Just as I was gettng used to this level of misery, overwork, bordom, ennui etc...IT'S TIME TO BLOW THIS POP STAND!!!
We received an email today saying that our White Coats are in the ETP office, we need to pick them up and that we need to IRON them and CARRY them to the ceremony...LOL
I have one more paper I'm working on; a case presentation of one of my patients who had had a BT shunt (Blalock-Taussig) at 16 and a Fontan at 24. Seems odd to have it so late in life, but after reading about it, I wonder if this is what Steve, my physics prof, has had. I haven't heard from him since last summer. The emails have stopped. Men are peculiar, especially the smart, funny ones. (shrug)
So, I've been trapped inside on this lovely sunny (but windy day) reading journal articles and writing my butt off.
I'm looking forward to finishing the presenation of this patient, because that's the last day of class, and I have 3 days off following it. I might go downtown and meet my friend Eric (Hey Eric!) I couldn't make it to the Asado he and his wife are having for their new baby, Zephyr (coolest name, or what?) and while downtown I might try to see if I can find something for my non-official preceptor, Flora, whom I adore. A few of the ETP anesthesia/acute care peeps are planning on a night of some billiards and LFTs (liver function tests...i.e. "drinking") Also, I need to hang out at the MOMA alone for at least one day, to clear my head of all the ugly I've seen here. I can't wait to go home and paint and sketch again...there's been no time for anything here.
For the preceptor that I don't adore, nor loves me, I bought her a hundred dollar collection of 6 CDs, with the librettos for some of the best Operas ever written. I wish I could afford such a thing for myself. We've discussed opera a bit, she likes to go, but I still don't get the American "Opera is a high end, snob activity for which one must put on all one's bling"mentality. Fuck that. I love Opera in Italy, which is for the people. A ticket costs as much as a night at the movies, and is frequently more enjoyable. In Florence, we used to go to the Opera Comunale; in jeans and tee-shirts and fit right in with the rest of the community.
I miss Firenze.
I will start to look for an apartment in Florence in earnest once I am done with school. It's the complete antithesis of New York. As long as it's got an extra bedroom (for you free-loading bitches :P) and a terrace where we can enjoy a nice red and some cheese at the end of the day and call down to the piazza "Ciao!"
I went in today to talk to my liason...give her the letter from crazy.
She laughed and said it was a damned fine evaluation...great even.
Anyway, long story short (is there every really such a thing) I asked her what she thought about the this business of Columbia ETP making it so that we need our 50 weeks ICU experience BEFORE stepping foot back in the MSN program, and they referred me to Judy, the dean of the nursing school.
So, I went down there to talk to her.
She was surprised about my concerns and offered to look into it.
So, I emailed everyone in the program (no sweat...there are 6 of us)
Not that I care, because I sincerely am hating it here, and want to go home more than anyone can imagine...but it's the principle of the matter... Just who the hell do they think they're EFFING with, here, eh?
As we say in Italy "Aaoh, che cazzo...?"
As an aside, I'm thinking of chanign my name...I really hate it.
OK, so this is what I'd look like in nursing whites, with pinstriped pants on, if I were at a gay rally holding one of Frank Chu's 12 gallaxies signs...LOL!
I'll print one or two of these up and post them in the Nurse's Lounge and at the nurse's station. I RSVP'ed that 10 people were coming--optimistic, LOL! I realize this cuts off some of the links to the right, but if I make it 400 pixels wide, you can't even make out the writing...so that's where it's at. As we say In San Fran "Deal wit it, bitches" :)
The acute care/anesthesia students have come to one concordance: they've set us up to fail. There is no way in hell that we will find jobs in ICUs within two weeks of finishing up here. Even the CCU has a trainee program that STARTS in August. Krystell has already submitted an application and letters of recommendation, and says that a few other ANES people are pissed off and feel cheated.
Cheated? Yeah. We could have gotten BSNs from anywhere, and not ended up $70K in debt. They made it sound like it's 1-2-3 and you end up with your CRNA at the end (like the proverbial pot of gold at the end of the rainbow...it's not there)
So here is my understanding of my life as it is: I owe 70 grand, plus credit cards. I will probably have to work my way UP to an ICU, and then the ICU for a while before even being able to apply for the MSN-ANES anywhere else.
