VA tape

 BCMS arranges lots of rotations at the nearby VA hospital so we had to go thru the federal background check, fingerprinting etc for access. It was a pain in the *#a.  Last year, I had 5 ppd skin tests, 3 background checks (in which I needed to list ALL of my lifetime addresses & local (to said addresses) people to vouch for my existence there, and two fingerprinting sessions.  The extent of my civil disobedience consists of 3 parking tickets that I accumulated a decade ago by parking in the staff lot at a local community college. I can't imagine how much worse it would have been if I were a naughtier person.

I've lived in 7 states. I had to dig through old letters that I saved to find all my former addresses (15 of them that I could recall- I'm sure I missed one or two..). Then I had to supply references for a) places that I had lived and b) places that I had worked.  I actually used myself as a reference a couple of times.  I laughed when I received the letters "Can you confirm that 'Narrow Room' was a resident here between August 1997 and July 1998?". Why yes, yes I can.

Ironically, the med students who struggled more than me with this insane process were the few who were actually current members of the armed services (and already had partial clearance). The VA required additional paperwork from them. Insane.

But now I have a med school ID AND an official "get thru security at the airport quickly" government ID.  I'm so cool.

But in reflection, the VA sat on our application paperwork for 4 months. I received an email in December that all was in order for my background check. The class didn't get notification until last week, though, that all was in order with our application and we could go to the HR office to press our fingers to the confirmation screen and pose for our (dashing) ID photos. 

Then, two days after this notification, BCMS sent out an email that the background check/fingerprinting for the VA expired that weekend, leaving us just 2 days to get to HR before we would have to start the process all over.

I waited in line (the day before an exam, mind you) for three hours. Apparently, all the VAs in the US operate on two servers so the backup during busy times can be insane. Several of my fellow students did end up having to be re-fingerprinted thus delaying their "go straight thru security cards" by 3 months.

Now I ask: "Why did they have us submit our application, background check and fingerprint us on the same day leaving only 4 days for the processing completion?"  Wouldn't it have made more sense to process the application (the rate determining step), then do the background check?

And this is for (useless MS1s). I can only assume that all new VA staff, those who can actually help the backlog of over a million veterans, struggle with the same stupid delays.

I'm not even going to start on the old Commodore computers they still use....

Friday Night, Weekend pre-Exam

Our first two exams menacingly loom over Monday morning.  I was managing just fine until this past Wednesday, when the lecturer piled 65 densely packed slides of intricate reaction mechanisms over 150 assigned pages of reading. Some of it was familiar; much was new minutiae. Ugh.

She repeated this distribution level both Thursday and today so I now have a mountain of new information to conquer before the weekend is out.

I'm in pretty good shape. I knew last week's material cold and have some familiarity with that of this week. I really feel for my classmates who don't have my chemistry background. They have a Herculean task. I think I'd rather steal the golden fleece, myself.

Anyway, I set up a study schedule and because I'm sacrificing my weekend to the (greater good?) of acing my first exams, I decided to treat myself to a pre-celebratory sushi dinner.

I walked down to the neighborhood sushi bar with my (amazing) Ipad full of notes and readings and snuggled into the banquette at a corner table overlooking the bustling bar.  Glass of wine in hand and saba sashimi on the way, I began to review ubiquitin modification in DNA repair. (awesome right? yawn.)

Losing myself in the notes, I didn't notice the couple next to me until the lady asked me what I was studying. I glanced down at my pad and then back to her smiling face and said. "Biology".

"Oh! Are you in nursing school?"

I smiled at her (I get that question a lot). I'm sometimes embarrassed to reveal that I'm in medical school; I don't want to EVER seem to be boasting and it's the type of confession that provokes preconceptions. Nonetheless...

"Medical. I'm at BCMS." (inner grin-thrilled at the self-reminder)

Gasp. Pause. Blurt.

"I've never seen a chubby med student before!" I could tell by her face, she was mortified at what slipped out.  I couldn't help my sharp shocked bark of laughter. Sometimes people just say the most awesome things.

"Oh. They make rare exceptions for really brilliant applicants." This was one of those rare times when my witty comeback didn't wait to 'come back' several hours after the fact.  Hee. She and her friend quickly settled their bill and I ordered a second glass of wine and some edamame.

