Four Pounds Of Butter

The baking season is in full swing here at the StudentNurse household. I am not exaggerating when I say that I have gone through four pounds of butter in the last week. Yes. I know you're thinking about saturated fat and heart disease and heck, you're nigh on a Health Professional here, StudentNurse, but that four pounds of butter was distributed pretty evenly over an entire elementary school

(that was the root beer cake for Family Heritage Night - bake something from your heritage! and somehow a root beer cake struck me as something my midwestern relatives may have baked at some point and I was feeling pretty ironic and all until someone plonked down a pink, greasy box with several dozen donuts in it)

and two elementary classes (carrot raisin muffins and sugar cookies X 2 batches oh, and the chocolate chip cookies that didn't go where intended because of a case of strep throat in one of the StudentNurse kids). And I have to say, too, that I am fully aware as a near'bout Health Professional (just a little over three months here, folks!) that all of this butter and sugar and root beer flavorings are not good in such quantities (especially since nutrition is one of my areas of self-appointed expertise (I couple that with my other Area Of Interest: vector-borne diseases- "Ask Me About Hanta Virus!" my bumper sticker would say), but, I repeat:

It Is The Baking Season. It can't be helped.

So, about the above cookies (that'd be batch #2). I got the recipe here and it is the best sugar cookie recipe I've ever met and I tell you I have made at least two batches of sugar cookies q year (q= every for you non-nurse-y types) for at least a decade using a different recipe every time and I am difficult to please.

I like these a bunch because they are not too sweet and, subsequently, they can take a full load of sprinklin' sugars, raisins, red hots, or mini M & M's without burning your taste buds with SWEET. And, by the way (and since you already think I'm evil in the nutrition department), the inventor of mini M & M's should be awarded some sort of candy Nobel Prize. Those things are perfect for making little mouths and buttons (et al.) on cookies. And, shut UP (no, YOU shut up), I am way more frantic about food dyes than you are - WAY MORE. I understand Yellow #5 is Satan's Own Yellow, but...

Baking Season.

Those poor snowmen need eyes and buttons here, people! My husband almost ran to our local grocery store to purchase candy corn so that I could fashion little candy corn cob pipes for those guys. THAT is evidence, too, of our devotion to The Baking Season. And did I mention that we live in a neighborhood considered to be grocery-store deprived (sure, plenty of liquor stores) so much so that not one, but TWO non-profits set up fruit and veggie stands within two blocks of my house (in either direction) on two different days of the week. And, also, when he made the candy corn offer it was well past 11 PM.

OK. A couple of notes on my sugar cookies.

A) What's up with refrigerating overnight? Forget it. An hour, maybe, but COME ON, this recipe calls for softening the butter and it's not a pie crust. Texturally these things are great. They are short-bread-y and not as sturdy as some work horse sugar cookies and so require careful packaging up to move from your house to the place of consumption/ admiration, but, just yum.

B) I used orange zest because my lemon tree is sorrowful and neglected and has two tiny green lemons waiting to perish in the unseasonably chilly weather going down right now.

C) You will need to use lots of flour on rolling surface and pin: this dough is sticky. I made it twice and once did fridge it overnight and that batch was even stickier than the dough I disrespected.

D) Have I mentioned how much I love parchment paper? That's my other bumper sticker: I *heart* Parchment Paper.

Finals Ate My Brain

Unable to rub words together to form sentences: it's finals time. And what happens in the StudentNurse household at the same time as 2/3rds of the finals weeks at Nursing School U? (No, gnashing of teeth and letting the house get to a disaster of CPS-taking-away-the-kids proportion happens EVERY finals week). Yes. One of the kids has a birthday. And, remember when they were three and you could get away with baking one cake? Now there's the school cupcakes and the family party ("Hey Bumble bee, howzabout a make-your-own-sundae bar for the family party?": Phew, that worked!) and the friend party. So, add the house already a disaster and a couple of baking prjects and now the house is a sticky disaster. And that's just the thing about this place: the fun never stops! We're sticky, but we have cupcakes lingering around. There's ice cream in the freezer and a doll wrapped in pink paper hiding in the laundry room. So it's a mess and papers are here and there and books are this way and that and dishes are under and over and in between...There's only so much paper, so many dishes and so many books available left to add to the mess, right? It can only get as bad as it can get because there's a limit to the materials here. (All right that's a serious stretch, but...) And one of my finals was canceled because of glitches with the school's networking system! It's a holiday!

Oh, did I mention that I have a preceptorship in L and D at the hospital I wanted? Woo hoo!

Nurse Molly's Search is from the Tiny Pineapple site.

Rocket Ship to the Moon

My son woke me up on Monday morning. "Rocket ships to the moon...Getcher rocketship to the moon here."

Aside: my son often wakes me up saying strange things. F'rinstance: when he was three he walked into my bedroom in the middle of the night and started talking about how microbats use echolocation to find their prey because their eyes are too tiny to see. What?

So I got up and I picked out a rocket ship amidst a fairly good selection. I chose the most colorful one because I was bleary-eyed and I felt it was a day that called for something festive.

See, my last big project for nursing school was due the next day and it was a monster of a project: It was, of course, a group project because all projects in nursing school require you to coordinate with at least one if not 7 other people all of whom live more than 30 miles from you and have some sort of unworkable combination of jobs and/ or kids. The three of us did most of the work over the phone and via email. It was one of those projects wherein various incarnations of the written bits are peppering the computer's desktop and they've been given names like "projectbest.doc" and "projectfinal.doc" and "projectfinalA.doc" and "projectfinalnoreally.doc" and so I can't really tell what the most updated version is and it's mixed in with the other docs and ppts and pdfs and I'm getting calls on the cell phone from other groups whilst on the landline with my posse, "What do you think she means by literature review?" and I can't answer because there's two phones and six people and 30 documents and the kids won't go to sleep and are mixing soap and baking soda together in the kitchen thanks to the whole gak experiment and now let's see what happens when we mix this messy substance with that other messy substance cuckoo, cuckoo.

So, I carried the rocket ship with me all day and every time I just couldn't take it I made little rocket ship whooshy sounds and headed to the moon and, I have to say, it helped because here I am. I am not exploded from stress. I have Thanskgiving pie action going on in the kitchen. There are toasty nuts cooling. There is caramel (oh, yes, there is!) in the fridge. There is vanilla custard. There's a graham cracker crust. No. settle down. These are components of two different pies: Banana cream (special request from my favorite niece) and chocolate caramal almond tart (organize those first three words in any way you'd like, but "tart" is the last name.

What was the point? Oh, yeah. So, the project to end all projects was an analysis of three research papers on an issue of interest. But, wait, there's more! We had to put it onto a poster to present it. So it was a three-dimensional paper. Somehow we got the thing together over the phone. Miss J. had purchased the poster and stayed up really late laying it out and nothing was fitting and we had pared it down as much as it would pare.

I showed up to class the next day just a tiny bit early and there's Miss J. and the poster and there were words leaking off the poster and onto the table and the edges of the paper were curling up at the sides and I think I gasped and the instructor walked in and I think Miss J.'s hand went up to her mouth because of the captain's platter of my gasp and the instructor walking in and I felt terrible. We couldn't really say anything because the instructions said that we had to work on ALL ASPECTS OF THE PROJECT AS A GROUP (and, yes, it was all caps). So Miss J. and I are taping up the curly bits and the instructor (sigh, I have to tell you she was my L and D instructor - not the biggest fan of me and you can refer to older posts on that one) says, "Not really in the lean and mean category is it?" In walk other groups with these gigantic posters. Turns out Target is not the place to buy those tri-fold demonstration posters and poor Miss J. had to work all night to fit everything onto this little board.

