A Nurse’s Pockets

 

3am. Night Shift. Patients are sleeping. Charts reviewed. Documentations done. Extra duties performed.

 

Here’s to list down what’s inside my pockets right now. Just to keep me awake, otherwise, I’ll doze off.

 

1. a multicolored pen – I use three different pen colors on my endorsement sheets.
2. a yellow highlighter – This is to highlight the important tasks in my endorsement sheets.
3. a penlight – to check pupils in neuro patients and also to use as a light when entering patients’ rooms when patients don’t want to be disturbed by opening the lights.
4. my hospital ID clipped on the pocket – of course.
5. a pair of scissors – very dependable, should not go out on duty without.
6. 6 gauge 23 disposable needles – I need this to put an air vent when IV medications in glass bottles don’t infuse well.
7. my folded endorsement sheet – I might go crazy if I loose this while on duty.
8. my wallet – just in case I need money
9. my cellphone – somebody might call me
10. a hanky – to clean my oily face in the later part of the shift.
11. medication trolley key – each nurse has their own key
12. disaster pager – tonight I was the one assigned to hold the pager
13. 2 3-cc syringe – to aspirate normal saline for flushing IVs
14. 1 normal saline plastic ampule – for flushing tubings before administering IV medications
15. micropore tape – always needed
16. my USB flash drive – co I could copy a document quickly
17. my pocket notebook – where I write step-by-step procedures, and phone numbers
18. a couple of alcohol swabs – to wipe vials, tubing ports
19. 2 tape removing swabs – used when removing tapes of infiltrated cannulas
20. some blank stickers – to label tubings
21. some garbage – caps of needles, and tubings

 

That’s all folks.

 

The stethoscope is on my neck, not on my pockets, just in case you’re looking for it…

Chaotic Night

Last night was a chaotic night shift. It was my test of patience, endurance and flexibility.

 

The night started really busy. There was a plan to do a major round of the whole unit, but then it did not happen because we could not manage to do that.

 

I was initially given a patient on Patient-controlled Analgesia (PCA) machine. But one of my colleagues objected on me having the patient because I was still new and have not done the competency test required. She was right and I agree with her. A few shifts ago, I received a patient from the operating room already on PCA, and nobody cared if I it was alright for me to take care of the patient. I was able to manage the patient though, because PCA is not new to me. I have handled PCA patients in my previous hospitals. But the policies and procedures just differ a bit from hospital to hospital so I really have to be knowledgeable on how they do it here in this hospital.

 

Well, at least somebody cared that evening, and took that patient from me. I got an exchange for a new patient, who sounded toxic in the endorsement, but I realized later he was not that bad after all.

 

My colleague who took the PCA patient started to become busy with that patient because there was something wrong in the orders and that some policies were violated. She needed to make phone calls, attend to the anesthesia doctor, etc etc. Her other patients kept calling, and so out of courtesy, I attended to them. One case was a major overhaul, after the patient passed bowel motion on the bed, and messed up himself and the whole bed. I had to clean him up, and change his gowns, diapers and linens. I stayed there almost half an hour.

 

After that patient, I saw one of my patient’s door lights on, meaning, he also needed a nurse to attend to him. I was on my way there when I was interrupted by one of the sitters from another room. He told me he needed a nurse urgently. When I got into the room, I saw the patient on the bed messed up with lots of blood. By assessment, I found out he was bleeding from the rectum. He was like swimming in his own pool of blood on his bed.

 

I called for help, and the nurse who’s in charge with the patient came in. To cut the story short, we got busy with that patient who was later pushed to ICU around 11pm.

 

Only then I was able to attend to my own patients. My patient who called earlier was, of course, disappointed that I have to come in late for him. He also needs to open his bowels, and he can only do that on a bed pan because he is on complete bed rest. I apologized for my delay and explained the reason. But of course, whatever the reason may be, I still placed him in a very uncomfortable situation.

 

After I attended to his needs, I started checking my other patients. I had six that night. All of them had the same lines “Wen Inta?”(Where were you?). I had to explain to each of them why I had to see them late. I was in a very uncomfortable position. I knew it was not right to see them late but what can I do? I had to help a co-nurse who had a critical patient.

