Friday, April 15, 2011

Clinical: Be careful what you wish for

[Forgive me if this entry isn't quite as eloquent as the ones you have come to expect from me, dear readers. I am not really sure how to express some of these things and they might come out jumbled, scattered, and sounding like they were written by a crazy person.]

I haven't been feeling well, my darlings, for the better part of two weeks now. It started out as a sore throat that morphed into an upper respiratory infection accompanied by a fever. And I have had a lingering productive cough, sinus congestion (alternating with a runny rose), as well as a general feeling of crappiness and lethargy. Basically, I don't have the energy for anything really and my mind has been quite foggy. And I really don't belong on a med-surg unit right now.
Let me proceed this story by saying, about a week ago during my mid-clinical evaluation, my instructor asked me what skills I have not had many opportunities to perform yet. I was honest with her and said that over the past two years, I have yet to deal with a PEG tube, insert an NG tube, or preform postmortem care. I told her that I found death disturbing [as most people do] and the thought of caring for a dead body left me extremely uncomfortable but I wanted to experience it while I was a student and was in a somewhat controlled environment with someone there with me.

So despite feeling like death warmed-up [bad choice of words for the content of this entry] this morning, I woke up at 4:30am (after falling asleep at 3:30am) to start my third to last day of clinical for my nursing degree.
I got to the clinical site at 0645 and walked into the surgery waiting area where we usually meet with our instructor. She could tell I was sick. I was pale [well...paler than usual] and I was coughing but whatever...the show must go on. The instructor asked me what unit I would like to go to and I said anything but med-surg. I actually wanted to go to the burn unit but the census was too low for students to be I ended up in the ER with one of my male classmates.

Usually in the mornings, the ER is really slow. Today was no exception. There was only a few patients on the unit...a psych patient under a PEC [physician emergency certificate] well as a young woman admitted for severe cramps. I assisted B [along with the ER tech] with an in&out catheter because he had never done one on a female before but after that there really wasn't much to do.

B and I were sitting with the ER tech when a nurse walked up to us and asked if we would like to help "bag" a patient. Thinking she meant "bag" like during a code, I said that of course I would help. We walked into the critical room in the ER as I was thinking, "It is awful quiet for a code to be going on right now."

I stepped into the room were there was a patient lying on the table with her mouth hanging open. She wasn't moving and she was very pale. I think it took me a full 30 seconds to process the fact that the woman was deceased and even then I didn't fully "get it" until the nurse placed a toe tag on the patient and opened the body bag.
I tried not to look at her face.
We rolled her over and moved the body bag underneath her. Just then, the patient let out a snore.

The woman....who was dead.....snored. It was all I could do not to leave the room right then.

We finish placing her in the bag and zipped it up.
At this point, something happened and she either exhaled or twitched because the body bag moved. WTF.
The nurse made a joke about how there might be some spirits still in the room because she was so "active" after her death [referring to the snore and the twitch]. B and I exchanged a look that in no uncertainty terms said "I would really like to get the fuck out of this room right now" as the tech laughed at the nurse and told her to stop trying to scare the students.

At this point, we covered the bag with a sheet and wheeled the stretcher to the morgue where we placed the woman's body on a metal table to be left in the freezer. The nurse started to wipe the ER stretcher with a sanitizing wipe and I couldn't help but wonder how many people have taken their last breath on that bed.

Back in the ER, B and I both attempted to start an IV on a patient [which neither of us could get because of her tiny, rolling veins...also, the fact that we were both still shaking a little bit might have had something to do with it]. The instructor said to leave it to the nurse because she wanted to take us to the cath lab to see an angiogram performed.

Although it was very interesting to watch, during the procedure, I began to feel even worse than I did earlier. I excused myself when I saw that it was over as a tech wheeled the patient out in order to find a restroom.
I think combined with the fact that I was already sick, the morning's events caught up with me. In a cold sweat, I leaned against the wall for support as my vision started to blur and the room started to spin. After a few moments, the dizziness subsided as a violent wave of nausea hit me. At this point, I said hello again to the yogurt I had for breakfast.
Exiting the rest room, B was waiting for me. He looked really concerned when he saw me and ever the gentleman, he said "Wow. You look like hell." I countered with,"Thank you, darling. Unfortunately, we can't all be movie star material like you." The instructor showed up shortly afterwards and noticed that I didn't look as perky as usual. She suggested that I go to the medical library and read until I felt well enough to get home.

Once home, I promptly stripped off my scrubs and crawled under the covers. My nap was not in the least bit restful. Nightmares of corpses and bloated, decaying bodies in every ER bay plagued my mind and I woke up in tears.

