Wednesday, May 30, 2012

Week 2 of Nursing School: Keep Calm and Carry On

When I started nursing school, I certainly expected long class hours and to go through the material very quickly, and prepared myself for an increased level of stress from my event coordinator job at a church. But I also make a conscious effort to focus on what I am learning in the present, and to not overthink future events, such as exams.
This does not mean that I slack off on my readings or studying. Rather, I try to focus on what I am learning each day, and not to worry about the exact composition of each exam. When I get a written assignment, I read the question and the paper's requirements, and proceed.

What bugs me about my program is the amount of class time in which people ask professors about what they need to study for each exam, what the exam questions are like, and how they should write a paper whose grade counts for 5% of the total class grade. As a detail-oriented person, I understand where these questions are coming from. I have always been very picky about my writing. What I don't get is why 30 minutes of class time is spent on these questions. Listening to people agonize over these things puts me on edge, and makes it harder to keep myself cool and collected.

When I go home, I look over my task list for the day, and sit down in the living room to do my work. Today, I punched out my 1-2 page assignment on patient learning while watching Parks & Recreation with my sister-in-law. It was incredible how much easier it felt to write that paper in a relaxed environment than when I was listening to people analyzing the rubric letter by letter. Likewise, I practice doing my blood pressure at home so that I'm not distracted by other people talking about how stressed they are about taking vitals.

Tomorrow is my lab midterm (doing vitals) and learning how to do an abdominal exam. Hopefully I can follow my stress-reduction mindset tomorrow morning and ignore other people's pre-midterm jitters.

Saturday, May 19, 2012

Summer 2012 Resolutions - Food

As part of my pre-nursing school physical and lab work (CBC, titers for measles, mumps, and rubella, etc), my doctor had my cholesterol checked. The total (non-fasting) was high, so she had me do a fasting lipids test. My good cholesterol was very high, but my bad cholesterol was also high, so I saw a nutritionist before moving to Philadelphia.

Since I only ate meat about 1-2 times a week in Boston (because I only eat kosher meat) and I will only rarely eat meat in Philly (my SIL is vegetarian so there is never meat in the house), the main things I have to cut down on are cheese and eggs. In addition, I am trying to eat more fruits and vegetables, as well as "good" fats, such as olive oil.

To help keep myself on track, I am going to make myself a list of foods to stock up on:

Friday Night at the Appliance Store

My first "official" day in the nursing school building, and my brother and SIL's adventures in home improvement. 

Wednesday, May 16, 2012

First Day in Philly

Tuesday morning, I somehow woke up at 6 AM, which startled my brother. For years he made fun of me for sleeping in on non-school/work days, and apparently expected me not to be up until much later. But I think the thrill of being in a new city and the large amount of sunlight that comes through my window gave me the inspiration to get out and explore. I had spent a week in Philly during February break my senior year at Brandeis, so I had already seen the Liberty Bell, Independence Hall, the Franklin Institute, and the new American Jewish history museum. It seemed appropriate to go to a place off the "standard" list.
Having read Swallow by Mary Cappello, which discusses the life of Dr. Chevalier Jackson, who developed nonsurgical techniques for extracting swallowed objects, I filed the Mütter Museum away as a potential destination. The Mütter has a set of drawers with all of the objects Jackson extracted, along with shelves of skulls, wax models of organs, and skeletons highlighting the effects of disease and trauma. For a nursing student who spent hours skimming Wikipedia pages on surgeries and diseases while working in a preoperative clinic, I had to see the Mütter.

The first takeaway I had from the museum was how much has changed in medicine and health (in the U.S.). Most of the full skeletons on display, which had been prepared in the mid-to-late 1800s were around my height (5' 2"). There were also a remarkable number of people in their 20s (and much younger) who died from now treatable infections, such as TB, and also several disturbing examples of rickets and osteomalacia (bone diseases caused by lack of vitamin D). At the same time, there was a display of spines curved abnormally from osteoporosis, and an exhibit on gunshot wounds during the Civil War. Though we have better treatments for gunshot wounds (particularly to prevent infection), there are still obviously many people who are permanently disabled or killed by guns, and the guns we have now are more destructive than those in the Civil War. My reflections at the museum, though, were lightened by the middle school group that was present. It was difficult to think too long about current medical and societal issues when there were fifteen preteen girls periodically commenting, "EW, GROSS" at the tissue samples and wax models.

