Update.

Whew, I need to stop abandoning this blog! I haven't been in the mood of writing lately, even though there is much I want to say. So here's an update of what's been going on in my life. I miss writing about nursing experiences, but I'm about to start my first job as a RN soon, so I hope hope hope that will get me back to writing. :)

Summer.

I like summer. After years of schooling, summer signifies a break for me. I’m not sure it will stay that way, now that I’m entering the working force—the real world, yo!—where you just keep on slaving away and summer will become just another season.

I’ve had two very interesting consecutive summers. Last summer, I was having the time of my life interning in New York. This summer, however, was quite the opposite. If last year I was in cloud nine, this year I often found myself in the deepest solitude. It doesn’t mean that it has been a bad summer, but it is just a summer full of introspections.

I graduated, I looked for a job, I didn’t get a job, I became a Registered nurse, I looked for some more jobs, and I finally got a job right at the eve of summer’s end. It was fitting, a full circle if I can say. I had many hopes at the beginning of this summer, but when those hopes didn’t materialize in reality and I found myself idle in this seemingly long summer, I realized that it was time to do some thinking.

As much as I was frustrated this summer, I am thankful that I had the time to reorganize my thoughts. Years of school being my priority did not leave much time to think about anything else, but now that I am done, I have all the time in the world to see things I had not seen before. I looked back to what has happened, to what God has done in my life, and to what I have become. Then, I looked to the future to set up new goals, to open myself up for new possibilities that God has in store for me, and to figure out what I want to become.

Life is about change, and knowing when to make that change.

Job.

The single word of “job” has overtaken my summer. The single quest to find one was enough to drive me nuts and leave me drained. But let me tell you the miracle of how I finally landed the job.

I had truly liked the unit where I did my last clinical at a highly reputable hospital in medical center. I had liked my preceptors. I had liked the unit director and the manager. I had like the nurses, the PCA’s, the unit secretaries, the whole staff basically. Although, I had not like this type of unit before I did this clinical, I had liked it two weeks into my clinical. Midway through the rotation, I started to feel like I know what I was doing and I was welcomed as a part of the team. A bunch of the staff had come up to tell me to work there after graduation, some had told me to come in wearing their uniform scrubs next time I’d come for clinical because I was already like one of their own, and even the patients’ meal service lady started calling me “baby co-worker”.

I gave my resume to the unit director two days before my last clinical. What I thought was supposed to be a short meeting between she and I turned out to be an encounter between she, the unit’s manager, the unit’s clinical educator, my preceptor, and I. They were all so excited about my desire to return, and the only rain on that parade was the lack of budget the unit had to hire more nurses.

I was disappointed, of course, but I kept in touch the unit director. We briefly exchanged emails ay the beginning of summer, and I never heard from her again. The summer saw me applying for various jobs and even interviewed, with no luck in landing an actual job. Also added to the equation was the complexity that is my international status. I was at my wit’s end trying to get a job.

I had lost hope for that unit, until on a whim, I decided to shoot the director an email saying that I had just passed my board and still interested to work there. She replied with words that she should hear about an opening in a week or two and that she had forwarded my resume to her recruiter. I thought it was just another false hope, so I didn’t think much of it. Lo and behold, the recruiter called a week later.

As I was talking to the recruiter, I kept waiting for her to schedule an interview. She never did. Instead, she scheduled for me to come in to take a medication exam. HOLD UP, I thought, medication exam isn’t supposed to be taken until one has passed all the rounds of interview and has gotten the manager’s seal of approval. Then, she kept on talking about doing background check and drug screen and paperwork, and I thought, WAIT A MINUTE, did she just offer me…?!

For a good week, I marveled at this fast turn of event. Did I just get a job?! OH YES I DID! Of course, I was still worried about my status holding me back, but they did not make a problem out of it. I claim this job in the name of Jesus, and as of now, I start orientation of my new job at the end of the month. I knew that this will come eventually, because I have faith that He will always come through. I just didn’t expect it to be this way with everything happening so fast once it started. But based on my experiences, He rarely does thing the traditional way. He’s funny like that.

The next level.

I’m content with my life, but I also know that, when God has finished a chapter, He has something better for the next one. Hence, I’ve been asking Him to take me to the next level. I need new challenges. I need experiences I’ve never had before. I need to build on my characters. But where do I go? What do I do? How do I prepare for this? How can I be a better person? It is a process, and it is not an easy one. I won’t know all the answers at once, but I’m willing to submit to His molding. That’s what I know for now.

What is this feeling?

As much as I'm at peace with my granmpa's death last summer, today I realized that I don't know if I'll ever be "okay" when I have patients in the similar situation my family and I went through that fateful July.

The first one happened last semester, and I wrote about it. At the time, I thought it was just a one time thing. It was my first and of course I was bound to feel...something. I thought it'd go away and but it didn't. Yesterday, I started to realize that one of my patients is dying and the family was finally able to made that difficult decision to let go of treatment and do palliative care instead. Today, everything is more...official, I guess. All PO meds are on hold, and the Morphine Sulfate surfaced in the order. Again, I got that uneasy feeling I did last semester.

