Moving right along

So...I got my first official pelvic exam under my belt -- so to speak. Our "guiding" patient was very knowledgeable about her body and the exam. She was really helpful in finding her cervix, ovaries, etc. I didn't do anything stupid like drop the spec on the floor, or cause her any discomfort. I found her cervix on the first try --- it just "popped" into view. I also palpated her cervix, uterus, and both ovaries. So I'd deem it an overall success. Also helpful, the model closely resembled a good friend of mine from college. Most challenging was not the exam itself but rather the language used throughout the exam. Our model recommended using direct, clear language but to avoid things such as "good," "wonderful," or "great." We needed to focus on "healthy" and "normal." Also interesting was feeling a non-pg cervix...very different from all of my prior cervix-feeling experiences.

In other news, I began my first clinical rotation at a very busy OBGYN office about 30 mi from my house. The practice is large with 9 CNMs, 9 MDs, and 4 WHNPs. They have several offices. I worked with one of (two) male midwives in the area. My preceptor has been a midwife longer than I've been on this planet. The office was fast-paced and we saw 17 patients in a "not so busy" day. Also, this first day was supposed to be mostly observation, but that didn't last long. Within the first twenty minutes, I was checking cervices, doing bimanual exams, measuring fundal height, listening to FHTs, and doing a majority of the physical assessment. Most interesting case of the day....a pt who comes in with 2 +HPTs and an IUD. In our office, she had a +pg test so we pulled the IUD. Turns out she had a ruptured bleeding ectopic on the right side. We sent her to the hospital for surgery. Kind of a big deal for my first day. I saw pts from age 16-61. And I worked with both midwives in the office. I'm going to be doing two days a week in the office for the rest of the semester. Seeing pg pts is my most-favorite, especially when they're full of baby. I just love laying hands on pregnant bellies and talking to the mommas. Just reinforces my love for what I will soon be doing. I found myself working with newly pg pts, calculating their EDC, then wondering...maybe I'll catch your baby.

And on another note, I think ICD9 & CPT codes are horrible. We have to track all of our patient encounters in a database for school. We have to add every patient we see as well as use the appropriate ICD9 and CPT codes. This is quite overwhelming...I've only been able to enter 6 of my 17 patients from this week. Ridiculousness continues....please explain to me why there's an ICD9 code for a Bartholin gland cyst and abscess but not a code for Skene gland cyst or abscess...? (Had a pt with one of those too.) I'm sure the coding will get a lot easier as I go along, but for right now with all of the other work I'm doing...it's way too much.

School is going alright --- I'm finding that a lot of information we're getting is repeated from my undergrad, since I am a segue student. In particular, my Advanced Pathophysiology class is almost verbatim from my other pathophysiology class. It's sort of annoying but also convenient because I saved all of my notes & study note cards (via iFlash). So I think I've got an advantage. My research class is terrible...full of time-consuming unimportant busy work. I will be happy to have this semester over.

Up for today...male genitourinary exam with a DRE on a "guiding" patient. This is going to be horribly traumatic as I will never take care of adult males, ever! Some of the other midwifery students did the exam last week and said it was terrible. *sigh* I see some alcohol in my near future.

I'm heading out tomorrow to go to VA for fall break. I'm super excited to see the family for a few days. I know I'll spend some of my time reading & studying because we have a midwifery exam on the day we come back.

On a side note, this week was Midwifery Appreciation Week :) We're having a celebratory ACNM chapter meeting next Tuesday. I'm really enjoying getting involved with the local chapter and going to meetings. The midwives in the area are a really closely-knit circle. A lot of our preceptors, we've met at the chapter meetings. I've got a lot more to share, but this is a good start.

T minus 3 hrs 15 mins

...until my very first official pelvic exam. I'm sort of nervous but not-so-much as my classmates who have already gone before say it's not a big deal. The big nurse-midwifery test was yesterday and I did pretty well. Although we did have some random ass questions that weren't very good. I think they may throw them out so my grade will be boosted a little more. Current lecture topic is breast health. Next up...sexual health. Followed by my female gyn check off.

