An Anniversary

On September 25, 2007, I was settling into a third straight overnight vigil by my father’s bedside.  Although slipping into a coma a few days before, he was still responsive to pain, and so my family took turns staying awake to monitor his breathing and push his morphine PCA when he screamed or moaned and panicked.

On September 26th, we were all exhausted and while we dozed or heated up a late lunch that afternoon, his breathing slowed.  At approximately 1630 PST, he left us, seeming to wait for a quiet moment to slip away in peace.

Tomorrow at approximately 1630 PST I will be leaving my clinical site and heading to the airport to fly home and spend the weekend with my family.  Rather apt timing.

This anniversary marks a year of grieving, of healing, of exploration and of growth.  I catch myself wanting to pick up the phone and call my dad about my mental health rotation.  He was a psychologist and would have been so excited to hear about my experiences, and even more thrilled that I have enjoyed it so much.

But even more importantly, he would have been excited that we are all finding joy in our lives.  We miss him desperately and we are all still struggling over how to live each day with a gaping hole in our hearts.  He saw his own share of tragedy in life, but those experiences brought him closer to his family and helped him find meaning and joy in the people he loved.  The best way I know to honor his memory is to follow his lead.

I’ve got some pretty big shoes to fill.  But I won’t be doing it alone.

Look At Me, Ma!

A victory of sorts for Nurse Teeny and her blog today. I have just been notified that “The Makings of a Nurse” has made its way into a “Top 100″ list – “100 Best Blogs for Nursing Students”.

I wasn’t even aware that there were 100 of us, but apparently nursing blogs are quite the find these days. I guess the emotional, mental and physical wear and tear of nursing school gets to all of us, and we’ve unknowingly created an entire universe out there. Community and mutual support are good things, people.

Check out the article at RNCentral.com. There are some awesome resources listed there, and they are sorted thematically so you can quickly locate the type of blog you may be seeking. Some of my own faves made the cut too.

Then scroll down to #63 if ya get the inkling. Apparently my “long and winding path” to nursing school is serving as a resource for others. Which is exactly why I started this e-tome to begin with.

That and to give myself a giggle now and then.

Thanks, RNCentral! My mommy will be so proud!

In Other News…

This is a big week in the personal life of Nurse Teeny.

Monday my divorce becomes official official, as in signed off, rubber stamped and LEGAL! I get my name back and get to go through oh-so-thrilling process of restoring everything – social security card, driver’s license, credit cards, bank accounts. But I don’t mind because I have been waiting for this day! And luckily the school has already got me listed under my maiden name so I don’t have to go through that rigamorole.

Then Friday marks the one-year anniversary since the death of my dear sweet daddy. I am flying home that night to be with my family for the weekend. Our wonderful friends are hosting a get-together for all the people who loved him and who saw us through the most painful experience we’ve ever had. S picks me up from the airport and takes me straight there.

Speaking of which, S has put up with a lot lately as I stress about school and deal with all of these big changes in my life. And he’s got his own stressors he’s dealing with too. Long-distance love is no picnic, and yet he still sticks around and makes me feel like I’ve got a real partner who will be there for the hard stuff too. That’s something you don’t see every day. What a keeper!

Halfway Through Psych

We had our mid-rotation evaluations on Friday. We had to evaluate ourselves in several areas of nursing and then turn in our forms to have our clinical instructor add comments. I think she likes me.

And I think I really like psych. So NOT what I ever expected to say. It is definitely related to the teaching environment the head nurse has created for us – she is making sure we get to participate in multidisciplinary teams, family meetings, group therapy, admits, and 1:1 sessions with the clients. She is sitting us down and explaining concepts, giving us advice on therapeutic communication, and using every moment as a teaching moment. She is forcing us to use “old school” BP cuffs even though there is an automated machine on the unit, because she says it’s no good using a calculator if you can’t sit down and figure it out with pencil and paper. In other words, if we can’t take a blood pressure without the aid of a machine, we’re up a creek. Next week we have to do a full assessment of a client, from start to finish. The final two weeks, we are responsible for leading our own group!