 

My medications were running late, and some other things were not yet done. I tried to finish all of them slowly but surely.

 

I had to mention that while we were running back and forth because of the bleeding patient earlier, there was this one patient of mine who kept irritating me by coming many times to the station just to ask for a tv remote control. I had to explain to him several times that I was still attending to a critical patient, and that he needs to wait.

 

If the remote was just as easy as picking it up and handing it to him, it could have been alright. But I will need to search all empty rooms to do that, and I did not have time for that. I asked help from our charge nurse, but also told me that she could not find one. The patient, who is up and about, and ambulatory, insisted that he wanted the remote NOW. Imagine! There was a dying patient, and here he was insisting that I look for a tv remote control stat.

 

I need to keep my temper, otherwise, I might end saying things I might regret later on. In the end, after things have settled, I found a remote for my patient, I have given my medications and my patients started sleeping. I had my dinner break around 230am.

 

The rest of the night went smoothly, and the 6 o’clock madness ( I call the 6 o’clocks here as “6 o’clock madness” because it does not matter whether it’s am or pm, there is always a lot of work to be done before the shift ends at 7), was manageable.

 

Wow, I am four days off starting today! Now that’s what you call vacation after some very heavy shifts. That would be enough to recharge my super drained energy.

Introducing Iñigo, Our Baby

The most awaited time has come. Allow me to introduce to all of you, our first-born child, IÑIGO GREGORIO BAUTISTA. He was born on the 19th of July 2008 via Caesarian Section at the Sacred Heart Hospital in Malolos, Bulacan.

Dra. Pura Corazon Villanueva attended his delivery. He was so big to be delivered normally, he weighted 7 pounds when he came out. He is a very healthy boy, thanks to his mom’s diet. He is fair-skinned with very red lips.

He is going to be a fine man in the future, as we promise a life full of love and inspiration for him. As his parents, we would try, to the best of our abilities, to provide him the best this life can offer.

Cheers!!!!!

Iñigo’s First Pictures

Today, I heard my parents talking over the phone about me. They said they need to bring me out today. Mom was scheduled for a caesarian section this afternoon so I could come out safely.

At 3pm mom was brought to the operating room. The doctors made a cut slowly into mom’s tummy until they finally saw me, and brought me out to this world! That was amazing!

The nurses gave my first bath and brought me to the nursery. I was placed in a small plastic crib which was later pushed near the glass window. On the other side of the window, I saw my relatives for the first time. They were all smiling. They seemed to be very happy with my arrival!

Thanks for the very warm welcome! I am so glad to see all of you!

         

IÑIGO’S BORN!

 

I was still sleeping when my wife called me up around 6am from her OB’s clinic in the Philippines. They were 4 hours advance in my home country so it should be 10am there. She wanted me to talk to her doctor so I could ask her some details about the status of her pregnancy. We were expecting her delivery tomorrow and she was due for a check up today with her OB gyn.

 

Dra. Villanueva informed me that it seemed the baby would not fit into her pelvis and a caesarean section might be necessary. They could schedule her up this afternoon, instead of tomorrow, since tomorrow is a Sunday and it would cost us a bit more if it will be done on that day.

 

I agreed on her suggestions, and Didith’s voice over the phone seemed like she was all ready and prepared. She was scheduled for the operation at 3pm (11am UAE). She was admitted after her clinic check up and was prepared for surgery.

 

I tried to go back to sleep since I have had only a few hours of sleep before I got the call. My son entered into my dreams, and I dreamt of having him in my arms. I was with my wife and we were in my parents’ house in Bulacan. Suddenly, may baby disappeared from where I laid him, and that was the time I got awakened. I knew that the subconscious mind works when we sleep, and it has picked up a sense of fear in my inner being. Who would not be? My wife is undergoing a major surgery.

 

30 minutes before the scheduled surgery, I called my wife using my mobile and gave her some moral support. I knew that’s the most I can make being away from her at this time, when most fathers-to-be are at their wife’s bedside.

 

I was working a night shift in the evening, but I knew I would not be able to sleep in this situation. On my next call, my sister told me she was already in the operating room. It felt as if my hands were caught in chains and I could not do much. I am a medical professional but I am away for my wife’s medical situation.

