To Rosalie

My first duty in the OB ward was a day I’ll never forget, thanks to you. Our night duty was supposed to be placid, irenic..free from strife; til you came along and derange everything.

This is not a resentment Rosalie, if that’s where you think this letter is heading. I do not want to add insult to injury for I know you’ve already suffered too much. When the DR nurse called upon your admission, the horrified look on our faces was indescribable.

Let’s dissect your diagnoses, shall we? Muriatic acid poisoning, 21 weeks pregnant. Now, it doesn’t take a genius to know that muriatic acid is a highly corrosive liquid not taken by mouth. I am perplexed as to who you were trying to kill. Was it yourself? Your baby? Or both of you? That was the mystery I wanted first to find out.

As soon as we received your admission, we transferred you to the bed nearest our station. With cases like yours, an hourly monitoring is critical which includes an hourly documentation of vital signs, IV flow, and urine/stool frequency. I have yet to discover the reasons for this malady. I know for every decision you make there is a story behind it. But first things first and I have to save your life. Yes, I have to save the life you wanted so much to end.

In between nursing intervention, I found out that this suicidal attempt happened three days before your hospital admission. I also found out that the baby you are carrying in your womb does not share the same DNA with your husband. I could only imagine your pain, Rosalie.  You wanted an easy way out but failed in finding your escape. You wanted your problems solved only to find out that taking one’s life is not a solution. If you’re going to ask me why drinking muriatic acid didn’t end your life abruptly, I have no concrete answer for that. Perhaps you have one more lesson to learn before you leave this world.

Throughout the shift, you were vomiting and excreting incessantly. More IV fluids were ordered to compensate for the fluid loss and a blood transfusion was added with urgency. You kept us alert and busy all night. Although we knew how poor your prognosis was, we did everything to keep you and your baby alive. That’s our job, Rosalie..to revive people even if they had given up on life.

You survived my shift, Rosalie..but died the next day. I realized that during the entire shift I had not exchanged conversations with you. All I remember was that your thoughts seemed too far away. Were you thinking of the three children you’d be leaving behind? I already felt sorry for them the moment I heard of their existence. But do you know who I truly feel sorry for, Rosalie? The little angel who died with you.

I could only wish for a different ending in this story, but not all stories end in beauty. You will never hear of this letter I wrote for you, but someone else in the same dilemma might.  May your mistake be a lesson for someone.

Rest in peace.

Sincerely yours,

Your OB nurse.

194 Letters and Counting..

On this particular morning, I woke up deciding to be my melancholic self.

Strange isn’t it? For we have been taught to wake up and pursue happiness each day, and here I am chasing the opposite. I don’t know what made me think this way. It’s probably my lack of plans for the day that had stirred me to be reflective for a little while.

For the past several months, my life has been trailing a get-up-and-go routine. I wake up at 5:30am, leave the house at 6:45am, and arrive just in time for work at the hospital. After 8 hours (and maybe even more) of taking care of sick children, post-partum mothers, and frail elderly…my energy inevitably reduces to nothing which makes it impossible for me to live a little after work. The next day, the same scene happens. But this post isn’t about my life as a nurse, or the lives of the patients I’ve tendered to. I have written no letters for my patients today. This day is for the people who took the time to write me letters of thanks, encouragements, and forgiveness.

On a specific corner of my dresser is a box that draws no particular attention. It has been there for as long as I could remember. What I couldn’t remember was the last time I opened it. And today, I felt the moment it has been waiting for finally arrived. 

Inside the box is a pocketful of memories. It consists of letters from high school friends (some I am no longer acquainted at present), college friends, family members, and even previous lovers. Some are not even letters. They were just post-it notes that have special messages on it. I kept it anyways because regardless of how short the messages were, I believe the person who wrote it put aside a precious time from his/her precious life to write it.

I couldn’t quite well recognize whose signature this is…good thing I know your handwriting too well, Aimee😉

Yes, brother. I managed to stay single for the rest of my high school years, thanks to you.

The most adorable find in my memory box!

You are a true friend, Jannel! Lol.

Thank you for sending me one of the longest and most touching letter I have ever received :’)

You know you’re in trouble when the guidance counselor starts giving you letters like this.

Rummaging through the 194 letters made me wonder if I was able to write every one back. Was I able to return to them the same special feeling that I felt when they gave me the letter? My heart says “I hope I did,” but my brain thinks otherwise.

