Week 5, Blog 3

On Thursday, I followed around a nurse named Sam. She was really nice, and she actually taught me a lot, rather than just having me follow her around. They have a special cart just for inserting IVs and drawing blood, so she showed me everything on the cart. She taught me what everything was called and what they are used for. Like, for example, there are different types of needle that are different sizes, and they choose which needle to used based off of what they are going to use the IV for and how big the veins are. There are small gauges, like 24 or 22s, and there are bigger ones, like an 18 gauge needle. They usually prefer the bigger ones, especially for drawing blood, but sometimes, like if the vein is too small, or they’re trying to stick a baby, then they have to use a smaller one. The only good thing about smaller IVs is that medicine can still go through it.

On Friday I wasn’t really under somebody, so I just kind of floated around to see what was going on. There we’re a couple nurses that I followed around, but in reality I ended up following a doctor around most of the time. It was more eventful than usual that day. The doctor let me watch him treat a case of MRSA. It was so gross but at the same time it was really cool. A guy had a bunch of pus underneath the subcutaneous layer of the skin, so all the doctor did was numb it a little but with 1% Lidocaine, and then he went right into making a deep incision in the skin, and then he pushed all of the puss and blood out. The guy wasn’t even numbed up all of the way.

I also saw someone choke on their own vomit, so that was a bit scary to watch, but the lady turned out to be ok though. When she finally got it out of her throat, the vomit was a vibrant green colour, and another doctor said that it was bile from her liver.

The last thing I saw was a lady going through spontaneous pulmonary oedema, where there was a build-up of fluid in her lungs. They had to ultimately knock her out and put a tube down her throat to artificially breathe for her. Furthermore, they needed to get a second IV in her for drawing blood, but they couldn’t find a vein, so the doctor had to put a central IV line into her jugular. He used an ultrasound machine to do it, and it took a long time. So long, in fact, that the doctor stayed 3 and a half hours past his shift for this one patient. Earlier, he agreed to let me interview him after his shift, but he worked so long past it (it was 12:30AM), he said we should to the interview Monday.

Week 5, Blog 2

What is surprising about the ED is that people primarily come in here for really benign things. What I mean is, I knew that some people without insurance use the ED as primary care, but half of the so-called “emergencies” are just ridiculous. Like, someone was admitted for anxiety, by ambulance no less. Psychological cases are so frequent that they have a room dedicated to them: room 8. It does have the normal things that ERs have in them – a sink, cabinets and drawers with medical supplies, etc. – but when someone that may pose a risk to oneself or others, a garage-like door comes down to close off everything in the room, so it is not accessible to the “dangerous” patient. They also have security, which is right next to the ED entrance, guard the outside of the room.

Other sad/disturbing things I’ve seen so far are people coming in off of the streets. For example, we got a call earlier that the police found a man on the side of Route 1 on the ground. When he was brought in my ambulance, we found out that he was intoxicated, and that was the cause of his fall. To make it even sadder, he was just released from a rehab center in Lynn the day before. He was walking from the center in Lynn back to his quasi-home in Danvers, and he had to sleep outside because it was taking him so long to walk home. He couldn’t call for a ride because his wife has a restraining order against him, so he wouldn’t have even been able to stay at his house once he got there. He also couldn’t call for a cab, because he spent his money on two 40s of beers. So I asked, “Who pays for these types of patients?” and, knowing the answer, a nurse said, “We do. That’s where our taxpayer money goes.” I discovered a lot of anti-socialist health care sentiment here, and I can see why they feel like that. “We pay for the hundreds of times he goes to rehab, too,” she continued to say. “Well if he didn’t have a way to pay,” I asked, “what do you think the rehabs should do?” She said, “They should give him one chance, and that’s it.” I her response was very cold.

Week 5, Blog 1

Monday was my first day in the Emergency Department (ED), and what surprised me, first and foremost, is how fast time goes by here. I don’t know why; maybe it’s because patients are in and out of here frequently – but not as frequently as one would expect. I’m starting to see some of the same faces as far as staff is concerned; the cleaning staff for Inpatient is the same, so I recognize them, and the pharmacist today is the same as was in Inpatient a few weeks ago. The nurse I followed around was Jan, and she is pretty nice. She’s also pretty opinionated, so I’m thinking that she might be a good person to interview. On the other hand, it might be better to interview a doctor – I really want to know how they get paid, and if the fee-for-service model really does influence other doctors to perform unnecessary tests. The hard thing about these interviews, I think, will be the controversy surrounding my topic; I don’t want it to seem like I’m trying to make anyone look bad, especially the interviewee.

