Breaking the Glass of Silence

There goes a story about a college chemistry class.

 The class contained some vibrant and some more reserved students. The second chemistry class of the semester began with an experiment involving 14 out of 40 students as the subjects.  These 14 students were singled out to stand in front of the rest of the class. There weren't told why, but just that it was an experiment. They were threatened with a grade cut if they refused to participate.  The professor, warned that she would treat them as if she was a military commander. They were each given a number and were commanded by the professor to speak only when their number was addressed. They were to respond only to their number and answer questions prefaced with yes Dr. Anonymous.  They weren't questioned regarding the actual content of the class, but rather questions regarding their ratio to that of the rest of the class, along with other very obvious questions regarding the classroom demographics.  After only one class, when the teacher had not yet learned all of their names, these 14 students were told that they were the culprits contributing the noise during the previous lecture. These select students were threatened with strict repercussions if they were to talk or interrupt during any future classes.They were forbidden from sitting directly next one another in future classes, with threats of consequences if they disobeyed.

This experiment was not randomized, nor was it related to the content of the class. The students were singled out, they were explicitly chosen to stand and face the other students; they were humiliated, criticized, and belittled in front of 26 other students. There was no proof that any of these 14 students had even opened their mouths during the previous class, yet they were selected as a whole. They were selected as a group, humiliated as a group; and without any solid proof that any single individual caused any disruption during the previous lecture. 

        26 other students watched as 14 of their peers were selected to be humiliated only because they shared a similarity as a group. 26 individuals watched  and didn't flinch, as 14 of their peers were selected by the mare fact that they were different. No one questioned, no one spoke up. 26 students, watched, and observed, yet they remained silent.

This story did not occur during the Holocaust, or during Africa's Apartheid. Nor did this happen in a segregated America. It happened in an American university, in the year 2011.  

When the University was notified, at first they did nothing but blame the students that perhaps they did in fact cause a disruption and were deserving of such reprimanding. With a bit of further pressure a senior member of the chemistry department came to proctor the next  lecture, but no one was singled out for special treatment during his presence. At that point he continued to excuse the professor's actions. No apologies were made, and no action was taken to address the fact that 14 students were segregated from their peers and humiliated without just cause or reason.  

What if those 14 students were the only black students in the class, or the only 14 Asians, or the only 14 women? The possible discriminatory lists goes on. Perhaps the professor would receive some sort of discipline for her actions, the story might make it to the tabloids, or a even a local newspaper's front page article. What happened to our country that headlines " All men are created equal"? Of the first breakthroughs in American history fighting and impacting changes to American  segregation, occurred in the educational system, with Brown vs Board of Education of Topeka, Kansas". Court had then ruled then that segregation in education is inherently unequal. Yet, in 2011,  14 students are segregated from their class of 40 students, and their peers and faculty are silent. 

What happened to standing up for what is right? During World War II, the world was silent as millions were singled out and killed. Back then people blamed silence on fear for their lives. Has society not progressed since 1945? Are we raising children to succumb to the "Bystander Effect"? Are we meant to stand quietly when inequality is resurfacing in the 21 century?

        5 years later, I remember standing up there like it happened today. I was number 13. My face still blushes with humiliation when I recall being addressed as a number. As an individual, with an intense love for learning, I was an active participant who sat in the front of the class and raised my hand to answer questions. However, I belonged to the Jewish Cohort in the University, and so I was made to stand out to be flushed with embarrassment in front of my peers. My friends in the class who were excluded from this experiment made no mention of the episode during later socializing or in study groups. It was as if the air of my humiliation just fluttered silently into the universe with an unknown destination. Although I attempted to file a harassment claim on the university's portal, I had received no response. I blamed it on a possible glitch in the system. But inside I wasn't ready to face speaking up, and was silently grateful for the ignored response.

I thought I had won it over when I passed the course with a great grade, and when I graduated and passed my board certification to become an RN. I felt as a real victor when I received the job I yearned for since I made the decision to become a nurse. 

Yet just the other day at work I paged a member of one the hospital teams and introduced myself as Devorah from 11 east.  The individual confirmed her recollection of who I was by asking  " Oh are you that cute little Jewish girl with the stylish scrubs with those wild curls and funky glasses?" Aside from being humbly, flattered by her detailed description of myself, I felt grateful to be working in a place where I am a proud, unique individual; but never singled out because of my differences. In fact I have only been met with respect for my differences, and have never been excluded or made to feel separate from my peers. I realized that being different and belonging to a specific group or race doesn't warrant any form of segregation, or humiliation. In fact in my case, it is how I am recognized and remembered.

Upon recollecting my day on my way home, and feeling suddenly grateful for my differences, I was brought back to the day when being different had me separated as a number, and I realized that I too am slightly guilty of chaining this story to silence. I didn't speak up then, yet inside blamed others for their silence. Perhaps back then I was still afraid of my status in school, my grades and the possibility of it impending my graduating with honors. Now I confidently embrace my differences, I don't want to succumb to the "Bystander Effect". I don't want to be silent like the cowards in my chemistry class and the faculty in my University, because what example will that be to my peers and those around me?

