I have neglected this blog. Although I did write some this year, I never posted.  I *should* say because school was so intense and I felt terribly crunched for time, studying, working, class, clinical… but that’s pretty far from it. It was more that I was only rarely inspired to write, and the few things that got me upset, or riled up, thinking non-stop — well, they often were either 1) quickly resolved through great conversations with new nursing school chums or 2) fundamentally rooted in my own personal conflict and not great blog-fodder. Yeah, things really haven’t changed.

Well, maybe a couple things have. I value sleep *way* more than I did as undergraduate. And I’m getting much better grades.

But in bullet form: Med-Surg was sheer chaos. Pharm, mere memorization. Anatomy gruesome, but great. Psych, a personal triumph. Peds, just boring — Med-Surg Jr.  Made $25 and a fool of myself in Issues in Nursing.  And Maternal-Newborn is proving to be my second calling.

Come July, Community Health will take me back to Boston… and then the nursing gods will give us five, all too short, weeks of respite.

The year has flown by. To think that it’s been almost a year since I left Boston is… impossible.

It’s been hard work, frustrating and tedious at times, often wonderfully rewarding and exceedingly boring in the same two hours. It has been less rigorous than I expected, the teaching far more inconsistent, the classmates more exceptional, the debates more emotional, the experiences… honestly, more mundane.

But I am still very glad to be here.

This first year is kind of oddly organized, with some classes lasting only a few weeks, some lasting a normal semester, some carrying on partway into the spring semester. But we all begin with Biomed (basically a crash phys/pathophys course), Intro to Pharm, and Med-Surg, which has both a clinical and seminar. About half of us (myself included) will also be taking Anatomy over at the med school.

GEPNs have classes two full days (MTh) a week (plus Fri afternoon if you’re in Anatomy) and two days of clinical (TW). We haven’t yet been given our clinical placements for the med-surg rotation, but we were given some idea of what the possibilities are and are aware that we have about zero chance of getting what we might think we want. But there’s a good mix of possibilities, all guaranteed to kick your ass and make you cry. We’ll be in groups of six students to one preceptor, and we’ll have six weeks at one site, and then six at another.

I can already see the fear in some of my fellow students’ faces. And I’m sure my hands will shake the first time I have to insert a foley or place an IV. But I am thankful for the experiences I’ve had that give me a little bit of confidence already, and take a lot of solace in knowing that hospitals are comfortable places for me. I’ve read hundreds of charts. I’ve interviewed scores of patients. I’ve drawn blood and sent labs. I’ve seen very sick people doing the gross things that sick people can’t help but do. I’ve seen death and trauma and anguish and I’ve watched great RNs handle all of these things with the utmost professionalism, grace, and humor.

So I’m ready to get my hands dirty and help them out. Let’s roll.

1. Don’t run from the police. That rarely turns out well. Doubly true while on a motorcycle.
2. Remember, cartoons are for entertainment purposes only — Gunpowder is not a toy.
3. Don’t get your octogenarian mother completely, totally, shit-faced drunk and then wonder why she’s having gait instability and slurred speech.
4. The Vagina: Not an approved storage device. For anything. Like, say, drugs. Or glass drug paraphernalia. Cuz that shit *does* show up on X-ray.
5. If you’re an IV drug user, don’t inject other things that might have once contained drugs. Like month- old wads of cotton.
6. If you’re an insulin-dependent diabetic, don’t embark on a solo multi-state road trip without any.
   
7. If you’re allergic to peanuts,  don’t get drunk and have a Butterfinger.
8. If you’re male, intoxicated, and your wife/girlfriend/sister/mother/any female bystander says “I don’t think that’s a very good idea”, cease and desist, immediately. Particularly if your plans involve firearms, sharps, fire, or a moving vehicle.
9. Parents, don’t drag your child in to the ER for a low-grade fever that they’ve had for all of three hours. It’s called Children’s Tylenol. And a phone call to your pediatrician.
10. Oh, and moms, the ER is not free daycare, and RNs aren’t babysitters. If you do bring your child in, expect to be with them the entire time. And if you really have to have that cigarette, don’t expect the nurses to be cordial when you take your toddler outside with you for your nic fit. Especially when she’s here for an asthma attack.
11. And finally, it’s never a good idea to threaten ER staff. For some reason the huge guys in suits ALWAYS take our side.

