Monday, April 26, 2010

A Real Tropical Vacation

I remember last year I wrote an entire entry about sending the newborn nursery babies on a tropical vaca to treat jaundice. Well, this spring break I really did go on that tropical vacation. Me and 45 other well intentioned medical personnel traveled to the Dominican Republic to help deliver medical care to poor and improvised communities.
Looking back, I'm not sure what exactly I expected. I didn't think we would be staying in a five star hotel. I was prepared to sleep on the ground. I figured I would eat bugs and gather firewood before milking our one goat. Like, whateves, it would all be in good fun and I could probably survive my spring break living like a Seattle runaway. But I hadn't thought that I wouldn't have basic medical equipment. I thought that, I don't know, the hospital would have WALLS.
We packed bags and bags of medical supplies with us into large canvas sacks and each of us was responsible for one. They weighed between 25 and 50 lbs, and every person in a 45 strong group heaved one to the Dominican on our backs. So we had a pretty intense supply of medications to prescribe and distribute at the little shack towns we visited every day. We also brought bags of surgical equipment and a few surgeons. We planned one doing GYN surgery on women with tumors and other issues that couldn't get help otherwise. The local hospital we worked with was letting us use their Operating Room. I thought we had packed enough. We were good.
It's comical how wrong I was. Alarm bells should have started to ring the first day we were there and I was approached to join the surgical team. Surprised, I said of course I would help them out, but I really had super limited experience as an OR nurse. No one cared. It was me or nothing.
Uh-oh. Could a nurse familiar with the OR work with them from the hospital?
No. It was already an issue getting an anesthesiologist. So okay.
The next morning, I dressed in my most fashionable scrubs and joined My New Surgeon Friend Laura. We rode to the hospital in the normal Dominican way, which means we were loaded into the back of a pick up truck.
When we got to the hospital we got a nice tour. It was sunny, shiny, and new.It was full of activity. It was missing a few walls and doors. A bird flew in. The nurses wore mint green polyester outfits with tiny white hats. I'm not sure why they were employed, because I basically never saw one. In the OR there were fly swatters.
We met our on-loan anesthesiologist. We said Hi and he waved back, with his one arm. Because the other arm was broken. We had a one armed anesthesiologist. During our tour, we learned that if any patient developed blood pressure higher than 210/150 to call Sue. Who Sue is or how to call her was not explained.
My New Surgeon Friend Laura reacted with amazing composure. She simply said "We are here to help. Let do the best we can with that we got." That became my motto.
I was asked to pre and post op care. We had met up with a team from Yale who were super excited to do some random surgeries with us, and they had an experienced scrub nurse. So I did vitals, medicated my patients, and put in IVs. These tasks were harder than expected for a few reasons including:
1. I had given New Medical Student Friend Caitlin my bag o trix. When I left good old america, i had packed an amazing kit with my otoscope, bp cuff, thermometer, bandages, cartoon stickers, and other VITAL things. Figuring these would all be at the hospital, I sent it to the shanty-town. It quickly became apparently all the bag o trix materials I so casually discarded were not readily available in my new situation. I was able to haggle a thermometer from a very frosty medical person whose position i never figured out (nurse? med assistant? DIRECTOR OF THE HOSPITAL?!). I was handed a mercury thermometer and a baby food jar filled with rubbing alcohol for cleaning between uses.
2. If you've never attempted IV insertion in a developing country, you should read up about it before you go. Imagine my surprise/desperation/panic when I realized that no, we hadn't packed IV insertion kits in the massive pile of other shit we brought. I once again had to haggle them from Snow Queen Hospital Lady. And they had no flushes or extension sets. I was given another baby food jar to disinfect the skin.
3. EVERYONE BLEW Their LINES. Constantly. I was having a meltdown. Giving meds is impossible when there is no access port and literally no access in the line. The Snow Queen came to help me. Her method was to literally slap the patient. I mean she slapped them left and right on both arms. I was shocked, an emotion I had basically experienced all day. She explained that slapping releases histamine and makes the vessels swell. I nodded like ooooh of course.

