Murse 53

Twitter, life, etc.

2009-08-17T02:39:00.002-04:00

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.

Cerebrophilia?

2009-07-08T22:17:00.002-04:00

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.

Mind your QT intervals...

2009-07-03T23:13:00.002-04:00

***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...
Compressions
1 shock delivered... converts back to PEA: sinus rhythm in the 30s
Compressions
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
compressions
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.

To Recap...

2009-06-07T15:26:00.002-04:00

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

School
--------
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.

Family
-----------
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
---------
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.

New Blog

2009-04-15T01:12:00.002-04:00

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.

Again...

2009-01-24T15:45:00.002-05:00

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.

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

2009-01-20T21:11:00.002-05:00

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)

"
http://www.alertnet.org/thenews/newsdesk/PEK277826.htm

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

Come on, America!

2009-01-19T19:28:00.002-05:00

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 CNN.com regularly a long time ago. These days I stick to drudge report and the bbc. good news is hard to find!

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

2009-01-15T22:16:00.003-05:00

SCHOOL
------------------
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.

POLITICS
-----------
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.

NURSING
-----------
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.

ETC...
----------
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.

Ok.........lahoma

2008-11-09T00:27:00.002-05:00

So, I played about 36 measures of moderate tempo bluegrass banjo for my old high school this weekend. They're doing a pretty good production of Oklahoma. It's been fun seeing how everything is pretty much the same, just with different people. Things really don't change that much...

Other than that, it's business as usual. I dropped my transcultural health care class due to being busy as a cracker, but I'll take in next semester. I should still graduate at the end of this academic year if I can test out of a couple of classes (I should be able to!) I've been spending lots of time with the fam. I've been working and going to school as well. On a happy note, we may go to Europe during Winter Break. Brrr..... Oh well, we can't afford to go in the summer!

Sometimes it's depressing to hear what people think of nursing. I try to avoid the subject with those outside the field because people are usually unintentionally insulting or patronizing. I think that much of what people believe about nursing stems from outdated feelings about class and gender. Nursing carries the stigma of not only being a 'technical' rather than academic field (which is only partly true), but also as 'women's work'. It seems that many people carry around this faulty, inherited idea of nurses being simple, but caring as they dutifully scrub bedpans and hand out pills. I'm not trying to say that undergraduate nurses are medical experts (some advanced practice nurses do have very advanced medical knowledge), but it just seems to me that there is a widespread misunderstanding of the profession.

My blog is now linked with facebook, too. Yay?

"You're doin' fine, Oklahoma.... O.K.!"

Sweet stuff...

2008-09-29T13:25:00.002-04:00

Check out http://www.denniskunkel.com it's very cool electron microscopy stuff.

Neuroblastoma

How Wilford Brimley got Diabeetus (it's got nothing to do with a so called: " Beetus-bird" )

2008-09-13T21:46:00.004-04:00

SLOPPY LIVIN' AND TOO MANY PANCAKES!

Oh, Surgery and Patient Care as not just a profession, but a skill set

2008-09-13T17:14:00.003-04:00

Remind me never to have surgery. There are just too many cases where: Patient A came in for an elective ______________. They went to OR, but then in recovery he/she went into acute renal/respiratory/heart failure (or had a stroke).

It's not like that's the majority, or even a high proportion of surgeries, but working in a Surgical ICU, that's a lot of what we see.

I'm learning to take advice better, too. When patients' family members/my nursing peers try to tell me how to take care of my patients, I need to realize that I have something to learn from everybody, even people who aren't "nurses". I'm working on reading Nightingale's "Notes on Nursing" and I'm realizing that nursing is a skill set, a knowledge base, not just a profession. Just like a layman may be able to teach a mechaninc or a plumber a trick or tip, they may be able to teach us ways to care for our patients that we haven't thought of. (BTW: Of course, it's imperative that we base our practice on research and not just the advice of strangers.) Many mothers have spent years caring for sick family members and may have valuable experience to share with us. Maybe.

Yeah, It is very much back to school time

2008-09-12T12:29:00.002-04:00

So, I'm working full-time and going to school full-time. I tried that last semester and ended up dropping a class.... I think it'll actually work this time!

My classes are pretty low-key for the most part. I think I'll be able to get through them alright.

It's a very community-oriented semester for me. It's interesting to see nursing focused on something other than direct physical needs. The role of the nurse (advocate, etc.) is the same, but instead of focusing on one sick person, the community nurse sets up systems to improve the health of communities.

FYI: Community health nursing is different than public health nursing...

I recently purchased two books by F Nightingale: "Notes on Nursing: What it is and what it is not" and "Florence Nightingale: To her nurses". Very good stuff! It's creepy that I'm starting to enjoy nursing theory....

Oh, Google Image Search

2008-08-25T14:35:00.001-04:00

apparently this is from some play about nursing called, "Too Nurse". I don't know whether I would like to see it or not! Kind of strange....

Back to school....

2008-08-21T14:42:00.004-04:00

Well, it is that time again....... Back for another wonderful semester of RN-BSN completion. More classes that aren't quite 100% useless, even though they feel like it. I think since I work in an area that is so centered on my clients' medical problems, I lose sight of all that nursing really is. Anything that's not pathophysiology seem pointless to me as an ICU nurse. Sure we deal with psychosocial stuff, but we also have chaplains, case workers, social workers, patient advocates, and loads of other professionals who are better equipped to handle these issues than we are. Betty Neuman said that nurses should be holistic in their care, assessing and intervening not only on a physical level, but also on psychological, spiritual, sociocultural, and various other less tangible levels, but when someone is septic or in respiratory failure or whatever, their sociocultural needs (important as they are) don't seem to concern us as much as their need not to sink deeper into distributive shock. Maybe it's just me! It may really be a nursing problem, but it seems that we barely have the time and staffing to keep some of our patients healthy/alive.

Anyway, here's a rundown of my classes....

COMMUNITY/PUBLIC HEALTH NURSING (5 cr.)

I think that I'll either be working with a school nurse or in a community free clinic. I'm hoping this experience will broaden my view of nursing. As a future NP, I hope this will also show me some possible career tracks. This is my first clinical course since Spring of 2007, so I'm really looking forward to doing my first clinical as an RN.

HISTORY OF ROCK MUSIC (3 cr.)

Oh yeah... let's hear it for area IV general education! It was either this or Victorian Novels or something like that. I honestly wanted to take History of Jazz, but it wasn't available... It's a music class, so it focuses on the musical development of rock. How much sweeter does it get?

TRANSCULTURAL HEALTHCARE (3 cr.)

Lesson One: Don't stereotype people
Lessons Two through Twenty: Various accepted stereotypes about the peoples of the world

DISASTER NURSING (1 cr.)

The title of my autobiography? No, silly, it's the title of the one credit hour weekend course I'm taking in September. I hear it's more of a pain than it ought to be.

That's right suckah, 12 credit hours. Did I mention I'm also working 36 hours per week in a challanging setting that require 4-12 hours on call per month with madatory upstaffing? Or that my wife is also taking 12 credit hours? Or that I have a four month old? Yeah, it's going to be busy. No, I will not get to eat a meal at home during the week. Fortunately we've hired my lovely 20 (soon to be 21) year old sister to watch our child. Unfortunately, I've had to drop my guitar lessons.... That made me sad, but there was really no other way. On a happy note, the federal government is paying me almost $600 to go to school this semester. That number will probably go up after my wife gets her Financial Aid package through. If I can do 12 credit hours this semester and 11 credit hours next semester, then I will get my bachelor's degree in the spring.... THEN ON TO NP SCHOOL! Yes, it's true, I'm pretty excited about that.

Life in the hood?

2008-08-07T18:11:00.002-04:00

Yeah, it's the po-lice. They're across the parking lot from my apartment and I know not why. Good times!

Theologica and epistemology

2008-07-31T21:56:00.002-04:00

I was thinking today how the New Testament reveals Jesus as Logos in some parts. One problem I've been dealing with for a while is how I can reconcile Faith with reason. Reasoning requires doubt. You can't search for answers if you're not allowed to ask the questions. Faith prohibits the asking of certain questions (at least in any meaningful way). God reveals himself to us as Logos, the word, logic. I think we need a balance of faith and reason. It seems that we need to have faith to even accept anything outside our self even exists in any real way.