It has been a long, long time since I last received a letter. I guess technology snatched away that opportunity to make people feel they are somebody to someone. Reading the letters allowed me to feel an assortment of emotions I cannot even make sense of. It’s like laughing so hard yet tears start to gush from your eyes and you cannot tell apart if you’re sad or just extremely happy. And though I am thankful for technology for making it effortless to communicate with friends, I believe handwritten letters are still a novelty.

Some people are withdrawn to writing their special someone a letter. They are afraid that laying them all out in a piece of paper might diminish the true meaning of what they really feel. But I believe otherwise. I believe it is important to let people know you love them, or that you are sorry for what you did, while you still got a pen and paper on hand. The seasons may change and the years will surely go by, and the people who wrote the letters may not even stay the same, but the letters will remain true till the end of time.

To Jake

How do I even begin writing this letter? To be honest, I had my doubts. I’m probably your least favorite nurse. Your worst nightmare. I don’t blame you. I’d hate myself too if I was my own nurse for I can be the most persuasive person I know. Yet somehow with you, I’ve failed in some way.

You are one tough patient to deal with. Everything with you is a bargain – eat your meal or we’re gonna start an IV line for you, take your oral meds or we’ll give it by injection, wear your face mask or we won’t let you walk along the corridors. Everyday is the same scenario with you. I know you are too young to understand the reasons behind our little bargains, but every task I ask from you is for the betterment of your health. I’m sorry if I had to be firm with the orders. I may look like the most hard-nosed nurse on the floor, but on the inside I’m a real flimsy. If I had to give in to your every day appeal, you wouldn’t be alive and kicking now.

Based from your blood works, you have pancytopenia. Exposing you to the other children in the ward could do serious damage on your health. I know it could get lonely in the reverse isolation room with no other kids to play with, which prolly explains your everyday terrible mood, but it’s the safest place we have for you. Yet I know the hospital is not the optimum place for an 8 year old kid to grow. You should be in school learning your math, or in the streets dancing in the rain.

No child deserves to stay in the hospital for more than a week..but you’ve been here with us for almost 2 months. I remember on a distressing night shift, your hemoglobin level dropped and so we had to transfuse 360cc of packed RBCs and you didn’t respond well to that. You yelled alot, you cried for unknown reasons..you were being your usual 8 year-old self. In turn, I went back and forth to your room every 30 minutes to check if the blood was infusing well, and to monitor any BT reactions. You have no idea how much I longed see the sun rise on that particular night shift.

After so many days of dissent and compromise, I realized there hasn’t been a day where I’ve seen you smile. I haven’t even heard you laugh. At times I became skeptic of whether you’re really a child or just a grumpy old man. Lighten up a little, Jake. You know, they weren’t kidding when they said laughter is the best medicine. You should try it sometimes. I don’t want you to grow up and think that we robbed away your chance of what could have been a beautiful childhood. In fact, the reason why we have to stick needles on you and make you drink the bitter meds is because we want you home as fast as possible..so you can enjoy the rest of your childhood while you still have it.

No nurse would want to inflict harm on their patients. We pledged to make life a healthful experience so people could enjoy the best of what the world has to offer.  And so when you become a man Jake, I hope you remember us, your nurses, as the people who saved your life, and not as the people who made childhood a living hell for you.

Be well, Jake. I’ll see you soon.

Sincerely yours,

Your Pedia Nurse.

It must be stressed from the beginning that I was not a born nurse. The entirety of how I fell into the fate of heroism is due to my mother’s imprint. She is a nurse, you see. A born one, who is to be envied. I cannot retrospect a time in our lives where we had been rushed to the E.R because of some queasiness. My mother knew exactly what has to be done, and unless your ailment is debilitating, no such hustling shall take place.

Perhaps I should start my story in my college days where nursing was viewed as a 7/11 store – convenient, available, and accomodating. At least that’s how I pictured it to be before I entered the gates of my university. Of the 181 students who graduated from my high school batch, more or less 50% had chosen the path of nursing. It took me an entire summer to finally come aboard with my fellow nursing compeers. Why? In the primal years of my existence, I knew I was the kind of person who takes the road less traveled. The person who leaps beyond what’s orthodox and doesn’t abide with whatever it is that’s conventional. I was my own person, until circumstances propelled me into a different wave.