While some cases that come in here are not unusual, there was one really sad instance where a chemo patient fell and really badly lacerated her arm and a little bit on her head. She was so scared, and she really wanted her husband there, but he was still out in the waiting room filling out paperwork. In a few seconds, he came into the room, and that made her feel so much better. She kept apologizing and saying that she felt stupid for falling. A big chunk of her arm was cut open, and she needed to have about 30 stitches.

Week 4, Blog 3

Today is my last day in the PACU and, just like with Inpatient, I feel like I’ve just gotten used to the routine here, and now I’m being moved. It’s not so bad today, because there are less staff on, so I feel more in charge and that I hold more responsibility. Usually it’s so busy and I don’t really know what to do, so I just go around looking for something to do. Today, I feel like there’s an order in which to do things, and also that it’s easier to keep track of everything that’s going on. So considering there’s nothing really remarkable about today as far as what I’m doing goes, I guess I’ll just go through what a typically day is like for a volunteer or a nursing assistant.

In the morning, I check every room to see that they have the proper set-up for the nurses to put an IV in. Then, once patients are brought in (pre-op), I take their vital signs, which consists of temperature, heart rate, oxygen saturation, and blood pressure. Then, once they go into surgery, I replace the room’s IV set up for the next patient. When the patients come back from the OR, I take their vital signs again, and I also print out their medication sheets and write down their future appointments and put that information in their room. Then, when they have left the PACU, I remake their beds and put the beds back into the pre-op area.

Week 4, Blog 2

Yesterday, despite feeling sick for most of it, was probably one of the better days in the PACU for me. I met another volunteer, named Nada, and she, like me, was equally displeased at the cliquey-ness of the PACU. So we talked throughout the shift about how much we hate making beds, and how much Vanessa’s (another volunteer) happiness and peppiness annoyed us. It was nice to find out that someone was just as miserable as me.

Also, I talked to Cynthia, a nurse educator (I think), about getting in to see another surgery. I’m not sure if I mentioned it before, but I got to see a Vitrectomy last week, which is a type of eye surgery. The surgeon inserts their instruments into the eye, and takes out obstructed or cloudy vitreous humour fluid. The fluid is usually obstructed from some other bodily fluid, the most common being blood. This causes the obstruction of vision, such as blind spots. While the surgery was in progress, the surgeon found that parts of the retina were damaged, and it actually had some humour fluid behind it. They had to remove the fluid and use a laser to repair the retina. This particular tear was unusual because it was very close to the fovea, which is where the optic nerve leaves the eye, which causes a blind spot. The surgery was really cool, and I hope to get into another surgery, but I probably won’t, considering this is my last day in PACU.

Oh, and they call me Juno now, ‘cause they think I look like her.

Week 4, Blog 1

Feeling really overwhelmed and not able to sleep, I realize that I haven’t posted a blog entry yet this week, so here we go.

Nothing much has really changed in the PACU. On Monday and Tuesday, I’ve continued to make an absurd amount of beds: stretchers, eye stretchers, and eye chairs. Eye stretchers and chairs are made differently in comparison with normal stretchers, because they are intended for use in eye surgery, and the surgeons insist that the type of fabric and colour of the sheets normally used risk pieces of lint obstructing the patient’s eye area. It sounds a little unrealistic to me, but the surgeons are the ones performing meticulous, if not stressful, surgery, and it’s probably best to keep them happy and do things their way.

Other than making beds, I’m getting better with figuring out what it is exactly that I am supposed to be doing in that unit, the challenge being that there is little to no direction in a unit with many more employees than Inpatient. Naturally, this leads to not really having someone to look to for directions. Therefore, I’ve taken it upon myself to look at the TV screens that have colour-coded patient schedules on them, and to learn the system. So now, I feel I’m doing the same things as before (making beds, taking vitals, and storing and retrieving patients belongings, etc.), just more efficiently.

