Where healing ends

Even as an adolescent, I recognized birth as a sacred moment. Perhaps this is why I just knew that I would find my niche, as many students believe, in women’s health. This notion, it turns out, was severely misled, but that is a whole other story for another time.

There is another sacred moment in life, one that isn’t as readily talked about. I’ve never encountered an aspiring nurse who claims end of life care as their specialty of choice. I think there are many reasons for this. Firstly, it doesn’t sound like very cheerful business. Secondly, as far as nursing specialties, it doesn’t sound very glorious. Lastly, we often label our work as a “healing profession” and helping people out the back door of this life doesn’t quite line up with that perception. The fact is, healing is not always the appropriate goal. Please don’t think me heartless or apathetic to the pain of losing loved ones. I know all too well the agony of grieving. The beautiful thing about end of life care is that you are not just treating a patient, you are treating the family and you are treating their loved ones. You provide comfort and dignity. You listen as they reminisce. You laugh with them, you pray with them. It is an extremely intimate process. My hospice rotation yielded some of the most rewarding and spiritual experiences I’ve ever had. I worked some home health, I worked some inpatient. The more I saw, the more I wanted to learn. It was from a dying patient’s care that I adopted my first personal unbreakable law of nursing. My favorite instructor said it as she pulled our whole group into the room. “NO ONE DIES ALONE.” The patient had no relatives. Just us, a group of strangers gathered around their bed. We held their hand, we spoke to them, we wiped their perspiring brow and wetted their drying lips. They say that, as the body shuts down, hearing is the one of the last functions to go. I like to think that is true, and I encourage you to speak, or even to sing to anyone who is “unresponsive.” Do whatever it takes to assure them that they are not alone.
I have never specifically worked in end of life care professionally, but I have, on occasion provided hospice care on my med/surg unit. I have let many things slip and I’ve probably “wasted” time in rooms of the dying that could have been spent tending to other patients. I don’t regret a second of it. We are born once and we die once. Every nurse has a code. “NO ONE DIES ALONE.”

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Sea legs

We learn many lessons from pain, but more effectively, I think from embarassment. Its because embarassment tends to linger longer.
The next rung on the ladder of my nursing education was the hospital. I just knew this is where I would learn “real nurse” work. (That very notion cracks me up by the way,  as I now know that 95% of nursing is customer service.) This is where I was assigned my first inpatient. I was responsible for their assessment, bathing, and any other needs that may arise. I also had a packet of documentation as thick as a T-bone steak to do on them. This thing was nothing if not thorough. Religion, work and travel history, registered voting party, sphincter diameter, favorite restaurant, you name it, it was in there. I spent the first hour poring over my patient’s chart trying to scavenge as much information as possible before meeting them. I had barely found anything before I was torn from the desk and ushered to my assigned room. Apparently we were there to care for patients, not charts. On opening the door, I was greeted by scathing glare of the most miserable soul to inhabit God’s green earth. Picture a dirtier and meaner Ron Jeremy’s fat torso sitting up in a bed from under a pile of blankets and you wouldn’t be far off. The packet of paper in my hand just seemed to get heavier. I after forcing out an introduction I began the tedious chore of interviewing my patient or “collecting objective data” for the sake of my assessment. I would have gladly endured bodily injury if it would have gotten me out of it. Now, what seemed like ten years and a billion sarcastic responses later, it was time for me to lay hand and stethescope to my patient for a head to toe inspection. I shined my little flashlight into his piercing eyes. I auscultated his dramatic and exasperated huffs and curses from all regions of the lungs. I located his heart, though I had my doubts of its existence, and identified both the lub and the dub of it’s pumping. Then, not failing to narrate my care, I told him I would need to throw back his linens to see his feet. Perhaps I should have narrated care before instead of during, because as I yanked the mountain of layers up, he quite clearly let me know that he “don’t have no damn feet.” Sure enough, he was a double above the knee amputee. I returned the blankets to their original state, ran out of the room, and never went back in it.
Truth is, I probably wouldn’t have gotten away with avoiding my only patient all day, but I was admitted to the Emergency Room.
Shortly after completing my “assessment” I was following our instructor around, along with a small group of students to learn something (I’ve no clue what exactly it was) but I do remember interrupting her to say I needed a chair. She looked at me like I was insane and said “I don’t think you’re going to find one.” Black curtains were suddenly being pulled in on my visual field as my knees started to go numb. Soon there was miraculously a chair rolled under my butt and a blood pressure cuff around my arm. I kind of thought I might be dying. It didn’t help that I apparently had no blood pressure. I may have been momentarily relieved that I didn’t have to go back to see my patient,  seeing as how I was dying and all.
Long story short,  was forced to admit myself to the ER to were I became rather angry and pouty because I knew that I now looked like the weakest link in the group, and that I was missing the bulk of a whole day of clinical, and that I would likely have an aweful time playing catch-up. As it turned out, I had just vagaled down and fainted: a phenomenon that I avoided from then on by keeping a granola bar in my pocket. And that is the story of how I barely survived my first day of hospital clinical.