After the museum, I had sushi for lunch, treating myself to some Philly rolls. Authentic Japanese sushi? Of course not. But cream cheese and smoked salmon with wasabi and soy sauce is a pleasant mixture of flavors and textures. On the way back to my brother's apartment, I stopped at the Superfresh in Society Hill to stock up on groceries. I was surprised to find that a lot of the produce was not fresh, to the point where I could detect the smell of turning lettuce, and stuck to non-produce. During my time at Brandeis, I used to complain to my mother that the produce section at the Waltham Hannaford was inadequate compared to the farmstand/grocery where she got our fruits and vegetables. Now I see that Hannaford was just fine, but there is hope in the form of a Whole Foods that is also within reasonable walking distance.

 I am surprised at how quickly I am starting to feel settled in, but I think a large part of it was this walking adventure - it was a good 1.5 miles or so walk each way, long enough to see changes from neighborhood to neighborhood but short enough that it didn't feel like something from Oregon Trail.

Today, I slept in, hung out with the cats*, and was introduced to Parks and Recreation by my SIL. Tomorrow, I get to familiarize myself with SEPTA by taking my first trip on the regional rail to Villanova. Classes haven't started yet, but tomorrow is Laptop Distribution day. I am not super excited about the computer itself (it's going to be a Dell, and I'm a Mac person), but I think it will be useful to have a school computer and a fun computer. As long as it stays alive, it'll be fine.

* = Brother and SIL have two cats, a compact, rounded tabby and a black cat. Both have taken to me pretty quickly, perhaps because my room has one of their food dishes.
More info on Swallow: http://www.swallowthebook.com/book.html

Monday, May 14, 2012

In My New Home City

After the drive to Philly, dinner with my brother and parents, and (starting to) unpack, I am too tired to write much. But so far things are going very well.

1) The textbooks I ordered online, which were originally sent to the wrong address, arrived at my brother's apartment last week.
2) Even though my guest room in the apartment is very small and lacks a dresser, I found places for my everyday clothes and office supplies. I accepted that many of the things I thought I would need for the first month can be left in their boxes until my brother moves to his new house (also in Philly).
3) My room in the new house (see above), which I move into next month, is spacious, has nice views, and has lots of closets. Also, I have my own bathroom for the first time ever, which is more exciting than I would have thought.
4) My brother and sister-in-law's two cats have accepted me and did not interfere with my unpacking at all. Other than sniffing the boxes (probably because they smelled like my cats), they didn't push anything off a table or try to play with fragile things.

And, number 5) my wonderful SIL put clean sheets on the bed in my room, so I didn't have to make the bed. All I did was lay my wool crocheted blanket on top of it.

I hope that I will find the time to write about my new city some more before classes start, and/or to get a little more work done on The Fiennes. If that doesn't happen, I'll just be happy to enjoy my last lazy days before the summer semester starts.

Sunday, May 13, 2012

Dark Shadows and Final Moving Preparation

Today, Dad took me to see Dark Shadows, which I was hoping would be quirky, a little dark, and richly entertaining, after seeing many of the previous Tim Burton and Johnny Depp in Pale Makeup movies.*

Sadly, while the visuals were riveting, the story and mood seemed to be all over the place. The movie seemed to go from quirky and fun to horribly depressing way too quickly at many points. I am not averse to movies having a balance of funny, scary, joyful, and sad, especially darker movies like Tim Burton's works. But it is annoying for the mood to switch from scene to scene, without any sense or rhythm. The lack of a cohesive storyline made this feel worse.

At times, the plot seemed to serve visual show-offs (explosions! blood flowing from paintings!), rather than the visuals serving the plot. This was also an issue in Repo! The Genetic Opera, which uses a lot of unnecessary blood and gore, but in Repo the strawberry red blood, even in excess, still serves some purpose. The organ repossession scenes in Repo highlight the brutality of GeneCo, the company which orders them. But the visual effects in the Collins mansion in the final scenes just seemed over the top for the sake of being over the top. I was hoping for a neater resolution towards the end of the film, and instead got bleeding paintings and later splashing waves, without little more tying it back to the introduction than Depp's moody narration. Oh well. There were some good lines, most of which were in the theatrical trailers, and Depp does look surprisingly good in the Moody and Pale look.

