The First

The first birth was awful.

I wanted it to be amazing. I wanted it to make me feel like a real midwife, like I could be good at this thing that I am both in love with and utterly terrified of. Instead, this woman I was with, she was only a couple of years younger than me and she did not trust me. In hindsight, this does not faze me. I get it. I'm 26, I was doing a less than spectacular job at faking any semblance of aptitude or confidence, and she was just done. Done with her contractions, done with the baby's father talking on his phone while she was racked with pain, done with her mother-in-law asking loudly when the hospital was going to do paternity testing because she was sure, she was positive that this baby was not her son's, and of course, done with the student midwife even being in the same room as her. So I did my best and offered to my preceptor to sit this one out and merely observe, in a genuine attempt to respect this woman's wishes, and was met with deaf ears.

"This is a teaching hospital. She needs to get over it."

Um, okay. Wow.

So in the end, no one was happy. My preceptor was annoyed that I dropped my hands away from the baby's head when the mother screamed, "No!! Don't touch me!" I was done trying to walk a fine line between respecting a person's body integrity and right to refuse whatever the hell they want to refuse - including having a student catch your baby - and trying to please whichever random "teacher" I'm spending a given 12 hours with. I was shaken by being so despised, in that moment, by someone who didn't know me at all, and - I'll admit - I was hurt and upset and took the whole thing far too personally. I grazed the baby's ears as they emerged and then, a few minutes later, managed to very messily deliver the placenta with shaking hands, waiting to be screamed at again by someone (anyone, really).

Ten minutes later, we were sitting in the chart room and my preceptor says matter-of-factly, "Okay, great. So that was your first catch. Here's the birth certificate, can you fill this out? Front and back."

I nodded, smiled, and excused myself to the bathroom where I sat on the floor, shivering uncontrollably, and took deep cleansing breaths until I'd breathed out all the adrenaline and guilt and fear and disappointment and anger and confusion until I was an empty shell of somebody calm and detached and wholly unlike me. That night, in the dark of my bedroom, I finally gave in to the sharp stab of hurt at being unwanted, of being terrible at something I so badly want to be excellent at, but mostly, at feeling such overwhelming sadness and guilt that I had been a part of something awful. Of a woman having a birth that was not her own, and not what she wanted. I hated everything about my implicitness in that.

If I've learned anything so far in school, it's that resiliency is far more important than aptitude. I still hate that school is a place where I am not the midwife I will be one day. Where I jump at the chance to perform amniotomies and place intrauterine pressure catheters because if I don't do those things now, I'll never learn how. Where I'm at the mercy and whims of every single preceptor, all of whom want different things, and none of whom are wrong. Where I spend 12 exhausting hours doing labor support for a primip only to be told to walk away at 7 PM so that the ER resident can catch her baby at 7:15. But - and this is a big but - the moments of wet squalling babies whooshing out on a wave of fluid, the pulsing cords, the reaching hands, and the tears that cross every language barrier in the room, those moments remind me why I'm here.

And they're what have finally brought me back to writing, after far too long.

Long Days

I hear the whispers outside the room in which I'm sleeping.  They float through my subconscious even as my body pleads, No, no, no it's not time to wake up yet, please no.
"Mommy, can I wake Cakey up yet?"
"What time is it?"
"Almost 6."
"Okay, but be gentle."

Tap tap tap.  I feel her feather hand on my shoulder and crack my eyes open to see her smiling face.  "Hi, Sage," I whisper sleepily.  She grins and flings herself in for a hug while I try to pull myself upright.  She is so grown up in daylight hours, eloquent and mature, and achingly in between childhood and adolescence, but at 6 AM on Thursday mornings, she is my sweet warm buddy again, crawling into my lap and telling me in excited whispers about her school's hiking and overnight trip she's going on today and do I want oatmeal for breakfast and how was my clinical yesterday and should we wake up June so she can see me too?

Half an hour later, June is still not awake.  I sneak into her room, where she is splayed across her mattress, naked except for her wedgied pink underpants, blankets tangled about her feet.  I stroke her back softly, whisper, "Juney-Bee, wake up..."  She turns toward me blearily, her hair in her face.
"Mommy?" she asks.
"No, sweetie, it's Cakey."
"Cakey??!  Is it really you?"  Her sleepy eyes wide open now, she pushes her bangs away, sees it's really me and scrambles her hot little monkey body into my lap and wraps all four impossibly long limbs around my torso and squeezes till my eyes tear up.  She lays her head into my chest and sighs.  "I'm so happy you're here, Cakey.  I love you."
"I love you too, sweetness.  I'm so glad you're mine."

