OR

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

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

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.