To be told it's the end.

Her eyes are a pool of tears

She can't look at her mom. 

They told her it was over. They told her comfort measures were being initiated. They told her further medical interventions may worsen the situation.

She yells in her native tongue. Her eyes form a lake of tears as her mascara leaks down her cheeks. She throws her hands up in despair. She says her mom was walking just a week ago. Today her mom needs to be fed. She says her mom was talking rationally, today an interpreter is called to translate the occasional jargon that  rolls off her tongue. She says her mom was cleaning herself. Today her bedside reeks of sweat and urine. It's takes 2 of us to wash her down.  She was a pediatrician in her native country, today I hand her, her medications with an explanation of its purpose prior to administering. 

We are sitting in one room; the interdisciplinary medical team. We were looking at a clinical scenario, but now are faced with the emotions, and the life attached to it. We are all professionals who see the clinical picture. We have gathered together to patch up our different observations of this specific case in junction with our background knowledge bases regarding similar  clinical cases. 

Medicine is largely based on speculation, often trial and error. Cancer, the epidemic of the 21st century; that unpredictable  sudden cell growth that aggressively intrudes a body's organs. It's unknown direction and spurt of growth that ensues a sea of interruptions to that perfectly fitted map of organs still remains a mystery in each organism it attacks. 

This mystery of cell growth intrudes a person's life, plays with their emotions, and shatters lifelong relationships.

 The textbooks say that the first stage of such grief is often expressed as denial; today I heard, saw, and felt those expressions of denial displayed via the family members behavior. The crying, the yelling, the cursing, the unrealistic expectations and suggestions.  

     I felt some of her pain. It was impossible not to. Her pain filled every crack of that meeting room. 
     That day I realized that although as health care workers we must provide the facts as much as it may hurt, as a nurse I can attempt to cushion those harsh facts by showing my devotion to the dying family member.  Perhaps as I showed the family member as I cleaned, fed, re-positioned her family member for comfort, held her hand and spoke softly; I was able to place a small cushion of pain relief to the emotional stress she was going through by demonstrating that people cared. 

As healthcare providers we must display the painful facts, but must also baste it with compassionate care and emotional comfort. 

11E Thanksgivukah

Feast.  11/28/2013

An RN Thanksgivukkah!

Chanukah,the holiday celebrating the victory of the Jewish people in their fight to practice their religion and traditions; Thanksgiving; with a similar type of thanks  came together on one day. This occasion was made memorable for me, not only because of the rare occurrence of this once in lifetime holiday combo, but it occurred in my milestone year, my first thanksgiving and my first Chanuka as a nurse. The way to show thanks for feeling free to practice religion is by actually practicing it.I marked some of my thanks towards God for reaching my novice state, by practicing my nursing expertise, all while celebrating the holiday and keeping my traditions.

Aside for the perk of earning overtime, celebrating this doubly monumental holidays on a unit tending to call bells and patient needs, does blow.
Sleeping in, enjoying hot coffee with mama's Chanukah cheese pastries with my frat house/ siblings, participating in my family's potluck Thanksgivukka party and it's mouthwatering delicacies, does sound way more appealing than leaking ostomies, and beeping IV pumps.
We celebrated on my unit with our very own potluck. I made the Chanukah contributions with doughnuts, muffins and chocolate coins while some others contributed pies, turkeys,and snacks. We sat around, in our usual green attire, pockets stuffed with our usual  saline flushes and alcohol swabs. Most of us managed to swallow 3 or more mouthfuls before a medication was due or a call bell rang end of our chewing time. It was almost as if our supply room, transformed into our makeshift dining room, was that haven, where for a few milliseconds we could forget our endless responsibilities and the sorrowful states of the individuals under our care, and provided a slight version of the holiday spirit being celebrated outside the hospital walls.

One of our Jewish patients, was elated to be going home for Chanuka and to be able to properly light his menorah with real candles, he graciously added an electric menorah to our 11E stash of Chanuka decorations. Even in the dark hallways of illness, we managed to hang sparkly decorations, quiet celebrations, and a beacon of the holy Chanukah light.

