A Clinical Lesson – Part III

Posted on by Steve Inguanti

One year of my nursing journey has somehow already passed, and unsurprisingly, the last three weeks have been the most significant thus far. My first clinical placement experience was an important milestone – I needed to test my strengths and weaknesses and bring all of the knowledge taken in throughout the year into the real world. Just how real is where the experience became a critical one.

There were many moments over the three weeks that will remain in my mind as I reflect on my interactions, but three moments in particular had what I feel will be a lasting impact. As in all accounts of a medical and personal nature, no real names are used in these stories that follow.

PART III

On the Thursday of the second week, we were doing a late shift. There was typically less to do on these later shifts as the only meal was dinner and most of the residents settled after this, either watching TV in one of the lounges or staying in their rooms. After helping with dinner, I saw a young boy and his father sitting beside one of the residents. The young boy was playing with three balloons and having a wonderful time, so I decided to go join in. He was close to two-years-old but he already knew the different colours of the balloons and each time I’d hide one behind my back, he’d know which colour it was. I was so impressed and his father seemed pretty happy about it too.

This was when I met his grandmother, who I later learned was of sound mind and full mental capacity, but had a failing body courtesy of Parkinson’s Disease. I didn’t know this at the time, and I certainly didn’t know that this woman would leave a very lasting impact on me.

The next morning, I was there to help with breakfast and lunch. As I approached the dining area before lunch, I saw three people sitting beside the grandmother and overheard them: “What do you mean a male nurse? Huh?” Her daughter (as I later discovered) was trying to make out what her mother was saying, as the Parkinson’s had now taken hold of her throat muscles, making her speech very difficult to hear for us, and making it very tiresome for her to even muster up a few words. So I walked up to them and introduced myself, to which the daughter smiled and told me how much the grandmother appreciated me playing with her grandson the night before, and apparently she’d never mentioned any of the staff before, but she was very happy with what I had done. I didn’t even realise the grandmother was aware of what I was doing that night! This is when it occurred to me just how cruel Parkinson’s is. To be of sound mind, but not able to express it must be incredibly frustrating (to say the least). I won’t attempt to suggest one disease is favourable over another, but at least with dementia, you don’t know that you’ve forgotten things – Parkinson’s strips you of your most basic abilities and you know it’s happening.

Once I got talking with the family, I discovered that this grandmother had the same name as one of my grandmothers (not a common name), so I started to feel a connection. I made an effort to always be there to feed her from this point, and most times, we wouldn’t say much, as I didn’t want to make her have to struggle to talk, but we’d glance at each other and smile (as much as she could anyway), and I’d just occasionally talk about random things.

After a few days, I told her that she had the same name as my Nonna, but my Nonna had passed away many years ago. Through her strained tone, she asked:

“How old?”

“66”, I replied.

“Too young”, she whispered while shaking her head. Yes, far too young. But then, as she stared straight at me, the moment I’ll never forget:

“I want to pass in my bed”.

I couldn’t make out what she was saying, there was a lot of noise in the dining area this day. I asked her to repeat it as I leaned forward to have my ear right in front of her mouth, and each time, I struggled to put the words together as much as she struggled to get them out. I felt so guilty that I was making her repeat these words, but I just couldn’t piece together what she was saying at that time. It only occurred to me later what she had said – her daughter had told me that her Mum had mentioned numerous times that she wants to die. The daughter wasn’t surprised, but she also knew there was nothing she could do. Victoria has just passed voluntary euthanasia laws, but they don’t take effect until June 2019. We discussed this, and she wished this was an option for her Mum, but the sad reality was, that the only thing her Mum could do was not eat much and let nature take its course. She was apparently refusing food most days and had recently lost a lot of weight. Her daughter knows what she’s trying to do, but what are you supposed to say to someone who tells you they want to die? She really has no quality of life and is bound to her bed and chair all day. All of her food has to be cut into very small pieces and all liquids need thickener added to them to stop her from choking. She clearly doesn’t like the taste of the thickener either, as she would always wince as I offered her a drink (with a straw, as this was the only way she could get a drink down). Who are we to say that her wish shouldn’t be granted?

Over the last few days of placement, I’d always seek her out and speak the very few Italian words I knew to her. I wanted her to feel seen, and to feel like she actually still had something to live for, even though I knew she was ready to go. And on the final day, just after I had finished feeding her lunch, with the little strength she had, she took hold of my hand, looked me in the eyes and simply said: “I’m very happy. You make me very happy”. I was speechless, yet so incredibly humbled at the same time. I wasn’t doing any of this for any other reason than to make her happy, and when she said those words, I knew this is my true calling in life. No other work I have ever done has given me this feeling and it’s quite difficult to put into words, but after she said this, I just smiled (trying not to break down into tears) and I said how happy I was that she was happy, and that it was an absolute pleasure to spend time with her. I thanked her for allowing me to care for her and then gently released my hand from hers and walked away. I can still picture this entire scene in my mind so clearly and I know this is going to stay with me for as long as my mind is willing and able.

