Saturday, September 17, 2005

More Musings on Nursing

As a thunder storm roars through the area, I set aside my school-prep and reach for the laptop. The rain spatters on the transparent roof of the porch, the smell of ozone in the air....

What a week! I have a number of patients weighing on my mind, as well as my professional life and career in general.

First, the gentleman with gastric cancer grows worse, death somewhat closer every day. This weekend they'll be starting palliative radiation in an attempt to slow the bleeding in his stomach from the mass which has grown there. The cause of his intractable vomiting is now clear: the mass is completely blocking the outlet from his stomach to the small intestine. Anything that enters his stomach has nowhere to go but back up from whence it came. His oncologist broke the news to him that he will never eat or drink again. He stared into space at that moment, a tragic realization sinking in.

We also had the very difficult discussion of resuscitation status and whether or not he wanted to be DNR/DNI (Do Not Resuscitate/Do Not Intubate). I had to explain the reality of what would happen if his heart stopped: the "Code Team" would come running from all over the hospital, they would put an artificial airway down his throat, and they would commence CPR immediately. In his condition, many ribs would be broken in the process, and it would be a traumatic and potentially violent event for everyone present. What we call a "Code Blue" is not pretty, and it is rarely depicted realistically on television. He has chosen to be DNR/DNI. On Monday, I'll go straight to the hospital and ascertain whether or not they decided to place a tube in his small intestine through which he could receive feedings and fluids, bypassing his ravaged stomach. He clearly stated that he wanted us to do everything to keep him alive and comfortable as long as possible. He has been in my thoughts all weekend.

My sweetheart of a patient recently discussed in another entry, is still in the hospital, the mass in her chest still unidentifiable after four biopsies. A more invasive surgical biopsy was attempted but aborted when her oxygen level and blood pressure began to crap out during the induction of anesthesia. We sit together in her hospital room holding hands every day as she becomes thinner and more dejected, never failing to ask me about my wife, son, and dogs, and to send her blessings for their well-being. As her face grows thinner and more gaunt, her eyes become more prominent, orbs of love and faith tinged by the knowledge of her obvious mortality and shortening life. She also will not leave my mind this weekend.

Aside from work, I now have school and teaching added to the mix. I struggle to learn my students' names, try to correct mistakes I made last year as a novice professor, and make good use of the materials created through hours and hours of preparation last autumn. Today I was able to simply edit and slightly change an exam created last year, cutting the time for preparing the exam for printing from several hours to perhaps thirty minutes. Teaching is a pleasurable activity made burdensome by the preparation involved, but as I gain experience and make us of my materials from last year, the ratio of burden to pleasure should widen.

That said, teaching gives me a way to take the nuggets of knowledge which I glean from my direct work with patients, and distill them down into illustrative stories which I can then relate to my students in a way which brings our subjects of study to life. The correlation and relatedness of my clinical work and teaching helps me to see my work in a different light, as well as to use my relationships with patients as a teaching tool.

I find my identity as a nurse very strong right now, and while I yearn for a time in the not-too-distant future when my work is not so central to that identity, I accept for now that there's plenty to learn about myself in that milieu. My greatest hope is that I will intuitively know when I'm ready to make a change and create a simpler, less stressful worklife. Until then, I bounce from the frying pan to the fire and back again, yearning for the days when I can rest on the back burner.
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