Lent-a-mente

On Ash Wednesday, as we're getting ready to leave for school, the kid asks what happens on Ash Wednesday. I said it's a religious holiday, a pretty serious time for many Christians, and Catholics often make some sacrifice for the next 40 days before Easter to show how serious things are. (I tried to tackle the concept of sin and redemption and then let that one lie. There are some things that a goddessworshipping pantheist is not qualified and Catholic sin is one of them. )

Later, I'm replaying what I said as I brushed my teeth, checking for gaps in my story. I realize that I have not ever given up anything for Lent, and that maybe an example would help him get the idea. Lightbulb! I was a super asshole the night before, with lots of hovering during homework, and slamming the cardoor open so hard when we got home because we were arguing about Harry Potter that I snapped the little metal piece in the door hinge and now I have to manually feed it into the door to be able to close the door every time. I'll give up yelling for Lent, I announced. he got all stern-faced because I yelled for him to come make his lunch and I had to qualify my pledge to give up angry yelling, because there's no way I could go for 40 days without being loud, for the love of Pete! it's molecularly impossible.

On the way to school, the kid announced that he knew what he'd like to give up for Lent. It's not something that I do that's bad, he said. Does it still count? Let me hear it, I said, bracing myself. I'm giving up the after-school program, he said calmly. I'll be a car-rider like (insert friend from wealthy family with giant house and great toys) and we can play together all the time. Ah. I see.

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!

more emo - who can get enough?!

Peds is still kicking my affective ass. After the shower-sobbing reaction to my shifts in the PICU and NICU, I then had a series of less intense but recurrent crying jags last week after my first 12 hour shift on the unit. I am SO good at dissociating that I can't even really tell you what triggered them - but it was akin to the med-surg crying, based loosely around the idea that during those 12 hours, I could have done something or not done something to hurt someone and would never ever know it.

Therapeutic interventions recently employed:

• massage. wow. I said to the nice LMBT, "I feel like I can't breathe a full deep breath, like there's a little ball of silly putty right *there* in my spine and if I could just bend the right way, it would crack open and I'd be able to breathe again. I've also been doing a lot of crying, and I don't want any of that sadness to get stuck in any crevices of fascia and fester". She said, "I can handle that." And she did. She did something under the edge of my rib cage that made me think of my ribs as completely detachable. And she did a controlled version of a sternal rub that warmed me up for hours. No surprise, I cried on the table. But not out of control, not like I wouldn't be able to stop crying - more like the way you might cry when someone you love tells you a very sad story and you hold their hand while they talk. It was good. I felt so guilty picking up my backpack after she'd just spent an hour integrating my upper body bilaterally.
  
• tea. I don't know why, but I seem to only think of tea when it's chilly outside. I can drink hot coffee through the summer - though with admittedly less enjoyment, I do have to shoulder through it. But it's been a journey through the Stash Herbal Tea Sampler Box lately. The colors of the little packages are almost as soothing to me as the tea itself. And I had enough honey and didn't feel like I had to skimp or be judicious.
  
• art. went walking around a historic neighborhood with an artist friend yesterday, looking at amazing pieces of art. It was a Winnie-the-Pooh sort of sky and blustery wind, I woke up in a good mood and so did the kid, it was good all over.
• a productive-feeling new notecard system for Psych and Peds exams upcoming this week. I'll sign off in about five minutes to do more of these. I'm really hopeful that they will help me turn around the Bs from the second exams back to the As from the first exams of the semester.
  
• journalling. Psych instructor, who I have a complete identity crush on (I love her hair, her shoes, her style of speaking, her humor) mentioned it the other day in class, and I have meaning to get started again. I stopped at some point around the time I left my husband, catastrophisizing about supeonas and whatnot. It was intensely helpful Saturday night when all of a sudden, I was going to turn myself inside out with feeling alone and sad and completely helpless to fix either of those things.
  
