just ten weeks. And on Tuesday I woke up in the middle of the night with a knife stabbing the back of my throat and with tonsils so swollen I was choking on them. I couldn't swallow. I was shaking and feverish. I suffered through skills lab (aseptic technique! PO (by mouth) meds! We got to put masks and gloves and gowns and caps and take them off again. We didn't practice giving each other PO meds, perhaps a good thing because I couldn't swallow a thing.). And then my doc said, "strep." So it's ten days of erythromicin. "Uh, can't I take Zithromax, doc?" which is twice/day (BID) for three days. And he didn't know. I go back to school and two random student nurses asked, "Zithromax?" arg.

My clinical is at a very busy hospital very close to home, thankfully. We did a grueling orientation and an equally grueling online course on fraud etc and tomorrow I tail an RN and see how they do the things they do at the place we're doing 'em.

Orange Tulips=Happy

Spring break: woo hoo.
This is a reminder to me: plant orange tulips again next year!

Finally

You can tell it's finals week around the StudentNurse household because a) I'm up late poring over my Pharmacology book, b) I'm obsessively making flashcards with which to quiz myself, c) I'm up at 2 AM making buttercream frosting for my son's birthday cake.

If you said c, you're right! Finals week is when the real baking begins. Ask a three-year-old (now four-year-old) what kind of cake he wants for his birthday and you get the above pictured cake: "I want dinosaurs and a volcano and I want Buzz Lightyear climbing the volcano and I want Buzz Lightyear to jump into the volcano..." and that's when I had to stop and tell him, "Honey," (and he said, "Call me pumpkin...") "the decorations on your cake are a snapshot in time. I don't have the technology and recipe to make the things move." OK, I made up the last part of the conversation, but, well, it's true. I can't animate buttercream. It's also true that I was up at 2 AM making it. And I would never in a million years make flashcards. That's just not how I study.

The best part of the cake, when I showed it to my little fella, was pointing out Buzz Light year. "hey, Pumpkin, what's that?" and he said, softly and - I'll admit - with a slight bit of awe - "That's Buzz Lightyear and the pterodactyl." (referring to the plastic pterodactyl stuck into the volcano) as if Buzz Lightyear and the pterodactyl is an already existing storyline. Heck, maybe it is.

The cake is actually two cakes and two different frostings. The base is a white sheet cake with a cream cheese frosting. The rocks are actually chocolate rocks (man, the kiddies LOVED that and they actually were tasty, too!). The volcano is a chocolate cake from The Cake Bible and the chocolate buttercream frosting from the same book (that stuff should be illegal it's so delicious). Gotta love finals week giving me the motivation to forgo studying in favor of baking!

Here's the white sheet cake recipe. I stole it from someone on Chowhound who says it's from the Barefoot Contessa:

2 1/4 sticks butter (softened)
3 cups sugar
6 extra large eggs
1 cup sour cream
1 1/2 tsp vanilla
3 cups flour
1/3 cup cornstarch
1 tsp salt
1 tsp baking soda

Preheat oven to 350. Butter a 12x18 sheet pan and line the bottom with parchment. Butter and flour the parchment. I used a 15 x 13 inch pan and it turned out fine, but would probably be better (moister because I could bake it for less time) with the correct pan.

Sift flour, cornstarch, salt and soda. Cream butter and sugar until pale. Add eggs, then sour cream and vanilla. Mix well. On low speed slowly add flour mixture to butter mixture and mix only until smooth. Pour into pan and bake 25-30 min until a toothpick comes out clean.

Household Scissors

Ah. The quarter is over except for two pesky finals (pharm and theory). I'm not going to let two tests stand in the way of relaxing and, even as I say that, I lie. (Major aside that is the side effect of end-o-quarter brain malfunction: one of my favorite Dr Seuss stories is from the Sneetches book,What Was I Scared Of? and one of my favorite Seuss stanzas is from that story:

I said, "I do not fear those pants
With nobody inside them."
I said, and said, and said those words.
I said them. But I lied them.

Tonight it was antivirals and antifungals, the -virs and the -azoles. Brain malfunction: I love the words "reverse transcriptase".