The day progressed with more mishaps that I;ve ever made. It was a constant comedy of awful. I quickly became known as the wasteful American because I required two sheets per bed. And the sheets were too small, so I would tuck in three corners, pull on the fourth, then another would pop out, OVER AND OVER. My translator was a great lady, but an awful translator because she would often forget I couldn't speak cereole and just stop translating for me. I'm not sure the nature of her position because I also saw her changing the drip rates on my IV lines. In American NO ONE TOUCHES MY LINES.

(Here is my JD-style internal monologue)
After, when I considered the day in the Dominican I realized why I found it so hard to adapt to this free style medical care. i mean, yes it was utterly ridiculous. But I seemed to have a more difficult time just going with the flow that everyone else. I realized it's because as a new nurse and a new student and a new EVERYTHING the one area I find comfort in is in absolutes. I relish control and knowledge and doing everything by the book. In the Dominican, I was cut off from my top of the line supplies, my piles of books, AND MY IPHONE FOR GOD'S SAKE. I had to rely on only my best efforts, and that's always scary.

Obviously I didn't bake anything there. I couldn't even drink the water.

Thursday, February 18, 2010

One Year Later

Yes, I am aware that I have left this blog to die and rot for about a year now. And I know the Internet world has been trying to go on and live without ridiculous stories of medical mishaps and delicious recipes, but I have decided to return. I will once again blog about baking and bringing.
Although, these days I'm not bringing much anywhere. The hellish year of fast paced hospital rotations and back to back exams has ended and I've moved up in the world to new type of hell: unemployment. This, however, yields significantly less entertaining stories, although it does leave more time for baking, and I had perfected a few bread recipes.
How did I end up here may you ask? I will tell. When I last wrote, I was finishing my maternity rotation and moving on to psych on a locked ward. After finishing my psych education, I did acute physical rehabilitation in a delightful mansion on a hill filled with 70-something year olds wheeling around after strokes. It was fun and adorable. By then, it was May and I began my summer internship in medical oncology, which was a fun 250 hours of priming IV tubing and memorizing horrific lab values. I was so busy I barely baked. And then.... it was over. My school declared me as an able bodied care taker and unleashed me out into the world, pending my passing grade on the board examination. If you are worried that I just skated over about 6 months worth of recipes and undoubtedly entertaining hospital follies, don't worry. I plan on elaborating in later posts.
In October, I sat for my boards. I showed up wearing plaid and keds, twitching like a nervous wreck and tossing my large amount of hair in my face like a hood. I didn't just look anxious; I was scratching myself like a crack addict desperate for a fix. After supplying the nessecary paperwork, I was brought into the testing room to be briefed on the use of the computers and format of the test. I was informed of my right to a bathroom break every two and a half hours. I was horrified. I said "No I'd rather just test until I'm finished. I won't be requiring any breaks." The exam proctor gently said "Are you sure? The test is 6 hours long...." My already obvious agitation got worse as I said "Really... uh... well I have somewhere to be in a little bit."
By then, it was obvious everyone in the testing center thought I was a total mess. As I took my exam, I continued to nervously scratch my scalp and bit my nails. 45 minutes and a number of questions about TURP procedures later, I raised my hand and told the proctor I was finished. She clearly thought I had failed and said "oh, well, it's okay you can always take it again.
I didn't fail. I OWNED that exam. I was an exam slayer that afternoon. I bent that exam to my will and destroyed in so completely it wasn't even a fair fight. Julie: 1. Boards: 0.
However, now the count is a little different. Now it is Julie: 0 Real Life: 10 million, because despite having crushed the boards with intelligence-created fire and brimstone, I can't find a job. I haven't done any patient care since my medical oncology internship, except for the occasional volunteer shift at free clinics and the temp work I did for public health vaccinating school kids against H1N1. My life has taken on a dramatic change since the fast paced sprint that was last year. Now, it is the monotonous, crushingly depressing life of the unemployed. I wake up at noon. I cry into my oversized coffee cup for an hour, dripping tears into the lukewarm liquid, while wearing my fucking bathrobe. I internet surf.Then I apply for jobs over and over, anxious scratching my scalp and twisting my hair like I'm back taking that fucking exam.
I, obviously, still go to school, but my schedule now consists of mammoth-sized chunks of class for like 12 hours and more days off. In my advanced health assessment I still get to wear a white coat and act like I have a purpose in life. But the rest of my time is free. Before, I slept during these intervals, but I'm trying a healthier, more active use of my time. So lately, I've been having bake sales.
Next month I'm going on a trip to the Dominican Republic with a bunch of other students. My job has been to raise funds by baking delicious cookies and cupcakes to sell for profit. Sweets and a push up bra can work miracles, so I've created a fairly lucrative business that is making me question my career choices. Should I really be an NP, or would to be better to open a corner bakery? I recently baked AWESOME sugar cookies for Valentine's Day that just plain weren't amazing, but lend themselves really well to being jazzed up:
Butter Sugar Cookies
1 cup butter, room temperature
1 cup sugar
1 large egg
1 egg yolk
1 tsp vanilla extract
1/2 tsp. salt
2 1/2 cups bleached all-purpose flour

