#1: The El is different in the early morning. Sleepy. The brown line train has only four cars instead of the usual rush-hour eight car caterpillars. The train rocks a bit more violently when it is empty. I am used to the sun peeking over the horizon as we approach the Loop. Not today. I review steps in my head as I listen to ELO’s “Mr. Blue Sky” on loop on my iPod. Dirty to clean, auscultate, percuss, inspect, educate, no wrinkles on the bed. What if I screw up? What if my patient falls? What if the IV slips out? The walk toward the hospital from the Polk station is lonely. Mister Blue Sky is living here today hey, hey.
Observation #2: I am nauseated and nervous. We are all a puddle of nauseated and nervous sky blue scrubs sitting in around a table, waiting for our orders. Our clinical instructor, T, arrives with a comforting smile. My fellow students support each other. We ask each other questions, make small talk and joke. Damn. I can already tell that I am going to be constipated tomorrow. T warned us about that. She has kind eyes.
Notes in my head: constipation, opioid tolerance, always constipation, always stool softener. I review the patient care plan. I am assigned to Mr. P, a late-70’s gentleman who fractured his neck. Neck. Wow, that’s awful. Why isn’t he on the Neuro floor?
Observation #3: I need to read more carefully. Take two: Mr. P broke his femoral neck. His hip. He has osteoporosis and possibly leukemia. Others read their reports: one will care for a young woman who had a bullectectomy—the technical term for a bullet removal. Another will care for a young man in sickle-cell crisis. Still another will care for an older man who will have neck surgery in a few days. We listen to the weary night shift nurses quickly rattle numbers during Report. I hover behind my nurse like a toddler at her mother’s feet.
Observation #4: The computer isn’t always correct. Mr. P’s preferred language in the computer states English, so I talk to him in English for the first ten minutes while he stares sleepily. I learned Spanish is high school, spent a summer in Ecuador teaching, and took a couple of college courses. The nurse does not speak or understand Spanish. I ask T what we should do. “Your best,” she said. Yo hablo español. Sort of. Por favor, lo siento, y gracias: “please”, “I’m sorry”, and “thank you”. Three essential phrases I need to memorize in every language. I will be saying a lot of those phrases today. I’m reluctant to speak Spanish. Where is the interpreter?
Observation #5: There are no interpreters on standby. Why would I think there would be?
Observation #6: El señor P is incredibly patient as I stumble with my language, the bell of my stethoscope, the blood pressure cuff. Where is the pulse oximeter? This machine one doesn’t have a working thermometer. Full Ensure bottles are huddled like chess pieces on his sticky bedside table. The Ensure arrives on his tray with his breakfast. It is warm. I wouldn’t want to drink warm Ensure, why would a patient? After breakfast, I put the untouched bottle on the table with the others.
Observation #7: El señor is light, but 120 pounds is still heavy to move. Moving a man with limited strength from the bed to a chair—a sum total of one foot—makes me sweat. Shit. I stepped on his foot. Lo siento, lo siento. I am grateful for the assistance of my friends, my fellow students. L helps me lift him, and changes the bed while I bathe him.
Observation #8: El señor would rather be bathed than bathe himself. He closes his eyes and smiles as I wipe his forehead. He washes his private area and places the soiled toalla on the tray. I don’t react. L smiles at me. Where are the Clorox wipes? After his bath, he still smells old. If only clean old people smelled like clean babies.
Observation #9: I like giving fist bumps. “Awesome!” fist bumps. “Rock on!” fist bumps. “Fuck yeah!” fist bumps. Exploding fist bumps. Fist bumps with sparkles (bump fist, open hand, make it rain). Fist bumps with shrapnel (bump fist, turn fist toward you, quickly open hand toward face). H discovered crackles in her patient’s lungs. A possible pneumonia caught early, by a nursing student no less! Fist bump! L helped me! Grateful fist bump! We got through the first day without killing or maiming anyone! Fist bumps all around! How can I say “fist bump” in Spanish?
Observation #10: I obsess too much over what I may have forgotten or may have done wrong. Did I chart his noon vitals? Was his weakness on his left side or the right? His cataract was in which eye? Should I be more concerned about the ecchymosis on his foot? These thoughts loop in my head until I fall asleep.
El señor is in my dream. We are in Ecuador. We are passengers on a bus. I am speaking fluent Spanish. Then he dances and laughs. I wake up and decided I wouldn’t be afraid to speak Spanish anymore.
The second morning is a bit easier. “No Diggity” plays on loop on my iPod as I bop my head on a quiet train.
Observation #11: I’m constipated. And I think my patient is, too. Despite bowel sounds and flatulence, he hasn’t had a bowel movement in three days. I ask fellow student B: how do you say “did you have a bowel movement today?” in Spanish? B says: ask him if he did a numero dos. Number two. I like the way you work it, no diggity, I got to bag it up.
Observation#12: El señor doesn’t remember me from yesterday. Memory loss? I was wearing contact lenses yesterday, but today I am wearing glasses; he is also visually impaired, so I am not too concerned. When I ask him if he knows today’s date, it is as much for my knowledge as it is to assess him. It’s already the 7th? Wow. Muchas gracias, Señor P. He laughs.
I try my best to use Spanish as much as I can. El señor teaches me. I now call him el profesor. He corrects me on my subjunctive tense. I help translate for the social workers that come in to discuss his transfer to another hospital. He is sad. Triste. He wants to go home. Yo comprendo.
Observation #13: His leg is much more swollen today. He is in pain. He has been saying he is in no pain when I ask. Then I remember the word for “scale” in Spanish. I ask him again, translating as best as I can, on a scale of zero to ten, with ten being the worst pain in el mundo as I gesture with my hands, how much pain do you have? He smiles. His pain is a five. He needs medication.
Observation #14: This afternoon, the hallway smells of hotdogs. Or barbeque. Barbeque hotdogs for lunch? We can’t decide. Damn, I am hungry. I want a hot dog.
Observation #15: The day ends too quickly. I still have so much to learn. About my patient. About disease. I explain to el profesor that my shift was done. I thank him for his patience, for his kindness, for his teaching. We shake hands. He thanks me and says that he hoped the nurses in the new hospital are as nice as me. I am lucky. I know all patients are not like el profesor. Muchas gracias, Señor. Thank you for going easy on me.
I wish I could stick el professor in my oversized scrubs pocket and take him home with me where he could get better, instead of being in a hospital, alone. But, we can’t take them home with us. T tells us that, smiling, on our way out the door.