Tag Archives: travel

“You can swallow a quarter, as long as….

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…as long as it gives you dimes and a nickel on the way out” –Physician guest speaker at SJCME.

ImageJust had my skills workshop on campus in Maine!  Here are a few highlights. A quarter is about the biggest foreign object that a child can safely pass… but that’s pushing it.

Xylocaine with epi has been shown in studies to be nearly as safe as plain xylocaine… however, my instructor strongly urges us not to use it unless absolutely necessary due to the risk of necrosis, especially on fingertips and toes. 2% lidocaine is perfect for adults, no more than 1% for children.  A tourniquet can be left on for approx 10 minutes or less to suppress bleeding in lieu of epi.  Too much xylocaine can be toxic– 3mL is generally sufficient.  This is VERY important in children!

Pig feet are an awesome learning tool for suturing. 6.0 thread is just about the tiniest needle imaginable and should be reserved for areas such as the face.  Your sutures should be spaced apart by approximating the distance from the former suture by 1/2 the width of your previous sutures.

Punch biopsies look like you literally used a hole puncher… but you don’t. It’s this very unsophisticated (yet effective) looking tool that you twist into the skin (using local anesthetic). You need just the tiniest amount of subcutaneous fat (very tiny) for the pathologist to estimate wound depth.  Any deeper and you’re going to have increased bleeding that may require stitching. The wound is closed with silver nitrate. If it requires suturing, you have to adjust the wound to make elliptical shape for closure.

If you have MDConsult, 5 Minute Consult, Ferri’s advisor, etc be sure to check their sites for instructional videos. I know 5 minute consult has excellent ones to review procedures :)  Practice, practice, practice.

I learned much more in class and will add as I go along… for now, I’m spending my vacation in Maine with my nose in textbooks!

Ooops!

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I just got back from Colorado. It was beautiful!  It was a short business trip, courtesy of Family Heritage. We snuck away from the group with a few friends for half a day to visit Mt. Evans.  It’s a 14,000 ft mountain that you can literally drive up.  It’s a 30 minute drive from ground to top.  It was 101 in Denver, and 50 degrees on the top of the mountain! It was amazing! Beautiful sights!  Of course, I was doing pathophysiology and pharmacology during his meetings and any chance I got. We just returned home a few days ago and then I’m off to Maine in 2 days! Busy, busy.

Pathophysiology is nearly done… I’m just a few critical thinking questions away. Hallelujah!!  I’ve never been so excited to move on to the next course :)  I found a preceptor and hope to start this September for clinicals. I just have a few MAJOR, CRAZY goals to hit to make that happen!  Pharmacology is underway, and health assessment will be started when I travel to Maine this week.  I’m doing a workshop for suturing, I&Ds, x-ray interpretation, etc.  I’m such a nerd… I’m more excited about a edu-vacation than I was when I went to Colorado without any forced learning :)  I think it’s nice sometimes to just have a break away from work, other people having fun, and feeling like you’re letting your loved ones down because you’re buried in a book!  In Maine… I won’t have to excuse myself for studying  :)  And what better place to celebrate with a few drinks for finishing pathophysiology?

Anyways,

I’m back on hiatus for another 2 weeks. Other students… feel free to let us know how your program is going & any helpful hints that you’ve found!  When I’m back from Maine, I hope to share a lot of what I’ve learned in the skills workshop and health assessment!!

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Cancer is the Worst.

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We recently studied over cancer in Pathophysiology. Reading the content really made me think about possibly working in oncology as a nurse practitioner. I’ve started looking at possible preceptors in the area that could give me some exposure, as well as potential employers. MD Anderson is in Houston… that would be AMAZING, only I’d have to live in the one Texas city I despise most. Traffic, pollution, crime… not that appealing. But to work at one of the most innovative, ground breaking facilities in the world? Dream. In fact, they’re internationally known for cancer treatment of Leukemia, which I just did a concept map on and found really interesting. I love analyzing lab values and understanding just what happens to instigate cancer.

But it’s the saddest job I’ll ever have! I’m not one of those nurses who can help diagnose something like Cancer, and then walk away the same person. I think that’s why I’d love it.

At one point, I had the meanest, most obnoxious patient I’ve ever loved. There was a lot of push and pull: hiding his medications from me, arguing with me about taking his medications, calling me on my personal phone asking to run errands (how he got it, I don’t know), dealing with destructive family members, and then… calling the last ambulance for him that ultimately led to hospice. I was so taken by this man!  He hollered at the unit nurses until I reasoned with him to stay by offering to buy him whatever meal he wanted when he got home. So he went home, and died hours before I came with dinner. Dagger. To. The. Heart. I’ve never cried so much! Before he died, I picked up his medications once with his direct instructions to “ask the pharmacist to go on a date with me!” Usually, we don’t pick up the prescriptions, but family issues left him with no one to do it for him. I met the pharmacist, told her what he said, and we had a great laugh and swapped stories! When he died, calling her was the hardest phone call I’ve ever had to make. I still think about him.

I think of the man who’s neck pain turned to thyroid cancer. The young man who just got his life together when his extremity numbness turned to brain metastases. The elderly woman who had gone a year knowing she had undiagnosed breast cancer, never sought treatment, or told her family because she didn’t want to hurt them. I think of the man who showed me a picture of him jumping out of a coffin, laughing because that’s how he wanted his family to remember him: not scared of death. And I remember my very first death as a nurse’s aid, when I gave a patient a diet coke and she laughed and said “honey, I’ve got cancer– think I could get the real thing?” and she passed peacefully before I came back, sneaking her a real coke. But, I think of all the lives we saved. I think of all the lives we didn’t save– I know that I gave the best care to them that I could, but I still carry them around with me. I mean, I really do. And it hurts.

So, why would I think to choose a career that is emotional sabotage? For the same reason it hurts: I carry those people with me. This consideration just came to me this week and I’m becoming more passionate about it every day.

In other news, I’m going to Maine in July for my physical exam course!! I’ll also be doing a skills workshop with suturing, I&D, EKG & X-ray interpretation, etc. I’m so excited! Housing includes lobster bakes, welcome parties, and weekend trips to certain areas of Maine. Here’s a picture of the campus, it’s beautiful!! They say the best day to buy plane tickets is on a Tuesday, so we shall see tomorrow!

As a reminder, these stories might be made up, they might be real. I might have added or subtracted facts. They might be stories from coworkers, or fake stories from coworkers. If you feel that these stories are about you or someone you know, this assumption is seriously mistaken. Cancer is the second most common cause of death in the United States and affects millions, so stories like these are unfortunately all too common and may resemble your experiences or someone that you know. I take confidentiality very seriously! Please see disclaimer.