Passive Aggressive Nursing

Three days later I entered the office of my new manager. She was a powerful woman with a strong presence and a firm voice. I sat with her in her small and overcrowded office with loud blue walls and too many books. I clenched my hands nervously together in my chair, bracing myself for the uncomfortable conversation that was about to ensue. Up to this point, I had done my best to be what I felt was ‘strong’, in hiding my lupus at all cost, even to the point of experiencing additional pain. I wasn’t looking for any handouts, and I certainly didn’t require any extra attention or pity. Nonetheless, I knew I could no longer hide.

My body, having a mind all its own, had decided for me.

And I had little option but to concede.

I inhaled deep and began sharing with her about my lupus, letting her know the changing of shifts from nights to days had been hard on me, and I was not responding well to the change. I was hopeful that she would be accommodating, particularly as I had learned another nurse had recently been taken off nights as she was trying to become pregnant.

Surely, this was a more concrete concern.

Surely, she would understand.

I studied her face from across the desk, searching for understanding, searching for any glimpse of sympathy. But all I saw staring back at me was a blank emotionless face. I paused, as she asked me to explain my lupus more fully. “What are your symptoms?”, she inquired. I shared with her about my joint pain and debilitating fatigue, but she didn’t appear satisfied. I watched as she crossed her arms together and went on to ask, “So what medications are you on?”. I wondered if she was even allowed to ask me that? Nonetheless and perhaps too easily, I complied.

I tried my best to describe the severity of my disease, but something in me told me I was not getting through to her. I couldn’t help but feel I was not penetrating the wall that she seemed to have put up. Concerned, I went on to include words such as “chemotherapy” and “kidney involvement”. Finally, I offered to bring her a doctor’s note to explain my health history along with pertinent labs to which she was agreeable.

I watched as she folded her hands together on her desk, finally conceding to a change in schedule, pending I provide her with the appropriate documentation. But something about our exchange felt off. Something about our exchange felt wrong. While I was thankful to be starting day shift only, I couldn’t shake the awkwardness I felt in leaving her office that day.

I dismissed my fleeting thoughts. Perhaps I was being oversensitive. Perhaps I was reading into things, as was my general tendency.

A few weeks passed, and I had happily started working day shift only. I was thankful to be sleeping at night again, knowing it was better for my overall health to be on a set schedule. I prayed my body would follow suit with the change.

But the shifts were busy.

Busier than I would have liked.

And in the world of hospital nursing, the day shift is known for being considerably more busy and chaotic than that of nights. This was in large part due to the sheer volume of people coming and going on the floor. There were visitors coming and doctors with parades of residents and interns performing their rounds. There were social workers and physical therapists. There were speech therapists and recreational therapists. And there were surgeons and specialists of all kinds coming to check in on their patients, all typically wanting some form of update.

The shifts seemed to be somewhat of a whirlwind, flowing quickly by. But my drives home were often pain filled, as my body was faithful to remind me of my unrelenting disease.

Even still, I told myself this was it. I had made a change, and I needed to make this work.

More, I cringed at the very thought of another awkward meeting with my manager. I needed to not see her for a while. I had to get the sense of the rejection I felt out of my head.

But my pain. My pain hounded me at every turn, interrupting my shifts, and following me down the halls. It screamed at me as I drew up meds and strangled my fingers as I attempted to complete my paperwork in time. A fatigue and general sense of feeling unwell had come over me, and I couldn’t help but wonder if working full time in this capacity was just too much for me.

It killed me to even let myself think those words, let alone have to say them to anyone. And no less, to my manager. Even still, I knew what I had to do.

Five days later, I stepped into that same office a second time, only this time there was another younger nurse sitting there as well. She had been in charge of helping me through my orientation period which I had since completed. I found it odd that she was to sit in on our meeting. I wasn’t comfortable sharing with her about my health information, particularly as she had been less than welcoming since I began working on the floor.

There were a number of younger nurses on the unit, which I initially assumed would make the unit a fun place to work. But I quickly came to learn there was a culture among nurses, one that all too often included a hierarchy and many cliques. More, while subtle and often passive aggressive, there was also a good deal of competition and bullying that took place. I encountered my share of nurses and even patient care associates who tried to intimidate me in this way or that during my time on the unit. I had an older nurse tell me I was “too confident and knew too much”. I wasn’t sure what that even meant. I wasn’t about to apologize for not being insecure. And honestly, while a rude comment here or there was frustrating,

I had bigger things to worry about.

