ED Vignettes

2026 Nurses Week and a Review of The Pitt Season 2

2026-05-09T17:58:00.000-07:00

The International Council of Nurses (ICN) officially announced the Nurses Day theme for the 2026 Nurses Week (May 6-12) as: “Our Nurses. Our Future. Empowered Nurses Save Lives.”

As a newly retired nurse educator with 35 years of Emergency Nursing experience, I was excited to watch the most authentic medical show ever, the HBO Max hit series “The Pitt”. Not just because they finally featured Filipino nurses (ahem), but because it captured the intense emotions, challenges, chaos, and frenzy of busy urban ERs. I watched the medical personnel struggle as they navigated the complex environment, bless their hearts. But on this special week, I have to give a shout-out to all nurses, but more especially the ER nurses. I am confident that nurses will continue to shine and save lives.

As in the first season, the show did not shy away from the realities of healthcare in the United States. Contrary to some opinions, the show’s portrayal of the challenges (insurance issues, immigration, and ICE agents) was NOT political. Heartily and passionately, I will argue that these are real issues that plague our country, regardless of political leanings. We have a broken healthcare system; truth hurts.

“The Pitt” concluded on April 16, 2026. I don’t think I am the only one with Separation Anxiety. Season 3 is scheduled to air in January 2027. What will I do in this interlude? Re-watch Seasons 1 and 2, binge on ER, Grey’s Anatomy, and try other medical shows like Amsterdam, Code Black, The Resident, and the comedies Scrubs and St. Denis Medical. I have a feeling that none of these shows is as realistic as The Pitt.

Season 1 The Pitt Review

In a nutshell, Season 2

The 15-episode Season 2 show delivered as a one-hour session per episode from 7:00 am, packed with a whole lot of excitement in this July 4 holiday shift. Firework injuries, a waterslide collapsed with multiple victims; Dr. Abbot came as a SWAT team physician; a new grad nurse was assaulted on her first day; a rape victim was given GHB by a friend; Baby Jane Doe was found in a patient’s bathroom, whose mother remained unknown; Dr. Landon’s first day of work after a drug rehab; a new attending physician with absent seizures; the bariatric patient needing diagnostic imaging and the compassionate way that the staff handled the dilemma; several patient deaths; missed diagnoses; and the Fourth of July fireworks at the end of a very exhausting overtime shift.

The computer downtime was a hoot, causing havoc, especially among the younger staff who struggled to adapt to analog procedures, did not know what Fax was, and could not even read the doctors’ cursive chicken-shit handwriting. Thank goodness for medical student Joy’s photographic memory of the computer screen census. Otherwise, the whiteboard would be just a blank board with no information.

It was also fun seeing Nurse Princess win the betting pool about the cyberattack in a neighboring hospital, then having to share her winnings with her buddy Perlah, who suspected inside information. I just have to add how funny Princess was as she got flirty with the handsome radiologist.

Graphic realism

Even after all those years in busy ERs, I still learned a lot from the show. I was taking notes and would use them in the next certification exam review class I will be teaching (still doing some per-diem teaching).

Drug use burns from xylazine; liver failure from turmeric overdose, resuscitative hysterotomy from the wild birth case; phytophotodermatitis or margarita burns; Thoravent (portable, one-way valve device to treat a small pneumothorax); Butterfly iQ3 handheld ultrasound- POCUS; slash tracheostomy; clamshell Thoracotomy; XStat (a rapid-acting hemostatic device); and a cowboy-maneuver of a closed, manual reduction of a unilateral cervical facet dislocation.

As graphic as some procedures were, I was enjoying the doctors being badass and pushing the boundaries.

Medical insurance

This is a hot button for me. Having worked in a city hospital for 21 years, I liked to think that, as a safety-net hospital, we were caring for the most vulnerable and underserved populations. Poverty caused people to miss their medications and refrain from seeking care until almost too late.

"Give me your tired, your poor, / Your huddled masses yearning to breathe free..." was written by the poet Emma Lazarus for the Statue of Liberty. Safety net hospitals (and EMTALA) would say, “Come to us, we will take care of you regardless of your race, gender, religious affiliations, or ability to pay.”

In Season 2, Orlando was underinsured, despite working several jobs. He was in diabetic ketoacidosis but signed out against medical advice because he could not afford a hospital admission. This is heartbreaking. He returned as a trauma victim after falling twenty feet at his construction work site. I couldn’t help but think that he purposefully jumped to unburden his family from the costs of his disease.

"You Can't Save Everyone"

However much we try, sometimes, we cannot save everyone. Some deaths are inevitable, may come as a surprise, and sometimes even a relief for those who have suffered with pain.

Louie was a favorite among the ER staff, the chronic alcoholic who spiraled into depression after his wife and unborn child died.

Roxie came to the ER to die; it is a final reckoning on how cancer is pulling her away from her family. She accepted her fate and did not want her sons to be forever traumatized by seeing her die at home. Her older son was able to say his final goodbye after his talk with Dr. McKay. It was heartwarming how they eased Roxie’s pain so that she could leave with dignity.

A kidney stone turned out to be an abdominal aortic aneurysm. The med student, Ogilvie, was heartbroken after assisting in the failed surgery.

The guilt or grief may linger in the provider’s heart long after the incident. We need to come to terms with it, or the heartache may come to haunt us.

Mental Health

Most of the ER staff is battling their own demons.

Dr. Robby’s 3-month sabbatical, suicide mission or not?

Self-harm scars on Dr. Santos' thigh?

Dana with her PTSD from the workplace violence in Season 1?

Dr. Al-Hashimi’s concern about her focal impaired awareness seizures (FIAS) due to a childhood meningitis?

Dr. Mohan's dilemma about her future in emergency medicine and her family issues?

Dr. Langdon’s insecurities after his drug rehab?

Javadi feeling overwhelmed by her overbearing surgeon mother?

Dr. McKay’s ongoing journey to maintain her sobriety?

Dr. Abbott’s involvement in the SWAT team due to continuing grief over the loss of his wife?

Dr. Mel King’s preoccupation with her legal disposition and her shock at her autistic sister’s sexual activity?

I am glad that some of the staff appeared to be coping well with the rigors of ER life. Perlah and Princess are each other’s support system and buddies at work, often speaking Tagalog to each other. Princess also disclosed that she de-stresses by watching a raunchy TV show. Dr. Whitaker seemed to have found romance with the farmer’s widow. At least, Joy knew that her mental health took priority, and she chose to leave after her shift.

The surprise karaoke session at the end of the show’s credits was the ultimate primal scream therapy. Both Dr. Santos and Dr. King were letting steam, temporarily forgetting the trauma.

Proud of being a nurse

On this Nurses Week, I support the theme: “Our Nurses. Our Future. Empowered Nurses Save Lives.” We need to secure our healthcare future by empowering the nurses to be the professionals they are, supporting them with the physical and psychological structure, and providing a safer work environment. To empower nurses means providing opportunities for growth through education and encouraging autonomy and leadership.

"The Pitt" showcases the ER staff in their frenetic environment. Nurses and doctors go from patient to patient. Nursing understaffing has been mentioned many times on the show. So, it is rewarding when you have time to connect with patients, to know them as human beings, not as people encumbered by their medical frailties. Time to offer a shoulder to cry on or to take time to shave their beard and cut their hair.

Digby was an unhoused patient waiting for an admission bed for IV antibiotics for his forearm cellulitis. Dana and Emma gave him a bath, then a shave and a haircut. The charge nurse told the new nurse to always respect the patients' dignity. When Digby saw himself in the mirror, he was teary-eyed and asked if his daughter would still remember him. And sometimes, some patients continue on their merry ways and return to the streets, just like Digby who absconded with Whitaker’s hospital ID and the resuscitation dummy.

Katherine LaNasa’s nuanced performance as a SANE (Sexual Assault Nurse Examiner) deserves another EMMY award. She was gentle and supportive as she performed the Rape kit evidence collection process. Compassion does take a toll. When the new nurse, Emma, accompanied the patient on a much-needed break, Dana finally allowed herself to cry.

The day shift employees made their way to the roof to watch the 4th of July fireworks in the Pittsburgh sky. They were reflecting on the shift that was. Perlah was emotional, perhaps remembering Louie’s fascination with fireworks. Dana shared that touching moment, perhaps remembering her own troubles.

ER nursing is not easy. It is not the place for the faint-hearted. I remain proud of the many nurses I worked with throughout the years, those nurses who questioned wrong orders, who advocated for their patients, who collaborated well with their doctor partners, those empowered nurses who stood their ground. When Emma held Louie’s hand during the debrief and persevered, continuing to work despite being choked by an agitated patient, I knew she would remain standing and learn from the best nurses ever.

THE PITT- A REVIEW FROM AN “OG” ER NURSE

2026-02-19T11:30:00.000-08:00

The HBO-Max TV show is set in a fictional institution called the "Pittsburgh Trauma Medical Center, affectionally nicknamed The Pitt. We referred to my former hospital as The Hurst. Even with a brand-name change, the nurses at another hospital kept the nostalgic name Santa Luca.

Season 1 had 15 episodes, smartly presented as one-hour shifts for this team of healthcare team. The usual 12-hour shift was extended to 15, after a mass shooting disrupted an already-crowded ER. Season 2 is also scheduled for 15 episodes. This time, the ER is bursting at the seams on the Fourth of July weekend with patients diverted from another hospital. For certain, there will be fireworks injuries, maybe traumatic amputations?

Authentic, real, and intense

In just a few minutes, at the start of the TV show The Pitt, I knew that this was as raw and authentic as any show about an inner-city ER will ever be. Dr. Robby walked through a crowded waiting room, was met by Filipino nurses, and had to talk a fellow doctor out of suicide.

