Will this be on the test?

I find myself giving test-taking tips at every tutoring session lately.

Five tips for taking tests in nursing school: *

• Read the question.

Seriously, read it. Stop, don't look down at the answers yet. Read the question once more, looking for these words or phrases: LEAST LIKELY, MOST LIKELY, PRIORITY INTERVENTION, NOT, FIRST. Underline them when you find them. You absolutely must know what the question is asking before you attempt to answer it. If the question makes you think of that awesome little song that you made up to remember the cranial nerves, go ahead and jot them down out to the side right quick BEFORE you look at the answers.

• Think of the patient.
  

When you study, think of how this will look in an actual patient. If I was in the room with someone who had a Foley cath in, what is the very first thing that I need to think about before that patient ambulates? My list of ALL the things to consider before they start traipsing about would include: where's the bag and who's going to hold it, when's the last time this person got up and should we sit and dangle first, are there any obstacles in the intended path and who will move them, and what other lines do we need to pay attention to (like IV poles, or wound drains, or whatnot). Now prioritize them. What must happen first? What can wait? What means Something Bad and what is an Expected Outcome?
Of those, I think that passing out onto the cold dirty hard floor of orthostatic hypotension has to top the list of Things to Pay Attention To. Having one's foley pulled out with balloon still inflated would be right up there as a very close second.

• ABC, 123.

When prioritizing interventions, as above, or in questions where you are asked to assess a patient and choose the most worrisome data, start as low on Maslow's pyramid as possible.
Airway Breathing Circulation
1 heart, 2 lungs, oriented x3 (who are you, where are you, when is it)
Risk for Powerlessness is always going to appear on my list of Relevant Nursing Diagnoses for any hospitalized patient. Always. Let's face it, laying in bed with no underwear does not increase one's self-efficacy. But I cannot assess anyone's psychosocial needs or even their pain level (which is usually next on my list after the ABCs and 123s) if they are currently not breathing or bleeding out.

• Do another med check.

Patient safety has got to be right up there at the top of the priority list. You have to do three med checks, but four can't hurt, especially if you're in a skills evaluation and you simply can't remember doing that 2nd one before you left the Pyxis. "Put on gloves" is always a good idea, along with "Wash hands and document". The phrase - siderails up times two bed low and locked call bell in reach - is burned into my brain forever. This stuff will find its way onto the written exams, too, so be on the look-out.

• "Call the doctor" is almost never the answer.

It seems like a good idea, I know. Interdisciplinary blah-blah-blah? They're going to have to write the orders? I know. But resist, for just a second.
Think about this - What are you going to say when she returns your page? Stammer, stammer, the patient uh, is, uh, doesn't look right and I think you should come down here. Click.
Assess before paging anyone - unless it's a code that you think you should call, and then holler away! Think through the information that a consultant is likely to ask you if you paged them - axillary temp, blood pressures for the last ten minutes, hematocrit levels, intake and output totals for the last 12 hours? What is the thing that made you worry about this patient and what information do you need to gather about that worrisome sign or symptom? Get it all written down, and then call (abcd - assess before calling doc).

*of course, I only know about MY nursing school. I know that all nursing students do skills evals, but I don't know if you will be able to talk to yourself throughout yours the way we were encouraged to do. I think these are pretty universal, and not just based on my Fundamentals professor. of course, your mileage may vary.

aqui, no mas *

Quick run-down:

Maternity - test this week on labor and delivery, extrauterine transition of the newborn, newborn care and teaching. take home points: Babies should be warm, pink and sweet and labor hurts a lot. Aforementioned clinical drama. Excellent patient interactions for two weeks running now.

