Molly, RN

I passed! I have my license in my wallet and an oddly-worded and, yet, official-looking (with the state seal and all!) document taped to the inside of my front door that says, "To Whom These Presents Shall Come, Greetings" (huh?) and my full name which is something like StudentNurse Molly and proclaiming for all to see that I am a Registered Nurse. And, now, anticlimactically and after four years of school and hard work, I need to find a job. I'd hire me without hesitation and I'm picky. Somehow I'm not too worried despite the fact that I'm told there are no jobs for new grad nurses around here. I may scrap the blog and start up a new one. Maybe I can use this blog to relay my tales of woe in the job hunt. Well, I'll get back to you...

Yours,

StudentNurse Molly, RN

The Horrible, Horrible Wait

Two years ago some "level III" nursing students came to our theory class along with some level II students and some actual nurses who had actually graduated from the same program at some point in the past. The level III students were there to tell us about their experience with the NCLEX and I remember one guy talking about taking BART and walking to the test center and that he thought, "And here were regular people going to work and doing regular people things..." in that he was not doing something regular or doing something routine.

Well, that stuck with me and I was thinking about it on Wednesday, the day before my test. "I'll be fine. I'm calm. Everything is fine. It's just a test," I was thinking. But the next day I sat on BART listening to my littlest iPod and I knew exactly what that guy meant two years ago. I could barely BREATHE and here were people going on with their day. I got off BART and I went into the highrise building The Test was being held in and I ran into a fellow Nursing School U student and she looked pale and shake-y and weary. She had taken The Test that morning and was just leaving.

I went up the elevator and I got my picture taken and my fingerprint scanned and I put my belongings (except my driver's license) in a locker (I picked #5. It's not a lucky number, it's just my favorite number) and I pocketed the key which was attached to a floppy rubber strip. The online test instructions said "no coats", but they let me keep my striped hoody. I was asked several times if I had anything aside from the key and my license in my pockets. I lied, "No. Nothing." I had a little lavender sprig in my back pocket. I had picked it from my garden on the way out the door. I had to smash the same finger onto another fingerprint scanner and then was led into the room. The test hostess (uh, what else could I call her?) sat me at a computer and logged me in. There on the screen was my picture, the one they'd just taken, the one with a big dumb grin...

And I flew throught the questions. I know this drug, I know this drug and I couldn't place it and then it came up AGAIN: that same drug. And then there was a whole chain of "select all that apply" and "who would you see first" kind of questions. And a bunch of peds questions. I swear to you, this test found every weak spot I have and shone a light on it and I got to question 75 and waited and waited to click "Next" because I was scared the test would continue and terrified the test would shut off and there was a million-year pause and the screen went blue and that was it. And I started crying really quietly and then the test hostess was there to take me away and I got to swipe *another* fingerprint (weird- I was being filmed and recorded- how could someone have taken my place, but, ok, fair enough). And then I recovered my belongings from locker 5 and I was down the hall and into the elevator and out on the street devastated and sure I had failed.

So, now I wait. Did I pass? I can only think of all of the questions I got wrong. And this test is really meant to screw with you that way. If you fail you get about half of the questions wrong. If you *pass* you get about half of the questions wrong it's just that the questions are harder. Apparently, if you get "recall" type of questions you're going down. They're the easy questions. So now I'm thinking, was that a "recall" question. At one point I got asked what a drug is meant to treat...And that was late in the test. That's a recall question. So, I failed. But am I that crappy a test taker and that lousy a nurse that I would definitively fail at *75* questions? (Non-nurse-y types: the test gets to 75 questions and, if it has been determined with 95% certainty that you have failed, the test shuts down. Likewise, if it has been determined with 95% certainty that you've passed the test shuts down). So, I must have passed. And people say if you feel like you failed and like your entire spirit has been crushed from your body and you just want to sit in a dark corner hugging your knees and rocking while humming childhood lullabies then, well, for sure you passed. So there you have it.

And now I wait.

Obligatory NCLEX Freak Out Post

Yeah, sorry. I know you read a couple of nursing student/ nurse-y type blogs and so you know the formula: Student Nurse signs up for NCLEX and writes the I'm-Freaking-Out-Here-People posting. I'm taking my boards (NCLEX) this Thursday, but I'm oddly calm. Have I been studying? Yeah, a bit. I've probably answered close to 3000 questions since September (some friends say, oh, those are the WRONG kind of questions: only *name of price-y test prep center* actually gives questions that are like the NCLEX), I've read through a comprehensive review book once, but mostly in a kind of space-y, half paying attention way. And I didn't pay a buncha dosh for a dull prep course. I took an ACLS class instead plus I'm planning a meal at my favorite spendy restaurant. Look, if it's not pretty, useful or yummy I'm not spending money on it.