While this placement presented many confronting situations, it also offered many highlights and uplifting moments. I have detailed some of the more challenging aspects but it just motivates me to continue learning and to look forward to my next clinical placement, which is less than two months away in a rural hospital. As there is in life, there will undoubtedly be more challenges to reflect on.

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A Clinical Lesson – Part II

Posted on by Steve Inguanti

One year of my nursing journey has somehow already passed, and unsurprisingly, the last three weeks have been the most significant thus far. My first clinical placement experience was an important milestone – I needed to test my strengths and weaknesses and bring all of the knowledge taken in throughout the year into the real world. Just how real is where the experience became a critical one.

There were many moments over the three weeks that will remain in my mind as I reflect on my interactions, but three moments in particular had what I feel will be a lasting impact. As in all accounts of a medical and personal nature, no real names are used in these stories that follow.

PART II

The second week of placement had a new challenge – feeding residents with varying levels of care requirements. This offered many insights, one of which was a gentle reminder to not take the simple things in life for granted.

There were three residents that I had to assist with their meals and each one presented a very different set of challenges. The first, a gentleman who had speech issues and also struggled to lift a spoon to his mouth, took me a couple of feeds to learn his quirks. One thing I kept reminding myself of was that this was a person deserving of the exact same treatment that any of us would expect – just because he had issues feeding himself did not render him useless or not worthy of my time or respect.

He was hard to read – at times, he would reply to my questions of what he wanted to eat next with a nod or a little smile, at other times he would just stare off into the distance. I didn’t just want to assume that he would eat whatever I put to his mouth. He really seemed to enjoy his beans and carrots, but his breakfast, not so much. Breakfast never really looked that appealing, so I could understand his lack of excitement for it. He would raise his empty fingers to his mouth, as if he thought he was feeding himself, so sometimes, I’d let him pick up his food with his fingers and eat that way. Sometimes though, I’d just raise the fork to his mouth and he would eat without hesitation.

After a few feeds, I was feeling more comfortable with him. So I was shocked when one of the carers (a loose term to use for this particular person) decided to walk up and take the spoon from me and force it to his mouth. “You have to feed him! You have to tell him what he wants. He doesn’t know”. I was so taken aback at their utter lack of care for this man that I didn’t know what to say. It seemed that my way of feeding was working just fine, but this was clearly a very bad habit of this carer. I did notice this person also doing some other things that did not please me, and I know they are under time pressure to get tasks done, but when you lose sight of the fact that each person under your care deserves respect and dignity, it’s time you find another job. Sadly, I did see and hear of other events that trouble me in relation to a lack of care from some staff – one morning while walking past a resident’s room, I saw a carer eating the resident’s toast. When they noticed that I had seen this, they offered an excuse: “she wasn’t going to eat it anyway”. I didn’t think it was my place as a student to say anything, so I just gave a disapproving look and kept walking.

The next resident I was assigned to feed was a dementia sufferer, and this presented much different challenges. She was so sweet, yet so frail. She would regularly fall asleep at the table, either before or during the meal. I’d ask which food she wanted and she would reply that she didn’t know. Everything appeared to be so tiring for her, even just trying to answer a question. Within the space of a few seconds, she would say she didn’t like chicken, but then proceed to eat it the very next time I asked. The only constant for her was ice cream – there was never any confusion about whether she liked ice cream! She would gaze at me with her troubled eyes and sometimes attempt a smile, but at other times, I could sense she was so confused about everything that was happening, and it was quite confronting to see.

Dementia is a cruel way to spend your final years – just imagine not knowing if you like a particular food or not, or what it is you’re actually sitting at the table for. It was heartbreaking. We all did our best to make her smile and took our time with her. She even said to me one day, “Hello RMIT”. She could see the logo on my uniform and obviously thought it was my name, and I just smiled and said hello back to her. I understand that she doesn’t know that she’s forgotten some of the basics, but it was still hard to accept that this is the way some people live out their lives. Seeing her sing along at the various events the facility put on made me smile, she was good with the lyrics to plenty of the classics, but it was the simple task of eating that seemed to provide her the most troubling test.

