The Division

Lately, I've noticed more than ever the effects of getting older. The canyon developing between my eyes, the dark clouds under the eyes, a wider set of hips, dimples on the bottom cheeks.

People always warned me about getting older (watch what you eat, it sticks!), especially patients. The patients never failed to sugar coat aging: "It's no fun getting older."

But nobody ever told me about the division that would come with getting older (age) and children; or should I say being child-less.

And if you're a military spouse reading this, you probably have already noticed this little unscientific factoid: it is rare to meet a 30 year old child-less couple in the military. I like kids. They are painfully honest and incredibly entertaining. But for personal, educational, and medical reasons, we haven't had kids yet (although hopefully maybe one day soon!)

Anyhoo-In an effort to expand my tiny circle of friends here in this new hometown, I was invited (by a friend who has kids) to a book club dinner. It was a good time, and I enjoyed the social aspect of it (although lets be honest: I can't contribute to a discussion on the merits of one car seat over another). I was included in their plan to meet up for trivia night as part of their Mom's Night Out. I gave them my email address, and most of the girls immediately friended me on facebook. I considered it a success.

Last night, I get home from work, shower, eat dinner, eventually get to the computer, and see on facebook that I'm part of a private group, 'bookclub' where there's a post saying:

"Made a group so we can have our book info here and that way Rachel can join and not have to see all the mommy stuff from our other group. Did I forget anyone?"

And I think.....it's nice. Except...you've made it known that there's a group out there that everyone except me is a part of.

I should respond. But I cant figure out what to say. To say something funny would come across mean or acerbic; And to ignore it would seem snooty.

Every time I read that line I feel this little black hole or better yet, a big fat black line.

I understand it probably wasn't the author's intent (and there will always be groups out there that you can't be a part of), but it was just made crystal clear that when people get together, those who have children vs those who have no children is taken into account of invitation.

But enough mulling; Time to change into some running clothes and meet up with the road hogs for a 5 miler followed by greasy pizza and pizza. Take that Dividers!

hoping

my exam shut off at 75 questions today. I feel sick. I feel like puking. I feel like jumping off a cliff. Two of my classmates were at the exam, and we actually had some very similar questions.

We all answered them differently.

I've answered well over 2000 questions in preparation for this exam, yet I don't think any of those 2000+ questions helped me with the 75 questions I answered today.

I can't stand this wait and see period...

puking blood

This is a good news bad news story, and I'm shaking as I write this. In the grand scheme of things, this isn't horrible bad, but it just looks bad more than anything.

Here's a very abbreviated glimpse of what happened. I interviewed at a small community hospital over a month ago. They never called back. They did however, ask me if I wanted to do my preceptor (kind of like an internship) there.

I told the hospital that I already submitted my letter but I would see if it could be changed. The school told me that it might not be possible to change.

Over lunch one day during class, we (my classmates + clinical instructor) were talking about preceptorships and one of the classmates asked if I knew anything about my placement (she knew about my asking to possibly switch preceptorships). I mentioned how it probably wouldn't change because yadayadayada. My current instructor, the one eating lunch with us said, "I'll see what I can do."

During all this time, the small hospital was quite pushy about changing my preceptor assignment, going as far as to call the school, me, etc. The hospital sent me multiple emails. I kept saying, "Thank you, but I'll see what I can do." I really didn't to make waves or force changes....it was no big deal to me where I did my preceptorship.

I eventually found out my preceptorship would be at the small hospital. Still no job offer.

My current clinical instructor and I had our end of clinical evaluations and she ended up questioning me as to why I wanted that position. She made some comments that were totally true and it got me to thinking about that area of medicine.

Still no job offer.

Then, about 2 1/2 weeks ago the small hospital called to say they were offering me a position in a department that I thought I wanted...the one with the preceptorship. I freaked out...asked if it was ok to let them know in 2 weeks. They sounded surprised but were OK with it (they wanted to know right then and there).