• write-ups. I know, it's counter-intuitive that school-work would help me feel less overwhelmed. But what's happened is that I'm less afraid to include this emotional response in my weekly reflections. I think that my experience in Psych a few weeks ago (jesus, it seems like a year ago) helped me get a point of comfort, that yes, I am usually able to judge what's appropriate to disclose, and what's inappropriate. And yes, when I say something, and someone looks uncomfortable, it doesn't necessarily mean that I shouldn't have said it - it may mean that they are simply uncomfortable. And no, I shouldn't avoid writing the story about how the nurse said that some parents should be sterilized to me in the break room because I'm scared of getting her in trouble. It's good information for my instructor to have that this is the kind of thing that I'm trying to integrate on a weekly basis. This is an accurate reflection of the level of emotional processing that I am personally doing. Sure, not everyone is having this reaction; who would expect them to? But I am, and that's okay, and I want the prof to know it.
  

The other thing that's been really helping me this week is reading and re-reading the Love Letter to Nursing Students at Head Nurse. I can see myself in some of the things that she is excited about, and I am vicariously proud. A Love Letter to Nurse Preceptors will be forthcoming posthaste.

Smitten Kitchen is feeding me lately with images of amazing food, and reminders that food is something that I love, not just something that means dirty dishes and rotten potatoes. (though rotten potatoes are hands down the most disgusting thing that can happen in a kitchen, I think. You reach in and it looks okay and then you pull it back and it's... not okay. not not not okay.) I've purchased pumpkin and french bread. I cooked a mini pumpkin for dessert last night for the love of pete! I'm considering stuffing some onions! Come on!

speaking of amazing images, these pictures at deputydog are broadening my horizons and making me sit up and drop my shoulders. love love love them. We already talked about the 7 amazing holes list that he has, right?! wow.

Things that are not getting written about this morning - the upcoming parent-principal meeting regarding the kid and his second grade class (still not going well), the fact that I hurt myself with my menstrual cup and feel really annoyed about it, my continual brokeness and the recent crisis proportions, the chance to do an hourlong interview with a grad student doing research on single moms who went to community college and then a four year school, and the upcoming trip for the ANS Mid-Year Convention.

later, tater.

PICU + NICU + forgetting to pick the kid up from school = sobbing in shower

PICU kids were:
one month old boy with hypoplastic left heart, adorable smile, and hard swollen breasts (they were doing an MRI to find out if there was something on his pituitary?) Ventilator, central line in jugular vein, continuous infusion of fentanyl, methadone q6h. Mom and dad cannot come to visit often, and are a little checked out about this child. The nurse I was following (who I had really liked up to this point) described dad's tattoos and said "Some people should just be sterilized, you know."

five month old girl with metabolic disorder. ventilator, concern during the shift that her BP was rising, and that her end tidal volume of CO2 was getting too high. Continuous infusion of fentanyl. Attended a family meeting in which parents were informed that her problem was a mitochondrial defect, and that there was essentially no treatment available, and did they want to call and gather the family now or wait a day or two on the ventilator?

a boy with necrotic pneumonia in right lung, lots of staff in and out of his room all shift, trying to get a tube into his left lung to focus ventilation on that one. On an oscillating vent that was giving 400 breaths/minute.

a teenager who was paralyzed, wearing hand splints and Prafo boots, with a trach. She wanted to be moved up in bed, and so her nurse asked my nurse and me to help, and off we troop. Her nurse wanted our help to turn her, so that she could see her back and assess for skin breakdown. The nurse discovers stool in her brief and so we all help change her and clean her.
Then her nurse wants to change and clean the inner canula of her trach, and asks me to help. Sure, I say, desparately trying to remember the procedures from skills lab. That was the worst possible set-up for trach care I've ever experienced.
The bed was too low,
the patient didn't want us to take her pillow away, so her chin was down and resting on the vent tube,
the nurse didn't follow the inner to outer and throw away process that I'd been taught for cleaning around the stoma,
the patient is trying to communicate with me by eyeblinks and mouthing words,
there's clearish bloody stuff coming from around the stoma behind the trach, and
I can't get the velcro of the trach tie back in.

after the nurse puts the new inner canula in, the patient's sats start dropping after we get the vent tube back on. Like 98-to 87- to 74. She tells me to grab the bag behind me, and squeeze. Oh my god, I think. Squeeze. What am I doing, I think. Squeeze. Okay, back to 80, that's good. Squeeze. back to 94 and we put the vent tube back on, and she's looking at us again, and I'm not sure exactly what happened, but I feel like some sort of hero.

