A Fierce Competition

Where it all began.  Just wait to see what
these become....

Fall is my favorite time of year for many reasons.  One of which being the mother/daughter apple bake-off!  This was our third year baking and we decided to do coffee cakes.  Everyone gathered at my moms in the morning with baking gear in hand and we headed to Jewel to "pick" our apples.  Since it was such a poor growing season, we didn't even bother going to an orchard, plus there was a full day of baking ahead of us.  Coffee cakes are no joke.  My mom told me she had a recipe, but by had a recipe she meant she had a barely readable copy of a recipe and was going to pretty much wing the entire thing.  I just went with it..  With apples in hand and snacks to graze on all day we headed back to get our bake on.  After a friendly champagne toast, it was serious business.  We baked for hours.  Around 3 or 4 our judges started to arrive.  We had pre-printed score sheets for them to judge on the following categories:  Appearance, Crust and Filling.  It came down to a tie with Angie and her mom missing it by 1 measly point.  Since my mom and I won last year we let Carla and Lee have the apple this time.  Next year it's already decided that Apple Cakes will be next...  

Apples picked and ready to roll!

Angie made this beautiful cocktail beverage
to toast off the cook off.
We had all things apple that day 

When the apples don't pour out,use your hands.
Besides, we're all practically family...

Lee can hold his own in the kitchen

Team work at its finest and yes, we have matching aprons!

Carla pretending to do something....
jk, her and Lee were a great team

Lori is a true baker and so knowledgeable too!

Trying to put our vision together.

So maybe I should have drained some juice before
I dumped the apples onto the crust. 

I don't know if this is Carla peeing in her pants because of
the excess liquid from my apple mixture or the effects of her
coffee cake rising ..

you be the judge... does this coffee
cake look like Jabba the hut?

Mar was kind enough to make two crock pots full of
chili for everyone.  It was soooo good!

The fruits of our labor.  Appearance can sometimes make
or break first place.

Judges getting ready.  This is kinda a big deal.

While a tie, we handed the trophy over for the year.

Angie and Lori didn't go home empty handed.  They may
have gotten the best awards in my opinion.

"Where kids come first"

Lurie Children's slogan is more than just a slogan, I have come to find it is a work ethic and a mission that the staff take very seriously.  I seem to be fitting in with that vision too.  I've been working for almost two weeks now and I am just shy of obsessed with my job.  When talking to my mom and aunt brina about my first day on speaker phone last weekend, aunt asked "Do you think you found your calling?" and I think I just might have.  My job description as a student nurse assistant is pretty simple and the same as any SNA at another hospital:  check vitals, change beds, help kids wash up, measure I & O, stock rooms for new admissions and strip rooms after discharge.

What I love about my job is my clientele.  The kids are amazing!  I love that I have to check in with a patient before I leave for the shift because he wants to show me another magic trick.  I love that I get to bring a crying girl a popsicle after the IV team put a new IV in.  I love that I can teach a 4 year old boy that his name starts with the letter N.  I love that I can have a mini dance party to make a 9 year old smile before transport comes to take them down for a procedure.  I love that I can sit and rock a 2 1/2 year old to sleep because he cries when left alone in his room.  I love that I can relate to a patient's Justin Bieber fetish.  I love that I can boost the confidence of a wheelchair bound child by commenting on their "guns" and how strong they are.  I truly love my job!

I've had patients aged 7 weeks old to 21 years old so every day is something new.  I've worked on a neuro floor, a respiratory and infectious disease floor and a transplant floor.  I've caught on pretty fast and this week the CNA that proctored me said while he's trained about 100 nurse assistants, I was by far the best and was going to be an awesome nurse.  He kept saying I saved him that day because he had a heavy caseload with kids that needed vital checks every hour and some every two hours.  Today, when I was making my final rounds and saying goodbye, a patient told me she didn't want me to leave because "I was so nice and funny and pretty." She might be a slightly delayed, but she's got enough going on upstairs to see my true colors!  Next week I hit up the hem/onc floor (blood disorders and cancer) which people keep telling me is where the sick, sick kids are.  I am looking forward to seeing if that is where I really want to be after experiencing a week in the life of...

