Mall Hopping in Dubai

 

 

 

 

 

 

 

My friends and I went to Dubai for some mall hopping yesterday.

Life is just so good. That’s all I can say.

(First Pic: IKEA Dubai, 2nd Pic: Festival Mall, 3rd Pic: Deira City Mall with Roger, Karen, and Ate Beth)

A Nurse’s Pockets

3am. Night Shift. Patients are sleeping. Charts reviewed. Documentations done. Extra duties performed.

Here’s to list down what’s inside my pockets right now. Just to keep me awake, otherwise, I’ll doze off.

1. a multicolored pen – I use three different pen colors on my endorsement sheets.
2. a yellow highlighter – This is to highlight the important tasks in my endorsement sheets.
3. a penlight – to check pupils in neuro patients and also to use as a light when entering patients’ rooms when patients don’t want to be disturbed by opening the lights.
4. my hospital ID clipped on the pocket – of course.
5. a pair of scissors – very dependable, should not go out on duty without.
6. 6 gauge 23 disposable needles – I need this to put an air vent when IV medications in glass bottles don’t infuse well.
7. my folded endorsement sheet – I might go crazy if I loose this while on duty.
8. my wallet – just in case I need money
9. my cellphone – somebody might call me
10. a hanky – to clean my oily face in the later part of the shift.
11. medication trolley key – each nurse has their own key
12. disaster pager – tonight I was the one assigned to hold the pager
13. 2 3-cc syringe – to aspirate normal saline for flushing IVs
14. 1 normal saline plastic ampule – for flushing tubings before administering IV medications
15. micropore tape – always needed
16. my USB flash drive – co I could copy a document quickly
17. my pocket notebook – where I write step-by-step procedures, and phone numbers
18. a couple of alcohol swabs – to wipe vials, tubing ports
19. 2 tape removing swabs – used when removing tapes of infiltrated cannulas
20. some blank stickers – to label tubings
21. some garbage – caps of needles, and tubings

That’s all folks.

The stethoscope is on my neck, not on my pockets, just in case you’re looking for it…

Chaotic Night

Last night was a chaotic night shift. It was my test of patience, endurance and flexibility.

 

The night started really busy. There was a plan to do a major round of the whole unit, but then it did not happen because we could not manage to do that.

 

I was initially given a patient on Patient-controlled Analgesia (PCA) machine. But one of my colleagues objected on me having the patient because I was still new and have not done the competency test required. She was right and I agree with her. A few shifts ago, I received a patient from the operating room already on PCA, and nobody cared if I it was alright for me to take care of the patient. I was able to manage the patient though, because PCA is not new to me. I have handled PCA patients in my previous hospitals. But the policies and procedures just differ a bit from hospital to hospital so I really have to be knowledgeable on how they do it here in this hospital.

 

Well, at least somebody cared that evening, and took that patient from me. I got an exchange for a new patient, who sounded toxic in the endorsement, but I realized later he was not that bad after all.

 

My colleague who took the PCA patient started to become busy with that patient because there was something wrong in the orders and that some policies were violated. She needed to make phone calls, attend to the anesthesia doctor, etc etc. Her other patients kept calling, and so out of courtesy, I attended to them. One case was a major overhaul, after the patient passed bowel motion on the bed, and messed up himself and the whole bed. I had to clean him up, and change his gowns, diapers and linens. I stayed there almost half an hour.

 

After that patient, I saw one of my patient’s door lights on, meaning, he also needed a nurse to attend to him. I was on my way there when I was interrupted by one of the sitters from another room. He told me he needed a nurse urgently. When I got into the room, I saw the patient on the bed messed up with lots of blood. By assessment, I found out he was bleeding from the rectum. He was like swimming in his own pool of blood on his bed.

 

I called for help, and the nurse who’s in charge with the patient came in. To cut the story short, we got busy with that patient who was later pushed to ICU around 11pm.

 

Only then I was able to attend to my own patients. My patient who called earlier was, of course, disappointed that I have to come in late for him. He also needs to open his bowels, and he can only do that on a bed pan because he is on complete bed rest. I apologized for my delay and explained the reason. But of course, whatever the reason may be, I still placed him in a very uncomfortable situation.

 

After I attended to his needs, I started checking my other patients. I had six that night. All of them had the same lines “Wen Inta?”(Where were you?). I had to explain to each of them why I had to see them late. I was in a very uncomfortable position. I knew it was not right to see them late but what can I do? I had to help a co-nurse who had a critical patient.