NICU: (nobody on pain meds here)
15 day old boy, 3180 gram born with sacral mengingocele, s/p repair. Two days ago, had a shunt placed from brain to belly to drain excess fluid. No IV access, foley cath from surgery that will be pulled later that day. He is the youngest of 6 kids, and has a 13yo brother who also has spina bifida. It was enough to make me want to take my folic acid right that second, even I never plan to get pregnant again. It wasn't until the end of the shift that I realized that his face really was all scrunched forward like that, it wasn't just because he was laying on his belly with his head turned to the right for the whole shift. Seven seconds into the shift, the nurse tells me to feel his head, and his fontanels. I'd call those full, but not bulging, she says. And here, these sutures, open wide is what I'd document for them. And when I say sutures, I mean the places where the bones of the skull should meet and knit together. I felt like I was touching his brain through his skin. He had never exhibited movement or tremors in lower extermities, no likelihood that he ever will. Mom is breastfeeding. Assisted nurse with cleaning and changing the stack of 4x4's under his butt that serve as diapers several times during the shift, positioning mom for feeding (which involves awareness of his foley tubing, ECG leads, incisions along his sacrum, incision on his head, no pressure on the shunt itself, no pressure on mom's c-section incision and 4x4s and pads under his anus to catch poop). He had a little plastic sheet (nurses called it a mud flap) stuck to his butt to prevent any feces from getting near incision site. I advocated for turning his head to the left, according to Neurosurgery's orders, because it seemed that his neck was starting to show some resistance and his opposite hand was cool and the pulse weak compared to the arm on the side he was facing.

33 week GA baby born 10 days ago, 1818 grams. She looked tiny, but so healthy. However, an echo had showed that she has no pulmonary artery, and the only way that blood is getting oxygenated is because the hole between her two atria hasn't closed yet. cardiology is deciding plan for surgical interventions. Currently on prostaglandin to keep ductus arteriosus patent. Some history of necrotizing enterocolitis. Pt has been NPO since last echo, and mom's questions are all focused on when she will be able to take a bottle again, without much insight into severity of cardiac condition. Observed bedside rounds while mom was present, holding baby, and realized how little of what was said would be comprehensible. Tried to translate after rounds were over. Even nurse greeted mom with news that she had only had 3 bradys overnight, so that was good. Mom indicated no understanding of what 'bradys' were, and I said to the nurse, Do you mean that her heart only dropped three times over night, and it was happening much more frequently? Nurse realized why I had asked when she looked at the relief on mom's face, and adjusted her language afterward. Come to think of it, though, her heart rate dropped to below 90 several times during our short shift and I don't remember seeing the nurse document. Fellow in rounds seemed to think that the apneic episodes and bradycardia were SE of the prostaglandin, and there was an order to cut the prostin in half by the time I left the unit.

Observed a PICC insertion performed on a 26 week premature infant. No pain meds on board, or any evidence of local anesthestic used. When needle was inserted, baby (who was completely covered by sterile towels except for her elbow) jerked and curled toward the arm. Nurse stated that she did have fentanyl PRN on her MAR, but that she's never had opioids before and you want to avoid them as long as possible because of her fragile state.

How do you care for a person that you don't think should be alive? How does it change your care to know that this person's lifespan will be only weeks long and contain no joy as you know it?
If you believe that some people shouldn't be alive, is it ethical for you to be a nurse?

So, yeah, sobbing while the kid did homework. I finally got in the shower so that I could feel like he couldn't hear me as loudly. He was all worried - I think he worries that I'm going to hurt myself and he's going to have to do something about it - and I just said that I had a really awful day, and that I needed to cry some of it out. I asked him if he would give me a hug in a minute when I caught my breath. I love that kid.

The situation with the dishes and the house is not funny and quirky anymore. It's not sexy-messy. It's rolled right into calling Oprah for an intervention. When the kid was a baby and after my dad died, my mom would come over on the weekends a couple times a month and we'd clean my house. I wish that she still did that. I wish that I didn't wish that at 33yo.

ouch.

Why is Blogger offering to type in Hindi for me? Did I select something or is this some sort of blog worm? ah, never mind. I can't be bothered.

