Friday, December 14, 2012

Senseless







Twenty innocent children, along with six adults, killed by gunfire in Newtown, Connecticut.

It is a senseless tragedy that defies any explanation or understanding. And because this time, the kids fell victim to one man’s insanity, the nation shares in the heartbreak.

The massacre is incomprehensible. And it hits close to home. Once again, we grieve.

The kids were supposed to be in a safe haven, while they learn their ABC’s or Math, while their minds were being molded by their teachers on the wonders of new knowledge. Instead, they learned firsthand about violence. About one pysychopath’s reckless disregard of that we hold sacred… the precious lives taken much too soon.

The kids who survived would need all the help they can get to banish the ugly visions of the carnage. It was a nightmare that unfolded before their very eyes.

Imagine the horror of the parents who heard the news as they rushed to the school, praying that their kids were spared, that they would hug their kids again. Earlier that morning, they had kissed their children goodbye, after the usual breakfast rush.

Imagine the devastation for those who learned that they would not see their kids grow up. Our hearts bleed for them.

We have all shed tears upon hearing of this incident today. Those who were left behind will cry themselves to sleep tonight, and for many nights thereafter. The healing will be a difficult and lonely road.

We search for answers. We advocate for better gun control. We hope that no man, or woman, will ever feel the need to kill again.

Senseless. Tragic. Heart-breaking.











Sunday, November 4, 2012

My 15 Minutes of Fame



So this is how it feels.

When you've just published your first book, and just had your first write-up in the magazine about your book. When your hospital just posted humongous posters about the book-signing and you have to stand the scrutiny of people who look at your book picture and your current self. When these same people exclaim, "So, you're the author."

This is all new to me.

In my last book-signing, I got to meet strangers who were drawn by the idea of one of their own coming up with a book that mirror their experiences. I was an unknown entity with an exciting new product... a book about nurses. And if I may say so, my cover picture was the best image that I ever had (or will ever have). So to break the ice, I said, "Yes, that picture of me is from twenty years ago."

It is disconcerting to finally have all eyes directed at me. I am a little reluctant to accept the sudden attention, with the imaginary spotlight upon me. Have I given too much information? Have I bared my soul to the prying eyes of a hungry audience? Would they look at me and find me lacking of the magic that authors are supposed to have?

Suddenly I'm conscious of the need to stand straighter and I berated myself for not sticking with my diet and exercise plan. I have to act like I’m super-confident and that I’m not freaking out that some critic may just tear to pieces the book that I have poured my heart into.

A part of me just wants to lie low and just stay under the radar. If only books can sell themselves. If only I have the backing of a well-oiled machine who will do the promotion rounds for me.

Okay, the book will not sell enough to allow me to quit my day job. Unless I come up with incredible stories about a boy wizard in Hogwarts. Or maybe write about the thirty shades of silver. But it doesn't matter. I am just incredibly happy at the realization of my dream.

Then I shake my head, take a deep, calming breath, and psych myself up. I have dreamt of writing a book since childhood. Now that I am living La Vida Loca, I should savor the moment. So I laugh at myself for indulging in this melodrama.

And however how long it lasts, I should just enjoy the good times. This is probably my 15 minutes of fame and I can still stretch it just a little bit longer. The hype is nothing compared to what Hollywood stars go through. No paparazzi chasing me. Thank God for that.

These are exciting times. Book-signings. News articles. And a google search on "Nursing Vignettes" yielding many results. I just have to come out of my shell and enjoy and bask in the glory of these new experiences. I did ask for this. I have dared to write a book, so I better enjoy the ride.

And most of all, I thank God for making all of these possible. With all humility, I appreciate His gift and accept His blessings.



EXCERPT FROM THE ASIAN JOURNAL ARTICLE- ‘Nursing Vignettes’: Chronicles of a Compassionate Profession

http://www.asianjournal.com/aj-magazine/midweek-mgzn/17941-jocelyn-seses-nursing-vignettes-chronicles-of-a-compassionate-profession.html#disqus_thread



In her book Nursing Vignettes, Jocelyn C. Sese, MS, RN, CEN, talks about the heart and emotion that she deals with on a daily basis. At core of the intense experience of being a health care professional is a very relatable story of care, compassion, and a genuine concern for her patients.

A dream realized

Nursing Vignettes is a collection of the fascinating vignettes or snapshots of Jocelyn’s life as a nurse of 22 years in New York. It is a coming-of-age book that chronicles Jocelyn’s journey as a Filipino nurse in America.

She confessed that it is also the realization of her childhood dream to be published as an author. She was able to utilize her experience to drive home the point that nurses do make a difference in their patients’ lives.

