Semester Four, Week Thirteen

Completed two more practicum shifts this week; one more to go next Friday, the 29th.

Sunday, my preceptor and I were on short stay procedural/cardiology, and the patient load was light enough that I was able to assume total patient care for our four patients. At the onset, it was admittedly a bit difficult getting together everyone's medications for the morning (we're talking 15-20 meds each!) As well as doing assessments, but, I prioritized care and got everything done. It was a great day, and true to how it always works out, I cared for a Jehovah's Witness patient with a GI bleed/anemia, and while a blood transfusion was what she "needed" she was able to have her volume replaced, and was later discharged. 

I also had a patient who was in alcohol withdrawal, and her CIWA score was 2, in regards to confusion on date, even when looking at the white board in her room signifying the date, she couldn't clearly identify what day it was. Anyway, her ammonia levels were elevated at 38, and she told her physician that she would refuse lactulose, because she did not enjoy the diarrhea that comes with it. (Side note: I was really excited when I heard the physician discussing lactulose, and I immediately knew I needed to check her ammonia levels).

My preceptor suggested I go in and talk with the patient, so I pulled up a chair next to her bed, and utilizing the information I learned in med-surg (woo hoo!) I held a theraputic conversation, specifically regarding AA, but also how lactulose works and how it will help her elevated annomia levels. I did not attempt to convince her of the need to take the drug, and I informed her that taking the medication was her decision, and she could refuse it, as that was within her rights. However, at the end of our discussion, she stated that she would like to take the medication after all. Both the physician and my preceptor were impressed!

During our second shift, we were assigned to the ICU, and it was admittedly a very hard day. Our assigned patients were stable, but in the room down the hall was a dying 22 year old patient, diagnosed with leukemia two weeks ago, and that morning, it was determine that she was not responding to dialysis, and despite best efforts, her pH was 6.8. As a direct result, comfort care measures were initiated.

Throughout the day, multiple family members and friends came in to say their goodbyes, and the sound of crying was heard nonstop throughout the day. The staff was clearly overwhelmed, as both this patient was dying as well as one across the hall; another young individual, diagnosed with interstitial lung disease.

Near the end of the clinical day, she died. After her family and friends had cleared out, preparations went underway to prepare her body for the morgue. I felt the need to help, and asked how I could do so. In addition to disposing of all the IV medications and fluids that had been administered, we prepared her body. 

While I have helped with the aftercare of the deceased a few times in my life, this situation felt different. For one, the patient was so young, and I was taken aback by the tragedy and destruction that cancer causes. She had presented to her physician two weeks prior with a sore throat, and diagnosed with cancer. Treatments failed, she developed ARDS and respiratory failure. It was a downward spiral, and as we cleaned her body, I couldn't help but think of all the life events she would never get to experience; 22 is far too young to die.

While placing her in the body bag, her nose began to pour blood. Her skin was jaundiced, edema all throughout. She looked peaceful; I kept looking at her hair; it was evident that she had just had it colored. She had a fairy tattoo on her right forearm, and the long dark eyelashes, and I wondered who and what she was like when she was well. It was an honor to aid in preparing her body for the morgue, but incredibly sad, and an excellent reminder of how precious life is. In that moment, it didn't matter that I had just put in over 12 hours, didn't matter that I had homework to catch up on, that I was exhausted and sleep deprived. What did matter is that a young life had been lost; someone who was clearly loved.

We spend so much time not saying the words that need to be said to people, not investing in friendships and relationships; letting people exit our lives because of conflict or strife. The loss of this young woman's life was, and will continue to be a solid reminder to strive for consistency, love, integrity and honor, in my professional practice as well as my personal life.

Semester Four, Week Twelve

In what perhaps is the greatest moments of my nursing school career, I finally had the opportunity to watch an open heart surgery this week. It was the most incredible thing I have ever had the opportunity to be a part of. From the first cut, to peering down inside the patient's chest as their heart was operated on, to the stopping of the heart with ice and potassium, to the repair and closure, this was actually one of the things I've always wanted to see, and now my heart is glad, having been given such a phenomenal opportunity that I will never forget.

