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Monthly Archives: October 2010

Butternut and chocolate: Soul soup

…And the happiness that $2.25 can bestow

No nursing stories today.

Soup for the soul, instead.

And first a story that is good for my non-New Yorker soul. This story renews my desire to make peace with the fast pace of Manhattan, the rats in the subway rails, and the lack of recycling or composting.

On Wednesday, I was going to my community clinical. This is one of the only rotations this year that I get to shuck my scrubs and don lovely business casual clothes instead.  I really don’t mind leaving my white granny shoes and compression socks at home, really, truly I don’t. Not that I hate the scrubs; they are pretty comfy, as far as polyester goes. But in the classy clinic that I am in for this rotation, I like my classy clothes.

But anyways, that’s not the point of this story. To go with my clinic clothes, I was carrying a purse instead of my school backpack. I had transferred everything I needed for the day into the purse, or so I thought. I even squeezed in a lunch.

I took the train into the city, and then skipped down to the bowels of the city. I swiped my unlimited metro card, very professionally. I am becoming an expert swiper, mind you. Nothing. I swiped again to be sure. Yep, time for a new card. So I went to a machine, which digging deep into my cavernous purse for my wallet. Then my heart sank, and I realized – no wallet. I brought everything except my wallet. Happens to the best of us. The scenarios that ran through my head in the next few seconds were not pretty. I saw myself holding a Styrofoam cup out for change, crumpled defeated in the corner of the station. Then I saw myself being turned down by 20 people, becoming increasingly more agitated and teary as I was rejected again and again for a swipe or a meager $2.25. For about 20 seconds, I could taste my fear, and it was not tasty. But there was no other option. I would have to ask the scary New Yorkers for cash.

I turned around, steeling myself, and almost ran headlong into the person directly behind me. Oh yeah. I forgot that I was at a subway ticket kiosk, holding up people behind my with my frantic wallet search.  He looked like a relatively nice guy – business suit, no eye stink eye. All good characteristics that made him semi-approachable. So I bumbled and blubbered my way through my story, and before I could even finish, he was already reaching for his wallet. Seriously! Relief washed over me, as I realized that I would not be in the subway station all day. Nay, not even two minutes extra. It was nearly painless, actually! Probably even more pleasant than it would be in Seattle (ok, maybe that is stretching it).

But, really, why do I think all New Yorkers are evil and mean? I guess it’s because walking down the street, they don’t automatically smile and greet me. Thankfully for this experience, I have now decided that it is not good enough evidence to pass such harsh judgment. I have now become one of the individuals on the subway that New Yorkers have shown compassion for, enough to reach deep into their pockets for some spare change. I see it happen here more than anywhere else I have been in the world. So, I ask myself: should the new definition of a New Yorker be the Good Samaritan?  Maybe I am pushing it too far, but still…food for thought.

Now for some food for the belly:

Butternut Squash Soup With Spicy Chile Theo Chocolate

co-starring: sage breadcrumbs


Ingredients:

1 onion
2-4 cloves of garlic
1 butternut squash
Salt
1.5 oz Theo Classic Chile Bar
Cayenne
1 Carrot
1 sweet potato
2 Qt vegetable stock (I would use less if making it again, maybe 1.5 Qt)
white pepper (to taste)

What to do:
Saute onions, garlic and carrots in a little olive oil. After they begin to brown, add vegetable stock. Peel and chop sweet potato and butternut squash into large pieces. Add to stock and cook until tender. Puree soup and return to stove. Season with salt, pepper, and cayenne and then top with generous amounts of shaved Classic Chile Chocolate. Enjoy.

My addition: sage breadcrumbs

Needed: baguette (cubed), olive oil, seasoning salt, garlic powder, sage (essential ingredient – be liberal), parmesan cheese

Toss all of the above listed ingredients together on a baking tray. You can sprinkle the cheese on last, if you choose. Bake at 400 degrees until toasty brown. The sage and salt make it nearly unnecessary to season the soup itself. Hearty goodness.

