Last night at work, one of my patients told me she is a psychic and she wants me to know that I am eroding my self-worth by being so susceptible to guilt trips. It's because of my past, she explained. "None of it was your fault, kiddo," she said repeatedly. "None of that stuff should have happened and it wasn't your fault that it did." She told me there was a million more things she could tell me, but I'd just get overwhelmed. "This is the most important thing for you to hear," she said. We were 15 minutes into our working relationship. Fifteen minutes later, I knew so many juicy deets about nearly every member of her family, some of which are So Wild. One of the stories involved someone hiring a hit man, and that was like the third most interesting thing we talked about. I offered up some vulnerability back, told her about how I'd been thinking earlier tonight about how this was the floor I'd been working on a couple years ago when I realized that I needed to seriously address my depression because I was losing my ability to be kind. Also because I kept thinking about how easy it would be to steal a lethal amount of opioids from the med room, but I thought that was maybe a little too much vulnerability to share with my patient.
But hey, maybe she already knew. I never established the exact rules of her psychic abilities, just that she said that she had had them her entire life, as had her mother, as had her grandmother. She's friends with shamans. She did reiki on her pets. This is her billionth hospital stay in the last year, and the length of this current admission is well into the double digits, but she just got a few tubes pulled out and some very promising lab results. She might go home soon, although she joked that if she did, she'd probably be back in a week anyway. She told me the thing that had made this hospitalization better than previous ones was that she wasn't keeping her gifts to herself. "I've passed on important messages to a dozen people that work here," she said, with the kind of smug satisfaction you only get from helping (or thinking you're helping) someone else. It's a great feeling. Heady. I gotta be careful with it. In addition to encouraging a certain paternalism towards patients and a sanctimonious delight in huffing your own farts, the embarrassment it transforms into when you realize that you actually weren't helping anyone is absolutely brutal. But sometimes you do help people. I don't believe in psychic abilities, but I'm glad she said to me what she said. It was good food for thought, and it's a very pleasant thing to experience someone striving to be useful and kind to you in particular.
A few hours later I met a different patient. She was calling out for help as I passed by her open door. You never know what you're going to get when you go into an unknown patient's room. Sometimes it's someone who just wants you to turn their lights off. Sometimes it's someone having a panicked mental breakdown. Guess which one this case was. She'd been brought in for the most mundane horrible reason that independent elderly adults come to the hospital: fell down, couldn't get up, and didn't get found for a long, long time. The patient had admitted earlier that evening basically catatonic. Wasn't catatonic now. I go in and get blasted by a fire hose of trauma--she's bouncing back and forth between the recent and distant past. Like absolutely sobbing about the last few days and then mid-sentence talking about something that happened three decades ago. Then back to the present, then back to her childhood, then back to yesterday, then back to the 1980s.
I stuck around and helped out a bit with a listening ear and a swallow eval to see if we can give her anything to drink. After she had some water, she'd calmed down a little and almost shyly said the the first thing I'd heard her say without crying: a local food establishment is releasing a limited edition cranberry lemonade for summer, and she was hoping to try it. Me and the other nurse who has come to help out are like, "we can get you fifty percent of that." I drop off a cranberry juice in the room, which I assume from her reaction was perhaps the greatest cranberry juice of her life, then page the on-call chaplain who told me she'd come by once she was finished in critical care. There was an unsuccessful code; the patient died. Spiritual care likes to be around when stuff like that happens. While we're waiting, the other nurse gets the patient cleaned up. It's actually incredible how much better she looks by the time I bring the chaplain in.
Chaplain and patient were still talking two hours later when me and another nurse were doing our assigned shift turning the floor's bedbound patients. We went into a room with another entirely new patient I have no idea about. I figure out from the sign on the door that she's a end-of-life comfort patient, and from what I saw when I walked, she was moving quickly along through the process of transitioning from "will die probably soonish" to "is actively dying now." There's an enormous piece of gauze on one half of her head. The other nurse pointed to it and said, "be careful with that." We repositioned the patient, minutely, gently, made sure she wasn't wet, tried to figure out if she was in pain. I try to always talk to unresponsive patients, let them know what I'm doing and why. I'm especially doing it tonight. My first patient, the psychic, she was telling me all about her out of body experience the time she died. "You see and hear everything," she told me. "And trust me, it changes you. I'm not scared to die anymore and I'm not sad about it. I'm sad that I'm going to make everyone who loves me sad when I go."
I have no idea what my current patient's thoughts on dying are, but we fluffed up pillows and straightened out limbs until she looked comfortable--or at least, didn't look uncomfortable. I tucked her back in, then looked up to finally noticed the sign someone had stuck up above the bed: NO PRESSURE ON RIGHT SIDE OF HEAD. PATIENT HAS NO SKULL THERE. I suggested to the other nurse that this sign should be bigger.
