Walking the streets

I had a conversation with my mom this morning, before class, she asked me how work was going and I told her the truth.

I always prided myself on the fact that I worked at a really large unit in a fairly large town in California.  I mean, we had 48 chairs, we had difficult patients, we had wild turkey’s that crashed through a plate glass window.  I mean, that is pretty hard core. (I am not kidding about the turkey, it really did happen).

I’ve been in several codes, had violent patients, been involved in many projects that, I felt, made me an experienced tech. 

Working in a large city in the downtown area which is known for being a little, um, challenging, has been mind blowing.

There are times I feel a bullet proof vest wouldn’t be such a crazy idea.  Most of the patients are nice, they have had a rough life and are among the strongest people I have met.  Then there are some that, perhaps, have lived too much of a hard life and take their anger out on the people who they perceive as being the cause of all their problems. 

I have always rationalized that a dialysis patient’s life isn’t easy, it’s painful, confusing and utterly unfair.  I can take a lot of verbal abuse before it bothers me, most of the time, it’s not about me, it’s just a way to let out their grief and anger.  Even I do that sometimes, I place my anger, frustration and hurt on things were it does not belong, so I understand that most of the time a patient’s outburst isn’t really directed at me.

Is it right?  No, probably not, but in my mind, I kind of understand.

Violence in the health care happens a lot, patients being violent against staff happen more then most might think.  That type of violence in a dialysis setting can go from abusive words to physical contact in about two seconds flat, if you think I am kidding ask a dialysis tech, most of us have experienced it or seen it happen.  It is a big problem.

Another big problem I was not aware of and has completely taken me off guard is the amount of homeless people we have in our clinic’s population.  We have homeless elderly and homeless middle aged and few homeless people in their twenties, many are addicted to drugs and alcohol, some have just hit a wall and are having a hard time picking themselves up.  Some have been burdened by the economy and social security checks not meeting their growing economic need.  Prices have skyrocketed but wages have stayed the same.

There was a day not that long ago that I was walking a few blocks to grab a coffee from Starbucks on my lunch break.  I had my iPod blasting in my ears and was bundled up in a college sweatshirt, cap and scarf (I am a big pansy people, it’s cold) and I passed a small group of homeless standing on the corner.  I didn’t notice the small child amongst them until it registered a few blocks down.  It didn’t register they were all homeless until an elderly gentleman came in with a QFC paper sack and the family towing behind.  A fellow co-worker told me they recently lost their one bedroom apartment and because of limited space at a family shelter had to split up at night, men going to one and the mother and child going to another.

That’s when I wanted to sit and cry, I guess, I never really thought about homeless families, in my mind, my very selfish mind, it was only those who didn’t want to try any more that were homeless.  Not with people with small children who brought in their elderly parent to dialysis and made sure his catheter was kept as dry as possible.  That family was probably one of the most compliant families in the place and they were homeless.

There were times, I was told, they would call for an extra treatment for their parent because dialysis was the only place he was able to sleep peacefully. 

See, dialysis is so much more then just putting a person on a machine and taking them off.  Many people think this is an easy job, and you know, perhaps a monkey can do it, but a monkey couldn’t make supply bags filled with gauze and tape and antiseptic materials so that if they get their catheter wet they won’t get it infected. 

This job isn’t for everyone, it isn’t just a job, it takes more skills then just phlebotomy.

It is perhaps, the most unappreciated health care field, but there are times I think I don’t want to be anywhere else.

Did you know….?

That in Western Washington the Medic One’s have a training day at a dialysis clinic and learn how to properly access patients accesses in case of emergency?  They even are taught some aspects of the machine.

Tell me why this isn’t done everywhere? Including you, California?  Hmm?

The Story of Four Kims

Did I ever tell you the story of when Kim was in grade school and she was so frustrated because there were twelve other Kimberly’s in her class and every time Kim tried to suck up to the teacher answer a question and was called on the twelve other sucker uppers would chime in with their answers?  Yeah, I was an angry fifth grader, geography was so my thing. 

Well, one day I took a stand and told my teacher that I wanted to forever be referred to by my middle name which no one else had and was exotic and very hippyish lasted for about two weeks during which Kimberly S., the evil whoreish brown haired future cheerleader would remark that Rheana wasn’t my real name. 

Kim S. I will find you on facebook and not friend you, so there, revenge will be mine!!

