Tanglaw Lahi

The rest of my week has been the most exciting and the most eventful so far. i enrolled in this 9-day-8Am-5Pm  training, sponsored by Philippine National Red Cross- Bataan Chapter.  I am already through First Aid (which we all happilly passed) and we’ve just finished with the final exam and return demonstration of giving CPR, but I m still uncertain if ever I passed that one… I wouldn’t be surprised if ever I failed. Man, the exam was indeed hard and really exhausting… just imagine consecutively breathing and pumping the chest of  an adult, a child and an infant mannikins. Plus the scent and taste of the alcohol used to disinfect the mouth parts of the mannikins stick in your throat after the each session.

But anyway, after the return demo, the whole batch was divided into three for the Bataan chapter’s version of a Disater Role Playing Game. The first group would play as the victims (consisted of 8 people), the second were the rescuer (were i belonged) and the third were the notoriously nasty bystanders.

i was exhausted not because of the victims that supposedly fell from the building, or the stabbed, unconscious guy juxtaposed the sewer, or the girl who had an eye popped out and when Dominique asked her if she’s okay replied “semiconscious ako” (I am semi conscious), I was extremely out of breath because of the bystanders who took our rescue paraphernalia. I put down the really huge spine board behind me while I was tending Ate Leah then suddenly the spine board was running already in the oppposite direction. I tried to run after the guy but he was too fast. Then they took our bandages. They even tried to steal the amputated hand.

It was fun yesterday. I wish i could bring you there. i am lost for words to describe how much i enjoy every part of this training. tomorrow we’ll be starting Disaster Nursing, i am keeping all my hopes high.

everything went well.. i didn’t have any photo because 1.) I do not have a digicam (so if anyone want to send me one….) 2.) my cellphone, or should I say my cellphone’s battery, is not working… Dang!

Lifting People and How I Dread for Tomorrow

A poem is when…
… words are too trite to describe the extraordinary.
…sentences are too brief to complicate the unsimple.
…paragraphs are too incoherent to connect to the soul.
… and when a period means all the universe, and you the God,
a mere speck of a sand.

Sponge

I was really grateful with my chance of becoming the circulating nurse last Thursday, and I wasn’t expecting for more. In fact, I was already planning to finish the Nursing Care Plans for my chosen case studies (of Cystic Fibrosis, Myocardial Infarction-that’s heart attack, Myocarditis, Acute Renal Failure, Osteoporosis, and Multiple Sclerosis) while the rest go in the operating room for their respective cases. That’s why I was really surprised when our CI texted me if I would want to take the Cesarean (CS) Case at one o’clock with Lallaine as the circulating nurse while I’ll be the scrub. The morning shifts in that hospital were dismissed a bit earlier so we are very much free to get their cases.

I was at another hospital completing my last make up duty. However the CI there knew very well how important OR cases are so she let me go even though it’s still 12:15.

I hurriedly ran outside and called for the tricycle. I texted back that I’ll have the case. I haven’t had my lunch yet, but who cares.

I was the first one but soon Lallaine came with Lorenza (Lorenza will do the neonatal care/case). Lallaine told me that she was also texted THE NIGHT BEFORE, minutes after our dismissal, to handle an appendectomy case. And after that, while they both went to a fast-food for dinner, she told our CI how I badly need a case.

We were ushered at the operating room at 1PM. I went straight to the sink and scrubbed my hands; from elbows to my fingertips. Brushing the hands with a really course and big brush hurts a bit… but the thought of me wearing the OR gown and staying sterile and all, and having to witness a birth via cesarean, plus the fact that I’ll be rubbing elbows (literally) with the doctors thrilled me more.

I put on the OR gown. Then I put on the surgical gloves. After that I helped my CI and the two surgeons to put on their respective gowns. I was amazed how fast I did this. I had a fleeting recollection of me doing the return demo at school almost two years ago.

When everything was set, my CI laid down the entire set of instruments; there were the scissors, the mayo, the Kelly (lots’a), the alice (more than the kellies), the clamps, the really huge retractors, the forceps (thumb and tissue forceps) and everything. I was praying not to drop anything or worse give a wrong instrument, (some first hand accounts said that Doctors sometimes throw wrong instrument back to the student’s face… ouch). Then we counted them all; even the sponges (rolled gauze).

