Pinkyrn

Just some thoughts on Birth, Nurses and birth interventions.

2009-11-08T06:17:00.000-08:00

Did you know that Jacho does not review Birth Centers? I just found out. I am thrilled. Cause I hate Jacho. I think it was started to help things out but has caused a lot of problems. It seems that Jacho and/or the Hospital wants to put each patient into the same little slot of box. Each person is the same so you can check them off the same and keep track of them the same. Makes for easy accounting.

Well as you know, we are not the same. One of the most interesting things about people are their differences. That is one of the things I really like about the Birth Center Concept. I am hoping to do some of my clinical in a birth center a hour or so away. One of the CNMs that I have worked with works there now. I have yet to ask her.

My reading has also discussed how hospitals have changed midwife practice. Very interesting. It seems like a catch 22. You need large turn over to perfect skills but with large turn over you become less sensitive to differences, I think. In the small community hospital, nurses skills like Iv placement, foley insertion, baby resus become rusty.

I think it wise to train new nurses in large tertiary centers to perfect skills. But also important to have them attend weekend doula seminars where everyone stays in the same house together chatting. I have done both and think I am better off for it. Also important to be open minded to change and different ways of doing things. When I first went to the large hospital, I spent most of my time in the room with the patient. Other nurses noted this. Some laughed at my interventions that were strange to them. Such as the hip squeeze and the press at the bottom of the spine. I don't think any new labor nurses I know, know these techniques. Which is sad because there are times when epidurals 1)don't work 2) due to medical reasons a woman cannot have an epidural.

Funny how history repeats itself. In the 60s and 70s women started questioning birth practices and some opted for home birth. This concerned the Maternity Center Association. MCA is a wonderful organization that has worked to help moms and babies since 1919. Really an amazing organization. Anyhow MCA started the first modern birth center in New York city in 1975. They had success with maternal satisfaction and good perinatal outcomes but they had to document it. So The National Birth Center Study was conducted from 1985-1987. It was published in the New England Journal of Medicine in 1989. "The study reported care and outcomes for more than 17,000 women enrolled for care in 84 birth centers and almost 12,000 women admitted to centers for labor and birth" (Phillippi, Alliman and Bauer, 2009).

So what did this study come up with? "The intrapartum and neonatal mortality rate was 1.3 per 1000 births, no higher than rates from studies of low-risk births in hospitals" (Rooks, page 92, 1997). I think the intrapartum mortality rate is much much lower now. Not sure. I will look that up at some point. Another statistic I would like to see if the mortality rate of infants from complications of Nicu stay. Not what put them in the nicu in the first place but complications of the Nicu. Some of which are definitely unavoidable but I would like to investigate that.

Anyhow I should continue writing my paper.

Home birth vs. Freestanding Birth Center. Would you go to the birth center if there was one near you?

2009-11-05T08:57:00.001-08:00

So I am writing a paper on the history of midwifery. It has been wicked interesting. Did you know that Jacho does not over see birth centers? I had to stand and applaud when I read that one.The Maternity Center Association was able to write their own standards. Why can't we do that?

The article is in the Journal of Midwifery and Women's health. Written by Julia C. Phillippi, CNM, MSN, Jill Alliman, CNM, MSN, and Kate Bauer, MBA. Title is The American association of birth centres: history, membership, and current initiatives.

So I got to thinking about birth centers. Would folks who want a homebirth because of the restrictive nature of the hospital, come to a freestanding birth center? Is there a demand for Birth Centers? Especially a Birth center across the street from the hospital that has a large staff and 24 hour Ob and anesthesia folks so they can handle anything you throw at them. And a Nicu would be good too. I was thinking, if we did start up a birth center across the street from the hospital I worked at, would it be used? If we build it, will they come?

So for any home birth folks out there, could you please leave me a comment on your thoughts. What would you need in a birth center to make it attractive to birth at?

H1N1 and the CDC

2009-11-03T06:19:00.000-08:00

"Elizabeth Weise: Hi. Thanks so much for taking my call. In talking to parents and pediatricians, I'm hearing a lot of concern that the H1N1 vaccine is not sufficiently tested. I'm wondering, were any corners cut on clinical trials? Is there any reason that people should be worried? Or is that -- is there any basis for that is this.

Anne Schuchat: You know, safety is a top priority to us. And what i want people to know is that no corners have been cut at all. The H1N1 vaccine is being produced exactly the same way that the seasonal flu vaccines are produced, with exactly the same careful oversight. We've gone a further step to that, and the clinical trials have not found any red flags in terms of safety. Safety is just extremely important to all of us. And it's something we take very seriously. Next question from the room? "

I got this quote from the CDC site. This was my concern about the vaccine. Seems I was given incorrect information about the vaccine being rushed to production. So this changes my mind on vaccinating small children. I think it is now a no brainer to get them vaccinated.

