NursingZen

So far the biggest challenge and greatest anxiety I’ve faced in my first quarter (which is quickly winding down –- 3 more weeks before break) is not the coursework or clinicals; it is going to sleep at a decent hour!

On the days before I’m to be up at 5:30 a.m., my anxiety about falling asleep slowly mounts throughout the day. At night I lie awake for hours thinking about having to fall asleep. I usually sleep only 5 or 6 hours. Next week, the pattern repeats.

But despite the part where I have to get out of bed, I like being up early. When it’s still dark out, I feel like I’m 12 again, waking up in the dead of winter and eating breakfast with my dad before school. I miss him. Now when I walk outside and the streets are just coming alive, I acknowledge the affinity I feel to the stray grey cat, the lone man crouched on the corner, and the workers on the empty bus.

A shift in perspective
Today at the hospital went by really quickly. Instead of wondering when I’d see or get to do something “exciting” (and feeling cheated when my classmates seemed to have more “interesting” patients) it recently dawned on me that everything I’m seeing and doing now is interesting and important. Giving a bed bath or walking with a patient may not make for a great story or for deep reflection, but they’re important because they’re part of what the patient needs for wellness. With this new perspective, everything I did for my patients today was infused with meaning. In particular:

• I spent time talking to an old Japanese woman with astonishingly beautiful skin. She came to the U.S. because she married an American 14 years ago but they since divorced. Before I spoke with her, everyone around me said she was “Japanese-speaking only.” Not true. If they had spent a few extra minutes with her they would’ve found her understanding and speaking English pretty well, only slowly. She just needed time (but time doesn’t seem to exist in hospitals). I chuckled when she asked me, “Why am I here again? I feel fine.”
• I fed breakfast to a 40-year-old black man dying of cancer. Literally dying. He couldn’t move and could barely eat, but he wanted to eat. He had nibbles of hash browns, eggs, bacon and oatmeal. It was a privilege to feed him one of his last meals.

Friday Update: I went into the hospital today thinking that I could see the man again. I was told he passed away last night with his family and friends surrounding him. I can’t stop thinking about the short time I spent with him and how I literally helped with one of his last meals. It rocks me a bit, but I’m glad I was there.

As it turns out, at the end of Week 3 everyone I talked to in the program was in the same boat: Partners felt neglected, couples argued, time seemed to slip away, tensions mounted. I think it’s funny that we all hit the wall–and were scaling it–at the same time.

Unfortunately, some people hit the wall harder than others: They wonder whether they’ll make it another day, whether nursing is for them, whether another program would’ve been better organized, and whether all accelerated programs are as crazy and intense as UCSF’s.

I feel for them. We all worked hard to get to this stage and it can be soul-wrenching to feel like the program may not be what it was cracked up to be, or that nursing may not be what one hoped for or expected. But I hope they don’t leave. We’re just getting started; former MEPNs have said that the first quarter is the toughest because we’re all getting adjusted.

Meanwhile, to my surprise, the anxiety and fear I felt leading up to and during the first two weeks of school have melted away!

Something clicked for me during my second week of clinicals: I like nursing. I really like it.

I like the fast pace, the constant, never-ending learning, the gross stuff, the sad stuff, the teamwork, the blend of social work, science, medicine, sociology, anthropology and psychology…It’s an amazing thing. There’s no field like this. (Yes, tag me “Idealistic” right now.)

And I can just go on and on about my admiration and respect for the nurses I’ve met and seen in action. They make me want to become an excellent nurse–no less.

I’m also relieved to have something to focus on, to be back in school, to have readings, tests and discussions that are applicable to real life, to meet new people. I can’t imagine myself doing anything else right now but be in this program.

Wow, these feelings blow me away. Is it really me who’s talking?

On the Saturday of the end of the second week of school, I was lying in bed wondering why I was so exhausted. Then it hit me: the enormity of what I’d taken on for the MEPN year.

