Ten years ago, I squirmed when I saw blood and guts. My best friend loved gory plastic surgery TV shows, but I couldn’t handle them. If someone had told the childhood version of me that I would be a nurse one day, I would have told them that they had the wrong Rachel. An author, sure. An artist, why not? A TV news anchor, yes for a short time, I’ll admit it. But never, not ever, would I have guessed a nurse. All those personality tests we had to take in high school (Meyers Briggs, career assessments…) none of them correctly predicted my future path. Granted, if they had come back with “Nurse Rachel,” I would have rolled my eyes even longer than your typical high schooler, but little did I know…
In our accelerated summer program, we only have one day/week of clinical time. It is welcome relief from sitting in the lecture hall for hours on end with our bums molded to the weirdly shaped red chairs, hunched over our computers and notebooks, furiously scribbling/typing away. 8-12 hours of classroom time every day is enough to make anyone grateful for an intravenous catheter insertion demonstration (or in my case, hands-on experience). I ended up at a well-known hospital for my first clinical site. Not only did I get lucky with the location, but I was placed on a RICU floor (respiratory ICU) which is like jumping into a freezing lake: much better just to throw yourself in without knowing the temperature of the water. Our patients have acute medical conditions, and the majority are in respiratory failure. The first clinical day, we spent most of the time in the patient lounge with our preceptor teaching us about the floor; essentially a crash course in Respiration & Ventilation 101. We were overwhelmed. At the end of the day, we went in, as a group, to visit one patient. Our preceptor was going to demonstrate how to dress wounds, specifically a pressure ulcer, but it turned out that this woman, Senora Vasquez* had more pressing concerns. She does not have a tracheal intubation (rare for the floor) and just receives oxygen from a nasal cannula. She was able to tell us more about her own disease process that the chart could tell us (with occasional reminders from the preceptor). I noticed that her bed was wet and wondered if he urinary catheter bag was leaking. Our preceptor noticed as well, and quickly determined that no, the bag wasn’t leaking, the catheter itself was leaking and “we” would change it. She asked which of us wanted to do it. Without thinking, I asked in alarm, “Wait, we can do that? We haven’t learned that yet!” She glared at me and said, “Well, I certainly hope you can do it Rachel! You better be able to do that.” I fell silent. She asked again, who wanted to do it. Suddenly, without my permission, a spirit possessed me and I somehow volunteered myself to change the catheter. Who me?? Yes, me. In a dream state, I listened to her instructions and prepared the sterile field. With 10 pairs of eyes (or 11 pairs, counting our patient) watching my every move, I tried to remain calm. I don’t remember much about the process, except that I went through 2 catheters instead of one because my preceptor forgot to tell me when to apply the Betadine the first time, but other than that, it went without a hitch. Luckily for me, this lady was no stranger to catheters and her urethra make an easy target. I was in shock at the end of this, “Oh…wow, that was me! I did that!” But the best part was realizing that in many ways, this wasn’t so different from working in assisted living. I helped someone. As (student) nurses, we made her day better. She had been lying in her own urine, and now she was clean and dry with a new catheter and a freshly dressed pressure sore. I may have felt a little too much sympathy for her condition, but I was also able to walk away feeling like we made a difference. So, that was two weeks ago.
This past week, we were paired in smaller groups with patients. Our patient was an older, emaciated woman, with a trach. When I first saw her, all I could focus on was the plethora of tubes and indwelling lines coming out of her body. Her face was caked with residual sleep, and her mouth needing to be swabbed badly. She looked uncomfortable. I cannot imagine being unable to get out of bed in the morning, stretch deeply, and relieve myself…perhaps splashing water on my face as well. Yet here she was, waiting for the assistance of someone else before she could “do” any of those things. Making matters worse, she didn’t understand that she couldn’t get up and go to bathroom, despite us explaining it to her multiple times. (What do you say? “I am sorry, but here’s a lovely bed pan for you to use instead? Yes, I know you feel like you have energy to walk to the bathroom, but you see, there are all these tubes you are attached to, and they are breathing for you…”) She tried to communicate via lip-reading, but really, she was much better at reading our lips than we were at reading hers. Understandably, this frustrated her immensely. Not knowing what else to do, another student and I started the bed bath. Washing her face, I watched a completely different emotion take over. From consternation and vulnerability her expression melted into total peace and relaxation. Her eyes closed, and her lips spread into a serene smile. It was amazing to watch, and my own body relaxed as well. I swabbed her lips, and suctioned her mouth. We worked our way slowly down her body, warming the water periodically, assessing her skin all the way down. It was a lovely experience, knowing that we were providing palliative care when there really wasn’t much else we could do. The day was draining. Our patient didn’t receive visitors and it was hard to see her all alone, knowing that no one came to see her. Her condition was acute, but not without a fighting chance of survival. Yet, I couldn’t help but wonder to myself whether she felt like she had much to live for. A week later, I was still pondering this conundrum until I realized something quite simple. It is not my place to wonder for her, or to make that decision. My role is to make her day, the moments that I am with her, a little better. I am there to ease her discomfort, ensure that she is not in pain, and fulfill her basic needs. I am there for comfort and healing, which is why I went into this profession. Remembering this, I leave the hospital feeling tired but satiated, as if I have just eaten a big bowl of steaming soup.