Another week, another interview...

The search for my first RN job continues.

This week I interviewed at the very first hospital I served at as a student. It's a small, private hospital about forty minutes from home. There are about 150 employees there. The med/surg unit I interviewed for was my first clinical assignment in nursing school. It has a little over forty beds, including a couple pediatric beds.

Revisiting this facility as an RN was strange...I hadn't been back there since my first semester of the RN program. Life was a lot different then. I was engaged to the girl of my dreams, and every day of patient care resonated with purpose and intimacy. It was a nice place to practice student nursing for the first time, the units were quiet, the pace was relatively slow, the Hospitalist was friendly and loved to test our knowledge with questions about patient's lab results and diagnostic imaging. The Nurse's aides were all older and experienced, many of them in school for Paramedic or RN. I spent more time learning from them than the RNs, at first. As a nursing neophyte I only had one patient to worry about at a time, a far cry from the hectic 4-patient assignments I took on as a senior student.

I still remember my first patient as a student, at that facility. A man in his 50s admitted for esophageal varices, diagnosed with hepatic encephalopathy. This was back when we received our assignments via a phone call from the clinical instructor the previous night, so I had plenty of time to pour over my med/surg and fundamentals texts and learn everything I could about the diagnoses.

The patient had stopped drinking well over a decade ago, but his liver function continued to decrease with age. The old damage caught up with him, and the decrease in portal circulation caused collateral circulation which distended the veins in his esophageal and hemorrhoidal plexuses. Ruptured esophageal varices are life-threatening, but since he was on our unit and not the ICU, he was probably through the worst. I did a ton of assessments on him. Asterixis, drawing simple shapes, hepatojugular reflux, you name it. He was on one-to-one care because of his altered mental status (the common wisdom as to why this happens is that liver failure leads to altered protein metabolism and increasing ammonia concentration in the blood, but I did a term paper a while back that cited research suggesting the ammonia may not actually be the culprit), so I spent most of the shift reminding him what his name was, where he was, and why he had to stay in bed.

I felt like I could take on anything after that assignment, even though it turned out to be a relatively easy evening.

Walking back onto the unit yesterday caused a flood of dormant associations to come flooding back. The first thing you see when you walk in is a wood-and-glass depiction of a tree in autumn. Each leaf is a plaque, inscribed with the names of each patient to die in the unit's hospice room. The entire unit, from the wallpaper in the bathrooms to the curtains in the rooms, is decorated with a falling leaves motif. At first I thought this was somewhat morbid, but I grew to appreciate the design choice over the course of the semester.

The Director of Nursing explained to me that very few codes occur on this unit, mostly due to the diligence and critical thinking skills of the RNs, as well as the availability of the rapid-response team for when someone deteriorates and we can't wait for an MD to return a page. She said the nurses there don't get paid as much as in other places, maybe 2-3 dollars an hour less than the other hospitals in my part of the state, but I don't mind that so much, and I told her so.

I think I talked a good game, but I'm never quite sure how well I've done after an interview. None of them have succeeded so far, anyway, and managerial types tend to clam up a bit when I ask for specific feedback about my interview performance. I did, however, hear that I had "passed" the interview for the state mental hospital (which is still in a hiring freeze, I've heard).

In the movie "True Stories", David Byrne reflects that someone (not him) once said that Highways, with their sprawling displays of engineering and stone construction, were the Cathedrals of our age.

I think a better candidate would be the Hospital. Not merely because of the religious funding of so many hospitals, and the resultant prominence of religious iconography in those hospitals, and not even because of the architecture and design of the buildings themselves (which is often impressive).

In the great stone edifices of ancient myth and religion, the great calling that they were wrapped around was regulation of human sexuality. At first by housing temple prostitutes, and later by establishing rules for how people procreate and structure their families.

In the Hospital (which I'm calling for sake of conversation the "modern cathedral"), some of the most intimate moments of their lives are played out, in the presence of the cutting-edge of medical technology and scientific training. People are born. People die. People are treated for life-changing illnesses and injuries. Through it all, the Nurses are there to educate, manage, and preside over these experiences. Approaching this task without an appreciation of it's sacred nature (independent of religiosity) is a commonly encountered source of failure of the therapeutic relationship.

Whether it's the small, modest community hospital or the sprawling inner-city hospital I'm walking in to, whether the particular place is associated with my own feelings of hope for a happy life or memories of desolation, betrayal and hopelessness, the place itself has it's own gravity, it's own purpose, it's own joys and sorrows that dwarf my own while still including me in them.

Adaptation to this situation is never easy, and it's a transition that changes you. It's a process that never ends, just as getting a black-belt in a modern martial art is really a sign that you're finally a "beginner", graduation from nursing school is the event that marks the beginning, not the end, of the journey. To react with grace to the extremes of the human experience is something that seems simple at first, but can take a heavy, hidden toll.

I wish so often that I could have made it this far with everything I started out with, maybe if I handled the transition a little better I could have.

Even if the happiness I imagined for my own life never comes to pass, I'll always have the patients. They have enough sorrow and happiness to last me whatever is left of my life.

Not enough to forget about you, though.


The23rdhour said...

Someone else uses blogspot eh?

by: PM, RN said...

yeah, i'm mirroring to myspace and livejournal. I'll add ya to my RSS reader!