Public Health - 92.1 on last week's test. Proud of the studying I did - in small chunks, used textbook for making study sheets, even though I never read before class. Also aware that this is one class where more studying likely will not bring better grades, but taking more time to read the questions will. A big relief.

one of the Disciplines - panel with new grads for class this week. Take home point was there's a relatively high rate of job-changing 1 year out of school, and attrition rate from the profession altogether. Choose your workplace based more on the co-workers than the patient population - it's never worth it to work with nasty-assed people. Also made the mistake of sitting in the back of the class, and listened to the back row bitch and moan and make snide comments the whole time. The irony was lost on them, of course.

the other Disciplines - watched the movie Wit with Emma Thompson and cried unabashedly. Excellent, excellent movie. Fodder for hours of discussion. I will have a hard time limiting my paper to a page.

Spanish - survived another conversation hour, complete with dialogos enacted in front of the class. received positive feedback on paragraph re: the usefulness of the pain scale with patients who are not native English speakers. I said, Shit, it doesn't work so well with patients who ARE native English speakers. Again, did not die during public speaking en espanol.

Patho tutoring - still need to drop off paperwork for payroll. Held session on SuperBowl Sunday night - 25 students showed up! I was thinking, maybe 10 would come! What's worse is that we were doing my weakest lectures - immunity, B's, T's, NKs, types of hypersensitivity reactions and classes of antibodies. survived.

State Board of ANS - another marathon meeting, this one with hours of driving attached on both ends. It's looking bad for our upcoming mid-year conference, and it's hard for me to get all gung-ho about it because it's so clear that most of our activities are merely for self-perpetuation. Approved an operating budget of $65K at the last meeting that included $1000 for scholarships. AND that pittance took over an hour to agree on. excited about nationals in Texas in March, sad that I didn't get my shit together for a resolution, excited about folks planning outreach projects with kids. also, i'm a big dummy and volunteered to take the minutes and have yet to send them out. shrug.

Honors - hmmm. Thought a lot about this. It seems a little insane to take another thing on this semester. But I've been wanting to do an Honors project since I started the program and was thrilled when I squeaked through with the GPA last semester to qualify. So I decided - Yes, I am doing this thing. Now, I just have to find an adviser in the next five days to sign my intent to participate form. hmmm.

the kid - getting my head around re-districting for next year. processing more worrisome progress reports from the teacher who doesn't have credibility with me, and from the art teacher who was more worried that I thought was appropriate. planning birthday hockey game with friend.

the house - rearranged the living room, with the bookshelves I bought for shoes two weeks ago. Nice to have the lake of shoes off the floor behind the front door. Appalling to see the amount of cat fur that builds up in two weeks. Dishes are going on 13 days now since original use, although they have been rinsed and stacked in varying arrangements twice in that time.

in the category of Nothing to do with Nursing School - hang on, I know there's something... hmmm. made new list of scholarship applications due on March 15th? no no that won't do. chinese food with friend which included discussion of nursing school, but also of her new job and dying cat? better. did taxes, and was impressed that I managed to earn only $4K last year, down from $10K the year before. Now that's gross income! badumdum. attended Friends meeting. good. very intense feeling of peace this last week, lasted about 4 minutes. distracted by making mental lists of this weeks errands. watched leaves blow outside.

*literally - here, no more. I've heard it used to indicate to a professor that one is present in class, but not at their best that day, so don't expect a whole lot.

the next week-ana-haf

It's not going to be pretty folks. Not pretty at all.

First off, tis the season to begin calculating what I'll have to get on my finals to maintain or improve my current grade in each course. And then, because there's still time left in the "fart around" block on my calendar, I can calculate exactly how far the 5 credit hours of a B in Peds is going to sink my GPA and if there's a way to recover. Since there's approximately 42.5* hours total left in my schedule for studying, and my other exam grades this semester have been 98, 85, and 84, it seems unlikely that I will score the 99% that I need on the final to make the cursed 92=A**. sigh.

today is a bust - but I did get the presentation for Thursday's genomics class done, and have about another hour or two to spend on my clinical worksheet for tomorrow, and then I'm taking my movie back to Blockbuster and getting something dumb like Fred Claus.

