A Clinical Lesson – Part I

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.

In the Wrong Place

As I grow older, one thing is becoming more clear – I need to travel. The benefits of travel are too numerous to mention, but the happiness I feel while abroad is unmatched in my current home life. That might sound really obvious – something that isn’t routine is more enjoyable than something that is. But there’s more to it than that.

Travel has allowed me to grow as a person. I’ve had to fend for myself in unfamiliar situations, sometimes in foreign languages. I’ve met wonderful people by chance and had very memorable experiences listening to their stories. There’s been the odd scare or two as well, but that is part of the journey and it’s also something that my own city provides every now and then too.

There is one thing that my recent travel has shown me though – that I am in the wrong place. There has been an uneasy feeling over me for some years and my time in Canada has highlighted this further. I don’t feel I belong in Melbourne anymore, and if I’m brutally honest with myself, I’ve probably been feeling this for at least the last six years. Not previously having the courage to act on it meant that I festered away and went through the motions. Something inside me is not allowing this to happen anymore, and so I went exploring.

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Toronto Pride, June 2017

Canada has always been a country of interest for me. I was offered an exchange when I was 20 to do one semester of university at McGill in Montréal. I didn’t take it, as I didn’t want to leave my Mum here on her own (she was going through some rough times, and my brother was also away travelling). Oh how I would do things differently now! Maybe it’s missed moments like these that fuel my desires to explore and not think of the reasons why I can’t do something. It’s more about why would I not do it?

So it comes as no surprise to me that my last two trips to Canada (luckily for me, these two trips have been in the last eight months) have had a profound effect. My time there has been overwhelmingly positive – stunning landscapes and cities, genuinely friendly people, a relaxed but proud attitude, a strong belief in diversity and acceptance – these are among the reasons that I feel I am in the wrong place.

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Credit: Zack Singer. Stunning sunset at Wreck Beach, Vancouver, BC, Canada. July 2017

It’s also why it was so difficult to leave Canada on both of these occasions. As my first time in Canada was ending, I cried uncontrollably as I approached the airport. I tried to wipe away my tears before they were visible, but the sadness washing over me could not be contained. I was genuinely upset that I had to leave and make the long trek back “home”. I did not know when I would be able to return, and the prospect of returning to my lonely existence back in Melbourne was something I was not ready for. There were other issues at play at this time, only serving to compound my sadness about having to leave. These inevitably made the transition back to routine a very difficult one – in fact, the few months after returning to Melbourne have been the most challenging of my life thus far. I was lost and feeling hopeless about all of the major aspects of my life, so it should not come as a surprise that I found myself at the dreaded door of depression and anxiety. I would not wish these few months of my life on anyone – there are few feelings worse than feeling like there is no hope. Every day. Every night. It all becomes too hard and it is so much better to hide away, rather than risk someone you know or love seeing you like this. Then the worst part happens – all this alone time compounds all of the negativity. The voices in your head take over every moment, always reminding you of the failures and never letting up. Sleep becomes more difficult each night – the mind does not rest, forcing the body into this same restlessness. A tired mind only conjures further negative thought, adding more turbulence to an already bumpy ride. All of this makes it even more difficult to see a way out. To ask for help, or to feel comfortable enough to open up to someone seems far too risky. What will they think? Will they laugh at me and tell me to suck it up? Will they not even care? Will they use this information to their advantage somehow? All irrational thoughts find their way to become rational when your mind is so clouded by overwhelming hopelessness.

I got lucky. A few friends noticed my changed demeanour and offered their support. I cannot underestimate the importance of being present for someone suffering through their own mental demons. For me, being able to talk about it without fear of ridicule made an enormous difference. I also sought professional help – something not everyone is either able to do, or feel comfortable to do. But I knew I needed help to get through this. It had become too big for me to handle on my own. Each time I would start to rise back up, the slightest setback would send me straight back to bed. There were days when I just could not face the prospect of getting up. I knew I was bad company, so what was the point in going outside and participating in the world around me? Spontaneous bursts of tears further added to the risk of going outside – what if I just started bawling at the supermarket checkout? I could not risk it, so I stayed indoors most days.

