Placement Week 6

As much as there is so much to learn in terms of skills and background knowledge, predictably I feel like I’m getting to grips with that much more quickly than the communicating with people thing.

Here is an insight into my brain on a typical placement day: okay, talking. I can do talking. I nail talking to people. I can strike up conversations with old ladies and highly confused men with dementia! Well done me. Ten points to Robin! Wait, did I remember to introduce myself?

What about all the other stuff? Should I have held her hand while we were talking? She probably would have liked that. Was I supposed to manually check her pulse as well as using the sats probe? Probably. Yes. I meant to do that before. Must stop being afraid of touching patients!

What about where I put myself when I was talking to him? Should I have been closer? Should I have tried to be more on his level? Did he hurry what he was trying to say because he thought I wanted to get away?

Why do people always talk when I’m trying to count breaths? Always.

One of our dementia patients has taken a turn for the worse, he’s very agitated and needs to have someone with him all the time. I witnessed him having to be pinned by six members of staff to be tranquilised. Sometimes I think delayed emotion processing is an advantage. I could get on with my day without freaking out. It was horrendous. The poor man had no idea what was going on, he was so panicked and can you blame him? In his head, he just wants to go home to his wife, he doesn’t know why he’s not allowed to walk around anymore. He doesn’t know why he’s not being allowed to do as he pleases. He doesn’t know why all these people are suddenly surrounding him. He probably felt like he was being attacked. Dementia is terrifying.

I did see the flipside later in the week, when two of our dementia patients dramatically improved. One went from being non-verbal, agitated and unable to stand when he was admitted, to walking around independently and having a perfectly coherent discussion about cricket. Luckily for me, I can bluff enough cricket knowledge to get by. The other man had been completely unable to communicate and was so agitated he lashed out when we tried to change him. No longer! He could tell Lilo and I to shut the window, because it was chilly. He remembered his date of birth when we asked him on the drugs round, even his family were stunned by that. It was such an amazing transformation!

I know that I don’t want to be on this ward when I qualify, although Lilo has said she’d love me to come back. I also know that I don’t really want to work with dementia patients. But this week was still such an amazing experience, seeing those two men improve so dramatically in such a such a short space of time. It did make me feel certain that nursing is what I want to do.

Placement Week 5

Tuesday was a disaster – I couldn’t face 12 hours with my mentor, I had a meltdown and went home. I tried using Brain in Hand, thee DSA funded autism app on my phone, but it has a fatal flaw: my shift starts at half seven and there aren’t facilitators to respond to pressing the red ‘I’m in a flap, help me now’ button until eight. Sadly nobody I know is up that early to stress at either. Or if they are, they’re at work. So home I went, feeling that awkward mixture of self-loathing and relief. I made the sensible decision to rearrange my shifts so as not to work with my mentor, since I have a co-mentor now, I don’t need to be with her for 40% of my shifts.

I had a very busy day with my favourite staff nurse – I realise it’s awkward referring to her as that, but this is the internet and names are personal. Maybe I should give her a name. Maybe I should call her Lilo, because she’s very bouncy and excitable and kind of reminds me of Lilo in Lilo and Stitch. It had to be a Disney name, because she spent a good part of the twelve-hour shift singing ‘Not in Nottingham’ from Disney’s Robin Hood. So now I have that stuck in my head. Pity me!

I spent a lot of the morning feeling utterly clueless because I got to help with the drugs round and I know next to nothing, which given that I studied biochemistry for more years than I care to admit to, is embarrassing. I did however pick up on a potential mistake, the medication dose in one of our patients pod lockers didn’t match the prescription, so we couldn’t give it. Ten points to me for paying attention! Fifty points to Lilo for being so strict on paying attention and doing the drugs round properly.

