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Category: Nursing

What Are HIV and AIDS?

Published July 9, 2021 by thewriterlyroad_2o62in

What is HIV?

Human immunodeficiency virus (HIV) is a blood-borne virus transmitted through body fluids (i.e., blood, semen, and vaginal secretions). As the name states, HIV infects the cells that help keep our immune system strong. Without a healthy immune system, our bodies are susceptible to a whole host of infections we wouldn’t usually get. It is important to remember that HIV doesn’t only affect a specific segment of society. Anyone can be infected with HIV regardless of their age, sex, race, ethnicity, or sexual orientation (AIDS Healthcare Foundation).

There are only a handful of ways to spread HIV. The first is through anal or vaginal sex. The second is by sharing infected needles or syringes to inject drugs or cookers used to make drugs. Lastly, babies can contract HIV during pregnancy, birth, or if they are breastfed by a mother who has HIV. In rare cases, patients can contract HIV from an organ donation or blood transfusion. This scenario is highly unlikely in the United States because of the thorough testing of organ and blood donors. Regardless of the route of transmission, the disease progression is the same. Many people don’t recognize the initial symptoms of HIV infection because they can be similar to the flu. 

Symptoms can include:

 * Sore throat 

  • Swollen glands 
  • Muscle aches
  • Skin rash
  • Nausea, vomiting, and diarrhea
  • Night sweats

It is not uncommon for patients to experience weight loss with a new HIV infection. If a patient presents with any of these symptoms, the clinician should complete a physical assessment, order blood tests, and obtain a complete medical and sexual history. Blood work would reveal HIV in the blood and a decrease in the white blood cell count. These findings are significant and different from other kinds of infection. 

In most cases, the body will produce more white blood cells to fight a new or growing infection. In the case of HIV, the virus is suppressing the bone marrow’s ability to make white blood cells. Additionally, another cell called a CD4 will also decrease. CD4s are often called “helper cells” because they help the immune system fight various infections; however, HIV prevents the helper cells from doing their job. As the disease progresses, the virus level will rise, and the CD4 cell and white blood cell levels will continue to fall, which further compromises the immune system.

HIV infection has three stages. Stage 1 is known as the acute phase. Some patients may have flu-like symptoms, but others may not have any symptoms at all. Because there is a large amount of HIV virus in the blood during this stage, patients are highly contagious. If a patient has flu-like symptoms with no other explanation, they should have an antigen/antibody test or nucleic acid test (NAT) to determine if they have HIV.

Stage 2 is the chronic phase. Patients still have HIV virus in the blood but at lower levels. However, they are still able to spread the infection to others. “At the end of this phase, the amount of HIV in the blood (called viral load) goes up, and the CD4 cell count goes down. The person may have symptoms as the virus levels increase in the body and the person moves into Stage 3. People who take HIV medicine as prescribed may never move into Stage 3” (Centers for Disease Control). Stage 3 is acquired immunodeficiency syndrome (aids). Although the progression of the disease can vary greatly among patients, stage 2 generally lasts for about ten years.

Clinicians should offer emotional support to a patient newly diagnosed with HIV infection. Significant strides in medications and treatments mean that patients with HIV can live a long and healthy life but there is still no cure, so the diagnosis can be a life-changing event. Clinicians need to be sensitive to the stigma some HIV patients may face with friends, family, and the public, and we should offer other community-based resources if required. These might include referrals to an HIV clinic, a social worker, a therapist, or a support group.

What is AIDS?

Acquired immunodeficiency syndrome (AIDS) is the third stage of HIV infection. At this point, the patient’s immune system is severely compromised, and they are at risk of contracting a variety of illnesses (known as opportunistic infections). 

Some examples of these opportunistic infections are 

*Candidiasis 

  • Cytomegalovirus (CMV) 
  • Herpes simplex virus (HSV) 
  • Lymphoma 
  • Tuberculosis
  • Kaposi’s sarcoma (KS)
  • Invasive cervical cancer 
  • Pneumocystis pneumonia (PCP)

As in the other stages, patients are contagious and can infect their sexual contacts. Even with proper treatment, the general survival period is about two years, although this can vary from patient to patient based on other co-morbidities. Patients are diagnosed with aids when their CD4 count falls below 200 cells per cubic millimeters of blood, or when they develop opportunistic infections.