So we go first and the instructor sits down and scooties the desk up to the edge of the table that holds our research poster and she squwinches up her eyes and we get some comments and questions and maybe I was the only one trying not to cry because, well, this statement should have had a reference and we didn't synthesize the three studies at the end and can't anyone remember the literacy rate in Turkey? And then we get a 97 and we're breathing again. Phew. it's over.

I said goodbye to most of my clients this week. I was surprised at how hard it was. I'm so tired and I feel like I've done what I can in the time I can and now what and I've been ready to move on. All three of them said something along the lines of, "Maybe you can call," or "Maybe we'll run into each other," and I felt like I was the one breaking up a relationship and gave some awkward "Um, yes. Perhaps I'll see you around town," and left and tried not to look back because I didn't want to see their sad goodbye faces and I know I won't see them around because, well, it's over. That's how it is. I'm all professional in my weepiness and all, see.

Gak

My application for the NCLEX (inclusive of all the checklist stuff: passport photo -drat, why did I wear the orange scarf that was my first and only knitting project?- check, photocopy of the form stating that I had the fingerprinting done - have you done that yet? The guy smashed and rolled all ten of my fingers on a scanner -, and the application itself) has been sitting next to the computer for days. I plan to send it certified mail and - did I mention I have a terrible cold? - I haven't picked up enough speed to get to the post office. I've been studying, though. I'm on page 85 of the gigantico study book. One of the first chapters is about leadership. "What type of leadership does this represent? A) autocratic B) automatic C) laundromatic D) dichromatic" Uh, you mean I really have to know that? Were you paying attention in that class? Yeah, no, me neither.

But then if you skip ahead to the fun stuff, let's say electrolytes and fluid balance (whee!) then you can start to wonder: Do I really need to know the acceptable levels of phosphorous in the human body (3.0 - 4.5 mg/dl)? And who knew there were so many different types of dehydration? Did I learn that? I was there for all the classes, right? You saw me sitting in front of you taking notes at a million miles per and asking questions to stay awake and engaged. Remember?

But, and, well, I'm not really worried. It'll be fine. They (those people who have taken The Test) say that the best thing an NCLEX- studying person can do is to answer lots of questions. Just practice answering questions. Post any questions you might have and I'll answer them.

Remember oobleck or gak? It's one part water to four parts cornstarch and if you're a REALLY cool mom (not like grumpy old me) you'll add a few drops of food coloring. That's some oobleck up there. Fun stuff. I recommend it.

Forensics

"Are you good at forensics," my client asked as I was on my way out the door. "Uh...what do you mean...forensics?" I was thinking chalk outlines, dead bodies in the basement and, perhaps, maggots. "I think someone is breaking into my house and poisoning me," says my client. She was calm and her tone was a lovely-day-we're-having tone. She showed me the rat poison scattered in her cupboard. "I put this here, but I didn't put the borax over here," she said pointing to a trail of white powder, all of it looking the same to me. I was standing in the kitchen with her and the flies were buzzing around the open garbage can and her little body was in front of the door and I looked over and...

why didn't I notice the lawn mower in the dining room before? It may have previously been concealed by the boxes leaking clothes and magazines. And here, folks, I don't mean a svelte push mower. No. This was a full on gas-powered mower (w/ clipping bag attached!) sitting right there.

"Rat poison is warfarin." She said cheerfully. Yeah, I guess so. Basically, rats eat it and bleed to death. And she pointed out that she's been having inexplicable bleeding. Sooooo, here's the thing: I've come to realize lately that I haven't always been asking the right questions. What do you say, here, when someone with a lawn mower in their dining room tells you that they are being poisoned? "Who is poisoning you?" was what I asked. That was probably the wrong question. I probably should have asked where she kept the rat poison motherlode and taken it away like I should have taken another client's 5 untaken Cipro pills away. Or hidden it. But, no. I got to hear the whole story.

And then she took me to her room and showed me the necklace in the vitamin bottle. "This was stolen from me and then I, later, found it here." And, so what is the wrong question to ask here? Yes. I asked it, "Uh, are you sure that *you* didn't put it there?" That took my client from pleasant to agitated. I should have asked how she thought it got there. I should have said, "Interesting." I should have asked about the lawn mower as a clever change-o-subject. So, to calm her down I said, "Maybe you have a ghost." and, weirdly, that did calm her down because she may have realized I was feeble-minded and that I just didn't understand. "No, I don't have a ghost." Flies buzzing in the kitchen and lawn mower looming I fuzzily lost all therapeutic communication abilities. I just nodded.

So, on the one hand, I'm glad my client is opening up to me a bit more. On the other hand, now what? Geez, what if my (I now realize) demented client is poisoning herself? And what's with the lawn mower? I'm back in over my head.

Flu Shot Fun

My community health class got to do flu shots today at a local senior center and, I have to admit, it was really fun. We got there and huddled around under the fluorescents in the early AM while the retired nurses drew up the vaccine. At first the person in charge was going to set all ten of us up at one small table at the outskirts and then suggested that a couple of us could move to the back of a second table in the middle "if we weren't nervous". Excuse me? Even the queasiest of us, the folks who fainted and looked pale at every turn in our first year (and, for whatever reason two of the most fainty and nervous students in our year are in this group) are hardened veteran (students) by this time. By the time things really got rolling we had taken over all of the tables and the retired nurses were in the back sipping coffee and chatting. I had a retired nurse buddy, actually. I'd shoot 'em (if you will) and she'd bandaid 'em (perhaps a less controversial term, except, well, the trademark issue and all).

Half of the folks came in tight long sleeved shirts and sweatshirts with at least one if not three other layers they had to wriggle out of. For the big guys I congratulated them for not crying. I apologized for not having lollipops to give out. It was funny to watch the folks sitting in chairs waiting for their turns. You could see them eyeing us to pick who would give them their shot. I wonder what their criteria was. One person said I looked like I'd do a good job, but lots of folks went over to D. who was the only one not dressed in scrubs. She was in her community health home visitin' clothes (you know, kinda business-y and button up). Maybe she looked like she was in charge.

So, I was in the nursing office at Nursing School U yesterday and one of my old instructors said, "I was looking for you!" And I thought, oh crap, what did I do this time? And, apparently, the social worker of one of my clients called Nursing School U to tell them that I had "saved [the client's] life" by helping her to change her diet and overcome the intractable diarrhea. That I was the only one the client would listen to and that my "good communication skills" saved my client's life. Wow. Aw, shucks. It was nice to hear and I felt all choked up and like, hm, maybe I don't suck and maybe I can make a difference. I'm sure we've all made a difference and "saved lives" (you know, she was so dehydrated, though, it's not an exaggeration), it's just that someone picked up a phone to follow up on it. Still, it is nice to hear and this quarter has been so hard I'll take all the good I can get: flu shot giving and saving lives and all.

Nurse Molly

I have mentioned my revelatory *You*-Are-The-Nurse experience at some point 'round here and today my Community Health instructor said, "You're ALWAYS a nurse." And she meant that even wandering the aisles of the grocery store or flossing your teeth alone in the mirror or dancing like a madwoman/man under a gibbous moon you're a nurse. It...doesn't...go...away. People always approach my mom

(Have I mentioned that my mom has been a nurse for longer than I have been a person? Yes. It's true.)

and they say, "I have this rash..." And it's ALWAYS a rash. Always. And no one knows what the heck that rash is, not even your board certified dermatologist. So, my mom always says, "It looks like a rash." And ALWAYS being a nurse is kind of like ALWAYS being a mom. And this comes back around to Nurse Mom, too. I called my mom one afternoon a while back and asked her some sort of question you'd ask your regular old nurse-or-not-nurse mom like "How do I get a stain out of...?" or "What ingredients are in homemade baking powder again?*" and she answered and I realized she had been sleeping and I felt bad, but she's ALWAYS a mom and that's what moms do: they know, they answer, they try not to visibly flinch.

