Climax

Waring: This post is pretty self-congratulatory.

Graduation was far more climactic than I had anticipated. Especially since I merely walked, I won't technically receive my degrees until August. A minor detail the director of the nursing program assured me, since there aren't any nursing positions right now anyway, and more time to study (read: more time to procrastinate studying?) for the NCLEX board exam for licensure. As close as I am to achieving my second degree, I would be academically bummed if I didn't go for the BA in Women Studies.

It's true, I miss the Women Studies atmosphere. Good old fashioned liberal academia, full of freedoms, individualism, empowerment, anger, human rights, attitude and political activism. I remember when I used to think that this was what nursing school would be about. Well now I know a bit more about that. I do feel that while nursing school has been a proverbial hoop, discipline, struggle, frustration, blood and sweat certainly do have their place in this world. I also realize that while a BA in Women Studies gives me an invaluable grounded position in this society, it doesn't--as readily--give me a job.

Enough negativity. Here is some positivity. 

I graduated! Did I mention that? My first bachelor's degree(s). I started down this road 8 years ago. First I dabbled in mathematics, primarily because I had a crush on my high school calculus teacher. Turns out I'm not great at math. So I switched to nursing, practical reasons; I could do well to take better care of myself, what classes would encourage that? Wait, do those classes offer a degree? A job!? Wooooow, I love nursing. Too bad nursing is really hard to get into these days. So I dinked around a bit, studied in the UK, became a doula, volunteered internationally etc. etc. Started a new degree in the meantime, and finally I was in [passed the perseverance test I'm thinking.] Two more-or-less amnesiac years later, poof! I can put some letters behind my name, never thought I'd see the day, nor did my folks.

There was even a grand culminating moment to all of this, my four and half minutes of small-scale fame. I was nominated by my peers and a faculty committee to give the student's commencement remarks. The only free-style speech at the ceremony. A responsibility traditionally offered to a graduate student in fact. So on behalf of 245 graduating BSNers, Masters, DNPers and PhDers I spoke the following words at my graduation last Friday:

_________________

What a privilege it is to speak on behalf of the various degrees of nurses having accomplished a major feat of academic pursuit and who are ready to re-join our greater community as a new and improved member of society. This is a ceremony of transition. Many of us are transitioning for the first time into the field of nursing; many others are transitioning from long standing nursing careers and are now here reborn as a nurse of a different color.

We are all functioning, contributing members of our healthcare system—no matter the political or financial condition. We are now officially a community of nurses who sometimes shared pain and suffering but who today share a sense of empowerment and great accomplishment. We transition through this stage in our lives together and with each other’s support so that we will be more capable of empowering others, namely, the patient populations we will soon disperse widely amongst us all, and contribute to a healthier society as a whole.

After all, nurses are patient-people.

It is also a great privilege to share this moment with an audience like you. Full of unconditional supporters: faculty, family, and friends. It is likely that without your encouragement, motivational, perhaps financial and certainly emotional support, that a few of us might not have made it. Nurses are strong, but we often require stronger support from those we love. Thank you all, for this.

I want to cheers to Nurse Flo, our founding foremother, in all her revolutionary glory, may we follow in her path and think of the little things that ease the discomfort of our patients as well think of the bigger things, and make room for more revolutions in healthcare. Say for example, advocating for a single payer healthcare system. And we again honor Miss Nightingale, and always wash our hands.

Today’s nursing graduations no longer involve the starched white cap ceremonies, but we know that we are part of an important tradition of care and expertise in our field. We do not need to denote our status in the field with this symbol of otherness; we are a community of healthcare professionals who meet our patients where they are in their process of health and healing.

Reflecting on what it means to be a part of this tradition of nursing, I often come back to 3  questions that frequently lurk when I am in a stressful nursing situation:

When is the best time?

Who is most important? and

What is the right thing to do?

Today I have the answers, they are universal, timeless, relevant to everyone and to me they represent what it means to be a nurse. They are from a children’s story adapted from a piece by Leo Tolstoy called The Three Questions:

“Remember that there is only one important time, 

and that time is now. 

The most important one 

is always the one you are with. 

And the most important thing 

is to do good for the one who is by your side. 

For these are the answers to what is most important in this world. 

This is why we are here.”

oo la la ladies n gents

j o e y & j a n e

c a t a r i n a w i n e b a r , s p o k a n e

I like to tell people we met at the gym... when we were 12 and seated alphabetically in phys. ed.

But sometimes I tell people that we met online... because we reconnected, after growing up, via a mutual friend on facebook.

Joe Sheehan is my long lost crush, and I have new appreciation for Spokane. That 4 1/2 hour drive stinks. But we share it.

Fun, fun.

x

Memoirs of a Nursing Student in a Lock-Down Psychiatric Emergency Department

[place holder post to remind me to fill in soon!]

