From Rock Bottom to Cloud Nine

Two years ago, I lay as a heap on the floor, crying and hopeless. The enemy of my soul whispered to me that my life was not worth living; that things would never get better, only worse. I had reached rock bottom and had no where to turn. I was isolated, trapped in my own thoughts and fears, hurt, and empty inside.

Each day seemed worse than the one prior; I had nothing left within me.

In a journal, I had written: "I find myself in crisis. False accusations. Lies. Pain abounds. My heart bleeds. I feel like a walking wound; seeping, hemorrhaging, about to cave. I maintain a facade; people think I am 'okay' but, I am not."

However, I had one promise from God that I clung to; it was, at times, the only thing that kept me going; a promise the Lord had given to me nearly a year prior.

Genesis 50:20: "As for you, you meant evil against me, but God meant it for good." 

I couldn't comprehend at the time the significance of that verse, but now, looking back, I see with utmost clarity that God was orchestrating a beautiful story.

My story of success is because of hardship. I truly doubt that my heart would be where it is today if it had not been for the avalanche of pain that came upon my soul two years ago. It was that pain that taught me the frailty of life, how quickly life can change for the worse, and how desperate the enemy is to destroy us; telling me, sometimes daily, to end my life. The lies were innumerable, insurmountable, and I walked a fine line of faith and fear.

I look back on the long days and nights, marveling at how far I've come, not in my own strength, but carried by the grace of God. A favorite song of mine, Never Once, states "Carried by His constant grace, held within His perfect peace; never once did we ever walk alone." And this, this is true.

He has walked with me every inch of this journey, and I see, oh how I see so clearly the favor of God in this story and progression in my walk of faith as I became an RN.

Taking the NCLEX was by far the scariest test to date. I originally had it scheduled out at a further date, but it lately had become abundantly clear to me that I was ready. Couple that with some events in my life, and I knew what I had to do; reschedule. I looked on a Wednesday to see if I could get in sooner, and lo and behold, there was an open slot for Thursday, June 16th. I took a walk, prayed about it, and felt, with certainty that I should seize this opportunity, and I did.

When I arrived at the testing center, I was palmar fingerprinted, had my photo taken, locked my keys in a locker, demonstrated that my pockets were empty, fingerprinted again, and was escorted into the testing room. Seated in a cubicle, a camera above my head, I began the tutorial. It gave me some practice questions so that I'd be familiar with the layout of the exam.

I was asked to place the months in alphabetical order and that's when it really hit me: I had forgotten the alphabet, I was so nervous. I couldn't get beyond the letter D. Ha!

But sure enough, I completed the tutorial and began. My first question was a select all that apply, and from there were a series of questions that made absolutely no sense to me, nor could all the studying in the world have prepped me for this exam. It was a series of guessing, and as the questions went on, I seriously had no clue as to what the answer could be for any of them.

I will admit though, despite the nervousness, there also was a calm; yes, I recognized that I could reach the 265 question limit, and even though it felt at times like I was taking the wrong exam, and had in fact never gone to nursing school, I persevered on.

And then the exam shut off. My fate was sealed.

Forty-eight agonizing hours of waiting, praying, fearing I had failed, and even trying the Pearson Vue trick, which, while faulty, has apparently demonstrated success to people in the past.

It told me that I failed.

Saturday morning, at work, right before my results were available, all the computers in the facility went down. There was no internet access, so, with trembling hands, I entered my information in to my phone on Pearson Vue to discover my fate.

That's sparking cider, in case you're wondering.

And in that moment, the totality of all my hopes and dreams came true. What started out as feeling that I had heard from God, transpired into reality.

At long last, I am a registered nurse.

So what's next? I have two job interviews this week, a  standing job offer at the facility I work at, and a third interview in the works. I don't know where I'll land, but I'm trusting in the God who does.

If you believe that God has called you into something, even if it sounds or looks totally crazy, trust.

Trust that you serve a good, good Father who will never mislead you, and know that He has a perfect, beautiful, and amazing plan. Even when life gets chaotic, confusing and downright painful, He is there. His plans are for your good, and He will carry you through.

A leap of faith is terrifying, believe me, I've lived it. But when you hear His voice, you'll know. All you need to do is obey, even if it "looks" impossible.

But keep in mind that once He has spoken, He won't show you the next step until you've taken the first.

He is faithful.

Prepare for a wild ride :)

Semester Four, Week Fifteen

A week before I graduated school, I took a long drive. As I drove past the spot my boyfriend and I broke up nearly two years ago, I reminisced of how dramatically, excitedly, and interestingly my life has changed since I got the email that I was accepted into nursing school April of 2014.

I moved to the area still heartbroken over a series of events from the summer; the wounds raw and sore. Having never ventured out on my own before, I found myself with a peculiar older roommate who had a penchant for following me around and having the most bizarre conversations, like how she'll for sure stuff her cats when they die, so that they can always be with her.

I was sad and lonely most of the time, essentially the exact opposite of how I hoped I would feel. I worried I had made a mistake; that I would fail nursing school, that pursuing this dream would end much like the rest of my life; in failure.

Time progressed, my heart began to heal. 

May 2015, my family and I were hit hard, again; a continuance of the summer of 2014's peril. The day after all was said and done, I drove, and cried. There was nothing more I could do. Classmates asked where I had been, what I had been up to. How could I explain?

Year one, done. Summer came, and passed. I dated the wrong guy, had my wisdom teeth extracted, developed complications, healed, sought housing, which resulted in a miraculous event: my own place for semester three.