The timeline is staggering when you really think about it:

• By the end of the summer quarter, in August, we’ll be allowed to give medications to patients.
• By the beginning of the fall quarter, in September, we’ll be continuing to shadow a nurse but will be responsible for total care of one patient throughout a 12-hour day.
• By the end of the fall quarter, in December, my instructors said: “We will be stepping aside and watching you take care of four patients.”

One year from now I will be taking the RN licensure exam and applying for jobs.

The following week, Week 3, my man and I got into some arguments. He was frustrated with my preoccupation with school and my inattention to him. Intellectually he understands that we’re in an adjustment period and that we’re going to be on different wavelengths for a little while. I promised to do my best to attain balance.

I can’t decide what I’m looking forward to most:

A) Change the dressing of a Stage 3 or 4 wound

B) Insert a nasogastric feeding tube

C) Change & clean out a colostomy bag

Each week we’re introduced to a set of skills that we’re then let loose to perform in the hospital (with supervision of course). When I first saw a pic of a Stage 4 wound (meaty with bone showing), I thought wounds would be my worst fear. But by the next week, (A) had been upstaged by (B). And then this week… (C) is at least tied with (B). I’ll be actively seeking out these things at clinicals because the fear and anticipation of having to do them is driving me bananas.

A brave classmate offered to let a student practice (B) on him (up the nose, down the throat and into the belly):

I finished my second week of clinicals last week. I shadowed a nurse who was my age and had been working for only eight months. She already seemed jaded and bitter, which made me sad and anxious. She echoed what I’ve heard from every nurse: The first year is the toughest to get through.

It’s been fascinating to see the different personalities and nursing styles. Most of the nurses I’ve observed are very organized and on point, but some handle the stress better than others. I’m realizing that a sense of humor is essential for survival. I’ve been lucky so far to not be with the nurse who yelled at my classmate for spending too long chatting with a patient and another one who talks to her adult patients like they’re kids and does only the minimum she can get away with.

Update on the 56 year old man with very aggressive thyroid cancer: He moved to a more acute wing. I visited him. Since he can’t swallow, he has a feeding tube now and currently he can’t talk. I was overjoyed that he remembered me. He and his wife maintained big smiles and a sense of humor even though his prognosis is bad: 100% of people with his aggressive cancer die; the docs give him 3 months. I left the room teary-eyed.

Soon I’ll post a photo of my horrendous hospital uniform…and nursing shoes that are so-ugly-they’re-trendy (at least in NY!)

For July 4th, I partied as though I didn’t have to be up at 5 a.m for my first day of clinicals at the hospital. Excitement and a hangover woke up my mind at 4:30 a.m. I slowly brought my body out of stasis with three unbearably stiff sun salutations.

6:45 a.m. at the hospital: The buzz around the nurse’s station was the true wake-up call. Until then it hadn’t fully registered in my mind that there were nurses working while I slept, and care was truly being provided 24 hours a day.

I also never realized how many hip, young, good-looking nurses there could be in one place. Dang. Meanwhile, we students looked liked tired lemmings.

The preceptor I was assigned to fit the former description too. She was nice but not sweet, a badass but not a hard-ass. She could be professional one minute, then shoot off a wisecrack or flippant remark another minute. I could tell she wasn’t thrilled to have someone shadowing her for–how did she put it—“the rest of our lives”—but she knew it was important and she took me on seriously and with intention.

Hour 1, 8 a.m.: My preceptor gets organized for her four patients of the day. Night-shift nurses give reports on patients to morning-shift nurses. Good communication and listening are essential.

Hour 2, 9 a.m.: My preceptor helps an obese woman on to her bathroom commode. She then conveniently says, “You can do her blood pressure, right? I have to go do something,” and runs off. While the patient has a long and labored No. 2 in the commode, I tryto take her blood pressure. But the cuff won’t fit properly. I don’t know what to do–Am I supposed to leave her to shit in peace? Stand there and keep her company? Should I leave? Should I keep trying to take her blood pressure?–I probably choose to do the most naive thing possible: I remain in the room and make small talk. While she sat on the john. My rationale is that I should get used to the smell of someone else’s poop sooner than later. In retrospect, though, I’m not sure if there was any “therapeutic” rationale for me to be in that room at that time.

