Word of the Day

From dictionary.com's "Word of the Day:"

laggard \LAG-erd\, adjective, noun:
1. a person or thing that moves too slowly or falls behind
adjective:
1. falling behind; slow

Yep, that describes me today. I sat on the couch and did almost nothing all day long. Technically, I'm not falling behind because I have nothing that needs accomplishing, but I would definitely say that not showering or getting ready for my day until 4:00pm counts as moving too slowly. I watched some quality daytime television, ate leftovers for lunch, made myself some coffee around 2:00, and showered at 4. So now that it's 6:00 I'm ready to start my day...

Good thing there's always tomorrow to accomplish all the things I didn't manage to accomplish today (a few last minute Christmas things, the gym, and some serious present wrapping)!

May the punishment fit the crime

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/13/AR2008121302147.html?hpid=topnews

What an interesting concept of justice...

The First Anniversary of my 25th Birthday

This year on my birthday, in addition to thinking about how OLD I am getting...I was thinking about how much things change in a year.  It's kind of amazing really.  I wonder what things will be like in another year...

As for the rest of my life, things are chugging along.  I ONLY HAVE ONE MORE SEMESTER LEFT UNTIL I'M DONE WITH SCHOOL.  I am more than thrilled about that.  I thought the end would never come...and here it is, staring me in the face.  Only 14 weeks of school stand in my way.  That might sound like a lot, but when you've already endured 14 weeks x 4, it really isn't so much (I'm not in the mood to actually do the math).  

Also, John comes home from his 5 week grand tour of Eastern Europe TOMORROW.  Hooray!

That's about it...

A new perspective

Yesterday in clinical I spent the day in the Intensive Care Unit (ICU).  I think I am going to get "DNR" tatooed across my chest.  The patient that I helped take care of was on a ventilator and was sedated.  He had been sedated for nine days.  He was in respiratory failure because he had pneumonia in addition to acute liver failure (his body couldn't process fluid very well and it overwhelmed his lungs).  The theory behind his treatment was that once he got over the pneumonia, he would be able to be taken off the ventilator.  My thoughts were...what if he couldn't be taken off the vent?  Did he say goodbye to his family before they intubated and sedated them?  What sort of mental repurcussions does being sedated for nine plus days have on a person?  This experience really made me reconsider what actions I want taken if I am ever sick or injured.  

Mid-semester vacation

My trip to Seattle a couple of weeks ago was wonderful.  I met John in Seattle the day his post-season meetings ended (Wednesday), he came to pick me up from the airport and then we headed south to The Dalles, OR.  We drove through central Washington instead of taking I-5.  We've both seen that stretch of I-5 more times than we care to count.  The drive was pretty.  Unfortunately John was not excited about stopping at the Historic Mural Museum in Toppenish, WA.  Also, despite what you might think (and contrary to what the billboards tell you), Yakima is definitely NOT the Palm Springs of Washington.  Definitely false advertising.  

We got to The Dalles, ate dinner, and headed out to John's aunts house.  She lives on a farm about ten miles outside of The Dalles.  The next day we headed in to Portland (about a 2 hour drive West) where we went to visit his Grandma in the hosptial.  She had bypass surgery about a month ago and then suffered a stroke about three weeks ago.  She's doing well.  She was unable to speak when we saw her, but she was all smiles when we showed up.  One of John's cousins was there too.  He has been sending out daily updates on how she is doing, and when he sent one that mentioned that John and I had been there...he got more emails back about me than he did about grandma!  After we left the hospital we had dinner with Courtney (my roommate before she moved to Portland) and then we headed to Margaret's house (a friend from college).  Friday we visited John's grandma again and then went to a Blazers game with Margaret.  After the game we met one of John's friends from college and went out on the town (well...one bar).  It was amusing, being Halloween and all.  Saturday, after a DELICIOUS breakfast, Margaret took us to OHSU where we rode the tram down the hill and back up.  Then John and I headed back to Seattle.  