To finish this thought on a positive note (it wasn’t all doom and gloom after all), it just needs to be said: do not, I repeat, do not underestimate how seriously residents take their bingo! I learned very quickly as I was calling out the numbers one day just how serious it is (to the point where one resident was cheating, and one of the other residents discovered this and made quite the scene about it!). One of them even “shooshed” me a couple of times as I was trying to have some fun with it. And if you don’t shuffle the numbers properly after every game, you’ll definitely hear about it too! Also make sure you know what to say with each number, such as “legs eleven” or “two little ducks” for 22 (followed by a “quack quack!”) – thanks to Google for helping out with that part. The daily activity time really was wonderful to see and the staff involved should be congratulated for their efforts to put smiles on the residents’ faces each and every day.

Part III to follow.

A Clinical Lesson – Part I

Posted on by Steve Inguanti

One year of my nursing journey has somehow already passed, and unsurprisingly, the last three weeks have been the most significant thus far. My first clinical placement experience was an important milestone – I needed to test my strengths and weaknesses and bring all of the knowledge taken in throughout the year into the real world. Just how real it was is where the experience became a critical one.

There were many moments over the three weeks that will remain in my mind as I reflect on my interactions, but three moments in particular had what I feel will be a lasting impact. As in all accounts of a medical and personal nature, no real names are used in these stories that follow.

PART I

In the days leading up to the start of my clinical placement, I was thinking about the challenges that lay ahead. One challenge that I knew I would be tested on was my ability to separate the emotional attachment from the task of caring for a person in need. Little did I know that this test would present itself in the very first week.

We were each assigned one resident to assist, and it would be a “simple” resident for now – one that did not require a high level of care with their daily activities (or ADLs, Activities of Daily Living, as we like to call it). I was assigned a friendly but reserved gentleman, who just one month on from his 94th birthday, had found himself admitted into residential care due to a complication with his eye sight after suffering a three-month pneumonia battle. He was otherwise mobile and independent, even though he used a walking aide. I only needed to assist with the trickier parts of a shower, and keeping an eye on a sore he had on one of his toes. Otherwise, I found my main assistance to him was just being there for a chat and we had a rapport right from the start. He was still processing the fact that he was now a resident in a care facility, something that was both unexpected and a little uncomfortable for him. It was the little things that were making a big difference to his transition, such as the lack of honey that was available at breakfast time for his toast (and of course, I set about trying to stash some honey away for him once I learned this).

After the second day, he said we made a good team, and that gave me a sense of satisfaction I’ve rarely felt in any work I’ve ever done. I was genuinely enjoying our chats – learning about his history as a merchant shipper, and the many fascinating places he had sailed to. I learned about his wife, who had passed two years earlier, and of the way he would spend his time down at the local stores with his neighbours. He told me of his three daughters and how proud he was of them. I had the pleasure of meeting one of them and I could see why he was a proud father.

Then, on the Friday, I knocked on his door as I always did and entered his room. I saw him sitting on his bed, quietly staring out the window, with all of his belongings packed beside him. This startled me, and it was almost like he read my reaction, as he started to tell me what was happening before I even had a chance to ask. He was being transferred to another facility, as this was only supposed to be for respite care. He wasn’t sure when he was leaving, but I said I would be there to say a proper goodbye. I thanked him for the opportunity to assist him and I told him how much I enjoyed our very brief time together learning about his story. I had some other tasks to attend to and then went back to his room about an hour later.

Clinical 1

The room was empty. My heart sank. My throat felt heavy. He was gone and I wasn’t there like I said I would be. I instantly felt like I had let him down and I was so disappointed in myself.

I went back to our meeting room that we used to debrief and told my educator and fellow placement buddies what had just happened. My educator had a look on her face, almost like she knew this was coming. I had mentioned to her at the start of placement that I thought I might struggle with the emotional side of things and here we were – on day five, already facing this test. But they rallied around me (something that I hope will continue to happen throughout my nursing journey) and reminded me of the reality of the situation – yes, I said I would be there to say goodbye, but this isn’t always possible. I was there when he needed me throughout the week, and then he needed to move to his next phase. I suggested that I would go visit him in his new facility, to say a proper goodbye, but my educator stepped up again: “Are you doing this for him, or are you doing this for you?” It was a powerful question, one that instantly highlighted to me that I had become too emotionally attached to the first resident I interacted with and proved this would be a real challenge for me to work on. People in need will come and go and I won’t always be there to say goodbye – things will rarely be that perfect or organised. There is a fine line between being the empathetic, caring nurse and the nurse that doesn’t protect themselves emotionally. I was already too close to this line and I had to back away.

Parts II and III to follow.