Calvin Coolidge was the 30th president of the United States. Ask me how I know.
I had a great time in the hospital last week. On Thursday I shadowed a nurse in the Emergency Department. A man came in having a heart attack, but they caught it early and he was doing fine when I left. Another man, a very old man, needed a nasogastric (NG)tube, and I got to do it! It was my first one, and it was not easy. An NG tube goes in through the nose, down the esophagus, and into the stomach. As you can imagine, it's extremely invasive.
The nurse I was shadowing told me that I was in luck; the man who needed it was very calm and cooperative. He sure was, until I stuck that tube in his nose. He promptly transformed into Octopus Man, writhing and moaning as the nurse held him and I worked the 15 inches of plastic into his nostril. It was intense, and hard to think of myself as "being of service." Later I was reminded of the first time I held a child in the ED at Children's Hospital, a three-month old girl who needed a urinary catheter. It was my second night on the job, and there I was holding her legs open while she looked me right in the eyes and screamed her lungs out. As with the old man and the NG tube, I told myself it was in her best interest. I don't like this part of nursing.
Tuesday and Wednesday, I was back in the telemetry unit, this time with two patients instead of the usual one. Tuesday was tough; I barely got everything done and was really stressed out by the end of the day. Wednesday was great; I was completely in the groove and had really connected with my two patients. I like this part of nursing.
Both of my patients were men. GH is 94 years old and CT is 90. GH just had his third heart attack. While giving him his physical assessment, he almost passed out while squeezing my fingers. Imagine for a moment that your heart is so weak that giving a good handshake tires you out. Consider what it takes to get out of bed in the morning, do your business in the bathroom, walk down the stairs, make breakfast. Whew! Time for a nap. And your day is just getting started.
I was able to spend time chatting with both men quite a bit. There's a unique elder presence to which I'm becoming more and more attuned. It's hard to describe. In certain mythologies it is called the "king" energy, or in Jungian psychology, the king archetype. For women it is the queen archetype. When I spend time with elder patients in the hospital, I experience it as the embodiment of a lifetime of experience and wisdom. And it is only with time that I am able to truly access its power and beauty.
On Wednesday I was on my way to the supply room. Walking toward me, one arm holding his cane, the other grasping the hand of another nursing student, was a man I had spent some time with the previous week. He is 88 years old, and looks like a skinny Don King. The resemblance ended there, as this man was one of the most gentle and elegant souls I had ever met. I say hello to him and approach. He extends his hand and gives me a firm shake. He does not let go as he looks in my eyes. I ask him how he's doing, and he says, "The Lord takes good care of this old man." I tell him I hope I look that good in five years. He laughs. The he says,
"I remember when Calvin Coolidge..."
"Excuse me," a nurse interrupts. "Can you give me a hand?"
I hastily said goodbye to my friend, and walked away from someone who actually had a story to tell about Calvin Coolidge. So how do I know about Calvin Coolidge? I looked it up! I never got the chance to go back and hear about our 35th president from someone who remembered him.
A few years ago I attended a seminar by Michael Meade, an anthropologist who does amazing work with teenagers. He was talking of stories, of how one of the distinguishing features of humans is that we tell stories. Or at least we used to. And the elders were the keepers of the stories, and it was their duty and honor to pass along their stories to the next generation. But now, Meade said, we don't listen to our elders. We don't ask them to tell us their stories. So their stories are being forgotten. And if there are no stories for our elders to tell, well, maybe there's nothing to remember at all. Maybe we're not just losing those stories; we're also losing our elders. And with it, a piece of ourselves.
Then someone raised their hand and asked Meade if this forgetting might have something to do with Alzheimers Disease. The room fell silent. Someone said, "Wow."
I'm going to be seeking out these stories as I continue down the path of nursing. And listening, really listening. What a great way to connect to another person.
One day in kindergarten, a bunch of us crazy kids were playing hide and seek in the playground. I was "it" and was sitting against a rock wall, eyes squeezed shut, counting to 10 or 20 as loud as I could. All of a sudden, I feel something wet against my cheek. I open my eyes, and this girl Jill is inches away from my face, smiling and giggling. Just behind her are three other giggling girls. One of them yells out, "She did it! She kissed him!" Then they took off running. I could have died.
Really. I could have died. I'm not being dramatic here. I had not had my cootie shots that day, and they probably knew it. I was pissed. I got up and ran after the little *&^%#. Obviously, since I'm sitting her typing this, I caught her and did whatever I was supposed to do to reverse the cooties. If you don't get the seriousness of what I'm talking about here, google it.