To be truly thankful, isn't just by eating heavenly delicacies, playing with dreidels and watching football games, but also by doing actions that show true thanks for being able to live by our traditions freely. We lit that menorah on our unit, decorated the unit, and allowed those people cuffed to our iv lines and heart monitors during the holiday to attain some semblance of the holiday spirit. TO be thankful for the light isn't just to savor it, but to share it.

   The food was delicious an company was divine.  Sitting around the food and enjoying my minor version of festivities all while feeling slightly left out of my own family's holiday celebrations with its mouthwatering menus; I can only think how grateful I am to be healthy and be the one caring rather than the one being cared for.

A 12.5 Hour Purpose

In 12 hours one can consume 3 meals and several snacks, wish loved ones a good day and come back and discuss the events of the day gone by. 
In 12 hours many can sign off on big deals, open and close up a shop, and travel across town and return.
In a 12 hour day a child goes off to school, spends the day, comes home, does homework, and heads to bed.

12 hours is quite some time; 12 hours is 720 minutes, 43,200 seconds.

 For me 12 hours, is a work day; it often includes one meal,  multiple medication dosages, and mostly running about trying to maintain the health and lives of those under my care. 12 hours seems so long, but often feels not long enough to provide all the care I want for my patients.
It takes not even one hour of introductions to the human being under my care and most of their life history and intimate details are revealed to me.
In that first hour my nurse brain takes immediate action. Who is this under my care? What is the health situation? What are the presenting signs and symptoms? What should and can I do during these 12 hours to make that situation even slightly better than the previous 12 hours?

But as the first hour drifts by like a blink of an eye the next few hours roll by almost as fast and I often don't get to watch the hours on the clock go by unless I'm tallying up my intakes and outputs or configuring the scheduling of my meds to cluster my care.

In those 12 hours my patients may progress or regress. They may upgrade from bedrest to chairfast, from stepdown status to regular room status.  These long hours often times are not long enough for me to provide both physical care and emotional care to my patients.

12 full hours of my work day, are spent dedicating every ounce of my brains, physical strength, knowledge and emotional abilities to improve the well being of another person.
Although my day essentially starts consists of 12.5 work hours, my 8-8:30 shift is prefaced by a lengthy train ride and gym workout.  Although my shift rarely ends what the night staff take over, as I often stay for hours beyond documenting the events of my day and doing just one more thing before I leave, those 12 hours are solely focused on the needs of those under my care.

My connection to the 12.5 hour day does not disappear once I leave the hospital doors. As I daydream on my ride home, or when my head finally reaches my pillow, my thoughts are on my 12 hour day. How did I do? How can I work better or more efficiently? What did I forget? It is either my neurotic nurse behavior, nurse instincts, or just me being a typical novice; that I often spend the first few minutes at home texting the night staff to double check something or another.
However, as I will look back at my days, my weeks, and my life I know that the 12 hours I spent on my shifts were hours well spent. These hours consisted if me caring, me thinking, me moving, me learning, and me attempting to help others simultaneously to my becoming a stronger, better and more constructive human being. Most individuals spend 12 hours of their day performing multiple tasks and have multiple purposes. My 12 hours on the unit are uni-focal: to optimize  and maintain the health level of those under my care. I spend those 12 hours with a sense of purpose, and with a hope of touching others lives and with a desire to make a difference. 

Happy Hour with my Green Team

Dreams of a Novice

I want.

I want to tend to your every need and concern.
I want to give your meds in time.
I want to sit and chat; get to know you.
I want to  have the answers to all the questions you ask.
I want to make you comfortable.
I want to have time use my whole lunch break for relaxation and recharge my energy for the rest of my care for you.
I want to answer your call bell as soon a you ring.
I want to cross off those tasks on my endless to-do list in a timely manner.
I want you to live a pain free healthy life.

But I can't

I can't because there aren't enough hours in the day.
I can't because I'm often called to endless numbers of tasks.
I can't because your neighbor next door has a life threatening condition in need of my attention at that exact second.
I can't because I must chart, lest I forget important info.
I can't because I've got only 2 hands. 2 feet and 1 head.
I can't because I'm new and often task oriented.
I can't because even years of experience won't give me all the answers.
I can't because I'm not God.


