Friday, August 27, 2010

Counting my Blessings

At Triage...

I worried about buying a new sofa and matching curtains for the living room,
a patient said he is homeless.

I fretted about not getting a pay raise and complained about the stress on the job,
the 55-year breadwinner with the chest pains was just laid off.

I whined about the high cost of hair color and how my highlights do not last long,
my chemotherapy patient was depressed about her alopecia.

I grumbled about my being stressed out with demands of my time from family members,
the elderly gentleman just lost his wife and now is all alone.

I ranted and raved about the nation's state of affairs,
this bright-eyed refugee from a third-world country gushed about free speech.

I complained about being tired from shopping all day long,
this young, gaunt HIV patient whispered, "I'm dying.".

And now that I am being inconvenienced by a little snow and rain,
the horrific images of the tsunami, typhoons, and mudslides just make everything else trivial and insensitive by comparison.

How can I complain?
I had learned long ago to count my blessings.

Nov. 2013- The aftermath of Typhoon Yolanda (Haiyan)

“Imagine being born without arms. No arms to wrap around a friend ; no hands to hold the ones you love; no fingers to experience touch ; no way to lift or carry things. How much more difficult would life be if you were living without arms and hands? Or what about legs? Imagine if instead of no arms, you had no legs. No ability to dance, walk, run, or even stand. Now put both of those scenarios together… no arms and no legs. What would you do? How would that affect your everyday life”- Nicholas Vujicic

Monday, August 23, 2010

Life in my ER

“Oh, what a beautiful morning. Oh, what a beautiful day”, sang this 250-lb flushed-face, alcohol-reeking man who graced our ED one day. He was a happy drunk, winking at the nurses, and even trying to slap a female clerk’s behind as she passed. After we restrained him up, and pushed him into a private room, he stopped singing. He was silent, but not for long.
Out he came, walked out of the room, buck naked, with the stretcher still strapped on his back.


What’s worse than a hypochondriac patient?
A gullible nurse.

Superstitions in the ED:
1. Do not ever say the “Q” word.
2. Cardiac arrests come in threes.
3. Full Moon brings in patients.


She looked haggard, walked like a Zombie, and snapped at everybody. Beware the Burned-out-nurse. Time for vacation again.


We keep a running tab on what’s the weirdest thing we found in any body cavity. Such is the life of an ER nurse. We live for the simple pleasures.


My non-medical friend asked, “How come when you nurses get together, you take so much pleasure in grossing each other out with talk about the hospital? Imagine talking about these fluids during meals. Yuck!”


A friend dropped by one day when the ER was in gridlock. It was 12 noon and the EMS stretchers were lined up all the way down to the ER ambulance door. Patients were cursing, and telephones were ringing. Nurses and doctors rushed through the crowded corridors to respond to a Trauma Team call.

With such disbelief in her face, she gasped, “You must be crazy to work here.”
The staff around us chorused, “We all are!”.

Friday, August 20, 2010

Letting Go

(Excerpt from my published article)

Redefining 'survival' in a profession that does so much business with death.

I remember when I was still untouched by death-when I was a child who believed in immortality and invincibility. It all changed when I became a nurse and came face to face with the harsh realities of death. Suddenly, the finality of it forced me to see us as the mortals we are. I dealt with my patients' dying by maintaining a "qué será será" attitude. It didn't mean losing my humanity; it didn't mean that I cared less for my patients. It just meant survival for me in a profession that sees a lot of suffering and death.

Until Mr. C came to the ED to die.

It was a warm spring day, and on Bed 3 *Mr. Contreras lay dying. Brain cancer with metastases-and the devastation of the disease was finally taking its toll on his 80-year-old body. He was unconscious, but a single tear clung to his right eyelashes.

The ED staff knew him as one of our "frequent fliers." He liked to be called "Abuelo"-Grandpa. He was always pleasant, even when he was in pain. His wife, Rosa, was a proud and feisty woman, and a bit protective of her husband. She used to complain to hospital administration that we were slow in giving him pain medication. "Why can't you give him more attention?" she grumbled.