My life for the next year is all about getting what I need, education-wise, and fluffing up my resume by getting my CCRN and other such things.
as a side note (of humor and interst) my preceptor finally agreed to write me an interim review, and wrote me the following letter:
"On clinical performance:
She has a good communication skills with patients, their families and other allied health workers. She is compassionate and caring to the patients and their families and her ability to communicate in Spanish is a plus.
Her background of Anatomy and Physiology is excellent.
Administration of medicines is safe and accurate although she needs to pay more attention to the scheduled time. Perhaps her lack of experience is the reason for this.
She is very much aware of her limitations and comes to me for guidance without hesitation. She however limits herself in independent practice for fear she will get me into trouble. I have encouraged her to have more faith in herself so she could get the maximum experience I allow her to do while still maintaining safe practice for both of us." (actually...it's not for her...it's because I don't want to kill an acutely ill patient with an idiotic medication error. I could care less about her or me; I'm insured, and it's her licence on the line, not mine)
"Overall, it is a pleaure to work with Lisa as we all know her.
I wish her all the best and happiness she will find in her role as a Professional Nurse in the near future."
WTF?
Anyway, because I had to call in this morning to see if she would be in, I completely forgot I had CLASS TONIGHT untill I saw Krystell who said "so...I guess you skipped class tonight?" and I had my "D'OH!" moment.
Holy crap, I don't even have a case study written up. SO that's what I'm going to do now...and email it to the prof with profuse explanation of my screwball preceptor and changing schedules upon whim.
I sent an honest email to my liason, and the coordinator; they're always so flipping mad to hear of what's going on. I told them she refused giving me an interim review and today I got back an email saying "either she does it and it's in my office by friday, or I'm going to the nurse manager"
Oy vey.
My preceptor and the Nurse manager don't get along. During meetings, they get into these long heated debates, it's like clash of the titans; will against will. Everyone just sips their coffee and makes eye-contact.
The nurse manager likes me and would probably come down on my preceptor, but you know what they say: shit rolls downhill.
I say this with fistfulls of my own hair (ok, not really, but metaphorically) My preceptor is whack.
So, we're supposed to be getting written midterm evaluations, which I told her about two weeks ago. So I reminded her today. At the end of the day she comes back to me with a blank form and saying she doesn't want to fill it out, because she doesn't want to base her evaluation on just what she's seen me do.
The form is fairly simple. Rate me from one to four (four being exceptional, one being unacceptable) on things like interviewing skills and thorough chart review, Differentiation of normal vs. abnormal assessment findings. Documentation of care, etc.
She said "I have no problems giving you a 4 when it comes to 'aware of own limitations' but in things like 'administration of medications' I can't say"
I think she thinks I am an orientee and is thinking whether or not I'm ready to be on the floor, alone, by myself. She's given me two patients of my own, but I won't let me do venipuncture, or start an IV (wtf?) but she makes me hang potassium (which could be lethal) and give narcotics. Oy vey.
I work for a total of 9 or 10 more days (a few of them with Flora) and I will put this whole experience down as a Buddhist lesson in patience.
I wanted to come here the other day, but I got a late start, and so I didn't. I guess the impetus is that every time I've ever seen a movie or tv show set in New York, the dang arch shows up. (Remember "When Harry Met Sally" when she drops him off at NYU right at the arch? That, for some reason, stayed in my mind)
So, I took the A train all the way down there (took an hour) and came out on West 4th street. I like the sign below, sort of like "Welcome. Whatever it is you came here to do, it's not allowed; please take it elsewhere (unless you came to stand stark straight with children, and pick up trash...then you're quite welcome!)
No one told all the people with dogs and riding bicycles that it's not allowed here. And it's a damned good thing I left my martini glass at home!
The arch is lovely; not as nice as the Triumphal arch in Paris, nor the Palace of Fine Arts in San Fran (which was also constructed of papier mache, then made permanent as this arch was) but it's pretty none the less.
