Saturday, May 17, 2014

Balance and Options

I’ve been a terrible blogger in these last few years, and my ability to write has you’re going to have to bear with me here.  I will wax a little abstract and reflective here, as I try to find my voice again.  It won’t be the same voice, because as a nurse and a human being, I’ve had to change and evolve—some things are better, and some are a little worse (rusty, shall we say?).  Initially, when I first became a nurse, I wrote because the sheer amount of information coming at me was overwhelming.  In a matter of just two years, I had changed my career completely, and it was absolutely the right decision, but the gravity of each moment on the floor weighed on me.  To know something abstractly, at the academic level, is one thing, but to synthesize that knowledge and apply it to a dynamic situation, is quite another.  And so, I let my neurotic self run rampant, researching every fact and detail, arriving at work an hour early in order to learn about the potential challenges of that day.  You see, each decision, because of my lack of experience back then, felt like I was about to either kill someone or save someone—and to a large extent, I was right about that.  For example, even the simple act of giving lasix was a struggle.  If I gave it too fast, I was sure that I would cause ototoxicity (which I just learned, while confirming how to spell ototoxicity, can be potentiated by Aminoglycoside—still learning).  So that one supposedly simple task, along with the millions of other things that I had to do, felt like an eternity if I was to do them with any integrity at all.  12 hour shifts felt like 48 hour days on another planet with a much slower rotation.  The long days on that planet, however, didn’t mean a slowing down on the planet's surface...far from it.

Part of me misses those days because of how profoundly focused and curious I was.  I genuinely loved the job (still do), but the lions share of my dogged mental effort was born mainly out of not wanting to cause harm.  Not killing anyone is pretty much an absolute necessity in this line of work, and a profound motivator.  To compound matters, anyone who knows me just a little bit, knows that I am a little ADD.  When in a room, I’m pretty much absorbing everything that’s being said, the overall temperature of the room, as well as psychological and physical assessments of patients, nurses, doctors, nursing assistants, and even the janitor.  Taking in that much information, simultaneously, is exhausting.  So the 48 hour days felt like 96 hour days, because I was always “on”.

Fast forward 6 years, and here I am.  A somewhat “seasoned” nurse.  So, out of necessity for not wanting to kill myself, I had to adapt.  I couldn’t take all of those 96 hour feeling days.  I was more than a little obsessed.  Didn’t take breaks.  Didn’t take care of myself.  I essentially did all of the things that everyone tells you not to do.  All nurses, in their way, will put others in front of their own needs.  It’s a part of our strength, and a large part of our weakness.  It’s our “disease to please” as one RN put it.  I kind of love and hate that phrase.  It sits heavy in my mouth, like a bad word.  But like all bad words, it has its purpose, and are often more effective at expressing things than long-winded prose.  But I digress.

So where is my nursing now?  Mostly better, and a little worse.  I can’t quote you the exact pharmacological mechanism of every med in encyclopedic fashion like I once did…but I know what’s normal and can sniff out a spiraling patient versus a minor set back with the best of them.  I am comfortable with my patients, whereas before, I was running around so incredibly frantically that I didn't know how to actually sit down and listen.  At the beginning, I didn’t know how to recognize the subtleties of a patient’s presentation.  A mildly elevated temperature might go relatively unnoticed, whereas now, because I can synthesize that temperature with coldish extremities, mild leukocytosis, a normal blood pressure (but abnormally low for that particular patient) and know that they are in the initial stages of going septic. 

I hate to say it, but a lot of is instinct now.  I can sniff out the problem.  Whether it be the new resident that is more interested in appearing to care for his patients versus actually caring for them (because they’re new inexperienced and scared shitless—as they should be) or knowing that their is a problem with the overall skill set for a particular assignment.  I know I need to get more specific with these examples, and I will.  I just wanted to get to a jump off point.  A place where I’m a little more analytical and less instinctual.  Writing has always inspired that process in me:  the ability to listen to my own thoughts that are swirling by so fast that I often can't pay attention to any of them.  

So, I’ve pretty much swung from one side of the pendulum to the other.  Whereas before I had a lot of information and no experience, it almost feels like I’ve forgotten much of the book knowledge and gotten a little too comfortable in my ability to gauge a patient’s situation based on instinct.  Maybe this is the time where I find balance in my life—both personally and at work.  Wouldn’t that be nice?

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