The first-year of nursing is a mixture of adjustment and ambivalence. You’ll have your first taste of epic failure, and that leaves you thinking “Was I right in choosing this profession?” I lost count of the many times I’ve pondered on deviating to a more suitable career. Besides, it’s only the first year. It’s not yet too late to make life alterations. But second year, third year, fourth year had passed, and I still found myself on the same ground. What is it in this profession that had kept me unmoved? Perhaps it’s because I was meant to be here and not there. I refused to be beaten by failures in a few units. Besides, it’s good to fail once in a while. You get to learn what your weaknesses are, and once you’re ready, you pick a perfect time to fight back. And by the the perfect time, I meant the final exams.  As what a mentor told me, we learn little from our triumphs and much from our defeat. I never forget.

I did not graduate as cum laude or with any distinction. I was not that smart, apparently. And as much as it pains me to admit this, I’m just like most people. Average. But I won’t bail out to my belief that there is something in me that others don’t have. Someday, when I discover what that is, I promise to write something about it.

Going back to the world of nursing, I’ve found that the people who are supposed to have your back are the ones that end up pulling you down. I had professors who never failed to include sarcasm in their encouragements, who belittle us in every way. A piece of advice: learn to teach your students without crushing their spirits. How would you help them build their confidence if you’re already doubting their ability from the start?

I also have senior nurses who often compare us to their dawning years, back when everything done is ideal. Newsflash: it’s already the 21st century. Gone are the days when sickness were as simple as cough and flu. If you want an ideal nursing care, then give us an ideal nurse-patient ratio. How else would we become effective at work if we’re handling 20 patients per nurse and only a pair of hands?

And to top it all off, I have a mom who is a nurse. Imagine the pressure.

Another thing I’ve uncovered when I started working as a professional is that, what they teach us in school is a far cry from what’s actually happening in the walls of the hospital. When I was a student, I would only be in charge of one patient…when in reality, you get to have ten or more. This is a true test of flexibility that I wished I’ve learnt from school, but didn’t. I may have heard a professor say,”As a nurse, you must be flexible,” or have read it in Kozier’s book or something, but never really got to experience it til now.

In school, they tell you to assume a great measure of emotional distance. Well that’s easy if you’ve only known the patient for a day or two (which is the typical duty days of a student per week), but what happens if you’ve cared for that patient long enough to call him by his first name? What happens if you have to do a post-mortem care to a child whose mother is weeping incessantly in front of you? Do you get to say “Excuse me,” or “Give me a minute..” You can’t. You’d think with all the tragedies we witness in the hospital, we’ve already mastered the art of apathy. Well I tell you this, if you’re a person who cannot connect with a suffering human being then there’s something wrong with you.

In school, they ask you to be nice to other nurses, to greet every doctor you meet in the hallway. But what happens when you don’t get back the respect you unquestionably deserve? For instance, when you call upon a doctor to report a 180/100mmHg blood pressure, you’d anticipate a “thank you for this referral” reply. But instead you’ll get “Go find doctor..this or that,” then they hang up without saying goodbye. You’re lucky enough if they answer the phone, or you’ll end up like a lost bird roaming the grounds of the hospital searching for Doctor Who. Don’t get me wrong, I understand that life in the hospital could get overwhelmingly stressful which does lead to situations such as this. I just hope I was primed for it.

When you’re a student nurse, the only thing you have to worry is to not be late for duty and to come with a complete paraphernalia. And if the gods of sky heard your plea, heavy rains have the power to cancel out your duty. In the real world, you have to attend to work  no matter how atrocious the weather is. What kind of angel of the sickroom are you if you stayed home while everyone else is needing your heroic service? Shame on you.

I guess what I’m trying to say here is that, if you’re a nursing student or planning to be one, toughen up. I know a lot of people who had the intelligence to pass the board exam, but don’t have the guts to face the true challenge of hospital work. It’s an exhausting job that often requires us to work beyond our shift. We cannot leave the hospital until we drained the last drop of patient’s X catheter. We cannot undo what has been written in patient’s A chart because erasures are prohibited.  You know for a fact that we leave no room for errors when we’re dealing with a human life.

Because of this, I am often visited by nursemares. At times I would be jolted at 2:00 am and call my co-worker who is on duty and ask, “Did I give patient X her medication?? Was I able to drain the fluid from patient A’s chest??” It’s a temporary madness that we nurses are very familiar with, because we know that one inadvertent error can spell the difference between life and death.

Have I mentioned how bummering a nurse’s schedule is? We rarely involve ourselves in social activities because A) We need sleep, B) our shift simply won’tt allow it and C) we need more sleep. There are times I don’t even know what day of the week it is. We nurses work weekends and holidays because people don’t just get sick Mondays through Fridays. This is not a protest for I fully understand the career I have employed myself into. This is simply a verbalization of what it’s really like to be a nurse.

