Yours Honestly, RN -- There are times...

I work on a very special floor of the hospital—one that not every hospital has. My floor specializes in Palliative care, which, in simplified and incomplete terms, is like hospice care. However, we also take normal medical patients on our floor—anything from the flu to GI bleeds to shingles, etc. Every night is unique and holds its own set of special challenges.

Of all the questions I get as a palliative care nurse, the most common is, by far, “How do you do this?” How do I take patient after patient that I know is going to die soon—and it very well may be on my shift.

Well, there are a lot of things that factor into my answer. Palliative care isn’t really something you’re prepared for in nursing school. All the lectures, every test question, all the NCLEX prep is aimed at “how do you save this patient.” Now I’m in a world where death isn’t the looming enemy to fight (unless we’re talking about my medical patients)—it’s the next step in my palliative patients’ journeys. One that I am to help them approach as gracefully and painlessly as possible. Frankly, there’s little way of knowing how you’ll handle palliative care (or if you can at all), until you’re there. And no matter how much you love it or how good you are at it, there will always be days where it shakes you—and that’s okay. Good, even (if you ask me).

There’s also the fact that, at the end of the day, that person is not my spouse or parent or sibling. I say this running the risk of sounding insensitive. I don’t mean to say that I don’t care about my patients—that I don’t build relationships or do my best to practice empathy—but it will always be different when it isn’t your family. By the time I meet these individuals, they usually aren’t really themselves anymore. They’re extremely confused or groggy or even unresponsive. I’m mostly building relationships with the families (and that can be where it gets hard).

All this to say, there are times…

There are times that the routine of it all gets stripped away, and you’re left standing face to face with the harsh reality of your own job. Many times, it happens when you least expect it—when you’re least prepared.

The other day, it’s when my pastor was describing the moment he found out his brother had passed away. He recounted the story of when he came to the hospital and the nurses told him to not enter the room quite yet—and why. I sat there listening to him, my throat closing up, thinking, that’s me.

I’ve made that early AM phone call.

I’ve run out of a room to greet a family who had just come to say its final goodbyes to a deceased loved one.

I’ve even stood there, helpless, as a man took what I knew would be one of his final breaths, while his daughter looked desperately at him, and then to me, and then back to her father. There were no words, no actions, to make that moment okay.

There are times when a patient who seemed to have days, even weeks left to live, passes quietly away, and you’re left there thinking, You weren’t supposed to die tonight. In those instances, I’ve seen a coworker, one who is specialized in palliative and hospice care, crumble after hanging up the phone with the patient’s devastated daughter. I watched as she hunched over at the nurses station and gave into her sobs.

There are times that you walk into a palliative patient’s room to find it’s a patient you had when he/she was still medical. At that time, you were doing all you could to get him/her better. You talked to him and joked with him. Now he’s lying there unresponsive, and you’re reminded that, at one time, every one of your palliative patients was vibrant as well.

There are times when death has suddenly touched the lives of people that you love. But you still suit up, go into work, and love on people who might not make it through the night. And as you titrate that morphine drip and check pulses and respirations, you can’t help but think, “Please don’t go tonight. I don’t want to face death again tonight. Just make it through the night.” Which may be a selfish thought—but it’s an honest one.

Finally, there are those times—those times that put all the others to shame. They’re the times when your compartmentalization skills chip away just the slightest, and you think to yourself that the day may come when you’re on the other side of the nurses’ station. You see your mother in that bed, or your father. You imagine a glimpse of your patient in his/her prime, and you’re reminded that he or she is just like you. Just like your family members. Just like anyone else. The pain and toil of life has marred his/her physical body, but in that bed lies years of memories. In that bed lies a once brand new mother, humming to her new baby. A father clapping proudly as his son walks across a stage. Reality comes crashing in, and it steals your breath on its way. There is the key—the danger and pain of true empathy. It’s scary and it hurts and it breaks you and grows you and changes you. I often fear that I don’t empathize with my patients enough, but the balance is difficult to find. I treat them with the same care that I would treat my family, but I can’t imagine my family member in that bed. Because I have imagined it—and I could barely breathe. Which is why I always tell these families, “it’s okay to not be okay.”

Because even though we see death on a weekly basis. Even though we can face it with a calm that many people cannot. Even though sometimes we take for granted what we do.

There are times.

Sometimes we’re not okay.

And that’s okay.