One of our patients died. I helped Lilo perform the final rites. It was different this time. I was there when the lady was admitted, she was quite old and she had a chest infection, but initially the doctors had thought she would go home. Her family stayed with her for a long time to say their last goodbyes, we offered tea (as you do) and gave them space. Because the day was so hot – and this is the UK so who needs air conditioning in hospitals? – the body was still warm when we came to perform the final rites. Lilo, a September cohort first year and I washed her, when we rolled her onto her side to wash her back, she appeared to vomit. I am aware that’s not the technical term. Once we had washed her face and dressed her, we had to call the morgue. Unlike other European countries, we use a euphemism when calling the morgue, in case other patients or relatives overhear. The morgue in our hospital is called ‘Rose Cottage’. I get the logic, but I still think it’s weird.

It was one of those situations, it was fine while I was doing it, but I did feel quite weird when I got home. It was one of those nights I slept with the light on.

Placement Week 4

Despite Monday bringing a huge relief, I spent Tuesday and Wednesday in a distracted state. I wasn’t sure whether Thursday would be me getting back to placement or me having to hurriedly try to rearrange a placement somewhere else.

My Link Lecturer visited the Ward Manager first and discussed my reasonable adjustments. She ten returned to give me forewarning that the Ward Manager and one of the ward Sisters, now my co-mentor would be in the meeting. She also gave me a list of shift dates running until the end of placement, with who I would be on shift with noted down. I marked the ones I couldn’t do and we went into the meeting. The Ward Manager was much more positive and went out of her way to tell me how angry she was with the university for not passing on the information about my adjustments sooner. She even apologised, albeit while absolving herself of any blame ‘I’m sorry things have been so difficult, I’m angry too.’ Still, I will take what I can get. All of my reasonable adjustments were accepted, although most of them required me to give some justification first. Meeting over with and shifts arranged, the only thing left to panic about was how to make up my hours. With a bit of luck I will be able to do a shift a week over the uni block.

I spent my first day back with my favourite staff nurse – but don’t tell her that, she’ll get a big head – so that was a nice way to start. She likes me because I make good tea. The most exciting part of the day was learning to give subcutaneous injections. I’m told I shouldn’t refer to that as ‘I learned to stab people today!’ It makes people question my suitability as a nurse. My first practice patient, a very sweet older lady, said that I was wonderful and that she didn’t feel a thing, so that was reassuring.

I spent half an hour with an awesome third year while we were writing notes. She helped me work out some goals for first placement. That helped a lot with my Initial review, which I finally got around to while spending a day doing admin with my co-mentor. The idea is to get to grips with the basics of patient care in this placement. That and learn get better at talking to people, who knew it would be so hard to remember to introduce yourself? I need a ‘Hellomynameis’ badge. Although most of our patients are over 70 and would need reading glasses to see it, so maybe not.

Placement Week 3

This week was the epitome of mixed feelings. Monday morning started off disastrously. I went in and was told my mentor wasn’t on shift…despite her telling me to come in on Monday. At first, I panicked and went to hide in the staff room. I called my mum and she was angry on my behalf, but helped me talk myself into going and finding out if there was anyone else I could work with. I spent a few hours with a lovely deputy sister and the rest of the day with quite possibly the bubbliest staff nurse ever. I had an amazing day! I started learning more about the medications and where to find them on the trolley. There are two draws, which are for different types of medicines, but inside the draws, there is no logic at all. Fortunately, my temporary mentor was patient with how long it took me to find things.

 

I saw my first body today. I had met the lady and her family in the morning, so it was very strange going back into the room and her body being there completely still. I kept half expecting her to breathe. This time I was there to observe while a staff nurse and a Care Support Worker performed the final rights, dressed and wrapped the body and made sure the right paperwork was prepared. It turns out quite often doctors don’t officially document time of death and have to be chased and pestered about it.

 

Tuesday I was with the staff nurse again. After practicing doing obs on Monday, I was allowed to do a few patients independently. I felt like I got the hang of it, but I probably should practice doing manual blood pressures more. It probably comes as no surprise to anyone that communication is the hardest part. Some people are good at chattering away to patients the whole time, I still sometimes forget to introduce myself. I have now written a note of what to say when I first meet people and things to talk about. Most patients do seem to like it if you keep talking to them, even if it’s just explaining what you’re doing – which is good, because when I’m doing obs, I need to talk myself through it!

