Wednesday, October 29, 2008

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.

Wednesday, October 15, 2008

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!

Wednesday, October 08, 2008

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.

Wednesday, October 01, 2008

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.