On being employed full time and being a full time mom

I was sending a note to one of my pregnant friends and realized how excited I was to talk about going back to work, so decided to share it here, too! This week was my first full week back. I have switched to day shift (I worked nights from January through the night when Eleanor was born) to make things easier schedule and sleep-wise for Chris and me. We decided that since I work three days a week, Eleanor will be with me four days a week, Chris one day a week, and daycare two days a week. Hopefully this arrangement is will work out well for our family.

On Chris: My first day back was a Sunday, so Chris was going to watch Eleanor all day. I think we were both a little nervous because I wasn't exactly sure how many ounces she would eat during the day or if Chris would be able to calm her down if she got reeaaaally fussy so I kept my phone on me in case he had questions. All I got from him all day long were adorable pictures and videos about how they made it to church on time, did tummy time, played on the play mat, took a nap in the swing, watched the Redskins game, hosted Bible Study at our house, and generally had no problems at all! When I walked in the door from work, Eleanor was sleeping on his chest on the couch and he had timed it up perfectly for me to be able to feed her when I got home. I was SO proud and impressed! I mean, seriously. He had her for almost 14 hours by himself and even got laundry done and the dishwasher unloaded and still did all the normal things we do on Sunday.

The other two days I worked this week, Chris has gotten Eleanor up, changed, dressed, and taken her to daycare in the morning and then picked her up on his way home from work and kept her for a few hours until I get home. Yesterday I even accidentally went to work with her carseat in my car, and he called a neighbor to borrow theirs to take her to daycare and came to the hospital between work meetings to come grab the carseat from me for the way home. I certainly have not made it easy on him but he is GREAT with her. This is really the first week that I've felt Eleanor's care was more evenly split between the two of us and I kind of LOVE it. It makes me so proud of him and I think he actually enjoys the extra responsibility and spending the time with her. It's not that he didn't spend time with her before but just not the extent of the time he spends with her now that I'm working full time. I don't even know if he realizes how huge a change it has been. Before, when she was fussy he would keep her and try to figure out what she wanted for 10-15 minutes before handing her off to me to feed, but now the other day he actually took her from me while I was holding her to calm her down when she got upset. I still plan out most of the details of getting her ready for a day without me, like making sure there are enough bottles, they are in the right amount for her to eat, her diaper bag is packed, etc, but Chris has gone to her room and picked out her outfits the last couple of days, and clearly I forgot the detail of the carseat so he is starting to pick up these things, too. He is an extremely capable dad and I really can't express how proud I am of how smooth this transition has been because of him. He's awesome :)

Some pictures Chris has sent me of their day while I was at work:

On me: It really has been easy to go back to work. It was a good transition to have Chris with her the first day because he texted me updates all day long (which I don't get from the daycare during the day). I had a pretty easy patient load my first two days, as well, so I really enjoyed being back, hanging out with coworkers and getting back into the swing of things. I miss Eleanor during the day, but I know she's in good hands so I don't worry about her. I'm also able to pump at work. I was actually thinking this week that if Chris' boss offered to double his salary so I could stay home and take care of E (my going back to work has sort of wreaked havoc on his ability to travel out of town for days at a time), I'm pretty sure I wouldn't want to leave my job right now! Maybe when she's a bit older or if we have more than one kid it will be a different story, but for right now, this is working for us. And I don't feel like a bad mom for going to work (and if you disagree, don't tell me - it works for us right now and that is good enough for me)!

On Eleanor: So far we really like Eleanor's teacher and she has said that Eleanor seems very content at daycare. She also said that E is the most popular baby there because she is the smallest and everyone knows babies and their weird movements are fun to look at. Eleanor also loves watching other babies so hopefully she is enjoying herself. We don't really think she has any clue what's going on right now though, so it will be interesting to see how she reacts in the coming months.

Eleanor with her teacher:

So overall the transition has gone well. We are still ironing out details on how this will affect sporting events, Chris' travel schedule, and things like possibly getting a second carseat, but we really couldn't have asked for a smoother foray into the world of two working parents.

