Monday, January 28, 2008

The closest I get to a poop joke

When I was studying for my nursing license exam a few weeks ago I came across a diagnostic test that was new to me. It's called a defecography. Here's what my book says:

- Measures anorectal function.
- Thick barium is instilled into the rectum, fluoroscopy is performed, and the
function of the rectum and anal sphincter is visualized while the client attempts to pass the barium.
- No preparation is required.

I disagree. Plenty of mental (and possibly emotional) preparation is necessary to receive a barium enema that you must then crap out while being judged on your ability to do so by medical professionals. They probably videotape it too. Realizing this is a terrible image with which to leave you, I thought of an alternate definition.

defecography /def·e·cog·ra·phy/ (def-e-kog´rah-fē)
The collected musical output of the band Def Leppard: "Photograph" is the best song in all of the Defecography.

Sunday, January 27, 2008

Unintential dramaturgy on public transportation

For a fleeting moment, I thought, "Maybe this is one of those theater in public spaces-type troupes." But no, the drama unfolding across the aisle was real.

Cast of Characters

YOUNG MAN, tattooed and deliberately scruffy with fake animal claw earrings
SELF-STYLED HUSTLER, 40, red-faced and somewhat grimy from being outdoors all day

The play takes place on a half-full city bus in Houston on a Saturday afternoon.


(YOUNG MAN sits at the front of a clearly identified Houston bus. He is engrossed, reading Douglas Adams' Dirk Gently's Holistic Detective Agency [great book BTW]. As the unseen driver opens the door at a stop, SELF-STYLED HUSTLER enters right carrying a beat-up plastic shopping bag. He has an unzipped jacket on, but no shirt underneath. His pants and shoes have seen better days. He looks around and, despite plenty of empty seats, sits right next to YOUNG MAN.)

Hey man. You got a computer?


I said, you got a computer?


I'll tell you what then. You can buy this computer stuff off me.


C'mon! Buy my computer shit.

Leave me alone.

Damn! I always said Texas people were rude. Why you gotta be so rude?

(Unseen bus driver, clearly perturbed, makes announcement off stage)

Will the gentlemen who just got on please pay at the front. (beat) Now.

(SELF-STYLED HUSTLER lurches up and goes right to pay fare, leaving bag on floor in front of seat. He fumbles with a wallet before finally extracting a dollar and feeding it into the fare box. YOUNG MAN meanwhile shifts over to take up both his and HUSTLER's seat, then kicks HUSTLER's bag downstage. SELF-STYLED HUSTLER returns and pulls up short when he sees the situation.)

Hey man --

(Barely suppressing rage.)

You're not sitting here. Stop talking to me and go sit somewhere else.

(SELF-STYLED HUSTLER grabs bag and stands right facing away from YOUNG MAN, but clearly still addressing him and the rest of the bus.)

I hate people from Texas. They're either dumb or pretending to be smart.

(As the bus pulls up to next stop, SELF-STYLED HUSTLER exits, yelling over his shoulder)


(YOUNG MAN scowls as he reads his book. Curtain.)

I'm not sure what to call it. The Worst Salesman Ever sums it up nicely, but it's rather plain. Yelling and Insulting Your Way to An Almost Violent Non-Sale is a little too on the nose. Ideas?

Friday, January 25, 2008

A damn fine book

A couple days ago I finished reading one of my favorite books again, The Perks of Being a Wallflower. Even on this, the fourth go round, it astounds me how perfectly the author Stephen Chbosky captures how it is to be an awkward teenager who's just figuring himself out and finding The Smiths, Catcher in the Rye, and audience participation at The Rocky Horror Picture Show through new, "weird" friends and a perceptive teacher. The book is just amazing and it makes my insides smile to know that it's also widely read. I'd go into more detail, but I love it too much not to let you experience it fully for yourself. Just to give you an idea though, here's a sample of the way Charlie, the protagonist, thinks. He's just finished making his first mixtape for a friend.