 It takes only one small voice to shatter a glass of silence. Perhaps, someday little Jewish nurse D, with stylish scrubs and tousled curls can be that voice.

. 

Where Health Begins... And Continues.

Health starts where we live, learn, work and play... spoke the first sentence of a free writing assignment in one of my graduate  school classes; and so my pen wrote, and it's ink stains metamorphosed from scribbles in a notebook to 'on the train ride home' slightly more legible blog post. 

My workplace. It's swimming in a pool of health. The very purpose of my day to day work is to promote health. Every step I take, every medication I administer, any time spent educating my patients; is all with that same purpose, to promote health. 

As  individuals preaching health, we ought to be examples of healthy beings; to show and teach by example.  However we are nurses, not angels; shocking, but true. Many of us are lacking sleep and excuse ourselves for skipping the gym, some spend half of lunch break purchasing fast foods and the other half munching it whilst administering some deadly lung therapy in the form of nicotine rolled with with tobacco. 

But behind the lady in green with an ID badge indicating RN, is a body in need of emotional as well as physical refreshments to keep that badge attached to a pumping heart and a clear brain. 

 Our body needs that nourishment in order to preserve and dictate energy for the daily, endless lists of responsibilities. Nourishment in terms of food and drink as well as that rare momentous opportunity to stare at the four walls and answer to no one; yet to gather some more strength for what the next call bell rings.

While most units have a room for those luxuries, the lucky RNs of 11e must sneak our snacks on our way to grabbing iv bags, and must inhale it before a superior notices. Our brain breathers consist of sitting in the nurses station with telemetry monitor's rhythmic beeps as our background music. 

 Yes much of our health begins where we start it; by the decisions we make, lifestyles we choose, and environments we choose to surround ourselves in. I decide to wake up early  to work out, to pack a healthy lunch, to immerse in occasional brainless activities as a mind breather. But that's only where health begins. 

However, health continues in places which advocate for the continuity of our healthy beginnings. A time and place to injest those healthy choices, and a place for the brain to take an occasional breath of mindless air. 

Health begins with mindset, it is continued by our actions, and it is maintained in environments which advocate for its accessibilities for fulfillment.

Nurse Residency-August 2014

1 year working as RN complete.

A Novice to Every Human

A Novice to Every Human

12 months gone by since my curly nest adorned in green marched into the doors of 550 1st Avenue. The heart pumping my five foot frame pounded its surrounding rib cage with a mixture of excitement and trepidation.

They say it's rough being a new nurse and novice, but all beginnings are hard. I walked through those doors anticipating the adventures of both the hardships and the satisfaction that I planned to experience during my venture into the novice nurse role. Every day has been an adventure in another way.

The bumpy roads during those 12 months are what make this a journey rather than just a job. The shifts that extended into midnight carved my experiences into stepping stones for growth. As I sought out knowledge from the senior staff that I aspire to be like during my times of confusion and frustrations, I was molding my road for my future nursing journeys.

Every day was a journey between completing the required tasks and attempting to go beyond the required. There were some days that I felt like a real winner; patients walked, ate, passed flatus and were still breathing when I left; and a real win when I managed to document it all. The rare calm moments allowed for the simpler mundane luxuries of socializing with new friends, colleagues and sometimes patients; the sweetness of peanut butter and saltine food contests, and back of nursing station “selfies”. On those days I walked home lighthearted and in smiles.

    However, a typical day doesn't usually sanction such indulgences; days often trend on a domino series of disasters whether it be decompensating patients, upset family members, patients with frequent bowel explosions, understaffing and days spend with real special cases who liked to throw the food they didn't like in their exhausted RN's face. Those were the days that reinstated my confidence in my career decision; when all hell broke loose, when mealtime and breaks were skipped, bathroom privileges unfeasible yet an RN with body still somewhat intact and equipped to face the new disasters and challenges of the next 12 hour shift ahead.

 

The smooth days were happy days. The rough days sealed the feeling of content on the heart that chose a life of nursing.

My novice year had its ups and down.  Yet it was a meaningful year. It build the foundation for my lifetime of caring. I accumulated new knowledge and pasted some of the knowledge from my textbooks into real life scenarios. Over the months I managed to create a version of a routine for managing the day. Although each day the possibility of a vast disturbance of this meticulously scheduled routine is bound to erupt, yet each disaster is received and handled with a slightly elevated level of confidence and skill. Every single day I continue to face new challenges and exercise the various fragments of my brain to master those obstacles laid out before me. However, with each new challenge; it is faced with a slightly more confident and optimistic game face. Every new patient I meet and attempt to understand, challenges my game plans and forces me to re-strategize in order to accommodate their specific set of needs. Each new patient; a new human being with a whole new set of comorbidities and health needs; is a blunt reminder of my imperfections, yet a simultaneous reality check measures how much I do know.

