L&D Leadership Journal Entries

The following are my journal entries for my leadership rotation in Labor & Delivery. I originally had to type these up and turn them in as an assignment. I thought this would be a good way to preserve for posterity my first trials and tribulations in L&D.

1. a) My personal goals: Become more familiar with all the paperwork involved in patient care so that I can be more helpful to my preceptor by dealing with it myself.

Evaluation: There is so much paperwork involved that it will take some time to become proficient at filling it out. I was able to create the parent and baby bands to be used upon delivery and fill out the consents as well as explain and have the patient sign them. When I left the hospital last night I grabbed the paperwork packets for all new admission, epidural, and c-section patients so that I could look them all over at home and become somewhat familiar with them on my own time. As my preceptor saidsaid, most of them will still be completely foreign to me but at least this way I can be more proactive and reduce the number of repetitions needed to become familiar with them.

b)My professional goals were to check a woman’s cervix and witness a birth since I did not have the opportunity to during my last shift.

Evaluation: During this shift we took care of one woman being induced and another who was imminent for delivery. My preceptor checked the latter’s cervix and asked if it would be alright for me to check after her and the patient agreed. We suspected that she was complete, but when I immediately felt a head in her birth canal and no ring of cervix encircling it, I asked, “So this is 10 cm?” and my preceptor confirmed this, much to my patient’s delight. This was hands-down the highlight of my nursing career thus far. After that I was able to witness the birth and observe first-hand the nurse’s role during a delivery. My preceptor said next time I can be more actively involved after seeing one done by her.

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1. Personal and professional goals for experience(s) this day.

A. Perform the admission process on my own with supervision, including placing toco, FHM, finding pt in computer system, admission assessment and charting.

Evaluation: Success! I have been involved with a few admissions but never really had the time to do it by myself. My preceptor and I are usually so pressed for time that one of us will take one task while the other completes something else. But yesterday I was with the charge nurse, who is not assigned patients and she was very patient with me and let me take my sweet time while admitting a labor check patient. I seem to be getting better at placing the FHM, which is a good thing because it's a horrible feeling to be pregnant and see some imbecile unable to find your baby's heart beat. I always tell them when I've found even the faintest trace of it that I did indeed hear the heartbeat, but that I am just looking for a louder spot to place the monitor. This seems to relax them.

B. Actively assist with a delivery.

Evaluation: I was able to work with my preceptor to deliver a patient, who also happened to be an RN, vaginally on 10/29. The patient had an epidural and pushed for 2.5 hours, only to have the doctor use the vacuum and perform a last minute episiotomy (*full body shiver*). I learned that there is a LOT of bleeding involved with an episiotomy and watched in horror as it streamed down her perineum into the bag under her bottom that catches the fluids during birthing. My preceptor and I got the bed, warmer, and delivery table ready for the delivery and assisted the patient to push for the duration. Afterwards she told us that she couldn't have done it without our encouragement. I spoke with the patient briefly after the birth about breastfeeding and gave tips and advice for getting through the first couple weeks if it doesn't come as naturally as she thought it would. She was very receptive and encouraged by this and I was sad to have to leave her int he care of the night shift so soon after the birth.

3. Supervise team members to determine if work is getting done, if any work is missed, and if members need additional assistance with their work.

As charge nurse, this is the main thing that we did. We were constantly watching the FHM from the nurses station and making sure that things flow smoothly such as calling anesthesia, nursery, and paging doctors as needed. One example of making sure work is done is that Rm 2, an IOL, was having consistent late decels on the FHM for about 5 contractions that were coming less than a minute apart. A nurse was in the room with the patient and after a few minutes we stepped in to make sure that she had turned the patient's pitocin off as repositioning and oxygen had not improved the baby's heart rate over the last 20 minutes or so. The nurse had indeed already decided to stop the pitocin, so we were just there as backup for her. I found this simple act very reassuring, and told my charge nurse that as a new grad nurse it makes me feel very happy to know that the charge nurse is watching my patient's strip and assuring that I am making the right decisions in such cases. Nurses have a lot of autonomy in their patient's care, and when you see a bad strip it is at your discretion as to how to handle it, either with positioning, oxygen, bolusing fluids, decreasing the pitocin, or discontinuing it altogether. So I am glad to know that a more experienced nurse is there to ensure the most prudent action is being taken. The charge nurse in no way seemed condescending or punitive while checking in on the other nurse.

10/29/10- I had a busy and eventful day this day. I was following my preceptor for most of it, but took the opportunity to follow the department manager for 3 hours as well as attend the bed management meeting that afternoon for one hour, as explained above. As far as patient care that day, it was madness on the unit with one IOL having what my preceptor called "nasty decels." I really did not get to do too many skills this day, but ended up observing and trying to stay out of everybody's way as much as possible. We had two patients ready to deliver at the same time, and one of them was an RN who's husband works at at the hospital as a surgeon and none of the other nurses wanted to cover them while we attended our other very friendly laid-back patient who was ready to push. The surgeon was a very strong personality who had managed to royally offend just about everybody on the unit by trying to see his wife's chart because he "was the one who impregnated her anyway and he's a doctor." Apparently surgeons don't know about HIPPA? So we had to stay with that patient who looked as if she would be complete at any time while another nurse attended our other patient's birth. Unfortunately, the doctor for this other patient pulled my preceptor aside and said she was being unfair to her patient by deserting her just because the other patient's husband was a doctor. She was very upset, but the charge nurse said that she made that call and if the patient's doctor had a problem she could take it up with her and the department manager. Of course the surgeon's wife did not end up delivering after all until 2 hours later, just before shift change, but we had a great time assisting with this birth and the surgeon wound up loving us and videotaping us and gushing the whole time about how great we were. One interesting thing I got to see was my preceptor getting doused in amniotic fluid while helping the patient to push. This has apparently never happened to her before, and the second time it did I had gloves on and saved her another shower by blocking the flow with my palm as it was arching directly toward her head, for which she was much appreciative. Glad to be of service!

11/3/10- This day I followed the charge RN. We did not do much as far as patient care, but handled scheduling, new admissions, and assigning nurses to incoming patients. One of my main jobs acting as charge nurse was to shoo family and friends from standing in the hallways and send them on their way down the hall to the waiting room. My charge nurse was much appreciative to hand this task over to me for a while. I did get the chance to start 2 IV's, the second one successfully. I also drew blood for labs, performed a cervical check on a 1 cm patient for which absolutely could not find her cervix for the life of me, but put on my "Oh, yes, I completely know what I'm doing" face anyway while the whole time I was really thinking, "Warm and squishy... and some more warm and squishy. I got nothing." I also got to do an amnisure test on this patient to see if her water had indeed broken, which it had not. I shaved another nurses's patient and generally helped her get ready for a c-section. Interesting and depressingly enough, not a single vaginal delivery happened on this day. Every single patient was an induction of labor and wound up with a c-section either for the baby being breech in one case, or the rest who had "failure to progress."

