For a month or so in September/October 2015
By this time, I’d spent a good 4 weeks at home, just slothing (being a lazy bum) and vacationing… not being particularly productive with my life other than agonizing over what I’d do next with my life and whether i’d go back to Saudi or stay in North America.
I decided it was time to step out of my funk and get on with work. Things would eventually fall into place with a long-term plan again… but while I sorted it out, I was desperate for some good, proper, really hands-on nursing again. I was going through patient care withdrawls.
Also, Miss Colorado (in some pageant) just made a major statment in international entertainment news when she wore scrubs and a stethoscope and went onstage and talked about her role as a nurse. But what really caught the world’s attention, and especially the attention of nurses around the world, was when a few ignorant talk show hosts, specifically the ladies of The View, made mention of her “doctor’s stethoscope” wondering why she as a nurse was even wearing a “doctor’s stethoscope.” Obviously, we were all a little offended. Nurses united around the world, speaking out on social media against the ladies of the view, and promoting our profession in whatever way possible!
So, I returned to work with great pride as a nurse, wearing my “doctor’s stethoscope”, grateful that I’d chosen this wonderful profession and not medicine. Because I chose to be a nurse and not a doctor. Nursing was not my fallback. I didn’t go into it because I couldn’t get into med school. I could have gone to med school. But instead I chose to be a nurse, to spend more time working directly with patients, being their main point of contact, being that person to see them at and help them through their most vulnerable times!
I have my very own stethoscope, and I use my stethoscope to listen to my patients lungs to ensure they’re not filling with fluid/developing a pleural effusion/observe for signs of infection… to listen to their hearts to make sure they’re in a normal rhythm… to auscultate their bowels to ensure things are moving through properly and to detect when they’re not so that I can fix the problem. Unfortunately, part of my job is also to use my stethoscope to auscultate a heart that is silent and no longer pumping blood throughout the body, and lungs that are no longer breathing and filling blood with oxygen… and then to tell a patients family in the kindest but always most inadequate words, that I hear nothing anymore and confirm what they already suspected, that the one they love is deceased. And it’s me, the nurse, who has to do that, not the doctor, with my very own stethoscope. However… that being said, I don’t mind it, because next I get to hug them all, and do exactly what I went into nursing for… to offer comfort and support and care for people at the most difficult moment in their lives. So, I’m very proud to be a nurse and part of this very honorable profession. I can’t imagine being anything else!
When I first graduated from nursing school, I was blessed to get a fulltime job on the unit I did my final practicum on, a Tertiary Palliative Care Unit. I know I put the unit way up high on a pedastal, and I consider my colleagues on the unit to be the very best nurses I’ve ever worked with. Maybe it’s just because they’re the first nursing team I’ve really been a part of? Maybe it’s because they’re the team that raised me from a green, super fresh and young baby nurse to the nurse I am today? Maybe I’m just super biased?
But then I think about it a little more and remember how I saw them interact with patients and their families on a daily basis… their infinite care and compassion… seriously, the most caring group of individuals I’ve ever met. Nurses with a heart and passion for one of the most difficult fields of nursing practice… nurses who daily pull together as a team and are so supportive of each other as it’s the only way to survive in such an intensely emotional environment… nurses who advocate daily for nothing but the best for their patients and consistently put a patients needs and desires above their own… nurses who go to great lengths to ensure comfort of both a patient and their family… nurses who go above and beyond every single day, without ever asking for or needing recognition, because it’s just what they do, it’s what they love to do.
They’re not just nurses. They ARE nurses. They are the people you want spending 24 hours a day with the person you love and who is at the most vulnerable and difficult point in their life. They are the person who will ensure that the one you love, is loved and taken care of so that they want nothing but to spend time with you in comfort and peace!
Palliative care nurses are a special breed of nurses. We are faced with death and dying and sadness on a daily basis. Yet we are happy, not sad and gloomy. And our unit is suprisingly filled with light and laughter and happiness, not just from the nurses but from our patients and families also. We’ve learned to see the good in everything, to find the shiny silver lining to it all! If we couldn’t see the flip side, it would be come intensely overwhelming and we’d all crash and burn out for sure. But we have each other, we have the most lovely patients and families… people who are generally focused on the good things in their lives and have let go of the bad because who wants to hang onto the bad and nasty things when theyre so clearly faced with their mortality?