Patients in the third stage suffer significant disability and physical challenges. The opportunistic infections may also cause multiple emergency room visits and hospital admissions. They may become unable to work, drive a car, or eat enough to maintain their weight. Fungal infections in the mouth may make it difficult to eat. In some cases, parenteral nutrition may be necessary. “Poor nutritional status and HIV infection interact with each other leading to the development of opportunistic infections, malignancies, debilitation and death” (Enwereji et al., 2019). Because patients can also develop a condition called HIV encephalopathy, they can have a cognitive impairment, making it difficult for them to perform their activities of daily living.

Treatment and Medications

As previously stated, there is no cure for HIV and AIDS, but medications and testing are advancing substantially. The main category of drugs currently in use is called antiretroviral therapy (ART). It is not uncommon for patients to be on a multi-drug regimen or “cocktail” of three or more medications to treat the disease. Each category has a different mechanism of action and works on different cells in the body. The multi-drug approach has effectively kept patients free from opportunistic infections, stabilizing or significantly reducing their viral load, and improving their CD4 counts. According to the Mayo Clinic, the classification of drugs is as follows:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant), and doravirine (Pifeltro).
  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen), tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).
  • Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).
  • Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy), raltegravir (Isentress) and dolutegravir (Tivicay).
  • Entry or fusion inhibitors block HIV’s entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

Like all other medications, side effects are possible. 

Common side effects of ART include: 

  • Bleeding
  • Bone loss 
  • Damage to the kidneys, liver, or pancreas
  • Lactic acidosis 
  • Heart disease
  • Hyperglycemia which can lead to diabetes

Treatment also involves regular blood testing to assess the viral load, white blood cells, and CD4 cells. As much as possible, patients should maintain a strong immune system by avoiding others who are ill, taking medication as prescribed and not missing any doses, eating a well-balanced diet, and minimizing stress.

Another positive step in the treatment and possible prevention of HIV is PrEP, or pre-

exposure prophylaxis. These medications are taken before potential exposure to HIV or if a patient is at high risk of exposure to HIV. PrEP is effective if it is taken regularly. PrEP can reduce the risk of HIV infection from sex up to 90% and in I.V. drug users up to 70% (Medline Plus).

According to the website HIV.gov, there are currently two approved medications for PrEP:

The side effects of PrEP are similar to ART and include:

*Nausea and diarrhea 

*Headache

  • Possible damage to the liver or kidneys
  • Loss of bone density

There is another class of drugs for patients who believe they have been exposed to HIV. These are known as PEP, or post-exposure prophylaxis. PEP may be ordered if a patient feels they were exposed to HIV during sex, after sharing potentially contaminated needles or syringes, and after being sexually assaulted. To be effective, patients must start PEP within 72 hours of exposure, and they must take the drug for 28 days. Just like PrEP, PEP is only effective if taken as prescribed.

Patient Teaching

Like other chronic diseases, patients with HIV and AIDS need ongoing education about the progression, treatment, and management of their illness. Clinicians play a crucial role in helping patients understand symptoms, side effects of medications, the need for regular blood tests, and how to handle and treat opportunistic infections. Teaching should empower the patient in taking their medications as scheduled and report side effects to their provider. Clinicians should strive to build rapport with their patients. In doing so, they stand a good chance of obtaining an accurate and thorough medical and sexual history.

Another critical component of teaching for this patient population is safe sex practices. It cannot be overstated how important it is for patients to understand behaviors that increase their risk of contracting his as well as actions that can decrease their risk. 

Behaviors that increase the risk of contracting HIV are:

 *Sharing needles and syringes 

*Having sexual contact with someone who has a high viral load the presence of another sexually transmitted infection

* Using drugs and alcohol during sexual encounters.

Behaviors that reduce the risk of contracting HIV include:

 *Abstinence 

*Less risky sexual behaviors

*Using condoms and lubricants 

*Reducing the number of sexual partners

*Taking medication to prevent HIV or reduce the viral load 

It is essential that sexual partners have an honest conversation about each other’s sexual practices and whether the relationship will be monogamous. Sexual partners can also agree to only engage in safe sex practices and remain committed to these guidelines during the relationship.

Lastly, partners should always be honest about their HIV status, especially if they plan to engage in sexual activity or become pregnant. Having HIV does not mean that sex or pregnancy is not possible, but extra precautions are needed to reduce the risk of transmission.

Medication Compliance

As researchers and health care providers learn more about antiretroviral therapy, it is clear that strict adherence to the dosing regimen is essential to keep the HIV viral load under control, increase CD4 production, and support the immune system. Clinicians play a pivotal role in ensuring that patients understand their medication regimen and the rationale for strict adherence to its guidelines. As health care providers, we should never assume that patients know what to do to keep themselves healthy. Therefore, assessing the patient’s knowledge level and willingness to follow the medication dosing is crucial to the successful treatment of HIV infection.