I cut them in to heart shapes, dripped them into chocolate I melted in a double boiler, and then sprinkled chopped almonds on them. They looked to cute for people to pass them up and I raked in the cash for my mission trip. These cookies are a good all purpose cookie that can be dressed up for a number of occasions!
So anyway, that is the current state of things. I'm sorry I have been so absent for so long, but now I am ready to start and bake anew. I can replay some of the more ridiculous hospital stories from the last 6 months, including the schizophrenic who told me i was pretty, and the patient who got run over by a wheel chair. I can also explain some of the more serious events, like my experiences helping my terminal patients and how important i learned it was to hold a hand. Plus, all that stupid stuff I did, like catching mumps, shoot myself in the thumb with epi, and being the only student to report an adverse event when I got exposed to H1N1. In the meantime I will continue to apply for jobs like mad, maybe study some pharmacokinetics and play EverQuest. I may be down, but not out.

Tuesday, March 10, 2009

A study on Irish roots in childbirth

All good things have to come to an end, and I have sadly finished my rotation on the labor and delivery unit. It's always exciting to go some where new, but delivering babies was so enjoyable that leaving is difficult. Our last week there was jam packed with excitement and very busy. I helped a woman whose family, like mine, hailed from Ireland and was expecting a baby girl. I was assigned to help with the delivery. It was like right out of a tv show, with me holding one of her legs back in a very compromising position and yelling at her to push. I wiped her brow, made her sip liquids from a straw, and tried to ignore the overwhelming smell of birth products in the room. I changed linens, ran water,and gripped her hand when she needed me. As high tech as medicine has gotten, I was struck by the natural flow of the whole event. We inherently know how to give birth and helps others do so. I felt extremely in touch with my Irish dozen-of-children-bearing heritage that has gifted me with the intrinsic ability to yell push and, I can only assume, spit out like nine kids of my own some day. 

When the baby was finally out, she was purple. The cord had been wrapped around her neck twice. She didn't cry for the longest time, putting me into a slight state of panic. But she started to turn pink, and then did the most amazing thing: she latched on to her mother's breast and began to suck like a starving monkey. She was there ALL DAY. It was astounding, because most babies don't do that right after birth. Not to mention most mothers don't have milk in that early, but this mother made her equally Irish ancestors proud by being more fertile than most believe possible. 

With mom and baby happily engaged in their nutritional needs, dad went out for a Guinness and I had time to roam around the floor. I reflected on some of the odd, yet endearing, qualities of the maternity floor. There are many nice paintings hanging on the walls in a variety of pastel colors. All the paintings are of vaguely vaginal flowers or waves with many folds. I'm not sure what the subliminal message is suppose to be, but it is soothing to know exactly what the specialty of the floor is based on the decor. Some of the other paintings are of lighthouses. These are fake frames that swing forward off the wall like a James Bond style hiding place. Behind them is all the emergency equipment needed when things go downhill super fast. I'm glad this was revealed to me in orientation, because I would never have guessed to look behind the phallic painting.


