I reluctantly returned to the field of nursing post pandemic in March of 2023 out of financial necessity. I left nursing in 2020 with arguably the best excuse in the world; maternity leave. The birth of my first born son, Atlas, my bearer of the spherical hemispheres baby boy conveniently pulled me out of the health care workforce when the world was shutting down in March of 2020.
I remember feeling guilty and lucky in the same breath. It was a time where my RN badge that I proudly hung on my rearview mirror to get me out of speeding tickets was tossed in the glovebox slammed shut into the shadows. Bachelor’s prepared Registered Nurse with over 5 years of bedside and administrative experience: who me?? As I slide my palm over my large round pregnant belly.
I felt like my stretched scrub top over my enlarged abdomen was my modern day scarlet letter. When things started getting serious on the national level with the disease spread, I often wondered if my co workers resented me for getting “knocked up”. We were already short staffed before I announced I’d be going on maternity leave early. I wonder if they called me a coward behind my back when I was refusing to perform any in person visits. I was approaching my third trimester and I negotiated strictly office work at a home health agency I was full time with at the time. It felt like our nation was going to war, registered nurses were our front line soldiers, and I dipped, ducked, dived and dodged the draft. The United States has not had a draft since 1973. I wish we could call up Florence Nightingale from the grave and see if she can shed some light on the Crimean World War II : The Pandemic. I wonder what she would have thought about all of this. 1
Nursing always metaphorically reminds me of the incessant busyness of a colony of ants. Living the majority of my life in the southern United States, it seems to be a right of passage to claim a southern upbringing if you had at least one traumatic memory with RED. FIRE. ANTS. One of my earliest childhood memories is staring down at my brand new pink jelly sandals covered in a mirage of ants. I don’t care which side of the pasture you fall on with Mossy Oak or Realtree. You don’t get to wear the southern girl t-shirt if you didn’t experience the sudden jolt of stinging bites shocking you into a full blown panic. You don’t get to roll your eyes at someone in a mid-west restaurant when they ask if you’d like sweet or unsweet tea; if you didn’t stare down at your feet engulfed with a blurry distorted image of a threat you had to immediately escape from in your rolodex of childhood memories.
Excuse my lack of southern hospitality in drawing the line of southern vs not. And this message is not about upbringings or the where I come from; it’s about the blurry distorted image of a threat that my career path as a nurse had ultimately led me to this obsession of escapism. I’ve been a Registered Nurse for a decade now. This Lady with the Lamp series is dedicated to anyone that has ever wanted to escape from something. I want to shed some light on a few stories that have been tucked into the caverns of my memory for far too long. I also want to explore how escapism is possibly the only reason I still have hope.
Escapism: the tendency to seek distraction and relief from unpleasant realities, especially by seeking entertainment or engaging in fantasy.
Lady with the Lamp: Story One
Over ten years ago, I was a 3rd semester nursing student in a 5 semester bachelor’s program. I was showing up for my first day of psych clinical at a behavioral unit in a hospital in Nashville, TN. I was nervously folding a magazine into a cylindrical roll in my hands while waiting for our assigned nurse preceptor to retrieve me and a few other students to enter the locked unit that was badge and key code protected. It was a TIME magazine. The title read: “The Optimist” in bold white letters with a picture of a old white haired man with black framed glasses that I’m assuming is Warren Buffet because the title reads: “Why Warren Buffett is bullish on America by Rana Foroohar.” 2 I didn’t read anything inside of the magazine, not even the front cover story. I had it splayed in front of my face pretending I was reading for what I felt a long enough period of time that would convince my peers sitting in the matching white scrubs beside me that I was not nervous about today’s new clinical assignment. No one else seemed to be nervous, so why was I falling a part inside? Maybe I’m not cut out to be a nurse, I thought.
