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The Touch

So, Megen wrote this post recently about “Therapeutic Presence.”  The following passage really caught my attention:

Question is: are there more things in nursing, Horatio, than science can explain? Can we touch patients and zap them with calmness or take away their pain? Can we, by our mindset during our provision of care, substantially affect our patients’ outcomes? Can any of this be taught? Can we do it on purpose? I don’t know. That situation has captured my attention, though, because the flip side must also be true—if I despise my patient, she can probably tell that too, regardless of how tightly I’m controlling my behavior.

 

Little backstory:  A few weeks ago I had a laparoscopic cholecystectomy.  Basically, a very nice surgeon made a few incisions into my abdomen, inserted a camera and some wrenches or something, and took my gall bladder out.  I had never had surgery before.  Never been intubated.  I have been on “the bed side” quite a few times, but never for surgery.

A week elapsed between the time we decided to do surgery and the time the surgery actually happened.  It was a really hard week for me as I was very anxious about the whole thing.  I’m not even sure what exactly it was that I was nervous about.  I trusted my surgeon completely, I had full confidence in the hospital I was having surgery at, and I know it’s a procedure that is done thousands and thousands of times a year with a very low complication rate.

Still…. well, I guess I have never been completely unconscious in a room full of people who were looking at my insides.  I have never relied on a machine to breathe for me.  I had never been under general anesthesia before.  Basically, I was going to be vulnerable and exposed.  One of the biggest things that caused me angst, though, was that I would wake up still intubated.  The anesthesiologist assured me I wouldn’t remember being intubated at all.  That was helpful.  I believed him.

Anyway, I was supposed to tie this in with the passage at the top, wasn’t I?  The point is that I was very nervous and the morning of the surgery found me in the pre-op area holding back nervous tears, sometimes unsuccessfully.  I had the footies on, had the gown on, admission assessment was done, IV inserted and then we were just hanging out waiting for the surgeon.

One of the nurses who would be with me in the OR came to wait with me and she was genuinely so sweet and caring.  Her general demeanor really put me at ease.  We really were just waiting for the surgeon to show up; it was about 10 minutes past when I was supposed to go in.  I was in the middle of mentally deducting stars from my future Yelp review of him when he finally showed up.  We had a little chat, and then he left to go scrub.

In the meantime, a second OR nurse showed up in my little pre-op area.  When the surgeon left, and it was time to go, I started crying a little again.  The first nurse was at my side and was very sweet and reassuring.  The second nurse was behind me, to help push the gurney to the OR.  When she realized I was upset, she put her hands on my head.

I am not a touchy-feely person.  When my patients are distressed, I’ll put my hand on their hand or arm and that’s about it.  Before this experience, if you had asked me what would reassure me if I was upset, touch would actually be way down on the list, and touching my head?  No way.  But for whatever reason, her hands on either side of my head was exactly what I needed right then and I was immediately calmed by it.

Why? Why would someone find solace in something they would normally consider to be annoying?

By the time we got into the OR, I was ready for some pharmaceutical assistance.  I moved over to the (very narrow!) table, and as the nurse was strapping my arm to the board, the anesthesiologist appeared next to me.  I told him I could really go for a nice intravenous cocktail anytime and he said he already injected some Versed.  The last thing I remember saying is, “Well, I don’t fee…”  Heh.

I woke up in the recovery room and felt nausea and pain.  All I had to say was “hurts” and “sick” and I was out again.  The next thing I remember was being asked to scoot over to my bed on the surgical floor.  I said yes when they asked if I wanted some morphine for pain, and dang!!!  That stuff really burns.

I went home later that day and my recovery was very uneventful.  I was really amused to see that my incisions were covered in skin glue!!  No dressings at all.  Just 4 incisions with a coating of glue over them.

Anyway, I had barely even remembered what the OR nurse did until I read Megen’s post.  I think she’s on to something.

 

 

 

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Knock, Knock. Who’s There? Asystole.

At work, we have Voceras.  They are little phones that we wear around our necks.  We use them to call each other, other departments, take phone calls.  They were a little annoying at first and kind of hard to get used to using, but now we all use them every day and I personally have found them to be really helpful.  Our unit is large, and instead of walking around trying to find Susie Q RN to tell her she has a phone call, we just click our Vocera button and can reach her instantly.  Easy.