Then, I got lucky again. The opportunity to study in a field that I’ve long admired presented itself and after speaking with some friends, I took this opportunity. I had something to be hopeful for, something to show me that I had a purpose. All did not feel lost now. It may have been a distraction to everything else, but it felt like things were changing. I wasn’t feeling sad all the time anymore. There were still ups and downs, but the ups seemed to be outweighing the downs now. Having a sense of purpose again was a fundamental shift in attitude and it was helping me recover.

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Vieux Montreal (Old Montreal) – 375 years old this year. Montreal, Quebec, Canada, June 2017

 

The opportunity to travel back to Canada appeared and I seized it. It would be my reward of sorts for making it through my first challenging semester of nursing. And what a reward it was – my second visit to this beautiful country could not have been a more positive experience. Each city I visited had compelling reasons for me to stay, helped by the fact that I now have friends in these cities. But this has also led to the inevitable fall that I am currently feeling. I have been back “home” for three days and I am feeling more alone than ever. I was again very sad to leave Canada (no uncontrollable tears this time, but I got close while sitting at the airport) – partly because I am unsure when I will be able to go back for another visit, but more so, because I feel like I need to be there. I felt so happy, comfortable and so welcome in Canada, and I do not feel that here in Melbourne. It’s hard to explain the exact reasons, but it feels like I’m in the wrong place. And that is a strange feeling, especially when the prospect of being able to leave is years away. I am too old to move on a working holiday visa, and studying abroad is too cost-prohibitive, so my only option appears to be completing my studies in Melbourne and relocating with my new qualification. That is a three-year prospect. I don’t want to wish time away, but three years seems a long time to live somewhere when you don’t feel you belong. I know I need to find a way to make this work, but those voices of hopelessness are starting to nudge their way back in.

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The Inukshak at another golden sunset, Vancouver, July 2017

I write this both as a coping mechanism and as a call out – life is feeling complicated and challenging again and I need to find a way to rise above it. For three years. If any of this is resonating with you, I hope these words can give you the strength to speak up, but more importantly, know that you are not alone. You might feel alone, like I do at times, but there are many others fighting these same battles. Some have been fighting them for a very long time, others are relatively new to the fight, but the more we talk about these issues, the more we can support each other through them. We are social beings and we are so much stronger when we are together. We are also better when we know we are valued, when we are seen, when we are heard. When we are relevant. When we are loved.

A Table For One

22 October 2015

It’s two weeks in on my Europe 2015 adventure, and it feels like a good time to reflect on where I’m at. I feel very fortunate to be able to do this – to get out and see some of my favourite places in the world, and have the freedom to wake up each morning and decide what I want to do on that day. It’s a very liberating feeling, possibly one of the best aspects of travelling.

I’ve tried to remain free of any expectations on this trip, but one thought that has occurred to me a few times is that of loneliness. I wondered before the trip commenced whether I would feel alone at times, not having someone familiar with me to share in the experiences each day. Sure enough, it has been evident that this is indeed an issue thus far – particularly when something reminds me of friends or family. Taking photos and writing a journal is one way of sharing these moments, but it’s certainly not the same as having someone there to actually experience it with. Social media helps, but it doesn’t fill the void either.

This is not to say that there is no benefit to travelling solo – absolutely not. There have been some moments of personal growth and character building, especially when first arriving in unfamiliar places and not knowing where to go and not having anyone there to help. Venice and Prague come to mind here.