I miss palliative care. I think it’s the best of everything in all health care disciplines brought together to create the most holistic and collaborative and patient/family centered care possible, care that is dedicated purely to meeting a patient’s goals and ensuring their comfort in everything! Due to the culture, the lack of education on palliative care, and just general misconceptions, palliative care doesn’t really exist in Saudi, at least not at all in the way it does in North America, and it really is a shame. While I was home I read the most fantastic book by Atul Gawande called “Being Mortal” who suggested that patients who have palliative care services involed in their care, generally tend to live 25% longer. That’s an extremely significant result. Depending on the estimated time frame, it could be anywhere from extra days to extra years… but if it were me, I’d take anything I could get, especially when it only means that I’d be more comfortable and experience less symptoms and side effects…
Anyways. I was so happy to get back into palliative care and work with my favourite colleagues for a good month while home. I was worried that I would have lost a lot of my skills as I’d been out of inpatient care for well over a year by this time, and outpatients is much different! But… it was like riding a bike… but so much better!!!!
I probably drove my colleagues crazy with all my comparisons of Saudi to home. But i forgot how well stocked our supply room is at home… all the time!!! Like heaps of IV fluids in all sizes and all flvours… NS, D5W, 2/3 1/3, lactated ringers, NS with 10, 20 or 40 KCL… it’s amazing!! And we never run out of IV lines either like we do in Saudi!!!
And don’t even get me started on the narcotic prescribing and accessibility!!! Appropriate doses, with ranges for nurses to use base on patient needs… with normal time frames for administration (anywhere from q30min for a PRN to scheduled q4hourly analgesics)… and then all the adjuvants… gabapentin, citalopram, etc… and meds to manage all the side effects of narcotics… And a Pyxis (electronic drug cabinet) filed with everything from Tylenol #3 (shit) to Morphine/Hydromorphine/Fentanyl/Methadone!! It was amazing!! In Saudi we have Morphine (5:1, i’ve never seen anything more than 5mg IV prescibed unless palliative care services was somehow involved and the patient was recieving long acting morphine 10mg) Demoral (who still uses that crap except ER??!!) and Tramadol (even more ridiculous especially as it seems to be the drug of choice for oncology physicians in Saudi!).
And our doctors… oh my goodness… they’re so fabulous. They’ll just sit and spend anywhere from half an hour to an hour just talking through problems with patients and their familes. And they’re so open to suggestions from nursing!!!! I feel valued and respected! It’s wonderful!!! (and the feeling is very much mutual!)
Anyways… enough comparison… I’ll just mention again how much I adore my colleagues, how much I loved spending so many nightshifts just catching up with them, how much I loved working as a casual and picking up heaps of shifts in a two week period so that I manageed to work with almost every single nurse on the unit, and how much I loved our Thanksgiving night potluck… it was wonderful!!
Wearing colored scrubs with no repercussions… instead of shapeless/baggy white scrubs!! Personally I think they’re so much more cheerful and make me much more approachable… plus, hello?… white coat syndrome??!!! Also, In Saudi, I’m not allowed to drink coffee on the unit unless i’m in the staffroom, and getting caught drinking coffee at the nurses desks can result in a serious talking to/written warning… so I very gleefully drank coffee on the unit/at my desk/in the lobby… all day long actually. I loved stopping at the Starbucks in the lobby for coffee breaks and drinking my coffee while looking out at the trees in the atrium… my seasonal “autumn” cup from Starbucks! And then… can’t forget stat holiday pay!!!!!! Working Thanksgiving night meant I got a couple hours of holiday pay… that’s another thing we don’t get in Saudi… (but considering we get 54 days vacation, i can’t really complain!!)
And then to top it all off.. breakfast with a few colleagues and a now moved on to Calgary colleague who came to visit with her adorable little munchkin…
And a wine night with one of my nursing school classmates who is now working on my old unit too…
I think it’s important to be able to sepearate our work and personal lives… but it is also amazing to be able to have a great relationship with your colleagues and spend time outside of work with them also!!!
So, when my last day of work in Canada came again… i was really sad to leave everyone behind again. (Not sure why i keep torturing myself with goodbyes!!!) But… back to the adventure… let’s see where this crazy ride takes me again!! I’ll be back again… and if not back to this unit… at least back to palliative care because every time i work in palliative care I know that is where my heart is… So… one day again soon…