Monday, August 17, 2009

Twitter, life, etc.

I'm using Twitter now. It was bound to happen. Early in Twitter's fame, I thought that I would succeed in abstaining from yet another social networking website, but I guess since a bunch of Iranian protesters used it to 'fight the man', it has a little more legitimacy in my mind. It's a cool way to pick up little nuggets of information. I suppose as long as I'm reading neuroscience tweets and my friends' updates, it's not all that bad. If I start reading celebrity tweets, I probably need to go ahead and be fully assimilated into the borg.

I'm gearing up to start grad school in a couple of weeks. I'm pretty excited. I've read the first chapters of all my books already. I'm just that cool.

I'm studying for my CNRN (neuroscience nursing) exam in October. Next summer I'll try for my CCRN (critical care nursing). Then I shall be unstoppable.

Angie and I are expecting a new baby! Feb. 14, 2010 THE SEQUEL (or our Sophomore release)

We got a dog! Max is a 3 year old male boxer, and he's huge. He's really nice and well mannered. He's house trained and takes all sorts of abuse from my daughter. He's just that cool.

I'm still keeping it real in ST(N)ICU. I was offered an interview with the Community Nursing department at Parkview a while back, but I declined (even though I applied, I really didn't think they'd give me an interview). I just can't leave the unit yet. I have a lot to learn, plus I feel like I'd lose my clinical skills. Hmmm... a 9-5 job with 1hr lunches outside the hospital where I get paid more to do easier work vs. 3a-3p job with 30min lunches in the break room where I get paid relatively little to do very demanding work. I think I have a mental disorder.

Wednesday, July 8, 2009


I've been obsessed with the brain lately (more than usual). It started when I read Oliver Sack's "The Man who Mistook His Wife for a Hat". It reminded me to keep the "mind" in mind while considering the brain. From working with acute CVA and neurotrauma populations, I have developed a tendency to think of neuroscience in terms of Glasgow Coma Scales, hemipalegias, aphasias, and all that spinal (not nearly as cool as cerebral) stuff. I had lost sight of the whole reason neuroscience attracted me in the first place: the philosophical intrigue of the matter that modulates my very existence. This rekindling actually started me on a bit of a neuropsychology obsession for a couple of days until I realized that many neuropsychologists are PsyD's or PhD's and not MD's. Lame. My attention quickly returned to neuroscience nursing, which is great because it can be neuropsychology, neurology, neurosurgery, or wherever I find myself when I'm all grown up with my graduate degrees, certifications, years of clinical experience, and prescriptive authority. (My name will be warped into some long, bizarre code of nursing bragging rights: Willard Keith Cupp, III, DNP, FNP-C, CNRN; for now I have to settle for Willard Keith Cupp, III, BSN, RN.) Whatever field of medicine my nursing practice ends up becoming associated with, the holistic nature of nursing should always lead me to consider my patients' existential state and their ability to cope with the stressors in all domains of their environment not just make a tally of their physiologic deficits.

I finished "The Man Who..." and I read most of "Awakenings" before I had to return it to the library. I would like to finish it someday. I'm currently listening to "Musicophilia" as a book on CD during my drives to and from work. It's given me plenty to consider, not the least important being the possible long term effects of a mild-moderate concussion I suffered in my junior year of high school. Gliosis? New onset of seizures twenty years from now? Will I be haunted by temporal lobe epilepsy or musical hallucinations? I highly doubt it.

I'm also reading a book about dreams and sleep. The exact title and the name of the author escape me for the moment, but it's by some prominent sleep doc with some hot-shot post at some Ivy league school. (Let's hear it for citing sources!) It's interesting, but I'm just getting started on it.

I'm also slowly perusing my Neuroscience Nursing text and refreshing myself on the finer points of neuroanatomy and pharmacology with my old texts from my first semesters of nursing school. I really need to start gearing up hardcore to study for my CNRN before school starts. For some reason, I'm becoming a big fan of the basal ganglia. Hmmm.

Friday, July 3, 2009

Mind your QT intervals...

