By aryr
There was so much noise from the idle chatter among the thirty students, it was impossible to even consider trying to think. No one seemed to have any type of control over the group. I had been called in by the school to cover the former teacher who was now out on surgical leave. So much for retirement.
After ten minutes of standing behind the desk with no indication of neither recognition nor reprieve from the noise, I decided to take control. By putting the tip of my thumb to the tip of my middle finger and then placing this configuration into my mouth on a slightly curled tongue I was able to produce a piercing whistle. The shrill cut through the noise like a fog horn. Silence then prevailed.
"Right! Now I would like everyone to sit in their seats; you know the ones that you were originally assigned to. You have two minutes, so hop to it." I calmly said.
There were a few mutters and grumbles, which was rewarded with another shrill whistle and an abrupt "Now!"
With everyone sitting in what I hoped were the right spots I proceeded with roll call.
"Starting with the front seat on my left, going back the row then down the second row to the front and so forth, I would like to hear everyone's name. Those speaking should be the only ones speaking and doing so clearly. Understood?"
A couple of hands went up, quickly followed by "Who are you? You are?"
I chose to ignore those requests and simply stated "When roll call is completed I will tell you who I am, why I am here and how we are going to do things."
I pointed to the person at the front of the left-hand row, and by the time we were done there were only two mix ups which were corrected. I definitely had their attention.
"I am Mrs. Armstrong, Mrs. Trenton has had to have emergency surgery and will be out for a few weeks. While I am here, you will arrive between 0815 and 0830-not before and not after. During the fifteen minutes you may have quiet conversations. At 0830 there will be silence, class will start. The first hour will be going over homework assignments, if you have questions then one of the other students will attempt to answer it. Of course, hands will be raised before any questions or comments. You are all adults and therefore will behave as such, you are all here to learn and learn you will. If anyone is not comfortable with this plan, then please feel free to get up now and leave. Oh, and by the way, homework assignments will be completed daily. Some days I will randomly collect and view during lunch break. I do not suggest that you at any time leave it undone. Now you have ten minutes to decide to stay or leave."
It was a long ten minutes. During this time I scanned the room for possible trouble makers, noting that there were only three potentials. Not really all that bad. Ten percent was actually quite good.
I had talked to Mrs. Trenton late Saturday; she had called to bring me up to date on the class. She had only been teaching them about three weeks, so she was still learning them herself. She had taken a tumble in the parking lot Friday evening and was now out on Workers Compensation until her two breaks were healed and she was reported fit to return to work. It would be a minimum of eight weeks and more likely twelve. She had been firm and they were all learning the anatomy they would need for their chosen careers as medical office assistants. She did report that some were not as enthusiastic about doing homework as she had hoped. I reassured her that they would be a changed group when she got back and she chuckled.
Ten minutes had passed and no one departed. I was starting to feel good about this class.
"Okay, now since this is Monday and I need to know where you are at with your studies; I will start with a few questions and then we will review up to the point you were at with Mrs. Trenton. There will be no assigned homework for tonight nor tomorrow night, but it would be wise to review."
I deliberately picked one of my potential problem children / adults to bring me up to date. He was polite enough to ask if he should stand and his response was very good. I was a bit surprised but hid it well. I turned to another potential problem to see if anything needed to be added and her response was that he was correct. I was beginning to think that perhaps they were not problems but more so bored.
| Author Notes | Thank you so much for the artwork/picture-Empty Classroom by Life is but a dream |
By aryr
By this time an hour had passed and the students had been drilled intensely. I now knew where they had left off at and what ground Mrs. Trenton had gained.
"Okay, people, since I know what you have learned and what we shall review today and tomorrow; how about we take a few minutes to stretch and refresh?"
No one responded either verbally or physically. They just sat and stared at me. I randomly picked a student to inquire about any confusion. It was 10:00 hours and yet no one stirred.
"Mrs. Armstrong, are you waiting for an answer or are you suggesting that we take a few minutes? And what exactly is a stretch and refresh?"
It appears that I had befuddled them with my suggestion, but at least I had their attention and their silence.
"Stretch and refresh means to take a ten minute break, where one can either sit or stand and literally stretch out stress and tight muscles. I usually suggest one mid-morning and again mid-afternoon. I like to think of it as a brief recess. Shall we?"
A sea of heads nodded in affirmation and chairs slide back from the desks. Some chose to stand with outstretched arms, while others twisted in their chairs. A few even bent over to touch their toes to loosen up. Ten minutes passed quickly but they all seemed to like the idea.
"Okay, now to the questions. Who would like to start?"
A timid young lady in the middle of the class raised her hand. She was about to stand, but I stopped her.
"Since we are all adults I feel that provided you speak clearly and loudly enough to be heard by everyone there is no need to stand. The choice of course shall remain yours. Your question, please?"
"When we were studying the flow of blood last week, can't picture it correctly in my mind. Do you have any hints?"
Two hands shot up. The first young man was correct with his answer, "It flows from the body into the right atrium, then to the right ventricle, then the left atrium and left ventricle." He smiled upon completion.
The second young man again raised his hand and I nodded. "It enters into the right atrium, through the tricuspid valve to the right ventricle, then through the pulmonic valve to the artery and to the lungs, it gets oxygen and goes back to the heart to the left atrium, through the mitral valve to the left ventricle, it goes into the aorta and then to the body."
"That is correct on both accounts, but does it help with the question? Are their any hints, any suggestions?" I asked, hoping to make them think about the question rather than quote a text book.
Another hand slide slowly up and I pointed in that direction.
"I first memorized the parts of the heart, then came up with 'R' for return and right side and 'L' for leave and left side. I don't know if that helps but that's how I do it." I was rewarded with another smile.
I focused on the young lady and asked, "We have had three answers to your question, have any of them helped you?"
She smiled as she said, "All three were helpful but the last one was the best for me to picture in my mind."
"Okay, so now you have an idea about how we will do the questions and answers. What is the next question."
At the back of the room, a hand raised and with my responding nod the young man asked, "I don't really understand why we can't take a pulse with our thumb?"
Several hands were raised. I deliberately picked problem person number three, who answered, "Because you get your own pulse from your thumb, you dummy!"
Because they were sitting across the aisle from each other the first young man responded after delivering a punch to the arm, "I am not a dummy!"
Before it escalated further, I interrupted. "There are no dummies in this class and no one shall be addressed as such. Is that clear? I would like the both of you to stay after class for a few minutes at the end of the day."
We went back to the question and answer protocol, until it was time for lunch. They were allowed an hour break. I encouraged them to be on time and that they would have until 1315 to settle. I was ready for my coffee.
By aryr
It was a pleasant surprise to have them all back at their desks by 1300. They came directly in at 1255 and sat. There was no chitter chatter. They were well behaved and eager to go.
We spent the afternoon with more questions and answers. It became a challenge to see who could come up with the creative questions and who could provide the most productive answer. I threw in questions of my own from time to time.
Mid-afternoon at 1430 was another 'stretch and release' time. No explanation was needed this time. The end of the day came at 1600 and class was dismissed. I reminded everyone to review what they had learned under the direction of Mrs. Trenton.
My two bad boys sat silently in their chairs.
"Well, gentlemen, I have several choices I can take. I could have each of you write out on separate blackboards 'I will not call other classmates names' one hundred times. I could have you both spend an hour all this week in a detention class, it would give you time to do homework. I could punish the one who started this or on the other hand I could punish the one who finished it. I could, of course, report both of you to the Dean which would be the same as reporting you to the Principal. I could let each of you decide your punishment, which you could write out and submit to me. I could let you both off with the understanding that behavior such as this would not be repeated nor tolerated. To do so would be automatic expulsion." I paused.
With each suggestion, I had watched the color changes in both faces. My last suggestion completely drained their color.
The minutes stretched by or at least it seemed to for the two men. At the ten minute mark they both simultaneously began to squirm in their seats. I pushed myself to wait fifteen whole minutes. Just when I was about to dish out their punishment and my rationale for such; my problem number three raised his hand. I nodded.
"Well, Mrs. Armstrong, it's like this. I know I goofed around in high school. Like everyone else I figured I would land an easy job and be set for life. It just isn't like that. The jobs I got were minimum wage, long hours-longer than I wanted and usually with no benefits. I am twenty-six years old and I have had at least ten jobs. The shortest was for two weeks before I quit and the longest was for two years before the business went broke. I have been on and off pogey so many times that they know me at the office. When they offered me this chance to return to school and get trained for a career I thought it was a great idea. But maybe I was wrong, maybe I should just leave and find what I can do for a while. I can always fall back on unemployment insurance or welfare. I am not good for this class." His head dropped, he pushed back the chair to stand. I stopped him.
"Please sit down for a few minutes. Now the way I see it, is that you are both adults so the idea of having you write on the chalkboard is just not going to work. Well it will make you dislike each other more and probably think I am a witch. Detention class is not a bad idea since you will get homework done but not appropriate. Neither is addressing who did what. So basically, I am left with sending you to the Dean and having you each decide your punishment. Oh, I forgot about letting you off with a warning."
They just sat there, waiting for doom to fall. One had already vented and verbalized his thought process and choices, the other sat silent.
"Okay since neither of you are jumping in to offer any ideas, I have decided that you are adults, trying to make your way in the world. Therefore, I am expecting you to both to behave as such in class, you will show respect for your fellow classmates and receive respect from them as well. You will put your 100% into your studies. I do not acknowledge nor accept failures and drop outs. Do you understand? Have I made myself clear?"
Their heads nodded in unison. The problem was solved, and I was confident that there would be no repeats. The clock read 1645, so I waved a hand towards the door as an act of dismissal. Nothing more was said, nothing more was needed. It was officially the end of day one.
I watched as they left the building; most of the other students had waited outside eagerly awaiting the outcome. They were all gathered around and listening to the two men. I was sure day two would bring a difference.
By aryr
Tuesday morning arrived with a blustery cold wind that whipped one's hair and seemed to bore through one's coat. Gloves were a definite necessity. It was a typical late January brutal morning.
Those who drove had to find parking which was scarce and rather expensive. Plus, there was the need to start your car or truck about twenty minutes before, in order to warm up both the motor and the inside. I was so glad that I had decided to use the 45 minutes travel time on the subway and the buses. Sure, it meant three changes, but I was not exposed to the cold. I decided to go in early with the plan to drop my things off and go up the street to the store for some supplies. The school had large coffee and hot water urns, so I stocked up on coffee, tea, hot chocolate, sugar, sweetner, powder creamer, cups, stir sticks and napkins. No one would suffer the cold during class, at least not my students.
And I needed time to make some photocopies. I had organized my plan last night. Learning would be both beneficial and fun. I was determined.
By the time people started to drift in I instructed them to get a hot drink of their choice and at 0830 everyone was seated, ready to begin.
"Good morning, it's cold out there so I thought something warm was called for. Please feel free to quietly get refills at any time. Oh and for bathroom breaks, take them as needed, you do not need permission. It is all about respect, you get what you give."
A hand shot up followed by, "What about roll call?"
"Well, after yesterday, I know who you are and where you should be, so unless you mess with me I don't have to do roll call."
Smiles radiated across the room. Another hand. "I didn't notice a collection jar for the hot drinks? How are we to pay for our coffee?"
"It's free, just help yourself and enjoy. I believe that a warm body and a warm mind works better than being chilled. Now let's start reviewing again."
Way at the back, Ralph, my previous problem person raised his hand and when I acknowledged him, he stood. "I don't know if you saw all of us out there yesterday in the parking lot. But William and I shared what you said to us. And for everyone here today, we would like to say thank you. Especially for remembering that we are adults not children and for giving us a chance." He sat as the others clapped in agreement.
"Thank you, Ralph, thank you everyone. I promise I will push you, I will annoy you, most likely irritate you a lot but I will never let you give up on yourselves. Now on to reviewing."
Several hands were raised with questions. And in order to be fair I pointed to a person and assigned a number to indicate the sequence of questions. The first was from a pudgy-faced young man- in all fairness, all of them were young or at least under thirty. It was an interesting mix of male and female and cultures. An interesting thought crossed my mind and I scribbled a note for another day much later in the year long course.
"Mrs. Trenton had taught us about the heart and blood flow and how to take a pulse and blood pressure, can we review the pulse and blood pressure again? She said we would work on breathing and temperature this week."
"Great, who would like to discuss how to take a pulse, who other than Ralph?" I laughed.
Sallie volunteered and came up to the desk to use me as her patient / client. The class listened to her as she explained each step and then followed through with a partner next to them. It was a great review and relearning experience. I felt confident that pulse taking would not be a problem.
Michelle eagerly waved when I asked for a volunteer regarding taking a blood pressure reading. I had taken my stethoscope and sphygmomanometer or to the lay people a blood pressure cuff out of my drawer, along with alcohol swabs to clean the ear pieces.
She like Sallie explained each step using me as her patient. She discussed finding the brachial artery, the sounds that she was listening to- the lub dub, the difference between systolic and diastolic and how to record the reading. She was about to talk about the normal ranges when I asked her to hold that thought while the others practiced.
The BP cuffs, etc were retrieved from the storage cupboard and partners again set up to practice.
I instructed each pair to take each other's pressure, then switch partners and take the person in front of them. When asked there was a wide variety of numbers for readings. With the equipment cleaned and stored, it was time for our stretch break.
"Okay, let's talk about blood pressure for a wee while." This comment caused a few chuckles. "What you haven't heard about a wee while? It means a little more than a few minutes but not as much as an hour." More chuckles.
"Blood pressure is created by the blood pushing against the walls of the arteries when the heart pumps blood. High blood pressure or hypertension, occurs when this force is too high. Checking blood pressure readings is the same for children, teens, and adults. Using a gauge, stethoscope or electronic sensor, and a blood pressure cuff. The lub sound you hear is the systolic reading when the heart is pushing blood with a heart beat, the dub sound is the diastolic reading as the heart rests. Now what would you do if someone had big fat arms? Or you could not find the brachial pulse? Where is the brachial pulse?"
Puzzled looks were the response to the first two questions. I was making them think and problem solve. Slowly a hand was raised for the third question. I pointed and nodded.
"It is an artery on the inside of the arm in the elbow area, where they usually draw blood from for lab work."
"Great answer but what if you can't feel it? And again what happens if the person has a fat arm? Think about it, I know you are all able to come up with answers or at least questions about possibilities." I paused to give them time.
I saw the hints of light bulbs coming on, but I waited. I wanted them to develop what is referred to as critical thinking, which is really a new title for problem solving.
Two hands went up, "What about a bigger cuff?" asked one. "Do we have to do it on the upper arm?" asked the second.
"Yes, we could get a bigger cuff, if we had one but what happens if the patient refuses to have their fat arm squeezed? No, we don't have to do it on the upper arm. It is considered to be more accurate the way you are taught, but I like to cover the 'what ifs' just in case. Michelle can you come back up here?"
I instructed her to check my radial pulse and then to wrap the cuff around my arm just below the elbow. The stethoscope was placed over the radial pulse and she was able to distinguish the sounds. The cuff was inflated and slowly released. Breaths were held as she listened. Her smile grew broader as she obtained a reading. Cheers went up around the room.
It was time for lunch.
By aryr
When we all returned from lunch break, I suggested that the next time we had the blood pressure equipment out for practice that everyone try what Michelle had success with.
I stood while picking up a small pile of papers, "I am going to distribute these papers which are to be placed face down on your desk. This is not and I stress not a test. When instructed I want you to turn the paper over and for the next thirty minutes label the diagram. It has been color coded to match the one in your text book. I suggest doing it in pencil, I have extras. When done we will review and you can change your answers as needed. This was designed as a learning tool for you to use."
There were collective sighs as held breaths were released. Several hands were raised for offered pencils. And they all began completing their diagrams.
It was interesting to watch them. Some focused on the paper. Others searched the ceiling as if the answer would appear there. The pencil chewers were the most fascinating. They would munch away at the end of their pencils, then have to pick the small pieces off their tongues.
Time was up so I pulled down the screen and added the unlabeled diagram to the projector.
"We will go down the right-hand row first then cross over and come back to the front, similar to roll call. As I point to an area on the screen, each student will identify it. If it is incorrect, the next person will identify it. Everyone will be given time to erase and correct if needed. I suggest that you put a small star or check mark next to it so that you will know it was one you had difficulty with. Ready?"
It took almost an hour to go through the diagram. I watched the occasional erasure that also included their frustrated sigh, the silent sea of smiles when they all got an answer correct. I gave them the time needed. When finished, I instructed them to keep them and use for studying. I also offered extra blank copies to anyone who wanted them. I suggested another break. No one needed directions and the room was briefly filled with silent activity.
"Okay, if no one has any further questions regarding blood flow, the heart, pulses or blood pressures; I propose we move ahead to breathing."
Text books and note pads opened, they were ready. I slid the projector to the side of the desk and raised the screen. I drew a quick sketch of the lungs on the chalk board.
"How long do you take a pulse reading?"
All hands were raised, I placed a hand behind my ear and was rewarded with the echo of "one minute."
"Great and that is how long to take a respiration or breathing reading. Does anyone know if you count the in breath, the out breath or both? Shawn, what do you think?"
He was quick to respond, "I know you don't count both but I don't think it matters if you count in or out, does it?"
"Absolutely correct. You can count either in or out but not both. Over the years you will find that you may have to change your choice depending on the patient themselves. Some people are mouth breathers but they can also be noteworthy inhalers or exhalers. So while you are thinking about that, let's first learn the parts of the body involved, Turn to page 14."
I listened as pages were turned. It was refreshing to see such eagerness.
By aryr
"Breathing starts by inhaling air through the nose hopefully or the mouth down the trachea and into the lungs where oxygen is exchanged into the blood and carbon dioxide is exhaled up the trachea and out through the mouth or nose. The diaphragm is an important muscle that helps our breathing."
They all looked like they were listening and I hoped they were studying the picture of their text book while I talked. Several were taking breaths through their noses while others were trying to inhale via their mouths. I could see fingers tapping on desks as they attempted to count.
"How about we do this as a group? On the count of three, take a deep breath in through your nose, hold it while I count to five then exhale through your mouth. We will do this about five times."
I counted them through this exercise. Then I instructed them to repeat the steps only this time they were supposed to breath in using their mouths. There were about seven coughers.
I laughed as I explained that some people just could not tolerate mouth breathing. The seven blushed and hung their heads.
I went to one of the front corners of the room, a point where I knew everyone would be able to watch as I demonstrated both methods. I instructed them to concentrate on both my chest and abdomen and then proceeded.
When finished I asked for comments and every hand went up. I picked the middle row as a starting point.
"You seemed to take deeper breaths through your nose."
"It was noisier using your mouth."
"Both your chest and abdomen rose when breathing in."
"Your abdomen definitely deflated by breathing out, sorry but I was uncomfortable watching your chest."
The comments continued and then I asked if anyone had attempted to count each episode.
Daniel who preferred to be called 'DJ' was the only one to respond, "I watched as you breathed in and saw that your abdomen rose, so I looked at the clock over your head and counted the number of times I saw your abdomen rise for a minute. It was twelve."
"Your count was absolutely correct. And that is exactly one way you can count respirations. When you have a patient who is sitting up, it might be difficult to watch the tummy, so you might have to look either at the chest or even at their back. If the woman is pregnant you will definitely watch the chest or back. If you are lucky they will be a noisy breather and you can count the inhale noise."
"What about the patient talking? How can you get someone to be quiet when you are trying to count their respirations?"
"That is a great question. There are two tricks you can use. First, after you take the pulse, remember the number but continue to hold their wrist as you count their respirations, they will think you are still checking the pulse and will not interrupt you. Second, you can always check their temperature while watching respirations. They can not talk while holding a thermometer in their mouth."
DJ smiled, proud of himself for his question.
"Now I would like you to pair up your partners. Try both breathing techniques and get a count. For those who are portraying the patient you can hold your breath now and then if you want to."
They spent the rest of the class, practicing and learning
By aryr
The weather was brisk, but the wind and bluster from the previous day was gone. The sun was shining, which was a good sign. Another day and different challenges. Coffee and hot water were ready.
They seemed to know and respect the drill, as I had heard one student called it. There was no malice in his voice, just a hint of humor.
Before I had chance to say any type of greeting, Raymond raised his hand, I nodded.
"Are we going to learn about the vital signs and the things that can go wrong in the body? I'm not sure if I said that right."
"Yes, we will but in all fairness to each of you, it is best if we learn about doing things right and the healthy workings of the body. Then I can work on confusing you." I chuckled, "Just teasing, but it is important for you to have a strong understanding of the normal body. That way when something is out of kilter you will recognize it. Fair enough?"
Several nods responded.
"Oh, good morning, before I forget." The room ruptured into laughter. "This course was designed to give you a firm understanding of the human body. But you also need to know both when and why something goes wrong. You will also learn how to take and how to document the necessary vital signs. Who can tell me what they are?"
All hands were up but I choose Marilyn.
"Blood pressure, pulse, breathing no, no, respirations."
More hands went up and I deliberately picked Ralph.
"She forgot temperature."
I smiled, so pleased that he had not added any name calling nor carried a demeaning tone to his statement.
"Absolutely correct from both parties, thank you. We haven't discussed taking a temperature but it has been mentioned. Does anyone have any idea why we check temp as it is often called? Yes Henry."
"It is a way to monitor the internal body temperature. If something is wrong, like a cold it can cause a fever or a high temp. I have seen on the news where kids have fallen in the icey cold water and their temperature goes really low which is bad too."
"Excellent answer. Now how do we take a temperature? What is used? And where is it used?"
I was happy to see the whole room responding. Wait, not the whole room. Tom was sitting there staring off into space.
"Tom, let's hear your answers."
"Yes, Mamme. A thermometer is used and can be placed in the mouth, it has to go under the tongue or in the bum, I am not sure of the medical name, or in the armpit. I think the same type can be used for the mouth and the armpit, but it is a different kind for the bum. And your reading is for one minute."
"I am impressed, Tom. It sounds like you have read ahead in the text book, am I correct?"
"Yes, I did but it is not going to matter anyway. Knowing all this stuff is not going to do any of us guys any good."
"Really, and why do you say that? You are learning something new and taking steps to a new career. Why?"
"Well, we are guys. Most of the medical office assistants or lab techs are girls, pardon me, women. So where do we fit in? Nowhere!"
I was shocked, not only to hear about how he felt but to also hear the pain in his voice. Tom had been problem person number one. There was just something off about him and now I knew. He was smart, he had drive but he also had what I thought of as a gender role complex.
By aryr
"Tom, where do you see yourself this time next year? Take your time to think about it before you answer."
"Oh, that's a no brainer. I will probably be sitting down the street from the apartment at the coffee shop. Listening to all the bull shit that is flying around. Those guys in there can shoot it so high, you would need a shovel to get to the door. I am not a fool to think I will be working, that only happens in dreams. The only reason I am in this class is because I am getting paid to take it, just like everyone else here. The only promise I got was that I would have my income cut in half if I didn't take it, there is no promise of work. You all know that, right?"
Unfortunately, the silent room was filled with nods.
"Does anyone here think they will have a job when done with this course? Do you all expect a job to be handed to you on a silver platter? Or do you plan to do the work needed, collect your income for the year and then sit and gripe about life after."
The silence continued. They were looking at each other, waiting for someone to speak, to attempt to answer my question. Life had obviously been hard on these people, they deserved better and I was pissed. I sat down and flipped open my laptop. No one made a sound as I searched.
"Tom, when was the last time you went to the doctor's or the hospital?"
"That is none of your damn business, lady!" He started to rise, slamming his books shut.
"Sit! I don't want to know why you were there, that is your business not mine. I just want to know when. Anyone can answer."
Tom slid back into his chair, glaring at me. Andrew raised a hand and I nodded.
"It was about a month and a half ago that I was admitted to the hospital for a few days and that was right from the doctor's office."
"Tell me about the people at the office, the staff not the patients."
"Well, there are three doctors, two are men and one is a lady. I think there are three nurses, all female and about five techs, two are female and three guys. I had the lady doctor, one of the nurses and one of the male techs."
"And the hospital? How was it staffed? If you can remember."
"Lots of people, I would probably say more men than women but like the office they were divided in what they do."
"Did you hear anyone say in either place that they did not want particular people taking care of them?"
"No, everyone knew their job and were good at it. I did hear one lady ask if she could have one of the male aides help her get out of bed because he would be strong and she would feel safer. Her room was across the hall and I saw her walking with a walker and an aide and she was a big woman." He smiled.
"Tom, have you heard anything that would imply that males do not have a role in the medical field unless they are doctors?"
He shrugged his shoulders and replied "No."
"Does anyone else have anything to share? If not, then I would like to read something. It is a list of statistics regarding both changes in roles in medicine and in the population of employment."
Everyone listened intently as I read about the numbers of female doctors rising while the male numbers did not decline. People were accepting females as doctors. Nursing numbers showed an increase in male nurses, again with the public acceptance. Aides and techs definitely had an increase in males.
"These numbers do not lie, they are government statistics. Why do you think the roles are changing? Why shouldn't all men be doctors and all nurses and aides etc be female? How about taking a look around this room? Last count there were twelve females and eighteen males. Perhaps those males have had doubts about their futures, but I would rather think that they have the courage to pursue a change. I think it is time for lunch, you will have an extra thirty minutes today. And Tom if you choose not to return, I certainly respect that."
By aryr
Tom did not return after lunch. There were, of course, scattered mumbles and everyone looked back to his empty seat several times.
"Okay, I guess we will get back to discussing temperature and needed equipment. But first I would like to say that it is my hope that each and every one of you not only succeeds in this class but that you find employment. It is out there, there is a need. When you go out for your clinical experiences, Mrs. Trenton will be checking up on you and talking to your assigned mentors and the clinic managers. Most students are actually hired into that clinic. It may not be the job you want for the rest of your life, but it is a start. Both Mrs. Trenton and myself will be writing references for you. That with the references provided by mentors and managers will go a long way. Don't give up on yourself, please."
There were sniffles, but they hung in there. One hand slowly went up and I was slightly surprised to see it was William. I nodded.
"Mrs. Armstong, I have a couple of questions or perhaps I should say a statement and a question, if you don't mind? I cannot and will not speak for the others, but I am here to learn; and I plan to do well, to pass and to work." The class erupted in clapping and agreement. "My question is, would you mind telling us how you got your start, where are you from? You know all that stuff."
"Thank you, William, for sharing that. Thank you to each and every one. I would be honored to answer your questions, however can we leave that until the morning? It has been a rough day, so we will leave the dull stuff until then, okay?" I laughed and they nodded.
"Now, lets talk about temperature. Does anyone know what a normal temperature is, Mandy?"
"I read ahead a little as well so I know it is 98.6 degrees Faranhid which is equal to 37 degrees Celcius, did I pronounce that right? And if you do it in the bum or rectally it is one degree higher and the armpit is one lower."
"You did very well Mandy, It is Fahrenheit, and I can see that you have read ahead."
I held up two thermometers, one red tipped and one blue.
"Other than one is red and the other is blue, is there any difference?"
Several replied by shaking their head 'no'. A couple of hands went up. And I accepted Andrew's hand.
"I think the red one is used in your mouth and the blue is for your armpit and rectally."
"Good try, but actually the blue one is for your mouth or your armpit and the red one is for your rectum. Always, remember that the color red is meant as an alert and something that is inserted into your rectum should not be used elsewhere. I know of several medical students who thought they knew everything, but forgot that one rule; it could have been hazardous for them. Even the solution they are cleansed in are different. Yuk."
Laughter flowed throughout the room as well as gestures of spitting out an awful taste.
"I will pass around the blue ones, please be careful not to break them. They are filled with mercury and you most definitely do not want to be touching that. They are three sided so turn them around so that you can see the silver stripe between the numbers. It will rise up from the base and I can guarantee you that no two people will see it at the same level. Proper handling is to hold it a finger width from the non-colored tip."
These were passed around and for a while I watched as they were turned and eyes squinted in concentration. I allowed almost a half an hour before asking if anyone could not find the line. With slight adjustments and checks to about seven, everyone had success.
"Now, without losing sight of your silver stripe see if it is anywhere near 98.6 degrees. Unless you have been holding the blue tip it should be considerably less."
Two hands went up and I was advised that it was just above that number.
"On to the next lesson." I smiled. "Any ideas of how to get the mercury to drop, ideally it should be around 80."
