Nursing is not for the weak, and nursing school is the epitome of that. There are two major things I didn’t learn in nursing school. The first is how to be a nurse. You don’t actually learn to be a nurse until you are a nurse. Nursing school teaches you how to be safe. Basic stuff like how to take a blood pressure, and the body’s physiology. In fact, I learned more about what kind of nurse I didn’t want to be while in school. Rotations through clinical sites gave me examples of nurses with bad habits I couldn’t wait to forget. One of my worst experiences in HIV stigma happened in nursing school from an instructor, and it made me question if a person with HIV could be a nurse. Yet here I am.
The second thing I didn’t learn was how to lose a patient to death. In thinking back, the only conversation about death was an abstract kind of idea that people die as part of the natural life process. Professionalism and distance make that easier. Or so they said. We didn’t talk about what it would feel like to walk into a patient’s room and find them and all of their things gone. My instructors never discussed navigating the talks with a patient’s family about what active dying looks like. During one of my rotations at an assisted living facility, I walked in to find the patient who had been there the day before had passed away. We had only been there a short time, but this particular patient was cranky and had dementia which made her loud, demanding and at the same time hilariously funny. I had to say, she made an impression. While it was a shock to find she had passed, I remember saying a prayer for her, and noting mentally that we didn’t discuss it beyond learning the cause of death. That bothered me, but there were things to learn and people to care for. Professionalism? Disconnection? Maybe a bit of both.
When I began nursing at the AIDS service health clinic I worked at, the idea of death and dying became more than an abstract idea. By that time, I had (mostly) given up the idea that I was going to die of AIDS. I was better educated, taking my meds like my life depended on it (she said tongue in cheek), and applying the wills and wonts of being a good nurse. It was a journey of navigating not only not dying but relearning how to live.
I was also listening to patients tell me about a time before meds when friends died every day. They spoke of stigma and about attending weekly memorials and funerals and forming a community. I witnessed PTSD and the flawed, but understandable guilt of being alive to talk about life when folks they loved were not. I honestly thought I had faced my personal mortality early on when I was diagnosed with HIV. I realized through their stories, I had only glanced at it in the mirror. Those stories, and the path from diagnosis to nursing in AIDS care, to now aging with HIV gave, and still give, me my own dose of irrational guilt every time I struggle to take my meds or skip doses because I’m burnt out on taking them. Not so long ago, at diagnosis they told people to prepare to die in three months or in a year. Now they say you aren’t going to die. The amount of living to be done that flows between those times and words is partially what makes death less abstract and more concrete.
I lost three patients to either comorbidities from, or complications of, an AIDS diagnosis. Three white, gay men I had zero in common with except three letters and some medication. Men whose visits I looked forward to, and whom I daresay felt that way about me. It could be arrogant to say I lost them. Certainly, they had families and lives outside the clinic. Yet, they were mine. I took care of them, knew their spouses and pet’s names. I gave them shots, helped them with questions and gave out hugs. We laughed and cried during visits. I was the nurse they asked for when they needed help. What is also true is, sometimes, they nursed the nurse without even knowing it.
In my head, the fact that I don’t remain disconnected or “professional” is one of my nursing superpowers. I learned how to be a nurse by practicing nursing. I learned about the reality of losing a patient the same way. Nursing is not for the weak, but neither is life with HIV.
Bridgette Picou, LVN, ACLPN, is a licensed vocational and certified AIDS Care Nurse in Palm Springs, California. She works for The Well Project-HIV and Women as their stakeholder liaison. Bridgette is a director at large for ANAC (the Association of Nurses in AIDS Care), and a sitting member of the board of directors for HIV & Aging Research Project-Palm Springs (HARP-PS). Bridgette’s goal is to remind people that there are lives being lived behind a three- or four-letter acronym.