I'm so glad I did! The next resident of the table turned out to be an adorable late seventies gentleman in a straw boater with a pale blue ribbon. He was unfamiliar with sushi but looking to be adventurous. We chatted; I gave him my recommendations and he told me about trying new things since his wife died.  I 'wasted' an hour of study time (totally worth it) meeting the character I hope I become when I grow up.

We left at the same time, hugged outside the restaurant and I turned to watch him stroll away, dapper with cane in hand.







 

Orientation Tomorrow

My anxiety has evolved into anticipation. I spent the evening checking and rechecking all my to do lists confirming that everything is, in fact, done.  I'm really excited.

Tomorrow is going to be mostly routine legalities: computer class, bursar's office, fin aid, security for parking and ID badge, student health etc.

Tuesday and Wednesday will consist of 'meet everyone even remotely affiliated with BCMS' talks. Deans, class leaders, volunteer services, student support services, advisors, student advisors, med spanish group, security systems, the janitors, patients who haunt the ED and the guy who rides his bike past the hospital every day all have an hour slot to tell us what they're about.

Thursday and Friday are the CPR classes. Luckily I'm slotted for Thursday so my first med school weekend is a 3day! Booyah!

Well, except for the "voluntary" day of service on Saturday.  Actually, I looking forward to it, it being the first time I'll really engage in my new neighborhood.

I leave you with a few photos:

Teton Range: Middle Teton is the far left peak

Me on Middle's summit with the Grand at my back

Even the homestretch had stumbling blocks

I know, I know, climbing a mountain is so cliché but the pimple on my chin looks exactly like the Grand Teton and I couldn't help myself. These photographs have the double contradictory effect of lifting my spirits and keeping me humble.  After my photo is taken twice tomorrow, once for the ID and the other for the composite class photograph, I'll carry (literally) the memories of my climbing adventures all through school.
 

Oh Brother

Sometimes, my oldest brother has a way of making me feel as small as a flea. I love him desperately; he was even more excited about my first acceptance to school than I was. I can remember the look of thrilled shock on his face when I told him. Everyone should have someone to be so genuinely, unselfishly happy for them. I’m fortunate.

That said, he’s a freakin’ type A, control freak, micromanager with so-not-his-business. Argh. I called him today to chat. We take turns calling and so usually talk several times a week. I mentioned meeting an aunt for coffee and visiting our maternal grandmother in the afternoon.

Gram took great pleasure in reliving some of my “stubborn little pip” anecdotes. She and my aunt laughed at memories of me, a naked 4 year old interrupted from a fight with her brother, claiming that “Just because little girls are staying with their grandma, doesn’t mean that the grandma OWNS them.” Apparently, I was aware of my civil rights even at age four. I blame my mother.

I gave him quick updates on several of our cousins then mentioned finding sprigs of pussy willows on a walk. I have bouquets of willow shoots, winterberry and dried hydrangeas, pretty, easy to maintain and much much cheaper than fresh flowers. He’d always admired my displays when visiting.

Anyhoo, I also mentioned that when I went to the market I noticed that sashimi grade tuna was on sale for 7.99/lb and splurged on a filet ($5.28). I was excited to indulge myself on this weekend off.

His temper exploded and he ranted. How I can’t expect to pay for school, our shared mortgage etc, if I can’t budget my income… blah blah blah.

Now. I. Am. A. Freakin’. Penny. Pincher. I can satisfyingly squeeze a week’s worth of meals on a $30 budget with some creative use of spices and inexpensive staples (quinoa, eggplant, cauliflower etc.). I am also a master of the free/cheap entertainment: volunteering with the zoomobile for a free season pass to the zoo, free city wifi and no cable TV, forgoing downhill skiing for cross-country in open parks. I haven’t seen a movie in the theatre in years. Other than a few pairs of (clearance-no grey’s anatomy for me) scrubs and my interviewing suit, the only clothing I’ve purchased in the last 2 years has been socks and underwear.
I don’t mind. I’ve always been pretty low maintenance, but hell if, at 31, I’m going to be explaining every little purchase to anyone. I told him so. It escalated. Dammit. He’s just like our father; careful, loving and thoughtful but rigid, old-fashioned and by-the-book.

I remember being a teenager and chafing against my father’s restrictions. It was the primary motivation for my moving thousands of miles at eighteen to work for national parks. Every time that I jumped out of a plane, hitchhiked to the rodeo, climbed a difficult mountain or pushed myself past things that scared me, I thought “so there!” to my father.

