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Tuesday, August 31, 2010

Crayola Crayon Colors -- Medical Edition 2010

The other night at work, some of the nurses and I were sifting through an old Avon catalog that someone had made behind and giggling over their products. After perusing the nail polish section, I admitted that I had always had a secret career ambition of being one of the people who comes up with the names for new Crayola crayon colors.

After some brainstorming, we decided that our hospital assortment might include:
-Cyanosis
-Meconium
-Last night's mac and cheese
-Jaundice
-Mahogany stool
-Bile
-Leukorrhea
-Turbid tea-pee

Feel free to contribute your own!

Monday, August 30, 2010

My husband rocks.

Last night, I was getting everything ready classes and setting it all on the kitchen counter before I packed it up. Wallet, important forms, notepad, glasses, diapers, extra clothes for MiniMan, etc. Of course, it didn't take long for MiniMan to pull a stool over to the counter and have a seat. I didn't think much of it, until he picked up my glasses and in one swift motion, broke them apart at the hinge.

I was too late this time. My glasses were literally in two pieces. I made a joking remark to my husband about now how people could really make fun of me for being nerdy, as I looked around for some tape to do a makeshift repair.

When I woke up this morning after my husband had already left for work, I found my glasses sitting on the counter, the hinge reshaped, held together with some kind of tacky clear glue. I wouldn't have to wear taped-together geek glasses on the first day of school! It's been a good day.

Note: this post comes to you from the campus of my large state university. I have attended two lectures and a discussion section, and everything is going great. Yay!

Sunday, August 29, 2010

The Saab Strikes Back

I have been basking in this wonderful, sort of giddy feeling for the past few days about taking classes. I'm excited. It's hard to sleep. It's like Christmas Eve when you're five years old.

My husband just came home after borrowing my car and putting some gas in it. Turns out, it broke down AGAIN. I just don't get it. My car breaks down the day before classes start? You've got to be kidding me. I think this vehicle has bad karma or something. Our mechanic, who we have a super-friendly practically family relationship with has graciously offered to let me take one of his loaner cars to classes tomorrow. Meanwhile, though, financial disaster looms once again. Oh man.


Wednesday, August 25, 2010

The saga continues...

Monday morning: I wake up and call admissions. "What's the quickest way to pay my [third!] application fee?" I ask. "Can I give you my credit card over the phone?"

"No, you may only pay by credit card online, but it will take a few days before you have the option of paying online." Don't ask me why this is. I talk to the admissions lady for a few more minutes and we decide that it makes the most sense for me to drive the hour and a half commute there to drop off my transcripts (for the third time) and a check. She also recommends meeting with the continuing education advisor, to see if she can help me sort this out.

I call the continuing education office to ask if my advisor will be there in the afternoon and if she'd be available to meet in person. Her secretary confirms she'll be around. I get my things together and start driving.

I arrive on campus. It's pouring outside and I'm wearing these bright orange mud-covered galoshes that probably make me look like I've just stepped off of a dairy farm. That's okay. My feet are dry, my hair is wet. I decide to head to continuing education first and look for my advisor. The secretary is gone. Everyone is at lunch. I'm told to come back in a half an hour.

I walk across campus to the building where the admissions office is. I drop off my check and my transcripts. I head back over to continuing education, but everyone is still gone, so I decide to do a miniature self-guided tour in the rain. Student union. Check. Campus bookstore. Check. Science library. Check.

I head back over to continuing education. It's been a good forty-five minutes, now. Everyone is still gone. I decide to wander through the building, get lost, and eventually find my way back over to their office. The secretary is back. I introduce myself. "Oh," she replies, "we wanted to call you, but I couldn't remember your name. It turns out that your advisor has a dentist's appointment today and won't be in until later this afternoon. You can wait for a few hours or just call her when you get home."

Rather than walk around in the rain for a few more hours, I decide to go home.

I call my advisor when I get home. She tells me that I should be registered by the next morning, and that if I'm not, that I should check in with admissions.

Tuesday morning: I still can't register. There are two more spots left in physics. I'm getting freaked out. I call admissions again and talk to the same unpleasant guy who I talked to last time.