With 35 years in ED nursing (newly retired), I consider myself an OG. Some say OG stands for “old generals or older generation”; I strongly approve of being called an Original Gangster. With just five of my fellow Baby Boomer ER nurses, we can probably account for 90% of the cases shown so far. And we approve this show as the best, most well-written, and most authentic medical show ever.

This show is highly realistic in its portrayal of the chaotic, intense ER setting; most hardened ER nurses would suggest there is organization amid the chaos that would have driven off a less courageous nurse on their first day. Yes, we have seen maggots, lice, bedbugs, and other crawling insects (fortunately not rats). We have seen many foreign bodies from all orifices. One time, a patient presented to Triage with a live vibrator inside her vagina that kept buzzing, and she had to stop her narrative because of orgasmic bursts (Psst, Pitt writers, maybe you can use this). There is mayhem and gore, but this is what makes the ER exciting for the adrenaline junkies that we are.

The ER producers hired real doctors and nurses to serve as consultants in the show. Some even act as nurses in the different episodes. To master the emergency skills, the cast underwent a 2-week bootcamp where they were taught the steps to intubate, put a chest tube, perform CPR, suture wounds, perform pericardiocentesis, and other procedures. They were also taught to confidently speak medical tongue-twister terms such as cauda equina, Sengstaken-Blakemore tube, Phytophotodermatitis, and methemoglobinemia. One of the executive producers, Joe Sachs, is a practicing (part-time) ER doctor.

The cacophony of sounds is not masked by background music. As in a real setting, we hear cardiac monitors, ventilator alarms, ambulance sirens, unit announcements, ringing phones, vomit sounds, the conversations between the healthcare team, and the groans and curses of the impatient patients and the short-staffed medical staff alike.

Like in all ERs (and other units), there is constant talk about staffing shortage, work stress, PTSD, diversions, overcrowding, burnout, mental health, substance abuse, insurance costs, and even patient satisfaction scores. What impresses me is that the ER staff came together in solidarity to save and care for their patients; the camaraderie was borne out of their shared experiences. The debrief after the mass shooting included everyone, including the ancillary staff, housekeepers, clerks, and Security.

When I wondered where the nursing leaders (Chief nursing officer, director, manager, supervisor) and other healthcare members were, my son explained that in a TV show, it may not be efficient to include so many characters. That will require more story lines, more characters to write for. So, it is artistic license, I realize. I am happy enough that I see Filipino nurses, at least.

The Cast

The cast is top-notch. Dr. Robby is played by Noah Wyle, formerly Dr. Carter from my other favorite show, “ER”. He expertly led the ER team in Season 1 to navigate an active-shooter disaster scenario. In Season 1, he welcomed new residents (of varying confidence and one with a predilection for bodily fluids splashing on his person) and a medical student (who fainted at the sight of a degloved foot). Throughout the show, he struggled with the traumatic memories of the COVID-19 nightmare when his mentor died. In Season 2, he is supposed to go on a 3-month Sabbatical after this last shift, like riding into the sunset, purportedly without a helmet (smh, as the Gen Z’s lingo).

The team of doctors from both seasons includes Al-Hashimi, Abbott, Shen, Ellis, Langdon, Collins, Mohan, McKay, Santos, Whitaker, Mel King, and med students Javadi, Joy, and Ogilvie.

Dana, played by Katherine LaNasa, is the charge nurse/ ringleader who keeps the combustible atmosphere from exploding into a sloppy mess. She reads the room, controls the patient board, and juggles patient rooms to accommodate new arrivals; most importantly, she knows who needs help at any given time. Situational awareness and mutual support make her the quintessential charge nurse. She organized the team to restrain a violent patient who needed to be sedated. She directed the new grad nurse to assist in showering/decontaminating an unhoused patient. She noticed the nurse, Perlah, fighting to control her emotions, so she took over in the post-mortem care of a patient.

Her team of nurses includes Lena, Perlah, Princess, Donnie, Jesse, Kim, Mateo, Sophie, and Emma.

https://www.townandcountrymag.com/leisure/arts-and-culture/a64355242/the-pitt-cast-characters-guide/

The show won many Primetime Emmy Awards, including Outstanding Drama Series, Lead Actor (Wyle), Supporting Actress (LaNasa), and Guest Actor (Shawn Hatosy, who played Dr. Abbot). At the end of Season 1, we learn that Dr. Abbot, a military veteran, is a single-leg amputee who uses a prosthesis.

A Patient’s Death

After episode 6 of Season 2, I bawled my eyes out, not only for Louie, but for all those frequent flyers I lost over the years, for those who we tried to help but couldn’t. Death is a constant in an ER, but there are some cases that hit us harder.

Louie (played by Ernest Harden, Jr) was a frequent flyer, a chronic alcoholic patient who appeared in Season 1. He was well-liked by the staff because he was well-mannered and always smiling, even with a blood alcohol level of 400. This time, it was the end of the road for him. Despite the paracentesis to relieve his ascites, he went into cardiac arrest. After the intubation, blood gushed out of the ET tube: pulmonary hemorrhage caused by liver failure. Even with the staff’s heroic efforts, Louie remained in asystole. Dr. Robby finally ended the resuscitation and pronounced him dead.

The debrief was heart-rending. For most ER staff who knew Louie, it was a surprise to learn the patient’s backstory. Dr. Robby relayed that Louie confided that he lost his wife and unborn child in a road accident, which catapulted him into a life of despair and led him to alcoholism.

The patient’s death, although not surprising given his worsening liver failure, was a shock to the staff who had cared for him in his frequent admissions to the ER. The staff paid their respects to a patient who had somehow been part of the ER family. A moment of silence; a gesture of humanity. Dignity even in death. Robby offered a Jewish mourning phrase to remember Louie: “May his memory be a blessing.”

There are so many stories behind the misfortune of our patients, if we only listen. Years ago, when I was a bedside ER nurse, I cried with the nursing staff when one of our favorite “regular’ drunks died from hypothermia when he collapsed in the street. He was quiet, never violent, never cursed us, never hit us, just smiled through our lectures. Before his alcohol addiction rendered him homeless (now called un-housed), he had a good job and a loving family. We used to bring a hot meal for “Mr. G”; there was no price tag on hunger, no restriction on being kind to vulnerable patients battling their own demons.

Workplace Violence

It is an unfortunate reality, but the world is not a safe place. In an overcrowded environment, emotions run high among some patients, who feel they deserve to be seen first. Dana was sucker-punched by one of those disgruntled patients (in Season 1). The whole staff was shaken by the assault on one of their own.

Instead of going home, Dana chose to finish her shift, to power through when a mass shooting called for a hands-on-deck response from the ER staff. The SWAT team showed up in the ER, just in case the shooter came in to finish his evil mission. It was scary. There was even a question if Dana was coming back to work.

According to the New York State Penal Code, “Assault in the Second Degree in New York allows felony charges, instead of misdemeanor charges, to be brought against someone who acts, “with intent to cause physical injury to a registered nurse or licensed practical nurse…while such employee is performing an assigned duty.”

In episode 6 of Season 2, we learned that the person who assaulted Dana was apprehended, but she refused to press charges. In real life, I have always persuaded the nurses to demand felony charges. It looked like Dana was still struggling with her decision to let go and may not have come to terms with the trauma to herself. Although she might appear to the world that she is coping well, she seems hypervigilant and edgy. The trauma lingers long after the assault. She didn’t even answer the student nurse's question about why she stayed. I suspect that at the end of this season, Dana will reveal her "Why".

Humor in the ER

To survive in the ER, the healthcare team often shares jokes with each other, reports on what new foreign object the patient ingested or inserted. Tongue-in-cheek humor; anything to brighten the day and to lighten the load. A chuckle a day keeps us sane.

Ruined Scrubs: In Season 1, Whitaker made several trips to the scrub vending machine due to several accidents from bodily fluids (blood, urine, vomit, and spilled milk of magnesia). In Season 2, Ogilvie had the dubious honor of poop exploding on him after a fecal disimpaction. A "poop cannon" or "assplosion" is a great rite of passage for an obnoxious medical student.

Dr. Shen held on to his Dunkin' iced coffee, even while acting as a Triage officer during the disaster. I think it is a “bird flip” to the Infection Control team.

A journalist faked an injury to slip into the ER, then slipped on a wet floor after being discovered. Santos then discarded his phone in a bucket of bloody water. Ooops, karma indeed.

Santos is someone who you would either hate or love. I think there is a soft, sad side to her that she tried to hide behind her snarky remarks and nicknames for her colleagues (Crash and Huckleberry). When a nun’s conjunctivitis culture came out positive for gonorrhea, Santos quipped, “Immaculate infection.” Perlah and Princess were gossiping, then Santos interjected in Tagalog.

(Update 2/20/26- In episode 7, Santos sang "Ili ili", a lullaby from a province in the Philippines, to calm Baby Jane Doe. In real life, Isa Briones is a Broadway actress.).

Rats!!!! Four rats scampered out from an unhoused patient’s clothes. The staff was so grossed out, and Dr. Collins jumped on the stretcher, wielding an IV pole. In a dramatic moment, Whitaker captured one of the rats, covered it with bed linen, and effectively broke its neck, just like an efficient former farm boy would. The staff broke into applause.

Dr. Mehta, the resident stroke neurologist, delivers dumb dad jokes. The staff just rolls their eyes behind his back.

The patient, Earl, witnessed Javadi flirting with nurse Mateo. With a raised eyebrow, he asked, “Am I at a hospital or in a romcom?”

Myrna was a gutter-mouth patient who wheeled herself around the ER, poking fun at anyone she encountered with her sexual innuendos, even calling Robby “fruitcake”.

Mel is neurodivergent and socially awkward. Her enthusiasm manifested in her inappropriate “high fives” and fist bumps after an exciting case.

Joy, the new medical student, is funny and sassy with her one-liners. After Ogilvie bragged about learning Farsi from his friends, Joy deadpanned, “I’m surprised he has friends.” As she was picking out glass shards from a bloody leg, Joy nonchalantly remarked, “Thrilling - totally worth $200,000 in student loans”.