So, my last week of clinicals. My patient was very sweet. I learned "Quantas dolor?" and felt for the first time that I was making a difference for someone when I put lotion on his very dry lower legs. And then, rumor had it, someone was having their wound vac changed (Yes, wound vacuum). Silently, I slipped into the room and about 8 other silent white-clad students were there. We had, the previous week, been very disappointed to have missed the insertion of a nasogastric tube and we were eager to see something a little more... learnable than a bed bath or giving patients medications with a spoon.This fella had a giant wound on his arm (I thought: That's quite the booboo). Polaroids of said wound were drying on the bedside table. And the nurse starts prepping the materials to cover the wound. I turned to the person next to me, "Are those....household scissors that he is using to cut that foam?" and someone asked, "Uh, are you keeping a sterile field?" Anyways, layers of stuff went on the huge booboo and the machine was started, schloooooop, and we went back to helping our patients shower or hiding out and chatting in the staff room.

So, wound vacs and household scissors aside...breadsticks. They're a good thing. I was up for snack week at my son's school and, um, that whole brain problem thing, I'd forgotten. So, what do you make when you have to give a group of kids a nice snack. Right! I though mini muffins, too! But, alas, very little sugar and no sugar-y stuff except malt syrup from my failed pretzel making experience (sigh). So, I did breadsticks. You could roll these breadsticks in anything: nuts, seeds, herbs, cheese, cinnammon and sugar (um, not all at once) and you'd be set. I did a little bit of cheese on some, but, sprinkled most of them with a little bit of salt before putting them in the oven and that was delicious.

Breadsticks, basic recipe

Package of dry yeast
2 1/2 cups warm water
2 Tbsp softened butter
Tbsp sugar
2 tsp salt
6 cups (plus) AP flour
topping of choice

Put warm water and yeast in a large bowl and let sit for 5 minutes. How warm is that water? It should be water that you would like to take a bath in, but your kids would say, "It's tooooo hot!" Add the butter, sugar half the flour and the salt. Using dough hook, mix until combined and add the remaining flour and mix until smooth but sticky. Turn into oiled bowl and cover with clean kitchen towel (notice that recipes ALWAYS specify clean as if we're filthy heathens who would use a damp, dirty towel) and let rise until doubled (an hour, about). Turn dough onto lightly oiled surface and divide into 50 to 75 pieces (it's up to you). Roll each piece into a 10 inch snake (ok, I did mine randomly as you can see in the picture. It was late plus the whole brain problems). Scatter your topping of choice over work surface and roll the snakes over it. Place snakes on a parchment covered cookie sheets. Cover and let rise for 35 minutes. preheat oven to 400 degrees and let snakes rise for another 10 minutes while the oven preheats. Bake for 15-20 minutes until golden and yummy.

Running Head: One More Week, Sorta

Does everyone here love APA formatting as much as I do? It's this huge scam put together by the American Psychological Association to sell a new manual about it every couple of years. In order to do that the APA has to change various things about the format. This is the only possible explanation for some its more bizarre elements. My favorite is the title page and the inexplicable Running Head. And I'm downright uncomfortable not capitalizing the words in book titles in my reference page. It seems so...disrespectful. If you don't know what I'm talking about I envy you. I long for the days when I didn't own the Publication Manual of the American Psychological Association. Oh, I mean the Publication manual of the american psychological association. OK, I know, I'm allowed to capitalize "American", but it wouldn't be as odd and uncomfortable and then my point would be, somehow, muted and you'd move on to the more interesting student nurse blogs, wouldn't you now?

Well, you already have. My patient: one almost 100 and suffering from dementia. The first day, she seemed fine: social, funny and charming. I would have barely called her forgetful. At one point she went to get her toothbrush and forgot what she had gone to get, but, heck, who hasn't done that? The next day that I saw her she told me to go away. She thought sleeping pills had been hidden in her banana (she pointed to a few brown spots where they had "clearly" been inserted). My clinical instructor thoughtfully rotated the banana around and looked at it closely, "No, no medication here." With dementia you're supposed to use "reality orientation" so I pointed out that every day she takes something like 20 pills and why wouldn't "they" just slip them in with her other pills. And then she said that people (specifically a "woman in a wheelchair") is spreading rumors that she's looking into windows. Next minute, she's charming and sweet again. All I could think of: check her O2 sat. 95% and that = fine for someone of her age, but it would get my son instant admission in the ER during an asthma attack. Next plan: give her a shower. That really perked her up, made me feel like I'm only half-feeble as a nurse.