I also visited the other students, like my friend Kim. Kim is the most in demand student nurse because she can speak many languages fluently. Currently, she was translating for a Spanish couple who had questions to ask about the pregnancy. Kim chatted away with them, her face looking increasingly uncomfortable. Later, she told me the husband began asking her questions like "Do we need a car seat?" then some how moved on to "How do we get a DNA test?" Kim didn't understand I thought maybe they were concerned about genetic diseases and began to counsel him on genetic disorders. He stopped her and said "No, I mean like paternity testing..... I had a little.... you know, problem with her a while back...." Thankfully, Kim is very fluent and knew exactly what this meant, while I would have probably needed further explaintion. 

I brought homemade girl scout cookies to the last day. They took me forever to make and were super time consuming, but people really loved them. I made Thin Mints, which I'm not crazy about, but others adore these fudgey treats!

Homemade Thin Mints
2 1/4 cups all purpose flour
1/4 cup cornstarch
6 tbsp unsweetened cocoa powder
1/2 tsp salt
1 cup white sugar
1/2 cup butter, room temperature
1/3 cup milk (any kind)
1/2 tsp vanilla extract
3/4 tsp peppermint extract

In a small bowl, whisk together flour, cornstarch, cocoa powder and salt.
In a large bowl, cream together butter and sugar. With the mixer on low speed, add in the milk and the extracts. Mixture will look curdled. Gradually, add in the flour mixture until fully incorporated.
Shape dough into two logs, about 1 1/2 inches (or about 4 cm) in diameter, wrap in plastic wrap and freeze for at least 1-2 hours, until dough is very firm.
Preheat oven to 375F.
Slice dough into rounds not more than 1/4 inch thick - if they are too thick, they will not be as crisp - and place on a parchment lined baking sheet. Cookies will not spread very much, so you can put them quite close together.  Warm dough in your hands if it crumbles.
Bake for 13-15 minutes, until cookies are firm at the edges. Pay attention, but its very easy to burn them! Cool cookies completely on a wire rack before dipping in chocolate.

Dark Chocolate Coating
10-oz dark or semisweet chocolate
1/2 cup butter, room temperature. I used a bit more, and it was okay, but more watery than I wanted.

In a microwave safe bowl, combine chocolate and butter. Melt on high power in the microwave, stirring every 45-60 seconds, until chocolate is smooth. Chocolate should have a consistency somewhere between chocolate syrup and fudge for a thin coating.
Dip each cookie in melted chocolate, turn with a fork to coat, then transfer to a piece of parchment paper or wax paper to set up for at least 30 minutes, or until chocolate is cool and firm.
Reheat chocolate as needed to keep it smooth and easy to dip into.

Makes 3 1/2-4 dozen cookies, if not more. You could make your own little cookie army with this recipe, which means you'll need more chocolate to coat if you make a ton. I ran out because I had more than 4 dozen cookies. I would make these again if someone requests them, because people loved them so much, but they did take forever to make!

Sunday, March 1, 2009

Tropical Vacation

A lot of babies get jaundice. Some babies get jaundice so bad you think to yourself "omg she gave birth to a carrot!" and then you are confused. It's a pretty common complication and most babies are able to bounce back without having us to intervene. However, there are times when treatment is required. The best way to treat really bad jaundice is with phototherapy.

Phototherapy is basically exactly what it sounds like. We put the little new babies under tanning lights. Like a ton of them. Well, at least three. They wear little diaper speedos and we put sunglasses over their eyes and lay them down on the tanning bed. Yesterday morning, the hospital lost electrical power, so we plugged the tanning beds into the emergency outlets and let the babies laze around under the lights. In the dim nursing lighting, it looked like all the babies were on tropical vacations, and I mixed them all up a bottle of pina colada to sip on. Because nothing clears up a touch of jaundice quite like dark rum. Fuck yeah spring break!

In keeping with a tropical theme, I mixed up some banana cookies the other day for some fun and healthy flavor! 