That's enough of my amateur theology, if you want any real answers, you should look on www.unencyclopedia.org they have all the real answers. Consider looking up "huffing the universe" for hints on how to become God.

Politics!!! Why not?

2008-07-27T23:14:00.004-04:00

Have you ever felt like ol' Federalism just isn't what it's cracked up to be? Yeah, I'm a states' rights guy, but when it comes down to election time, the two-party system just gets me down...

What about proportional representation? Besides the fact that it's completely unconstitutional, what's the big deal? Let's just try it out for a while.... Could you imagine congress? California and New England would have their own red army in there, but they would be balanced out by Texas's and the midwest's congressmen with actual firearms. I guess a congress with actual ideological conflict would be better than a bunch of fat cats who sit around and play politics so they can line their pockets with gold.

What ever happened to America? Doesn't our constitution say a few things about liberty or freedom or something like that? The Dems will stick you in a Prius and make you suffer through state-run healthcare (and restaurants, and churches, and schools, etc.), while the Republicans will tell you who to marry (and what to smoke, and who to kill, etc.). Sometimes I think we haven't done much right since ol' Georgie boy left office (Washington, that is). Okay Abe Lincoln was pretty awesome, but didn't he suspend habeus corpus? (shhh... I've heard that's a pretty unpopular thing to do these days).

It's too the point where I actually decided to support BOB BARR..... uggg. The guy supposedly paid for his wife to have an abortion. SUPPOSEDLY. He's for making abortion a states' issue though, so I suppose that's what matters (he rationalizes to himself). I can't see myself supporting John McCain, closet liberal. I definately can't support HIS ALMIGHTY LORDSHIP DESCENDED UPON US FROM ON HIGH, SHAH barack hussein obama, MAY HIS NAME BE PRAISED FROM SEA TO SHINING SEA, AND FROM THE RISING TO THE SETTING OF THE SUN FOREVERMORE, AMEN. Although he does believe/hope in changing the future for the good of all of the people who also hope to believe in the goodness of the future without naughty McDonalds or the shame of Wal-Mart. You know, the bastions of industry that supply the stupid, ignorant, inarticulate, writhing masses of gun-hoarding, God-fearing hayseeds of America with employment and artery-clogging McNugget goodness. Which brings me to my next point....

LIBERALS: condescending, guilt-ridden, gullible, arrogant, afraid, appeasing, lazy, did I say condescending?

NEO-CONS: bullies, arrogant, ignorant, artless, nosy, self-righteous, fascist

MODERATES: three from the liberal category + one from the neo-con category

LIBERTARIANS: three from the neo-con category and one from the liberal

ME: a smattering of all of them

----------------------------------------------

THE BOTTOM LINE: IN A TWO-PARTY SYSTEM, NO ONE IS TRULY REPRESENTED

P.S.- THE GOVERNMENT BIG ENOUGH TO GIVE YOU EVERYTHING YOU WANT, IS BIG ENOUGH TO TAKE EVERYTHING YOU HAVE (Barry Goldwater)

TNCC

2008-07-25T00:17:00.003-04:00

For all you folks that don't know, TNCC stands for Trauma Nursing Core Course. It's mandatory for all of the nurses in my unit. It's not that hard, but it is kind of a cool reminder of what kind of stuff to focus our assessments on with fresh traumas. I guess it doesn't hurt to have a TNCC mindset with old traumas either. I can proudly say that because of a trauma nursing course I took a couple of years ago, I set my assessments up according to the primary assessment as laid out in TNCC. Here is the basic outline of TNCC:

Get report from the medics, maintain C-Spine immobilization, and then:

PRIMARY ASSESSMENT (VERY IMPORTANT, ASSESS & FIX):

Airway- consider adjuncts such as oral/endotracheal tubes if needed
Breathing- check rate, pattern, bilateral chest rise, skin color, acessory muscles, etc.
Circulation- pulses, bleeding, IVs, cap refill, JVD, etc.
Disability (Neuro)- Level of consciousness, pupils
Expose/Environment- Remove clothing and check for problems, make a safe environment

Secondary Assessment:

Full Vital Signs/Five Interventions (pulse ox, EKG, foley, NG, labs)/ Family
Give comfort
History/ Head to Toe assessment
Inspect Posterior / Injuries

Provide/suggest follow-up diagnostics and interventions such as consults, imaging, or labs

Prepare for OR, Admission, or Transfer

It's good stuff. A, B, C, D, E, F, G, H, I

IN OTHER NEWS:

I like MySpace a lot. I don't know why, but it seems like it's much more libertarian than Facebook's rigid layout. Facebook is creepy.

I'm not sure if I want to be a nurse practitioner. I'd make (a little) more money and have more authority and better hours, but my work wouldn't be nearly as cool (Surgical/Trauma ICU vs. Family Practice Office). I guess it's a career, not a hobby; it's not about what's cool or fun... It's actually a really complex issue since NP's have a really weird niche with lots of possiblilities (good and bad).

I'm sleepy.

I'm watching the little sib's this weekend. Good times.

ST elevation

2008-07-22T22:45:00.003-04:00

Hey, not all ST elevation is indicative of acute MI. Who knew? Well, I guess I knew it could also be pericarditis, but still... If the ST segment is in the shape of a frown, then your patient should be sad because they are probably having an MI. If it is in the shape of a smile, then be happy! It could be either pericarditis or benign repolarization. Trust me. I am a very trusty source.

I worked 16 hours today and I feel more entitled to complain than ever. I will make it short: I am tired and my feet hurt.

I was in Neuro ICU again today! Woot. Good times for all! I was managing ICP though, which is usually a busy process. Fortunately no Mannitol today (way too many labs with that one), but I was pushing sedation hourly. Oh the tedium. Not really, I like managing ICP, it is a good chance for a nurse to use discretion and make a real difference.

A few random goals for my work days:
-Patient has better sounding lungs when I leave than when I came
-Bond with the family
-Finish report before 1530
-Leave the patient and the room cleaner than I found them
-Lots of other groovy things

Fact: When I see commercials on TV encouraging people to pursue careers in healthcare, I shout at them, "Noooo". I actually think healthcare is very swell. Swell like edema. I wonder how swell ever came to be an adjective that means "great". I am sleepy. Hypnotoxins!

Italian Spiderman

2008-07-19T18:10:00.005-04:00

MAKE ME A MACCHIATO, PUSSYCAT!

watch Italian Spiderman on Youtube or MyspaceTV; it's pretty funny

House

2008-07-18T23:03:00.003-04:00

Yeah, I like that show a lot. My wonderful wife rented Season 3 today and I'm just starting the second disc.

The Standard Nurse Complaints:

1. They don't give nurses any credit...
- Yeah, it's true they give firefighters more medical competence than they do nurses, but that's standard procedure for TV. There are a ton of important team members in the hospital; it would be impossible to make characters for all of them.

2. The doctors do things they'd never do...
- I can just see a big shot doc running a patient through the CT scanner (or performing phlebotomy, etc.). Most of them don't even know how to use our IV pumps, but again it's probably a matter of getting as much time as possible with the main characters of the show.

Yeah, I'm a crybaby. Oh well. Nursing still has a long way to go. So does televison.

Anyway, I love this show and I will watch it in spite of my complaints!

addendum

2008-07-15T23:08:00.003-04:00

I had my first patient die the other day. It was strange. Where a person was, a body lay. I had empathy and compassion for something that occupied that body, something which was striving and had purpose and soul. Then, with the flattening of a line and the quieting of a beat, that something was gone and the body became flesh. Since there was no clergy or physician available at the time, it was left to me to tell the patient's dearest loved ones that this had occured. With compassion, but without pretense, I informed the family that the soul they had cherished was now beyond their reach. Maybe someday, when their living bodies still and become flesh, they will be reunited, but I left that for them to work out. All I knew was that the person I had cared for was now gone and it was up to me to get the flesh off of the bed so the housekeeper could wipe it down and we could put a new body onto it.

