Inked Again

So, to celebrate the successful completion of nursing school, I have decided to get a tattoo.  I'd been tossing around the idea of getting a second one for a while, but I was having difficulty settling on a design.  Then an idea struck me.  And I was certain it was right.  

I have a feeling that I'm going to be explaining this tattoo multiple times, so I felt I had better get used to finding a concise way to do so.  As such, there have been many, many shower conversations with myself, trying to hone this down.

My original text was "THIS ISN'T THE PAIN OLYMPICS."  However, in discussing placement and all else with the artist, it was simplified to help it fit, removing the "pain."  Honestly, when he mentioned it, it didn't click immediately, but we needed to make it a bit smaller to fit well, particularly when I wasn't budging from the font choice.  However, I'm grateful to have trusted my artist because in the end, this allowed it to A) look very nice on how it landed on my arm, B) save me a lot of quizzical looks and required explanations, and C) allow the original definition of the tattoo idea to expand.  

The original thought has become an important saying in our household.  For me, it means two simultaneous and important things.  

1. No one's suffering wins over someone else's, meaning that everyone's pain is valid.  I have been in conversations or watched someone shut their own feelings down because they didn't have it as bad as someone else or they didn't want to add to the problem by voicing their own concerns.  I shut down the shutdown in these places, as I have emotional energy to do so, that no one has to "have it worse" in order to be heard.  Now, there are extreme spaces where the timing isn't great, that in a crisis it isn't time to address everyone's hurt--one must triage, take care of the person that is bleeding to death before the person with a stubbed toe--but pain is pain and valid.  
2. There is no medal for suffering, for lasting the longest.  Talk to someone; take the ibuprofen; politely harass your doctor.  Pain can physiologically stop the body from healing.  Address it.  I hear patients that are worried about addiction, not wanting to feel groggy, feel like they "should just tough it out," think that not taking them will get them home sooner, or any number of reasons to delay pain medications express these concerns while guarding wounded parts or explaining through gritted teeth.  In the hospital specifically, we're a setting where these medications are used correctly, for their purpose.  No one is going to clap them on the back and say "Good job!  You waited five hours; here's your bronze."  I watch people refuse to talk about or process their experiences, not wanting to be a burden on their family members or family members shut down the processing by stopping it with reassurances.  You can give yourself compassion, too.  I remember that when I recognize pain in myself, I should address it as soon as possible, before it goes any further, and to take a moment to express compassion to the parts of my body that are "failing."  

So the super short version:  It reminds me that everyone's pain is valid and no one gets a medal for ignoring or enduring pain.  

However, there are so many other places where I can apply it as just "the Olympics:"  there is a huge difference between pushing through something and white-knuckled striving.  I think about it with pain first, but there are also many, many other places where I can apply that mentality.  I don't win a medal for trying harder than my body or the circumstances will allow.  No one's success invalidates someone else's success.  Staying in a toxic relationship does not give anyone a medal.  Ignoring one's mental health isn't a virtue.  There isn't a committee of judges dictating the "right" way to approach a challenge.  Asking for help is not against the rules, nor will it deduct from your score.  

When I feel overwhelmed or harried, I can pause and ask myself, "Am I white-knuckling through this or pushing through this?"  If it's a pushing through, it's time to pause and refortify; if I'm white-knuckling, it may be time to stop.  Withdrawing can be a courageous act.  And there isn't an audience watching nor nationalistic pride at stake, mostly just the unnecessary pressure we've put on ourselves.  

This isn't the Olympics.  It's just "today."

Seeking the Edges

My final clinicals for my Adult III class had a wealth of experiences crammed into one summer semester.  We had a couple of days on a "standard" floor and practiced charting in a different hospital system, working on their "downtime" charting--i.e. everything was on paper, utilizing the kinds of paper charting we might if all of the computers happen to bork simultaneously (which can absolutely happen, hence the need for a plan B).  Intermixed in those spaces, we also had days in the ICU, open heart surgery, cardiac catheterization, and endoscopy.  Pretty cool, right?  The variety of those spaces and the kinds of procedures we'd get to see as part of it, well, it was definitely exciting to see that clinical schedule for the term.  

