Week 2 of CPE II

So, of course, because I said that it was easy last week I got a difficult patient this week.  In fact, I got a high maintenance patient.

High Maintenance Patient
This patient could do quite a bit by himself, but he didn't want to.  He laid back, looked exhausted, and expected to be cleaned, fed, and whatever else I could do for him.  He also specified when he wanted certain procedures (wound changes, enema, bathing, etc) to be done, and expected everything to be done immediately when requested.  If I took a little longer to look up information or confirm that I could safely administer/combine something, he would get angry.  He'd demand to know why it was late, and then he'd refuse it altogether.  Grr!

This lack of patience extended to other things too.  While I was on break, he noticed that his IV site was red.  Rather than call for a nurse, he pulled out his IV by himself.  He eventually pulled out his own foley catheter too (the tube that lets you pee into a bag).

The thing about catheters is that there is a little balloon on the end that prevents it from falling out of your bladder.  You're supposed to deflate the balloon before you pull the tube out.  He didn't know that.  He just pulled it out with the balloon intact... ouch!

Anyways, he didn't actually mind me so much.  He just didn't like to wait.  He felt like he knew what was going on and what he was entitled to.  So he made sure that he got what he wanted, even if it wasn't always the best thing for him.

He should have been up and out of bed moving around, instead he laid in bed all day.  As a result, he had terrible constipation.  So, tip for you if you ever get hospitalized and take a lot of pain meds: if the physio and nurse tell you to get out of bed and move, you should try to do it.  Otherwise, you might get very constipated and be very uncomfortable.  Six days later, he was still constipated... poor guy.

Angry Patient

After the high maintenance patient, I got a very emotional patient.  I have nothing against emotional patients.  It's to be expected when someone goes through a trauma.  This particular patient thought I was the best thing ever.  She missed me when I was gone, looked forward to seeing me every day, and had long conversations with me about anything under the sun.  She was basically awesome to me.

However, she could flip like a switch when she didn't like someone.  She would snap at them, point an angry finger, shout insults and expletives, kick items in the room at them.  I was shocked.  Some of the nurses asked me if she might have had a head injury or whether this was normal for her.  I have no idea.

I think that, perhaps, the stress of the trauma made her kind of hyper-reactive against certain things.  Her stress level would shoot up and then she's sort of lose it.  She was unnaturally calm and cheerful after all with me.  Maybe she was just holding in all of her stresses and it would come pouring out a times at unfortunate targets.  I think that when she's done with all of her healing in the hospital, she will want to heal herself emotionally.  I think she went through a lot.  She says that she doesn't remember anything from the accident, but I think the emotional outbursts show that there's something that needs to be healed underneath.

Building Confidence
My teacher says that I should work on being more assertive.  She thinks I could have been more firm with the high maintenance patient and made him clean himself and get out of bed.  Maybe I could have reasoned with him about why some things take more time.  I think she's right to a certain degree, but I can't force someone to do something that they don't want to do.  I like to ask nicely, suggest, and encourage.  I rarely speak firmly and order people to do things.  Maybe I should try a mix and see how it goes.

Dressing Changes
In terms of skills, I got to practice changing wound dressings.  It was really cool.  I have watched a lot of nurses do this and assisted, but I had not changed the dressings entirely on my own before.  The thing that kind of bothered me was that a lot of the wounds had HUGE 5-6 inch fluid-filled blisters around them.  Apparently this can be caused by damage from the fracture/accident or from a reaction to the wound dressings (allergy).  They looked horrific to me, but I washed them carefully and put soft, new dressings on them to protect the wounds.

Losing a leg
I had the opportunity to talk with a patient before and after he had his leg amputated.  I can tell you that it is a hard thing for a young man to accept.  He told me how hard it was to wake up each day and to see his leg gone.  He would think about how his life had changed and whether he could still be a good husband and father, and he would weep.  I did my best to listen to him, and to support him through his transition.  I printed out some resources for him to look up, such as a support group for people with amputations.  I hope that he will be okay.  At very least he knows that a little student nurse cared about him and thinks he has the power to cope and heal.

