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Throughout my experience as a medical professional I have come across many tough situations that have profoundly tested my personal capacities. As a Combat Medic serving in the U.S. Army my intestinal fortitude was tested constantly. I learned that I am capable of handling intense, gruesome, high stakes situations that require rapid fire critical thinking, decision making, and clear communication. However, over time I also learned that this high stress style of living and working was not conducive to my mental or emotional well-being. I was able to thrive in that environment for a while because of my Type A personality and extreme levels of conscientiousness. Now, however, in the civilian sector of healthcare, these traits seem to be coming back to bite me. I’m used to following a straight forward algorithm with set delineated parameters and performing rapid fire serial task management, but the current nursing world I find myself in demands complex, independent thinking and multitasking. The adjustments I have been making to accommodate to this new style of healthcare haven’t come easily or naturally to me. I love the fact that I get to treat people like people again instead of just bodies, but multitasking is a surprisingly difficult skill that I still need a lot of practice on.

Additionally, I have found that my Type A personality can sometimes be a little overpowering in some situations which causes unnecessary friction between me and some of my colleagues. I am confident and able to take charge and lead, but I sense that my Spartan style of leadership can create some resentment from my team. I need to learn some softer tactics and apply them to more situations where I am leading a team of female nurses seeing as how this will be the most likely situation that I will face in the future. This isn’t meant to be derogatory of course, but from my experience women tend to need a little more emotional/relational attention than men do in a team setting.

The last thing that I think I’ll admit is that I am not very skillful at stress management. I like to think that I am able to use the stress of a given situation to drive me to accomplish the mission, but more often than not in this new clinical setting, there are no clearly defined objectives; goals are set for patient care and then they shift as the patient’s health status changes. It feels like shooting at a moving target or punching at thin air instead of something solid. The stress doesn’t push me in a definitive direction but rather just shoves me around until I become overwhelmed and depressed. Perhaps I am totally off base, the way I like to contextualize it is that I either need to learn to swim better or get out of the water. I’d like to learn to manage my stress more effectively, though I think it would also be prudent to search for a less overtly stressful area of nursing to settle down in for the long haul.

The episode opens up in a floating pan-galactic emergency department where we see the typical goings on of a regular earth hospital except all the people are aliens. Suddenly, Jerry, the comically pathetic father of the Smith household, and his family come bursting through the main doors with Jerry laying on a gurney vomiting costic acid from a mutant bacterial infection, one that Rick (mad scientist/smartest man in the universe/grandfather to Morty) had invented and left in the second fridge drawer in the kitchen. The alien nurse reassures the family that they have come to the best hospital in the galaxy and that Dr. Glip-Glop would be able to cure him. Jerry vomits on Dr. Glip-Glop  and turns him into a raging monster at which point Rick promptly vaporizes him thus abruptly ending the patient/provider relationship. Later in the episode, Jerry wakes up cured from the infection and is informed by another alien doctor that he is in an alien hospital. Jerry takes this all in stride, but is confronted by a group of alien diplomats who explain to Jerry that they need his penis in order to perform an emergency heart transplant on an important civil rights leader whom is also in the hospital. At first the doctor explains the general anatomical details of the procedure, then the diplomats try to shame him and berate his species for their childishness and lack of wisdom which angers Jerry. He brashly agrees to the procedure to spite them without consulting his wife, Beth. The doctor then describes the procedure pre-operation in very sterile medical language while drawing on Jerry’s “peri-area” at which point Jerry starts to become uncomfortable with the whole situation and asks to talk to his wife. The doctor graciously obliges and tells Beth that they will be replacing Jerry’s penis with a state-of-the-art prosthetic handing her a brochure of all the latest models they have on offer. Beth flys into a rage about the whole situation while flipping through the brochure and the doctor, in a very unconvincing tone, tells her that he “understands” which Beth obviously doesn’t buy and is prompted to more anger. But once she gets a good look at some of the models, she calms down and starts seriously considering which prosthetic she and Jerry would like best. After a heated spousal argument, the doctor shows Jerry into his office to afford him one last opportunity to “use”  his penis before the procedure. There is alien pornography open on his desktop as well as extensive medical records of other patients including the civil rights leader… and obvious HIPPA violation if there ever was one. He tells Jerry not to look at the medical records and leaves him in the room alone. The rest of the episode goes haywire and ends with Jerry getting shot to death by security guards and brought back to complete health by the super sophisticated alien medical advancements at the hospital.

