Tuesday, July 17, 2007

"CLASS" test

REFLECTING ON: Being obsessed with grades...writing to teacher that has urged us to stop nit-picking tests and start thinking about matters of substance.

"Dear P--,

I told myself that I wouldn’t buy into the grades and the nonsense and the madness….but I did. Damn it. I’m all in and all about learning what I need to know in order to do this job. If I do this, I will learn what is important, which may or may not be included on the class test. But, if I am to pass the CLASS test, the real definition of class, I will realize that my sincere effort and desire to be competent can’t be graded so the grades shouldn't matter as much.

I'm trying to get this new learning curve-ball that's being thrown at me. Let me explain.

I'm trying to get the actual lesson here. I've had a fair number of "teachers" in my life, at least in name, but very few mentors. I think that's what you are trying to say here: chill out and get the real knowledge of what it means to be a good nurse. Not a wanna-be doctor, not a heal thyself case, and not an academic: a nurse. Working on it.

I gotta realize that this process is a harsh reprogramming of my mind. Having forced myself to stay academically competitive all my life (I mean, I got in to UCSF, right?) has put me at a mental disadvantage sometimes when looking for the "real" lesson. Clearly, many of us, especially me, need to be challenged to get past the nit-picky details of what we have memorized to get 4.0s, 90%ile GREs and find true, substantive, practical knowledge (wisdom?).

We'll get it--just in different ways.

I personally need to have some yell, "Hey buddy, what are you doing?" every once in a while to be reminded of what I'm actually trying to do here (something I'm still not sure I even know). Keep in my ear and maybe I'll just get it. I personally look forward to you yelling "Let's get it started" every morning.

Take care,


Saturday, July 7, 2007

Patients as Heroes

REFLECTING ON: Interacting with patients on the Oncology Unit at the Hospital where I have been assigned clinical rotations...

There was a distinct feeling that I got Thursday and again yesterday at the end of clinicals: this is doable. Not only that, I got the distinct feeling that I was meant to do this. I am built to be a nurse.

One of the issues that I continually confront with a “do-gooder” personality is offering help in situations where perhaps it isn’t always requested, needed or appreciated. Though there are certainly subtleties and nuances in providing care to patients, generally speaking, I am there to help and it is most certainly needed. It feels good to be needed and appreciated. Such a contrast from my last job where I continually had to grow thick skin, suck it up, and deal with all sorts of abusive language/behaviors without much of a grain of appreciation. I don’t know how I did it for as long as I did.

I am working on the oncology unit for my first clinical rotation. Everybody there is dealing with the big “C”. Generally speaking, it is my impression that in American society, cancer is synonymous with death. Sure there are treatable types, but the word “cancer” seldom describes good news unless you are defeating the disease.

These patients my heroes. They are humble, possibly because they have no choice, but nearly all of them are kind—and attitude is something that they do have a choice in. I don’t want to romanticize their situation that is so far from glorious, but then again, perhaps we need a new definition of glory.

I met this man, Alfonze, a 29-year-old father of two, who is fighting Acute Lymphoblastic Leukemia for the second time. His prognosis is not good: his cancer has metastasized. To compound matters, his youngest son is also fighting cancer at another hospital.

Bright-eyed and bushy tailed, I walked into Alfonze's room yesterday to practice taking vitals just as he had received the news that a second tumor was found in his son. The expression on Alfonze's face was clear: he already knew the second tumor was a death sentence.

Writing “Death sentence” sounds harsh to me right now, but I am not going to mince words here. I am not going rehash some tired words that “everything is going to be okay”. What a line. Try as we might, we cannot control everything—we are not gods. Not me and not the physicians who write the treatment orders. Everything is far from okay. A father and son that I know have a greater probability of dying this year than they do living and that is so far from okay.

And yet, here is Alfonze, being so kind to me as I fumble with the blood pressure cuff. That is glory: bravery manifested as kindness while facing almost insurmountable challenges. Alfonze is glorious. My definition of glory includes people that fight with dignity and character.

Friday, July 6, 2007

Nurses eat their young

REFLECTING ON: Nurse burnout and the old school...

The last thing I wanted to do was make waves on my first week of clinicals. Oh well. But I swear this really had nothing to do with me…this time anyway.

So there I am, in the oncology unit’s nurse’s lounge, sitting down and trying to “play nurse” with my preceptor, Lee. I’m looking at the patient file and literally trying to figure out what “MAR” means (let alone its contents) when this mean looking nurse comes in and scolds me, or more appropriately put, tears me a new one. “You’re not supposed to be in here doing work—this area is for relaxing only.” Please meet Mildred, and for all terms and purposes, this is a fitting way to meet her.

