Learning to Catch

How Pain Management Conversations Work

2009-06-11T18:40:00.002-04:00

Nurse: What were you thinking in terms of pain management?

Patient: Well, I really would like to do this myself, without meds. An epidural would be an absolute last resort. I've thought about this and if I need some help, I'd like to have some Stadol.

Nurse: Right. Well, epidurals have no risk, but Stadol crosses the placenta and hurts your baby. You should really consider the option of being comfortable. If your labor were more comfortable, you husband would be happy. So would your mom and family. And, really, I'd be happier. Plus, when they wheel you down the hallway for your c-section (first mention of possible c/s to the patient), you'll be ready to go, and it'd be all done.

Patient: I would really like to avoid a c-section if at all possible. I was really hoping for a water birth. I would only want a c-section if I or my baby were in danger.

Nurse: My daughter had three, and her epidurals were started before 1 cm. She's happy and the babies are healthy. Besides, you can always have a vaginal birth for your second baby.

What MCM wishes she could have said while in the room: Holy &^)#, have you lost your mind? Have you made a conscious decision to trample upon this woman's rights as a patient and a human being? Has it occurred to you shut your stupid trap and respect this lovely woman's vision of her birth? Could you maintain basic courtesy and nod and smile despite your obvious incompetence as a nurse? Am I on another @~*!ing planet? Is this for real? Have you ever heard of ethics? Crawl back in your archaic hole full of paternalistic bull%-$& and don't come back.

Instead, MCM will do something rational and well-planned like, oh say write a letter. It doesn't beat venting the rage, but alas, there's that whole decorum thing.

Alright, alright

2009-01-08T18:35:00.002-05:00

MCM has been a little absent from this blog-O-sphere.
MCM has been a little absent period.
Holy hell, let it be said how nice it is to sleep. eat. talk. sit. knit. walk. cook. shower. watch movies. It's amazing!

Now for longer-term good news. There are only 700 days or so until MCM moves back to her beloved homeland.

Nursing school has been many things, mostly good. Yet, MCM is not a big fan of this city. She misses her friends, and the comforts of home. Where is home you might ask? A) MCM wouldn't disclose such personal information. And, perhaps more importantly, B) She doesn't entirely know. She can however narrow it down to a particular side of the country.

Yeah, I hear ya. So much talk about coming and going. Well, at some point, MCM will have something to tell y'all about the babies and vaginas she came out here to hang out with. But, for now, you're stuck with soon-to-be stories of psych folk.

Thanks to the Jewish Guy on the Corner of University and Oak

2008-11-14T17:54:00.005-05:00

MCM isn't religious. You could call her spiritual. You might even call her Buddhist since she meditates and enjoys Buddhist ceremony. But, as Forest Gump might have said, religion is as religion does.

For example, Christian groups that bring starving children in Sub-Saharan Africa bibles when what they need is food and safety...those are bad, ugly, evil people. Or, at the very least, they're brainwashed and heavily misguided.

But, people who are active in church groups to fund-raise for communities or to help animal rescue groups or feed hungry families for the holidays...those are good people who use religion for good. MCM likes these people. MCM's best friend is both a Christian and an amazingly good person.

Today, while walking downtown, a Jewish man approached MCM and asked her is she was Jewish. She replied that she was not, but that she had participated in a handful of Jewish ceremonies, and really enjoys the beauty of their religion. This man offered MCM a set of candle holders, candles, and the offer to have a female Jewish student come to MCM's home to teach her how to light them and sing for Shabbat. How nice is that? He wants to encourage students to come together, Jewish and non-Jewish.

Now, to the meat of the matter...Prop 8.
MCM is pissed off. Why do Mormons feel the need to fund hate against gay families? Really? Could they not think of any other places to spend their money? Really? Poverty, child abuse, families who lose their homes with the economic downturn, cancer, AIDS, and chronic illnesses, I could go on? Really? Priorities people!

Candles are so much better than hate.

MCM is pro-candle.

A Whole New World

2008-11-06T20:59:00.004-05:00

Obama! Mr. President-to-be Barack Obama! YES WE DID!!!

Really. MCM is pinching herself. Words can't even touch what this means. It's been a long time coming. An intelligent, articulate president. A president that sees ambiguity, and weighs decisions with the benefit of the people at heart. A man who chose an intelligent woman as his equal life partner, and devotes himself fully to the happiness and well-being of his children. And, yes, a black man. A man who represents the untapped power among the many who have been made to believe they have none. A president with an intricate life history, one that mirrors the amazing tapestry that makes up this country. It's been a very long time since MCM was unequivocally proud of a political event.

Well, there is one item on MCM's wish list: Mr. Obama, would you please reconsider your perspective gay marriage? Equal rights are key, but, there is no good reason for the the denial of the usage of the word "marriage".

MCM is pretty darn certain that her life as a future provider of women's reproductive health care just got a whole lot easier.

