Friday, May 23, 2014

10 Lessons Nursing Taught Me

It would be kind of cliche to say that I knew ever since I was a little girl that I wanted to be a nurse. I can't say that's true but I knew in high school though. I knew then that I wanted to work with the premature babies too. I even wrote a paper about it senior year. Fast forward 12 years and here I am...living in Germany and working in a Swiss Neonatal Intensive Care Unit! Not exactly how I had pictured my life going but satisfied none-the-less.

Last week was Nurses Week. I would have forgotten if it weren't for all the Facebook posts about it. It wasn't Nurses Week in Europe. I don't think it exists here. I didn't get a lunch bag or an umbrella with my hospital's logo on it. No one patted me on the back or gave me a gift card to the nearest grocery store either. Instead, I gave a gift to myself. I reflected on what this career means to me. What nursing has given to me. 

When I would tell people I am a nurse in America I would get a lot of "God bless you" 's or "thank you for all that you do. I could never be a nurse." But here, in Germany, it's different. I noticed even when I was just visiting here that when I told people I was a nurse, it wouldn't get the same reaction. Instead, I got more of a "mmm, ok," response. I think it has something to do with the lesser amount of required schooling. They don't realize that I graduated high school, studied at a university for 4 years and I have my bachelors. In Germany, you only have to go to school for 10 years and then do an apprenticeship for 3 years. It's like they think I settled. I got that feeling sometimes in America too when people would ask "Oh, you're a nurse? Well, you can always go back to med school to be a doctor, right?" I didn't "settle" for this job. I wanted it. I sought it out. I worked hard for it and I am damn proud of it.

As us nurses take the time to thank each other for our hard work and companionship over the years let's toss it back to the profession itself. Throughout the years I've experienced things through my job that have taught me valuable lessons. I wouldn't have encountered these things had I had a normal "desk job." I know every nurse has many tales to tell. Here are some of my unforgettable lessons.



1. The value of a heartfelt thank you and a smile. (Bonus: People naturally want to be happy.)
I once cared for a man who was paralyzed from the neck down. He was addicted to IV drugs and wanted to get the highest of highs so he started injecting the drugs into his spine. The injection site eventually became severely infected, damaging vital nerves and he lost movement in his arms and legs. I remember getting report on his case and thinking "how dumb." I cared for him over the course of a few days and I had to work hard on not passing judgement on him. My prejudice melted over time. He liked to laugh and joke around too! I had just helped him with something and as I turned to leave the room he called me back in -

"Hey Rachel?"
"Yes?"
"Thank you."
And he flashed me a huge, toothless smile. Well, I shouldn't say toothless. He had one tooth. A yellow snaggly one, bottom right bicuspid. It was one of the sweetest smiles I've ever seen.
"You're welcome."
He actually looked happy...truly happy. Every human just wants to be happy and who am I to judge how they try to reach that happiness? I can't remember what I did for him to make him say thanks but it felt good to know that I helped him come to a place of genuine satisfaction and gratitude.

2. The importance of saying goodbye.

I'll never forget the first time I heard in report that my patient from the previous day had died. He was a younger man, maybe in his 50's? We joked a lot the previous day. At the end of my shift I said "Ok, 'Mr. Smith,' I'm done for the day. I'll see you tomorrow." The feeling that I got when they said he died in the night was a kick to the gut. I was still in nursing school and didn't think too much if I had missed any signs or symptoms. I was just...shocked. Surprised. Stunned. Sad. It was a pulmonary embolism and now he's, poof, gone. From that shift on I made it a point to try to say goodbye to each of my patients at the end of the shift. You just never know.



(This is not the man I am talking about but rather another patient of mine that became a good friend. He was also taken too soon.)

3. Being in the right place at the right time.

While still in clinicals, I took care of a younger woman who just had back surgery. During her stay in the hospital she got her period...however, she was unable to move. I had to help her clean herself and put on her ugly hospital net underwear and pad. She cried the whole time. As I helped her turn she repeatedly alternated the following two sentences-

"I'm sorry about this."
"I'm so happy you're here with me."
"I'm sorry about this."
"I'm so happy you're here with me."
At some point, I had to pause for a moment to calm her down. I gave her some tissues to catch the tears rolling down her face. I knew the tears were because she was in pain but also because she was embarrassed. I thought about the nursing assistant working that day, a man. Very efficient but he wouldn't "get it." I thought about my preceptor for the day. Running around passing meds and charting. She didn't have the time. I had time.
"Hey hey hey, shhh, 'Mrs. Smith' it's ok!"
"I'm sorry about this."
"It's fine. Don't cry."
"I'm so happy you're here with me."
I made sure to look her in the eye and say "There's no place else I'd rather be right now."
At that moment, I truly meant it.
I was supposed to be with her. It was my job, an honor.


(Junior year of college about to head off to clinicals with the roomie C. Fitz.)