The Girl doctor stood at my left and her husband, her assistant doctor, in front of her. After the patient was all covered with linen exposing only the parts from the umbilical cord down to the symphysys pubis, she yelled “knife”, so I gave her the blade. She pierced the mark were the previous CS was done and slid it downward. I was expecting for a bloody laceration but it was not. She repeated the cut down to the fatty layer and down down below until the layer was to thick and hard that slicing alone wouldn’t do he trick. They asked me for more… and more instuments. My CI smiled at me and told me that I was doing okay. She even commented that it is good that I am not that nervous. Sometimes they would call my CI for the cautheter; they burn some of the veins to stop the bleeding. This leaves a stench that is similar to burning dog’s meat.

The path that the instruments embarked came deeper and deeper until they have found her amniotic sac that covers the baby. They don’t need the scissors since the membrane is too thin. They pricked it with the thumb forceps (and voila)… the head of the baby appeared. With my help, we stretch the abdomen to give way for the child. I had with me the bladder retractor and was pulling the opening downward. The two doctors pulled their respective sides of the cut toward them. Imagine a rubber hot water bottle… think you are stretching the mouth open wide…. It felt like that.

When we have finally taken the baby out, they immediately clamped and cut the umbilical cord. They then went inside to look for the placenta. It was a bit gory on this stage of process but my CI is always ready to suction the excess fluids; a mixture of amniotic fluid and blood. After that,  the cut was closed by suturing.

When they were still stitching… or at least when they were almost through stitching, my CI asked me to count the instruments and the used sponges. It is essential to know if they are all complete, who can tell what could have happened if we have left a single one lurking inside the lady’s abdomen. They were only 8 sponges; originally they were ten.

My CI was trying to hide her grin but I know she was playing some kind of trick or maybe a test at me. She caught what I was thinking so she defiantly said she didn’t hide any of the sponges while she touches the in front pocket of her gown. She asked me again where the two other sponges are.

My nape started to itch as I tried to think where the two sponges are. I said, “Maam parang bigla kong gustong magkamot ng ulo.” (Maam I think suddenly I felt the urge to scratch my head). She laughed; we cannot touch anything unsterile. So she finally gave up and told me that the first sponge was used to wipe something and was already in the dust bin. And the second one… the second one … THE SECOND ONE!!! … she looked at the doctor who unfolded the top most linen, which covers the patient, and lo and behold the sponge neatly snuggled in it.

(Mental note, while I was typing this, my sister, Gem Imee called me and told me to send her a testimonial and blog about her birthday. And I was like, “I cant blog your birthday, i have a far more interesting thing to blo about. I was a scrub nurse yesterday.” And she was like… “AAAHHH, tagakamot ka ng doktor?”— HAPPY BIRTHDAY NA LANG)

Laparoscopic Surgery- My First Major Case

I was dismissed from my 6 AM- 2PM duty at the Pedia ward in a General Hospital at 12 as a consideration so I could still prepare for my Operating Room Duty in the Doctor’s Hospital where I met the dancing CI. Actually, although we had had a lot of experiences (at the medical mission and in different DRs) with surgeries, this was the first time that we’ll have a really legitimate OR experience. The last time we’re here, there was no scheduled operation so we just watched a movie at Mara’s house.

I was at the hospital at quarter to one, the morning shift were still there. To my dismay according to them they had 4 cases just that morning and there is only one left for the afternoon. The last time it was the other way around, we were the morning shift and they are for the afternoon. We didn’t have any case and all the operations were scheduled at the afternoon. I was not very optimistic that I’ll have a case that afternoon.

However, when my groupmates came, I was really surprised when Angelo said that I should have the case for today since I lost my notebook (where I listed my case numbers in the last medical mission). Kawawa naman daw kasi ako (I am pitiful according to him.)

The case was Lap Chole (Laparoscopic Cholecystectomy- removal of the gall bladder through a laparoscopic surgery). I took the case with Hanzel. I haven’t been in any major operation so I told him that I’ll just be a circulating nurse to acquaint me a little with the work and he can be the scrub. Both of us wore our respective mask and bonnet; however he scrubbed his hands from the elbows to the fingertips while I just did the normal handwashing. He wore the sterile OR gown while I remained in my clean scrub suit helping him not to touch any part the inside part of the gown. He helped the doctors wear their gowns while I stared… dumbly. Heck, I shouldn’t have switched work with him, I already know the steps.

