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.