Friday, August 27, 2010

Return to Nursing 1988

I left nursing to become a full-time mother, and by 1988 I had three children, a son age 9, and two daughters, ages 7 and 3. I loved motherhood; we spent long hours at the park and library, and made ceremony of bedtimes and snowy days. The children caught insects and had the usual lineup of pets; rats, toads, & an ill-tempered box turtle named Mort. I was a big fan of finding new things for the children to try, especially during the interminable summer breaks. This year was radically different, though; my then-husband had been laid off for several months and after a month or two of dithering I decided I'd better take the nurse refresher course in case I might need to work as a nurse until he found another job.

A nurse refresher course was readily available through my old college nursing department, and with very little ceremony I found myself sitting among 24 peers, listening to day-long lectures on body systems. I did surprisingly well on the tests. I had not wanted to go beyond nursing school in college; this experience made clear that I could do the work. After a month of study, we were required to do 2 weeks of clinical experience, which I also passed, and then I had to do the thing I least wanted to do in life; leave my children and go out to work. Because I was sure I would not stay at any job for long, I didn't apply at a hospital, but chose to work for two agencies. They sent me out to do whatever was available; staff relief, nursing homes, private duty, and home care.

The paycheck was about the only good part of the experience. Despite taking any work offered to me, I didn't make enough to pay all our bills, a fact my husband reminded of every time a bill came in. Rotating shifts was bad enough, but leaving the children in the hands of their father who might--or might not--maintain their daily routine was very difficult. I would call home and ask, what are the kids doing? "I don't know; they're outside." "Where outside, what are they doing?" I don't know," he'd say, "I'm working on the porch."

The children hated the whole idea of me working, and their natural energy demanded a response I couldn't give. It seemed to me that they were all lined up with their hands out; one wanting to play, or tell me a story, or show me a picture, or ask me when is payday. I remember coming home from work one night so tired and depressed all I wanted to do was have a shot of whiskey (make that several shots) and go to bed, to find we had drunk all but the last three drops. There was no money to buy more. I broke down and cried.

I worked 3-11 so I could spend part of the day with the children, but found it hard to get up in the mornings with any enthusiasm. I worked 11-7 when it was all I could get, and even did a few 12's, which I found utterly draining. Oddly, I didn't have the energy then that I have now. I also worked staff relief in a hospital gynecology/oncology unit, which was the first place I ever used an automatic BP cuff and O2 saturation monitor. The patients tended to be frequent fliers, and many of them had perfectly horrific fistulas, obstructions, and non-healing infections.

I recall one of my favorite patients returning with a possible bowel obstruction. I got the order to put in an NG tube. I laid out the equipment, explained things to the patient, handed her an emesis basin, and began to pass the tube--whereupon she hosed us both with about 500ml of stomach contents! I managed to get her a wash basin for the second round of emesis, and between heaves the patient apologized profusely. "No apology needed," I said, managing a smile, "Looks like you really needed that tube!"

I also worked the general surgical floor, which was a nightmare of heavy patient assignments. One end of the floor held oncology patients who were admitted for chemotherapy, which was administered with much cautious preparation by a harrowed RN named Stella. Many of her patients had nausea and were generally miserable, which kept Stella running. I did a number of shifts in orthopedics, which I liked. It took no more than a few overwhelming evenings on the GU floor to understand why they had a chronic staffing problem; the patient load was heavy and the patients' conditions subject to rapid change. Oddly, it was there that I met my first Cystic Fibrosis patient. On most units where I floated the staff was happy to see me arrive because I was filling in, but no unit seemed like a place where I would spend one shift longer than necessary.

Home care was a bit better. I found my natural empathy went a long way toward calming patients and most of them liked me. I remember heart patients and chronic kidney patients, and a bowel-obstructed oncology patient whom I connected to TPN every night. I once arrived to start an IV infusion for a troubled young woman and I needed to take vitals first. Damn; that day I had left my nurse bag containing the BP cuff etc., at home. I knew I was in trouble when I phoned then-husband and asked him to bring me my nurse bag, and got the truculent reply, "What do you need it for?" I was on the patient's phone--which was in her room--trying to maintain a calm, professional, demeanor while I wrangled with him and the minutes ticked by. Finally convinced of the importance of having my equipment, he consented to bring me the bag. As always, his attitude was that his work, whatever that was, was "important" but whatever I was doing was not.

In home care I met Luke, my first AIDS patient, who was being cared for at home. Luke had a Hickman catheter, and I recall spoiling more than one Tegaderm trying to stick it to Luke's chest and not itself. After awhile, we became something like friends, as much as could be expected considering neither of us was where he wanted to be. I often thought I did more for his family than for the patient, for I was able to provide them emotional support during that difficult time. I had cared for Luke for several months when I stuck my finger trying to close a sharps box in his room. I went to the bathroom, poured bleach over the finger, and forced it to bleed. I forced myself to breathe slowly, remembering a prayer someone once prayed in extreme circumstances; I prayed, "Jesus."

The needle had been on a saline flush syringe, which greatly reduced the chances of me coming in contact with an HIV virus. I couldn't go back to Luke's after that. Everything was a haze of HIV testing and months of gut-wrenching worry. Luke's family was devastated. That was when the irritable bowel syndrome began in earnest. "All I wanted was to earn enough to feed my children; I can't believe I could die for it!" I said to myself, although it never came to that.

Catastrophe always goes in threes. At the same time I thought I might be pregnant, and not long after, our Aspen wagon caught fire in the parking garage. Fortunately, a security guard saw it and called the fire department. The catalytic converter had burned itself out which only happens once, so don't worry, our auto mechanic said cheerfully. Two weeks later, in the same parking garage, the Aspen caught fire again and this time it burned out the entire auto interior; no one noticed.

There was a steady stream of chronically ill home care patients, including two children under the age of 3. Both had been born prematurely; one was expected to live, and I spent long nights caring for her. The family living room was overflowing with the baby's crib and equipment which included apnea monitor, continuous humidified O2 to her tracheostomy, and G-tube feedings. She was an irritable child who would not suck or feed or do much else except grasp occasionally and stare at tv; she never smiled and had an eerie noiseless cry when displeased, which was often. Some nights I looked at her and wondered whether the parents, who had gone so far to save her life, had not saved her for a life of abject misery.

My other patient had obvious developmental deficits incompatible with living to school age. Obvious, that is, to everyone except his mother, who had given up everything including her marriage to "save" her baby. I stood in this child's room where he was surrounded with soft colors and beautiful plush animals, listening to Mom explain his care. Her unresponsive son was an edematous respirator baby, about the size and consistency of an oversized doll. His world revolved not around his furry menagerie but the tubes forcing air into his unwilling lungs. Despite Mom's chipper narrative and affectionate attentions, his response never advanced beyond blank, open eyes. Through experiences like these, I came to understand that medical science has a long way to go and while it knows how to prevent death with devices that can perfuse the body's tissues almost indefinitely, that is not at all the same thing as living.

The year 1988 ground on as I redeveloped nursing senses & saw all sorts of patients. It was my personal opinion that I still lacked some element of knowledge or attitude that would have made me a good-enough nurse. Add to that the fact things were going no better at home, I was chronically exhausted, and I was just holding on until my then-husband got a new job so I could go back to motherhood. Over the few next years, I enjoyed some aspects of nursing, but had an abiding animus against nursing as a career; it took me a very long time to understand that nursing was not really the problem.

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