*moment of truth*

I have to confess, I have a new addiction. Hopefully by admitting it, I can better control it. My name is Laura, and I am a SOCK addict. Yes, socks. I've realized that they are the only part of my uniform that I can really have any control over, so I've found enjoyment in purchasing fun knee-high patterned socks to wear with my classy Danskos and attractive unisex scrubs. Not that you can really see the socks, but that makes it even more fun -- to wear the brown socks with green and yellow pastel stars, completely mismatched from my outfit. Love it. I know, I'm such a rebel... gotta break free from the masses somehow, right?

SO... I find myself on another Sunday evening, relaxing comfortably in the tiny lofted nook that I call my bedroom on the 3rd floor of this quaint rowhouse... I love it here.  This space allows me to escape.. to focus.. to BREATHE.  It has been a "home away from home" and I am grateful for that.  It's amazing how a house can become a "home" and really bring a sense of peace and comfort into your life. 

This past week really changed my perspective and boosted my confidence - I finally feel like becoming a nurse is my CALLING and that I have the knowledge and skills necessary to take on the title of "RN."  Up until this point... my focus has been primarily on learning the skills necessary to care for the physical needs of my patients... whether that be learning how to administer IM injections, starting IV meds, doing appropriate physical assessments, etc... but this past week in clinical gave me a new outlook on the real impact my presence can have on a patient.  I had two different patients between Thursday and Friday, and two very different diagnoses to prepare for.  My first patient, an older gentleman, was suffering from fluid volume overload, as a result of his long-standing history with congestive heart failure and associated complications.  He was being discharged, with his wife and daughter present to assist him with all the educational points we had to go over for his home medication regiment.  He was well-versed on his cardiac meds, but we reiterated the importance of maintaining a healthy diet in accordance with what his cardiologist has outlined in addition to taking his medication on a regular basis.  Although he was suffering severe consequences of a lengthy battle with this commonly terminal disease, he was in good spirits because he was able to leave the hospital and return home to be with his family.  With not much to do for my patient, I spent most of the day out in the hall, reading up on his various comorbidities (other illnesses) and studying the lab values that result from those diagnoses, just to get a better understanding of expected abnormal values with certain medical problems.  While I was standing near the nurse's station, I overheard a young woman talking with one of the floor employees about a failed attempt to obtain an autograph on the pages of a book that she was clutching to her chest.  The clerk asked what had happened, and the girl replied "Oh, he seemed quite busy and not too happy to be interrupted.  It's okay, I'll be seeing him tomorrow for my residency interview."  The clerk offered to hold the book for her, and talk with this VIP about signing it when he was not so preoccupied with work.  The girl thanked the clerk for her offer, but declined and quickly walked off the unit.  I turned to the employee, curious as to the identity of this person that the girl had bombarded with requests for an autograph, only to find out that it was Dr. Ben Carson -- head of Pediatric Neurosurgery here at Hopkins, and well-known around the world for his successful separation of two sets of conjoined twins who were attached at the head (as well as multiple other complex, and successful, neurosurgeries).  He has written a few books, and has had a movie made about his life ("Gifted Hands" for those who might have heard of it).  Yes, he is a big deal.  And I would normally not find fault in requesting a simple signature on a copy of one of his books (much more respectable than any Hollywood celebrity) BUT the timing of this situation was probably not in the best interest of this current resident applicant.  Wouldn't you want to focus the attention of your interviewer on your own accomplishments and honors, rather than addressing his list of accreditations?  That's just my opinion... but highlighting quotes from his book to discuss with him hardly seems like an appropriate topic of discussion for an interview.  Who knows, maybe she'll manage to impress him... but I feel it safe to say that she should start looking at other options.  All in all, it was quite funny to witness... my first experience brushing up against the elite physicians that Hopkins is so widely regarded for. 


As for my second clinical day, I had a much different experience...  because my Thursday patient was discharged, I was assigned a different patient on Friday, and I had the opportunity to choose which patient I would like to work with, as long as the diagnosis was different from the previous medical problems that I had worked with.  I looked at the list of patients, and one in particular stood out to me.  I reviewed this elderly woman's chart to learn that she was living alone, with limited contact with any family, and was quite overwhelmed with the worsening of her medical concerns.  She was diabetic, had history of high blood pressure and congestive heart failure, but was currently dealing with the clinical sequelae of end-stage renal failure.  She was retaining excessive amounts of fluid, and her renal clinic decided it was best for her to be admitted to the hospital for further observation.  She was placed on "contact precaution" due to the presence of VRE (a very serious drug-resistant bacteria, worse than MRSA) which requires any individual who enters the room to don a gown and gloves - thereby limiting any chance of cross-contamination between patients, as well as protecting the health of the workers.  Because of these precautions, many people are deterred from entering these patients' rooms because of the added hassle and time needed to put on a gown and gloves.  I decided that I would take it upon myself to spend the majority of my shift in her room, caring for her needs and making sure that she was receiving adequate and appropriate care.  Over the course of that day, I busied myself about her room, ensuring that all the physician and nursing orders were completed, but instead of focusing strictly on my technique and efficiency and accuracy, I focused on gathering more information from her about her health history in order to better understand what brought her to the hospital.  It was during this time that I realized how much I have learned over the past 8 months of school - I was able to integrate my knowledge into coordinating her care, according to what she was telling me.  Focusing on her as a PERSON rather than a patient really opened my eyes to how important nurses can be in guiding the outcome of a patient's experience.  I stood by and watched as two different interns (physicians) entered her room and barely acknowledged her before jumping into some complex discussion about some of her presenting signs that indicated fluid volume excess.  They didn't include her in this conversation, even though they were obviously discussing her current physical state.  Later on, I stood by as another resident attempted to find a vein from which to draw blood for a test, and he literally poked and prodded her frail little wrist at least 10 times.. and no, he did not stop once to apologize or acknowledge that he was inflicting pain on this poor woman.  After he walked out, I looked at her and apologized for his apparent lapse in judgment and appropriate bedside conduct.  It was frustrating.  But I did all that I could do to ease her obvious discomfort... gave her a foot and hand massage, and talked with her about her life outside of the hospital.  As I left the floor that day, she took my hand and looked into my eyes with sincere and genuine appreciation, and offered her gratitude for my willingness to stay with her that day.  It was as a tender moment for me, probably the most meaningful experience I've had out of my clinical rotations to date.  As I went home that night, I had time to really think about the impact that nurses can have, and how grateful I am that I have discovered my calling in this world.  I can't wait until those skills and assessments become more second nature (as I have already started to witness) so that I can focus on attending to the needs of the PERSON behind the medical diagnosis.  I may not be able to cure their physical ailments, but I can provide a safe and comforting environment that can impact their overall experience, and hopefully provide at least a temporary relief of their suffering.  What a blessing and privilege I have to be a nurse!

WELL... after that lengthy soapbox moment.... I will leave you all for now, it's now Monday afternoon (when I am finishing up this entry) and I have some prep work to do for a new class that I'm starting tonight -- Breastfeeding!  I'm soaking up all the knowledge that I can in order to better prepare me for my future in L&D and, eventually, Midwifery.  It should be an interesting class... and because I am completely unfamiliar with this important aspect of Maternal/Infant health, I feel it would be very worthwhile to spend my Monday evenings gathering more information to take with me to my future career.  So exciting, this pursuit of knowledge... I love school!  haha.  Okay, leaving now. Have a wonderful week!

- Laura Newman, (future) RN