One of these days :: N30010 :: Clinical Journal Entry #25

There are no headlines
for everyday heroes
there is no tickertape
no standing ovation

sometimes it's all they can do
to set their feet on the floor
in the morning

they go through their days
the best they know how

no rainbow need arch
through the sky
to inspire them
they have a special courage
shining deep inside

they go through their days
the best they know how

Ted Hibbard

This came into my inbox today while I was at clinical. 

Today, I could not wake up.  My alarm went off, I took a shower, threw on my scrubs, ate a bowl of Cheerios in record time, and left for clinical.  We were supposed to be on OB today and next Friday, but our instructor said since everyone has seen births, we had an option of not going to clinical next week and going to campus instead.  It's December, and we're all dead.  Guess which option we chose.  So today was our last day in clinical for obstetrics.  We're done.  (Well, next Friday we have presentations, course evals, and an "educational" movie, but that doesn't  count.)

I begged to go to OB Triage today simply because our instructor was confused and assigned other people to Labor & Delivery and I sure was not going to do Postpartum again.  Plus, a lot of births were going on so I figured Triage would be a happening place  (Any pregnant patient who comes to the hospital is sent up to OB Triage.  They could have the flu, a broken bone, or be in labor - most of them know to come to OB Triage and the ones who go to the ER get sent up anyways.)

Not a single patient came in until probably about 11am.  It was all insane from there.  December 1st was a full moon, so don't ask why it all happened today, 3 days later, but it did.

We got a woman who had a stomach virus (and was vomiting so loudly that I almost wanted to do so myself) and we loaded her up with a cocktail of phenergan/benadryl/reglan.  Then we had a woman who had a scheduled C-section (4th baby, 4th C-section!) who needed prepped.  This was my favorite patient because I got to start her IV!  Now, rumor has it that no one teaches us IV insertion in nursing school.  Apparently it's the orientation responsibility of wherever we get a job.  That always sounded stupid to me, and thankfully my instructor isn't into going by all of the program rules.  (I love her for it though - she's smart about it, she just has a much more creative, free-spirited approach to nursing)  Everyone knows though that one of the meds I'm on make my hands shake.  As in a tremor kind of shake.  I'm a steller phelebotomist (or I was in my nurse technician days) but sometimes it freaks patients and instructors out.  So my instructor felt my hands to see if she wanted to "let" me try the IV.  Not even kidding.  Then she randomly puts her hand on my stomach and says, "Wow, your entire body tremors."  Yeah, welcome to the misery.  I told her I was comfortable doing it and thought I could, so after I told her what med I was on and she about attacked me to find out why the doctors make me take it (umm, because I'm allergic to every single aternative?) she finally agreed to let me attempt it.  She asked me what I'd need to start an IV and draw some blood (I voted for the 22 gauge, but the RN said I had to do an 18 - scary!), we reviewed the exact steps the process entailed, and I beautifully gathered all of the supplies in a Chux and carried them into the patient's room.  (Of course I know exactly what you need to start an IV - I've only had like 100 in my lifetime...)

Oh and let me just insert here that Jen (my bestie) taught me how to do an IV (at my kitchen table - just like the time she taught me how to draw blood!) but I completely blew her vein.  She told me to try again, and I was too traumatized by creating a huge blood bruise to accept the offer.  I had just asked her this morning to come over this weekend so we could practice again.  Too late!

So the patient was African American and didn't have good veins at that.  So not only were her veins harder to see, but they just were crooked, deep, or way too "wiggly."  I put the tourniquet on and felt around.  I finally found a hand vein that curved back and forth but it was the best she had.  My instructor liked the site and told me to go for it.  I inserted the needle, bevel up, and there was no flash.  I was panicking when my instructor said, "Push it in just a little more."  Flash!!!  I pushed the button to retract the needle and threaded the catheter in.  Blood started spurting everywhere (that's a good thing!) so I quickly connected the adaptor and popped a blood vial in.  Full.  2nd vial.  Full.  I removed the adaptor and popped the IV tubing on.  Beautiful.  I got a warm rag to clean up the blood on her hand, and we covered it with a Tegaderm and taped the tubing securely.  I had primed the Lactated Ringers so I opened the line and let it go.  (I guess in Triage they just "eye" it and don't put it through a pump.)  Drop. Drop. Drop.  The LR were infusing perfectly in an IV that I had put in.  It was working!  Then later I piggybacked 2 bags of antibiotics, and they worked, too!  (Why they wouldn't, I have no idea.  But I was still on IV-high.)  I had an issue with the 2nd bag, but the RN said sometimes it's just the position of their hand, and sure enough, we had the patient place her hand a different way, and the med started infusing.  Good to know.

The day I performed my very first blood draw on a real patient (Jen doesn't count) I was teching and I called and texted pretty much everyone I knew (and Twittered!) and about died from excitement and pride and well, it was a little weird how excited I was.  Well, that was nothing compared to the IV.  The feeling of knowing I could successfully insert an IV made me feel almost like I'm a real nurse now - the IV is always the "big, scary" thing that everyone is petrified to do.  Well, I've done it, and I did it well.  So I can do it again.  And it feels sooooo good!  Major high.  Other than things involving my fiance like our engagement, first kiss, picking out the ring, blah blah blah, oh and maybe getting accepted into the nursing program, or the birth of my furbaby puppy, it was probably one of the most exciting moments of my life. (And if you're not a nurse or nursing student, you probably don't get it - that's okay.)

