A Thousand Firsts

I recently mentioned to one of my fellow nurses that I loved being a teacher because I could have the same experience for the time a thousand times. Teaching and performing even the most basic of skills never gets old. It's so much easier to remove surgical staples when you get to do it with somebody who's so excited about it you know they'll be talking about it for days to their roommates.
This week it was a little different however. One of my students experienced her first death. The patient was a middle aged Chinese woman. Cancer had caused her body to waste away so that she looked like a skeleton with skin lying in the bed. He husband was so attentive, he had been at her bedside for days.
I had gone in to see this patient a few times and had had a brief discussion about end-of-life care with my student. On Friday morning as I was assisting another student with IV medication, I saw the first one standing outside the room. I quickly finished with the medication and went out to talk with her.
Tears streamed down her face as she told me that her patient had just died. "She hadn't taken a breath for several minutes so I listened to her heart. I could faintly hear something at first but then it just faded away. What do I do for her husband? Is it OK to cry with a family? I'm trying to pull myself together..."
Yes, unfortunately as a nursing instructor you experience death a 1000 times for the first time too. They ask questions like: "Why did this happen? What will they do now? This just doesn't seem fair. It seems odd that in a few minutes I will have to see my other patient in another room and carry on like nothing has happened when I know their whole world has changed."
All my "teacher words," no matter how true or how profound, can't take away the pain and shock of losing your first patient. So there we sat in the break room behind the door. After few minutes of sobbing and a bit of talking, she fixed her makeup and went back into the room just in time to help her husband dress her in a beautiful Chinese robe before the rest of the family came to bid her farewell.

There's and App For That?

This morning while traipsing across the hospital I noticed signs announcing the new Da Vinci surgical system that had just arrived. The sign said that they would have the machine on display for demonstration in the hospital lobby this afternoon. My nursing students are on Medical/Surgical rotations and are rotating through the operating room. I thought they would be excited to learn about the new system so I snuck downstairs and asked the company reps if I could bring them by. Of course the reps are excited to talk about their product to anybody who will listen so they had no problem with it.
I arranged for the students to meet in the lobby for post clinical conference. They played with it for a few minutes and managed to complete the tasks of displacing and replacing a series of rubber bands on tiny cones in a matter of minutes. My one and only male student says, "That's cool, now what are we doing?" Another one says, "There's an app for that!"
A quiet Chinese student just stands staring, "This is the cool thing you wanted to show us? I'm shuddering as I picture all the video game geeks becoming surgeons."
Well, you win some and you lose some... I let them go home a few minutes early and I stayed the extra time to play with the "robot surgeon."

Peanut Butter Milkshake and a Walk in the Park

A peanut butter milkshake and walk in the park, those were my "self care" activities of choice following my phone interview for the WSU PhD program this morning. I had been dreading that interview for over a week, why couldn't I just drive to Spokane and do the interview in person. It doesn't matter now... at least it's over.
Since for some odd reason I don't have a phone in my office and the functionality of my cell in this building is rather dubious, I used the dean's office to make the call. I think in some ways sitting at his huge desk surrounded by all of his post-it notes to self and numerous degrees made the process more intimidating.
Now we wait...

Ineffective Individual Coping on Whose Part?

He came to us around Thanksgiving, he was on death's door. Mr. Jones (not his real name of course) had been dealing with a congenital heart abnormality all his life, and now at age 50 something it was catching up with him. I remember the evening he came us. With his breathing and circulation were controlled by machines, it appeared that his only hope was a heart transplant.
After several days in intensive care, Mr. Jones recovered enough to breath on his own. His prognosis was starting to look a little better. It wasn't long, however, before he experienced another setback, a massive stroke, a major risk for patients with ventricular assist devices. By Christmas his brain function was very minimal. Even so, his wife Sue, faithfully sat his bedside. Because she wouldn't "pull the plug," some of the nurses had her pegged as "in denial" and gave her a nursing diagnosis of "ineffective individual coping."
I found myself as his assigned nurse on several occassions. On the days I wasn't too incredibly busy I chatted with Sue as I changed dressings and IV lines. I found out that she was a high school language arts teacher, that she was a mother of 3 young women, that she had met Mr. Jones while they attented college in Canada... I found Mrs. Jones to be a very pleasant woman with a great head on her shoulders who just happened to be going through a very difficult time.
Last week I was assigned to a different hall. I was charting and watching monitors when Mrs. Jones walked by. We greeted one another in passing and I asked how she was doing. She told she that she had decided to see a counselor as a way of taking care of herself so she would have someone to talk to. "I'm doing it to be fair for my girls. They are already greaving enough over their father, they don't need to worry about me too..."
She told me about how when she went to meet with the counselor, she noticed that the counselor seemed uneasy. "So basically you're greaving over your husband before he's even dead?" Mrs. Jones was a little surprised by this unexpected response from a "mental health professional" so responded to this remark by asking, "You don't like me, do you? Am I making you uncomfortable."
The counselor responded with this: "I don't like myself when I can't help people."
Wow, that really hit the nail on the head. It isn't Mrs. Jones who has the "ineffective individual coping."
"I'm trying to keep at least one foot in real life. I want to do what's best for my girls and those I have left," she said as we finished the conversation and parted ways.

That's What Christmas is All About Charlie Brown...