V-day

Happy Valentine's Day! I worked today but when I got home Chris had made me brinner! It was my first full week on the floor and it seemed I worked all (extremely minor) holidays. Tuesday the nurse manager passed out beads to wear in honor of Mardi Gras, Wednesday was Ash Wednesday, and today was Valentine's Day. After working three 12's in a row, I am pretty exhausted and can't wait to sleep in tomorrow morning.

Passed boards

It's been a busy weekend around our place, but I wanted to share that I passed my state boards and am officially an RN now! I took the exam on Saturday morning and when I logged into my account today, I had a license!

Started work today

Well all, today I rejoined the full-time work force. I was originally supposed to start two weeks ago, but due to some rather frustrating red tape (and slow-pokiness) on the side of the university and the state board of nursing, I had to delay my start date until today. I was definitely a little bit disappointed and Chris, who has been eagerly anticipating this date for the last 18 months was, as you can imagine, even a little more disappointed than I was. On a brighter note, there are still people who were in my program who have not yet heard from the state board, so I am counting my blessings.

Work this week is consisting of a company orientation, a hospital orientation, various skills workshops, and a whole lot of online mandatory education. As happy as I am to have this job, I am really looking forward to getting these weeks of orientation over with as soon as possible. In the meantime, I am working on adjusting to an everyday 8-5 schedule again, if only for a few weeks :)

Graduation

People, it's over. I graduated last Friday - and I am thrilled to be done! Chris is equally thrilled because 1. I will be working more and 2. no more tuition to pay for. I say this now and hope I never have to eat my words in the future, but I will never go back to school full-time again. My parents and Chris' parents came down to celebrate with us and we went out to dinner at the Tobacco Company afterwards.

The end of my program was pretty smooth - I finished my clinicals back in October and have just been waiting for it all to wrap up since then. I accepted a job at the hospital in Williamsburg back in November and will be starting there in January! I also gave my notice at work a couple weeks ago so next week will be my last week of work there. NO MORE COMMUTING!! YAY!

Also, a huge thank you to everyone for all the congratulations and well-wishes, and especially to all the nurses in my life who have been so welcoming and kind - my aunts and my sister-in-law. You guys are wonderful!

Let the application process begin

Yesterday I applied for my first job. Today I applied for another. With just over two months to go before I finish this program, I figured it was time to start. If things were to work out ideally, I would have a job lined up before I finish, but I'm not holding my breath...I know it will probably take some time! That being said, I have never really enjoyed the process of applying and interviewing for jobs. It always seems to take a lot longer than you anticipate and it always seems to be a fairly frustrating process. With that in mind, I've been trying to front-load a lot of my clinical hours over the past few weeks so that I will be freer in November and beyond to focus on the application process.

Overall I am a lot more confidant now applying for jobs than I was both when we graduated college and again when we moved to Farmville. I have a lot more professional experience behind me and that seems to count for everything these days. Plus, not that I want to, but I already have a job that I can pick up more hours with for a few months into next year if I need, so I've got that added security that I won't just be bored at home going crazy until I find something. 

The end is in sight, people! I can hardly even imagine what it will be like having two paychecks again...

Final push

This week begins my final push to finish school. Hopefully in just 4 short months you will hear how I passed my boards with flying colors, it was all worth it, I have a (full-time) job again, etc, etc. Because, you know, things always go the way we plan.... :)

My actual plan for the next few months is to enjoy living here during the fall, which happens to be one of the best times of year in Williamsburg, invest fully in my relationships here in town, and to not let myself become sidetracked from those goals by trying to finish up what has been a fairly arduous journey.

