It's official (and it has been for some time now) - I've graduated school and passed all the necessary requirements to practice nursing in Texas! In this state, in addition to the NCLEX, there is also the Jurisprudence Test that must be taken to be registered as a nurse. It's extremely easy though, and it's essentially open book (or open browser - it's online and any resources can be used.) It's also official that my husband, The Pug and I are moving! This is a big deal to me - I dislike almost everything about Texas, particularly the conservative rat hole devoid of any concept of social justice where we currently reside. Texas does have its redeeming qualities though, most notably the generally friendly and endearing "Howdy y'all!" populace and the liberal progressive oasis of Austin. We'll still be in Texas, only in an exponentially better location.
I also have a job! As a graduate RN in Texas, many people mistakenly assumed that finding a job would be easy. Unfortunately, at the time of graduation in December, more than one third of my 100+ person class was still jobless, and that included myself. Several hospitals around here even have a hiring freeze, as do several of the places in our new city. When even the job outlook for nurses in Texas is bleak, something must be seriously wrong with the economy.
I tried to sell myself as best I could, and even with the magna cum laude on my diploma and volunteer work on my resume, I only got one bite at one hospital. And holy crap, was that a nerve wracking job interview. I practiced for hours before hand and am pretty sure that I bombed several questions, and then had to wait over 3 weeks for a callback. Luckily I got the job for the only position I was even considered for. There were only 3 positions even available, even on a 64-bed Med-Surg floor. Apparently budgets are pretty tight right now.
Anyway, the hospital is, unsurprisingly, religiously oriented. It does a metric ton of charity work in the area though and is not-for-profit, and that's something that I'll be proud to be a part of. (I don't want to get into politics at this moment, but let's just say that I don't think health care should be a for-profit venture and everyone should have access to quality healthcare.) It'll be interesting to see if there are any signs of the hospital's religious background in my day-to-day nursing experience. Obviously there are crosses on every wall and a point is made to notify visitors and patients of the hospital's mission, but hopefully it ends when it comes to employees. Overall, I think it will be a great place for me to start out and is full of opportunities.
I am excited to be able to continue on relating stories of the amazing people I come across and how they change my thoughts and views. I can't wait to grow as a person and care for my future patients. Next week, I start a new life.
Saturday, January 30, 2010
Tuesday, November 3, 2009
Graduation: The Pinning Ceremony
For the past four years, I have looked forward to the day I graduate. It wasn’t especially exciting for me to graduate high school, because I knew that three months afterwards I would be starting yet another four years of school until I actually was able to start real life. And lo, the time has come! In December, I will walk across the stage and be able to wave adios to college (until graduate school, but I’m going to try and forget about that for now.) For those of you who aren’t familiar with graduating from a nursing program, there is a special ceremony (aside from the typical graduation ceremony) that most schools have – it’s called a pinning ceremony.
I can’t speak for any more than the couple nursing schools I know about, but generally, each student nurse walks up on stage one by one and gets a special pin with an insignia from his/her nursing school pinned on him/her by a special person in the graduate’s life. For example, as a side note, I’m hoping my husband and mom can pin me, but my husband has extreme stage phobia to the point where he needs medication or else he’ll faint and my mom already told me she’s going to bawl her eyes out just looking at me, so it looks like I’ll have to recruit my dog to pin me. Anyway, back to the pinning ceremony. So all the students get pinned by a loved one, some faculty members give a few speeches, and we eat some cookies or something. Oh, and did I mention the Florence Nightingale Nursing Pledge that we all recite (AKA The Nightingale Pledge)? Ahem. Here it goes:
This is what I am dreading the most – well, besides the fact that the pinning ceremony is going to be held in a megachurch (I’m in Texas, remember?). There are some more modernized and updated Nightingale Pledge variants floating around, but I’m not sure which one my class pinning committee has decided on. I have heard many older nurses mention “the Pledge,” normally in addition to whatever else they’re using to deride us about something or other. “Hmph. New nurses these days… don’t they know about the Pledge?” So at least for older nurses, it is considered something relatively important in the field of nursing; it’s essentially our Hippocratic Oath.
I personally don’t think it’s necessary at all for us to take an oath (or for anyone to ever take an oath, for that matter – it’s not the Middle Ages.) Any licensed medical professional should be competent enough to understand the main concepts of caring for other people: don’t hurt them intentionally, strive to prevent errors and mistakes, and abide by all of the general ethical principles of veracity, fidelity, beneficence, nonmaleficence, etc. It’s common sense, and they should be followed regardless of whether an oath is taken or not – it’s part of the job, and part of the responsibility we bear as health care workers. It’s ridiculous to think that student nurses aren’t going to behave ethically until we robotically repeat some century-old phrases.
I am ecstatic about graduating and can’t wait to actually begin practicing in the field that I have worked so hard for, which will undoubtedly provide me countless stories to retell here. Even though I don’t necessarily look forward to some parts of the pinning ceremony, I understand its symbolism is well-intentioned. Unfortunately, I have the sinking feeling that I might be the only student nurse at the ceremony not pledging myself “before god” and passing my “life in purity”. Instead, I’ll strive to be a rockin’ nurse who treats all patients equally and has the benefit of not being biased toward any religion or god at all. But for now, that’ll have to remain my little secret.
