BlueFabian on Xanga

life is a flower

Saturday, 14 November 2009

the road that lies ahead

Ever since Facebook became an activity of mine, Xanga has undeniably taken a back seat on my ride. Can't help it. It's easier to type a few words and gather tons of comments and responses than to make a lengthy entry that taken 2-3 views, if you are lucky. There used to be a lot of subscribers and people whom I subscribed to which were fun to read and interact with. They have since ceased to exist in xanga-dom.

But, I shall not leave this ship. Even it is sinking. Worst that I can do is strap on my scuba gear - buayancy compensator on, regulator on my mouth, fins on, tanks open - and float or swim my way through the waters when that time comes. In the mean while, I am enjoying this cruise voyage.

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Of my present life...

I am still doing part time as an ER nurse in my old hospital. 12 hours shift seems to be very long anywhere I am/was working, more so when things got so busy. I can attest that there were times when I was only to work one day after a 3 days hiatus and yes, I dreaded coming to work. I gave a long and deep thought whether staying in clinical field is something that I can see doing for a long time. Would love to gain more experience but doing so here, in Kuching is not as beneficial as it can be. In the end, I will just be wasting my years, having a miniscule salary upheaval per year. Of course I said money is not everything - but, I am not interested in selling my soul to the devil either.

Oh yeah, I just went through my 'mock teaching' interview in UiTM. Somebody called me up a day before the event, told me that I need to prepare a presentation. And I was just done with my night duty. Less than a day to get something done. I just had my sleep and then dig out my old presentation from many years back - altered a few things. Spent the whole night reading on my topic even. By far, the most troublesome interview I had.

On the day itself, I was interviewed by someone from the English department, the Dean and somebody from the nursing faculty. Overall I think I did OK. But no high hopes for me as I am not even sure if this is the path that I am going into. Teaching? In a university environment? Am I qualified enough for the job? Am I experienced enough? Most importantly, will I love it?

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Christmas is coming soon. I am happy to be here to celebrate it.

Wednesday, 04 November 2009

ER blues - 3rd November 2009

The day was hecticly busy in the ER yesterday. And as predicted, my partner for the day was really late into coming to work - showing her face at about 2pm, just about time when the main chaos of the day had erupted. I was the only ER nurse there (and I am a part-timer), being assisted by two clinic nurses who may as well ran out of the unit when their service is needed. As messy as it sounds, it actually went well. I had no qualms nor do I got stressed over the flooding of patients and procedures to be attended. Except the doctor, my other partner of the day took the thing as really a work that needs to be done. Really, I have no idea why some people are obssessed with making things fast - when it's not even an urgency. And hello - understaffing. At least these times, I can see that the vitals have been entered into the triage form.

Truth to be told, everything was handled well. Not perfect but can be said as above the mark.

What are the other highlights of the day? Too many actually, but these are the memorable ones-

1. The ECG (electrocardiogram) paper had ran out. I looked all over the place and there were none!!! How can these people missed this. I am a part timer, I don't involve with stocks and indenting. So I ran up to the angiogram room and asked the Unit Manager if there's a spare of if I can take the machine from the Special Diagnostic/Stress Test lab. He said, the paper needs to be ordered from the Purchasing department. I asked him to do that pronto. So, I went down and told the next patient to wait until the paper arrives.

Truth to be said, I did print out more than one copy per patient. I mean, I MUST BE SCEPTICAL if a Myocardial Infarction suddenly changed to Normal Sinus Rhythm on the next one. This are matters of the heart, I must take this seriously. Cost is another thing. Human lives are more precious. Rechecking doesn't hurt anything other than money.

2. Too many people are taking influenza shots these days. I even encountered a patient who wanted three shots at a time - Hemophilus Influenza B, H1N1 strain and pnemococcal. One patient said that the rainy season is coming in and thus the need for the shot. Well, it's not winter. My take - people are just too worried about this. Personally, I am not a fan of short lived vaccination that had not showed justifiable proof of immunity. And it's a virus - they'll mutate. Soon enough, there is a need for another vaccine when a new strain came up.

3. Attended on my on a patient who had a cut on the eyebrow from his coming in to the unit, until he is admitted for an operation. Understaffing, what can I say? Established his line, took bloods, prepared all the tests done and off he went on the wheelchair. In times like these, it is no wonder sometimes how ER nurses can be one of those that can really worked independently. We just have to. No choice. With four patients on each bed, even a one-to-one ratio is impossible. That day for example - I attended to three patients at one go. And I have to leave them in between to attend to other outpatient cases that came in.

