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Monthly Archives: January 2011

Poaching a Snow Day: Perfecting Egg & Toast

Today’s snow day breakfast was this:

 

Just what the Nurse Practitioner ordered for a head cold on a snow day: poached egg with toast, tea and DayQuil. Yum.

For the record, last snow day’s breakfast was this:

 

Crepes A La Snow…

Made with this:

 

Uncle Bill's hand-hewn mixing spoon in its innagural batter

Apparently the only things I accomplish on snow days are delicious breakfasts. I haven’t been outside yet to view the (supposed) 19 inches of snow, nor have I cracked a textbook. But I did learn how to make poached eggs. Who knew that all it took was a splash of vinegar in a barely simmering pot of water, swirled into a whirlpool with a spatula? Now you know too.

Nothing much to add to the recipe that I found on Smitten Kitchen, except to comment that is perfect, has an incredible photo montage dedicated to the process (which I am not sure how she accomplished with only two hands), and is only missing red-hot chili flakes it its garnish. The toast fingers are ingenious. Check it out.

The crepes recipe was found in a tiny little cabin in the North Cascades, in an old cookbook. I think it is a pretty darn perfect recipe as well. I copied the recipe on an old sheet of notebook paper, which I now can’t seem to find anywhere. I promise the recipe in a future post, when I alight on the it again…

In the meantime, I will most certainly be making more poached-belly eggs. They are runny and delicious and my boyfriend is missing the “eggs-taste-good” gene, so they are all mine.

In my post-poached egg bliss, I am spending a moment reflecting on my clinical experience yesterday. I have given some more thought to bed pans. They really are dreadful. It was one thing to help my residents use the toilet while working in Assisted Living, but it really is quite a different thing to help a patient scoot a pink plastic oddly-shaped…thing… under his/her bum. From the moment I walked in at 7:30 to take vitals on my first patient, to the 30 minutes I spent before leaving at 2:00pm helping my nurse clean up a patient who had been lying in her own excrement for too long, most of my day was about poo. Again. I can’t seem to escape it. Even as a nursing student, where there are many more “important” things to mull over (like my recent successful IV insertion in the ED last week, or the deodorant container that was found in the rectum of another individual the very same day), poop just seems to follow me, and I really think it’s important to dwell on the un-enchanting topic for the patient’s sake. I think we all can relate. I hate needing to go #2 when I am on a camping trip, or in a public restroom. But sh*t happens, and sometimes you just have to. However, now put yourself in the shoes of your bed-ridden patient. Can’t you see the conundrum? Not only do you have to go #2 IN bed, you need to co-opt someone’s help in order to do it! And if you try to hold it, telling yourself you will be out of bed in just a few days? Oh no, you’ll be much worse off now: the doctors and nurses will note that you haven’t had a recent BM and will give you all sorts of fabulous concoctions to make more BM appear from your rectum than you ever dreamed possible. The bed pan will become a fleeting dream of the past, something you wish you had used gratefully, now knowing that the alternative is soiling your diaper/chuck every 5 minutes and needing to press the call bell for yet another fresh set of sheets.

The underlying theme of all this is the loss of dignity that seems to necessarily occur for hospital inpatients, especially of the bedridden variety. But is it really necessary? While crouched in a position of extreme vulnerability, trying to help a patient attach her diaper from where she was awkwardly standing over me holding onto the bed (don’t ask me how I got in this position), this patient looked down at me and shook her head sadly. She said, “Growing old really is the pits. Everything turns upside down and inside out and you look at the situation and it seems so surreal. I don’t even know how I got here.” From my awkward position and preoccupation with getting the diaper successfully fastened, I could hardly think of the right thing to say. I think I mumbled something comforting, but when I finally got her seated again, I tried to rectify the pacifying words I had said before. I gave her an opportunity to share more, but she seemed past the moment of vulnerable sharing. She smiled at me, held my hand closely and told me my hands were cold. She thanked me gracefully, and I was reminded how powerless yet strong these elderly people can be. What I wish I had said to my patient while crouched on the ground was this:

“You’re right. It can be difficult and frustrating to grow old and lose independence. I can only imagine what you feel like right now. I know that so many other people feel exactly the same way that you do, powerless and a burden on others. But we will all be in your place some day.  We all will need and rely on the kindness of others. I can only hope to age as gracefully and willfully as you. Your warmth and willingness to share helps me see you better for who you are, not just a patient but an individual with a life and an incredible story. Thank you for sharing part of it with me.”