You've got to come and see my tulips! Now the sun is up when I leave the house at 6:15 AM and I run past them, some are dropping their petals, some are in their prime and some are various stages of about to happen.

Pain

Is the quarter almost over? I keep telling my friend and fellow nursing student, S., "It's only two more weeks!" and she says, "Uh, no, it's three." I'm just going to keep telling myself it's only two weeks because I'm pretty sure I can make it two more weeks without popping, imploding or screaming up and down the street in the rain. And, you know, it's not the care plans, it's not the impending math test that I have yet to study for, it's not learning the language of pharm (acology), and it's not the lack of sleep. It's all of the above and/or I'm ready to move on. I'll have fewer classes next quarter, for one thing. I'll be working at a hospital much closer to home. Patho and Pharm will become History of Nursing and, heck, history used to be one of my majors. How hard can it be? How boring can it be? (don't answer the last question if you already know. I want to be surprised!)

My patient last week was a sprightly woman in her late sixties. I was impressed by a) the normalcy of her toenails b) the amount of pain medication she takes on a daily basis and still describes her pain as an "8" on the pain scale (that's on a scale of zero to ten, zero is "no pain" and ten is "the worst pain you've ever had in your life"). Eight. And she has a fat fentanyl patch on her chest. I had to pick, the night before, between studying for my pharm test and stdying pain and I, crappy nurse, picked the pharm test. So I was useless to her. And I couldn't even hear her heart murmur.

The Isolation Ward

Every week we get to pick a new patient. It's a little frantic...A bunch of us descend upon the Skilled Nursing Facility at the same time after our skills lab and scramble through the "cardex" looking for patients who are going to be there the whole week and who, ideally, have problems we comprehend. It's either luck or an art form, but three students out of eleven had their patients go home by Thursday. The other fun part about picking a patient is deciphering the patient's file. These things usually weigh about twenty pounds and every one of them is different. Sometimes, it's pretty easy to figure out what they're "in for". A lot of times the medications take several pages to list. And where is the "nursing language" class? LOC? Is that Loss Of Consciousness? Is that Locus of Control? Level of Care? Laxative of Choice? All of the above? You betcha!

So, I picked a "bad patient." I panicked. I wanted to pick someone who looked like they'd be there all week and I picked a patient recovering from MRSA (methicillin resistant staph aureus) sepsis and who had T-cell lymphoma. She was in the isolation ward. When I got there the next day, she was barely conscious. I was ready in my plastic gown and gloves to give her a bed bath, when the occupational therapist called out to me, "Oh no, she needs to do her ADLs [activities of daily living]." Uh. OK. This woman can barely move. And, not only that, but apparently T-cell lymphoma makes a person itchy. VERY itchy. My patient had bloody lesions all over her body from scratching (my care plan will correctly id them as "excoriations" and I'll have them listed in a range of measurements from 3-7 mm). And my patient was 5'7" and weighed 160 pounds. I'm almost 5'1" on a good day. So I had to get my patient out of bed and into the wheelchair, And then off of the wheelchair and onto the potty (oops, too late, Code Brown). And back into the wheelchair and back into bed and then, says the occupational therapist, "Oh no, she can't be in bed. She needs to sit up in the wheelchair." And, here's the suck-y thing about the isolation ward, you can't leave the room in the gown, you have to take it off, take off the gloves and THEN you go find help. It took several heftings of my patient before I realized: I can't do this. I can't move this woman by myself. So, every time I needed to move her somewhere, off goes the gown and gloves, out to the hall to track another student down (heh, heh, can't hide from me: white scrubs REALLY stick out), new gown, new gloves and on the count of three up she goes.