To be honest, I agree with what Loyd has been posting on his blog. How can one expect a workplace to change enough in order for three posts to be written every week? I understand that teachers want to see that we’re showing up at our internships, but this feels very much like meaningless busywork.

I’m very stressed out with the status (or lack thereof) of my paper. I have an extensive outline, but the research involved in fully understanding the complexities of my topic, healthcare, plus the time it will take to write it, is seriously overwhelming. Between the times spent at the hospital and at my job, I feel like I have absolutely no time to do it, considering I’m busy from the time I wake up to the time I go to bed.

I’m seriously thinking about quitting my job to get this paper done. There’s one thing for sure though; a rough draft won’t be ready in two days from now.

Week 3, Blog 2

Yesterday was my second day in the PACU. I still haven’t been able to see a surgery yet. All I feel like I’m doing is making beds and getting food for people. I’ve taken like one vital sign, and that’s it. I feel like I should be learning more things, but it’s so busy in this unit that I feel like I’m bothering people if I stop to ask them a question. I still don’t know anyone’s names yet, because there are so many people. I also feel like it’s cliquey up here; the young Nursing Assistants and Unit Coordinators stick together while the older nurses kind of do their own thing. I also feel like I annoy the Nursing Assistants; they’re kind of like “Revere girls,” no offence. I kind of feel too lame to be around them. There’s also another intern, but from what school I don’t know. She’s only been here for two weeks, but she runs around like she knows exactly what she’s doing, which I guess she does. She’s reeeeeally upbeat and enthusiastic, which bothers me. Is that bad? Honestly, I can’t even remember that much from yesterday because I feel like I didn’t do anything all that important. What’s most frustrating, however, is how little I’m learning about my paper topic, the cost of healthcare. Whenever I ask anyone about it, or even their opinion of it, it seems they don’t know anything about it. On the upside however, I did figure out who I could talk to about it; the only problem is that they are pretty high up in the hierarchy around here, so I don’t know how accessible they will be to get to.

Week 3, Blog 1

Yesterday, I was moved from the Inpatient Unit to the OR/PACU. Dana was moved from the ED (emergency department) to the Inpatient Unit. OR stands for “operating rooms,” and PACU stands for “post-anaesthesia care unit.” So basically, the PACU is where people go when they come out of surgery, because they need to wake up and/or recover from the anaesthesia that they have been given. They are also monitored for any post-surgery complications, and they are given instructions on how to deal with the recovery processes of their surgery. The PACU is kind of a misleading name, because there are patients there that are waiting for and preparing to go into surgery. So it’s really not just “post-anaesthesia” but “pre-anaesthesia” as well. There are 23 beds divided into four sections: post surgery, post endoscopy, pre endoscopy, and pre surgery. Endoscopies are procedures that allow doctors to see inside of the body with a camera, most frequently a gastrointestinal endoscopy, where they can look at parts of the digestive tract, either down the throat or up the large intestine. They differentiate the endoscopies from other procedures because Lahey Peabody directly hires the doctors that do endoscopies, while the other surgeons work privately.

I’m not sure how I feel about this unit yet. It’s bigger and more staffed, so it’s naturally more hectic than Inpatient. I feel pretty out of place, not yet knowing what I can and can’t do, but I’m sure I’ll figure that out over time. When given the tour, I was told how to use the fax machine, which it upsetting, considering that not what I’m there to learn. On the upside, however, I was told how I could get a job there more easily. There are different people I can talk to, so I look forward to seeing how that goes.

            

Week 2, Blog 3

(Originally handwritten on April 26^th)

Today is my last day in the Inpatient Unit. It’s kind of sad, because a lot of the staff here is really nice, especially the Nurse Assistants.

Yesterday, a woman came in complaining of dizziness. She was really drunk and smelled like cat pee. She was missing four of her front top teeth, and she had a pretty nice naked-lady tattoo on her right boob. She seemed pretty weird, and it turns out that she does heroin, cocaine, smokes one to two packs of cigarettes a day, and drinks two FourLocos a day. The doctor is Argentinean, so Sam (a nursing assistant) and I had to explain to him what that was. I know a woman like that isn’t funny, because she has a lot of problems, but the nurses sure thought it was yesterday.

