First Day Back, Block Four

Haiku of the day:

"Math tests are the worst. I've had twenty-four hours of diarrhea." -anonymous classmate

The first day we supposedly had orientation for clinicals and our math test. Well it turned out to be a partial orientation, and we had our math test (passed, and it was the easiest one yet) and then we had lecture all afternoon starting our Process class. We got dumped on with a ton of papers, and so much information to absorb, and our first exam is next week and I'm already about 25 chapters behind! EEK! Like they say, this semester is good for procrastinators because there's no time to procrastinate.

I am excited about the content and the clinicals this semester though. Looks like the care plan situation will be much improved. It will be a lot of work but we only have to do one major care plan for each segment of clinical: one ICU, one Peds, and one OB. For my ICU rotation I got 2 days in ICU, 2 days in telemetry, and a day in the ED. Should be fun! Plus our group has changed. We originally had a lot of the attention-seeking, high maintenance people in our group but they have all gone to Metro. That's because two people didn't pass Block 3 and one more person deferred to fall. As a result the group has much improved, and I am paired with Gail, who went to high school with me, she was not in my class but she was there at the same time as me and knows some people I do even after 25 years.

First day of class we were crammed into the classroom from hell- auditorium seating in these rickety old chairs with hardly any desktop space. Some days we will be in there for 9 hours. That's going to be tough. My butt already hurts from 7 hours today.

Well I need to get organized because there is no spare time. More as soon as there is more....

Peace, love, and lomotil,

Towanda, RN2B

How Many Nurse Recruiters Does it Take To Change a Lightbulb?

None, because a dim bulb is much brighter than any nurse recruiter I've ever met.

This week I applied for two jobs here to get a few interviews and have some options in case the Colorado thing doesn't happen soon enough.

I have in the back of my mind a plan in case. I want to go to one of the other hospitals in town and try to get an interview in their telemetry dept for practice. I have also applied at telemetry at the hospital where I'll be this summer, which is where I'd like to work if we stay here for any length of time.

The other hospital is easy to apply for because it's all online. Even though I get these emails from their recruiters every other week or so asking me if they can help me with anything. It's the interview thing. I would love to have more practice, but the last 2 job offers I've had, I can't seem to get anybody to interview me first. Scary.

I went to the website where I work and I need to apply as an internal candidate here since I'm an employee. I checked out both hospitals and saw there were a lot of telemetry jobs at one. Hmmm. Red flag. There were only a few at the other one with only one during the day. I thought I'd apply for that since it said 0-6 months experience required, which usually means new grads can apply. There were about 7 jobs at one campus and 3 at the other. Roger must be right when he said they eat their young at the one with 7 jobs.

I went to the online application and there was a space for a cover letter. I didn't know the name of the manager there but I called the hospital to ask. No one could tell me. So I called human resources and they put me in touch with a nurse recruiter. I told her I wanted to know who to address the cover letter to and she said she would find out the name of the manager and call me right back. A while later she called back and I missed her call but she left a message. She started spelling the name, she didn’t know how to pronounce it, and she spelled it partially and then trailed off in the end of the last name and said, "e-r-i- or something like that... I don't know" and then she said "that's close enough!" I saved the message on my voice mail. Never know when I'll need some comic relief. I think she sprung an air leak...ffffssssssst.....thanks for the refill!

Is it just me or would you hesitate to send a letter to a prospective employer and totally butcher the spelling of their name? I ended up calling the recruiter back and she told me to send the cover letter to her (the recruiter) because I would be going through them anyway. So I did. But later I found out the name from Dale who looked it up on the computer at work. It wasn't all that hard, either.

So far I think the only recruiter I have talked to who seems halfway intelligent since all this nursing stuff started was the one at the hospital I liked in Colorado.

The other thing that's been happening is I'm starting to dream about being a nurse. It’s scary. I had this one dream where I was dressed in blue scrubs and working on a floor and I had to escape. I went running out of the building and ran across the hospital campus to another building which housed a sort of gym or recreation facility with locker rooms for old people. I had to hide out because I couldn't let anyone find me, I had to escape. I was running through this building and ended up in a locker room, I kept hiding out in different shower stalls and closets because I knew they were looking for me. Finally I got to the far end of the building and took off my scrubs and wrapped myself in a white towel. I was about to open the exit door to escape and run away when I saw security drive by with a nurse from the floor I had escaped from. I had to wait until they drove by in their little golf cart and then I ran out, wearing the white towel wrapped around me, barefoot, across the concrete path and onto the grass, behind another building and I escaped.

I spent today trying to get ahead in my critical care reading and practicing math problems for the test on Tuesday. I'll relax and hang out with Dale over the weekend and then Tuesday I will be possessed. As of today it's 11 weeks to graduation.

Peace, love, and intact filaments,

Towanda, RN2B

Colorado: A Matter of Time

I went to Colorado for the week. I was originally going to check out lots of places, a lot of different hospitals.

I narrowed it down to two. Actually, between the two it was one-stop shopping because they are in the same hospital system. I had all these plans to do an intense job search, but the reality of it was that I'm tired from the intensity of school and what I need is a vacation.