I can.

I can try my very best.
I can accept an occasional constructive criticism.
I can receive reminders to follow up and research your questions.
I can learn from my mistakes.
I can get more organized so I can save some time to sit and get to know you as a person.
I can get better and more knowledgeable each day.
I can ask for help.
I can see you for the individual human being you are.
I can care for you with all my heart and endless devotion.

I hope.

I hope to convert some of my "wants"and "can'ts"' into 'I Cans"

Cups and tray tables thrown my way.

True story. 

The cups, along with many other contents residing on the beside tray were thrown my way just as I, a battered, hungry, frizz-headed, overworked, yet still energetic nurse toiled to untangle a patient from his tubing mess.

He wasn't mad at me per say, but at his situation, and I can't blame him. I wouldn't want be a patient either. It is tough stuff having someone poke and prod, tell u when to eat, ask you how much and what time you peed, and make you walk and breath on other's commands. 

As nurses we toil all day, we run from room to room,always in a rush to get care done. Sometimes we are so preoccupied with the clinical aspect that we forget that behind those drains and IV tubing, is a human being. Often these human beings are older, probably wiser, have life histories and experiences that have shaped them into something more significant than a room number with a diagnosis. These people with a whole life behind them are suddenly succumbed to our rules, and dependent on us for their daily care.

That tray table thrown my way, was my kick-in-the-butt reminder, of the soul and feelings of the human being behind the hospital gown, monitors, and IV tubing entanglement. 

Looking back at past bridges crossed and the people who guided you as you balanced your way across;  such as those from student to professional, makes crossing the larger bridges in life seem way more doable. 

A Green Side

The Greener Side

     Nothing is greener than a NYU new orientee, or rather more specifically #auntynurseD, on first day of RN orientation.
  
     Green from top to bottom, literally; from glasses down to patent Dansko shoes and a mop of curly mess to top it off. 

     On the walk from the train to the hospital I'm all smiles; this shall become my daily routine, these will be the blocks that will witness my pondering of what a new day will bring and panic about what I may have missed out after long, busy days gone by.

     These streets merit being the oaths with which I will walk each day, a slightly better nurse than the previous day.

     But after days back in a classroom atmosphere, drenched in the knowledge of RNs wearing green just like me, but years more experienced and knowledgeable than I am; all I wish for is to be the lady in green on the other side of nursing. 

     The side of knowledge and experience, the side of attained ambidexterity, ease with IV insertions, and speed in accurate documentation; the side of comfort and smooth ability to save lives in any dire situations facing my way.

 They say it takes time. Time and experience will be my mode of transportation towards crossing the bridge to the greener side of the nursing profession; the progression from novice to practiced RN. From green to truly green.

New life born to a friend, and new job born for me!

New Beginnings

     A friend began the life of a mom the day I initiated the true beginning of my nursing career.  Ironically one influenced the other.  No, my career start did not influence the birth of any baby.    

     Visiting her in the same hospital I worked as an extern, the very hospital I failed to apply to because of rumors of a hiring freeze. 

     While in the facility I popped in to say hi to the sweet folks of my old unit, and learned that the hiring freeze need not apply to former externs. 

     From there a sequence of events fell into place, an before I could go on a quick vacation and grab even the slightest version of a suntan; I was a wintered, pale faced, new grad dressed in green and sitting in an RN new hire orientation.

That night I came home from visiting the new life my friend began,  I wrote an email that would begin a new life of my own.

1 day later; I scheduled and interview.

2 days later, I passed my boards and got my RN.

5 days later, I had a double interview and signed papers for my first job as a RN.
     

     Thoughts of a summer lacking an adventurous  vacation or a glowing suntan vanished. A quick tan on my Brooklyn backyard deck would do.

      I was just thankful for my stroke of luck, or perhaps for the sequence of events that allowed me to reach that day.  My life was slowly settling in,  and best of all my "when I graduate list" would soon merit a task complete and worthy of being  crossed off.

     Sometimes it's a dose  of intense motivation, Y-connected to a few doses of genuine  prayers to keep God on your side; as well as being at the right place at the right time, whilst meeting and chatting up the right people who will influence the direction   of the next few steps in your life.

