Saturday, July 15, 2017
I am a service animal. My human is who I am loyal to. Please do not make fun of him because he is disabled. He is trying to make the most of what he’s got. I am the only one who can understand him. I go with him everywhere, even to the hospitals. As long as I behave, I can stay at the bedside.
I am his seeing eye dog. He can see shapes with his right eye. He lost his left eye several years ago in Afghanistan. As he walks by my side, he feels for the tug of my leash to warn him of danger in the path ahead. He responds to my subtle moves. Step to the left, step to the right. When I stop, he stops. After four years together, he trusts me. I once saved us both when I warned him of a car who whizzed by without regard to the blind man and his dog.
Yesterday, my human had to go to the hospital. The security officer tried to block me from coming into the emergency department and wanted me chained to a corner. I did not growl at him, but I was tempted to. It's good that the nurse came right on time to lecture the security officer of my human's rights.
I guess the officer was just too eager. There are a few people who try to pass off their pets as service animal. If the dog is just for emotional support, that is not enough to qualify as a service dog. My human told me of Mrs. Harris, our next-door neighbor, who tried to smuggle Rosita into the hospital. That chihuahua could not stay quiet at all. She even tried to bite the nurse. Ahem, then there is Senor Diaz, his pet ferret is not a service animal even though he claims he need Chester for emotional support.
My human suffers from what he calls PTSD. When there are these loud things in the distance that he calls “damn fireworks”, he cowers in the corner, just like me. We hold each other, and I try to calm myself so that he can stop shaking.
My human said that the American with Disabilities Act protects his rights as a disabled person. The public cannot discriminate against a person with a disability. He said that nobody can demand proof that I am a service dog especially since it’s obvious that he is disabled. I don’t have to have a license or a certificate. Sometimes, I wear my special vest except during the hot summer months.
When my human meets up with his old friends from his old platoon, that is when I also bond with the other service dogs. One German shepherd barks when his human’s blood sugar is getting low. A golden Labrador warns his human before he gets a seizure. I am a beagle and I am the most experienced dog in my group.
Oh, have you heard that miniature horses can also serve as service animals? I would love to meet one someday.
An artist was prevented from boarding a United Airlines flight with her "emotional support" animal. Not a dog or a miniature pony as allowed by the American Disabilities Act. She tried to bring a PEACOCK on the plane. Really?
Monday, January 2, 2017
I write about Nursing because I am proud of the difference we make in our patients' lives. This is a profession that is definitely and infinitesimally life-affirming and emotionally rewarding. Then on Thanksgiving day in 2015, I received an email from a patient. His story is unforgettable and inspiring. I will call him Mike to protect his privacy.
Hi Ms. Cerrudo,
On this Thanksgiving, I write to simply say "thank you'. I randomly come across your blog. I'm not in the medical field, but know it well - as a patient. A few years ago I was taken into surgery for an emergent surgery. The doctors discovered several masses. Unfortunately, the hepatic artery was nicked during the case and I began bleeding profusely- I subsequently coded twice during the case and it was a very skilled RN that helped perform open cardiac massage. After several weeks of intense recovery, I made it home.
I now face a second major surgery in a month to attempt to repair a thoracoabdominal aortic aneurysm that is pressuring both the spinal cord and diaphragm. Additionally, they will attempt to remove some metastatic lesions on the upper and lower GI tract. They have estimated a 16-hour case with a 70% intraop mortality rate.
I write to you to thank you for sharing all of your stories to exemplify how important nurses are in the most dire of situations. I was able to obtain authorization for an observer during my upcoming surgery and was wondering if you might want to observe - I think so much good could come out of you sharing my story and to re-emphasize that medicine is a balance of technical skill, compassion and humanity. I could think of nobody better to tell that story.
My heart goes out to you. Despite all that you have gone through, you still managed to recognize the contribution of nurses to your care. I have never received a request from a patient for me to share their story. It will be an honor and a privilege for me to assist you in any way I can.
Let me know how I can help. When is your surgery? I will be leaving for a 3-week vacation in January. I wish I can see you before then. I would really like to meet you.
Thank you for getting back to me. Would you be open talking to me very soon? I would love to tell you of the many ways that the nurses made a difference in my care. How they comforted me when I was anxious; when I just needed someone to talk to. Can I send you my case study?
I read your case study. Words fail me because I cannot imagine how difficult it is for you and your family. If you would like to discuss this with me, I would be available this Saturday before the holiday rush. In mid-January, I will be out of the country on vacation. I do want to speak to you by phone or in person, if you're up to it. Your story needs to be told.