 

I had Wednesday off and spent an embarrassing amount of time sleeping. Sleep schedule needs work, that was predictable. I had a couple of wobbles at ninja class, I think because it takes so much energy keeping myself together when I’m on shift. I feel like there’s a very fine line between being okay and having a meltdown at the moment.

 

Thursday was a complete and utter disaster. I had a meeting with my link lecturer, I thought I was going to discuss the problems I’ve been having with my mentor, but apparently not. Since it has been resolved now, I will cut the rant and give the short version. It turned out to be a meeting with my link lecturer, a ward sister and ward manager in which I was essentially being pushed out, told that my brain ‘wasn’t working the way I wanted it to’ and I wasn’t well enough to be on placement. The basic message was, go home and think about whether you’re doing the right thing, while heavily implying that I wasn’t. I didn’t meltdown then and there. I did exchange a flurry of emails with my academic advisor to arrange a meeting with her. I did still have to miss two of my planned shifts, which has messed up my hours for this placement. Oh well, who needs a summer holiday?

I took my mum to the meeting, which was on Monday, but I’m writing about it now. My link lecturer was in that meeting too, but she didn’t have too much to say. The placement lead and my academic advisor more or less said that the meeting on Thursday shouldn’t have happened and that my mentor wasn’t fulfilling her basic responsibilities. It turns out that my occupational health review has gone walkabouts, so the placement wasn’t made aware of my reasonable adjustments. Had my link lecturer and my mentor done what they were supposed to, it wouldn’t have been a problem. Now everyone has a copy of my reasonable adjustments, which the placement lead said were very reasonable and most of them were basic things that should be done anyway. The short version is, Uni fucked up and it’s not my fault.

Placement Week 2

I went to my GP, she’s a big, bubbly, super expressive woman who has a son with anxiety. She told me I had low blood pressure, but unless I collapsed while I was exercising, I had nothing to worry about. Then she confirmed exactly what I had thought – going in was the issue, I needed to do it as soon as possible. I have been back to the hospital, mum took me up there just to sit for half an hour while she went shopping. I could do that without panicking. I set a target for my next shift: Follow my mentor around like a little lost sheep and don’t worry about anything else.

 

I was very anxious, but I coped. We did the drugs round and I didn’t faint, it was already better than day one! I was also on the lady’s bay and some of them were quite chatty and very sweet to me. One woman was very upset, I went over to her, held her hand and let her talk. She told me I had nice eyes and I would make a good nurse. It made my day. I was feeling so lost and uncomfortable. She made me feel like I had potential and didn’t need to run away and give up now – thank you brain for the ever useful advice.

 

My mentor is hard to work with. I don’t know if she’s had many students before, which is difficult because I don’t have a clue what I’m doing. She doesn’t explain things or tell me what she wants me to do or make time to do my paperwork. If I was someone else, I would probably have the confidence to bring that up. But I’m me and I feel like I’m barely staying afloat as it is. I do not have the spoons to have an awkward conversation. I feel like she thinks I’m fragile and totally incompetent. Maybe I’m just projecting, I don’t know. We haven’t had a chance to go through my paperwork, which explains my reasonable adjustments, so that is only making things worse.

 

Conclusion: My mentor sucks, but I love nursing.

Windows and Domes

It has been a while since I have written about the snow globe. At the moment, it feels like the snow globe is in a constant state of thawing and refreezing. Sometimes the glass is as thick as ever and so frosted I can barely see the world outside through it. Other times the glass is more of a shimmering bubble and it’s all too real, too intense, too much. Sometimes, the river running through my snow globe swells, overflows and crashes over me. My skin starts tingling, my throat closes, I feel sick. The tears I haven’t shed over the last five years have finally found my eyes. On the days when the snow globe walls are thin, I am constantly on the edge of tears. The tiniest things tip me over the edge. I am either utterly detached or constantly a breath away from meltdown.

