Sunday, July 27, 2008

all about the nurse

In my third week I had three patients on three different days as I followed three different nurses. I wish I could say that my experience was three times better than the previous two weeks (which were tough), but I can't. Last week was a gazillion times better! My nurses were amazing. I didn't knock over anything. I wasn't scared, just a little nervous when I was giving shots, which was as exciting as it was scary.

It's amazing how different it was in the south wing. It's the telemetry unit, so I'm thinking the caliber of nurses is better because of the heart thing. Everything about the south wing was better for me: the nurses, the patients, the atmosphere, and mostly, my attitude. I'm sure that having a supportive nurse enabled all of this. Each of the nurses I was paired up with really cared that I learned, and did so by challenging me and encouraging me. During the first two weeks I questioned my decision to become a nurse at few times a day. Not once did I doubt my path last week. Sweet.

My favorite patient was Mr. B, an elderly man with a teenager's heart. As I was getting ready to give him his shot in his abdomen, I asked him to please raise his gown. He said, "Sorry, you're not built right. Have her ask me." I mean, this guy was sick, and he just kept the jokes coming for two days. My inspiration.

The big shift for me was that I was able to relate to my patients as people. Imagine that. Having a supportive mentor nurse made all the difference in my confidence. Since I didn't have to figure everything out myself (like the first two weeks), I was able to relax and just be present with my patients. I feel like I finally experienced caring for a patient. It felt good, I learned a lot, and had fun.

I took my first full day off of studying yesterday, and spent it up at the Russian River with a bunch of friends who were there for the entire weekend. It felt great to not open any books all day, play softball, catch up with friends, swim in the river, and eat way too much. The downside is that I had a hard time studying today. I just wanted to go outside and play and forget about all this studying stuff.

Despite my experience at school, this past week in the hospital has me looking forward to the coming week. This is good. Really good. My goal is to feel this way every Sunday night for the rest of the program, and I know it's possible. It's all about the attitude. And the nurse. It's all about the nurse.

A good nurse really does make a difference.


Friday, July 18, 2008

week the second

Friday was tough, my hardest day so far at the hospital. And I'm only referring to the first four hours of the day. I was assigned the same "disappearing nurse" as last week, clearly a sign that I'm working out some bad nurse kharma. Hopefully, (not) being with her is clearing up most of it. I tried to stay positive, to use this as a learning experience, but I wasn't very successful. Thanks and apologies to my fellow nursing students who listened to me whine as they traversed their own challenges.

My patient was a very unhappy man who, in his words, "did not want to be used as a guinnea pig" (for a nursing student). Hard not to take that personal. Then I couldn't get the thermometer to work for another patient (a sweet elderly woman), who let me take her temperature four times until I got the machine to work. That and a general feeling of being completely clueless and incompetent had me seriously wondering what the hell I was doing trying to become a nurse. I *really* wanted to leave, get the hell out of there and get a job at a bookstore. Good thing someone else drove today.

Then good happened. I went to ask the disappearing nurse a question and she told me that this was no longer her patient. Huh? A few minutes later I was in the unhappy patient's room and the new nurse came in. She already knew the patient and I could see how comforted he was by her presence. I followed her out of the room and over the next three hours I learned more about nursing skills than in the prior three days. She actually explained things to me! She *wanted* to teach me, and even tried to convince the patient to let me give him his shot. He wouldn't, but it was great to have her be my advocate. While we were doing charts I found out that she's a traveling nurse from New York, and lives just 20 minutes from where I grew up. Then I noticed that she was wearing scrubs from the same hospital my mother worked at for 20 years! Way cool.

Speaking of advocacy, earlier that day, my incredibly caring supervisor came in with me to see my primary patient. The unhappy guy who didn't want to be a guinea pig. I was in awe of how compassionate and caring she was. He slowly softened up to her, and even started saying how hard it was for him. I was half expecting him to cry, (and probably would have joined him) but he just seemed to relax. Watching her in action, I realized that what she was doing was perhaps the most important part of nursing. I like to think of myself as caring and compassionate person, but it's been hard to show up like that as I walk around in self-doubt and confusion. This will be one of next week's goals.

I'm still getting C's on the exams, secured in the 20th percentile of the class. Humbling doesn't begin to describe the experience. I'm trying to really believe that what matters is that I'm working hard, and I only need a C to become a nurse. C == RN. I know I could pull A's in a slower-paced program, and if I could choose again, that's what I would do. But I can't, and here I am, in this perpetually cram-for-the-test-paced program, so I'm gonna make it work for me. I never wanted to go to grad school anyway.