I drove to Trout Creek the first night, I only stopped for gas and to pee. I ran across the pass the next morning and saw some antelope on my way down into Chubb Park. After I ran and had coffee, I drove the last 30 miles to our cabin and felt like I still had to stretch my legs. That afternoon I went part way up Boreas Pass road, which was still closed, so I parked at the gate, and ran up the road for a half hour. It was quiet and peaceful and beautiful. The aspen trees didn't have their leaves but looked like it would happen any day.

It was mild temperature-wise. A little frost the first morning but I made a fire in the woodstove and was too hot, I had to sleep with the front door wide open half the night! It was so nice up there, I wanted to stay. I knew I had to go down to Denver and all I could think of was coming back to the cabin and hanging out. I decided to come back and see if I could make it all the way up to the pass after my trip down there.

Driving down to Denver there was nothing new except more of the same. Denver never appealed to us. As far as other parts of Colorado I can do without the old Focus on the Family disciples in Colorado Springs with their own damn exit sign on the freeway. Focus on your own damn family! I love Colorado Springs for the Barr Trail, Garden of the Gods, and other places for running, but I don't think I could stand it politically. Also it's crowded and expensive.

Boulder is politically more my style but it too is expensive and crowded. Anywhere north, more than 30 minutes commute from home, plus the still-crowded conditions on I-25, commuting sounds like even less fun. They still have only 2 lanes in each direction from Ft. Collins to Longmont. Therefore it was even easier to narrow it down.

I stayed with an old friend on the first night. It was great to see her, always like no time has passed. It was great to catch up and think about maybe soon we will be able to get together again on a regular basis. She lives within walking distance of the Boulder hospital. I was thinking about the hospitals in Loveland, Longmont, and Lafayette and didn't want to get scrambled brains talking to someone at Boulder so I decided to hold off on stopping there until after I talked to them up north.

The Longmont hospital ignored my repeated attempts to contact a human being, so it was further down my list. And the super big corporate hospital chains, the ones with no nursing shortage when it comes to hiring new graduates, I skipped them altogether. Especially good idea after I heard through several people that they don't have a very good reputation anywhere. I decided to concentrate on places north of Denver first and worry about all the other places later if I had the energy.

Before the appointment I drove around Loveland and checked it out. There's a lot more development, huge subdivisions and shopping centers and strip malls. Huge. Looks a lot like any town in the desert southwest except without the palm trees. Strip mall city. They have the old part of town that looks like a retirement town like Mesa, Arizona, and then there’s the new part that looks a lot like Desert Valley. Lots of expensive new box homes with no yards and all jammed in together so you can almost press your nose up against your neighbor’s bedroom window. After driving around Loveland for an hour or so I pretty much ruled out wanting to live there. I went as far north as Ft. Collins and checked out the hospital there too.

I did talk to nurse recruiters in Loveland, Lafayette, and the northern suburbs of Denver. They told me all kinds of good stuff about the hospitals- doing her own sell job there, telling me that they are good with new grads and she wanted to know all about why I came all the way up THERE to look for work, so I told her a little, we used to live up there, Dale used to work up there, etc. They told me the plans for hiring new grads and which areas they would hire them in. I asked about orientation length and how many beds the units were, what training they give you, and how extensive the training and classes are.

I told them more about myself and why I want to move back there, and tried to slip in a few more selling points about myself. It's weird with these recruiters because you never know what they are looking for- they seem to act only like PR people for the hospital in some places, not so much screening you for employment. I asked questions about the telemetry dept. and told them I was interested in cardiovascular ICU too. They do train new grads in ICU but don’t hire very many right out of school. They did say I should mention that when I apply if I'm interested.

One of the hospitals offers relocation assistance of up to $3000 for someone moving from where we are. They even have realtors all ready to help you find a place to live- they have this whole package set up. She offered to give me a realtor contact. She asked me if I would consider working at any of the hospitals in their system in Colorado and I said yes. She said that's good because they will be looking for people to be flexible while they work out the fine details of what their needs will be. They are opening up a new hospital and are not sure yet of how many people they need in each area until they offer positions to existing employees in the system.

Their benefits are comparable to Desert Valley in every way except they offer a little less in education benefits- tuition assistance is less, but still adequate if I wanted to take classes. But that's no big deal to me since I have had it up to my eyeballs with school and if I do go on for a BSN for some ridiculous reason I will do it online and one class at a time.

I thought one hospital sounded pretty good and I have no answers yet and nothing is certain because they haven't even posted the positions yet- when they post things for external candidates it will be in late June, on the website, and she told me how I should submit my application and to go through her, and to specify certain things. Starting today I will be watching that website like a turkey vulture on fresh roadkill.

I spent the rest of the day going out with old friends who live in Fort Collins, we went running and went to dinner. It was great to see them, it’s been nearly 10 years. They haven’t aged a bit but I feel like I have. After cruising around and checking more places out I headed up to the cabin later Saturday morning. There was a huge traffic jam on I-25. It sucked. I do not want to deal with that commute.

When I arrived at the cabin, the first thing I noticed was on the doorstep. The stone steps leading up to the cabin are overgrown with irises. They were leaf blades when I left on Wednesday. But by Saturday afternoon the irises grew these huge purple bud-like things about to burst! I was so excited, I started talking to them, and I watered them. I told them they had to open up before I left.

I woke up early Sunday morning and got ready to run Boreas Pass. Did the Irises bloom? Stubborn. They will only do what they want to do, when they want to do it.