We eat oatmeal at the table and the chatter washes over me while I pour milk and slice apples and we talk about what to wear for school picture day and hiking trips and their mother, a former boss, and now a friend, smiles at me over their heads while I mouth, Thank you for all of this, and she only laughs and shakes her head and wraps me in another hug.

It's a long drive to Massachusetts every Wednesday afternoon for a clinical shift in a tiny community sexual health center whose two exam rooms are each big enough to touch all four walls while you stand in the middle.  I cram myself by the door while my midwife preceptor wedges herself behind the exam table and moves mountains for her patients and teaches them about birth control.  I leave with my face hurting from smiling and my stomach rumbling its emptiness.  I drive to the home of the only nanny family I still keep in touch with, where I bask in the light of being loved and needed and welcomed and family, even while I miss my own family so much it hurts.  I drive the two hours home, shower in a flurry, drive to work and prop my eyelids open for the rest of the day, momentarily panicking when I remember I have a midterm on Monday, a test on Tuesday, an assignment due Wednesday, and a mountain of work before clinical next week.

But today I got to wake up to my two favorite girls and for now that is more than enough.

Wrapping It Up

I finished my first year of nursing school, my entire RN education today.  I turned in my last assignment for Community Health.  I closed my computer.  I burst into tears.  And then spent most of the rest of today crying.  For a lot of reasons, most of which have nothing to do with school, but I may or may not have sat up in my bed this afternoon, where I had been dozing with tears leaking out of my face for the better part of an hour, thrown my pillow to the floor and said out loud, "This is NOT how I pictured feeling at the end of this year."  Like I said, may or may not have happened.  I think I just need to sleep and speak to myself in a soft, soothing voice and keep everything at a low level of stimulation for a few days until my emotions and hormones recalibrate from "past the knife edge of crazy" into "mostly normal."

Next up: pass my boards.  Gulp.

We picked thirty pounds of sour cherries...

Pitting them was a lot of work.

Like, a lot.

Worn Out

I am so tired.

It runs through my head, it's a permanent state of being by now.  People say hi, how are you, I say fine, good, thanks, how are you?  I don't say, I'm tired, I'm just so, so tired.

I wake up feeling uneasy, like I've just been unceremoniously returned to this bed and this body in order to wake up and get on with the day.  Part of me lingers in wherever I was before and I spend all day trying to remember it.  Some nights I am unconscious in seconds, only surfacing as the sun creeps through the window the next day, my hand reaches out, searching because I can't remember if I'm in his bed with him or in my bed alone.

Other nights I fall asleep, I dream vivid ghastly dreams of being alone in the delivery room, everyone has left and it's just me.  The woman grunts and I tell her not to push, just breathe, I don't want her to tear and I'm scared, I'm so scared.  I reach out and catch the squirrel she has just delivered instead of a baby and I almost drop it because it is like looking inside of Hell and wanting to scoop out your eyes rather than remember what you've seen.  The mother reaches down and cuddles the animal with its wet fur and beady eyes and I turn, vomit, start to scream and wake up.

Some nights I float in the between place, neither awake nor asleep, for hours.  As the birds start to chirp, my body finally gives up and I sink into sleep for forty-five minutes.  The alarm rings and I want to cry.

What day is it?  What time am I supposed to wake up?  Where am I?

It takes me whole minutes to find the answers to these questions.  I feel like I'm trying to pluck them out of the air - elusive, like catching dandelion fluff to make a wish.  You open your hand, sure you had it, but there's nothing there.

Am I the same person I was when I started this?  
Does anyone here even know me at all?  
Do I know who I am anymore?  
I don't remember.  
I'm so, so tired.

Birth

You know what's awesome about birth, babe?

What's that?

It's like...today was one of the biggest days of these two women's entire lives, because their babies were born, and - and - you get to be there for it.  And for me - all it is is Thursday.  But for them - it's a day that they'll never forget.  I can't believe I get to be there for all of those days for the rest of my life.

Well, I can't think of anyone better to be there for them than you.

I'm so lucky.  I just can't believe how lucky I am.

So are they, he tells me.  And I laugh because this can't possibly be my life.

And yet it is.

