clinicals!

So the first two weeks of clinicals are over. I have been placed on a surgical unit that does a lot of GI, pulmonary, and trauma-related surgeries. It was very much a baptism by fire. Things on the unit rarely go as planned, and no amount of learning about something can take the place of actually doing it. This is outside of my comfort zone because I like to learn by thinking, rather than by doing. I could tell you all the physiological mechanisms underlying why a drug works, but the first time I went to insert that medication directly into my patient's veins, I found myself terrifed. I actually ended up breaking an IV pump because I put the drip chamber in wrong, and while I was tearing up, my instructor and my patient were laughing.

Throughout the course of the two weeks, I've learned a lot. Yes, about charting, about what nurses actually spend their time doing, about IV Protonix and Zofran, about how to use pneumatic compression boots and incentive spirometers, about how to empty drainage from a nasogastric tube or a JP drain. But I've also learned how to interact with patients, that the way you treat them as people is just as important as the way you treat them as a body full of organs. It takes a certain kind of confidence to believe that you are capable of healing people, and I've had to learn that confidence, first by being coached to smile at my patients more, and then by taking on challenges that I don't feel capable of mastering. Then I find that all in all, the procedures go well, the patients get healthy, they go home, feeling grateful for the help of the nursing students who cared for them.

So at the end of week 2, I'm feeling contemplative and of course, as scared as ever. I ask myself if I have what it takes to be a nurse, to make decisions that can change lives. But really, don't we all make decisions that change people's lives? Nurses and patients are a special class because it is a more knowledgeable group acting on a more vulnerable group, but all humanity is full of give-and-take relationships that shape what is real for us. Sit down to tell the story of the most life-altering day of your life, and I bet there's another person involved.

So really, we are witnesses to patients' suffering and advocates for them. We can validate what it must be like to be in such pain and then advocate for their receiving pain medication to treat it. We can do a million technical things and those I am still learning and they are constantly overwhelming me. But what it comes down to is how well we care for our patients, and that cannot be taught. Once you recognize that every human being has dignity, no matter how sick or unpleasant or scared, it becomes our duty to care for these patients the way we would care for any other dignified being, our own sister, for example.

well, i don't know about taylor swift, but i'm feeling 23

I feel like every time I update this blog, it's the middle of the night. I never seem to get around to it in the middle of the day, but when I can't sleep and dreadfully wish for something to do other than studying or staring at the shapes my furniture makes in the dark, I stumble upon these words.

There is something both exciting and trapping about birthdays. On the one hand, I have grown strangely comfortable with being 22, finally feeling like I can manage its demands, and then it ejects me out "there" into being 23, and I feel wholly ill-equipped to handle it. 23 sounds "adult" and "responsible" and like I should just KNOW the answer to any sort of question in the same way I thought I'd KNOW when I graduated college or when I got to college or when I became a teenager. I then realize, of course, that whatever this grand THING I am supposed to know is, I simply don't know it, which is cause for panic. I talk a good game, but I don't really feel like I've "made it" into the world of adults who just know things, like where they keep their income tax forms and whether it's going to rain tomorrow.

And there's the dingy side of birthdays, too, which is the opportunity for self-reflection, the "oh, but I never thought I would still be in this place by NOW" and "I should have ... and then by now I would have been..." This wishy-washy longing to be somewhere other than where I am now gets louder on "event" days like birthdays and holidays simply because I remember where I was 1, 2, 10 years ago at this time, which makes for an easy comparison. But the danger lies in being too close-minded when doing the comparison and forgetting that while I may not have made it to the moon yet, some damn good work has been done in the past few years. Where getting through the day was once a terrible struggle, I now find quite frequently that I enjoy myself. And in life, a little bit of joy goes a long way towards making life meaningful and pleasant and manageable. So let's not forget the growth in all the staring back at old camera reels.

So subtle sometimes, it comes, and yet so dramatic at other times. I've had to draw back from intense self-awareness because I used to over-analyze everything to the point of not understanding. As a child, I greatly feared skipping a single word or mark of punctuation when I read, so I would read and underline the same lines so many times that I tore holes in the pages. Focused, I was... but I could not have told you what on earth the "point" of the matter was. I had read every word five times, but I could not have expressed what the sentence was saying because I was too busy reading the commas. I do the same thing inside my head where I hyper-focus on something to the exclusion of being able to put it in perspective and see it. Taking something apart to understand it only works if you're able to put it back together when you're through. If you spend so long looking at the broken pieces and being fascinated by what each one does that you no longer remember where they fit in the puzzle, then you're left with a pile of scrap metal and no way to drive to work.