Oh yeah, I had a crush on a patient, an older woman. We're not supposed to do this, so don't tell anyone. She's 92 years old and helped me overcome my fear of caring for an elderly person. When she looked at me it was like she was looking in me. I thought I would be freaked out by the frailty of a very old person, but instead I found myself wanting to go in and spend time with her all afternoon. I was too busy being a klutz with my primary patient to do so, and when I finally went to say goodbye to her at the end of the day, she had been dismissed, off to an assisted living facility.

Often I'm wishing I was somewhere other than adult med-surg, either working in pediatrics or backpacking in Peru. This is mostly when I'm uncomfortable, which is usually when I don't feel competent, which is most of the time. I know this will change as I gain experience, and my job is to stay positive and remember that I'm learning and I'm probably the only one who expects me to know everything.

This week I'm moving to the other wing of the med-surg unit. The patients there are more critical and the nurses are reputed to be more open to having a student.

Hopefully my disappearing nurse won't follow me there....


Sunday, July 13, 2008

week one

Standing at the nursing station, alone, my first day at the hospital, I silently planned my escape. The nurse who was assigned my proctor, my "mentor," had left me within two minutes of meeting me. Well, she didn't leave me completely alone. She had left me with three patients. Two were on contact precautions for MRSA (a very contagious little bugger) and the other was a quadriplegic. I was, how you say, fu*king freaked out.

It's 7:20am.

I stood there for a few minutes, looking down the hall at my two companion student nurses scampering around with their buddy nurses. I watched with envy at how their mentors actually talked to them. Now, let me be fair to my mentor. When I said hello to her, she didn't completely ignore me. Her response was, "What can you do?" After three seconds of no response from me (I couldn't remember what I could do), she asked, "Can you do vitals?" "Yes." "Can you do AM care?" "Yes."

And then I remembered. "AM care" includes poop. Shit. I mean damn.

So two minutes later I'm standing there, tumbleweeds blowing through the deserted nursing station. A crow lands on my shoulder. It's just me and those three patients, waiting for the macho nurse to change their beds, wash them down (all of them), and take their vitals. I decide to start with the quadriplegic man. The room is just a few steps away. I walk. I stop. I walk. I enter his room. I leave his room. I enter his room again. I stay.

My patient is a 40 year old Latino man, probably about 250 pounds. He says hello to me as I walk in. I say hello. I tell him I'll be right back. I look out into the hall. No one. I go back in. He's just finishing his breakfast. I take his tray, another excuse to leave the room. I come back and tell him I'm going to change his sheets. I ask him if he wants me to clean him or if he would like to clean himself. He says I can clean him. I say, "I"ll be right back."

I walk down the hall, pure fight or flight. I'm pissed at being left alone, scared because I don't know what to do, and I don't want to do what I think I'm supposed to do. I'm heading to the other nursing station in search of my clinical supervisor. I see her. I walk up to her and say, "I don't know what to do." Her face softens with the compassion and wisdom of the Dalai Lama. "You know what to do," she says. "Just do what I showed you in lab yesterday. Start with the clean areas and end with the dirty areas."

No problemo. I'm the macho nurse. I can do this. I walk back towards my patient's room.

It's 7:50am.

I walk into my patient's room, still terrified of washing his large, sweaty body. He has no motor or sensory function from the neck down (limited use of his arms), so he lives with a 24/7 Foley (urinary) catheter. And he can't tell if he needs to poop or if he does poop. Guess that's my job. I walk over to him and set up my bathing supplies next to his bed. I start to wash his face. I'm not very graceful. I realize I need another towel and need to leave the room, again. I go out and this woman is standing there. She's a "lift technician," part of the Patient Mobility Team. She grabs my arm and says, "Are you the nurse for Room X?"

"Well, I'm the nursing student. I don't know anything." (did I say that last part out loud?)

"We need to install an air mattress in his bed," she says. "Let's go!"

A major risk to bedridden patients are pressure ulcers, the super bowl of bed sores. You can learn more about them at Air mattresses are a big part of prevention efforts.

I followed her into the room. The good news here is that in order to put in the air mattress we need to change the sheets. "We" being the operative word here.

"I need to wash him, too."

"Well, let's get at it!" says my guardian angel. I'll call her Angel.

So together we strip down this large man. I daintily apply soap and start washing with a hand cloth. She grabs a full-size towel and starts washing this guy like he's going through a car wash. She's not rough or anything. She just does it. And this is not her job. So I start putting a little elbow grease into it, washing with bigger and bigger strokes, moving down his neck to his arms, his chest, and abdomen. And voila! This guy has a penis. As I'm standing there figuring out the best angel at which to approach, Angel swoops in and starts cleaning and then I start cleaning the penis and the testicles and I look up and this guy's just reading his book. His bible no less.

New wash cloth in hand, I start cleaning his hairy legs and work down to his feet. Nasty. Lots of sores. I start cleaning. I remember to clean between his toes. They need it. I do it. I'm getting good at this. A real natural. Then Angel tells him we're going to turn him over and clean his back. And his butt, I think to myself.

