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.
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.
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 http://www.nlm.nih.gov/medlineplus/ency/article/007071.htm. 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.
What was YOUR first week like?
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