I can’t speak for any more than the couple nursing schools I know about, but generally, each student nurse walks up on stage one by one and gets a special pin with an insignia from his/her nursing school pinned on him/her by a special person in the graduate’s life. For example, as a side note, I’m hoping my husband and mom can pin me, but my husband has extreme stage phobia to the point where he needs medication or else he’ll faint and my mom already told me she’s going to bawl her eyes out just looking at me, so it looks like I’ll have to recruit my dog to pin me. Anyway, back to the pinning ceremony. So all the students get pinned by a loved one, some faculty members give a few speeches, and we eat some cookies or something. Oh, and did I mention the Florence Nightingale Nursing Pledge that we all recite (AKA The Nightingale Pledge)? Ahem. Here it goes:
I solemnly pledge myself before God and in the presence of this assembly:
To pass my life in purity and to practice my profession faithfully;
I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug;
I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling;
With loyalty will I endeavor to aid the physician in his work and devote myself to the welfare of those committed to my care.
This is what I am dreading the most – well, besides the fact that the pinning ceremony is going to be held in a megachurch (I’m in Texas, remember?). There are some more modernized and updated Nightingale Pledge variants floating around, but I’m not sure which one my class pinning committee has decided on. I have heard many older nurses mention “the Pledge,” normally in addition to whatever else they’re using to deride us about something or other. “Hmph. New nurses these days… don’t they know about the Pledge?” So at least for older nurses, it is considered something relatively important in the field of nursing; it’s essentially our Hippocratic Oath.
I personally don’t think it’s necessary at all for us to take an oath (or for anyone to ever take an oath, for that matter – it’s not the Middle Ages.) Any licensed medical professional should be competent enough to understand the main concepts of caring for other people: don’t hurt them intentionally, strive to prevent errors and mistakes, and abide by all of the general ethical principles of veracity, fidelity, beneficence, nonmaleficence, etc. It’s common sense, and they should be followed regardless of whether an oath is taken or not – it’s part of the job, and part of the responsibility we bear as health care workers. It’s ridiculous to think that student nurses aren’t going to behave ethically until we robotically repeat some century-old phrases.
I am ecstatic about graduating and can’t wait to actually begin practicing in the field that I have worked so hard for, which will undoubtedly provide me countless stories to retell here. Even though I don’t necessarily look forward to some parts of the pinning ceremony, I understand its symbolism is well-intentioned. Unfortunately, I have the sinking feeling that I might be the only student nurse at the ceremony not pledging myself “before god” and passing my “life in purity”. Instead, I’ll strive to be a rockin’ nurse who treats all patients equally and has the benefit of not being biased toward any religion or god at all. But for now, that’ll have to remain my little secret.
Wednesday, April 15, 2009
A Difficult Conclusion
I have known of quite a few patients in the ICU that I’m in that have died. I have even cared for a few of them on a day shortly before their deaths. However, I have not yet seen a “code” situation or watched a person die, let alone clean up their bodies afterwards.
Today I had that experience. When I arrived on the floor a little after 6AM, the night shift nurses were all unusually busy, and both the night shift charge nurse and day shift charge nurse were in the same room, along with two other nurses and a respiratory therapist. They were shaking their heads frequently and running around, saying the patient's O2 sats were in the 70s-80s (which is pretty bad, but is by no means a death sentence.) When the charge nurse came out, I purposely (unknown to her) asked to be with a different patient, even though I knew the previously mentioned patient would certainly be an intensive learning experience.
Since my first day on the unit, I have been unbelievably petrified of having one of my patients code. The charge nurses always try to give us very sick patients because they are the best learning experiences for students – so I have gladly welcomed opportunities to learn. Regardless of my desire to learn, I have still been, simply put – TERRIFIED – of being in a code situation and having to give chest compressions, bag them, push epinephrine/emergency meds, etc. It doesn’t help that I have a pretty low level of confidence in myself, which is almost crippling at times. So this morning, there was something in the air about this guy – and I did NOT want to be on the front lines when he crashed, which seemed pretty likely.
About two hours later, I hear the calm, almost robotic voice of someone calling a code blue over the intercom system of the hospital. People came running from every corner of the campus – cardiac, chaplains, pharmacist, anesthesia, respiratory backup – everyone. Not to mention the three students (including myself) that were already on the unit. I walked over from my patient’s room to the room where the code was happening, and there were already 20 or so people crowding the room. The large glass doors were flung open, and one of the nephrologists (he was in the room when the patient coded) was giving chest compressions – but the nurses were clearly running the show. I walked over at the same time as the patient’s three family members came rushing to the room, and my heart broke. In a matter of seconds as they saw the nightmare scenario before them, they began crying and quivering and clutching each other while sobbing. I wanted so badly to say something to them and comfort them, but I started crying just looking at them and had to control myself and look away to remain “professional.” It was frightening to me too; I’d never experienced anything like it.
