Slip & Slide

When I showed up for orientation, I had that nervous excitement that you get when you are about to embark on a new adventure. The kind you get when your life finally, suddenly has a purpose and you know exactly where you are going and what you are going to be doing for the rest of your life. As I sat and listened to the requirements- lecture hours, laboratory hours, clinical hours, a required physical exam including blood work and vaccinations, homework assignments… my head started to spin. I saw it spinning and spinning and spinning like a top until it popped off like a jack in the box. Only instead of Jack, the woman at the front of the room popped out with her clown face laughing and laughing and laughing. The nervous excitement slowly drained out of my body and it was quickly replaced with fear and dread.

I left the room in a daze, completely overwhelmed. What did I get myself into? What does a nurse even do? At that moment, I realized that I didn’t even know. I’d never even set foot in a hospital. I’d never even known someone that was sick. Did I really just sign up to do something for the rest of my life and I don’t even know what I am going to be doing? I sure did. The overwhelming feeling and nervous excitement inside me was slowly brewing into anxiety as my first clinical rotation was quickly approaching.

I tried to suppress the quick beating of my heart every time I thought of it and reinforce the excitement that I felt. My uniform came in and I put it on several times. Practicing in the mirror, “Hi, my name is Hope. I will be your nurse today,” as I struggled to build up my self-confidence. Maybe if I said it over and over again, someone would actually believe me. Perhaps if I practiced enough, I could fool the patients and they wouldn’t be able to hear the nervous tone in my voice or see the dubious look in my eyes or the awkward hesitancy in my actions. Fool the patients! Ha, who was I kidding? The clinical instructor was the person I really had to fool. Rumors from the previous semester had already trickled down to our class and our instructor had the reputation of being the most stringent. That would be my luck, but as with all stressful periods in my short life my Mother’s words of encouragement whispered in my ears. “Hope, anything is possible.” As simple as those words were they did always give me a bit of confidence, even if it was just a small bit.

The morning of my first clinical, I begrudgingly got out of bed at 3:01 am. The night before, I made a trip to the long term care facility to select a patient. Once home, my assignment was to write up a care plan. The care plans included a summary of all the medical diagnosis, any recent tests or procedures that the patient had and why, and three nursing problems with interventions and rationales. I didn’t have a computer so writing it all out was extremely time consuming. I finally completed it at midnight, tucked it into my bag so I would not forget it in the morning, brushed my teeth and went to bed. I was exhausted, yet sleep did not find me. I tossed and turned, my nerves getting the best of me, until I glanced at the clock and saw 3:01. I decided that sleeping was futile and as much as I would have liked to just stay in bed the entire day, getting up was probably the best thing to do.

There was no calming my nerves today. I tried to eat breakfast but nausea superseded my hunger. I looked in the mirror one last time giving myself a once over to ensure that my uniform was within school policy. My blonde hair was smoothly pulled back, off my face, in a low pony tail. My face held little make-up, just a hint of blush and pink lip gloss. My nails were trimmed (actually chewed), clean, and without nail polish. My white polo shirt was neatly pressed under my green pinstriped nursing smock. I glanced down to my legs, fashioned in crisp white scrub pants and pressed with a straight crease right down the front exactly in the center. My new white shoes practically glowed by the moonlight shining into my room. And for the finishing touch, my stethoscope (my favorite color, pink) hung around my neck, my pocket protector with my pen light, scissors, and pens lay in my smock pocket, and my name tag pinned to the upper right side of my chest. As I turned to leave, I took one look at my backside and was mortified to see my blue striped underwear glaring at me through my white pants. Realizing the save from embarrassment, a sigh of gratefulness came from me.

I quickly ran to my underwear drawer for a pair of whities. Digging through the drawer, beads of sweat built on my forehead. My heart nearly stopped when no white underwear were found. I contemplated going into my sister’s drawer for a pair of hers but was immediately disgusted by the idea. Slipping off my blue striped underwear, I did what I had no choice but to do and went commando. I walked out of the door with a silent prayer that I would not have diarrhea today. My nervous stomach rumbled confirming that was a very strong prayer.

My first clinical instructor was Ms. Annsak. She was tall and lanky. No, tall was an understatement. She was beyond tall standing over six feet. She reminded me of Olive Oil from Popeye, except she had blonde hair and was bigger than I would have imagined Olive Oil to be. She was gangly, long-limbed, and awkward and I was scared shitless of her. In fact, I was scared shitless of the whole situation. This would be my first patient ever. I tried to be positive. “You can do it, Hope. Remember with Hope anything is possible.” But my skepticism came through.