And I've lost the point.

My friend and fellow Student Nurse R.A. says to me re: Community Health, "I have to make all of these calls to doctors for my clients and I don't even have time to call a doctor for myself." And that's it. She hit the nail on the head for me with the whole Community Health thing. We're out there helping our clients get their stuff together and we're barely keeping it together ourselves. And another thing my CH instructor said today: "I wish someone would come to my house and tell me what to do."

But I am enjoying my clients for all their quirks and charm. I am beginning to feel like I'm making some headway, like I have a plan and it's a good plan even if that plan will go nowhere because, well, it's hard to change even in small ways. Shoot, I've only been the way I am for a handful of decades and now I'm asking DogStink fella to walk for ten minutes a couple of times a week. Did I pick on his daily bacon habit? Nope. Did I wag finger at the soda? Didn't TOUCH it. I told him that he needs to add one more piece of fruit to his diet every day. Let's see...And then we can talk bacon.

So, above, I found that on this site, Tiny Pineapple there are a ton of cheesy nurse romance covers there. Check it out!

* Homemade baking powder: sift together 1/4 cup cream of tartar with 2 Tablespoons of baking soda. Now sift it again. Tada!

The Clients

I looked under the hood a bit more today on a second visit with one of my "clients" and I'm in way over my head here. And the other two "clients" aren't exactly filling me with confidence in my ability to do much to make any improvements in anyone's health this quarter.

The first time I visited "Client A" she was chatty and friendly. She had an I'm-taking-gooooood-care of myself aura and I thought, phew, this ought to be easy. Sure, there's the issue of the pain that has her screaming in rooms alone and, ok, it's a problem that she's not leaving her home, but once those are addressed (I thought last week) we can talk yearly mammograms and What Are You Reading. Today, I took a look at the kitchen after "A" let me in, grumbling in her shiny pj's. There was rotting food on the table and flies buzzing around. I noticed the boxes stacked in the hallway, the bunched up area rugs,

[And, for goodness sake! (my seven-year-old has been exclaiming that a lot lately), what is it with frail, homebound elderly folk and bunched up area rugs? Is it just my "clients"? If I was in charge of that statistic it would be 75% of frail, homebound elderly folks have a bunched up area rug waiting around to be tripped upon (and, yeah, head injury..broken hip...unable to reach a phone: Yes! I was thinking the SAME thing!). I'm not kidding, 3 of my 4 people have this affliction. Nursing diagnosis: Knowledge Deficit; Area Rugs.]

clothes in stacks on many surfaces. "A" was agitated and going through her meds I realized she's not always taking 'em and the blood sugar was too high and the blood pressure was too high and I'm jabbing the bottom of her foot with my pointer finger -hard - and she finally says, "Yes. I can feel that." Let me say, too, if I haven't already, she was not really into working with me today. So... exhausted, I'm on to my next "client".

And I thought "A" had clutter. I had to get a map from the front desk, just about, to find "B's" apt in the Senior Apartment Complex. And, once there, there was a walker-wide swath cut through the clutter and things teetered on every surface. Random things: a clay mask, a balancing act of books stacked here oh and, also, there, leaking pens, plates. This was an area about this big and now multiply it by 20 and you get the whole 9 by 12 foot apartment. "Oh, and I'm moving." Ah, I said. "Will it be an, um, bigger place?" Turns out, no. No it will not. It will be a smaller place. The great news, though, no area rugs! After this visit I was on the phone with a fellow Nursing Student and she was trying to remember the name of the edema that's so bad it leaks ("weeping?" "seeping?" <----- that was my suggestion!) after having talked about "B's" legs.

And then Stinky Dog Guy. His closing salvo: "Ah, great, next week we can talk about some other ways my doctors have tried to kill me!" Sounds fun! The area rugs might beat his doctor to it.

So, we need to keep track of all the hours we're putting into Community Health: drive time, client visits, prep, conference. My other Community Health People and I are joking about how we can "double bill" our time when we're chatting about the class whilst writing progress notes. I am considering counting this blog posting towards my hours. But the sad, sad truth is that I don't need to throw it in. We're all going to have way, WAY more hours than we need.

Have you ever seen a million ladybugs in one palce at one time? It's...neat. Maybe a little creepy (all that writhing and all), but mostly neat.

Back to School: Bear Poop

I thought I had enough time to recover this summer what with the swimming and the tomatoes and the stack of fiction and all, but I'm just not feeling it. I'm doing Community Health this quarter and it should be meshing with me: it suits my background, we have a lot of independence, I love working with elderly folks, seeing people in their "natural environments" is always a thrill (um, more on that in a second), and one of my friends keeps saying, "Hey, we don't have to go to the hospital to pick patients EVER again!" I'm not sold on it. I have to make phone calls on my own time for one thing. Have you ever called me at home? It's almost impossible to find a quiet moment. It's a small house. I have two kids. They don't always get along/ someone is constantly getting injured.

And, the other thing. My patients aren't patients anymore. They're clients. It's almost like there's some sort of business transaction occurring. And then there's the whole question of: What am I doing here anyways? Yes, fine. I can do a lot to help folks with their health in their own home and, Yes, health is not just physical health, but do I really need to organize transport for people or play what's-that-smell? (No, not kidding. One of my client's caseworkers asked me to try to figure out what was stinking in the house. She thought mold. I say rotting dog. Please. Do you want details? OK. Hang on...) And, yep, I'm on my own out there. Cool! Not really. I find that I'm at a client's home and normally I love the stories about how someone's mom greased their chest with goose fat and covered it with warm flannel to treat rheumatic fever (the question I had asked, by the way, was: What are the health issues that are impacting you the most right now?), but I find myself thinking: Dang, I've been here for an hour and a half and I need to make some phone calls before I have to pick up the kids.

And that's the other thing. Time suck. I could spend hours and hours and hours researching goose fat and transit sources for the elderly. How can I get this guy out of the rotting-dog-stink house? Could it be the meds that are causing the intractable diarrhea? I could go on and on here. I have four clients for ten weeks (um, well, I have three. It'll take more phone calls to scare up a fourth). They're like my project. And I'm already tired. It should be fun! I can make a difference!
I'm tired! Can't I just go pick a patient and write up a care plan and have hours that end and go home now? Is something wrong with me?

OK. The good part. One of my clients has problems with incontinence. She's in her nineties. She said, "I can't skip anymore. Skip while you can." She also said that they didn't have elastic during WW II. I almost wrote on the back of my hand: Skip More. Appreciate Elastic. My client today is the most fantastic and interesting person. She had this great diorama/clock/light. It's plastic. There's a clock at the back (of course there's a crack in it, the plastic is faded and the clock doesn't work). It's the last supper. There is a little LED light in each corner. I don't even know what to say about it. I'm totally going to become attached to this gal. Oh, the other bad thing: emotional drain. Ten weeks and then goodbye/luck. That's going to hard in some cases. I just know it.

I can't go on here. I'm sure you were waiting around to hear about the rotting dog house and I want to tell you that I'm not going to help roll up and get rid of those rugs even though they are a tripping hazard and Rotting Dog Client is functionally blind. I'm not. No.

The picture is bear poop from my swimming hole trip.

