Busy, busy, BUSY!!!

31st October (Friday) - Dashing in with just few seconds to spare as I slammed my finger to gain access for clocking in (or thumbing in), ran as though I'm being chased by wolves. Then finding out I went to the wrong ward, I ran to the other side and miracle of miracles, I'm still early. 5 minutes after that the morning shift TL finally came in and started the report. Whew, close call.
I thought the girl I'm working with is okay, turns out I'm being a naive simpleton, as always. She must've found out I was being too chummy with one of the senior staffs because she seems intent on making my life miserable. Making me super busy til my feet felt like falling off.
One of my biggest surprise was following one of the professors. I did not know who he was until too late, when he asked me for chemo protocol. Ohhhh, he's the one that tends to yell at people but...he's nice, I think. We had a nice chat, and I told him about how my dad refused to let me join the oncology field because he's worried that I'll become sterile. The prof made a "hmph" sound and said, "I started working in the Oncology field in 2002, and I got 2 kids. You don't see me sterile." Well, that's surprising. They way my dad  kept going on, it's as though people who joined the oncology field end up becoming sterile. Huh, I'll have to let my dad know about this. It's going to take tons of convincing but maybe he'll get it.
Today is a busy day again. Patients are not heavy care, but it' a full house with one or two who needs attention. Lord knows but the 5th room lady is always pressing the dang bell for every little things. Sigh, keep cool keep cool.... Don't lose your temper over her, it's not worth it. Remember that crazy aunty who kept asking for attention and whom caused us all in trouble by bad mouthing us??? Stay cool...
Moving fast forward, nothing much happened besides sending patient to the OTs, and following profs. And I received a nice call from the other ward whom passed me a message by uncle who's finally being discharged. After 3 long months, he can finally go back. It's really sad that I won't be able to serve and care for him anymore, but I'm also glad that he is finally able to go home. I mean, who enjoy living in a hospital?
With all of the excitement I totally forgotten about Halloween. Happy Halloween everyone. Halloween is one of the rare times that I'll do a Halloween-themed art but since I'm working in the noon and I'm exhausted these past few days, all my writing and drawing had to be put on hold on a moment. On a brighter note, my mo-neh is in. I hope I can get Redeemed, if it has arrived.

And The Torment Continues...

'Does thou not hear the pity of his plaint?

Does thou not see the death that combats him

Besides that flood, where ocean has no vaunt?'

Dante Alighieri, Inferno, Canto II

30th October (Thursday) - Even though it's a morning, it's almost like a repeat of yesterday. Yesterday there were a few rooms left, but today is a full house. Nutty, and they are all heavy cases. Neuro, critical, cancer cases.... I ended up becoming a runner because of all the heavy cases. This is also one of the rare instances where I do not put up drips, sponging and such. We were too busy, that somehow I ended up doing bed making solo. What to do? Some patients were alright, but most of them were sleeping. Because all of us are in a rush and in constant demand from patients and professors alike, we didn't had a lot of time to do bed-making. I was settling uncle after his shower when the doctor came. Uncle is going back tomorrow, so the doctor came over to make sure he is all ready to go, with the right equipments for his rehabilitation. After that, I had to give his feeding and made sure he is all rested up and ready. Then because there were too many patients, I started observation early.

The other uncle, the one with the advanced cancer is looking worse. Just few days ago, he could talk and joke with me.When I came in, about to do his vital signs, the prof came in and stopped me, telling me there's no need. Uncle looks, no other ways to put it, awful. His eyeballs are looking upwards so that you can only see the whites of his eyes, tinted with an unhealthy yellow. His breathing is shallow and he barely responded when the prof called him. The prof then explained to me that he's already entering the stage of dying. He pulled me aside and told me, most likely at uncle's condition, he only had today or tomorrow. No, not again. Ever since I joined here, I've been seeing terminally ill patients dropping a lot. He told me, no point active resuscitation because the cancer had spread everywhere in his body. He said to me, just do what you all can, give him care and support so that he doesn't suffer in his passing. The one thing all of us we are worried about is what if he passes during midnight, there won't be any doctors. We need to find who's the Doctor on Call, because as I reminded the prof, as nurses, we can't pronounce a death of patient. Only doctors are allowed to do so.  He made a few calls and said, "If he really does pass and you all can't get the Doctor on Call, call me." He then put down the Doctor on Call number so that we know who to contact later on.
The kid is another problem. He keeps crying so hard that made all heads turn. He wants attention form everyone. And if you don't give him the attention he wants. he yells and chase you out of the room and refuse to cooperate with you next time he sees your face. What to do but to give him the attention he needs so that you are able to do your work smoothly, otherwise you'll end up getting yelled the prof.
And discharges, of course people want to leave fast, but they kept shoving us to go fast. Come on, we can't proceed a discharge until the prof signs off. And there are too many admissions. And they are all yelling non stop for rooms. Look, our rooms are limited, and we only have three wards, and they are all jam packed. The nurses are all stressed out, with all the procedures and the demanding patients. Grrr.
I even ended up being bullocked by a patient on our first meeting. Well, not the patient, her daughter to be exact. From the way she talks, I know her type. Snobby, educated, rich type whom expects everything to be perfect. The moment I just stepped into the room, she went like this. "We waited so long for a room. Why you all don't have any spare rooms?" "Oh my God, this room is so old and disgusting! Look at the walls, it's all cracked!" "Your water heater light is spoiled, and you call this a VIP room? It's so badly maintained!" "What's the difference between a single and VIP? Tell me, tell me, TELL ME!" Ugh, she basically back into a corner and bombarded me with all of these questions and remarks. Look, our ward is basically full and rooms are limited. You think we can chase out our patients just to fit you in? And there is absolutely no point complaining the maintenance to me. I gave her the customer feedback form and took her to fill all her complaints in. Good thing I kept my cool, otherwise I might end up snapping at the daughter. It's really not easy to keep your head low on this kind of patient's family, but I'm learning....

Breaking Point

My son, Here indeed maybe torment, but not death.

Dante Alighieri, Purgatorio, Canto XXVII 

28th - 29th October (Tuesday to Wednesday) - I'm so so so dead. I've just came back from two days off and I'm being blasted by senior staff nurses and heavy cases alike. The major event that happened was there are many old patients back in, with two cases of brain tumour. One is a patient whom I familiar with, he's an old patient. Sadly, he had a recurrent tumour. D: Poor boy. The family are given the choice of chemo or surgery. Chemo, they are not too keen. Understandably, would you want your child to start chemo at a very young age? Nobody ever opt for chemo unless it's really that bad. Even my other uncle who's in a critical stage refused chemo, only giving him hydration and support. He's such a strong man, that uncle. Have it not been his cancer, he would've gone to Taiwan to become a monk. His pain threshold is superb, seriously. The morphine is only like a support, the only thing that is of concern was his restlessness. And most cancer patients I treat are always in pain.
Back to the story, this child, well teenager had a surgery done. According to my report, this child often wails and cries so loud because of his condition. One of the senior staff asked me to take a look at his drip and his hourly CBD output. Simple, yes? All I had to was watch out for his wails and cries... Bzzt. Wrong, so wrong.
I stepped in, greeted the family and explained I needed to top up his dip. I don't know what happened, seriously, I'M INNOCENT FROM THIS POINT, I was about to change his drip when the guy grabbed me hard on the wrist and went, "Sisterrrrrr." Ahhh, not again. The last time I got into this mess was when I was below helping a young adult, who had electrolyte imbalance and I needed to milk his CBD tubing to get his hourly urine output. He too, reached out (not grab) for me and went, "Sisterrrrrr, please help meeee." Oh dear. Except this guy kept wailing and crying until I was like, "What's wrong? Why are you sad?" And he just hugged me hard and went, "Sisterrrrrr, please call the doctor. I cannot breathe." Nothing I say will dissuade him, especially when he gotten violent until his family had to step in. When he finally calmed down a little, he kept going, "I want to see prof now, now, NOW. It's an EMERGENCY." "I WANT TO SEE PROF AND SPEAK TO HIM PERSONALLY." Yes, he maybe a teenager, but he insists on talking to prof personally. He sure got guts. And he kept hugging meeeeeee. *super awkward* I kept looking at the family for help and they were like, "You better hug him, girl, Otherwise he's not going to let you off." So I just pat him lightly on the head while he wail and cry onto my shoulders. Sigh.... ~.~ Suddenly I missed me good old patient from the below ward, at least he's not too clingy.
My mood was worsen when a senior staff demanded me to wash a colostomy bag. I get the theory, but never done it before. And then she started blasting me about wasting my student life and how come I never done it before. I told her firmly I used to be in a private hospital, where the cases are all separated, and the patients usually refused to let us do once they know we are students. She then start yelling some more when am I going to learn and I told her, "Now, of course, at first chance." Her anger cooled down a little once I prepared my equipment, I may not have done it before, but I know what needs to be prepared, just roughly. With guidance form a kinder staff, I managed it.
The next day was no better. I'm working in the morning and so early, in the wee dawn the profs are all coming for their rounds. And most of the patients are fast asleep. One of the profs were wondering whether they are coming in for their rounds too early (Erm, yes.) That kid, is seriously scary. When another prof came in, not his primary doctor, another one, he demanded his family and the nurse to get out, out, OUT, because he wants to speak to the professor personally. What to do but my poor colleague and the father was sent out while the prof had to deal with him alone, and came out moments later looking harassed. I don't blame him, that kid is a tough cookie. And then only we realized his depression was getting worst til they needed to get a psychiatrist.
If you think that's bad, near eleven, we are all harassed and running around like mad bunnies, running after profs, not to mention the new admissions that came flooding in, the heavy care that most of our neuro and critical care patients needs. Even I gone mad and nearly lost my temper because of one of our regular patient who likes to be pampered (Not uncle). I managed to cope with one of the toughest prof and he asked what happened to my fingers. Blisters and skin peeling. He asked whether I was playing with firecrackers and I went in shocked tones, "NO!" Then he went, "Just joking, girl."
When 12.30 came, I had enough. I was seriously losing my cool and had to get out of the "war zone" now before I cracked. I grabbed my bottle and bread and start chugging the whole thing down as though my life depended on it (I regret later cause my stomach was a bit bloated.) just as another staff nurse came running in and said she had to get away from all the chaos. Join the club, senior. Same here. And it does not help that our ward is full with heavy cases by the end of our shift and I'm working morning tomorrow. Please, let the patients go back tomorrow... TwT