With time you learn that a good nurse should always see themselves as a novice. A novice by Webster’s definition is; “a person new to or inexperienced in a field or situation”. Every human being we meet humbles us into the novice role when we must look at their individualized map of clinical circumstances. Each day on the unit I learn new things that help me be a better nurse. I gain knowledge as well as comfort and confidence in my work. Yet, that air of the “novice” mindset must continue to exist, for each person is new human being unlike the one previously. Each patient is a new body, a new set of genes, and a new life to consider. I must take my knowledge accumulated from other clinical scenarios and apply it to the new patients I come across, but that combined with a novice attitude that everyone is different and my clinical focus and care will never be the same for each person I encounter. I am a novice to each patient’s specific clinical needs, but with each patient and experience my care can be masked with a slightly elevated level of confidence in the work I perform.

During my Nurse Residency celebration following my year of completing my first year as nurse, I was astonishingly informed that all this time I wasn’t in fact a true “Novice”. A “Novice” nurse is more directly associated with a nursing student who is completely new to this environment. According to Benner’s model of nursing competence, I began my first year as an “Advanced Beginner”; A novice with a slightly more elevated level of confidence. I now unpretentiously accept my stage as an “Advanced Beginner” as I continue to work my up this competence ladder, as I accumulate further skills, continue to accumulate more of the infinite measures of available knowledge and ask questions during times of uncertainties.

And so my nursing journey continues; I hope to continue to rise in my level of nursing competence. I now venture in and reclaim my status as a student with a limited social life, as I embark on the next part of my nursing journey; graduate school. 

The title of my blog “my year as a Novice”, is only slightly outdated.  The year is up but I will continue to be a “Novice”. I will be a “Novice quite literally as I begin my graduate/nurse practitioner journey, as well as a “Novice” in attitude as I hope to continue to provide my care humbly, to each new individual, as a new experience, as a new clinical picture.

In The Nonskid Socks Of The Human Wearing The Bar Coded Armband

My own heart beat raced, as if chasing the ringing monitors. Although I didn't physically rush to the beeping alarm to silence its nagging sound; instead I froze, analyzing each wave and silently questioning each variation. Each abnormal rhythm launched electrical signals through my own heartbeat.  I squeezed the hand of the patient under the oxygen mask as they gasped for breath attempting to describe the stabbing like chest and shoulder pain.

I counted the seconds which rapidly shifted into minutes, following each medication administration; impatient to recognize its effects on that being.  The feeling was a combination of fear and confusion. I didn't belong on this side of the bed, I wasn't meant to be that harried individual with endless lists of questions. I knew what was meant to be asked and so I did, but I also knew when I was expected to be silent as decisions were made and interventions were initiated. And so I trusted and I watched.

A nurse's role is to lend a heart to the being conducting the overhead monitor's rhythmic tunes. A nurse is meant to provide comfort to the patient and their family. Nurses are expected to have answers to the endless lists of questions or at least know where to search for them. But tonight the beating monitors weren't just the familiar rhythmic tunes of a nurse's daily shift. Tonight the questions weren't asked to me, rather by me. Tonight I didn't scan the arm band receiving medications but I held it; skin to skin, getting and giving comfort simultaneously. The heart rhythm wasn't simply a wave on a screen, nor did the heartbeat's sounds effects play a familiar lyric. This time I felt the heartbeats in my own thumping heart as the rhythm on the monitor orchestrated its own set of disorganized symphonies in my own heart. This time the blood conducting the terrifying melodies, was one with genes mirroring my own, those lyrics belonged to my own flesh; so at that moment, for me, they sang a completely different tune.

Nursing care entails a multifaceted approach. When we treat a patient, we don't simply treat one diagnoses, we treat an entire map of diagnoses that formulates the patient’s condition. We treat their past and current comorbidities. We treat their current health state as well as their future. We help manage their care and health maintenance for when they leave.   Very often we not only manage a person’s maze of comorbidities and past present and future health conditions, but we also help arrange and manage the lives of individuals involved within the life of the humans we scan with each medication administration. The family member’s involvement can determine the direction of the disease, the treatment and the health maintenance of those under our care.   We include the members in the planning process, and we allow them to be involved in their loved ones care. As we use family to help us attain certain levels of care for our patients, the family becomes the subjects of our care. The same way we provide comfort and reassurance to our patients, we comfort and educate the families. Everyone involved within the life of individual wearing that armband becomes our patient, becomes our concern.

At times the challenges within our care involve the family more than the patient. The questions they ask the requests they make, the complaints they email about. Very often large families often fail to communicate and as a nurse I must consistently update each member that comes by with questions and concerns. A task not limited by ability, but rather by time.