In Seattle we stayed with Kerra (my roommate in college...she still lives in the same house I lived in too).  We did a lot of eating there.  Thai food for dinner, Molly Moon's for dessert (http://www.mollymoonicecream.com/).  I had balsamic strawberry ice cream.  It was amazing.  Sunday we went to Zoka for breakfast, had some Vietnamese noodle soup for lunch, did some shopping at UVillage, and went to Etta's (a restaurant in the market) for dinner.  Monday we said our goodbye's to Kerra and David (they had to go to school) and headed back to Zoka for breakfast.  They had my favorite...ginger peach scones!  We ate at Aladdin's Falafel Corner on the Ave for lunch.  I had the most amazing falafel I've ever had (sorry grandma) and John had a gyro that was rather large and very tasty.  We stopped by the Museum of Flight since we had some time to kill before going to the airport and then returned our car and came home.  

It was a short and relatively busy trip (although I feel like we didn't DO much of substance...but that was kind of the point), but wonderful and much needed.  Now John has run off to Europe for five weeks and I'm slogging through the last five weeks of my second to last semester of school!  

For Greg

I recently recieved some very sad news.  A good friend of mine killed himself last week on Thrusday.  It's one of those things that you hear about all the time and hope dearly that it never happens in your circle of friends.  I worked with him at Royal Celebrity Tours for the past four summers and he and I briefly dated last year about this time.  Most recently we were on good terms.  Given the fact that I worked at RCT again this summer, I decided it was just easier to forgive and forget and go on being friends.  

I'm having a really hard time dealing with this.  Actually, I'm not dealing with it all.  I don't know HOW to deal with it.  How do you deal with the death of someone who, at one time, cared about very deeply.  I guess part of the issue is that since we ended things, I have been the standoffish one and I feel like if I had more time, I could have gotten over that and we could have gone back to being "normal" friends again.  

I thought that writing him a letter might help.  But it didn't...because now I have this letter and nothing to do with it.  So, I've decided that I'm going to cast my letter into the abyss of the World Wide Web.  I'm pretty sure that the dead don't check their email, but maybe they can read things that are floating around on the electronic superhighway.  The internet does everything else...why wouldn't you be able to use it to tell those who have died how you feel?  So...here it is...

Dear Greg,

I have so much that I want to say...and yet it all seems so pointless. I am sorry for whatever 

happened to you that made you feel like you just couldn't take it anymore.  You were always 

so generous in giving help to others, it is unfortunate that you never were able to ask for it or 

accept it on your own behalf. You always said that you didn't really like to talk about things.  

Neither do I, and if nothing else, I guess I will take this this as a lesson in how important talking 

about things can be. Sometimes it helps just to tell someone else what you are feeling. It makes

it a little more bearable, even if the other person says or does nothing.

I want you to know that I am extremely sad. I am sad not just because I lost a good friend, but 

also sad for all the other people who have lost a good friend too. There are so many people out 

there that would have done anything keep a good friend around. I am heartbroken at the thought 

of you out there all alone.  The image of you lying in the bushes in the dark truly breaks my heart.  

No matter how much you do not want to live, you should NEVER have to die alone.

I am also angry. I'm angry at you. Did you think that no one cared? Or that we wouldn't miss you? 

Did you care that we would miss you?  I realize that you probably were not thinking of anyone else, 

but you must have been because you called someone. Someone knew where to find you. I know 

you have been through a lot, especially this last year. Were you just tired of waiting around for it 

to get better? Were you afraid that it might just get worse? Again, I know you were probably not 

thinking of anyone but yourself, but did you ever consider what those of us you left behind have 

to go through? I can't help but wonder if I, at any point in the four years that I have known you, 

contributed to your decision in anyway. I'm pretty sure I'm not the only one either. Now we all are 

all left wondering how we could have missed all the pain you were experiencing. We all want to 

know if there was anything we could have done, something we should have noticed. But worst

of all...did we have anything to do with it?

Were you scared? Was it hard for you to do? Have you been planning this for a long time or did 

you just decide at the very last minute that you couldn't take it anymore? Did you think about 

what would happen to your dogs? Your house? Did you think about what everyone else would 

have to do to take care of all you things? Did you even care? Did it hurt?