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Posted by on October 26, 2010 in Healing Spoonful, Soups

 

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Oh so overjoyed to be back with the old folks!

“Maggie and Lynn Buxley*?” I scan the waiting room, and my eyes immediately land on two little old ladies, dressed to the nines, almost identical to one another despite not being twins. They look up simultaneously, smile demurely, and start gathering their luxurious wool coats, mohair berets, and patent leather purses. These are some of the fanciest looking patients I have seen yet. And the story gets better, just weight. I mean, wait… 😉

Time really does fly! I am already finished with my pediatrics rotation and onto the community rotation. This 5 weeks is spent in class, skills lab and one day of clinicals per week. As students, we are scattered all over the city in community clinics, visiting home nursing care, and teen pregnancy clinics to name a few. Since I have been contemplating a specialty in geriatrics, I was fortunate enough to land with one of my didactic instructors at a nurse-practitioner run clinic that serves the elderly as one of its primary populations. What I didn’t realize is that this clinic happens to be in one of the most pish-poshest neighborhoods of Manhattan, which I guess makes it also one of the fanciest in the country. Since I plan on working in a community health clinic for my career, I guess this might the most plush practice that I ever see, but hey, it’s a great learning experience!

So, back to Miss Maggie and Miss Lynn, 85 and 80 years old respectively. These are two sisters who presented to the clinic in all their daytime finery for…drumroll…flu shots. My instructor (the ARNP) warned me in advance that these two little ladies were “real characters” and that this visit would surely be more than “just” flu shots. The trot on in, and sit themselves down, one on the examining table and one in the chair. I perch myself on the windowsill in the corner – there’s not much room for all four of us! And the history-taking begins. It turns out that these ladies come in fairly regularly, but they are both on different doses of different blood pressure medication, as well as many other meds, so there’s lots to discuss. One of the sisters (the older one) speaks for the both of them and she knows everything, and I really mean it, about both of their health statuses. They are cracking me up with their NY-high society-talk (I’m not good enough to even try to imitate it) but my NP doesn’t even bat a lash, so I try hard to keep a straight face. Soon it’s time for me to take their vitals – weight, blood pressure, pulse and respirations. Both ladies start to moan and groan about the weight-taking immediately. I am completely startled because they are teensy-weensy minuscule little things, with not an ounce of extra fat anywhere on their bodies! I weight Lynn first who totals a whopping 86 pounds (but she refuses to face the scale because she is afraid to see it). Then she asks me what the number was anyways, and when I tell her, she grimaces and says, “Ah, I knew I felt my clothes getting tight, didn’t I tell you Maggie?”

And Maggies replies, “Well, Lynn, you know that I make up two of you!” Now this is just plain ridiculous because at most she is 10 pounds heavier, which hardly constitutes fat! She weighs in at an impressive 100 pounds, and sighs dramatically. Now, here’s the thing. Should we worry about them? Clearly they have some form of body dysmorphia but they’re 85 and 80 and healthy as can be, for their age! I guess my NP decided a long time ago that behavior change wasn’t likely to happen now, so I just let it go at that. Both of their blood pressures were also fairly well-controlled, another good sign. When I tried to roll up the sleeve of Maggie’s uber-soft and lovely sweater, I apologized for stretching it a bit. She just tinkled a little laugh and patted me on the shoulder saying, “Oh, this old thing? Don’t even bother worrying!” Now let me tell you, “this old thing” was something that I probably couldn’t afford unless I used 3 months of my food budget on it. It was beautiful and soft and perfectly in fashion, and if it wasn’t a huge HIPAA violation, I would totally look up their home address and go look through their dumpsters for the amazing clothes from last year’s Vogue styles that they are probably throwing away!

