Nursing School Update: In the Hospital

 It's time for another nursing school update, I think.  The week off between classes was regrettably not much of a week off.  There were several little things that needed doing that week:  we met in person for the first time to practice and test out on skills that required manikins and certain guidance; a number of training pieces for our clinical settings needed addressing prior to clinicals starting; we had to get tested for our N95 masks for our maternal infant clinical; a dozen and a half mini-paperwork moments; and, oh yeah, our basement is in a particular state of shambles as we continue in our renovation process.  

Just like with the basement, though, everything is starting to take shape.  

I had a 22 gauge needle in my hand.  I've had so many IVs in my life, and the needle that I had in my hand was for going into someone else's.  Well, specifically a rubber arm, but, still, there was that moment, that rush of excitement when I saw a flash of "blood" return on my first stick.  The rest were more of a struggle, but that first one, that was edifying.  It will only get better.  It's a matter of time and practice.  It's starting to feel more real.  

We also have had the opportunity to meet some of our peers in person, after months of shared virtual space.  And it's fascinating to see how tall folks are in real life, if nothing else, yet the conversation is different, too, without folks worried about computer lag or whether someone else will speak up by the time they unmute themselves.  Now folks moved with a particular freedom among one another, while somehow still holding on to the awkwardness of moving through an unfamiliar space.  In short, it was an interesting balance between tentative and confident, that we knew one another in a sense but still didn't know how to know each other in this space.  We all had to find new ways to sort out the politics of a strange world--this was a small microcosm of that which fascinated me.  

And now, I can also include some generalities of my first clinical day, which happened last Sunday.  What do I mean by "clinical"?  Great question; glad that I pretended you asked.  It's a place and time where we are in some kind of care setting as students, to work with real patients and situations while supervised.  Most of mine happen to be at Bromenn in town, and I am working through a particular program that has twelve hour shifts, following a nurse for their whole shift.  

I certainly cannot get into the specifics of the persons or cases I saw, but I was astounded that in my first actual day doing anything on the floor, I found some very specific parts of my health history reflected in three individuals that I worked with.  There was an immediate sense of "I know this and I know you in this moment" that I felt for each of them.  In short, I'm going to be processing parts of that for a while, both the edification that my own suffering can benefit my empathy and response to the current suffering of another and sorting out what the bombardment of trauma triggers meant in those moments.  

Other than that, I fought with blood pressure cuff cords, changed linens with the patient in the bed, realized just how long a minute can be when you picked an awkward position to take pulse and respiration counts, hid computers so that I would have one when I needed one, stared at the wall of supplies trying to find that one thing, talked to a patient that was genuinely confused on where they were, pilfered thermometer covers from another room when mine had run out, loaded my pockets with saline flushes and alcohol swabs all used by the end of the day, figured out when to peel off and grab a swig of water, clicked through four screens trying to find where to document a urine output in the right place, rushed to help encourage a patient to sit back down after their bed alarm went off, and all around started to feel like maybe this could very much make sense.  And I'm sure that it was a slow day.

Staring at the patient med list, I'm acutely aware of how much I have to learn.  I still haven't started an IV on a real person, for example, nor have I experienced a number of things outside of a textbook.  Yet, I'm also ready to ask questions, be helpful in turn, and to try.  The time management pieces, I can do that with confidence; the experience pieces will come in time.  I feel a sense of belonging and rightness in these places but without a magical, glowing light or rose-tint around the edges--it's both real and right.  

We're in to week two of classes and many more adventures ahead!

Melvin & Me, Part 32: Public Ostomy Toilets

So, I've mentioned recently that we're working on an ostomy toilet in our house.  Truth was, I didn't even know this was an option or an idea until a few months ago.  

See this picture?  I knew what it meant immediately.  This is placed outside of some public restrooms in Japan.

I have found a couple of articles (here and here) that broke down what needs an ostomate has in the bathroom, what went into the decision to make ostomy-friendly spaces, that they have been available since 1998. The general idea was noting that when a public safety emergency forced Japanese citizens into a shelter, it was realized that the needs of these individuals was not well met within the shelters as they were built--in a box of "medical supplies," one is generally unlikely to find ostomy appliances.  And thus, there was a response to that need, leading the the design and implementation of these in certain places.

