Its a living...

As a rule, I try not to post work related things here. I am a nurse and with all the HIPPA and privacy concerns I would hate to accidentally compromise someone. But the fact of the matter is this - sometimes the best way to cope is to 'write what you know'. 
In 2008 I was a member of an on-line writing group. One of the members put forth a challenge for those of us who work in public service. The challenge just happened to coincide with Nurse's Week. To my surprise, my essay won first place. And ever since, once a year, I write an essay about my own personal experience aso a nurse. What follows are those essays.
As this first essay states - I never planned to be a nurse. I never did surgery on my Barbies or bandaged the dog. I never wanted to 'save the world'. Rather, my dream was to document the world around me and maybe poke a little fun. 
So, I suppose in a way, my dream did come true.

                                                                       *2008*
In Service
I am a nurse. I have been a nurse for 24 years. This is longer than I have known my husband, longer than I have known my closest friends. I was not called to this profession. As a child I did not dream of wrapping bandages and holding hands and saving the world. In considering a life of service, I became a nurse for the worst of reasons. I knew this would be a job that was secure and paid well. Period.

My true dream was to be a journalist, changing the world with witty well written commentary on the state of things. I wanted to live in a high rise apartment in a big city. I wanted to travel and see things no one else had seen.

Be careful what you wish for.

I have seen things many have never seen. I have done things that my family and friends can not even comprehend.

I have welcomed babies into this world and I have lavaged the stomach of a child that got into Grandma’s purse and ate all her pills because they were kept in a mint tin.

I have held pressure to stop bleeding on accidental wounds from chain saws and deliberate wounds from knifes. I have packed nose bleeds, one several times when the poor patient would sneeze the packing out after we were finished, creating a scene more fitting the scariest slasher film ever made.

And, I have stood by helplessly as a young man bled to death despite our best efforts, his blood creating a lake of brown on the floor, soaking my shoes to my socks. I threw away the shoes; I will never be able to throw away the images of the young man’s face or that of his father…or the faces of my co-workers, mirrored in my own that morning.

I have given drugs that have saved lives. I have given drugs that could kill in an instant. I have given the wrong drugs a time or two, thankfully with no harm done. But I carry those mistakes with me like grandma’s pills in that mint tin and pull them out from time to time to remind myself that it only takes an instant and I pray daily that I will never do it again.

I have been asked to cook a steak that was stolen from a local grocery. I have been asked to resuscitate a puppy. I have heard explanations for fish hooks in nostrils that defy physics. I have been asked “why” and “when” and I still don’t have a good answer.

I have been called every curse word known to man, in a variety of languages and in combinations that should be awarded a Pulitzer Prize. I have been pinched and grabbed and once, nearly had my wrist broken until I mustered the strength in my 5’5” frame and used the self defense I had been taught to slam the 6 foot junkie into a wall and free myself. The element of surprise really does work.

I can apply 4 point restraints in under a minute to much admiration from some paramedics…but that is another story.

I have been puked on, spit at and coughed on. It has been suggested that I am an experimental incubator for the vaccine to cure all communicable diseases. I have wiped more butts and cultured more vaginas than I care to really think about. I have seen more penises than an Amsterdam hooker.

I have comforted, laughed and cried with my patients, their families and my coworkers. I have been there to witness death… unexpected, welcomed, self-inflicted. I still cry when I talk with those left behind.

I was not called to this profession. I keep telling myself I am in it for the job security and the cold hard cash.

I am a liar.

Over the years I have come to the realization that I am actually in this for a selfish reason. I have become a different person for this job and I like the person I have become. I have discovered that my education only began at Deaconess Hospital School of Nursing. My education has never ended.

I have learned how to ask questions to get the real answer. Not “do you take medicine” but “Are you suppose to take medicine”. Not “do you drink” but “how much do you drink” and then “what size are those beers?” I have learned to talk to everyone, from the wealthiest to the most destitute. I have learned that it is OK sometimes, to laugh with the person that just called you everything but…and I have learned to laugh at myself…always.

