A Look Back and Final Thoughts

Disclaimer: As I plan for this to be my last post, it might get rather long-winded. Apologies in advance.

Let's start off by talking about the farewell dinner. On the Wednesday night before I left, there was a banquet for all of the Summer III's and their clinical coaches. It was pretty fancy, and the food was delish. There were some speeches given by Summer III's and the vice president of nursing. After that, they read my story from my last post! I totally didn't realize that they would read it for the dinner, but I was glad I got to share a good experience. Afterwards, my clinical coaches, the other girl on my floor, her clinical coaches, and another nurse met up for a little goodbye party. It's kind of strange to see nurses without their scrubs on. Here's a picture from that night.



Looking back, what did I learn this summer?

1.I learned confidence. So much of learning how to be a nurse is just being a nurse. This summer was a fantastic opportunity to experience real nursing. I feel so much more confident talking to patients, performing assessments, talking to doctors, and thinking through situations.

2.I learned how to prioritize and multitask. A big part of nursing is learning how to handle your day. You have multiple patients who might need things at the same time. I learned how to become more efficient and to get things done in an order that makes sense.

3. I learned about medications. This is by far my biggest weakness, but I have already gotten so much better at recognizing medications.

4. I learned about the heart. I think that I might have just a little too much enthusiasm about EKGs and the workings of the heart. So cool!

5. I learned about teamwork. It was fantastic to see a good model of the healthcare team. The doctors, PAs, NPs, nurses, therapists, social workers, and many others all have a role to play. I learned a lot about how that works and how to be a part of a team.

6. I learned a lot about my patients. I invested a lot of time into those people, and I grew to love them. I still think about them frequently. I know that there will be many days where I think, "I wonder where so-and-so is right now and how they're doing?"

7. I learned a lot of random things. There are things that I saw at Mayo that I highly doubt I'll see anywhere else. There's a reason people go there as a last resort. They know what they're doing.

8. I learned a lot about myself. I know that I love nursing. I love being at the bedside (I do not want to go into surgery). I am pretty good at educating patients. I don't like night shifts very much. Apparently, I like blogging.

Final thoughts. I laughed and I cried. I prayed with patients and I cleaned up poop. I removed IVs and I educated patients. I went to church and I rode the bus to work. I was complimented and I was criticized. I woke up at 5:30am and I stayed up til 8:00am. I had a 15 year old patient and I had a 93 year old patient. I cooked for myself and I fixed the dishwasher. I went from following my nurse around to taking the lead. I had days where I hardly sat down and I had days where I didn't have anything to do. I saw families full of hope and I saw families without any hope at all. I held hands with patients and I held pressure on their bleeding site. I felt powerless and I felt empowered.

I'd say that the themes of the summer were brokenness and healing. Some of the people I saw were broken and that made me feel broken too. Last week, I had a patient whose procedure failed. They weren't able to fix her problem and she was crying all afternoon. I had a few patients who had congenital issues that will never be cured. There was a lady who had two conflicting health problems that each prevented the other from being treated. I saw patients who preferred to be in the hospital because they received more love there than they did at home. I saw patients go home to get ready to die.

However, I also saw a lot of healing. I saw a woman that was nearly comatose who couldn't talk or move on her own. After a few days of treatment, she was able to sit up, eat her dinner, and talk to her family. I saw patients who had been living a low quality life who came in and left feeling so much better. I saw families coming together to support each other. While there were some things that made me feel broken, the healing overcame. I feel like I did make a difference. Don't tell anyone, but I would have worked the whole summer for free. The experience was invaluable.

Here are some nursing quotes that accurately portray how I feel about nursing. I had wanted to slip these into some previous posts, but I forgot.

"Our jobs as nurses is to cushion the sorrow and to celebrate the joy every day while we are just 'doing our jobs.' "    -Christine Belle

"You treat a disease, you win, you lose. You treat a person, I guarantee you that you'll win no matter what." 
- Patch Adams

"They may forget your name, but they'll never forget how you made them feel." -Maya Angelou

"When you are a nurse, you know that every day you will touch a life or a life will touch yours." -Anonymous

So....What next? Oh, I just love that question. I'm not sure. This year, I'm going back to school and will continue to learn as much as I can. After that, I don't have any answers. I guess we'll just have to wait and see where God leads me and what opportunities are presented. It's gonna be pretty great. :)

Thank you all for reading. Thanks for letting me be weird, nerdy, and emotional. Maybe I'll start blogging again once I get a job. Who knows?
Love you all.
Peace out.

P.S. There are just some things that shouldn't go onto the public internet. However, there is a story that still makes me laugh every time I think about it. Next time you see me in person, ask me tell you. I'll know what you're talking about.

On the Last Page

Here I sit in a nearly empty and clean room. The bags are packed and only 23 hours stand between me heading out of Rochester. I'll have an ending post or two with some final thoughts, but right now I'm feeling sentimental so I'd like to make a few shout outs and thank you's.

Thank you the people who organized the program! It was excellently planned and executed. They made the transition to Rochester very easy.

Thanks to Crossroads College who let us stay in their townhomes. This made the experience so much easier without having to worry about finding an apartment.

Thank you to my nurse manager and nursing education specialist who allowed me to work on their floor and were supportive, encouraging, and helpful.

Shout out to my roommates! It still amazes me how 7 girls who are completely different and have never met each other can live together with very little conflict for 10 weeks. I'm excited to see where your nursing careers take you!

Shout out to Fr4C! It has been a privilege to work on such an amazing floor where everyone is so helpful and fun. I'm afraid that I'll be disappointed with other floors I work on because Fr4C is an amazing place to work.

To the other Summer III's! Thank you for all of the conversations, trading patient stories, and fun times. There are going to be some great nurses coming out of this bunch. Good luck senior year!

Thank you to the Recharge group from Autumn Ridge Church! You guys were so welcoming from the very beginning. I loved getting to know you and having some great discussions. I've had a really hard time finding a small group at school, so becoming connected so easily this summer was a blessing. I'll miss you!