We become judgmental when the family looks over our every move, asks questions about our every task and scrutinize every intervention we initiate upon their family member. We are judgmental until it is us on the other end. For me it took seeing my own flesh being scanned for every medication, turned and positioned, treated with medications to relieve the pain, explained the plan of care and the depths of the medical situation in a layman's level of understanding, to fade out some of the critical attitude towards the familial component of my nursing care and responsibilities.

It's no party sitting on the side of the nonskid socks. Lying on the other side, with the one being scanned is undeniably less preferred to the one with the bursting bladder that lacked its turn for emptying due to the demands of the workload.  If given the choice, being the on  the side acquiring the anxiety inflicted on by the families scrutinizing eyes and  from the inability to produce all the answers to questions would be chosen easily over the side of  the one worrying and spilling of questions to voice the uncertainties.

I was on the other side, I felt the feeling of how so many under my care feel, I saw things the way those under my care see it; I lived the other half’s life.

I can now relate to the worried faces, the scrutinizing eyes and the infinite questions. Being on the other side of the scanner, deep into the non skid socks and snooping in on the muttering and jargon of the medical teams as they pop into the room for an express visit; did not dissipate the occasional annoyances but allows me to understand; thereby increasing my tolerance thus steadying  my stance for this particular work challenge.

Novice Meets Angel of Death

The staggered breaths painted shapes on the monitors. It jotted out perfect waves for one minute, and childlike scribbles the next. Those scrawled shapes relayed fluctuating signals; between hope and dread, between life and death. It was as if the ‘angel of death’ was there, had his sword in hand, target area marked, blade in place, but hesitant to make the hit. The breaths were present, but were the waves of storm rather than the waves in a surfers dream; rocky, damaging and unpredictable. The heart beat like a stationary race-car, rapid but thready, and unable to perfuse the body’s arterial racetrack. The translucency of the skin, windowed a dense yet motionless being.

Lips moved in prayer, while minds weighed the depth and upshots of their decisions. DNR. Legs raced as if on a mission, but never leaving as far as the edges of the bed. The corridors signaled the finish line, only centimeters away but reaching it meant the end was met, so the feet tread those areas cautiously. Those lips whispering prayers, dreaded, yet awaited the finish line.

The hours passed by. The screens fluctuations between the dreaded straight line and a perfect QRS wave confused the humans reading the signals. They asked me if it was the end, the monitor seemed unsure. I enter the quarters of the beating monitors possibly masking a life gone by; I am face to face with the thin wrinkled being curled up in the sheets, gasping for each breath, and a morphine infusion running in attempt to wash the pain away.

I felt the pulse. Thready and fast. It seemed to weaken as the seconds passed by. I kept my hand on the pulse, for at that moment it was the only sign of life, yet proof of its nearing end. Perhaps if I let my fingers go, that life might slip away, right through my fingertips.

My job is to promote life, and here I was anticipating death. My job is to chase away the ‘angel of death’ and here I felt like mapping out the directions for his next stop.

The ‘angel of death’ was well acquainted with the being curled up in the wrinkled sheets; the ‘angel of death’ had chased this being before. He didn’t wait till her 93 years to greet her. His multiple introductions to this being began over 65 years prior when she cooked for the Germans in the barbed wired gates of Auschwitz. The ‘angel of death’, marked his target back when she was out there fighting diseases in the concentrations camps, he was there when she  used to sneak in potato peels to share with her bunk mates, he was there every morning when she awoke before sunrise to the threatening barks of the soldiers on guard.

Now she can surrender, because she has already made her victory. Every day that she lived, and made lives through the offspring she produced and raised, made her the victor. We watched as her chest rose and fell with trepidation, each movement using much effort, until all efforts were used. We called the doctor, he marked the time, and we covered her. Her soul had won its last fight.

The monitors stop, their frantic scribbles and the straight line of defeat stretches to eternity; and our hands meant for healing are cuffed to our backs preventing us from evading  the inevitable footsteps of ‘the end”.  Yet perhaps an even greater challenge is when that line marches on, merging with all the other listless strings of lifeless pulses. This was the first, so it hurt; but so did my first IV insertion and the many ‘firsts’ of painful things I had to initiate for the good of the humans it was inflicted upon. Time and experience forms an armored defense that can make each patient’s death a little less personal and a little more algorithmic. Experts might argue that such is an uncomfortable inevitable, but deems it unwise to bear the burden of each meeting with the ‘angel of death’. Yet one can also choose to take each opportunity to familiarize oneself with the tragedy it brings and practice the touch of caring that goes beyond the life of the being in the bed sheets. The challenge is to continue to be the blessing that escorts one’s journey from one world to another.

How can we be that blessings despite the forces that monotones those moments into listless tunes with each death we encounter? Dr. Vidette Todaro-Franceschi , RN PhD FT advises that it is how one faces death  that prevents that burnout, that oscillating rhythmicity, that predictable sensation we may acquire as we repeatedly guide patients and families towards their loved one’s line of defeat . How can we conquer that intoxicating compassion fatigue hovering and buzzing over our nursing care, threatening to sting our compassion with every straight lined monitor and pulseless being that we encounter?

