The New Normal

20140415-162143.jpg

It’s so easy to get caught up in the whirlwind of my schedule this term…there’s always one more thing. Case in point: I told myself I wanted to be in bed by 10pm, to get at least 7 hours of sleep before a full day of clinical. I rolled into bed at 11 instead. Despite the long list of things and limited hours in the day, this post has been on my mind for a while and I don’t want to forget how amazing it feels right now to be diving deep into the nitty-gritty of acute hospital-based care.

I swim through each day vacillating among feelings of overwhelm, thrill, anxiety, nervousness, accomplishment…and if exhaustion counts as a feeling, well, throw that in, too. One of the nice things about my clinical site this term is that it’s a 15 minute walk from home…so I have a built-in half hour each day for deep breathing, movement and reflection. Some days I can’t wait to get home (to eat or sleep, or do research on a patient’s condition). Some days I linger at the local coffee shop on the way home, needing a little more time and space to process what I’ve witnessed and learned.

My New Normal is a paradox of routine and semi-controlled chaos. I’ve been trying really hard to wake up and go to bed around the same time each day, even on weekends. I’m not naturally an early morning person, especially since B’s a night owl…but this term, I feel like I have to be more consistent. So, 5:30am wake-up and 9:30-10pm bedtime it is. I’m actually really loving it. I get so much more done in a day! I’m developing my little morning routine, which has been really grounding.

So, you ask, what does it actually look like? Monday mornings I have a Leadership class from 8:30 to 11:30. It’s part two of a two-term course. Then Tuesday through Thursday I’m at my clinical site (surgical oncology for the first five weeks, medical for the second five), from 7am to 3:30pm. Fridays from 9-3 I have my Acute/End of Life Care theory class, in which we review case studies and talk about what nurses actually do to care for their patients. Each week we review a different category of acute illness–this week it’s neuro-focused (stroke and delirium). The weekends are spent working on case studies, writing clinical reflections…and catching up on laundry and trying to cook ahead for the week.

My New Normal involves lots of Not Knowing. I walk onto the unit each morning with a patient I’ve been assigned the night before. I look up their history, their medications, try to wrap my head around their story and experience of their illness or condition and develop some semblance of a plan of action to move them closer to discharge…but each day offers New Surprises. Flexibility and Plan A-Z is the name of the game. Some of surprises are related to the patients I’m privileged to work with and care for. Many more of the surprises are about myself and my capacity to stretch and push myself past the fear and anxiety of “messing up.”

The reality is, seasoned nurses don’t get the night before at home to prep. They walk on the floor, they meet their patients (sometimes 4 or even 5 of them!) and they just roll. The more I observe my preceptors, the more in awe I am of the work they do. I have observed some stellar nurses on the surgical oncology floor so far…they exemplify compassion and healing of nursing care, in addition to being superb teachers.

My New Normal includes a lot of adding things to my list of Things to Look Up. It doesn’t stop, my friends, and there’s not enough time to do it all…and that’s part of the New Normal, too: learning, sometimes painfully, how to prioritize. Call it the Art of Nursing 101.

One of the things I appreciate most about this rotation is the clarity it’s bringing to other aspects of my life. Being on an oncology unit brings you in close proximity to death. It’s not something I’ve ever been afraid of, per se…but there is something very profound about working with people who are nearing the end of their life.

I have not yet witnessed a patient’s passing, but it’s entirely possible that I might in the next eight weeks. I don’t think there’s anything that can prepare me for that. But I find myself checking in more frequently, trying to figure out my own personal life priorities. It’s so, so hard to do this when you’re in school and life is moving at 150 miles an hour. But the greatest gift that we bring to our patients is our humanity–without that core, we are nothing as nurses. So I find myself resonating deeply with this question from Pema Chödrön:

Since death is certain, but the timing is uncertain, what is the most important thing?