"I had an amazing feeling when I finally held the tape in my hand. I just thought to myself that in the palm of my hand, there was this one tape that had all of these memories and feelings and great joy and sadness. Right there in the palm of my hand. And I thought about how many people have loved those songs. And how many people got through a lot of bad times because of those songs. And how many people enjoyed good times with those songs. And how much those songs really mean. I think it would be great to have written one of those songs. I bet if I wrote one of them, I would be very proud. I hope the people who wrote those songs are happy. I hope that they feel it's enough. I really do because they've made me happy. And I'm only one person."

Ach, nailed it. Really, find it and read it. I've never been in a bookstore that didn't have it (some put it in young adult, some in regular fiction) and I see it pop up in used bookstores regularly. Also, praise and glory to Carole for giving me the book in the first place. Whoo.

Tuesday, January 22, 2008

Role confusion r/t gender stereotyping, pride, and an unfortunate shade of blue-green

For the first time since moving here, I had this exchange while riding the bus:

Person looking at my scrubs: "Are you a doctor?"
Me: "No, I'm a nurse."

This was a frequent occurrence in Austin. Mostly when I was wearing a lab coat, though sometimes when I was just in scrubs at a hospital or grocery store. I'm never defensive about it because, well, I'm not defensive about being a guy who's a nurse. In anything, I'm ridiculously proud of it as should be clear by the name of this here blog and the pic up there. Plus I really am a Registered Nurse now so it makes me happy inside to say so.

Turns out the person on the bus was about to start surgical tech school and wants to work at a hospital. She knew where I worked based on the color of my scrubs, which brings me to another point. In an attempt to cut down on patient confusion, many hospitals are requiring staff to wear color-coded scrubs. Nurses wear this color, respiratory therapists wear that one, housekeeping this one over here. Nurses at my hospital have to wear teal. Like this:
Teal. Ugh.

Couldn't it have been navy blue? ER nurses get to wear black. Damn their oily hides. The really bothersome thing is that my favorite style of scrub pants (made by Cherokee with cargo pockets on both legs, slit pockets, and a fly with a zipper) don't come in teal. Based the various offerings from multiple scrub makers, teal is considered a lady color. Sure they have "unisex" scrubs, but it's not the same. Not to put too fine a point on it, humans with penises need pants with flys.

Thankfully, I was clued in to a shop here in town which will custom-make scrubs with pockets and genitalia access points wherever you want. I'm going to take them the pants I like (in navy blue, sigh) and say, "Make me three pairs in teal that look just like this." Maybe they'll disassemble them and make a pattern a la Project Runway. At least no one has to wear this medical mistake:

Are there matching hose?

There's no way you could actually do the work of a hospital nurse in that thing.

Saturday, January 19, 2008

Yes but what are the side E-ffects?

There's a new medication on the market to treat GERD (gastroesophageal reflux disease). It's called AcipHex. Pronounced "Ass Affects." Who named this drug?! On the page you can see what they were going for with the acid and the pH, but as said out loud it's only natural to infer that the drug has an influence on your ass. Did they test market the name? Cause I'm thinking that the majority of interactions went like this:

Marketer: "What do you think of when you hear AcipHex?"

Consumer: (fearfully) "It's going to do something to my butt."

Terrible, terrible name.

Friday, January 18, 2008

Ugly day, better now

Work was fine, more computer training modules, but leaving the hospital I walked into a downpour. Getting home by bus is great, until you have to run blocks in the rain. I ducked into a dessert shop for a hot drink and to wait out the heavy rain. After a chai latte and a slice of green tomato pie, the rain had dwindled to a light drizzle. Now I'm home, in pajamas, about to watch The Wire. Much better.

Thursday, January 17, 2008

The limits of providing patient comfort

Lots of necessary, yet often tedious information today in orientation. Small moment of amusement when one PowerPoint indicated some definition of nursing at the hospital as something like outstanding care with a personal touch. So of course I whispered to my friends, "But not, you know, too personal."

