Although there are several interesting aspects to the Hopkins Student Nurse Relief Corps trip to New Orleans this year, I thought one key point was extremely relevant to anyone thinking of going into nursing.
I am going to start off letting you know that I am purposefully keeping some parts of this blog a little vague as to not have it turn into a political sermon. Also, keep in mind that the Lower Ninth Ward was not the ONLY area affected by Hurricane Katrina, it is simply the only city affected where I have family, and the only neighborhood where I grew to know some of it residents.
The Hopkins Student Nurse Relief Corps spent one week in the Lower Ninth Ward in New Orleans over Spring Break. We worked and lived at Lowernine.org (check it out online) and partnered with Touro Infirmary, Lower Ninth Ward Clinic, and St. Anna’s Mobile Clinic. I was able to spend time with the people at Touro and L9 Clinic.
Darren, who works at Lowernine.org had survived Katrina by sitting on his roof for four days with no food or water, only to then be rescued to a nearby bridge, still with no food or water and 500 other stranded neighbors. After Katrina, he returned to the Lower Ninth and began cleaning, plowing roads clear of debris, trees and even a dead body or two left behind. His story was similar to others that we heard.
Patricia, an RN, returned home quickly after Katrina and opened her house into a functional clinic (again, check it out – http://www.l9whc.org/). She and another RN began to provide healthcare free and then later with a minimum fee to residents slowly returning home. At first most of their patients were construction and demolition crews, now a steady influx of long-lost friends and neighbors walk through their doors.
While in the Lower Ninth Ward, I met person after person who never questioned returning home after the hurricane. No matter what you believe politically, after meeting the people of the Lower Ninth, you cannot deny that these neighbors came home to a warzone, pulled up their bootstraps, held their neighbors hands, and began to rebuild their homes, together. Volunteers from all over come to help out, but you can tell the spirit of those who call L9 home is what keeps the efforts going.
As I recounted some of these stories to friends, I picked up on their sense of loss, as if the stories they were hearing were depressing, and they felt sad for these people, felt sorry that these residents ever had to endure this experience. And that is SO NOT what I got out of my week with the men and women and children of New Orleans.
I know this is rambling, and by now, youre thinking “How is this related to nursing?” So here’s the link, as promised.
Surveys have shown over and over again that nurses are the most trusted profession. They are allowed into the most intimate moments of the patients and their families’ lives. Pediatric nurses, Oncology nurses, Hospice nurses, all have stories of a patient who was terminally ill but promised to live until their next birthday, until their daughter got married in the spring, until their husband graduated from his masters program… and those patients lived just as long as they promised and not a day more. You could view it as a pity that this person ever had to endure the pain of losing their mother, the agony of a miscarriage, or having to overcome a narcotics addiction to save their family. But I do not view it in such dim light. My life if mundane compared to what most of my patients are going through, and I am honored to be allowed in and to be part of a strength that only presents itself in the most dire moments. It is this strength that is more beautiful than anything else in the world.
And you, as a nurse, get a backstage pass to see this wonder on a regular basis.
so I was leaving the hospital friday afternoon, after having worked 2 days with THE BEST PATIENT EVER!!!! She was a tiny old lady from abroad (yes, I know where she's from, but Im sure saying so violates a HIPPA thing). I had helped her take showers, I had suctioned her trach, I stuck her with needles, I gave her tube feedings. I hung out with her equally awesome older sisters, and taught her daughter how to do tube feedings and trach care at home. I had SERIOUSLY bonded with this family. So Friday afternoon rolls around, and Im not gonna see these people again, so with a room FULL of her extended family, I got a little emotional and thanked her for being such a wonderful patient and that I REALLY enjoyed working with her, and it was awesome to see such involved loving family, blah blah blah...I mean, I REALLY laid it on thick.
She weakly lifts her hand up to her throat and presses on her bandaging (as per doctors orders) to speak, and Im thinking "here it comes, she's gonna say an emotional Thank You, or she's gonna tell me Im the best that's ever been, or she's gonna say how awesome of a nurse i'll be someday" and literally I am holding back the tears of emotion...
the entire room is silent...
and she says, softly in a hoarse voice, using ALL of her energy:
"The trash in the bathroom is full"
... and this last hilarious impression she left with me, simply solidifies her as the best patient.
