How I became a nurse after exactly 1 day of clinicals.

I was in my first semester of nursing school. We were on the oncology floor and we were allowed to "pick" the patients we wanted to research, assess and care for.  I worked on the floor below that one (the cardiac floor) as an aide, so I had some semblance of familiarity with the hospital.  Thanks to that, I was not particularly timid about answering call bells or checking sugars or whatever the RNs needed. The RNs were in report and I asked them if there was a patient they felt needed a little extra TLC for the day. (I chose that approach over "ooh do you have anybody GOOD" with 'good' meaning multiple system failure and tons of meds and labs to learn from) I suppose even from the beginning I've been much more patient focused rather than disease focused.  The nurses looked knowingly at one another and said, "Well.. there is one.. but.. this is your very first semester and your first clinical?" I steadily looked at them and said, "Whatever it is, I can handle it.."

And with that, I had my very first nursing student assignment.  A tiny little woman with inflammatory breast cancer. Her left breast was the size of a football. She was admitted a few hours prior. She was incredibly sweet, a little confused, and extremely anxious.  Her younger brother was in the room with her.  He's lived with her and cared for her for years. He was a little backward, but very nice. He told me she doesn't like Drs or hospitals, and that last month she told him she thought she felt a lump in her breast when she was in the tub. Since he's her brother, he felt awkward asking to see it, but he told her maybe a Dr should look at it.  She said "no no no! If a Dr. sees it he will tell me I'm dying!".  The brother didn't push, and she bathed only twice weekly and kept quiet about her breast after that for a few weeks. Then the day before her admission to the hospital he asked her about the lump and she started to cry and showed it to him.  He called for an ambulance.

Drs came in and spoke with her, wrote for dry dressings to go over the wounds on her breast.  She needed dry sterile dressings loosely applied with no tape.  Why?  Her breast was spotted with black necrotic tissue due to her paper thin skin being unable to stretch with the rapidly growing tumor and the skin split opened and subsequently became seriously infected. (according to the Dr's estimation, the tumor grew from a golf ball to a football size in 4 weeks).

The RN for this little lady gladly gave the reigns to me in caring for this woman after seeing me interact with her..the patient responded very well to me and trusted me completely- much moreso than any of the other professionals who came into the room.

I provided am care (washed her, applied lotions, etc). And then attempted to dress her wounds on her diseased breast. She looked down and really looked at her chest.. and started to hyperventilate. I told her to look at me... I put my hand on her arm. "We are going to cover that up and give you medicine to feel better, okay? Deep breath..relax. I'm with you." There was no way that gauze was staying on her without tape, but I didn't want to tear her skin. So I had an idea... I called the maternity floor and had them tube me those mesh panties they give to new moms.. I slid her swollen breast through one of the leg holes of the mesh panties and slid the dressing underneath. Then I buttoned up her gown.

My instructor came into the room with the RN to admire my handiwork.  Not long after, the hospice case worker and the Dr. arrived to break the news to her and her brother.  She had about a week left, if that.

The news should not have hit me like it did, it shouldn't have surprised me. Luckily, I was out in the hallway when I heard it (and not in the patient's room).  I briskly walked around the corner to the nurse's station. Everything became blurry, my throat tightened. Deep breaths.. deep breaths.. A question entered my left ear "Are you okay?"  it was one of my classmates.  I answered shakily, "She's on hospice.. she's going to die.." And she hugged me.  The RN and my instructor walked over. "Do you need to talk?" I answered, "Not now.. I need to be there for her.  I can process all this later."  I went into her room and sat with her and her brother.

I held both their hands and talked to them about the inpatient hospice facility she would be going to.  How beautiful it is, how great the staff are, etc.   I printed out  a bus schedule for her brother and told him he can sleep at the facility to be with her if he wants.  He liked that.

About 2 hours later, the transport team arrived to transfer her to inpatient hospice. I hugged her and said my goodbyes. I hugged her brother and told him, "Just be with her. You don't have to tell her any magic words, there aren't any. You are giving her the greatest gift a person can give by keeping her from being alone."

I cried heavily the moment the elevator doors closed, her little hand lifting from the stretcher in a final wave of goodbye.

I turned to one of the nurses who debated on whether or not to give her to me and I said, "Maybe I couldn't handle it after all..."  She put her hand on my back and she said, "You handled it like you've been a nurse your whole life.  Welcome to the profession."