Now, Rosa sat with hunched shoulders at the bedside. She looked tired and resigned. Her face reflected her fears; her eyes, unspoken misery.

The cardiac nurse told me that the family had signed the DNR papers. Marco, the couple's only child, stood vigil on the opposite side of the bed, gently caressing his father's wrinkled forehead. His face was in agony, but I sensed a quiet strength within him. He would need it now.

I tried to leave to give the family some privacy, but Rosa held on to me with her other hand. "We've said our good-byes. Now I'm letting him go. He wants to die in peace. We're all ready now." Rosa's voice quivered. I nodded because I knew that Marco had reconciled with his father four months ago after a long estrangement.

The intravenous line was removed. The patient wore a clean white shirt. The Foley catheter was discontinued. We all stared in silence at the flickering cardiac monitor, mesmerized by the even graceful strokes. Sinus bradycardia ... pulse 50 and thready. BP steadily going down ... now barely palpable at 70 systolic ... respirations shallow. Abuelo was at the threshold.

The numbers held our attention. Heart rate 40 ... 34 ... 29 ... then asystole. The ED resident shook her head. A gasp escaped from Marco, and Rosa broke into sobs. I stood transfixed as a life ebbed away and the single tear rolled down Abuelo's cheek. His face stunned me. I expected to see suffering, but instead I marveled at a face that in death looked peaceful, almost ethereal. He died in peace, surrounded by love.

Rosa hugged and kissed her husband of 50 years. I tried to say something that I knew would comfort no one but me, but there was a lump in my throat. I just hugged her and we cried together for this wonderful man whose life had made such a difference. "Thank you for everything," Rosa finally said. Mother and son then walked away to begin a new life, and I said a silent prayer for the family.

I remember them to this day, several years later. I hope that their memories of togetherness sustained them through their grief. And I'm thankful that it was a quiet day in the ED, and that I had time to listen and to grieve. From them, I learned what strength there is in just letting go.

* Names were changed.

Wednesday, August 18, 2010

ED Vignettes

Before the ED had our electronic documentation, patients sign up on a paper form. Liz, the triage nurse, loudly called for the next name... “Culo Grande, Culo Grande”. Nobody responded, and instead most of the patients were grinning, some with chests heaving with laughter every time Liz called out the name.
A Hispanic hospital police officer sidled up to Liz, “Do you know what ‘Culo Grande’ means?” It means “Big Ass.”.
Liz refused to triage after that.


Do you know you can get drunk just from breathing the off-gases from the patients in the ED on New Year’s Day?


Everybody knows CG, our resident drunk. He came via EMS, he came walking, he came in any which way he can especially on cold winter nights. He slipped in and out of the ER in sync with our mealtimes. Then he was gone for a month.
He came back one day, all cleaned up, dressed up in clean dress pants and shirt and a blazer. His sister got him into Rehab. We patted him on the back, even high-fived with him. “Way to go.”, “Keep it up”. TL smiled ear-to-ear, and blushed beet-red as he accepted all the compliments from the staff. We all felt that there was still hope in life.
A month later, he came back drunk and seizing.


The red EMS notification phone rings. All ED personnel stopped in their tracks and listened with bated breath. The triage nurse answers, “No, sir, this is not a pizza parlor.”


Everybody gasped. On the endoscopy machine screen, the patient’s stomach lining was littered with debris of her experiments with exotic food: an eraser, a paper clip, a teaspoon, a capped syringe, and a ring.
The GI consultant exclaimed, “So, that’s where my wedding ring went!”.


The medical intern volunteered to do the chest compressions during a code. The strong, even strokes reflected on the defibrillator screen. Then the compressions became weaker, slower until the intern dropped on the floor.
Somebody said, “Uh-oh, there’s still Nitropaste on the patient’s chest.”