Student Nurse Molly, RN

Molly, RN

2009-05-02T12:32:00.000-07:00

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

2009-04-19T00:00:00.000-07:00

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

2009-04-13T00:45:00.000-07:00

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

2009-03-20T18:47:00.000-07:00

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

2009-03-02T10:53:00.000-08:00

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

2009-02-22T00:20:00.000-08:00

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

2009-02-11T13:53:00.000-08:00

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

2009-02-01T00:59:00.000-08:00

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

2009-01-21T19:51:00.000-08:00

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

2009-01-15T11:51:00.000-08:00

"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

2009-01-10T00:17:00.001-08:00

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

2009-01-05T20:55:00.000-08:00

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!

Four Pounds Of Butter

2008-12-18T23:57:00.000-08:00

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

2008-12-06T00:23:00.000-08:00

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

2008-11-26T23:34:00.000-08:00

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

2008-11-12T23:37:00.000-08:00

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

2008-11-06T12:07:00.000-08:00

"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

2008-10-29T22:45:00.000-07:00

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

2008-10-15T20:13:00.000-07:00

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

2008-10-08T21:48:00.000-07:00

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

2008-10-01T20:00:00.000-07:00

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

2008-09-23T18:43:00.000-07:00

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

2008-08-27T14:09:00.000-07:00

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!

2008-08-01T14:09:00.000-07:00

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

2008-07-07T17:05:00.000-07:00

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

2008-06-26T09:35:00.001-07:00

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

2008-06-06T22:52:00.000-07:00

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

2008-05-20T22:51:00.001-07:00

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

2008-05-08T21:37:00.000-07:00

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

2008-05-03T22:21:00.000-07:00

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

2008-04-16T14:18:00.000-07:00

"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

2008-03-26T12:03:00.000-07:00

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

2008-03-21T08:59:00.000-07:00

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

2008-03-11T23:23:00.000-07:00

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

2008-03-06T23:48:00.000-08:00

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

2008-02-24T13:06:00.000-08:00

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

2008-02-18T22:31:00.000-08:00

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

2008-01-18T22:26:00.000-08:00

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!

2008-01-10T23:09:00.001-08:00

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

2008-01-04T16:59:00.000-08:00

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!

Travelling To Remote Locations

2007-12-21T10:10:00.000-08:00

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

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

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

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

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

I See You

2007-12-08T00:18:00.000-08:00

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

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

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

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

OR

2007-11-17T23:00:00.000-08:00

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

Sorry. No Thanksgiving recipes this year.

The Caramel Season

2007-11-07T20:27:00.000-08:00

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

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

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

Can't Fail Caramel

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

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

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

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

Remove from heat immediately.

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

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

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

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

Shock

2007-10-26T09:28:00.000-07:00

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

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

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

A Tale of Two Brownies

2007-10-20T22:54:00.000-07:00

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

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

OK.

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

Peanut Butter Brownies of the Gods

for brownies:

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

for ganache:

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

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

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

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

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

Cool completely in the pan on a rack.

Ganache:

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

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

My Grandma Mary Ellen's Brownies:

1/2 cup softened butter
cup sugar
2 eggs

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

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

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

Dinner With the Anorexics

2007-10-12T10:37:00.000-07:00

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

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

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

Bagels

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

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

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

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

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

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

Preheat oven to 400 F.

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

Do this with all of the bagels.

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

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

Cool on a rack.

Me...Now In Cupcake

2007-10-05T23:51:00.000-07:00

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

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

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

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

More Pie

2007-06-19T23:03:00.000-07:00

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

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

Hand Pies 'Til The End

2007-06-01T21:49:00.000-07:00

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

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

So, nursing school year in review:

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

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

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

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

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

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

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

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

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

OK, that recipe was paraphrased from Martha Stewart.

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

tickticktickticktick

2007-05-19T23:09:00.000-07:00

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

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

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

Talkin' 'Bout Stomas

2007-05-11T16:24:00.000-07:00

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

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

Bananas

2007-05-03T21:24:00.000-07:00

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

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

AMAZING Banana Cream Pie

For the crust:

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

1 tsp sugar

4 Tbs butter, melted

For the interior:

1 2/3 cups milk

¼ cup plus 3 tablespoons sugar

½ vanilla bean, seeds scraped out and reserved

3 Tbsp cornstarch

1 egg

2 egg yolks

1 ½ Tbsp butter

For topping:

1 ½ cups heavy cream

¼ cup crème fraîche

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

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

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

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

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

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

grumblegrumble

2007-04-23T22:43:00.000-07:00

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

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

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

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

Large

2007-04-11T16:19:00.000-07:00

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

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

Back To School Fun

2007-04-05T22:30:00.000-07:00

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

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

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

Orange Tulips=Happy

2007-03-28T20:05:00.000-07:00

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

Finally

2007-03-20T22:52:00.000-07:00

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

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

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

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

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

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

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

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

Household Scissors

2007-03-16T00:19:00.000-07:00

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

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

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

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

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

Breadsticks, basic recipe

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

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

Running Head: One More Week, Sorta

2007-03-07T21:28:00.000-08:00

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

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

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

Pain

2007-02-26T22:28:00.000-08:00

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

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

The Isolation Ward

2007-02-16T21:49:00.000-08:00

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

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

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

Sugar Cookies

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

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

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

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

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

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

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

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

Patience

2007-02-08T21:31:00.000-08:00

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

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

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

This is hard.