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1. Personal and professional goals for experience(s) this day.

A. Follow the lactation consultant and learn how to help with proper infant latching.

Evaluation: Met. I had a very informative experience following the lactation consultant at the hospital. Got to see many examples of helping new and experienced moms with proper breastfeeding technique.

B. Master "baby wrangling" (finding the baby's heartbeat with the fetal heart monitor).

Evaluation: Met. I took it upon myself to adjust as many patients as possible when their monitors lost the heartbeat. This is something that I figured would only come with practice, and after spending 12 hours doing just that I feel much more confident!

11/5/10- Followed the lactation consultant. I learned how to work the breast pumps on the unit, how to determine the correct size attachments for each mom based on nipple size/shape, and how much colostrum to expect for the first few pumpings (just a few drops!).

11/9/10- Another 12 hour shift working with my preceptor. We were actually pretty slow this day and one of our nurses even got floated to Mother/Baby. I was able to attempt an IV start on my first AA female, which sad to say I failed miserably. :) I could neither see nor feel a single vein in this poor girl's arm, but my preceptor helped me locate one and I gave it my best anyway. Later we had a new admit transfer from the ER complaining of spotting at 32 weeks and tingling of her head and arms (???). I did her entire admission assessment, computer charting, and got to watch the midwife do a speculum check, during which I got to get a gander at my first cervix (awesome!). Come to find out she had herself a nice hemorrhoid that bled when she wiped and the exam was over quicker than all the admission paperwork could be completed and she was sent home with instructions to call the office first next time!

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1. Personal and professional goals for experience(s) this day.


A. Help with a c-section.

Evaluation: Unfortunately, I still have not had a chance to help in the OR! This is rediculous because c-sections happen at at this hospital literally every day but by luck of the draw my preceptor has not had one on our shifts. I am hoping to attend one during my last shift next week.

B. To be so utterly pleasant and helpful to everybody on the unit that they will be lost without me and beg for the manager to hire me.

Evaluation: So far so good! :) I had a really great day with the charge nurse today and was actually able to take quite a bit off her plate for her. I did 3 complete admissions by myself, which entails a whole lot of computer work and questions. I also got to help my nurse manager who speaks Spanish ready a Spanish speaking patient for a c-section. She was actually less familiar with the paperwork and computer than I was and I was able to give her some pointers!

Description of days:

11/16/10- The day began with a teenager in labor at 32 weeks having a vaginal delivery of a tiny baby. The nursery team was on hand as they are experts in resuscitation and the baby would also be immediately transferred to the nursery. The baby, who was expected to weigh less than 3 lbs, ended up weighing 4 lbs 2 oz and was breathing and crying on its own immediately after delivery. I learned later that he took a bit of a downturn about an hour later, which often happens because they do not have the reserves to maintain the effort to breathe. His mother had received her 2nd dose of celestone (steroid for baby's lungs) 24 hours before, at least. We had a second delivery on a mom with a fever and ruptured membranes that evening of a 7 lb 11 oz baby girl who got stuck in the birth canal after her head had delivered. The midwife had a hold of this baby by the neck and was pulling as hard as she could but she just would not budge. I swear I thought she would break the baby's neck. She finally came out, though, but with her fist up by her neck so she had passed through the birth canal with one arm folded across her chest increasing her diameter. She came out completely limp with her arms dangling and I thought for sure her arm was broken. My preceptor snatched her as soon as the cord was clamped and yelled, "we need nursery! floppy baby!" and handed her off to the L&D transition nurses. They stimulated her and bagged her 5 times before she started breathing and crying on her own. The nurses said she was just stunned for a minute from the birth. After that the mom started hemorrhaging and lost 2 liters of blood. Her uterus was firm the entire time and she had no hematomas or lacerations, and another doctor came in to help do a speculum exam to visualize her cervix for tears. They did cytotec, methergine, and hemabate to no avail. They finally called her mother in to tell her they would be taking her to the OR for a D&C and possible hysterectomy to save her life if the bleeding didn't stop. I was pretty much trying to stay out of the way during all this and fetch things as I could. Her bleeding finally stopped on its own just before they took her to the OR. My preceptor asked me to put a foley cath back in her to prevent another hemorrhage, and placing a cath correctly the first time on the wreckage that was this woman's nether regions is probably one of my finest accomplishments! This situation had just about shaken my resolve to be an L&D nurse but seeing how all the nurses on the unit came together to handle the situation gives me confidence that I will never be alone.

11/17/10- Today I followed the charge nurse and did 3 admissions, 1 successful IV, and one unsuccessful. I have gotten quite good at getting moms on the monitors and finding babies' heart rates, thank goodness. I also got to physically assist during an external version to turn a breech baby, and the doctor had me dig my hands into this woman's belly to stabilize the baby's bottom while she flipped her around (it worked!), which was pretty much awesome. I gave a baby her first bath, even washing her hair in the sink one handed like I've seen all the nurse's do, as well as giving the baby her first bottle. Then I followed the nursing supervisor and observed her make rounds and assign beds and staff all over the hospital.