I looked at my schedule specifically for endoscopy.  I have had somewhere between thirteen and twenty colonoscopy-type procedures at this point in my life, and I was both curious to see what it might look like on the other side of things but also very uncertain how triggering it might be for me.  It wasn't on my schedule.  We had seven students (including myself) in our clinical group, so not everyone could do everything; it just so happened that this was the one that didn't fit, by luck of the draw.  

I chewed on that for a while.  We were told we could switch days with other students, and I waffled for a week or so whether I wanted to try to swap with someone.  Eventually, I came to the conclusion that I needed to know where my edges were.  

With my particular experiences as a patient and the associated trauma I have with those moments, there are spaces in my nursing program where I found certain material difficult to get through, because it was out-and-out triggering.  I was back in my hospital room remembering particular sounds and sensations and emotional spaces that were painful to stay in that sucked me down and held me fast.  Some of these triggers are obvious--the whole chapter on sepsis, for example, was a rough one for me, and I knew in advance it was going to be difficult.  There are also spaces where I am surprised by those emotions, blindsided and confused by the sudden wave of everything.  

I decided that I wanted to know where as many of these edges were as possible, differentiating the places that are uncomfortable because they're uncomfortable and the places that are uncomfortable because they are on the edge of triggering.  If you turn your head and squint, it kind of looks like desensitization therapy, but this was more of a perk rather than the goal.  Knowing these edges can allow me to explore for these when I'm able rather than incapacitating me when I have a vital task that needs to happen.  It can also help identify the beginnings of activation to intercede before overwhelm sneaks up. 

So I reached out to a peer and asked about swapping days.  That didn't work out with their planning, so I asked our clinical leader--she graciously allowed me to come in on the make-up day for endoscopy, trading a random clinical day off to instead come in during finals' week.  It was a calculated risk to intentionally enter into a likely triggering situation during finals week, but I needed to know.  Anxiety is sometimes best combatted with information.  

However, there were other days in the term, and I decided to carry this same resolve to other pieces of my final clinicals, both in my Adult III and Leadership clinicals--I intentionally looked for situations I felt would be triggering, all in efforts to draw a crude map of where the landmines lay.  It made for an emotionally elevated term.   I learned a lot, on multiple levels.  In retrospect, I definitely should have coordinated parts of it with my therapist.  

Here was a common theme:  I am profoundly not okay when patients lose their personhood, when they are objectified.  When a patient is anesthetized, they are still respected, but they are also moved into whatever position was required, often intubated, and their faces covered with a blue cloth (aside from the anesthesia team's view), becoming a sack of meat, frankly, because we need to fix whatever is mechanically broken.  They were no longer a person, just a surgical field.  Additionally, six different times this term I was put in a position where I was helping hold a patient down, because they were unconsciously pulling at tubing or not in their right mind or unable to understand the need for a painful intervention for other reasons.  There are times where it is absolutely necessary to hold someone down, and I can recognize its necessity and grieve the action in the same breath.  When a patient's pain is dismissed and they don't feel like they have any control in their situation, I identify too much with them in those spaces.  

Over time, I can stretch these boundaries, expand those places, but I can also avoid some arenas--I probably won't be a surgical nurse, for example, as cool as surgery is.  Or maybe it's a reason to do it, to ensure that every patient is met with a warm, reassuring presence for the whole time they're awake.  The edges move, but they can also be better met by fortifying my skill in self-awareness and self-management.  The goal is to stop the onslaught at a five before it's a roaring nine or ten, and to be familiar with what spaces are insta-tens.  

There will be breakthrough spaces--I have no illusions that I'm going to condition myself out of everything immediately or even eventually.  Just more and better.  That's feasible.  That's worthwhile.

End of Term and ALL THE THINGS

Whelp, I'm gaining enough space, now, to kind of gauge what the hell happened that required a hiatus in the first place.  Yeah, it's still a lot, and a great deal still to think about that.  

Real picture of me in those last few weeks

I chose the accelerated program because I wanted the intensity of that kind of structure.  I requested the DEU clinical structure (six or seven shifts of twelve hours instead of ten to twelve of six or eight-ish) because I wanted that similar density.  That doesn't mean, though, that when I was staring down my finals and juggling group projects and weighing my required reading list that I was feeling particularly grateful in those moments.  