To those who have kept reading this silly blog. Thanks for all of the encouraging words. It was a lot of fun :)

Finally, thank you to my clinical coaches, Frosty and McFlurry. You both made my summer an unforgettable experience. I loved learning from you. Thanks for answering all of my silly questions and letting me fumble my way through. I've gained so much confidence by working with you. I'll miss you!

One Story

All of the Summer III's were given the opportunity to write about an experience they had this summer. To be honest, I don't know where it's actually going, but I wanted to contribute. This is what I wrote.

   It was a quiet morning on Fr4C. My clinical coach and I had been very productive all morning. We were all caught up on orders, assessments, charting, and medications. We had just sat down to look up some notes on our patients and my coach had brought along an EKG book for me to browse because I had some questions about bundle branch blocks.

     As we were sitting at the nurse’s station, we noticed that the O2 levels on one of our patients had dropped a bit. My coach went into the room to make sure the monitor was on correctly. After a minute, I went in to make sure everything was ok. The patient’s oxygen levels were still dropping, and he wasn’t responding to us. We put oxygen on, got a blood pressure, tried to wake him up, and kept watching the monitor. As we were watching, his heart rate and O2 levels kept dropping rapidly. We called the doctors and then the Rapid Response Team. Nurses from our floor had noticed and had come in to help us out. Within one minute of calling the RRT, we had to call a Code because there was no pulse.

   What happened next will stick in my mind forever. Almost instantly, there were 20 people in the room. They each took a job and performed it expertly. Within seconds, they had started CPR, attached the AED, were administering breaths, had begun to intubate the patient, and were giving medications. Everyone was calm and collected. They were working as a single unit, as a team, to try and save this patient.

    During this time, I was able to sit with the wife of the patient. She was holding a pamphlet in her hands with some Bible verses on it. I asked her if she would like me to pray with her. She said yes, and as twenty people were attempting to save her husband’s life, I was able to pray with her. I then escorted her out to the waiting room where a chaplain met with her.   

     Going back to the room, I was able to watch the amazing teamwork and precision that the healthcare team had. In the end, they were able to reestablish the patient’s pulse. I was the one who was able to go tell the wife that her husband was still alive and was moving to the ICU. I don’t know a lot of what happened to him after that day, but the memory of that experience will be burned into my memory.

     It was the single most terrifying moment of my life, and yet it was one of the most powerful. The nurses from my floor who ran into the room saved a patient’s life that day. I was able to be with a family member during a very terrifying and vulnerable moment.  The respect and admiration that I had for the nursing profession grew exponentially after that day. I had a glimpse of what nursing really is- a collaboration of people with expert training who truly care about patients working together to improve lives. 

If I was limited to sharing one story that summarized my summer, this would be it. 

One More Week

I was going to try to be clever by entitling this post 'One Week More' and then making up my own lyrics to the song from Les Mis. But I'm lazy. Sorry people.

Instead, we'll arrange today's points by having a countdown.

7. One week left in Rochester. It's hard to believe the summer is nearly over. I have to start thinking about school things again. Bleh.

6.  As a person gets older, their heart starts to create additional small arteries in the heart called collateral arteries. These supply extra blood to the heart when the main ones are blocked or narrow. Collateral arteries in and of themselves are amazing! This explains why people are more likely to have greater damage if they have a heart attack when they're young. You haven't built those collateral arteries yet, so if the artery is blocked, there's no other way around it. Anyway, cool thing I learned on Friday. There's this really random procedure that is done for patients with chronic angina (chest pain) that can't be cured by the normal treatments of angiograms, ballooning, and stenting. These people usually would need a heart transplant. Either the vessels are too far down in the heart, or they are too diseased. They are extremely limited with activity because their hearts are sick. This treatment helps build collateral arteries in the heart. Here's a video because it's nearly impossible to explain.
http://youtu.be/vjU29pxyTlM 
It basically promotes the formation of collateral arteries in the heart. It looks like gigantic blood pressure cuffs that inflate and deflate really quickly. You get it done for one hour, five days a week, for seven weeks.  I saw a guy who had been going to this process for about four weeks. When he started, he was wheeled in with a wheelchair and got short of breath getting onto the table. Now, he can walk in without hardly any issues. It's so cool! Right now, they're doing research on it to see if it could possibly help with peripheral vascular disease. It's not widely used though- the lady who taught me about it told me that a lot of doctors either don't know that it exists or they think it's not reliable. I thought it was fascinating.

5. Some of the nurses on my floor brought in cake, pop, chips, and subs for me and the other girl on my floor. It was the last day that the two of us were working at the same time, but it was really sweet of them. I felt very special.

4. I worked 5 days in a row this week and had two of the same patients for four of those days and one of them for five. This meant that I got to know these patients very well. Getting report in the morning lasted about 20 seconds. I've never had a patient more than three days, so this was really cool to see how they progressed through the week. It also makes taking care of them much easier. You don't have nearly as much stuff to figure out.

3. Some of my roommates went skydiving yesterday. I'm jealous. Someday.

2. It's four o'clock on a Saturday afternoon. I haven't done anything productive and it feels amazing.

1. Maybe it's a good thing that there's only a week left cause I've run out of interesting things to say. See you soon!

Goat roping

I've told you about a lot of things this summer. However, I've somehow always forgotten to mention these subjects.

Let me tell you about some of the people who work on Fr4C.

Our main housekeeper is an amazingly sweet woman. She bakes a cake for every single person on the floor for their birthday.

