Breaking point

It happened.

Grad school pushed me to my breaking point.

I’m talking full on emotional breakdown, anxiety attacks, re-emergence of repetitive behaviors…

It got bad.

For some reason I hit a wall and could not move past it.

I went to work and functioned as if I was ok, however mentally I was losing it!

It all started with one class… Pathopharmacology. Now let’s remember, I’m in school for my masters in nursing education. I was not prepared to cross paths with this class. It hit me like a ton of bricks. The grading rubric was 5 pages long with part “A” consisting of like, 3 of those pages. I hated it. It’s not a class I have ever wanted to take. It did not interest me. I couldn’t retain the information. The paper I turned in was basically a pompous regurgitation of information that no one wants to read.

It sucked.

The sheer weight of the paper that was due gave me anxiety so I procrastinated. The procrastination made me anxious. The anxiety made me procrastinate more. The procrastination gave me anxiety.

It was the feedback loop from Hell.

I almost broke. Quitting actually started to look like a viable option. I was literally in tears thinking about the paper.

It was the beast I could not defeat… or so I thought.

I had to have friends and family really rally around me and offer support to help pull me back from the edge. They managed to get me to take a step back, breathe, and break the monster down into manageable pieces.

I have a great support system, something I don’t acknowledge enough.

After hours of research, coming up with an outline of what was needed, and taking the paper in small chunks, I completed it. I turned in 36 pages of absolutely glorious regurgitated information. It’s what they wanted, so it’s what they got.

I passed the paper and the class.

It was if a 10-ton Boulder was removed from my shoulders. I could finally breathe. I celebrated by drinking wine and playing Final Fantasy Online with my cousin. It was amazing.

I’m now in Health Assessments. It’s at least something I have some familiarity with. I know the advanced practitioner health assessment is far more involved but it’s something I can learn and retain. It’s useful information, I mean I’ll have to teach that to nursing students one day (hopefully). So, I’m nervous about the assessment I have to record. I’m nervous but not panicking. I’m learning to breathe and take things one step at a time. I finally have a plan to move forward. It’s doable.

Alpha-gal syndrome

I learn about new disorders all the time here in MRI. Normally I’ve at least heard the name of the disease or disorder before, or I know a teeny bit about it.

I have never heard of alpha-gal. At least, I’ve never heard the name.

Turns out, I have heard of the disorder before. I had a patient once tell me he was allergic to pork because of a tick bite.

Alpha-gal is a “sugar molecule found in most mammals (except in people, apes, and monkeys)” (CDC.gov, 2019). Turns out there is a tick (lone star tick) that can transmit the molecule in blood from the animal to humans. We humans don’t normally make the molecule but apparently we can make an immune response to it. If we develop an allergy then we can no longer eat meat from cow, pork, rabbit, deer, lamb, essentially the animals work hooves! The odd thing about it, and what makes it kind of hard to diagnose, is the fact that the reaction tends to take place 3-6 hours after the ingestion of meat. It’s hard for a lot of people to make the association between meat and their allergic reactions.

I found a good podcast about the disorder. Lots of information about how it works and the ongoing research around it.

One of the things I realized while looking further into the disease is how important it is to ask your patient about allergies. Alpha-gal is uncommon, however, patients with it can’t have certain medications. Heparin is typically derived from pork. Some insulin is derived from pigs and cows as well. There are quite a few medications that have porcine or bovine derivatives. A nurse would have to make sure to take this into account for their patient with this particular allergy.

Then again, when is the nurse not taking safety into account, right?

DiGeorge Syndrome

Have you ever heard of DiGeorge Syndrome?

I hadn’t until I had a pediatric patient with the diagnosis. So what is it?

According to the Mayo clinic, it’s a genetic disorder caused by the deletion of a section of chromosome 22. Patients tend to exhibit heart defects, cleft palate, weak immune systems, developmental delays, and behavioral problems.