We swap that hovering sting with a “butterfly power” and we “flutterbye”.

Dr.Vidette Todaro-Franceschi, RN, PhD, FT coined this verb based on meteorologist Edward Lawrenz’s idea of the “butterfly effect”. The flapping wings of a butterfly that we see are connected to another event somewhere out in this world, and we were meant to witness it for a reason.

Dr. Vidette Todaro-Franceschi describes nurses providing care as butterflies flapping their wings, We think we are a separate entity providing care for a specific human being, but we are really one entity with the human being cared for. We are present during this most vulnerable and unforgettable time in a patient and their loved ones lives, because we were meant to be there and be a part. To be truly compassionate is not to see compassion as what a caregiver does, but to view our nursing care with a sense of belonging.

Wiklund and Wagner write how we are one with individual and their family, we are mutually engaged and must acknowledge our own and the other’s dignity and vulnerability to consistently provide compassionate care. We must view each experience as event connected to us, that we are a part of it; we are one with the patient and the experience.

Death happens to each person only once. When we guide those through that death path, it is a first for us, as one entity, at that time. The first one always hurts; and so with each race to meet that straight line, we must slip out of our cocoon and flap our wings with our patient. Each race confronted is a first; to flap our wings, to “flutterbye”.

Every greeting with the ‘angel of death’ should not build a comfort and familiarity that dampens the sadness that rides along with its presence, rather each experience forms and molds us. That is what will define one’s commitment towards learning and perfecting our practice and skill of caring. Rather than be smoothed out and molded, with each experience I hope to be sculpted and refined.

From my ‘Novice’ meeting to my ‘Expert’, I shall attempt to not to lose sight of the person under the sheets, the being behind the numbers and the family tiptoeing close by.

Knowledge Nesting In The Attic Of My Brain Matter.

One of my greatest fears upon beginning my nursing career, was that emergency situation and the ‘what to do’ about it. Will I know what to do? Will I freeze? Will I jump to conclusions and make incorrect choices?

 The myriad pages of textbooks, hundreds of slides and quite a significant number of professor’s voices seem to curl up in to a messy ball only to be stored in the attic of my brain matter. The knowledge continues to exist, but often spends some most of its time collecting dust in the folds of that brain matter. Kind of like those necessities hiding in our attics; they seem appropriate for chucking into bins, yet remain lingering about, collecting dust for most of their lifetime but complete a picture and save the day when the dust is shaved off and the product becomes the missing puzzle piece in a dire situation.

Nursing is all about dealing with the unexpected, but even when my own patient takes a turn for the worse, I am usually aware of the patient’s medical background, the possible sequence of events that have led up to that moment and often the probable causes of the acute, unexpected change. There are also times when I may be faced with emergencies within a public domain, but the resources are often too limited so interventions are often narrowed down to the basics of A, B, C; airway, breathing and circulation, as well as maintaining safety until more help arrives.

However, recently while in a hospital setting, a place where I’m in a certain mode of knowing the health conditions that have prefaced the acute or unexpected change, I was faced with an emergency situation within the walls of the hospital, on my own unit, but to a complete stranger. With only 2 nurses on the unit at that time, there were only 4 hands available to maintain the safety of the patient found experiencing a 'Clonic-tonic' seizure, until more help was summoned and arrived at the scene.  The 2 minutes it took until the Emergency Response Team and other healthcare workers to come help at the scene was one of the longest 2 minutes I've ever experienced. The speed at which I ran to grab the necessary oxygen equipment, vitals, medications... surpassed the speed I ran in the gym when attempting to compete with the fastest treadmill runner nearby. It took only an instant for the dusty knowledge regarding nursing care for a seizing patient to rinse itself off and climb out of the storage box and into mine and my colleague's brains. Between the treasures hiding in both of our brain matters we were able to assemble the adequate knowledge for our dire situation at hand. 

That day I truly felt as though I saved a life. I also felt a slight sense of gratitude for the information I've been able to accumulate, store and utilize when the need came around. I am grateful that my job entails the constant utilization and application of my brain's knowledge. I not only avoid brain senescence through my continuous exercising of my brain's web of knowledge, but each day I strengthen the capacities of my brain by pulling my daily nursing tasks together and accumulating the resources of knowledge stored there, to be hauled out of my brain matter for times at which they will help me make life saving decisions. 

Voice of the Human Under the Hospital Blanket - Part 3

So how does one measure "great"? How does one quantify "fantabulous"? Surely not with a ruler or a scale, or a score on the G.R.E.s.  And  rarely when that person being measured is staring at herself in a mirror. No, anything of real value is in life's looking glass.
And that perspective is only attained by measuring the value that person has for others. The valuable person steps outside herself, and then, and only then, is her worth revealed. And the world becomes a better place. Because there a few very special people who do special things in this life.
People like DP. She has God in her eyes.

