Que idiomas?

Ahh, a bit of a break after three in a row. I really like working my days back to back. It really keeps me in the mindset, but then I have to shift back to relax mode once I get home, or I drive John crazy!

Interesting story from day two. I've had a couple of encounters with Spanish speaking patients, a few traumas, a couple at the free clinic I volunteered at, one or two since I've moved. Every time my minimal amount of Spanish has sufficed until I can get an interpreter or call on the "language line." Yesterday, a patient came in that spoke ONLY Spanish, understood no English (most of the time there's a bit of leeway) add to this that she was seen in fast track where there are no phone jacks, and there were no physicians that spoke Spanish either. I did as much as I could and relied heavily on Rosa one of our registrars, but it really hit me how much better I could do. How much better we all could do if we could communicate just a little bit better. I could understand that her stomach hurt, and had been for four days, she had a headache, hot flashes and needed some medicine. I had Rosa come in to get a bit more history on her because all her triage note said was "Unable to triage." Crap.
We found out she had been seen at the free clinic and was here to have some blood work done and get a prescription for her____. Rosa didn't know that word. Crap again. She looked at me and said, "Listen, is that the word for arthritis? She's saying her body is aching and she feels hot because of her ____. She needs medicine for her _____. She's had it for 10 years."
So we had her say it again, and again, and again. No success. I could barely even make it out. Then she said she had a lump in her throat (I knew those words)
"Thyroid?" I said pointing at my neck.
"Tiroides."
"Es medicina levothyroxine?"
"Levothyroxine 100 meeleegrams."

Wahoo!! I figured it out!
I told her I needed to draw her blood and would be right back. Boy, was I proud of myself I was able to explain that to the physician. Phew. It was a fun day. I learned there's a lot I could learn to help out. I've never felt better than when I did discharging her. I printed out her instructions in Spanish, but her follow up information wouldn't automatically translate, so I had to do that as well. I had to get her a map to another clinic, Rosa explained which ones she had to take her ID to so she could be seen and we made sure she understood they could get her lab results over the computer and she should go sometime next week. It felt good.
So I spent this morning translating our triage assessment into Spanish. Really simple yes and no questions because there are no phone jacks at triage, we can't get the language line until they're in a room.

The mind is really funny. Once I started trying to speak Spanish again I kept mixing in German and I found myself signing to her as well. I was accessing all of my secondary languages at once. It was incredibly difficult to focus on the one language and say the correct words. This was probably the most difficult part was trying to pick out which word from which language was the correct one for the situation.

Now.
Necesito una muestra de orina.

; )

July 28, 2010

Alright so it's the up and coming of The Professional!
IEEE. I've got to be a grown up now. Work today was great, really great not too many or too difficult patients. I had plenty of time to talk to managers about things that I find to be lacking. We even came up with a few solutions!
I feel like I'm in a place where I can make a difference. John suggested I going somewhere that had more trauma or was more well organized, but no. I can do something here. I'm excited this could be a huge step for me.
I gave them what I had on sedation, RSI, strokes, chest pain, and cath lab patients. I really think I could be a big help with all these resources.
I'm very excited about the changes I could be a part of.

Plus! I'm going to start podcasting! Once John starts school I got it in my head to make a new nurse podcast! So look for it in iTunes!

I'm enjoying a coffee here in the breakroom whilst I eat my lunch/dinner. No crazy patient stories yet. Let's hope things keep on the current route.

Running has been such a blast recently. I've been making great distances if not great times. I really feel like I'll be prepared for this marathon when it comes. Too bad it doesn't cool down here until mid-November. I'm getting sick of the treadmill.


I'm at home now, they sent me home early. Something about being incompetent. (Ha.) I'm multi-tasking, blogging and watching Manchester United vs. MLS. Sorry if this is disjointed and makes no sense now. Soccer is on.

Had a good long conversation with my Mom. Things are going fairly well back home. My Grandma is having some back problems and seems to be hitting people with a cane just to let them know she's not just to having to use one. She's got a history of benign spinal tumors so she went for an MRI today. Lets hope for some good news within the next few days.
As far as bad news a good family friend is unconscious in the ICU on a ventilator. I hope Grandma gets well enough to visit her friend soon.


Man, I'm hungry!
Back to work tomorrow. We'll see what comes up then!