"I'm calling to inquire about the status of my application," I tell him.
"Did you check online?" He asks with exasperation.
"Yes. It has been received but not processed. My advisor in continuing education suggested I call you and check in if I was not able to register by today."
"Can you hold?"
I hold for five minutes, literally. No joke.
"We've received your application online."
(Duh, I knew that).
"Have you submitted a payment?" He asks.
"Yes, I dropped off a check (and my transcripts) in person yesterday."
"It will take us a while to process the check. First it needs to be deposited, and then it needs to cleared. After it clears we can process your application. I doubt that we'll be able to process your application until after classes start, so I suggest you contact departments independently and see what their processes are for getting into classes that are closed."
I politely detail the nature of all the crap that I've been through already. "Is there any way that you might be able to expedite things considering these extenuating circumstances?"
"I'm sorry, you'll just have to be patient," he says unsympathetically.
"Okay. Thanks for your help." (Not).

I hang up the phone and start sobbing somewhat hysterically. MiniMan, my nearly two-year-old, is sitting at the kitchen table with me looking disturbed. I blow my nose. Then I cry some more.
"Mama. Sad." He says. He picks up the used tissue and wipes my nose.

I give him a hug and pick up the phone again to call admissions back.
"Admissions, can you hold?" I wait. And wait. And wait.
"Hello, admissions." Finally.
"If I drive up today and drop off cash instead of a check, will this speed up the processing of my application."
"We do not accept cash. You may pay online with a credit card, though."

Am I going out of my mind? I think I'm going out of my mind. I pay online with a credit card, and then call the chemistry department as recommended by the unpleasant guy in admissions.

"Chemistry department, this is the really nice secretary speaking."
"Hi, I'm E. Greene. I talked to you last week. The unpleasant guy from admissions who you suggested I call suggested I call you again."
"Oh dear."
"He told me that I couldn't be deferred and that I'd have to reapply. I reapplied but now I've been told that admissions won't be able to process my application until after classes start..." My voice wobbles as I try to hold back tears. I start crying again.
We talk for a few minutes. I must sound really pitiful, because she starts making jokes to try to cheer me up.
"Okay, I'm going to have to call some people, but in sum, you're looking to take undergraduate classes as an unaccepted, non-matriculated student, right?"
I laugh. "Exactly!"

Tuesday afternoon: Super-nice chemistry secretary calls me back.
"I talked to admissions and they're processing your application. You should be able to register this afternoon, or by tomorrow morning at the latest."
I gratefully thank her and wait expectantly at my computer.

About an hour later, I actually register. I get the last space left in my physics class, and a spot in the huge gigantic chemistry course, too. I am not sure how I ended up being so freakishly lucky, but I am forever indebted to the really nice secretary in the chemistry department. I wonder what she said to make admissions give me the time of day? I have noticed that sometimes only by breaking down and exhibiting signs of complete desperation, will people actually notice you. I'm not sure if that was the case in this instance or not. Anyway, how do I thank her? I want to write her a note and perhaps do something involving food. Chocolate cake with fresh raspberries? Wine? Both?!

Friday, August 20, 2010

Greetings from Grumpyland

I am getting really, really, really frustrated with my huge state university. I had contacted continuing education early in the summer to make sure that everything was on the right track and I wouldn't have any problems with the registration process. I was assured that everything was in order.

About a week ago, I logged onto the campus student website (what people use to look at unofficial transcripts, pay bills, register, etc). I got some kind of weird message that I needed to reapply. So I called continuing education and asked what the deal was. Continuing education said, "we don't know, call the graduate school." I call the graduate school. "You need to reapply," I am told. I was annoyed to say the least. It's not like the application process is that bad, but this was the third time that I would be applying to the same school where I had repeatedly been accepted in the past year. Now I need to apply again? Apparently so.

I end up calling admissions again to ask them if I'm eligible for an application fee waiver. I talk to a student who puts me on hold, and then finally puts me through to an admissions counselor who never answers the phone and doesn't have voicemail. I call back, listen to their five minute automated message, and talk to another student. They put me through to the assoc. director's voicemail who is on vacation. The associate director calls me a few days later when he returns from his vacation, and says that I have to contact a different office. I call the other office and am told by a woman on their staff that I will have to reapply. She promptly hangs up. I call her back "what about the fee waiver?" I ask. She replies that that is not available and that I will have to reapply. I start explaining my situation to her and then she puts me on hold. She says that if I contact the department that I'm taking classes in (for ex. the chem. dept.) then they may be able to grant me a deferral and then I won't have to reapply. Okay, now we're getting somewhere.