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11/22/10- My last day on the unit was very bittersweet for me. When I arrived I took report on two patients, one woman pregnant wither 3rd child who was there to be induced, and another 32 week pregnant woman being treated for premature labor. I did the admission on the induction on my own and attempted an IV start to no avail. I find that I often find the vein just fine and get the flashback of blood, but when I advance the catheter and remove the needle there is no blood return. I refuse to stick a patient more than once, so I always let my preceptor fiddle with it and see if she can get blood return (sometimes she just moves it a little and then it will work) and then re-stick them if needed. When the doctor came in at about 8:30 am to check the patient’s dilation before we started her pitocin, she was found to already be 3 cm dilated. To make a long story short, after only an hour on pitocin the doctor broke her water to speed things up and within 15 minutes her husband informed us she was very uncomfortable and ready for her epidural. We paged anesthesia, who arrived within about 15 minutes and placed her epidural. I was prepared to place her foley catheter immediately afterward (her epidural had not even taken effect yet) when she said she felt like she had to push! She had only been on pitocin for 2.5 hours (most women take 2 days for a successful induction) so my preceptor said to just keep my sterile glove on after placing her foley and check her cervix. When I did so, I felt a giant head already halfway down her birth canal. As I felt this, I looked up at my preceptor and apparently the look on my face said it all and without even asking what I’d felt, she called for the delivery tray. Things moved very fast after this, and I removed her foley because it was time to start pushing. When I placed her legs in the stirrups we could already see the baby’s head crowing. Whoa! The doctor made it in the door just in time for one good push that delivered a baby with hair so long it was in her eyes. I was able to transition the baby myself, which includes taking her vital signs. Counting a newborn’s heart rate for a whole minute is a bit like trying to see a hummingbird’s wings in flight, and I have yet to do it with any sense of confidence. This sweet girl was so pleasant though that she laid there quietly and allowed me to silently count with my mouth as fast as is humanly possible (try counting to 145 in 60 seconds… not so easy!). This was my last experience at this hospital, and it was nice to end my rotation with a freakishly easy, happy birth for everybody involved. Well, the mom might say otherwise since her epidural did not have a chance to take effect, but considering she was only even uncomfortable for about 25 minutes and had an intact bottom after only one push, I’d say she SHOULD be happy! It was very sad saying goodbye to everybody on the floor, and hugs were bestowed upon me as I made a complete fool of myself and cried as I walked out. I thought I would be much happier to finish my clinical hours because that means I’m only days away from graduation, but it felt so WRONG to be leaving. The last 6 weeks have been the most professionally fulfilling thing I have ever done in my life and the thought that I am no longer a part of their team in any way, shape, or form kinda breaks my heart. They all assured me I will soon be haunting their halls again (only this time as an RN!), but even the possibility that I might not get hired is enough to make me cry all the way home. I am happy to have walked away from this experience with new skills, a confirmed passion for L&D, and relationships that will continue thanks to Facebook.

Rectums, Fistulas, and Bagels, O My!

Well, a lot has gone on since the last time I've written on here, and there's some housekeeping to be done. Let me just say that I realize how long these things get (Chatty Cathy and all that).

1. I am in my final semester of nursing school, and at this point already 5 weeks in. This semester's clinical hours are divided up 6 weeks with two 8 hour shifts in the medical/surgical floors at MUSC doing really, really gnarly crazy gross stuff that they would not let us even look at before. The last 6 weeks I will spend doing 88 hours in the Labor and Delivery department at Trident, and generally begging them for a job for the duration. I'm currently on the floor at MUSC that receives patients when they graduate from the ICU, so alive and kicking but just now stable. I have one week of this left, and probably the craziest thing I have seen so far is a 21 year old gang banger who was shot in the abdomen with a shotgun and no longer has an esophagus or intestines, yet continued to eat in the ICU. Now, if you really think about that statement.... there's nowhere for the food to GO, per say. So his body (amazing) created a fistula (abnormal tunnel) from his neck to the outside of his body so the food falls onto his shoulder when he eats. The surgeons, seeing that this was never going to stop, created a nice little stoma for him there on his neck so he could attach a colostomy bag. So now us lowly nursing students have the pleasure of fetching him insane amounts of food from Subway, then watching him eat and drink and his little baggie fill up, he empties it into a basin, and we flush it down the toilet. Modern medicine for ya, ladies and gentlemen!

2. I kinda wish I could go back and do nursing school all over again. Not in any way because I am eager to spend another 16 months of my life like this, but because I was so uncomfortable the entire time and I'm just now finding my groove. I feel like if I could go back to the beginning with the level of comfort I feel now, I could have gotten so much more out of it. Its not the schooling that has been difficult, I've always been book smart and up for a scholastic challenge, but nobody realizes the insanely uncomfortable things we are asked to do every day at a student nurse. Let me see if I can put this is lay man's terms for you: say you're in Harris Teeter and you're in the bread isle and you see a nice man in a wheelchair choosing bagels. Now say your boss comes up to you and says, "See that nice man? Go put this enema up his butt and squeeze the contents into his colon then help him to the bathroom so he can blow his intestines out of his bottom. Good girl. Oh, then measure his stool and record it, but make sure to wipe his butt for him first." As one is shoving a piece of plastic up a strangers rectum, one cannot help but hear the little voice in one's head saying, "WHAT AM I DOING?!!!!!" Well, that voice has been loud and strong and adamant in my head through most of nursing school, and it really has not been until this semester that it has given up trying to convince me that social norms still apply to me in particular. It has pretty much been ruining my life in a very real way up until recently. When I am out of my comfort zone (ie The Hospital) I get nervous and become an absolute bumbling idiot. I cannot talk properly, I stutter, I spit when I talk, I cannot so much as pick my pen up off the medcart without sending it cartwheeling in a trajectory toward my own eye, I trip over my own feet, and generally want to crawl under a rock and die. You think I'm exaggerating, but I really am not. For example: I was putting a client's meds into a little cup for him, not exactly rocket science. I was popping his pills out of the little foil packets and as I'm pushing a harmless little ibuprofen, it (I kid you not) shoots 20 feet down the hall and rolls into a patient's room under his bed, where there are of course 2 nurse's to observe my little mini-fiasco. So I have to walk into this stranger's room, face these two experienced nurses (did I mention I'm dressed in white polyester head to toe?), and march over to pick up my fugitive capsule. Then I have to go find my assigned nurse and tell her she needs to go back to the med room and get another ibuprofen, and of course she's going to want to know why.... the humiliation really never ends. So this is how clinicals are for me, one fumbling incompetency after another. But... this semester I seem to have turned a corner. I love people, I love talking to patients, that has never been a problem. But when I am that far outsize my comfort zone, my personality is locked in a dark little padded room in the back of my mind somewhere sobbing quietly and leaves me to bumble through alone, socially incompetent, and practically drooling on myself. Wednesday I had three patients to care for, one who is a known pickle and the RN's on the floor avoid being assigned at all costs, one who I've taken care of 3 times in the past, and Mr. Gunshot Fistula Neck Man. For some reason nursing school is starting to percolate in my little brain, and I'm realizing that I really do know a lot about a lot of things (as opposed to a little about a few things and feeling chronically stupid). Its gotten to where I have been doing the same things now for so long that the little freak-out voice in my head has transferred more into a "Wow, what a nice rectum you have Mr. Bagel Man" as opposed to the previous "RUUUUUUUUNNNNNNN!!!" impulse. So I talked to Ms. Pickle Patient as if she were one of my massage clients as I wiped her butt, and she wound up absolutely loving me. She wanted to know all about my childhood in Mexico and Wyoming, and had me tell it again when her husband came. She was as polite as could be, and my nurse was flabbergasted. My other elderly patient, who I'd had 3 times, refused to have her mouth swabbed by my nurse who said she doesn't even try anymore, but I told my nurse she'd always done it for me. I got up in her face and cajoled and cooed and next thing you know I have that nasty tasting swab in her mouth scrubbing every last corner, and I look up at my nurse who says, "You're my hero." It was a good day, and I'm finding that I'm having more and more of those these days.

