Thursday, October 14, 2010
Saturday, September 25, 2010
LIFE, DEATH AND RENEWAL
A sense of foreboding gripped me as I entered the department. The aides were pushing a morgue stretcher away, leaving sharp intakes of breath and a muffled cry. Three nurses huddled around the triage desk, one nurse was visibly upset.
Outside the trauma room stood two burly policemen. The aftermath of a trauma resuscitation greeted me: the blood-splattered floor was strewn with discarded clothes, a used stylet, wadded gauze, and the blue overwraps from the instrument trays.
The night nurse looked shell-shocked. On Bed A, an unconscious male patient lay in a tangle of wires and tubes. The ventilator hummed and the monitors bleeped. Endotracheal tube to the ventilator, sinus rhythm on the monitor, an arterial line, two large-bore IV lines, a urinary catheter, right chest tube, right leg splint, dried blood on bandaged head, and his left hand cuffed to the side rails.
"Here's our 20 year-old trauma patient... this..." the night nurse bit her lip to stifle an expletive. "This person just murdered his girlfriend, her two children and her grandma. Shot them point-blank. He jumped four stories off the roof after he was chased by the police. All this because she tried to leave him after a night of beatings. That was the youngest child we just sent to the morgue. " Her voice broke and we both shuddered.
We stood at the bedside and shared each other's anger. The thought of the carnage this man left behind made me recoil in disgust. I felt a need to cry; bile rose up in my throat. Even in repose, this man's face looked so evil, almost satanic. Despite all the repulsion I felt, I had no choice; I had to take care of this patient. My training and my ethical responsibility will ensure that I give this patient the best of care, no matter what.
The night nurse struggled to finish the report. She was rambling, obviously wanting to simply put the ugliness behind her. I could only pat her back. "He's pending the CAT scan results. His pupils are fixed and dilated; he's unresponsive to any stimuli, no corneal reflexes, and he's posturing." This patient is as good as dead, I thought. The machines keep him alive.
As if on cue, the physician strode over. "He's got a huge subarachnoid bleed. No surgery for him. We're starting brain death protocol on him... and surprise! The cops just found his organ donor card."
Somehow, my anger simmered away. I clutched at one straw of sanity... in one rational moment, this man has willed his organs so that in his death, others could live. The organ donor card tells me that at one point in his life, this man cared enough. A little too late. Why couldn't he be as generous in life?
http://jo-cerrudo.blogspot.com/2010/08/ed-vignettes.html
Friday, September 17, 2010
Patient Privacy and technology
The advent of technology has a lot of advantages. With Yahoo Messenger, Skype and other internet chat/ conferencing services, we can now talk to relatives and friends around the world at no cost at all, or very minimal if any (that's if you have to go to the internet shop and pay per hour). It allows us to rant or praise through blogs, reconnect with friends and make new ones through networking sites, and practice our writing, photo editing, singing, dancing instrument playing talents. Mobile phones are becoming cheaper and more high tech, you can now have a mobile phone, a camera, a videocam, an organizer and an mp3 player all rolled into one teeny tiny phone (and that's just the basics). Technology allows for better documentation of our daily affairs, reunions, vacations, projects, etc. Unfortunately, people have gotten overboard with these new found powers. They air their dirty laundry for everyone to see, mess with videos and pictures to destroy people. Some are premeditated acts, and some just fell victim to ignorance. Sad but true, even nurses have had issues with misuse of technology.
The first sensationalized case in the Philippines involving nurses was the canister videotape scandal where members of the medical team deliberately videotaped (using a cellphone) a procedure on patient who came to the ER with a very humiliating situation. That video found its way to the world wide web. It was very malicious and there's no way it could be argued that it was (the videotaping and the posting) an honest mistake. They thought it was funny, and even funnier if the patient suddenly finds his face plastered on the internet. These were people, who took an oath, to respect the dignity of any patient, regardless of color, race, political, religious or personal beliefs, etc. Shame!
Then this year, the technology bust came through again, this time in the form of the right-of-passage summer ritual among boys - circumcision. It's nothing new, every summer, there's medical missions offering free circumcisions to young boys. It's tradition. What was new was this year, pictures from these activities flooded the internet. Worse, it showed young boys, faces, penises, and all. No effort was done to protect their privacy. Worst of all, members of the medical team were seen smiling and posing over patient's agonized faces, or their private parts being cut (and that oh-so-annoying finger sign!) I doubt one will argue the "free" gave them the right to do whatever they please. It wasn't that at all. It was ignorance, and maybe complacency. After all, it was a good deed, a medical mission. Surely, anyone would be excited to share in someone's being hero for the day....right? Pictures started being shared and perused by friends, friends' friends, and so on and so forth. Pictures were re-tweeted, side shows became available on youtube. And then someone cried FOUL!
All of a sudden, Filipino nurses and doctors are being called pedophiles, exhibitionists etc. We've been branded! There's even a facebook page about it. You should see what's being said about us over there. It's unfair to be branded and generalized, it's true. But what's even unfair, is that the patients' rights to privacy and confidentiality were again violated, our oath to protect was disregarded. Seems to me like that oath isn't worth squat.
We can blame technology but I think that technology has helped us (in a twisted sense) realize that in every action that we do, we always need to look at it 360 degrees. Specially if it involves patient care. The patient always come first. Boohoo, You can't post pictures of the excitement, or need to take time blurring patients' faces. But remember, you took an oath. Better serve up.
The first sensationalized case in the Philippines involving nurses was the canister videotape scandal where members of the medical team deliberately videotaped (using a cellphone) a procedure on patient who came to the ER with a very humiliating situation. That video found its way to the world wide web. It was very malicious and there's no way it could be argued that it was (the videotaping and the posting) an honest mistake. They thought it was funny, and even funnier if the patient suddenly finds his face plastered on the internet. These were people, who took an oath, to respect the dignity of any patient, regardless of color, race, political, religious or personal beliefs, etc. Shame!
Then this year, the technology bust came through again, this time in the form of the right-of-passage summer ritual among boys - circumcision. It's nothing new, every summer, there's medical missions offering free circumcisions to young boys. It's tradition. What was new was this year, pictures from these activities flooded the internet. Worse, it showed young boys, faces, penises, and all. No effort was done to protect their privacy. Worst of all, members of the medical team were seen smiling and posing over patient's agonized faces, or their private parts being cut (and that oh-so-annoying finger sign!) I doubt one will argue the "free" gave them the right to do whatever they please. It wasn't that at all. It was ignorance, and maybe complacency. After all, it was a good deed, a medical mission. Surely, anyone would be excited to share in someone's being hero for the day....right? Pictures started being shared and perused by friends, friends' friends, and so on and so forth. Pictures were re-tweeted, side shows became available on youtube. And then someone cried FOUL!
All of a sudden, Filipino nurses and doctors are being called pedophiles, exhibitionists etc. We've been branded! There's even a facebook page about it. You should see what's being said about us over there. It's unfair to be branded and generalized, it's true. But what's even unfair, is that the patients' rights to privacy and confidentiality were again violated, our oath to protect was disregarded. Seems to me like that oath isn't worth squat.
We can blame technology but I think that technology has helped us (in a twisted sense) realize that in every action that we do, we always need to look at it 360 degrees. Specially if it involves patient care. The patient always come first. Boohoo, You can't post pictures of the excitement, or need to take time blurring patients' faces. But remember, you took an oath. Better serve up.
Saturday, September 11, 2010
what if??
As a nurse, it's all part of our job to render health teachings to our clients. What to do, what to eat and drink. While doctors were the one whose explaining to them their medical status or medical condition. These were the routines were used to do inside the hospital.
But what if one day, you are the one whose hospitalized? You are the one whose lying on the hospital bed. You'll be the patient taken good care by others. Are you ready to listen? Are you ready to accept the findings? Are yo ready to face death?
Been asking this question inside my mind. Working inside a hospital, death is inevitable.
