So I realized I let too many days pass before posting. It wasn’t intentional but in hindsight, probably necessary. I needed to unplug. We went for walk along the river, explored a rose garden and completed an early morning hike. It was bliss to feel the sun on my face and breathe in air that wasn’t recycled or stale. Watching Ali Wong‘s stand up didn’t hurt either.
I needed to hike and laugh away all the garbage that clogged my head from being in that nursing home for the past two weeks. Witnessing some of the staff substitute hand sanitizers for washing their hands after handling bodily fluids, seeing feces left on wipe packages that were left inside the patient’s bedside and hearing about a dirty bedpan being stored in a bag until next use made me want to throw up. (Note- we reported this all to our clinical supervisor). I watched a fellow classmate linger just long enough in our patient’s room and stare unnecessarily while exposed to totally creep me out. I quickly reacted in a way that communicated they were not welcomed in there any longer. It was rough.
This past week I had to turn down some invites and be indoors when all I wanted to do was be outside, doing something fun. School is a challenge in and of itself but summer classes? They suck. They are painful. OK- not cracking your shin on a corner painful but pretty close. Finding new faces on Instagram, dreaming of living in a larger city again, and travel all keep me from getting swallowed up by my studies. If you’re not following NurseNacole on Instagram and are a nursing student or pre-nursing student, go find her. She’s brutally honest, funny, and cares deeply about what she does. She’s a badass.
Stay tuned for an announcement Wednesday on a new short-term goal I’m working to reach! It’s a biggie. Right now my focus has shifted to finishing up one of my online courses and getting through a second class that is condensed from 8 weeks to 4. What happens in a condensed class like this? Let’s just say we had 9 lecture modules to read the first week. In just a few short weeks I’ll be done and my summer will begin, at which point I’ll be blasting this at full volume and putting in some quality pool time.
Monthly Archives: July 2018
Looking Back
There were a couple times today I wanted to take a picture of the scene I was looking at where we had our clinicals; the hands I held today as I looked at a patient who was only minimally able to communicate verbally, the smiles, the expressive faces I had connected with but would never see again.
Unfortunately, that would be a gross HIPAA violation so I’m left with the pictures burned into memory. It was a day I both looked forward to since I’m not a fan of nursing homes, and would miss because of these patients. These past two weeks were brutal with a 4:15 wake up time. The sheer physical aspects of it all- the bending, stooping, lifting, shifting, miles up and down the halls etc. take its toll. The smells were interesting”. The Vicks in the nose approach worked wonders but when it wore off, watch out. There’s not a cow patty field out there that can beat it. It’s just an odd combination of scents that can’t be described. It’s a cross between bad hospital food, bodily fluids, sweat, mustiness, and halitosis. \There were moments my partner and I didn’t know what we may have stepped in on the floor that was sticky or looked funny and a Costco sized application of hand sanitizer wouldn’t satisfy our need to get our hands feeling clean.
In this time in all it’s ugliness and beauty, solidified one thing- this is the field I’m meant to be in and where my heart points. The smiles and eye contact I made today, the goodbye to the hospice patient we adored were priceless.
Tomorrow we return to the classroom where we will spend the next few weeks intermittently, to further practice our skills in the lab in preparation for the state exam. In addition to a written test, we will need to perform 3-5 skills within 45 minutes for the state testers. There are automatic fails such as not wearing gloves for certain skill sets, not turning a patient on their side for oral care if they are comatose etc. Attention to detail is everything so we will be practicing as much as possible, which means more fun bed pan simulations and wedgies when we attempt to dress one another. Humor is everything!
Right now I’m balancing two other 4 (each) credit classes online and am happy to have a reprieve from anything additional so I can focus on them. Mid August when this all wraps up cannot come soon enough! In the meantime, nose to the grindstone. This time without Vicks.
C. To the Diff
Today in clinicals the magic term was uttered. I use the word magic affectionately and with a heavy dose of sarcasm. The ones that immediately get class attention and draws “ooooooooooh” and that look Carrie got on Sex and the City when she ran into Nina Katz (SNL writer) after her Aiden break up. That look. That term being C.Diff. One patient but it was enough to make me do a double take. We heard about it in clinicals. It’s one of the prime examples referenced when standard precautions and infection control are mentioned. It’s nasty stuff and difficult to get rid of.
