break time

Not much to report this week. We finished up our ten-week rotation, and are heading into a much deserved two-week break. Just one more final exam to go and then we're done with our first of three semesters!

I'm going camping next weekend with my men's group, and then it's back to New York for my brother's wedding. The night before I leave NY I'll be getting together with a few friends from high school. We haven't seen each other in over 10 years! Well, I guess it's really more like 25 years. That would make me how old?

What I've learned so far working in the hospital:

• Sick people aren't so scary after all.
• Older adults are really, really special people.
  
• It's easy to make a mistake administering meds if you're not careful.
• It's easy to be careful administering meds.
• Some nurses are nice; some nurses are not so nice.
• Some people are nice; some people are not so nice. (Wait, I already knew that)
• Poop ain't so bad.
• People don't like having a plastic tube shoved down their nose.
• Hospitals may generate more pollution than the automobile industry.
• It doesn't matter (to me) if I don't get A's, as long as I'm learning and having more fun than misery.
• As a nurse, it's good to wake somebody up and see how they're doing. They may not seem happy about it, but it's what they need in the long run.
• In two months as a nursing student, I handled more drugs than I did in four years as a high school student. Well, not exactly, but we sure do dish out a lot of drugs!
• Sick people need nurses.
• Nurses need sick people.
• I guess that breaks down to, "We all need each other."
  
• Cool.
  

So what did YOU learn last week?

Macho Nurse out.

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Calvin Coolidge

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.

And so much better than texting.

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cooties

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.

Who's going with me?

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DNR

This week I fed an 87 year-old woman.

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.

Guess I did talk about it.

What do YOU think about it?

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alone

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:

No one should have to die, or suffer, alone.

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another first

Today I saw my first body bag.

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.

And what an honor it is to be someone's nurse.

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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.

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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....

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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 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.

It's 3:00pm.

What was YOUR first week like?

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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)

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