Tuesday, June 9, 2009

My Little Brother

My little brother, Elliott, was born at eight and a half months with a clubfoot. That was an outstanding outcome given the complicated nature of the pregnancy. Under doctor’s orders, my Mom had been bed-bound for the last three months of her pregnancy after her amniotic sac prematurely broke, induced labor but then miraculously resealed itself. Bottom line: today Elliott is healthy and my hero. He's 22 now and going to nursing school.
Elliott’s actual birth followed the pregnancy’s theme of dramatic and unexpected events. Already on edge due to the previous complications, when my Mom’s water broke for the second time at 5:30 am on November 19, 1986, my Dad drove us to Kaiser Sacramento at over 100 miles per hour. I was nine years old. When we arrived, all the doors of the hospital were locked due to an ongoing nursing strike. We pounded on the doors for what seem like hours. My Dad had me run up and down the hospital looking for open doors. As I ran, I can distinctly remember watching nurses picketing while my Mom lie panicked on the sidewalk. I did not understand why they wouldn’t help us. I still don’t. My Mom suddenly screamed in panic because she knew Elliott was well on his way. This was her third child. My Dad, always heeding the call of an emergency, grabbed the locked steal and glass sliding door, and with the superhuman strength that you read about, unhinged the door and moved it to the side. An alarm went off that triggered the attention of an irritated, all too casual nurse to walk down an extremely long hallway and yell at us, “What the hell is your problem?” My Dad ignored her, carried my Mom passed her and to the nursing station of the birthing center, and got the help of a more interested staff member. Almost fully dialated, she went straight to the birthing room. While on the gurney, my Mom howled just like a wolf and could be heard throughout the hospital.
In the shuffle, I was left with the nurse we had first met. She put me in a little square room and said, “That your Mom?” I nodded, she snorted, told me to stay put, and closed the door. I REALLY didn’t like her. Following my Dad’s example, I ignored her and left the little square room and followed the still audible howls. In my mind, the hospital staff was suspect and I wanted to make sure my Mom was okay.
I followed my Mom’s howls through a labyrinth of hallways and doors. I found her. The birthing room had a large window and I had arrived just in time to see my Dad cutting Elliott’s umbilical cord. Elliott was born at 7:00 am. Another nurse came up to me and told me I wasn’t supposed to be there. I just looked up at her and pointed through the glass and said, “That’s my brother.”

Wednesday, January 7, 2009

UCSF MEPN interview

Two years ago, I went through the UCSF MEPN interview. It scared me silly and so I prepared for it in a variety of ways. Here are some ideas; my "brain storm", or more appropriately stated: "brain fart".

My understanding is that this year in the UCSF MEPN interview, y'all are doing a panel interview with a couple of interviewers. One will represent your specialty and will have a slightly more academic/administrative slant to their perspective. The other interviewer will be a clinical nurse and, logically, will be more concerned with clinical/bedside nursing than the advanced practice degree specialty. The panel interview differs than in years past, when we interviewed with the same people, but in two separate interviews. In any any event, these are, by and large, the questions you will be asked. My answers are there too, but clearly you shouldn't copy those.


• Why do you want to be a nurse?
• Why do you want to do critical care/trauma?
• How will you handle the stress?
• What do you think will be the most difficult thing about being a nurse?
• How do you intend on using your specialty in 5 & 10 years?
• Why not medical school?
• How will you prioritize your day?
• How will you know when you are being a good nurse?
• Give an example of a difficult/high stakes decision you’ve had to make and describe the thought process you went through
• Describe an ethical conflict that you’ve gone through
• Describe a frustrating experience at work and how you dealt with it
• Why no pediatric nursing?
• Describe your strengths and weaknesses.

-Q: Why do you want to be a nurse?
-A: Fundamentally I want to be able to help people—that’s a part of who I am. I’ve always worked with at risk or marginalized youth in a variety of settings because I feel it is the most necessary and practical work that can be done. In the same vein, I feel that in helping people, it is important to know how to treat the physical as well as the psychological, especially since the two are extensions of the same being. In my obsession with practical care, I realized that it was important for me to know how to care for the whole person, not just the mental aspects of care.

Furthermore, I have always worked in and around youth that are in crisis. The students at ___ and residents at _______were extremely violent and verbally abusive because of their past histories and troubles with their families. I thought it was extremely necessary to work with type of person because they absolutely needed some outside help to resolve some of their psychological issues. Sometimes that was as simple as having their meals prepared for them in a consistent manner. Often it involved de-escalating a child that was highly emotionally reactive.

Often, an emergency would take place where someone was injured and I wouldn’t have the knowledge to care for the people. That bothered me: not being of direct use in an emergency situation. So I started volunteering a year ago at _______ Emergency Department in order to see if the crisis management skills were at all applicable to working in the ED. I found that they were. Youth going through emotional crises are fundamentally similar to people going through a physical crisis—they just need several types of care within both the psychological and physical realms. I have been assigned to act as an information liaison in the ED at ______ where I announce my presence at the beginning of every shift to the patients and families that are waiting in the ED to see if I can be of use to them. Many patients will have been there for 3+ hours, so waiting time is often a concern and many people will be quite reactive to not having been taken care of within the time frame that they see fit. Maintaining a calm, consistent, and honest presence is of the essence in dealing with these situations. Occasionally I can use humor, but not until I have established professional rapport with the people in the ED.

Beyond the desire to help folks when they need it most, I also really enjoy the technical knowledge of nursing. I love to think systemically about patients and what is ailing them while I work in the ED. Using my basic knowledge of Anatomy, Physiology, and Chemistry I steal glances at charts, EKGs, x-rays, blood pressure readings, lab reports and CT scans and try to think critically about all the elements that are contributing to a persons illness. I like to ask a ton of questions to the RNs and MDs—especially about pharmacology, which I find fascinating.