This week in clinicals were assigned new patients. This is good because we get more exposure to different scenarios and varying levels of independence on the long-term side. On the downside, the ones we sort of became familiar with and became invested in, we missed on some level. My partner and I popped into one of the previous patient’s room and said hi. Their spouse was there and the smile on the patient’s face was priceless.
You never know what you’re walking into with clinicals. It could be a help to the bathroom, a brief change, a request for coffee or ice water. Someone might need assistance showering or we may have to use a Hoyer lift to get a patient out of their bed and transferred to their wheelchair for a meal. For me, I enjoy feeding patients. Food is a basic need. To see someone delight in dessert or eating mashed potatoes, or even a simple cup of coffee is a small piece of joy. It’s also when I feel the most depressed about them being a state of needing that assistance. I can’t explain it. There’s a vacant look in their eyes. What once was there is a shell. There are emotions, expressed through facial expressions and noises but to see someone decline food, prefer to sleep through their meal or simply sit in a hallway to pass time and watch life go by is, well- a bummer- for lack of a better word. It’s all some of them have and some families have no choice because the care becomes too great or a risk to patient safety. It’s still a dark place for me.
On the upside of thing- I have some good news coming down the pike. It’s an opportunity to experience something rewarding and a way to give back on a large scale. More to come in my next post. For now, I’ll go wash my hands for the fifth time since I’ve been home and try to watch something “fluffy” on TV to see joy and laugh.
Small Talk, Scrubs, and Vicks
Before I stepped inside our house after clinicals, the first thing I did was remove my shoes at the door, carry them gingerly upstairs and place them directly into the washing machine. Then I peeled off my scrubs and threw them in. This is what happens when you shower an incontinent patient. Do not pass go, do not collect $200. Make no contact with anything in the house and definitely do not hug your loved ones until you’ve had a shower. 
We were happy to do it. It’s a part of life some people have to deal with and you blow it off to help them maintain any sense of dignity. You make small talk, try to sooth them and provide a distraction. Between that and the prep prior to it and getting the patient dressed, the whole thing took nearly an hour. Patients are usually exhausted after and can become agitated. This patient was a trooper.
This has been a challenging week. First I had to learn how to remember I have a watch on my wrist. Then read it. There’s no touch screen. It’s an actual watch with a second hand. 
The thing came with a manual longer than Ikea furniture instructions and was in about 10 different languages. Each time I needed the time I instinctively reached for my phone in my pocket just before realizing I had the thing on.
The skills you learn in class primarily teach you basics and how to test. The real world is very different. Hygiene and standard precautions are always in place but the reality is that processes of the skills we learned, do change. Transferring a patient that can only briefly stand or not at all takes a lot of time and patience. Feeding someone that can’t do it themselves does as well. Keeping them focused and engaging in conversation with them about things they are vividly seeing in front of them but aren’t really there, is challenging. It’s heartbreaking to see patients that decline their food or sleep through a meal simply because they are tired from their long life and whatever brought them there. It’s painful to see patients who don’t have visitors or who sit alone during the day, preferring solitude. On the flipside, there are the patients whose smile lights up a room or one that can’t communicate properly but whose eyes tell more than any words.
We are paired in twos and my partner today was a rockstar. She remained calm and cool and is so kind to everyone she comes into contact with. The majority of our class is moving on to nursing and it’s apparent. Stopping to say hi to patients in the hall and listening to their stories, empathizing and laughing with them, you can see the compassion. It’s not a trait you can fake. It’s palpable. We know we might smell. OK, we do smell and we know it. We walk around with a bit of Vicks under our noses to help with odors but somehow still manage to smell ourselves. We hear and see pain but manage to laugh at something at the end of the day.
My eyes will barely stay open, my body is fatigued, and sleep can’t come soon enough, but today was a good day. Today I confirmed I’m in the right place and going in the right direction. With clean shoes and scrubs, of course.
Don't Sniff the SNF
I was expecting a smell. That odor that hits you square in the face when you walk in and stays with you until you shower it off. It never hit me. I was stunned. Anyone who’s ever set foot into a skilled nursing / long-term care facility knows this smell. It’s unfortunately all too common.
