ED Vignettes

Not Just a "Room Nurse"

2013-03-05T09:38:00.000-08:00

It is not just a case of ignorance; it is a prime example of how clueless some people are about the work of nurses. It is also a blatant disregard of how the Filipino nurses had helped save a nation, and gained the respect of other nations with their compassion, intelligence, and competence.

Cynthia Villar, a senatorial candidate in the Philippines, ignited a firestorm of angry retorts from nurses and the general public after her thoughtless remarks to a question by broadcaster Winnie Monsod in the February 23 episode of GMA News TV’s “Pagsubok ng mga Kandidato”.

The show aims to provide the viewers “with insight into how the candidates think and more importantly, how well they think” by presenting tough leadership questions to the senatorial candidates.

The candidates had to think on their feet, without the benefit of speechwriters or paid advertisements. Because they were limited to a one-minute response and would not have the time to embellish and to give a “politically-correct” answer, what you get is similar to the “word-association” game used by psychiatrists. That means, the interviewee gives more or less a gut response. A reflection of their true feelings.

Monsod’s question was: “How can you reconcile your desire to help the poor at pagpanig ninyo sa may-ari ng nursing schools na gusto sanang ipasara ng Technical Nursing Committee at ng CHED?” (How can you reconcile your desire to help the poor and your siding with the owners of nursing schools which had been ordered to close by the Technical Nursing Committee and CHED)

The question was in reference to Villar’s role as then Chairperson of the House Committee on Higher and Technical Education, to intercede between the nursing schools and CHED (Commission on Higher Education) which had ordered the closure of about 20 substandard nursing schools. As a result, none of the schools were closed, a business decision to protect the interests of the school owners.

"Hindi naman kailangan ang nurse ay matapos ng BSN (Bachelor of Science in Nursing) kasi itong mga nurse ay gusto lang nila maging room nurse, o sa Amerika o in other countries, e ano lang sila, young parang mag-aalaga. Hindi naman sila kailangan ganoon kagaling." (Nurses do not need to finish the BSN program, because they just want to be room nurses; in the US or in other countries, caregivers. They do not need to be that efficient.)

Understandably, the nursing profession reacted quickly and explosively. It is very disappointing that an elected official has such disrespect against our nursing profession that she would think we can “get by” with limited education because we are only “room nurses”. The implication was that excellence should not be a nursing standard. Once again, nurses were relegated as 'second class citizens".

Villar’s response to the controversy was a mumbo-jumbo of excuses about time restriction. "The 30-second limit for me to answer the question posed on the news program was too short to give the complete details surrounding the issue. I hope that this statement will clarify the issue. I am sorry if it has created confusion. Thank you."

She is still clearly clueless how nurses are vital to the medical field. Instead of accepting the responsibility about her disrespectful and denigrating attitude towards nurses, she claimed she was misunderstood. She still could not explain her concept of a "room nurse". I wonder how she faced her own daughter, a nurse herself, and told her that she was JUST a "room nurse"

I do not wish her to get a dose of her own medicine, if she lands under the care of one of our own. I believe that when faced with difficult patients, a real nurse will still uphold our oath of service; that we still give the best of care, no matter what.

I must admit, I thought of how the Washington, DC politician Marion Barry disparaged Filipino nurses in one of his speeches and then had reversed his bigoted opinion about Filipino nurses when he found himself under the care of one.

I want to give Mrs. Villar (and other clueless persons like her) a re-education of what a nurse is, and what it takes to become a nurse.

Mrs Villar, I AM A NURSE AND PROUD TO BE ONE. I was a product of a Filipino educational system that had placed value on competence and commitment to excellence. My student years at various military and public hospitals provided me with an invaluable hands-on experience so unlike what American student nurses experience today due to restrictions from a legal-conscious society.

My years of clinical experience here in the United States and my advanced studies had brought me to where I am now, a clinical nurse specialist. This is not a time for false modesty, but rather just pride in my journey, and for all others who had pushed the Filipino nurses to the top of their game.

The Filipino nurses abroad are not mere hand-maidens to the physicians. We had gone a long way from being unrecognized in our field, we are now collaborators in the care of our patients. We had helped train many medical residents, and we had, in fact, intervened so that our patients were not harmed by wrong medical orders.

Among our midst are advanced practice nurses in many specialties: nurse practitioners, nurse anesthetists, managers/ supervisors, clinical nurse specialists, educators, entrepreneurs, nurse attorneys, administrators, and nurse authors (ahem).

Those nurses who choose to remain at the bedside as staff nurses are well-regarded by our peers as competent and compassionate professionals. Conscious of the delicate responsibility of patients' lives on their hands, nurses deliver safe care to the patients, using critical thinking every single day. The frontline nurses are consummate multi-taskers, who have to think on their feet, even as they advocate for their patients.

Filipino nurses abroad had risen as shining examples of this noble profession, even as nursing heroes. In his last State of the Union address, President Obama singled out Menchu Sanchez, a Filipina nurse who initiated the safe transfer of sick babies out of a flooded hospital during the height of the hurricane.

So, what can you do to make up for this transgression? Let me count the ways by which you can truly apologize and not just pay "lip service":

1. Elevate the standards of local nursing schools by making them accountable for higher nursing licensure passing rates. Do not side with nursing school owners who provide substandard training. An educated nurse is a safe nurse.

2. Enact laws to prevent the abuse of the nurses who pay to be “volunteers”. Absurd. And totally wrong.

3. Provide scholarships to deserving nursing students. Not just for BSNs, but also Masters and doctorate programs.

4. Improve the working conditions for nurses in local hospitals by providing responsible representation for nurses’ rights.

5. Investigate unscrupulous nurse recruiters with their exorbitant fees. Streamline the hiring process for overseas work.

6. Sponsor a nurse to provide informed and expert consultation in important health service committees.

7. Sponsor a bill to increase the base pay for nurses, as they deserve.

But before all these, you must really understand how it is to be a nurse. Volunteer to shadow the nurses in different fields as they continue to persevere in their chosen profession despite the odds stacked against them. And maybe, just maybe, you will truly understand.

We are much more than just a “room nurse”, Mrs. Villar. Filipino nurses deserve the respect that you obviously did not feel. Your remarks left a sour taste in our mouths, but we will continue to shine, in the Philippines and overseas.

Thankfully, you do not define our profession. We do. We make a difference in other peoples’ lives..

And this is how Winnie Monsod looked in disbelief at Villar's remarks.

Nurse of the Future, 2025

2013-02-19T14:00:00.002-08:00

SEPTEMBER 2025

It's time to say goodbye to her 'virtual' nursing cap. Dr. Jade Marciano is ready to hang up her stethoscope, finally. After all, she had been working as a nurse for 42 years now. After completing her Doctorate of Nursing Practice degree 10 years ago, she had moved on to the executive leadership position in the hospital.