The new Alice

Ahem, how to do this tactfully...


That movie sucked.
Personal opinion. But here are the reasons.

Aside from the continuity list (Most discovered without skimming IMDB but this list is nice and keeps me from typing them up.) this movie failed completely to capture the "essence" of Wonderland.

Mia Wasikowska's acting left a lot to be desired, like maybe some expression or arm movement. I left this movie believing her to be suffering from a serious vitamin deficiency that made her so listless she couldn't even pretend to be mildly fascinated let alone curious.

Why only the monster from The Jabberwocky? If you're going to throw in additional Lewis Carroll creatures why only one? Why not multiple? Snark? That would not have been lost to this generation. (Plus Jabberwocky is the name of the poem.) Why couldn't we have other characters come back? Walrus and the Carpenter?

To continue on that point. I feel this film was more an homage to emo-goth-punk kids than Lewis Carroll or Alice's Adventures in Wonderland. For one thing I found it incredibly difficult to find any logic or mathematical puzzles Carroll was known for. Wonderland wasn't scary or frightening. It was mildly intriguing. I guess I was just following "Alice's" interactions with her surroundings, vague and indistinct. I guess had I been there I would have been more shocked or surprised by what I was finding. What I did find was lots of GI and good costume design. Nice additions to a movie but they don't make it good. I did not find curiosity, excitement, or wonder.

After watching this awful film I got online to see how and why they screwed it up so bad. Maybe it was a mistake, lost budget, ran out of time, etc.
No, the things about the movie I did not enjoy they did on purpose.

One of my issues was it's deviation from the original overreaching theme of Carroll. A girl lost and wandering encountering strange strangers. Burton was quoted as saying, "It was always a girl wandering around from one crazy character to another, and I never really felt any real emotional connection."His goal was to give "some framework of emotional grounding" and "to try and make Alice feel more like a story as opposed to a series of events."
Also, the Mad Hatter wasn't unstable enough. In the same previously linked article we find it's because Johnny Depp (still a great actor) wanted to make him more human, someone you can identify with. Then you're completely missing the point! He's mad! He's been poisoned by mercury. It looked more to me like he'd had a stroke with those unequal pupils...

And the proportions?! The Knave was supposed to be 7 feet tall? What? Did anyone else pick up on that?

How come dresses only rip inappropriately when needed. WTF was she wearing when she shrunk? (John thinks it was a sock.)

Also, Carroll's Alice was very political. Now while I did shudder to think I was going to hear more about unnecessary wars, or oil spills, or healthcare plans I was hoping maybe they would try to do the film justice in this aspect. Make a reflection on today's societal nonsense. Maybe they could stick with the original theme and make fun of Victorian society (mild in the beginning and end parts) but no. Just mostly visual effects not a lot of substance.

I feel like this story was pushed along WAY too quickly. I didn't have time to settle on "moments" the movie provided before I was reminded of them again. It was like watching previews for a movie over and over and over. All the good bits were ruined. What was with the movie recap during the fight scene? Do you think I would forget that quickly?

I like Danny Elfman, I think he does a great job with music. But this was too much. EVERY scene had to be EPIC. I had no rest or break between MAJOR EVENTS. It was like this paragraph, TOO MUCH CAPS LOCK.

Also, they made her a exporter to China? Confused. I found out the reason for that choice. It's because of the myth that Alice was a drug induced hallucination and this was in reference to the opium wars between Britain and China at the time.
...

Sigh, I'm sure there's more about this movie that made it difficult for me to enjoy. Alas, I've exhausted myself.

Strength and Endurance

I miss journal access. John keeps waiving it over my head that within a few weeks he'll have AMAZING journal access.
Jerk.

So I TRIED to do a bit of research and here are some preliminary findings. This isn't professionally done or anything, just dinking around.

I began by searching google scholar (yes, I know, but I don't have access to much else) with the keywords "endurance training strength training" It came up with over 128,000 results. I skimmed through 5 pages of results for relevant findings. Studies were included for review that met the following requirements: compared results of endurance and strength training verses endurance training alone, participants were under the age of 65, study included women.