Right now, I’m garnishing my tuna in a lemon wasabi remoulade (less than $1.50 to make- even with locally raised free range and hormone free eggs) sipping a glass of prosecco ($2.25) and thinking “so there!” at my brother.

Addendum: My brother, bless his soul, sent me an apologetic message a few minutes ago. He and my (favorite) sister-in-law have been under unrelated stresses and he didn’t mean to take it out on me. * sigh * How can I maintain my rebellious angst (damn you! Camus and Morrissey) when my family is so bleeping awesome?

Hovering

So my nurse manager has been present on the unit later than usual these last few days. He’s interviewing graduate nurses for our summer influx. Between his interviews, he hovers around the desk. I think it makes the nurses nervous, but I used to work for an honest-to-god narcissistic personality disorder with an impulse control problem. Mauro used to chase us down the restaurant screaming and spitting in front of the guests, just to make sure we dropped a check in a timely manner. He was CRAZY. Hovering Nurse Manager (HNM) is easy-peasy in comparison.

It’s actually been great. I think he’s finally seeing how busy our shift can get. Yesterday, the phone was ringing nonstop, the call bells dinging and two of our surgeons were piling their charts haphazardly across half-wall of the nurses’ station. BAM! Two of the charts fell and exploded like ticker tape flutter across the floor.

The nicer of the surgeons picked up the mess and brought it to me to reorganize. The other surgeon complained to his PA about the cheap folders the hospital uses for charts. HNM whispers to me that maybe he should call another nurse in. I snorted and said that it was calm compared to the previous day and he turned new eyes toward the scene.

The resident, interrupted by her pager and a call from the covering attending, swore during her dictation. As she rushed to the PACU (something about p-waves), she called out a verbal orthopedic consult request to Mean Surgeon. He turned to Lackey PA and snidely commented that she was going to save a life. HNM turned to me and asked if I had heard her swear. I mentioned my childhood with brothers and an acutely developed selective hearing. People swear. There are bigger things to worry about.

As I shuffled through the disordered progress notes, we chatted. I mentioned my love of Nick Drake and the new discovery of Damien Rice’s music and HNM said he totally digs him! How awesome is that? I am a little resentful though that so many people have known about this great musician for so long and didn’t share the riches (Yes, I’m talking to you, Solitary Diner ☺).

I notice that the admission orders for one of the charts being reassembled demands that the patient (admitted last week) be under cardiac monitoring. OOPS. I point it out to Nurse Manager then page Cursing Resident. She calls from, ironically, the telemetry unit. I hear in the background: “GI Bleed-rapid response”. I hand the phone to HNM who takes a telephone order to discontinue cardiac monitoring.

I update the Kardex, manage a new flurry of phone calls and flag down HNM to record a critical labs result. I admit it is nice having an RN at the desk. Normally our charge takes a group and so I’m left responsible for all the mechanics of unit flow. Though I like having my finger on the pulse of the action, it sucks that there’s such limitation to my scope: I can’t take telephone orders, record critical lab results, verify medication orders or ‘waste’ narcotics (verify the use of only a partial dose) for the nurses. I sit helplessly waiting for someone certified to have time to step in.

I often stay late to finish up everything I’m allowed to (checking diets and labs, stuffing charts etc) but it sucks when there are dozens of charts to be checked (hours of work) and I’m on the elevator waving goodbye at the bleak faces of nurses with a longer night ahead of them.

This week, I hope that HNM realizes how much work gets delayed because he doesn’t schedule a nurse to run the desk after 1500. I really think that if the powers that be break it down, it would be much cheaper to eliminate my job and add a nurse to the roll call. Having a nurse at the desk would likely eliminate at least 6 hours overtime every night. That combined with my income minus said nurse’s wage would amount to more than $45,000 saved for the institution every year.

Laundry Pieces and Admission Oppositions

Laundry had piled up. It had overflowed from my hamper in the bathroom sprawling into the hall. Plus, I was completely out of clean underwear, even the old granny panties formerly buried deep in the bureau. So I spent the morning, and two rolls of quarters, at the Laundromat, armed with two months of un-listened to news and politics blurbs on my Ipod. I am now caught up, sort-of, in a dilettantish way, on world mechanics.