The Long Week

2007-02-01T22:05:00.000-08:00

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

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

Back to Baking

2007-01-24T23:52:00.000-08:00

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

Cabbage

2007-01-16T21:18:00.000-08:00

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

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

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

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

Back to School

2007-01-10T14:12:00.000-08:00

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

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

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

Filler

2007-01-03T20:06:00.000-08:00

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

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

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

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

Christmas Pastry

2006-12-27T16:40:00.000-08:00

It was well after midnight on Christmas Eve when I realized that not only was I making a yeasted dough (please see my post about the Bread In The Pipes Incident) but that it was a yeasted puff pastry dough and I still had two more "turns" to do and still needed to chill the stuff for an hour before I could carry on. But the pastries (recipe here) were, my husband said, "One of the best things you've ever made". I changed the recipe a bit. What's the deal w/ beating the butter w/ a rolling pin? Nope. God and Cuisinart teamed up to make the food processor for this very reason. And, besides, the kids were in bed and "Santa" was in the living room wrapping presents and drinking beer, so I couldn't wake them up in the name of Following the Recipe Exactly. Sometimes the science of baking has to take a hit to keep the visions of sugar plums dancing and all. And I didn't have cream cheese. I had mascarpone. And there was the panic: Pinch what, fold how? Huh? And yet.... I wanted to put the picture of the little layers of the finished dough with its lovely layers, but I thought the pastries looked better.

Oh, yeah. The score on the accursed paper was increased juuuust enough to get an A in That Class. Happy New Year!

Just...Can't...Take...It.

2006-12-19T22:43:00.000-08:00

So, the funny thing is, now that I'm on winter break I start wondering, "Can I do it? Can I handle nursing school? Am I tough enough? Do I *really* want to be a nurse?" And, I know what you're thinking. You're thinking: idle hands are the work of....Aw, you just need to keep busy during the long break...etc. No. I'm making a quilt for each of my kids (that I want to have finished by Christmas, ho, ho, ho, uh), I'm planning to make five different kinds of candy for the neighbors (plus Christmas sugar cookies the kids can cut out and decorate): almond toffee, peppermint bark, homemade crackerjacks, chocolate-walnut fudge, caramels (I've been wanting to make caramels out of honey for a while. Have you tried it?). I have Christmas shopping to do. I'm in desperate need of a new pair of shoes and some new bras. Have you seen this house? I'm having the family over for brunch on Christmas morning and there are books and notes and clipboards and other finals-studying detritus that are strewn across every horizontal surface waiting to be shelved in shelf-spaces that don't exist or burned (depending) in a fireplace I don't have. Sigh. So, no, it's not that I've suddenly been granted all of this time and head-space to contemplate nursing school and nursing and what do I think I'm doing. It's..

just not fair. I turned in a group paper (remember the Constipation project?) and it was marked down to a C. And points were taken off for things that were included in the paper. And this was by the instructor who (pretty much) put smile-y faces and "great job" on very other paper, who told me, "Don't worry about it." when I asked about the mysterious "Appendix B" in the rubric (I want to spell that w/ a "k" instead of a "c". Is it just me? Is this-the rubric- a new school thing. I don't remember rubrics twenty years ago. Does it have something to do with Powerpoint, also a non-thing twenty years back...). Word on the street: Smiley-face teacher gave everyone 100 on the paper and was told she needed to be more critical. My guess: she took random points off rather than re-read the paper. Stopped reading any emails from students. My group has turned to the head of the program for a re-grade. Someone, I'm told, who worries a lot about "Appendix B".

So, who cares right? Let it go. Because of this paper I got a B in That Class. The one I barely endured. And I got an A on the final, but only because my friend, "S", made excrutiatingly detailed notes and gave me a copy. And, the other sucky thing= I was responsible for finishing up the paper and I deemed it "good" (that should read "B" to anyone taking notes, but was "Great Paper" and smiley faces for that instructor). So my group goes down with me. And that leads me to the peppermint bark. Pictured up there is the toffee. I'm not going to get into the toffee with you. It's good, real good, but if you haven't already made toffee before I don't want you to curse at me. You'll be stirring the sugar-y goo and it will take twenty minutes to get to the hard-ball stage rather than 10 and, if you're an idiot like me, you'll be using a meat thermometer to take the temp (it has a 5 inche pointy probe so you have to hold the thing with one hand and stir with the other and that thermometer hand is hovering pretty close to a goo that is registering 300+ degrees and it's bubbling like a mud pit in Yellowstone NP), and it's a rainy day which, apparently, in the candy-making world= potential for doom markedly increased because it's not the heat it's the humidity. sigh.

Anyways, we're on break here, people! We're not doing science. We're not measuring anything! We're stirring something up and slapping it down and letting it cool and eating it.

Here. Peppermint Bark.

About a pound of white chocolate broken into pieces(I know what I said about white chocolate, the peppermint counterbalances its evil) - not the chips, they melt funky

around half a pound of semisweet chocolate, small pieces- chips are fine

two or three splashes of cream (I dunno, 6 Tbsp)

one lid's worth of peppermint extract

10ish smashed candycanes or 30 or 40 crushed up round peppermints

Line a cookie sheet with parchement paper
melt white chocolate in double boiler (mine is a random saucepan at a crazy angle in another random saucepan with about an inch of water in it over medium-low heat)
pour half of it onto parchement spread it out with a spatula (but not all the way to the edge) add about half the crushed candy, spead evenly,and chill 'til firmish in fridge.
melt chocolate combined w/ peppermint extract and cream in "double boiler" and combine 'til smooth. Working quickly, pour the chocolate over the white chocolate, spread w/ spatula and fridge 'til firm (um, half an hour?). Re-melt the rest of the white chocolate and working even quicklier (I was slow and the top layer of white chocolate melted some of the real chocoalte and turned my top layer light brwon, but still tasty) pour and spread white chocolate over real chocolate layer and spread. Add the rest of the crushed candy. Fridge until firmish. Use the parchement to lift it out of the cookie sheet and put it onto a cutting board. Remove parchement. Use a sharp knife to cut it into pieces (keep it right side up or you'll make a mess).
This is sooooooooo goood.

Is It Thursday Yet?

2006-12-12T20:39:00.000-08:00

Ah, finals week. During my first tour of college around twenty years ago I would stay up all night studying. I'd drag my sleepy, studied butt into class and take whatever test it was and then stay up all the next night re-loading for the next test. I can't do that anymore. Can you say, "Almost forty."? Can you count the two kids over there? Chances are with the two of 'em, one will wake me up w/ a bad dream and one will have forgetten the How To Put On Your Own Blanket at 3 AM training session that we've gone over and over world without end anyways. And, so, I'll be up and bleary-eyed the next day anyways.