There are about 6 or 7 guys who work on our floor full time. They.....add personality. There's a small conference room on the floor with a TV that the guys claimed as the Boy's Room. They eat their lunch in there even though everyone else sits in the actual break room. It smells bad.
For whatever reason, if there are 3 or 4 guys working at the same time, they will often all be down the same hallway. Even if they aren't assigned to that hallway, they'll try to do most of their charting and 'hanging out' down with the rest of the guys. Sometimes a girl will be stuck down that hallway with them and will come seeking refuge with the other females whenever possible.
The guys like to speak in German. They don't know German. They don't care that they don't know German. They have a few favorite words that is their go-to response to everything. I don't get it.
There is one murse in particular who enjoys causing trouble. He once stuck a dry erase marker to the bottom of the housekeeping cart. The poor woman wheeled it down the hall, leaving a long black streak behind her. He will unscrew the top to your water bottle so the next time you take a drink, you get a nice surprise. He will put signs on the patient's doors that don't apply to them. He'll hide your chair in some random room. He turns off the lights to the nurse's station every time he walks by. He throws dirty gloves at you. When I came this summer, the Summer III's filled out a sheet that had the basic questions like 'where do you live?' 'do you have pets?' 'what do you like to do?'. This guy wrote under my interests that I loved goat roping.
I thought I graduated from middle school?

On my first day on the floor, I was told that our secretaries were the ones on our floor who worked the hardest. There are days when I believe it. They are wonderful. They know the floor inside and out. There have been a few days where we have a sub and you can tell.

I've been so spoiled on my floor. The nurses are fantastic. I'm not exaggerating when I say that I got one of the best floors in the hospital. If someone sees something that needs to be done, they do it. You might ask yourself, "Shouldn't all nurses do this?" Yes, they should, but they don't. Call lights are answered by anyone, there are usually 3-4 nurses in a room when a patient gets transferred back from procedure and needs extra help, they are willing to answer questions, and they work together really well. I'm going to miss them.

Tell me a story

"Words are how we think, stories are how we link" -Christina Baldwin

    Once upon a time, in St. Mary's hospital, there was a grouchy old man. He came in for chest pain, just like many other patients. He was told that he had badly clogged arteries in his heart. They would do a catheter procedure and try to place some stents to open up the arteries. He insisted that they not perform surgery. However, after the procedure, he was told that his arteries were even worse than they thought. Placing stents wouldn't do him any good. He was told that if he didn't get surgery soon, he wouldn't live much longer. Begrudgingly, he agreed to prepare for open heart surgery for a triple bypass the next day. Unfortunately, he took out his frustrations on the nurses taking care of him. He wasn't an easy patient either. He required blood sugars to be taken each hour, needed help going to the bathroom about every half hour, and with his chest pain, he needed frequent medications and assessments done. He wasn't very pleasant and he never said thank you. After taking care of the patient for a full two days, the nurse and her nursing student were pretty willing to hand him over to the next nurse and have a good weekend off. At shift change, the nursing student went in to say goodbye and good luck. The patient asked to go to the bathroom again, asked for some cold water, but then said something else. After 16 hours of being in this man's room at least every half hour, he said, "Thank you for being patient with me."

     Once upon another time, there was a woman whose husband was in the hospital with a massive heart attack. He was doing much better, but she was extremely concerned about the lifestyle changes she was going to have to make. She had very little knowledge about what would be a good diet for the heart. We taught her about maintaining a low-fat, low-cholesterol, low-sodium diet. We handed her about 5 different pamphlets about diet suggestions and went over the basics. Throughout the course of the day, she would walk out of the room to the nurse's station and ask us some questions. She wanted to know if it was ok to use frozen food, if she could still make bread, if she would let him have cake, if she could make his favorite steaks, what kind of vegetables she needed to buy, how to read food labels, what to use instead of eggs, how to cook with different seasonings, etc. At one point, she burst into tears because she felt so overwhelmed. She told us that she felt that the heart attack was her fault. She admitted that she didn't know what she was doing and that she still wasn't prepared. We set her up to meet with a dietitian at the hospital and recommended one for her at the local grocery store. As she wheeled her husband out of the door, she looked at us with a smile and said, "I'm still uneasy, but I think I can do it!"

    There once was a woman who had been to the hospital frequently over the years for various heart issues caused by rheumatic fever. If she got you in the room, you would probably end up staying there a lot longer than you meant to. She could talk about anything. She and her husband had obviously been there too much because they had the whole hospital visit thing down to a science. They knew exactly what food to order, which soaps worked best, how to make the bed so that we didn't mess it up when assessing her feet.. Some of her lab results weren't what the doctors wanted them to be so she had to stay an extra few days. Her response was, "I'd rather be safe than sorry". She was completely independent, so she kept herself busy walking up and down the halls, reading the newspaper, and talking to other patients.

     There once was a girl who went to the hospital and fell in love. Not with any of the residents or murses (male nurses), but with the experience that she got. There was the nerdy side of her that loved reading EKG books, going over NCLEX questions, and reading about cool procedures. There was a part of her that loved being familiar with her unit- knowing what to do and gaining the experience of grown-up nursing. There was another part that loved the coworkers that she was with- these people took an interest in her, accepted her, and helped her grow. Finally, a large part of her fell in love with her beautiful patients. They made a difference to her, and she will keep some of them in her heart. Always.

    There are still two weeks left of the program. I am working 9 more shifts. It has gone way too quickly. I'll have more stories by the end of it. But then there's one more year of school and the rest of my life. While there might be a 'happily ever after', there isn't going to be an 'the end' to these stories for a very long time. Thank goodness. I always hate it when good stories end too soon.

Nerd rant followed by a slew of emotions

The next few paragraphs are going to be filled with boring schoolish type things. If you are still on summer break and don't want to think until the end of August, I suggest you skip down the end of the post.

EKGs
These are beautiful, beautiful things. I am amazed how the slightest bump can mean something very significant. I have an enormous appreciation for modern technology and whoever spent the time figuring out what exactly every single little wave meant.  If you are unfamiliar with EKGs. Here is a normal one.

That my friends, is a beautiful EKG. Now, here's one of someone having a bad heart attack.

Here's an extremely dangerous rhythm called v-tach. Or ventricular tachycardia.

Here's one with a pacemaker.

