Spelling, Painting, & Whining :: N30020 Clinical Journal Entry #16

Know this: I hate to whine.  I hate to complain.  I love to learn.  I get frustrated when I am bored.  I get tired when I've been up since 5am.  I get crabby when I'm tired and my back hurts and I'm frustrated and I'm bored.  Thank GOD rush hour was not a nightmare tonight or I might have just lost it.

                  What.       A.       Day.

Thinking back, I don't think it was as bad as I made it out to be during the course of the never-ending day, but add in the exhaustion and frustration and boredom and a few medications and BAM.  Welcome to my brain.  I am now de-toxing from my day with a few Ativan.  Yeah, that bad folks, that bad.

So morning report. [And remember, I totally rock the HIPAA so I may change any detail I so wish to hide the identity of the patient! Snaps for me!]

10 years old, H.  Girl cut her foot while running in flip flops.  Turned into - get this - MRSA cellulitis.  The apparent story was, she cut her foot.  She was at Grandma's house and Grandma put a band-aid and Vaseline (Umm? Wrong answer!) on it.  Nobody washed it with soap and water.  H proceeds to go swimming in Grandma's pool with her cousins.  Grandma's pool may or may not be properly chlorinated, but Mom has a feeling that is a negative.  Anyways, H has a fun, wonderful time in the pool and proceeds to "run around in the dirt and mud" in the woods behind her house.  "I love playing in the dirt!"  So the story gets all twisty and somehow she ends up with Dad who says it's just a cut, then Mom sees her a WEEK later when H wakes up with a fever and a large white circle around the cut, surrounded by a red border.  Oh and she's now limping.  So Mom took her to the ER where they treated her and sent her to the family doctor.  Family doctor also treated, some blah blah blah, somehow, eventually, not-sure-on-the-story sent her to the hospital.  Umm, yeah?  Why didn't ER catch it?  Anyways... Tests were run and sure enough, MRSA - a nice little staph infection.  Oh and the kicker?  Kid's allergic to amoxicillin and sulfa drugs... so the key is to find a drug that will kill this strain without giving her a reaction.  Thankfully it worked out easier than that sounds.

So this tiny little cut is so small, completely scabbed over in blacks/dark reds, and has her foot so swollen.  The resident palpated it and when H winced when she touched the bone, Doctor worried about osteomyelitis (the infection spreading to the bone).  The tenderness, combined with the fact that the cut was healed so much that it wasn't properly secreting fluids anymore, prompted MD to order an MRI.  Who knows when that happened.  They said around 4 but we were gone for post conference around 4:15.  They also promised Infectious Disease would be in this AM, and we didn't see them either.  Optimal patient care friends, optimal.  Gotta love it.

Patient walked, talked, played GameCube, watched music videos, took a shower by herself, went to paint with me... Perfectly fine except for one little dot on her foot.  Funny thing is all day long, I check and check and check and she claims no pain, no pain.  As for meds, she only had 1 antibiotic IV piggyback.  Oh and did I mention we were SHARING patients again?  Yep, low floor census so 2 of us students to a patient.  ...To patients who today, did not need much of anything.  I love working with my cool clinical groupie friends, but when your patients are this straightforward and just really "not needy," things get done fast and by 10-11am, you're wondering what in the world you're going to do until 5:30.

So back to my ranting.  Because today was just, well, today.  Here is the problem... I could not find learning and you better believe I tried.  I wanted to get dirty and messy in diseases and complications and interventions and procedures, but do you know what I did?  I painted butterflies in the play room.  Seriously.  And I thought about going home sick like 3 times.  I had the worst headache and was so nauseous.  Probably my nerves because I was going insane being so bored.  Plus of course, I got whiney and complain-y.  And then my instructor caught me for spelling edematous wrong... like are you seriously kidding me?  Who knows it's not "edemous"?  Made sense to me at the time...  lol  Oh and don't take a machine pulse on a kid - mandatory apical pulse, the slowwww way. I don't mind but, like we were supposed to know that?  From what?  Definitely not our instructor. So okay, I guess I did learn 2 things today.  How to spell edematous and for peds, chart apical pulses with each vital.  Ta daaaa!! Oh, and you cannot mix blue paint out of a selection of red, yellow, green, purple, teal, and neon yellow.  H was sure you could, but I told her about primary colors.  Then I remembered I think I'm supposed to be an art major.  What ever happened to that great idea?

Now seriously though, I did befriend this sweet little girl and we had all kinds of discussions.  These kids have so many different stories and lives.  They come from two million and a half different places.  It's amazing to hear their viewpoints on things as well.  Their dreams, their ideas, what matters to them.  Then you remember yourself at that age...  It's fun.  And yes, you know I did totally ADORE sneaking to the play room to paint! 

But come on... can we please have our OWN patient like we did in our very first clinical a zillion years ago?  You know, when we were REAL "nurse babies" and didn't know how to do anything at all?  But you threw us in and we learned, learned, learned?  We know so much more now and yet we have smaller loads.  I want to learn, not be bored.  So until then... I just enjoy the kids.  And the painting.  And I try not to whine too much, but it's hard when you were up before the sunshine and a prof is seriously perturbed by your inability to spell "edematous."  Good grief.

h a p p y
W E E K E N D !