“These short vignettes celebrate the tremendous impact of nurses on the patients they take care of,” she explains.

“Having been an educator for a long time, I wanted to change the perception of the general public about nurses – that we are not mere handmaidens to the physicians, and that we are autonomous and able to use critical thinking and skills to save patients’ lives.”



TOP OF THE WORLD





DON'T STOP BELIEVING



Saturday, October 20, 2012

Nursing Vignettes- (book excerpts)


Thank you to all who bought my book "Nursing Vignettes". It has been an incredible ride for me. I am humbled and delighted with the support from my hospital which had sponsored a book-signing for me. It felt surreal to have humongous posters of my book displayed in the hospital lobby, although I was quick to point out that the picture is about twenty years old.

"Nursing Vignettes: A Filipino Nurse in America" is a coming-of-age book that chronicles my journey as a Filipino nurse in America. It is a realization of my childhood dream to be published as an author. Thankfully, I was able to use my nursing experiences here in New York to drive home the point that nurses make a difference in their patients' lives.

These short vignettes celebrate the tremendous impact of nurses on the patients they take care of. Having been an educator for a long time, I wanted to change the perception of the general public about nurses- that we are not mere handmaidens to the physicians and that we are autonomous and able to use critical thinking and skills to save patients' lives.




"The bright lights of New York City beckoned. Across 8509 miles and 20-hours of turbulent plane ride. As a 22-year old, the world was my oyster. It was the promise of a fantastic adventure that had sustained me through five years of nursing school. I was more than ready for my many firsts."

"I heard singing from the dying patient's room. The male voice tried to hum a familiar melody, but the words were garbled, as if the singer could not get the words out."


"All the patients around us looked bewildered at the sight of nurses with tears in our eyes as we grinned and high-fived with Pedro. I said a silent prayer of thanks."

“'Woof!'. I am hallucinating. That couldn’t be a dog who just went through the revolving door of the ER and is now just outside my triage booth. No way!"



For every Filipino nurse who survived and thrived in this far-away land, there are countless memories that should be shared with others who would probably derive inspiration as they begin their own adventure. The untold stories would probably be familiar to several readers. I would like to imagine that nursing students can learn valuable lessons from the clinical vignettes that I have highlighted in the book.

I hope this book serves as an inspiration to all, Filipinos or not, nurses or not, that with hard work and determination, they can also realize their dreams here in distant lands.









Photos courtesy of M. Fister-Centorcelli- https://www.facebook.com/PhotographyByMargaretCentorcelli?ref=stream
I have used Margaret's photographs for this blog only. Wouldn't it be wonderful if our future projects would include her beautiful pictures?

"Nursing Vignettes: A Filipino Nurse in America"- available at Amazon.com

Friday, August 3, 2012

FIRST BOOK

I am so happy to announce that my FIRST BOOK is now available for purchase. Please share among your friends. This is not just for nursing or for Filipinos. This is for all of you with dreams in their hearts. This is my lifelong dream, finally realized.



http://www.amazon.com/Nursing-Vignettes-Jocelyn-Cerrudo-Sese/dp/1477614362/ref=sr_1_66?ie=UTF8&qid=1343996451&sr=8-66&keywords=tatay+jobo+elizes







Excerpt from my Introduction:

In 1980, as I lit the candle at my pinning ceremony, my heart was brimming with excitement for the future. In my imagination lived a nurse whose hands touched lives and whose compassion made a difference.

Nursing in America is a delightful journey into independence and self-fulfillment. As a young nurse living thousands of miles away from family, life was filled with challenges to both my personal and professional lives. Like countless other Filipino nurses working abroad, I have carved my own little niche in my chosen profession.

More than ever, I realize how fortunate I am to belong to a service profession that is most definitely and infinitesimally life-affirming and emotionally rewarding.

My life is enriched with the fascinating vignettes that gave meaning to the long hours and hard work.

I have lived my mother's dreams, which had become mine as well.

Here is my other dream, a book that chronicles some of those stories that make me proud to be a nurse. This is my journey as a Filipino nurse in America. But my stories of life as an ER nurse reflect what any other nurse had gone through.

We only need to believe in ourselves.

Dream some more.

Have faith.





Update: 8/11/2012

Yes, we've been #1 for several days now on the Amazon Hot New Releases chart.

Tuesday, July 31, 2012

Stronger



Her face bore the bruises that could not be hidden any much longer. The abuse had escalated.

A few months ago, her discolored arms were concealed underneath the long-sleeved tops; her face a picture of contentment and happiness. With beautiful twin daughters and a hunky young son, a thriving career, and a successful, seemingly loving husband, she was the antithesis of a battered woman.