=====
dhee, r.n.
But what if one day, you are the one whose hospitalized? You are the one whose lying on the hospital bed. You'll be the patient taken good care by others. Are you ready to listen? Are you ready to accept the findings? Are yo ready to face death?
Been asking this question inside my mind. Working inside a hospital, death is inevitable.
=====
dhee, r.n.
Monday, September 6, 2010
More Than Words
Hello dear nurses,
I got a call recently from a client who was desperately seeking support for a nurse accused of misconduct and facing losing her right to practice as a nurse in Ireland.
When first hearing about the case, I asked a lot of questions and it seemed that communication difficulties were among the issues that patients had complained of about this nurse.
When I sat down to have a chat with this nurse to see how I could help her, it turned out that she was highly educated and communicated quite well.
One thing stood out about her communication and that was her pitch (how high and low her voice modulated). After reading a little about her mother tongue, it turned out that pitch was used quite differently in her mother tongue than in English. In English, people often raise to a high pitch when annoyed or nervous or anxious but in Hindi, this nurse's native tongue, pitch is used to emphasise content that is important.
It seemed that this nurse was simply transferring a habit from her mother tongue, without realising the effect on her patient.
The episode clearly highlights that communication is so much more than the words we use; it's all about how we use them. Knowing a language is more than having an extensive vocabulary; it's about how we use that vocabulary. The use of pitch (high/low voice range) in English is very different to other langauges and good to know that a raised pitch signals some kind of distress or anxiousness, something that patients are bound to react to as it signals something is not quite right with the speaker.
Have you had miscommunications that were due to something like this nurse's miscommunication - more than words?
Until next time,
Marie
I got a call recently from a client who was desperately seeking support for a nurse accused of misconduct and facing losing her right to practice as a nurse in Ireland.
When first hearing about the case, I asked a lot of questions and it seemed that communication difficulties were among the issues that patients had complained of about this nurse.
When I sat down to have a chat with this nurse to see how I could help her, it turned out that she was highly educated and communicated quite well.
One thing stood out about her communication and that was her pitch (how high and low her voice modulated). After reading a little about her mother tongue, it turned out that pitch was used quite differently in her mother tongue than in English. In English, people often raise to a high pitch when annoyed or nervous or anxious but in Hindi, this nurse's native tongue, pitch is used to emphasise content that is important.
It seemed that this nurse was simply transferring a habit from her mother tongue, without realising the effect on her patient.
The episode clearly highlights that communication is so much more than the words we use; it's all about how we use them. Knowing a language is more than having an extensive vocabulary; it's about how we use that vocabulary. The use of pitch (high/low voice range) in English is very different to other langauges and good to know that a raised pitch signals some kind of distress or anxiousness, something that patients are bound to react to as it signals something is not quite right with the speaker.
Have you had miscommunications that were due to something like this nurse's miscommunication - more than words?
Until next time,
Marie
Saturday, September 4, 2010
My Colostomy Story
A repost from my blog.
********************
Today, I had to deal with the dilemma of me being an experienced neurosurgery nurse, working in a general surgery unit. I worked in an ER and neurosurgery environment for the last seven years, and I knew that I would be faced to deal with some unfamiliar cases in a new work place.
I had a patient with a colostomy. Well, it may sound so simple for some general surgery nurses out there, but it was a big deal for me. It’s not that it was my first time, because I have had several patients with a colostomy. But it was my first time in several years to actually perform colostomy care – to actually touch and clean the stoma.
I was busy with another patient when I heard somebody screaming. When I looked out of my patient’s room, I saw one of my co-nurses coming out from one of my patient’s room. She asked me if the patient in room x is my patient, so I told him yes and asked her what’s wrong. She said the patient was complaining because he was yelling for an hour already and nobody is coming for him.
Since I was finished with my current patient, I decided to check the complaining patient out. I went to his room and I was welcomed with some more yelling. I asked him if he was pressing the bell since that is the proper way of calling a nurse. He said he did but it seemed the bell was not working.
I investigated further, and found out that the bell cord was not attached to the plug. So that was the reason nobody was coming to him. I was successful in trying to pacify him. I asked him what he needed and found out that his colostomy leaked up to his back. He said he was trying to open his colostomy because he felt it was full of air. When he opened it, he got surprised with the contents and everything leaked out and went to his clothes and sheets.
My patient had a colorectal cancer and the surgeons tried to remove the cancerous part of his large intestines. A new opening was made on the left side of his abdomen where his stool can come out, and will be drained to a pouch called colostomy bag.
I checked what I needed to clean him, and after that I told him I need to get some things in the stockroom. When I got into the stockroom, I took some fresh linens, pads, cleaning wipes and saline. To my horror, I found that there were different sizes of colostomy bag. How would I know which one is for my patient? I decided to just bring one from each of the different sizes. I thought it would be safe since I do not have to come back if one size fails.
When I went back to my patient’s room, I checked his colostomy so I could choose which size of bag I would need. To my surprise, none among those I brought were the same as my patient’s. I needed the biggest size which seemed not available because I did not find that size before. I knew I took one sample from each of the sizes I saw.
I went back to the stockroom and searched for the largest size. I did not find any, so I asked one of my seniors. He helped me search until he finally said it was probably out of stock.
I decided to go to another ward and asked for that size. I knew that every minute counts for my patient who was irritable initially. I found the size from another surgical unit and hurriedly went back to my patient.
When I got into my patient’s room, I was greeted by a frown. I explained to him why it took me a bit long to come back, that I needed to get his size from another unit. He seemed dissatisfied with my explanations, so I just tried my best to talk to him nicely.
I detached the old pouch from where it was connected. I placed it in the bathroom since I wanted to save the wire that closes the pouch at the end. I cleansed his stoma with normal saline. After cleaning, I tried to attach the new pouch to the connector. It seemed I could not connect it. It was either I was doing it the wrong way, or I just do not know what I was doing.
While I was trying to attach it, I tried to converse to him to try divert his attention from what I was doing. I explained to him some facts about colostomy, and how to take care of it. I was posing to be a pro with what I was doing, when deep inside, I knew I could not connect the bag. It was hurting him when I pressed harder on the pouch lid.
I then decided to ask help from a co-nurse. God probably heard my heart beating fast, and gave me a colleague just passing by my patient’s door! I asked her to help me attach the colostomy bag. She told me how to do it and watched me do it. It was the same technique as what I was doing before. But she also felt it was difficult doing it that way so she suggested for me to just remove the part that was attached to the skin, and apply a new one. The adhesive part that was touching the skin and the bag should already be connected before sticking it to the skin.
I actually thought of that, but I knew it was the harder way of changing the bag. But now, it seemed there was no other way but to do it that way.
I was successful in applying a new bag on him. I went back to the bathroom and took the wire from the old bag. It was heavily stained with stool so I just tried to clean it. I closed his colostomy bag using that wire.
I wiped him a bit, and brought him to the bathroom after that. I changed his gown and placed new linens on his bed. His mood has changed, and was apologetic about his attitude a while ago. I told him it was pretty understandable for him to get mad in his situation. I left him clean and satisfied with what I have done for him.
In the evening, before I left the unit, I checked him out in his room. He was with his family, and I was introduced to them. I told him that my shift is over and that I was leaving. He asked who’s replacing me, but I was not sure who’s taking care of him next. I saw in his face that he still wanted me to stay for him.
Before I left, he said smilingly “See you on Sunday!”.
********************
Today, I had to deal with the dilemma of me being an experienced neurosurgery nurse, working in a general surgery unit. I worked in an ER and neurosurgery environment for the last seven years, and I knew that I would be faced to deal with some unfamiliar cases in a new work place.
I had a patient with a colostomy. Well, it may sound so simple for some general surgery nurses out there, but it was a big deal for me. It’s not that it was my first time, because I have had several patients with a colostomy. But it was my first time in several years to actually perform colostomy care – to actually touch and clean the stoma.