(The Governor's Palace)

As an update to those of you who have been interested in what I'm up to on the nursing side of my life; I have been handed a respite for the first time since beginning this program: I am assigned to a Williamsburg hospital for my capstone course! I'm going to be doing my hours on a progressive care unit, which is essentially a step-down floor from the ICU where patients go when their needs are a bit more complex or demanding than can be cared for on a regular floor. In addition, for my community health outreach, I'll be serving as a volunteer doula for Richmond mothers that can't afford those services on their own. I am thrilled that I'll only be commuting 2-3 days a week and working here in town the other days!

UNOS and floating

I am done with school for the summer and am pretty thrilled that I have a mental break of a couple weeks ahead of me to recuperate from the busy weeks behind me. A highlight from the last month was a trip to visit the United Network for Organ Sharing (UNOS), which is the organization responsible for arranging transplants within the U.S. It was incredibly interesting to hear how they organize organ donation, transportation, and transplantation. They are also responsible for linking donor families and organ recipients post-transplant if that is wished on both sides. Currently there are over 100,000 Americans waiting for organs, so if you haven't registered to be an organ donor and feel like that aligns with your values, please register (in Virginia, you can register at save7lives.org). UNOS also has a memorial to remember some of the past donors out in their gardens. It was very touching to hear some of the donor and recipient stories.

(Part of the fountain at UNOS. The stones say "mother", "father", "brother", "sister", etc.)

I also have been able to pick up more hours at work the last couple weeks as things with school have died down. I got floated to one of the PACUs (post-anesthesia care unit) a week or so ago, which made for a pretty interesting day. This PACU had a lot of children (it was ear, nose, throat surgery day, so a lot of kids were getting tubes in their ears) and I was surprised to see how different recovery from anesthesia is in kids than adults. The kids are much more disoriented and distressed, but still pretty cute and can mostly be cured of their distress with popsicles. It also made me appreciate my job a little more because I only have to hear crying kids when I have to take a little one's IV out instead of all day. Though I have to say, the kids are a lot cuter as patients than adults :)

Body Worlds

Last week I went to the Science Museum of Virginia with my clinical group to see the Body Worlds exhibit while it was in Richmond. If you have never heard of this exhibit, just type "body worlds" into a google image search and you will get a little taste of what it's like. It was so interesting and definitely worth the trip. I was definitely bummed that I couldn't take pictures inside, but perhaps one of the most interesting parts of their entire exhibit was the guest book at the end. A few excerpts for your enjoyment:

"I heard people are dying to get in here"

"I like the dead ice skaters"

"The moment I walked in I hated it. it was so discusting" [sic]

Well, that kid had it right - the exhibit definitely isn't for people with weak stomachs. We enjoyed ourselves walking through guessing what each person in the exhibit died from (not the point of the exhibit, I know, but when you study sick people and how to improve their health all day, it's what the conversation naturally turns to). Overall it was a great exhibit and worth the trip if you get the chance to see it near you! Our bodies are incredibly fascinating, and if you get nothing else from the exhibit, you will leave knowing that your body and all it does is amazing.

Massage and ice cream

So this week is what our hospital calls "week of the nurse" and what everyone else calls "nurse appreciation week". To me, that doesn't really mean much of anything, but it certainly was wonderful yesterday because a couple of massage therapists came into work and gave us all free massages - best work-related event ever. I had a new employee shadowing me for the day, which I don't ever mind doing; however, it just makes everything a lot slower because you have to explain and teach evvveerryything. I typically enjoy showing people how to do things, but it was a very busy day yesterday, so the massage was a huge stress-reliever half-way through my day.

Totally unrelated - a couple days ago, Häagen-Dazs was giving away free cones and Chris and I found a store nearby that was participating. I had some sort of caramel something that ended up being delicious. I don't know that I've ever been to a Häagen-Dazs before, but their ice cream is good!

We got our cones and then walked through CW after work. I really would love to live within walking distance someday!

Spring semester over

Well - I'm finally done with my spring clinicals. Since my last updates (womens, peds), not much has changed. I did get to see a cesarean section...and since I don't want to scare anyone and know that the outcome is typically good at the end of that surgery, all I will say is...wow. Hope I don't have to ever have one, but I guess at least you get a healthy, happy baby at the end.