CD of the band Side A hummed with us. It was 2:30.

Laparoscopic surgery is virtually a no-cut/bloodless surgery. The surgeon will just use a camera entered through a 12-millimeter-trocar (that acts as the portal) at the umbilicus. Another 12 mm trocar is inserted on the hole made at the Epigastric region while another two (5 mm trocars) were made on the sides. Istead of looking at the tummy, the surgeons look at the TV monitor in front do the surgery by manipulating the instruments. It is like a computer game with sterile joysticks.

While Hanzel was still dressing up, I saw the real circulating nurse cleaning the sleeping woman. She started with an alcohol at the umbilicus. She made sure that it was very clean. Then she brushed betadine at the girl’s abdomen to the groin and to her reproductive organ. She opened the vulva and also inserted the sponge and brushed it with betadine. It dawned to me later on that she did this so she can insert the folley catheter. I haven’t tried inserting any folley catheter so I took the chance to observe. She first looked for the urinary meatus. For a while I thought she was inserting it at the vagina because she seemed to be having a hard time putting it in and the hole looks a little bigger; however she’s successful in the end.

Then one by one they covered the girl with different assortment of linens until only the right side of the abdomen is visible. Everything is covered from head to foot.

The trocars were inserted at their respective places. They inflated the abdomen with Carbon dioxide. The inside was very visible, I saw the deposited fats that resemble the yellow part of balut with all the veins in it. The veins, the faschia, the liver are all clear, think you’re watching the National Geographic. I was asked to hand them the unsterile stuff like hot water (where they dip the camera to wash, or IV. I even had the chance to place the Naso Gastric Tube in the patient’s nose (since the anesthesiologist, the real circulating nurse who went somewhere, to eat I supposed, and I are the only unsterile people who can touch the unsterile face of the woman) while the operation is in the process.

They used different extra elongated instruments that are called as grasper, scissor, and many many many more.

When they have finally reached the gallbladder, the surgeon tear a hole in it and an exudate of purulence issued out. It was pearly to whitish, slimy liquid. While th3e surgeon was vacuuming the slime, my CI said, “ay parang sipon.” (It’s like a mucus.)

Then another doctor replied, his eyes naughtily twinkling, “hindi ah… para syang ano… ano…, “ (of course not, it is like a… a…) then he paused then grinned which is still discernible in spite of the mask, “ano parang… alam mo na kung ano.” (You know… you know what it is….)

Everybody laughed because everyone knows what the slimy, pearly, viscous, stuff was like. Then he added, “Basta tayo nagkakangitian na alam mo na yun.” (When we have finally smiled at each other, you already know what I mean.)

The Side A band incessantly rumbled in the background and the operation still go. The scrub nurse was really nice to teach us and the observers some of the equipment being used. I asked her a lot of times and she’s more than happy to reply. She looks like Dra. Peaches.

Although there were momentary episodes of jokes, none has really laughed out loud, the operating room seems like a sacred place… and nobody dared to ruin that atmosphere… although sometimes the scrub nurse or the anesthesiologist sang a line or two of the songs by Side A that is being played.

The operation has ended at exactly 6:45. The funny thing is, just as when the lights were turnede on, the mellow song of Side A was immediately replaced by the original version of Beyonce’s song…

The song was like… “Heyyyy love to love you baby.” Everyone noticed this and a really crispy set of guffaws erupted.

Kung Mamalasin Ka Nga Naman

My sked of internship is from Thursday to Saturday only, however, since I had an absent I have to pay it with three make up duties. I went to the General Hospital yesterday to finally pay my debt but the CI was absent so I just went to Jollibee to have a breakfast (I had my breakfast at 3 AM so by the time the group that I encountered called the CI I was starved already) and at the same time do my case study.

Today, I expected that the CI will attend the duty. My father woke me up at 3:00 but it was too early so I stood up at quarter to 4. I was already through all the morning rituals at 4:45.

The jeepney stopped for too long and waited for any passenger so  I was not able to ride the 5:00 Genesis bus. I was able to take the next one, going to Pasay, at 5:15. Then the bus stopped at a gasoline station. He was there for about another 15 minutes until the driver told us to wait for the next bus since the temperature of the bus is drastically rising. I was pissed of course.