Oh, and I also got to give my first flu shot! Maggie gracefully told me I could practice on her (clearly, I didn’t divulge that she was my first victim, though). And so, with my NP watching over me,  I squeezed her miniature deltoid muscle and gave my first attempt at “darting” the needle in, and then injecting the vaccine! It was quick and I was only a wee nervous, maybe a little shaky (I’ll admit) and she told me she barely felt it! Ah, those social graces. Gotta love ’em. 🙂

Upon leaving a few minutes later, they both donned their adorable little French berets, and bid us goodbye in the most proper but sweet way and hobbled out together arm in arm, probably headed home to their Park Place apartment that they share…

This may not be the kind of clinic that I want to end up in, but it sure is a lovely place to be for now. We saw so many patients, they were all so sweet, compliant, friendly – and for the most part – HEALTHY! What a concept! It’s refreshing to remember that not everyone super sick or on the road to recovery. Some people just need preventive care and I look forward to being one of the providers and educators.

*names changed to protect privacy

 
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Posted by on October 11, 2010 in Clinic, Healing Spoonful, Nursing School

 

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Caution Advised: You may become attached

This is the warning that should be posted on the door of every pediatric patient on the Oncology floor. Beneath the warnings of “Fall Risk” and “Contact Precautions,” a fluorescent sign should also caution that there is an adorable, yet very sick child, that lies within the bounds of the four walls you are about to enter. Their disease might not be contagious, but attachment is catching.

Mercilessly, our clinical instructors place us with the same patients each week, if they are still admitted to the unit. Quite obviously, this is in the best interest of the pediatric patient but it also led to serious attachment issues for me. When they first told us that we might be paired with the same patients for weeks at a time, I was impressed and excited. It would mean more opportunity to learn about the child, to form a bond, to gain their trust, and of course, to delve deep into their manifesto of medications. As an uncertain freshly-scrubbed nursing student, my underdeveloped emotions clearly were just waiting in the wings to do a gutsy cannonball jump into the swimming pool abyss of my heart.

And what a cannonball it was.

During post-conference on my second to last week in Pediatrics, I almost started bawling in front of my peers while just trying to present on my three patients. I could barely string three words together, much less speak about their conditions and the care that I provided. This is the story I meant to share with my fellow nursing students, instead of the feeble, “I had a really rough day today…I am feeling very sad.”

I haven’t been able to get a couple of patients out of my mind. The first is a young teenage girl who I took care of on 4 separate clinical days. She is Spanish-speaking, and came to the US for the very first time for her treatment because she wasn’t receiving treatment in her country. She flew here alone, with baggage that didn’t need to be checked: leukemia. While there are some relatives staying with her in the hospital, her mom, dad and siblings are all back home, a few thousand miles away. Her relatives are blood-related, but they are not mama y papa. The saddest part to me is that she is clearly wasting away day by day. She is only on her 2nd cycle of chemo, with many more rounds left to go, at least a year’s worth of treatment. She says she can’t eat because food makes her feel sick. She rarely gets up and out of bed anymore. It’s true that chemo causes horrible side effects, and I can’t imagine how unappetizing food must look with the amount of nausea and pain that she’s in. But it feels wretched for me to pull the scale in each day and see that she has dropped another quarter kilo. She lost 3 pounds in a week, and this is on a slight girl who was already underweight upon admission. Each day she sighs when she sees me clumsily rolling in the standing scale. I wish I didn’t have to weigh her, almost as much as I wish I could give her MY stomach full of the nutrients she needs. But of course, that really would be a band-aid solution wouldn’t it? So much of pediatrics is psychological, and it is heart-wrenchingly sad to see the emotions play across her face when she tells me (at first too quietly for me to hear, and the more loudly) that she just wants to go home.

