A week in pictures

Lovely juicy berries on the way!

Homemade pierogis

Salad Blue potatoes growing in bags

Tomatoes and peppers looking happy in the garden

The new coop

Prince, the terrifying beast!!

Iris

Praying mantis nymph

Rhubarb, prepped to make wine

Howdy!

What I've learned this week...

If you throw up at work in the middle of getting report, they will send you home, and then you will be stuck wide awake and feeling like crap all night long, trying to be quiet so you're honeybunny can sleep. 

When you hear in report that a patient is "a little sleepy", that could very well mean "entirely unresponsive to verbal or painful stimuli" for your shift. 

"On hospice, DNR, but ok to intubate" is a very confusing combination of terms to use when discussing the code status of a patient.  Don't wait to clarify this with the patient, family and physician.  It sucks having to call a family member in the middle of the night when there's a change in the patient's condition and no one before you has determined EXACTLY what they want done for that patient.

Potatoes are slippery, and freshly sharpened knives will go right through your thumb if you're not careful.

Baby praying mantises are super cute!

Happy Beltaine!

May is upon us, but man oh man does it feel like August out there today.  The sun is burning the leaves of our swiss chard, and I am hiding from it inside our cool stone-walled little cave.  The cooking, gardening, and outdoor projects can wait until the worst heat of the day passes. 

Yesterday brought the opening day of our local farmer's market, and I pulled myself out of bed after two hours of sleep to make it there on time... I was hardly even tired, it felt like Christmas morning!

We were pleased to discover several produce stands, folks selling goats milk and organic raw cow's milk, and even a guy growing pesticide-free greenhouse tomatoes!

We left with two bunches of asparagus, a bunch of kale, three bags of spinach, a bunch of rhubarb, half a gallon of raw milk, three tomatoes, and plenty of yukon gold taters. 

My plan for this evening is to make pierogis, rhubarb crisp, and kale/chard pie.  Nomnomnomnom.....

Last night I hosted a women's circle in celebration of the full moon and of Beltaine, and I found it incredibly refreshing to spend time with 12 other women of different ages and backgrounds discussing the challenges we're all facing regarding balance, success and happiness.  I've felt the need for more feminine energy in my life lately, and feel recharged and inspired today.

Time to make the best of this summer-like day and make some sun tea!

Another month gone by.

April is drawing to a close.  This means several things to me right now.

My orientation period as a new nurse will be over in one week, and I'll be on my own.  That's not to say that I won't have help from my coworkers, but it is a transition from "orientee" to real, honest-to-goodness "employee".  I am really hoping that I do my job well.

Our frost date approaches.  I cannot wait to let all of my little tomatoes and peppers and squashes stretch out their legs and take root in our raised bed.

Our CSA should begin its weekly deliveries soon!  I intend to blog each week about what we receive and how we use/preserve it.

I will be 23 years old very shortly. I distinctly remember a time when I could not imagine living to be this age. Time is going by too quickly and it frightens me.  I am looking at my life and wondering if I'm really doing everything I can to maximize my time on this planet.  I need to find a way to give more, to be more creative, and connect with the people around me.  I've been very hobbit-ish lately, wrapped up with my own little life and concerns.  I'd like to change that. 

Baker's fury.

If I were just a little bit more mentally unstable than I am right now, I might just put a few bulletholes in the POS oven we have in this place.  14 cups of homemade granola, burnt to a blackened crisp.  The oven was set to 300 degrees.  The thermometer that I put in there read 300 degrees.  I put the baking sheets full of nuts, seeds, oats and goodness in the oven, and when I came back ten minutes later to stir them (halfway through the cooking time), the thermometer read 475 degrees, and my delicious, nutritious and somewhat costly granola had become chicken food.  I want to scream, cry, and break things.  I used to last of my sunflower seeds in it.  I need a hug.

The dark side of the garden

I am learning that in order to be a successful gardener, one must be positively ruthless.  Don't let the bright orange daisy-patterned gloves fool you!  A good gardener must marshall the land with an iron fist!