 

Like her surgery last March, I started sending text messages to everybody on my cell’s contacts. My message read: Hi po. My wife Didith is in OR right now undergoing Caesarian Section. Please pray for her. It was overwhelming to receive text replies, and even calls from friends who gave very encouraging words.

 

It was almost 1pm here when I got a call from my sister, and she announced that the baby was out already. He was a healthy 7-pound baby with long limbs as my wife’s! My sister tried to describe my son as I tried to imagine what he looks like. She said he looks like me. He had a fair skin and very red lips. She was standing in front of the nursery window as she vividly described my baby’s features on the phone. I envied her, and wished I was the one looking at my precious child.

 

My wife was still inside OR that time. I wondered if she has seen our baby. I knew she would forget all the pains once she sees our child.

 

My cousin was fast trying to send pictures of my baby. When I opened my yahoo, I saw my son for the first time and it felt the most wonderful of all the emotions. I was teary eyed as I looked each and every pictures of him. He is the small me!

 

My sister later on called again to inform that my wife has come out from surgery and is now resting in her room. It was a big relief knowing my wife is safe, and my baby is out healthy.

 

I will be working tonight, and though I haven’t slept during the day, I knew that I was charged with a powerful energy within my veins. I will be working carrying a different perspective in life.

 

 

 

 

 

Check out my other sites!

Aside from digital catharsis, I am also managing three other sites. Some has known the sites through my link in this page’s blogroll. But for some who have not visited my other blog spaces, allow me to introduce these very cool sites. Just click the titles to link you to the sites:

 

Iñigo’s First Journal – This site was born during the time when my wife started conceiving our first baby. I felt that a new individual is starting to grow, and that he might have some things to say, that he just can’t put into words at the moment. The father-to-be takes the baby’s point of view in this very special story of a baby’s growth starting from his being a fetus.

 

Nelsondidith.com – A dear friend bought us this website as a wedding and valentine gift. This site is a picture story of our marriage, and the people around us. I think it’s a very nice way of sharing a life full of love, courage and inspiration.

 

Sentimental Journey – I initially made this site a second version of digital catharsis, until I recently changed the blog’s theme to a more interesting level. It has now become a nursing blog where most stories are my real-life experiences and struggles as a nurse.  I draw inspiration from my work, my colleagues, and my patients.

Nothing is Impossible with God

Today I am a witness to a miracle.

 

We had a patient in our unit who has a gastric carcinoma. He wasn’t my patient actually but I got to know him because I had to fetch him from the endoscopy unit where he had a series of endoscopic procedures.

 

The patient was actually diagnosed from another hospital, and tissue samples confirmed of his malignancy in the stomach. He was scheduled for a gastrectomy tomorrow, where his stomach will be removed. He went to the endoscopy today to verify the findings and to locate the exact area of the operation.

 

My colleague went for his lunch break when the endoscopy unit called and asked for a nurse to bring the patient back to the unit. I went there myself to get the patient. The nurse there gave the endorsement, and she was also surprised about the findings: there was no carcinoma seen in his gastrointestinal tract. He was cleared from cancer! We had to lower down our voice so that the patient does not hear what we were talking about, because the results can only be relayed by the doctor to him.

 

Later in the afternoon, the patient’s wife talked to me about the endoscopy results. The doctor has explained to them what they found out, and of course, the surgery tomorrow might get cancelled. She said she prayed a lot, and that God answered her prayers. It’s a miracle indeed!

 

Nothing is impossible with God. When we feel that life is too much, we should just always remember that there is somebody Above who never sleeps.

The Colostomy Story

Today, I had to deal 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!”.

 

 

Tour Guide

I was expecting Laarni this morning because I knew earlier that she and her batch mates left thePhilippines last night. I knew her from the recruitment agency, and we did our written exams, interview and medical exams at the same time. She is now a ninang-to-be of my son. 

 

 

My wife visited her in our Antipolo house before she came here, to ask the favor of bringing to me some of the stuffs I forgot to bring here. It was a coincidence that our subdivision in Antipolo was just next to the subdivision where her house is.

