For the last year ( two, if you count the pre–reqs) this has been my life, day and night. Some days I was sure someone glued me to the chair. Rose still asked everyday, “do you have studying, mom?” always hoping the answer might be no! I loved it though, I love school, (I know, I’m a nerd; the science was always my favorite part). I even liked taking tests, I like the feeling when I read a question and absolutely know the answer and can explain why, it is a powerful feeling. Then we got to work in the hospital with actual patients, and I was sure I was doing the right thing. I was scared out of my shoes that I wouldn’t know what to do, and often, I didn’t, but the patients always looked to me for help and comfort, and somehow I provided. I went from feeling like and impostor in white scrubs, grateful to be able to empty the bedpan; to gradually being able to manage 3 patients care by myself and having the sense that they are “my” patients by the end of my preceptorship.

Then we graduated a week before classes were over. We still had tests, and shifts, but we walked with our robes and hats and all. It felt great! That’s me in the middle of my new friends. Twenty nine years since my last graduation, this one meant so much, and I appreciated the opportunity so much more this time.

We did a few more presentations, and papers and exams, and then school really was over. We had our pinning ceremony, where we get pinned by another RN as a way of welcoming us into the profession. It was very touching, and we celebrated being done, finally!

Here is my pin, the initials are for Samuel Merritt University, we are the first class to graduate from the University, after 100 years of being a College. That is a lot of nurses! It is inspiring to come from such a long tradition, too bad we didn’t get the little white caps too!

BUT…. the studying wasn’t really over yet. I still had to take the board exam, the NCLEX. So my friend Marti and I kept meeting everyday to study for a couple of hours. We practiced thousands of questions, and quizzed each other, and looked up obscure drugs and diseases. We even spent a couple of days in Tahoe with two other classmates to study away from the distractions of house and family. We really did study, though nobody believes us. Then I spent a day in Yosemite, by myself, hiking and enjoying the scenery before I drove to Fresno to take my test.
I couldn’t have been more ready for this test, we studied all year, reviewed for several weeks, I relaxed for a whole day, got a good night’s sleep the night before, ate a healthy salmon (brain food) lunch and had a latte, and walked into the test center ready to conquer it.
It was the wierdest test I have ever taken. First, they take you one at a time, after you have been photographed, fingerprinted and pockets emptied into the test room. They don’t even let you take a tissue in there, I had to leave my bottle of water and my dark chocolates in a locker outside ( those of you who know me, I always have a couple of dark chocolates on my desk with me when I take a test, for that little boost when my brain wears out!). They sit you down in front of the computer and log you in and let you know that you are being video and audio taped during the test and if you need a break, raise your hand and the proctor will escort you to the bathroom. So, I sit down, a little unnerved by all the security, but ready to get this done. I speed through the little tutorial that takes you through some sample questions and push the button to start the real test. Now I should tell you that we have six hours to answer from 75-265 questions with breaks scheduled at 2 and 3.5 hours. The test is constantly evaluating how you answer each question to determine what the next question will be. It keeps asking questions until it determines that you clearly pass or clearly fail. I was determined to go slowly and carefully read each question a few times, since you can’t go back and change your answers. The first few questions were pretty reasonable and I felt pretty sure I was getting them right, then boom, they got hard, drugs I had never heard of, questions about priorities that I couldn’t rank, and then phwew, a few math questions. I love the math questions, because I know how to do them, they are concrete. It is the question about which patient you would see first that always gets me. Well, I am tooling along, I don’t really keep track of how many questions I am answering, (the last time I looked at the counter, I was on 55). The questions are hard, and I feel like I am guessing on many. I am sure I am not getting most of them right, so I am shocked when the whole computer screen goes black. Oh NO!, there is a power outage! right in the middle of my test! will I have to start over? But no the proctor comes in to escort me out and I realize that the screen went black because I was done! I quickly tell her this can’t be, I am not finished yet, I haven’t answered enough questions! there is no way I am up to 75 yet. Can she check? She smiles and shakes her head, no, there has not been a malfunction and there is no way for her to check the number of questions I answered. In a daze I walk out, put my finger on the fingerprint checker (what, was I going to somehow sneak someone else in to take my place while being videotaped? it is really me walking out now!) I collect my stuff, and see that only and hour and ten minutes have passed since my test started. Well maybe I started a little bit early, since I arrived at the center early, let’s say and hour and 15 minutes. Still that is 75 questions in 75 minutes, there is no way, I was going to go slowly! what happened? Oh no! what if I went so fast that I answered most of the questions wrong and I actually failed! I get in the car to drive the 3 hours home and try to think of who I can call that will make me feel better. Marti; she took the test the day before me and we hadn’t talked yet. Aachhh, I hear the sinking silence on the other end of the phone when I tell her that it took me 75 minutes, she took 2 and a half hours with 2 breaks. I didn’t even get a break. That is bad news, Marti is the speedy smart one. When we studied together she usually had the answer before me. I made some more phone calls looking for reassurance, which was given but I didn’t feel it. Nothing was going to make me feel relieved.

