...are the ones that make the biggest difference


New job....sort of

There's this older episode of Scrubs where all the characters reflect on their best day in medicine. They start off with some funny moments or stupid moments, but eventually all come to think about this one particular patient and his young son. For me, the best moment I've had in medicine took place at my previous job. Most of those patients were on the upswing after a lengthy ICU stay, so both patients and families were settled in for the long haul of recovery. For families sometimes those initial moments of loss, fear and doubt are the hardest to deal with, and sometimes it is trying to see the light at the end of the tunnel as your loved one struggles through yet another day where progress is measured in millimeters, if at all. I walked into a room with a patient and his wife to answer the call light. This man had had a host of problems and infections, leaving him short one leg, severely weakened and with a bad case of C. diff (I won't describe it; let's just say its bad stuff). The wife was standing, looking out the window and I could tell she was crying. So casual-like, I start talking about the progress her husband has made, how getting well is sometimes a three-steps-forward-two-steps-back kind of thing with the elimination of a major problem causing some minor ones and how, once this problem was nipped in the bud, he'd start really getting back to his old self and going home. I spent 30 minutes in that room, which was 25 minutes longer than I needed to accomplish my task but not one second less than I needed to do my job. By the end of our conversation, the wife was smiling and laughing and I think finally able to see the twinkle of light off in the distance.

That is my best moment in medicine so far, so I'm not sure why I find it so surprising that I'm not particularly liking my present position. For the last 6 months, I've been working in the ICU as part of a student nurse program. Its been a great experience and I've enjoyed all the new things I've had the chance to learn. We have a diverse patient population, including traumas (car accidents and the like, including the occasional shooting or stabbing), post-op heart and cardiovascular patients and a neuro-ICU where we have stroke & brain injury patients. There's a fair amount of excitement with codes and bed-side procedures and always something new to watch or do. But pretty much everyone is unconscious or intubated, which makes developing relationships with the patient difficult, to say the least. And visiting time is severely restricted, not just because we're in and out of the rooms so much and with families things just get too crowded, but also because we do do so many bedside stuff that other patients' privacy would be compromised. So again, not much room to develop relationships or help them find hope. I really expected that all the technical expertise that goes into being a critical care nurse (and its a lot, let me tell you) would be fulfilling for me, but it just isn't. There are parts that can be quite satisfying, but overall, its just not making me look forward to work as I have in the past.

Thankfully, I've been able to change my position so that I will now split my time between the ICU and the oncology floor. If I really enjoy oncology, I may simply go to work there full-time. I'm hoping that oncology will give me the best of both worlds; most patients are still in relatively critical condition and oncology requires its own unique expertise, but most patients are also alert & oriented, which makes conversations a whole lot easier. I should start there in a few weeks, just as summer school is wrapping up.

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