Marshmallow and Day Off Emergency

27th October (Tuesday) - Although it is my day off, I'm here to update the events of my past few days. Noon to morning shift and then two days off.  To start off, during noon shift, I'm finally allowed to do checking of blood with the staff due to lack of seniors. I wished I could transfuse blood to brush up my practice bur for some reason it always ends up on the wrong time, like when I'm doing my doctor's rounds, doing some other procedures, or picking up things from below. Argh, I think I have the most crappiest timing in the world, but no matter, there will always be one or two due to the constant case of chemotherapies in the ward.
Moving on, we got a Datin in the ward, she's an okay person, but what I can't stand is her entire family or village are always crowding in the room. Seriously, there are always thirty plus people in her room, and little kids running around the place. A few times some of the senior nurses had grumbled because they are always running and screaming around the ward corridors, which is dangerous. What if they slip and fall? The blame is going to go to us. It happened before. Not kids, remember the story I mentioned? The one with the hot porridge? Exactly. Datin is always on the chair, while her grandchildren are all playing with the bed remote. According to one of the senior staff who went to serve her medicine, the kids had made the bed into a V shape. Imagine that, and they were playing on the bed. The nurse got so worried that she adjusted the bed back. And sadly to say, the family, friends all ignored her.
I finally get to administer insulin for uncle. Oh yes. I used to do things the old fashioned way, with the tuberculin syringe. But now it's all about insulin pen, pen, pen. I really dislike insulin pen for one reason only. The needle. It has a small cover that you have to gently loosen it, otherwise you'll end up with a needle stick injury. A colleague of mine gotten poked by it before because he twisted too hard. Luckily it was a new needle, if it's an old one...*shudders* And I gave it to uncle while the other girl fed him. Uncle must be tired seeing my face all the time. ^.^
I did some of the pre and post op stuff due to everyone being busy. Some of the OT staff seemed to remember me, cause they were 'You again???" Nevertheless, they handed me the patient and I hand things over to them. What to do...This is what happens when you have lack of staff, or everyone is busy til you have to do it. I even got nicknamed a marshmallow. "Too fair, too nice and too soft," according to one of the OT boys when I sent the patient down with him.
I seemed to be tense lately because I can't seem to focus on what others are saying. They were like, "Are you kidding? We been saying it since from just now..." Then they said while it is good that I focus on the work before me, I shut out things around me. "Relax, kiddo. You got to let your walls down. Don't be tense or you won't survive your job." Oh, okay. I seemed to have built my walls a little too high.
The following day is basically a repetition of yesterday, since I was in the noon shift. Morning is just like normal, sponge, linen and then doctor's rounds. The only thing that happened is when I did the routine observation, most of my patients are having high blood pressure. SAY WHAT???? And all my colleagues laughed and joked, "Most likely you are too pretty so the blood pressure shot up." ^.^ Thank you for the compliment. although my mother always say that I'm ugly.The only thing that spoiled my mood is in the Datin's room. Her blood pressure was okay, but the daughter is such a.....I'm not going to say anything, but she kept demanding me to check the blood pressure over and over again. Arghhh, she's not having hypertension, alright?! Don't get me wrong. Datin is an okay lady, but the daughter is so.... She was even shouting at us about the oxygen leaking and are we trying to blow them all up, cause what if someone brought a lighter and cause an explosion. "HOW?!" "WHAT'S WRONG WITH YOU?!" Those were what she's saying. She's very lucky we are all nice and swallow the insult and screams and went to get a portable oxygen tank. We been trying to get maintenance since from just now, but no luck.
The following day I have to attend a cousin's wedding, where my first aid skills were put to the test for the first time. My nephew banged his nose against the door and ended up having a bleeding nose. I saw all of my relatives tilting his head back. Oh, heaven, save me. My dad then said to me, you are a nurse, help him. What can I do? I didn't want to interfere, but my family shoved me to the front line. So, the first thing I demanded was tilt  his head down, and everyone went, "NO! What are you doing?!" I then explained to them whenever there is a nosebleed, always tilt the head DOWN, not UP. Because when you tilt the head back, the blood might form clots and may cause difficulty in breathing. When they go it, they allowed me to do the job. My tutor explained in first aid emergencies like this, you are not armed with your medical tools, Since I was in a restaurant, I ordered the waiter to get me a napkin and lots of ice, and they did just that. Hands shaking, but my mind firm, I made an ice bag from the napkin and apply it on my cousin's nose and forehead, alternating each parts, while telling him to breathe normally, but don't blow his nose hard. My uncles and aunties were asking me whether he should go to the clinic and I said, he'd better. But it was after 10 and most clinics are closed by that time, I told them to get to the nearest ER and have him checked. Once we managed to control the bleeding, he was whisked off to get further care. I must say it's rather different from acting in the classrooms. I was in half-panic but at least I managed to do something. Who knew those first aid skills could come in so handy in a restaurant?
Well, I'm beat and I got to work noon shift tomorrow. Over and out. ;)

Scrambled Eggs and Ogawa

23rd October (Thursday) - Back in the same ward again, and it's round two for the continuous noon shift. Today from 8 patients, we gained 4 more. HDU was all empty, and all I ended up doing was hopping up and down as though I'm on the choo-choo express. Send a patient to the 2nd floor for removal of pig-tailed drain, collect blood from the 1st floor, go back up to the 2nd floor to send the blood to the OT, run to get a patient back from ECHO. Barely after that, I did blood transfusion checking with another staff, hourly observation, call bells and the usual. Oh and Endoscope too. Remember the lady whom I aspirated with the coffee ground and such? She got her NG tube removed today, so no more aspirating. Thank heavens for that.
The real running up and down began at about 5pm, It's the time where many of the patients on our side are going for op, and I checked the HDU booking and we had a full house. What I didn't know was there's not just the usual 3, but more than that. After a quick dinner of waffles and Milo, I had to run to get a patient from the OT. What I didn't know, a girl had already went down and the post op orders had already been passed. What??? Did I hear my orders wrong? I was supposed to take this patient, Mdm So-and-So, under Prof So-and-So, but how come another girl is already there before me? When we got back, everyone was like, "Whaaaat? Why is there another girl with your patient?" And I went, "Isn't this my patient? Mdm So-and-So, under Prof So-and-So?" And they were all, "Yes, you girl, whose patient you were supposed to take?" And the girl said Prof xxx. Now things made sense. That girl was supposed to take another patient, but she misheard, and took mine instead. Then I told her to pass all the post op orders to the TL since I missed the entire thing and went to settle the patient. Thank God it wasn't me or the seniors might um, 'strangle' me, like those cartoon style.
Okay moving on, the girl finally got her right patient, and because HDU were flooding with tons of patients coming in at the same time, we were all hopping and helping the patients there too. Nutty. And just as I had settled three more patients whom all just came back from OT, another patient needs to be brought back to our ward. Yikes, crazy. So, before I passed my shift over, I hurry to the OT, get my patient back, transfer her back, rush my report, help a prof in translating and finally, finally, my shift's done. Ugh., my mind is basically juggled, like scrambled eggs. The TL then told me, "You better go to Ogawa once you're free." And, cause my mind is already scrambled, I was, "Whaaaat? You want me to go to OGAWA?" And the TL looked at me funnily and answered, "The massage chair brand, kiddo." Ohhhhh. For a second there I thought she wanted me to take a one day tour to Japan on my day off. Heehee. My bad, my bad.  