(In truth, I was so touched by Mike's trust in sharing his case study. He's not even thirty yet, and he has gone through a lot. The doctors removed some lesions on his gastrointestinal tract. The names of the OR staff were redacted in the operative report. The case details chronicled the whole session. The assisting surgeon prayed for spiritual guidance for the OR staff. She also prayed for the patient- for his comfort and peace of mind so that he will feel the “hedge of angels surrounding" him. She also prayed that the lessons from this case study will benefit others in the future.
Except for a month’s stint in the operating room as a nursing student, I have not known much about how much stressful it is to work in the OR setting; how tenuous a life is; how in one instant, patient can bleed out from a ruptured artery. The attending surgeon stepped out twice to inform Mike's parents of complications during surgery. Each single time, the attending came back with the family’s decision for a full code. The OR surgeons, physician assistants, nurses, and scrub techs all rooted for Mike, and he survived. No neurological complication from the two episodes of cardiac arrest- one from ventricular fibrillation and one from an asystolic rhythm.
Now, he wants me to write about how the nurses cared for him. I should write about how he inspired me. I cried after reading Mike's OR report. I hoped and prayed that his upcoming surgery will be a success. With all that he went through, he still wanted to honor the nurses. I may not know him personally, but I wanted to reach out and hug him.)
Was there anything in-particular that resonated with you about my case? Have you ever had to perform compressions on the table during a non-emergent case? Both external and internal?
Several things that resonated with me about your case:
1. Your resilience. Your strength comes through loud and clear. The operative report was so graphic and so detailed, especially in the resuscitation efforts. Everything was so surreal.
2. Your spirituality. I did not even know that prayers are held right there in the OR.
I have been an ER nurse for about 25 years. I spent the last 12 years as an educator. I have done my fair share of external cardiac compressions. When I was still doing trauma, I had assisted in cardiac resuscitation using the internal defibrillation paddles, but I have not done an internal cardiac massage. The closest I have ever come to seeing this was when the trauma surgeons opened up an eight-year old boy who was hit by a baseball in his chest. To this day, I still get goosebumps when I remember the day the boy came back to the ED several weeks later, alive and well. I have never been so happy seeing the healed scar on his chest.
(In fact, I wanted to tell Mike how grateful I am that we were able to talk over the phone. I felt emotional hearing his voice, especially since I realize that his impending surgery is complicated. He expressed optimism, but I sensed that he was resigned to the fact that he might not make it this time. With the 70% intraop mortality rate, the odds are against him.
When I asked him why did he want me to specifically thank the nurses, he said, "I thanked the doctors enough, but the nurses don't get enough credit".
He was not able to expound on his experience with the nurses. He was getting tired, so I suggested that we can just make another appointment to talk again. We did not have a chance to speak again since he was busy with more tests).
In a few days’ time, you will undergo surgery again. I am sorry that I would not be able to be there for you because I am boarding the plane to see my family. I will pray for you. Would you email me back when you have recovered? Be strong.
Mike, I pray that the operation was a success. Please email me back.
(I called him from overseas. The phone just rang and rang. I prayed that he was just busy recovering).
This is Jocelyn. It has been awhile since we corresponded. I am not sure what happened since then. Can you please e-mail me back?
Mike, are you there? I tried to call your phone, but it was not in service. I also tried to google your name for any news.
Mike, it has been a year since you e-mailed me. I am afraid that it is not good news since I haven't heard from you. I do not want to intrude on your family's privacy so although I know your real name, I couldn't reach out to your family. Are they even aware that you want your story shared with the world? I do not know you personally, but I am convinced that for whatever little time you have on earth (I feared the worst), you have enriched the lives of those around you.
I am humbled that you chose me to tell your story. You wanted to honor the nurses. Instead, I honor you.
Mike’s requested scripture readings before the surgery:
He heals the brokenhearted and binds up their wounds.—Psalm 147:3
Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.—Isaiah 41:10
For I will restore health to you, and your wounds I will heal, declares the Lord, because they have called you an outcast: 'It is Zion, for whom no one cares- Jeremiah 30:17
Wednesday, August 17, 2016
The red phone rings above the din of the mid-day controlled chaos of the emergency department.
Gloria, the charge nurse sighs and picks up the phone. The resuscitation room nurses and Dr. Cooper, ED attending, approach the nursing station with expressions on their faces something akin to dread. The weariness of the back-to-back cardiac arrests and trauma cases in the past three hours is still visible on their faces. “Oh, no! Trauma again?" is the collective response from the ED staff.