Three patients, three women all within five years of each other on the same medical floor. I floated there last night because it's my job to go to whatever unit is short-staffed, so I go somewhere new every night. Even if I was assigned to that floor again, I'm not working for another couple days. At least one of those patients will be gone by then. Maybe even all three. It's overwhelmingly likely that I'll never see any of them again, and frankly if I hadn't written this post, it's also likely I would never have thought of them again. I've worked in the hospital for almost five years now, with a new patient load almost every night. The half-life of my memory of the average patient is like twelve hours. They're gone from me by the next night. A few stick with you, probably forever, but 99 percent rest fade into an amorphous blob of humanity that you hope you've helped more than you've hurt and has given you more than it's taken.
And y'know, sometimes I write stuff like this, then sit back and go, "This is exactly the fart huffing I was talking about." I struggle with posting about nursing because I don't want to boast and I don't want to self-flagellate. I don't want to sound like I think I'm the pinnacle of nursing, I don't want to sound like I have a delusional lack of self-esteem about my own abilities. I want to represent myself as I am, I want to represent my field accurately, I want people to enjoy reading the posts, I want people to like me, and God willing I want those things to happen at the same time from the same words. Which is. Occasionally hard.
Like okay here's some more stuff from last night: that first patient, the only one that was actually my patient, I didn't do her CHG bath even though she had a central line. I realized that at 0500 when I still had two hours to do it, and instead I was like, "that's a day shift problem." That was an irresponsible choice made for my own convenience that could have a very negative effect on the patient. Or another, I was too pushy encouraging a patient to pee on their own when I should have just straight cathed them. Realized that in retrospect after someone else had to straight cath my patient at shift change. At one point, one of my patient's call light went off, and I didn't want to answer it, so I frowned at my computer and started typing intensely like I was dealing with really serious problem to see if someone else would get it. Which they did. I've got plenty more dipshit maneuvers like that, some based on good faith clinical judgment that ended up being wrong, some based on me not wanting to stand up again after I sat down. I don't really want to write this paragraph. I don't really enjoy publicly enumerating ways I've been selfish, lazy, mean, incompetent, or otherwise fallen short. I feel varying degrees of bad about the stuff in it. I feel varying degrees of worse about the stuff I've left out. I worry about the occasionally brutal anons who engage with me as a representative of a healthcare system that has brutalized so many people, and I worry that acknowledging that worry overexaggerates the degree to which it happens. Almost everyone is nice to me, which makes me feel guilty. But it also makes me feel good, and then I feel guilty about feeling good because that's egoism, and then I feel good about feeling guilty because surely only a really, really good person would feel this bad. Right?
The point of this post got somewhat away from me. Guess I really have been thinking a lot about my psychic patient's shared revelation. I wanna go back to my patient and be like, "They aren't guilt trips if you should feel guilty," but partially so she'll dispute that thought for me. I do think you should feel some amount of guilt when you fall short of the person you want to be in a way that affects other people. Sometimes you just gotta sit with that, and think about why it happened, and whether it'll happen again. But I also think you go too far down that path and you're back in the med room, staring at 100 pills of Dilaudid and thinking, "What if?"
I'm an above average nurse, but not all the time and not always to the same degree. I gave the comfort care patient the standard care that any patient is entitled to. I gave the fall patient an extraordinary amount of my time and effort that I didn't have to. And I gave my patient the thing that she said she found more helpful than anything else--the chance to use her connections to the spiritual world to help other people self-actualize. Like, I haven't self-actualized, but I sure have thought a lot in ways that I believe have been productive. Another W for psychic powers. And hey. Maybe the way that I thanked for her insight was by not waking her up at five in the fucking morning for a full body wipe down and bed linen change when she'd finally fallen asleep. Like to be clear, my own laziness was a massive factor, but also deferring that task a few hours so day shift had to do it was also a matter of clinical judgment. She's an elderly patient on delirium precautions who gets woken up at least every three hours for some medical intervention or other. Sometimes laziness and thoughtful nursing care can be the same thing. And the patient I didn't straight cath thanked me for taking her back pain so seriously because that doesn't always happen in the hospital, and then I successfully got her from 10/10 pain to a solid 5/10. And the patient with the call light--I mean...they were fine. They waited an extra minute to go to the bathroom. Later that night I spent an hour helping a new nurse stop her confused and agitated patient from ripping out every single tube in his body. Then I hid in an alcove and did crosswords for fifteen minutes. Maybe it all evens out in the wash. Hey am I crazy or do these farts actually smell great? Should I get a little medal? It was a pretty good shift, all things considered. One of my psychic patient's story involved a guy getting his penis stuck in a vacuum. I'm glad I wrote about it so I have literally any chance at all of remembering that it happened.
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