I'm taking an extra elective class which is driving me nuts. The format and content isn't really fun for me. Plus it keeps me on campus an extra 16 hrs for the next couple weeks. I heard through the grapevine that we are getting our clinical assignments next week. Then we're off to clinical doing all sorts of well-women care., including pelvics, paps, prenatals. I'm super excited. I hope my site is appropriate for me.

Still haven't called the clinic director yet. I've been putting it off because I've been enjoying my minimal time off. Fall break is fast-approaching and I will be heading home to spend some time with the family for a few days. Gonna go back to paying attention....

Back in action

So blogosphere...I am back. A lot has been going on with life and school -- so let me hit the highlights. I finished the BSN portion of my program, passed my NCLEX, and now am working on the *uber fun* MSN portion. I had been working pretty regularly but decided to leave my job to focus more on school. I will (hopefully) get another job at a women's clinic in the area where my friend works. Unfortunately, the hiring manager is very bad at following up with people so it will probably involve me hounding her.

Classes this semester are: Advanced Pathophysiology, Theory & Research, Nurse-midwifery I, and Advanced Health Assessment. I also added an elective -- Teaching Institute. I've been in school for about three weeks now and have been quite busy. In fact, my very first pelvic exam will happen this Wednesday with a professional medical model. My first test is Tues in NMW, so I've been studying/reading/reviewing for that. We've covered STIs, Family Planning, BV, normal pregnancy database, and maternal physiological adaptations to pregnancy. Sounds like a lot, but most of it is review. No clinical yet; they start sometime in October with just office hours. Next semester is when we begin to take call and catch babies. So stay tuned.

And although, I've been gone for awhile, I do still read all of my favorite blogs. In fact, a lot of information gleaned from my blog-reading is shared with my classmates and professors. Most recently, I showed everyone the Beautiful Cervix Project . It's awesome because we're learning about what healthy cervices look like as well as the influence of hormones on the cervix.

Anyways...life is good. All is well. I'm so excited I'm all the closer to catching my first baby.

Blech

I don't feel so hot this morning. I'm up early at school for this dumb emergency preparedness simulation. In fact, I thought the sim was at 8am, but it really doesn't start until 9am. Boo. I could have slept an extra hour. Oh well. My stomach is upset this morning. It kinda feels like I still have last night's dinner in there. Worrisome, but I'm going to just keep an eye on it. So I'm sorta nauseous and cranky. And I've already taken some Tums that haven't helped much. I have a pocketfull just in case.

Went to work on Tuesday night and had my first bleeder. Yay! Not yay that someone bled, but yay that I got to experience it. My boss and I had joked that I hadn't had one yet so I suppose she jinxxed me. This lady had a normal (vaginal) delivery and everything looked alright when she came up to the floor. Although, I had a nagging feeling about her. Sure enough, within an hour, she almost completely tanked. Hypotension, lots of bleeding -- we had to break out the "bleeder box." The box is this bright orange tacklebox full of things you'd need to handle a bleeder. Think: a code cart, sort of. Tons of people come -- supervisors, LDR charge, MD, the lab, etc. I helped out a bunch -- documented, ran to get supplies, etc. Overall, we fixed her and her bleeding stopped. So yay. Score one for me.

After a bleeder, you have to replace the box. This was my job which involved me carrying the old one down to the basement of the hospital. BTW, hospital basements are never a good thing. The place I had to go was next door to the morgue. Lovely. Also, this bright orange box marked in bold with "BLEEDER BOX" catches a lot of attention if you're just walking around. Several people (staff mostly) were like OMG where are you going? And I was like...Oh no --- nowhere -- we already did it.

((Yawn.)) Anyways...I think that's as exciting as I get this early in the morning. I hope my stomach gets better soon. I hate feeling nauseous. More later.

Mmmm coffee

So I'm sitting here with my nice warm yummy cup (number 1 out of 3) of coffee. Ever since I quit smoking, I transferred my dependence to this little cup. It's also during this nice spring weather that I want to smoke more than ever. I didn't like smoking in the summer, but the spring was my favorite. I'm glad I quit when I did, but feel like I could start back up at any minute. I still think there's something sexy about it. But realistically, I couldn't imagine smoking during nursing school. Your classmates/professors harp on you enough without you doing the #1 preventable risk factor for an abundance of medical conditions. It would be more than I could stand.