Anywho, my mother got a progress report in the mail which stated that Rheana was doing well in school, in which my mother was utterly confused and said KIMBERLY!!!!   Alas, middle name as first name died in a fiery ball of a mother’s fury.

12 years later I am faced with the same thing, only the shortened version.  There are in fact three other Kims in the class, and one teacher named Kim.  The other instructors started calling us Kim and then the initial of our last name, but that also got confusing since two of us Kims have the same initials and really just too much energy to expend.

So that is when I became Dialysis Kim, which neither makes me happy nor brings a smile to my cold, hard face.  This especially makes me agitated when the otherKims get names like Bodacious Kim, Kim who wears heels to class, and Kim the runner, I could be, I dunno, Kim who walks at a normal pace, or, Kim who doesn’t wear a jacket because she still thinks she’s in California. I don’t think that’s a mouth full at all, do you? 

So, the four Kim’s got together and decided we’re gunna start a gang and call ourselves the Kims, or more hippish a all girl punk rock bank also called The Kims, perhaps both, we haven’t really decided yet, but we do have a gang sign already and synced all of our iPods, so we are totally set.

Week Two

Well as you can see this blog has been a hotbed of activity, ha!

In case anyone hasn’t told you, nursing school is busy, working and going to nursing school is very busy.  Hopefully in the next few weeks things can be more balanced but needless to say I am extremely tired.

This next week marks our first clinical days which I am extremely excited about.  I know very little but expect to be using what I do know.

On a few other fronts I have been a tad homesick.  I love Seattle, I love I am in nursing school but I haven’t exactly made a lot of friends, which might be my fault and the circumstances I am in.  See, I am not a rich daughter of a doctor, I am the poor daughter of butcher and my parents aren’t paying for my schooling.  I am.  Now, I am not complaining, it was my decision to go to a expensive four year university in another state, sometimes I regret that decision.  Living at home where my mom would make me dinner after a long day at school would be nice right now.  But alas, I am an adult and I will be fine.

Enough whinning…I will write more later, I promise.

I have a few good dialysis stories stewing in my braining de-HIPPA-fying.

On not finding your lobster

I blame myself, to be honest I haven’t been very good at answering emails, returning phone calls or being accessible at all for the last few weeks.

The fault lies with me and for that I am sorry, I was excepted for who I was but I can’t blame him for not wanting to try anymore.

Hopefully one day I will learn the balance, so far it is unevenly sided with nursing school.

The only political thing ever to be stated on this blog…

…and really it’s pretty selfish.

Anyone from California in the audience?  Hello, yes, you guys come forward I am talking to you, the rest may sit and listen.

Prop 8 is basically saying that gays and lesbians can no longer marry in California.  Saying yes would mean you don’t want them to do this, saying no would mean “hell, love is love, free speech, free will, who am I to stop them?”

Kim’s brother, E, is getting married to his long time partner D, E and D are like peas and carrots, like pot roast and broth, like rainbows and ponies.  Plus, they are throwing a huge ceremony and reception where Kim gets to wear a really awesome dress, like, the most awesome dress you have ever seen and really awesome shoes, Steve Madden shoes.  Their wedding date is set for December, which means if this bill passes Kim’s awesome dress and Kim’s awesome shoes won’t get worn by Kim on this joyous day, and that my friends is a waste. 

Not only that, but my brother and his partner D, they deserve to be married, as does anyone in this world who loves someone else, regardless if it’s same sex and opposite sex. 

Now go over to Blurb’s place and read about this, that should ruffle some feathers.

And that my friends is my first and last political post.

IT WOULD BE A SHAME TO LET THESE SHOES STAY IN THE CLOSET.

National certification

Due to the recent influx of hits this blog has received due to the words “bonent exam” sometimes confused with “bonet exam” which is not the same thing, by the way, I have decided to actually compose a post related to this subject.

I have mentioned it a few times on here, I passed the BONENT exam in February of 08, which wasn’t all that long ago.  I passed with a pretty good score, but I still would hope everyone would take what I have to say with understanding that it is my opinion. 

With the recent Medicare Conditions of Coverage (all Dialysis peeps should know about this, so I am not explaining it, it takes effect in mid-October of 08) all dialysis technicians have to have a National certification to practice in a dialysis setting.  This is a huge change for many states who did not require their dialysis technicians to have a state ccertification.

Personally, I think this is a huge step forward for the um, profession, yes, I just called it a profession, you want to know why? Because, my dear techs out there, we are responsible for people’s lives.  Yes, we follow MD and RNs orders but ultimately we are the patients first line of care.  We do the needles, we take the blood pressures, we listen to them when they talk to us and most of the time we can spot a change before the nurse does.  I think it is about time we are held responsible for our jobs, er, professions.

