Saturday, January 29, 2011

At the end of the first of 9- 60 hour work weeks...

I'm ABSOLUTELY exhausted! I don't know how other people do it! Lawyers put in ridiculous hours. MD's are known to pull crazy all-nighters (although with the ever changing laws, that's getting much better!)

I'm thoroughly planning to enjoy each and every minute of this sweet weekend off! Sure, there's homework to do, but there's also some serious sleeping in to be enjoyed!

The last 2 days of my week were exciting, draining, emotional, fun, and eye-opening. Such is the life of a PICU nurse!

I was able to take care of a little one with a brain tumor. More than once doctors have told her family she would not make it. And more than once she's defied all logic in medicine.

She's had 5 brain surgeries, multiple chemo and radiation treatments (mostly study drugs), and she's even been to a "healing retreat." But still, the tumor is taking over.

Her "wish" was to meet the "I-Carly" character (Miranda Cosgrove) in concert. Many months ago she was granted her wish, getting front row seats, back stage VIP passes, and even entry into the sound check before-hand.

But, unfortunately, she wouldn't be able to make it...she's stuck in the PICU...really sick : (

So what did her mom do?? Like any amazing mom, she wouldn't give up. She ended up contacting the producer and long-story short, Miranda, along with a back-up singer, a guitarist and her mom, came and gave a short, sweet, personal concert for my little patient.

It was amazing. We were able to break some rules and pack her room full of family and friends...all getting to watch her enjoy her (most likely) last wish! Smiles were all around, but the tears were also free-flowing.

I don't know how the oncology docs and APNs do it all the time. Cancer, brain tumors, in children is just not right. It's not fair.

But to be able to be a small part of it, to make the patient more comfortable, and provide even the slightest bit of comfort to the family as well, is so rewarding.

Sometimes the adventure is not all fun and excitement. Sometimes it involves gathering the family. Singing sweet songs to a patient who longs to sing along, but a raging tumor will not allow. Providing comfort, to both the patient and the family. Smiling when they smile, crying when they cry.

It takes so much to do this. So much time, energy, effort, and empathy. And yet, I'm given back to in a much larger way.

Truly this little one has touched the lives of many. This is evident in the amount of people gathering around her bedside. This is evident in the way a celebrity rushed to give her a personal concert to fulfill her wish. And it is evident in the way almost every network in the area picked up this story and shared it with people.

To see her story, and a piece of the concert Miranda gave, click here:

*If you look closely, you can see me in the background at one point- I'm the one wearing the chili pepper scrubs : )

Tuesday, January 25, 2011

The Training Wheels are Off!

So they took the training wheels off today. We went into clinicals, got our patient assignment and had to present them in rounds. No more "observing" more being a shadow. We ran the show (for our patient)...

Now I normally don't mind public speaking. I love giving inservices or classes at work. Eventually, I'd love to teach!

But presenting in rounds is a whole other ball game!!

I was the last person in our group that had to present...great, more time to freak out about it...I mean think about it and prepare : )

But it actually went ok! Sure, there were some minor details that I missed...but nobody even noticed or needed those pieces of information. It wasn't as bad as the first APN student had...she got cut off by the attending within the first 10 seconds because she had totally left out large pieces of the puzzle. And then the questions just came firing away!

And luckily, all 3 attendings (PICU, Cardiology, and CV Surgery) were all VERY nice...and understanding of the learning process!! That makes a huge difference!

So tomorrow the alarm will go off at 4 am (not a time I'd ever like to see again after these clinicals are over!!) and I'll do it all over again! And I know it's only going to get better and better as I go.

The training wheels are off. Now I just gotta keep working on staying upright!

Friday, January 21, 2011

First Week of Clinicals

So the big (anti-climactic) blog post on the FIRST WEEK OF CLINICALS!

Day one: purely observational

Day two: Cancelled (YEAHHHHHHHHH!!!!!!!!!!!!!)

I'd be lying if I said I was even the slightest bit disappointed that clinical day 2 was cancelled Wed. I told a friend if you want to feel like a total moron, walk into another hospital's PICU in a completely different role, and be expected to fit right in.

It took me right back to my first day ever in the PICU. It was exciting, horrifying, nerve-wracking and stressful all rolled into one. Eventually, the negative descriptives went away one by one until all that was left was the "exciting."

I wish I could fast forward to that now! But, I know that this is how it is for everyone. You gotta start somewhere right???

So I lucked out and didn't have to present my patients in rounds to the big scary docs staring at you...didn't have to manage a really sick kid who's only 2 months but already has had multiple heart surgeries (oh yeah, I failed to mention that I was assigned the sickest kid on the unit day one- my preceptor said, "You work in a PICU, you can handle it!"---- hello, she's SO wrong!!) Good thing the poor kid had multiple other health care providers looking over her that day!!

So on my day off, I curled up on the couch with some HGTV and Food Network and got a TON of homework done...and it was AWESOME!!!

The only thing I was worried about was having to make up the 12 hours sometime (WHEN??? I don't have time for that!) But, my preceptor e-mailed us all and told us since it was her fault and she was cancelling we'd get signed off on those 12 hours!

Hello- like the perfect snow day where it's not that cold and you can go sledding...and you don't have to make it up at the end of the school year!!!

So this weekend I work....hopefully the last time I'll be caring for my little man (so sad for happy for him!) I'm hoping he gets to go home this Tues! I'm going to enjoy my time in the PICU where I feel smart...I feel confident...where it feels like home! (nothing like doing AC PNP clinicals to make work seem amazing!)

But I will return to clinicals on Tuesday. And hopefully return to my blog with some great or funny things to share!

Sunday, January 16, 2011

Hello Blog, it's Me, PICU Nurse

Wow, I can't believe it's been almost 2 weeks since my last post!! It's crazy how fast time flies when you're...