Wednesday 11-28 - up at 5:20a, leave home by 5:55a with lunch and hard boiled egg breakfast, drive thru coffee kiosk by 6:13a, park and ride lot by 6:22a, hospital by 6:42a, conference room with oatmeal ready for report by 6:46a. Twelve hours of 14 yo with idiopathic scoliosis s/p spinal fusion due to 41 degree curvature, logrolling q 2hr, monitoring morphine PCA and IVF, possibly d/c a foley and hopefully think of something to keep him from being bored out of his skull. I wonder if he plays chess? Catch the bus by 19:08, park and ride by 19:22, home by 19:51, feed cats, shower, eat something that doesn't require me to wash the dishes, make tea, finish worksheet, email genomics ppt to prof, trade out the laundry, scoop cat shit and collapse in bed by 23:28.

Thursday 11-29 - alarm at 6:12a, snooze til 6:32, leave house at 6:55, park at elementary school and feel slightly guilty for not saying good morning to child by 7:15, coffee from library coffeeshop at 7:38, sneak into lecture hall past man who yells about food and drinks by 7:51, Peds from 0800 to 1100, Genomics from 1100 to 1200. Get food from bookstore, take bus to elementary school, work on missed assignment from week before last in Research in school multipurpose room til 1330. Collect reading buddy, read Bear About Town and A Color of His Own, return buddy, collect new buddy, repeat. Return to MP room at 1430, refocus on Research assignment and lament the lack of reading completed for this class all semester. At 17:45, present self at Music Room for assistance with the Herding of the Parade of Children for the Multicultural Gala, in which child will be singing "Hello to All the Children of the World!" and cheesing it up as usual. Stay as short a time as possible, corner ex-husband to review end of semeter schedule, demanding a commitment for child care during next Saturday's scheduled final exam in Research, and dash home. Repeat Wednesday's evening activities at home, without the genomics email and with the added joy of supervising ready-for-bed activities of child.

Friday 11-30 - alarm, snooze, park at elementary school all as per Thursday's schedule. Present self at the library at 07:25 to work a shift at the Book Fair, collecting quarters for pencils and imprinting credit cards slips in an old ca-chunka credit card thing. Bus to campus, coffee from bookstore, lecture hall by 08:58 at which point all the good spots will be taken and I'll have to climb over five rolling bookbags and six laptop cords. Psych lecture from 0900 to 1100, and ATI test from 1100 to 1200 to heighten my anxiety about finals and my Lack of Mastery of the Material. Lunch with friends that I haven't seen in two weeks because of conference and then the holiday. Research at 1300, for which I will realize that I haven't prepared at 12:47. Prof will read her ppt, break us into small groups and then release us an hour before class is scheduled to end. Buy a 20oz Coke, and go to library for 1hr 15min to print out everything I can think of to use up my printing allowance for the semester. Bus to elementary school. Collect child from after school program, who will not want to be collected, and who has likely forgotten one of the following items: lunchbox, jacket, Gator Communicator, water bottle. Go to Food Lion for veggie chick'n nuggets, juice, bread, milk. Home. Cats. Dinner. Bed for kid. Write agenda for committee mtgs tomorrow, and reports for my position for November, and goals for the year for meeting tomorrow. Wish there was wine in the house. Bed for me.

Saturday 12-1 - Plan to get up at 0700 and study for an hour, then at 0800 to go to farmer's market for eggs from the Happy Chicken guy. Sleep in, and wake kid up to go to whole foods with friends around 0945. Wake up friends. Go to Bank and deposit amazing Merry Christmas check from Generous Aunt which will make it possible to avoid working any shifts at the restaurant during finals week. Mentally thank Generous Aunt again. Sit around drinking coffee and eating overpriced underdone scrambled eggs for an hour. Leave child with friends, remember that I forgot my scrub top at home for group picture and go get it. Drive to nearby city for board of directors meeting of state nursing student association - struggle to find parking and arrive at bldg 12 minutes late. Meet until 2pm, avoid snapping at abrasive board members, and find a way to discuss grammatical errors without offending. Pick up kid, chat with friends, offer to take her child to park with us, go to park, knit while kids run. Drop off kid, offer to spend some of Generous Aunt's money on dinner for the four of us. Eat a lot of delicious breakfast food. Go home. Glare at the cats, their shit and the still-unwashed dishes. Also, on Saturday, I have 2hours worth of work to do on my clinical presentation due next Wednesday, which includes a 2page paper, 2 articles and a handout for my classmates on my interesting case study. Do this and then spend half an hour shopping for vibrators and dildos.

