Surviving Nursing School: Your First Patient

(Previously published, May 2009)

After mountains of prerequisites and enduring a waiting period of two-years because every other Tom, Dick, and Harry want to be nurses, you finally got into nursing school.

Hooray. For. You.

You get your list of crap you need for school…books, charts, other books to tell you how to read the nursing books because they are written in some dead language, but you really get excited about the list of stuff you will need for clinicals. Clinicals!! It is the opportunity to get out there and get your feet wet. You get to show off those new skills you learned in skills lab on a practice dummy that can’t tell you what an idiot you are for putting it in the wrong hole. This is your time to shine! You’ll be so good at it, the nursing instructors will have no choice but to pass you after your first day, and recommend that you take your boards immediately!

Usually, you start out slow. You get one patient to take care of for a clinical day, which generally lasts 8 hours, but actually breaks down into 4 hours when you subtract lunch…and conference with your instructor before and after your “clinical day” where you dissect everything you managed to fuck up without actually killing the patient. The day before “clinical day”, you go to the “clinical site”…which is just a fancy way of saying hospital or nursing home, to get information on that one patient that will be your charge for a total of 4 hours.

So, you get dressed up in your smart business wear, because you have to look professional when you go to piss off the nurses by stealing their charts to pour over for 3 straight hours, writing down all the information that is pertinent: diagnosis, past medical history, current orders, old orders, procedures, medications, when they last passed gas. If you’re patient is relatively new, you struck gold. If your patient has been there since the invention of the foley catheter, you probably pissed off your instructor at some point, and this is their retribution.

Armed with your mountains of notes, you go home and spend the remainder of the evening writing up care plans, and small essays defining the diagnosis of your patient, and researching every little medication the patient takes, right down to the medicated pad they use for their hemorrhoids. And when you are done, you have just enough time for a 2 hour nap, get up, get dressed in your snappy nursing school uniform, and report for clinicals…usually stopping at Starbucks on the way to pick up the strongest drink they make. (I blame nursing school for my caffeine addiction.)

Most nursing programs start their students out in nursing homes before exposing them to the cutthroat world of hospitals. You go, get your standard little, blue-haired lady. You give her scheduled medications. You give her a bath. You do an assessment. You chart about the whole experience. You spend the day talking to her and have her brag to you about her grandchildren, (or sometimes you get to hear them complain about their horrible children who put them in the home and never come to visit). You go home feeling good about the new career you have chosen for yourself because you get to help people. A relatively easy and positive experience.

Yeah, too bad that didn’t happen to me.

I got my patient assignment, and made a beeline for the facility after class because I was an excited, young nursing student. I asked the nurse for the chart of my patient, and I could have swore she smirked at me. Whatever! I sequestered myself to the staff break room and furiously wrote down everything, right down to the last time the patient pooped and a summary of what it looked like. As I wrote down the history, I gave pause to the phrase “morbid obesity”.

Webster’s Dictionary defines morbid as “grisly” or “gruesome”. Apparently, there’s Garden Variety Fat, and there’s Stephen King Fat. My patient being the latter.

After my copious note-taking, I went to my patient’s room. It was customary to introduce yourself to your patient, as the student nurse who would be taking care of them the following day. Maybe this served as a warning to the patient that they had approximately 12 hours to try to hurl themselves down a stairwell, or find some other means to get themselves transferred to another facility, hospital, or mortuary.

I knocked softly and entered the room. All the doctor’s notes in the world could not have prepared me for what waited on the other side of the door.

If Jabba the Hut and a troll doll were to make mad, passionate, love and out of that forbidden love created a child, that child would have been my very first patient in nursing school. For there, in a bed that could have easily supported the weight of a Chevy Silverado, lay my patient. All 700lbs of her. And crowning the top of her head was the hair in an eye-catching shade of hot pink. It was standing straight up, just like a troll doll.

After an internal struggle to keep my shocked and mortified expression in check, I talked with her for ten minutes. As I drove home, I tried to figure out just what I did that curried the anger of my clinical instructor. Not even two weeks in, and I was already pissing people off.

The next day, I show up, Starbucks in hand. I’m told I need to give my patient a bath, as in get her out of bed and into the shower. I blanch. This requires the work of ten nursing students, using a hoyer lift. We wheel my patient into the shower and proceed to hose her down, all coming out equally drenched. We find out later that the patient hadn’t seen the shower room since the previous semester when nursing students invaded the facility, and that this patient had just been getting bed baths up until now.

But on a positive note, I found the remote control she had been missing for a few days.

Somehow, I managed to survive the day. While I never had to have Bertha the Troll back, my other classmates did get their turns…and clinical days were much of the same: hoyer lift, shower, the twist being the item we would find nestled in her, ahem, folds. Sometimes it was food. Sometimes it was a comb. Other times it was something we couldn’t readily identify.

The charming, blue haired lady with delightful tales of her grandchildren? I never got to take care of her. Instead, I get the frosty old bat who complained about her hemorrhoids all the time. The mentally retarded patient that ate his boogers. The senile old man that pinched my boob and left a big, bruise. And the lady with Alzheimer’s that pulled me into the bathtub with her during that fleeting minute I turned my attention away.

And such was my first semester of clinicals in nursing school. Nursing…welcome to it.

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