Immediately there was the dreaded response, "Put it in cold water."
"Wrong, never ever put it in cold water or for that matter hot water. When cleaning them, the reds and blues are always kept separate. With the tips down they are washed with warm water and soap then spread out on paper towel to dry, when they can be put in the appropriate containers. Used ones are put in containers that contain rubbing alcohol for soaking, usually full strength for reds and half strength for blues."
Notes were rapidly written. It was ironic that at no time did anyone consider laying down their thermometer.
"The technique used to bring the mercury down is to firmly hold the non-colored end and create a good flick of your wrist, remember hold tight." After demonstrating a couple of times, "Now you try."
Thankfully there were no flying thermometers and within two flicks the required numbers were noted. The room was filled with 'ohhs, awws and wow'.
"Since no one but you touched your thermometer, I want you to check your own temperature. Under the tongue and watch the clock for one minute. Then wipe it off, lower the mercury reading again and try it under your armpit or axillary. For today we will do it above your clothing but normally it is directly on the skin." I passed out tissues as I watched thermometers go under tongues.
Silence was beautiful for that minute.
"If anyone has an oral reading of over 98.6 or thereabout do not panic but raise your hand and likewise if you have a low temperature such as lower than 88 raise your hand."
I had quite a few hands and most of them were for high temps. To those I whispered in their ear questioning if they had hot drinks within the last few minutes, all nodded yes. There were two with low temps and I asked if they had cold drinks and again the nod was yes. I let them proceed to the axilla area. When finished I collected the thermometers in a tray filled with solution and the tissues in the garbage can.
It had been a productive day. Since everyone had been active in their seats we had proceeded without breaks, so everyone got to leave fifteen minutes early. I did so miss Tom's presence.
By aryr
"Good morning. Yesterday, I was asked for some information about myself and I might add justifiably so. I thought it might be a good idea, if after I share with you that you share a little about each of you as well. It can be as little as your full name or as much as you desire. Fair enough?"
I was rewarded with a room full of smiles.
"Let's see, where shall I begin. I started out with less training than each of you will have. Many years ago, there were no medical office assistants, no lab techs, no CNAs. In fact, RNs and LPNs were the only ones allowed to work in any medical capacity other than the doctor. Oh, in case you are not familiar with those, CNAs means Certified Nursing Assistant, RN is registered nurse and LPN is Licensed Practical Nurse. The only nonmedical person was the receptionist or clerk."
Melissa raised her hand, "Why no lab techs? Who drew the blood?"
"The RN or the Doctor usually drew and blood work or the patient was sent to a laboratory where the nurses did nothing but do phlebotomy. When I started it was as a nursing aide in a nursing home. The only training, I received was about three weeks. In that time, I learned how to change diapers, clothes and sheets, how to bathe using the shower or doing a bed bath, how to feed people without choking them and that for all else you got the RN or LPN."
It was interesting to watch the various degrees of amazement wash over faces.
I worked at that job for about three years. I had to start out on the night shift but for the last year I was promoted to days. Before all of this I had been working in a truck stop at night, sometimes serving and sometimes cooking. I wanted to do something with myself other than cooking. I had been trained in high school to be a secretary, you know, short hand and managing all the equipment. However, there was an influx of those skills so unless you were an honor student and I wasn't, there were just no jobs. So I do understand how you are feeling."
I paused for a few minutes before asking, "So how about we start with the first row and learn a little about each other and then I will continue."
The first row provided a great deal of information about themselves, not enough to be considered excessively personal.
"I was shopping one day and anyone who is a parent can relate to the adventures of shopping. My daughter was just a few months old but old enough to be distracting and entertaining. I met my former English teacher from high school."
We talked for a few minutes, when she broached my previous interest in nursing.
"You do know that the school is now offering a LPN course, those who already have a high school education such as you can even apply for scholarships. And I understand that after working for a year you could then apply to the RN program." Mrs. Offerski commented.
"So I could possibly get a scholarship, work for a year and then get into the RN program. The LPN course would give me the sciences I didn't have from the business course. Is that what you are saying?" She had my attention.
"Listen, I will give you my business card, after all those years teaching English, I switched directions right after you left, I am now a school counsellor and also responsible for interviewing LPN potentials. I know your history and your interest so let's consider this our interview, shall we?" She passed me the card, "Please think about it and call me as soon as you can."
For a few seconds I was speechless. No one had ever offered me such a gesture of kindness. I remembered thinking during her classes that she was a tough old broad but 150% fair. I was speechless and in awe.
"I will, I promise, just let me talk to Bill. I have no doubt that I can do it; but I would have to work out a few details. You know my loss of income, daycare and all that. But I will call, one way or the other."
She smiled, turned her head in question and opened her arms for a hug. It felt like going home for a parental hug.
All of this I relayed to the class and then suggested that the second row completed their part of the getting to know each other.
"Now of course, I called her. Bill was very encouraging and our dear neighbor who was both a widow and retired offered to babysit. The only stipulation she had was to be allowed to provide the care in our home so that my daughter would be less confused. It was a giant step for me."
"The year went by extremely fast. I managed to obtain two scholarships, so the income was as if I had never quit working. The first one was at the beginning of the course and the second one was awarded at the half way mark. This one was a total surprise. It was for the high grade student. And if I maintained my grades, it would extend to cover my first year tuition, provided I met the requirement of one year of employment."
"I aced the course, I had found my love for life. I was actually asked if I would be interested in working in the psych unit. Nowhere in the state had a LPN been hired for psychiatric work. It was an honor. I actually did almost two years and remained as part time for the duration of my studies to become an RN."
At this point I called upon the third row and when they had finished, I suggested a stress release break.
"By working part time, I was able to continue to contribute to the family income. Oh, and because I was a LPN I was exempted from about 2/3 of the first year. I used the scholarship for my second year."
Silence still prevailed. I wasn't sure if they were all actually interested or just glad not to be doing lessons. But I had promised and so I went on.
"Okay, back to more about me. I worked for about a year after graduation in psych, it was totally different as an RN. I did a lot of counselling and a lot more paper work. My husband was transferred to a larger city and so did my nursing career. I enjoyed working as a floor nurse until opportunity struck once again. Several of the fourteen hospitals decided to boast the number of nurses trained for ICU or Intensive Care Unit nursing. The offer was that the hospitals would continue to pay your regular wages and tuition for the year long program. It was a win-win situation. The only stipulation other than passing was to sign a document which promised that you would work for that hospital for two years. I liked the hospital I worked at and didn't have a problem. Ultimately, I chose neuro ICU, but was trained to work in any ICU. I just felt that it was more challenging to figure out the causes of brain damage rather than the problems in other ICUs."
I paused for a few moments, partially for myself, so I could recall some not so great memories and as well to let them absorb.
"My husband died when our daughter was almost eighteen and just getting ready for college. So, I became a widow and an empty nester within the same year. I continued working because I did so love the medical field. Over the years, I had been promoted to various positions; there is a benefit to sticking at one place. After five years in administration I decided to retire and take time for me. Mrs. Trenton actually used to work under my direction. She had called me about two years ago to see if I would be interested in teaching part time. We never had agreed but when she called on Friday and then the school called within ten minutes to offer the position, I stepped out of retirement for a dear friend. And now I am here."
| Author Notes | Sorry that the chapter was so long but I couldn't find a place to chop it in half. |
By aryr
The room remained quiet for several minutes. I looked around in a quick check to see if everyone was still awake. Ralph's hand went up and I acknowledged him.
"So, you have always been a nurse and not a teacher? How do you step from one role to the other without having the training? You must be good if the school called you. I know it is a private type school, just for adults and no kids, but still! They didn't know you from Adam."
"That's right, once I got on the path to nursing I never once looked back. Now if you think about it, anytime you have a medical appointment, regardless of the reason; someone teaches you something. How to check your blood sugar or your blood pressure? Someone answers your questions. Nursing and any other medical job is about sharing information, teaching something. You all will do so when you are working. You will, definitely tell clients and patients what you are doing, how you will do it and why. Isn't that teaching?"
At this time, about ten hands went up. Once again, I pointed and numbered them before settling back on number one. "Yes?"
"I hope you don't mind but I recorded what you were saying, so I could listen again later. Is that alright with you? Because I will erase it, if it makes you unhappy."
Several others echoed "Me too."
"That is fine, I am known for recording and sometimes without permission." I laughed, "But never ever involving a patient or client. Please remember that."
"So, Mrs. Trenton worked for you? She isn't a teacher either? Wow. Who would know."
"Mrs. Trenton is about twenty years younger than I am. And no, I am not going to tell you either of our ages. She worked in the ICU with me. In fact, she took advantage of the same training program that I had done years before. I think her group was the last one approved. She worked for about twelve years and then decided it was time for a change. This school was opening and needed a RN to teach and voila, she is here. When she had first asked me about teaching, the school had also called and talked about my background for an hour, so they knew who I was and my nursing history. Now since it is almost lunch time, I suggest we just go early and then work a little harder this afternoon. Scoot, off you go and enjoy."
When they returned, they were back in learning mode. We spent the first hour talking about how to properly record vitals signs. We also addressed the need to clean earpieces and cuffs with alcohol swabs, the prepackaged type rather than cotton balls and a bottle of alcohol. I advised them that even when they had their own 'ears' it would become second nature to clean them. One just never knew when it would be borrowed. Then after a quick break they broke into groups and practiced. Each student had their own thermometer, but they shared stethoscopes and BP cuffs. Everyone recorded their readings on a pullout page. They were instructed to use just initials with the four people. I wandered around the room, checking what was written and answering questions as they arose.
Around three-thirty the class took the initiative on their own to clean up. All of the equipment was cleansed appropriately and returned for storage in the cabinet. The classroom desks and chairs were returned to order. It was neat and tidy, I was proud of them.
At the end of the day they were instructed to review the chapters pertaining to the cardiovascular system (heart and blood), to breathing and vital signs. Someone whispered "test" and I smiled and simply nodded.
My evening, after a Chinese take-out supper, had me reproducing diagrams of both systems and creating twenty-five questions. All of them were multiple choice. By ten pm I had my first test done and I was wide awake. Time for a hot cup of tea and a good book or my kindle. I settled in the recliner with a promise to myself to go to bed at eleven pm. I had made a small pot of tea which gave me about two cups. Tea was always best when hot and without additives. When I was younger I would enjoy a bit of honey, but now just hot tea hit the spot. Wiggles, my black cat jumped up to share the chair and my lap.
At two am, my bladder woke me with a sense of urgency. The bathroom called, the tea was cold, thankfully I had only a couple of mouthfuls left. The book had fallen to the floor and Wiggles was snuggled into the chair beside me. After addressing the immediate issue, I trotted off to bed. Sleep once again found me as my head laid on the pillow. Wiggles had relocated to my side and we were settled.
Years ago, I had decided that the queen size bed was too large, so I moved it into the second bedroom that had been my daughter's but was now a converted office. I purchased a twin bed and moved the office stuff to my new bedroom. It was convenient for me and made more sense. I also had a spare bedroom if I ever needed it.
By aryr
Because I had worked late into the evening yesterday, I did not have to get up as early as I had been. Of course, I thought that would mean extra time sleeping but Wiggles had other ideas. She must have run at least a mile as she chased my hand under the covers. I finally decided it was time to get up, so it was off to a long, lovely shower. I was never one for a lot of makeup so a whisp of eyeshadow, a hint of mascara and a weak spray of Shalimar. I had a quick cup of hot tea before applying lipstick.
As I rode the subway, I allowed myself to reflect on the changes I had made in my life after retiring. For so many years I had worked under the guidelines of absolutely no perfume, since some of the patients were possibly allergic or it might be offending. A touch of eyeshadow was allowed but no mascara, it could run when one was perspiring in the over heated rooms because the poor patient was freezing or perhaps it was due to the hard work. Hair was maintained in a simple do or pinned up, it never touched your collar. And heaven forbid that you even thought about artificial nails, they collected bugs and germs and were hazardous to the patient. I had gone through the clothing or uniform changes; initially it was all white including panty hose, definitely no pants and one must wear their cap.
Over the years I watched the changes and adapted. Hair was longer but still required pulling back, uniforms were colorful, as were shoes, caps were discarded. Ironically when I was ready to retire, the colors had gone from one spectrum on the color circle to the opposite, black was becoming the choice. I remember wishing for black or navy blue when I started out. It was a more realistic choice over white. I envied the nurses in England and other foreign countries who did indeed wear those colors and an apron or bib to cover and protect. I didn't envy the concept of being called 'Sister'. Things changed, and life goes on.
I got to the school and after dropping off my bag, starting the photo copies and locking the class room door I scooted down the street for a fresh bagel and cream cheese. I did so love that combination and could probably eat them daily. It was a wise decision to limit myself to once or twice a month.
Part of the old school nursing was the limited coffee and meal breaks, so one learned to eat fast. Even as I tried to slow down, I still devoured it in fifteen minutes.
When I returned, even though it was before 0800 about 2/3 of the class were there so I let them in and after putting their things on the desks they went ahead and started the coffee and hot water. The room filled with quiet chatter.
By aryr
At 0830 I was ready to pass out the test papers and everyone appeared ready to get started. I walked the rows pacing one test on each desk, facing down, giving instructions as I did so.
"Okay, you will have one and one-half hours to complete the test. I suggest you use pencils and I have extras. Your name and date on every page. I recommend that you look over the diagrams and then read each question, before you start. If you are unsure of a question, raise your hand. When you are finished, please quietly turn your paper in. If there is more than ten minutes of the remaining time, you may leave the room but preferably not the school. If you really need to smoke, then just outside the doors is fine. I will mark these over the weekend and we can spend an hour discussing them on Monday. You have five minutes to grab a coffee or pencil."
They started at 0845, I watched and started working on next weeks test. Although there was an assigned curriculum, which we were following, there were no tests other than the midterm and final exam.
In the hospital, even before I switched to administration there were regular tests for annual qualifications. Each floor had an assigned educational person responsible for these test and records. It was part of one's recertification and registration requirement. Continual education was a mandatory requirement. I found that 99% appreciated the regular tests as a review and thus thought they would be advantageous to the students. Now it meant that I had to create them, but I enjoyed doing so.
I had expected Tom to return by now and had made a copy of the test for him. It sat on my desk, unused. Out of habit I had made thirty-one copies, protocol at the hospital required that the tests were kept for two years and included a blank copy. I kept the original for my home files. So, I just continued. Some of them were done after 45 minutes and left, everyone was done by 1000. They drifted back in at 1015.
"I figured that since everyone had at least fifteen minutes to break we could ignore the usual stress break. For the rest of the morning I would like you to partner up again and practice your vital signs. After lunch, you will come up with your partner and do a vital sign check, which I will then check. While you are waiting you can start reading Chapters 6 & 7 or continue to practice. Remember no more than two times in a row per arm. Get your equipment."
After the first five people they decided it was faster to hand out supplies, so three people distributed the stethoscopes, BP cuffs and thermometers. They remembered on their own to use the blue tipped ones.
I was surprised but very pleased that William and Ralph had problem solved and invited Andrew to join their group. With Tom being gone it left one person without a partner. The room was quiet as they checked and rechecked. At lunch they put their equipment on their own desk before leaving.
Since I had brought a salad for lunch, I decided to get a start on the test papers. I chose green as my marking color, just to shake things up. I would use red on the two examinations but otherwise it was a color of my choice, less intimidating.
By the time lunch was over and they were drifting back in I had gone through twenty-one papers. The reason I could go so swiftly was because most of those papers were 100% correct and those that were not only had one or two questions wrong. It was encouraging to see that the mistakes were made on the diagrams and were spelling errors rather than labelling errors. They were seated.
"I would like each pair to come up front and take vital signs, I will then repeat, and we will compare recordings. I think the first group shall be William, Andrew and Ralph. I do thank you two for recognizing a problem and coming up with a way to solve it. Oh, I forgot, when you are finished after you clean your scopes and cuffs, you are free to go. Enjoy your weekend, you have all earned it. Thermometers go in the container I have filled. Let's get started."
By 1415 everyone had finished, equipment was cleaned and put away. Two of the guys had even cleaned the coffee and hot water machines. All that was left for me were the thermometers and one cabinet left unlocked. I had put a reminder on the chalk board regarding their reading assignment.
On the ride home, I finished marking the rest of the tests. I was impressed. They had all done very well, very well indeed. With their vital signs we had three low grade temperatures which we learned were false alarms because they had all had coffee just before; two slightly elevated blood pressures and one irregular heart beat that had been undetected. After all they had not learned abnormalities yet.
When I got home, I changed into an old set of scrubs, said 'hello' to Wiggles and provided some loving play time and then called Roni. Roni was Veronica, or Mrs. Trenton and a dear friend. Our work relationship brought us together as friends, but over the years we made it grow and grow, we were best friends.
By aryr
Roni and I had been working together for about a year when she calmly asked if it would be okay to call me by my first name when we were off the floor. I had no problem with the idea and told her my first name was Jaqueline. She however decided that since she didn't really like Veronica, she would be Roni and I would be Jax. And thus, it was to be.
She answered on the third ring. I had called her cell phone, not knowing if she had been discharged yet. She had it with her in the hospital, so I was safe either way. She was still there, waiting for her daughter, Darlene was to arrive from out of town. She was to get in early tomorrow and the equipment was to be delivered before noon, then Roni would be discharged in the afternoon. Roni took a quick breath then continued.
"Well, according to the social worker who has checked with insurance, I will need some equipment at home. The list includes a hospital bed, a commode or potty chair, a wheelchair with a strong leg extension, a bed table and a hoyer lift. God, those things are scary, I would have never guessed. To think of all those patients we moved with them, they must have been terrified, I was. Darlene has to learn how to move me from bed to wheelchair, to the commode. I might just teach her at home how to do a transfer rather than that thing. Hey, you could come over and help her."
I smiled as I listened to her ramble on. I didn't have the heart to tell her that when I did my geriatric rotation or as some called it the old folks rotation, I had the privilege to use all those things and probably more, because our instructor was a firm believer that we should experience what we would be doing to people.
In recollection, I honestly think we did have some interesting and unusual instructors. In my LPN course, I had the geriatric lover. She had us partake in pairs as a geriatric patient. We were dressed in left over clothing from the nursing home, which was wore over our normal undies. We each had a entire shift as such. Of course, after being provided with vaseline coated glasses to blur our vision; gloves with cotton balls in the fingers to alter our dexterity and we were restrained to prevent us from moving on our own. Life was limited that day to either being in bed or in a wheelchair, being fed breakfast and lunch. I can say it was interesting having cold stew, warm milk and melted ice cream. We also had the thrill of being an incontinent patient. We had all been instructed to bring an extra pair of undies, so that on our day to be a patient, at some point warm water was poured onto the incontinent pad in our wheelchair. We then got to sit on it for at least one-half hour. The purpose was to let us feel what it was like to lose bladder control and sit wet. We all decided on our appointed day that we would be vigilant regarding incontinence.
In the RN course we did things like injections using sterile water, starting IV's, drawing blood for labs, putting NG tubes (nasal gastric tubes) into each other, and having a bed bath while wearing a bathing suit. NG tubes were those clear ones that would be inserted through one nose and go to one's stomach.
Over the years, these techniques have been stopped, but I will confess that when you are doing these things to your class mates and having them done to you; it instills a sense of concern and awareness of what you are doing to patients. I must admit I do have some fond and not so fond memories and definitely lots of chuckles. This was even before Roni's time.
I reassured Roni that I would come over and help Darlene. I also suggested that they go ahead and arrange for the equipment and I would go over for its arrival. I would get up early and pick up her key then go to the apartment. She hung up to let the social worker know.
It was time for supper, I did enjoy salads, so of course that was my dinner choice. I could top a salad with anything, chicken, sliced beef, cheese, boiled eggs, lamb or whatever. Tonight, it would be a combination of eggs and cheese. Wiggles was ready for her supper as well.
I liked the size of my condo. It was a wise purchase years ago. It was a convenient location for all three of us, Brian, Kelly and myself. I fell in love with it because of the eat in kitchen rather than a separate dining area as well as the small but efficient laundry room. So, it was the large kitchen, a comfortable living room, the master bedroom with its own four piece bathroom, the second bedroom with a three piece bathroom, the foyer. Because we both had good paying jobs, we did double payments and it was paid off in one third of the time. It came with enclosed two parking spaces, so I was settled. I had everything I needed.
I settled into the recliner after eating my salad. This was my TV time. I recorded programs that I would have missed during the week and now it was time to catch up. I did so love NCIS regardless of where they were filmed. And I will admit to being a big fan of Murder She Wrote, I had watched every episode a couple of times and always knew who did what but I guess I was really a big fan of the lead character. British humor also fascinated me, but tonight was NCIS night.
I was almost through my second hour when Roni called to confirm that the equipment was coming, that she had talked to Darlene and could I please pick her up a toasted bacon sandwich in the morning. We had developed the same eating habits at the hospital. The toast was always perfect and the bacon crispy and oh so yummy, add a little ketchup and it was a breakfast for royalty.
By aryr
Morning came faster than I wanted it to, but I was motivated to help a friend. Because Roni lived about two miles from me it was easier to drive than take public transit for the numerous trips. I belonged to a couple of committees at the hospital, so I had maintained a parking pass. The cafeteria was open twenty-three of twenty-four hours, they had to clean sometime. It was spotless and well organized. Since I was getting breakfast for her, I decided to treat myself. I had the food for two delicious bacon creations and coffees. Off I went to her room.
She was awake, bathed and dressed in her track suit. When the time came there would be no stopping her. Breakfast was the priority and we savored each bite. It had been a long time. Next was the plan for equipment placement. Roni had three children, all grown and away from home; in other cities in fact. She had sold her house, a five bedroom, after the last child left for life on their own. Her husband left her life shortly after the last child moved out. He had found other interests in life and with the children gone, felt that he had no need to stay there. She found a nice two bedroom apartment and she was okay with all this.
The plan was to place the bed in the master bed room, her bed would be pushed over against the wall, but her clothing would all be there. The commode would be in the corner ready for use. The hoyer lift would be in her bathroom. When she was up she would either be in the wheelchair or on the couch. Darlene would arrive around noon, drop her things off at the apartment, then head to the hospital to learn about her mother's care. It was interesting that none of our children had gone into the medical field. Well it either interesting or smart that they avoided the medical field. They were all good kids and were prepared to help at the drop of a hat.
With the key tucked safely in my purse I gave her a hug and left. I had a few things to do to get the apartment ready. The drive over was easy and there was minimal traffic. Security recognized me because we visited each other weekly. I took time to advise him of Roni's accident and that Darlene was going to stay with her for a few weeks. He appreciated the heads up. I parked and went in and up to the tenth floor. She did like her view and I will admit it was great. Within an hour, I had the apartment rearranged. I got the coffee maker ready, because I knew she was a coffee addict. I am grateful that she had at least switched to decaf a couple of years ago. I sat enjoying my tea while I waited.
The company arrived at 1000 and after setting everything up left at 1100. I cleaned and made up the bed and out of habit cleaned the surface of the other equipment. She would not be exposed to other peoples' germs. Security called when Darlene arrived and a few minutes later she was at the door. We hugged, years ago when Roni and I became first name friends I had become Auntie Jax to her children and she was Auntie Roni to my daughter. We were family.
By 1400 Roni was home, we were all glad that the ordeal was officially over. Darlene and I practiced with the hoyer lift and with other transfer methods. It was decided that unless Roni became too bossy she would be transferred, the hoyer lift was a backup. I went out and picked up Chinese for supper and then sat with Roni, while Darlene went out grocery shopping.
It had been a long day but everyone was home and happy.
My plan was to reunite with NCIS for the evening.
By aryr
Sunday was a catch-up day for me. I cleaned, did the laundry and cooked a small pot roast. My grandchildren called as usual to update me with their successes at school and the events of interest in their lives. I talked to my daughter for a while and in general felt good that things were going well for her. We arranged a visit for next month.
I had the TV on just for background noise. I was just not up to music today while I read. Wiggles was once again very comfortable on the couch, after a half an hour she scurried under the throw cover. We were settled for a while.
The pot roast and veggies were great. I organized my paper work for class and set out my clothes. I had discovered that my dress pants with a blouse or pull on sweater was an ideal choice to be combined with one of my two old but favorite lab coats. It was great having pockets.
I called and spoke with both Roni and Darlene, things were going well for them. Roni and I had talked and decided that it was foolish that we hadn't thought of it before, so we exchanged keys. Roni explained that she and her daughter had figured out how to manage her appointments. Darlene had a larger car, so her mother would slide unto the back seat and lean against the back door on a pillow. I was so glad that we had mastered transfers. I encouraged both of them to call me at any time. And I promised Roni that I would give her a weekly update on how the class was going. She was impressed that I had created the test and that the students did so well. I think she plans to continue with the tests when she returns.
I decided to watch TV for a while from bed. After both of us got comfortable, the cat and I, the choice was between a comical movie or a documentary. The movie won. I laughed and chuckled as Wiggles snoozed and snored.
Monday, I was up and on my way. There was something to be said about the subway system. It provided reading time, napping time or just plain old people watching. I was surprised to see that about 2/3 of the class got on at the last switch. They were a noisy group competing with the others. Everyone was chatting, no one was attempting to sleep. All of them acknowledged me and a couple asked if I had the test results. I just smiled and nodded.
When we got to the school or rather the building that became the school, I changed protocol and advised them that I would open up for 0800 and they were welcome into the class room rather than the hall. They were quiet and orderly and took it upon themselves to set up the drinks area. One asked if it was okay if they brought in cold drinks, which I approved.
Class started at 0830, I had put the test papers in order according to the seating plan. I walked down each row distributing the marked tests. Everyone was turning to surrounding students to show them their results. Pride flushed their faces.
"As you can all see, there were minimal mistakes. Those who lost marks did so because of spelling rather than labelling. I am so proud of each of you. Unfortunately, I can not use these grades towards your final mark, but you can use the tests as reviews."
By aryr
It was 0845 when there was a knock to the door. I answered with a "Yes, come on in."
The door opened just wide enough for the Dean to ask if I could step outside for a moment, she had something to ask me and preferred to do so privately. I instructed the class to be quiet and stepped out.
I closed the door and was shocked to see Tom standing there in the hall. Mrs. Phillips responded to my gasp.
"Tom, here, came into the office about 30 minutes ago. He explained that you liked to start class at 0830 and wanted permission to reenter the program after his absence. He is aware that the choice at this time will be yours. Tom, go ahead and say your piece."
"Mrs. Armstrong, it was wrong of me to snap at you the way I did. You did nothing to warrant my response. A couple of the guys caught up with me on the weekend and let me listen to what had been recorded when you were nice enough to answer their question about your back ground. It sure sounded as if you had your struggles every bit as much as we do. I will understand if you say 'no', but I would like another chance, please."
"Mrs. Armstrong, would you like a few moments? Again, the choice is yours." Mrs. Phillips asked.
"It is okay, I do not need extra time. I do have some stipulations that have to be met and if Tom is willing to do so, I do not foresee any problems."
Before I could continue, Tom eagerly comments, "Anything, I will do whatever is needed, get whatever and agree to whatever, right here, right now."
"First and foremost, you will need to catch up on what you missed on your time, not the classes. You will never, ever doubt your abilities again. In order to catch up, you will stay after class, this week for an hour for review and teaching. And lastly, there is absolutely no need for you to explain to anyone in the class, why you are back, why you decided to come back or the circumstances about being back. If you agree, we can shake on it and go back inside."
His hand was out before I could even extend mine. His smile made his face glow as if there was a 200 watt bulb facing him. Mrs. Phillips nodded and went down the hall to her office. Tom and I went into the classroom.
There was a brief pause of silence, then clapping and controlled whistles erupted. It was more than obvious that everyone was glad to see Tom. I gave them their few minutes to enjoy his return.
"Okay people, back to work. Now if I recall correctly, I was commenting on the test and the results. Again, I can not use the grades towards your final mark, but I think it will be a great review tool. Oh, and please do not let Tom see any of the papers, he will be honored with two tests this week." I smiled, and everyone chuckled.
"Now because of Tom's return, we cannot review the mistakes, but I want you to keep them and on Friday after this week test we will review these. Tom will be doing his on Thursday. I did speak to Mrs. Trenton over the weekend. She is pleased that everyone is doing well, and she is home. Her daughter is providing care and they both know to call me as needed."