***This is a modified retelling of a real clinical experience. The details have been changed to protect the privacy of the people involved.***

Some time ago, I arrived at work at 0300 to be assigned to (along with a 36 yo M s/p MVC) a 70-somethings male in no apparent distress who was admitted to Neuro ICU per the Neurosurgical service s/p being found down at home by his spouse and presenting with a 'tiny' right parietal subdural hematoma on CT scan of the head w/o contrast enhancement. In report I was told that he had no neurological deficits and that he was hemodynamically stable. The only problems he had overnight were EKG disturbances.
He had a seven beat run of VT and his EKG tracings had changed from a sinus rhythm in the 60's with occasional PVC's to an irregular, bradycardic, sinus rhythm with what appeared to be slightly wide complexes while throwing more frequent PVC's. Cardiology had been updated several times throughout the night, with orders stating that this tracing was acceptable and that nursing should call cardiology if the rate was sustained < 40BPM.
I began my care with some apprehension r/t his rhythms, but more or less eager to perform a thorough neurological assessment to see if I could isolate some small neurological deficit. We proceeded seamlessly through my assessment and had made it up to testing recent memory. I had given the patient three words to remember and I told him that I would ask him to repeat those three words in five minutes. We didn't make it that far.
I had turned to the computer in the room to begin charting my assessment findings when I noticed that the bedside monitor was sounding a red alarm. Bad news. Sustained V-Tach on the monitor. I rushed to the bedside. Weak pulse. Patient rapidly became short of breath, his eyes rolled back. Pulseless.
"Call a code!"
I smacked the code blue button on the wall, dropped the bed into position, slid the backboard under the patient and began compressions (crushing his poor, aged rib bones like toothpicks).
"Call Cardiology! Page Neurosurgery! Did anyone call that code yet? Why haven't I heard it?"
Of course it had all been done. The team in the unit works seamlessly as always.
My co-workers rushed in. Techs were bringing carts, supplies, and making calls. Other RNs were hooking the patient up to the defib, getting the drug box, and starting the code record:
1 amp epinephrine
Still PEA...
1 shock delivered... converts back to PEA: sinus rhythm in the 30s
1 amp atropine
Cardiologist arrives (a USELESS hospitalist had been there the whole time... anyone can read straight from the ACLS protocol... he fled the scene as soon as the Cardiologist arrived and couldn't be reached by phone.)
still PEA, compressions
1 amp epi
1 amp bicarb
weak pulse
transcutaneous pacing initiated to keep HR > 50

The patient was quickly taken to the Cardiac cath lab to get a transvenous pacer.

Outcome: Patient left the ICU after receiving an AICD a few days later. I never took care of him again, but it turns out that somewhere along the way, he did have a CVA... I wish I had the chance to look into that more. Fortunately his deficits from his stroke were very minor, and I have to think that things could have ended up much worse if effective CPR hadn't been started right away and the nursing staff hadn't done such an excellent job of working together for this gentleman.

Of interest: The neurosurgeon was actually angry at us for calling him at four in the morning to let him know that the patient that his partner had admitted was coding. Maybe it's not standard practice to let an admitting physician know when his patient is dying... Beats me.

The bottom line: This guy needed a pacer. His heart decided that 1.25 hours into my shift was the perfect time to issue an ultimatum. He got a pacer.

Sunday, June 7, 2009

To Recap...

I haven't posted since January, but I have been prompted to do so by a buddy of mine, so here we go!

I finished my bachelor's degree this semester. Upon hearing the news, many people ask me, "So, does that change your job title or anything?" The answer is no. It doesn't change anything on the surface. Basically, it gives me the opportunity to go on to grad school, I get a small bonus from Parkview, and it gives me more opportunity for advancement.
I am looking forward to grad school. My RN to BSN program focused on nursing leadership, community health nursing, etc., but I am looking forward to learning more advanced pharmacology, pathophysiology (related to pathology), and physical assessment skills. It's exciting stuff.

We moved. We bought a house in Wolf Lake and we love it. We have a lot of stuff we'd like to do to it, but it's in pretty good shape, and it's much better for Anika. Plus, we have a yard!

Music? Oh yeah, I like that don't I? I used to have time to do anything with it? Yes, I seem to recall.... It's all coming back to me!
Anyway, I've been trying to keep up with practicing my guitar and doing some digital stuff, but it's difficult with eveything else I'm doing. I think I should focus on making digital music since I do enjoy it so much, but I'm worried that I would then lose my physical abilities on the guitar, banjo, etc... It's a dilemma!

Anyway, I'm lovin' life! It is good, despite my inability to keep pace with all of my obsessions.

Wednesday, April 15, 2009

New Blog

I've decided to start a second blog. This one will be focused more on professional issues. Sure my profession is a big part of who I am, but I think I would be more comfortable splitting the two up. You can check out my new blog, On the road to advanced practice nursing.

