Trauma and Tramps in Nursing Education

She wouldn’t leave the hotel room without her stone. The lucky one that her best friend found in New Zealand, a small piece of the other side of the earth. There were ten legs standing in the doorway, two walkie-talkies, one stretcher, one AED, five watches ticking, two security guards waiting to disable the keycard to the room, three EMTs ready to make a phone call. There was one story on repeat told to each person who entered, and whispers as I left to look on the mahogany desk under a pile of drink glasses, reading glasses, faded jeans, and concert programs. I handed her the stone. She got on the stretcher.

She won’t remember.

hand over mouth

There were two nurses and one aide, a gaggle of doctors and screaming from the other side of the ER. Pupils dilated, round, equal, and reactive to light, eyes puffy, skin clammy and cold and red around the eyes, pulse tachy at 110, respirations brady at 9, blood pressure 110/89.

Patient’s friend reports she vomited three times but patient cannot remember.

Patient’s friend reports patient got lost halfway through the show, but patient cannot remember.

Nurse asks about the bruises on patient’s arms, but patient cannot remember. Patient’s friend wasn’t there.

Patient looks like she has been crying, wears a hospital gown over jeans and her sweatshirt pulled on only over her arms. Patient does not remove shoes.

old school nurse“Don’t look like a tramp,” said our nursing professor last week. That was the conclusion of the 20-minute lecture on how to dress professionally as a home-health nurse. Which came after the explicit instructions to not wear mini skirts and let your “nasty bits” show, nor to wear high heels in case you had to run. It was confusing, as no one tells women not to wear high heels, but they expect you to learn how to run in them.

Nursing faculty believe in words like “professional.” They use them loosely.

They talk about how to maintain a sterile field and appropriate use of silence and how to talk to people who don’t speak your language. They tell you that babies cannot vocalize, but we still know to hold them and feed them and speak in a soothing voice. They say to apply the same logic to all patients.

They teach you about critical thinking and therapeutic communication and how to educate a patient with asthma about smoking cessation without sounding judgmental.

They do not talk much about trauma.

charcoal-pillsThey do not teach you how to use nonjudgmental language when asking how many drinks she has had. In a field dominated by women, they do not emphasize how one in every six American women will be the victim of attempted or completed rape in her lifetime. That if we count our female friends on all our fingers and toes, count our female patients on all our fingers and toes, three are survivors of sexual violence.

They do not teach you how to avoid trigger words or how to speak with a victim. How to avoid telling her that you don’t believe her, that she is just drunk or crazy or irresponsible. That she dresses like a tramp.

They do not teach you how to tell someone that there is no commercial test to detect GHB or how language can be incriminating.

They teach you about disease processes, about non-pharmacological interventions for pain, about screening and prevention, and eating right. They teach you how to care for the whole person, how to advocate, how to make decisions to the best of your ability, at the bedside, in the home, on the street. How to assess.

How to recognize in that instant, amidst five Adam’s apples and two batons, two notepads, and ten utility boots, that finding one stone may be the most powerful care you can provide.

My Country Tis of Cheese

Of all the domestic issues the presidential candidates debated last night, the one that evokes the most passion within me continues to be avoided: If we want to achieve success as a nation, we need to work on our branding. Starting with cheese.

America, you are better than American cheese. In fact, I hate your cheese. It’s not actually cheese at all.

A look at all the processed cheese that is killing you.

This cheese is killing me.

While my distaste for the plastic-wrapped “single” cheese product dates back to my discovery of actual cheese, my recent fury is inspired by a string of breakfast-sandwich mishappenings.

New York City is the mecca of sandwich. Our delis promise succulent possibilities between two slices of bread or halves of the bagel. In all their griddle glory, breakfast sandwiches are an NYC morning comfort food. Even Our Lady of Domesticity Martha Stewart shares a recipe on her website for a “New York Deli-Style” sandwich.

The infamous “egg and cheese” – or “bacon, egg, and cheese” if you swing that way – is a simple art consisting of two components: 1) the namesake or soul of the sandwich, egg and cheese 2) a main carbohydrate group in which to envelope said inners – bread, roll, or bagel. On special occasions, there are enough free seconds in the morning commute to request the addition of a plant-derived element, like tomato, onion, or avocado (the latter being saved for fancy days).

organic cheese product package

Look closer: “Organic American Singles” or “Pasteurized Cheese Product”

While I’d estimate myself to be a bi-monthly breakfast sandwichier (pronounced “sand-wi-shay”), I have learned that local sandwich artists consider egg and cheese to contain American not-cheese by default.