One thing: I have noticed that lots of tests and meds harmlessly turn urine some non-urine color and I'm supposed to, as a nurse, be able to say to my "client" (yeah, yeah, I know, that's how my main prep book refers to patients) "This is a harmless and expected side effect of this medication/ procedure." But, right now I can't tell you what a normal bilirubin level is and I'm supposed to have that burned onto the interior of my eyeballs by now, right? I'm fixating on all the wrong stuff and I'm also doing dishes and celebrating holidays and family birthdays AS IF I WAS LEADING A NORMAL LIFE.

I did splendidly on a predictor test ("Oh, but that means nothing," those friends say). I'm getting anywhere from 10 to 40% of my questions wrong, but I'm calm. I just want to do it like a bank robber: Get In, Get Out, No One Gets Hurt. I'm ready for my test and maybe a large part of it is that I am ready to be done with it. And if my calm and cocky and cavalier attitude should come back to laugh in my face should I fail, then, oops.

I'm sure I'll be posting with the formulaic I'm-Sweating-And-Anxious-Did-I-Pass-Did-I-Fail posting in the interim period between taking the test and getting my results.

That's my garden in late February before it's tulip-y splendor really peaked.

Needle Stick, Limbo and Stuff

That just about sums it up. All done. The End. I wish I could just re-title the next month's worth of blog as "Interim Permittee", but now the name reaches back to the beginning. It will change again because everything is in flux even as I sit here doing nothing waiting to learn when I can take the boards. Here I am in limbo; not a student nurse, not a Student Nurse, not a nurse. I'm an Interim Permittee. That's a person who occupies the time and space between finishing school and passing the boards. So my last week of nursing school went something like this:

No one could start the IV on the former heroin addict (I was able to draw blood from the IV start, but couldn't thread the catheter) and so an anesthesiologist was called in and s/he re-capped the needle on the lidocaine after using it on the pt (Double bad practice = re-using the needle in case another site needs to be used plus re-capping the needle. Hey, all the cool kids do it. Heck, I had done both earlier.). The needle curled under and went right through the cap and into the anesthesiologist's finger. Blood in the finger of the glove: it was a really bad stick. I had to tell the Dr the pt had a blood-borne disease.

So, kids, the lesson here is Don't Re-Cap Your Needles. Yeah, I know you just learned it in school, too, and you said to yourself at the time, "Why would I ever re-cap a needle?", but it's common practice and it's a major cause of needlesticks. I saw it happen.

My very last day I picked a pt who was at 9 cm thinking that we'd have a baby and she stayed at 9 all night and then came the ugly late decels and the trip down the hall to the OR where I said goodbye to the pt right after shaving her abdomen. Who knows how the story ended. And with that I walked out of the hospital and into the night and out of nursing school without so much as a round of applause or a handshake or... well, anything. I was just finished.

The Velamentous Insertion

This is not really about a velamentous insertion. I just like the sound of the words and I saw an umbilical cord recently that had one (fine outcome; velamentariness not discovered until the placenta was delivered). You can read all about cord troubles here.

Last night, with two patients, one an antepartum patient and one a patient being induced for a low amount of amniotic fluid, I ran into my patients (that'd be mom and baby) and FOB (father of baby) from the night before. They were in the hallway in front of their labor room, babe in plastic wheelie bassinet and mom in double hospital gowns, taking pictures. They called me over and wanted a picture with their cutest little one. I picked the little swaddled fella up and I'm sure I had the world's biggest smile in the picture; mom had scooted next to me, and also had a huge smile.

I love L and D. It's the drama, the blood (it looks like the scene of a crime sometimes after a birth), the family hovering and worried then ecstatic with tears flowing, the cute babies (and even the not so cute ones), being on the verge of life (and death; that happens, too), the tedium of a long labor, the terror of a fast one, the fetal monitor with that quick as nervous baby heart beat in the background when you're starting the IV

which, by the way, I finally did successfully. Yes, last night. There was something about last night wherein everything seemed to come together. I did more things right than wrong, I had patients who deserve a framed picture on the wall in some sort of patient-of-the-month montage and then the happy family from the previous night so excited for me to be in a picture holding their baby and so sweet and thanking me.