When families ask me how I do it, I don’t really know what to say, but I do tell them this: I see it as a privilege to do what I do. Palliative has changed the way I look at my world. My goal has always been (and still is) to work in Labor and Delivery—to watch life enter this world (though there are times in that setting as well, that the entrance will also be an exit). But I am so thankful for the honour of being with those leaving this world. It’s just as significant as birth. It can be ugly, yes, but, believe me, it can also be beautiful.

“A good name is better than precious ointment, and the day of death than the day of birth. It is better to go to the house of mourning than to go to the house of feasting, for this is the end of all mankind, and the living will lay it to heart.” Ecclesiastes 7:1-2

Fear, Faith, and the Pasta Sauce Aisle

“Today is so full of blessings!”

That’s what I exclaimed to Matty yesterday afternoon as we sat at Starbucks after my loooong day of orientation. Just a couple hours later, he was rubbing my back as I cried in the pasta sauce aisle at Walmart, because I was overwhelmed and missed my mom.

And if all that isn’t an accurate representation of these past couple months, I don’t know what is.

Truly, for as much change as these past few months have brought me, they’ve brought equal doses of mood swings—overwhelmed by blessings, then fear, peace, fatigue, excitement, doubt... I’ve gone through more attitude adjustments than I’d care to recount. And I’ve learned and grown. I’m still terrified of what’s ahead—of being an RN and getting an apartment and getting married—but God relentlessly assures me, through countless ways, that I am exactly where He wants me. That I’ve been in daunting situations before, and He has always proven Himself faithful. He may not provide in the way I expect or the way I think I want Him to, but I can rejoice in the knowledge that His way is always, always best.

I’ll be starting on a Palliative care floor—a far cry from anything I ever thought I wanted; yet I find myself excited. I feel such assurance that this is exactly where I’m supposed to be. And I think most of that assurance comes from the fact that the circumstances that got me this job were so clearly orchestrated by God and not by me.

On July 29^th, right before I opened the envelope that would tell me whether I got a job at Lakeland Regional or not, I prayed, “Lord, whatever is in this envelope is Your best for me. Help me to have peace in that, even if Your best isn’t what I was wanting. Help me know that this is your will—because it is.” I opened that letter to find out that I had not been hired on at LRH; instead, I was put on a waiting list. And in that moment, amidst the pain and confusion and humiliation, it was like God was urging me—“THIS IS my best for you. You have to see that I am in control here—not you. Your will is not mine, and I’m forcing you to have to trust me more. I will provide—My ways are higher than yours.” And, to be honest, my response was, “I know God—but that doesn’t mean that I like it.”

Then, through God’s hand (and He used the body of Christ to provide in a beautiful way), I got a job at LRH. On a Palliative and Acute Care floor. I wanted women’s health or pediatrics or emergency department—and I got Palliative care. But because God provided in a way that was so obviously through His mighty power and not my own faulty will, I have such peace that this floor is the best possible floor for me at this time of my life—that He has some great things to teach me there.

Yet I’m still terrified. I still sit in my orientation sessions thinking, “I take it back—I take the past two years back. Please let me just go be a barista at a coffee shop or something. I can’t do this.” But I also wanted to quit after my first semester of nursing school, but God provided. And these past two years have shown me His provision in ways I had never experienced before. So even though I’m so nervous I want to turn off my 4:45 AM alarm and pretend that I never decided to be a nurse, I’ll set that alarm. I’ll get up tomorrow morning and put on my crisp black scrubs. I’ll clip my name badge on and look with disbelief and overwhelming gratitude at the words “Registered Nurse” under my name. I’ll go to my new floor and meet my manager. I will be scared. And I will find, like I do every day, that God’s mercies are new every morning—great is His faithfulness. 

Yours Honestly, NS: The biggest lie about nursing school

We’ve all heard it, and the majority of us have said it: “I have no life—I’m in nursing school,” “Nursing school is my life,” “I have no life outside of nursing school,” or some variation. We say it as a complaint, but, deep down, we all kind of wish it were true. Because, even deeper down, we all know it’s not. No matter how much we wish we could just take these couple years and tackle this torment that is nursing school, life insists on continuing around us—and we are forced to keep up.
Ben Rector (my favourite artist, but that’s irrelevant), has a song that states (pardon the terminology), “Here’s the truth: life sucks sometimes. When it hurts so bad that you can’t go on, life keeps moving on.” I wish that all I had to deal with were nursing school. I wish that I didn’t have other aspects of life to handle as well—but I do. I have relationships to maintain, I have work to go to, I have dishes to put away. Sometimes we feel like all those are put on hold, but they’re not. Every mother in the program that has to care for her sick child when she could be studying for a test knows that. The one whose house was destroyed by a natural disaster… the one whose family member died… the one whose family member was rushed to the hospital… the one who got engaged…the one who broke up…. They all know it. We all know it. Life won’t stop, so neither can we.