A patient who used Super Glue on her fake eyelash dismissed Dr. Langdon (the actress’s real-life boyfriend) and asked to be treated by the super-popular medical influencer on TikTok, Dr. J, who turned out to be the medical student Javadi.

At last, Pinoy Nurses in an ER medical drama

“The Pitt” features two Filipino nurses, Perlah (Amielynn Abellera) and Princess (Kristin Villanueva), as part of their ER team. Not just background players, but crucial to the emergency department team and highly respected for their expertise in the crazy, hectic world of emergency medicine. They provide comic relief when they speak Tagalog to each other, perhaps a coping mechanism to the work stressors. There is something therapeutic about bantering in your language, and sometimes communicating just with your eyes (and pointing with your lips).

The duo seemed to be planning a surprise 21st-birthday party for the med student Javadi. I hope that they will order the famous Filipino party food, lumpia and pancit. I am sure the ER staff would prefer these to pizza and donuts. If there were a betting pool like the one the security officer, Ahmad, ran, I would bet there would be lumpia and pancit at the party. After all, we don’t need any excuse to throw a party in the ER. I will be amazed and impressed if that happens.

After 15 seasons of “ER” without Filipino nurses, we see these bad-ass nurses and work besties claim their rightful place as part of the PITT team. As a Filipino ER nurse for 35 years, I felt represented. Finally.

Episode 6 “12:00 PM”, Season 2- a homage to nurses

This episode was directed by Noah Wyle and written by Valerie Chu. Thank you to the Pitt crew for showing what the nurses do best- caring and being excellent. Thank you for recognizing our profession.

Kudos to Dana, Perlah, Princess, Donnie, Lena, Jesse, Kim, Mateo, Sophie, and Emma.

Whitaker echoed what Robby told him before: “Always listen to the nurses. They run the ER; we just try and stay out of their way.” I am glad to say that real-life doctors have said the same thing to their new interns and residents every time they start their ER rotation, usually in July. A doctor I worked with advised his residents: “If the nurses like you because you gave them the respect they deserve, they will have your back.”

Dana is a queen, part-Mama Bear and part Incredible Hulk. Lena, the night charge nurse/ part-time death doula, is a great partner to Dana.

It is true that many nurses have saved lives by suggesting alternative interventions, as when multilingual Princess suggested an EKG for an abdominal patient. Perlah took over Charge when Dana was hurt. Donnie was ready for his new role as a nurse practitioner and impressed the new interns with his suturing skills. Mateo’s triage skills were on point; he’s someone you would want with you when the going gets tough. Kim and Jessie not only play nurses on TV, but they are real-life ER nurses. Kim expertly recited the steps for a Fluorescein injection. Silver-haired Jesse (also a drummer) knew what he was doing, an expert among other actors. Sophie is actually a physician assistant who also taught in the cast bootcamp.

I see myself and my friends in all these nurses. I can relate to their challenges and uncertainties, as well as to their determination to give their best. We were like Emma once, naïve, unsure if the ER was right for her. When she reached for Louis’s hand during the debrief, even if she did not know him at all, I knew she would make a great ER nurse.

Triage Stories: Believe It or Not

2025-10-11T16:41:00.000-07:00

HAPPY EMERGENCY NURSES WEEK

OCT. 5-11, 2025

Some Emergency Department nurses hate being assigned to Triage. This patient encounter may mean the difference between whether the patient enters the Main treatment area or has to wait in the crowded waiting room. A difference between life and death. It is a stressful assignment.

A triage nurse is at the front lines, in the front-line department of the hospital. The word “triage” came from the French word “trier,” which means sorting out. In a big, urban community hospital, the Triage area is like a marketplace, where everyone clamors for the Triage nurse’s attention. With a long list of walk-in patients waiting to be seen and a long line of EMS stretchers, the nurse sorts the patients according to their level of acuity. It is neither an assembly line nor a first-come, first-served process.

A Triage nurse cannot be easily frazzled. She needs to be the most level-headed and calm person in a sea of disjointed conversations and screams that beg for attention. In an environment fraught with tension, worried relatives, pushy EMS personnel, and harried and overworked staff (doctors, nurses, technicians, and registrars), patients demand to see the doctor ASAP. Actually, it is those non-verbal patients who are the sickest, not like those asthma patients who state “I cannot breathe” while speaking in complete sentences and carrying on a loud conversation on their phone.

A new grad should not, must not be assigned to triage. It is a disservice to them and to their patients. Distinguishing between Level 1 (likely to die) and Level 2 (high-risk) patients from Level 3 will require the clinical expertise and knowledge that an experienced nurse, with their “gut instinct,” can easily provide. Some doctors even question the nurse’s decision, despite not being trained that a Level 5 does not require any resources and a Level 4 needs only one resource. No, oral antibiotics and tetanus injection are not a Resource. It would be beneficial to post the Emergency Severity Index (ESI) triage algorithm and the Resource table in both the Triage room and the doctor’s lounge to prevent such microaggressions as questioning the acuity level.

Emergency Severity Index (ESI) Triage: Prioritization

Despite the stress, I actually enjoyed my stint as a Triage nurse. It was fun sometimes. Indeed, full of surprises, interesting, and weird stories for the lunch discussion in the nursing lounge.

ER nurses are superstitious

Beware: Never say the word “Quiet” in the middle of the ER, unless you are ready to incur the wrath of every single ER personnel who finally had that precious time to take their bathroom break, or even to take a breather. That "Q" word is a jinx and will bring in a swarm of locusts, or worse, a busload of patients.

Mass Casualty events are not fun, unless you’re doing just a drill, complete with moulage and badly-trained actors and a roomful of C-suite VIPs who get in the way.

Foreign Bodies

ER nurses live for the simple pleasures. We keep a running tab on what’s the weirdest thing we found in any body cavity. With every Triage class I teach, I poll the nurses on what foreign objects were found in all orifices (oral, ear, vagina, rectal, and penis).

The inquisitive kids put anything and everything in their mouths and ears, including lithium batteries (medical emergencies that can cause life-threatening internal chemical burns). But adults are more inventive, and sometimes, scandalous.

As experienced as I am, I am still amazed by what others have discovered. It has almost become a contest on who can come up with the weirdest thing that “accidentally” went in “there (front or back)”. Sometimes, patients say, "I just slipped and fell, and that thing got pushed up into my rectum."

The trusty Wikipedia (smirk) wrote: "Polyembolokoilamania is the act of inserting foreign bodies into orifices such as the rectum, urethra, and vagina. It is often exhibited by patients with Smith–Magenis syndrome. When motivated by a desire for sexual gratification, it can be considered a paraphilia.”

Here’s a more reliable article from the National Library of Medicine: https://pmc.ncbi.nlm.nih.gov/articles/PMC3357565/

Foreign bodies found were “eg, beans, dried peas, popcorn kernels, hearing-aid batteries, raisins, beads, coins, chicken bones, fish bones, pebbles, plastic toys, pins, keys, buckshot, round stones, marbles, nails, rings, batteries, ball bearings, screws, staples, washers, pendants, springs, crayons, toothbrushes, vases, razor blades, soda cans and bottles, silverware, hinges, telephone cable, and guitar picks.”

More sensational pieces were re-purposed for sexual gratification, including a live vibrator that kept buzzing, and the patient had to stop her narrative because of orgasmic bursts. Now that all these points have been discussed, it is not to make fun of the patients, but rather for the purpose of nursing education. No HIPAA violation, no patient identification disclosure, I promise.

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

Virgin births and surprise pregnancies

Case #1:

“Are you pregnant?" the triage nurse asked the female patient who rushed into the room. The patient was puffing hard and writhing in pain.

"No way! I'm just fat. I take birth control pills."

Minutes later, the patient's spandex began to sag at the crotch. The nurse barely had time to catch the baby.

Case #2:

Patient: "I swear I'm not pregnant. Shouldn't be. I’m not sexually active. But my belly hurts soooooo much!"

Parent: “She’s only sixteen. She’s a virgin.”

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.

Patient Teachings

There are always opportunities to teach patients about misconceptions and harmful practices, such as polypharmacy and overreliance on herbal medications that can interact with their drugs.

Workplace Violence- Felony Assault Law

Zero tolerance for workplace violence. According to the New York State Penal Code, “Assault in the Second Degree in New York allows felony charges, instead of misdemeanor charges, to be brought against someone who acts, “with intent to cause physical injury to a registered nurse or licensed practical nurse…while such employee is performing an assigned duty.”

EMTALA

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. As a Christian and as a nurse, I stand in support of this- hospitals should provide a medical screening examination to anyone seeking emergency care, regardless of their ability to pay, insurance status, or citizenship. I would have never allowed a dying patient to wait for services to check their immigration status. It is inhumane, immoral, and un-Christian behavior.

Counting my Blessings

Being a Triage nurse changed my perspective. I knew how crucial it was to get the patient to the right place with the right resources for treatment at the right time. I also felt blessed to be in a position to assist the patient in the best way possible.

I counted my blessings every day, because whatever inconveniences and worries I had at that moment, nothing could compare with the sufferings out there. I have seen many moments that broke my heart, and some moments tugged at my heartstrings.

Dear Classmates, 45 Years Later

2025-09-17T17:47:00.000-07:00

Dear classmates,

Thank you for a wonderful reunion experience in Europe. Our class reunion was a hoot! Sixteen classmates from the Arellano University BSN Class of 1980, along with their spouses and sisters, gathered for the 45th anniversary reunion in Norway, then went on a cruise along the European coast via MSC Poesia Cruises.

Not everyone gets a chance to reunite with those they started the journey with. Not everyone has the opportunity to reconnect and restore the camaraderie borne by the blood, sweat, and tears of nursing school. After our graduation ceremony in the Philippines, we went our separate ways to navigate the challenges of our personal and professional lives.