In a shortened version, here is what actually happened to cause the code blue. The man was (clearly) ridiculously ill. Among other things, he was on continuous renal replacement therapy (dialysis) and the nephrologist was in the room with the nurse to secure a usable access site for the dialysis. During this period, the nurse noticed that the patient’s already low O2 sats were getting lower, and he had no pulses – this is called PEA or Pulseless Electrical Activity. It means that, essentially, the patient’s cardiac electrical system is working just fine – so on an EKG, the heart appears to be just beating away and working fine. However, it is pulseless, meaning that though the electrical conduction system is working, the contractile abilities of the heart are gone, and so the patient’s heart isn’t pumping a drop of blood. The body can only sustain this for a small amount of time, because eventually the cardiac muscles stop receiving oxygen. At this point, this particular patient went into ventricular tachycardia and then ventricular fibrillation. The defibrillator was fired up while CPR was done, and then the patient was defibrillated. On the first try, they brought back a rhythm and pumped him full of a number of emergency drugs to bring up his blood pressure. Even though they brought back a heart rhythm, he was in respiratory arrest as well and his blood pressure was really almost nonexistent. Shortly after that he went down again and they attempted CPR, but the doctors told the family that there was nothing more they could do.
An hour or so later, one of the nurses asked if I would like to help prepare the body. I said no, but went anyway. We were taught about this in school, but I hadn’t yet ever experienced a death. Basically all of the tubes, IVs, catheters and other lines need to be removed and the body is bathed. Clean sheets and gown are then arranged, so the patient looks as clean and “normal” as possible for the family. This all sounds simple and nice, but I’m going to be honest – it was pretty disturbing. Because of chest compressions from CPR, air gets pumped into the patient and they kind of burp when you roll them – and it smells of their insides. Because the blood pools, the skin on the underside of the patient becomes mottled and purple. He also bled out of some of the small holes where his IVs were because his body wasn’t clotting any longer, and along with other body fluids, it was kind of messy. The oddest part of this was how the room smelled and how he smelled – it wasn’t any cleaning solvents, medicines, or blood or body fluids – I could distinguish those well enough. The smell was not unpleasant… it was almost a sweet odor, musky and fleshy. I wondered if that is what death smells like, when the body is just beginning to disassemble itself and dissolve back into the ground.
The whole day didn’t necessarily make me sad, but it got me thinking. Mainly I feel an awful, painful sympathy for the patient’s family. The look of terror and despair on their faces was more than I can handle, and I’m not sure I could work on a unit where that look is commonplace. It made me realize just how important a role nurses can play in saving a person’s life with smart, efficient decisions and delegating. But at the same time, I felt a deeper knowing of how gloomy, disheartening, and achingly real it can be.
Today I had that experience. When I arrived on the floor a little after 6AM, the night shift nurses were all unusually busy, and both the night shift charge nurse and day shift charge nurse were in the same room, along with two other nurses and a respiratory therapist. They were shaking their heads frequently and running around, saying the patient's O2 sats were in the 70s-80s (which is pretty bad, but is by no means a death sentence.) When the charge nurse came out, I purposely (unknown to her) asked to be with a different patient, even though I knew the previously mentioned patient would certainly be an intensive learning experience.
Since my first day on the unit, I have been unbelievably petrified of having one of my patients code. The charge nurses always try to give us very sick patients because they are the best learning experiences for students – so I have gladly welcomed opportunities to learn. Regardless of my desire to learn, I have still been, simply put – TERRIFIED – of being in a code situation and having to give chest compressions, bag them, push epinephrine/emergency meds, etc. It doesn’t help that I have a pretty low level of confidence in myself, which is almost crippling at times. So this morning, there was something in the air about this guy – and I did NOT want to be on the front lines when he crashed, which seemed pretty likely.
About two hours later, I hear the calm, almost robotic voice of someone calling a code blue over the intercom system of the hospital. People came running from every corner of the campus – cardiac, chaplains, pharmacist, anesthesia, respiratory backup – everyone. Not to mention the three students (including myself) that were already on the unit. I walked over from my patient’s room to the room where the code was happening, and there were already 20 or so people crowding the room. The large glass doors were flung open, and one of the nephrologists (he was in the room when the patient coded) was giving chest compressions – but the nurses were clearly running the show. I walked over at the same time as the patient’s three family members came rushing to the room, and my heart broke. In a matter of seconds as they saw the nightmare scenario before them, they began crying and quivering and clutching each other while sobbing. I wanted so badly to say something to them and comfort them, but I started crying just looking at them and had to control myself and look away to remain “professional.” It was frightening to me too; I’d never experienced anything like it.
In a shortened version, here is what actually happened to cause the code blue. The man was (clearly) ridiculously ill. Among other things, he was on continuous renal replacement therapy (dialysis) and the nephrologist was in the room with the nurse to secure a usable access site for the dialysis. During this period, the nurse noticed that the patient’s already low O2 sats were getting lower, and he had no pulses – this is called PEA or Pulseless Electrical Activity. It means that, essentially, the patient’s cardiac electrical system is working just fine – so on an EKG, the heart appears to be just beating away and working fine. However, it is pulseless, meaning that though the electrical conduction system is working, the contractile abilities of the heart are gone, and so the patient’s heart isn’t pumping a drop of blood. The body can only sustain this for a small amount of time, because eventually the cardiac muscles stop receiving oxygen. At this point, this particular patient went into ventricular tachycardia and then ventricular fibrillation. The defibrillator was fired up while CPR was done, and then the patient was defibrillated. On the first try, they brought back a rhythm and pumped him full of a number of emergency drugs to bring up his blood pressure. Even though they brought back a heart rhythm, he was in respiratory arrest as well and his blood pressure was really almost nonexistent. Shortly after that he went down again and they attempted CPR, but the doctors told the family that there was nothing more they could do.