I had the mother of one of my past pediatric patients chase me down when she saw me on the street in Richmond to update me on her kid and their progress. I was very touched because I had only been with them for 8 hours on one day and didn't think I had made that much of an impression. I also got to spend some time in the pediatric emergency department and in the NICU; the latter being an awesome experience, and the former being eye-opening to say the least. What you and I would consider an "emergency" is probably not very much in line with what some of the patients and parents I saw consider an emergency. At least it was interesting! The NICU was also interesting - lots of tiny, tiny babies needing a lot of love and care and some not so tiny babies, also needing lots of love and care.

I've got a couple more weeks of class and finals and then it'll be back to an adults clinical for the summer. I am definitely looking forward to taking some vacation time around my school schedule this summer...starting with a girls weekend with some of my best friends in just over a week!

Driving

Last night as I was leaving the hospital, the craziest storm was picking up in Richmond. I literally ran the half a mile from the hospital to my parking garage in a downpour with thunder, lightning, and wind that felt like it could pick me up off my feet. By the time I got to my car, I had to change into a spare pair of scrubs, after I dried off with a t-shirt I had in my bag. I then drove home barefoot because my shoes were sopping wet. With the amount of lightning I saw on my way home, I'm surprised I didn't burn my retina or something.

Anyway, last night was one of the nights I was extremely thankful that I was only driving 50 miles home on a major highway instead of 77, part of which was on hilly, one-lane roads (like I was doing to Farmville). Though I don't get to drive into the sunrise and sunset every day since I'm heading the complete opposite direction, I still get to see those in my rear view mirror sometimes. In addition to saving me gas money, wear and tear on my car, and about an hour of commuting time each day, there is another good thing about now living in Williamsburg: I have a carpool!

I met a few girls earlier this year that also commute to Richmond from Williamsburg and now two days a week, we drive together. It is awesome - I am not paying nearly as much as I was to fill up my gas tank every week and the time passes by so much quicker when you are with other people. Also, since Richmond is one of Chris' main locations for work travel, he has twice been able to arrange his schedule so that we could ride together. I still don't think I will want to keep this commute up come December (when I hopefully will find an RN job), but it definitely makes it much more do-able and pleasant.

Clinical update - pediatrics

So to finish off my nursing school update, the other clinical I am in for the next couple months is pediatrics. I am on the "older kids" side of the unit, which typically means school-aged, or approximately 6-18 y/o. A lot of what I see is kids with cystic fibrosis, asthma flare-ups, sickle cell disease, or other genetic childhood diseases. I love working with the kids, but some of the kids in this hospital are just really, really sick, so it's also very sad.

Despite being on the older-aged side of the unit, it happens to still be winter, so the infant/toddler side has had a ton of overflow onto our side. Though I am supposed to be working with school-agers, I have also cared for a few in the 3-12 month old range with RSV and other acute respiratory issues. These little ones are so adorable and I can only imagine how frightening it is for the parents when their kids have these illnesses (example of stridor, a symptom common in kids with croup, epiglottitis, and other respiratory problems). 

The thing I have most had to work on this semester on the pediatric floor is communication with families. The hospital I work at encourages "rooming in", where the parent stays with their child in the hospital as long as the child is there. It promotes healing and most often reduces the kid's anxiety and stress related to the change in their routine. Some of our patients' mothers have not left the hospital in over a week. They are anxious for their child, and in some cases, they want to know everything there is to know to help. It has taught me the importance of knowing every drug you give, and knowing the reasoning behind every nursing action you perform so that you have an answer when the parent (who is watching your every move) asks you why you're doing that.

Overall, I feel like I spend most of my clinical time this semester teaching. Teaching mothers, kids, parents, etc. how to better manage their illness, baby, etc. Last semester (working with adults and psych/mental health patients), I did a lot less teaching because either (a) the patient already knew about their disease and how to best care for themselves through research or past teaching, or in some cases (b) the patient was not capable of understanding at the moment because they were in an acute situation and mostly needed help stabilizing first. I have to say I prefer what I'm doing now to what I did the last few months; however I'll be back to working with adults this summer (this time in the critical care setting), so hopefully I will enjoy it more this time.