Conclusion

The progress made in the battle against HIV and AIDS is nothing short of phenomenal. A disease that at one time would have meant a sure and quick death is now being held at bay by advances in both testing and treatment. If handled properly and conscientiously, HIV patients can expect to live long, quality-filled lives. More than ever, HIV patients can hope that they won’t suffer disability and devastating illness because of the virus. This hope extends to friends, family, and the community as well.

Clinicians can help this patient population by not being afraid to have open conversations about medical and sexual history, medication compliance, and overall health status. Additionally, offering emotional and psychological support will help these patients better navigate their journey of living with the virus. HIV and AIDS once may have been the worst-case scenario for many, but that is not the reality now. We can hope the next phase is a cure.

References

AIDS Healthcare Foundation. What is HIV? HIV Basics. HIV Care. (n.d.). https://HIVcare.org/hiv-basics/?gclid=EAIaIQobChMIgaaX__3x8AIVZz2tBh0WuAUCEAAYASAAEgJ_MvD_BwE

Centers for Disease Control. About HIV. https://www.cdc.gov/HIV/basics/whatisHIV.html

Enwereji, E.E., Ezeama, M.C., Onyemachi, P.E.N. (2019). Basic principles of nutrition, HIV, and aids: making improvements in diet to enhance health. DOI:10.5772/intechopen.84719

HIV: PrEP and PEP. https://medlineplus.gov/HIVprepandpep.html

HIV.gov. What drugs are approved for prEP? https://www.HIVgov/HIV-basics/HIV-prevention/using-HIV-medication-to-reduce-risk/pre-exposure-prophylaxis

Mayo Clinic. HIV/AIDS. https://www.mayoclinic.org/diseases-conditions/HIV-AIDS/diagnosis-treatment/drc-20373531

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Fodder from the Frontlines: Day #7

Published July 24, 2020 by thewriterlyroad_2o62in

Although it was a slow day, the pressure and stress are starting to show. We are all a little too quick to question each other and become defensive over the smallest perceived slight. One nurse who has anxiety has developed a constant eye twitch. Over the weekend, one nurse became agitated when another accidentally bumped into her. She screamed, “Don’t touch me! Don’t touch my stuff!”

Today we began random testing of 10% of the staff to look for positive COVID tests. I volunteered as one of the first to be tested. My anxiety about this virulent virus isn’t unfounded. Two of the complications are renal failure and blood clots. Not only do I have one kidney (I became a living donor in 2015) but I also have a clotting disorder. Contracting this virus could mean a potentially devastating outcome for me.

As I wait for the results, I think about what a positive result would mean. I’d be done working, I would have to stay at home and have my groceries delivered. Can I still sit out on my patio, or walk my dog, Harper? So many questions with blurry answers, and such a new and unfathomable world spinning before our eyes. All three of us who tested are negative. I am so relieved I go to the bathroom and cry.

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Fodder from the Frontlines: Day #6

Published July 24, 2020 by thewriterlyroad_2o62in

t was a busy day but the team handled the flow like a well-oiled machine. We have a system and it’s working. We are processing everyone’s samples while staying safe. Young people are still clearly hanging out with each other and don’t seem to take the threat of this virus seriously. Part of me understands this. At eighteen, I made some profoundly stupid decisions, and no one could tell me I was wrong.

Human beings do not have a fully developed frontal lobe until about age 25. The frontal lobe controls decision making and impulse control, so it’s not surprising the younger ones don’t get how bad COVID can be for everyone. I did a lot of patient teaching today. Some of these kids were offended but I don’t care. A huge part of nursing is helping people comprehend how their actions affect not only themselves but others. I will not stop talking about the right thing to do.

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Fodder from the Frontlines: Day #3

Published July 24, 2020 by thewriterlyroad_2o62in

Day #3 at the COVID clinic. Reality is kicking in. The bridge of my nose is red and inflamed from wearing the N95 mask, and now I have it: “macme.” Acne caused by wearing the mask for so many hours and sweating under it. I was sweating so badly underneath the bodysuit, masks, face shield, and gloves that it ran into my eyes and was dripping off my face.

Luckily, the nurses I work with are awesome and we help each other, no matter what.