3. I know stuff. :) I have had 3-4 classes each semester learning the bare bones of nursing concepts, in addition to spending time in the hospital for hands-on training. We've had to take NCLEX practice tests all though school to determine our probability of passing our state boards upon graduation. It's not your typical 100% grading, a holy-grail score for such a test is considered a 73.3%, which has been pretty much unattainable because we had not learned everything yet. Well this semester we have no class instruction, we have learned everything about the human body, disease processes, and drugs that we are going to. We just had to take the mother of all NCLEX practice tests on Thursday, and there was a lot riding on it. It is graded in 3 levels: Level 1 means you are no way no how going to pass the NCLEX, Level 2 means you might pass but you need to study a LOT between now and then, and Level 3 (anything better than 73.3%) means you're golden, keep doing whatever the heck it is you have been. Anybody who did not get a Level 3 on Thursday's test has to go into mandatory remediation the rest of the semester, and re-take the predictor test the day before graduation, and if they still don't pass they don't even get to graduate. So we had a lot riding on this test, and considering most of my class has never even made a Level 3 before, it seemed unlikely. The class before us has 75% of their class placed in mandatory remediation. Scary! My previous 2 practice tests I'd scored a Level 3, but one still never knows about these things. As I was taking the test, it slowly dawned on me: I know this stuff. I am a nurse, and the nearly $50K I've invested in my brain the last 16 months has worked! I scored a beautiful 82.3%, and right under my score were the words, "Probability of passing the NCLEX on first try: 99%" Bring it on, baby.

4. I was chosen for the MUSC Women's Club Scholarship recently. I had to go to a fancy luncheon/tea to accept my $1500 award, and one of the women on the Scholarship committee pulled me aside just to tell me that when they were choosing the recipients, my application got almost unanimous votes out of all 60 and that has never happened before. For the life of me I cannot remember what the heck I wrote on that thing! I was touched an honored, but even more so seeing that I was the only nursing student selected and there were only 14 awards handed out university wide (as in Pharmacy, Medicine, Physical Therapy, Ph. D, Dental, Physician's Assistant... the list goes on and on). I certainly did NOT mention to anyone there that I planned to buy myself the mother of all tattoos with my money, a nice little graduation present to myself. Somehow I think they would not approve....
Here is a link to their webpage and you can see for yourself how I stick out like a sore thumb in this crowd, they really had no idea what to think of me even after taking all my facial jewelry out and covering my tattoo. I saw one 80 year old women eyeballing my sparkly green toenails during the ceremony. :) http://academicdepartments.musc.edu/womensclub/scholarship_recipients10.htm

5. I have been invited to join the Sigma Theta Tau nursing honor's society, which is a little bit awesome (and apparently expensive!). Right now I have the 3rd highest GPA in my class, and with a 3.975 I am certainly not begrudging the people ahead of me. Everybody says that when it comes to grades in nursing school C=RN, but after being told in no uncertain terms that not only would I never make it into the program, and NObody makes an A at MUSC I just want to go dance on somebody's grave. Or at least go find that little floozy Trident student nurse at St. Francis and wave my degree that will say Summa Cum Laude and my pretty little graduation cords in her face and say, "Booyah!" This shall terminate the gratuitous boasting portion of my blog.

Ali's Birth Story

Last week I got to act as doula for my friend Ali as she gave birth to her (of course) adorable baby boy, Elijah Conrad Blum. As is the case most Mondays, she dragged me kicking and screaming (ok, not really) off to Zia Taqueria for their $2.50 fish taco Monday special, which she lovingly and efficiently refers to a FTM on her multiple Facebook status updates regarding said special. Anyhoo, we are all about taking out the proverbial two birds with one stone, so she came by about noon to watch Ayden's birth video and see an actual unmedicated birth of somebody she actually knows before we were to indulge our taco habit. Her first birth was unmedicated, if you don't count the Pitocin the hospital had running through her veins throughout, causing extremely painful and unnatural contractions with her now 3 y/o son, Benjamin. After watching my video and I imagine feeling much justified and reciprocated by getting to see my inhumanly swollen and distorted vagina plastered across the 30" television screen, she informed me that she had been peeing on my couch the whole time, so sorry. This is really nothing too new for her, she peed herself on a regular basis with Ben and again with this baby, being that their giant noggins push against her bladder more than any other pregnant woman I've known. She was quick to inform me that she was indeed wearing a Poise pad just for the occasion, thank goodness. Something as insignificant as incontinence was not going to keep us from FTM, so I kissed my boys goodbye and off we went. Little did I know that I would not see them till the next afternoon.

During our 15 minute ride to Zia she informed me that she had again wet herself at least 4 times, and we were discussing whether perhaps it was not urine and her water had again broken at 37 weeks, as was the case with Ben. The fact that she had not really been having more Braxton Hicks contractions than usual combined with her history of going potty in her pants (hehe) made it difficult to determine. As you can imagine, Ali is a common spectacle waddling through Zia and this day the usually snooty (and hot) bartender asked her if she had a month or two to go until her baby came, and she looked at him in abject horror and informed him that no, she was 37.5 weeks and hoped to have him TODAY. (She had Ben at 37 weeks and was already 3 days more pregnant than she ever had been in her life and was quite put out by it.) While standing in line we simply could not take the suspense and she said she would go to the bathroom and try to determine for sure if it was amniotic fluid. When she had been gone about 2 minutes I got curious and entered the bathroom only to have her tell me she was just calling me on her cellphone to come see for myself. So I go into the stall and she warns me, "Ok this is gross but look at my toilet paper. What is this?" We are giggling maniacally at the preposterousness of the whole situation at this point, but I look and the toilet paper is indeed wet but not discolored. Short of having some litmus paper to test the pH of the mystery fluid, all I had was my own 5 senses. So I tell Ali, "Ok. Do NOT move your hand a fraction of an inch... I'm gonna sniff it." To which she bursts out laughing and is most certainly NOT holding her toilet paper wad still at all, but is still more than willing to let me give it a go. That is friendship for ya. I give it a sniff, fully aware of how insane this is but after all I am practically a professional and fluids are soon to be my lot in life, and it has absolutely no smell. Hmmmm! At this point I'm telling her it would probably be a good idea to call her midwife, but she would rather eat tacos.