I was busy with another patient when I heard somebody screaming. When I looked out of my patient’s room, I saw one of my co-nurses coming out from one of my patient’s room. She asked me if the patient in room x is my patient, so I told him yes and asked her what’s wrong. She said the patient was complaining because he was yelling for an hour already and nobody is coming for him.
Since I was finished with my current patient, I decided to check the complaining patient out. I went to his room and I was welcomed with some more yelling. I asked him if he was pressing the bell since that is the proper way of calling a nurse. He said he did but it seemed the bell was not working.
I investigated further, and found out that the bell cord was not attached to the plug. So that was the reason nobody was coming to him. I was successful in trying to pacify him. I asked him what he needed and found out that his colostomy leaked up to his back. He said he was trying to open his colostomy because he felt it was full of air. When he opened it, he got surprised with the contents and everything leaked out and went to his clothes and sheets.
My patient had a colorectal cancer and the surgeons tried to remove the cancerous part of his large intestines. A new opening was made on the left side of his abdomen where his stool can come out, and will be drained to a pouch called colostomy bag.
I checked what I needed to clean him, and after that I told him I need to get some things in the stockroom. When I got into the stockroom, I took some fresh linens, pads, cleaning wipes and saline. To my horror, I found that there were different sizes of colostomy bag. How would I know which one is for my patient? I decided to just bring one from each of the different sizes. I thought it would be safe since I do not have to come back if one size fails.
When I went back to my patient’s room, I checked his colostomy so I could choose which size of bag I would need. To my surprise, none among those I brought were the same as my patient’s. I needed the biggest size which seemed not available because I did not find that size before. I knew I took one sample from each of the sizes I saw.
I went back to the stockroom and searched for the largest size. I did not find any, so I asked one of my seniors. He helped me search until he finally said it was probably out of stock.
I decided to go to another ward and asked for that size. I knew that every minute counts for my patient who was irritable initially. I found the size from another surgical unit and hurriedly went back to my patient.
When I got into my patient’s room, I was greeted by a frown. I explained to him why it took me a bit long to come back, that I needed to get his size from another unit. He seemed dissatisfied with my explanations, so I just tried my best to talk to him nicely.
I detached the old pouch from where it was connected. I placed it in the bathroom since I wanted to save the wire that closes the pouch at the end. I cleansed his stoma with normal saline. After cleaning, I tried to attach the new pouch to the connector. It seemed I could not connect it. It was either I was doing it the wrong way, or I just do not know what I was doing.
While I was trying to attach it, I tried to converse to him to try divert his attention from what I was doing. I explained to him some facts about colostomy, and how to take care of it. I was posing to be a pro with what I was doing, when deep inside, I knew I could not connect the bag. It was hurting him when I pressed harder on the pouch lid.
I then decided to ask help from a co-nurse. God probably heard my heart beating fast, and gave me a colleague just passing by my patient’s door! I asked her to help me attach the colostomy bag. She told me how to do it and watched me do it. It was the same technique as what I was doing before. But she also felt it was difficult doing it that way so she suggested for me to just remove the part that was attached to the skin, and apply a new one. The adhesive part that was touching the skin and the bag should already be connected before sticking it to the skin.
I actually thought of that, but I knew it was the harder way of changing the bag. But now, it seemed there was no other way but to do it that way.
I was successful in applying a new bag on him. I went back to the bathroom and took the wire from the old bag. It was heavily stained with stool so I just tried to clean it. I closed his colostomy bag using that wire.
I wiped him a bit, and brought him to the bathroom after that. I changed his gown and placed new linens on his bed. His mood has changed, and was apologetic about his attitude a while ago. I told him it was pretty understandable for him to get mad in his situation. I left him clean and satisfied with what I have done for him.
In the evening, before I left the unit, I checked him out in his room. He was with his family, and I was introduced to them. I told him that my shift is over and that I was leaving. He asked who’s replacing me, but I was not sure who’s taking care of him next. I saw in his face that he still wanted me to stay for him.
Before I left, he said smilingly “See you on Sunday!”.
(picture credit: butler.org)
A day in a life of an EMT: Drink while driving
Several weeks from now, it's going to be October. We all know what that means; it's going to be beer, beer, and more beer because of Oktoberfest. And as you've noticed, I'm overlooking September since I'm still assigned in Rockwell post for the whole month, which FYI-- is the most benign post you'll ever get assigned in. We hardly have multiple runs in a shift there. Sometimes we get lucky but most of the time we run once, and the rest is all eat and sleep.
It will be my first October in Lifeline so I'm not familiar with the statistics of trauma but I'm guessing we'll be having Lifeline members driving piss-drunk that month. I could be wrong though; investing in healthcare is something a smart person would do. A smart person wouldn't do stupid things like gulping vino and then go behind the wheel.. but hey, we can't put alcoholics and juvenile delinquents out of the picture right? Haha. Let's face it: idiot drivers will give me much of the practice I need in intubation. I swear if I encounter an RTA with GCS 8, the moment the cot locks at the back of the ambulance I'll be over his head, prying his jaw open with a Macintosh. Medical practice. Nursing practice. Eh. There's a reason why they attached the word "practice". Of course I know what I'm doing; indications, advantages, disadvantages, complications.. I took ACLS. The success rate, however is an entirely different thing. I know what I'm doing, I'm just not that good at it yet. Burned!
So when October comes, think twice about driving drunk. Sure we' ll save your life; dial 16-911 and we'll be happy to extricate you from your Prius (with spinal immobilization of course). But the time you don't respond to sternal rubs and then your oxygen saturation takes a nosedive below 90% despite a well secured BVM before we reach the nearest ED, I assure you I'll be the first one to shove a tube down your throat. Drive safe people.
It will be my first October in Lifeline so I'm not familiar with the statistics of trauma but I'm guessing we'll be having Lifeline members driving piss-drunk that month. I could be wrong though; investing in healthcare is something a smart person would do. A smart person wouldn't do stupid things like gulping vino and then go behind the wheel.. but hey, we can't put alcoholics and juvenile delinquents out of the picture right? Haha. Let's face it: idiot drivers will give me much of the practice I need in intubation. I swear if I encounter an RTA with GCS 8, the moment the cot locks at the back of the ambulance I'll be over his head, prying his jaw open with a Macintosh. Medical practice. Nursing practice. Eh. There's a reason why they attached the word "practice". Of course I know what I'm doing; indications, advantages, disadvantages, complications.. I took ACLS. The success rate, however is an entirely different thing. I know what I'm doing, I'm just not that good at it yet. Burned!
So when October comes, think twice about driving drunk. Sure we' ll save your life; dial 16-911 and we'll be happy to extricate you from your Prius (with spinal immobilization of course). But the time you don't respond to sternal rubs and then your oxygen saturation takes a nosedive below 90% despite a well secured BVM before we reach the nearest ED, I assure you I'll be the first one to shove a tube down your throat. Drive safe people.
Friday, September 3, 2010
A Push to Future Nurses
"I did my best and I know I have my chances." - an excerpt from a now RN friend.
This is one statement that stuck in my head years after the night our NLE result was released. I was fortunate to have passed the exam but was also heartbroken trying to comfort good friends who did not make it. It never occurred to me that the minute I become a boardpasser I am to apply all the nursing therapeutic communications I have learned in and out of the classroom. During this time it was hard to be full-throttle celebratory that I could only settle with being thankful.
The NLE, like any other board examinations, can be a life-altering event. Making it to the roster gives license to practice one's chosen profession. But while others take it as one huge step to reaching their dreams, to some it becomes a make or break deal. I have seen test-takers who were either disheartened or digressed by ill luck in this exam. Perhaps because we program ourselves to pass and never do we make any contingency plans that we put ourselves into instant defenselessness. Not making it the first time then becomes a more onerous test - a test to one's character. There are those who start to question their abilites, others turn either cynical or sour, and there are those who hastily decides to call it quits without attempt for a second try.
