A whole new world.

In less than a month, I will leave the great state of Texas to spend the summer in the great state of New York, where I'll be doing my internship. I am excited, nervous, anxious, and scared all mixed into one. It's getting closer and I still find it hard to believe that I've gotten into this program, not to mention that I'm spending 3 months in NYC, one of my favorite places.

I got my tickets and I got a place to live for the summer (with a cool roommate to boot!). Then, my friend Stepha will visit me the weekend before I start orientation, and if last summer's vacation in New York is any indication, we're going to have a blast this year too. Eeeeeppss! I'm so stoked for this summer! It's going to be one heck of an experience, I can hardly wait! I've got 3 finals and a short semester to go before I can leave though, but oh wells, I have greater things to look forward to once I get over those.

Oh and one of my bestfriends is coming for a visit this weekend, yay! She wanted to visit me in New York but she can't due to her busy rotation (she's in PA school) this summer. So she's just
going to visit me now and we're going to try on bridesmaids' dresses for our bestfriend's wedding. FUNNESS!

And yes, I fully realize that am going out the Saturday before finals. But hey, I've been studying this week so it's a much deserved break, and it's not every weekend I get to go out with my girls.
Plus, I would like to come in next week and actually be somewhat sane when I do those exams.

I hope your summer is looking wonderful too!

Death.

On our last day of clinical, my instructor called me out in the hallway. She said, “Cee, come over here and stand with me outside this patient’s room.” As I walked apprehensively toward her, she spoke once again, “The door is open and I want you to look inside. Tell me what you see with the patient. Think out loud for me.”

I saw an old lady, grey haired, small in stature, sitting up on the bed, using her left elbow for support. “She’s breathing through her mouth,” I told her.

My instructor nodded, a gleam in her eyes. Knowing I said what she had hoped I noticed, I continued, “You can see clearly her chest is rising up and down.”

“And she’s sitting up on the bed,” my instructor replied.

I looked at the patient again, “Leaning forward.” Right then, a realization struck me and with an alarm look I turned to my instructor, “She’s having trouble breathing. She can’t breathe.”

Instructor smiled and nodded, calmly she pulled me away from the room. “Let’s go see what we can find about her,” she said. Off we went to the nurse’s station to find the patient’s chart and the nurses taking care of her. In the meanwhile, my mind raced with thoughts of why we aren’t helping her and where was the charge nurse.

I didn’t realize I was fidgeting until my instructor spoke again, this time to the charge nurse, “Cee here noticed that your patient in room 10 can’t breathe.” There was that glint again in her eyes when she informed the charge nurse, “We were standing in front of the room, and she saw that the patient has trouble breathing.”

The charge nurse smiled, and my brows furrowed, there wasn’t anything to be smiled about in this situation, so I thought.

“She has a long history of COPD and a primary lung cancer that has metastasized. Her heart is not pumping properly. She’s having fibrillation and flutter,” the charged nurse informed me.

“Oh…,” I uttered, taken aback by the sheer reality of the patient’s condition.

The charge nurse pointed to a group of physicians gathering a few feet away from us, “See that, they’re deciding what to do for her. If we intubate her, she may never wake up. If we don’t, she’s not going to make it past 24-48 hours from now. If her family agrees, we will take comfort measures and let her pass.”

“Wow…,” I whispered sadly.

“But you noticed,” my instructor told me, “You noticed that she’s having problem breathing. Not a lot of nurses will.”

“But it was obvious…,” I disagreed.

My instructor shook her head, “You’d be surprised at how many don’t see it. But you did, and there is a lot you can do even though her condition is terminal. You know she won’t tolerate any activity, you know not to have her do any activity because anything can break her.”

“I guess,” I said, accepting her input.

“You see here?” The charge nurse brought the chart over, “Someone wrote for a PT consult for her, do you think it would be a good idea?”

“No,” I replied. “She can’t tolerate any activity and it may…kill her.”

Both my instructor and charge nurse smiled again, “You got it. You’re right.”

With that, the charge nurse left, my instructor did too, “You did good, I’m proud of you.”