1. i have a headache. likely because it is in fact quarter til two and my ass is not yet in my ridiculously comfortable bed, with the window open to ridiculously cool air.
   
2. my tonsils hurt. like i've been smoking american spirits, which i HAVEN'T and so this sucks super bad. i've had right tonsillar megaly for about two years now, and at some recent visit, hopefully not my annual pelvic, it was deemed 'no big deal'. But it hurts. it feels like the nasal passages are inflammed? is that anatomically possible? I just want to figure out a way to squirt some warm water somewhere that will make it feel better! Gargle? Snort? Mouthful of it and breathe through my nose? flark!
3. i have my first clinical in peds on monday. I'm terrified. this won't surprise you. more details below.
   
4. i am contemplating asking the principal for a transfer to the cooler 2nd grade teacher from the asshole 2nd grade teacher. the risk in asking? that she might say no, and then I'd have to resign myself to dealing with the asshole all goddamn year and I just don't know if I work myself up to ask for this, and then I don't get it, how badly will that actually suck?
5. I. must. stop. signing. up. for. things. Run for election on state Board of Directors of Assoc of Nursing Students? Excellent! work with LGBTQ folks on my side of campus? Great! Read with kids at my kid's school twice a week for an hour? Super, thanks for asking! Work on the World AIDS week planning committee? Okay! Go to the Global Health Committee meeting because it might mean inroads with the community health folks at the SON? wellll... Meet with SON folks about gay stuff? good idea, but is this the semester for it? sigh.
6. i got a haircut today. i'm growing out the crew. shaggy surfer boy chin length here I come. in the meantime, I'm working on how to make it less fuzzy looking. the stylist said that using scissors, not clippers, will help. and smoothing serum. and i'm driving home, thinking, yeah, having it be all one color instead of salt and cinnamon might help, too. Who AM I that I wash my face twice a day, pluck my eyebrows, purchase and actually wear kitten heels, apply nailpolish, and consider dying my hair again? it's like a remix of the 80s. I thought I was done with all these femmey trappings! (also planning the breast reduction I want with my signing bonus. eep!)
7. my dishes still aren't done. yes, it's been at least 3 weeks since I updated. i still haven't washed that lasagna pan and i only recently ran out of clean gladware, so I actually will have to do it now.
   

Peds Clinical
Get this - Summer was my first clinical rotation, right? Med-surg, adult health, GI floor, lots of ostomy bags and wound vacs. Tube feedings and such. I only had a pt with a NG the last day of the rotation, and managed to fuck that up by removing the old nasty tubing to the canister and throwing it away, gettting distracted on my way to the supply closet to get new tubing and getting called back to the patient's room bc he was nauseous bc i had left him off suction too long. i still don't get NGs.
So, after that 11 weeks of patient care, I had a week of finals, three weeks off for break, and then the first half of the semester was my psych rotation, where it's simply not a good idea to touch the patients. I did vitals on the unit one morning, and I took a BP for a man who was having a hypotensive crisis (with a seated BP of 72/54 and a standing BP or 62/42, he was sent back to his room to wait for the physician - thank you for the excellent example of how to NOT provide patient-centered, competent care). No direct physiological patient care in about three months.

My first shift in peds rotation will be in the PICU. I'll be there for only one shift. I'll go in at 9a, get info on my patient. This is at a hospital where I've not worked yet, so I have the access codes for the computer, but have never used them. I'll come back at 1pm and work til 7pm with this patient and a preceptor, whom I've never met. I was thinking that this was fine, because it was just going to be observational, right? They won't let me touch really sick kids, will they?

Then I read this paragraph* in the syllabus, while looking up what to wear. It took me ten minutes to calm down and realize that I won't be in the Peds ED tomorrow, that's not for another two weeks. Then I started to freak out again when I realized that the only IV that I've ever started was on my lab partner, and the canula kept sliding out and I tried to shove it in with my finger... I'm all about the psychosocial support. I'm *very* supportive. Drawing blood? Fuck that. I gotta go.

Okay. Time for bed. I'll be up in a couple months, when it's winter break.