I don’t mean to be pessimistic—it’s not just the bad stuff that butts its head in. It’s the good stuff, too. Sometimes, it means forfeiting study time so you can go see one of your best friends get married. Or to babysit your nephew. Or, for some, to have a child (those girls are straight up HEROES). “If it’s good or bad, if it’s slow or fast: life keeps moving on." 

Sometimes, you have to say, “this test is important, but this person is more important.” Because we know, in 20 years, we won’t care if that test was a 70 or an 80. We’ll care that we have precious memories with the people that we love. I’ve yet to regret a movie night or cup of coffee that I’ve squeezed into my schedule.

So, new nursing students or those who aspire to be ones—don’t believe the lie. Yes, when school starts, you’ll be busy. You will have to sacrifice a lot. You’ll feel, at times, that all you are is a nursing student and that’s all you ever do. But it’s not. And life will make sure you find that out. So be prepared for the bad; be excited for the good. Life will find it’s way into all the mess of assignments and tests—and you can do it. You can cry yourself to sleep one night and get up and do school the next (you may need a power nap, but you’ll make it). Don’t feel guilty when you do something other than school—you need that. You are human. And you are more—much more—than a nursing student. No one that has gone before you has been perfect—so don’t feel like you need to be. Sometimes life hits you like a truck; sometimes, life makes you feel like you're flying. “And it’s beautiful and tragic, different verse but same old song. Sometimes the only thing you learn is that life keeps moving on.”

Yours honestly, NS.

(all lyrics from Ben Rector’s “Life Keeps Moving On”)

Yours Honestly, NS: Fragile Facades

            I believe one of the most challenging things about being in nursing school is how little anyone can relate to you besides nurses and other nursing students. The moment nursing school begins, you’re plunged headfirst into a world—an education system—extremely different from any you have ever experienced before. Some of the differences are subtle, others outstanding; they compound to mold you and change the way you view yourself. Before, classes were gen-eds. The most set-apart were the sciences, but you were still among various majors. Aside from college acceptance and a passing grade in any pre-required class, there was nothing weeding people out of your classes; the levels of academic fervour amongst the students were significantly varied. However, when you look at the faces around you in nursing school, you know that each and every one of those people earned his/her seat, just like you did. They had to have gotten good grades and a good TEAS score to make it into a program this competitive. You’re looking at fellow “top of the class” students, so there’s nothing particularly special about you anymore. Unless you’re completely consumed with your grades and very forthright about your vigor for the class (there are those students), you’re just another good student working hard to do well. Yes, a hierarchy develops; not everyone is on the same plane. As I said, you still have your go-hard grade-obsessors (you can refuse to believe me, but I am not amongst them), and there are those who are barely scraping it out. But the middle class is vast and is made up of those who were likely once viewed as “top-notch” students. Everyone in the class is smart, though not all in the same way. You never realize how much you were accustomed to being the top of the class until you’re just another number in the middle.

            Then there’s the fact that nursing abilities are not the same as academic abilities. Yes, you need to be strong intellectually to be able to do nursing, but test grades coming easily is no indication that nursing skills will. It does not help that I did not grow up around any nurses, nor have I nor any of my family members ever been hospitalized for any substantial amount of time (at least, not during my lifetime). Because of this, I often feel as if I might as well be illiterate. Nursing uses a language of acronyms, multi-syllable words, and medication names, both generic and trade. Having taken Medical Terminology at CCC (thank goodness!), I’m decent with terms that use the Latin word parts, but these people speak letters and abbreviations and drug names. And they expect you to be familiar with them, especially since a good chunk of the class is. I’m in class with CNAs, EMTs, LPNs, etc. who hear this stuff every day. The instructors insist that this does not give them an advantage, because they probably picked up bad (lazy) habits that they’ll have to break while in school. But at least they can understand what is being said at the front of the classroom. And it seems like, if you’re not already in healthcare, then you probably chose nursing because you sat at your loved one’s side in the hospital for a year and absorbed everything via osmosis. I’m about as clueless as new nursing students come, and I’m not quick to pick things up.