The patient actually *fell asleep* while I was starting the IV. I'm all about using a little intradermal lidocaine bleb now! I told her, "This was the easiest IV I've ever started!" which, when translated meant, "This was my first successful IV!"

I just feel like The Nurse now. Somehow. And, more than that, I feel like The L and D Nurse. I have only two weeks of nursing school left and then, who knows. The word on the street is that there are no jobs for new nurses. I'm not going to worry about it. Things will work out, but,

Here's My Question For You:

Should I change the name of my blog when I'm no longer a student?

I'd like some opinions. I'd like to call it The Velamentous Insertion, but then my readership would, likely, drop from three to one (Thanks mom for your loyal readership!).

That is a portrait of me drawn by my daughter. I'm wearing my scrubs (as you can see). No. I don't actually have problems with my liver.

Good And Bad

The ob used the amnio-hook (looks like a thin knitting needle) to break the pt's water. Sometimes when this happens the cord can suddenly get squished in the wrong way. No one said the word "prolapse", but one minute later that babe's heart rate plunged to 60 and stayed there one minute, two minutes, OB says, "I can only take one more minute of this," three minutes and suddenly there's a crowd in the room, the sodium citrate is in my preceptor's hands and being downed by the pt who is already wheeled out the door in her bed and to the OR for the emergency c-section. Babe's heart rate comes up a bit in the OR so the pt lucked out and got a spinal rather than being put under.

Babe comes out and the cord is around the neck, under the arm, around the abdomen, around the leg. It looks like this little one had been tied up in umbilical cord and the wee one was big and green-tinted from the mec but cries the instant s/he hits mama's tummy and then doesn't stop crying, thank goodness.

There are times when a c-section is the best of western medicine. It's amazing how quickly a baby can be removed via surgery and, when the baby crashes like this one did (we'll talk about induction in a sec here) then we can all sing the praises of technology and advances in medicine. But that's the tough thing, too. C-sections represent the worst in western medicine, too. "Failure to progress"? What does that mean? Clocks are ticking. Women are supposed to open their cervices in labor at the rate of 1 cm/ hour. Are you kidding?

And even at the groovy, pro-women and birth-is-a-positive thing hospital I'm precepting at, induced labors happen for some questionable reasons. "Cervidil was placed." I see that up on the board and sometimes it's just because the ob wants all of his/her pts to deliver when the ob is going to be on for the night. Or they are 40 weeks and a day and, hence, "post-dates". So, they get cervidil or cytotec in hopes of forcing the cervix to "ripen" and then we "pit" 'em (give them pitocin via IV at gradually increasing rates). Then clocks are really ticking, especially with ruptured membranes (broken bag of waters). Sometimes things don't go well when you try to force the body to do what it is not ready to do. Pitocin makes labor much more intense and painful, so then the pt gets an epidural and a foley catheter and a blood pressure cuff constantly inflating on the arm. And lots of obs pit all of their pts just to move things along.

But, with my pt with the nuchal cord and the green babe, that c-section was going to happen at some point by the looks of things. It was good that the ob was in the room and ready to go even if it was stupid to AROM (artificial rupture of membranes) the pt in very early labor.

So, I'm graduating in three weeks and there are no jobs for new nurses in my neck of the woods. We're all being told to move out of state or at least to places no one wants to live to get a job. So, I'll go from being Student Nurse to Nurse in Limbo. It's frustrating and discouraging and I've stopped studing for the NCLEX because I feel...defeated, exhausted, and, well, what's the point?

The cupcakes! You've got to try these. Use my usual recipe for chocolate cupcakes and then this here recipe for cinnamon-chocolate frosting and yum! I left out a tsp of the cinnamon and dusted the cupcakes wih it and added red hots. Next time I'll add more chocolate to the frosting.

NCLEX tip #3: Memorize your fundal heights. Geez, I ALWAYS get this wrong and it shows up in so many px (practice) tests: "click on the image at the spot the fundus should be at 23 weeks gestation/ 2 days postpartum" (whichever) and I could tell ya, I could feel it on a pt, but on paper/ a computer screen I never click the right spot.