Wow, I use a lot of parentheses.  So many thoughts!

Anyways...

That was the highlight of my day, and I spent the rest of it helping check in new patients and then wasting time.  Not kidding.  The story...

We had this huge rush of new patients in Triage, all with what they called "contractions," one who said, "I'm not sure, but I think my water may be leaking.  I don't know," and then a couple women who both said their due dates were tomorrow so they were sure they were in labor.  Funny because most of the patients were in such early labor we couldn't even admit them.  Anyways, I went in with the nurses and helped put on the fetal and contraction monitors, get their urine samples, answer questions, get their data... etc.  After awhile, everyone was just chilling because that's what the Triage patients do - they sit there for a couple hours (unless they're obviously in active labor) so we can read a good amount of monitors to see what stage of labor (if any) the patient is in, and how the baby's heartrate is.  I think it's more like a "we know you're not in labor, but we need to legally cover our butts" kind of thing.  Not sure, but that's my theory because it's kind of monotonous.  And yes, most of them end up being sent home.  If you're contractions aren't under 5 minutes apart and completely regular, if you are in no obvious distress and have not had your water break, don't come to the hospital.  The nurses and doctors don't mind, but you will be very, very bored and miserable waiting and watching and then being sent home.

So Triage got quiet really fast.  Everyone just waiting to be sent home to walk around, have sex, do whatever they want to get their labor going faster.  Then they'll probably be back tomorrow in active labor.  It's crazy.

Our instructor said if we were bored, we could go study in the  conference room.  A lot of things happened in the morning and early afternoon, so there were a few of us who were bored out of our minds by 2:30/3.  We went to the conference room and rested, talked, went to the cafeteria (yes, just because we were bored and hungry), came back, talked some more, and just waited for postconference.  We were all completely absent from our brains by that time, one of us had a broken arm, another hurt her back when a patient attacked her this week at her tech job (seriously!), a few were hungover, I was in extreme fibromyalgia pain and had a migraine coming on, and of course we all knew it was the last day on the floor.  We were slaphappy and exhausted, and our instructor looked like death (she has fibro too and was having a bad day), so we all agreed to leave a little early.

And now I am typing this as I babysit (which is insane seeing how much pain I am in from this day) and will momentarily take a nap until Mom and Dad come home.  I'm with my nanny girls, and L Bug's grandma watched her today and let her talk her out of taking a nap.  I literally had to drag L Bug into bed as she's screaming, "I'M (sob) NOT (sob) SLEEPY (sob sob)!!!!!"  She's barely 2 so it was kind of cute, but also distressing at the same time.  She's never that bad.  All I could think was, "I feel like sobbing and yelling I AM SLEEPY!!!!" 

This nursing thing - although amazing and fulfulling and perfect- is going to physically take every last bit of me.  3 more semesters + a summer externship.  It seems impossible, but I don't know what else to do.

Oh and as a side note, Jen (my best friend, remember?) took her boards yesterday and PASSED!  She's an RN!  She was going to reschedule her test but failed to do so within 24 hours so either had to take it without studying at all or waste the money and pay to take it again.  She told me she knew she'd fail, but she figured she'd already paid for it and it would be good practice, so she went.  And passed.  Without studying.  That is so my best friend.  She texted me this AM and said "I know you're in clinical but I need you to call me ASAP."  I snuck into a hallway behind a door and called her.  We were both almost crying.  It was such a great moment.  Then she called me tonight.  She techs at a hospital and landed a job on her floor, which she loves.  Apparently she talked to the nurse recruiter this afternoon, and she's having Jen start orientation on Monday.   Tomorrow is her last day teching forever.  She's an RN, and she starts making an insane amount of money Monday morning.  She will be working on her favorite unit, loving every minute of it, and making the living she's worked so hard for.  Snaps for Jen.  I'm so proud of my amazing, crazy soul sister.  24 hours ago, she thought she was taking a practice NCLEX and she'd definitely fail it, and right now, she is an RN and starts work on Monday on her dream unit.  Absolutely insane.  God is pretty awesome.  Oh, and she has a new boyfriend too.  First "real" boyfriend ever.  It's so sweet when life is so good. 

Today, her day, almost makes me forget how far away from nursing I feel after remember what I realize at the end of each clinical day  - my body cannot do this job for more than a couple hours.  My heart can, just not my body.  Everything starts aching and throbbing and crushing and burning.  My energy dips steeply at about noon, and then I drag.  I come home and load up on percocet, a muscle relaxer, a pain patch, sometimes a zofran... and I sleep for 2 solid days.  Then during the week, I forget how hard it was and look forward to the next clinical.  Then it nearly kills me, and it happens all over again.  I think it hurts my soul more than it hurts my body. 

One of these days, life will be okay.  One of these days...