Sunday 12-2 - shit. I have no idea. schedule reads Peds from 09:00 to 12:00, county library with kid from 12:00 to 14:00, childrens museum from 14:00 to 16:00, grocery store from 16:00 to 17:00, dishes then dinner then dishes again from 17:00 to 19:00. There's a note that a chorus meeting is from 13:00 to 15:00 at the Friends Meeting House, but I don't know if I'm going. At some point, kids' father is sposed to pick him up for a roller derby match, but idk when. schedule also notes more Peds study time from 1900 to 2200, but that is unlikely. More likely that I will be on the computer until 0100, paying my bils with Generous Aunt's money and deciding on yarn for that afghan I'd like to start over break.

Monday - 12-3 get up at 06:18, leave house with kid (and whichever of the four essential items that made it home on Friday) and hardboiled Happy Chicken eggs and go cups of juice by 07:08 to be able to park at elementary school by 07:38, get kid inside before 07:40 bell. Buy the kid's stocking stuffers (with G.A.'s money of course) from the Book Fair. Collect reading buddy at 08:00, read for 20 min, collect another buddy, read, and then walk to bus stop for bus to campus. Coffee from coffeeshop, up to favorite nesting spot, plan to spend nine straight hours studying Peds and Psych. Fuck Genomics and Research. The finals are worth 40% in those classes? Oh. Spend an hour obsessing about grades in all four classes and filling in next semester's academic calendar. Spend another 30 minutes getting a latte, toasting a bagel and checking email. Wish that I still smoked and could take a smoke break. Force myself to go back to nest and sit down for another 3 hours. Take last bus to park and ride lot, forget that car is at the elementary school, take bus back to campus and then back to elementary school. Get home by 23:00. Glare at cats and their shit. Feed them, then go to bed.

Tuesday 12-4 - this morning is going to be hard. I don't have anything *scheduled* until 10:30 (which is my first dentist appt in SEVEN YEARS, and I'm a little Anxious About It) and it will be tempting to sleep in. I would like to get up at 0700, shower, make coffee and quick breakfast, then sit down to look at Peds for two hours before going to the dentists. After dentist, park and ride, campus, read Research in hospital lobby. At 15:00, go up to unit and get patient assignment for Wednesday, research chart for two hours for clinical worksheet. bus to park and ride, car to elementary school. home, cats, dinner, dishes, chess, kid = bed. clinical worksheet, set five alarms, self = bed. Remember to email clinical group my presentation and print multiple copies of handout and articles.

Wednesday 12-5 Okay, this morning will be harder than Tuesday's! The kid has to be at his father's workplace at 06:15 for me to have time to drive to parking deck and be ready for report at 06:48. I don't even want to think about when we have to get up. clinical until 19:00, parking deck, whole food buffet which had damn well better include some macaroni and cheese, home, cats, shower, type up clinical worksheet from a day's worth of scribbled notes. wait to email it until Thursday to allow for one more editing opportunity - I need every point I can get on these worksheets for that mythical 92! tea, email, check for an episode of house, fall asleep during it.