I didn't know this, but there's a statue honoring Garibaldi there. Seems the area was inhabited by the poor and working class Italian imigrants, back in the day, and they wanted a statue to commemorate Garibaldi's victories as well. NYU owns much of this area. Everywhere you can see students, and they were having a big barbeque in the park and took over a whole section of it. I can't say I wasn't envious and didn't think of how shitty it is in Washington Heights. Quite a different Washington altogether!
I really liked this neighborhood.
I wanted to live right here, in this little place (though, in the winter, this must SUCK! If I had to, I could live here, or the west village, or soho...I like these areas.
I walked around for an hour, then went to the park to chillax for an hour or so. There was so much live music (a really great jazz combo that was getting drowned out by al the damned hippy jamborie, tambourine fest/greatful dead/phish covers...blech!) Such a ruckus! (it was great!) I later went to get a slice of pizza, and checked out the area. It reminded me of Telegraph avenue in Berkeley, meets the French Quarter of New Orleans, and maybe a little of Amsterdam, too. (without the "Coffee houses")
There was also a street fair going on and it reminded me of the San Lorenzo market in Florence. All sorts of stuff for sale, and food, and pick pockets galore, I'm sure (one of the pockets to my bag were undone, but I don't keep anything in here, so sad surprise for Mr. Stickyhands, LOL)
I thought to myself about how in the last month or so that I'm here, I'm actually starting to enjoy it. I realize it was the weather, the program, taking 22 units, my health, being away from home, etc.
I guess if I have to come back in a year, it won't be so bad.
I'd like to say it was a good day; it was--for me; but a patient died on my unit, so I am hesitant to call it "good day" overall. No wars ended, no cure for any disease was found.
But, if we are to carry out this philosphy, there is some tragedy happening somewhere around the world, at any given time; does this mean there are never to be any days described as good days?
I suppose I tend to wax philisophical in the face of death.
Let me start over.
Today, my preceptor was in a good mood. She assigned me one of her two patients and gave me access to the pixis drug dispenser, and webcis, for charting. For twelve hours, I had everything to do--give meds, answer his call bell, charting, drawing labs, inserted a foley (much to his horror) and provided all the standard nursing interventions which make up a day of care in the CCU.
I loved it. The day went so fast, and I learned a ton. My preceptor and I got along like friends--she touched my arm when talking to me...this must mean she approved of me today. Either that, or she had taken her medications.
When she told me she wouldn't be around tomorrow, I said "neither am I, It's my birthday." Unknown to me she collected money from everyone and bought a cake for me.
We even shared lunch! Suzie, the ICU tech frequently cooks and brings in food to share with everyone--it's very Philipino to pot luck and share food in a communal fashion; it's kinda nice. So she made a big pot of white rice and some mung beans that were really good (some acorn squash, spinach or similar greens, pork, and a hint of some type of pepper...it had some kick) and my preceptor kept urging me to eat.
Afterwhich, someone showed up with the cake, and they sang happy birthday to me. I was touched.
Even if they didn't get my name right :) (that's Philipino and Spanish for "Lis")
And then, I was touched to see a message on the assignment board someone had written.
I didn't cut the cake right away, because of what happened in my community placement. I was afraid that there was some weird ritual of cake cutting that I didn't know about, or that 45 people would have to get a slice because they chipped in. No such--these guys are normal. So someone later said to me "go cut your cake!" and when I walked into the lounge, someone said "hey, cut that already so I can have a piece!" So I did.
As I sat and ate a bit of it, someone walked in and said that the lady next door was in full code. I put my cake down and went over to see if I could help.
She came back, for about 20 minutes, but then went into full arrest again, and this time, they couldn't revive her. So with the taste of my birthday cake still on my lips, she died in front of me. Her family showed up within the hour and I was very sad to see them. I wish they could have been there. I guess dying in an ICU isn't like dying in another place, where you can go peacefully--there is no way to have the family there watching all the crap that goes on.
It was much calmer than I thought it would be...none of that shit you see on ER or any other television show where they're all screaming at each other and the paddles are brought out, someone screams out "CLEAR!" or "GIMME TEN CCs OF BLAH-BLAH..STAT!!" That's just bullshit for tv drama. Or maybe it's just that these folks are not healthy people with so much to lose. They're already one foot in the grave, many of them waiting for someone somewhere to die and donate a good heart so they can go on living.