This may sound terrible, but I would also like to thank you. Thank you for making me realize 

how incredibly important it is for me to tell the people in my life how I feel about them. I guess 

I never know when I might be seeing them for the last time. I am going to try my hardest not to 

let my feelings go unsaid. With that said, I want to tell you that I'm sorry if I haven't been the 

most pleasant to you over the last year. First I had to deal with the fact that you hurt my feelings 

pretty badly by lying to me. Then I had to deal with the fact that every time I talked to you I felt 

like you were trying to wriggle your way back into my heart again. I dealt with that by being 

standoffish. Not the best choice, I know. Nothing hurts me more than knowing that if I had more 

time I could have gotten over all of this...and then maybe we could have gone out for coffee again 

like we used to. Asfriends.

I wish that when you came to get coffee on Monday I would have known that I would never see 

you again. I wish that I could have said goodbye. Given you a hug. Or wished you all the best.  

I hope that wherever you are now is better than wherever you were before. Please know that we 

all cared and that you will be missed.

Always,

Martha

My triumphant return to the gym

So I finally got my act together and joined the gym.  It's amazing what some good music and 45 minutes of gut busting exercise can do for the mind.  I'm glad that the gym has declared itself the "judgment free zone" because I might have been dancing while I was stretching (I can only imagine what people thought in spite of the judgement free environment).  

John made me go both Saturday AND Sunday (such a slave driver...I know!) but I had to force myself to go alone today.  But now after my 45 minutes of hell, a shower, and some delicious food...I'm feeling much better!

Something to chew on...

Just something to think about from a blog I read (www.dooce.com) 

Why any woman who intends to vote for McCain should reconsider

FRIDAY, OCTOBER 17 2008 FILE UNDER: DAILY

Two of my favorite bloggers in the past couple of days have explained in succinct detail why we (women in particular) should be sickened by John McCain. I implore you to take the time to read these, they're not just a bunch of liberal propaganda or pro-choice cheerleading. These are stories of people's lives.

From Alexa at Flotsam:

McCain states that he would deal with the issue of abortion with “courage and compassion.” I quote: “the courage of a pregnant mother to bring her child into the world and the compassion of civil society to meet her needs and those of her newborn baby.” As if terminating my pregnancy would be the easy way out, the way not requiring his precious “courage.” As if dictating my medical care based upon his religious beliefs is compassionate. And I find it interesting to note that his “compassion” for this newborn does not extend to guaranteeing it health insurance.

And Julie from a little pregnant:

He means us when he holds up his hands and says with that single scornful gesture that we don't matter. That we are a figment of the "pro-abortion movement's" imagination. That — what, we're making this whole "staying pregnant might kill me" thing up?

... even if you're implacably, unconditionally opposed to abortion, a matter on which reasonable people disagree, I don't see any way a thinking person can look at those air quotes and see anything but pandering, contempt, and a dangerous willful ignorance.

"Fall" in Alaska

This picture is from last week.  I love "fall" in Alaska!

On death and dying

I learned today that a patient I took care of a couple of weeks ago died.  She was 8 years old and had a brain tumor.  This was the third time that she had a recurrence.  Her radiation therapy and chemotherapy gave her an infection in her lungs that she was not able to overcome.

I know death is a normal part of working in the field of medicine, but that doesn't make it any less sad.  The saddest part is that her parents didn't want to tell her that she was most likely not going to make it.  I realize this conversation would be extremely difficult to have with an 8-year-old, much less your own child.  But kids have amazing intuition and she probably knew that something bad was going to happen.  I think that having that conversation with her could have relieved a lot of anxiety for her.  Her parents just wanted her to be happy, but it's hard to be happy when you're scared because you don't know what is going on.  I know this isn't my decision, but I think I would feel differently about her death if I could believe that she wasn't scared.  

I doubt that having patients die will ever get any easier.  In fact, I hope it doesn't, because death is not something that I ever want to be desensitized to.  

