A Path of Learning

**dianah**, ASN

Over 30 years ago, I was a young 'float' RN doing morning Team Leader rounds in the Post Partum unit.

I had just left a four-bed ward on my way to the next two-patient room. My mind remained on the mothers from that four-bed room, joyfully discussing and comparing their newborns, sharing names and hopes.

As I entered the next room, I glanced at the information on my clipboard, locating the correct room and patient name.

I smiled at the woman in the first bed, who looked, as did the mothers in the last room, healthy.

She smiled back as I greeted her by name and asked, "and what did YOU have?"

She didn't miss a beat but inclined her head as her smile grew broader. "You poor thing," she said. "I had a hysterectomy."

She was most gracious about my faux pas, even laughed about it.

I, however, after climbing the Mountain of Mortification, resolved from that point on to enter each room properly armed with the patient name and knowledge of diagnosis and the focus of this particular patient's care foremost in my mind.

About six months later I floated to a DOU unit, what would today be called a tele unit.

Again, I was Team Leader. I had reviewed the patient's names, diagnoses and where they stood in their treatment and recovery phases.

It had been a particularly busy morning. My morning rounds had repeatedly been interrupted by pressing needs and I hadn't even talked with three of the patients on my team. I had inquired of their direct caregivers about the three patients, and in my running around had noted one of the patients, a man in his 50's who was recovering from an MI, walking in the hall. Relieved that he felt well enough to walk around, I continued at the more pressing duties.

Around mid-morning, I finally got a chance to poke my head in his room to introduce myself and inquire about him.

"I'm glad you're doing so well," I nodded.

"What makes you think I'm doing well?" his eyebrows raised as he sat on the side of his bed.

"Well, I saw you walking in the hall and I assumed you were doing well enough to walk around."

"Young lady," he frowned. "Do you know what happens when you assume?"

Dumbfounded, I shook my head.

He continued, "You make an *** out of U and Me."

Ah, and I embarked on another trip to the top of the Mountain of Mortification. I spent the next half-hour in his room, mainly listening to him but receiving a lesson in checking out details, asking pertinent questions and, most important, listening to the answers.

We came to an understanding, he and I. He realized I wasn't willfully ignoring him and that I did care about his progress and about him as a person.

In turn, I learned from him to revise my time management practices and to gain information directly from the patient, rather than from my own misconstrued hints and assumptions.

In that first year as a young grad, I floated to the ICUs as well as the less-intensive units.

One of my most memorable patients was a young man in the SICU who had been in an auto accident on his way from his wedding to the wedding reception.

He had multiple rib fractures resulting in flail chest, which required ventilator assistance. He had chest tubes, an NG to suction, a foley, required frequent blood gases drawn (no A-line), many antibiotics and IV medications to be hung, rhythm strips to print out and examine, and other routine maintenance that was the standard of that day.

I took his vital signs every hour, suctioned him, measured and emptied the foley, hung the antibiotics, drew blood gases, assessed his lungs, 'milked' the chest tubes, measured and emptied the NG canister, talked with him about what I was doing, assessed his IV sites, and wondered how he was doing mentally. Most of the time he seemed awake and alert. How, I wondered, was he feeling about all this? His long-anticipated wedding day so abruptly and painfully interrupted, and for how long? And, what residual scarring would remain when he left the hospital?

He HATED being turned, and with those rib fractures, I certainly didn't blame him. I medicated him before turning him, warned him before I turned him and then waited for his signal that he was ready. In spite of the pain medication and preparation, he still grimaced with pain each time the deed was done.

In spite of his many time-consuming and care-intensive needs, as a young nurse, I was proud of the way I'd cared for him and tended to all that needed doing for him.

About two weeks later I happened to float to that same ICU.

As I passed a cubicle I recognized him: sitting in a chair, chest tubes out, extubated, color in his face, able to talk! I was thrilled to see him and eagerly greeted him. He remembered me, said it had been a rough road, being in the hospital, but was hoping to go home in about a week.

"Does anyone visit you?" I asked, remembering I'd never seen anyone visiting.

"Yes, my wife works days but she comes by every night to visit."

"So, tell me," I continued. "What do you think has most helped your progress, your healing, through all this?"

I waited, thinking of all the nursing assessment skills I'd learned and used, and tasks I and the other nurses had performed, caring for him when he was so injured and helpless.

"Most helped?" He paused, but only briefly. "Seeing my wife here every day. THAT gave me the will to go on, to get better."

I realized he spoke the truth. He was not just 'a patient' who needed a bunch of nursing tasks done, important as they were.

He was an individual and my teacher, guiding me to a greater appreciation for the human spirit and the power of love to provide hope in the face of extreme obstacles.

A Path of Learning

About dianah, ASN

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