Mrs. Finkle

Lesson #7: “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ~Maya Angelou

On July 30th, 2013, I gained a better idea of the type of nurse I want to be.  

It was another clinical day at Good Shepherd Medical Center in Marshall, TX.  I was assigned to the 5th floor (my favorite), and I was looking through the list of patients available for me to take care of for the day.  I always ask the nurses which patient they think will keep me busiest, because 8 hours is a lot of time to kill when there isn't much to do and if you know me, I can't really sit still.  My nurse chucked and said "take room #5071, her name is Francis Finkle (*not a real name*) and she is an Alzheimer's/Dementia patient who was admitted for hypotension."  
 
When the nurse said that Mrs. Finkle would keep me busy, she was right.  All that woman wanted to do was eat, and talk, and walk, and talk, and eat, and talk, and press her call light.  What made the day interesting, to say the least, was that each time I walked into the room I could have been a different person because she forgot who I was after 10 minutes of leaving the room.  I must have introduced myself 20 times that day, trying desperately to get her to remember me.

Because of her Dementia/Alzheimer's she would ask for something, I would go get it, and by the time I brought it back, she would ask, "what the hell is that for?"  I would try so hard not to laugh to myself, because Alzheimer's is such a sad disease, but Mrs. Finkle was hilarious and I like to think she was that way before the disease process started.  

Mrs. Finkle's admitting diagnosis had been resolved the day before, so she was basically waiting to be discharged.  Because of this, I wanted to introduce my instructor to Mrs. Finkle so she would understand why my paperwork was over her primary medical diagnosis, not her admitting diagnosis. 

Now remember, at this point in the day, I had spent 6 hours with Mrs. Finkle.  I stayed in her room with her for most of the day because each time I left, she managed to get herself into some sort of trouble. (like squatting over the trash can to go to the bathroom) We watched soap operas, I listened to her stories (not knowing if they were true because of her memory), ate lunch with her (she ate, I sat bedside), she talked about church and God, she told me how men can be the most terrible creatures on the planet and that she actually had a favorite child.  Her stories were filled with elaborate details that could not have possibly been true because they contradicted stories she had told me in the earlier hours of the day.  But I didn't mind, she was funny, witty and made me laugh. I didn't know exactly how to talk to her because her thought process was all over the place, so I mainly listened.  She was the true definition of a "difficult" patient, but at least she was good company.  

So, in walks my instructor. 

Mrs. Finkle says, "Oh great, another nurse who's going to tell me what I can and can't do."  I explained to her, for what must have been the 10th time, that I was a student, and this was my instructor.  Mrs. Finkle said, with her curly, matted white hair and little attitude, "Well instructor... do you have a name or are you going to stand there and not introduce yourself?"

*I'm laughing right now as I type this* 

With a surprised look on her face, "Well hello Mrs. Finkle, my name is Wendy and it's very nice to meet you!" 

And then the talking began. "Wendy? Such a pretty name.  My middle name is Winifred and people used to call me Wendy." And Mrs. Finkle went on and on and on...

In between their conversation, we passed her medications and Mrs. Finkle moved to the chair so I could change her linens.  I stayed out of the conversation mostly because I wanted Mrs. Lewis to hear what I had been listening to all day but also because she was better at talking with Mrs. Finkle. They talked, and talked, and talked some more.  Mrs. Lewis kept calling her ma'am, and Mrs. Finkle finally burst out with, "Calling me ma'am is RUDE! What do you think I am, old?" 

She then proceeded to ask Mrs. Lewis how old she looked and to guess her age.  Apparently, it took her too long to guess so Mrs. Finkle shouted, "I'm 80!" 
Mrs. Lewis: "You look great for 80!"
Mrs. Finkle: "Well I bet I look damn good for 87 then because that's how old I REALLY am!" 

Mrs. Finkle shot us a grin and Mrs. Lewis and I burst into laughter.

Not long after that, Mrs. Lewis said she had to go help with some other students, that it was very nice chatting and left the room.

Mrs. Finkle went back to talking, and this time around I received a whole new set of stories.  Her children's names were different, she had a different career than she had previously told me, and she said she hadn't eaten, even though she just ate TWO sandwiches only a two hours ago.  As I was getting up to get her a yogurt from the patient refrigerator, she stopped me.