“Hi, Tita Jade. I will miss your daily stops.” Her niece Charlene gave her a quick buzz on the cheek before she ran over to the ambulance ramp to meet the EMS trauma notification. Charlene is the senior nurse practitioner on duty.

Nurse practitioners had finally been integrated into the fabric of ED care. It had taken years of resistance from the medical community, but after the exorbitant malpractice insurance costs had driven down enrollment in medical schools, the emergency attending physicians had begrudgingly accepted the NPs to practice alongside the EM residents.

Dr. Jade chuckled at the thought of one clueless senatorial what’s-her-name candidate who had tried to belittle the nurses in her native country by implying that the student nurses could get by with limited education. Her concept of “room nurses” had angered the Filipino nurses, and she eventually lost the election in 2013. In her wildest imagination, she probably did not even think that nurses would even rise in stature even more.

The 2010 Institute of Medicine’s landmark report had been quite a revelation in its success. The hospital had achieved an unprecedented 100% BSN-prepared nursing staff, belying the prediction of a nursing shortage by 2020. A remarkable 35% of the ED RNs has Masters’ degree, and had been utilized as Senior Staff Nurses 5th level, with expanded responsibilities as patient care navigators and evidence-based practice advocates. The ED administration had wisely adjusted their staff by providing more Patient Care Techs and other ancillary staff to offset the higher salaries of these advanced practice RNs.

Dr. Jade is a prime example of the IOM’s vision. She was trailblazer in her profession, having collaborated with the physicians to introduce new care initiatives. She agreed that the public’s and medical community’s perception of nurses had greatly been turned around when faced with more educated nurses.

“Trauma Team, Resus 51”, a melodic announcement interrupted Dr. Jade’s thoughts. A patient from a multi-vehicular accident had just been wheeled by EMS, with a mechanical compressor performing CPR on the bloodied patient. There was no time for an intubation in the field.

In the age of microchips, only the most privacy-concerned patient would have an unknown medical history. The triage nurse bar-scanned the patient’s wrist and soon the patient’s recent medical history was displayed on a medical I-Pad Patient Screen under the cardiac monitor. The patient was an open book, a reality (and a necessity) in Big Brother's world.

Mr. C was a 35 year-old man with an AICD from a cocaine-induced cardiomyopathy. The EM-NP quickly deactivated the AICD. A glove EKG remained on the patient’s torso, a far cry from the bulb-suction EKG electrodes of Dr. Jade’s student years.

The ED attending wrapped a DBAC (Deep Bleeder Acoustic Coagulation) cuff on the patient’s upper arm to seal an arterial bleed. The trauma surgeon then activated the ultrasound zap to coagulate the severed vessel. The nurse had started her Trauma Bleed cocktail- Tranexamic acid (antifibrinolytic), Kefpush (an IV push antibiotic) , and Tetanus toxoid.

The EM-NP also had started an intraosseus line and gave a Blood Substitute polyheme on the accident scene; a necessary intervention in a depleted Blood Bank supply. There was no need for cross-matching; no chance for a transfusion reaction.

The ED attending stopped the compressor to check for the pulse. The patient pulse was steady and bounding, Sinus tachycardia was reflected on a sleek touch screen. The patient was still unconscious and was having labored breathing.

“BP 90/62, HR-120, O2 sat 92% on 100% non-rebreather.”, the nurse announced just loud enough to be heard by the Trauma Team, as well as to record the vitals on he lapel mike that was attached to her Dragoneer Head set. The hands-free device allows her to tape her assessments while she assists with patient care. As soon as she would have the time, she would review then accept the recordings on her own hospital-issued mobile phone to be written into the permanent electronic chart. Most of the nurses preferred the mike than typing into their mobile device.

NP Charlene assisted the Trauma resident in intubation and administered the dosage-controlled bar-coded RSI meds via the brachial line, and soon the resident inserted a Glidescope for easy tracheal intubation.

“ETT to vent, Tidal volume 500, F1O2 100%, AC rate 0f 16”. The trauma nurse continued to intone into her mike, as the respiratory therapist connected the endotracheal tube to the new compact-sized three-pound portable ventilator.

The trauma nurse had sent the blood tubes on the Chute to Lab, but gave the smaller sample tube to the Patient Care Tech for bedside testing.

The Patient Care Tech keyed in the results of point-of-care hematocrit, lactate and basic metabolic panel and transmitted the results on the Patient Screen. The ED attending reviewed the trended results, and nodded with satisfaction on the improved hematocrit level.

The Trauma attending brought out his newest gadget to show off, a hand-held body ultrasound scanner to check on a possible aortic dissection or any vaso-aneurysm. There was none, and suppressing a disappointed sigh, he called for the x-ray technician to come into the room.

The technician turned on the switch and the portable multi-purpose x-ray/MRI scanner lowered down from the ceiling. A series of clicks and lights emanated from the machine, creating a surreal glow around the patient.

A lacerated liver was displayed on the Patient Screen. Snapping to attention, a gaggle of trauma residents started to disconnect the patient from the cardiac monitor.

Even with the sophisticated and ultra-modern technology, the doctors still did not know how to calmly prepare the patient for transport, without unhooking the wrong tubes and tangling the IV lines. In their haste, they just wasted precious time. The nurses quickly took over, and finally declared the patient ready to go.

It all happened in twenty minutes, and off to the OR did the patient go. The RFID tracker recorded the patient’s move.

An audible decrease in the decibel and excitement level in the ED coincided with the patient’s transfer. And soon, the ED was back to its usual non-trauma frenetic pace.

Dr. Jade surveyed the newly-renovated ED, and decided that she will again propose more beds to be added. The patient daily census still remained in the 500s because of more hospital closings. The medical scene would remain a challenge.

Back at her corner Penthouse office, Dr. Jade enjoyed a 180-view of Brooklyn and Manhattan. It is a good feeling to have gone through it all. She had emerged triumphant.

From a simple nursing student in the Philippines in the late 70’s, where the students used to help sterilize the glass syringes and needles,, make their own cotton balls, reuse most supplies, and carry the metal patient charts for the doctors with their superior airs.

When she moved to the United States in the early 1980’s, she was thrust into a chronic care hospital. With 40 patients under her care, she was introduced to functional nursing. Most times, she gave out meds with only a 2x2 index card with transcribed hand-written medication orders.

In the 1990’s, she entered the world of emergency nursing and she was hooked. It was a world in transition. The nurses had to prove themselves against some medical doctors who could not believe that nurses should have a voice.

The 2000s was a year for innovations, and medical breakthroughs. Electronic charting decreased medical errors. And nursing was poised to take bigger roles in hospital leadership. In 2012, she started her Simulation journey. Now, all her nurses prepare for real-life nursing with mandatory intensive simulation experience in the state-of-the-art Sim Lab..

Now, in 2025, the transformed nursing workforce had fulfilled its promise to take a much-deserved equal acknowledgement from the public. Somehow, the world had embraced the new and expanded roles of the nurse. An empowered nurse.

