Activity Log Sheet #8

Journal Entry #9

Amita Raj

Abney

6^th Period

Journal Entry #9: Thursday October 21 and Monday October 25, 2010

                I spent Thursday with my mentor in her clinic. I saw two traditional cases of kidney disease and learned a great deal about biopsies and a lot of the chemistry-related details behind the lab work.

                My second visit with my mentor was at the hospital, and I had the opportunity to see more interesting cases. I learned a lot about various types of catheters and the risks and complications that accompany the different kinds. I met a patient who was in her seventies who has had juvenile diabetes since her childhood. This led to kidney problems quickly and she had to go through many surgeries with many different temporary catheters. She had a lot of scarred tissue and they were running out of places in which a catheter could be placed.

                This meeting with my mentor was very educational in terms of the patient-doctor relationship. This is because I was actually able to talk to the patient in length about her conditions and the precautions that she has had to take. I look forward to interacting with patients in the future.

Interview #2

Amita Raj

Abney

6^th Period

October 20^th, 2010

Interview #2: Leesa Sims (ICU Nurse)

Type of Interview: In person

Name: Leesa Sims

Occupation: Nurse

Job Title: Charge Nurse/Registered Nurse of Intensive Care Unit

Place of Business: St. David’s South Austin Medical Center

Mailing Address: 901 W. Ben White Blvd. Austin, TX 78704

Phone Number: (512) 447-2211 (Hospital Number)

E-mail Address: leesa123@austin.rr.com

Q.     What universities did you attend and what activities were you involved in?  What was your major?

A.      I got my basics at Texas State. Then, I went to a three-year nursing program in San Antonio in Baptist Memorial School of Nursing. I was mainly in sports-related activities in college. I started out in other majors but I ended up with Nursing. I temporarily held a job in the hospital and worked as a phlebotomist for extra money. That helped me after I got out of school because I already knew how to draw blood and start IVs.

Q.     While you were studying, did anyone motivate you to take the path you chose as a nurse?

A.      My grandmother was an LVN (Licensed Vocational Nurse) and I used to go up and watch her, she worked in a nursing home, and visit with her and I knew then that I probably wanted to end up doing that.

Q.     After you graduated from medical school, what was your first job?

A.      Nursing shortages seem to come around every 7 years. When I graduated in 1980, it was the peak of the nursing shortage then. I moved to Dallas and was hired immediately in a Neo-Natal ICU. I would never recommend that to any baby-nurse that’s fresh out of college because in Neo-Natal ICU you have absolutely no room for air. Those are tiny little things that you have the ability to hurt if you don’t know what you’re doing. But, I stayed the year and as soon as I left that I moved back to Austin. I was immediately offered a job here at St. David’s. This hospital hadn’t even opened yet but it was in the process of opening.

Q.     How long have you worked in this hospital?

A.      I have been with this particular hospital since the day it opened in 1982, so we’re going to 29 years. I feel like this is the place God wants me to be, so here I am.

Q.     How has nursing for you changed at the hospital since you first began working here?

A.      I believe it has become more computerized and things are done a lot faster now than they used to be done. People are in and out of the hospital generally faster. The nurses in general, I believe, don’t have to know as much as they did before. Procedures, for example, if your patient comes in with a heart attack, they don’t wait as long anymore to get that fixed. They go straight to the CATH Lab; we’re not required to stabilize as much anymore, they get fixed quicker. So I think nurses have a little bit of an easier time than they did 20 years ago.

Q.     What exactly does your job entail in the ICU?

A.      I am the Charge Nurse. So, I am over a 20 bed unit and I have to make sure that I know the knowledge base of each of my nurses so I can give them the appropriate patient load. Then, even though the nurse is ultimately responsible for his or her own patient, I am responsible for all of them in a sense that I am the one who makes the assignments. On a day-to-day basis, I may or may not have patients of my own. I make sure the upcoming shifts have enough nurses, so I am also involved in the scheduling.

Q.     Have you always worked in the ICU?

A.      Yes.

Q.     What characteristics do you think would make a person successful in your field?

A.      Critical thinking skills. They would need to have a lot of common sense and a lot of quick-thinking. Like, something happens and you have to think “what can I do right now?”If you’re the type of person who needs to ponder it over or think about it, this is not the place for you. The ability to handle stress. Your sciences are important, you need to be able to pull from what you learned in school. You need to pull all those things together more here than you would on any other floor. ICU is a very broad field. Nurses need to know a broad range of things. It’s very rewarding.