*Clinical Experience: The student will spend time in the Pediatric Acute Care in the Pediatric Emergency Room setting, where he/she will participate in caring for acutely ill children. Included will be nursing interventions such as triaging patients; assisting with procedures such as assessments, IV starts, blood drawing, teaching families; and providing psychosocial support to children and families.

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.

grumble.

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.

What are you going to be when you grow up? Jesus said, God.

The kid and I have been having this lovely conversation about God the past few days. It started as a bit of a stand-off about diety gender, when he said He and I said She, and he said god's not a girl, and I said, God is both and neither. There's nothing you can think of, or see, or feel that's not god. The kid chewed on that and agreed and that's where we've been for days, pulling out the most random things we can and testing if we believe they're god - they always are. :-)

So, last night, he says, I can't go to sleep because what if the world ends tomorrow?

hmm. That's a show-stopper, dude. I take a deep breath. I begin, "Well, I can see how that would be really worrying to think about. but there's times, baby, when you can think of a thing (and even think it over and over) that doesn't make you happy or healthy or doesn't help you at all. there's times when you need to let go of the thought, put in a box or a balloon or whatever, and let it drift off. Thinking something over and over doesn't mean that you have to pay attention to it over and over; sometimes it means you have let go of it over and over."

He said, I can't put in a box or a balloon. I just can't. It's too scary to ignore. (and also, he wants to keep talking and keep not sleeping!)

hmmm. more deep breaths. (I'm mentally working through The Work at this point and wondering how to frame it up without a lecture.)

Kid, do you think that that thought is god?

Yes.

I do too baby.

silence.

sleep.

'night, baby.

Eritrea is a cool word to say! and folks there use bread for forks!

On my second day of spring break:

1. The campus bus drivers, as a group, were the most talkative that I've ever experienced. Usually, the drivers that serve my route are pleasant, but in a sharing-an-elevator way, with a nod and smile and sliding eye contact that doesn't demand anything else. I feel comfortable NOT making small talk with someone who is responsible for mine and many other lives. But today, they were all about the weather, and initiating the Have a great day! and Thanks, folks! and The S bus is broken down, so we'll be making one stop at Lennox and then resume our express service this afternoon. I wonder if there was some sort of in-service, or if spring break makes them sprightly.
2. The director of the LGBTQ office on campus is absolutely on point! I made an appointment to talk with her about ideas for a project that I could submit for the SON's multicultural award (read: $1000 scholarship). I had some really vague stuff about men in nursing carrying a gay stereotype, and tracing the roots of that deeper. She started talking about best practices, and how in one study of very out college students, 46% of them stated they were not out to their health care provider. Which is huge! How can I provide adequate health care to a person when I don't know what sorts of things to be on the lookout for? And the curriculum, as I've seen it thus far, doesn't necessarily include those things to be watching for (one of which is apparently an almost 50% chance that you won't know the patient is queer, transgendered, etc.). There's a line in a textbook that up to 10% of my patients could be gay, and so don't ask questions like Are you married? that assume heterosexuality, but nothing beyond that. I'm excited. and she said that I have to watch a video called XXXY about two intersex people.
   
3. I did about four hours of not very much in the library today. organized my pens. made a list of what I should do for each class in each week of the remaining semester. Did half of the two remaining homework assignments for my online Nutrition class. Found my Health Assessment textbook - which was a blast of good luck, since I didn't know I had lost it, and I have a test in there on the Thursday we get back. I also signed up for two shifts this week, which means that today was my only day to do all the catching up I thought I might do over spring break. Well, my prof did say to relax, right?!
4. Had the most loverly evening with the kid. We went to Whole Foods and made big salads and had interesting conversations about the Red Sea and the Mediterrean and the Caspian and what countries border those. Is it normal for a first grader to have this kind of grasp of world geography? Do I need to get this kid tested or something? He hand-jives a lot, does that indicate that he's gifted? We picked out cupcakes from the dessert case, and pastries for breakfast, and just had a wonderful time in each other's company. We ate on a blanket out in the front yard, because it was stunningly beautiful outside, and the house is an utter shithole at the moment. He put together our new spinning rainbow flower thingy, and I laid on the grass and was happy and still.
   