I think what did it for me is seeing the Morphine PRN dose on the MAR first thing in the morning, just because that is the staple drug for end of life patients to keep them comfortable. It's become some kind of a sign for me that, yes, the time is near for that person. We were given doses of that, too, from the hospice care for Grampa when he went home from the hospital. I had to give him that, and so did my cousins.

Then my chest got thighter as I walked in the room. The patient is much like my Grampa was before he died. Eyes opened but no one is there. They can't talk and you wonder if they knew who you were, and you wish they remember who you were. They're just lying there, waiting for their time to come, and it's an excruciating wait for the family members.

It's a weird weird thing to experience, I can't say enough how uncanny it is to watch a dying person, especially when you've watched a family member went through it. I wasn't exactly sad or upset, I didn't feel like crying or breaking down. There is just...an uneasiness to it. There is a voice screaming in my head that this is the same thing as Grampa: the Morphine, the inability to talk, the waiting, the what happens when we bring him home, the ever present wondering of when he'd actually die. It keeps screaming I have been here before and I should never be reminded of it again.

But it's life. People die everyday, and unfortunately, you will witness that more times than you'd like. Heck, I'm only a student nurse and it already happened twice. My career awaits many a future experience of taking care and witnessing dying patients. After the first time, I thought I had to find a way to be okay with this, to erase that feeling out of me. But after today, I realized I can never make that feeling go away, and I'm accepting that I will forever be taken back to Grampa when that happens again. I will always take a sharp breath, my chest will always feel thight, and I'll always get this inexplicable feeling when I have a dying patient.

As if one dying patient isn't enough, the universe, of course, just has to mess around with me some more. Another patient on the floor, although wasn't mine, vomitted, had a seizure, and went into a code. (This was also a second code, the first one I saw was also last semester) Oh, the brouhaha of a code, there's nothing like it. It seems like, in a code, no matter how fast you're moving to get things, you are never fast enough. How many times did I hear that doctor yelled out "I NEED PROPOFOL 10 cc FAST!!! WHERE IS THE PROPOFOL?! GIMME THE PROPOFOL!!!" in the 10-15 seconds it took the other doctor to get the Propofol and have it drawn up in syringe? You're trying to bring someone back to life, get that heart beating again, breathe air into the lungs. It's a person's life literally in the hands of the many medical staff who rush into that room, and I don't think you'll ever be fast enough. No matter how experience and collected these people are, it's still a total and utter chaos.

Now, the code didn't do anything to me. It was actually exciting, to be honest. This patient was actually in a much somber situation than my dying patient, but I was fine. I've never had to watch a family member going through a code, having tube inserted down their throat, surrounded by doctors and nurses doing everything to revive them. After 30 minutes--that seemed like hours--the patient was stabilized and transfered to an ICU unit.

And then I knew there is a difference. In some cases, I'll be fine. In some others, I'll just have to deal with that weird feeling. That's just the way it goes now, and perhaps for the rest of my career. All in all, for me, it's still an other wordly experience to witness births and deaths. They make me appreciate and respect life more.

5.16.2009.

I just applied for graduation.

I will be walking in that cap and gown across the stage on May 16, 2009.

Wow, I, and the other 64 people in my class, finally get to say that. I don't know how they feel, but I'm pretty stoked about it.

But scared too, because ohmahgaah this is it I'm going to be a real nurse and how the heck am I going to do that when I feel so inadequate and incompetence and I don't know anything and jebus am I going to make it am I going to be a good nurse there are patients' lives on the line here!!!

Yeah, it freaks me out, sometimes a little and sometimes a lot.

School does its best to teach and provide us with experience, but it's nothing like the real thing. How many times have I gone to clinicals and come across drugs that I never heard before in class? How many of the machines I saw, when I had clinical at the Cardiac Recovery Unit that one time, can I name and tell you what they're for? Heck, I'm a senior II and how many IV have I put in? None. And how many venipuncture have I done? Only one, and that wasn't even on a patient, it was on my internship friend for a check off (and yes, my friend did one on me too).

But then, it always surprises me at how much I know that I didn't know I know before. I know, I just lost you right there. Do you know what I mean? Okay, okay, I'll stop.

What I mean is that, the general feeling among the seniors is that we don't know anything. It's like, wait-how many conditions does this patient have? How do you pronounce this drug?! What is that futuristic looking machine is for? They did what on that patient?! Is he gonna cra--holy sh*** BP's dropping--fast--he is crashing! Will we know how to think and act critically? My own immediate answer to that question used to be "No.... I don't know...maybe?" But now I'm starting to think differently, in that I think I know more than I thought I do.