They added a feature a little while ago.  The Voceras now tie in with the patient monitors.  I don’t know how it all works; for all I know, the unit secretary brings out a magic wand, chants a spell, and then the monitor and Vocera both know what patient I have that day.  This results in a couple of things.

First, when MY particular patient puts their call light on, in addition to hearing it throughout the unit, my personal Vocera makes a sound so that I know without looking around that it’s my patient who needs help.  Next, and this is pretty interesting – when my patient has an arryhthmia, my Vocera makes a “do-dunk” sound.  It kind of sounds like a knock.  I look at the little screen and it tells me which room is alarming and what the alarm is.  All very helpful when I’m in my other patient’s room.

So one day, I had a patient that wasn’t doing very well.  We were communicating with the patient’s family and trying to decide whether or not to make him a no-code, or withdraw life support altogether.  It’s an understandably difficult decision to make and the family was struggling with it.  As the day wore on, though, the patient was becoming more and more unstable.  The monitor started alarming, which made my Vocera start doing its “do-dunk” sound when the patient started having bradycardia.  The family still wasn’t comfortable with the idea of taking him off of life support though.

Then it came to be my turn to go to lunch.  We had a break nurse, so she could completely take over caring for my patient and only my patient while I was gone.  I brought her up to speed on the situation.  As I left, I could see the family coming out of the room to talk to the nurse that took over for me.

I went to the cafeteria to get lunch, brought it back to the break room, and started to eat.  I was talking with a coworker about our kids when I heard the familiar “do-dunk.”  But when I looked at my Vocera, it said, “Room 2-0-1-1 ASYSTOLE.”

And that is how I found out, over lunch and lighthearted conversation, that my patient had died.

I told my co-worker what my Vocera said, and without even looking up she replied, “You know, you can push that ‘Do Not Disturb’ button.”

Um… yeah.

When I returned from lunch, the break nurse started to say, “Your patient…”

I just said, “Yeah, I know.”

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My turn to be interviewed!

Online Nursing Degrees is doing a series of interviews on nurse bloggers.

To learn more about how nursing students mature into seasoned healthcare providers, we studied popular nursing bloggers to see what they had to say on the subject.

We found the voices of dedicated professionals with intelligent conversations and compassionate stories illustrating what is happening: in hospitals, classrooms, organizations, public health, state-run or federally sponsored institutions, private hospice care, and more. These are nurses (some currently students themselves) who intimately understand the questions, concerns and the feelings shared by many nursing students: they embody the statement, “Been there, done that.”

You can see the whole series here (we are at the midpoint now, each day another link will go live).  My interview was posted today.  Enjoy!

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Interview – School Nurse

Well, what better time to post my interview with Erin at Tales of a School Zoned Nurse than now, when everyone’s headed back to the classroom?

Erin is a school nurse in the “cash strapped state of California.”  Her position covers two elementary schools and a middle school – almost 2000 students!!  She has been blogging since last year and her blog has definitely become one of my favorites.

She says she was never too set on working in a hospital.  After nursing school, she worked at a couple of summer camps, which gave her the idea to look into being a school nurse. She was hired right away and “leapt in without a second thought.”  She is starting her second year in this position.

Erin’s daily schedule is quite varied:  hearing and vision screenings, cleaning up playground accidents, making various referrals for a number of issues (such as dental and vision checks), scoliosis screening, making sure the school in compliance with state mandates (e.g. immunization requirements), checking on diabetic children and dealing with whatever else arises during the course of her day.

She blogs a lot about the parents of her students and I am almost always blown away by her Scary Parent stories.  She says incompetent and neglectful parenting is by far the most frustrating part of her job.  (Read Exhibit A, Exhibit B, and the continuing saga of Exhibit C)

One of the highlights of Erin’s job is her ability to be a good role model to the kids.  She’s spent time in the classrooms and after-school programs talking about her job and as a result, the kids got to know her and look up to her.  “It feels good to be someone kids turn to when they need someone to talk to or confide in.  It’s satisfying when I’ve made a different to someone, like seeing a student with glasses after making a vision referral.”