Ah, Summer! Part Five: Swimming

I still have one more day of summer (even though the equinox was yesterday) and, darnit!, I'm going to cling to it until I roll into the orientation for Community Health tomorrow morning. But, well, hm, arg: I'm faking it. The TB test, the wait at the DMV (without an appointment, too: we live on the edge in this hazy house of summertime bliss) for my driving record, the emails from instructors about dress codes (gawd, not this again: no sandals, no tight clothes, no short skirts: summer's over FOR YOU and don't forget your name tag, you're in the army - oh, uh, nursing school -now!), the sudden need to pay attention to Nursing School U's logic-less beaurocratic, mistake-ridden and often contradictory mulit-media communiques. And that dread-inducing need to make several, undoubtedly pointless, clarifying phone calls to poorly paid, grouchy Nursing School U phone answerers. And the phone ringing = fellow the-sun-was-in-my-eyes nursing students: What are *you* wearing? Do you think the orientation will take the whole day? This textbook is only this much money here and that much there but rumor has it we don't need it anyways do we and are we almost done already? It's all too much. Summer is over. Over. But, hey, check out the cool swimming hole.

Ah, Summer! Part Four: Cupcake Competitions

All the summer birthdays around here were in June or July, but summer is moving at a different pace than most of the year, so I've just gotten around to the cupcake photos. I hope you made it to the Second Annual StudentNurseFamily Cupcake Competition. I'm declaring myself the winner with the chocolate 'n' salted caramel cupcakes I stole from here. But I used Alice Water's chocolate cake recipe for the cupcakes and mine don't look as pretty because I frosted them outdoors on a picnic table in the sun prior to the competition. And that frosting recipe.... Melt the butter? Don't do it. It cannot be correct. I say soften that butter and whir the thing up in your mixer. I melted the butter and then I had to double up the recipe using softened butter and more cocoa powder and powdered sugar. I'm not going to blame that for my too soft frosting, though. I'm going to stick with blaming the sun.

So, today was my kids' first day back to school. It was my son's first day of kindergarten. I was sure I'd cry and cry what with my littlest one going off to the big elementary school, but instead I slept really poorly last night. I had these strange dreams wherein I brought my son to kindergarten, but he wasn't my son as he is now, he was a baby, but not how my son was as a baby (come on, you know how dreams go). He was, alternatively, a big fat-armed stereotypical baby with puffy cheeks and fat, wet rosebuddy mouth wearing soft blue cordoroy shortalls and smelling like sour milk and Pampers or he was my son, but a miniature version of him like a painting from the Middle Ages where children are just smaller adults. So, all night I was bringing my baby to kindergarten and I guess I got over it. This morning I said, "Ok, I'm going now," and my littlest one barely looked up from the play-do to give me a goodbye.

Ah, Summer! Part Three: Tomatoes!

It's not that I've forgotten you. No, really. I've just been having a summer here in all the best ways.

I don't really have dreams about tomatoes in non-tomato times of the year (say, February), but I think about them when I'm awake almost every day. And then July comes around and the cherry tomatoes start showing up and we're having them in pasta, on salads, on bruschetta (shut up, it *is* pronounced broo-sketta!) like above all mixed up with basil and olive oil and red torpedo onions. And now How-Ya-Doing-August! and we're getting some of those dry farmed tomatoes that are RED! and smell like sunshine and all that is good and I'm thinking of a million ways to slice 'em up and eat them.

And if you are what your pregnant mom ate then my daughter is about 35% tomato. I was pregnant w/ her over a summertime and that's when my love for tomatoes began, really. I adored the ugly tomatoes; yeah, the heirlooms. The uglier and bulgier and more vividly-colored the better. And that gal will eat a tomato out of hand like no seven-year-old I know. They were even featured in a song she wrote about fruit in a crescendo of To-May-TOWWWWWW!

I actually dream about peaches, though. Even more than tomatoes, they live large in my dreams of summertime and they are the reason that summer is my favorite season even though I'm not such a huge fan of excessive sunshine and swimsuits (my "Anxiety Zones" can't be resolved with artful tummy panels or clever uplift devices, bold patterns and slights of hand). I can't get a picture of peaches, though, because I eat them too quickly. Now you see it, now you.... My daughter's fruit song ends with, "and that's...my...fruit." and that's how I feel about peaches: And That's My Fruit.

So I was buying myself a few chocolate truffles today and I kept saying: ooh, what's that one? That's purdy, what flavor is that? and I finally asked The Chocolate Lady if she had a chocolate map and she gave it to me. She said, " I was just enjoying your energy, so I didn't tell you we have this." and she handed me the descriptions of the chocolates. I had just come from my son's preschool. I spent the whole morning hanging kids' artwork on the wall and it put me in the best mood. If you're ever feeling sad, I recommend hanging out w/ kid artwork. It's so charming and the colors are often so bright and the messages are usually so simple and clean and pretty and the materials are sometimes so multi-textural and the glue and the placements can be so half-hazard (yeah, yeah: haphazard. I don't care.) and large groups of this stuff hanging on a wall is really sweet and lovely.

And it's my son's last day of preschool. Today is. Thank goodness I have the chocolate truffles and the head full of large groups of kid art or I might be crying that my son is a big schoolboy and not my baby anymore. OK.

Ah, Summer! Part Two: Camping

There's nothing like sleeping in a tent and eating dinner off of a paper plate. And nothing = summer like a camping trip. The kids got sticky w/ marshmallows. And 'round these parts summer nights are pretty cool so we wore warm hats and shivered in our fog-encased tent. Somehow the kids hiked about five miles and only melted down a coupla times.

That's a picture of my dusty camping feet in (what were before the camping trip, anyways) brand new shoes.

We used this sauce over grilled tofu on our trip and my friend at The Kittalog requested the recipe. Here it is!

This is slightly modified from Vegetarian Suppers by Deborah Madison:

Miso Topping

1/3 cup white miso
2 Tbsp rice vinegar
2 tsp grated ginger
minced garlic clove
fresh ground pepper
1 tsp roasted sesame oil
splash of tamari or soy sauce
3 Tbsp mayonnaise

Combine by hand or in a food processor. Savory!

Ah, Summer! Part One: Stone Fruit 'n' Berries

It's just now hitting me that I don't have to hunch over the computer muscling through another care plan or set the alarm for a time before 6 AM and that I can say "6 AM" and not 0600 w/out fearing a med error.

It's two weeks into summer vacation and I'm just now looking around and thinking about cleaning the house. I had to spend two weeks not lifting my nose out of a fiction book and watching really bad tv (at the same time!). We upped our Netflix membership around here and we're almost done with Season One of The Sopranos (don't tell me what happens! I've somehow remained oblivious to the show until now).

I'm looking forward to a long line of camping trips w/ the kids, bread making and stone fruit (above: peach, dapple dandy pluot and ollalieberries (spell check is dinging me on "pluot" and "ollalieberries" when I was, just a few weeks ago, getting dinged on "hypermagnesmia" and "cholangiopancreatography": now *that* to me means it is really summer!)).

Last Clinical EVER

My last clinical was in CCU on Wednesday. My patient had a thousand problems and a million lines and a trillion meds and the nurse I was working with, pretty much, let me do all of the care which mostly meant grinding up meds w/ a pestle the nurse brought from home, mixing the powder w/ water and giving the slurry through the NG (nasogastric: through the nose and to the stomach for my non-nursy friends) tube and charting the vital signs every hour. The rest of the time I was trying to understand the patient. The patient would mouth "help me" (she had a trach and was on a ventilator for half the shift) and I would have to figure out what the problem was. Starting at the feet, because that's where my patient's problems started, I'd work my way up: Is something bothering you in the toes, foot, lower leg, upper leg, etc)? It was tedious and only worked half of the time and half of the time I just held the patient's hand until her eyes closed. (The next day I saw The Diving Bell and the Butterfly and realized we -my patient and I - had it pretty easy in the communication dept) Then my patient was moved to another wing of the CCU. It took about 10 people, one of 'em bagging her the whole time, several moving machines and me throwing her belongings into bags and adding labels. Once her med drawers and the med fridge were emptied she had five crammed-full paper sacks of meds. The night was over and I said goodbye, but her eyes were closed. The nurse I was working with - I never even caught her name. Is that weird? She was just all business and no chat - didn't even check up on my charting.