It has been 3 days now and I check the BRN website way to often to be considered sane, and still haven’t seen my name on the list of licensed RNs yet. I did the trick that someone said to try to register to retake the test and if the website won’t let you, then you passed. It wouldn’t let me, but I still don’t feel relieved. SO I AM STILL WAITING! I spent today listing all the hospitals that are within a one day drive of me and checking the job openings on their websites. The job hunt is another story that I will save for another post. In the meantime I am trying to keep busy and WAIT.

Well, I took the NCLEX today and walked out of the test feeling pretty nervous. I think the computer shut down after 75 questions (the minimum), I am not sure because the last time I looked at the counter it said 55 and then all of a sudden it shut down. The questions were hard, so either I answered well enough that it moved me to the harder questions and I passed or….. I don’t even want to go there. Now I will keep checking the BRN site to see if my name pops up under RN verification. Next, renewed efforts to land a job in this economy.

Wow, today was amazing.  I have a patient that has many issues, recovering from a major abdominal surgery on two weeks ago, and suddenly needed neck surgery.  Somehow the planets lined up just right for me and I was allowed to observe his surgery.  I went with him to pre-op and observed how they handle patients getting ready for surgery. He did not want to cooperate though, he refused the TED hose and didn’t want the intermittent leg inflation machine either both are used to help prevent blood clots from forming in his legs.  He answered all the OR nurse’s history questions though and was consistent in denying his diabetes even though he is on glucose monitoring and insulin injections.   Then I followed the OR nurse like a puppy into the locker room, donned surgical scrubs, booties and cap.  We went into the OR to prepare the room.  I met the anesthesiologist and the OR tech.  Watched them get the sterile field ready, get the gurney set up, count all the sponges, sutures, an other things.  Then I helped wheel my patient into the OR and transfer him to the table.  Since he is obese, this took several of us plus the lift team.  The surgeon came in and the anesthesiologist put him under. They sedated him first, then paralyzed his muscles then intubated him and put him on a ventilator. Everything is monitored, breathing, brain function, heart, blood pressure, temp.  They make sure there will be no breakthrough awareness. Once he was under they put that intermittent leg inflating machine on and arranged his limbs and tilted his head to expose his neck.  The OR nurse cleaned the area with betadine and the surgeon draped him with sterile drapes leaving only the front of his neck exposed.  The anesthesiologist sat at the patient’s head and watched a bank of monitors and adjusted medications.  He could see the patients face under all the drapes but unless he stood up, he could not see the surgery.  I was allowed to stand at arms length from the patient and watch, they explained some things that they were doing, the nurse was very good about telling me what the steps were and what they were watching for and concerned about.  The surgeon pointed out the thyroid and parathyroid as she was going, and called me to step closer to get a good look.  I felt very privileged to be there and didn’t interrupt with many questions.  As she started to cut (after carefully marking his skin) and cauterize the vessels, the OR tech kept handing her instruments and using suction and sponges to mop up the blood and fluid.  He seemed to know what she needed, the surgeon did not have to ask for much.  There was an assistant surgeon that came in to help after the thyroid was exposed.  The OR nurse spent most of the time during the surgery charting at the computer what was going on and getting things like the clean bucket for waste, and step stool for the other surgeon.  They found the mass on my patients parathyroid and were able to excise it from the thyroid pretty cleanly.  The parathyroid and the mass was huge, the pathologist commented that it was the biggest he has seen.  He took it away to analyze it to make sure it was parathyroid tissue that was removed.  Then they had to obtain a blood sample within 10 minutes of removal of the parathyroid to check the PTH level.  That was a challenge.  I got to hold the sheet up for the anesthesiologist to get in to use a foot vein to obtain a sample, while the surgeon tried to get a sample from one of the neck veins in the open part of the neck.  Neither one produced enough blood for the sample, finally the surgeon dug around to get at the internal jugular vein and was able to get plenty.  That got sent off to the lab STAT and they started to close him up after the pathologist confirmed that the tissue was indeed parathyroid tissue.  The assistant surgeon left at this point and the surgeon sewed the subQ tissue first and then the outer skin.  They chatted about their own lives at this point, they no longer had to focus so much on the surgery.  Then they counted everything, on the table and  in the wastebasket to make sure nothing was left in the patient.  After they removed the drapes the OR nurse came over and help the anesthesiologist rouse him.  I guess that once you stop administering the anesthesia, it wears off pretty quickly, although the nurse said he would have no memory of this time period.  