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This Time, The Personal is Not Political

Published July 13, 2020 by thewriterlyroad_2o62in

Wear a mask. During the pandemic, all of us have heard this request. The direction seems simple enough, and yet, every day I see people walking around in public with their faces fully visible. They seem not to have a care in the world as they stroll along potentially infecting their fellow humans.

I had an unpleasant conversation last week with a woman in the grocery store. She waltzed right in carrying a young girl on her hip. Neither of them were wearing masks. I was in the checkout line and when she passed I said, “You need to put on a mask.” She ignored me and continued to walk through the store. She came by a second time (headed towards the wrong exit) and I repeated my statement.

She replied, “Mind your own business.”

I said, “This is my business.”

She shouted, “I’m not your fucking business!”

Classy.

Feminist and writer Carol Hanisch wrote an essay titled, “The Personal is Political.” By the time of its publication, the phrase was already commonly used among feminists of the 1960s and ’70s as a way to explain that both personal choices and political policies had an effect on women’s lives in the United States.

However, that feminist rally cry doesn’t apply here.

In the case of this worldwide pandemic, there is nothing political about wearing a mask. The issue is one of safety. Infectious disease doctors like Anthony Fauci tell us that people can be asymptomatic and still spread the virus. This is especially concerning when one considers how many in our community are vulnerable. Children younger than a year, the elderly with chronic health conditions, and those who are immunocompromised are all more likely to die from COVID-19 than the general population. Unfortunately, we are seeing that this virus, just like the ones before it, does not discriminate. Even if you are not in a high-risk group, you can still die.

I have a couple of medical conditions that make this particular virus dangerous for me. I’ve never been in this position before because I’m in good health, but the reality is that if I contract COVID-19 there is a high likelihood I will die. My life literally depends on everyone following the protocols for wearing masks and maintaining social distancing.

Wear a damn mask.

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Excerpt from ‘I Stopped Fighting the Flowers’

Published February 25, 2019 by thewriterlyroad_2o62in

As a kid, my house was surrounded on three sides by what seemed to me ever-blooming lilac bushes. The scent coming from those lilac bushes was positively intoxicating. Even in winter, I was convinced that I could smell some distant, lingering trace of the lilacs sleeping under the snow. In the summer, I would be high from the smell of lilacs. I’d lie under the crabapple tree in our front yard, shaded and drowsy, and just breathe it all in. I was a voracious reader then, and still am. I would read and dream, dream and read. The lilacs’ scent was the fragrant anesthesia that carried me off to the fantasyland of my childhood.

Those lilacs seemed to require very little maintenance. Some occasional watering and lots of sunshine were all it took to propel them towards the sky and release the scent I adore. My parents never pruned them or gave them fertilizer. They never talked to the bushes while stroking their buds. Nah. Those plants wanted to thrive and they did.

After all of the time I’ve spent trying to get my own lilacs to grow, I’ve learned something. If a plant does not want to thrive, it will not. The will is everything. I can work every form of magic that I know, but they will still go on and die. They have their own set of priorities that have nothing to do with me. The more I push, the more they resist.

The lilacs are a lot like people.

At my nursing job, I have a little lady (and I do mean little—she weighs in at a slight 86 pounds), who wants to die. She does not want to get out of bed, eat, do physical therapy, or talk to anyone. When I look at her emaciated frame lying in bed, there is a part of her that has receded. The part that holds the essence of her life force is in permanent hibernation. The internal pilot light of her soul is barely lit, and it is painfully obvious to everyone. Death is coming for a visit, and he will not leave empty-handed.

Her family is apoplectic. They want us to force her to eat and get out of bed. “Do something! Make her eat! She will eat if you just give her the food she likes!” they exclaim. And we try, we do. But it doesn’t do any good. She doesn’t want to live, and has made that clear, with every rejected bite of food and stern refusal to move an inch. Her caregivers come to me, palms open and facing skyward, and with halting broken English say, “She don’t want to do nothing. What I can do?”

I used to think that being a part of the world of medicine with all of its technology, medications, and vast knowledge, I would help keep people alive, no matter what. This was the naiveté that carried me through the first years of my nursing practice. We push the envelope on every front, breathing for people when their lungs don’t work, pumping them full of I.V. antibiotics when their immune systems are overwhelmed by infection, and stitching them back together when their bodies are ripped open by trauma. I was convinced that we medical professionals could beat back most of the tragedies that threaten to cut a life short.  And we do manage to pull off a lot of major—and minor—miracles.

But what cannot be beaten back is that will. The will is more powerful than any surgery, treatment, or tincture. It has a veneer of iron, and when intentionally raised, is impenetrable to any curative weapon created by man. You can kill bacteria, but not the will of someone who has made up their mind to die.