“I am programmed to specify my cheese to avoid such an incident,” says fellow New Yorker Emily, who rates her sandwich knowledge in the top 1 percent.

Since Kraft Singles and the like are not legally allowed to be called “cheese,” I question how establishments get away with serving them on a product called “egg and cheese.” Just look at the packaging – nowhere does it say “cheese.” It has to be sold as “cheese product,” even if it’s claiming to be organic.

After two sandwiches at two separate locations were served to me with American cheese, despite my overemphasis on the word “cheddar,” I put on my thinking cap. Maybe if I asked for a differently colored cheese, they wouldn’t make the same mistake. That theory proved wrong when provolone turned up as a greasy, melty blob atop my egg that New Yorker Jessica calls “a disturbing shade somewhere between orange and salmon-colored.”

If I get a sandwich with American cheese, I won’t eat it. This is where I draw the line. How can I eat something that’s distinguishable from its packaging only by color?

I’m not alone in my thinking, as a school in Tucson caught onto this sentiment in 2010 upon banning American cheese.

To prove that American cheese is a devilish substance that is slowly killing us all (and to validate my feelings), I conducted a focus group, interviewing a select group of omnivorous friends. Members of this group hailed from such varying locales as: Jackson, Tennessee; Columbia, Maryland; St. Ignace, Michigan; and Cherry Hill, New Jersey. All now live in major cities.

I went into this exercise expecting feedback like “it reminds me of my childhood.” After all, it wasn’t uncommon to open a fridge in my grade-school days and see that shiny red, white and blue logo adorning the bottom shelf. Everyone I knew ate low-fat Kraft Singles as children. And margarine. Before we realized that food-like substances and hydrogenation were the enemy, we steered clear of saturated fat.

I’m proud to say that my friends have embraced whole foods. Interviewee Mitch replied to my inquiry: “This might be the greatest email anyone has ever sent me. My bathroom book is the Cheese Lover’s Companion.”

Mitch noted: “I hate Kraft Singles.” When asked to describe the cheese, he claimed, “American cheese is made of the convoluted beliefs of the Midwest.”

But even Midwestern-raised Emily concurred that American cheese is “not real food.”

Bay-Area resident Shannon is a native of Tennessee, where Velveeta flows like water – but she turns her nose up at calling it “cheese.” “It is the equivalent of calling Cool Whip the same thing as whipped cream, which could not be further from the truth.”

The truth is that consumers continue to buy legally regulated not-cheese, often because it’s what the government provides. Perhaps therein lies the real problem, which is a whooooole other story. I urge us all to band together as a country and just say “no” to American cheese.

Adult Learning is Phun

I like the morning as a concept. How lovely it is to wake up at the crack of dawn, listen to the urban rooster-cry of the garbage truck, and feel superior for seeing the sun rise. That is in no way my morning scenario, but it sounds lovely.

Lab Safety

You make-a my dreams come true.

Thus, 9 a.m. Saturday class is not a thing that I do–the rare exception being my first class in MFA school, which consisted of writing about how rocks “spoke” to me and how this made me feel. But sometimes we must make sacrifices to ensure that our future lower back pain is the result of the normal aging process, not from being chained to a desk in Corporate America.

Fast forward many moons and I’m shocked at how fun it is to learn about normal flora and pathogens. There is shit crawling all over us, all the time! So much so that we have to wear latex gloves to stain E. coli. Gloves! Microbiology is academic crack for hypochondriacs (me!), germophobes (not me-I cut the mold off fruit and eat it), and chronic hand-washers (sometimes me). DNA is pretty rad, too. The icing on the gram (positive) cake – it’s not chemistry.

Having taken three whole science classes before, I know that initial lab classes entail a safety video that stars who I imagine to be the 10 foster children of Hall and Oates (hence, the “video” and not “DVD”). They get themselves into all sorts of shenanigans by adding water to acid (you have to add acid to water, which we can remember by the abbreviation “AA”), teasing their bangs, and donning flammable poly-blend stonewashed denim.

I remembered the second science lab consisting of a lesson on significant figures and measurements, which was about as basic as the first lab. Except for that discriminatory assignment of having to measure our feet. Donning a ladies size 12, my 19-year old classmates were in shock and awe over how I could achieve such feats (no pun intended) as registering for a community college class, having been sprung from Transylvanian giants. (Technically, I wear an 11.5 narrow, to be specific, but I won’t even go there. Just know that my life is hard.)