“Yes anything is possible.” I told myself, “including dropping the patient, or worse killing the patient.”

Our clinical group met with Ms. Annsak at 6 am sharp for our pre-clinical conference. Here we discussed the patients that we selected and what our priority of care would be. For our first day, our focus was on basic care needs of the patient, such as washing, changing linen, feeding, dressing, walking, etc. At 6:30 we were released to care for our patients. “Should be a piece of cake,” I told myself.

I stood outside my patient’s room gathering my nerve to walk in. I encouraged myself, “Hope, just play nurse like you used to when you were a child. Just pretend. You can pretend anything.” And just like that I entered the room and pretended to be a nurse. Relief passed through me when I saw Lisa. She was my lab and study partner and her patient shared a room with my mine.

I picked Lisa immediately when I saw her looking at the lab rotation and noticed that we were in the same rotation. I sized her up and seeing that she didn’t look like a nerd or a dork or annoying, I asked her if she would be my partner. Picking her was my plan to save myself from being that last student without a partner who ends up paired with the random nerd, dork, or annoying student who is also left without a partner. We became friends quickly and studied together. Her grandmother was in a nursing home and she would visit her frequently and take her for walks in her wheelchair and sing songs to her. So when it came to old patients and doing basic care, Lisa was very comfortable. In the time that I walked in and introduced myself to my patient, Lisa was already nearly done with her bath.

My patient had a doctor’s appointment at 10am. My job was easy. All I had to do was get her cleaned up and ready for her appointment.

“Mrs. Holiday. My name is Hope. I’m a nursing student and I’m going to help you get washed up and ready for your doctor’s appointment.”

“WHAT?” she yelled. I forgot she was hard of hearing.

In a louder voice I repeated myself, “Rose, I’m going to get you up and in the shower to get you ready for your doctor’s appointment.”

“Oh, NO! NO! I can’t get out of bed.”

I tried to convince her, “But Rose, you have a doctor’s appointment. You have to get up.”

“CANCEL IT. I’m too sick to go to the doctor,” turning her back to me, she pulled the covers over her head.

“You can’t miss your doctor’s appointment.”

“Go away. I’m not going. I have diarrhea.”

“That’ll be two of us,” I thought to myself, “when Ms. Annsak comes in and sees that I have not gotten you cleaned up yet!” But who was I to argue with her? I would have to clean her up in bed. I turned to see if I could find a basin, when Ms. Annsack walked in. It was already almost nine and Rose was still in bed, unbathed, and not ready for her appointment. The morning was flying by and I really hadn’t done anything at all.

“UP, UP, UP!” Ms. Annsak repeated in her high-pitched voice.

“Rose, has diarrhea. She can’t…” I tried to explain but Ms. Annsak wouldn’t hear it.

“We must get her out of bed for her appointment.”

I looked at Rose in bewilderment. I had no idea how I was going to get her out of bed. She was close to 200 pounds, weak from being in bed and having diarrhea and she reeked of urine. Ms. Annsak must have seen the look on my face, and before I could turn around she was already back from the shower room with a shower chair.

The shower chair also doubled as a toilet chair. The seat looked like a toilet seat with a hole in the center, but it was tall and wide enough to slide over a toilet and on wheels so you could push the seat from the toilet to the shower without moving the patient. Or in this case, you could get the patient in the chair and push her to the shower. With little help from me, in one sweeping motion, Ms. Annsak had Rose in this chair. Rose yelled the entire way, insisting that she should stay in bed. “I can’t get out of bed. I have diarrhea!”

Ignoring Rose, Ms. Annsak, said. “There! Now get her in the shower.” And swiftly turned and left the room, leaving me with Rose’s protests.

I turned to wheel Rose to the shower, Lisa was at the bureau picking out jewelry for her patient to wear. Her patient was clean and sitting in her chair applying her make-up. The two of them were having friendly conversation. I silently cursed her. I began to push and tried to be positive at least Rose would finally get her shower and soon would be at her doctor’s office. Half-way across the room my right foot slipped. Taking two more steps my left foot slipped. Slipping and sliding, I tried to regain my footing. What the hell? Why is the floor wet? I thought to myself. No longer had I completed that thought, the loud thunder of Rose’s butt reached my ears, as she expelled feces. Unable to get traction, I tried to push faster to get the chair over to the toilet but only slipped more on the stool that had fallen to the floor. Finally, with Rose in the bathroom and over the toilet, I could still hear her mumbling angrily, “I told you I have diarrhea.”

