OB clinical eve!

This is my 4th first day of clinical experience. Every time has brought this crazy anticipatory/excited/terrified feeling that’s somewhere between the night before Christmas and a root canal. Currently leaning a tad more towards the latter, aha. This has a ton to do with the fact that I’m dealing with postpartum women because A) adults after only having kids for 2 months and B) the awkwardness of areas that need assessing.

I truly am freaking out about a lot of the assessment stuff. The acronym BUBBLEHEP is intimidating as anything and includes all of the areas we need to look at with moms. I have this terrible vision of everything being incredibly awkward when I have to ask her invasive questions or perform exams. I’m afraid that I’ll screw up, break down, and cry.

Excitement, on the other hand, is very palpable as well. I can just imagine how squishy and sweet the babies will be. I love babies and specifically newborns so much. I get to be a part of some of the happiest times for moms/families. I’ll be able to teach on a variety of skills and information that can be invaluable to a new mom. Starting now, I will see if OB nursing is something I could find a passion for.

Tomorrow (and the 4 weeks following) is going to challenge me. I want to push through to learn as much as possible. I need to use my voice and ask the hard questions. My professor will be there to support and guide me. I have the nurses too. One regret I had from peds is how little I interacted with my patients some weeks. I don’t want that mistake again now. I have to savor each patient interaction (especially when that includes my littlest patients).

I feel so honored that I am getting a look at new life: the sweet hours or days old babies and their incredibly strong mamas who brought them into this world. I’m not just there to complete my assessments and move on. I can be an educator and help mom learn how to care for herself and her baby. I can give her support if she’s overwhelmed and help in any way possible. I can make sure baby and mom are both doing well throughout the entire day. I will devote my day to one mom and her baby and make sure they both get the best care possible.

I have so much more to say and I’ll try to edit it in later, but for now I’m leaving it here. If I fall asleep in 10 seconds immediately have around 4.5 hours of sleep. Time is most definitely ticking.

February 13th: then and now

One year ago was one of the best days I have ever had. It changed my life and gave me so much hope. I doubted myself entirely and prepared for the absolute worse, as I usually do. Thank God that wasn’t necessary. February 13, 2017 I received my acceptance letter into the nursing program.

That feeling was incredible. I cried tears of joy because finally all my hard work had paid off. Taking off the semester for residential, struggling through strong ED thoughts and behaviors, an extra year of school, depression, and the huge amount of stress I encountered didn’t take my dream away from me. The fact that I could push through all of the barriers showed my strength. I felt proud for all I accomplished just to get there.

One year later brought another amazing, anticipated, life-changing day. Yesterday I was able to have an off-unit experience in the NICU (neonatal intensive care unit) at our children’s hospital. I have been interested in pursuing this field for a long time now. Part of the reason I switched to nursing from PA is because there are NNPs but not neonatal PAs, so if I go to graduate school I could still work there. I’ve read countless blogs, personal stories, and other accounts written by NICU nurses/families, but still had no idea if putting it all into practice would continue to be a good fit. I wanted so badly to experience it hands-on. I cried when I found out that I was one of the people who would go visit for the day (and I get to see the OR, so double fun for me!). I’m honestly surprised I didn’t start bawling right in our clinical meeting, aha. I counted down the days with such excitement. I didn’t even care that I had to wake up at 5am while everyone else in my group got the day off. I thought it would be worth it, and I was so very right.

I still can’t believe how lucky I am to have spent a whole day in the NICU. The nurse I followed was great and did everything possible to maximize my time there. She has worked in the NICU her entire nursing career, over 40 years. We took a tour of the floor, which is HUGE and holds up to 110 babies, and I got to see everything from older babies who just needed a little bit of help to micropreemies  born 27 weeks gestation or less. She had 3 patients, 2 of which were former micropreemies she took care of for a few months and the other an older preemie about to go home. It was really interesting seeing how a g tube works, watching her interaction with parents, observing an ophthalmology exam, and being able to help in any way that I could. I got to feed one baby through his g tube, and despite being super anxious I did well with it. One of my favorite parts, of course, was holding sweet babies. I went back and forth between the two. The one was a little “feisty/drama queen” and didn’t even want me to leave her after I put a binky in. She was teeny while the boy was 2 kilos heavier, even though they were the same gestation born a day apart. It’s pretty crazy how different the growth and development is for each baby. Another part I truly appreciated was how willing she was to explain everything, answer questions, and share her experience as a nurse. She was drawn to NICU nursing for very similar reasons as I am: building a relationship with the family, being able to watch the child grow stronger over time, celebrating when they finally go home, and very involved hands on care. Despite the long hours and craziness, her choice to stay for such a long time proves what a great area this is.