5. Got my second disk of the Facts of Life season one in the mailbox. Oh Blaire. Don't spend your time with those ridiculous boys, Jo will be along in a few short episodes for torrid sexual tension! I swear, this show is stupider than I remember, but I'm loving Ms. Garret more and more.
6. Fart. Fart. Fart.
   

early morning dream

The kid and I were getting ready for work. He and I were both going to an elementary school to teach that day - the kid was subbing in one class and I had another class across the hall. We taught in the morning, and then around lunch we went to the gym for a training session. People were set up in pairs all around the edges of the gym, one "teacher" and one student. At one point, my kid had a meltdown because he couldn't get his student to do the exercise. Another teacher was yelling at him (my kid) and I came over, sat down and pulled him into my lap and told her to leave him alone. He cried for a minute and then got up and went back to the exercise (something with magnetic letters on a board).
There was a very disturbing part where I was trying to figure out to buy some cigarettes, and I went online and found a convenience store that sold them, and ordered some, but when I went to pick them up, I realized that I had actually ordered some porn, and everyone stared at me for bringing my kid with me to buy porn. I tried to explain, but the fact that I was only buying cigarettes seemed just as bad and we left. The guy behind the counter kept leering at us and it was all quite creepy.

Shhh, that doesn't hurt!

At the park yesterday, I was trying to study Patho while the kid was playing on the big slide. I wasn't having much success. There seems to be a cloud around this particular park - I can't relax and let the kid play here. I'm always watching the other kids, sitting on my hands, and biting my tongue to keep from yelling at kids that aren't mine to stop jumping on their little brother's head. Why I brought my notebook and that ginormous textbook I can't figure out.

This dad puts his daughter up on the swing. She's less than 6. The dad already put the under 2 yo in the baby swing and she's happy and safe. The dad pushes the swing, the girl slips out and lands flat on her back on the ground. Wham. Silence, and then a gasp and crying. Now, in my head, I'm rooting for the dad. Get down, I urge, down on your knees in the dirt right this second. He complies to a certain extent, crouching, but still looking around him, not at the baby, but for witnesses. Dude, I think, it's cool, I saw it and I've done it before. Everyone who has pushed a kid in a swing has had at least one time that they weren't ready, or you pushed too hard on the first push. Get down on the dirt and pick her up in a big hug. Now.

He ignores me, and starts talking. Uh-oh, I think, he's shaking off the signs from the catcher. Bad move, skippy. He says, Shhhhh, now. Hush, honey. You're okay, it's okay. Okay, so I get the motivation to reassure. Fine. But the hushing? At approximately 3.2 seconds post-traumatic, scary thwumk on the hard ground? Get real. That is a- not going to happen, and b- ridiculous of you to suggest.
They are about 10 feet from me for this whole encounter, and I am unfortunately blatantly staring while he continued to argue with her about the severity of her injuries and hugged her too hard (which made her cry harder and yell at him to get offa her). At one point, he started saying I'm sorry that you fell and hurt yourself. I'm so so sorry that happened. Hedging, dude. Weasel-y. Bad call.
I really don't get this impulse to blow off kids. You can't win by saying to a kid yelling that it hurts, that no, it doesn't. Um. Yes, it does. No, it doesn't. You might mean that it shouldn't, or that it's inconveinent for you to be yelling about right now, or that I don't have it in me to muster the sympathy that I should be showing you, or that I think you are a big fat baby whiner. But as the person not experiencing the pain, trauma, or discomfort, you cannot say that it does not hurt.

True, this girl made some noises like she was dying. Like she was about to fucking expire. Like Scarlett OHara when Ashley left her and the Yankees came to Tara. In my opinion, she made those noises because she doesn't feel like her dad is listening. She has learned in five short years that she has to ratchet up the drama in order to get him to engage, even though he engages poorly when he finally shows up.

The girl screeches, with raggedy breaths, I want to go home. The dad says, Well, how about this, honey, why don't we - and the girl screams it again. The dad gets annoyed. Dude, you're using too many words. I know that you're thinking out loud. I do that, too, all the time, and I know that it's annoying to many around me, including my kid. There are times when you are better off shutting your mouth and thinking. Anything you say that is not, Okay, baby, let's go get our stuff and go on home - pointless, like that Far Side cartoon about what dogs hear. blah blah blah. So your thinking time needs to be devoted to any reason why we cannot go home right now, and that reason needs to be limited to they are exterminating our house with dangerous chemicals that will affect our neurologic functions.