My findings concluded that in men and women under the age of 65 would gain initial benefits in endurance training by supplementing their workout regimes with strength training. However, while VO2max improved across all groups the initial explosive strength of those in the strength and endurance groups was less than those in the strength group. Leveritt M et. al. post two hypothesis as to why this occurs. Their chronic hypothesis theorizes that the muscle fibers cannot adapt to the two varying requirements for both endurance and strength training simultaneously. Their acute hypothesis supposes that strength training combined with endurance training is less effective because of residual fatigue from endurance workouts.

So, if you want to be buff and strong, go lift weights. Get a good cardio warm up, but skip the long runs.

For those of us who enjoy the serenity of long distance escapes you might find those first couple of miles easier if you add a bit of strength training either on your off days or your fewer mile days. We won't get all buff and beefy but we can go farther.

These studies did state that determining effects of strength training on long distance (marathon) endurance was inconclusive and difficult to determine. However, the assessment of endurance over shorter distances had less fatigue and faster speed times. This would lead one to conclude that if you are less tired and faster for the first half of your marathon your speed and distance would improve from this initial boost.

Limitations in this author's review of the literature included: lack of journal access, two glasses of wine, and the final level of Super Mario Galaxy 2...

Potential for strength and endurance training to amplify endurance performance

Interference of strength development by simultaneously training for strength and endurance

Neuromuscular adaptations during concurrent strength and endurance training versus strength training

Effects of strength training on lactate threshold and endurance performance

Comparison of two regimens of concurrent strength and endurance training

Concurrent Strength and Endurance Training: A Review

The effects of strength training on endurance performance and muscle characteristics

Unit Council? Me?

Getting started is sometimes the hardest part.

Do I write about the weekend at the lake house?
Do I write about my quick surprise trip to Springfield?
What about making nursing unit council?
The past three days at work?
My silly cat?
What about almost beating Super Mario Galaxy 2?
Sigh, so much to say.

I love Sunday mornings, sitting around, drinking a latte, browsing reddit. It's relaxing.
The past few days of work were...interesting. We're under-construction (they opened this new ER less than a year ago. WTF?) Well, they did the flooring wrong so they're tearing it up and replacing it. I think I've talked about this before. Anyway, my understanding is pod 2 will be out of commission for another week or so. Right now the fumes from the sealant are atrocious. They're causing respiratory problems for just about everyone on staff, patients and family members are having allergic reactions, plus it's enough to make ME gag. Not good.

Ah yes, the interesting story of how I found out about unit council.
I was really surprised and nervous to learn I was nominated. I had been there 2 weeks by this point and wasn't even off orientation. However, once I was on my own and the voting was taking place I was starting to see all of these areas for improvement. In the past few days I've seen a LOT of areas for improvement. So I was really starting to want the position. I know I'm young and naive and I think things can actually change for the better, but maybe that's what this needs. Someone who hasn't been around long enough to know nothing will ever change. I can be an optimist, I don't know any better.
So, the tale.
I had a patient with a dislocated shoulder. Obvious before xray. I got everything set up for a conscious sedation so we could pop him back in place. I was looking for the correct documentation for this procedure and no one seemed to know where it was or what it was. There were no consent forms either. I was a little freaked out. No one thought it was a big deal that legally we were missing several components I thought we needed. I asked the charge nurse where their protocol was so I could do it per hospital policy. He informed me they don't do that kind of thing, just make sure he's "fine" before he goes home. How nice and vague.
So, while I'm discussing why there should be protocols for procedures with the charge nurse, the physician comes up and tells me he wants me to use propofol for this patient. To which I reply,
"Only if you give it to them. It's illegal for me to push that medication."
"But we do it all the time."
"I don't. I could lose my license."
Our charge nurse was shocked. Apparently these nurses do bolus propofol. Not me.
All the while, our manager was standing behind me. While I was describing as to why I won't give a medication that could end my career she speaks up and says,
"Those protocols sound like a good idea, you should bring that up at our council meeting. Oh by the way, did anyone tell you yet you made it?"
Instant red-face. No, I hadn't heard. I was very happy.

There are a few things I would love to change about my work environment. Sometimes it feels like doing what I consider a "standard" is way beyond what they feel is necessary. Like putting someone with chest pain on a cardiac monitor. Or checking someone's vital signs again before they leave. I'll never forget the look on their faces when I took the crash cart into the room when I was administering adenosine. Well, since it's a medication that stops the heart, I thought I would like to have a back-up plan.