But (no pun intended) it's not that bad. It's not that great either, but I do it. There wasn't too much poop, which was nice, if you know what I mean. We finish up the "bath," install the air mattress, and put on the new sheets. Done. Angel says goodbye. I feel like I should buy her dinner or maybe smoke a cigarette. I don't smoke, so I just say thanks.

It's almost 9am.

Even though I've successfully completed AM care, I'm still incredibly shaky. This is just too real. Where are those cute little kids I worked with as a volunteer at Children's Hospital? The rest of the day gets better, ever so slowly. While my "nurse mentor" didn't say anything to me all day, my clinical supervisor was extremely supportive. I'm not sure that I would have made it without her. She helped me with my paperwork and gave me enough compliments and encouragement to want to come back the next day. Which I did.

I didn't sleep well that night. I could smell my patient, the sweat, the urine, the poop. I "took on" way too much of his situation, imagined his pain and suffering, and learned not to do that. I'm sure I'll need to learn that a few more times before I really get it. The gift and the curse of compassion.

Friday. Day Two. I'm driving to work with two of my fellow nursing students. One says, "Let's set some goals for today." I said, "I'm going to stop focusing on what I imagine my patient is going through and show up with an attitude of service." Which I did.

My mentor says hi to me today. The next time I see her is to say goodbye. This time I walk into my patient's room and my new confidence is immediately evident as we jump right into conversation. We had begun speaking Spanish the day before, and today he wanted to speak English while I spoke Spanish. Fun, but not easy. I cleaned him all by myself. I washed his hair. I helped the Wound Care team and later the Physical Therapists. I did my paperwork, with interest (I refused to do paperwork as a teacher). I was like the phoenix rising from the asses.

The last hour of my second day was spent helping another nursing student bath her patient, a 64 year old woman in a vegetative state. Another student joined us, and together we figured out how to clean this brain-dead woman who was someone's mother. We washed her and talked to her a bit, occasional sounds coming from her. I volunteered to clean her butt. Which I did.

I was fifteen minutes late to our end-of-day debriefing meeting because my mentor reminded me that I needed to empty the patient's urine bag. I arrive to the meeting and sit down. I'm listening to another student share about their day and realize that I feel great. No, fantastic. I'm full of energy and enthusiasm and wow.

It's 3:00pm.

What was YOUR first week like?


Friday, July 4, 2008

poop and all

On Friday I spent three sinful hours hiking in the Oakland hills. It was the first time I've been on the trail since the program began six weeks ago. That's not good. Being in the woods is like going to church for me, and I get to pee where ever I like. It's a god thing.

On Thursday we made our first trip to the hospital. My cohort of nursing students will be spending the next ten weeks at a hospital in the East Bay. The nurses were really nice to us, making a point of welcoming us and letting us know they were happy we would be there this summer. That felt great.

On Wednesday we met our clinical instructor for our first of three clinical skills intensives. We really lucked out with her; she's completely committed to our having a great experience in this hospital. We began the day with a little ice-breaker consisting of three questions. One of them was, "What is a fear you have about starting clinicals?" The other students had responses like,

"I'm afraid I'll give the wrong meds."
"I'm afraid I'll freeze up and won't know what to do."

I said, "Poop. I'm afraid of the poop."

Ya gotta understand, the night before I had watched an instructional video that showed a nurse wiping a patients butt. I just wasn't ready for that. Now, I've seen Hellraiser, Pulp Fiction, Kill Bill, and even the Simpsons. I can take gratuitous with the best of them. But the poop...

Actually, I'm not afraid of poop. It's the wiping of the butt that kinda freaks me out. As a single man with no kids, I've only changed about 20 diapers, and those were OPK's (Other People's Kids). I'm still on my learning curve here. I'm sure that after a few swipes it'll be like a walk in the park.

Poop Park.

And it's not even about the butt. It's about being with people who are really vulnerable and fragile, and about how much they really need me. Sure, it feels good to be needed. but this is different, somehow. It's a different kind of neediness, a different kind of vulnerability. And maybe it's about the responsibility that comes with meeting someone's needs. And the trust, the trust that this person is giving you. Trust given, not earned, is much more precious.

So I'm standing there in the supply closet, listening to our clinical instructor tell us about the syringes, commodes, and IV pumps, and all of a sudden, it hits me. And as it's hitting me, I turn around and look into the room across the hall. Two nurses are behind a curtain with a patient. All I can see of the patient is his foot, flying in the air, flailing around as the nurses try to wash him and change his sheets. It hits me and I smile. I smile on the inside and on the outside.

I really am becoming a nurse.

Poop and all.

So what is (or was) YOUR biggest fear about becoming a nurse?
(or whatever kind of work you do)