Book Excerpt – First Day of Clinicals
Clinicals were over by 3:15. Lillian was exhausted, running on fumes since she had been up since four that morning. She changed into her jeans and was at her part-time job by 4:15.
She was greeted by Carolina, one of the company administrative assistants, “Hi there, Nurse Ratchet. How was your first day of clinicals?”
Jackie, the buxom red headed legal secretary approached Lillian and Carolina. “Lillian!” said Jackie loudly, in her animated way.
Bridget, the chief financial officer’s secretary, heard the commotion and joined the group. She was skinny, in her late 30’s and perky. “Hey Lil!” she said, sounding like a cheerleader. “What do you know?”
The three ladies waited for Lillian to talk.
Lillian stood there, somber, in front of her three new best friends, unable to look any of them in the eye. She successfully fought back a small tear that dared to expose her vulnerability. She swallowed to dislodge the lump in her throat that now threatened to make her vocal cords quiver. “It was horrible. I think I made a big mistake going to nursing school. Who am I kidding? I don't even want to be a nurse, I just want that four-year degree!"
“Ohhh… What happened?” asked Jackie, sympathetically.
“I hate it!” said Lillian. “I saw people I didn’t know existed in this world. There was this lady patient with tubes in every nook and cranny of her body and she couldn’t talk. And there was another one with contorted arms and legs who talked too much. To make matters worse, I was so nervous I actually pooped in my pants, confessed to my instructor I take a prescription tranquilizer, and almost got in trouble for insinuating a patient ought to give up and die.”
Carolina, Jackie, and Bridget, laughed. Jackie said, “Don’t worry, girlfriend. It’s bound to get better, right?”
Lillian rolled her eyes and tried hard not to look pathetic.
Bridget said, “It’s gonna be okay. Don’t give up.”
Book Excerpt - California Nursing
Two weeks later, Lillian had adapted to her new assignment on the maternity ward of a California county hospital. The work was easy but she had concerns about some of the nursing care. Having much fewer patients than in Houston, Lillian found plenty of time to chat with her nurse colleagues from foreign countries.
One Nigerian nurse talked about her frustrations of being in this country. “I used to do episiotomies, Lillian. I used to deliver the babies by myself. In Nigeria nurses had so much more responsibility. Now I can’t even give a patient a Tylenol without a doctor’s permission.”
Lillian saw a South African nurse crying in the nurse’s station, with her arms and head on the table. Lillian asked, “What’s wrong?”
“I miss my babies, my husband, my parents.”
“Where are they?”
“Back home, in South Africa.”
“How long have you been gone?”
“Two years. My kids are growing and I can’t be there to see them.”
“How many children do you have?”
“Six.”
Lillian listened to the South African nurse who was eager to talk about her children, ages three to 14.
Lillian spoke with another nurse. “What was it like being a nurse in Cambodia?”
“It was much different than California. Sometimes I was only nurse in hospital with 60 patients.”
“How could you do everything?”
“I prioritized. Families help me.”
A very young nurse who had recently arrived from the Philippines approached Lillian. “I worry for my patient. She has rash. I don’t want to bother the doctor.”
“Tell me about her. Why does she have a rash?”
“She had a cesarean section yesterday. She’s getting morphine. I think she’s allergic to morphine.”
“Did you check to see if there’s an order for something for itching?”
“Yes. I checked all the doctor’s orders. And there is nothing for itching.”
“Would you like me to call the doctor for you?”
“Would you?”
“Yes. And I want you to observe.”
Lillian picked up the phone and paged the resident in charge.
She hung up and said to the young Filipino nurse, “You must never apologize to a doctor for calling unless you made a mistake. It’s the doctor’s patient just like it’s your patient. And it is your job to advocate for each of your patients and it’s the doctor’s job to listen to you.”
The nurse looked at Lillian and said, “I always feel like I should apologize for bothering them.”
“In this case, you have no reason to apologize. In fact, the doctor should apologize to you.”
The young Filipino nurse looked confused. “Apologize to me? Why?”
“Because rashes are a common side effect of morphine. The doctor should have anticipated the reaction and given you orders to address her itching.”
The nurse listened carefully to Lillian.
“Now, because the doctor failed to do his job, you must take time out of your day to call. You have been inconvenienced, and so has your patient. Now your patient must itch and scratch while she breastfeeds her baby, and recovers from her surgery. She will be uncomfortable until a good nurse calls a doctor and until that doctor decides to call back.”
“Oh. I never thought of it like that. You think very different, Lillian.”
“It helps if you put yourself in the place of the patient. We nurses must do everything to make them comfortable and teach them what we know so they have a successful, beautiful birthing experience. We have the power to make that happen.”
The phone rang and Lillian picked it up. “Maternity, this is Lillian.”
It was the resident.
“Hello, Dr. Crawford, I’m Lillian Gonzalez, one of the nurses on the maternity ward. One of the patients is having an allergic reaction to the morphine. She’s very uncomfortable, itching. Could we put her on Demerol and give her Benadryl?”
Lillian answered several of the doctors questions and got the orders to fix the problem.
The Filipino nurse smiled and left to medicate her patient. When she returned she said, “Lillian. I am very impressed that the doctor did not yell at you. Usually doctors get angry.”
“Then you must get angry back. You must stand up for your patient.”
The young nurse smiled a shy smile.