I parked at the road closure gate again and ran up the pass. I waited until late enough in the morning so I wouldn't have to worry so much about mountain lions. I know where the one lives in town but I figure they must be around. The aspen leaves were opening up, everything was a lot greener than a few days earlier. I saw lots of deer and thought I might see other people on mountain bikes or walking, but no one. I "hauled ass up the pass" and got up there in less than 2 hours. There is no way that is 16 miles like the mile markers say. I would say more like 13 miles round trip.

When I got within a half mile it was a solid snow field. It's not real steep and it didn't look like any avalanche chutes were possible there, and the snow felt pretty solid. I took a few steps and decided to go for it, it was only about 100 yatrds across and I could see the road on the other side and the boxcar at the top of the pass. When I got up there it was quiet. The buildings were still locked up and the road gates on the Breckenridge side were closed. It was so warm on top of the pass I didn't need any extra layers over my shorts and t-shirt. I sat there a while, then walked around and took some pictures, then headed back down. The irises still hadn't bloomed even though I was sure they would have with all the water and sunshine. I took a long nap and relaxed all afternoon at the cabin.

Monday morning I woke up at 3:55 am, and figured I might as well hit the road, it was 11 hours up there and will be at least that much back. I checked the irises as soon as it was light enough to see. The purple tips were still showing but no flowers yet. Damn. I bet you anything they opened up that afternoon. I suppose I could have stuck around waiting for the irises to open but I am sure they would take their time. And I needed to get back and study for my math test and sort through my thoughts and talk with Dale about everything.

I had my coffee, cleaned up the cabin and shut off the power. We'll be back in less than three months for a family vacation. The irises will be dried up by then. Maybe by next year it will be a quick 2 hour drive from home to see the irises in bloom. On any weekend.

It was a hard drive back, there was a wicked dust storm from west of Albuquerque along I-40 and it sucked when I had to stop in Grants for gas- I had to keep my eyes squinted shut while I used the gas pump. My hands and shoulders got tired from having to hang on and steer during the gusts. But I made it home in 11 1/2 hours, and got attacked by the girls. They yelled at me and I told them I was busy finding us a new home. Dale was happy to see me too, but he didn't bite me on the nose, scream in my ear, throw me on the floor, lick my face and sniff all my stuff. The girls can have any house they want in Colorado.

When I got home I also got a pleasant little surprise in the mail, I got a letter from COS, she told me I was awarded a small scholarship from the school of nursing. I didn't apply for it. It was for academic achievement, I must have had the high score in class or something. Anyway it is a small amount, will cover a portion of the cost of my boards, but it was nice of them to do that! I will need to thank COS and the dept. chair. I will be getting a check from them in the end of June. (I guess it does pay to be the class nerd. Think about how many butts I might have had to wipe for that. And after I wrote all that mean haiku!)

I have a week left until school starts. I need to brush up on stuff and get ready to go. I feel ready. I am ready to get this over with. I need to get my life back! Eighty days to graduation is all. It's going to be pure torture, double strength, but quick.

Peace, love, and patience!

Towanda, RN2B

First Job Offer, and Hitting the Road for a Better One

Thursday I went into the hospital to get my staff evaluation. Even though I haven't worked in 4 months, I am still on call so I get evaluated. I thought my evaluation would be given to me by the floor supervisor, I don't know why I thought our manager wouldn't be there. But she was. The session turned into a heavy-hitting recruiting attempt. I didn't want to say yes, yet I didn't want to say no. I tried to be vague about it. I said I was considering it and I said I wanted to see how my preceptorship goes in telemetry and how things go in Block 4.

She kept saying, "Why do you like tele? Why do you want to do cardiac?" as if I was crazy not to want to work in med surg buttwiping, being a waitron, without the tips. She was all ready to sign me up for the orientation program that lasts 18 weeks, starting in September. She was shoving papers in my face, "look at this", "you'll get 18 weeks of orientation, we'll pay for ACLS, Jill and Carrie from 3C are doing it, blah blah blah" (referring to two students who recently finished Block 4 who trained me as a CNA- they are coming to work for her and starting this program)

Let me get my license first, please! She said they have a program starting either September 18th or October 5th. Either date would work fine, but it's a long drawn out orientation program, which would be okay, and I know that floor- I could get days, and 8 hour shifts if I wanted. This hospital does pay new grads well. I could probably deal with it for a year and think of it as a great learning experience. The nurses there wouldn't devour me alive like in some other places. But I also know my boss and she has a mean streak. I felt like the room was closing in on me, it was like vultures on dead meat. I should have anticipated itbeing like this.

I felt like a jerk not saying yes but what else am I supposed to do? I'm graduating at a time when I could get a job almost anywhere doing a lot of different things, why should I choose this crazy med-surg floor that's full of incontinent demanding total care geriatric patients who are always on contact isolation? The only other thing that would be good about working there, other than the nurses I like and know already, is that I would learn to do everything. It would be good for learning. But talk about stressful. That floor gets everything imaginable, and is always short staffed and has high turnover. I know there are better places to work out there.

I need to be more prepared to ask questions about what they are going to offer... I have been so focused on school I haven't given it any thought. What do I want from my employer? I need to be able to compare. In Block 4 our leadership class is going to help us prepare for that part. I think they need to offer that course sooner because most people are already well into the job seeking process before Block 4.