4. Another male catheterization procedure - which I don't really like doing actually. At first it's fun when you are the only one that is allowed to do that. Now, it's more of an automatic responsibility. There might be another female nurse there, but it will be ackward asking them to do it. And of cos on part of the patient. Of course male prefers to be attended by a male when it comes to this part.

5. Most memorable event of the day - assisting the physician with a chest drain for a pleural effusion case. Left side of the lung is notably visible on the chest xray - even us nurses can note that. It's amazing sometimes, how a simple complain of breathing difficulty or shortness of breath can turn as severe as lung fluid accumulation. Respiration rate don't tell much, so does the oxygen saturation which stood at 96%. Remarkable to think that one complain can be traced to so many things, and the doctor have to be really sharp in figuring which is which.

Anyway, I've assisted once in a chest tube insertion - but it has been a long time. Some principle is the same, but the application is different. The physician wanted to use a supra pubic catheter for this - rather unusual for me because they either uses a dedicated tube (with a steel trocar) connected to a chest drain. So it was really exciting because it's new and more invasive than our usual procedure. Both of me and my friend decided to help the doctor during the time - intentionally leaving the ER without any nurse!!! Ha, ha... Why? It's an exciting thing to see and there's no patient around at the time. Well, there were some - one waiting for the orthopaedic surgeon to see him in the ER. We both knew that the surgeon will shout and scold us when he is around and there's nobody to assist him, yet we took the risk. One of us will come out anyway if that's really the case. But luckily, he came and went out - us spared from the usual wrath.

Well, I became the main assisting nurse. Tada! And honestly, I have never really assisted in this kind of procedure before. What really made me confident of being in front of the doctor was nothing more than a recollection from what I did in the ATLS (Advanced Trauma Life Support) class when I was in Saudi. Application and technique different but the aim is the same. With that in mind, I assembled all the tools, syringes, anaesthetics and collection container beforehand. And remarkably, most came out correct. Ha, ha.. Never ever underestimate the usefulness of a three days class - even if you were an observer.

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Now, I am eager to assist in a central line insertion via guide wire again. Has not been doing that ever since I quit dialysis. Saw that we actually have a few sets there in the ER (here, I was told it is usually done in ICU), but never seen them being used.

Oh! Night duty again. Unlike day time, I don't like to experience drama in the middle of the night. Let it be peaceful today and tomorrow!!!

Monday, 02 November 2009

ER blues - 2nd November 2009

Life at work has been interesting lately. In mean in the ER, anything and so much can happen in a day. Since that I am spending most of my time there in the mean while, I can't help but to blog all about the nonsense and memorable moments there.

Act 1
Some guy came to the registration counter telling us that his worker/friend needs to have his leg 'antiseptically' cared for. I listened and had my ears all up to the story despite having something else to be done then. At first I was annoyed with this 'self diagnosis doctor' - coming up with a medical intervention before even being seen by a real doctor!!! And telling us what to do and how to do it!

After asking him to gave us the IC, we told him to sit in the waiting bench until being called upon. At times he did came up to the counter again and again, maybe wanting to be served pronto (and he is not the one being sick!). But I ignored him since the name had not been entered into the system and there were hoards of other people around. I need to organize my priorities. His (actually, his worker's) is equally important but not life-altering urgent. He can still wait.

When I got my act together, I called upon the worker to sit on the examination bench to have his blood pressure, pulse rate, temperature and some history taking being done. Then, this historic dialogue took place.

Man : No need to do this! The pain is in the leg!!!

Me     : (being annoyed already) It's OK. This is what we do when a patient came in. We need to have his vitals signs taken.

Man   : THIS IS USELESS!!! (Obviously, a snobbish, know-it-all is in the radar). If the pain is in the leg, YOU TREAT THE LEG!!! WHY DO YOU HAVE TO DO THIS?

Me     : I need to do this because we it enables us to get a baseline of how his condition is. The doctor which will be seeing him after this will examine him and recommend further intervention.

Man : BLA, BLA, BLA, BLA.......... USELESS!!!..... BLA, BLA, BLA...

Honestly, I was burning inside and ready to have an eruption there and then. I know who I am and what I do. Being a part-timer, I don't have the liability to hold my patience and even if I talk back at him - the least that the hospital can do is not to get my service again. Which, I don't mind. I am not dependent on this place for a living. I am just here to pass some time and to refresh some of the skills long forgotten.

