On Mountains, Valleys, & Beasts

One of the foremost lessons I've learned in my internship is that our unit is like a live, wild animal.

It breathes. It eats. It's reactive.

And if you're not careful, it will bite you.

Just when I think I've gotten a handle on it, something comes along and takes my legs back out from under me, leaving me on my knees.

And so it goes--I have huge mountaintop experiences where I've safely admitted extremely unstable and complicated patients. It is such a rush when you're literally managing a hemodynamically unstable patient's life on a minute by minute basis through the titration of 4 or 5 different vasoactive drips. It's cathartic. And it's easy to see how god-complexes develop in physicians because it's addicting. It feels oh-so-good when you're doing it the right way and your patient lives. The rush whispers in your ears, seducing you with it's siren words of success. I've had 3 such admits so far, and I only look forward to more.

But there are the valleys too. Like when a simple case comes back, and suddenly I'm paralyzed because nothing is as it should be. There's no index to shoot, there's no cordis, but I've got two art-lines, and I don't know why. The patient is a 31 year old mother of 3 that discovered she had a ASD when she had a TIA at home taking care of her kids. A simple septal defect repair done through the femoral artery--it completely blew my mind and I imploded. I simply couldn't think of what I needed to do next. So humiliating, and unbelievably frustrating.

I just have to keep getting up and going back to work. It may not get any easier, but I know I'll be better for it in the end. And I can tell I'm becoming a stronger nurse each passing shift.

And that my friends, is even more cathartic, and more addicting.

The thirst for knowledge and experience is almost unbearable at times. My skin prickles from the sheer volume of electrical activity required to lay down the new neuronal pathways. It's like a drug. And it's not always a therapeutic dose. Often it's a back-alley, Bic-lighter-and-rusty-metal-spoon black-tar of a rush.

The knowledge also lives and is animate, I swear. I can feel its hot breath on my neck while I work and move among my patients. It lays in wait for the right moment to pounce on its unsuspecting prey, to remind me that I am not in control of it. Untameable. But when harnessed, lurches us forward at synergistic ability and speed...

And so I exist, abiding in the mist of the gray, no black or white in sight. Between scope of practice and patient need. Trying to bridle the knowledge just enough to battle the specter of the horrible beast that is the life-or-death illness that stalks the patients on my unit. All the while I'm holding on for dear life, only hoping to come out the other end of the shift having honored the needs of the patient and served their families in a way that I can be proud of.

And I love it.

Every.

Vicious.

Second.