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.

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.

Nurses Treat People

Orientation lasted all of this past week, and by Wednesday late afternoon, we were fading fast.  Put 82 nervous, exhausted, hyper-caffeinated and tremendously awkward graduate school students in a windowless lecture room for three days straight, eight hours a day, and by the third day, it will all start to fall apart.  By the time we had been herded into room 118 one more time for this, our last presentation of the day, nobody much cared who it was we were listening to.  Turned out it was the chief of police, which meant we all sat up marginally straighter and propped our eyelids open with a little more effort.  The chief of the New Haven police department spoke, and then so did the chief of Yale Police, and then we watched a slideshow about how to use the emergency call boxes, and then we heard a speech about not walking and texting (yes, I'm serious), and then it was almost 5 PM and we all wanted to cry.  My butt was numb.  I was starving.  The room had started to quiver as people furtively began gathering their things as it became clear that the presentation was coming to an end.  The chief of New Haven police stood up one more time, a burly and intimidating man to say the least.

"I want to say one more thing, before we go."  The shuffling got more furtive, and a few whispers were shushed.
"I have to tell you all, we do at least thirty presentations like this at the beginning of each academic year, and I mean it when I say this to you - this, coming here to speak to you all, is my absolute favorite."

The shuffling stopped.  Silence fell.

"I've been a cop for more than thirty years, and there are two kinds of people that I respect more than anybody else: my fellow officers, and nurses.  I've known a lot of nurses.  Hell, most of the cops I know are married to nurses.  We go into these fields for the same reason - we want to help people and keep them safe.  There will be people that don't appreciate what you do, just like there are people that don't appreciate what cops do for them.  Don't ever think that I - or any of my fellow officers - are one of them.  What you all, as nurses do for people is beyond anything I could imagine.  I talk to doctors, to surgeons, to the incoming medical school students every fall - let me tell you, there is no one, no one like you all.  Don't you ever forget what a special job you all have.  You have the respect of me, and every single one of my fellow officers.  We all know that the saying is as true as they come: doctors may treat patients, but nurses - nurses treat people.  Thank you for your service.  We are all so grateful."

The silence rang long after he finished, and there wasn't a dry eye in the house.

Unrest

Our usually peaceful household has been well, a lot less peaceful over the last few weeks.  The unrest is separate from the stress of moving and unpacking (which is largely over), as well as  the seemingly small yet strangely exhausting tasks of buying silverware, lightbulbs, groceries, car insurance, etc, all in a new place.  It also has nothing to do with the potential for adjustment that the Nanny and I might have anticipated from transitioning from living in the same building in separate apartments to now living in the same apartment, in bedrooms connected by a Jill-and-Jill bathroom (I figure it's only a Jack-and-Jill if there's a Jack involved.).  No, this unrest, this disruption to the calm, this excitement, if you will, comes from one creature, and one creature only.  Tucker.

Photoshop skillz by Nanny

Tucker, as it turns out, is having a midlife crisis.

I can think of no other explanation.  Though he seems a bit young for such a major life event (he's four and a half), I can no more deny his emotional turmoil than I could deny the truth of global warming (which, depending on your political leanings might not be all that demonstrative of a comparison, but I digress).

He meows at all hours of the night, his dreams apparently disrupted by his own emotional duress.  My bleary explanations to him that there is food in his bowl and that his litter boxes are clean are met with stony glares.  Obviously, I don't get it.  I go back to bed, obviously indifferent to his pain.

During the day, despite frequent exercise chasing his toys, he'll tear around corners in the house after his sister, Lucy.  How dare I infantilize him with my pathetic offering of yarn toys, anyway.  Only after Lucy has exhausted herself running away from him will he occasionally settle down for a one-eye-open nap.

He graces us with his regal presence anytime we go into the bathroom.  Don't try to tiptoe so that he won't hear you.  That's insulting.  Are we less than thrilled to have a furry, purring companion during all bathroom activities?  That's absurd.  Soak up the love while it is given.  Turn on the faucet too, in a small, yet steady stream.  Make sure it's not dripping.  Leave it on for as long as he needs it.  Don't pretend you have something more important to do.

He retires to rest again.  After all, nighttime will be here soon, and with it, a new chorus of mournful meows.

Perhaps this would all be solved if I could afford to buy Tucker a red convertible and some expensive sunglasses.  Doesn't every hardworking man deserve some fun?  A chance to cut loose?  To leave his responsibilities behind?

Tucker, your six-dollars-a-bag organic dental treats are going to have to do for now.  Sorry.

Love,
Mom

Are We Home Yet?

Home is a difficult concept, yes?  It is charged.  Mostly with expectations.

Expectations for who we are when we are there, as well as expectations for what home should be like, always and unchanging.  Unrealistic, of course, because everything changes.

The sky changes, every day, and we hardly notice.  But enter the house whose very consistency and constancy you cling to, and a new chair, or a different rug can make your whole world feel off-kilter.

I have a tattoo that says, "I am home."  Like a lot of tattoos, this one says something that I claim to believe but really, probably is more like something that I want to believe.

I want to feel at home, wherever I am.  In my body, and in the world at large.  Often, I don't.  Usually, I feel like the world is one big whirling party that I'm too scared to join.  Or, if I do join in, I become some caricature of myself that mirrors and compensates and bows to every idea or influence or person and I long to jump back out, to catch my breath, to stand at the window and watch some more.

Home is a lot of things.  It's the big things, like a structure, with doors and keys and a mortgage or a rent payment.  And it's the little things, like a clock on the wall, a plant in the kitchen, and a cat on the bed.  It's the people you invite in.  It's the food you cook, the arguments you have, the tears you cry.  Mostly, it's the time that it takes for all those things to happen.  Just like a relationship doesn't blossom overnight, a house is not a home without some settling of the dust.

Patience is not one of my virtues.  Suffice to say, I would never get a tattoo that claims I am so.  But few things change with the rapidity and spectacularity of a sunset.  If they did, would we appreciate them?  Would we even notice?

I'll leave the porch light on.  We'll see who stops by.