Hour 3, 10 a.m.: My feet and lower back are starting to kill me. I look at the clock and laugh that it’s only 10 a.m.

“My” patients this week were:

• a spunky, 60 year old woman with a deep wound/abscess in her knee. During a dressing change she gladly showed me how deep her wound was by poking a cotton-swab stick right into it; it went in about 3 inches.
• an 80+ year old Chinese woman in palliative care. This means she was no longer being treated for her cancer but was being allowed to die naturally and as comfortably as possible. I talked with her awesome daughter in Chinese.
• a 56-year-old man with very aggressive thyroid cancer. In the 2 days I saw him he went from upbeat and talkative to no longer able to swallow. His wife, his high school sweetheart, was with him the whole time.
• the 30-year-old 400+ pound woman who was going on her 4th week in the hospital, more for psychosocial treatment than medical.

It’s 7:17 am, I’m showered and typing, and I feel fairly awake. I’m impressed by this small miracle. I need to remember to celebrate small steps toward being a nurse. Another item of note: I haven’t been late to class or any appointments this week. One week. It is a bit crazy to realize that I’ve only been ‘on the go’ for a week. I definitely felt Gemini-like this week too, which I may have to get into another time. I’m afraid I’m going to be starting a coffee habit again, too.

Update: It’s the evening now. I’ve met about 40 people in one week, half the class. I’m one of those who find it awkward to stand or sit next to someone whose name I don’t know but who obviously is part of my life now. So I introduce myself.

We took our class picture today. Over the past two years I was one of those prospective students who looked longingly at the 2006 MEPN photo, trying to see if I could glean any secrets to gaining entry to this program. And now here I am in that picture. It all feels a little surreal.

Today, while soaking in the sun during my lunch break, I read one of several academic journal articles that I downloaded out of sheer interest. This one was called “Illness Beliefs of Depressed Chinese-American Patients in a Primary Care Setting.” At first I felt a bit nerdy to be reading something like this out of choice, to be so thoroughly engaged with an article about a scientific study that by necessity is written in a very academic, dry way…but then, inexplicably, I began to feel a satisfaction that’s hard to describe…and then–and then I began to feel a glimmer of hope! A hope that maybe I’ve actually chosen the right field of study for me…otherwise why would anyone independently forage for these types of readings?

Then something else miraculous happened: I found that the article wasn’t over-the-top scholastic; it wasn’t daunting to read; it was even comprehensible; in fact—gasp—do I dare say it, I found parts of it a little too simplistic. I thought it could have gone deeper. I had questions and saw at least one important aspect overlooked by the eminent MDs! I was shocked by the idea that maybe I do or will have something to contribute!

The master’s portion of my program will consist of a lot of reading, analyzing and writing of journal articles and research studies. It will consist of learning how to apply these studies to practice. I’m excited for all of that. It’s the RN year of the program that is provoking all my anxiety right now.

When I graduated college and got my first job, one of the first things I did was buy myself a new book from a chain bookstore. Not a used one or a borrowed one, but a new one that was just released, that I wanted to read that very moment, that was my very own. The next thing I did was buy a full-price skirt from Meghan Kinney. A new one from that season, not one on sale. With these two purchases, I felt like I made it, like I had taken my first step toward being a self-sufficient, self-actualized working adult.

In a few months time, I gravitated back to used books. I missed the musty smell of the secondhand stores, the digging around for titles I forgot I wanted to read. I gravitated back to clothing on sale and secondhand skirts that smelled like the secondhand books.

Today, I’m back at the public library, to the anticipation of seeing whether a book will be on the shelf, to waiting patiently in the queue for a book to be returned, to the frustration of trying to finish a book within the one-week deadline, and often accruing late fees. I write off these late fees as my donation to a public library system that sustained me throughout my childhood.

Not much surprise here: with my free time ticking away, with competitive, grueling days and sleepless nights imminent, my drive to write has picked up. The desire and dreams of writing full time have come alive, taunting me, guilt-tripping me, demanding of me why I’m about to sign away the next few years of my life to something other than writing.