There were a couple of questions regarding the severity of her break, of her surgery and of her recovery. I answered them all to the best of my ability. Roni knew they would ask and was okay with them knowing.
"Great, if everyone is ready, we shall get to the digestive system. First, however, I do believe I need a coffee, a little caffeine to enhance the anxiety of the day. Anyone else?"
Several scrambled to get coffee and then there was quiet.
After two sips, I started, "We have seen in the diagrams that when we breathe-- hopefully through our noses-- the air goes down the back of our throats into the trachea and then the bronchial tubes. When we eat or drink, it goes into our mouth and down the back of our throats but into our esophagus and to our stomach. If you can picture in your mind, a toilet seat that keeps the esophagus open when you are eating because it closes off the trachea. It is actually a sphincter of muscles that open when you eat and close when you breathe. We will talk about sphincters a little later. So, when you take a breath and try to swallow food or drinks, it goes the wrong way and into your trachea which makes you cough and sputter and usually blow stuff out your nose.
How many have had that happen?"
Every hand in the room went up and a few volunteered both hands.
"Okay, now that we can all admit to living through at least one of those embarrassing moment. The food or drink is squeezed down your esophagus to your stomach, where all sorts of acids and gases work to break it down to a mush consistency, from there is goes into the small intestines and the large intestines and finally out your rectum as a bowel movement. That my friends, is the short version. Who read chapter 6 over the weekend?"
Again, every hand but Tom's went up.
"Okay, let's start on the left side of the room and at the back, and you can use your books, I would like each of you to tell us about the flow of food or drink in its correct order. And the mouth, teeth, tongue and saliva count as one. So, Peter, will you start and explain what happens in the mouth, then Nancy will follow with the next part?"
We worked through the entire digestive system. I had several students involved when it came time to talk about the stomach and its acids. When they discussed the small intestine, I had another group talk about the gallbladder, the pancreas and liver. It took the full morning to learn about the system.
I jokingly reminded them to enjoy their lunches.
By aryr
After lunch they were given the opportunity to listen to some tummy sounds and the gurgles of the intestines.
"Hey, we can tell time by listening to Stan's gut. His is always grumbling but it gets worse at lunch time. Sorry, Stan, just playing with ya. We're alright, aren't we?"
"We're okay. My mom and dad say the same thing, but they won't let my brothers and sisters say anything. I wait until I am really grumbling and then I sit next to them," he laughed, "and they can't say a word. It's great."
The text book the school had chosen for the medical courses were not only fundamental in nature but wisely put together. The beginning chapters covered the basic anatomy and the next group of chapters covered the diseases and malfunctions. In my mind I was hoping that when they got to the problem area, they would think about their own bodies and solve some of their issues. I was sure Stan's were related to diet. It was amazing what these youngsters lived on, their weird food choices. I knew that some of the situations were financially created and some were from just not knowing.
I had already in my mind, planned to have a couple of days to discuss cultures, so why not add some of these ideas that could help change their families lives and probably for the better.
"Okay, since we have listened to some of our bodies' weird sounds, let's talk about what happens to the food or drink as it passes through the various areas. Did any of you realize that the digestive system is the only 'open' system of the body? Basically, what you put into your mouth will come out your rectum, in a different form, of course."
A hand shot up.
"Yes, Helen, what is your thought?"
"Well, when we drink a lot or maybe just because we drink, is what we pee part of the digestive system?"
"Actually; it is not, but it will all become related. Our body is like a machine. Maybe you can think of it as a car. The wheels, the engine, the fuel, the different parts will not work on their own but when put together they become a car and they work and provide transportation. Our body is like that, it all works together."
I paused for a few minutes to let them absorb this idea.
"Our meal consists of meatloaf, mashed potatoes, green beans, gravy, a couple of buttered rolls, water, sweet tea and a donut for dessert. What happens first?"
Stan raised his hand, "I would think I had died and gone to heaven with that much food."
"Okay, how about you give me the food choices from a typical supper in your house?"
"Pan fried ground beef, the greasy kind. Boiled potatoes which you can smash up or cut up, a slice of bread with margarine, tea or coffee and no dessert." He offered.
Around the room, heads were nodding.
"We now have our meal, what happens first?"
Another hand rose, "We stuff a big mouthful in, chew it fast so no one takes from your plate, swallow and do it again. You are done in less than fifteen minutes."
And another, "You forgot that you sort of hunch over your plate; kinda like you are protecting it. And your fork never stops, stab or scoop and shovel."
Once again, heads nodded. I was wondering how I could teach normal when life was so abnormal for so many.
"Let's pretend then for this class. You do not have to rush, you do not have to protect. It is recommended that you chew each bite twenty-eight times before swallowing. Now I know that doesn't happen unless you are royalty or very high class but at least pretend that it is chewed at least ten time. What happens?"
"Twenty-eight times?" Several students asked.
By aryr
"Yes, twenty- eight times for each bite. Okay, we are going to side track from the schedule for the rest of the day. Close your text books. You are free to take notes, but you will never be tested on this information and you may ask and offer whatever you wish."
A few minutes later, they were organized for their unknown adventure. Everyone had note books out and pencils ready.
"This will be a life lesson, instead of an instructional lesson. Does everyone understand that concept?"
They all nodded.
"Each of you have life lessons that are important to you alone or perhaps you and your family. Everyone has reasons that certain things happen repeatedly. Today I hope that what I share will inspire you or at least some of you to make some small changes that will affect your life and the lives of your family. Does that make sense?"
Again, a roomful of nods.
"First of all, I need to ask a few questions. Only those who wish to answer, should respond. And I don't need the whole room to do so. Who does the grocery shopping in your home? Who does the meal preparation? Does your mother work outside the home? How many children in your home? Who does the housework? The laundry?"
Several hands went up, and I wrote brief notes as I gathered information.
"I have noticed from those who responded that there were only a few of students who were an only child, are there other others here, beyond asking that I will not bother the non-responders further."
Three more hands went up. This meant that in a class room of thirty, nine of those were only children. Almost one-third, interesting. In most cases it was the mother figure who shopped, cooked, did the housework and all worked outside the home. The only time any type of help was offered was with the female students.
"Would someone describe your typical day, actually a typical weekday and a weekend day?"
Stan volunteered, "On a week day, I get up around 6am, shower, get dressed, have breakfast, grab my books, coat and stuff and I am out the door. I catch the bus then switch to the subway, get off at the stop up the street, walk here, have class until lunch, I like going to the burger joint that is two blocks down, come back to class. We leave at 4pm, so it's a subway ride then the bus. When I get home, I have a coffee and do my homework or study. When supper is ready I eat, then I watch TV for a while, unless I go down to the coffee shop with my friends. I make sure I am home for 10pm and in bed by 11pm. On the weekend..."
I held up a hand and stopped him before he started in describing his weekend routine.
"Does this sound somewhat familiar to everyone?"
Ironically all the males were nodding 'yes' whereas all the females were nodding 'no'.
"Okay, continue with your weekend."
"Well, I usually don't get up until around 10 am, shower, dress and call my mom or sister for breakfast. If, I have studying, I do it until about 1pm, if not I watch TV with my kid brother, he likes the cartoons. My mom makes a sandwich for me and one to take, since I go to work for 2pm to 10pm. I got a job at the hardware store, which closes at 9pm but then I stock shelves and clean up. When I am done, I go home and if my mom is not watching one of her girlie shows, I watch TV for a while, then I go to bed."
Once again, I asked if this sounded like a weekend day and again, the guys nodded 'yes' but the girls nodded 'no'.
"How about one of the ladies sharing their day, your choice of weekday or weekend?"
Michelle offered, "I get up at 5am, every day. I shower, get dressed. At 530 I start the first load of laundry, sometimes there is two or three loads, but there is laundry every day. I don't always get it done in the morning, but it is finished before I go to bed. I usually help get breakfast ready and my mom makes lunches while I do the dishes. We each have to clean our shared room, weekly, but I do the laundry since I am the oldest. Saturdays are sheet changing day, so I have about five loads. It takes me two subways to get here so that's about 45 minutes. I don't go out for lunch because I have my sandwich. When I get home, I start supper and mom gets in about 6pm so we eat, then I get the little ones to help me with the dishes. Some evenings I babysit for the neighbors and some nights I just watch my younger brothers and sister, so mom can have a break. She likes to soak in the tub for a little while. We make sure everyone has gone and done their thing before she goes in so that she has a half an hour. I study when I am babysitting rather than watching TV. Then I go to bed at 10pm."
"How does this sound to the other ladies? Somewhat familiar?"
They all nodded.
"Now, the gentlemen in the room, what do you think of the comparison? Do you notice a trend? Tom, you felt the other day that being a man in this career would be detrimental, what do you see happening to the girls here?"
Tom, was quiet for a few minutes, but he did stand.
"I think we see the girls following in our mother's footsteps. They do the woman's work, that needs to be done around the house. I honestly, never thought about it like that." He literally plopped down into his chair.
I looked around the room and saw smiles on the faces of the girls and a mixture of shock and surprise on the guys.
Andrew raised his hand, he had a sheepish look on his face. "I don't want any of the guys to think that I am a wimp or weird, but I do the dishes all the time and keep my room clean. My mother has been teaching me simple cooking, like scrambled eggs, meatloaf. She thinks every guy should know how to take care of himself, when he leaves home. Simple cooking, simple housework and laundry."
There were several comments of approval from both the guys and the girls. As well as other murmurs that encompassed an hour of time.
"So, how can we change things? How can we make your lives better and those of your families? I want you to consider this tonight and we will continue our discussion tomorrow. And Tom if you would please read chapter 6 & 7."
By aryr
It was refreshing to arrive at school the next morning and be greeted by so many smiling faces. The chatter among them reflected that they had indeed spent time last night thinking about what we had discussed.
With the normal routine completed, I opened the class for general discussion. I wanted to hear their thoughts. I did remind them that only one person spoke at a time. It was rather ironic to note that none of the girls jumped in, the boys jumped in with concerns and ideas.
Stan volunteered that after thinking about what was said in class yesterday, he had helped his mother and sister get supper ready and did the dishes by himself.
"Do you guys realize that when you do the dishes, you have the whole kitchen to yourself. It is so quiet. It gives you that peace and quiet that we all wish for in the bathroom. I even propped my book up behind the taps and read chapter 7 again. And I remember most of it. I plan on doing the dishes every night, so I can either read or study."
There were a lot of 'wow' and 'good idea' comments.
Bill, not to be confused with William, shared his story, "Well, I offered to do the dishes after we ate, but my mom had to feel my head in case I had a fever. Then she looked at me as if I was on drugs or something. I just left the kitchen but headed to the hall closet where the washer and dryer are. Our washer has died, so the laundry goes to the building's laundry room in the basement and then back upstairs for the dryer. There were two baskets, so I took them downstairs and washed them. Like Stan I found that it was quiet, well other than the machine noise. There were other machines going but no one was there. I found some magazines with some good stories. They were all what I call women magazines, nothing for guys. Oh, never wash anything red with light colors, they come out pink." He blushed.
The whole class broke into laughter, myself included.
Several ideas were bounced around with promised to continue helping with the daily chores. Every one of the guys thought that it was great that Andrew was learning to do chores that would teach him to be on his own.
Some suggested doing things like changing light bulbs or doing small time maintenance on appliances. Bill planned to check the washer on the weekend to see if he could fix it and if he couldn't he was going to check with Stan about maybe getting a machine on payment.
Stan offered to come over and help him out on the weekend and then he would talk to his boss. The team or group support was about to begin.
After their lunch break I would offer some suggestions, so off they went.
"As you can see, some of you have come up with some great or rather fantastic ideas and plans. But ask yourself this; for how long? Will you do these things for a few days, maybe a month or two, only to revert back to where you were at yesterday? I think that you are all smart enough to know that saying and doing are two different things. The only way to make permanent changes is to say and do, both are important. Take the time to sit down with your parents first and explain that you want to do more, and you have ideas. Then talk to your brothers and sisters. It will be not only you but your whole family that will make changes and perhaps become an influence on other families. I have some ideas for you to consider. Do you want to hear them?"
I reviewed with them, some of the things we as nurses had had to do for the community. Suggesting that they each do a meal log for at least a couple of weeks but probably for a month. This meant writing down everything that was eaten in the home and unfortunately for lunches, so trips to the burger joint were off limits for that time. I promised that in a month we would review them. I also addressed financial concerns, which did seem to embarrass some of them, but I reassured them that we would not talk about the budgets of individual families but, more so, I would offer constructive suggestions to help it out. Using the example of what Bill and Stan had planned to do about the washer as an example.
The girls appeared more eager with this part of the discussion. One offered that she babysat two evenings a week for about three hours each without pay. Instead she was given a couple of pies each time. The other times she was paid.
I explained that this was what was called the barter system, performing a job or service in exchange for an item or even a service and praised her doing so.
Another commented that once a week, when she was babysitting she would shampoo all the kids hair and she got a bag of oranges and a bag of apples as well as her babysitting charge. A great example. The parents did not have to deal with the shampooing and she got fruit to take home for her family.
"One other way you can help your family is by creating and taking the responsibility for maintaining window box gardens. This is a great job for the younger ones, have them water the boxes every other day. They love to have jobs as long as they are not overloaded. The boxes will fit inside during the cold months and go outside during the warm ones. You can even put several on your patios. If you have room for bigger pots outside you can even do potatoes, turnips and carrots. What food you grow that you know your family can not use can be bartered for something that you need. Now the guys are creative and handy with tools, so you can even find wood or get cheap wood and make them. If a bunch of you get together you can share the cost of the wood and paint. And when you have produce, you can barter among yourselves."
I stopped to give them all time to write their notes. Girls were talking among themselves and the guys were grouping together based on their apartment or house location. I watched as pages were being filled, and suggestions were exchanged.
When sufficient time had passed I continued.
"Make up a chore list, to ease the burden on your parents. Remember, not to overload the younger ones but do give them something to do. If nothing else, have one of the slightly older ones read to the little ones. An hour away from a TV is more productive with a book. Little ones can also dust, fold clothes etc. Be creative."
Many suggestions were offered and written.
"How many of you have extended family living with you? Are they underfoot all day? Give them a simple task to do. In fact, some nursing homes provide constructive activity to occupy the patients. I remember one Alzheimer patient who folded napkins all day. Staff would just, walk by and ruffle a few up so she thought she had lots to do. And she was praised for her contribution. It was nine years before she peacefully passed, nine years of napkin folding, but she was happy. Anything you can do to give especially your mothers a break is great. They are the twenty-four hour care givers of everyone."
More notes and more mumbling.
"Before I forget, the nice thing about those window box gardens, is that your family can redirect the money normally spent on the basic veggies to different meats and fruits. You also get a bigger variety of vegetables. And it is better for your health, especial those who have medical problems like diabetes. It's time to go home. Back to the digestive system tomorrow. Have a good night. Tom, are you ready for your hour?"
"Yes, ma'am."
Last night we had reviewed what he had missed last week, tonight he would practice vital signs.
I locked up, when he was gone. I hoped that the suggestions of today would be helpful.
By aryr
"Okay, if you are all ready, let's continue with digestion. I do believe we were going to discuss what happened to that meal. Andrew, we will start with you. You have stuffed that bite into your mouth, what happens?"
Each student was able to answer correctly when called upon. They now had an understanding about the reason and purpose of saliva and of the gastric juices and the enzymes of the gallbladder, the pancreas, the liver and the bowels.
"In regards, to digestion, different foods take different lengths of time to break down in various parts of the system. For example, some meat products take up to 72 hours to work through our system. Most fruits break down and are used within a few hours if that. It all depends on what the food choice is and how our individual bodies react to it."
Ralph raised his hand in question, "So what happens when we eat something like pizza- all those different food types."
"An excellent question, Ralph. Each food group is recognized by the gut and the appropriate enzymes are activated to process it. So, if you had pizza with the crust a carbohydrate, sauce which is a veggie but really a fruit, cheese is of course a dairy, pepperoni is a meat or protein, chopped onions and peppers are veggies and carbohydrates and pineapple another fruit. Then all necessary enzymes would kick in. The fruits and simple veggies would be the first to complete the digestive process, followed by the bread, then dairy then protein."
Notes were quickly scribbled.
"Another word I would like you to be familiar with is, peristalsis. I do realize the example I am going to use will probably gross out the girls and maybe some of the guys. The entire digestive system is designed to work on what is referred to peristaltic action. What you put in your mouth is squeezed down to your stomach then to your bowels and finally out your rectum. I know you have all seen the example I am about to use either in real life or on TV. There is a large snake, that captures a mouse. Once it is in the mouth, you can see muscles contract forcing the mouse further in. This is an example of peristaltic action, the muscles squeezing and pushing it down. When you have a bowel movement, you have the urge to push and the stool / feces or poop comes out, then another urge and another push. This is one of those important words to know, hint."
All of the girls were engrossed in what I refer to as the 'yukky response, even some of the guys.
"As the broken-down food passes through the bowels by means of what action?" I paused as the entire class responded with 'peristalsis or peristaltic action.'
"The proteins and carbohydrates are absorbed by cilia or little hair like fingers of the bowel and then into the blood stream. They are actually very similar to the hairs in your nose, which by the way is a filter for impurities. If you are ever in a smoke-filled room, first get down onto the floor and crawl or pull yourself out, if you have something to put over your mouth and nose, do so and if not then strictly nose breathing. For the couple of you that tend to be mouth breathers, I would also suggest you reteach yourself, over time there is the chance that you might develop carbon dioxide poisoning because you are breathing out then back in through the same path, so never fully clearing your lungs. Sorry for the distraction but these are things you need to know; not necessarily for testing but for your safety."
They learned that the noisy rumbles were caused by the food choices as well as the extra air we swallowed as we ate and sometimes by the amount of carbonated drinks consumed. All eyes turned towards Stan, just briefly, but they looked.
"It will be interesting to see your food logs, but it will, I promise be helpful for you."
The day passed quickly as did the time with Tom. I reminded him of his test for the next evening.
I decided to go down the street, almost to the next subway stop, to one of my favorite East Indian restaurants for supper.
| Author Notes | Thanks to Tom B for the reminder. |
By aryr
"I do realize that it may appear to some that we are jumping around but because both the digestive system and the urinary system deal with elimination. The designers of the book, put them back to back. Which I myself think is a great idea. Now, I know that everyone has read chapter 7, correct?"
I waited as all hands went up.
"When we drink something, it still goes through our digestive system, except that it is quickly absorbed into the blood stream and through the kidneys, most people have two of them and they do look like a kidney bean but much larger. The kidneys filter the impurities and send down the ureters to the bladder, which fills up and then creates the urge to urinate, void, micturate or pee. Your bladder is like a balloon, it fills up and stretches and then you urinate. Oh, the proper term for not having control and being able to hold it in for whatever reason is incontinence. However, it is important for you as the tech, to distinguish whether it is incontinence of bowel, bladder or both. This is related to a disease process or the aging process and of course for babies. Thank goodness for the invention of adult diapers and the disposables for everyone."
Andrea raised her hand, "So, when someone pees themselves when they cough hard or sneeze, is that considered incontinence?"
"That's considered to be 'stress incontinence'. We will get back to that later, okay?"
She nodded, so that I could continue.
"When your bladder sends out the signals that it needs to be emptied, you are still safe and have the time to find a restroom, it's like you are getting a warning, a heads up. Now if you wait too long then indeed you have to rush and you may have an accident. The path from your bladder outside your body is the urethra and varies in length between male and female. With the guys the urethra is inside the length of the penis and similar to that of the esophagus there is a little valve or sphincter that opens and closes depending on whether you are passing urine or semen. The girls are luckier in a sense and have distinct separations from their urethra and vagina. Let's take some time to look at the diagrams of the urinary tract."
Books were opened, pages flipped. Silence filled the room as the pictures were studied.
I heard muttering to one side of the room and directed the student to please share their comments; it might be something educational for the others. Phil snickered into his hand as he looked at Randy. I could hear his 'not likely' comment.
Randy swallowed a couple of times and turned beet red. "I said to Phil, that the pictures looked so much more gross than the real thing."
The class erupted into peals of laughter and chuckles. His embarrassment caused him to go deeper red and hang his head. It took several minutes for the class to quiet.
"Thank you, Randy. Someone had to break the ice, the reproductive system for some reason is surrounded by embarrassing thoughts. It is all part and parcel of our bodies. One thing that I would like to stress is that neither gender should ever assume that they know the actions and feelings of their opposites. Yes, you will all have the knowledge to understand the physiology or how body parts work; but you are without the feelings or the emotions."
"Is that like having a baby?"
"Great example. Exactly like having a baby. For the girls, you have not gone through the hormonal and physical changes, nor have you delivered a baby. For the guys, you get to see the mood changes and their body changing but you don't feel any of those things. The best you get is the feeling of pride if the pregnancy was planned or if unplanned the dismay and stress. Either way there is stress."
I paused for a moment to let what I had said sink in.
"One of the worst habits you can ever allow yourself to fall into is what I call 'the we syndrome'. I know you have all been exposed to this already, think about how you feel when you hear it. How are we today? Did we urinate in the specimen cup? We are going to draw some labs today. We are doing well with your labor, when we feel the need to push, just let us know. I am sure this sounds familiar, I am strongly suggesting you avoid this and there are those out there that will try to sway you; but don't. It is annoying."
Several students offered other suggestions that they had been exposed to.
Since students frequently got up for coffee and cold drinks as well as restroom breaks, there was no need for stress breaks and lunch time creeped up rather fast.
"It is that time, again, enjoy your lunch and then we will have time this afternoon to talk about the reproductive system."
Lunch was over, and I could sense the hint of nervousness that hovered over the class.
"I want to try to get everyone in a different mindset. The key thing is that all along you have been studying the body, its parts and how they work. Everything has been okay, until this point. Now it has taken on a personal, in your face, feeling and it is uncomfortable. So, everyone expresses their nervousness in their own way. Some are silent, some are afraid to look around, some giggle and snicker, some are so cool and nonchalant. All these responses are perfectly normal. What I want each of you to remember is that if you cannot be comfortable here in the class room you will never be comfortable talking to your patients in the real world. We are not going to share your personal life here nor will you share it when you are working. At the best, the girls may say 'I have never had a baby, but I do understand the pain, the frustration, the discomfort.' Or perhaps in years to come they may change that to, 'I do remember feeling the pain and discomfort, but when you hold that little one, you will forget all that and focus the baby. I will help you get through this'. So, take a deep breath, look around, because everyone here is in the same situation, be professionals and learn."
We spent the afternoon talking about the reproductive system, fertility, menstrual cycles and intercourse. They learned that it was important to ask their patients about this private aspect of their lives.
At the end of the class, Tom was settled and prepared to do his first test. He was well prepared and only needed thirty minutes to complete it. I offered to mark it as he waited and was not surprised when he accepted. His score was 100% and he was elated.
By aryr
When everyone was seated, I instructed them to take out their tests from the week before. Most eyes turned to Tom's direction to see how he had done. He smiled at everyone and gave them all a thumbs-up gesture.
"Okay, Tom has caught up, so we can discuss this test. The only mistakes were not really mistakes, they were simple spelling errors. Since the entire test was comprised of twenty-five questions and twenty-five labeling, I gave each correct answer two points, for the spelling errors I subtracted one point. I also printed the correct spelling. Does anyone have any questions or comments or even complaints?"
I scanned the room and saw a roomful of smiles but no hands.
"Okay then, test two, same rules, leave face down, everyone will start at the same time; when you are finished you may go out quietly after turning your papers in. Since you have until lunchtime to complete your test, those done early will just have a longer lunch break. Name and date on all page, please. Anyone needing a drink, a restroom break do, so now, as I pass these out. Pencils are on the desk."
I waited until everyone had resettled and then instructed them to start. The first thing I noticed was that everyone read through the entire test before picking up a pencil. Then they added their name to the first page and started. Each page was named as they turned to the new one. It was impressive to watch their diligence and concentration.
Since I knew of course what the schedule was for next week, I once again worked on questions for the next test. I had made copies of the blank diagrams, that I wanted to use, from the back of the book. It was a shame that there were no questions for them to review.
I believe everyone realized that this was not a race to get done, so completion times took longer, but they were all finished and went off to lunch.
My lunch was once again spent marking papers. There are times when something rather simple is really enjoyed. This was the case with my peanut butter and jam sandwich, an apple and hot tea. I picked up the second to last paper when I received my shock. There was a name and date on each page, but absolutely nothing else. No answers to the questions and not labeling to the diagrams. There was however, doodles on the back of each page. I skipped to the last test and marked it. I would definitely need more time to examine the doodles. They meant something, but what.
The students returned and for the afternoon, we reviewed what had been covered during the week. I kept a close eye on the student who had turned in a blank test. I saw no indication of stress or concern. Class participation was unchanged. Those doodles bothered me, they meant something. Should I ask the student to stay and request an explanation? Should I just leave it be, after all the test marks did not count against their grades? They were certainly not obligated to do them. I pondered my many options all afternoon.
As we got close to the end of class, I reminded Tom that he didn't have to stay behind today. I also requested that at some time over the weekend they read chapter eight, I did warn them that it was a long one. I promised to have the tests marked by Monday and that we could review them first thing. With that thought in mind, I put myself out on a limb and offered to be available if anyone wanted to talk about how they thought they were doing privately. I suggested after school conversations because they did give more privacy and explained that I usually left about one-half hour after everyone else but could and would stay if necessary. The offer was made.
By aryr
Unlike Roni, who I called Friday night to see how things were going, I did not give out my cell number to any of the students. My thoughts were that things would take care of themselves either during class or privately after class.
Roni was doing well, and Darlene had things under control. This was proving to be a great mother daughter time for them. Darlene felt it was a nice vacation from her own children who had their other grandmother taking care of them. Grandma and grandpa spoiled them, while their father tried to maintain discipline. I could have told him there was minimal chance of success.
Saturday morning, was chore morning- dusting, cleaning floors, laundry. In the afternoon, I decided that I would do some prepared meals as I listened to music and I did so want to study the doodles.
It was around 3pm when Roni called to advise me she had gotten a call regarding a request for me to return the call. When she mentioned the student's name, I decided to fill her in on what had happened and what I had offered. She had given out her number for student contact but primarily for when they were doing their clinical rotation. This student had called her. I took the number and promised to call her when I knew more.
I called the number not knowing if it was a house phone or a cell phone. I was hoping for the later and that it would be answered by the person I wanted and needed to talk to. I was in luck, she answered the phone.
"Hello! Mrs. Armstrong? Is there any way we could meet at the school? Or I could come over, if you don't mind me knowing where you live? I really need to explain why I did what I did with the test. I really need to talk to someone." Andrea sounded desperate; this was indeed a call for help.
"First, I guess I need to know where you live? I do understand from what you have asked that it would not be wise for me to go there, you need privacy, so I am trying to determine which would be closer for you, the school or my home."
She gave me her general location and I knew she was just a short bus ride from my home. I provided my address and which bus she would need to take. I then called security to let the people on duty know that I was expecting a guest. Their protocol was that visitors in cars would be given directions and those arriving on foot would be brought to the door in a golf cart, thankfully it was enclosed in plastic. During the day and early evening there were two staff members on duty.
It took her about twenty minutes, before she was knocking on my door. She looked nervous and I wasn't sure if it was the condo, me or her need to talk. I took her coat and gestured towards the living room, after asking about tea, coffee, hot chocolate or a cold drink. She smiled at the offer of hot chocolate and asked if she could follow me to the kitchen. I nodded so she followed.
"Have a seat anywhere. It will take a few minutes for the milk to heat, do you want marshmallows or mint or both?"
"I have never had hot chocolate with either, so you decide. I have just had the packaged kind."
"Then both it is, you are in for a treat. I always used marshmallows until a friend told me about putting mint leaves in a tea ball and dropping it into the milk as it heats. It's become one of my favorites."
There was silence after that until the hot drinks were ready, she looked comfortable, so I simply sat down in one of the other three chairs placed around the table. The extra two chairs had been placed in the bedrooms at the desks. She wrapped her hands around the hot mug, closed her eyes and inhaled the aroma of chocolate and mint. She took a tiny sip.
"Oh my God, that is just super delicious." Another sip, "Okay, I was really upset yesterday, and I guess I shouldn't have let it influence my thinking in class, but it did."
