mark, my words. *mark brings me my dictionary* thank you mark

Me *Opens all the PO medications and places them neatly into a convenient med cup to hand to the patient*

Too many of my patients: *pour the medications from the med cup into their hand, dropping pretty much all of them in their bed*

Me *Stares into the camera like I'm in The Office*

Every time ...

I feel attacked personally.

Brain Anatomy

Cerebellum - located at the back of the brain beneath the occipital lobes 

Frontal Lobe -  largest of the four lobes 

Occipital Lobe - located at the back of the brain 

Temporal Lobe - located on each side of the brain at about ear level

Parietal Lobe - 

I’m going to hell for this one.

A note about LGBTQ+ and nursing

A good nurse will listen to you and address you however you want to be addressed.

We do need to know some things to help you with your care such as:

- which organs you have, don’t have, and what has been removed. (surgical history)

- if you are on hormone therapy: what kind, how long? (Medication history)

- who is your support system and do you feel safe at home?

- are you satisfied with your sex life and do you feel safe with your partner(s)?

These questions seem super personal, but it is our job to make sure that we are providing the best possible care. A lot of things differ when organs are different. (Ex. A trans woman that still has a prostate can still get prostate cancer.) Lab values change, and we can’t risk a misdiagnosis because we didn’t know details. And we are bound by HIPPA to keep your medical information private.

Nursing is a profession where you HAVE to be accepting of everyone. If you can’t, find another career.

Okay, hot take? Bisexual and pansexual are functionally synonyms, and the decision to ID as one or the other comes down to personal preference and interpretation, and any attempt to further separate the two is driving a wedge between two communities that should have nothing but love and solidarity for one another. 

We have more in common than not, and the words for our respective identities should not be pitted against each other. 

Yeah with overlapping identities like this I just go for whichever one I like the pride flag the most.

That’s so valid. 

The most common mistake I see with starting IVs

The most common mistake I see when people are learning to start IVs is that once they see flash, they stop and try to advance the catheter. When you puncture the vein with the tip of the needle, you’ll get blood return, but you still need to advance the entire bevel and the catheter into the vein before advancing the catheter. See the attached (and crudely drawn) illustrations. Let me know if you have questions!

Tough conversations.

“I love you mom, I’ll miss you when I’m at camp!” Scrawled on the poster hanging in her room. 

 A wife and mother, obviously dearly loved and only 45.  The previous night I promised to give the cytology results as soon as we knew. “At least for now no news is good news, and I have one less night to worry,” she revealed. Her perspective was completely the opposite of most patients or my own. 

Mid morning I heard from my attending,  the cytology was positive for malignancy. The team - myself (the intern), my senior, the attending and the medical students - apprehensively crossed the threshold of her room. Privately the team was devastated. Graciously my senior agreed to run the meeting. Revealing a devastating diagnosis is anxiety inducing for anyone. It’s still hard for me to contain my emotion as a provider with these conversations, I am getting better - and experience is helping. Her eyes were red with fresh tears and heartbreak. She knew. 

By chance, or not, our grand rounds earlier that morning was on conversations in serious illness. It seems like in medicine as soon as I learn something, or a grand rounds/noon conference etc is presented, I can apply it.  We discussed the tool that I’ve included in this post which was published  in this article Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices in JAMA 2014. 

As I listened to my senior gently walk through these questions, my heart broke for her.  She was strong and wanted to fight with another round of chemo - we discussed her goals, wishes and tradeoffs. 

I’ve now used this tool several times and to be honest each time I have this conversation, the responses intrigue me and almost surprise me at times. Most of what I would’ve assumed, would have been wrong. It’s humbling and reassuring that the patients have made their decisions prior to ever needing them. 

I recently finished Being Mortal by Atul Gawande where he discussed Dr. Susan Block using this tool with her father. (I highly suggest this book to everyone in medicine or not.) She was surprised, and relieved that she had this conversation with her father. It made her decisions easier, because they weren’t her decisions they were her fathers. 

As we are starting a new year,I encourage you to try this tool as a conversation guide. The guide was meant to use with clinic patients or during post hospital visits, but some of the language is helpful for family meetings, especially the opening. It’s certainly helped me, I used to loathe these conversations. But as the year moved on and I became more comfortable with end of life, these conversations became more tolerable and important to me. 

End-of-life/serious illness discussions are a learned skill, and a vital one that so many healthcare professionals still don’t know how to do well.

I remember first learning that you can cry from any emotion, that emotions are chemical levels in your brain and your body is constantly trying to maintain equilibrium. so if one emotion sky rockets, that chemical becomes flagged and signals the tear duct to open as an exit to release that emotion packaged neatly within a tear. Everything made sense after learning that. That sudden stability of your emotions after crying. How crying is often accompanied by the inability to feel any other emotion in that precise moment. And it is especially beautiful knowing that it is even possible to experience so much beauty or love or happiness that your body literally can’t hold on to all of it. So what I’ve learned is that crying signifies that you are feeling as much as humanely possible and that is living to the fullest extent. So keep feeling and cry often and as much as needed

SHIT WHAT

Also let yourself cry. It really is a biochemical release valve to dump out all the chemicals that make you feel stuff.

I honestly think one reason men in western culture have so many problems is that we don’t let them cry, and literally their brains get stuffed with all this crap that doesn’t have a release valve. Men, please cry. You’ll feel better. It’s ok. You are not lesser for taking care of your health.

This is why tears from different emotions look different under an electron microscope. They’re literally made up of different things. 

Happy tears are structurally different than sad tears than angry tears than overwhelmed tears etc.

I looked it up, cuz that tidbit was dope to me and..

Never would have known

Ah yes, the emotions: grief, change, onion, humor

those are emotiong? i thought they were hogwarts houses

how to avoid education burnout

Patient: Have you done this before?

Me: *don’t say it*

*don’t say it*

*don’t say it*

*don’t say it*

*don’t say it*

*don’t say it*

Me: Sure have. This will be the second time. LOL.

3 Common Blood Pressure Medications

when your patient asks you what a medication youve never heard of does on a cellular level

When you’re trying to sweet-talk a vein out of a hard stick

Me before starting every new clinical placement