Saturday, January 24, 2009


China reports 4th bird flu death in 2009
The Associated Press
Published: January 24, 2009

BEIJING: A woman in China's far west has died from the H5N1 strain of bird flu, the Health Ministry said Saturday, the country's fourth death from the virus this year as the biggest festive season approaches.
The victim, a 31-year-old woman from Urumqi, the capital of the Xinjiang region, had been to a live poultry market before she fell ill on Jan. 10, the official Xinhua News Agency reported, citing Wang Xiaoyan, a deputy director of the regional health department. She died Friday.
A woman in eastern China, a teenage boy in southwest China and a woman in Beijing have also died from the disease this month.
A 2-year-old girl was also sickened with H5N1 but recovered. The Health Ministry said her mother, who like the toddler went to a live poultry market, had died of pneumonia in early January. Doctors said they could not confirm the cause of death.

Tuesday, January 20, 2009

Don't take your eye off the ball...

From Reuters AlertNet,

China warns of "grim" fight against deadly bird flu

21 Jan 2009 00:29:01 GMT 21 Jan 2009 00:29:01 GMT
Source: Reuters

BEIJING, Jan 21 (Reuters) - China faces a "grim" situation in preventing and controlling human cases of bird flu, the health minister said, after announcing four human infections in the last two weeks and three deaths.

Health Minister Chen Zhu called for hospitals to spare more resources in diagnosing and treating bird flu and more cooperation between agriculture authorities and his ministry, Xinhua news agency said.

A Chinese newspaper reported that the mother of a toddler diagnosed with bird flu had died of severe pneumonia earlier this month, but no samples had been taken to see if she had bird flu. She had been in contact with poultry before her death.

The toddler, and the three recent fatalities, have all fallen ill in areas where there have been no known cases of bird flu in birds. China vaccinates heavily for bird flu, raising concerns among some experts that the vaccines could be masking the presence of the virus.

"The current cases are separate cases. There's no connection," Shu Yuelong, vice director of virus control and prevention with the National Centre for Disease Control and Prevention, was quoted by Xinhua as saying.

"But these cases warn us to improve prevention and supervision over the epidemic and ensure early detection and diagnosis when new cases are found."

The H5N1 strain of flu remains largely a virus among birds, but experts fear it could change into a form that is easily transmitted among humans and could spark a pandemic that could kill millions worldwide.

Since the H5N1 virus resurfaced in Asia in 2003, it has infected 391 people, killing 247 of them, according to WHO figures released in mid-December.
At least 34 people have been infected in China and 23 have died.

(Reporting by Lucy Hornby; Editing by Nick Macfie)


It's still out there, people. If you're not prepared, get prepared.

Monday, January 19, 2009

Come on, America!

Compare the above news sites. The top is the BBC's health news page, the bottom is CNN's. Take a moment and compare the two if you will. The BBC has stories about cutting edge medical advances while CNN has Dr. Gupta revolutionizing modern medicine by curing our inaug-aphobia or whatever. Okay, I admit, if you give the CNN page a second or two, the main story changes, and there was one that might possibly have some interesting neurology in it, but of course it was about eating. CNN seems to be focused on stress, eating, and China's plastic surgery queen, while the BBC is talking about the genetics of cardiology, curing previously incurable diseases, and *perhaps with an eye towards the prurient* something about sperm. Anyway, I stopped checking regularly a long time ago. These days I stick to drudge report and the bbc. good news is hard to find!

Thursday, January 15, 2009

Back at it! School, Politics, Nursing, etc...

Yes, it is back to school time. I'm taking Nursing Leadership, Professional Seminar III (Legal and Professional Issues), and Transcultural Healthcare (the one I dropped part way through last semester). It's shaping up to be an okay semester. It's the last semester before graduation, so how could it not be good!
Last semester was sort of rough due to some dramatics between our class and a new professor. I'll just say it wasn't a great start for her at IPFW. She really seems to have a heart for CHN, but the way our class sessions were organized and executed made it difficult to know what to expect on the tests. It was sort of a trainwreck. Despite the turbulence, I came out with an A in the class, so it's all good.
I'm recomitted to staying organized this semester. I say that pretty much every semester and then end up getting off track halfway through, but I think working in the ICU has drastically improved my organizational abilities. I invested in a very sleek, black planner that outlines every day in 2009 down to the very hour. I have actually been using it and taking it to class and work, and so far all is well.