Being rather new, Erin does have other experienced nurses she can go to if she has questions.  She is the only nurse at her 3 schools, but there are 10 other nurses spread throughout the district.  They stay in contact often by phone and email.  But other aspects of her job aren’t as supportive – the computers she has to use are “from the dinosaur era” and she carries her audiometer and vision charts with her because there aren’t enough to go around at the schools.

Her position is salaried on a teacher contract, so she works 7.25 hours per day.  The timing is left up to the nurse since they cover different sites on different schedules.  Depending on what school she’s going to that day, her schedule is generally 8-3:15 or 7:30-2:45.  She’s able to accomplish what she needs to do in those hours, but not everything she wants to do.  “I can finish the required health screenings and state mandated requirements, but there is never enough time in the day for the other stuff that I want to do:  get new shoes for the girl whose mom won’t take her in, diabetes teaching for my newly diagnosed diabetics, following up on referrals so kids can get the glasses they need.”

To prepare for her job, Erin became a certified school audiometrist (a 4 unit class).  If she decides to remain a school nurse, California requires a separate license, which requires more education.

And of course, my favorite question:  One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom. Do you find that to be the case with your job as well?

“I don’t always get to eat when I want to, but there is time during the day – eventually – to do so. I’ve learned if I bring a hot lunch I’ll probably need to reheat it at least once during my meal, because I usually take lunch at my desk and am frequently interrupted by tetherball accidents.”  (How many nurses can say that??)

My son will be starting Kindergarten this year and one of my main concerns is his peanut allergy.   His preschool was peanut-free and this will be the first time that he’ll be out in the peanut-filled world for such a long period of time without my own constant vigilance.  So of course I wanted to get Erin’s take on the current allergy situation:

“Food allergies are definitely a big concern, and though I haven’t myself, I know many school nurses that have had food allergy related 911 calls. It’s a huge gap in our care: nurses are technically the only epipen trained staff (just starting this year other school staff can volunteer to become trained, but most I’ve talked with don’t want that responsibility), and when we have three school sites we obviously might not be at a school site when an incident occurs. I do my best to reduce any incidents by first calling the parents to find out exactly what kind of reaction they might have – sometimes parents claim allergies when their kid just doesn’t like the food.  [Ed:  ARRRGGGGGHHHH!!!!!]  At the school, I notify the staff and call the student into my office so I get an idea of how well they understand their allergy. Then…. Then I just hope for the best. For parents, I really recommend talking directly with your child’s teacher and nurse – please! And bring in those Epipens!”

(Not only do I have 2 separate boxes of Epipens; one for the classroom and one for the office, I have a brand new bottle of Benadryl that I’ve already opened, taken all the plastic off and marked the appropriate dosage on the medicine cup.  I also have his photo taped to each bag of meds, which includes a copy of the doctor’s orders.)

And this is what Erin wants you to know about school nurses: “The job is what you make of it. I think there’s a reputation that school nurses have that is undeserved: we’re practically retired nurses working a boring job. There are certainly those nurses that do this job for the schedule, just like there are those hospital nurses that just do it for the money, but we’re not all like that. It just depends on how involved you are with your schools and kids; the more involved you are, the more you see there is to do, the more there is to keep you busier than you have time to be…but the more involved you are, the more rewarding it is, too, even if exhausting.”

Thank you, Erin, for giving us some insight about being a school nurse!

(My post about this project and a list of interviews done so far is linked here.)

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Calling Hospice Nurses

So, I’m considering a career change.  It’s probably far off, as my little baby is only 1 year old and won’t be starting school for awhile, but I wanted to start preparing as much as I could.  I am interested in hospice, either in-hospital or in a home setting.

Are there any hospice nurses out there that read this blog?  If so, please contact me – codeblogrn@gmail.com

Thanks!

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Opening My Heart & An Interview with Tilda Shalof

Well, not my heart.

I was contacted awhile ago and asked if I wanted the chance to read and review Tilda Shalof’s new book, Opening My Heart.  (Amazon link, but NOT an affiliate link – I live in California and due to a new law, Amazon has cut all ties with us).

