Tests, Foodbank, and Condoms

It's mid-October. I got an 85 on my psychosocial test, which I am rather amused by. You'd think that would be my strongest class, huh? And I wouldn't do so hot in the more FNP-oriented classes, where we're learning to do things like pelvics on women and differentiate between lung diseases (things I'll never do in practice). Ah, but no, that's not how it works. I'm cool with it, though because an 85 is passing and that means I don't have to repeat it. Enough said.

I volunteered at the food bank Thursday and enjoyed it. AIDS Services of Austin operates a food bank out of their office on alternate Tuesdays and Thursdays. I filled orders and helped carry bags to cars. Yes, a glorified bag boy -- ha. But the fun part was meeting my fellow volunteers and talking with them. I met a truly cool chick who's been there (she says) 20 years. I think she's a transsexual (don't know her well enough yet to ask) but I must say, she is gorgeous and so full of personality. Made the time fly by. And the social worker that worked the counter, checking clients in and handling issues, had the coolest modified flock-of-seagulls hair style and various piercings. I definitely need to wear my bright-green Anthro capri's next time to keep up with this crowd! One of my fellow bag boys was this hot young Hispanic UT student who - get this - is getting his social work degree and then he wants to become a doctor. Don't think I've ever met someone with that particular combo but doesn't it make great sense? We had a lot to talk about. Ah Austin, that's what I love about you.

And today was Austin's AIDS Walk. We went as a family - well, not with Nile, of course. He's married to his PC and I respect that relationship. It was a bit hot today, but it's a pretty short walk - a 5K - and this was, shall we say, a stroll. Definitely not race-walking. Greg Louganis was the celebrity who led the walkers. Fox News was interviewing walkers while we were all getting ready and I said a few words about how condoms are so much easier and cheaper than the drug regimen for AIDS -- kind of doubt they'll run that, but you never know. I'll certainly never know since I'm not exactly a Fox News kind of girl, KWIM?

Friday I had drinks with Holly at Hula Hut. Such a completely perfect afternoon to do that, and such a completely perfect Austin thing to indulge in. Ken met us for dinner after we had thrown back a few. And as I said on the drive home through gorgeous Westlake Hills -- ah, I love it here.

Somehow I'm finding time to still do the fun stuff like that, but I have a lot of work to do and the next 6 weeks will be hard. I did get a mani/pedi Friday and they are doing this new process called SNS - they actually dipped my nails into this micro-fine powder for the color -- really. And it looks great. See?

And More About School

I started clinicals last week and it was a eye-opener. This is for my Advanced Health Assessment class. I'm paired with a Family Nurse Practitioner (FNP -- yes, it's a bit of giggle when you say it like this: "you dirty effin' P") and she sees patients in a practice with 4 MDs and a Physician's Assistant. I liked Pam right away -- she is a fit, rocking, over-40 woman, with a brain and lots of confidence. All I did was observe, but boy....as I told her at the end of the day, she has a fascinating job. To be honest, I had felt as a future FPMHNP (Psych NP) that FNPs see the boring, routine cases - the colds, the earaches, the routine physicals. That's how the day of her appointments looked on paper: 48 y.o. woman for thyroid check, 28 y.o. woman for back pain, 45 y.o. man for physical, 52 y.o. woman for cold/flu/earache, 40 y.o. GYN checkup with pap, 72 y.o. woman for physical. We were also supposed to see a 5 year old - she sees the whole lifespan - but they cancelled. But that's what the day looked like on paper at 8:00. I thought, ok, all of that is routine. Maybe the kid will be interesting since my experience with Peds has been limited.

Here's the deal about confidentiality. I'm not going to give details about where I'm working, Pam's real name (it's not Pam) or any patient identifiers other than age and gender. So it would be impossible for anyone reading this to know who I'm talking about.

And yes, we did a routine physical but it was a real challenge -- this patient was an older woman with a loooooong list of meds to treat chronic conditions -- heart failure, hypertension, anxiety, chronic pain, and diabetes. That visit actually took the longest. Just going over her list of medications, making sure she's still taking them, all her specialists are aware of the meds, none of them conflict....wow, that took some time. And besides that, it's important to actually perform a physical exam and assess how she's doing. Stakes are high if something gets missed. One thing I like about Pam is that she did a skin check on every single patient. Hiked up the gown, looked at all their moles, the whole deal.

And here's the truth about psych -- you see it everywhere. We saw 5 patients (one of the 6 scheduled refused to let me observe -- the only guy -- interesting, huh? maybe that reveals psych issues right there, ha!) Two of the five (in my opinion) displayed emotional issues that needed to be addressed. One of them was the young woman with back pain, who ended up crying on the exam table. It was an uncomfortable minute, I so badly wanted to have a mini-therapy moment with her. (And she wasn't crying about the back pain, it was being told "Oh, by the way, your labs from last visit reveal that you have an STI."), but I couldn't step out of my role as the observer. Honestly, it was excruciating. Pam did her best to address the issue in a methodical, task-oriented way, but it wasn't the way I would've done it. My way would've taken more time, so I guess that's why it didn't get done. What I settled for, finally, was handing the patient a tissue.

Next week I'll get to do more - they've already told me I'll get to seat the patient in the room, do vitals and a quick intake assessment to prep them for Pam. I'm ready to feel useful. And thank goodness for those 3 years of med-surg -- none of this intimidates me, and I know that's not true for some of my classmates who've been exclusively in pysch for years. The wound clinic work has helped too - I'm quite comfortable in a clinic setting and understand the workflow issues.

Another cool thing that happened was that I had a few of my cultural encounters for my pyscho-social class. Yes, the stuff I was complaining about, where I have to talk to multi-cultural people about their healthcare experiences. Holly had a party Friday and I was able to talk to an Indian woman and my sister-in-law, who is from Taiwan. And here's the cool thing -- I enjoyed it. It's quite something to meet someone for the first time, ask probing questions about their intimate lives for an hour and then go away with a new set of thoughts and feelings. I liked it. (Now as a psych nurse, why should that have surprised me? After all, I'm used to asking patients I've just met if they have any suicidal thoughts right now. And I like that too.) One of the reasons I love psych is that it's such a challenge - it's a mystery, a puzzle. You can't tell from a physical exam or labs what's really going on with them. Those are clues - a disheveled, rambling person who can't sit still is telling me all kinds of data non-verbally - but you have to figure out what's underneath the behavior and what they say. And yes, you must by definition doubt what the patient tells you. Because they may believe absolutely in what they say -- after all, we're all pretty skilled at deceiving even ourselves -- but it may not be the truth. So, thank you, Dr. Fredland, for giving me this assignment that I initially hated. My lab partner, Maggie and I are going to pool our resources and do some of our encounters together. We have two lined up for the next few days already.

So more on all that next week. I took two tests yesterday - things are moving along in the semester. So far, I've been really happy with all my grades. It's funny though - I had a very specific goal in nursing school to graduate with a 4.0, and I did. That is not my goal this time.