Through the Years
Forty years, how can that be? Today it hit me on my commute into work, punched me right in the gut...forty years. I started out as a still wet-behind-the-ears nurse ready to take on the world one (or twelve) patients at a time. I would supervise an LPN with her 12 patients and I would have my 12 patients and that was the hallway we took care of. We had an aide to empty drainage bags and to take patients to the bathroom and to ambulate patients, but we did the rest. I hung all the IVs and gave all the IV meds for those 24 patients. I mixed up and gave chemotherapy drugs to patients who I would later care for during their death. I prepared Adriamycin, Cytoxan, 5-FU for use intravenously, without gloves, without a hood, without any sort of protection for me or the patient. I drew the correct amount up out of the vial and we weren’t even required to double-check our doses with another nurse. I even gave chemo through a chest tube, more than once. I prayed a lot during that time that I wouldn’t make a mistake. I gave my patients a night time back rub and sat with some while they struggled to fall asleep. Charting could always wait back then.
I took care of patients on blue plastic laminar air flow mattresses and Stryker frames, even some patients who could only get comfortable in a recliner. I turned, I cleaned. I had poop thrown at me and have been thrown up on more than I can remember, I had my bright white nursing cap ripped off my head with the bobby pins still clinging to a few strands of hair. I accidentally filled a shoe with urine from a urine bag that I didn’t get clamped well enough. One of my patients flipped an entire bath basin full of Betadine soap onto my white uniform, for a good reason of course, that she didn’t like to do the soaks her MD had ordered. I have cleaned out bedsores, deep bedsores full of stuff I can’t even identify and have seen white bones shining up from the wound bed.
I held many a patient while they died alone, alone except for me. I gave that last dose of pain meds to ease them into their next life. I watched a mother who was my mom’s age die from cancer that had eaten her breast away. A lot of these deaths were painful and hard to see. I was only in my 20s, yet I held so much in my hands. It was 1980, pulse oximetry wasn’t a standard of care, and my COPD patients had a daily ear oximetry spot check if they were really sick.
When I started in the NICU in 1982 pulse oximetry still didn’t exist for babies and we evaluated how well our patients were oxygenation by pulling back on their arterial lines to see how bright the blood was. Or if they didn’t have arterial lines we just looked at their color, were they grey or pink or blue? If they were pink we lowered the oxygen by 1%. Those were the days before surfactant was approved in the US in the late 1990s...surfactant really changed the outcome of a lot of preemies. Less time on the ventilator, shorter hospital stays; but we were saving babies very young, which in itself led to a higher morbidity rate. More intraventricular bleeds, more eye problems, more gut problems, more airway issues, more feeding difficulty.
The onset of developmental care for preemies came about in the late 1980s while I worked in the NICU as well. We made more developmental appropriate outcomes a possibility by trying to limit the noise, light and tactile sensations for our tiny patients. I attended a national conference to learn how to take care of the most fragile babies developmentally. I got to meet the clinicians who came up with those early protocols to protect the tiniest of brains.
I worked in a pretty big NICU, so I was honored to see a lot of anomalies and sad cases...I saw conjoined twins more than once. I took care of babies without a brain, babies with their heart beating away on the outside of their bodies, babies with tails, babies with wonderful parents who were so saddened by their baby requiring intensive care. I watched baby with a newly placed hours old trach cough it right out on to his chest. I immediately slipped it back in without thinking and probably held my breath for 3 minutes as I waited for the baby’s color to change to pink again. I watched a baby as he perforated his bowel on Christmas Eve, regardless of how many times I notified the resident, I feared for this baby’s life. I held moms in my arms as they cried for a baby they would never take home. I cried too for this life that wasn’t meant to be.
I have sheltered deformed babies from the prodding and staring of residents and medical students. I have held dying babies in my arms when a parent couldn’t or wasn’t in the same hospital. I have helped moms breast feed and have heard all sorts of stories from all sorts of families. I have had families love me and had some hate me.
My own baby was in the NICU where I worked and so I learned why those moms cry when they go home without their babies. And that made me a better baby nurse. I worked during two NICU moves, one to another building close by and one across town.
I moved on to adults, saw my first HIV patient in the mid-1980s, I ran peritoneal dialysis, watched as a man farted as a joke and died immediately from a myocardial infarction. I worked nights during a power outage when all the monitors went out. I worked during a hospital fire, evacuating patients. I took care of adults until I suffered a life-altering back condition that I struggle with even today.
I worked as an IV nurse, starting IV lines on all sorts of people, I started PICC lines, just feeling for the vein, I also was privileged to use an ultrasound to place PICC lines. I was proud of my abilities to find even the smallest vein. I glued lines back together when they tore and they were desperately needed.
During this time I made some good friends in my work and I raised my son while I worked. I worked outpatient pediatric clinics and got to see all sorts of things and again, meet some great people, patients, and their families. I worked with incredible doctors and some who had opportunities for improvement. I moved halfway across the country for a new job.
I have been fired from a job, even escorted out of the hospital with an armed guard (not to worry, I had done nothing wrong to warrant that type of an escort). That was my most painful nursing experience ever, but I survived that. I don’t regret any of my nursing experiences; they all are a part of the tapestry that is my career.
Now I work in an area where I only say what is scripted, where I cannot offer advice to my patients, I must say only what my script says. I never meet my patients, I only talk to them over the phone...It’s been a difficult adjustment. It’s a business job, but it’s alright and I work with some great people. I think it is a fitting way to end my last two years before retirement.
And, I'm Still Not Finished ...
This morning I got a text from an associate on Linked In, asking if I was interested in a traveling nurse position in a small rural hospital near Washington DC. I asked some questions, and it sure sounds nice...
Not sure what I will do, but it sure sounds nice.