THOSE WHO TAKE RISKS ARE LUCKY

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. ;)

SERIOUSLY... (AS LONG AS IM NOT MENTIONING NAMES AND PLACES i think IM SAFE HEHE)

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.

MAINIT

I'm in deep shit.

I'm doomed.

Expect the worse,

Hope for the best.

Whatever the decision will be,

Accept it.

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.

Back-up plan......

Scout for other possibilities..

Opportunities...

Don't elaborate.

This is bad....

I won't be able to sleep soundly now...

Anyway, {pluuggghhh!!!!}

Dx

SOMETHING IS NOT RIGHT WITH ME...OR WITH THE UNIVERSE?

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

TUMAKBO AKO PARA SA PASKO 2011 EDITION (The Road to House #320 Brgy 28)

After arriving from Manila last October, my self-esteem crushed, and itching to make a radical decision to change my life, a friend of mine, who is an avid runner, told me that there will be a Fun Run which will be held here in Laoag City on December. I have already started doing laps on the tracks as a way of conditioning myself for the upcoming Zombie Apocalypse. Her announcement came at a great time. She told me that when the organizers will start distributing forms to Fun Run "parokyanos" like her, she will reserve one for me. I registered, paid the fee, received my singlet & route map 2 days before the race, and partially helped indigents from Western River Side have a "bountiful" holiday season (i still have strong feelings against on this part, i am not a huge fan of dole-outs).

I am not a running virgin anymore. I lost my "running virginity" when i joined the Ilocos leg of the 35th Milo Marathon last July wherein i 'competed' in the 5k run. It was an impulsive move. It was more geared on proving to myself that despite lack of preparation, i will still be able to pass the finish line. Passed it i did, but my time suffered. I ticked in at a disappointing 1 hour 35 minutes. Almost 2 kms into the race i almost hit the Wall. I told myself "you're so fat, boy.. you won't make it!" I ran for a few meters and find myself walking again. I just couldn't do it properly then. Plus my feet were already aching, and my lungs started to fail me. But the sensation of finishing was amazing. It was a relief to finally stop. This was when i decided to shock myself after almost 5 months of non-acceptable exercise.

Takbo Para sa Pasko was my 2nd running experience. This time i was more prepared. It all started after a Singapore agency crushed the very essence of my existence. "Lose weight and we'll consider you, perhaps even hire you." they told me. My weight was even a huge wake-up call. That was when i vowed to immerse myself in rigorous lifestyle modification. I started with quitting sodas, and then i cut down my red meat consumption, i started running again setting up a personal goal every week, i did upper body strength and toning exercises, this is Lifestyle Modification Shangri-La. The running was partly for health reasons, and partly in preparation for an incoming Zombie Apocalypse. Rule # 1: Cardio. So when Takbo Para sa Pasko emerged, it arrived on a perfect time. I started training myself to finish 3k in less than 30 mins, achievable, until i realized who am i fooling? I need to step it up a notch in order for me to fully prepare myself. So i increased the distance, 5k in less than 30 mins. Then i figured, though possible, i am slowly killing myself with a rather ambitious goal, so i made the time frame 60 mins or less. I have had some ups and downs, best days and worse days, encounters with the Wall, stopped right there but mostly climbed it, then race day came, and it was all worth it.

My rule is always like this: "slow and steady, gradually increasing speed" so i won't prematurely deplete myself of oxygen. It always works but i still need more training in order for me to perform continuous running. That is always my problem, even if i have already built up my momentum, my stamina always fails me. Which i think is still okay at this point. I wish to correct it in the long run though. My body surprised me during the run. I was able to continuously run for almost a km and a half, a feat i couldn't do at the tracks (which is 5 rounds without stopping). I think my stride and form have improved since i did not experience the worse DOMS in my life since July's run. To think that i ran more this time than my first time. I was indeed prepared for this. I even made a "smiling friend" in the presence of the girl who overtook me just right after the turning point. She smiled when she passed me, i smiled back. It was not an "insulting" "ha-ha! eat my dirt fat boy!" smile. After i crossed the finish line, and we walked passed each other we smiled again. This sport was more than running and feeling good about yourself, it is also a healthy way to practice sportsmanship and make friends, even "smiling friends". The feeling of having a complete stranger recognize you and acknowledge you with a smile is rewarding. Or maybe she already knows who i am, i just didn't recognize her. Oh i hope she'll forgive me for i am not good with remembering names and faces!