Clinical update - womens

It's been quite awhile since I've updated on how school has been going and what I've been doing. The biggest news? I will finish this program 9 months from Wednesday! Thank goodness! I've mentioned already that I'm currently in rotation for both women's health and pediatrics, but now I'm half way through the semester and I've had some pretty interesting experiences. Today I'll share a little bit about my women's health clinical.

My women's rotation has been very eye-opening. In labor and delivery, I have now assisted with two births and watched one. Essentially "my assistance" includes feeling for contractions, telling the mother when to push, and helping hold one of her legs and/or hand. I've done the first set of vitals signs on two brand new, 1 minute old babies, given vitamin K shots in their tiny little thighs, weighed, swaddled, dressed, and diapered babies for the first time and got to hand them over to some pretty excited parents. I've been handed a cell phone by a younger mom saying, "Take a picture for me! I wanna see him!" when a NICU team was assessing her baby from a somewhat difficult delivery (though the baby was awesome, strong, and very healthy). I've foot-printed babies for their official records. I've monitored contractions and fetal heart rates, and I've watched epidural placements (which I also do at work for patients pre-surgery to manage their post-surgery pain), and to be completely honest, watching it makes me never want to get an epidural if I can help it.

On our mother-infant unit, the hospital is trying to switch to a couplet care system, so I get assigned a mother and her baby as my patients for the day. On that floor, typically a lot of teaching and a lot of reassuring is involved. It is a good sign when mothers are concerned about everything from a little rash developing to how little they feel the baby is eating. I have also seen some not so good signs - but no one wants to hear about those. In the nursery is where things like circumcisions, car seat trials, and PKU screenings take place. If the babies aren't in there for procedures or to let the moms get a little sleep, they are usually with their moms in her hospital room. I've also juggled trying to teach a non-English speaking mom how to take her baby's temperature once she gets home while holding the interpreter phone in one hand, and trying to quiet her her screaming baby by letting her suck on my (gloved) finger because we can't give pacifiers to breastfeeding babies at the hospital. (For those of you future moms who want to breastfeed, here is a tip on breastfeeding and pacifiers.)

Overall, I have learned a lot about how much goes into a "routine" delivery and also a lot about what goes into those non-routine deliveries. I've learned a lot about pregnancy, a lot about breastfeeding, and a lot about what a newborn endures during its first minutes and days of life - they are surprisingly resilient for just entering this world. Plus, they are pretty cute, which just makes them likable patients :)

Orientation over

I finished orientation for my new job just in time for the new semester to start back up (tomorrow). I'll still be shadowing at work for a couple more weeks until I am independent, but thank goodness most of the meetings and training sessions are over. I know it's all important information, but since I've been at the same hospital in a different capacity for the last 8 months, a lot of it was very redundant and therefore, hard to sit through. There was a code on my unit during my orientation phase, which freaked me out a little because I've never been present for a code before, but everyone was pretty efficient and things turned out well. I was told that coding on our unit is a fairly rare event, so hopefully there won't be any more of those any time soon. 

So far I really like my new job. It is very fast-paced and busy pretty much all day long, but the time passes so quickly. I am generally on my feet the entire day and the first shift starts at 5:30am, so by the end of the week I was pretty exhausted. I won't be working full time though starting this week, so thankfully I won't be getting up that early every day :) 

Chris and I are both looking forward to the near future when we find a place to live and we can get our stuff out of storage and start to settle here in Williamsburg. We feel like we're still in transition (because we are) and though we're thankful to have the time to look for a place, we're ready to be settled. We spent the majority of this weekend looking around town and will hopefully make a decision on something soon. It's been a looong process already and one that I think we're both ready to move on from. Hope everyone enjoyed their three day weekend!