I have learned that holding a hand is sometimes the best thing to do. I have held the hands of children, young women, old women, men of all ages…even the most foul, angry coked up gang banger will respond to a squeeze of a hand when that person is truly frightened.

I have learned patience from the lady with emphysema that would arrive every week or two. She would be nearly unable to breathe, anxious in the knowledge that this might be her last visit. She would always tell us a joke, between gasps, as we tried repeatedly to start an IV and draw blood from her needle scarred arms. And, I learned to put others need for comfort ahead my own when our little band of night shift workers attended her funeral.

I have learned that there is a human-ness that we all share. I saw this in the dignity of the homeless man that would only take dry socks when offered clean clothes. I saw it in the alcoholic that had a degree in literature and quoted Shakespeare to me for the better part of a shift. I saw it in the eyes of the Harvard trained doctor that needed help knowing what to do when our patient refused to respond to our attempts to resuscitate.

I have learned true disgust, anger and sadness but I have also learned true amazement, peace and joy. I no longer get aggravated when something goes wrong; OK, that’s not entirely true. I have learned to reign in my annoyance and focus that energy on something positive. Most days this works but…I am still learning.

I am constantly encouraged to return to school. I need to get a degree, and then an advanced degree. I could have every letter in the alphabet after my RN but it would never change the fact that the lessons I really need to learn are at the bedside.

I do not want nursing to become my career. Nursing is my job. I was not called here…but I am glad that I stopped by.


                                                                              *2009*
                                                                                 Life
I am a very faithful person however, I do not go to church. I do not feel sitting in a building for an hour and then drinking stale coffee in the church hall once a week brings me closer to God. I do feel His presence daily. I guess today he was busy somewhere else.
Today I took care of a patient that shared my son's birthday, given a year. My son will be 20 soon. This young man will be 21, God willing.
My son is a healthy college student. This young man is healthy looking but he has a tumor which had grown beyond repair. The surgery they did today was supposed to give him a little bit of time.
 It failed.
I had to stand by and watch as the smiling face of this young man changed to a dark tight lipped grimace when he heard the news. I saw the resolve in his father's eyes. I could not look at his mother.
When they wheeled him from my bay, I went to the bathroom and cried. I felt such sadness for him and his parents yet all I could think about was my son and how lucky I was that he was safe at home. I felt so self absorbed. I felt betrayed.
It is easy to care for adults that are dying. Not easy like tying your shoes but easy to put a place in the cosmos for what will happen. I do not work with children as a rule because the cosmos are random in their actions and there is no reason.
Of course, there really is no reason for anything. I truly believe that God did not give this young man cancer, it just happened. Yet today, I need a reason why.
It came to me on my way home that perhaps I am here as this young man's witness. As his other acquaintances, friends and family are witness to his life, even for the short time I had him in my care, I witnessed his strength, his sweetness, his charm and his potential.
I will have faith that this is the lesson I needed to learn today.
                                                                                
                                                                                  2010

       Nursing Shoes

I bought a new pair of nursing shoes the other day. They are the brown slip-on variety that seems to be in vogue if you take fashion advice from a shuttle bus full of middle age women working twelve hour shifts. These shoes are a world different from my first pair of nursing shoes.


Those shoes were shiny and white. They tied up tight for extra support should you need to run down a hallway in response to an emergency. They had crepe soles so you could slip in and out of a room in the middle of the night without waking the patient that finally fell asleep with the call button clenched in his hand. There were times when they squeaked on a freshly waxed floor, usually after stepping in some questionable liquid that you told yourself had to be water…or maybe Mountain Dew. I spent hours buffing white KIWI wax into the leather on Sunday nights so no one would see the smudges acquired on the previous shifts. Those first shoes looked great but really weren’t too comfortable. When I think about it, I was a lot like those shoes.