***

Wow, so apparently this was a ridiculously busy quarter. It's now June 5th. I finished all my hundreds of practicum hours just yesterday. So naturally, now I have some time to update.

"Psychiatric Emergency, this is Jane,"

This is how I answer the phone down in the psych ED at Harborview Medical Center. It feels like we're in a basement with no windows (for safety), and it's kinda dreary with nothing on the walls; no eclectic hospital art or any color at all really (for safety in reference to the lack of art, but color?) But I love it. I love psychiatric patients. I love the team of providers and staff. It has been, by far, my most rewarding clinical experience in nursing school. I had chosen "Psych" for my senior practicum placement because I studied psych nursing in Thailand, and wanted to see what the American system was like. Now I have an idea. It's horrendous. Psychiatric illness and care carries an intense stigma in our culture, and it is one of the least resourced sectors of our healthcare system. In fact, the majority of our population suffering from psychiatric illness is homeless and the biggest provider of psychiatric "care" is our prison system.

This may very well be one of the main reasons why I feel so drawn to this patient population, it is one of the most vulnerable and disadvantaged communities in our country. For me, as a pseudo-provider, this means that often a small gesture can go a long way for an individual in crisis. I can do small gestures, I can make very small differences, and this helps because there is an infinite amount that I cannot do for this population...

Enough political advocacy for now, here are some of my favorite stories from the past 10 weeks.

A patient watches me give medications to another patient in the hallway. He comes up to afterward and says, "Hey, I take Topomax, and I haven't had it yet today..." and I replied, "Oh, I'm sorry, but you're here because you overdosed on Topomax." The patient starts laughing, "oh yeah, I forgot. I'm probably good for a few days."

My preceptor says to staffing on the phone: "We're great, we have three nurses" and I say, well maybe 2.5. He says again, "Oh no Jane, When we get a float nurse from the main ED, then we have 2.5. We count you as a whole nurse here."

Wow, a whole nurse!

Once we did get a float nurse from the main ED (see previous post: A Montage regarding the Harborview Emergency Department from August 2008-a serious ED that has amazing nurses, but they are not psych nurses..) She asks the group of us, or maybe no one in particular, "So what are you guys doing these days for folks with mental problems.. er, uh, mental issues or whatever it is you call it now?"

The Emergency overhead pager goes off: A voice crackles over our heads "51 year old male whose been involved in a scuffle with a gun-" is immediately interrupted by another, more snarky voice chiming in with "Ok Lexi, as soon as there's a gun involved, it's no longer a 'scuffle', new criteria have been met"

One new admit on the psych emergency unit demands "How can you detain Jesus?" RN answers: "Immaculate detention?" Later, same patient profoundly inquires "How can you inject Jesus?" RN suggests "Omnipotent injection?" Patient states matter-of-factly during an initial assessment on the unit, "Yes, I am Jesus... but I can't walk on water." Religious preoccupation was one of my favorite manifestations of an illness presentation.

And on a heavier note:

I became inducted into the team officially as a psychosis doula. I went to the admission room to collect a new patient. He was sitting at the processing desk with a ball point pen aimed at his jugular. The receptionist says "What are you doing with that pen, can I have it back?" I ask him to give me the pen, and I will take him back. He responds and mentions "I am supposed to do it, today is the day.." We enter the lock-down unit and he pauses in the doorway, "I don't know if I can go in here, they say it's not a good idea," We settle into his room and begin to talk. I leave to retrieve some water and a urine specimen cup for him to pee in. When I return to his room he is crouched on the floor lifting the head of the gurney and looking underneath. He turns to me when I distract him and says "I am supposed to lift this, and put my head here, and then pull it down, hard." We talk more. We discuss safety, and self-control. He asks to be placed in restraints, he doesn't feel that he can be in control. After doing so, he reacts to the physical restraint by yelling, and jerking his body on the gurney, which is now chained to the wall in this tiny fear-inducing room. I sit with him, with my hand on his shoulder, and all of a sudden doula voice sets in. It's ok, you are safe now. This is a safe place. When you feel anxious about not being able to move freely, take a deep breath--like this, with me--and tell yourself you are safe, you are safe. The patient breathes with me, deeply, like we have been transported to a beautiful sunny yuppie yoga studio. He repeats "I'm safe, I'm safe, it's ok, I'm safe" over and over until he actually falls asleep.

My preceptor walked by and observed this for a moment. She pulled me aside and said "I'd heard you were a doula... well done."

This is when I fell in love with schizophrenia, for anyone remotely interested please read this incredible story: The Day The Voices Stopped by Ken Steele.

After many more experiences on this unit I became twitter-pated with Autism, Asberger's, Borderline Personality Disorder, Delirium Tremens, methamphetamine-induced psychosis, hallucinations in general, mania, malingering and more. My love for them relates to a strong desire to learn everything about these conditions and how they effect a person, and how society in turn treats them. There is a lot to learn.