Friday, September 28, 2007

research, addiction and other things I am angry about today.

My friend told me that I was very distractable today. I didn't really listen to her because I was trying to figure out how to get one of those cute little KEEN shoe keyrings... I also wasn't listening because I'm jealous that she gets to take her Master's degree in Research and roll out at noon on Fridays, whereas I have to remain on campus for at least three more hours, and possibly as many as four more hours. It's just horrible.

I turned into that back of the room asshole today in Research. After one prof read the damned slides verbatim to us, and offered nary a word of additional information or real explanation, another prof flashed a list of journal article titles on the screen and asked us to tell whether they were primary or secondary sources, and if they were empirical or theoretical. From the title alone.

I get that if it says review, it's secondary and if it says exploring or study, it's primary. But for one example, she said that it was not theoretical although SoandSo's Theory of Anywho was in the journal article title. We murmured and buzzed like the courtroom of Matlock when Andy Griffith makes his startling revelation, and she said, yes, it's empirical, because SoandSo didn't deal with these other subjects when she developed her Theory of Anywho, and so this article is actually creating a theoretical model, but not dealing solely with the theory.

Um. Prof? I have a question. Since we haven't studied SoandSo, nor her Theory of Anywho, we would not have been able to reach that same conclusion. I personally am still not clear by what you are using as the definition of theoretical framework and theoretical model. Will this sort of question appear on the midterm that you keep alluding to in such vague and threatening ways each week?


We had a guest lecturer in Psych today, talking through Psychopharm and fucking it all up.

Five minutes into the lecture, she said, in essence, that if someone becomes tolerant to a medication, they are addicted to it, and that addiction and physiological dependence are one and the same*. When several of us in succession raised our hands and explained that that was directly contradictory to what we had learned in Pharm and Adult Health and Fundamentals, that the bigger concern for the general population was untreated pain due to a fear of addiction, that addiction is a pattern of behavior motivated by craving the euphoria effects of a substance, not the physiological tolerance that most people develop to drugs like narcotics.
She responded that we should challenge our professors and question that teaching (and I'm thinking that is a ridiculous statement to make, when although a Guest Lecturer, she is still a lecturer and should have some concept of the rest of the curriculum of the program, especially before she rolls in and starts talking shit).

To add insult to injury, this class is a combination of second semester accelerated students, third semester traditional 24 month students, and last semester traditional students. So, the seniors are just so over our questions, and one of them eventually raised her hand and said, all snotty, Can we just move on? It seems that we're not getting anywhere with this. I cannot imagine saying such a thing to a professor. It's really amazing to see entitlement in action at 10am on a weekday.

Ridiculous Guest Lecturer also told us that she is more likely as a nurse practitioner to adjust someone's lithium levels based on their experience than based on their levels. Sure, sure, know the levels for the boards, she says, and yeah, yeah, hydration and I&O's are important. but I think that a tremor is a better indicator of toxicity than a level over 1.2.

In good news, I got a voicemail from the lady with the testing company that administers the Nurse Aide Certification test that I took and failed on Saturday, and I think that she hinted that upon review, I did, in fact, pass it. I don't believe shit until I see the score report. I dare them to tell me that I have to spend $22 and an entire morning answering scenario questions about what to do when you find a patient masturbating and how to properly handle a patient who doesn't want to eat breakfast and throws it at you, whether to abandon the patient you are transporting when a fire alarm sounds and my very very personal favorite (I actually laughed out loud when I read it!), whether it's a good idea to respond to a patient touching you inappropriately by touching him appropriately and asking him how he likes it?