Excerpt from the essay “I Stopped Fighting the Flowers”, Copyright 2009 Hudson.

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The ‘N’ stands for Nurse

Published February 25, 2019 by thewriterlyroad_2o62in

LVN = Licensed Vocational Nurse

RN = Registered Nurse

That’s right, I am a nurse. I may have the letters LVN behind my name instead of RN, but that doesn’t mean you can talk to me like I’m a moron. Or ask me “Are you an RN?” and when I say, “No, I’m an LVN” you reply “Oh, uh-huh” as if that explains everything. As if I’m something smelly that you stepped in and want to wipe off your shoe so you can move on and find the realnurses.

Yes, LVNs go to school for a shorter period of time than RNs.  And yes, our scope of practice is different, and our licensure limits us to certain nursing tasks. But what does the ‘N’ in LVN stand for? It stands for nurse, that’s what.

I don’t have anything against RNs. Heck, some of my closest friends are RNs. Once you spend some time with them you figure out they’re okay. They have a lot of responsibility and depending on the personality, they can wield their power like a light saber, cutting you down in their wake. They can make an LVN’s work life tough or easy. But if they’re not too drunk on their own power, most RNs will give a gal a chance to prove herself.

But let me tell it like it is. There are RNs who assume that LVNs, simply because of those pesky letters, aren’t qualified to clean a bedpan. There is a hierarchy, a caste system, that exists between RNs and LVNs. Some RNs look down their noses at us LVNs. Yeah, I’m talking to you. You know who you are.

Some of you think you’re better than us because you went to school for longer than we did and you can hang I.V. antibiotics and push medications, or because you get to play charge nurse and tell everyone else what to do. The idea that you would have to work elbow to elbow with one of our kind on a medical/surgical floor fills you with disdain. We couldn’t possibly be as smart or as capable as you, and you will spare no opportunity to remind us of that.

In this caste system known as nursing, everyone is kept in their place. We don’t want anyone thinking they are high-falutin’. And so it is that from the time I did my clinical rotations in nursing school until now some RNs still insist on treating me like a third class citizen. In the beginning of my nursing career this really bothered me, and I would vociferously defend myself to anyone who tried to put me down. As time went on, I learned that the best defense is a good offense. In the nursing world this means a solid skill set and consistently good nursing judgment. Through the years I’ve cultivated both. Despite this, the patronizing continues.

Hey, here’s a question: have I cleaned up any fewer body fluids, supported and comforted fewer patients, or handled emergencies less efficiently? Absolutely not. As a matter of fact, I get turfed a lot of the really unappealing jobs because I’m lower on the food chain. This is especially true when I work as supplemental staff or as a travel nurse. Hey! Who’s up for a fecal disimpaction? No worries—the LVN will do it.

I’ve made mistakes but I’ve learned from them. This is very important in a profession where you hold peoples’ lives in your hands. If you can master critical thinking and throw in a dash of good old common sense, you will go far as a nurse. But critical thinking and common sense are not enough. We have to help each other succeed.

Excerpt from “The ‘N’ Stands for Nurse.” C–2010 Hudson.

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Can a Smell Kill Me?

Published February 25, 2019 by thewriterlyroad_2o62in

In nursing school I completed several clinical rotations. I worked in hospitals taking care of medical and surgical patients and women who just had babies. I learned how to treat people with acute and chronic health problems and how to recognize when they were taking a detour off the road of recovery. The work was challenging, but the most interesting experience was my geriatric rotation at the Veterans’ nursing home in Denver, Colorado.

*   *   *

Probably erected sometime during World War II, the building still has a lot of the original equipment. And when I say original equipment, I’m including the staff. Most of them have been here so long, they’ve actually taken care of the guys returning from Vietnam. They enjoy horrifying the nursing students with stories of soldiers who had limbs blown off or were full of shrapnel, and take great pleasure in assigning us tasks where we have to dodge the highest possible amount of body fluids. They like to give us the creepy old guy who tries to cop a feel as you’re changing the dressing on his trachea site.

The patients have been here forever, too. One guy has been here for twenty-seven years, although looking at him I am hard pressed to tell. He has avoided many of the complications that can ravage a body that is immobile, like skin breakdown.

The staff is proud of the fact that his skin still looks so good after so much lying in bed. It’s true: the around-the-clock turning, range-of-motion exercises, and copious application of skin moisturizer pays visible dividends. But I wonder if the patient knows or cares. He is in a coma, after all. What good is all of this gloriously soft skin to him? It’s not like he can go out and woo women with it. Hey ladies, check it out. Look at my wonderfully intact dermis. This makes you hot, doesn’t it?

