At Least I Know What Unit I Don't Want To Work On

I stood in the hallway outside the room, nervously looking on at my first CRT (Critical Response Team) incident. Before the CRT was called, the woman was on a bedside commode, slumped over and moaning softly. “Clara,” her nurse, shook her shoulder and put the woman’s head between her hands, trying to get her to open her eyes. “Mrs. Jones, open your eyes! Can you hear me, Mrs. Jones? Try to look at me.” The woman was virtually unresponsive. The nurse I was working with ran into the room and asked if Clara needed help. “Call a CRT. Now.” Within minutes, the small room was swarming with help and the woman was whisked off to ICU. The relief Clara felt after the patient was stabilized and off our unit was palpable.

CRTs are sort of a pre-code blue; they are called by the nurse in the hopes that help will arrive and the patient will be stabilized before they lose consciousness and stop breathing. They are not called frequently, particularly on the unit where I work, so it was several months into my training before I experienced the one above. The charge nurse will show up quickly, as will all nearby nurses on the floor, and the ICU charge nurse and another ICU nurse will come down to assist as “another pair of eyes” to help assess the situation. The room fills almost instantly with helpful (and sometimes just curiously nosy) bodies.

Since ending my orientation on the unit and beginning to work on my own, I had a list of three (albeit irrational and somewhat ridiculous) fears that I had successfully avoided dealing with on my own. A month or so ago, I conquered all three of them in a single 3-day workweek, from 3rd most feared to the number one most feared, strangely enough. #3: Changing a PICC-line dressing on my own. (For those other nurses out there, I know this is bizarre. But I’m always afraid they’ll slip out!) #2: Putting a Foley catheter in. (I somehow managed to not put one in since nursing school.) #1: Transfusing blood/blood products. (Legitimate to fear, but still not worthy of months of avoidance.) In any case, I thought I had conquered the worst if it and have been feeling, for the most part, pretty competent at work. The last lurking fear I had that occasionally stressed me out was walking into a patient’s room and finding them unresponsive (or worse) and having to call a CRT or code.

The other day I squelched that one and made it through my first CRT. The man was a diabetic in renal failure who had been evading his nephrologist for some time who wanted to start him on dialysis. He came in for an unrelated surgery and when his labs came back the morning after, a slew of doctors convinced him to stay in the hospital and have a dialysis catheter (Permcath) placed and hemodialysis started. For this surgery, he needed to be NPO (nothing to eat or drink) for at least 8 hours, which can be tricky for a diabetic. Toward the end of my 12 hour shift, I was in the room with him and noticed a slight alteration in his mental status and also that he was profusely sweating. My suspicions proved correct when I checked his blood sugar and it was 30. This is quite low, and can be very serious – the normal accepted low is at least 70, but normal blood sugar is closer to 100. I began to follow our hospital’s protocol for hypoglycemia but despite two attempts, we couldn’t get his blood sugar higher than 60, which is still too low. I notified the MD and implemented the orders. He was started on what is essentially a sugar-water IV drip and I thought everything would turn out alright.

An hour later, I was in the room with him explaining his surgical consent, and within minutes before my eyes he began to decline; he was sweating worse than before and was extremely drowsy, mumbling, and tremulous. I checked his blood sugar immediately and was shaking as I waited for the results, knowing they would be awful. His sugar was 26. I ran into the hall calling for help and snagged a bottle of D50 (very concentrated sugar water) and told someone to call a CRT. In under a minute I had half a dozen nurses in the room assisting me, and within 2 minutes the full critical response team had arrived. My hands were shaking so badly I couldn’t draw up the D50, but someone graciously took over that task. The patient eventually stabilized and after a maddening amount of arguing with the internist, we transferred the patient off the unit.

I will still have lingering worries about worst-case scenarios and crashing patients, but at least I feel like I’ve had a little taste of the worst things this unit has to offer. One this is for sure – with those embarrassingly shaky hands, I sure as hell know the ICU isn’t for me!

Dementia; Or, the First Time I've Felt the Need to Post Since Graduating

“Do my daughters know I’m here? I need to see my babies, they need me to tuck them in at night. I always tuck them in.”

“Your daughters are all grown. They brought you here a few hours ago. They’re doing very well.”

“Do they know I love them? I need to tell them I love them. I love them so much. I’m so lonesome for them.”

“I know you are, but I’m here for you right now. They do know. You told them over the phone a few minutes ago, and they love you very much too. They told you so, and they’ll be back in the morning.”

“Why are you spying on me? I want to go home to the lake. I should’ve never fallen down that manhole. Why did they leave the cover off that manhole? Do my daughters know I’m here? They need me to tuck them in.”

“Your daughters are all grown up and they know you’re here. They love you very much. They’ll be back in the morning.”

“Why am I in prison like this? I just want to go back to the lake with my daughters. Please can I go?”