Unlike chemistry, microbiology entails no self-measurement. And unlike weekday classes, Saturday classes are comprised of fewer 19-year olds who say things like, “you look like a photographer.” I’m assuming this is the same as “you look like a vegetarian,” which I only get when I’m wearing glasses or pretending I have no idea there is chicken broth in matzoh ball soup.

Sometimes it’s fun to be the grown up, like when I explained to my lab group why they were not allowed to do heavy drugs without health insurance. Perhaps that’s an embellishment – but I did explain that if they didn’t study hard, they would end up on a lot of conference calls.

Homage.

I never write anymore. I feel like the fun got sucked out of writing around 2008. It was the place I went to escape my head, to let the thoughts pour out of me, like the result of taking a wrench to a fire hydrant in the city heat. The mad rush of jumbled words begging to be released. One day it stopped being fun. I sat down, grazed the keys and felt sadness echoing against my bones.

What would it be like if we all stopped doing things that weren’t fun? I imagine 20% of our lives is fun, if we are lucky.

I don’t know that writing was ever fun. It was more of a compulsion. It was the problem and the solution. I’d go into my own dark place and ache and drip words and sometimes hate what was on the page.

Then I tried to impose structure on myself – I was going to WRITE. I was going to write with PURPOSE and have things to say, neat little essays with clear sentiment, SMART and WITTY. I had so much anxiety over trying to BE all these things that I just stopped.

So here I am, thoughts in tow. The sadness still lingers, but it’s not just mine.  It’s my friends’ parents who keep dying, the juxtaposition of leaving a rehearsal dinner to drive someone I love upstate to identify her father’s body. Sometimes I don’t know how we beat on.

I take comfort in simplicity, in the make-believe, in the ever-evolving adaptations of this life.

My friend, who lives with my brother, said we should see the film adaptation of our favorite book. He bought me a copy for my birthday or my going away party in 2003 when I left for Australia. He inscribed it: “To Golfer, For hours of high schools sadness.”

If you don’t know what high school sadness is, then we probably aren’t friends. Except for my girlfriend, who was popular, who was crowned homecoming queen – excuse me – court warming queen, which I’m told is different. She has a collection of tiaras (she was also Miss St. Ignace, which she claims was a scholarship pageant, but I have seen “Toddlers and Tiaras,” and I know what it means to win a crown). I begged her to try them on when we were in her childhood house this summer. She laughed. I guess they didn’t go with her tie.

She’s not home now. She’s working, because she finally got The Job. I’m supposed to be writing the essay that will lead to The School that will get me The Job, but the words never flow when I want them to.

My friend does not understand my incessant worrying. He responded to a neurotic rant with beautiful prose, because he is disgustingly talented (which I wholeheartedly mean, despite my recent efforts to rid my vocabulary of adverbs):

“Not to always try to be the sunshine of optimism to your cloud of stress, but we’re young, we live in the best city in the world and we’ve got people around that care about us. And most importantly, we are infinite.”

I suppose we are only as infinite as we feel. Which is an homage to the aforementioned “The Perks of Being a Wallflower,” which the New Yorker says is lovely, so it must be true.

I’m going to close my eyes and not worry about the image that will accompany this post and imagine that all the potential energy in the world lives beneath my fingertips. I won’t focus on the sad. I will focus on what comes of it. Like the moment when I said to my brother, “do you ever look at the cat and convince yourself for a second that it’s Dad?” And instead of the look I expected, he didn’t miss a beat and said, “I know exactly what you mean.”

I know exactly what I mean.

Dreams, science and life realigned

bookshelfAt 16, you always thought you would die after high school. It’s not that you wanted to die, but you couldn’t fathom how you would keep going. What it would look like to follow those big, big dreams. You secretly felt stupid about having dreams. Your brain couldn’t picture it happening; therefore, it couldn’t exist.

Your thought pattern was half-right—not about fearing the unknown, but about the vision. You don’t have to know how you will get there, but you have to know you want it. To squeeze your eyes shut tight and see yourself at the end goal, no matter how insurmountable or ridiculous it seems. And the rest is just hard work. Head down. Light on.

You open your eyes. It’s Monday. It’s unseasonably warm. The cat is asleep on the couch. It’s 4 in the afternoon and you are home. It’s not a holiday. You don’t like this feeling, the heart palpitations that start when you remember you don’t know when you will get paid next. You send out invoices like sweepstakes entries. There’s $40 in the bank, but you’re owed $3,000. This is how you make your living now. You are lucky.