Today that didn’t happen. I mean there was “a” smell but only what you’d expect to be normal for what it is. It was one of the nicer facilities I’ve been in. You have these visions of One Flew Over The Cuckoos Nest and wait to see Nurse Ratched lurking around the corner. Instead, we were met with a resident fat cat and passed by a beauty shop complete with a roof and siding to look like a cottage. My class will spend the next two weeks here learning and working with patients to apply the skills we’ve been studying in class.
Prior to class we practiced vitals
, took turns riding the Hoyer lift, and one by one transferred our clinical instructor from a hospital bed to a wheelchair. Doing this with your study partner or classmates is not the same. You unintentionally “help” them so she wanted us to know how this would really go down in the real world.
The lift was entertaining, to say the least. It’s slower than a Ferris wheel and there’s no view, but we all got a good laugh out of trying to maneuver the unwieldy thing and avoid hitting someone’s head on the metal bar supporting the lift… or knocking their feet against something. 
You feel like a taco all folded up and your backside hangs out the bottom but it’s good to know how the patient feels. By the way, the smiley faces and funny mask looking emoji’s aren’t to be humorous. Unless I have explicit permission to use someone else’s image in a photo, it gets blocked out. My friend was kind enough to give the A-OK here. 
Did I mention the hornet’s nest in front of the building that got disturbed when some water was dumped unknowingly on top of it? Didn’t think so. And I’m not making this up. As I ran inside the building I got a view of the nest with hundreds of pissed off hornets swarming frantically and taking aim for anyone passing by. A few people suffered more than one sting
It wasn’t pretty. Moral of the story? Don’t piss off a hornet.
Calm vs Chaos
I’m posting two pictures of our skills practice area today; one of a calm, room with sunlight pouring in and a neatly made up bed and the other with stacks of bed linens, gowns, and supplies strewn about. 
Rather than sunlight bathing the area, there is harsh fluorescent light piercing the space and the drab grey walls fall away to the background. It didn’t hit me until I looked at them side by side; this is how medicine works. One minute you’re bringing food to someone while in another room a patient is crying out in pain or dying. At our local hospital, a lullaby plays when a baby is born. It’s very sweet and people stop and smile knowingly. We get fanfare when we enter this world but all is quiet and hidden as we exit.
These two pictures capture a moment of this odd juxtaposition; being caught between the life and death. As we completed our second week of CNA class and prepare for clinicals next week, we performed mocks of the skills we learned in preparation for dealing with patients. While we laughed at some of the precarious positions we needed to be in and made light of it to get through it all, the reality is that next week these patients will see us for the first time.
We will bathe them, help them with hygiene and toileting needs. We will be with them when they are in pain and when they are angry at losing independence or swear they see something we know could be a hallucination. They might not remember what day or year it is. We’ll help feed them and clothe them, noting their vitals. We may be there when they die or cry out for a loved one. We are complete strangers yet somehow we are invited into their lives, their homes, into the most intimate moments that we take for granted every day.
I’m a horrible patient. I mean that. I follow instructions from my doctor but am the worst at surrendering for help. I am fiercely independent and cringed when I had to ask my husband for help brushing my hair, getting to the bathroom or even shaving my legs after my back surgeries. I can not fathom losing this independence for the long-term and having to ask to have my teeth brushed. My hope going into next week is that I will gain the trust of the patients I’m lucky enough to care for and keep their perspective at the forefront of my approach in every thing I do. This was a longer, more serious post but this is the reality of the field I chose to be a part of and it’s not all bed pan jokes and studying. Next week will be challenging and I’ll do my best to portray it as accurately and honestly as possible. Stay tuned.
BP, Basins, and Bedpans Oh My!
You’re not truly friends until you’ve placed a bedpan under your study partner or faked the perineal care skillset with them. 
We had a few laughs, especially when we realized just how off we were with the placement of said bedpan. Let’s just say it’s a good thing we made that discovery in the classroom.
This is the second week of CNA class and so far it’s going well. We all definitely have a sense of humor and that’s a good thing. In just a matter of weeks, we will be performing the skills we’re walking through in class, in front of a state instructor and with a stand-in actor. This means when we place the pair of sweatpants from 1983 on with a plaid button up shirt, there will be no giggling or making Steve Urkel references. I defintly can’t put my hands in the air and say wee as the hospital bed raises to waist height.
