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.

Semester Three, Week Sixteen (Aka: Done)

Somehow, I made it.

Amidst all the fears, tears, heartache, and struggle, I've passed third semester, with an A in advanced concepts of medical-surgical nursing, to boot.

One semester left. I graduate in less than five months.

What have I learned this semester?

1. God is present.
2. Even when it seems impossible, I can persevere, and triumph. 
3. I can do more than I ever thought possible. 

Medically I've seen or done:

• PICC line insertion
• IV insertion
• IV push meds
• Care of paraplegia/tetraplegia
• End of life care
• Cancer care
• Juggling four patients (assessing priority of care)
• Cath lab (stent placement)
• End stage renal failure care
• Care of the patient with heart failure
• Psychiatric care

This semester wore me out. It brought many disappointments, but also many victories. I wish, so much, that my heart was still in tact. While I'm delighted to be done with this semester, a part of me is burdened by other factors in my life, that I've come to realize, can only hide under the surface, but will pop up, always. 

I guess I struggle with why this prayer for nursing school was so easily, quickly answered, why I had such clear direction and understanding of what God was asking of me, leading me to do, when all the other aspects of my life are not as clear, and at best, confusing. 

What if all I ever have is a nursing career? What if the years of my life to become a wife and mother never come? Will I be the old maid who contributes all that I have to my job, only to come home to no one? This. This is what is on my mind today, December 15th, as snow lays on the ground, storm overhead, at long last on break, but not at rest.

~
I waited a few hours before posting this, and I took some time to think about life. Okay, so I'm not exactly where I wanted to be at this late stage in the game, but I serve a good, good Father, and He knows what's best for me, even if I can't fathom that this is best. He is perfect in ALL of His ways. So, I'll continue resting in His grip, even when I can't see, and I don't know. 

We'll talk again in a month or so.

Semester Three, Week Fourteen

Last day of clinicals.

The anticipation was high. I made it. I didn't love it, and it was perhaps my most challenging clinical yet, but I learned I can safely handle four patients, I can do IV push meds (always forbidden before this semester) and my knowledge base really, truly has improved.

It's funny though; on one hand I feel like "I've got this, nursing isn't that bad." On the other I'm like "I am going to kill someone. I know nothing! How the heck did I get this far?!"

Thursday evening, the primary nurse assigned to my patients ("my", ha!) has never liked me. I don't know what I did to her at the start of my clinical rotation two months ago, but she's been against me since day one. Actually, I do remember; I had no computer access, our patient's blood pressure was outside normal perimeters, and I asked her, when she had a moment, if I could pass along some info. She blew me off, then begrudgingly had me tell her, to which she blew me off again. The following week, she apologized for being so rude, as she "never does that" and I received the apology gracefully (if I do say so myself), but from that point on, whenever she was working, she'd a) ignore me b) scowl at me or c) treat me like I was a moron.

Attention RN's: I am here to be a help. I am here to learn. I am not a dim-wit, competition, or going to disservice you in any way. In fact; I am here to help. I am here to lessen your work load. I am here to make sure that you get what needs to be done, done. So, I'd appreciate a little respect, and for you to not cut me off, glare at me, or treat me like I'm less than human. Because I notice it, feel it, and hate it. So, thanks.

Completed my last med-surg exam (not my final) this week, with a 96%. The neuro exam was ridiculously easy. So at this point, barring some unforeseen disaster, it does appear as if I will be completing my third semester of nursing school, you know, the one that was promised to be the worst of the worst?

I feel as if I'm dreaming, constantly. None of this seems like reality. My clinical instructor told me that she could see me working as an oncology nurse. There's a thought. I don't know. The last month has seemed mindless to me. I'm trapped in my grief, and I can't summon up the...anything to care.

Monday. We'll talk Monday (or later), after the big, bad final (that I haven't really studied for/can't find the gumption to study for.)

Semester Three, Week Fourteen

I'm always in such a state of disbelief as the semester creeps to an end. It never feels like real life. One moment, I'm launched into the beginning of a semester, all the fears and concerns at the forefront, the next; I'm preparing for finals, ending clinicals, submitting paperwork and getting ready for a month off.

I'm struggling.

This year has been difficult.

I found out yesterday my friend's cancer has returned. And we're not talking a minor recurrence; we're talking stage four cancer with distant metastasis.

It really feels like there is a dark cloud over me; a heavy weight that cannot, will not be lifted.