It’s challenging and frustrating and oh so wonderful! I am really digging this rotation.

But despite my enjoyment, I am resisting the possibility of psych nursing. There are a lot of reasons behind it but it all boils down to self-awareness. I know what it would cost me, mentally and emotionally because I know what it already is costing me. So although it makes me sad in a way, I can cross one specialty off the list of possibilities.

Three weeks left, then a weeklong Fall Break. Hallelujah!!! Med-Surg clinical starts as soon as we get back. My classmates currently in that rotation are getting schooled. Oh joy.

Kudos

Nursing school is killer in the self-esteem and confidence departments, so I thought I’d take this rare opportunity to toot my own horn.

Today when I gave my shift report to the evening staff, I was complimented publicly by the head nurse on my report. Apparently I covered all the bases, gave a good history and included my client’s medication information. Apparently all elements of an excellent shift report.

Go Nurse Teeny, go!

A Circle That Has No End?

Today I sat in a circle during process group with seven adolescent females, all of whom had either tried to commit suicide or were hospitalized before they could carry out their attempt.  They looked around the room at each other and one noted how sad it was they were all there, because they were all “awesome people” and it was sad any of them wouldn’t want to be alive.  They were a quiet bunch, but when they spoke, it was powerful.  They supported each other, they shed tears, they shifted in their seats when they were uncomfortable.  They were seven adolescent females who could have been anywhere.  But instead they sat in a structured day room wearing hospital wristbands, bearing physical and emotional scars.

It reminded me of the book Reviving Ophelia, an incredible book by a child psychologist who writes about the difficulties of growing up female in today’s world.  The family dynamics, the social pressure, the media messages, the issues of sexuality can all mix together and boil over easily.  How much is “teen angst” and how much is a DSM-IVTR diagnosis is anybody’s guess, but the pain these girls felt was palpable in that room.  As was the gravity of the fact that every single one of them would have rather been dead than face whatever it is they were facing.

We’ve all been there.  Any one of us could have ended up in that room.  So what pushed these girls over the edge?  And what can we do to make their burdens a little less heavy?

Danger, Will Robinson, Danger!

I have literally not stopped studying this weekend. I took a break to eat and watch a movie with my study buddy last night.  But otherwise from Saturday morning until now, I have studied for two exams, taken one, and read four chapters.

That only leaves six chapters, another exam, and a paper …

…By WEDNESDAY!

Welcome to my world.

Kids These Days

The good news about my psych nursing rotation is that we are being treated like actual nurses with actual responsibilities. On Day One, we were doing vital signs before breakfast and this week we had our own patients (which included doing 1:1 therapy with them), did our own charting and were responsible for reporting to the next shift.

The bad news about my psych nursing rotation is that we are being treated like actual nurses with actual responsibilities. Whatever work we are given we are expected to complete without passing it along to a “real” staff member if we run out of time. Lunch breaks have lasted 15 and 20 minutes, respectively, because there is a very narrow gap between when we finish morning activities and begin afternoon process group. And it takes us forever to do anything because we’re not familiar with the vocabulary of psychiatry yet – how many times did I hear the term “labile” before figuring out what it means?! Look it up.

But the good news outweighs the bad. I feel challenged and exhilarated by the work, despite the absolute exhaustion when I get home at the end of the day. I’m still trying to figure out a decompression strategy to protect myself from bringing everything home with me – we hear and see some heavy sh*t.

In some ways, these kids are just like any other mopey, manipulative teenager you might encounter. “Pukey adolescents,” as my dear dad called them. C’mon, we’ve ALL been there! But these are pukey adolescents with a twist. Be it a history of abuse, a dysfunctional family relationship, a genetic predisposition to mental illness or an actual psychosis (or perhaps some or all of the above), each shift brings forth intense revelations that are really hard to hear and even harder to process. To end up on a locked inpatient psych unit, you have to be determined a danger to self or others. So … yeah.

