What a difference a year makes!

We did it. We’re halfway there! I don’t know about the rest of you, but in some ways, it feels to me like this school year (or is it just the past few weeks?) stretched on forever. In other ways, it feels like it was yesterday we very tentatively tiptoed into our first patient’s room.

We’ve come a long way from those days of fumbling with blood pressure cuffs and sterile gloves. We also have a lot more ahead of us–not just school, but our first days as nurses.

But for today, let’s revel in this milestone, in our achievement, and in–yes, say it with me–summer vacation. Yes, most of us have a summer course to deal with, but think of this: For 3.5 glorious months, we can sleep past 6 a.m. on Saturdays and Sundays. We can see our kids and significant others. We can enjoy barbecues. We can take an afternoon nap instead of study or write an ADPIE.

As you put (or throw) away your notes this week and reflect on what you’ve learned, think about what you’ve learned about yourself this year. You’ve learned you were stronger than you thought you were. Smarter than you thought you were. And way better at dealing with bodily fluids than you thought you were.

Then relax. Pick up a book that doesn’t have “Fundamentals” or “Clinical” in the title. Turn on the TV. Sit on your deck with a glass (or bottle) of wine. Whatever suits you best.

You, my friends, are halfway to being a registered nurse!

Carry on, angels… See you in September.

The light at the end of the tunnel is NOT an oncoming train…

… it IS, in fact, the end of the semester. Two more “real” clinical days, then that wonderful “evaluation” day (translation: get your evaluation and give the nurses goodies, then go home obscenely early), no more required classes… and a final. Savor this moment: We are almost halfway done our nursing school. It feels really, really good. Just imagine what it’s going to feel like NEXT YEAR at this time.

I’ll close with a good suggestion from my sister’s NCLEX blog: “If you’re struggling with school and especially with clinicals, it’s important to remember all the things you do RIGHT. A clinical instructor once gave me this tip: buy a notebook (a composition notebook is best, so it won’t have a spiral to degrade and snag on your uniform) and write down everything you do right as a student nurse. Did you pick up on the beginning of skin breakdown? Write it in the notebook. Patient compliment you on your teaching? In the notebook. Ace an especially difficult test? In the notebook it goes. When you graduate, you can use the notebook to review the development of your skills, and remember how far you’ve come. And don’t stop using the notebook after you pass that NCLEX…there will be days in your life as a nurse you’ll want to have some instant encouragement. C’mon, what are you waiting for? Go get that notebook!”

Do what you love

I’ve had a lot of opportunity to ponder death this semester. Sounds macabre, I know, but honestly, while it’s been tough, it has also been very refreshing and, on some level, very liberating.

I lost my father to cancer 28 years ago, when I was 14. He died in the days before hospice and and healthcare’s focus on maintaining the comfort and dignity of the dying person. Rather, his doctors focused on keeping him on alive as long as possible, even when his weight had dwindled to nothing–his clothes hanging on his 5′11″ frame–and even after the sepsis they managed to “cure” had left this man who graduated from high school at 15 unable to read or write.

I feared and hated hospitals for a long time after that. I avoided people who were dying, and I avoided friends with family members who were dying.

In recent years, I stopped fearing hospitals, but my fear shifted–I grew to fear dying myself, especially after I lost a former college roommate to adrenal cancer at age 38 and watched my sister deal with the loss of her partner to ovarian cancer. I feared (still fear) dying primarily not because I’m worried about the “after” (I’m comfortable with my faith), but because I worry about what I will leave… my kids, my husband, all I’ve done in this world.

This semester, I’ve cared for a dying patient who was able to be comfortable and communicating with his family just 48 hours before his death. I’ve cared for patients whose condition was ultimately terminal, but who refused to make behavioral changes that could improve the quality, and extend the length of, their lives. I’ve cared for a patient who refused her meds because, she said, “I’m dead already. What’s the use?”

And then I think about Harry Kalas, the Phillies broadcaster who died in the broadcast booth last week at the age of 73. And of a friend’s mother-in-law, who died in her sleep after whooping it up at a family wedding. And of the 10th anniversary of the shootings at Columbine High School.

The conclusion I’ve come to? Life is short, regardless of how, and when, you die. It’s too short to not step outside to smell the fresh air. Too short to not give your toddler “one mo hug,” or to tell your snarling teenager you love him anyway. Too short to not leave your sleeping husband a note telling him you appreciate him holding down the fort while you’re at nursing school. To listen to a coworker who needs to talk. And most of all, life is far, far too short to do something you don’t love to do, that you don’t want to give 110% of your heart to.

I still fear death, but death has taught me that what I fear most is not having given everything I do my best shot.

What are you passionate about? Is it nursing? Something else? Give it everything you’ve got–and the mark you leave on the world will be indelible.

It’s ALL on the test

Doesn’t it feel like we’ve been studying forever? In reality, it’s only been about seven months—not counting any prerequisites you may have taken. It’s the overwhelmingness of everything that makes it feel like that, right? We have seven tests behind us for this school year, but we still have two to go. And then there are the communication and pharmacology focus sheets, ERI tests, and countless ADPIEs. As Gilda Radner said, “It’s always something.” Are you thinking what I’m thinking?

When is all this going to be over?

The honest answer: Never. When it comes to nursing, Charlie Brown said it best:
“In the book of life, the answers aren’t in the back.”