Welcome to the world, baby girls.  Today was an awesome day to be born.

In Like a Lamb

And then it snowed six inches last night and I lost all hope.  But no, I'm sure that spring is coming.  I have to have hope that it is because otherwise I will curl into a ball of melancholy and only poke my (freezing) nose out to breathe.

* * *

As of 5 PM this evening, when my last assignment was due, I am officially on spring break!  This means that my first year of nursing school is now two thirds of the way done.  When we resume at the end of the month, we'll be doing units in pediatric, maternal-newborn, and chronic disease nursing.  I met up with an old Smith/Boston friend tonight on her way through New Haven.  We got coffee and I excitedly listened to the updates from her end.  When she asked me how nursing school was going, I felt a little at a loss for what to say.  Everything that springs to mind sounds trite and meaningless.  I think I spat out some brilliant summation along the lines of, "It's challenging and overwhelming, but really wonderful, too," which basically says a whole lot of nothing in eight words.  The truth is, I just don't know.  Trying to talk about nursing school from right smack in the middle is like trying to describe what the ocean is when you're barely treading water and there are no boats to be found.  I still wonder if I'm on the right path sometimes.  I think quite frequently that I will never be any good at this. I say the wrong things to patients, I get angry and frustrated with doctors and clinicians but say nothing and then hate myself for standing by.  I forget information that seems absolutely essential, and I lie awake at night, loathing my own privilege and not knowing what to do about it.  Usually, I feel useless.  Often, I feel worse than useless.  Challenging, overwhelming, wonderful - I could fill pages with meaningless descriptions and not say a single true thing at all.

A Year Gone By

It occurred to me tonight as I was brushing my teeth that exactly one year ago (or pretty close, I don't remember the exact date) I was convinced my life was over.  I know that when someone close to you dies, they say that it takes at least one full year to adjust to their absence - you have to live through the pain of every birthday, every holiday, every season change without them by your side in order to fully accept it and move on.  Maybe that's a little bit true for a heartbreak as well.  When the person you loved most in the world up and leaves your side, it certainly takes more than a couple of weeks to adjust to life without them.  And though the first few months of 2012 were downright miserable, as the seasons warmed, so did my heart.  I thought of Alix on her birthday in August, yes, and I reminisced about our life together on one of my trips back to New York to visit friends.  But if I hadn't gotten to a place where I felt okay about being on my own, and where I was excited and proud to be going to grad school of my own volition, and yes, even a little bit more comfortable in my own skin, I never would have met this person.

And I will not compare them.  Because that's just tacky.  But I love that when I'm stressed about finals, he will pull out a jar of bubbles - yes, bubbles - and blow them around the apartment until he can get me to smile.  Or that when we run together, the miles slip away under our feet and with them, the worries and stresses of the day and there is nothing else, just me and him.

I don't know what the future holds, indeed none of us do.  But today seems like a fitting day to close the door on a part of my past that I am happy to leave behind.  This past year of at first overwhelming and piercing, and then lessening and dulling grief is done.  Happily, I am letting it go.  I hope that Alix, too has found a better love, that she has left her demons behind and found a path that fulfills her and brings her joy.  I think that both of us deserve that.  

* * *

And with the successful submission of my online Anatomy & Physiology final this evening, I am officially done with my first semester of nursing school!  It was harder than I could have anticipated, and in ways that I never could have predicted, but ultimately - I am so glad I am there, learning as much as I am, and one semester closer to catching babies down the road.  That said, I slept 12 hours last night and took a 2 hour nap this afternoon, so Yale, you're awesome in a lot of ways, but the amount of sleep you allow me is seriously an issue.  Let's work on that, okay?

A letter

Dear next year's GEPNs,

Your fate (as it relates to grad school) is currently being decided by my professors on the admissions committee.  I know this waiting game is nerve-wracking, but it's out of your hands now and you've done everything you can do.  You worked your butt off on that application, I know you did (because I did too).  I signed up a few days ago to host you in February when you come for your interviews, and I'll also be speaking to you as a current GEPN when you split into these little sub-specialty groups, also on your interview day.  But I have something to tell you now.  And I will tell you this again and again. And you might look at me as someone who is not even finished with her first semester of nursing school and roll your eyes and wonder what in the hell of value I might have to share with you (and you would probably be right) but bear with me.