Yesterday has 1000% confirmed how much I would LOVE to work in the NICU one day. It’s one thing loving the idea, but experiencing it in real life just showed that it is what I thought it would be. Of course I may change my mind in the next year and a half before I actually work as an RN, but I am certain that NICU is going to be a top contender no matter what.

I honestly haven’t had this amount of joy in a very long time. I couldn’t stop smiling (at least internally considering some of what I saw was hard). It just feels right. I’m not really sure how else to explain it.

I want nothing more than to return one day, but next time with blue scrubs and a badge that says “RN” 🙂

First day back.

*Disclaimer: I will not ever be talking about patients, things that happen with patients, etc. Confidentiality is important. My reason for this post is to explain my experience and how it felt in general with being back at the hospital. Also, I know a joke about HIPAA, but I can’t tell you 😉

It was the craziest of days with emotions and everything. I’m not quite sure what all I expected, but my time so far at the hospital has surprised me.

It’s hard to explain, but once I stepped in the hospital and those doors closed behind us, it was like being transported back to 2 years ago. My heart started racing, there was a sinking feeling in my stomach. It felt a little like I was reliving my experience there as a patient. This didn’t last for a long period of time, but also recurred throughout the day. I saw all of these familiar places: the courtyard, patient rooms, dreaded lunch carts, nurses’ station I used to stand by, phones, room where ED met/ate, coloring pages (the SAME ones from before), etc. For many brief moments, it was like I was there again.

Feeling “there” is not a pleasant experience. It brought many panicky moments and racing thoughts. All I could think about was how I would be force-fed, locked out of my own room, and not let out again.  It was distracting to the point of zoning out multiple times. I had to keep repeating to myself: “I am a student. I have keys. I am free to leave.”

I only stayed inpatient for a week, plus about a month in partial (although we only went through a small portion of the hospital then). That is only a blink of time, especially compared to residential, but somehow it matters. It gives this place hold on me. I hate it, but I know it is also something I have to work through. I’ll be here the next month or so and I don’t think I will be able to gain as much from it if I’m stuck in a bad place.

There were many opportunities for me to disclose that I’ve been to FV before (not as a patient, we were asked if we have visited too). For whatever reason, I want to scream that I have been here and just let it be known. No clue where that’s coming from. At ALL. I truly don’t want my peers/prof/staff/patients to know that I was once a patient too, but it feels like I have to bottle up this secret and that I am wrong for having been sick. I obviously am not going to say anything. I guess maybe this could be related to wanting to push past stigma/show others mental illness doesn’t stop you/show my classmates they’re just like us? I have no clue and that paragraph is very embarrassing.

Lunch was a challenge. It probably helps a little that ED never ate in the cafeteria (that would be so much worse as a patient omg), but this was by far the most overwhelming part of my day. I have had the exact meal before and I saw all of the “amazing, lovely, wonderful” desserts displayed for us. Here, I was given the gift of choice: what I wanted on my burger, veggie or beef, vegetables or no, what type of dessert, salad or soup, finish everything or not, etc. Coming from an ED treatment background, this feels empowering. It made me think back to when we were handed these trays and basically forced to eat them or given an Ensure. I am thankful to not be there anymore. The meal was still scary, though. All I wanted was a support person to text during meals like I do normally if needed. There was conversation, but I pretty much made myself eat with little distraction available. This is probably not anything that will change unless I try to make it a point to get others to talk. I’ve never been very good at this, but we shall see. The worst part of the meal was caused by Ed. As per usual, sitting with a group of people led to me “needing” to eat less than everyone else. It gives me this sick satisfaction if I do “better” than others. This ended up causing me to be the only one who didn’t get dessert. Lunch could have gone much worse, of course, but I want to do better next time.