When the housekeeper was nearly finished in the room, I noticed a scrap of paper pressed up against the side of a clear trash bag (clear trash bags in a hospital, what a swell idea). In the final hours of life, my patient had scrawled some barely legible message on this sheet. Seeing that handwriting was eerie. There was a bit of my patient's spirit stuck to that page. The symbols on that page weren't just a note, they were the last remnants of that individual's consciousness left in that room. It made me think a lot about the frailty of life and the nature of what we leave behind. In the hospital we have lots of plaques on the walls dedicated to old-timey physicians who were probably big shots back in the day, but to me now they are no different than any other dead person. Life is too short to be prideful, arrogant, and hateful.

Someday your lungs will fill with fluid as your heart loses the capacity to push the blood through your body; your cells will starve and you will die. In the same way, the field laborer, the imbecile, the artist, and the trauma surgeon will all finish their lives. Many will do so with a young nurse standing by, ready to file their paperwork and clear their bed.

Isn't it weird sometimes how the more you experience, the less you know?

"People are just people; people are just people like you", "and everyone must breathe until their dying breath". (Yeah, I'm kind of a Regina Spektor nut lately.)

yeah, i pretty much forgot about this thing...

2008-07-15T22:28:00.003-04:00

Okay, I haven't written here in a reeeaaallly long time. Basically, I've had a very busy summer.

May

6th- Anika was born! Off work for a couple weeks.
9th- Finished the semester w/ A's and B's after some rescheduled finals
20th- back to work...

June

First two weeks- BLC Camp Nurse! Good times. Scrapes, sprains, and a suprising amount of Otitis Media. Also earned my Pediatric Advanced Life Support certification.

14th- 1 year anniversary of my RN licensure

20th- officially off of orientation @ work! I became an independent ICU nurse (oxymoron... no ICU nurse is independent; it is a team effort. that sounds retarded, but it's true!).

July

10th- went with Angie to Indy for the weekend; left Anika with mom and dad. I gained seven pounds in four days! proud to say, it's all off (it was all water and *ahem* 'bowel' weight, i guess).

14th- back to guitar lessons after missing approximately one whole month of them!

so I'm back. i hope i remember to write more. i'll give you a brief run down of where I am with my life right now.

WORK

yeah, it's nice not to have to work with a preceptor any more. i get my own assignments now. i've been almost exclusively assigned to the neuro section of the STICU, which is fine with me because I love neurology and because it's intentionally quiet back there for our SAH (subarachnoid hemorrhage) patients. i'm not really antisocial, but perhaps a little schizoid/paranoid in some social situations (namely school and work; in four years at IPFW, I haven't made a single close friend!). I do fine with patients and their families, but with my co-workers I just am really shy. anyway, the nursing in 'the unit' is cool and complex; i have learned a ton! I'm working on my Advanced Cardiovascular Life Support Certification now. Good times. I'll then take my Trauma Nursing Core Class next week. Good times x 2. I had to save my patient's life from some family practice residents the other day. They were literally writing the order to withdraw all care from this individual until I dragged his family in there and explained to them exactly what was going on. They had been completely misinformed. It was a disaster. Anyway, work is quite good.

SCHOOL

starts in August.......

MUSIC

I finished my first book of classical guitar technique (shearer's book). I'm now on a book of novice/intermediate arrangements of classic guitar pieces (royal conservatory of music's guitar series 2). It's first/second position stuff in the keys of C, G, and D for the most part. I love it!

ETC.

sis is still in Yellowstone! hurry up and get back here...

I love being a dad. It rules my world.

Anika Marie Cupp

2008-05-07T11:18:00.002-04:00

She was born May 6, 2008, weighing 7 pounds, and measuring 20 inches long. She is happy and healthy and resting comfortably! Go to my MySpace page to check out pictures and video of da baby! The link is on the right side of this page.

Atrial Flutter

2008-05-04T23:57:00.002-04:00

Anyway, I can't sleep. I took a two hour nap at about eight o' clock and now I'm up for a while.

I've been on a digital camera binge lately. I've taken like a hundred pictures in the last few days. I put most of the good ones on my MySpace page http://www.myspace.com/cuppwk01 they're okay pictures, mostly of my fam. I don't post much on my facebook page, sort of because I can't really stand facebook. I started a flickr account until I realized that I really had too many various accounts already.

We had our second baby shower today. It was pretty cool; we got a ton of baby stuff. We also went to church at Bear Lake today for the first time in a long time. It was pretty cool. I love Bear Lake very much. Every time I drive out there I just think how lucky I was to grow up somewhere so cool and so grounded.

May Day

2008-05-01T18:06:00.002-04:00

I think that May Day might be a communist holiday, but I'm not sure.

Work was cool today. I was very busy and I think my preceptor was getting kind of impatient with me being a little behind the 8 ball, but I was keeping up alright. I'm excited about getting off of orientation in about a month. That will be good times. I was in the Neuro ICU today (possibly my favorite wing of our unit). One patient had a hemorrhagic stroke yesterday and the other has a massive cerebral infarction over night.
There are always ethical dillemas in neuro. The only one that really gets me is witholding nutrition. Not feeding someone who is capable of taking enteral nutrition goes against every nursing instinct I have. I can understand taking people off of ventilators or medications, but witholding feedings just gets me.

My guitar lesson was subpar. I felt like I had a decent grasp on the music, but each week we add new layers of complexity to what I'm supposed to be doing, so I'm always just falling short of our goals, but improving none the less. For one thing, I can't get my nails right. This impedes my tone a great deal. I need to just let them grow and quit messing with them. My guitar lessons should go much smoother from now on, since I am finishing school next week (although I'm taking IV Therapy in the summer, it shouldn't be much of a challange).

I've got my eye on the finish line....

2008-04-27T20:54:00.002-04:00

Yeah, a great song by Pedro the Lion, but also true about me right now. School is practically over, I'm almost off orientation at work, and the baby is due in three weeks. The funny thing is, when those things happen, they just create new things for me to do. So, basically there are no finish lines.

I went for a jog today! It was pretty short (just to the video store), but it's a start. I was so out of breath when I got home, I auscultated my chest to make sure I wasn't having some kind of critical cardiopulmonary event. My lungs were well ventilated without adventitia and I didn't have any S3 or S4 heart sounds, so I figured I just ran up a healthy O2 deficit. Ten minutes later I was fine.

Last Monday I had a pathophysiology test that I didn't even know was on the syllabus (my organization has been atrocious this semester). It was on my weakest subjects, nephrology and gastroenterology. Give me hearts and brains any day, but kidneys and guts just have too many small parts to keep track of. I WANTED TO HANG MYSELF ON THE LOOP OF HENLE! stupid nephrons...

I'm probably getting a new old car sometimes soon. It'll most likely be a tiny import. Take that, global warming!

Also, my time at Blackhawk is now complete. We taught our last weekend of Sunday School this week. We've been teaching these kids for about a year now, so I'm sure gonna miss them, but now we're going back to good ol' BLC! Good times for all.

Overhaul

2008-04-09T15:09:00.002-04:00

Yeah, I've changed everything because I don't feel like talking about work on here, most of the time; although, I really like to talk about work in general.

So, yeah.

Ultrasound Numero Dos

2008-04-07T14:57:00.002-04:00

Well, it's week 33 and we just got ultrasound #2. We've been measuring about 2cm small the entire pregnancy, so our CNM wanted to see what was up. Apparently nothing was up. The ultrasound was completely normal, and everything looks good. At the first ultrasound we elected not to know the sex, but this time we couldn't wait. We found out that we're having a girl! It surprised us because we thought the first ultrasound looked boyish. This one seemed even more convincing, though. Plus, at 33 weeks, things are fairly obvious. 21 weeks was a little early. Well, Willard IV will have to wait; Anika Marie Cupp will be first!

hmm.... plans

2008-04-03T10:49:00.001-04:00

I oscillate between a few different options for my graduate education. I go back and fort between nursing and seminary. Right now, I'm thinking seminary, but I'm sure I'll have a good day at class and go back to nursing, but who knows?

oblivio accebit

2008-04-03T10:03:00.002-04:00

Yeah, I still hate school. I thought I liked pathophysiology and couldn't stand my other classes because of the subject matter, but I think it's because I don't have to do anything for patho. For exampe, I read a little bit of the endocrinoloy section to brush up on the old pituitary hormones, but didn't read any of the cardiovascular or pulmonology chapters and still got a 94% on the multiple choice section. It's not that I'm awesome at those things, it's just that it's an easy class if you're already a nurse. Then, last night, I was doing homework for my research class, which I had previously liked, when I decided that I hate that class with a passion. My school-assocaiated laziness has reached a new level.