Now, she sat in her chair, her back rigid, and her eyes closed as she waited for the detective to finish his conversation with the social worker. As I waited by the door to come in to her room, I noticed the rivulet of tears running down her battered face.

I asked myself, “How could I have missed the signs?”.

My friend is also a nurse. As if that is some sacred reason why her husband would not use her as his punching bag. As if being a successful professional shielded her from the volatile behavior of an abusive husband.

Thankfully, the EMS brought her to another hospital. Away from the prying eyes of our own ED staff. Away from those who will make their own judgment. I could hear it already, those accusations that her businessman husband could not possibly have done this, and somehow she had made this all happen to her.

Elizabeth opened her eyes, and grimaced in pain with the effort of smiling through her tears.

“Surprise!”. She was still the ER clown, always with the jokes, always laughing. She had the most beautiful smile with a laugh that rang free and uninhibited in the nurses' lounge.

Who would have thought that the carefree nature hid a troubled soul?

But here she is now, in an emergency room on the other side of town with a sprained wrist, a bruised face, and a broken heart.

Her husband was in a local jail, nursing a broken nose courtesy of a bat she wielded after he paused during the night of terror. After he punched his own 17-year old son who lunged at his father in defense of his mother.

The sight of her son writhing in pain was the last straw for Elizabeth. Finally, after years of abuse, she fought back.

The stories of torment came rushing out. I could only sit by my friend's side, listening in horror at the unimaginable experience she had gone through, and at the same time, unable to process the image of Elizabeth with the usual patient we get in our ER.

Just yesterday, we had such a patient, an immigrant from an Asian country. She was unable to stand up to her husband, bound by her custom of obedience, crippled by her financial dependence on the man who controlled the purse strings, and who hid her passport.

Elizabeth stayed with the patient long after her shift was over. But there was nothing extraordinary about that. My friend was a nurse's nurse who gave her all for every patient under her care. Her compassion to her patients was legendary, but now I understand the connection she felt with the battered women who come in fear.

When Elizabeth's parents came, they looked stunned at the unraveling of the family that they've upheld as the model one in their family. And when they saw their daughter, I saw the determination in both their faces to never ever let this happen again. Elizabeth and her children will be returning to her parents' home in California.


Five years later, as I was walking back to my car at work, I heard the familiar and unmistakable laughter.

Elizabeth ran to me and hugged me tight. With her now grown children smiling behind her, she looked extremely happy with no cares in the world.She was just visiting her brother in New York.

She smiled at my unspoken question and squeezed my hands. "I'm not with him anymore. We're divorced, and he has no part in our lives. He's living in another country now."

She beamed, "I am happy. I am strong. Thank you."



Sunday, July 8, 2012

LEIGH'S SYNDROME: A Day in the Pediatric ED

 

It was an EMS notification of a 2 year old in cardiac arrest that stopped us in our tracks. The Pediatric ED was unusually quiet that morning when the EMS call came. Our hearts did a collective thump when we got the call.  

Some of the adult ED nurses rushed to the Peds ED to help. The rest of the ED staff called their families to check on their kids.  

The resuscitation room was crowded with personnel, four nurses, three doctors and a respiratory therapist. All trying to change destiny.

This poor boy should not die, too soon, too young, I thought. Did he choke on something; does he have a congenital disease? Kids are not supposed to come in cardiac arrest.  

From what I could see from my vantage point, he had thick hair and long-lashed eyes. His eyes were thankfully closed.A beautiful Indian baby face. The EMS had already intubated him at home, scooped him up from his crib, and brought him to our hospital.  

One of the nurses kept his rhythm as he maintained a one-hand compression on the child's sternum. The senior pediatric nurse's face was wet with unchecked tears. The pediatric attending's brow was creased in concentration as he managed the resuscitation efforts. Another nurse was checking the Braslow tape to guide with the medication doses.  

The cardiac monitor showed asystole. The orders came rushing: Epinephrine, continue CPR, Sodium bicarb, warmer, saline bolus, anything.  

"He has Leigh's syndrome.". The resident informed the team after he got this information from the mother. Everyone's shoulders sagged with the news.  

Leigh's syndrome is a rare neurological disorder that progresses rapidly in mental and psychomotor abilities, and eventually respiratory failure. It is a death sentence, just like some of the other congenital diseases that are brought to the PEDS ED every day.  

The triage nurse had escorted the mother to the next room while the doctors and nurses worked on her baby. There was nothing to do, but just sit with her as she closed her eyes in prayer. Her hands were on her mouth, as if she was trying not to break into hysterical tears; clinging to the hope that her son will survive.  

I relieved the triage nurse from her vigil with the mother. Her bleak eyes glistened as she looked hopefully for any information about her son. I could only say, "They're still taking care of your son."  