Prolonged bed rest causes other problems. Hospital-acquired infections (also known as nosocomial infections) are prevalent and can take a long time to treat. One such infection, known affectionately in medical circles as “c-diff”, short for Clostridium Difficile, affects the gastrointestinal tract. Sometimes it occurs as the result of continuous antibiotic use, and sometimes it happens because a patient’s immune system is weak. The infection sees an opportunity, finds a foothold, and digs its little bacterial feet into the gut.

There is a slightly sweet smell to c-diff, followed closely by a pungent smell of rotting flesh. It changes the consistency of the poop, too. Instead of a regular bowel movement, c-diff looks like a brownish-grayish gelatinous mess.

I don’t know that I am about to come nose to stink with this most foul of infections.

We arrive to start our shift on Monday at 7 a.m., eager, naïve little nursing students ready to serve and learn. In true “Let’s stick it to the newbies” fashion, they give me the guy with the worst c-diff—ever. We all knew who he is. I don’t need to know his name or room number; I just follow the smell.

Maria, one of my fellow students, leans over and says, “Make sure you wear a mask when you change his diaper, girl. That smell will kill you.” But I’m not allowed to wear a mask unless the patient has a contagious respiratory infection, and this man doesn’t. It is disrespectful to put on a mask just to block an odor from a patient. I can feel little beads of sweat start to form above my upper lip. I hope I can get through this without vomiting.

The morning goes fairly smoothly, or as smoothly as it can for a group of first-timers who have absolutely no idea what they’re doing. The patients have lunch and then it’s time to put some of them back to bed. My c-diff patient is on the list. “But first”, our instructor advises, “make sure you clean them up before putting them to bed.” This means digging in and changing soiled diapers.

The time has come. Yowza. Here we go.

Maria is helping me with my patients. When we get to my c-diff guy, we take a deep breath—and hold it. We bring him into his room and it is obvious that his diaper needs changing. We get him into bed and start in earnest, trying our best not to show how disgusting it is. I look over at Maria, and she is twisting her face in sheer horror. I whisper, “Maria! Stop making that face! It’s disrespectful.”

I don’t want to make a face. Of course this is impossible. The stench coming from this guy’s butt is enough to make me want to pass out. It’s as if some small woodland creature has crawled up there and died. Judging by the stench, that little critter has been dead a long time.

It seems to take forever, but we finally finish and leave the room. As we’re walking down the hall, I glare at Maria. She looks at me and says, “What?” I say, “Why did you make that face? We’re supposed to respect the patient and not show how gross it is.” Maria keeps walking and in a casual voice replies, “You read this guy’s chart, right? You’re forgetting something.” I don’t know what she’s talking about. I’d read his chart, but it was one of probably fifteen I’d reviewed since working at the VA. It’s hard to keep track of everyone and their ailments.

Maria laughs. “We lucked out. That guy isn’t going to care that I made a face. Know why? Because he’s blind.”

Copyright 2009–Hudson.

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Am I A Teacher?

Published February 25, 2019 by thewriterlyroad_2o62in

I just started a new nursing gig: I am a clinical instructor in a vocational nursing program. I’m a little stunned with my new title, because I never thought I’d be a teacher.

For years, various people have told me that I should teach. I pooh-poohed the idea at every turn. What, me? A teacher? Nah, I can’t do that. I’m too anti-establishment, too much of a wild-child and rule breaker. With my personality, I don’t know if I can successfully lead others towards their career and academic goals.

You know what? I was wrong.

I really like teaching. I like seeing the look on a student nurse’s face when she goes from I-don’t-get-it-and-I’m-a-deer-in-headlights to Ah, now this is starting to make sense. That is a truly inspiring moment for me, and I want more. I am helping these students achieve their goals, and it’s cool being a part of that.

Who knew? I am a teacher.

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Not As Easy As It Looks

Published February 25, 2019 by thewriterlyroad_2o62in
My first clinical rotation was challenging, to say the least. One student dropped out at week four, and another just couldn’t get it together on a behavioral level. She didn’t make it either.

I’ve learned some valuable lessons from my first swim in the waters of teaching. First: I have to get a handle on inappropriate behavior(s) right at the beginning, because once that monster gets away from me it takes on a life of its own. Second: I should always praise in public and criticize in private.

Last but certainly not least, I am proud of what I do.

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