An hour or so later, one of the nurses asked if I would like to help prepare the body. I said no, but went anyway. We were taught about this in school, but I hadn’t yet ever experienced a death. Basically all of the tubes, IVs, catheters and other lines need to be removed and the body is bathed. Clean sheets and gown are then arranged, so the patient looks as clean and “normal” as possible for the family. This all sounds simple and nice, but I’m going to be honest – it was pretty disturbing. Because of chest compressions from CPR, air gets pumped into the patient and they kind of burp when you roll them – and it smells of their insides. Because the blood pools, the skin on the underside of the patient becomes mottled and purple. He also bled out of some of the small holes where his IVs were because his body wasn’t clotting any longer, and along with other body fluids, it was kind of messy. The oddest part of this was how the room smelled and how he smelled – it wasn’t any cleaning solvents, medicines, or blood or body fluids – I could distinguish those well enough. The smell was not unpleasant… it was almost a sweet odor, musky and fleshy. I wondered if that is what death smells like, when the body is just beginning to disassemble itself and dissolve back into the ground.
The whole day didn’t necessarily make me sad, but it got me thinking. Mainly I feel an awful, painful sympathy for the patient’s family. The look of terror and despair on their faces was more than I can handle, and I’m not sure I could work on a unit where that look is commonplace. It made me realize just how important a role nurses can play in saving a person’s life with smart, efficient decisions and delegating. But at the same time, I felt a deeper knowing of how gloomy, disheartening, and achingly real it can be.
Wednesday, April 1, 2009
To Judge or not to Judge
Again, it has been far too long since I posted an entry. I think it is largely because even now, I am afraid that I will somehow get into trouble for writing about my experiences. I do believe though that as long as I divulge no specifics, I’ll have done nothing more than share my boring life with the world. In any case, I have had an interesting semester so far. Here is a brief list of some of the craziest/saddest/most fascinating stuff:
-Saw a “drive by” birth; i.e. the mother comes rolling down the hall at 9cm dilated with no prenatal care and shoots the baby out within minutes. Oh, and she spoke no English. And my god, she screamed as though she was pushing out a bowling ball covered in razor blades.
-Saw far too many children slowly being eaten up by repeated bouts of cancer
-Caring for and feeding babies so premature they are the size of water bottles
-Two words: necrotizing fasciitis. Due to the misfortune of catching such a horrible infection, my patient passed away just the night after I met her.
There have been other things of course, but the vast majority of my stories are more subtly heartbreaking rather than so mentally or visually disturbing. I have quite a few more days left in my ICU rotation, and I’m sure I’ll see far more depressing, ethically challenging things before I’m done.
Specifically, I cared for an emaciated critically ill man who had been transferred from prison to nursing home to the hospital. He required intensive, detailed, gentle care, and during the day as I watched him grimace and slowly deteriorate I wondered what he had done to land himself in prison. He looked so helpless and childlike, it was hard to imagine the life he'd led. I later found out that he was a murderer. It made me feel strange to know that, but it didn’t change how I felt about him or my day. It’s interesting to learn about patient’s lives – who they love, who they are, what they’ve done, their transgressions. I have to constantly remind myself to not judge patients and their family members for ignoring or neglecting one another. A dying grandfather whose family has deserted him, while appearing sad and lonely, may have been an unremorseful pedophile or abuser. A middle-aged woman’s family may seem calm and relieved after learning of her impending death - not out of malice but out of love – she’ll soon be out of her extended misery. A forlorn bald child with cancer whose family rarely visits – her parents may be doing all they can to make enough money for her treatments.
I know it all sounds cliché and stupid, but I swear, half of this “being a good nurse” stuff is about working through the emotions of it all. Making sure I don’t turn myself one way or the other. Most of all, I'm trying not to judge what goes on in a hospital – almost everyone is at their very best or their very worst, and you have no idea who’s who.
-Saw a “drive by” birth; i.e. the mother comes rolling down the hall at 9cm dilated with no prenatal care and shoots the baby out within minutes. Oh, and she spoke no English. And my god, she screamed as though she was pushing out a bowling ball covered in razor blades.
-Saw far too many children slowly being eaten up by repeated bouts of cancer
-Caring for and feeding babies so premature they are the size of water bottles
-Two words: necrotizing fasciitis. Due to the misfortune of catching such a horrible infection, my patient passed away just the night after I met her.
There have been other things of course, but the vast majority of my stories are more subtly heartbreaking rather than so mentally or visually disturbing. I have quite a few more days left in my ICU rotation, and I’m sure I’ll see far more depressing, ethically challenging things before I’m done.