Take a look at the CDC site. I got it from Confutata which is Squillo's blog. The site is very informative.

http://www.cdc.gov/media/transcripts/2009/t091001.htm

Nurse specialty. Which one would you pick?

2009-11-03T04:38:00.001-08:00

If I had it to do over, if I could be transported back 10 or so years, I think I would choose to become a cardiac ICU nurse. Maybe a cardiac surgery ICU nurse? Why? Well I kind of fell into L&D. I never meant to be an L&D nurse. Not overly excited when I did my clinical at school. It has been a wonderful experience but I do have a spine problem from the experience.

My plan 10 years ago was to become an ICU nurse. I thought hearts and lungs were fascinating. I still do. And when you turn ICU patients you have time to decide what posture to assume.

On the other hand, I would have missed out on 10 years of helping folks into this world. It is mind blowing, even today, to imagine the baby was inside the Mom and now the baby is outside breathing air, crying, moving. It is still mind blowing. It is still amazing when the small baby looks at me and gives me a confused look. As if to say, "Did you get the number of that bus that hit me?"

I would have never learned how to scrub into surgery. Which is also extremely interesting. I would never have met so many wonderful couples and been able to really get to know them. To get to know their story. Amazing what comes up in a 12 hour shift where you are sitting in the room with the couple the whole time?

I would never have caught a baby. Which is also an amazing experience. That is one of the many reasons I am going to Midwifery school and not NP school. The other reason is that I don't like how the Maternity system is changing. Many young L&D nurses don't learn how to support women who do not want an epidural or cannot have an epidural for medical reasons. Too much time is spent charting and not being with the patient. Too much time is spent at the desk instead of in the room with the patient.

So I think I should rephrase my question to, "What kind of specialty would I pick if I could not have been and L&D nurse." I think many of the expediences I have had, I would not trade. Even though my spine is in bad shape for it. Who knows, maybe it is not from being and L&D nurse. Maybe it is from skiing during my 20s and 30s. Really hard to pin point it. But I think it is the job. Also many of my L&D friends are broken in various places too. Backs, knees, shoulders, those are the injuries most of us have.

So, if you are a nurse and you had to pick a specialty other than what you are doing now, what would it be? If you are not a nurse, what kind of specialty would you pick if you became a nurse tomorrow?

Yes, I should be writing my paper. Yes, I am procrastinating. Yes, I have given myself a due date of Wednesday. I got a lot of work done last night. So perhaps this is not procrastinating as much as taking a break. At least that is what I am going to call it, for now.

The question is not are you procrastinating, but what are you procrastinating over? And some more about H1N1 since I was procrastinating.

2009-11-02T08:43:00.000-08:00

Today's procrastination is a paper on the history of Midwifery. I did some of it. I read a bunch of it prior to getting all OCD about my Patho class. I have a bunch of articles and a textbook that basically say the same damn thing. So how hard could it be? Well really hard it you keep procrastinating!

I have given myself a due date of Wednesday. I think that is doable. Also I have to drive my a$$ one hour North to attend a faculty meeting for the college I teach for. Last time I told my boss I was not able to go she didn't take it well. She gave me a guilting over it and I just can't take another one. We are both Irish Catholic so she can hand over a really authentic guilting. You end up feeling bad for 3-4 days at least. So I am going.

Oh and about H1N1, Orac says it does not cause dystonia which Gloria Lemay had suggested on her blog. The dystonia cheerleader actually got the seasonal flu shot. Not the H1N1 so....I would not fear the dystonia. And Jon Gossling, LIndsay Lohan and Tom And Kate are still on the shelves of the grocery store. Just in case you didn't know...ANd wanted to. Also You tube has extensive video on how to lance an abcess..Just in case you wanted to know. Not that I have been spending my time watching it.....I cannot confirm or deny wasting my time doing that.

ADHD, yes again! Too bad the drugs didn't help with procrastination!And a few words about H1N! vaccine

2009-11-01T03:53:00.000-08:00

http://www.ncpamd.com/Treatment_of_women_and_girls_with_ADHD.htm So this is a site I found very helpful for women. Especially young women and girls. Definitely worth reading.

I wish the ADHD drugs helped with procrastination. Once I start a project, I do stick to it. Unfortunately I get hyper focused on it. And often I do not want to stop until it is done. That has helped in Patho class. I am 1/2 way through. However I have not done a thing in the other classes. They are papers. Once I start a paper I am OK. I just need to start. And boy do I need to start these 2 papers. I think I will start with the easy paper. Less intimidating!

I did take the weekend off to do some homework and get caught up. I also need to buy a chair that is ergonomically better than the one I am sitting in right now. Also my Daughter suggested we have dinner with her boyfriend. So I am making lasagna. Boy I hope she is not pregnant! Terrible that is what I think when she suggest we get together with her boyfriend. I discussed this with some of the girls at my clinical. One of the girls said, "That is what I did when I told my Mom I was pregnant!" Sh!t.