These are some of the basics. Every single wave on an EKG can mean something. For example, if the QRS in leads I and aVF are both positive, there's no axis deviation. But if aVF is negative, there is left axis deviation. Another cool one is that if the R wave in V1 and either V5 or V6 are greater than 35mm, there is  left ventricular hypertrophy. The cool thing is, I can understand a lot of this! I am so far from being able to read one on my own, but I've definitely come a long way. If you ever want to have an in-depth conversation about EKGs or the heart's electrical conduction, hit me up. :)

Cool Procedures
-Frozen Elephant Trunk- no joke. This is an actual procedure. And it's almost what it sounds like! They 'freeze' you and then put in a prosthesis that looks like an elephant trunk. Cool huh!? It's used to treat aortic aneurysms (ballooning of the vessels in the aorta).
-Radio frequency ablations. I can't remember if I've talked about these before or not. This is a very common procedure on our floor. Basically, there are parts of the heart that are being overactive. They are firing electrical signals at the wrong times. In this procedure, they go in and actually burn the tissue in the heart that is misfiring. I don't know how they actually know which tissue is misbehaving, but it's pretty amazing what they can do.
-Cochlear implants. This isn't heart related, but I had a patient who had gone completely deaf due to medications (nurses! make sure you give meds correctly!). He received a cochlear device that he would put on his ear in order to hear. It's not a hearing aid- it doesn't just amplify sound. It was like a little star trekky machine that went on the ear that enabled him to hear. It was super cool.
-Putting in Pacemakers. Again, I might have mentioned this before, but man technology is cool. We can put in a little machine as big as a flip phone that can detect the heart's activity, monitor it, and do it's job for it if necessary. A lot of the time, the pacemakers don't have to 'pace' unless the heart fails to send the correct signals. However, for some people, their pacemaker supplies all of the electrical activity. It's amazing.
-CABG. In this procedure, they replace and refigure some of the coronary arteries so that they get good blood flow.
They're basically reconfiguring the way that blood gets to the heart. Once again, amazing technology. This isn't even considered rare anymore. How cool!

NCLEX
This has nothing to do with Mayo Clinic, but my clinical coach lent me a review book for the NCLEX (the test nurses take to be certified). This is a little insight to what nurses go through after school. This test is like none other. As you do better, the questions get harder. Therefore, if you feel like you don't know any of the questions and you feel like you're failing, you're probably doing well. There are many select all that apply questions. It's not based on knowledge. It's application of the knowledge that they're assuming you already have. In short, the test is rude. It is the perfect way to drive perfectionists absolutely crazy.

Ok, enough with the boring stuff. I know the reason I read blogs is because I want the nitty gritty details of people's lives. Well here you go.

-I worked this weekend. It was good! I definitely prefer days. Here's the thing about weekends though. On my floor, most of our patients come in for procedures that are scheduled. They stay for a night or two and then go home. What this translates to is that the people who are left on our floor during the weekends are usually the ones that are really sick and can't go home. Some of my patients this weekend were really sick people. Here are some excerpts of experiences that I've had over the past week.

-We had a patient who had extremely severe pulmonary hypertension. It was so bad that she actually had a negative reaction to the medications usually used to treat it. Pulmonary hypertension is a terrible disease and the prognosis is not good. This poor woman was going through so much. She had a reaction to some medications and had a terrible rash all over her body. She was in so much pain. Also, her husband was there and I think that he was in more pain than she was. It was heart wrenching to watch them. I don't think that there was anything the doctors could really do either.

-I had a patient who had extreme COPD (a respiratory disorder). She wasn't that old, but she literally could not walk to the door of her room without becoming extremely short of breath. She was proud of herself when she made it to the bathroom. Can you imagine living for years with a disease that doesn't let you do anything? When sitting up knocks you out of breath?

-There was a man who had a medical history a page long. He was complicated. His wife was there, and I honestly think that she probably knew more about nursing than I do. She had been taking care of him so extensively, she knew exactly what she was talking about. Her dedication was beautiful to see.

-One man came in for chest pain. He had short term memory loss and was from New York with a very brusque attitude. We had some hilarious conversations.

-There was a lady that was pretty young. She had many heart problems, so she had been functioning for years with very little oxygen. When I say very little oxygen, I'm saying that you or I would have been passed out on the floor, but she went to work every day with blue lips. After her procedure, she had a number of complications, but she felt so much better than she had before. It was amazing because the other nurses and I were really sympathetic towards her cause she was going through a lot. However, to her, it was actually better. She was a tough cookie.

-I had a patient who had a severe heart attack. He blamed his wife. He said that the cake that she had made him had too much fat in it and that had given him a heart attack. She was in tears. We reassured her again and again that it wasn't her fault. It takes more than a cake to cause a heart attack. We spent more time talking to her than the actual patient.

-There was a patient who I had taken care of earlier this summer. I walked into his room this week and he was crying because the nursing home where his wife was wouldn't take him. He would be living separately from his wife for the first time in 62 years. I didn't know what to do but sit there and hold his hand.

-Overall, this week was really good. I got to see a lot of things that went beyond the cardiac side of things. I saw situations that looked pretty hopeless, but also situations that were full of hope. 

Because of the Lord's faithful love we do not perish, for His mercies never end. They are new every morning; great is Your faithfulness! I say: The Lord is my portion, therefore I will put my hope in Him. Lamentations 3:22-24

Just Another Day

I was really tempted to start this post with some classic Rebecca Black.
 "Seven A.M. wakin up in the mornin, gotta get dressed, gotta go downstairs. Gotta have my bowl, gotta have cereal, seein everything the time is ticking on and on, everybody's rushing, gotta make it to my bus stop."
I guess I just did. But it was too good of an opportunity to pass up.

So anyways.... the true purpose of this post is to give you a little glimpse into my everyday life. Gone are the days when nurses were merely women with cute aprons tending broken limbs. No more do they only bathe a dying soul's forehead with a cool washcloth. We can only remember the times when nurses would put leeches on a limb to suck out the bad blood.

