Boobs in a Box

So today we had our 3rd week of lab. Lab has been focusing on the head to toe assessment. We had to learn to do the head to toe assessment last year, but we did that as nursing students. This year we are learning to do the head to toe assessment as nurse practitioner students and let me tell you, there is a difference.

Nurses can assess, but they can't diagnose. Nurse practitioners, like medical doctors, can diagnose, write orders for further tests, and/or write orders for drugs. So you have to learn to do the assessment on an elevated level.

There are lots of things between the head and toes: cranial nerves, heart sounds, lymph chains, muscles, reflexes, boobs. Yes, boobs.

Everyone has a lab partner. This is good because you need a real body to feel real aspects of the human anatomy. It's nice to use your partner as your constant "body", however, your partner gets to use your body too.
So, today we go to lab and our professor is set up in the middle of the lab with a box. She opens it and there are the boobs. She props the dummy boobs up and begins to explain about the breast exam. It was awful. The whole class was anxiously nervous. To make matters worse, she kept moving the boobs so the whole class could see them, and just like real boobs, they jiggled. Every time the boobs jiggled a nervous laughter filled the room. The professor was unaware the boobs were jiggling and kept telling us there was no reason for us to be nervous and we all needed to relax and take charge of the situation. Then she'd move the boobs again and they would jiggle and we would laugh. So she showed us how to make deep circles around the boobs starting distally and then moving proximally to the nipple. The exam ends with a tweak of the nipple, that is the incorrect way to say compress between the forefinger and thumb.

Then it was time to break off in pairs and reveal our pairs. It was somewhat embarrassing. But we just owned the situation and did it. I'm so ticklish though and was practically laughing the whole time. I just stared at the ceiling and endured it. When I had to do my partner it wasn't nearly that bad and she didn't respond as I had which made it easier for me.

It was a crazy experience, but it could definitely be worse. Other specialties (midwifery, women's health) have to use their partners too and as they say, "they know each other inside and out". I'll have to learn how to do pelvics and testicular exams too, but luckily for that we get surrogates. People the school pays for us to use - I have both a male and female day scheduled for that. Like I said, it could be worse.

The NCLEX

The NCLEX has been looming over me the entire summer. As I have previously mentioned it is a test I have to take and pass in order to continue on in school. If I should take it and not pass, then my 2nd and final year of school would turn into 2 years.

The NCLEX is what is known as a CAT, a computerized adaptive test. So it’s a smart test. If you do good it gives you harder questions. If you miss questions it gives you more of the kind you missed. Although this seems mean, really it’s to help you pass. The NCLEX is trying to see if you are competent or not. As a health consumer I think this is incredibly important – I want competent people taking care of me. As an individual who has never been a good test taker I think this somewhat stinks.

The test is also very variable. It can be as short as 75 questions or as long as 265 questions. You don’t know how many questions you are going to get until the computer just shuts off. Yes, it just shuts off. Then you have to wait for 2 days to find out if you passed or not, and to make matters worse you have to pay $7.95 since to even find out if you passed or not.

Not only is the test nerve racking, but taking it is too. I have to drive downtown Nashville to this testing site. Once I get there I have to provide identification. They then give me a key to a locker that has a 12 inch long key chain that I am supposed to keep on my person. They then proceed to give me forms to fill out. They then call me back up to the desk where they ask me for my identification again. Then they make sure I have nothing on my person (except the 12 inch long key chain). Then they finger print me. Then they escort me 10 feet down the hall where they fingerprint me again – three times. They then escort me into the testing room where I am assigned a computer. The computer has a video camera perched above it and it is recording me the entire time with audio. Also there is a woman behind a window in a box staring at me the entire time. If I should need to use the facilities then I must be escorted and have my finger prints taken again before entering (this is so I won’t change my fingers while I’m using the facilities). When I am done and the computer shuts off they then walk over to me and escort me out of the room (I’m still carrying around my 12 inch long key chain). Out of the room I must be fingerprinted again. They then instruct me to get my things out of the locker return the 12 inch long key chain, and have a nice day. A nice day? How can I have a nice day when I don’t know if I passed this monumental test or not?