The good news would be that she is almost 25 so she is not a youngster so it would not be earth shattering and she is gainfully employed and going to nursing school too. It is a 2 year school. She has a 4 year Biology degree and gets good grades. And she is the light of my life. Her and her brother. Funny you love both kids the same but different. One could not replace the other. I have a special relationship with my Daughter because she talks to me more than the boy ever will. She opens up to me. Always has. And she loves me, loves me, loves me. I never went through the "I hate you phase during her adolescence." Anyhow, I will see tonight if she has an agenda.

One of my students asked me my opinion on the H1N1 virus. And I left a comment on Gloria Lemay's blog about my opinion. The thing is, we don't really know enough about this vaccine. It was rushed to production. However, the virus is somewhat deadly. Has killed young healthy people, kids and pregnant women.

I don't have the time to do a full investigation but have looked into a few things. The March of Dimes is suggesting pregnant women get the vaccine. The March of Dimes is an organization that does not seem to have another agenda other than keeping babies healthy. So I would call them a good source.

I have decided, if I can get vaccinated, that I will. I will also ask my Daughter to get vaccinated and my 11 year old son. He is also going to get a booster shot for whooping cough since that has been going around and it is F-ing miserable! However, my student has a 1 year old and she is worried that the vaccine is alive, that is what she said, "it is a live virus!" Well it is a severely weakened virus. They call it attenuated. And they have been using attenuated viruses for years. I certainly can see her concern. Her baby is small. Much more susceptible to compromise. I sympathize with her plight.

I told her that I sympathize and that it is not an easy decision to make. My suggestion was to write down the pros and cons for taking the vaccine and the pros and cons of not taking the vaccine. Or the list of possible outcomes. Then decide what she can live with. And do some reading at the March of dimes, the CDC and the NIH. Also talk to her Pediatrician. This is a decision she must make. She is going to get vaccinated. Ester on Mainstream parenting blog is a pedi she might have more good information about the vaccine.

Galatosemia in the fetus with a mother who has active TB.

2009-10-31T06:00:00.000-07:00

So instead of doing my home work, I have been googling this concept. Why? Because last night at clinical one of my students said that galactosemia is an effect of active TB in the Mother. I have recently read the word galactosemia in my large Path textbook and it got me wondering how that process works. I really got nothing from Google.

I also have to review hyperbilirubia for my clinical kids. They are going to be tested on it and the student who gave the report on it missed a bunch of stuff that they might be tested on. So I will review that with them next Friday. I think I will also call the class lecture teacher and find out what she is testing them on. That way I can emphasis those points.

Good news is that I am half way through my patho class. And I ordered one of those book holders to hold my book up so that I won't kill my neck as I have been doing. I am sick of neck pain. It makes it harder to concentrate when you feel like a knife is being stuck in your neck.

My students have gotten a lot done this semester. I am so happy they have all been able to see births. And they all seem to feel comfortable doing assessments and taking vital signs. So we are in good shape. I really like teaching clinical rotation. However, I don't think I can fit it in next semester. I need to stay with employment that is flexible and teaching a clinical group is just not flexible.

I have also been procrastinating starting my concept paper. Yes, me, procrastinate! Shocking!

Well that is all for now folks...

Staphylococcal scaled-skin syndrome....Affects neonates...

2009-10-29T04:45:00.001-07:00

http://www.dermnet.com/Staphylococcal-Scalded-Skin-Syndrome/

So I was studying my dermatology unit and came across this skin infection. When I read what it entailed and how it looked I thought, "Sh1t, I better do a post on this. I could totally miss this one and that would be bad." So many new Moms complain about skin problems with their newborns. And most Docs blow them off and say it is rash of the newborn. And usually it is. And yes, new Moms are hyper alert and worried about the health of their baby. Nothing wrong with that. I think nature made Moms that way.

Anyhow I saw the picture above and thought, "shit I would look at this and think no big deal." And I would be wrong. This is a picture of Staphylococcal scaled skin syndrome. It is the most serious staphylococcal infection that affects the skin. (Huether and McCance Understanding Pathophysiology.

Clinical symptoms begin with fever, malaise, runny nose and irritability followed by body redness and tenderness of skin. There may be an associated impetigo. Within 48 hours, blisters and bullae may form and the pain is severe. (Again Huether and Mcance).

I guess most Moms would seek medical advice when the baby gets a fever. If you see a rash like this, you may want to get the baby swabbed for staph infection. Tell the Doctor your concern.

I imagine if Esther is reading this she may have more current information.

I don't mean to scare already nervous Moms. But this kind of scared me. So I thought I would share it with you in case you come across it. Information is key.

TTFN back to studying

PMS and an exacerbation of chronic spine pain. A deadly combination. To other people.