It was a good night to end on. I felt like: I am the nurse. And that's what I got this rotation. When I made mistakes that I should have known better than to make I said to my instructor, "well, the nurse said blah blah blah" and my instructor said, "*You* are the nurse." And with that I have only finals coming up. And you know what finals mean? Yes. Baking!

Nursing School Greatest Hits

I was going to entitle this Sunshine, Lollipops and Rainbows and Everything because I need a little too much happiness around here. I have two more weeks of school left before I finish my second level

(and, no, people tell me that you don't count the week you are currently enmeshed in EVEN if it is Monday (and it isn't Monday it's Tuesday), so this week counts even less. And you don't count finals week. Finals week is like a couple of hours of tests and lots and lots of procrastinating flecked w/ some studying, so, that really doesn't count either. Heck, I'm just going w/ the program here, folks I didn't make these rules.)

I've been such a grouch and I'm so sick and tired of nursing school and all that it means to be a student nurse so I've decided to talk about my favorite things from nursing school. Then I can say (in a I'm-Talking-Myself-Off-A-Ledge sorta way): "See, it's not *all* bad! Cheer up, li'l student nurse. Dust off those crappy care plans, buck that daily lack o' respect, forget your feeble skills and failing confidence and lookee here..."

1. How about those psych ward burritos? Not too bad for psych ward burritos. Every Monday night in my first rotation this year we - my adolescent psych ward buddy and I - got to serve and eat burritos w/ our anorexic and/or psychotic patients. Yum!

2. My peri-op instructor. The most patient instructor in the world. I would never, ever want to be an OR nurse, but it was my one of my favorite clinical rotations because of the instructor. And I loved doing a day in ICU during this rotation. I, pretty much, have never done so many skills in one shift AND my patient, in multiple organ failure and looking really grim (um, yeah, hard not to w/ multiple organ failure) survived to kidney punch one of my fellow students later in the week.

3. My geriatric rotation. Loved telemetry. How reassuring to see those P waves. How lovely when the QRS complexes march out so neatly. How gripping when they don't! How many PVCs do they allow around here, people?! And loved the patients with all of their pathologies and stories. One of my patients had had St Vitus' Dance when she was a kid. Who gets St Vitus' Dance these days? It was just rewarding on so many levels most of the time.

4. My night in Hem-Onc during pediatrics. My pt, a teenager, had a below-knee amputation (BKA) d/t (oh, sorry, the nurse-ese creeps in: that's "due to") cancer and hadn't left his room in a month. I got him down to the special "teen area" and asked him, "Oh, how many times have you been here." and he: "Not often. Uh, never. Uh, this is my first time." He made a t-shirt for his mom, painted it with glitter paint. It was beautiful and careful and I helped hold the stencil and he was proud of it. And then we went around the unit, he in his wheelchair. I decided to make him famous. I introduced him to everyone I knew: pretty much every nursing student and most of the nurses, some of them high-fiving the kid and everyone jovial and happy to see him. By our third time around the unit he was waving like a celebrity and grinning.

5. In L and D my instructor was hoping I'd see a c-section on my last day there. She sent me to a delivery room of a patient who'd been at 10 cm and pushing for the entire night, sure she'd be "sectioned". Half an hour later the patient delivered a little boy vaginally, occiput posterior (that's sunnyside up, or face up to my non-nurse-like readers...a tough way to deliver), while I held a warm cloth at her perineum. Half an hour later I was in the hallway with my nurse and there was a "code stork" announcement. That means someone is about to give birth in the ED or in some non-L and D area. I ran with two nurses to the ED, missed the pt who was screaming in the elevator on her way up to the unit. No one had any idea who this woman was and twenty minutes later, with me holding her leg, she delivered a little girl... occiput posterior! The midwife (same one for the previous delivery) was amazed. Two in a row in under an hour, both sunnyside up!

6. My current clinical group. I'm sick of nursing school, I'm sick of everyone. I'm grumpy as anything and, yet, they're just fabulous! We did a group project together and it went so smoothly and no one cried and we got good reviews and a good grade plus there was a funny video! World's. Loveliest. People.

7. And, finally, TWO WEEKS LEFT.

(those are some of my spring freesias. My garden is having an in-between moment right now (read: my neighbors hate me) eh heh heh. Wait'll I get my hands on those weeds. And how long are we waiting? Yep. TWO WEEKS!!!

Medical: They Like Me, They Really Like Me

I'm on to my medical rotation (my last) now. It's here at Hometown Hospital. My patient last night pretty much told me when I came to take his vitals and do an assessment, "I don't want you in my room." Um, OK, Am I going to assess you over the phone? By the end of the night this young man clasped one of my hands in both of his hands and was thanking me and asking if I'd be back the next night.

So, my patients like me. Is that a good thing? Is it like the teenager w/ the "cool mom". You know, the mom who doesn't give the kid a curfew and ignores the smell of pot seeping through the floorboards? Maybe I'm being too easy on my patients. Maybe I'm not pushing them to get out of bed often enough or I'm not encouraging them to do enough coughing and deep breathing or I'm bringing them too many graham crackers. Maybe I'm enjoying the "psychosocial" part of the assessment a little too much: "Oh, hm, do you still talk to your brother after that incident?... And you've been doing that job for how long?" Am I chatting?

God, do I love nursing for all the wrong reasons? I feel so lucky to be in this private universe of a person, to learn interesting things about them, to pick away at their lab values and wonder what is going on inside. It's a privilege to get past the taking of vital signs and to try to figure out what is really going on with someone and then to come up with solutions even if it just means moving a pillow. Maybe I like nursing because I'm nose-y and curious.

And then, at Hometown Hospital, half of my group's patients last night had substance abuse problems. Heck, my patient did. And, hm, half of the patients were in a lot of pain including mine. I'm told: Pain is what the patient says it is. And there are laws 'round these parts that we have to treat pain, but there's also a culture in nursing that suspects substance abusers of being "drug seekers". My nurse last night said "I don't want him to become addicted." (I'm taught: when used for pain treatment, very few people become addicted to narcotics) But, you know, substance abusers often have a lower tolerance for pain and maybe they're substance abusers in an effort to self-treat some kind of pain. Is it for me to judge? Well, yeah. My patient wasn't due for anything narcotic and when I offered him some-perhaps less "fun "-drug to help him out he said he didn't want it, so you gotta wonder. Yeah, he's probably a drug seeker, but he's probably in pain, too.

For my maternity rotation I had to follow up on a family after they'd gone home with their babe. I asked the new big sister (she's five) to draw a picture of her and her brother and that's it above. I love the big smile on the baby. It made my week and, phew, that was a tough week. I think a lot of my fellow Nursing School U students are going through similar breakdowns and burn out. I've heard lots of stories of staring off into space with the inability to do anything, other tales of going home and crying and I pass by tired looking familiar faces on campus where we both just barely pick up the chin for a "s'up" and scurry away with too many books in our backpacks and strategies for making it through the next four weeks in our heads. There's the Muscle Through It Strategy, The Countdowners, the I'm-Just-Going-To-Take-It-One-Day-At-A-Time folks...

Maternity Rotation

When I was pregnant w/ my daughter (my first kid) I made a quilt. It's a bunch of strips of fabric put together in the "log cabin" pattern. When I went into labor I was working on it and I had finished everything but half of the edge. Now, seven and 1/2 years later, you can see that it is pretty tattered (that's a very small section of the quilt there). We sleep under it every night and wash it in the washing machine and treat it like what it is: a blanket to keep us warm. It's special to me but, more importantly, it serves a function.
It does remind me of the hard work of being pregnant and giving birth, though, every time I look at it.