Specifically, I cared for an emaciated critically ill man who had been transferred from prison to nursing home to the hospital. He required intensive, detailed, gentle care, and during the day as I watched him grimace and slowly deteriorate I wondered what he had done to land himself in prison. He looked so helpless and childlike, it was hard to imagine the life he'd led. I later found out that he was a murderer. It made me feel strange to know that, but it didn’t change how I felt about him or my day. It’s interesting to learn about patient’s lives – who they love, who they are, what they’ve done, their transgressions. I have to constantly remind myself to not judge patients and their family members for ignoring or neglecting one another. A dying grandfather whose family has deserted him, while appearing sad and lonely, may have been an unremorseful pedophile or abuser. A middle-aged woman’s family may seem calm and relieved after learning of her impending death - not out of malice but out of love – she’ll soon be out of her extended misery. A forlorn bald child with cancer whose family rarely visits – her parents may be doing all they can to make enough money for her treatments.
I know it all sounds cliché and stupid, but I swear, half of this “being a good nurse” stuff is about working through the emotions of it all. Making sure I don’t turn myself one way or the other. Most of all, I'm trying not to judge what goes on in a hospital – almost everyone is at their very best or their very worst, and you have no idea who’s who.
Friday, January 23, 2009
Dang!
It has been nearly 3 months since I've posted. I feel bad about it, like I'm neglecting my baby or something. This blog was meant to be my baby after all.
Luckily, I have found myself settling in to nursing school and feeling more comfortable with my fellow students. But school is practically over now; in December, I will graduate! More and more often, life takes the opportunity to smack me across the face with the realization that IT NEVER SLOWS DOWN. I feel old and haggard already and I'm not even 22 yet. It seemed like just yesterday when I started this blog.
In any case, it's now the NEXT semester. I have Labor and Delivery, Critical Care, and Pediatrics this time around. Since the beginning of school, I've kept my mind completely open about what field of nursing (there are dozens) I want to get into. I've always had a special place in my heart for pediatrics, however, so I'm excited to see how I actually like it. Enjoying working with the little ones is probably the one stereotypical girl thing I possess. I think it's because I find it difficult to not be able to touch patients for fear of lawsuits and charges. Nurses are certainly allowed to touch patients, but it is more suggested that we do small things like holding a hand or petting an arm. But sometimes, someone just looks like they need a big hug! And with adults, it's much harder to know when that's appropriate or not and whether the patient would feel comfortable or not. Hell, there've been plenty of times when I have needed a hug but I don't know how to ask for it or I feel awkward initiating it. On the other hand, with kids and babies, it's pretty well established that hugs and touching are requirements for proper growth and development. It makes it a lot easier for someone like me!
Also, wiping a kid's butt is a lot less weird than helping an embarrassed grown man use the bathroom. I don't know if that's a common perspective, but it's how I feel and it's hard for me to get around it.
But enough of the chatter! This is a blog chronicling, to some degree, my dealings with religion and nursing. So far, more of the instructors than not have mentioned religion in some form. When one student sneezed, "GOD BLESS!" popped out of an instructor's mouth before the sneeze was even completed. Another discussed her entry into L&D nursing: "You never know what god has in store for you." Several of them graduated from Baptist schools or have husbands that are pastors or reverends. I am curious as to what it is about nursing that draws overtly religious folks. Perhaps it is a Bible Belt phenomenon.
By now it is easier for me to not be outwardly surprised by the things they say. I am intrigued and nervous about what they will teach us about circumcision, breast feeding, and labor and delivery care in general. With some things I can bite my tongue, but when I come across something that is being done just because "it's what we've always done!", I don't tolerate that very well. In general, Western birthing culture seems to be a bastardized, sterilized version of what nature intended. Don't get me wrong - I'm not saying our technology isn't wonderful and life-saving. In the case of circumcision, in probably 99% of cases it is unnecessary (I will probably dedicate a post to the topic as it deals directly with religion). Additionally, many Christians in this country do it because "It's in the Bible!" Yes it sure is; but it's referring to the Jewish peoples' covenant with god. Last time I checked, Christians aren't Jews. See how my sarcasm is cropping up already? It should be an interesting semester.
Luckily, I have found myself settling in to nursing school and feeling more comfortable with my fellow students. But school is practically over now; in December, I will graduate! More and more often, life takes the opportunity to smack me across the face with the realization that IT NEVER SLOWS DOWN. I feel old and haggard already and I'm not even 22 yet. It seemed like just yesterday when I started this blog.
In any case, it's now the NEXT semester. I have Labor and Delivery, Critical Care, and Pediatrics this time around. Since the beginning of school, I've kept my mind completely open about what field of nursing (there are dozens) I want to get into. I've always had a special place in my heart for pediatrics, however, so I'm excited to see how I actually like it. Enjoying working with the little ones is probably the one stereotypical girl thing I possess. I think it's because I find it difficult to not be able to touch patients for fear of lawsuits and charges. Nurses are certainly allowed to touch patients, but it is more suggested that we do small things like holding a hand or petting an arm. But sometimes, someone just looks like they need a big hug! And with adults, it's much harder to know when that's appropriate or not and whether the patient would feel comfortable or not. Hell, there've been plenty of times when I have needed a hug but I don't know how to ask for it or I feel awkward initiating it. On the other hand, with kids and babies, it's pretty well established that hugs and touching are requirements for proper growth and development. It makes it a lot easier for someone like me!