Twenty six years ago I too was shiny and new. I didn’t want anyone to see the scuffs and smudges so there were times when I would buffer my lack of knowledge with quiet observation. I did a lot of running; usually on account of my own disorganization than any true emergency. And I squeaked aloud at times when faced with questionable situations. My support system consisted of a group of girls with equally shiny shoes and I needed those shoes to tie up tight.

Yes, these new shoes are a world different from that first pair. These shoes do not show the dirt but rather, they have taken on a weathered and worn appearance. They offer support in the arches for long days of standing, but very little running – they slip on and off too easily. They are not quiet. They make a very distinct clunking sound as I walk down the halls. I wonder what my grandmother would think of these new shoes.

She was also a nurse. Her shoes were white and laced tightly but rather than crepe soles, they had hard soles with a sensible one inch heel. In her day, nurses wore white from head to toe – dresses, stockings and caps. Nurses of her day needed that heel to remind them to stand up just a little straighter as they faced the challenges of a world where women with children rarely worked and nurses were trained. Now nurses are educated. Our jobs have evolved and the white dresses and caps were left to archives of a “good old day”. We have exchanged those early notions for scrubs and critical thinking.

I have evolved as well. I am no longer that shiny new nurse I was years ago. I don’t spend nearly as much time running because of poor organization and my support comes not from a tightly tied pair of shoe laces but from an amazing group of co-workers who freely offer their experiences and accept mine as a sort of continuing education process more easily accessed than any computer program. I let the world see the dings acquired during the day and don’t feel the need to buffer the smudges. There are still times I squeak – if only in my head – when the situation or questionable liquid calls for it but I don’t feel the need to enter a room silently in hopes of going unnoticed as I know I am there for a reason.

Yes, I think Grandma would approve of these new shoes. They are comfortable. Just like me.
                                                                      

                                                                                    *2011* 
        Taking Care



Its that time again – National Nurses Week makes rounds the first part of May. (Notice how I have incorporated ''nursing lingo" into that first sentence.) The theme this year was 'Nurses-Trusted to Care'. I can't think of a more timely theme. As nurses we do care. We care for our patients – we care how their treatments are planned, we care that they are comfortable, we care that they do not suffer adversely from all those outside influences that can delay healing or increase length of stay. It can get exhausting what with all that caring going on.

In fact, not too long ago, I was in need of some major caring. It had been a typical busy morning and I was well into patient number four. Patient number four was the sort of patient that makes me wonder what it is I am doing here. Patient number four was sick – not lying on the couch, sipping chicken soup and watching game shows sick – but the sort of sick where no matter how awful things are there is not even enough energy to complain. Across the way, my colleague was caring for the "What time is it?" patient. This is not the patient concerned about keeping an appointment or missing the finale of Survivor. This is the patient that knows if the surgery only took an hour then the prognosis is bad. Real bad. 
This surgery had taken only minutes.

My colleague and I exchanged the "If I stand here much longer I'll start crying" look; joked about the size of the margarita waiting at home, reassured each other that we could do it; and returned to the job at hand. Pain medication, reassurance and all the other tasks that require that the thoughts of how fragile life is be pushed to the back of your brain.

Lunch time couldn't come soon enough and as I sat down to my uber tasty Lean Cuisine Sesame Chicken and bag of carrot sticks I was joined by another friend and co-worker. She promptly regaled me with the trials of her day thus far while tearing into a steamed chicken breast with such enthusiasm as to make me think there might be something better for lunch than a frozen dinner. As more staff joined our lunch table the conversation became more animated...and more graphic.



PS- if you have ever eaten a meal with a member of the medical field, you know that much like a Quinten Tarrintino movie, nothing is sacred and the grosser the better. I have often wondered about the mental health of our own kids – having grown up with an ER nurse for a mom and a dad who is in law enforcement. In fact, on arrival to a parent teacher conference, I was told that my promptness would rely on whether or not anyone decided to DIE.