So that about sums my second week in CPE II.  I would have to say that working in a trauma and orthopedic ward can be kind of traumatizing if you share a lot of empathy with the patients.  I worry about them, care about them, and I try to lessen their load.  However, they have been through a lot and their emotions are fragile.  This means that it takes a lot more effort to navigate through their emotions each day and to avoid pushing the wrong buttons.  However, it feels good to help those in need.  It's heart warming.

Have a great week!

Week One of CPE II

Too soon, my vacation has ended.  Now it's back to school I go.  *groan*  

I know, I shouldn't be so reluctant.  I should be excited!  But vacations are always so good.  I never want them to end.

Clinical Begins

This term, I don't have any classroom classes.  I only work at the hospital three days a week for 8 to 9 hour shifts.  I like to think of it as free labour, but it's meant to help us to practice our skills and become better.  After this semester we will be able to work as employed student nurses. 

Close One

So far, my experience has been good.  I was expecting something much worse.  There are a couple teachers at my school that have a notorious reputation for failing students.  I don't know if the accusations are true, but my classmates have made it sound so terrible that I was preparing for the worst.  I had put down my top choices for hospitals and accidentally chosen the hospitals with these notorious teachers.  (Oops!)

I don't know how it happened, but I didn't end up getting either of my top picks.  I think they placed me with a student that I normally carpool with (very thoughtful!), and that student chose one of the other hospitals.  So, magically, I got placed with a super nice teacher instead.  She has been nothing short of sweet and informative so far.  

You can imagine my relief.

First Impressions

The first day of clinical was an orientation.  The next day we got to shadow a nurse.  My initial impression was that the hospital was very posh.  They had wide hallways, gardens, big atriums, a fully-loaded cafeteria with actually tasty food... it was pretty amazing.  Best of all, I didn't notice a single hallway patient (the ones that live in the hallways on beds when the hospital has no rooms available).  

Super Nurses, Super Place

I was available to help my nurse all day, but she didn't actually need my help (huge surprise).  She could manage all of her patients and I just watched.  She also only had four patients.  

I didn't know what to think.

Either she was a super nurse (which she was because she could remember up to two patient's worth of data without writing it down at all), or this hospital had a good patient to nurse ratio (which is also probably true because the nurses I've met so far usually have more than 4 patients).  I think the hospital must be rich or something, but that doesn't really make sense because all of these hospitals are publicly funded.  Maybe this hospital gets a lot of private donations?

I'm stumped, but I like how things are better here.  Each patient has their own blood pressure cuff, the blood sugar testing machines require less blood (and they're smaller), and the bed pans are made of metal (I hated those environmentally friendly paper ones.  They were rough and I always feared leakage.)

The Guinea Pig

After a day of shadowing, I was given a patient from the day before.  He had never had a student nurse before and he was very skeptical.  He assumed that he was a "guinea pig" and he didn't like it.  I promised him that it would be a good experience and that he'd get special treatment.  "What kind of special treatment?" He asked.  

"You can have water whenever you want," I joked.  He scoffed.  He told me that he was going for a walk.  

"What time are you getting off?" He asked.

"Two."

"I'll be back at two," he said.  I felt a little hurt and I hoped he was joking.  I laughed anyways and told him to be back soon for his medications.

Special Treatment

Once he was gone, I had nothing to do.  He was my only patient.  So I changed his sheets and made his bed.  I got his medications ready, set up his breakfast tray, and I filled a cup full of ice.  I remembered that he had liked this the day before.  I even tidied up his room and cleaned the table.  

When he got back, I was ready with everything that he needed.  He looked around and he couldn't hide his surprise.  I don't think he expected me to be so busy while he was gone.  

"See? I told you you'd get special treatment." I said.  

He still went out for walks frequently, but he wasn't upset about having a student nurse anymore.  He got his medications on time, I spent time talking with him and cheering him up, and I even massaged moisturizer into his dry skin.  He was literally pampered.  

