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ILASIK = Intralase Laser Assisted in-Situ Keratomileusis

Most people know LASIK as getting one's myopic eyes zapped by a laser and waking up the next morning with 20/20 vision. That is mostly accurate. A newer version, iLASIK, sounds like a bad, Taiwanese, advertisement: "I LASIK. How about you?"
I've wanted to get LASIK for over ten years, but worried about long term effects and The Flap. A laser or microkeratome cuts a circular flap in a subject's cornea in order to modify the tissue underneath. Articles online warn readers about "dislodging the flap." If one loses one's contacts on the taekwondo mat, fine, pick them up, toss them, whatever. If one loses one's cornea flaps...

The good news is all-laser LASIK, as opposed to LASIK that uses a blade, is far less likely to be associated with flap complications. (If trauma occurs, keep the tissue moist and get thee to an eye surgeon, stat). Guess it's a good thing my violin student talked me out of the older LASIK way back when in Taiwan.

In 1995, PR…

LOC = Level of Consciousness

Tibetan Buddhists see the dream as the middle world between life and death, and our waking lives flickering shadows in Plato's cave (to mix our philosophies). The aboriginal Senoi of West Malaysia actively practiced lucid dreaming; their dream control and utilization mostly freed them from mental illness and violence. For those interested, below's a quick and dirty manual for lucid dreaming.
A simplified architecture of dreaming uses the model of The Tibetan Book of the Dead:
I. Chikhai Bardo: complete transcendence--beyond words, space-time, self--non-rapid-eye-movement descent into deep slumber.
II. Chonvid Bardo: the self, or external game reality, in the form of dream visions.
III. Sidpa Bardo: the return to consciousness through awakening.

I. During the first period, observation and self-remembering increase the likelihood of a lucid dream. Using critical thinking and observation, make a habit of noticing when things simply don't make sense. As you drift off to sleep,…

Week 17. HS = Hour of Sleep

HS, hour of sleep, aka bedtime--a beautiful word to hardworking, sleep-deprived people all around the world. The primary function of sleep is unclear, though it clearly contributes to physiological and psychological restoration. Humans spend a full third of their lives in slumber.

Circadian rhythms regulated by sleep are cyclical, as are sleep cycles. Rapid-eye-movement periods bring the most vivid and curious dreams, including lucid ones. If one recognizes a discrepancy or missing logic in one's surroundings and realizes this is a dream, one becomes suddenly lucid, holding the potential to control an entire dream world, along with the people in it.

When sleep goes wrong, insomnias (difficulty sleeping), hypersomnias (e.g. narcolepsy), and parasomnias (e.g. sleepwalking) occur.

A sedative at a low dose becomes a hypnotic at high dose. Sometimes a paradoxical response occurs; instead of feeling sedated, one develops insomnia, euphoria, anxiety, or rage.

Benzos: Diazepam, Lorazepam,…

Week 16. LPAT = Leveled Physical Assessment Tool

Approach a patient during the head-to-toe physical assessment with no preconceptions, no assumptions, no judgement. Also, with kindness, patience, and respect.
Please allow me to take your temperature, pulse, respiration, blood pressure, and O2 saturation. What is your pain level on a scale of 0-10? How did you sleep last night?

What is your full name? Do you know where you are and what brought you here? What time/day is it?
If you don't mind, I will check your head for lumps and bumps and run gloved fingers through your hair. I see your eyebrows, nice lashes, the whites of your eyes a bit bloodshot. My, what big eyes you have. Do you wear contacts or need glasses? Can you hear this? How about this? Sniff for me through one nostril, then the other. Thank you. Please open up wide so I can see your tongue, mucous membranes, and teeth/dentures. Swallow for me. Say something. Okay, no aphasia, but I'm going to pretend you didn't just say that.
You're breathing a little har…

Week 15. TOD = Time of Death

Dear Mom,  Some nights I still dream of you and in the dream you’re alive (and I’ve forgotten you’re not); we’re arguing about something mundane and I’m angry at you. I wake up and want to return to the dream, because I’d rather argue with you alive than think fondly of you six feet under. I’m thankful for the time we had together, how you’ve helped me grow through a bit of a journey, and as a former psychology major I’m sure you’ll appreciate that Murdock’s The Heroine’s Journey presents a convenient psychosocial model. 1. Shift from Feminine to Masculine: Family have told me when I was little I was glued to your skirt, something hard to imagine because as far back as I remember we never touched or were affectionate. (None of us were affectionate, but it was no secret Dad was my favorite.) 2. The Road of Trials: I’m sorry for rebelling, for not becoming the concert violinist you’d wanted for a daughter. I wish you had believed me and protected me when I told you I was threatened and a…

Week 14. Rx = prescription

Rx, Latin: recipe, to take, prescription.