Yes, it’s time to retire and hit the beaches with Max, her doctor-husband, 12 years her junior.

Nursing Heroes

2013-02-13T09:18:00.000-08:00

When disaster strikes, heroes emerge.

Heroes come from many places. The police, firemen, and emergency responders deserve all the praises that are heaped on them by virtue of them putting their lives on the line every day. Soldiers here and abroad should earn our utmost respect for their incredible sacrifice to protect our country.

Hurricane Sandy brought forth to national consciousness the noble women and men in nursing. Because of generator failure, New York University Langone Hospital was forced to evacuate some 200 patients to nearby hospitals. What makes this truly incredible was the fact that the transfer was made during the height of the hurricane, at a time of dangerous winds and unrelenting rains.

On February 12, 2013, in his State of the Union address, US President Barrack Obama honored one nurse who exemplified the nobility of our nursing profession.

MENCHU DELUNA SANCHEZ, a Filipino registered nurse in NYU-Langone, thought of the plan and organized a group of medical professionals to carry 20 critical babies down nine flights of stairs, with illuminations from cellphones to guide them along the way.

The medical team composed of nurses, doctors, medical residents, ancillary staff, and hospital administrators joined in perfect harmony to carry those precious babies to safety, and to other hospitals which welcomed these patients. Countless acts of courage and dedication to duty. To protect the most vulnerable of patients.

“We should follow the example of a New York City nurse named Menchu Sanchez. When Hurricane Sandy plunged her hospital into darkness, she wasn’t thinking about how her own home was faring,” Obama said in his address before a joint session of Congress. “Her mind was on the 20 precious newborns in her care and the rescue plan she devised that kept them all safe.”

http://globalnation.inquirer.net/64251/filipino-nurse-hailed-as-role-model-in-obamas-state-of-the-union-address

A picture of a nurse who hugged a premature baby to her chest as she gingerly led the way down flash-light lit stairway with her team of doctors and ancillary staff gave me chills. I thought of the premature baby whose very survival depended on the commitment of each member of the team. I thought of the baby’s parents as they worried about their child. For all the parents, the hospital staff members were the angels sent to protect their own little angels.

While Sanchez was saving lives in the hospital, her own home in New Jersey was flooded rendering the first story of her house still uninhabitable to this day.

But on that Tuesday evening, as Menchu Sanchez joined the First Lady Michelle Obama and the Vice-President’s wife Jill Biden in that honored spot, it must have been a surreal experience to be celebrated for a job well-done in a setting that only a few had achieved.

It was a fitting tribute to nurses everywhere, and to all Filipino nurses who had identified with her work ethic and professional integrity. For Menchu, it was probably a culmination of years of hard work and dedication to her nursing profession.

Mabuhay, Menchu! I celebrate your achievements. You make us all proud. You’ve come a long way from your native Philippines.

Here are other profiles in courage, just snapshots of nursing heroes:

In Afghanistan, JAMES GENNARI, BSN, RN, TNS, As department head for a mobile ED and shock trauma platoon, with an explosive ordinance removal specialist removed a 14" rocket propelled grenade that was embedded up to the patient's buttock in three tugs.

http://nursing.advanceweb.com/Features/Articles/Nurse-Hero-in-Afghanistan.aspx

JERRY AVANT, JR. died while protecting others. Doctors said the 39-year-old male nurse was shot more than two dozen times Sunday while trying to shield others from a gunman at a Carthage, N.C. nursing home.

http://www.cbsnews.com/2100-500202_162-4902345.html

Nurses do great things every day. As part of their daily lives, they care for their patients even though they are under-paid and under-staffed. Their efforts are unsung, and mostly under-appreciated.

But in extreme circumstances, a few nurses shine more than others. They do things above and beyond. These are the nurses who selflessly rise above their own expectations and who provide the care that can only be called heroic. It is so heartwarming that the nurses are finally getting their spotlight.

“Our planet is filled with heroes, young and old, rich and poor, man, woman of different colors, shapes and sizes. We are one great tapestry. Each person has a hidden hero within, you just have to look inside you and search it in your heart, and be the hero to the next one in need.” By Efren Penaflorida, 2009 CNN Hero

Senseless

2012-12-14T21:00:00.000-08:00

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.

My 15 Minutes of Fame

2012-11-04T15:00:00.000-08:00

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

Nursing Vignettes- (book excerpts)

2012-10-20T18:58:00.002-07:00

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.

I would like that nursing students will be able to learn 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 The graphics are just for FB and for this blog. Just wanted to highlight some excerpts from the book.

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

FIRST BOOK

2012-08-03T20:16:00.000-07:00

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.

Stronger

2012-07-31T18:46:00.000-07:00

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."

LEIGH'S SYNDROME: A Day in the Pediatric ED

2012-07-08T16:29:00.000-07:00

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

Get Naked, Get Wet

2012-05-05T09:41:00.000-07:00

"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!

If Tomorrow Never Comes...

2012-04-15T15:35:00.000-07:00

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 Kübler-Ross

UH-OH!

2012-04-06T21:30:00.007-07:00

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/

A Date with Mr. Smith

2012-02-18T10:40:00.000-08:00

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

Top Five Things I Love Being an ER Nurse

2011-10-29T18:38:00.005-07:00

I love being an ER nurse. I got into Nursing because my family wanted me to. I was one of the lucky ones who actually learned to love being a nurse , and to love the profession even after 20 years of ER nursing. Nursing in the USA had given me great financial rewards and had allowed me to help my family at home.

But, I would not have remained as nurse if I was miserable in this job. So I find it annoying when I read about too many complaints and regrets about the profession. Whenever I read anybody bashing Nursing, my first question had always been: “Why stay any longer?”

Some nurses vent their frustrations (understandable) of not finding a job after nursing school and of their righteous indignation of being exploited as "paying" volunteers (total contraindications). Nurses in the Philippines deserve recognition for their service despite the "horrendous" situations in most of our hospitals.

Some nurses may actually find out that they don’t like being a nurse. That’s fine; that’s perfectly acceptable. Not everyone is suited to be a nurse. They may be a perfectly decent and compassionate people, but Nursing may not be for them, period.

But please do us a favor: just leave nursing to those of us who’ve found a niche in whatever field we’re at. Do not enumerate all the reasons of your disillusionment, because by doing so, you are merely mocking the profession that had actually brought happiness and fulfillment to most of us.

Have you finally realized that you'd rather be anyone else but a nurse? Then, just GO! Take a deep breath and move on to whatever your heart desires. Follow your non-nursing dreams. Make your choice and don’t drag down your fellow nurses with your negative vibes.

Life is challenging enough to be working alongside a person who does not share the passion. It is a disservice to the patient if we stay for the wrong reasons. The patients deserve nurses with service in their hearts; who care for them because they love to and not because they love the money or because they were “forced” to. If I were a patient, I would not want a nurse who think only of her overtime money and who could care less if I need any pain medication.