'Psycho' Patients

22nd October (Wednesday) - Few days of skipping posts... That's because my net has gone bonkers again. Sigh, I really think I should start saving my salary for a good internet plan (Any recommendations for a good internet plan are always welcome). Okay, today's Deepavali, but I still have to work. No matter, I get to claim one PH for working today. It's my motivation for working besides the mo-neh and learning.
Okay, I was shifted to the other ward because...there's only three staffs working there with eight patients, while some other staffs had been given day offs. To get me going, I brought tons of Horlicks (malt-flavoured) drinks that I received from the kind uncle after that time I nearly fainted in his room due to my gastric attacks. I was sorry I couldn't thank his wife in person because she was the one who kindly reminded me and insisted that I take the Horlicks packets so that I can keep myself going because I was at the other side, but I will definitely find a way to thank her in person once I go back there.
To start things off, eight patients seems like a piece of cake, right? Bzzzt. Wrong. A few of the patients... to politely use the term, whacked. My colleagues on insisting using the term 'psycho', but I'll say it's difficult. To begin with, the moment I just stepped foot to start work, all the bells start ringing. Seriously, three to four bells ringing at the same time. I joked that the patients all probably have telepathy and they stimultaneously press the bell together. One of my colleague answered they probably know that it's after two, so riiing. Off to handle their requests.
Remember the Residual Urine Passing Urine (RUPU) I did long time ago with a senior guidance? Apparently it's not a clean procedure, it's a STERILE procedure. Oh... I managed to do it, but I'm going to need tons of practice for this. At least I poked the catheter in the right hole. Back in my student days, I've seen some people poking the catheter into the wrong hole. Seriously, I'm going to keep my mouth close about who was it but I was so traumatized til I armed myself with a torchlight just to make sure I'm seeing the right hole. That was a very close call, although not much urine came out because the patient isn't drinking much.
Then I had to attend to lots of old Chinese ladies whom are all...shall we say, sarcastic, just because I couldn't speak Cantonese, but I'm able to understand, and they were all like, "You can't speak Cantonese? How sad, and you're Malaysian." Well, I'm able to speak Mandarin, geez. One of them even commented that my Mandarin sounded fake because of my 'accent'. I was raised in English-speaking first before going over to Mandarin, and they all went, "No wonder your Mandarin sounded weird." Should I take it as an insult or compliment? I say both.
Then apparently there's this lady who had stayed for nearly a month at that ward (wow, nearly the equivalent of our uncle, except uncle's been there for already two month plus) and she's well, again, a little whacked. She claimed that she has press the bell tons of times but nobody came to attend her and she was ready to breathe fire at us. So one of the senior staff tried pressing the bell and took a peek at outside...And nothing pops out. Her call bell's been spoiled. Well. we apologized to her and she cooled down, but even so... One lady who stayed opposite is a little...pampered, she often shrieks at the tiniest bit of pains and I have to force myself to politely assured her I'm going as slow as I can. She's not drinking well and every time her line needs to be flushed. If she doesn't let me put up the drip and open the line, she won't be getting anything into her system and I'm going to get a bullocking from prof himself.
Then after having dinner, I have to do an aspiration for an old lady. Now aspiration's is my first time but it's simple. It's just like feeding, except instead of feeding, you just aspirate. So, I equipped myself with a kidney dish, glove, the 50cc syringe is already in the patient's room. Ready and syringe out!
1st round, 60cc. Coffee ground. 2nd round, 60cc. Coffee ground. 3rd round, 60cc. Coffee ground. (Getting really worried here!) 4th Round, 60cc. Coffee ground. (Families are getting worried while I bit my lip and kept aspirating) 5th Round, 60cc. Coffee ground. (Oh my Lord, this is getting out of hand!) 6th Round, 53cc. (Finally! Some resistance.) Put all the total together and it makes a whopping grand total of 353cc coffee ground!!! Congrats, I just broke the record, previously held by 280cc.
NG Feeding and PEG Feeding. Now I'm introduced to JJ stent Feeding. This is through the JJ stent with a help of the kangaroo pump. You mix the milk and everything like normal, but instead of the jug, you mix everything and then separate them into two bags, one for flushing, one for feeding, then just follow the instructions, hit the auto flush, connect and voila.
I followed a prof who's mainly based in Emergency Medicines. He seems nice at first sight, but he asks tons of things. I remembered talking to him on the phone once, I had to drag the nursing care plan folder in front of me, and the entire patient's folder with me just so I could answer every single one of his questions. Crikey, he's real scary although he looks nice on the outside. And his patient is that lady. Before entering, I was praying very hard to heaven that she don't go and bad-mouth us to the prof about how we never attend to her when she needs help. Luckily, she did not say any of that and just answered nicely to the prof. Whew. Close call.

Severe Gatric and Gesture of Kindness

17th - 18th October (Friday - Saturday) - Helloooo, no, it's not a good Friday. Um, no. Anyway, the day started off with a patient of mine who needs to remove his nasal pack which is already the due date. Roughly I knew what to prepare: a pair of latex gloves, tons of gauze, two kidney dishes, one nice zip bag of ice and a nice big yellow bag. Okay, off we go. Now see, I saw the patient's nasal pack, it looks small and it's held with two strings. So I thought, oh okay, it should be no biggie. Just take out the packs and we get on with our merry way. Bzzzt, wrong. The prof took hold one of the string and pulled.
AHHHHHHHH! That's my patient's screaming.
Me? I felt my stomach drop as I saw the nasal pack. Our nostrils is so small, and the nasal pack is as huge as a Paddle Pop popsicle. Dear Lord. And the attendant who helped me get my ice came in just at that moment and she nearly flipped. Well, the first pack came off and the patient is coughing and vomiting blood-mixed phlegm, plus blood were dripping from his nostrils like a flowing crimson river. Within minutes, the kidney dish that I gave him is already one quarter soaked. And when the second one is pulled out, another bloody popsicle came out. Then I handed prof the ice-filled zip bag and he showed the patient how to put it on and off on the septum of his nose. Oh, and I handed him most of my gauze to stop the blood flow. And two more kidney dishes at last count.
Then I ran into an old cancer patient whom I once took care of on a Sunday. He has a bad cancer diagnosis but he was still alright at that time. When he came in here, well, it's bad. Really bad. The government side said he was already in a really bad state. If you have to stage the cancer, then I say it's about stage three. critical to terminal. But we'll just wait for the prof. It was nothing but a mad rush, topping up drips, updating reports, attending to patient's needs, following prof to get their consent for op on the following day. The TL refused to let me go for break because no one went at all, even though I explained that I'm having gastric. Her reason was, "Nobody went for break, so don't be selfish." The moment I went back, I ate two plain crossiants, but even so...
The next day, the day started off okay at first. But then I had major diarrhoea. And if yesterday's gastric was bad, today's worse. It felt as thought my whole stomach is being twisted. And I nearly passed out few times. But I stayed strong for my patients' sake. I have to send a patient down to the OT and I did okay, medicines, blood reports and stuff alright. Except for one tiny thing which no one told me. TED stocking. After I sent the patient down, everyone was like, TED stocking. Oh, uh-oh, OMG. This prof is super particular, one mistake and your name goes to the matron. Everyone told me to start preparing my apology speech and these words kept running though my mind. I'M SORRY, PROF... We managed to send the stocking down so I hoped I won't have to give my apology speech to the prof.
After that, I helped to prepare feeding for uncle before he go for his home leave, but my gastric tortured me. The pain was so bad til uncle actually saw how much it hurts. His family too, and the strangest thing was, they gave me a small cup of Peptamen to drink. I refused, but they insisted because my gastric was getting worse. After a small sip, I felt a little better. A very kind gesture indeed. They questioned why I didn't eat much and I just shrugged and answered, most people said when you join nursing, migraine, back pain and gastric are part of the job description. They shook their head and told me to take care of my health. Thank you, auntie and uncle :D
Remember the other uncle I mentioned, his cancer is now really bad... Let's just say all we are doing now is improving his quality of life, but I don't want to wrap up another body, or hear another case like, "Oh, hey, your old patient has passed away." Please, uncle, stay strong.