Somehow I made it through the clinical. I got to school and I realized: shoot, I helped my patient put underwear on and she had a catheter. That's got to be contraindicated! I'm the worst nurse ever. What if it prevents the urine from draining? What if she's really uncomfortable but too out of it to say anything? What if I get thrown out of the program for being an idiot? I went home. I finished my care plan: 20 diagnoses and Impaired Physical Mobility. On Tuesday she could barely lift her head, but on Thursday, she got up out of bed and walkered her way to the bathroom! I hadn't killed my patient! She was much better (despite another Code Brown on her wheelchair) and my Expected Outcomes? Out with the contaminated gloves. I was just hoping she'd sit up in her wheelchair for an hour. I told my patient I was proud of how much she'd improved. Maybe I can be a nurse.

Sugar Cookies

This is an easy recipe. It produces a tasty yet sturdy cookie. I made about 150 of them for my daughter's 100 Days of School Celebration.

3 1/2 cups AP flour
1/4 tsp salt
1 tsp baking powder
1 cup chilled butter
1 1/2 cups sugar
2 large eggs
2 tsp vanilla extract
sanding sugar (or just extra white sugar) or royal icing

Whisk together flour, salt and baking powder. Set aside.

Beat butter and sugar using paddle attachment. It'll take little while, but beat until creamy. (I think the chilled butter makes a flakier cookie without compromising the structural integrity)

While beating the butter and sugar, whisk together the eggs and vanilla. Drizzle slowly into the creamed butter and sugar with the mixer on low. Combine. Add flour half the flour and combine. Add the other half. (Heck, you could add it all at once, but if I do I get a huge flour cloud).

Divide dough in half and wrap in plastic, fridge for an hour.

Line two cookie sheets w/ parchment paper. (you don't have to, it just makes the cookies so much easier to remove)

Roll one dough blob on a lightly floured surface with a lightly floured rolling pin. 1/4 is a good thickness. Cut out cookies. put on cookie sheet. If you're not using icing, sprinkle with sugar.
Bake for about 10-12 minutes or until just brown around the edges. Leave them on cookie sheet for a few minutes and then transfer them to a wire rack for cooling.

Patience

Our real clinicals started this week and I'm so tired after having gotten up at 5:30 AM to get to my clinical site at 7 AM and then onto my classes all afternoon. Up until this week I thought: wow, being in nursing school is *way* easier than getting into nursing school and the prereq courses, but I'm revising that. This has been an exhausting week. Perhaps part of the exhaustion is that my two kids have been sick with some horrible coughing plague (my daughter sounds like a barking seal and my son is like an accordion with the "breathe" key pushed in.) and there's been extra juggling on everyone's part to make sure they have an adult caring for them all day. And the night waking: my daughter's little fever-y body smashed right next to me in the middle of the night barking like a seal and, me, awake counting down the hours until the alarm goes off. It's always weird to leave the house when it is still dark. There's a semi-exciting/ partially nauseating feeling and it should be dream time, but now I'm on the highway and it's still dark when I get to my clinical site.

So I picked my first patient. I thought, phew, this woman has congestive heart failure, TIAs and is on a million medications (including the drug I feared the most for nasty side effects in my first pharmacology test: amiodarone). I thought: this is going to be hard. And it was really hard. She didn't really want any help from me. The first day I "took care" of her I was panicky. She was happy to let me take her vital signs, but, while all of my fellow students were merrily bed-bathing their patients,wiping patient's butts and checking heart and lung sounds, I was chatting with my patient. She didn't really want me to check her for edema or help her with her range of motion exercises. It was...very pleasant, but I felt like I wasn't doing my job. I had a list of assessments I should have been doing. The form sat on my clipboard, ignored, until I got home. And then I realized, Hey! I did a lot of assessing in chatting with my patient. I was able to fill in information about almost every one of the body systems (cardiopulmonary, integument, etc).

Then came my first care plan. I spent more than two hours trying to write my Expected Outcomes (um, they're goal statements with a very specific language and format). Two sentences. Two hours. OK, some of that time was on the phone talking about the expected outcomes, but still. Two hours! And, here's the "funny" part. I didn't implement my plan. My patient's sister had died and she found out while I was there. I was mostly an ear today. And, even if I was able to implement my plan, it was all wrong for my patient. I was going to ask her to change her routine and I think that's what keeps her going every day: the steady regularity of her day (get up, breakfast, meds, get dressed etc) that is in contrast to her heart's dysrhythmias.