The Asking of this question, the Listening, and the Living with the answers that emerge in the quiet moments, are slowly forming my New Normal.

Lists

I don’t know about you, but I’m a list maker. Whether written by hand (groceries), typed in an app on my phone (books, new movies, etc), or stored away on Ravelry (knitting!) or Pinterest (recipes), I’m always filing things away for future enjoyment.

Sometimes, I even write my emails in lists…it helps me stay organized, or less overwhelmed when I feel like I want to write a huge long novel but know I need to keep things focused.

So, here’s a current list of my spring break and transition into the fourth of five terms of nursing school. It’s a glimpse into the whirlwind of, well, everything.

20140327-123458.jpg

1. New Music: Mala Rodriguez. Oh, man, one of the things I love most about visiting my friends K&L is stocking up on new music. They always know the latest and greatest. I’m loving this fierce Spanish rapper. What a great way to practica mi español.

2. To Do: Finish the on-boarding training for my clinical site this spring. Epic, glucometer testing (again?! sigh…), HIPAA, Pyxis. Also, my first practice NCLEX. I’ve finally starting coming to terms with reality and have been reading the strategy section of my study book I bought.

3. For Fun: Get started on this beauty (people, there was a 50% off sale on yarn at this wonderful store in LA…I may have come home with 6 skeins of worsted Malabrigo in the most delicious colors!).

4. To Read: Just started Ruth Ozeki’s A Tale for the Time Being. Fiction!

Yes, spring break has been lovely, my friends, but dare I say it…I’m looking forward to getting back into the swing of things. This term is going to be:

1. Hard
2. But filled with lots of practical learning.
3. That is all.

Nerdy Nursing Moments

Nerd

You know you’re a nursing student when…

…you get brochures like this in the mail and you think to yourself, “Gosh, this actually looks like it could be really interesting. I really need to brush up on my lab interpretation skills…”

Can you tell that I’m starting to get excited about next term? Or, maybe I’m just really ready to be done with this one. Or both. Either way, I’m super stoked that spring break is a week away. Two weeks of vacation, then I get to launch into ten weeks of acute care.

Oh, and I have I told you yet? I’m going to be on an oncology unit for ten weeks in clinical next term! I think 5 weeks will be medical, the five surgical…but regardless, I’m really excited. Terrified, but excited. I know it’s not going to be an easy term…but I feel like I’m ready to go through this next rite of passage, in which I’ll finally get to learn some of those core hands-on skills like IV’s and reading EKG’s.

Mostly I’m excited to get back into direct patient care. This term, which has been more population-based care has been great and I used a lot of my organization and leadership skills. But I don’t want to be an epidemiologist or policy-maker or clinical administrator. I want to be a midwife.

I’ve started re-reading Mukherjee’s Emperor of All Maladies (it actually makes for a really compelling read-aloud book, which is what it has become for B and I)…as well as Theresa Brown’s lovely memoir of her first year as an oncology nurse, Critical CareI’m slowly making my list of books, movies, blogs, etc.  about cancer. Any recommendations you’d like to share?

So, what’s nursing school like? {addendum}

Upon re-reading yesterday’s post, I realized it may strike some as a bit “Debbie Downer.” That was not my intention at all…but there is truth to the fact that it’s a bit of a roller coaster.

That said, today was most definitely an up-day. I had the opportunity to shadow a FNP who works at my clinical site this term. Today she was seeing patients in the clinic’s mobile van, which travels to various places in the city, providing care to low-income and uninsured patients. The majority of this morning’s patients were Spanish speakers, so it was a wonderful chance to practice my own translation skills, even if I wasn’t actively interpreting.

My favorite moment came when a patient asked about the meaning of some test results that had come back for her. Despite running several patients behind, the FNP took time and care in explaining what exactly the test measured and what the range of scores meant. It was such a simple thing, really, just two or three minutes to explain. But when the FNP finished, the patient teared up. The FNP thought maybe the patient misunderstood her explanation and thought she was actually ill.