Pictures

I FINALLY uploaded the pictures from my camera from John and my trip to Copper and our hike on Powerline Pass.  You can view them by clicking the link on the right to "My Pictures"

Getting political...again

So I acted like an adult today and watched the first round of presidential debates...big mistate...they just made me mad.  Not that I was ever going to vote for McCain, but he DEFINITELY lost my vote with his little plan to stop spending money on anything but defense and taking care of our veterans.  Excuse me?!  What about the rest of us?

http://www.slate.com/blogs/blogs/xxfactor/archive/2008/09/27/i-like-veterans-as-much-as-the-next-girl-but.aspx

Back to school

After a WONDERFUL two week vacation from school, I'm back to the grind again.  During my break I got a chance to play a little and work a little extra.  John and I took a trip to the Copper River Princess Lodge (http://www.princesslodges.com/copper_river_lodge.cfm) just outside of Copper Center, AK.  We lucked out and got a room there the one week that they weren't completely full (in order to get the$25/night employee rate, they have to have at least 10 empty rooms...and there's only 80 rooms in the whole lodge).  It was so nice to just relax and not have to worry about anything.  I will post pictures as soon as I get them onto my computer.  We took a couple of walks, a late morning walk down to the Klutina River (about a mile each way) and an after dinner walk on the "Back 40" Trail...but that one was cut short by a torrential downpour, in which we got completely soaked.  We warmed up by ordering some chocolate fudge cake, sitting in front of the fire in the lobby, and playing cribbage.  On our way home the next day we went to the Tolsona Mud Volcanoes (http://www.nps.gov/wrst/planyourvisit/upload/Mud%20volcanoes.pdf).  It was a short trip (and a long drive, 3.5 hours each way), but exactly what I needed.  

Two weeks John and I hiked up Powerline Pass from Indian (usually people start in town and go out to Indian, we went out and back from Indian).  It was nice to get out in the almost fall weather.  Again, I will post pictures when I get them onto my computer.  It was supposed to be a "training" hike for me because I was going to run a race that goes over the pass (13 miles total).  However, last week I was running with a dog (who shall remain nameless so as not to tarnish her otherwise spotless reputation) and she decided to stop dead in front of me.  I proceeded to trip over her and fly through the air and landed smack onto my knee.  So now I am nursing and injured knee...and will not be running the race.  

Anyway, I'm back in school now.  I start my Psych rotation in clincal tomorrow and on Wednesday's I'll be in Pediatrics.  Those should both be good for some stories...

Please make it stop...

NOTE: If our relationship will be greatly affected by the fact that we may have different opinions on certain sensitive subjects...please do not read this. However, I will respect your beliefs if you will respect mine.

I hate politics and I try not to get too worked up about political issues. But recently that's gone out the window. I am tired of hearing about Sarah Palin. Really, I'm just tired of her in general. As a woman, I'm offended at McCain's choice of Palin for VP. He needed a woman...any woman would do...so why not chose a good-looking woman that's much younger than him and 75% of the people who are going to vote for him. Who cares if she knows what she's doing, people will be so distracted by her looks that they won't care what she is or is not saying or doing. Makes perfect sense, right? I'm even more annoyed that the whole "hockey mom" role is being played up as a good thing. When do you think was the last time she took her kids to a hockey game or school? I'm pretty sure she's been a little busy running the state and now she's a bit preoccupied with this whole VP thing. Yes, she's a mom, but she sure is heck isn't BEING a mom right now. I'm pretty sure she's too busy traipsing across the country trying to win an election.

McCain and Palin's take on many things scare me. They are definitely for abstinence only sex education...because IT WORKS. And now her daughter is pregnant. Sex ed is not condoning pre-martial sex, it's simply a way of telling young people how to protect themselves from disease and pregnancy whenever they do decide to have sex. How many teenagers (ourselves at one point in our lives included) do you know that wouldn't do something if you told them not to? I don't know that very many would. We don't let kids drive cars until they are at least 16, but we teach them how (with a learner's permit) before we let them loose. Sex ed is kind of the same deal. We are simply teaching them how to be safe even if we aren't going to allow them to participate is such activities.

Let's also take away a woman's right to chose whether or not she can have an abortion. And make birth control even more expensive then it already is. Expensive birth control + abstinence only sex education + the outlawing of abortion = more overpopulation, illegal/botched abortions, lots of pregnant women who can't afford or don't care to get prenatal care (which is dangerous for babies and mom's), and abandoned babies. That sounds like a world I want to live in. Not to mention the fact that Palin's daughter CHOSE to have her baby (or maybe it was Palin who chose since she thinks minors should not get to make that decision on their own either)...but if McCain and Palin were in charge SHE WOULDN'T HAVE HAD A CHOICE! Interesting article: http://www.slate.com/id/2199258

Wait...don't Republican's tend to believe in less government involvement...but let's get the government involved in really important things that affect women's bodies. I don't want the government to decided what I can and cannot do with my body. While we're at it, we should outlaw obesity, alcoholism, and smoking.