Somehow, our class came together again. In October 2011, the 1st Global Reunion of the Arellano University College of Nursing was held in Las Vegas, with nine classmates from Section 2 in attendance. That was thirty-one years after our class graduation in 1980. We screamed, hugged, chatted away, and laughed at each other’s jokes and remembrances, as we tried to make up for the long years in between. We resolved to reunite at least every two years.

Nursing Student Years- 1975-1980

Those years in class and in clinicals—ranging from V. Luna Medical Center, Quezon Institute, Mental Hospital, to the community centers—provided us with invaluable hands-on experiences that prepared us for the challenges of “real life”. We wore striped blue seersucker uniforms with stiff, starched white aprons and large nursing caps perched on our heads—the good old days.

Manila Sound birthed the Original Pilipino Music era. The musical tapestry of our lives featured songs from Hotdog, Cinderella, Freddie Aguilar, Apo Hiking Society, and, as sung by Rico J, “namamasyal pa sa Luneta.”

We overcame “terror” instructors, struggled through our thesis projects, and played skits for our patients on our last days of clinical rotations. We graduated despite the butt-numbing traffic and waded through floods (flood control is an ongoing problem in the Philippines, but I digress).

Forty-five years later, most of the OGs have retired. We are the Baby Boomers, what some people call “Old Guards”, although I prefer “Original Gangsters”, because, you know, we were badass nurses.

On August 29, 2025, we descended into Oslo, Norway, and were welcomed by our gracious hosts Alma and Homer. Our program began with a Welcome address by Alma, a Celebratory remark by Shirley, a birthday celebration for our four classmates (Amie, Louie, Cely, and Janet), and a closing remark by Ces.

How can I describe the party? BELLY LAUGHS!

Not just a mild or polite chuckle, but that deep, loud, and hearty laugh from the games: Grouping ourselves, Charades, and Hephep Hurray. Just a good thing that none of us needed Depends yet. We let go of our inhibitions, being carefree, being young, and playing as if we were kids again, and we were grateful for the camaraderie and for being able to enjoy each other again. Unabashed joy in just being silly together. Priceless.

Our class reunion was like this. Hatakan, hampasan, takbuhan, naiihi, mahina, sigawan. The floodgates opened, and we shared memories from our student years. The chatter crescendoed to the point that the spouses wondered what banshees we are. You can now check this off your list: no Alzheimer’s memory loss yet, because those moments were captured in our hearts.

SALAMAT PO, MGA KAMAG-ARAL

Alma and Homer, thank you for putting up with this group of gaggling hens and their supportive spouses. You were like shepherds trying to control the errant flock. That was a colossal effort to plan the itinerary, which included the bus ride to Vigeland Park to see the sculptures (especially the imposing Monolith), the Holmenkollen Skating Arena, the Evening fjord boat ride, and the reunion party held in Stortua. Cheers for your patience and fortitude. Homer, you’re a stand-up comedian; your low-key comedic liners are hilarious.

Cely, thank you for your generosity through all these reunions. You have sponsored the reunion t-shirts and the tarpaulin. You are so giving; that’s why you are so blessed. The green t-shirts are my favorite; the color is so vibrant and hopeful. In truth, the bright green color served as a beacon, or, to put it more bluntly, like an invisible rope to get us all tethered to the large group.

Ampy, thank you for starting all of this when you and Althea searched for our classmates online. You were like our mother hen/detective in coaxing us out of hiding, even opening your gorgeous house in New Jersey. I would definitely drive 2+ hours to your Robbinsville house to savor your delicious food spread. And thank you for sharing your health challenges with us; you are a survivor.

Salha, thank you for your persistence and ingenuity with ChatGPT to provide travel tips to us, especially for those who are newbies with cruise etiquette. You are so level-headed, even redirecting us when some of us are impatient (maybe we have ADHD). You're like an encyclopedia when it comes to travel experience. I nominate you to be the Secretary for this group.

Luz, thank you for commiserating with me when my hip pain sidelined me due to my overconfident walking. My fellow PWD, lol. Yet, you're still poised and fashionable. I do think you're a great Zumba instructor.

Shirley, thank you for your invigorating celebratory remarks. I appreciated how you engaged the group with your words of wisdom and encouragement, spoken like the great nurse educator that you are—hats off to our Magna cum laude. I would have loved to be in your class.

Yoly, thank you for joining us and sharing your effervescent and bubbly personality. Thank you for your financial tips. When we visit Ampy again, I look forward to all the corn cobs you can bring.

Neth, thank you for surprising us with your “pregnancy news”, lol. I still remember how you surprised us as Speedy Gonzales at our Florida reunion. I hope your son Michael wasn't traumatized or exhausted by our group's shenanigans.

Lita, thank you for being such a bundle of energy, fellow ER nurse. I love your stories about your grandkids. We will not tell anyone who your favorite is. Congratulations on being a survivor, too.

Amie, thank you for being the “selfie queen”. You made sure that we posed for the pictures, but sorry, we are just bad at following directions. Asoo!

Janet, thank you for opening your heart and sharing memories of your dog, “Pogi,” with us. I can relate, because we lost Boomer at around the same time. Time heals.

Mate, thanks for inspiring me to get fitter. We didn’t know about your accident, but you persevered. You’re a Superwoman.

Ces, thank you for being you: honest, joyful, funny, and pragmatic. You were quiet during our nursing days, but now you have a lot of stories to tell. Who can forget how you went over the fence that got you expelled from your dormitory? You're the quintessential Treasurer of our group.

Louie, thank you for sharing your wife, Yo, with us; she is delightful. Thank you for the scarves and the lunch treat. You have always been generous; remember that you paid for the half-page ad for our class section at the Las Vegas reunion.

Dori, thank you for joining our section. You blended in very well. Please join us at our next reunion.

Sisterets, thank you for the three sisters who patiently tolerated their "Ates": Bheng, Poleng, and Lucy. We enjoyed your company.

Spouses (Homer, Ed, John, Arnold, Mel, Gerry, Gary, Manny, Ofre), thank you for supporting your respective wives. You are a big part of this experience. As eager as you were to pose for the pictures (this was your reunion, too), you certainly did better than the ladies in following directions. It was a joy to see you enjoy the games, too.

Dear classmates, take a bow. We have achieved greatness beyond our own expectations. We traveled different paths, but we made it through these days. We define our own success, inspiring others in our own unique ways, and for that, as Shirley said, “Pat yourselves on the back. Let us celebrate ourselves.”

We’ve come a long way from the naïve and bright-eyed nursing graduates in 1980. Forty-five years never looked so good.

I am happy we continue to grow as a “family.” We first sang “That’s What Friends Are For” in Vienna in 2018. Just promise me, please, next time, you'll know the lyrics by heart.

Let's take care of ourselves, and we'll see each other in January 2027.

I. Am. Retired.

2025-08-21T20:21:00.000-07:00

This is it. End of shift last July 23, 2025. I. Am. Retired.

I waited one month to write this post. I took the time to reflect on this moment, which I have been waiting for since I stepped on American soil 42 years ago. I needed to savor the significance of this career milestone: being suddenly freed from the rigors of waking up early, sitting in traffic, driving through icy roads, and having to hold my tongue to maintain peace. I wanted to sit in the space of reflection, to marinate the concept of retirement in my mind, and to drink in the wonderment that finally the time has come to hang up my lab coat.

Two years ago, my friends opted for early retirement, often enticing me with pictures of their travels, but I was not ready to let go. My work gave me a sense of purpose (aside from my family). My work friends filled my head with compliments about my guidance and mentorship, and my students’ feedback was both satisfying and encouraging; they even urged me to post on TikTok, especially when I used the analogy of dysfunctional romantic relationships to teach heart blocks.

Frankly, the thought of retirement scared me. “How will I spend my day? Would I lose my mind with boredom? Would my muscles weaken from non-activity? Would my brain cells shrivel up for lack of mental stimulation?”

The epiphany that it was time for retirement sneaked up on me. I was feeling energized after a vacation in the Philippines, and I realized that I wanted to travel the world more than I ever did. My college classmates, most of them retired, regaled me with their travel stories. For our 45^th anniversary since graduation in 1980, the BSN class of Arellano University College of Nursing was preparing to have our reunion in Norway.

I was also mesmerized by some painting vlogs on Instagram. My Facebook algorithms shifted to drawings and instructions on acrylics, watercolor, and gouache mediums. I realized that I wanted to pursue my long-dormant artistic side. My Renaissance area beckons me.

Retirement is a milestone, a gift, a blessing that is often denied to others. It is taking control of my narrative and choosing how to live my life, when, what, and how at my leisure.

Bookends of my professional life

In January 1983, I was young, naïve, and eager. Fresh from my stint with the Philippine National Red Cross, I embarked on my nursing career in New York City with stars in my eyes and dreams in my heart. I was ready to conquer the nursing world.

I made a meme of my younger self as I stood on the grounds of Roosevelt Island looking toward Manhattan, “Someday, you will retire. And you will know that you were a bad-ass nurse who cared for her patients and her colleagues.”

After working at Coler Memorial Hospital, I began my career in Emergency Nursing at Elmhurst Hospital Center, Maimonides Medical Center, Mount Sinai Morningside, and then St. John’s Hospital. I must be a glutton for punishment, or maybe an adrenaline-junkie. Perhaps I needed to channel my nervous energy into the high-stakes patient care. Life was never dull, never placid, never predictable. The word “Quiet” jinxes everything, and whoever uttered that word would be ostracized for the rest of the shift.

I have many stories to share, some of which were featured in two memoirs that I published. What a journey it has been. I am humbled by the opportunity to care for all the patients that I met and to work with strong, gracious, and compassionate colleagues along the way.

Before I officially retired, the staff at St. John’s Episcopal Hospital threw me a surprise party. The Nursing Professional Development educators organized a celebration attended by nursing leadership and staff from various units. It was my special "Lollipop moment". A “lollipop moment” is when someone said something or did something that fundamentally made your life better.