Thursday 12-6 I would like to get up at 07:00, be at the library at 07:45, get coffee and a study room, and spend all day on Peds, with short study breaks of Psych and Research thrown in. Maybe meet with study partners from last two semesters, but I'm feeling like it's a bad idea to study with them for the first time this semester the day before the final. I really hope that next semester will allow for some more regular study times when we're all on campus. This semester, it's been scattered all over for clinicals M T W, and in class from 8-4 Th and F. Rescheduled Reading Buddies to another time, maybe Monday morning. Eat a good dinner, take a bath, lay out my clothes, and set five alarms before I get my 8 hours of sleep.

Friday 12-7 Peds final exam 09:00 to 12:00 Get to campus early enough to get coffee and a bottle of water. Sharpen pencils. Layer clothing. Read each question three times, underline key phrases, circle any negatives, check each answer backwards - does the answer make perfect with the question? I will plan to be there until noon. I will not dash out of the room to be the first one done because I'm nervous. I will also spend 5 hours on Research Friday afternoon, and repeat the whole Twas the Night Before a Final routine Friday night.

Saturday - 12-8 Research final 09:00 to 12:00. I am too exhausted to even think about this.

Sunday - 12-9 Write Genomics paper on asking my family about their medical history over the holiday

Monday 12-10 Psych Final 09:00 to 12:00 Write Genomics paper on Case Study Project. Read all Genomics powerpoint slides

Tuesday 12-11 Genomics Final 09:00 to 12:00 Collapse into small quivering pile.

Wednesday 12-13 I've decided that this would be a good day to donate platelets. I don't know WHY I decided this. I've also scheduled myself to work a lunch shift on this day. I think I'll keep the platelet appt and release the shift - I deserve a day on the couch with a season of Scrubs, a big bag of Grandma Utz's potato chips, some sour cream dip and a two liter of coke. mmmm.



* Oops, make that 41.5. I just spent 30 minutes catching up on Google Reader and I'll spend at least 20 constructing ridiculously long sentences here.
**It's not even a real 7 point scale. 100-92 = 8. Dammit! It's annoying enough to make 92 the lowest A, but don't call it a 7 point scale if you do so!

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?

sigh.

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.

If I make 205 out of 250, I can pull a B.

But apparently, not a B+. And this is something that I have never worried about before. It seemed a little snooty to be all about the A+ or the B+, because I thought that GPA was just based solely on the letter grade, not the plus and the minus parts. But now I'm all sad and pissed because I should have been wavering between an A and a B in that class, but after losing points on four skills evals over the semester and the Most Awful Final Exam in the World, I'm trying to keep the B.

not to mention the pluses and the minuses.

damned seven point grading scale. i don't like it one bit. there's no wiggle room!

dude. so much to say.

worked all weekend last weekend. skipped class this morning because I stayed up all night watching a disk of House. had a mini-crisis (almost entirely self-created) last week because I hadn't done an assignment that was worth 50 points of a 1000 point class average. At the same time, it was a 6-8 page care plan for a stroke patient - you know, integral skills to have for the field! The stuff that I'll be doing non-stop from here on out in nursing school! eep. Eighteen mini-panic attacks later, I turned it in, not even late, and complete with all five journal articles, cited in APA format. This time the payoff for resolving the drama that I created wasn't so good, didn't really feel worth it. fuckit.

Finally went to Campus Health to put my cloudy, smelly urine in a cup and find out if it's a uti without the pain and burning (i've been symptomatic for about a year now, and have only recently had health insurance and easy access to a clinic to see someone. Can we say functional limitations in healthcare?) Starting cipro today and I even managed to advocate for a follow-up urine sample to be ordered to ease my mind that it is resolved with the drugs.