I think I'll move to Canada.

Halfway done!

Last week I officially past the halfway mark of the nursing program. Only 2.5 more semesters to go! We have finished up our first round of Med-Surg, which I will definitely be adding to my list of things I don't want to do. This week we started our OB rotation, where we will spend three weeks before moving on to community.

Today was my first day in OB, I was on the mother baby unit, which is where mom's go after they have delivered and stay until they are discharged home. It was very different from all of the other clinical experiences I have had, mostly because I was not assigned a patient, but instead I followed a nurse. There were also babies involved, and I know very little (medically) about babies, so pretty much everything was new to me today.

Only 289 more days left!

Finally

So I am finally getting around to updating this. It's been a crazy couple of weeks (well, four weeks actually). My class is only 7 weeks long (followed by another 7 week class to finish the summer semester), but we have to fit 15 weeks worth of material into it, so I have lecture for four hours twice a week and clinical twice a week, plus a two hour lab, and work on the weekends.

Clinical is going well. We just finished our rotation through the medical unit and I will be moving to the surgical unit next week. I've had a couple of interesting patients. The most interesting of which was a huge ethical issue. She has a history a mile long, but was brought into the ER for abdominal pain. She coded en route and required 25 minutes of CPR and was put on a ventilator when she got to the hospital. About a month ago she had been in the hospital for other intestinal problems and had a J tube (feeding tube in the jujenum) and an ostomy put in. She's been in the hospital for over a month, is fairly unresponsive, has a trach, and the doctors have determined that she will never recover. Her husband has accused the nursing staff of trying to kill her and the ethical committee had a meeting and was going to stop all of her life saving measures (but for some reason, probably the husband) they never did. Last week when I took care of her, her J tube was leaking copious amounts of bile everywhere and compromising the integrity of the skin around the opening. The husband was also ordered by the doctor to not be involved in any of her care while she is in the hospital - he was doing her tube feedings (mostly legal reasons I would assume). Taking care of her was an interesting lesson in putting your own personal ethics aside and doing what you have to for a patient in any given situation.

This week I had a couple of interesting experiences. I got to take out a chest tube on a deceased patient, and I had a patient that had a 3cm x 3cm abscess on her butt...it was over 8cm deep! I watched the wound therapist when she did a dressing change and repacked it. It was pretty gross.

Since Thursday's are my short days of class, John and I have been doing some hiking which has been great. Our hike last week was an interesting mix of excessive mud and snow. But it was nice to get out and do something!

Faithful Readers

Dear Faithful Readers,

I have not forgotten about you. I have much to tell. What I don't have, is time to tell it. I will try to locate some before I forget what I have to tell. Perhaps there is some smashed between clinical and dinner somewhere, or maybe after dinner but before breakfast? No wait...that's when I sleep...

Reality bites

As my good friend Allison pointed out today when we talked..."your readers are waiting." Although I question the number of faithful readers I have, never fear, your wait is over.

Tomorrow is the last day of a much needed three weeks off from school. I started out my break on a cruise with a college friend, Margaret. We spent seven days in the Caribbean on the biggest passenger ship on the ocean. We went to Puerto Rico, St. Thomas and St. John, and St. Maarten.

Here are Margaret and I having a lunch of sushi and fries

San Juan, Puerto Rico


A view from the Castillo Juan Felipe del Morro in San Juan
Another view from the "castle"
On a ferry from St. Thomas to St. John (about a 40 minute ride)
We went on a hike on St. John to Honeymoon Beach. According to National Geographic, this is the seventh best beach in the world.
Back on St. Thomas, a street in Charlotte Amalie
We went kayaking in St. Maarten. This was our French guide who deemed us "Team M&M" and made it known that we were, in fact, his favorite.
I had a little bit of a hard time adjusting to life again when I got off the ship. It's hard to go from eating a five or six meals a day (included in the cost of the cruise) and having your bed turned down and mints left on your pillow every night, to eating cereal for breakfast, leftovers for dinner, and not sitting on the beach the entire day. But, after the initial shock, and numerous compliments on my carefully acquired tan (yes, my white Alaskan skin tanned, even through SPF 45!), I've come to terms with reality again.