I had the most adorable little 7 year old with DiGeorge. She didn’t have the cleft palates that is common with the disease but she did have cardiac issues. In fact, one of her ventricles was huge! She already had cardiac surgery before and it looked like she would need to have it again. Apparently she would be dealing with this for the rest of her life.

Working in radiology I come across at least one disease a day that I have never heard of. I like to look up the disease just for my own medical knowledge. Any diseases you’ve run across that you knew nothing about?

Team

You need a team.

If you’re a nurse, you need a good team. There is no way to survive on any unit without team work.

When you interview for a position, ask about the team work. How well do the nurses work together? How is bullying handled?

You’ll want to know these things. A unit that isn’t a team is a unit headed to hell in a hand basket. It can’t function effectively. Trust me, I’ve worked on units where it was every nurse for themselves. It was horrible. There were nurses that wouldn’t help with the new admission. It took an act of congress to get someone to help clean up a patient. Gossip spread like wild fire. Nurses ate their young for fun. It was two years of nursing that I never want to experience again. From that point on I decided I would not waste time on units like that.

That’s why finding about the team mentality is so important. You want to work somewhere with nurses that work together. You want to work in an environment that is not toxic. Regardless of how the shift is going, you want to know your coworkers have your back.

Nursing isn’t a solo job. We aren’t super heroes that can handle everything on our own. We have to depend on each other to get through the day. When the shift is nuts, you want someone you can vent to. When you aren’t able to save the patient, you want someone that understands the pain. You’ll want someone you can ask questions to that won’t make you feel like you’re stupid. You’ll want a team.

Do yourself a favor, find a good place to work.

Pacemakers?

My hospital is one of the few in our area that will perform an MRI on patients with pacemakers.

It makes me nervous.

I KNOW it’s supposed to be considered “safe” now. The newer pacers and defibrillators are being made to be compatible with MRI scanners.

It still makes me nervous.

I just don’t feel I should be throwing a person, with a magnet sensitive device, into a giant magnet. I feel like it’s a risk everytime I do it. Is an MRI of the wrist really necessary on this 79 year old man with a pacemaker/defibrillator combo? Like, is this life or death? Are you going to do surgery?

No?

Then why are we taking this risk?

I just don’t like it.

Do any of your facilities perform MRI’s on patients with pacemakers or defibrillators?

“Exceeds expectations”

So, it’s evaluation season. Doing my own eval is uncomfortable for me. It feels like I am tooting my own horn, so to speak. I don’t like talking about myself. I don’t want to sit down and tell you about the great things I’ve done over the past year.

So, I sit down for my eval with my manager… As we start going over each section she tells me the ratings she has given me.

They were all “exceeds expectations”!

What?

I have been a nurse nine years. Every eval I have gotten was rated “fully meets”. I was always content with that. However, for the first time I exceed. My manager started mentioning all the things I’ve done that’s she’s noticed. She gave me compliment after complement for the care I deliver. I honestly didn’t know she paid that much attention. She manages over 100 nurses, she’s always on the move. However, she makes it a point to stop by our department and check in on us. She is always available. To be honest, she’s the best manager I have worked for. To know that with all she is doing, she still noticed my hard work, it felt great.

My actions are not so that I can be noticed. I just do what’s right for the patient. Ultimately, that who we are here for. I never thought I was going “above and beyond”.

It was a great feeling.

I’m in the right place. I’m definitely in the right place…

July…

It’s July. For some of you that’s no big deal. However, if you work in a teaching hospital July means something deeper… Darker…

The “brand new” residents begin their rotations…

Chaos ensues.

If you have had the pleasure of avoiding the July rush, you’re lucky. For the rest of us, there’s a sense of impending doom.

So many orders. Most make no sense.

-pediatric doses ordered for adults.

-level one head CT for “AMS” on your 98 year old patient with known dementia.

-12.5 mcg of fentanyl q3hrs for your chronic pain patient.