I stood there, trying to figure out what was that for, and to be honest, I was quite resentful to my instructor for doing that to me because I felt like I didn’t need to know of a patient that wasn’t mine was dying and I had the image of that patient’s trying to breathe in my head. I had a lot on my plate from school already, and I’m drained, and I just felt I don’t need to have this reminder that I just saw an old lady who wouldn’t be alive in the next 2 days. I still can’t get the image of that day out of my head, I still think of what happened to her, and how her family is dealing with her death.

I know that one day I will witness my own patient’s death. It is inevitable with the career I’ve chosen, but I’m not ready for that yet, even when it wasn’t directly my patient. I still want to see life in everyone I come across, not impending death. I’ve seen death, I saw a dead 24 weeks fetus, and though I still can’t forget that image, I didn’t know anything about it. I saw it in the hall, heard the story from the nurses who were taking care of it, and that was it. I didn’t see the mother, I didn’t see it delivered, and I had no previous contact.

I guess it’s just still weird for me to see that lady that day and to see her struggling for one more breath, knowing that it was more or less futile and wondering two days later if she was still alive or not. Hopefully, as I go further in this career I’ll find a better way to deal with death and to not let it affect me.

Seriously!

Just as I am determined to stop the doh! moments, my brain refused to co-operate and continues farting, and in the process humiliates me even more. I am sure by now my friends are wondering how the heck did I get into nursing school....

Doh! moment exhibit 1235263512362:

Cee saw J, a friend in the same OB group and who she used to carpool with to the hospital, who sat a few rows in front of her. Mind you, clinical has been over for 2 weeks now, and we have not carpooled since then, and today we start our series of group presentations.

Cee: "Hey! Are you presenting today?"

J looked at me funny and mouthed: "I'm in your group!"

Cee did not understand and mouthed back: "What??!!"

J looked at me strange: "We're together!"

Cee still did not get it: "Huh?! I can't hear you!"

O, who sat next to me: "She said she and you are in the same group TOGETHER!!!!"

Cee: "Oh...right...."

*HEADDESKS*

Wow, my brain is fried....

Doh!

Doh! moment number 1823623563513 :

Last night I was so exhausted I went to bed without setting my alarm, hence my waking up at 7 am today. SEVEN!!! And I have a group meeting at EIGHT!!! And it takes me one hour to get to school with the bus!!! *headdesks* Needless to say, I have never done my morning routine as fast as I did this morning.

Obviously, I missed my group meeting. Thankfully, my group mates were forgiving. Desperately, the doh! moments need to stop.

Blargh

I'm diagnosing myself with burning out related to ineffective coping with stress secondary to nursing school as evidenced by excessive fatigue, "doh!" moments, and whining.

This isn't a good time for me, I've got 2 group presentations, 6 essays for the take home final, 2 more assignment for research class, and 3 final exams in the next 3 weeks. Lord help me....

Lost.

I just lost my USB drive, the one that has all my works from last semester until now. Every care plans, every papers, every group projects, everything.

I cried.

I probably only have 1/3--at the most--of those documents on my hard drive, because I mostly do my work at school so the ones I have on my computer are outdated. That USB is my baby, I'm mostly bumped that I lost the care plans I did this semester because I worked my ass off on those and they're great care plans, unlike the crappy ones I did last semester.

At least the fact that those complete documents that I lost are things I have already submitted comforts me. Of the current paper I've been working on, I miraculously have saved it on my PC and have only lost 2 paragraphs. Thank God.

I was so happy today because it's the last Acute clinical. But now I'm sad. So very sad. :(

Papers.

The amount of papers I have to write for the remainder of this semester is insane!. I've still got 3 discussions, 3 journals, 1 module (which is a compilation of 5 assignments a.k.a 5 papers), and 2 group projects to write/do, and those are all I'll be doing for the next 3 weeks. Nothing but type type type and type, write write write and write.

And i can't stop procrastinating, of course. I am just so tired and so over this semester. I just hate the last quarter the semester because I have no energy left, I'm tired, and I'm whiny. I just want it to be over noooooowww!!! See? Whiny.

Wish me luck as I go on this straight path to the Carpal tunnel syndrome lane....