Signed a lease on a passive solar apartment yesterday - wow oh wow it is cool! big windows, brick floors, W/D, and no pet rent. exactly what I wanted, although not on the side of town I was hoping for.
May is looking a little crazy-making - finals the first week, a much belated birthday party for the kid the second week. The semester starts (with my first clinical rotation!!!) and later that afternoon, I'm leaving for a four day retreat in the mountains in the third week, and then I'll get to pack and move before June 1. sigh. I really don't understand how I've been able to pay a security deposit before the summer fin aid dispersement.

found out this weekend that one of the cool kids from work is going to join the Army for six years. I teared up, and then handed him my address like I was in the third grade and had just found out my family was moving to Georgia. I was embarrassed, and sent this email today. Still a little embarrassing, but it feels resolved now.
Hey R!
I saw you on campus the other day, and realized I could look up your email through the campus directory. I wanted to apologize for throwing a little tantrum the other night. It was such a shock to realize that I wouldn't see you again at work (and since that's the only place I see you of course, then it's not likely that we'll meet again). I was a little surprised at how upset I was, and didn't really know what to say (or what was appropriate to share without being creepy and weird, you know?).
It's odd to think about the loss of a close acquaintance - you are someone that I'm always happy to see, and who I really enjoy talking with. I like the way that you are sarcastic, but not often nasty (probably since I think that I tip that balance too often toward just being rude, as opposed to funny or clever). You manage irony without being an asshole - which is a rare gift, it seems. I think that you're crazy smart and genuinely a sweet person. You remind me of my kid in a way (and I know that's weird to say - and possibly to hear) and that's most of the reason that I was upset to hear you are going into the Army. I don't know anyone personally who is serving in the military right now - and so I'm privileged to be (sarcastically) academic and removed from the whole situation.
My dad was in the Marines, mostly before I was born, and I know that it was important to him to enlist, and to serve his time. I also know that he was a unspeakably different person after having served than he would have been without the experience of service in Vietnam, and I usually think of the loss of innocence, the gain of the burden of seeing horrible things. I don't really have a concept of the other more positive pieces that he spoke about regarding his service - the discipline, the feeling of being a part of something that made a difference, the actual 'service' part of serving the country. I had this irrational hope that time could be just frozen, that we could just talk when I happen to work with you, and talk about how ridiculous the world (and the restaurant) is... The thought of you being at the whim of the nutbags running this country's military takes my breath away, truly. At the same time, I want to say that I support your decision, since I know that you've thought it through carefully, and I feel like you have the strength to handle the experience. Other than having a kid, I've never done something like this that so immediately and profoundly affects my life.
I would be proud if my son grew up to be like you.
I wish you all the best. I'd be happy if we kept in touch - it would be good to know how you are doing.

with love, kati

Yep, it's officially reiterated - I'm a geek.

ow.

still burnt. applying aloe liberally. wincing each time I reflexively swing my backpack onto my shoulder. today, i managed to pull off the cute swingy shirt with crocheted sandals, but the sandals made little blisters on the inside of my heel and by the end of the day, I was carrying my shoes in my lunch bag and both of my bookbags in the other hand.

These blisters were invisible compared to what my marathon-running friend showed me yesterday. She said that the first aid stands were pitifully stocked and six miles apart. (I'm thinking to myself that I haven't walked six miles in years, if ever!) She said, "When it burst, I screamed out loud. But after a while, it just sort of went numb." She finished the race, within her time category. I stopped whining about my bra straps cutting into my sunburn for a while after she told the story.

Developmental exam yesterday seemed super easy - and stayed relatively on the surface of the EIGHT CHAPTERS of material it covered. I love the affect of the prof for that class, but she told us that to prepare for the test, which covered material with only one corresponding lecture, we should 'focus on the text'. No. the word you're looking for there is 'read'. When one focuses, one often has a shorter list than 250 pages to attend to. shrug. I thought I blew Health Assessment out of the water last Thursday and pulled a half-hearted 89. shake shake shake and roll.

I have a Fundamentals test tomorrow that is so difficult to study for - not because I've finished Barack's book, or because I had dinner with friends last night and tonight, or because I spent all weekend at a CPR class, getting a sneaky sunburn, and 'focusing' on eight chapters of developmental psych. It's hard to study for, because it's the mamby-pambiest material stuff of the class that already seems to slip out of my fingers each time I study it. I can't remember a bit of the last test, only that what I studied for that one was not on this one. The material we're covering is Stress, Sex, Aging, and Med Administration. I just don't trust that it's as easy as it seems. here's my study guide:

• Be prepared to be directive when patients are exhibiting signs of sensory overload or ineffective coping.
  