Venice was particularly challenging. I was told that I would surely get lost, but nothing quite prepares you for that feeling of helplessness. Your thoughts become clouded with doubt, and a mild panic sets in. You question yourself where you normally wouldn’t. I can read a map, but why can’t I now find this street? It undoubtedly gets frustrating and you just have to take a moment, stop, collect yourself with some deep breaths and remind yourself that you’re capable of figuring this out and that you’ll be fine. Eventually. A little tip for Venice too – don’t bother with Google Map walking directions, they are close to useless! It really comes down to intuition and asking for help.

Prague was a similar experience initially, although I think the weather played a significant role in my uneasy feelings here. It was getting dark (an added layer of complexity when you don’t know where you are), it was quite cold and it was raining steadily. By this stage of the trip, I’d figured out that the GPS function on my phone still works without a phone signal as long as you preload your walking directions when you have wifi, but for some reason, it didn’t seem to be helping once I’d left the main train station in Prague. I wandered the streets until I finally came across a hotel, where I went in and asked for help. Turns out I was heading in the right direction, but I still felt a little anxious. I continued on my way in the rain, past crowded alleys and beautiful sights (no time to enjoy them just yet though) until I made it to the Old Town Square. This made me a feel a little better as I knew I was close to finding my hotel, and sure enough, I made it shortly after this.

However, I didn’t feel comfortable in Prague until the next day, when I took the advice of friends and joined a free walking tour. As a social person that enjoys engaging with others, I really enjoyed being able to interact with other travellers after two weeks of almost no contact with familiar faces. I picked up the distinct Aussie twang of one of the girls on the tour, and it turned out she was also from Melbourne. We had a quick chat, but I wanted to interact with travellers from other countries. I next started chatting with a guy from Dubai, who had decided at the last minute that he was going to have a weekend in Prague (as you can do when you live in this part of the world). He was a Palestinian, so we started chatting about the current situation there and what might solve the crisis. He was very interesting to chat with, and even bought me a coffee when we had a quick break from the tour. I’d given him some small change for the toilet earlier (you always need change in your pocket in Europe if you want to use a toilet!), and he felt he had to repay the favour. We also discussed the sad state of affairs in Australian politics – I was somewhat surprised he knew a bit about what’s going on in Australia (in particular about our treatment of asylum seekers), but it just shows that we’re making headlines for the wrong reasons. I also had a chat with a lady from San Diego, who was on a three-month tour of Europe with her two brothers. They were winging it, and just going wherever they were enjoying the most. Part of me wished I’d done the same, instead of planning each stop and pre-booking all of my train trips. Each method has its pros and cons, but I feel like my next European adventure will be an unstructured one. I’ll buy one of those train passes and just go with the flow. I would have stayed longer in some places if I hadn’t organised each step – Verona for example, was utterly charming and 24 hours there simply wasn’t enough. Another thought I had while on this walking tour was how amazing it would be to do the same back in Melbourne, as a tour guide. Why not share the love I have for my home town with those that decide to travel there? Something for me to follow up, that’s for sure.

Inevitably though, when I go back to my room, or when I go out for dinner, the loneliness factor kicks back in. I wonder whether this might be a result of being in a long term relationship that’s recently ended. You get used to having your partner there to share experiences with, or even them simply just being there when you’re having a good or a bad moment. I was single for all of my twenties (another by-product of not coming out fully until I was 28), so I developed a pretty steady state of independence, but it feels different now. There’s no magic bullet and there’s no script on how these things are supposed to go, but maybe I’m not feeling all that comfortable in my own space right now. It’s been nearly three months since our break-up, but it can still be a presence in these times when I’m on my own, or after I’ve just had a positive experience followed by alone time in my room again. I know I’ll be OK and that I’ll come through the other side, but I think it’s important to acknowledge these feelings and deal with them as and when it feels right to. Things will be different when I return home, and that’s exactly what I need.

While it’s obviously a matter of personal preference of whether you travel solo, or with others, I think my next trip will be with at least one other person. It’ll probably be more spontaneous too. More time to live the moment, less time to follow a script – sort of sounds like how life in general should be. Plus, I’m a bit over asking for a table for one at dinner each night.