The Beauty of Birth

I am coming to the end of my OB experience and I must say it has touched me in a way I never thought it would.  I was able to witness two births this week during my labor and delivery rotation and it was indescribable, but I'll do my best to try.  It started at 8 am when this lovely couple came in for an induction for their second child.  We got them settled and acquainted to the room.  Mom was really nervous about labor and delivery because she vividly recalled her first delivery where she was in stage 2 labor (10 cm dilated and 100% effaced to delivery of baby) for three hours which ended in a forceps vaginal delivery with lesions to the perineum and the epidural wearing off.  She came in and we started her on a slow pitocin drip.  She had been 3 cm dilated for 3 weeks now and after a few hours on pitocin she had only dilated another cm but contractions where now 3 minutes apart.  The doctor was notified and because he was busy with another surgery he said decrease the pitocin because he didn't want her delivering until 4 or 5 that night.  It was a little disheartening to turn things down when the couple a) had a horrible first labor experience and wanted to get it over with asap and b) had told their little preschooler that she could come see her sister after school.  These are the things we never tell the patients, we just make the best of situation and see where things go.  I told her that the pitocin jump started the process, but we wanted to see what her body would do and hopefully their daughter will have a sister by the time she got out of school.  She had a hunch we were working on the doctors schedule and when she mentioned it, I just kinda smiled at her.  Since we were slowing things down and she was still only 4 cm dilated I went to lunch.  No kidding, 30 minutes later, my instructor was rushing into the cafeteria saying your patient is about to give birth.  I rushed up stairs and when I got into the room, the babies head was already out.  It literally took 3 more pushes and she was out.  Total time in stage 2 labor.... 15 minutes!  Her doctor wasn't going to make it in time so they had to use the "doc in a box" or better known as the on-call doctor.  After getting APGAR scores and vitals we wrapped the baby up and handed her over.  The couple was still teetering on two names and asked me, of all people, what I thought she should be named.  I had to plead the fifth.  That is no decision for a student nurse to make.

After that my clinical partner's patient had a sudden decrease in fetal HR. She went from 120 to 60 bpm for six minutes.  Everyone was rushing into the room, the pediatric recover team was called for resuscitation and the NICU was notified that they'd be getting a new patient.  There was an army in the room already so I just stood at the nurses station staring at the monitor hoping either that the HR would increase or the baby would deliver so they could start reviving him.

FHR Monitor Strip

(Teachable Moment: a fetal heart rate monitor will tell you the baby's heart rate (the top graph on the monitor strip) and when the mother is having a contraction (the bottom graph on the monitor strip), but it doesn't show the intensity of the contraction.  You need to feel the mothers stomach during a contraction to know how strong it is.  If it feels similar to what it feels like when you press on the cartilage at the tip of your nose it's weak, like your chin it's medium and like your forehead it's considered a strong contraction.)  Now back to the story.... The baby came out floppy and not making any sounds, but everyone was there to start interventions and within five minutes of delivery things were looking promising.  Still the baby was brought to the NICU for close watch.

Later that day I saw a c-section.  The baby had a heart condition where the doctors felt he wouldn't handle the stress of a vaginal delivery.  Rather than taking the chances they scheduled a cesarean section.  I was able to talk to mom in the OR as everyone else set up and did counts.  She looked petrified, so I thought small chat would mask some of those emotions.  Now one might think a c-section is the easy way out.  You cut, you pull out the baby and voila!  Oh no.  You cut a little bit and then you pull and tear and stretch the abdominal muscles.  Pulling allows for a quicker recovery than cutting.  Then after getting through the  fat and muscle and fascia they finally reach the uterine muscle.  With one little slice from the scalpel fluid comes gushing out.  The residents forearm literally disappeared into the incision and fished around for a while.  Then a leg came out.  It was just one leg out for a while and they tugged and pulled on that leg a lot.  I thought babies just slipped out with c-sections, but I was wrong.  It reminded me of the dairy farm video Aunt Gam has where the calf was stuck in the cow.  After a couple more twists and tugs, the baby was out.  It was a crazy day, but Im glad to have this experience with me forever. However, I still can mark this off my list... OB nursing is a no go!      

Run Chicago Run!

October 7, 2012 was an exciting day in Chicago.  It is hard to believe, considering I've lived in the city for a while, but I have never gone out and watched the marathon until this year.  My pathophysiology instructor is has been on the head medic team for a few years and a while back she made an announcement to our class to volunteer in the medic tents.  It sounded like an amazing experience so I signed up.   As did 20+ other nursing students from our cohort.  

Since I had to be at Grant Park at 5:30 am, there was nothing exciting on my agenda for Saturday.  Anne wanted to make posters for the runners and they had a little cheer group for Team Bear runners.  I love crafts and glitter so I was in.  We made a nice dinner had some glasses of wine and went to work.  The toenail and balls posters are my works of art.  

