Faking Healthy for Clinicals
During nursing clinicals I had to stuff catheters up my sleeves under the long-sleeved shirts that I wore under my scrubs. That way no one would know I was sick. No one would know that I couldn’t pee without medical devices.
Dr. Metta was the urologist that I was seeing for my issues around not being able to pee. For the last few months I constantly felt like I had to urinate. I had also been unable to fully empty my bladder. Over the last week I’d been unable to pee at all on my own. Now I had to rely completely on catheters that I inserted myself to drain out all my urine. Once the urine finished trickling out and my bladder was empty, I would pull it out and toss it.
The Urodynamics Study Results
A month after my original appointment with Dr. Metta, he had me do a Urodynamics study.
When I returned to Dr. Metta’s office to discuss the results of my urodynamics study, he looked serious. Instead of going into the exam room first he pulled me into his office. Dr. Metta pulled out an empty plastic chair for me, and then sat down in his black office chair with a memory foam cushion on it.
“You do have a neurogenic bladder, as I suspected. For the same reason, your stomach and intestines are paralyzed, your bladder is also paralyzed. The connection between your brain, nerves, and muscles is just all out of sync.” He explained to me after we sat down.
“So what does that mean?” I asked.
“Your bladder squeezes and contracts to let urine out. Your bladder is not able to squeeze when it needs to, because the nerves aren’t sending the right signals to it. You have something called an obstructive bladder. This means the messages and impulses between the nerves and bladder muscles are getting miscommunicated which is preventing you from being able to urinate.” He told me.
This Dysautonomia Thing and old Clinicals
“So, the dysautonomia thing causes it?” I asked, remembering vaguely having had a patient with dysautonomia in one of my med-surg clinicals from nursing school.
“Dysautonomia means that there is a problem with nerves causing a disconnect between the unconscious nervous system and the organs and muscles they govern. People with dysautonomia normally have trouble maintaining their blood pressure and heart rate. They tend to have GI issues like gastroparesis and intestinal dysmotility. Dysautonomia gets in the way of regulating temperature and pupil reactions. It can even cause organ damage due to the malfunction between the body and the brain. “
“But what does that have to do with me not being able to pee?” I asked.
Neurogenic Bladder
” Another very common symptom of dysautonomia is neurogenic bladder. Some people have an overactive bladder where they overflow and leak or have the urgency to urinate all the time. Other people like yourself have an underactive bladder and can only go small amounts and don’t fully empty their bladder each time they go to the bathroom, or as in some cases like yours, can’t go at all anymore.” Explained Dr. Metta.
“Will it ever get better?” I asked nervously jiggling my legs up and down and back and forth. My gaze stayed focused on the diplomas mounted on the wall. That way I wouldn’t burst into tears. I had big dreams, I wanted to be a nurse and save lives and publish books on the side. From the way nursing clinicals and my writing classes were going, it was seeming like I could do both. Was this diagnosis going to up-end everything?
And in the Blink of an Eye, Your World Changes
“We need to find out what form of dysautonomia you have and will then be able to figure out more about it. Some forms of dysautonomia can be treated. Other forms of it can’t be treated or are degenerative. “
I felt a chill go down my spine when he mentioned that some forms were untreatable or degenerative. Then I quickly pushed those worries out of my head, refusing to allow myself to think negatively. In my head, I told myself, “of course, you don’t have a degenerative or untreatable condition”. Once I took a steadying breath, I turned my attention back to the doctor.
“I can only tell you that right now that your best option around urination is to continue straight cathing five to seven times a day. Getting an indwelling catheter or suprapubic catheter raises infection rates. As long as you have the ability to self cath, which you do, it’s the best method for treating an obstructed bladder. Once your doctors find out more about your type of dysautonomia there may be more we can do.”
Catheter Forever
“Will we be able to fix my neurogenic bladder?” I asked. “Will I be able to pee again?”
Your neurogenic bladder is probably permanent. You will probably need to rely on catheters for the rest of your life.” he explained as gently as he could.
It was a lot to digest. I sat there in complete shock for a good five minutes. My focus on the diplomas on the wall was blurring over and I felt like if I moved I’d sob.