 

My medications were running late, and some other things were not yet done. I tried to finish all of them slowly but surely.

 

I had to mention that while we were running back and forth because of the bleeding patient earlier, there was this one patient of mine who kept irritating me by coming many times to the station just to ask for a tv remote control. I had to explain to him several times that I was still attending to a critical patient, and that he needs to wait.

 

If the remote was just as easy as picking it up and handing it to him, it could have been alright. But I will need to search all empty rooms to do that, and I did not have time for that. I asked help from our charge nurse, but also told me that she could not find one. The patient, who is up and about, and ambulatory, insisted that he wanted the remote NOW. Imagine! There was a dying patient, and here he was insisting that I look for a tv remote control stat.

 

I need to keep my temper, otherwise, I might end saying things I might regret later on. In the end, after things have settled, I found a remote for my patient, I have given my medications and my patients started sleeping. I had my dinner break around 230am.

 

The rest of the night went smoothly, and the 6 o’clock madness ( I call the 6 o’clocks here as “6 o’clock madness” because it does not matter whether it’s am or pm, there is always a lot of work to be done before the shift ends at 7), was manageable.

 

Wow, I am four days off starting today! Now that’s what you call vacation after some very heavy shifts. That would be enough to recharge my super drained energy.

Nothing is Impossible with God

Today I am a witness to a miracle.

 

We had a patient in our unit who has a gastric carcinoma. He wasn’t my patient actually but I got to know him because I had to fetch him from the endoscopy unit where he had a series of endoscopic procedures.

 

The patient was actually diagnosed from another hospital, and tissue samples confirmed of his malignancy in the stomach. He was scheduled for a gastrectomy tomorrow, where his stomach will be removed. He went to the endoscopy today to verify the findings and to locate the exact area of the operation.

 

My colleague went for his lunch break when the endoscopy unit called and asked for a nurse to bring the patient back to the unit. I went there myself to get the patient. The nurse there gave the endorsement, and she was also surprised about the findings: there was no carcinoma seen in his gastrointestinal tract. He was cleared from cancer! We had to lower down our voice so that the patient does not hear what we were talking about, because the results can only be relayed by the doctor to him.

 

Later in the afternoon, the patient’s wife talked to me about the endoscopy results. The doctor has explained to them what they found out, and of course, the surgery tomorrow might get cancelled. She said she prayed a lot, and that God answered her prayers. It’s a miracle indeed!

 

Nothing is impossible with God. When we feel that life is too much, we should just always remember that there is somebody Above who never sleeps.

The Colostomy Story

Today, I had to deal the dilemma of me being an experienced neurosurgery nurse, working in a general surgery unit. I worked in an ER and neurosurgery environment for the last seven years, and I knew that I would be faced to deal with some unfamiliar cases in a gen surg ward.

 

I had a patient with a colostomy. Well, it may sound so simple for some general surgery nurses out there, but it was a big deal for me. It’s not that it was my first time, because I have had several patients with a colostomy. But it was my first time in several years to actually perform colostomy care – to actually touch and clean the stoma.

 

I was busy with another patient when I heard somebody screaming. When I looked out of my patient’s room, I saw one of my colleagues coming out from one of my patient’s room. She asked me if the patient in room x is my patient, so I told him yes and asked her what’s wrong. She said the patient was complaining because he was yelling for an hour already and nobody is coming for him.

 

Since I was finished with my current patient, I decided to check the complaining patient out. I went to his room and I was welcomed with some more yelling. I asked him if he was pressing the bell since that is the proper way of calling a nurse. He said he did but it seemed the bell was not working.

 

I investigated further, and found out the bell cord was not attached to the plug. So that was the reason nobody was coming to him. I was successful in trying to pacify him. I asked him what he needed and found out that his colostomy leaked up to his back. He said he was trying to open his colostomy because he felt it was full of air. When he opened it, he got surprised with the contents and everything leaked out and went to his clothes and sheets.

 

My patient had a colorectal cancer and the surgeons tried to remove the cancerous part of his large intestines. A new opening was made on the left side of his abdomen where his stool can come out, and will be drained to a pouch called colostomy bag.

 

I checked what I needed to clean him, and after that I told him I need to get some things in the stockroom. When I got into the stockroom, I took some fresh linens, pads, cleaning wipes and saline. To my horror, I found that there were different sizes of colostomy bag. How would I know which one is for my patient? I decided to just bring one in each of the different sizes. I thought it would be safe since I do not have to come back if one size fails.

