Running with the Red Queen...

I haven't blogged for a while, and feel quite guilty about it. I've read and commented at times on my usual blogs, and lurked on several others but have only fit those in during the chaos. (Never start blogging right before the start of a new school year...between a college age child and a HS junior, along with my own classes for my new job, I've been quite busy).

Today's title comes from Lewis Carroll's Alice in Wonderland stories. Running with the Red Queen is a phrase my best friend and I use when , like Alice, it takes all the running we can do to just stay in one place (Through the Looking Glass, Chapter 2) I have been running for the last few weeks and don't think I'm managing to stay in one place, much less progress!

As a medical person, I am drawn to blogs by other medical people, or those who write about science and nature. I am not really into political blogs although I may follow links to them to read them here and there.

One thing I have found most surprising is the numbers of people who verbalize their mistrust of "conventional" medicine and believe all they hear about "alternative" medicine. I am NOT knocking all alternative medicines. I use ginger for stomach upsets, and (worthless testimonial here) preferred a comfrey ointment over any conventional diaper rash ointment when my children were babies. In fact, in a test, one weekend I put Best Selling Brand on one side of my daughter's rash, and used the comfrey ointment on the other. When she returned to daycare the following Monday, the providers wanted to know why she was healed on the comfrey side and still red and sore on the BSB side. As a midwife, I have used other unconventional methods of care, but ones that had been reviewed and some efficacy documented. The old "Lawrence Review of Natural Products" was my bible for years.

The vaccine furor surprises and bothers me. I have been vaccinated, I have had my children vaccinated. I am nonimmune to measles and mumps. I had rubella as a young child and was found to be immune. However....I also had mumps and measles as a child. I am not immune to those diseases. When I started graduate school I had to have an MMR (at age 30+...) Even after the vaccine titers showed I was not immune. So, I am dependent, to some extent, on the herd immunity because as an adult I am far more vulnerable to increased severity of disease. Yes, my interest in making sure I don't get the diseases is selfish. Isn't everyone's goal in life to remain healthy?

Another reason I haven't been blogging much lately is that my grandmother recently died, and I inherited many things from her. One thing I received are the letters she and my grandfather wrote to each other during WWII. The rounds of disease, the fears of exposure, and the deaths she mentions are frightening. And this is in a large, midwestern city with modern sanitation, good nutrition and medical care. Discussing some of the letters with my mother, she remembers vividly having measles and mumps in the same year...the classmate who died from complications of measles, and her own brother's near death from the same disease. My grandmother's letter to my grandfather, detailing my uncle's illness, brought tears to my eyes. The fear and anxiety in it are something I am delighted that I have not had to go through.

There is so much information in her letters. Reading them from a modern point of view, I can see the progression of medical care. I also recognize that my extended family struggled with a severely autistic child through the 30's and 40's. The boy was not seen as retarded although he was non verbal. (He did eventually end up institutionalized in the 1950's and died in the 1960's according to family history). They struggled with disease and a world war. They survived.

I will survive my chaos and blog more soon.

Learning basic nursing skills...not for the timid!

Most students returning to college for their sophomore year feel a sense of relief. No longer lowly freshman, they know their way around, how things are done, and where to find things.

My sophomore year was actually scarier than my freshman year. As a nursing student in the big university, it would be the first year we would go into the hospital. The thought was both exciting and scary. We stood in the hall in a long line to be measured for our uniforms. Like most nursing student uniforms, we considered ours to be hideous. Blue and white pinstripes, with a huge white placket in the front like a baby bib, but pleated. The dresses weren’t flattering to anyone. How envious we were of the men in our class. They would be able to wear black slacks and a tunic top…pinstriped like our dresses but without the ugly placket.

After measuring day, we were broken up into smaller clinical groups and assigned “lab days”. For those of you who haven’t survived nursing school, student nurses learn how to care for patients in the lab before being let loose on real human patients. Our excitement level was quite high, because once we had learned some things, we would have clinical in the hospital.

And how quickly our excitement fell the first day of lab, when we spent 2 hours learning how to make a bed! Like many hospitals back in those days, Big University Hospital did not have fitted bottom sheets. Flat sheets were used for both top and bottom, and we had to learn how to tightly fold and tuck the bottom sheets so they wouldn’t wrinkle, then place the pads on the bed, correctly put on the top sheet and blanket (NOT forgetting to fold them both in a pleat at the foot of the bed so that the patient would not have the linens tight over his/her feet) and tuck everything in neatly. Oh….and I almost forgot….it took the longest time to learn how to correctly insert a pillow into the pillowcase. One NEVER shoved the pillow into the case and shook it down. To insert the pillow properly, you gather the pillowcase up in one hand, grasping the bottom seam, place the pillow into the case and gently slide the case up over the pillow. And don’t forget to raise the bed to waist height (back in the era of hand-cranked beds) to save your back!