I am here to tell you that the culture of nursing has to change, and it can change, and it is changing, and you are part of that.  It starts with us.  It begins with us, as nursing students.  It goes like this - for a long, long time, nursing has been about "eating your young."  I'm not going to get on a soapbox as a baby nursing student and say a lot about the value of how preceptors and instructors teach us, but what I am going to say is this, so listen closely:

You need to take care of each other.

You need to.  It is nonnegotiable.  Other graduate programs might be about competition.  They might be about beating each other out for opportunities at internships and jobs, and they might be about proving yourself to your instructors and your peers.  I wouldn't know.  I wouldn't know, because I chose a profession that is built on a foundation of caring and that begins with how we take care of each other.  You will hear Linda make offhand references to getting close to your clinical group members, or you might hear older students talk about the connections they've made within their specialty.  That is not enough.  Hear me now, and hear me good - when you show up to Yale next August, you are not alone.  You are not an island.  You will not survive, you will not thrive, you will not be happy if you try to be an island.

You need to hold someone's hand when your first MedSurg test grade is posted.  You need to be able to look at someone in your clinical group and with only your eyes tell them that you need help bathing this patient, that it is too much and too hard for you to do alone and they will do it.  You need to be able to go hide in the bathroom at clinical and cry for two minutes (and two minutes ONLY) and know that they will cover for you.  You need to be able to study with someone (or multiple someones) late into the night before your test, and you need someone to tell you to take deep breaths and help you brainstorm nursing diagnoses for your care plan for your patient that is dying.  You need to be these things for your peers.  You need to be brave, and do these things even when they don't come easily to you (believe me, they do not always come easily to me) because as much as you will hear other people tell you during interview day and orientation and over and over again that you need to take care of yourself (and this is true, you do) you need to take care of each other, too.

You will be a better nurse because of it.  You will be a better person, too.

I wish that someone had told me this when I started.  Because I am fighting to make this true now.  And I am fired up about it, in a good way.  I was lonely and sad last week, and wallowed for a day and then stopped.  Because I am not the only one that is lonely.  We are all orbiting around in this incredibly hard new universe, feeling lonely and tired and scared and alone.  It doesn't need to be that way.  I know it doesn't, because I stretched and bent and reached out and I didn't break and things are better and it can be that way for you too, from the very beginning, not just starting in December.

Take charge.  Take care of each other.  Be each other's best resource, be the person someone calls in the middle of the night, be the best version of yourself that you never knew you could be.

Because nursing school is a long road.  But it's a hell of a lot more fun when you've got great people on the road right there with you.

Love,
Cait

The Blank Page

The second-year specialty midwifery students (me in two years) are officially done with "school" tomorrow - in the spring, they do an extended internship/job situation where they work as a midwife under a preceptor before graduating in May.  At a send-off dinner for them tonight, we sat around and listened to stories and memories of their last two and a half years here at Yale and I sat and thought two different things, overlapping in my head like two lines of melody in the same piece of music.  One was, "That's only two years away, and that will be you.  Holy shit."  The other was, "What makes you think that you will ever be up to the task of doing this thing, this sheltering and fostering and holding and catching and guiding of new life into this holy glorious fucked up world we are in?"

I don't know if I will ever stop grappling with that second question.  Truthfully, I don't think I ever should.  Because birth is a small thing, yes.  It is everywhere, it is billions upon literal billions of people.  It is over and over and over, the hormones and bones and muscles and breathing and work and sometimes it goes horribly wrong, but mostly it goes so right that it becomes just another whisper in the babble that never ends.  And sometimes, I can picture myself doing it.  I can see how it might look, and I can see students like those I saw tonight, who are doing it and have done it and look, Cait, yes it's a real thing and it will happen to you because you are here and that is why you are here.  But so much more often, and probably for years to come, what I feel more is the vast and gaping space between my fierce intention and my complete and full acceptance of the knowledge that this is just all so much bigger than me and bigger than I can catch and bigger and scarier than anything I could ever do.  And how on earth did I think that I could be that person, catching life and bringing it in?

Because birth is also huge.  It is everything.  It is the dark and terrifying tunnel, it is the orbit, and it is the way out.  It is endless hours, the single moment, it is the breaking down and the building back up.  It is sometimes the end, but it is so much more often the beginning of the very beginning.  The very first page.

There is something that I repeat to myself a lot, ever since starting this program.  One of those things is that, "Done is better than good."  This helps, sometimes a lot.  But another is this: The first and most important thing you need to do is show up.