Last.

Last night was my last OB clinical, and I was sad to leave. I have truly enjoyed the experience due to my amazing instructor, who has a wide range of experience and tries so hard to let us see and do things we've never seen an done before. She is amazing. My friend said, "If I could have all of my clinicals with her for the rest of my school career, I would". I agree, she's just so wonderful, and I'll miss her.

The hospital we were at is not one of the magnet hospital in this city, it's a general hospital where the low income population and everyone else who has no insurance go to. I knew of the fact that I will not have an encounter with, as my instructor said when we started, "the Gerber baby family" who lives in the suburbs, 2 cars, 2 stories house with a front and back lawns and white picket fences surrounding it. It's an entirely new and different experience for me, but I'm so grateful I had the experience.

It taught me what being a nurse is about, that when you care for your patients, you see past what society has labeled them and you just see them as persons who need you and your care, and that is who they are. Their history may say they're drug addicts and the CPS is going to take their baby away, or they're brought from jail with one leg chained to the bed, or they're 37 weeks who've had no prenatal care and not taken any prenatal vitamins, or they're unmarried teens with their 2nd baby, but you don't dwell on that piece of fact. They don't deserve less medical attention based on what their history says, they still need the doctors and you, as their nurse to care for them. I love what my nurse said last week, "When you take care of a patient, you take care of them like you take care your family. You'd want them to be comfortable and you'd make them comfortable". And that is one of the things I will take with me throughout my career.

Last night was great for a last clinical day. I got to draw blood and saw another C-section, this time less traumatizing for the mother--and me for that matter. A complete opposite of the C-section last week, phew. The mother was actually my patient that was admitted to the triage. They were going to admit her to Mother-Baby, but at last decided she would go for a C-section due to a few circumstances. Then after the baby was out, the surgeons lifted up the uterus for us--4 nursing students lined up against the wall--to see and showed us the ovaries and what not.

One other thing to mention about that, is it was very nice of the surgeons to do that, but my friends and I still joke that they did so because they felt guilty about kicking us out of the OR in the beginning. It was all good though, we knew they were really concern about the amount of people in the OR as they were prepping and fear of contaminating the sterile field. So after one of them contaminated her gown when one of the staff accidentally touched her, she ordered us to "stay outside and come in after the baby was out or something". We were like "What?! Until the baby out?! What the heck?!" So we watched from the window until they made the first cut, and she actually sent a nurse to get us back in before we were going to sneak back in regardless of waiting until "after the baby out or something". Afterward, as we were about to start post conference, she came to find us and apologize for earlier, so that was very nice of her. See? Doctors and surgeons are nice, and I like them a lot when they're that way.

So that is it. That is the end of OB clinical this semester. Wow, I can't believe Junior II is ending in a matter of 4 weeks. Yesterday, I also registered for next semester as Senior I. It's surreal, time has really gone by fast. It seems like it was just yesterday that I started this blog to journal my journey (heeey, rhymes!) as I started nursing school.

Senior I. Dang.

I like today.

I like today because I had a very pleasant patient who was interested in learning and appreciated me, a student.

I like today because I had a charge nurse who didn't mind a student and she taught me how to give meds. through a J-tube, charting, and more.

I like today because my instructor told us today that we have NO MORE CARE PLAN TO DO!!!

I like today because I know tomorrow is my last OB clinical and next Wednesday is my last Acute clinical.

However, I don't like today because I have to submit an article critique by 2359 and I'm dead tired and I have 40% to go.

Empty seats.

Who skipped the lecture this morning to study for OB test and do the papers due this week?

60% of the class! Yours truly included.

Now, I don't know whether I'm ashamed of skipping class or actually proud that it's taken me this long to do so. I mean, five more weeks left to school and this is my first skip of the semester?! Open that record book, please.

In another unrelated news, my bestfriend is getting married early January! Woot! I'm so happy for her!

I am officially the maid of honor, and will be at her service with all the wedding planning. Today, we went to see the possible church for the ceremony and to a bridal shop to browse possible dresses. Yes, I skipped class and I went out. A day before a test. I must've felt like I'm a God with the power to know all the correct answers tomorrow or something when I made that decision. (Actually, I am thisclose to be done with studying and I am thisclose to finishing all my papers for this week. Okay, so maybe I did feel like I'm God.....)