 

When I went back to my patient’s room, I checked his colostomy so I could choose which size of bag I would need. To my surprise, none among those I brought were the same as my patient’s. I needed the biggest size which seemed not available because I did not find that size before. I knew I took one sample from each of the sizes I saw.

 

I went back to the stockroom and searched for the largest size. I did not find any, so I asked one of my seniors. He helped me searched until he finally said it was probably out of stock.

 

I decided to go to another ward and asked for that size. I knew that every minute counts for my patient who was irritable initially. I found the size from another surgical unit and hurriedly went back to my patient.

 

When I got into my patient’s room, I was greeted by a frown. I explained to him why it took me a bit long to come back, that I needed to get his size from another unit. He seemed dissatisfied with my explanations, so I just tried my best to talk to him nicely.

 

I detached the old pouch from where it was connected. I placed it in the bathroom since I wanted to save the wire that closes the pouch at the end. I cleansed his stoma with normal saline. After cleaning, I tried to attach the new pouch to the connector. It seemed I could not connect it. It was either I was doing it the wrong way, or I just do not know what I was doing.

 

While I was trying to attach it, I tried to converse to him to try divert his attention from what I was doing. I explained to him some facts about colostomy, and to take care of it. I was posing to be a pro with what I was doing, when deep inside, I know I could not connect the bag. It was hurting him when I to press harder on the pouch lid.

 

I then decided to ask help from a co-nurse. God probably heard my heart beating fast, and gave me a colleague just passing by my patient’s door! I asked her to help me attach the colostomy bag. She told me how to do it and watched me do it. It was the same technique as what I was doing before. But she also felt it was difficult doing it that way so she suggested me to just remove the part that was attached to the skin, and apply a new one. The adhesive part that was touching the skin and the bag should already be connected before sticking it to the skin.

 

I actually thought of that, but I knew it was the harder way of changing the bag. But now, it seemed there was no other but to do it that way.

 

I was successful in applying a new bag on him. I went back to the bathroom and took the wire from the old bag. It was heavily stained with stool so I just tried to clean it. I closed his colostomy bag using that wire.

 

I wiped him a bit, and brought him to the bathroom after that. I changed his gown and placed new linens on his bed. His mood has changed, and was apologetic about his attitude a while ago. I told him it was pretty understandable for him to get mad in his situation. I left him clean and satisfied with what I have done for him.

 

In the evening, before I left the unit, I checked him out in his room. He was with his family, and I was introduced to them. I told him that my shift is over and that I was leaving. He asked who’s replacing me, but I was not sure who’s taking care of him next. I saw in his face that he still wanted me to stay for him.

 

Before I left, he said smilingly “See you on Sunday!”.

Tour Guide

I was expecting Laarni this morning because I knew earlier that she and her batch mates left thePhilippines

last night. I knew her from the recruitment agency, and we did our written exams, interview and medical exams at the same time. She is now a ninang-to-be of my son.

 

My wife visited her in her Antipolo house before she came here, to ask the favor of bringing to me some of the stuffs I forgot to bring here. It was a coincidence that our subdivision in Antipolo was just next to the subdivision where her house is.

 

And so I waited for her this morning. From my flat, I can see who’s coming in and out of the building where she was assigned to stay. There was no sign of her until the afternoon, so I decided to check her out in her building. I knew beforehand from the “compound madam” which unit she was going.

 

When I reached her unit, I saw her and some of her batch mates coming out as they were planning to go to the town. The thing was, they did not know where they were going, and Laarni pleaded for me to join them. Though I had plans for the evening, how can I say no to them.

 

I remember when I first came here, no one was there to really guide us where to go. I got my sim card like two days after I arrived. And so family back home was pretty worried that time since I was not communicating to them for the last 48 hours. I also was not able to change my money to dirhams immediately, so I settled on the food that was already in the fridge when I first came in. I feel for this group, so how can I say no to them.

 

And yup, I was the tour guide of the evening. I oriented the group about bus timings, and where to get a bus going to the town. We initially went to an exchange center where they could change their pesos and dollars. We then proceeded to a cellphone store where they sell a sim with free cellphone. After that, we went to a Kodak shop as some needed to get ID pictures as required in HR.

 

We then went to the nearby supermarket where they can initially buy some necessities to be able to live decently.