Eventually she promised to call them after we ate, so we soon settled into our delicious baja fish tacos, Ali joyously wetting herself every few minutes. She was still a little reluctant to call because she felt silly not knowing if it was pee or fluid, but I told her to just give them the facts and that its their job to figure it out. They told her to come straight to the birthing center and be checked, so off we went. They, unlike me, have bonafide tools of the trade other than their sniffers and within seconds were able to tell with their handy roll of litmus paper that her water had indeed broken and she was going to have a baby today. She was totally shocked, and asked if she should call the bartender at Zia and tell him she really was in labor. I think she might have actually suggested that before thinking to call her boyfriend. :)

She had come back positive for Strep B, which is a totally random strep colonization that some pregnant women have, which means that they are increased risk of the bacteria crawling up through a dilated cervix and getting to the baby if the bag of waters has been broken, which can lead to infant pneumonia or sepsis (bacterial infection in their bloodstream, very bad). She had this with her first pregnancy, too, so when her water broke with Ben she was rushed off to the hospital where they started her on an IV antibiotic and told that she had 12 hours to give birth or her baby would die. Considering she wasn't really even having contractions at the time, this was not going to happen. We got her up and walking and contracting regularly, but a few hours later they said she "wasn't progressing fast enough" and started Pitocin to bring on stronger contractions, which also happens to be excruciating. This is how she ended up going through labor climbing the walls in pain and still refusing medication. So with this pregnancy we knew she'd probably handle natural contractions like a walk in the park.

This time, her midwife started her first dose of IV antibiotics and gave her instructions to go home, pack her bags, make their miracle castor-oil recipe, and come back at 9 pm for her next dose and hopefully she'd be in labor by then. Her boyfriend Tim was out of town but met us at her house at about 7:30 p.m. and took us to Denny's for Ali's last pregnant meal. She had the hep lock IV port in her right hand, which she casually gestured with as she told me, "You always see the most interesting characters in Denny's," looking for all intents and purposes like a woman who has escaped the maternity ward for cheese fries and a grilled cheese sandwich with her two willing accomplices. She was having regular contractions about every 3-8 minutes at this point, but they were so mild she'd talk right through them and forget to mention them. Seeing as how this was at almost 9 pm, I knew I was in for a long night. I had specifically told her a couple days before to NOT call me too soon into labor because I needed to try to get some sleep and preferred not to spend an extra 12 hours or so "coaching" a woman that really doesn't need help yet. Instead, she kidnapped me for a taco at noon and just never returned me to my family. Oh, well. I had been really worried she would go into labor nearer her due date and I'd be off break and back in school and would miss the whole thing, so I was just happy I literally had nowhere to be and a husband who is fully capable of taking care of Ayden at home. So I told her I'd need sustenance and fresh clothes and she could just keep me indefinitely. I made her molotov-castor-oil-cocktail which she gagged down on the way to the birthing center, and Tim and I ruminated on what we were going to do all night, seeing as how Ali was still happy, bubbly, and completely unfazed by her mild contractions. At about 11 pm Ali agreed to go for a walk and try to speed things up and I was unprepared for the pace she would keep with her Amazonian legs, moaning softly and plugging away right through the contractions, determined to get the most bang for her exercise-induced-contraction-buck. About 10 minutes later as we approached the birth center, she yelped and said that the rest of her water had just officially broken and was flowing down her left leg. From then on the contractions got much more serious, and by 1 am she looked like a true woman in labor, moaning and generally not enjoying herself, although still texting between contractions only to vehemently spew forth indignation at some of the ridiculous suggestions virgins and epidurral-moms alike were sending to her cellphone (as Tim and I smiled at each other about her stereotypical labor crankiness). Soon after this picture was taken, her tub was ready and she eagerly got in, where she was able to move effortlessly into any position comfortable during contractions. She was the most active woman I've ever seen in labor, constantly moving and turning and generally traveling all over the tub, which the midwife said was very effective in helping the baby to move more easily down the birth canal. At this point I'm sure Tim was wondering how on earth he'd managed to wind up in a tub with his fertility-goddess girlfriend who was obviously in a lot of discomfort and dealing with it as her body saw fit by moving and moaning and being quite vocal (which I am a big proponent of) with three women encircling the tub who seemed completely unfazed by the spectacle and offering constant reassurance. When a woman is in heavy labor like this, its almost like she is completely gone and her body takes over like a primitive birthing auto-pilot. You can see from this picture how Ali is completely lost inside her own experience, constantly feeling strange sensations and urges and a bit shocked by the whole experience.
In a way it is very difficult seeing a friend or a loved one go through this, but knowing that this is all a part of the physiologic process of birth and that this is something she wanted makes it easier. At this point I was totally willing to "take a few contractions" for her and give her a break (they were every 3 minutes like clockwork since 11 pm), but of course this is not something one can delegate. Instead, when she looked me in the eye with her huge scared cartoon eyes looking panicked, I was able to lean in and tell her "You are doing great, you are ok, your baby is coming" and see the panic instantly dissipate as this simple message filtered down to wherever her consciousness was hiding, which has got to be one of the most satisfying things I get to do in this life.

Toward the end she wound up having the fabled "back labor" because Elijah was facing forward with his back grating against her tail bone, which has been known to actually break a woman's coccyx in labor. Back labor could effectively function as birth control for hoards of teenage girls if they had the opportunity to witness it. I will just say, it seemed very, very painful. Even so, between contractions she would have 1-2 minutes where she would quietly rest and take comfort from Tim, which her nurse said is worth 1 hour of sound sleep.
Every so often between contractions, Ali would surface and say something so totally casual and off the wall that she had us almost rolling on the floor. For example, after suffering through two particularly gruesome contractions back to back with almost no break between and generally about to lose her mind, something bloody floated by and she instantly snapped to attention and said in the most fascinated/excited little girl voice, "What is THAT?!" to which we all burst out laughing and her nurse fished it out with a fish net and said, "A fish, honey." Another time she was just coming down from a contraction that looked very much like it was about to break her back and then looked between her legs and serenely said, "Oh.... I'm peeing. Look, its yellow. Thats nice."