As I walked down the colorful path, each person handed me a lollipop. In my classes, I have encouraged my students to remember the impact they have on their patients and coworkers. I also encouraged them to reach out to those special people who have made an impact on their lives, as introduced by Drew Dudley in his TED Talk, by giving them lollipops.

Imagine getting my lollipops and receiving notes of thanks from everyone. I love, love, love the Lollipop moment notes and the touching words from everyone. Priceless!

https://www.facebook.com/100000202167830/videos/pcb.25096204806636245/1276051227389132

Thank you for the memories

I am grateful for the experiences that have shaped me into the nurse I am today. I stumbled along the way, but through it all, I rose even stronger. No longer a fumbling neophyte, I am a confident nurse who knows I have succeeded on my terms. I don't define my success by other people's definitions. I am proud of how I have metamorphosed from a novice to an expert, mainly due to the lessons I have learned along the way.

As I rose from the ranks into leadership and educator positions, I stood on the shoulders of those who came before me, and in turn, I extended my support to those who came after me. As an ER nurse, I navigated the psychological landmines by focusing on the emotional rewards, which strengthened me, even through the pandemic's challenges. I found my joy in nursing by being mindful and intentional in seeking those serotonin boosters and mood lifters. I fought burnout by acknowledging the impact and influence of nurses in the lives of our patients, even though we sometimes may not get the instant gratification and appreciation from them.

I am an unapologetically sentimental person, which I inherited from my father and passed on to my son. I treasure the memories and appreciate the messages and remembrances from my colleagues and the other staff nurses. Over the years, I have collected messages and emails from those who acknowledged my contributions. In moments of self-doubt, they reinforced my “Why”.

Please indulge me when I include some of these kind words:

“As a novice educator, you took me under your wings and provided guidance, mentorship, and encouragement that I am so appreciative of. Thank you for always providing a listening ear and giving constructive feedback that continues to guide my career.”

“I have been holding on to you tightly since I joined EHS, and you have welcomed me with open arms. I am honored to say that I have received guidance and support from THE Jocelyn Sese.”

“Your dedication to EHS has been instrumental in elevating our nursing care and fostering a positive shift in our culture. You've set a remarkable example for all nurse leaders to aspire to. Personally, your guidance has been a great source of validation for me, ensuring I'm on the right path.”

“I want you to know that I truly couldn’t have reached this milestone without the solid foundation I gained during our two weeks of didactic training with you. Today, I’m able to confidently speak the language of critical care, relying less on my usual hand gestures and more on solid clinical communication. I am living proof of the impact you’ve made on the next generation of nurses.”

Post-retirement Life

When someone asked me what the first thing I would do when I retire, I answered without hesitation that I would attend the solo concert of Jin of BTS in New Jersey. The Jin concert at the Prudential Center in New Jersey on July 31 is my gift to myself for retirement. Jin was excellent; he did not phone in his performance, but gave it his all, with bulging neck veins and exposed deltoids, too. Mr. WorldWide Handsome winked, smirked sexily, and blew us his trademark kiss. I am eagerly awaiting the reunion of the 7-member supergroup BTS for a concert next year.

Retirement checklist:

Attend our 45^th class reunion with my BSN group in Norway and a cruise (from August 24 through September 6)
Complete the “Art with Suzanne” online course, start painting, and explore the creative process
Travel more and write more travelogues.
Attend more music concerts and Broadway shows.
Swimming lessons so that I can snorkel and dive on my next vacation
Finish my BTS Lego set, continue crossword and jigsaw puzzles for my mental exercise
Write my third book
Write, write, write
Read, read, read
Consider other Social Media platforms and learn more about Artificial Intelligence tools.

(Psst: I do have some teaching gigs waiting for me after my Norway vacation. Cannot just go cold turkey. Need to wean myself.)

The Final Curtain

The final curtain has closed. As Frank Sinatra sang, “Regrets, I've had a few. But then again, too few to mention. I did what I had to do and saw it through without exception. I planned each charted course, each careful step along the byway. And more, much more than this, I did it my way”.

What a journey it has been. I am proud to be a bad-ass nurse.

I am ready to live my best encore. Bring it on.

The Power of Nurses... and the Countdown to my Retirement

2025-05-11T18:56:00.000-07:00

This week, from May 6 through May 12, we celebrate National Nurses Week, starting with Florence Nightingale's birthday.

The American Nurses Enterprise chose the theme “Power of the Nurses” to shine a much-deserved spotlight on nurses' impact and influence on healthcare, from the bedside to the boardroom, from novices to experts.

At the Blessing of the Hands ceremony, the nurses recited, “May our hands always bring healing. May they always be gentle. And may they always remember the power they hold—the power of a nurse.”

The hospital held a Super-Nurse Cape Competition as a fun activity. The cape is an iconic image symbolizing the compassion and caring of the nurses who served under rigorous conditions. It is a poignant reminder of our “super-hero” status during the height of the COVID-19 pandemic, but our powers never left.

The power of our minds as we embrace new technologies, research, and evidence-based care.

The power of our vision as we promote professional growth, participate in the hospital’s strategic initiatives, and continue to make Nursing a loud and credible voice in healthcare programs.

The power of our hearts as we navigate nursing challenges through staffing issues and workplace violence, the power of our hearts to find our joy in the workplace, and the power of our hearts to put caring for our patients as our “why.”

The power of our hands as we healed and cared.

Our group of nursing educators from the Nursing Professional Development visited the different patient units with our Wellness cart filled with goodies (a variety of teas, granola bars, lip balms, pens, hand lotions, stress balls, lollipops, lavender sachets, and Skyflakes chocolate biscuits). A simple Thank You for a job well done. The smiles from the nurses, as they paused from their busy work, to engage with the educators: Priceless.

This Nursing Week is a turning point for me. A milestone of all milestones. It will be my last Nurses Week as an active-duty nurse. I have reduced my work hours for the past year and slowly inched forward to retirement. After 42 years as a nurse in the United States, I will retire this year at the end of July. Yes, 2025 will be, not next year. This is it.

It will be a great honor to join the ranks of those who retired to enjoy the fruits of their labor. I reflect on the great work of those who led the way, whose profound influence left an indelible mark on those they worked alongside. They touched many lives, dried many patients' tears (and their own), uplifted many hearts, celebrated their peers, endured the long hours, and overcame many challenges. They were powerful nurses; on their shoulders we stood and learned.

A life spent in service is well-lived and blessed with immeasurable emotional rewards. Thank you to Paula, Cecil, Rosemary, Trish, and Avis for allowing me to use your pictures. They have many stories to share and precious memories to inspire. These ladies are legends in their own right, leaving a legacy of excellence through the years.

Many more retired before me, and sadly, some who did not make it to retirement. I am humbled to have worked with them, from Coler Memorial Hospital, Elmhurst Hospital Center, Maimonides Medical Center, Mount Sinai Morningside, and St. John’s Hospital.

It has been a wild ride. Promise, I will post more photos on my Retirement blog. What a journey it has been. My countdown begins.

Five Years Later: Surviving the Covid-19 War

2025-03-31T20:40:00.000-07:00

Five years ago, on March 11, 2020, the World Health Organization officially declared COVID-19 a global pandemic. I remember the day as if it were only yesterday. The memories are vivid in my mind; the heartaches of losing friends and numerous patients leave an emotional scar in our hearts that will haunt us for the rest of our lives. The fear remains that another pandemic might come and change our world again.

I wrote this about my burnout:

At the beginning of April 2020, the Covid-19 pandemic burnt me out.

I remember waking up in bed, physically drained from a fitful sleep and emotionally shattered by the friends and patients we lost. I debated calling out sick that morning because I dreaded hearing the frequent overhead pages for the code team. For the first time in my long nursing career, I was at a crossroads I never thought I could ever be at; I thought of quitting. I wanted to run as far away as I could, away from dying patients, away from the heartaches. But I could not abandon my staff, so I stayed resolute in fighting alongside my courageous staff in that dreadful war.

Five years later, I feel privileged to be part of the army of healthcare staff worldwide who battled the war. Today, I browsed through the photojournals that chronicled our fight.

Yes, we survived. There was a light at the end of the tunnel. It was just taking one day at a time, putting one step ahead, until finally, the vaccine came, and later on, we finally took off our mask.

I am not the only one remembering that day. The burnout and the PTSD that followed were real.

Five years later, these are just distant memories for most. I know that for all the healthcare workers who struggled through the "war," it was an emotional and challenging process to move on to the new normal. May we all support each other as we learn from the past, and hopefully, we will not have to go through this again. I celebrate the resilience of these nurses and all those who continue to make a difference every day.

We are bruised but still standing.

Covid Diaries:

https://fliphtml5.com/ywabu/nkyh

https://fliphtml5.com/ywabu/bmzj

Lollipop and Halo-halo Moments: Mindful and Intentional Self-care

2024-11-24T19:42:00.000-08:00

It is not easy to be a nurse nowadays, not even for a staff nurse or a nurse leader. Amidst all these uncertainties, nurses struggle with the stressors of an increasingly demanding profession. Nurses hold the fabric of patient care in a stressful environment. What if the fabric is frayed at the edges? How can nurses take care of their patients when they need help themselves?

The job is emotionally exhausting, and we often try to continue caring for our patients to the point of burnout and, in some cases, clinical depression. We survived the Covid-19 pandemic four years ago, but it had an immense impact on our mental well-being. The statistics show a dire picture of post-traumatic stress disorder and suicides in the healthcare profession.

Mental Health and self-care

The American Academy of Nursing (AAN) Expert Panel issued their Consensus Statement in the spring of 2023 about the drivers of Nurse Suicide: the stigma associated with asking for and receiving treatment to support mental health, job-related stressors, and lack of access to mental health treatment.