Below are three archetypal pharmacology test questions for your reading pleasure (yeah!), so that you might also experience the exquisite pain that is the biweekly proctored pharm exam.

Type I. The Lab-Values-From-Hell Question.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105° F. The patient’s skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:
a. iodine-131 (131I).
b. propylthiouracil (PTU).
c. intravenous levothyroxine.
d. methimazole (Tapazole).
Answer: Besides levothyroxine, these are actually all great things that might help a patient with hyperthyroidism, but as the patient is experiencing a thyroid storm in the ER, pick the drug that will act the fastest, which is PTU.

Type II. The "Which Patient Will Die First?" Question. The nurs…

Week 13. DM = Diabetes Mellitus

Diabetes, Greek, to pass; mellitus, Latin, honeyed or sweet.

In 1552 B.C., Egyptian physician Hesy-Ra noticed that ants were attracted to the urine of those with a mysterious disease that also caused emaciation.

150 AD, Greek physician Arateus described the illness as, "the melting down of flesh and limbs into urine."

Today we know diabetes as a disorder of carbohydrate metabolism--the body cannot utilize and store sugars effectively. Characteristic symptoms include the three polys: polyuria, polydipsia, and polyphagia (lots of pissing, drinking, eating). Long term, poor management of the illness can lead to cardiovascular disease, blindness, kidney disease, and amputations.

Diabetes (type II) is also a disease of civilization; modern technology led to surplus calories compacted into innocuous servings, less physical activity, and obesity rates resulting from both increased energy intake and lack of energy expenditure.

A diabetic can be spotted from a singular, extended hand…

Week 12. pH= power of hydrogen

The K├╝bler-Ross stages of grief provide a perfect model to comprehend blood pH (among other things). Denial, neutral, pH 7.35-7.45: One feels neither acidic or alkaline, somewhat ambivalent, almost okay. Also, maybe this was all just a misunderstanding, a nightmare, a midautumn night's dream. Just wake up, and all that transpired will poof, and one can carry on like before.

Anger, acidosis, pH 6.90-7.35: One's so metabolically upset one's lungs are hyperventilating, or so busy yelling & arguing one forgets to breathe and kidneys are dropping sodium bicarb like crazy. Blame, frustration, accusation. Do not keep sliding left down that slippery slope, because acidosis means denaturalization of one's proteins--past the tipping point one plummets all the way to uncertain death.

Bargaining, neutral, pH 7.35-7.45: One tries to make a deal, make the most of things, strike a bargain with supernatural entities, dead ancestors, former partners, the universe. I'll do anythin…

Week 11. CN = charge nurse

Here's a day in the life of a charge nurse, framed within the structure of the monomyth, or the hero’s journey (saving Murdock's The Heroine's Journey for another time).


The Ordinary World: The charge nurse, an intelligent, independent and capable professional, enjoys a quiet night’s sleep in her warm bed on a late October night, the windows cracked just so, allowing the chill of winter to creep in and crisp the air in her bedroom.

The Call to Adventure: After working the day before, she had accidentally left her pager on, and as a consequence she is abruptly woken up by it before the skies were beginning to brighten, with a request for her to come in to the hospital and help manage the floor from 7am to 7pm.

(Near) Refusal of the Call: The nurse hesitates. Having worked yesterday, she knows there are several transfers, shortage in coverage due to multiple admissions and an RN calling in sick, two one-on-one safety sitters required, therefore fewer CNAs on the floor...not a f…

Week 10. CPR = cardiopulmonary resuscitation

Scenario 1. 
An alarmingly white, well-lit airport. Ticket counter.  Your partner grimaces, collapses.  You turn to ask for help, and when you turn back, your partner has turned into a plastic mannequin lying supine on the floor.  No breathing, no pulse. You must compress the mannequin’s chest hard enough with interlaced hands to light up two green lights above the left clavicle.  Two breaths.  Thirty compressions. Please, call 9-1-1! Someone, get an AED... Analyzing: shock advised.  Charging.  CLEAR!  Shock delivered. Resume CPR. Your partner may turn back into a real person, but meanwhile, compressions and breaths keep blood pumping and oxygen circulating. Your partner’s life--interlaced in your hands.
Scenario 2.
The comfort of your home. Your cute 7-month-old mouths toys on a colorful playmat.  You turn around, and NO, this cannot be happening. Baby has been replaced with an open-mouthed, nonresponsive, rubber infant.  Luckily, you are a nurse practitioner and know exactly what t…

Week 9. HF = heart failure

Starling's Law: the healthy heart can handle precisely the volume of blood brought to it by veins. The greater the volume and fiber length, the more Romeo-and-Juliet-like actin and myosin behave, and the heart pulses as hard and fast as necessary to pump all of one's blood through the body once in one minute.