I was reminded of this near-death experience last week in the OR (that's "operating room" for those of you who don't watch ER or Gray's Anatomy). We each spent one day observing a surgery or two. I got to see a thyroidectomy on one patient and laproscopic surgery of the colon on another. The thyroidectomy, as a learning experience, was pretty boring, and I couldn't see much. I did enjoy spending time with the surgical team and watching how they worked together. They listened to eighties rock and pop and made jokes. They were trying out a disposable scalpel, which generated a nice little conversation about the ridiculous amount of landfill generated in hospitals. It really is insane. I wrote a paper on it last term, which I recycled.
The laproscopy was pretty cool, both from a medical and technological perspective. The patient had an obstructed bowel, so they went in through the stomach to explore. They made three holes, one for the camera and two for surgical instruments. The doctor and surgical tech looked around for a while, and then started cutting away the adhesions, fatty tissue that was "sticking" the colon to the peritoneum (the cavity in which many digestive organs call home). The technician operated the camera and the doctor operated the pinchers and clippers. It was amazing how they worked so smoothly together, a dance of sorts.
The OR nurses were very welcoming, and it was great to see them in action. One reason why we were given this opportunity was to think about being an OR nurse in the future. Action for an OR nurse seems to be making sure that everything runs smoothly, which is much trickier than it looks on TV because of this thing called the sterile field. Sterile means no contaminents like bacteria, nasal hair, or cookie crumbs. The center of the sterile field is the patient, specifically where the operation is taking place on their body. The field then extends out across their entire body, then to the surgeon and the surgical technician. The surgeon and technician go through elaborate cleanup before the surgery to become sterile, and part of the OR nurses job is to help them stay sterile by being the interface to the non-sterile world. The surgeon and technician keep their hands above their waist to maintain this sterile field. They cannot touch anything outside of this field, so you see them inching past each other's backs (which are not sterile) as well as equipment and furniture, looking like an alarm might go off if they touch anything. It's extremely important that they don't, as there is the very real possibility of the patient's wound becoming infected, which in worse cases, can cause death.
Kind of like cooties. And the OR nurse is the cootie police. I don't think it's for me.
Last year I started watching the show ER on Netflix. It was the perfect break while studying for my prereqs such as anatomy and physiology. When nursing school started, I took a break from the show. Last week I started watching the show again and it was a completely different experience. I understood pretty much everything they talked about! It was a surprising barometer for how much we've learned in school and at the hospital. And it's only been three months!
I'm thinking that by the end of the program I'll be able to audition for the show. Or maybe House, MD. Or maybe even that new reality show, America's Hottest Nurses.
This was yet another first for me, feeding an older adult. She had just arrived at our floor after a week in the ICU recovering from pneumonia, and was in very bad shape. She had been admitted to the hospital in a dehydrated state, brought on by not having eaten for a week. So when I say I fed her, I'm referring to coaxing her to take one more sip of juice or water, one more tiny piece of fruit.
We also talked a bit, mostly about the Olympic swimmers on the TV. She used to enjoy swimming in the pool. I told her I grew up swimming in fresh water, preferably jumping from a rock or bridge. As the hours passed, her answers became more and more distant and repetitive. The next morning she was sent to a hospice facility, her cards, flowers, and radio stuffed into a plastic bag. As I wrote in her chart later that morning, I noticed she was coded as DNR, or "Do Not Resuscitate." I was glad I had run to the elevator to say goodbye before she left.
Volumes have been written on the moral and ethical dilemmas regarding "quality of life," and who has the right to end a life, even their own. I'm not going to talk about that here. I certainly have my own opinions on the matter, though like a crazed football fan who has never put on cleats, of death I plead the ignorance of a spectator. As a nursing student, I'm learning of the many ways in which humans are fighting death. Sometimes we say we're treating an illness, but I think it's ultimately a war on our mortality that's being waged. Be it with pharmacology or prayer, sometimes we're just trying to convince ourselves that we can paddle against the current of life.
I want to paddle with life, not against it. And when that waterfall comes, I want my hands up in the air. So if you're kind enough to hold my hand when things ain't looking so good, be ready to let go.
Nothing to report from the hospital this week, as we began our new rotation with three days of clinical skills in the lab. We learned about starting IVs, oxygen therapy, and pouching an enterostomy. What's that? It's simply a hole in your tummy where your large intestine drains into a bag. The nurse's job is to make sure the exit site stays clean and that the bag gets emptied and changed as needed. Kinda makes wiping butt sound fun, eh?