Tidying Up....

16th October (Thursday) - No Q&A today since I'm in the noon, and that staff nurse is in a different shift, or clearing her leaves. So today I'm going back to my normal routine for today. I got my room assignments, but to start things off I ended up helping a prof syringe out. What does it mean? I was shoved into the room with a couple of 10cc syringes with a kidney dish. The prof took a look and shook her head and said she wanted a 20cc syringe. So I gotten one, unfortunately it doesn't fit. Neither does the 10cc one. Argh, how can a drainage tube be so funny? Seeing as neither tube fits, we discarded the syringes and the prof ask me to fold the tube while she 'milk' it. Thank God the drain managed to vacuum and flow in the end, so the outpatient went back with relief in his heart.
Then there's a patient who's in ERCP, And lucky me, I remembered where Endoscopy is, 6th Floor South Tower, so off I go to fetch the patient. She has been there for 2 hours and I was handed over the report. Post procedure order : NBM til review. Um, okay. When I took the patient back, first thing first, made sure patient's okay, and then vital signs. The usual stuff. At least I know what to do at this point, if I don't, I might get a healthy does of yelling from the senior nurse. She's okay, it's just that, she's impatient to teach and she expect you to pick up fast. Alright, alright. I'll just take them as they come.
A new child had came into our ward. I saw his hand in a bandage and I saw the note,s but all I saw is the hand with a part of it shaded in. Turning it around 360 degrees got me nowhere, so when the prof finally came, we asked him what is wrong with the child's hand and he showed us the before and after shots. It's creepy. The child's hand looks alright on first sight, but his pinky finger is massive like gigantism. It's a congenital thing and he had to go for surgery which they cut part of his muscles and tissues to shrink it into an ordinary size. I can't tell you the diagnosis because its spelling is complicated, but you get the idea.
Then I was ordered to change a nasal pack. When she said nasal pack, I thought it was the nostrils one, the one that you stuff ribbon gauze with, but she said, no it's just gauze, Then I realized, nasal pack is not the one in the nostrils, but the one outside, the little gauze. Ah. That's nothing. I just have to fold it into a rectangle, fix the hyperfix into place and ta-da. Nasal pack changed.
Then there's the PEG feeding, I think most of you got it by now. Uncle got a new wheelchair. not the remote control one, that costs a lot, but just a brand new one, I think I'll know once uncle takes it out for a spin.
Okay, about reports. Anyone, and I do mean anyone can write a report. But how do you write a good report, one that follows the flow? That's one of the things that you have to practice you see. A good report follows the flow, it's detailed and with the relevant information. On occasion when I'm rushing, my reports sometimes tends to jump about. The info are all there, but the flow, on and off. A senior staff nurse who had the patience taught me how to write a good report by practicing on post op reports. I would love to show you the format, but it's P&C.
On a brighter note, I'm getting the hand of the profs except for certain few, whom shall not be named.

Cracking Knowledge

14th October (Tuesday) - Today I only attended a few patients because I was supposed to complete my clinical performance record, so instead of the usual posts. I'm going to put up a sort of mini Q&A about the things that I had learned in these two months. Okay?

> SAFETY OF PATIENTS

Safety of a patient is actually a wide field. Safety not only means the patient themselves, but it also applies to us. I'll list it down in brief summarized formats with brackets as the rationale/ reason/ my thoughts and views.

Patient:
Orientate patient about the ward surrounding and the hospital system. (This is really general.)
Whenever patient is going anywhere, whether it's just outside the hospital or home leave, make sure they inform the nurses at the counter. (This is something common that patient often does. They leave without telling anyone, or they give us false information. I got a patient last week who said he went downstairs for a while, but when we called him after an hour or so, he said he's in the BANK. Ohhh, how could he...  At least he came back safe and sound.)
Smoking, especially the male patients (I know it sounds small, even I thought it was a small thing until today. But smoking is an absolute no-no because the hospital is full of flammable stuff, especially those who are in oxygen. Fire and oxygen comes together and KA-BOOM. So, take my advice, do not smoke.)

Environment:
Orientation (Again, the most general)
Keep the environment hazard-free. (People thought slippery floor, the odd bit of this and that scattered all over the floor is not a big problem, but it is. I still remember last time I saw a light screen railing nearly dropping on top of a patient (Lucky he wasn't tall, and the screen was hanging on to the other two hinges that weren't loose.) There was an incident where a small slip up involving a hot bowl of porridge also caused a huge drama. The staff brought in a bowl of hot porridge and told the patient that he brought in hot porridge, but the patient and her family weren't listening. The staff set the bowl on the table and left to attend to other patients. The family were distracted by their own chatter that they moved the table roughly and...you guessed it: Hot porridge went flying in the air and landing on a relative. You can imagine the huge scene it caused, which involves X-rays, incident reports, the relative getting admitted and running through the CCTV footage for firm evidence. Sharp objects are also not permitted to be brought. I know patients tends to say, "I brought a knife to slice my fruits." But when a heated argument starts, people tend to grab something nearest to them, whether it's a pair of scissors, a misplaced syringe, fruit knife to name a few. I also once encountered a police bringing his gun into the ward as well. It was empty, but even so, it's also not permitted. We managed to sort it out by asking his wife to take it back home via our Sister's intervention.)

Self:
Protect yourself before you protect others. (This is very true. We had always tend to sacrifice a lot til we all ended up suffering with the common stuff that you often hears: migraine, gastric, deep vein thrombosis, back pain, stress, insomnia... Well, something I had learned when I entered the field of nursing, work smart, not work hard. If you collapse from exhaustion, no one is going to take pity on you, as most people had often reminded me. Proper disposing of sharps are important too. I had come across several incidences where some people cap their needles back, and POKE! Otherwise, another will be putting all sorts of sharp stuff in a kidney dish, and placing a tissue on top. What will happen if people thought it was normal rubbish and then POKE! It's enough to give me a major heart attack or make me cry. Ohhh...)

> In an incident of a fire, will you rescue the patient first or yourself?
Yourself. (No, it's no joke. International protocol says you should save yourself first, but if there are bed ridden patients that needs your help, do your best to save them, but with the blazing inferno heat bearing down upon you, save yourself first. NEVER EVER BE A HERO, a sentence that keeps ringing through my ears ever since I learnt psychiatric nursing.)

> If there's a big fight going on between two patients, what would you do if you were the only staff nurse around, and it was a night shift?
Call the police. :p (I'm joking, the senior staff nurse tried to trick me with this answer and I told her the police will never come. I mean, what are they going to do? Arrest the two patients? Bzzzt.)
Security. (At any event, there'll always be 24 hours security guards to solve this problem. Again, NEVER BE A HERO. If the security of our building is unable, we have to contact the ones from the main building.)

> Safekeeping of patient's valuables. The patient insisted on you to keep his valuables and he hands over to you the following items : A handphone, a ring and a wallet. How do you safe keep them?  
List down every item in specific details and lock them in our steel cabinet. (We don't have a vault. Different hospitals, different style. Anyhow, for phone, write down the colour and brand. Eg : A WHITE APPLE Iphone, A RED ASUS handphone, A BLACK SAMSUNG tab... For ring and various jewelries, write down the colour of the item, NOT GOLD, SILVER, DIAMOND. Eg : A YELLOW ring, A WHITE necklace, A WHITE pendant with a WHITE stone... For wallet, count the money in front of the patient and note down the currencies. Eg : 7 POUNDS, 5000 YEN, 15 USD, 40 PESOS... There are some patients with black hearts who claimed that we cheated of their money... So be careful. And we also have an invoice like book for safekeeping valuables. So seal all the things into a plastic zip bag, label it clearly and pass the invoice to the patient.)