A busy day tomorrow:

  • eggs from the happy chicken guy at the farmers market at the crack of dawn before he sells out, because they really do look and taste sooo different and better and because he has a photo album for the love of pete, a photo album, of his chickens and the Great Pyrennes who herd and protect them from predators.
  • Pride parade with the kid, bouncing between the gay parenting folks and the gay students from the university.
  • haircut for the kid, because school pictures are Tuesday and he's a tad shaggy. Incidentally, I'm thinking of growing out the crew cut and going for the chin length shaggy surfer cut that the boys are sporting these days. I love it.
  • museum to see them feed the bears and give Kongs to the lemurs
  • home to remove the clutter that has accumulated, and police the house for shoes, trash, and stray tumbleweeds of cat fur.
  • spend AT LEAST an hour on notecards for peds, since there's an exam next week, and another hour reading the material for research, which may enhance my experience in the course a bit.
  • make brownies and watch the disk of Scrubs that Blockbuster so thoughtfully mailed me today.

*I thought this phrase was - one in the same - for many many years.

Tuesday, September 25, 2007

still thinking...

Minority Midwifery Student's got me thinking again.

Our Research prof was talking last week about how she had this radical discovery after her first focus group in the Latino church. She wants to know if cardiovascular interventions for Latino folks like education on risk factors and exercise and whatnot are more effective if they are sponsored by the church. The church members interviewed said - We are glad that you are here and wanted to ask us questions and listen to what we say. And so we really feel that we have to tell you that we don't have time to talk to you about cardiovascular health and diet and exercise. We have enough other things to worry about - like when to buy food, keeping the car running or enough money for bus fare, and making sure that someone can always be home with the baby."

I'm getting all these messages lately that I'm not listening to what I am hearing. from newFNP, MMS, and my own District Health Action Committee that does not in fact want to talk about health disparities in the schools of my district, but would rather continue to advocate for compostable lunchtrays. I love the idea of corn-plastic cups, and composting lunch, and organic food for all school children. Get that Fast Food Nation guy in here right now for a sound bite. But also, there's shit going down that I would like to be working on, and instead I'm real busy jacking around.

I've been writing scholarship and election essays about how I want to work community health after I get my MSN, and after I spend a couple of semesters taking more conversational and health-care focused Spanish. But the more I edit those essays and really pay attention to what I'm saying, I realize that they are not reflected in my current day-to-day. In fact, I could be practicing my Spanish at the store up the street instead of driving past it to go the big chain store. I could be listening to Spanish on my mp3 player on the bus.

I wonder if I'm putting off the idea of working at the clinic until I am an FNP because I'm really scared to do that. Part of it is that I haven't had Community Health yet, but since when do I wait for the nursing school to come bring me the shit that I want to learn? I've trotted out to the workshops at the Pharmacy school on Plan B and over the library to meet up with the gay folks.

I guess I have this idea that once I go into the clinic as a practitioner, that I'll only be able to stay so long before my motivation/energy will be used up. Seems like that was my experience as a patient or the parent of a patient at the clinic - after a few visits, when I knew that being treated like shit was the norm, not the exception, I would go in with these high hopes, trying to muscle through as much bureaucracy before my momentum wore off, like that slow motion football player throwing off tackles left and right, and finally leaping over the goal line by inches... She finally... gets... the prescription... and she's clear.

Workshops on incontinence are important, yes. Seminars on the IRB process for the survey/honors project I want to do on nurses' cultural competency w/r/t LGBTQI folks, good. But following up on the shit that I said I was doing is also critical. And it's bugging me that I say I'm doing it for the people who will give me money, but I'm not doing it yet.

maybe that's why I'm still awake at 2am?

Monday, September 24, 2007

knit one, purl one, double crochet.

Currently I have the following fiber arts projects started:

one shawl, aforementioned in this blog, for which I have begun the far shoulder and have one cake of yarn left. We shall see.

pads, knitted and crocheted from kitchen cotton, flat and in the round. These are in an attempt to use up the bags of the stuff that I bought at Michaels last summer, when I was just learning to knit and thought I'd make a thousand facecloths for holiday gifts to practice on. Lately, I've been teaching myself to use dpns and my friend has been teaching me how to do matched decreases, and how to add crocheted trim to knitted items. So far I have learned that I am still a lumpy purl-er and that stockinette curls even with crochet wings added. I did manage to make something that the kid at the playground suggested looked like a trout. Great.