Throughout the episode, Jerry’s relationship to his medical team (namely just his doctor)  is very distant and only serves to drive the plot along. The doctor acts like any normal, disinterested physician would toward a hopelessly naive and emotionally stunted patient would. He tries his best to be patient and stay calm by presenting himself as a professional  clinician. He distances himself from the chaos surrounding Jerry which allows him to do his job and serve other patients, but doesn’t do anything to help Jerry stabilize. This causes Jerry to fly out of control and hold him hostage while he is in the middle of doing the heart transplant. Jerry then gets completely blasted to bits by security but is then brought back by the miracle of advanced alien medicine.  I think this shows that we as clinicians need to be at least somewhat invested in our patient’s care in order to develop an appropriate therapeutic relationship and to keep our patients from getting gunned down in the OR.

Throughout my clinical experience so far, my biggest challenge has been communicating with patients with altered mental status. I had a patient with serious dementia, among other life-threatening health complications, who would constantly yell, “HELP!” When anybody went into her room to see what the matter was, she would stare bug-eyed at the person and waggle her head slightly. She seemed to be able to understand simple words if spoken loudly or written on her room’s whiteboard. The care team opted to use the whiteboard so as to not disrupt any of the other patients on the floor. Whenever I went in to take vitals, she would pull her arm away from me and say, “I DON’T WANT THAT ON ME!” I found myself at a complete loss for what to do in that situation. Should I simply forgo the procedure, or should I do it anyway for her own good since she is so far out of her mind that she likely doesn’t know what she’s saying or what’s going on. I think I simply lacked perspective and understanding of her since I had never dealt with anybody with hard-core dementia before (thankfully all of my grandparents were sharp into their old age). I had no conception of what life was like for her and so I couldn’t make a connection. What might help is more exposure to that patient demographic and to mentor a bit with other health care providers whom have experience caring for dementia and Alzheimer’s patients. Honestly though, the whole situation made me extremely uncomfortable and I’d rather avoid it entirely if at all possible.

Today I sat in the RPAC upper main lobby during peak lunch hour and watched a super-colony of humans interact and maintain social cohesion. It was after my workout as I was calmly sipping on a protein shake eating a banana, and I noticed that despite the fact that there were well over 300 people in a confined space everybody seemed to get along just fine. Groups of friends laughed and socialized as they walked through the main entrance or stood in line at one of the cafes. Individuals with earbuds in and hoods up made zero eye contact as they hauled their hefty gym bags onto their next mission. Old, seasoned coaches reminisced about their glory days and debated the latest team rankings in their preferred sports. Students lounged on the lower decks and slouched in chairs glued to their laptops and Apple products studying for their next quiz, shopping for cute boots on Amazon, and watching dumb cat videos to relax after a grueling class lecture. What truly amazed me about this experience was how normal it all felt; how despite the mass commotion that was taking place, nobody seemed to think anything was out of the ordinary. It was truly surreal.

Hello! My name is Skylar Speiser and I am a second year Nursing student here at The Ohio State University College of Nursing. I work as a Student Nursing Assistant at the Wexner Medical Center University Hospital and my background is in emergency medicine. I was an active duty Combat Medic in the U.S. Army before coming to Ohio and was stationed with the 10th Mountain Division in upstate New York. I eventually want to work in primary care as a health coach, or at least that is the plan for now. My interests are in sports medicine, health and fitness, holistic and alternative approaches to healing, disease prevention through lifestyle improvement, teaching, and environmental consciousness. I am excited to learn about Evidence Based Practice because it makes logical sense to use solid evidence to guide decision making. Simply put, it’s obvious. There’s a quote by Bruce Lee that I have always tried to live by, “Research your own experience. Adapt what is useful. Reject what is useless. Add what it uniquely your own.” This, I think, gets at the heart of what EBP really is.

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