It was all about anesthesia getting her an advanced airway, (yep, just like the ACLS guys were saying...bagging way too fast, once every second or so) they gave her compressions every now and then, some epi, some atropine, a little bicarb, and then it was over. No one raised their voice, no one broke a sweat--business as usual at the CCU.
Blow out the candles and make a wish, Lis; the lady next door is dying.
This morning, I dragged myself out of bed after about 4 hours of sleep and got into my ugly blue uniform, with the synthetic, scratchy pants, and the ugly white shoes...who knew I had such an aversion to white shoes? I swear I'm never wearing another pair of white shoes ever again...and I dragged my tired ass to the CCU.
When I get there, I look at the schedule and my preceptor isn't on it. I have somehow added in a day that she was off. So, my other two preceptors weren't there either, so I had to just turn around and come home.
Not had to, I was feeling guilty, like I made it happen by dreading going in today--I wish I didn't have to...I wish I didn't have to...that sort of thing.
So, I guess I'll hop back into bed for a few more winks of shut eye, and then get up and start my day over.
So very tired. I'll be 41 next week, but that's not it. Everyone is dragging ass. Even the 20 somethings. That makes me feel better...at least I know it's not the MS.
I have a crazy schedule this week. Seems like they tell you you can't/shouldn't work more than 3-4 days a week, and then they tell you that if they go to visit you and your preceptor is there and you're not, you'll have some explaining to do.
So, my schedule for two weeks is like this: on three days, off one, on three days off one, on three days off one.
These are 12 hour shifts we're talking about, and I should say, they're twelve PLUS hours with my crazy preceptor. So, I'm doing like 6 days a week, almost.
If they overlap you and put all your free days up front in the week, and on the back end of the next week, it ends up that you work like a week straight or more without stopping.
And it sucks.
I'm so beat, I couldn't do any of my homework during the week, so I had to get up today and do it all before class. It's half-assed, too...but we've never gotten back any of our past assignments so we have no idea what we're doing.
We all met at Coogan's, a sort of sports/karaoke bar around the corner from school. And started the festivities...
Catherine was hiding the school uniform under a hoodie...school spirit, she came straight from clinicals!
Gretchen, Aric and Arthur singing something on the karaoke screen
Mahogany, Krystell, Wilson and ?
Arthur finally got up and sang "I got friends in low places" and brought the house down...we did our best to support him.
then Aric got up with Krystell and sang Van Morrison's "brown eyed girl"
Aric's girl, Claudia did her best to remind all that this is HER guy...LOL
Then, someone said something to the guys about there being a place that had burgers and fries up front, alcohol and club in the middle, and porn in the back, so naturally, the party moved there. Love was all around, as everyone but me and Cindy were paired off with their S.O. (and Arthur and Mahogany let out with the fact that they've been dating since summer...WTF?)
We first went to the burger/porn/club place. It's called POP (on 9th ave between 14th and 15th) Going thru this portal, you are hit with loud music, and the door guy looked like Marcelus from Pulp Fiction...he looked at my ID and said "ok Miss California" as he let me in, and Gretchen was "ok, Miss Iowa" LOL
A lot of 40 something guys in the club district. They go out in hoards, in their suits and hang out outside and smoke and check you out as you're going in. Sort of had a European skeevy quality about it. But honestly...I think it may have been the tastiest burger I've ever had!
Then Aric knew about some swanky-ass place on the roof of some hotel around the corner, and we stood in line and went in after about 20 minutes. I should have gotten a picture of the inside...it was very sleek and "Jetsons" like the clubs in Europe, but despite the great music, no one was dancing! it was like a stand around/sit around and be seen kind of thing...New York clubs are weird! they're about the scene and not having fun, it seems.
This was the elevator ride up in the swanky hotel (hotel G? is all we could hear) on 9th and 13th streets, off the 14 subway stop.
the only place we found was the outside roofdeck, so we hung out there (with all the smokers, blech!) but the view was nice...made me homesick, a bit.
From here, we decided that it was late (2:30) and we all had a day of writing clinical logs and case studies ahead of us (and blogging) so we called it a night.
Maybe because today is Friday the 13th, maybe because it's the 3 year anniversary of my mom's death, I don't know...but today was a tough day.