The FNP took a deep breath and was about to explain again when the patient said, in halting English, “No, it’s just…thank you for taking the time to explain to me. None of my previous doctors ever took the time to explain anything, just ten minutes in and out. They never saw me as a person with feelings. Here, I feel like a human being.”

We all, the FNP, the interpreter, and I, all started tearing up in that moment. It was such a poignant reminder of why we’re here, why we’re doing this work, why we’re called to nursing. We’re here to be there for people in both the pivotal and ordinary moments of their lives, to help them make sense of their bodies and their health, and to help them feel empowered to bring their whole selves to the conversation of health and wellness. We don’t treat illnesses, we work with people to help them heal themselves.

Just another day in nursing school.

So, what’s nursing school like?

20140224-182016.jpg

I probably get asked this question at least a few times a week by family members, friends, folks reaching out who are considering nursing and/or midwifery. I’ve tried to write this post a million times, but the totally clichéd truth is that the experience of being a nursing student defies neat labels. When I’m completely honest with myself, there are some days that I love being a nursing student, some days when I hate it, and some when I’m just so tired I almost forget why I’m here in the first place.

But that doesn’t answer your question, does it? You’ve probably heard some variation of this already: it’s hard, intense, it will push your limits, it will make you uncomfortable. And yes, it does all these things. Especially in an accelerated program.

Part of why I haven’t written this post is because it seems so overwhelming to try to capture this experience in one post…so I’m going to approach it the way I approach most writing projects in my life: by making a list. Probably just the first of several lists. 

Anyway, here’s a start:

1) Nursing school is lots of work. Lots and lots of work, probably only some of which you will find interesting at any given moment.

2) The first task is setting aside what you are passionate and interested in and learning how to be surprised by the things you’d never thought you’d be interested in: Renal pathophysiology. Beta-blockers! Diuretics?! Alzheimer’s…

3) Nursing school requires that you figure out how you learn. If you don’t know this about yourself now, you should figure out in a hot second, or you will not survive. As a nurse, you have to be good at letting your ego go and just asking the Stupid Question (P.S. We’re all thinking it and hoping someone else will ask). It’s not really about you anymore–it’s about the safety of your patient.

4) Nursing school is all about learning how to work in teams. It sounds corny, but this is crucial. If you envision yourself as the Lone Crusader saving patients by sheer willpower and some slick CPR skills alone, this ain’t the place for you, darlin’. Know your strengths and weaknesses in team work. Capitalize on the strengths. Build up the weaknesses. Be willing to admit when you’re wrong, and when you simply don’t know, which will be All. The. Time.

Nursing school truly is a daily ritual of “I don’t know, but I’ll find out.” Get comfy there. It’s going to be a while.

5) Nursing school will frustrate you to no end. You’ll have instructors that drive you crazy. You’ll wonder what you’re paying for. You’ll doubt whether this is the right place for you. You’ll feel like an imposter. You’ll delude yourself into thinking you’re the only one that failed that pathophys exam.

Yeah, you heard me, failed. I’ll say it one more time: Big. Fat. F.

(FYI, nope, you won’t be the only one. Also, the pathophys prof is amazing and she will spend all the time in the world with you to help you understand, but you have to ask for her help. It’s not the end of world. You’ll still become a nurse. I promise. And I haven’t even taken the NCLEX yet, but I have good sources that tell me it’s true.)

6) Nursing school is initiation into a new culture, new language, new history. It’s all-consuming. Some days it feels swell, almost graceful, exciting. I can catch glimmers of myself in the future, practicing as a nurse-midwife. Some days it’s kind of a bore. That’s ok. It is what it is. Learning a new language takes time, it doesn’t all come at once. And I’ve never been one of those people who found grammar super sexy, so sometimes, I just have to take a deep breath and show up.