At 5:45 a Genesis bus going to Cabanatuan came. This one was miraculously fast and I was already at the hospital at 6:15.

I ran…. But to my horror there was not a single Student Nurse to be seen except those that were interning in special areas (DR, OR, ER). i asked a staff nurse if we have a duty and she said that there is a meeting.

I was so disheartened. Of all the things that ive been through this morning plus the thought of the fare i paid really irritated me.

I was like… “what am i gonna do now?” First I thought of going to Jollibee to have a breakfast but I was not yet hungry. Then I remembered that it is my inaanak’s (godchild’s) birthday and i still do not have a birthday present. I know a bookstore somewhere that opens as early as seven o’clock. Since it was still too early, i decided to walk from the hospital to that bookstore. The bookstore was like more than a kilometer away but heck.

I embarked the whole length of Capitol drive. When I have finally reached the bookstore it was already 6:45 but it was still closed. For a split second I wanted to sit in front of its doorsteps and wait for its opening, but I decided to turn around anyway and head for the minibus terminal.

I felt so down so I walked really slow. It was exactly seven when I managed to ride the  bus home.

A Lot

I have typed this entry as early as 12 noon today but I did not post it immediately since I want people to read this entry first… but the time went on and no one has commented yet so here it goes….

As my father lead the whole family today to vote… we met a guy on the street and he exclaimed, “Ang dami nyan ah.” (Hey, that’s a lot) And we all laughed. It was clear that man was not pertaining on how many children my father has but on how much bribe he got from each registered voter in my father’s family.

I received two envelops correspondingly from the two Mayoral candidates here in our town… and I should say I voted for the higher bidder… straight, complete with his name and his councilors.

Isolated Delight

As a punishment, our latest CI sends off the late comers in the isolation ward. The isolation ward is the most dodged ward in this district hospital. It is where all sorts of patients with all sorts of communicable diseases (like Tetanus and Rabies) or even those that are suspected of having these diseases are “isolated”. It is no wonder that nobody wants to be stationed and be”isolated” in that ward.

Although Neil and I live in Mariveles, Bataan… the southernmost tip of the peninsula. We, together with his Girlfriend Rose, were always the first ones to come. We were like always thirty minutes earlier. Today, however, is different. I tried to wait for my other groupmate. Therefore, when we finally reached the hospital, I hastily ran and told them that whoever is last would be banished to the distant, noxious ward… THE ISOLATION WARD.

To my relief I was at the number five in the sign up sheet. The list was 1.) Rose Ann Almario 2.) Neil Franz Andoy 3.) Alexander Acosta (not related… never have… never will… and I thank God) 4.) Reza Liza Areja… and NUMBER FIVE RICHMOND Q. ACOSTA.

After we passed our assignments, my CI started handing out the patients… Rose’s name was mentioned… then Neil… then Alex… then Reza… then my… my… what the… hey she jumped my name and called Aiza… until she has finally handed out all the patients in the decent wards to my groupmates then asked very (VERY) quizzically… “That’s all?” so I raised my hand and said, ”Maam I think you have forgotten that there are two Acostas here.” You see she calls us by our surnames.

No Wonder We’re So Poor

Among my group and classmates, I am the one who lives in the farthest town (the southernmost tip of Bataan- Bataan Economic Zone), however instead of boarding I decided to just travel more than an hour a day to get to school. Whenever people ask me why, I always answer, “Because I don’t know how to cook.”

But actually I first tried to live with different roommates when I was a freshman… but I found the experience traumatizing. No I was not bullied; I just find it hard to share my personal belongings to others (I mean toiletries as in sponge scrub). For me a Sponge-Scrub-slash-my-nylon-loofah is as sacrosanct as my toothbrush… but heck the story, I think, is too good and it deserves its own page… because this entry is about the new area that I am currently interning in (I mean the cost I have to pay just to get there).

I am currently interning in a District Hospital in Arlo Cordova’s town. I have been in a farther hospital before but this hospital is in the middle of Arlo’s town, unlike the other hospitals where I can just ride an Air Conditioned bus and TUH-DAAA!!, I’m there.

In order to get there first I have to wake up at 3:00 AM (today my alarm clock rang at 2:30). Then I have to leave the house at 4.