Having fun?? NOPE...

Are working in the PICU while doing grad school...BTW with a grad school director who thinks nobody works, so she schedules papers and papers and papers like nobody's business!!

But it's all good...I have seriously never said "It's only 9 more weeks...I can do this for 9 more weeks!" as much as I have in the last few days! And after those 9 more weeks, I'll only have to say that in 11 week increments twice more!!

Last week finished up our last week of "Clinical Prep" classes, and this week starts the real deal! Last week we did stuff like practicing "Difficult Conversations" which came in handy the next day because I had a dad yelling at me at work (more on that in another post! : )

And then we moved on to practicing presenting our patient in rounds. Now I may give report to nurses every night before I go home. And I may be a part of rounds, listening, every morning for my patients in the PICU.

But PRESENTING your own patient in front of a group of medical students, doctors, nurse practitioners, and families is a whole new ball game! Just to spice it up, my professor would interrupt us at various points (just like an attending would...scratch that...will do!) and say things like "Where are you going with that??" or "What does that even mean!?"

Not because they don't know what it means, but just because they are testing us. So I'm sure I'm in for a crazy ride this week!!

But I'm glad to have the class part behind me and the practice part in front of me. While I'm sure there will be days I leave thinking there's no way I want to go back, it'll be worth it.

I'm going through this whole (excruciating : ) process for an end goal, and I will get there! Nobody said the adventure would always be fun. And nobody promised that it would be stress free.

So here's to entering into the next chapter of grad school. The new adventure of walking into the PICU, not as a nurse, but as a Nurse Practitioner. It may be the same "home," but when I walk into that unit, I will be walking in as a guest. This is definitely a new role for me. But I welcome the lessons that I will learn...and the crazy, adventurous ride that it will take me on.

Here's to the upcoming Adventures of an Advanced Practice Nurse! : )

Wednesday, January 5, 2011

This Little Piggy...

There may have been a piggy that went to the market...

There may have been a piggy that went home...

But the piggies today, cried "Wee Wee Wee" all the the lab table(unfortunately for them!) Actually, there was no crying involved. Their crying days were over...luckily for them, because...

I got to intubate, place a chest tube, perform a thoracotomy, do an arterial stick, a lumbar puncture, and suture the heck out of that little guy!

And it was AWESOME!!!

Don't get me wrong...pigs are my FAVORITE animal out there! I would own a cute little pink guy if they didn't poop, or pee, or squeal really loud! When I was younger I had about a bazillion stuffed animal pigs...and even now, my BFF gives me pig stuff for my birthday as a joke!! So, it was a bit hard to see them laying on the table all pale and sunken...

but once the procedures started...

it was AWESOME!!!

It's amazing to be able to do procedures that I assist with and watch all the time in the PICU. But it's equally amazing to me to realize today how very little I knew about these procedures. I know how to position the patient, what vital sign changes to watch for, the risks etc., but the actual procedure, I guess I just never watched that closely to truly understand step by step what goes on.

I must say, I did a rockin' job. I actually LOVE suturing. If there is a job that highly involves suturing, I'm there! I'm thinking that ER would be great for this... hmmm....

On the other hand, intubation (AKA putting in the breathing tube) was the hardest/most nerve wracking for me! Despite knowing that 1.) this is NOT a child, it's a pig, AND 2.) the pig is not even alive, it still made me nervous!! I needed to give this little piggie an airway!

It was a great, but very long day of procedures! Our group of 6 nurses grew close by the end of the day. And it's always fun (funny?) to see a group dynamic. In our group you had:

1.) The girl who was the know-it-all, until the last procedure which she just couldn't get...finally- she wasn't perfect!

2.) The girl that screamed, or jumped, with nearly EVERY procedure...good luck girl...I would NOT want her putting a chest tube in my kid!

3.) The girl who turns BEAT RED in the face with every procedure...she was good, but man does she flush!!

and 4.) The socially awkward girl who may or may not be a can't tell b/c you can't get passed her totally awkwardness around you, the professors, the pigs...everyone!

And then the other 2 of us were just somewhere in the middle. I'm sure one of the 4 girls above has a blog, and is probably writing something about me...but like I said, group dynamics are always fun/funny!

Tomorrow we talk about being summoned and how to handle being sued (agghh...what am I getting into!?!?). Not as exciting, but definitely some information I want to have a good heads up on.

One more day of this class extravaganza...and then it's back to working life in the PICU. Ahhh, there's no place like home : )

Monday, January 3, 2011

Exceptions to the Rules

We live in a time and place that lives by the motto "More is Better" or "Bigger is Better."

We live in a time and place that teaches values, such as sharing, to our children.

We live in a time and place that we say family should always stick matter what.

At first glance, it may seem that these are good things...great things even. But looks can be deceiving. I had a family yesterday that would beg to differ with the truth of the above statements.

You see, I admitted a 3 month old girl who had RSV...pretty bad RSV. She was having a hard time breathing, and it was looking like we were going to have to help her do that with a tube. The mom was having a really rough time watching her baby girl breath so hard.

But she was having a harder time trying to figure out how to divide her time and energy...her 2 year old son was in the room 2 doors down...also with RSV. He too was having a hard time breathing, and was crying for his mama!

So while "More" may be better, it is NOT better to have "more" than one kid sick at the same time!

It is not good to teach kids to share when it is germs that they are sharing back and forth!

It is not better to have families stick together so closely and always when it means that when one child gets admitted to the PICU, the other follows!

Maybe it should be said "More is better"...sometimes! Sharing toys is great...sharing germs is not! And families should stick together...except when it comes to hospital stays, jail, and death!

There is always the exception to the life, in families, even in the PICU!