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*Please be aware that any time a patient is mentioned in my stories, I have changed details and often create “composite” scenarios in an effort to protect their privacy and dignity while doing my best to preserve the authenticity of the

experience.

Stepping behind the veil

We were told early on that our journey would not be one that most wouldn’t understand. Stepping into healthcare is stepping through a closed door into a world of both beauty and torment that most aren’t privy to.
It was my day to work in the shower room. I was greeted by middle aged woman with a bubbly disposition. She was a veteran CNA and obviously had wonderful report with her residents. This was also a second if not a third job she worked to support her houshold.
She showed me around the room as it began to fill with steam. She revealed me a tub of body wash, deodorant, and lotions. She explained that she liked to give them a little something special when she could. She winked and I realized she had purchased these things with her own money.
It wasn’t long until the stalls started filling up. I was directed to one and we worked assembly line style. Once you got to me you were already disrobed and ready for washing. The room got hotter and wetter by the minute as I got more somber. There were those with diseases of the mind which had stripped them of their logic and sometimes even their speech. As I washed, I couldn’t escape the notion that their healthy and unaffected self was just under the surface, scratching and begging to be acknowledged, to be valued, and to be loved. There were also those whose ailments were physical. They would often apologize for the burden they believed themselves to be or say nothing at all. they’d just stare at me, eyes begging for any shred of dignity I could offer. Did they know I was nobody? Little more than a stranger off the street who was given some cloths to wash with, I had no credentials and no experience. I felt I was doing these men and women such a disservice with my clumsy hands and terrified expression. I don’t even think I was able to conversate with them as they probably truly needed. I was far too stricken.
That day I left in soggy shoes that I barely noticed. It was my first peek into a world that most are shielded from. I was quite brokenhearted, yes, but it was more pride I felt. Not pride for my performance that day, far from it, but pride in the profession that I had chosen that is filled with people who really want to make a world of difference even in the smallest ways.

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Baptism by fire

I daresay the cleanest, most heavily staffed and compliant nursing homes in existence aren’t able to completely conceal the unsavory, yet natural goings on of the human body.
We were standing attention at twilight in front of our first clinical site receiving our assignments.  Half on bath duty and half on vitals. We were to switch the next day. Our whites were ironed and our hair neatly pinned back per dresscode. Stethescope: check. Clipboard: check. Unwavering confidence: uh… hardly.
It has been said that if one knew what they were getting into before hand, they might opt out of marriage. The same may be said of entering nursing school. The majority of us had never laid hands on a human stranger for the purpose of delivering care. I think that we all had a feeling, however that we were about to crawl through the trenches that day.
I was partnered with, of course, one of the same girls I was so intimidated by in the classroom.  I’m ashamed to say, it felt a little good to see the tiny glint of defeat in her eye as we were tossed what looked like a mile long list of names. I swear it was at least two columns and no margins. Supposedly it was one hall’s worth of residents’ names and we had until noon to collect and document blood pressures, heart rate, respiration rate, and oxygen saturation on each of them. Luckily we had prepared by taking each other’s vital signs for an hour in the lab the day prior, so we were basically experts with unparalleled efficiency when it came to vitals. Not. Additionally,  we didn’t know these names and faces from Adam. Also, who’d a thunk? Nursing home residents DO NOT just hang out in their assigned beds all day waiting to get their vital signs taken! They are eating, playing bingo, smoking Virginia Slims, and gossiping in the dang flower garden! We were running all through the place trying to track these folks down with little to nothing to go by.
A couple of hours in, my partner and I were pretty proud of the dent we had made in our list. We actually got a system down pretty quickly and were feeling like Batman and Robin. Then we are handed another full sheet of names. Everyone except the two of us had been pulled to the showers or bed baths and the pair of us were to finish out basically the entire facility with the vital signs. It was really a blur. I know there was some wailing, some wondering, and some wollering. At our noon rendezvous my peers were stained, sweated out, winded and drenched up to the knee. We were all painted with the stuff you might expect from that sort of work. My partner and I turned in the two crumpled and smeared sheets with vitals scribbled beside three quarters of the names.
We were later told it may be a good idea not to work with each other because we were an inefficient team and your company could make or break your performance in this program.
Three years later she was the backbone of the Emergency Department in the facility where I worked med/surg. We always had each other’s back and worked together like cogs in a clock. We have since shared many laughs about that day in the nursing home. I think we learned more than anticipated and I value every moment of it.

