Okay, I’m not quitting today because I need to get a paycheck on Friday and the next Friday and the next until I make alternative plans. But if I were able to quit whenever I wanted, this day would have been the day.
Let me set the scene.
I had one patient with paranoid schizophrenia. He brought himself to the emergency department with a very infected hand. He needed wound care and IV antibiotics. He was admitted and the psychiatrist who was consulted in the ED placed him on a hold, meaning we legally had to keep him in the hospital and not let him leave because he is a danger to himself and/or others, cannot care for himself, is not aware of his mental incapacity, and unable to make safe decisions (i.e. would leave the hospital when he should stay for care). He was delusional and afraid of getting raped, getting his organs harvested, his money being stolen, and snakes coming out of his hand. As his agitation increased, he started getting dressed to leave. I called security but made them stay outside the room. Uniformed men storming in would only make the situation worse. When he actually tried leaving and fighting me and the people trying to keep him to stay, I couldn’t protect him any longer. Three security officers took him down while he screamed and fought and I stood there in tears because all his nightmares were coming true and my heart broke for him.
Across the hall, I had another patient: homeless like the other one, could not walk, could barely speak comprehensibly, was incontinent and wearing a diaper but did care if it was soiled, didn’t know the date or which hospital he was in, screamed when he wanted things, and was combative. All of that aside, we weren’t really providing him any more medical care, so he had to be discharged. The social worker got him a taxi voucher and donated sweatpants, a long sleeve shirt, and sneakers. She arranged to have his medication delivered to the hospital, but the patient wouldn’t wait for it. I printed his discharge instructions, but there was no way he would listen to that. He wasn’t going to take any medication anyway, so that section could be scrapped. He put his shirt on over a bloody arm from ripping his own IV out. I helped him put sweatpants on over a diaper that smelled like urine that he wouldn’t let me change. I stuck his papers that he would never look at in his pocket with the taxi voucher he wouldn’t use. I called transport who wheeled him downstairs and out the front door to the streets.
Of course, I had three other patients: one who needed pain medication every two hours, one I needed to discharge, and a new admission.
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Let me explain why I got into nursing. A couple things happened before I was even considering the field, but I believe played large roles: the 2004 Indian Ocean tsunami and Hurricane Katrina. Both of these disasters left me feeling powerless and so sorry that I couldn’t help. I was in high school without much of a savings account and no skills to offer up. I was useless. I didn’t care about the penny drive we had at school. I wanted to get on a plane and help with my hands, save lives, pull people out of waters, press a baby against my chest, wrap a tourniquet around a bleeding leg, and gently pour clean water into needy mouths.
Later, I was in my freshman year of business school because owning my own shop was the only thing I could think of wanting to do with my life when I rethought things. I actually have no memory of what made me realize it, but I decided pulling people out of flooded streets and pressing babies against my chest would be what I do with my life. I wanted to heal people. People who truly needed it. Those who lived in places who had no access to medical care or even education on health, those who could not help that their health rapidly deteriorated within hours or days due to a natural disaster, those who never had a chance to begin with, these would be my patients. They needed me. I could help them. They would appreciate me. Healing others would be my career and life’s work. I would be a nurse.
Sounds freakin’ glorious, doesn’t it?!
God, I loved this idea so much. Disaster relief and working in developing countries is what made me realize nursing is what I wanted to do, but I knew I’d probably work a regular nursing job too, at least to start. It was a real career, a good career. I’ve written so many essays on nursing — for scholarships, for school applications — and I used to tear up writing words like the ones I just wrote. I was passionate. I guess it’s what got me through three more years of school studying public health, four and a half years of working as a nurse assistant, and two and a half years of nursing school. I knew it would be worth it.
Spoiler alert: IT WASN’T.
Or maybe it was, I don’t know!
I still care about disaster relief and health in developing countries. I believe that if I’m working with people that haven’t eaten themselves or drugged themselves to the chronic mess they are currently in, if the patients participate and cooperate in their care, and if the patients respect and appreciate me, I would hate my career a lot less. *When I say appreciate me, I just mean I don’t want to be verbally and physically abused at work. (Dream big!) This kind of nursing is still something I want to do in the future. After I moved out of my parents house and I was able to get my own dog, I had to decide between puppy and working abroad. You know the choice I made and I’ve never regretted that. I also wanted to work in med-surg in a hospital to gain experience and not immediately head to Africa so I had years to kill anyway, with puppy in tow.
Working in America among the obese, diabetic, hypertensive patients that either do not know how to take care of themselves or do not care to take care of themselves is not where my heart lies. I truly feel for those who care but do not have the knowledge. I would love to help a person who cares, but just didn’t know. They want to change, they need my help to change, I can heal them! However, only a small portion of the patients I see (inpatient, medical-surgical units) fall into this category — the willing and wanting to change. Wouldn’t it be nice, though, if they didn’t have to experience years of poor health, get admitted to the hospital for a temporary fix, and then continue the rest of their years in poor health?