The mother's sari looked big on her; she must have just grabbed whatever she could. Her husband was just on his way in. The charge nurse gave instructions for the taxi driver-husband to just park at the ambulance ramp immediately.  

Her soft voice was tinged with worry. "He was just seen by the doctor two days ago, and he was doing well. He was sleeping two hours ago. Then when I looked at him, he was not breathing at all"... her voice trailed away as she stifled a sob.  

Even in the face of certain death, the PEDS staff would not give up., but all their efforts were unsuccessful. It seemed so much longer but it was just thirty minutes. At the end, the baby was pronounced dead.  

After the doctor broke the news to the parents, the mother rushed to her son's bed. From the room, we heard the plaintive keening of a grieving mother. The mother’s cries tore into our hearts, and even the paramedics were dabbing their eyes. The sound of sorrow stays with you for a long time.  

"This breaks my heart every time.", the seasoned pediatric nurse told me.

"I'm glad you're here so that I don't have to be here.", I said to her. I was being truthful. Pediatrics had always scared me.  

Emergency nurses are supposed to be the tough guys, but in my opinion, the nurses from Pediatrics, Oncology, and the Hospice are the toughest of them all.  

And in our ER, there was no time to dwell on that heart-wrenching scene. Just an hour later, a febrile baby came in and was worked up for sepsis. She lived.  

Just a few hours later, five kids were pulled out from their burning house. The fire started in the kitchen, but thankfully, all the kids (siblings and cousins) were fine, especially after an enterprising social worker brought in some lollipops. No smoke inhalation, no skin burns.  

The Pediatric ED staff does an incredible job every day, and as the nurse said, "It’s never easy to lose a child, even when it’s not our own.”  



Leigh's disease is a rare inherited neurometabolic disorder that affects the central nervous system. This progressive disorder begins in infants between the ages of three months and two years. Rarely, it occurs in teenagers and adults. Leigh's disease can be caused by mutations in mitochondrial DNA or by deficiencies of an enzyme called pyruvate dehydrogenase.  

Symptoms of Leigh's disease usually progress rapidly. The earliest signs may be poor sucking ability,and the loss of head control and motor skills.These symptoms may be accompanied by loss of appetite, vomiting, irritability, continuous crying, and seizures. As the disorder progresses, symptoms may also include generalized weakness, lack of muscle tone, and episodes of lactic acidosis, which can lead to impairment of respiratory and kidney function.


http://www.ninds.nih.gov/disorders/leighsdisease/leighsdisease.htm

Saturday, May 5, 2012

Get Naked, Get Wet




"If you fail to prepare, be prepared to fail."- M. Spitz


Of all the things that I teach in my CBRNE class, this is what my students remember most. "Get Naked, Get Wet". It's not a rallying cry for indecency. Not that they're unnaturally preoccupied with nudity, but hey, that's just what might save you from that nerve agent.

The class is more popularly known as Bioterrorism. Actually, it's more than just smallpox rashes and anthrax ulcers; more than just donning and doffing the Haz-Mat suits. It's CBRNE- Chemical, Biological, Radiological, Nuclear, Explosives.

It's the sign of the times. Terrorism is alive and well. The terrorist attacks on 9/11 had shaken the collective consciousness of Americans. It ushered in a new era of fear; "the "mighty has fallen". We are vulnerable, and we must be prepared. The better-prepared the nursing work-force is, the better our chances are to mitigate the impact of disasters.

Unfortunately, most hospitals choose to bury their heads in the sand. In their mistaken notion that 9/11 would not happen again and that somehow the man who ran away with the missing vial of smallpox would not even know what to do with it. There is no urgency in training front-line workers in recognizing and responding to a CBRNE emergency. What a damn shame.

As I had written before, in September 11, 2001, I stood on the platform of a Manhattan-bound E train to spend my birthday morning at the bookstore cafe in World Trade Center. Just as the train was pulling into the station, something inexplicable gripped me. I turned around, crossed to the west-bound platform to the train back to home, to safety. Divine Providence.

I have taught CBRNE classes for about 13 years now; even before the World Trade Center attacks. I had gone to several emergency preparedness classes, even to faraway Alabama in a long-abandoned military barracks, just to be fully immersed in a full-scale disaster drills with 'disaster victims' in realistic moulage.



So, in all my classes, these are the highlights:

1. IF YOU SEE SOMETHING, SAY SOMETHING

The reminder is everywhere. The Metropolitan Transit Authority has even taken radio ads: "If you see a suspicious package or activity on the bus, on the train, or in the subway, don't keep it to yourself."

I preach Healthy suspicion without paranoia. Recognize when something is out of the ordinary. Be suspicious if patients flock to the ER with Flu-like symptoms in the middle of summer.