I have so many feelings about this.

Firstly, anger.  I have been a part of this world since 2012 personally, 2000 peripherally.  People have had ostomies for FAR longer.  Why the HELL are these not showing up over here?  Do I just need to go to bigger cities to have visibility?  I can't recall ever seeing something like this at stopovers in O'Hare or even the Mayo Clinic.  I feel so unseen--if I come out of the handicapped stall because I needed space to better tend my ostomy, I don't look disabled enough for some people, in my mind's eye.  I plugged in ostomy toilets into Amazon and got mostly results for smell-masking products--when I'm looking for accessibility and to be seen, the pieces recommended to me were about covering up.  I mean, heaven forbid that I go to a bathroom and take care of my bodily needs, right?  

And then comes a fair bit of grief.  How many people feel unseen and unwanted when there isn't a space made that can include them.  What nonverbals are we sending when we don't make a place wheelchair accessible, for example?  How many persons we don't realize we are excluding is sickeningly high.  It takes intention to learn how to see people; it takes practice.  And I am intent on growing that for the sake of others I will come across.  I'm sad for myself and the pressure I have felt in those spaces; I'm sadder for others that don't know how to break past that.  

Then there was a lot of spiteful resolve.  Spite is a mighty, mighty motivator.  I will have a bathroom space that does not make me feel like an outsider.  I will not feel like an inconvenience in my own home.  And many other affirmations as we started planning out some significant changes to the bathroom.  

And here we have a lot of rather loud sounds and rumbling from our basement at the moment--the whole floor is shaking as I write, actually.  It feels...fitting.  

I'm not done with this idea.  

...Also, when we're allowed to travel again, I may genuinely plan travel with specific intent to see these spaces in person.  Thirty-some-odd hours of flight, just to see some bathrooms.  

Bathroom Adventures

With finals behind me, I have been better able to jump in with house tasks with Andy, which has included painting the rest of the deck, installing a new mailbox (involving learning about concrete), planting some new trees, and other bits and pieces around the house that have left us quite exhausted this last weekend.  

AND we started work on the bathroom.  More specifically, we have a contractor working on parts of our basement, that whole corner now walled off with plastic and painter's tape.  It has a very satisfying billow when you walk by it quickly.  Getting the the laundry room is a challenge but still possible.  We've made a few interesting discoveries--two cups embedded in the wall that have definitely been there before we broke through, some really dumb wasted spaces, the original linoleum was green, and they did not use greenboard.

I spy with my little eye...

For those unsure about that last one, let's expand a bit.  Drywall.  It's the kind of wall that most houses are made of.  The "regular" kind is white and as the name might suggest is meant to stay dry.  There is a different kind called greenboard, which is moisture resistant.  The BATHROOM in our BASEMENT next to the UTILITY room was NOT made with the water resistant kind and there was no ventilation built into this room.  The possibility of mold, wall-breakdown, Lord knows what else was waiting in the walls.  We're immensely glad that we have started this project sooner rather than later, for the health risks if nothing else.  We're definitely curious what other shortcuts some of the previous owners might have taken, but in the same breath I cannot spare the energy to think about it.  

Instead, I'm thinking about what our bathroom will be.  For example, we'll have more than half an outlet--there was only one, and the light fixture plugged into one of the spots.  Two of the switches on the other side of the bathroom would not work independently of one another, always giving priority to whichever was flipped last, meaning lots of heavy sighs to walk back across the room and flip one back to flip the other--we're going to fix a lot of this ridiculousness when the walls are down.  I'm still aghast at the decision to waste a 3x3x2 solid shelf-worth of space within the walls, twice--when they had created so much built-in shelving already, that they did this twice instead of finding a better solution astounds me.  

