Fledgling Nurse, Part 12: Patient Cares v Patient Tasks

I would not claim to know every nurse's reason for getting into the field.  However, I have taken a small sampling and found some similar themes that include (but are not limited to) the following:

• A loved one (or that individual themselves) went through a hospitalization and/or needed care at home that the individual participated in; they found that they had an affinity for it
• A notable nurse had touched their life in the past
• Biology is hella cool, man, in all its grossness
• It seemed like a good idea at the time, and now "I could never think of being anything else"
• A desire to demonstrate compassion for persons by direct care

That last one, I would say that many of us need to have this in at least some degree, whether or not it was the key driving force.  There has to be a degree of willingness to serve others, to work toward alleviating suffering where possible.  The job entails service and advocacy for others.  Sometimes that involves a bit of tough love and hard, direct questions.  Sometimes it is a painful dressing change on a wound.  Sometimes it is a nagging to get up for yet another walk.  Sometimes it's a timely delivery of pain medication.  Sometimes it is a gentle washcloth on the chin after feeding the patient.  

One of my favorite spaces, though, is when I am able to stop and listen to patients, honor their emotional processing through whatever else is going on and see them as a person.  This is not every nurse's particular desire nor skillset--some nurses prefer their patients anesthetized (e.g. surgical nurses), and there are definitely days where I see the wisdom in that.  However, there are days where that space simply is not possible.  This can be for a number of reasons:  

• The patient and I have some kind of communication barrier, most frequently because they are hard of hearing but sometimes language (the translation tablets are supposed to be used primarily for communication related to their care specifically)
• The patient does not feel like talking
• The patient has their own visitor(s) or is otherwise already engaged
• The patient is confused and/or with low memory, participating in their own world only

The most common reason, though, is that I simply do not have time.  From eight to ten in the morning is an absolute flurry of activity.  I have received report from the night nurse, gathering my bearings on these patients, introducing myself, and setting goals with them for the day while also performing an initial assessment on them to form some of my own conclusions; then I am checking, retrieving from the correct location, preparing, all of their medications for five separate patients (one after the other, since all at once is a logistical nightmare, particularly with some patients that need pills crushed, swallowed one at a time, cross-checked with another nurse, etc.).  At the same time, I'm getting calls from lab, physical therapy, occupational therapy, respiratory therapy, patient family members, case management, social work, my tech, physicians, and, of course, the patients themselves needing to go to the bathroom or other morning routine elements.  

In the rest of the day, I am also expected to round on my patients every other hour (their tech on the other hours), turn patients that need turned, administer timely medications, troubleshoot and/or start new IVs, discharge appropriate patients (calling nursing homes or home health for the handoff, sometimes scheduling appointments that haven't already been made), admit new patients, teach patients about their care, perform dressing changes, notify the physician of any major concerns, and respond to any other issues in the day.  

My internal self in the morning med pass

Oh, and document it all.  

In other words, my goal might be to be with the patient as a person, but sometimes my reality is that I have a series of tasks I have to perform with that patient, and this may be all of the space I have available to them.  I leave those days feeling a level of frustration, that I was so busy performing patient cares that I may not have been able to care for the patient.  

I don't like it when my patient becomes a list of tasks rather than a person, but, again, sometimes that is all the space there is, particularly when other patients on my load simply need more, in one way or another.  There are times, though, when a patient is a list of tasks partly to protect myself--perhaps they are lashing out against their situation by making snide remarks to staff members:  I will minimize my time in those spaces, clustering my obligations together and perform the bare minimum of interaction. I am not neglecting them by setting a boundary, as their tasks are still addressed, but it feels different.  It's an interesting cognitive dissonance, to know that I am caring for people by actions even if I am not engaging with them emotionally.  I do not need to be "friends" with a patient in order to feel fulfilled by the day.  I can know that I am advocating them while I'm not being present in the room; I can know that I'm simply a part of the "holding pattern" before other decisions are finalized and know that this effort is not strictly needed (I cannot make insurance approve pieces any faster).  

In the end, it is all a balance of resources.  What emotional space I have to offer depends on how much has been used toward all of the task elements that must be completed.  I prefer to have the time to see to their emotional needs, but it cannot be at the compromise of someone else's safety needs.  What's left is to make peace with that.

Peterson Family Update, #94038 Phi

 It's that time again!