Fast forward to two weeks later (which was last week). I had an interview at the big hospital. 2 days following the interview, I called the nurse recruiter. we played a game of serious phone tag.

My friend got a spot for the same position I interviewed.

Next day I still couldn't get in contact with the recruiter from the big hospital. I hastily call small hospital and leave voicemail saying I'll take the job.

4 hours later I get offer from big hospital. Better pay. Better benefits. In state (read: one state income tax, not two).

I play phone tag with nurse recruiter from small hospital. Finally get in touch with her today. Tell her I'm very sorry for not being about to get in touch sooner. Tell her I'm sorry about the offer. I know I verbally accepted over the voicemail, but I am no longer going to be able to work in their state. Repeat I'm sorry. She was silent and then said thank you for letting them know. Then that was all.

I didn't know what to do and I feel sick to my stomach. I'm worried about the preceptorship assignement and am hoping that the school doesn't hate me after this. I honestly don't care if I still do my preceptorship there. I never told my instroctors that I was even offered a job there, because honestly, I just found out a couple of weeks ago, before the preceptor garbage went through.

Seriously. Want to be an ostrich right now and stick my head in the sand. I'm confident that iI'm making the right decision in employment, and I hope that everyone else can come to this realization. I just hate that I made that hasty phone call.

Anxious

So I might have some big news about that thing you're supposed to start after graduation. It's big. It's so big that I'm hoping my cards are played right and that I'm making the right choice after screwing up eariler today. this is cryptic and vague, I know. Let's just say I can't manage to keep my foot out of my mouth and I have the inability to make a decision and I might have to change a decision that I made on a whim. The decision on a whim was made today and within 4 hours, the mind was changed. But as I haven't signed anything, I think it's ok. Bad, but not as bad as it could be. And because the more I type the more cryptic this message becomes, I think I'll write about something else.

Like parties!

There's an holiday party tomorrow night....one of the traditional students at my school invited me to her holiday party, which is complete with turkey and ham (!), so I'll need to figure out something nice to wear.

Shiny leggings might not be appropriate.

but they might be good for Saturday's Tacky Xmas party (you know, where you wear one of those awful sweaters/sweatshirts that are Xmas themed). I feel bad for all the older ladies out there who spend that much money on those sweaters!

Here's what I have so far to wear:
reindeer headband? Check
Red/Green sequined headband? Check
Rudolph blinking nose? Check
cream colored mock turtleneck with tiny snowman motif? check
Red sweatshirt with white lace collar, complete with design of xmas teddy bear wearing an xmas bow? Check
Xmas themed pins? Check and Check
leggings? check

I think I'm going to have to go with the stirrup leggings. As you may have seen from a previous post, the shiny leggings with a shirt above the butt aint' so cute (sorry, had to use the aint').

leg warmers? Check...although I might take those off...I think they were made for a 10 year old. no wonder they were only $4.

Keep your fingers and toes crossed that the right choice is being made and nobody gets upset... And that the xmas parties are fun :)

Weekend in Review

Too much to say, too little time (need some sleep!)

• Friday night Trivia: we rocked it with 2nd place! Followed by a very cold & brisk walk to other local bar for karaoke, followed by brisk and colder walk to friends home for some shut eye.
• Saturday: gourmet breakfast at friend's house, grocery shop, class project, Gator Game (um, YAY!!!!!!!!!!), Scrabble
• Sunday: NY Times @ local coffee shop, Costco (we bought a vacuum), lunch, try vacuum. In disbelief at amount of hair/dirt sucked up by vacuum. Empty canister. Repeat vacuum in same spots. Begin to wonder if the vacuum comes with dust bunnies that are to be released into canister or if vacuum is sucking so hard that the carpet will disappear before our very eyes. Finally, more lazy reading, purchase Xmas tree (complete with ice chips!), decorate, cook, eat, etc.
• Monday: Xmas tree is on floor, in horizontal position. cats are wisely hiding out and no where to be seen.

