Wednesday, March 11, 2009

Bring it.

There are times in everyone's role transition in which they wonder if they are, in fact, cut out for the career they chose.

NewFNP had several such instances in which she thought - whoa pal... perhaps law school.

The first involved a patient who had a horrendous necrotic pressure sore that was so deep, it almost exposed the bone.  This woman also had MRSA which meant that all staff were on contact precautions which, in newFNP's training hospital, consisted of a mask, gloves and a plastic gown.  

It was the end of the day's rotation and newFNP had been busy as hell.  She hadn't eaten.  She was tired.  And the smell of that pressure sore plus the tenting of the skin as the physician cut away necrotic tissue plus newFNP's hunger plus the millions of people in the room causing increased temps (and smell) plus the plastic precautions gown equaled newFNP sitting on the floor with her head between her knees in an attempt not to pass out.

A successful attempt, but clearly not a shining moment in student nursing history.  

Another involved a patient who had undergone a partial pneumonectomy and, for reasons that now escape newFNP's memory, had failed to heal well.  As a result, he had what is best described as a gill-like slit in his side that moved in a gill-like fashion when he breathed.  And in that gill-like slit, there were strings of mucous that would quiver during respiration.  

The vivid recollection sends cold shivers down newFNP's spine.  

NewFNP left the room and told her preceptor, "I don't think I'm cut out to be a nurse" to which her preceptor raised one eyebrow - her way of saying that she disagreed.

NewFNP wrote about another unsatisfying olfactory experience three years ago.  NewFNP recalls feeling so disheartened.  How on earth would she take care of her patients if she could not even observe this procedure and remain on her feet? she wondered.  NewFNP's consulting physician attempted to console her by confirming that that was, in fact, a hella smelly abscess but it didn't really make newFNP feel much better.

NewFNP has come a long way, baby.  In these past three and a half years, newFNP has incised and drained her fair share of abscesses, but for the past year, the abscesses had dried up.  

Until today.

When newFNP hasn't performed a procedure in a while, she feels a tad apprehensive prior to embarking upon one.  Especially when it involves a scalpel and lidocaine and inflicting pain.  But the beauty of having a few years under one's belt is that it all comes back to you when you need it.  For better or for worse, even the inflicting pain becomes easier in one of those you've got to be cruel to be kind kind of ways.

And - gross though they may be - procedures are kind of fun.  They are so much better to perform than to observe.  In the case of an abscess, the results are immediate.  The smell doesn't seem to bother newFNP so much when she is doing the cutting, expressing, irrigating and packing.  

In fact, she wonders how her MAs are such tough asses in their assisting whereas newFNP has near syncopal episodes.

NewFNP is ready for more!  

Again, for those struggling students out there, it's worth it.  You'll be ready, too.


Kim said...

Thank you!! I am trying to get into nursing school now, but this is the kind of thing I am reading nursing blogs for - I need to know the real nitty gritty, not that reading about it is the same as experiencing it...

T Rex Mom said...

Thanks for sharing. My first three weeks of med/surg clinicals in school all my nursing diagnoses were "alteration in elimination" - I nearly quit after being "eliminated" on 4 times - once right in my hands! Thank goodness for gloves! I wish I would have been a mom then - I think I would have handled it better after what one goes through with their kids!

Niles said...
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Anonymous said...

i love your blog.. it is the only blog i have ever followed and am truly glad that you have gotten back into more frequent postings.... thank you so much.

i pee'd my pants reading about the 'fronting' posting... hilarious....

Anonymous said...

Ugh! When I did a summer internship in an ED we had a patient whose leg was more than halfway eaten away by maggots--that were still alive and falling off his leg. And he could walk!! The med students jumped all over themselves to clean his leg while the rest of us looked on. There are times, it seems, that you can't really prepare for but just hope to work your way through as professionally as possible. But the image of him, his leg, and the teeming maggots is one I will never forget.

Nurse Teeny said...

I've had a few of those moments myself these last couple months. But your blog is definitely helping me survive - the thought of being done with this and actually practicing gets me through those med-surg shifts. And I know I'm learning A LOT in the process!

Anonymous said...

I had a similar experience with a pressure ulcer as big as my fist that DID reach the bone...My second week of my very first med/surg clinical. We were watching the skin care specialist help attach the vacuum, wearing contact precautions gowns, gloves, crammed in the small room. Needless to say, I had to move next to the exit in case I needed to a) pass out, or b) get to a basin superfast!

But it was so heartening for me when I made it through!