I was listening to the NPR weekend edition podcast “In Today's Economy, How Far Can A GED Take You?” from 2/19 and the closing music was the instrumental of Dar Williams’ “February”. It’s my least favorite song on that album; I prefer “Southern California Wants To Be Western New York”- mostly because I was once (still am? ) a mousy SUNY student composting in long underwear and the idea of being lusted after… a lovely novelty. Still… I love NPR ☺

Also fruit flies that drink alcohol are protected from parasitic wasps who can’t hold their liquor. It’s self-medication of an awesome sort. Courtesy of “Cheers! Fruit Flies Drink To Their Health, Literally” from weekend update 2/22.

I went head to head with admissions last night. Our unit was one patient away from its limit. Our nurses are not supposed to have more than 7 patients (which, in my opinion, are still way too many, particularly with the acuity we often have on our med-surg floor. It’s dangerous). Anyway, we had been slammed with 6 admissions/add-on post-ops, all within an hour when we got the call for the final one: 50yo man 400lbs AMS and oozing cellulitis, combative, infected with everything that you can think of, bacterial and viral. Bah.

I studied the census board and then called down. We’ll need to move these ladies together, transfer that dude to that room and then we’ll put Conan into this bed.

Admissions response? “Just put Conan into bed 36A.” I could hear her eyes rolling through the receiver.

“We can’t put Conan there. The roommate just had a major surgery. You don’t put infected patients in with surgical. Besides he needs to be closer to the nurse’s station. We don’t have enough staff for a sitter.”

She argued.

Jeez. Did she think I was just looking to occupy my time? We were crazy busy on the floor and who would be doing the actual physical transfer of the patients and all of their belongings and update all the computer records, charts, assignment sheets, ADT book and kardexes? ME. All she had to do was enter in a few keystrokes.

More arguing.

I called the nursing supervisor. She came up, glanced at the census and then called down to the admissions office.

She !!still!! argued but, eventually, the lady in admissions acquiesced and plotted the patients.

Seriously.

Drink of Choice

It was a very busy day at work tonight. The hospitals in the area are at red alert; maximum census. We traded and juggled patients within our unit and with other floors to maximize bed usage. I'm the one responsible for making sure that, in these situations, the patient's television and meal services follow him/her.

We have different bed models and I have to make sure that the model bed in the room is suitable for the particular patient. Some beds can support the trapezes used by the orthopedic patients, others can't. Some beds can be lowered closer to the floor for the lols and loms who have trouble getting up. With a dozen discharges and admits/transfers, it can get fairly hectic.

All in all, there were dozens of little tasks that needed to be balanced throughout the night. Charge and I, deflected some of the stress fantasizing about paradise. It didn't include 72 virgins but rather several handsome men (we decided that we didn't need as many as 72), tropical beaches and endless backrubs and beverages.

Anyhoo, I mentioned that I don't care for most liquor but that an occasional scotch is divine.

One of the nurse's came back to the desk as I was describing my drink of choice: a rich, peaty scotch with hints of wood, straight up.

It wasn't until she laughed that I realized that it sounded like I was mixing my fantasies up. And so a new euphemism 'sipping the scotch' was born into our unit vernacular, joining, among others: "nasonexing the gift" -another sexual reference whose etymology is convoluted and traces back to the behavior of one of our frequent flyer patients.

Oh the things we come up with....

Tantrums at Work

One of our exclusively elective surgeons is on vacation and so our unit census is low. When this occurs, our scheduled staff rotates either floating to another unit or gets called off.

This nurse arrived, saw that a coworker was floated and proceeded, behind the closed door of the breakroom but perfectly audible down the hall, to shout, slam things around and basically throw a ten minute tantrum worthy of an ambitious two year old.

Why?

Apparently, it was her turn to be called off and she's so sick of other units 'taking advantage of our low census' and 'stealing' our staff.

Wow.

Directions

One of the new attendings came up to me today and asked for directions. She was new to the area and not sure on how to get home. She lives next to a major landmark and the drive is pretty straight forward from the hospital, a two-turn trip.

Because she seemed so dubious about my verbal directions, I drew a little map.

Still hesitant, she gratefully watched as I pulled up the google maps version.

Aha!

As she was walking away, I called out: "do you want the map?"

"Oh no, I'll just GPS it. Thanks."

We all laughed about it the rest of the night. So ridiculous!


BTW: Interview invitation Numero Dos esta noche!! ole!