My patient was slow to arouse however. He did not respond to commands or seem able to breathe on his own.  He could initiate his breaths but did not take in a deep enough breath to oxygenate his body.  They have criteria the patient has to meet in order to remove the trach tube, one of them is ability to follow commands, and the other is the strength to squeeze the doc’s hands and lift his head up for 5-10 sec. My patient could do neither.  They were also concerned about his blood pressure which was dropping pretty low.  Finally the anesthesiologist decided he should remain on the ventilator in the recovery room until he could breathe better on his own.  So we waited till they got all that equipment ready for him in the recovery room (PACU as it is called at this hospital)  The nurse was pointing out to me that it is much safer for the patient to remain in the OR while on the vent until they were ready because he could crash at any time.  They were all pretty calm considering what seemed to me pretty dire situation for my patient.  When they were ready we wheeled him into the recovery room and a new crew of people swarmed around to work on him.  The respiratory therapist was there to work the ventilator, the anesthesiologist stayed, the recovery nurse started her assessment with the help of a couple of other RNs.  This is where I felt in the way. I didn’t really know what to do and there was a lot of activity right away all around him.  The RT was watching the ventilator to see how deeply my patient was breathing, to determine when they might remove the tube.  The surgeon came in to check on him and examined the wound from his previous surgery (done by another surgeon)  and ended up cleaning it, culturing it and repacking it with gauze.  I watched all this pretty carefully.  Meanwhile the patient was coming around a little more and was agitated about the pain in his abdomen and the tube in his throat.  He wanted it out.  The nurse wanted to give him some pain meds but the anesthesiologist (who was still sitting there) didn’t want him to have any since it would affect his breathing.  But the patient was in pain and agitated so he let him have some, and it helped immediately.  He wanted the tube out though. They drew a blood sample for arterial blood gas test, the RT did this, I understand nurses don’t usually do this procedure.  I got to watch that too, but I couldn’t really tell how you know you are drawing from an artery and not a vein.  He use the patient’s wrist.  The anesthesiologist decided his breathing was getting stronger, (an hour in recovery) and he could be extubated if they put him on the BiPAP machine.  It is a machine that delivers positive pressure to the lungs on inhalation and also a lower pressure on exhalation but through a mask instead of a tube.  However my patient got very upset about this, and waved the machine away as they were bringing it to his bedside. He didn’t want this machine.  The anesthesiologist then decided not to extubate him then.  He just didn’t trust that the patient would be able to maintain his airway and reintubating him after neck surgery would be extremely difficult.  So they ordered an ICU bed for him.  At that point I had to go back to the floor since he would be going to a different unit and I would no longer be able to follow him.  All in all it was a very exiting day for me, although quite a difficult time for my patient.  I wish I could follow up on him to see how he does after a night in ICU.  The report that his PTH levels were decreased was good news but it will be a few days before we hear if the mass was cancerous or not.  I was relieved that I was able to watch the procedures without getting grossed out, or fainting or even feeling sick.  You never know how you will react until you are actually in the situation and I am glad I did fine.  It was actually really fun.  I wonder if I might like working in surgery, who knows.

I have been studying all weekend for a test Monday and another one Tuesday. However I did take many breaks.  Yesterday I spent a couple of hours communing with my roses.  They have been quite neglected these last couple of months but they are still producing abundant blooms and making hips like crazy.  I pruned and deadheaded them, got them back into shape.  I got to see how well some of the new bushes we put in last season are really taking off this year, and that there are a couple of bushes that are still looking weak and spindly in spite of the good pruning they got in February.  They may need to go, and make room for some new ones this fall.  One thing about gardening is that you have to be ruthless sometimes, if it doesn’t produce and look good with the level of care I can provide, it gets pulled out and replaced.  I do give them a good long time to come around and produce, but I can’t wait forever.  I took a nice long study break today to wander around the garden and harvest some flowers to brighten up the inside of the house.  Brian has spent a lot of effort this year to grow some of these from seed for our butterfly patch and cutting garden.  When I spend hours in front of the computer and under two gigantic textbooks (each one is 2000 pages) I need to get up and walk around in the fresh air and breathe in the fragrance of flowers.  I picked a whole basket of asters, cosmos, hydrangeas and others that I don’t know the names of and arranged them in vases to set around the house.  I put one on my study table too, so I just need to glance up from my computer screen and see the explosion of color.