Second Thoughts

Today was the first day in the clinical setting where I actually thought, "Why am I doing this?" and "Is this (nursing) the right move?"

Nobody yelled at me or anything (my instructor actually said, "What the hell is wrong them?" in reference to the students who made this week's patient assignments), but that didn't stop me from feeling incredibly incompetent today.

Hopefully tomorrow is better.

Today...

was the first day I had to wipe ass.

No seriously. I was flirting with the idea (to myself of course) that I might actually get through nursing school without wiping adult poop.

But for this med/surg rotation, I'm on a medical floor (previously I was on a surgery floor). A floor that has a history of lots of poop.

Ick.

L&D Week in Review

In three days I “helped” deliver 2 babies. The first delivery was a C-section after over an hour of pushing. The second delivery was a vaginal delivery. I don’t normally get queasy, but I almost didn’t make it through the vaginal delivery. Newborn assessments went smoothly, but this experience confirmed that L&D isn’t for me. One of the nicest things (extreme positive) I saw during my L&D rotation is the love among the mother, the father, and the present family members.

Of the 5 nurses I worked with, two were pretty great. They didn’t mind when I asked questions, they invited me to try new-to-me procedures (my first real foley-yay!). I don’t want to go into negatives here, but when I become a nurse, if I ever have a student assigned to me, I will answer questions, show and explain procedures, and talk to them. I hope I won’t read Cosmo, ignore the student, or roll my eyes at the student or instructor whenever they ask a question. I hope to take advantage of teaching opportunities and, in a sense, pay it forward.

And about those teaching opportunities, here’s one where an MD got a chance to show a nursing student (me) how little she knew (not that I ever pretended to know much about nursing, much less epidurals). Be forewarned, it’s a lengthy post…

On Friday, the last day of the L&D rotation, a patient who was just admitted was getting set to receive an epidural and I was invited to observe the anesthesiologist administer the epidural (my first time).

I put on a mask and hair cover and the MD asked me why the woman was in pain.
SHIT. I wanted to say that the patient was in pain because she was in labor. So as I’m trying to not to pee my pants, I’m going on about “…well, uh, so, she’s um, in the first stage of labor….in the active stage…”

MD: Yes, but why is she in pain. What tissue is the cause of her pain?

Me: What tissue is causing her pain? Her uterus…uterine tissue? (Seriously, it felt like 2 minutes passed before I could answer that)

MD: Yes! You’re exactly right! Good. And what’s causing her pain?

(Another long pause)
Me: She’s having contractions…the baby…the fetus…the contractions…blood vessels are constricting…???(shhiiiiittt…I have no clue what this woman wants me to say. I don’t know! I feel like a certain woman from alaska!)

MD: yes, but what is causing the pain?

Me: I’m sorry….I don’t know.

MD: Ischemia. Decreased blood flow to the tissue. Ischemia is the cause of her pain.

At this point I feel like an ass. Of course ischemia is causing pain...that plus the build up of lactic acid....But it gets better.

MD: So, why is it important that I monitor the patient’s blood pressure after this procedure?
Me: The epidural is going to lower her blood pressure and we don’t want it to fall too low.
MD: yes, but why is it going to lower?
Me: (long silence). Her blood vessels are going to dilate….
MD: Ok. But before that. What is going to cause her blood pressure to lower?

I am nearly trembling. My knees are locked.

MD: We’re going to get her relaxed. That’s going to help lower her blood pressure. But what else is going to lower her blood pressure. Before (or did she say after??) we get her relaxed. Why (or what?) is going to lower her blood pressure.
Me: Numbing…we’re numbing? the numbing....I'm sorry, I’m not sure….

At this point the doctor says something about numbing the smooth muscle fibers (I think that’s what she said). Seriously, I was so low, beaten, dumb founded that I wanted to fall to the floor and faint just to get out of the interrogation.

And it doesn’t end there. The nurse I was assigned to had to leave the room and the doctor apologizes to the patient, “I’m sorry that you have to hear about this lesson while I yell at my student.”

