First Day Lessons

My clinical placement for the semester started today.  Unlike other semesters, with one consistent placement, this one will change half-way through, and the two placements couldn't be more different.  For the first six weeks I'm placed on an acute inpatient psychiatric unit.  For the last seven weeks I'll be on cardiac care unit.  Like I said, quite the difference in approach.

I made breakfast for dinner, put on my pajamas, and was in bed to crash and veg by 6:00 tonight.  Eight students and one instructor spent an intense four hours in a tiny conference room on the psych unit today.  I can't remember the last time I had that much information thrown at me at once.  It was overwhelming.  Add to that a 2 hour commute home by bus in a blizzard, and I was pretty done in by the time I managed to get here.

I wasn't expecting to feel overwhelmed by a psych placement.  I've dealt with my own struggles with anxiety and depression for close to half my life, and continue to take medication and meet with my therapist to manage that.  I have close family members and friends who have gone through severe and ongoing mental illness challenges for decades.  I've worked with the homeless population in our city in the past.  Unlike most of the students in my group, this was not the first time I've seen the inside of a psych unit.  I really thought I was prepared for this.  I don't feel anxiety when I discuss mental illness.  I don't struggle to have conversations with people who also battle those illnesses.  But something about all that information being thrown at me in a concentrated manner drowned out my usual calm and invited anxiety out to play.

I knew that working on psych could trigger some of my own struggles, and so I was mentally somewhat prepared for that, but just the four hours of orientation left me feeling a bit like I was drowning.  It was easy to lose all the positives in the face of thinking about nursing on a unit where wearing a stethoscope is a risk to your health because having it around your neck could be a choking hazard if a patient became aggressive.

I sat on the bus home feeling overwhelmed and alone.

The creeping feeling of anxiety still scares me.  The little ways it manages to sneak up and become BIG still surprise me, and as I sat on the bus, it was BIG.

Quite frankly, I spent a large portion of that bus journey throwing myself a pity party.  I was overwhelmed, and that made it easy to fall into old patterns, to believe old lies.  I sat there feeling miserable, telling myself that I was alone, that I didn't have anyone to talk to about how I was feeling, how overwhelmed I felt, the creeping anxiety that was threatening me.

And it was there, on the bus, that the first day lessons merged with the lessons I've spent the last couple years of therapy working on.  Coping strategies kicked in.  I remembered that four dear friends had promised to hold me in prayer before the day ever began, because I'd been wise enough to anticipate the potential for anxiety and share that with them in advance.  I sent strategic text messages to friends who I knew would not only hold me in prayer, but would help to draw me out of my pity party. I rearranged my evening plans to accomodate the need for increased self-care.  I was able to recognize that several things that depress my mood were in play today - I was in a new and overwhelming situation, I hadn't had breaks for appropriate nutrition, it was blizzarding (Seasonal Affective Disorder anyone?), I didn't get enough sleep last night,  and I'm dealing with hormonal health issues this week that always make my mood that much more labile.

And in that is where the lesson lies.  It's continually a revelation to me when certain things emerge.

After a decade of wrestling with poor boundaries and not great relationships, I had no less than nine friends who I could easily text to ask for prayer and support.  Friends who I can trust to know and love me even on the icky days.  I'm NOT alone!

I can recognize when I need to do better at self-care.  I can remind myself just how important it will be for me to eat appropriate meals and snacks over the next six weeks, and be diligent about getting to bed.  I can plan to pull out my SAD lamp and use it more regularly.

I can recognize the things that I can't change immediately (hormones, weather) and acknowledge that I don't need to be afraid of my mood, because I understand what's making it labile.

I can recognize that though I haven't needed to see my therapist as regularly lately, I might need to be a little more proactive with that in the next six weeks, and that I should book an appointment to talk through some of this experience.

And I can say no.  I can change plans because I need to honor my introversion or need for rest.  I don't have to force something that isn't me.

And with those revelations, I feel just a tiny bit more confident heading back to the unit tomorrow. Because in those revelations I see healing, I see growth, and I even see my word for the year, honor.  I am learning what it is to honor the space I'm in, even while I'm continuing to grow into new spaces.

It's going to be a challenging six weeks.  I'm going to see and experience new things - some of them very hard things.  Some of those are probably going to trigger afternoons like the one I had today.  All of them are going to teach me.  They're going to instill greater compassion and understanding in me.  They're going to inform my practice as a nurse.  And I can choose to focus on the fact that they might be triggering, or I can choose to focus on the fact that even the triggering moments are ones for growth, for learning, and for recognizing how far I've come.  And I can choose to be grateful for that.  (Remind me of that, would you, if you catch me having any sort of extended pity party?  I might vent, but I want to choose to honor this season, too, and to honor it with thanksgiving.)