I patted her arm in reassurance and told her to continue whenever she was ready. I also thought it was important to let her know that whatever she said would be in confidence and that I would only share it with Mrs. Trenton. She nodded. After a couple of sips, she went on.
"I live with my parents and two younger brothers. About three weeks ago, my uncle moved in with us, it was only supposed to be a weekend for starts and then it changed to a week. Now no one knows how long. Anyway, he does work during the day, so he is gone. He is home for supper and on the weekends. The plan was that he would sleep on the sofa, since he got up early in the morning and would go to bed when my parents did. And he does pay rent, which goes into savings for them, they will probably use it for a really good Christmas next year."
She paused as she took another sip.
"About a week ago he started making comments and suggestions when he was around me. He would find a reason to touch my arm or my back. It really felt creepy with him being so close. Now I am nearly 22, so I am not a prudish girl; I am a good Catholic and plan to save myself for marriage, but he just feels wrong. Two nights ago, he suggested that everyone should kiss everyone goodnight. My brothers who are nine and fourteen giggled and laughed and thought the whole idea was hilarious. The oldest one even thought it was yukky. My parents thought it was cute and sweet. I was outnumbered so I went along with it. Except when he kissed me goodnight it was on the lips with his tongue invading my mouth. That's what threw me off with the test. I couldn't get over what had happened, and I was afraid of what the future would hold." Tears were flowing down her cheeks, she nodded when I got the tissue box.
After another sip she added, "Last night I complained about a scratchy, sore throat and that I didn't think it was a good idea, in case I got everyone sick and they all agreed. What am I going to do? I can't lie anymore. I can't talk to my mother and father, especially my father. I could probably move out, but my folks depend on what I get for going to school. I keep about $100.00 a month for whatever I may need and give them the rest. I have managed to save a bit because I don't use the whole hundred. I just can't take that away from them. It's not fair that he is wrecking my life."
She was weeping now, her shoulders shaking with her sobs. I gave her all the time she needed to get this out of her system as well as time for me to gather my thoughts.
"First, it's time for a fresh hot chocolate, some of the adult type. You are over 21 and a wee touch of brandy won't hurt you and I don't think either of us will be driving." She gasped at the comment but smiled.
As I made a new batch of hot chocolate she washed and dried the mugs without asking. She needed something to do.
"If you look in the third cupboard you will find plates, grab one and then get some cookies, the striped jar has peanut butter and the flowered jar has chocolate chip. Oh, any allergies?"
"No, ma'am! Should I get both kinds? Which kind do you like?"
"Both will do nicely; the milk is almost done. The brandy is in the last cupboard on the bottom."
She retrieved the brandy but took a few minutes to survey my booze cupboard. I had a small bottle of most things like gin, bourbon, whiskey and schnapps, a larger bottle of scotch (with one as a spare), brandy, vodka and several bottles of white and red wine. The cupboard had been specially made with booth shelves being slide outs and each had built in dividers, so nothing fell over.
I laughed as I commented, "The little ones are for when I have company, who prefer one of those; the larger ones are my favorites that I treat myself too on really cold days or the weekends and special times, like now."
With the two mugs and the plate of cookies we sat at the table again.
"Okay, what about just talking to your mother; is that an option? You could explain the situation, your concerns and ask her for help and guidance."
"I guess I could try. She won't ask him to leave because he is her brother-in-law, but she may have some ideas that could help. I really hate to ask but could you be there with me? You know like support or something like that."
"Sure, but I have a better idea. How about we call her and see if she would come over here, that way you two can talk in private and there would be no distractions."
"That is a great idea. Before we call her, can I do my test, I really do know the stuff and then I won't feel so silly on Monday. I told her I was going out to see a friend and wouldn't be home for supper. She goes out to see her friends from work all the time, so she understands."
"I don't see why not, I will just give you the copy that you doodled on. Those were interesting doodles and I was just figuring out that they were 'a call for help'. When Mrs. Trenton called, I was considering calling you to see if I could help. Sit here while I get the test. Since you won't be home for supper, I'll cook while you do your test."
She thanked me as she reached for another cookie, "These are delicious, what brand are they? I'd like to treat my brothers to some."
"They are homemade and here is the deal, after we get things sorted out you can come over and we will make two batches, one for me and one for you to take home. Deal?"
She nodded and I went for the test, thinking that problem number three was not really a problem at all.
With her test completed and supper shared, it was time to call her mother. I planned on correcting her test while she called.
| Author Notes | Sorry that this one was longer. |
By aryr
"Mom, don't let on that you are talking to me, please, this is important. I am at Mrs. Armstrong's house. We would both like it if you could come over, so we can talk without all the guys being around. It is only a short bus ride and she makes great hot chocolate and cookies." There was a pause while she took a deep breath. "I did have supper and I am sorry that I lied to you, but I needed to talk to her and apologize for something I did."
There was silence as Andrea listened to her mother. The look of dread changed to a smile, and finally she handed the phone to me, so I could provide the address and bus number.
She promised to be there in about thirty minutes, explaining that she would just tell her husband she was going out to see a friend. After all it was sports night on the TV, so she usually caught up on chores.
I could see Andrea relax with relief for a few minutes, then she tensed again.
"What do I tell her? How do I tell her? Oh my God, I can't tell her."
"Yes, you can, and you will. Start out with the test and the apology that you felt you owed me. I will let her see the test and give her a chance to look at the doodles. Let's give her some time to see if she can interpret them. Then you will go on to explain what has been happening with your uncle. Now, I think we both know that she is not going to go back home, scream at your dad and kick your uncle out. Unfortunately, life doesn't always work like that. But I have a suggestion, that I will share after your mother knows everything. Okay? Just relax."
It was easier said than done; but her expression changed to relief when her mother arrived. I had once again called security to advise them of Sarah's arrival. They rushed into each other's arms and hugged for a while. Mother rocking her baby and muttering soothing words.
"I am Sarah and I am so grateful that you opened your home to Andrea and now to me. I know from the nature of her call that something has happened, and it is serious. Again, thank you Mrs. Armstrong." She grasped my hand, rather than a shake.
"First, it is Jacqueline or as my friends prefer Jax; that's friends not students, Andrea. I am just glad that she felt she could trust me enough to call. Let's go into the kitchen, it's more homey than the living room. And I do have hot chocolate brewing."
As planned, Andrea explained about the test from yesterday and that she had apologized. I handed her mother the test which Andrea had scored 100%. I took the time to explain that the tests were meant as review material only. Her mother looked over the test and the doodles. She frowned at several of them. Then she spoke to her daughter.
"Honey, this isn't you. I have seen your art work and you doodle all the time, but they are pleasant things. Not dark like this. Something is bothering you. Tell me, I promised not to get angry, tell me, please."
Andrea shared her story of her uncle's behavior, adding a few more details, and of her concerns. Sarah gasped in shock to what was being said.
"Oh, Andrea, we will figure something out. You know that I just can not ask him to leave. He is your fathers' older brother. He was his support system when he was ill. He feels like he owes him. I am so sorry that he is behaving like that and that you didn't feel you could talk to me. We will think of something to fix it."
"Mom, it wasn't that I didn't feel like I could talk to you, there just wasn't any private time. I am sorry if I made you feel bad."
"Well, he is just a damn, old pervert as far as I am concerned. I wish I could just slap him upside the head."
We all laughed, as we sipped the hot chocolate, which was not laced with brandy. It was nice to have laughter in the house again.
"I have a possible solution. Since, we all know that he will not be in your apartment forever or at least we hope so; Andrea needs a place to stay. She needs to be able to feel safe so her studies will not be affected. It is not realistic to try to explain things to her dad, so unfortunately it will be necessary to lie a little. Now you do know that God will forgive a little white lie of protection."
They both looked bewildered as they wondered what I was talking about.
"First step is to tell everyone that she has been offered a great opportunity, Andrea you will have to do this and yes I know it means seeing him again. For tonight, Sarah you will just tell her dad that she is staying with friends- a girl's night out. Tomorrow after church, I will drive Andrea to her home, so she can tell her story. I won't bother going up, in fact I will park up the street."
They both hunched forward, listening intently.
"The story will be that there was a posting on the school bulletin board seeking someone to be a live-in babysitter for two school aged children. Room and board in exchange for evening and weekend care. She would have every second Saturday afternoon off, so she could visit family. She would have to move in on the Sunday. After she thought about it for Friday and Saturday she realized it would make life easier at home. Her parents had their bedroom, the boys had theirs and Andrea's room could then be used by her uncle. If he doesn't feel guilty about her sacrifice, then he truly is a mean old man."
"But there isn't any such posting, and I don't have anywhere to go!" Andrea exclaimed.
"The three of us know that, and only the three of us. Oh, by the way, there is a board, way down past the deans' office for jobs etc. With security being as great as it is, no one from your family except you, Sarah, can get in. I will make sure you are both on my list of approvals. So, Andrea can stay here. I have the second bedroom, lots of food and I will enjoy the company. Of course, you will not be able to tell anyone at school; you don't need to struggle through being 'a teacher's pet'. What do you think? A great plan isn't it?"
Both had dropped jaws.
"It is so crazy that it will work."
After a few minutes of stunned expressions, we worked through the details. Andrea's contribution would still be maintained by her family. She could still save whatever she could from her monthly stipend. It was great that her course check also included an unlimited transit pass.
She would pop into the apartment while everyone was at church and pack up her bedroom. All of her things would be stored in my car. And after her story, while they ate lunch, she would be ready to go. She could even explain that she took the job, had been interviewed on Saturday and accepted the offer of the husband to pick up her things, which he had done.
"Mom, can we pack up my sheets and store them in the closet? And can we get a mattress cover for the bed? When I come home, I want my bed back, not his old stink."
"How about, when he leaves he can keep the bed and dresser and drapes. I think you deserve a new set after this and I will make sure your sheets are safe."
By aryr
We all hugged as Sarah was getting ready to leave. We had agreed that on Wednesdays she would visit after her family had been fed. And that she would call Andrea nightly to see how things were going. She went home after one more hug and a kiss to her daughter's forehead.
I found Andrea a nightgown and robe, showed her around the condo and suggested that since it had been an exhausting day, we both get some sleep. Wiggles was excited about having a guest and for the first time, I actually got to sleep alone.
Morning came, and I made French toast for breakfast. I had tossed her things in the washing machine and dryer the night before, so she had clean clothing for the day. We spent a couple of hours talking about anything and everything until it was time to go. I did explain that while I was waiting for her, I planned to call Mrs. Trenton to provide an update.
It didn't take her long to pack up her stuff. Her whole life fit into two large suitcases, three tote bags and about six shopping bags. She stripped her sheets and put them in the washer, before remaking the bed with a set of extra sheets, hardly ever used. She grabbed her uncles' pillow and blanket and put them on the bed. She was even nice enough to put his suitcases and duffel bags in the room. When she was done she came down to sit in the car, until she saw that it was almost time for her parents to come home.
I grabbed a coffee to sip on while she had lunch. I had brought a bagel with me, so I was set to make my call. Roni was stunned, when I shared the events. She did however think it was a great idea and that she would have probably done the same.
Lunch went well and then Andrea shared her story. Sarah managed to look surprised and shocked and shed some tears as well as proclaiming some objections. The men and boys were dumbfounded. The boys thought it would be a great idea, until they realized that she had set up her room for her uncle. He had nothing to say.
Everyone was hugged, and all eyes were either tearful or at least misty. Andrea forced herself to accept a hug from her uncle, but her mother watched closely and stood at her side. At the beginning of the extended hug his arms were around her ribcage, but then one hand drifted south to grope her buttocks. Her mother saw this and intervened.
"I guess it is time to let Andrea get on her way, to her new home. I am sure that we all want to wish her well and good luck. Now, I do know that she has a long chapter to read before class tomorrow, so we best be letting her go."
She provided the last hug and whispered, "I saw him, I just might have to make some hot chocolate for everyone and mix exlax in his."
Out loud she sniffled and said, "You keep in touch. We will all miss you, but it is a good learning experience for you. You will be fine. Now, off you go."
At the last minute, Andrea remembered her sheets in the washer. "Mama, I forgot, I washed my sheets and they need to be dried."
"I will take care of them, now go."
Andrea was crying when she got to the car. She grabbed a handful of tissues and cried all the way home.
After we had emptied the car, I suggested that even before she put her things away, that she have a hot shower and change into something comfortable. I had stew in the slow cooker and rolls ready for the oven. But we had lots of time before supper.
After her shower and transformation, we settled into the chairs in the living room with soft music in the background. Andrea was engrossed in her text book while I enjoyed my novel. Silence prevailed for several minutes. Then she spoke.
"I don't know how to say thank you enough, or how I can ever repay you for what you are doing. I feel safe and I know that my mom knows I am safe. Thank you."
I reassured her that it was not a problem and that I hoped anyone given the same conditions would step forward. We both smiled.
We returned to our reading until it was almost time to eat. I put the rolls in the oven while she set the table. After I put the stew and rolls on the table, I grabbed two wine glasses and a smaller bottle of Merlot. It was partially gone.
"I tend to make my beef stews with wine in it, so I figured we could enjoy wine with dinner."
Andrea chuckled as we ate and asked, "So how do I do my meal log? I am not at home anymore."
I patted her hand and said, "Fake it. Write down what you would normally have. If I am correct, you were all structured in your eating and probably your chores. Certain meals on certain days, the laundry done in a specific manner. I would even hazard a guess that you did yours on Fridays and your brothers on Saturday. That was also the day you changed the bedding and did your towels."
"How did you know? That is amazing."
"It is easy, I used to live a regimented life style and had a family to take care of. I even had days set aside for certain meals. Now, since I don't really cook for anyone, I just make what I think I want. It will be nice having someone here to cook for."
Supper was finished, and we did the dishes together. I planned to watch TV, there was a new movie coming on and since she only had about four pages left in the chapter she joined me. I made tea and she chose a soda.
It was enjoyable that we chattered through the movie, about this scene or who was going to do what. Bedtime came all too soon. I told her to wake me with any concerns. Wiggles was back in her normal place.
By aryr
We were up and ready for the next adventure at school. Andrea decided to finish the chapter, on the transit. I knew the station changes by heart, so I could tell her when it was time to change. For the last train, we decided it was best to sit apart. Other students joined the train at that station. On our way out, I had advised security that Andrea would be staying with me for a while and that Sarah would be visiting. Andrea had the security code for the doors.
Everyone settled in and I passed out the tests. I was so pleased that everyone had made 100%, people had taken their time and concentrated on spelling.
Michelle's hand shot up, "Hey, I really like the purple this time, it's my favorite color, thanks."
There was very little to review so I suggested we get onto the next chapter. Today and for most of the week, they would be learning about bones and muscles.
"Who would like to tell me how many bones we have in our body?" I laughed at the antics of William and Ralph. William was holding up his right hand with two fingers, and his left hand- indicating a zero. Ralph had a five on one hand and one on the other.
"Okay, Ralph and William have it right. 206. How about we go over the bones from head to toe? And I don't need anyone doing a musical version. We will start at the left back corner."
I will have to admit that these guys and gals knew their bones. We made several trips up and down the rows to complete the tasks. Now of course, each area was covered in depth, for example the structure of a hand. I think that since some had made spelling mistakes on the first test, everyone was now making an effort to know the proper name and how to spell it. It was encouraging.
After lunch I picked random students to indicate where a certain bone was located and then explain its function. We discussed long bones, short bones, vertebrae and the fact that bones provided not only our support system but protection. I had them turn to chapter 32 to read, I gave them an hour to read it. Most would be done long before and I did realize that I was changing protocol slightly. But asked that they bear with me.
It was important that we covered the concerns, the diseases, the mishaps at this time. I had collected an enormous amount of chicken bones. They were meat free, cleaned and dried. I planned to have them break to investigate. By covering this chapter, they would also be able to determine the type of breaks.
After they were done reading. I once again went into random mode asking people to describe bones. What were the ends of the bones called? Were metacarpals big bones or little bone.?
At the end of class I suggested everyone reread Chapter 32. The chicken bones would be their surprise for tomorrow.
Andrea and I did a reversal of our transit trip. She chattered on the way home, wondering what her brothers were up to. She revealed that her mother worked five mornings a week from 9am to 1pm. She was a receptionist for a doctors' office and she split a shift with another worker who could not do full days. She enjoyed her job and two days a week she stayed until 3pm and did the filing. It gave the family extra income and they could visit the doctor anytime and not be billed. During school vacations the boys were now old enough to care for themselves, but when they were younger, they were allowed to attend to clinic day care at no cost. It was an ideal setup. Her mother hadn't gone to work until Andrea was in school.
When we got home I suggested that she should get caught up on her laundry, get her room organized to her liking, and perhaps do her reading while I started supper. Tonight, would be lasagna and salad.
The evening and the night were uneventful. All the tasks had been completed.
The dawn brought another day. I noticed that for the second day, she just had juice in the morning and didn't make a lunch, so I asked why.
"Well, I feel a little guilty about staying here and not really paying my way. So, I have the juice because you already poured it and I grab a bag of chips for lunch."
I was so surprised.
"Okay, first, I invited you to stay for your safety. Second, part of that safety includes your health, eating is part of being healthy. And third, it is nice to have company. Since you are concerned, how about I give you some chores in lieu of paying?"
"That sounds workable, what do you want me to do?"
"After breakfast we can talk about it on the ride to school. Scrambled eggs and toast, while I am scrambling you can make a couple of sandwiches for lunch. And don't you dare ask me what kind, surprise me."
On the ride, I suggested that she keep her room clean, do her own laundry, make the lunches for school, vacuum and dust the condo once a week except for my room. I also offered to teach her to cook both simple and fancy but, cost effective meals. She readily agreed.
At school we both enjoyed a cup of coffee, it didn't make sense to make it at home, except on weekends.
Class started with me asking what some of the diseases were, in regards, to the skeletal system or bones. Several answers were offered.
I got out my pail, my rather large pail of bones. I had a smaller one too, which had been specially prepared, but every bone was clean and dry.
"As I walk around, I want each student to take three or four bones. Until I am done, I just want you to look at them, feel them and think of words to describe them."
For the next half hour, I watched them examine the bones. Then they shared comments to describe them. Words like strong, white, yellow, rubbery were used.
"Bones tend to be strong to provide our frame. Think about how much you weigh and that your bones in your legs and feet support that weight. They are yellow or white depending on how old they are, how they have been cleaned and even how they have been abused over time. Being rubbery is partially about their formation or how old they were when I got them and possibly because instead of solid bone they are cartilage. Your ears and the tips of your noses are cartilage. Good observations. Now try to determine the source of the bones. They are all chicken bones, but are they part of a wing or a thigh?"
It was indeed interesting to watch them study each bone. Some had a nice mixture, whereas others had either wing or thigh bones. They quickly thought of sharing and small groups formed. Another excellent aspect of critical thinking.
I allowed each group to pick a team leader to explain what type of bone and why they as a group made that decision. The answers were well formulated. The only group, who got anything wrong, was the one who unfortunately had the bone from a rather large chicken and they identified it as a thigh when it was really a wing bone.
I excused them for lunch. Our ham and cheese sandwiches were a delight and a surprise. I never thought to add just a hint of jam.
When they came back, feeling revived and refreshed, they were each instructed to break one of their bones by snapping it in half, smash one with their book and twist one until it broke. Some were just to weak to be successful but other students came forward to assist.
When this task was done, we investigate bone marrow and reviewed its purpose. Then we discussed each of the break or fracture types. The final adventure with bones was the smaller pail. Each person took one. They were very white and easily broken. There was no marrow to be found. I explained that these bones had been cleaned, dried with a cloth then baked to further dry and in doing so I had dried up the marrow.
Class for another day was done. Tomorrow's plan was to start with muscles and then the next day would be joints.
By aryr
Andrea spent about two hours each evening in her room, reviewing her notes and the text book chapter. She decided to skip this week's phone call to her mother. We had talked about her chores and I let her decide when to do them. I did suggest that Saturday morning we could make cookies, so she would have something to take home to her brothers.
I was pleasantly surprised on Wednesday, when the students knew all about muscles. They practiced on each other to name the muscles used when they flexed or relaxed. Now the next day, joints presented a bit of a problem. It was difficult for some of them to try to visualize a joint and how it worked.
I guess I could say I was blessed but at the time I felt stressed; when a dear friend, whom I had worked with for many, many years died and willed me his collection. The said collection included plastic desk top sized working replicas of various parts of the anatomy. And they all had parts that could be disassembled. I had lined them all up on the top shelf of my walk-in closet. It was time to take them to school to help the students learn. He had actually used them, when he was doing patient consulting and teaching. It allowed the patient to better understand what was going on. The other thing I admired about how he worked was that he never talked down to a patient and always spoke in every day language that he knew they understood. Questions were encouraged.
I asked Andrea if she would like a ride to school on Thursday or did she prefer to take the transit. She eagerly accepted. I did tell her that I wanted to do some shopping on the way home, since I had the car out and she was delighted and receptive to the plan.
As a class, we talked about the various joints in the body, the parts that generally made up a joint and then I sat the shoulder and arm replica on the desk. They were all engrossed as I explained each part of the joint, muscle and bone which made up the arm. They learned about tendons and ligaments, synovial fluids and movements.
Lunch time approached before they were even aware, of course Stan's stomach was making announcements and we laughed.
After lunch we discussed some of the disease process related to mostly bones and joints but included a few regarding muscles. Arthritis and its variations was vastly covered, and we touched on bone cancer. Three of the students had relatives who were suffering from this and about three-quarters of the class had family or friends with arthritis.
It was the end of the day. I placed 'George' in one of the empty cupboards and locked the door. I called him that out of respect for the friend who had left him to me and because I thought it sounded cute.
Andrea and I were off to the shopping plaza, she wanted to get a few things in the plaza, so off she went. We had agreed to meet back at the car and if I wasn't there, for her to look for me in the grocery store. I had casually fielded out her likes and dislikes over the week and planned on having some choices on hand. She really wasn't a picky eater.
I really didn't have a long list, so of course, I was done and back at the car before she was. Although I normally avoided Starbucks because of their prices, I indulged in a Chia tea, which I sipped while I waited. I saw her burst out of the doors with a frantic look on her face. She ran to the car.
"I am so sorry," she gasped, "I saw a couple of friends and we got talking and I forgot all about you waiting. I promise I won't do that again. I am sorry."
"It's alright, Andrea. And I want you to remember that you are not obligated to spend every waking minute with me at home. Now, I do think going out during the week might present a problem because you are supposed to be babysitting, but you could come up with a white lie, once in a while as to why you are out and not at your new home. I want you to be happy and not stressed. And I would never, ever leave you stranded, okay?"
She smiled, and I could see her relax and we were potentially on our way home.
"Since we are out already, how do you feel about supper out? My treat!"
"Sure, that sounds good, it's been a while since we all went out to a restaurant. But what about the groceries that need the refrigerator or freezer?"
"Got it covered. Many years ago, I found insulated bags to keep groceries cold for up to five hours and if we take that long, we will need a wheelbarrow. Any preferences? Anything that you would like?"
She replied with things like Pizza Hut, Burger King, Wendy's; all the typical fast food places.
"How about we try Cracker Barrel? It has a wide variety of food choices, even breakfast all day long if you wish. I like your ideas, but I think of them more as a quick lunch. This way we can sit enjoy a meal and not have to worry about dishes. You will still have time to study."
"Okay, then, that's the plan. Cracker Barrel here we come. Hey, is there one on the way home? You know, I have never been to a Cracker Barrel, I have seen them from the buses, but never been in one. I am guessing if you suggested it then it is a pretty decent place. I do like all those rocking chairs out front, they look comfy and relaxing."
"Yep, there is one about ten minutes from here. Those chairs are so comfy, I have three on the balcony, but they are covered now because of the cold weather. It is nice when it is warmer to have the music on, the sliding door partly open and just sitting out there with some tea and listen to the sounds of nature with the music in the background. I can spend hours out there."
We chatted about nothing specific as I drove, and then we were there. She was delighted and surprised when we walked into the gift shop area. For the first timers this was indeed a surprise, having to go through the gift shop to get to the restaurant. We browsed the area for about twenty minutes before going over to register for supper. The decor was also amusing and created several questions about what items were used for. Although many were way before my time, I did know what they were for and of course I was familiar from items from my childhood. We probably took longer than most customers to decide on our meal choice, because she wanted to review the entire menu. We enjoyed our salad and our meal but skipped desserts. She wanted to buy a couple of candy sticks on the way out-more treats for her brothers. So I just added them to the bill.
When we got home I declined her offer to help put groceries away and suggested she read or study for the test tomorrow.
By aryr
With everyone seated, I handed out the tests and repeated the same instructions. Because this one covered a larger amount of information it was obviously much longer. There were three pages on diagrams to label and forty-five questions and a surprising short essay question. I addressed this essay question as I walked the aisles, informing them that they had a general question with three options and that their essay should reflect on one of those three options.
Moans and groans flowed through the class. I further explained that this was in preparation to the midterm which did have an essay question on it. They were given the freedom to get coffee or drinks as desired, but to use caution because restroom breaks were not allowed. When completed they were free until after lunch. And they started at 0900.
As per usual, I worked on the test for next week, knowing that the week after would be their midterm exam. I felt confident at this point that they would do well. It was 1115 before the first student was done. He was shaking his head as he left. At 1200, I advised the five remaining students that time was up. No one, I noted had left feeling confident.
I decided that my plan of action would be to mark all the diagrams first, then go back and do the questions, leaving the essay answers for the last of the three parts.
There were lots of spelling mistakes but only four errors. I managed to get half way through the questions before lunch time was over. They returned refreshed but looking rather dismal. I advised them that the afternoon was being devoted to reviewing and they all looked relieved.
I threw out questions about everything that had been covered from the start of class. I specifically randomly picked students. This group knew their stuff. Like a lot of people, they could talk about a topic, but to write it down, became a different challenge. At 1500 I released them and reminded them to reread the chapter that they had learned this week.
"What about reading for next week?"
"Let's just leave next week until next week, I want you to feel good about what you have learned this week."
"So, we really did bad on the test? That's what you are saying, isn't it?"
"Well first I changed the marking plan for this one, I have marked all of the diagrams, again there are spelling mistakes but only four errors, so no, you all did well. I only have half of the questions checked and they are great. Over the weekend I will finish the questions and do the essay parts. You all looked so unhappy, I just want you to all feel better about yourselves. Take the time to reread it and you will find that you know more than you thought you did. Off you go. No homework today."
When we got home, I suggested that after supper we make the cookies instead of in the morning, so they would be ready for the boys tomorrow.
"But I didn't get the things to make them. You shouldn't have to feed them as well as me. So, I wasn't going to bother this week." She argued.
"The boys deserve their treats, just let them know it is not a weekly thing, besides we will have our stock as well. That way you can catch up on anything you need to do tomorrow before your visit home and then just rest on Sunday after church."
She saw the wisdom of my suggestion and agreed.
Supper was a meatloaf that I had made earlier as one of my premade meals. I cut up and cooked fresh potatoes and green beans. I even had a small container of beef dripping to make gravy. While everything was either reheating or cooking, we got the cookie stuff out and organized. I let Andrea copy out the recipes for both batches.
After eating we cleaned up and put all the ingredients for the first batch together and slide two of the six trays into the oven, then cleaned the mixing bowls.
"Have you ever thought of having a dishwasher? It would make life so much easier for you, with all these dishes to do." Andrea asked.
"I did have a dishwasher but when this condo was constructed, I chose not to have one. I enjoy the time it takes me to do dishes because it gives me time to think about the day, or things I have to do, as well as things that are bothering me. It is relaxing and doesn't take much thought to do, therefore relieving my mind to think of something else. Besides I have been told it is good for your hands." I laughed.
When we were finished, we had completed six trays of each kind. I had a few clean and empty tin boxes, which I offered to the boys as cookie jars, Andrea was delighted.
Saturday morning was a sleep-in morning for us. Instead of getting up at 0600 we slept until 0800. Andrea took care of her chores, while I pulled out the tests to mark. I spread myself out at the table. I continued with my original plan to finish the questions and then the essays.
We stopped for lunch and then Andrea got ready to go. She had planned to stay with her family for supper and be back early in the evening. Within a few minutes she was gone. I made my pot of tea after she left and got back to marking.