The National Academy of Medicine suggested a bundled approach to sustaining a positive work environment, reducing the stigma for those seeking mental health care, and focusing on the mental well-being of healthcare workers.

On November 20-22, 2024, the 1199SEIU League of Registered Nurses held a nursing conference in Montego Bay, Jamaica, titled "Empathy in Action: Caring Beyond Ourselves and Honoring Self-care." I was honored to be one of the instructors. My topic was "Finding Your Joy by Finding Your Lollipop Moment." It was a truly enriching experience to promote self-care and mental health to about 148 nurses who traveled to Jamaica. I dedicated my presentation to two of my former staff nurses who we lost to suicide.

Lollipop Moment

Although the topic was somber, it was uplifting as we discussed ways to find joy in our personal and professional lives. I encouraged the audience to share their "lollipop moment," which was originated by Drew Dudley, a dynamic leader, author, and inspirational TED Talk speaker. A “lollipop moment” is when someone said something or did something that fundamentally made your life better.

Nurses make a difference every day, but sometimes, they must be reminded about their lollipop moments. The nurses did not take long to share their proud moments of touching someone’s life, whether a patient or a fellow nurse. It was heartwarming when one participant thanked her mentor (who was also present) for her guidance and support during the COVID-19 pandemic.

One nurse approached me after the session to express how empowered and inspired she was. She acknowledged that she needed to hear all the instructors drive home the truth that nurses must place themselves at the forefront of mental health care.

Halo-halo moment

Then, I introduced my Halo-halo moment, when I pause and enjoy my comfort food, forget my A1C (blood test to diagnose Diabetes), and savor the incredible moment of finding joy in the simplest things. Halo-halo (“mix-mix”) is a popular cold dessert in the Philippines made up of crushed ice, evaporated milk, sweetened kidney beans, coconut strips, toasted rice, sago, leche flan, and ube ice cream. My son Jordan described it best.

Caring beyond ourselves

We also went to a local school to distribute book bags to grade-school children, who welcomed our group with shy smiles but were eager to hug anyone who opened their arms to them. The group of nurses also visited churches and a local hospital to conduct community teaching on kidney health, managing severe bleeding, and maternity child health.

Mindful and Intentional

We must be mindful and intentional as we seek our moments of joy to keep our mental well-being. We must maintain our focus on strengthening the morale of our nurses. We need to help and support each other.

The Jamaica trip was restorative and invigorating. There were singing, dancing, and laughter. There was healing.

The nurses enjoyed the amenities of the inclusive resort but also ventured out of the hotel to experience other attractions. As Bob Marley sang, "One Love, one heart. Let's get together and feel all right".

Coler and Us... Through The Years

2023-10-05T19:07:00.006-07:00

In the 1980's, the Pinoys invaded Roosevelt Island. Forty-one years ago, on this tiny island in the middle of the East River between Manhattan and Queens, the Filipino nurses started coming in earnest. In the 70’s, Filipino nurses were recruited for the two chronic care facilities on that little island. But in the 1980’s, the nursing shortage was at its worst. The Pinoy nurses were the city hospitals’ solution for the nursing crisis. With stars in our eyes and dreams in our hearts, we immigrated to the land of promise. After the first five Pinays came in 1982, there was an avalanche of nurses with about 100 nurses recruited from January to May of 1983 to work at Coler Memorial Hospital.

We are forever bonded by the experience of starting our nursing career in the United States. We struggled to adapt to a new life and culture. We had to learn the lingo, and I am almost certain that somebody else, aside from me, did not know that a Q-tip is a cotton applicator. My four years at Coler started me on a good path, and my memories of my first years are forever in my heart.

Sept. 30, 2023- Coler Filipino Nurses Grand Reunion at D’Haven Restaurant and Club.

And so we all came together to celebrate our beginnings, all 71 of us who answered the call from the organizers, the Glowing Gold Ladies. The nurses of Coler Hospital (retired and not) converged from far and wide- from California, Texas, Florida, and New Jersey. The out-of-towners brought their little sunshine to cheer the rain-drenched New Yorkers.

The Origs from 1982 were there. Then, the different batches of nurses who arrived in 1983 and beyond showed en force. So happy to reconnect with those who started life in the United States as young, naive, and eager nurses. A return to our wonder years, when life was challenging but simple.

Thank you to the Glowing Gold Ladies for organizing such a massive and fun reunion. Thank you for the historical presentation about Coler, as well as showing our old pictures. At first, it was difficult to remember the names (getting old, you know) but the souvenir journal helped to clear the cobwebs in our minds. Love seeing familiar faces light up with recognition. Somehow, I am still Cerrudo for most.

And we got to celebrate our September birthdays again. I wish to have been able to collect some nursing stories from this group with their varied experiences. Collectively, we have a lifetime of memories to share. But tonight was for being young again and just having a good time. We started as colleagues, and we ended as a Coler family.

Oct. 1, 2023- Day 2 Coler Filipino Nurses picnic reunion at Cunningham Park sponsored by the energetic Glowing Gold Ladies. I bet that this dynamic group can do anything they set their minds to. Well, I have a proposition to them that I will talk about in a new blog post soon (this one). I came only for a short visit due to another appointment but I just wanted to bond again over our shared experiences when we started at Coler. The food was great, the music was infectious, and the camaraderie made this whole weekend such a momentous occasion.

We’ve come a long way.

Look at how far we've come; no more fumbling neophytes but confident and successful Pinoy and Pinay nurses. Back then, we were nervous, naïve, and unsure about our future in this foreign land. Along the way, we forged our own paths, drawn by our interests and passions. We defined our own successes and chased our own rainbows. We stood on the shoulders of those who came before us, and we extended our support to those who came after us.

If we wrote a letter to our 1983 selves, we probably would have written several pages of advice. But we learned from our mistakes, and we grew stronger from the trial of fire. I made a meme of my younger self as I stood looking toward Manhattan, “Someday, you will retire. And you will know that you were a bad-ass nurse who cared for her patients and her colleagues.”

Writing our Stories

Ever since I can remember, I was always writing. As a nurse, my experiences since I started In Coler have given me a rich source of inspiration, and creative ideas, but most importantly, writing was my personal therapy. As a nurse educator, I learned that telling stories about my clinical experiences made my lessons relatable, and easier to understand.

In 2017, a patient reached out to me. I didn’t know him at all, but he read one of my blog posts. He wanted me to tell his story. He was facing major surgery after an unfortunate complication from a previous operation. He wrote, “I write to you to thank you for sharing all of your stories to exemplify how important nurses are in the most dire of situations. I would love to tell you of the many ways that the nurses made a difference in my care. How they comforted me when I was anxious; when I just needed someone to talk to.”

Our nursing stories do not have to be used only in classrooms. Our stories (poignant and sad, humorous and satirical, emotional and inspirational) can also be shared with the general public. Have we not often despaired that nurses are underrepresented in news stories and movies?

According to the Gallup poll, Nursing is the most trustworthy profession, but where is the hype about the impact of nursing? After the hero-worship during the peak of the pandemic, the balloon had deflated and healthcare workers, especially the nurses, are now even subjected to workplace violence.

I wrote in the preface of my book ER Nurse: The Warrior Within, “With my stories, I want to magnify the nurses’ voice, to define and exemplify the resilience of the front liners, I believe that there is always something in my stories that will resonate with any nurse or any caregiver. I hope to inspire future nurses and to reassure current nurses that they make a difference in somebody’s lives”.

As I was driving home before our grand reunion, I had an epiphany. The nurses of Coler have so many stories to tell, enough to share with the next generation of nurses who will rise up to the challenge of a new life away from home. The narratives would be rich and compelling for future nurses to learn from. Enough stories to fill another book, right?

So my dear Coler mates, why don't we write our stories? Maybe an anthology of our first-year experiences, or our rise to the top? Maybe your love stories?

The First Funny Years in America

http://jo-cerrudo.blogspot.com/2023/01/the-first-funny-years-in-america.html

My Firsts... as a Nurse in the U.S.

http://jcerrudocreations.blogspot.com/search/label/firsts

Nursing... Thirty-One Years Ago

http://jo-cerrudo.blogspot.com/search/label/Coler%20Memorial%20Hospital

Kindness Matters

2023-03-30T18:10:00.013-07:00

As a nurse, I see kindness daily from the healthcare workers. Even if they are short-staffed, they still treat their patients with utmost respect and care. During the height of the Covid-19 pandemic, the ache in my heart was eased by the kindness of the staff to their patients, and to each other.

In my previous hospital, a night nurse stayed beyond her shift to provide emotional support to an anxious, elderly nursing home patient awaiting surgery. I have always known that a heart of gold lies beneath the tough, no-nonsense exterior. She went above and beyond that day, recognizing that the feisty, belligerent patient was just scared.

Last week, a patient with explosive diarrhea slipped on the floor. He was morbidly obese, and he needed help to get back to his bed. He was obviously embarrassed, but a group of nurses and techs reassured him and cleaned him up quickly, without any fuss, and treated him with respect. When his family arrived, they saw a smiling patient, his dignity intact.

Despite the troubling news of crime and violence, some stories tug at my heart when I read about simple acts of decency and humanity. After a hard day's work, I do not want to read more of man's atrocities against their fellow men. I prefer to read feel-good stories. Maybe it’s a mindful exercise to positively fill my life, despite the challenges and adversities. Just like the personal protective equipment we use every day to protect us from contamination, I think that a daily dose of kind thoughts gives me the moral fortitude to carry on.

Last month, my friend Rosemarie wrote this when she picked up her son at the train station: “While I was sitting in my warm car, I noticed an older couple lying on the bench. The woman ensured the man was snuggled and wrapped tightly in a blanket and then secured herself. I have never seen homeless where I live, and seeing them struggle broke my heart. But watching their compassion for each other and knowing they were sitting in 30-degree weather. I realized I was sent to this train by my dad. I told them if they could walk a few blocks away while I waited for my son, I would make sure they would be safe at a hotel for the night with food. Twenty minutes later, when the room key was handed to me, I knew my dad sent me as he would always help anyone in need”.