But I didn't. The real patient, who was the actual sick person, had been so nice. I was thinking that, if I did what I wanted to do, all that will suffer most from this stupidity is him. And I sympathise on his behalf. Plus, the unit and the hospital might be in trouble with the commotion - it's bad to bite the hand that feeds you (well, so to speak). So... I kept quiet and decided not to talk at all with the cocky man. Instead, I proceed with interviewing the patient and ignored the presence of that ass beside me. When I was done, I asked them to wait until the name is being called.

I tried to cool down and went back to the registration counter, trying to get other things done. Then the doctor of the morning ask me pulak this question "What is the problem with the patient? He wants to do dressing, he wants to see doctor or what?"

Well, of course he's here for treatment!!! How can he do a dressing without even knowing what kind of injury or the extent of it. I was further annoyed with this lame questionaire and I just said "I don't know".

To make matters worse, the Unit Manager was there. Directly infront of me when the shouting took place and he did NOTHING. Not then, and not later. Not even coming to calm the man. Not even there to soothe me (I am a strong nurse OK. At least give me some moral support).

I am really amazed how people can be so rude for really lame reason.

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Act 2
We all were very busy with the procedures and patients coming from everywhere. To the extent that we (the nurses) had little time to properly attend the outpatients that came in.

After a while, when things settled down - I came to the registration counter to finish anything that was not done. Then I saw the triage form.

There were no vitals taken, no report at all from the nursing column. Yet, the back page column for the doctor's note were nicely written.

I really found this to be unacceptable. No matter what - vitals for the patient must be taken. Yes, the nurses are busy - we can't help it. We are understaffed and overworked. But there cannot be an excuse for a shortcut. Vitals signs is the most basic and important.

I can't understand the need to do things so fast. It's not like we can go back faster if things finish up earlier. Worst comes to worst, ask the care assistant to do that for you. They know how to do this and have been doing this when we are busy. Or if that is also not possible - DO IT YOURSELF. I know some doctors did this. We do not request you to do this on our part, we were just not there at the moment.

Or, just wait until somebody is free to do that. It's not life threatening right? The patient can wait.

There's no way I'm gonna lay my signature on the 'Attending nurse' part with all this nonsense. But I did anyway. But I wrote this: 'the vitals were not taken as the doctor had seen the patient even before the nurse had the chance to attend to them first'. Fairy tale as it sounds, I actually did wrote that out.

No way am I gonna put some imaginary figures or numbers and wrote something I dunno of - when it didn't happen.

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Act 3
My colleague and I were moving a patient from the trolley up to the CT scan table. Actually I was not bothered to help but thinking that she was heavy - I was sure they WILL WANT MY HELP. So there I was grabbing the bedsheet and pulling her into place. As we were just barely done, there was this noise shouting in

" WHY IS THERE NO NURSE?! WHY ARE ALL THE NURSES HERE?! THERE SHOULD BE SOMEBODY WITH ME NOW! I WANT A NURSE WITH ME!!!"

The hell? A bit shocked I was but not totally surprised since this particular specialist is notorious for this behaviour... we don't really care at all.

So, I offered myself to be HIS NURSE (oh, how holy thou duty!). Went around to help him collect some wound culture, did the dressing and even establishing a line for the antibiotic administration. An old man with fragile veins some more. So many tasks, all alone and within minutes. It's a norm here - it's not amusing.

By the way I cannot help to feel funny with this particulat dialogue between the specialist and the patient's relative.

Relative   : Wah doctor! You look fatter and bigger now hah?

(The hell? This is so not the type of conversation with this kind of people!)

Specialist : It's been a while. I remember seeing you two years ago. A lot has changed you know

Yeah right!

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I have another day shift tomorrow. Yet, even before it even began - troubles and mischeifs had started to show it's shine. A friend had changed duty with me because she is tired working 5 days straight (can't blame her - it's a 12 hours duty - in ER!!!) and requested me to do it for her. Then later in the day, the friend who is supposed to work with me tomorrow had requested that I work for her instead. Which is impossible because I had agreed to the very request on the very same shift earlier on.

Now, she called in to say that she is having trouble to come tomorrow since something really shitty just happened. Now she is desperately looking for people to replace her. Yet people either don't pick up the phone or are just not available to spare. I told her this anyway:

"I can work even if I am alone. Man, women, child... I can do them all. But, I will not try to speed up my work. If there is so many dressings to do, I'll do them but it will be one by one. Lantaklah the patient bising or doctor marah - there's only one nurse".

