Life as a Worker

Ok I was never the perfect worker. I sort of screw things up at the till (cash register) and I still don't know all the products at Tim Hortons. Oh well it was still my second day as a trainee (that was sent straight into the fire with out any manuals or references at all). I sure wished that they gave me a manual so that I could study it.

I feel like I'm always on duty in the hospital because the shift is 8 hours and I have to deal with different kind of people, I'm stressed, and the work is not for the lazy and for the weak at heart at mind (like me hehehe).

But life is made easier with fellow co-workers who help you on the way, customers who are friendly and understanding, and a fellow Filipino that makes you feel in place.

Working sure is difficult but I'll give it my best shot.

The Boy Who Said "Dili"

Gosh I feel really old! I mean I feel that I'm already facing a midlife crisis and to think I'm only 19 years old! Midlife crisis is by the way defined by Wikipedia is "Midlife crisis is a term used to describe a period of dramatic self-doubt that is typically felt in the "middle years" of life, as people sense the passing of youth and the imminence of old age."

Ok I also do think about my future but what really keeps me occupied is reminiscing about the past? Talk about being old. And the thing that I remembered was the little boy who I met during one of my duties at a pediatric gastro-ward. It was my first time to handle a whole ward too! That’s right! I have only tried handling one or two patients but now, I’m the master of the whole Gastro Ward! As you might have guessed the Gastro Ward has patients (normally pediatric patients) who suffer from acute gastroenteritis and other GI problems.

Working in the gastro ward was quite ok. It was air-conditioned (it was a private hospital, thank God) and there was a TV (but I didn’t watch it because I was busy regulating IV flow rates). The patients were just adorable and the patient’s family were very nice and accommodating to my questions.

There was this 1 year old boy who was so cute and hyper-energetic. I really liked this patient a lot and I loved playing with him during my free time. I just have a difficult time in checking his IV flow rate because he always asks for attention and he regulates his own flow rate! That’s right he knows how to regulate it but unfortunately not at the right drop rate. One thing that I’ve noticed with this boy is that his love for the world “Dili” or “No” in English. I heard his mom say this word so many times to him because he was so hyperactive, jumping on his crib and throwing his ball away. Although he says “Dili” with a playful smile I just think that saying no to your child could be bad for him.

According to Erik Erikson’s Developmental Theory, a child in his early childhood (18 months to 3 years) could feel so ashamed and would lack in self-esteem if his parents keeps on telling him “NO!” Because instead of the child being able to explore his surrounding and learning (Autonomy vs Shame) the parents are trying to suppress his will to learn.

So parents out there, allow your children to explore, get dirty, and even break some things because in this way they can learn.

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Anyway the adorable boy in the photo is not my patient or is related to my post hehehe. Photo credits goes to subterfugemalaises.

Air Bubbles are NOT Cute

Do you know what takes most of my time when I’m duty at the hospital? It’s regulating and checking the IV flow rate. Yup I’m so obsessed with getting the number of drops perfectly that if I have nothing to do I check the drop rate over and over again. It’s supposed to be checked by the hour but I guess I over do it and check it every 5 minutes or so. What can I say? I’m afraid that the patient might get under-infused or worst over-infused and this could lead to hypervolemic shock or heart failure if the patient has a serious heart problem. Plus I don’t want to be get an extension (it’s equivalent for detention for student nurses).

But regulating IV flow rate is not that a big deal. The big problem would be air bubbles! Yup you heard me. Air bubbles may seem harmless but once 5mL of air bubbles is injected into your blood stream this could lead to pulmonary embolism. Another worst possible situation is when the air bubbles flows to your brain or heart and impedes blood flow. The medical term for air bubbles getting into the body ladies and gentlemen is air embolism.

I also had an experience once when I was in the hospital (this time as a patient), a nurse from a rival school (I’m not telling which school hehehe) came in to inject cefuroxime (an antibiotic for my tonsillitis) through my IV line and when he left I noticed air bubbles! Lots of air bubbles! I stopped the IV infusing and pressed the button calling for any nurse. When the nurse came I told her about the air bubbles and she then removed the air bubbles using a syringe at the connector for “piggybacking” other IV fluids. And then a few hours later I realized that the nurse that almost got me killed with air bubbles was the brother of my brother’s girlfriend. No wonder he’s trying to kill me, I’ll kill myself too if that’s the reason (Lol).

As a student nurse I really hate air bubbles. Sure I can try tapping them so that they could go back to the drip chamber or roll the IV tube with my pen so that the bubbles would disappear into the drip chamber but most of the time it’s easier said than done. And the only way to get rid of them is by aspirating them into a syringe… and this is quite a hassle because as mandated by the Philippine Nursing Act of 2002 (R.A. 9173) IV lines are off-limits to students! So I have to run to my clinical instructor and disturb her with her work (hehehe).

So fellow student nurses: if you see air bubbles don’t think it’s cute… it could kill your patient so watch out!