Then I’ll ride a tricycle… there isn’t too much of a passenger during this time, the factory workers work at 5… so I have to rent the tricycle to the bus stop for 25 Pesos. After that, I’ll ride the usual air conditioned bus at 60 Pesos (that includes already the student discount). The trip goes on for an hour (it takes 1 ½ in ordinary bus) then I’ll ride a tricycle to another Bus terminal for only 10 Pesos. The tricycle ride is followed by either a jeepney or an ordinary bus ride for only 15 Pesos.

Overall I have to pay (okay do your Mathematics);

Php25 + Php60 + Php10 + Php15 = Php 110

Going home is another, much cheaper, story…

I have to pay the Bus or jeepney ride that costs 15 pesos, then ride an ordinary bus to my town for 57 Pesos (Ordinary Buses do not give discounts on Holidays, summer and Christmas Breaks, and weekends) and finally a jeepney ride for only 6 Pesos.

Kindly please do your Math again;

15 + 57 + 6 = 78 Pesos.

how to make a correct nursing care plan?

My previous CI is so far the funniest that i have ever had, and I dont think i would ever meet another one as crazy as or even crazier than she is. She started cracking jokes the moment we met her. We felt at ease with her in seconds. She is really nice as compared to the ultra toxic CI downstairs. She was the only CI who spent dinners and snacks wit our group. She didn’t allow us to go out the hospital so we just call for a McDo or Jollibee Delivery.

Last Saturday night, while she was checking our diaries, our two classmates, August and Lorenzo, who were interning at a nearby hospital, visited us. They went to our quarter to ask for some materials in their case studies.

My CI was greatly intrigued by the students so she queried us. We told her that August was eternally late in his every class and as a punishment, our professors order him to dance before entering the class. We also told her about an event when our group had our duty with their group and he lead the prayer.

Her eyes glistened and her lips curved deviously and she told August to dance. August was very reluctant so Angelo (another groupmate) decided to show him some moves. But Angelo’s attempts and our teases to persuade him failed so it’s time for my CI to make a bold move.

She stepped in front of the mob and told us to close the door and hand her the phone cameras. When everything was clear and she’s sure that nobody is recording her she danced with Angelo while we sang… ITAKTAK MO. Man she was so hilarious. If only you could see her. We went from one song to another and she danced them all. Then we all stopped when a Student Nurse from the first floor came in to check on her locker… My CI promptly straightened herself and said in an as-a-matter-of-fact voice, “And that is how to make a correct nursing care plan. Is that clear?” and we nodded our heads… sniggering.

PS In the end August did not dance but my CI gave her niece’s number to Angelo. She wants Angelo to court her niece… she didn’t like her niece’s current boyfriend.

An Afternoon Record

Our CI requires us to pass a sample charting and a diary of what happened to us during our duty. Every nine PM she checks them then lives a comment at the end. Last night I was the Head Nurse and this was my entry;

 

Uhm

While reading this entry, be reminded that it took me the nth time of incessant editing and rephrasing just to write this incredibly, brilliant literary work-”My Day’s Extraordinary Memoir”… or maybe not.

Actually, in contrast with my profoundly exciting yet toxic night yesterday, this afternoon offered an utterly uneventful day. So there goes my predicament, I need to pass a really interesting “Diary Entry” yet I have had one of the most boring duty ever.I originally planned to write about my task today as a head nurse but everything that have happened was just too insignificant to even bother to record.

I think this day will come and go just like any ordinary day and my life would still be be the same. Nothing interesting happened… nothing worth retelling nor worth remembering.

And this was my CI’s comment.

Being a head nurse is significant on your training to be one of the BEST NURSES in the future. Eh? ‘Cause I see you’ll be one.

I was really happy with the comment but i tried my best not look pleased with the IT, though I hinted my thanks to my CI.

But this made me felt bad when we were about to go and i was checking my groupmates’ charting and I was already endorsing our records to the staff nurses. Uhm… let just say Neil, my assistant, and I forgot some of the small details. I felt so dumb and irresponsible… sigh.

PS Nabitin ako sa katapusan ng Mirada De  Mujer kagabi… parang may kasunod pa ay. Tapos yung Letty La Mas fea akala ko gumanda na yung bida talaga… aba ay kasura pa rin.