 

We all went back to the compound later in the evening. I invited Laarni for dinner and I got my stuffs that my wife requested her to bring to me.

 

And that’s the story of today’s tour guide.

Bloody First Night Alone

Last night was my first night alone. What I mean is that I have finished the number of shifts required to work with a preceptor and so I had to start working by myself, without my guide following me up.

 

During the last weeks, I worked with my preceptor Jaime. I followed his schedule, and handled the patients he was having. He provided me with the necessary information about the actual ward work, which cannot be explained in lecture halls. Learning the know-hows in the war are usually learned in the actual battlefield, they say.

 

And since it was my first night working alone, I expected a chaotic night. Before coming to the unit, I thought I would be given a light load. But I had the same load, as the ordinary staff gets, and so I had a very busy night. I was still very slow with my work, especially since I am still adjusting to the new environment, system and computer documentations.

 

I had a patient with Non-Hodgkin’s Lymphoma, who always want to get out of his room , so I had to disconnect and reconnect his IV tubing many times. Eventually, his IV cannula site got infiltrated early in the morning. He had very bad veins because he’s been having chemotherapy. He needs a new and good line because he’s having chemo in the morning. He also kept on bugging me about transferring him to a single room because his insurance covers that.

 

I had an old man who was involved in a road accident previously, which caused him now to be bed-ridden. He is on NGT feeding and because he is confused he pulled out his tube twice. The first time I was able to reinsert it. The second time, I was not able to do it because of a nasal blockage. I got help from my charge who eventually got it inserted. He keeps on sliding down his bed which caused him to reach his NGT even with restrained hands. He is also diabetic with blood sugar monitoring every six hours.

 

I also had a post tonsillectomy patient who came from surgery just a few hours ago. He complained of throat pain and difficulty swallowing which was relieved by tramadol. He was on IV antibiotics too.

 

I had a post TURP patient who had a foley’s cath that kept on draining. He was so obsessed about his uring bag that he would press the bell just to get it emptied, even if he did not see how much was in it. It would always be just a quarter full.

 

I had a patient who was post amputation of some toes on the right foot, and was connected to a vacuum machine. He presses the bell whenever he wants to go to the bathroom because he had to be disconnected from the machine. He also had fever early in the morning and on blood sugar monitoring.

 

Another patient was also a post op patient whose big ulcer on the sole of the foot was covered with a skin flap from the left thigh. He also spiked fever early in the morning.

 

My last patient was my admission directly from OR around midnight. I picked him up from the recovery room, and on the way to the ward, he vomited  on the bed. My hands got vomitus as well after trying it by the kidney basin. He was on heparin drip, IV fluids, a foleys, and an IVAC. Later in the unit, he complained of pain so he was given tramadol IV. Just minutes after the injection, he felt weird and hallucinating. He started shouting saying he’s going to die. He said he was so dizzy and nauseated so I gave him metoclopromide IV. That settled him down until morning.

 

When I got home from work this morning, I had no more energy to prepare breakfast. I just had a glass of Horlicks and I crashed on the bed, as if I was knocked out by Manny Pacquiao.

Last Night’s Bday Dinner

It was one great evening last night. It was the first time that my flat was filled with people and it was so strange to look at my living room full of guests, when most of the time it was filled by no one but me.

 

People started coming in half past seven. Some came from the morning shifts. Most of my guests were my batch mates – the same people who took the same plane coming here for the first time in UAE. Everybody had their new stories to tell, after having worked in our own respective units for the last three weeks.

 

My preceptor Jaime came in as well and gave us some info about the in and outs on working in the UAE.

 

I wished there were videoke and some dancing, but I did not have the appliances yet for that. Well, it’s understandable since I have not even worked for a month. I only had my laptop’s media player for the background music of the night.

 

By the way, they loved my world-famous spaghetti! They also liked the buttered veggies! Successful home-cooking!

 

It was a nice evening when my flat was filled with stories, laughters and cheers.

 

After my guests left, I did a quick party “post-mortem” care. 

 

I woke up this morning and made some more cleaning. I’m working three nights starting tonight. Hell, I’m back to reality.

Bday Dinner Preps

It is 530pm and I am still waiting for my guests to come in. I have prepared dinner for my newly-found friends here in UAE. My birthday is actually on the 28^th, but I will be working on a night shift on that day so it’s impossible to hold it on the actual day.