In general, the questions were not all that bad. The errors, I think were more related to over thinking and reading into the question and answer choices which confused them. The essays were a different story. They started out dealing with one of the three aspects and then drifted to another aspect. Some students even addressed all three. All of these concerns could be easily corrected. Monday morning would be used for this.
By aryr
Andrea made it back by 1900 and reported that it was a great visit. Her uncle was gone all afternoon and only showed up for supper. Her brothers were surprised by the cookies and the tins and proclaimed them to be delicious. She stressed that they had to make them last because she would only bring them every two weeks. After supper she gave them their candy sticks stating that they had been purchased for her to give to them.
Her parents asked how she was doing with both the job and the course. Her uncle did not have too much today to say during the time he was home. He had excused himself and went to his room, immediately after eating. There was no mention of him leaving. Andrea figured her mother would let her know when that happened.
We watched a movie again, commenting all the way through it. Night came, and it was time for bed.
Early Sunday morning was church for Andrea and a time for me to make my prepared meals. I liked to make my casserole dishes and layered meals ahead of time, so I declined her invite to attend mass. I also wanted to call Roni and see how things were going with her recovery.
When I called, she was out, which really didn't surprise me. I called her cell and found her at the Waffle House indulging in pancakes and bacon. Her grandson was celiac, so everyone tried to be aware of where they were eating. IHOP, unfortunately added pancake batter to their scrambled eggs, so rather than taking a chance, the choice was now Waffle House. Wheat could be avoided as needed. I felt guilty bothering her breakfast, late as it was, so I let her go after hearing that she was doing well. I asked about a Wednesday evening visit. Sarah would be over to see Andrea and this would give them time to really visit.
I usually made enough for four people when I made my pre-made meals. I pre-cooked my bite size pieces of lamb and then assembled my shepherd's pie, which went into the oven to bake. Of course, I made lasagna again, since it was an easy meal with some garlic bread. I planned to make a hearty stew for supper and fresh rolls or rather instruct Andrea to make it. Then after supper we would get things ready for chili for tomorrow. I do so love slow cookers.
Church was over and after a quick lunch, I had her cutting the meat and vegetable into bite size pieces and placed them in the slow cooker. We stirred in the pureed tomatoes, spices and bread crumbs. I explained as she worked the difference between a home cooked stew and canned. More nutrients, better smells and a sense of achievement. I also showed her how to make rolls from scratch with a plan to make enough for tomorrow.
Years ago, this was made in the oven on a low temperature for eight hours. My ancestors used to make this in a covered pot in a sunken fire pit for the entire day.
After getting supper started, she disappeared to her room to reread the assigned chapter. She made notes on what she thought would be important. One can never learn too much. We had been together for a whole week. Our routine together seemed to have settled. We were open enough that we respected each other.
I enjoyed a good book while she studied, I could smell the rolls rising and the aromas of the stew. I sipped some scotch on the rocks as I read, while enjoying the crackle of the fireplace.
Late afternoon she came out of her room.
"I can't read another word that is anatomy related."
"Just sit and relax then, Listen to your music. What about texting one of your friends, to see what's happening in the world? Did you check on the rolls? I could smell them rising. They can go in the oven in about an hour."
She smiled, and her head dropped to her phone. Within minutes her head was bopping to the music and her fingers were traveling a mile a minute over the screen. She left the room to check the rolls and came back with a thumbs-up signal. I am so glad she had ear buds. I watched briefly and thought that if it were the olden days she would have been a whiz on the typewriter. Unfortunately, in today's time, even computer-based jobs were grabbed up quickly. She would have been a great secretary, she was detail oriented.
Before she knew it, it was time to put the rolls in, I got up and waved for her to follow. After brushing with butter, in they went. Supper would be ready in a few minutes. She like so many who did not understand slow cookers wanted to peek and even stir about every hour. That, I advised her defeated the whole concept of slow cooking. The trick was to put things in, cover and leave it until at least four hours later, in fact the longer the better. Our stew would have gone almost six hours.
When they were ready, she took the rolls out, so pleased with the golden crust and that she had made them. I set the table while she transferred them to a basket. Then she carried the slow cooker pot to the table and placed it on a trivet. A new word for her, which simply meant a barrier between the table and hot pot. She removed the cover and rich aromas filled the room.
She was so amazed that she had made something this delicious. While she had been preparing everything, we had talked about the approximate cost of the items and then compared the cost of canned goods. Another surprise for her was that she could actually make one for supper and then overnight make a second pot for the freezer, since this would freeze and reheat well, all for the same cost as the canned goods for one meal.
"Sometimes my mom just grabs a couple of pizzas in the frozen section and that becomes supper. I suppose even pizza could be made at home cheaper. I think when I go back home I am going to surprise my mom with a slow cooker and show her how she can save money and have great meals." She commented as she ate.
We had both decided to skip the cookies and have ice cream later, so I let her get the things ready for the chili that would cook tomorrow while we were at school. I took the opportunity to tell her about the benefits of soaking beans the night before rather than using canned kidney beans. Now, I happen to like both beans and meat in my chili so that was the way I taught her. She cooked the ground beef while I while I washed the dishes. When the beef was done she placed it, the tomato sauce and spices in the cooker and covered it with saran wrap for the fridge. In the morning, the beans would go in and then it would cook all day
By aryr
I watched as she finished putting the ingredients together for the chili. I made breakfast as she did that. Soon it was time to venture out the door.
Class settled as I distributed the marked test.
"I want you all to realize that you did very well, once again your spelling caught up with you, so I am going to think of something to help with that. I just need a day or two. I am also going to change things up. This morning, we are going to review the essay writing part, which unfortunately confused all of you. Then instead of a test on Friday, we will have it Monday after lunch. With the exception of the mid-term and the final, I will have you mark your own, so your mistakes will be fresh. And if you wish to have those two on a Friday, thus freeing yourself up for the weekend. Just let me know. Now let's talk about these tests and essay writing."
"So that means we will have to study over the weekend?"
"No, it most certainly does not! It means that, in the morning we can have a review, either before or after our new lesson and that you will be nourished from lunch, rather that skipping breakfast like most of you do. Now if you chose to reread or study on the weekend then it becomes your choice. I try very hard not to assign homework on the weekend. I figure if you work hard all week then you need your down time. Any other questions?"
Two hands went up and I picked Stan over Andrea, "Will you tell us what our next chapter will be, so those of us who want to read it can do so over the weekend?"
"Not a problem, how about we agree that I tell you every Thursday afternoon what chapter we will be covering the next week. That way you can still read it on Thursday night instead of the weekend. Andrea your question?"
"It was the same as Stan, thanks."
"Okay, now let's talk about essay answers. Would someone please read the question, just the question, not your options? Ralph, go ahead."
"Please, write a short essay, which describes how one of the following three, affects joint action?"
"Fine. How many of how many?"
Several hands went up, and I picked one. "One of three."
"Great. Now quietly read your essay answer, then we will discuss how many of the three, you actually answered. I will give you a hint, only five of you answered just one, so that means twenty-five of you got the question wrong."
A few minutes of silence, as they read. I watched as all sorts of scribbles took place.
"Hands up for those who answered all three parts."
More than half the class had hands raised.
"Now, hands up for those who wrote about two of the three parts."
Several hands were raised.
"The five who got the question correct with one aspect, please raise your hand. And would one of those five tell me why the others got it wrong?"
Of the five, I chose Andrew.
"Well, I am only guessing, but I think it was one of two things. They either read the question wrong or they just got carried away with their answer. I almost did that. When I decided to answer about the synovial fluid, my answer just seemed too short and I wanted to add about the muscles used or the ligaments and tendons. But I remembered it was just one of the three, not all three, so I stopped."
"A wonderful way of explaining it. The question was intended to see if you could read and follow directions rather than being a question, if that makes sense. All those actions had been addressed in your multiple-choice questions. But like Andrew said, your answers looked too short. You were writing for the sake of writing and probably to impress me and yourself. You were however, not following directions. Think about it."
I gave them the time needed, to reread the question, reread their essay answer and to check out their questions. When they all settled once again, I asked Andrew to read his essay answer.
"Synovial fluid is a lubricating fluid found in the joint which allows free movement."
Several heads had turned to watch him as he read, then slowly smiles presented and they realized their mistakes.
"So, what are you going to do for the next essay question?"
There were several, 'read it carefully', 'answer just what the question asks'.
"One of the reasons I always suggest that you read through the entire test before doing any answers is to put you in a test taking mind set as well as providing a review. By reading through it you have an idea of what is being asked. My other suggestion is to go with your gut. I know it is your brain that is retaining all this information, but your gut or your inner feelings will direct you. Whatever you pick as your first answer, stick with it, don't change it. Statistics have proven that when you change an answer, your first answer was usually correct, so now you have it wrong."
It was encouraging to see that notes were being written on the back of the test papers.
"Now, how about a quick break before we start on our study of the nervous system, it's even longer than the bones, muscles and joints. Oh, and a FYI, it is not on the midterm. So, don't add stress."
After fifteen minutes we were ready to rock and roll. Some had stretched and grabbed a coffee and started to read.
"Who would like to tell me what the nervous system does for us?"
"It tells us what we are feeling physically and emotionally." Michelle answered.
"Correct, for as far as you took it. What are the main parts of the nervous system?"
"The brain, the spinal cord, the nerves." Billy offered.
"What are your senses? How many senses do we have?"
"Hearing, smelling, seeing. That three so far." Stan provided.
"Tasting and touching for a total of five" Tom stated.
Andrea and Ralph raised their hands at the same time, I pointed to Andrea.
"Isn't there a sixth sense, something to do with intuition or what you called gut feelings?"
"That's what I was going to ask." Ralph commented.
"You are both correct, but the sixth sense is usually avoided when studying. It is there, never not respected. But other than today, it will not be a part of studies."
Everyone nodded.
By aryr
"When you see something, the signal travels from your eyes to your brain. It occurs in reverse and your brain sorts it out; the nerve used is your optic nerve. Smelling works very similarly except only the optic nerve does things in reverse. Smelling uses the olfactory nerve, the tiny hairs in your nose work as filters and receptors. Hearing works with the auditory nerve. Tasting is possible with the taste buds, that detect salty, sweet, sour and bitter. Of course, you need your sense of smell which enhances what you are eating. Think of when you have a cold and stuffy nose-all food tastes the same or bland. I bet you didn't know that nursing homes add sugar to their vegetables to make them tastier. Sweet is a favorite of the elderly. Touching or physical feeling is interesting because it involved nerves just under the skin and we can detect different temperatures, different sensations such as a slap which hurts or a pat that feels reassuring. Touch is also referred to as tactile."
It was interesting to watch people sniff, taste their coffee, pinch themselves, or touch each other.
"Phillip, could you please come to the front for a moment?"
When he arrived, I turned my back to the class and whispered the following directions.
"I want you to whisper this message on the card to Brenda, exactly as it is on the card. When we are finished, I will ask you to read it aloud, but wait just a moment while I give the class instructions." I turned, "Phillip is going to whisper something to Brenda, who will then whisper it to Jon and so forth up or down each row until we get to Andrew, who will stand and repeat it out loud to the class. Everyone ready?"
Phillip walked back to Brenda and whispered the message, who then stood and whispered it to Jon. Each student listened and then whispered. When it finally got to Andrew, he stood and repeated it to the class. The room filled with gasps and chuckles. Very little of the original message was left, the people in the first group realized this and shook their heads. I had Phillip stand and read the message from the card. There was a stunned silence.
"This was used in several ways. As you can see the message was distorted as it was passed from one to another. It was at one time, part of a psychological test. It is also a very popular game for children or in the olden days a great parlor game. No one is at fault, it is just how your mind interpreted it. After lunch, we will try some other sense test."
While they were off eating, I prepared my treats for them. There would be coffee overpowered with chocolate for them to smell and taste. It would be instant, so I just had to add hot water. Blot tests to see what they saw, as well as the charts used to check for color blindness. And regular sugar and salt in bowls rather than shakers.
It proved to be an interesting afternoon. The small testing methods were somewhat enjoyed and very educational. We learned that we had two people who had minor difficulties with colors.
One student had purchased a couple of cans of green beans, of carrots and of peas. His rationale was so that everyone could see what veggies tasted like with sugar added. Unfortunately, no one liked the combination.
Two students passed their glasses around to allow others to see what distorted vision was like. And one young man plugged his ears with his fingers, as he talked to and tried to listen to two others. He was shouting at them. All great learning experiences.
It made them all aware of their senses and it was a good start to the nervous system.
We talked about the fact that the system was responsible for transmitting signals, that there were voluntary and involuntary actions. Voluntary as in walking or even exercise, since you chose those activities, and involuntary as in what keep you alive such as breathing, your heart beating, your digestive system.
We also discussed that there are two significant parts to the system. The first is CNS or central nervous system which is comprised of the brain which is sheltered or surrounded by the skull and the spinal column surrounded by the vertebrae- the bones provide protection. The other is the PNS or peripheral nervous system which consists of miles and miles of nerves which look like bundles of wires.
I provided examples of withdrawal reflexes where one moved their hand from an open fire or hot heat source and of when one saw a movement in their peripheral vision they tended to move their head to look at the source.
Before we called it a day and I gave the students their assignment to read as much as they could on the chapter regarding the nervous system. It was brought to my attention, that they had talked and as a group had decided to do the mid-term and final on a Friday.
By aryr
On Tuesday, Wednesday and Thursday, we continued studying the nervous system. Learning about the actual action and path of transmission was met with eagerness and intrigue.
Sarah came to visit as planned on Wednesday evening and I went to Roni's. She was, of course, driving Darlene insane. It was difficult to remember that she had been given permission to yell at her mother, to make sure she did what she was supposed to and not to, run her ragged. I suggested within a few minutes of arriving for her to have a hot, sudsy, relaxing bath. I don't think I have ever seen anyone leave a room so fast.
Roni reported that she was transferring very well and did not use the hoyer lift at all. She was taking her pain medicine before she went to bed so she would get a good night's sleep. She was feeling a lot better, but she included that she would feel better when she got the cast off.
We talked about the situation regarding Andrea. She was glad that I had made myself available to help her. We both wished that her uncle would relocate so she could return home. Of course, Roni was not aware of the close relationship between the two brothers. She chuckled at the thought that I had gotten two very devoted Catholics to not only tell but live a white lie.
During our visit, we consumed several cups of tea. We heartily laughed as we made it to the toilet. We may be old, but we still had our skills. I guess once a nurse, always a nurse. We made it back to the living room just as Darlene finally came out of her bathroom looking relaxed.
She made it a nightly event to skype with her children and of course, grandma Roni always got involved. Tonight, I was included, and it was so enjoyable to watch the children's excitement at having a larger audience. I was having such a good time, it was time to leave before I realized it. It was a short drive home and I secretly hoped that Andrea had gone to bed. It was late, and I was tired. Unfortunately, Lady Luck was not smiling on me tonight. She was wide awake and seemed anxious about something.
"Good you are home. I didn't want to call you at Mrs. Trenton's because I knew it could wait, but it was so hard not to call. I could hardly wait until you got home. Okay, quick sit down. My mom told me that my uncle is leaving Friday after supper. She told him he could have the bedroom stuff and he was glad of her offer. Apparently, his rooming house was being closed, so he came to our place until he could find an apartment and get some furniture."
She had to pause to breath.
"He is still going to come over on Saturdays for supper and to learn some cooking from my mom. If I can find a small slow cooker, I will probably get him one. Oh, and one of the ladies in the building is going to a nursing home, so he can get her couch, a recliner, the TV, her kitchen table and chairs and her kitchen stuff. I think she had some trouble peeing the bed, so he doesn't want that. His apartment is about a mile away. Her son is going to toss anything he doesn't take."
"That sounds good. I am glad things are working out. You will be able to go home soon. I will miss you, and if you want to come over to make cookies, you can."
"That sounds great and I will, as long as you are sure. My dad is going to go with him tomorrow and they will move the stuff over from her apartment. And then on Friday he will help him move the bedroom stuff. My mom has ordered my new furniture to be delivered Saturday morning, so I can go home then. She can ask her friend to come over and pick up my stuff here."
"There is no need for that, I will run you home Saturday morning. How about we go shopping tomorrow after school to find those slow cookers. I know where you can get them at a decent price and they come with a basic cookbook. I am sorry, but I am tired, I am going to bed."
"OMG, it is late, I am off to bed as well. See you in the morning."
We retired. I suspect we were both asleep within minutes. Thursday would be a long day.
By aryr
Rarely did I use the parking tag for the school lot, but today it was a blessing. During the drive, I learned that Andrea's uncle had found a small one-bedroom apartment in a senior citizen complex. His age was a match to the criteria, even though he still worked full time. He would be on the ground floor facing the secured parking lot. Each ground floor apartment had a fenced patio with a small gate, while the other four floors had their private balcony. The patios and balconies each had a lockable glass door and a screen door. He would have a place to sit outside. I had, what I thought would be a great idea. I would get a couple of lawn chair for patio use.. Andrea said that her uncle would get the dishes, the pots and pans, a toaster oven, a toaster, an electric fry pan and some baking dishes.
We got to the school before the rest of the students, so we had time as planned for coffee and bagels. Andrea was happy talking about her plans to move back home. Then the look of puzzlement came over her face.
"I just realized something important. What am I going to tell my dad? What do I tell my brothers? I can't drag mom into this, that would not be fair. Oh, God, what am I going to do?" She burst into tears.
"It's simple just tell the men that it didn't work out, so you are home. Nothing more. I am sure your mom will back you up. She can say you called and explained, and if you called her when we get home she won't be lying. Just call her and tell her what you are going to say, and everything will be fine."
She brushed away the tears, "When I get back to school, I have to run to the bathroom and fix my eyes." As she smiled.
Today, we talked about different sensations we felt and tried very hard to match the nerve involved. Tomorrow, we would start putting the systems together. Determining how nerves influenced our movements, our digestion, our heart beat, in fact our very being. But for now, we had the challenge of the nerves.
We made it through the day, everyone was eager for tomorrow and Andrea and I were ready to shop.
When we got to the car, I asked if she would mind a quick stop at Wal-Mart and she was fine with the idea. We pulled into the parking lot and I explained that I was going to get her uncle two lawn chairs. Of course, she balked at the idea, so I told her all the card would say would be 'from a friend of Andrea'. We agreed to meet at the cash registers.
I headed to the lawn and garden area, which at this time of the year, was barely stocked but I did find something suitable. They also had a couple of cushions that were what I considered to be 'masculine colors'. I also picked up the items she would need to make stew and the rolls for Saturday and for cookies and hot chocolate, non-alcoholic, of course. She could teach her mom about using a slow cooker and then explain the idea to her uncle before she gave him his cooker.
She really was a charming, caring person. She just hit a rough patch and she didn't know how to handle it. She truly liked her uncle, just not his sense of attention.
I went to the cash register area to wait for her. It was several minutes before she showed up. She had gone to the small appliance area to check out what was available. She was delighted to find that they had the same brand I had, and in three different sizes. She got the larger one for her mother and the smallest one for her uncle. She had also dropped by the card department to get a thank you card for her mother and welcome to your new home card for her uncle. After paying for our purchases, we packed our items in the car.
As we climbed in I suggested supper out and that the homemade chicken pot pies would be okay for tomorrow night. She readily agreed and asked if we could go back to the Cracker Barrel. I smiled and nodded and turned the car in that direction.
On the way, she texted her mother that she would be calling her before bed, but that she was fine, she just needed to talk to her.
We arrived, and both chose something different from the first time. As with that time, I let her taste what I had. When we were done, I once again got two candy sticks for her brothers.
When we got home, I stored the meat in the fridge and decided to read for a while before bed. She went to her room to study and to call her Mom. I simply told her I would see her in the morning.
"Hi Mom, I thought I had better call before I started studying. Everything is fine. Mrs. Armstrong suggested I call and explain what I am going to tell Dad and the boys. This was all you have to say is that I called and explained, so you won't be lying." She chuckled before continuing.
"I am just going to say it didn't work out and leave it at that. But I do need you do something for me. I already have a thank you card for Mrs. Armstrong, but could you get a bottle of her favorite brandy, she puts it in her hot chocolate, remember how good that was? I thought you could get it on the way home tomorrow. She is going to bring me over Saturday morning with my things, so I will tell her she needs to come up to say hi to you. I can pay you for it after she leaves."
"Sweetheart, you don't have to pay me, it will be my treat for you to give to her. After all, she did help us both out, when she didn't have to. I like her."
"Thanks mom."
"Not a problem. Your bedroom stuff will be here real early, it will be the first delivery, so I am guessing about 730 am. I plan to clean your room Friday night, when your father is helping with the move. I picked up some curtains and a bedspread on my way home last night. So once your furniture gets here we can set up your room. Your dad is going over Saturday to help organize things, so it's just us girls. Now get some sleep. See you Saturday."
"Night, Mom."
She snuggled into bed, reading until sleep was ready to over-take her, as it had already claimed Mrs. Armstrong.
By aryr
Friday was a typical end of the week day. The few minutes of chatter revolved around the various plans, they each had for the weekend. It was chatter but well under control. Andrea told two of the other girls, that she was going to make cookies for her brothers. I smiled to myself. I knew she was hoping that her mother had the ingredients and I hadn't said a word about the things I had purchased for her stew and the cookies. When it was time to start class, I simply clapped my hands for their attention.
"If you recall, there are muscles, ligaments and tendons attached to the bones. We haven't talked about fat tissue yet but it's there. Also, there are miles and miles of blood vessels and nerves. And they all work together to either keep us alive or promote movement of some sort. The brain is the control center for everything to work. Our hearts keep pumping and we keep breathing. Our digestive systems either grumble because we are hungry or because we have eaten and in the digestive process. But these actions are due to the workings of our brain. It's actually a super computer when you think about it. Our senses help us prompt certain actions as well."
The entire class was mesmerized.
"I would like everyone to take a few minutes and think of something that involves movement of some sort. Oh, I would like you to write that down. Try to work out which sense is involved, and it can be more than one. Then think of the muscles, the bones, the nerves involved. I am going to get George out, so we can use him to demonstrate some of these actions. I'll give you thirty minutes to work on this, and before anyone asks, yes you can use your notes and the text book. By then I will have things set up and each of you can present your thoughts. I am aware that you will probably pick something that a couple of others are doing, so try to be creative."
I got out all the pieces of George. Poor George was, actually a collection, which included the skeletal system with the detachable muscles, the circulatory system for the heart and its associated arteries and veins, the respiratory system with lungs which would interlock with the heart, and the digestive system. I also had a three-foot body that had all the parts of all the systems including the red arteries and blue veins and the black nerves. Not every single nerve, artery or vein but enough to present the idea.
When it was time, I had each student present their answer and I demonstrated on the structure as much as I could. There were the typical arm movements related to a variety of senses, such as hearing and seeing a wasp and swatting at it. The leg movements included seeing and hearing a rattlesnake and then running. I thought the running part was a wise choice of actions. I was impressed with the action of blowing up a balloon. The correct senses, muscles were identified.
We had completed about half the class before lunch break and finished the balance in the afternoon.
They clapped and complimented each other on their achievements and raised hands appropriately to provide missed information. They were helping and learning together.
When class was done, Andrea and I headed home. The transit was quieter, and I wondered if it was the fact that we were an hour early. It was an enjoyable trip.
I suggested during the trip home, that I would put in the chicken pot pies, while she packed some of her things and we could both take them to the car. She agreed and even suggested leaving her back pack in the car.
While I took care of the pies, she put in a load of laundry and then packed up her small totes. The two larger ones would carry her clothing. We carried what we could to the car. By the time supper was ready, she had switched the load to the dryer. After the dishes were done, she folded her laundry and after taking out what she was going to wear home, we took those totes out.
In the morning all she would have to do was shower, get dressed and have breakfast. I planned on sneaking the groceries out while she was in the shower.
It was soon time for sleep. I guess Wiggles suspected it would be her last night, because that is where she slept.
By aryr
Morning came and before we knew it, the time to leave had come. Andrea had been up for hours. She had taken the time to wash the blanket and bedspread with the plan to do the sheets once I was up.
She had surprised me by making French toast, the way I had shown her. So, it was French-toast, juice and coffee for breakfast. After we cleaned up the dishes she excused herself to take her shower. I hurriedly took the groceries to the car. The bags were inside one of the lower cupboards and she hadn't bother to check the bag in the fridge which had the meat, butter, eggs and milk. I had showered before going to bed, so I was dressed when she came out.
"I put the sheets in the washer, but you will need to switch them over when you come home. The blanket and bedspread are folded on the bed. I know you are going tell me I didn't have to, but you were so kind, so I just did it."
I held out her coat, but she side tracked it and walked into a hug. We both sniffed and patted each other on the back. It was time. She took her coat and I reached for mine.
We were both silent on the drive over. I managed to find a parking just a couple of spots from her building door. Before we got out of the car, she turned to me to tearfully tell me she really appreciated all that I had done. We hugged again.
She ran up the steps, into the elevator, so she could tell her mom we were there. Within minutes, both she and Sarah were back and the three of us carried up her belongings. I excused myself after the last trip, so that I could get the groceries.
When I got back up to the apartment, Andrea was showing her mother how to work the slow cooker.
"Great, just in time. Let's wash it up and then Andrea can show you how to make stew. Then I want to see this room, although, I am sure she has already checked it out. I am sure the three of us can get things set up faster than she could do by herself. Then she can make the rolls and get started on the cookies. Okay people, move it." I laughed.
"See I told you she was bossy. Mom you are going to love this stew and the rolls are to die for. And for the record, no, I have not made it to the bedroom." She laughed as she started to wash the cooker. She instructed her mother to just watch for now.
She cut everything up and mixed it into the cooker. She covered it and showed her mom the difference in the settings.
I had no choice but to laugh, when she pointed her finger at her mom and waved it, as she told her to never, ever take a peak, that's why the lid was glass. She decided to set up the rolls before we went to her room. She retrieved her recipe card and mixed them up. Then she covered them with paper towel for rising.
Her mother was impressed. The slow cooker was a fantastic surprise for her and the groceries were a delightful surprise, for both.
Off we went to her room. Andrea was once more surprised, her single bed was a day bed, with all the throw cushions which complimented the bedspread. Her new curtains were of her favorite color -green and brought out the brightness of the other colors.
We moved her bed to where she wanted it, put the clean sheets, blanket and bedspread on it. Sarah and I set up her desk while Andrea put away her clothing. The last thing was to hang her towel and facecloth. With so many people in the apartment, it was decided that everyone would keep their towels in their bedrooms.
Andrea was set.
We all headed back to the kitchen to make cookies. The boys came in from their morning at the boys and girls club. Until two years ago, it was gender separated, but now it was mixed company.
They were surprised to see Andrea and even more surprised to see me. The biggest surprise was that Andrea was back home. However, their tummies out ranked the surprise and between the delicious smell of the stew, the rolls rising and of the cookies, the rumblings won out. Andrea was so glad I had brought what was needed to make hot chocolate which paired nicely with the fresh cookies. I was proud that she had learned my secrets so well.
After their cookies and hot chocolate, the two boys disappeared to the living room to watch their favorite TV program. Andrea and I did up the dishes, as Sarah watched in amazement. I was so proud of her actions and that she was following my suggestions.
"Mom, this is the new way of doing things around here." She laughed. "I am going to teach the boys to do dishes, and I will help with the cooking. You make sure we all have a good breakfast and pack our lunches, so helping in the evening, will be great for us all. This is how we work together, one night I wash and the next she does. So, the same for us. You wash, then I wash, then the boys wash. Now I do think for the first few times you should watch the boys to make sure they are doing it right, okay?"
Sarah agreed and then got up to leave the room. She came back with a bottle of brandy with a bow on it. Andrea grabbed a card that had been hiding behind the toaster.
"This is for you, Jax. I mean, Mrs. Armstrong. It's from my Mom and I as a thank you for helping us out."
"Jax is fine at this time. You, guys, did not have to do this. It was a pleasure to let you stay. I just hate it when people like your uncle tries that stuff. I know as I suspect you both know, he is not really an awful person. He just lost his way a little. The stress of losing his home, of having to be reliant on his baby brother probably made him seek out a little affection from someone. And you, my dear, are by nature a very giving person. He just took it the wrong way. So how about we have some special hot chocolate? As long as, you two can put up with me for an hour, I will be safe to drive home. What do you say?"
We indulged and enjoyed. Now of course, I could not drive home with open alcohol in the car, so the brandy stayed, and I had an open invitation.