Which reminds me of a story a nurse told me. I won't go into the details, but the moral is even if the patient is alert, oriented, and quite handsome, do not assent to his request for a "massage" with full release. Also, don't giggle about it with co-workers the next morning cause you will all get fired for being highly unethical and really stupid in addition to cheap and tawdry. I can't recall an Aesop fable that covers this lesson so perhaps I should write one substituing otters or squirrels for the people. Wombats? Ooh, I can illustrate it with tasteful linocut prints!

Tuesday, January 15, 2008

¡Átame! or Atase, I don't know Spanish that well

Today was the second day of orientation at my new job. I now have health insurance, a 403(b)like a 401(k) for non-profits, and no vacation/sick days for three months. Oh, and an understanding of the standards of nursing practice. The important stuff is what I'm saying. We also practiced putting restraints like these on and tying quick-release knots.

Depending on your sense of humor or kink factor, these might seem mean/sad, adorable (that second one is called a mitten), or stimulating. Well you're all wrong. Hee. Restraints are necessary equipment to prevent patients from doing dangerous things like pulling out tubes and wires. Being ill or injured in the hospital can be disorienting and things sticking into your arms, chest, nose, mouth, etc. tends to be uncomfortable at best. When a patient is not all there and some bit of medical equipment is bothering them, they often pull at them.

I was caring for a patient once that grabbed his Foley catheter (that's the tube that drains the bladder) and pulled so that the tube sheared off where it was taped to his leg. He was lucky. Foleys stay in place because there's a balloon at the end that's inflated with saline to anchor it in the bladder. If the tubing hadn't sheared, he might have managed to pull the balloon THROUGH HIS URETHRA. Yeah. It's happened. The penis maybe doesn't work so well after that kind of trauma.

Restraints are also necessary for even calm, oriented patients if they are intubated (tube down the throat to maintain airway), with or without a mechanical ventilator attached. Cause everything can be fine and dandy, they're writing messages for you, participating in their own care, and then they get a little irritation, start to cough, and the first thing they do is grab the thing sticking down their throat and pull it out. Since the endotrachial tube has a cuff that's inflated to hold it in place below the vocal cords, pulling it out damages the cords badly. So possibly no more talking. And then there's the problem of the patient no longer having a patent airway. Bad stuff.

In conclusion, restraints are often necessary and very much therapeutic despite the initial image of tying a patient down against their will. I realize now that this isn't the cheeriest of topics, though to be it's just part of the job. Uh, just be happy I didn't link to a video of a Foley catheter insertion? Unicorn chaser?

Monday, January 14, 2008

RN. W00t!

I passed. Now I'm a real murse now. Well, actually not until my official letter comes from the state Board of Nurse Examiners in four weeks letting me know that I now meet the minimum standards to be qualified as a nurse. They don't give you a score on the NCLEX. It's just pass or fail. Kinda like that joke, "What do you call the guy that graduated last in his class from medical school? Doctor."

I guess a celebratory glass of wine is in order. Good thing I have a vacuum stopper or I'd have to drink the whole bottle.

UPDATE: Red wine, pizza, and HBO are nice when celebrating. Wheeee!

Saturday, January 12, 2008

Lazing around

In an attempt to
1) temporarily distract myself from worrying about my NCLEX results
2) avoid unpacking moving boxes
3) better myself as a human
4) get caught up for the new season

I sat around all day today watching the fourth season of The Wire, the best TV show and/or film ever made to this point IMHO. I'm sure it would amused some of you greatly (ahem) to see me gleefully sniggering or captivated with jaw slackitude. Dear lord I love that show. And in a couple more days I can start watching Season 5!

Friday, January 11, 2008

The final test

This morning I took the final test to determine whether I'm licensed as a registered nurse (RN). The NCLEX, as it's known, determines whether the candidate possesses the entry-level knowledge so as to "provide safe and effective nursing care." It's a computer adaptive test, which means that each succeeding question is determined by how the test-taker is performing. At the beginning of the NCLEX, the computer program gives you a medium difficulty-level question. If you get it right, the next question is more difficult. If you get it wrong, the next question is easier. The idea is to maintain your performance above a line of competency. It's okay to dip below it occasionally, but then the candidate has to answer more questions correctly to rise above the line again.