7) What is my day to day reality? Really, truly, it’s different every day. It’s writing papers, evaluating evidence, reading journal articles. It’s practicing vital signs, shadowing nurses, learning about wound care. It’s considering leadership and studying epidemiology and learning the signs of ischemia. It’s a lot of stuff. So, so, much stuff.

But really, it’s learning how to think. And this is why it’s so exhausting. Mentally, I feel like I’m two again, learning new words for everything. It’s great. I’m able to communicate more and more effectively with other health professionals. Also, I want to nap, All. The. Time.

And with that, I conclude my first list. What else do you want to know? Send me a note, I’ll try to answer your questions!

{this moment}

{this moment} – A Friday ritual. A single photo – no words – capturing a moment from the day, week, or year. A simple, special, extraordinary moment. A moment I want to pause, savor and remember

20140130-230637.jpg

{this moment}

{this moment} – A Friday ritual. A single photo – no words – capturing a moment from the day, week, or year. A simple, special, extraordinary moment. A moment I want to pause, savor and remember.

image

2/5

I have never been so relieved to be done with a term as I was yesterday at 1:45pm. Everyone said this would be the hardest term of the RN year: the first clinical term, with chronic care as the theme, and still having to deal with Patho and Pharm. By comparison, next term is going to be a breeze!  (More on that in another post…first, I need a few more celebratory drinks and pajama days with my stack of books.)

If I learned anything this term, it is this:

The lack of self-care will kick your butt in a serious way. 

It feels hard to write about because, well, sometimes it’s easier to put on the cheerful persona and pretend that I feel confident and competent about this whole nursing school thing:

“How’s school going?”

“Oh, you know…it’s hard but we’re learning so much!”

Ha.

The truth? This term was hard. I didn’t love every minute of it. It was hard to sit everyday with the experiences of chronic illness and end of life care. It was hard, sometimes almost impossible, to balance school and personal life. It was hard to stay motivated when I walked into the ten billionth poorly organized, unimaginative Powerpoint of my life.

I was not a graceful spouse this term. Nor was I much of a good daughter, present friend, or most attentive student. I certainly was not particularly kind to my body (sorry about the caffeine and lack of exercise…I promise, we’ll get back on track!).

And…

I also learned a lot. Maybe not as much about nursing per se, but about life. I learned a fraction of the thousand ways one can be with patients in difficult moments. I came face to face, once again, with myself and those old habits of thought and that lingering self-doubt. I learned how to hold tight to what keeps me going when all I want to do is say “I’m not enough.” I saw glimmers of how I want to craft my practice as a nurse-midwife and teacher.

In sum, getting through this term felt a little bit like dodging an avalanche.

Mostly, I learned that I can do it. Maybe not gracefully all the time, but I can make this dream happen for myself.

So here’s to finishing the second term. Here’s to self-care and self-confidence and being gentle with myself. Here’s to re-connecting with friends and family and with the calling that led me here in the first place.

Here’s also to cleaning my desk and the kitchen and doing the laundry. And books!! (Recommendations accepted)

clinical reflection 1

This week was actually Week 3 of clinical…it’s going by so fast! I want to take more time to write and reflect, but it feels difficult to find the time. There’s always more work and the reflections often get set aside in place of trying to stay afloat on assignments.

To be honest, this fall has been challenging in several ways, starting with time management. Funny enough, my nursing mentor that I worked with yesterday singled out my time management as a strength of mine, which I think is hilarious. I felt behind all day long, whether it was because I couldn’t find the right dressings in the med room, or because she had to re-check a manual blood pressure I charted, or because my fingers just couldn’t press the right scroll button on Pyxis, or because Epic is…well, an Epic Monster to navigate.