I looked, horrified, at the trail left, smeared from my shoes. My eyes followed the trail which led from Rose’s bed across the room to the bathroom where I stood. That’s when I saw my shoes. Revulsion overcame me, as there were my brand new white shoes layered with brown diarrhea, no longer glowing, and my white pants that were so clean and ironed so perfectly were now speckled with brown dots all the way up to my knees. Suddenly, I became aware of the smell. The putrid, pungent smell of diarrhea and I wondered in disgust if the diarrhea on my pant legs went through and was touching my legs. The retching came on suddenly. I tried to hold it in, but Rose let out another loud fart with explosive diarrhea. The smell, intense and fresh, met my nose again, and while Rose let it out, I turned and vomited into the shower. I looked down again at my white speckled brown uniform and cursed the person who decided white was a good color for nurses.

My composure regained, I felt for Rose. She must be humiliated. I cleaned out the shower and laid towels on the floor where the diarrhea was and when Rose was done I pushed her into the shower room to wash her. I cleaned every part of her body, until to my dismay I had to clean her butt. I leaned down to peer under her, I could still see diarrhea hanging from her butt, but what I wasn’t prepared for, was what her butt looked like. What the hell? I thought to myself. Rose was obese, but her age had turned her firm obese body into a sagging obese body and there in the hole of the chair her body sagged. Nearly 12 inches of loose skin sagged down into that hole and hung there waiting for me to clean it. Reaching to clean the stool that I thought was still clinging to her butt, I realized that it wasn’t stool at all but a very, very large hemorrhoid hanging like a small cluster of grapes.

By the time, I got Rose dressed, transport was there to take her away. I was glad as this gave me some time to get myself cleaned up. I cleaned my pants and my shoes and then cleaned the floor. Then I changed the linens on Rose’s bed and made the bed perfectly, folding the corners up and then tucking them in under the mattress as I was taught in school. When I was done, I waited for Rose to come back but she didn’t. I saw Ms. Annsak approaching and busied myself in Rose’s room.

“Hope”

“Yes Ms. Annsac?”

“I just got word that Mrs. Holiday was admitted to the hospital with dehydration. I’m not sure if she will be back tomorrow, so you better select another patient.”

My heart sank. All of the work I did on her careplan and I was going to have to do it all over again on another patient. “I’ll get at it right away.” I said with a smile.

At 3:00 we met for post-conference and discussed the day. Anxious to get home, I barely heard the conversation that was taking place. My mind wandered to my shower and my bed, but the thought was pushed aside as I still had to get information on my new patient. So I could prepare another careplan all over again. I walked out of the care facility and asked myself, once again, “Hope, what are you thinking… A nurse? Are you sure that is what you want to do?” I realized that the more I learned about what a nurse does, the less I knew what a nurse did at all. I hoped for a better day tomorrow.

Completing my careplan, again at midnight, I fell into my bed in exhaustion. I needed to get a computer. Writing the same diagnosis as yesterday, but on a different patient was a complete waste of time. With the little time that I had to work, all of the money that I earned went to pay off the semester of school, car insurance, and gas. How was I ever going to afford a computer? My thoughts wandered to Rose. I wondered how she was doing in the hospital. That would be my luck to get the patient that ends up in the hospital. The thought of me pushing her across the room slipping and sliding in poop, while Lisa picked out jewelry for her patient threw me into a fit of giggles. Still laughing, I turned to my side, curled up in a fetal position and fell asleep.

I had confidence today would go much better than yesterday. Walking into the ward with my head high and shoulders back, I found my new patient. I was surprised to find that she was in the bed that Rose was in yesterday. Her name was Betty. Betty was awake when I approached her bed. She had a big bushel of grey hair that stuck out every which way.

“Good Morning! My name is Hope, I am a nursing student who will be working with your nurse today.”

“GOOD MORNING!” She yelled back. Another patient hard of hearing, I made a mental note to myself to be more aware of the elderly’s hearing impairments.

My day with Betty went unhitched. I ambulated her to the shower room. After she showered, I helped her dress and eat breakfast. When she finished, I went to get her medications – a couple of blood pressure pills and a daily anti-anxiety, and after she swallowed them we sat down to play some cards.

About an hour into our card game, Ms. Annsack, walked in. Today I could be proud. I got my patient out of bed myself, helped her with all of her daily activities and even gave her medications on time.

Ms. Annsack approached me, sitting in my chair she towered over me like a giant.

“HOPE. Why are you not attending to your patient?”

“W-W-Well, Ms Annsack, th-this is my patient, Betty,” I stammered.

