Thursday, June 23, 2005

A Speech for Graduate Nurses

This speech will be delivered by yours truly this evening at 6pm.

Good evening. For the benefit of my students and fellow nursing teachers, I’ll open by saying that I am currently experiencing tachycardia, tachypnea, and diaphoresis at the moment. For the lay people in the audience, that translates as rapid heartrate, rapid respirations and profuse sweating. Allow me a moment to compose myself.

That said, when my students invited me to be their speaker for this pinning ceremony, my first response---aside from feeling both humbled and honored---was to ask them the following question: Why, after listening to me talk for six hours a week for nine months, would they choose to voluntarily listen to me for yet another five minutes on this, their most special day? They convinced me that the invitation was sincere, and I am here today to honor them for their accomplishments.

I am sure that a vast majority of the audience gathered here tonight are family, friends, and loved ones of the graduates. The first acknowledgement I wish to make is for the sacrifices and endless hours of study and clinical that you needed to put up with as your family’s nursing student struggled his or her way through the program. As I look out at you tonight, I wonder to myself how many dinners were missed, how many games not attended, how often was your family’s particular nursing student locked in his or her room, studying for yet another exam? For your sacrifices and support, I encourage the graduates to stand and applaud you for your unerring support.

Speaking of family, several of our students experienced the loss of a loved one during this past year, and I ask for a moment of silence in memory of the family members who left this world during the last ten months, not to mention those who passed before. I believe that they are here in spirit, smiling down upon you all with unceasing pride.

Now that we have acknowledged the loved ones who kept the home fires burning while the students were battling the demons of nursing education, I would like to turn our attention towards these courageous and ambitious individuals who have been doggedly pursuing their education and professional betterment for the last ten months.

Often, when thinking of students, our minds may wander to the quintessential and stereotypical undergraduate—living in a dorm, buying food with a campus meal plan, perhaps buying clothes and other necessities with Mom and Dad’s credit card, possibly working a part-time job on- or off-campus to supplement financial aid. But these graduates sitting here in this auditorium tonight are a different breed of student altogether. Oh yes, many of these graduates have children, mortgages, rent to pay, spouses, ill family members who need tending to, bills, loans, debts, and, last but not least, full- or part-time jobs. While lecturing to this class, I was painfully aware that many students, after leaving a six-hour lecture from 4pm to 10pm, would rush home for a bite to eat, don a uniform or scrubs, and head out to an overnight shift in a nursing home or hospital, working 11 to 7, only to come home in the morning to get the kids off to school before collapsing for an abbreviated sleep before clinical or another lecture. This is nothing short of heroic, and I stand in awe of your dedication and hard work.

Having been there myself, completing two different nursing programs over the last ten years, I understand how much concentration and dedication it takes to forge ahead, even when the studying is laborious and the exams seem to never stop coming. Being adult learners, you have little time for socializing and leisure---if you’re not engaged in some type of study, class-time, or clinical experience, you are most likely helping your kids with their homework, cleaning the bathroom, or going grocery shopping. The fact that you are all graduating today, ready to be licensed professionals, is an amazing feat deserving of much praise and recognition.

It’s often said that nurses eat their young, and it’s also said that nurses are overworked, undervalued, and underpaid. Bearing that in mind, I personally find that there is nothing more satisfying for me than nurturing and encouraging new nurses to be their best and perform well, whether in school or in the workplace. As for overworked and underpaid, that may be true in some settings, but nurses are also held in high esteem in this society, and just saying that one is a nurse can feel extremely gratifying in almost any social situation. While not being self-congratulatory, nurses can count themselves as members of a profession which holds compassion, caring, and healing as three of its central ideals. Saying that one is a nurse is something I encourage the graduates to do with pride, as well as with humility.

Speaking of being a nurse, many of you may realize you’re really a nurse when everyone you know begins coming to you with every ache, pain and symptom they experience, fully expecting a definitive diagnosis. You also may find yourself washing your hands for a full minute in public restrooms and turning off the faucets with your elbows. On the bright side, whenever anyone asks for a pen, you’ll probably have three in your pocket. But it’s most disconcerting when you start checking out people’s veins for IV access while standing in line at the grocery store. Just try not to be too obvious, and refrain from touching strangers.

Despite the sarcasm and jokes, being a nurse is a noble and honorable profession, and it was a true honor and pleasure to be your professor for this past year, watching the light bulbs go off in your heads as we discussed the finer points of fluid balance and kidney function. You are a bright, kind, considerate, funny, and only moderately argumentative group, and I will miss you all very much. Thank you for your patience during my first year of teaching, and thank you for making the experience so heartwarming and enjoyable. My blessings to each of you today and always.

Monday, June 13, 2005

Oh My

The continuing saga of Rose........She actually refused to go in the ambulance on Friday night and avoided the police who were sent by Protective Services by leaving the house and staying with her daughter. The visiting nurses thought she was hospitalized so Rose missed her methadone and other meds all weekend. Damn!