Turns out that the reason the dad was hedging on the pack-it-up-and-roll-out idea was that he wanted her to get back on the horse. He thinks (I saw it above his head in a big balloon) that if he lets her go home crying because of this fall, that she will always be scared of swings and this will be a weakness for the rest of her life. Been there, too, man. I totally understand. But stop it. First of all, at no point in this process have you, the adult, the one who did NOT just get hurt and scared, not once yet have you shut the fuck up and just hugged the kid. Try it, please. You have demanded that she be quiet, repeatedly commanded her to take a deep breath and calm down, and told her that it's not a lot of blood and she shouldn't be scared. Stop. Take a deep breath of your own. Sit with her. Listen to what she's saying. Look at her eyes. Let her know that what she's saying, what's happening for her is important to you. Hold your own agenda for a second - of not looking like an asshole that just pushed your kid off the swing, of making sure she doesn't develop a lifelong swing phobia, whatever.

I kept wondering if she would respond to me if I went over with water for her to wash her fingers. I kept imagining that I would do all the right things, and like the Dog Whisperer, she would instantly quiet and calm. I think that I did not go over because I didn't want to know that this movie was totally fiction.

What I did do was pack up my own books and kid after the second time he came tumbling out of the slide crying. Apparently, their clog-up-the-slide-halfway-down game had gone awry and he got a foot in the ribs. Okay, I said, matter-of-fact, Time to go. Of course, I muttered 'just like I told you it would be if you kept playing that dumb-ass game with that big kid who was jumping on his brother's head'.

It really makes me wonder what other parents think of me on the playground.

i hate nursing school.

I'm very happily in bed, staying up way too late to go to that silly walking tour of the wildlife preserve tomorrow at 8am and comforting myself by calling it silly and whining in advance about how early it starts.
I'm reading about scrotums and books and the controversy when the twain shall meet at bitch, ph.d. good stuff. reminds me that i need to actually get a hard copy of a wish list for reading started, instead of just thinking, Oo, I'd like to read that and then always feeling like I do at the video store, that there's tons of movies I've wanted to see, but not able to remember a single title.
And then the kid is all with the loud, irregular breathing. Honestly. Take last weekend's croup, a sleep study that found him to have moderate sleep apnea* last year and this week's content on Respiration in Health Assessment and I can barely fuck around on the computer anymore what with all the freaking out I'm doing mentally. Even if i muscle through and don't freak out right now, it'll just creep up on me randomly in the future when my defenses are down. Now I have to go google apnea again. Oh fuck! Was that Cheyne-Stokes!? this is not funny. it's not okay. I thought nursing student disease was when you were convinced that YOU have all the diseases you're studying, not your kid! me, fine. the kid - fuck this. i'm outta here.



* when the doc was concerned about his tonsil size and I was concerned about the number of times I hear him quit breathing before I fall asleep (nothing like your kid's desperate snort of apnea for an adrenaline rush!). His dad's sposed to be a CPAP machine himself. whee!

Duck Rice and Croup

the kid celebrated his birthday, not with a hippy ritual in the gazebo of the rose garden walking around the sun and talking about what he's learned in his seven years on earth and hearing good things from whomsoever had gathered, but hanging out in the bedroom with me, watching movies with the humidifier running non-stop. The good news is that we only had one episode of really scary barking coughing gagging dash to the bathroom and crank up the hot shower and sit on my lap while i sit on the toilet and try to tell him that it's going to be okay and he should just relax and not worry so much about how he can't breathe. After approximately seven minutes of that hell, his coughing had stopped, and his breathing has certainly eased, and I left him in the bathroom to get my best diagnostic tool. My fancy new red Littman? Nay. My fancy new black laptop. While the screen got all foggy, and I started to wonder how long we could all spend in the bathroom without meltdown, I confirmed my diagnosis of croup (remembered from an incidence during infancy) and called the advice nurse. Because, of course, I am not the advice nurse. I am simply in the very first semester of nursing school. We haven't covered auscultating for abnormal breath sounds yet in Health Assessment. Hell, i'm just as likely to use the bell as diaphragm on that thing, or put the (very uncomfortable) ear buds in pointing to the back of my head rather than my nose. The advice nurse was quite helpful, very calm and my new best friend. She told me that no, I don't nec. need to make a Saturday appt for the kid, and that since croup is viral, the most common medication would be steroids to open the airway if the steamy bathroom (or head in the freezer, which seems rather cruel and not very infectious-control-smart) doesn't work in 15 minutes (which seems like an eternity when your kid is looking at you like 'Aren't you in nursing school? Can't you fix this shit, mommy?').