Today there is a really, really nice old lady in room three. She has an amputated leg, and she has a cast on the remaining one. She looks so frail, and there is something wrong with her right eye, although I don’t know what it is. Despite looking the sickest I’ve ever seen anybody be in Inpatient, she is really pleasant, positive, and has really strong will-power.

We discharged a lot of patients today. By the time I left, I think there were about three patients left. It is really quiet when there aren’t many patients. The rest of the time I was there, we went about the normal routines. We cleaned up lunch trays after lunchtime. We went around the rooms taking vital signs every four hours. We check the rooms every hour to make sure all the patients are cared for.

Week 2, Blog 2

Today, the Nurse Assistant, Jackie, told me it seems like I’m a whole lot more comfortable here around the patients now, and I’d have to agree with that. I feel a lot more useful now that I’ve learned a lot of what goes on in Inpatient. Learning what CNAs do definitely is helping me to be able to do more hands-on things, instead of just shadowing. I basically can take vital signs now, which is really the most that CNAs to in regards to anything medical. Every once in a while we do extra things, like put air-pump wraps around people’s legs to keep blood flow moving and to prevent clotting. We also frequently deal with air tubes, which a lot of the patients here use because they are quite old.

Anyways, when I left yesterday, a lot of drama was happening around the nurse’s station. One of the patients was insistent upon leaving. He kept getting up when he wasn’t supposed to (he is a fall risk) and trying to put his normal clothes back on. He was under the impression that he was already discharged, so he called his caregiver to come pick him up. The doctor reluctantly discharged him, and when his ride came, he was unable to get himself in the front seat without assistance, so the caregiver refused to take him home, considering the patient and his wife live alone, and the patient provides homecare to both himself and his wife. If he can’t take care of himself, how can he take care of his wife? So he had to be re-admitted, and now he is out sitting by the nurse’s station, because they have to keep an eye on him because he still gets up when he’s not supposed to.

Week 2, Blog 1

Right now I’m sitting in the Emergency Department break room, and I figured I write this blog during my lunch break, considering I really had no other time to do it. I only had about 3 hours on Monday and 2.5 yesterday. Today I get to stay here until about 2:30, because I have to go pick up my retainer from the orthodontist. I really wish I could spend more time at my internship because I really like it, but it seems that a bunch of life stuff just gets in the way. I wont be able to get my 25 hours this week, so I’ll have to make them up some other week.

I’m realizing that, over time, I’m following around the RNs less and the Nursing Assistants more. CNAs do more hands-on things, like waiting on patients and taking vital signs, while nurses administer medication and fill out paperwork. Following CNAs will be good for me though, because I’m doing more physical things instead of just watching. Plus, I’m going to call the Red Cross to see about their CNA certification program to see if I can take some classes in Peabody to become a CNA; that way, I can get the hell out of my awful restaurant job and do something actually relevant to my future. I really like it here at the hospital.

So today, we basically went around taking vital signs, bringing things to patients, making beds, etc. I’m getting the hang of it. The CNA let me write in the vital sign binder, and she also lets me go and get supplies. I’m even learning how to make a military-style bed; it might not be medical, but I have to learn it at some time or another. I’m still thinking about who I can interview about healthcare for my essay, but other than that, this internship will probably have little to no relevance to my paper. I don’t mind though, because I feel that I’m doing this internship for me, and less for my essay.

Week 1, Blog 3

Yesterday was my 3^rd day in the Inpatient unit, and things are starting to get less, well, new. I’m still learning things, but it’s quiet a lot more than I would have expected it would be. It’s just the usual stuff; new patients get admitted, and old patients get d/c-ed. I got there around 10:30, and by then one of the COPD patients had already left. I wish I could’ve said bye; she was really nice. She was the skinny one that the dietician wanted to give TPN to, but it turns out it’s an extremely expensive procedure so they didn’t do it. The other COPD patient also left a few hours ago. The more I talked to her, the more forgetful I realized she was. I think she’s developing Alzheimer’s. Anyways, she was really nice, and I’m finding that a lot of the old people in the unit are nicer than I expected, because, you know, old people are stereotypically grumpy. In fact, the nurses are probably more grumpy than most of the patients here.

I was with another nurse, Tammy, today. She was very mellow and down to earth: quite the opposite of the first nurse, Karyn. I honestly thought that having me follow her around would annoy her, but as time wore on I think she got used to the idea. Needless to say, I was pretty happy when Karyn showed back up at around 3:00. I also talked to Pam from Human Resources about CNAing, and she said that it was definitely an option, and that I should talk to her in the next few weeks about it. I honestly would like that so much better than the job I have now. 