Early morning

I have never applied for any healthcare jobs before in my life. I've applied and interviewed for a host of other types of jobs, but never anything in the healthcare setting. Well, this week I applied and interviewed for my first healthcare position and I'll be honest - I was pretty lost!

The application process was similar to every other job you can imagine, but once I scheduled my interview, I blanked. What do you wear to an interview when you know your interviewer is going to be wearing scrubs? I had a psycho-education presentation the morning before my interview at one of Richmond's behavioral health sites, so since I was already going to be dressed nicely, I figured I'd just go as-is. I'm still hoping that was the right move because as I guessed, my interviewer and everyone else I met was in scrubs. 

The woman wanted to schedule a follow-up/more hands-on interview, so I figured I would try for today (Thursday) since I was going to be in Richmond anyway. I believe her exact words were: "Great, does 5:30 tomorrow work for you?" I usually get done with clinical around 4pm on Thursdays, so I told her I'd be there - no problem. Then she said something along the lines of "Wonderful, I get here by 4:30 every morning, so come find me up front when you get here." That is when I realized my follow-up interview was at 5:30 am, not 5:30 pm. Yeah.

So this morning I got up at 3:30, hopped in the car, was given some scrubs from the vending machine, and started my "interview" at 5:30. I'm sure all of you out there with small children that regularly start your day at oh'dark-thirty are laughing at me. But I have at least learned to be appropriately clear from here on out when scheduling my interviews, as it turns out, normal rules don't apply. Craaazy.

Clinical demystified

The other day I was talking with a friend and she asked what I did on a typical clinical day in the hospital. I explained to her that, in general, I'm assigned a patient and I provide the care for that patient that day. She seemed pretty surprised that patients would be okay with students providing a significant portion of their care and expressed some safety concerns, so I thought I'd take a minute to explain how this clinical situation works for those of you unfamiliar with it.

So, lest you think we students descend on the hospital in droves, pass medications willy-nilly, document our whimsies in patients' medical records, and perform whatever procedures we come across unassisted, I am here to tell you: that is not the case!

First, we register for the unit/floor we want in groups of 8-10 and each group is headed up by a preceptor. The preceptor stays on the unit whenever we are on the unit and is available for help, questions, supervision, etc. The patients on the floor are assigned unit RNs, just like on any normal day. Each of us students are assigned one patient (or two on a slower day), and we make sure that when we go into the patient's room in the morning to do our assessments, we inform them that we are their student nurse, and that they have an RN, as well. Patients at this hospital are told that it is a teaching hospital upon admission, and though they do have the right to refuse care from a student, most don't. The thing is, we are typically not the first students these patients encounter. This hospital also trains medical students, PT and OT students, pharmacy students, dental students, NP and CNS students, PA students, etc, etc, etc.

In effect, getting a nursing student to manage your care for the day can be a blessing. RNs on our unit typically have anywhere from 3-6 patients, and we get 1-2. Our patients get a lot of attention, and in addition to us looking over and questioning their orders, they also have our preceptor and their RN reviewing them. Everything we document as students is read over and verified by the preceptor or RN before it becomes an official part of the patient's medical record, and any procedures we perform are typically either supervised, or performed while assisting another professional. Before we can give any medication, we have to know its class and therapeutic range, the action of the drug, intended effects, side effects, and exactly why our patient is taking it (among other things). In general, there are a lot of people around to make sure these patients get very effective and safe care.

So next time you get a student in a teaching hospital, just remember that it's not the worst thing in the world :) We're looking out for you, others are looking out for you, but most importantly, ask questions and look out for yourself.