Bereavement is normal. We are humans afterall. But redemption will have to be a matter of choice. To those people who remain averse about retaking the exam will never know the difference; while those who prefer to rise to the occasion will have their chances of becoming certified one day. In this case, fortune may clearly have to favor the brave.
With the recent release of the new batch of registered nurses, I can't help but look back at that night when I had to share strength to colleagues who needed them. Years passed and I am proud to say that these friends of mine are not only licensed, but now fair in the industry, simply because they did not give up. What our future nurses should not fail to see is that NLE is a rite of passage; and it serves another purpose of bringing out the best or the worst in its test-takers, either of which for their own choosing. Life is larger post oath-taking to just miss out on it.
I often say that it's not about who's the smartest or who's the most studious in class who succeeds in this kind of endeavor. It has got to be the most determined that brings home the greatest reward. Because in a parallel universe where the smartest, the studious, and the determined all fail, the latter already has the determination, the spirit that will deliver.
Wednesday, September 1, 2010
Call a Code Blue!- A brief education on a medical emergency
So who doesn’t love a good medical show? Nowadays the shows that are medical related are a dime a dozen. From House, to Grey’s Anatomy, to the never forgotten ER, these shows give us a peak in the lives of health professionals. What I want to talk about though is the infamous code blue. You guys know that moment in the show where you see the health staff yelling “code blue, code blue”. Then you see the patient on their bed pale, unresponsive, and they look like they literally have no life left in them.
In this article I will explain the basics of what is going on in the person especially their heart and what the medical staff is basically trying to do. This will be nothing to in depth just a basic education, because to be honest what is exciting to watch in TV is actually very scary experience in person especially if it is your own family member.
The heart which I like to call the “Real Muscle” of the body is responsible for ejecting blood to your major vital organs of your body. Without your heart outputting a sufficient amount of oxygenated blood, your organs suffer and basically don’t get their needed oxygen. I know all you guys have held your breath before and what you are basically doing? You are depriving the body of oxygen which your body needs and ultimately building up carbon dioxide which accumulates.
So which leads me to my next point, your heart rhythm is basically an electrical conductive system. Your heart has pacemakers to help set the rhythm and the rate at which it pumps. The main pacemaker of the heart is your SA node, but just in case that one fails there are backup mechanisms. With that said those backup mechanisms aren’t as efficient as the SA node. Your heart basically is full of fail safe pacemakers just in case anything goes wrong, but they may not pump at a proper rate or put your heart in a proper rhythm. When your heart is pumping in its proper rhythm it is called Normal Sinus Rhythm which pretty means Life is GOOD! You are getting proper cardiac output and your heart isn’t working too little or too hard, it is going just right.
Two of the main deadly rhythms that are mostly seen in a code blue situation are Ventricular Fibrillation and Ventricular Tachycardia that is pulseless. These two heart rhythms are so erratic and so inefficient that your basically getting no cardiac output. The ventricles of the heart which are parts of the heart have the ability to be pacemakers but are horrible in doing so. So what you get is a patient with an abnormal heart rhythm with basically no cardiac output. Especially in Ventricular Fibrillation the heart is basically just quivering with no real actual efficient pump to eject the blood.
In the hospital when we notice this we call a “code blue”. Our basic goal here to either shock the heart back to a normal rhythm to help re-sustain some decent cardiac output. The quicker we are to react as health care professionals of course the better the outcome. Every second we don’t do something we are depriving the entire body of oxygenated blood. We use the defibrillator which will basically deliver an unsynchroized shock or electrical energy. What happens when the shock is delivered it trying to depolarize which basically means we are trying to reset the rhythm of the heart, in doing so we would hope the SA node would kick back in and reset the heart to a normal sinus rhythm.
I can go further in depth on this article but it would take me another page . I just wanted to give a basic brief summary. Once the heart rhythm is back there is many other things that can happen or must be done. For instance, trying to sustain a normal blood pressure or trying to raise the heart rate. I will save that for another day. In the meantime when your out in a public place and see the little box with the letters AED. That stands for Automated External Defibrilator and is used just in case someone needs it in a public setting.
Jed Jularbal, BSN, RN
The Methodist Hospital- Houston Texas
Email: jrjularb@gmail.com
In this article I will explain the basics of what is going on in the person especially their heart and what the medical staff is basically trying to do. This will be nothing to in depth just a basic education, because to be honest what is exciting to watch in TV is actually very scary experience in person especially if it is your own family member.
The heart which I like to call the “Real Muscle” of the body is responsible for ejecting blood to your major vital organs of your body. Without your heart outputting a sufficient amount of oxygenated blood, your organs suffer and basically don’t get their needed oxygen. I know all you guys have held your breath before and what you are basically doing? You are depriving the body of oxygen which your body needs and ultimately building up carbon dioxide which accumulates.
So which leads me to my next point, your heart rhythm is basically an electrical conductive system. Your heart has pacemakers to help set the rhythm and the rate at which it pumps. The main pacemaker of the heart is your SA node, but just in case that one fails there are backup mechanisms. With that said those backup mechanisms aren’t as efficient as the SA node. Your heart basically is full of fail safe pacemakers just in case anything goes wrong, but they may not pump at a proper rate or put your heart in a proper rhythm. When your heart is pumping in its proper rhythm it is called Normal Sinus Rhythm which pretty means Life is GOOD! You are getting proper cardiac output and your heart isn’t working too little or too hard, it is going just right.
Two of the main deadly rhythms that are mostly seen in a code blue situation are Ventricular Fibrillation and Ventricular Tachycardia that is pulseless. These two heart rhythms are so erratic and so inefficient that your basically getting no cardiac output. The ventricles of the heart which are parts of the heart have the ability to be pacemakers but are horrible in doing so. So what you get is a patient with an abnormal heart rhythm with basically no cardiac output. Especially in Ventricular Fibrillation the heart is basically just quivering with no real actual efficient pump to eject the blood.
In the hospital when we notice this we call a “code blue”. Our basic goal here to either shock the heart back to a normal rhythm to help re-sustain some decent cardiac output. The quicker we are to react as health care professionals of course the better the outcome. Every second we don’t do something we are depriving the entire body of oxygenated blood. We use the defibrillator which will basically deliver an unsynchroized shock or electrical energy. What happens when the shock is delivered it trying to depolarize which basically means we are trying to reset the rhythm of the heart, in doing so we would hope the SA node would kick back in and reset the heart to a normal sinus rhythm.
I can go further in depth on this article but it would take me another page . I just wanted to give a basic brief summary. Once the heart rhythm is back there is many other things that can happen or must be done. For instance, trying to sustain a normal blood pressure or trying to raise the heart rate. I will save that for another day. In the meantime when your out in a public place and see the little box with the letters AED. That stands for Automated External Defibrilator and is used just in case someone needs it in a public setting.
Jed Jularbal, BSN, RN
The Methodist Hospital- Houston Texas
Email: jrjularb@gmail.com
Tuesday, August 31, 2010
All about Dengue Hemorrhagic Fever.
Dengue Hemorrhagic Fever is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti).
CAUSES
Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person catches a different type dengue virus after being infected by another one sometime before. Prior immunity to a different dengue virus type plays an important role in this severe disease.
SYMPTOMS
Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock-like state.
Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin ecchymosis). Minor injuries may cause bleeding.
Shock may cause death. If the patient survives, recovery begins after a one-day crisis period.
Early symptoms include:
- Decreased appetite
- Fever
- Headache
- Joint aches
- Malaise
- Muscle aches
- Vomiting
Acute phase symptoms include:
- Restlessness followed by ecchymosis, generalized rash, petechiae, and worsening of earlier symptoms
- Shock-like state (cold, clammy extremities and diaphoresis)
POSSIBLE COMPLICATIONS
- Encephalopathy
- Liver damage
- Residual brain damage
- Seizures
- Shock
I am posting this because one patient of mine just died due to this illness. The virus that Aedes aegypti mosquitoes carry is really alarming. Pertaining to the aforementioned patient, I have provided utmost care and effort for the child to recuperate as soon as possible. All along, I thought everything will be positive as I left him. I had two days off and I didn't know what is already transpiring inside the hospital. I had no single idea if the patients I handled were still confined or already discharged.