I didn't think they'd take that long to make, but I ended up heading to the marathon with only 4 hours of sleep.  As I was getting up and ready for the big day, Tyler was texting me to see if I was home because he was going to have people come over after going out.  I appreciate the consideration for my sleep, but how sad...he's just coming home and I'm already getting up for the day.  I had to chuckle as I was walking to the red line and the bar staff was still cleaning up from the Saturday night crowd.  Now any other weekend I would have opted for a cab at 4:45 in the morning, but marathon weekend the el is filled with runners and supporters.  It's a very positive, non-threatening environment and you could already sense the energy and excitement even before the sun came up.  

I made it to the volunteer village and there was already a vast crowd of people standing around.  I suppose a 45,000 person event requires a lot of volunteers.  I picked up my "all access" medic team badge (oh yes I said all access), and free nike marathon jacket and hat.  The other Rush nurses and I stood in the line for breakfast with no idea of what the day would bring and what was expected of us.  It was a little unorganized in my opinion and didn't get much better.  We went to the main medic tent that we were assigned to.  It was on Balbo at the end of the race.  There were three sections:  Critical Care which is easy ache and pain stuff, maybe some ice, General Care, where we had cots laid out and vitals would be checked, IV starter kits were available, warming blankets etc. and an ICU section where we would bring the extreme general care cases.  I was assigned a general care position.  After we got the scoop on how the day would go they allowed us to go see the start of the race.  Since we had our all access passes we were right up next to the runners.  I couldn't believe the clothes that were left behind when the runners got the cue to advance to the start line.  The street was literally covered with sweatshirts, jackets, pants jars of vasoline, garbage you name it and the regular volunteers would go pick everything up and throw it to the side before the next corral advanced.  It was comforting to know that all the clothes would get donated.  We were cheering and and giving high-fives as they jogged by the start line.  One guy was running his third marathon without shoes on and says he never has a problem.  

As the race started it kind of resembled herding cattle, but again with 45,000 people running you need a good system.  I think it was a 2 hour process to start everyone which is kind of funny because as the last runners were leaving the start line, Kebede of Ethiopia was finishing with a course record time of 2:04:38.  By then we were back at our station in the medic tent just waiting for runners.  The people that finish first rarely have medical issues because their bodies are trained to do this.  It's the ones that wake up one morning and say, hey I'm going to run the marathon this year that we mainly see.  I think because we had optimal running conditions, things were kinda slow, but there were a few good cases I got to get my hands on.  The worst was a guy who came in shaking uncontrollably, feeling like he was going to pass out and hardly able to walk.  They put his feet up and started their assessment with basic vitals.  Because we need accurate information and fast, we only take core temperatures and for those of you who don't know what that means it means we put a thermometer about an inch up your butt.  Just an FYI for you runners out there.  Well this gentleman instantly had a temp of 103F.  We grabbed bags of ice to put on his groin and neck, they prepped him for fluids by starting an IV line and they drew blood which I rushed to the lab station to get electrolyte and blood gas levels.  Before I could even get the lab values back he started to have mental status changes so they took him into the ICU tent for more aggressive treatment.  I don't know what happened to him from there.  

Most of the cases were not that intense though.  I had a guy who ran his third marathon and got a PR but cramped up all over at the finish.  He ran his first marathon in Japan.  Another patient was a doctor at Rush actually, who was running for asthma until his cramped up and lost his breakfast three times at mile 17.  Good thing charity donations are not contingent of finishing.  I loved hearing everyone's running stories but I didn't forget that I needed to get the PQRST for their charts.  It's an assessment tool nurses use to get a good picture of the pain patients feel.  Here are a few examples for each category.

• Palliate/Provoke:  Is pain relieved when I do this?  What makes it worse?
• Quality:  Describe the pain:  sharp, shooting, dull, aching etc.
• Radiate:  Does pain travel anywhere or is it isolated in one spot?
• Severity:  Rate pain on scale of 1-10
• Timing:  When did it start?  Does it come and go?

While exhausting it was a great day and it would be a pleasure to do it again.  Im looking forward to next year, especially because Chelsey said she'd volunteer to be a massage therapist too!

Bound for the Looney Bin

I just finished my first week of work.  It's pretty official now.  I am an employee of Lurie Children's Hospital and I have the ID badge and key fob to prove it.  I had orientation Monday which was pretty generic and very lackluster.  It was for all new employees and I mean ALL from head chef to security to finance to shipping to research to interns to gift shop to nurses and everything else in between if you can imagine.  We went over benefits and insurance plans which I have come to terms with the fact that I will never understand.  Orientation went from 8:30-4:00 so I had to miss both of my classes that week and to top it off we had a test so I needed to make that up.