Somebody messaged me yesterday on LinkedIn. I don’t know what I did precisely to merit such, but I appreciate the unexpected message from my former nurse. I was her head nurse in the ER 27 years ago. She thanked me for my kindness to her when she was a novice nurse in one of the busiest ERs in New York City.

When I came home today, I found a Thank you card from a former patient care technician who struggled to complete her nursing education while working. Because I saw her potential to be a compassionate nurse, I approved her request for flexible scheduling. In two years, she completed her accelerated program, graduated with her Bachelor’s degree, and later joined the ER as a full-fledged registered nurse.

Kindness matters. It is a gift to another human being; a gift that anyone can pay forward. I have received benevolent and selfless gestures from family, friends, and sometimes strangers. Angels in disguise, my lifeline when I needed support.

A random act of kindness can mean a whole world of difference to somebody at their saddest point. To a lonely person, a simple smile and a caring touch mean they matter. For someone in need, a helping hand may give them that fighting chance.

I resolve to make kindness a daily presence in my life. As other special people changed my life and showed me that there is light at the end of the tunnel, I want to be part of the wave of kindness for someone else.

I am human, just like everybody else. Perfectly imperfect, but I try to live a good life. I make mistakes, but I will not consciously be unkind to somebody, nor I will I intentionally cause harm to anyone. I believe that for everything I do, blessings come back tenfold.

Yes, kindness does matter.

The First Funny Years in America

2023-01-31T21:00:00.032-08:00

Forty years ago, in January 1983, I started my nursing career in America.

A month ago, I found an old note I wrote on my first night on New York soil. It was both a time of uncertainty and excitement for this new journey. It was exhilarating and yet tinged with homesickness. My first time away from home. I felt unprepared to be on my own, not knowing how to cook or do the laundry. Even though my family was not rich, we still managed to have a housemaid at home, mainly because my parents wanted me to concentrate on my studies.

I was young, adventurous, and full of dreams. Suddenly independent, suddenly an adult.

Back then, nurses were only paid about $18,000 a year. I felt rich.

New friends

There was a small group of Filipino nurses who came before us in 1982. They were our mentors. Our group of 20 nurses was the first of many batches of recruits from the Philippines who settled in Coler Memorial Hospital, a long-term care facility in picturesque Roosevelt Island in New York. The influx of Filipino nurses was the city hospitals’ answer to the nursing shortage that gripped the US in the 1980s.

Coming to America was a culture shock. New to the country and new to the hospital system. The LPNs ruled the roost for a long time, so our advent was met with cynicism and hostility. We were young, bright-eyed, naïve, and ready to serve. Thankfully, the camaraderie among the Filipino nurses made us strong and united, and we were able to charm our way into our fellow staff members’ hearts. Somehow, the barriers came down and the LPNs and the RNs worked well together. It may be because we worked our asses off, as well as we were generous in sharing our food with everyone.

It was a whole new world for us. Most of us were in our twenties and we were ready to take on the world. But I was actually unprepared to be on my own in a foreign land. I was not domesticated at all; completely sheltered and spoiled. I never learned to cook, Thanks, Mom. I admit that my mom gave up on teaching me when I almost burned the house down when I tried to fry a fish or was it when I overboiled the egg?

We survived because we found humor in anything and everything. Mostly we laughed at ourselves and at our clumsy ways to acclimate ourselves to our new lives. For our first month in New York, we were housed in a dorm near the hospital. We spent our nights comparing notes of our misadventures with each other. Soon, our funny stories were epic among our friends. These were funny moments that could have been great for a stand-up routine. If there was a female nurse Jokoy, it would have been one of us.

Accents/ Pronunciations

For any new immigrants to a new place, getting used to the accent, slang, and colloquialism is always a challenge. I sometimes got defensive in my mind when someone snickered at my mispronunciations. Isn’t it that research showed that those who are bilingual actually are intelligent people? So what if my tongue got twisted, at least my grammar was way better (modesty aside) than some of the native speakers.

On our second day in New York, my friends and I wanted to venture out to Manhattan to see the famous Bloomingdale’s and ride the Roosevelt Island tram. I approached the security officer in the hospital to ask for directions. I asked for a “map”. His face showed his confusion, but he gallantly gave me a “mop” that he borrowed from a passing housekeeper.

Behind me, my friends were doubled up in laughter as they teased me, “long aaaa, use your long aaaa”. They were actually wrong because "map" has the soft 'a' sound like 'clap', and 'mop' has the soft 'o' sound like 'shop'.

The next day, I got my revenge. One of the doctors jumped in fear when he heard my friend ask the clerk if she saw her “bag”. The doctor thought my friend saw a “bug”, or as he called it, “Cucaracha!” Of course, I muttered to my friend, “Short 'a', use your short 'a' ”, exaggerated gesture and all. Soft vs short, how confusing. My gosh, it wasn’t easy to be “Americanized”.

One day, my head nurse sent me out to the Supply Room for some Q-tips. I was confident that I could figure it out because the bins were all labeled. For 15 minutes, I searched and could not find anything resembling a tip shaped like a "Q". I was almost in tears when the head nurse came into the room and grabbed the cotton applicators herself.

Cooking

After a month, our friends (Tess, Evelyn, Fe, and I) moved in together as roommates in a walk-up apartment in Steinway in Astoria, Queens. Hence, we were called the Steinway ladies. We shared cooking duties, but it was soon apparent that I did not have the talent to dice, slice, stir, and season the food to anything near palatable. My food experiments became fodder for jokes at our parties.

For some, cooking relaxes them. Just the thought of having to come up with an edible dish stressed me and ruined my day off. My "monggo with sardines" never passed muster. By mutual agreement, and to the relief of all sides, I was assigned as the official dishwasher. Actually, it saved our friendship and my sanity.

First Blizzard

In February 1983, we experienced our first snow. The first snow crystals that came down from the skies were magical. I remembered sticking out my tongue and thanking God for finally experiencing what I only saw in the movies. I hugged a tree and did my first-ever “snow angel”.

The nice snow turned into a "Megalopolitan Blizzard" that buried New York with 2 feet of snow. We should have been hibernating in our cozy and warm apartment and enjoying our off days decorating our new place. But we needed a dining set. So, after the storm passed, we trudged through snow that came up to our thighs carrying the dinette and four chairs, about 2 blocks away from home. We should have been mortified at the cars honking at us, but we comforted ourselves that nobody would recognize us with the scarves covering our faces. It was a strange sight, indeed.

One day, I hang my hand-washed white pants outside our window to dry. The next day, it was stiff as a board. Because all my uniforms were still in the dirty hamper, I had no choice but to blow dry my pants. So, I came to work with my legs stiff, but at least, warm and toasty.

At the Laundromat, as told by Fe

“The first time we went to the laundromat for the first time, I panicked when I looked into the washer and could not find my clothes. I told Evelyn that my clothes were probably done so I climbed and looked at the back of the machine. I even asked the owner of the laundromat 'Where are my clothes?'. It’s good he did not understand me. Then, the machine stopped spinning, and like magic, my clothes were back.”

Bebs and her funny memories

Bebs was from another group called the Astoria Ladies. She said, “The funniest and scary moment was when I went to the World Trade Center with Malou. We wanted to send money home through the Philippine National Bank. Bagong salta sa Amerika. It was lunchtime then. Just imagine we were with all the businessmen either going to their office or whatever. The elevator was terrifyingly fast then I saw the sign “Press to stop”. In my curiosity (rather, my stupidity), I pressed the button. The elevator went to a sudden halt like there was an earthquake. Somebody called on the elevator phone, “A girl in the elevator pulled the emergency button”. My face turned red. What should have been only a few minutes to our destination floor took maybe 20 minutes to have the repairmen get the elevator back to normal operation. It was one of the most embarrassing experiences I had as a newbie here in the USA."

“Remember in the hospital cafeteria, we were being watched for using a spoon and fork to eat!!!?”

“When we went to use the public washing machine, I put too much detergent that the bubbles overflowed out of the top.”

“We fell in line in TKTS to see a movie; we thought that’s where to get movie tickets”.

Hey, Bebs! Don't forget that you posed like the University of the Philippines Oblation statue.

East River flirting

During our first summer, my friends and I often hang out at the riverfront overlooking Manhattan. The skyline was magnificent, The towering buildings rising majestically against the blue skies. Sometimes, we waved at the bare-chested men on the boats as they sailed along the East River.

I can only use the excuse that we were young, daring, and adventurous because we also threw kisses at the sailors, thinking we would never see them up close and personal. Until one boat motored up near the bank. We all scampered away like rabbits as if our mamas were after us with their slippers.

West Point

One of my fondest memories is that of Evelyn and Fe (former Steinway and later Broadway roommates) running down from the pier at the West Point Academy as the ferry boat sailed away back to NYC. It was my fault for being so distracted in the art museum that I missed the bus that was supposed to take us to the pier. At the last moment, they noticed that I did not make it to the bus. Tess had gone ahead with the other group and was unaware of my drama.

So, Evelyn and Fe got off the bus and ran back to the museum to retrieve me. I thanked them profusely for not leaving me stranded on my lonesome, hahaha! We were relieved that at least Fe had her Amex card so we were able to take the Amtrak train back to the city. It must have been me who clapped and shouted the loudest "We're now in New York" when the train conductor announced we were in Penn Station.

Christmas Tree, as told by Fe

"Evelyn and I went to Manhattan to see the Rockefeller Christmas tree. We took lots of pictures of a massive tree adorned with beautiful lights. It was when we got home that we realized that it was not THE Rockefeller tree."

Looking back, the first few years as we adjusted to our new lives were challenging, to say the least. We survived because we embraced all our experiences with gusto and with a sense of humor. Those were the days when life was simpler but exciting with new possibilities.