The door clicked loudly and we see a nurse walk towards us and wave us into the locked the doors. I was distracted and failed to put the magazine back on the waiting room table so once in the unit I rolled it length wise to fit into the deep right pocket of my white lab coat. The five students were split up with other nurses, two, two and one, me the outlier. I felt lucky to be excluded from the pairs though because I was assigned with this smiley female nurse instead of the two male nurses the other students were assigned to shadow. My nurse was young, still in her thirties but her deep set purple under eyes did make me question upwards to mid-forties. She gave me a brief safety recommendation of removing my stethoscope from my neck as to prevent a patient from potentially strangling me. I quickly uncoiled my stethoscope from my neck recoiling it into my left lab coat pocket trying to tuck it out of sight. I followed her throughout the unit. I observed her charting, rounds and medication administration with each of her assigned patients. I sat down in the common area where a variety of patients were seated playing dominoes. I joined in.
I noticed a patient pacing to the right of my periphery watching me. While trying to act engaged in the dominoes game I lost sight of this patient. My preceptor was still charting and I discreetly bent down as if to fix my rolled scrub pant so I could tilt my chair to an angle to have a better view on where that male patient went. '“Can I read that?” Barked a loud voice over my left shoulder making me jump and spin back around bumping the table knocking down a few of the patient’s in play domino pieces. I quickly apologized to the table of guests without taking my eye off the pacing patient that was now very close to me. I stood slowly smiling in an unthreatening manner backing towards my preceptor that was charting at the nurses’s station in the back corner of the room. “Can I read that?”, he said again pointing to the magazine rolled in my lab coat with the red TIME letters visible above the top line of my pocket. “Oh, sure.” I said reaching for it relieved this patient wasn’t eyeing my stethoscope in the left pocket. I began to feel guilty for allowing the patient to put me on edge when he was likely just pacing near me trying to find a good time to interrupt the domino game and ask for the magazine. I handed it to him and he snatched it abruptly from my hand and lurked away.
I rejoined my preceptor to ask more about this patient’s background and current plan of care in place. I sat near her to take some notes and jot down some observations I had made about the unit and a few ICD-10 codes I wanted to look up later. F20.9 being one of them. 3 I overheard some yelling in the distance and I could see another pair of students backing away from a patient that was repeatedly cursing at one of the male nurses. I made eye contact with one of the other students and we both tried to look at each other with a reassuring glances but neither of us believed each other. There was a sudden new busyness and stir to the unit that seemed to all happen at once. It was now late into the evening of our shift, quickly approaching shift change. Our student shifts were staggered to end at 2000 (8 p.m.) so we could observe shift change and how the nurses exchanged report at 1900. (7 p.m. ) At the domino table a patient became frustrated and swiped a few dominoes to the floor exclaiming, “Cheater!!! You saw what I had earlier!” directed at another patient. My preceptor stands up from her charting to walk towards the domino table. Smack, smack, smack, another patient is open palm smacking the narrow window on the unit exit door yelling at an empty hallway on the other side of the glass, “Get me out of here!” he shouted. Yea buddy, me too I thought as I glance down at my watch.
I could feel my heart beat in my cheek as I clenched my jaw with how uncomfortable I was feeling. I found myself closely hovering by my preceptor now. Observing her calmly redirecting patients from verbal behaviors and dispensing prophylactic evening medications. It felt like someone had just nudged over the ant hill with a steel toe boot and chaos was now hastily moving around me. It looked like the ant hills I would see as a child when it was about to rain. I would notice the insects spilling up and over the mound of the ant hill readying for the storm. I used to envy the ants for knowing rain was coming before I did.
I followed my preceptor as she quickly swiped her badge to return into the med room. I turned my body horizontal to slide quickly in behind her as the med room door slowly depressed shut. I had a lot of questions about the medications she was checking out but I remained quiet and on her heels. I was sweating due to nervousness and trying to keep up with the pace of my preceptor. I asked if I could leave my lab coat in the locked med room. “Just don’t forget it when you leave. That new Littmann will be gone forever.” she nodded toward the counter to place it. She was referring to my newly purchased shiny Littmann stethoscope. I was embarrassed how new it looked. I balled up the coat and shoved it on the counter corner. She swung the med room door open and balanced a transparent cup holding medications in their little paper packs leaned on her forearm against her chest. I caught the door for her to breeze out making sure the door locked back behind us and caught up with her with a few quick strides to follow her down the hallway.