Gloria writes furiously on the log book, her script almost illegible in her haste. “Stab wound to the chest, patient hypotensive 90/50, tachycardic 118, alert and responsive, paramedic, 3 minutes ETA”. The word “Trauma” is like a magic wand that transforms the frenetic atmosphere in the ED to an even more hyped-up vibe. With a quick consultation with the ED attending, Gloria activated the Trauma Team. The phone operator repeats her every word “Trauma Level One, Adult, stab wound to the chest, Resus 1”.
Team in action
The ED team galvanizes into action. Three minutes before all hell breaks loose again. The EMS notification gives them time to prepare. Sometimes, patients walk in from a trauma incident. Other times, victims from gang-related incidents are dropped off by their friends at the ambulance area. Usually, the friends scamper away when the police authorities come around to investigate.
The team leader, Dr. Cooper, calls for a brief to reinforce the roles and responsibilities of his team. There is a diagram on the wall and painted squares on the floor to remind the team. Gloria pulls one of the triage nurses to act as the scribe nurse. The team members all suit up with gowns, gloves, and goggles. The airway physician checks his airway equipment, and pulls the glide scope from the other room. The nurses prepare the chest tube set-up and the rapid infuser. The survey physician is the intern who is visibly shaking since this is his first month on the job.
Other ED staff and visitors try to come into the trauma room, only to be rebuffed by Gloria. The diminutive charge nurse is intimidating as she takes her place outside the trauma room; she will not allow any other non-essential personnel in the room. Somehow, a trauma case attracts rubber-neckers and it is Gloria’s duty to do crowd control, until the nurse manager comes to take over.
The patient comes. Gloria could not help think “It’s show time”. The EMS paramedic directs her report to the team leader, not losing her beat as her partner motions for the transfer of the patient to the trauma stretcher. The other team members work in silence as they half-listened to the report while they undress the patient and hook him to the cardiac monitor.
The paramedic intones “This is a 20 year old male who was involved in a battle between two gangs. He was stabbed on his right chest. The knife is with the police now. He was carrying on at the scene cursing a streak, then he became hypotensive and tachycardic so we just rushed him in here.”
The ED attending glances quickly at Gloria when the paramedic mentions the gang. Gloria instinctively scans the crowd gathered outside the room. She mouths “gang activity” to the nurse manager. Marlene is an experienced ER nurse who had seen her share of gang-related traumas in her previous hospital. She immediately summons a security officer who then moves all the on-lookers away from the door. Security will need to contact NYPD to apprise them of the situation of the potential for gang retribution and to secure all entrances to the emergency department and the hospital.
The team leader asks the survey physician to report his primary assessment. “Airway is intact but there is decreased breath sound on the right. I will put a chest tube”. The secondary nurse readily hands over the 38-french chest tube and insertion kit. The chest tube drains three hundred mls of blood. The patient is still alert and awake but no longer belligerent. He finally realizes that he is in big trouble and he silently endures the poking from the survey physician after he received an intravenous pain medication.
Like clockwork, the nurses effortlessly insert 16-gauge IVs antecubital bilaterally. The primary nurse, Rick, hands the labeled blood tubes to Gloria who then hands them off to the patient care tech to run over to the Blood Bank. Dr. Cooper activates the massive transfusion protocol. The nurses prepare the new rapid transfuser. Gloria retrieves two units of O-negative blood from the room refrigerator.
However, the responding surgeons come in droves and crowd control becomes a losing battle. Marlene tries to question everyone who responds to the trauma activation. All this talk about crowd control has to be directed to the surgeons and the consultants who bring three members of their team inside the crowded room. Everyone thinks they’re indispensable.
Initially, the ED team communicated quietly with each other. The arrival of the surgeons shatters the peace, but only for a few minutes. The team leader takes control and says in a firm but controlled voice, “Everybody shut up. The only person to talk is me and the chief surgeon and the nurses or whoever I ask to speak”.
The scribe nurse Aysha calls out the vital signs. The blood pressure responds to the blood transfusion with the blood pressure slightly higher. “BP- 100/52, heart rate- 100”. She keeps track of the vital signs and guides the survey physician as he does the secondary assessment.
The chief surgical resident discusses the patient disposition with the ED attending. He then says to his junior resident, “Call the OR now.”