You have to show up.  That's always the first step.  There are steps beyond that, and they might be hard, and you might never feel like you were ready until after you've done your first (or tenth) one.  But you have to be willing to show up.  You have to be willing to write the first page.

To Be Here Now

A few weeks ago, I took the train to New York to see my dear friend, J.  It was a week after Superstorm Sandy devastated the East coast and they had managed to turn a post-Halloween costume party that was doubling as a birthday party for one of their dogs into a kind-of-fundraiser "Wear a Costume and Bring a Canned Good" party that extended the promise to lots of friends that if we provided food and booze, then they should donate a little something to the hurricane relief effort.  Oh, and everyone had to wear a mustache.  (We provided those too, lest anyone show up and lament that they couldn't wear a mustache because they just didn't own one.)

Sitting on the couch, chatting with a friend of theirs whom I hadn't met before, he said something and I replied something about one of my patients from the week before.  Then this happened:

Him: Oh, where do you work?

Me: Oh, I'm still in school, in nursing school.

Him: At NYU?

Me: No, no, I live in Connecticut, actually.  I used to live in the city, which is how I know these guys.

Him: Whereabouts in Connecticut?

Me: Um...in New Haven...

J (from across the room): She goes to Yale - Cait, you go to Yale, it's okay to tell people that!

Enter me blushing furiously, and why, exactly?  I mean, yes, I go to Yale.  But I go to grad school there, which is something that - at least in my head - is fundamentally different than coming out the other side of the lions' den that is their undergraduate admissions process.  For whatever myriad of reasons, I don't talk about where I go to school.  I don't like the connotations that the name carries, and I certainly don't think it lends me any extra clout or prestige in the nursing world.  But grad school itself (nameless or otherwise) is something of which I am intensely proud.

College was a given in my family.  Not because either of my parents finished their own college educations.  And certainly not because we could afford to be sending all seven children on to four years of post-secondary education.  No, purely because my mother was bound and determined that we would all be given the best possible future she could muster for us and so out went the TV, in came the homework and the extracurriculars and the part-time jobs and the wrinkled-up cried-over admissions essays but by golly, she did it.  We all went.  Every last stinking one of us.  And by the time I was old enough to be aware of it, the standard was set: I was going to college.

Grad school, on the other hand, was up to me.  From start to finish.  And there are days, still, where I look around at my life and I think, holy shit and Is this real? And it is!  It is real!  I actually am in grad school, becoming a nurse, and then later becoming a nurse-midwife and it's so freaking cool that it still makes me smile.  I am proud of myself for being here.  That I got myself here, all by myself.  That I'm doing this with my life.  And that when the question arises: What would you do with your life if you could do anything at all?

My answer is this.  Exactly what I'm doing right now.

30 Days Hath November
Day 01: A place I'd like to travel.
Day 02: A favourite movie.
Day 03: Something I never leave the house without.
Day 04: A friend I adore.
Day 05: My hometown.
Day 06: A book I'm reading.
Day 07: A song for the day.
Day 08: Three inspirational quotes.
Day 09: A close-up of my day.
Day 10: A favourite recipe.
Day 11: Three years ago today.
Day 12: The last item I purchased.
Day 13: Something I'm proud of.

Pages and Pages Before I Sleep

Far be it from me to call reading about diabetic ketoacidosis boring.  Me?  Never.

There are 1,577 pages in my Med/Surg textbook.  I saw that number on the day I brought it home from the bookstore and sighed a sad sigh as I looked longingly at my bookshelves.  Someday, when I have graduated, I will read for pleasure again.  In the meantime, I keep some of what I wish I could read by my bed, essentially as talismen.

Someday.  In the meantime...from page 841:

"...[The] hyperosmolality of the extracellular fluid characteristic of diabetic ketoacidosis leads to the stimulation of thirst with resulting polydipsia, and fluid shifting from intracellular to extracellular space.  The sodium shift that follows is referred to pseudohyponatremia..."

30 Days Hath November
Day 01: A place I'd like to travel.
Day 02: A favourite movie.
Day 03: Something I never leave the house without.
Day 04: A friend I adore.
Day 05: My hometown.
Day 06: A book I'm reading.