I slept pretty well. Went to bed around 3ish after working out and showering. I don't know why I like to work out at 1 or 2am. It really calms me down and gets me ready for sleep. Plus, there's no one in my apartment's little gym. On Thursday, I broke out my Total Gym and had a pretty decent upper body workout. I'm still sore. Yesterday, I was especially girly. I painted my toenails and primped for awhile. I also had some yummy beer. Some restaurant's special brew. Yum.

The plan for today is work at 7p. I have to be really good about being on time since I was late last time. Boo. We have no "grace" period for when we clock in. And without a doubt the most annoying thing is someone who stands at the clock, swiping their decrepit badge that won't scan, as other (on time) employees pile up in line behind the dumbass as the precious minutes tick away. I mean cmon ... you know your badge doesn't work well, so please GET OUT OF THE WAY! It's super annoying and happens pretty much every time I go to work. I need to pick up a few shifts so I can have some extra cash. I just don't feel like working any more than I already do.

So as far a job concerns go, I am more than likely staying at my hospital after I graduate. They have said (unofficially) that I can stay on after graduation and continue to work, getting paid RN salary for doing the job I currently do now. SWEET! Then once, I pass boards, I will take their intern class. The official party line is that the next class isn't until September, but I'm not sure if I will want to wait that long. So the plan is to stay on as a tech, get paid RN salary, and I'm under no obligation to wait around until the intern class starts. Then, if I don't want to stay, I will already have my license and I can look for work elsewhere. But the job market (even healthcare) sucks right now. Only 10 or so of my 95 classmates have jobs after they graduate. Pretty much by this time last year, most of the graduating class had positions. Nowhere is hiring -- most hospitals are on a hiring freeze. My hospital is only offering positions in-house to people who already work there. And I will have been with them a year in June. Although Mother-Baby isn't my ideal, I will take just about anything now.

As far as graduation, it's fast approaching. Since I'm in the segue program, I am not "officially" graduating but I am still participating in the activities. It was really hard to get this degree (Bachelor of Science in Nursing). And I'm pretty proud of myself. I think getting here will be the most difficult part of my program. I took my exit exam and it predicted that I will 99.9% pass my NCLEX the first time I take it. So I'm just going to keep reviewing but not go overboard. Our pinning ceremony is May 9th. This is probably the biggest deal. Graduation is May 11th with us participating in the school-wide commencement, then having our own nursing school ceremony. My dad is supposed to be down for that weekend but he has yet to purchase a plane ticket. I think I'm going to end up just buying it and he can pay me back. He's the worst at making arrangements like this. My stepmom is still on the fence about coming because it's Mother's Day weekend. With all of the recent familial turmoil, she thinks she wants to spend it with her mom. And plus, I'll have another graduation May 2011. You can't be too picky when you've already had a graduation or two. By the time I'm finished, it will have been three! I need to stop with the higher education. Another good friend has a cousin who is graduating from Emory too, so he's thinking about coming down.

I need to figure out my summer agenda. I want to go home sometime for awhile. But I'm not sure how my schedule is going to be at work. I'm just kinda waiting it out. I know I want to go like June/July, perhaps even take my NCLEX in VA. August is going to be a challenge to go anywhere. We're not renewing our lease here, so we'll be moving Aug 1. We haven't found a place but I'm sick of living here. With the real estate situation as it is, I think we'd be able to easily find a cute little house for rent in one of our favorite neighborhoods for what we pay here in rent. Plus, I want a yard so the dogs can go outside and play. We'll see how it all works out.

I really haven't had a lot of VA people come to visit, but a few of them have mentioned coming down here to hang out. over the summer I think it would be pretty fun. Although, I have one really good friend here, there are a lot of friends that I have in VA that can't be replaced. Plus I miss my good friends. It's hard to appreciate living in the same place for pretty much your entire life, how everyone knows everyone, until you move to a completely different place. You forget how much you rely on personal connections and networking for all sorts of things (such as getting an appointment with so-and-so's hairstylist). I do like this area, but am unsure I will want to stay here after I'm finished.