Since all of my students are on Christmas break I have been working a lot more at the hospital. I have to admit that while I do generally enjoy my work, any sort shift in the schedule upsets the extremely delicate balance I have worked so hard to make it that way.
Last Wednesday was my random one day off in a long string and I was looking forward to spending it visiting with some good friends. My friends live about 40 miles south of me so I try to take advantage of making such a long trip by adding in other things I need to do in that direction. That morning it was taking the car in for service.
I left the house early as I had accepted the first appointment of the day. Traffic was a bit heavy so I was late by a few minutes. As I hoped out of the car and started inside I suddenly realized my keys were still in the car and the car was locked! Oy Vey!
Fortunately it was only about an hours walk to World Vision where my mom works. It was a cold morning but the walk gave me time to reflect. Of all of the days this could happen at least I had the time to deal with it today. Was it really that bad, more embarrassing that anything I guess. So I spent part of the morning praying as I walked.
I was able to borrow mom's car to drive all the way to my sister's place to get the key to my house and then to my house to get the spare keys. A few hours later I arrived back at World Vision to deliver mom's car to her. Of course with mom being mom, she didn't want me to walk back to the mechanic. "I get off early at 4 today, you can wait here for me." Ahhh... It was only 1 at that time.
So there I sat in the lobby of World Vision with my laptop half working, half people watching. Then I noticed a family outside looking at the statues of Jesus and the little children. As they entered, the children (a boy and girl about ages 8 and 1l) excitedly ran up to my mom's desk. They wanted to buy farm animals for people in Africa.
Of course mom is the receptionist and switch board operator, not the person who takes the donations. She tried to explain this to the family but the disappointment on the children's faces was just too much. As she called around to find a solution, the kids counted and recounted the precious money they had earned for this specific purpose.
They managed to create a elaborate plan to maximize their gift using every last dollar they had. Mom filled out the papers and gave them each a little receipt which their mom said she would hang on their Christmas tree.
"I hope you are rich when you grow up, you would just give it all away," said the mother to the little girl.
As I thought about that statement I thought about all the different ways we could be rich and all the different ways we could give it away. I'm hoping to take that as a challenge.

Christmas Greetings

Greetings everyone and a Merry Christmas!
The last few years have been full of blessings and new adventures for me.
In May of 2008 I traveled to Rwanda as a part of my master’s thesis to teach a class in basic trauma nursing. I had the pleasure of working with my friend Julie Yerger at Kibogora Mission Hospital. The experience was nothing short of amazing, I am sure I learned much more than I have ever taught.
In June 2008 I successfully defended my thesis and presented the work I did in Rwanda completing my work and officially becoming April Morgenroth RN, MN. It is much more exciting than it sounds however, as all it meant was a change in offices and an increase in responsibility. I suppose I could add to that eligibility for a PhD program, but that of course means many more years of work (and hopefully more trips to Rwanda).
In September 2008 I officially became the Northwest University Medical Surgical clinical instructor at Overlake Hospital in Bellevue. I have truly enjoyed the experience and have been blessed two years in a row with the “Best Clinical Group Ever.” We have had so much fun learning, laughing and growing together and I feel so incredibly blessed by them.
June of 2009 was the first year in 13 that I wasn’t in Mexicali, Mexico on the MOP mission’s trip with the high school students. The trip was canceled this year due to violence in the border cities. I must say there were a lot of disappointed high school students but we’re hoping to resume this year.
Of course I couldn’t let summer go by without any international travels… July found me in Cambodia with a medical team from New Life Foursquare Church. We served the Province of Ratanakiri by setting up a free clinic at a local orphanage. Thirteen practitioners saw over 1600 patients in only three days! We saw everything from Malaria to heart disease and everything in between. The clinic was actually cut short by some political activity but God has His hand on us and everything turned out for the best, even better than we had planned in fact.
Two weeks after returning to the U.S. from Cambodia I left for Mexico City with four students, one nurse and one nurse practitioner. This was part of a pilot program for a summer nursing elective travel course. The class was on trauma nursing and we partnered with the Mexican Red Cross. Fortunately I was able to modify the same curriculum I had developed for Rwanda for the work became a little more manageable.
The trip was amazing and we all made many wonderful new friends. Each team member was also able to bring in an extra suit case packed full of much precious donated medical supplies. An ambulance crew received their very first and only bag valve mask, a clinic was outfitted with a nebulizer machine and oxygen equipment and most of all, everyone was encouraged. The new curriculum has officially been approved by the office of the Provost and we are all looking forward to next summer.
These last few months since the beginning of the school year I have been dividing my time between University of Washington in the intensive care unit and Northwest University with my “9 kids.” The year is going by so quickly, I’m excited to see what the next year will bring.
Merry Christmas Everyone!

A Happy Thanksgiving

This year for Thanksgiving I had four nursing students with me who lived far away and were unable to go home. Two are sisters from India and two are roommates, both from out of state. We started out at my house baking bread and making delicious curry. In the afternoon we headed over to my sister's house to enjoy the Thanksgiving meal with the rest of my family and some other friends.
The food was delicious and everyone seemed to be enjoying themselves and eachother. Lisa and even broke out the Wii. It was a kick in the pants to watch my students play Wii bowling with my mom. Everyone seemed to be getting into it to extent of making sound effects.
After most of the guests had left, we got Priya and Reena to play Guitar Hero; what a hoot! I am so thankful for all the fun loving people in my life!