But you have to know, though nursing is the most exhausting job I know, it’s also the most rewarding. It’s true you can get two or more patients for admission on your shift, but you also get to discharge a few whom you’ve helped in their remission. I know I’ve only been working in the hospital for ten months but I am proud of myself for weathering the storms. My principles may not always concede with the hospital’s and my beliefs may differ from my workmates, but at the end of the day, you are your own person. And in those ten months, I was able to deliver a baby into life, and grant a patient’s last wish which is a decent death. Now tell me, what’s more awesome than that?

To Marieliz

“The human capacity for burden is like bamboo — far more flexible than you’d ever believe at first glance.” My Sister’s Keeper, Jodi Picoult

I hate cancer.

My grandfather died of prostate cancer. My grandmother died of rectal cancer. And now, my Aunt is currently battling cervical cancer.

So imagine my dismay when I found out I have four kids for chemotherapy today…

Yes, kids! as young as one year old are now diagnosed with cancer. I slipped into the reverse isolation room and that’s where I met you, Marieliz. You were the oldest among the troupe, yet still so young to be sickened with cancer. If it weren’t for your pink pajamas I would’ve thought you were a boy. You’ve lost all your hair already, an expected reaction of your body from the chemo drug. It must have been hard to look at the mirror and see a bald version of yourself especially now that you’re approaching the stage of adolescence. But we both know there are far bigger issues than that.

I’ve learned you have been brawling leukemia your whole life and I was exalted to know you win everytime. How else would you reach 12 years of age? Of course you weren’t alone in this battle. Your mother was with you all the way. When I look at her, I see a mom who would dive into the ocean to save her drowning daughter even if she knew it would drown her too. She was a fighter just like you.

For someone with cancer, you seem so joshing. Every time I walk into your room you never ran of stories to tell. I remember how you spoke of your travels in Manila and how it topped the list of The Best Memories with your family. I remember how you recounted the day your sister developed a crush on another school boy, and made you wish you’ll have that feeling too. I remember how you long to come home and  would often call your sisters and ask them to come visit. And I remember the look in your eyes when they failed to do so.

You’ve always displayed a vicious energy, and so one day when you weren’t bantering of how your day was going I  knew something wasn’t right. I scanned through your chart and found that you have Pancytopenia which means you are low in everything: RBC, WBC, and Platelet. Any minimal infection could kill you now.

I don’t know how many units of blood we had infused in your system. All I remember is how you killed death every day that you lived. Your mom couldn’t be more proud.

But we all know you cannot cheat death all the time. Somehow, someday..your body’s gonna give in.

And yes, leukemia had finally consumed you. I performed your CPR in an attempt to bring you back to life, but knew too well that it was good-for-nothing. When the doctor asked me to stop, your mother jumped into my position and took over the CPR. At this point you’d think she’d already accepted your fate but no, she just couldn’t let go. It was almost too painful to see. And there I realized no matter what, no one would fight harder than your own mother for you.

I left the room. I left your mother to deal with her grief alone.

I know you have many questions in mind, Marieliz. Questions that I cannot even decipher. If you’re going to ask me how cancer snatched away your life, I can give you a detailed answer for that. But if you’re going to ask me why’s, I’ll leave that to the Big Guy up there. Don’t worry, your family will get by.

As for your mom, she is stronger than ever and can now overcome anything life throws at her. You taught her well, remember?

Sincerely yours,

Your Pedia Nurse

To Kathleen

How are you feeling today?

It has been two weeks of silence with you and I am not liking it. I admit, I despise seeing kids cry, scream in pain. But at least they get to feel, Kathleen. You, you have been a dormant volcano for days, and I’d rather see you display a little grimace than sense nothing at all.

Seldom do I see patients your age in my ward. But more than that, your disease is also a flaky one. Usually, I come across kids who fell off a tree, who swallowed a P1.00 coin, who caught a flu in school. So what does a 16-year old like you doing in my hospital? Shouldn’t you be in school enjoying the best of your senior year?

T/C SOL (to consider, Space-Occupying Lesion), that’s the admitting diagnosis that I read from your chart. From your CT scan, an infarct was found on your brain that had caused you a temporary loss of consciousness. From the looks of it, they might as well call it a mild stroke. But a stroke on a 16-year old? That’s a strange possibility, but still possible.