It's always been a source of fascination for me to observe, even study, people's emotions. With their families,with their friends, on the job, with strangers or at play. The source of the emotions is often easily identifiable: the crying child, The Boss, the significant other, or just someone sitting nearby on the bus. People come in all sizes, shapes and favors, so the feelings they engender in others can run the gamut.

Now the emotions themselves provide a fertile field for study. But I'm much more intrigued by watching how people HANDLE those emotions?
What's the outlet?
Where's the safety valve?
Is there an "off" switch?

So how can any person (and remember, I'm referring specifically to you, a Nurse-Hero, in this essay) juggle the thousands of variables that fill the day? I suppose some people turn inward, and introspection does offer a semblance of privacy. But others turn outward, an seek their outlet with family and friends, some of whom might be nurses themselves.

"You won't believe what happened to me today"?

Now I'm certain this happens with teachers, bankers, housewives and construction workers too, but withe a Nurse, there's always the specter of life-and-death situations hour by hour. People's lives can be on the line. Nurses, as heroes, can't just be "normal" people just doing a job. They have to be special, even extraordinary, to do what they do every day they show up. They can't have an "off" day on this job. A family's future might be at stake.
How do they handle that?

Maybe they write a blog...

Written by the human being in Rm 1126-2

Voice of the Human Under the Hospital Blanket- Part 2

So this beautiful, green-uniformed young woman walks into my room, standing on tiptoes, enabling her to write her name on the whiteboard. Devorah.  DP.   Her first few sentences inspired instant confidence. The word "serenity" was coined for just this wondrous lady. And she's in a situation, daily, that is anything but serene. The more she says, the more you want to listen. A gemstone.
Now, I could discern that she was very bright, but I really had no clue. I mean, judging a book by its cover, or its title page, and all that.....

And then I read her blog.

The depth of emotions, the insights, the feelings......one word describes it perfectly: Overwhelming. Not the simple musings of someone with time on her hands. No, the colors she used to explain the details of her job and  her life were a full palette, overflowing with shadings. She felt for people she made you understand. She made you feel everything through her eyes. You felt her.
Incredible. Compassionate. And she is only 23!!!  Absolutely amazing. Ridiculous. Awe-inspiring.

I can only imagine a novel, play or song lyrics from this brilliant young woman. The English language has always been a precious thing to me. I don't write, but I appreciate writings in others.
Like everyone else, I've read a zillion books, articles and essays, yet I've rarely encountered such erudition. It was totally unexpected. And I'm sure she hasn't the first inkling about the effect of her words. The strength and beauty they possess.
Remarkable!

Who can predict the paths her life might take? How many lives she will undoubtedly change? How many will know they have "lucky stars" to thank because they met her?

Written by the human being in Rm 1126-2

Me: Blushing. Humbled. .

Voice of the Human Under the Hospital Blanket- Part 1

A hospital room, undeniably, is often not the most welcoming venue. It can be daunting in the best of circumstances. Various people, in various roles, shuffle in and out, performing tasks that are alien to the general populace. Sometimes, doctors add an air of comfort and caring along with their medical knowledge. Sometimes not. You are fortunate if you meet one that inspires confidence. Most times, they dispense facts from their accumulated storehouse of knowledge. And that's all they do.
Often, a patient is meant to feel as if Moses was coming down from the Mountain with the Tablets. There can be a disconnect. The Doctor Knows Everything. The patient, Nothing.

This is not how the system should work. There has to be that person who knows much of what the doctor knows, but is much more accessible. Someone who will listen. And knows what to listen for. Someone who will understand. Someone who will care. Omnipresent. Indefatigable. Doing everything from cleaning up to assisting with surgery. Making the unknown palatable. Helping the patient understand their frailties as well as their strengths. Manufacturing courage, even when hopelessness seems inevitable. Moses? They are under no such illusion that that is their role. Their role is simple, yet complex. Sometimes easier than others, sometimes next to impossible. They are critical, yet often overlooked.

They are nurses.

Day after day, night after night, one double-shift after another. Saving patients and their families. Getting things done that simply cannot be done. Lessening fears. Giving emotions an outlet. Providing weight, nuance and meaning. Making things digestible. Sometimes they are thanked by the grateful. Oftentimes, not. That's unforgivable.  Often, they are intrinsically motivated. They have to be. As a group,they are rare. They are heroes. They are nurses.

Written by the Human being in  Rm 1126-2.

The Character Above A Prosthetic Leg And A Failing Kidney.

He may be missing a leg, and have a non- functioning kidney squatting inside his body, but his mobility is far more stable than many people standing on two feet. The depth of his character and personality go far deeper than some bodies with completely functioning organs. Heart, mind, attitude and personality; all fully intact. His upbeat, jolly and talkative personality is infectious. It is surprising I managed to complete my many nursing tasks for him during the short 1.5 hours from when he was firsts placed under my care one evening until I handed that role over tonight shift; because conversation does consume time.