> For a patient being referred to a dietician, what do you do?
Pass over the relevant information and details. Make it short and brief. (Patient's name, MRN, Dr's Name, Diagnosis, and what type of feeding that is required.)

> During blood transfusion, a patient suddenly develops severe reaction. What you should do?
Stop the drip immediately. Take vital signs, check the patient's condition. Inform the prof and get ready some samples. (This is pretty straight forward. Before you call the doctors, always equip yourself with the data that you need, like patient's vital signs and condition. If you call empty-handed, you'll end up with a total bullocking from everyone.)

Alright, I'm beat.

Procedure Rush and Tears

13th October (Monday) - Yesterday I came to work 10 minutes late, but it was a Sunday, so thank the Lord not many people are working. Highway jams, sudden loops, turning a big round to unfamiliar roads... A usual less than 30 minute drive becomes 30-45 minutes. Thank goodness I already knew about the crazy jam since I was working on weekends, so I came out early and managed to reach there by 6.45 am. Thumb in, and it's working time.
Here we go, I'm now aiming for procedures now. Besides the usual PEG and ECG, I'm now trying to aim for Redivacs, blood transfusions, chemotherapy and dressings. Super important procedures in the ward I'm working in. Redivacs, because of tons of Obs and Gynae case. Blood transfusions and chemo protocol because of tons of cancer cases. Hoo boy. We may not be an Oncology nurse, but you do have to learn fast if you want to survive. Dear God, I'm not sure how much I can keep this up. My head hurts, not to mention I'm having gastric again. The past three days I nearly fainted from hunger cause I'm going on a diet. Not going into that story right now.
Now, pulling out Redivac, I used to think it was all about sterile, sterile, sterile... Nope, two ways to remove Redivac drains. Medical hand wash - Forceps; Surgical hand wash - Surgical gloves. Ahm, okay. The one I saw was medical style, previously on the big drama incident, I use Surgical style. Well, everyone has their own style, as long as you don't spread infection, but as I always tell myself, follow the Standard of Practice and you'll never go wrong.
Blood transfusion - A simple procedure, but a mistake may cause a lot. Always check the blood bag with the stickers and form that came with it, a blood giving set with blood warmers, and most importantly, Normal Saline. Super important. If you give any other fluids with thicker concentration like Dextrose (Glucose Water), you'll end up clogging the whole tubing because blood is also a rather thick concentration of fluids. Lucky I remembered that thanks to my previous CIs drilling the rationale and theory into my brain.
Chemo drugs are so cytotoxic that you have to run them fast at a certain time limit. But follow the chemo protocols and you'll never go wrong. Just remember to hydrate after certain drugs. And make sure to wear proper PPEs. I even got the chance to witness staples to off, but it was super fast, done by the prof himself. Too quick, in my opinion. All he did was open the staples with the clip and ta-da. All clean. O.O
Remember the patient with severe anaemia?  I said that he was in a critical case. But it's much much worse. I followed the primary prof on my Sunday morning shift and when he asked me regarding about the patient, he looked at me and shook his head, "Prognosis is not good, not good at all." Got that right, prof. He isn't looking too good, after several blood test results and scans, it shows a big capital D. His severe anaemia is one thing, but then his brain lost some function, his heart was a little inflammed, he got fluid accumulating on the right side of his lung, his liver is nearly shutting down, his kidneys already failed, and I mentioned to the prof that his toes are bluish-black. And it is. The prof then asked me to take his saturation, but it wouldn't get his reading. I stayed in his room for more than hour just to get his saturation but I just couldn't. I tried every fingers, forget about his toes, it was too bluish, I even tried his earlobes as per prof's suggestions, and I still can't get it. In the end, prof said then we have to accept the fact that we can't get his saturation level, although the senior nurse said when she first tried, she got a reading of 83% with 10L oxygen via face mask. when he wrote in his report, multiple organs failure, somehow I just knew with sinking dread, especially when he asked for somewhere private and told the family to gather for a meeting. It's already too obvious, and they are also unable to take him back to Sarawak. After I did oral care for him,and just as I left, he passed. That's what I found out on the following day, How awful.
Okay, I'm going to sleep now. I'm exhausted. =.=

Giggles and Fury(!!!)

