The little things that make it all worth it...

[MattiesMama]

I've been really struggling lately and wondering if this is the right path for me, but I had a little moment today that just reminded me why I chose nursing and what it's really all about...this is actually my weekly journal entry for clinical but I wanted to share it here...and maybe have a thread where we can all put our positive experiences that keep us going :redbeathe (names changed per HIPPA and all that stuff of course!)

It's funny that it happens this way but I find a lot of the time, in clinical, the patients who I struggle with the most end up teaching me the most valuable lessons and re-enforcing why I chose this career in the first place.

Jean is a difficult patient and I was not looking forward to being assigned her. Number one, she is physically exhausting to care for, but more than anything she is just such a sad case-I look at her and all I can see is a woman trapped in a body that is betraying her...She's severely brain damaged from a stroke, and bound to her bed and wheelchair. Her movements are constant and spastic, her ability to communicate consists of grunts and high pitched wails. For me, I thrive on communication with my patients. Especially with LTC patients I feel like one of the most important things is for them to stay connected with people, to feel like their voices are heard and that those around them truly care. With a patient like Jean, that's hard. I know that the interventions I take with her are necessary, but at the same time when I hear her cry out in pain every time I reposition her or inflate the blood pressure cuff, I have to fight my natural instinct to stop what I'm doing. It reminds me of when my daughter was a baby and she got a horrible ear infection-I had to give her ear drops every 2 hours and she screamed out in pain every time I gave them to her. I literally had to hold her down while she was writhing on the floor to get them in her ears, and I'll never forget the way that she would look at me afterwards-the look of shock and betrayal. And the worst part was not being able to explain it-how do you tell a 6 month old that you are doing this for her own good? All she knows is mommy is holding her down and making her hurt.

This is how I feel with patients like Jean...I see that same helpless look in her eyes and I wonder if she sees me as some kind of monster who comes into her room and disturbs her when she probably just wants to be left alone. Every time I touch her it seems to hurt. She screams when I wash her and when I put lotion over her inflamed skin. She screams when I turn her and when I pry her contracted hands open to put her wrist braces on. When I ask her questions, I watch her struggle to spit out an answer that never comes, and I can see the frustration, the utter defeat of living a life filled with pain that you can never explain to anyone.

On Thursday, I did everything I was supposed to do. I changed her brief and made sure that she was clean and dry. I fed her and got her dressed, and I put her in her wheelchair. I took her vital signs and assessed her from head to toe and made sure she was ready to see her husband when he came. But at the end of the day, I felt like I had achieved nothing. When I left, she was the same tormented soul that I had first encountered.

Then today, I had a moment...it happened after I had done all of my care for the day. I took her downstairs to see her husband, who was running late. I asked one of the nurses if it would be alright if we sat outside together and waited for him, thinking that the fresh air and change of scenery might be nice. So we sat outside on the patio, just the two of us. I showed her the different flowers, and some pictures of my daughter. Then, I reached out for her hand and to my surprise she reached back and held it. Tight at first, digging her nails deep into my skin, but as I continued to talk her hand relaxed. I looked straight into her eyes, and saw that same pleading look I always see when I look at her, and I asked "Jean, do you understand me when I speak to you?" and she nodded. I wasn't positive it was a nod, because she often moves her head spastically, so I said "squeeze my hand if you understand me" and she squeezed it, hard. I said "do you understand what people say, but you just can't always find the words to respond to them?" and she nodded again. "Does that make you sad?" I asked, and she nodded again, this time with tears in her eyes. I asked her "what is your husbands name?" and, clear as could be, she said "Joooe". I asked "how long have you been married?" and she said "Idunnoo". "A long time?" I asked, and she nodded again. It was that moment that her husband showed up. I told him about the interaction we had just had, and I saw his face light up "she said my name?" he asked, a huge smile on his face, and he bent down and kissed her cheek, and told her what a good job she was doing and how proud he was. He thanked me for taking care of "his girl" and said he couldn't remember the last time she had said his name. He didn't need to thank me, because Jeanette had made my day. It was such a small little thing, but when it was just me and her outside, away from the constant hustle and bustle of tab alarms ringing, TV's blaring and the comings and goings of the staff and residents, I was no longer a student assigned to a patient; I was a human being connecting with another human being. And for a moment, I felt like I was able to pull her out of the prison of her body and touch to the soul inside, and I feel like it gave both of us hope.