I had always wondered exactly how a midwife is able to tell that a woman is done dilating and ready to push her baby out, seeing as how the mom is left to labor in peace in the tub and not constantly being checked by nosy doctors and nurses as often happens in the hospital. Ali had been in the tub for 2 hours, moaning and generally acting a bit weepy during the contractions (perfectly normal and she was eagerly anticipating this sign that things were drawing to a close), then during one contraction things were totally different and she stopped writhing and got a focused look on her face and bared her teeth like a wolf and growled deep in her throat; it was positively primal and powerful and mama-bear all rolled into one and it gives me goosebumps just typing this. Judy, the midwife, wanted to check her cervix one last time to make sure there was none left so she could start pushing. As you can imagine, having somebody's hand in your vagina when it is already painful and occupied trying to oh, I dunno, PASS A HUMAN THROUGH IT, is not much fun. Judy felt a small anterior lip of cervix left, but said that she might be able to push it out of the way during a contraction and then she could begin pushing, but that it would be very painful. Ali agreed, and during the next contraction screamed bloody murder in Judy's face while she moved the cervix past the baby's head. Judy was saying, "I'm sorry, honey" as Ali bellowed and then all of a sudden Ali would take a breath and say sweetly "Its ok not your fault, AHHHHHHHHHHHHHHHHHHH!!!" It was crazy.

Within seconds Ali was pushing and I could see the head crowning as she leaned back against Tim who helped hold her thighs back for her. Her back was pretty much in agony at this point and it was all we could do to get her attention and tell her to keep her legs open because her baby's head was already out. One more big push amidst the blood curdling screams and he popped out, and Judy instantly lifted his head out of the water. Ali went from completely absentee and screaming to instantly present and literally snatched her baby from Judy's hands saying, "My baby!" Always the professional, I burst into tears and blubbered a bit. In the matter of a second everything she'd been through ceased to matter and she held her baby contently and said, "Tim, touch him" as she guided his arm around her and cupped his hand on Eli's naked bottom. It was beautiful.
Afterwards, Judy told Tim to change into dry pants and had him lie down on the bed and put Elijah, still covered in vernix, directly onto his chest and covered them both with warmed blankets. He stayed there for the next 20-30 minutes while we got Ali out of the tub and laid her on the bed next to them where she delivered the placenta and was told she had not torn. Lucky duck.

So that, ladies and gentlemen, is how baby Elijah was brought into this world. Every birth I attend I learn something new, and this one was no exception. It was fascinating how she went from a woman barely in labor at 9 p.m. and pushed a baby out at 3:30 a.m., which I honestly did not see happening. Back labor is also a new phenomenon for me, and something I spent the next 24 hours living in active fear of and rethinking my current plans of getting knocked up in the next 12 months. Seeing her suckle this tiny little thing as he gazes up at her adoringly has pretty much cured me through sheer jealousy, though.

And the best part of all this? I caught it ALL on video. >:)

An Itty Bitty Pity Party

I think nursing school has finally caught up with me. Today as I was kicked back completely horizontal in this funky chair waiting at my chiropractor's office when I realized it. As I laid there with my feet in the air it occurred to me just how unable I am to relax. I had absolutely nothing that I should have been doing other than waiting patiently for my God-Among-Men-Chiropractor to retrieve me and manipulate my throbbing back on his glorious torture wrack. Instead I lounged there with my eyes closed, outwardly appearing for all intents and purposes completely relaxed and at ease. Unfortunately, on the inside my heart was pounding, my muscles were tensed and poised for attack, and my mind was absolutely racing trying to figure out what I've forgotten to do, what I still need to finish, and what is coming up around the bend. Even though I accomplished an extraordinary amount of busy work in peds class today during our dependably dull guest speaker, my psyche still would not allow me a solitary moment of peace. When did this happen?

For example, twice already while writing the above paragraph I have clicked over to another tab and emailed myself a reminder to do something that I will most likely forget. Welcome to my life. I clog my own inbox with emails demanding that I "pay credit card!" or "pick up Rx from Costco!" or "submit outpatient paperwork!" or "wash beige underwear before clinicals!" Its depressing.

Lately I've been trying to remember what its like to have this thing people keep referring to called "time." I know there must have been a point in my life when I worked, came home, and spent the rest of the hours in the day doing what I wanted. Surely? What is it I did, exactly? Television? Cooking? Reading (for pleasure!!)? Was there a time that I actually spoke to my husband or child more than to just complain or relay instructions to wash hands, brush teeth, wipe his butt better (Ayden, not Dustin)? Because if there was I honestly cannot remember what it was like. The best thing I can compare it to is childbirth, you know it happened, you know the general way things went down, but you can't remember how it FELT. I feel like a goldfish who only has a 3 minute memory and whatever its been doing the last 3 minutes, that's what it thinks it's been doing its whole life. I've been stressed out, overworked, sleep deprived, and inundated with too much homework my whole life. Well, more like the last 11 months but it sure doesn't feel that way. I see friends and family members who go off to work and upon returning home do whatever the heck they want, completely taking that fundamental freedom for granted and I'm finding it increasingly hard not to be bitter. I come home, get on the internet, complain with classmates on Facebook which is equally as important as actual study time, sift through the 20 some odd emails I receive every day from MUSC demanding I do something or other, and sit and cry over the sheer load of memorizing and paperwork/busy work that comprises my daily education.

This semester has been particularly grueling because we are now in class and clinicals all 5 days per week, which leaves no time during the week to breathe or work on what's due the next day. It does help that I skip class as often as humanly possible, but that only gets me out a day or two and only when we don't have tests. That may sound like a lot, but we've literally had a test almost every single week for the past 11 or so weeks. Ahhhh! My weekends are inevitably spent typing, formatting, printing, highlighting, and doing my best to memorize 15-23 pages of size 10 font to be regurgitated a few days later for a test. My tolerance for such banal activities is minimal and inevitably leaves me cranky and using my time un-wisely (commence Facebook pissing and moaning here).

I keep telling Dustin to remind me that we always knew nursing school could be like this and that I walked into it with both eyes open. We both knew that he may wind up an MUSC widower, but I guess its just never been quite this all-consuming and up till now I've managed to keep my head above water. The only thing that gives me any sense of peace at all right now is knowing that in 136 days I will be walking that stage and accepting my BSN.

I'll sign off now because its time to go take my 8 pm sleeping pill and crawl in bed so I can get up at 4:30 a.m. and go take care of sick/dying children. My favorite. *sobbing silently*

Best Day EVER!

