I am not an ordinary student.
It’s funny how people react to me in Nursing School. At 50-years-old, I am what is commonly referred to as a “returning adult student” or, sometimes, a “non-traditional student.” Yale’s euphemism for us is the “educationally-interrupted.”
In my mind, I’m just another student going to class. Coloring my greying hair, taking ibuprofen for my aching back and all. I don’t see the old chick going back to school.
I cross the quad like any other student, with my 50-lb books in my grey North Face bookbag with my long red hair pulled back in a scrubby ponytail like many other students. I wear a tee shirt and jeans with nondescript sneakers or shoes on my very tired and aching feet. I do not walk briskly. Rather, I stroll, unencumbered by youth and first loves and first times away from home.
I’m not sure if other students automatically assume I’m a dotty teacher. Or maybe some weird adjunct faculty. I often forget that I’m not 18 years old anymore — and I forget that other people may not see me as just another student.
Which is fine with me at the end of the day, but it makes for something of a lonely experience. I don’t have much in common with most of these teenagers anyway. And the minute I open my mouth, it’s obvious that I’m not like everyone else.
Consequently, I think on a very different frequency than the much-younger students do. Consider that if they are 18 years old, they were only one-year-old when the towers fell on 9/11. I was thirty and a government employee working that day. I have a whole, long 9/11 story — they don’t. What I saw that day, they’ve only seen from the comfortable distance of time in movies or TV shows or books.
A brief survey of the Nursing 101 classroom convinces me that I am also possibly the oldest person there next to the teachers. Out of apx 60 incoming freshmen, there is a smattering of adult people either in their 30’s or 40’s. One woman wears her greying hair proudly. Two others have, what I like to call the “I want to speak to your manager!” haircut and color. But by and large, the student body is 18-22 YO.
In the grand tradition of the nursing profession, most are women; about 10-15% are male. One of my fellow students is a very nice lady who lives near me and offered to give me rides to clinicals on Fridays. Of all my classmates, she is probably the closest to my age — she is about 5 years younger than I am. She has a few kids who are teenagers and after years of home schooling her kids, she’s embarking on a long-dreamed of career as a nurse.
Interestingly, most people in the group are there because a nurse had a positive effect on them at some point in their life. That’s pretty cool.
But it’s clear that there’s differences in our thinking. I have a lot more experience with disease process than they do. Years of studying anatomy, physiology, medications — since I was about 10 — means I have a breadth of experience and knowledge they do not. I hear them speak about medicine and it reminds me of when I was 16, trying to make sense of my father’s failing health with the limited understanding I had at the time. I have much better comprehensive and complex understanding now.
BUT — and this is an important distinction — by-and-large, my cohorts are learning more and performing better than I am. Oh! For all I know, how much more there is to know!
Why did I fail? Honestly: hubris. Because so much of what we are learning feels like repeat information for me. Like it should be common sense. My brain is refusing to engage, refusing to really LEARN the way they want me to.
The importance of testing is paramount to passing Nursing school. Everything at college is geared toward passing that all-important apex — the NCLEX exam — the nursing licensure. So even the smallest detail is taken into account because, if the NCLEX thinks it’s important — even if my brain does not — it will be asked on the exam. And if I don’t know the answer because my brain is busy saying “that’s stupid!” — I will fail.
As happened last Thursday. Our first major NU101 exam.
Most of the first exam was comprised of legal issues, knowing the exact roles of the medical team, and infection control. I studied. I paid attention to details as best I could. But most of what we were learning felt rote and boring. My brain HATES that stuff. I am desperate to show off what I can do, and they’re making me learn the differences between a tort and a law.
So… despite, or due to, my cocky indifference, I failed. Not spectacularly, of course, but shamefully nonetheless at a mere 72 (75 is passing). About half the class failed the exam, so I’m in good company. Most of the rest passed by 5-10 points. The elite, however — well, they studied more effectively than I did and, therefore, did better than I did.
Now, you might say that 72 isn’t all that bad. Aw, that’s cute. You’re trying to appease me, and I appreciate that. But 72, nonetheless, is failing, so I must now endure a process called remediation. I meet with one of my professors to go over what I did wrong and how I will move forward in grace and start passing my exams. I’m sure there will be additional homework involved as well.
Then came Friday, my first real clinical, where I am assigned a patient in an actual hospital and get to “practice” on them.
It was my first time in this particular hospital. I was walking around in my green student scrubs and white lab coat (I was the only one of my classmates who chose to wear The Coat.) I noticed several other teams of students from other schools wandering around the hospital looking lost too.
But, keep in mind, I was coming off the failed test the day before, still beating myself up about actually failing what should have been an easy test through nothing more than sheer hubris. Maybe I’m not meant to be a nurse, I thought, maybe this whole thing was a mistake.
My team of 10 met in the cafeteria around a large table where we would choose our patient assignments. Our instructor rattled off the condition of the first (a simple UTI) and one of the girls chose it. I was grumpy and miserable and wanted nothing to do with this. I thought, for sure, I’d get thrown out for being a fraud. Who was I to think I could be a nurse, anyway? It was 7am, I was half-asleep and I had barely consumed any caffeine, had only a granola bar in front of me for breakfast. I felt thorougly and completely sorry for myself.
The next patient assignment was a 66-year-old woman admitted two days prior in a hypertensive crisis. “Big whoop,” i thought. Dammit, if I wasn’t determined to be miserable! As my instructor continued the rundown of the 66 YO’s condition, I could actually feel my brain start stir a little. It was getting interesting. This poor lady had a laundry list of problems including renal failure.
Then, once my instructor started listing off the lady’s medications, after one particular mention, I looked up from my half-eaten granola bar and said out loud, “Wait. What?!?” It was a medication that I knew. I knew was contraindicated for renal failure. Why is an elderly woman in renal failure being prescribed a med that will worsen her condition?