In other words, we don’t need this information in our heads just to pass the test next week, or on May 13. Everything we’re learning now will be on The Test—because the ultimate test is called “Life as a Nurse.” We’ll never be able to stop learning.

But here’s the great part: Every new piece of information we cram into our tired brains creates a strong and long-lasting foundation upon which we’ll build our careers—and most importantly, the kind of care our patients need and deserve.

And yes, it will get easier. And yes, we will be proud of ourselves. And yes, our patients will thank us.

A more serious thought for a Wednesday

Saw this in the wellness blog in The New York Times, and it reminded me that “living in the now” is such a gift.

A laugh for a Wednesday

I dunno how the rest of you feel, but I texted Deb last night and asked, “Is it May yet?” I love school (really), and I’m so glad I’ve chosen nursing, but I am plumb out of energy and ambition. Thank god for the summer, when I can focus on just one job at a time…

So I could use a laugh, and thought you might be able to use one, too. My day job employees gave me a great “nurses” daily calendar for Christmas, and I thought this entry was amusing, especially in the midst of all these tests and our own individual struggles with clinicals. Enjoy:

Nursing School Survival Rules

1) When in doubt, wash your hands.
2) The correct answer is either “hand washing” or “patient airway.”
3) If it moves, ambulate it. If it doesn’t move, turn and reposition it q2 hours.
4) Remember the 11th Commandment: Thou shalt not cross thy sterile field.
5) The instructor is always right.
6) See Rule #5.

Books and a bit

So I’ve become quite a book hoarder since I started nursing school. Never one to pass up books, I of course buy them (usually used — thank you, Amazon), but then they gather dust on my shelf. Now, in addition to my hoarding habit, I have also discovered I have a compunction for purchasing books related to the medical field. I’ve found a few gems that I hope to read this summer; take a look if you can still stomach medical “topics” over summer break:

• The Gift of Years: Not exactly medical, but a new way of thinking for those of you who care for older folks in clinical (oh, wait, that’s all of us!).
• How Doctors Think: I’ve only read bits and pieces so far, but interesting look into diagnosis and treatment from the other side of the fence.
• Another Day in the Frontal Lobe: The world of neurosurgery — and how could you resist that title?
• Gilda’s Disease: A book co-authored by an oncology doc and Gilda Radner’s widower, Gene Wilder. A touching look at Gilda’s life and death–and the disease that killed her. Remember — Gilda’s symptoms were repeatedly dismissed by her doctors.

And the thought for the day, from none other than Joan Rivers, on the death of Natasha Richardson: “Anyone who doesn’t get up in the morning and say, ‘How lucky I am,’ is an idiot.”

Bad days?

Admit it. In the last four weeks, you’ve had a bad day or two (or three, four, five, six or more). You can’t go to nursing school nights and weekends and hold down a full-time job without having a bad day sprinkled in there at least every month or so. (And yes, you stay-at-home moms, you have a full-time job. You just aren’t getting paid for it!)

I had a couple of those last week, including two days down with a stomach bug and a stretch of testy coworker interactions (it happens when your company’s stock price drops from $75/share to $4/share in six months). On one of those days, after being scolded for a fairly inconsequential infraction, I was grumping to my friend Libby, who is a breast cancer survivor and a hospital chaplain out in Wisconsin. “I’m having a bad day,” I e-mailed.

Libby has the wonderful gift of saying impertinent things without insulting the person they’re addressed to. “Be gentle with yourself,” she sent back. “Ask yourself, what makes it a bad day?” It was a great response. Because first of all, she knew (knowing me all too well) that I was probably having a bad day because I was being too hard on myself (I was). But she also very quickly put it into perspective. Really, was I having a bad day? No, not really.

I thought about Libby’s comments at clinical this weekend, as I rotated into OB and worked alongside classmates I really know very little about. We all bring different skills, different personalities, and different backgrounds to our experience as student nurses. I got to know a little bit more about their struggles and their joys, and it made me realize that we do really need each other to put those bad days into perspective. We need to be gentle with ourselves—and with each other.

I received another e-mail from another wise friend, with this quote from Audrey Hepburn that really sums it up: Remember, if you ever need a helping hand, it’s at the end of your arm. As you get older, remember you have another hand: the first is to help yourself, the second is to help others.

Carry on, “Angels”!

Medication errors

When you get frustrated at how slowly our learning our meds is going, read this.

Magical moments

My sister says life is a struggle, and I tend to agree with her, in that life overall can really be tough—even for those with the resources they need to make it fairly pleasant. But one thing that’s been brought home to me in my short seven months as a student nurse is that the joy of life is in the countless beauty-filled, laughter-inducing, breath-taking moments that make it up.

Those moments help me get through the days when I’m getting up at 5 a.m. for the umpteenth day in a row, the nights when I arrive home after everyone’s in bed, and the weeks when May 2010 seems like it will never come:
• The brilliant deep reds and purples of the sunrises I’ve glimpsed on my way to clinicals.
• My toddler’s bubbly, infectious laughter at his older brother’s making his stuffed penguin talk.
• The unexpected hug from an anxious, high-maintenace patient when I say goodbye to her at the end of my shift.
• My teenagers’ cries of “ewwwwww” when I tell a poop/pee/puke/other bodily fluid story after clinicals on the weekend.
• The grin on a dying patient’s face when he asks me for a beer. (Who knew you could have that kind of sense of humor so close to death?)

What are your moments? Enjoy them. Embrace them. Share them.