The table is littered with textbooks, a TI-83 calculator inherited from an old love and mechanical pencils. It’s unfamiliar, the evidence that someone in this house is doing math or writing not in pen. Yet somehow, the subject you always hated is growing more appealing. You like that it’s finite, that there are rules to be followed, that there is a right and a wrong answer.

It’s a shift from all the pretty lines and the yearning and the whimsy that you crave. And in that moment, I swear we were infinite, reads your favorite line from “The Perks of Being a Wallflower,” which your friend bought you for your birthday one year. He inscribed the inside cover, “…for hours of high school sadness.”  Sometimes you miss feeling infinite. You miss feeling breathy. You think about the clichés of getting older. Aging doesn’t scare you so much as losing yourself, as the fading intensity.

You are about to turn 30 and you are back in school with 19-year olds. They speak freely, they listen when you talk, they cannot believe you are that old. You all want to be nurses, you collectively lament over organic chemistry.

electrons

Your professor is a baby boomer, a retired chiropractor and an avid storyteller. She infuses lessons on elements with anecdotes about the ’70s. While the space between electrons is too small to fathom on the human-sized scale, it’s highly significant at the atomic level. And if all the electrons were aligned in a specific pattern, there would be enough space to put your finger straight through a solid piece of matter. She swears she proved this once in her early twenties, when she and her friend both watched a potato chip fall directly through a table. They looked everywhere and couldn’t find the chip—and concluded that it was caught inside the table between the electrons. This had nothing to do with being stoned, and everything to do with proving scientific theories, she said.

School is different the second time around. Or the third time, if you count your previous degrees. Or the fourth time, if you count all the times you started and stopped the process when it got to be too much. When it was scary, when you chose friends over homework, when you thought you were too old to be making drastic changes, when it wasn’t comfortable to be broke, when you didn’t believe you were smart enough to tackle science. When you couldn’t fathom not being a writer, even though making a living off of it was making you unhappy. When you lost sight of the end goal.

School is different this time around. It’s no one else’s fault that you chose the path of most resistance; you own it as a means to an end. You are learning the art of patience with your eye on the prize. You are learning how to settle into discomfort, to welcome the unknown, to put one foot in front of the other and recognize that it’s all you can do. Sometimes you can’t see more than three steps ahead, and that’s just the reality of now.

You are sure this is right. You are sure that if you keep your head down and not allow yourself to be consumed by the forces working against you, you will make it through. You are sure that there is space—no matter how small or inconceivable—where everything lines up.

A Mild Winter’s Tale

No, sunny, unseasonably warm day in February, I will not be tempted by your charms. You cannot lure me into thinking that the period following fall is “not so bad.” I know what you are doing here. I saw “Jurassic Park,” and I know that nature always finds a way.

Mother Earth isn’t going to let us get away without a good, old-fashioned, desolate winter.  It’s like she’s dangling the sunny carrot of doom in front of us, and we don’t know when it will turn into a nine-day sleet storm.

I shudder to think of it. My people wandered in the desert for 40 years eating carbohydrates. Therefore:

  • When I see snow, I think, “apocalypse.”

    Putting the "no" in "snow" since 1525 B.C.E.

  • I refuse to retire my down accouterment until the temperature has surpassed 53 degrees.
  • Word association: You say, “cactus.” I say, “solidarity.”
  • Every election year, I threaten to move to Canada, but only if Canada and Mexico agree to switch locations.

Furthermore, it’s not just the cold that I hate. It’s all the things that go along with it. I do not understand:

  • Performance! Fleece!
  • [insert any number below 40] degrees
  • Skiing!
  • Winter “wonderland”
  • The Anti-Ugg Movement, comprised of those blessed with optimal circulation, who don’t empathize with my frigid feet in the month of (normal) January

I know, I know, I should be happy that winter is going easy on us. But instead, I am trembling in fear. While we are frolicking in the unnatural 60-degree temperatures, Eastern Europe is having the Mel Gibson of all winters, killing civilians with its aggressive cold spell.

In the words of Ned Stark of Winterfell, “winter is coming.” And it might be in April. Or August.

Come to think of it, I miss the season where I refuse to go snowboarding, arm myself with a space heater and don some sweet Sweater Uggs. Dammit, winter, come back to me!