Nine days, and I'll be done with third semester. I've completed pharmacolgy; had standardized testing to measure my knowledge against other nursing student's across the states. Incentive: If you do well enough, you get to skip the final. I remember hearing about that possibility my first semester of nursing school, and thinking I'd never get the grades to pass. Sure enough, no problem.

I have completed the last of this semester's Med-Surg lectures, on neuro disorders. There's something about declaring brain death that makes me feel incredibly uncomfortable and sad. Some of the tests to confirm said death are ancient sounding (reading the apnea test) while other's yet simply make me yearn for Heaven all the more. I'm tired of the pain, death, and suffering of this world.

One more week of clinicals. I really look forward to the end of that experience. I felt like a dunce during my clinical day yesterday, and just felt like I couldn't get it together. Though there was a moment when explaining what I heard on ausculation of a patient's lungs, that it felt real; here I was, so easily discussing rhonchi in the middle and lower lobes. Surreal.

We placed our fourth semester preceptor requests this week. I wrote "The reason I entered nursing was to eventuate in emergency medicine. It is my passion! I am willing to drive anywhere." I am hoping, praying for an ER preceptor spot. That alone would make my semester. If not (ever the Eeyore) I'm asking for anything but long-term care. *Shudder*

I'm just not feeling good enough for anything anymore. I can't snap out of the funk of losing my dog, and discovering my closest friend has cancer, again. The words of a friend stated a few weeks ago continue to echo in my mind "I keep you at arms length. You're a 'I'm in crisis' kind of friend."

Mix that in with the fact that I met a nice fellow over Thanksgiving break, got the commitment jitters and ran away faster than you can say peace. I'm a flight risk.

And so, nursing school. (I've been digressing a lot lately.) As of this writing, there are nine days, fifteen hours, and forty-two minutes left to this hellacious semester.

Semester Three, Week Thirteen

Hours after taking my exam on GI issues, highlighting diseases such as diabetes and pancreatitis, my dog, my wonderful, amazing dog of 12 years died in my arms, succumbing to complications from diabetes and pancreatitis. My heart is utterly, completely, totally broken. Presently, I could care less about school, nursing, or anything else, really. I'm broken. I can't stop crying.

But life goes on, doesn't it? Just because your world stops spinning, doesn't mean that anyone else's does. I've purposefully kept myself insanely busy this past week, volunteering in my friend's EMT class, going on a ride-along with my police officer friend, staying up as late as possible,

It was a crap week. I cried almost all day in class on Tuesday, and left early because if I didn't leave just then I may very well have imploded.

I didn't care that I did well on my exams; my second exam this week was a day after Cadie died, and all I could think was "This is the first exam I've taken without Cadie." It's the memories that kill me.

Clinicals were a comfort, though. I had a patient who needed extra care, and in a sense, I was able to pour out extra love on her, a patient who desperately needed it. I learned, once more, what nursing really means; it's stepping away from the "medical" side of things and recognizing before you is someone who is hurting, someone who has been defined for years by their diagnosis, and they've lost sight of who they really are.

I signed up for my final semester, and a part of me was in awe, while the other just couldn't summon up enough anything to care. So what that I'll graduate soon. So. What.

Returning to town yesterday, I buried my dog. She's in the front yard of my parent's house now, and I hate it so much. I hate that she died, I hate that she suffered, I hate that I feel this way, struggling to breathe, to function, to live. Making sure I eat one meal a day is a struggle enough on its own. I've (temporarily, I hope) lost the will to live. Perhaps that sounds overly dramatic, but I've known all along that once Cadie goes, a part of me goes, too.

I attended church last night and saw the dreaded boy I had dated this summer. He hates me something fierce and made it overtly obvious as I went to approach his (assumed) new girlfriend (an acquaintance of mine) to say hello. He not only purposely turned to walk away from me, he made sure to angle his back just enough away from mine in a dreaded effort to come off as casual and easy breezy. I noticed two things, 1) he's almost always wearing the same shirt 2) he has man boobs. So there.

It's not all about me, but it most certainly feels gut wrenching and world ending right now.

I waited all semester for this damn break, and now that it's here, I hate it and wish it would end.

Semester Three, Week Twelve

Another week, come and gone.

There were no exams, thankfully, but the additional hours of lecture were indeed excruciating. I only have about ten million slides to go over for Monday's exam, all on GI and endocrine related material.

My dog is sick again; presumed pancreatitis. She's worse off this time around than she was last time, and I find myself in a healthy state of denial, pretending like she'll pull through this again, even though she's presently lying at my feet and too weak to ambulate well.