Blood pressures were interesting today. The instructor will have us use a stethoscope with two sets of ear pieces so she can guage whether or not we are accurate in our readings. No pressure there. Badumbum. OK, that was cheesy. 
In all seriousness even though I feel pretty good about this so far, today I didn’t slowly release the valve on the BP cuff at the end to make sure the beat I heard was truly the last one. This is where practicing in class is so helpful. I’d rather make a mistake now and learn from it than do it in front of a tester. Today I walked through an entire oral care process, getting all the steps correct but forgetting that when you’re dealing with mucous membranes (in the mouth) you need to don gloves. Won’t be making that error again. My 100% would have been a big, fat, steaming pile of zero.
Next week we start clinicals so we’ll be performing these tasks on real people. My friend and I (and the others in our small class) do laugh a lot to ease the stress but we also work hard and correct each other out if we see something missed. Developing good habits now means not breaking bad one’s later. None of us wore a bedpan as a hat today so there’s that. We have a way to go but I’m pretty proud of how far the 10 of us have come in just a little over a week.
One Week Down
There’s a scene from the movie Gross Anatomy where med students have been studying for so long and so intensely that they actually forget what they were studying for a brief moment and one begins pacing noting how she’s tired, she’s tired of being tired, and her hair smells. While it may seem absurd, there have been several moments of that this past year. We look at each other after hours of figuring out physiological processes and try to recall what exactly what the question was we were researching. This is usually followed by one or more of us laughing hysterically at something that is either totally inappropriate or should not be funny in the first place.
The movie is dated being from 1989 (did anything bad really come out of 80s movies? (The answer to that is always no by the way.) It’s relevant in the sense that you reach a point of exhaustion, much as I am now but you still get excited about something as minor as figuring out how a nephron works.
This week, while not as mentally taxing, was fun. Today we learned to do vitals. I nearly cost my friend her arm after forgetting to fully release the pressure on the sphygmomanometer (bp cuff) 
once I completed the reading (maybe more than once) but hearing the heart and learning this type of thing is exciting. It’s applying what you are learning to real-life scenarios.
Our attempts at rolling a patient over in a hospital bed may have involved trying to avoid them rolling off completely and possibly realizing you raised the bed too high to the point the patient could have got a nosebleed. It felt good to laugh.
One week of CNA class down and one to go before clinicals. It’s late, I almost didn’t blog but I’m committed for better or for nurse. Badumbum. Man, I need to sleep. Or get better jokes. Maybe both. Good night!
The More You Know
I knew summer would be a doozy balancing online classes with a full-time CNA course. I mean it’s not rocket science but these are real people we’ll be caring for and my online courses require time management to keep up and maintain an A.
Today in class we learned how to transfer a patient in and out of bed, into a wheelchair, how to ambulate with a walker and perform range of motion exercises. It may not sound exciting but the prospect of working with patients is. This is someone’s grandmother, sister, or mother we’ll be dealing with and it matters. I was grateful for the humor today as we all got a little more comfortable with one another. Each skill we learn must be practiced, each step called out and walked through and critiqued. Fortunately, making up patient names like Ringo and Jesse’s Girl kept things light.
You know what else the practice does? Make you acutely aware of your breath, whether or not you remembered to put deodorant on, and making certain you wear clothing that will stay put when you are lifting someone or being the patient who’s rolled over in bed. Noone wants an unavoidable wedgie from wearing clothing that’s too tight fitting or your loose fitting shirt wrapped around you three times when donning and doffing protective gowns. I definitely won’t be eating anything heavy on the garlic for the duration of skills practice, out of respect for my fellow classmates. You’re welcome.
It was a good past couple of days. Tomorrow we have the holiday off and I’ve made the decision to follow my gut and take a mental health day. Studying tonight, reading my assigned chapters, and memorizing vocabulary will afford me time with my hubby and family. Sometimes you just have to take a day and walk away from it. Some call it self-care, I call it a recharge. Getting fresh air and just enjoying some rare downtime sounds easy but when you’re juggling and focusing on time management it’s easy to forget to do this and get burned out.
Have a happy and safe 4th everyone! When I say safe I mean don’t blow your hand off or catch your hair on fire. Trust me, it happens and it’s not pretty. Google it.