It was a difficult semester, mentally, and emotionally. My thyroid levels were out of control, my dog became sick, and died, my friend was re-diagnosed with cancer. To be honest, I don't know how I made it through. The grief was real, dark, and I was drowning.

Another break, and I learned another hard lesson about life: sometimes the hardest thing and the right thing are the same.

Semester four, the last of them all. An uphill climb, stressful, yet it flew by, and I've connected well with classmates whom I had not connected with previously. Spring break, capstone begins; I learn what autonomy looks like.

Awarded for academic excellence; I was soaring. A few bumps in the road, for you know, with victory also comes hardship.

Capstone ends. And here I am, ready, at long last, to graduate.

Semester Four, Week Fourteen

It was a little more difficult than I anticipated, turning in my badge shortly after I had finished the last hour of my practicum. It felt a little like turning in one of the last parts of me being a student.

When I first began nursing school, and what sustained me all throughout were, on those early waking mornings, preparing for clinicals, I'd remind myself that this is not about me. This is about my future patients, this is about the process of becoming an RN. Now that this phase of my life is nearly over with, and I face the reality that I am days away from graduating, and hopefully only months away from taking my boards, the accumulation of my forever dream of becoming a nurse is nearly here.

I've learned to balance multiple patients with a variety of health problems, piece together the pathophysiolgy of a disease process, but more importantly, I've learned how to communicate with patients. I think it's too easy to forget that our patients are more than people in a bed, more than people with a medical diagnosis. They're people with real health conditions and needs, oftentimes laid up in bed, at our mercy. They're people with pain, and if they rate it as a 9 out of 10, and even if you really don't believe it, tough. Act like you do, and give them their prescribed pain medication, while keeping your eye rolling and mean thoughts tucked deep inside. People deserve to see compassion, passion, and kindness, especially at the bedside.

I read a quote the other day that impacted me, simple as it was: "You'll never regret being kind."

This is so true, and important to practice in the nursing profession. Now, I know I am but a newbie to the scene, and I have a lot to learn, and I'll probably be duped once or twice, but I'll be darned if I will not be nice to my patients and co-workers, even on the days when it is trying.

Friday, I wasn't feeling so nice, initially. I was not particularly in the mood for patient care, nor was I plum pleased when my preceptor handed over to me three patients, two of whom would require a lot of care. I was worried that I would make a medication error and kill someone, thus being deemed unsafe to practice and fail nursing school. My preceptor and I were in the intermediate care unit, which is a step down from the ICU, and that meant that their admission diagnoses weren't exactly easy. I felt cranky, especially with an isolation patient in whom I had received in report was difficult, rude, drug seeking; you know all the characteristic qualities.

I walked into their room expecting to be shot down, but what I got, and what I saw was an ill patient just needing some love. Needing some empathy. I have never received so many thank you's from a patient throughout the course of my day, and when he, in a moment of feeling utterly hopeless, laid his head off his bed, bemoaning the fact that people judge him, and that really, he just feels awful, I knelt down, and stroked his head. Yes, that may sound weird, but this was someone who needed a human touch. He needed to know that I was in their corner, and that I was not passing judgement. I was his ally, and would advocate for him. It was one of those moments that reminded me, again, that this path in nursing, this career, is not about me; it is for the care of those sick, and in need.

The 750+ hours that I have spent in the clinical setting will always be remembered as my moments of refinement. I went from fumbling through head to toe exams, to developing confidence and proficiency. I went from wanting to know about diseases and how they manifest, to learning how to care for the patient, and having the knowledge to act as backup to my bedside care. In all, this has been the most incredible journey that I have found myself on, and I know that Friday's pinning ceremony is but a transition, stepping out from the student role, and into the role of a graduate nurse.

This has been a long time coming, but I can truly say that I am feeling more confident and prepared than ever before.

Semester Four, Week Thirteen

Completed two more practicum shifts this week; one more to go next Friday, the 29th.

Sunday, my preceptor and I were on short stay procedural/cardiology, and the patient load was light enough that I was able to assume total patient care for our four patients. At the onset, it was admittedly a bit difficult getting together everyone's medications for the morning (we're talking 15-20 meds each!) As well as doing assessments, but, I prioritized care and got everything done. It was a great day, and true to how it always works out, I cared for a Jehovah's Witness patient with a GI bleed/anemia, and while a blood transfusion was what she "needed" she was able to have her volume replaced, and was later discharged. 

I also had a patient who was in alcohol withdrawal, and her CIWA score was 2, in regards to confusion on date, even when looking at the white board in her room signifying the date, she couldn't clearly identify what day it was. Anyway, her ammonia levels were elevated at 38, and she told her physician that she would refuse lactulose, because she did not enjoy the diarrhea that comes with it. (Side note: I was really excited when I heard the physician discussing lactulose, and I immediately knew I needed to check her ammonia levels).

My preceptor suggested I go in and talk with the patient, so I pulled up a chair next to her bed, and utilizing the information I learned in med-surg (woo hoo!) I held a theraputic conversation, specifically regarding AA, but also how lactulose works and how it will help her elevated annomia levels. I did not attempt to convince her of the need to take the drug, and I informed her that taking the medication was her decision, and she could refuse it, as that was within her rights. However, at the end of our discussion, she stated that she would like to take the medication after all. Both the physician and my preceptor were impressed!