I was gone, when the two men came home for supper. The stew was enjoyed by all. Andrea gave her uncle the smaller slow cooker, explaining she had learned the delights of one pot meals while she was away. She then gave him the patio furniture and the card, he had no clue who it was from, but greatly appreciated it. He planned on putting it out when he got home and would cover it for now.
Andrea and Sarah saw him through different eyes.
By aryr
Sunday was an uneventful day and Monday followed, somewhat faster than anticipated.
As previously planned, everyone reviewed the last week work in the morning and then had their test in the afternoon. It was refreshing that the marking and grading went well. It was obvious that the diagrams and last chapter had been reviewed.
I asked them to read the chapters on skin and the endocrine system, which we would start on tomorrow and continue through to Friday's midterm.
"Will we get chance for a review of everything we have learned so far? Is this week's work included on the midterm?"
"I promise that there will be time to review, we will probably do that on Thursday, and no the skin, the endocrine and the nervous systems will not be on the midterm. Everything else is fair game. Now, a couple of the diagrams are what I call 'double diagrams', meaning that two systems are on the same diagram; but I cannot tell you which ones."
The week went well, as they learned that skin was actually, considered an organ, which acted as a thermostat for the body and provided tactile stimulation. The endocrine system were glands that controlled so many of our bodies functions by means of hormones. Glands such as the pancreas and the thyroid.
They learned that shivering created heat and increased metabolism. That sweating was the body's way of cooling down. They chuckled when I shared the quote that I had learned in nursing school. 'Horses sweat, men perspire, and women glowed.'
I was glad that this was a class of young adults rather than hormonal teenagers, when it came time to discuss ovaries and testicles and the appropriate actions. I did remind them that whatever name they gave to their personal body parts, were not the names to be used on either the tests or professionally. It was however, wise to know what some of those names were, just in case they received blank looks during their screening questions. Laughter filled the room.
A wide variety of names were created-Mary, wee Willy, the rooster, buttercup, the thingy, Peter were just a few offered by the students. I suggested they get comfortable with using vagina and penis.
The typical question was asked, one that had been asked for many years in the past and would be asked for many years into the future.
"Why do we have to have menstrual cycles? You know periods, the messys, the curse. Why us girls, why not the guys?"
I drew to their attention that the guys were just not equipped to deliver babies, whereas females were. I then explained that the monthly cycles were our bodies way of providing a cushion for the baby, should we get pregnant and if we didn't then it was simply flushed away from our body. This of course, produced raunchy comments from the guys.
I just couldn't resist playing a joke on them.
"Now for the guys, I think I need to warn you that modern medicine is working on having the men carry the baby and then deliver it by cesarean birth. This would mean abdominal scars for every delivery, and the guys would still have to go through labor But it would also allow those who didn't want to work to stay at home to become 'dadmoms', freeing up the women to be the provider."
Almost, all of the guys moaned and groaned at the thought and settled down. And the girls all caught my smile after the comment.
Thursday crept up faster than anyone expected. We finished the two systems in the morning and then reviewed through the afternoon. I suggested that they only refreshed the diagrams this evening.
They would have until 1300 for the midterm, if needed. Since they were going to be dismissed when they finished the exam there was no need to bring their text books. I did remind them of the reading assignment for the weekend and that there would not be a test on Monday.
Friday morning came. Everyone arrived on time and were sitting quietly. The air was so tensed and stressed, one could literally cut it with a knife. Several students were pale, only a couple were flushed, but everyone was quiet. I smiled as I recalled seeing the same features on my fellow nursing students just before an exam. I hoped that I was projecting a sense of peaceful comfort rather than doom.
I gently reminded them to read through it like they did with their test. I explained that there were two different exams being circulated. This was designed to reduce the temptation to cheat. Pencils were provided. Any question that made them stumble was to be left and then they could come back to after all other questions were done. It was better to miss one or two if needed than miss ten because of time.
I wished them all good luck, passed out the papers and had them start at 0845. For the first fifteen minutes, pages rustled as they read. Then silence started to prevail.
As they worked through their exam, I was preparing the test for the second Monday. It would include the nervous system, skin, the endocrine system and diseases that affected some of the systems. There would be three diagrams, that included the three systems.
On Monday I would temporarily give them back their midterm paper with the noted errors and corrections, strictly for reviewing. These exams had to become part of their permanent files.
It was 1130 before the first student was finished, he shook his head in doubt as he turned in his paper. Shortly after a few more finished and departed. By 1245 there were four people left and I could see that they were all working on the last page which involved the essay answer. Only one needed close to the full time. At 1255 he turned his paper in.
I cleaned up the room, locked the classroom door and walked out of the building at 1330. I would have a busy weekend and I wanted a head start.
I decided not to attempt to mark any papers on the way home, but I did separate them into the two groups. Marking would be so much easier by doing this. Each exam came with its own grading sheet.
When I got home I changed into something both comfortable and relaxing and after making a pot of tea started in on the papers. I worked until 1830 before stopping. I rubbed my eyes, pinched the bridge of my nose, rotated my shoulders a couple of time. I was ready to stop. I needed supper. I did one last count before leaving my desk area. I had marked seventeen of the thirty papers.
I called for my pizza and sat back with my last cup of tea, thinking that I would be able to get the rest of them done in the morning.
Within forty-five minutes I had my delivery. It was piping hot and I poured myself a glass of red wine. I know, it was a little foolish to have wine with pizza but that was what my mind and body were calling for. I managed three pieces before I acknowledged that it beat me. It was okay because I was one of those weird people who enjoyed cold pizza for breakfast. There were no dishes to do so I wrapped the rest and stored it in the fridge.
I had some TV calling out to me. By 2200 I was ready for bed, so after a quick shower, Wiggles and I snuggled in. Saturday morning, I did indeed treat myself to cold pizza and then tackled the papers. By two, I was finished. I decided that I would putter around doing little chores for the day.
Sunday was a sleep-in day for me, it was 0900 before I rolled over and decided to get up. I do believe even Wiggles enjoyed the extra time in bed. I didn't have anything planned, so after a few weeks of going all out, I was bewildered as to what to do to entertain myself. I smiled as I thought about doing absolutely nothing. It was like I was refreshing retirement. At that thought I had to laugh.
| Author Notes | The next few chapters will be short ones, I just like to forewarn you. |
By aryr
We started the week by going over the midterm exam. I told them I was impressed with the results and especially the essay part. They had not only learned but had listened. No one failed, and although there were several minor mistakes that meant no one scored 100%, the lowest mark was 88%, which was great as far as I was concerned. They all seemed equally pleased.
After collecting the midterms, I started talking about the disease processes of the heart and the cardiovascular system. I had calculated that it would take approximately two weeks for each of the systems. Part of the study would also reflect on the anticipated symptoms and changes in the patient's vital signs.
"Will you be doing some of the clinical supervision, when Mrs. Trenton returns? In the class room, she can sit behind the desk or even on it; but in the clinical areas she has to travel around and then will have to be standing a lot, won't she?" Andrew asked.
"My plan is to ask her if she needs assistance and then check if the school approves it, but we will cross that bridge, when we get to it."
Mentally I was calculating the time I had remaining. And given that at her last check up, the doctor had told her that she had four more weeks in the cast and then four to six weeks of rehab, it would be close to their clinical time. At least the studies and the final examination would be completed, they would be working on the practices they would be using in their clinical.
Because of the question, I decided to talk to the group about what they could expect in the future of the class.
"As you all know, we are going to start studying the diseases which affect the various systems. We will address the disease, why it is happening, what the symptoms are, what if anything we can do in our own lives to reduce the risk and what changes we will expect to see in the vital signs. Hopefully, you will be able to see that the effects can be seen in other systems. An example of this is being diabetic, which is primarily a malfunction of the endocrine system. However, it affects the urinary system because there is an increase in urinary output, it also affects the digestive system because of increase thirst and down the road the kidneys can be problematic, which will then cause skin issues and usually weight loss. As you can see, all of the systems are related."
I paused as they scribbled notes.
"After studying the diseases, there will be of course, your final examination. It will be an all day exam. You will be allowed one hour for lunch, and when you return the second part will be distributed. It will consist of multiple choice questions, diagrams similar to those of the midterm, and two essay questions. You will all have the following Monday off, to allow time for marking. You have to pass the final, in order to learn the skills needed for your clinicals. When you all started, you agreed that you would allow your classmates to draw blood specimens and that you were also expected to provide urine and stool specimens. Drawing blood will be under strict supervision. I will not follow you to the restroom for the other specimens."
Laughter erupted through the class.
"All specimens will be coded, so your identity is not compromised. You will learn the collection process, how to perform the various test and to interpret and report the results. This is usually a six-week process. Then you will be assigned to a clinical area for your twelve-week completion. Most of these clinics will employ a couple of students. They may not be close to your home, but your transit card will be provided for one year after your hire. This allows you time to apply elsewhere if you wish. Some clinics request more students to become employees, so those positions will be offered. You may or may not get a job using all your skills; but this gives you a future. Any questions?"
"So, no one knows whose blood, urine or feces; they are testing?"
"Well, I did say it was coded to protect your identity. However, I or Mrs. Trenton will know what code is assigned to what student. The only reason we have the coding is if anyone does present a medical problem, we can privately talk to them and recommend a visit to their physician."
"What about AIDS and HIV, can we get it?"
"No, you cannot get it within this class room. And by the time you go to your clinicals you will be considered experts on the skills. At the start of class, you were all asked if you had any communicable diseases and signed forms regarding this. Anyone with such a disease would be testing their own specimens, so that other students would not be exposed at this level. Are there risks out there in the real world? Yes, of course, but you will learn how to protect yourself. Next!"
There were no other hands, so we proceeded with the cardiovascular system.
By aryr
We discussed various things, such as blood clots, decreased circulation, high and low blood pressure, aneurysms, atrial fibrillation, heart attacks and the different heart murmurs. And I assured them that each process would be covered in greater details.
I took the opportunity to talk about the fact that there were potential blood pressure concerns and murmurs within the student body of the class room. I, of course, made sure it was okay with everyone before I would identify those involved and I stressed that none of the conditions considered were life threatening.
"Could I have a show of hands for those students who are not willing to have other members of this class being aware of these unusual but not life-threatening conditions?"
There were no hands raised.
"I would like to have a show of hands for all who are willing to share this information."
Every student raised their hand.
"We have three students who have a slight murmur. I want each of you to grab a stethoscope and listen to their heart beats, and for those three, please listen to each other. Ralph, Billy and Michelle would you please come up here. And remember, your murmurs are just your uniqueness, your stamp of difference."
We spent the rest of the day listening to the differences and I promised the few who were having difficulties that they could try again the next day, when they were fresh in the morning.
"Before you leave I would like to ask the three of them a question. Do any of you three, feel that your health has been compromised? Have you any of you felt that you have been barred from activities because of your murmur?"
All three of them denied any concerns in their past, as well as not having concerns because they are a little different.
"One last question and then we will call it a day. Does anyone in the class feel that they have noticed difficulties or felt concerned for the welfare of these three?"
Everyone was shaking their head 'no'.
"Okay, off you go. Have a great evening! See you in the morning."
We continued the next two weeks, discussing, reading, reviewing.
Midway through the second week, I called upon Phillip and Betty to come up to the front every hour to let two students check their blood pressures and advise me if the reading was high or low and by how much.
I was delighted that everyone was correct and now that they knew the normal range we able to also identify that the readings were still within the text book range but were either the bottom of the low range or at the top of the high range. Again, they were both advised that they were fine.
I had had their interest when they were studying the systems; but now that we were talking about the concerns they were more than active.
Everyone was willing to share information about a parent, a sibling or a relative that had something specific wrong. Even histories of their grandparents who had died, were talked about.
It was as if the lights were finally clicked on. Although we were still talking about the cardiovascular system, they were starting to see how the diseases affected more than one system.
They were interested and becoming medical detectives.
By aryr
The next system we attacked was the pulmonary system. Problems such as asthma, COPD or chronic obstructive pulmonary disease, pneumonia, aspiration and sleep apnea were some of the conditions addressed. They learned what caused wheezing, what caused snoring and the difference between a cold and the flu, as well as how to treat them.
I did caution them that was not information they were to share with the patient. Only physicians were permitted to diagnose, they would simply share the symptoms, vital signs and complaints.
Several students shared information about their asthma and the use of their inhalers. They reported that high humidity environments were the hardest for them to deal with.
One brave gentleman asked if I could explain about drowning.
"When one drowns it means that instead of air or oxygen, they have taken water into their lungs. Because of this, their body does not get the oxygen it needs to continue life which means that the heart stops beating and ultimately the brain stops functioning. There are however cases in which death can be reversed. Those unique cases involve hypothermia, where the water is so cold it causes the body temperature to drop substantially and therefore shuts the body down. The drowning victim is placed on a ventilator or breathing machine, intravenous or IV antibiotics and is gently warmed to normal body temperature. Sedation is used to keep the person in a comatose or sleeping state to prevent them from fighting and dislodging the machines tube into their trachea and upper bronchial tube."
"Can all drowning victims be saved? Does resuscitation always work?" asked another student.
"Unfortunately, no it doesn't always work. Even, a large number of the hyperthermia victims succumb to death."
They were all deep in thought. Silence prevailed.
"I think this will be an opportune time to discuss resuscitation or CPR (cardiopulmonary resuscitation. It doesn't always work but medicine has gone through leaps and bounds with the guidelines and in a fairly large number of instances it does prove to be successful. How many here know CPR and have been certified?"
I was amazed to see that three quarters of the class were certified. The remainder all voiced that they were intending to do their courses when they started their clinicals. I reminded them that they as well as anyone needing recertification could do so through the school.
An instructor would spend a whole day with those interested and at the end everyone would receive their certificates. I explained that because they were students their course would be a flat $10.00 fee and that when they started to work the courses would be provided by their employers. It was a mandatory requirement for employment in the health field.
I had several of the certified students explain the reason why they did CPR, what they were trying to do, and the various steps involved? Without the use of 'ResusciAnnie' it was not possible to demonstrate. Three of the students did however, manage to show those who were not certified, all of the steps except the chest compressions. I was indeed, impressed.
Everyone immediately wanted to sign up for a CPR course, in fact, everyone chose to sign up, I promised that I would make the necessary arrangements. But I did ask, why the ones certified were signing up.
Hands went up and I heard comments like, "I only have two months left on mine." "I have never used it so if I redo it, I'll be fresh."
One young man even voiced that they were in a class together and they would all stick together and graduate together. Everyone cheered at that comment.
"It's too bad you cannot do the course. That would be great because you explain things, so we understand. What a shame!" Andrew commented.
I reassured them that although CPR was important, it was designed that anyone could learn the technique that could potentially save someone's life.
I didn't have the heart to explain that I was an approved CPR instructor, so I kept my silence. It was the one thrill that I allowed myself. Most of my classes were booked for Saturday, once a month. It was my way of keeping in touch with the medical world of my past. That would be my surprise to them when they attended class.
I did however ask if they wanted to use a class room day or a Saturday and nobody had any preferences, so I chose a class day and suggested three choices of potential dates.
For two weeks we discussed and reviewed breathing difficulties. Once again stories were shared about relatives.
We also discussed the safety factors of oxygen use. I was amazed that they all knew not to smoke when oxygen was being used. They did not fully understand why but they knew not to. I explained that oxygen was a combustible gas which basically meant that when exposed to an open flame it could explode and burn. The small end of a cigarette was considered an open flame.
I asked the girls what they had been taught by their mothers and grandmothers to do if a pot or pan caught on fire. Their answer was to put a lid on it and then turn of the heat. Several of the guys nodded in agreement. I explained that with a fire there were only three things needed for a successful burn. There had to be a flame source, had to have an oxygen supply and a fuel source. If one of the three was removed there was no fire.
Since we were talking about oxygen use, I explained the care needed for equipment. Oxygen can be very drying when it is on higher settings, for this reason when it is used in hospitals there is a small canister of water that bubbles in place. This bubbling water hydrates the oxygen as it flows through the tube to the face mask or nasal cannula. People on oxygen at home have this built into their machines and the water level is checked by the patient or family. I reinforced that only distilled water should be used.
"Why do some people use a mask and others use the cannulas?" asked Stan.
"There are several reasons to consider. What level of flow rate is being used? Only so much can be pushed through those little prongs that fit in your nose, so sometimes a mask is needed. Some people just do not feel comfortable with the cannula, so they wear a mask. Now of course, there is less freedom with the mask, how do they drink? How do they eat? Can you hear them talk? Sometimes the higher levels of delivery are noisier."
"Are those tanks we see full of oxygen? Are they dangerous?" asked Michelle.
"First, I will address your second question. Yes, they are dangerous, and it is important that you make sure the tanks at your facility are secured and stored safely. Equally important is for you to educate your patients and your family members." I paused for minute.
" Although I knew of the documented dangers, I was not fully aware until I witnessed the devastation. As a visiting nurse, I always taught patients and families to deal with oxygen safety."
They were intently listening.
" I arrived at one home, where I had repeatedly advised them to store the tanks in a used milk crate and a bungy cord. Of course, they were determined to do as they wished. On this day, disaster hit. Grandchildren were running around, which amused both their parents and their grandmother. One of them slid into the unsecured tanks causing several to topple over. One tank landed on another tank and the tip or the spout cracked. Fortunately, the tip was facing the patient and the tank was facing the wall. It became a torpedo, breaking through that wall. It went through the bathroom after breaking off the front part of the toilet bowl, through the outside wall of the bedroom beside the bathroom and about 100 yards down the street. It managed to miss any of the other houses. The father managed to shut off the water supply to the toilet before there was extensive flooding." Once again I paused as they absorbed what I had said.
"It was an expensive lesson, but one well learned. Because they had been instructed several times about securing the tanks and all the information was documented, their insurance company refused to cover repair costs. For me it was a reality check of the danger."
The room filled with a variety of sounds associated with surprise.
"To answer your first question, they are filled mainly with oxygen. If you have noticed all the trucks transporting, large number of the tanks have them loaded in an open truck and they are chained and secured in crates. Most people are not aware that room air is approximately 21% oxygen to be breathed in and when breathed out, it is still about 17%. Other gases are involved but not necessary for you to remember."
By aryr
The two weeks passed quickly. It was time to conquer another test and to move onto the next system. Which would of course, be the digestive system. As we had progressed through the diseases of the other systems, it became more and more apparent to the students, that the systems interlocked.
I also took the time, before going to the next system, to caution them regarding the use of Vaseline or any petroleum-based product for people who used oxygen. It sure felt good because the oxygen is drying but it is petroleum and when mixed with the oxygen is combustible.
The diagrams were a success, they definitely knew the body parts, however, the questions were proving to be more challenging. Marks dropped substantially, but they were still eager which meant a lot. The tests were meant to merely give them good study resources.
Within the digestive system we discussed ulcers, flatulence which was the proper name for gas, diverticulosis, blockages, diarrhea and constipation; to name a few.
Unfortunately, this also became the time to tease Stan about his grumbling gut. He was great about it and laughed right along with the others.
During this time, we also talked about the various food journals, they had recorded. We actually spent a whole day reviewing them, then two days discussing the food choices, the digestion processes and how the foods affected their bodies.
For example, the class learned that Stan's diet consists of a lot of beans, cabbage, onions and soda. And a fair amount of low cost red meats rather than chicken and fish.
I explained that red meat does take longer to be processed, thus more activity in both the gut and the bowels. Beans, cabbage, onions and soda were all food choices that produced gas. So, his choices were responsible for creating gas which caused the grumbles of tummy. I also expressed that he probably had lots and lots of flatulence, and maybe some issues regarding his bowel movements. Constipation and diarrhea were common when people had poor eating habits.
He just blushed a deep red at that suggestion.
The class slowly was becoming aware that their diet was affecting what their bodies were doing.
"I recently had the opportunity to eat asparagus, which I had never had before. It had an unusual taste, but not in a bad way. I liked the crispy chewy taste and I loved the butter it was baked in. I did notice that the next day, that every time I went to the bathroom, I had stronger smelling urine. Was that the asparagus?" Andrea asked.
"Yes, it was food related. Some foods will affect you with stronger odors that usually pass in about 24 hours. Always remember that if there is an odor but no other symptoms or discomforts, it is probably a new food or medication. For example, some antibiotics cause unusual odors for both urine and feces." I smiled to myself as I recalled the meal she was referring to. I had cautioned her about her urine.
"Is it true that if you ate a lot of lemon poppy muffins, you could have a positive urine test?"
"Absolutely, I strongly suggest that you avoid eating them. If you know you are having lab work of any kind you avoid anything with poppy seeds. You may end up with a false positive for opiate use." I smiled, and the class laughed.
"For this reason, it is important to ask your patients what they have had to eat in the last 24 hours. The other thing to remember is to always check that they have been fasting the required amount of time. For example, cholesterol tests required at least ten hours fasting, with the exception, of water. Diabetic testing such as glucose tolerance is the same. These things you will learn."
We discussed the symptoms of diabetes, even though it was part of the endocrine system, it was highly related to the digestive system as well.
They learned to be concerned when there was increased thirst, hunger, urination and weight loss.
Also, that skin irritation or itchiness, especially in the genital area was a concern.
I reminded them that in the old days, diabetics were put on high starch diets such as potatoes and cabbage before the invention of insulin. Now there were a multitude of treatment methods.
We circled back to the food journals and I was asked about dietary changes.
The best things, that I could suggest was a change in the amount of red meat they consumed, to cut back on their consumption of bread and sugar. We even discussed the best liquid to drink, and of course, the answer was water.
There were a multitude of questions, that took up the rest of the day. Were canned goods better than frozen? Were fresh better for you than canned and frozen?
Several had decided that after talking to their families, they were going to do the window sill gardens. They had even decided who would grow what and how to trade out items. They did however, question if it was possible to freeze some of the veggies they grew. I provided a list of what could and could not safely be frozen and what they needed to use as it grew.
It sounded like they were indeed working on better diets not only for themselves but for their families.
I was extremely proud of them.
By aryr
It was another test day, and everyone seemed to have questions for the review. The next two weeks would be used to discuss problems and concerns regarding the endocrine system and skin. In three weeks they would be doing their final exam.
It was ironic that they were all more worried about the lab portion prior to their clinical rotation than their final exam.
I think partly they were feeling confident with what they had learned, even if their marks had dipped. They were still all making passing grades.
It was scary to think about drawing blood on each other. To be handling someone's blood, urine, feces. To be fearful about what you might be exposed to.
The morning passed in a review of what they had learned from day one to the current time. After lunch they would have their test and we would mark it as usual.
William stayed for a few minutes after everyone had gone to lunch.
"Could I stay after class for a few minutes, Mrs. Armstrong? I have something I would like to discuss with you." he asked.
"Of course, you may. Is it anything we can quickly talk about right now, or is it something that needs to wait for more time?"
"I think it is better if we wait, it might take a little time. That is if you don't mind."
"No problem, once everyone leaves, the class room will be ours and we can lock the door if needed. Off to lunch, it's important that you eat."
They all filtered back in and the tests were distributed. For the first few minutes pages were flipped as they read their questions. Then they began.
When they were finished, I gave them a quick ten-minute break before we started to mark them.
Everyone did well on the diagrams, there was only one error. However, the questions posed an entirely different matter. No one scored 100%, in fact the highest grade was 80%. Disaster had struck. There were four failures in the group.
I immediately reassured them that this mark was not part of their course grading. And that this was a study means, nothing more.
I suggested that for now they simply take their papers home. Tonight, after they had read the chapters required, that they look over them and see if they can determine where they went wrong. Tomorrow we would do a review using the tests.
"The four of you, who did not do well, don't worry yet. I am glad this happened now rather than with the final exam. We will figure it all out."
The room filled with grumbles and I watched them leave with shoulders slumped.
William stayed behind and when the last student had left, he asked if he could lock the door.
That was my first indication that our discussion would be of a serious nature. He came to the desk and pulled up one of the chairs.
"My brother did something very stupid. At least, that is what everyone in the family feels. Randy has been curious about many things in his life. He is only eighteen, still growing, but thinks he knows everything." He paused to shake his head.
"Anyway, he decided that he wanted to know more about drug use and the effects of drugs. About a year ago, for four or five months he tried different pills and smokes. Then about six months ago he decided to try injectables. I know, he was dumb. And according to him it was only three times. A month ago, he was called and told he needed to get tested for AIDS, one of the guys he shared with had just been diagnosed. So, he got tested and came back positive."
Another pause.
"My problem is that for the past four years, I have been receiving platelet transfusions every few months from family members. The last one was from Randy; he hadn't used anything for at least three months and it was just before he got his call."
His eyes teared. "Because of that call, I also had to be tested and my result came back positive as well. I avoided going until two weeks ago and I just got the results back two days ago. So, I will be going to see the specialist, I do want to finish this course, so I will have to test my own specimens."
I rose from my chair and went around the corner of the desk to him. I leaned over the back of his chair to hug him. I didn't feel the need to comment right at that moment, as he sobbed. It was several moments before I spoke.
"It is not going to be a problem and I will definitely make sure you get your own specimens. There is no need to make anyone else in the class aware of your concerns. Is there anything I can do to help you?"
He shook his head 'no'.
"If you need to talk, or anyone in your family want some advice, I am here for you. I can come in early, I can stay late, I can even go to your home, just let me know. When Mrs. Trenton comes back we will sit down together and talk to her. Okay?"
He simply nodded. He sat for a few moments and then stood to leave.
"Thank you for listening and understanding."
By aryr
The next morning, after a restless night, I passed William a note asking him to see me after class. He nodded in reply.
The class started, and I asked if everyone had a chance to read through the test the evening before, all heads nodded 'yes'. We began by going over each question, tearing it apart, searching for the confusion.
About half way through the questions, a pattern was beginning to form. They were rushing themselves in an attempt to get done. In doing so they were reading the question but not fully reading it or understanding it. They were catching the highlights but not the little words that can make such a difference. Something as simple as the difference between 'a' and 'the'.
Once this was pointed out, we reviewed each question once again and the responses were more appropriate.
Their confidence was back.
After a short break, we began the next section. They learned that the endocrine system with its glands that produced various hormones was an intricate part of the body's function. They had a reassuring knowledge of the pancreas and diabetes.
Their interest in the other glands such as the thyroid, the adrenal glands, the pituitary was very noticeable.
Lunch came and went, we were back. Helen has a question.
"We are learning that everything interacts in our body, so if a person has diabetes they have what is called an autoimmune system disease, correct?"
I nodded both to acknowledge her question and to encourage her to go on.
"There are other autoimmune diseases. Is there really leprosy?"
Everyone gasped.
"That is a great question. There are several autoimmune disorders, in fact. Diabetes or diabetes mellitus is but one. Others include rheumatoid arthritis affecting the joints, multiple sclerosis or MS which affect the nervous system causing things like pain, muscle spasms and blindness. Then there is Guillain-Barres Syndrome, inflammatory bowel disease or IBD /IBS, Lupus, psoriasis. All of these are also considered inflammatory diseases. Whereas shingles and leprosy or Hansens disease are infectionary processes that affect the skin and produce lesions."
I paused. "Yes, there really is leprosy, however with advanced medicine there is a treatment available and there no longer are leper colonies. Years ago, people were isolated to colonies to prevent others from catching it."
There were more gasps and I saw several of the students actually shiver at the thought.
"Guillain-Barres is not only an autoimmune disease but considered to be by some to start with an infection, sort of double barreled."
"It is note-worthy, that because no two countries, in fact not two counties use the same abbreviations, that laboratories require that the physician write out the disease process in full. There can be no confusion."
We continued with more and more processes. The requirements of the course, was that they know of the different diseases, but not necessarily know the causes, the symptoms etc. I made sure that they were aware of this.
"I do have some cue cards, that might be helpful for when you are working or even in your clinical rotation. Mine include the basic body parts, the various lab tests, the diseases, the normal vital signs. If a couple of you would be willing to bring your lunch for a couple of days, we can make copies for the class."
The entire class raised their hands, I chose William and Ralph and suggested bringing lunch for the next three days.
With everyone leaving, William lingered behind as requested.
"I had a thought last night and I was wondering if you would be willing to provide me with both your doctor's name and number as well as that of your specialist. I also need you to call both of them and explain that you have given me permission to call and speak with them. I will not give you a false sense of hope, but I do wish to discuss something with them. Then I will talk to you in more depth. Does that sound reasonable?"