Work is still cool though. I got a new preceptor since it's the halfway point in my ICU orientation. His name is Tracy, he's been an ICU nurse for like ten years and he's a pretty cool dude. The bad thing about my orientation is that no one knows how long it should be, nor at what point I am at along that line. When I was hired, I was told that I would have an abbreviated orientation, but it hasn't really worked out that way. I would like it to work out that way since one of the reasons I was hired was that I had been an RN for about 6 months already, so they were thinking I would be sort of ready to go. The truth is that working full time in the STICU on days is pretty much the complete opposite of working part time on the medical neurology floor at nights. I do think that I have a bit of an advantage from my experience though in that I'm used to having responsibility for my own patients, working independently, and some things specific to being an RN in the Parkview system.

The other day, one of my patients was getting a percutaneous tracheostomy. Two pulmonologists, a family practice resident, and the endoscopy nurse came to do it. So, one of the docs was using the bronchoscope via the ET tube and the other was doing the cutting (I'm sort of surprised that a general surgeon didn't do it, but you know.) Anyways, the doc doing the cutting told one of the best lame jokes I've heard in a while. Keep in mind that it was on St. Patrick's day. "What is Irish and gets left out on the porch all night?" .................................."Patty O' Furniture!" Also, after they were all finished, I was helping the endo nurse clean everything up and we found a picture that was left behind which was printed from the bronchoscope. The pulmonologist using the scope had accidentally taken a picture of himself with it. It was strangely amusing. Nothing compromises an airway like aspirating a pulmonologist.

Music and movies

2008-03-31T10:56:00.001-04:00

Music- Sufjan Stevens, Seven Swans

Movies- Nines

Yeah, pretty cool stuff.

Post-Spring Break Resolve

2008-03-25T11:59:00.002-04:00

Well, after the first week back to school after Spring Break, I have found myself less motivated to do well in school than ever before. Nursing classes are interesting, but not nearly as challanging now that I have a good chunk of Critical Care RN experience under my belt. My classical guitar lessons are pretty much the only (somewhat) academic obligations I look forward to. Other things are good, though.

Work is going alright. I feel like I know the science prett well, it's just the day-to-day application of that science that gets me. Example: My patient in Acute Renal Failure status post AAA rupture is on a Nicardipine drip @ 10mg/hr to maintain SBP below 140 mmHg. I'm concentrating on titrating the drip and monitoring vitals. An experienced RN taking my patient at shift change notices that at the concentration of Cardene we are using, 10mg/hr is 100 ml/hr, quite a bit for someone in kidney failure with practically no urine output. That is the kind of thing I never had to worry about (as much) on the general neurological floor. I guess that's why ICU has such a long orientation. Also, it seems that every time you find a critical change in your patient, the very presence of a physician undoes it. The other day I had a patient who was "rapid responsed" from the medical floor down to the ICU. He was sedated for intubation. A few hours later he was still unresponsive. I was going through all the steps of the neuro assessment, voice, touch, shouting, peripheral pain, etc. and I wasn't getting anything from him. We finally persuaded his nephrologist to give us a neuro consult. The first time the neurologist talks to him, the guy perks right up. Very embarrasing. The dialysis nurse who was with me the whole time was just as surprised as I was. Apparently the sedation was just taking a long time to wear off, frakkin' Versed. Why couldn't it have startd to wear off before we bugged the nephrologist for a neuro consult?

School = lame. Pathophysiology is interesting, but not difficult because it's a mix of ASN to BSN (Bachelor of Science in Nursing) students and straight BSN students. The unlicensed (straight BSN) students have to take some very difficult classes at the same time as patho, plus they really don't know very much yet anyway, so it keeps the class at a fairly shallow level. Nursing Research is interesting, but kind of redundant. I've already had Nursing Informatics and Nursing Statistics; research is basically the combination of those two. English W233 is laaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaame. Expository Writing. I hate this class. We write pointless papers, she marks them off for arbitrary matters of style, then we redo them. I hate general education courses. Well, I'm kind of lying about that, because in the fall, for my Gen. Ed. area IV, I'm taking: HISTORY OF ROCK AND ROLL, which I am quite excited about. I'll be taking it alongside Community and Public Health Nursin (which has a clinical component) and Transcultural Healthcare (kill me now, please... can you say: fabricated interviews with my Burmese neighbors?). A total of 11 credit hours, I've become weak in my old age. The more I get tangled up in "real life" (work, babies, taxes, and such), the less important school seems, but if I want my real life to include normal hours and comfortable environs, then I had better stay very interested in school.

My musical endeavors are actually fruitful and satisfying. I'm taking classical guitar lessons with IPFW's professor of guitar studies. It's really cool. I've never practiced my guitar in such a focused manner. I'm almost finished with Aaron Shearer's Classical Guitar Technique, Volume I. Soon I shall be truly Bach-ing out.

The baby is doing well. We're at thirty-one weeks and everything is looking good. It kicked me in the head the other day, though. Angie is doing amazingly well. She has gained exactly the right amount of weight, her blood pressure is stable, and she has little to no swelling yet. She feels pretty good most of the time.

We're still deciding on when we want to move. We're going to start going to Church at Bear Lake after the baby is born, but we're not sure we actually want to move this summer. We'll probably wait another year.

Research Symposium and Biology in general

2008-02-09T13:14:00.000-05:00

It was pretty cool. I'm not really prepared to deal with a lot of the basic research side of things, but there was some interesting clinical information presented. The first three speakers were Cardiologists. Lame. Not really, the heart is pretty cool for an organ with one lame function. My favorite speaker was Dr. Fen Lei Chang, neurologist with FWN and a dean of the IU Fort Wayne Medical School. He basically spoke about how basic research in neurology, on animals and whatnot, doesn't translate well into clinical trials. He explored some of the neuroprotective studies and their, for the most part, failure. The last presenter was over Hematology-Oncology. It was interesting, but not extremely relevant to my practice at this point. I think being an Oncologist is a losing game. The better they get at treating Cancer, the less Oncologists they're going too need. All hearts and brains will go bad eventually, but Cancer can be prevented and cured.

It's always cool to see people who have pushed the boundaries of human knowledge. What those guys are doing is essentially filling in the blank spaces on a map. They can show with their research what others can only speculate over. It's pretty sweet.

I love looking at molecular biology though. The fact that we are not just one living thing, but actually many, many smaller things is facinating to me. Thinking about the fact that our existence is mediated by atoms trying to get their share of electrons is bizarre. When I'm feeling like my life is mundane or small in the big scheme of things, I like to remember that I am a dazzlingly complex array of Carbon and Calcium and Sodium and Potassium and many other elements bound into molecules that make living cells which cooperate and strive to keep me integrated. You may think that the fact that we are made of dust and water makes us ordinary, but I disagree, I think that it's the opposite. I think it makes us miraculous.

I think that the dichotomy inherent in humanity, animal v. elevated, is facitnating. I think that's why I love the brain so much. It is the embodiment of that conflict. The whole notion of this sort of conflict, rests on a lot of philosophical assumptions, but what meaningful thought doesn't? If we couldn't accept any assumptions, then we couldn't think anything at all because we couldn't trust our senses or our reason. You know, I think that I'm a bit of a rationalist. I have no philosophical education whatsoever, so I'll probably misuse these labels; but, I'm quite sure that I'm not an empiricist. Yes, I believe in the scientific method, but not without some philosophical backing. If I didn't see value in human life then why would I want to help preserve it?