“No, Hope. Betty is in the next room. In bed. Waiting for her nursing student to come in and take her to the shower room.”

“What?” No this is Betty. My thoughts went into a panic. It had to be Betty. How could I make this mistake?

“This is Rose, Hope. How could you not recognize the same patient that you cared for yesterday?” Ms. Annsack looked at me with disgust.

MMHH, let me think about that. Maybe because I was covered in shit!! My thoughts went from anger to panic again. But no, this couldn’t be Rose. I would have recognized her. I checked her ID band before I gave her medications. It wasn’t Rose, it was Betty. Betty Cooper that is what her ID band confirmed.

“No Ms. Annsack. This is Betty. I checked her name band before I gave her blood pressure medications. Look.” I reached for Betty’s hand and as I turned her name band to face Ms. Annsack, I was struck with horror and confusion, as her band appeared before our eyes – Rose A. Holiday.

Ms. Annsack, looked through me. “Hope, you gave this lady blood pressure medications, when she just got out of the hospital for dehydration and low blood pressure? Take her blood pressure now.” Reaching for the blood pressure cuff, it was too late. Rose turned sheet white and fell forward in her chair.

“Call a code!” Ms. Annsack yelled.

I searched for the code button, but could not find it. Ms. Annsack, seeing me fumbling and searching, pushed me out of the way and hit the code button. The force from her push caused me to stumble. Tripping on the chair that Rose had been sitting in, my head made a big thunk as it hit the side of the bed. Lying unconscious on the floor, the chiming of the code alarm buzzed in my ear. “Get up! Get up and help!” I urged myself.

Sitting up suddenly, I was disoriented and confused. Where’s Rose? Where’s Ms. Annsack. Looking around I saw familiar shadows and an astounding relief passed through my body as I realized I was in my own room. The buzzing sound in my ear was not the code bells at all but the sound of my alarm clock. I thanked God that it was just a bad dream.

Reaching over and turning off the alarm clock, I could still feel my heart thumping quickly and strongly through my chest. The air around me crisp and cold from my open window, I pulled my warm covers over my head and wished I could just stay in bed today. I would give anything to stay in my bed, surrounded by warmth and comfort, where I was safe and clean from patients with diarrhea but more importantly I was safe from harming my patient.

I finally got out of bed and while in the shower, tried to build up enough self-confidence and courage to make it through the day. I met Lisa in our pre-conference.

“Hey, Hope. You want to go to Connie’s Pizza when we get out of here?”

“Oh, yes. I will need a big beer after these past two days. Not to mention some food. My nerves have been in such a bunch I have barely eaten anything the past two days.”

“A beer? Did you get a fake Id?”

“Oh yeah! The best one you can get. I didn’t tell you?”

“No, but please do.”

“Saturday I took my sisters information and went to the DMV and told them I lost my driver’s license. Without any questions, they took my picture and gave me a new driver’s license.”

“All right then, Connie’s it will be.”

After clinical, I raced to Connie’s, starved from not eating and relieved to be done with the day, a feeling of freedom and serenity prevailed. I didn’t have a careplan to write or a test to study for so I was ecstatic. I found Lisa in our favorite booth. We came here frequently for their family size salad. After tests we would meet here and rehash test questions and answers. We were so good at remembering the questions that we would often know our test grade before we actually got our test back. Today was definitely a pizza and beer day. We both ordered Miller Lights and when I was carded, I handed over my ID with confidence.

Over our personal Deep Dish Pizzas, we compared our careplans.

“What did you get?” I asked Lisa.

“I got 6 out of 10”

“What! What did she mark you for?”

“She marked me for not giving scientific rationales for my interventions.”

“She marked off 4 points for that?”

“Well, not exactly. I only developed two nursing diagnosis with interventions. By the time I completed those it was 10 o’clock. I was too tired to complete a third one. I went to bed. I need my sleep. So what did you get?”

“I got 9.5. Apparently she took half a point off because I didn’t describe the smell of Rose’s diarrhea.”

“No way! Let me see that.” Lisa ripped the careplan from my hands. Sure enough there on my careplan in big red letters next to my assessment of large amount of loose brown stool was SMELL? DESCRIBE.

Lisa gasped and giggled as she read my careplan, “Is she serious? So Hope what did the diarrhea smell like?”

“Well you were there. It smelled like shit!!” We both fell in a fit of laughter. Lisa rehashing what my face looked like when I realized I was slipping in shit. Other customers gave us dirty looks, but we didn’t care, we laughed even harder. We finished our beers and our waitress game with our second round. Raising our glasses, we toasted to making it through our first week of clinical.