Nothing can top that medical experience, but I also did watch a cardioversion, and a transesophageal electrocardiogram, which really makes me stop and wonder if God is wanting me to enter into a cardiology profession, considering 3/4 of my nursing career has been surrounded by the heart, and man, do I love it.

Also watched a colonoscopy this week, which, while it was not entirely thrilling, it was enjoyable, and I learned a bit. Also, to make me feel extra "nursey", I placed in IV in a gentleman who stated that he is a tough stick. There are few things that make me feel less like a nurse than placing an IV. Everyone has their niche.

My practicum site has been nothing but phenomenal, and I would be so incredibly honored to work there, I have decided. I am hopeful, but remaining ever open to the possibility of something more.

I met a kind employee at my practicum site, and have been pleasantly surprised with how refreshing, and nice some people can be. Its times like this that make me feel really sad that nursing school is coming to an end, because here, in this moment, life is beautiful. Yes, I know it's always beautiful, but within this context, I am at a place of hope, joy, and (almost) rest.

Three more shifts to go, and I will seriously miss this practicum; I'm having the time of my life.

Semester Four, Week Eleven

I've had a most magnificent week, really. It's times like this that make you wonder how life could get any better, but also, if you're a pessimist with a history of things going bad-wrong real quick, wondering what's next, what's ahead, what could go wrong.

But, let's focus on the positive, mmmkay?

I spent 1.5 fabulous days with my preceptor, day one in the ICU, day two in what is known as short stay and procedural, meaning overflow med-surg patients and post-op from stents and pacemakers.

The ICU was incredible, as always. So much happening, so many critically ill patients. I think I want to one day get certified as a critical care nurse.

But anyway, I finally felt brave enough to suction a ventilated patient, and did so. I enjoyed it oh so much, and that probably qualifies me for the looney bin. I love medicine. I love this field. Some days, (most days) I catch myself and wonder how on earth all of this possibly happened, how I could be so incredibly blessed.

One patient referred to me as malak, which is Arabic for angel. Ahh. Angel. :)

Day two was also great; we were on a step down unit, and my preceptor gave me four patients to manage on my own, and while a bit bumpy, I really felt like yeah, I can do this. I can easily be a medical-surgical nurse, though that is not my dream, I could do that for a time. I enjoy assessing, giving meds, calling the shots, giving shots, starting IV's, setting up the pump. It feels....right. I'm certainly more and more comfortable at the bed side.

Last week I was notified that I had been nominated by my nursing faculty for an academic excellence award. Not only was I notified, but I won. I have never one anything in my life, and downplayed the award reasoning that it was either an error or something everyone gets. When I mentioned it to a faculty member, she squealed in delight and told me the vote was unanimous; the nursing faculty at my school nominated me because to them, I am excellence, I am what nursing looks like.

This was certainly one of the most amazing, humbling, awe-inspiring, giving praise to God moments in my entire life. Anyone looking back on my story can see how far the Lord has brought me, and what He can and will do with a life that is completely surrendered to Him.

So, Thursday, I cut out of clinicals early to attend my award ceremony. I initially wasn't going to go, but my preceptor heartily encouraged me to do so, and I did, and I am so thankful that I was in attendance. The speech my instructor gave to the audience about me was beautiful. I kept thinking how I don't deserve this, how this award is merely because of Christ in me, and to be honest, it so isn't about me. And that is fine by me.

After all was said and done, I needed to take a walk and be by myself. With all the fan fair, I found myself being distinctly disappointed, and needed some time to figure out why. The answer was simple; while the victory was great, I had no one close to share it with. My family was unable to attend, one friend attended the ceremony, but had to leave shortly afterwards, and in the quiet, I realized, I'm super, duper alone. It would be so incredibly nice to have someone take me out to dinner and celebrate this accomplishment, help me feel like I matter. I know, this isn't about me, and I shouldn't be so self-centered, but as it so often goes, the desire of my heart is to have someone to partner with, especially as I've gone through this unbelievable journey. Its been such a time of learning to be alone, savoring victory, and learning defeat. Sometimes I'm just so tired of going at it alone. One may argue: You have friends, family, co-workers, and it is true, altogether so very true, but none of them can fill that gap in my life that a companion could fill. Again, sorry to make it personal, but here it is, guts and all.

Guess there are some prayers that just don't get answered, no matter how many times its prayed.

