Archive for the ‘The Literary Nurse’ Category

Advanced MedSurg: Round 2

Today I find myself in the same spot I was a few months back. Tomorrow I take the final exam in Advanced MedSurg for the second time, and for the second time it all comes down to this test. It’s very simple: pass the final, pass the class. No other way around it.

Everything is riding in this exam. It’s not just the class, but also my continued attendance at MDC School of Nursing, since I can only retake a class one time and that’s it.

Better not to think about it.

One exam. Sink or swim.

I’m swimming. Here’s hoping I reach the shore.



I cannot properly convey how tired I am.

It’s just about the end of the first half of the semester, the end of Advanced MedSurg, and I am wiped. You may see me up and about doing stuff (I try to do my best around the house even if it isn’t a lot) and studying (not today Friday, but seriously, I’ve never studied this hard ever before) and working out (I’ve been running regularly for the past three weeks), but I am beyond depleted. If I had a little battery icon like my phone, I would be in the red.

The sad thing is that I’ll get to sleep tonight and tomorrow during Shabbat, but it won’t really help. Yes, I’ll feel somewhat refreshed and renewed, but in light of the two days after, during which I need to finish studying an entire semester of Advanced MedSurg for my final on Tuesday and ATI (standardized) test on Wednesday, it will simply be a like bandage on an arterial bleed.

Still, I have no option but to continue ahead and hope copious amounts of coffee will be enough to give me energy and focus.

Early End of Fall Semester and Plans

November 5, 2012 Leave a comment

I was hoping that this post would come in mid-December, but that was not to be. As I mentioned in my last post, I was barely scrapping by in Advanced MedSurg, with my chances of passing resting on two exams on the final week of class. I took both, and the combined scores left me below the cut-off point for a C (which in Nursing is a 77/100). So Friday afternoon, home after the final exam, exhausted from non-stop studying over the past week, I got the email from my professors that confirmed I had not passed the exam, and therefore failed the class.

It was like a punch to the gut.

I’m feeling better about it now. I’ve gone through the five stages of grief and accepted that there’s nothing I can do about it now, so I need to move on. It sucks, yes. I’m not used to failing, and I had to fight hard not to let an overwhelming feeling of worthlessness overtake me. But I’m good.

Today I met with my professors, discussed the situation, and made plans for the future. The paperwork still needs to be processed on the administrative end, but I will be joining the next session of Advanced MedSurg, in January, which will put me on track to finish my Nursing degree in March. So it’s not so terrible, it’s not like I have to wait another six months for the upcoming Accelerated Option class. I did pass my Advanced MedSurg Clinical, so there’s that silver lining.

In the meantime, I suddenly find myself with lots of time once more. I am putting together a plan of action that will structure my days off, so I don’t get too rusty, but I’m also going to rest and recharge, and do some of the stuff I have neglected due to school, like writing.

Sword of Damocles, Thy Name is Advanced MedSurg

October 26, 2012 Leave a comment

I haven’t written about what’s going on in my nursing classes since the end of the Spring semester. I’ll have to do that at some other point, though in short, it was an interesting mix of Nursing specialties and I did fairly well.

Right now, however, I find myself in the same spot I did back in Spring in relation to the first part of Medical-Surgical Nursing: I am on the very edge between passing and not passing (I got an F on the first exam [long story], and a C on the second exam), and all rests on the final exam.

It would suck to fail Adv MedSurg at this point, since it is the next-to-last class in my year-long program; it isn’t something I want, nor want to think about too much, but it is something I have already considered. It isn’t the foremost thought in my mind, however. I am still in the game, and with a really good grade it is possible for me to pass this class and move on to Leadership, the last class before graduation.

That message in the meme picture above? That is my mantra for the next week.

Bring it, Adv MedSurg.

End of Spring Semester: Encore

Though we’re officially in the Summer semester at school, I was still taking MedSurg up until the first day of June, when I had my final exam. I needed to get an 85% or higher on that final in order to pass the class, due to that F I got earlier in the year.

I took my test, went out with some friends, got drunk really early in the day as I could barely stand the suspense. Then around 1 PM I got the email.

It read: Congratulations. See you Monday in Pediatrics.

I passed!!! I was so happy I was laughing and crying at the same time. Unreal.