So I am trying to dis-engage from my head a little bit and check into my body, my life, my spirit, these non-intellectual pursuits that I get around to when I'm trying to avoid studying.

on walking

"What saves a man is to take a step. Then another step." -- CS Lewis

"We all want progress, but if you're on the wrong road, progress means doing an about-turn and walking back to the right road; in that case, the man who turns back soonest is the most progressive."-- C. S. Lewis

"Begin at the beginning and go on till you come to the end; then stop." -- Lewis Carroll

I am a collector of quotes. I love to find a quote that expresses what I can say more eloquently than I can say it. These three, to me, sum up what I need to know about my journey. First, that I must be moving, second that I must be moving in the right direction, and third that I must keep moving until I reach my destination.

There have been times in my life when each of these components has been the most difficult. During the depth of my depression, movement itself seemed impossible. Dragging my body out of bed required effort that I just couldn't muster, and so it seemed much easier to pull the covers over my head for another hour, to shut myself in my room for another day, and to stall any progress I'd been making in my life. Interspersed with these periods of depression were periods of frenetic movement. This was a time of great activity, but it wasn't action. I could barely sit still, and yet I got very little done. Or I'd be productive with school but all the rest of the tasks I filled up my day with were just spiralling me deeper into the wrong direction. I was taking many steps, but I wasn't making any progress. Most of my energy was spent self-soothing or self-destructing. I leapt from crisis to crisis without any real growth in between, and my life revolved around staying just well enough to avoid a catastrophe but not well enough to challenge the way I'd been living my life.

Now, I keep myself busy. I definitely have the step-taking part of the equation mastered. I'll allow myself a few minutes to rest here and there, but I know that ruminating isn't good for me, that isolating only makes the devil on my shoulder start to sound logical. And most days, I am at least aware of which direction I'm walking on my journey. I literally have moments where I am so conflicted about what path to take that I will walk a hundred feet down the street, abruptly turn around, walk back two hundred feet in the opposite direction, turn around, and then continue down my original path. The constant conflict in my head-- do I let go of old ways even though it's scary or do I retreat to them when I feel threatened?-- plays itself out as I bounce down the street like a ping pong ball. But some days, I am able to choose the right path and walk down it with conviction or at least catch myself when I'm walking down the wrong path and try to find one that's more progressive.

So now, once I've managed to walk and walk with the proper direction, I must prod myself to keep walking until I reach my destination. This is difficult, too. Sometimes, I get tired of walking. I wish I could just fly to wherever this final destination is. So I stop walking and get lost in a reverie, flapping my wings like an idiot on the side of the street thinking that if I wish for it hard enough, then it will work. Or I sit down on a stone to catch my breath and find myself rolling down the hill in the wrong direction. Or I simply play the childhood game of "Are we there yet?" I ask how long it's been, how far it's been, how many minutes are left so often that there are only tiny fragments of life lived in between the constant tabulating. When I used to be injured and stuck on the elliptical, I would calculate every minute what fraction of the way done I was, cheering myself on with "you are 7/16 of the way there!" Since I've started running marathons and realized the depressing sound of "you are 1/4 of the way there" when I've already been running for an hour, I've seen the beauty of the mile mark. Don't look at the race as a whole because it's just too intimidating. Your job is to make it alive to the next mile mark, approximating goal pace. If you accomplish your job this time and then focus on your new job, the next mile mark, the next goal pace, you will get to the finish without ever having to face the overwhelming distance before you. In your head, you get lost-- you think you cannot do it. But if you can simply shut your brain off, your body knows what it's doing. The body has the skill of proprioception, of knowing where it is in space, even with your eyes closed. 

So here comes the final quote, a favorite of mine:

"Try again. Fail again. Fail better." -- Samuel Beckett

I think I want to work with patients with diabetes. My undergraduate background includes a lot of sociology and public health, and so I'm really interested in why people act as they do and make the decisions they do. We tend to think that education is always the answer. If a patient has high blood pressure or high blood sugar, send them home with a pamphlet; surely that will help. It must be a knowledge deficit problem, we tell ourselves. We cannot figure out why anyone who had the proper information would not act accordingly. And so we pour ourselves into research, seeking ever more knowledge, grinding our cognitive wheels searching for The Answer and believing it is up there in our heads somewhere.