During our second shift, we were assigned to the ICU, and it was admittedly a very hard day. Our assigned patients were stable, but in the room down the hall was a dying 22 year old patient, diagnosed with leukemia two weeks ago, and that morning, it was determine that she was not responding to dialysis, and despite best efforts, her pH was 6.8. As a direct result, comfort care measures were initiated.

Throughout the day, multiple family members and friends came in to say their goodbyes, and the sound of crying was heard nonstop throughout the day. The staff was clearly overwhelmed, as both this patient was dying as well as one across the hall; another young individual, diagnosed with interstitial lung disease.

Near the end of the clinical day, she died. After her family and friends had cleared out, preparations went underway to prepare her body for the morgue. I felt the need to help, and asked how I could do so. In addition to disposing of all the IV medications and fluids that had been administered, we prepared her body. 

While I have helped with the aftercare of the deceased a few times in my life, this situation felt different. For one, the patient was so young, and I was taken aback by the tragedy and destruction that cancer causes. She had presented to her physician two weeks prior with a sore throat, and diagnosed with cancer. Treatments failed, she developed ARDS and respiratory failure. It was a downward spiral, and as we cleaned her body, I couldn't help but think of all the life events she would never get to experience; 22 is far too young to die.

While placing her in the body bag, her nose began to pour blood. Her skin was jaundiced, edema all throughout. She looked peaceful; I kept looking at her hair; it was evident that she had just had it colored. She had a fairy tattoo on her right forearm, and the long dark eyelashes, and I wondered who and what she was like when she was well. It was an honor to aid in preparing her body for the morgue, but incredibly sad, and an excellent reminder of how precious life is. In that moment, it didn't matter that I had just put in over 12 hours, didn't matter that I had homework to catch up on, that I was exhausted and sleep deprived. What did matter is that a young life had been lost; someone who was clearly loved.

We spend so much time not saying the words that need to be said to people, not investing in friendships and relationships; letting people exit our lives because of conflict or strife. The loss of this young woman's life was, and will continue to be a solid reminder to strive for consistency, love, integrity and honor, in my professional practice as well as my personal life.

Semester Four, Week Twelve

In what perhaps is the greatest moments of my nursing school career, I finally had the opportunity to watch an open heart surgery this week. It was the most incredible thing I have ever had the opportunity to be a part of. From the first cut, to peering down inside the patient's chest as their heart was operated on, to the stopping of the heart with ice and potassium, to the repair and closure, this was actually one of the things I've always wanted to see, and now my heart is glad, having been given such a phenomenal opportunity that I will never forget.

Nothing can top that medical experience, but I also did watch a cardioversion, and a transesophageal electrocardiogram, which really makes me stop and wonder if God is wanting me to enter into a cardiology profession, considering 3/4 of my nursing career has been surrounded by the heart, and man, do I love it.

Also watched a colonoscopy this week, which, while it was not entirely thrilling, it was enjoyable, and I learned a bit. Also, to make me feel extra "nursey", I placed in IV in a gentleman who stated that he is a tough stick. There are few things that make me feel less like a nurse than placing an IV. Everyone has their niche.

My practicum site has been nothing but phenomenal, and I would be so incredibly honored to work there, I have decided. I am hopeful, but remaining ever open to the possibility of something more.

I met a kind employee at my practicum site, and have been pleasantly surprised with how refreshing, and nice some people can be. Its times like this that make me feel really sad that nursing school is coming to an end, because here, in this moment, life is beautiful. Yes, I know it's always beautiful, but within this context, I am at a place of hope, joy, and (almost) rest.

Three more shifts to go, and I will seriously miss this practicum; I'm having the time of my life.

Semester Four, Week Eleven

I've had a most magnificent week, really. It's times like this that make you wonder how life could get any better, but also, if you're a pessimist with a history of things going bad-wrong real quick, wondering what's next, what's ahead, what could go wrong.

But, let's focus on the positive, mmmkay?

I spent 1.5 fabulous days with my preceptor, day one in the ICU, day two in what is known as short stay and procedural, meaning overflow med-surg patients and post-op from stents and pacemakers.

The ICU was incredible, as always. So much happening, so many critically ill patients. I think I want to one day get certified as a critical care nurse.

But anyway, I finally felt brave enough to suction a ventilated patient, and did so. I enjoyed it oh so much, and that probably qualifies me for the looney bin. I love medicine. I love this field. Some days, (most days) I catch myself and wonder how on earth all of this possibly happened, how I could be so incredibly blessed.

One patient referred to me as malak, which is Arabic for angel. Ahh. Angel. :)

Day two was also great; we were on a step down unit, and my preceptor gave me four patients to manage on my own, and while a bit bumpy, I really felt like yeah, I can do this. I can easily be a medical-surgical nurse, though that is not my dream, I could do that for a time. I enjoy assessing, giving meds, calling the shots, giving shots, starting IV's, setting up the pump. It feels....right. I'm certainly more and more comfortable at the bed side.

Last week I was notified that I had been nominated by my nursing faculty for an academic excellence award. Not only was I notified, but I won. I have never one anything in my life, and downplayed the award reasoning that it was either an error or something everyone gets. When I mentioned it to a faculty member, she squealed in delight and told me the vote was unanimous; the nursing faculty at my school nominated me because to them, I am excellence, I am what nursing looks like.

This was certainly one of the most amazing, humbling, awe-inspiring, giving praise to God moments in my entire life. Anyone looking back on my story can see how far the Lord has brought me, and what He can and will do with a life that is completely surrendered to Him.