Today is an example, we had a 50 questions pharmacology exam that wasn't counted for a grade, just to see what we know so far; students usually don't do so hot on this impromptu exam. During the review, the instructor asked, "Once you start Iron therapy in an anemic person, how many days will it take until you see some improvement?" There was a lot of answer thrown out, "a month" being the most common I heard, but "120 days" just rolled off my tongue. I wasn't shouting it out to be heard to the class, more like saying it to myself, and I didn't hear if anyone else has shouted "120 days" also. I was just thinking, "120 days, that's the lifespan of adult Red Blood Cells, you have to wait 120 days for the new RBC's to see some result from that Iron."

And I was right.

My exact thought at that moment was, "Huh. Where did that come from?! How did I come up with that?!" While the grade of that exam is a failing one by the school's standard, it's still better than what I expected and it's higher than the class average. I've been surprised at myself a lot--especially in the last semester, perhaps it's time for me to start setting higher expectations of myself.

I guess what I need to keep telling myself from now until that May graduation day is that I am more competent than I thought I am, and I am more than I give myself credit for. I have been pushing myself to trust my gut and go for it for the past year, and I've found out that--actually--more often than not, I was doing and/or saying the right thing. It's like this whole nursing thing has finally been coming together in my head, unbeknown to me, and I am now starting to realize it. Although, I still have to admit that believeing in yourself is sometimes easier said than done in this world.

There is still much learning to be done and confidence to be built in on my part.

But you better your bottom dollar I'll be as ready as I can be when 5.16.2009 comes along.

Ready to launch.

I have been thinking.

A lot.

I have put in so much into this decision and I'm going to commit to it and do my parts to go through with it.

I'm moving to New York City in June 2009.

For some people, this isn't a surprise, even for you (I have no idea how many--if there is any) if you've been following my blog because I've talked many times about my amazing summer there. But now, now I'm saying it out loud and putting it out there. I didn't just make this decision in the time following my summer stint there. Although it sealed the deal, my journey to have come to this point began more than 3 years ago.

I visited NYC for the first time in 2005, and I fell in love. There is just something about it that charmed its way into my life and managed to stay since then. For a while I thought I'd move a year or two after graduation, but for the last year or so I knew if I'm ever going to make this dream of mine come true, I have to move right after graduation. Then the internship fell into my lap, an offer I couldn't refuse, and the 3 months I spent there confirmed every reason I have for moving and drove away every doubt I had about making the move--okay, maybe not entirely drove away the doubts, but those doubts were greatly minimized to a point where I am not afraid of them anymore.

A lot of people want to move to NYC, it has a lot to offer: the fun, the lifestyle, the people; it's the best City in the world, they say. I have many reasons too. Out of the places I have traveled to in the U.S., NYC is on top of the "Yeah, I can see living here..." list. I just feel like I fit there, and I am not alone in thinking this way. My family and friends are very supportive and encouraging, telling me that they, too, can see me living there and making it.

I've been where I live now ever since I moved to this country, that is 9 years ago, and by now, I'm getting restless. I want to go to the next level of my life, where I'm out of my comfort zone, where I can grow as a person, where I can open my eyes and see more of what this world can offer, where I can meet new people, where I can make a difference. I'm young and this is my time to spread my wings, if we want to be cliche here.

Having said all of this, I do think that I'm not going to live there forever. I do feel very strongly that once I'm settling down, I'll move somewhere calmer, even come back to this Texan city that has been my second home. In my 23 year old mind, there is no way that I see myself raising a family in the jungle that is New York City, but this will be another decision I will have to make when I get to this bridge years from now. For now, let's just deal with actually moving there first before any thoughts of moving away from there.

This decision has been more than 3 years in the making and you have no idea how much I am relieved and excited to be able to say it out loud that yes, I am moving to New York City in June 2009. Yes, I am and will be making arrangements from now till then. Yes, if God's willing, I'm going to start my nursing career and a new life there.

With my last semester of nursing school--oh man, I can't believe I get to finally say that, my.last.semester. Wow, where has time gone?--starting next week, I'm excited and nervous all mushed into one. A lot will happen within the next 5 months let alone in the rest of the 12 months of this year, in a life changing way at that--applying for jobs in the City, job interviews, HESI, graduation, moving, NCLEX. It's overwhelming I can barely keep my head from exploding.

But I'm ready. I'm ready to launch this year. I'm ready for what may come. I have my faith, I have my family and my friends, I have myself to carry me through. Intermission is almost over, let's get Act II of the Senior Year rollin'!

Reflecting.

The internship, I miss it. As I started my Child Health (Peds) class this semester, I realized just how much I'd learned over the summer. Even when, at the time, I complained that it was unfortunate that we as interns were limited in what we were allowed to do. Now, I saw just how much knowledge I've gained by doing what were seemingly trivial tasks over this summer.

Those urines I dip and how to get them out of diapers, keeping track of I&O's and the importance behind it, checking on IV's every hour and keeping track of those numbers, monitoring those vitals during conscious sedation, the little tricks you use with children to get them to cooperate with you, getting blood from those central lines. They all came rushing back to me, and when my instructors lecture or showing us things in the lab, they make an absolutely perfect sense. And once again, I am humbled to be where I was this summer.