For instance, seedlings.  I nurture these little guys from seed to stalk, anxiously awaiting those first sets of leaves, watering them gently and moving them outside for sunlight and inside to protect them from the cold... but ultimately, the time comes when the seedlings must be thinned.  I pinch the heads off of the weaker half of the lot without a second thought.

And slugs!  I try to be a gentle person, and honestly believe in the right of all living things to exist and live in peace.  Except when it comes to slugs in my lettuce patch.  I happily sprinkle diatomacous earth on my top soil, humming as I do so, thinking about those little buggers getting their bellies all sliced up as they approach my tender green-lings.

And let's not even go into detail about what happens to those big, juicy grubs dug up while turning the soil at the start of the season... but it does involve eleven chickens chasing one another around the yard excitedly.

Oh goodness no, it's certainly not all flowers and strawberries and butterflies out there... not by a long shot...

Objective vs. Subjective

As nurses, we cannot document "this patient exhibits drug-seeking behaviors and is not experiencing any real pain at all, why the hell are we feeding their habit and allowing them to manipulate the system?"  Subjective documentation is a legal nightmare and will get you sued in a second, not to mention the fact that it may not always be accurate, as they are tainted by your perception of what happened.  All we may document is what the person says, and what we actually see.

So, this morning, my progress note looked something like this:

Pt c/o pain 8/10 "all over" and requested Dilaudid, no facial grimacing, pt smiling, laughing, ambulating in hallways with steady gait, full ROM and relaxed posture, talkative and conversational with staff, requesting snacks.  Given Dilaudid IV as ordered, encouraged to rest in bed and utilize positioning to assist with pain management, verbalized relief, will continue to monitor pain, sedation level and respiratory status.


Some physicians will prescribe the drugs just to shut the patient up.  And, if the patient states that their pain is above a certain level, and if the required span of time between doses has passed and there are no concrete contraindications for giving that dose, I must administer it.  Even when it is painfully obvious (bad pun) that they are high as a kite and horrendously addicted... even when the same pattern of behavior is seen again and again, each time they are admitted for a new complaint (which always turns out to be unfounded).

This particular patient will know the drug and the dose and how often they can get it, and they will stay up all night if they can, enjoying the high and watching the clock so that they can get their next dose as soon as possible. 

It turns my stomach.  And it also amazes me a little bit, as the large and frequent doses of Dilaudid we were giving to this person would be knocking me out into next week.  Long-time abusers build up such a tolerance...

Things I learned in the past week

#1 Mulching really does work.  The strawberries we planted in our windowboxes have doubled in size and vitality since mulching them with leaf compost.

#2 You can fit 2 humans and 6 full-sized bales of straw into (yes, into, not on top of) a 3-door Hyundai Accent.  I do believe that this pretty much defines urban farming. 

#3 Some people don't want to be around for their loved ones when they die, and after you've called them and informed them of the change in that loved one's condition, all you can do is accept their decision to go back to sleep instead of coming in to say their goodbyes.  To each his own.

#4 If you are doing something that is far enough outside the mental "bubble" of the general public (such as doing circus arts in the middle of a grocery store), they will act as though you do not exist.  This reminds me very much of Neil Gaiman's description of people, things, places and times "slipping through the cracks" in Neverwhere.  It makes me laugh, and pushes me to do more and more absurd things just to see if people notice.

Two years

I don't want to post about this past week of work on night shift, nor about the heavy labor we've done in the garden this weekend.  All I want to do today is celebrate the gift of having my Honeybunch around for the past two years.  Two years ago tonight we picnicked in the woods and watched the moon rise over the tree tops, and two years ago tonight we shared our first kiss. 
It's a happy day.  Yay us!!

Night shift.

I bawled my eyes out in despair the whole way home this morning.

Last night was my first shift on 11pm-7:30am. 

The entire hospital was full.  Med-surg patients overflowing into the rehabilitation unit.  Only two beds open in ICU, an ER full of patients waiting for beds, and literally no beds on our floor... we had only open room, but no physical BED to put in that room.  7-8 patients/nurse on our unit, with only one nursing aide to care for the forty-something patients.  And then, they pulled that aide to ICU for 2.5 hours. 