I cared for a dying patient during clinicals this week. Their diagnosis was self-inflicted, and I recognized, how far too easy it is to judge. As I cared for him, I saw that this was a broken man, someone who took their addiction too far, but I also saw someone who is genuinely making an effort just to live. His family member also stated as such, and said she wants him to keep on going. His requests were minimal; to shower, to have lotion and chap stick, to have a breathing treatment for his wheezing and dyspnea when lying supine.

Nursing care requires love. It requires impartiality. It requires an open heart, and when judgement attempts to seep in, it is reminding yourself that at the core, there is a problem. A heart problem, a soul problem. As a nurse in training, I am so honored to be just a temporary part of my patient's lives, and (hopefully) showing them the non-judgmental love of Christ.

I once more was reminded of that yesterday, when rounding with the wound care nurse. A young patient, defined as an IV drug abuser with a raging infection, but I saw someone who is so lost, their cause (almost) hopeless. Their gaping wound as a result of drug abuse and infection was no match for the ache, the heart pain of a young addict who had a perfectly functioning body and was riddled with disease, once more due to addiction. As the tears poured down their cheeks, I wanted so badly to hug them; but was reminded of the need to remain professional, showing neither sympathy or judgement; just the facts, Jack. But there is no way on the planet that I will ever be able to remain that impartial, and so I silently prayed for the patient. I love secretly praying for people.

Another patient was recovering from their ostomy surgery. The wife was learning how to change the ostomy dressing and bag, and I commended both the patient and his wife on their willingness to learn, taking this life change in such stride. The wife shrugged, stating "What else can you do?"and I nearly had one of those blasted break down moments, wondering who would care for me if I was sick, if I needed an ostomy, or had a life changing event. Yeah, yeah, that's what your parents and sisters are for I hear you saying. But nothing [yet] has erased that deep void in my hear to have someone by my side in sickness and in health.

Sometimes it feels like I give so much of myself but receive so little in return. And this isn't about pity, or wanting recognition. Nursing life is hard work. It requires selflessness, but sometimes I wonder if I'm getting too prideful, as I recognize how "selfless" I am, yet still wish for more.

Semester Three, Week Eleven

Oh, that rumor mill.

So, remember when I inadvertently walked in on my instructors "discussing" (to put it politely) my class last week? Well. I made the error of telling two (2) people.

When I walked into my classroom Monday morning, people were talking about the event as if they had actually been there. Also, the story had been changed that our instructors hate our class and say we're stupid.

This exploded into threats of talking to the dean, people actually going to the assistant program director, demands for action via facebook, and a general poor attitude. The instructors are acting differently around me. At least, I perceive that as such.

My stupid mouth...

I thought my vision was slowly fading recently. Being concerned, I scheduled an appointment with an eye doctor. He told me my eyes are overly strained from all the dang studying I've been doing, and need "computer" glasses. (Whatever those are.)

My cardiac exam on Monday went exceedingly well; with extra credit, I received a 92%. Thank you, God.

I had a patient ask me if I was married. I replied "No" but that I pray for a spouse. She told me to pray to the Virgin Mary, and I wanted to cry, not because of any affiliation with the Catholic belief system, but because I have prayed, so much and so often for a spouse, and it yields no returns.

Visited the cath lab on Friday; it was really neat, even if I had no idea what I was looking at most of the time. I saw a stent placed, and watched as the right coronary artery went from being 95% occluded to wide open, thanks to a well-placed stent. Cardiologists and interventionalists are amazing. They make this process of stent placing look so easy, when most assuredly, it is not.

Now back in the day, when I was a newbie to medicine, I participated in a voluntary internship to gain some medical experience. I recalled visiting a cath lab all those years ago, and thankfully, I blogged about it. Re-visiting who I was once is pretty comical. Take a peek here.

I was naive in the ways of the world, and I sometimes wonder if I'll look back on this blog and chuckle at my naive self, again. Perspective.

I feel, sometimes, like the more I know, the less I understand. I also feel that nursing school is the best of times and worst of times. It's complex, really. One minute, I'm flying, the next I'm doubting my self-abilities. But I'm working my butt off for this. It's rewarding, challenging, joyful, and stressful. And it's worth it.

Five more weeks. Four, if you exclude the Thanksgiving break. I hope, I pray I complete this semester successfully. It most certainly is the most difficult of them all, to date. So much busy-work on any given week, that you can't really catch up. I wrote a three page paper on nothing. It was defining PICOT. Any paper that requires one to define an acronym is just about pointless. But I digress.

Five (four) more weeks.