Dead birds outside your window? Don’t panic. Don’t imagine an apocalyptic scenario. The 3,000 red-winged blackbirds that dropped dead from the Arizona sky in January 1, 2011 were reportedly felled by trauma from the fireworks for the New Year's eve celebration. That's what the National Geographics wrote. Uh, okay.

2. S-I-N

I teach my students to sin. That they should not rush into action unless they know what they're getting into. Only fools rush in.

S-I-N: Safety first, Isolate the problem, and Notify the authorities.

Knowledge is power. But how can you protect yourself and the people around you if you cannot recognize that you are looking at a patient with descending paralysis from botulism toxicity. How can you effectively treat your patients when you yourself had succumbed to the nerve agent? How can you ring the alarm when you didn’t even recognize that something was so completely wrong?

3. ISOLATION FOR SMALLPOX, PLAGUE AND VIRAL HEMORRHAGIC FEVER (VHF)

Common presentation of fever, general malaise and body aches can fool even the most astute triage nurse. The index of suspicion should be raised with the following: synchronous formation of rashes that start in the face and extremities (smallpox), hemoptysis and rapid progression to acute respiratory failure (pneumonic plague), and bleeding (VHF). Thanks to those TV movies on Ebola, the public is aware of the devastating effects of the disease.

The most important take-away is that these diseases can be transmitted from person-to person. ISOLATE, ISOLATE, ISOLATE. Immediately.

4. PERSONAL PROTECTIVE EQUIPMENT (PPE)

In 1995, cult members in Japan released the nerve gas Sarin in the subway station. Twelve people died, but thousands more of the "worried well" rushed to the nearest hospital. Well-meaning nurses and doctors ran to meet the patients. No masks, no gloves, no gowns. Like soldiers running to the battlefield without guns. They did not S-I-N.



5. TRIAGE- THE GREATEST GOOD FOR THE GREATEST NUMBER

In normal times, the dying gets the most attention and the ED staff works hard just to prevent the patient from being another statistic. Disasters nullify what we hold dear in emergency nursing. Suddenly, the dying gets passed by. The limited resources demand that the rescuers spend time to those with reasonable chance of survival, whether they're young or old. It would be devastating to turn your back to somebody, but what can you do if your resources are scarce?



6. GET NAKED, GET WET

As slogans go, this one just makes everybody smile. The light-heartedness is just a defense mechanism for the sobering fact that nerve agents kill. Modesty be damned. Get those clothes off and get wet, right now.

Decontamination is the physical process of removing debris, harmful substances, and chemical agents from the skin, clothing, and other items. Knowing that the clothes and the exposed areas of the body get the most contamination, it makes sense to undress right away and flush the debris with water.

Do not worry about the water run-off if your decontamination chambers are not equipped with such. Let the water run off to the sewer. The alligators will just glow in the dark. Who cares?



At the end of the class, there's that photo opportunity of posing in that Haz-Mat suit complete with the hood and the powered-air-purifying respirator (PAPR). Cool!

Sunday, April 15, 2012

If Tomorrow Never Comes...




Placed third in the 81st Annual Writer's Digest Writing Competition

March 2011, New York

I heard singing from the dying patient's room. The male voice tried to hum a familiar melody, but the words were garbled, as if the singer could not get the words out.

Outside the door, one of the hospice nurses was talking in reverent tones to an elderly female. The patient’s mother sat at a chair; her face lined with unspoken grief. She clutched on her daughter’s wedding picture. I glimpsed at the image of a vibrant young woman in her wedding dress, her beautiful face caught by the camera as she basked in the adoring eyes of her equally vibrant husband.

The hospice unit occupied the left wing of the surgical floor in the community hospital. The atmosphere was somber, to reflect the inevitability of death in the unit. This is where terminal case patients spend their last moments on earth, in the company of their loved ones.

In this unit, death is a constant presence. Although an air of sadness permeated the unit, there is an undeniable sense that the staff in the unit feel that they belong.

The nurses, nurse practitioners, social workers, and the doctors in the hospice unit take pride in their work. The walls are dotted with plaques of appreciation from the patients’ families, a testament to the staff’s impact on the families left behind.

The big rooms accommodated a daybed, two comfortable chairs, a television set, a refrigerator and a microwave. The amenities would no longer benefit the patient, but have at least provided comfort for those who stayed vigil at the patient’s bed side.

Working as an adjunct faculty for the clinical rotation, I was assigned a group of 10 nursing students from the community nursing school. This was their last semester in nursing school, and so I wanted to give them a clinical experience that was fulfilling and inspirational.