2009-10-28T06:27:00.000-07:00

I am feeling a little homicidal. Just a smidge. Mostly I want to kill my husband. Why? Because my spine hurts. My neck is F-ing killing me from reading the humongous textbook I bought. I think they should sell textbooks in 3 parts so you can lift them easily and not hurt yourself with them. I cannot find a comfortable reading position for a 10lb F-ing textbook. I am up for suggestions. I have thought of cutting it into pieces. I still might.

However, my neck really f-ing hurts. My back hurts and I have PMS. A deadly combination. Now I am on ADHD meds so I won't forget, either!

I will keep you posted.

TTFN

Oh, my husband is home sick. He never gets sick. Obviously, he is now. So actually that is untrue. Historically he has almost never gotten sick.

I am afraid to take my test!

2009-10-27T05:01:00.000-07:00

The next patho test has so many things on it! I must admit I am a bit afraid to take the test. I am almost done with all the reading. I am going to listen to the lecture one more time. Then I have to bit the bullet. I have been procrastinating this morning. So I have to cut that out.

I have a finite amount of time so I have to make like NIKE and just do it!

TTFN

What not to do while listening to on line lectures.

2009-10-26T13:57:00.000-07:00

I fell asleep. I got really comfortable on the couch and fell asleep then took a 3 hour nap. which is actually good since I had put in from 5a to 10 and then some. And the night before I put in a lot of work. So my body needed the sleep. Note to self, 'listen to lecture when wide wake....

Now I am going to take my ADHD meds and a coke and continue reading the patho textbook.

Fifth day on the ADHD drugs.

2009-10-26T04:09:00.000-07:00

So the ADHD drugs help. A lot. But I have noticed I need at least 10mg or 15mg. He prescribed 5 mg twice a day. Being a nurse, I am obnoxiously noncompliant and make up my own regime according to my drug book. I have however found dangerous interactions between drugs I had been prescribed by Docs so I feel that gives me the right to read up and decide what I should take instead of blindly taking what they think I should take. I can assess the results better than they can, because it is my body. But I digress. So I guess the Ritalin has not kicked in yet.

Kathy mentioned that the blood type diet might help ADHD. I will try anything. I didn't eat well yesterday but today I ate breakfast and I am drinking my blueberry juice. I am studying Cancer cells so I am motivated to eat more fruits and vegs and just eat better. Less sugary food. Did you know obesity will increase your risk for certain cancers? Well I didn't. So that was interesting.

Well must get back to studying. TTFN.

Better day on the psych floor for Pinky.

2009-10-25T13:04:00.000-07:00

So I had a better day today. Why? Well I had it in my brain that the guy I worked with was an a$$hole. That is never productive. I vented a little to the supervisor who is a regular Joe and knew it would go no farther and then realized I needed to have a heart to heart with this guy.

Having an open, honest conversation about how you communicate with someone you just met is never easy. It is far easier to bad mouth them behind their back and request that you never work with them again. However, I try to treat folks the way I would want to be treated. So by the middle of the day, I initiated the conversation. It actually went pretty well.

I think because I told him my goal was to be able to communicate well with him so that we can work well together. I explained that not everybody immediately gels or gets along and that is OK and sometimes you find out that you don't really get along and that also is alright. It is, premature to make a decision on weather we can get along and work well together. He seemed to accept this well. He did get a little defensive so I just let him tell me how he sees things. I did a lot of listening and not commenting.

We then worked out some ways to communicate with each other better. I told him that he has to tell me when he feels something is important and I need to listen. Then he has to tell me why he feels it is important. I prioritize everything. That is what most nurses do. So if you tell my WHY you think something is important, I am more likely to stop and listen to you. I can get wrapped up in my own work and thoughts and blow you off. I know this about myself. He in return told me that many times folks do not get a great first impression of him. So he was being reciprocal in trying to work out a good working relationship and for that I applaud him. He could have said, "Pinky, F-you! You are completely wrong." I thought he may. But he didn't so that shows maturity. He also explained to my why he is a bit stand offish to the night nurse who gives us report. She embarrassed him and it was about a factual medical thing. And she was wrong. So that is frustrating why you are correct, you tell someone the fact and they just completely disregard what you say. That is the thing about new grads, they just read most of the stuff!

I guess it comes down to respect. I respected him enough to discuss the problem. I listened to his concerns. I listen to his point of view and his knowledge of medicine. Listening, really listening shows respect. I am not always listening to people I know. But if we are having a heart to heart, I am not sitting there thinking about what I am going to say as a rebuttal. I am just taking in what they are saying. And I think that defuses a lot of folks. Also my Mom always told me to keep the focus on me. If I say how I feel or how I have processed the situation. It is far easier for others to deal with instead of me saying "You pissed me off." Actually a saying you pissed me off is never a productive thing to say to a coworker.