I have come to believe that the answer lies first in translational research rather than further knowledge acquisition and second in acknowledging that a patient is a person first. As such, he or she is not just a brain when he or she makes decisions but a body, a spirit, a brain, all together, acting according to sentiment, emotion, behavior, whim, constrained by time and money and knowledge and social support and place.

It is not that the doctors and nurses have any lack of knowledge of why someone would have high blood sugar or what that person could do to bring their numbers down. Somehow, though, we are not doing a good job of communicating that to our patients. We approach them from a preaching sentiment rather than from a teaching and partner role, and they tune us out.

"Yes," they say, "I know I should eat fruits and vegetables, but..." and here is where we need to listen for their barriers to change: their neighborhood has three McDonald's and no grocery store and they don't have a car. Or their children won't eat fresh foods and they don't want to cook three separate meals. Or they can't afford to buy salad and fruit and fresh meat. Or they don't know how to cook or are intimidated by it. Or they're working three jobs. Or they're stressed out and use food to self-soothe. We can only learn these barriers if we're willing to listen.

I want to be that patient advocate that takes the time to understand where my patient is coming from rather than throwing out generic solutions, to acknowledge that a person is a product of the social systems from whence they came BUT that he or she is also a dynamic agent with the capacity to make tremendous changes in his or her life. In my own life, I have felt alternately empowered by those who have made me feel like I could change my circumstances and disempowered by those who made me feel like I was too weak, too sick, too stuck to ever make much of myself. The difference between these individuals was largely their capacity to listen to what I was saying and to validate it and take it seriously.

With all the research that is out there, there is no reason that people should be losing limbs and lives to illnesses like heart disease and diabetes. They are preventable in many cases with good nutrition and exercise. But lifestyle habits are firmly entrenched. And so the costs of these diseases are so high, so burdensome on the sufferers and their loved ones. It is troubling to think about all those who needlessly suffer diseases that we know how to prevent, even if the pill is tough to swallow. It will take health care professionals who engage patients in trusting, long-lasting working relationships. Just like you can't uproot an oak tree with your hands the way you would a dandelion, you cannot un-learn lifelong patterns of diet and exercise the way you can un-learn a more innocuous habit like gum-chewing. It takes dedication, knowledge, strong social support, supportive infrastructure and public health systems, engaging follow-up care, and the will to overcome the occasional failure.

contrariwise

"Contrariwise, if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic."-- Lewis Carroll

I find that I spend a lot of time thinking about The Way Things Should Be. Or better yet, The Way Things Could Have Been. This leads to avoidance, regret, rumination, all manner of mental acrobatics. And I am left holding the reality that, like it or not, I have this truth that I must live with, and that is that life is sometimes hard and always imperfect and yet, we have the right and the obligation to make it worthwhile. In the middle of a game of 52-card pickup (which has no right to be called a game, as it's merely a way that the obnoxious kid at school taunts the compulsive kid with a knack for cleaning up), you can stare ponderously at the upset pile of cards spread out on the floor, feeling sorry for yourself because, after all, it's unfair that you should have to pick up a deck of cards that someone tossed in the air for fun. Or, you can be a pragmatist and get to the task of picking up the cards. 

We humans tend to congregate around the water cooler and complain. We call it "venting" and pretend it's good for us, but what starts as a healthy airing of emotions soon turns into dwelling on the negative and getting stuck in it. I have been caught in that trap before, that murky quicksand of "why me." People wonder about those who are too optimistic, and we often bond by complaining, whether it's about tests or work or feeling tired. On a similar note, I sometimes find myself with so much school work to do before I leave to babysit that I am too overwhelmed to do anything but take a nap to avoid it all. And how does this help me? I later realize, when I wake up groggy and still not having accomplished anything, that I'm further behind than before.

So where do I go from here? Start from the beginning. And keep walking.

“The White Rabbit put on his spectacles. 'Where shall I begin, please your Majesty?' he asked. 'Begin at the beginning,' the King said gravely, 'and go on till you come to the end: then stop.'”-- Lewis Carroll