What a night!

I just had the best night in L&D since I began school. Finally my preceptor and I had laboring patients. Not cervidil inductions with "therapeutic" rest or Pitocin inductions. Actual patients who were in real labor, on their own terms. Freakin' finally! So when we got on shift, we had a pt who was pushing. Her birth was alright ... her OB showed up for literally five minutes, to yell at her for her pushing, impatiently cut a ML epis, delivered the baby, the placenta, threw a stitch in the perineum, gave a quick fundal massage and abruptly left. I swear he was there for no more than five minutes. We finished her recovery period, did pericare, fundal massage, took VS, straight cath'ed her, got her cleaned up and ready to go upstairs (postpartum). Pretty much within minutes, we were admitting someone else in actual labor. She was sent from the office because she was dilated 4/80%/-2. She denied feeling any of her q 2-3 minute contractions, but happily made progress until 7 cm when she politely asked for her epidural. She was such a wonderful patient. I wished we could have been there for her delivery.

My most favorite patient was this woman who suffered from Marfan's syndrome. She had a PMH of preterm labor and she labored quickly. She came in dilated 4/80%/-2 with regular contractions. We got her comfortable and she labored well. I got to check her cervix twice after she got her epidural. She went quickly from 5 to 7 to complete. She pushed maybe a half a push and her baby was born. Her OB was fantastic. Probably the best OB-attended birth I've ever seen. He didn't break down the bed and put the pt in stirrups. He sat at the edge of the bed, encouraged her to push when she felt ready, basically caught the baby, let dad cut the cord and told him to "present" his baby to the world. Dad picked up the baby and presented him to mom and grandma. Baby went immediately skin-to-skin with mom (this has been the first time I've ever seen the illusive immediate postpartum skin-to-skin.) Mom's OB said that his midwives had been rubbing off on him. Intact perineum, no rough man-handling of the placenta, no loud provider-directed pushing, no alarmist comments; overall, very reassuring, calm and collected. He stayed for a little while afterward, but it was a really quiet, low-key birth. Awesome way to end an 8 hour shift.

Happy (almost) Valentine's Day

So it's almost Valentine's Day.  I've been super busy but that's nothing new.  My weeks are about 60 hours of actual stuff I have to do (work, school, and clinical.)  Plus I've been trying to buy a pre-owned car in my (non-existent) spare time.  Beloved is going out of town for Valentine's Day so she surprised me with one of my most favorite things (an Ed*ble Arrangement).  Ever since my family sent me one for my birthday, I loved them!  Isn't it cute?  I got her a couple of DVDs she wanted.  

This past week we had to attend an "interdisciplinary team training" day with M3 medical students.  It was mostly boring and somewhat interesting.  We did a simulation together where we were able to mix up what roles (med students could be nurses and vice versa.)  They focused a lot on Universal Precautions.  I'm pretty sure this entire day was someone's thesis as we had to sign consents, do pre and post-activity surveys.  Blech.  After that day, I went to clinical and attended a surgery where no Universal Precaution (ie. surgical time out) was done.  So much for integrating theory into practice.  

Clinical has been going well this week.  I circulated a stat section and recovered the patient.  She ended up going to my floor in Mother-Baby so I saw her the next day when I was working.  Actually, this past Tuesday I saw a lot of moms who delivered on Monday night when I was at clinical.  It's funny because they remembered my face & name.  Kinda hard to explain to them why I see them all the time.  But whatever.  I emailed  the powers that be at work to see if it would be fine for me to stay on as an RN once I graduate.  I don't anticipate any problems.  I'm 0 for 3 in the IV starting department.  The last one I tried I got flashback but then her vein just disappeared.  I'm not stressing it -- it's just one of those skills that you have to just keep working at in order to consistently get it.  

Another project I've been working on is purchasing a car.  It has been going on for the past couple of weeks.  I know I want a H*nda -- either 2006 or newer.  It's kind of been narrowed down to two or three cars.  I'm going to test drive one in a little while and see if I can talk their price down at all.  If not, I will buy the car I've had my eye on for a little while.  Either way, I will post pics once I get it.  I haven't had a car for awhile, but I've promised myself I won't abandon my bike, especially now since the weather has been so beautiful.  I can handle 70 degree weather in February.  Hopefully it's not a fluke.  