Once we learned to make an empty bed, we were taught how to do it with a patient in the bed. This was much harder and required the assistance of another nurse, who would help the patient lie on their side while you rolled up the dirty linens longitudinally, then placed the clean linens on half of the bed, also longitudinally. Then, the poor patient had to ROLL back over this huge hump of linens. You held the patient, again on their side, while your coworker whisked the dirty linens off the bed, into the hamper, then pulled the clean linens straight and tucked them in. After the bed was neat and tidy, the exhausted patient could roll back onto their back and recover.

After we learned how to make beds, we started clinical in the hospital. We could only perform the skills that we had learned in the lab, so the first day in the hospital was rather unsatisfactory once all the beds were made. And how conspicous we felt in our uniforms. Our white hose was spotless, our white shoes were spotless too. We hung around the nursing station, hoping to be allowed to do something...anything!

Other skills swiftly followed…how to bathe a patient, how to help a patient with personal hygiene activities (shaving, brushing teeth, washing hair). I missed the lesson on bedpans due to illness, and wouldn’t you know that my patient wanted a bedpan the minute I walked into the room? I picked up the heavy metal bedpan and looked at it warily. I had no idea how it should go underneath this 65lb 90 year old lady. I carried it over to the bed and the woman’s daughter helped me turn her onto her side. As I began to slide the bedpan under the patient, the daughter suggested quietly that perhaps I should turn it around; the rounded edges go under the buttocks! I blushed crimson and followed her suggestion. Getting a very full bedpan out from underneath a patient without spilling it was a skill I never acquired. Thank goodness for bed pads (now called Chux…BUH had the old fashioned rubber backed cloth kind)

But the days in the lab I remember most clearly were the days learning to give injections. Yes, just like the stories, we started with oranges, learning how to clean the skin, inject quickly and remove the needle neatly. BUH did have disposable needle sets for the most part, although some units still used the glass syringes. For 2 lab days, we practiced on the oranges, leaving with our hands sticky from juice.

After we became proficient in oranges came the day we all dreaded…practicing injections on each other. That day, we were put in pairs and were to inject each other in the two most common areas for adults—the deltoid (arm) muscle and the gluteal (buttock) muscle. The nursing instructor, sensibly, had the “injectee” lie down on a bed so the “injector” didn’t have to worry about fainting patients. I gave my two injections without too much difficulty. Then it was my turn to be the patient…..

My partner was (and is) a lovely girl, very shy and timid back in those days. The thought of causing pain by giving an injection made her hands tremble so hard she dropped the needle package twice before managing to open it. She gave an excellent deltoid injection and gave a loud sigh of relief. Following directions, I rolled onto my stomach for the second injection. I am very ticklish, and have a hard time with injections for that reason. As my partner cleaned the area for the gluteal injection, I began to giggle. I lay on the bed, shaking with suppressed laughter, as she began the injection. When the needle entered the muscle, I flinched and really began to shake. In a panic, my partner let go of the syringe and needle and backed away, apologizing for hurting me. I continued to laugh, lying on my stomach, with a needle sticking out of my hip until I could control myself enough to ask that someone PLEASE remove the needle! The whole room was exploding with laughter, except for my partner who was in tears at the thought she had hurt me. The instructor walked over, took my partner by the hand and assisted her in completing the injection and finally removing the needle.

This was our last learning lab. We had learned all the basic skills. Other skills would be taught when we began specialty clinicals (Obstetrics, Pediatrics, Psychiatric nursing) but they would build on the basic skills learned. Over time, basic skills become instinctive and an experienced nurse becomes very proficient at them.

I recently ran into my clinical lab partner in the ER at BUH, where I had gone for an injury that would require a tetanus shot. We recognized each other and a large amount of waiting time was beguiled by updating each other on our lives. But when she came into the room to give me the tetanus shot, I requested she give it in my deltoid!

Five years ago today

Today, many people are remembering. Bloggers are memorializing those who died. I can’t do that yet. The memories are still too painful and bring tears to my eyes. I will not watch the news re-showing the event, I am not reading the numerous articles in the paper. I have avoided all TV shows, movies, and videos. I will stop in and read the memorial articles written by bloggers linked to http://www.jamulian.com/db911 I hope that blogging will help me lay some of the ghosts to rest. (In order to protect my neighbors’ privacy some identifying details have been changed a little or left out).