Chronic diseases (obesity, diabetes, heart disease, cancer, etc.) are the leading cause of death and disability in the United States. They are often referred to as “nutrition-related chronic diseases” and are preventable. We grew up on the USDA’s food pyramid, on Mom cooking what she thought was a “balanced” meal with the ever-so-holy glass of milk to wash it down. Our nutrition was, and to this day is, based on a little science and a whole lot of politics and big-money corporations. Tyson, Hood, Conagra, they own our food and nutrition knowledge. Advertising taught us, school health class taught us, Mom and Dad taught us, exactly what they wanted us to believe. We need the beef they sell to get enough protein to be healthy. We need the milk they sell for strong bones. The nutrition education children receive in schools is not based solely on science, which nutrition is, but on the U.S. government’s dietary guidelines. And we know the U.S. government is completely fucked.
This isn’t a conspiracy theory; this is fact: The dietary guidelines are issued by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS). Good-intentioned health and nutrition scientists and experts on the Dietary Guidelines Advisory Committee base their recommendations on years of scientific research. The USDA is in charge of strengthening (read: making more money for) America’s food and agriculture industries. You know who the USDA’s primary stakeholders are? The big food producers, of meat and dairy especially. So there’s old, fat, white guys that have major stake in certain foods we eat, sitting on the boards of some of the biggest food production companies, who also sit on the board for writing the dietary guidelines. They don’t like when nutrition experts report that the food they produce may negatively influence health, and I promise you they don’t sit by and let that information reach the public. Before these recommendations can get in the final report, data gets manipulated and recommendations get changed by the USDA and HHS.
This information should make you very, very angry.
The patients I talked about to start all of this aren’t your basic chronic diesease-ridden patients, although they had some of those too. In addition, they had mental health and social issues. Our country is not taking care of these people well, but that’s a whole different story. I can’t even start to think about how to fix this, but I know I don’t want to be so closely involved, watching the fire burn. I talked about those two patients because this day at work was really the last straw on the camel’s back. I couldn’t stop thinking WHAT AM I DOING HERE? WHY AM I HERE? WHAT IS THE POINT? I’m not helping anyone. Anyone can get yelled at by a schizophrenic. Anyone can discharge someone to the street. Anyone can educate why you’re giving twenty units of insulin lispro to a patient who will never change their diet. Anyone can do wound care on an abscess caused by shooting meth under the skin and I promise that patient will be back soon. Anyone can throw hypertension medication at someone instead of educating on lifestyle changes that would decrease their blood pressure. Anyone can throw opioids at someone who you know is addicted because of our doctors and our system. Why do I have to do it? If I don’t come back, anyone can take my place.
After witnessing the general health, or lack there of, in most of my patients, I’ve taken away two main points: 1. We need to be raising kids better from the very start with health education and also, coping skills and other mental health education, and 2. my passion in health lies in wellness and prevention, not in putting bandaids on bullet holes as the patient walks out to another gun fight.
I have been thinking long and hard about how I will have a career in this, but I don’t have the answer yet. Are you familiar with the downstream/upstream story; the primary prevention analogy? We (health care) are so busy trying to save drowning people in the river, that we never look upstream to see why they’re falling in. I currently work downstream. It’s exhausting and not rewarding to pull people out of the river just for them to go back upstream and fall in again. I want to work upstream. I want to make a difference there. It is not lost on me that a great career would be having a hand in changing the system, but that’s not what I want to do at work every day. That day with those patients, I just wanted to leave and not come back. I wasn’t inspired to create change; I wanted to get the hell out of there. That’s not a noble action, but it is how I feel in this situation. I do want to help, but in a different way.
I have lots of ideas involving health, wellness, nutrition, and education, but not one plan yet that will get me my dream job. For now, I have decided to (try to) be content where I am right now. For so long I was always actively working towards the next thing or at least had near-future plans to actively work towards the next thing. For the first time in years, I am going to sit still and be present here. I am so happy to be travel nursing now, as I won’t want to travel forever. I will use this time to gain health care experience and knowledge of the diseases I want to be able to prevent and to also focus on more personal goals.
So, stay tuned for career updates. In the meantime, take a walk and eat your goddamn vegetables.
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Those patients were at my assignment in San Francisco, where I frequently reconsidered my career path. I am now in Longmont, Colorado where I have not cried at work once! The hospital and staff are lovely and I don’t hate my job every day. Henley and I have been hiking on most days off and I have friends in Denver that I love being near again. The sunsets over the mountains don’t suck either! A good assignment doesn’t change my outlook on nursing as a whole, but rest assured, we are happy here.