 

And so I waited for her this morning. From my flat, I can see who’s coming in and out of the building where she was assigned to stay. There was no sign of her until the afternoon, so I decided to check her out in her building. I knew beforehand from the “compound madam” which unit she was going.

 

When I reached her unit, I saw her and some of her batch mates coming out as they were planning to go to the town. The thing was, they did not know where they were going, and Laarni pleaded for me to join them. Though I had plans for the evening, how can I say no to them.

 

I remember when I first came here, no one was there to really guide us where to go. I got my sim card like two days after I arrived. And so family back home was pretty worried that time since I was not communicating to them for the last 48 hours. I also was not able to change my money to dirhams immediately, so I settled on the food that was already in the fridge when I first came in. I feel for this group, so how can I say no to them.

 

And yup, I was the tour guide of the evening. I oriented the group about bus timings, and where to get a bus going to the town. We initially went to an exchange center where they could change their pesos and dollars. We then proceeded to a cellphone store where they sell a sim with free cellphone. After that, we went to a Kodak shop as some needed to get ID pictures as required in HR.

 

We then went to the nearby supermarket where they can initially buy some necessities to be able to live decently.

 

We all went back to the compound later in the evening. I invited Laarni for dinner and I got my stuffs that my wife requested her to bring to me.

 

And that’s the story of today’s tour guide.

 

Bloody First Night Alone

Last night was my first night alone. What I mean is that I have finished the number of shifts required to work with a preceptor and so I had to start working by myself, without my guide following me up.

 

During the last weeks, I worked with my preceptor Jaime. I followed his schedule, and handled the patients he was having. He provided me with the necessary information about the actual ward work, which cannot be explained in lecture halls. Learning the know-hows in the war are usually learned in the actual battlefield, they say.

 

And since it was my first night working alone, I expected a chaotic night. Before coming to the unit, I thought I would be given a light load. But I had the same load, as the ordinary staff gets, and so I had a very busy night. I was still very slow with my work, especially since I am still adjusting to the new environment, system and computer documentations.

 

I had a patient with Non-Hodgkin’s Lymphoma, who always want to get out of his room , so I had to disconnect and reconnect his IV tubing many times. Eventually, his IV cannula site got infiltrated early in the morning. He had very bad veins because he’s been having chemotherapy. He needs a new and good line because he’s having chemo in the morning. He also kept on bugging me about transferring him to a single room because his insurance covers that.

 

I had an old man who was involved in a road accident previously, which caused him now to be bed-ridden. He is on NGT feeding and because he is confused he pulled out his tube twice. The first time I was able to reinsert it. The second time, I was not able to do it because of a nasal blockage. I got help from my charge who eventually got it inserted. He keeps on sliding down his bed which caused him to reach his NGT even with restrained hands. He is also diabetic with blood sugar monitoring every six hours.

 

I also had a post tonsillectomy patient who came from surgery just a few hours ago. He complained of throat pain and difficulty swallowing which was relieved by tramadol. He was on IV antibiotics too.

 

I had a post TURP patient who had a foley’s cath that kept on draining. He was so obsessed about his uring bag that he would press the bell just to get it emptied, even if he did not see how much was in it. It would always be just a quarter full.

 

I had a patient who was post amputation of some toes on the right foot, and was connected to a vacuum machine. He presses the bell whenever he wants to go to the bathroom because he had to be disconnected from the machine. He also had fever early in the morning and on blood sugar monitoring.

 

Another patient was also a post op patient whose big ulcer on the sole of the foot was covered with a skin flap from the left thigh. He also spiked fever early in the morning.

 

My last patient was my admission directly from OR around midnight. I picked him up from the recovery room, and on the way to the ward, he vomited  on the bed. My hands got vomitus as well after trying it by the kidney basin. He was on heparin drip, IV fluids, a foleys, and an IVAC. Later in the unit, he complained of pain so he was given tramadol IV. Just minutes after the injection, he felt weird and hallucinating. He started shouting saying he’s going to die. He said he was so dizzy and nauseated so I gave him metoclopromide IV. That settled him down until morning.

 

When I got home from work this morning, I had no more energy to prepare breakfast. I just had a glass of Horlicks and I crashed on the bed, as if I was knocked out by Manny Pacquiao.