First off, I'd like to say that I know nursing school is not nearly as fascinating to everyone else as it is to me. ;) I feel that this blog is a good forum for me to record my experiences for posterity and that 10 years from now I can look back on these things and re-live what I will most likely have completely forgotten by then (knowing my pitiful long term memory).

I had my very first Labor and Deliver clinical on Tuesday. It was AMAZING! First off, I was assigned to do clinicals at Trident hospital, which is my #1 choice for where I would like to work in Labor and Delivery when I graduate in December. They are the most progressive of all the area hospitals. Jobs have been extremely hard to come by for the classes that graduated from MUSC in the last year because of the economy, so I have eagerly anticipated spending this summer getting to learn on the very floor I want to get a job, letting the nurses and nursing supervisor see me in action and (hopefully!) make them fall in love with me and want to hire me when I graduate. For that reason, every clinical I do there this semester is practically a job interview, and there is a lot riding on what happens there.

I started the morning off at Trident hospital introducing myself to my two patients, one of whom was a hispanic woman who obviously did not speak any English and was writhing flat on her back in her hospital bed (gasp!) in heavy labor, while her husband sat reclining in a chair texting and nodding his head as if he could understand what I was saying. Awkward! But having been on that floor, let alone that hospital, for all of 30 minutes my main goal was to stay out of the way and fly under the radar, so I backed out of the room. Within minutes, staff went pouring into her room because she was ready to push. I stood in the background and listened to the doctor try unsuccessfully to communicate with her. The only word of Spanish anyone in that room could speak was "puja" for push, so they just kept saying that over and over. Then I was told to grab one of the laboring woman's legs and hold it for her as she pushed, which is something I have thankfully done many times before. At one point the woman was not working with her contractions and pushing, and all the doctors and nurses were yelling "empuja!!!" but it just wasn't getting through to her. In the heat of the moment my shyness and reluctance to get in the way was overcome by the excitement in the air as I saw the baby's head starting to show, and I said to the woman, "empuja otra vez!" which means "push again." All activity in the room literally came to a crashing silent standstill, the mom almost jumped out of her skin and looked at her husband in shock, and my assigned nurse said, "you can speak Spanish?! For God's sake jump in there!" I spluttered and tried to explain to the staff that I really don't speak Spanish anymore and just know a little bit, but the energy in the room was as if I had saved the day and everybody was positively giddy. Just then the baby's head crowned and I told the woman in Spanish that I could see the baby's head. After her baby was born, the doctors were asking me to try to tell her all sorts of things and I did my best but it was just humiliating how little I remember. One of the nurses said, "You're hired!" You can imagine how great those words were to hear! When most of the staff had left, I stayed to help the mom get comfortable, put her bed back together, and help her get the baby latched on. The nurse who said I was hired was still in the room, and I said to her, "I'm going to take you up on this whole hiring me thing, this is where I want to work." She said to tell the boss that Tammi wants me, and that I speak Spanish. Come to find out, she was actually the charge nurse on the floor! Whoa! Needless to say, I will be brushing up on my Spanish before December.

Then I got to witness a medically necessary c-section and take care of the mom in recovery after her surgery. Something I thought was very interesting is that Trident has paid attention to the natural birthing practices that go on at the birthing center, and have changed a lot of their policies because of the great outcomes they've seen. One such change is that they now leave the c-section babies in the OR with mom until she comes out to recovery, where they bathe the baby in front of mom and dad and then put the baby naked and skin-to-skin on mom and encourage them to breastfeed just minutes out of surgery. I remarked to my nurse how great that is, and that my sister-in-law had a c-section there a year ago and her baby was taken to the nursery. This is when she told me that they implemented this new policy not even a year ago "after they got their heads on straight." That is why I want to work at Trident, they are paying attention to stuff and willing to change and not just do things the same because they've always been done that way.

Probably my favorite experience that day, though, was when I was helping that same mom after her c-section. She had breastfed her first child, but said she'd had a very difficult time getting it started. One of the nurses helped her roll onto her side and get the very eager baby to latch on and start nursing. When the nurse walked away, I asked the mom if she felt like the baby had enough of the nipple in her mouth, and she asked if I could help her check. The nurse, hearing us, came back and took a look and found out the the baby did not have nearly enough so repositioned them and tried again. She worked with them for a minute or so, and eventually walked away saying that the baby still didn't have enough in her mouth, but it was ok and that mom would just be a bit sore afterward. As a lowly nursing student who has had no classroom education on such things, normally I would not have intervened, but I am a mom, I have breastfed, and I would never let one of my friends do it badly in front of me without helping. Without even considering my place, I asked the mom if she wanted me to help her get a proper latch and I told her that that's where I went wrong with my child, getting blisters from his first nursing due to a bad latch. She was very appreciative and after about 30 seconds I had that baby latched on beautifully just as the nurse, who just so happened to be that same charge nurse, returned and saw this crazy nursing student manhandling her patient's breast looking to the world like she might actually know what she was doing. There were some raised eyebrows, but results do not lie.

By the end of the day I was walking on cloud nine. It was so fantastic to feel that I was finally doing something I am good at, interested in, but the best part was I walked away from that experience feeling that I really brought something to the table as a person. Usually in the hospital setting, us students are unsure, confused, and scared to death most of the time. But as a labor and delivery student nurse, I am already an expert at helping women in labor, I knew how to calm their fears, and I could help them breastfeed, and I walked in there like I had been there for years and did what I love to do most. This was my first time since starting school that I felt like I was MADE to be doing nursing! I guess it just took finally being give the chance to do the type of nursing I want to do.

I have discovered recently that I will need at least a year of labor and delivery nursing before I can apply to grad school for midwifery. At first this was devastating, because I did not particularly want to be a nurse and already feel that I've wasted nearly 30 years of my life not being a midwife already. But after talking to some midwives, I agree with them that one must master all the basics, especially the medical-type interventions such as fetal monitoring and cervical assessment before training as a midwife where these interventions are purposefully minimally done. Up until Tuesday, I had believed that I could only be happy working in a birthing center assisting with natural childbirth, and that seeing all the unnecessary interventions done to women on a routine basis in the hospital would suck my soul out. Interventions are wonderful, even life saving in certain situations, but certainly should not be done on everybody who walks through the door. But now I realize that while I'm spending this year learning the ropes, there is a lot of good I can do as a nurse working somewhere where high interventions are the norm. For example, none of my patients will be left to labor alone, flat on their back in a hospital bed which is the most painful position for a woman in labor. I will be that nurse telling them to get up, walk around, lay on their side, teaching dad how be helpful, putting the head of their bed up when they push, spending the extra time it takes to help them be successful at breastfeeding, whatever it takes to give them the best mother-baby outcome possible in their given situation. It seems like these are small things, but I think these are the type of things that a lot of nurses most likely do not take the time or initiative to do, and its what can make a painful and difficult process just a little bit better and give mom back some of the power that is taken from her on the hospital floor. I want to be known as the "super nurse" on the floor who's moms have the best support, most attention, and high success rates. At this point in my life, I cannot think of a better way to change the world than that.