So for the rest of the day the mood in the office was much nicer. Much less tension in the air. And for me, how I get along with my coworkers is huge. If I am not happy with the folks I work with, I am not happy. So we shall see.....

So to update you on my ADHD medication regime, I was able to study for 5 hours straight last night after work. 4:30 - 9:30. I got a lot done. I was able to do one of the graded assignments and I got 100% so I was thrilled. And then I was able to sleep too. I took 10mg of Ritalin at 3:30pm... So I guess it is working! I was never able to spend 5 hours straight reading and studying before. I am happy with the results. I will keep you posted.

TTFN

What not to do as a new grad.....

2009-10-24T12:35:00.000-07:00

Today I worked with a guy who has been an RN for 30 days. He knew the floor well so I thought, let him do the notes and deal with the Docs and I will pass the meds. Big mistake.

I was fooled into believing that someone can be a useful RN and completely competent at 30 days. It is not an acute area. So I thought I would be Ok? I was wrong.

So here is my list of what not to do as a new nurse:

Don't bite off more than you can chew. If you usually pass meds. Then do that when a nurse you don't know comes onto the floor. A floater can usually float well. The floater knows how to work the system. You may not.

Don't call the supervisor for every thing. First ask the nurse you are working with. If a nurse says, "I will handle it." They will. Check at change of shift. Or ask how that went. The nurse will tell you how they made out.

The one thing the new nurse does not know and it will take a lot of time, is what is the priority. I cannot teach you that. You must learn it. But anything that could cause death, dismemberment or comma, that is a priority. Writing height and Weight on every fucking piece of paper? Not so much.You should do that after to take care of the oh shits.

New Grads do not know nurse speak and nurse esp. Nurse esp is when seasoned nurses see me doing one thing, they do the other thing. They don't try to do the thing I am doing.

So today was painful. Probably for both of us. I hope tomorrow is better. Now I have to go study.

Pinkyrn not the only one with ADHD, who knew? Well not Pinky obviously!

2009-10-23T02:48:00.000-07:00

So I used to think inside my brain that I was one of the remote folks who had ADHD. That most folks do not have ADHD. Which is probably true. But I have been fortunate that some folks are coming out of the blogosphere woodwork and saying, "oh I have that too." Which makes me feel better. It is nice to know you are not the only one.

If I look back on my life I think, most of the time folks thought I was lackadaisical or as my own Mother said, "Pinky, you are just not one for details!" I think my Brother thought I was retarded and did it on purpose. He used to get so pissed at me. We don't have a good relationship today. Well actually, no we do have a good relationship as long as we don't talk and we live in separate States.

In my family growing up my Sister and Brother were both in advanced classes. I was the "slow one." But not slow enough to warrant any intervention. I was not hyperactive in school so nobody noticed. Instead my mind would wander and I really had no control over that. But I could do the minimal and get by.

My Doctor asked how I got through nursing school. Good question. I guess it is due to taping the lectures. If I listen to something twice I usually have it down. That is if I listen and I am paying attention. When the lecture is taped I can rewind it and relisten to spots. It worked out really well for me. I got all A's and B's in Nursing school. Think I have a 3.5 average.

I think when you have ADHD you pick up other skills to work around the deficit. I have a warehouse memory. Once I pay attention and listen, I usually retain it for a very long time. I am good at remembering diseases and what you do for each one. I have not taken care of a patient with a high potassium in 10 years but I still remember how to treat. Calcium IV, Insulin iv (small amount) Dextrose, Kaexalate.

Well I guess that is it for now. I need to study my patho then take the test. I must not procrastinate or I will be so behind and that will cause more stress. I don't really need more stress.

First day on the ADHD drugs.

2009-10-22T11:44:00.000-07:00

So I started taking Ritalin today and I think it is working! I am finishing things! I finished a whole pack of cigarettes. Then I finished a whole jug of mad dog 20/20. Then the neighbor who annoys me? I finished him off too. Hid his body under my shed! hahahaha....No I am only kidding. I could not find my neighbor.

No actually I don't smoke or drink. Bad for you. And it smells bad too. And homicide? Well that would be time consuming and stressful. So none of those activities did I partake in. I did however, bake cookies with my Son and I finished reading my patho chapters. I think I might have even understood what I was reading. My plan is to review the material a bit more and take the test in the morning.

That is it for now.

Once upon a time there was a blogger named Pinky who had ADHD and denied it for years:

2009-10-21T15:29:00.001-07:00

So for years the running joke has been my ADHD. Everyone at work knows I am the poster child for ADHD. One of the secretaries told me I NEEDED Ritalin. I was annoyed by her. I thought it was rude of her to say it that way. I really thought, "Hey I have gotten around well so far. Yes it takes some work but I am OK."