So, Thursday, I cut out of clinicals early to attend my award ceremony. I initially wasn't going to go, but my preceptor heartily encouraged me to do so, and I did, and I am so thankful that I was in attendance. The speech my instructor gave to the audience about me was beautiful. I kept thinking how I don't deserve this, how this award is merely because of Christ in me, and to be honest, it so isn't about me. And that is fine by me.

After all was said and done, I needed to take a walk and be by myself. With all the fan fair, I found myself being distinctly disappointed, and needed some time to figure out why. The answer was simple; while the victory was great, I had no one close to share it with. My family was unable to attend, one friend attended the ceremony, but had to leave shortly afterwards, and in the quiet, I realized, I'm super, duper alone. It would be so incredibly nice to have someone take me out to dinner and celebrate this accomplishment, help me feel like I matter. I know, this isn't about me, and I shouldn't be so self-centered, but as it so often goes, the desire of my heart is to have someone to partner with, especially as I've gone through this unbelievable journey. Its been such a time of learning to be alone, savoring victory, and learning defeat. Sometimes I'm just so tired of going at it alone. One may argue: You have friends, family, co-workers, and it is true, altogether so very true, but none of them can fill that gap in my life that a companion could fill. Again, sorry to make it personal, but here it is, guts and all.

Guess there are some prayers that just don't get answered, no matter how many times its prayed.

Semester Four, Week Ten

Well, I have finished week one of my practicum, and I must say, it started off on a most positive note. I wasn't sure what to anticipate initially, but my preceptor was fantastic at communication even before we met, so that made this transition process a lot easier. 

Day one was spent in the ICU, and it  was initially scary, realizing how critically ill our patients are, the sounds of venilators everywhere, and me having no ICU experience. However, my preceptor gave me a piece of practical advice, which set my heart at ease: Assessments are the same whether you are in the ICU or on a less critical unit. Look at the patient as a whole, evaluate their needs, and treat accordingly. With that, our day began with two patients: One had an anoxic brain injury due to a respiratory/cardiac arrest in December. He was young, and it was evident that he would not ever be returning full-functioning capacity. There were no voluntary movements, his Glasgow coma scale was 6 (anything below 9 indicates a coma), pupils were nearly non-reactive. It was a tragic case, and as I looked at the photograph at his bedside, taken not too long ago, I saw what once was a vibrant, healthy man. Before me was a patient with a blank stare, completely dependent on the care of others. However, as I've learned in school, just because a patient is deemed comatose, that doesn't mean that she was incapable of hearing what we were saying, and so with each intervention, my preceptor and I were conscious to tell the patient what we were doing. He later received a tracheostomy for continuance of respiratory care, but his secretions were so copius, even with the administration of anticholingerics, which aid in drying up said secretions. It definitely was a case that caused me to stop and evaluate the sanctity of human life, and what makes a person "alive". 

Our second patient was a post-operative abdominal aortic aneurysm repair, who was recovering well physically, but emotionally was fragile, recalling the series of events that led to her emergent surgery. Chest pain had begun acutely immediately after a shower days prior, and he described a pain that was severe and non-relenting. Her husband had brought her to the emergency department, and per the patient, some time passed, as staff had ruled out a heart attack, but during a CT scan, it was identified that the patient had a dissecting ascending aortic aneurysm (read: EMERGENCY!!!) Post-operatively, the patient had some delirium, self-extubating, but the patient was heavily reflective upon her emotional trauma, so she and I spent some time conversing throughout the day, having a healthy therapeutic conversation about her experience and recovery. She had wonderful social support through her family, and would soon be transitioning to a step down unit.

Day two, my preceptor and I floated to the intermediate care unit. Our patients weren't especially heavy; two admitted for cervical spine fusion, and an elderly patient with diverticulitis, with a long history of heart failure, COPD, chronic kidney disease and a recent acute kidney injury, due to dehydration. Initially, when the patient had been admitted, he was hypovolemic, then inadvertently fluid-overloaded, but as his time in the unit progressed, the attempts to diurese him were unsuccessful; he had a poor urine output, with only 25-50 ml's out, every few hours, resulting in about a total of 100 ml's for the day. He had expiratory wheezes, dyspnea, no appetite, poor intake, tachycardia....clinically, he was not looking well, and a palliative care conference was planned for this weekend. 

I had the opportunity to watch a heart echo, and afterwards, the technician showed me some prior cases of his that were definitely beneficial to my learning. I watched the heart valves opening and closing, and for the first time, was able to finally visualize what blood flow looks like; suffice it to say that it was an incredible learning experience. The technician also showed me an echo from a patient that had recently been in the ICU, admitted with a pulmonary embolism. In addition to his PE's, a clot from a DVT had also broken off into his heart, and, during the echo, the clot was seen, literally seen floating around the heart! Granted, as the tech explained, at that very moment, the patient was unconcious, intubated, and had multiple doctors surrounding him, attempting to save his life. Perfect time and place, for a patient with a clot in his heart, if one must have such an event happen. The imaging was unbelievable!

I'm really enjoying this experience and look forward to my development as a future nurse. I've already had an opportunity to place a dobhoff feeding tube, started an IV, and medication administration without being watched; which is a new, and exciting freedom. I am hopeful to gain more confidence in my patient care, especially when auscultating heart and lung sounds. I look forward to my continual development in patient care, managing multiple patients at once, providing total patient care. After graduation, I would love to be placed in a new grad nurse residency program, so my preceptor is helping to facilitate that by introducing me to managers on each unit. It is wonderful, and I am so thankful. 