Ok...so what do nurses actually do? They can't order medications...they can't perform surgery...they can't decide hardly anything! What do they do?

Well.

5:30AM - alarm goes off
5:31AM- Caroline groans and reluctantly rolls out of bed.
6:00AM-pack lunch and eat breakfast
6:28AM- bus comes
6:40AM-arrive at hospital
6:42AM-get assignments and look up patient information
6:58AM-get the now essential coffee
7:00ish-get report and meet patients
7:15-9:00- Classify patients, check orders, look at heart rhythms, get vitals, do assessments, chart assessments, give meds. I like all of this to be done by 9:00 on an ideal day. It hardly ever happens like this because you end up talking to patients, getting them something they need, blah blah blah.
9:00-11ish- Most doctors round during this time. We always try to be there when they do so that we can get a clear picture of what's going on. Finish up morning tasks, get patients in shower or bed bath, often patients start the process of getting discharged at this time, catch up on charting, etc.
11-1ish- take another nurses patients for one of these hours and go to lunch for the other hour. This is when the morning rush is over and things potentially calm down.
1-3ish- a lot of patients are done with procedures around this time, so they come back and you have to do checks on them every 15 minutes or so. Sometimes on our floor, we pull sheaths from where they have catheters placed which takes a while. A lot of education happens if the patient is being discharged (education is one of my favorite parts). We get 2:00 vitals. We update the plans for the next nurse so that they have the basics for the next shift.
3:00-3:14- give report
3:15- catch the bus.

If you work the evening, it works nearly opposite. You have most people coming back from procedures early in your day. This requires a lot of vital signs and site checks. As the night goes on, a lot of the doctors leave, but sometimes the patients can actually be more complicated. I personally like the mornings better because you do everything that is assigned right off the bat. Then you can spend the rest of your day doing things like education and discharges and site cares.

PRN (as needed in nursing terms. Don't ask me why this is an abbreviation for 'as needed')
-If a patient changes in nearly anything, we call the doctors, get orders, and take care of it.
-We often get admissions that can come at any time during the day. That process takes a while because it requires a full assessment and asking a lot of questions.
-Patients have call lights going on all day. It could be because they want you to take their meal tray away or it could be because they are in serious pain.
-Patient head off to tests and stuff, so you have to make sure their monitors are off and they're all set to go.
-Patients take walks and if they are unstable, you have to go with them.
-Help people on bedpans or emptying urinals.
-Place orders for new IVs
-Talk to patients- this takes up a lot of time, but it is very valuable time. Patients can be very anxious or depressed, so talking to them is very important.
-Sometimes there's a situation that requires special care- like the time where I stayed in a patients room for hours because he was determined that he had to leave and go get his mail when he was hooked up to 8L of oxygen.
-Look up meds or procedures to make sure that the nurses know what's going on.
-So much more. Sometimes I don't even know how I spent my day.

Here's what I do know. I love it.
I can't emphasize enough how fulfilling this is for me. I love going to work. I love learning. I love figuring things out and being able to help change what's wrong. I love the nurses that I work with. I love my patients. I love educating. I love getting to see patients go home. I love hearing their stories. I love interacting with the families. I love getting to love on complete strangers. I love it all. I come home fulfilled and happy. I smile as I walk down the hallway. I want to learn more all the time. This is it. I've found my calling.

In No Particular Order

1. Thank you to everyone who has sent me some snail mail this summer! It makes my day every time!

2. There is a procedure entitled the Frozen Elephant Trunk. Hehehe.

3.  I attended a class on Tuesday that talked about how to apply for jobs at Mayo or other hospitals. They were talking about benefits. I'm moving to Neverland tomorrow.

4. When you spend your free time reading a 400 page book about EKG rhythms, you should probably go into nursing.

5. Living on the third floor of a home that has air conditioning on the first floor during a heat wave can make one's room a little toasty.

6. One of my favorite treats is to freeze a banana and then mix it with just a little bit of peanut butter and nutella. I named it Banella. Try it. It is more delicious than some types of ice cream- and it's healthier if you care about that sort of thing.

7. I'm working 12 hr days this weekend, so if I am MIA on the blog- I apologize.

8. It's almost the end of week 7 already. Time flies!

9. I don't have anything to say, but I want to make it an even ten.

10. I love you all! Thanks for reading my silly blog!

Scale of 1-10

One of my most common questions on my unit is "On a scale of one to ten, ten being the worst pain you've ever been in, how would you rate your pain?" - In those exact words. It's like my tongue has a memory. I could recite this phrase even if I had stage 6 Alzheimers.

Therefore, in the spirit of having this phrase ingrained into my being, I'm going to ask some similar questions.

Caroline, on a scale of 1-10, ten being the worst pain you've ever been in, how would you rate your pain?
-Well, considering that I played soccer again yesterday and the fact that I picked a scab on my knee, I'd say about a 2. Mostly in my calves. No medication please though...

On a scale of 1-10, ten being the best food you've ever tasted, how would you rate the food that you usually prepare for yourself?
-I'd say about a 5 usually- not because it tastes so good, but because I eat whatever my stomach asks for.

On a scale of 1-10, ten being absolutely ridiculous, where would you rate the TV show 'The Bachelorette' that you watch on Monday evenings with your roommates 'for girl bonding time'?
-10. I am ashamed.

On a scale of 1-10, ten being the point where you'd call even your very straight hair curly, how humid is it in Rochester this summer?
-Probably an 8. There are days when I feel like a geyser.

On a scale of 1-10, with ten being passed out on the floor, how grossed out are you by really disgusting smells and sights in the hospital?
- I don't mind the gross sights at all, I'd rate that at a 2. However, I have to say that I'm very thankful for my poor sense of smell. It serves you well in the hospital. Nevertheless, I can be pretty grossed out by certain smells. This is a PG rated blog, so I won't delve into that, but I'd say a 5.

