Tuesday, February 21, 2012
I had a cigarette break conversation with a volunteer nurse from the ICU last night after she pointed to me one of the newly-hired Attendants. I asked her if she applied for the position too. She just answered "No.." and contined on with "because i'm expecting to exit this February." As if having a Babel Fish lodged down my ear i immediately understood what she meant by "exit" and had to ask where she's going. "Singapore" she replied. I had to ask again how long she's been working/volunteering here and she told me she just started. That she just graduated last year. I was mind-fucked. How the hell did you land a work visa there with no previous work experience, i asked, puzzled. One word, "Connections." Lucky girl. I wish i have connections as badass as hers too. Unfortunately i don't. My only connection is my cousin in Abu Dhabi, who can not promise me an employer that will secure me a work visa. But thay's ok, i am an understanding human being. I won't let that destroy our blood relationship. So you might be wondering, where am i going with this? Unlike my previous posts this past month, this won't consist of rants. It placed me on a different perspective on what i will do with my life. TAKE RISKS. It is time consuming and not practical but if this is the only way for my rocket to finally come, i will do it. The other day an agency texted me, urging me to report to their office immediately in order for me to be prioritized in one of their urgent job opennings for Abu Dhabi. I was thinking of ignoring it, then this conversation with a colleague whom i have never met before but i may have seen way back in nursing school (we went to the same school together, i was 3 years her senior), happened in between 2 sticks of cigarettes. It ignited the flame i once had a few months in after i was hired in my past job. Back when the only rejection i received from agencies was the organ between my legs. Back when i was neither frustrated nor greatly disappointed in looking for employment opportunities abroad. I just need luck. And if i'm not gonna do something about my irrational fear of rejection or my cheapness, then i'd be doomed to stay here forever. I asked her if i can apply as walk-in, she told me i have enough experience here in the PH to land me an offer there. I do hope she's deadpoint on that statement.. Because i needed something to boost me up. I joked that maybe they can recruit me as well. She was polite and told me she'll ask if it would be possible. My hopes are not high on that last part, but then, who knows, she could be Lady Luck in disguise. ;)
Saturday, February 18, 2012
Okay, so first off let me start with something pleasant. I am (nearly) officially "underworked - overpaid". I will be expecting a 60 % boost from my previous salary in my past job in exchange for 12-hour shifts for 4 days/week and an average daily census of 5. Plus, i have an Attendant. It's like working overseas but with Filipino salary. :DDDDD
Now, on with this week's rant. :/
How could anyone be so stupid to not anticipate the problems of a patient? The diagnosis was T/C UGIB, and yet there was no order to perform gastric lavage. History suggests possible bleeding from the upper GI for obvious reasons: number 1 - the patient hasn't had any decent meal (in fact the patient has not eaten for more than 2 weeks!); number 2 - prior to consult, SO's claimed vomitting of gastric contents mixed with "dark" blood. Number 2 alone is indicative of GI bleeding, it may not be active, but it is possible that there is presence of it. And here i am again, about to compare this to how we used to do it back in my previous workplace. A health worker who cares for his/her patient would do something like this: order NPO temporarily, inserts NGT, performs gastric lavage until output is clear, hooks NGT to drain. Not all physicians are always right. In fact, they are human too like the rest of us health care workers in the "lower" heirarchy (this is how we are being treated in this country), but then, if you are a keen observer, and you know your job well as a nurse (which is to CARE for the patient, as easy as that), and you observed that what the physician ordered is just plain silly, you would not bother suggesting or even better, correcting the physician of his/her mistakes. Because in the long run, if you, the nurse, allowed these mistakes pass, you will be the one who will suffer. Referrals after referrals after referrals. The key here is to ANTICIPATE future problems. I remember the post-op order of a visiting OB-GYN from my previous work, even if her orders occupy an entire page of the Doctor's Orders sheet, you can see that every order is relevant. She's anticipating what to order if certain complications arise from her post-CS patient. It is not being lazy to do rounds in her part, it's more like encouraging the Nurse in charge of her patient to literally just focus on her patient. Because if she does not anticipate, and base all orders on what already happened, it would be time consuming for her and for the nurse. Referring problems/progress of the patient can eat up alot of time when rendering care. Patients need undivided attention from their nurses. The chart, computer or intercom is not our client.