So, here's the deal, when you're old like me and you're busy like me and you go back to school the second time around you have to do it right. You do the reading when it's assigned. You start studying for the hard tests *at least* a week before the test. You show up to every class. You take The World's Best Notes (in part because all the note-taking keeps you awake!). You annoy the hell out of your fellow students by asking a million questions if you don't understand something. And that leads me to That Class: Nursing Theory. It will be my final final for this quarter and it's this Thursday. That test is the only thing that stands in the way of the completion of this first quarter in nursing school. And I have done NONE of the things I've just mentioned. Someone recently used the word "endure" to describe what it takes to get throught that class. I haven't endured. I've flaked. And I don't even care.

My pathophysiology final was today. I did, indeed, practice my exemplary busy mom study habits for that one. Still, hard test. My friend, S., came to class and informed me that I could get 13 wrong and still get an A in the class. It's good to have friends who figure these things out in their spare time! So, here's my list of the 5 diseases (not counting infectious diseases -um, ew, guinea worms!) I do not want to get in ascending order from, uh, "best" to worst:

5. Right-sided heart failure. There's something about all-over edema that really creeps me out.

4. Cirrhosis of the liver. You get varices (extra blood vessels) that can burst, especially in the esophagus. And, well, we're back to edema, especially in the abdomen.

3. Pancreatitis. Two words (or is it one?): auto-digestion.

2. Chronic renal failure. It's the edema, again. And this time it's in the lungs. And the urea build up. You can get a "uremic frost" wherein your skin is coated w/ crystals of urea like a dusting of candy-sugar or light snow. And it smells like pee. You wipe it off. It comes back.

1. Diabetes. It's the number one cause of renal failure, but it's not just that, it's that many of the complications occur because you're all sugary. Sugar literally gums up the works and causes everything from blindness to artheriosclerosis. And the infections! You are the perfect sugary breeding ground for bacteria.

Ooops. I left alzheimers off of the list. Oh, and hemorrhagic stroke. I should have done a top ten, but I need a break from pathofizz for a while. I have to spend time not studying for my last final.

The End is Near...Let's Bake!

2006-12-06T21:23:00.000-08:00

There may, indeed, be something wrong with my brain. I have finals this week and next and I've spent all my "spare" time baking and cooking rather than studying. I just can't get around to it. My daughter's 6th birthday was today and making her tasty cupcakes and setting up a make-your-own pizza dinner was more important to me than doing well on tomorrow's nutrition test. And they *were* tasty cupcakes (recipe below).

I had my first final on Monday in Skills Lab. I had a horrible night's sleep the night before and I barely studied. I really felt like I knew my stuff. I've been watching the DVDs (Hygeine! Asepsis! (Oh No, It's) Bowel Elimination!), I've done the reading. But the test was horrible. Horrible! It had questions on the manufacturing instructions for glucometers. What are trocanter rolls and what do they have to do with patients in a coma (the question of the day)? After the test I asked one of the instructors. "Oh, you'll learn that *next* quarter." Um. It was, apparently, a test on premonition skills. But the worst part was the random skills part of the test. This was the doing part of the test and I thought I had it down cold, had it wired, had it in the bag etc. But the instructor handed me the card with the instructions on it and the four (hey, they told us three, see, here in the syllabus...) skills I had to perform and then snatched it away from me and gave me grumpy looks and muttered comments while I did my thing. I asked, "Um, aren't rectal temperatures contraindicated for end-stage AIDs patients?" and she grumbled something and had me do it anyways (I think she was hoping I would miss that so she could pounce on me for it.). Let me back up. Some of us were doing our skills on another student, but I got the mannikin (complete with place for rectal thermometer!). So while everyone else was chatting w/ their fellow nursing students and happily doing vital signs I was giving a bed bath to a mannikin with Growly Instructor glaring away at me. I knew the night before that I would have to make an occupied bed. I worked so hard on making beds (I'm not, uh, by trade, much of a bed maker) and it was the one skill I really improved on. I've nver practiced making a bed with gloves on (AIDs patient, er, mannikin, though, remember?) and it must have taken me a half an hour. It wasn't terrible. You should have seen some of my mitered corners before, though. I was so flinging proud of 'em. These just hung there like lasagna noodles stuck to the pan. Growly was not impressed and told me so. I tried to look at the instruction card and she was trying to hide it from me. Then she told me to write something down. "What?" "Here," she said, flashing the card at me, "you have to document it." Um. "Document...it? uh, document what?" And the card was waving around again, but she wouldn't let me look at it. I wrote down 300 mL of urine ( I had to empty a "Foley" - the bag that catches urine from a catheterized patient. A skill that I never practiced and was shown once 2 minutes before class let out one day in October). I wrote down (on a scrap of paper, mind you) 38 degrees C, rectal temp (I figured that's a good temp for a mannikin w/ a fever) and I handed it to her. She scribbled down something in my permanent record and I went into the other classroom where the untested students were sitting. "Geez, what did they have you do in there?!" people asked. I was in there for an hour and fifteen minutes. And, just chatting with a group of people I started randomly crying. Does that ever happen to you? You're just chatting all of a sudden tears are slipping out of your eyes before you can stop them. Not about the test. I'm just overwhelmed which leads me to the cupcakes.

Make These Cupcakes

I stole this recipe from Epicurious.com, but it's for some sort of cake w/ apricot this and such and I've turned them into the perfect kid party white cupcake.