"Sure, that is fine with me. Do you want me to call them now? I can, they are still open. I am curious, but I will wait."
"Okay, how about calling them and having them call me after the office closes. This is my number."
William called and spoke with both physicians. He was lucky that his primary doctor had known him for most of his life and he had a direct number to him. With the specialist, because he was a new patient, his calls were put through. Both men promised to call this evening.
William went his way and I headed home. This was going to be a challenging couple of conversations; but I was resolved to try anything. I had finally realized that these young people had become a vague extension of my family, something that none of my co-workers over the years together had managed to do.
By aryr
I had just finished supper when the first call came in. It was delightful to hear the voice of Dr. White. He was devoted to his career and his patients. He had worked for almost ten years before he specialized in HIV / AIDS. He was indeed an expert. I was surprised that he remembered me. I apologized for keeping him late. He actually interrupted me.
"Jax, it is so nice to hear from you. So, I am gathering that you are having concerns regarding William, right. Is it possible? Damn right it is. Whether it is thirty years or just one day, it is always possible. Let me guess, you want three new lab draws at three different labs. Consider it done, old friend. It was devastating to see that young man walk in here and tell me the news. I really feel for the entire family. It is like he was blessed when he confided in you. You are his ray of sunshine in this darkness. It was the early 80's when we met if I remember correctly."
"I remember, Dr. White. It is as clear today as it was all those years ago. It was heartbreaking, and I lost a good friend. I am thankful and will always be that you were there, and you cared. Thanks for taking care of this for me. If it is possible can you pick the same three labs? I am expecting a call from a Dr. Blanchet and I will explain to him the reason for our chat and that you are taking care of things."
"Sounds good to me. Dr. Blanchet is a dear old guy, I am surprised that he hasn't retired. I guess when his wife died, he had nothing left but his work. It has to be about fifteen years ago. They both lost their only son about ten years before that."
"The poor man, I didn't see him at the hospital like I did you, so I didn't know. What a shame. I will talk to William in the morning, just so you know."
"Alright. So, other than this exciting challenge, how have you been? I thought you had retired."
"Oh, I did retire, then I got a call from Roni, she left the hospital around the same time. She has been teaching at a private school. Anyway, she fell and broke some bones and called me to help her out. I had already been to the school about covering some of the clinical experiences, so they were pleased to have me on board. It has been interesting, but I do think I will be glad when she is back."
"Okay then, I will let you go, but please do keep in touch. Yes, I know you are older but still, friends are special, and you certainly have taught me a lot. Deal?"
"Deal. Bye now."
I filled the sink and washed the dishes. I had just finished when the second call came through.
A gruff sounding voice identified the caller as Dr. Blanchet.
"Thank you for calling me, Dr. Blanchet. As William said, I am Mrs. Armstrong, a retired RN and one of his instructors. He has confided his medical situation to me and I have spoken with Dr. White. If you will indulge me I would like to explain my background and the reason for my call."
I paused, waiting.
"Well, get on with it girl. I am not going to live for forever and you are taking up my time."
I smiled and continued, "Thank you, sir. As I said I am a retired RN, I used to be an administrator of the ICU after many years of nursing there. I was also employed part-time in the beginning at a doctor's office for allergy testing, an interesting and enjoyable position. We worked as couples, two RN's, one would draw the blood for labs and the other would do the allergy testing. We switched out every week. One particular day, we had a young man come in for testing. Janice drew his lab work and in the process of passing the tube to me for racking, it exploded. The tube was between our palms and our latex gloves were torn by the broken glass."
"We followed protocol and immediately washed away the splattered blood. As we turned to apologize to the patient, we noticed his extreme paleness and thought he was about to faint. Suddenly he tearfully said that he had recently been tested and was positive for AIDS and he couldn't apologize enough."
"We finished our task, redrawing the lab work and doing his allergy testing. Then we both went to the physician and explained what had happened. We both advised him that neither of us had found any cuts. He advised us that we still needed to be tested because of the exposure. AIDS was still new enough that it was a concern."
"Oh my, I certainly understand what you are saying. I felt so bad about William and Randy. That's why I called Dr. White."
"I understand. Anyway, we went off for our testing and had our follow up appointment for one month and six months. That was the protocol then. We got our results back a week and a half later. We were both positive. We were dumbfounded. We had no cuts, no scratches, no nicks. We had both told our families what had happened on the day of the event. Now we had to tell them about our results. We continued to work."
I paused, because even the memory brought tears to my eyes and voice.
"Are you alright, my dear? Is there anything I can do?"
I am fine, thank you. All I need is for you to listen. We went back for our scheduled visits and again both times we were positive. Both of us were suffering from the anguish of the disease as well as the stress it placed on both of our families. We were afraid of contaminating our spouses, our children."
"We were close to the one-year mark, when I got a call from Janice. She joked as she told me she had just got a call from her primary lab that she had been five years free of breast cancer. She had her labs done the week before. She laughed almost manically, as she said she was cancer free but doomed to die from AIDS. I calmed her down over the phone and told her I was coming over. I called her husband and advised him of her call."
"When I got there, she didn't answer the door nor her phone. I called her husband back and he told me where to find the spare key and that he was on his way. I found the key and a few minutes later I found her. She had shot herself in the head."
"Good God, woman."
"I called 911 and they arrived before her husband. I kept him back as they investigated the scene. He was devastated and worried that the children would be home from school soon. I called his mother and arranged for her to pick them up, then called her parents to advise them of her death. The news eventually covered the entire story. About two weeks later her husband called me and asked me to call her cancer lab."
"When I called, and I told them who was calling they asked me if I could come over, that they would rather talk to me in person. I agreed and went over. They asked me if what they had heard on the news was correct-that we were both positive HIV, which I confirmed. They then asked permission to draw labs and again I agreed. A week later, I had the results and neither one of us had been positive."
"I was furious. I knew that Dr. White was considered the doctor in the know about AIDS; so I called him and actually got an appointment for the next morning. I saw him and learned that some of the older labs did not have either correctly calibrated equipment to do the test or the techs to do so. I was tested at three separate labs and came up negative. My friend had taken her life and 95 other patients had been tested as positive. Not only our lives but that of our families were affected. Of course, there was a law suit."
"I would seriously hope so, that was a criminal act as far as I am concerned."
"My concern, is that some of the labs that do the free collections are still using some of those machines. Now I know the newer techs are aware of how to calibrate because we teach them how to do it; but what if."
"What if it was an older tech, who didn't know. I can see why you are concerned. Is Dr. White ordering new lab draws? Sorry for interrupting."
"Yes, he is calling the three labs that I used, and we will have William and Randy go over for the blood work. He is also aware of the young man that possibly infected Randy and will have him retested."
"Well young lady, I am glad you were quick on your toes. It sure doesn't hurt to do the testing again and I will keep those boys in my prayers. And being as old as I am, I do have some clout in this city and I will be talking to the mayor about providing new equipment for those labs. It's not safe if the results are wrong. Some of these people can't afford regular labs. My God. We will pray."
"Thank you, sir for understanding."
"No, it is I who thanks you. I will be in touch. Oh, and the name is Harold, not Dr. Blanchet nor Sir, just Harold, okay?"
"Yes, Sir or I mean Harold and I am Jax. Talk to you soon."
I really hated sharing a past memory with a complete stranger, but sometimes that just what has to be done.
| Author Notes | I am sorry that this chapter was so long but it really could not be broken up. |
By aryr
When William came to class the next morning, I immediately called him out of class, even before he put down his back pack. We went to the teachers' lounge where we could talk privately. I explained my concerns but not my memory, and that after talking to both doctors, he and Randy were to be re-tested and I provided him with the addresses of the new labs. I also advised him that there would be no charges for the testing, which produced a sigh of relief.
I excused him from class and that I would see him later in the day when he was done. He walked down the hall calling his brother and explained that he would meet him at the first lab and then explain things. He smiled and waved as he went out the door.
He had no clue of the outcome, but because of his respect and his trust, he was willing to fly on blind faith.
Of course, everyone in the class room was concerned, so I just told them it was a family emergency and to remember to be sensitive to his feelings when he returned.
Class was prepared to go on.
Stan raised his hand and I nodded.
"Why is it that sometimes I crave something? Is it because I am missing something in my diet or my body? Pregnant women really crave weird things, or I should say from what I have seen they tend to."
"What an interesting question. Thank you, Stan. You are right about pregnant women, because it is hormonally related there is no rhyme or reason. To the guys in the class, when you marry, and your wife is pregnant, get her whatever she desires. Have no fear that she will make you eat what she is because she will want it all for herself."
Laughter filled the room.
"A craving can be caused by several things- stress and depression because we want what we call comfort foods. Lack of sleep or not sleeping restfully can be a cause. Studies indicate that cravings are controlled by the same part of the brain that deals with memory, pleasure and rewards. Sure sounds like comfort to me. I do think that some cravings are related to nutrient deficiencies, such as wanting chocolate, not only because it tastes good, but it is also high in vitamin B6 and magnesium. Sometimes a change in our normal level of leptin and serotonin can create a desire for foods that will replace it. There is a tendency to want sweet, salty, meat and cheese. And in some cases, you will notice an increased intake in sugars, salts or fats. The key is to change your environment- if you are inside watching TV with commercials about salty chips -try chewing gum, change the channel and better yet, go outside for a walk. Even popcorn is better for you than a bag of chips."
There were several chuckles and lots of head nodding.
"Going off topic for a minute; did you know that you and you alone can consume a whole bag of chips while watching TV. You are concentrating on the show or movie and not the action of your hand feeding your mouth."
Surprise was on almost everyone's face.
"One last thing about craving, medical science and researchers now believe that the craving period is a rather intense one, but it only lasts around five minutes. If you can make it past that apparently your craving disappears. With the exception of being pregnant. It is important though not to confuse basic hunger as a craving. If you haven't eaten for a while, then it is hunger calling to you not a craving. Yes, Ralph?"
"What does leptin and serotonin do?"
"Leptin is a hormone that is an energy enhancer, it basically tells you that you have eaten enough to keep you from being hungry and that you have energy to do what you need to do."
There were no other questions.
"Serotonin is a mood changer, some think of it as the controller of your well-being and your happiness. It is found or produced in several places but primarily in your digestive system, your CNS and platelets. How many remember what CNS stands for?"
All hand went up and I pointed to Betty.
"Central Nervous System." She smiled.
"Correct. Thanks Betty. People with low serotonin levels have a tendency to become depressed and before that level tend to have poor sleep patterns. Any other questions?"
Head were shaking 'no'.
"So, when you think you are craving something, try to think about something else, it will pass."
We continued talking about hormones and glands until lunch.
William returned after lunch, smiled and held up three fingers.
I nodded and said that I hoped his family emergency was taken care of.
Everyone, of course, was concerned. Some were down right nosey and wanted details but all he said was that it was a problem with his younger brother and left it at that.
Because we had addressed the cravings of pregnant women, there were several who wanted to know about the hormonal changes involved which lead to others wanting to know about the change of life or menopause for women.
For the rest of the afternoon we reviewed pregnancy, the symptoms of a pregnancy, the changes over the nine months. The stages of labor and the events of delivery.
Just about everyone felt that there was a gross part somewhere in the process, if not more than one. They all departed with instructions to read tonight.
By aryr
The next morning, we started with the dreaded menopause. The girls groaned about the prospect. Everyone was surprised that not only did their parents, but the so called senior citizens still had sexual relationships. Most thought that concept was even grosser than yesterday's delivery.
"I guess I shouldn't share with you all, that the highest rate for STD or sexually transmitted diseases is among the elderly. One would think it was be teenagers and young adults but surprise."
There were several looks of shock throughout the room.
"Oh, and I probably shouldn't tell you that all of you guys, will go through a shorter period of male menopause, just like the girls go through their female menopause."
There was a stunned silence for at least five minutes. I remained quiet and let them absorb what I had said.
"Wait a minute, I don't have any periods and I don't get pregnant. So, what are you saying? That I will still get a menopause?"
All the other male students maintained a confused look, while the girls just smiled, and some laughed.
"No, you don't have periods. No, you don't get pregnant. But yes, you will go through male menopause. And I would even bet that you are more familiar with the symptoms than you think."
Again, all the guys shook their heads.
"While thinking about your fathers, your uncles, your grandfathers or the older store owner, how many of those men have a receding hair line or have started to or have become bald? How many have beer bellies, and they are proud of those? Some of them don't even drink beer. How many of you have seen any of these males checking out the younger females? How many of you have divorced parents and when did it happen?"
Silence once again, took over the room. I ventured one step further.
"How many of you have step mothers who are just slightly older than you and have step siblings several years younger?"
More silence.
"Unfortunately, males do have a period of menopause, during which these things can happen and a lot of them do. Females on the other hand from puberty deal with breasts and periods, raging hormones during both pregnancies and their monthly curse, as it is sometimes called. And then they suffer through menopause. They have decreased periods until they stop altogether, devastating hot flashes that can happen at any time. They tend to gain weight. Look at me, I used to be as thin as a popsicle stick and now I am a pleasingly plump grandma."
They looked around at each other as if they could see what their classmates would look like in twenty or thirty years.
"Yes, you will all have some form of menopause, but at least now you know about it. My advice is that as these changes start to take place, remember this talk. Look at your spouse and remember what made you attracted to him or her. Then talk about what is happening and how you are feeling. You may be surprised to learn that they are going through difficult times as well. They just did not know how to approach the subject."
I paused as what I had suggested sunk in.
"In fact, for the guys, be sympathetic toward your wives. Tell them that you understand the changes that will happen and that you are willing to talk about anything. And the girls should do likewise for their husbands. Communication is truly one of the best actions to maintain a relationship. And remember, you are never, ever, too old to look; it is the touching that gets you in trouble."
The room erupted in laughter. And within minutes, they were all standing and clapping. Wow, my first standing ovation.
A week later, William came into class, looking sad, lonely, discouraged; all the negative aspects that could be thought of. He was physically there, but mentally detached. Several noticed and tried to cheer him up. They had no choice but to give up when he rejected their efforts.
I stopped him as he was leaving for lunch and locked the door.
"What's happening? Bad news? Did you get positive results? Talk to me."
"It's just that it has been a week and we haven't heard anything, not a word from any of them. I might as well give into the fact, that thanks to my brother, I have this screwed up life. I won't ever marry or have kids. I sure hope I never infect someone else. Will I even get a job?"
"Okay, first, you know that it can take two and sometimes three weeks for the results, so don't push it. Second, it is natural that you want to blame your brother for this and you are right. This is all potentially his fault. But you will forgive him, and you will help him live through this, just like your parents are helping you. They cannot love either of you less than the other children because this happened. Everyone will become wiser because of this. You may marry, who knows what fate has planned for you? And what is wrong with adopting? And yes, you will get a job, I have no doubts regarding that. So, give it some more time. Now let's you and I get some lunch, my treat."
He nodded.
It was two days later, that Dr. White called. I excused myself from class, with a glance at William.
"Jax, I am going to send you a text and an email shortly, but I wanted to call immediately. I hope it was okay to do so. I am so glad that you interfered. I have all three lab reports on William, Randy and his drug buddy. They are all negative. I have called the lab that did the original test and advised them that they produced faulty reports and not to use the equipment for any testing. They asked if they were going to be sued and I told them I would try my best to have my clients avoid doing this. I did tell them that they would need to have everyone tested for HIV to be re-tested at two or three different labs and that they would have to absorb the cost. I was glad to hear that there were only five others, but still five is too many. Apparently, they just got that machine three months ago. So, will you please tell William the good news, I am going to call Randy and his buddy and have them come in today. I hope to scare the shit out of them, so that they never think of drugs again. Thank you so much for stepping forward."
I was crying as I promised to tell William, and then hung up. A quick trip to the restroom and a cold paper towel refreshed my face. I took a deep calming breath before opening the door. As I stepped into the class room, there was silence. I looked at William.
"Class, I need to speak to William privately, so would you quietly read through the chapters on specimen handling. William would you please come with me, bring your back pack. After we are finished talking I would like you to go home and gather your thoughts."
Books were opened, and he meekly followed me out of the room. We once again went to the teacher' lounge and I locked the door.
"Please sit down, I am too old to be picking you up off the floor. Dr. White just called. He just now got the results in from all three labs on the three of you."
He was crying, "God, I knew it. I just knew it was going to be bad."
"William, it is not bad. All three labs have cleared you. You do not have AIDS, neither does Randy or his buddy. You are clear!"
"What? What? I am clear? Randy is clear? Are you telling me the truth?"
"Yes, you are clear and that is the truth. Dr. White is calling Randy and his so-called buddy as we speak. He is going to have them come in and hopefully scare the dickens out of them. But everyone is clear."
"Oh my God. I can't believe it. Do my parents know? God, I would like to beat the hell out of Randy right now, but I won't."
"No, your parents do not know, that is why I am letting you go home, you need to be able to tell them in person. Then you and they can be ready for when Randy gets home. Now the lab was really concerned when Dr. White called them. They have just had the equipment three months and have five other patients to notify and arrange free re testing. It is up to you and your parents if you wish to sue them."
"No, I don't think I want to. It would become public for Randy and me and the family. Everyone would know, and we don't need that. I'll talk to my parents and Mr. Dumb Ass."
"Okay, so I will see you in the morning."
"I can't ever thank you enough, I am so glad you were here and so glad you helped so much."
We hugged, and he went on his way and I returned to class.
By aryr
We or rather the class managed to complete all their studies. The last test resulted in better grades and a definite increase in their confidence.
There were no failures, but there were some close calls. They all passed, some with higher grades than they expected.
For the final exam, they had all day to complete it. With it consisting of two parts, it was realistic for them to leave after completing the first part and coming back after lunch for part two.
I began marking the first part, while they worked on the second part. It was pleasant to see that everyone had answered the diagrams correctly. The questions proved to be more challenging and I was seeing the grades drop.
The plan was the same as with the mid-term exam, They, would have a long weekend and didn't have to return to class until Tuesday morning. I, as well, would have a long weekend of grading the exam.
I wished them all a great weekend when they were done. There was no rushing by anyone, and they all finished within minutes of both each other and the finish of the day.
Although, there were no more chapters that required testing, I did ask everyone to read the last two chapters of their book, that covered specimen collection and some of the equipment used in various tests.
Every student was aware that, in order to fully pass and get their certificate, they had to complete the practice part of the class that would be a full month. Then they had a three-month clinical component. These two portions would simply be marked as satisfactory or not satisfactory.
Tuesday would be a day of excitement for everyone.
We spent the entire day examining the different supplies that they would be using. The variety of specimen tubes for blood, the containers for urine and stool and most importantly the use of gloves and face shields. We discussed what information was needed on label, such as full name, MD name, date of birth, date and time of specimen and their initials.
I reminded them that in class, instead of their full name, their assigned code would be used. They were to come up to the desk, one at a time, for their code. It was simple, we were using their social security number. They were instructed to write their own ID information on the tube and the 'tech' would enter the rest.
I only opened five syringes with their needles, the vacutainers and their needles needed, butterfly needles for the tiny veins. And I demonstrated safe recapping techniques, but I reminded them that under normal working circumstances, they would never recap a needle. Only here would we do so as they inspected them. I then passed them out to the first person in each row with instructions to check them out and then pass them back. I stressed that all needles were to be capped before passing to the next person.
Although I showed them the tourniquet, I advised them we would learn to apply them tomorrow.
The next day, we discussed the use of tourniquets and they took turns applying and removing them. After about thirty minutes of this practice, I had them then find a vein that they could use if they were drawing blood. I did caution them to only leave the tourniquet on for a few minutes and suggested that the 'patients' squeeze their hand open and closed a few times. I had each student find about five veins. And encouraged 'patients' to alternate arms.
When they were done with the vein search, I had them try to find veins on the same people without a tourniquet. It was almost impossible, and I explained that by using a tourniquet they were really restricting most of the blood flow that was attempting to return to the heart.
I had each of them apply a tourniquet to another student's wrist and investigate the veins on the back of their hands.
"Ma-am, mine roll around a lot, what do we do if that happens?" Betty asked.
"That is a great observation Betty. A large part of the population has roller veins. There is a trick to prevent this. I want to give your hand a rest, so I will explain the set up for a blood draw, then I will have you come up and with groups of five I will show you the trick involved. Now I have to warn you that if one has rolling veins in their hands, it usually means they have them everywhere. And most people who have rollers and know so will tell you, in hopes they only need one stick. The rule of thumb is you get two sticks and then it is time to get someone more experienced. That applies to nurses in the hospital and starting IVs as well. Fair enough?"
They all nodded.
I used the desk to lay out the printed order, the required specimen tubes, the vacutainer, one of the vacutainer needles that I had opened as well as an unopened one, a syringe just in case, a tourniquet, an alcohol swab, an unopened square of gauze, a strip of tape and gloves. I also explained that some clinics or labs used a bandaide or stretchable wrap instead of tape.
I had them each answer the reason for each item, then we discussed the various colored tubes and what tests could be done with the blood. Most importantly, I stressed that the tubes should be rotated slightly but not shaken.
"Why are there different colored rubber stoppers on the tubes? Is that something to do with the test?" asked Melonie.
"You are absolutely correct, you have managed to ask a great question but also answered it. Well done. Each clinical lab area has specific guidelines for drawing and handling specimens, so you will adhere to those rules while you are on clinical rotation as well as when you are employed. Basically, the order in which you draw your specimens are all the same. I will not give you a guideline printout because each lab has their own cue cards."
Several heads nodded in acknowledgment.
"If you have among your orders, blood cultures they are always without question drawn first and you use a marble or tiger striped tube. However, if there are no blood cultures, it is usual protocol to draw a waste tube which is discarded. Then the order is as follows-for pre-surgical test a gold, not yellow or red & gray top, red top is used for infectious diseases, donors and drug use. An orange or grey & yellow if there is a concern about clotting activity and is considered a STAT order. What does STAT mean? Yes, Andrea."
"To be done immediately, if not sooner." She replied.
"Correct. Lavender or pink ones are used for CBC, another abbreviation you should know. William?"
"Complete blood count, which compares the amount of red blood cells, white blood cells and platelets."
"Good answer. Next if ordered is the light blue which is used for platelets and coagulation or clotting. Green is for plasma levels but there is also light green or a green with grey that is an enhanced green one because they have a specific gel. Grey is used for glucose or blood sugar levels. Some of the rarer ones are dark blue if the doctor is looking for trace metals in the blood, light yellow is used for blood bank testing, DNA and paternity, tan is when the doctor suspects lead in the blood."
I paused briefly, and Andrea raised her hand. I nodded.
"Will we be expected to know all the tube differences before we start clinical?"
"Absolutely not, you will find there are poster guidelines over each collection site as well as elsewhere throughout the labs. I only know them all because of the years I have worked. Way back when I started, the RNs were responsible for starting IVs, doing lab draws and changing sterile dressings. LPNs were because of licensing not allowed to be as productive as they are now and there were no aides on the floors. So, we not only had to know everything, but we did everything as well."
Several students had looks of surprise and there were a few 'wows'.
"Now I would like each of you to come up, in a single file and pick up what you would need if you were doing three separate lab draws. I will write the three orders on the board. Remember it is three different people. And do not open anything, you are just learning to get organized. When you are finished collecting, set up your desk as if it were three trays. When this is done I will have Betty come up, so I can show you the trick in handling rolling veins. There are baskets to collect your items in. Okay, let's get started.
They were quicker than I expected.
Betty came forward and after placing the tourniquet on her wrist, her veins popped up almost immediately. I showed the class what was considered a rolling vein. Several felt they would never be able to get blood. I then, put a little tension or pulling back on the skin just below where the needle would go, and the vein no longer rolled. The others did but not that one.
I let Betty go back to her seat and advised them all that I would walk around to check their three potential trays, if there were concerns I would tape them on the shoulder and they would have a chance to make a correction.
| Author Notes | Sorry another long one. |
By aryr
I started to my left and from the first student, there were items missing. The entire class were missing at least one item and one poor soul was missing six. I waited for a few minutes, until I started my second trip. I wanted to give everyone time to get what they thought they were missing. After three trips around the room and several students were still missing one or two items, I asked.
"How many patients were there to collect from and are any identified as children?"
"There are three patients and one with age nine in brackets." answered Andrew.
"Okay, then how many pairs of gloves should you have?
Everyone answered 'three' and the four people with only one pair came up to get what they needed. I was surprised that they answered three but only chose one pair.
"Now, how many tourniquets should you have?"
Surprisingly all but two answered 'one'. The lone wolves were Tom and William and they both held up three fingers.
"Does anyone remember reading that you always use fresh supplies for each client, you never cross contaminate?"
Sheepishly twenty-eight of them came forward for tourniquets.
"Now we have a child to draw from, do you know if they have had blood drawn before? Are they afraid of needles? Is the child big for their age or small? What would you suggest? William?"
"I would suggest a regular vacutainer needle, a smaller size one and a butterfly in case they have tiny veins."
"Good answer, so I would like everyone except William to pick up a butterfly set."
They all got up to collect one.
Tomorrow we will review the steps of a blood draw, for today I will pass around paper towels. Please use one for each set up you have and if you want you can write #1,2,3 on the corner of the towel so you know which set will be used.
One hand went up.
"Yes, Michelle?"
"Does that mean we are going to start drawing blood tomorrow?" Her voice quivering.
"Absolutely. We are limited on the amount of time to get everyone prepared, so we will not waste a minute. How about after our discussion in the morning, you volunteer to be the first person to do a blood draw? I will be right there at your side the entire time. Okay?"
She meekly answered, "If you say so."
Everyone took care of setting up their supplies and left. Well almost everyone. There were three students remaining and from their stance they all wanted time to talk. Michelle was one of them.
"Mrs. Armstrong, I think I need to tell you that I faint at the sight of blood. If I cut myself, my mom takes care of everything while I am passed out." She reported.
"Mmmmm, well we shall just have to make sure you don't faint tomorrow or anytime. It is interesting why you chose this type of career when you knew you would be exposed to blood. Would you like to share your thoughts? And the other two, do you have similar problems?"
The other two almost jointly said that they were afraid of needles and one admitted to fainting.
"Well, we do have a problem. On one hand it will be good for the rest of the class to learn how to deal with fainters because that happens more frequently than you may realize. On the other hand, I do not want to cause you stress and put you in potential danger. Since this course does cover the information needed for both Medical Office Assistants and Laboratory Technicians, I suppose I could just sign you three off for the MOA after I check with the dean. If she permits it then I need to be sure that you all realize that your certificate will be for that position only."
They all stared at me with wide eyes and pale complexions.
"I would though, like to see you all try once to draw blood and have blood drawn. I don't want you to give into your fears. You just might surprise yourself. If you don't mind I would like each of you to talk to me privately about your concerns. Can you do that?"
They all nodded and the other two quietly left the room.
"Okay Michelle, tell me what happened to make you afraid of blood?"
"Well, when I was about four, my mom was pregnant. We were in the kitchen making cookies and she doubled over and there was a big gush of blood. She had shown my older brother and me how to call 911, so I did. The ambulance came and took my mom to the hospital and I had to stay with a neighbor until my dad got home. Mom was in the hospital for a few days, she had lost the baby, it would have been my sister. So, when I see blood I think of that and I think I am going to die." She was crying as she told her story.
"Now I want you to think really hard, okay? Does this happen any time you see blood or just when it is your own blood?"
She thought deeply and then answered, "Only my own blood. I saw my dad cut himself, in fact he cut the end of his finger off. There was blood everywhere."
"And you managed dealing with that accident, right? It must have been rough when you started your period."
"Oh, that part was okay, my mom had talked to me and explained everything, and it wasn't bleeding from a cut."
"I see, so it just your blood and if it is from an accident. Why did you sign up for this course?"
"I thought I might be able to get over my fear, but now I am not so sure."
"Okay you have told me about what happened to your mom, that was traumatic for you. Now you have seen that your mom didn't die and neither did your dad, but you know your sister did. Somewhere along the way, you have developed a fear that if you lose your blood through an accident you will die. Honey that is not going to happen with either drawing blood or having blood drawn. Let's just try that one time. You will be fine drawing blood and I will be holding your hand when you are the patient. I want you to promise that you will look the other way and take slow breaths. You can do this."