There are three holes

I had three exams in the last week.  One after another - boom, boom, boom.  As the days whipped by and I had less and less time to study for each subsequent test, I swear, it felt like my head was screwed onto my neck just a little too tightly, and if I turned even a bit too quickly, it was going to fly off and I was going to explode.  By the third test, all I had time to do was study for 24 hours straight, with a ten minute power nap the morning of, that I awoke from in a blind panic, drool hanging off my face and terrified that I had missed my test.

So maybe it was the severe sleep deprivation and strong feelings of whiplash that we were all experiencing, but today, during seven straight hours of lecture and lab - medication administration, IV tubing, blood transfusions, and catheterization - professionalism and decorum had all but worn off.  So when my med/surg professor grabbed the decoy penis off the table and started telling us that, "Cath-ing a man is so friggin' easy - I mean, come on!  It's staring right at you, saying, 'Here I am!'" - let's just say, I was not the only one laughing.  Within minutes, I was in tears.  Still from laughter, I promise!

"Now, for men, the psychological pain is much worse!  If they didn't know that you were putting a pipe in their penis, no sweat.  But the minute you hold up your little red catheter, they start to sweat, and you'd think you were asking them to bend over and close their eyes, if you know what I'm saying."

"Now, for women, what you've got to remember is that you're not going to be cath-ing a cute little 24-year-old like all of you!  Nuh uh, you're cath-ing an 84-year-old who had six children and can't hold her legs apart.  So that's why you bring a friend.  Someone for the legs."

"Now, if they have fistulas, you're gonna pick the wrong hole.  Usually, there are only three holes.  Are we clear on that?  Everyone?  That there are THREE HOLES??  Okay, good.  Well, for a lady with fistulas...there might be six or seven holes.  So you're going to be all up in there, so damn proud of yourself because you got your sterile gloves on without touching your hair or the bed or the patient, and you're going to find the hole and stick that baby in and you're thinking, no sweat, I got this, and all of a sudden that catheter is peeking back out at you because you picked the fistula hole and now it's on its way back out and oh my dear god, you should see your face when that happens!  You all just about poop your pants.  Funniest thing.  But it's okay!  You just leave that catheter in and try again with a fresh one.  Once you get it in the right hole, you pull out your wrong ones.  One time I had a student go through eight pairs of gloves and four catheters.  You can't possibly do worse than that."

How's that for encouragement?

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.

Cliff Jumping

A new friend and I were walking to the shuttle stop after the end of our first day of class yesterday (Was it only yesterday?  I swear, it feels like it was a week ago.).  Our collective nerves were crackling like live wires as we tried to wrap our heads around, well, everything.  "I feel like I'm standing on a cliff," I burst out.  "And, it's like, I climbed up here on purpose, I struggled up the freaking mountain, I did everything I possibly could to get out to the very top of this cliff, with the idea being that I was going to jump off, and now I'm here, and I'm so scared and I don't want to jump!  I desperately do not want to jump."
"Yes, exactly!" my new friend agreed, and we elaborated.
"And even though you know, you know that you'll be okay in the water down below once you jump, you know that you'll figure out how to swim and you know that climbing up to the cliff was the right choice, right now, it feels like the last place you want to be."
"But you can't go back."
"Nope."

I want to be in nursing school.  I really, really do.  But when I think about how for the next three years, there will always be homework to do, and how for the rest of my life, I will be taking people's lives in my hands and doing the best I can to care for them and I will not do everything right, and people will hurt, and people will die, and there is nothing I can do about it - when I think about that, oh you have no idea how badly I want to turn around and scamper back down the mountain to my nanny jobs and my no homework and my few responsibilities.

The leap from the cliff has already begun.  Classes started yesterday, and along with every single thing I learn, comes the more terrifying reality of how incredibly little I know.  Yes, I now know what the risks of IV feeding are, and why we are sleepy after we eat, and what the difference is between the pharmacokinetics and the pharmacodynamics of a drug.  But I sure as shit don't know what to say to a patient who has just been given six months to live.  I don't know how to comfort a mother whose child has just been diagnosed with cystic fibrosis.  I don't know how to feed someone who has leprosy and gangrene without gagging, I don't know how to take care of a dying baby without crying, and I don't know how to come home when faced with all of the ways I can't help my patients and get up again the next day still committed to help in the ways that I can.

I will walk into the hospital next week for my first clinical shift.
I will be assigned a patient.
I will walk into his room, introduce myself, and tell him I need to take his vitals.

And with that, the leap will be complete.
Yes, the water is rushing to meet me, but I'm going to try to enjoy the flight.