“I will see you at least twice a year for follow-ups and I will keep ordering the type of catheters you want.” Dr. Metta informed me. “If you get symptoms of a urinary tract infection then you need to contact me immediately. Do you know what those symptoms are?”
“Urgency, burning, foul smelling urine, cloudy urine, debris in urine, fever or chills,” I recited. All of that had been covered in med-surg.
“Great, impressive! So if you get any of those symptoms contact me immediately and we will test your urine. The sooner we get your urine culture back, the sooner we can start you on antibiotics. UTIs happen more frequently in people who use catheters.
I left the office feeling as though my world was escaping me as I got sicker and sicker.
A Downhill Slide
For the next two years, I struggled with multiple hospitalizations due to heart issues, blood pressure issues, bad urinary tract infections, feelings of needing to pee but not getting any urine out, an inability to maintain my potassium and other electrolyte levels, and intermittent need for NJ tube feeds.
I continued to go to nursing school in between all of that though, refusing to allow my diseases to stop me. I worked closely with the disability office to make up time from when I was hospitalized or too sick to attend classes. Despite my extensive health issues, I was able to maintain a 3.98 GPA and made up for nursing clinicals over the summer or holiday vacations, when I missed them.
Nurse Becca at Clinicals
Clinicals were amazing, I felt like a whole other person when I put my school’s hunter green scrubs and white sneakers on, swung a stethoscope around my neck, grabbed paperwork on a clipboard, and walked into the hospital to get my patient assignment and take care of patients.
In nursing school, we were only given one patient at a time but were assigned total care for that patient along with the help of the nursing instructor and the patient’s regular nurse. Even things that were normally taken care of by a nurse’s aide were our responsibility.
We would come in either the night before or earlier in the morning of our scheduled clinicals to get our patient assignments. Then we would look them up in the computer charting system. It was put to us nursing students to read their history, their labs, their past physical exam, their medications, any surgeries they had done, and their treatment orders.
When clinicals actually started for the day we would go into the room and introduce ourselves and ask our assigned patient if they were okay being taken care of by a student nurse along with our instructor and their assigned nurse.
Feeling Like a Real Nurse in Clinicals
If they agreed, which they always did, we would conduct a thorough physical exam, take vital signs, and give them their medication. Later we would help them wash up, help feed them if they needed assistance, follow other treatment orders, and do anything else they needed help with. We would insert catheters and give injections and IV meds when needed.
Sometimes we would hang antibiotics and IV fluids, and give meds through a feeding tube or formula through a feeding tube. Other times we would clean and dress wounds. Anything that popped up as part of patient care in our eight-hour clinicals, we took care of.
Superstar in Clinicals
I never had a patient refuse to be taken care of by me, and I always made sure that my patients were comfortable and well cared for.
Inserting catheters was a breeze for me as I always inserted my own catheters by then. I was also frequently told that my injections were done so painlessly the patients barely felt them. After all of my time giving my own subcutaneous injections twice a day I’d perfected the art of using a wrist flick to dart the needle in quickly and carefully. I also knew the exact angle at which to hold the needle to minimize pain.
It took extra time, but I would comfort patients and allow them to air their concerns in an open manner. I would then do my best to listen carefully, and find suggestions and answers. If it was something I couldn’t address on my own I would get extra help to alleviate their concerns.
Nothing Was Going to Stop Me From Excelling at Clinicals
My patients raved about me, my instructors for my clinicals were full of praise, and I felt empowered and successful. Each one of my clinicals was slightly different, but I thrived in them all. It was a refreshing change of roles (compared to always being a patient) that I loved.
The first clinical was long-term care/nursing home/rehab setting. Then I did two medical-surgical unit clinicals, I also did a veteran’s psychiatric hospital for psych nursing, a school nurse position, a pediatric inpatient nursing clinical, a labor and delivery clinical, and more.
It seemed like for once my life was turning around. Even when I had to go to clinicals with a feeding tube in my nose, I just shrugged off the stares and made people see it was just a normal inconsequential part of my life. By the end of sophomore year, I was a totally different person from that scared little girl being called elephant-nose and anorexic, that I was eleven years before.