I got a C in the class, passed it and can continue on with the summer specialties: Pediatrics, OB and Community Nursing.

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Putting It All Together (or Holy Carp, It All Makes Sense!)

I’m studying for my MedSurg final and I remembered this incident that happened last week during clinicals.

My patient was very stable and compliant that day, so after doing my assessment and morning care I went to check with my assigned nurse to see how else I could help her. We saw all her other patients and then I tagged along while she gave meds, which gave me a chance to review desired and side effects as we went along.

One of her patients was a middle-aged man with severe wrist swelling. As she prepped his meds, I would tell him what he was taking and some side effects to watch out for. For one of the meds we had to check his sodium level, which at the time of his last labs was 131, slightly under normal (135-145 mEq/L). As I applied a topical gel to his wrists to help with the pain, he asked us if he was scheduled for a brain scan that day. The nurse and I looked at each other, a bit confused by his question. She said that there was nothing in his chart about a brain scan. I asked him why would he have a brain scan and he said he’d been having extremely vivid dreams for a while, the type where you don’t know if you’re awake or asleep. The nurse said she’d check again to be sure and I filed away this information.

As I went on about my duties, I kept thinking about this patient and his question. Something in his case was triggering memories in my head but I quite couldn’t put my finger on it. It hit me about an hour later, while I was helping my patient back to bed after she had eaten her breakfast and I saw the slip on her tray that said “Cardiac Diet” (which means no more than 2g of sodium a day).

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End of the Spring Semester

The Accelerated Option nursing program has a weird schedule that doesn’t exactly match the regular academic year at Miami Dade College. That said, last Friday was the end of the Spring Semester, and that brought the end of two of the four classes I was taking since March. How did I do?

  • Nursing Medical-Surgical Skills: A
  • Pharmacology: C

I am extremely happy with my grades for this past semester. That C in Pharmacology? I sweated that C! We had a terrible time with that class due to having a really bad “teacher” that was simply not interested in teaching us the material. We mostly learned it all on our own, and with the help (finally at the end!) of our other professors. So yeah, a C there was gold, because it means I passed, and that’s what I needed.

I am still taking Medical-Surgical Nursing and Clinicals for another month, so I’ll update those grades when I get them.

My Clinicals Group

MedSurg Clinical Group

The basic unit of Nursing school, to me, is the Clinicals group. Though we’re all in the same class, and at times have taken classes at different time slots, it is when we go to clinicals that we separate into smaller units and achieve that squad-level tight focus. Above is my clinicals group for MedSurg (except for the guy at far right, we were all together as well for Fundamentals clinicals). These are my peeps. These are the people I spend time at the hospital with, the ones that stand by me, and me by them, when we face medical issues for the first time, when we have exams, when we’re stressed out, when we’re overwhelmed. These are the people that I high-five when we do something cool, when we celebrate the little victories and the big ones. We talk about wildly inappropriate things during lunch, know way too much about each other’s bodies, and are the only ones who truly understand what we’re all going through. These are my friends, and without them, nursing school would be practically unbearable.

Resolving Personal Issues

Nurses care for patients. That is our primary and overriding duty. But in order to care for our patients, we also need to take care of ourselves.

During my Death & Dying lecture in Fundamentals, one of the key lessons we learned is that in order to effectively help patients and their family deal with such issues, we need to have our own issues with the subject resolved. The rationale being that one who has unresolved issues with the topic of death and dying won’t be able to properly offer the help and care the patient will need at such juncture. It makes perfect sense, actually. The greater truth is, however, that this same lesson applies to pretty much every type of care we offer our patients.

This is a lesson that was driven home today for me in my skills lab when we learned how to insert a nasogastric tube. An NG Tube is a type of catheter inserted into the stomach through the nasal passage. It is used to decompress (get stuff out) the stomach, as well as for feeding and delivery of meds in some cases. In most cases, it is a treatment done for only a few days, except in rare cases. My mom was one of those rare cases.

Mom developed a duodenal tumor that shut down her gastrointestinal tract cold. In early February of 2009, I had to take her to the ER when she started feeling unwell. By the time we got there, she began to vomit violently and continuously, some eight times in a one-hour period with no signs of stopping. By the time she was finally taken into the treatment room, she was almost unconscious from all the fluid lost. She was immediately given an IV for rehydration, and when they detected very little bowel sounds, the doctor ordered an NG Tube be placed to decompress her stomach.