 

My library is going up haphazardly, the shells are built, the interior is empty. I’m upstairs in the Creativity block, the ceiling is a glass dome. Some days I feel like hiding in here and letting the world disappear. Some days I am so afraid that depression is returning. Some days I want to sleep and hide and dream and do anything to avoid having to be. Maybe I’ll leave this room bare, have a role mat on the floor and an assortment of blankets, so that I always have somewhere to hide.

 

When I fainted a few weeks ago, something very odd happened. I suspect that it was my half-conscious brain misinterpreting people talking around me, but I felt like I went somewhere else. I was here, then I was not here. It felt like falling through a window into another world. The only thing that stuck with me was that I didn’t want to come back. I think I need to write more. Even when I’m tired. Even when the blank page or the blank screen is terrifying and turning on my laptop or picking up a pen is too much effort. Sometimes that helps. Even if it doesn’t help to trap the dreams words, there’s always hope that one day I’ll write something that has enough potential that I can get it published. Then maybe I will let the world outside the snow globe go, for the most part, and live in a shed in the garden and write. At least then I would feel safe. I wouldn’t have to rely on the fragile glass of my snow globe to keep me safe, I would have real walls to do that. I would have a pass to be as eccentric as I please.

Placement Week 1

In my head, I have built up my first placement into a do or die challenge. The deciding factor. A confirmation that I made the right choice or the epitome of poor judgement. In my head it could mark the beginning of a life’s work or it could be another dead end. When I’m anxious, my head becomes a very dramatic place to be. Sleep becomes something I used to do. Ah 3am, my old friend.

As it turned out, true to myself, the first day was an utter disaster. What did I put on my to-do list for the day? Survive placement. Seriously Robin, you had one thing to do. One thing!

FAIL

I passed out on ward rounds. My mentor left me with the drugs trolley for five minutes while she helped transfer a patient and I started feeling a bit sick. I tried deep breathes, my vision blacked out. I blinked and all I could see was black. I crouched down to get my head low. My vision cleared. Thinking it might be that the bay was hot, I got out into the corridor and sat down, head on my knees. My head was still spinning and my vision kept blacking out. The ward sister asked if I was okay, I told her I was blacking out, funny, sometimes when I’m really overwhelmed, my fear of people evaporates. She and another nurse helped me to the medication cupboard because it’s cooler in there. I collapsed as we stepped through the door. I can’t have been out for more than a few seconds, I came round while they were putting me in the recovery position.

The nurses took my blood pressure, it was so low the machine alarm went off and I had to go to A&E on a trolley and have a heart trace. Fortunately, it didn’t show anything wrong. I was however told to go home for the day. I went back to the ward to collect my bag. The ward sisters and my mentor were very sweet about it, mostly they were just worried about me. I suppose now I can ask all the stupid questions, because nothing is going to be more awkward than collapsing on shift! Placement literally cannot get worse.

I’m not sure what lead to the collapse, possibly a combination of heat, anxiety and possibly anaemia. The main thing is, it wasn’t anything serious.

Unfortunately, fainting on shift wasn’t something I could have prepared for. I had prepared for all sort of stuff, I had prepared for not getting on with people, people dying on my watch, not knowing what to do, not knowing where things are, feeling shy, feeling lost, constant noise, almost everything I could think of. But that is something that hasn’t happened to me before. Over the next few days it built up in my head, until, on the morning of my next shift, I got up, got dressed, even got out of the front door and then had a panic attack. I couldn’t leave the front garden. My legs turned to led and I could not stop sobbing and saying ‘I can’t’. My breath caught in my lungs, my teeth were chattering in spite of the warmth and my whole body shook. I ended up calling the ward in tears and trying to explain what happened.

I know my brain pretty well at this point. I know the problem is getting to placement, once I’m there, in all likelihood I will be fine. My link lecturer disagreed. She wouldn’t let me go in for a short day the following morning, which was the one day I could easily get a lift in. I felt so frustrated. Not going in only made the anxiety worse, because now I have to worry about making up hours.