IV Starts L and D Style

I've failed at two of my two attempted IV starts in the past week. My preceptor said to me, "It doesn't get any better than this. In labor and delivery women have big, fat juicy veins." That made me think of what my son calls blood vessels: blood pipes. That's a much more accurate word for 'em, I think. When I think "vessel" I think earthenware, handles, a spout. Maybe a gravy boat. A vase, but one with useless little ear-like handles up at the neck, you know the style. Maybe blood tubes, but Tube Week has come and gone here on StudentNurse. Yes, I was sad you missed it, too.

But I think it *does* get better than this. First, I have to use lidocaine. Have you done that yet? You use an insulin syringe and make a little lidocainy bleb just under the skin and then wheeeeee! that vein in obscured or pushed to the side and suddenly you're going nowhere fast with that next fat needle. My precpeptor allowed me to go without the lidocaine, but I decided I would give my patient a choice (so, you'll be poked TWICE with TWO needles, but it might make the second stick hurt a wee bit less. What's it going to be gov'nor?) And, good afternoon, we're going 18 gauge here people. "What if they need blood products?" It's not like the needle is as fat as my pinky, but that monster obliterates those fragile hand veins. Gotta go for the forearm. You can't see 'em, you may not be able to feel 'em (especially with that bleb), but you know they're there.

So, I've gotten into the vein (check out the flashback in that hub!) and I've gotten the needle into the right spot, but then chickened out on the digging around for the vein because my patients were squirming so much (yeah, so much for that lidocaine). My precpetor was able to get it in with my start by pulling back a little and going a little deeper. And then blood comes kasplorching out on the chux ('cause remember it's that big fat needle in a big fat pregnant vein in that blood pipe-y forearm neighborhood...) and then, the final L and D challenge, you have to risk the whole IV start to draw blood because we don't want to stick these laboring women more than is necessary. So, I apply the Vac-U-Tainer (JC, how about some logo artwork?) and (with the first gal) popped four tubes in and wiggled four tubes out.

Oh yeah, L and D IV starts are a dream. Next time: no lidocaine for you!

So, I go to "work" and I'm all preening in the mirror beforehand. How do I look? And why do I care? Have you ever been in the nurses lounge on an L and D floor? Take a look around. Hair is neat, earrings and necklaces are worn, jaunty sweaters are thrown over festive scrubs. What's up? I have been in several photos now: Here's baby's first bath. Look at baby getting his first little beanie. Baby's first hepatitis B vaccine: aw, cute! And some of the posed ones: Here's our whole birth team.

But don't look at the shoes in L and D. My preceptor has some tennies with mesh and there's a blood stain on them. One of the midwives has a pair of dark blue Danskos that are really nasty looking. I notice lately she's been wearing shoe covers. I have my bright-white-from-last-year's-dark-days -of -all -white shoes just waiting to be oozed or kasplorched on. On average, a woman loses 500 ml of blood during delivery. That's two cups. And, name that bodily fluid, many of them make an appearance during labor and delivery.

NCLEX tip #2: When in doubt, assess.

PM Shift

Working the PM shift...wait, I can't call it "working" can I? I don't know what else to call what I'm doing (precepting the PM shift, doing the PM shift, riding the PM shift, studenting the PM shift?), so, let's just say "working" until someone comes up with a better word...

Working the PM shift is making me a somewhat lonely person. I can't call most of my friends when I get home (most are doing days, some are doing nights so one is reluctant to call those night-shifters at all because they're probably sleeping at noon in a room with tinfoil taped to the windows or something). The kids are asleep and Mr StudentNurse is grouchy waiting up for me. I drop the kids off at school in the morning and say, "See you tomorrow." Ouch. Have I mentioned that one of the reasons I went into nursing is that it's a good Mom Job? Have I mentioned that nusing student is not at all a good Mom Job? I do like working the weekends, though, I get to hang out with the kids in the morning (Well, I'm sleeping past 10 AM on the weekends. Can you blame me?) and afternoon and I get to kiss them goodnight at 2:30 (oops, sorry at 1430. That was a potential med error..) instead of at 0800. Sure, the hubby is grumpy when I get home, but it's a Saturday night, right? He can take it.

