Nursing: Tribulation & Triumph.

Hey guys- This is another journal-like entry as I reflect on this past year. I don’t want to forget these pivotal moments, but to my loyal readers- do not feel obligated at all to read this one. It’s quite long! 

Do you ever have too many thoughts swirling around in your mind that the idea of trying to articulate them is intimidating? I’ve been putting off this post simply because I do not know where to begin. But something I have learned through writing these last couple years is “just write it”. It’s like if Nike modified their slogan to fit not physical athletes but those who win essay competitions, those who fuel up on coffee rather than Gatorade, and who suffer from carpal tunnel injuries rather than sprained ankles. Writers are athletes in their own right (or in their own write). Oops- now, this is the problem with just write it… it can get you far, but maybe not in the right direction.

Allow me to redirect this metaphorical train back to the topic at hand.

I  have not mentioned yet in my documented nursing rhetoric around here that in order to pursue a doctorate full time, I cannot continue to work full time simultaneously. I will be traveling cross country a few times a semester, potentially driving for hours to and from clinical assignments, and then studying hours on end. After extensive conversations with my husband we agreed it would be rational to begin the program without the full-time commitment, then potentially reapplying for part time or per diem positions once I feel out the flow of the program. I turned in my notice about a month ago. My managers could not have been more supportive. As I began telling each of my coworkers individually the realization started to set in …

You all know this job (although job seems such an inappropriate word), this calling that began on March 20th 2017 has been an obstacle, or rather a series of obstacles, tribulations, and triumphs. It has been the most strenuous, yet the most rewarding venture I have ever embarked. It has pulled my heart strings in nearly every direction that at times I thought it would tear. It pushed me to such utter fatigue that I felt that I didn’t have energy to speak at times. It shoved my emotional boundaries where I often wondered how my body could possibly produce another tear. It forced me to grapple with the most profound questions of life and come face to face with with the most integral parts of humanity- and to recognize the best and at times the darkest parts of myself. It brought to light the robustness of the human spirit- it showed me what true strength looks like as I walked along my patients, warriors, who fought tooth and nail for another day.

As the last day of work approached, this past Friday June 1st, I was overcome with reflection and contemplation. I didn’t realize it was possible to grow this exponentially in one year. I think back to my first days where I knew next to nothing. For about the first three months, I felt like I was given an insurmountable to-do list. I was given a  group of HIPAA names at the beginning of each shift that represented human beings that I was responsible to keep alive and I didn’t know how. If I made one wrong move, this person would lose his or her life because of me. The one phrase that resonated with me was, “you don’t know what you don’t know”. But what do you do when you “don’t know what you don’t know” involves peoples’ lives in the scales? The “don’t know” can be the difference between another day and the grave. Is there anything more terrifying? Every time I woke up to go to work I knew I would potentially be facing the next worse day of my life. This sounds melodramatic, but it’s the bleak truth- during this time I would often quietly hope that I would get in a car accident on the way to work so I wouldn’t have to go in (I know how awful that is- and I sought the proper help when those types of thoughts started creeping up). I don’t want to admit that, but it’s part of this story and it’s the cringe-worthy truth. I was depressed, and I was desperate, and I was failing. I was not going to make it through.

Then a note came around month four. We have these cards patients can fill out before they leave the hospital to thank someone who cared for them. I received a note from a patient thanking me for talking with her about some tough things she was going through outside of being sick and how much that conversation meant. When I received this note, it changed everything for me. To see I could have that type of impact changed my perspective and renewed my passion. It gave me a fire and strength to continue on. Then the next note came, then the next, then the next. I started to feel that I was actually making a difference, and nothing is more fulfilling than that.

And it was a two-way street. I reflect often on these patients that, conversely, impacted my life, and made every day, as hard as they were, so worth it. The past couple weeks these memories and interactions have flashed in front of my mind. There was the paraplegic man that was rotated among nurses because he was an “ extra difficult assignment”. When it was my turn for him, my heart just broke- he was not in good shape and, you know, I’d probably be cranky too. After a morning filled with a long string of complaints, aggravation, cruel words, and a ceaseless scream for “NURSE” that echoed into the halls, I had a moment of conviction. God was pulling on my heart strings to offer to pray for him. But God.. He won’t let me… it’ll make him more upset that I even offered… I still have to be his nurse for seven more hours… But ultimately the conviction won over. Through a single exhale I asked if I could pray for him. He looked thoroughly stunned, but quickly mumbled that would be ok. I prayed over him, and he was quiet for a moment. He thanked me and for the first time that shift, he asked me my name and didn’t just call me “nurse”. We had a great rest of a shift together. He asked if I would be back the next day. I wouldn’t be, but I was sad I couldn’t be back with him for a second day in a row.