Since my weeks are very hectic it only worked out that I could make up my test on Tuesday.  Im telling you I am getting pretty good at this balancing act.  I started my day by going  to Children's early to sit in the sky lounge and get a last minutes study sesh in before day two of orientation.  Day two was a little better because it was more interactive.  We had to sit through this "diversity training" class for the morning and then met with our managers and nurse educators in the afternoon.  I had to skedaddle after lunch go to Rush and make up my test (which I was 10 min late for because the el was taking forever).  My teacher was like take a breath and then put your stuff down and she gave me ample time to finish.  I didn't really study and showed up late for the test yet did 10% better than the first test we had.  Perhaps this should be my new approach to tests for the rest of the program.  I think I wasn't over thinking or second guessing myself on this one.

That didn't end my day though.  As soon as I finished my test I had to turn around and go back to Children's to meet with Ann, the nurse educator, because my first day on the floor was saturday and that was the only time she could meet before then.  We went over scheduling, policies, the computer system, and many other things.  Because I had clinical up in Evanston at 7 in the morning the next day, she didn't want to keep me too late and pretty much went over the "need to know" info on the floor.  I knew how to clock in and where to go, the rest I'd just learn on the job.  Ann didn't seem too concerned though.  She said my biggest challenge was going to be shutting off my brain and assuming the role of the nurse assistant, not the nurse.  That's okay with me though.  I have no problem sitting back with less responsibility and learning from the nurses on the floors.

I keep telling myself there is an end in sight and I am so lucky to start doing what I think know I want to do while still in school.  This job will open a several opportunities and I will forever be able to write Lurie Children's Hospital of Chicago, a nationally ranked pediatric hospital, on my resume.

Beary Busy

So I feel like Im at a point where I am stretching myself thin again.  I have a habit of not being able to say no and over extending myself.  After this week I will start orientating at Lurie Children's and that will trump these volunteer opportunities I've been extending myself to.  Not that I don't want to do good out in the community but there is only so much a lady can do.  From here on out I am narrowing my focus:  School, Work, Bear Necessities, and SNA.  That is more than enough to keep me busy.  Before then there are a few obligations that I was happy to volunteer to fulfill.  

Yesterday I worked a Flu Vaccine Clinic at Rush.  I probably gave 180 IM injections to students, doctors and staff and that's no hyperbole. I had a ton of fun and loved prepping that vaccines, giving the patient a quick hello and then a shot and then having most of them tell me that was the most painless shot they even had.  Now I'm not going to lie, some flinched and said ouch, but I attribute that to their sensitivity not my skills  ;o)  One lady was petrified of shots and insisted that I tell her when I was going to stick her.  I was like okay I'll give  you a 1-2-3 count.  The anticipation of the shot is the worst so I stuck her on 2 and was pretty much done by 3.  She said that this time wasn't bad at all.  Come Sunday I will be working the medic tents for the Chicago Marathon but after that, I am done with the volunteer work. 

Bear Necessities has had a lot of stuff going on in the past month and I've loved being a part of every minutes of it.  I am a member of the service committee, which focuses on events for the families and children that are faced with pediatric cancer.  Late September we had our Annual Teddy Bear Ball at Lincoln Park Zoo.  We rent out the pavilion and give families a chance to relax and enjoy time with each other in a non-stressful environment.  It was our biggest year yet with 35 families and over 100 people.  There was a face painter, games, a DJ and a plethora of crafts.  I of course woo-d all with my crafty abilities.  One kid was making a web out of pipe cleaners so I made him a spider.  He thought it was the coolest and kept finding me to teach him and make more.  By the end of the day he had a mom spider, a dad spider and a ladybug wrapped up in the web for their dinner.  The kid was a hot mess, shoes untied, hardly wore his jacket and had snot running down his nose continually, but is was a day not in the hospital and I could see in his mom's face how happy she was that that day he was able to just be a kid.  All the kids were all full of energy and had a blast.  This year was exceptionally special because we also gave away laptops to children that won a contest when they wrote about their story.  I can't wait for next year with anticipation that it will just get bigger and better.

laptop winners

These kids were so cute.  The little girl was adamant about
getting a bulldog face painting.

The spider kid

A huge success

You should have seen this girls excitement when the DJ
instantly played her Taylor Swift request.

