Out of the Woods

Last Saturday, I took the train to New York and saw Bon Iver at Radio City Music Hall.  I've been back in the city a couple of times since I left almost a year ago (I still cannot believe it's been that long), but this time felt different.  I wandered around my old neighborhood.  I stopped by the bakery where I used to work.  I hoped I wouldn't awkwardly run into any of the families for whom I used to babysit or nanny (I didn't).  It felt both intimately familiar and incredibly foreign.  I couldn't help but wonder, as I wandered and walked and looked around, did I ever really belong here?  Was I ever happy here?

The concert was amazing.  Bon Iver is one of my favorite bands (artists?).  Anyway, the show was unreal.  And incredibly surreal.  I started listening to Bon Iver last November, late at night and early in the morning, on those infernal bus trips where I watched the rain streak down the windows and I took deep breaths to quell the pit of anxiety that knotted my stomach.  They became the soundtrack to the hardest winter I have ever lived through.  When Alix left me and I drove that night the eight hours through the frigid darkness home to my mother's arms, I listened to their newest album on repeat the entire way.  I couldn't risk hearing a single song that would remind me of the relationship from which I was so freshly torn and so I listened to the songs that had only been carrying me through the last month and a half.

Listening to Bon Iver does not make me happy.  Not in the way that listening to Ben Folds does, because it reminds me of doing dishes with my siblings when we were kids, or the way Paul Simon does, because I remember listening to him in the car with my dad, the windows open and the wind whipping my hair around my face.

But I listen to their songs, and I know that even though there will never come a time when I am absolutely, perfectly happy - just like I will never move somewhere where, magically, the depression doesn't know how to find me - I know that things will always change.  And the hard times will be, if not less hard, differently hard.  Nursing school isn't easy.  Neither was falling out of love with Alix.  But look, here I am.  Still listening and singing along.

The Beast

Mr. P, are you having any pain?
No.
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.

Another Fall

Lub-dub. Lub-dub. Lub-dub.

My heart beat pounds in my ears, and I rest my forehead against the cooler porcelain that edges the tub, closing my eyes against the bright overhead light.  The water rushing into the tub is drowned out by the blood rushing in my head.  Subconsciously, I begin to count my pulse, opening my eyelids to slits to glance at the second hand of my watch that lies on the floor, partially buried under the heap of my discarded scrubs.  Eighty-eight beats per minute.  My normal resting heart rate is around sixty-two.

Slow down, I implore the weary organ.  Please slow down.

Bon Iver plays faintly from the stereo, and I want to stay in the bathtub forever.  The water cools around me, my skin begins to wrinkle, and still I sit, wrapping my arms around and behind my knees to try to stay warm.

I blink back tears and wonder idly why I'm crying.  Why oh why can I not make it through these seasonal transitions without falling apart, I say in my head, I mean come on Cait it's fall, it's not the fucking end of the world.  It's fall, it's school, it's raining outside, it's we haven't been grocery shopping in three weeks, it's I can't see my bedroom floor for the mess everywhere, it's everything and nothing and who even knows.

The leaves have begun to blow in the streets.  In the predawn darkness of 5 AM, I can nearly see my breath.  It's fall again, and I panic.

They chose wrong.  They have no idea how wrong they were to pick me.  I don't belong here.  I will be in the 2% of my entering class that doesn't graduate.  How could they have been so stupid as to choose me?

My first patient, he's on contact precautions.  He has MRSA.  It takes me five minutes to gown up to go into his room, my preceptor nearly twitching with impatience at my ineptitude.  I find his pulse, and press down to start to count.  His hand jerks, his face grimaces in pain, and I realize that I've found his pulse on the wrist of the hand that has a fresh IV.  I want to cry, I feel so bad.  He offers me his other arm, and I take the pulse on his left wrist, awkwardly leaning over the bed.  I dig for my watch underneath my disposable protective gown, start to count, and give myself a talking-to.

This isn't about you right now.  You are going to fuck up.  You are going to fuck up a lot.  You need to get over it.  Look, he's already over it.  Get ahold of yourself.

And it's true, he is.  I take his vitals, and we talk about the operation he's scheduled for the next day.  He tells me about his fifteen-year-old grandson that called him just minutes ago to ask him to tell Nana, his wife, to make sure to drive safely home from the hospital because it was storming.  I ask him if he needs anything, make sure his call bell is within reach, and I tell him to get a good sleep because he has a big day tomorrow.  I fumble taking off my gown and gloves before I leave his room, and I idly wonder if I'll come down with MRSA from my first real patient.  I wipe my stethoscope extra carefully with the caustic bleach wipes provided outside his room.

It's 11 PM.  I feel like I've been awake for a month.