"When you come back, will you bring Wendy with you? She was really nice and I liked her." 

I couldn't get Mrs. Finkle to remember my name all day long and in that moment, I learned a valuable lesson. 

Mrs. Finkle was not going to remember me and she wasn't she going to remember Mrs. Lewis next week.  She didn't remember the conversations we had earlier that afternoon and she could barely remember where she was half of the time.  She couldn't recall that I was a student, and she had no idea that she suffered from Dementia/Alzheimer's.  

My goal for the day shouldn't have been to get her to remember me by name because at the end of my 8 hour shift, the only thing Mrs. Finkle remembered was how someone made her feel.

That is the kind of nurse I want to be.  
   
I want to be a nurse who leaves their patients at the end of the day with feelings of worth, joy, laughter, and kindness. (And obviously provide the best medical care possible)  Not a nurse who wants to be remembered for the who they are and what they do, but for how wonderful they make their patients feel about themselves. :)





(A few weeks later, I had Mrs. Finkle again.  She didn't remember me, but by the end of the shift she knew who I was when I walked into the room. :)

It's Okay to Care.

Lesson #6: If you're compassionate, don't restrain yourself from spilling all that you are.

Before I ever stepped foot into a hospital in the role of a student nurse, I had a preconceived idea of how I would react in certain situations.  I believed I knew myself well enough to predict my emotional response to death, even though it is not something I've been surrounded by or exposed to very many times in my life. 

When I started my nursing journey, I prided myself on keeping my personal views, opinions, and emotions to myself.  Especially my emotions.  I've always been a "sap" but I started school with the idea that I would condition myself to keep emotions regarding patients out of sight.  I thought in doing so, I would portray a "professional nurse" image.

Fast forward a year.

I showed up to clinical and was assigned to the ICU.  Oddly, my patient was awake, alert and oriented X3.  He was going back and forth about whether or not he was going to get an internal jugular tube (central line) that afternoon.  After chatting for 2 hours over breakfast (pancakes and sausage) about life, his past, his family and his medical condition, he decided to sign the consent forms and follow through with the procedure.

We wheeled down to the lab, prepped, suited up in the appropriate medical attire, and I was able to stand in on the procedure.  I stood at the head of the table, where I could see him under the sterile blue sheet.  We continued chatting as the procedure began...

I had no idea the mans hand I held that morning was going to code on the table later that afternoon and I was not at all prepared the way I had planned in my head.

My first code was a roller coaster ride full of emotions.  Everything I had conditioned myself to believe, immediately went out the window.

I replayed the conversations we had that morning about his wife and children and how the scariest thing he had ever experienced was during war.  I replayed  his words when he said how he really didn't want to do the procedure because it would only prolong his life, making himself a burden to his family even longer.  I recalled his laugh when I accidentally spilled his juice all over the table and how he told me what a great job I did when my instructor checked me off on his IV push.  All I could think about was his voice,  (that I heard just 15 minutes earlier) and how he wasn't breathing now.

The room was chaotic, I couldn't focus on one single person because there was so much going on.  The voices all blurred together and in my mind, this was going to be the end of his life.  I could only focus on the monitor and the nurse doing compressions.  It took every ounce of my being not to cry.  I started sweating, it felt like a million degrees.  I stood in the corner, zoned out.  One minute felt like eternity, but after an hour, he was stable again.  Unconscious and intubated, but "stable."  (He died later that week)

I will never, ever forget that day.

I know they say it gets easier and easier each time you're exposed to the death of a patient, and that may be true. However, I don't ever want to be so disconnected from my patients that I cannot feel the emotions associated with grief and loss or share their joy in the happier moments.  I want to be able to have enough control over my emotions to not buckle under pressure but not so much control that I lose the genuine ability to sympathize/empathize with the people I care for. 

It was silly for me to believe that I could take a passion and put reigns on it, or that I would want to dull something about myself that makes me who I am.  I no longer believe that the "tough" nurses are the most admirable, nor do I believe that being emotionally invested in your patients health and well-being is a weakness. In fact, I think it's what makes the best nurses.

Unexpected, Unlikely Friendships

Lesson #5: You'll make friends and meet people you'll never forget. 