I'm on my lunch hour and forty-five minutes. This is because we start at 7am and she likes to take her lunch at 11, and she doesn't stop at all, all day long, so she adds her one 15 minute break to that hour and a half...then, she doesn't leave when I do (so she sends ME off at 11, but leaves herself at noon) then when I come back from my lunch hour and forty-five, I sit around for another hour or so, farting around on the computer, looking at my email, reading up on procedures...
whatever.
So, last week my preceptor was realy sort of down. Very laconic, curt even. I'd ask her stuff and she wouldn't even answer me.
Yesterday she was ecstatic, almost orgasmic, all day. Laughing a little too loudly when others were upset about something (one of the Fellows was really mad that an admission hadn't been reported to him before they came and she was cackling)
Sheesh. Was she on some mood elevating drugs? It sure seemed like it.
She was up up up (as Homer Simpson said "The dizzying highs, the terrifying lows...the creamy middles...")
Only, no creamy middles. It's all highs and lows with her.
Yesterday I got a ton of info, got to do a bunch of stuff and it was all good.
Today, she sort of cornered me in the med room and said she was surprised I didn't know about certian things with the IV pumps. She acknowledged the things I'm good at (mechanics, like understanding the swan ganz and how to zero it) but things like the IV pumps, and the fact that I didn't know where something was going to hang on a patient that has about fifty lines.
Again: Whatever.
She said she wants me to get more confident, yadda yadda, and basically this means giving meds by myself, which I know my school is dead against. But she really wants me to despite the warning in the preceptor handbook.
Again: Whatever.
Now I know why yesterday she said "why don't you go into teaching, or research?"
Nice. Is that your way of saying that I'm not up to the task?
I'm supposed to be LEARNING here, not coming here to show off what I already KNOW. I don't KNOW SHIT yet. I can't get her to understand this. The other nurses are asking me why she's treating me like an orientee.
She's in her fifties, and has been nursing since her teens, I guess...it's all she knows so everything is so natural to her.
Evan, the night nurse was also in the ETP program and this morning before she showed up, I asked him where it all came together for him. He said it was really the orientation that did it.
anyway, instead of a nap today, I spent my lunch hour looking up the Swan Ganz catheter again, because though I haven't done it in a week, I know I'll be expected to do it again today, by myself, no prompting. (and of course, she didn't even notice I was there, after lunch, let alone quiz me or let me do the swan ganz thing.)
Also, she asked me to list the effects of digoxin toxicity, which I did, (either bradycardia or tachycardia, usually ventricular, leading to poor cardiac output and therefore things like shortness of breath, poor perfusion so mental status changes, syncope, etc) and then she said, "No, no, no; those are the effects of digoxin toxicity...what do you want to tell the patient to report to you if they start feeling, those other things are too late. So I said "palpitations, heart rate changes, dizziness..."
She told me to go look them up.
I did.
It said "Shortness of breath, changes in heart rhythm, Fainting (syncope), change in mental status,palpitations...etc."
She also got after me because I had pulled out a med that was discontinued from a patient's regimen...let me preface this by saying that I can't get into the computer, so I have to rely on HER to get ME the med list and times of delivery.
I copied the time that was written on HER sheet, in pen by her...as she told me to do.
So we go up and down on this merry go round, me trying to figure out what she wants, while getting what I need (to learn some shit.)
This is so hard. I'm thinking maybe a CCU is a bad idea for the year off working...I might try to find a micu or sicu to go to. We'll see. I'm hoping they'll be as good training for the Anes program. I'd like to continue adding to what I'm learning here, but the thing that scares me is that Cardiac Patients are so damned acute, and on so many things, that I feel like I'll never learn enough in the next month to be a viable candidate at a CCU, let alone a CTICU.
Still, it's not as bad as what a few of my friends are going thru.
I'm going to make a list of the things I say, that I realize are California-isms or surf-lingo that I take for granted people understand. Yet, I say them here and people look at me like "what?"
"No worries" This is how I say "you are welcome." It means, don't worry about it; it's nothing, the least I could do, etc.