• Whelp, I have gotten my second COVID booster now for a couple weeks now.  I qualify under the immunocompromised stipulations.  
• Had another successful trip around the sun, and I celebrated my birthday with a few buddies going axe throwing, doing an escape room, and screaming at a videogame.  It was brilliant fun.
• I have more than six months of a nurse, now, under my belt!  Holy crow, I have learned so much since January, let alone since August.  At this point, I've even had my first review with my manager, which included some good discussion.  I have a lot of space to grow; I'm eager to see it.  
• Had a family vacation this last week!  We gently tumbled into some tourist traps, properly ooh-ed and ahh-ed at the Smokies, went to Dollywood, and got to play some games together as a family.  

Wonderworks, and all the 
ridiculousness therein

The view from the Ferris Wheel at the Island.
There's actual TOPOGRAPHY out there.

Andy had to get creative around some 
obstacles at minigolf

Would just like to point out that I managed
to be the top-scoring player in our round of 
lasertag...because I camped and sniped people. 
Literally have no idea what 3/4s of the place looked like

The Pirate's Voyage dinner show was a lot of fun,
with some wonderful surprises

• Our household was unaware of quite how many songs we sang to/about Luna until we were away for her for a few days.  We knew it was quite a number, but, oof, it was revealing when we started one, made eye contact with another member and sighed.  There were zoomies when we came home, so I like to think it was mutual.  (Thank you again, Anthony, for watching her!)
• One of the tourist traps was a Jurassic Park boat ride that Mother and I peeled off to while the rest of the group made toward the go-karts, knowing full-well that it was going to be silly.  However, I did not put two and two together to realize that the whole thing would be in the dark.  With some things roaring and moving toward you.  Neither of us are the person you want to take with you into the haunted house as your "protector," to say the least, which meant there were a couple of points of "No, don't you pop out at us!" and some legitimate yelping.  I guess I thought there would be more "nice" dinosaurs before the chaos inevitably happened.  Still, the right kind of silly.
• We have a few coaster enthusiasts in our group and Dollywood had some real zingers.  My favorite part of any coaster is good airtime, when you crest a hill and float for a moment or two.  Lightning Rod was our first coaster of the day, and it was definitely one of the top coasters I've ever been on.  Brilliant airtime, loads of fun.  
• Back at the Vrbo, we played Euchre, Pinochle, variants of Uno, Trash Pandas, and Telestrations.  The latter always dissolves into a particular brand of chaos, even when we're not trying to actively sabotage each other.  For example, I failed to read "Raisin Bran Cereal" correctly and interpreted it as "Russia Brand Cereal," hence the drawing of Soviet Flakes.  Kitty, however, delights in deliberate but tangentially related sabotage, which is why she is labeled "the black hole."  
• I tried to count how many times Andy was in conversation with strangers about the Rivian, and I lost count somewhere.  One notable moment had a dude pulling next to us at a light and yelling "what the fuck is that?" over their toddler and replying "It's badass!" after the name/brief explanation.  Tutti definitely pulled a LOT of gazes when we drove by the old truck expo, with all of these vintage Fords and Chevy's out in the lot.  Andy has a lot of fun with it--really, Rivian could not ask for a better ambassador.  He held court in more than one parking lot, certainly.  
• Speaking of the truck, Andy and Mike had the chance to take Tutti through an off-roading class and course.  They have a much more tuned sense of the truck's dimensions after that adventure, for some reason, as well as some good stories.  
• I have another couple of days at home before going into three days in a row at work, which will include some recalibrating back to some degree of routine.  I've also been putting off a couple of things until after vacation, which include a new workout system called TapFit as well as some rock climbing classes.  For TapFit, I already do a fair bit of Zumba and the like, but I wanted to shake things up a bit there, try a new style of something.  The community on the surface seems more focused on the weight loss angle, though the self-paced choreography basics are intriguing me in the right ways, for the first couple days in at least.  
• I am already poking at what our next adventure might be.  I had forgotten how much I appreciate a good road trip but for these last few destinations (Minneapolis, the Wisconsin Dells, and Pigeon Forge) I daresay the company at our destination had something to do with it.  
• Andy has already planted another tree and at least a dozen small plants this season.  I will have to make a cleaner budget line for gardening supplies for future months, but I comfort myself in knowing that he'll run out of space EVENTUALLY...even though I know that there will be some significant new landscape features.  Even over the sound of my wallet screaming, I see how much joy it brings him, and I don't mind seeing the flowers nor would I stop myself from enjoying the black cherry tomatoes right off the vine.  While I limit my involvement mostly to engender Andy's creativity and vision (following direction but seldom giving it), I also acknowledge my poor record for keeping plants alive, taking a backseat to minimize exposure of my herbicidal aura to the area, if you will.  
• I am remembering from last summer that not only should I be wearing sunscreen because I have had a basal cell carcinoma dug out of my shoulder, but I am also basically mildly allergic to the sun, too.  Post-vacation, I have a few spots on my arms that will need some help and time to go away, maybe some prednisone again.  I'm considering what kind of light, full-sleeved options I want to employ so that I am not permanently painted white with SPF WowYou'reFlourescent to take Luna on a walk (yes, it has been that bad).  
• Andy and I hit our ten-year anniversary on May 26th!  He's still my favorite and brings color into my life.  I look forward to our adventures to come.  
• And speaking of, happy early birthday to Andy!  I predict there will be more plants bought as part of the celebrating.  