National certification will make so that across the board we all have the same knowledge base, every state is going to have techs who are supposed to know the same thing.  This should be comforting to patients and staff alike.  Take for example me, Kim, the person who writes this blog, I moved from California, which requires it’s techs to have a state certification, to Washington state, which has a state certification but is not as, um, hard to get as California’s is.  The state of Washington also has a different scope of practice for its dialysis techs which I mentioned here.

To obtain my certification in Washington was pretty easy, I paid 105 dollars to the state and sent a copy of my BONENT card and a letter from my employer stating I had passed their check off list.  Done, received my Washington Dialysis Technician certificate.  Easy as pie.

I am sure, I just lost half of my peeps who found this blog by typing in “Bonent exam” but if you’ve stuck with me, here is the meat of what you want to here.

Unless you are a chief tech or someone who fixes machines or does a lot of water treatment, I would suggest you not get the BONENT exam.

The BONENT exam is also a bit more expensive then the other’s offered, instead of 150 for the NNCC exam, the BONENT is 200, but it also lasts for 4 years. 

Oh by the way, BONENT stands for Board of Nephrology Examiners Nursing and Technology.

The BONENT exam is harder then the other national exams available.  It relies heavily on water treatment and technical aspects of the job.  It has been suggested by many dialysis institutions to take the exams provided by NANT and ANNA (links to be provided below).

If you don’t know the level of endotoxins that is allowed in dialysis water, or the levels of magnesium allowed in dialysis water then I would suggest you look elsewhere.  I am not, however, discounting this knowledge, I think it is important we all know what we are working with.  It could mean our lively hood and our patients life if we don’t.  I just think there are easier ways to meet the new Conditions of Coverage Medicare is giving us. 

I will also be sitting with my fellow co-workers to take the CCHT exam (Certified Clinical Hemodialysis Technician) because Kim likes alphabet soup behind her name, and it because why not be certified twice?

And the links:

NNCC

BONENT

ANNA

I would also like to know if this helpful for those people searching for answers and how you feel about these changes.  I think building a positive dialysis technician community is helpful and ultimately a useful tool, interesting times are a head of us in the nephrology field.

Kim R, CHT
Seattle, WA

‘Cause I dunno it’s been a whole week since my last Rufus post

Actually I don’t know how long it’s been since I posted about my cat, but clearly Kim needs to get some action.

“Touch my belly?” 

He likes to watch television.

Week One

So it wasn’t exactly a full week since we started on a wednesday, it was however, a full three days.  We filled out a lot of paperwork, read a lot about what we were up against and washed our hands in front of everyone until they were dry and cracked. 

Proper handwashing, people, will keep you from disease.

And then most of the class feel ill. 

I wish I can say it had something to do with a group make-out session but I think it’s a combo of stress, close corners and well germs and some of my co-workers had been sick too, so there ya go.

I am still super excited about, so much so that my enthusiasm has spilled over into work where most everyone just stares at me thinking evil thoughts. 

Next week we learn more about heart and lung sounds and practice on each other.  We shall see what interesting sounds we have with the lot of us sick and congested.  I know when I get a cold I end up having to use an inhaler since things get all jacked up in there and I am unable to cough up said yuckiness. 

Sorry this isn’t very exciting, or really anything worth while.  I am just tired and sick and all woozy everytime I stand.

On working in an inner-city dialysis clinic

Just some things that a girl from a middle sized Californian town observed while working in a large downtown dialysis clinic:

• The transvestite hookers are harmless and often better dressed then the non-transvestite hookers who are farther down the street.
• Also, they are good escorts at midnight when you need to get to your car, and their fake Prada purses are not fake, people, not fake.
• Finding a crack pipe behind a patients chair is the norm, no, I am not exaggerating.
• Seeing a roach scurry across the floor is not worthy on jumping on a roller chair and screaming, “eck, a roach!”, they are just “a part of downtown, like a mascot or something.”
• Imagining said roach getting big enough to lounge in dialysis chair and watching MTV while telling you it’s too damn cold in the clinic may not be something you express to your teammates.  They may think you are odd.

All in all I totally love working in the “poor” section of the city, the people you met are one of a kind, the experiences are valuable and my California “this is the way we roll, take it or leave it” mannerisms seem to pay off.

Who knew.