On a scale of 1-10, with ten being the job of your dreams, how great is the atmosphere on Fr4C?
-9 and 3/4. I got so amazingly lucky with my placement. It has been fantastic. The nurses and doctors have all been extremely patient with me. I'm in a really good place to learn both basic things about nursing, but I also have the cardiac side which is fantastic. Mayo Clinic takes care of its nurses. I am very fortunate.

On a scale of 1-10, with ten being equal to Superman, how much of a hero were you tonight?
-Not quite Superman, but it was a cool story! Tonight I rode with 3 other students from my program. While we were waiting for the fourth one to arrive, someone walked up to us and asked us the way out. We told them, but then realized that they were wearing no shoes and had a patient bracelet on. The alarms in our heads started going off, so we started to walk after them. We found a nurse and asked her what we should do, but she wasn't much of a help. We decided to call security and just let them know what we saw. It ended up that it was a patient who had left the hospital without permission and we had saved the day! They were able to find the patient and bring them back. Well done Summer IIIs, well done.

On a scale of 1-10, with ten being completely, perfectly, and incandescently happy, (catch that reference?) how happy are you?
-After tonight's shift, I'd have to say I'm pretty close to a perfect 10. I am in the right place. I LOVE nursing. I'm going to go ahead and toot my own horn a little bit. I took care of a patient on Thursday and Friday last week. This evening, she wasn't my patient anymore, but I went in to visit her anyway. She saw me, got this big smile on her face, and said "I'm so glad you came to see me! I missed you!" When I was leaving, I went in to say goodbye (she's being discharged tomorrow), and she got up to give me a big hug goodbye. She told me that I was going to be an amazing nurse (little does she know of my incompetence with pharmacology). I also visited another previous patient of mine who was leaving. The reaction wasn't quite as big, but he took my hand, looked me in the eye, and said 'Thank you'. I overheard another one of my patients telling his wife that his nurses were 'pretty great'. I've got to say, this put me in a pretty good mood. :)

It's all worth it. All of the poop, the smells, the grouchy patients, the heavy lifting, the boring charting, the frustrating doctors, the crazy families.... it's all worth it. I'm so blessed.

All that lives

"All that lives must die" -Shakespeare in 'Hamlet'

I've had a few different patients this last week or so that are very old and are probably living the last few days or weeks of their life.

I have some thoughts:

1. Everybody dies. Unless Jesus comes back and rescues us all within my lifetime, I'm going to see a lot of people die. The two patients that I've seen this week have lived a long life. When they were told that they didn't have a lot of time left, they both said something like, "I know everybody dies, so I think I'm ok with that." They knew that everybody dies. It's part of living.

2. As a nurse, it's a little bit tricky to watch an old person die. Our goal is normally to promote quality of life, but most of the time we want to 'heal' people. In these cases though, there's no healing to be done. Both of my patients this week have DNR and DNI orders. This means that if the alarms go off because our patient's heart stops beating, we can't do anything to save them. I totally understand this because it could cause them prolonged suffering. However, I can't imagine being the nurse who has to stand there and watch them fade away. I'm sure this will happen to me at some point, but I'm hoping that I can hold out for a while.

3. My heart hurts for the families. They know that their loved one is old. That doesn't make it any easier for the family. I've had the opportunity to support some family members for a while, but it's so hard. There aren't words.

4. I'm a Christian. A lot of my patients probably aren't Christians. I pray for each of them on my own, but I don't know what to do other than that. I honestly don't know what's appropriate. It makes my stomach hurt.

5. I hope I never get 'accustomed' to death.

6. I think that it's appropriate to write a blog post all about death. It's something that we need to struggle with and think about. It's a hard part of life, but it's definitely a part of life. Also, thinking about death makes me want to live more fully while I can. Finally, death can give me joy because I know that death doesn't have to be the end.

My people

I struggled a lot with the title of this post.

Who are these people that I'm with every day? I take care of them- sometimes for a few hours and sometimes for multiple days. But that's not all that happens. I don't want to call them 'patients' or 'clients' because that's not all they are. They're not my 'kids' or 'buddies'. They're not 'the sick' or 'the invalids'. They're not quite my 'friends' either, but they're definitely not just an 'acquaintance'. 'Humans' or 'Homo sapiens' are way too technical. And I officially declare that I'm still too young to call them 'blessings' or 'gifts'. What are they? They're my people.

My people are pretty stinkin awesome.

-One was 89 years old and had been married to her husband for 69 years- 70 this summer. They were both still totally with it and were one of the cutest couples I've ever seen.

-One had just been diagnosed with cancer, but refused to let that affect her. She had an amazing, positive attitude. I wanted to be in the room with her because she made me happy.

-One of my peoples cried when they got their IV inserted and when I took off a piece of tape from their arm. They were a nervous wreck, but I brought them some lemon ice and they were ok.

-My poor person had a bad experience where one of the doctors was going to do a procedure, but decided not to. This meant that he had to go an extra 2 days without eating so that he could prep for the procedure. However, he was still very sweet to the nursing staff. He knew it wasn't our fault and refused to take out his frustration on us.

-Another person gave up smoking, alcohol, and motorcycle because of the birth of his daughter. He wanted to be around for her as long as he could and did everything possible to make that happen.

-One of my most memorable patients could be coaxed out of a bad mood with hot chocolate and grilled cheese.

-My guy who was 93 had 13 great grandchildren so far. They were told they had to stay at home because there would be too many people in the hospital room. I think that is one of the best 'problems' in the world.

-I've found that the response to drug regimen is split about half and half. Half of them hang on to every word that I say. They want me to write things down and repeat everything at least twice. The other half couldn't care less about the potential side effects a med could have on them. They'd take 10 pills in a sitting and wouldn't be able to name more than 2 of them.

-My people aren't just the patients. They're the families too. Sometimes, I look out for my people by trying to keep the family from being too hovering or annoying. They stress the patient out! Give em a break!

-Other times, the families are more effective than the entire team of doctors and nurses. I've learned how important it is to listen to the family because they truly know the patient. They know what's normal.