Maybe it's good that I'm in composition class after all. I think I could use some help with paragraph structure, among other things.

Wikimedia

2008-02-06T01:36:00.000-05:00

It is a drug... Wikibooks and Wikiversity are almost completely undeveloped. I may just waste my life there trying to build up the nursing information.

Super Tuesday?

2008-02-05T12:10:00.000-05:00

Yeah it is. Go Paul. Anybody but McCain will be just fine.

My microphone will be here tomorrow! I went to Guitar Center on Saturday to see if I could get one without waiting, and when I asked if they had the Behringer, the guy behind the counter almost interrupted me to say that apparently I didn't want a Behringer. Okay my friend with the weird hair, I know what I want and I don't need you to try and tell me. I guess I'll see if he was right tomorrow! I've had a Behringer audio interface for over a year and I have no complaints.

I'm registered for the Parkview Research Symposium on Saturday. It should be very fun and enlightening.

I had a dream last night. In the dream, there was a song. It was really awesome, but I don't remember it.

New mic for me!

2008-02-02T12:45:00.000-05:00

I'm buying a new microphone! It's not exactly top of the line, but it's what I can afford. A Behringer C3 shall be my new singin' hole. I know a lot of people knock Behringer stuff, but I've had my FCA audio interface for about a year now, and I really can't complain (For the price, that is). It should arrive in about 2 weeks, and I'm a bit excited.

composition

2008-02-01T15:37:00.000-05:00

Well, maybe it's not such an atrocity, but I still like the way I write my papers more than the way my lame teacher wants me to write them.

The End of January

2008-01-30T23:40:00.001-05:00

Work is good. I'm learning a lot about the form and function of the STICU. I feel more comfortable with a ventilator now. I was terrified of them when I first transfered. I've had a few classes over Swanz-Gantz catheters, hemodynamics, and the various and sundry ICU-only drips. It's really facinating. I hate all the paperwork that goes along with an orientation, though. Trying to keep up on all the little check-offs is a real pain.

School's alright, though I've fallen behind a bit already. I enrolled late into an internet Gerontology course. I'm trying to get caught up on the posts and skimming the readings. Healthcare research is a so-so class. I think I'll pick up some details about research methodology that I missed in Stats, but I'm not sure how much attention I'll be able to give it. English is a total waste of my time. I have to write meaningless papers and listen to condescending lectures. The whole idea of a composition class is shady anyway. How can you tell someone how to write? Who is sitting on the throne, dictating to us how the English language is to be used? You cannot formalize language. If I want to use seimi-colons in place of commas, there is no law that says I can't. I know that in actuality we all share an unwritten standard of what is and isn't good writing, but the whole thing is so subjective. My biggest and favorite class is pathophysiology. We are reviewing all of the things we have already been taught, but more in depth. It is a lot of reading, but it is interesting.

I really want to get a lot out of school this semester. In the Associate's Program I did what I had to do to pass, but this time I want to really absorb the knowledge. I want to have a more informed practice now and be ready for graduate school in a couple of years.

Spring 08!

2008-01-14T21:52:00.000-05:00

Yeah, so I've started the new semester, the new job, and being a father (expectant). School is cool. Pathophysiology promises to rock me to the core. Basically it's stuff we learned back in Nursing 115/116/224 but more in depth. We started with a quick rehashing of cellular A&P/metabolism blah blah blah. Then we got into Fluid & Electrolytes. I used to hate F&E. Anymore I think it's kind of cool. When I was a student it was just a bunch of pointless numbers to memorize, but now that I'm a practicing nurse it has context. It seems very relevant. People's lives may depend on whether I recognize their hypocalcemia or not. Knowing what the IV fluids are doing to my patient at the cellular level is so important, but the AS program only scratches the surface. You have enough time to memorize the words Hypo/Iso/Hyper- tonic and then it's on to something else. Dr. Kaskel rules. She is intelligent, but makes an honest attempt at teaching us.

My new job is cool. Or will be soon. I've been doing ECCO, Essentials of Critical Care Orientation, computer training. It takes at least a week to get through it all. It goes through each body system, outlines the A&P, diagnostics, and major Patho issues, and quizzes you on them. I guess it's just to dredge up the things you flushed out after boards. I'm also starting my ICU core classes, hemodynamics classes, and dysrhythmia classes for work. My brain may explode. Monro-Kellie hypothesis: explain that. Expanding brain matter? Maybe increased ICP from irritation.

So yeah, I'm the father of a 21week old, gestationally speaking, baby ____. We had our ultrasound, but asked them not to reveal the gender of the child to us, however, after looking at the images I think it is a boy. They're posted on my MySpace/Facebook pages.

SAD NEWS: I have to drop my music minor........ ARG! On the up side: I'm working full time and approaching fatherhood. I still plan on taking classical guitar lessons, though.

And the things of earth shall grow strangely dim......

2007-12-13T17:22:00.000-05:00

my life is playing at about 150bpm. what to say................... too many ellipses in one post..... .........lots of drama........ ..........or too much captain Kirk............

It's a two-fer. Nursing v. Medicine, Round 2

2007-12-12T09:45:00.000-05:00

My practice setting is focused on patients who have very acute physiological problems (medical issues). In Neuman terms, their intrapersonal, physiological stressors are penetrating their system nearly to the core, and since per Maslow, physiological stressors are first priority anyway, it follows that everything else would fall to the wayside, making it seem like nurses are only concerned with medical issues. What about discharge planning? What about calming fearful relatives? Even in acute care settings, we deal with broad issues. Plus, nurses work in other settings as well, i.e. case management, psychiatry, family practice, community/school health, etc.

NURSING IS MORE BROAD THAN I ORIGINALLY THOUGHT

Finals Week

2007-12-12T09:39:00.000-05:00

Long lay the world in sin and error pining, 'til he appeared and the soul felt its worth. A thrill of hope! This weary world rejoices, for yonder breaks a new and glorious morn. Fall on your knees and hear the angels' voices. Oh, night divine, when Christ was born.
0-o-o-o-o-o-o-o-o-o-o0-0-0o-o-o-o-o-o-o-o-o0oo-o-o-0oo-o0--o-0-0-o-0o-0-o
This may very well be the most important week of my life: for my career, for my education, and for my family; which is all well and good, but the fact of the matter is I still don't have a Christmas tree.

Nursing Theory --- Epiphany

2007-12-05T14:06:00.000-05:00

I had a vision of sorts today. Admittedly, it was sort of a weird vision, but it's probably the closest thing I've had to a true epiphany, a paradigm shift perhaps.

We were doing nursing theory presentations in our Professional Seminar class today, and all of the sudden, it dawned on me.

For the last probably 6 months, from the end of the Associate's Program until now, I have struggled with the definition and role of nursing. Are we the doctors' servants? If so, then why do we work just as closely with social workers and therapists?

The answer is NURSING THEORY! Nurses do not just deal with medical conditions, we help our patients achieve integration with their environments. That means helping them through family disputes, money problems, and explaining their medications. Roy, Neuman, and many other theorists have worked very hard to give us this vision of nursing.

I was brought up on Neuman. I did not see its significance at first. By studying Roy, it's like learning a second language. When you're a child, you don't understand the complexity of English, but when you learn French, you see all of the aspects of the language you took for granted. I have seen that nursing theory is there to tell us who we are, and establish our true identity as the ultimate patient care profession.

Big Snow = Me Happy

2007-12-04T23:48:00.000-05:00

Snow lays down absolution upon the corpses of autumn.

The Redheaded Step Child

2007-12-01T16:15:00.000-05:00

So apparently neurology is a money pit for the hospital. Some bum cracks his head on the sewer grate when he passes out? Admit him to neuro. Some young girl with psych problems and no parents is faking seizures? Only one place to go! No one chooses neuro, neuro chooses you.

Apparently, orthopaedics is extremely lucrative. Old rich old lady wants a handcrafted hip? Bring her in! Some homeless guy has a bum knee? He can forget about it unless he has some infection ravaging his body, and then he is probably a medical patient with an ortho consult. Orthopaedics is like a surgical get-a-way for old people and golden young athletes; whoever has the time and money to get elective surgery. (In fairness, they also take some trauma patients and some medical overflow like the rest of us.)