A hat for my step-father. This pattern looks like it will be perfect for his head, and within my abilities to make. But it called for Cashmerino Aran weight. I didn't want to pay that much for a muffler, and wanted the lady at the yarn store to help me find an alternative, but then the kid started to rip things off the walls and she wasn't as helpful anymore. So, I'm back to internet searching.

I just finished crocheting the blocks I was making for kitchen decorations. I was thinking of felting them for trivets, but then I remembered that I was using Superwash. so. not so much with the felting...

Projects I am contemplating:

felted placemats because I think more surfaces in my home should be coated in cat fur.

a sweater, sweet jesus. why? or hell, let's just make it really complicated!

socks for the love of pete.

mittens to go with the hat for step father, and an alpaca mitten/ scarf set for mother.

a bathmat to use up the rest of this god forsaken pale variegated cotton, which unfortunately can't even be dyed, right?

a super fancy blanket with super fancy yarn. Oh Babette, why are you so attractive?

In other news, I have no plans for the Pride Parade which is this weekend, other than to trot around with the kid in tow. I made cute shirts for the Dyke March a coupla years ago - the kid's said Mommy, what does queer mean? and mine said Hi kid! I'm queer! My friend, who has a girlfriend this year for Pride, and who I am ridiculously jealous of at the moment, is thinking of making a shirt that says Does this shirt make me look gay? which I think is incredibly clever. I'm still jealous of her girlfriend, though.

Speaking of knitting and such, I have done not one stitch of my lit review assignment for research. It was the only thing on my agenda for the day, and I have spent the whole day working on essays, and surfing, and catching up on email and blog-reading and posting, and daydreaming about going to a honest-to-goodness arts and music festival with tent camping and everything!


I've been working hard to drag myself out of a trip to the sucking thought-spiral of despair for the past couple weeks. I had been feeling sad and lonely, and sort of on the verge of tears - the kid wouldn't go to sleep, I was being a raving angry shrew anytime we were together, and then teared up when he told me he wanted to go spend the night with his dad. That's the first time he's said that, and though I knew it would happen at some point, I just figured that point would be in five years when I wouldn't let him go bungee jumping or something. All my free time had been taken up with writing essays about how super super great of a student and a human being I am so that nameless bureaucrats would award me some money, which other nameless bureaucrats in the Fin Aid office would then process in such a way that I couldn't get my hands on and pay my cell phone bill, which somehow was doubled this month because of usage charges since I was out of class for three weeks and everyday was a holiday!

And then my clinical instructor wrote "Very interesting! Let's discuss!" on the top of my write-up for Psych, and I cried on her when we had our midterm conference. I figured she meant interesting like "I'm speechless with how poorly you have completed this assignment! Let's talk about how you can get some points for this by re-doing it entirely! You actually have no empathy and should consider a new professional track immediately. " I cried, and stammered that it seemed like she was telling me that I didn't listen to my patient, and of course I listened to my patient, I had just written 500 words about how I want to be a nurse because my inherent capacity for empathy and attentive listening that I will provide my patients from traditionally underserved groups.
She suggested that I seek counseling, because as I had shared with the group, these patients and their PTSD and alcohol abuse issues were obviously close to some emotional issues I hadn't yet resolved with my own father. She didn't say anything that I hadn't said in post-conference to the whole group, honestly - she just linked all that I had said to the fact that "I was moved to tears by feedback on my first paper" and said that "my reaction suggested that I have a bit more anxiety about this rotation than I thought I did". She was calm and compassionate. My reaction to her suggestion that I seek counseling, when I had, in fact, sought counseling in the past, and was currently medicating my way through a bout of depression/anxiety, was to instantly feel like I am much crazier than I thought, and that I had embarrassed myself in revealing what it was like to grow up with a father who had PTSD.

In fact, it turns out she wrote that on everyone's paper, because it was the first time any of us had done an IPR (interpersonal recording - patient said, nurse said, was nurse therapeutic, how is patient's diagnosis exhibited?).