In the failing heart, Starling's law breaks down. In 40 minutes, death from pulmonary congestion can occur. (Some online instructor, long ago, thought it funny to include a picture of a tombstone in green grass on this particular PowerPoint slide. Incidentally, the Chinese call marriage the dirt grave of love.)

Do people still believe in love? Surely, some do, because there's such a thing as broken heart syndrome. Sadness -> stress hormones -> vascular constriction -> chest pain, shortness of breath, hypotension, arrhythmia, possible heart failure. It is literally possible to feel one's heart break, over and over, years apart, especially since humans …

Week 8. PRN = pro re nata, as needed

Pain, like taste and attraction/connection between people, is highly subjective and individualized. There's no one-size-fits-all pain pill or absolute guarantee of relief. Different people's experiences of the same procedure vary widely. Vicodin may have been candy for House, MD, but might do little for others.


While living pain-free, one does not ponder pain intensity scales, Wong-Baker faces or WHO analgesic ladders, but if one is in pain on an hourly, daily, seasonal basis, those pain measures and meds are like saying the right thing and going to the right houses/neighborhood as a trick-or-treater and getting the good candy.

But sometimes one's family doesn't want one to get the good candy, those big candy bars or entire bags of Skittles and M&Ms. Even if one is end-stage-something-rather, one's family somehow isn't convinced one won't end up on the streets trying to score more candy. So non-opioid analgesics it is. And pain, coming in waves, dull th…

Week 7. D/C = discontinue or discharge

Many things can be discontinued: a specific medication, intervention, intravenous infusion no longer needed or working as it should, nurse-patient relationship, any relationship. Though of course something discontinued can always be started again, if needed, perhaps elsewhere. If there are no good veins left on upper extremities, the nurse starts digging into veins in a soft calf, even if the patient protests softly, "Ai, ai, ai."
An IV can be d/c, but only living, breathing people can be D/C (discharged): to go home, to a skilled nursing facility, to a specialized facility, or in some cases, back into the streets. Some people go home alone and perform self care, self medication, self everything. Some require the care of family. Some go to fancy nursing homes much like four star hotels. Some need around-the-clock monitoring and medical attention. Some have no idea what year or date or city or realm they exist in although everything seems to always smell faintly of urine and …

Week 6. EtOh = Alcohol

In honor of the weekend (and no invisible planet hitting us today), here's a really-quite-serious, "How drunk are you?" quiz based on how pickled your brain feels (loosely adapted from Table 38-1 in Lehne's Pharmacology for Nursing Care, 9th ed.)


1. Increased confidence? Euphoria, decreased inhibitions? Congratulations, the alcohol has reached your frontal lobe. Blood alcohol approximately 0.05%.

2. Loquacious? Judgement altered? Your frontal lobe continues to be affected, and you are now at or past the legal limit of intoxication, 0.08%.

3. Tremors? Involuntary body movements? Reduced attention? Your parietal lobe's been breached. 0.15%.

4. Reduced motor skills? Slurred speech? Parietal lobe conquered at 0.2%.

5. Altered perception? Double vision? The occipital lobe's getting pickled, 0.25%.

6. Altered equilibrium? There goes your cerebellum. 0.3%.

7. Feeling apathetic? Inert? In a stupor? Really shouldn't continue, because you're down to the diencep…

Week 5. Drsg = dressing

Wounds must heal from the inside out, the ruptured skin one's largest organ.

Wound care: to change dressings, carefully loosen the tape around margins. Moisten if dressings stick during removal, then assess and measure the damage, including size, color of tissue present, amount and type of exudate and color. There may be tunnels, undermining, necrosis, awe-inspiring and terrifying geological formations of the flesh, craters and caverns, deep vale all the way to white bone. Irrigate with 0.9% saline, or tears, if you like.