And yet another new world - a new clinical rotation, the halfway point of med-surg. Psych is creeping up upon us. MCM's new floor is a surgical unit. Her patient today had an aortic valve replacement. He was a kick - a physicist, and sharp as a tack. It was wonderful when he warmed up to MCM, and told her about his life, his wife, and his hopes for the future.

MCM is feeling like a confident vital sign taker, medication administer-er, IV pusher, physical assessment assessor, comfort measure provider, I & O measurer, weight-taker, ambulator, pathophysiology understander, care plan writer, chart reviewer, paperwork filler in-er, patient educator, clinical information communicator, relevant questioner, and nursing student impersonator (ok, just kidding 'bout the last one, sort of). Furthermore, she aced a test, a hard test. She's sure it won't last, but while it's here, she'll rejoice in the joy that is her newfound competence!

9 weeks, 6 exams, 3 skill check-offs, 6 care plans, only 3 bouts of crying, and 1 very sore cerebral cortex. And toin = 10 to 20 (yeah, don't worry about that one)

Nurse, Heal Thyself

2008-10-10T02:25:00.002-04:00

Risk of mental/physical/emotional collapse related to direct-entry graduate nursing program as evidenced by lack of sleep, headache, self-report of ridiculously high anxiety, and general bitchiness.

Sometimes the beer gods heed your cries

2008-10-03T19:38:00.009-04:00

The gods have heard the whimpering deep within MCM's soul. And, they answered it with "free beer for grad students" night. This event apparently happens on a regular basis, and with it being October and all, there was also hot spiked cider. Oh, and tater tots. Seriously? Heaven!

Exam 3 is nipping at MCM's heels.

Skill check 2 is a thing of the past, and she almost nailed it - except for the part where she threw a piece of glass in the trash. Note: glass is sharp - it belongs in the *sharps* container.

Next week will be week 4 of clinical. Up til now, MCM has been blessed/cursed with relatively healthy patients. They've been able to move their own bodies, and eat their own food, swallow, and even talk - gasp! Now, it's been nice to have minimal butt-wiping, relaxed vital sign-taking, no need to turn Q2, and a lack of worry about the patient having some sort of serious issue thing (insert 'medical crisis' in lieu of 'issue thing' if you're picky about word stuff) while MCM is in the room. But...with health comes boredom. Isn't that aweful? Yes, MCM is mildly evil. But, you learn from having sick patients who have foleys, and pressure ulcers, and NG tubes, and betadine boots, and another half million tubes entering their fragile, failing bodies.

Oh, and care plans. Oh, care plans. To MCM's wonderful clinical preceptor: thank you for not giving a crap about whether our care plans are perfectly formatted, regurgitated information. Care plans are a bitch and a half. As much as MCM loves going to spend 2 hours to review her patient's chart after a long day of class on the night before clinical, then spending 4 hours writing a care plan before getting up at 5:30AM, she really dislikes having to squeeze BS into cute little Word boxes that inevitably re-format themselves without asking permission. She sees it as an exercise in futility. But, what she does find helpful...carrying pharm flash cards in her lab coat for each of the drugs her patient is on. MCM uses Mosby's Nursing Drug Cards. Boy howdy, the drugs that old people take would astound you! These folk, Buddha bless 'em, are taking drugs to increase the rate of eyelid blinking, and another drug to maintain the structure of their toenails, and another to keep lint from accumulating in their umbilicus! Whew: one patient, twenty-five drugs!

MCM put in a good 5 hours today studying drugs and their drug-like properties for the upcoming test-o-thon. And, now, she shall eat a little dinner, sober up, and get back to it.

She's almost finished with the anti-hypertensives. Did you know that Loop diuretics cause ototoxicity? Yeah, she didn't either. Her brain could use a tad bit of diuresis. Next at bat: drugs for heart failure, angina, and anti-hyperlipidemics.

A word for the wise: don't overdo it with the cheeseburgers and milkshakes. There is evil that lurks within your blood, waiting to kill you.

Insert complaints of sleeplessness, mental fatigue, and desire for beer here: ___________

2008-10-01T21:52:00.003-04:00

Nuff said?

Right, well, allow MCM to elaborate.

Tomorrow is exam numero dos. The course has a name, but really, it's a catch-all for all things scientific not mentioned elsewhere. And, MCM is really not 100% certain how knowing that polar bear liver is high in vitamin A will help me clinically or how the Chicago Cubs relate to GP6 and glutathione. But "Ours is not to reason why. Ours is but to do or die", right?

Death is bad, so MCM has opted for doing.

A Pharm exam is soon to follow, and the approaching weekend seems to be more of a weekstart.

If it hasn't been said enough, allow MCM to contribute the following factoid: grad entry nursing programs are hard.

One thing that she am greatly looking forward to: Thursday night. The bigger ass Palin can make of herself, the better MCM will feel. So, Sarah hun, please don't let her down. Oh, and, if you're scared, MCM hears that Tina Fey is available to be your stand-in.

Ok, now - nuff said. Goodnight.

Things come and go so quickly here...

2008-09-21T00:03:00.003-04:00

If you knew that the title is a reference to the Wizard of Oz, you earn 5 brownie points in MCM's book.