Well, prepare to share the wealth, my friends. America has opted for "change" and is being rewarded for it by getting an executive branch with a lot of old Clinton-administration folks and other Democrat party fixtures. Also, DR. SANJAY GUPTA HAS BEEN TAPPED TO BE THE NEXT SURGEON GENERAL? REALLY? Maybe Oprah needs a position in the State Department. I guess Dr. Gupta is a neurosurgeon and all that, and I'm not really clued in to the Surgeon General's job description, but I'm guessing that there are probably docs out there doing more substantive things than cute little news segments on CNN, that are probably better candidates for the job than ol' Sanjay. I guess it's sort of a symbol of part of the reason I'm not crazy about this administration. Barack Obama is sort of a pop star in my eyes. Yes, I realize the fact that being popular is sort of the way a politician succeeds in a Democracy, but I feel like a lot of people like Obama for the wrong reasons. Anyway, I hope Barack and Sanjay both do a great job for America and our health care system.

Anyway, it's not like we have a great alternative to Obama right now. The Republian party has abandoned conservatism for a sort of (cliche, I know) fascism. I'm not sure what else to call strong support for the welfare state mixed with strong nationalism and 'interventionalist' foreign policy. The Republicans need to get back to a more libertarian conservatism along the lines of Ron Paul or Berry Goldwater. They would have to figure out how to market it, but without standing for truly conservative principles, the Republicans will just languish in their current invertebrate state.

On a side note, one thing that gets me about the Democratic Party, is how they can feel like they're civil libertarians while supporting socialist economic policies. How can you be free when the state is footing your bills? The government controls the schools, so they control what our children learn. When the government pays for your healthcare, they will tell you how to live. Both parties are chipping away at our freedom in their own ways. They make it seem good and necessary, but in the end, they are insidiously stripping us of our liberties. The patriot act from one side, nationalized health care from the other. We need to recommit ourselves to proteting our freedoms in this country.

Well, I've been in the STICU for a year now! It really doesn't seem that long... I've learned so much, but it's just the tip of the iceberg. So far I enjoy caring for septic and neuro patients the most, but I am really interested in critically ill patients in general.
My practice is evolving every day. Between work and school, I am going through a lot of growth as a nurse. Every time I show up on the unit, I learn some new aspect of how a certain presentation is medically managed, or I see some unique way that a client psychosoially adapts to their new circumstances. After each shift I am better able to anticipate the needs of my future patients. School is also augmenting my care by teaching me to apply nursing theory and research in new ways. Community health nursing taught me how to better integrate my patients' cultural backgroud into my care, and how to assess families as clients. It also improved the case management side of my practice. I look forward to learning more about the legal aspects of nursing this semester as well as how to improve my nursing leadership abilities.
Basically, I'm loving my job right now, despite the usual complaints. Staffing, pay, prestige, all the things that nurses usually don't get! I love the nursing, it's all the things that get in the way of my practice that get me down.

Are Angie, Anika, and I moving to Albion? Probably not. Everything was going swimmingly until we couldn't get the loan. The loan officer at the bank said he has never seen conditions like this. Our credit is pretty darn good, and no one really expected us to have difficutly getting financed, but that's life. We're still negotiating with realtors, but it looks like it's probably not going to happen. Sorry!

Music: I don't get to practice/play enough right now, but summer's coming! Plus, I bought a glockenspiel! Well, actually it's a student bell keyboard set, but it's a lot like a glockenspiel! THE WELCOME WAGON IS THE SWEETEST MUSICAL GROUP SINCE SUFJAN STEVENS! Okay, that's not very long ago, but they're very awesome. They're on the asthmatic kitty label and Sufjan Stevens produced their music. The group consists of a Brooklyn preacher and his wife singing music in the style of traditional Christian hymns with Mr. Stevens' signature sounds to back them up. It's folky and it sort of reminds me of the 150 year old Church in the middle of a cornfield that I used to go to as a kid (that's a good thing).

Movies: I guess a lot of people didn't like it, but Angie and I thoroughly enjoyed the movie, Seven Pounds starring Will Smith. Yeah, it was extremely emotional and improbable, but I personally enjoyed the darkness, the psychology, and the overall feel of the film. Plus, it has a very endearing love story or some such girly thing like that.....

Oh yeah, it's X-TREMELY cold outside.

I'm done now.