4. I take everything for granted.

In college we had to go to Cleveland inner city schools and help teach the kids about the importance of exercise, healthy eating, hygiene, etc. I'll never forget the time that we were chatting with a little boy (about 9 or 10 years old) and saw he wasn't wearing any socks. We asked him why he wasn't wearing them. I totally expected him to say "Socks are dumb!" or "I hate wearing socks!" but instead he matter-of-factly told me -

"It's my sister's turn to wear the socks."
Time stood still as I comprehended what those words meant. 





(Health Fair 2007. Check out what's in my purse. Just working on my Deutsch on our break.)

5. Sorrow has a sound.


I'll never forget the first time I helped a mother say goodbye to her dying baby. I had been working my butt off for hours drawing up meds, hanging fluids, pushing boluses, giving blood when finally the decision was made to let him go. The doctor came up to the mom and said "We are stopping his breathing machine. That means, when we take this tube out of his mouth, he is going to die." The words were true but they surprised me. It had to be said in a clear way so that the parents knew what was going to happen but if I felt shocked and unprepared....what were the parents feeling at that moment? We took the tube out of his mouth and watched the heart rate get slower and slower on the monitor before I powered it off. The doctor took the small stethoscope and listened to his chest. She looked at everyone in the room and shook her head. He was gone. I closed the curtain around the family of three to give them some privacy. I sat down and I began to chart everything that happened. As I sat, I felt relief. Relief in my legs, relief in my brain but also relief in my heart for the baby. "He can go now." I told myself. We won't be poking or prodding him anymore. He went quickly and for that I was grateful. I hoped what I was feeling was only a fraction of the relief and rest that the baby felt. Shortly thereafter, the cries started. No, not from the baby, like some popular internet articles describe...the cries were coming from the mom.


I will never forget the sound a mother makes as she mourns her dead baby in her arms. It chills you to the bone and silences the whole unit. They are loud, and deep, and there is so much pain in the sound. I don't know if I could accurately describe it. It's chilling. It enters the ear and goes straight to your gut. Eventually I took him from her again. I told her I would bathe him and bring him to her room later. I barely got to the word "bathe" before my voice cracked. I tried hard to pull it together for the family but I know they noticed. I scorned myself later for breaking down in front of the parents but I hoped they would understand I am human too. I cared for him too.

I enjoyed bathing his small body. It gave me time to process what happened and time to say goodbye to him. During his bath I told him I heard great things about heaven and that there are a bunch of wonderful people there. I took hand and footprints, snipped off a piece of his hair, and took pictures. I tried to hide his deformities and bruises for the pictures and I was proud with the way they turned out. Afterwards, I brought him back to his parents. This time there were many visitors in the mom's hospital room. I told her she can take as much time with him as she needs and that I'll come back and check on her later. Eventually the time came for me to take him away for good. She wrapped him in a receiving blanket and asked me if he could stay in this blanket. I said "of course"...knowing full well that they will just throw away the blanket downstairs...and I carried him away.

Later that evening I brought her a box with his outfit, hand and footprints, hair, and pictures inside. No one was visiting her anymore. Instead, she was crying in the dark. She was alone. I placed the box on the table and hugged her. I told her I was sorry and that he was beautiful. "It was my pleasure taking care of him." She never responded. As I walked down the hall back to my unit her cries continued. The cries floated out of the room and followed me down the corridor. The cries will follow me forever. Sorrow has a sound and it's unforgettable. 


(A mother snapped this picture of me while I was working. She felt so bad that I had to work on Valentine's Day and that I couldn't be with my husband. I told her I would be spending the evening with a very adorable boy...her son!) 

6. Dads cry just as hard.

Similarly, I'll never forget the time I heard a dad sob in emotional pain. He was a tall, strong built, black man, with tattoos, and gage earrings. I never would have expected to see such a sight. Over the past 2 days, he was a man of few words. He came to the unit and never took his eyes off his son. Even as I explained the procedures, equipment, and findings, his focus remained on the little boy in the incubator. I had just handed his dead son to his girlfriend when he started to break down. He cried harder than the mother. It broke my heart that I couldn't help anymore.



(Tea time during my break. They're a little more lax in Switzerland. We are allowed to eat and drink on the unit.)

7. Every baby born healthy is a true miracle.

Speaking of dads crying, it always gets me. Occasionally we have to go back to the birthing rooms for high risk deliveries. Whenever a dad cries when the baby is born I have to hold back tears too! Shortly after giving birth to a daughter, we took the baby from the mom over to another table to assess her. Eventually, the dad came over too and looked at her in awe. With tears in his eyes he looked up and asked us "What if she doesn't get asked the the prom?!?" I had to laugh at such a random thought. "No need to worry about that just yet!"


(Me with two awesome labor and delivery nurses.) 

8. The babies that are born "unhealthy" are even bigger miracles.

You've never seen a will to live until you've seen a preemie. They are fighters. They know nothing else. They don't know to complain or to give up. They keep chugging along until they can't anymore...until they've literally burned up all their energy or something just stops working. When I take the time to actually look at my little patients it is awe-inspiring. They are perfectly formed. They are wonderfully and magically formed from God. By the time they come to me, they have all their little parts.

Meet Estelle.