Dr. Singh calls out, “Team, thank you. Our in-situ simulation is over. Please stay for a few minutes for a quick debriefing. Great job, everybody. ” He covers the simulation manikin and turns off the lap top with the programmed scenario.
Monday, July 25, 2016
Readers, this past week, I heard of two ugly encounters in the emergency department. Two patients disrespected the nurses who were trying to help them because of the color of their skin. Sadly, this is nothing new. I wrote this letter about 15 years ago after a similar experience. Somehow, the hateful vitriol is further emboldened by xenophobic rhetorics from bullies and haters. I have always worked with an exemplary diverse staff who see patients as human beings. I stand proud as an American citizen and as a nurse, even as we face all these challenges with professionalism and decency. As the incredible First Lady of the United States Michelle Obama elegantly said, "When they go low, we go high".
I wish I can erase that hatred in your heart, that xenophobic attitude against anyone who doesn’t look like you. You cursed at me and told me to “return to my country”, even as I was just trying to triage you. I swallowed the bile in my throat as you ranted about immigrants who stole your job. I have two college degrees, dear patient. Based on your incoherent and ungrammatical ramblings, I am pretty sure you could not perform my job.
I knew you were sick so I ignored your blatant racism. I allowed my orientee to interview you just so I can get enough information why you have tachycardia and back pains. I did not call security to escort you out because I realized that you needed medical help, despite the obscene gestures. You are an ignorant and a bigot, but you are my patient.
You don’t know that I was the one who recognized that you were dying. You even refused to be seen by our Asian ED doctor and the African-American resident. But then, you collapsed in front of us. You don’t know that I was the only one who could insert a good IV line in your fragile veins. Now that you are unconscious, you would never realize that the emergency team who took care of you was a diverse group, a multi-colored group of professionals. If you knew you were dying, would you have accepted our ministrations?
The rainbow of ethnicities in our emergency team did not divide us but instead united us in our efforts to serve the diverse community. Our team of doctors, nurses, and other ancillary staff did not care about the color of your skin. There was no question about your sexual orientation, or political and religious affiliations. All we were concerned was to race against time to save your life.
You are our patient. If you are conscious, we would not tolerate your disgusting behavior. But unfortunately, you are now intubated and brain-dead. So we have to be blind to your faults. We will not respond in kind to your ignorance and bigotry. Despite your evil thoughts, we will remain true to our sworn oath to take care of you, as we do with all our patients. I see you as a human being. No matter what.
Your Filipino-American nurse
P.S. You signed an Organ Donor Card. It is great that you did not state a preference for the recipients of your organs. I'm sorry that you would not be able to read this letter. I was hoping this would open your eyes and touch your heart.
Saturday, July 16, 2016
Cartoons paint eloquent visuals of a nurse’s life. There are so many stories to tell, sometimes sad, mostly funny. We cannot take things too seriously while at the work place. For there is so much more that we can poke fun at. After a hard day’s work, we need to take a deep breath to remind ourselves why we go through the stress of taking care of others.
Laughter is the best medicine, so they say. Laughter is a tonic that releases endorphins. It’s a feel-good chemical, a natural high. It is an antidote to a negative vibe. A chuckle is a start to a rumbling roar of a hearty, ROFL laugh. We should always share a smile, a chuckle, a giggle, a guffaw, and a belly laugh. Negative out, positive in. Leave the work drama behind. Come and draw a cartoon.
More to see at: http://jocerrudosese.blogspot.com/
Saturday, March 12, 2016
I would never know how your own family feels right now. I just know this is a difficult time for them.
It shouldn’t be like this that our Elmhurst ED work family would see each other again. Not at your funeral. Old familiar faces returned to pay respect to you, one of our own. There was no joy at the unexpected reunion, just profound shock and melancholy at such a sad occasion.
It was tough to say Goodbye. You’re gone too soon. I have always thought of you as fierce, vibrant, and invincible. The soldier and the nurse; you’re twice a hero. I am heart-broken.
Wasn't it just yesterday when you came for your interview for an LPN position? I was impressed at how articulate and confident you were. Through all these years, you showed your strength, tenacity, and courage to finally get your RN license. As a soldier, as a nurse, and as a union representative, you were one tough cookie. I salute you. I just wish I had seen you one more time. Isn't it tragic that we always want to have that one more day to remember someone special by?
Someone said “Death leaves a heartache no one can heal, love leaves a memory no one can steal”. I have many fond memories of you, Angela. You were an excellent nurse, a straight-shooter (no pun intended), firm yet compassionate, and meticulous yet with a wicked sense of humor. You were there in our parties, baby showers, retirements, birthdays, and summer picnics. I heard you suggested a summer picnic before your untimely death. Maybe you missed the fun and games; maybe you longed to play with your work family.