After all that, I got the feeling when I walked out of my boss's office, that as soon as I closed the door, she'd be making some rude comment about me. She does that, I've seen her do it to a lot of people.

It was great to see some of the nurses again, I do like the nurses on my floor. I didn't like the CNAs. None of the ones working on the floor today looked familiar. Maybe all the lazy ones are gone. I am sure there will be new lazy ones to replace them. I also saw my favorite friendly doc, the polyp. I saw him everywhere at South, he scowls and evades eye contact, a reminder of things I'll be dealing with as a nurse. I'll have to see what the energy is like down at tele in South. I have to admit that there's something comforting about knowing you have a job. BUT....I can find something better...

I need to go down to campus today, I have to get some signatures on my graduation form, and I am curious to see how I did on the Process final. COS said she posted them on her door. I ended up with an A in Process but she did not post the final exam scores, just the grade. I also need to see Roger, he wrote a nice letter of recommendation for me to take up to Colorado.

I'm off to do errands before it gets hot, it got up to 100 plus yesterday is what I heard.

Monday morning I leave for Colorado. At this point I'm focused on one particular hospital and will check out several others. Dale doesn't sound too excited about too many places in Denver, so I'm going to focus on areas north and south and not knock myself out in Denver. I'm going to see a lot of old friends and that will be the best thing about the trip.

Peace, love, and hot asphalt,

Towanda, RN2B

Thanks for the memories, ya bitch!

Here's a breakdown of final exam day, Block 3:

part 1. Morning Assessment final:
After yesterday's ego-demolishing experience we were treated to more insult this morning. We got there this morning for the Assessment final and Misery Kate was there. She wouldn't look at directly at us. Before we started the exam she said something about she's not as mean as she looks, then gave this sort-of speech about how she sees "intermittent" signs of professionalism and competence in “some” of us, and she wishes us luck. I wonder if the nursing faculty receives their evaluations before grades go in? I'm wondering if she got served her new electronic version of an anal orifice already and she was taking it out on us.

The exam was a joke. A vocabulary test. And we thought the coconut's stuff would be half the test, it was only a small portion of it. I thought it was pretty easy though there were a few I had to go back to and guess. What gets me is that so many of her questions are so easy it's like an insult to our intelligence. It shows the level where she teaches.

I came home and I will go through my endocrine notes for a while and eat lunch and head back. Laura said she'd get a table for us at the mexican restaurant, since Laura is usually the first one done with every exam.

I am so glad to be rid of misery Kate. I hope I forget about her real quick. Now we have to relieve ourselves of the chihuahua. Like peeing on a fire hydrant? I actually liked the chihuahua as a teacher but her extracurricular ankle-biting and barking has worn me out. She always has some nagging reminder of some little chore we have to do. Woof.

each student needs a
central line after exam
for margaritas

for three weeks we are
no longer fire hydrants
our ankles can heal

Off to study for the last twist of the knife.

Part 2: Later, Tuesday afternoon:

I survived Block 3, pending the results of the Process exam. It wasn't that bad, so I'll say I survived. I'd like to forget it all. At least for a while. I glossed over my endocrine notes during the 3 hour break and said screw it. I tried to eat lunch because I knew it could be a long time to margaritas.

When I arrived at the classroom it was already full, seemed like everyone was already there. COS was spazzing out as usual, barking at everyone to mind their ps and qs and all the other little things she does to bite our ankles, like shushing us. "SHHHHHH!" Right before 1:00 Misery Kate walked in with our final exam grades from the morning. Everyone leaped to their feet to go look at the board. I almost yelled, do you guys want the added anxiety of knowing your grade before this exam? I guess they did. I checked mine. Only missed 2. Got an A in Assessment.

Finally she handed out the exam, in exchange for our receipts proving we did the online evaluation. The Process exam started out with a lot of vague psych questions. I couldn't remember a lot and I guessed on several. I would say I probably did the worst on psych. The rest of it was fresher in my mind, I felt like I did pretty well on renal and endocrine. There was some GI and almost no immune, and a little peds. I felt like I did well enough. We'll find out probably tomorrow when she posts them on the computer.

After I was done I zipped over to the bookstore and bought myself the new Neil Young CD I've been wanting. It was my reward to myself for surviving Block 3. I drove over to the Mexican restaurant and met Laura in the parking lot. We were the first ones there, and Anne drove up as we were walking toward the front door. The three of us sat down and ordered margaritas and pretty soon about a dozen of our classmates trickled in. We got to be pretty loud and there was some good gossip going. We tried not to worry too much about the exam but there was some debate about a few of the questions, but mostly gossip.

We discussed how much we wanted to forget Misery Kate, and then we got to talking about a few little comments Denise the sociopath said, like the one I forgot about until now: her Block 2 classic, "I don't know why this class gets so anxious about everything. Trained monkeys could do this."

We all left by 4:30 and here I am. I can't believe how much one margarita affects me. I am done, and I survived another semester. The worst one, I hope.

Ninety-three days, 13 weeks to graduation. As of Thursday it will be down to 2 months & change. Now I have to do an ultra- getting ready to go to Colorado and look for work. All my job applications resume, references, some interview clothes, appointments, maps, contact numbers... I have my work cut out for me.

I’ll be looking for a job as a trained monkey.