Of course, though, I am thinking about my ostomy sink.  This has been no small amount of puzzlement in the back of my mind.  I'm so accustomed to adapt to a situation in the bathroom, that I have to stop and change the discussion:  "what would work best for what I need?"  What I mean to say is I have so many strategies on how to adapt but only a few concreted ideas on what it would look like to be built for me.  

What I know:

• It should be at waist height.  No more bending over or squatting to negotiate a favorable positioning.
• It should not require a second step, meaning that I want toilet paper to go in the same place (instead of twisting around to throw it in the trash or toilet) or that I don't have to wipe everything down each time--a flush and it's done, heading straight into the septic system.  
• There should be significant counter space.  Putting my bag supplies out when doing a bag change should be easy to spread out and work with.  

So we have a flushable sink of some kind and a counter being built for it that will have it at the right height and have a good bit of space.  Check, check, check.  

...now what?  Namely, what I'm struggling with most is where I want to put the toilet paper and how I want it to roll.  I know what does and doesn't annoy me about standard setups, yet the question of right vs left, top vs side, I cannot figure out what makes sense, trying to pantomime with muscle memory I don't have yet.  

And that's part of the magic of this process, though, that I have the opportunity to figure this out over time.  I mean, I'd like to have as much of it sorted while we're in immediate contact with knowledgeable persons, where we can easily add pieces as we go, but we do have the flexibility to make some changes as we go.  I can figure this out in stages, just like how I've adapted to the ostomy everywhere else.  

That conclusion sapped away a great deal of anxiety. There is time to fix.  There is time to improve.  We've started the first steps in making space for these things.  

Additional updates forthcoming.

Melvin & Me, Part 31: Bathroom Gymnastics

Bathrooms aren't exactly made with my needs in mind.  I've mentioned elements of this before in other posts (here, for example), but there is a particular place that I have talked around I want to expand today.

So, my stoma, our dear Melvin, is about an inch up and three inches over to the right from my belly button.  That placement is going to be an important landmark to bear in mind for some of the visualization that I want to impart.  Feel free to take a moment to find it on yourself, if you don't mind.  Now, mentally attach a plastic baggy of chocolate pudding to that spot, a bag that is shaped roughly nine inches long and five inches wide.  To match me, you could wear the long side of the bag horizontally; or to match many others, you could have the long side lay vertically.  

With me so far?  

Now, of course, that hypothetical baggy is not actually full of chocolate pudding.  How do you open the end and let its contents spill out into the toilet while wearing as little of the pudding as possible?  What way do you want to maneuver your body to avoid splashing or spillage on your toilet seat or clothes?  Keep in mind, too, that the top of my bag happens to end either just below the top of my thighs or several inches above my thighs, depending on which way I'm negotiating the long side.  

----------------

--Option A--  Stand up and empty the bag into the bowl

Pro:  no extra bending; fight the man and demand that the world apply to you

Con:  LOTS of splashing and post-cleanup after a multi-foot drop, meaning a great deal of soiled clothing and bathroom cleaning; discourteous to other persons

Conclusion:  No one is actually going to do this, unless they threw out their back or there's some kind of emergency.

--Option B-- Sit on the toilet "normally," spread your legs as far as possible, and empty the bag into the bowl between your legs 

Pro:  does not look weird to the person in the next bathroom stall; feels more "normal;" a lesser drop for the bag contents to fall; bag easier to control sitting down

Con:  splash possibility likely; incredibly tricky in a skirt; incredibly difficult if you have thick thighs or have limited range to stretch your legs out; incredibly difficult if you have a significant gut, even if you're all the way back on the toilet seat; likely to leave streaks at the comparatively dry front of the toilet bowl

Conclusion:  If you have a small toilet bowl or have any kind of gut-weight, this gets tricky quickly.  Also, with as high as my bag sits, we're still talking about a bit of a plummet.  And trying to do this with a skirt takes significant negotiation.  Emotionally, this feels more reminiscent of the old "normal."  