Combine these two units, and who gets what they want from the brass?

Turkeygeerble

2007-11-21T10:03:00.000-05:00

I'm soo-oo-oo tired. I haven't slept a wink.

I've been up for 22 hours now. I'm pretty sleepy. Yeah, I'm sure lots of people have stayed up for obscenely longer, but I don't care. I picked up 11-7 last night and I have a group meeting from 9-11. I think I'm going to make 24 hours! Anyway, I'm glad I like my job. I remember dreading going to work as a CNA. I'm glad that's behind me. Oh, I'm going to shadow a nurse practitioner here pretty soon. It should be enlightening. I think I want to go on for my Doctoral degree so that I can teach. I'm not sure yet...

TIRED FACE IS MY HEAD!!!

Some people build their own houses

2007-10-29T17:57:00.000-04:00

So, I thought it would be a good idea. I sold my old house in the city. It had nice features and good cabinets to hold my sweet nutrients, but I thought it was very old. I mean, one day I was walking around upstairs and when I went downstairs to put my socks on, their was dust on my feet. I looked at a cobweb and said that this was enough. Piles of dead flies, geez.
I held an auction in the fall. There were four people and a sheriff in attendance. The whole house with a crapload of old posessions and portraits of my ancestors went for like a hundred thousand bucks. My neighbors were there. I hated my neighbors. They were all very old. They mowed their lawns in jogging suits and hearing aids. They loved each other, too. I think they were all jealous of my house.
It rained on my neighbors, my old house, and all of those freaks who wanted it. It rained on me too, but I think it got the dust off of me.

So, I went out in the dead of winter to a hill in the woods. I'm not sure who owned the property, but they probably lived far away. I looked around at the huge trees and moss and animals. It was nice since they were all dead or cold. It would be easier that way.
I took the hundred thousand dollars and bought a saw, some nails, and a hammer. It was really hard to cut the trees since their insides were frozen, but if I waited until about six in the evening, they would be soft enough to make some progress.
The very first thing I did was to clear every old thing off of my hill. I cut down every tree and pulled up the stumps with my bare fingers. I used the claw end of my hammer to scrape up ever piece of grass and every stretch of moss. I killed all of the bugs and animals that came through.
One time in kids' school, they told me that the stars we see are actually very old. I almost threw up. I know that teacher was a liar. She was young, but I still think she lived with her great-grandma or something.
I think I almost died that winter. I coughed blood from December until February. One time, I slipped on a patch of ice and fell off my roof. I don't know how long I was knocked out because no one keeps track of me. My hands bled every day and I still have no feeling in the soles of my feet. It was all worth it. In the first week of March, I decided that I could go into my house. I had built the outside of my house first, so that the inside would be as new as possible.
I think that this was the best time of my life. I hung every wall with ingenuity and precision. The corners stuck in my mind and the edges were confrontational. I cherished every nail and could feel each blow of the hammer. The sound of the pounding was the sound of my heart and I think I cried more than I spoke during that time. I held each piece of board close to me and laid up against it when it was pressed to the studs. From March to the middle of April, I was in love. For the first time in my life, I realized that this new home was the place I was built to inhabit.
The second half of Spring found me making forays into the nearby town. I opened a small practice and was seeing patients for the first time in years. I could stand looking at their rashes and old faces because I knew my happiness was waiting in the blackness of the forest. I even made some friends.
I met you on June first. You were kind and could speak more than anyone I had ever met. I listened and you spoke. Your face was the only one that God ever made by hand. I knew it because it was the only new one I had ever seen.
The day after I met you was the day that I hung the las wall of my new house. I was in such a good mood that I decided to play a little joke that I had read on a comic. I put construction clothes on a new skeleton and lay it to rest behind my wall. I smiled when I nailed the wall to the studs.
When I went to bed I wondered whose skeleton I bought. I had dreams about it too. I dreamt you were old and stained and living inside my walls. I hated you. Why had you aged? You were the only good one ever made. Didn't God care about the good things? But, you were in my house. My house could not age. Neither God nor weather could touch the inviolate youth of my dwelling. It stood bulwark strong against disease, time, Einstein, Nietzsche, Darwin, and St. John. They would surely break upon it like wind on it's facade. I woke with the surety of my own ceiling above me.
I saw you the next day and asked you to come to my house. You said okay.
We got there and quickly ate dinner. We spoke.
"I like your house."
"Thank you."
"The walls look new. I wish I could live in a place like this."
"You can stay here if you like it."
"I would like that. I would like most of all to grow old with you."
Little white explosions dotted my field of vision. I thought I might fall over. I probably vomited. I wish my mind could throw up things that made it sick. I'm not sure what happened after that, but I know you left in a hurry and I slept in the attic that night.
I woke up the next two days, but I could not move. I tried, but each time my brain sent a signal to my arms, my arms sent a message back in a language that my brain could not understand. My conscious mind tried to mediate for me, but I mostly just cried. I cried and called it a liar. I didn't want to ever hear my conscious mind again, which is sort of a funny thing to think. If we are one unit, how can we tell ourselves things. When I realized that I realized that part of me was old. I saw that my conscious mind was the part of me that I had got from old people who decided things about our sound pictures and thought rules and I was furious that it had snuck by me for so long.
I did what I had to do. I called my mind out. My id, ego, and superego. They appeared before me in stark contrast. My psychology professors were all liars. My id was not some idiot baby. It was a man with a beard and tangled hair with broken glasses and a dirty coat. My Superego was not some sunday school teacher or judge, she was holding the id's hand and stroking his shoulder, she wore a kind dress and had nice hair. My ego was the true horror. It was a gross caricature and amalgam of my parents, my school, and my country. It drooled and bled and smelled like death. I raised up off of my floor. I raised my hammer and began to beat the beast. I drove nails into the thing and pulled the decaying flesh off of it with the claw of my hammer. The distrubed result of a child's attempt to reconcile conflicting desires, my ego was the one pinning me to the floor. Rationalizing and ignoring, pleading and hiding it strangled me. I tore and tore at the animal until I had torn every piece of flesh from its body. Inside was the prank I had hidden between the walls.
"Joke's on you," it muttered and smiled.
"Uncle Leon?" I embraced the empty frame, cracking a few ribs.
"You little freak. Don't you know you're acting retarded?"
"Uncle, I told you. We don't talk like that anymore."
"Sorry, bud. Hey, what's with all this new stuff?"
"I built it because I hated you."
"Ha! Well, you're certainly a poor carpenter."
"Well screw you, Leon."
So, basically Leon and I moved to Greenwich Village. He's a poet and I opened a free clinic. I guess I still think about you once and a while. I throw up a little sometimes. We go to protests and stuff, but he's really into anime, so we're always watching some weird cartoon with subtitles. He says the dubbed stuff is gay. I tell him he's a freaking plastic skeleton. Then, he turns to me. Opens his bony jaws, and in a raspy voice with dog's breath says:

"Happy Halloween, you butt-munch."

-----------------

I think I just spent an hour writing that. I feel better. At first, I just thought it would be funny to write a tell-tale heart story about a guy who builds a skeleton into his walls. Then I think I just started to throw in some half metaphors. It might be about my first two years of college, but I wouldn't look for too much meaning in it. It wasn't meant to mean anything. Then, It was getting really old, so I made it into a halloween thing. I might be retarded.

Nursing v. Medicine

2007-10-24T11:12:00.000-04:00

Nursing is not independent of medicine. It is a limited application of it. That's not what my teachers say, but that's what I find @ work. A Doctor can do a nurse's job, but not vice versa. Am I missing something?

I'm a one stop answer shop, a bus stop, i stop busses

2007-10-17T20:24:00.000-04:00

So, I don't think we evolved from monkeys, but I'll be honest : ...(I wasn't there) ! I know, be calm. I still don't think we did. Even if we did: it doesn't change what we are. It doesn't even rule out Adam and Eve or the Garden of Eden. Plus, we could live under a California Communist regime, and I still may be able to lead a happy life. On that note, if gay people could get married, I wouldn't care.

