Aminophylline, Amlodipine, Amiodarone, Amytriptyline

The exam is 4 weeks away and while I've made progress, I fear I will run out of time.  I threw money at the problem last weekend by spending $140 at Barnes and Noble on an up-to-date drug guide, the 2009 edition of Saunder's NCLEX-RN Review, complete with CD-Rom of 4000+ practice questions (I'd been working from the 2004 book I bought back when I started training), and two spiral bound reporter's notebook style booklets: a collection of drug flash cards with supposedly mnemonic cartoons, and RN Notes, a surprisingly accurate and useful instant guide to just about every aspect of nursing I can think of. 

This all has helped. I told Phil that they must have dumbed down the exam between 2004 and 2008 as I seemed to be getting more of the questions. But I think it has more to do with the simple number of hours clocked. My brain has finally woken up, and things that I stared blankly at a month ago  -- even though I knew that I used to know it -- now make sense. And my memory of work experiences, specific patients, conditions and advice from helpful nurses has returned. But it was weird that it all had been filed away so deeply. It probably didn't help that I just finished reading Still Alice, by Lisa Genova, a wonderful, painfully vivid book about early-onset Alzheimers.  I found myself staring at phrases like H2 Receptor Antagonist and muttering that I didn't know anything about it, very much like Alice in the book. And then I dug out the notebook I'd carried on the wards at Kingston Hospital, listing contraindications, side effects and other useful information about H2 receptor antagonists, and dozens of other medications...

Here is proof that I did once work as nurse -- the only photo of me in uniform. It's Christmas Day 2007, about 6am, my second-to-last day of work.

Drugs have been a particular problem, but I found them difficult the first time around. The medication names always seem to me to be almost random collections of syllables.  Until I started working and actually administered them, metronidazole and metroclopromide were all but interchangeable in my brain. And when I first came to London, so were Fulham and Feltham; Islington and Isleworth; Hemel Hempsted and Hampstead. None of the names of these London "villages" had any meaning for me until I'd been there quite a while, and had driven around by myself and could specifically attach people to the various places, such as that Fulham was where Rick lived and was therefore fashionable; Feltham was on the way to Phil's parents' house and had a rare drive-thru McDonalds.

So now, when I do a practice exam, I am taking a little comfort in the knowledge that the stuff I've covered in my review schedule, I know fairly well. I still need a few hours each on oncology, maternity, pediatrics, renal, IV drug administration, eyes, skin disorders, ECG interpretation, AIDS and HIV, and blood products. And there just aren't that many days left. But I've been lucky with exams before...

Motivation

I'm having a hard time making blog entries, because if I am not playing with Fred or doing domestic duties, then it seems to me that I should be studying. And if I'm going to skive off completely, then I might as well make myself happy and knit.

The problem is that I am scheduled to take the NCLEX on December 11th. I am overwhelmed by the things I've forgotten in the last 18 months, and more seriously, by the things I never learned, which I need to know in order to pass. American RNs do several activities that British RNs do only once qualified, after on-site training such as giving IVs and taking arterial blood gases. They do other things that British nurses either never do, or do only after taking on advanced qualifications, such as auscultating chest sounds. I did know this, having lurked around on several nursing sites before I started training. So I knew that I would have to make a big jump up to the exam level. Thousands of nurses from all over the world do it every year. What I did not expect, was to have only 8 weeks in which to do it.

The practice books I have are full of sample questions, many of which I am getting wrong.   I have met a wonderful neighbor who is an RN and now a lecturer on the faculty of UT school of nursing. She came over the other morning and talked with me for two hours about the exam and how to practice for it, and what items are most important. 

What annoys me is that many of the things I need to learn are things which I would have expected to learn at the University of Surrey, but did not. Things like the normal lab result ranges for blood counts, and the side effects and contraindications for the 50 most commonly used medications. I can't really remember what we did instead of all this. I remember multiple lectures on various NHS and Department of Health initiatives, on the benefits of socialized medicine, and repeated labs on how to move patients safely, to avoid injuring ourselves and - presumably - lawsuits for our employers.

will post some more cheerful photos this weekend. 

Legal at last

Here's a nice thing. I finally have a Texas driver's License. That is huge. Americans know how necessary that is, and how absolutely taken for granted it is by everyone except foreigners.  I couldn't walk into Lucy's school without an elaborate explanation to the security guard about how UK licenses didn't have the magnetic strip she was trying to scan into her ID sticker generator, and that, Yes, I did  live here, but No, I hadn't yet got around to getting a license, and Yes, I really must do because it would make HER JOB so much easier....

It was a HUGE palaver, as they say in England.  I had to start completely from scratch, despite waving my old Illinois license which expired in 1992 (and such a sweet photo!). Starting from scratch means a huge identity parade, consisting of every legal document I've ever owned, followed by The Written Test, followed by the Road Test. Each phase meant getting to the Department of Public Safety before 7am to queue up, and phase 1, the document screen, involved a 3-hour wait. Luckily phase 2 - the written test - involved enough of a wait that I managed to skim the Texas Rules of the Road booklet, which enabled me to pass the test. There were some totally unfair questions about the penalties for drunk driving ("on a first offense, is the penalty A: $10,000; B: $5,000 or C: $2000." The answer is C, but the penalties go up steeply for repeat offenses.)  And actually the written test involved pressing buttons on a computer screen and no writing at all. I only just passed with 85%.