Week 1, Blog 2

Today was a slow day. But hey, at least I found some small scrub pants. Anyways, a lot of the same patients from yesterday were here today. One of the two COPD patients is showing signs of improvement. We gave her an Ativan yesterday to treat her anxiety, which we thought was the reason for her COPD exacerbation. It helped a little, but we really wanted to avoid giving her steroids if we could help it. It turns out she did need them, because when she was given Prilosec this morning, her respiratory problems improved significantly. The dietician visited the other COPD patient, who is skinny due to Celiac Disease, and she might need a TPN (total parenteral nutrition), which is a mixture of nutrients given to the patient via intravenous. What is interesting about her is that she also has hypothyroid, which usually causes weight gain. That just shows how much more powerful her Celiacs is.

The patient complaining of back pain was still there today. Her MRI came back, and showed nothing more than a couple of bulged disks. Now, this lady is pretty big, so, besides continuing to take Oxycodone and Oxycontin, the thing that I think would help the most would be to loose weight, which I doubt will happen, because it seems to me she’s treated like a queen back home. I really don’t mean to be harsh, but she’s dramatic, complains a lot, and smells horrible. Her husband and daughter sit in her room with her. Her husband looks like he could be her son. None of them talk to each other, despite being in the same room for 2 days straight. The situation is just odd.

Our patient suffering from vertigo was released into a nursing home today. To me, she’s always seemed aloof, but I just found out she has schizophrenia, which I thought was interesting, because she didn’t fit my idea of what a schizophrenic acted like. Although, it’s true that there are many forms of schizophrenia.

There was a new patient to take the vertigo lady’s place. She had been admitted last night around 11:30 due to a fall she had while walking down the street. She fell right on her face, and now she is severely bruised up. It looks like she got punched in the face like 50 times. We took her for a walk, and she may have been our oldest patient so far (81), but she definitely walked the fastest.

As far as learning goes, I’m trying to understand the massive amount of paperwork that is done for each patient, mostly vital signs and medication. “d/c” means "discontinue". “PRN” means medication given "as needed". “Q” means "every", as in, “take this medication Q (every) so-and-so hours.”

Lastly, Karyn mentioned to me about becoming a CNA (Certified Nursing Assistant). I looked into it, and the Red Cross holds classes that last between 6 to 12 weeks. I’m old enough, and I hate my job, so why not look into this further? I talked to a college-aged CNA who told me that was the best thing she ever did, and she’s learned a lot. CNAs make $10 to $20 an hour, but the classes cost at least $800. I’m going to talk to Pam from Human Resources tomorrow to find out more about it.

Week 1, Blog 1

Today was my first day at the Lahey Clinic in Peabody. I met with Dana Filias and waited for the Director of Human Resources, Pam, to show up. When she did, she handed us over to a nurse named Karen to show us where we would be for the next six weeks. Over all, Dana and I will be rotating in two week intervals: two weeks in Inpatient, two weeks in the Emergency Department, and two weeks in the Operating Rooms. Karen gave us our scrubs. Unfortunately, there were no small scrub pants, so I have to wear mediums for now, which is okay with me; I’m just happy to be there. Karen placed me in Inpatient and Dana in the Emergency department.

I thought that Inpatient would be the most boring out of the three departments, but I was totally wrong! I love this internship even more than I thought I would. The nurses are really nice, most of the patents are really funny, and the whole treatment process of overnight patents is really interesting! My Inpatient supervisor, Karyn (not Karen), showed me a lot of paperwork, computer programs, technology, and medication that they use on a daily basis. We had four patients throughout the day, and I found out I can talk about them as long as I don’t use names. One patient was complaining of extreme back pain, and she needed an MRI. Two had COPD (Chronic Obstructive Pulmonary Disease) exacerbation, and on top of the COPD, one of those patients is 5”2’ and 85lbs. The last patent had extreme vertigo and vomiting, which we believe to be caused by an inner ear problem, so she went to the ENT (Ear, nose, and throat) for a check-up. I don’t care that I have to wake up at 5:45 tomorrow. I want to go back!

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