We’ve come into the Nursing with our eyes wide open. Our parents must have nudged us with visions of jobs abroad but I doubt it if they promised us a rose garden. Nursing is hard work and entails many sacrifices. It meant that my life would not be as glamorous like if in show business but I rolled up my sleeves, and got to work. I accepted that the uniform does not pave the way for a life in the limelight, of high fashion and easy money.

For once, I was too brusque to a nurse who whined about all sorts of things. I turned to her, and asked, “Then, why are you still here?”. I realized later that she was burned out, but I just did not want to be sucked into her miserable existence. The negativity was burning a hole in her personality that it was a torture to have her around.

After all these years as an ER nurse, one would expect a sense of disillusionment, or burn-out. But instead of waning, my passion for emergency nursing is burning in its intensity. When you find the nursing field that you’ve been looking for, any other department is inconceivable. And I realized, it is a double blessing when you enjoy the work you do. Nurses make a difference.

Here are top five things that I love as an ER nurse:

1. Variety is the spice of life- No two days are the same. There is no such thing as Ground Hog Day. But there are many instances of deja vu. It’s like a different flavored ice cream every day.

A staff nurse has different assignments and sometimes can be switched to different positions in a single shift. Every single day is an adventure, sometimes overwhelming but never boring.

You never know what will come through the ambulance doors. It is when it is too quiet that we scratch our heads and our hearts flutter because surely, something dramatic will come. We should always prepare for the unexpected. We should always be on our toes; this is not a place for the faint-hearted.

One day, a small dog wandered over to the ER with a splinter on his paw. Another day, a woman protested too much, “I’m not pregnant. I’m just fat.” Moments later, she squealed and out came a baby.

2. Organized Chaos – The ED is always overcrowded and it is gridlock time. Grand Central Parkway at 5pm. Stretchers next to each other. Any floor nurse who visits the ED would be horrified at what they perceive as a chaotic environment. An ER nurse knows that although the activity level is frantic, the staff knows what to do.

And there is organization amidst the din; there is controlled chaos. The adrenaline rush sustains the nurse as she flies from one patient to another; her focused and determined look means that she’s managing her time as best as she can, so please get out of her@%&*@ way.

3. Interesting Patients/ Funny moments- A nurse will never run out of amusing stories to tell.

After a snow blizzard, EMS transported a patient using a snow sled. An inebriated man pushed his compadre to the ED on a grocery shopping cart and told the nurse stoically, “my friend needs help.”

A trauma patient came in after a motorbike accident with a fractured leg; he was totally covered with tattoos. His eyebrows, nostrils and lips were pierced. His genitals were covered with his brand of art. But when he saw the 14 gauge angiocath, he screamed in fear.

A clergyman came after a freak accident with a cucumber lodged where it doesn’t shine. We keep a running tab on what’s the weirdest thing we found in any body cavity. Such is the life of an ER nurse. We live for the simple pleasures.

4. Inspiring people-
I get inspired by colleagues who lead by example: they spend their vacations on charity missions abroad. They spend their own money to go to Haiti or Guatemala. They come back with appreciation of their ability to touch lives.

And then there’s this nurse who worked cheerfully while struggling with a brain tumor. Her patients never knew that the nurse who comforted them needed comforting herself. But she persevered and gave her patients her very best.

Several of my fellow nurses were stuck inside the hospital when the blizzard rendered all roads impassable; they gamely took care of the patients. Some of us trudged through snow banks that were taller than us just so that we can relieve those who have worked before us. They’re our family.

5. Emotional rewards- It might sound too corny to some, but it is rejuvenating to see that you’ve made a difference.

Let me count the ways: you correctly triaged a patient with altered mental status as hypoglycemic; you assisted a battered woman find shelter away from her abusive husband; you monitored your stroke patient’s vital signs and now he thanks you for your help. You found the time to listen to your elderly patient who missed her loved ones who never visit. You helped deliver a baby.

We may not always get a Thank You, but when a patient gets better because of you, that’s good enough for me. That should earn us points in heaven.

I’m counting my blessings. I enjoy my work . I am an ER nurse.

The Great Escape

2011-08-08T18:57:00.000-07:00

Tim slowly opened his eyes when he heard the door close. His pretend snores must have convinced the nurses to leave him be. He heard one nurse remind the other not to tie his wrist restraints to the bed side rails but to the metal support under the stretcher. This time, they left his boxers and socks on, and his feet unrestrained. Since he is an ER regular who loves his beer too much, he finally caught on to why the nurses always dressed him up with the "green gown". It was meant as a signal to all that he is an escape risk.

I need to leave. I need to escape, Tim muttered this to himself like a mantra.

Earlier, his cute nurse fiddled with the EKG leads on his chest and the heart monitor beeped with the now-familiar rhythm. She looked young and naive; her look of concentration as she applied the restraints belied her nervousness as she tried to imitate the confident efficiency of her preceptor.

"You must be new here, aren't you?" . Tim loved it when the newbies flinched as he growled and trashed in his bed. They quivered in fear, probably debating how long they would stay in the profession. Sometimes, when he is in the mood, Tim would put on a tantrum, his language as colorful as befitted the occasion (and most especially when the hospital police are nowhere to be seen). But there's another nurse named Josette who looks so sweet but could really shock you with her colorful string of curses.

Of course, he needs to maintain his reputation as the Obnoxious Drunk. The louder he is, the more the newbies scramble to give him extra helping of sandwiches and apple juice. On a really good day, he gets a hot meal during dinner time, then gets another one after a shift change.

Hahaha. This ER is so much fun. That's why he did not mind when the EMS used to bypass another private hospital to drop him off to his favorite city hospital. Here, everybody knows his name.

The senior nurses already know his modus operandi. While a junior nurse would try to cajole him into submission by giving him food, the senior nurses just raise their eyebrows at him, and quietly display the cloth restraints out. Those tough girls would not hesitate to slap a four-point restraints on him at a moment's notice. These nurses mean business, especially that night nurse named Tina. One look from her and he shuts up. They've come to an understanding: if he calms down and just sleep off his intoxication, she would leave him alone and she might even give him a cup of Colombian coffee that her Juan Valdez- look alike boyfriend brings her.

The "Banana bag" was infusing through his left arm vein. For some inexplicable reason, nurse Jackie (no, not that one on TV) had taken a liking on him. One night, while she was cleaning off a laceration on his hand, she started to educate him about the multivitamins in his intravenous. Now, he knows that the "banana bag" means he's well-nourished.

I got to go. My friend Dolly is waiting for me in the park with the Chivas Regal that she claimed that her boyfriend Frank gave her.

Tim looked up and found his salvation.

A hole in the ceiling. Yes!!! All that he had to do is get out of his restraints, retrieve the clothes bag under his stretcher and run for his freedom. But he needed to go up the ceiling because his jailor Tina would surely catch him if he tries to sneak out from the waiting room.