Did I already tell you how much I LOVE labor and delivery? I am going to cry and cry (and cry) when my preceptorship is over. My second patient tonight was in there with her family. She had on pajama bottoms and wanted "female providers only" (she's Muslim) and her mom was in there rolling on her back with a wooden rolling pin. She was a tiny little thing with an out-sized tummy and even at 8 cm and with no pain meds on board would politely say, "I'm having a contraction now," and breathe quietly. My preceptor let me take care of her with minimal help and, at first (with intermittent monitoring) it took me FOREVER to find that babe's heartrate, but by the end of the night I knew EXACTLY in what neighborhood I could pick up that hummingbird-fast heartbeat. I actually felt...competent.

Doesn't that picture look like it was taken with an electron microscrope? It's actually a close-up of that funky, swirly cauliflower that probably has a name but it's 0130 and I can't come up with anything anymore.

Name That Tube

There's a large aspect of nursing that deals with tubes. You're either putting in a tube, taking out a tube, putting something into a tube (or, well, yes) taking something out of a tube or you're checking tubes.

So, my preceptor tells me, "We're going in to see the patient and I want you to check her tubes." Got it. Check the tubes. I check out her iv site and all the tubes stemming from it(lactated ringer's, Pitocin. ampicillin) I assess the Foley catheter and, hm, what else. Right. Her IUPC (intrauterine pressure catheter to measure uterine contractions in millimeters of mercury). I brush my hands together in that "I'm done and I'm washing my hands of it" gesture and then my preceptor says, "Don't forget the epidural." *Another* tube (connected to a locked plastic box. Oh what fun it would be for some, I suppose to have that bag o' bupivacaine and fentanyl). And this for a relatively normal delivery. (Yeah. We'll talk about that whole can of monkeys later) Are you keeping count?

One of the fun activities I get to do is to d/c ("discontinue" for you non-nurse-y types) the epidural catheter. You take off all the tape which runs all the way from shoulder to waist and from left to right side. That tape is almost embedded in the poor woman's skin and, after labor, pretty much I want to baby the new mom, but instead I'm removing the hair from her back: ouch. And then taking the epidural catheter itself out is unsettling. I can d/c a nasogastric tube, I can d/c an iv, but something about pulling that thin (thinner than a pencil lead) tube out of someone's back (pull down, not up or out)... It doesn't give easily, there's resistance and it's coming from the spine. Tip: yes, that's it: tip. Check for the tip (it's black) because it could get left behind (I've heard tales of this occurring, "Why just last week..." began one).

So, I'm motoring right along in studying for the NCLEX. I'm on page 228 (almost done: just 1000 + more pages to go!) and I'm about finished with the chapter called Tubes! (It's really called something like Caring For The Patient With Tubes, but I like my title better. It's more festive and jazzy). My favorite tubes are the GI tubes. And by "favorite", I mean that I like the names: Lavocuator (the infamous pump-your-stomach tube), the Salem Sump, and the lovely Sengstaken-Blakemore tube (I think the Sengstaken-Blakemores used to live next door to me) for all your esophageal hemorrhage needs (well, many of those needs, anywho). And you gotta love the respiratory tubes. Cuffed or fenstrated, single or double lumen: you want 'em, I need to know 'em to pass my boards! Do not get me started on chest tubes. Should it bubble? Is it ebbing and neaping like the tides? A possibly deadly leak in the system or normal functioning of the equipment? I remember in our skills lab, the instructor was so confused she said, "Read the manufacturer's instructions."

Another unsettling thing. In Anatomy and Physiology (geez, years ago now) I learned that we're all tubes. The center part of our tube runs from our mouth to our anus. I don't know why being a tube bothers me, but it does so I'm going to move on now.

NCLEX tip number one: If the question asks you which symptom requires a call to the MD and "stridor" is one of the answers you should pick it.

That's one of our inaugural cupcakes. My mom made the cupcakes, I did the frosting and the kids sorted out and sprinkled the red and blue M & M's.

I Hope This Doesn't Discourage You

"You could go another lifetime and not see something like this," said the anesthesiologist while he had one hand squeezing a bulb on the tubing hustling the packed red blood cells to my patient. I hope that I could go six or seven lifetimes and not see something like that.

My patient, baby's heart rate isn't recovering like it should, is taken to the OR for a "double set-up" (they'd try to assist the baby out old school and, failing that, section her) and things went further south and the patient is prepped quick, quick as a bunny. The docs cut into her uterus and a fountain of meconium (fetal poop = not a good thing) -filled fluid fountains up a foot into the air and splashes everywhere. Babe gets a 2 on baby's first test (Apgars: this is out of 10 points. Two= not a good thing.) Everyone slaps the ob on the back: good call, nice work and baby is intubated, but only briefly, and perks right up and gives a hearty cry and, phew.