Estelle was born weighing 335 grams. That's not even 12 oz! Can you comprehend that? That's ZERO pounds 11.8 ounces. It's weird to think I eat steaks bigger than she was! She is one of the smallest babies I've seen to have survived...and I'm proud to say her mommy is my friend!

I'll never forget the day Estelle was born. Estelle's aunt, also my good friend, called and told me Estelle was born and her mommy was in critical care. I couldn't believe my ears. She shouldn't be here yet! How is she doing?! How is her mom?! Estelle was only 24 weeks plus 6 days when she was born. That is about 3.5 months too early! Many babies can survive being born so early but Estelle's birth weight scared me. She had very little amniotic fluid to swim around in and that made me worry for her lungs. I was worried for her brain too. Her mommy's blood pressure was too high and she began having seizures. They had no choice but to take Estelle out. I was scared for her. I was scared for her mommy and daddy too. 

It was hard for me to be a friend and not to be a nurse. I wasn't Estelle's nurse but I wish I could have been. It was hard to get secondhand information and not to be the one at her bedside. I just kept telling them to take lots of pictures. I told them to take a lot because they grow so fast but I secretly wanted them to take a lot because I wasn't convinced she would make it. The first few days passed and then a week. Eventually I was able to visit her and it was hard to keep my eyes and hands to myself. I wanted to look through her chart, talk to the docs, and care for her but instead I prayed over her and looked at her in wonder.



Estelle was in the hospital for almost 4 months. This was the first time I actually got to hold Estelle in my arms. I cried tears of joy. She was a miracle. I told her I was sorry for doubting her. I apologized for ever thinking she might not pull through. 

It's a wonderful feeling when the parents of the preemies bring their babies back in for a visit. It's weird to think that the first time I saw their babies, their eyelids were still fused shut, their tongues were no bigger than a Tic-Tac, and they could literally fit in the palm of my hand.
(Estelle's perfect little fingernails at a few weeks old.)


(Here is a picture of our smallest blood pressure cuff that barely fits my thumb. This is our smallest diaper but it is even too big for some of our babies. The same goes for the pacifier).

When the babies come back for a visit, it is so nice to pinch their chubby cheeks and squeeze all their rolls! It's nice to see them smiling and running around. It's nice to see it all come full circle and realize that what I do daily saves lives...little itty bitty baby lives! 


(Estelle now)

Thanks to technology, science, and lots of research many premature and ill term infants can grow to live normal, healthy lives.


(Trying to look important while presenting our research project.)


9. Illness knows no bounds.

It doesn't matter your age, race, or gender, it will catch us some time or another. I worked on a "VIP" floor and it just proved to me that no matter your financial status, no one is completely safe. If you're healthy, you are rich. If you're pain free, you are blessed. (For the record, every one of my patients is a "VIP" to me!)

10. There is a lot more to nursing.

Nothing annoys me more than when people say all nurses do is change bed pans and wipe butts all day. First of all, I haven't seen a bed pan in almost a decade. I change my patients' diapers with one hand. Secondly, like I said before, while I was helping the younger woman, it was almost an honor to be needed so desperately. And lastly, carrying on from lesson number 9, every single one of you will need a nurse one day. When that day comes I bet you won't be so condescending. Instead, you better be extra nice. We can pull and cut a lot of strings in the hospital.

My sister-in-law, Olivia, is in school to become a nurse and I am so proud of her. I like to think she picked this career because she has seen how complete it makes me but I think it has a lot to do with her hospital experience while she had cancer. I'm so excited for her to start out in this wonderfully fulfilling career. I told her to buy a journal and write down small details about her patients. No names or identifying factors, just memorable experiences. You think you'll remember but you forget over time.


(I did not graduate from Case's School of Medicine, my mom just posed me there while visiting during high school and we had to do an after shot on graduation day.)




Germany vs. America

291.   You can't buy over-the-counter medicines in the stores in Germany. You have to specifically go to a pharmacy and tell the pharmacist what you're looking for. Inconvenient!

292.   In Germany/Switzerland you can do banking at the post office. Convenient.

293.   It used to cost me 25 cents to send a text message to Germany and 20 cents to read one!

294.   I think we pay taxes every 3 months. That's all I know about that. Luckily, Eddie handles that.

295.   It's a lot easier to exchange money in Germany. Only some banks do it in the States and of course at the airports.

296.   I know I talked about this in a previous post but it needs repeated: The Germans do not love/idolize David Hasselhoff. I hear more about him in America than I do when I'm in Germany.

297.   Coupons are rare in Germany. :( Boo!

298.   When talking about houses/apartments, the Germans counts rooms not bedrooms. Not a "4 bedroom house" but a "3 room apartment." The bathroom and kitchen do no count as rooms. We have a 4 bedroom house but the Germans would say a 5 room apartment. It's confusin.

299.   FYI "Warm" means utilities are included. "Cold" means not including utilities.

300.   Achtung! (Careful!)
American voltage - 120 volts. 
German voltage - 220 volts.
R.I.P. Hair dryer, curlers, flat irons 1&2, XBox cable, Juicer, Candle warmer, etc. etc. etc.!



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