Tim flexed his hands. How smart of him to rub petroleum jelly on his hands just before the police picked him up from the street. He's not known as Houdini for nothing. Just a couple of tugs and he got out of his restraints. Next, he pulled out the intravenous on his arm just like how the nurses did.

Uh-oh, no time to dress up. He saw one of the doctors coming to his room, but thankfully, she was sidetracked in deep conversation with another nurse.

It's now or never. Tim stood up on the stretcher and started to climb up through the hole in the ceiling. Darkness awaited him but Freedom was within reach. He lifted himself up on shaky legs but he felt the green gown rip on a nail stud. Unbelievable, he was stuck! His legs were dangling in the air and his much-maligned derriere was in full display when Dr. S came through the door.

"Gotcha!"

* The names had been changed to protect the innocents (wink).

Till We Meet Again

2011-06-07T18:59:00.000-07:00

What a journey it has been.

I said I will only be staying for two years. Like all others before me, I stayed longer and now it took twenty-one years for me to leave this place that I have grown to love. Elmhurst grabbed my heart and refused to let go.

It is a lifetime of memories. Through the years, we've created a kaleidoscope of special moments and bonded with a team of nurses, doctors, and support staff. Together, we've pulled through stressful times of overwhelming patient volume, poor staffing and personal differences.

I looked around the ED and marveled at the changes in the landscape, both in the physical environment and in the personnel who staff the ED day and night. The ED had changed but what remains true is that we are entrusted the responsibility of caring for others who are more vulnerable and unfortunate than us. To be able to spend your life in service of others is a blessing.

I started as a novice ED nurse who trembled every time I heard the red EMS notification phone ring and evolved to be a confident and knowledgeable nurse due to my multi-faceted Elmhurst experience. What's more important to me is the knowledge that I have made a difference.

Thank you for being a part of my journey. I will forever treasure the shared reminiscences and your kind words and expressions of support. It makes me happy to be appreciated by those who matter.

And now it is time to explore the world beyond these four walls and to create more memories in another hospital as their new clinical nurse specialist. Although I will be leaving a piece of my heart, I know that this new road will bring new opportunities for professional growth for me. If I made it here, I can make it anywhere.

To paraphrase Oprah, No sadness from me, I look forward to the next chapter in my life.

And when our paths will cross again, I expect to get a tight hug from you. Till we meet again.

The Mule

2011-04-10T19:10:00.000-07:00

Revised version as it appears in Nursing 2012, November 2012 edition.

1993, New York.

The elderly Filipino woman was shaking when she was brought by the EMS paramedic to Triage. She clutched my hand, pleading in silence.

The EMS paramedic bypassed the other triage nurse and zeroed in on me, correctly guessing that his patient and I share the same ethnicity.

“We picked her up at the airport,” he told me. “Her plane had just arrived fromBrazil. The flight attendants noticed that she was very agitated and crying uncontrollably. It seems she’s traveling alone, but she won’t talk to us.”

Anybody’s grandma

She was in her late 60s, with gray hair and a stooped posture; she looked like anybody’s grandma. In fact, she looked a lot like my own departed grandma. She held tightly to her purse and her eyes filled with tears. My initial reaction was to pat her shoulder in a gesture of comfort. As I rubbed her back, I felt her tremble.

At that moment, two men in suits appeared and handcuffed “Grandma” to the stretcher. The narcotics agents informed us that she was suspected of swallowing condoms of cocaine and she had to be isolated from the general population. They planned to wait for her to pass the condoms. I hoped that the cocaine packets would remain intact. Rupture of the packets would result in severe intoxication, seizures, and death.

Her story was all too familiar. She was a drug courier—or, in the colloquial term, a “drug mule.” But she was much older than the couriers who’d come to our ED in the past. None of the other couriers I’d seen looked like “Grandma.”

In my naiveté, I wasn’t prepared to think of the possibility of my patient as a drug mule. As I looked at her in disbelief and disappointment, she averted her eyes. Thrown off by my preconceived notions of what a drug mule should look like, I couldn’t help but ask, “Why?” She kept her eyes closed, but tears ran down her cheeks.

The agents were frustrated with the lack of information. “We need to find the people who contracted her to carry the drugs,” they told me. Their interviews with the patient were met with silence. She looked afraid; she provided all the demographic data for the registrar but refused to give any contact information. Maybe she didn’t want to give any information for fear of repercussions.

Taking a turn for the worse

Suddenly she grimaced in pain as she pressed on her stomach with her free hand. Alarmed, I yelled for the physician STAT. The patient’s BP was rising and her heart rate was racing. I was afraid that the cocaine packets had burst inside her.

“How many packets did you swallow? Tell us, please!” The patient hesitated, but as she squirmed in pain again, she mumbled, “Ten.”

The next few minutes were frantic as we prepared to send her to the OR for exploratory surgery. We were racing against time.

As she was wheeled out of the room, she turned to me and said, “I did it for my family.”

No room for preconceptions

“Grandma” didn’t survive the surgery. As we later learned, she died because she needed money to pay for her daughter’s cancer treatment back home.

Although we’d expected it, the news of her death affected the ED nurses who knew about her story. Our stereotypical image of a drug mule shattered, we were also touched by her sacrifice for her daughter.

To what extent would you go to help a loved one? we asked ourselves. How tragic that our patient felt trapped by her circumstances and fell prey to the drug lords who took advantage of her need.

I learned an important lesson that day: No patient is stereotypical; as unique as we all are, we respond differently to the chaos in our lives. There’s no place for preconceptions in nursing. We should be able to rise above our personal feelings and take care of each patient the best we know how, without passing judgment.

My Favorite Things

2011-04-03T18:46:00.001-07:00

I said I will only be staying for two years. Either I am a glutton for punishment, or just have an insatiable lust for adrenaline rush, or I really do love the ER. Twenty years later, the ER had taken a stronghold on me and I would never ever think of going anywhere else.

These are my favorite things:

1. EXCITEMENT GALORE- Nothing boring about ER. Every day offers something new and surprising, or out of this world. Days pass quickly, and however we try to manage our time, there's always something that needs to be done (including a bathroom break).

2. QUIET INTERLUDES, although infrequent, and temporary, are greatly appreciated and much-needed after a hectic day. Empty stretchers in the hallway are a welcome sight. This precious respite from the usual bombardment of patients allows time to sneak to the bathroom, catch up on each others' lives, and the chance to spend more time with our patients. Grab the moment to breathe because it means that a busload of patients are coming soon to break the peace.

3. HAPPY DRUNKS make up for the aggravation of having to fight off the nasty drunks. One day, a happy drunk masqueraded like a Luciano Pavarotti. His booming and impassioned O Sole Mio was surprisingly well-modulated and brought a smile to everyone, including our Alzheimer's patient, who stopped squirming in his stretcher. Somehow the familiar melody broke through the cobwebs of his mind, and he joined our happy drunk in total harmony.