This is hard.

The Long Week

oops. I wasn't able to do my post yesterday. I had my first clinical today and I had my first pharmacology test today and I had to wake up at 5:30 AM and somehow make it happen. The clinical was at a skilled nursing facility. Today we just followed around nurses and CNAs and tried to stay out of the way and help as much as possible. The first CNA we followed was not the friendliest person around. She mostly gave bed baths to patients (not one of whom was younger than 90) and checked blood pressures. My partner and I were cringing. She didn't use bath blankets on any of the women we saw her bathe. She squeezed a wet washcloth on the patients so the water splashed down on them in a startling way. She was rolling the patients over like they were slabs of beef. One woman (she was 104!) -when the CNA left the room - said, "She's a terrible teacher! Use your own discretion." I think I will pick her as my patient for next week so that I can give her a more gentle bath. I mean, she's 104. That's amazing. She shouldn't be rolled over like meat. The next CNA was very gentle with the patients. Introduced herself, touched them gently, chatted with them. I realized today that, hm, maybe I can do this. Maybe I will be a good nurse. I enjoyed talking to the people who were able to talk. It was exciting to try and find the pedal pulse (top of the foot) on a patient who had had knee surgery. She also let my partner and I test her for pitting edema (I'm a gal who knows how to have fun!). The elderly folks had such interesting bodies that were actually lovely in their own way.
The downside: well, I'm not that into making beds and we had to clean up a poopy bed. The nurse we attempted to follow was not thrilled to have a bunch of nursing students dressed like marshmallows (remember, we have to wear white from head to toe) hovering over her. And, it seemed like the nurses spent all morning scanning medications. We had our first pharmacology test afterwards so I was trying to read all of the labels and detect possible drug-drug interactions (The only one I came up with was Tums and ferrous sulfate).

The pharm test? I knew right off that I got the first question wrong. Pharmacotherapeutics isn't reeeally a word, is it? Um, apparently, but tell that to my spell checker. I did ok, somehow, but it was a squeak.

Back to Baking

I've been slacking. You can see it in my posts. What happened to the baked goods? What's up with cabbage rolls? That's cooking. That's not...science! I should be reading my pharmacology book. Calcium channel blockers? Beta blockers? Angiotensin huh? I'm lost. And it's week 3 (or is it week 4?) of the quarter and it was just two days ago that I finally removed the plastic from my Physical Assessment book. So, it's back to work....tomorrow. Next week I'll be starting the real clinicals. Am I nervous? Nah! Let's bake! These are probably some of the best chocolate chip (well, technically "chunk") cookies I've ever made or eaten. Here HERE click here for the recipe. Go ahead. Try and find a better recipe. I challenge you.

Cabbage

So, I'm pretty grumpy about my school right now. The nursing program is fine - I feel like my classes are more focused on information that I can see applying during nursing practice. It's the school itself that is getting to me. And it's not just that I am offended that I'm being asked (nay, forced) to take a writing skills test (what, is this high school? Isn't this a *university*? Aren't we all adults here?).

A few years ago my school changed its name. I think I've mentioned that my school is not exactly located in the hippest town around and that, if you were to drive through it, your main impression would be: ah, another strip mall/ auto dealership/ fast food place/ rotting warehouse/ freeway on-ramp. So, the name change, ostensibly given to "reflect our [sic] growing regional role" (quote from the second sentence in the answering message on the main university phone number), was probably more about distracting people from the dismal city within which nursing school u resides. Yep. Anyways, I was running around the track at school today and the initials from the old name were being pried off of the dead-weed-ridden hillside by some workers. They were hacking at the middle part of the letters (made out of - appropriately -asphalt) and rolling the (what looked like) black rubber cinderblock outline for the letters down the hill. Fine. I understand the workers probably needed a truck to haul away the asphalt and odd cinderblocks, but I had to "pull over" to let three other trucks go by while I was running on the track. And I wasn't going to bring this up because there are a LOT of other things I could complain about (there's a great view from my campus and it is not visible from any structure but the administration building that, oddly is featured on the student i.d.. prompting my husband to ask, "Why is there a parking garage on the student i.d.?"), but the most crappy thing about my school is that there are always trucks driving around in random places on campus. There are no tranquil paths on the campus, no peaceful quads, no tree-lined picnic areas. Everything, apparently, is a road. And they are not ambling along at 5 MPH. They're jamming: maybe 20 MPH or maybe it just seems that way because the paths they are driving on are no wider than 4 nursing students across. It's...unsettling. And, yet, given the nature of the town (as previously mentioned), it is, perhaps, not surprising.