My Nephew has ADHD really bad. His parents were reluctant to put him on medication. Our family said loudly, "he needs medication!" They have finally put him on medication and he is doing fabulous. He is getting all A's now. And he is delightful to chat with now. A few times I thought to myself, "Do I annoy folks as much as he is annoying me right now?" That was before he started taking an adequate dose of whatever he takes.

My Doctor gave me a written test today. I answered all the questions that indicated I have ADHD. He looked at me and asked how on God's green earth I got through college? I told him I used to tape the lecture. That way I could listen to it while driving. So I could take it in small quantities. The problem with Grad school is that I don't have that luxury. I HAVE to read a lot of stuff and I have a finite time to get it done. I sat down yesterday and could not concentrate on what I was reading. MHC, CD4, T-cells, B-cells....They all take a lot of concentration that I just don't have. So I need to admit to myself and the medical institution that I have ADHD and I am going to need a little help with this. I cannot work around it!

Maybe that is a good thing? Maybe, finally admitting the I have this and it needs to be dealt with is a positive step. I know denying the truth really never did much for anyone. And the good news is that they do have treatment for this. I am starting on medication tomorrow. They are starting me on Ritalin. "Deep sigh" I will keep you posted on how it is going.

Right now I am going to take a shot at reading some patho. TTFN.

Pinky and her ADHD

2009-10-21T03:46:00.000-07:00

For years now folks have been telling me I should be on ritalin. It is common knowledge that I have ADHD on the labor floor I used to work on. I have always been able to work around it. I would write myself notes. But then I would forget where I put the note!

For someone with ADHD, I have done alright. I got through college twice. Perhaps it is getting worse with age? Not sure. Maybe it gets worse with stress? Also not sure. But I have a Doctors appointment today and I think I will chat with him about it.

I am having a terrible time concentrating on my reading. Also when my spine is hurting me badly, it is harder to concentrate. Chronic pain sucks. But hey it could be worse. When I go to work and see all the poor bast@rds in the psych hospital, I think I am one lucky Bast@ard. So that is it for today. TTFN

Just wanted you all to know that:

2009-10-20T17:03:00.001-07:00

Immunoglobulins consist of four polypeptide chains: two identical light (L)chains and two identical heavy (H) chains. The class of antibody is determined by which heavy chain is used:" gamma (IgG, mu (IgM), alpha (IgA), epsilon (IgE, or delta (IgD). The light chains of an antibody molecule are of either the kappa (K) or lambda (wtf) type. The light and heavy chains are held together by non covalent bonds and disulphide linkages. A set of disulphide linkages between the heavy chains occurs in the hinge regions and in some instances, lends a degree of flexibility at the site. (Huether & McCance 4th ed.)

I know realize I need divine help to pass this class. So if you all would start praying for me, I would appreciate that. I will be reading along fine, understanding everything, then BAM I get a whole section like this. And then I think, "how on God's green earth will I remember this? I guess I will take it one step at a time. I made flash cards. I listened to the Dim Dim session. I will listen again. At some point tomorrow I will finish the chapters and then I will probably read them again.

Oh my, what have I gotten myself into? I complained to my spouse and his response was, "quit." I asked him, "would you quit?" He said he would not but that is him.

So for some good news. My Son is doing great. He is happy I am home most school days. He is happy we got him a Halloween costume. He is getting good grades. We have gotten into a nice schedule. I am home Monday - Thursday doing home work and house keeping/ Mommy things and Friday, Saturday and Sunday I work.

My plan for the week is to do the next test by Thursday come hell or high water. Which ever comes first.

Off to read some more....TTFN

The agony of defeat!!!

2009-10-20T04:43:00.000-07:00

So I took my first big test for Grad school yesterday. I had been studying like a mad woman and putting it off for a long time. Too long, I think. I got a 71. This was a huge blow to my fragile ego. I even had a fleeting thought of quitting altogether.

After I wallowed in my sorrow for a while, I called my teacher to find out what went wrong. We discussed the exam and come to find out a few of them I really did know, I just didn't answer correctly. Too much anxiety I think. So now I am in WTF mode. Which is better, actually. I looked at what I did to study for that exam and discovered what I did wrong. I did all my reading and studying last week. Then I worked 3 days in a row. I did a review of all the stuff I studied. Then took the test. I think I need to read all the stuff, review, then do the test in a short period of time. So that the material if fresh in my mind. Oh yeah and don't smoke hash before the exam! I think the hash might be key?

Also I am getting organized. It took a while but now I think I have it. I work Friday evening for the college teaching clinical. Then I work Sat and Sun for the psych hospital. The psych hospital usually floods my mind with things to think about. So taking a test the day after I work there? Not a good idea. And of course, don't some hash or crack before the test. Words to live by.

And on another note. I need to stop telling myself things like, "oh sh1t, genetics. I have never been good at genetics. I am going to really fuck this test up." By doing that. By thinking that I will not be able to get it, I give my mind instructions to shut down. Which is really not productive at all. I need to be open to learning new material and embracing it. And of course, don't smoke hash or inject heroin......Words to live by.