Actually, no crying into open wounds, because maintaining a sterile field is imperative for healing. Never turn your back, either. Pack gauze, cover, tape, box method.

And if the gruesome, bone-in-the-middle wound doesn't kill one, one's GPS might try to kill her by repeatedly sending her back to the same spot, barking, "turn left," (into oncoming traffic), over and over again. She might survive, but the P. sennae butterflies liquified against h…

Week 4. IM = intramuscular

So many things are skin deep. Beauty, blemishes, piercings, skin itself. An intradermal injection done correctly: bleb on half a hot dog, tiny yellow bubble on the hefty cake of human flesh or adorable meat cupcake. If you were vaccinated for TB as a child, no more skin tests for life. (It's radiation from chest x-rays for you every two years instead.)


Almost always, the vaccination is worth the risk. Protect your child, protect the immunocompromised, achieve herd immunity.

But we can't vaccinate for everything--not the unexpected, the accidental. Sometimes an old ampule explodes in one's hands, all glass shards and beads of blood, a symbol of something specific in one's life shattering into a hundred pieces, embedding tiny crystals in the skin, the clenched towel insufficient to stop the bleed. Sometimes the hurt is too deep, subcutaneous, intramuscular, all the way to the heart. (The heart's mostly muscle, too.)

But it's no use worrying every time an ambulanc…

Week 3. Inj = injection

"Take then thy bond, take thou thy pound of flesh." (Shakespeare, Merchant of Venice 4.1.13) The star of this week: Shylock's pound of flesh, courtesy of Limbs & Things. Half a log cake: rubber epidermal frosting, spongy subcutaneous cake, red muscular filling. Best thing ever because all those injections would have gone into our skin, our flesh. (This time next semester we'll be human pin cushions.) Also great for petting in lap like Dr. Evil's cat.  Pound cat--no claws, slightly sticky to the gloved touch.
Sterile gloves must be opened up and put on in very specific manner. Hands do not go below the waist; keep every finger in sight at all times. Sterile supplies like Foley catheters must be unwrapped, laid out and prepared just so. Lubricate the tip before contaminating one hand holding apart patient's bits. Never cross the sterile field, lean, or talk over it. 1 inch borders all around. 
Do not inflate a balloon in someone's urethra, or what'…

Week 2. ADL = activities of daily living

The humanity of it all:

Nurse squeezing feces out of colostomy bag of depressed young man, and since the bags are not single use, quietly replacing the curved, plastic clip on not-exactly-sterile bag. Embarrassed Grandpa's clip falling out (and everything else along with it) in the middle of a family gathering.

Enemas (four types), sometimes repeated, or raised and lowered like aquarium-cleaning pump, changing the water if too much solid matter appears.

Patient being lifted by hospital's version of a miniature forklift, dangling in gigantic, plastic stork's pouch like a baby again.

How everything comes full cycle, the girl the mother of the woman, the woman mother of the girl. What starts on four legs, goes on two, and ends on four? Same goes for men, and everyone in between.

None of the positions dignified, upsetting for family to see even though positions change every two hours to prevent bedsores (and with them, lawsuits). Fowler's, dependent upon the bend of the ho…

Week 1. Nsg = nursing

8am's a little early to be watching a dick bath on a large projector screen, but one cannot be shy in nursing.

In the afternoon, everyone will give Tiresias, old rubber man with wrinkled dugs and two options for genitalia, a full bed bath. Also, turn him without breaking his leg off and change his bed with him in it, hospital corners and all. Perform oral care, taking extra care with dentures.

We also take one another's pulse, blood pressure, and respiration, and the vitals of the incredible, programmable, $160k, wifi-enabled, anatomically-functioning man-doll hooked up to a monitor in the mock ICU.

In another room, we practice restraining one another, to a wheelchair or hospital bed.
But every one of us is Houndini.

And this happens--twice.
"Ms. Chao, do you remember me?"
Oh no, here it comes.
"I was in your Engl 1A. It was a really long time ago."

One knows one taught community college too long (and hasn't stayed away long enough) when one goes back t…

DNA

DNA, Deoxyribonucleic Acid, blueprint molecules for everything that makes you you. Race/ethnicity isn't a biological thing present in your DNA, however.

There's a lot we don't know about the estimated 20,000 or so genes present on our 23 chromosomes and the simple and complex traits they govern. We do know that genes coding for superficial traits such as skin, hair, and eye color, are just that--superficial. Scientists argue that race (e.g. African, Asian) is a social construct because there aren't genes only present in Africans or only present in Asians and not present in other "races," and there aren't genes present in all members of a particular "race," either. Two people from the same perceived race can be as genetically different as two people from different races.