The other main highlight of the day was finishing my packing. Dad managed to fit all of my boxes into the back of the new family car (it's a hatchback; the previous car was a very petite sedan). This means we don't have to rent a monster car or van, which is wonderful because now my parents can entertain themselves by playing around with the new car's audio features (including connecting to Dad's iPhone's music library). And I can listen to them go on about how they should probably read the manual for the audio features, but let's try this button and see what happens.

It will be a fun trip to Philadelphia.

* Edward Scissorhands, Sweeney Todd, Corpse Bride (even if it was technically a clay representation of Depp). If you haven't watched them, the basic look was a powder white face with dark eye circles (done with dark brown and black eyeshadow), sometimes accented with blood or scars, and dark clothes.

She's Leaving Home

Despite spending my last two years at Brandeis (plus the year after graduation) planning and preparing for nursing school, I had come to a point where I was unconscious of the new step I was about to take. In addition to starting the classes and clinical rotations that will prepare me for nursing, something I had never imagined choosing when I applied to college, I will be leaving my home state for the first time.

Tuesday, May 8, 2012

Last Week in MA

My master plan for moving from MA to Philadelphia had been to finish my church job and my volunteering gig at Brigham and Women's in early May, take my Pathophysiology final, and give myself a week to pack/say goodbye to my friends. But plans have a way of being interrupted.

Saturday, May 5, 2012

Touring the Microbiology Lab

This is my second post about shadowing general medical residents, and talks about our tour of the Microbiology lab.

If you don't like reading about blood, feces, or dissections, you might not enjoy this post.

In addition to seeing patients and attending a lecture on kidney development, the residents I shadowed went on a tour of the Microbiology lab to learn how they did blood cultures. Blood cultures are run when a clinician suspects sepsis (blood bacterial infection). The first step is to find if the blood has anything growing in it. The lab does this using an automated machine which incubates the blood samples and lights up if one of them reaches a certain level of growth (the blood sample bottle has an indicator of some sort). This way, only the blood which has detectable bacterial growth is put on culture plates, saving the lab time, money, and labor.

If a blood sample sets off the alarm, the lab tech disinfects the bottle top with iodine and then extracts a small sample, putting a drop of blood on each culture plate. The plates have different varieties of agar (a gel made from algae), including blood agar (which has sheep blood added to show bacteria that can break down blood cells) and chocolate agar (in which the blood cells are heated to break them up - these plates show bacteria that cannot break down blood cells - there is no actual chocolate). I wish I had taken pictures of the plates; they were oddly beautiful. Even though some of them had nasty bugs growing on them, seeing the different shapes of the bacterial colonies (some looked like snowflakes) against the red and brown agar was fascinating.

For those who are curious:
http://en.wikipedia.org/wiki/Agar_plate
http://en.wikipedia.org/wiki/Chocolate_agar

The most amusing takeaway from the lab was hearing which type of sample the lab techs despised most. I thought there would be widespread detest for fecal samples, given the smell factor. Acknowledging that working in a lab may desensitize one to strong smells (they used acetone to do Gram stains), I also wondered if there was a diversity of opinions about body fluids. After all, many of the nurses I have worked with admitted that even though they could deal with (name a list of body fluids) pretty well, there was still one fluid that made them nauseous or uneasy.

I know that I am much more tolerant of blood than of fecal matter. Watching an open prostatectomy during my tour of the surgical wing (through a window to an OR) did not phase me. Oh, look at all those red sponges, I thought. They almost looked pretty in the periwinkle blue organizer that had individual pockets for each used sponge.  I attribute my comfort with blood to watching my dad do fingersticks (for blood sugar tests) for 23+ years and being a blood donor for 6 years.