• Patients should use alternate positioning after hip surgery (though we never elaborated on this, and I felt I had pushed the boundaries of appropriate class discussion far enough when I asked if sex was considered to be an Activity of Daily Living by most texts).
• Old people are useful, and you shouldn't use baby talk when addressing them.
• If you need to give someone 50 mg of a PO med, and the tablets are 25 mg, then give the patient two.
  

I need to make a list of the random nursing questions I have. My addition today would be - why no more than three tablets at a time? Is this as random as provide patient care from the right side of the bed?

Speaking of stupid questions, let me leave you, gentle reader, with this gem. We had an information session about next semester today regarding how to register for the section of clinicals you want, and how it's not uncommon for 100 students to register in 3 minutes, so set your flipping alarms, and pay that parking ticket by Friday. After most everyone had left, Another Student asks if I know what exactly we'll be doing in clinicals. I have the same question, so AS and I trot up the Dr. Undergrad Dean. After a brief lead-in by AS, I say, "I mean, will I ever be alone in the room with the patient this summer?" Dr. UD looked at me carefully and said, "Yes."

I am going to have to be a bit more careful about what I say, lest I become the talk of the faculty lounge. Who is that short-haired sunburnt woman? Why is she always asking such ridiculous questions? Oh, don't worry, she came from a community college, and those students always have a difficult time transitioning.

Oh Dorothy Orem, why doth thou vex me so?

I feel a bullet blog entry coming on!

• My test this morning in Fundamentals was hard. More than one question about the formatting of nursing diagnoses, which I am not so clear on, and less than one question on the risk factors/outcomes/interventions for the specific nursing diagnoses covered in these chapters. I feel like my studying wasn't very effective for this test, and I'm not quite sure how to fix it. Perhaps I'll begin with an appt with the instructor, whom I love.
• Did I mention that I got Bs on both the developmental test that I was so sure about, and the Patho exam that I strutted out of feeling all confident?! pride do cometh and alla that.
• I'm trying to decide if I should go to the Health Action Committee meeting for PTA tonight. On one hand, it's been on my calendar for weeks to talk to one of the women on the committee who works as a school nurse about mentoring for possible ANS functions and personal mentoring type stuff. she's super cool. On the other hand, I have a thousand things to do tonight, and the meeting is sposed to run til 9pm. there's only so much I have to contribute to a conversation about peanut allergies in the elementary schools and making sure water is available in the lunch line. I can talk to the mentor lady anytime, I suppose. My main concern is that if I start skipping this meeting (only once a month) then I'll keep skipping this meeting. pish.
• Before I go to bed tonight, I have to make a casserole for a random family I don't know because I got an email asking for folks to participate in a dinner delivery service for this woman in the nursing program ahead of me who just had a baby, blah blah. number one - she is in a two-parent household, so I'm a little snotty about her need for provided food, but I can quickly see that's selfish/irrational since I was in a two-parent household when the kid was born and I would have been thrilled beyond measure for strangers to bring me a casserole. number two - stop volunteering for things. just stop it. number three - what the hell am I going to make for her, when my child and i have been eating veggie chicken nuggets, defrosted frozen peas and mac-n-cheese with spinach this week. I have this mental picture of Black Bean and Sweet Potato Enchiladas, with a batch made up for me, too. I just don't know if that's realistic.
  