8 oz imported (read: Lindt) white chocolate (I don't like white chocolate either, but it works in these cupcakes)
2 1/4 cups cake flour
2 1/4 tsp non aluminum baking powder
1/4 tsp salt
10 Tbsp unsalted butter, softened
1 1/3 cups sugar
4 large eggs
1 1/2 tsp vanilla
1 1/4 cups milk (I used low fat)

preheat oven to 350.
spray oil muffin tins (will make more than 12 cupcakes, maybe even 24)
Melt white chocolate in a double boiler (my "double boiler" is a smaller saucepan in a larger saucepan with the flame on the stove down low). Sift flour, b.powder and salt. Cream butter and sugarin mixer 'til fluffy. Add eggs one at a time, mixing after each addition. Add vanilla. Add dry ingredients alternatively with milk in 3 additions, beating after each one and blending until well-combined after each addition. Add melted white chocolate. Fill muffin tins 3/4 full and bake for 15-20 minutes until toothpick comes out clean. Let cool in tins for 20 minutes before removing. I frost 'em with cream cheese frosting, but you can use your favorite.

Picture is of my daughter's cake from her party Sunday.

It's All in Your Head

2006-11-29T12:51:00.000-08:00

Neurologic disorders are always really fun to learn about. Raise your hand if you've ever thought you had a brain tumor. See? And some of the symptoms are things that happen to you all the time. Are you ever fatigued? Have a headache? What's that ringing in your ears (is it *really* someone talking about you or could it be...)? A little more forgetful than usual? In pathophysiology we had our first neurologic disorders lecture and the loveliest thing about it for me, personally, is that I was suffering from one of the worst migraines I've had in months. It was one of those migraines wherein everything looked like it was backlit by a soft glow and I just wanted to throw up even if that would only offer a moment of relief from the nausea. So the lecture was on head trauma and disorders of extra cerebral spinal fluid (that's CSF for those of you taking notes). There are two types of head trauma in the world: closed and open (and if you have to choose one, pick closed. I don't want to go into infection and skull fragments here). It sure felt like I had something jabbing into my brain and I was wondering if I had one large swirly-gigging pupil and one normal one and almost turned to the person next to me and said, "Can you make sure I don't lose consciousness?" Apparently, with a head injuy you want to keep the person awake so that you can monitor their level of consciousness. You can ask, "What's your name?" and check them for crazy pupils. My sister often draws people with one big swirly/googly eye and one regular eye. And that's the way it is with head trauma, so I have learned. It would have been a good day for a lecture on endocrine disorders, but, with The Migraine From Hell, the last thing I wanted to hear about was things going wrong with the head and brain.

We had our last Skills Lab before our test. We got to give each other bed baths. We all wore or brought shorts and our own towels to class. It was one of those class times when you really cross your fingers for a good lab partner (oh, please not the Grumpy Woman who pumps the blood pressure cuff past 200!). And, you know, it was kind of pleasant having someone else brush my teeth and wash my feet. But it's only because I didn't Grumpy Woman as a partner.

Bread

2006-11-24T18:27:00.000-08:00

Ooops. I forgot to post on Wednesday. I was too busy chopping vegetables and baking. Now I've lost all three of you, my loyal readers. One of the best parts about the Thanksgiving holiday was skipping That Class to go to the Farmers Market. The funny thing about going to the Farmers Market two days before Thansgiving is that it is not any more crowded than it is any other time of year, but if you go to your usual grocery store the lines go all the way down the aisles and the wait is about an hour. You get to check out what other people have in their carts and spend a lot of time staring at the canned goods and thinking, "Huh, who knew you could get *that* canned....?" and that leads me to bread. I have to confess that I haven't made yeast bread for over a decade. The last experience was so bad I have been too scared: I was visiting my folks when in my twenties and decided to make a loaf of bread. Got it together, kneaded it by hand, and left it to rise on the back of the stove. Came back either minutes or hours later and it hadn't changed a bit so I threw it in the sink and shoved it into the garbage disposal and went home. Turns out, the warm pipes were the *perfect* place for the dough to rise. It did and required a price-y visit from a plumber. ooops. And last week I wanted to serve bread with a vegetable gratin for dinner and had only 3 slices left in the bag (and, well, besides, I've been disgruntled with the quality of sandwich bread available these days). I made the whole wheat walnut bread on the back of the King Arthur flour bag. There's the picture. It was very tasty. Next time I'll let it rise a little bit longer, but it made perect sandwiches the next day.

This quarter is almost finished. I'll be 1/8 of the way finished with nursing school. That sounds pretty crappy, but after next quarter I'll be 1/4 of the way there and, hey, well, shoot, that sounds pretty crappy, too. I haven't been studying. I'm daydreaming about baking bread and what kind of cake I'll make for my daughter's sixth birthday. And what's with the baking and the nursing school? I've never really been a big baker, more of a cook. A little of this and a little of that and -voila!- it's tasty on a plate. Baking, though, it's a science. A little too much flour and the wrong-sized pan and -sad violin music- all that work for nothing. They say that nursing is an art and a science. Maybe I'm working on the science part of my brain these days. I don't know.

Make These Biscuits NOW!!!

2006-11-18T13:49:00.000-08:00

Part of the reason I'm putting out this recipe is because the one I cut out of Cook's Illustrated magazine a couple of years ago is falling to pieces. It has so many tack holes from being consistantly pinned to my kitchen bulletin board and so many stains from buttermilk splashes. I want to preserve the recipe here. These are the foolproof biscuits; delicious and easy to make. Perfect for Thanksgiving and for making sandwiches the next day.

Buttermilk Biscuits of The Gods

Dough

2 cups unbleached AP flour
1 TBsp baking powder (non-aluminum to prevent that acrid flavor that comes w/ lots of bp)
1 TBsp sugar
1 tsp salt
1/2 tsp baking soda
4 TBsp (1/2 a standard stick) of cold unsalted butter, cut into little cubes
1 1/2 cups cold buttermilk (can be made by using milk and adding a TBsp of vinegar to it, but the real stuff is better)

For Forming Biscuits

1 cup unbleached AP flour
2 TBsp unsalted butter, melted

Heat oven to 500 degrees F. Spray 9 inch round cake pan w/ oil (can rub generously w/ melted butter instead). Spray or butter inside and outside of 1/4 cup dry measuring cup and set in pan.