Suddenly, a colleague of mine sent me a message telling that patient CN already passed away. It is so heartrending to know that the children you treated with quality nursing care are already gone in a snap. More so, this patient's relatives are very kindhearted and sympathetic that's why he's adored by many. I was totally taken aback with that news. I know, he's happy where he is now and I believe that he's watching over us from now on.
One piece of advice: Getting too emotionally attached to patients and their relatives will really give you a heartache eventually. Emphasis on the adverb too. There is nothing wrong with being attached to them, just be prepared enough when this kind of scenario comes into picture.
To all the parents out there, take good care of your children. Don't let a single mosquito bite take away their lives. As we all know, we only borrowed our precious lives from Him. Remember, as what the famous adage says, prevention is better than cure.
Drexel Heinz Magpantay Cruz, RN, RM
Pediatric Nurse
Saturday, August 28, 2010
We Are Patient
The word patient originally meant "one who suffers". This is the reason why patients are called such; to serve as a reminder of how patience plays a huge part in our everyday role as care providers. When we attend to the sick and the incapacitated, we are integrally reminded that they need us to be patient with them without telling. When we are burnt-out from a 16-hour shift and we get more calls, we do not complain. Even when we deal with irate, demanding, or impossible patients, we learn to endure and just muster patience some more. This is because we are nurses and a lot is expected from us: skills, knowledge, and attitude. With the kind of service that we provide, patience thus becomes very much inherent in our profession.
But the act of forbearing should not only be used for the purpose of human interaction. Sometimes, in the process of becoming a nurse, we need to be patient within our selves too..
I am a nurse from the June 2006 batch. Since that time I took the infamous board exam everything seemed to become a test of patience for me. Like the rest I had no choice but to retake and create a new victory. I now celebrate a 2007 license. Getting my IVT card was another story. When I passed my NCLEX it was in the midst of retrogression in the United States. My attempts to sponsorship only lead me to accept that it was not the time to force it but a more sensible time to retreat. When my IELTS expired I had to retake in hopes of trying my chances in Australia. I got unnecessary delays in my application and unfortunately was left by co-applicants in doldrums. And just like most of the struggling nurses of today, it has been three years now that I continue to hop from one hospital to another in search of training and volunteering slots, mindless of the promise that maybe someday I would be absorbed because of my capabilities and not because I have the strongest of connections. Needless to say, this has been the common plight of my contemporaries. I am not yet a full-fledged nurse yet my patience has already gone through rough weathers.
There are many instances wherein our patience will be put to test. Not only by the people we deal with, but also by adventitious challenges we face as nurses: the wait for our license to care, the wait for compensated employment, and perhaps ultimately, the wait for a greener pasture and a chance to a better life. Little did we know that when we entered this field we are bound to become the most patient people we could ever be. With the 'sufferings' attached in our profession, we only need to constantly remind ourselves that one cannot be a nurse without patience. We become our own reminder of this virtue.
After a year, I finally got my approval to bridge in Australia. I am still patiently waiting for my turn to serve.
A day in a life of an EMT: A bland week
I've been assigned in SLEX post where it rained long and hard. Still no patient. Apparently, I have been evaded by runs that are potentially learning experiences. I know, it's a cruel thought to hope someone gets careless behind the wheel but let's face it, you get better with experience, and what way to gather experience as an EMT other than being in a superhighway where people don't use seatbelts, don't inspect their breaks, and learned how to drive in Edsa. Well it's not that I want anyone to get hurt, all I want is if something happens.. I want to be there to do my job. Plus I'm really itching to use the hydraulic cutters; man, I'm not part of the extrication team but hell do I want to tear an expensive car into pieces (take that hell-borne capitalists!). Anyway, it was quite a dry shift. All I did was eat, sleep, and watch the hostage taking in Quirino Grandstand. Speaking of which, I felt quite disappointed regarding this issue. Actually, early in the afternoon I knew the hostages were toast. Considering the lack of training of our supposedly best of the best. A few years ago, something similar happened, I don't know if some of you remember; they shot through a child whom they assumed have already died to drop a hostage taker who was starting the cleave the child with his knife but as it turns out, the child died from the bullets the child took, whereas the wounds she got from the knife could have been manageable. Depressing.
Change topic: I was on standby at DLSZ yesterday. It was an overall crappy shift but somehow things came through, we had two patients so time flew a little faster. Both were for x-rays so together it took 2 hours of the 9 hour shift. So, they had an event, Linggo ng Wika. Kids there were really cute, they were wearing traditional Filipino garments the whole day skipping the uniforms. And then there was one this lady passed by and I was like "Wow, that teacher's super gorgeous!" She was wearing a white Filipiniana dress with the hair fixed and all the makeup.
Okay. So maybe I didn't really say those exactly words. Revised it a little. It's not just appropriate since this blog is just a grant and.. well, my other reason you'll know as I let on.
Where was I..? Right, I saw this lady who walked past the ambulance and my jaw dropped. Man she was beautiful. I was warming myself up to approach her and introduce myself until my partner who has been assigned in DLSZ longer than I was, whom I thought was napping (thank God he wasn't) told me that she isn't a teacher and that she's actually a fourth year high school student. I was like "Oh crap, that was close" I mean she looked exactly like a fully developed woman if you know what I mean, it's not like she's got statutory written all over her. Which reminds me, I'd like to share something I've learned from EMT school, which has proven to be true in pre-hospital and clinical practice.. and day-to-day situations such as this.
Never ASSUME; because it will make An ASS of U and ME.
Change topic: I was on standby at DLSZ yesterday. It was an overall crappy shift but somehow things came through, we had two patients so time flew a little faster. Both were for x-rays so together it took 2 hours of the 9 hour shift. So, they had an event, Linggo ng Wika. Kids there were really cute, they were wearing traditional Filipino garments the whole day skipping the uniforms. And then there was one this lady passed by and I was like "Wow, that teacher's super gorgeous!" She was wearing a white Filipiniana dress with the hair fixed and all the makeup.
Okay. So maybe I didn't really say those exactly words. Revised it a little. It's not just appropriate since this blog is just a grant and.. well, my other reason you'll know as I let on.
Where was I..? Right, I saw this lady who walked past the ambulance and my jaw dropped. Man she was beautiful. I was warming myself up to approach her and introduce myself until my partner who has been assigned in DLSZ longer than I was, whom I thought was napping (thank God he wasn't) told me that she isn't a teacher and that she's actually a fourth year high school student. I was like "Oh crap, that was close" I mean she looked exactly like a fully developed woman if you know what I mean, it's not like she's got statutory written all over her. Which reminds me, I'd like to share something I've learned from EMT school, which has proven to be true in pre-hospital and clinical practice.. and day-to-day situations such as this.
Never ASSUME; because it will make An ASS of U and ME.
Friday, August 27, 2010
COUNTING MY BLESSINGS
http://jo-cerrudo.blogspot.com/2010/08/counting-my-blessings.html
I worried about buying a new sofa and matching curtains for the living room,
a patient said he is homeless.
I fretted about not getting a pay raise and complained about the stress on the job,
the 55-year breadwinner with the chest pains was just laid off.
I whined about the high cost of L'Oreal and how my highlights do not last long,
my chemotherapy patient was depressed about her alopecia.
I grumbled about my being stressed out with demands of my time from family members,
the elderly gentleman just lost his wife and now is all alone.
I ranted and raved about the nation's state of affairs,
this bright-eyed refugee from a third-world country gushed about free speech.
I complained about being tired from shopping all day long,
this young, gaunt HIV patient whispered, "I'm dying.".
