When I was in nursing school and early in my career, I had grand ideas about nursing -what it was, what it should and shouldn’t be, and what a revolutionary and holistic nurse I was becoming! I had big plans to be an NP, a holistic nurse practitioner, of course! I was going to make a difference, damn it! I was going to do yoga with my patients, I was going to teach them how to meditate, how to lower their pain level and blood pressure with deep breathing and relaxation and guided visualization, damn it!
I was all puffed up and hell bent and holier than. I was fueled by fear, self-righteous indignation, unprocessed grief, and also a deep and genuine desire to help others to heal. Prior to nursing, I taught yoga, and though I found that my sharing the miracle that is yoga helped people and filled my soul, it didn’t fill my bank account nor squelch my fear of homelessness and starvation. I’m a shape-shifting-technicolor-spiral dancing-dreamer and I’m also logic-reason-evidence-security-seeking and practical. I’m a delightful paradox. I could go into my astrology both Western and Vedic to show you how my mercurial nature was written in the stars, LIT-erally, but I’ll just save that specialness for a future burst of cosmic yet grounded focus.
You know, maybe nursing is almost too practical. I got my LPN ( Licensed Practical Nurse ) before I got my RN license ( The word liscense, lisence, LICENSE is so damn hard to spell! Also: Did this mean I was practically a nurse?)
Wait… I still am a practical nurse!!! Well, practically.
of or concerned with the actual doing or use of something rather than with theory and ideas.“there are two obvious practical applications of the research”
so nearly the case that it can be regarded as so; virtual.“it was a practical certainty that he would try to raise more money”
Why am I practically a practical nurse? Well, I do lots of stuff I never get credit for. I don’t chart each and every wise /intuitive or just standard intervention I implement. I’d rather spend my time actually helping rather than theorizing about helping. ( Okay, there are exceptions, like that confused and incontinent patient on isolation for active C Diff? I’d prefer he were just theoretical ) All nurses know that what you learn in school~ all theory all the time ~ is not how it goes down in practice. Still: “If you didn’t chart it, it didn’t happen,” is bullshit! Do you get that it’s bullshit? So, if I chart it, do I still have to do it? Yes, Kate, yes you do.
Just like writers, nurses live twice.
Shit, where was I? This post has a point to make and I damn well do plan to make it! Damn you, spiral dancing dreamer!
Oh yes, idealistic fire-bellied nursing student/savior story!
I remember going to clinicals one morning while in nursing school and listening to the nurses give report to each other. I picked a patient to care for who had just come from a self-imposed 28-day drug detox center. He was hospitalized because he needed IV antibiotics to treat a gnarly infection in his leg. The infection came from shooting heroine into his leg veins cause his arm channels were no longer hosting his high. He developed green goo lower extremity ooze from shooting up in his leg which led to the wound. He waited a a long time to get treatment. He waited so long in fact, he could no longer walk because of the pain, so his “friend” brought him his heroine and took advantage of the easy access made possible by deep open flesh and began injecting him in his wound. Unfortunate guy’s bed-boundedness led to contractures in his calf-muscles which led to a painful hobbly tip-toed gait that he was practicing in the hospital with a physical therapist.
I know, I know… it’s almost too much, but what I thought was more than too much was the way the nurses talked about him like he was a piece of garbage. He was a wastoid heroine addict in their eyes. That’s all he was to them, a disease. The night shift nurse- a mean old hag- said to the oncoming day shift nurse-younger, but still mean-so also a hag , “He wants a nicotine patch, it’s up to you if you want to get it. I didn’t.” To which the young mean hag nurse replied, “I guess he should have thought about what he wanted before he tried to kill himself.”
I was shocked and disgusted. I knew I would never be like them, why were they even nurses? I went on to to ignore the nurse I was working with, except to ask her/bug her throughout the day to get his nicotine patch until she finally did. I didn’t do any of the standard stuff you do when you go to clinicals and you’re assigned a nurse to work with. I dared her with my defiance to ask me why I didn’t want to give any of his medications. I sat next to his bed in his mostly dark room and I talked to him. I learned his story. His mother was from Vietnam and his father was an American soldier he never knew. He was conceived in Vietnam. He had no friends other than his junkie friends. He had no home other than the one he shared with the guy who shot him up in his leg. He wanted to live. he wanted to heal.
The social worker came in wearing the same snooty skin as the nurses. I asked her about his options, and she handed him a list of phone numbers, half-way houses and so on. This guy had no one to help him. I asked the social worker if she was going to make phone calls for him, she said, “He can do it.” He didn’t have the focus nor the spirit to make phone calls to find a home, duh. His nurse came in to hang an antibiotic, and asked me if I wanted to do it, I said, “No, I think my time is better spent helping him find a place to live once he’s discharged.” She never asked me again.
