Yesterday was our third clinical day. Last week most of my classmates had their own patients, but I had been on the cardiac floor with an LNA, so this was my first time with my own patient. It’s incredibly nerve-wracking to get a room number and a patient last name and have no idea what you’re going to encounter. But it was a good experience, all in all.
I got to listen in on my patient’s nurse receive report from the prior shift and I really appreciated that the nurse from the prior shift made sure to speak to us students as he was talking about the different patients we would be working with. My patient’s nurse actually had three students covering her patients, one other from my program and a girl from the local Catholic college, so I can imagine it would have been annoying for her, but she didn’t seem to mind at all and let us follow her around and ask any questions we may have had. Throughout the morning I got to know my patient pretty well. I felt bad for her, she was in so much pain and then ended up feeling sick to her stomach, but she was the sweetest thing, so worried about putting us out. She told us that she had wanted to be a nurse when she was young and she always liked watching what they did. I ended up getting to change the dressing on her IV site, which was pretty neat.
A big part of the learning process is working with the other students because we help remind each other of things we might have forgotten. Plus we get to see what each other’s patients are up to. And of course the patients teach us a lot, too. I was amazed at one woman who was going in for an amputation. You’d expect this to be a traumatic event in her life, but she was actually pretty chipper about the whole thing. After all the problems she had her attitude was one of, “Just take it off, already!” There was a woman last week who had had multiple surguries in her past and she was pretty matter-of-fact about it, too, even joking about how every time she came to the hospital she left with less than she came in with. Of course I don’t expect most or even many patients to face these things with that sort of attitude, but it definitely gives meaning to the idea of wellness within disease. We also had our second experience with a palliative care patient. The background was very sad… she was not an oncology patient but rather one who faced a sudden incident which was not going to have a happy outcome. What we have found most appalling about the two palliative care incidents we’ve come across is the seeming lack of the “care” part of the phrase. Our instructor suggested to the family that the patient’s nursing student could help to clean her up and they were so grateful mentioning that she always cared about her appearance and would want that to be taken care of. When the instructor and two of our students started her bed bath they found her cut underclothes still tangled around her, a BP cuff left on her arm, and a pile of sheets wrinkled underneath her. I don’t know whether this was the trauma department’s responsibility or that of the floor when she was admitted, but either way it’s no way to leave a patient, conscious or not. Perhaps the attitude is one of, “Well, why spend the time on daily care when she’s on her way out anyway?” But the family cares. The neighbors care. They want her spirit honored, even if her physical self is no longer able to know. We may not be able to save her, but we can make her exit from this world as peaceful and reverent as possible, can’t we? We can help ease the last memories for those close to her, can’t we? I wonder if we’re all going to lose this idealism. Whether, once we’re “real” nurses, we’ll get so wrapped up in prioritizing care that we will let these things slip that bother us so much now.
I felt strange being so close to death. I’ve never experienced that before nursing school. As the students were finishing up with this patient a priest was coming in. I’m not Catholic, but I know when the guy with the robe and the backwards collar shows up with the bible in his hand that he’s there to administer last rites and in a way seeing him there made it seem so final. Like, maybe there was a tiny shred of hope before that she would spontaneously recover. But in my heart I think that she was holding on until she had had last rites and her husband had returned. That was one out of two. It felt wrong and right at the same time. She was going to go peacefully, surrounded by those who loved her with her spirit prepared for the journey. Yet I could see the anguish of those around her. It’s times like that when I begin to understand more deeply why religion is so important for people. It puts a sense of peace and order to a process that is often anything but peaceful and ordered. Our brains may crave science, but how is the knowledge of the biology of death comforting? I’d say it’s the opposite. We need that spiritual side to be nurtured by the belief in the unknown, no matter what name we give to our invisible compass.