• Three hours and ten minutes until my test in Disciplines. It's 40% of the grade for the course, and the only power-point presentation that the instructor has done was three slides long with a definition from Nightingale, Henderson, and the state board of nursing about how to define nursing. Do I need to get all detailed about the Henry Street Settlement? It's really interesting to me. Should I memorize who founded the ANA? Watson's ten carative factors? This is the course that sounds like a lot of words strung together to me. meaningless drivel is my first impression. True, with careful reading and synthesizing from other courses, it's getting more easy to understand and see the relevance. But distinguishing Rogerian nursing from Orem's self-care theory? The difference between a conceptual model and a theory? BLAH! bring on the sick people! Bring out the mannequins and the needles! Let's get to the good stuff. Oops, I'm exposing my occupation of Benner's novice stage of skill acquisition (person barely knows how to do something, is inflexible, and unable to apply said knowledge/skill appropriately).
  
• Going to supplemental practice lab for med administration tonight - which seems smart.
  
• Did not bring texts for Health Assessement (quiz at 8am tomorrow) - which does not seem smart. there's a test, a lab, and a pan of enchiladas between me and that textbook.

in other news, my lunch was not adequate. I'm off to get a latte and a scone.

really here

So, I'm starting to feel like I'm in nursing school. I went to my second nursing student association meeting today, and beyond promising myself to expunge 'um' from my public speaking if I ever decide to run for an office in this organization, I was shocked to figure out that I've been here a month already!

I still have no clue what the prof in Fundamentals is talking about (nursing diagnoses all sound the same to me - and apparently there's some difference between 'as evidenced by neuromuscular weakness on left side' and 'related to inability to use left side of body', though it's certainly not obvious to me!), but the stuff she says is starting to sound familiar. I still don't get it, but I know she talks about it every class! I really feel like the first lecture in that class should be totally reworked - I didn't understand anything of what she said, and it was apparently really important, because I haven't understood her since then. Thankfully, I think I signed up to be on the advisory board for this class - maybe I can bring this up to her then. She is hands down one of my fav. profs!

My big news this week is that I passed my first skills eval - hand washing, sterile gloving, universal precautions with gown mask and gloves, and vital signs !!!! SHEW - what a relief to have that done and done well, according to the teaching assistant. There was a lot of contention among the students that didn't pass those skills the first time - they had to come back later this week and re-do specific skills - crazy stress and lots of folks felt like the variation of TA's was unfair. I don't know - it's not Scantron, and there are specific little checklists to follow... but I did see at least two instances of TA assholery that would have just done me in. Pa-Pow! Apoptosis! I felt lucky that the TA evaluating me was the TA who teaches my lab section - so easy. I think, though, that I will sign up for practice lab sections with some of the other, scarier TA's so that if I happen to get them in an eval, I won't freak out as badly.

My other big news is that I made an A a B+ on my first exam! It was more general than I was expecting, but it feels like I studied the right stuff and knew the kinds of things she asked. It was in Health Assessment, where we talk about what you expect to find in physical exams of patients, and what various findings might mean. We go from head to toe, and this class has a big evaluation at the end of the semester, where we do a head to toe assessment on someone (which apparently takes a couple hours!). We have labs to practice that examination, and this test was over the lecture portion of the class. this A makes me feel so confident that I'm doing what I should be to handle this material. I also have a little more confidence that I can handle this seven-point grading scale! A 92 is an A-, but it's still an A! (Right?!!! Isn't it!!????) oh well, maybe she'll throw out a question that I missed, like the one about what fungusy fingernails look like.

Nice to have two successes this week, since I've got two tests next week. Development, which will be nothin', and Patho, which is making more and more sense as I actually read the book.

So. my dishes are dirty, and my laundry is in mountains. But I'm happy, and feeling good. I'm eating well and remembering to bring my lunch to school most days. I went to the kid's school last week and taught his class to knit - wow! I'm still reading with a couple of kids at his school each week as a volunteer. I'm singing with a chorus led by a woman who used to teach music at the kid's preschool - she's super cool and full of quotes by Rumi and Hafiz about the present moment and releasing attachment to thought. And I'm going to a conference of officers of other Association of Student Nurses chapters this Saturday. The kid is good and super excited about his birthday next week! This birthday really seems like a departure from babyhood/toddlerhood.