Being assigned for one month at the hospice floor seemed like a daunting task, even for an emergency department nurse like me. I have seen a lot of deaths in my own inner-city ED, but somehow, I have protected myself from investing too much emotion. My armor was to shield myself from the constant reminders of man’s vulnerability and the helplessness and devastation that death and suffering bring front and center in the healthcare profession.

The hospice nurses provide an invaluable support for their patients and their families during these last days. They are like angels of mercy in a place where loss happens almost every day. I could not imagine being that strong.

Most of all, the hospice patients give us a lesson on fortitude and bravery every day. These men and women are courageous than I can ever hope to be. Because they face death in the face. And they live with it and die with it. They accept that the end is here and then they go, albeit unwillingly because of the family they leave behind, but at the end, they leave with dignity.

The nurse practitioner had given an inservice just an hour ago to my students. He reviewed Kubler-Ross' Five Stages of Grief. He admitted that their patients sometimes take a long time to reach the stage of acceptance. And when they do, the hospital staff would make their last days as comfortable as it possibly could be.

He was passionate in his work, and made my nurses tear up with his accounts of the memorable patients in his care. Somebody asked how he survived unscathed from the constant loss, he smiled sadly and said, “I take joy in knowing that my patients do not die alone.”

The nurse practitioner had informed us earlier that the cancer was detected during the patient’s pregnancy, but she held off chemotherapy until she delivered a baby girl just six months ago.

My student nurse looked distressed and her eyes were filling up with tears. She had requested that assignment, and knew from the primary nurse that the 35-year old patient with terminal ovarian CA would probably die that day.

I approached my student in order to pull her out from the assignment. I was afraid that it would be traumatic for her to witness her first patient death at this point. And besides, we always want to provide utmost privacy to the hospice patients and their family. In the throes of grief, they would not want strangers to hover around and intrude on their loss.

The singing stopped. And a male voice called for the nurse.

It was the patient's husband. He looked much older than his 40 years. His eyes were red-rimmed; he looked exhausted and defeated.

He asked, "Can anyone sing this song? It's her request, but I just couldn't." His lips trembled as he proffered a crumpled sheet of tear-stained paper towards the nurse.

It's the song lyrics for the song "If Tomorrow Never Comes" by Garth Brooks. It was also recently covered by Ronan Keating. It’s a song that I know very well.

The primary nurse shook her head; both her and my student nurse, who is a recent immigrant to America, didn't know the song.

The husband turned to me, and plaintively said, "Please, it's our song". It was obvious to everyone that the request was not made in jest.

The patient's thin face still bore the proof of her beauty despite her ashen color. The morphine eased the pain, and her glassy eyes turned intense for a moment as she kissed her husband's hand. My heart broke as she sweetly smiled and softly said, "Please."

I have an ordinary, sometimes pitchy, voice, and I could not even have imagined I would find myself in such an unusual situation. I was reluctant at first but then I realized that all that mattered for this couple is to hear the song again, for the last time.


If tomorrow never comes
Will she know how much I loved her
Did I try in every way to show her every day
That she’s my only one

And if my time on earth were through
And she must face the world without me
Is the love I gave her in the past
Gonna be enough to last
If tomorrow never comes






And so I ended up singing a song a capella to the dying woman, as her husband of five years held her hands. The patient’s lips twitched, as if she was trying to sing along.

It was an honor and a privilege to be a part of something so poignant and so powerful… to sing a wonderful song that meant so much to them. It was a herculean effort not to sob uncontrollably in the midst of all the misery. But what had helped was the thought that the couple was listening intently to the lyrics of the song.

While I was singing, I thought of the couple’s shattered dreams, of their lost hope, and the inevitable loss. But looking at them, I realized that this husband and wife had come to terms to the wife’s eventual passing.

However they had arrived at this acceptance, it was evident that they chose to savor every last moment that they were still together. There will be grief, there will be difficult moments ahead, but there was also a feeling of gratitude for having loved each other.

The patient’s elderly mother sat at the other side as she stroke her daughter’s hair in a gentle caress. She looked resigned to the fact that her daughter would be going before her. The husband continued humming the song long after I finished.

Just as I was leaving, the wife tried to raise her hand to me. She was weak and could only muster a light squeeze to thank me. I smiled through unshed tears and acknowledged her thanks, thinking that I should be the one thanking her.

It was a poignant but peaceful moment. I believe that the song comforted them, that it assured both the husband and wife in the knowledge that the love they shared had manifested its presence when it mattered the most. Its meaning transcended the obvious; it had somehow reassured the couple that although their tomorrows together will not come, they will be joined in eternity.

The patient held on until the rest of the family came. One last time. Another chance to hug each other. One long hug to keep in their hearts.