Yes, the accelerated program at Hopkins is difficult.
Yes, nursing is difficult.
However, not once in this school, have I ever felt alone. That may seem like an obvious statement seeing as how every morning over one hundred fellow classmates rush into the main lecture rooms, and there is ALWAYS a line during class break at Me Latte, but that is not exactly what I mean.
Any time there is a computer glitch and your final paper disappears into oblivion, or anytime you click 'Submit' and instead of the screen telling you your score on the online quiz, you get an error page or you're kicked back to the Honor Pledge page, anytime you completely go blank on how to study for that first exam in a class and find yourself in your professor's office having to "discuss" your grade... EVERYONE, and I mean, EVERYONE here at the School of Nursing has consistently bent over backwards to help the students.
Melinda Rose has sent me emails over the span of a month, searching and digging for current masters students or alumni who have done exactly what I want to do... just so I can ask them "Are you still alive after doing your masters full time and working full time?"
Kathie Reese has walked me through a basic dosage calculation problem, as I stare at her blankly... not giving her much to work with.
Mindi Levi and Patty Wilson have worked with me for over a month to get my work hour paysheets and signatures in order, no doubt wondering how this could be such a source of confusion for me.
And the most recent reason why I love this school, and essentially the purpose behind this post:
My dad went into the hospital over a week ago for a heart attack, and during a routine cardiac cath procedure, had another heart attack on the table. His lungs filled up with fluid, just like Laura Taylor said they would in Pathophysiology. He became short of breath, watched the medical staff around him become panicked, he yelled out a quick "Come on, boys! Tighten up" before they rushed him to bypass surgery.
Mom and dad are in Richmond, VA, a quick 3 hour drive, 4 hours if you take Route 301, 2 hours on 301 if youre worrying about your dad. I could drive home that night and be with mom while dad was in surgery, but I would most definitely miss clinical hours... which incidentally this school nails it into your brain that you MUST NEVER MISS CLINICAL... EVER... unless you, not a relative, YOU, are dead. So with trepidation, I called my clinical instructor, Germaine, and told her the story, said I would try to make it back for the second day of clinical, which she promptly responded with "Renee, if you need to miss Friday as well, that's completely understandable."
I didn't entirely believe her, and on the 2 hour drive back to Richmond that night, I had come up with several alternative plans for how I was going to finish my BSN/RN degree. I could move home for a bit, maybe dad and I wouldnt argue so much if he gets percocet after this surgery, Im SURE we could live together just fine. I'd go to some nearby community college and finish up MedSurg and the rest there... what a lovely little jaunt I had into Hopkins, so sad it's surely over.
But Germaine was serious, and Meg Bernstein was in on it too. Arrangements were made for me so that I was not super behind on clinical hours, and there was no mention of having me pack my things to move back to Richmond. Everyone was simply concerned about the health of my dad and welcomed me back to school with open arms. Instructors and course coordinators were helping me the entire time.
And today, I found a card in my student mailbox, from an awesome classmate, Amber Robbins, sending warm wishes for me and my family. Thanks Amber, and Thanks School of Nursing. Thanks for making me feel loved during a major time of stress.
Incidentally: Dad's doing fine, he was in the hospital for a grand total of 12 days and is home now. Valuable lesson learned: When something goes wrong in a medical procedure, remain calm for the sake of the patient... you never know what they'll remember, even after 4 days of a propofol coma.
Asleep in bed at 11:30pm (what's a nightlife?), the phone rings.
My high school friend is calling... odd because we talk so rarely between work and school now.
"Hi Renee, what are you doing?"
"Sleeping."
"Really? Wow, its early."
"Yeah."
"Well, anyway. I have a question for you."
"Uh huh."
"My dad shattered his knee cap on Friday. They managed to basically put it back together, but now he's got something like a drain in it with a little baggy thing attached to it. And tonight, my mom called and said that my dad has a fever, like 102. But she gave him advil and now its like 100. What do you think is going on? Do you think something major is going on, or do you think its infected??"
"Is your dad have any other problems besides the fever and obviously pain around his knee?"
"No."