And now that I am being inconvenienced by a little snow and rain,
the horrific images of the tsunami, hurricanes and mudslides just make everything else trivial
and insensitive by comparison.
I had learned long ago to count my blessings.
At Triage...
I worried about buying a new sofa and matching curtains for the living room,
a patient said he is homeless.
I fretted about not getting a pay raise and complained about the stress on the job,
the 55-year breadwinner with the chest pains was just laid off.
I whined about the high cost of L'Oreal and how my highlights do not last long,
my chemotherapy patient was depressed about her alopecia.
I grumbled about my being stressed out with demands of my time from family members,
the elderly gentleman just lost his wife and now is all alone.
I ranted and raved about the nation's state of affairs,
this bright-eyed refugee from a third-world country gushed about free speech.
I complained about being tired from shopping all day long,
this young, gaunt HIV patient whispered, "I'm dying.".
And now that I am being inconvenienced by a little snow and rain,
the horrific images of the tsunami, hurricanes and mudslides just make everything else trivial
and insensitive by comparison.
I had learned long ago to count my blessings.
Thursday, August 26, 2010
BAYANIHAN
Filipinos are very warm and caring people. Part of our culture is the practice of "bayanihan". Bayanihan is a tagalog word that signifies the joint effort of a community to help a fellow man in need. Back in the days, when a family had to relocate their home, neighbors would literally help carry the house to a new location by lifting it with bamboo poles. Through the years, this practice has evolved into various ways of helping others.
I am one of many Filipino ICU nurses working in Laredo, Texas USA. Every day, we are exposed to critically-ill patients. We feel the pain that they and their families go through. We try our best to be there for them. It is an amazing feeling when we are able to help a patient recover from a life threatening disease. And it is heartbreaking when despite our best efforts, a patient dies. Unfortunately, this happens often in our line of work.
A few months ago we were moved when one of our fellow Filipino ICU nurses was diagnosed with cancer. What happened to her opened our eyes that it can happen to any of us at any given time. All of a sudden her life changed. From being a nurse, she became a patient. From being the caregiver, she became the one in need of caring.
She had to undergo surgery and now she is having her chemotherapy. Since she could no longer work, the expenses piled up.
To help her, we had a Filipino plate sale a couple of months ago. We cooked adobo, pancit and lumpia. This was a big hit in the hospital. Even our Hispanic co-workers bought and enjoyed the food.
The money we were able to raise was used to buy electronic gadgets for a raffle that would generate a bigger sum. The grand price was a 40 inches plasma TV. Other prices included digital cameras, bluray players, gps and mp3 players. We were surprised with the turn out. So many people from work helped to sell tickets. All in all we were able to raise $9500.
It felt good to know that bayanihan is still very much alive today. Not just in the Philippines, but in the hearts of Filipinos, wherever in the world they may be.
Sunday, August 22, 2010
The noble heroes of modern time.
It can never be denied that we, nurses, are vital foundations of any healthcare institution. Without nurses, a hospital cannot function well. Without nurses, who will take care of ill persons 24/7? Without nurses, who will make the patients get better and stronger? No one else can do what nurses do.
There are times that people don't understand the sacrifices that nurses make in order to render quality nursing care to patients. As a matter of fact, the term "holiday" is not anymore included in a nurse's vocabulary. During Christmas season, nurses are taking good care of unwell strangers instead of spending the special occasion with their loved ones. During birthdays, a lot of nurses don't even recognize that it's their special day due to hectic daily routines. Apparently, nurses spend more time with unknown people than their family members. That kind of sacrifice is seemingly incomparable.
Nurses should also be credited for their good deeds. It is very heartrending to know that most nurses receive deprecating and belittling remarks from patients and physicians. We are not owned by someone. We have our own heart, mind, and ego. Hence, we do know how to think, how to react, and how to reason out. We were born to be exceptional nurses and not mere robots.
I admit, we get tired and stressed out everyday but we still manage to put a smile on our faces. A smile that never fades away, a smile that is fortified by the gratification we get from helping people survive life. For us, seeing our patients get well is more than enough. The mere appreciation of the people you've helped to recuperate is sufficient to relieve the tension and stress that we shoulder.
When I was a child, all I desired was to be a physician. It never crossed my mind that I will be a nurse. Now, being a nurse makes me so proud. Without exaggeration, I feel highly esteemed whenever people see the "RN" right after my surname. We, Filipino nurses, should always be proud of our profession. Regardless of the negative upshots concerning our noble profession, we should still be honored that we make an unequaled difference in the lives of people we do not personally know. Because as we all know, it is evident that the Nursing profession faces countless dilemmas nowadays. From the growing number of unemployed and underemployed Filipino nurses up to the noticeably abysmal quality of education that some Nursing schools offer. Hopefully, there will be well-defined solutions to these alarming conditions.
Let us not focus on what is negative, let us give ourselves proper acknowledgment on the great things that we offer to the world. Without the service of nurses, life and subsistence are hardly achievable.
Be proud of what you can do. Be proud that you save people's lives. Be proud because you're a hero. We, nurses, are the undoubted noble heroes of modern time.
Drexel Heinz Magpantay Cruz, RN, RM
Pediatric Nurse
Saturday, August 21, 2010
A day in a life of an EMT: Prelude
Firstly, I'd like to introduce myself for future references. I'm Mikey, a Nurse/EMT. I work in Lifeline Ambulance Rescue formerly known as Lifeline Arrows.
Here in the Philippines, most people don't know what an EMT is. But they do know what a paramedic is, although the said term is often misused because people here don't know what it really is. EMT stands for Emergency Medical Technician. It's a profession by itself, providing pre-hospital emergency care to patients requiring immediate stabilization of their airway, breathing and circulation so they can reach the closest medical facility alive and as much as possible without any debilitation. The term paramedic is a skill level of an EMT; from an EMT-Basic, it goes up to EMT-Defibrillation, EMT-Intubation/Infusion, EMT-Advanced, and finally EMT-Paramedic. We don't have Paramedic schools here yet, we only have one EMT school which is in Cubao, despite that they only offer up to the second level.. and the only existing Pinoy paramedics in the whole country are only three; they are sort of retired, and two of which are my instructors. So the next time someone introduces himself a paramedic, ask for their license. The EMT will soon be a legally recognized profession here if ever our respectable senators and congressmen ever start to talk about passing bills (starting with this one specifically) on healthcare.
Anyway, this week I am taking up the second level. It's sort of hard, but I am hoping to get an outright passing mark. When I took the first level which was several months ago, I did quite well.. so the staff has expectations from me that I hope to live up to. It's basically a training module for a basic technician to be adept with the use of a manual defibrillator, a 12-Lead ECG and reading various arrhythmias, and what to do with it. Pretty much, it's like pre-hospital Advanced Cardiac Life Support without much of the bulk in medications. I wish to learn a lot from this class, and I hope I can use everything I learn in the field.
I pre-wite my posts since we had rotations here. If you are reading this, then my classes are already over and have already become a the living epitome of the third chain of survival.
Here in the Philippines, most people don't know what an EMT is. But they do know what a paramedic is, although the said term is often misused because people here don't know what it really is. EMT stands for Emergency Medical Technician. It's a profession by itself, providing pre-hospital emergency care to patients requiring immediate stabilization of their airway, breathing and circulation so they can reach the closest medical facility alive and as much as possible without any debilitation. The term paramedic is a skill level of an EMT; from an EMT-Basic, it goes up to EMT-Defibrillation, EMT-Intubation/Infusion, EMT-Advanced, and finally EMT-Paramedic. We don't have Paramedic schools here yet, we only have one EMT school which is in Cubao, despite that they only offer up to the second level.. and the only existing Pinoy paramedics in the whole country are only three; they are sort of retired, and two of which are my instructors. So the next time someone introduces himself a paramedic, ask for their license. The EMT will soon be a legally recognized profession here if ever our respectable senators and congressmen ever start to talk about passing bills (starting with this one specifically) on healthcare.