Banana Oatmeal Cookies

1 cup all purpose flour

1/2 tsp baking powder

1/2 tsp baking soda

1/4 tsp salt

2 tbsp butter, very soft

1/2 cup sugar

1/2 cup brown sugar

1/4 cup mashed banana (1 small/medium)

1 egg

1 tsp vanilla extract

1 1/2 cups oats

Preheat oven to 350F and line a baking sheet with parchment paper.
In a small bowl, whisk together flour, baking powder, baking sodaand salt.
In a large bowl, cream together the butter and the sugars. Beat in egg and banana, followed by the vanilla extract. Gradually, on low speed or by hand, add in the flour mixture. Stir in the oats. It'll be thick, so I usually mush with my hands (then lick them later).
Drop dough by tablespoonfuls onto prepared baking sheet.
Bake for 11-14 minutes at 350F, until set and lightly browned.

You can add chocolate chip to these for some variety. I'd probably use mini chocolate chips so they don't overwhelm the banana flavor. What I really love about these cookies is that they bake up super high and airy, instead of being dense and heavy like you would expect. But this does make them super addictive! I hid them in my pockets, then passed them out to random patients who look they they needed a boost, because I might be early for spring break, but babies can't tell time anyways.

Tuesday, February 10, 2009

The Final Day of Pediatrics

My last day on the pediatric floor was the total opposite of the rest of time there.
It sucked.
I was on the verge of tears from most of the shift. I had to deal with a horde of medical students poking my poor nine year old medical mystery, while being totally annoyed with following percautions protocol. If I never see a blue plastic protection gown and mask again, I will die happy. I was nervous about the intense medications being given, including Ativan, Prozac, Depakote, and Risperdal, which I've never even seen used in kids. I watched over her for most the day, because it was possible for her to have a seziure at any moment, but no one taught me what I should do if it actually occured. So I just kept praying it wouldn't happen, figuring I'd just cross that bridge when I got to it (this probably isn't smart). As miserable as I was though, I was able to help out my patient and her mother by capitalizing on a unique gift God has bestowed upon me and I use to spread happiness throughout the world: sticky fingers.
I am very very good at stealing things. I think no one expects me to be stashing tons of things underneathe my white coat all day long, so I float by undetected with all my pilfered goods. I have weighted myself with and without my lab coat on, and there is a ten pound difference because of how much I have shoved in the multiple pockets. My patient's mother told me she was insanely bored, and suddenly Better Home magazines began disappearing from the waiting room. Cookies and coffee went missing from the break room. I totally just claimed a vital signs cart and blood pressure cuff and hid it in a closet, figuring my need of it was probably greater than others without unstable patients. Obviously, I didn't go rob a bank or anything, but I have begun a life of crime.
As it was the last day, I made something decedant for the peds nurses: cheesecake brownies. Brownies are really strange to make, but apparently I have mastered the art of creating them, because I get requests all the time.

Cheesecake Brownies
1/2 cup butter
2-oz chocolate, chopped. Dark is probably best, but I didn't have any so I used 1 oz milk and 1 oz unsweetened
1 cup sugar
2 large eggs
1 tsp vanilla extract I couldn't find my vanilla. Turns out it fell off the spice rack, and I found it later in the back of the pantry. Instead I used 2 tsps of rum. I know this sounds weird, but OI sometimes use it in place of vanilla. It has a much more grown up taste that makes things a little interesting.
2/3 cup flour
2 tbsp cocoa powder
1/4 tsp salt

Cream Cheese Layer:
8-oz cream cheese, room temperature
1/3 cup sugar
1 large egg
1/2 tsp vanilla extract

Preheat oven to 350F. Line an 8×8-inch square baking pan with aluminum foil and lightly grease.In a small, heatproof bowl, melt butter and chocolate together. Stir with a fork until very smooth. Set aside to cool for a few minutes.In a large bowl, whisk together sugar, eggs and vanilla extract. Whisking steadily, pour chocolate mixture into sugar mixture. Stir until smooth. Sift flour, cocoa powder and salt into the bowl and stir until just combined.Pour into prepared pan and prepare cheesecake mixture.In a medium bowl, beat cream cheese, sugar, egg and vanilla extract until smooth. Drop in dollops onto prepared brownie batter. Gently swirl two batters with a butter knife.Bake for 35-40 minutes, until brownies and cheesecake are set.

The brownie layer is thin and SUPER fudgey and the rum made it taste really dense. Overall, I think they came out good and it was a great way to bribe the nurses to let me come back to pedatrics.