Ever since I decided to go to nursing school I've wanted to be a labor and delivery nurse. And I just finished my labor and delivery rotation and, I have to be honest, it was my least favorite rotation. I don't know if it was because I put so much pressure on myself to do a good job or because I'm really burned out right now or because I've had such high expectations for it, but I'm leaving this rotation feeling crappy about my abilities, feeling lousy about nursing in general and just really fed up w/ being a student. I've done what I can to embrace my student-y role: I've resigned myself to being humble and admitting that I know so little, I've polished my study habits until they are gleaming and precise, I put myself out there and ask questions that no one else wants to, I've taken on a student nurse gov't position, I've made a ton of friends and on and on. But I'm so tired now. I just want to be finished and get a job as a nurse and take care of my family.

I'm not ambitious anymore. I thought: I could be a midwife or an ob/gyn nurse practitioner. Ive always had a passion for women's health issues (ever since I took female physiology and gynecology - "gin fizz" - my first time in college) and I just adore working with children and families, but I'm not going to put up a fight for it. My maternity nursing instructor just wasn't impressed by me. She said, "You're just average. You're not the 'total package'. And you want to go into this field?" She had already approved me to do a preceptorship (that's like an internship for you non-nurse-y readers) in L & D, but I've heard if she doesn't fight for you that you could still not get it when it comes time to finding a preceptor to take you in the specialty. So now I've convinced myself that I'm just an average nurse and I would have hated to have an average nurse help to deliver my kids. It was just such a pivotal moment in my life: the birth of my kids. Now I just want to switch to the regular old, average nurse med-surg preceptorship so I can stop fretting about the whole thing. I'm just so tired. And I'm really feeling sorry for myself.

The M Room

"We call it the M Room," the security guard told me.

"What?"

"The M Room. We don't say morgue. In fact, most people don't know we have a morgue here."

And I'm thinking: It's a hospital, of course you have a morgue here. Doesn't that go without saying? I was waiting for the nurse I was working with to come back with a a warm blanket. There were a couple of steel doors that said: Head This End. And me and the security guard who decided to chat with me, at random, about the fella (well, I guess the former fellow) who had been in the M Room since January. It made me fidget: Head This End, all the gleamy doors and drawers, the warnings about the formaldehyde, the unclaimed body (I guess they cremate them after a while and scatter their ashes somewhere nice: so sez the security guard).

The nurse came back with a mountain of warm blankets and we had the patient's bar code sticker stuck to the bassinet that bothered the nurse so much. You've seen the regular newborn "bassinets", right? They are clear plastic, tall and on wheels. We couldn't find one and just had the one made out of wicker, with frilly fabric and a cute little sunshade all decorated with pink ribbon roses. The nurse said, "It makes people want to look inside and oogle." And that's the last thing we wanted. The security guard opened a metal door and inside was a box and out of the box came a package and the nurse read the numbers on the bar code and the numbers on the package and they matched up. She laid the package in the bassinet and opened it. He looked like a little old man: clear skin, very pink (not like an old man) no fat, long legs and arms and a calm little face. He was born at 23 weeks and died. He weighed a little over a pound and was only this big (I'm holding my hands about a foot apart). The nurse wrapped him in blankets to try and warm him up before we brought him to his mom who had been asking for him all morning. He was freezing cold and when we brought him to his mom she held him with a little smile and tears and I cried and my nurse cried. She's been doing this for years and still cried. "He was so cold," she said. "They should have left him with her."

I'm doing my maternity rotation.

Pleur-O-Vac

My pal, J., made my vision reality.. Last week I mentioned that pleurovac should be Pleur-O-Vac in gold fifties letters and - voila! - here it is!

So, my next rotation is Labor and Delivery: woo hoo! I'm so excited. Now I need to find some time this week to relax and enjoy my spring break. We just got back from a trip to the snow w/ the kids which was lovely, but now I'm sitting in this House O' Disaster (I'm afraid to put that into a font/ decade imagining!). Books from studying still open, notes scattered around, suitcases and backpacks strewn here and there creating an obstacle course from the front of the house to the back of the house. Every surface = sticky. Every bookshelf = books stacked this way and now that way interspersed w/ broken toy parts, dust, bottles of sunscreen, hair ties and paper clips (and I'm just describing one shelf here people).

So, when I was in labor w/ my kids I had to remember to try to relax and be calm in the moments between contractions. Those moments, for me, were pain free and (if I blurred my eyes a little) I didn't notice the chaos of the people in the room and the monitors and the fluorescent lights and tile floors. And, for me, those moments only lasted a very small amount of time because both my labors were super-fast. Spring break is short here. Just a few days left. I need to blur my eyes and find a way to relax amidst the chaos and between the test of my strength/will/ spirit that these quarters this second year of nursing school have turned out to be.

A baking project perhaps.....

All The Dummies Are Tamika

It was Tamika's 28th birthday recently so we combined her birthday w/ the end of the quarter and had a little party. Tamika is the mannequins in our skills lab. She's not just the one shown here, she's ALL of the mannequins (a class favorite is the clean cut fellow w/ the removable vagina). They all have the same name and birthday on their hospital id's. All of the doctors' orders are for Tamika. We've inserted Foley catheters on Tamika, changed her chest tube drainage unit (The Pleurovac which - hello - should be spelled Pleur-O-Vac in a gold fifties-style font), put in an NG (nasogastric) tube, cleaned her trach. We've also made fun of Tamika's hair, been a little too rough w/ her, talked about Tamika right in front of her (or him, Tamikas are both genders and sometimes at the same time), so it was time to throw the gal/fella a party.

Ah. Is it time for my nap? I need some bonbons and fiction STAT!

Oh, wait, I have to clean the house and run some errands. Somehow I don't get spring break from my, um, real life.

The Quarter Must End

This is my last week of the quarter, not counting finals week, which for me will be brief with a final on Monday and one on Tuesday and then = helloooooo large stack of fiction books, netflix movies and housecleaning projects combined w/ a trip to the snow w/ my little ones. I have some ambitious plans to get some stuff done combined w/ unambitious plans to do nothing. With less than two weeks for spring break (woohoo) I've got to get pretty busy not being busy so that I can get back to being way too busy.

I've been working my way backwards in my clinicals here. This past quarter I went from geriatrics (over 65) to pediatrics (18 and under - so I skipped a few decades...shrug...) and then next quarter I'll be doing maternity (followed by medical where I'll pick up those missed decades). I've loved working w/ kids and their parents. I can see myself working as a pediatric nurse. I had a patient who had her entire extended family in the room with her at one point. They were eating noodles and doing work on laptops and they all gathered around when a new IV needed to be started (nope, I learn that skill next quarter so I just assisted). It was almost festive and it certainly chaotic and that's what family is all about. You really get a sense of treating the whole family when you're dealing w/ kids and that's fabulous. I'll never be able to take care of a patient again without thinking about how their health and wellness is affected by the (usually not physically present) people gathered around and eating noodles.

Tomorrow is my last peds clinical day and I'm not on the floor w/The Bad Instructor. I'll be doing my observation day in oncology and hematological disorders: hemonc (pronounced "heem-onk"). I'll get back to you on that.

Every Easter when I was a kid, my mom would haul out the egg molds and we'd make sugar eggs topped by royal icing roses. Us kids would put little scenes inside. My brother would do some post-apocalyptic easter (probably) w/ pink-eyed bunnies being attacked by giant spiders under a steel grey sky (all topped, of course, by pastel royal icing roses). Then came the Easter where mom decided she'd make a few extra dollars by selling the sugar eggs. There's a picture of my mom somewhere looking sticky and exhausted piping roses out w/ a bunch of blurry eggs in the background. That was the last year we made eggs, though my sister reminded me that one year my sister and I made and sold eggs for some cheap wine/ comic book money. Somehow I don't remember that. Anyways, grandkids inspired my mom to bust out the dusty plastic molds and, well, that's my egg above.