Upon receiving an email last weekend outlining the things I needed to turn in on the first day of class, I quickly un-came to terms with reality (I realize that is far from grammatically correct, but I feel it is the only way to truly capture the essence of my situation). Thus, I have spent the last week in blissful denial that I have to go back to school. In said state of denial, I have accomplished something. I've read two books. The most recent of which I would highly recommend (Three Cups of Tea by Greg Mortenson and David Oliver Relin).

That's about all the updating I have for now. I'll try not to keep everyone waiting for so long next time!

Vacation!

I'm going on a cruise...and I got all A's this semester. What more could a girl ask for?

Bored

I'm mostly done with school for this semester (minus the test I have tomorrow), and I'm now patiently waiting for Lucy from Seattle to call me and confirm me on my cruise. I'm supposed to leave tomorrow...if only I could will my phone to ring!

----------------
Now playing: Death Cab for Cutie - I Will Possess Your Heart
via FoxyTunes

Uninspired

I know it's be quite a long time since my last post, but I have been feeling somewhat uninspired lately. I think it's the whole end-of-semester slump thing coming back to haunt me...again.

What have I done since March 1? Well, I went to LA to visit my friend Katie (pictures to follow when I work up the motivation to load them onto my computer). I had a great time. It was nice to have some time in the sunshine (not the kind we get here in the winter...that doesn't count) and replenish my bodily supply of vitamin D (something I have been diligently supplementing all winter long). It was also great to see Katie and get an idea of what life is like in LA. I also got to see a college friend who lives in Portland on my way home. I had a 4 hour layover, so she came and picked me up from the airport and we had dinner.

As for school, things are wrapping up for the semester...thank goodness. Clinicals are still going well. Last week I got to do my first blood draw. My instructor was really impressed with me...apparently my patient's veins were not all that good...but they were MUCH better than the "veins" in a dummy arm!

I also recently got a part-time job. I'm going to work at Kaladi (a local coffee chain) two or three days a week.

As far as things to look forward to (other than the end of the semester), I will hopefully be going on a cruise with my friend Margaret (the one from Portland) once school gets out. I am awaiting confirmation as it is space available (employee deal from my job last summer). I'm keeping my fingers crossed, seven days of sunshine is just what I need after 15 long weeks of academics!

Week in pictures (and some words too)

Here I am at clinical last week showing off my really ugly white shoes. Don't I look official in my scrubs?
This week we learned how to draw blood and start IVs. This is the dummy arm we practice on with it's "blood supply."
First you have to put on a tourniquet.

And then you have to hope you hit the dummy vein! The worst part is due to the lack of pressure in the dummy arm's circulatory system...you don't really get anything out.

What I learned in school today

Today was by far the most exciting day I have had in a long time! I spent the day in the OR at ANMC observing surgeries. I even got to participate a little!

I watched three surgeries, two laproscopic tubal bandings, and a non-laproscopic ovarian cyst removal (they ended up doing a lot more than just that though). I got to do catheters on the first two patients. Who would have thought that draining someone's bladder could be so exciting. After the first patient was anesthetized, the nurse asked me if I wanted to do the catheter. I was caught a little off guard...I can do stuff?? Even though I knew exactly what to do, she was very nice about walking me through the process to make sure I didn't forget anything (it's not too complicated - put on sterile gloves, insert catheter, makes sure other end is aimed appropriately). The first two procedures were very fast. After the patient was asleep, the whole process of cleaning and draping them took longer than the actual procedure. The camera goes in through the belly button and then the banding contraption goes in through a port in the lower abdomen. The contraption that puts the bands on the fallopian tubes was pretty neat. It picks up the tube and pulls it into a metal sheath and then slips a tiny little rubber band over the kink (kind of like kinking a garden hose and then putting a rubber band on it).

The third procedure was much more complicated (and there was a lot more blood too). It was a lot harder to see what was going on because it wasn't on a TV screen, but I was able to stand at the head of the bed and see a lot. They ended up removing the patients ovary, appendix, and her cervix (she had already had a partial hysterectomy).