Alright, all joking aside. If I learned anything I’d really want to share, it’s this:

Your PCP’s practice always has someone on call. Trust that qualified professional to decide whether you need to come to the ER at 3AM for your hemorrhoids or sore throat or the back pain you’ve had for eight months — because maybe, just maybe, it can wait until Monday and a routine office visit.

Because the ED is for (gasp!) Emergencies. The MDs and RNs there are trained to manage crises. It is not their job to solve all your medical problems, diagnose and treat all your possible ailments, and update all your medications in three hours. It is their job to determine if the symptoms you are having are life-threatening or require immediate medical intervention, and once they’ve decided that is not the case, you will get the ‘follow up with your PCP’ dispo and shown the door. You may not have any answers. You may still feel like shit. You may feel like you wasted a whole day and a large copay for them just to tell you what you don’t have. But that’s how they manage to save lives and still keep one or two beds open for the MVAs and the heart attacks and strokes. Just something to remember next time you come for a visit.

Oh, and one other thing.  Use car seats.  Wear helmets and seat belts.  And for the Love of Bob, people, don’t drink and drive.

But what I can claim to have experienced is a noticeable amount of negativity from nurses here regarding my decision to pursue the MSN/NP. I’m well aware of the clash some RNs and NPs have about the Direct-Entry-never-been-a nurse-before-becoming-an-NP-Programs, and I’m even sensitive to the fact that choosing Yale over the local schools might be seen as elitist, so to be honest, I’ve tried to keep my fall plans under the radar of the nursing staff here. But this place is Gossip et Busybody Central, so you can imagine how successful I’ve been. But I guess I wasn’t really prepared for the reactions I’ve gotten. It hasn’t all been bad, because a few nurses I would call friends have been very supportive and enthusiastic, but I would say that the majority of people who’ve commented have said something snarky. One of the ACNPs was completely unsupportive and was kind enough to wrap up her disdainful lecture with “Well, you won’t get a job since you don’t have any experience.” Gee, thanks for the warm welcome to the profession! Ditto for the RNs, who usually ask a bunch of questions only to say something discouraging in response. I even had one RN say “Well, Excuuuuse Us!” and walk off in a huff off after overhearing that I was leaving the hospital to go to Yale.

That one actually stung a bit.

The hard part about all of this is that I don’t feel like these nurses have any rhyme or reason to judge me, but they’re doing it anyway. They’re taking my career plans as a personal affront — without knowing anything about why I’ve made this choice. Most of my administrative coworkers are in their early 20s and have high school diplomas or are working toward associates degrees — so very few of the nurses know that I’m a bit of an anomaly with my age and my work/educational background: I’m 28, this is a second career for me, I already have my bachelor’s and work experience, yada yada. And as much as I actually do enjoy answering their phone calls and keeping track of their paperwork here in the ED, this wasn’t my life’s work. Oddly enough, I think that if I was going to medical school, they wouldn’t be so harsh. But my choosing NP over RN, that’s clearly insulting. Sigh.

The one truly positive conversation I had was with a staff nurse who was graduating from a local MSN program who was supportive about my not choosing to attend BC (she had precepted there and felt the program was, indeed, rushed) and who actually confessed to me that she “used to be against the direct-entry programs” UNTIL she went through an MSN/NP program herself. She said that now that she really knows what NPs do and what their training is like, she thinks people are comparing apples and oranges — that what RNs and NPs do is so different that having the RN experience really doesn’t make a difference. She said that she thinks she’ll be able to use her RN experience to bring something additional to her NP practice, but she didn’t think her classmates without it would be worse practitioners.

So that was the one exception to the rule — a nurse who was both positive about my becoming an NP and who didn’t think I was a jerk destined to be jobless for doing Direct-Entry. She made my day.

Needless to say, I’m looking forward to being at Yale soon where I’ll be part of a community that’s excited about all kinds of people becoming APRNs… and that I hope that I never become a nurse who eats anything other than a vegetarian diet.

Something about driving in Boston makes you homicidal.

I turned 28 this week, and 48 hours later got into my very first car accident. I’ve been driving since I was sixteen, and although I’ve never owned a car, I’ve done seven years of driving in CrazyTown (courtesy of Zipcar) without mishap. But on Thursday, I had to drive to Worcester to attend the Mass Fall Prevention Coaliton’s statewide symposium. I took the Pike out there, but on the return trip in the afternoon, I thought to myself, “I’m not in any hurry! I should take some back roads and see some more of this fine state I’m abandoning shortly!”