The lunch conversation devolved into which advertisement is grosser – women's shaving products or those hideous toilet paper bears. The lunchroom door opened and more staff entered carrying two huge sheet cakes and a bag of bagels. All were partially eaten but regardless of the overall gnawed on appearance the treats were brought in the spirit of caring. It goes back to my favorite Nursing Theory: If all else fails, eat. And as I cut into a 17000 calorie slice of cake (the calories would be counterbalanced by the aforementioned diet TV dinner) – a weight lifted. I took a deep breath and looked around the room and for an instant I knew what it was like to be taken care of. We might not always agree, but the group sitting at that table all have been where I was that day and behind the laughter and mildly off color language were the faces of people that care. And they care deeply. Not just with cake and stale bagels, but with words and looks and hugs and a spirit of support matched by none.

So to all the Nurses out there – Congratulations on another Nurses Week! I hope your employer provided you with goodies but more importantly, I hope you each took a moment to look around at those you work side by side with every day and I hope that each one Takes Care.

                                                  (and because 2011 seemed to be extra inspirational)
                                    Where its Okay to Wake Up With Strangers

“So, you’re a nurse.”
“Yes, in Recovery.” Wait for it, the dull stare…the questioning
look.
“Oh…you mean like Drug Recovery….”

And there it is.
No one really knows what a Recovery Room nurse does. If they have been
to surgery they don’t remember us. Try to explain to someone that you
essentially wait for people to wake up.

“Oh, so you get paid to watch people sleep? Wow, that's sort of creepy...”
Well…



We do watch people sleep in Recovery. But we aren't just lurking around your head like the tooth-fairy or hiding under the mattress like the boogie man. Nope. While our patients sleep the weird analgesic sleep of surgery we are assessing breathing, drawing blood, performing EKG's, emptying drains, assessing breathing and heart rate, checking dressings, treating pain, assessing breathing, blood pressure, heart rate...do you recognize a pattern here? While life in the Television World of Hospitals is all yelling and running and thrills, life in the Recovery Room is not. It is quiet anticipation with quick efficient action. We don't have the thrills of the Television Nurses because we don't want them. And, we are capable of preventing them.



And so, we assess and assess and intercept before the need for yelling and running. All while our patients sleep.

Life in the Recovery Room is great. Very few nursing jobs offer Monday through Friday positions with flexible hours. Oh sure, we do cover on-call but this is a small part of our time. The pace is fast and interesting. In any given day I might start my shift caring for a simple out-patient hernia repair and end it caring for a patient who has just received a new kidney from an anonymous donor. We see patients with traumatic fractures repaired and devastating cancers removed. Our staff collectively has experience in every field of nursing and no one is stingy about sharing their knowledge. In the general duties of the day we all teach one another and we learn as well.



All while watching our patients sleep.



So I say to my fellow Post Anesthesia Care Unit Nurses: when someone askes you just what it is you do in Recovery smile and say: Why not come to the PACU*where it is okay to wake up with strangers!**


I have been a Recovery nurse for nine years. I never intended to be a Recovery Room nurse (of course I never really intended to be a nurse so…) I did my two year mandatory sentence on various med-surg floors then at the first opportunity I finagled my way into the Operating Room. On occasion – read that when on call after hours – we circulators had to recover our patients. This was in a very tiny hospital, I was pretty young, and frankly, there were many other things I would rather be doing at 2AM than watching people sleep only to wake them up and give them drugs so they would go back to sleep.



As my family life changed I moved on from an on-call position and landed in the Emergency Room Nights. I loved the ER.(It was still called an ER back then, not a fancy Department like it is now.) I never wanted to leave. Until the night when someone swapped us a half bottle of Jack Daniels for a vaginal speculum (used). The thought of someone wandering South Broadway performing drive-by PAP smears was too much. I began looking for a new position in a less ‘urban’ environment. And that is how I wound up in Recovery.



But this time, I was more mature, well voiced in medications, emergencies and medical students and I discovered that I actually enjoyed the job. The pace was good, the patients were interesting, for the most part devoid of lice and well, there are very few nursing jobs that offer hours more along the Monday through Friday range.