--Option C-- Sit on the toilet "normally," spread your legs as far as possible, double in half, and empty the bag into the bowl between your legs

Pro:  same pros as above; even less splashage; very controlled release

Con:  if you have a significant gut, you're now flying completely blind; in fact, you're occluding your space and most likely flying blind; requires some flexibility; you're putting your face closer to the splash/smell zone; still very tricky if you're wearing a skirt; likely to leave streaks at the comparatively dry front of the toilet bowl

Conclusion:  The doubling in half is because my stoma sits high AND I wear my bag to the side.  It's hard to get your hands in there and not have a great view because of all the limbs, which means trying to move your legs wider which may or may not be easy with whatever clothes I'm wearing.  This is the most controlled so far, but it also takes the most flexibility in positioning.  

--Option D-- Sit on the toilet backwards, spread legs as far as possible, bend as necessary, and empty the bag into the bowl between your legs

Pro:  the back of the toilet becomes a shelf; there is more water at the back of the toilet bowl, meaning less residual poop in the bowl; controlled release into the bowl

Con:  if you scoot back too far, you could fall off the front of the toilet; depending on ostomy placement, you might have to bend so far forward that your head is resting against the toilet tank; the person in the stall next to you is very confused; still difficult to negotiate a skirt; requires some flexibility

Conclusion:  My stoma sits a little too high to make this practical, where when I bend over to get the lip of the bag close to the water, I'm on the very edge of the front of the toilet OR half-resting my head on the top of the toilet tank bent over.  That extra shelf can come in handy, though.

--Option E--  Knell or squat in front of the toilet bowl, lean your body over the toilet bowl

Pro:  glorious visibility; a lot of control on the release into the bowl; negotiating a skirt is about as difficult as any other clothing; works regardless of toilet bowl shape

Con:  BALANCE; your poor knees; emptying into the front of the toilet bowl has a higher chance for residual poop; greater chance of trailing clothes; face close up to the bowl and you become very aware of how clean the toilet is or isn't; the person in the stall next to you is concerned that you're unwell

Conclusion:  This is the one that I tend to use, because regardless of what I'm wearing or the shape of the toilet, it will work.  It also gives me the most control and visibility.  My knees, though, are not going to be okay with this forever, meaning that this is not something I would recommend to anyone with knee problems.  

-------------

There are a few things that work for all parties, such as laying down a couple of squares of toilet paper to help keep the ploppage to a minimum, breaking the surface tension and also helping move out stool from the front of the bowl more cleanly.  In summation, though, it takes a fair bit of art and adaptation to negotiate a surface that is not built with me in mind.  And, of course, depending on how loose the chocolate pudding is that day and what you're wearing and what shape the toilet is and what room you have to move in, the variables will recommend different approaches.  

SO.  If the world won't shape to me, we intend to at least shape our small corner of the world.

We have found a contractor, and we'll be redoing our downstairs bathroom.  We're looking forward to this for a number of reasons, including having actual ventilation in that bathroom, building a master closet as part of the project (on the other side of the wall), and having a shower that Andy can stand up in.  Yet my shining detail is that we're also adding a flushing sink, something that I can use to empty my ostomy at standing height.  

Details and updates forthcoming! 

Doctor's Orders

I ended up using Teladoc for the first time this summer, and it was a pretty cool experience.  I have been doing mental health calls over the phone without incident since March, but reaching out for something that was strictly physical, that was slightly different.  There are a lot of ways that telehealth can help us connect safely in this time, but also connect to places that maybe don't have all of the same resources:  people might have access to a phone or an internet connection even if there isn't a major hospital nearby, and persons that can't get to the doctor's office because they cannot travel there for one reason or another can still facilitate that conversation.  In short, in removes barriers, even folks who have anxiety talking to a healthcare professional have some additional security. 

So, the nurse I spoke with agreed with my assessment of things and set a prescription rolling to my pharmacy of choice.  And then she ended the conversation with the direction to make sure that I follow up with my primary care physician in X amount of time.  I thought momentarily about my school schedule over the next chunk of time, and had the distinct internal assertion "Yeah, I'm not doing that." 