I contact the chemistry department and repeat my story, once again. The woman who I talk to says that she's never heard of anything like that. She says that she will have to call some people and get back to me. She leaves me a voicemail today, saying that I need to contact someone in the office that referred me to her. I talk to this guy, and he says that I'll have to reapply, and that there are no fee waivers except for poor minority students who are in their poor minority student program (which is only for matriculated students).

I get online, repeat the application this afternoon, and then realize that unlike their other application, there is no way to pay the application fee online. So now I have to drive an hour and a half to the school on Monday to drop off another check, and more transcripts (which I've already given to them, twice).

To make matters worse, registration begins for students with my lowly status on Monday. So, I'm pretty much screwed. I feel like this is some kind of secret test of patience and endurance. If that's the case, bring it on.

Monday, August 9, 2010

SDCOD

SDCOD (sleep-deprived comment of the day) should probably be changed to SDCOW (week) or SDCOM (month). I'll aim for SDCOW, and we'll see how that goes.

And now... an excerpt from doctor's orders for a patient in our unit:

0.4mg sublingual nitroglycerin for chest pain, every 5 minutes x 3 doses PRN. If chest pain unrelieved after 3rd dose, call 911.

Thursday, August 5, 2010

Did I make the wrong choice?

I just called the daycare center at the university where I'm taking classes in the fall. I learned I'm not eligible for their financial aid program because my husband and I make over $3500/year together. It's frustrating. I sometimes feel like some of these aid programs are practically an incentive to quit my job, because then if I did, I'd actually be poor enough (by their standards) to get assistance.

The cost of daycare plus the cost of gas to commute to school alone will eat all of my take home pay each month. I still haven't figured out how to pay tuition (or any other expenses like the utility bills, groceries, etc). After finally giving up on private loans (which were all variable interest rate and scary), I applied for a second credit card in an act of desperation. I can pay for tuition with a credit card, right? And after all of this, I still don't even know if I'll be able to get into the classes I needed to take because I'm non-matriculated.

I opted to take the "design my own post-bac program route" because I thought it was more direct and made more sense financially. But honestly, I don't even know how we'll pay the bills. The whole thing stresses me out so much I can't sleep.

Did I make the wrong choice? Last year I applied to the bioengineering program at the same school and was offered grants that covered the entire cost of tuition, plus ample money for cost of living in federal (not scary) loans. I would have had an advisor. I would have been able to get into classes. I would have been able to take voice lessons and get involved with research. It would have taken four years instead of two, but now I'm not even sure if I'll be able to figure out how to take classes this year. I would so much rather spend some extra time in school and be intellectually engaged then spend some extra time waiting to take classes and pulling my hair out.

Is it completely insane to call the director of the program (I met with her last spring) and tell her I changed my mind? Do you think they would actually let me back in?

Wednesday, August 4, 2010

Weighty Matters

I've been called in with four other people to help hold up the panniculus of a fifty-year old woman in our emergency department so that one of the nurses can catheterize her. The big flap of abdominal tissue that nearly extends to her knees is firm and pocked, and almost scaly in areas with patches of dry skin flaking off under my gloved fingers. With the help of my coworkers, we grab the the heavy lump of tissue and pull it up so that Matt can prepare to insert the Foley.

"I can't find her vagina," he mutters in exasperation.

We all shift around a little bit, trying to pull the panniculus up a little higher and shift the position of her legs. After a few more minutes, Matt manages to find her vagina.

"Are you guys doing okay?" He asks. "How are your backs?"
"We're fine, don't worry," says one of the ED techs, her forehead damp with sweat.

Mike unwraps the catheter package, puts on his sterile gloves and prepares a sterile field, lubes up the tip of the tube, drapes her, swabs her, and gives it a go. The catheter is in. None of us thought it would be that easy.

"You're done?" Our patient asks. She smiles. "I've never had anyone put in a catheter that fast before!"

These kind of situations were initially really shocking to me, but more and more, I'm realizing that they are becoming commonplace. It is not all together unusual that I will come to work and we'll have a patient in the ICU who is so obese that she is unable to move her legs or even turn onto her side. I will later read histories and physicals, and see that some of these patients were not in nursing homes before they were admitted to the hospital. How do they live independently? How do they go to the bathroom, take a shower, clean their house and get groceries? Who takes care of them? It is terrifying to me that some peoples' obesity has become so out of control that they are nearly trapped within their own homes.