Well, I didn’t end up being too impressed, and really, all I can recall now is thinking that I was going to end up rear-ending someone because of the traffic and the typical Masshole driving I encountered on these actually-not-so-back roads. It proved all too ironic that I was so worried about it, because five minutes from home, a local MD driving a Porsche Cayenne dialed his cell phone while in the midst of a very busy intersection and gave little red Matrix Munoz a nice hard smack on the ass.

Not much damage to the car, and I only have mild whiplash-type achyness today, but what a pain. Since I didn’t own the car and had never been in an accident before, I really had no idea what the procedure was. Apparently the procedure is a lot of effing paperwork. And a little mild hysteria once the other driver left and the Zipcar person asked me five times, “Are you sure you’re okay? You don’t sound so okay.”  Yeahh… I guess you’re never too old to have a wee freak-out.

I’ve been thinking for a while about what things I’m not going to miss about this town, and to be honest, most of them involve the Green Line, but right up there is going to be the way Boston drives. Because it wasn’t the extra second the MD took to dial his phone that truly caused the accident — it was the asshole two cars ahead who led all of us into this crazy intersection and then attempted to make a ridiculous (and very illegal) 160-degree left turn.

The comment was on this post from January, about my experience visiting the nursing school at Yale. The most important thing to note, which my dear flame-thrower did not, was that nowhere in my blog did I say that I felt unsafe in New Haven. The whole point of my post was that I was TOLD that I should feel unsafe there by Yale-affiliated-folk. The staff and students I met were clear: No walking around the nursing school, call for the shuttle if you’re going anywhere after dark, etc.  And what about my good friend in New Haven, who for eight years lived in one of the less-gentrified areas of Cambridge (where, I clearly recall, he had no problem letting me wander around intoxicated at night)? Well, he DROVE me to YSN and back and asked me to take a cab the two blocks to the train station. 

Those were the things that gave me pause, dear readers.

I am perfectly willing to consider that this may be alarmist behavior on behalf of Yale and/or the individuals I met and not a real reflection of the state of New Haven affairs, but I think it’s totally reasonable that I was a little, um, disconcerted.  I’ve felt comfortable being on my own in major metropolitan areas since I was a teenager — to be told by adult men that they don’t walk around at night alone in a place I might live was a bit hard to swallow.  And then discovering that the going rents in New Haven were more than I’m paying to live in a very safe and walkable/T-accessible area in Boston — well, the whole thing was a bit surreal.

That said, I’m not a hater. I’m excited to move there and am looking for apartments. I’ve been back for a visit, had some apizza, drove and walked around some parts of town. So simmer down, flamer. But I’ll reply to the best bits of the comment because it was so random, and delayed, and hell, the blog’s been pretty slow….

“By the way, homeless people tend to gather in the most vibrant and safest parts of any metropolitan area — Midtown Manhattan, Harvard Square, downtown Austin, San Francisco, etc. are all examples of this. New Haven is the equivalent. Homeless people don’t want to have to wander the suburbs or outskirts of town where they would just get beat up. Just because you see a homeless person doesn’t mean a place is dangerous.”

Whoah! I didn’t say a single word about the homeless population or use the word “dangerous.” Anyone who’s lived in an major urban area (thanks for mentioning Midtown Manhattan and Harvard Square, two places I’ve lived and worked for extended periods) for any length of time knows that in general, homeless people aren’t dangerous. The three personal crimes I’ve been a victim of (one in Manhattan, one in Boston, and one in Cambridge) had nothing to do with homeless people and everything to do with young men with too much time and not enough prospects. But still, that’s not the point. I don’t think I even saw any homeless people while I was there. Again, my concerns about New Haven had absolutely nothing to do with anything I saw and everything to do with what I was told by people who live, work, and study there.

“There are now literally hundreds of New York Times-five-star-rated restaurants, bars, clubs, jazz halls, galleries, etc., lining the streets, with $3500/month luxury apartments above. Guess you missed them while you were visiting there… probably because graduate students tend to be from the leafy Princeton-like suburbs and have a skewed sense of reality.”