 

My preparations started about a week when I started buying stuffs for this evening’s affair. Whenever I did my grocery, I include bits and pieces for my planned dinner. I have already bought some canned goods, pastas, paper plates, spoons, forks, cups etc etc. It’s better than doing the shopping in one time when it will be heavier to carry all the plastic bags.

 

The last major shopping was last night at Carrefour. I bought the last items I needed for tonight – chicken drumsticks, rice, and drinks.

 

I started cooking this morning. I prepared the fruit salad first since I need to chill it the whole day, so that it will be cold and ready by evening.

 

I had limited casseroles so I had to really plan my cooking. I cooked the pasta for the spaghetti, and used the same casserole for the spag sauce. Remyr came in around lunch time and helped me with the chopping of vegetables. After cooking the veggie dish, we had the spaghetti for lunch. Remyr had to leave after because he needed to sleep in preparation for his night duty in the evening. He will actually be missing tonight’s event,

 

Karen came in around 3pm and helped me fry the chicken drumsticks after rolling them in a breaded mix. She left later to go to the gym, and promised to come back for dinner. Meanwhile, I cooked rice while starting to clean out the place. I brushed the living room carpet, and scrubbed the bathroom ceramics.

 

I felt the food might not be enough so I called KFC to post an order for a bucket of chicken. The delivery man came in few minutes later with the chicken, pepsi, coleslaw, fries and bread.

 

I found out from a text message that my wife is also having a party back home in the Philippines. Her officemates threw in a surprise baby shower party for her. She received lots of baby gifts, she mentioned. Wow, talk about simultaneous parties…

 

I took a quick shower after that, and started preparing myself for my night.

 

I think everything has been prepared. And now, it’s just the guests that are missing…

 

My First Night Shift

Whew! I just arrived home after I surpassing another milestone in my budding nursing career in the UAE – my first night shift (7pm to 7am). This was after a year of having my nights spent on sleeping, and the days on working. I knew I had to make adjustments in my body clock.

 

My preceptor and I had 7 patients last night. The cases and activities were as follows:

 

1. A patient with cancer of the larynx who had tracheostomy and PEG insertion. Because he can’t talk, I had difficulty trying to understand him. I had to clean the Swedish nose attached to the trache twice because there’s no stock of that at the moment so we could not throw that one away. His IV line got infiltrated so a new line was inserted. He had very difficult veins, and after several tries, one of my co-nurses managed to put one. He’s a sharpshooter! He needed that for his IV antibiotics.
2. A patient with cancer of the pancreas, who had a whipple’s procedure two weeks back. He passed BM twice and everytime he did, I had to change his bed linens because he messes everything up. I also did his abdominal dressing which was very mucky, because aside from the oozing wound, it was stained by his stool. I got a low blood sugar from him in the morning, so I encouraged him to eat something. I rechecked his blood sugar after an hour, and it picked up to within normal limits. His IV line got infiltrated as well but reinsertion was unsuccessful because his veins were all so bad.
3. A patient with Osteomyelitis on the right femur who previously had an Incision and Drainage surgery inThailand. His wound looks infected. He’s in the hospital for pain management. 

4. A patient post road-traffic accident with compound fracture of tibia/fibula. He recently had removal of the external fixator, with intermedullary nailing. This guy is already mobilizing full weight bearing, and is for possible discharge today.
5. A patient who was admitted for hematuria. He was on a foley catheter draining reddish urine. He called twice just to get his urine bag emptied when it was only half full.
6. A diabetic patient who had amputation of the 2^nd, 3^rd, and 4^th digits of the right toes two weeks back. He was scheduled for Angiography today, so I inserted an IV line on him last midnight and started him on IV fluids. I did not have any difficulty inserting a cannula for him because he had very visible veins. His blood sugar shoot up in the middle of the night so I had to give him some regular insulin. It went down to within normal limits in the morning. His groin was shaved in the morning in preparation for the angiography.
7. A patient who had renal stones, and had undergone urethroscopy to remove ureteric stones. He complained of flank pain around  1030 in the evening, so I gave him a tramadol injection in the right gluts. He complained again at 2am and said that the injection I gave did not work much. I then gave him a more stronger analgesia – Pethidine injection on the left gluts. That knocked him down, sleeping till the morning. I feel he needs to be reviewed again this morning because of these pain episodes even if he is for possible discharge. He did not have an IV line but he had orders for IV antibiotics this morning so a line was inserted using a butterfly, and I removed it after the medication was consumed.

 

And that goes my first night shift. I survived. Glad to be still alive. And yup, I have another night tonight.