BEEP BEEP BEEP [horizontal ellipsis] The alarm is screeching. The patient has just come back from surgery. He's in pain, afraid to open his eyes as I change his colostomy bag. I notice air in his IV tubing and read the display on the pump: "AIR-ADVANCE AIR." Could it be a pulmonary embolism? I panic, run from the room, seeking my preceptor, leaving the patient with a leaking colostomy bag. "You have to help me," I beg of the older nurse in the hallway. "There's air in my patient's IV tubing. Something's wrong!!" The preceptor laughs, rolls his eyes, and sits down to explain. I should simply have pressed the advance key on the pump.

How am I supposed to know that a few air bubbles in a peripheral IV line aren't harmful? In school I learned how and when to use all lines, but not how to solve problems that might arise. I return to my patient. His eyes are still closed. He lies there, afraid to breathe, hoping I will be the one to help him with his new body, his new life. But how can I, when I am as frightened of my new life as he is of his?

My more experienced colleagues tell me that the fear of harming a patient never completely leaves a nurse. Sometimes on the subway after work, I worry that I forgot to give a medicine or infused a drug incorrectly. Such thoughts consumed me at the beginning of my orientation. I wondered during each sleepless night how I could learn this job in a mere 12 weeks.

Because nursing schools can't expose students to all the equipment used in critical care, there's plenty of on-the-job learning. Still, I thought I was expected to be not only technically proficient but also compassionate-all the time. In my experience, mastering the technology almost always trumped soothing the patient. I was certain that my patients thought less of me because of my inexperience. And that had to change. For example, I hadn't had much exposure to central venous pressure (CVP) and arterial line monitoring in school. When it came time to set up or disconnect a line so a patient could walk or I could draw blood, I was flummoxed. The complicated mechanisms took so much of my attention that I barely saw anything else. Often, I was too busy to answer the patient's questions. My preceptors repeatedly told me I looked nervous around patients.

One afternoon after my shift I went directly to the nursing education department to practice on spare IV pumps. I practiced drawing blood on dummies; I studied arterial line techniques. Some nights I left work exhausted, but I could stand exhaustion. What I couldn't stand was feeling incompetent when using certain equipment.

Although I often felt like a child for asking questions, I forced myself to ask my preceptor to accompany me while I performed a procedure that I was unsure about. When discontinuing an arterial line, for example, several ports must be turned in a certain direction before the line is removed; otherwise, blood can leak. It took several tries with a preceptor for me to feel comfortable doing this independently.

With their help, as well as my practice sessions with the mannequins, I could care independently for two patients by my sixth week of orientation. And what do you know? With independence came confidence. It's as though the poet Rainer Maria Rilke had me in mind when he wrote1:

I would like to beg you dear Sir, as well as I can, to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don't search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.

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