One of the most frustrating aspects of my day came at the end during our debriefing. We all met to go over what happened, get our assignments the next 4 weeks, and ask questions. My professor said this: “I do not want you working with eating disorder patients, especially not one-on-one. You could say one thing and they will crumble, completely unraveling their progress. I would rather have you stay far away, but if you do go to a group do not say anything at all.” The request here bothered me a little, but the way she explained her reasoning was what upset me most. I’m sure she was attempting to protect us from harming a patient, in her mind. I don’t agree with 95% of her statement. I don’t see people with eating disorders as weak to the point that 15 minutes with a nursing student could erase all progress made in treatment. The 5% agreement I have is over what exactly could be said. I’m pretty sure that any of us wouldn’t be oblivious enough to mention the patient’s weight, tell them they don’t seem like they have an eating disorder, or anything of the like. Those topics and others would absolutely have more power to harm. Anything else that would come up in a nursing assessment/general conversation doesn’t have that same potential really. I see those of us with eating disorders as strong, especially when facing your fears in treatment, so I am a little hurt by her insensitivity. I wish that I could let her know some truth of what this is like. I also would like to ask her rational (was it a guideline set by FV, her own feelings, etc). Maybe that will happen before the end of my time here, maybe not.

I’ve focused plenty on the struggles of returning to the hospital, but now I want to highlight some lighter things that came of my time there so far. Probably the biggest thing is that I have keys. I was absolutely shocked when my prof handed them out. It’s kinda crazy, right? Two years ago I was locked in and now I’m able to venture all over the hospital. The freedom is weird but also comforting in a way. After looking at patient charts to see how they lay out diagnoses, meds, group notes, progress reports, and more, I’m so curious about what mine looks like. This past time I had the psych doctor fudge my records somewhat so insurance would cover inpatient (for those who don’t know, I was admitted a week and a half before school started, so time in treatment was a huge priority). I wonder what he actually wrote down and just how nurses, my case manager, therapists, psychiatrist, and MHW’s talked about me. I’ll never get that opportunity, but it’s still entertaining to think about. One of the funniest/almost embarrassing things was when we were on our tour. She said where we were headed next without direction on which way. I remembered exactly which way it was, so I started walking towards it before I realized I’m supposed to act clueless like everyone else. I covered for it but I can imagine my classmate and prof’s faces if I had actually unlocked the door or something.

I head back tomorrow morning (at 7am, wayyyyy too early). Now that I have experienced my first day, I want to set some goals for the next month of clinicals. My hope is that I’ll be able to learn and also decrease the amount of fear and anxiety I relate to this place.

  • practice deep breathing, thought stopping, and other DBT skills in the moment when I start to panic
  • eat my correct exchanges and a freaking dessert at lunch (thanks to my therapist and dietitian for that one gah)
  • give each patient my full attention and take a few steps in their shoes
  • remember what it was like for me because it will help me understand patients more
  • ask lots of questions
  • take away as much as possible

 

Back to the hospital

Next week, I will be returning to FV in the inpatient unit for the first time in over 2 years. This time around is much different. I won’t be a patient there now (and hopefully never, ever again), but I will be completing the majority of my mental health clinical hours.

My anxiety has gotten pretty high over this. I’m worrying like crazy and trying to calm that down. After plenty of talking with some staff from IOP/friends I do feel a little better. I think what I need most is to write out some intentions so I can hold myself accountable.

