Thanksgiving

Here is a picture of the only Thanksgiving type food we had at our apartment. I made George a pumpkin cheesecake Wednesday to welcome him home from South Bend. This turned out to be just a fancy way of making pumpkin pie, but didn't hang around long enough to really merit complaining about how it was so similar.

Unfortunately, because I had to work on Thursday, George spent the day alone with no feast. Instead he gathered plenty of zzz's so that he could manage the 13 hour drive the following day. Including some annoying lake effect snow off of Lake Erie from Ohio, through Pennsylvania, and into New York. Other than that, smooth sailing.

Thankfully, our trip to Massachusetts has more than made up for our lack of what Julia describes as a "food party." She used this phrase last Thanksgiving, and I think it is quite a fitting description! We began with Thanksgiving leftover (yum, yum!) and progressed to an all out Mexican buffet on Sunday night when Claire invited some family friends over for a visit.

More to come on our Thanksgiving Break '07 experience, but wanted to share a post with everyone before getting too far behind.

We hope your holiday was a good one, filled with yummy foods!

Thanksgiving prep

Actually, I have to work on Thanksgiving, but we are preparing for our car ride to Massachusetts the day after. George and I are looking forward to some together time in the car after a month apart. I think a 12 hour road trip will be sufficient to catch up on things, huh?! We will be out east for a week, and George has some residency interviews scheduled in Maine and western Mass, as well.

In other areas of preparation, I got a haircut. I have a confession, I really like going to the salon. I find it relaxing, I'm not at all uptight about what will turn out, and don't their hair products smell wonderful?! If I don't like it, get this, it will grow back! So its my little way of pampering myself (once every 3 months or so). Though today, it was difficult to roll out of bed for the appointment because its dark and rainy. Ahh, sleeping in would have felt really good after two long days of work.

Anyway, I can never recreate the salon look, so here's a photo of the finished product.
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I have just a couple of comments to add about the South Bend visit last weekend.

1. The Notre Dame marching band was very impressive. I experienced a nice trip down memory lane to high school marching band days - they had so much energy, great sound, and good formations (pictures on the field, for those who aren't down with the lingo). It was definitely a highlight of the weekend. I was not, however, impressed by the football team itself (I'm sure other season fans would agree, its been a rough year). Though I'll admit, it was fun to be at the game, experiencing all the traditions.

1a. In addition, we were also treated to a quick concert by a portion of the bagpipe marching band. Apparently this is one of the hidden talents of one of the doctors in the family practice group -- so they played a couple of tunes for our tailgate party. Another musical bonus.

2. We found a VERY yummy place to get mochas. The South Bend chocolate cafe, which is part of the South Bend chocolate company. Wow. Tasty treats found here. It was located right across the street from our hotel, how convenient.

3. We met a resident who has a 2 month old little girl named Charlotte, so I got to hold her so we could have "Charlotte bonding time." I informed them it was a good choice, but I wasn't used to hearing it used when people weren't referring to me. In the crowd of people, I found myself turning my head when I heard the name because I'm used to being the only one! She was so cute. I'm definitely looking forward to the baby cuddle time that lies ahead.

Well, I'm off to put together my green bean casserole for the Thanksgiving pot luck at work tomorrow.

Happy Thanksgiving, everyone! Gobble, gobble.

Oh, and a special mention to my sister, Jessica. Happy Birthday!
Have fun with the parents and the Sanfords. We can't wait to see photos of the occasion.

Finishing up in South Bend

Hi All

Coming to the end of my time in Indiana. Charlotte was here for the weekend for their "First look" weekend, a chance to get to meet the residents and enjoy some leisure time here. I've enjoyed the rotation, but as always, it's hard to be away from Charlotte. Seeing her this weekend was wonderful - she looks great, and we're getting even more excited about bringing a baby into the world! We've got to do some more research on things like car seats. There's so much to learn about, things I didn't even know I didn't know - and this is all BEFORE the baby comes!

Like I said, she looks really well, but is reallying starting to feel the change in her body. We went to the Notre Dame / Duke football game on Saturday, and the narrow wooden benches really don't cut it for anyone's back, never mind being almost 27 weeks pregnant. We left after the half when the band did an impressive rendition of the Super Mario Brothers theme song. Do you think that Koji Kondo could have ever imagined that this video game's theme song could have become so predominant in pop culture???

Pretty sad when people recognize the song so well as to say "ooh, this is the part when Mario is under water!" but they haven't a clue to the name of other famous musical compositions (i.e. I didn't know "Black Horse Troop" - do you?). The band did a bit of "Shipping up to Boston" before the game which was ironic given the BC rivalry, but it sounded really tight with all the brass.