On the Liberal Arts and Parachutes, Part I

Expecting a 17-year old to choose a life path is like asking a third-grader to create a financial portfolio for 2021. Sure, there are the occasional kids who are wired with pragmatism and wisdom beyond their years. But for the most part, these developing minds aren’t any more equipped to predict their future desires than they are to sign a debt-inducing promissory note that will haunt them for years down the road.

But four years of college is the American way for the middle class. Unlike my grandparents, who came to this country after the Holocaust without a penny to their name, I grew up in a house where going to college wasn’t an option; it was the next step after high school. This was a stark contrast from my father’s life, which, as a first-generation American, did not entail such a definitive path. Instead of hitting the books, he worked. Back in the olden days of the 1960s, college wasn’t a necessary or assumed step. So he forewent higher education in search of work – selling shoes, managing restaurants and eventually to owning a small retail business.

It was this business that put me through school in the hopes that I would make a better, easier (presumably white-collar) life for myself. I was lucky. I grew up watching my father leave before the sun came up to commute into the city and arrive home far past my bedtime. Education was supposed to be my ticket to avoiding this.

My parents weren’t thrilled at my choice to get an English degree, or later, a master’s in creative writing that I have come to deem my “master of arts and crafts.” What they fail to tell you as a wide-eyed teenager is that a liberal arts degree, though useful for developing critical thinking skills and expanding one’s mind, does nothing to prepare a student for the Real World. I didn’t know that English was the color of my parachute; but 17-year old me would not be caught dead getting a business degree. I was a writer. I was going to make documentaries and save the world and rawr riot grrrrrl.

English majors are a special breed. The English building at my school was at the South Pole of campus, a solid 35-minute walk from my dorm. I traipsed across the grassy pathways and found myself in front of an entrance that reeked of Marlboro Lights, t-shirts commemorating The Cure and the occasional Renaissance-inspired ensemble. Inside, we discussed worn novels with tiny notes inscribed on the edges and listened to each other wax philosophical on post-modernism and the Southern Gothic. I found solace in the rants of my classmates about why Hemingway was actually a feminist, even when I knew it was nothing more than marijuana-induced, masturbatory, right-brain dribble. We were THINKERS. The world was our oyster, its pages lined with all that we needed to know.

Imagine my surprise when I started working as a corporate proposal writer two weeks after graduation. Oh, the horror of cubicles and phrases like “value-added” and the sad little brown-bag lunches that my coworkers ate at their desks. Learning the cold, hard truth that my ability to excel in British Literature did not matter when it came to “impacting change.” Or that people would cringe when I responded to the obligatory “were you in any clubs in school” with “I produced the Vagina Monologues.” (Corporate America did not like to be reminded that it had genitalia.)

Why did the sales team, comprised mostly of men of a certain age with a fondness for arena rock, think that I could staple copies any better than the rest of them? And for the sake of all things holy, DID NO ONE HERE CARE ABOUT THE EGREGIOUS USE OF THE SEQUENTIAL COMMA?

The answer to all of these questions, I learned, was that I was in the Real World. Where absolutely nothing I had learned in the past four years could be applied to the actual work I was doing. Sure, I could dot I’s and cross T’s. My saving grace was having worked for my school newspaper, where I learned how to “thrive in a deadline-driven environment,” a phrase gleaned directly from my current resume.

My parents were thrilled I had acquired a job so quickly. Even though I hated every second of it. “Stick with it,” they said. “You are one of the lucky ones.”

That’s exactly what I did for the next 7.5 years – I stuck with the idea that I was an English major, and I was supposed to be dotting I’s and crossing T’s. I could always try to make it as a Writer, but that didn’t involve health insurance. And not having health insurance meant that I was asking to get hit by a bus, a fear my Jewish mother instilled in me early on. My string of writing jobs in various capacities did afford me some good times and better friends; my  stint at a small advertising agency was one of my favorite jobs to-date. But eventually I moved away and desk life began to wear on me. Writing for pay in a windowless office on someone else’s schedule was sucking the fun out of…writing for fun. And writing jobs in New York – corporate, university, nonprofit – are a breed of their own. I will happily work as a freelance writer any day – but the thought of going back to full-time desk life is enough to propel me through a drastic career change.

As I sit here on my second-to-last day of desk life, I am pushing away the fear of embarking upon an adventure into the sciences – to what will eventually be nursing. Seeing as how I took one biology class in four years of college, this shift is nothing if not drastic. But it is necessary. Rawr grrrrl power.