What I will do

  • Act “normal.” What I mean by this is pretend that I’m just a nursing student and not a patient. At this point, it has been over 2 years since my one week inpatient stay and 3 for my PHP experience. I feel well removed from those situations and I fully believe I won’t suddenly revert to feeling like a patient once I am back in that place.
  • Cover up my scars – for obvious reasons. This will also protect me from looking like someone who suffers from mental illness. While my professor knows I have a history with mental health (no details there), the patients I interact with are not going to have a clue. I want to keep it this way.
  • Eat in the cafeteria. Gah this kills me. More than anything, food brings up the most negative reaction from things that occurred at FV. I can still picture the trays, being forced to eat things I didn’t necessarily like, those stupid desserts every.single.lunch, the staff “offering” Ensure if you didn’t eat every single bite. I realize this is going to be different. Instead of a room with just ED patients, I’ll be in the cafeteria with other staff. I will not be watched like a hawk. I get real choices to get whatever sounds best. It will be a struggle for many reasons, but I hope that I’ll realize that eating there will be a good thing.
  • Avoid VH aka Dr. VanDouchebag. If there is one person who I would absolutely avoid FV  again for, it would be him. He is the ED psychiatrist aka the guy who threatened me with inpatient, told me i would be tubed, and basically was the most frustrating hardass to work with. I will never be more thrilled that never having to see him again. Even if it was as a student instead, I just don’t wish to interact with him in any way. If only I could nonchalantly tell my prof being on his service isn’t an option, ha!

What I will stay away from

  • Telling my professor about my eating disorder. Maybe this seems counterintuitive. To me, it’s not. I don’t wish to be treated differently because of my past. I hope to have an experience there that will help me learn the most. I think her knowing about the ED would cause her to keep me off of 1-2 units out of 5, which would definitely hinder my experience.
  • Disclosing of my history at FV. I think this would be just as harmful, if not more, than talking about my eating disorder. I have a feeling she wouldn’t feel so comfortable with me doing clinicals there. (Fun fact: I specifically chose this site so I could experience the hospital from a different light)
  • Ask to change placement in the hospital. I don’t want special treatment and asking to change where I am assigned to would do just that. Dr. C is especially concerned with this. After needing it last year with missing classes, she doesn’t want a repeat. She believes it would negatively affect my nursing experience. There is no good reasons for that to happen, except…
  • Let my recovery be jeopardized. If it becomes absolutely necessary, I will reach out. I can’t see that happening at this point, given I’ve been in treatment for a million hours this year and am completely used to hearing potentially triggering things. In the minute chance it does occur, I will find some sort of excuse before I would actually disclose personal information. No clinical experience would be worth slipping backwards in recovery, especially considering all the hard work I’ve put in.
  •  Say hi to staff (unless alone/away from my prof and fellow students). There is one staff member I particularly love. She has worked during IOP as well and was there during the time I got accepted into nursing <3. I would absolutely love to update her and chat for a bit. I do plan on this if at all possible. On the other hand, I’m thankful for HIPAA and the fact that any staff who remember me cannot say a word. It will fully be my choice to acknowledge that past relationship or not.
  • Tell any fellow patients from my time there that I remember them. Unfortunately, these relationships aren’t really protected by anything. If someone recognizes me they have all the rights in the world to ask me about how I’m doing, say hi, etc. This one somewhat freaks me out. While I definitely care about them, talking to them for reasons other than a therapeutic one would clearly let on that I was a patient once too. I really hope to protect that information and not be the broken/unstable student.
  • Provide care for anyone I have talked to outside of treatment. I mostly doubt this would happen. I am not in contact with 90% of those I was at FV with. The ones I do still talk to are not there currently. Even if they became patients again I would probably see it first on Facebook or something. Still, I am prepared for the slight chance of this happening. I wouldn’t even have to disclose why or how I know them here, just that I do and therefore cannot be involved with their care. If there is a case of recognizing them without seeing them outside of treatment, that wouldn’t need to be avoided unless they would be uncomfortable with it.
  • Let my adviser (who isn’t the prof for clinicals) know about my treatment and struggles the past year. She is aware of my eating disorder and the fact that I went to residential. The last time I mentioned it was right after, so around a year and a half ago. I’ve considered talking about IOP, the semester from hell last spring, and the fact that I spent the vast majority of my summer in treatment. While this has been a significant part of my story, it really shouldn’t affect anything if she isn’t aware (at least I’m telling myself that). I can imagine Dr. C’s disapproval if I asked her advice on the subject. She would call that special treatment that would follow me through the next 2 years.

I’ll admit, I am uncertain about some of these rules I’ve made for myself. It bothers me that I can’t predict the future of what will happen the next month and a half. It could go fine, but it may also mean everything I’ve set up will be challenged. All I want is to get the very most out of my time at FV. I’m trying to believe in myself and my ability to make returning to the psychiatric hospital a nonissue.