A frustrated Notre Dame fan who was shouting at the referee reminded me of my college roommate whose ability to recite football statistics was DIRECTLY proportional to the number of alcoholic beverages he consumed. The more he drank, the better he was - he sounded like a belligerent drunk sportscaster. This fan was just having fun, but it did take me back a bit.

We got to see 'Touchdown Jesus', so Charlotte was happy. My BC friends will be happy to know that although I did attend the game, I did not wear or buy any ND gear, and I did not take part in any Notre Dame themed singing. Their student section was lively, but very odd. Very organized hand coordinations with the songs.

We had a nice visit with the residents and staff physicians and their families on both Friday and Saturday night - a really nice group of people that I could envision myself working with. They are very supportive of each other with families, etc.

I'm definitely enjoying the rotation, and getting to see what it's really like to be a resident here. They have a great program and see lots of interesting patients. Their clinic serves a number of Hispanic patients, which has been nice for practicing Spanish.

Charlotte's just switched to working days, which is awesome - I'm convinced that since she's returning to the world of the "real people", as R.P. McMurphy would put it, and being up in the morning and sleeping at night. It's making a big difference!

So, I finish up soon here, and then we both 'ship up to Boston' for a post Thanksgiving vacation with some interviews tossed in.

looking forward to a good cannoli, a cup of coffee from the old country, and some good peanut butter. Family and friends also!

I got a little link-happy at the end.

Weekend of Work

I realize that the last few posts have been focused mainly around working for me. To be quite honest, its all I've really been up to since George has been away, so bear with me. Additionally, I've also been more "career-active" lately because I've finally had the opportunity to attempt a few certifications. Last weekend, I became ACLS (advanced cardiac life support) certified. I've only been trying all year to accomplish this and have had some obstacles with scheduling and other conflicts, so I was thankful it finally worked out. This is especially useful because our unit rotates "Code Call" (code blue: when a person is in cardiac or respiratory arrest) with the cardiac intensive care unit, and technically, you're not supposed to go unless you're certified. So now I'm official.

The other opportunity I took advantage of was attending a CCRN review course. CCRN is a certification for critical care nurses that is sponsored by the American Association of Critical-care Nurses (AACN). It was something I'd been considering, but sitting in the classroom for two 8 hour days of lecture isn't very appealing when you work the night shift and would struggle to stay awake. Now all I have to do is take the test. There's a little question as to whether I'm eligible or not (I have the appropriate number of contact hours, but its unclear as to whether they would consider eligibility for a nurse that has only a year + of experience). Apparently, they want a minimum of two years experience. Oh well, it was certainly a good review, regardless.

Don't worry, I did inform the woman organizing the class session that it would probably be wise to put that information in the brochure, as paying a fee for the class, sitting through two days of lecture, and getting a "pass-guarantee within 90 days" from the company that hosts the seminar is a little irritating if one is not eligible to sit for the exam.

One last remark for this post, I learned a valuable lesson this weekend. I worked a "double" on Saturday to alleviate some short staffing on the night shift (meaning, I worked from 7am to 11pm - staying over my shift for 4 hours for a grand total of 16 hrs) with the caveat that I would turn around and come back Sunday at 11am to stay until 7 pm. Unfortunately, no matter how smooth my day was on Saturday, my legs and body disagreed with this schedule the next day. Oh the aches and pains! So I won't be doing that again, as I simply don't have access to good pain relief in my pregnancy state (I don't care what the commercials say, extra strength tylenol leaves much to be desired!).

Nursing stories

I think there are a few stories from my nursing experiences that I will never forget. This week, I've been blessed with two.

This week, I cared for the oldest person I have ever met. She was 104 years old. Unfortunately, she passed way on my shift, but I found myself completely amazed when thinking about how much she must have seen since 1903.

The other experience was a patient who self-extubated. When a person is intubated (meaning they have a tube into their lungs and on a ventilator to help them breathe) we take safety precautions to ensure they do not remove the tube on their own. This consists of placing the patient in soft wrist restraints, as a minimum to tie their hands to the bed and prevent them from reaching up and pulling it out. In addition, I even had mitts on my patient (they cover the hands and prevent someone from grasping anything). I was going to grab a quick breakfast snack, reported off to another nurse, checked the patient (who was sleeping, restraints intact) and returned 15 minutes later to discover he somehow, despite the necessary precautions, had managed to remove the tube. Fortunately, in this case, he did fine without it and managed to remain off the ventilator throughout the day. However, I still have to report this in an official "occurrence report" that gets sent to my manager. Of course, only the day before the entire unit received an email from our manager about how last month we had 2 self-extubations and a fall. This was unacceptable, yadda yadda yadda. So I don't relish the thought of having to explain this to my manager, but I am very thankful that the patient did well after this incident! The kicker is that this patient had severe lung disease due to smoking and the first thing he says to me is "can I have a cigarette?"