I've been thinking a fair bit about how I might handle this attitude with my future patients.  I know a lot about my case, and I have taken many, many efforts to understand my case.  I am also in tune with my body in some specific ways, and I express my patient's rights, including the responsibility of being active within my own care.  These are all things I've intentionally practiced and unfortunately have a lot of practice practicing.  And yet, there are still places where I make choices, and I accept responsibility for them.  Therein lies that mindset that I'll need:  everyone is free to make their own choices, but the poor choices they make toward their health will not be from ignorance or misinformation.  I will challenge choices are made on bad science, ignorance, or a lack of information.  Simultaneously, I will let it go when someone expresses that they have taken culpability for their own choice.  

Now, how does this apply to wearing masks?  Wear a fucking mask.  When people advocate for not wearing masks, they're not advocating to have the freedom of choice:  they are advocating for the freedom to put other people at risk.  If you like to drink alcohol for example, I accept your choice to drink or not drink, but I absolutely have things to say about endangering other people by driving drunk.  In other words, saying that you won't wear a mask because you are uncomfortable is the same energy as saying that you plan to drive home roaring drunk rather than call a cab.  Full stop.  

I'll say it again:  the masks are to protect other people, where when we all accept roles in society we mutually protect each other.  Stubbornly saying that you have the right to put other people at risk--to take away their choice--is not okay.  What choices you make for yourself, I won't interfere; but when your choices are actively hurting other people, that's where the censure belongs.  We also agree as a society to obey stoplight signals, for the safety of other drivers--saying that you don't want to wait and blowing through a red light has consequences, not because it is a biblical commandment, but because it was a societally constructed rule created to keep persons safe.  So are mask rules.  This is why the internet is shaming these persons and why we as a compassionate society need to enforce the rules.  

Two additional points: 

• If the mask is truly stopping you from breathing--ignoring a great deal of people erroneously making that claim--then you ABSOLUTELY should not be out, meaning that you are at the greatest risk.  
• For folks invoking the ADA (Americans with Disabilities Act) I want to be very clear that the ADA does not give you carte blanche to do whatever you want.  Instead, it grants you the right to reasonable accommodation.  What does that mean?  It means that you should still have access to the same things, even if this looks slightly different such as curbside pickup for groceries (instead of going into a store), access to the community meeting, a bathroom stall that you can operate in, etc.  In other words, the ADA is a mandate to ensure that persons that need accommodations have those accommodations; it is not to be used as a weapon to demand certain rules don't apply to someone that is mildly inconvenienced.  

Advice

There are a lot of uncertainties right now in the world.  And folks in our nursing program are feeling a very particular brand of this pressure right now.  We could not be in person for this first stretch of class, most notably the labs and clinicals.  It is difficult to, say, practice IV insertion without a manikin arm or needles because they were not something dispersed in our supplies kit, for safety, certainly.  It's not what anyone was hoping for, but it's what we have to do for the time being.  Fall hasn't been fully sorted out yet, for that matter.

We have staff steadily working to design ways to provide both practice and make-up times, pantomiming what parts we can in the meanwhile.  In short, we're focusing very much on that essential nursing skill of flexibility with a touch of improvisation.  I have some folks within my circle that can provide me with some assurances, too, that some hospitals have a specific hiring process for new nurse graduates that involves additional training time that is likely to be altered to reflect these kinds of needs.  It seems that most hospitals have some kind of onboarding process that includes how certain skills are to be done to the facility's policy specifics.  

That said, that's the logical side of things.  Fear isn't always logical.  And with so many things uncertain in this time, well, I've also had some shower conversations with myself.  

I've spun the internal argument to my shampoo bottles a few different ways, ensuring my hypothetical employer that I am worth taking the risk, that I there is less that they will have to unteach me and that otherwise I am a fast learner that is comfortable asking questions.  

And I also think of a piece of advice that I was given a while back now.  There was a man in this group that said there were times he felt inadequate.  Everyone at the table immediately began to insist that he was capable and other kinds of sincere rebuttal, all of which he waved off and continued:  "I may not be the best man for the job, but I'm going to work hard enough that it isn't going to make a difference."  