Maybe I am type-A and neurotic, but I get things done and I feel safer about them. Later I printed up a bunch of articles for the physician about the hemodynamic effects propofol can have on patients and a few on etomidate as well. (He didn't want to use etomidate because he'd never heard of it.) The patient had a resting heart rate in the mid 50s. I didn't want to give him a medication that could slow it down more. I don't know if he appreciated it or not. But he did thank me with a joke about his current amount of free-time.

I sent this to my family as well...

I'm reading The China Study and it prompted me to type this hurried email to my family. I think I should share it with my friends as well.
I really really really would like to hear anyone's feedback on this. I really think this is important.



I normally don't do this. In fact I don't think I've ever done this. Type up and send a massive family wide email to those whose email I currently have in my gmail. (If it is incorrect, please forward to the appropriate member and let me know.) But I think this is important and you all should know.

You're all aware John and I have been mostly vegetarians for the past two years. I was never strict about it or brought it up much because, there's no need to be rude or pushy. My reasons for becoming a vegetarian have never been the "animal rights" route, although I do believe that is very important. Animals are amazing creatures that need to be treated with respect. However, I was more concerned about the health aspects of altering my diet. I know diet can be a very touchy subject for anybody what with the implications society has put on it about being "lazy" if you're overweight. Recently, I have learned a few things (or at least I'm able to articulate better) that I feel if I didn't share with you I would be a cruel mean person.

I'm almost positive this is all information you know, but I want you to think about it as if I am telling it to you based on my education and research. Not a commercial or a diet book. All of this information I am pulling from The China Study conducted by T. Colin Campbell. this study is known as one of the most comprehensive studies ever done on nutrition and diet. It's results were simplified and published in a book by the same title. I highly suggest you head to the library website and place a hold on this book.

In this country we are suffering mostly from diseases of affluence, diabetes, heart attacks, cancers. We spend way more than any other country on medicine and we are dying of these disease more than any other country. The first greatest "killer" is a heart attack. The second greatest "killer" is medical errors. I'm writing this to all of you to try to keep you out of the hospital!

I adopted a vegetarian diet to become more healthy. There's a lot of misleading and completely wrong information out there about obesity, weight loss, exercise, diets, etc. I want you all to know this. A plant-based diet low in animal proteins is healthy and will keep you well. It reduces the risks of diabetes, heart attack, stroke, obesity, cancer greater than any medication that can be prescribed. I do NOT like medications. I see what it does to people and how many pills it can take to "improve" someones quality of life. As a person who constantly sees the effects of "health care" I am advocating health prevention to my family, because I love you.
There are plenty of proteins found in plant products. I have never purchases those weirdly packaged specialty vegetarian items because it is unnecessary. It is less expensive and much better for you to not eat meat.

I say this with hope because you all know me. I am not skeletal thin, I am not lethargic or suffering from any vitamin deficiency. I don't take any medications or vitamins or supplements. I have no health conditions and don't plan on having any. I have been a vegetarian comfortably for two years. I know you all can and will benefit from changing your diet. What we are eating is not natural. It's easy and convenient, but that does not make it correct. It's average and normal. Not natural or healthy. It's not what you need to be eating. Everyone is ok with taking pills to correct daily imbalances that accrue overtime because of what you eat daily. Just fix what you eat and you don't need these medications!

Please, let me appeal to your logic. Try to reduce your meat intake for the next 3 months. Even just try following the American Heart Associations diet (which, based on research is inadequate and poor for actually reducing heart disease.) A "typical" meat portion should be the size of a deck of cards. If you can't get rid of meat completely try this for three months. If you're really wanting to make your life better, please please eat more vegetables. I can give lots of delicious recipes and advice for doing this. I am really concerned for you all, but can't do a thing about it.

I know most of you will read this email and delete it. Who wouldn't? I kind of typed it in a panicked state. But I really want you all to try this. You don't have to eat only salads or reduce the amount of food you eat, but eat lots of vegetables and whole grains. Really do it. Write to me about it. I would be more than willing to share advice or anything about transitioning into vegetarian. There's a lot of research out there about how much better vegetables are for you. What's it going to hurt?

Thanks for reading this.

Where to start?

Iiiee!