Another patient was an older adult who was there for a spine surgery related to cancer. He was having a challenging recovery, but by the third day we had together we were able to get him up and walking. I rarely ever had time to walk with my patients, but this day I was able to squeeze one in with him, it was special. He was thrilled to be out of bed, walking about, and proud of his progress. At one point as he whipped around a corner with his IV pole I even had to pull out one of my go-to cheesy nurse jokes, “You better slow down, or you’ll get a speeding ticket!”. But soon, the nausea caught up, and I sat with him as he threw up. I loaded up his IV with anti-nausea meds and pressed a cold washcloth to his head to help him get it under control. He was so disappointed in himself, but I was not about to let him forget his tremendous progress. He was a rockstar in my book. That goodbye was a challenge because I knew he would be discharged by the time I returned. Upon saying goodbye he said to me, “I will never forget you for as many years I have left”. I will never forget him either, for as many years I have left.

There was the stroke patient who was engaged at the time of his stroke, he was trached, peg’d, unable to speak, and it was unclear how he would recover- if at all. He was one of my most trying patients from an acuity perspective and from an emotional perspective. I at times was at a loss for words with how to communicate with the family. After caring for him for three shifts in a row, I was on my day off, running outside. The whole situation suddenly hit me like a ton of bricks. Out of nowhere I stopped, I couldn’t breathe- and suddenly I just sobbed in the middle of the sidewalk. It’s not fair, I thought to myself. But for the first time I realized my tears were not from anxiety, they were from deeply grieving for my patient and his family. He wasn’t in my rotation of patients for a couple weeks, but one time I passed him when he was sitting in the hallway. He no longer had his trach and looked so much better, he was awake and seemed aware. I walked by and said hello and he spoke back in full sentences. For the first time, I saw a drastic recovery like this, and thought, I love my job.

Perhaps one of my most difficult assignments was when I was floated to another unit. I was assigned a man with a terminal illness who was showing signs of quick and acute decompensation. He was not yet comfort care, but I didn’t think he looked as though he was going to make it through the night. After consulting with the doctor, she was able to get consent from the family to convert him to comfort care– meaning we do everything possible to make him comfortable without continuing life saving treatment. His family was clearly in denial- which is extremely common. It can be confusing when we were just drawing labs, taking blood pressures, and giving fluids, and now all the monitors are turned off. He was slipping in and out of consciousness, and I told his wife if they had any family they should call them right away. I think it finally hit her, and the begging, the pleading, the crying, the look in her eye- is something I will never forget. I gathered with the family and we prayed over him and did whatever we could to make him more comfortable. It was 4:30 pm, and my float nurse insisted I take a lunch. We are required in California to go off the clock for thirty minutes, but the whole time I just mechanically ate like a robot- tasting nothing at all, only eager to return to the bedside. I thought my patient was going to pass on my shift, but he waited until later in the evening to go peacefully. During that shift and when I was home, I reflected on repeat what one of my clinical instructors said to me, “It’s a blessing to be there when someone comes into the world, but God hand picks those who are there as someone leaves it”. What a great responsibility it is to be a nurse.

I could list these stories, these actual realities for many, for pages and pages. Countless individuals have changed me as a person in a single year. I do not view life the way I did only a year ago. My outlook and priorities have changed. The job itself is relentless and hard, but I would not have made it through without my patients, their hugs, their encouragment, their humor, and inspiration to find a strength that pales in comparison to their own.

Working in this call, despite the pain and challenges, despite how the beginning was marked by an overwhelming cloud of anxiety, I have been filled predominantly with gratitude and appreciation. I would have conversations with God on the way to and from work, asking why he would entrust me with such amazing individuals’ lives, how do I have the honor to call myself a nurse? How did I end up at a teaching hospital where I was getting the best education and learning? How did I get blessed with such an unwavering support system to make it through? More than anything this experience made me appreciate the most basic elements of life.

I remember on a particularly tumultuous day, I stood in the supply closet forcing back tears and just found myself thanking God for the ability to breathe on my own, to pee on my own, to walk on my own, to speak on my own.