Easy Peasy

I had convinced him that student nurses were a good thing, and he told me that I was the best of the bunch.  That cheered me up.

Anyhow, this wouldn't be possible if I had more patients, but one patient is pretty easy when he can toilet and bathe himself.  While he was out, I took care of the patient next door.  That patient was supposed to be a real grump, but I think she took a liking to me.  She kept asking if I could come back and help her again.

End of Week One

Sigh, so week one is complete.  Only four more weeks to go.  I don't believe that it will be this easy all term so I need to gear up and get ready.  This is a Trauma and Orthopedics ward.  The patients are recovering from motor vehicle accidents, falling from heights, sports accidents, work accidents, etc.  My patients so far were at the end of their hospital stay, but I expect that patients at the start of their stay won't be as easy.  

There's a lot to learn.

Have a good week!

 (P.S. - This is my succulent plant collection from last year.  It survived through winter and now it's growing "tentacles".  I have no idea why it's doing this, but it looks cool!  Kind of like an octopus!)

Somewhere Over The Rainbow In Hawaii - My Trip in Photos

I'm back from my very first trip to Hawaii.  What a beautiful place!  I hope I'll get the chance to go there again one day.  Here is my trip in photos to share with you!

As the plane approached Hawaii, the skies were vivid blue with fluffy white clouds.  A far cry from the grey, rainy city I had left behind.

The clouds cast shadows on the blue waters.  I found it neat to see the clouds from above instead of below. Airplanes are a marvel to me.

Thanks to a three hour time difference, we gained three hours on arrival.  Sweet!  A full day to spend exploring Hawaii.  We were greeted with marvelously fragrant leis made from tuberoses.  

We came to recognize this fragrance as a way to identify newcomers at the hotel.  You could smell the newcomers from a mile away and they smelled sooooo gooood!  :P  For days after, the hotel room smelled fantastic. We put one lei beside the shower and one in the bedroom.  I was sad when they finally wilted, leaving a light, lingering fragrance.  I wanted to dash out and buy a new one!

The beaches looked amazing.  The waters were so blue and the waves so... alive!  They would crash onto the white sands and soak you, throwing interesting coral bits and stones your way.  Sometimes I would see a  shell, but before I could grab it, the waves would literally suck them away out of my reach.  So fast!

Children played in the shallow waves at the beach front and surfers played in the bigger waves farther out.

Here's an interesting beach thing I found.  Is it coral?  I liked the orange colour and the texture. 

 I made myself a little collection on the sand.  I'd run about the waves, collect bits and things, run back to deposit them on the sand wall my hunnie built as he baked in the sand, and run back to the ocean to find more.  It was fun. Once in a while, a big wave would come up and take the sea things back.

There were pretty seaweeds along the water edge.

 I saw some sea creatures as well like fishes in the water and crabs.  I also saw a funny looking spotted fish thing.  I didn't get a good picture though.  The ocean sucked it back too fast. 

This is overlooking some coral reefs.  There are a lot of people with scuba masks padding around here. 

I didn't get to swim here, but maybe I'll do that if I ever go back one day.

 

We visited a Japanese temple and there were sooo many koi!  Here they are in a feed frenzy as I throw them some food.

This dove looks like he's enjoying the fish too.  It looks like he wants to eat the fish, but really he just wants to eat the fish food.

 See?  Tasty, tasty!

 Plants that I've only ever seen in the middle of malls or in the tropical section of Home Depot grow wild here.    It's weird seeing tropical house plants grow so lush here. 

 On Lei Day (May 1st) our hotel had tables set up with piles of local flowers and greenery.  A volunteer showed me how to make this pretty corsage.  It smelled great (most of the flowers in Hawaii seem to smell good).  The lady who sat beside me turned out to be a florist from Canada, and she was commenting how expensive it would be to make something like this in Canada because fresh tropical flowers cost a lot to ship over.

