Monday, July 24, 2006

Still pregnant...

...This pregnancy thing is taking a lot longer than I thought. I know how long its supposed to take, but these last few weeks have felt like forever!

Here are a few things on my mind:

1) Exams. Its that time again. When I bow to the ridiculous set-up of the Israeli university system, and spend over a month taking exams. This year there was the added challenge of trying to complete exams before the baby showed up. I have to say, taking exams at 9 months pregnant seems to be working for me. Sure, I'm still not allowed to use a dictionary. I keep getting assigned to the same lecture hall for my exams (4 times out of 5 exams) and I actually do not fit in the desks! I can get into the seat, but then I cannot close the "lid" over the seat that provides a desktop for writing on.

One proctor actually yelled at me that I was trying to allow people to cheat off of me, because I was placing my answer sheet on the desk next to mine. Um, nooooo, I just can't fit! The same proctor wouldn't let me go to the bathroom during a 3 hour exam. Usually they make exceptions for the preggos.

However, I did get one grade back (Nursing Oncology) and I got the first truly respectable grade of my nursing school career - one of the top grades in the class! I'm hoping that holds true for my other exams. I only have one (real) exam left to take.

2) My anniversary - was last Wednesday. Due to the war in the North (and its a war, not playing with the words here) and the state of my belly, Bryan and I opted not to go to the Galilee for Shabbat (as was a possible plan) or the Dead Sea (too far from the hospital) and decided to go low-key. We exchanged cards (it is the paper anniversary) - not gifts, since we've got some big expenses lined up :) And then Bryan made reservations at a pretty nice Japanese fusion place on the beach, which I highly recommend. I decided I'd held back enough for the past 9 months and ate real sushi (as opposed to cooked fish) and wine and ribs. And then we started what I hope will be a tradition: We shared what we felt we had learned about the other over the past year. The most surprising things, the most important things. I hope we'll be able to continue that tradition and that we'll keep learning new things about the other.

3) Our Penis Plant - Yup, you read that right. We received a plant as a wedding gift last year. I have what can definitively be referred to as a "black thumb". Against all odds, this plant has lived. I have no idea what kind of plant it is (I just saw a website that referred to it as a "peace lily") - but Bryan took to referring to the one white flower the plant had as its "penis". Unfortunately, around October time the penis withered up, turned black, and died. Bryan had a great attachment to the "flower" and when I finally insisted on cutting the dead stem off and throwing it away, he wore the "flower" pinned to his lapel for a whole day in solidarity and referred to me as Lorena. If it really is called a "peace lily" then the fact that we refer to it as a penis plant is even funnier.

Since then, our plant, though alive, never regenerated its "member". I water it once a week, it never gets any good light, but in the past 2 weeks it has sprouted not one, not 2 but 3 penises!! And there is evidence of a fourth one! We have no idea whether our baby is a boy or girl, but Bryan has taken this as a definite sign - triplet boys!

4) This all brings me back to being pregnant. I am truly ready for this to be over. Firstly, I am so curious about who I have been hosting in my body for the past 9 months. Boy or girl? Dark hair, light hair, no hair? Personality type?

Secondly, I am so physically uncomfortable. If anyone here thinks about getting pregnant and timing it to give birth in late-July/early August and lives in a city that never goes below 85 degrees/28 degrees even at night, with like 100% humidity - let me just save you now. Don't!

I'm hot, I'm large. I have new, painful stretchmarks every a very attractive belt around my hips. My heartburn has progressed to reflux is way too powerful for the wussy Israeli Maalox, and I've run out of my wild berry flavored super American Maalox.

My hips are doing strange things - I finally went to the very nice osteopath who sits next to me in shul. She realigned my hips for me (my anniversary gift to myself) but they're already slipping again. Swimming seems to be the only activity where I feel half-human. Strangely enough, while I may have been more self-conscious about being seen in a bathing suit as a non-preggo, hauling my huge belly around in a bathing suit doesn't bother me in the slightest. Maybe because my maternity bathing suit is so big its practically a sundress?

I'm off to the obstetrician now - he'll give me an update on my progress - and there damn better be some! As soon as I get the okay I'm drinking castor oil and running around the block til I go into labor!

Monday, July 03, 2006

Making a difference

I've missed blogging. I know that sounds lame from someone who hasn't posted in 2 months, but its true.

I can't say nothing has been going on in my life because, well, I'm 35 weeks (or more) pregnant, I'm in finals at school, and I just finished my first nursing rotation.

Of course, most of the pregnant updates fall under TMI (who wants to know when my stretchmarks first appeared? right, no one). Most of my school stories are just rant sessions. And most of my nursing stories, if I shared them, could easily be called a violation of patient confidentiality.

However, now that my rotation is over, I can sit back (as far back as my gigantic belly will allow) and take stock of what those 15 weeks meant to me.

When I first got assigned to the General Surgery ward, my first thought was "oh, yuck". My still somewhat queasy stomach would be checking open surgery wounds, with somewhat yuckier patients. I was hoping for Orthopedics, or Internal Medicine which would be less yucky.

We spent almost the first 10 weeks of the rotation simply talking to patients. We were not allowed to do anything to them (makes sense, since we didn't really, even after 2 years of nursing school, know how to do anything). We took lots of patient histories, learned how to interpret their charts, how to interact with patients, and how to make nursing diagnoses - which are very different from medical diagnoses.