Nurses in the ED have so much autonomy to care for the patients and they are always thinking on their feet and problem solving at all hours of the night. I like the challenge—the constant challenge of thinking about things that will help someone heal.

I also love the way nurses learn: it’s like an apprenticeship where clinical experience trumps all academic experience. Often times nursing is super physical and mechanical and demands refined expertise.

-Q: How will you handle the stress?
-A: I will handle it in that I am actively involved with how I experience stress. Some people appear to be impermeable to stressful situations. I don’t believe I am one of them. I get tired, irritable and my decision-making skills can become compromised unless I take consistent inventory of how I am experiencing stress. During a stressful situation I am usually so ensconced in working the problem that I am hardly aware of how I am physically feeling. Then, once home the fatigue and irritability sets in.

Techniques that I’ve learned to handle stress are
(1) Go running everyday
(2) Ask for help: Recognize that I am not the only person in the situation and that I can rely on others. I am extremely independent so this is often difficult for me.
(3) Take a break
(4) Eat all the time. I am somewhat hypoglycemic, so being aware of that is helpful.
(5) Breathe
(6) Honest with myself and others. Being clear and straightforward lets people know what expectations are and therefore doesn’t allow for unrealistic expectations to put added pressure on me.

-Q: What do you think the most difficult thing about being a nurse will be?
-A: I feel that the most difficult thing about being a nurse will be overcoming the inevitable process of habituation to the routine—and the “hardened” perspective that goes along with habituation. In working at the school for severely emotionally disturbed youth, I found that after about a year, I started to become too accustomed to being there and would, on occasion, let the routine take over rather than being actively involved with my students. This occurrence would make me a less aware/less perceptive/less skilled teacher. I think the same thing could happen in working with patients—I might become accustomed to being there and therefore less sympathetic and less aware of their plight. I think it is incredibly important to keep your assessment abilities sharp and acute no matter how long one has been there.

-Q: How will you know when you are being a good nurse?
-A: I’m pretty realistic about people’s behavior. I learned to have realistic expectations from working with SED youth. Frequently, I would be celebrating Ds and Cs and the fact that a student wouldn’t hit someone that week. It’s not that I’ve lowered my expectations—I want for them to be really successful and get As and be all that they can be. It’s just that I have realized that it is important to have realistic expectations. Being what they have gone through, it’s sometimes a miracle that they wanted to wake up. I have realistic expectations for patients that are in crisis and people in general. More often than not, people let you know when they are unhappy but will not let you know when they are content. Thus, if all of my patients are being quiet, it’s most likely that I am doing a good job. I’ll still be doing my rounds if they are quiet though.

-Q: Describe a frustrating experience at work and how you dealt with it
-A: Too personal, can you believe it???

-Q: How do you intend on using your specialty in 5 & 10 years?
-A: Upon graduating from UCSF with an advanced practice degree in nursing, my immediate plan is to gain outstanding clinical experience—humbling myself to the people that have knowledge and experience within the field and carry themselves with professionalism and a well-adjusted attitude. I plan on letting my clinical experiences be my guide as far as specialization in treatment. I am particularly interested in diagnosing internal injuries with non-specific symptoms, myocardial infarction, and severe wound management. Once I can gain enough expertise in an area of special interest, I would like to be a consultant in an ED/ICU for other nurses. Once I have tried my hand at teaching other nurses in a clinical setting, I would like to seriously consider getting my PhD in nursing and teaching clinical rotations within a nursing school such as UCSF. I could also very well wee myself working as a consultant in order to write legislation that would effect bills that would change health care. It’s up in the air in many respects, but my dedication and focus and quest for answers is second to none.

-Q: Give an example of a difficult/high stakes decision you’ve had to make and describe the thought process you went through
-A: There are two types of high stakes decisions: (1) those that require “from the gut” type decisions because there is some sort of emergency, or (2) those that give you a little leeway in terms of time.

If a decision requires an immediate response, I am not someone who sits back and does nothing. That’s part of the reason that I want to learn critical care/trauma nursing so that I can be of use in an emergency. An example of a time when I had to make a quick, high stakes decision is when: AC caught on fire, I heard it, nobody responded so I evacuated the house.

When a high stakes, life changing decision allows for a little time, I do research and talk to members of my “team”: my wife, my brother, my Mom & Dad, my friends, and my co-workers. Two high stakes decisions that I’ve had to make are (1) getting married, and (2) deciding to become a nurse. In deciding to become a nurse, I wanted to be sure that I knew what I was getting myself into, so I started voluntering weekly at ________ from 9-midnight so I could look before I leapt. There I observed, investigated, and absorbed as much as possible. I also spoke with my wife, to see if she would support the decision. Being that she is in law school and I was the primary earner in the household

Questions for her:
How did you get into nursing? Why? What is your specialization?
Do you do more administrative work than clinical work? Do you miss clinical work?

-Moral: I believe in making the right decisions
-Work Ethic: second to none.
-caring & dutiful: I feel it is important to take care of people and feel that it is my duty to do so.
-perceptive: I enjoy observing situations and seeing nuances of behavior that give me insight as to how to deal with people.
-always willing to challenge myself: I like running up hills.
-independent: always thinking for myself and not within groupthink—allows me to be more objective.

-rigid: Somewhat rigid when setting goals and pursuing them: difficult time shifting gears—result of me being a perfectionist.
-judgmental: used to making a lot of quick, split decision judgments in order to take care of people—this can affect how I treat people.
-too independent—sometimes have a hard time working with others.
-too dutiful: sometimes don’t take time for myself.