Q.     What do you most look forward to every day?

A.      Making a difference. I don’t like to come to work and just get myself and my patients through the day. I like to know that at the end of the day that I left them a little bit better than I found them. That’s always my goal when I come to work: being on top of my game and that my patients have somehow benefitted from me.

Q.     What do you least look forward to every day?

A.      Mayhem. Because I’m in charge, if I remain calm then most of my staff remain calm. But if we have difficult family members and my staff starts getting upset then it kind of snow-balls. Or if there is more than one test happening at a time then it snow-balls and things don’t work cohesively. So, you hope when you come in that everybody works cohesively and not too many things happen at one time and your staff can step up to the plate.

Q.     Do you want to expand or develop your career?

A.      This is a comfortable fit for me. This is where I believe God wants me to be. When I can no longer physically take the challenge, then I will go to the sedentary pencil-pushing job but hopefully that won’t be for a long time. I enjoy what I do.

Q.     What do you look for in a resume?

A.      I look for if job stability if they have been a nurse before. I am not impressed with a job-hopper. I am not impressed with somebody who just goes from place to place to see if the grass is greener on the other side. When I hire somebody I fully expect that they are at least going to give it a solid year because it takes 3 months to get them up and running. We like to think that they have the common decency to stick with it. I look for that in a person, if they are flighty enough to jump ship if things get a little hard. I do not pay much heed to grades because not everybody is a good test taker. So, whether you have a 2.8 or a 4.0, it’s not that big of a deal with me. The fact that you are sincere and don’t try to build yourself up too much, you tell me the truth and you tell me what you’re looking for, what you hope to get out of it. I am more impressed with your abilities to tell me your weaknesses than your abilities to tell me your strengths and then I know that you know that you got something to work on.

Q.     What advice would you give to students who want to get into your field?

A.      I would tell them that they need to self-evaluate. Ask themselves questions like: Can they handle blood and death? Can they handle trauma? Can they handle someone yelling and screaming at them? You don’t think that family members would do that, but when they get upset they are going to yell and scream. Doctors are going to yell and scream. Nobody ever really means to, but you have to be thick-skinned. If all that stuff bother you, this isn’t the place that you need to be. There are so many other things to do and you need to sit down and decide what you want to do. The ICU is very fast-paced and you have the ability to kill somebody unintentionally by omitting something, by not paying attention, by not being on top of things. If you cannot live with that kind of stress, then you need to work somewhere that is not as autonomous. In the ICU you are the person who is taking care of patients .You call the doctor when you need something. But otherwise, it is your eyes, your years and your intuition. You need to be ready if this is the place you want to be.

I happened to stumble upon this Charge Nurse by chance. I was initially looking for one of the ICU nurses I have known since I first began volunteering at the hospital. However, he was absent during his usual shift. After talking to a couple of nurses, they led me to Mrs. Sims and told me she could give me a great deal of information. She was more than happy to be interviewed. The nurse was very confident about what she was saying and I feel like her responses were true to her character. She was honest and straightforward. I admired that she practiced what she preached, requiring her nurses to have had stable backgrounds and being committed and loyal to her jobs as well. I have seen the ICU in chaos-mode so it was easy for me to understand some of the hardships that she had described.

Activity Log Sheet #7

Journal Entry #8

Amita Raj

Abney

6^th Period

Journal Entry #8: Monday October 18 and Tuesday October 19, 2010

                I spent Monday with my mentor in the hospital and spent Tuesday in her clinic. In the hospital, I saw two patients. One was in the general ward and had a more stable kidney function than the one in the ICU. However, woman was having major difficulties because she had a distended abdomen. This was filled with about 8-10L of fluid and had to be drained out periodically so it was not harmful to her body. The man in the ICU simply had chronic kidney failure. A certain level of ammonia in the body can have negative effects on one’s neurological system. It caused him to be confused, but after treatment, he became more mentally stable.

                In the doctor’s clinic, one patient was forced to be in a wheelchair because of a foot infection that was caused by kidney disease. Her other vitals seemed normal, and she had about 50% kidney function. She was on a great deal of medications (I counted over 15) and this was having a negative effect on her body. However, the doctor said her condition was manageable and she should come every month to the clinic to make sure that her kidneys are not deteriorating. The second patient I met at the clinic was deaf. She had  a translator with her, and it was interesting to see how the doctor communicated with her. This woman also had a manageable kidney disease, so the doctor was very positive that she did not need to see this patient as often anymore.