I had the chance to include a story in a book that Tilda edited a couple of years ago called Lives in the Balance.  So I had fond memories :)

I’ll say up front that I enjoyed the book.  I had a range of emotions while reading it – frustration, worry, happiness.  Frustration because although Tilda is a very experienced ICU nurse, she doesn’t take her own health seriously at all.  I read with disbelief as she described her incredible denial of the obvious need to treat the heart condition she was born with.

I was amused at her doctor’s and husband’s reactions when she tried to tell them that if anything went wrong with her surgery, she didn’t want to be kept alive on machines.   She explained that she used to have a dog and her husband absolutely refused to euthanize the miserable thing.  I liked this passage in particular:  “To Ivan, love means never stopping love or giving up.  This is what families say.  They can’t let go because of love.  I hope no one loves me this much, ICU nurses often say to one another.”

Amen, sister.

Tilda writes about her surgery and subsequent recovery, which I found fascinating.  I love hearing about patient experiences, and having a nurse tell it from her point of view was pure brain candy to me.

She writes a lot about her friends and coworkers and her interactions with them.  I admit I found those particular parts of the book a bit draggy, but maybe others would find them an enjoyable read.

Lastly, she wrote a lot about depression after her surgery.  I don’t know for sure, but I don’t think this is addressed much when the doctor is informing the patient about what heart surgery will be like.  I think it needs to be given more consideration and that patients need to be told that it’s a completely normal thing that happens after such a big surgery.  Not dealing with it can impede healing and recovery.  I was really pleased with how much attention she gave to this particular part of her experience.

Anyway!  Tilda very sweetly agreed to be interviewed!  I am really excited about posting an interview with her on codeblog.

How did you get started writing books?  Did someone come across something you wrote and suggest you write/publish a book?  Or did you write a book and send the manuscript to agents?

I had been writing for many years before I got published.  Taking writing courses, sending my manuscripts out, and receiving numerous rejection letters from publishing houses was the extent of my writing hobby for years.  In 2004, I got a lucky break when I sent my true stories of being an ICU nurse to one of Canada’s top publishing houses, McClelland & Stewart.  To my surprise and shock, they offered me a book contract on the spot.  They said it was a new perspective, a real insider’s view.  Well, who better to provide that than a nurse, I thought?  I hope with A Nurse’s Story and my other books, that I’ve opened a door to more nurse writers to get their stories out.

Have you always been a writer or is it something you started doing as an adult?

Yes, I’ve always been writing, recording my life and observations, but it was only in the last few years that I have been published.  It took me a long time to be ready to share my stories with the public.  I had a lot to learn about the craft of writing.

Many nurses haven’t published books – what is something we’d find surprising about being a nurse author?

The most surprising thing I’ve learned from being an author is not how many amazing nurses’ stories there are – I knew that – but how few are actually undocumented.  Nurses aren’t speaking up enough and thus their voices aren’t being heard. I hope I’ve started a trend with writing about my nursing life.  Other nurses love to read these stories and the public needs to know what we do. It’s a matter of their health and safety to understand more about the roles and responsibilities that nurses have, otherwise, misconceptions and stereotypes can flourish.  Otherwise, we also run the risk of being invisible and completely overshadowed by doctors who traditionally have had a lot more power and stronger voices.

You mention your coworkers and friends many times in the book – do you use real names?  How do they feel about being mentioned?

Yes, I use real names of friends/co-workers and usually ask their permission to do so.  So far, no one has objected, and most are pleased, or at least in agreement with what I’ve said about them.

Do you do a lot of book promotion (signings, readings, etc)?

Not much book promotion per se, but a lot of speaking to groups of nurses, doctors, and the public at large about what nursing is all about.  Now that my new book, Opening My Heart is out, I enjoy speaking also to patients.  I love to be invited as a guest speaker and wherever I am invited, I am thrilled to go.  Also, I enjoy connecting personally with nurses on my Opening My Heart Facebook fan page and one-to-one emails through my web-site – www.NurseTilda.com.  That’s truly the best part about being a nurse author – connecting with other nurses.  If anyone writes to me, I always write back, usually in a day or two.

Do you have marathon writing sessions or do you write a little every day?

Both!  I love the opportunities to immerse myself in my writing world for extended periods of time, but for an hour in the morning after a night shift, or on a day off from work, in between household responsibilities and being with my kids – two boys, 16 and 14 – I squeeze in some writing, too.  If you wait for the perfect conditions for writing, you might not ever do it.  You just have to plunge in amidst the chaos of a day.