The floor I interned at receives Hematology/Oncology patients, so a lot of the children that I've taken care of are frequent fliers or regular costumers, which means they stay on the unit for a long period of time and/or frequently return for treatment. As a result, the staff get to know them and their family pretty well and vice versa. There is not a day that has gone by since I ended my internship that I don't think about those "regular costumers".

How are they responding to their treatment? Have N & M lost their hair? Is P still scared when it's time to change his port-a-cath needle? Is G still refusing his meds? Has R finished her round of chemo? How are they and their family coping? Is Y home by now? I hope her count stays up. I hope C's bone marrow transplant goes well. I hope none of them relapses....

My heart breaks for them, for what they have to go through. I used to read their charts in the lounge, then I'd watch from the window in the corner, out to the green of Central Park across the street. A playground was there, swings, slides, monkey bars, you name it, and everyday I watched as kids filter through that playground throughout all hours of the morning and afternoon, wishing the kids I had on the unit could do the same. I'd take a long sigh and get back to work, saying a little prayer as I pass each room for them to get better a little sooner.

Yet in all of this, I've found great courage. Cliche to say that, but it couldn't be more true. For two days I watched as one family broke down as their 3 year old was diagnosed with Leukemia, but in the days afterward I watched them gathered every strength they had to pull through. They took in every ounce of information the doctors tell them--treatments, procedures, side effects, risks, prognosis, asked questions, and clang to every hope. They braved procedures that they have never heard before--lumbar puncture, bone marrow aspirate, port-a-cath insertion--and one they've heard but never thought would exist in their family--chemotherapy--being done on their tiny child. They held their child's hands and soothed their child through every vitals, labs, and meds with "It's okay, it's okay. It's gonna be okay." Sometimes, I even think they said those words to assure themselves too.

Those children, they're bravery and courage personified. As angry as they might have been, as scared as they might been, as rebellious as they might have been against all of these diseases, they manage. They just do. Somehow, along the way, they find a way to cope, to accept, to fight, and a reason to live. Every so often I'd come across charts so thick with health history, full of conditions so foreign to me, I had to google as I read those charts, and every so often afterward, I've found myself dumbfounded as to how they find the strength to go through all of that for years and years. My hat is off to them.

I really do miss those kids. Baby D, unaware of the how sick he really is, moving his head happily when you play his music toys as you take his vitals. Little N, the little tod, screaming bloody murder at everything and anything done to him, but once in a while when you're just checking on him throughout the day, he'd show you what game he's playing, he'd smile and you'd forget an hour ago he was kicking all four limbs as you and your nurse restrain him down for an oral med. R, in her early teen, as sweet as she can be, letting me draw my first central line blood from her even though she's very particular about her line. S, who came in for a sickle cell crisis, was quiet as a rock, but once she talked 50 mph with her 5 year old imagination, you knew she was no longer in pain and she was going home soon.

With this experience, I look forward to my Peds clinical this semester. I love working with children, they are a source of inspiration.

Lists, they complete my life.....

Another list to compile the non-hospital related things I did--or didn't--while in New York.

-Everyday I walked up and down 4 flight of stairs to get to and from my apartment.

-My cooking ability is still not enough to be called "skill".

-I lint rolled the clothes I was wearing before I left the apartment, while walking to the subway, on the subway, and sometimes once I got to my destination. Those cats shed like there's no tomorrow. Damn.

-Speaking of cats, I cleaned up cat's puke once.

-During the 3 months of my stay, I have only worn heels one night. ONE, and a ONE inch heels at that....

-Holy a lot of walking, Batman!

-Bought many a flat shoes.

-Once, under the influence of an impulsive friend (you know who you are), I spent way more that I usually would on a dress. Like, 5 times more that I would. To this day, no matter how good that dress makes me look, I still cringe when I thought about it. What the hell was I thinking?!

-Gone out past 2-3 am on many occasion, which usually is unheard of when the semester is in session.

-Smoked Hookah for the first time. Did not like it.

-Went to the Met twice and to MoMa once and was surprised that I actually enjoyed museums more than I thought I would.

-Fell in love with the little boutiques in SoHo, even though I barely buy anything from them.

-Didn't see as many Broadway show as I thought I would. I only saw 2, shocking, considering how big of a Broadway fan I am. Why didn't I see more will remain a mystery.

-Kayaked on the Hudson River. For free! So much fun!

-Spent a weekend in Boston with my roommate and my friend. One of the best weekends this summer.

-Took a day trip to Washington D.C. with another friend. Another fun time.

-Until we arrived in East Chinatown area at 1 am-ish with no yellow cab in sight and only black cab drivers trying to woo us.

-The subway already looked scary enough for me when I got there earlier that morning, so I bravely took the black cab.

-And was scared shitless the whole way home. The driver was nice and my gut trusted him, but still you know, unregistered cab past midnight is nevertheless shady.

-Then I scared my roommate shitless when I got home. I had tried to be as quiet as possible, but right when I entered the room, the cat had woken her up, plus the light from my cell phone screen was on. There was some screaming alright....