In food processor, pulse the dry ingredients (flour, baking powder, sugar, salt, baking soda) to combine - about six 1-second pulses. Scatter cold butter cubes evenly over dry ingredients and pulse until mix resembles course cornmeal, about ten 1-second pulses. Transfer mixture to medium-large bowl. Add the buttermilk and mix w/ a rubber spatula until just incorporated. It'll be a messy, lumpy, wet batter. That's ok.

Spread the 1 cup of flour onto a baking sheet. Using your greased 1/4 cup measure, scoop up a glob of batter and drop it into the flour on the baking sheet. Use a spoon to free the dough if it sticks (sez the original recipe, I use my finger and do it quickly. The point is keeping the dough as cold as possible to allow the still solid butter to melt into little airy pockets in the oven, right?). Repeat w/ the rest of the batter. You'll make 12 biscuit-mounds. Flour your hands and gently and quickly pick up a dough lump and coat it w/ a little four, shake off the excess and put it in the cake pan. Repeat, going around the inside edge of the pan in a circle w/ 9 biscuit lumps. Three biscuit lumps go in the center. Brush or drizzle with melted butter and put in the oven. Bake for 5 minutes, reduce oven temp to 450 degrees and bake for 15 more minutes. They'll be a lovely golden brown. Remove from oven, cool in pan for 2 minutes. Invert biscuits, carefully, onto a clean kitchen towel and break them apart and place them upright. Cool for 5 minutes. Eat. Sooooooooo goooooood!

No picture. Sorry. The picture is of a club near Nursing School U. The sign has, clearly, been changed to reflect the "current" decade at least once. Thus is the town of Nursing School U.

And I've changed the settings. You can now post a comment without registering for the site. Give it a try.

Student Nurses Milling Around

2006-11-14T22:36:00.000-08:00

There we are, a clod of student nurses. Yes. I'm the Old One. They make us dress in white so that a) we will blind people w/ our brilliant clothes and they won't notice that we don't know what we're doing and b) people will know that we're students and don't know what we're doing. Take your pick. We went back to an "elder care facility" to do our "teaching". Remember I told you about going and taking elder folks' blood pressures and such? We had to gaze at our data and decide what we wanted to teach the elder folks about and our "nursing diagnosis" (glad you're keeping up with me on this!) was "constipation" and "risk for constipation". Pretty easy to teach about, right? So we spent hours hunched over images of colons, rifling through info about constipation-inducing drugs, banging out brochures and and science-fair-style posterboard making (look at the lovely colors!) and (my three-year-old said the other day, "Drum roll, mommy,") only three people showed up. We were a cluster (herd? school? flock? pride?) of about twenty white-clad and eager students w/ our various posterboards, our brochures, our snacks (did I mention our tasty high-fiber food selection? The other presenters had food, too, though I have to question licorice as a food choice.), info in hand and brain ready to go and hardly anyone came! Arg! Maybe it was our "pick-up line": "So, are you constipated?" Maybe it was our bright posterboards or eager faces. Maybe it was because it was Veteran's Day and people had better things to do. We mostly stood around snacking on high-fiber foods and chatting. I had a great conversation about constipation with one very attentive elderly woman. I then learned that she had late-stage Alzheimers. Sigh.

I'll try and post a Thanksgiving recipe for you before next week. Do you want something sweet or savory?

The Process

2006-11-08T16:19:00.000-08:00

So I may be poised to get my first B on a test since my second go-round in school and the worst part of it is that the B may be a C. It's That Class again. And, here's the problem: it's important information. It's pretty much How To Be a Nurse (you know, in the head). Here's how to communicate. Here's how people develop. Here's what you can expect from a typical eight-year-old. What are the symptoms of anxiety? How to care. How to comfort. What the heck *is* a nurse anyways? And some of it is kind of snazzy info, too. Like nursing diagnoses. As a nurse I can diagnose people with Risk for Powerlessness, Spiritual Distress, Fear, and Disturbed Energy Field. And unlike medical diagnoses (asthma, depression) you can actually resolve a lot of the problems you diagnose as a nurse! Or, well, at least that's what they say. There's lots of things you can do for Hopelessness and, heck, you don't have to be a nurse to cure someone with Deficient Diversional Activity! And you can see things coming, too, in nursing. You can diagnose people with a risk for....Social Isolation or Ineffective Denial.

So why can't I get it straight? Why can't I focus in this class? And it may just be me having trouble. Everyone else walked out of the test looking heavenward and sighing, "That was much easier than I thought it would be." I left thinking, "Crap, I can kiss a future MSN ba-bye." And not only am I The Virtually Undisputed Queen of Calm and Quick Test-Taking (come *on*, you know me: I'm unflappable in the test world, right?) but I'm also She, Formerly of Liberal Artsdom. Heck, it's ALL about theory there. I should be getting this stuff. I got it before! Could it be that my aging brain is now all about Science and Math (uh, ok, maybe not math. We'll talk later)? Have I lost all patience for anything that is not straightforward, not linear? Could it be the D I got in psychology 20 years ago? It can't all be the miserable room and the confuso-teaching team. It can't all be the unfocused wandering from subject to subject. Some of it has to be....me. Just...Not...Getting...It. "Hi, I'm your nurse. I can take your blood pressure, but I can't comfort you because I forgot Erikson's 20 Stages of Whatever It Is That He Broke Into Stages."

Calzones

Is there any more perfect category of food than Hand Food? Ah, calzones. Put whatver you want in 'em and they say Dinner. I like olives, mozarella cheese, fresh pasta sauce (see recipe previously posted; I'm making the same thing now, but using canned tomatoes), and sauteed mushrooms. How about broccoli? I've used vegetarian pepperoni. Provolone? Carmelized onions? It's your calzone. You decide. Here's the dough. It's ripped off from Deborah Madison. I wont tell if you use store bought, but it' *so* easy to make your own!

