NursingZen

The Lunar New Year is on Jan. 26. Beforehand, in the Buddhist tradition, my mother-in-law cooked our ancestors a nice meal. They feasted as the incense burned. When the incense finished burning, it was our turn to dig in. We stood by rather impatiently and joked about which ancestor would eat the fastest (we all knew who that would be).

It’s 10 o’clock at night.

Me: Hello, patient Smith in 5323 requests Colace before she goes to sleep.

MD: You’re paging me at night for Colace?

Me: [shit]. Uh, yes, it was D/C’d this morning because of soft stools the last couple days, but the patient wants Colace now.

MD (voice incredulous, a bit stern):  You’re paging me at night for Colace? Is it a medical emergency?

Me: Uh, I know it’s not an emergency…but… [absolutely no excuses in my head]

MD: You should only be paging at night for medical emergencies.

Me: I see. Uh, I’m new. I thought it was OK to get a verbal order.

MD (voice softens or sounds amused): It’s OK. Just tell the patient the day team probably had a reason to D/C the Colace so they’ll talk to her tomorrow.

Me: OK, thanks. Boy, I’m going to remember this one. Ha ha.

MD: Do you need my name?

Me: No, it’s OK.

MD: Yes, you do. You need my name. It’s Jones.

Me [let me go away fast as I can]: OK, thanks, good night.

Alright, please laugh. I’m not too proud to look dumb a few times (this might be the 20th time). I’d laugh if I wasn’t so mortified, because I’m still wondering whether I paged him at home. I thought I was paging a doctor on-call in the hospital, if that makes this situation any less embarassing. I’m still completely clueless about many, many protocols and dynamics in the hospital. No one ever told me when to call or not, because every time I’ve needed an order, my colleagues have said, “Page the doctor.” So, I did!

I cannot wait to pass this phase where I don’t know crap.

“Whereever you go in this world, I’ll find you. If you run to the end of the earth, I’ll find you.”

Imagine this lyric. What do you hear? Love? Sorrow? Vengeance?

Imagine the lyric again, this time from a 70-year-old Jamaican woman. How does it sound? Do you like it?

As my patient repeats this over and over, I can’t help but hear a reggae song. I marvel at how poetic she is at this moment that is as far from poetry as I can imagine.

Because at this moment, she is lying on her left side, her head is buried in her arm, and she is crying, yelling, and writhing in pain as a head nurse pushes a fecal incontinence tube into her rectum.

“Whereever you go in this world, I’ll find you. If you run to the end of the earth, I’ll find you.”

I don’t think the nurse hears her, but I do. I hear pain, shock, anger, and vengeance. Just when I assure her that the worst is over, the tube falls out. The nurse wants me to put it in. I manage to do it, despite the patient’s protests, because I trust the nurse’s judgment – she’s a manager and a veteran nurse after all. I do it, because … what do I know?

It’s burned in my memory. The plastic balloon at the end of the tube is quite large and my finger has to push it up inside. The nurse finally tells me I can release the tube.

My patient, whose baseline is confusion, yells, groans, and curses for hours. She tries to attack the head nurse when the nurse tries to calm her down. My patient lets loose language that reflects exactly how angry, soiled, and violated she feels. The nurse laughs and leaves to relay the “colorful experience” to anyone who listens.

My patient looks at me with pleading and trusting eyes like I’ve never seen before. I don’t tell her I was the one who put the tube in the second time.

As the evening wears on, I begin to think that the fecal management system (FMS) could not possibly have been the first, best, or only resort. I’m inclined to take out the tube, but without nursing experience on which to base my judgment, I feel helpless. I ask a few nurses if I should take it out, but no one gives me a clear answer. Finally a nurse appears who knows the patient, and she’s appalled that the FMS has been used, because the patient has had previous bouts of uncontrolled diarrhea, but that by no means called for a collecting tube. That’s all I need to hear. The tube is out in seconds and my patient sheds tears into my hands and whispers, “I love you.” All I can do is apologize.

Her groans soon dissolve into whimpers, then into quiet, tired sighs.

I leave work wrought with guilt, but also a shade less naive.

Hopefully this is the end of blindly trusting others, and the beginning of trusting in myself. All I have to remember is: “Whereever you go in this world, I’ll find you. If you run to the end of the earth, I’ll find you.”

I’ve been independent for 8 shifts now, and I like it.

I like the sound of “my patients.” They’re not “my nurse’s” or “my preceptor’s.”

I like the sound of “Hello, I’m your nurse this evening,” not “Hello I’m a student nurse,” or “Hello, I’m working with so-and-so today.”

And I confess — I feel a thrill when:
- giving report
- taking report
- signing “RN” after my name
- being asked to witness a narcotic waste
- being asked to check a heparin or insulin

There’s even something satisfying about charting — when there’s time.

Along with the thrills is the responsibility. In the beginning it felt unbearable, but my mind and body are learning to shift and balance the new weight. Sometimes the responsibility feels like a burden, but usually it does not. I’m hoping it’s a new dimension that will eventually fit naturally into my everyday.