As I entered the office, I grabbed a seat next to my fellow nurse, flashing a quick smile in her direction as I sat down. She looked toward the manager, as if to take her cues only from her. I exhaled, bracing myself for what was to come, already feeling a little ganged up on. Nonetheless, I began to share with them the difficulty that I had been having in working full time. I thanked my manager for having already been gracious enough to put me on the day shift. I then shared that unfortunately my symptoms had not quieted down as we had hoped. I was becoming sicker and would likely need to drop down to a part time schedule of thirty-two hours per week or whatever she had available.

The room went silent. They just sat there, staring intently at me. My manager then went on to inquire as she had in our first meeting, “So, what are your symptoms?”. I obliged and filled them in. She then leaned in toward me, lowering her voice and queried, “Are you sure you are not making this up so that you can have a particular schedule?”.

I was stunned.

It was as if everything froze in that one terrible moment.

I sat there, not knowing how to respond. My heart was suddenly beating faster in my chest, and I heard myself back petal with my words. I inhaled deep, calmly assuring them that I was indeed not looking for a “particular schedule”. I reiterated that I was in fact sick and offered to bring in more blood work if needed to prove so.

I knew she didn’t believe me. I saw it written all over her face.

For the first time in my life, I was being discriminated against because of my illness.

What I didn’t know then was that it wouldn’t be the last.

Defeated, I left the unit that day with my head hung low in frustrated sadness. Was this really happening? My manager told me she needed to look at the schedule and would get back to me. I didn’t know what that meant, but I did know in that moment I began to despise my own profession. This was supposed to be the ‘helping profession’, known for being some of the most caring people in the world.

Was I being unreasonable?

I couldn’t be the first person with a chronic illness to require schedule adjustments.

It just didn’t make sense.

And none of it sat well with me.

Later than night I sat on the kitchen floor in my parent’s house as I had so many times before. I told them of our meeting and the reaction I received. I glanced at the worn linoleum floor as I sat, noting it was cool to touch. I knew I was sad, but as I told them of our conversation, something in me broke. She had no idea what I had endured these past few years. What all three of us had endured.

It had been the fight for my life.

I saw the pain I felt reflected in my mom’s eyes. “She just can’t do this!”, my mom erupted. I knew they were upset for me. I saw it written all over their faces. I heard it in the mention of pursuing legal action, but that wasn’t a course I was willing to take.

I didn’t want revenge.

I just wanted some compassion.

And I knew I wasn’t going to get it from my manager.

I knew I had to make a change. The problem was that she was influential throughout the hospital. I feared her disdain for me would follow me to other units should I make a transfer. And I couldn’t risk that.

No, I needed to start over. Some place new. Perhaps even in a different field. My mind began to wander, considering all the possibilities.

As much as she had hurt me, I knew I needed to forgive her. Even though it still hurt, and I most certainly didn’t want to.

There was no denying. 

It was time to move on.

Pediatrics

Winter lingered, and I felt the coolness of the air enter my nostrils as I walked, giving my nose a familiar pink hue. I inhaled the clean morning air, noting the snow crusted grass in the distance. I quickly checked my appearance in the window of the approaching building. Things were changing again. Only this time, they were welcomed changes. Changes I had worked towards for quite some time.

I nervously adjusted my turquoise scrub top under my jacket as I entered the building. I wanted to look just right.

Today was the day I would begin my career as a registered nurse.

I was so excited, having completed clinicals in a variety of settings. General medicine. Obstetrics and gynecology. Surgery. Oncology. Geriatrics. There was however, one particular area that peeked my interest above the rest.

Pediatrics.

I loved kids. I had been babysitting since I was eleven years old. And as soon as I began my clinical rotation on the unit, I fell in love. It was an infant toddler unit, meaning birth through five years old. There were kids with tubes in their noses and IVs in their arms. There were children requiring surgeries for a variety of conditions including pyloric stenosis and Hirschsprung’s disease. There were colon resections and hernia repairs. There were babies born addicted to the drugs their mothers consumed who were in need of careful weaning. Their piercing cries were unlike that of any other child.

There were respiratory viruses and asthma attacks where parents and staff alike fought tirelessly to raise oxygen levels in tiny constricted lungs. There were allergic reactions and fevers of unknown origin. There were pinworms and bodies covered in scabies. And there were cases of sexual abuse and neglect, often occurring in children under the age of two. These sweet ones, unable to speak for themselves, were particularly vulnerable to abuse of all kinds.

And it was all I could do not to become attached to each one as I learned how to bathe, dress and feed them during my clinical rotation. Something in me wanted to help. I knew these kids were strong. But I also knew I wanted to, in some small way, be a part of their story.