-Went karaoke in Ktown and experienced the horror that is Korean background video as we sang. Nothing like watching bloody war video as you're singing a love song. Really....

-Walked the Brooklyn Bridge from Manhattan to Dumbo. The view of Manhattan from Dumbo was worth the long walk across the East River.

-Fell in love with the East Village. St. Marks, what would I do without you?

-Ate out a LOT and tried many a fabulous food and desserts, which is not conducive to said cooking skill mentioned above.

Speaking of food:

-Had a hotdog from the food stand on the street. It was like a rite of passage to New York or somethin'....

-Went to Serendipity and had the famous frozen hot chocolate. It was good.

-Went to had Japanese ramen. Great, but Samurai noodle in Seattle still wins by a mile.

-Spent an afternoon at Cha An teahouse in the East Village chatting with girlfriends. Good time.

-Went to this two super cool and authentic Japanese places, Oh Taisho! and Kyotofu. Gah, I love Japanese food.

-Went to Rice to Riches, a whole store of rice pudding desserts with a plethora of flavors.

-Tried the cupcakes from Crumbs. Overrated.

-Went to Max Brenner, the chocolate desserts haven. Can't get enough of it.

-Had a very very good Korean BBQ at Madangsui.

-Had Indian food for the first time at one of the Indian restaurants on the Indian street in East Village.

-Had the ever delicious soup dumplings from Shanghai Cuisine.

-Tried the hot chocolate soup dumpling from Rickshaw.

-Ate many a dish from my home country in Elmhurst. Yuuummmeeh!

-Took advantage of New York's Restaurant Week twice. First to Cafe Centro at the Grandcentral terminal, and second to Firebird, a Russian restaurant.

-Fell in love with Martha's Country Bakery across the street from my apartment. Everything there tastes delicious, like little pieces of heaven. Gelato, cupcakes, pound cakes, cakes, pies, pastries, you name it.

-I went to Coney Island and had an affair with a very yummy funnel cake.

Okay, enough mentions of food.

-Bought my first laptop.

-And also bought my first digital camera. Both with the money I earned from the internship. :)

-Met the cutest baby ever. That Kayla, she's all cheeks and rolls, a doll that one.

-My roommate and I, on our way out for a night in the city, went to her friend's apartment due to some rat incident. Needless to say, we didn't go out and I experienced the infamous New York rat-in-the-apartment story.

-Speaking of roommate, I had the nicest, funniest, most wonderful roommate ever.

-Went to my first Jazz concert.

-Stepped out of my comfort zone of being quiet and pushed myself to be more talkative with new people, however uncomfortable that made me feel at first.

-As a result, I've made friends with wonderful people. They made my New York experience all the more memorable.

-Over the summer, I've met people who are copywriter, graphic designer, clothing designer and store owner, model, music therapist, accountant, art director, Wall Street person, nurse, doctor, interior design student, food science student, media student, etc. It's like, wow, I've never thought I've met such a diverse group of people in one short period of time.

I'm sure there's plenty more that I did and didn't do, that I can't remember on top of my head right now. So for now, this is it. I'm sure I will still make some New York related posts for some time. I mean, summer in New York, can't write about it in a single post....

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.

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.

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.

Oh baby!

I don't know if I like the fact that babies just pop out whenever, wherever, and however they want. Las night I was on mother-baby, which, I'm not going to lie, tres boring. The mama was progressing very slowly, only opening 1 cm more every 2 hours. She was 3 cm when I came and was 5 cm an hour before I had to leave. In the meanwhile, my friend's patient had the baby within 30 minutes of us stepping on the floor. My other friend's patient had the baby 2 hours later. So there I was thinking, well that's it for me, no birth witnessing for me tonight. Bah humbug....

But half an hour before I had to leave for post conference, my nurse check the cervix because patient said she was having a lot of pressure in her pelvic. Lo and behold, we got a 10 cm and a baby in the birth canal on its way out. Alright! Let's get this show started!

The birth went smoothly, plus, my instructor wasn't mad that I was late to post conference. In my defense, I was by the bed and can't get out anyway with the doctors and the equipment tray in the way. Honest to blog, I was stuck, and heck yeah I'm glad I was stuck!

By the way, this letter for the out of town externship just could not come any slower. I wanna knoooooooooowwwwwwww!!!!

The one with the job interview, part deux.

So a magnet hospital in town called Tuesday evening to schedule an interview for the externship job this summer. This is the only hospital in town I applied to and I've been waiting for this call, so it was a nice to finally heard from them. It's the same hospital I had my problematic (see previous post) Acute clinical at, and when they called, I was actually there picking up a patient. Anyhoo, interview is scheduled for Monday afternoon after class.

I haven't heard from the out of town externship I had the phone interview for. I should hear from it sometimes next week, or the week after at the latest. We shall see.