Had a very interesting conversation with the mom of one of the kids I invited to his birthday party (note to me: never invite more people than you are willing to un-invite the day before the event.) everyone followed the script: I'm so sorry he's feeling bad, please tell him that we hope he feels better soon, when will the party be rescheduled? But one mom added that her son was out with a bad bad cough several days last week. I casually asked if it got worse at night and came with a fever, which it did, and did he sound like a seal, which he did. Well, there's that mystery solved then - and I managed to not be an asshole (I hope) when I said that I knew it must have been circulating in the classroom, but that we wouldn't have the party so that it didn't go any farther. The kid's got one grandparent undergoing chemo for breast cancer that's moved to bone marrow and one recovering from outpatient biopsy of the tongue. not a good equation.

So, this weekend was a great chance to practice my study skills at home with kid. I have studying in the quiet room of the library down pretty well, but can't seem to get over the hump to reading or doing note cards at home. I whine about how I don't have a table to sit at and spread out my books - in 500 sq. ft of living space, I literally don't have a table. I whine about how the kid and I seem to always be on top of each other, how my usual distracted-ness (which I have learned will take up about the first 20 minutes of any study session) gets exacerbated by the cats or requests to play Thomas the Train on my computer or urges to get up and make a cup of tea or watch just a few minutes of whatever the kid is watching (hey, I like Wallace and Gromit!), ad infinitum. It was a little ridiculous this weekend because I have two tests and three quizzes this week - and have not spent a lot of time keeping up with the reading in either class. the tests I thought that I aced last week with minimal studying came back with good solid B's. damn this seven point grading scale!

Also got to figure out what would happen if I couldn't make it to lab - email the TA and pray the skills can somehow be made up. The kid's dad ended up taking him this morning, and then bringing him to campus after lab so the kid could see my classrooms and the library and then ride the bus back to the park and ride lot. I told the kid that we usually go to the library after class and he asked if we had to walk single-file. it took me a second to figure out what the hell he was talking about!

I'm a little sad that I missed my psych appt and my med eval to get some Wellbutrin answers. I hope that I don't chicken out on rescheduling those.

Last week at work, the chef made fried rice for the end of shift family meal. This has been a bit of a challenge since I decided to stop eating even the small amounts of meat that I used to consume at the beginning of the year. Usually fried rice is made with strips of various meat - and I can feel relatively comfortable that I can scoop around the meat and still get free food. But last week, we apparently had a couple of ducks coming up for expiration soon, and so the chef made duck fried rice. I scooped out a small bowl and started my search and avoid mission in the corner of the kitchen. Sam walked by and said, how's family meal? I shrugged and said it was a little hard to avoid the shreds of duck, but the rice was good. He was all - You're eating family meal tonight?! But you're a vegetarian now! and then his face softened and he got all calm and objective and says 'wow. you must be really hungry to eat that duck rice.' Sheesh - the guilt! I ended up eating brown rice with potsticker sauce and fried wonton noodles. I hope there will be a point that I will have cycled through all the times that I was accustomed to eating meat and worked out acceptable substitutes. Last Tuesday at Golden Corral, I realized that the brown gravy beside the mashed potatoes was probably verboten now, along with all the soups, and that delicious broccoli salad with the raisins and the bacon bits. I'm good with the meat analogues, and the overall concepts of nutrition within a vegetarian dietary pattern. I'm still a little leery of being 'difficult' to hosts - but had good practice last weekend, when i had to speak up at a conference with free lunch that consisted of a big bowl of pork barbecue, buns, apples, and bags of chips.

In other news, got to practice administering meds via NG tube today and gave a plastic butt an enema this morning. nice.