The whole night consisted of moving patients in bed, cleaning up their urine and feces (cleaning up people is fine, I'm certainly not above it and it's so very important for their health... but cleaning up people while they're yelling at you for waking them up??  I believe that is the definition of a thankless job), and doing a TON of paperwork.  I was so exhausted by the time morning came that I felt nauseous and dizzy, I was dropping things left and right... so relieved to get in the car to drive the 40 minutes home...
And then I discovered what 7:30am traffic looks like along that commute, and arrived home 70 minutes later after literally having to slap myself in the face to stay awake and breaking down into exhausted tears.

Give me back my early morning shift, please?  Give me back waking up at 5:30am on Saturday mornings without an alarm, give me back hunting down charts for hours at a time as they get passed from physician to physician to case management to physical therapy to physician to the radiology department as your patient disappears off the floor for a study and you still haven't even SEEN the orders...  give me back prepping patients for testing, handling pushy family members, and, "Surprise! We're ready to take your patient to the OR right NOW". 

I suppose this is something I'll just have to get used to.

Garden update

It's April and I am garden-giddy.

Our heirloom tomatoes are thriving... we transplanted them from the seed starting tray to their own little pots and I can almost hear them stretching out their little toes and drinking in long gulps of the summer-like sunshine.

We've started our squash seeds, and thinned out the pepper plants.  We're growing two kinds of heirloom sweet peppers, and then some cayenne, chiptole, sahuaro... and a mystery mix of hot peppers.  I'm amazed at how much potential energy a squash seed has stored inside its little package.  These guys burst into what you see below overnight!

On impulse, I decided to grow brocolli.  I have a dangerous habit of going overboard when I see the farmer's markets and garden centers with plants out for sale...

The strawberries have begun to blossom... I have them scattered all over the yard in containers, window boxes, and a small patch beneath our Japanese Maple.

We enjoyed our first serving of swish chard last night, wilted in aluminum foil on the grill with garlic and asparagus. 

Good Neighbors have planted some leeks, and I'm anxiously awaiting the sprouting of a row of carrots I planted in front.  Peas and green beans will grow behind and form a screen in front of the hot tub!

Casa de Chicken is almost finished!  The babies are sleeping in it at night now with a heat lamp and enjoying helping us fertilize and aerate our tomato and pepper garden plot during the day. 

A bit more paint and trim and we'll move it into the run before laying the roofing material and installing the roosting bars.  A few features of this design are particularly convenient: the roof overhang that keeps us from getting soaked in rain or sunburnt while cleaning, the metal floor surfaces for easy cleaning and to prevent the floor from rotting out, and the "poop chute"... see below :)

This is the "poop chute".   A shelf below will hold a plastic bin into which we will scrape all of the soiled bedding.  This makes for easy cleaning and transport to the compost bin.  We cover the chute with a peice of wood when not in use so it's not a chicken trap door :)

Two large nesting boxes on either side, set a bit higher than the floor of the coop, should be plenty of room for eleven laying hens to share.

Time to go collect some more free leaf compost... we're going to try growing potatoes in bags this year to open up more room in the raised bed for juicy tomatoes! 

Easter...

...means eggs!
Our girls produce truly delicious and beauitful chicken eggs...

But we couldn't resist purchasing a few emu eggs from our local health food store.  We'd been admiring them for weeks but couldn't justify the cost... but Easter seemed a fitting occasion. 

We used a Dremel to drill a hole in either end of the egg.

We used a bamboo skewer to stab and stir and mix up the yolk to make it easier to blow the insides out.

 Then a deep breath and blowing as hard as one can into that little drill hole!  The goodies inside streamed out, looking like custard.  Our dearTreeman friend looked on with interest, and perhaps a little bit of disgust...

 There was more in there than we'd thought there would be. 

Once the goodies inside were all blown out, we did a few passes of pouring water in and blowing it back out to rinse out the inside of the shell and removed the soft inner sac.  We set the eggs in glasses to dry, and made an emu egg scromblet (scrambled omelet) for breakfast.  I was surprised to find the eggs themselves somewhat bland in flavor, but wetter and somehow creamier than chicken eggs.  I think that they'd make better quiche or souffle than they would omelettes, but it was still tasty and nutritious!