4. LIVES SAVED We lose some, but most of the time we snatch patients from the brink of death. A 17-year old patient should have been a vegetable after a cardiac arrest, but we cooled him down and saved his brain. Five days later, he walked out of the hospital with full neurological functioning, ready to plan dates with his girlfriend again.

5. A SOILED METS CAP. A 9-year old boy felled by a direct blow on his chest from a baseball. He recovered from Commotio Cordis and came back to the ED to thank the staff. Pedro was in full Mets uniform, his blood-stained Mets baseball cap clutched in his tiny hands.

6. THANK YOUS.- A hurried discharge from a harried doctor left a patient and her family bewildered and frustrated. I spent just a few minutes to explain the discharge instructions. And I got a hug and a sincere thank you.

7. BULGING VEINS. Nurses always have a euphoric response to bulging veins, the ones which bulge before you even apply a tourniquet. No 22-gauge angiocathethers, no need for a vein probe, no need to call our vein expert. Just that quick pop, a gentle slide into a vein and Yes, you're home.

8. ELDERLY COUPLE HOLDING HANDS. The hopeless romantic in me triumphs at the sight of one elderly couple who held hands as they patiently waited for the ambulette we ordered to return them home. The husband comforted his wife with the sprained ankle. He catered to her unspoken needs. The wife soothed the husband who was getting impatient with the wait. I enjoyed watching them, even as I felt envious for the experience of spending a lifetime with a soulmate.

9. BABIES. Sometimes, babies are too eager to see the world and could not wait for the delivery room on the 5th floor . When the mother announces. "The baby is coming out!", the ED stops in anticipation and waits with bated breath. When the baby wails, the staff breaks into applause and coos as the baby is placed in incubator. Always a happy sight. We've seen enough deaths, so a new life reaffirms our purpose in being.

10. TEAMWORK. When the going gets rough, the ED staff gets going. Way past their scheduled off if the ED gets a call of a mass casualty. We trudged through several feet of snow, dodged drunks along the way, and stumbled through black-out streets. We held hands as we gasped in disbelief and watched helplessly at the horrifying scenes of 9/11 as played on tv. And then together as a team, we prepared the ER for the victims who never came. We hugged each other, and worked side by side to care for the rest of our patients.

ED ODD

2011-02-26T19:08:00.000-08:00

As if medical stories are not weird enough: Harlequin syndrome, asparagus pee smell, brain surgery via the eye socket, jeggings and yeast infection, coffee-induced strangling, steak-caused positive drug result, 'hormone of love' or 'cuddle chemical', and "sphenopalatine ganglioneuralgia" or brain freeze.

And now, Botox to cure vaginismus? I guess smoothing wrinkles takes a whole new dimension,huh?

Truth is stranger than fiction, and it has never become truer than in the ED.

Patient: "An animal went into my ear, it's now in my brain."
Doctor: "What kind of animal will go inside your brain?"
Patient: "You're rude. My left brain does not want to talk to you."
Doctor: "Can you tell your right brain to talk to me?"

At triage...
Patient: "I looked at the mirror and saw a blinking eye on my left butt."
The nurse thought the patient was crazy, but the patient insisted in being examined.

So the nurse and the intern took the patient to the room and looked at the patient's butt in question.

An eye blinked at them.

On a trip to South America, an insect had burrowed itself on the patient's butt.
(story by D. Dillon)

It's important to follow directions.

A patient bought an over-the-counter topical genital enhancement product from a neighborhood store. He did not follow directions. Instead of just rubbing the ointment, he ingested two doses in preparation for a date. He did not know that the Atropine effects would make him very, very sick.

He died the day after.

Toxic Sock Syndrome- when your patient's socks had melted into the skin, and the smell travels all the way to the hospital lobby. The patient is oblivious to the suffering around him. The staff tries to hold their breaths and waits anxiously for their shift to end.

Toxic Tampon syndrome- when a first-time user thought the tampon will absorb on its own.

SURPRISE!!!

2011-02-02T19:08:00.004-08:00

Expect the unexpected. Brace yourself for a day of wonderment and what-the-hecks... of jaw-dropping and head-scratching incidents that defy explanations. You think you've seen it all?

Surprises abound in this place. And we love them. Not a 9-5 job where you can pretty much expect how you'll spend your day.

Huh, Welcome to our Emergency Department.

At triage...
Patient: "I swear I'm not pregnant. Shouldn't be. I'm on the pill. But my belly hurts soooooo much!"
Nurse: "Let me just put you on the stretcher."
Minutes later, the patient screams, the nurse lifts up the sheet, and finds a baby on the stretcher.
SURPRISE!!!

Nurse: "Miss, can you please give me some urine for a pregnancy test?"
Patient: (Giggles) "You're so kind. I'm really a man. "
SURPRISE!!!

Nurse: "Your son just went to x-ray, ma'am".
Woman: (outraged) "Excuse me, that's my husband."
SURPRISE!!! (awkward, too)

Undressing a homeless patient then finding wads of twenty-dollar bills tucked away in his underwear. Total amount = $10,000.
SURPRISE!!!

Foreign body in rectum, all types, all sizes.
SURPRISE!!!

December blizzard 2010... EMS brought a patient on a sled.
SURPRISE!!!

Patients help each other. An intoxicated patient was carried into the ER on a grocery cart by a similarly-ETOH intox friend.
SURPRISE!!!

The nurse heard grunting from the other cubicle. Thinking "Molly" (one of our ER alcoholic regulars) was in pain, she drew the curtain. Molly and her boyfriend were in a compromising situation. So much for privacy.
SURPRISE!!!

http://nurses.definitelyfilipino.com/index.php/2012/03/surprise/

Goodbye, Kettly

2011-01-22T17:24:00.000-08:00

Emergency Department... a place where we see deaths up close and personal. The ED staff who choose to stay do so because they love the rewards that come from saving lives. We are hardened (crazy) souls who have accepted life's realities. But it is difficult when you lose one of your own.

Today, we said goodbye to Kettly.

Through life’s ups and downs, Kettly managed to smile her way into her fellow nurses’ hearts. She reveled in the deep friendships that blossomed amidst stressful times in the ED. As she struggled with illness, she persevered and impressed her hospital family with her indomitable spirit of resilience and tenacity. Her easy wit and sense of humor brightened our days as we all commiserated with each other at the end of each day. Kettly cared for her patients, even as she needed caring herself. She offered hope.

It is difficult to imagine that the once-vibrant nurse who delegated cooking duties like a drill sergeant for the holiday party is no longer with us. Could she have been preparing us for her untimely passing by creating special memories of friendships and by showing us the value of team work? Did she realize that the new triage nurses would remember the words of encouragement she gave them on her last day in the unit?

As she held her family in her heart, she reserved a special place for her hospital family.

