Tag Archives: nursing

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.

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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.