I've been eagerly waiting to see some expectant friends in L&D.  Maybe I will run into you all tomorrow?  I'll be in L&D from 3-11p.  Saturday I will be doing Mother-Baby 7p-7a.  Let me know.  

Blogging while stuffing my face

Alas, I am at the hospital again.  I swear I practically live here between my 24 clinical hours and my 24 actual working (and getting-paid-for-it) hours.  I have my computer because I came straight from school to the hospital.  Tonight I'm posted in HRP (High risk pregnancy.)  My new preceptor is a clinician so we don't have formal patient assignments.  Although non-traditional, I think it fairs better for me because I get to do things with different patients.  I pre-opped a C/S, drew labs, and urine specimens.  HRP is good for starting IVs and clinical skills, in general.  The next IV start is all me.  I think I should do alright.  No pressure.  Anyways ... my preceptor is all about teaching and letting me go out there and do stuff.  I'm all for that.  I might start an IV on GuyRN who has awesome veins.  We will see.  Only 3 and 1/2 hours to go.  I'm beat. 

Beloved made me such a wonderful dinner.  Rice & beans with some yummy steak in there.  She's really learned how to cook recently.  I love it.  Alright...I'm headed back.

Gr

I am annoyed for the following reasons: 

• My teacher says that ORIF always refers to the hip.  Google "open reduction internal fixation" and you come up with more things than just a hip replacement.  
• Same teacher says a moist wound bed is bad for wound healing.  Wrong.  

That is all for now.  At least I still have my coffee in my hand.  

25 Things about Me

Rules: Once you've been tagged, you are supposed to write a note with 25 random things, facts, habits, or goals about you.  At the end, choose 25 people to be tagged.  You have to tag the person that tagged you.  If I tagged you, it's because I want to know more about you.  

1. Coffee is my ultimate love.  It is the first thing I want in the morning -- the one thing I need to get my day started.  Please don't ask me to make any major decisions without first having my morning cup 'o joe.  I even purchased a brand new coffee maker for my parent's house because I snobbily disapproved of theirs.  
   
2. I'm kind of a nerdy geek.  I like technology, the internet, new gadgets, and marching band.  I think nerdy is cool.  
   
3. Despite my nurturing spirit, I can kill almost any plant that comes into my life.  
   
4. I want to be a midwife more than anything.  It's my calling.  Seeing a baby come into this world is by far the most amazing thing I have ever seen.  Ever.   It warms my heart when my friends say they want me as their midwife when they have babies.
   
5. I'm Native American -- NC Cherokee to be specific.  
   
6. My family, especially my father, are my heart and soul.  I would do anything for them.   It sucks being so far away.  I'm the oldest of 9 children.  Amazingly, I can remember everyone's names!  Mostly, we all look like my dad.  
   
7. I was a nanny for like 6 years before coming to Atlanta.  My favorite was nannying for twin girls.  I still stay in contact with their momma.  They're four this May.  
   
8. I've only quit one job.  Ever.  It was a horrible job that has scarred me for life.  
   
9. Sometimes, I boycott shaving, especially in the winter.  It takes up too much of my time.  
   
10. My Fuji Crosstown 2.0 in burgundy is my primary mode of transportation.  I have a rack, an Ortlieb waterproof pannier, and (new) black fenders.  I hope to add new bell soon.  
11. I can be super mean when you're trying to wake me up.  I say things I don't remember and will tell major lies in order to stay in bed.  Not sure how this is going to work when I'm on call-shifts. 
    