Peace, love, and amnesia,

Towanda, RN2B

Eating my way through finals

I was toast after the last clinical day on Friday, I didn't sleep too well the night before and then being up at 4:45, being there all day and then going out to dinner and not getting home until after 8 pm, and then I couldn't wind down so I stayed up on the computer until 11. Saturday I was pretty worthless, I studied the newest notes for the two finals and prepped a little for our skills final for clinical. I was exhausted and I didn't even run. I was so tired I couldn't do anything. I decided I would get through the day and hope I could have a productive day studying on Sunday.

Sunday I woke up early again despite going to bed at a reasonable time. 8 hours was not enough. I was fried and looking at the huge pile of handouts I'd collected all semester from the Chihuahua and the Amazon it looked like an impossible task. The pile of notes was getting taller. My notebook is jammed with paper, the 3 rings are full and I can't even get it closed. Coffee didn't help. I started studying at 6 am on the new renal and endocrine and peds stuff, and took a break at 7 to walk the dogs. Around 8:00 I ate a huge breakfast with eggs and tortillas to keep my energy up for the day and by 9:00 I was still not concentrating well. It was taking me forever and nothing was sinking in. I tried to lie down and take a nap but that didn't work, so I got back up and forced myself. By 10:30 I was thinking about food again.

I don't know what came over me but suddenly I wanted to eat and there was nothing to snack on in the house. I went to the store and saw some fresh corn that looked good so I piled a bunch of ears into a bag, and saw some catfish, thinking maybe I'd make that for dinner. I went home and ate all of the corn and half the catfish. They were small ears of corn but I ate 4 of them. I kept eating. We also had half a pint of ice cream in the freezer and I ate that too! I made it through a few more handouts but I wasn't retaining anything. Around noon I decided to try taking a nap. I hopped into bed with the dogs and crashed hard. I didn't wake up until 3:00.

Then I zipped through the rest of the psych notes, the GI and immune system notes by the time Dale came home from work and then we went running. It was about 90 degrees outside. Then we made tacos for dinner. I ate four tacos. I have not had an appetite like this in forever. I think I didn't eat enough on Friday and Saturday. Sometimes when I'm so tired I forget to eat. But I felt a lot better this evening! I don't know how effective my studying was but at least I feel rested.

Monday afternoon we had our clinical "skills" final. Or what they told us would be skills. It turned out to be totally different than what they told us it would be. They told us we will be tested on certain skills-NG, trach and IV meds, and given scenarios. I interpreted that to mean it would be a scenario where we used those skills- NG tubes, trach suctioning, and IV meds. Well as it turned out it was not set up the way they told us and we did not go by clinical groups. There were 3 instructors there and 3 scenarios set up and I got stuck with Denise, my clinical instructor from block 2. They told us that it would be those skills and we have been studying GI, renal and endocrine stuff so that is what was in my mind. Roger told us he was going to give a scenario on CHF congestive heart failure. I don't know it never occurred to me that it would be another cardiac scenario but that's what it was.

This scenario was a patient complaining of severe back pain. They had a history of diabetes, hypertension, and anxiety. It listed their drugs and vitals signs and age. I had no idea where to even start. I asked the patient about their pain. Then I went to check the order to see what was ordered. Only morphine.
I gave pain meds and the person was still in pain. I stood there like an idiot waiting for Denise to prompt me on something else. I had no idea what she was thinking. The person was complaining of back pain. What did I think? I thought it was renal or GI-related.

No. It was an MI. I felt like the biggest moron. She would ask something and I'd offer my clueless response. She said, your patient's screaming and short of breath. What are you going to do? I'd raise the head of the bed. Look for pain medication orders. Put oxygen on. How many liters? I said, Two. No, the patient has a mask on. Okay then, 6. What else do you give them and how do they take it? I said, give them nitroglycerin. How many times? 3, and check their vital signs and pain level. What else are you going to do? Start an IV? What kind of solution do you hang? I said, normal saline. Why? I had to think. They're diabetic. I said, because you don't want to give them dextrose. They're vomiting, what do you do? Anti emetic. No, what can do for a patient who is vomiting? I looked at her. Put a cool rag on their head?

I had no freaking idea where she was going. She said, no, what SKILL do we do for a patient who is vomiting? I said, NG tube? (I'm thinking- for an MI?) Yes. The pain got better after the nitro, now what are you going to do? I'm like, call the doctor, try to get them to order an EKG and some labs? She gave me a little talk about how you know its cardiac if you give them nitro and the pain goes away. She said, you guys haven't been in the ICU yet and you'll see that in Block 4. Then she picked up my little sheet of paper and marked, "passed" on it. I must have had this look on my face like, "screw you". I was so pissed. What was the point? They could teach us this stuff in a way that's not counterproductive to our learning. This felt like hazing.

I felt like such an idiot, I could not believe that she passed me. On the one hand I can see that this scenario makes sense, of course it's a classic thing you would run into as a nurse. But the way they told us to prepare for this and with what we've been studying, I had no idea that it would be cardiac unless we got with Roger who said he would do CHF. I never thought that's what they'd give us. We haven't studied cardiac at all in Block 3, we had a taste of it in Block 2 but it's all in Block 4.