Confused, I look to my preceptor who is now making a thorough examination of the ceiling. Mildred continues, “Not only that, the student nurse shouldn’t be taking seats from an actual nurses doing actual work.” Sweet. I just stepped on toes, got thoroughly trounced, and I don’t even know what MAR means. Since Mildred is belittling me and addressing me in the third person, I think it’s safe to say that I shouldn’t ask her.

So, wow. Okay. Let’s not lose our cool. Clearly there has been a misunderstanding. Let’s approach this logically and diplomatically. After all, we’re all professionals here. “I didn’t know”, I say, “my apologies…I’ll move my work somewhere else.” I’m a bit miffed that my preceptor hasn’t said anything to Mildred since she was the one that told me to sit in here, but I let it go. Completely resolved to avoid further confrontation, I begin gathering my effects.

“And maybe the student could clean up while he’s at it.”

No way. This is a power play and I am having none of it. I don’t care if I get moved to another floor or even if this is how students are normally treated. This woman has no manners. And if this is how nursing students are treated, I don’t want any part of it. Having worked with emotionally disturbed boys for nearly a decade, I’ve developed thick skin to insults that range from my manhood to my mother…but this third-person nonsense has got to stop. God I hate bullies.

Standing up, I look at Mildred, “Okay. I get it. I’m the new guy—and a student to boot. But the student’s name? His name is Nat.” Extending my hand in a manner of greeting I am more accustomed to, I stare at Mildred straight in the eye. “Nice to meet you.”

For all her bluster and braggadocio, Mildred crumpled like a house made of cards. Extending a limp wrist handshake, she mumbled, “Well you’re still a student to me,” and walked out of the room.

Feeling vindicated, I turned to Lee who sat there stunned. “Wow, way to stand up to Millie there. She does that to everyone. She’s of that old-school style of nurse. You ever hear the saying, ‘Nurses eat their young’, well that’s Millie.”

I hadn’t heard the saying and my first reaction was that it was just horrible. Nurses eat their young? Yuck. Just disgusting. I mean, I get it, some folks need to toughen up sometimes, but I’d rather not feel that I’m going to be consumed like the runt of the litter in some unspoken, pseudo-Darwinesque training program while learning a profession that presumably embraces compassion. I mean, there’s got to be middle way. Right?

The following week, I, yet again, inadvertently crossed Millie, but this time she avoided me altogether. You see, someone had “unknowingly” assigned me to her patient caseload because I had unwittingly done pre-lab on one of her patients. Instead of shifting me off that set of patients, they shifted Millie. When I realized what had happened, a very flushed and very angry Millie stormed passed me shouting, “Twenty-five years here and they treat the students better than me!”

Later I learned that Millie had thrown a magazine and then broken down into tears in the nurse manager’s office. Clearly, this had nothing to do with me. Another veteran nurse confided in me that Millie had been the “elephant in the room” for a while now. I just happened to be the last straw that blew in and broke her back.

Millie was clearly experiencing burnout, and was given some mandatory vacation. I never saw her again that quarter, but I certainly am reminded of her on a daily basis. Burnout is a common affliction in the nursing profession. There are tireless nurses and there are tiring nurses that are under the delusion that they are the former. Having seen first-hand the exhausting and emotionally jarring work that nurses do, it surprises me that there are not more Millies in the world. I feel simultaneously sorry for and leery of Millie. Sorry, because I later heard that Millie, in fact, was an excellent nurse. And leery because I am scared that I, too, have the potential to act like her and not know it.

If I ever act like Millie, you have full permission to put me in check. I’ll thank you for it later.

Monday, July 2, 2007

Gungo Ho Balance

REFLECTING ON: General thoughts on the first week...

I’ve been up since 5:00am. I figure 6 hours of sleep is how I will roll during the week and then I will catch up a bit on the weekend. I feel so out of sorts and overwhelmed with all of this right now. We’ve been assigned like 1 billion pages of reading, and none of it is all that mellow. I mean, it all has to do with saving lives, right, so how could any of it be mellow?

As I read the pages over and over, I am inundated with the same thought: can I really do this? I answer, “Of course I can. Others have done it before me and so can I.” But I’ve never done this. I’ve never been through this. It is SOO overwhelming I can’t even describe it in words.

Then, the logical part of my brain kicks in: Okay, so if you can’t do all of the reading, then probably most other people can’t as well. Just keep working and do the best you can, Nat.

I really hope that working hard and plugging away is enough.

I’m going to school with some pretty cool and interesting people. Several of them even seem balanced so I’m going to try to take some hints from them.

Today, Sonia said that we were really lucky. We get to learn what we really want at an outstanding institution and that’s all that we have to do. We get to do this. It’s a privilege. It’s true. Not an obstacle—a great opportunity.

I get to work really hard and become competent at helping people. I get to be dedicated and focused and supported. I am lucky.