Of course I didn’t say all this. But I hope she got the gist of what I wanted to share with her just with my presence. Her response to my fumbling care was kind and comforting, while another patient’s was jarring but just as understandable. At 7:30am, while I made rounds on my patients and taking vitals, I walked in to a patient’s room and greeted him, so as not to startle him out of his sleep. He didn’t look up from his cocoon of sheets. I gently pulled back the covers, as I do with many patients, and attempted to place the blood pressure cuff on his upper arm without disturbing him. Quick as lightning, his arm snaked out and grabbed my wrist and said a harsh, “NO!” Totally startled, I dropped the cuff and backed up quickly. I meekly mumbled that I was just a nursing student, there to take his morning vitals, and  that I was sorry to bother him. But already he was shaking his head. “No, no, no you cannot take my vitals. I don’t care what you are here to do. You all take my DIGNITY. Yes, my dignity, it is a good word for what you do, and I can’t take it anymore.”

His string of words made no sense to me in the moment, but I knew that they must connect to some event that I wasn’t involved in, although I felt personally wounded by them. I tried one more time to explain myself, but his refusal was clear as he pulled the sheet back over his head. Not wanting to risk another violent encounter, I left the room, shaken. I informed my nurse preceptor of the events, and she shook her head, confused as well. Since it was a new shift, we had both just arrived. However, she told me that this particular patient usually had a sunny disposition and had been singing to her just the other day. Later on, we discovered the source of his injury. Apparently, towards the end of the night shift, he had rung his call bell incessantly, to no avail. He needed to use the bed pan, and for whatever reason, no one responded. Unable to get it himself, he immediately felt stripped of power and independence. But his dignity was not lost, he said, until someone finally came in and put him on a bed pan and then left. That person, whoever it was, then went home, probably forgetting entirely that he/she had placed a patient on a bed pan and forgot to inform the responsible party in shift change. From my vantage, I could see how the mistake had occurred, but the patient suffered as a result. I know that one day I will make a similar mistake. It is impossible for a nurse or nursing assistant to remember everything, all the time. Mistakes are bound to happen. I don’t blame the nurse/tech who made the error, but I hope that when I make my mistake, I will have the opportunity to rectify it with the patient myself. It feels so bad to let someone down, especially someone who is so dependent on you. In this instance, I was able to listen to the patient and let him vent. He let out a torrent of emotion and feeling, and by the afternoon, he was singing again. It was a good outcome, and an important lesson for me. These wounds can be healed, and mistakes forgiven, but we have to listen to our patients.

 
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Posted by on January 27, 2011 in Breakfast, Healing Spoonful

 

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Spoonful of Beans

 

beans, beans the magical fruit...rinse them well and you won't toot!

YUM. Every time I go over to a certain friend’s house, she has the most delicious beans simmering on the stove.  The mouth-watering aroma fills her house. However, I never get to see how the process begins. It appears to be a seamless cooking process with no definitive start or finish. A dash of this and that, simmer for a few hours, maybe more, and then taste test. Sprinkle in a bit more of this and a lot more of that, then ¡voila! there are amazing beans to eat. Put them in a taco, mix them with stir fried kale and sausage for a nontraditional breakfast, or eat them solo, piping hot. Finally, after craving them for eons, I emailed her for the recipe. (By “eons” I really mean the extent of this freezing cold on the East Coast that they call winter, instead of appropriately titling it “Arctic Chill.”) Alas, my friend admitted that there was no official “recipe” but gave me a list of suggested ingredients and vague instructions. Trying not to get my hopes up, I went for it, infusing my own sprinkling style into the mix. No measuring spoons or cups used, just instinct. So that’s how the following recipe looks, laundry list style. I won’t be able to recreate exactly what I made today, but I have faith that I (and you) can create delightfully unique but equally delicious Bean Surprise.

Ingredient List

Beans (I use the 17-bean mix from TJ’s. Amazing mix at an unbeatable value)

A few yellow onions, finely chopped

Cloves of garlic, minced

Carrots

Apple or dried apricots

Cumin

Paprika

Cinnamon

Red chili flakes (or anything you desire for some heat)

Few teaspoons apple cider vinegar

Splash of wine

Worcestershire sauce

Chopped chipotle peppers from can (with sauce)

Tomatoes (fire-roasted can version, or a small container of tomato-ey salsa)

Brown sugar and salt, to taste

1) Soak beans overnight, or “quick soak” (soak them for an hour and then boil until slightly softened). Set aside.

2) In a large pan, sauté onions and garlic with a little olive oil and all the spices. Mix in carrots/apples/apricots.  Let these ingredients simmer together for a couple of minutes.

3) Add beans, (keeping some but not all of the liquid that you boiled/soaked them in) to the onion mixture.

4) In no particular, combine with apple cider vinegar, wine, Worcestershire, and tomatoes.