On the first day of class, I only saw two people I knew prior and the rest were strangers. 

Here I am a year later, and I can tell you that I have made some pretty awesome memories and those unfamiliar faces are now the faces of my friends. 

"Call it coincidence, or fate, or sheer blind luck." Whatever it is, I know that I somehow ended up in the right place, at the right time, so I could meet the right people. 

Each of these people have completley different personalities, and that's what I love most. They all bring something unique to our friendship, making me a better person at the end of the day. 

Without meeting these people, it may have taken me a little while to learn these valuable tidbits:

 #1: 

     Humor is the best therapy. There will be moments when you'll find yourself in, what feels like, the most unfortunate situation. Some of those situations will be completely out of your control. Don't get too bent out of shape, instead find the humor in it and laugh it off. Sometimes that's all you can do. 

 #2:

     Don't judge a book by its cover. When you meet someone, it's our natural human instinct to make a snap judgement. However, rarely are these judgements accurate. If you take the time to truly get to know someone, you may find that you have a lot more in common than you would have imagined. People will surprise you!

#3:

     You don't always have to talk to say something. I am a person who finds comfort in conversation but not everyone is like me.  Most of the time you will learn more about a person by watching their actions than by the words they speak. It's okay to enjoy silent company. Just because someone doesn't speak about everything on their mind, doesn't mean they don't have a lot to say. It just means that when they do talk, it really, really means something. 

#4:

     Some people you'll just click with.  You won't be able to explain why, or how, but it's a feeling that doesn't happen often. I think it's because you need something from eachother that you can only get from one another.  Don't ignore that connection. 

Nursing school is one of the most difficult challenges I have accepted, but my friends make it one of the most enjoyable experiences. And the truth is, you may not stay in touch after nursing school, or you might. Regardless, the people you meet and the friends you make will change you. That alone makes them irreplaceable and unforgettable. <3

P7693

Lesson #4: Small things really do matter.

*Disclaimer: the names used in this blog are fictional.*

P7693 was my laundry mark.  In the Air Force we were given the first letter of our last name, followed by the last four numbers of our social security number.  That number is what you wrote on everything to identify it as yours.  P7693 was mine. 

I remember one of my very first clinical days back in level 1.  I was brand new to the hospital setting and didn't know much about anything, so I followed my nurse Lisa around like I was her shadow, and I watched.  I watched and I listened to every single move she made, and how she made it, and how she said things.  As far as I could tell, she was a great nurse.  The other nurses seemed to like her, she was well organized, and always on her feet. But as I listened, there was one thing that really bothered me. 

We were sitting at the nurses station and one of the other nurses asked Lisa a question.  "Hey! Does "49" need new linens?" And later I heard from another nurse, "Don't give "64" anything, they're NPO," and "36" needs a chest x-ray ordered," and "57" is being discharged."

So I thought to myself for a little bit, and then I decided to try something to see if what I was hearing was actually true. I approached Lisa and said, "Ma'am, does Mr. Whatley need his vitals taken Q2H or just the regular scheduled vitals?"

I was hoping her response wasn't going to be what I thought it was, but here is what I got. "Um, Mr. Whatley....ummmmm....Whatleyyyyyy.....what room number is he again?"

I remember being really disappointed in that moment.  I couldn't believe that she didn't know the name of the man she had been providing care to for the past two days.  I imagined how I would feel if I was his daughter, niece or friend and heard him being referred to as "39." 

Our patients will feel more respected and valued when we remember their names.  They will feel more engaged in conversation.  Knowing and using someones name can make a difference in how that person feels about you, how much they trust you and how much they share with you.  Sometimes it's the little things that make a big difference. 

So please, the next time you find yourself or hear someone else shouting out "47", "96", "64", remember that our patients are not room numbers.  They are people and they have names.  

All For One, One For All

 Lesson #3: When you help others become successful, you will also succeed.


You will begin with 40 to 60 individuals. 

There will be men and women from all different states and some from other countries. Some will have lived in the same town their entire lives and others may be here in Kilgore for the sole purpose of attending nursing school.  The ages will vary greatly.  Some will be in their early 20s and others will be in their 50s.  For many of us, this will be our first career and for others, it may be their 2nd or 3rd.  There will be single people and people with families who have up to 8 children.  You'll witness pregnancies, marriages, divorces, births and deaths within your nursing circle.