12. I want lots of kids.  Circa 5 or more.  And I want to have my babies at home. 
    
13. I don't really like to put my clothes away.  If it weren't for Beloved, I'd have my clothes decorating every surface of my apartment.  
14. I graduated with a BA in Women's Studies in 2007.  My diploma still isn't framed.  
15. I don't really like cartoon-themed scrubs.  I have sworn to myself that I will not wear them.  
16. My DivaCup is freakin' awesome.  If you have any questions, please ask.  
17. Aside from my eyes, I'd say my breasts are one of my best features.  People who don't know my name at school have aptly settled on the girl "with the boobs."     
18. I used to smoke.  I quit almost 4 years ago when I started dating Beloved.  I'm so glad it happened before nursing school.  
19. I like the L Word.  Even better than the show is the Planet Podcast with KC & Elka.  They are so funny.  
20. I like artists.  My two most serious relationships have been with a painter & a musician.
21. I had two monologues in my university's production of The Vagina Monologues.  My father and entire family attended.  I had the see-you-next-Tuesday monologue.  
22.  My baby brother is 7 years old.  He was born when I was a senior in high school.  He and I are super close.  I was the only one who could put him down to sleep until age 2.  He's still spoiled.  People used to mistake him for my son.  
23. I am friends with all of my exes.  Pretty standard in the lesbian community.  
24. I'm addicted to Pandora & PandoraJam.  
25. A quote from Peggy Vincent's Baby Catcher, "Seeing a white dove fly free from a wizard's cupped hands paled in comparison to watching a glistening baby with pink fingernails and wet eyelashes appear from inside a woman's body.  It wasn't magic.  It was real.  In that moment, I knew I wanted to spend my life caring for women having babies."   

Please leave me a comment to yours, so I can read it.  Thanks for playing!

I tag: 

• Chronicles of Conception
• Family O
• Finding Chaos
• Stand & Deliver
• Sage Femme
• Navelgazing Midwife
• Minority Midwifery Student
• Magical Mystery Land of Community Health
• Not Nurse Ratched

But if anyone else who I didn't tag wants to play, go right ahead!  Just leave me a link to the post so I can read it. 

It's been awhile

I know I've been a terrible blogger of late but much has been going on in my personal life thus forcing me into survival mode these past few months.  Last semester was my Med/Surg clinical.  In the midst of that, my father had a terrible freak accident, I missed weeks of class, went home on several unplanned trips, and barely made it through the semester -- emotionally, physically, academically or otherwise.  His health is just starting to come around again, but I bounced back much slower than anticipated.  During all of this, my car died so I donated it to charity.  As a result, my bike and I have been spending a lot of time together.  I've just started my last semester before becoming a RN (real nurse -- lol).  This semester should be fairly easy and quiet since I completed my community health course last summer.  Right now I'm sick with the flu (type A -- to be specific) despite getting the vaccine.  And that brings us up to speed.  

I'm currently doing my role transition (senior practicum) in Labor & Delivery at my hospital where I work.  I've only had one day on the floor so far and I really enjoyed myself.  My preceptor seems interested in teaching me, so that's always a plus.  And I am working in a familiar setting where I have a locker, know people, and in general feel quite comfortable.  I had hoped to "try on" this unit to see if I wanted to work there after I pass my NCLEX.  Unfortunately, they don't let you do part-time in L&D so I may just end up working in Mother/Baby.  As long as I have a job, then I will be happy.  I'm ironing out the details but should have a position secured shortly.  It's nice to know you'll have somewhere to go once you're done with school.  I'm not interested in working on a Med/Surg floor at all.  

In reflecting on my experience on the L&D floor, it's much better than my prior maternity rotation at the university-affiliated hospital.  Did I mention that student midwives from our university do not have privileges at the university hospitals?  How ludicrous is that?  Our students come to my hospital or another public institution for their training.  Can you imagine the med students not being able to practice in our university hospitals?  There would be an outrage.  This is one area that really angers me about my program.  Needless to say, the lack of midwifery care at the university hospital is apparent.  In my practicum, I have already worked with a couple midwives.  I always ask them where they went to school -- last week I had someone from Georgetown and before that someone from my program.  

Beloved and I are doing well.  Her father is helping me to find another car to purchase.  I'm thinking about the Honda Fit because I think it's super cute.  I want something small and practical.  Hondas seem to last forever -- my very first car was a Honda.  I'm ready for something practical.  

Despite my silence, I have still been keeping up with my favorite blogs.  I'm sure I will be back to posting regularly now.