            It’s hard, knowing that so many have great expectations for me. I’ve always been this “A” student that loved science and just got it; when I said I was going into nursing, first reactions were always, “Wow! What a great field! You’re going to be a great nurse!” It was encouraging.

But nursing school is not encouraging, and it steals the encouragement out of others’ statements.

Because, suddenly, I don’t just get it. I panic through my drug calculations. I fumble through tasks and end up squirting water over my entire sterile field. I go to school, smile and nod, pretending that I understand the stories people tell me about the drug or surgery or whatever so-and-so had. I go through lab, desperately trying to catch on and complete my skill before moving on to the next one (I often don’t succeed). I often go home feeling defeated, unworthy, and embarrassed. When I go somewhere that’s not school, I am asked how school is going: cue the conflict of deciding whether or not to sugar coat and bend the truth to prevent discomfort for both parties or to just state the painful fact that school is hard, and I’m discouraged. I usually settle somewhere in the middle, and people tell me that they’re sure I’m doing great and am going to do so well. I seem ungrateful and rude, I know, but you have to understand that those comments don’t help in the way they were intended to. Because, all the while, I’m thinking, “how can you know that?” How can they know how good or bad I am at placing a Foley catheter or assessing my patient or doing vital signs? They can’t. It makes me feel lonely and misunderstood.

            Growing up, my mom (and other teachers) would always say to ask questions, because if you’re wondering it, odds are another student is too. If you feel lost, you’re probably not the only one. But being placed somewhere where you feel like the minority, you get that false idea that you’re the only one who’s lost. The only one who didn’t understand. The only one who sobbed at clinical. So you keep it to yourself so people don’t think you’re incapable. The problem is, lots of us get lost. Lots of us don’t understand. And I know I’m not the only one who cried at clinical.

            The girl I ate lunch with one day—she cried at clinical as well.

That guy who works at a hospital and is good at it—he struggled with his shift assessment too.

            Goodness, someone even threw up!

Yes, I’ve had at least three category 5 meltdowns—two that my mother is aware of. My mom told a nurse she knows about them, and the nurse’s response was “Only two!?!”

            Anyone who has ever heard about nursing school is familiar with the infamous nursing school meltdowns, but I don’t think they really understand what they entail. They’re not your run-of-the-mill stressed out meltdowns: the ones when you’re tired and cranky and just want a good long nap. They’re more than that—at least, mine are. They involve the deepest levels of self-doubt.

What if I fail? What if I keep going, and my incompetency hurts someone? What if I ruin—or end—someone’s life? What if I have wasted all these hours, all this money, on this childish dream that I could accomplish something so great—so heroic? What was I thinking? I’m going to be a disappointment. An embarrassment.

            It takes a nurse looking at me with sympathy and strength, telling me that “You’ll get it; it comes with time,” or another student’s confession that she was terrified as well, to remind me that, just because everyone looks put together, doesn’t mean that they always are. And just because it doesn’t come as easily or quickly for me as it does for some other people, doesn’t mean it’ll never come.

          

           

I didn’t write all this to pout. I didn’t write all this to gain pity (please, anything but pity!). And please know, to all who have given me encouragement, I don’t want to make you feel bad about trying to encourage me. I sincerely understand and appreciate your intent. Why did I write this, then? Part of me is asking myself that same question right now—like I usually do when I write a blog post (you might be surprised at how many posts get started and/or completed, yet sit unread in my documents). I think I wrote this, because I know I would like to hear a fellow nursing student admit these things. It’s comforting to know that you’re not the only one who doesn’t have it all together. Who wonders if she made a mistake. Who has to summon every inch of her will to bolster up a smidge of confidence. Who even chants, “I will not drop out of nursing school. I will not drop out of nursing school,” on her way in, some days. Who is mastering the art of carrying on a conversation in which she doesn’t understand 10% of what the other person is saying.

Maybe I am the only one who feels like this. If so, I guess this will be an embarrassing post. But what if I’m not? What if there’s another aspiring nurse out there that has hit his low point and just needs to know that he is not alone? Who knows, deep in his gut, that he will get there; he just needs someone who actually understands how he feels to be honest about it.

Yes… I guess that’s why I’m writing this.

And if nursing school has taught me anything, it’s that we all go through it differently. No one’s experiences are the same as another’s. And that’s okay.

Yours honestly,

            NS