I think I'm handling the anxiety/fear/nervous level I wrote about the previous post about Acute clinical better this week. I wasn't as much of a wreck as I had been two weeks before, and that's a good improvement. I think my charge nurse was part of the reason too, she was so nice and helpful, plus my CI knows who the R.N. well and trusts her. Hence, I was left alone for the most part. Also, CI let me do a procedure (empty and change a stoma bag and stoma care) with an R.N. without her being in the room! When I first told CI the opportunity had come up and asked if she could be there so I can do it, I was thinking I'd be lucky if she even wants me to do it and be in the room, let alone leave with me with the nurse, because she's very adamant about us not being able to do anything if she's not there, even if we have the R.N. teaching/watching.

So this week was a week of surprises, a good week to my anxiety and worry ridden self. Also, prayers work, they really do.

On the more serious note.

So I'm going to be open and talk about feelings for a little bit. Yes, feelings and all things personal, because when I decided to make this blog it's not for fame or millions visits per day or anything like that, I wanted it to be a diary of my journey through nursing school so that I could look back at the written memories (and I'm only lucky and grateful when I see the few comments and support here and there) someday, and those include the good and the bad. And this post particularly about the bad and I think it should be written as a part of the memory.

Remember a few posts back when I wrote about the gruel that is the Adult/Acute (I keep forgetting what I call this class/clinical on this blog, let's just say it's Acute because next semester it's Chronic) clinical? Well, at first I look at it a t a challenge--well, I still do, in a sense. But I think it's either that first week I got grilled really shook me bad or I just want to be good at it so bad or I'm just plain so overwhelmed that I have this feeling of being terrorized by this clinical. This nightmare of I'm going to mess up and my instructor is going to chew me out for it, in front of everybody nonetheless.

I have this nervousness comes Monday night because Tuesday I have to pick a patient and it will keep me up late to do the drugs information and calculation and do a sort of plan of care for the next morning. Then this anxiousness comes Tuesday night and I couldn't sleep well because of it. Then this fear come and stay with me from the moment I wake up Wednesday morning until I finish clinical. And the thing that bothers me the most is that I know I'm worrying for nothing because I've done good so far, yet I can't shake the nervous, the anxiety, and the fear off. I know I made up for that first week, CI even praised my care plan, I know she knows I'm trying and I'm prepared. All I want is to come to clinical without having this unreasonable fear and doubt that are just, ugh, so negative!

Dang it, positive thinking, where did you go?!!

I don't like this me. Something has just been "off" with me lately, can't pinpoint exactly what. Something--or things--just changed and I'm...different, I guess. I feel like I'm back to being a teenager, in that awkward stage and not knowing who I am, trying to figure things out. It's as if everything I know of just shifted, and if only I know how to catch up with it. It could be the stress too that is getting into me, this past month and a half has been a blur of a lot of thing that are just chaotic in nature.

Needless to say, I've made an appointment to see the school counselor sometimes soon. I figure I'd better make use of this "free" service--well, we paid for it in our tuition, but it's still not paying $200/hour to sit on a shrink's couch anywhere else in this city.

Plus, there is nothing like telling your friends "Hey, I have an appointment with my shrink on this day at this time!" and watching their faces change when they assume you're this damaged little soul with so many problems that you need a psychologist's help.

I'm just kidding.

Anyway, hopefully I'd grow out of this weird phase soon.

The one with the poo.

Okay, I get it. I get why parents can be obsessed with their baby's poops.

I spent today's clinical at the newborn nursery, and having changed many poopy diapers, all I want to tell my friends now is the many kind of poops I saw. I mean, did you know that a cutie patootie baby can generate a poop of gross epic proportion?! And it that color?! And in that form?!! And that often?! Who would've thunk it?!

I also believe my kidlet invented a new game called "Oops, I did it again!", in which I change the dirty diaper, turn around for a second to dump it in the trash, only to find upon return that the kidlet has pooped--again--and peed--again. Anyway, today was a good one--a really good one--aside from how many times my baby pooped.

Oh, one more thing, counting newborn's heart rate is another story. It sounds easy when they say "You count for 6 seconds then times 1o", not so easy when heart rate goes 123456789101112131415 in 6 seconds.... I think I lost track and had to redo it several times before getting it right. Oh, and I gave erythromycin eye ointment and vitamin K shot. Yay!

And by now I am also tone deaf to newborn cries....

Game plan.

Upon meeting the acute CI last week, my group and I thought "Holy intense Batman!" So I prepared the best I could last night for clinical this morning, but I've got news for ya. No matter how much you think you're prepared, first day is still first day, meaning you don't know what to expect and you're clueless. You know zip! Ok, I lied, I knew one thing: we were going to get grilled, I just didn't know to what extend. Well, let it be known that we got grilled very very well done today, some of us were even burnt. I was the first one to be put through the ringer. My God, I've never felt that stupid before.

I've never had someone pushed me to my limits like this before, I've never had someone made me think constantly about how my patient's doing and what I'm doing to them and why I'm doing it to them like this before, I never had to prove myself until this. Goodness gracious, this is something else. Now I know we need to be of top of our game at all time. Cover your ass is fast becoming my group motto.

