Lessons Learned: Week 5

(cross posted on riveracnp.blogspot.com)
Not a lot of time right now, but I was reflecting on last week's dichotomy of humor and despair. That's kind of what it's always like: an emotional roller coaster, and you've just got to stay stable.

We're learning what honor it is to be a nurse. I mean, really. That's part of week 6's lessons, but it seriously hit home for me in week five.

The most difficult thing, I learned, is not to watch someone die or even lay there and suffer.
The most difficult thing for me, I've discovered, is to watch the eyes of someone who loves that patient, and who has loved that patient for decades, as that patient is treated, tested, writhing in pain, out of it.
When you see the partner of a patient- and that partner is so alive, so intelligent, and so present, and then you look over at the patient helpless in bed, struggling to remember his name...
And then you see the way that partner looks at your patient, as the doctors and nurses place the ECG electrodes on that patient's body - you see that partner's eyes, and you look at their wedding rings, and you realize that the sweating, hyperventilating *person* in the hospital bed who can't even tell you his/her name at that moment because they're so out of it is *everything* to this person in the room, who stands in the corner, out of the way, strong, keeping it together, letting us do our work, stabilize, extend life another minute, hour, day.

I lost it for both of us. I had to leave the room and duck into the closet. Trauma has never bothered me, but that look in her eyes cut me right to the soul.
I fought tears, and lost.

A fellow MEPN (and good friend) asked me, "Did you see her eyes?"
"Yes. That's why I had to leave."
He nods. "I had to leave, too."

We just stood there, hugged each other for a bit, sighed, and went back to taking vitals.

Later that day, I found out that another patient had received a final cancer diagnosis, and that it was not only extremely early, the prognosis was very good, AND it was treatable. She hugged me and we jumped for joy together.

A nurse practitioner friend of mine told me that not a day goes by that she doesn't give bad news, good news, cries, laughs or hugs a patient. And she says if you can't feel, it's time to leave the profession.
I think I understand why.

Remember: there's a life in front of you. There's a person in that bed. We are so much more than the sum of our diagnoses.

Stunned

Each day, I am stunned by the joy and the suffering that exist intertwined in this world.

Working in healthcare weaves me into the fabric of other people's joys and sorrows in a way I did not fully grasp when I thought about becoming a nurse. It is a reality I am coming to inhabit over the course of this MEPN year. Last quarter in my labor and delivery rotation, I helped coach a woman through her labor and the birth of her first baby, then helped her learn to nurse her child. In my community health rotation, I filled syringes with liquid morphine for the family of a hospice patient to squirt into her mouth to relieve her pain in the last two days of her life. I've walked with patients in the hospital halls, I've bathed them, I've accompanied them to frightening tests and procedures, I've celebrated with them when they're ready to go home and to re-enter their lives on the outside of the hospital. Until recently, I had no grasp of the power and the gravity of playing that part in a person's story, nor of how grand and improbable our stories can be.

I used to think that most of life was mundane, habitual, full of errands to run and tasks to accomplish, only occasionally punctuated with moments of joy or of tragedy. Increasingly, I see how precious, how fragile, and how impermanent life is; intertwined joy and tragedy, all the time, if we're paying enough attention to notice. I don't know if all budding nurses encounter suffering and joy, their own and others', in such intimate and constant ways as they come into their new roles, or if they also struggle to understand how we are to interact meaningfully with it all. What colors this year most vividly though, far beyond any lecture or clinical skill, is my effort to fully face the depth of wonder, beauty, sorrow, and pain in my patients' and their families' lives. It has been a year of striving, sometimes desperately and often clumsily, to sort out my place amidst the messiness of life, as difficult, as poignant, as radiant, and as tenuous as it is.

Past Midway

As of now I have finished two and a half quarters of the MEPN year. Probably a good time to provide an update on how things have been going.

In short, school and my induction into the nursing profession has been fantastic. The first quarter was the most stressful, the second quarter was the most difficult and most rewarding, and the third quarter has been somewhat chaotic. But all phases have been extremely valuable and I can barely comprehend how much I have already learned.

Learning happens at a fast rate with the combination of focused classwork and rich, intense hands-on experience in the hospital with patients and other professionals. Nearly every one of my precepting nurses has been extremely willing to teach and happy to work with me. They have given me great latitude and trusted me to do sensitive, complex work with vulnerable patients.

The classroom experience has been mostly good, but frustrating at times. Usually over issues of disorganization, including schedule/curriculum/experience changes. Guest lecturers have been very high caliber professionals, and have given extremely valuable information on all sorts of topics. Lisa Day, our q1 Pathophysiology and Pharmacology instructor, was fantastic and a steadying influence on us all.

My classmates are good people. Collectively we have a tremendous amount of talent, energy, and drive. I feel we have something to offer to the nursing profession. We take this very seriously, and I have faith we will all be competent, diligent professionals.

Currently, I am in Psychiatric Nursing. My clinical rotation is in the Forensic Psych unit at SF General Hospital, my old stomping ground as a volunteer. I really love that place, there is just something special about it. Forensic Psych is absolutely fascinating. Our patients are jail inmates, or otherwise facing new charges. It is difficult for me to describe these people now because A) I have little understanding of mental illness and treatment thereof, and B) their symptoms are extremely varied. But the observation and interaction with these patients, sometimes one-on-one when the deputies and other nurses and docs aren't around, has been mind-blowing. More on this later as I gain understanding and experience.

After another 3 weeks Psych is finished and Spring Break begins. Q4 begins in late May, with Labor and Delivery and Issues in Nursing. In June I graduate, then study for and write my NCLEX in June, to become licensed as a Registered Nurse. And HOPEFULLY I will get a job which starts in July.

My goal is to work in the Emergency Department at SF General Hospital, Highland Hospital in Oakland, or Stanford Hospital, in that order of preference. I will work full time for one, maybe two years before scaling back to part time work and returning to UCSF to begin work on my Masters. After two years of school and work I will complete my Masters and seek licensure as an ACNP (Acute Care Nurse Practitioner). Hard telling what will happen at that point. Depends on job opportunities in San Francisco and elsewhere, as well as personal life factors.