Pretty Please

Although peds and psych lectures both started back in August, the clinicals were broken up so that we did one at a time (I had psych clinical first). New rotations are usually preceded by a “clinical immersion” (think one-day clinical crash course); we just had one for peds this past Sunday.  But this weekend is the real deal—we’ll be starting another round of 12-hour shifts at our assigned hospitals, 630am to 630pm. Oy vey.

Most people know that I plan to specialize in pediatric nursing in one way shape or form after it’s all said and done—whether it’s pediatric intensive care, oncology, or maybe even palliative care. So since I began this journey over a year ago (wow, has it really been that long?), I have been looking forward to peds—I absolutely couldn’t wait to get here. This will be my sixth clinical rotation. I have fought my way through fundamentals, health assessment, maternity/OB, med-surg, and mental health to get to this point. After all of the running out the door at the butt crack of dawn with one eye open and mix-matched socks on, the Nurse Nastys and the Cindy Lou Whos, the stress and the hair loss I’ve had to endure to get this far, and even though I’ve been less than pleased with lecture portion of peds (and that exam last night was KIL-LER), I am praying that my peds clinical experience is all that I’ve hoped it would be.

So with that said…

I’m goin in, I’m goin in, I’m goin in, I’m goin in… (in my Lil Wayne voice)…

Some Nurse…

When (medical-ly) things go wrong in my own house, right under my own nose, it really makes me start to question how good a nurse I can/will be. If I don’t even notice when one of my own kids is in respiratory distress then how in the world am I supposed to be able to assess multiple patients?

One of my daughters—the “small girl” as she calls herself, not the much taller one from my strong therapy post—was admitted to the hospital this week (hence very few tweets and status updates from yours truly). I was at work, actually in the middle of taping another Insights in Nursing podcast episode over my lunch break, when I got a call from the daycare saying that she was breathing pretty hard. Of course I hightailed it over there, stopping by the house to grab her barely-used inhaler. Until this admission, the docs refused to label what she had as “asthma.” They said she was too young and her symptoms were just a bad reaction to a virus, so up to this point she had not been on any type of maintenance therapy. Nevertheless, I did still have that trusty rescue inhaler (which had probably not been used for close to a year). I get to the daycare and she looks absolutely horrible. I could see her working to breath through her hoodie. I gave her her “puffs” and put her in the car. By the time we got to the hospital she was tachypneic, with intercostal and suprasternal retractions. How could I have not noticed any of that this morning? Surely, she did not go that downhill that fast and without showing some preliminary signs/symptoms; she didn’t look like that when I dropped her off that morning.

Thinking back, there had been signs—just none that I had readily accepted. She’d been coughing recently. It started out as a dry cough; I now noticed that it had become junky. Just that morning, she complained that her throat hurt, and she looked tired as all hell. I sort of brushed it off thinking (or hoping) she was “just” coming down with a cold and even told her that she’d “be alright.” And of course she was tired. Our lives are hectic as a side effect of all of our various responsibilities; we get up at the crack of dawn after staying up late nights most of the time. I’m sure our entire household could benefit from a few more hours of sleep.

But this was bad. She’d had a similar “episode” (since we weren’t calling it asthma) sometime in 2009, but it wasn’t like this. It took her a lot longer to come around this time. The albuterol and prednisone weren’t even touching her wheeze (which sounded more like an expiratory snore). I felt horrible. I am under such tremendous pressure and stress—between home, work, studying and keeping my grades up in school, trying to stay “involved,” community service, networking…all on very little sleep. But at what cost? I already know I’m stretching myself thin. But everyone keeps telling me that it’ll all be worth it in the end… 

I think my overpacked schedule and subsequent need to have things proceed in an orderly, organized fashion (such as not having kids get sick when I already feel like I’m being pulled in a million different directions) has led me to develop “hyper“chondriasis (sort of the “opposite” of hypochondriasis). Yep, that’s what this was—a case of hyperchondriasis by proxy. My kid was really sick, but I was in some type of manic denial.

Through it all, I did learn something new…retractions seem to work their way UP. As in the patient usually has subcostal retractions first, then intracostal, then supraclavicular or suprasternal ones. My daughter’d had retractions before, but never up at her collarbone area.