That is how the entire second half of my twelve hour shift went. She had dementia and was incredibly sweet, pleasant, and cooperative, but she couldn’t remember anything that I told her and was surprised every time I repeated my stock answers to her litany of questions. I’ve never dealt with someone whose mind was more like a sieve. She was, of course, a fall risk, and I had the bed alarm turned on so that a blaring noise went off whenever she tried to get out of bed without one of us there. For 6 hours, this went off almost every 10 minutes. I do tend to exaggerate at times for comedic effect, but I only wish I was exaggerating about the previous sentence. I repeated the same thing every time I went in and reset the alarm. I sat with her for a solid hour and a half, but she was insatiably lonely and immediately tried to get out of bed as soon as I left. I distracted her with magazines, foods and drinks to nibble, tried to find a show for her to watch, and even asked her to “help” me fold towels and washcloths to keep her hands busy. None worked for more than a few minutes, ten at best.

I can’t imagine being the caretaker for someone with a disease this severe. It’s unfathomable and devastating. When I finally caved and called her daughter after several hours of repeated pleading, I could hear the tension in her child’s voice over the phone. She apologized to me, saying that she wished she could be there, but she needed a break. Just a little break and some rest. I couldn’t blame her for failing to warn me what my time alone with her mother would be like. I had to hang up the phone even though she wanted to tell her daughter that she loved her one more time.

I cried on my drive home, my first time crying because of work since I started in February at my first real career. I’ve been so proud of myself when the other nurses ask how many times the job has made me cry. “None!” I’ve said, and they’ve been surprised. I’ve been emotionally drained from patients before, but never like this. Everything I did for her and said to her was pointless. Hopeless. Irrelevant. She couldn’t remember all the times I’d repeated myself over the past hours, but somehow, her frustration was building and all she could recall was that I was keeping her hostage. “This is America, you know. The United States. I’m not a prisoner. I’ve had my picture taken with the Statue of Liberty. I’m free.” No matter how much I soothed her, hugged her, held her hand, stroked her face, and reassured her that both she and her daughters were safe and loved, she forgot it within 5 minutes. I kept my voice calm and gentle with her, but as soon as I left her room I would lose it. Over and over.

I’m not entirely sure what to make of this day, or this post. It’s cathartic. And depressing. And terrifying that it may happen to someone I love. Terrifying to think I might have to do this for more than a day, way more than a day. I don’t think I’d want to live if I was that way. At what point do you just give up?

New Town, New Job, New Life

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.

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:

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.

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.

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.

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%.

Reflecting on the end of the Semester

I have one more day left to spend in the hospital, but I am essentially done with classroom learning in the main nursing skills class so I figured I could write about it. I've been putting off writing about the "spirituality" and "alternative treatments" chapters, which is strange because this blog is titled Atheist Nurse. I dislike confrontation with most people (except for my mom - Hi, Mom!) so I didn't really want to write about this until now. It's not like I have anything profound or interesting to say about it; mainly I'd just like to get some crap off my back about the ignorance and magical thinking some people (and college book writers) possess.

I'll start with the Spirituality chapter. I don't have any particular problem with learning about different types of spirituality in nursing school; I look at spirituality as something I don't have, but for a majority of people there is a physiological basis for their belief in god/gods. Some peoples' brains are incapable of not believing in god/gods. Therefore, if they are in spiritual distress or are depressed because they think their god dislikes them, I need to treat them with the same care and compassion that I would treat someone with a broken leg. This is especially important because the psychological health of a person is directly correlated (in most cases) to how well their bodies can heal physical wounds they may have.

So, disclaimer aside, I hate this book. It says that the definition of an atheist is "a person who denies the existence of a God." Um... what? Atheists do not deny the existence of a god with a capital G. All the atheists I know have concluded that there is no evidence to support the existence of any god or gods - not just the Judeo-Christian god they seem to favor. They even have this as a question at the end of the chapter to make sure the people understand what an atheist by the book's definition is. I have a test tomorrow over some of this material, and I'm unsure of what I'll do if the teacher (who happens to be the wife of a minister and a youth minister herself) has a similarly misleading question on the exam. In class, when teaching this material, the teacher insisted "Everyone needs spiritual care - even the atheist - because we all have a spirit, and they all need care!" ...Right. And there is also only one atheist in her world, evidently.

The chapter also has several ready-made prayers available for the student nurse to use in his/her practice. One general prayer in case we aren't used to praying, and one specially created nurses' prayer. I find this all wildly inappropriate, mainly because the only acknowledgment of the non-religious people is the single-lined definition of an atheist and agnostic with the admonishment that "They deserve respect for what they choose to believe." Beyond that, it's 25 pages of how to care for religious folks and how to become friendly with your own spirituality. Oh, and also some Critical Thinking story about how if a kid is diabetic and his parents won't take him to the doctor because they're Christian Scientists, you should put off calling CPS until you consult with the family, the family's church and your nursing organization. This is because the nurse in the story believes in the "power of prayer." Hmm.

I wanted to go on about the Complimentary and Alternative Medicine chapter, but I'll just mention some of the things they "teach" us about. Like the value of chiropractic "medicine," homeopathy, fixing your Qi, Therapeutic Touch (a horrifyingly ridiculous nursing practice that the book touts as scientifically valid), the scientifically proven positive affects of intercessory prayer (I'd love to see the studies they're referring to - because all the ones I've read show that is has negative affects), and how to feel your own energy by holding your arms out and then pulling them slowly in to feel when something "pushes back." Wow! Sounds like valuable educational material.

Like I said, I hate this book.