Lastly, it was time to introduce the Chickiechickiepeeperpants clan to the egg of their dreams.

Bambi tried it on for size, but decided that she'd rather aim for quality rather than quantity.

A last minute trial

Today was my last day of orientation on day shift.  Starting Monday night, I'll flip to four weeks of night shift (11pm-7:30am) orientation before they cut me loose on my own.  In the past eight weeks, I've had patients die (who were DNRs and were supposed to die), and critical lab values to deal with... there have been codes on the floor, but none for any of "my patients" where I was really involved.  I haven't really had any true "emergencies". 

This morning I received in report that one of my patients, a middle-aged woman who had come in with new onset atrial fibrillation, was on a new anti-arrhythmic drug that we'd just started using in our hospital.  I'd only just recently gotten the education material on the drug, and was familiar with the protocol (which involved measuring QTc intervals on 12-lead EKGs after each dose and clearing it with the cardiologist before the next dose).  I knew that the protocol was to give 2g Mag Sulfate in 50ml normal saline over 10 minutes if the patient should develop a ventricular arrhythmia.  Fine, no big deal.  She wouldn't get her dose until noon, and when I went in to see her she was feeling fine, no pain, dizziness, shortness of breath, or palpitations.  She was gonna be an easy one!

She's sitting on the bed chitchatting with me, and I hear my name being paged to the nurses' desk over the intercom.  I excuse myself and go to the desk, to find the cardiologist and half the nursing staff staring at the telemetry monitor... I learn that my patient is in ventricular tachycardia.  Huh.  How about that.  V-tach is an arrhythmia that causes the heart to contract in a disorganized way, and if unresolved, leads to decompensation and lack of blood flow to the brain, heart tissue, and everywhere else.  The beating of the heart will degenerate further until it is simply quivering.  In other words, it is fatal if not corrected. 

I run into the med room, get the bag of magnesium from the med cart, prime the tubing, do my first two checks, and book it into her room.  Calm as a spring day, I explain to her that she's not tolerating the drug we'd been giving her for her heart rate, and that I needed to give her some magnesium through her IV to get her heart to beat in the right way, and that just to be safe we're taking her to the intensive care unit. She tells me she has a funny feeling in her head. I tell her to lay back in the bed and relax.

I do the calculation in my head, check it, and get the drip running.  I repeat back a verbal order from the cardiologist for IV Lopressor.    We hook her up to the portable heart monitor/defibrillator, and I run to the med room to draw up the drug, when I return the doctor tells me to hold off on the Lopressor for now, and he and I join our patient and two other nurses in the very crowded elevator down to the ICCU.  I jokingly tell her that it's all to do with the lousy cup of decaf tea that one of the other nurses made her this morning, she smiles.  We all pretend to not be looking at the tracing on the portable monitor. 

We get her into the room, hook her up to their telemetry, I find the chart to write the verbal orders, call for a stat 12-lead EKG, and chart a note documenting all that had happened in the last fifteen minutes.  I give a thorough and accurate report to the nurse taking over her care, give my patient's hand a squeeze and tell her she's well taken care of, and return to my work.  I learn an hour or so later that she converted back to sinus bradycardia.  I breathe a sigh of relief. 

I kicked ass.  I knew what to do, I did it calmly, safely, and quickly.  I was "the nurse", and I did my job without causing my patient to panic.  I feel prettty darn good about that.

Chicken drama

We are in an awkward spot.

Raising chickens in an urban area is challenging.  Raising them from day-old chicks in a small apartment with an open layout is an even greater challenge.  Our babies have been living in a big plastic tub in the laundry room.  This has made washing the laundry particularly difficult.  They have tripled in size since the day we brought them home, and the tub is no longer big enough for all seven.  They've begun pecking at each other's hinder ends, and the "cute" is wearing off as the "stinky" increases.  It's still a bit early to scooch their little butts outside, even with a heat lamp running the coop... perhaps next week we'll try it... but that's only if we have a coop to move them into!