I’LL TAKE IT.
Brain now alive and zipping along at 100 miles an hour, I hopped on the elevator with my cohorts with my phone fishing through Medscape and looking at the latest research on renal failure and hypertension. We reached our floor and wing, and were set loose to our assigned patients.
First step, check patient’s records. As a novice, I didn’t know where the records were, and I didn’t have a password for the computer systems yet, so my ability to get data was limited. They had a med list for her — a mile long — filled with unnecessary medications and duplications. I wanted to read through Miss M’s chart — a three ring binder with several pages and pages of procedures and history — but didn’t get much chance before I was shuffled into her room to do an impromptu head-to-toe basic physical exam.
So I went in to introduce myself to my patient.
They say you always remember your first patient. I don’t know if they mean as a student, or while you’re in practice, but I will likely remember Miss M for the rest of my career either way. She was a surprisingly spry 66YO AA female, about 5’3″ tall, sitting up in bed and having her breakfast, most of it was uneaten. She grimaced as she took a sip of her coffee (it wasn’t to her liking.)
Most of the students are shy at first. They don’t know how to act in this new environment without feeling foolish. Me? I was a stage performer before all this, so I know how to feel foolish AND greet a crowd of strangers. I just walked into her room as if I owned the whole hospital, smiled, and greeted my patient openly and fondly.
I found her to be alert and oriented, though softspoken, and very cooperative despite what I had been told by staff. I’m a pretty friendly person, so it’s possible that my efforts to put her to ease helped her mood. I noted that she was missing her entire bottom row of teeth. Admitted two days for hypertensive crisis and is in end-stage renal failure for which she’s been receiving dialysis treatments three times a week for the last six months.
As I was standing over her bed asking questions about her medical history, I tried to be careful with what I said. I had to remember what we were taught in class (the test I failed) on SCOPE OF PRACTICE — I am not yet a real nurse, so I must remember my place. I must not overreach.
Also, I felt a growing discomfort in the power difference while standing OVER her bed. I remember what it was like to have med students and nurses standing over me poking me and prodding me and asking me things. It’s intrusive. Lying on a bed, you’re so vulnerable…. frankly, it felt rude. So I grabbed a chair and sat down to chat with her in a more eye-to-eye fashion. No sooner did I do this, than my instructor came in and hurried me back out to view an IV procedure.
In my few moments with Miss M, I found her to be friendly and engaging. She lives alone not far from the hospital in her own apartment. She has a daughter and two sons. One son helps lay out her medication for her and checks on her when he can. She has trouble taking her medication because there is so much of it, it’s confusing. She also has dialysis for her kidney failure three times a week, but often cannot go.
I want to tell you I know more, but that’s about it. I got shuffled out so fast, I really didn’t have a chance.
And frankly, I was so disoriented in the hospital, being that it was my first day, I didn’t know what to do. And my instructor had 8 other students to work with, so I had minimal oversight. I busied myself with the stack of paperwork I was given to fill out, most of which could be done from her charts — which were incomplete.
The five hour shift passed surprisingly quickly, and soon we were all in the cafeteria again for a debrief on our patients. I have to tell you — I should have, but I honestly didn’t care about anyone else’s patient. I only cared about mine. I can’t report much on the UTI patient (I believe she was being discharged), nor do I know much about anyone else’s patient (or, rather, client as they like to call them now). I was busy on my phone checking research and cross-referencing medications.
When the teacher came around the table to me and asked about my experience, my brain lit up like a neon sign and went to town.
I was chattering away a mile a minute. I presented the case. I talked about my patient’s history, the circular link between hypertension and kidney disease, how the pharmacology of the meds she is on could be exacerbating the situation. How if I could, I’d talk to her physician about her polypharmacy issues. How dangerous some of the meds are and how, particularly this one and this one, have unexpected consequences when prescribed together.
I expounded. I spoke definitively. I spoke from a place of earnestness and evidence-based fact. I cited papers. Seriously. I cited papers. All off the top of my head.
Shit, I admit — I impressed myself.
I felt like a race horse that had finally been let out of the barn.
Then my teacher looked at me and said, quietly, “So what are your nursing implications?”
My nursing WHAT?
“Your nursing implications,” she said calmly. “What would you do for your patient? As a nurse.”
Silence. You could practically hear crickets. I was momentarily silenced and dumbfounded. I had to switch gears..
“Uhm,” I began unsteadily, “I guess I would watch for edema and monitor her fluid levels? Make sure input and output are consistent?”
“Uh… well… uh… I would begin planning her discharge. Her BP is stable. I would maybe recommend her to social services to make sure she was hooked up with someone who could make sure she gets her meds on time and goes to her dialysis appointments regularly so she doesn’t get into a crisis situation again.”
I’m sure she was looking for more nursey-type things like watching for pressure sores and such, but I couldn’t think of any. So, I went with what I knew.
“I would talk to her treating physician about all those meds. I know this is an acute care situation, but somebody needs to do something about that!”
“Do you think that’s within your scope of practice?” She asked.
“I don’t know, but I would feel morally and ethically bound to say something.”
“If you did, what would you say?”my instructor pressed.
“Huh?” I asked, dumbfounded again. What was she driving at? “What do you mean?” I asked.
My instructor said, “You would do your research, right? And present the doctor with your specific findings and cite those sources of yours, right? You would be specific, right? Because sometimes doctors don’t always get it right. They don’t always know every side effect and interaction, right? You need to be respectful.”
I don’t know if I was right or wrong. I am not an ordinary student.
Now if I can just pass, I’ll be fine.
“Pretty good is not good enough, I wanna be great.” — Christina Yang, Grey’s Anatomy