I walked out of there feeling totally humiliated. I felt so stupid, but then, they gave us no clue that was what they'd test us on. I don't get it. And I felt like I shouldn't have passed, I was standing there like a clueless idiot. That's good for your confidence. So what's the point? They pass you even if you are a total moron? I don't get it at all. And then everyone else is standing around as you walk out of the lab, shell shocked, asking what did they give you? so the people who went early got a raw deal. By the time the people who signed up last get there, they'll know what's coming at them. I'll remember not to sign up for an early slot in Block 4. Anne was lucky enough to get Roger so at least she was prepared for hers.

And of course we didn't get our evaluations for clinical again. Roger was going to be tied up with those skills tests all afternoon. He told us to get there early, which most of us did, but he didn't stick to his end of the deal and he got there late and we didn't get to do the evaluations like he promised. I wish I could get some feedback.

It's enough to make you want to eat another pint of ice cream.

And I have two exams tomorrow to study for and now I don't care. I don't care about the fine differences between nephrotic syndrome and acute glomerulonephritis right now. I am so tired of all this crap and so disgusted that I want to be done. I ran into Patti outside the lab, she must not have had a good experience either. She sits next to me in Process and she happens to be moving to Colorado after graduation, too. We stood out there commiserating under the sparse feathers of a tiny mesquite tree that serves as shade in the hot parking lot, and she said, "I hate this, I'm so sick of them, I can't wait to get out of this STATE!" Couldn't have said it better myself.

Get me through the next 24 hours.

Peace, love, & haagen-dazs,

Towanda, RN2B

Cinco de Mayo y 15 pounds

Quince libras de gordo. Pardon my Spanish. It's rusty.

Today we had our last day of clinical for Block 3! Wahoo!!!!

It also happens to be Cinco de Mayo and we went out for post-conference to a restaurant in downtown Desert Valley and Roger treated us to dinner (and once all the uniforms were off, most of us had margaritas)

I finished up Block 3 with an easy day, a challenging patient, and a fantastic nurse. A good end to a long tough semester.

I went down Wednesday to get my patient on the trauma/ortho floor, which turned out to be a good thing. Wednesday afternoon there were few patients to choose from and none of the nurses were helpful. As I was wandering around I ran into sociopath Denise (Block 2 teacher) who was there with her Block 2 clinical group. We talked briefly, she referred to me by my name for the first time ever, which surprised me, I didn't know she knew my name. Caught me off guard, she's not the type to acknowledge students personally. Even after having her all last semester and in Pharm this time. As I was walking away from talking with her, I saw a patient being pushed down the hall from PACU (post anesthesia care unit- where patients recover from surgery) and I zeroed in on it. Fresh flesh! A potential patient! Sure enough, she was there for the taking and I swooped down on her like a turkey vulture.

The nurse who had her was a BITCH from hell, but I knew that in 2 days the chances of that same nurse being there and still having that patient were next to zero. I went for the chart as soon as they were done with it. Interesting patient. She was a hospice client but had fallen and fractured her femur and had surgery to nail her leg back together. She had cancer and it had metastasized to the bones and I'm sure that was a factor in her fracture. I also think it was in her brain too, but who knows-she did have psych issues and respiratory problems which didn't help her mental state. As I read through the chart it said she had been combative with staff and tried to bite them and threw things at them. I thought about finding another patient for a minute but then I thought what the hell, I like psych, it's interesting, and maybe I can help her have a better day.

Thursday I had my patient and only had to write my care plan, the only one, so no trips down to the hospital. (Plus gas is now $3.25 a gallon tonight here in town so I beat the latest price increase when I filled up downtownon Wednesday!) Good thing I picked her on Wednesday, the damn care plan took me over 4 hours. She had over 25 different medications and several I wasn't familiar with, and Roger insists that we know everything about the meds. Plus I had to look up all this stuff about her surgical procedure, it was new to me.

When I got there Friday morning the nurse was awesome. She was sort of new herself, had graduated 2 years ago from our program, and she was the best nurse I've worked with so far. She was there for me all day. She helped me with my charting- she went over the whole day's charting with me and taught me all these little things I never learned before, gave me tips on doing the neurovascular checks, and coached me through changing the central line dressing (my second one ever) and everything she did was professional and meticulous. I am going to write her a thank you note, she was so great. So far in my whole experience I haven't worked with any nurse who was so good. If I was interested in working on that floor I would ask her to be my preceptor.

My patient was pretty calm in the morning. She had this look about her though- her color was not good, it was what we call "dusky". She kind of looked grayish-purple, this cast to her skin. She also had some bruising and mottling on her ankles and feet. I recognized this because I had a patient last year as an aide who ended up dying right after my shift and I remember she had all these signs of death approaching. So this morning I had this weird feeling about my patient and I kept going back in the room, seeing if she was still warm, checking her pulses, seeing her chest rise, even though she was on a pain pump and taking anti-anxiety meds, muscle relaxants, and all kinds of stuff that should have mellowed her out to nothing. Still she got agitated off and on. She was in a lot of pain and both occupational and physical therapy worked with her. The other thing about her is that she had been a Hospice patient but upon admission to the hospital her family made her a full code. Which means that if she tries to die on you, you have to resuscitate her. I can't even imagine seeing her get chest compressions- what a mess, her lungs were already trashed and she was basically crumbling, and I don't understand why the family would do that- would put her through all that suffering in case she died in the hospital.