Every person and situation one encounters in life may be used as an opportunity to learn and grow from; whether the encounter is negative or positive. This man may have been missing a leg, in addition to a list of co-morbidities, and he was anxiously awaiting to hear possibly life altering medical decisions related to his health condition; but his cheerful and positive personality remain unchanged. 

I tell how it amazes me how he is handling the situation. He is so strong. I ask him how. He says it's a mask, that he isn't showing his concerns and his doubts. He puts up a darn good front. Just speaking to him, not knowing the health situation, and closing eyes to his hospital room location and the prosthetic leg resting at his bed side, one will meet an individual who sees life's colors, and makes the bland in life tasty. He taught me that life will hit you in the face wither way, one can choose jump that bridge or cautiously balance  way across it. He is balancing with one leg and a failing kidney, and I’ll bet on the success of his journey.

As a new nurse, an air of confidence must be masked whether true confidence is present beneath it or not. Sometimes a patient may challenge the mask we put on, others manage to unknowingly keep it sealed tight and sturdy. He managed to peel off the mask and find the genuine face of confidence in my work and rapport with my patients. 

Each morning the nurses on my unit write our name on the whiteboard at the patient's bedside, so throughout the day, we aren't called nurse, we are called by name by those under our care. We write goals on that board, things we will work on with our patient's that day. Usually the daily goals consist of getting up to a chair, walking, pain control... When I asked him his goals the next morning he was under my care, he said world peace and to win the lottery. And so it was written on the white board; and then the day began. 

As our conversations throughout the day continued, I told him about how I express my nursing thoughts and experiences via my blog, next thing I know; there was a read a-loud of my stories in his hospital room. When I came back in the room for evening medications, 2.5 out of his 4 chapter response was written. His words humble me, and puts the my writing to shame.

With his permission I will share his response. I only write about the side of the caregiver. His writing exposes the story of the cared for, the organism receiving the meds, the human being under the blankets of the hospital bed.

A Thanks that Makes a Rough Day Worthwhile.

We sweat and toil to keep patients alive, safe, and stable. We patch up wounds and clean our patients to maintain a steady state of well being. We demonstrate and we teach, so that our hard work and efforts are maintained after our patients are discharged. The families of the ill are our patients too. 

The work of a nurse is rough, but the occasional thanks, especially when it comes along with mouthwatering chocolate delicacies, makes that crazy, lunchless day all worthwhile. These small gestures of appreciation are what  gives us that boost to return for yet another shift and to keep on going. 

#valentinesdaysweets #thanks #nursepower #sugarhigh #chocolate. 

Victory of the Caring Heart for the Infectious and the Infected .

Nurses; we are always multi tasking. Whether it be physically; charting, whilst on the phone getting new orders verified by the pharmacy, all while noting a patient's heart rate and rhythm on the screen. The multitasking is part of what keeps our adrenalin going, why we so infrequently sit down during shifts. All that multi tasking whirlwinds inside of our heads and inside our entire beings as we go about a day’s work. When caring for patients we are not just looking at a body, at clinical scenario; we are looking at a human being and all aspects affecting that human being both physically, mentally and emotionally. With so much time invested in some of those beings under our care, we often get so involved in the care, which  inevitably requires us to consider our own emotions and opinions as we administer the care.

In my simple novice mind the world of a nurse and a nurse's work is divided in two; one is our physical care, including our medical knowledge, tactile skills, and critical thinking. Second is our emotional feelings regarding our patient's condition, as well as our personal feelings and opinions related to the decisions we make and the decisions made by those under our care.

Within the emotional aspects of nursing are that of caring and of empathy. For many these may be the easiest of our many roles. To care for a young mom going through surgery to remove a tumor from her breasts, or the patriarch of a large family recently diagnosed with a brain tumor, even the lonely middle aged gentleman having a colostomy placed and has not received even one visitor since his admission. One doesn't need nursing school to care and empathize with such individuals, nor is it something that requires a conscience effort. It only requires utilization of our innate abilities to have the heart to care.

Even the occasional homeless man who was rolled in from the Emergency Room reeking  from a combination of stool, sweat and urine, one who even after some extraneous scrubbing still manages to chase his neighbor out of the room due to his incessant spouts of cursing and his unrelenting body odor.

     For someone like the aforementioned homeless man with layers of tart lining his teeth, caring and empathy may be difficult,  yet he is still helpless, and so caring is still somewhat  doable.

I have always found the caring aspect the easiest of all my nursing tasks, even when it took a conscience effort on my part to do so. In the 6 months since I've began my career, this week 02/02/2014 did I really have to somewhat mask my inner feelings and opinions and build a conscience effort towards extending a caring attitude for a patient under my care prior to entering a room.