Meanwhile, I had also been fitting in tech shifts, 0700-1900 on different days.  Even now, I'm making many mistakes, but I'm appreciative of the moments of correction--I need to know what other facets I can improve.  I need to be reminded to check X or Y until it becomes a habit (*cough* turning off the bed alarm before moving the patient *cough*).  I need those nudges of "the hospital prefers that Z be tracked in THIS box instead of that one, if you could go fix it."  I've had one patient call me multiple times for the same issue in a ten minute span while I was unable to leave my current patient for their safety.  I've watched how other persons have interacted with an unruly patient to choose what tactics I could adapt in the future.  I've had patients teach me better ways to care for them.  And I'm absorbing.  I will keep refining.

At the end of each shift, I found my brain hurt, my body was tired, but my heart was full.  ...and maybe a little tired.  

However, there were three unexpected byproducts of working as a tech while in school.

1. My focus in class shifted from "what do I need to know to perform well on the test?" to "what interests me and what can I take away to keep in my practice?"  I took the pressure off of myself in those spaces while simultaneously giving myself permission to be invested where I want to be rather than out of obligation.  It worked because I like to learn; it probably would not work for everyone.
2. I felt less pressure to absorb everything in my clinical days, which means I tend to relax a bit into them.  I'm VERY confident charting and taking vitals, given how frequently I do them in a shift as a tech, so I tend to focus on other aspects on my student days, finding other skillsets to explore.  
3. As I find more comfort in walking around in a hospital, I do carry myself differently, hesitating less to go into different spaces or to jump in and help.  I tasted independence as a tech.  Here's the real kicker:  the impending imposter syndrome is ebbing.  As a new tech, I have asked questions, made mistakes, corrected those mistakes, found help, and found places to improve--this will happen as a new nurse, too.  I will ask questions.  I will have places and people to lean on when I feel overwhelmed and support them in turn.  

The result of all of these pieces is I feel ready to start.  Moreover, I'm impatient to start.  There are still things to learn, but I want to get to the apprenticeship-like portion.  

And then a new abrupt stop:  another "hurry up and wait" period.  I'm picking up a good swath of tech shifts (the hospital is FULL about now), getting back to a regular workout routine, and working through a few house projects.  This space feels like I'm just in a week off between classes, so there's pressure to rest and accomplish projects as quickly as possible.  It's difficult to switch my head out of that pattern--there is no new normal yet and there won't be for some time yet.

I'm trying to lean into that discomfort, that it's okay for things to be soupy for a while.  I've got a lull before boards, and depending on when that happens, there may be some additional lag before orientation starts and at some point after enough training days there will be a switch to night shifts, more likely than not.  So, yeah, no steady kind of normal is in the periphery for a while yet.  It's uncomfortable, but I have the space to ask myself why, to dwell in some of those spaces.  

There are going to be a LOT of changes before the end of the year, drastic stretches of personal growth in a number of spaces.  I won't be able to see it if I don't take good stock of where things are now.  Thinking back to how much I knew last year at this time compared to what I know now, well, what I know after another year is going to be something worth seeing.  

Reflection, for the Accelerated BSN Group 2021

 So, I had the opportunity at our pinning ceremony last week to say a few words.  This came about because I had offered to entertain questions for the incoming class on what to expect in the course of the program.  After that experience, I was also offered space to say something at the pinning ceremony a month or two later.  Ordinarily, I prefer to have major bullet points and talk through them as preparation, however in this case I needed to adhere to a three to five minute time limit and the remarks needed to approved by the dean first--so I did write everything out this time.  It felt a lot like a blog post.  The following is a transcript of those remarks.  

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Hello all!  Thank you for allowing me to say a few words to and about this accelerated cohort. 

We all came into this program for different reasons, with different contexts and baggage.  I came into this program with some sickeningly type A study skills; others have a nonchalance about deadlines that I simply can’t understand.  Some came in with a clear objective of where we were going to land and have not wavered; others have allowed the experience to shape and explore their interests.  For some of us, we will graduate as nurses needing experience for whatever that next step might be—be it NP, CRNA, or some other flavor of alphabet soup—and for others this has always been the destination. 