The last hour of our skills training was on palliative care, that is, caring for the dying patient and their family. We mostly listened to our instructor, who spoke of the logistical and practical aspects of this care, as well as shared some of her experiences with dying patients. She told us of a time when, as a nursing supervisor, she entered the room of a dying patient. This man had not had any visitors, and was soon to die. She saw he was holding on, struggling against the inevitable. She walked over to his bedside and held his hand. She told him that he had led a good life, and that he didn't have to hold on anymore. She told him that it was okay to die.
And then he died.
We were all sitting there in silence as she finished the story. And then she really brought it home for me by saying, "No one should have to die alone."
Damn. How many people do end up dying alone? That's just wrong. The epitome of a basic flaw in our culture: unnecessary loneliness. I used to work for a non-profit called Challenge Day. It's an amazing organization that leads workshops in high schools on social oppression issues that manifest as bullying, teasing, well, you remember high school. One of the issues that continually came up was how alone kids feel in high school, even in the crowded quad of 1,000 students. How can we do this to our kids? To ourselves? To our elders?
On Friday a group of elders came to our school to perform for our class of nursing students. They sang some funny songs, did a rap of sorts, and told their stories of being in the hospital. One thing that struck me the most was a piece on getting old and being lonely. I worked in a nursing home as a young teenager and remember how lonely everyone looked. Even in my constant state of stoned, I knew this was wrong.
The elders performed as part of our gerontology class. Another assignment was to interview an elder living in the community. I'm fortunate to know quite a few elders; it's made my life much more rich. This past Saturday I interviewed my friend KH, a 74 year old man who I really love. The last question of the interview was "Do you have any words of wisdom to share?" KH said,
"When you're working with older people in the hospital, be sure to touch them. That's really important to older people."
So I'm sitting here typing this next to my 2,000 page nursing textbook. We had about 200 very dense pages to read this weekend. I got through maybe half of it before my brain started melting. Then I started wondering if I'll be able to keep up with this program. Then I realize that I'm not that passionate about all this medical stuff anyway. It's interesting, but it just doesn't fill my heart. And now, as I write these words, I remember why I'm becoming a nurse:
It was 7am and I was on my way to check in at the nurse's station. The only reason I looked in the room was because there was a security guard standing at the door. As I greeted him I glanced past him and noticed it. It wasn't fancy or anything. The room appeared even more drab than usual, empty and sterile. The housekeeper was washing down the handrails with sanitizer. Two nurses were speaking quietly next to the bag. I went to tell my fellow nursing students what I had found.
It wasn't like I was gawking or anything. It was just very, very real. The day before I had spent a bit of time with this patient, and now she was gone. Dead. In a bag. We had not spoken; she had recently had a major stroke. Her family had been in the room while I was taking her vitals and there was quite a bit of tension, but I couldn't tell why. I guess I know why now.
Yesterday I came in to find my primary patient (a different woman) in worse shape than the day before. She was asleep and shaking and warm to the touch. I took her vitals and found that she had spiked a fever and her oxygen was really low. I checked it three times before I went to get her nurse. We did this and that to get her temperature down and her oxygen up and she improved, but not enough. Her doctor came in and heard fluid in her lungs and ordered tests and sent her to the ICU. Pretty exciting for me. Not so much for the patient. It's a very mixed experience, hoping that people get better and wanting enough sick people to make the job interesting and exciting.
Later at the nurse's station some nurses were saying that she should not have gone to the ICU, that she would have been fine staying there, and that she would be back the next day. The next day (today) she returned to our unit. Trust your nurse.
Today, despite having experienced the death of a patient, was extremely slow. There weren't enough patients or experienced nurses for me to do the usual buddy nurse thing and work with a patient. So I helped bring an 83 year old woman down for cardiac tests. She told me all about her family and some adventures from her childhood. It was really nice. At first I was upset that I wasn't practicing skills, but then I realized that I was practicing just being with patients. After all, they're just people, people who happen to be sick.
I can see how easy it would be to focus on the illness or disease and lose sight of the patient, the person. That's where doctors and nurses are different. Nurses do get to do their own diagnoses, but they're more patient-centered rather than disease-centered. I like that.
The woman who died this morning was quite old. I had not become very attached to her. It's a fine line between caring and getting attached. The Buddha said that attachment is the root of all suffering. I don't think he was talking about the kind of attachment that is caring for someone. It's getting attached to a certain outcome that we desire that causes pain. Like the desire for someone to never die. People die. People we care for die. And sometimes they end up in a bag.
I'm planning on becoming a pediatric nurse. Many nurses won't do it, especially those who have their own children. I don't have any children, which is definitely part of why I've worked with kids. But pediatric nursing will be different than teaching and counseling. Children will suffer. Some will die. I will be there. I will become attached. It will hurt. I know this will be a powerful lesson in being present with another person, present to their life, which is only in that moment. And what a precious moment.