Semester Four, Week Nine

I've been reflecting a bit lately that the people I didn't like so much at the beginning of the program, I like them now, and the people I enjoyed at the beginning have drifted off; our communication no longer daily.

Anyway.

I met with a professional resume writer, and I was pretty excited for what she had to offer. In addition to being a former physician's assistant, she had excellent examples of her work. Granted, she spent a bit too much time talking about her cat and her autoimmune disorders, and the heart attack she once had, but, I was pretty excited to get a solid resume. Until she told me the price.

Over $1100.

Thanks, but no thanks. But oh, how she tried to get me to pay right there on the spot, even suggesting that I could split the payment between multiple credit cards. Nope.

I'll find someone else, thanks.

My preceptorship schedule is all set now, and I have a pretty fantastic rotation, if I do say so myself. I get to be on a float pool, which is like a dream to me, considering I get easily bored on one unit and want to see all that the hospital world has to offer. I begin March 31st, and couldn't be more excited.

Successfully completed my last (HALLELUJAH) clinical calculations exam, nearly getting tripped up on the darn reconstitution problem, but like most issues in my life, it's really not that difficult; take the prescribed dose and divide it by the amount to be reconstituted. (Makes sense to me, at least).

Spring break is upon us, now, and while I will be working on a group project regarding alarm fatigue, there's not much school-wise happening between then and now. Ye-haw.

Semester Four, Week Eight

Oh what a joyous moment it was, discovering I had successfully passed my last course of medical-surgical nursing.

Of course, leading it up to it was like a roller-coaster ride, as the day before, I decided to join in on a group study session that filled me with doubt, worry, and concern. A student stated that she's taken this final before, and it was the worst one ever. Apart from that, it was going to be near impossible to pass, unknown and untaught information would be thrown our way, and you better brush up on ABG's, EKG's, and every other subject ever taught in the history of the nursing program.

After that downer moment, I struggled in vain to study, and was not entirely successful in my efforts. The day of the final, I broke down and paid for a massage, which is a big deal for a poor person like me, but dang, my back, and neck ACHE. My masseuse informed me that my muscles should not be this tense for someone my age. Nursing school for the win. The massage did not help much, sadly.

That being said, the final was not that bad, and I left feeling confident. I even went out and celebrated with some of my cohort and had an alcoholic beverage, (or two).

Leadership began the next day, and with no more exams to study for, I find myself spacing out in class, or perusing the world wide web. I did so mid-day Wednesday, and discovered that I have landed a most wonderful preceptorship position at the very hospital I just completed my clinicals at. It is with great delight that I announce that I won't have to be at a long-term care facility for the remaining 108 clinical hours.

There are fears and concerns associated with a preceptorship, or capstone, or whatever one would like to call it, but this is where I begin to be released from the nursing school nest, and discover what autonomy looks like, and where I belong in the profession. It's really happening. I am incredibly close to achieving a dream that has been six years in the making.

Semester Four, Week Seven

I've had a really great week. Maybe that's because I had one test (that I rocked!) and two mandatory non-graded exams to track my progress (still looks like I'm on track to pass NCLEX, woot!) Apart from that, I've had a lot of down time, which I think I've needed, as I've been so focused on being busy and going from class to clinicals to work, I haven't had any time to be calm in the last six weeks or so.

Fact: I'm not always entirely comfortable being by myself, and I've had some moments like that this week as I reflected back on my life and some of the people I've wasted time on. Yeah, you know those moments. ;)

But, as I've come to terms with the realization that graduation is coming, I've contacted a professional resume writer (do they have an official title?) and am preparing to meet with them in the next few weeks to put on paper who I am. I've been scouring the internet for new grad nurse residency programs and feel amazed, emotional, and overwhelmed that this, the dream, is culminating and I'm preparing to head into the real world of nursing soon.

It's easy to get caught up in the panic of "what will I do after May 6th?!?" but, I have to rest in the fact that God will show me as I go. No sense in rushing ahead of things.

Studying for the final is cumbersome. People keep stating how awful it will be, but you know what? People all along this journey have said that every class, every semester, every exam is awful and impossible. Someone dropped yesterday that the final has a lot of questions regarding the cardiac system, and briefly, my heart dropped and all panic ensued because I don't feel like cardiology is my strong suit, and what if, what if, what if.

Enough!

I visited a women's shelter on Tuesday with a friend to teach the women about stress and other health literacy topics. My last clinical instructor was wild about health literacy, and now I understand why; people generally don't have much, if any. We discussed stress and then opened the forum to any questions, and oh, I was in a nursing student wonderland. I knew answers to the questions asked!

However, one of the attendee noted that while I was knowledgeable, I am so young and an "old soul". Old soul? I'm not that young anymore, sadly. But, quite peculiar that she noted I am an old soul. I've always been conscious of that fact, but never thought it translated into my interactions with strangers, particularly when discussing medicine.

So, there's the med-surg final next week. And then the start of my transitional course. Gone are the days of new medical knowledge and being bombarded with information. I'll miss it, I've decided. I have enjoyed, so much, transforming into someone new.

And, on a side note, being that I will continue on with my BSN after graduation, I had written a really marvelous scholarship essay that my computer randomly deleted. But never fear, after searching for it the world over, and even having Microsoft remote in with absolutely no luck, I re-wrote the essay, brand new, from scratch, and feel that it's a better representation of me, anyway. And is it true that Earnest Hemingway once lost a suitcase containing his best work, and had to start from scratch? I can't tell if that's fact or fiction, but it's a nice touch.

Blessed.

