Last week on peds

This week, my last on the peds floor for my clinical, was one that got me thinking. My patient was a 17 year old girl who had been diagnosed with a medulloblastoma (brain tumor) almost a year ago. What gets me most with these cancer kids, I think, is how they initially present. Bruised shins, headaches, nausea and vomiting-- things that kids just get, except this time, they ended up with cancer, too.

I've chosen mostly heme/onc (hematology/oncology) kids for my patients, and I've seen them all at different stages of the disease and treatment process. My first week on the unit, my patient was in the middle of her third round of chemo for ALL (acute lymphoblastic leukemia). A few weeks later, my patient, who's squamous cell carcinoma had been complicated by several intense cases of pneumonia and metastases to lung, liver, and bone, had just become a DNR/DNI (do not resuscitate/do not intubate) status, and was at the end of a very long battle. His dad was at the bedside, waiting for the snow to stop so that he could take his son home to die. A few weeks later, my patient was a toddler who had, that day, been diagnosed with neuroblastoma, and had a tumor the size of a football in his belly. This past week, I finally got to witness a little bit of success.

This adolescent girl had presented a year and a half ago to her primary care physician initially because of some vision changes. After being lost to follow up for nearly 6 months, she came back because one side of her face had started to droop, and she had headaches. After MRI showed a mass in her left parietal lobe, this young woman underwent surgical resection (yeah, we're talking brain surgery) and radiation, and then chemo. This week, she was hospitalized for her final round (of 6) of chemo. With her Mom at the bedside, she was hopeful and optimistic; this 17 year old was the friendliest patient I'd had all term, even being pumped full of poison. She was doing really well-- clear lungs, 0/10 pain all day, eating well, ready to go home and get back to school.

When a mishap with the shower (she somehow leaned on the curtain and knocked the pole--and the surrounding tile-- off of the wall) forced her to move rooms, she randomly ended up in the same room where her chemotherapy had first begun. As her nurse and I hooked her IVs back up and got her settled, her Mom stood at the window with tears streaming down her face. She remembered months before, watching snowflakes circle to the ground, wondering if her daughter would survive to see her 18th birthday.

She had come full circle. And for my very last day as a pediatric acute care nursing student, I couldn't have asked for anything better.

a little history

History is an integral part of any thorough exam, right? We need to know where our patients have been in order to have an idea of where they might be going.

So, in an attempt to get us all on the same page, I thought it might be helpful to let you in on my history. I grew up in Southern California, and my parents divorced when I was young. Dinner table conversations consisted of my father's comments about the "VSD that we couldn't get off bypass," the "20-gauge scalp line in the premie," and the "FLK's circ done under general". I remember wishing that I understood what he was talking about...I wanted so badly for him to share with me, but how does one explain these things to an 8-year-old?

In high school, I decided that I wanted to save the world. Not with nursing, no, that came later-- I wanted to be an environmental scientist, and I wanted to specialize in the destruction of the world's oceans. I got SCUBA certified and started college at an extraordinarily granola university, and the further that I got in the program, the less convinced I was. I considered law school, but my oldest sister's less than exuberant anecdotes about life as a 1L really didn't suit me.

I bounced around a little bit and finally, in the fall of my junior year, narrowed the field down to 'something medical'. I studied human physiology, struggled through anatomy (I was somehow unaware that my first anatomy lab was with cadavers), and hit my stride. I graduated and moved to the big city. I was hired out of, I'm sure, good faith alone, as an inpatient phlebotomist.

Make no mistake, phlebotomy is much more than just a skill. Running from room to room at 3:30 in the morning; waking people from a dead sleep; narrowly escaping vomit, spit, urine, and fists; attempting to maintain control, speed, grace, and accuracy-- all while keeping in mind the looming bloodborne pathogen risk. Perhaps this sounds simple to you, but for me (as unexperienced as I was), it was a challenge to say the least.

I heard from both the sweetest and the most hateful of patients in my year of drawing blood. I gained a sense of humility that many of my coworkers had either lost through time or never had to begin with. Yes, I learned to draw blood. But I also learned that I like the way it feels to walk out of work and struggle to get up the stairs of the parking lot, but do it anyway. I learned that even after 10,000 successful draws, I will still miss from time to time. I learned that, despite all the swearing I do in traffic, I actually do care about my fellow human being. And today, in the third of five terms in nursing school, I use what I've learned.

FIRST BLOG!!

New nurse, new project. Well, let's not get too far ahead of ourselves, shall we?

I'm still in school. But everyday brings me a little bit closer to graduation (this December), and as I'm well aware of the masses of 20-somethings (and 30, 40, and 50-somethings) starting out in Accelerated Second Degree programs for Nursing, I thought I might have a market here. If not? Well, that's fine too. I want to remember for myself what these days were like.

I want to share my day-to-day life in (and outside of!) nursing school, dispel rumors and myths about the rigors that this type of education brings, and talk about the real stuff. I want to address issues that I've had and am having (like why, despite my previous experience as a phlebotomist, glowing recommendations from clinical instructors, high GPA, and all around good nature, I can't get a job taking vital signs and giving baths).

I've recently really gotten into reading other people's blogs-- from codeblog to CF stories, this type of expressive informational medium left me interested and envious. I want to share my stories too! With a little nudging from my BFF back home, this blog was born.