According to her primary nurse, the patient kissed the sleeping baby that she would be leaving behind. The baby was smiling in her sleep, oblivious to the sadness around her. But she will be loved and cared for; she is her mother's legacy.

The inevitable could not be delayed any longer. The patient died later that afternoon.

The student nurse thanked me for letting her share in that heart-wrenching but valuable experience. I was grateful that I have given the husband and wife a chance to listen to the song again.

In our post-conference meeting, I reminded my students to learn from the song. In the patient’s death, an important life lesson emerged. We should hold tightly on what we hold dear and live life to the fullest.

If tomorrow never comes… we should try every way, every day to show our loved ones how much we love them. We should seize the moment.



Watching a peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever.
~Elisabeth K├╝bler-Ross









Friday, April 6, 2012

UH-OH!




It's that moment in time when you realize that you made a mistake. That particular instance when you just close your eyes, hold your breath, and hope that it would not be as bad as it looks right now.


It feels like air just popped out of the balloon and ... then you feel like as if your heart dropped to your knees. Time stood still and you are caught inside the Time Travel machine that's teetering precariously on the side of the cliff. Or like when you're on a run-away roller-coaster and you just know there's a steep drop at the end.


It could also be when you find yourself in an awkward situation, and all you can do is hope that you don't get hit by an errant fist.

It's that particular instance when you just mutter a curse under your breath, and just wish that you ignored that annoying alarm clock and just slept through it all.

It's an" Uh-Oh" moment... synonymous to "Ooops", "Oh, No", "OMG", and in a more direct-to-the-point colloquial "Patay kang bata ka".





"Sige na, Day". "Sige na" Loosely translated, it means "So long" "Arrividerci", "Adios".
"Day" is a common Cebuano nickname. Totally harmless?

A patient's family member tearfully approached the Nursing Station and asked the Head Nurse, "I thought my mom is doing well but I keep on hearing the nurses say that she is going to die."

At that point, the outgoing nurse waved at the her friend and cheerfully (and loudly) said, "Sige na , Day"
Uh-oh!







The female accident patient lay strapped on the backboard with a cervical collar. The nurse cuts the patient's winter coat and the down feathers flew into the air around the Trauma Room.

The feathers getting into our faces and hair, into little crevices, nooks, and crannies. Into the Trauma Chief's nose as he glared at you but could not take out the offending feather because he was all gloved up.


Uh-oh!






It was change of shift at the Trauma Room, and the in-coming nurse just couldn't tolerate a messy room. She threw out a yellow basin filled with dirty pads that was sitting on the stretcher. The housekeeping guy followed after to empty the garbage.

Then the triage nurse came back to the room to finish her documentation. Suddenly, she sat straight up in her chair and screamed, "The finger! Where is the finger?"

The patient 's index finger was accidentally amputated - man vs. meat grinder- and the moist-gauze soaked finger in a bag of ice that EMS had deposited on the patient's stretcher was nowhere to be found. That finger is supposed to be reunited to the patient via microvascular reimplantation. That is, if they could find the finger.

Two nurses bolted out of the room running after the housekeeper.

Uh-oh!

Thankfully, the finger was found after the second garbage search.




The patient's visitor was obviously his gay lover. The patient presented with severe chest pains after "an extremely long aerobic exercise".
Another nurse brought in a female visitor.
"You have another visitor, sir. " The nurse turned to the visitor, "Are you his sister?"
"No, I'm his wife. And who is this man holding my husband's hand?"
Uh-oh!









The four-year old girl broke into a smile when she saw the glove balloon that a nurse's aide made for her. Her mother came in with abdominal pains, but did not have anyone to watch the child. The father was just on his way to the hospital. The nurse's aide was assigned to watch the child until then.


The string of the balloon flew away, and before the obese nurse aide could get up from her chair, Baby Jessica started to chase after the flying balloon. Off she went in-between the double-parked stretchers in the hallway, barely missing bumping into anything, or being squashed by a passing stretcher.


Uh-oh!




http://nurses.definitelyfilipino.com/index.php/2012/04/uh-oh/

Saturday, February 18, 2012

A Date with Mr. Smith

I had a date with Mr. Smith today. But he would not be going anywhere.

Mr. Smith laid on the bed surrounded by his nurses. The Normal Saline IV on his left arm was just to keep the vein open. His eyes stared unseeingly but his eyes blinked. A thin sheen of moisture on his waxy face suggested diaphoresis. The nurse looked at the cardiac monitor and her face showed concern at the tachycardia and the hypotension.

“His radial pulse is bounding. Heart rate is 126, BP 90/70″, she reported to the other nurses at the bedside.