Pizza Dough

1 1/2 cups warm water
2 tsp active dry yeast (it's about a package)
2 Tbsp olive oil
1 1/2 tsp salt
1/2 cup whole wheat flour (gives it a nice toothsomeness)
3 cups AP flour and then some (up to 1/2 a cup)

Add yeast to 1/2 cup of very warm water. Set aside and let foam. It could take 10 minutes. Sometimes my kitchen is too cold and it doesn't happen and I use it anyways and, so far, the yeast has dome the right thing when asked to.

Add the rest of the water, the olive oil, the salt and beat in the ww flour. I use the dough hooks on my mixer. You could do this part w/ a spoon. Add the AP flour and mix until you get a shaggy dough. (You can do this by hand and just knead and knead until it comes together. ) Turn out onto a well-floured surface and mix, adding dough, until you get a relatively smooth, but still semi-sticky dough.

Put the dough into a lightly oiled bowl and turn it to coat. Cover it w/ a towel and allow to rise until doubled in size. It takes my chilly kitchen an hour to do this. I've started putting it into the oven after I've heated it to 150 and then turned it off and this works well. Still takes an hour.
Preheat oven to 450.

Remove dough form bowl and cut into eight pieces (you can do 6, but those calzones are monsters and will scare the children). Flatten each ball into a disc a using a rolling pin. sprikle them with a wee bit o' flour and let them rest on the counter while you prepeare the filling ingredients.

Mound filling onto half of the disc, leaving some edge free of stuff. Brush a little water on the edge, fold the top part over the filling and roll the edges shut. Do this well or your ingredients will leak all over the place. Bake until golden about 15 to 20 minutes. Brush w/ olive oil and sprinkle w/ parmesan. Your family will diagnose you with Good Dinner-making.

Kidneys, Don't Fail Me Now!

2006-10-31T21:16:00.000-08:00

So That Class. Today the hum of the fluorescent lights combined w/ the whine from the instructor's microphone in a way that made me feel like I was going to throw up. I don't know if anyone would have noticed. We're all hypnotized by the overly wordy Powerpoint (I'll make it one word this time) slides and the information which made no sense. People tried to ask questions, but they were deflected by Confuso-instructor as she motored on and on at a pace that was too slow to render her speech into a soothing drone. That Class is Contemporary Nursing and I enjoy *not* doing the reading because it makes the mixed bag o' lectures a little more exciting. What'll it be this time: Piaget's cognitive theories? Anxiety? Or The Adaptive Exchange Model? The latter is something made up by someone at Nursing School U and is the flow chart/model that will help us to better help our patients. Arrows are pointing here and there and it's water in/ water out (or, wait, that's the fluid intake/ output we were supposed to track that led to my belief that I have impending kidney failure and, no, it's not because we're looking at diseases of the kidneys in pathophysiology right now and, all right, you don't want to hear about pee anymore) and when I asked, "What are you talking about?" to the Other Instructor Who Teaches the Class (the one who talks so fast it has become a whole new language, because, yes, the class is taught by *two* instructors on alternating days because it's not insane enough otherwise) she said, "Oh, you should have seen the other guy's theories! You'll be thanking us for our lovely theory. At least it fits on ONE PAGE." Except the other guy is not a guy she's a nun. And now that this is all clear to you (just as clear as it is to me!) I have a great muffin recipe for you. This one is soooo easy and sooo tasty! I stole it from a random web site and modified it to make it less healthy and more tasty.

Mini Apple Nut Muffins

2 grated apples
1/2 cup of brown sugar
1/4 cup of butter
1 tsp salt
1 teaspoon cinnamon
1/2 teaspoon of nutmeg

1/4 cup of milk
2 eggs, lightly beaten

2 cups of AP or cake flour
1 TBsp non-aluminum baking powder
1/2 tsp baking soda
1/2 cup walnuts, chopped

Spray mini muffin tin w/ oil or butter lightly.

Preheat oven to 425.

Combine flour, baking powder and baking soda in a large bowl. Set aside.

Put first 6 ingredients into a saucepan. Bring to simmer. Cover w/ lid, reduce heat and simmer for 10 minutes. Remove from heat and stir in the milk. Add the eggs.

Mix wet and dry ingredients.

Stir in walnuts.

Fill muffin tins w/ batter. It wont quite make 24 so put a 1/4 inch of water into empty tins. Bake for 10 minutes or until toothpick comes back almost clean.

I don't have a picture of them. They were eaten too quickly. Those are pumpkin guts.

Cups O' Pee

2006-10-25T11:22:00.000-07:00

Nice title. Now you wont try my corn muffins, will you?

So, every nursing student blog has the gratuitous photo of the required books stacked to the heavens and, heck, who am I to go against the genre? So there it is. The quarter in the lower left is to give the behemoth some scale. And, I'll add here, I did not fluff this stack up with any extraneous textbooks from, say, Anatomy or Microbiology, though I have them around and I use them all of the time. And, I must say here, most of these books have tissue thin pages and fonts of a size I thought unreadable for their microscopity a few months ago. Um, maybe I still think they're unreadable, but the flow charts in some of these books! Oh, the flow charts. They are...baffling/beautiful. And, for your information, the book buying is not done. That's just this quarter (not the one for scale, the one that is a breakdown of the academic year).

I had my first clinical last Friday. We went to an elder care facility and took blood pressure and glucose readings on some folks. And then we interviewed them. A good time was had by all and I only had to re-do two out of the three "client's" glucose tests. And two out of my three "clients" had high readings which made me feel a little sad about the festive and out-sized donuts sitting there gleaming w/ sugary coatings. They were brought by my instructor. Whoops. The quarter for scale would have been itsy bitsy next to those monster-donuts. They would have eaten the quarter.

My favorite class is Skills Lab. We get to do fun stuff like: blood pressure readings until you're blue at the fingertips! Make an unoccupied bed! Make an occupied bed (oooooh!)! Poke your lab partner's fingers for glucose tests! Do it again because you were too chicken to press hard enough and they were whining when you tried to "milk" the blood out of the first stabbing! The real fun was perineal care on the mannikins. They have interchangeable genitals so you can practice washing the man and then - switcherooneee - washing the woman. It's a Code Brown! And then there was peeing in cups. We had to practice dipstick readings w/ our urine. And the bathroom is a quarter mile down the hall. On the way from the bathroom w/ full cups we could just pretend we had small drinks, but on the way back down the hallway to empty the cups o' pee we were wearing our gloves and it was pretty obvious that the cups did not contain beverage.