Anyway, this week I am taking up the second level. It's sort of hard, but I am hoping to get an outright passing mark. When I took the first level which was several months ago, I did quite well.. so the staff has expectations from me that I hope to live up to. It's basically a training module for a basic technician to be adept with the use of a manual defibrillator, a 12-Lead ECG and reading various arrhythmias, and what to do with it. Pretty much, it's like pre-hospital Advanced Cardiac Life Support without much of the bulk in medications. I wish to learn a lot from this class, and I hope I can use everything I learn in the field.
I pre-wite my posts since we had rotations here. If you are reading this, then my classes are already over and have already become a the living epitome of the third chain of survival.
Wednesday, August 18, 2010
Letting Go
(Excerpt from my published article)
Redefining 'survival' in a profession that does so much business with death.
I remember when I was still untouched by death-when I was a child who believed in immortality and invincibility. It all changed when I became a nurse and came face to face with the harsh realities of death. Suddenly, the finality of it forced me to see us as the mortals we are. I dealt with my patients' dying by maintaining a "qué será será" attitude. It didn't mean losing my humanity; it didn't mean that I cared less for my patients. It just meant survival for me in a profession that sees a lot of suffering and death.
Until Mr. Contreras came to the ED to die.
It was a warm spring day, and on Bed 3 Mr. Contreras lay dying. Brain cancer with metastases-and the devastation of the disease was finally taking its toll on his 80-year-old body. He was unconscious, but a single tear clung to his right eyelashes.
The ED staff knew him as one of our "frequent fliers." He liked to be called "Abuelo"-Grandpa. He was always pleasant, even when he was in pain. His wife, Rosa, was a proud and feisty woman, and a bit protective of her husband. She used to complain to hospital administration that we were slow in giving him pain medication. "Why can't you give him more attention?" she grumbled.
Now, Rosa sat with hunched shoulders at the bedside. She looked tired and resigned. Her face reflected her fears; her eyes, unspoken misery.
The cardiac nurse told me that the family had signed the DNR papers. Marco, the couple's only child, stood vigil on the opposite side of the bed, gently caressing his father's wrinkled forehead. His face was in agony, but I sensed a quiet strength within him. He would need it now.
I tried to leave to give the family some privacy, but Rosa held on to me with her other hand. "We've said our good-byes. Now I'm letting him go. He wants to die in peace. We're all ready now." Rosa's voice quivered. I nodded because I knew that Marco had reconciled with his father four months ago after a long estrangement.
The intravenous line was removed. The patient wore a clean white shirt. The Foley catheter was discontinued. We all stared in silence at the flickering cardiac monitor, mesmerized by the even graceful strokes. Sinus bradycardia ... pulse 50 and thready. BP steadily going down ... now barely palpable at 70 systolic ... respirations shallow. Abuelo was at the threshold.
The numbers held our attention. Heart rate 40 ... 34 ... 29 ... then asystole. The ED resident shook her head. A gasp escaped from Marco, and Rosa broke into sobs. I stood transfixed as a life ebbed away and the single tear rolled down Abuelo's cheek. His face stunned me. I expected to see suffering, but instead I marveled at a face that in death looked peaceful, almost ethereal. He died in peace, surrounded by love.
Rosa hugged and kissed her husband of 50 years. I tried to say something that I knew would comfort no one but me, but there was a lump in my throat. I just hugged her and we cried together for this wonderful man whose life had made such a difference. "Thank you for everything," Rosa finally said. Mother and son then walked away to begin a new life, and I said a silent prayer for the family.
I remember them to this day, several years later. I hope that their memories of togetherness sustained them through their grief. And I'm thankful that it was a quiet day in the ED, and that I had time to listen and to grieve. From them, I learned what strength there is in just letting go.
Redefining 'survival' in a profession that does so much business with death.
I remember when I was still untouched by death-when I was a child who believed in immortality and invincibility. It all changed when I became a nurse and came face to face with the harsh realities of death. Suddenly, the finality of it forced me to see us as the mortals we are. I dealt with my patients' dying by maintaining a "qué será será" attitude. It didn't mean losing my humanity; it didn't mean that I cared less for my patients. It just meant survival for me in a profession that sees a lot of suffering and death.
Until Mr. Contreras came to the ED to die.
It was a warm spring day, and on Bed 3 Mr. Contreras lay dying. Brain cancer with metastases-and the devastation of the disease was finally taking its toll on his 80-year-old body. He was unconscious, but a single tear clung to his right eyelashes.
The ED staff knew him as one of our "frequent fliers." He liked to be called "Abuelo"-Grandpa. He was always pleasant, even when he was in pain. His wife, Rosa, was a proud and feisty woman, and a bit protective of her husband. She used to complain to hospital administration that we were slow in giving him pain medication. "Why can't you give him more attention?" she grumbled.
Now, Rosa sat with hunched shoulders at the bedside. She looked tired and resigned. Her face reflected her fears; her eyes, unspoken misery.
The cardiac nurse told me that the family had signed the DNR papers. Marco, the couple's only child, stood vigil on the opposite side of the bed, gently caressing his father's wrinkled forehead. His face was in agony, but I sensed a quiet strength within him. He would need it now.
I tried to leave to give the family some privacy, but Rosa held on to me with her other hand. "We've said our good-byes. Now I'm letting him go. He wants to die in peace. We're all ready now." Rosa's voice quivered. I nodded because I knew that Marco had reconciled with his father four months ago after a long estrangement.
The intravenous line was removed. The patient wore a clean white shirt. The Foley catheter was discontinued. We all stared in silence at the flickering cardiac monitor, mesmerized by the even graceful strokes. Sinus bradycardia ... pulse 50 and thready. BP steadily going down ... now barely palpable at 70 systolic ... respirations shallow. Abuelo was at the threshold.
The numbers held our attention. Heart rate 40 ... 34 ... 29 ... then asystole. The ED resident shook her head. A gasp escaped from Marco, and Rosa broke into sobs. I stood transfixed as a life ebbed away and the single tear rolled down Abuelo's cheek. His face stunned me. I expected to see suffering, but instead I marveled at a face that in death looked peaceful, almost ethereal. He died in peace, surrounded by love.
Rosa hugged and kissed her husband of 50 years. I tried to say something that I knew would comfort no one but me, but there was a lump in my throat. I just hugged her and we cried together for this wonderful man whose life had made such a difference. "Thank you for everything," Rosa finally said. Mother and son then walked away to begin a new life, and I said a silent prayer for the family.
I remember them to this day, several years later. I hope that their memories of togetherness sustained them through their grief. And I'm thankful that it was a quiet day in the ED, and that I had time to listen and to grieve. From them, I learned what strength there is in just letting go.
Wednesday, August 11, 2010
IS IT JUST BASIC EDUCATION?
IS IT JUST BASIC EDUCATION?
By: NOEL D. DE OCAMPO, MSN/ED, RN
http://thefilipinonurseforum.blogspot.com/
August 11, 2010
Now that the Philippine Senate is shifting focus, or at least paying a little bit of attention to our country’s education system, it is time for everyone to get involved and join the discussion. With the new administration, perhaps something positive will come out. It is true that the Philippines’ 10-year basic education system is much shorter than the international norm of 12 years. Maybe it is a good idea to adopt such education system. But is it the only system to blame?
It is common knowledge that passing rates in the Philippine Nursing Licensure Examination has been in the decline for the past five years. Many fly-by-night nursing schools, as well as questionable nursing review centers, are continuing to open and many nursing schools not showing improvement in their passing rates are continuing to operate. Shouldn’t there be some form of policy enforcement done by government regulators regarding this problem?
There are too many nurses, but not many places to practice. Many nursing graduates are resorting to the now norm of paying “unscrupulous hospitals” that are taking advantage of the system. It is now common for new graduates to pay hospitals in exchange for “clinical experience”. After these so-called clinical terms, many nurses are still faced with the dilemma of not getting jobs abroad because many of the prospective employers rarely consider “unpaid clinical experiences”. There are too many nurses, a plethora of deficient nursing education programs, and very few chances to get legitimate and paid employment; where will the predicaments end?
