Wednesday, June 04, 2008

still numbers here

It was my first day on the floor. I met my clinical coach with whom I will be working most closely throughout the summer. Today she was charge nurse. On a full unit at M, the charge nurse has a lot of responsibility, so I wandered around on the computer system researching various topics on the intranet for a large portion of the shift. I've been annoyed with all of the people spelling internet wrong. It just so happens that if they were to spell internet correctly, it would be wrong. This system is one that can only be used within M, thus intranet. It contains incredible amounts of information including research studies, definitions, disease processes, and drugs. We're encouraged to use this system for all our cares, especially as it pertains to drug usage, so that things are standardized within m. I also did some of my preliminary paperwork - a necessary evil.

I did get to care for a couple of patients, though. One had a rare disease called carcinoid syndrome. He had tumors in various places in his liver and abdomen, but his organs were functioning well. His main problem was the overproduction of a certain hormone which is a vasodilator. When your blood vessels dilate, a few things happen. This patient had a flushed face and palms. One of the most important manifestations of vasodilation is decreased blood pressure. His blood vessels were dilating so much that he had spells of extreme hypotension and experienced fainting spells.

His wife had nursing background, so after I told them that they were my first patients at M, she opened up a little bit. People are always making exclamations about how wonderful it is here. She went on about her husband's rare disease saying, "Put it in your stuff," meaning that I should make some print-offs about the disease and put it with my study materials.

His rare disease seems to be on the brink of treatment discovery. At the time of his diagnosis (within the last ten or so years), it was estimated that 1 in 400,000 had the disease and there were no drugs with which it could be treated. Now, he has been taking Sandostatin to curb his symptoms and to prevent what is called carcinoid crisis. The disease is now estimated to occur in 1 in 100,000. This man is scheduled this month to be part of a clinical trial to test new drugs for his disease under M's advice.

There are studies going on in every corner at M. In fact, because of a study that took place (during the eighties?) when my building was being built, there are no corners on my unit. Scientists wanted to see if straight corridors were better for nursing practice than a round unit. Although there are only twelve beds, there is no room one and no room thirteen, so my unit has twelve patient rooms numbered 2-14 surrounding the nursing station like cogs in a gear. I was told that there is no room thirteen in the entire M complex.

I was also told to take vitals in seven. It occurred to me that even though this is M, and everything pivots around individualized patient care, the patients are still called room numbers sometimes. I'm not sad about that. I think it's a coping mechanism. They have to be numbers sometimes.

Today after work, I wandered around for a little while waiting for a meeting to start. I was looking for a piano, and I found one being played by a man in a black suit. His tune was familiar, one of my favorites, in fact, Prelude in C# Minor by Rachmaninov. Incredible. I wandered around some more and found another piano just in time to be beat to it by a girl carrying her music with her. Oh well; there will be many more days.

I went to my meeting which was an orientation-type meeting to the health and wellness facility here. I was flabberghasted at all of the services offered for 75 bucks. That's all I'd pay for the full summer. If I was staying longer, my fee would be smaller, but since I'm temporary, I can't get the best deal. I have to mull over it for a couple of days, simply because it's nice outside. Everything is state of the art, though, and the services that come with membership are incredible. One of the services mentioned involved similar features to a twelve-week program that cost $300-600 at the local Y back home. Their slogan is something like, "healthy employees, healthy community, healthy world." They're hoping to start something worldwide right here that becomes an obsession: healthy living. The founder invented slim fast and donated 30 million or something crazy like that for this place.

I learned about a drug today that was taken by a patient undergoing what was called "aggressive salvage chemotherapy." I'm sure you can guess by the title that his chemo treatments didn't work the first time, so this patient and his doc opted to hit it harder with a second round.

My fake tooth is bothering me more and more each day. I find the pain to be about a 1 or 2 on a scale from one to ten, but my anxiety about it at a 6 or 7. I decided today that I will call my dentist's office and ask for his email address. I think that will be the best way to contact him.

My clinical instructor is great. She thinks out loud a lot; perhaps it is only for my sake. This might be the thing about her that I most appreciate thus far. I think I'll follow suit. I read a patient's profile today that mentioned something called "numb chin". "Numb chin, numb chin, numb chin," I repeated and started to laugh. She said something about a Chinese dish which I thought was funny. This symptom isn't funny, though. It's considered ominous. It has to do with the mental nerve. Maybe we're the ones going mental. The profile mentioned a couple of symptoms including the above mentioned numb chin and bilateral knee pain. The doctor explained how "of course" mental and/or meningeal involvement was suspected.

Of course.

Maybe someday, I'll look at symptoms like numb chin and bilateral knee pain and express something about it with the words "of course" attached. Anyways, I dove into my unending M resources. Maybe I'll get swallowed up by all of the information before I reach "of course".

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