I CAN'T separate my religion from my politics. That's okay because my religion says for me not to make laws that force you to feign righteousness. Laws don't reign inside my religion, so why would I manufacture laws to force on others? In America, laws are just rules we all agree on to make it possible to live in the same place.

I'll try to separate my feelings about myself and my life from my feelings about you and yours. I promise that I'll try to think. I think that'll help us live closer together.

I just spouted emotional rubbish. That's not very constructive is it? It might be. To make up for that, here is something completely opposite:
-------------------------------------------- -----------------------------------------

I chose to analyze the descriptive statistics of a study done in Southeastern Europe, published in 2005, examining relationships between nosocomial bloodstream infections and the medical interventions that had been performed upon the patient.

The authors of this study effectively used descriptive statistics to clarify and point out patterns in their data. They frequently used arithmetic mean +/- the standard deviant and grouped frequency distributions. They used these methods to quickly show relationships between data that were rather obvious without further analysis (i.e. average patient age, percentage of patient with nasogastric tubes, etc.). The writers also employed multivariate logistic regression analysis to find correlations between their dependant variable and their various independent variables (i.e. nasogastric tubes, aggressive procedures, etc.). The report also included a few simple tables which were effective in highlighting relationships without becoming distracting.

Overall, the authors effectively used descriptive statistics to clarify the raw data, and point out relationships between variables. Their statistical analysis was thoroughly explained in the text, and all of the analyses were relevant. I would also point out that these researchers employed SPSS software in their analyses.

Suljagic, V., Cobeljic, M., Jankovic, S., Mirovic, V., Markovic-Denic, L., Romic, P., Dragan, M.
(2005). Nosocomial Bloodstream Infections in ICU and non-ICU Patients American
Journal of Infection Control, 33(6) 333-340.

-------------------------------- -------------------------------------------------------
Take that! You don't to find the Pearson Correlation Coefficient of me and awesome to know that we have a steep slope indeed. = humility

Sometimes I'm Jealous of Artists and the Upper Class

2007-10-15T12:53:00.000-04:00

Buisness man in your Italian 3 piece. You laugh at a young man doing women's work. You have built your reputation on deals, plans, and stocks. Your gray hair is re-dyed black. People see you and respect you or hate you because the cloth on your body cost you what we pay to keep our homes each month. Your vehicle is new and your liquor cabinet is full. But, I have seen you. I have seen you when the cancer might be back. I have seen that even though you run marathons and build empires, that glioblastoma multiforme doesn't care about contracts or mortgages. A clot is not dissolved by stock options. I have seen your three piece traded in for a hospital gown. I have seen your work ethic and pride dissolve into humble kindness and frustrated anger. I was there to bring you into the world that you would buy. I gave you the vaccines that enabled you to live through childhood and make it into the Ivy league. I was in the ER when you had that car wreck and at the psychiatrist's clinic when it all got too heavy. Now, when you are fighting for your every breath, I will try to make you as comfortable as possible and honor your wishes, and tell you that your life was lived to the fullest.

Artist in your militant jacket, your convictions lined in metal discs on your sleeve. You carry a guitar and paints. You confront, you explore, and you examine. You write and expound about the mysteries that surround you. You see the sheep in polo shirts, wal-mart slacks, and white shoes and think that perhaps they don't see the same world that you do. You subject practical concerns to metaphysical ones. Your long hair, strange face, and fringe politics make you an uncomfortable figure for many. You prefer it that way. You live to confront expectations. You also age. The war that you lived to end in college, will come to an end. The president you despise will grow old and die. Your music will either fade out completely or be re engineered into a popular blasphemy of its former self. You may continue on with your convictions into old age, or the wearing of gravity and necessity may mold you into a more convenient form. I have seen it go either way. I have seen your adolescence in with intractable headaches, seizures, or some other young brain problem. You make a Michael Jackson glove out of the mesh we use to cover your IV site by cutting a thumb hole, we do that all the time, but I compliment your ingenuity anyway. I have seen you old and disabled. Your paintings hang on your wall. Every night you tell me that you were a great artist and a teacher. You tell me about Paris. I have actually seen your painting in someone's home. I have seen you come in to us with no intentions of leaving. You do not wish to be resuscitated. You want peace, quiet, and solitude. You didn't cry when you had your shots as a child, either. I will bring your morphine on schedule and try not to wake you.

Christian, in plain clothes, happy with your family, but working hard. You seem poor and somewhat ineloquent. You put all of your eggs in one basket. Sometimes you carry the knowledge of your faith like the sky hold is blueness. Sometimes you carry your faith like a heavy, splintery, cross. Sometimes you try to hide your faith in the bushes while you engage in some indiscretion. You go to your Church to meet your friends, you go to your knees to meet your God. You have many facets. You are supposed to support guns, wars, and the free market, but you're not sure why. You are pulled toward pluralism, but you hold on to the Scriptures as your anchor. You call the businessman greedy and the artist immoral, although you know that you are both of these. Others see your dim exterior, but cannot guess what lies inside you. I have seen you also. You lie in bed quietly. Your Bible is on your bedside table. I don't think I've actually seen you reading it, but it is there. You take your meds and trust your doctors. Sometimes you blame things on God that are not his fault. Your locus of control fluctuates from internal to external and back again. If you are in a coma, your family invariably leaves Christian pop music on 24/7, which I suspect may annoy you, but they think that 88.3 heals. Your family cries much harder than you do. They want treatment options, home health care, and second opinions. You don't mind. Your faith grows stronger as you breathing becomes more difficult. Sometimes you have visions of celestial beings.

I have seen myself in all of these. I live in pretense and die in pain. I cling to the present, long for the past, and am anxious about the future. Sometimes it seems like riding a bike down a dangerously steep hill, you know you will wreck soon, but some of us just make it longer than others. The important questions are, what's at the bottom of the hill, and how can we enjoy the ride?

Indy and @ Working

2007-10-15T12:13:00.000-04:00

Angie and I went to Indy to celebrate her birthday, "A-Fest 2007". We had a lot of fun. We went to the zoo and a Pacers game on Saturday night. After the game we went to a night club called, "Nicky Blaine's". It was pretty cool. It was a cocktail/cigar bar. Low lights, lots of smoke, loud music, big leather couches, pretty sweet. I had my first mixed drink and whiskey. I had some kind of nasty martini with lots of lime. It was too fruity. Then I had a Johnny Walker Red on the ice. It wasn't too bad. It was like beer with more alcohol. I had never had two drinks before, so I wasn't sure what it would do for me, but it didn't really do much for me, just made me a little looser. Good times.

I had to work sunday night. It was an easy night. Four patients, two strokes, one cancer, one meningitis. Easy stuff.

16 hours, drudgery, and Indianapolis

2007-10-09T16:20:00.000-04:00

I worked my first 16 hour shift at Parkview last night. I stayed from 1500-0745. It wasn't really that bad. The only real difference for me was that I was noticeably sleepier than usual at the end of the shift. I went home and slept until like 1430. Also, I found out that I will work from 7p-7a, two days per week on the new unit. Very cool. The bad thing about night shift is that there is a lot of lame work we have to do. It's stuff that normally unit clerks would do (note: unit clerks rule!, but some of the stuff they have to do is not so awesome) like put rounding reports in the charts and enter all of our own orders. It's alright though, it's nice to get everything in order for day shift.

I love the internet, I HATE INTERNET CLASSES! It's like, I like bikes, but if I had to ride one for too long (like the amount of time I have to spend checking on these idiot classes) , I would vomit blood.

Angie and I are going to Indianapolis on Friday and staying two nights! We're going to either a dinner theater or symphony orchestra on Friday night, seeing Indy on Saturday, and going to a Pacers game on Saturday night. Plus, we're 21! We can go anywhere! It will rule.