I wish to run again soon. Hopefully i will be able to compete in a more advanced category. But i need to train first. I need to condition myself before deciding to level-up. More cardio for me, i guess. Iv'e been enjoying its benefits so far. Maybe on the next few Fun Runs i will be joining i would be competing at the 10k run. My goal: Half-marathon (21k) at Takbo Para sa Pasko 2012. :D

I need gear upgrade. New shoes, more shorts. :D

RN MEALS MY ASS

In our constant battle with injustice towards us Filipino nurses we are faced again with another obstacle: a DOH Circular Letter stating that DOH retained Hospitals are now prohibited from accepting Nurse Trainees and Volunteer Nurses. Okay, so.. big deal. No more unexperienced nurses to train, no more training fees, no more working without pay. While it may sound like great news to some, it posed a major threat on us. Nurse Trainees as very essential in the workplace: lesser events of understaffing, one gets to practice supervisory/managerial/leadership skills, and admittedly, it's a joy to impart new knowledge to novices who haven't grasped yet practicing nursing in the real world. Another thing is, their training fees is where our bosses generate our salaries. Now their abolishment from the faces of DOH hospitals greatly affected us. There have been proposals on how the hospital will continue to pay for our services. One is to cut down our daily basic salary, another is to cut down our number. Whichever the solution they almost came up with that time would have definitely cost us, and none of these would have benefited us other than the Hospital. Social injustice on our very faces. The nerve of those who are in the position to subject us in that kind of degradation. We are, after all, Professionals like the rest of them, but we are not treated as such. Then the answer to their prayers came. DOH encouraged these hospitals to adopt the ongoing RN HEALS (Registered Nurse for Health Enhancement and Local Service) Program [bit.ly/siAV9H]. Basically what our hospital did was it converted us Contractual Nurses into RN HEALS Trainees. The good thing about being RN HEALS is we have a relatively higher salary compared to when we were still funded by the training fees, we have a monthly P 2,000.00 allowance provided by the institution, and we are funded directly by the DOH which meant, supposedly, no more delayed pay dates. Sounds good but there's a catch: the contract's only good for one year, it is yet unknown to us if we will be renewed after the contracts end and we are required to submit paperwork which includes a journal on what we "learned" during our "training" as RN HEALS and a research paper... a fucking RESEARCH PAPER! And since we are constantly subjected to injustice in our institution, the good parts of being RN HEALS were altered. The P 2,000.00 monthly allowance were converted to Food Allowance (which we branded as RN MEALS) provided to us by the Dietary Department. The idea of eating hospital food is disgusting, but the fact that we will be paying P 90+ per meal is absolutely distasteful. We are being force-fed with food we don't want to eat while being cheated at the same time. Our salary was divided into 22 days, with every minute tardy, an amount is subtracted from our basic, if we absent ourselves with or without a valid excuse, we don't get paid for that day. We wonder where the money not being given to us will go... the removal of Nurse Trainees meant taking away the Pool Nurses as well. The Pool Nurses get their funds from us then Contracted Nurses, they equally divide to the Pool nurses the money they deduct from our salary everytime we absent ourselves or go on leave. Now, there are no longer Pool Nurses in our hospital, so where does the money go? Blatant corruption on our faces. And what are we doing about it? None... due to fear of termination. The Chief is a tyrant. It pains me that we are either too afraid or too indolent to act on this injustice.

By the time i would have posted this, i would have taken and passed the screening exam for a supervisory plantilla position in another hospital, i look forward to being called for the Personnel Screening Board, and hopefully by the end of this year or early next year i will not be experiencing constant degradation in the workplace ever again.

OFACIAL COVER OF PAC MOM IN VOGUE ITALIA

A few days ago i was quite intrigued by Dionisia Pacquiao's (fake?) Preview Magazine cover. The first thing that came to mind was "Fuckin' seriously??!" and immediately after that, "CHALLENGE ACCEPTED!!"

Since this was Mommy D's first cover in a fashion magazine (i think... i still have doubts if it's fake or not, but seriously, Preview. SRSLY??!! O_O ), why not twist it a bit and be Franca Sozzani's new cover girl -- or lady.. her Senior Citizen's ID say so.

And now, presenting Dionisia Pacquiao a.k.a Pac Mom / Mommy D on the cover of the December 2011 issue of VOGUE Italia..