When I did a fetal pig dissection in anatomy and we had to examine a portion of the large intestine, though, I stepped back after feeling the intestine between my fingers.  I can't explain why cutting into a sheep brain or looking at a cow heart didn't phase me, but fetal pig intestinal contents did. It is mostly the smell, I think. There are definitely serious pathogens that are transmitted in both blood and feces, but my automatic reaction to the latter is that it is dirty and nauseating. While a stranger's blood is a disease risk, I don't look at it as an inherently dirty substance.

But the most hated sample category among the lab techs was not blood or stool. It wasn't urine, either, which they process a lot of as well. It was foot wound samples (i.e. diabetics with infected foot sores), simply because of the number of organisms in each sample. One tech's quote was: "where do people put their feet?"

On that lovely note, enjoy the rest of the weekend and cover your foot blisters!

Outside of Seattle Grace…

… medical residents see patients who actually look sick, and not just actors with slightly pale complexions and overly dramatic spouses. For the last day of my most recent hospital volunteering gig, I shadowed a group of general medical residents on their morning rounds. As much as I suppressed the images of rounds I had from Grey's Anatomy and St. Elsewhere, I still pictured a semi-orderly series of patient visits, interspersed with questions about what conditions the residents would consider with certain findings. Though my Pathophysiology course this spring only covered the most common diseases, and skipped over some key systems (the GI system and reproductive system), it was rewarding to be able to follow some of the residents' discussions and to see a variety of non-surgical patients. (I had spent months seeing all sorts of hernias, hearing about colonoscopy preparations, and learning about hysterectomies - it was good to have some new sights).

When I worked in the preoperative clinic, I found that one of the anesthesia residents was fond of pointing out "interesting" details in a patient's history or showing me what physical findings were abnormal (such as a loud systolic murmur whose "whoosh do whoosh do" I can now distinguish from the moderate, even "lub dub lub dub" of a normal heartbeat). During rounds, I noticed that some of the general medical residents made a point of talking to me about cases that to them illustrated a major clinical issue. One such case was a person who had a serious allergic reaction to a prescription drug. The resident mentioned this case not only as an example of a serious immune reaction, but also to make a point about how unnecessary prescriptions of antibiotics can raise the risk of an allergic reaction.

While the practice of pointing out clinical curiosities may seem like it reduces people to abnormalities, seeing the manifestations of a disease (or a combination of conditions) in a real person broadens the sometimes narrow image of an illness that one gets from a textbook description. Even reading a person's lab values does not always give a complete picture. One resident noted that a sick person "looks sick." That may sound obvious, but it does highlight the importance of looking at the patient and talking to him/her. We can learn a lot from lab values and vital signs, but every person's body responds differently, and some people do not follow "textbook" patterns or our preconceived expectations. One of the preoperative patients I remember best was a man in his 80s who I assumed (based on his medical history and age) led a fairly quiet, less active life than in his youth. He proudly announced that he still did household renovation work. That certainly taught me the value of a thorough physical activity and occupational history!

Tuesday, May 1, 2012

Nursing School Fashionista

For most people my age who work the year after graduating college, the transition is marked by a dramatic change in self-image. Gone are the days of sleeping in until 9, 10, or even noon, and shuffling to class in yoga pants or sweats. Those lucky enough to land a professional job start to accumulate trousers, crisp shirts, and smart blazers. One of my best friends, who spent 90% of her time in yoga pants or jeans and a hoodie at Brandeis, now looks like she walked out of a Banana Republic ad. Even her going-out jeans are darker, more polished.

I knew for a long time that the dress code for nursing is based primarily on functionality. My nursing student uniform, navy slacks and a white button-down with our school's seal, also serves a symbolic function by marking us as student nurses. Sadly, it was one of the less aesthetically pleasing uniforms I had seen. I decided that I definitely wanted to have some cute summer clothes to wear to class, and stocked up on bright tees and a floral wrap top.

While I had been trying to find a new pair of jeans, I got an email from my Health Process and Assessment instructor with the course syllabus. Realizing that the lab portion of the class involved performing (and receiving) thorough physical exams, a new pair of yoga pants began to look much more practical than a new pair of jeans. This was how I ended up getting stretch capri pants at Target.

In a month, I can picture my friend sailing into work in a few weeks with her elegant Longchamp bag over her shoulder, while I show up to class with a stethescope and sneakers. But at least my stethescope and blood pressure cuff will match.