Pictured above are some stuffed cabbage rolls (prior to saucing) that I made from a modified version of this recipe.

I replaced the ground meat with a vegetarian ground "meat" substitute, added a bit more rice, used plain yogurt instead of sour cream and I used a stick blender to make the tomato sauce smoother. I reduced the cooking time to reflect the fact that I didn't need to cook raw beef. I cooked it for 1/2 an hour covered and 1/2 an hour uncovered. Next time I might reduce the total time down to 1/2 an hour and keep it uncovered.

Back to School

It's back to school this week and, so far, I have an easy schedule. One of the classes I'm taking is online which is splendid. That means my body does not have to be anywhere specific at any appointed time to take the class. I think the hardest part of my day is making sure that I show up at the right place and time, but the difficulty is not really with my classes, it's with picking up and dropping off the kids. On any given day I have to run through my mind: What kid is where? Who's picking them up? What time? From where again? The nice thing, I guess, is that they aren't really confused about it. When I catch my daughter putting a toy into her dotted backpack (she's not supposed to bring toys to her kindergarten class) she'll say (in classic tsk, "gu-u-uy mo-o-om" tone), "But mom it's Thursday and I go to the afterschool program. We can bring toys!"

My first class on Monday is Adult Physical Assessment. Cool. We're learning how to assess the wellness (or otherwise) of each of the body systems. We launched right in and did the musculoskeletal system. Observe first, then grapple (oh, wait, I think the word is "palpate") the patient/client/lab partner. And, the neat thing is, there are a couple of different ways that you can palpate someone. It ranges from light touch to feeling for an organ (there are words for these things, maybe just light and firm, but maybe something more exciting than that). I was proud of my observation skills when I detected that my lab partner's left leg was shorter than her right leg. When I measured her it was true! It was a full quarter of an inch shorter than her right leg. She pretty much started talk of joining a circus side show (forget nursing, be a freak!). The funny thing was, though, when we were tested on our musculoskeletal assessment, S.'s legs were of the same length.

In my first theory class I was AGAIN handed a twenty dollar bill (see this post)! OK, I had lent it to my friend the day before. Narytheless, I hope that is the only thing that this version of theory has to do with last quarter's. Well, aside from the fact that it's the same students (that wacky bunch!) and the same instructors (Overexplano teacher and The World's Fastest Talker).

Filler

I don't go back to classes until Monday. We start our real clinicals this quarter which I think will be the toughest part of the quarter. How hard can pharmacology be? And this quarter's theory class seems to have somewhat of a focus: "Care Of Adults". Heck, *I'm* an adult (we're all adults here, right? Or that's what they say, anyways) so it's not like trying to understand Shakespeare or the Kreb's cycle right? And then there's a skills class and some random class "Human Development" that means nothing to me currently.

So, this is a useful website: All Nurses. My nursing student friend, Tom, pointed it out to me. The student forums are useful. And there's a couple of nursing student/ new nurses blogs I've been checking out. There's a whole mess of blogs listed if you click on the nurse+blogs button somewhere on this page. Two I've been reading regularly are Confessions of a Student Nurse (though she's a new ER nurse at a children's hospital) and Student Nurse Jack because she's an older mom going back to school like me. Do you have any favorites?

There are some lovely food blogs out there, too. This one has some interesting cupcakes (maybe a little too interesting, but they're lovely narytheless). And this one always has lovely pictures even though recipes aren't really posted (it's kind of an evil "buy the book" thing: you get links to the cookbooks the recipes came from). OK, I spend *way* too much time reading food blogs. This one is also lovely.

And, finally, lichen...I could look at lichen forever. It's a fungus. It's an algae. It's both working together. And the fun never ends. Check out the Lichen Portrait Gallery and see for yourself. The picture above was taken while hiking on Mt Diablo.