Well, yes, I did miss (and will continue to, unfortunately) the Zagat-rated eats and the swank downtown lofts, and you’re damn right, it’s because I’m a graduate student — but definitely not because I have a “skewed” sense of suburban reality. I’m going to miss out on these gems of New Haven as a graduate student because I’m going to be poor. I’m guessing, Sir Flamer, that you’ve never been a starving graduate student living entirely off of federal loans. I don’t have a car, I can’t afford much in rent, and I’ll be working and studying long hours. Great restaurants and galleries and beautiful condos are unfortunately, irrelevant — I just want to be able to live somewhere where I can walk to school and clinicals and to a reasonably-priced grocery store to get the milk and PB&J I’m going to be subsisting on for three years. But from what I’ve been told, that’s not really an option — the neighborhood near the nursing school apparently isn’t a safe one, and the nicer neighborhoods still in my price range require a car or relying on the shuttle for getting to class and work and errands. And that’s where I was disappointed with my options in New Haven.

“Downtown New Haven may not be a leafy suburb filled exclusively with white people, but it is the place of choice for young people in Connecticut and it is expensive because of that — it is the most desirable place to live in Connecticut, if not the entire Northeast. New Haven has more 25-34 year olds than any other community in CT by a huge margin, and it also is the most bikeable major city in the Northeast, in terms of the % of the population that commutes to work via bicycle.”

That’s good to know. Honestly, I’m glad to hear it. Biking is awesome for a million reasons. And young people are also key to my quality of life. And I’m sure the New Haven Tourism Bureau appreciates the proselytizing you’re doing on their behalf. But I think even their staff would probably hesitate before taking the hype all the way up the mountain to “most desirable place to live in the Northeast.” And I have no clue where you got the idea that I was desiring New Haven to be a “leafy suburb filled with white people” but hey, thanks for the tip, I’ll make sure to warn any visiting friends. Just in case they’re expecting New Haven… to be like the rest of New England.

Also, lastly, I just gotta say, you are really into this whole “leafy suburban” thing. We have leaves in the city, too. They’re on our trees.

Otherwise, see you around town. I’ll be the girl in blue scrubs who smiles and says “Hi.”

Add that to the offer of “starring in the movies” I got from one of the ETOH pts a little later (due to my ravishing beauty, of course) and it’s been a pretty weird evening for the ego. Although later he loudly and repeatedly announced his desire for STD testing, so I’ll think I’ll take a pass on whatever kind of movie’s he’s involved with.

Other than that, there’s not much going on over here. Working a lot, sleeping not so much. Trying to figure out how much I’m willing to pay for rent in New Haven and whether I really need to round up a car. Boring stuff like that.

But I’ve been staying awake on the slow overnights reading NewFNP’s blog — although I doubt my practice in gerontology will ever end up quite as interesting (or as hilarious) as hers, it does keep me excited about my future as a nurse. Five months and counting!

I have somewhat mixed feelings, but it’s clear now that if I can barely afford to move to and live in New Haven, Seattle would be a bit of a stretch. All the YSN GEPNs are freaking out about having to take out nearly 60,000 in loans, just for the first year. Emesis indeed. I was a total basket case yesterday.

But I got a personal loan this morning so I at least know that I will have no more revolving credit card worries and that the monthly payment on that loan should be manageable while I’m in school as long as I budget well and get a cheap apartment. Which I am committed to doing.

So there! Take that, evil nursing school and associated debts! I shall make you my bitch!

And I just made some tasty banana muffins. Today is going much better, thank you. 

I’ve wondered off and on (along with the debate of MD vs. NP, a story for another blog) about whether or not I should’ve chosen Acute Care and if I’ll be bored going into geriatrics/primary/long-term care after two years of fascinating cases in the ED. But the more I think about it, I realize that I’m  just plain excited by everything that has to do with taking care of people. And I think I’ll always be eager to be a part of it.

ps. For another amazing nec fasc story, check out this book by another Boston doc. 

Now what I’m going to do all night at work without assigned reading, I don’t know… 

You know what else is kinda funny? When I was in elementary school, I had a blue Yale sweatshirt that I wore all the time. I have no idea where it came from, I’ll have to ask my mother if she remembers it. I know we didn’t know any Yalies. And I also recall owning one other piece of collegiate apparel – a cheap Harvard T-shirt. I guess someone must’ve given them to me, or maybe I asked for them since my brother was always getting Michigan stuff and for some reason I decided to align with the Ivies. I remember wearing those shirts all the time and telling amused aunts and uncles that I was going to go to one of them… Funny that I didn’t apply to either as an undergrad but will end up with an affiliation to both after all.