There is a reason why some hospitals are magnet and some aren't. The hospital we're at is none of the county general hospital. It's huge, it's a magnet hospital, and it's got reputation to live up to. The difference between this and the hospital for my OB clinical, which is not of this caliber, is mindbogglingly obvious. So I get it. I get why my CI is very strict about us truly knowing whatever it is that we're doing--or lack of doing of things we're supposed to, to protect us and to protect the patients. Heck, if CI feels we need to know what patient's BM smells like, you better bet our noses would be near that toilet. (This, of course, is an exaggeration, I really really hope no good smelling sense will be assaulted this semester).

Said CI works us to our worth, it is exhausting and involving all feelings reminiscent of the Spanish inquisition. It's going to be one hell of a clinical, one where we're whipped to greatness. It's a lot of work, it's nervewracking, and dammit I sure am going to bitch my way through this, because it's uncomfortable and unpleasant to be under this kind of supervision. But I'll deal. I'll survive. I'm liking the challenge. I want to learn to be a great nurse. I'd like to see how far I can be pushed and how far I can grow.

And how long it's going to take me to do care plans for this. They are as hellish as the clinical itself.

Damn. There goes my life....

Not so brandnew anymore.

I just volunteered at the school's new students orientation today, and it's minboggling to realize that three months ago I was one of those newbies, nervous and confused about what is to come.

Today, I gave the incoming newbies information about the scrubs they need (all hail the elastic pants! Drawstrings hate me, they keep falling off on me!), which sthetoscope is good (Littman is your friend, your expensive friend that is), what supplies they really need to get (blood pressure cuff? Won't need it until 3rd semester Community class; clipboard? Good for something to write on, a hassle to carry around), and answered questions about the classes & professors (Concepts sucks, and yes, it's OK to skip lectures as long as you know which one, and you'll love your Patho and Pharm instructors).

It is a very strange feeling to realize how clueless I really was and to see how much I've gained in just three months. It's crazy! And those newbies, they're so fresh and unassuming, and all I can say to them is "Buckle up because it's going to be one hell of a ride!"

It is finished.

I am done with clinicals, huzzah!!! I can't believe that next Tuesday I no longer have to wake up at an ungodly hour of the morning. So long Med/Surg floor! We had a little celebration today at post conference. CI brought us lunch and we got him a cookie cake since it's his birthday this weekend. 'Twas lovely.

Clinical has been a great learning experience and my first CI has been nothing but helpful and encouraging. I'm satisfied with the evaluation he gave today, there are areas to improve of course, like not being shy to talk to the patients to build a better rapport and taking more initiatives with the charge nurses, but CI said I'll improve in time. Out of the good feedback he gave, I'm most happy that he said I relate theory to practice, adapt readily to changes, and seek learning opportunities, meaning I'm proactive, yay!

On this last day, I was not on the floor actually. I was in the OR observing a laparoscopic Roux en Y Gastric Bypass, which was interesting. Surgery and I have a love/hate relationship. On one hand I love watching procedures and I kinda sorta wanna be a scrub nurse. Only kinda sorta though, because on the other hand I hate the standing and the cold temperature and the lack of patient-nurse interaction. Yes, there is that doctor-nurse interaction and it could be a fun and laid-back one like today, but I know that's not always the case. Let's face it, a jerkhead surgeon will most likely curse you out if God forbid you're 3 seconds late handing him the ten blade. So for now, surgery is not in the cards for me. Every once in a while, I'll get a shadowing opportunity for the OR experience, but as far as career field go....*throws it out the window*

Oh, the Pharm test this evening? Yeah, the respiratory drugs killed me. I did great on the other parts, but respiratory...bah! I knew the drugs and the classes they're in, but I choked on their mechanisms. I knew Beclovert is a corticosteroid, but I went blank on the fact that it reduces inflammation. How the heck did that blanking happen??!! Ugh, I hate the way my mind works sometimes....

In the meanwhile, I have 1 test, 1 head to toe check off, and 3 finals to go before the semester is over and I can catch up on sleep and cleaning the room. The room...oh the room...it looks like my closet flew in there and exploded in the middle of it. Tres messy....

World Spins Madly On

…and it spins fast too.

Is this what it means when they talk about objective vertigo in that Assessment textbook? The person feels as if everything around them is spinning?

At least that’s how I feel. My world is not spinning out of control per se, it just spins…faster, way faster than it used to be. I’ve been trying my best to get a hang of it, alas, no such luck yet. Things come my way in bulks and they swoosh away before I get to the bottom of it most of the time, and I’m left exhausted at the end. I wonder if I’ll ever catch up or find my footing soon…or ever again.

The wind is blowing harsher, too. My hairs are strewn all over my face, covering my eyes. Sometimes, I can barely see what is before me. I reach one hand to hold my hair back so I can see the road ahead while the other one gripped my pole of faith, bringing it close to my heart as I try to take a step forward. My feet start to tremble as the wind blows hard against me, lifting and swirling particles of the earth and blocking my vision. I struggle to set my feet firmly on the ground, “If I fall then so be it,” I thought, “I have my source of strength here with me.” And I do fall, but not for long. It’s not always easy getting up, but it always worthy of trying. I use my ever presence pole of faith to pull myself up, slowly but surely, until I regain my balance and stand up straight once again. Then I dust the dirt of my knees and continue on the journey.