We walk past a room on our right and we both at the same time make an abrupt stop and step back to do a double take as we saw bright red blood dribbled all on the floor. I peered up at the walls over the bed and saw with red bold capitalized words “TIME” drawn with fresh bright blood. It was the patient I gave the magazine too, with the diagnosis F20.9. The magazine was pulled apart splayed all across his bed and he was standing with his entire body turned with his nose in the adjacent corner of the room, his face not visible. His body appeared rigid and his fists were clenched down to his side. He reminded me like a small boy that just had a tantrum and was being forced to stand in the corner in timeout. I look to my left and hear my preceptor page with her walkie talkie to the staff, “ I’m gonna need a biohazard kit and some help down wing 1.” I go to look back toward the room at the bloody scene in front of me and my preceptor screams, “RACHEL, BACK UP.” My name wasn’t Rachel but I did jump back as the patient shoved the bedside table over with one hand and tried to grab my exposed forearm with his other visibly bloody hand. The preceptor shoved me out the door as my white scrub top grazed the wall smearing blood on my shoulder. She pushed the door shut and calmly spoke through the narrow window towards the patient as if he were a little boy, and as if he was just in the time out corner and needed to go back. She was unsuccessfully redirecting him to sit down on the edge of the bed so she could come back in and check on his “boo boo's”. I hear the walkie talkie unclip from her pocket again as she pages back to the other nurse requesting they also bring IM Haldol.4 I could see one of the male nurses walking with a long stride waiving a syringe and capped needle in the air and radioing back; “I went ahead and drew 100mg, since it’s a full moon too.” Proud of himself for anticipating her needs and briskly walking towards us with a heroic swagger to his step.
The two students quickly trying to catch up to their male nurse as their eyes grow wide seeing my stunned face and my bloody scrub shoulder. My preceptor begins donning PPE5 and she mutters under her breath. “Patient is HIV+, did you see he removed the staples from the spine of the magazine and had them wedged between his knuckles covered in his blood?” “He was trying to grab your arm to expose you. You’re not going in Rachel,” she said sternly making eye contact with me for the first time since the start of the shift. “None of you white coats are going in this room.” announcing to the other students that were helping the male nurse into his shoe covers. The two nurses look at each other and he mouths, “shock and awe?” She nods in agreement, grabs the injection from his hand and repeats the words “shock and awe” as they barge through the patients room, flinging the door with a loud bang against the wall. The male nurse swiftly grab the patient’s arms pushing the patient down seated on the bed pressing his gloved thumbs into a pressure point making the patient release the bloodied staples from his knuckles to the floor. The female nurse jabs the syringe into the patient’s upper thigh straight through the patient's pants. She turns around and says through the open doorway to all of the students with deer in the headlight expressions included myself, “Who’s the idiot that brought a magazine on the unit?!” I raise my hand with embarrassment. “Do us all a favor Rachel when you get out of nursing school, if you can even pass your boards, make sure you don’t ever work psych.” She insists. “You should probably specialize in OB6 or something”, as she rolls her eyes and sneers to the male nurse with her knee mounted onto the patient’s other thigh that didn’t receive an injection. I respond with, “My name is Rebecka.” Now visibly annoyed, she continues to lecture me with an elevated tone while holding down the patient that is growing calmer by the second. The room goes silent. I look to the ground seeing the front page of the magazine with Warren Buffet looking directly at me. His slight smile is now covered with blood, so even he looks disappointed in me glaring through his black rimmed glasses with a furrowed brow. I answer to the room of people to no one in particular but still holding eye contact with Warren: I’m not an idiot. I’m an Optimist.
Spotify: Ants Marching by Dave Matthews Band
This is the first of many stories for the Lady with the Lamp Series. I’d appreciate if you share the Macon You Breath Publication with one person to help me grow my community here on Substack.
Breathe in… Breathe out gently.
Florence Nightingale history and image: https://www.atlasobscura.com/articles/florence-nightingale-infographic
TIME magazine January 23rd, 2012 edition: https://content.time.com/time/magazine/0,9263,7601120123,00.html
ICD-10-CM Diagnosis Code F20.9: Schizophrenia, unspecified
Intramuscular injection of Haloperidol (Haldol) is used to treat schizophrenia.
Personal Protective Equipment (PPE)
OB-Obstetrics Nursing