"Its still a little early to tell whats going on. But if he's able to tolerate the fever and it doesnt spike up in a short amount of time this evening, let him ride it out. It is flu season and he might just have a mild fever from getting a cold or something, in which case, the fever should break during the night. If he wakes up tomorrow and he still has a fever, call the doctor and go in to see them. A fever typically means theres an infection of some sort going on, but its hard to tell from just two temperature readings whats going on. If you're mom is able to, have her check the injury, especially any incision sites for redness and heat, like abnormally hot to the touch. Swelling too, but that may be harder to tell since his whole knees probably swollen. Did your dad take anything for the fever?"
"Yeah, advil."
"Okay, well. Keep in mind that fevers can be good. If this infection is mild and bacterial, a fever can help to cook and kill the germs. Also his lowered temperature might have been skewed by the advil. Its like if my thermostat in my apartment were broken. My heaters are all going full bore and its SO HOT in the place. So I open the windows and let in the freezing cold air... my apartments temperature reading will be lowered, and Ill feel better, but it doesnt fix the problem that my thermostat is on crack. So just watch out for anything else weird like nausea, vomiting, lightheadedness, sweating or anything NEW or different."
"Okay, Thanks Renee. I was just all wound up and couldnt go to sleep yet. Hearing that made me feel alot better. Go back to sleep."
"Uh huh, and send me an email or something tomorrow to let me know how it worked out."
So thats all fine and dandy, except that I was so sleepy and out of it, that I thought I dreamt it all the next morning. Only to see on my phone that my friend DID call and an email was waiting for me to say that her dad's fever had broken during the night and he was as hunky-dory as any man could be after shattering his knee cap... and oh, it wasnt a drain, it was some nifty coolant cyclical thingie.
This posting was just a reminder to all my fellow classmates who are PINING for this semester to be over and may be feeling a little worn out, wondering if ANY of this information is sinking in or not... well, it is. Let's just hope my future patient's call me while Im sleeping. =)
The patient in one room violently vommitting, while a staff member asks "Are you having any abdominal pain?"
The patient with such horrible alcohol detox shakes that she can barely initial the consent form.
The patient that snears at you for even having the nerve to ask her if she's interested in getting tested for HIV today.
The swarms of police men surrounding the trauma room with the latest admission.
The 50 year old on 15 medications.
The Physicians Assistant that avoids your eye contact, although you're not sure why.
All of these smalls upsets are part of my every Tuesday. And again, I love this job. I was sitting at my desk thinking that I really would not rather be anywhere else. I like being in the ED. It's exciting to hear the physicians review hyperkalemia with the resident (too bad the resident had not taken pathophysiology with Laura Taylor or he would not have needed the review); it's exciting to see 5 people go running down the hallway to the newest critical trauma. Its exciting to see teaching staff and guest speakers from last week's classes come strolling through the ED, I try my best not to be a nerd, although all I want to do is yell out "Hey remember me?! You spoke in my class last week? I asked that question... and... and... you said it was a great question! Remember? Hey! Can I do research under you? You know, since we have a connection. I work in the ED, you walk in the ED. Hmm? Yeah?" I love explaining to curious nurses where they themselves can get free HIV testing, and how often they should be doing so.
I love it in the ED, but I am occassionally reminded that it is still a scary and traumatic place for a lot of people. On the way back to the office, I walked past a father, holding a small child, surrounded by police, social workers, doctors and nurses, all of them asking the dad questions about "did anyone see her fall? has this happened before? when was the last..." while his child in the trauma room across from them screamed and cried at the top of her lungs.
You get into the swing of things at any job, but here, you frequently get reminded that this is not "just another day" for the patients and their families. Im sure there are a million other professions with less stress, less emotion, less drama and more pay... but for some reason, again, I would not want to be anywhere else... And now, thanks to Dan Sheridan's class last night, I know for sure that I do NOT want to be a Medical Examiner.
Sorry such a long time between posts, next week is less busy, I promise to update you all then. Hope you had a great Halloween!
My ultimate goal is to eventually become a Nurse Practitioner with a regular group of HIV positive patients with whom I can monitor meds, CD4 counts, viral loads, overall health and any counseling needs.