I also made this orchid and plumeria lei.  When I considered how each orchid plant costs about $30 at Home Depot and how I had just used over 60 blooms to make this lei... yup, it would be costly to do this in Canada.  In Hawaii, you can buy a lei for $5 or make it for free (like I did!). It makes me want to run out and buy/make a gazillion leis each day while I'm in Hawaii. 

 We visited the Pearl Harbor Memorial.  It's a beautiful but somber place.  Black dots of oil still leak from the ship sunken below and they call them black tears.  Thousands of soldiers are still buried with the ship because it was impossible to get them out without making the ship explode.  

The driver told us about how his relatives cried one day a month after the ship was sunk.  The divers had discovered that they could still hear knocking coming from the ship.  People were still alive in the ship, but there was no way to get them out.  I can't imagine the horror of waiting to die in this ship when it's so close to the surface of the water.  There were thousands of people on that ship.  So the memorial remembers and respects those that were sacrificed for the sake of their country. 

I was pretty depressed after thinking about all those people trapped below the memorial, but the people of Hawaii are generous and kind.  They treat you like family, and they feed you like family.  We went to Ono's Hawaiian Foods.  It's just a little hole in the wall place, but the food is delicious.

They make an amazing dish called Lau Lau.  It's chicken or pork wrapped in taro leaves and steamed.  It doesn't look like much, but it tastes soooo gooood.  I don't know why we don't eat taro leaves.  They're so yummy!

I also liked the Lomi Lomi Salmon.  It's very refreshing.  I loved the Kalau pork too.  I found the taste was very good.  If you go to Oahu, you should check out this restaurant.  Don't expect stellar service and expect a hole in the wall, but the food will be tastier than the fancy luaus you go to (we went to both the luau at the Polynesian cultural center and the one at Paradise Cove.  The food at Ono's is tastier.)  Oh, and for $20 for a set meal for two people, it's a seriously good deal!

It was good enough that we went back on our last day.  Back for Ono's and back for Leonard's fresh malasadas (donuts).  My favourite was the hot macadamia filled version.  Yummmmm!

 As a random photo, check out the price of milk here!  $10 for 4 liters, and that's on sale!  The driver joked that it was because there's only one cow on the island  :)

Our trip was winding down.  We had learned so much about a different culture, a different lifestyle, and we loved it.  Hawaii is a mixing pot of different people from all over the world.  As a result, the Hawaiians we met treated us like family, what they call "Ohana".  They call you their cousins when they greet you, much like we call people "brothers", "brotha", or "buddy" around here. 

This is not to say that everything is perfect.  We saw a different side of their city while we were there too.  We saw an old man (homeless?) walking around drunk with poop coming out of the top of his pants.  Another man came and saw him and told him to stay there so he could go get help.  Unfortunately, while he was gone getting help, the old man found a $20 in his pocket.  His eyes glowed with delight and he stumbled away into the nearest liquor store.  It reminded me of downtown Vancouver.

As we walked along Kapahulu, we saw a man who looked utterly depressed and hopeless.  He had his head down like Eeyore and his shoulders were slumped.  He was the saddest man I had ever seen.  The image was a stark contrast to the tourist areas I had come from, and the image of happiness and perfection that they talked about.   

I walked the beach for the last time, and I looked at the little bird foot prints in the sand.  Pigeons in Hawaii are white and they are everywhere.  They're even in many restaurants because most building are open to air.

Most of Hawaii is dependent on tourism now.  Plantations like the Dole plantation have shrunken down to a small fraction of their original size.  I saw mango trees everywhere with juicy fruit hanging down, and yet when I went to buy mangos at ABC stores the mangos were from Mexico.  I didn't know what to think.  It  didn't seem right.

One day, I'll go back to Hawaii and eat a ripe mango fresh from the tree.  I think that will be a very nice day indeed.

Have a wonderful day, and remember to enjoy your life.  Life is short, and there are so many beautiful and wonderful things in this world to experience.  You should go try them  :)

Take care~!