My Unprofessional Enthusiasm

Nursing school has driven me so crazy I chopped off all of my hair w/ a dull knife. Um, I'm kidding, of course. I had my hair cut by a professional w/ sharp scissors. And, though nursing school *is* driving me crazy I have been planning to cut my hair for a while. And now I look like every other Woman Of A Certain Age in my town except that my clothes aren't as nice and I wear a backpack more often. But I love my hair short and I probably wont go back to long hair even though I think it looks rock 'n' roll when women w/ white or gray hair have long, tidy braids. Why haven't you short-haired people mentioned how comfortable and easy short hair is? I guess I always associated short hair w/ lots of gummy, gooey, stinky hair products and blow dryers and those creepy circular combs that would = painful and tedious extraction for a long-haired person. So, there's my before and after pics.

I'm so flustered and fed up w/ school right now I don't even want to talk about it w/ you. My peds instructor (you know, the mean and confused one) pulled me into her office during my own time and told me that I approach her too enthusiastically. Um, ok. I said, "Uh, I'll work on that. I'll try to approach you more...[ and here I sought the word that would express the opposite of enthusiastically and came up w/ boringly, disinterestedly, dully, cautiously, but settled on] calmly." And that wasn't good enough for her. She had to tell me that my enthusiasm is "unprofessional".

OK, I don't know what profession you're in, but tell me: How is enthusiasm unprofessional? And my profession, currently (in case I need to remind you) is Student. Enthusiasm is in my job description. So, my sister (do you have one of those - a sister? I *highly* recommend one for occasions such as these.) says to me: "Maybe she meant that you're rude and bossy." And then my sister (she's a teacher) got upset and demanded that I seek justice. So after I cried and questioned my chosen Student profession (been doing a lot of that lately) I did speak w/ the authorities and, it turns out, that was the right thing to do. And, let me say, I'm not telling you the whole story here because it's worse than the enthusiasm comment and I'm counting down the days until the end of this rotation which is sad as anything that is sad because I love peds if I blur my eyes and imagine the dream instructor who is not confused and mean.

I haven't been baking much. Finals week is coming up and that must mean that one of my kids' birthdays is coming up (because that's such a convenient time to bake a gigantic cake, find some good gifts and throw a party!) and when you combine birthdays and finals around the Student Nurse home the baking fun never ends!

Puffed Pancakes: My Undoing

It happened like this: As some of you may or may not know, I'm in nursing school. And I'm a mom. It's a bad combination (Do I *need* to say that?). My kids watch a little too much TV, because, even though I vowed to limit my studying to times when the kids are asleep (unless there was a dire and pressing deadline), it just hasn't been working out that way. And somehow (the chain of events is building here) the kids went from PBS kids to the hardcore stuff of Nick Jr and Cartoon Network and now we have TV commercials which really do eat into their brains in a bad way... The kids saw a commercial for some sort of now-only-19.95!!! puffed pancake pan. Now mix in an overly-indulgent grandma (go'bless her) and SUDDENLY there's a puffed pancake pan waiting for me when I got home from school. So, I figured: I make pancakes ALL THE TIME. We have pancakes for breakfast, lunch AND dinner 'round these parts. I can make pancakes with nothing more than a notion and a few ingredients and I don't even need the *right* ingredients: I'll improvise.

No. These things took me two hours. I was flipping 'em with skewers, burning my fingers on molten jam, cursing the TV, grandma, the puffed pancake pan, my husband. The first two batches came out burnt. The next two were anemic and probably unsafe for human consumption (those were the ones I ate) and then - voila! - got it. I serve them to the kids and my son (go'bless him) said, "Ew. These are yucky." Great. So I says to my husband, I says: "I need to quit nursing school." And he says (go'bless him): "Maybe you should quit exotic baking projects instead." Exotic? They're pancakes!

And, well, here's the fun part of the story. I have my pediatric midterm tomorrow and am I studying? No. I'm making puffed pancakes and writing in my blog. See, that's fun, right? And tomorrow is shaping into a 14 hour day (Now w/ midterm!). And tonight is shaping into a very long night. Pediatrics is hard. It's a whole new barrel of monkeys and that = lots of reading, and an instructor who is double-dipping us on the lectures (we get a handful in person and, additionally, online lectures that go on and on and on). And the instructor is often wrong (eg. "Hotdogs should be served to infants in cylinders." Which is *more* wrong: hot dogs served to infants? Or hot dogs served in the ultimate choking hazard form?) and she's often mean (she lectured us for 15 minutes on the first day about how our papers are always late: um, we haven't turned in any papers) and she's almost always confused (see other examples).

Wheeeeeeeeeee!

Peds

Shouldn't it be "Pedes" or "Peeds"? I always read Peds like heads, but anyways that's the rotation I'm doing now. I'm working my way up the ages. I've worked w/ a baby w/ a form of spina bifida and, tonight, a toddler w/ meningitis. The kids have been pretty unhappy to see me coming because they see medical person and remember the shots and the IV insertions and having to get out of mom's arms and be prodded. And the little one tonight was in isolation so here I was this lemon-yellow-paper-gown coated student nurse w/ a mask and gloves. I was smiling and talking, but my little patient couldn't tell past the mask. I hit on the idea of giving her a popsicle and brought it in without the mask: see? here I am: friendly gal w/ popsicle.

(And who knew that popsicle was a brand name? What do you call them? If I spell it w/ TM will I stop getting the you-spelled-it-wrong-underlining?)

And it worked for a while until the little one's IV got pulled out by a tripping-over-it family member. And it took two nurses two tries to re-establish the IV and it was heartening how much the little one cried and screamed -to be honest - because that's what a two-year-old should be doing. But all my popsicle-y good will went out w/ old dressing there and I still had to do a neuro check and vital signs. So, I'm not making many friends in Peeds. The family tonight was so sweet, though. They thanked me for my kindness and it made me want to cry: this sweet family and their tiny one so sick and unable to walk but still fighting like a two-year-old.

I haven't been posting much. I've barely been able to look up every now and again: this has been a hard quarter and I've only wanted to quit once/week, but there's something heartening about working peeds. I'm tired so maybe I can't explain it. I guess there's so much possibility w/ kids even when it's hopeless and maybe doing good care (cuz that's what I'm doing or aspiring to do, right?) can make a big difference even if it's only for a little while. And I guess the hard part is that everyone is so scared: the kid, the family, um, me.

OK. This is The Best Chocolate Cake recipe EVER. It's from the new Alice Waters book, The Art of Simple Food.

Chocolate Cake:

4 ounces unsweetened chocolate, chopped
2 cups cake flour
2 tsp baking soda
1/2 tsp salt
6 tablespoons cocoa powder
Stick of butter (8 Tbsp), softened
2 1/2 cups brown sugar
2 tsp vanilla extract
3 eggs, room temperature (put 'em in a bowl of warm water)
1/2 cup buttermilk, room temperature (I heated in the microwave for 10 seconds)
1 1/4 cups boiling water

Preheat oven to 350 F.

Butter a 9 inch cake pan (oops, I just noticed that it says one cake pan. I've been using two eight inch cake pans and two ramekins for a cook's treat! Yummy all around.) and line the bottom w/ parchment paper. Butter the parchment and dust the pan w/ a little cocoa powder. Shake out the excess.

Melt the chocolate. Set aside.

Sift the dry ingredients together.

Cream butter in mixer. Add and mix until fluffy the brown sugar and vanilla.