Our Good Neighbor, for whom we are raising four of these chicks, is building a brand new chicken coop to house all eleven birds.  The coop that we built last year for our four ladies will be insufficient for the lot of them.  However, the weather has NOT been cooperating with the plan.  It has been raining nonstop since the beginning of the weekend, and the frame for the new chickie home has been sitting out there unfinished and getting soaked.  We're hoping that the nice weather coming our way will enable us to finish it up and move the girls on out to their new digs. 

Until then, however, we have to find room for a second large plastic tub, somewhere in the apartment that will be safe from the cats (the laundry room, which doubles as our closet, is the only place in the house with a door that closes except for the bathroom... and the bathroom is too small).  I'm fearing that the chickies, if kept in their close quarters for even another few days, will swarm like a colony of bees that has gotten too large for the hive, and we'll find them living like feral cats in the refrigerator or something...  either that, or they'll peck each other's butts so bloody that it'll start to look like a scene from a horror movie in the laundry room.

In the meantime, our seedlings are growing, and leaning into the light on the windowsill... I know exactly how they feel...

As far as the nursing thing goes... it's fine.  I'm taking five patients each day now, and it's getting easier and easier as I adjust to the routine and the paperwork and the personalities.  I'll be switching over to night shift the week after next, and I'm sure it'll take me some time to adjust to that... but I'm feeling hopeful.

Okay, it's time to indulge my obsession with "Firefly" and watch another episode... I'm going to be so sad when we finish the series... why only one season?!  WHY?!

Pain: a subjective experience.

I consider myself to be a compassionate, empathetic person.  I loathe seeing other people in pain, and do what I can to make it better.  This is why I became a nurse.  And I truly believe that pain is a subjective experience, and that it's an important goal in healthcare to assess and treat pain based on the patient's description of it.

However, I'm also a firm believer in the principle of personal responsibility.  And when 30 year old Man-Baby, "a frequent flyer" in our hospital, comes in YET AGAIN with diabetic ketoacidosis and hypertension because he failed to comply with the medication regimen prescribed to him, I can't help but roll my eyes a bit when I see his name on my assignment in the morning.  And when Man-Baby's mother comes in and offers to spread mayo on his sandwich for him, I roll my eyes again and sigh. 

When Man-Baby flirts with me, tells me that I "smell good", laughs and jokes and chitchats on his cell phone........ and then fives minutes later grabs the nursing aide and tells her his pain is 6 out of 10... and when I go back into the room to investigate, demands his Dilaudid... I have a hard time believing it.  I have a nagging suspicion that he simply enjoys passing his time in the hospital in an opioid-induced stupor.  I have to give him the medication anyway, so long as it is prescribed.  He falls asleep soon after.  He is pleased to be sedated and numbed and relieved of responsibility for his own poorly managed health and life. 

Down the hall is a 70-year-old woman with ovarian cancer, mets to the lungs and liver, who has just today decided to pursue hospice care.  She is in pain from the cancer, and receiving morphine.  She lets me know when the pain is creeping up again, and we keep it under control as best we can without oversedating her.  She welcomes our suggestions for non-pharmacological pain management techniques.  She smiles through the pain, and talks to me about passing on her "famous" lasagne recipe to her granddaughter.  This woman is experiencing physical and emotional pain like Man-Baby cannot imagine, and is doing so with such grace and dignity and gratitude that it puts us both to shame. 

I really don't want anyone to have to be in such pain... but sometimes, on days like today, I wish that people like Man-Baby could have a little taste of it.  Just enough to give him some perspective.  It's not just about the physical pain... but to feel yourself at the end of your life.  No more time.  If he could feel what that is like... maybe it would scare him enough to start taking care of himself.  Or perhaps it would encourage him to quit doping up on pain meds, and to actually get his young and relatively healthy butt out of bed to go to the bathroom instead of using the urinal... to become an active participant in his care.


When I see a young life wasting away like that due to negligence and apathy... it really does hurt. 

The start of the growing season.

Happy Spring!

We celebrated the Vernal Equinox with a potluck dinner, party and fire spin jam at our place this past Saturday.  It was wonderful to throw the first real outdoor party of the season, complete with fire pit, homemade wine and a little offering of sweet grass and mead to our newly dug garden plot.  We couldn't have asked for nicer weather... 72 degrees and sunny all weekend long!