On Personality Tests

2007-10-03T11:40:00.000-04:00

How do I always get these abstract, feeling things on these tests? If I had talent, I might be a decent artist. I have very strong feelings and aesthetics, but I don't have the dedication to sit, compose, and revise. Maybe I have talent. I wouldn't know due to a lack of training and dedication. : - (

From the E-Medicine, Gilbert's Syndrome article:

History: At least 30% of patients are asymptomatic, although nonspecific symptoms such as abdominal cramps, fatigue, and malaise are common. Abdominal symptoms in these patients are a poorly defined entity and may be secondary to underlying anxiety. However, not all patients with Gilbert syndrome and abdominal symptoms are anxious; nevertheless, they appear to have organic-type discomfort that is hard to characterize and frequently eludes diagnosis. No relationship exists between these abdominal symptoms and plasma bilirubin levels. Abdominal symptoms apparently may be multifactorial, with underlying anxiety probably playing an important role.

Gregorc Delineator

2007-10-03T11:23:00.000-04:00

Concrete v. Abstract and Sequential v. Random. Which two am I?
.
...
......
.........
......
...
.

Abstract Random! Surprised?

Actually, I scored AR=30, AS=27, CR=27, CS=16. 27-40 = dominant style, 16-26 = intermediate. I am primarily a feeler, but also an idea person and researcher. I am not a nose to the grindstone, focused, lame-o.

This is why... partly...

2007-10-03T01:00:00.001-04:00

Music, work, and a piano

2007-10-02T14:28:00.001-04:00

I'm probably going to take on a music minor with guitar as my instrument. It's somewhat intimidating, but I can do it! It's going to take me probably two extra semesters to get my bachelor's degree, but you know. I just worked out my scheduling for the spring semester. Community health nursing w/ a clinical, IV therapy (kind of below my paygrade at this point, but it couldn't hurt), Disaster Nursing (one weekend), Clinical Pathophysiology, Guitar Class, and Concert Attendance. 13 credit hours all together. I'll be on campus on Monday and Thursday, plus some random Friday & Saturday. The guitar class is TBA, so I hope it is in the morning, and won't conflict with work! I get to buy a new guitar. Very exciting. No more tuba, though, which makes me sad.
Work has been nice. I got to hang blood for the first time. I also got some good experience suctioning trach's. Good times.
I'm trying to get a piano moved from Albion to Fort Wayne on Saturday. I'm mustering recruits. It should be thrilling.

9/25 Mmmmm.... Burgers

2007-09-25T12:35:00.000-04:00

We had a sweet cookout today at work. Our bosses made us hamburgers and hotdogs and stuff. It was pretty sweet. I didn't see anyone from my unit there, though. I hope they were coming later, and weren't just mad about the whole merger deal.

I'm working on some cover songs again. I'd like to start playing in the coffeehouse, but I think I need some practice first.

9/24 Arg

2007-09-24T15:07:00.000-04:00

09/24/2007 Firefly Coffeehouse History and Physical

Willard K. Cupp 21 M 0001298321

Chief Complaint: Generalized Headache, Anxiety, Restlessness

History of Present Illness: Patient arose at around noon today after working until 3 AM. Upon waking, the patient immediately was assailed with the triple threat: headache, anxiety, and restlessness. He planned on taking some Ibuprofen and eating something delicious to relieve his symptoms per his usual routine. Upon finding that he had no snacks in the house and forgetting to take his meds, he was forced to carry on without relief. He proceeded to put away laundry and pack up the laptop under the crushing weight of his ailments. The patient managed to complete these tasks and drive himself to the firefly for treatment without incident, except for forgetting his cell phone. Upon arrival, the patient self medicated with a ham and cheese sandwich and a Jone's soda, in an attempt to avoid his usual "unhealthy" choice of a brownie and coffee. This mistake cost him $4 more than he usually pays, with no relief from any of his symptoms.

Family History: Significant for being awesome, but maybe a bit neurotic.

Personal/Social History: See HPI. RN at Parkview hospital, AKA he works like a dog. Also, everything on his unit is being changed as they merge with another unit. He is also a full time college student. Married: his wife will probably kill him if he spends another five bucks at this place.

Review of systems: Negative. As in: I don't feel like writing all this stuff out.

Impression:

1. HEADACHE DUE TO CAFFEINE DEPRIVATION
2. ANXIETY DUE TO VARIOUS SOCIAL/PERSONAL SITUATIONS

Plan:

We will attempt to proceed with internet, time wasting treatment. If this does not lead to resolution, then we will proceed with coffee therapy. If anxiety continues we will look into brownie options. As he needs to get started on his homework soon, time is of the essence and we may need to initiate treatment very soon.

Thank you for allowing me to participate in the care of this patient.

Your Mom, MD

9/19 Babelgum, boredom, and bone spurs

2007-09-19T11:44:00.000-04:00

Don't go to the doctor. A month ago, I was perfectly healthy. Now I am afflicted with Gilbert's syndrome and I have a painful bone spur on the posterior, lateral aspect of my right talus.

Babelgum.com, it's a pretty cool site. You can download the client and watch indie films. I haven't had time to really check it out, but so far it's pretty cool.

I am so bored. I'm on the internet way too much. I've noticed I have an inordinate number of posts on my friends' various profiles.

Visual DNA

2007-09-18T11:20:00.001-04:00

Read my VisualDNA™ Get your own VisualDNA™

9/18 introductions, meetings, and dedications

2007-09-18T10:45:00.000-04:00

Okay, I am going to try to blog again. I tried Xanga for a while, but I just don't like it very much. Sorry, but it's true. Inspired by Matt's Med School blog, I'm going to give ol' Blogspot a chance.

I'll try to talk about my life as a male nurse and make that the focus of this blog. I'll probably avoid talking about specific, significant others in my life. I may also rant about politics, philosophy, music, or religion. I will probably sound pretentious and ignorant at some point. That's okay because everyone is ignorant at some point or another and we all have a duty to present our views to foster dialectic discussions. If I am obstinate or obtuse, then it' becomes a problem.

Work: I worked from 3 PM until 3 AM last night. Not bad- that's my usual. I didn't get downstaffed, so I can't complain. I did get floated from 3P-7P. I went to ortho. It was my first time floating, so it was somewhat horrifying, however, everyone was exceedingly gracious and my patients were mostly medical anyways. I'd better get used to it, because neuro (my unit) is combining with ortho and trauma in November. The old-timey, cap-wearers are pretty ticked about it, but I've only been on Neuro for 6 months, so I'm barely a 'neuro nurse' anyway. I'm keeping my job, so really I'm sort of excited about getting some trauma experience. We had a joint staff meeting with ortho at 8 AM today to talk about this wonderful merger. That meant I only got like 3 hours of sleep last night. I can't complain though, I spoke with a family practice resident who said she worked over 100 hours last week! I always thought she was a bit short with us, I guess I can't blame her.

School: I'm officially sliding into the middle semester slump. I'm taking my classes for granted and just doing what I have to do. I'm putting forth an effort starting now to regain lost ground. It's hard to feel motivated about Stats, Professional Seminar, and Informatics. I love Health Assessment even though it's just basically rehashing basic techniques, at least it is clinically focused. My music class rules. I get to play my guitar. What else needs said. Music Minor: prognosis is guarded. Changes to my work schedule may make my dreams of a minor nearly impossible. We'll see!

Life: Good! Teaching sunday school with Ang. It's tough to get up early, but I'm really enjoying it. If I'm too crusty to work with kids at this age, then I've really got issues. I'm going to the CN football game on Friday. Good times for sure! I still need to make it out to a CN soccer game. I'm sure I will, it's just a matter of scheduling.

Music: Practicing the tuba daily. My tone is gross, but not as bad as it was. My sightreading is improving. Still focusing on longtones, buzzing, and scales. No banjo/mando practice as of late. I've been playing my guitar for class, so that is very cool. I actually HAVE to compose melodies. It's the best class ever.

Politics: Who to support for president? Nobody! I think I'll write in Jesus for president this year. Plus, what to do about healthcare? How can we maintain competition while making care affordable? It's a toughie. I guess people should just do what they have to do to get themselves insured, but I guess that's pretty naive. Also, gay marriage... should it be illegal? Should the government even be involved in something that is so religiously/philosophically based (marriage)? I'm not sure yet!

I hope I can blog as dedicatedly and as well as my sister, who's Xanga posts I look forward to in my inbox.