We also just had the 18th annual 5K run/walk out in Algonquin.  It was a beautiful sunny morning and the perfect temperature.  I of course walked opted to walk it and my friend Brook brought her dog Clementine along for the hike.  I came in 26th in my bracket, which happened to be 500th overall.  I like to look at it as I beat over 100 people.  I was very disappointed when they only gave out metals to the runners and not the walkers since I anticipated adding to my collection, but I quickly got over it.  There was a pancake breakfast to follow and touching speeches from children and parents.  There was a team that walked in honor of their 9 year old son Jake who passed away 5 months ago.  They raised over $3,000 for Bear Necessities.  I remembered this kid from our public service announcement because when asked what he wanted to be when he grew up he replied, "a good dad" which I thought was the sweetest thing ever (give the link a click).  It was hard to fight back the tears as his mom gave her speech.  It was another amazing Bear Necessities event and it is unfortunate that this is the last year they are doing it.  It pulled in over 600 people this year and it's great to reach out to the suburban crowd, but the volunteers are just burnt out.  I am hoping aux. board can pick it up in some fashion.

You won't find me in this picture.  I was way in the back.

Jake's parents representing Team Jake

Next wednesday we are having Oktobearfest.  I am really looking forward to it and hope it pulls in a big crowd.  I have spread the word and hope everyone who says they're coming does to make this another successful event.  If you aren't busy and want to come on out to the Bird's Nest I guarantee it will be a good time!  

  

  

Thoughts on Childbirth

So I started off this quarter thinking I'd be more petrified about child birth the more I learned about the process.  However, as I am learning more, I'm actually finding the exact opposite and my hypothetical birth plan has made a hypothetical 180.  Now that may be easy to say being that I am by no means close to the actual thing, but I think if the time comes I want to try to stick to my guns and here are my reasons why.

Epidurals
I use to be like, yes please.  Why would I want to be in pain if I didn't have to?  Truth is epidurals start a downward spiral to medical interventions.  When on an epidural, labor is prolonged and usually does not progress as well as it would naturally.  When labor isn't progressing to the doctor's convenience, pitocin is used which causes more intense contractions more often.  The pain issue is revisited and it is likely that your epidural dose gets increased.  This in turn slows progression so more pitocin is given and it becomes a vicious cycle.  While pitocin mimics oxytocin, the natural hormone of labor, it is not oxytocin and the maternal brain doesn't recognize it, making it harder to control pushing in Stage 2.  Uncontrolled pushing will lead to an increased risk for tears and episiotomies.

Cesarean Section

I am grateful that modern medicine has discovered a way to quickly remove a baby from the whom in emergency situations for if not, you might not be reading this blog.  However, elective cesarean for the convenience of setting a date and fear of pushing though the pain is ridiculous.  It is major surgery.  The recovery time is longer, the risk of infection drastically increases.  The list goes on.  It seems to be the only field where surgery is a readily accepted alternative even when evidence of best practice is lacking.  The US is the only country that will express through labor with elective c-sections when no complications exist.  There is no "time frame" that a baby needs to be delivered after the water breaks.  As long as the fluid is clear and odor free you can technically go as long as you need to.  It's like they want to get you through so they can get another person on the table or more likely, go home.  When looking at the rate of c-sections, they are highest around 4pm and 10pm, the I can make home for dinner and I don't want to be here all night times.

The body does miraculous things when pregnant.  The body mimics heart disease to compensate for extra blood volume, the thoracic cavity expands before major changes in fundal height, a mucus plug comes out of nowhere to form a barrier against ascending bacteria, and don't even get me started on the placenta.  How the maternal body just creates an organ out of nowhere baffles me still.  Sure there have been advances in medicine with regard to childbirth, but some of those advances have also lead to increased deformities and even death.  The thing is, it isn't until 10+ years down the road, when there is enough data available, that researchers can link the drug to the ailment and take it off the market.  I feel we sell our bodies short on the last step of pregnancy and we should allow it to work like the well oiled machine it is during labor and delivery.  However, if that is not your outlook I completely respect that and don't think any differently of you.  You may be thinking this is a rather opinionated post, but bottom line is childbirth is probably one of the most exhilarating experiences you will have and you should do what you think is right for you and your baby, uninfluenced by others.     

I find it interesting that Americans spend the most money on childbirth, yet we have some of the worst results compared to other developing countries.  It makes you wonder whose best interest is really at hand here because it doesn't sound like the mom's or the baby's.  In 1900 95% of births took place at home, by 1938 about half and since 1955 over 99% of births were taking place in hospitals.  Babies are a business just like everything else in a capitalist society.  Now I shall step off my soapbox...