Imagine for a moment having a 15-inch plastic tube stuck into your nose and down your throat. Now imagine that while having an almost uncontrollable urge to vomit because you have three-days’ worth of food, liquids, and body fluids stuck in your stomach.

I saw the nurse put the NG Tube in Mom and it wasn’t pretty, even though we all knew it was for her benefit. It did its job, though. For the next 100 or so days of hospitalization over the following six months, Mom would not be without an NG Tube for more than 10-20 days. Towards the end it stayed in permanently; she took it to hospice home care and had it on the night she died.

I have unresolved issues with NG Tubes. Every time I see one a shiver runs down my spine as I recall that moment when it was inserted into her as an emergency procedure, and I remember how long she had it. I knew today we would be learning this skill and I steeled myself as best as I could before even leaving the house. The moment the professor pulled out the equipment, I lost my resolve. I withdrew, physically and emotionally. I hid in the back of the room. I fought back tears. I did not want my classmates or professors to see me this way. When I couldn’t take it any more, when the mannequin looked like Mom to my eyes, when I felt the world collapsing around me, I got out of the skills lab and hid in the bathroom.

I am a nurse student, and part of my training is going through situations like this so that I can face my own demons, fight them, vanquish them, and in the process gain the wisdom necessary to serve others who will be where I was back in 2009, or today for that matter. Putting in an NG Tube is a skill I need to be able to perform to pass this class, so you can bet that I will go back to the lab during practice hours and learn how to properly do it. And for that I need to resolve my personal issues, because ultimately there’s nothing I want more than to be a nurse.

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Car-Free in 2012 (It Seems)

March 12, 2012 3 comments

Back in 2010 I had this idea to go car-lite, then eventually car-free. I had a tag for it on my blog, I was taking notes on expenditures to validate my findings, and I was generally pumped up to do it. Then my bike got stolen, my class schedule changed, I lost impetus and it all fell by the wayside. Fast forward two years.

Much like in 2010, right at the start of classes in January my car was put out of commission, this time with the brakes ceasing to work instead of me getting my license suspended. My school is just on the other side of the bay from Miami Beach; it took me 6-7 minutes to get there by car, and being right next to the hospitals, it gets excellent public transportation coverage. So the next day I took the bus, decided it was doable on a regular basis, and after purchasing the reduced-cost bus pass for students, I made the switch entirely to public transportation.

I have not regretted it at all. Even though there are mornings when I arrive a few minutes late because of missing the bus, I still take it over the hassle and costs of driving.

In February, when my clinical rotations started, I happened to have my wife’s car available those two weeks, and when I didn’t, I car-pooled with a classmate. My next clinical rotation was at a hospital that is only 3.1 miles from my house, so now I get to commute by bicycle twice a week.

And I absolutely love it. I wake up early, yes, but then I ride for about 20 minutes around Miami Beach as the sun is rising. I get to take pictures in dramatic light. I get to arrive fully awake and ready to rock, whereas my classmates all arrive sleepy and groggy. Then in the afternoon I get to ride at a leisurely pace, stop along the way (maybe for a beer, maybe for a donut) and get home still with ample time in the day and some 7+ miles bicycled in m pocket. Seriously, what is not to love?

My car has been parked for two months and I have had absolutely no need for it. I have learned to live with the extra time public transportation/bike commuting requires and decided that the savings in cash and driving aggravations more than make up for it. I get in incidental exercise twice a week and help the environment just a little bit.

At this point I am considering selling my car and using that money for bus passes during the year. That means I’ll save the money I’d spend on repairs, parking permit, insurance and tag renewal. Even with a possible clinical rotation during the summer some 30 miles south (and an accompanying 3-hour public transportation ride starting at 3 AM), I am sure that it is the right thing to do now.

And how does this tie in with nursing, aside from the obvious connection with going to school and clinicals? This is role-modeling at its best. Although I have yet to take my Community Nursing class, I know it is an area with appeal to me, and one where I will seek to integrate my love of bicycles as much as possible. What I’m doing now can be considered research; it’s walking-the-walk so that I can talk-the-talk in the near future.

So, two years later, but look at that, I have achieved my goal of being car-lite, and eventually car-free!