There’s this thing I do between words. In my dayjob, I am a Registered Nurse. I started out twenty years ago at Sinai Hospital in Detroit, working on an Endocrinology floor and then a Medical/Surgical floor. After a few years, I decided to try life as a visiting nurse and I found my niche. Though the decision was based mostly on the desire for a more flexible schedule in anticipation of one day having children, I quickly learned that home health care was a good fit.
The years I spent in the hospital, caring for patients with a wide variety of illnesses, trained me well for the autonomy of home care. No fellow nurse in the hallway to pull in for a second pair of hands, no physician at the desk to help out with a quick remedy or solution to an acute problem. I arrive with my bag and my skills, and I can usually tell within a few minutes of laying eyes on my patient how things will go: good, bad, or worse. In my field, a common misconception is that home care is where old nurses go to die. Not literally, of course, but the myth we are constantly working to shatter is that home care is easier, slower-paced, less intense, and requires only the most basic of technical and interventional skills. I’m here to tell you this isn't true, and the reason why is also why I am glad I’m a nurse.
I’m a Jack of All Trades. In less than an hour, I can do a full assessment on you, picking out any anomalies that need attention. I call your doctor and update her--via the office nurse--on my concerns, and if I’m lucky, I get a call back later that day with her plan of action. While we’re waiting for that call, and of course using extensive sanitizing and disinfecting protocol, I start an IV for your newly ordered medication we’ve received through our infusion pharmacy. I mix your antibiotic, begin your infusion, and take care of changing your wound bandage while the IV runs. When the doctor’s office calls back, I quickly do a lab draw for the CBC your doctor wants run stat, labeling and storing the blood in my bio-hazard bag next to an ice pack. Once I've instructed you on the new medication that is now waiting at your pharmacy, I disconnect the IV and flush the line, securing it until tomorrow.
Before I leave, I let your constant companion back in from the yard: let’s say he’s a Bernese Mountain Dog (my personal favorite), too big and fluffy to be underfoot during all of your medical care, but friendly and anxious to see that you’re just fine in spite of me. I make a detour to your kitchen, where I warm up the lunch your son left for you and grab a protein drink from the fridge, depositing both on the table next to you along with your phone. In one final survey, I retrieve your remote control from behind the couch, place your blanket back over your legs, and mark your calendar with my next scheduled visit date and time. In my car, on the way to the hospital to drop off your lab specimen, I call your son to tell him about the new medication he’ll need to pick up, making sure he understands he must give it to you 2 hours apart from the Iron pill you take at dinner time. At some point during this brief, productive hour, I've entered all of this information into your chart in my laptop, which has safeguards and passwords galore to keep your protected confidential information just that. I finish charting sitting in the hospital parking lot, in my car, while the details of your visit are fresh in my mind, before I turn on my GPS to begin navigation to my next patient.
I’m actually more tired after breaking all that down in print than after the actual job! I enjoy it. I am gratified when I see clinical findings slowly improve day by day, when I see the smile on my patient’s face as I remark how beautiful that photo of her grand-daughter is, and especially on the day I discharge the patient who is well enough not to need me anymore. I am lucky to have a dayjob which provides me such fulfillment … even in those rarer cases where the patient doesn't get better, where the situation is sadder than sad, because in those circumstances, I know I am blessed to be the person doing everything in my power to help, to effect change, comfort and calm.
Every nurse has a handful of triumphs to balance a heart full of losses. The triumphs aren't in the scenario described above. That one falls under “just doing my job, ma’am.” The triumphs are those moments we truly make a difference. Those instances when, if we hadn't been there, that patient’s life would have changed inexorably for the worse. Sometimes the very worst. But we were there. We happened to see the patient on the exact day she needed us, the exact day things went south. Even if no one realized it before we walked through that door, patted the Bernese Mountain Dog on the head, and laid eyes on the patient, we realize it instantly. Our assessment only confirms what our other senses have already told us, and within minutes we've called an ambulance, administered the proper medication, phoned the triage nurse in the waiting ER, notified the doctor, hugged the son, gathered the current medication list and recent surgical history, and given report to the arriving paramedics. Believe it or not, this is where the triumph comes in. Hours later. Hours after our work phone is normally turned off, but this time it isn't; it rings on the couch next to us while we watch TV with our family, seeing nothing, that patient still in our thoughts since the ambulance screamed away.
The triumph comes in the voice of the son on the other end of the line. His mother is stable, resting comfortably, and is expected to return home tomorrow. It was a clot, he says. Or maybe it was a collapsed lung. Or a host of other potentially life threatening problems—pick one. The emergency has passed, the problem has been neutralized, and the patient will see tomorrow. We will see the patient tomorrow, this time bright eyed and breathing just fine. This is why I’m a nurse. Just in case you wondered.