Our new raised bed is 13' x 5', and will be about 6-8" deep after the topsoil and compost settle following this first rain.

This little plot is about 2' x 8' and will be home to our greens, herbs and pear tomatoes.  In front we have a dwarf blueberry bush who somehow survived the winter after I forgot about it in the snow, a baby fig tree and a dwarf pomegranate tree (who doubled as our Christmas tree this past year!).

It's been good chicken-cuddling weather.  Popcorn's little feets are free of mud since it's been sunny and the snow is all melted away!

                                        

Our seeds are starting, and I'm nervously waiting to see if our tomato and sweet pepper seeds germinate.  I've honestly never grown such plants from seed (I've always cheated and bought young plants).  But this year we purchased some really neat-o varieties from http://www.seedsavers.org/, and I'm feeling hopeful!!

We planted a small strawberry patch as well, but it started to rain so I didn't get any photos yet.  There's probably about 30 strawberry plants in the bed, and then 6 in each of our two window boxes.  We're planning to grow hops up the front of the building in BIG EarthBoxes... and I'm curious to see how they'll fare in containers.

Now the rains come, and help my little transplanted babies drink deep and build strong roots.  So long as it isn't snow, I'm not going to complain!!  Bring on Spring rains and daffodils!!

New babies and learning to run.

It's that time of year again... time to increase the flock!  And since we don't (can't) have a rooster, we went out to the feed store and picked up 7 new baby chicks.  Three of them will be ours, and four of them will belong to our neighbors (who we have converted to chicken people as well).  We are awaiting the arrival of a Silver Laced Wyandotte pullet who is currently on order, and she will bring our total to a dozen chickens in our suburban backyard.

We have decided to name our girls Lady Jane Grey, Anne (Boleyn), Marie (Antoinette), and Mary (Queen of Scots).  Our sense of humor can be morbid, yes.

One of our Barred Plymouth Rock pullets.

Australorp, Rhode Island Reds, our blue Cochin (Lady Jane Grey), and the butt of another Australorp.

Lady Jane Grey, with her adorable feathery feets!

It feel so good to have the sound of babies peeping away under the brooder light in the laundry room.  Our cats are curious, but have been more interested in the fact that we've had the doors and windows open to the screens this weekend to enjoy the fresh air and 50 degree weather.  Spring is coming, and that excited full feeling is swelling up inside of me as the daylight grows longer and the mornings more mild.

When I was younger and very much into lacrosse, I used to run for a few miles every day.  It was a pleasure and a challenge that I looked forward to... until I picked up smoking (stupid teenager) and started my afterschool job (bye bye lacrosse!).  As I got older, I found running painful, especially in my ankles, knees and hips (I also got avulsion fractures in my right ankle three times within two years)... and though I longed for that feeling of hitting the trails and pushing full speed through the brush, I avoided it for fear of injury.  I still dream about running and the feeling of absolute power and freedom it inspired in me.

Since reading "Born to Run" by Christopher McDougall, I've been trying to alter my gait to allow for safe and effective barefoot (or nearly so) running.  Yesterday, I found running more enjoyable than ever before, especially on the rocky trails of the beautiful woodlands near our home.  I was grinning as I sped downhill, and huff-puffed uphill so very slowly, and tried to think "easy, light, fast" and run to a 180bpm rhythm.  It felt amazing... and I felt like a mad wolfwoman, soaked in mud and snow up to my knees, tearing off layers of clothing until I was down to a tank top and feeling the wind and the sun on my shoulders.  I ran when I wanted to, and slowed to a walk when I felt I had to, and before I knew it we'd been out there for 2.5 hours.  Extraordinary.

However, running in shoes with thin, flexible soles and very little traction can be hazardous on the snowy, north-facing side of the hills.  I lost my balance and pulled my back pretty darn good as I tried to keep from tumbling down one of them.  I kept running, and didn't really feel it until I tried to get up out of bed this morning.  Yikes.  Hoopdaddy took the reigns and went to teach our weekly hoopdance class at the gym, and thank goodness for that.  I've been stretching it out and I'm hoping to get back out on the trails this afternoon while the sunshine lasts... but it's amazing how one's body can simply say, "nope, not doing that right now" of its own accord. 