Much love, all.

Intersections of Life

I've had these same thoughts before and yet I feel the urgency to speak about them again, namely the element of "sonder," that particularly realization that those we interact with live a life that is as vast and complicated as one's own.  The hospital has cross sections of life that all manage to intersect in some fascinating ways.  I mean, I know that this is technically true everywhere, but it seems more apparent in this environment as hospitalizations and new diagnoses are significant turning points for many people.  So, not only are lives happening, they are changing drastically and with all the big emotions that implies which is now suddenly put into context against what they (formally) knew as normal.  Weddings, graduations, new jobs, new family members, and many other significant life events are happening, even as a loved one from another family is dying in one of our hospice rooms.  

One patient is worried about whether their professors will be flexible with their due dates while they are hospitalized.  Another is concerned if they are going to lose their job, which is the only reason they have health insurance.  Another still is contemplating how to explain to their aging parent that their needs are beyond their ability to care for them alone and they need to consider what other options are there.  Another still will be following up outpatient now that they've stabilized in order to find out what their new chronic illness actually is and what that will mean for themselves and those that love them.  A group from another family in hospice is so busy "helping" that they somehow fail to be present in the moment with the patient in their final hours.  Another knows that their family member does best when they have a familiar face around to reorient them but also cannot get enough time off of work to be present.  Another family member is completely fed up having to pick up this patient for the umpteenth time from the hospital, wishing that the patient may make some more positive changes this time.  Another patient only let the problem get this bad because they could not afford anything preventative--the emergency room and admission were the only parts of their care covered.  

Folks wander up to the desk asking for a cup of ice completely oblivious to what is happening two rooms over.  In fact, patients and their families can be so intwined in their own situation that they seem to forget anyone else is here.  These seems most true for hospice situations, particularly if the change over to hospice was sudden.  Their understanding of a world larger than themselves simply vanishes.  Even in less extreme circumstances, I cannot count how many times someone comes to the front desk and says something like "my mother needs to go to the bathroom" or some other similar request (a cup of ice, pain medicine, has a question, etc).  I have no idea who they are, let alone who their mother is.  As such, there are many points where I have to ask "who is your mother?" and they might tell me a name, but I have to clarify still "what room are they in?" because I will not be able to find someone simply based on their name without cross-checking things because even the rooms do get switched from time to time.  Additionally, I won't magically know important context to their case nor specific bathrooming needs because I'm wearing navy blue scrubs--chances are, I'll need to find their nurse or tech.  I will know many specifics about the patients I am assigned that day; I will not have such intimate knowledge of the entire set of thirty patients possible on our floor.  Maybe I should try to look less approachable.  Yet the point remains:  I don't think that they're being egotistical on purpose, assuming that I know who they are because they are the only ones in the hospital but more because they are so focused on this pivotal moment that they do temporarily forget that there is anyone else outside of them.  

Yet in the meanwhile, the nurses and techs and doctors are discussing the new hospital visitor policy, talking about the asshat who cut them off on the way to work, on a house hunt, wading through family drama, trying to find someone to cover them to go to their child's game that week, planning their garden for their day off, managing their own appointments and conditions, thinking about their next vacation, considering picking up additional time to pay for said vacation, sorting out how to get their car back from the shop with their work schedule, and a thousand other things. 

I don't need the patients to pull themselves out of that self-centeredness, except for small moments at a time.  In fact, I would encourage folks to stay in a place where they can process and feel what they need to that they might be otherwise ignoring for at least doses at a time.  However, I do need enough awareness to firstly acknowledge that I have other places I also have to be and as such I am not slow to reply for any vicious reasons.  I am a side character in their event.  And while I am providing a service, I am also an individual with my own goals, needs, and limitations.  

All colliding and intersecting, requiring uncomfortable pauses and emotional processing while, somehow, the world keeps turning outside of the hospital walls.  Time moves differently in our hallways; time moves with portent and either with startling speed or as a maddening crawl.  Yet, it moves forward all the same.