Today I physically brought her to the clinic to see her primary doctor. After multiple telephone consults on the phone between us, Protective Services, and the hospital, we convinced the hospital to allow us to "direct admit" her, bypassing the ER and going straight to a room. I sent her home extracting the promise from her family that she would go to the hospital as soon as the call came that a bed was ready. I crossed every finger and toe.

At 6, the Admitting Dept called me--the bed was ready. A quick call to the daughter and Rose was on her way to the hospital, at least for a 24-48 hour tune-up while we buy time to figure out what to do next.

At 7:30, her daughter calls me on my cell while I'm at a meeting in my hometown for one of my volunteer gigs (she has Caller ID and has my cell # now)---Rose snuck out of the hospital fifteen minutes after her daughter dropped her off and was on their front step like a puppy dog within forty minutes! I pleaded and cajoled them to return, which they eventually did. Just now (10pm), I called the nurses' station on the floor where she is staying and suggested they give her some Ativan and post security at her door to keep her from leaving in the middle of the night and putting herself at risk on the dark streets. She has AIDS dementia, after all. The friendly nurse on the other end of the line agreed to bring this up with the attending physician stat. That was my 11th phone call about Rose today, and I interacted in person or on the phone with at least six other patients and/or providers in the course of the day---plus the ubiquitous paperwork which such interventions necessarily generate.

Now it's 10:30 and I ruminate. Could I have handled it better? Was my game-plan on Friday a mistake? Most likely. Will Rose get through the night at the hospital? I hope so. Will I sleep tonight? That would be nice. Does the week stretch before me like a gaping maw of unmet need and unknown crisis? Most definitely. Do I still love my work and maybe enjoy the adrenaline and drama? Is the Pope Catholic?

Well, The Daily Show with Jon Stewart is on soon. Must take a shower and settle in for some laughs. Maybe it's me who needs that Ativan......

Sunday, June 12, 2005

Mixed Emotions

My patient Rose who I wrote about recently was deemed legally incompetent on Friday due to my reporting her to Protective Services for the Disabled. Although I have mixed feelings about making such a report, I felt I had no choice based upon her deteriorating state, her children's inability to properly care for her, and the increasing risk that she and the entire building would eventually go up in flames (her bed is covered with cigarette burns from Rose nodding off while smoking).

I have been aware for months that Rose is not long for this world and I have been doing my best to put appropriate services in place. Given her untreated Hepatitis C and HIV, seizure disorder, anxiety disorder, history of trauma, and Xanax addiction, Rose's chances of survival in her current situation are next to nil, and I seemed to be the only person ready to step up and make the call that would legally change her status.

I have called the Department of Social Services once when I felt a patient's children were being neglected, and my hope was that this would lead to a better life for these children. I don't think it worked, but this has alot to do with the relative inefficiency of our state programs. In Rose's case, my hope is that a court-appointed attorney will become her legal guardian, and that she will be placed in an environment where her addiction, HIV, and anxiety can all be addressed appropriately, not by the band-aids that I continually attempt to put in place, often to no avail.

Tomorrow I return to work and hope that this situation can improve, that her life can be qualitatively improved and quantitatively lengthened, and that I won't suffer any negative consequences from taking action.

I sit here in the steamy heat and ruminate on my work, but now I must return to my regularly-scheduled Sunday afternoon.

Thursday, June 02, 2005

Small Victories

Some of you may remember Patient X from January and February postings. He is my patient who was hospitalized for alcoholic hepatitis and had moderate cirrhosis and very severe psoriasis. Well, I am happy to report that he is doing swimmingly well. He has not had an alcoholic drink since getting out of the hospital in January, his symptoms have all abated, he's losing weight, and his psoriasis is incredibly improved. He and his friends credit my weekly visits and demonstrated desire to help him for this astounding recovery. I think that my regular presence has simply shown him that others can care, and that his own self-care can pay enormous dividends. In short, this man's life is being extended---not necessarily by medical intervention, but rather by compassion, attention, and renewed self-respect.

Another patient of mine who had been seen as a lost cause can now finally enjoy having her advanced AIDS completely controlled and suppressed through the taking of antiretroviral medications. She has been free of any complications, is doing extremely well, and has energy to spend time with her school-age daughter and son. She is one of my stars.

Mr. D, someone who has failed many antiretroviral regimens due to his unwillingness to take his meds religiously, is now completely suppressed as well, with rising T-cells (immune cells) and a quantity of virus so low that we cannot measure it. He is seeing the benefits of this turn of events and looks great. His previous skin eruptions are gone and he is gaining weight. His wife--also with AIDS--has been much better about taking meds all along, and she is in excellent health. Their young children are benefiting directly from their parents' self-care.

In this line of work, we need to remind ourselves to take the time to count our successes, celebrate our victories--however small--and take a deep breath on occasion.

Today I am off from work yet again, preparing for a trip to Boston tomorrow for my son's graduation from The New England School of Photography. You, my dear Readers, will necessarily need to tolerate some photos of the happy event upon my return, not to mention gushing sentimentality about our wonderful boy---er, young man, rather.

Happy day to you all.