————-

I thought Opening My Heart was a great read and I recommend it.  And thanks to Tilda for taking a few moments out of her day to answer some questions!

 

(My post about this project and a list of interviews done so far is linked here.)

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New Shoes!

For Nurses’s Week, Timeberland PRO Renova offered to send me a pair of shoes to try out.

I chose these, the Professional Slip-On.  I usually wear athletic shoes for work and those have served me well for over a decade.  I did try backless shoes once, but I kept shuffling my feet in them for some reason.

I’ve worn the Timberlands for a few shifts now, and I have to say that I like them.  They kept my feet cool.  Honestly, my main criteria for good work shoes is how my back feels at the end of the shift.  I get suspicious that my shoes are wearing out/aren’t good when my back starts to ache at the end of a shift.  Timberland claims to have some fancy “anti-fatigue technology.”

Whatever technology these shoes possess, I have to say that my back and feet felt great.  For a die-hard tennis shoe gal, I found these to be very comfortable.  I also found that going up a half size from my tennis shoes worked well, so keep that in mind if you want to try these!  I’d definitely recommend them.  There are a variety of styles, colors, and patterns.

Some interesting tidbits from the “Always on My Toes” survey:
*    Always on their toes – literally!: 54% claim the longest shift they have ever worked has been over 16 hours, which is double what a typical person works in a day.
*    Caught Stepping Out: 35% have worn their nursing shoes outside of work because they are so comfortable and a whopping 92% also noted style was important when it comes to their nursing shoes.

Disclaimer:  I was given a free pair of shoes to test out, but this review is my own. I really just have nothing bad to say about them!

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Interview: Cardiac Cath Lab Nurse

Ready to learn more about nurses who work beyond the bedside?  Nurses who work in the Cardiac Catheterization Lab (CCL) play an important role in cardiac care.  Amy Sellers, RN BSN CCRN CSC CMC blogs at Nursing Influence and graciously agreed to give us a peek at what a nurse is responsible for doing in the CCL.

Amy has worked in the Cath Lab for about 6 months now.  She previously worked in CVICU for almost 5 years before deciding that she needed a new challenge.  She is paid hourly and works three 12 hour shifts per week (all daytime Mon-Fri) with lots of opportunities for overtime and call shifts.

A cath lab is an area of the hospital that uses fluoroscopy and contrast dye to check for narrowing/blockages in arteries or veins in the body. Using special equipment, they are able to perform angioplasty (open the arteries with a balloon), place stents, insert IVC filters (a filter that is inserted into a large vein which prevents blood clots that form in the leg from getting to the lungs) as well as inserting pacemakers/ICDs.  ICDs are Implantable Cardiac Defibrillators.  They detect if a patient’s heart goes into a lethal rhythm and provides a shock to the heart if necessary to get it beating correctly again.

What do you do all day?

I care for patients, of course!  We have 5 cath labs and we have at least one nurse assigned in each lab (a 2nd nurse may be assigned to that room under the role of “scrub”, meaning they prepare the sterile field and assist the physician during the procedures). When I’m assigned to the nurse role, I am responsible for all things related to patient care & medications during all of the day’s procedures. After the physician arrives, I am responsible for administering conscious sedation, performing all of the charting during the case, monitoring patient status during the procedure, as well as giving any emergency medications that may be needed during the case.

Amy says she loves the direct impact that she’s able to have on a patient’s life. For example, patients come in to the cath lab from the ER actively having a heart attack. Within minutes, her team is able to locate the blocked artery in the heart and open it up, restoring blood flow and improving the patient’s clinical symptoms.

“In addition the impact we have medically, I feel like I make a difference each day by helping to calm the nerves of our patients undergoing this procedure. Most patients are pretty nervous as we wheel them into the lab and I really take pride in being able to talk to the patients and help them through education or just small talk.”

Do you feel you receive adequate support for your responsibilities?

I feel like I get a great deal of support from everyone in the team, from the physicians, to the radiology techs, to the scrub techs. It’s the combination of everyone’s skill and experience that makes the cath lab run so smoothly and helps to back up the growing skills of a newbie to the cath lab (like me).