Also, wiping a kid's butt is a lot less weird than helping an embarrassed grown man use the bathroom. I don't know if that's a common perspective, but it's how I feel and it's hard for me to get around it.
But enough of the chatter! This is a blog chronicling, to some degree, my dealings with religion and nursing. So far, more of the instructors than not have mentioned religion in some form. When one student sneezed, "GOD BLESS!" popped out of an instructor's mouth before the sneeze was even completed. Another discussed her entry into L&D nursing: "You never know what god has in store for you." Several of them graduated from Baptist schools or have husbands that are pastors or reverends. I am curious as to what it is about nursing that draws overtly religious folks. Perhaps it is a Bible Belt phenomenon.
By now it is easier for me to not be outwardly surprised by the things they say. I am intrigued and nervous about what they will teach us about circumcision, breast feeding, and labor and delivery care in general. With some things I can bite my tongue, but when I come across something that is being done just because "it's what we've always done!", I don't tolerate that very well. In general, Western birthing culture seems to be a bastardized, sterilized version of what nature intended. Don't get me wrong - I'm not saying our technology isn't wonderful and life-saving. In the case of circumcision, in probably 99% of cases it is unnecessary (I will probably dedicate a post to the topic as it deals directly with religion). Additionally, many Christians in this country do it because "It's in the Bible!" Yes it sure is; but it's referring to the Jewish peoples' covenant with god. Last time I checked, Christians aren't Jews. See how my sarcasm is cropping up already? It should be an interesting semester.
Thursday, October 23, 2008
Mental Health
Thanks to my dreadful schedule, it has been quite a while since I posted. While it is still manageable, I have less of a life than I did last semester. Here’s what I figure – you’ve got the first two out of four years taking pre-reqs, right? Those aren’t too bad; you get to set your own schedule. Then comes the second two years that are the actual nursing program. The first semester is pretty stressful, because you’re getting used to this strange thing called “being a nursing student.” But by the end of the semester, you’re like “Hey! This is a piece of cake. Bring it.” The second semester, the one I’m in now, takes quite a bit more of your life away – and a large part of it is with what I’d like to call busy work and other crap you have to do on your own time. The lack of actual classroom time fools you early into the semester into thinking this will be easier than before. Wrong! And from what I understand about the last two semesters, you essentially have no life. Every minute of your free time is now Nursing School Time. Every ounce of dignity you had left is sacrificed to the Holy University in hopes of gaining enough knowledge to pass the Blessed NCLEX. (Oh, and passing grades so that you get the opportunity to even take the NCLEX.)
Needless to say, many of my fellow students (as well as myself) have been ridiculously stressed out at the idea that, as the senior students whispered so eloquently when they thought I wasn’t listening, “If only they knew. It only gets worse from here!” I have heard stories of girls sobbing randomly while driving or eating dinner, or even tearing up in school after a test (“My god, I think I failed! My life is over! They’ll kick me out of the program!”). I have even seen two male students blow up at each other during class because one of them randomly yelled “Shut up” at the other. Madness and book, chair, and door slamming ensued.
Lucky for me, I had a great conversation with my mom and have done my best to be realistic about all of this, as any outsider may consider to be the easy solution. Don’t worry! There are only two more semesters, you can do this, you’re smart, you’ve got this far, take it easy. Easier said than done, but I’m working on it. I am so grateful that for some reason I’m handling this way better than I did last semester. A few weeks ago, I even thought I was becoming depressed again, because I stopped caring and I felt so overwhelmed. That brings me to the main point I wanted to make in this entry.
The people on the psych floor, and the days I’ve spent with them, have changed my life. I have no idea what it’s done for other students, but for me, it’s been huge. Listening to the suggestions made by therapists in group meetings have been helpful things that I can apply to my own life and my own inner thoughts (Step 1: Stop telling yourself you’re stupid, ugly, useless.). Hearing from patients’ mouths how they got over disturbing and horrifying abuses have helped me rethink some of the things I’ve gone through in my life and some of the pent up hatred I have – how you have to either forgive the person, or just literally let it go and not think about it any more. Denial is my preferred coping mechanism, but perhaps I can learn to think like they do.
The patients – they are so strong, and they don’t even know it. They are so brave and beautiful yet feel scared and hopeless. They buoy up everyone else, praising their peers’ efforts with words and hugs, but shredding themselves to ribbons with their own thoughts. The worst part is the guilt and shame most of them feel for being in a psych facility – they, like most of our society, think that the ward is filled with homicidal sociopaths and scab picking schizophrenics. That is the farthest thing from the truth. But to convince the patients that society is wrong, it’s okay to be here, you are so brave and strong for coming here for help – that is practically impossible.