In any event, she’s home now, doing much better, and back to jumping off the walls and eating us out of house and home. 🙂

Welcome to Whoville

I’ve nicknamed my mental health clinical Whoville (land of the “small” people). One of the nurses on the unit, I’ll call her Cindy Lou Who, hasn’t been outright mean (like some of the Nurse Nastys of yonder clinicals), but she just makes these random, jabbing comments. First it was that we were only allowed to look at certain charts. “Well, you can’t look at all of the charts…just the one for the specific patient that you’re going to talk to…” Well um, since we’re not assigned specific patients, I kinda need to look at a few to decide which one I want to attempt to talk to since none of them really want to talk to us anyway. But fine, whatever, I brushed that one off. Then it was, “You do know what HIPAA is right? That you can’t talk about the patients when you leave here and all?…” Thanks for the heads up but um yeah, I didn’t start nursing school yesterday… Brushed that one off too.

Then today was the kicker. The patients have morning community meeting directly followed by another group. To make a long story short, for various reasons we decided (along with our clinical instructor) that we were not going to attend the second group meeting. Cindy Lou Who pops her head in the report room where we were working on our process recordings and says they were about to start group and that “if” we wanted to go we should go now as to not disturb the group being late. We nodded/acknowledged/said okay and continued to work on our assignment. When we emerged a little later Cindy Lou Who assumed that we had left in the middle of group and starts going off about how we can’t just walk out of group. In order to calm her frazzled mind, I jumped in “Oh no Cindy Lou Who, we didn’t walk out—we decided not to attend the group today. Our instructor thought it might be better if we gave the patients a little space and not attend both groups since they’re back-to-back.” Well the sky just opened up and the lightning struck. She goes off saying that she went out of her way (ten feet down the hall?) to ask the guy if he minded if we attended his group (he honestly did not care one way or another) and that we should have told HER we weren’t going to attend and that the fact that we didn’t was “disrespectful.” Now I admit that maybe there could have been an ounce more of communication, but disrespectful? I think that’s a bit much.

So for the remainder of the day, Cindy Lou Who’s whole demeanor towards me changed (you get very good at reading nonverbal/body language when you take psych) and at the end of the day when we made sure to tell her (because I for one sure didn’t want to be accused of being disrespectful again) that we were going to post-conference she gave me the grizzly!! WTF?!? How old are we again?

Then we have Betty Lou Who, the other nurse on the unit, who usually just flat-out ignores us. She even told our clinical instructor on our first day in not so many words that they “don’t really deal with the students.” Some teaching facility huh? Most days I am just splen-dant with just tuning her out. But today, she asked if we minded doing some vitals for her. Surprised that she even acknowledged our presence we said sure no problem, it’d provide an opportunity for some small talk with the patients…especially since they were still a little hesitant to open up to us. Then one of the other staff said to her that we weren’t “here for that,” but were “here to learn about mental health.” To which Betty Lou loudly replies (as if we weren’t standing right there) “SO!! It’s not like they have anything better to do!!” WOW. Just. Wow.

After lunch, we normally have a mini post conference with our instructor to discuss any morning issues before we head back to our units. Perhaps she thought we had snuck off to Starbucks or something so I guess she thought she was putting us on blast or getting us in trouble when she exclaimed quite grandiosely (in front of our instructor) “OMG!!! You missed it!! You missed the patient escalating! Where have you been all this time?!?” I was pretty much dumbfounded with her behavior at this point as for the past month or so she hasn’t given us a second glance so I am pretty sure my mouth just hung as I looked at her like she was crazy. She had this sort of self-serving smirk on her face as if she had really stuck it to us. Imagine the amount of salt she had to remove from her shoulder when she was informed that where we had been, was with our clinical instructor (imagine that…).

I really don’t get the whole nurses eating their young thing, but to me it just goes against the very grain of what I thought nursing is supposed to be…

“You’re a vile one, Mr. Grinch…You have termites in your smile…You have all the tender sweetness of a seasick crocodile…Mr. Gri-inch…Given the choice between the two of you, I’d take the uh… seasick crocodile…”