BTW, there really are only two nurses working per shift in that place. Tomorrow - maybe one.

Ha, ha, ha... if it is not for my experience in this crazy field - I would never be able to be so cool.

Sunday, 25 October 2009

sun scarred

My face, my back and my arms are itchy and tingling right now after being sunburnt on my last afternoon swimming pool outing. It was about 2pm, and I was the only person in the place. What can you say: it's a Friday. The sun was not on full power, it was bright but not as scorching as a midday heat. And there I was, only with my trunks and gleefully gliding away through the waters.

Actually, I am aware that you can still get sunburn even when you are under the water (say - snorkelling) because the light will be able to hit your skin anyway. And... the heat and intensity of the sun have little bearing on the its burning power. Light is light no matter what.

I am OK with this surprisingly. I can bear the discomfort maybe because I have been used with all these when I started diving months ago. My skin however is playing topsy turvy with it now being slightly darkened. It was just two months back that I thought I will be a bit black from then on. But somehow, it managed to be peachy and snow -whitey clear again. Seems like I will be having a roller coaster with my skin colour from time to time.

Wednesday, 21 October 2009

laxed and loaded on a tight schedule

I have abandoned my affair with sloth months ago after deciding to sell of my PS3 to a friend and leaving the game discs at my brother's home. Apart from the computer and the net, there is nothing else that I took away my attention as much and as stationary. These days, I am pretty much an outdoor person. And believe it or not, my hobbies - those that I am maintaining at a steady pace is quite.. a lot.

1. SCUBA DIVING
Frequency: Almost every weekend if I could. Visibility and monsoon plays wreck to my diving days here since the sea is 1,000,000 X much, much, much tougher and unforgiving here in Kuching. It's been a month that I've been a landlubber ever since my last dive (which was awesome). But if I could, I go everytime. Being a landlubber kills me so I might be looking into river diving or expanding my divers group to diversify my options.

2. SWIMMING
Frequency: many times per week, everytime on my off days. This is mostly to relieve my longing of the sea and that feeling being underwater, though it's hardly replicated. The deepest pool tops at 4 metres and that has been discouraging me to practice my dive there. It takes a long time to finish a full tank at that depth. The best part is, after being in and on the water for a while, it became second nature and you'll feel as comfortable as on land. A good practice before heading out.

3. PHOTOGRAPHY
Frequency: Hard to say, I take snaps when I saw a good subject. With my phone or with two of my cameras. It depends on the situation, subject availability and mood. I am in the midst of purchasing another compact with an underwater housing for my diving adventures. So, taking snaps is something I am doing both on land and underwater. For most part, I love landscapes. I love taking pictures of mountain range, skies especially, and buildings. For unknown reasons - I dislike potraits and people, except my own that is. If I were to invest in a lens, wide angle would be it.

4. CYCLING
Frequency: Evenings, when I am not working. I just bought a bike for the main purpose of exercising my calf muscles to better handle the currents underwater (and to make them stronger and less prone to cramps). In addition to improving my cardiovascular fitness, and improving my lung function. No secret it's all diving related. But, cycling is something that I consider as a cheap, fun and fast alternative to recreation when I feel the need for it. I do have plans to carry the bike in my car and drive to a park or some housing (with great lanes), before making my way around the place. I might just brought it along to the village next time and cycle my way to the garden next time. If the traffic around Kuching is not hectic - I'll cycle my way to work. But I'm not gonna kill myself on the road.

5. CLUBBING
Frequency: fortnightly. No hanky panky, no boozing around - I am there just for the dance. In fact I usually ordered the drink more as an entrance fee since I have no desire to celebrate with liquor anyway. Just not my thing. Never have I in the history of clubbing finish a drink off. But there's a rule to it - If I am to dive the next day, clubbing is off limits. Need to be sober underwater

And this is just a small list of the main things I do on my free time.Would you believe it if I say that I am maintaining all these hobbies persistently even with my semi hectic work schedule? Yes people, if you can divide your time well, you can do everything.

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BlueFabian

- Name: Fabian
- Metro:
- Birthday: 4/26/1981
- Gender: Male
- Member Since: 1/21/2006

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Interests: Being curious and jovial, thinking of small little things that matter, finding the answer to life's simple queries and living my time in this heaven of mine
Occupation: Nurse