Semester Four, Week Six

At long last, I finished med-surg lectures. On the flip side, that means no more medical lectures, and nothing new medically introduced again, until I take the NCLEX. *panic*

My professor stated that we now have everything we need to pass NCLEX. *Life comes to a screeching halt* Whaaaa?! There is no way that I am now lectured enough and prepared for the biggest exam of my life. Time flies, my friend.

I also have successfully completed my 120 hour clinical rotation. It was a long haul, busy days, crazy instructor, high-acuity patients, but in the end, I wound up loving that rotation more than the others, and even came to appreciate everything that came with it. In fact, I'd love to be a part of the health system that I did my rotation at. I was beyond impressed.

Not much was done in the way of studying this past week, but I tried to master burns, musculoskeletal trauma, emergency preparedness, and bioterrorism. Another exam tomorrow, and the week after that, the med-surg final.

Is it crazy to say that sometimes, I will miss nursing school? I don't know who, or how one can miss this insanity, and yet, as the final months dwindle down, and I come to terms that this phase of my life is ending, I recognize, over and over again, how much I love this. My life, my heart, was such a train-wreck when I began this journey, and so much of it has healed since then. It's so nice not being the scared mountain girl anymore, but being so much more confident and prepared to take on the world.

Of course, I was (kindly) reminded today that the confidence will go away for a time one I begin my first job as a new grad. That's life, though; just a series of repeated patterns. Predictable at times, almost. But good. Life is good.

Semester Four, Week Five

Lately, and perhaps more and more, it has struck me that I am very likely going to graduate from my nursing program. (This shocks me. Silly, I know.) I have been feeling rather sentimental this week, realizing that this nursing school life I've grown accustomed to is wrapping up. In a few months time, I will no longer be a student nurse. I (potentially) will be an actual registered nurse. Like how, even though I am *this* close to passing, I'm still doubting myself, too? Some thing never change.

Yet another exam passed by; you can guess my grade. But, passing is passing. More humble bragging from some, and, only one more lecture, and two more exams. Time is flying by...

We had our senior photos taken on Tuesday, and again, felt like a dream. I don't know how I've gotten here. Well, I do know, but the road doesn't seem as hard as I know its been. As I sat for my photo, my photographer said he wishes all students looked as natural as I do. Ha! I looked awful, but felt proud.

Attended a critical care nurses meeting, as part of graduation requirements to attend a professional meeting. I felt like there is a distinct possibility of joining a group one day, and that I have great potential; that I am going to go far in my career. (My turn to humble brag). I could totally be wrong about the bright prospects of my future, but this is what I hope and feel.

Clinicals brought about a wave of difficulty this week; there were a lot of patients dying, or having just received notice that they were terminal. I held hands with a patient who was hours to days away from death. The first thing I noticed, as seems to be what I always notice, (See here) was her manicured, hot pink nails. Death was knocking on her soul, and yet, as I gazed upon her polished finger nails, I imagined what she was like when she was healthy, how she must have been feeling pretty good when she got her nails done. Her gasping for air twisted and turned my heart; in part because the loss of my dog is never far from me, but also for the life that was slipping away, and how hard of a battle she was fighting just to live.

I sat in on a palliative care meeting with another patient, and again, hospice was discussed numerous times. The end of a life is....well, I'm at a loss for words. Life ending is so common, yet faced with it multiple times this week made me realize, once more, the value of life, and joy that it can bring. I sat with a patient, who, after receiving news that their condition was terminal, began to reminisce about the good days, the days of laughter, health, fun, and love. As they talked; I reflected: Will it be like that for me? What will I reflect on? Who will help care for me?

Today, as this was the trend, I encountered an individual who was recently diagnosed with multiple myeloma. Their spouse explained to me that treatment was an option, and a good one at that, but why, why did life have to be so unfair? As they lamented, I focused on what I had learned in school: Multiple myeloma is not curable, and early fatality is altogether frequent. I peer into these people's lives and ache, knowing that they are not yet done living, but cancer, or illness has begun to carve away at their bodies, and it's so often a losing battle, fought valiantly, but not victoriously. At least, not on this side of heaven.

Semester Four, Week Four

What a delight it was to learn about about the kidneys this week, both acute kidney injuries and chronic kidney disease. Additionally, we covered cancer pain and end of life care, and once more, the familiar raw ache of losing my dog came to mind, and I hate it, I really do. I'd give anything to have her back. It eats away at me, daily, and there's this deep ache that penetrates to my core, making it difficult to imagine I'll ever feel whole again.

Another exam transpired; another B. For the first time in my nursing career, I forgot to place an answer on my score sheet, thus bringing down my grade two points ~sigh~ (Is it too late to still blame my thyroid?) Even more annoying is that this question was one that I had to use all my brain power on to arrive at the correct answer, only to have it marked wrong because I forgot to, you know, actually write the answer down. I'm getting a wee bit better at interpreting ABG's, but man, please stop making me interpret if "my" patient is in respiratory or metabolic acidosis or alkalosis.

Studying was not on the top of my list this week, and I feel like I just haven't done enough, yet am struggling to actually commit the time needed to learn all there is to know about the good ol' kidneys. All I know is no urine output = really bad.

Clinicals brought about an exciting time, as I had the opportunity to suction a patient's oral secretions for the first time. (You're thinking, 'wow, suctioning a patient. Now there's a good time.') But I've never had the opportunity, so when it arose, wham, bam, excess saliva be gone! I will admit though, I nearly lost my cookies when a huge glob of mucous entered my suction tip. I was literally dry heaving and had tears pouring down my eyes. Guess among other things, I have found what I cannot tolerate too well; giant mucous blobs. That and poop really turns my stomach inside out.