OR

This week I had my observation day in the operating room (OR) on the surgical floor of the hospital. As I mentioned before, a couple people who had gone before me got to see some pretty interesting surgeries, but unfortunately, some did not (one girl had to watch teeth being pulled all day! Probably not fun to watch...). I had to check in at the peri-surgical unit to get assigned my patient, meet the patient and family, and then follow the team into the OR. My patient was getting an aortic valve replacement due to aortic stenosis (which is a fancy way of saying that the valves separating the heart from the main artery supplying blood to the body doesn't open all the way very well, meaning blood flow to the body is reduced), so I got to watch heart surgery! For those of you interested, I found a picture on google images to illustrate this problem:

For my part, as soon as I got the unit I had to take off my usual scrubs and put on paper scrubs. They're thicker than real paper, but if you're not used to them, they do tear (one of the other nurses putting hers on tore her shirt). I also had to wear a mask, goggles, a bouffant to cover my hair, and little booties to cover my shoes. This is probably what I looked like (also found on google images, link):

I am going to do my best to explain the rest of the day using my best non-nursing vocabulary possible. As soon as we got into the room, the surgeon marked the patient (marking means they draw on the patient in sharpie where the incisions will be - which helps to reduce the risk of performing the wrong surgery on the wrong patient), and then they oxygenated the patient, put the patient under anesthesia, and intubated (intubation means they insert a tube down the throat to create an artificial airway so they can control the patient's breathing). The rest of the procedure I spent watching from behind the surgeon, running notes between the anesthesiologist and the circulating nurse (the nurse not scrubbed into the sterile field) and talking about the procedure with the rep that sells the valve they were putting in the patient and the other OR staff. It was fascinating!

Anyway, if you are easily grossed out, do not read this paragraph, because I'm going to describe what happened in surgery (to the best of my observation powers, which probably contains a bunch of inaccuracies, so sorry in advance)! Surgery: First the scrub nurse prepped the patient and set up the sterile field, which shockingly, took at least an hour. As you can imagine, there's a lot of prep-work for heart surgery. Fast forward a bunch...a few lines are placed (one through the femoral artery, which is in your pelvic area) and the surgeon made the first incision in the patient's chest, the length of which was already marked out earlier (maybe around 2-3 inches). The surgeon was explaining that he calls this surgery "minimally invasive" (it isn't), just because they don't open the patient's entire chest up (the chest is opened only in the area of the sternum). After they cut through the skin, the anesthesiologist deflated the lungs and they used a saw to cut through the sternum. Then they clamp open the incision/sternum and cut through the pericardium (a layer of tissue that surrounds the heart), and all the sudden I was staring at a beating heart! Crazy... As soon as the pericardium was cut, another line was placed coming from the heart out of the incision area itself and the patient was placed on bypass. Bypass was actually really interesting to watch because what happens is that they stop the heart using a combination of ice and medications, clamp the aorta and let the body's blood run through the lines they placed earlier. So the blood is flowing out of the patient's body through clear tubing into a machine that circulates and oxygenates the blood (so the patient does not have to breathe and the heart does not have to beat) and then flows back into the body. As soon as bypass was started, things kicked into high gear because the surgeon said they try to minimize the amount of time a patient is on bypass. The surgeon made an incision in the aorta below the clamp and exposed the aortic valve (which he announced so everyone could take a quick look). Then they cut out the valve's leaflets (see picture above - the aorta has three leaflets) and started stitching in the new valve. Basically they place sutures around the circumference of the aorta, then pull the sutures through the circumference of the valve, and when that's done, they just slide the valve down the sutures until it's in place, tie them, and cut them off. After the valve is in place, they stitched up the aorta, took the patient off bypass (bypass lasted for just over an hour), restarted the heart by using paddles placed directly on the heart, and then checked to see if the valve was working based on an ultrasound-like image taken from a camera they had put down the esophagus during intubation. Since it seemed to be working fine, they used a talon (pictured below) to close the sternum, stitcheded up and sent the patient to the ICU to come out of anesthesia. 