She complained a lot in between getting doses of her pain medication from the pump. She would complain about how bad the nurses had treated her yesterday, and then how bad her last hospitalization was (at another hospital). She had a wound on her arm that was healing- one of the IV medications she had been taking a month of so ago had leaked out into the tissues and done a lot of damage. And she could hardly breathe any time we lowered the head of her bed for any reason. Then she would suddenly be quiet, calm, and cooperative. Then she would ask for the phone and I'd dial her daughter's number and she'd call and beg her daughter to come. Her daughter said she wasn't going to be there today. After she got off the phone she started to cry and said how horrible she felt and that she wanted to go home, and she feels like she's going to die, and wanted her daughter to come. I went and got the nurse and told her what happened, and the nurse called the daughter and the daughter didn't answer. The nurse left a message, something to the effect that it was important that she come see her mother today as soon as she can.

I had this feeling as the day went on that I was going to see something bad happen with my patient. I didn't have any other patients so I did frequent checks and she wanted to talk, so I talked with her. She seemed to like me, and all day long whenever the physical therapist or respiratory therapist or anyone came into the room she would ask me to stay with her while they did their thing. I held her hand a lot while she was getting various things done, and I helped her with the TV and got her a lot of diet sprite. The doctor came in at one point to unwrap the ace bandage from her leg so the incision was visible, and he hardly said a word to her. A nurse from Hospice and the case manager from a community psych agency came by. I was glad there were people coming by to talk to her, it was distracting her from being upset about her daughter. Whatever was going on with the family was not good- plus it sounded like the family couldn't take care of her- not if she was falling and breaking bones!

Roger came up while I gave her some IV push steroids, and I learned a little about the pain pump settings today, and also troubleshooting the pump. Roger didn't say anything about my patient's condition and I thought he would when he saw her color. I told him later I was worried all day that she was going to code! Turned out the patient didn't code. She was still hanging in there by 4:30, and her vital signs were pretty stable all day. She drifted in and out of agitation and lethargy all day, and she kept saying things that didn't make a lot of sense. But she was hanging in there and she was asking for food. I asked her what she liked to eat, to see if there was something she might be able to get in the hospital that she liked. She said turkey sandwiches. I hope she can get that. She was about to order her dinner about the time I left.

Roger told us to meet at the restaurant at 5:00, so around 4:30 I started getting my stuff ready to go and walked out to the elevator, and went down to the lobby and out to the parking garage. I didn't see any of my classmates. Liz left the floor a minute before I did, I was finishing up with the nurse as she went over my charting, and I told Liz not to wait for me, that I'd be done in a few. I had a change of clothes in the truck-jeans and a shirt- and planned to change in the parking garage- I am good at doing that. I used to do it all the time when I'd go to my personal training client right after work at the hospital- I'd get out of my scrubs and change into my workout clothes inside the cab of my truck while I was parked in the garage. There's usually no one around so it's not that hard to do.

When I got to my truck there was no one around, so I got in, moved the bench seat back and proceeded to change out of my uniform. I got my top off okay and had another top on underneath so I wasn't exposing myself. I put my regular shirt on over it and then I had to deal with the jeans. I figured I could pull my scrub pants off- that's the easy part- they have the elastic waist. I was looking around to make sure no one was coming. I was in my underwear on the front seat of my truck, which also happened to be full of books and other crap I've been needing to clean out of my truck.

I bought this pair of jeans last summer when I had gained a few pounds after Block One. I remember feeling sad as I bought my first pair of size 6 pants- kind of a sad good-bye to my youthful waistline and hips. I remember feeling comfort in the fact that the size 6 jeans were big and roomy, not tight at all, a little baggy in the butt. That was last August.

As I started to slip my jeans on in the front seat, I realized I was going to need a little leverage to get them up my thighs, so I stretched my legs out over the front seat. I needed a little more leverage. I needed a tube of KY jelly, or maybe one of those big ass jars of Vaseline they have at ultra aid stations. You know, the community Vaseline jars, for public use, ones that lots of people stick their fingers in when you have no idea where their fingers have been.

Pretty soon I was fully stretched out across the seat, My head bumped up against the drivers side door and my feet were pushing against the passenger door as hard as I could. I thought I was going to bust the door open! I was pulling and wiggling to get my butt down into those jeans enough so that I could pull them up over my hips. I thought I was going to pull the belt loops out and smack myself in the face! Then my feet began to cramp.

I never drink enough water on clinical days, and here I was in my front seat, I hope no one walked by my truck at that moment because I would have been straining as my body was bent into a triangle, my face creased with agony as my quads and hamstrings and feet cramped into little tight spastic knots, stuck on my back with my head jammed into the door, my white cotton underwear up in the air, my butt slowly working itself into another spasm, visible through my back window, straining to pull those stiff tight jeans over my wide ass! Meanwhile I was cramping- I never get enough to drink all day during clinicals, and now my body was contorted into this position, stuck in the confines of my front seat of a little Toyota pickup.

And there, exposed to the world through the window in the back of my cab on the east side of the third level of the visitor parking garage at Desert Valley South, at about 4:45 pm, May 5, 2006, my epiphany arrived. Suddenly I was faced with a turning point- a midlife crisis of sorts- reality hit me- whatever you call it. Which was: I'm not so young, agile, flexible, and small anymore.