Last night, we gave Kettly a White Rose tribute and showed our appreciation by honoring her with our Nursing flag. The nurses, all dressed in white, stood en masse in solidarity with a few of our colleagues who struggled to read lines from a poem written by another nurse:

To witness humanity—its beauty, in good times and bad, without judgment,
She was there.
To embrace the woes of the world, willingly, and offer hope,
She was there.
(“She Was There” is copyrighted by D. Jaeger)

Kettly, we will miss your carrot cake, your de-boned turkey, and your words of wisdom. But most of all, we will miss the nurse who showed us quiet strength and resolve through adversity. We will miss your regal presence.

Alone On New Year's Eve

2010-12-25T16:01:00.000-08:00

New Year’s Eve,New York

An urgent call from her frantic supervisor roused Jenny from her bed and derailed her New Year’s eve plan to brave the throng of New Yorkers in Times Square to witness the ball drop with her friends. Her whole family lived far away in the Philippines, so she always made sure that she spent the holidays with friends. They were all in their mid-twenties, all single and enjoying the freedom of youth. The pangs of homesickness are better dealt with when amongst friends.

Two of her co-workers had figured in a minor accident but would not be able to make it for their shift. And since she was single and lived alone, she was the most obvious choice for her supervisor to cajole into submission.

Jenny was supposed to spend this New Year’s Eve with someone special. She thought that Reese would break through the defenses she had put up, but just last week, she finally conceded that their relationship was not meant to be. Dr. Reese Walton had pursued her for about six months, but it looks like he had just given up. Maybe he could not understand her reluctance to open her heart again. Just when she had decided to accept him, she heard that his ex-girlfriend had claimed his attentions again.

Jenny, once again, was alone on New Year’s Eve.

At 5pm, the Emergency Department was bursting at the seams. The masses had descended upon the ED with a spectrum of complaints ranging from the minor in-grown toe nail to the major gunshot wound traumas. Patient volume was high; there was no open stretcher in sight. It used to be that the presence or absence of stretchers lined up in the hallway leading to the ED spelled the difference whether the ED staff would have a good day or not.

Well, it looked like the neighborhood drunks decided to spend their holiday in our ED. Free meals, a clean stretcher, and an occasional smile from a pretty nurse. And a chance to blow off the excess alcohol through their system, out from the cold winter streets, in the sanctuary and warmth of the ED.

Jenny had often joked that one can get drunk passing through the hallways, just from breathing the off-gases from the inebriated patients as they kept a cacophony of snores through their stay. The nurses had given up trying to undress these patients; priorities made them concentrate their efforts on the truly sick, especially when they’re two nurses short. And besides, all that was needed was time… when these patients wake from their drunken stupor, they demand to be released back into the streets. The ED was a merry-go-round for those who cannot get rid of their addiction to liquor.

A patient caught Jenny’s attention. He was usually a happy drunk, not shy in expressing his appreciation to the female form by way of wolf whistles and suggestive remarks. Now, he laid back on the stretcher, and accepted the intravenous with no protest at all. Jenny whipped out her ever-present penlight and shone it on the patient’s eyes.

A frisson of fear snaked down Jenny’s spine as she saw the unequal pupils, one sluggish and dilated. True enough, a quick CAT scan revealed a huge subarachnoid bleed. The patient was quickly rushed to the OR. Whew, another life saved. But looking at the mass of humanity in the crowded waiting room, it would be back-breaking work for the personnel of this busy New York City ED.

Resigned to the long night ahead, Jenny worked with the other triage nurses until at about 1000 pm, all was quiet in the triage area. The EMS crew had hunkered down to their station to watch the ball drop…until the next 911 call.

A transport clerk brought an old woman to the triage area. Denise guided the woman to a triage chair. “I found her wandering in the lobby. Couldn’t understand what she’s saying.” She whispered to Jenny, “I can smell alcohol on her.”

The woman looked Asian, probably in her 70?s. Clutching a big bag close to her chest, she shook her head when Jenny asked her questions. She was well-groomed with sensible shoes and a thick wool coat, but she was reeking of cheap beer. With tears in her eyes, she presented a worn picture to Jenny. The sepia picture showed a young couple holding hands amidst a backdrop of what looked like a Chinese temple. The woman was dressed in a dark-colored cheongsam, while the man‘s attire looked like a loose-fitting, light-colored shirt with an upturned collar.

Jenny commandeered a Chinese doctor to interpret for the patient. When asked about the alcohol smell, Mrs. Chen looked embarrassed but finally admitted that she bought a pack of beer from the grocery so that she can sleep through the night. She spilled the first can of Heineken all over clothes. She started to feel dizzy, so she decided to leave the pack of beer to a group of homeless men on the streets. But she felt disoriented on her way back home, and was then picked up by a passing EMS van.

According to the translator, the woman’s husband of 55 years passed away about six months ago, and she lived alone in her house. Mrs. Chen had always been independent but during the holidays, it had been their tradition in their close-knit family to spend New Year’s Eve together. Mrs. Chen had expected a call from her two children who lived in New Jersey, but when no call came, she decided she did not want to spend her New Year’s Eve alone.

The woman continued to reminisce about the good old days with her husband, and she started to cry miserably. Her sobs filled the small private room. At that time, the doctor was called to the Trauma Room, and Jenny was left alone with the woman. Unable to comfort the woman because of the language barrier, Jenny just patted Mrs. Chen’s frail shoulders. Jenny knew too well about holiday blues.

Because there was no social worker on duty at that time, the hospital administrator volunteered to find help to locate Mrs. Chen’s family. The patient could not remember her children’s and friends’ phone numbers. At that time, it looked that she needed to remain in the ED.

It was already 11:30 pm. Almost time for the ball drop. The table at the employee lounge was heavily laden with ethnic food and the TV played the pre-show celebration in Times Square. There was excitement in the ED; half of the staff gathered in front of the TV to wait for the countdown. No EMS crew stayed around. All the admitted patients had gone up to their floor beds. The doctors had discharged most of the patients, except the drunks… and Mrs. Chen.

The administrator brought back the good news that NYPD had gotten Mrs. Chen’s family’s telephone numbers. They had been frantic to locate their mother who had initially told them that she was spending her holidays with friends. The sons would be coming to pick up their mom after midnight. Mrs. Chen looked relieved that her family had located her, but admitted her disappointment that she would be away from her family at midnight.

It was Jenny’s meal break, and she should have been in the employee lounge joining the festivities, but she took two plates of food to share with Mrs. Chen. She did not want Mrs. Chen to spend New Year’s Eve alone. Two other nurses followed her to Mrs. Chen’s room. As the TV screen in her room displayed the revelry in Times Square, Mrs. Chen happily ate the food that Jenny brought.

11:59 pm. Sixty seconds to go and the glittering Waterford crystal ball had already started its 77-foot descent. Mrs. Chen clapped her hands in delight as the nurses counted down.

“Ten…nine… eight… seven… six… five…four… three…two… one. Happy New Year!!!!”

Jenny hugged Mrs. Chen and pretended she was her mother back home. A flood of emotions gripped Jenny as the two women shared their loneliness. The older woman reminded her of her mom- talcum powder and cooking oil.