So there's something insidious about these ancestry sites that analyze your DNA and tell you what percentage you are of which ancestry. What these sites are calling Irish, Eu…

How to Buy Your College Textbooks Cheap

1. Before the semester begins, find out required text(s) for a course (from the bookstore), and email the instructor to confirm whether an older edition would be acceptable. The difference between editions can be well over $100. Also doublecheck if online access (such as through Pearson) is required--usually online access includes the etext, and publishers might offer an additional looseleaf copy at a low price.

2. Check Amazon for the cheapest used copy of the text (including older editions, if the instructor allows use of older editions). Looseleaf copies can't be resold online, but are usually significantly cheaper. You might also consider renting. But before buying from Amazon--

3. Just in case, Google the title of the text and "pdf" or "free ebook" to check if it's available online. www.gutenberg.org offers over 54,000 free ebooks, for example.

4. If no free copies are available,  try www.addall.com, which searches over 40 used book sites, including Am…

Needle Phobia

As a kid, I was convinced that glass thermometers, like needles, hurt. I lost my shit when the doctor busted out with a big honking needle.

I've only fainted once, in college, after a blood draw. It wasn't my fault, though, because I'd looked away, and when I looked back, the nurse was wiping up a puddle of bright red blood she'd spilled all over my medical form.

20% of the general population experience a fear of needles, according to Healthline.com. Needle phobia is a thing. It comes with its own terminology:

Belonephobia: an abnormal fear of sharp pointed objects, especially needles

Trypanophobia: a fear of injections

Vaccinophobia: a fear of vaccines and vaccinations

This fear actually makes sense in terms of evolution. Heavy-handed symbolism aside, if, like Aurora on her sixteenth birthday, one sees a sharp, pointy thing and thinks, MUST TOUCH, one might not live to pass on one's genes.

I have no problem popping the blueberry-like, bulbous body of a large black…

Some Tips from Orientation

No canvas shoes; blood and urine will spill.
No jewelry besides flat wedding bands, unless you like the image of mashing diamonds in the microbial-habitat equivalent of raw hamburger meat. Protruding jewelry might snag elderly patient skin. No facial piercings; nurses will rat you out in a heartbeat.
Do not violate HIPAA.
Do not engage in criminal activities. Even when you’re not a nurse, you’re still a nurse. They’ll make you go through hell to get your license back, if you ever get it back.
Get CPR-certified, vaccinated, background-checked and drug-screened.
There may be times when you’re willing to pay $80 for a hotel room just so you can get a few hours’ sleep.
ATI, ATI, ATI.
Keep textbooks handy in your car.
Spend time with your family this summer--they won't see you for two years.
If reading poetry under the conference table can get you through orientation, it will probably get you through the RN program.

What's in a Uniform?

While uniforms may perpetuate stereotypes and differences in social status, they also remind us that underneath the fabric, we aren't all that different--those few alleles coding for skin tone and hair color/texture are nothing in the grand scheme of the human genome. In fact, we have far greater differences internally (blood type, e.g.) than externally (hair, skin).

Uniforms were a large part of my formative years, from kindergarten aprons and hats, sailor outfits in music school, hideous military-style khaki in junior high, to shirt, tie and pants/skirt in senior high. We even had uniform hair--I was one of the last generations of Taiwanese girls with 3-cm-under-the-earlobe regulation haircuts (boys had shaven heads). Sure, our faces looked different, but with other variables controlled (no makeup or piercings, socks and shoes regulated), we also appeared the same.

The uniforms were our identity. If one wore the dirt green shirt and black skirt of Taipei First Girls, people wond…

To Be A Nurse

Got a letter of acceptance in the mail: I'm in the Registered Nursing Program.
This all started almost two years ago, when an ambulance took my mother, unconscious, to the ICU of Irvine Hoag. Pneumococcal meningitis secondary to metastasized endocervical cancer. After multiple surgeries that had attempted to preserve her life, then brain and motor function, she came home with us for home hospice.
Being her nurse made me want to continue being a nurse, if not for her, for others.  
After some chem, math, anatomy physiology micro, here I am. At the same community college where I first started teaching after gradschool, where I was repeatedly mistaken for a student at the Registrar, except they were right after all, because it's true, I'm right back where I started ten years ago, but this time as a student.