If I could teach ANYthing to any of the people that might come across this blog and read something, it would be about the mentally ill. There is no reason for mental illness to be taboo – really consider it for a moment. Your skin, your lungs, your heart, they are allowed to get sick, but your brain is not? Why should all the other organs be allowed to get diseases and deserve treatment but the brain does not? A person with asthma deserves their inhaler, and the pharmacist won’t look twice at them when they order it. But the shame someone feels when picking up their Prozac – can you imagine how that might impact someone’s treatment and recovery when the pharmacy tech gives them the side eye and lifts their eyebrow in disdain?
My point to the world is this – there is NO SHAME is seeking treatment for mental illness, whether it is inpatient, outpatient, or seeing a therapist. There is NO SHAME in taking medication for your mental illness, even if it is for the rest of your life. It is medicine that keeps you alive, the same as insulin keeps a diabetic alive. Mental illness is no different than any other physical illness, except the unlucky people with mental illness have no physical proof of their pain. Please consider this the next time you come across someone with a mental illness, and do your best to not judge them – they have probably been through hell, and someday you or someone you love could also become a victim of mental illness. Keep in mind – the lifetime likelihood that a person will get a mental illness is thought to be over 50%.
Needless to say, many of my fellow students (as well as myself) have been ridiculously stressed out at the idea that, as the senior students whispered so eloquently when they thought I wasn’t listening, “If only they knew. It only gets worse from here!” I have heard stories of girls sobbing randomly while driving or eating dinner, or even tearing up in school after a test (“My god, I think I failed! My life is over! They’ll kick me out of the program!”). I have even seen two male students blow up at each other during class because one of them randomly yelled “Shut up” at the other. Madness and book, chair, and door slamming ensued.
Lucky for me, I had a great conversation with my mom and have done my best to be realistic about all of this, as any outsider may consider to be the easy solution. Don’t worry! There are only two more semesters, you can do this, you’re smart, you’ve got this far, take it easy. Easier said than done, but I’m working on it. I am so grateful that for some reason I’m handling this way better than I did last semester. A few weeks ago, I even thought I was becoming depressed again, because I stopped caring and I felt so overwhelmed. That brings me to the main point I wanted to make in this entry.
The people on the psych floor, and the days I’ve spent with them, have changed my life. I have no idea what it’s done for other students, but for me, it’s been huge. Listening to the suggestions made by therapists in group meetings have been helpful things that I can apply to my own life and my own inner thoughts (Step 1: Stop telling yourself you’re stupid, ugly, useless.). Hearing from patients’ mouths how they got over disturbing and horrifying abuses have helped me rethink some of the things I’ve gone through in my life and some of the pent up hatred I have – how you have to either forgive the person, or just literally let it go and not think about it any more. Denial is my preferred coping mechanism, but perhaps I can learn to think like they do.
The patients – they are so strong, and they don’t even know it. They are so brave and beautiful yet feel scared and hopeless. They buoy up everyone else, praising their peers’ efforts with words and hugs, but shredding themselves to ribbons with their own thoughts. The worst part is the guilt and shame most of them feel for being in a psych facility – they, like most of our society, think that the ward is filled with homicidal sociopaths and scab picking schizophrenics. That is the farthest thing from the truth. But to convince the patients that society is wrong, it’s okay to be here, you are so brave and strong for coming here for help – that is practically impossible.
If I could teach ANYthing to any of the people that might come across this blog and read something, it would be about the mentally ill. There is no reason for mental illness to be taboo – really consider it for a moment. Your skin, your lungs, your heart, they are allowed to get sick, but your brain is not? Why should all the other organs be allowed to get diseases and deserve treatment but the brain does not? A person with asthma deserves their inhaler, and the pharmacist won’t look twice at them when they order it. But the shame someone feels when picking up their Prozac – can you imagine how that might impact someone’s treatment and recovery when the pharmacy tech gives them the side eye and lifts their eyebrow in disdain?
My point to the world is this – there is NO SHAME is seeking treatment for mental illness, whether it is inpatient, outpatient, or seeing a therapist. There is NO SHAME in taking medication for your mental illness, even if it is for the rest of your life. It is medicine that keeps you alive, the same as insulin keeps a diabetic alive. Mental illness is no different than any other physical illness, except the unlucky people with mental illness have no physical proof of their pain. Please consider this the next time you come across someone with a mental illness, and do your best to not judge them – they have probably been through hell, and someday you or someone you love could also become a victim of mental illness. Keep in mind – the lifetime likelihood that a person will get a mental illness is thought to be over 50%.
Saturday, October 4, 2008
Dying
My patient, Miss Smith (not her real name), is sleeping once again, as she has been most of the day. For the third time, she forgot where she was and what day or year it is. For breakfast I had to feed her slowly, bite by bite, and she was very proud of how much she ate - the most expressive she was all day. "Will you tell my daughter how good I did?" she croaked hoarsely. After she ate, I gave her a bath, careful of her paper-like skin, and noticed just how frail she was under all her blankets. Her thighs were only a little larger than my upper arms, and she was so dehydrated that her skin was dry and flaking over most of her body. Prior to today, I was nervous about bathing patients and giving them "complete care," but this woman was child-like in her confusion and for some reason it wasn't awkward - it just seemed like something that needed to be done - the care she deserved.
