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Archive for the ‘Graveyard Shift’ Category

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.

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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.

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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.

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To Christopher

Today is a day for tears, for we have lost you Christopher – our dearest angel in the ward.

Twenty days ago, nobody, not even our best doctors, believed you were going to outlast 24 hours of existence. Who wouldn’t? At the sight of you, even non-medical practitioners could bluntly say you wouldn’t have the strength to make it. But a day had passed and a week had gone by, and you were still fighting.

Gastroschisis. That’s the medical term they used to describe your diagnosis. In my five years of studying the human anatomy, I have never encountered this kind of condition, let alone see one. But the mere appearance of your body could already tell what lies behind your affliction. You were born with a defect in your abdominal wall through which your intestines, both small and large, freely protrude. In lay man’s term Christopher, everyone could see your abdominal contents right outside your body. I took a picture of it and still have it on phone. But I decided not to post it with respect to the departed.

The doctors have already primed your parents on the bleak future you are going to have. But what future? The surgeons said you were too young and ineligible to undergo any extensive procedure. But I figured, if you weren’t here in my country and had been confined in a high-end private hospital, maybe there was hope for you. I see it all the time on TV, babies undergoing medical procedures like conjoined twins being separated, congenital heart defect that are surgically repaired. So why not you, Christopher?

Deep down I know the answer. There’s a reason why you are here in my hospital and not elsewhere. Your parents, they visit you all the time. I remember seeing your father for the first time and he asked me why has the surgeon done nothing for the situation. I told him what every nurse would say. That we are doing everything that we can to keep you still. Your father replied that even if we are just awaiting your demise, the surgeons should still examine you for your daily needs and status. I told him I get what he means and will inform the doctors about it. But the truth is, nobody would ever understand a father’s pain who’s wondering when his son be taken away from him.

First year in nursing class, we are already taught the basic principle of every person’s right to live. But there’s a counterpart for that. That every person be given a right to die in dignity. And though we had already seen death coming, we still did what we had to do. Everyday we would change the sheet of your crib soaked with fluid coming from your body, we refill your dextrose to replace the lost liquid, we change your diapers to at least make you feel a little comfortable, and we even transfused blood twice even though I don’t see the point of it all. We treated you as if you had a remaining hope.

I feel shame for the doctors who didn’t have the means to cure you; who didn’t take the time to check up on you. But then I realized there are also other dying patients in the hospital. They must have been busy saving the lives of those whom they know have greater chances of living. And so we might not have given you the gift of life, I hope you should know that we had given you a decent death. An extension of your life is beyond our command, but you had 20 days of being with us Christopher. And that is a miracle itself.

Sincerely yours,

Your NICU nurse.

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To Rachel

I held you in my arms at 2:35 am. As soon as the ER nurse called your admission, I began my distress. “For standby intubation,” –these are the words most dreaded by any nurse who knows how to read beyond doctor’s orders.  In medical world, that basically translates into “you have a few hours to live.”

Yet I stood there, hoping you were a miracle.

You were breathing heavily, too rapidly, and the oxygen support didn’t seem to be of much sustenance at all. In fact, your O2 Sat was 9 digits low. Again, I began my uneasiness. I laid you under close watch service, on the first bed where I could see you from the nurse’s station.

I’m sorry you had to share a bed with another patient. I couldn’t risk placing you on the farther side of the ward, in case…you know, something bad happens. You need to be attended every hour. You were high-maintenance, and though I had 21 other patients last night, you pretty much consumed my 8-hour shift.

Your chart wasn’t modest of your condition. It read: Pneumonia very severe s/p colostomy 2010, Down Syndrome.  You had, not just one, not just two, but three diagnoses. First problem was that your airway was clogged with mucus, which explains the little oxygen circulating in your body. Second, you weren’t blessed with an orifice on your rectum so in 2010, they had attached a “poo-bag” for you. That, by the way, increased your risk for infection. And third, you were born with chromosomal aberration.

Am I now sounding too technical for you? Don’t worry. You don’t have to understand these things at such a young age. All you had to do was fight your battle. You carry a deadweight much heavier than you can endure but you lay there with your eyes closed, looking tranquil in sleep. Were you dreaming of heaven, Rachel? I guess I will never know.

Your mother was kind, and so is your grandmother. They amenably did what I asked them to do and they never left your side. But at around 4 in the morning, your vitals started deteriorating. Your O2 Sat fluctuated from 90 to 64 to 85. Your heart was pounding for the lack of oxygenated blood, and on top of that, you were having a hyperthermia.

Nebulization every two hours began and we suctioned your secretions after that. Did you feel any bettering? Your vitals expressed no, but only you can best judge what you had felt. Just one more hour and you will be surviving my shift. I put away the emergency cart since you didn’t look like you were going to have a cardiac arrest within my duty. But in the midst of the endorsement, 30 minutes passed my shift, your mother came running and said something I could barely understand. But no words needed for that, because as soon as I saw her face, I knew. I jumped on my feet, grabbed the stethoscope and rushed your way.

When I reached you Rachel, you were no longer gasping for air. I placed the stet on your chest and heard nothing. The pulse oximeter now reads 0 0 – negative for oxygen and negative for pulse rate. I immediately called your physician and while on his way, I grabbed the emergency cart that I just put away. I didn’t notice how malnourished you were until we had to stripped you off your clothing and do chest compression. I could do a mental count, not only of your ribs, but as well as your intercoastal spaces. That’s how skeletal you were. I injected Epi in your system to start the heart pumping, but not even a flutter could be heard. Your O2 was now on full blast, but we were the ones doing the breathing for you.

Last try, another dose of Epi was ordered. But you were still a flat line.

At 7:45 am Rachel, your doctor pronounced you dead. I started returning everything that I had put out for you: the pulse oximeter, the nebulizer, the suction machine, the E-cart, and the O2 tank. None of these equipment were strong enough to fight a much bigger force.

 You fought a hard battle, Rachel. Now it’s time for you to continue living in your dreams.

Sincerely yours,

Your Pedia Nurse

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