8th - 9th October (Wednesday to Thursday) - Noon to morning. I'm sure most of you probably realized by now, but during noon to morning shifts, I tend to update them together. First, cause I was exhausted, second, noon to morning - sometimes there's not much difference, y'know. Unless there's a sudden late night admission, but that's rare too, since majority will be in bed, and admission office runs at office hours.
Let's see, the same thing happened like the previous day.The same prof approached me...again, since I was at the counter at that time. I silently winced because of the previous day's incident. But today he looks okay -sneaks a peek- he doesn't look like he's going to eat me. We went back to the patient and she's being discharged. Well, thank God for that. Her mother is doubtful about my ability to remove branulla but this part, I am able to re-assure her that removing a branulla from a child and adult is not much difference, and I was able to her by removing the branulla smoothly from her child's leg, even though I got a nice kick in the jaw in the process. Argh, this is why I never really liked caring for kids. My one month of posting in the Paediatric Ward is a nightmare.
Then because there wasn't enough attendants, I ended up sending uncle back and forth from the ward to the gym and back again. After several false runs, I managed to find my way to the gym. Why do they have to lock the shortest way and make us run a long way? Uncle was even laughing as I tried to navigate my way. I managed to come up with a simple solution, keep to the left, find the right sign and voila, I found my way. Total joke. At least I didn't call the ward and ask them for directions, I would've been a laughing stock.
While waiting for uncle to come back, we had to take care of another uncle. This uncle is pretty much in a critical case, with severe anaemia. He comes in only for blood transfusion, about two pints per day if possible, otherwise on alternate days. He kept having jerking of the right side, nearly like a seizure. When I first saw it when he first came back from ICU, I was in a panic cause I didn't know whether to grab him or leave him. A slightest mistake may be deadly, so I went to get a senior nurse after making sure his face is slightly to the side so that he wouldn't choke on his saliva, and she assured me it's not a seizure. Even so, it scares me. And he was placed at one of the farthest room because his family insisted on a bigger room, like a VIP suite. Nothing I can do about it but to make sure he stays safe and give him constant care.
When I brought uncle back from the gym, I noticed this man dressed all in black with a Le Meridien T-shirt and a bag. He kept hovering near our sink and my first thought was whether he's a visitor who is looking for the right room. When we got uncle back onto the bed, he came in, and it turns out he's a priest. That's a surprise. I thought priests often wear those clerical collar and robes, and he sure doesn't look like one, with his down to earth casual look. He was joking with us and uncle and he came to say a prayer for him. So once we settled uncle back onto his bed, the priest locked the door and started the prayer. Okaaay, I thought he was joking, but on the other hand, it makes total sense. You wouldn't want anyone disturbing your prayers, wouldn't you? At 6.20pm -The priest said 6.15, but I'll give him some extra time in case he needs it- and when we walked in, he was pampering uncle. So funny. As he was about to go, he said to uncle jokingly that he was surrounded by angels who treat him like a king, whereas he have to go back home and bathe on his own. It had us all in stitches. Then he finally said goodbye and left us to do our job.
My poor colleague, she came in late due to being involved in an accident. Her whole hands were trembling the whole time we were sponging and turning uncle. I won't go into much details, but she said she'll have to get the front of her car fixed since it was all dented. Then, when we were sponging uncle, he mentioned Segambut. I was thinking why does uncle keep saying Segambut, then it turns out he's asking my colleague to take her car to Segambut because he has a friend who fixes car over there, whom he and his wife had been going to for more than 20 years. My colleague thanked him for his concern but she can't afford to go all the way to Segambut. My colleague mentioned she failed Geography and tried her best, saying Segambut is at... Pahang? Uncle replied Ipoh, Perak. ^^ I mentioned to uncle I don't even know most parts of Malaysia seeing as how I rarely travel. My book about the US, it involves tons of research and reading about Manhattan to get some settings right and how typical American people talk, like culture and populations and such, with images to get the structures right. He also offered to try to help me out with my book once he's fit enough to return back to work. Uncle is such a nice man, although he got a stroke and has been with us for more than 2 months, all of us are rooting for him to a route to recovery. He even brought us his latest book about Endau Rompin, the name sounds familiar, but I can't quite place it. My colleague tried again, Negeri Sembilan. Bzzt, Endau Rompin is a jungle area in Johor. Good try though. ^^
After settling uncle, I went for dinner after settling everything for him. I noticed on our new bulletin board there's a really pretty thank you card decorated with daisies, so I went over to take a look. It's from the family of our late patient whom passed on the 29th September. (refer back to my 29th September entry). When I read the message, I was touched. The family wrote a long thank you to us for taking care of him til his passing. He didn't suffer like some patients I've seen in the past, so I'm sure he's in peace.
Some nurses had been giving me funny looks and when I asked why, they said, "You hair is sticking out." This is something that often happens back in my 3 years of training. I tie my hair up neatly, and sometimes it comes sticking out. Then I answered that when I get stressed out, it often sticks out. And they went, "Oh, we get it now. If the ward is stressful, then your hair will comes sticking out, if it's relaxed, it'll stay neat. Okay, so if we need to know the ward condition, we'll just look at your hair." Oh dear, I seemed to have become a weather forecast for ward conditions. ^.^
The following day, we had even less people working than before. Oh no. 5 nurses taking care of 15 patients, and most of them are heavy cases. Fortunately, the big boss try not to give us tons of admissions by diverting them to other wards instead of others. Well, seeing we only have two admissions coming in, I say she's keeping her word.
I did sponging for the uncle with anaemia whom is at the farthest room. No, he's not a difficult patient actually, but he just refuses to help you out. When I try to turn him, he often stiffens himself, and he often fight backs with you  by refusing to turn where you want him to but you can still turn him, it's just that he's stiff. The whole time when we were sponging him, I'm really scared that he'll go into a seizure, so I was praying hard that he stayed relaxed. My prayer was heard and it was all smooth, but he seems to love turning to the left and curl up like a foetus. Funny uncle. I set a lot of pillows, including a small pig cushion that he has to protect the right side of his face. One thing I understand, his right side is just jerky movements. If it's a seizure, his eyeballs will roll upwards, becomes dazed, he'll be drooling, be even more tense and stiff. So, yeah, the jerky movements are not seizures, but even so, we have to be careful.
Then I followed a few doctors around, sticking to them like glue, but one of the nicer one was telling, "Relaaax, girl. Relaaaax. I don't bite." Ahm, okay. He told me not to worry that he won't torture me with illegible handwritings. Thank you, prof. I still can't get used to doctor's handwritings. Then I had the chance to put up chemo drugs, like last time, like getting the protective dark bag and slipping the drug into it to protect it from sunlight, then run it slow. But even so, I have to run to get an infusion pump from downstairs to make sure it doesn't go past midnight, because as we all know, cytotoxic drugs like chemo are highly toxic. Oh, and try to find the patient's company insurance GL form. Where did it go??? Fortunately, I put out a look out sign for everyone to please put it in a folder if they managed to find it.
The thing that pisses me off is near noon time, this Indonesian-Chinese lady came with a pre-admission form for her niece, whom is scheduled for operation tomorrow. The problem is... she booked a flight on the 11th October, while the surgery is on the 10th. Ohhhh. And the first thing that she asks is whether we can slot her in for surgery today. Now, look here, madam, you can't just slot in and out as you please. We have certain systems and guidelines to follow, and we can't just slot in and and slot out other patients, it's not fair for them. Then, the second thing that made all us mad, she asks for our handphones to make a call to her family in Indonesia. !!! Who wouldn't get pissed?! If she makes a call to Indonesia with our phone, who is going to pay for the outstanding bill? I know these type of people . They use your phone, make an oversea call, then wipe their hands clean when the outstanding bill come and when you demand them to pay, they just say not my problem. Honestly, does she think we are that dumb to hand over our phone? The manager also gave her a funny look and said, "Who's handphone are you going to use? We nurses keep our handphone only for emergency." Nevertheless, we took pity on her and the manager tries to settle her problem, but she sure made all of us fuming. Such thoughtless questions. ><
Overall, today is not such a bad day. I top up my drips, update my I/O charts and attended some patient, and that concludes today. Thank God I'm having a day off. I'm going to need it.

Hellmouth

Midway upon the journey of our life

I found myself within a forest dark,

For the straightforward pathway had been lost,

Dante Alighieri, Inferno, Canto I

7th October (Tuesday) - You are probably wondering why there's a quote from Dante Alighieri's Inferno on the very top of this post.... Well, because it sorts of sums up today's day. Today's the seventh, seven is supposed to be like a lucky number, you know, like triple 7, jackpot, that sort of thing. People usually say 7 is a lucky number but my lucky number is 4. Shi no shi, it may seems odd but most of the time, four is a good number for me, with various good reasons.

Noon shift, once I gotten the report, I was sent to assist a prof who specializes in genetics mutations (abnormalities) in paediatrics. Today is hectic and there's a shortage of staff, so there's no choice but for a junior staff like me to step out and take on the job. Now according to the report, the morning shift had prepared everything ready, nice and easy for him. But when I showed the tray to the prof, I got a major bullocking. And it turns out he's the type that wants hundred percent perfect. Oh God, because there's not much senior staffs around, we have to assist, and I kid you not, he was grumbling and complaining the whole time, "Why are new staffs assisting me? Where are all the senior staff nurses? Prince Court?" I did ask him nicely whether he can teach me, but the whole time he's grumbling and said to me, "I don't have the time to teach you new girls. You have to learn yourself." But if you put it that way, how will we ever learn to hit hundred percent smooth sailing? How are we juniors going to be as good as the seniors? And besides, it's not that I don't handle children, I can care for them, but his is a special case. Remember the baby I was stuck with for 2 hours? Caring for special children is no easy task. You need to undergo a proper post basic training for paediatric, then only you can call yourself a Paediatric Nurse. Eesh.
Then I had to assist him for another prof's case. He was grumbling because this child is not under him. He asked me to assist him again by grabbing the child firmly and lucky, another staff came to assist him, whom had helped some other prof in their paediatric cases. Lucky I knew which needle to put into the tray, but not the bottles. Yellow or blue only. Since the girl is rather chubby, we standby a lot of blue needles, getting a line for is not easy. Her veins are too smooth. She got poked at four different places and no luck. Poor girl. She was crying and screaming hard til my heart feels like going out to her. And because the prof couldn't get a line for her, the fourth attempt was settled with taking blood from her. The whole time he was grumbling and scowling, mainly because he could not get a line. Sigh. The other two profs whom I assist are not so bad. One can even joke with me the whole time even  after he couldn't get a line until the fourth to sixth attempt.
Noon shift duty originally only had three people on duty. TL, she takes care of all the ward, Med Nurse, she takes care for the medicines, me, reduced to taking care the patients. Lucky we had help from others, one who stayed back to help us, and one from downstairs to help us. Between us three, we managed to handle the normal care, but the attendants is too busy til she had to sleep for a while. Poor girl. The little baby whom I assisted in the line, I had to collect her from the audiology room, take her up to the ward, then get her baby ready, send her back down to the MRI room, where I had to spent 30 minutes writing my entire reports, since I barely even had time to write from 1400hrs.Crazy huh? At least I'm able to pass the reports properly.
Then because of all the seniors being busy, I myself have to send patient to the OT, on my own, with no guidance. I only double checked with the the senior, then when everything is tip top, I send the patient down, hand over the case, and then head back up to the ward, and help out in sponging and feeding our favourite uncle. He is so much jolly-looking now, and the funniest thing was, during feeding, he laughed which caused some of the PEG milk to bubble over. Funny uncle, lucky I didn't fill it too full otherwise I'll end up getting a milky fountain spilling all over me.
There was a call from a really mean big boss, and she gave me a telling off for interrupting the TL before a report. Well, if she wants to wait 30 minutes for me finding all the busy senior nurses, then maybe I should do that. Then some genius misplaced a patient's NCP til we are all running up and down, on our our knees searching every nooks and crannies for the folder. It caused us an hour plus just to search for the folder, if we couldn't find it, we'll end up in BIG TROUBLE later on. There are few instances that I have to make a call and a senior staff was busy giving me another telling off, because I don't have a code to activate the phone. I've been asking everyone what is the code of the phone to make outside calls but does anyone want to give me the code? Nobody. Sigh... Horrible day. I guess it's enough to make anyone depressed. 