All this being said- it boils down to this. Almost nothing is universal when it comes to patients. However, no matter what age, what background, or diagnosis, every patient has two things in common.
1. They are made by God.
2. They want to know when they're allowed to eat.

Halfway There

Welp, this weekend marks the end of week 5 of my summer at Mayo. Time doesn't just fly, it travels at Mach 5- maybe even maximum warp.

When I was home this week, I was asked a bunch of questions and many of them were similar. Here's some of my answers to the FAQs :)

What's the highlight so far? 
Praying with a patient's wife while the patient was coding. In the single most scary moment of my life, God was there. Although it was terrifying, it was definitely the most powerful.

What's the hardest thing? 
Night shifts. Hands down. There's a wall that you run into headfirst around 3am. It's not a soft wall either. It's made of brick.

Are you  happy with your floor? 
Most definitely. I think that I got really lucky with my placement. My floor has a wide variety of patients and nurses play a key part in their care. I've learned how to think like a nurse. (Obviously there's still a long ways to go) The people on my floor are really considerate towards me. If something exciting is going on, they'll invite me in to watch. I have great clinical coaches. Also, cardiology is extremely important. If something is wrong with the heart, it can affect the rest of the body. There is so much to learn.

Have you learned a lot?
Yes.

Is it hard being away from you family?
Yes. I miss them, but I'm not homesick. I think that's a good place to be.

What do you do with your free time? 
I blog. I do Spanish lessons. I read. I sleep. I eat. I bike places.

Would you go back to Mayo after this summer?
Tricky question. I'm loving it here. I love Mayo and I love my church. Roughly 80% of Summer III students get hired back. It's tempting. But I know there are great hospitals in Chicago too- this would let me be a lot closer to home. We'll have to pray, wait, and see.

Would you go into cardiology after this summer? What's next? Nurse practitioner? 
I'd definitely be open to the possibility of going to a cardiology floor. I've learned a lot and I truly enjoy it. There's this part of me that is ambitious and wants to get a masters or doctorate degree because I can. But there's this other side of me that really just loves being a staff nurse at the bedside. I love my patients and developing relationships with them. You don't need a masters to do that.
 Another thing that has sparked my interest is oncology. In my amateur opinion, it seems like a good mix between the technical side of nursing and the emotional side of nursing. Once again, we'll have to pray, wait and see.

What are you going to take away from this summer?
I'll tell you what I'm not going to do. I'm not going to be super cocky when I get back to school because I've had this amazing experience. If I've learned anything, it's that I know nothing. I'm going to take back my patient stories, my highs, my lows, my tears, my smiles, my days that went by quickly and the days that dragged on. I'm going to take back what I've seen other nurses do, what I've seen doctors do, what works and what doesn't. I'm going to take away the frustration, the amazement, the joy, the pain, the accomplishment, the confidence, and the awe that I've experienced this summer. And that's the condensed version :)

Here's to the next 5 weeks!

"Well that's cool"

There have been a number of things in the past 4 weeks that have made me go "Wow! That's really neat!" I'd like to share some of those things with you.

1. LARIAT procedure. This is a brand new procedure that's done for people with a high risk of heart attack that can't take blood thinners. There's a pocket in your heart (in the left atrium to be precise) that is the cause for about 90% of the blood clots that cause heart attacks. This procedure goes in and ties off that pocket so that it falls off and dissolves into the body. How cool is that?
Final Grade: B+

2. Magic Wand: I was able to watch the wound care nurse take of a stage III pressure ulcer. Pressure ulcers in general are very difficult to heal. This treatment had a little mist spray thingy that was filled with normal saline that went on the wound. However, the cool part was that on the handle for the mist, there was ultrasound technology that was supposed to kill the dead slough that was on the pressure ulcer. It was like a magic wand! How cool is that???
Final Grade: B

3. Your heart has its own pacemaker. However, if this one fails-which can happen a lot when you're old- there are two backup systems that God designed to support you until you can get medical help. It's like our bodies are equipped with two spare tires to help you out. You don't want to drive on it too long, but it's there to get you to the repair shop. How amazing is that? Good job God!
Final Grade: A+

4. Cardioversion: This is a common procedure when someone is in an abnormal rhythm. They put you to sleep for maybe 7 minutes, give your heart a shock, and that can make it go back into a regular rhythm for an indeterminate amount of time. Sometimes it works for a long time and sometimes it requires another or a different procedure. And when someone gets shocked, they actually do jolt into the air. It's pretty cool!
Final Grade: C+

5. Broken heart syndrome:  Also known as apical ballooning. This is a syndrome that feels the exact same as a heart attack. It is usually brought on by high levels of stress or trauma. The most common one is the death of a loved one which gives it the name Broken Heart Syndrome. The irregular hormones stress the heart, enlarge the heart, and restrict blood flow to the heart which gives the symptoms of a heart attack. It resolves on it's own. Not necessarily cool, but definitely interesting!
Final Grade: C

6. Modern day pacemakers and ICDs: These implantable devices are so cool! They are able to detect exactly what the heart is doing and respond accordingly. They can have different settings and adjustments. Some basically function for the heart and others only help the heart out when it's in trouble. So cool! Modern technology is amazing.
Final Grade A-

Hope this wasn't too nerdy for you :)

The Aftermath

Whoever said that weekend night shifts are boring has clearly never done them right. So there.

At Mayo, I have two clinical coaches that I work alongside. Both of them are great. They are encouraging to me and have really helped me learn. For blogging purposes, we'll name them Frosty and McFlurry. That being said however, whenever I work with McFlurry, something crazy happens. Together, we've experienced a full code, a BERT (behavioral emergency response team), a RRT (rapid response team-a step down from a full code), trying to get an MRI set up while continuously running Flolan through 20 feet of tubing, getting swung at, and other challenging but not as exciting adventures. I love them both, but McFlurry and I have been through a lot together.

I worked two 12 hour night shifts this weekend with McFlurry. I actually was able to stay up through the night without too much difficulty, but I am so glad it's over. It was not an easy weekend.

