Downhill

Mid-semester has passed, I can feel the momentum of racing downhill. And yes, did a little of that Sunday at the Capitol 10K, the 35th annual event & the fourth largest 10k in the US. It was fun, kind of hot, but no complaints. Ken and I cheated a little and actually veered to Lady Bird Lake trails near the end. It was just so shady and nobody on them. We weren't timed anyway. After that, we had a big family lunch (excellent Thai food) at Holly's house, my aunt Pam was in town.

I've got two big projects left, well I guess it's actually three. Two are papers and the other is being videotaped while I do a psychiatric assessment of a "patient" (really a classmate). Tricia and I are doing this together, we take turns playing the role of the patient. We read a secret script of a patient with a particular disorder and we get to impersonate them. It's not strictly scripted, we choose how to respond, and we have to demonstrate an understanding of the disorder and its manifestations. But ick...who likes being videotaped? I have managed to settle my nerves by thinking through how much of this I've done in real life as a floor nurse on a psych unit. It's a standard routine for new admissions, and that actually was one of my favorite tasks.

The other projects are a health assessment of a family, which was quite complicated, it involved interviewing someone, drawing diagrams of her family health history and analyzing the psychosocial functioning of their family unit. Plus identifying a health problem that they are willing to address and developing a plan. Anyway, it's 20 pages long (really), with 3 attachments. The last thing is a paper and presentation (with a partner) on the new cervical cancer screening guidelines and how best to explain them to patients. The new guidelines actually decrease most women's screening to less than annually, and I've seen some patient reactions in clinical - most aren't very happy about the idea. So the assignment could have some validity - it's a difficult thing to explain the science behind it, and takes some finesse.

And there's the day-to-day fun. A pharmacology test every Thursday, other tests sprinkled in, yes like jimmies on an ice-cream cone. I actually ....gasp.... got a 100 on a pharm test. I really had decided that he just didn't give that as a grade. But I'm still taking it pass/fail. And there's the big group presentation in my research class. The topic my group chose is pain management in post-cesarean section women and an association with post-partum depression. Let me just scream now --- I hate group projects. I don't mind things with a single partner, but our freaking group has seven people. Yes, that's not a typo.

Clinicals are still the most fun on the block. I just wish they didn't take 14 hours a week to do. I have Peds now on Fridays, and I'm paired with a Pediatrician (a physician, not an NP). I have to say, she's great. She's young, just graduated last year, couldn't be more helpful. At the end of our first day, I hugged her and said I wanted to give her a best preceptor award. (yes, I hugged a doc -- ha) We see patients at a community clinic, most have no insurance and are covered under Medicaid. I got to see coxsackie virus on the first day. And it was an amusing day at the University Health Center after Spring Break - literally two days after the kids returned - they were all sick as dogs. I mean, no sleep, too much sun, too much beer... I think I saw Sherry hand out antibiotics to every single one and she never does that. It was highly instructional -- like, this is what happens when you're stressed, you compromise your immune system, you have a tickle in your throat but you go out all night anyway...yep, this is what you get. A monster sinus infection, strep throat, a terrible exacerbation of asthma, etc.

I've got my summer lined out. I'm taking a required nursing class first, Health Policy. Then I get to take my elective, and I am still researching that. So many choices, it's just way cool. Things like the psychology of health in AIDS patients, human sexuality, deviant behavior, the advertising of health promotion, etc. But before all that starts, I'm going to Boston for two days for a review course for my board exam. I know, it's a year early, but it gives me a heads-up on what's important this last year. And what's really valuable is the manual - I can then study that whenever I want to start, I'm not dependent on scheduling of a live class.

So I'm going to leave with a cool quote I got from a fellow nurse at a lecture.

Philosophy of Sharing Ideas (K. Kirksey)
A large group = culture
A small group = cult
2 people = love
1 person = psychosis

ha!

Catching Your Breath

It's almost Spring Break and I can't wait to have some unstructured time. It turns out that I'm going to write 5 papers. Really, yes, five of them. Two are fairly straight-forward patient write-ups like I will do with an acute-care visit as a real NP (it's basically all the documentation that's done in the chart), but in much greater detail. Like, 5 pages of detail just for a sore throat. But it's all good, one of my papers gets to be on Carl Jung's Red Book, and I actually ordered a beautiful replica of that off Amazon as a visual aid. I've been interested in Jung for years, when I first heard some lectures about him at the Unitarian Church in Baton Rouge. A truly great church that does incredible good work (the atheist says).

I'm starting to inhabit my role as an NP student. I realized today at clinical as I was introducing myself and examining patients that I really feel completely comfortable doing that now. Last semester, I felt a bit like an impostor in that white lab coat. I've had some excellent role models and teachers, and that is really what's made the differences. I do like most of my classes, but the clinical -- it's just plain fun. I so look forward to it. I'm going to end up doing extra hours because I have Pediatrics yet to start, but hey -- it's only going to help. I was reminded today that I have a privileged role in the full arena of human experience -- which is to say, sometimes awful things happen. I mentioned a child with leukemia in my blog months back, well I found out today that the child died. I was shocked because childhood leukemia has become an eminently treatable condition - I know the cure rate is over 90%. But not everyone survives.

Even though my clinical experiences are not in a psychiatric setting, I still see patients with mental health issues. I learned something valuable Tuesday when a young man came in because he's training for a marathon but having strange shortness of breath spells. His assumption was that it's related to overtraining. He described his HPI (history of present illness) to Sherry, and she immediately asked him about recent changes in his life and his stress level. And sure enough, he'd had a terrible loss recently and these breathless spells were anxiety. Now it took her a while, probably 15 minutes of quiet conversation to elicit that conclusion, but she pretty much recognized it right away. Afterwards, when we de-briefed, she explained to me that his breathless spells were happening when he was still and quiet, and able to think about his loss. He was having no symptoms at all while exercising. She said that in her experience, many people having severe anxiety of this nature for the first time in their lives will present in just this way -- feeling like they can't catch their breath when they're still and their mind starts turning over the problem. A big learning for me.

Some random things that I find interesting/amusing: there is an entire section in my psychiatry book on what they call the "drug-assisted interview process". Yes, they are talking about truth serum. Just like from the 1970's spy movies that I watched as a little kid. I have to say I was pretty dumbfounded reading this - I mean, I know that trying to ascertain exactly what's true in what a patient tells you is difficult - but really? We need to do that? Somehow, I'm pretty sure that won't be part of my practice. The UT campus went smoke-free on March 1st. I know -- it's 2012, I wonder how many places are left in America that aren't smoke-free. There must have been a powerful regent that smoked is all I can assume. Even psychiatric hospitals have been smoke-free for years, and believe me: those patients all smoke and one could argue, need to smoke when they're hospitalized. Can you imagine dealing with all your demons, maybe detoxifying from alcohol and drugs, and you have to quit smoking at the same time? I keep having these nifty little memory-lane experiences around campus. I met with a classmate to study Pharmacology (and by the way, I have an 89 in that stupid fricking class now. I will not let myself make an A in that thing) at a little coffee shop on Lamar. I drove by the little dog-leg intersection where Lamar meets San Gabriel -- and I immediately remembered when I burned my leg on the back of Bret's motorcycle on the way to class right there, back in 1983. He had to yield there quickly, and my leg pressed against the tailpipe. Ow. This happens a lot -- I mean, those were memorable years and it's just weird to be back now.

So one last thing: if you wear those cool canvas Toms shoes that all the young hipsters have now, wear socks. They really make feet stink. Summer's going to be fun.