Last week I started my new job in the Johns Hopkins Emergency Department, where I try to test AS MANY patients as possible for HIV using the OraQuick test (it looks like the Q-tip and the Pregnancy test had a baby). So far, the job entails hours of spending quality time with patient's gums... there are more toothless people in Baltimore than you would expect. The testing doesnt require a lot of dialogue, its pretty simple:
"Hi, My name's Renee. Im one of the HIV testing counselors here. We just want to let you know that Johns Hopkins offers FREE HIV testing to ALL of their ED patients. You would get your results back while you wait. Can I interest you in being tested today?"
What Im really saying though is "Hi, My name is Renee. Im a wide-eyed naive nursing student, who only has an inkling of what youre in here for. And Hopkins offers free testing to ALL patients so dont be scared, no one looked at you and said 'THAT ONE! TEST HER!' But while youre waiting for someone to patch up that right leg that seems to be torn off, and remove all those shark's teeth from your abdomen (cause I cant really help you with that) Would you like to be tested for HIV? Dont worry, I have brochures for ALL possible outcomes! And please please please dont be HIV positive because I havent given a positive result yet, and that sounds super scary."
Suprisingly most patients must not read into it that deeply, because most say yes to being tested, typically get regularly tested and are less scared of their results than I am. My stomach is in knots the entire shift.
HOWEVER... I absolutely and profoundly LOVE this job. I cant contain my excitement when a patient has questions about HIV for me and I LOVE seeing people fill out their surveys on what risky behavior they have and whether or not they consider it a risk of infection. I love the little old ladies, practically asleep from waiting so long in the ED, giving me a one-eye-open BAD look when I ask them if they are a Male-To-Female transgender. I especially love that now in clinical, I have NO problem walking into a patient's room and introducing myself, because, afterall, at least in clinical, Im not going to be asking them if theyve ever traded sex for drugs.
And considering the ultimate goal here, this is a teeny tiny little baby step... in the right direction.
Today in clinical, yes again a rich source of blog material, I performed a maternal assessment post-partum while being supervised and critiqued by my clinical instructor. I knew the basics, starting with heart and lung sounds and rates, and moving on to Breasts, Uterus, Bowel, Bladder, Lochea, Episiotomy, Homan's and Emotional state (Thank you, BUBBLE-HE). I spent a few full minutes on each key note, poking and prodding and asking the mother questions about how her BUBBLE-HE feels.
"Does it hurt when I press down on your abdomen directly above your c-section incision?"
"Oh it does?"
"Oh you say you just gave birth yesterday? Well please bear with me, I have to find your uterus... oh, and Im new at this, so I REALLY have to push hard to make sure Im not feeling a bladder or perhaps a lost jar of peanut butter."
"Okay, all done poking your abdomen. Is there anything I can get you before you leave?"
"Well, your order says here that you cant receive Motrin for another 3 hours."
"Im sorry I didnt make that out. You were grimacing while speaking."
"Would you like me to massage your abdomen to help with the pain?"
"Ma'am there's no need to yell 'NO!'"
JUST KIDDING! As a sidenote with a touch more of reality in it: Thank you to my clinical instructor for waiting until we were outside of the patient's room to inform me that I do not need to perform a FULL breast exam for post-partum purposes. Apparently the purpose is NOT to detect breast cancer! Thanks also to my patient who put up with me performing a 5 minute boob massage.
The first semester was a complete and total blur. Sorry to say that, all you new students. When I went home for summer break, friends and family would ask if I enjoyed nursing school. To which, I would respond "I don't know. It's all going way too fast for me to decide if I like it or not." Summer semester was composed of respiratory assessments, EKG leads (both physical and the direction of the current), older adult falling statistics, epidemiology and learning how to wipe an older gentleman's bottom three times in two hours. None of those experiences really sealed the deal for me. The topics were interesting, but it was all just way too new for me to get my head around it and form an opinion.
This is now my second semester, and by no means has the program slowed down at all. I am required to study, know, apply and practice FAR more than during my first semester (which my professors are extremely willing to point out to us). However, this semester, the basics are clicking in my brain and I am able to focus on more detail (a double-edged sword in itself). I have straight-cathed a liter of urine out of a woman, three hours after she just had a vaginal delivery, I have already learned about beta-blockers, the dangers of free-floating ribosomes and some of my friends have even seen electro-shock therapy in depression patients.
I have no doubt that this semester will drag me through the mill and that I will come out battered and bruised. Yet, this semester I can already say that "Yes, I like nursing... I actually REALLY like it."