What is something a nurse who does not work in your particular field might find surprising about your job?

I love the positive relationships that the staff in the cath lab have with the cardiologists. Working in the CVICU prior to the cath lab, I felt like I had a good relationship with most of the physicians. They would listen to the observations and suggestions I made about my patient, leaving me feel like I was making a difference for my patients. The relationship between staff and physicians in the cath lab is much closer; it truly is a team. Physicians ask for, and accept, suggestions from staff as far as the best equipment to use for a particular case or which vessel is more crucial to fix before another. Physicians and staff get to know each other to the point that it feels like a second family – they ask each other about their children’s school plays, volunteer activities they’re involved in, etc.

Amy says she finds that she does accomplish her responsibilities in the time frame she is given:  “Working in a procedural area makes this easier as cases are scheduled within a set time frame. When emergencies happen, we have a 3-person call team available at all times during non-work hours.  Working in the cath lab is 100%, without a doubt, a job that requires a great deal of teamwork. Without one of the essential staff members, a case could not be done.”
Was there any extra training besides on-the-job learning that you were required to complete for this job?

As a cath lab nurse, there is no specific training, but experience in the cardiovascular field is highly recommended as advanced EKG recognition and knowledge of hemodynamics are a big part of the nurse’s role. A nurse that is new to the cath lab will more than likely need about 2 months of orientation to be able to function safely and proficiently on his/her own.
One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom. Do you find that to be the case with your job as well?

I always have a few seconds between cases to use the bathroom…. but the problem of using the bathroom can happen during a case that runs unexpectedly long. As the only nurse in the room, we are unable to leave. So, at that point, I’m thankful for the bladder control I developed during my days in the ICU. :)

Thank you, Amy, for sharing what it’s like to work in the Cath Lab!

 

(My post about this project and a list of interviews done so far is linked here.)

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GIANTmicrobe Winner!

I hope everyone had a great Nurse’s Week!

To pick a winner for the GIANTmicrobe, I printed out the names of everyone who commented and put them in a bowl, then had my 4 year old pick.  And the winner is…. Katie!  Congrats!  I’ll email you soon with details on how to get your lovely plush microbe :-)

I spent many hours last night revamping my blogroll.  I updated buttons for those blogs that adopted a new look over the last year or so and weeded out some blogs that seemed, well, dead.  I also added a few.

I also had a chance to interview a few more nurses for the interview series!  I’ll be posting those soon.

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Happy Nurse’s Week!

Hi everyone, happy Nurse’s Week!  I’m sure your hospitals are doing fun and exciting things for you this year – giving out free penlights, stethoscope name tags, a little bag of candy?  Maybe an ice cream social?

Actually, I kind of like the ice cream socials.

Anyway!  Here at codeblog, we might have a little something to give you in honor of Nurse’s Week!  Remember when I got mono?  Well, courtesy of GIANTmicrobes, you can get mono, too!  Or if you’d prefer, we could get you some cholera, toxic mold, or even gangrene!

How freaking cute is gangrene?!  Those vibrant green eyes!  The cute little ruffle!

Or Giardia??  Don’t you just want to cradle it and tell it everything will be okay?

One commenter will be rewarded with the bacteria, virus, amoeba or cell of their choice.  And pursuant to my post all those many years ago, they have indeed added C. Diff and MRSA!  And one of them could be yours!

To be eligible for your disease-of-choice, just leave a comment telling me something you got for Nurse’s Week from your place of employment.  If you aren’t a nurse, leave a comment suggesting something nurses SHOULD get for Nurse’s Week.  Or what your mother, father, sister, brother, 3rd cousin twice removed or dog’s best friend’s owner got that one time.

One lucky commenter will be chosen at random (which may or may not involve throwing all of your names into a hat and letting my preschooler pick).  And, of course, the fine print:  this is open to U.S. residents only, please leave a valid e-mail address because that is how we will contact you for your address and choice of toy.  The lucky commenter may choose any 5-7 inch plush doll.  Although those little petri dishes are really very cute, you are on your own if you want one of those!  :)

Any comment made at this time until midnight PST on May 17th, 2011 will be eligible.  One comment per person, please.

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Author

  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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