Double Public Holiday

5th - 6th October (Sunday - Monday) - Noon to morning shift, as you can see, that's how my shift often goes. Although there were some staffs whom challenged me to take on noon to night shift, then go back in the morning and then take on the next day which is noon shift. Now look, I'm only here to do my job, learn as much as I can, and then upgrade myself. I'm not here to dig my own grave by competing against others on a who-can-do-more-shifts match. Although money is important to me, knowledge is more important, at least, in my opinion. Since usually I only spend my money on books. (House of Night Redeemed and Shopaholic to the Stars...)
Let's see, today there's a blood transfusion going on. It's been a long time since I set a blood transfusion. I only done platelets, but that was like more than a year ago. I still got the theory with me, but theory and practical, as we all know, it's a totally different thing. Now, before you give blood products, always remember, pre and post flushing with Normal Saline. I remember back then I used Lasix after normal saline to prevent fluid overload. Different hospitals, different practices. So check the blood product, flush with saline, put up the blood with the warmer, let it run, then put up another saline. Yep, same flow.
It seems that people often thinks I never follow profs. Well, that's not fully true. I do follow profs, just not often. And sometimes I follow the profs, I ended up doing really silly things, like asking the profs' names, end up tripping when I dash to grab something, well, you get the idea when you're a newbie junior. Some profs are nice, some profs are impatient, some are tolerant, some are really scary... I've been making a list of who is whom but even I myself can't remember them all, although they remember me cause of being the only sore thumb sticking out. Sigh... There's not much patient, but even so, there are two that are seriously fussy. I try not to talk with them too much because they often jump into conclusions. From my experience, when you encounter these kinds of patients, sometimes it's better to act dumb and talk less.
Since these two days are a public holidays, there's actually not much patients. I went to the downstairs ward to help out. And was reunited with my other two friends. Not much of a chance to be reunited, so let's enjoy the day today. Today the patients are okay, except for two. One is the family of an elderly lady and a young man. I'll get into the story one by by one. Let's start off with the elderly lady. She's nice, really, but her family is a little bit of a worrier-type, almost like the lady that I took care of, the one with he blood transfusion. When I did the BP checking, they were all hopping that it shouldn't be that high. Now let's assess, the lady is in her 60's, with an average diagnosis (I'm not stating it in detail), she may need chemo and she's on NG feeding with CBD with drips. Of course her BP will be ranging around 140-160. But they insist on me to check every hour. ahhh, the TL was a little annoyed and ordered me not to, shall we say, serve their needs too much. Because we have other patients who needs more attention besides her. Not to say that I refuse to serve her, but the family request are a little bit too much.
I also met a cute little girl who's in love with ducks. Ohhh, how I love Donald Duck, and she had a whole row of rubber ducks of all sizes, and a little soft yellow duck plush. She even let me poke it a little, so soft and cite. She's going to be discharged tomorrow, but I'm glad to be able to meet her, even if it's only briefly.
Okay, the second patient. He's not as bad as the elderly lady's family, but he's the type that we categorize as the spoon-fed type. You see, he's rather sick, not terminal ill, but just sick. He's on NG tube free drain, PICC with Kabiven and saline drip, and CBD. And he's very young. only few years older than me. Once I knew that his CBD is something that needs to be measured hourly, I went into his room every hour, sit on a chair and slowly "milk" the catheter to get the urine out to a decent amount. Because his urine are all at borderline range, we are all worried. I won't go into further details, but he kept begging the prof to remove his catheter which is causing him pain on his you-know-where. While I was "milking the catheter", he kept begging me to take off the catheter, but the prof told him to keep it for one more day, but he's nearly in tears and kept crying to me, "Sister, please help me. Please remove the catheter. It hurts badly, Sister." Now I really pity him, but orders are orders. I tried to get him to walk a little to get his kidneys active but he kept saying his you-know-where hurts and that he has to strain a lot to get the urine or stool out. Sigh, poor guy. In the end after talking with the senior staff, she told me to give him Lignocaine gel to apply down there. I gave it to him and he immediately applied down there. I hope it helps him to bear the night. That's all for today.

Discharge Dash

4th October (Saturday) - Morning again, and I got my next roster. Man, it looks bad. I got slammed by my first ever noon shift for Saturday, which means no more Japanese class, on a plus note, I got a Sunday morning at last, which means I can go out on Sunday noons. I have a Friday day off, which is alright. I'll just be happy with what I get.
So coming to work, I'm finally back at the ward, and what do you know, tons of discharges. But there are some really bad patients, bad not as in bad-hearted, but more of thinking too much til they have to question every little things and freak out like, "Nurse! Nurse! There's blood in the tubing!"."Nurse! Nurse! There's so much blood in the drain! Do something!" "Oh my God, is it an open incision? Is she anaemic?" Okay, it's not that I can't answer most of the stuff, but it's better to let the prof handle this. I mean, for goodness sake, there are some things we can't just simple answer. The tubing and the drain, I can handle it. But other family members asking about the procedures? Lucky I was smart enough to consult the senior staff and she told me, "There are certain parts we can't answer. Tell them to wait for the prof." So I just answered the family back to wait for the prof and they grumbled but this is to maintain confidentiality and professionalism.
Then I followed a few profs around. Well, two. Good enough, simple orders for discharges. Unfortunately they weren't the only one, four or five profs came at the same time and they were all discharges, discharges, discharges... Aiyaiyai, We were all rushing to fill in our reports, the discharge forms, the system, and most importantly, the billing. Because Monday is a public holiday, so everyone wants to discharge. Poor billing department. They had a major traffic jam thanks to tons of discharges rushing in like a tidal wave. Not just our ward but the others as well. More than half of their patients are rushing to go home. If you are using cash or credit, then it'll be fast, but if you use insurance, you'll end up waiting more than two hours plus. Sad. That's why we were rushing our reports billing.
The favourite uncle of ours, he's not so jolly anymore. :( I really don't know what's wrong with him. He has the PEG inserted as planned, but he's not happy, just moody. He refused shower until about 11 plus, I squared myself firmly and wake him up, gently but firmly, because when I was a student, I used to wait for patients to call, but my CI told me, when it's near noon time, you have no choice but to wake the patient and get them to shower. After some talking, with some help, we decided to sponge him. I also did his feeding and he's a little happy, like his old self. I wonder if he's frustrated because he couldn't achieve his goals? It's not my business to dive into personal matters, but I hope he goes back to his jolly self, with some help and encouragement.