Nursing School is Serious Business

May 21, 2010

Beware, ladies and gentlemen, this is the face of who might be taking care of you in your medical moment of need come December 2010.

Swans in Trashbags

Well, I've survived my first semester of nursing school. :) Well, I still have 2 cumulative finals and a proctor test over the next 2 days, but after going through the last 4 months this just seems like a hiccup. I have learned the most extraordinary amount of information, which I guess is a good thing since as of this moment I am 1/4 of a nurse. I am 12 months away from holding fragile sickly lives in my hands. Terrifying! But we're all terrified so I'm in good company. We learn a lot, but its taught in a totally different way. Instead of rote memorization, they teach us concepts. So acing a test really isn't about memorizing lots of trivia long enough to regurgitate it for the exam, but really understanding how things work and why you need to do what you do. Which is good, because my brain refuses to retain what it deems as useless knowledge. Every question on the exam starts with, You have a 48 year old female patient with.... then gives you a scenario and they ask any number of things. So if you really know how the body works you can generally reason your way through to the right answer. That being said, its still an unholy amount of stuff you just have to know, and I've never been so happy with 3 A's and a B before in my life. I will never understand how I got an A in the class who's teacher's name has become my class's unofficial swear word, but I'll take it!

I started the downhill slide to Christmas break by having my final evaluations with my clinical instructor at the VA. Let me just mention that she is one of the BEST teachers we could have asked for. She is unfailingly patient, kind, and protective of us. We follow her from floor to floor like she's our mama hen and we are her chicks, only she lovingly refers to us as her "swans." Quite a stretch for anyone who has seen us in in what we nostalgically refer to as our "button down trashbags" (white nursing uniforms...nobody, let me repeat NOBODY looks good in these things!). In my evaluation she said she wishes she would have taken a video of us huddled around the nurse's station our first day looking terrified and green around the gills. I will admit, she kept telling us it gets better but none of us actually believed her. Just as we got comfortable with the staff, the floor, and the basic concept of manhandling old men, the semester is over and they kick us out. She did say something to me, though, that absolutely made my day/week/month/semester. She said that I have one of her top 3 all-time favorite bedside manners. That she loves the way I deal with patients and how I come across as friendly, genuine, and confident and that it makes the patients feel safe. This meant so much to me, especially since I actively dreaded every Wednesday clinical at the VA for the first 7 weeks or so, thats how far outside my comfort zone I was. Then I had this really great 83 year old guy, a stroke patient who could barely walk and only had use of one arm. For some reason I just turned a corner with him, and saw that even though most of what I had to do horrified me, he really needed my help and it felt REALLY good to help him. As he sat on the toilet in nothing but his birthday suit I washed his back for him and put lotion on and he told me how great that felt. Something so simple. Granted, at that point I was blissfully unaware that in a minute's time he would provide me with what has come to be my classmate's favorite story for me to retell over and over, complete with hand motions. They encourage us to have the patients do as much for themselves as possible because its good exercise and keeps them moving their joints. So when he was done on the toilet I handed him a warm washcloth and instructed him to go ahead and clean his "bits" while he was standing there. He was hardly stable, so I held him securely by one elbow while he did so. As you can imagine, his face was only about 12 inches from mine and he proceeded to vigorously wash himself for 3 minutes straight... looking me straight in the eye for the duration. *here you must picture me doing an impersonation of him, beady-eyed, breathing heavily, whole body shaking from the exertion* It didn't get weird until about the 1 minute mark, then I was like, uhhhhhhhhhh..... is this OK?! Just then my instructor, Nicole, popped her head in the door and said, "Kayte, you doing ok in here?" I said a perky "Yep!" with only a slight note of hysteria in my voice. After working with these old guys all semester you see that very few nice feeling things happen to them and I'm much more understanding of an extended tryst with a warm washcloth.

My next fun patient was, I kid you not, the cutest old man any of us had ever seen. Even my instructor said so! He was 85 with Alzheimer's, but just the most pleasantly demented person you ever could meet. When we got to the floor and were waiting to get our nurse assignments, a nurse standing next to an old man strapped into a walker-slash-chair contraption said, "This one belong to any of you?" Sure enough, there's my patient, placed in front of the nurse's station so they can keep an eye on him. She said, "Good luck with that!" when I claimed him. A moment later one of my classmates tapped me on the shoulder and informed me he was trying to escape. I looked over and he was working at his seat belt with his breakfast fork. Yup, it was gonna be that kind of day. Within minutes he was out of his belt, had figured out how to open the walker's gate, and was headed down the hall. It took 3 of us to get him headed to his own room, but he was laughing and giggling the entire time so that makes up for part of it. I ended up dragging a computer station into his room so I could do my charting at his bedside because he was a 90 lb. version of Ayden when he was 1, constantly on the go. At one point I was unable to persuade him to stay in his own room and we ended up in another patient's room, where my patient proceeded to climb in this poor guy's vacated bed. The whole time I'm pleading with him and trying to convince him this is not his bed, he's looking at me with what my father would have perfectly described as a "shit-eating grin" on his face, and told me, "Now THIS one is comfy!" as he gently bounced his bottom on the mattress. I actually had to go get my instructor and tell her my patient was in somebody else's bed and I can't get him out (I may never live this down). When I got him back to his room I handed him a newspaper and put his reading glasses on his face in hopes it would keep him entertained for a minute, which lasted all of about 5. After that I asked his roommate if we could use his playing cards and proceeded to play poker with my patient, who kept hinting that he knew how to play strip poker then would collapse in a fit of giggles and snorts. After about 30 minutes of this, his roommate's wife came in and I overheard her complaining that she couldn't find her husband's reading glasses anywhere. Panicking, I took the glasses off my senile patient's face and sneakily slipped them onto the bedside table behind me, only to hear her 10 seconds later turn toward me and say, "Oh, here they are!" OMG. I had my patient wearing another man's glasses while he didn't even own any glasses himself.

Here is a picture of my clinical group and instructor on our very first day at the VA, trying not to look as terrified as we felt. Nicole, my instructor, is the pretty blonde on the left.