Going back, here's what happened when this patient was endorsed to me. The patient has a history of mental illness. If you would go back to the basics of mental health, a clear indication of mental illness is neglecting normal ADLs -- meaning, the patient won't bathe, eat etc. In the case of this patient, she wouldn't eat for fear that the food would be stuck in her throat, choking her to death. I reviewed the orders: no diet was ordered. Again, going back to the nurse being (actually we are REQUIRED to be) a keen observer, the admitting nurse would've noticed the absence of Diet in the orders. So i asked the admitting physician, he/she said "Soft diet, encourage the patient to eat." So i did, i ordered the diet from Dietary. Then i had an epiphany and started questioning why there is no NGT, why lavage wasn't done in the ER, why the physician is ordering Soft diet when the patient wouldn't eat for the past 2 weeks. Okay, so the last one was so-so for me, when the patient was coming to her senses, she would ask for water and actually drink some sips of it. Then miraculously she asked for food. We offered her the food but she always ended up refusing. This went on for a couple of times. I was about to refer her to her attending when the Neuro-Psych consultant arrived. Thankfully, the consultant ordered NGT insertion if the patient can not tolerate or continues to refuse solid food. We tried feeding her again yet she still refused. I informed her attending, and we inserted a NGT for feeding. I performed lavage, output was not as clear as NSS, but in my experience, the output would pass as clear since there were no clots in it, actually it was a bit yellowish. The attending ordered for milk feeding. Her laboratories arrived and it showed possible failure of the kidneys (Crea and BUN were through the roof) and electrolyte imbalance. The next day, the patient showed progress, she looks less weaker, with some lucid episodes. OF feeding was started by the day shift. During my shift she complained of abdominal discomfort. I asked the outgoing nurse if they performed lavage. She affirmed, saying the initial output was coffee-ground, but they were able to were able to obtain clear output. Good, this is progress, Omeprazole is working. Pior to feeding i performed lavage, output was clear with some residuals, but not enough to hold feeding. But throughout my shift she kept saying her belly aches. I learned from her SO's that aside from the OF, the previous shift was also feeding her with milk, with an hour interval. Immediately i checked for residual. I was able to remove almost half a liter. This can't be good. I had to hold her last feeding. I observed relief, but she's started to grow out of her lucidness again, and would scream at me whenever i go near her. This is the hard part of being a nurse, maintaining your composure amidst all the screaming you get from your clients. I was able to endorse her to the next shift resting. None of these would have happened if her needs were anticipated in the first place.
So the moral of the story is to never always rely on what is being ordered. If your instincts tell you something is wrong, voice it out. We are all human, we make mistakes, as the cliche goes. It is not illegal to question your fellow health worker as long as you think you are right. We are no longer in 19-kupong kupong, the nursing profession has evolved into one of the most sophisticated and noble vocations and is currently being recognized as one in developed nations.
Tuesday, February 14, 2012
I'm in deep shit.
Expect the worse,
Hope for the best.
Whatever the decision will be,
What i need right now is brain juice.
A back-up plan.
For the following weeks may be my last.
I'm really in deep shit.
I'm not in Shangri-La anymore.
I'm in deep shit.
Seriously, I AM.
Scout for other possibilities..
This is bad....
I won't be able to sleep soundly now...
Saturday, February 11, 2012
In less than 2 months, marks my 3rd year as an employed nurse here in this country. I don't know what is wrong with me... why after all these years I am still here, overworked, underpaid, unhappy, and not earning a single cent from my salary. I will be turning 25 this year which means I have already spent (wasted) a quarter of my life in this shithole place. The devastation grows more whenever I see photos of my "much more successful" batchmates living and enjoying life in a land with greener pastures. I know that starting over is tough, but at least they are already there. Call me a victim of colonial mentality but with what our country's heading right now, I really wish Lord Voldemort would Avada Kedavra me right now if life would keep on fcking me in the face with each failed attempt to secure employment overseas. I kept on saying, "2012 is my year!" Then i realized i said that same crap last year ("2011 is my year! Year of the Rabbit."), and where am i now? Suffering in this god-forsakened country with nothing but a few pesos in my pocket, no earnings, no bank account, no good investments, splitting my head from this unbelievable inflation our country's experiencing, while i slave over for an honorarium that is always, always delayed (i thought i would be freed from this curse when i transferred, but the universe tricked me and made it worse). What do i do? Since i have been fed up with building my metaphorical rocket, i decided to tear it down and start from scratch. 2012 is NOT my year. It is somebody else's year. I think i need to spend another year in this crappy place in order for me to realize my full potential. Compensate by saying "i need to earn experience first". And when i have gained enough exp points i will dedicate 2013 to the rebuilding of my rocket..... actually, NO. Because if i fail again i would be in this same situation again ranting, bitching and moaning how, after all these years of being a slave to this fckd-up basketcase of a country, i still messed up the previous years opportunities? Having a kick-ass resume/experience is NOT really all you need in order to succeed, you need luck. Fuckn LUCK. Fck that... how come i'm not getting enough of that? #AKML