Perhaps there is a greater lesson here, too. Preparation for parenthood. No matter how much we try to maintain our patient's safety, we cannot be completely responsible for their actions. I imagine the same is true for children.

South Bend

George is in South Bend, IN this month for a family
medicine rotation. I'll let him describe in more detail for you what his experience has been like so far in subsequent posts.

What we have learned, though, is that
1. Housing prices are very reasonable in South Bend.
2. The residency itself is higher paying than other programs (if there's a catch we haven't figured out what it is yet...)

In two weeks I'll go to visit him, and not being familiar with the area, the only attraction I can think of as a "must see" is Touchdown Jesus. The official title is the Word of Life mural on Notre Dame's campus. I first heard about this from a professor at Simpson College who described just what I imagined in the photo. Recently, I visited Notre Dame's website and learned that the mural is constructed of a marble mosaic, and putting it together was quite an engineering feat. If anyone thinks of anything else to see, please let us know!

Please note: Although George's alma mater is a great rival of Notre Dame, we have no great allegiance to Boston College football. Though we do congratulate them on their success this season!

George is gaining good experience visiting a few various locations for rotations, however, it will be nice to have him home again (to stay) after this month. His first interview for residency will be in South Bend next Monday. This should be a good introduction to the interviewing process, as he will already know the people with whom he is meeting.

Working blues

Work has sure caused some undue stress lately. For a time, there was uncertainty about whether I would actually be going to the day shift, as people on midnights keep quitting, having personal tragedies, or surgeries. While I am desperate to join the land of the living and function as a normal person with waking and sleeping hours that mimic the majority of the working world, I am also afraid for my co-workers on the night shift.

Not only does working short-handed bring down staff morale, but the system of moving people to days has a small flaw. Generally, the list is formed with seniority providing priority to those who wish to switch shifts. However, this leaves many inexperienced nurses behind by default. Recently, we've had an influx of new grads (those that graduated in May, oriented on days during the summer, and transitioned to nights a month or so ago). As a group, they are very hard-working, intelligent, and caring individuals. Nonetheless, when they have questions, they need a resource to turn to for answers. Therein lies the problem. In general, the resources have been relocated to the day shift. Though I'm flattered that I am considered a "seasoned" nurse after a short year of experience in the MICU, it also says a lot about the potential dangers involved in patient care when this is the case.

Additionally, I was becoming quite irritated with the inconsistent answers I was getting about whether my schedule would, in fact, change to days, being that the new schedule wasn't out, but would start in a weeks time. So, I went to talk to my manager. Apparently, I must have come across pretty strongly, as she thought I would quit if I didn't get day shift. So, day shift it is. Though the thought of transferring had crossed my mind, I figured it wasn't worth the hassle to find a new position and go through orientation, only to be on maternity leave in February. So now I'm feeling guilty about the assertiveness and what that means for the night shift. I certainly didn't intend for things to work out this way. Bummer.

In addition, last week I had a rather frustrating experience with a patient. I cared for a 21 year old with cerebral palsy. He was about the size of a 2 year old, and truly belonged in the Pediatric Intensive Care unit as we simply don't have the equipment readily available to suit his needs. However, the PICU was full, or short nurses, so he was in the MICU. I spent half my night just gathering the right size of equipment (blood pressure cuffs, needles for starting IV's, drawing blood gases, etc.) and adjusting my expectations for blood pressure measurement, urine output, heart rate, etc. for pediatric guidelines. I have to admit, it was nice to care for a small person. When it came to repositioning and moving him, since he was so small, it didn't hurt my back and I could do it myself.

This experience was a slight wake up call that nursing school was, in fact, a year ago and there is stuff I'm surprised I remember, and stuff I'm afraid I've forgotten. It also reminds me that there are other types of nursing out there which pique my interest. The longer I stay in an adult ICU setting, I wonder if it would be more challenging to enter these new areas later down the road.

Week 24 (6 months, already?)

Another visit to the doctor. Another good report. I'm still at my goal of ~1 lbs per week for weight gain. Ok, so there was an extra pound thrown in there, but I'm thinking it was all of the Halloween candy they had at work. Just a reminder that I should really try to exercise a little more each day.

Baby's heart rate was 140 and I'm measuring appropriately. This was a quick check up, and next time I'll have to do the glucose test and have blood redrawn to check, again, for anemia. Though, instead of 28 weeks, it will be more like 29 because George and I will be in Boston.

Here's another photo for Week 24. Believe me, I wear a sweater over this shirt as we've had cooler weather in November, but wanted the belly to be visible in the photo. My bun in the oven isn't keeping me that warm. :)