"Crazy" this is how I say "very." It's like--"Pedro in the mail room cut his hair and it looks CRAZY good." "New York in summer is Crazy hot"
or, sometimes, it's stretched out as in: Cray-zeee. This is an interjection when someone is telling an incredible story and "wow" just won't do it justice. Every other interjection becomes "wild!"
"F'I" (rhymes with eye) This means "if I..." "F'I had a way to get out there, I'd go"
I also catch myself saying "fitty" just like in Daly City. fitty bucks? nah, bro, that's too much scratch.
"scratch"-- money
I call people Bro and Brah (short for Brahdah, or "brother)
"howzit?" Generalized greeting, short for "how is it going?"
"wiped" means tired can also be "beat"
"yo" is sorta like Dude. "I'm wiped, yo." it also means, ya get me, do you follow what I'm saying, are ya aware?
"going aggro" This is when someone is being a trouble-maker, or is just ranting and mad, making a scene. "that dude went all aggro"
"stink-eye" When someone shoots you a dirty look, they just gave you the stink-eye. There's some Crazy Stink-eye being tossed around in New York!
"zah" Pizza
These are just the ones I remember raising some eyebrows, and getting a funny look or a "what?!"
I hate the week from Wednesday until the weekend. My case management class is wednesday nights, so I use up my weekends and tuesday night writing out my patient logs, and case study/soap notes and stuff...but from Wednesday to the weekend, it's a vast sea of NOTHING to do.
Bored, Bored, Bored! Why were we breaking our necks taking 22 units this summer, 20 the next? Were they trying to break us?
Summer was nice, because it was crazy hot, and we all went out on the patio/roof deck and drank, looking up and down town, and mostly across at that ugly George Washington bridge.
So, I think I saw on myspace that this Saturday Charlie is planning a shin-dig that starts at Coogan's, and moves south. He said something about getting LFTs and I knew some liver abuse was on the way.
I wanted to go SOMEwhere this weekend...I'm feeling all pent up and antsy. I was planning on going to a museum with my friend, Ashley, who invited me to her family Easter dinner but I was SO wiped out from the ACLS class (and the two hour's sleep I got cramming for the test sunday) that I had to respectfully decline. Unfortunately, she has to work saturday, so I'm on my own this weekend.
Oh yeah, here's a pic from the other night when we all went out to the Saigon Grill. There were 13 of us total, but here's one group pic I show up in:
and the "who's who"
I've been really bad about taking pictures and downloading them to the computer, then uploading to photobucket to post here...as you can see from the pic--I'm a mess!
Yes, I look tired. Yes, that's a much darker hair color than I usually dye it...they don't stock my "Natural" hair color here in Washington heights
and Yes, I've put on a few pounds. The Philipinas are fattening me up, I told ya.
Oh yeah, I took and passed my ACLS course (Yay!) I was completely sure I was going to pass out, or fail or something because Crista hadn't passed the hands-on bit. But the instructor I had was awesome, and I think he pitched me a nice easy one, like he knew I was going to be a girl about it and faint dead away. He said he didn't, but I dunno...I still think I got pretty lucky with the scenario he gave me.
So, I have been on a 3 day stoke, to put it in surfing terms.
I told all my friends here about the course, and to ask for this instructor. Of course, some of these poor wankers will wait until they're working so the hospital can foot the bill. Bitches, we're already $70K in debt...what's another $300?
Anyway, it's on my resume. Now I have to pass that damned NCLEX...then the CCRN...then get into the anesthesia program in the Bay Area so I don't have to come back out here....
It's funny, though. Now that I'm done with the didactic portion of this crazy course, I don't mind New York as much as I once did. I think I was loathing it pretty whole-heartedly. Now, well...it's not San Fran, but maybe there's some stuff I can see/do here before I leave it that might take the rotten taste out.
Last night, I went out to dinner with a friend, and had some really decent sushi. Of course, it cost about 4 times what my favorite sushi place back home charges...but that's the real estate I guess. We were on the water, in Jersey, looking back at Manhattan, and it was very interesting to even be that far away from it...I sorta missed it in some odd way.
Don't get me wrong, I still hate it.