The road test, which I took just before school started,was a complete fiasco, because after leaving the house at 615am to queue up for a later test time, I returned to the DPS, drove into the test line and was told by the tester that my car was not only unsuitable for testing, but not road legal. It seems there is a kind of MOT in Texas, at least a vehicle emissions test, which was completely news to me. And my car's had expired 3 months earlier. However he took pity on my pseudo English accent and sent me to a garage around the corner which would administer the emissions test for $28. I drove home to collect all 3 children who had been splashing around in the pool, drove into the garage and parked all four of us, including Fred's buggy, in their tiny waiting room. Half an hour later, we raced out with the pass certificate in hand, drove around the corner to the DPS, and queued up for the test a second time. I sent Fred and the girls for a walk in 104F heat up to the Wendy's restaurant on the next corner with instructions to buy ice cream, and waited my turn.  The same man beamed at my documentation, asked me to drive around the block and complete one parallel parking maneuver and passed me.

It came last week in the mail, followed by a $200 deduction in our car insurance premiums, as we're no long aliens, in their eyes. And Texas no longer includes height and weight on their cards, no doubt because everyone lied about it anyway.

Authorization To Test

It's weird to me that I have so many lovely friends here and none of them know anything about my recent career upheavals, and that's probably a good thing. And being a SAHM (stay at home mom) for the last year and a half has been fun, although it will be better once the building work finishes. But all that is about to change. After six months of completing online application forms in the US and UK, repeatedly emailing the registrar's department at University of Surrey and waiting in computerized phone queues, the grandly named Commission on Graduates of Foreign Nursing Schools, and the Texas Board of Nursing have suddenly come together and approved me to take the NCLEX, the US national nurse licensing examination. 

The approval came yesterday via a cell phone call while standing in the beer aisle at Randalls, and thankfully Fred was tired and quite happy to sit in the driver's seat of the little tykes car attached to the front of the shopping cart (wish they had those in Tescos!) while I explained my situation to the woman from the Texas BON.

The NCLEX is administered with what's called computerized adaptive testing, which means that you answer a certain number of questions (for the RN exam, it's 75) and then the computer checks to see how you're doing. If you're passing, you've passed. If you're failing, you've failed. If you're borderline, it lets you go on and answer some more questions, up to 260. You are given 5 hours to complete it.   If I don't pass I can apply to take it again.

So, now, I have to hit the books. 18 months of brain atrophy to overcome and the pharmacology is going to be especially difficult, I fear.  Fortunately, Fred has just started 2 mornings a week at a mother's Co-op pre-school, and I plan to do the very Austin thing and sit in a nearby coffee shop and study for three hours, at least when I'm not taking my turn as host mother at the pre-school.

He went Monday for the first time and enjoyed it. They said he led the class singing the Barney "clean up, clean up everybody everywhere" song...

But back to the nursing business... I don't know when the next exam date is, but I'd prefer at least 3-4 months of revision time. And I'm officially NOT thinking about where to work, or what kind of work to do; I'm just trying to pass the exam. I'm hoping that walking into Seaton or St. David's (the two big hospital groups in Austin) waving my RN license, will be the best way to talk my way into a flexible part-time position. Or maybe into a super cool fast-track graduate preceptorship thing where you do a multi-department rotation and after a year get to run the ER.... OK, not after a year. But it would be fun to have the experience. I do miss working, and I really miss the NHS, using it and working for it. Really. The NHS is part of the reason I became a nurse in the first place. But that's a whole other story.

Smug

It's over. The heat is gone, and everyone is creeping out of their air-conditioned houses and meeting up in parks and playgrounds and sitting out on porches, and talking again about how great it is to live in Austin. And of course it is.  It was lovely today -- about 80F and sunny with a light breeze, and the memory of those 68 days of 100F is fading fast. (And if you were following, it was only 68 days, and we did not break the 1925 record.)

And although Rollingwood's Stage 2 drought restrictions are still in effect, we had at least 7 hours of rain over the weekend, and a flood in part of our backyard, after an old French drain failed (we think) and spilled a stream of water from the higher streets behind us down the embankment in the back yard. Fortunately our pool design was a good one, and the water just went around it. Jessica and I spent more than 2 hours channeling it into the Berm (or overflow creek) at the back of our house.  We started out innocently enough, arranging rocks and diverting the small flood stream away from the patio, but escalated into major excavations as I ended up digging a 8ft long channel from the back of the pool to the berm, so that the water would flow away safely.  It stopped raining in after an hour or so, but the forecast was for more the next day, and I didn't want to take any chances. Rollingwood has no storm sewers and its public works dept. acts as though we're all living on the frontier (except regarding fences) so I do not expect them to take any responsibility for flood control.