So, in lieu of a more thoughtful, well-crafted reflection, here are a few tidbits of things I’ve learned in the past three weeks:

  • how to empty catheters and teach patients how to take care of them at home (when you’re on a urology unit, you get to see a lot of catheters)
  • go slow with the Pyxis (the touch screen is super sensitive)
  • answering the call light right away takes so little, but it means so much to the patient
  • warm blankets can totally change a patient’s mood
  • take slow, deep breaths. lots of them. often. yes, the patient’s need their meds…but they need them from a nurse who is calm and focused and completely present in the moment
  • eat breakfast before your shift, even if you don’t feel like it
  • keep practicing manual blood pressure, even if everyone uses the electric cuffs. you never know when you’ll need to check (and re-check)
  • listen. listen, listen, listen.

Tall, Tall Shadow

I can’t stop listening to this amazing song from Basia Bulat’s new album of the same name. I first heard it last week on Jian Ghomeshi’s show Q while driving home. It came on just as I was pulling into the driveway. I turned the engine off and sat mesmerized, my heart in my throat for the next four minutes. It came at just the right time…I’ve been struggling with the abrupt switch we’ve had here between summer and fall. I’ve been listening to this album every day since, letting the lyrics sink deeply into my bones:

“Take it to heart, you can’t run away when you know that the tall, tall shadow is yours…”

Disclosure: There’s always been something about this shift in the wheel of the year that tugs deep within, sometimes uncomfortably. I know I have a history of seasonal depression. And it’s true that right now I feel tender. Half-way across the country, a beloved elder in my family is journeying closer to the end of her life and I hate that I can’t be there right now to hold her hand.

The rains are coming and the light is fading into the endless gray that characterizes this region of the country during winter.  I try in vain to re-write the script in my head about how I deal with the gray, despite nearly eight years of evidence that this time of year has always been a struggle. If only I could think myself into a more positive attitude, I tell myself…but every cell in my body just wants to embrace the slow, dark melancholy rather than fight it. What I really want to do is channel my inner grizzly bear, find my cave, and go to sleep for the next six months.

Instead, I up my vitamin D and dust off the sun lamp and dive into a term that is based around chronic and end of life care. One of our term-long assignments is to read the blog of someone who is dying. I find myself vacillating between wanting to cry and wanting to scream. Chronic care brings up a whole slew of emotions for me–so much of it involves diseases that to me exemplify all that is wrong with our so called “health care system”.

My clinical instructor (a nurse who I respect and admire deeply), said that if he could sum up the experience of chronic disease in one word, it would be spirituality. More often than not, he sees chronic disease as a journey to find meaning in one’s life. The midwife in me totally understands this and can even see the potential beauty and transformative power of this experience.

But right now, I find no satisfaction or peace in this framing of chronic disease. My fellow students are all so excited to start clinical, for the opportunity to start feeling like a “real nurse,” to “get their hands dirty.” This is what I say, too, because it’s easier than telling the truth.

The truth is that thinking about chronic illness makes me feel angry, and not just angry, but hopeless. In my mind, the devastating prevalence of chronic illness in our country is not just a woo-woo opportunity for spiritual enlightenment on the individual level. That’s a high price to pay for some level of self-growth. In my mind, chronic disease is also the direct failing of a medical system that prizes compartmentalized care rather than holistic well-being. It’s the result of a system that prizes allopathic medicine over naturopathic medicine. It’s the legacy of deeply rooted historical disparities that target people of color in low-income communities. It’s a systemic failing on a grand scale to adequately address the life-long health care needs of an entire country.

I don’t see spiritual awakening in diabetes or emphysema or renal failure. I see a fucked up health care system driven by a senseless greed that prioritizes profit over true health. And because I’m tired and it’s fall and I haven’t found my groove yet this term, I question whether I can actually have a meaningful impact on any of it. This is when I start to question whether I will ever feel truly satisfied as a clinician when the systemic issues stare us in the face. But I think this will always be my struggle, one of my many “tall shadows” that I will continue to run away from until I can learn to make friends with it.

“Take it to heart, you can’t run away when you know that the tall, tall shadow is yours…”