I graduated with a BSN in Nursing in 1973. My four year degree was the exception, not the rule, at the time. I received no extra pay or recognition. As with so many careers, training really began my first day on the job.
I learned about the demands of the relatively new hospital concept called “intensive care.” There was no internship, no syllabus, just flying by the seat of my support hose and white down-to-the-knee uniform. I pulled my hair into a bun and stuck my pens there, a sort of nurse’s kanzashi, to keep them handy. Charting consisted of half a page of lines and dots for vital signs and no more than eight lines for patient notes. Back then I documented drug infusions by flow rates, drops per minute, not dosages. I can’t remember how we documented medications. Self-edification drove my critical care learning. I enrolled in EKG classes, had the privilege of spending two days listening to Dr. Marriott explain the most complex arrhythmias, attended respiratory care seminars, and took advanced physiology to have the academics to support my practice.
Along the way I mastered how to finesse shaving a man with a heavy beard, how to navigate delicate family matters like a wife bumping into a girlfriend at the bedside. I learned a farmer rested better if I read him the bean futures or told him what I’d paid for a dozen eggs. I watched a learned professor die from his addiction to alcohol. I worked in a small unit where the patient was barely an arm’s length away. What happened to my patients I carried home, tucked in a portfolio of images, smells, and sounds. No escape, no mercy. I took every day personally.
Looking back on a forty-three year career, I evaluate myself and my profession. I ask, as Dr. Paul Kalanithi posited to himself in his book When Breath Becomes Air, did my life, my work, matter? I grew up in the Golden Age of Nursing. Before JCOH. Before computers. Before order bundles, protocols, and health care framed itself, first in a corporate model, now in a hotel management model. Before what was documented became more important than what actually happened.
I mourn its passing.
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