And then it's time to close and I get the student-worthy job of counting and bagging the bloody gauze ("laps") (remember the Bag-It! I previously mentioned?). The last c-section we filled up maybe four or five Bag-Its, so even I, Student Nurse, started sensing trouble when I was running out of places to hang the bags. There were more and more bloody laps and a doctor came in, "I heard her INR is 3." (and for you lab value fans the d-dimer was over 10,000: what's your diagnosis?) And the c-section turns hysterectomy and there's more blood than you could think was possible. It's spilling out everywhere, there's bloody footprints from blood-soaked shoe coverings. Another doctor is added, more nurses appear. I heard that every stitch opened up a new place for blood to ooze from.

Half of all cases of DIC (disseminated intravascular coagulation) are pregnancy-related. What happens, see, is that via some problem (trauma, infection, auto-immune dysfuntion, etc.) a clotting cascade occurs and teeny clots establish throughout the body and the body is really cool and sends out stuff to break up the clots (d-dimer is a by-product of the break-up of clots) and, phew, there was so much clotting that occurred the body is not able to muster up all that it needs to clot anymore. And, well, you need those clots to stop bleeding and you introduce say, surgery, and you get what happened on my third night out as a preceptee: scared.

I couldn't sleep. I went home and looked up everything I could on DIC. Stupid Wikipedia (yeah, sorry, I did look at my med-surge book first, though) said that DIC is sometimes nicknamed Death Is Coming.

But, the next night I visited the pt in the ICU (so, let you get this straight: I'm precepting in L and D... I had no idea I'd be hanging out in the ICU). She's groggy, but looks pretty good. I hold her hand (I really wanted to hug her I was so glad to see her up and running or at least unbloodied and conscious) and she says to me, "I hope this doesn't discourage you from going in to nursing."

Not at all. It just reminded me that birth is an amazing thing and that you never know what can happen and I was going to say, "So be prepared." But I don't know if any nurse, student or not, could be prepared for what happened. Let's just hope I get at least another lifetime to find out.

Happy Birthday

So, on the first day of my preceptorship, I was walking down the hospital hallway with a chilled bottle of champagne and on the second night I was watching my patient's uterus getting stitched up in a chilly OR. My mom always says about nursing: There is never a dull moment.

My first night, my pt had her whole family in the delivery room. Her dad was holding her leg as she pushed out her baby. It was just the sweetest thing in the world and they were the most adorable family and all had tears in their eyes when the baby landed and the mama had had a 48 hour labor and came through it all great. There was some drama at the end when the shoulders were stuck (dystocia is what it's called for my non-nursing pals) but babe squeezed by and mom had virtually intact tissues (and she was a primip - her first birth - too!).

I think my preceptor was dissapointed on my second night when babe 2 got stuck in an unfavorable position and the (heart) decels were too deep and too long. Two obs were in there trying to push the baby into a better position but baby was looking straight up into the sky (well, the bottom of the uterus anyways) and each contraction was bending the back of the head into the babe's back. My precpetor is very prepared and I saw her take out the sodium citrate and I knew that meant c-section. (Sodium citrate can be given before surgery to neutralize stomach acid in case any is aspirated into the lungs. Acidic stomach contents plus lung tissue do not mix well.)

So she's wheeled into to chilly OR and strapped to the table and drapes are draped and her abdomen is prepped and her arms are spread out on the armboards like Christ on the cross (isn't there some sort of crucifix-y name for that position...? Maybe I'm imagining it.) and she's gotten an incredible amount of pain reliever and anesthesia in her epidural AND Versed and Versaid again and she's still feeling it. They cut her open and I'm trying to hold her hand and every time I try (the babe's father is stil out in the hall), my preceptor walks me back around to the other side of the drape to watch which would be fine, but my pt is moaning and obviously terrified. Finally, my preceptor says, "You wanted to watch, you're not a doula, come see the medical side of things." OK. (Here I'm all torn. Wait, haven't I been told that my job is to help patients cope with illness and the treatment of illness? )

My preceptor, though, is my mentor and I'll be working with her for 9 more weeks and - let me say - she rocks in that old-school-tough-as-nails-does-it-right-the- first -time-I'll-take-questions-later kind of way that, frankly, you want your preceptor to rock. And, also, I like the way she introduces me to people sorta proud-like "*This* is my preceptee." And I like that she's as tall as I am short. I feel sometimes less preceptee and more side-kick-y.