There will be a wide range of personalities.  You'll have the question asker, the over achiever, the slacker, the coat-tail rider, the quiet one, the loud mouth, the class clown, the crier, the brown noser, the leader, the 4.0 student, and the one who is barely hanging on.

Yet among all these differences, you will have one thing in common: nursing school.

And because of nursing school you will have many other commonalities.

Only your nursing circle will comprehend the enormous amount of pressure you will feel before you take that HESI.  They will accept your moodiness from lack of sleep and exhaustion.  They know why you no longer have time for a social life or why you can't afford to go grab a few drinks on a Friday night.

Your nursing circle will understand  what it feels like the first time you lose your patient, or how excited you were to stand in on a surgery.  They will share your frustrations. They will know exactly what to say to cheer you up after a failed exam or how to make you laugh when all you want to do is quit.  You will spend a ridiculous amount of time with one another and during this time you will cry together, laugh together, fail together, succeed together, learn together but most importantly, you will one day be nurses together..

Support one another and take the time to help your fellow student nurses when you can.  If you see someone is struggling with the material because it's hard to learn 8 chapters in a week, invite them into your study group.  Lend a helping hand at clinicals, don't just look out for number one. Bring extra copies of your paperwork, use teamwork in patient care. Take advantage of each others strengths and aid with each others weaknesses. (Tom Steele is the reason I learned how to confidently use dimensional analysis and I sometimes feel like if it were not for him, I might still be in Pharmacology) Share your best study tips and be generous with words of encouragement.

You never know when you'll be the one who has a sick child at home all weekend and don't have time to complete the study guide, or maybe a family member ends up in the hospital and you don't have time to print out the required documents for the next day.  It could be you just need ONE day for yourself to keep your sanity from slipping, and you just can't bring yourself to wake up and get to school.  You may need someone to take notes or record a lecture. Your nursing circle will understand because despite our different backgrounds, beliefs and lives, we are all trying to survive nursing school.

Whatever it may be, big or small, remember that a little help goes a long way and when you help others succeed, you will also be successful.



 

Perfection Does Not Exist

Lesson #2: "Sometimes we succeed, sometimes we learn." ~Shauna Painter

I have not mastered this lesson and I have a pretty good inkling it may take me quite some time to do so, but regardless, this lesson deserves a spot at the top.

A clinical instructor once told me that I needed to work on my need for perfection, because perfection does not exist.  

Everyone remembers a time when they had to walk into their patients room, with their instructor and perform either a skill, or an assessment.  It's a pretty stressful experience.  You've got your patient laying in the bed and all you can do is hope they are cooperative while your instructor stands behind her clipboard and watches your every move from the corner of the room. I was more focused on making sure I didn't miss something on the checklist than I was actually caring for my patient.  Mostly,  I got nervous because I didn't want to mess anything up. 

I can recall starting IVs at my kitchen table on all of my friends and being successful on every single one.  However, as it would happen, the day I went to start one on my patient, I had 3 failed attempts before the nurse had to do it.  (she got it on the first try).  I was bummed out for the rest of the day, knowing that I had been successful many times before, but buckled under the pressure of trying so hard to get it right.

I learned very quickly the importance of clamping a G-tube in-between medication administration.  Not because I naturally knew to do so, but because it only takes one patient, coughing one time, for you to realize that gastric content mixed with medication is capable of projecting 5 feet in the air and hitting the ceiling.

I also learned that it's always a great idea to turn off the pump when you're discontinuing an IV because when you come back into the room to take down the tubing and bags,  it's very likely there will be a gigantic puddle of normal saline on the floor. 

Each time an incident like this happened, all I could think about was what a failure I was going to be as a nurse.  I'd say things to myself like, "geez, you're an idiot.  Use some common sense." Or "how on earth are you ever going to make it when you don't have an instructor following you around making sure you're not destroying the place." 

The truth is, we are not going to be perfect and we are never going to know it all.  There will be times when we have to admit that we don't know the answer and there will be times we will need to be shown one more time how to do something...and that is okay.

