Friday, October 26, 2007
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.
Saturday, October 20, 2007
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.
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
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)
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.
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
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 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
Friday, October 12, 2007
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.
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
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.
Friday, October 05, 2007
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.