So, they get through the skin (which is nicely wrapped in what I'm going to describe as yellow Glad Wrap (just to be funny)), they get through the fascia and they start going through the uterine muscle and I'm sent out to get dad and miss the emergence of the babe. I hear my pt moan/ scream and there's the babe when we come back in. So, pt's uterus is out on her abdomen, yes, out of the abdominal cavity and (reminder: all of my previously participate din surgeries were micro surgeries) it looks like a small, raw thanksgiving turkey (because all products of surgery are described in relation to food items: "It was about the size of a small orange." "It was the color of a blueberry." etc, I'm just upholding the traditions of my profession here).

My preceptor is doing gauze counts and they have this nifty hanging bag thing and - I'm not kidding -it's called Bag-It! (except there is no exclamation point) that looks like one of those cheapy clear plastic things you hang on the back of your closet door to hold your shoes except instead of shoes there's bloody gauze. See, it's a handy way to count the gauze: five pockets per Bag-It! and one or two bloody gauze per pocket (depending on user preference).

And then, bloop, back into the abdominal cavity goes the turkey and all the layers are stitched up and mom is still scared to pieces and babe is whisked away.

Baby is cute as a lil button and fine and mom came out of it all great: a little shakey, a little scared, but snuggling in the recovery room with her little one.

Well, happy birthday. Two ways and two cute-y pie babes and two tired mamas and two bigger families and a very tired student nurse happy to be here.

(That's part of my daughter's cake. I stole the doggy with present idea from somewhere and now I can't find where I found it. oops)

Hi Hat Hell

So, like many cupcake aficionados, I've fallen for the whole Hi Hat Cupcake trend (oh, you too?). For those less into the whole cupcake thing, but still curious, they're those tall 'n' swirly cupcakes w/ a creamy, white frosting dipped into chocolate. They're visually reminiscent of chocolate dipped soft-serve cones.

Like any semi-decent baker out there I did my research and found that many of the reviewers on that Martha Stewart recipe had difficulty dipping their frostinged cupcakes into the chocolate, so I checked out some blogs out there and got a sense of what was working for people. This recipe on The Barmy Baker looked good, but then I blew it in a couple of ways. First, I was making the cupcakes for the kids so I wanted a vanilla cupcake and so used my good tried and true white chocolate cake recipe and I used Martha's dippin' chocolate recipe (which made use of semi-sweet chocolate) instead of Barmy Baker's (essentially I just used the meringue frosting recipe from Barmy Baker).

Big mistake. For one, I think a more lightly-textured cupcake than my white chocolate ones (they're pound-cake-y and dense) would have held onto the meringue better and, secondly, Martha's dip was too thick so when I dipped those things, the meringue came off in the chocolate. It was like a boot stuck in mud. I think I also needed to be less timid and dunk 'em quick and deep so that the top of the cupcake paper was included in the dip and provided more of a sturdy base for pulling out of the heavy chocolate. So, I scooped up the meringue, mostly coated in chocolate and plopped it back on the cupcake. I know, they're ugly. My sister is rolling over in her grave right now and she's not even dead. My sister and I fight about cake and baking all of the time and her big thing is the aesthetics of the stuff. And, (I sense an angry comment here..) I think that is her biggest concern so she is probably UPSET about how ugly the things are. But, they tasted good. The kids wanted the undipped ones, though and it wasn't an aesthetic thing. It was a we-like-vanilla thing.

Do you food bloggers out there usually only post about your successes? See, I want to know where you went wrong. Did you bake it too long? Too much rosemary? It fell off the spatula?

I'm supposed to be starting my preceptorship this week, by the way, but I just got my preceptor's name and number today. The person coordinating that whole thing at Nursing School U is new at it and disorganized anyways and now I look disorganized. I called my preceptor and left a message, "Uh, hi I'm your preceptee and we're starting this week, so, uhhhh, give me a call so we can synchonize our watches." Or something like that. Needless to say she hasn't called back and that watch is ticking and I've heard from those who have gone before me that doubling up on the schedule later on to make up for lost time is like Hi Hat Hell. Zort!