It is physically strenuous to care for these kinds of patients, even in the hospital setting. It sometimes takes four or more people to turn and clean up the patient in bed if she has a bowel movement. They seem predisposed to skin breakdown between the folds of their skin. We need to find special bariatric commodes, wheelchairs, and beds (in our hospital, there are a limited few) with special bariatric sheets, and use bariatric gowns because normal hospital gowns do not provide adequate coverage.

Many of these patients are in the hospital due to complications of their obesity (heart disease, hypertension, diabetes, sleep apnea), and some healthcare personnel are not terribly sympathetic, having an attitude something along the lines of it's your own fault that you let things get this out of hand.

I don't know exactly how I feel. As an aide, it's rare that I have the chance to get a very complete picture of any of our patients. I don't really know what the contributing factors are to their obesity, how they got there, what they tried to do to help themselves. What did their doctor try to do to help? Did they even have a doctor? There's a part of me that's always a little baffled. I always imagine if I were becoming seriously overweight, I would be alarmed at my weight gain and I would do something. If my attempts didn't help, I would seek help until I found a weight-loss strategy that worked.

At the same time, I feel like these patients who are so obese they can barely move are practically past the point of no return. How can they exercise if they can't stand up? Even just as a pregnant woman it was uncomfortable for me to exercise, so I can't even imagine what that would be like if I were 300+ pounds. By the time these patients are in the hospital, their prognosis is likely even more dismal, so in my book, these patients are deserving of any kindness and help they can get. After all, it's our job.

So I guess my big question is, how does a healthcare provider keep patients from getting apathetic about their weight? Do you think it's an issue of motivation, education, or something entirely different?




Tuesday, August 3, 2010

Where did I go?

I've been really grumpy, lately. Everything seems like kind of a crapshoot. I delayed taking classes until the fall, but then I encountered an insane car bill and have now spent most of the money that I had been saving for tuition. I applied for several private loans but was rejected for all of them even with a cosigner (which surprised me, because my credit rating is in the 700s). I think it is really hard to get loans as a non-matriculated student taking 5th year undergrad courses. I'm feeling screwed.

Spending nearly four years exploring menial jobs to confirm my interest in medicine has proved to be overkill, and now I feel like I'm going to lose my shit. Working overnights sucks. I never get to sleep during the day as much as I would like to (between two and six hours) and I think the sleep deprivation is messing with me.

It's depressing not to be challenged, and I constantly feel torn between wanting to learn (one of my favorite activities is reading charts, and looking up terminology that is unfamiliar to me) and doing what needs to be done (emptying foleys and urinals, stocking supplies all over the unit etc.). Stocking is this endless task that no one wants to get stuck with. We stock about a hundred supplies in each room; it's mostly boring stuff: shampoo, toothbrushes, suction liners, tubing, yankauers, emesis basins, etc. Initially it was cool to familiarize myself with some unfamiliar equipment, but it's just banal repetition. Compelled to do my job as well as I can, I always do whatever needs to be done over what I enjoy doing. The thing is, I stand there filling these cabinets while I imagine my brain atrophying and grow more and more bitter. The nature of my job involves few puzzles, little problem solving. If I actively seek it out too much, I feel like I'm slacking off. I guess the good news is that it's not forever, but I just don't know if I'll really last two more years as an aide while I finish my pre-med requirements.

Despite this, we recently had a patient who was detoxing, but two weeks later, was still significantly confused. He came in reasonably oriented, and I was puzzled as to why he wasn't getting better. I asked one of the nurses if it was normal to have DTs for such a long period of time -- don't they usually subside by this point? Do you think the benzos are making him loopy? And then wide-eyed and excited, "maybe he has Korsakoff's Syndrome!" recalling tidbits from a human neurobiology class from undergrad. His nurse looked up at me, "what's Korsakoff's Syndrome?"

Tonight I was reading a progress note by one of the internists whom I really respect, and he too, was curious about the origins of this guy's encephalopathy. And what did he consider? Tail end of DTs, adverse reaction to benzodiazepines, and you guessed it, maybe Wernicke Korsakoff's syndrome. I was really surprised with myself. Usually I just laugh at myself and the ridiculousness of an aide throwing out ideas as a diagnostician. I think the thing that I have to remember is that I'm learning, even if only by osmosis, a lot the time. Hopefully some day some of that will actually be useful.