                With respect to the field of nephrology itself, I learned a great deal about the biochemistry involved in the functioning of the body. I remembered some information from AP Biology about sodium and potassium (etc.), and I was pleased to see that the doctor was impressed by that knowledge.

Annotated Bibliography #2

Amita Raj

Abney

6^th Period

September 15^th, 2010

Annotated Bibliography #2

Tierney, By John. "Salt Wars - NYTimes.com." Social Sciences and Society - TierneyLab Blog - NYTimes.com. 22 Feb. 2010. Web. 10 Oct. 2010. <http://tierneylab.blogs.nytimes.com/2010/02/22/salt-wars/?scp=2&sq=nephrology&st=cse>.

            Salt intake is one of the major aspects of basic body function. The best way to figure out how much salt the body is taking in is by using a 24-hour urine sample. This particular research conducted contained an unusual amount of conflict of interest. Many of the researches worked independently and communication was hard between the scientists. These are the ‘Salt Wars’. This article was somewhat deviant from my work at the placement, but relevant to the effects of research on nephrology in general. The results of research which is conducted by these scientists are what is used during treatment and diagnoses. The most important electrolyte in kidney function is sodium, and the amount of salt we eat (on two extremes) can eventually lead to kidney failure. This article highlights that even though research is conducted for the purpose of medicine, there are still economical politics that can hinder development. This hindrance may also prevent further diagnoses of unknown conditions. I was able to identify with this article because the more my mentor talked about her private practice, the more I realized that being a physician also involves being a businessman.

Activity Log Sheet #6

Journal Entry #7

Amita Raj

Abney

6^th Period

Journal Entry #7: Thursday October 7 and Tuesday October 12, 2010

                I spent both days with my mentor in her clinic. Since I was here last week, I knew what to expect with the kinds of cases she would receive. On Thursday, I saw a man who had just gotten a surgery for a fistula in his left arm. He was middle-aged and had very bad kidney failure. The fistula is used during dialysis. (Note: A fistula is formed when an artery is connected to a vein.) The doctor showed me that if I touch his arm, I will feel I slight buzzing because of this unnatural connection. It felt somewhat like a cell phone on ‘vibrate’. The rest of the time on Thursday, the doctor talked to me about some of the other interesting cases that she had at the clinic, describing in detail the kinds of medicines that were used in treatment.

                On Tuesday, I prided myself in being able to remember many of the medicines that I had previously learned about (although I cannot spell any of them). On this day, I was able to see one of the scariest cases of obesity that had led to Stage 3 (there are five stages, 5 is the worst and means they need dialysis) kidney disease. This woman had many other conditions like psoriasis, edema (caused by kidney failure, build up of fluid especially around ankles; is treated with diuretics), cirrhosis (caused by Hepatitis C rather than alcohol), and rheumatoid arthritis. In addition, she lost one of her kidneys some time ago and the only one left was barely functioning. However, the medications that she had been taking seem to have stabilized the kidney function.

                The second case I saw on Tuesday was extremely interesting. The patient was a 27-year-old man who had suddenly exhibited symptoms of kidney failure. He is not a smoker, a drinker, and never used illicit substances. He had slightly high blood pressure but was not obese. There was no family history of kidney disease either. The doctor was disturbed that a man so young would already have only 35% kidney function. She tested him for other diseases like HIV that would probably affect his kidneys. However, every test she ordered came back negative. This was when she decided she needed to do a biopsy on him. The results of the biopsy showed that the disease this man has is Focal segmental glomerulosclerosis (FSGS). This disease is normally found in children and adolescents, but can lead to kidney failure in adults. What scared me most was when the doctor said, “Kidney disease can never get better, it can only get worse. Our aim is to make the disease get worse slower than it would so you can put off dialysis for a long time.” The patient was nervous about the idea that he might have to start going for dialysis treatment within the next 5 to 10 years.

Journal Entry #6

Amita Raj

Abney

6^th Period

Journal Entry #6: Wednesday, October 6 2010

                This week, with my mentor, I worked one at her clinic and one hour at the hospital.  At the hospital, she showed me a patient with Peritoneal dialysis and explained how the machine cleaned the blood without being too intrusive on the body’s arteries. We discussed the importance of surgery with respect to kidney disease .

                At her clinic, I was able to see patients with milder forms of kidney diseases.  Most of the these patients showed good progress with their diagnoses and the treatments seemed to working out well, showing that there is great hope for the future. Our discussion also included the various medicines that the doctor used for treatment in her cases. She explained the implications of each and showed me some of the research that will be happening for future drugs.

Activity Log Sheet #5