 It does not mean that we are failing, it means that we are learning.

"ZERO WEEK"

Lesson #1: There are some things in life that you can never be fully prepared for.

In the Air Force, when you first arrive on base you are greeted by screaming, angry drill sergeants.  You get off the bus in a foreign place, surrounded by strangers with blank confused stares and terrified faces.  You have no earthly clue what is going on or what the next step should be.  They call this week "zero week" and it is the week dreaded by all trainees entering the military. 

The first week of nursing school is EASILY comparable.

 I once conducted an interview with Ms. Schneider, our level one classroom instructor for nursing foundations, and asked her for one piece of advice for level 1 students just entering the program.  She said, "Don't listen to the horror stories of nursing school.  Just take one day at a time."  She was absolutely right.  Don't listen to the horror stories, they are lies.  It is FAR worse than anyone could ever describe. 

Seriously though, the first week of nursing school could be described in nearly the same fashion as hell.

What do you mean we have a test next week?  We haven't even had a lecture yet! And what is this class I have to attend for an additional 3 hours that isn't even listed on my schedule?  I am going to be up here 5 days a week? And a dress code?  No nail polish, or jewelery or colorful socks? Khakis and polos? Gross.

For someone like me, with no medical background or history, the first week was a debacle. Complete and utter chaos.  It has taken me 27 years to learn the English language and now all of a sudden I'm supposed to know the meaning of PRN and NPO?  Those aren't even words....and come to find out, the letters don't even make sense for what they stand for. 

You have no idea how to take notes, you feel like you have to write down every.single.detail that comes from your instructors mouth, you can't keep up, they use big words that you have no idea the meaning of, your hand cramps when you write, and at the end of it, you look to your new best friend on the right or left of you and realize that neither one of you have a clue what's going on.  I believe dumbfounded was a word created just for the way a "zero week" student nurse feels for the first 7 days of school. 

Lets not talk about the load of crap you are now responsible for toting around.  Approximately seven books, a computer, a purse, a lunch box,  a calendar, a skills kit bag, stethoscope, blood pressure cuff, pen light and a phone.  Oh, and you have 2 feet of table top space to organize your belongings.

If you're lucky, your school won't have difficulty with the thermostat, but if you're at Kilgore College you'll either leave the classroom as an ice cube or with pit stains.

I never knew it was possible to sit in a chair for 8 hours a day and leave feeling exhausted...like you could sleep for the next year exhausted.  Your brain never stops, they don't let it.  They bombard you with foreign concepts and tell you that from this point forward you are to critically think.  By the end of the first week, you will honestly consider rethinking your decision to become a nurse.

But stick with it, because even though there isn't a single thing anyone could say or do to prepare you for that first week, it gets better.

Better, not easier.

Oh, the things Nursing School will teach you.

You just don't apply for nursing school.  There is a process set in place leading up to the moment you actually get your acceptance letter.  For me, that process began with many derailed paths, followed by a desire to be successful.

I can't share one of those stories about how I used to "play nurse" with my teddy bear or how I "always knew" that nursing was my calling.  Truth is, I never even thought about becoming a nurse.  I never had dreams about it.  In fact, I never even considered it until the fall of 2009 when I went back to school. 

Class after class, I kept truckin' along with my eye on the prize: become a nurse, make great money. Become a nurse, cash that first paycheck.  I am guilty of looking for the fastest way to make the most amount of  money, and nursing seemed to be that answer.

Then came the day I realized I was in my last semester of prerequisites. I was nervous to apply.   Not because I was desperate and determined to be a nurse, but because if I didn't get into the program, it would mean I had failed after 2.5 years of hard work.  It meant I would have to explain to my friends and family that I, once again, had to find another career option.

I sat in my car that day and cried when I opened my packet.  I read the acceptance letter over, and over, and over again because I could hardly see through my own tears.  They were tears of joy and relief. It was a very proud moment for me. 

What I didn't realize in that very moment was that I was facing a 16 month journey.  I also didn't realize it would be one filled with many new friends, struggles, successes,  and many, many life lessons. 

So here is to nursing school and the many things I have learned here. Here's to the good, the bad, the ugly, the fun, the tears, the struggles, the friends, the teachers, the patients and the memories.