My writing muse is passive aggressive. When I had all the time in the world for it, it did nothing, it asked nothing of me, and it gave me nothing. So, I detached from it and listened to what else my soul needed. My soul told me I also needed human contact; I needed to be out of the office, on my feet, helping people, and talking to people; I needed to keep learning and keep being challenged. But now…oh now that I’ve committed to myself to humanitarian work, this muse that is like a passive-aggressive-fickle-co-dependent-lover keeps calling me, trying to entice me back with confidence/ego boosters and whispers of story lines and must-write characters.

My writing and humanitarian selves have been going at it these past few days. They keep me up at night or wake me in the middle of the night. But the writing muse is the worst. It has me second-guessing myself and fantasizing of a drastic change in course. Like that old co-dependent lover who shows up out of the blue, it teases and I’m tempted.

But TODAY I realized I’m older and wiser now. I’ve been around the block, so to speak, and I know myself better. I can see there’s a very good chance that if I (again) give myself all the time in the world to write, I just won’t do it. That’s the sad truth of it. For me, for now, it’s the angst of not having time to write that drives me. What a messed up psychology! I know that is certainly not a recipe for success.

But I can’t keep going back to the writing muse when it shouts for attention. When I decided to try nursing, there were many good reasons for it and many hours of agonizing decision-making that led me to that choice. I’m not going to throw that all away now, not before I give it a real try.

The idea of ‘being a writer’ may be more appealing to me than actually doing the hard work to get there. I think I’ve already given myself ample opportunity to take it seriously, and I didn’t capitalize on it. I can’t blame it on systems of inequality, parental pressure , ignorance or lack of resources anymore. Most of those barriers were probably real in college, but not now. I’ve had years to try it and I didn’t. Why? I don’t know. Could be sheer laziness, could be fear of success, or just plain fear. But I don’t deserve any more excuses. I am committed to a new path now and I’m going to see it through. If my writing muse is my true love, it will stick by me and be there for me during and after school.

Talked to one of my best friends. For the first time, I expressed my confused feelings and rambling thoughts about embarking on the new journey. I admitted for the first time that a part of me hoped I wouldn’t get accepted to UCSF so that I could take a more laidback track at Samuel Merritt. A part of me also feels a bit guilty for taking the place of someone who might have wanted to get into MEPN more than I did.

“Are you trying to self-sabotage?” my friend asked.

I don’t think so. But I realized that if I keep focusing on feeling anxious and scared about the work ahead, I will only feel defeated before I’ve even tried. I must stop this.

I also realized that my apprehension is not about the work per se, but about the realization that much will have to be sacrificed this year. I won’t have time for any of the fun activities that I’ve been dabbling in these past few years. No more writing, reading, sewing, iMovie.

But while talking to my friend, I realized that I need to stop complaining about and fearing what hasn’t happened. I need to EMBRACE the amazing opportunity I have to be in the MEPN program. I need to get excited. I need to give myself 150% to this opportunity, otherwise why do it at all? What a waste the last two years of preparation would have been, what a waste the next few years will be if I don’t approach this journey with all my passion.

During my volunteer work at the hospital, Roel, an older Filipino male nurse said to me: ‘You can do anything and everything is worth trying because YOU NEVER KNOW WHAT YOU WILL THINK OR HOW YOU WILL DO. Don’t listen to what others say; don’t let their anxiety or even pragmatism scare you.’

It’s sinking in a bit more. I just realized that I’ve been sleeping deeply the last two nights. When I woke up in the morning, I no longer woke up wondering about school. WHAT A RELIEF. It’s amazing. I realize now how disturbed I was all month. I was aware of it intellectually, but didn’t realize how great it’d feel to not have the mystery on my back.

I’m also thrilled to see how the week of deep cleansing prior to this day turned out to truly be the closing of one chapter in our lives and the opening of another.

I’m getting more excited. I can feel it in my bones. Especially when I think about my end goal, which is to work with low-wage workers. I couldn’t be more optimistic. Life is a trip.