5) Cover and simmer gently over a stove for 1-2 hours, letting the flavors meld. This does not need to be tended often, just tasted occasionally and seasoned to taste. I added a small teaspoon of brown sugar and a dash of salt towards the end.

6) Let the mixture cook down until there is very little liquid left and it is a thick stew-like concoction. Enjoy served over toast, quinoa, eggs, in tacos, or any other delicious vehicle you can come up with.

 
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Posted by on January 9, 2011 in Legumes, Main Dishes, Snacks

 

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The Ilk of an Interview

There are so many kinds of interviews. From the factual nature of a journalist’s interview to the nurturing version of a therapist’s, I never considered all the different kinds that exist until now. The quality of interview that a nurse performs is unique in its own right but is also reminiscent of the compassionate contact that a friend might provide. In the didactic portion of nursing school, they teach you an alphabet of acronyms to remember, so that you don’t forget a single sign or symptom to ask for. But OPQRST, MAKING IT P, and OLDCARTS only get you so far. For me, the letters get jumbled in a heap in my brain and I can hardly extract one without tripping over another. It can be difficult to recall that the interview you are conducting is hardly more than a conversation. And most of the information you need will be provided if you just ask the right questions. Most of the questions we are told to ask are basic common sense.

Still, when my new nursing instructor for Med Surg charged us with the responsibility of taking a comprehensive patient history, the task was daunting. I went into my patient’s room timid and bashful, hoping that I somehow, impossibly, exuded confidence. My patient initially seemed reluctant to speak with me, a mere student, after he had shared his story probably a gazillion times before with people much more “important” than me. After a few minutes of probing gently, I was ready to throw in the conversational scalpel and call it a day. I had the basics: his chief complaint was chest pain that radiated down his left arm. He lost consciousness while doing pull ups and didn’t remember the specifics of his initial symptoms, but knew what it felt like when he regained consciousness. His past medical history consisted of a TIA when he was 30 years old, and an amputated leg from 1988. He is currently not much older than 30. Too early for a stroke and possible AMI? It seemed that way to me. Especially considering that he works out religiously, dare I say compulsively, six days a week. Genetics couldn’t be the sole cause of his problems. He is in good shape and it seems impossible that lifestyle factors play a big role. In asking about his nutrition (his cholesterol leaves room for improvement) he reported that he never cooks with salt, prefers to cook for himself than eat out, and consumes vegetables indiscriminately (except spinach, he amended with a shudder). We laughed together, and had a brief moment of friendly banter — about spinach, of all things! Without realizing it, our conversation began to flow. Soon I was able to insert more sensitive questions about drug and alcohol use without an inward cringe that he would close up tight like a clam. He responded well, albeit in the negative for drug use. Still no progress on why he was experiencing cardiac symptoms. Finally, I addressed the elephant in the room, his prosthetic leg.

By this point, our conversation was running smoothly like a well-greased bicycle. I was confident but still faltered over the question, not knowing what answer it would elicit. It was my patient that led the conversation now. He told me the story, with barely a word from my end as I listened and absorbed. As a young, prepubescent teen, he had been playing a game called “quarters” with a few friends on the sidewalk. Oblivious to their surroundings, they didn’t even look up as the events occurred around them in mere seconds that would change the lives of these young boys drastically. A drunk driver ran a red light and was T-boned by a car that had the right of way. The drunk driver’s car flipped up in the air and landed on the sidewalk, where the boys were playing. They were all hit. A few died instantly, a couple walked away virtually unscathed (physically, at least) and my patient was pinned between two cars. He spent two years in a hospital, recovering. One leg was mutilated beyond repair. The other one was in bad shape as well, but miraculously they salvaged it. His skull was “crushed,” although I didn’t get the specifics of what this meant. But suddenly, it all became clear. His early onset TIAs and unstable angina must be due, at least in part, to the trauma and stress he underwent as a young teen. All of this history-taking was essential for complete understanding of his current diagnosis and hospital admission. When I went to his chart, in hopes of filling in the gaps, I realized that I had more information in my head than was written anywhere on paper. Certainly I couldn’t interpret the troponin and creatinine kinase levels as well as one of his medical providers, but I had his background and health history, an essential part of his focused physical assessment. I felt like this was quite the accomplishment for my first day on the floor. I sincerely hope this bodes well for my five-week-speed-read immersion in the catchall speciality that is fondly known as “Med Surg.”

Now, if only I could take 30 minutes for history-taking with every patient, even after graduating from nursing school…Hey, a girl can dream.

 
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Posted by on January 7, 2011 in Hospital, Nursing School

 

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