I remember your father beginning to exhibit some madness, not at your condition, but to the hospital I’m working at. Yeah, he said some mean things that are unmentionable. They call it frustration, I call it displacement. You know, when you’re so mad at the world you couldn’t blame anyone else so you’d pour it out on the first person who’s in front of you. And well, that person happens to be me.

Thank God for your sane sister! She keeps your dad calm, and takes good care of you when I’m busy tending to other patients. She’s only 18 but I admire her strength. I’ve learned your mother couldn’t come home because of the ongoing war in Syria, so your sister took the maternal role instead. And yes, she’s pretty good at it. Looking at her makes me wish I have a sister too.

On a frightful night shift Kathleen, you were displaying some odd behavior. You spoke in different tongue, you were restless, you were febrile. Your father thinks you were being possessed by some evil spirit. If I know nothing about medical world, I may have believed him. But I knew better, so I put up your side-rails to keep you from falling and injected an anti-pyretic drug hoping it’ll keep you afebrile and asleep the entire night.

In the succeeding days I noticed some improvements with your behavior. Well, you’re still asleep but most significantly, you are no longer restless. And your starting to show some movements with your body which is a good sign. I just hope one day you’ll be able to open your eyes and share stories with your sister again. I’m sure she misses you, so get well.

And I have some yearnings for you too. I want you to regain the weight you lost because you are simply beautiful. I want you to attend your JS Prom because it’ll be your last. I want you to know how good it feels to graduate high school. These are just a few but you have to see for yourself what life has in store for you. So please, open your eyes Kathleen. Don’t give up on me or your sister, because we won’t be giving up on you. I promise.

Sincerely yours,

Your Pedia Nurse.

Note: As of this moment (June 12, 2012), Kathleen is now transferred in the  intensive care unit. On a night shift where I wasn’t on duty, her vitals started diminishing and needed vigilant monitoring. She is now in comatose. Her mother finally made it, so thank God for allowing her to come home at the time when her children needed her most.

Please, if it’s not too much to ask, offer a prayer for Kathleen.

To Aryana

“Baby out 1:50pm. It’s a girl,” echoed by the obstetrician who delivered you via C-section. I let out a sigh of relief when the last part of your body was pulled out gently by our medical team. But wait, maybe I was wrong in relinquishing that sigh sooner because I heard no cry and saw no movement from your body.

 And then there’s another problem. You are missing two of your limbs, Aryana. Perhaps a congenital anomaly uncommon to full term babies like you. But first things first, and that is your airway. I kept in mind that your breathing is my priority and the rest, we’ll just have to deal with later. Together with your neonatologist, we rushed you to the cord dressing area and established a clear airway for you. I rubbed your back, an intervention used to stimulate a cry from newborns. I wasn’t very successful with that. All I heard was grunting…but that was better than no cry at all.

“Ready for intubation,” said Dr. Tin. She was about to place the laryngoscope in your mouth when suddenly, you let out a laborious cry. It wasn’t blatant, but any cry from you would be very much acknowledged. Be proud Aryana, you just saved yourself from manual ventilation.

But the battle isn’t done yet. I now have to face the dilemma of your absent limbs. Yet what can I do? I am a  nurse, not a miracle worker. But rather than focus on what I am  incapable of doing, I turned to what I am empowered to do. I spoke with your father and shared with him your brief and honest situation. Of course it’s your doctor’s job on filling your family with pathologic explanation. The technicalities of your case are left to her, while my job is to provide your family with words of comfort. For me, that is an even harder task because anyone can explain the physiologic deficiency of your body, but to say “it’s going to be alright” to a family who’s already dismayed by the outurn of events is a crucial toil. Giving words of encouragement to them is like watering an already dead plant. Useless and disappointing.

But you are my priority Aryana, your family comes second. And as I am writing you this letter, you were already discharged from the hospital. I wish to tell you a lot of things,  but know that you are much too young to understand. I’ll say it anyway for I don’t want to let time pass with words left unsaid.

Baby Aryana, you are a gift from God. You are His masterpiece regardless of how you look like. What you lack doesn’t define who you are. You may not become a famous runway model, but maybe in time you’ll discover some talents with your hands. Perhaps become a painter, or a writer like me. The world is harsh, so be strong. Remember, you have to be brave with your life so others can be brave with theirs. Be an inspiration.

You are a blessing, Aryana. Please never forget that.

Sincerely yours,

Your NICU nurse.