Jenny missed her mom terribly and wished she was with her own family celebrating the season noisily as her big family always did. Their house would have been filled with relatives enjoying a sumptuous meal after a night of fireworks display. The Filipino New Year celebration was always boisterous. It is during the holiday season when Jenny feels homesick for the familiar comforts of home.

The old woman’s eyes filled with tears but she was smiling this time. “Xie-xie”. Thank you in Chinese.

Jenny was thankful for the chance to help Mrs. Chen, and for, even for a minute, just be able to hug someone who reminded her of her own mother. She didn’t spend her New Year’s Eve alone after all.

She responded with “Salamat po.” Thank you in Tagalog.

Happy New Year!

A new year had just begun. At one o’clock in the morning, Jenny made her way to her car, resigned to the idea of spending the first day of the year sleeping off the loneliness.

Reese came up behind her, armed with a bouquet of flowers.

“I’ve been calling you for since last week, Jenny. Why are you avoiding me?, he sounded tortured.

“Just leave me alone, Reese. Stay with your ex.”

At the confused look on Reese’s face, Jenny exploded in anger and recounted all the stories she heard of the reconciliation between Reese and his former girlfriend.

Reese vehemently denied all her accusations, and proclaimed his love for Jenny. It was there in the middle of the deserted parking garage, with fireworks in the background that he hugged Jenny tightly. His voice quivered when he said, “Believe me, Jenny, it’s you who I love.”

Here was a man, successful in his career, with everything going for him, but he laid his heart open to her. Jenny hugged him back, and with tears in her eyes, kissed the man she loved.

She thought, I’m not alone after all.

* not her real name

Dog in the ER

2010-12-08T18:20:00.000-08:00

“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!

The Waiting Room in the ER was quiet; at 3am, only the sickest of the sick venture out, and most come via ambulance. Adrienne had finished triage for all her waiting patients, and now the waiting room is like a ghost town with just a few family members staring blankly at the plasma tv screen.

Adrienne prefers being in the middle of the action in the Cardiac and Trauma Room. With nothing to do at External Triage, she was trying to stay awake through the questions for her nursing certification review. The coffee didn’t help; the words swam before her eyes.

“Woof! Woof!” The insistent barks pierced through her consciousness.

I’m not hallucinating. It really is a dog!

“Hi Adrienne! Is that your dog right outside your booth? ” The clerk came back from his break and saw the little Yorkshire terrier.

“Bill, I don’t know whose dog this is. I just saw him go through the door, right at the time when a patient’s family member went through.”

“Really? Are we accepting dogs now in our ER?”

Curious, Adrienne got out of her booth. A dog lover, she felt comfortable enough to approach the strange dog with the puppy eyes. The dog’s blue-black and tan coat was silky and appeared well-groomed; obviously not a stray dog. The dog whimpered as if in pain, and he shifted his weight off his right leg. Adrienne squatted down in front of the terrier who accepted a pat on the head.

Bill’s inquiries with the occupants of the waiting room were met with more blank stares. The dog didn’t belong to them.

Adrienne noticed streaks of blood trailing from the ER entrance to where the dog was sitting. Lifting the dog’s right paw, the triage nurse saw a piece of glass sticking out from the lateral aspect of the terrier’s right paw.

There was no other choice but to bring the dog to Fast Track. The medical resident on duty took one look; not his usual patient but he ushered the dog to a patient bed. Surprisingly, the terrier appeared to accept all their ministrations with just a soft whimper, but did not attempt to bite anybody. Two physician assistants held the dog as the medical resident pulled the offending glass.A quick wound clean-up was followed by a bandage on the dog’s paw.

Maybe as a thank you, the dog licked the hands of everybody in Fast Track. He happily accepted a piece of Adrienne’s hamburger.

Bill later reported that he could not find the dog’s owners either outside the ER ramp and entrance. The administrator volunteered to notify ASPCA, as soon as office hours open in the morning. Several nurses and PAs volunteered to take the dog home while the owner is being located.

The nurses named the dog Andrew in honor of the medical resident who removed the glass on the dog’s paw. Andrew the dog went home with a physician assistant. Sadly for Rochelle’s three young kids, the dog was reunited with the owner three days later.

Based on a true story.

Cooling

2010-11-20T16:01:00.000-08:00

"I've got a pulse. He's back."

The EMS tech triumphantly declared as the crew rushed the patient to the Cardiac Room.

The patient was only 18 years old; much too young to die. “Oscar” just wanted to get some extra money for a date with his girlfriend of six months. But he fell off the ladder while at his construction work after a live electric cable rendered him unconscious and stopped his heart. His co-workers had confirmed that he fell onto a tent. There was no head injury but the electric shock caused his heart to go into ventricular fibrillation.

Bystander CPR and EMS CPR gave the patient the chance he needed. Upon arrival to our ER, his heart started beating again, but he remained unconscious. His endotracheal tube and the ventilator ensured that his lungs are relieved of the work of breathing.

The question on our minds: have we saved his life but left him brain-damaged? All those free radicals in his brain needed to stop wrecking havoc on his neurons. We needed to inhibit those excitable neurotransmitters and stop further cell death. As per the latest recommendation, we should cool the brain to reduce oxygen consumption, to give his brain a chance to heal.

Induced hypothermia is an evidence based practice that was fully endorsed by the International Liaison Committee on Resuscitation: Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation (VF). “Cool them” is the mandate.

He was only 18 years old, and we would not let him die. Our hospital was considered the most prolific in New York City; we were gungho about cooling. And since Oscar met all the criteria, we cooled him to give his brain a fighting chance to normalcy, so that he can go to as many dates as he can.

Iced fluids ran through his veins, and the cooling blanket was wrapped around him burrito-style. Target temperature is 34 degrees centigrade. As the nurses monitored his esophageal temperature, they checked his shivering and sedation status. Fentanyl kept him deeply sedated, and there was no sign of microshivering: he was a Zero on the Bedside Shivering Assessment scale. He was to be maintained on hypothermia for 24 hours before he can be rewarmed; that is, if he did not succumb to his injuries, or if we could still save his brain. We prayed that he would not end up to be a “vegetable”.

Oscar was sent to the ICU, still cold at 34. His parents and girlfriend followed him, afraid of the journey ahead; their questions unanswered, his life uncertain. At that point, they were just grateful that his heart was beating again.

A week later, Oscar walked out of the hospital, hand in hand with his girlfriend. Neuro check: alert and oriented x 3. Even if he could just afford fast food for a date for now, he now has a lifetime to plan for more dates.

Who Says Medical People Can't Rap and Sing?"

2010-11-15T19:35:00.000-08:00

Just in case this nursing job doesn't work for us anymore, maybe we can do something like these...

"UAB ER Rap"

"Waking Up is Hard To Do" by Laryngospasms

"Anaesthetists Hymn"

"Colorectal Surgeon Song"

"Pink Glove Dance"