He had to work outside of halfway houses in order to qualify and he couldn’t even walk more than a few feet and this was with the help of a physical therapist while using a walker. He couldn’t go to a traditional half-way house. I made lots of phone calls, and eventually found a faith-based organization that would take him if he agreed to pray and go to mass everyday on their campus. I talked to him about healing and the wisdom of letting go of control. Surrendering. He wasn’t Jesusy, nor was he anti-Jesusy, and he was already surrendered. He agreed and we set it up. Coincidentally, (or not ) I happened to have 8X10 photographs on my notebooks of beaches and sunsets in Vietnam that my best friend had taken on a recent trip there. I gave these to him to calm his mind and heart. I said my goodbyes and prayed prayed prayed for his healing. I told my instructor about my day and she asked me to write about it, which I did. I don’t know what happened to my writing, I remember she asked me if she could send it in to a journal of some sort…
I don’t know what happened to him.
I also understand now that as a nursing student, I had the luxury of helping him the way I did. As nurses, we are so overloaded with tasks, that meaningful connections and interventions that go beyond what will keep the patient alive and not get anyone sued are luxuries indeed. Still, looking at a human being as simply an illness, or unworthy of compassion and care based on your own perception of right and wrong is low level humanity and if you ask me…it’s malpractice. Abuse.
I’ve been an RN for over eight years now and here’s what I now know for sure: I’m an awesome nurse! One of the best when it comes to caring for a patient holistically. I advocate so hard for my patients it sometimes gets me in trouble. I get lippy with doctors and techs and anyone else I feel may be unintentionally causing some harm to my patient. I can be unprofessional and I forget to chart things and I freak out ( It’s a mostly freak-in now, because I’ve been ‘coached’ on how to manage my emotions at work.) when other nurses don’t tend to their alarms. They let them go on and on because they have steely focus and even though the patient is trying to heal from being butchered and the sound of his IV pump is beeping the audible equivalent of Chinese water torture, “If you don’t chart it, you didn’t do it,” trumps all.
I’m a shitty nurse on paper. I belong to zero organizations, I haven’t an advanced degree, or more than just RN behind my name. I no longer push against the system unless it’s to protect my patient or myself from direct harm. I don’t give a whit about disease, nor do I care much for medicine, though I have a healthy respect for both. I care about people and prevention. In the allopathic world, we are taught to focus on pathology, not on prevention- not on healing. Not real healing, which will take us back to the beginning…prevention, and if not possible, still, relaxing the sympathetic nervous system, which supports healthy immune functioning and reduces inflammation and diet and exercise and nature and a connection with the divine and creative expression and on and on and on… I am not fascinated by disease. I am fascinated by root causes and imbalances and how to prevent pathology and pharmaceutical intervention when possible. I didn’t fully grok all of this when I started my journey.
I thought nursing would be different. I thought I was someone else.
I am also fascinated by how much my job has supported my dreams and grown me into the nurse who hopes to retire from nursing before she becomes the Nurse Ratched knockoff I worked with last week. The bitter burned out nurse who called one of my favorite doctors and his residents jackasses because one of them put an order in wrong. I wanted to poke her in the eye with a hypodermic needle, but only every moment of every hour I worked with her. The one who is probably only 60, but looks 70. The one I watched be borderline negligent and downright unkind to her patients. The one who answered her phone almost yelling while scolding the person on the other end, because they let it ring so long while she was in an isolation room. She then bragged about it to me afterwards. I held my tongue. I have been coached. At one point, she was complaining about something- she looked at my face- which I am not good at making into masks that don’t spell true, and she said, “You know I’m kidding, right?” I said, “I stopped listening to you a long time ago.”
The coaching only goes so deep.
I walked around cursing her under my breath all day and saying to myself, “I would never…” and “How dare she…” and “She needs to retire…” Still, no matter how hard I tried, I couldn’t fully convince myself that I wasn’t a wee bit like her. With a little less consciousness and several more years in a hospital, I would be my own Ratchedy version of Nurse Ratched. I don’t want that for myself or for the patients who deserve compassionate care delivered authentically by aligned hands and heart.
My career as a nurse has an expiration date. I don’t know the date, but it will be long before I become the nurses I described. For the most part, I work with the most compassionate, intelligent, and supportive team of doctors and nurses around – this I know. If you had to go to the hospital, you’d be lucky to be cared for by our team. You’d be blessed. I am blessed. I couldn’t do this job anywhere else. I get how those nurses became hardened. The job is pretty ridiculous- rewarding in many ways, but still…it’s absurd on so many levels, and so much of what we have to do has not a damn thing to do with caring for our patients. The healthcare (misnomer) system is a diseased mega-monster, no matter what arena you find yourself in, and keeping one’s heart open and mind sharp in the face of a system that breaths and breeds fear is enough to break even the most idealistic among us.