Profs Right Round

3rd October (Friday) - And good morning to all. What a whirlwind ride it has been yesterday. Supposingly I was supposed to be back at my good ol' ward, but because there wasn't enough staff on the other side, I was sent back there as a runner. Maze Runner.... Ha ha, well, technically that's what I am, a runner, running back and forth attending the patients. Not in the Maze, I hope, I get tired easily due to having low blood.
Today I did tons of shower and sponging compared to linen changing, because most of the elderly ladies requested me to give them a nice shower. Who doesn't want a nice shower? I encouraged some of the patients to wash their hair because when I asked some of them, they answered, " It's already been 3, 4 days since I last admitted. I never washed my hair at all, nurse." Well, we can't have that... So, with some gentle pushing, I got the ladies to wash their hair, which makes them look so much fresher. When the patient looks good, you too will feel good :) Some of the ladies even advised me to stand far away so that my uniform doesn't get wet... ^^
Then, I followed one of the senior to assist her in a bed sore dressing. Compared to some of the cases I've seen back in my student days, necrotic or infected to the bone with pus dripping out (ugh), this is pretty much a basic bed sore, but with a sort of slough-like plastic on top. The senior staff said she didn't dare to take it off, so she used her forceps to give it tiny pokes in order to get some of the slough out. The madam, who's a 99-year-old lady, gave a few twitches here and there as she felt the thing poking her. Now, I've been trying to talk to her since I first took care of her, which is on a Sunday, and she had never gave me a response. As I was going out today after finish assisting, she suddenly opened her eyes and said, "What???" in Cantonese and all of us were cheering. Yes! Finally a response from the madam. I pray hard that she will be able to live to 100. Wouldn't that be so wonderful?
Then I had to follow a prof for a round. The patient whom I helped shaved yesterday had finally went for her angiogram and he needs top remove the angiogram dressing. So off we go. He did it quick and efficiently and the lady was allowed to be discharged. Her angiogram shows nothing abnormal so she's also happy. All we encouraged her to do is rest til she's well again. Take care, madam.
After that, there's another patient coming in as an outpatient. The prof is someone that I've been following for quite a while, so I was able to go with him alone and carry a tray of blood taking equipments like a syringe and some vacu-containers. It was simple enough and he's hand-writing is okay so I was able to carry out his orders with ease.This lady ended up going to the ward below for an op and I was able to quickly send her blood samples to the lab, because if it's prolonged, then her op will be delayed. May she be able to proceed the operation and hope all goes well.
The third prof I followed is a cardiologist who done a sleep test for an obese patient. Who knew sleep test is such a wonderful invention, but the results with its graphs is a little scary. I used to watch it in TV shows, but in real life is so much detailed and clearer. Like how they monitor your breathing, your saturation, the sleeping stages you are in, how many times you dreamed. To cut the long story short, this patient saturation takes a dip when he's dreaming so the prof advised him to lose some weight through exercise and diet and to come back again after 6 months to repeat another sleep test after seeing him in an appointment. Your orders are my command, prof. ^^
The there's yet another prof coming in to check on his patient. This patient is a lovely gentleman who had been in the ward since Sunday for a neurosurgery. He's so funny because he never presses the bell. When he needs to nurses, he just walks out and ask us for something. Anyway, he insisted that he's fine and wants to go back home, except prof says he needs to stay one more day he is all fit. The patient was crestfallen so the prof told him, "Don't stay in your room all the time. Why not go out for some cake and tea at Secret Recipe?" But the patient went, "I want to go home..." And the prof was like, okay, if you are good, I will discharge you tomorrow. No worries. That's that.
My last doctor round of the day is the anaesthesist. It's actually my second time following an anaesthesist and so I got some of the points. Take the anaesthesist record, maybe order some drugs like antibiotics anti-pyretics (fever), painkillers and anti-inflammatory for post-op, explain to the patient and finally, the consent. He also wished to set a line but unfortunately the patient did not bathe, so he said, it's alright, he'll set the line in the OT. Then he requested me to call the other 3 LA cases so that he can start early, but since everyone was busy, he said it's alright and he'll call them himself by getting their contacts. I called him a prof and he was laughing and said, "I'm not a prof, I'm just ___." Oh, Dr. ___. My bad.
And there you have it. Right round, right round.

The Good, The Bad and The Nice

2nd October (Thursday) - I'm working in the noon shift today, but today I was sent to the other ward. Since I already worked there once on a Sunday, I'm trying to keep an upbeat attitude for my sake and the patient's as well. And do you know? Even though it's a full house, there are some discharges and most of the patients are nice people. Really.
So to start things off, reports are taken and then since I'm still not familiar with this ward, So there are incidences where I'm at a lost to find the equipments and some of the system. Anyway, once the rounds are done, I went to write some of my reports and of course, handling drips. Since we had a patient on chemotherapy, I'm eager to try handling some chemo drugs with the protocol. So asking the med nurse for guidance, I handled some of the chemo drugs and do the hydration, which is using normal saline with potassium to flush the vein. Funnily, it wasn't so hard. All you have to do is use the protocol, double check with senior staff and you won't go wrong. Oddly, I wanted to be an oncology nurse if I couldn't make it for midwifery but my whole family shot that down because they went, "You're so young and you want to handle all these kind of toxic drugs... with the radiation?!" I mentioned this to the med nurse and she said that's not true. As long as you follow the protocol, put on your PPE and handle things properly, you won't go wrong and become sterile.
There wasn't much attendants due to them being busy with sending patients for discharges or for scans, so being the most junior staff, I volunteered to do an errand. One of the patients being discharged requested for a 6 week MC but the prof had ran off to the ward below. I think you all should know who it is by now if you had been following my previous blogs, to catch him you have to run like you are going for the Olympics, so I ran all the way down and what a relief, he's still there, but super busy talking with relatives and other profs. What could I do? I meekly stepped up and requested him to sign the MC. But I forgot to ask him how long. Luckily, the senior staff called and asked him and he answered, "4 weeks." Well, he and I had a very awkward relationship, but the senior staff assured me, "When he gets mad, it's only for that day. The next day, he'll just go up to you and say, "Hello, how are you?" " Well, okay, I'll try not too panic around him.
Then because some of the senior staff said I rarely follow profs on their doctor's rounds (I always seemed to end up doing something funny when they arrive) I took the chance and followed some of them. The first one, well, he was furious at first because a patient's family ran off without waiting for him. Each time he asked the family to wait for him, they just POOF! Disappearing act. What scares me is he grabbed the phone, dialled the number and started shouting in Cantonese about how they don't respect the his time, and how can they just keep running off when there's something important. I never seen prof/ doctors yell at patient's family before, and I swore to myself that no matter how rude some patient's families may be, if there's something important, hold them down til the prof arrives.
He then asked for a group and cross match, but he wants the nurse to do it. OMG, I was stunned but not tongue tied. I told him, "Prof, sorry I'm still rather new. Will you teach me, please?" The prof laughed and answered, "Sorry, girl. I can't teach you. This is something that you have to do on your own." :( Lucky, he got one of the senior staff to do it and I followed her to see how she take blood from the patient. Scary, I never learnt how to draw blood in my student days and I don't dare to do it without the skill. It's called bearing the responsibility and I certainly do not want to get into major trouble with the big bosses.
Then once settled, I followed another prof to a new admission. The first time I ever get to see cellulitis up close. It's red, but not as bad as another patient. It's just all red like well, a lobster. Nevertheless, he was one of the nicer prof so it was okay for me. I hovered near him but he was like, "It's okay, don't look at me. Go and do your job." So off I went, running in between hourly observations and topping up drips. Once done, I handed over the medication cardex to the med nurse so that she can prepare the new antibiotics as per order.
Things started going slightly downhill then. A prof came up and asked for the second prof whom I followed's patients. I'm a little bit blurred because :

a) I have no idea who this prof is.
b) He said someone called him but I have no idea who it was.
c) WHO IS HE???? (He overheard me on that one til he took his tag and showed it to me. How mortifying.)

Checking the board, I handed him the folder and stethoscope. He looked at me all funnily and said, "Um girl, you do know ortho surgeons don't carry stethoscopes right?" Ah, w-w-what? But the prof I followed was a nephronlogy (kidney) specialist. He doesn't use the stethoscope much but he often carries it with him. Oh dear Lord. The prof was lecturing me that only anaesthesist and cardiologist carry stethoscope, but never an ortho surgeon. I'm sorry prof. I'm SORRY.... TwT We went to the wrong patient's room, but after some confirmation from the TL, it was actually the other room. So we headed there and I was forced to assist him in his dressing, solo. I was a little panicky, again, but I managed to do some parts right, although there were some slight misses here and there, like getting a bigger gauze with the primafix. That patient's wound is bad, really bad. It's three huge infected ulcers right to the bone with slough and redness all around. And every movement caused the patient to scream and cry. It was that bad, okay. I get it why they said she need strong painkillers before each dressing, it was torture for her. In the end, the prof ordered her to do an X-Ray, and if she wants to, to consent for an I+D in the OT.
Well, in between running up and down topping up drips and observations, today is actually an okay day, aside form the near miss when I was drawing out potassium and nearly got a needle stick injury (NEARLY). My last task for the day was shaving a lady's arms and groin for an angiogram. She's a really nice lady, full of warmth and joy. The 45 minutes I spent in her room was alright. She asked me whether I liked nursing at first, and I honestly told her, that I originally wanted to be an English teacher or a journalist/ writer, and she was like, "But isn't nursing so much fun?" And I told her, it is. The 3 years I spent training to be a nurse was a hellish journey, but the reward is satisfying, where I get to meet people and help others. And she agreed and said that she wanted to be a nurse too, but couldn't get in, but she became a teacher in the end, and went on to become a publisher and commute from home. She understood my dreams to be a writer and she said, "Do you have a blog? Why not write about your nursing life?" I told her that I do, and that most people actually enjoyed reading it because it was funny. And she said, "Who knows? Maybe someone will like your writing that they'll try reading your YA fiction." I thanked her very much and wished her well as my shift come to an end. Good night all, rise and shine for morning shift tomorrow.