So I think the next test will be better. Wish me luck.

Public disclaimer: The author does not ingest street drugs of any kind. The drug use information is purely for entertainment purposes. When on any kind of mind altering drugs, please do not drive or use heavy equipment. Alcohol may intensify this effect. And please take with food.

H1N1 whose got the vaccine?

2009-10-20T03:41:00.000-07:00

So I work in a hospital. It is a psych hospital but a hospital nonetheless. And they have not started immunizing their staff. Which would be me! I also took my Boy to the Doc's yesterday for an ear check d/t him complaining of ear pain. He is fine. No issue just some water behind the drum. I will give him Dimetapp. The Doc's office did not have the H1N1 vaccine either. WTF people? Do I have to buy this on the black market?

If the CDC is saying that this flu is killing young people, shouldn't we have enough vaccines for the young people?

Here is the good news. My town is holding a vaccination program for the children. I just have to do a survey on line. I might volunteer to help out with the process. I shouldn't because I am wicked pressed for time. But I think it may be important. And I want to make sure my boy gets the vaccine.

I am not afraid of the vaccine. I am afraid of the disease. Flu can be fatal. And fatal is pretty definite

My weekend at the Psych Hospital.

2009-10-19T03:28:00.000-07:00

I work in a psych hospital. This weekend I worked on the adolescent unit. some of the kids are real mouthy and you want to smack them. Some you meet them and you want to take them home with you. I felt both ways this weekend.

The thing I like about adolescence and I never thought I would like anything about teenagers. Didn't like being one. Not fond of them in general. But the thing I do like about young people is that they can change. They are more likely to change. They can decide to turn their lives around and come out as a productive nice person. I truly believe this. Cause if I didn't, I would be really really burnt and cynical.

I guess it is like Santa Clause, I don't have to see it to believe it. I don't really have to believe it. But I do. However, many of the kids I take care of will end up one of 3 places; In jail, dead on the streets or back in a psych hospital. None of which are attractive options.

Many of the adults that frequent the psych hospital will also end up in the end with an early grave after a lifetime of abusing drugs, hanging out with lowlifes, committing petty crimes and misdemeanors and taking advantage of the welfare system....Hmmm. Very sad. I must not dwell on that.

There are the occasional normal folks who are just having a bump in the road. That is actually a breath of fresh air. You see that their life has gone OK thus far and after this episode, they probably will put it back together and move on. I think the episodic psych patient might get scared sh1t back to normal after meeting the regulars and thinking, "wow could that happen to me? I better get my sh1t together and start taking my meds!"

And I should probably stop typing this post and do my homework. TTFN.

The good news and the bad news.

2009-10-17T14:53:00.000-07:00

So here is the good news. I have got a midwife, that I used to work with, agree to precept me and it will be in a place I am very familiar with. That is good news.

I am getting to like my new job at the psych hospital. The hospital has been very good being flexible with me. So they are making life easy. And I really like most of the folks I work with there. And it is close to my house which is awesome.

My family is good. My Son is happy in this grade so far. He is a good boy and he has been doing well in school and is very disciplined about doing his homework. My Daughter is working and going to school and doing well. She is happy.

The bad news is that I procrastinate too much. And it is based on fear. I am afraid to take my test that I am ready to take. I keep reading and rereading it. So I am letting myself get behind. I have to be much more disciplined about that. So I am going to take the genetics and immunity test on Monday. I will definitely be more than ready to do it. By Monday I will never be more ready to take it. I have to take it during the days when tech support is available.

Next in the line of bad news is that the College I work for is being very inflexible about my other responsibilities. Especially Grad school which makes no sense because they are the folks who told me I needed to get a Grad degree.

I found out from some of the students that there has been a lot of turnover with part time faculty. HMMMMMM. I should have been suspicious when they hired me on the spot. I also should have been suspicious when there are two types of clinical instructors. Either they have been doing it a long time or just one year. I think the lady who teaches the class is a bit much. She was really nice last year but I think the honey moon is over. She wasn't very nice on the phone to me the other day.

So I am not sure I will do this clinical teaching next semester. It would be easier to just pick up one more shift at the psych hospital and it would be less work. Yes, I really like teaching clinical, but I need employers who are flexible. I need to do the on-line conferences. Yes, I could just listen to them taped later, but it isn't the same. I like the interaction and the chance to ask questions and get a response right away. I guess it is all about priorities. If the College cannot accept they are not my first priority, then perhaps it is time to say goodbye?

More bad news is that I miss my Niece and Nephew so much that my heart hurts.I miss how my Niece would lie in wait for me to get out of work (I parked at my Sister's house)then ask me if she could come over my house for a little while. She is just so cute. It was hard to say no. So, of course, mostly I would say yes. My Sister is working now too so she is not home with the kids as much so many times I want to go visit, they are not home. Think I will drive over to their house tomorrow after work.