By the end of my rotation, I was thrilled to see her nibbling on crackers waxed thickly with butter. She might only eat one in an hour, but it is something. Her weight had almost stabilized, a milestone even though she is clearly emaciated. I also was privileged to sit in on a session with one of the child psychologists. An interpreter was present, and it was a wonderful example of some of the amazing services that the hospital offers, working together in perfect harmony. She was a little teary, but she told me afterwards that she felt better and it was good to talk. It’s amazing for me to recognize how important these social services are to the kids. Child Life is available for scary procedures (armed with teaching tools, videos and distractions galore); clowns and dancers come in for private shows; and there’s even a Martial Arts team that comes in for “Kids Kicking Cancer.” My little girl is the perfect example of how important these services are. She is physiologically anorexic from the chemo and her depression about being so far from her family. I still hear her voice, “I just want to go home.”

I heard this mantra again on my last week of the rotation, by a very different patient. This little boy, Tommy*, has Down Syndrome and ALL (leukemia). He has the cutest little face and sunny demeanor, or he did, that is, until his chemo treatment began infiltrating his subcutaneous tissue. Seemingly instantly, a cadre of nurses surrounded him, acting speedily to access the site, attempt to suck back out what chemo they could, and then re-access the tender site with another wide gauge needle. As they palpated to find the port, Tommy* got more and more agitated. As many of these little patients do, Tommy has incredible parents. Dad was holding Tommy so he couldn’t squirm away, but it was the most gentle and loving “hug” restraint that I have ever seen. Mom was positioned behind Dad and son, stroking her little boy’s forehead, soothing him and whispering encouraging words. As the nurses continued prodding and Tommy got more uncomfortable and upset, he finally said, “Mom, I want to go home now! I want to go home.” He said it in a way that was so sweet and naive and it just tore at my heart. A nurse looked up at that point and said kindly, “Ok Tommy, how about we start counting now?” Without missing a beat, Tommy shouted, “1,2,3,4,5,6,7,8,9,10!” The nurse smiled and said, “11…” And Tommy said, “12…”

On and on it went until “49…” and then Tommy was silent. The nurse asked, “Tommy, what’s next?” He replied, “I dunno what’s next!” Laughter ensued. Then the nurse said “Fifty!” Tommy said 51, and off they went again. Tommy barely flinched or cried out when the needle pierced his skin. It was truly impressive. I was amazed at how smoothly it all went, even though I was on the verge of tears for most of it. (By the time I met Tommy, I had already dealt with an onslaught of emotions from seeing other patients in various positions of pain and discomfort.)

I think my sadness about “really sick kids” was triggered mainly by another little boy, only 3 1/2 years old, who most likely will not get better. Timothy* had ALL (leukemia) long before I met him. His chemo treatment put him into remission, but also sadly, gave him secondary AML, a different leukemia – much harder to treat. He was treated with chemo yet again, and this time, a bone marrow transplant (the only curative option for AML). He was in remission for quite some time, and then he relapsed. And this is where I met little Timothy. By now, little Timothy also has a host of other complications, and it is nearly impossible to decipher whether it is the chemo or the disease causing these other problems. I met him in week 2 of my 5-week rotation, and by the end of my 5 weeks, it was pretty clear that he will be going home soon, not with a cure, but for palliative care.

Sick kids are so sad. For me. Dealing with death isn’t easy, but I thought I had a grasp on it from my work with the residents in Assisted Living. Now, I realize, that they were the ones making it easier for me. They were so graceful in life and in death. Not everyone has made peace with dying, but my residents taught me that since they didn’t fear it,  I didn’t have to fear it for them. I was lucky to learn about death in this way. Maybe some of these same concepts that I learned from my residents can be applied to pediatric patients too, but I haven’t figured it out yet. My pediatric rotation is over, but I am still working through the emotions and sadness I am feeling. I question whether I want to deal with kids that are this sick on a regular basis. Luckily, my school has a number of resources for me, including a clinical nurse psychologist with a specialty in helping children with life-threatening illnesses. I can only imagine what an amazing resource that she will be in my journey as a nursing student.

 
 

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