The Death of My Patient

I actually didn't know how to feel when my patient died. It was a sort of mixed emotions that were so strong that I wanted to run away somewhere far. I was so helpless as I watched my patient die. Like I know that sooner or later he was going to die. He had the classic clinical signs of shock like cold clammy skin, he was diaphoretic, his pupils were dilated, and he had consistently low blood pressure. Imagine, I had to re-check if I had the right BP taking because his BP was 40/20 mmHg and this was the first time I've ever encountered this low BP. I was at first excited and happy even that I was experiencing so many new procedures that a normal student nurse could encounter in a medical ward. I was able to assist in inserting a catheter, a nasogastric tube, and I was able to insert an IV fluid as a side-drip. On that same day I was able to observe the insertion of an endotracheal tube and I was able to compress an ambu bag (bag-valve-mask). I have also observed suctioning procedures and even nasogastric tube feeding. My patient was transferred from the medical ward into an (intensive care unit) ICU and of course my partner and I had to go with him. If I didn't have a partner at that time I wonder if I would have survived. we monitored his vital signs every hour, we monitored his O2 Saturation, his ECG, his infusion pump, and he even had a ventilation machine since he was already in coma.

I had a gut feeling that he would die. I just knew it. He had 3 consecutive cardiac arrests and the ward would constantly have to call a cold blue. It was just like in the movies where nurses would inject epinephrine or atropine so that his heart would start beating again. But I just wondered why they never used the defibrilator to revive the patient, they just used the standard CPR. On the third arrest the doctor finally announced the patient dead. I was still deflating and inflating the ambu bag valve mask like crazy because I didn't know whether to continue or just stop. The family of the patient already started crying and their mother called her other children saying that their father had died.

It was weird, I was at first doing procedures to save his life... and then a few hours later I had to remove the tubes and connections that where keeping him alive...

But somehow I don't feel pity for him. Death may be scary and all but he saw it coming. My patient was an alcoholic, drinking too much everyday. I can already imagine him going home late at night drunk and very violent. When you're drunk you become to do stupid things and this has been proven by so many people already. He drun k himslelf to death. That is all that I can say. He had drank so much alcohol that the veins in his liver grew larger until they finally bursted. He had an upper GI bleeding and he literally vomited blood (hematemesis). He went into coma and I guess he died from the bleeding.

Here is a lesson to all alcoholics out there. You just don't kill yourself from drinking. You destroy your family and you become a menace to society when alcohol reaches your brain and you start being stupid. Domestic violence and some crimes happen when people are drunk. Stop drinking!

I don't know why people love to kill themselves. I also had another patient who said that he will stop smoking for a while because he has difficulty breathing and he has blood tinged phlegm. Stop for a while? Why not stop totally? He has been smoking for 30 years (started at age 12) and he hasn't learned that it does nothing good? He's not only killing himself too. His family and the people around him are the ones who are twice affected by his smoking.

Bad vices gets you no where. They may at least make you feel good (as some people say - I wonder how and why) but the outcomes aren't that good. My point? Nothing is gained from smoking and drinking. So too our dragons and drunkards out there have pity on your loved ones. They suffer more than you do.

Operating Room Experience

The Operating Room (OR) rotation at Xavier University Community Health Care Center (or more commonly known as German Doctors Hospital) was very fun and memorable. It was unfortunate thought that we weren't able to get inside the OR during the first week of duty because there were Australians who were on a sort of medical mission surgically repairing cleft palates, hare lips, and etc. It was cruel but they only allowed two student to scrub in and it was unfortunate that I wasn't one of the two. So what was I doing during the first week? We had to be in the Interplast Ward and gave preoperative care to the patients waiting to be called in the OR. In short, we just stood there and took vital signs every four hours or so.

But I was lucky enough to get a minor surgical case. An excision of a fibroadenoma at the left breast. It was a pretty quick operation, around 15 minutes, and every moment was really amazing. The surgeon took up nursing as his pre-med course and he was very skillful and nice. It was a shame but I broke my sterility but the nurse and surgeon were very understanding that this was my first time and all. But after my first assist in a surgical operation everything seemed ok although I have to admit that I still have a lot to learn especially making nurse's notes (hahaha).

I also had the opportunity to be a circulating nurse for one of those cataract-removing-lens-replacing surgeries (which is PECLE, in medical terms, or Planned ExtraCapsular Lens Extraction). It was really amazing how the doctor used microscopic instruments to do the procedure. At first I thought he was just playing with his hands but then I remembered that he was using a suture that was very fine and could only be seen with the use of a microscope.

It was unfortunate that my group mates and I only had a few cases but it wasn't totally that bad because we were able to use that extra time to bond and improve our team work and such.

The OR rotation may be one of my favorite rotations so far, aside from the delivery room rotation, and the pediatric rotation where I was all of the sudden assigned to a patient in the intensive care unit.

Note: We were allowed to bring our cameras and cellphone inside the operating room to document the procedures. No patient confidentiality was breached in these pictures.

Additional Note: There was no patient in the operating room when the student nurses were happily taking pictures of themselves.