But you know...just for a moment, the whole year flashed before me. Last May, I was worried about passing physics, and bothering Steve every morning about the assignments and homework. I was cramming my last Chem class ever and worried about not getting an A...I was worried about being away for a whole year...thinking about my health, how was the weather going to effect me? How was not having a car going to effect me...that sort of thing.
Now with 33 days left on the clock, I'm looking back and thinking, maybe it wasn't that bad. Maybe there's time to have a litte fun before I leave; see some museums, sight see, that sort of thing.
I'm not thinking about San Fran yet. If I do, I'll go crazy. I'm focusing on things like Balloon pumps, and implanted pacemakers, and cardioversion, and that kind of stuff. I still have my preceptor to worry about (she's sort of taken a turn and seems to not like me so much, anymore...I've no idea what's happened to change her demeanor)
I'm so tired, I don't have the energy to sleep, even.
What a tough and amazing week it's been.
So, on my unit, the nurses are so nice and amazing. I was joking today that I feel as though I've been adopted by the Philipines, because they are constantly feeding me and teaching me stuff...they're so amazing and nice.
I'm not on again until Wednesday, but Weds night they're going to a restauraunt called Saigon Grill, and said "of course you're coming" (this should be fun, they're a fun bunch.)
Anyway, of course I feel completely inadequate, like I don't know anything. My one saving grace is that I'm really good with physiology and pathophys and basic pharm, (the common meds we use over and over) so I'm able to talk through what's happening and why, so they all think I'm some kinda smarty pants (which, I'm so obviously not.)
"you're so good with the patients" "You're so good with the families" "what do you want to learn?" I need it all. I don't know a damned thing...show me, teach me...everything.
We had the same pt for 3 days in a row, a super sweet guy, with acute renal failure on top of his cardiac problems, so he's confused, a lot. The hemodialysis is helping but he thinks we're in the airport, then a hotel, then a restaurant, etc.
He has two sons and a daughter. The youngest son was nice to me, but then as I walked out of the room, he turned around and ripped into one of the nurses, later demanded of the physicians an explanation why it seemed no one knew what the others were doing, and the attending...all he could do was put his head down and apoligize. Since I'd already met them and they trusted me, I was able to tell him that though it appeared no one was communicating, they were...and things were well documented for all the staff to read, and that the reason nothing had been done yet, is they were trying to rule out certian things, and wait to see if his dad was going to respond to certain therapies, or not, and that that in itself would help lead to a more confident dx. I reminded him that the clinical setting is not like running a company. You can't expect two patients with the same condition to have the same outcome on the same treatment. You can't rush this--they still don't know what's really wrong.
After the attending left with his tail between his legs, I told him not to push them to jump into a treatment. They had been wanting to do a pericardial stripping, and from what I'd looked up, that didn't look like such a hot prognosis (only 10-20% efficacy) and the risks were big...that they were not in agreement that this is a procedure that he needed etc.
My acting preceptor, Flora, said "you're so good, so confident to say things to him, he's mean"
Nah, he just wants straight talk; honest talk.
Then when the daughter showed up with her mom, I asked them about DNR/DNI and what they had in place. He had really responded badly to them trying to stick a duotube (duodenal feeding tube) in and the spouse and daughter came in to plead with the residents to stop. The worry is that he'd wither away without proper nutrition.
So, they thought they had a DNR but they had a DPOA and I told them that wasn't enough, and got the physician to talk to them about it. The spouse and daughter went home to talk about it, and read the forms, etc.
So, I did ok. They thought I was a rock star, and the nurses were patting me on the back.
Anyway. I'm one of the lucky ones. I don't think the other student on my unit doing nights is learning as much, but at least she's learning more than a friend of mine who was placed in a step down unit.
Walking home together tonight, he told me that his preceptor is advocating against him and against students in general being on that unit. So, he's not having a good time.
Sad thing is, I think he's one of the best, if not the best student in this program. Not only academically, but with patients. So it's very sad. He's not alone...several people have shitty placements and are getting bascially ripped off with this integration experience.
I'm super lucky. Finally, I hit a good streak.
Although, they like me so much they said the were contemplating not passing me for the integration so I'd have to stay in New York and have to come back...they don't want me to leave.
That's sweet, but couldn't I just come back to visit you all, instead? :)