Corn Muffins: Mini!

2006-10-21T23:41:00.000-07:00

I've been making a lot of mini muffins 'round here of late. It's nice to have something to give to the kids first thing in the morning and a mini muffin makes a perfect kid-sized snack. Sometimes the kids help make the muffins. We've done blueberry (not the best for mini-mizing - something about the big blueberries does ungood things to the texture), pecan, lemon poppyseed, banana nut (I process the nuts in the food processor for the fussy eater. The fussy eaters always have a thing about texture), and Cleanin' Out the Cupboard muffins (coconut, oatmeal, walnut - good, but half of 'em fell apart coming out of the tin).

The corn muffins have been the biggest hit. I adapted them from a Bobby Flay recipe that I found on the Food Network website. That recipe used blue corn and jalapenos (Fussy is not going to eat blue food or spicy food. nope. not happening). These things are almost a meal.

Best Mini Corn Muffins

3/4 cup unsalted butter
1/3 cup sugar
4 large eggs
1/2 cup milk
3/4 cup mild cheddar, grated
3 ounces cream cheese (I just used some grated mozarella instead, but the ones I did w/ cream cheese were great, too)
1 cup All Purpose flour
1 cup corn meal (I used whole grain corn meal)
2 1/2 teaspoons baking powder (I used aluminum-free baking powder. Perhaps healthier, but it eliminates that odd bitter baking powder flavor you can get when using such a large amount)
1 tsp salt
2 Tbs poppy seeds (optional)

preheat oven to 375.
Spray muffin tins w/ oil or butter them generously (that cheese makes the muffins clingy). Cream butter and sugar. Add eggs and mix well. Add milk. Mix well. Add cheeses and mix well. Sift together the flour, cornmeal, baking powder and salt. Add to batter a cupfull at a time and mix after each addition just until barely combined. Stir in poppyseeds if you're using 'em.

Fill mini muffin tins a little more than half full. Bake for 15-20 minutes or until toothpick in the center comes out clean. Color is not an indication of doneness. Do not overbake.

These made about 30 mini muffins. You could also make it into a cornbread in a 9X9 pan or do full sized muffins.

Yum.

Corn

2006-10-18T13:13:00.000-07:00

There are a LOT of things that can go wrong with the heart. And I'm going to be tested on that tomorrow. I've already filled half a notebook (5 subject even) w/ notes in my pathofizz class.

So, I'm crammed into overheated, windowless rooms (4 out of 5 of my classes are in windowless classrooms - you do the math) with the same goup of 64 people. Sometimes we're broken up into smaller groups, but it's still the same people. And their quirks and annoying qualities are starting to show. I found myself being really grumpy about some of them ("man, she's annoying!" "shaddup already!" "Quit jabbing my finger w/ a needle!"). Maybe it's the lack of sleep. Maybe it's that I am dying (Right Now. As I Type This.) of several different and, possibly, unrelated heart ailments, but some folks in Nursing School are a little pesky. There's Hat Woman. She ALWAYS has something to say. And it's ALWAYS self-referential. There's Woman With Ill Boyfriend. She ALWAYS has something to say and it's ALWAYS about her boyfriend and his health ailments. There's Drunken Party Gal. Ok, she's not ACTUALLY drunk during class (um, I hope), but she ALWAYS has something to say and it's ALWAYS a question about drinking LOTS and LOTS of alcohol. Aside: she also went on and on, at one point, in a conversation I participated in with her, about the directions she ABSOLUTELY refuses to drive in. I only remember that she wont go south. (I don't really want to go south, either, but I will, at least, DRIVE south.) And then there's Odd Eating Habits Woman. She - IN PUBLIC - ate an apple and spit out the peel into a plastic baggy because -get this- she is worried about the pesticides on the skin. Um. Ick. Then there's Insensitive Guy (one of the rare fellas in the program) who always has some sort of comment that offends at least one person, but, more often, the whole class. Example: "I mean, come on, the guy's 41. He shouldn't be playing BASKETBALL! He should be creaking around in a golf cart." I've missed some people. But, here's the deal. I've started looking for good things about the people who annoy me the most. Hat Woman? She's really friendly and, even though it's the same hat every day, it suits her. She of Ill Boyfriend? She's got some nice tattoos. Drunken? She's got an infectious liveliness to her (there's a there there). And, heck, we've all gotta have boundaries. ApplePeel? She's lovely, smart and elegant. Maybe it's not all bad. But next time my lab partner pumps up the blood pressure cuff past 190 (I think my finger tips popped) and gives me high blood pressure ("uh, 120 over 90?") I think more than my fingers might pop!

That's a picture of popcorn the kids picked at The Harvest Festival this weekend. We'll pop it for Thanksgiving. It has to dry first. Ask me about my failed pretzels!

That Class and Tomato Sauce

2006-10-11T12:44:00.000-07:00

My Contemporary Nursing Class is this amorphous blob of a class taught by two very different instructors. Neither instructor ever talks to the other instructor or that's how it seems. It gets worse (remember, this is the class where they gave everyone $20? I asked, "How bad could it be?"..): it's held in a room with no windows. The room is painted stark white and the starkness is interupted by smudges on the wall. I don't clean my floors very often, but I got some sort of good housekeeping diploma (suitable for framing) when my floors were compared to the floor in this classrooom. I think the coffee cup lids are actually permanently imbedded in floor-scum. I'm afraid to put my backpack down. It may never come up again, but the room is so crowded, well, I have no choice. There is a constant hum from the cheap-ass flourescent lights above and there's an almost imperceptable machine-whine from the computer monitor that assists The World's Dullest Teacher in displaying her Power Point (is that one word?) slides w/ perky old-fashioned traingle-hat wearing nurse images tucked into corners and what may (or may not) be an outline of what WDT is blahblahblahhing about up there. Oh, right. It's either about Florence Nightengale, Don't Date Your Patients, or The Nursing Process, but it all blends into the hum and the whine and the scum and the windlowlessness so she could be reading from the phonebook and I'd be equally engaged. The woman next to me writes on her notebook, "Kill Me Now" and angles it my way.