Ally McBeal moment here: I envision taking this woman out with a karate move. But I continue standing there with my hands behind my back. I don’t even roll my eyes like the nurses on the floor.

And then just when you think it couldn’t have gotten any worse, the interrogation continues (seriously, if I was the doctor I think I would have kicked the student (me) out of the room for her lack of knowledge).

MD: Why did I use these two syringes?
MD: What happens if we get the medication in the blood stream?
MD: What will the patient feel if the medication is her blood stream?

And finally, the end occurs. The MD approaches me and tells me I should really review and become familiar with this medication, as I will be using it nearly all the time, on any nursing floor. I thanked her and she said, “No thank you! We really enjoy working with students…blahblahblah”

So that was my scary Friday. I honestly couldn’t sleep that night. True, I probably should know more about epidurals. Unfortunately, my maternity professor never went into detail about epidurals except to say that 60-70% of laboring women receive them, they are inserted between L3-L4, a side effect is hypotension, and THAT’S IT. My maternity lab instructor often voiced her opinion that too many women receive epidurals. None of our lab scenarios involved women receiving epidurals.

The questioning will strengthen my back bone (even if recounting the scenario as I just did makes me anxious). Clinical is about getting asked a gazillion questions in which you are not supposed to know the answers. However, it’s never happened to me so unexpectedly. Plus when questioned by our instructors, they help guide us and eventually, we end up recalling the processes studied in class. In my med surg clinical, if I couldn’t answer a question off the top of my head about a medication, I would tell my instructor, “I don’t remember off the top of my head, but I know that it’s in my folder on my drug sheet.”

A professor this past summer gave us some advice as we were starting our first clinical experience (med-surg). She said something to the effect of: “Don’t be that person who sits at home at night memorizing drug information and disease processes. Study the information. Take notes. Bring a clipboard containing your notes into clinical with you. Your instructor wants you to do your homework and care for the patient, not memorize facts and figures. It’s more important that you are able to find the information you need than to memorize. Over time, you will get your facts and figures down.”

Post partum rotation is next week, then psych. More soon-

drink please

worst clinical day ever.

Time to crawl under a rock.

BlubberMouth

ARG! Does anyone else blubber into the phone when talking to an answering machine? For the past year I was the 'welcome' contact for our squadron and have probably left my fair share of funny messages on the voice mails and answering machines of spouses new to the group. What I always meant to say was this:

"Hi! This message is for NEW SPOUSE. My name is Rachel _ and I'm calling from the _squadron spouse group to welcome you to the new area. I wanted to let you know about the spouse webpage and spouse coffees, information about the base and area, etc. My phone number is__. Please call me when you get a chance so I can tell you about everything, or answer any of your questions."

Except usually the messages came out:

"Uh, HI! This message is for NEW SPOUSE and I'm calling from the Dover Welcome Spouse Group-I mean the _spouse squadron group, er, the _squadron spouse group. My phone number is __. I wanted to let you know about the squadron and spouse group, how to sign up for emails, get on the webpage, spouse groups, and just to see if you had any questions about the area. So, again, this is Rachel and I'm calling....."

You get the idea. That's just one of the reasons I passed on the torch of "welcome person."

Today I got the nerve to call one of my professors. I'm not sure why, but I tend to get nervous talking to professors over the phone. Naturally this isn't an every day occurrence, which may explain blubber mouth. Two weeks ago, I called one professor who is also my academic advisor. I stuttered my way through, and my sentences made no sense (but she still agreed to complete the endorsement form-score!).

Anyways, back to today: I need a second professor to complete an Endorsement Form on my behalf...she never returned my email, which I thought was odd, but then figured she might just be out of the office. Classes don't start until next week, I figured she might be back at her office, but no such luck. I left a message on her voicemail and already, I'm cringing. She's probably thinking that English isn't a first language...(more on that later). Fingers crossed she gets back to me!