I have been thinking about this a lot in my current context.  My circumstances in nursing school are no one's fault, and I will still bear the weight of the effects, but I will practice and I will work hard enough that it's not going to make a difference.  

The feelings of frustration are real; so is my determination as well as my resignation that the situation isn't what anyone expected.  All exist in the same space.  

...aaaaaand even with that momentary boost of confidence and certainty, it's time to panic about the three tests I have next week.

Peterson Family Update, #782

Whelp, SOMEHOW, life has this weird way of continuing onward.  I had about a half-dozen different ideas of what I was going to write this week and with all of my course readings, each of them has decidedly fallen out of my brain.

**Time to Deploy the Bulleted List of Random Thoughts!**

• I am still doing all of my class readings.  It's interesting to me to see some folks in the group assert that they don't, as though it were a point of pride.  Simultaneously, I don't think that I'm morally superior for having done the reading (particularly around Sunday evening when there was a lot more skimming happening than when I started).  I do it because I know how I study and have specific goals for what I want out of the program.  Again, no moral judgement, but it strikes me as interesting how doing no readings and doing all readings can be very odd bragging points.  
• Black lives still matter, folks, even when it's not trending on Twitter anymore.  
• Even though we would like to ignore COVID-19, it is, in point of fact, indifferent to our boredom and spreading remarkably fast.  Pretending something doesn't exist does not magically make it not exist.  
• I have had the good fortune of good groups in all of my group projects thus far.  I know that I have jinxed myself terribly for all subsequent terms, but I also needed to express that gratitude.  
• We are in week eight of the term, over the halfway point.  ...and cue the mad laughter.  I feel as though time has flown in the same breath that I feel as though I have slogged through some components impossibly slow.  And then some other moments where I've run fast as I can just to stay in the same place.  
• There was a lot of pressure at the beginning of the program, where professors and other leaders would remark repeatedly on how close-knit these groups tend to be, leaving me in a particular state of "GAH!  Must force friendship now!" in the back of my mind, while the rational part kicked in with a "dude, chill out, and let it develop."  Well, I have definitely found some folks in the program by this point.  I haven't worked with all members of our 38 person cohort yet since we're not all in every class together, but there are some people I've had the chance to actually get to know.  
• I have had some Ah-ha! moments in the material we're learning, places where things connect in a satisfying and applicable way.  In many other places, I simply don't know what I don't know.  It ebbs and flows.  
• Andy is still working from home, on the other side of my wall.  We've been in close quarters for almost four months, and he's still one of my favorite things in this world.  He, Mike, and I have all been doing well together as good roommates.  
• My older brother is staying with us for a week while my folks are working on the initial moving into the new house.  This naturally involves reshuffling of space and the like, but we are doing well with it.
• Andy's gotten a couple of housing projects under his skin:  the deck is about half painted so far, and the light fixture in the dining room is down, the new ceiling fan waiting on some additional consulting since the box was a weird size.  We still have a lot of ideas for that downstairs basement and might be ready to start compiling quotes soon, to at least get a fence around what resources we need yet.  
• I drove down to see my parents' new house this weekend--it was emphatically good to spend some time with them and get some pictures up on the walls.  I also enjoyed the quiet freedom of an hour drive down the highway and country roads, feeling my world start to expand ever so slightly.
• Realizing that I need to balance in some fun reading with my class reading--the tricky part is finding a book that is good enough that I want to keep picking it back up but also not so good that I get too absorbed and I read nothing else, which is where I've found myself a few times in the attempt.  It's partly why I've leaned more toward a movie or a video game as a nightly ritual instead of late.  
• Fall is not officially sorted out with ISU yet--there are a lot of questions that remain, but the sincerest hope of the group seems to be that we'll be in person as much as possible.  The world is evolving too quickly right now to have the answers so readily available.  I have my own suspicions and places where I would quietly place my bets, but it is speculation only.  In any case, the pace of my courses should slow a bit, and I'm looking forward to that if nothing else. I do hope to meet my peers in person sooner rather than later, though (provided we can do so safely, of course).  
• ...and I have a few tests to study for so that's about what I've got today.