September 11, 2001….a beautiful sunny, warm day. My good friend’s birthday. I arrived at work and settled into the routine of the day. All of a sudden, a coworker came over and said that an airplane had crashed into one of the twin towers. From our workplace across the river, we had a very clear view of the towers through the windows. No one could get any news, so we checked with one of the directors in his office. He had a radio, and turned it on as we all looked out his windows at the smoke. The news of the time was solely that a plane had crashed into the tower. No one knew anything else.

We returned to work, then, as a few of us walked over to the windows a short time later to look again, we watched as another plane flew towards the towers. We commented that the plane looked quite low, but it was not uncommon for us to see fairly low flying planes, being near three major airports. Then, we watched in horror as the second plane flew into the other twin tower. We screamed, then began to cry as the tragedy of the crash hit and the news reported this was another terrorist attack. For the first time we heard about the other crashes being reported on the news.

All over the building work was abandoned as employees crowded around the windows and watched the smoking of the towers. Employees who had family working in the city tried frantically to call them. Then, the worst sight of all….the collapse of the two towers. Even now, I can see the crumbling as the towers fell, and an enormous cloud of smoke and dust rose into the sky. We hoped and prayed that everyone who could had gotten out safely; those who had family working in the towers kept trying to call. No one could get through to New York as lines and cell towers dealt with the overwhelming amount of calls.

I called my children’s school. The secretary told me the schools were closing as the children were hysterical, especially those who had parents working in New York. Business ended for the day; the company sent everyone home. My children, when I arrived home, told me the good and horrible news….our cousin, who had an appointment in the towers, was safe as his appointment had been cancelled at the last minute. BUT….our neighbor, the woman who took my children to school every day, who was a wonderful, kind, loving mother and wife, who was a fantastic financial person, who worked very high up in the towers, had not called, had not come home, and no one knew anything.

My children were in tears, and I was finding it hard to be strong for them. They had several friends whose parents (one or both) worked in the city, and in and around the twin towers. Only one friend had heard that her father was OK and on his way home. The rest waited. The children across the street cried as no word came from their mother, and their father battled his way through traffic to come home.

When he, I walked over and talked to him…heartbroken and shaken, he had not been able to contact his wife. He had spoken to her only minutes before the first plane crashed and had not spoken to her since. Our tears flowed together as we suspected the worst. We both knew, if she was alive, she would have called, or arrived home by the time we met. Like him, my family continued to hope she would arrive home. Her children ran to the sidewalk every time they heard a train whistle, hoping to see her car driving down the road.

Another neighbor, whose husband worked in the towers, arrived. Her husband was a funny, loving father and husband. Always involved with his children’s activities, he and his wife were well known around the schools and the town for their willingness to help where needed. She, too, had no news and was hoping desperately to be told he had gotten out alive before the crash of the towers. She clung to her children as we stood outside and waited. Other neighbors, also waiting, came by and left. Some had spouses coming home, alive and well. Others had had telephone calls, their family member was OK, but couldn’t get home due to the traffic and disruption of mass transit. Others just waited.

When Husband arrived home from work that day, he and Childling #1 went to a local park, from which the towers could be seen on a clear day. There were many people at the park that day, staring at the still-billowing clouds of smoke, leaving flowers on a table. No one spoke, although many cried. Strangers comforted each other as they stared across the river. That night, I lit some candles in a local park and cried as I remembered.

As the following days passed, joy and hope bloomed, faded and ended. Some neighbors came back home. Other neighbors didn’t come home and, perhaps worse, their bodies were never found. .Memorial services, remembering their lives, were held. Life continued. But, even five years later, we have not forgotten.

The First Time....

Something most nursing students don’t see much of, if you are in a big university program, is death. If there is a code blue on the unit where you are, you are shuffled out of the way so you don’t interfere with the care being provided. In fact, during my nursing school days, I never saw a code when I was in the hospital for clinical.

However, I was fortunate. A big inner-city hospital near my home hired senior nursing students to work in the hospital. As senior students, we were permitted to do everything a nurse did, with the exception of giving medications. Unlike nursing school where I cared for one or maybe two patients, in BIC hospital I carried a 8-10 patient load, responsible for patient care, documentation and reporting to the next shift. It was a very good job and I learned a lot. But it is also where I saw my first death.

It started as a usual day. I had a full patient load of 10 patients. One of them was Mrs. Smith, who was on our unit with pneumonia. Mrs. Smith also had Alzheimer’s disease, and she was very hard to care for. She kicked, bit, scratched, and did anything she could to hurt people. I learned a LOT of four-letter words from this lady. Her husband, who sat by her side continuously, was mortified by her behavior. From him, we learned this lady never raised her voice in their 40 years of marriage, always was immaculately dressed, had her nails done weekly, and never swore. Mr. Smith adored his wife. He made her up daily, made sure her nails were still done weekly, and tried to keep her clean and neat. Unfortunately, Mrs. Smith had some behaviors that made that very difficult for him. We had to put her hands in restraints to keep her IV in place because not only would she pull it.out, but she would dig out feces with her lovely nails and rub them all over herself.