I watched a thorocentesis, which, again, is something I've wanted to watch for a few years now. It was quite enjoyable, but a new unenjoyable trend in my life is being jealous of the cool, white-coated professionals who identify themselves as doctors. They seem so smart, collected, calm, and assured of their purpose in life. Meanwhile, I stand there in my dorky mismatched school uniform, worried I'm not representing my college very well as I have no school pride, all while feeling small and insignificant.

However, if I ever do find myself in a high position, I hereby promise to remain cool and not act as though I am above the world as most of these residents and interns act like. C'mon people, we're all here for the same reason: love of medicine, right? Right? Anybody?

Speaking of amazing doctors, I about near died yesterday when the most amazingly handsome doctor approached me and actually spoke to me like I was a person. Not only that, he allowed me to partake in placing an NG tube on a patient, and went over the anatomy of the facial region shortly thereafter. He was enough to make me tachycardic and (briefly) hopeful as I planned out our wedding, but, he was soon on his way, and I, as well as one of my classmates swooned over him all day long. Ah. <3

I'm still finding it rather difficult to be present in the moment. I just keep spacing out, or something. Which makes time fly by, as I'm disassociating, or something, and my days all blend into one, with time propelling on by, yet never seeming to go by any faster. (Am I losing my mind, perhaps?)

Two more lectures in med-surg. Four more clinical days. One more Sim lab. It's coming down to the wire, my friend. Somedays, I feel like, yeah, I'm totally going to do this. I am totally going to become a nurse.

Other days, I feel trapped in this zone, where it's two steps forward, and one step back. As I drive 1.5 hours back to my hometown to work, and hang out with my family, I also am able to attend church. My church has been a source of support, even tonight, I received gift cards for gasoline, and that in itself is such a tremendous gift. But on the opposite side of the love is (again) my "ex" (I can't even really rationalize calling him that, but that's another story.)

Said "ex" just doesn't want to talk to me, and that's cool, and so when he did come my way tonight to sit next to a mutual friend, I say hello cause, well, I want no hard feelings. I noticed he's wearing the same shirt every time I see him, but apart from that, as my mind wandered throughout the service, I'm thinking about how everything in my life has changed over the last 1.5 years, and yet, here I am, in the church I grew up in, in the town I grew up in. But, on the flip side, I'm all over the place, attempting to become an RN, and my semblance of normal is so much different than it used to be, and half the time, I'm so focused on academia, that I've forgotten what the other side looks like. Nursing is literally almost all I think about. I'm constantly running through my mind signs and symptoms of this, or that, or thinking about diseases, like Goodpasture's.

To further drive my point home, I'm really bummed that I'm left out of the group of people I used to have all because I didn't want to keep seeing this dude. Isolation in church is a rough thing. I'd love to share some nursing stories, but my social circle grows smaller, and it largely consists of people in the same boat as me; almost everyone I know these days is involved in medicine. Medicine is all I know anymore; its become my safety net.

Remembering the good old days, wishing for stability, and grateful, so grateful for what God is doing. Cherishing life. There is life outside of medicine, I'm sure.

Semester Four, Week Three

That could basically be my face for life right now. There's been a lot of "down with life" moments of late; For one, my blasted thyroid is hyper again, meaning a) I feel like crap allllll the time b) I'm fatigued and foggy allllll the time and c) it's affecting my cardiac output, so I'm basically slowly 

destroying my heart and other organs. It's way outside normal perameters, and I cannot get it to a good level, despite all the pharmaceutical intervention in the world.

I have a classmate who loves to humble-brag about their grades, and it's making me cray-cray.

I passed my exam this week, a B with the offered extra credit, but dang. I know I could have done better, and it aggravates me greatly to know that. (Can I blame my thyroid and diffuse panic/feeling of constant insanity?) So then, again, imagine said classmate humble-bragging about their academic achievements.

On a personal note, I've realized of late that I'd rather be someone's choice rather than an option. Just sayin'.

Clinicals this week were a trial, and I'm now better prepared for the management of PEG tubes. I also had a patient slap my hands and pinch my face out of frustration. That's correct, slap me and pinch my face. I must be the prime example of nursing professionalism, being that I didn't lose it right then and there. The reason for said abuse was due to trying to examine a tele box, to you know, see their heart rate and oxygen levels. Cause I care, as a student nurse, that my patient is still alive and such.

I worked with a soon to be nurse from a different school who, in an eerie way, reminded me of an ex, so I spent my day staring at him (not in a creepy way, but a "why do you remind me of him" way.)

A few weeks ago, I had an opportunity to be a guest speaker at a nursing school welcome to current and future students. The opportunity arose from me and a classmate seeking free food, and suddenly, we were asked to speak, and answer questions. I've seen a lot of changes in myself since I began this adventure, and I earnestly hope that I get to graduate during the prescribed time (this May). I'm so tired, and thanks to my thyroid, no matter how much sleep I get, I never feel fully rested.

On another note, and again, it has to be thyroid related, otherwise, I have a mental condition happening, I don't feel like I'm in reality very much these days. I constantly feel like I'm dreaming, or on the outside, watching my life transpire. I hear and see myself, but there's a rather disturbing "disconnect" that makes me feel like none of this is actually happening. (Yeah, get me a straight jacket...)