I will have to say that this was one of the hardest tests I have ever taken . About 10 questions in I felt like I wasn’t even qualified to be taking this test. It was hard, very hard. But 2 agonizing days later I paid my $7.95 and found out that I had indeed passed.

I am now officially a registered nurse and licensed to work in the state of Tennessee.

Yeah me!

The Wedding

There have been few times in my life when the actions, the story, the choices of another have brought true joy to my heart. I am usually caught off guard and taken aback by the briskness the situation has at infiltrating my heart. However, with this most recent of rare occurrences, I was not caught off guard, but, much like the situation, the truest joy slowly flooded my heart.

There are some love stories that people are not privy to observe. The blooming relationship of one's parents is one, one's grandparents is another. Time and circumstance forfeit opportunity and we are left observing that which has maturated. There are times, however, when life circumvents itself and we are able to observe a love story out of time - but in its place.

I have not known the man to be without, to be alone, for most of my life. Yet the past few years that is how he has been. Unpartnered, unmarried, unwed. He had not finished his maturation process with her and yet he had. And there he was. He hurt. It was evident in the worry wrinkles around his eyes. He had lost a spark.

Then he had a friend.

A friend who he could eat with, watch movies with, talk with, share with, cry with. A friend who in time he learned to love. A friend who in time he learned to need. A friend who in time he didn't want to be without.

As I sat there amid the congregational singing on his wedding day my heart was finally full. I felt that last drop of joy spill in that caused my heart to overflow. My eyes began to water and the tears began to fall. What a homecoming! What a gift! I had been gone too long - chased away by grief and sadness, by the knowledge that things would never be the same. And as I sat there I observed life going on, new people smiling, old people smiling. Life is not so different after all.
When things change it can be shocking. It can be paralyzing. But the courageous ones gather themselves up.

And when I left I saw that thing that filled my heart with joy the most - he had his spark back. That twinkle in his eye.

Mr. and Mrs. Richard Dodgen

August 16, 2008

The Stress Response

Yesterday I learned that there are over 1400 physiological processes that occur in response to stress. That is quite an amazing fact I think. Those 1400 physiological processes effect nearly every aspect of our bodies: eyes, hands, lungs, urination, heart, brain, GI tract, cognition, etc.

We often allow ourselves to do things, to think things, and to fear various things and we truly have no idea how those "things" affect us. Not all stress is bad, this is eustress. Not all stress is good, this is distress.

Stress in truth is the bodies responsed to discomfort. Fortunately, our bodies compensate to most types of discomfort. However people who live in a chronic state of compenstated comfort (or people who are chronicly stressed) are living in a state of allostatis. Unfortunately, our society is trending toward allostasis as normal life due to our complicated and busy lifestyles. A recent book has been written that I wish I had time (and the understanding) to read; it's entitled "Allostasis, Homeostasis, and the Cost of Physiological Adaptation". Really that is just a fancy title to say how we are physically running down by living a life in a constant state of stress.

Chronic stress can cause serious physiological consequences of :

• Mental dysfunction (Depression, Panic anxiety, Obsessive-compulsive behavior, Poor memory, Anorexia nervosa/ malnutrition)
• Active alcoholism
• Aggrevated PMS
• Asthma
• Inflammatory bowel disease
• Common cold/mononucleosis
• Opportunistic infections (e.g., herpes - this is the shingles type)
• Dermatological manifestations (or acne)
• Burnout (Feeling overwhelmed, fatigue, Angry outbursts, Forgetfulness or disorganization, Guilt or self sacrifice, Disillusionment, Passivity, Distancing (that is pushing others away), Letting your self go, Substance abuse, Physical illness, etc.)

It's funny how those little things that keep us up at night, that we carry around in our hearts and minds throughout the day, that nag us as we drive to and fro, those little things that stare us in the face when we take the time to look - it's funny how those little things can have such a powerful effect on our bodies. All those little worries, all those little fears, all those little thoughts.