Add the eggs one at a time.

Stir in melted chocolate. Add half the dry ingredients and combine. Add the buttermilk and the rest of the dry ingredients and combine. Add the boiling water on low speed (um, careful!) until just incorporated.

Pour batter into pan or pans and bake for 30 or 35 minutes if more than one pan is used and for 45 minutes if you use One Big Pan. You know the drill: the toothpick will come out clean when it's done.

Cool completely on a wire rack in the pan. You may need to run a knife around the edge to loosen the cake. Remove the parchment paper and cool completely before frosting w/ the frosting of your choice.

It's really good chocolate cake!

Atrial Flooder

I'm in the midst of my geriatric rotation. We're on a telemetry floor and so there's lots of talk floating around about how to read the EKGs: Is it a second degree block or is that atrial flutter (I was really tired during report and I wrote "atrial flooder" in my notes.)? Could it be a winky-bock? (No, that's not how it's spelled, but I like it better that way) Is that two P-waves? I can't keep it all straight and all of these things might be the same thing. I was just happy to be able to point to an EKG print out and describe the mess of lines at one part as "artifact" (that's stuff that is not meaningful and happens when a patient is wiggling around excessively, say). When I'm bored I go hang out w/ the EKG tech and ask 'em questions:

( "So, uh, do you get hypnotized watching all of these patterns?" And this one got a really good answer and I suddenly really liked the fellow and my respect for EKG techs multiplied by, like, 150. "No. Because I put a lot of the leads on the patients myself and I know what heart meds they're on, and I know w/ Mrs. K. here that when her heart rate drops to 35 it's OK unless it stays at 35 and I know that 110 is a normal rate for Mr. H. over here." In other words, he was connecting these squiggly green lines on the screen w/ the patients behind them and he was paying attention.)

I hung out and got to be "Nurse Leader" tonight w/ a fellow student. That meant, essentially, that we got to help other students and nurses on the floor w/ their patients, but it mostly meant that we spent a lot of time looking stuff up using the other student's HUGE number of resources. She had books; some flippy ones that were in her pockets and some bigger ones that were in her backpack. Most of the books had handy and colorful tabs on the side labeled as "IV" "pediatrics" "procedures" "emergency" and other handy things. She had a palm device (um, a Palm device maybe) w/ a poke-y stick that she tickety-ticked w/ and all kinds of useful info came up: Yes, Haldol can cause neuroleptic malignant syndrome. Here's a third degree heart block EKG, right here, see? SHUT UP: cranberry juice can interfere w/ coumadin? It made me aware that I'm under-info-packed out there on the floor. I have a barely-used flippy RNotes crammed into my backpack and sometimes I'll bring my drug book.

It was a good night, though. Monday was a hard night. After I took care of my patient, went to dinner and came back her family told me they didn't want students taking care of their family member anymore. Um, OK. They wanted someone more efficient, apparently. Sigh. I went home and fretted about all of the things a student nurse, mom and all around busy person frets about and cried and now I'm feeling better, but mostly it's because it's a three day weekend and I might have time to relax and clean the house and do some extra-curricular reading on heart arrhythmias. See, I know how to have a good time!

Wheeeeeeee! Care Plans!

No. That's not one of my cakes. There's something really odd about brown roses, but I will admit that I had the cake commissioned from Costco and the sentiment is what counts there. Of course, this was one of the cakes from our holiday party so the quarter is not now over. It was over then. Now I'm up late tippity typing away on a care plan. Somehow -and I don't know how- I've never done a care plan for someone who's had a myocardial infarction (that's a heart attack in common vernacular). I've danced around MI: I've done CHF. I've done atrial fibrillation. And who of my patient's hasn't had kidney failure related to high blood pressure? Arrythmias? check. Dysrythmias? check. OK: quit paying attention; they're the same thing. I know.

Here's the thing. I like doing care plans. Sorta. I like having the info about the disease all tidily written up. I like to have a list of the signs and symptoms. I'm a fan of the knowledge of complications and nursing interventions. I *really* want to know what the side effects of my pateint's medications are. It's good stuff and I go into my patient's room and am as semi-on-top of what's going on as a nursing student can be. So why are we nursing students always complaining about these things, these care plans? We-e-e-e-e-llllllll...A big part of it for me and perhaps you, my fellow nursing students, is that you have to spend hours and hours hunched typing at a computer w/ half of your nursing texts splayed in your lap, on the table behind you, on the window seat next to you and w/at least three web pages open from drug manufacturers and disease support group sites and all. It's a logistical nightmare and then it's also a formatting nightmare. I've always felt halfway computer savvy, but I'm constantly changing font sizes, adding or removing columns from tables and trying to make text fit where it doesn't want to. These monster crazy-quilt formatted things crash my computer every other sentence so I've become a nervous wreck w/ the CTRL-S. It's my care-plan-doin' nervous tic. And then there's all the "See Attached's" that I'll have to staple on later. And this is just the pre-care plan fun. The care plan itself with the activities and the analysis is where my fiction-writing skills need some special honing. I have to have goals and they have to be measurable and they have to be run through this systems theory machine created by past instructors at Nursing School U *and* it has to make sense and a lot of times I'm in there with my patient just trying to address the three million things that pop up in their day. Ooops. Plan. What plan? It only works out about half the time and I'm being pretty generous there. So. Um. That's a problem. Hurray! The quarter's over! ... in 10 more weeks.

Back Atcha

It's back to school on Monday. *sigh* I barely had time to slouch horizontally on the floor, drool and read fiction whilst watching bad television and eating chocolate "bon bons" (those'd be from the 10 pound bag of Hershey's kisses left over from the holiday party we (the Nursing Student-y Organization that I'm a part of) threw for the nursing students and staff). I was barely able to take the kids to holiday-flavored events and locations and now I have to go back. I spent most of the break coping w/ my badly-removed tooth and the perplexing and constant issue of Toy Storage that always comes to a head 'round about now.

This quarter I'm doing my geriatric and my pediatric rotations. Most of my clinicals have been pretty geriatric, actually. Everyone in the hospital these days is elderly, it seems. And a lot of 'em smoke, or are obese or are drinkers. I'm not being cynical. These are just observations. Someone back me up here. I'm actually looking forward to going back despite the list of things I didn't do at home, the things I didn't bake and the parks I didn't take the kids to. *sigh*

Pictured above is the ice cream sundae I made for Christmas. The ice cream is from one of the best ice cream places in a town of good ice cream places. Yes, it's mint ice cream and the color comes from ground up mint leaves. It's topped w/ hot fudge (recipe follows) and whipped cream and pulverized candy cane because -darnit- if it's not sprinkled w/ pulverized candy canes in December it might not be worth dipping a spoon into!

Hot Fudge Sauce

1 cup heavy cream
1/2 cup corn syrup (hey, can any of you find corn syrup *w/out* added vanilla?sheesh!)
9 ounces fine quality bittersweet chocolate, finely chopped
1/3 cup dark brown sugar
good pinch of salt
2 Tbsp butter (skip adding salt if using salted butter, but you wouldn't use salted butter would you?)
1 tsp vanilla

Bring cream, corn syrup, salt and chocolate to a simmer in a heavy saucepan over low to medium heat. Once it's bubbling, turn down the heat and cook for five minutes. Stir it half as often as you think you should. Remove from heat and add butter and vanilla. Cool to warm before serving. You can refrigerate it and heat a little bit up until shiny before serving.

Note: a lot of recipes will lecture you about "breaking " your chocolate sauce. This is when the solids and the oil separate. Apparently, these grumpy bakers believe this will lead to a grainy sauce. Every time I make a chocolate sauce it breaks and I just cool it in the fridge and whisk whisk whisk until it comes together and I have never had a problem with poor texture...so there!