As for the passing out problem...I didn't actually pass out! I got light headed during the first surgery, but not until the doctor was putting the trocar for the instruments in. I sat down for awhile and was better before the whole thing was over. I felt completely fine during the second surgery, but got light headed again during the third one (while I was standing at the head of the bed looking directly down into the huge abdominal incision). Again, I was fine after sitting for awhile. I think the second time it was a combination of claustrophobia (there's nothing like wearing a mask for three hours) and of being hungry and dehydrated.

Fun with needles

Today in my skills lab we got to play with needles. We did IM (intramuscular), subcutaneous, and intra dermal injections on sponges and hot dogs. I could really use some practice on a real person...anyone need a flu shot?

Clinicals, etc.

This past Tuesday was my last clinical day in long-term care. I'm glad to have had the experience, but also glad that it is over. In my quest to answer everyone's question of, "what kind of nursing do you want to go into?" I can now say that I do not want to work in long-term care. I am glad that there are people who enjoy it and are good at it, but I am not one of those people.

Next week we do our orientation at the Alaska Native Medical Center. We will be on the orthopedic floor for the remainder of the semester. I am a little nervous about the hospital, especially after my near passing out experience. Hopefully that will go away soon. My good friend Allison told me that in order to cure myself of this ailment, I should go to the burn unit and just stand in someone's room. I don't think I'll be able to do that, but thanks for the advice!

I'm pretty excited to be taking a very mini vacation this weekend. My friend Katie who moved to L.A. in November is back in town for the week. I'm driving down to her parents house in Soldotna on Friday to get her so that she doesn't have to fly in a small plane to get back to Anchorage on Saturday (I know...I'm such a good friend). I'm excited to spend some time with her...and to cure her of her newly acquired L.A.-ness!

I'll never be a nurse now!

I had an experience today that made me wonder if I will ever make it through nursing school. We had an opportunity to see/do a dressing change on a patient with a PEG tube (percutaneous endoscopic gastrostomy aka a feeding tube). The patient is not responsive, so this was the perfect opportunity for us. Well...all of us except me. I had to leave the room because I almost passed out. How embarrassing. I don't know what happened because there was no blood or anything, just a hole with a tube in it. Hopefully repeated exposure to such situations will cause this phenomenon to subside. Otherwise, I might have to consider a career change.

Self diagnosis

Today in class our professor walked in and told us to take out a sheet of paper (a statement which usually causes extreme panic). She told us to write out a nursing diagnosis for ourselves this morning. Nursing diagnoses are designed to address human responses to disease processes. There is a standardized list of diagnoses and they follow a specific format. There is the diagnosis, the etiology, and the signs and symptoms. Here's what I came up with

"Ineffective coping related to being in class on Friday when there is fresh snow to be skied in, as manifested by increased blood pressure, extreme agitation, and a lack of interest in the present class."

I volunteered to read my diagnosis out loud in class. Luckily our professor is one of those people that not only understands, but also appreciates sarcasm.

Let the clinicals begin!

On Tuesday we had our first clinical day at the Anchorage Pioneer's Home. Luckily, it wasn't nearly as scary as I thought it would be. In class our professor made it sound like they were just going to turn us loose on our elders (that's what they call the residents of the Pioneer Home) for seven hours. Good thing that wasn't really the case! Our clinical instructor (whose name is also Martha) gave us a tour of the facility and then introduced each of us to our elder. We ended up spending most of the day going through their charts to get some information for the paperwork that we have to fill out. We will be doing a complete "mini" assessment of our elder (assessing the major functional areas of their life: activity/exercise, mental status, nutrition, health maintenance, cognition, self-perception, role/relationship, values/beliefs, as well as their medications) and creating an individualized care plan for them.

The facility was very nice and most of the elders seemed to enjoy living there. My elder said that they do a good job of providing a variety of activities and that the staff is all great. The one thing that I found somewhat amusing was the area for those who tend to wander off (I believe it is the acute Alzheimer's unit). There is a set of locked double doors and the side facing the unit is wall papered to look like a brick wall, which keeps them from trying to leave. I just find it amazing that it works!