"I never thought of it that way. I will try." She smiled as she got up and left.
Henry was the next to come in. I asked him why he was afraid of needles.
"I wasn't afraid of them until I was about fifteen. My grandpa was really sick, so he came to live with us. They had a nurse that came every day, she said he was dying and he wanted to die at home instead of the hospital. At first, he had pain pills but then he couldn't swallow them and when he couldn't swallow the liquid pain medicine, they taught my mom and dad and me how to give him his needles. Sometimes my parents would take a little break and I would be with him since I was the oldest. He would scream at me to give him his damn needle, it would always work. He died one night, I wasn't awake but ever since I don't like needles." He was shaking when he finished.
"Wow, that was very hard on you. You were pushed into a position that you were not really old enough for, but your parents needed your help. It sounds like you managed, and you helped keep grandpa's pain controlled. Now I want you to think really hard about this question. Did your grandfather ever tell you that the needle hurt him?"
"No, he would yell and holler that he needed his needle and when he got it, he would calm down and most of the time he would go to sleep. I remember every time he would say thank you."
"So, the needle wasn't hurting him, but it probably hurt you to give it to him, correct? You do know that you have an advantage over everyone else in the class. You know how to handle needles. You will of course be doing something different, but you do have that knowledge. I think your dislike and fear is based on what you went through with your grandfather and your responsibilities at the time. Don't blame yourself for what you did, you kept him comfortable."
He pondered my words, although he remained silent.
"I want you to try tomorrow, Michelle is going to draw blood first and I would like you to go second. If you find you just can't do it, then I will talk to the dean. Fair enough?"
"Okay, I will try, and I will think about what you said. Bye Ma-am. I'll send Fred in."
I nodded, and he left the room and I watch Fred walk in.
"Last but not least. Fred would you please tell me why you are afraid of needles."
Fred had been the quiet one, he was not an outgoing person. He answered when called upon, he knew his stuff and he was very polite, but he was quiet.
"It is hard but not hard to explain, if that makes sense. When I was little, I think about two, my mom got pregnant, so my brother and I got twins. A baby brother and a baby sister. The boy was born first, and he was much bigger than my sister, but she was a fighter. A wee little thing but she fought. They were not very old, maybe three months when my mom noticed that she was gaining weight, but he wasn't, and he might have even lost some. So, when she mentioned this to the doctor he of course ordered lab work. I can't remember what was wrong, but it had something to do with a blood disease."
He paused for a moment, his eyes were misty.
"Anyway, the doctor decided to check everyone's blood. I was the closest match. So, until I was nine, every two weeks I had to go to a special lab where they basically did a sort of dialysis to pull off plasma which were then given to my baby brother. It was our Thursday morning adventure. Some adventure. Just before my ninth birthday, my brother who was now six told me he hated doing this, he hated being stuck all the time, he hated me having to be stuck. I tried to cheer him up by telling him we were a great pair because we had our own plastic tube connecting us. He was really depressed."
He had to stopped for a few minutes, as if he was gathering his thoughts or perhaps sorting his memories.
"He lost his will. We were all worried. Even the doctor was worried. He told my parents that my brother had basically stopped responding to the treatment. He also mentioned that my brother had requested to have them stopped, to leave me alone and to let him die. He was only six, but so grown up and so wise. It was hard for the doctor to have this talk with my parents, but it was so much harder to decide to stop."
He gasped and shuddered as sobs over took him. It was several minutes before he could continue.
"It took him five weeks to die, but he lived those five weeks the best he could. He laughed, he smiled, he joked, he played. Several times when we were alone he would apologize for causing me so much pain. It was almost as if he could feel what I was going through. Every time they stuck me, I would tense up and squeeze my eyes shut, praying for the two hours to be over. I always reassured him that it was okay, and it wasn't really all that bad, but it was. He was tired one day and laid down for a nap and never woke up. He was gone. I think it was after the first three months that I decided I hated needles, that they hurt too much."
I gave him a few minutes to collect himself before I spoke.
"That was indeed a challenge for you, I am not sure if I could have done the same. The sad part is that three adults took the choice and the decision away from you and your brother. They decided and you both just did. And unfortunately, sometimes that is just the way life is. You gave him a wonderful gift, the gift of life. You and he had a special bond, that very few people have."
I gave him time to absorb what I had said.
"Have you had any needle sticks since that time? I suspect you have but tell me about them."
"Yep, I have the flu shot each year, I had some immunization shots and I had labs once."
"So, you can manage being stuck from time to time, but you don't like it, correct."
"Yes, Ma-am. I just tense up really bad, so I had to tell you. There is one nurse that I like to ask for. She always reminds me to breathe and not to hold my breath and she has a funny counting system. She tells me she will stick on three and then she says something like one, two, fifteen and sticks on the fifteen. I know the fifteen throws me off and I am breathing, or at least that's what I think."
"You are absolutely correct, it would be interesting to see if she went to the same nursing school, that I did. We had one professor that taught our class that. She said when someone held their breath it made the muscles tighten so it was like hammering a nail into steel, but if the count threw the persons thought off it was like going through paper. It also works when patients have to be turned, but it is important that if you need a partner that they know the turn will be on the odd number."
He smiled and wiped his eyes.
"Fred, I think you are going to be okay with this. I do want you to try tomorrow, how about having you be the patient for Michelle. You can be the child, so it will be a hand stick and using the tiny butterfly."
"Wow, that soon? Can I think about it?" he asked.
"I would rather you just commit yourself, I promise it will be fine, I will be there for both of you. I know you can both do this."
"Okay then, I am once again, a nine year old." He smiled and stood.
"See you in the morning Fred."
He nodded and left.
By aryr
Morning came much faster that I thought it would. We began class with me demonstrating how to hold the vacutainer and needle properly. Having obtained a willing volunteer, I showed them how to have the patient sit as comfortably as possible, while I verified the information and explained how many tubes would be collected-in this case and for the class, just one. I advised everyone that it was rarely just one tube but for the first stick it was one, we would learn about changing tubes another day. I advised the patient that it would hurt a little because I did have to insert a needle but that it would feel like a bee sting or tiny prick. I also instructed them to leave the dressing on for at least an hour and not heavy lifting with that arm for at least two hours.
"Are you ready, Miss Andrea?"
"Yes Ma-am."
And so with her permission I proceeded with the specimen draw, putting on my gloves, tying the tourniquet in place above the elbow, feeling for the vein, cleansing the area with an alcohol swab, uncapping the needle, having the tube in my other hand, inserting the needle, attaching the tube, untying the tourniquet, removing the tube, rotating it in the time it took me to lay it down, grabbing the gauze and placing it over the injection site, applying slight pressure as I drew the needle out and discard it in a sharps container, I increased the pressure when the needle is out and reach for the tape.
"Wow, that was so smooth, I hardly felt it at all. I hope I can learn to be as good as that." Andrea commented.
"Everyone will do fine, the more you do, the better you get and once you have done one you will never forget."
I got up and moved the waste basket to be beside Michelle's desk. The sharps container and the specimen rack where placed on the desk next to her.
"I have a question that is not really related but I am curious. When nurses start IVs how come some get a little blood on their gloves and the patient, and others don't have any blood at all?"
"Tomorrow, I will bring in an IV needle that you can look at, but for now let me explain. An IV needle has a latex free plastic sheath covering the needle, when it is inserted the needle is then pulled out and there is a backflow of blood from the vein, if you press on the plastic cannula that is in the arm you will cut off the blood flow and you hook up the IV tubing with your other hand and tape the site. Years ago, there were no cannulas, so we placed the arm on an arm board to prevent movement. Does that answer your question, Peter?"
"Yes ma-am, I can picture it in my head."
"Okay, everyone, take a ten-minute break and then we shall start."
When they were all back, I announced the plan.
"Michelle will do her three draw first, then she will become the third patient for the next drawer. Fred will be her second patient. Henry will be the second drawer, Fred will be third and Henry will be his third patient. I have a list of who is drawing and who will be patients. Trust me everyone will get to draw and to be a patient. I would like everyone who is not actively participating to stand where you can see the activity but not be close enough to interrupt the person drawing. I will be sitting on the side close to the patient, so I am available for both parties. I will offer guidance, correction and assistance as needed. If you are doing everything correct I will not interrupt. If you get tired of standing you may wander to stretch your legs, but I have learned that the more you watch the better you become."
Everyone nodded and rose to stand around Michelle, who was rather pale.
"William, would you be our first patient, please?"
He ambled up and sat in the empty chair that had been placed for him. I had the students place one on each side of her desk for patients, as well as a another beside those, where I would sit. Since this area was organized, it would be the draw site and each student would sit there. They would bring their supplies with them.
"When a patient comes in, it is appropriate to ask them if they have a choice of which arm to use for the draw. The chairs are equipped with an arm rest for each arm, but here we will just have the students pick a chair since the desk will be the arm rest."
Michelle took a deep breath and let it out.
"Hi, Mr. William, my name is Michelle. Dr. Smith has ordered some lab work for today. I will only need to draw one tube. It will hurt a little, but I will be a gentle as I can. Do you have any questions or concerns?"
"Have you been doing this for a while? I would hate to have a first timer doing this." He asked with a serious looking face.
I smiled at him, but I smiled even bigger at Michelle's response.
"Now, don't you worry one bit, I am very familiar with drawing blood. Shall we start."
I knew that I was allowing them more verbal time than a tech would have, but this was important. William nodded.
I was close by as she went thru each step with perfection, even remembering to turn the bevel or needle opening upward on insertion. When she was finished, she took another deep breath and let it slowly out.
"That was great, Michelle, I have had lots of labs drawn and you did it perfectly, as far as I am concern." William said with praise in his voice. I nodded in agreement.
"Fred, I believe you are the next patient. Michelle this is your child and I would suggest that everyone use the butterfly today for their child. I am thinking that way each arm and one hand will get stuck."
He stepped up and took his seat. Michelle went through each verbal and physical step without a hitch and Fred managed just fine. He did flinch a little when the needle went in, but he kept breathing by talking about the weather.
I called on Betty next and once again Michelle did a great job, she even remembered the trick to use with rolling veins. When she was done she stood up, sighed and fanned herself. She had a big smile.
"Henry you are the tech and your first patient is Ralph, get yourself organized."
He did great following Michelle's example. His next patient was Andrea and I suggested that she was the child. Again, he did well. Although I did note that he was perspiring, small beads had formed on his forehead. His last patient was Michelle, and I sat close to her and reminded her to watch me, not Henry and what he was doing. They both survived. He was smiling as he moved out of Fred's way.
It was Fred's turn as tech, his first patient was Andrew and things went smoothly. Peter was his second patient and the child. Henry was his third. He did very well on all three. I had suggested that if Henry needed he could look away, but he didn't, he was fine.
We had another ten students as techs before I advised them to take a lunch break. Every student had been stuck once and they were all chatting about it as they went out. Things were going well. I was so proud of them.
After lunch we continued with the rest of the students as techs. Their techniques were exceptional. At the end of the day, I suggested they each reread the short bit about changing tubes for tomorrow. Some of them would have a single change and others would have up to three changes. They no longer looked fearful and as if they were dreading tomorrow.
"Michelle, Fred, Henry could the three of you stay for a few minutes, please."
When the other students had left, I turned to the threesome.
"Well, what do you each think? Shall we call it quits and I will talk to the Dean? Shall we push on? The three of you did fantastic today both as a tech and as a patient. You were awesome. I sort of suspected. Henry, that you were expecting a little more than 'good job' or 'well done' after your draws, but I play fair with everyone. But you all did super jobs."
All three spoke eagerly at the same time. I was hearing three conversations that were all saying the same thing, that they would continue. I smiled as they left.
By aryr
The next morning, I check each puncture site. For those sites that were bruising, I advised the student to let the site rest for the day. Only half the class would be drawing blood because of the number of tubes taken. The other half would draw the following day. I had prepared lists for both days.
There were some stumbles with the tube changes, which I expected. There were several who dislodged the needle and had to start over using the other arm. Fortunately, everyone involved controlled any bleeding without difficulty. Two students had their tubes in the wrong order, I reminded them to study the order, but we continued. Hands were shaky, but everyone accomplished tube changes.
The next day was just as interesting. Those that had had needles dislodged proudly showed their bruises. This group was just as shaky, but there was no dislodging. Five students mixed up the tube order. I suggested that the next day we reviewed the order once again and everyone breathed a sigh of relief.
As promised I brought in an IV needle set. This time I had them come up in pairs as I showed them the plastic sheath which covered the solid needle, demonstrated how they went through a piece of paper then withdrew the needle leaving the cannula in place. Of course, everyone thought that this was 'cool'.
With it being a short week, it was time for them all to enjoy their weekend. The next week would be here soon enough.
It was a quiet weekend for me. I did my housework and small chores, caught up on my TV stories and reading. I concentrated on the TV shows on Sunday, while I was preparing my meals for the week. With the small TV in the kitchen I could work, watch and listen. The evenings were spent with a glass of wine and a book. I did call Roni and learned that she was to have the cast taken off on Wednesday and then start her therapy. Things were doing great.
The weekend was over, and everyone was back at school. I shared the update regarding Mrs. Trenton.
After the tube order review. I had suggested that they utilize the poster and to put their tubes in order between their fingers. The first one next to their little finger and if they could fit two great, the next two between the ringer and middle finger and so forth.
We had been blessed that the class room came equipped with two centrifuges, four microscopes as well as an endless supply of tubes, specimen containers, pipets and glass plates for the microscopes.
I introduced them to the various pieces of equipment. Then reviewed their use and the reasons for such. The plan was for ten of the students to pick a partner and draw two tubes of blood. One of the tubes would be placed in the centrifuge and when both were filled they would be spun. The other tube would be used for a blood count under the microscope. The ten techs would be operating the equipment. After lunch, the first group of ten would do the same, then the second group.
"Now, considering you know what you will be doing, what color of test tubes should you use?"
Several hands went up and I decided to pick on Nancy.
"I am thinking a red top and a light blue top."
"Well done, absolutely correct. So how about we pick the first ten people from last week as techs and the second ten as patients. Tomorrow the second ten will be techs and the last ten as patients, then the next day the last ten as techs and the first ten as patients. The group that is not assigned an activity will ramble and watch what is happening. Look at the techniques, look at the blood, look at the slides."
I paused, thinking I saw a hand go up but came back down.
"Stan, did you have a question?"
"Yes, ma-am, I didn't see anyone here and I didn't see you blow on the area to dry it after you wiped it with alcohol. I have seen people blow on it or fan it with their hand. Is that right or wrong?"
"An excellent question, and a great observation. Does anyone want to try to answer this? Phillip, thanks for volunteering."
"If you blow on it you are blowing your germs and maybe bad breath on it and if you fan it, I am not sure, but I would think you are fanning any germs in the air right to it."
"Phillip, I would give you a 95 for that answer. The first part is definitely correct, the second part is partially correct. Always remember then when fanning you create the risk of unintentionally touching the area and contaminating it as well as what you said about fanning germs."
Sandra offered, "I remember reading that you weren't supposed to blow because of contamination."
I smiled and nodded.
Okay let's break up into our groups. Set up the desks for ten stations. Get your supplies. And I will watch over two draws at a time, then we will play with the equipment.
"What are we supposed to do with the light blue tube. I know it is to do a cell count but how do we do that?" Ralph asked.
"Have patience, Ralph. Let's get the blood drawn before we start that. Okay let's get at this."
The blood draws went exceptionally well, each step was followed correctly. I had the techs manning the centrifuge. After I had them read the instructions on the use, they spun the red top tubes. Then they were to identify the layers within the tubes.
The students portraying the patients were to carefully take the stopper out of their blue tube, then using the pipet were to put on drop on the gridded specimen class and count the three major blood cell. They had studied the different cell picture and now they were to compare their different counts and make a report. If there was an increase in white cells they could have an infection, a decrease in red cells could indicate anemia and a decrease in platelets could cause a bleeding concern.
After completing their task, they would switch places and redo the tests. The remaining students would wander and observe.
I also explained that there was high tech equipment now, that could do the counts mechanically, but if that equipment should fail to work, they would be doing things the old way. They all laughed.
"Well, I am glad we are learning how to do this. I like challenges." Stan offered.
For the next three days, they worked hard at accomplishing their tasks.
By aryr
Then I surprised them. Using the same groups of ten I had techs collect anywhere from 3 to 6 tubes, the patient group would not only donate their blood for specimens but also provided a coded urine specimen. And we would rotate through the three days.
As suspected this produced several comments. Such as: 'Oh my gosh.' 'That's so gross.' 'Yuk.'
Each student came forward with their urine specimen and it was coded and left sitting on my desk. It was an interesting array of pee, as one student had named it. Various colors were noted from the palest of yellow to a deep amber orange. Some clear, some with sediments, some cloudy or milky. All of these things were important and indicated various things.
Once all the specimens were placed in the centrifuge and spinning. I had them turn their attention to the urine specimens. I picked up each of them one at a time and explained what was different. Of course, they had been shuffled around so placement could not draw the attention of the donor.
"This pale specimen is indicative of someone who drinks a lot of water, whereas this amber orange collection is from someone who does not drink what is considered the daily required water. Does anyone know how much you should drink, and that is plain ordinary water?"
All hands went up, and I picked Sally. "Six to eight glasses that are eight ounces and also what ever you want to drink."
"Andrew, how about telling us why?"
"Because water flushes our kidneys and that helps get rid of toxins and for those wanting to lose some weight, that too."
"Good answer. Now will you continue to lose weight because you drink the required amount of water each day? Andrea?"
"Nope, your body adapts, so instead of discarded fats cells and toxins, it is just toxins."
"Well done. Now, this specimen is rather interesting. Please do not identify yourself, but I am guessing it has been provided by a female who is having her period. I know you are all wondering how I can tell. There are hair-like strands of blood in the specimen, which means either a period or a serious infection. If it was an infection, the person would not be walking upright, they would be slumped over and in excruciating pain. Since no one here is like that, it is a safe guess it is a period."
"This is like being a detective, isn't it? We get to solve mysteries." Andrew commented.
"You sure are. Now, I want you to come up in groups of ten, grasp the bottle with a thumb and fore finger, turning the bottle to see what the temperature range is, it should match an internal temperature. Then as a group, space them out, remove the caps and at a height that would be similar to that of sitting and see if you detect aromas. If you do remember the code number. Recap them and let the next group and then the next, check them out. If you are not checking urine identify the spun specimens or do a count."
It seemed like everyone agreed that they all smelled the same that first day, a slight ammonia odor. It wasn't until the third day that anyone found a difference and once again they all agreed. The urine was very dark. It looked like strong tea and it had a strong odor.
Tom raised his hand and announced, "I had two large kidney stones last weekend and I knew when I was being examined that it because I didn't drink enough fluids of any kind. I sort of got busy at work and just forgot. Then when I started hurting around ten pm, I knew. Any way I was lucky I passed them and man that hurt, but they started me on antibiotics for ten days."
"Thank you, Tom for sharing that with us. As you can all see, what we eat, what we take as medication can play havoc on our bodies. Now today I would like each of you to grab a fresh bottle and get a urine specimen that you will be testing yourself. Bring a paper towel to put on your desk."
When they all returned, I passed the various dip sticks around. I explained what each one was used for testing. Some had a single patch on the end of the plastic stick, while other were longer and had five to seven pads. I used the projector to show the grid results on each bottle and had each student test their specimen for various things such as pH, specific gravity, protein and sugar. Each different test strip was time sensitive, so eyes were moving between the strip and the clock.
I further explained that with each specimen they were to document the color, any sedimentation, aromas, temperatures and test results. This was normal procedure.
It was a pleasure to watch the excitement on their faces as they discovered the result.
Just before the class dismissed for the day, I asked the first group of ten to stay for a few minutes and that I would like the other two groups to see me first thing in the morning.
"Unfortunately, you, as the first group, will be the providers of a stool specimen. I will provide you with the necessary supplies and instructions. You will bring in your specimen in the morning and before we begin examining, you will take the second group to the back of the room and instruct them, then provide their supplies for the next morning. In turn they will then do the same with the third group for the morning after."
They all looked shocked, one ventured to ask, "You want us to poop in a bottle?"
"Actually, you will write the last four of your social and all the other information on the specimens first. Then you will defecate on a paper that sits on the surface of the toilet water, Then when you are finished you will wear gloves, of course, and using a tongue depressor you will scoop up some for the specimen bottle, at least half full, and you will also smear some on a small flip card that I will show you. The gloves are removed and thrown in the garbage. The paper dissolves so you can flush the toilet. The specimens are wrapped in the provided paper towels and put into the zip lock bags. All of this will be placed in the brown bag and brought to school. After leaving the specimens on my desk, you will take group two to the back and prepare them. Okay? Got it? Good, let's get your supplies."
There were groans of surprise and their walk was hesitant.
"Does just one of us explain and then get their supplies or do we do it as a group?" Harold asked.
"I would like you to each take a partner from group two, explain as I did what they are to do, then get them their supplies and reexplain the process. As I will as I hand out each item to you. I am just not doing it one on one. This is a good practice for when you are dealing with patients. They will be just as surprised as you have been and somewhat shocked. Sometimes the doctor just says that they are sending them to the lab for test and gives them no other clue, so you become the teachers."
We went to the cupboard and I handed out supplies in the order they would be used and explained what to do. Everything was placed in the brown paper bag for them to take home.
"What if we are constipated or have diarrhea, do we still collect?" asked Andrew.
"Yes, you collect regardless, your patients will have all sorts of problems and their stool will vary. Remind me of that one tomorrow, please."
"Do patients ever have to go to the bathroom there at the lab for the specimen.? Stan asked.
"That is a good question, will you please ask it again tomorrow after we get the groups settled. But the answer is no, not for stool. We just can not make people defecate on demand, however so people do go if they can, otherwise they bring the specimen back the next day or two. Now urine specimens are on the spot. If they can't go then you offer them a cup of water and have them wait."
"Will we test our own stool? No offense to anyone." Harold questioned.
"No, you will not. Tomorrow you will provide and group two will test, then they will provide for group three to test and then you will test their specimens. It will be okay, and it is part of your job. You may be in a clinic where people rotate through areas, remind me to mention that tomorrow. Some tech decide that they just don't like drawing or testing blood and volunteer for urine and stool work. You never know."
"Do we have to put our specimens in the fridge overnight? My brothers are so damn nosey."
"That I am going to make you answer as a group. What did you read? And I expect you to share that information with the next group."
They all thought and chatted among themselves and concluded that refrigeration was not necessary. And I agreed. After confirming there were not more questions I shooed them out the door.
By aryr
The next morning after the specimens were placed on my desk. I explained what the plan for collection was. As expected the second and third groups responded with disbelief and shock. I had the first group remind me of the issues from last night. Then I told them who would be testing whose. More shock. I did however relieve some of the tension by telling them that everyone would be given a mask.
I let the group explain the procedure and get supplies, when completed the second group spoke with the third group. It was now time to test.
"Everyone in group two will get two paper towels, a mask, gloves and a tongue depressor for their desk and then come up and pick up a specimen bag. The other two groups can hover and watch. I will pass out testing solutions, there are two kinds. You only need one drop of each, so don't drown your specimens. Both are used to detect occult blood, one is used for the card and one for the actual specimen, the bottles specify which. I will also bring around two slides, you will smear a small amount of stool on one slide and then place the other slide on top. We will examine those under the microscope. Please, everyone, write down your findings."
Group two looked doubtful but got everything they needed.
"I have no idea, what each of you will find, but you will have stool of some sort. I suggest you read the bottles first. Oh, when we are finished these specimens just like the blood will go into the biohazard containers. Fortunately, we can flush urine down the toilets.'
I noticed that several techs as well as others in the room had great gag reflexes. But they did manage to succeed in their tests, as did the next two groups. Under the microscope they checked for specimens that showed ova and parasites. There were none, but of course, my dear old doctor friend had provided some in my collection. It was surprising the things this man had collected. Even more surprising was the fact that I was finding it useful.
When we were finished with stool collections we had another day of drawing blood. A continued source of practice. They were doing great. All signs of nervousness and fear had disappeared.
We spent a day discussing the procedure for taking swab specimens, where they could be taken from and why they would test. We also reviewed sputum collection and phlegm. They now knew the difference and how to direct the patient to produce and provide them.
The next day was again a blood draw day. They all recognized the need to be comfortable and to be as perfect as they could be when they ventured out to their supervised clinical experience.
The next day covered a topic that I am sure none of them had thought about, probably never wanted to think about and one that they were now hoping not to have to think about ever again.
Emesis which is not really a threatening word, until you realize that in common everyday language it meant 'vomit', 'throw up', 'barf' and 'up chuck'.
Everyone was astonished to find out that they did learn about testing and handling. I guess this would be a good time to mention I had such co-operating friends. One young lady was in the early stages of pregnancy and suffered severe nausea and vomiting. Because of this she was a great supplier of bile. Bacon and coffee smells produced excellent samples. She had her good and bad days. The bad seemed to be the days she decided to cook bacon for her husband as well as brewing his coffee.
I had a couple of other friends who were both willing and able to provide emesis samples. They had both had gastric by-pass and yet still enjoyed over indulging at least once a month. The result was of course vomiting. I truly believe one has to have the correct mind set to have this type of surgery.
Regardless I was able to get ample supplies of both specimens and they were used for class. I explained that although we did not have the correct equipment available, that sometimes they would have to run tests on such samples. The best test we could do was with the litmus paper. I also told them that in some cases it would involve determining the stomach content.
Doing the gastric strip test caused every one of them to gag and dry heave. In some cases, just picking up the closed specimen bottle produced these effects. I cautioned them all not ever to do so in front of the patient.
I even shared the story of the doctor who used to delight the nurses by eating an egg salad or tuna salad sandwich while he did rounds for his comatose, ventilated patients. One day, I was concerned about one such patient and called him. I do believe he made a stop to the cafeteria before coming to the floor, because sure enough he had his sandwich.
"I can't believe you called me, especially before my scheduled rounds. And I don't believe a word of what you told me on the phone. So, this had better be good."
I directed him to the patient, that was my concern. Explained once again what I had discovered and set up to suction via the trach. As it was earlier, I was suctioning up the same thing.
"Holy shit, those are live maggots in the tube, call down for an immediate flush. We have to get all those little buggers out and fast."
"Yes Sir, I will be accompanying the patient and will call you when we are done so you can check her again."
"Thanks, and I am so sorry I didn't believe you. That will never happen again."
Then he turned and vomited his sandwich into the waste basket beside the patient's bed. It was the last time he ate during rounds and the patient came through the procedure fine and in fact woke up about five months later. She had come in unconscious, needing a ventilator about a month before the maggot issue and remained comatose for about five months after. One day she just opened her eyes and she was back.
Again, everyone gagged and several tore out of the room and down the hall to the rest rooms. It was a day, that everyone of them would remember.
The time was passing by so fast. It seemed as if they had just started their clinical learning, but now they were tying up the loose ends. The last couple of days were used to have them complete different forms that they would use or see.
I called Mrs. Trenton the Thursday evening before they would go to their clinics the next week. Roni has graciously called the labs listed that were willing to accept students and made all the arrangements. She also announced that she would be returning for the clinical checks and that she had been called by the dean. I would be assisting her. We were both so pleased.
On their last Friday, they gathered more to meet and say goodbye. They all knew that they would be able to pick up their certificates the last week of their clinicals. They were delightfully surprised when I advised them that Mrs. Trenton was returning. They were super happy to learn that I would be assisting her. I took the opportunity to remind them that, at any time they could call Mrs. Trenton or myself, with questions or concerns. And that Mrs. Trenton or I would be checking in with them every second or third day.
They were each given their assignment, the location, the required dress code and their name tags. The usual dress code was dress pants and navy blue collared polo shirts. Of course, comfortable shoes, after all they would be on their feet a lot
.
I had brought in a cake and sodas. The class room was decorated with streamers and balloons.
They equally surprised me with a card signed by them all and a wonderfully silver serving tray. They had a card for Mrs. Trenton and a small gift. We hugged a lot and I promised I would see them in their clinical.
It was enjoyable to watch them grow, as they gained experience. The reports Roni and I received were of outstanding performances. We were both pleased to meet with each of them as they came in for their certificates and we released them to fly on their own.
The End.
| Author Notes | Thank you to everyone who faithfully followed. Mrs. Armstrong and her students will miss you. (smile) |
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