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".

Today was my first day at B. "Welcome to B," everyone kept saying over and over today. Sometimes it gave me goosebumps the way they said it.

It feels like it was actually a couple of days; we took in so much information and saw a lot of new sites. It's going to take a couple of days to get oriented, I think. There are a lot of firsts for me here. We'll take the city bus to and from work each day.

We've been treated like queens so far. People treat us as though we're something special and talk about the great opportunity we have to learn in a setting which strives to provide "the best nursing care in the world".

Today, the man who welcomed us read one of the applicants' essays about why we want to be at B. I could have sworn it was mine, and I think my face was getting red, but at the end of the story, it was revealed that it was his own essay from a number of years ago. Many of the people in charge of our orientation process have been in the program I'm in, and chose to stay with B through their years. He kept saying during his speech, "You were meant to be here."

I found out today that 140 applicants were chosen of 600. The chosen ones are from all over the United States here. It's kind of exciting to meet so many new people. I feel like I'm at a state sports competition with the way we've been treated and all the hype about us being so extraordinary.

I learned today that my unit for this summer is hematology/oncology, aka: "heme-onk", and BMT which stands for blood and marrow transplant (not bone marrow transplant like I thought). It's an overflow unit, so instead of only seeing oncology patients or hematology patients or BMT patients (each of those are considered our "sister units"), I get to see all three during my shifts. I was told that 60% will be hematology patients, 20% onc, 20% BMT.

We have quite a few people over us this summer, a nursing manager (who oversees all of the nursing goings about on the unit), a nursing educator specialist, and a clinical coach (under whom we will work directly during all patient-cares). I haven't met my clinical coach yet, but the other two people are nurses with whom I felt very comfortable. They were approachable and knowledgeable. I feel very relieved! I think that when things come up this summer that I need help with, I'll be able to address these people confidently and comfortably. My nursing manager played on a volleyball team with Miss Volleyball from my home town. Small world.

There are two girls in the same boat that I am on my unit. One is from Boston. She's going to school in DC at the Catholic School of America. The other grew up in Montana on a ranch "with cows, horses, sheep... all that jazz". Pretty opposite posts in the world. The one from Montana kept on saying, "Oh! I didn't know it would be this big of a deal. Wow. This is really big. Wow. This is really nice," all day long. It was funny to me. She also said that she applied for the position because that's what everyone else was doing, and didn't really know what was going on when she got accepted. I kept thinking, "You're in for a ride." She's small and blond and reminded me a lot of a girl I know from Maryland. Every time the girl from Boston was asked a question, it sounded like she was reading off her resume or answering a question for a beauty pageant about world peace. When asked about her hobbies, I think she said, "My involvement in the campus ministries at my school is a very important part of my life." She's very tall and red-headed and has a kind of loud presence about her. She was dressed like a city girl. I love this taste of diversity.

I'm pretty excited to be part of something that is so much bigger than myself. It's been easy lately to get wrapped up in the all of the things in my daily life and I feel like this is a chance to get out of myself. I feel small, and really big at the same time. Small compared to what's going on here - just a tiny piece of the B world. 6500 people on nursing staff, I think they said today. Big - I feel like a little bit of a big deal with the way they are treating us. It seems as though it's really just such a prestigious place that the people on the top serve the people on the bottom (me).

The people on our unit, especially our nursing manager, seemed extremely excited for us to come on board. She said that our arrival signifies the beginning of summer for them. She also said that all of the staff really feed off of our excitement and enthusiasm - that our arrival is a breath of fresh air for all of the employees.

Wow.

Really?

I haven't seen all of the facilities yet. But all of the ones I have seen are gorgeous. There is beautiful artwork and architecture everywhere. There are grand pianos just sitting around, and people just play them at any random time. I played one today while waiting for my roommate to finish her orientation process. It was a beautiful piano, and it was really nice to sit down and play in this huge hall.

Anyways, like I said, this is a pretty sweet deal - away from my normal life. Bigger than normal life. Bigger than feeling so sad about certain life situations. This is something outside of my personal life, and it's refreshing.

Our living arrangements are really great. the furnishings are nice, and a lot of people have said that they've just done some remodeling. Out by the dumpster, there's about twenty couches and other pieces of old-looking, shoddy furniture. Ours look very new and cozy and comfortable. I just got all of my stuff settled into my room tonight, and it's pretty much perfect. Just right for ten weeks of living.