Dummies

So this week in our skills lab we learned about changing dressings on wounds and catheterization. Here's the problem with putting in a catheter on a dummy...dummies are not exactly anatomically correct. The male and female anatomy on a dummy is somewhat out of proportion (i.e. the target is MUCH larger than it would be in real life). I have a feeling when any of us get the opportunity to actually put in a catheter, we will all be slightly surprised at how much more difficult it is in real life (at least I realize the hole it goes in really isn't a 1/2 inch in diameter, right?).

Nurse...or mom?

After class yesterday I was thinking about all that I have learned in the last week or so. I have acquired all kinds of useful skills such as hand washing, feeding others, moving people in bed, bathing people in bed, providing assistance with various aspects of personal hygiene (hair care, mouth care, etc.) and changing linens while someone is in the bed. Am I going to school to learn how to be a nurse, or a mom? I'll have to get back to you on that one...

Also I learned that I'm not going to the Mary Conrad Center next week, I'll be going to the Anchorage Pioneers Home (http://www.hss.state.ak.us/dalp/anchorage/default.htm) instead.

What a week!

Last semester, students from the semester ahead of us warned us that we would feel overwhelmed and confused at the beginning our next semester, but by the third week it would all make sense. Even after being warned about it, I was still thoroughly overwhelmed and confused. Having one class with four parts that all relate to each other makes for a lot of confusion. Not to mention the fact that in every part of that one class they talk about "in clinical you will be doing this" and "in clinical you will be doing that"...well, clinical starts in a week and there is no way I'm going to know all that before I go! On top of the feeling that I have no idea what I am doing, I also have no idea what I am supposed to read or turn in when or who I am supposed to turn things in to. Why? The calendar is broken down by week and assignments that are due are listed on the week, but with no specific date, who you turn things in to depends on which part of the class it is for and what day it is due and readings vary depending on where you look. Confusing! I hope the "more seasoned" students were right and it will all make sense in a few weeks.

Despite feeling lost and overwhelmed, I do feel like I actually accomplished something. Here's what I learned this week:

• When taking a history you actually have to ask, "with what gender do you identify?"
• Having your finger poked to check your blood sugar hurts more than you think it might
• Feeding fellow students pudding is hard to do without laughing
• People actually agree to be filmed receiving enemas so students like us can learn proper technique (I'm not kidding, I saw the video)
• I'm not as good at washing my hands as I thought
  
• Talking to dummies (the inanimate kind) is also hard to do without laughing
• When inserting an NG (naso-gastric) tube into a dummy, it is not ok to stick your finger in their mouth to check whether it has reached the esophagus...you have to use a tongue depressor (something about pretending to be in a clinical setting...)
• It is also not ok to accidentally stab them with a safety pin when attaching the NG tube to their gown
  
• People do not volunteer to be filmed while having an NG tube inserted

Back to school

The last three weeks off from school were much needed. I was able to catch up with a few friends who were in town for the holidays, work a little (but not too much of course), and play outside in the much anticipated snow!

Yesterday it was back to school. My feelings are a little mixed. I am glad to have something to focus on and to be on a schedule again, but I am not excited for all the work! This semester we only have two classes, but one of them has four parts. It's going to be a challenge just to figure out where I am supposed to be each day. In addition to Pharmacology, I am taking Foundations of Nursing II: Therapeutics. Foundations consists of four parts: theory, clinical, assessment lab, and skills lab. For the first two weeks we don't have clinical because apparently we need to learn skills in the lab before we can go into a clinical setting and practice. After the first two weeks we will spend three weeks in long-term care facility. I will be going to the Mary Conrad Center, a 24-hour nursing care and rehabilitation facility (http://www.providence.org/alaska/facilities/mary_conrad/default.htm). In the long-term care facility I will have one patient for three weeks. I will do a complete health assessment of my patient and complete a set of nursing related tasks (analyze the information, identify nursing diagnoses, and write a care plan). After completing three weeks in long-term care, I will spend the remaining nine weeks of the semester in acute care at the Alaska Native Medical Center. I will complete many of the same activities in acute care as I did in long-term care, but with more patients.

Today instead of having clinical (being the first week) we had a lab. We spent seven hours watching videos about patient confidentiality, hand washing, fire safety, and moving/positioning patients. Not the most mentally stimulating day. Tomorrow I have assessment lab where we will practice the art of interviewing patients and taking histories. The most exciting part is that I get to break in my new stethoscope!