I do wonder, sometimes, if I’ve made the right decision or where this particular road leads to or what the other roads are like. Does the wind there blow as stormy as it does here? Do things churn heavily and quickly as they do here? Does it take this long to get to the end? But there is this little voice I can hear clearly amidst the chaos that is my surrounding. His voice tells me to keep going and trying, to keep my chin up and my eyes straight ahead, to keep moving forward on this path I’ve chosen, and most importantly, to keep that pole of faith in my hands.

Then there things along this road that don’t go as fast as the others do. The people who have been in my life are still around me, I don’t see them as often as I would love to, but I know they’re cheering for me as I go on. They might be somewhere else in this big world and I can’t see them within my field of vision, but I believe technology will keep them in my world always. Perhaps, the most exciting are the new people I’ve met along the way, those whose worlds are spinning as madly and as vastly as is mine. In the short time I’ve come to know them, we have laughed and whined together, and we have made each other smile. They push me forward when I stop on the same spot too long and I them.

In all of this madness, the one thing that keeps me hanging on is hope. The hope of a new strength for each day. The hope that the heavy wind will turn into a gentle breeze. The hope of the ability to regain my footing. The hope that I will find what and who I am looking for. The hope of where this road could branch to. The hope of what I will be. The hope of the rain He will send now that I have prepared—and am continuing to prepare for—the field.

So throw me a rope to hold me in place. Show me a clock for counting my days down….

Scribbles from a bored student

If I could take pictures without it being obvious to the instructor, you would see both friends on my left and right texting the outside world on their phones. Neither of us paying attention. Such model students are we.....

Anyway,

I shadowed in the OR yesterday and in level II nursery today. I put in my first Foley, scrubbed the patient with disinfectant, fed and changed a premiee, it was an interesting experience overall. I definitely enjoy working with the preemies the most, wasn't too crazy about the OR. Well, I guess being a scrub nurse could be fun, getting to watch the procedure up close and being occupied throughout rather than being the circulating nurse.

I also had the chance to walked around the NICU and talked to the nurses there as well. That was the best part of today because I've always wanted to be a NICU nurse, so having to see and hear about what it was like was great. The nurses there were such a riot, they're so funny and wonderful too, I love them.

'Tis a fabulous weekend, I hope yours is/was too. :)

My first

First clinical and patient, ah the nervous train wreck that be.....

Note for my CI:

When introducing me as a first year student to my patient, would you please not add the "This is her first and you are her very first and she's very green" part? You know, the part that made the patient laughed nervously while looking at me with questioning eyes? Yeah, the part that reduced me into a nervous mess.

Okthanksbye,

Cee.

Anyway,

Upon picking up said patient the day before and discussing our assignments with fellow group mates, I immediately knew I was in for a rude awakening the next morning. Boy, was I right.

Pt. had been admitted for radical surgical procedures several days earlier and had a complication secondary to said procedures that requires another surgery to fix it the day after my clinical. While fellow group mates got a chance to shadow their primary nurse after their patient care was done, I did not because my patient required frequent check up and care due to the complication. Needless to say, my patient really worked me for those 5 hours.

Here's one thing I wondered about that day. One of my fellow group mates voiced a disagreement over my decision to help a tech with a patient next door to mine. My patient was resting and as I went out of the room to find my primary nurse--thinking that "Hey, let's watch some cool thing!", a tech who had helped me earlier approached and asked for help with a patient next door. I obliged, thinking that "Hey, making an occupied bed! In a real hospital! Not in lab!". Then, as I was finishing up, the tech had helped the patient into the shower and while doing so, the tech got called out and as you can guess, asked me to help the patient with the shower. In which, as you can guess, I obliged, thinking "Hey, assisting pt. with ADL's!".

My judgment is that, as a first semester nursing student, I need to get as much experience as I can. We all know we're doing the tech's job descriptions such as vital signs, bed bath, making beds, hygiene, etc. on top of giving oral medications and injections. Hence when the tech asked for help, I agreed to do so, especially when it didn't interfere with my own patient's care. I had told my pt.'s family member that I was next door and she could find me there should my patient needs anything.

However, this fellow group mate thought that I shouldn't have helped the tech because the patient next door wasn't my assigned patient and I shouldn't do it again next time. On top of that, I was disappointed to hear her say that if I keep helping the techs than the techs won't do their job and will impose it on me. Am I naive to think that she made a ridiculous stereotype and judgment? I know for myself that I'm not too nice to let the techs ride me over with their requests that I'd neglect my patient or miss a chance to watch/do other skills, but this was one time and dang it, fellow group mate, what is your problem?!

Was I right in my decision to help the tech? Or was I supposed to find my primary nurse instead to see if she was doing those skills that this fellow group mate appeared to deem higher than making bed and assisting pt. with his ADL's?