Well that is it. I am in pretty good shape. I just need to be more disciplined and get my school work done.

Oh and I started another list on the blog. It is for folks with a very different point of view. I started with Squillo's suggestion.

Book mark folder named Wack Jobs.

2009-10-16T05:01:00.000-07:00

A few months ago my Sister was on my computer and was looking into my favorites. She saw my folder marked Whack Jobs. Yes, I had a folder marked Whack jobs and you guessed it, it was for folks whom I thought were complete whack jobs and post their nonsense on the World Wide Web for all to see.

My Sister laughed then told me that normal folks do not have a Whack Job folder in their favorites. I never claimed to be normal. I did delete the folder. Unfortunately, I remember my favorite sights! I think I am addicted to whack jobs. At least I have stopped commenting on their blogs. It never did any good to tell them they were mentally ill and all the crap they are spewing is exactly that, crap. Now that I work in a Psych unit, I realize some of the craziest folks have no idea they are crazy and won't admit it anyhow. Which is unfortunate because until you admit or recognize you are bat sh1t crazy, you probably won't do anything to fix it.

I realize I am a bit crazy. Why else would I become a nurse? That or I have a fondness for stress and abuse. Not sure which?

I would love to do a post where folks could submit their favorite whack job. But that would be mean. Even too mean for me. But if you do have a favorite whack job, you can email me the link. I know I said I was going to quit my whack job obsession. But I miss it. At least I don't reply anymore. I just read, laugh and then go back to my homework. I guess it is a guilty pleasure. Well I must go back to doing homework. I think whoever made up APA guidelines should take their place in hell next to the Jacho folks....TTFN

Birth is inherently as safe as life gets. What an inane thing to say. Life is not really all that safe.

2009-10-08T11:41:00.000-07:00

So I read my blogs this morning. I read Rixa's Freeze's blog. We disagree with a whole bunch of stuff but we are respectful of each other. Weird but true. So she is a daily read alone with Dr. Amy and when Kneeling woman or Squillo do a post, I read them too. But anyhow, I digress. The point is I read a wide variety of opinions.

This morning on Rixa's blog there was a nice montage about a home birth after Cesarean which was nicely done and really made me think. I thought how nice it was for this lady. I was glad the baby was safe and the mom was safe and why can't we make birth better for all mom's and babies? We can and I think eventually if we work hard enough we will. But the montage did not convince me that homebirth is a good idea. I am glad it worked out for this lady and I am glad it has worked for folks in the past.

I went to my new job. I went through my day until I complained that I needed to get home asap so I can dig into the books. That lead to a conversation about my midwife program. And then it led to a discussion....

I am new to this place so I don't know everyone. The lady next to me said, "I have a very close friend who had lost a baby in February." I tuned right in and told her she has my deepest sympathy. And she does! I asked what gestation. Because usually in hospital if a woman loses a baby, it is preterm or previable.

When she said 40 + weeks I almost fell off my chair. She went on to tell me of a home birth with a midwife. No she didn't think the midwife was a nurse. Her friend had been ruptured for 3 days. Went to the hospital that she hated. Her friend is a hospital hater, and the OB did an ultrasound and broke the news that her baby had passed. Where is this woman's empowerment? Who is helping nurture this woman? Who helps her get through the day? The good news is that there are other women who are out there to help.

My new coworker said, "I am a social worker. If I screw up there is a board that patients can submit complaints. If I am found to have bad judgement of judgement that hurt a patient, they will take my license away and keep me from hurting other people." That does not seem to be the case with the midwife of her friend.

ANyhow I got to thinking about the NCB slogans like "Birth is as safe as life gets." Hey life is not safe. We do things to increase our safety. We wear seat belts, we try to get some exercise so we won't drop dead of a heart attack. We protect ourselves when we go into the woods and there are bears or wild animals around. We go with a big gun if we are smart or we don't go at all.

ANd we don't ignore signs of danger. If two men in jail house pajamas rang your door bell in the middle of the night, would you let them in? No you would call 911 and get out your mace. The same thing with birth. I think even Ina May would agree if you have a bad heart rate pattern, or some other risk factor, you may want to mosy over to the hospital but quick. You can always leave the hospital. They cannot imprison you.

The problem with some homebirth midwifes today is not that they want to practice inside someones home. I can accept that. I don't want to do it. I don't think it is safe but that is not the major problem. The major problem is that they want to practice inside someones home and ignore all the signs that something is going wrong with the birth. Or even worse, they don't know the signs that something is going wrong with the birth. They will not entertain the thought that birth sometimes needs some help especially when you have a population that is very very mixed.

The sad thing is that it sounds like that baby did not have to die. But because of someones ignorance or hubris, it did.