What to blog about? If I didn't procrastinate so badly I might be more caught up.
The ER is under construction at the moment. Odd since they opened it about a year ago. I found out however the company did a terrible job on the floors and (because they were still under warranty) they are going to fix them now. Yes, but, now we have patients here. So, they've completely closed down pod two. Yep, the one in the very middle. So to get from pod to pod we have to walk all the way around the outside. AND there's no nurses station for pod two. Yea, we didn't close it, we can still have patients in the rooms, but there's no center.
I was pod two a few days ago. It was a five minute walk to my patient's rooms and they had no call lights. I had no monitors or windows. My "desk" was a computer on wheels (where I had to keep all my stuff) and I was stationed between the med room and the charge nurses' desk. So I was a little in the way.
It was terrible. Kinda funny in retrospect, but man, I was so worried I'd get a critical patient and be hosed.
And they ask me what changes I would make down here. Ha.

The past two days I've been in fast track. This is were non-critical patients go (broken arms, eye complaints, etc) to keep the flow going. It's been slow and boring. I've mostly been searching the internet for Masters and PhD programs. Any advice on these would be great.

My running is getting much better, I ran 6 miles without much difficulty Saturday. The difficulty came later when I tried to get out of bed the next day. Ouch.

Still waiting to hear back about nursing council, it'd be great, but I don't think I'll get it. I just don't know anyone here yet!

Lots to do. Maybe I'll think of more to say later!

Good morning everyone!

I worked my first 11am-11pm shift yesterday, all by myself in my new job. Its so different there. The "pod" where I work is only open for the time I'm there, so by 1030 I had to move my patients down to pod 1 or 2. Strange. They really don't see as much. I find it hard to wrap my brain around closing parts of an ER when there are still patients in the waiting room. I say this and then notice that there were only 2 in the waiting room and 3 beds being cleaned. So, whatever works for them.

I was a bit silly and agreed to work 3pm-3am today. I forgot about the Holland game! Oh DOES! I have to figure out how I'm going to watch it. Hmmm... There are so many more opportunities for overtime here. Once John's in school I can really pick up the hours and get myself that much closer to my Masters'! I've been looking at Walden University online. Most of their reviews came back very highly recommended. Any advice would also be great.

Speaking of great. I was informed that I had been nominated for Nursing Council. I was a little shocked. I mean I was told this on my first day off orientation. Who knows me? What's going on? Still excited and I hope I make it. That would be pretty cool. There's also a "project" thing I could do and as long as I turn it in by next July (with a research paper) I can make a quick $3,000. Not too shabby.

But what's money?
Here's what I really like.
Enjoy a too long video of my cat playing with a straw.

Bad blogger, bad, bad.

Oops, so I fell into my trap of forgetting/not blogging.
Let's hope this period is behind us because today is my first day of my NEW SCHEDULE!

Whee! I've been looking forward to this 11am-11pm shift for a long time. Very long time. Yay.
I think the last thing I blogged about (other than the camera incident) was my parents visiting. That was a fun weekend. Since then, I finished up my 2nd week of orientation and I feel much better around the hospital. My last day I printed off a map and wandered around the building for about an hour. Then I learned that I had found an old map and there was an entirely new section (like the ER). So it was pretty much useless, but I do know where the cafeteria is!

John and I ran the Firecracker 5k. The winner this year had a time of 13:48. We were barely behind him at 32minutes. I was reeeeeeaaally proud of him, this was his first race and he did a great job! Now he has a huge blister on the bottom of his foot. My bad.
This was the best part of the race, running by the speed meter. The police were cracking up.

John's mom stopped by on the beginning of her world travels. She's such an inspiration. She packed up (after about 2 days of "planning" as my understanding) and decided to drive down to Georgia I think to visit some cousins. She's got no plans other than to visit where ever she feels like. She felt like visiting us.

We ate a Bruno's Little Italy. Good good pizza. We looked up some nearby restaurants on an iphone app called Yelp! Very nice. I signed up to start reviewing things. Something fun to do and because, the world needs more of my opinion.

Oh, and here's something I've been wanting to post since we got it. I have such a happy washer/dryer. You would not believe how joyous it is to do laundry in my house. Not only are we happy not to visit any shady laundromats. It's just a cheery time.
Here's my singing dryer.