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Square peg, round hole

Two and a half years after I saw the lady in the lavender scrubs, I became an official student nurse. My second year of applying won me admittance to the most abusive course of study I could imagine. A small branch of the university,  the nursing department is in a lovely,  but terrifyingly intimidating building. Soon after my arrival, as our instructors began to introduce the world we had stepped into, my attention drifted, as it often does, to my peers. The bulk of them were females very near my age. Most would say that I fit the typical mold of a new nursing student, as there are usually very few males or non-traditionals. I picked up very quickly that I was, however, going to be and outlier when I saw dozens of planners and tabbed notebooks fly out of designer bags every time a professor opened their mouth. My idea of being prepared for class was a pen behind my ear and a 44 oz Diet Dr Pepper in hand. These girls were on their game. Obviously “A” students with a competitive drive and likely some kind of 5-year plan, I was feeling more out of place by the minute. “What in the world am I doing here?” I thought. As the instructors continued to outline the intense two years that laid ahead for those of us who “make it that far” I began to worry about how I would be able to continue to have income. I had always kept an evening job while being in school. “How is this going to work out?” “Who am I?” “How many people are going to die because I have no business in this field?” “I’m going to need more Dr Pepper.”

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The lady in lavender scrubs

Truth be told, I’ve never divulged the details of the day I decided to pursue a nursing career to a single soul. Not a colleague,  not my mother, not even my husband and father of my child have ever heard this story. I always have, and still do adamantly believe that those who are rightfully in nursing are answering a divine calling. Perhaps it is not always immediately recognized as such.
     It must have been December. I was wrapping up my first semester at a four year school for which I had miraculously obtained enough scholarship money to pay tuition. I was groggily trudging across campus to my 8 o’clock, which I’m sure was a basic class chosen by some “advisor” who no doubt couldn’t remember the face of the country girl with no declared major and no direction.   It was cold and I would have liked nothing more than to stay in my cocoon on the top bunk in the tiny dormroom. I’m sure I looked like a walking pile of dirty laundry crunching my way across the frozen lawn, contemplating nothing but my desire to return to bed. Eventually,  I must have gotten tired of staring at my feet (which isn’t a very safe walking habit) so I looked forward. This moment is one burned into my memory. She was a fair bit ahead of me, headed in the opposite direction. She had smooth,  caramel skin and her black hair was pulled back neatly. She had a stethoscope draped around her neck and wore lovely lavender scrubs. The sun casted the warmest orange glow behind her as it began its work of burning off the mist and frost. The lady didn’t appear much older than my eighteen year old self, but there was something different about her face,  a wisdom, it seemed. I don’t know where she was headed, but she definitely knew, she looked so determined. She never so much as glanced my way.
     By the next day, I was no longer an “undeclared major.” I had taken the first step on a journey that would ultimately define me in many ways. Yes, essentially I saw a lady and thought “She’s got it together, I think I’ll go for that.” I don’t know why such a mundane passing of strangers has such an otherworldly effect on my existence. Furthermore, I don’t know why someone in lavender scrubs was doing on campus at 0730. Student nurses wear burgundy and white. Perhaps she had worked a night shift and was furthering her education by day… although her scrubs were rather neat and fresh. Perhaps she worked at the Student Health Clinic, although I’ve never seen them wear scrubs. You can speculate for yourself who or what she was and what her business was that day, I have my own theories.

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Creative play

     I have felt my idea machine was  running a quart low as of late. As a result,  I’ve had a terrible time with my writing projects. Today I got desperate enough to investigate some creative exercises to get things rolling again.
    I didn’t mean to, but I believe I have found a new addiction. I approached it very cynically, but was soon giggling in delight. It is completely nonsensical, which of course, I adore.
     You write the first word that comes to mind,  then follow it with whatever flows out. You focus more on the way the words sound more than their actual meaning,  and you make a poem out of it.
  

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Please excuse my barely legible penmanship.
    
     Obviously,  it can be as long or short as you want it to be. You are essentially just playing. I found it incredibly difficult to stop, and was surprised how quickly and fluidly I was pouring the gibberish out on paper.
    

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     The exercise is supposed to make you use the right side of your brain so that the perfectionistic side doesn’t ruin your creative flow. I definitely feel like the gears were greased. Even more so,  I had so much fun doing it! It’s so funny to read it back aloud. I’m pretty sure that this is one I’m going to go back to again.

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I found the information on this exercise   here. I encourage you to read more on it.

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Some people do zen tangles, I think this is my new therapy.

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      You literally can’t be bad at it, because it is supposed to be aweful, and it is. Awfully awesome!