 Vaccinated a senator.

Auscultating in Harlem

My Peeps

My Adelphi Mates

My support group
My fellow RNs
My besties
We went in together and completed together.

A Metamorphosis of Dreams

The "When I graduate list"  slowly metamorphosed to the "When I pass my boards list", to the "When I get a job list", to the "When I pay off my loans list".

The quote "Man plans and God laughs"; my own plans  perhaps served as a source for one of God's many comedy shows. God has been kind; he breached the natural evolutionary phases of my well planned lists and created the "When I get a job list" before the "When I pass my boards list".

From the very beginning of my nursing journey, I realized that my hard work and efforts can become null if I don't go out there, and not be shy of my yearnings, hopes and my dreams. ... And so I became Nurse Devorah to most people I met. It became my grand topic of conversation in those rare social circumstances that I was involved in. To be a nurse was no longer just a career choice, it became my label, it became my name.

God was probably smirking when I took a job as a youth director in a synagogue to make money on the one day I was technically forbidden to work. (Although it was legally ok, because I did not disregard the Sabbath laws during the job). To me it was an opportunity to become part of a community outside my home and nursing community, and to help pay for some living and school expenses; but God had other plans. This job became my second home, my community, and a source that greatly influenced the success of my nursing career.

Whomever I spoke to, I managed to leak into the conversations, little drips of my hopes and dreams for a life dedicated towards nursing. Together with organization on my part for applying for an externship on the day applications opened along with some fabulous networking sources from my new synagogue, I got an externship at NYULMC. That externship allowed the "when I get a job list" to precede the "when I pass my boards list".

As God continued smirking at my not so quiet mouth, and my odd jobs to keep a nursing student going; it was a kind smirk; the type that has something really special in store for someone striving for a dream, the type that shows that someone else runs the world, the type of smirk that reminds to me to be thankful for that which has allowed some of my life's dreams to metamorphose into a scary yet  jubilant reality.

As I begin my career in actuality, I feel God, I feel the 'kind' type of smirk; it serves as a reminder that someone else is in control of my efforts of success and my efforts towards saving lives. God isn't a accessory that I put into the pocket of my scrubs each morning and hope it still there at the end of the day, because those often get lost. I feel that smirk with me every time I give a medication and help a patient. My pens and alcohol swabs often fall out of my pocket, but that higher power guiding me each day, keeps my pocket in place, right over my heart.

...So it has all become more than just a dream list. Now it is just about a novice nurse getting through a day by just saving and not killing anyone; something that a silly list for new boots, new makeup, and new bikes have become all but a  hopeful bonus.

Prep for a lady in maroon Life of a student.
7 am clinicals/ awake at 5 am
Adelphi University School of Nursing

When It Was All On A List

The list was created during freshman year, it wasn't a list written on paper, or as a note on my phone; it was a starkly printed bold font, in my head and sporadically on my lips during the occasional chitchat. The title of the list went through an evolution of its own as my life’s milestones progressed. The ‘when I graduate list' emerged in 2010, it was my endpoint, my tightrope walker’s finish line. The list served as an incentive to keep on going even when the shifts were long, and reading assignments incessant, and bank account shallow. The list was my reminder that my wants in life will wait, as I invest in my noble career and my promising future. That list differentiated my wants from my needs, and served as my personal vow towards fulfilling some of my selfish mundane desires in life.

Three years of school meant 3 iphone upgrades, 3 boots seasons, 4 vacation-less school breaks, and and innumerable amount of social opportunities either simplified or simply avoided all due to an unreliable income and textbooks and PowerPoint presentations in dire need of my love, attention and devotion. To many, this might sounds as a sorrowful life for a young gal, but each pair of boots I looked at, imagined myself wearing, but left on the shelf; every phone upgrade I imagined utilizing, every country I dreamed of exploring, and every social experience I longed to participate in but neglected due to the prioritizing of my schooling needing my complete and devoted attention; I chose to see these not as sacrifices, but rather each was a step on that ridiculously long staircase to a life spent toiling with bed pans and syringes all while making a difference in others lives.