In addition to level-of-difficulty, questions are categorized by Client Needs category. Candidates have to demonstrate competency in Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. You can't crap out in one category and then make it up in another either.

Practically, the computer adaptive format means you can't skip questions and come back to them, a favorite tactic of mine. Really though, the format is not that bad. You are presented a scenario and usually have to choose between four answers. Sometimes you have to fill in the blank, but that's usually a medication calculation question with a numerical answer. The beastly questions are the ones where you must select all that apply with five options. Get one wrong and the whole question is wrong.

Here's an example of a question from a test prep book with my explanation of terms in brackets or a link to a picture:

A nurse is caring for a client with a T5 spinal cord injury. The client complains of a severe headache and is feeling anxious. The nurse notes the client is sweating, is experiencing bradycardia [pulse below 50 beats per minute], and is hypertensive [high blood pressure, exact number is situation- and client-dependent]. Which nursing intervention is most appropriate initially?

1) Notify the physician
2) Medicate with an analgesic [pain-relief]
3) Check for bladder distention
4) Discuss the client's feeling of anxiety

The correct answer is 3. To answer this question you have to know such spinal cord injuries put the patient at risk for autonomic dysreflexia, the symptoms of that condition, the likely cause, and that assessing for a distended bladder is the INITIAL action of the nurse.

This question is at the analysis level in that you have to know some facts and then apply them to the scenario. This is actually a pretty easy question for someone right out of nursing school. It's common knowledge that notifiying a doctor is almost never the right answer (there's always something to do first), and discussing feelings is always a low priority - physiologic concerns first, psychosocial later. So even if you don't remember autonomic dysreflexia, you're down to 50/50 anyway. Getting it down to two answers happens all the time. Often, two or three answers are right and it's just a question of which is more right. It's difficult at first, but nursing school tests are usually written this way so students have plenty of practice with the format.

The minimum number of questions on the NCLEX is 75 of which 15 are unscored because they're just being tried out. After 75 questions, the program reviews your performance and decides that either that you are competent, not competent, or that further assessment is necessary. If the latter, the program keeps giving you questions until the answer is decisive. The maximum number of questions is 265, though few candidates get that many. You have six hours to take the test and again, few take that long.

The first-time pass rate for students from my nursing school hovers aroung 98-100% so I wasn't too worried. Still, it was nerve-wracking to take a test that determines whether I'm allowed to practice what I've been working toward for three-and-a-half years. The general wisdom is that if the questions are somewhat confusing and nebulous, and you walk out not really knowing what the hell you were doing, you performed well. If the questions start to look like:

The brain is

1) protected by the skull
2) insane in the membrane
3) solely for mucus production
4) wait, you mean the one in my head or Big Steve downstairs?

you're in trouble. I took 80 minutes to answer 75 questions of which I definitely, no doubt about it KNEW the answers of about 10. So, good sign! I'll find out the unofficial results Monday or Tuesday. Oh and my diploma came in the mail today, so that's nice.

Monday, January 07, 2008

The highs and lows of moving

So here I am again. I graduated from nursing school in December and moved to Houston a couple days ago. Friday I take the Registered Nurse licensing exam and Monday I start my new job. Just got the series of tubes hooked up to my new apartment so I thought I'd finally post again.

Since arriving in Houston I've been hit my small bursts of excitement prompted by things like moving books and CDs from boxes to shelves, the nice grocery store a 10 minute walk away, a new bed, coffee, finally having time for DVDs again, and anticipation of my new job. Those bursts of excitement have been interspersed with moments of trepidation prompted by things like studying for the licensing exam, realizing that most of my friends are hours away, pondering life in Houston sans car, and anticipation of my new job.

To sum up, life in Houston so far has followed a pattern: unpack, JOY, study, FEAR, shop for groceries, JOY, figure out bus routes, FEAR, ponder my new life, JOY/FEAR. JEAR? FOY?

St. Murse

PS I pledge to post regularly going forward. Sorry about the delay. You know how it is. Or maybe you don't. Anyway, I'll be back-filling posts summarizing school and such from now back to April. Check back in the archives for those posts as I write them.