And as we were preparing to start this new adventure, the world around us broke a little bit. 

No one had planned on the ‘Rona, and it colored our experience.  The logistics were a veritable mess to sort through, and I did not envy the powers that be the task of untangling them.  All of our expectations required significant adjustment and more than once it was highlighted to us that one of the most important nursing traits was flexibility-- in some ways, this was far harder on the staff because at least we didn’t have anything to compare to.  Both the frustration and determination existed in the same space. 

On the one hand, we had a more hands-on maternal infant experience, since we did not have to manage crowd control.  We had the opportunity to be participate in vaccine administration.  We have been a part of changes that will become permanent.  At the same time, we can grieve some of the experiences we missed out on.  These exist in the same space. 

And time continued anyway.  In the second week, I recall very clearly looking at the syllabi and thinking “my God, what have I done?”  As we started to delve into the material, there were places where we recognized the information was just something we needed to remember but there were also those spaces where the material had a face, reminding us of someone we knew and the information was real in visceral ways.  And eventually there were the names and faces of patients that made that information real all over again.  We started alone on Zoom islands and they steadily became archipelagos.    

We all first met in person a week before second term for a skills day.  My favorite part was realizing how tall people were and whether that fit with the mental image I had of them.  This last term, the water between the islands dried up and we were together.  It required some new logistics, but I found it to be cathartic, one last hurrah together. 

That continued tenacity has brought us through—I won’t say unscathed, because we all might burn a little sage when we uninstall examsoft—but we have the foundation to ease into a more apprenticeship phase.  Whether we face our new opportunities with imposter syndrome or find the journey with that sense of coming home, we are all ready for that next step, for that new sense of becoming in our true skin—these can exist in the same spaces, too. 

Families and friends, you have loved us through these places, and you’ve been supportive of us when we were caught on mountains of doubt, even in some places you were low-key terrified of what we were learning.  This has meant some repriortization and hard conversations in different places. Where we go from here will be as unique as the contexts we brought in with us.  We have met people that we will carry with us; we have people that we are exceedingly grateful to never be in a group project with EVER AGAIN; and at least this is the last time some of ya’ll will have to listen to my voice. 

Reflecting on this journey and journeys to come, I want to share a paraphrased quote that has become important to me when processing major events.  “Ten spears go to battle.  Nine shatter.  Did the war forge the one that remained?  No.  The war only revealed the one that would not break.”

I wish you all well in your future battles and in your further discovery of self in those places.  I wish you a well-deserved rest and those that love you a contented pride.  And most of all, I wish you good health.  Congratulations on your accomplishment.  Any questions?

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Return of the Blog

AHHHHH!  After [fifteen months] I'm free [from nursing school]!  It's time to conquer [the NCLEX]!

Well, it kind of feels like that.  It's finals week, and we're celebrating the homestretch.  And, yes, it's starting to also feel pretty real.  

My post-it to-do lists started dwindling.  The chapters left to read did not have new ones added.  I've shelled out a chunk of money for my licensure testing.  And now I'm trying to figure out what to do with the sudden shift of everything.  For example, I can binge watch a show without feeling guilty about avoiding my classwork.  ...And then I felt pretty terrified, because I still find blank space rather triggering, putting me back into mental spaces where I was immobilized due to illness.  So I started writing a list of things that I was looking forward to, mixed with some tasks that simply needed doing.

• Reading...FOR FUN
• Drawing a new family portrait in charcoal
• Fun doodling on my Surface and/or resuming Bob Ross Parties
• Fix the drywall hole in our closet
• Finishing up the last few pieces of our bathroom project
• Remember what a workout schedule is, particularly if it can involve a pool
• Get a semi-regular walking schedule with Luna
• Prep for the NCLEX
• Hanging with some good friends this weekend :D
• Getting a tattoo :D
• Getting some good catch-up conversations started

I'm also picking up several tech shifts, to absorb everything that I possibly can.  Every shift I am picking up something new, whether it's the minutia of things that must be done but cannot be well-articulated in a welcome packet or a helpful trick that someone has cultivated over years of practice.  And I get to start thinking about some of those next things.  At the same time, I have a lot of processing to do on some of what they hell just happened.  

It's good to be back.