FINALLY! I got the damn things over my hips and then had to get out of the truck to re-adjust everything- by then I had a thong going, and I needed to rearrange things before I felt comfortable driving over to the restaurant and being in public. As I was standing there trying to shake things down, Anne walked up the stairs and appeared on the same level of the garage that I was on. She headed straight for my truck when she saw me. Somehow, as I calmly greeted Anne, it felt like redemption. Even though by then I was pouring sweat off my forehead and was a little winded too!

We met at the Mexican restaurant and had a fun dinner, and Roger's girlfriend joined us so we got to meet her, and she was cool. Roger bought dinner for all of us. We gave him a gift, too. And we ordered margaritas and we all sat around, laughed, and occasionally turned our heads when the plastic people with perfect surgically-altered bodies walked by. It really is the cottage industry here. We talked about silly things we did this semester in clinical, hemorrhoids on mannequins, and other interesting things you can make the mannequins do. And Roger gave us some hints for our upcoming skills final on Monday. He also told us that yes, he IS our clinical instructor in Block 4 for ICU. Wahoo! Block 4 will be a challenge & we'll be doing a lot more with the mannequins. Those hemorrhoids are so cute, I can't resist.

And now we're off to study for finals, and if all goes well, as of Tuesday at 3 pm I'll be drinking margaritas on a different patio, with Anne and others, celebrating our survival of Block 3 and our survival in general. Only four more days to temporary sanity.

Peace, love, and skinny butts,

Towanda, RN2B

My aching coconut!

Today was the last day of lecture for the semester! What a relief! By 4:00 I was ready to scream. I had such a headache from being in that classroom with the usual cast of characters. Miss Anxiety and the attention seekers were in their best form today. Every time there's a little uncertainty, they all go apeshit and freak out.

Yesterday we had our Pharm final. I did well and ended up with an A in that class. One down. Three to go.

We started out early with Misery Kate, she gave us a quiz that we had to show up early for, it was a "make-up" for the two quizzes she gave us earlier, that we bombed. This one was a joke, it was a list of matching terms. I can't even believe she went through the trouble to get us in early. She must have been worried about the whole class raising hell.

Then the Coconut lady finished lecturing for a half hour, and then we had our group pediatric lab checkoffs. We had the other peds teacher. We stuck with the same groups from the adult checkoff and I was with Laura and the same two other students. We did well on this one too. It was an 18 month old who refused to eat. Easy. It was a good thing we reviewed all the assessment info for toddlers while we were waiting for her to call on us because I wouldn't have had a clue.

Our group was done by 10:30 so I went home for lunch, I had a break until 1:00 for Process. And while I was checking my e-mail I received another e-mail from the chihuahua! Does she never stop barking? This one was about some scholarship opportunity. They always let us know about these things at the last minute.

I went back to class and Coconut lady was giving us our last lecture in Process. While we were waiting for her to get started there was a big flap about graduation. A few of the students including our class president, want the class to wear white caps and gowns at our pinning ceremony (what they call the graduation ceremony in nursing) They have decided to petition the Dean of Students after they were first denied their first request to do this. They still haven't heard from the dean. Usually the nursing class wears white scrubs to the pinning ceremony. I think that sounds silly. But I don't care.

The class president and a few others have already ordered their caps and gowns without the entire class being on board, though. So today that came up- for the first time a bunch of people voiced their objection to wearing the caps and gowns as a protest, and the class president wasn't too thrilled. Also, the attention seekers were trying to convince some of the objectors and it turned into a whole mess. Who knows what will happen. At this point I don't care. I don't feel like doing the cap and gown thing myself but I would go along with it if the whole class was doing it. Sounds like not everyone wants to, and I guess the people who already have their cap and gowns are going to have to figure out what to do now. That's not my department. I don't need to worry about that at this point. Ask me on August 9th. There's always Fed Ex. This class is so OCD I am sure we'll have it figured out by the end of Block 4.

It was the Peds version of GI, renal and endocrine stuff. And she told us the dept. secretary was coming at 3:45 to give us updated paperwork on Block 4. The clinical groups were finalized and we could do any switches if we wanted to. Unfortunately they don't tell you who your instructor is. I think it's Roger but I'm not sure now. I will have to hope it is, because I'm not switching. The only bummer is that there are two people in that clinical group who are totally high maintenance and I'm going to strangle them. One is one of the attention seekers. Other than that the group is pretty good.

Then the Coconut lady sprung a little surprise on us. We got to pick our preceptorship sites for the end of Block 4. We had 4 hospitals to choose from and whatever area we wanted, and we got a first and a second choice. I put Telemetry at South for my first and ICU at North for my second. I'm sure I'll get my first choice, they go by grades, that's one advantage of being the class nerd. Actually I hesitated for a while because I sort of wanted to do ICU at some point to check it out. But from what I know from what other students say, they aren't too nice to students in the ICU. I could have asked for County ICU but I don't want the extra driving time and gas expense.

And for dessert, today I'm serving up a recipe in haiku, inspired by today's classroom experience...

forty coconuts
toasted baked shredded and flaked
marinate in whine

I have clinical this week and a care plan to do. But tomorrow I am going to spend the day starting to study for finals. One more week of this.

Good news: ONE HUNDRED DAYS TO GRADUATION! Tomorrow we're in the double digits!

Peace, love, and coconuts,

Towanda, RN2B