Being a nurse is such a delight.

Today, the lady who we put a temporary pacer on yesterday for multiple 5-second pauses in her heartbeat was healing from her permanent pacemaker placement that was done late yesterday afternoon.  She also somehow mistakenly thought the telemetry unit was a day spa and hung on the call bell (or, alternately, screamed "NURSE!!!" as loud as she could) ALL DAY LONG requesting tea, first iced, then "no, not iced I want hot tea!", backrubs, take the blankets off, put the blankets on, put the pillow under my feet, take the pillow away, I want a turkey sandwich instead of a barbeque sandwich... I want chicken soup and not tomato soup (our dietary staff comes in and personally takes your order for the day in the morning, there was no excuse)... oh and don't forget to rub my feet, they're achey but DON'T cover them with a blanket, but wait now they're cold, do cover them with a blanket then...

Today, I straight catheterized a 80-something-year-old man and discovered how slippery a thing can be when old, wrinkled, uncircumsized and covered in iodine...

Today, I had three different physicians write three different diet orders on the same patient within one hour, causing plenty of extra work for me entering and cancelling orders in the computer system, and confusion for the young lady coming in on the next shift ("NPO til tomorrow morning... wait, no, ice chips only then NPO after midnight... wait, no, clear liquids and then NPO after midnight")...

Today I ran a heparin drip for the first time, and I drew blood from and flushed a chest wall port for the first time.

Today, I got my ass OUT of there on time and with my documentation and hand-off communication complete, and each of my patients comfortable, safe, and well taken care of.  I actually kind of felt like a nurse. 

Tomorrow, four patients. 

The horror.

Sometimes, I really wish that the illegal drugs in this country would be contaminated with something that causes infertility in the people who use them.  Some people should not have the honor of becoming parents.  *shudders*.

The "new nurse".

This past week was my first as a "real nurse" on the telemetry/PCU unit. 

I am more exhausted than I think I have ever been. 

Throughout the week I've been continuously evaluating myself, identifying what I need to change, how I need to adapt the knowledge and skills I've gathered in my years of school to the real world.  A few highlights:

#1.  There is no way that I can give every patient of mine the kind of attention and service that I'd like to when I have 5, 6, 8 of them at a time.  It is simply impossible.  I need to learn to streamline and prioritize... the sickest patients get the most of me, the most stable patients get the least.  Unfortunately, this means that occasionally my patients and their families will simply have to wait for some of the things that they want from me.  This reality is very, very hard for me to swallow.  I am praying that our unit manager succeeds in convincing the higher-ups to mandate a 1:4 nurse : patient ratio.

#2.  "The nurse does the nurse things, the aide does the aide things".  This is what my preceptor has been trying to teach me all week.  The reality is that I cannot be assisting a patient to the bathroom when another patient needs insulin.  I'm struggling with this, as I don't want to be one of "those nurses" who passes off every single bedpan and bath to the aides and makes them feel taken advantage of.  I want ALL of my colleagues to feel like I respect and appreciate them.  So, I need to learn how to delegate in a way that shows gratitude and grace. 

#3.  While I must continue to be empathetic and caring, I cannot give 150% of my energy to every single patient, every single day.  I've found myself coming home feeling like I just spent the day in the hospital with an MI... I am so completely drained of all emotional and spiritual energy that I have NOTHING to give to the people I love at home.  I couldn't even handle my cats coming to me for attention one afternoon this past week.  I don't want to live like that.  I have to learn to insulate myself from being leached of all lifeblood during my 8.5 hours at work... I need to titrate the amount of energy I give to the people I care for to keep myself from burning out. 

Aside from all of that, I am learning an INCREDIBLE amount on a daily basis.  I'm building confidence and becoming more fluid and comfortable with the tasks presented to me.  I even had a patient I cared for come back after being discharged to bring a nice little snack and thank you note for my "compassionate care".  A little encouragement goes a long way!

Blizzard Breakfast

We got a good two feet of snow in our area Friday-Saturday... and apparently we forget to put our bikes undercover.  Oops! 