What I'm really proud of is how I handled it. Not initially, of course. For three days or so, I mucked around in a shallow pond of self-doubt and pity. I had imaginary conversations with her, and started arguments with my ex-husband about the cell phone bill and our custody arrangement. I told the story of our conversation to any friend that would listen, and filled in any boring places with sarcasm and dramatic analogies. I felt betrayed by this professor, who I had for a class my first semester and for whom I had much respect.

But then, I went for a long walk in the woods on the cross country trail near my house. I took my mp3 player and listened to the Non-Violent Communication files I have saved. I realized how far removed from reality and the present moment I had become lately. I sweated and swang my arms and stomped along the hills of the trail. I ate an entire huge slice of chocolate cake and checked out two discs of Scrubs to watch back to back. I made notecards for the house to remind me to say "I feel --------- because I -------." instead of "You made me really mad!" and "It's none of my business what anyone else thinks of me." and last but not least, "You can't MAKE anyone do anything. You can only make them regret it." And I decided that I had shared my experiences appropriately at the time, and that my embarrassment was about exposing my tears and emotions to my instructor. And that my sense of betrayal was based on an assumption that because I already had a level of comfort with her, that she wouldn't push me at all during this rotation, when I explained that there was some real potential to get sad while talking to veterans that reminded me a lot of my dead father.

I also remembered that each semester so far has had its own teary day. Remember when I burst into tears because of I couldn't inject saline into the hotdog! How much fun was that?! I realized that I thought that the Wellbutrin was going to protect me from emotional outbursts - and decided that I had experienced the emotional equivalent of breakthrough bleedings. I'm actually grateful to know that I can still have super sad experiences while taking the meds; it would be scary to think of never experiencing strong emotions again.

And that when one, who shall nameless, walks around looking for things to mock and deride, then she will get really really good at mocking and derision. And one who is really really good at mocking and derision will be tempted, nay, compelled to occasionally mock and deride herself.

And then I was not an asshole to the kid for one whole afternoon, and made oatmeal cookies with him, which he pronounced "surprisingly delicious".

All is well.

Friday, September 14, 2007

why, White People, why?

My people are busy sucking again.

Listened to report the other day about how a patient was noncompliant with the Kwell shampoo. I perked up because this is the new admission that I saw coming in, a 30-something AfAm male with 5" dreads. What is Kwell shampoo, I wonder? And why are they trying to wash his head? And why are they confused that he would be noncompliant with this plan? The report on this patient ends with the fact that "pt did allow us to apply the Kwell lotion and understood that we would need to leave it on for 8 hours. He stated that he was offended by our original request and that he had psoriasis. After our conversation, he seemed less agitated and was less loud."

okay. let's get the bullets out:

  • I don't know a thing about the situation, because my instructor wouldn't allow me to talk to the staff nurses about it.
  • kwell shampoo is apparently used for lice, according to my clinical instructor.
  • did the patient in fact have lice?
  • does the staff have a clue that rules for washing and caring for white hair are totally different from the rules for black hair, and dreads have their own policies and procedures as well? Did anyone do a quick google search on whether kwell shampoo was the appropriate treatment for a patient with dreadlocks and lice?
  • Yes, lice IS in fact a concern in this unit, as it would spread like wildfire and be very difficult to eradicate.
  • However, did the patient in fact have flaky skin on his scalp that got mistaken for lice by the intake nurse?
  • And, was this nurse the same one who left the report, because I've watched her and she has demonstrated a marked lack of social adeptness in a variety of situations. Including, but not limited to, responding to a patient's statement during community meeting that he doesn't know where his stuff is and didn't receive an itemized receipt for his belongings when he was admitted by saying that "you shouldn't bring things of value with you. I mean, when I go to the doctor, I don't bring all my cash and my jewelry and whatever with me!" Um. Hi. I have a comment. This patient was involuntarily committed and brought here in cuffs. What the fuck did you expect him to do?

minority midwifery student has been writing of this bullshit this week.

and I'd like to add my offer of help to all my people. White folks, let me know if you need some help on this from one of your own. I'll be running a little workshop on Saturday in the park, come on by and we'll have graham crackers and talk it through.