My instructor had taken a liking to me during my rotation on the unit, and upon graduation I was accepted as a staff nurse. It was a hard adjustment on many levels. Starting my career was certainly intimidating, as I now had people counting on me. Tiny people counting on me. And parents with wide eyes, looking to me to do the right thing. And worse, say the right thing. More, I didn’t know how my body was going to respond. As hard as I had worked to get through school, I had yet to complete a twelve-hour shift, and I knew these would be the bread and butter of my new-found career. I figured I was a hard worker, and I was determined. My body would surely follow suit.

It had to.

I grabbed my list of patients on that first day and nervously punched the code for the med room. I told myself I had done this many times before. I watched anxiously as another nurse drew up her meds, knowing I was next in line. The thing about pediatrics is that you had to be somewhat good at math. There were many calculations, as the majority of the medications to be administered were weight based. And an error in calculation could be fatal.

I swallowed hard, trying not to overthink things, reminding myself I had earned the right to be here. Earned the right to care for these little ones. Just as much as any other nurse. It was a strange dichotomy in those first few weeks, wondering, as I brought an absurd amount of juice boxes to patients and their families, if I had set the bar all too low, while simultaneously hoping and praying that I wouldn’t inadvertently kill someone later while administering medications.

As the weeks passed, my initial fears were assuaged, and any remaining apprehension was quickly replaced by a new-found confidence and sense of routine. I was eager to learn new skills, knowing there would be much on the job training. It seemed with each newly dropped nasal tube and each newly placed dressing, I was in some small way, proud of myself.

And proud how far I had come.

I hadn’t give up yet.

And while this wasn’t the dream I had set out to do from the start,

I was still here.

Those first weeks passed quickly. My shifts, like those of many new nurses, were not ideal. I was placed on a rotating schedule that included working one week of days followed by one week of nights. Weekends and holidays were also included. It was hard on my body. Harder than I wanted to admit. My joints had begun to ache again, and the fatigue was written all over my face. I wasn’t responding well to the change in shift work, and I could feel it.

But what choice did I have?

I told myself I would get used to it. Used to the schedule of it all. I just had to give it a little time.

But the shifts were busy. It was spring time now, and the units were booming with patients. I had been told many nurses become quite ill within the first year of working on the unit, having been exposed to a variety of illnesses. One had to “build up an immunity”.

But what would that look like for someone like me?

Was I going to get very sick?

I swallowed hard as I parked my car that evening. I hated taking the shuttle into work, but it was getting darker, and I knew I had little choice. It felt like an event just getting to the hospital building, often leaving me fatigued before my shift had even begun. As I neared the unit, I quickly pulled my hair up in a ponytail, telling myself I would drink some coffee and that things would be okay. Promising my body that I would feel better. And that it wouldn’t always be this hard.

But for now, I knew I needed to focus. There were children, most of whom were far sicker than I, who needed to be cared for. There were vital signs to be checked and intravenous bags of food and fluids to be hung. There were assessments to be made and oxygen levels to be monitored. There were dressings to be changed and tubes to be placed. More, there were medications to be given and all too much paperwork to complete.

Later that night I sat in the doctor’s lounge under fluorescent lighting with two other nurses dressed in flowery pink and blue scrubs. We sat around a large rectangular wooden table, each with a chart or two open, attempting to complete notes on our patients for the night. I found charting to come fairly easy and without much effort. And as such, I often found myself curiously listening to the doctors from across the room as they discussed cases. Who were they talking about and what diagnoses were being made? I found myself drawn to them, secretly wishing I were a part of their team.

I had hoped as I began my career in nursing that I would be able to more fully let go of my dreams for becoming a doctor. But as time passed, I found a growing part of me ached bitterly, as I recalled the horrid thin envelopes that had been delivered in the mail all those months ago.

“No, it could have been different.” I told myself.

I could have gone out of the United States for medical school. But that was a risk I just wasn’t willing to take. Not with my health history. Even still, as much as I loved being a nurse, there was something in me that, as much as I tried to deny it, wanted more.

A few moments passed, and I watched as my pen rolled off the table. I quickly bent over to pick it up, noting a sharp pain in my right knee. I reflexively braced my leg as I sat up, noting it was swollen to the touch. I exhaled, recalling the exhaustion I had dismissed not a few hours early. My frivolous doctor thoughts were suddenly dispelled, as reality was setting in.

I was sick again.

And getting sicker.

Despite my best efforts, lupus was not going away.

And to my fear and dread, I needed to talk about it.