Luckily, neither Hoopdaddy nor I had to work, so we got to stay home and enjoy the beauty of it. 
Today we woke up to a blindingly bright, sunny day.  I made a simple breakfast for us that is quickly becoming a favorite: fried eggs and toast, ginger carrot salad, and grapes.  I thought I'd post this because it's a cute idea for a Valentine's Day breakfast or brunch.

Neighbordog Luke went romping in the snow.. .and this was after we'd just shoveled!

I guess we won't be eating breakfast in the yard today!!

Fried Eggs and Toast for your Lovebug

Start with a good hearty loaf of bread.  We used my Birdseed Bread recipe for ours.  Cut two nice thick slices.  Using a knife or a sharp metal cookie-cutter, cut out a heart from the center of each slice and place all of the pieces in a hot frying pan coated with olive oil.

Crack open an egg into each of the heart-shaped holes (this particular egg came from Cerberus!).  Sprinkle with black pepper and garlic salt.

    

Let set until the white is cooked through.  Depending on your preference, you can cook only on one side for a runny yolk, or flip over quickly to cook the rest of the way through.

Turn the heart-shaped toast pieces when they begin to brown.

 

Serve with fresh fruit, a green salad, or ginger carrot salad (recipe to follow):

 

Rosella's Ginger Carrot Salad

This recipe was given to me by a friend and neighbor who is an AMAZING chef.  Her simple and elegant dishes astound me every time, and this super easy raw salad is a staple in our house.

Shred 4-5 large, peeled carrots into a bowl.  Peel and mince or shred a piece of fresh ginger (a piece about the size of your thumb should do it).  Mix ginger and about 1/4 c. of golden raisins into shredded carrots and serve!  This can be refrigerated for up to 5 days in an airtight container.

Vegetarian Enchiladas

This is one of HoopDaddy's favorite meals... and it has very quickly become one of mine as well!  We have a great time collaborating in the kitchen... I prep the veggies while he rolls out the tortillas, some good music playing, a bottle of homemade wine chilling in the fridge. 

This recipe can very easily be adapted to be vegan (and heart healthy)... use vegetable fat instead of butter, eliminate the cheese and sour cream... they're still delicious even without all of that fat and salt!!!

Wheat Tortillas

1 c. all purpose flour
1 c. whole wheat flour
1 tsp. salt
3/4 tsp. baking powder
3 tbsp. butter
2/3 c. warm water

Mix the dry ingredients together in a bowl.  Rub in the butter, stir in the water and knead into a soft dough.  Cover with plastic film and let rest 15 minutes.  Divide into 12 equal parts and shape into balls.  Roll out on a floured surface (I use a silicone mat called a Silpat for this and it works great, no sticking!) into rounds 6-7" across.  Recover with a dampened towel to keep moist.  Heat a griddle/frying pan and cook each tortilla 1-2 minutes, turning it as soon as it starts to bubble.  They should stay flexible, but if they start to crisp up don't worry too much, they'll soften again as they bake with the moist enchilada fillings.  Recover with a towel to keep warm and moist. 


Veggie Enchiladas

3-4 peeled, medium sized carrots
1 large green bell pepper
1 medium sweet onion
salt
1 c basmati rice
2 c boiling water
salsa
extra sharp cheddar cheese
avocados
sour cream

Julienne the carrots (I love my mandoline for this), dice the pepper, and finely chop the onion (if using a stronger flavored onion, saute in oil until lightly browned).  Mix all together, sprinkle with a bit of salt (I use black volcanic salt, nomnom).

Cook the rice in the boiling water, fluff with a fork when done.  Fold into the vegetable mixture. 

Spoon the vegetable/rice mixture onto the tortilla, sprinkle with a handful of shredded extra sharp cheddar, and roll them up so that the seam is on the bottom.  Place them nestled up together in a rectangular baking dish.  Spoon some salsa over the top of the enchiladas, sprinkle with a bit more cheese, and bake at 375 degrees for about 20 minutes. 

Serve with sour cream, sliced avocado, and some extra salsa on the side.  Slice up some ripe pineapple for dessert.  Light the candles, pour the wine, and enjoy!