Unfortunately, I’m also extremely frustrated by the way the system works. These kids come to us in crisis and our job is to assess them in as little time as possible, determine that they are safe and send them on their merry way because insurance companies won’t cover them if they aren’t in crisis anymore. Many of them are “repeaters” to the unit. Some have left here and subsequently committed suicide. A number have told me they don’t want to leave because this is the safest they have ever felt. The staff works really hard to help the patients develop coping skills and take advantage of therapeutic opportunities, but there’s not enough time to really do the work these kids need.

So talk to me… How do I advocate for my patients in a system that is designed to fail them? And how do I take care of myself so that I don’t agonize over that very question?

Adolescent, My Dear Watson

Mental health clinicals have officially begun!  Thursday we oriented to the hospital and to psych nursing with our clinical instructor, and got to tour the units.  Because it is a large medical center, there are dedicated units for child and adolescent clients separate from adults, as well as a chemical dependency ward.  We had thought originally we’d be able to rotate through and spend a couple of weeks on each unit, but the child/adolescent staff wanted whoever was working with them to have more continuity.  So the six of us had to duke it out: 3 to adults (chemical dependency is still being negotiated), 2 to adolescents, and 1 to children.  I ended up on the adolescent unit, which I am super pleased about.  The staff has really welcomed us and put us right to work with taking morning vital signs, charting the basics and sitting in on group therapy sessions.  Next week we’ll be expected to carry our own clients while we’re on duty, which basically means being available for 1:1 therapy, charting, and being responsible for reporting on them to the next shift.  Jeepers!

Locked inpatient units are typically short-stay, which means the kids we met Friday likely won’t even be there by the time we report Thursday morning.  Thank the insurance industry – I’ve heard from two different staff up there that mental health is the unwanted step-child of insurance companies.  Because time is so limited, it is vital that we work efficiently to understand the clients’ perceptions of why they were admitted and why they need support, and determine whether it is safe for them to go home.

I realized while sitting in on group therapy how little actually separates us from them.  How much environment makes a difference.  How situations completely out of their control have resulted in vulnerability, brokenness and a lifetime of wondering “Why?”.  And how I or any one of my peers could have ended up on that same unit if things had happened only slightly differently – there was a girl recently admitted who reminded me so much of myself at 16, it was uncanny (and a little bit scary).  I wonder how many of the clients down on the adult unit were also admitted as adolescents or even children.

It’s heartbreaking to hear their stories.  But I can only hope that something we do will make enough of a difference that they won’t have to come back.

More stories to come.  Break out your tissues…

Tell Your Story. But Wait, There’s A Catch!

I hate APA with the fire of ten thousand suns. Yes, it was the format of choice for my undergraduate major too, but sheesh, could there be a more user-unfriendly, aggravating way of citing your sources?

Okay, I feel better now with that rant out of the way. I have spent the last couple of days writing a “personal paper” for my Role Development class. Basically a re-creation of our nursing school admission essays with some research into nursing roles and values thrown into the mix. But as you probably surmised from the title of this post, there was a definite twist to our little assignment. In order to “ease” us into the practice of academic writing, we are not allowed to use first person language. When expressing our opinions or describing our experiences, we have to use the phrase “This nursing student…” or something along those lines. N.B.: It is supercalifragilistically difficult to tell your story without using “I”. Try it sometime.

A few more papers under my belt and I’ll feel better about this whole mess. But right now, my brain and my keyboard don’t seem to be on very good terms.

P.S. Wanted to give a shout out to my classmates who have discovered Nurseteeny’s blog via trusty ol’ Facebook! Hello folks – I promise that as much as I use this venue to rant and rave over the next few years, it won’t be directed at y’all. We’re in this together and I truly believe that.

Welcome to my brain on nursing school!