Your Elmhurst “peeps” showed up en force, even those of us who have left to work elsewhere came back to share the grief. The White Rose Nightingale tribute was a poignant homage to your tremendous contribution to the department. After the nurses read the words to the poem "She was There", they gently laid a rose on your reposed body. It was a touching image, especially with the nurses dressed in white and the military guards standing in attention next to your casket. You have made a difference in people's lives many times over, Angela.
We've lost too many through the years. Kathy, Angel, Beckley, Ruthie, Siony from PAC, Derrick, Timmy, Kettly, Jennifer, Phyllis, Brad, and Dr. Neil Oster. There were two more who we lost, their names forgotten but their absence was nevertheless mourned. One was a new nurse who was a victim of domestic violence. Another one was a PA who took his own life. With every passing, our hearts break not only for the family but also for the co-workers they left behind.
The ED is a challenging place to work at, but it has certainly brought us together. We struggled, we saved lives, we laughed, and we cried. We grieved for every single co-worker we lost. In the process of keeping our heads above water, we became a family. Nurses, doctors, PCTs, PAs, clerks, transporters, and many more. And Elmhurst, our home.
And now you... You will be missed. More than you will ever know. My deepest sympathy to the Palmer family.
Thursday, December 31, 2015
One New Year’s Eve many years ago, EMS brought in an elderly man with dementia to the emergency department. The patient had become increasingly agitated due to the loud fireworks outside the nursing home. I have assigned a nurses’ aide to stay with the patient as we tried to sort out the bolus of patients who came in to the ED.
At the same time, a “happy drunk” staggered into the ED. Thankfully, the patient, who was a regular in the ED, just wanted an audience for his singing. The “happy drunk” entertained the triage area with opera songs like a Pavarotti. His impassioned O Sole Mio was surprisingly well-modulated and brought a smile to everyone, even to the ED staff who worked on the holiday, away from their family.
The elderly man stopped squirming in his stretcher. Somehow, the familiar melody broke through the cobwebs of his mind and he joined our happy drunk in total harmony. We later learned that he was an accomplished tenor in his prime. He remembered what he loved most.
I remembered the elderly man a few days ago when I accompanied my friend Anita when she visited her mother in the nursing home. Mrs. D. sat by the window, her stares focused at the gardens outside. Was she enjoying the beautiful flowers or was she lost in her own memories? Her gnarled fingers were gently caressing the lace shawl on her lap.
My friend Anita approached her mother. “Mom, I brought my friend today.”
Mrs. D. looked at us. I didn’t expect her to recognize her daughter’s friend from our apple-picking outings when we were still new in the United States. After all, she didn’t even recognize her own daughter.
Alzheimer’s disease had robbed Mrs. D. of her memories. She looked at her daughter like a stranger. She didn’t even respond to her daughter’s embrace. Her lined face was raised in fear at the sudden intrusion to her physical space.
Mrs. D. used to be a human dynamo. After she was widowed, Mrs. D. ran her daughter’s home with such efficiency as her daughter and son-in-law worked hard at their careers as nurses. She was a loving but firm grandma to both of her grandkids. I remembered her humming her favorite songs whatever she was doing at that time.
Anita’s family had no choice but to transfer her to a nursing home when she started wandering away from home. Mrs. D. had been missing for two days until an alert hospital worker notified the police of an unknown woman who was dropped off at the emergency department. She was lost in her own world. Mrs. D. was now a shell of her former self.
The deterioration was slow, but equally painful. What was once a vibrant woman was now profoundly changed. During the early stage of the disease, she expressed frustration for not remembering, for being a victim of her forgetfulness. Now, she looked calm, probably because she did not even realize what she was powerless to do.
Anita was sobbing in frustration. Mrs. D. was not responsive to any of her daughter’s attempt at conversation. I remembered my old patient from several years ago and suggested to Anita to sing some of her mother’s favorite songs.
“Saan Ka Man Naroroon” (Wherever You Are) is a Filipino love song about a woman’s promise of loyalty to her loved one. This was the theme song of Anita’s parents. As soon as Anita sang the song, her mother’s face relaxed and her eyes focused on Anita. Mrs. D. smiled and caressed her daughter’s hair.
At that moment, with the sweet melody of a beloved song, there was a respite from the darkness in her mind. Her heart remembered, even for just a few minutes.