I go home, and climb in the bath.

Clinical is over.  Until next week.

And this is how we study in nursing school...

Don't ever think that your sense of humor atrophies in direct correlation with the number of hours you spend studying cardiac.  Well, maybe that depends on what you think is funny.  Give me three hours of sleep, an alarm set for 5 AM in order to study for two hours before school, and it's surprising how hilarious these will become.  

One last groan-worthy moment of (attempted) humor:

I met a boy a few weeks ago.
(This is actually true, this is not just for the purpose of making dumb cardiac jokes.)
I really, really like him.
He gives me premature ventricular contractions...

...he makes my heart skip a beat.

Four(teen)

June has stopped asking me if it's okay with me if she gets any bigger.  Come to think of it, I don't think she's ever asked me.  Girlfriend turned four this weekend.

No more lisp.  No more shy smiles.  I walk in to the party, and my once-upon-a-baby stands up on her chair, face lighting up like the sun, and proclaims, "Caitlin's here!  And I love Caitlin.  And she loves me."

"What if cake was a vegetable?" she asked me.  "And vegetables were cake?  Then we could say no to vegetables, because you can always say no thank you to dessert."  Pause to shovel spoonful of cake into mouth.  A contented sigh.  "But I would never say no to cake."

I love them.  Pure and simple.  I'll still be squeezing them onto my lap when they're twenty-five and twenty-one.

Happy birthday, Junebug.

Touched

We live in a culture where physical touch is highly charged.  Someone bumps us on the subway or the sidewalk and we - especially if we are a woman - go on full alert, shying or jumping away, clutching our bag closer and even preparing to run.  This is not a bad way to react.  Fight or flight is all too necessary in situations where people's ill intentions can put us in real danger.  There are certainly lesser degrees of inappropriate or unwelcome touch that may warrant discomfort or anxiety, if not full-fledged fear.  A stranger doesn't ask before rubbing your pregnant belly.  A new acquiantance ignores your outstretched hand and instead presses you into a long embrace.  We step away quickly, and try to reclaim our personal space.

In medicine, touch is an incredibly useful tool.  For diagnosis yes, but as nurses especially, for comfort and assurance as well.  Before this week, I had never really thought about how to touch someone.  I was lucky enough to grow up in a family that never shied away from physical expressions of love and affection.  I've been cuddled, hugged, kissed, wrestled with, and patted for longer than I can remember.  To this day, I will occasionally sidle up next to my mother, hover for a moment, and then ask shyly, "Can I have a hug?"  She never says no.  Even in the middle of cooking, she will set down her spatula, turn to me with a smile, and envelop me in the reassuring embrace that is the foundation of all that I am.

With friends too, I have been blessed with an easy intimacy.  My high school friends and I would pile into one bed together at sleepovers, wrap each other in hugs, and fall asleep on shoulders and laps during long bus rides to field hockey games.  In college, without men in our midst, I found my closest friends yet.  Friends who will be there for decades to come, holding my hand and wiping my tears, just as they did for the four years we lived on top of each other.  In the two relationships I have had, as well, I found (after some initial stumbling) connection through touch.  We figured it out, and I felt okay about it.

But I did not get to twenty-four unscathed.  Like many women, I have been bumped or groped on the subway or the sidewalk.  I have been sidled by and leered at, and reached for with bad intentions.

I have also been pushed, hard.  Held up against a wall of a dark room, by a man I did not know.  Face pressed to mine, muffling my yell for help.  Hands under my shirt, my heart thumping with terror, my legs twitching with the urge to run, trapped, touched in the most raw and violating and unwelcome of ways.

A touch like that can change a person.  For a long while, it changed me.  It's been years since I trusted a man to touch me without the bile rising in my throat and my fists clenching in fear.

As a nurse, it is my job to touch everyone.  Those who bring my easy sense of Before innocence, as well as those whose eyes widen in fear, because they, too, are part of the After club.  My touch is uncomplicated.  It carries no agenda, no complication, no desire for reciprocation.  My hands are warm, my nails short and clean.  I gently but firmly press the first three fingers of my right hand into the softness of your upturned wrist, training my eyes on my watch as I begin to count your pulse.  I palpate for the artery in the crook of your elbow, and make light conversation while taking your blood pressure.  Lastly, I rest my hand on your shoulder, while I listen closely to your lungs, asking you to take deep breaths.  And that's it.  I can read in your eyes if you want me to step away now.  That is absolutely your right.  If you want me to stay, though, I can do that too.  I can hold a hand.  I can wipe a brow.  I can be the uncomplicated, the unadorned, the unselfish touch.

After all, I know what it's like to want nothing more than that.