And if that wasn't enough adventure, it rained so much that the pool level rose almost to overflowing, and we actually had to DRAIN it for about 15 minutes. (Are you getting the irony here?) We had to unravel a flat coiled hose connected to a waste valve and stretch it out towards the back of the yard, turn off the filter pump and basically throw it into reverse.  And the water sprayed out over the already sodden grass until the level in the pool had dropped about an inch and a half. 

Parts of Williamson Co., north of Austin, got 7 inches of rain on Saturday. We got over at least 3-inches, they said, not counting our self-inflicted bit.

Robin Yarns Vintage Tea Cosy

I was surfing around Ravelry and other sites looking for Tea Cosy patterns and other cute household items that might make fun homemade gifts, when I remembered that I had some fun "mid-century modern" patterns of my own that might be worth exploring.

This crocheted tea cosy pattern was originally published in a small 1960s British pattern booklet entitled Robin "Oddies" #2040 and priced at 14p (about 25 cents?). Robin yarns are still available from Thomas B Ramsden, a British yarn manufacturer based in Leeds. You can learn more about them here.   

The booklet was given to me by my mother-in-law, the wonderful woman who taught me to knit back in 1993 and changed my life.  I have edited the pattern only by amending the old UK crochet hook sizes, and by changing the UK stitch names to American.  Very cute and easy...

I had intended to publish this pattern but then realized that there may well be copyright issues to deal with. So I contacted Robin yarns to ask for permission. They responded very promptly via email and said yes, go ahead...So here is the pattern:

TEAPOT AND EGG COSIES

Materials:

3 balls double knitting yarn in the following colors 

2 balls light

1 ball each medium and dark

4mm (US6) crochet hook

I used leftover skeins of Jaeger DK 8ply (yes, very posh tea cosy but I liked the colors).

No gauge is specified. Finished size is 6 inches high x 11 inches wide at the base, and will stretch easily over a large teapot.

My tension is quite loose at 13dc to 4 inches.

Make two pieces:

With  4mm (US 6) hook and Light make 37 ch. Work 1 sc into 2nd ch. from hook, 1 sc into each ch. to end, turn with 1 ch.

Next row: work in sc, turn, break Light, join in Dark.

*Next Row: 2 ch., work in dc to end. Turn, break Dark join in Medium.

Next row: 2ch., work in dc to end, turn break meduim, join in light 1 ch.

Work 2 rows sc, break Light, join in Dark.* 

Rep. from * twice more do not break Light.

 

Continue in sc. with light to 5 ins from beg.

Next row, working in sc, dec 7 sts.evenly over the next and each of the following 3 alternate rows. Work 1 row. Take 2tog to end of row, fasten off.

Leaving openings for handle and spout, join pieces tog.

Make a loop from double yarn and sew to top. Press lightly on wrong side using a warm iron over a damp cloth.

Egg Cosy

With 4mm hook and Light, make 27 ch. and work as for teacosy until the 2nd rep of patt. has been completed, do not break Light. Continue in sc until work measures 3 ins. from beg.

Dec. 6 sts. evenly over the next and each of the 2 following alternate rows. Work 1 row.

 

Next row: Take 2 tog to end of row. Fasten off, join seam.

Make loop and sew to top. Press as above.

Going for the Record

Normally, we're told by the meteorologists, Austin gets about 12 days of "triple-digit" temperatures each year. This summer we've had 67. In the last week of August they were displaying a calendar on the evening news showing the high temperature at Austin's airport each day of the month, and it was 100F or higher on all but two days, with three or four days remaining.

The record is 69 days, which was set in 1925, and the general consensus is that we've come this far, we might as well break it. But wouldn't you know, we could be running out of time. Just this week something seems to have shifted and it's been noticeably cooler in the mornings, even if hits high 90s during the day.  And then there are all those hurricanes flitting around the west coast of Mexico and they seem to be sending us a few more clouds and occasional thunderstorms.

And anyway, now that school has started it FEELS like summer is over even if it isn't. And the crazy weather has been going on so long we've pretty much adjusted to it.

A few updates:

We are back in our own house, which is wonderful. We have no television, and no access to the living room, no hot water upstairs and EVERYTHING is covered in dust, but it is still - to my mind - much preferable to being in the rented house.  We just wipe down surfaces every evening, move the chairs back into the kitchen to eat and go to bed early as the workmen start at 730am each day.  We are still dithering about the tiles for the downstairs but the whole project is remarkably on schedule. 

Phil has accepted a formal job offer from the local firm of actuaries he has been working for as an intern for the last three months. He has passed the first two of the five major examinations towards becoming an actuary, and is also modernizing the company's IT systems.  I've tried to point out to him that this is a huge accomplishment, considering that he has broken into a completely new field, in a city where we knew almost no one, in terrible economic circumstances.  And all he's said is, "well, I've got an inside office, instead of one with a window"... Ah, the English modesty...