The global Filipino nursing workforce positively affects our country economically. If Filipino nurses show greater clinical competency around the world, more job opportunities for future nurses will come with it, resulting in more foreign money coming into the country. It is just fitting that the nursing profession in particular be included in the discussion about education in the Philippines. Many people has been calling for a review of our country’s nursing school systems for many years, or maybe a review of how regulations are enforced. It is time to stop the bureaucracy and time to change the system. Limit the quantity, and instead focus on improving the quality of nursing education with the hope of producing much more competent nurses. It’s time to do the clean-up. Check the system, and check it properly. Close the worst-performing nursing schools. Isn’t it time?
By: NOEL D. DE OCAMPO, MSN/ED, RN
http://thefilipinonurseforum.blogspot.com/
August 11, 2010
Now that the Philippine Senate is shifting focus, or at least paying a little bit of attention to our country’s education system, it is time for everyone to get involved and join the discussion. With the new administration, perhaps something positive will come out. It is true that the Philippines’ 10-year basic education system is much shorter than the international norm of 12 years. Maybe it is a good idea to adopt such education system. But is it the only system to blame?
It is common knowledge that passing rates in the Philippine Nursing Licensure Examination has been in the decline for the past five years. Many fly-by-night nursing schools, as well as questionable nursing review centers, are continuing to open and many nursing schools not showing improvement in their passing rates are continuing to operate. Shouldn’t there be some form of policy enforcement done by government regulators regarding this problem?
There are too many nurses, but not many places to practice. Many nursing graduates are resorting to the now norm of paying “unscrupulous hospitals” that are taking advantage of the system. It is now common for new graduates to pay hospitals in exchange for “clinical experience”. After these so-called clinical terms, many nurses are still faced with the dilemma of not getting jobs abroad because many of the prospective employers rarely consider “unpaid clinical experiences”. There are too many nurses, a plethora of deficient nursing education programs, and very few chances to get legitimate and paid employment; where will the predicaments end?
The global Filipino nursing workforce positively affects our country economically. If Filipino nurses show greater clinical competency around the world, more job opportunities for future nurses will come with it, resulting in more foreign money coming into the country. It is just fitting that the nursing profession in particular be included in the discussion about education in the Philippines. Many people has been calling for a review of our country’s nursing school systems for many years, or maybe a review of how regulations are enforced. It is time to stop the bureaucracy and time to change the system. Limit the quantity, and instead focus on improving the quality of nursing education with the hope of producing much more competent nurses. It’s time to do the clean-up. Check the system, and check it properly. Close the worst-performing nursing schools. Isn’t it time?
Friday, August 6, 2010
Looking for Bloggers!
I am looking for Bloggers/Photo Bloggers who are in the medical profession (Doctors, Nurses, Administrators, etc) who can write for this blog. The fact that you’re reading this is exactly how you will be exposed. I am writing this in the exact same place where you will be writing your articles. We are growing more and more everyday and what we offer is great exposure for you and your blog --- potential exposure to more than 127,000 members.
Don’t worry if you’re blogging about a specific subject. You’ll be in rotation with others, so one could be writing about nursing, the other could be life in the medical profession, etc. The most important thing is that you have a passion for something, and that you are blogging about it already.
The only requirement is that articles should be relevant to the lives of medical professionals as a whole. Also, you will need to be able to keep up with your rotation. You may need to write an article once every two weeks at the most!
If interested, please send us an email with "Medical Blogger" as the subject to recruiting@definitelyfilipino.com. It is very important that you include links to your articles. I will be in touch with you if I like what I see.
Thank you!
Admin
Don’t worry if you’re blogging about a specific subject. You’ll be in rotation with others, so one could be writing about nursing, the other could be life in the medical profession, etc. The most important thing is that you have a passion for something, and that you are blogging about it already.
The only requirement is that articles should be relevant to the lives of medical professionals as a whole. Also, you will need to be able to keep up with your rotation. You may need to write an article once every two weeks at the most!
If interested, please send us an email with "Medical Blogger" as the subject to recruiting@definitelyfilipino.com. It is very important that you include links to your articles. I will be in touch with you if I like what I see.
Thank you!
Admin
Friday, July 23, 2010
DEF Idioms
Happy Friday nurses!
If you love idioms and want a way to learn more quickly, here are some ideas. On my last post I chose body parts with ABC. Here are 3 body parts with EF that are used in the following 6 idioms. It's a good way to learn new language quickly.
Eye
A blue-eyed boy is the favouite in any group or the pet of a group
To have an eye-opener is to have an enlightening experience
To have half and eye on something: to not give something your full attention
Face
To face the music is to face criticism/punishment as a result of one's own actions
To have a face as long as a fiddle is to look depressed
To stare one in the face is something that is obvious and clear to see
Try putting any of the above in a sentence that is meaningful to you to help you remember any one you like the look of. Always put a new word in a personal mental sentence to help you remember it. And, remember that if you don't use it, you lose it so start weaving some idioms into your language today.
Until next week,
Marie
If you love idioms and want a way to learn more quickly, here are some ideas. On my last post I chose body parts with ABC. Here are 3 body parts with EF that are used in the following 6 idioms. It's a good way to learn new language quickly.
Eye
A blue-eyed boy is the favouite in any group or the pet of a group
To have an eye-opener is to have an enlightening experience
To have half and eye on something: to not give something your full attention
Face
To face the music is to face criticism/punishment as a result of one's own actions
To have a face as long as a fiddle is to look depressed
To stare one in the face is something that is obvious and clear to see
Try putting any of the above in a sentence that is meaningful to you to help you remember any one you like the look of. Always put a new word in a personal mental sentence to help you remember it. And, remember that if you don't use it, you lose it so start weaving some idioms into your language today.
Until next week,
Marie
Tuesday, July 6, 2010
ABC of Idioms with Body Parts
Hello world-class nurses!
Kamusta mga pogi =)
This week I’d like to write about idioms. The English language has thousands of idioms. By an “idiom” we mean a number of words which, when taken together, have a different meaning from that of each separate word. If at the end of a long day, a person tells you that they’re “on their knees”, they are using “knees” idiomatically to mean that they’re extremely tired and feel like collapsing. If someone talks about their money worries and in the same breath tells you that they’re just about “managing to keep their head above water”, they mean that they’re struggling to keep out of debt.
In English, words and phrases connected with parts of the body are extremely common in idioms. Here are a few idioms connected with body parts beginning with ABC. Should you enjoy them, let me know; there are lots more to follow.
Arm:
To keep someone at arm’s length: to avoid being friendly.
To give one’s right arm (usually with would): to be willing to make a sacrifice to get something.
Back:
To be on one’s back: to be ill in bed.
To have one’s back to the wall: to be struggling against great difficulty.
Blood:
Blood is thicker than water: one’s own relations come before all other people.
To get blood out of a stone: to achieve the impossible.
Bone:
To be all skin and bone: to be very thin
To make no bones about doing something: to have no hesitation in doing something (usually unpleasant).
Brain:
A scatter-brained person: a careless, forgetful person
To rack one’s brains: to think very hard; to solve a problem or remember something.
Cheek:
To have the cheek to do something: to be bold, rude enough to do something.
To turn the other cheek: to refuse to retaliate.
Chin:
To have a chin-wag: to chatter, talk with friends about unimportant matters.
To take something on the chin: to suffer severe difficulties with courage.
These idioms were shared from Everyday English for International Nurses. There are lots more to follow should you enjoy them. How many idioms do you know with body parts EARS, EYES and FACE?
Share the idioms you know with these body parts so that together you build your repertoire as a team of world-class English speaking nurses.
Warm hugs from
Until Next Week,
Marie
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