This is very, very similar to what the OR I was in looked like (also google images):

All-in-all, the surgery took about 4.5 hours. I followed the patient up to the ICU and then went back down to the surgical unit. I found the surgical nurse from my procedure and since they were just finishing cleaning up the room, she then took me to watch a total knee replacement and a total hip replacement (orthopedic surgeries). We only stayed for about 30 minutes in each. Those surgeries were much more like a construction side with saws, drills, fragments flying, and blood everywhere. Compared to the cardiac surgery I had witnessed earlier they were disaster zones. These surgeons were rocking out to music and were more than friendly and happy to explain everything they were doing as they did it. The atmosphere there was a little more relaxed since the procedure wasn't as rapid and fast-paced as the valve replacement.

It was an incredibly interesting day and I was glad to have the experience to see heart surgery. I definitely never thought I would watch heart surgery, but I guess you never know what life throws your way. Also, shout-out to my Aunt Janet, who I believe works in cardiothoracic surgery with pediatrics. Before I went to the OR, while I was waiting with my patient for the team to show up, I saw a surgeon come down into the next room, and he came out carrying a toddler down to surgery. My heart just about broke when I saw the red, puffy eyes and the hospital crib being wheeled out after them. I hope everything went well!

Last thing: the surgical team I was with was discussing a surgery planned for this week to separate conjoined twins. I just saw this article online - guess it was successful!!

Food = nurses' love language

Last week I was sitting on the couch after dinner and reached for the computer to find something to bake for my last day on the inpatient psych unit. It was getting late and when I told Chris I had to bake something he seemed a bit incredulous. I think his exact words were something along the lines of: "What?? Is this like first grade? You have to bring something in on your last day?"

It made me think. Why is the tradition to bring in food to say thanks to your nursing staff? Not only do we students do it, but other nurses bring in food, and I've seen patients' families bring in food. I mean, I totally understand food as a way to say thanks and/or as a gift (hmm...Chris gave me a 1lb. bag of peanut M&Ms for Valentine's Day before we started dating...wonder if this is why we have lasted so long?!), but why not a gift card, or a framed picture, or some sort of other, more lasting token?

Regardless of the reason, it seems that food is a nursing staff's love language. I know that around hour seven of a shift when I only had about 10 minutes to eat a third of my lunch a couple hours ago, that finding a cookie or some other type of snack in the break room is about equivalent to finding $10 that you didn't remember having in the back pocket of your jeans (low blood sugar changes your priorities...it's probably scientific). 

So we baked. And I'll probably bake again for my other clinical, and probably again next semester, too.

Halfway through fall

It's been awhile since I've updated about how school has been going, so I guess it's time! I am a little over halfway done with this semester...phew! I'm halfway done with my adults clinical and three-quarters of the way done with my psych/mental health clinical. It's been busy, but I am always surprised when another week is over so quickly. Overall, I'd have to say that school is not actually hard, it's just very time-consuming. I am doing well in all of my classes, and the things I don't do as well on are simply due to the fact that I have other (more pressing) things that need to get done, rather than thinking about the test I've got to take next week. I just don't have the same amount of free time to dedicate to school as I did when that was the only thing going on in my life.

Working in a hospital makes you very thankful for your health. Due to advances in medicine, so much can be taken care of now in doctors' offices or through out-patient surgery, so unfortunately the people we see on our unit pre- and post-surgery tend to be really sick or have a lot of complications. I knew going into this clinical that I would be seeing people at some of their lowest lows, but I have been surprised by many of my patients' optimistic and cooperative attitudes despite their circumstances. One of my favorite patients is a lady in her 80's who has been there for weeks, but every time I come in, she is making brisk laps around the unit with her IV pole in tow. She told me her goal now is 5 miles/day (I have no idea how she measures this or if she even comes close to it) - but due to her commitment to recovery, it sounds like she will be going home this week!

Next week I will be in the operating room (just for observation), so cross your fingers that I don't do something silly like pass out. I wouldn't put it past me, but I'm hoping for the best. We rotate through the OR in shifts, so two other people in my clinical group went last week and their stories of the surgeries they sat in on were pretty interesting. I hope I get to see something equally interesting, and if I do, there will be a post to follow!