Thursday, February 5, 2009

Obstetrics Day #1

Today was the first day of my rotation on Labor and Delivery. I woke up in the slight panic and needed to take at least 10 deep relaxing breaths before heading out the door. I was so jazzed up, I was a little concern that I had accidently given myself seretonin syndrome, a bizarre fear I've been harboring for a few weeks now.
Anyways, I wasn't super excited about Delivery. I had loved pediatrics and wanted to stay there. Maternity freaked me out, because I had no previous experience to draw upon and didn't really feel fit to care for anyone's reproductive plumbing. Plus, the word fundus always make me giggle in class, and I didn't want to insult anyone if I burst out laughing when they gave report. Thankfully, my anxiety level started to fall after my third soothing cup of coffee and I found out I had been assigned duty in the nursery. My experience in caring for babies in much more advanced than caring for their mothers, so I felt comfortable swaddling infants for the next 12 hours. However, when I got to the nursery, I found out all the babies were off with their new moms, rendering me utterly useless. After 20 hopefully minutes where I prayed my clinical instructor would just ship me off to some place I could disappear, like the OR, I was assigned a nurse to follow and a patient. She was not postpartum, but had given birth to a little boy a weekend ago before developing preeclampsia. She was also an NP who worked in the ICU at my school.
Preeclampsia sucks. It is high blood pressure greater that 140/90, with protein in the urine, low platletes, terrible headaches and epigastric pain, visual distrubances, and the nasty habit of causing seziures. I have no idea why it happens, and it freaks me out that so much can go wrong so quickly. It is however, diagnostically interesting, at least to me, and the use of mganesium to treat is bizarre because normally levels of over 2 are not great and my patient's was 5.8, which in this case is considered theraputic. Also, preeclampsia was on an episode of House a few weeks ago, which really is the greatest learning tool available.
I had a great day with her. A few hours of chatting and two foot rubs later, I that she was awesome and gave her my email address when I left. Interestingly, I found out that she had been doing "natural family planning" where she monitored her cycles as a method to prevent birth control. She was married April 12. She was prgnant April 18. She told me "I think we need to re-evaluate our methods..."
After lunch, to my surprise, I found out I was still considered the nursery room nurse and there was a baby I needed to care for. I walked into a room and quickly realized that my new patient hadn't been born yet, but was apparently coming soon. The nurse, pedatrician, and I set up suction, tubes, and blankets while the mom pushed, and I whispered to the doctor, "Um... this is my first day..." and he was like "um.... really? Wow, intense first day huh?"
The birth was what you would logically expect. A watermelon sized head was attempting to fit through something much much smaller. I watched the fetal monitoring strip that reported the baby's heart rate, and thought "Oh this is total shit" as it declined to dangerous levels. The doctor was forced to quickly cut an episotomy and pull out a baby that we grabbed. About a billion things suddenly happened at once, and I started adding up the APGAR score in my brain, while I tried not to cry/puke/pass out. After, I took a "bathroom break" where I just sat in the stall clutching my cellphone, our generations comfort item.
I've decided I love labor and delivery.
I brought 10 grain muffins, because I had a bag of 10 grain cereal in the pantry, and I really hated it, so I figured I'd bake it up. They were a total hit with the nurses, who requested the recipe a million time. I was relieved, because I really thought they were crappy muffins, but they enjoyed them. Here is the recipe:

1 large Egg
1/2 cup Sugar
1/3 cup Margarine
1 cup whole wheat flour
1 tsp Salt
1 tsp Baking Powder
1 tsp Baking Soda
1 cup 10-Grain Cereal
1-1/4 cup sour Milk or Buttermilk
Mix 10 Grain Cereal and milk; allow to stand for 10 minutes while preheating oven and assembling other ingredients; cream sugar, margarine, and egg together. Add dry ingredients and milk mixture. Stir only until mixed. Spoon into greased muffin pan. Bake at 400°F for 15 minutes. Makes 12 muffins.

I added blueberries and almonds to mine, which gave it nice color and a good crunch. I also ended up with 13 instead of a dozen.