I’ll always remember that first morning, listening to report with you, feeling like everyone was speaking an inexplicable new language. You were so kind, introduced me to everyone, made sure they knew I was Nursing I, not III or IV. At first it was almost overwhelming, tubes, lines, pumps, alarms coming from everywhere. These people were sicker than anyone I had ever seen. But they needed lots and lots of basic nursing care, and that is what a Nursing I student is capable of giving, especially after the expert, hands-on teaching that you provided. I’ve felt so blessed to have had you as my clinical instructor, because excellent groundwork was laid that I will carry with me throughout my career.

I’ll never forget that you told me that I would see “levels of care”. You reinforced in me the type of nurse I want to be, the one who is really WITH her patients. We were either in the rooms with the patients or sitting at a little table just outside their doors, charting during the brief periods of time that they slept. “Our” patients were unable to take care of even the most basic human function for themselves, simply turning over in bed was beyond them. I was able to watch you manage the complicated IV system and ventilators. With your teaching and help, I could keep them clean, dry and comfortable, give them their P.O. meds, do the glucometer testings, measure I&O, perform passive range of motion exercises, sterile dressing changes and help them reposition. Every time I came to clinical, I had new skills that I had learned in lab and you made sure I got to put them into practice. There were days that I felt like the pericare queen, but there is a certain satisfaction knowing that their skin remained clean, dry and intact and their needs were met immediately and with skill and compassion. We never stopped communicating with them. Usually the most they could respond was with a nod or shake of their heads, but we explained everything we were doing, tried to keep their spirits up, maintained their dignity and their sense of value.

We had other patients too....the families. They were an education in themselves. You really could teach a class in therapeutic communication. Because these experiences were all “firsts”, they are engraved forever on my mind. I’ll never forget seeing you with Mr. M’s wife, after she was just so angry and emotionally shattered by the rather callous remarks of a consulting physician. You were down on your knees, holding her hands in yours, looking into her eyes, reminding her that her husband’s neurosurgeon had expressed a different opinion, the infectious disease specialist had thought that there was progress and that while one had to be realistic, which was what this doctor had been trying to convey, there was reason for hope. I watched you help put her back together that night. I’ll never forget loving, distraught Mr. F., (“Wake up and come home to me, Baby” to his wife of 60+ years), or even the daughter from Florida who never spoke to her mother, but kept writing down every action that we took and every reading on the monitors. (It was my first day and rather unnerving.)

Another lesson I’ll take with me is handwashing. We washed when going into the room, before leaving the room and at the sink in the unit between rooms. Gloves are the final step, not the entire solution. I know from my own experience as a patient’s family member, how reassuring it is to see the nurse wash her hands. Even if the patient or family member does not have knowledge of nosocomial infections, seeing the nurse take the time to wash her hands raises the level of trust that things will be done correctly and that she really does care what happens to this patient. In SICU, the importance of handwashing is sometimes taken to a whole new level, i.e., our patient who had not only MRSA but, at the end of the day, the infectious disease doctor came onto the unit to explain the implications of the cultures that were positive for the organism that causes meningitis. We had taken care of this man all day, but were gloved, gowned and masked (wearing the masks with the eye shields). We did this so we wouldn’t carry any MRSA organisms to other patients, but with the new culture information, I was grateful for the protection also.

I think the most important knowledge you shared with me was the joy you still have in nursing, 30 years into the field. As a nursing student, you hear horror stories of the senior nurses who warn students away from the profession. I’ll never forget the day when Mr. M., who had been unresponsive except for localizing pain, first moved his tongue for me when I told him I needed to take his temperature. It was exciting just to think he had heard and responded. By that afternoon, when he raised his arms and legs independently at your request, we applauded and cheered like he was the quarterback who just threw the touchdown pass. His wife arrived on the unit just then, and you brought her in to see this...and he did it again. Then his friend walked in, kidded him about getting back to work, and Mr. M. actually smiled, really smiled, ET tube and all. It was group hug time with Mrs. M. Then, when we went out into the unit to give the family some private time, we were simply elated with what had just happened. We had tears of joy coming down our cheeks. You said to me, “THIS is what nursing is all about!” Yes, it is....and I want more than ever to be a part of it.

Thank you, Marianne, thank you,

Nancy Mach