At the start of my shift, I went and checked on Mrs. Smith and the remainder of my patients then returned to the nursing station to chart the vital signs I had taken on my patients. No sooner had I sat down then the Smith’s daughter, who had arrived for a visit, came running down the hall yelling that her mother had stopped breathing. I followed her back to the room, took one look at Mrs. Smith and hit the code button.

As I began CPR, the charge nurse came in, followed by the respiratory therapist. The other nurse brought the crash cart and opened it as the code team entered the room. The charge nurse ordered the intern to take over CPR and instructed me to start keeping notes as she escorted the family out of the room. The Code Team senior physician asked for the medical history, which I gave. He stated, “Pulmonary Embolism” which really impressed me, that a physician could 1) make a diagnosis that fast and 2) that a pulmonary embolism could cause this.

Although they tried for over an hour, they were unable to resuscitate Mrs. Smith. I followed the doctor as he went down to the waiting room to talk to the family and stood in the corner as he spoke to them. The family’s shrieks and wails rang through the room. I didn’t know what to say or do, so I opened the door and left.

I returned to Mrs. Smith’s room, where the nurses were finishing preparing her for the morgue. I stared at this lifeless body, so still after all her activity. I had never seen a dead body before, never encountered death before. Family members had died, but I had been very young and not been taken to the funerals.

Death had a face. Death was someone people had loved. I finished the shift, thinking about Mrs. Smith, her family, and their grief. I learned a lot that day, and I’ve never forgotten it. And yes, the attending physician was correct…she had died of a pulmonary embolism.

Testing, Testing...

Since I commented on PZ Myer’s blog Pharyngula, I decided to let the book meme virus infect me. I figured it would be a good way for me to test whether I had worked out most of the PC problems I’ve been having lately. (No comments from the Mac gallery, please…I get enough of those from my brother LOL) And, I love reading book memes because they introduce me to books that I never encountered.

A book that changed my life: David Hough: Street Strategies. The first book about safe motorcycling I came across and read (and still re-read), along with his two books Proficient Motorcycling and More Proficient Motorcycling. Three great books for any motorcyclist to read and keep in their library, whether new or experienced. Every time I read them I learn something new.

A book I've read more than once: Lousia May Alcott’s books...all of them. I don’t know how many times I’ve read them but the first time was back in the 1970’s and I can quote huge chunks verbatim. Great stories, mindless reading and I STILL cry every time Beth dies.

A book I would take with me if I were stuck on a desert island: If I was limited to one book…Robinson Crusoe by Daniel Defoe. Or a field guide to edible plants. Other book options might depend on whether I was stuck alone or not. ;) (Thanks are due to The Minstrel Boy who caught that I gave the wrong author.)

A book that made me laugh: All the books by Randy Cassingham (Thisistrue.com), Darwin Awards and so many others, who look at people and modern life and point out how stupid humans can be. (So far, I have not appeared in any of these books…)

A book that I wish had been written: The one I have in my future plans…I have my grandparents' letters to each other from WWII and I’d love to create either a novel based on the letters or a book from the letters to show what life was like during those years. But there is so much information in them that it will take a long time to whittle it down.

A book that I wish had never been written: I don’t know. Books I hated other people love. Guess, like PZ Myers, I would have to say the Bible. So many evil things have been done based on someone’s interpretation of it (although there are some beautiful passages of sheer poetry in it).

A book I've been meaning to read: Since reading KA’s blog Biblioblography, I’m going to start Voltaire.

I'm currently reading: Several books at once (as usual). Thanks to the rainy weekend, I plan on finishing the third book in Mercedes Lackey and James Mallory’s The Obsidian Trilogy When Darkness Falls; I also am reading The Darwin Awards (again) and Nora Robert’s new book Morrigan’s Cross.

I really have a wide variety of books in the house; so many that Husband has threatened to leave me if I bring any more home. It’s an addiction. My books range from motorcycle ones, romance novels, science fiction, 20^th children’s literature, history, to my secret infatuation, 19^th century children’s literature. Particularly as a woman, reading some of those books makes me so glad I live in the 20^th and 21^st centuries!

I love to know what others read too, and why. It gives me more titles to buy and bring home! Or maybe I should hit the library so my husband doesn't leave... So, to quote PZ, “…infections aren't made by the virus's choice, so if you leave a comment here, consider yourself contaminated.”