I have had to enforce fluid restrictions for patients with critically low sodium levels, and the way they would beg for just a sip of water….it was one of the most awful orders I had to carry out- I couldn’t give this water to them because they could die. It even made me appreciate drinking water at my leisure.

Working in the field of neurosurgery with my neurosurgical patients has been the most awakening, perspective changing and humbling experience. Each day is a gift, each moment, each breath is a gift.

Day by day, I slowly found my confidence in being a nurse. It didn’t mean it became easy, far from, but there was an empowerment I experienced with more competence. I felt more pride, ownership, and reward as I navigated the scary medical waters. I found I could advocate for my patients, communicate with them better, answer more questions, and confidently provide the best possible care without questioning every single thing I did. I found myself multi-tasking in a way I never realized I would be able to. Skills that would scare the code brown out of me at the beginning, I was able to do much more at ease. I was advanced to a Clinical Nurse II by my six month mark. I didn’t feel entirely deserving of the advancement in title, but was determined to do my best to live up to it.

Each day was still immensely intimidating, but around month eight I found myself able to separate home and work, having less anxiety, and experiencing more rewarding shifts. On Christmas Eve, I walked in to do a neuro assessment on a patient who had a marked change. I recognized something wasn’t right with her strength in her legs as it had been the previous assessment. I let the MD know, and as soon as the order was in I rushed her up to an MRI and CT scan…the resident came running into the CT room, out of breath, with a  surgical consent form in hand explaining she had an spinal epidural hematoma and needed emergent surgery. We got her into the OR right away. For the first time I think I saw how clearly I had saved someone’s ability to walk, potentially her life in a moment. As I was silently basking in this save while back on the unit changing another patients’ wound dressings, my phone rang. The secretary was on the other end, “Uh.. hey.. your patient fell in 9A”. “WHAT! Fell?!”. I couldn’t believe my ears. I can’t seriously have my first patient fall today I thought. On one of my best days as a nurse, I also had one of my worst. Tis’ nursing. The next day, Christmas, I received back the patient from with the epidural hematoma after a night in the ICU. She was moving her legs about and had no complications. It was one of the greatest Christmas presents I could have received. We sat and watched parts of a hallmark movie together as I pushed antibiotics through her IV, and I remember thinking, These holiday shifts aren’t so bad.

Come springtime, I was voted employee of the month, which I thought was a typo in the staff email or surely there was another person with my name on our unit because it couldn’t be me?! March I was our class representative at our Residency program graduation and gave the class speech. And this is not at all to brag or say I did anything special- I say this to highlight the fact that I was perhaps the most inadequate for this job, but my patients, family, friends, coworkers, and God’s providence pulled me through. With Him all things are possible, it is true, because this was an impossible obstacle in my mind.

Then my last day came… I felt so much love from my coworkers in a way I never expected. They even threw a surprise potluck complete with a sheet cake from Costco (the best, right?). It touched me deeply, and I will miss every single one of them. We have been through the thick of it together. I gave my last shift report and in true nursing shift fashion one patient reported chest pain, the other went into a state of delirium, and the other suddenly couldn’t pee. I tried to help tie up the last few loose ends best I could, but recognized I had to entrust my last few patients (for now) into the next, exceptionally competent nurses’ hands.

As I left the floor I had a moment, where after all the chaos quieted I was alone in the break room. I was about to leave, my hand turning the doorknob after cleaning out my locker, but I stopped, turned around for a moment and took in the view of the room one last time- this room had seen so many tears, fears, and victories. With a bittersweet sigh, I turned back around and walked out the door for the last time, leaving a job but taking an intangible amount of learning, stories, and faces with me.

I washed my scrubs for the last time today and as they tumbled in the laundry machine, I received an e-mail about class scheduling for school. I don’t know how I arrived to this place, but I am thankful. My heart is saturated with gratitude. I am humbled and honored to have had this experience. My patients have no idea the effect they have had on me- and they are my motivation to be the best darn NP I can be, to be the best person I can be. I realize now the most grueling of times are vehicles for the most tremendous growth. I have learned sometimes there is not a clear line between ugly darkness and beautiful light, but often they dance together contrasting one another in a profound way.  I understand that God will not give us more than we can bear, but he will often give us more than we think we can bear. He is faithful and will carry us through. And I realize now that some superheroes do not wear capes, but instead wear hospital gowns. Patients think we save them, but they often save us too.