He was young, promiscuous, admitted to sleeping with more partners in than there are days in the past month. He wasn't compliant with medical recommendations related to his care. He would continuously have trouble breathing,and required my presence at his bedside frequently. Each time I walked in his room, the thought of all those individuals who might have been affected by this infected individual would send my usually achievable caring abilities on a wild goose chase. It was the second time in my nursing career that I needed to exercise the "nurse self focusing" prior to entering a patient's room. Prior to entering his room, my mind was stormed with thoughts of all those who might have been affected by him, and all those other people they will unknowingly infect. 

But how things change...

The above section was written after my first day with this patient.  After spending multiple days at his bedside, as I watched his struggle to breath, as I tirelessly encouraged him to comply with the care, all judgment and the parts of my brain once consumed with thoughts regarding those he unknowingly infected, quickly dissipated as I struggled to maintain the breaths from the battered lungs of this individual. I soon became so consumed with making sure this guy was breathing, that my opinion on what caused his health condition was no longer lingering in my head as I watched his oxygen saturation drop as he continuously coughed and struggled to catch his breath. My views regarding those affected by him were only a flicker in my mind as I called and Medical Response Team on my way off shift one night.  Those judgments and opinions completely disintegrated into my brain matter when I learned that this man was intubated, infected by more diseases than I imagined, and was in an Intensive Care Unit fighting for his life. 

As human beings, we do brainless things, and we often do not think of the consequences; because we are human. We are imperfect humans living in an imperfect world. My care for this helpless individual may have been compromised had I continued to judge him based on his imperfections. He may have physically infected others, but we all infect others as well. Everyday that we go out publicly and breath the air we walk, or speak the words we talk, we are affecting those in our surroundings. Today, I learned that my job is not to judge or blame, but simply to care.  He just as I am is imperfect, and I just as he, deserves to be cared about despite any past errors.Today I came to recognize the power of a heart, how it can simply discard the most logical mind. When you walk into a room, and into a patient's life as he struggles to preserve it before your eyes, the heart will stump and grind any bit of logic, blame or excuses with its pillars of caring and of empathy. At times a mind should rule over the heart, but when it comes to a failing heart, the well heart must step up and be the victor.

Pager Vs.The Paged

     On those rare occasions that I get some  sit down time during shifts, I often attempt to chat up and get to know some of my colleagues. Whether it be a fellow nurse, nurse manager, nursing assistant or hospital clerk. We often vent about the difficult patients, laugh uncontrollably from the ridiculous  ones, cry from the truly crazy or stool incontinent ones.  Sometimes, we even share pictures of our newest purchases, and discuss our hopeful vacation hot spots. 

      On a recent holiday, while many bankers, school teachers, city workers and even some surgeons had the luxury of sleeping in and not needing to trek out to their workplace in negative degree weather, I myself had a small luxury of being assigned to some well behaved patients which allowed me to become acquainted with the surgical resident on call.  

     Amidst our random chitchat about patients statuses and comparing our levels of exhaustion, our banter was interrupted by the nagging buzzing sounds of his beeper. After complying with the requests of the nurse on the other end of the pager, we began to compare notes regarding being on each side of that beeper;the woes of both the pager and the paged. 

     As a nurse we are given a pager that connects us with a another person who can make decisions regarding our patient's care. This allows us to communicate when we need the necessary or the menial things that are outside our scope of practice, such as prescriptions signed and orders readjusted. Often times these pagers are our source of communication when an incision dehisces or eviscerates, when our patients take an unexpected turn for worse and need the immediate attention from the doctor. However, too often we use these pagers as a way of badgering the team to come speak to patient's family who are badgering us nurses for the direct attention of the surgical team, or even just to clarify something regarding patient care. Our pages aren't often unnecessary, or so I thought, but often to cover us/our licenses.  In the  event that a detrimental event occur, it was known that we did attempt to intervene before that event occurred- and to enhance patient satisfaction with our attempts for timely care.  

     After I  shared my extensive list of reasons of why  I may need to badger the poor, tired, overworked yet on some occasion ruggedly handsome resident for his attention; this particular tired, overworked and yes, ruggedly handsome resident described the woes of answering our incessant paging. He is on call for 24 hours, has 16+ patients under his responsibility in comparison to our 4-5, he can't even make all the decisions because he must often answer to the Attending, plus he often gets paged for those menial tasks such as signing a prescription, so we can discharge our patient before noon, while he is dealing with a suddenly hypotensive patient on another unit two floors down.

     Our discussion describing the endless list of reasons for a nurse's constant paging and a resident either being rude or ignoring the pages went back and forth for a while. It was concluded by yet a page from another unit requiring the resident's immediate attention, and my patient's call bell buzzing for my attention. 

     

     We agreed to be understanding, but most importantly polite; and promised to continue the argument of the pager vs. the paged until the next holiday, or for that very  rare calm day. 

     I'm now sometimes hesitant to page for a menial deal because I have somewhat a greater understanding regarding what is going on on the other side of the pager. 

I page anyway, to cover my butt; and other residents still either delay returning the page or begrudgingly answer it;  but I am slightly more apologetic for my badgering, consistently more polite, and somewhat more tolerant of my pages going ignored.