There's another exam tomorrow, and it's hard to believe that the academic insanity starts up all over again; I never get a day off! (Well, I did have a day "off" due to a snow day on Tuesday, but I spent the day studying, so that hardly qualifies.)

I am working my butt off, giving 100%, and am leaving the rest to the Lord. I can do no more and no less, but give it to the One who knows me. 

My clinical view 

Semester Four, Week Two

At the time of this writing, I'm beside myself in grief again, all teared up and snotty faced. It hit me out of the blue in lecture; we were covering shock, MODS, SIRS, and I wondered, did my dog die of shock? Did I kill her? Could I have done anything to save her? And as I wrestled with those thoughts, it only became stronger how much I dearly miss her.

At home, I'm reviewing what we learned, and I'm sobbing as I read about what happens to the GI system when its been subject to decreased tissue perfusion. New tidal waves of grief have knocked me off my feet today, and I cannot muddle through this material without profusely, and embarrassingly weeping aloud.

Days later, I still can't work my way through sepsis without getting teary eyed.

~Sigh~

Clinicals began this week. I'm at a premier facility (I don't actually know what that means, but I like the sound of it.) My clinical instructor is sharp, witty, and I think could be an asset to my budding career.

After ten hours of orientation on Thursday, and two hours on the floor, I then went home and did a few hours of prep-work. Lucky me, my patient had many complex co-morbidities and a billion medications to research.

Walking back to my car, I couldn't quite remember where it was, and so I wandered the streets of Denver, dodging the stumbling drunk man, and praying that I wouldn't be killed. (I wasn't.)

Back at 'em the next day, I was successful in trying my hand at giving medications via a dobhoff feeding tube, and assessing a patient in respiratory distress. Yes indeed, learning is happening here, even though I'm wildly exhausted and have little time to study. My memory is awful these days; I feel as though I'm in a fog. I literally cannot remember what someone told me after a few moments have passed. It's awesome.

My job is an hour and a half away from my clinical site, so every Friday night for the next month, I will further torture myself with an extra long drive after an extra long day, all so I can work for 8.5 hours, and bring in my awesome $~400 a month. #worthit #notreally

My limited time to study is further compounded by the fact that lecture is making almost no sense whatsoever. Literally, I was in lecture on Wednesday and felt like I had been dropped in the wrong class. The respiratory lecture was way over my head, and I haven't even begun that, as I make a desperate attempt to comprehend the material for my upcoming first exam; HIV/AIDS, immune system, autoimmune, transplantation/rejection, wound care/assessment, MODS/SIRS, Sepsis, septic shock, and severe sepsis.

God help me. Literally. I cannot make it through this semester without Him.

Semester Four, Week One

The first week really wasn't that bad. I mean, I only had class for two days. On the second day of lecture, we were bombarded with three hours of immunology, HIV/AIDS, autoimmune disorders, and hypersensitivity reactions. My instructor said that this should all be review, but I'll be darned if it is. Review from five years ago, maybe...

I'm settling in well to another semester, with only a small/moderate amount of stress as I attempt to manage my ADN and BSN courses.

I'm determined to change some of the un-pleasurable aspects of my life, including, but not limited to, distancing myself from complicated friendships, and not being readily available. To attempt defining insanity, by doing the same thing over, and over, and over, and over...

In addition, I will attempt to venture out more, be even more adventurous, say "yes" more often, and be willing to transition into a side of myself that has yet to be uncovered. Sarah, RN. Won't that be the best day ever, to sign RN on documents...

I don't want to fail. Those thoughts came creeping in, again, as I attempted to understand the components of white blood cells.

Clinicals begin next Thursday. Gonna be a doozy. 120+ hours of fun!

I had another clinical calculations quiz this week, and I'll be darned if that is not the most stressful experience for me. My hands shake out of control, and not only that, they become numb and tingly. I'm sure my pupils are dilated, and my respiration rate beyond the 12-20 norm. It's ridiculous, really, and yet, I suspect, will be my nemesis until the very end here.

I still wish I had become a nurse sooner, lived life a little braver, not held back by my own perceived limitations.

Is it the journey, or the destination?

Semester Four: A new beginning

How?

How has time simultaneously flown and stopped over the course of the last year and a half? How is it possible that I am entering into my last semester, 108 days away from my pinning ceremony?

It doesn't seem possible, and yet, as I am one day away from beginning the last semester, I recognize my personal growth, that my thought process has been adjusted, and when I see a patient situation, while it is still a work in progress, I'm beginning to think like a nurse.

I had a patient tell me that he's been using an inhaled medication for his COPD, and recently has begun to notice a burning sensation on his tongue and down his throat. I immediately flashed back to pharmacology, and recalled that said medications can cause thrush, a fungal infection. Passing this information on to his nurse, the doctor evaluated and prescribed nystatin to treat. A victory.

Or, a patient is in respiratory distress. I suggested to the relatively new RN to re-position, leaning forward, in an effort to expand her poorly functioning lungs. He took my recommendation (!!!) and it provided some relief.

The point is, I feel like I'm thinking like a nurse, and not having as many "deer in the headlight" moments as I used to. Will I still have said moments? Yes, of course. But my goal is to progress beyond them, and endeavor to make accurate interventions for the safety and well-being of my patients.

I've been researching nurse residency programs. I am so hopeful that I will get into a program post graduation and ease into my new role.

Of course, I'm still a long way off from graduation, and those old "failure" fears are creeping in, but I'm hopeful. I'm excited, and nervous, optimistic, and ready to take on the insanity, again, for the sake of becoming, accomplishing, and entering into the world of a registered nurse.