Thursday, September 27, 2012

The Beast

Mr. P, are you having any pain?
The answer is soft, his eyes barely flick upward from his lap where his hands are resting, the 22 gauge IV port jutting out from the back of his right hand, don't touch that, I remind myself and steer my trembling hands almost comically far from the site.
I search for a pulse on his left wrist instead, reaching my hand underneath the nest of blankets he has created in his bedside chair.  His left arm is so swollen with fluid that my at-first tentative fingers leave indentations behind when I'm finally done counting his pulse.
His lungs are hard to hear, I cannot ask him to lean forward, so I struggle to listen for crackles while his heart thuds distractingly in the background.
Ventricular gallop, the words crystallize in my brain from his chart that I studied until 2 AM this morning, my eyelids dry and scratchy, my stomach sick from too much coffee.  2/6 murmur, audible at apex.
I lean over him further, reaching my stethoscope under his left arm, feeling my inadequacy like a beast, like an animal that roars and sheds and drips and makes its presence known and fills the room and I can't breathe, it's so loud, it's everywhere I am, and I am trying to remember, The base of the heart is called the apex, who the hell comes up with these things, is that the same place as the point of maximal impulse, which is the same as the apical pulse, which is at the fifth intercostal space in the mid-clavicular line?
The room is dim, but his gown slips and I see, I see the hematoma from his pacemaker insertion a month ago and the two fluid draining operations he's had since then that removed gallons of fluid infected with yeast, the pacemaker lead that had irritated the pericardium and filled his chest so full that he could not breathe, his eyes went wild, he sat on the edge of his bed and gasped for a day before the surgeon cut him open.  The bruise is huge.  It's bigger than my pinky to pinky with my thumbs touching.  It's purple and brown and I swallow, hard, remembering his answer to my first stumbling question, Do you have any pain?
He said no, he said no, he said no.
I stub my toe on my bedpost, and I swear a blue streak and fall into the fetal position on my mattress.
I bang my hip on the kitchen counter and I whimper like you just kicked my puppy.
How can he not be in pain?
I rest my stethoscope as lightly as I can over where I think his apical pulse should be, my own heart is beating so loudly in my ears that I can barely hear anything else.  I listen, hard, concentrating all of my energy into trying to find the extra sound.  I hear nothing, and the writhing, room-filling animal of my ineptitude licks my leg and I want to cry.
I gently pull up his gown, and readjust his blankets.  I notice his untouched dinner on the tray table and remember more of his chart, Patient is severely malnourished, nutrition consult order of 1725 kcal per day, goal of 65 g of protein per day.
His wife sees my glance, and shakes her head.
He's not hungry.  He just wants to sleep, she tells me, and glances pointedly at the door.
I start to ask, Is there anything that you need? but the words die on my lips because it is so obvious, so unbelievably clear to everyone here that I have nothing to offer.
I leave my gloves in the trash, and the beast follows me closely, panting at my heels, as I slip out the door.


I want to be clear about something - I expected nursing school to be difficult.  In ways both predictable and not.  I hoped that I could bring something to the table, but I had no fantasies or imaginings in which I was anything more than awkward and well-intentioned, especially in clinical situations.  Whether or not this was realistic, however, I also expected to be able to learn.  I hoped that my willingness and eagerness to learn would be what was needed in order for my instructors to teach me how not to be useless.  In that, I was wrong.  Hopefully not forever, but for now, and for the next four weeks, yes.  I dread Tuesday and Wednesday nights with a ferocity that scares me.  I sit in my car outside the hospital and hyperventilate until bile rises in my throat and black spots appear in front of my eyes.

There are some things that I have been able to teach myself - how to knit a scarf, how to survive in the real world.  How to be a nurse is not one of them.


Anonymous said...

hi caitlin

i'm a long time reader of your blog :)

as a third year med student, you and I have a heck of a lot in common with respect to feeling completely and totally useless as students.

Every time I go see a patient and have to poke them 20 times because i keep missing the vein...or when I swear on my life I can't detect the extra S4 sound even though I forced the poor patient to move in 20 different directions in an attempt to hear better...i feel totally useless, incompetent, and quite frankly unsure as to why I even chose medicine as a profession. But then of course I think about it some more and realize that I chose medicine probably for some of the same reasons you did...the free coffee, and the fact that we look like hot shit wearing stethoscopes.

...I'm kidding of course (sort of)...we're obviously here to make a difference, to dedicate our lives to giving and bettering the lives of others, and we're here because we want a profession that will both challenge and educate us.

Just from reading your blog and seeing how incredibly strong you are as a person, I know you're going to be a fabulous nurse someday soon. Just keep a positive attitude and get out there and kick some ass!!!

best of luck!

PS - have you seen this?

Allison the Meep said...

Nurses and doctors are amazing people and I don't know how you do it. My mom is a nurse too, and she used to come home and tell us stories about people that she helped, and just the stories made me cry. How you manage to put aside your emotions and just care for the person in the room and be fully present is really something I can't grasp, because I don't think I would be strong enough to do it.

Anonymous said...

In your first few months and years of nursing school, you should be useless. If you could do everything, then there would be no need for being in school in the first place. You're supposed to make mistakes and struggle and hit rock bottom, so that you can pull yourself back up and be the best damn nurse you can be. And all of the struggling and fighting will make you a better person along the way.

No one ever said it was easy. In fact, everyone says it's hard. But you do it because no matter how hard it is, it's not as hard as being told you have cancer and having no one there to support you, or finding out you have 3 months to live when you thought you had forever, or spending 3 nights of your week getting dialysis and just hoping that one day someone might give you a kidney...maybe. You do it, because some people's lives are just harder than you can ever imagine and you realize that no one deserves that. And you realize that you are in a position to do something about it. Right now, you can't do a lot. But no one expects you to. You're expected to fail and to learn from failure until one day you reach the other side and join the ranks of those who are making a difference every day. Some days the differences are small and some days the differences are huge, but you keep going because any difference is still a difference.

You know that you are capable, you just have to keep pushing.

Cait said...

Thank you, everyone, for your words of encouragement, humor, and much-needed perspective. One day at a time, right?