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[ Page 5 ] / [ Previous page ] The next Monday, Julia reported at 7 a.m. for her first solo shift as an ICU nurse. She quickly discovered that M.J. wasn't kidding when she warned that there would be no special treatment. The patient waiting for her was one of the toughest cases in the SICU that day: an immense, schizophrenic man who apparently had steered his wheelchair into the path of an oncoming car. Now, Julia realized, it really was time for her to ''sink or swim." The man, 42, had come up painfully short of suicide, winding up in a coma with head injuries, a fractured pelvis, a ruptured bladder, possible kidney failure, a broken leg, pneumonia, and a drug-resistant staph infection. He lay motionless, covered only in a loincloth, his breathing so shaky that it was unsafe even to X-ray his injuries. ''He's a do-not-move right now," said night nurse Deborah Simonetti. But there was plenty of work for Julia: To start with, her patient needed 20 different medications, from pain relievers to antipsychotic drugs to laxatives. Julia was surprised that she had such an unstable patient on her very first day, but she was game, peppering Simonetti with questions -- What's the blood pressure goal? What kind of IV fluids? Does he have bowel sounds? -- and writing down questions for the doctors on a piece of white adhesive tape that she stuck to a small table. After a half-hour briefing from Simonetti, Julia did her own assessment of the patient, taking his temperature, flashing light in his eyes to test his responsiveness, checking his respirator for leaks, leaving nothing to chance. ''I'm starting to figure out what I'm doing," she said. |
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But there was still so much to learn. Julia gave a puzzled look when nurse Suzanne Francis handed her a small black box with two electrodes to test her unconscious patient's reflexes. Francis asked if she could show Julia how to use the Innervator, but Julia demurred, preferring to figure it out for herself. She attached one electrode to the man's left wrist and the other to his thumb, then turned on the electrical current. The patient's left thumb jumped ever so slightly, showing that there was lingering nerve function; her patient was not completely comatose. ''Yes!" said Julia. She had solved her first puzzle as a full-fledged ICU nurse. And she had done it without asking for help. In the weeks that followed, M.J. waited for the rumor mill to pass word of how her former student was working out. M.J. knew that, as the teacher, she, too, would be judged by Julia's work, and that other veteran nurses would be quick to let her know if things had gone awry. But all the reports were excellent. One nurse did have a conflict with Julia, but when M.J. investigated, she took Julia's side. By early June, M.J. said: ''I've had nothing but good feedback the last two to three weeks. Somebody came up to me and said, 'You guys did such a good job. She's very focused.' " The favorable reports have continued into the fall. |
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For M.J., the final proof of Julia's growth came one day in May, when she was tending a patient across the hall from her former student. Julia needed to get an unstable patient ready to leave the room for an MRI, a time-consuming test that requires more preparation than the usual movement of patients between rooms. Because Julia had never done it before, she crossed the hall to ask M.J. for advice. ''At times," MJ reflected on their long months together, ''I thought she was acting more like a medical student or a resident rather than a nurse. . . . Now that she's on her own, she realizes that she has to be a nurse. . . . I think she's going to be a great nurse." Julia, too, felt as if she had come a long way from the day she showed up at Mass. General, cocksure but also a little intimidated. There was no single moment of enlightenment, she said. ''But at some point, I just got it." Julia now understood that she would never ''know it all," and that she would always draw strength from those working with her. ''Nurses who have been here for 20 years have situations where it's not obvious what to do," she said one summer evening. ''In that kind of situation, you are supposed to work together. I don't mind going and asking people questions. I'm more willing now, because I'm on my own." Scott Allen can be reached at allen@globe.com. |
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