All day long I wished for a smile from her, something to let me know that she understands I'm here to help her. Occasionally when she opens her eyes I see a recognition in her face, but her cloudy eyes blink and its gone. I checked on her nearly every twenty minutes on my 12 hour shift - one, because she was my primary patient for the day, and two, because no one else on the floor seemed to care.
An hour after she ate, I found her sleeping once again, covered in yellow vomit full of all the food I had so carefully fed her and she had so painstakingly eaten. I made sure she was not any more confused or unconscious, and then internally freaked out. I found the charge nurse and she kindly helped me clean her up and change the linens. Miss Smith was still confused and disoriented, but luckily no worse than before, and there were no signs she aspirated the vomit into her lungs. I was sorely disappointed that she got sick - especially because she had just taken her pills for the day and was malnourished enough already. I gave her another bath, but she was bewildered and only asked "Can I go back to sleep now?" in just about the saddest way possible, like it was the only thing she wanted.
Later in the day her IV became infiltrated, and I berated myself for not noticing it sooner. Her painfully thin arm had a swelled lump the size of a grapefruit near hear inner elbow, and in a way to make it up to her I continued heating a wet washcloth to help it go down, checking on her every few minutes. At lunchtime, they brought her greasy ground beef and noodles and green beans, and I tried to pick them out for her. She refused them and turned her head after two bites, and I was kind of glad - the sound of her grinding dentures made me nauseous. It sounded like dying, like a desperate attempt to make old jaws process forced food when the body just wants to give up.
She left me thinking about death all day, and now still. Not so much death itself, but this act of dying so slowly and with such little dignity. This wonderful 97 year old woman left me wondering what she was like when she was younger. I wished I could talk to her, and kept willing her medicine to start working so she'd really wake up. Regardless of the effectiveness of the medicine, her Alzheimer's would've undoubtedly prevented us from having a meaningful conversation. I wondered what growing up as a young black woman in the early part of the last century was like for her, and what effect living through the wars and Great Depression had, and whether some mistreated part of her from long ago made her frightened of me. Mostly, I wondered what I would do if I went into her room and she wasn't breathing. I asked my instructor at the end of the day, and she was chipper and made a joke. The other students in my clinical made a joke about a student giving CPR chest compressions to a patient in the ER last week, how maybe it was him that killed her. I was the only one who didn't laugh. I wonder if it's because I'm an atheist, that maybe I have a different outlook on death and dying, because it's so final - there is nothing else after. Or maybe I'm the only one that hasn't turned myself off and become numb to caring for a dying human being. All I know is that I don't want to become numb.
All day long I wished for a smile from her, something to let me know that she understands I'm here to help her. Occasionally when she opens her eyes I see a recognition in her face, but her cloudy eyes blink and its gone. I checked on her nearly every twenty minutes on my 12 hour shift - one, because she was my primary patient for the day, and two, because no one else on the floor seemed to care.
An hour after she ate, I found her sleeping once again, covered in yellow vomit full of all the food I had so carefully fed her and she had so painstakingly eaten. I made sure she was not any more confused or unconscious, and then internally freaked out. I found the charge nurse and she kindly helped me clean her up and change the linens. Miss Smith was still confused and disoriented, but luckily no worse than before, and there were no signs she aspirated the vomit into her lungs. I was sorely disappointed that she got sick - especially because she had just taken her pills for the day and was malnourished enough already. I gave her another bath, but she was bewildered and only asked "Can I go back to sleep now?" in just about the saddest way possible, like it was the only thing she wanted.
Later in the day her IV became infiltrated, and I berated myself for not noticing it sooner. Her painfully thin arm had a swelled lump the size of a grapefruit near hear inner elbow, and in a way to make it up to her I continued heating a wet washcloth to help it go down, checking on her every few minutes. At lunchtime, they brought her greasy ground beef and noodles and green beans, and I tried to pick them out for her. She refused them and turned her head after two bites, and I was kind of glad - the sound of her grinding dentures made me nauseous. It sounded like dying, like a desperate attempt to make old jaws process forced food when the body just wants to give up.
She left me thinking about death all day, and now still. Not so much death itself, but this act of dying so slowly and with such little dignity. This wonderful 97 year old woman left me wondering what she was like when she was younger. I wished I could talk to her, and kept willing her medicine to start working so she'd really wake up. Regardless of the effectiveness of the medicine, her Alzheimer's would've undoubtedly prevented us from having a meaningful conversation. I wondered what growing up as a young black woman in the early part of the last century was like for her, and what effect living through the wars and Great Depression had, and whether some mistreated part of her from long ago made her frightened of me. Mostly, I wondered what I would do if I went into her room and she wasn't breathing. I asked my instructor at the end of the day, and she was chipper and made a joke. The other students in my clinical made a joke about a student giving CPR chest compressions to a patient in the ER last week, how maybe it was him that killed her. I was the only one who didn't laugh. I wonder if it's because I'm an atheist, that maybe I have a different outlook on death and dying, because it's so final - there is nothing else after. Or maybe I'm the only one that hasn't turned myself off and become numb to caring for a dying human being. All I know is that I don't want to become numb.
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