It started out great! Saturday night, we got all of our assessments, meds, and charting done nearly right away. It was a good thing too. One of our patients started experiencing delirium.  He kept trying to rip off monitors and oxygen masks. He was aggressive at some points. Basically, we were busy the entire night trying to get him to bed. It was a definite test of patience. I've never been cussed at or heard so much cussing in my life. I felt really bad about the whole thing because I know that wasn't his normal personality.

The next night- he was a different person. He was downright sweet. It was the most drastic change I've ever seen. The whole night was going rather smoothly. We were finishing up everything in the morning when one of our patients had a scary heart rhythm. McFlurry and I ran into the room and ended up calling RRT. Great way to end the morning.

That brings me to now. I had so much adrenaline pumping through me after the whole RRT thing that I couldn't really sleep this morning. I'm currently on a bus heading home to be in a friend's wedding this week.

Things to note:
Both nights around 4am, McFlurry and I treated ourselves to some ice cream. We deserved it right?
Also, on Saturday night, the nurses brought in some ingredients for a nacho bar.
The rumors are true. Night nurses eat a lot.
Coffee is glorious.
Also, dancing in the halls can help keep you awake.
When you're in the hospital, there's almost no way you're going to get a good night's sleep.
When giving report after a 12 hour night shift, be proud of yourself if you can be coherent.
One thing that threw me off the most was when I needed to brush my teeth. You brush your teeth when you get up and when you go to bed. For some reason, I wanted to brush my teeth at 7pm, 12am, 7am, after my morning nap, and after my afternoon nap. I was so thrown off. I guess there's no such thing as overkill when it comes to brushing your teeth.

More stories to come soon. Right now, I'm going to take a nap.

Night shift

Tonight I'm going in for the first of two 12 hour night shifts.

I have pulled an all nighter once in my life. It wasn't pretty.

I'm told that there's no way to prepare for a night shift unless you do them consistently.

I'm told that it's either crazy busy or ridiculously slow.

I'm told that night shift nurses end up eating a lot.

Oh boy.

Wish me luck.

More importantly, wish all of that luck onto my coworkers and patients who I interact with tonight.
Especially after 3am.

The 5 Secrets to Life

When educating patients, I find myself repeating the same things over and over again.

People keep looking for the secrets to living healthy. They try new diets, new exercise programs, and other things to try to live better. Well here's what I have to say to you.

It's really not that complicated! Here are the five things that I would say are the secret to living. (please don't take me too seriously here. This comes from my imagination and has no research behind it.) If I were to ever stand on a soapbox, this would be my message.

Caroline's 5 secrets to living forever

1. Don't smoke. It's bad.
2. Don't drink too much. It's bad.
3. Exercise regularly. It's good.
4. Eat a well balanced diet. When I say well balanced, this doesn't mean that you have to go crazy and only eat vegetables. Follow the  food pyramid or plate or whatever they have. Drink a lot of water. 
5. Practice loving. Love other people, love yourself, and love God. 

That's it! Granted there are things that these five steps won't help. This doesn't cure cancer. It doesn't make you look like a model. But you don't need super complicated and expensive diets or exercise regimens. It's pretty simple.

Moments

Thought of the day: I am going to take care of thousands of patients over the course of my career. I'm going to forget their names. It would be unrealistic for me to remember all of them. They might have a dozen or more nurses assigned to them in one hospital stay. The time that I spend with them is short. I might not remember it. And they might not remember it.

This could mean one of two things.
1. I'm a nurse so I need to do my job well, but there's no sense in trying to make a lasting impact on every single person.
2. I could be assigned to this person specifically for a purpose, and I have only a few moments to allow that purpose to emerge. I don't know what God is doing in that person's life, and I'm not always sure what He's doing in mine either. What I do know is that allowing the Spirit to work in you can change everything.

People are so different. I've had patients who were terrified of their upcoming procedures. There are others who have had so many procedures done, they couldn't care less about what's next. There are people who have never heard of metoprolol or coumadin and others who know my drug book 10x better than I do. There are patients who have family there supporting them every step of the way. There are others who are all alone and are thrilled to be in the hospital because there are people looking out for them. Some patients have a ridiculously high pain tolerance. Others are wimps. Some feel like they are entitled to every free thing in the hospital whether it's ice cream, a bedpan, or the shampoo. Others are extremely grateful when you bring them a warm blanket. Some patients can't wait to get out of their beds. Some won't leave their beds. Some people give themselves a shot every single day, but others are terrified of needles.

Point is, when I walk into the room for the first time, I don't know what I'm going to get. I have just a few moments to be with them. Just a few moments to love them. Most likely, they'll forget my name and my face. But maybe they'll remember how I made them feel. And I guess it's up to me what that feeling will be.

Yay!

This post really has nothing to do with anything Mayo related, but I was very proud of myself, so I wanted to share that with all of you!

On the first weekend here, we tried to run our dishwasher, but it wasn't working. We emailed maintenance, but they took a while to respond. They came today, but it still wasn't working. I was sick of washing dishes by hand, so I decided to investigate by myself.

I FIXED IT!!!!! I did some research on the internet, flipped the circuit breaker, unplugged it, and looked at the control panel or whatever it was underneath the stinking thing. It finally worked! I am currently sitting on my kitchen floor filled with unspeakable joy. :)

I have never changed a tire or car oil or done much to fix anything, but I have now gained a new sense of confidence in my ability to live independently. Yay me.

Also, I did a whole transfer buses multiple times thing today with success. I'm always paranoid about missing a bus, but I handled it today with grace. Take that!

You can tell you're a nursing student when....

  You can tell you're a nursing student when you spend your Saturday nights playing an NCLEX review board game with your roommates.

                                                                    This is a picture of me and my roommates

Tonight I played soccer on a woman's team with my clinical coach. I had a blast. I scored two goals. Not bad for someone who hasn't played for months. 

Well, talk to you all soon!