As I opened my mailbox today, I marveled at how the body can act so independently of what my mind was trying to tell it. I told myself not to get anxious or excited, but it was useless. My heart was racing even though I believe my mind was fairly ambivalent. Knowing the sympathetic nervous system, my pupils were probably wide and my breathing quick and shallow. The envelope was slim, but it felt hefty with more than one piece of paper. I peered through the address window and saw something that looked like a form. A part of me knew then that this must be an acceptance, or a wait list, because why would a rejection ask for more info? I opened it and scanned for the “Congratulations!” that was in the letter that offered the interview, but didn’t see it. There was a split-second of disappointment, until I started reading from the beginning. There in no-frills yet kind of somber (I thought) language was my acceptance. I found the language a little strange and couldn’t quite put my finger on why. I didn’t shout and scream with ecstasy or break out into laughter. It was the way it was in my dream… a little ambivalent, a little anticlimactic. In retrospect, I think I was in mild shock. I hadn’t let myself believe I would get in b/c of fear of crushing disappointment. I think I also became instantly anxious – about whether I got in by the skin on my teeth, whether the professors would wonder if they made a mistake a year from now, whether I’d be able to handle the work….I think I became overwhelmed with both relief and nervousness.

I felt like the acceptance had happened to someone close to me but not to me exactly. Maybe that’s an apt feeling – half of me wants to identify with being a nurse; the other half with being a writer. I’m hoping my two selves will get along.

During the past week I’ve had an intense motivation to Organize and follow through with things in my life – and I’ve been doing it each day, several times a day. The organizing has been both big and small: from throwing away pens that have run out of ink and moving the shredder to the front door to buying a filing cabinet and changing office to bedroom and bedroom to office, I’ve been having a hard time thinking of much else. The organizing has become more than that. I think I may understand the meaning of ‘deep cleanse’ now. I feel like I’ve never done this before to this extent.

It all began last Wednesday when I began obsessing over boxes. Storage boxes for files. Files for writing ideas and magazine clippings that inspire writing ideas. I realized it was ridiculous that after all these years I can’t find any article or quote or poem that I remember reading and thinking, yes, I need to remember this for my stories.

I began to evaluate other areas of my life that are just full of paper, and I wonder, where are those things? How can I build knowledge, history, meaning and inspiration if I can’t refer to anything I’ve learned about or come across in the past? I used to think I could rely on my memory to build one piece of knowledge or experience on another. I’m finally realizing the mind doesn’t work like that. It retains only bits and pieces, and sometimes very cryptically and vaguely. I can’t rely on memory. I need tangible evidence before me.

Over the past week, I sold some books. I rearranged all my books by genre. I dedicated a definitive section to my science books and a section right next to it to my non-fiction and fiction. This was definitely a declaration that I am accepting nursing’s place in my life next to writing. The science books are important to me, especially as I study pathophysiology and need to continuously refer to books from previous classes. I realized I enjoy building this library.

I feel like I’ve crossed some threshold where I’m able to take a little more control of my life and start to unravel the jumble of conflicts and multitude of interests in my mind.More metaphors: I feel like I’m starting to break through a blockade in my mind that had been holding me back, making me procrastinate, perhaps freezing me in fear of something. Maybe this is the first step to unblocking the ‘writer’s block.’ Perhaps it’s not just writer’s block – it’s also life’s block. I feel like that big black spirit in Spirited Away who became unplugged and released mounds and mounds of junk and sewage from inside of it. Suddenly he became who he truly was and floated happily away.

I might be suddenly obsessed with organizing my life because I’m trying to distract myself from my growing anxiety about UCSF as the date draws near. But I also feel the motivation and the unplugging have felt so real and have been so joyful that there must be more to this than just my mind’s clever way of passing time. The notion that the universe may be helping me to prepare for a new phase in my life is apt whether I’m accepted to school or not. Either way, after this week, my life is entering a new phase. Big changes are on the way this year. I want to be present and mindful and appreciative of each and every one of those moments.