I am not sure what upset me more, the actual experience or the nightmares, but I texted my favorite lesbian [she's a classmate, a paramedic, and one of the strongest women I know]. I can always rely on her for a little wisdom or tough love whenever I need it. Here is how our conversation went-

Estelle: So how long did it take you to get used to dealing with dead bodies when you first started as a paramedic? And I am not even talking about the dismembered ones.
A: Never had a problem with it. No one I know in the medical field ever had a problem or they probably wouldn't have gotten into it in the first place. It bothered you that much?
Estelle: Yeah. It bothered me.
A: Okay. Then I am worried about you. Are you gonna make it? What will you do if it's actually your patient and they code in front of you? That's a scary thought.
Estelle: I don't know. I feel like [name of our notorious classmate who washed out in our third semester after a series of potentially fatal mistakes she made during clinical that could have cost anyone of her patients their life] right now. I mean, the lady had been dead for two hours. All we did was put her in a body bag. That was it. I shouldn't be this freaked out about it.
A: No. No. No. She was a dumbass. Not the same thing at all. You're just a tender heart.
Estelle: Well, I feel like a total dumbass right now.
A: And no, you shouldn't be upset. She was old. Not smelly or decomposing or ripped apart in a trauma. Death is a part of life.
Estelle: I know.
A: Just find a way to accept it. Tell yourself it is what it is and everyone dies. And try to move on. Do the best you can.
Estelle: How the fuck could I have made it this far only to realize now that I don't have what it takes to do this?
A: You can do it. You just need to learn to displace the hard crap. Fortunately, the death rate isn't that high in L&D.

About 10 minutes later, my phone starts to ring. It was A's girlfriend. Being that I was sobbing uncontrollably at this point, wondering if I would indeed be able to do this, I sent the call to voicemail. A few moments later, she texts me that if I needed to talk, she was around and that A told her what happened and that she wanted to take me out for a drink. I told her I appreciated the offer but that I wasn't very good company at the moment. She told me that is what friends are for and to not hesitate to call if I needed anything.

After a few hours of crying and exchanging messages with a bunch of other nursing students on Twitter (by the way, ya'll really should get Twitter is awesome. Follow me: @EstelleDarling), I texted A that I would be okay. She responded like a protective big sister with "You better be."

And I will be okay, readers. I needed this. For the past two years, I think I have been functioning under the delusion that I would never have to deal with death in the hospital. I won't lie. This was a really shitty experience [although, I am sure that some of you are thinking to yourselves "Um...get a grip, Estelle. It wasn't even that big of a deal"] but I am glad it happened.


Zazzy Episodes said...

First of all let me start by saying I'm proud of the way you handled yourself in the ER, you totally could've ran out of there screaming or projectile vomited everywhere. But no you kept your cool and finished the job and then after things settled a bit it hit you. I wouldn't have handled the situation any better, so don't beat yourself up.
Secondly, death is scary and none of us are use to being around it. We hang out with people, who are alive, so don't panic about your fear of death.
In the end your desire as a nurse to help the people who are sick or injured far outweighs your grip of fear with death. I think you're normal for having those crazy dreams and that is your subconscious way of dealing with what you saw.
Take it easy on yourself and know that you needed to witness a dead person and that you got it over with in a controlled environment before you graduated. I think God was looking out for you that this happened now instead of after you graduate. Hang in there chicka, it should get better.

Cartoon Characters said...

Death is only a small part of the nursing world....depending on what area you will be working.

I saw more of it when I worked extended care - just starting out...Less working L&D....and in the other places I worked - somewhere in the middle.

You really do "get used to it"...but perhaps there are some issues with death, facing your mortality or feelings you have about it?

Meanwhile, don't dwell or worry about your reaction too much... everyone is different and it's ok to feel this way...never mind you aren't at all healthy at this time, which can make things seem worse.

It certainly isn't an indication as to how good a nurse you will be!
Be kind to yourself.

GADAFINY said...

nice post

Pollyanna said...

Death is hard to get used to. I've been caring for hospice patients at this job, and have done so while they're in the process of actively dying, but haven't done postmortem care yet. It just hasn't happened that any of them have actually died while I'm there. I'm nervous about it too, and am just crossing my fingers that when it does, it's one of my nice residents so that if they sigh or twitch, I won't think they're about to attack me. I was doing "comfort care" (what we call what we do for someone who is in the process of dying) for one woman at my job, and she suddenly reached up and choked me, and scared me so badly I almost wet my pants. She used to try to choke everyone all the time, so that wasn't unusual for her, but I wasn't expecting it from her since she was so weak. She didn't have the strength to hold onto my neck, thank goodness, but now I'm really wary of the combative ones who are about to die.

Zazzy Episodes said...

How super scary Pollyanna, I don't know what I would do if the person I were taking care of..near death.. was to reach up to choke me.
Haha that's kinda funny though.

Absentbabinski said...

Death is a small part of it (I can count on two hands the the number of last offices I have performed), but it is so very important.

It is also a hell of a dichotomy for most people. You have to find a way to make it as much a routine (for want of a better word) and still intimate.

I talk to people as I lay them out. I think in part to remind myself that this was a person and also to normalise an activity which is almost entirely unique to nursing.

You did well, though. And it does get easier, if you want it to :)

Oly said...
This comment has been removed by the author.
Pollyanna said...

@Zazzy it was definitely funny ... as soon as it was over! If a sign of impending death is "she didn't choke me as hard as usual", you can predict that not a lot of her CNA's will be at her memorial.

Estelle, I hope you're feeling better both physically and emotionally xoxo

nurse XY said...

Hey girl, just checking on you, been kind of quiet over here...