-one unit of blood for an hgb of 5.

-MRI of the ankle to look for osteomyolitis of the toe.

Many, many more orders from an alternate reality…

In this moment, it is your time to shine! You are the only barrier between your patient and a doctor that is still getting their bearings. You’re going to have to speak up, a lot. You’re going to have to advocate. You may even have to knock a new doc off their self-appointed pedestal (when they tell you you’re “just a nurse” please refrain from punching them in the throat).

You can do this. Take a deep breath and remember: you’ve made it through many July’s and you’ll make it through many more…

Arch nemesis

Classes have started for me. In fact, I’ve already completed one class. I’m liking the program so far but my fight with my old arch nemesis has reignited:

APA formatting 😒😐

I despise APA. I don’t even understand its point. Margins of this size, very particular page headers, citations that are done *just* so, reference pages with indentions done differently than the actual paper, references sited differently depending on what they are…

Why can’t I just write this damn paper and send it in?!

I get that APA formatting is to help maintain consistancy with how research is published and readability. What I don’t understand is why make it so damn complicated? It almost feels like the creators made it complicated because it made them feel smart.

I hate it.

APA has always been a thorn in my side. I’ve never been very good at it. I find the rules convoluted.

As you can see, I’m already over it…

Set up… To fail

So, the higher ups have decided to implement new changes in our department to make us more “efficient”.

😒🙄

Are the changes going to work?

No.

I say no, not because I am against change. I embrace change and fully believe medicine is an ever changing field.

I say no because the changes are rigid.

Our department is very fluid. We may not have a single patient one minute, and the next minute 6 outpatients are here and there is an vented ICU patient on the way down and a patient waiting to go back to their room. Our patient flow changes throughout the day and unfortunately the decision makers don’t recognize that. They see numbers. They see productivity. Pie charts and bar graphs.

Patient care just doesn’t work like that.

However, we are going to implement the changes. We will go along with what management wants. We will grumble and groan as we see how poorly the changes work. We aren’t afraid to speak up. The speaking has been done. At this point, we are going along so we can watch the changes fail and create more problems. We are doing this so that they can see how inefficient their decisions are.

Sometimes the only way to get through to someone is to stop talking.

Drug dealers

Sometimes I feel like the health care industry are some of the biggest drug dealers around.

Case in point, the largest drug bust involving medical providers happened just this month. I first heard about it on the news while at work. Of course I had to look into it because I didn’t want to believe professionals in the very field I work in would stoop this low.

I was wrong.

This NPR article gave some numbers that were astonishing. There were almost 60 individuals caught in this bust. The Appalachia region of the US has been hard hit by the opioid epidemic. It was discovered that over 32 MILLION opioid pills had been prescribed in this region. If you don’t know, that’s more pills than there are people in most of the states in the Appalachian area! Doctors, NP’s, pharmacists, even a damn dentist was part of the drug problem. The Washington Post article tells a little bit more about how absolutely unbelievable these “professionals” were. Some traded opiates for sex. One doctor operated a pharmacy in his waiting room. The dentist apparently unnecessarily pulled teeth to justify writing prescriptions! However, the article goes even further with all kinds of things these people were doing in exchange for writing prescriptions. It’s shameful. So many people are dying of overdoses. So many are in our emergency rooms getting narcan to try and save their lives. So many people are on our units going through horrible withdrawal symptoms. Why would anyone in the medical field want to contribute to opioid epidemic?

It seems like the DEA (Drug Enforcement Administration) is starting to crack down on medical field when it comes to opioids. The New York branch of the DEA just charged a pharmaceutical distributor with unlawful distribution. This case is one of the first of its kind in the country. If this works out as planned, I feel like we may start to see more companies held responsible as well as individuals.

It needs to happen. There needs to be some sort of accountability for the medical field. Some of us are a part of the problem, they need to be removed. We are here to save lives, not destroy them!