Semester Four, Week Ten

Well, I have finished week one of my practicum, and I must say, it started off on a most positive note. I wasn't sure what to anticipate initially, but my preceptor was fantastic at communication even before we met, so that made this transition process a lot easier. 

Day one was spent in the ICU, and it  was initially scary, realizing how critically ill our patients are, the sounds of venilators everywhere, and me having no ICU experience. However, my preceptor gave me a piece of practical advice, which set my heart at ease: Assessments are the same whether you are in the ICU or on a less critical unit. Look at the patient as a whole, evaluate their needs, and treat accordingly. With that, our day began with two patients: One had an anoxic brain injury due to a respiratory/cardiac arrest in December. He was young, and it was evident that he would not ever be returning full-functioning capacity. There were no voluntary movements, his Glasgow coma scale was 6 (anything below 9 indicates a coma), pupils were nearly non-reactive. It was a tragic case, and as I looked at the photograph at his bedside, taken not too long ago, I saw what once was a vibrant, healthy man. Before me was a patient with a blank stare, completely dependent on the care of others. However, as I've learned in school, just because a patient is deemed comatose, that doesn't mean that she was incapable of hearing what we were saying, and so with each intervention, my preceptor and I were conscious to tell the patient what we were doing. He later received a tracheostomy for continuance of respiratory care, but his secretions were so copius, even with the administration of anticholingerics, which aid in drying up said secretions. It definitely was a case that caused me to stop and evaluate the sanctity of human life, and what makes a person "alive". 

Our second patient was a post-operative abdominal aortic aneurysm repair, who was recovering well physically, but emotionally was fragile, recalling the series of events that led to her emergent surgery. Chest pain had begun acutely immediately after a shower days prior, and he described a pain that was severe and non-relenting. Her husband had brought her to the emergency department, and per the patient, some time passed, as staff had ruled out a heart attack, but during a CT scan, it was identified that the patient had a dissecting ascending aortic aneurysm (read: EMERGENCY!!!) Post-operatively, the patient had some delirium, self-extubating, but the patient was heavily reflective upon her emotional trauma, so she and I spent some time conversing throughout the day, having a healthy therapeutic conversation about her experience and recovery. She had wonderful social support through her family, and would soon be transitioning to a step down unit.

Day two, my preceptor and I floated to the intermediate care unit. Our patients weren't especially heavy; two admitted for cervical spine fusion, and an elderly patient with diverticulitis, with a long history of heart failure, COPD, chronic kidney disease and a recent acute kidney injury, due to dehydration. Initially, when the patient had been admitted, he was hypovolemic, then inadvertently fluid-overloaded, but as his time in the unit progressed, the attempts to diurese him were unsuccessful; he had a poor urine output, with only 25-50 ml's out, every few hours, resulting in about a total of 100 ml's for the day. He had expiratory wheezes, dyspnea, no appetite, poor intake, tachycardia....clinically, he was not looking well, and a palliative care conference was planned for this weekend. 

I had the opportunity to watch a heart echo, and afterwards, the technician showed me some prior cases of his that were definitely beneficial to my learning. I watched the heart valves opening and closing, and for the first time, was able to finally visualize what blood flow looks like; suffice it to say that it was an incredible learning experience. The technician also showed me an echo from a patient that had recently been in the ICU, admitted with a pulmonary embolism. In addition to his PE's, a clot from a DVT had also broken off into his heart, and, during the echo, the clot was seen, literally seen floating around the heart! Granted, as the tech explained, at that very moment, the patient was unconcious, intubated, and had multiple doctors surrounding him, attempting to save his life. Perfect time and place, for a patient with a clot in his heart, if one must have such an event happen. The imaging was unbelievable!

I'm really enjoying this experience and look forward to my development as a future nurse. I've already had an opportunity to place a dobhoff feeding tube, started an IV, and medication administration without being watched; which is a new, and exciting freedom. I am hopeful to gain more confidence in my patient care, especially when auscultating heart and lung sounds. I look forward to my continual development in patient care, managing multiple patients at once, providing total patient care. After graduation, I would love to be placed in a new grad nurse residency program, so my preceptor is helping to facilitate that by introducing me to managers on each unit. It is wonderful, and I am so thankful.