For example, let's say a patient comes in with high fever, problems breathing etc. A medical diagnosis would be "Pneumonia" and the treatment plan would easily be "antibiotics".

In nursing, the diagnosis and treatment completely depend on the patient. You could have 2 patients with identical medical diagnoses, identical medical histories, and totally different nursing plans. the same patient with pneumonia could have a diagnosis of "Decreased functioning in the family home, secondary to pneumonia, expressed by failure to work". And the treatment would either be to educate the family or the patient. If however, the patient lives alone, there would be a completely separate diagnosis and treatment plan.

Although I began to get bored of taking these long histories, and feeling like all I was doing was invading the patient's privacy, eventually it all started to make sense. When I started admitting patients before their surgeries, I began to pay attention to little cues I would have missed earlier. I had a patient in for a relatively small surgery, who seemed overly anxious, with a very high blood pressure and pulse (sign of stress). She told me she took antidepressives and that she was a widow. And that none of her adult children knew about her surgery. Eventually I worked out that her husband had committed suicide a year earlier, hence the depression and extreme anxiety.

One of the things that bothered me about my rotation was that it seemed pats on the back were few and far between, but criticism was available in abundance. Students got kicked out of the program for relatively minor infractions, but when someone did something really noteworthy - nothing was done.

When I first started doing admissions before surgeries, one of the first patients I got was in for a thyroid removal. I had to take the extremely long history, with questions that seemed inane and useless to the patient. Plus, the questions, at least in part, are repeated by the doctors and anesthesiologists. This particular patient was really irritated by me. She'd already met with the doctor, the surgeon and the anesthesiologist, all of whom had asked her the same questions and who had all approved her surgery.

Then I come along. I am required to tell her I'm a student (plus my name tag says so), and then I start asking her all the same questions she already told the real doctors, plus questions that seem useless - such as what floor is her apartment on, how many children does she have.

I ask her what medications she takes. She tells me a few drugs, mostly for high blood pressure. A few minutes later I ask her the same question. I do this because patients often "forget" some of their drugs, but after talking about other things (past illnesses, dietary contraints) they are reminded of more medicines, or things they don't consider to be medicine but really are. She remembers that she also takes aspirin once a day, prophylactically. People often do this because it has been shown to prevent strokes and ischemic heart disease.

I finish my medical history, and go to my teacher to have her review my interview. For liability reasons, before its entered into the computer a real nurse has to sign off on my work. The teacher signs off.

As I am entering the data into the computer, the penny drops. Patients who take any sort of blood thinner (such as Coumadin, Heparin, etc.) have to stop these drugs 10 days before surgery or they risk bleeding out during the surgery. One of the drugs that thins blood is....Asprin. The reason it prevents strokes is because its a blood thinner. I run back to the patient, who is about to go home for the evening (and return at 7 am to have her surgery) and ask her if she stopped her aspirin. She looks me at me like I am nuts and says, "Why would I do a thing like that?" I ask her to wait, and tell her I need to check with the doctor but that there is a possibility her surgery will be postponed.

She's pretty irritated with me now - all of the doctors, surgeons and anesthetists have signed off on her surgery and told her she was good to go. What's a lowly nursing student doing telling her it may be pushed off?

I shared my findings with the doctors (who are also irritated to be "caught" by a student). In my communications class, one of the topics we covered was "How to tell a doctor he's made a mistake without losing your job". I had to tell the head of the surgery department, a somewhat arrogant man who definitely does not like students, that he missed a vital bit of info without making it sound like he did anything wrong. Not to mention tell my teacher, who approved my interview and didn't catch the problem herself.

The surgery was cancelled and rescheduled for 2 weeks later.

I was a little upset that no one, especially my teacher gave me a pat on the back for catching something so important that everyone else missed, which could have really hurt the patient. If I had done something of equal magnitude that would have hurt the patient, you can bet I would have received an automatic failure.

As luck would have it, two weeks later, I was assigned a patient who was just waking up after surgery on her thyroid. The name rang a bell, but I couldn't figure out from where. I introduced myself to her husband, and said that my name was Noa, I was a student, and I'd be caring for his wife. He immediately woke his wife up and said, "Is this the Noa that saved your life and got the whole surgery rescheduled?"

Even though my little catch went totally unnoticed and unrewarded by my teacher, the patient realized what went on - enough that 2 weeks later her husband (who I never met) remembered my name! And that's what nursing is about to me - making a difference to patients, whether they realize it or not.

I have no idea what grade I will get on this rotation - and I am sure that my "save" won't even get factored into my grade - but it doesn't matter to me. The thing that most concerned me about this rotation was that perhaps afterwards, I would decide I really didn't want to be a nurse. I have, after all, been known to change my mind a lot. And the past 2 years of nursing school, while difficult, have been totally hands-off. This was my first time interacting with patients.

I managed through the 15 weeks without getting any truly disgusting patients - I have no idea how that happened. No one vomited on me, I never had to change anyone's poop bag. For some reason, cleaning a patients' penis while his catheter was in didn't disgust me. Everyone else had at least one truly memorable patient in terms of the gross-out factor. Don't let anyone kid you - we may be semi-professionals, but we do still occasionally get yucked out - the professionalism simply requires us not to show it.

But I do think I made a difference in the lives of at least a handful of patients - so I know I am on the right track.