Of course, I am a nurse and we aren’t anything if not restless and so four years ago (this coming October) I made the move back to an urban setting. I now work in surgical recovery at a large (huge) teaching hospital.I know it sounds suck-uppy but I really do like working Recovery here. Just when you think you have seen it all, our doctors manage to figure out something new to do to our patients – and they do well! Our hours are pretty good. And, our staff is the best. Just sit back and watch a patient roll into Bay 24. That patient will be swarmed on like teenagers on a Pepperoni Pizza (free). We collectively have experience in every field of nursing and no one is stingy about sharing their knowledge – in a good way!

So, when someone unfamiliar with Surgical Recovery asks just what it is that I do I just smile and say, "We watch people sleep."



Because in the PACU its Okay to Wake Up With Strangers!**



*PACU is the acceptable abbreviation for Post-Anesthesia-Care-Unit. Probably renamed by those same guys that thought ED was cooler than ER.



**This Phrase was coined by one of those awesome people I work with. She has a lot of experience waking up strangers...

                                                                            * 2012 *
                                                                             Thinking 
 
Don't you just hate it when a patient makes you think?



I was forced to think a deep thought not too long ago. I was floating in PACU and was waved to the bedside by a man just a few years my senior who was recovering from a semi-minor surgery. The surgical units were full so he had spent several hours in the recovery room. Hours enough to be wide awake and a little bored but more importantly, long enough to need to use the urinal.


He felt steady enough to place the urinal himself so I pulled the curtain and stepped aside. After what I hoped was an appropriate amount of time I called 'knock knock' and asked if he were doing okay. I was answered with a questioning 'well...?'


It seems that while the act of using the urinal went on without a hitch, removing the rather full bottle did not. His sheets were not the only thing soaked. The look on his face was one of a person caught in a downpour without an umbrella. "I am so embarrassed," he said, barely making eye contact.


"Not to worry," I replied. "Let me get someone to help and we will get you fixed up in no time." To my surprise, the patient replied that he would rather not have more people in his room. He felt he could turn without difficulty. I gathered the needed supplies and returned to pull the curtain and proceed with his clean up. The patient was quiet as I went about my work. Then he said, "I just can't decide which I lose first at the hospital – my modesty or my dignity."


His very frank comment surprised me and it started me thinking.


Modesty is a personal quality with many influences – religion, society, upbringing – and it is truly fair game when a patient enters the hospital. We as nurses attack Modesty with the subtlety of Joan Rivers and her Fashion Police. Oh sure, we try to keep it alive with pulled curtains and draped towels but face it: there is no way to insert a urinary catheter into an awake patient without dealing a tiny blow to Modesty.


Dignity, by definition, belongs to the patient. It encompasses self worth, self esteem and the idea that a person is due respect. Nurses support this definition by addressing patients as Mr/Mrs/Miss until asked to do otherwise by the patient. We limit our clinical discussions while at the bedside to avoid making the patient feel like a diagnosis rather than a human being and we treat all our patients equally, regardless of the circumstances that brought them into our care.


So as I finished assisting the patient I replied, "Well, I think we both know Modesty gets pretty much checked at the door when you sign your admission paperwork. But Dignity, well, that is yours. Ideally, we help you to protect it but ultimately you are the one to give up on Dignity."


We both fell quiet for a few seconds. Our eyes met and simultaneously we burst out in laughter. Me over the fact that such a deep thought could form and exit my brain and the patient at how ludicrous is must look to hear such deep words coming out of a woman holding a half full urinal and a handful of wet sheets!


I excused myself to finish disposing of the clean up supplies, trash my gloves and wash my hands. As I came back around the corner to the patient's bedside I was greeted with the first genuine smile I had seen all day. He was still chuckling but it was clear that my words had started some thoughts of his own. We had several conversations during his stay in PACU that day. His smile remained.


And I have thought about him almost daily ever since.





1 comment:

  1. Such great stories!!! They should be published!!! All persons in training to be a nurse should be required to read these stories!!!

    ReplyDelete

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