And then there's the tomato sauce. Those are san marzano tomatoes from the farmers market. And This Is The Best Sauce Ever:

8 to 12 tomatoes or so
Small onion: chopped real fine
2 cloves o' garlic: smashed or pressed
2 Tablespoons of fresh basil
splash of olive oil
salt and pepper
dash of red pepper flakes

Saute onion and garlic in splash of olive oil until softened (I dunno, five minutes)
Peel tomatoes by immersing them in boiling water for 10 seconds and then peeeling skin off with your fingers. Ouch to you if you have any cuts on your fingers, but it makes the sauce better to not have curls of tomato skin in it. Seed the tomatoes by cutting them in half and scooping out the seeds w/ your finger. Whir the seedless, skinless tomatoes in your blender or food processor until smooth (or chop it in chunks if you want a chucky sauce). Add the tomatoes to the onion. Add the basil, salt, pepper and red pepper and let this simmer over low heat for 20 minutes or so until thickened and tasty. This is so good over pasta w/ scraping of parmesan and it's fabulous in calzones if allowed to thicken appropriately. Even better, let the sauce sit in the fridge overnight and re-heat it. Now you're talking!

These tomatoes came from Tip Top Produce. The farmer who grew them just killed herself at age 38 and this will probably be the last sauce I make w/ her enormously delicious tomatoes. So very sad.

Asepsis!: A Review

2006-10-03T20:26:00.000-07:00

Movie Review: Aspepsis! +

One of my textbooks (aside: I spent more on textbooks this quarter than on tuition! Don't try this at home, kids!) is actually a set of DVDs about nursing skills. My favorite so far is the one entitled Asepsis!+

The scenario is that three nursing students are learning how to keep things clean. We learn how to remove soiled gloves, how to keep a sterile field (DO NOT let your hands drop below waist level!) and Proper Handwashing Technique. I give the "film" three stars (out of a possible five). The action never ceases, the actors are perky and semi-believable (though the actors playing patients are a little too bit tidy and overly-friendly to be real patients) and the cast is diverse to a fault. There's the funny Asian American Guy Nursing Student! There's the amicable African American Gal Nursing Student! There's the patient Older White Gal Nursing Student (hey, I thought, that could be me...if I was tall and thin and had an assymetrical bob-do)! The conflict in the film comes about when a slovenly nurse is leaving the room of a patient who has an antibiotic resitant infection and she's NOT WEARING PERSONAL PROTECTIVE EQUIPMENT (which is up to and including a full on plastic mask) when confronted by the Amicable African American Nursing Student she (just about ) pops her gum and (actually) says, "What..ever." Next we find Amicable talking to her nursing instructor about it. I don't want to spoil the ending for you. Suffice it to say, you'll have to see it in the theater.

Next: I review the American Psychological Association's writing format.

+ The exclamation point was added by me, Student Nurse, for extra drama

First Day of School

2006-09-29T22:11:00.000-07:00

Yesterday was my first day of Nursing School. I shuffled from a PE class (oh, sorry Nursing School calls it "kinesiology" class), to Nutrition (Apparently you *are* what you eat), to Pathophysiology (that's diseases to you and me) to, uh, some other class. I was so tired at that point I can only call it The Class In The Room With No Windows Whose Climate Control Is Operated By Someone With An Undermedicated Thyroid Disorder. But I was given a crisp twenty dollar bill almost as soon as I sat down ("sign here," they said)+, so how bad can the class be...? Did I mention the climate control? Yes? Bad.

So I heard that there are many people in midlife making career changes to nursing. So, where are they? Not at Nursing School U where I am going. Nope. There are maybe 5 people out of 65 over the age of 30, I'd say.

Apples. Do you know what that means? No more peaches. And pretty soon tomatoes will be gone, too. I'm sorry. Apples don't stand in for peaches and tomatoes for wonderful. The apple tree in my folks' backyard fell down. It was host to many delicious apple pie apples. No. It was a golden delicious tree. Who knew that golden delicious apples make the Best Apple Pie in The World. Yep. Mom's apple pie.

+ so, the school decided to pay for my malpractice insurance and, apparently, the twenty clam was money I'd given them at Nursing School orientation

Refrigerator Pickles

2006-09-23T22:38:00.000-07:00

I want to eat sandwiches all day long so that I have an excuse to eat these homemade refrigerator pickles. I used this recipe:

1 Pound Pickling Cucumbers (about 8)
1 cup of water
1 cup white distilled vinegar of 5% acidity
2 Tablespoons sugar
2 Tablespoons kosher salt
1 teaspoon slightly crushed dill seed
1 teaspoon slightly crushed mustard seed
1 teaspoon cracked peppercorns
1/4 teaspoon red pepper flakes
1 cup fresh dill
4 cloves whole garlic, peeled

Combine cukes (I sliced 'em into rounds, you could leave 'em whole or slice 'em lengthwise), water, vinegar, sugar, salt, dill seed, mustard seed, peppercorns and red pepper in a large bowl.

Let it sit for four hours

Four hours later, place fresh dill (I choped it just a little) and whole garlic in a clean wide-mouthed jar (I used a big bowl w/ a tight-fitting lid). Remove cukes from brine and put them in the jar and cover them w/ the brining liquid (I included the seeds and such). Refrigerate for TWO WEEKS.

The first time I made these I used celery seed instead of dill seed. The question was: sliced or not sliced? I sliced 'em. The hardest part was having to wait for two weeks for the things to cure in the fridge. I tasted them after four hours and they were very cucumbery, but after a week they were more pickly (but still had a cucumberyness to them) after two weeks they were the best pickles EVER. A little spice-y and nice and crisp!