Mr. Smith’s lips did not move but a disembodied voice startled the other nurse who was listening at his lungs. He said, “ It feels like an elephant is sitting on my chest”.

Nurse 1 changed Mr. Smith’s nasal cannula to a 100% non-rebreather mask to raise his oxygen saturation from the 92% displayed on the cardiac monitor. She raised the head of the bed and asked the patient care technician to do a stat EKG. The nurse looked around and caught my eyes. I knew what she wanted so I reassured her that I called for the doctor already.

Nurse 2 reported that he heard rales 1/3 up bilaterally. Both nurses exchanged a worried look. The outgoing nurse tried to finish her report. “Mr. Smith just came to the ED one hour ago complaining of shortness of breath for several days exacerbated by walking up the stairs. This morning, he woke up feeling he was drowning with his secretions. Chest x-ray showed bilateral pneumonia. We got him his Lasix 40 mg already.”

The foley catheter bag on the side of the bed was draining with 300 ml of amber-colored urine. Lasix urine, I thought.

Nurse 1 said, “Uh-oh, his BP is going down. Where’s the doctor ?”.

The patient stopped talking. Nurse 1 darted a look behind her at the unexpected turn of events. “Mr. Smith, are you okay?” . The cardiac monitor displayed ventricular fibrillation. There was just a second hesitation when the nurses processed what they were seeing on the machine, but soon their ACLS training went into gear.

Nurse 2 felt for the carotid pulse. “No pulse”. The outgoing nurse stopped her report, and started her compressions. But she had to stop for a few seconds as she grabbed a stepstool from the other side of the room.

There was a slight tremor in the Nurse 2′s voice but he pulled himself together and, after making sure that everyone cleared off the patient, quickly delivered a defibrillation shock on the patient. He reported later that it felt empowering to press on the paddles and deliver the shock that his patient needed.

“Still no pulse”. The other two nurses resumed CPR; one nurse doing compression on Mr. Smith, while the other nurse pushed air through the ambubag. Thirty compressions, two breaths.

The doctor came in and the first nurse gave a quick report. Dr. Morris had not even given the order yet, but the nurse handed her an Epinephrine, clearly anticipating the first drug on the ACLS algorithm. Dr. Morris was a second-year ED resident and this is her first code. The attending physician was busy with another code in the other room.

Dr. Morris took a deep breath, but she knew that the other nurses had worked in the ED for a long time. The code continued with the veteran nurses basically suggesting the next step to the doctor who just happily agreed with all their suggestions.

The patient was their focus and the team members worked as hard as they’ve always done. After the initial confusion, the team had settled down and continued with the ventricular fibrillation algorithm.

After another cycle of defibrillation, compressions, and drugs, a pulse check revealed a strong pulse. The cardiac monitor showed Normal Sinus Rhythm. The blood pressure was still low, so upon the nurse’s suggestion, Dr. Morris ordered a Dopamine drip.

Mr. Smith opened his eyes and spoke again, “Hello there”. Everybody smiled. And applauded that they survived Simulation.




End of Simulation. Start of Debriefing.

I stepped behind the one-way mirror of the control room. My students stood around Mr. Smith in the room that was outfitted like a state-of-the-art ED room. I led the group into the Debriefing Room.

That was my date with Mr. Smith. He’s our new hi-fidelity human patient simulator, our newest toy in nursing education.

Mr. Smith is the high-fidelity sim-manikin that we’re using in my hospital. He can pretty much do anything else, well, almost anything. He’s an interactive manikin specifically designed for training in anesthesia, respiratory and critical care. He is capable of realistic physiologic responses, including respiration, pulses, heart sounds, breath sounds, urinary output, and pupil reaction.

Simulation training in nursing education had established itself as an effective teaching strategy. It allows the students to be involved in patient care experiences, with the use of simulation manikins, where they can practice clinical skills and demonstrate their critical thinking abilities in a safe environment. Simulation learning also permits learning team work and good communication among the different disciplines who are involved in patient care.

The Debriefing is where we reflect on the just-concluded simulated case scenario. The students reflect on their feelings, and their performance during the scenario. I reviewed with them key points in the scenario, putting emphasis on successful performance of expected skills.

The nurses enjoyed their first date with Mr. Smith. I told them that we will be introducing more case scenarios with Mr. Smith. COOL.




http://www.meti.com/products_ps_hps.htm
Key Features:
1. Pupils that automatically dilate and constrict in response to light
2. Thumb twitch in response to a peripheral nerve stimulator
3. Automatic recognition and response to administered drugs and drug dosages
4. Variable lung compliance and airways resistance
5. Automatic response to needle decompression of a tension pneumothorax, chest tube drainage and pericardiocentesis
6. Automatic control of urine output