I'm sure I would want to kill myself once it's sunk in that I'll be juggling nursing school on top of helping with this wedding planning jigmajig, which includes throwing a killer bachelorette party.

I'll let you know how it goes from my deathbed.

Fetal demise, PIH C-section, late decels all in one night.

Last night was all kind of things mixed into one. I mean, damn, was it a full moon or something?!

Before I ramble on, you might wanna stop reading if you're squeamish.

So, it started off slow, my patient was 5 cm when I came in and stable. After a few hours with her, I ventured around the corner to where my two group mates were, and that's when I saw something odd in the basinet next to the baby warmer across from us. It was a bunched bloody blanket and I saw a surface of red flesh and I thought it as a placenta and wondering why would they wrapped a placenta and put it in the basinet?

My friends spotted the same thing and all three of us went to take a closer look, and that was when the nurses told us that earlier that evening a 24 weeks mom had come in saying she hasn't felt the baby moved in a week. Sure enough, it was a fetal demise, and she was induced to give birth to a stillborn baby.

I will never forget what I saw last night, I don't think I will ever that image of the nurse unwrapping the blanket to reveal the red glob of fetus beneath it out of my mind. Judging by the appearance of the fetus: red, floppy with no apparent bone structure (it looked like a red blob of Jell-o or a red water balloon), underdeveloped features, and peeling of the skin, they were thinking it died due to chromosomal abnormalities and that it had died a week or more before the mom came in last night. As I went back to my patient's room, I caught a glimpse to the stillborn's mother's room, where silent grief enveloped the family that had gathered there. I said a prayer for them.

My patient, in the meanwhile, was progressing slowly, only going from 5 cm to 6 cm, so the doctor order the Pitocin to speed it up. Sure enough, minutes later late decels started showing up on the monitor and it was a "Holy crap! Is that what they meant when they talked about that in class?!!" moment for me. We turned the mom to the sides, put her on O2, and turned the pit off.

It's funny because in class, my instructor taught us a song to help us remember what to do when decels happen, and that exactly what was done last night. I'm still getting used to the feeling when things I've studied in the textbook happen in front of my eyes, it's like "HEEEEYYY!!!", the dots connected, light bulb goes on, whatever.

Mother and baby were okay after that, and nearing the end of my shift, my instructor came around telling us that she was going to sneak us into a C-section in a few minutes after they got the mother settled down and ready to go. The mom was 32 weeks along with PIH and overweight, which is not a good combination for the surgeons and the anesthesiologists.

They started and not long after that the patient started moaning and you can see everyone was alarmed, but the anesthesia team reassured that she was just feeling uncomfortable from the tugging and retracting they surgeons were doing to try to locate the uterus. As they cut through more layers of fat, the patient started groaning and it got louder and louder.

My friends and I looked at each other wide eyed, thinking "What in the world?!!", then we saw the surgical tech and my instructors rolling their eyes and giving each other "What the hell are they doing?!!!" It was bizarre to see someone with their abdomen open and blood flowing out and hearing them making noises that indicate that she is obviously in PAIN!

All this time, the surgeons continued to try to get to the baby as fast as they could, and the anesthesia team announced to the room whatever everything they cannot do because she was so large and hypertensive with low platelets therefore the pending complications, and I was just screaming in my head "DO SOMETHING, SHE IS IN PAIN!!!!"

They finally got the baby out after a series of groaning from the mom, who was still groaning as they sew the uterus. The baby needed intubation and some helped to breath, but the NICU team finally go the baby to cry, so that was good. We left right after that and didn't see the rest of that procedure.

I had no idea why the anesthesia didn't seem to work completely and why the team couldn't get it right. I knew the mother posts a series of complications but it doesn't mean you would just let her feel the pain of her surgery. Uncomfortable? Okay. Pressure? Okay. Pain? Oh hell no! That's not right, but unfortunately, it happens.

So that was my night on the OB floor yesterday. It was a night to remember for sure.