But, really, it's true.
The first day of clinical has come and gone. The first skill check-off went down with maximum drama and insanity. The first exam is rapidly approaching, and will no doubt fly by, and usher in many more hoops and hurdles.

The first clinical day was relatively uneventful. Real-world bed baths are a lot less comprehensive and infinitely less academic than the lecture. The hospital seems to be full of objects, diseases and techniques that have names, and people who don't.

It troubles and disturbs MCM that she doesn't remember the name of the woman whose old and ailing body was exposed to 8 strangers so that her clinical group could learn to give a bed bath. The woman whose ability to communicate was so diminished that MCM's convinced that were she to feel uncomfortable with said exposure, it would have gone unnoticed.

In the Know

2008-09-09T19:21:00.005-04:00

This time last year MCM was in an information-acquiring stage. You've read allnurses.com, right? Well, she spent days upon days upon months trying to ascertain what the first few months of an advanced program like this was like. She learned very little, and wondered why no one could seem to articulate their beginning experience well.

Allow MCM to fill you in:
Your brain is overtaxed you feel like you'll vomit, but you're terrified of letting the fear in because of the nagging feeling that you're the only one who's screaming bloody terror on the inside. Of course, you're not. Everyone is freaking out and insecure, and has deep-seated fears of their own incompetence or unpreparedness. You'll feel like an impostor, like you accidentally wound up where you are.

You may think you know about Physiology. You're wrong. You may think jumping into the middle of the ocean with no flotation device will be refreshing and fun. You're only 10% correct. It is fun. That adrenaline kicks in and that feeling of "holy crap" is highly motivating. It's also scary, and lonely, and strange. And that fear of drowning doesn't go away, even when you're told you'll be fine, even when you know you're not alone, even when you know you're smart, even when you know you'll work hard. I guess the trick will be to, every now and again, take a look at your limbs and realize that you are in fact swimming, slowly but surely.

In the next few days, MCM will provide some variety of clinical care to patients. Did anyone tell them that some scared-out-of-her-mind student with no experience was going to be sticking a needle in their arm, or helping them with footcare, or taking their vital signs? Did anyone warn them? Really, this can't be a fair shake for them.

But, MCM will smile, and do her very best-est, and give her very all-est, because like her momma says, that's all you can do...

SyllaBUSLOAD of work!

2008-09-03T19:52:00.002-04:00

MCM has a stack of books on her desk that could rival the weight of a small sumo wrestler. Actually, if NASA satellites flew over, she's pretty sure they could spot the multiple chunks of tree text on her desk from several light years away. Uruguay called and they'd like their rainforest restored. You get the point...

For some odd reason, MCM feels compelled to do all of this reading. 80% of it is not particularly useful. And, she already knows a great deal of the information contained in the silly intro chapters, but hey, it's an assignment right?

Can you hear the pitter-patter of the goodie two-shoes?

Gratitude sans Platitude at an unknown Latitude

2008-08-25T21:26:00.002-04:00

Although MCM is not naming her Institution of Higher Learning, she would like to express how happy and grateful she is to be where she is, and to be with the people she is with.

And, she'd like to thank from the bottom and the top and the sides of her heart all the people that rooted for her along the way.

Cheers to happy new beginnings and to a long-awaited dream in the making!

How dumb do you feel when you fall down the stairs?

2008-08-22T13:33:00.002-04:00

While moving boxes today, MCM tripped and fell down the stairs of her apartment. She wasn't injured, and no one saw it. And yet, she couldn't feel much more stupid sprawled out against the railing.
To her credit, the box (which included a set of knives) she was carrying remained undropped and undamaged! Maybe she's smarter than she thinks...

Books, Scrubs, and other Nursing Paraphernalia

2008-08-21T00:17:00.002-04:00

MCM has dutifully obtained her school supplies. She roamed the "back to school" section of Target with all the other school kids.
And, she ordered books.
And, she ordered a spiffy backpack to carry all this stuff to and fro everyday.
Thanks to her lovely friend, also a nursing student, she now has a traveling receptacle to carry her drug of choice, caffeine. And said receptacle matches her new backpack.

MCM's mom has a picture of mini-MCM standing in the doorway, holding a lunchbox and wearing pink overalls, on her way to kindergarten. It's kinda like that, only she's taller this time around.

Bienvenido

2008-08-11T12:53:00.001-04:00

So, presumptuous as the web address may be, I am on a mission. I want to catch miracles.
I'm about to start nursing school in one of those pack-it-all-in-3-years sort of institutions. In the end, I'll be a brand spankin' new Nurse-Midwife.

So, this will be the place where my journey will be cataloged.

Let me begin with this important, but not yet necessary, caveat:

ALL details included in this blog regarding any patient contact that I have will be changed significantly to protect patient confidentiality. ALL OF 'EM. Cuz that stuff matters.

To make things more fun, and because I adore newFNP, I'm going to remain anonymous. From this point on, I will call myself Miracle Catcher in the Making, which for obvious reasons will be abbreviated as MCM.

Cheers,
MCM