In 1983, Karen Carpenter died of anorexia nervosa. Michael Jackson's Thriller went to no. 1 on the US 200 Billboard album. Lionel Richie's “You Are”, released in 1982, was the first song I heard on the radio. The MASH finale. The nursing shortage.

Forty years later, there is a nursing shortage again. I hope that those who will follow our steps will have as many laughs as we had.

It was 8509 miles and 20 hours of a turbulent plane ride, but I am here to stay.

My Firsts... as a Nurse in the U.S.

http://jcerrudocreations.blogspot.com/search/label/firsts

Nursing... Thirty-One Years Ago

http://jo-cerrudo.blogspot.com/search/label/Coler%20Memorial%20Hospital

Tasty and the Reluctant Cook

http://jcerrudocreations.blogspot.com/search/label/Reluctant%20cook

Joy on the Horizon

2023-01-22T17:04:00.016-08:00

Just another busy shift. After a hard night's work, the staff nurses at a busy cardiac unit were preparing to head out. One of the nurses looked outside her patient's window on the 10th floor. She quickly summoned her co-worker Phillip Tubale, RN, who then snapped this breathtaking photo of the upcoming sunrise over the horizon, one of the many pictures Phillip had taken over the years, but this one is absolutely spectacular.

While most of New York City was sleeping, nature was showing off. The triumphant and vibrant colors were mesmerizing. The sky over Manhattan was emblazoned fiery red near the horizon and a sliver of yellow promising the coming of the glorious sun.

An instant mood-lifter. A much-needed Serotonin-booster. A joyful welcome to a new day. A million-dollar view.

The scientific phenomenon of the sun's rays bending through the atmospheric layers creates a gorgeous palette on the sky. The brain's orbitofrontal cortex responds to beautiful pictures of nature and helps reduce stress and anxiety. I bet my bottom dollar that sunrises brighten our dark days. :) Here comes the sun. Joy in the horizon.

On that particular morning, the sunrise evoked feelings of joy, and in others who commented on Facebook, the picture brought them hope. I am confident that the nurses on 10East went home feeling energized, and I hope that the awesome display outside the window also inspired the patient.

In the movie Collateral, Jamie Foxx is a taxi driver who dreams of establishing his own limousine business. Whenever he felt discouraged, he flipped his car visor and felt instantly calm and happy at the stunning picture of Maldives, with its overwater bungalows and crystal-clear lagoons.

It is not easy to be a nurse nowadays. The nurses' strike in major hospitals in New York was resolved, and we still wait with bated breath for the promise to become a reality. Amidst all these uncertainties, the frontliners struggle with the stressors of an increasingly demanding profession. To keep our mental well-being, we also need to seek our moments of joy.

At one of my classes with the nurses, I shared with them the photo album that I titled "Joy-triggers" (aside from my family):

Pictures of sunrises and sunsets.
Fall foliage.
My favorite singers.
Other random images that make me smile.

And soon, other nurses shared their pictures, and as I hoped they would, they shared the stories that gave them joy as nurses. Some were even teary-eyed as they recounted the emotional rewards of caring for their patients, despite the healthcare challenges that they face every day.

Finally, I showed the nurses a picture that kept me going during the Covid-19 pandemic while working in my previous hospital as a nursing director. A family with four kids from the community came to our Emergency Department to thank the staff for our service. They brought several pies of pizza with handwritten Thank You cards from the children.

I still treasure those cards, to this day.

My Happy Pictures: Mood-lifters

https://jcerrudocreations.blogspot.com/2022/11/my-happy-pictures-mood-lifters.html

Emergency Nurses Week 2022

2022-10-10T15:50:00.009-07:00

In 1990, the first time I stepped into a city hospital Emergency Department (ED) and saw nurses and doctors rushing by what I thought was a frenzied scene, I almost threw up and ran away back to the chronic care facility I came from. The noise from the monitors, the sirens wailing on the ramp, the ringing of the telephones, and the curses from the intoxicated patients. “This is not my world,” or so I thought.

After one perceptive nurse noticed my pale face, she tapped my shoulder and made me sit by her side at the Ambulance Triage while I waited for the nurse recruiter to return from an urgent phone call. She gave me a glass of water and entertained me with funny stories about the ED. “You haven’t seen anything yet.”, she teased me in her slight Indian accent, “but you will love it here. And you will never leave Emergency Nursing.”

“Sanni” was absolutely right. It is difficult to believe that I survived thirty-two years in emergency nursing. And loved the hurly-burly and exciting life of an ER nurse. And appreciated my colleagues through the years.

Like an arrow to the heart, emergency nursing lodged itself in my heart refusing to let go despite the adversities. I loved the staff and even craved the chaos. I stayed at Elmhurst Hospital for 21 years. Then, I worked in other urban EDs where life was never placid, never dull, and the word “Quiet” jinxes everything. My stay at Maimonides Medical Center and Mount Sinai Morningside provided me with a plentitude of stories and a lifetime of memories that strengthened me more as a nurse and as a person.

Never did it occur to me to leave the scary world of emergency nursing. The nursing, medical and ancillary staff in the ED stood resilient through the vagaries of demands from the patients in agony and despair. It was a world with emotional rewards because we made a difference. My career brought me from the bedside to several leadership positions, and I can honestly say that I enjoyed leaving a legacy of hard work, integrity, and fairness, I try.

Then the Covid-19 pandemic wrought emotional scars that brought me to the crossroads of my career. I almost walked away from nursing. I was emotionally bruised from feeling helpless and staying strong was a challenge. My body was keeping score.

According to the book by Bessel van der Kolk, the effects of trauma affect the emotions, the mind, and the physical body. He described hypervigilance and hyperarousal as causing physical ailments manifesting in the bodies of those who continue to suffer under stress. The constant adrenaline rush was wearing me down. My body was definitely keeping score, and it was giving me dire warnings to slow down, maintain my work-life balance, and do my self-care.

Life presented many trials on top of all the stressors we suffered with Covid. Realizing that I have to love myself first, I gave myself time to heal. My worth as a nurse and as a person is not tied to the insincere approvals from anybody, but to the overwhelming support and love from those who matter: the nurses whom I work with.

In 2021, I published my book “ER Nurse: The Warrior Within, Bruised but still standing". This year 2022, the Emergency Nurses Association is formally celebrating Emergency Nurses Week on October 9 through October 15. It seems surreal that this year’s theme is “Standing Strong”.

I looked back at the pictures I collected over the thirty-two years and I smile with pride for having worked with my sisters and brothers on the battlefields. There are many psychological land mines in this profession. We have survived the storms and we will continue to weather the unpredictable and unprecedented challenges that come our way.

I cherish the camaraderie with the staff. I remember the fun moments and the simple pleasures that lightened our load. I treasure the hugs after a difficult day. I celebrate the lives we have saved and the thanks from patients and families for whom we made a difference. And most of all, I honor my fellow nurses on the front lines who inspire with their courage and resilience against all odds.

So, let’s continue to take care of ourselves first, find the time to enjoy our co-workers, and rejoice for the grace and blessings of caring for the sick and the injured. To the new nurses, especially those that I have personally taught in a nurse residency course in my new job, please hang in there. I hope that, many years later, you will look at these memories with fondness in your heart and gratitude for having touched countless lives.

Happy Emergency Nurses Week.

Recovering from Nurse Burn-out

2022-05-02T21:34:00.038-07:00

(Published in the November 2022 issue of the Journal of Emergency Nursing under the title "Finding Joy: Fighting Nurse Burnout")

Finding Joy- JEN

At the beginning of April 2020, the Covid-19 pandemic burnt me out. At one point, I was ready to quit nursing. I wanted to run as far away as I could, away from dying patients, away from the heartaches.

I remember waking up in bed, physically drained from a fitful sleep, emotionally shattered by the friends and the patients we lost. I debated calling out sick that morning just because I dreaded hearing the frequent overhead pages for the code team.

The Apex of this pandemic that we were preparing for came much too early. Doctors, nurses, and techs were running around responding to calls for intubations, desperately trying to race against time. We were all covered from head to toe with impervious gowns, face shields, double gloves, boots, and surgical caps; the N95 masks would later leave marks on our faces. The scars in our hearts were unseen, PTSD a real threat.

We were protected, we assured ourselves, but how could you be confident about how safe you are when the Covid fatalities keep on rising? The whole hospital (and the whole city) was in a pandemic chokehold.

It took a few minutes of deep breaths before I could summon the courage to rise from my bed. For the first time in my long nursing career, I was at a crossroads I never thought I could ever be at. I considered myself unshakeable. “Been there, done that; nothing can ever make me turn away from Nursing,” or so I thought.

That morning, I felt burnt out, but I went to work. To fortify myself, I looked up onto the heavens and whispered, “My Lord God, take charge of my life.”

ON THE FRONTLINE

The New York streets were empty. The City that Never Sleeps was in total lockdown since March, and only the essential workers were allowed to travel. Along the Cross Bronx Expressway on my way to work, what was once a traffic nightmare looked more like an apocalypse with nary a car nor a truck in sight for miles on end. Times Square was a ghost town. The silence was both eerie and deafening. I felt like I was going to war, but I was scared and helpless. I hated being vulnerable.

I was on the frontline but felt like a spectator. I was not actually at the bedside giving direct care as I wanted to be. The responsibility of being a Director of Nursing in an emergency department amid a healthcare crisis was overwhelming, but not more than what the ED nurses, techs, medical providers, and other ancillary personnel had to go through. I can only imagine the enormous impact of the unending crisis on their psychological well-being when their best efforts sometimes fail.

My nurses forbid me to go into the rooms, even to help prepare the bodies for the Morgue. They wanted me safe. I even joked that I was not that old, that I could fight alongside them. Just like in Imposter Syndrome, I felt inadequate and not quite pulling my own weight on the battlefield.

All I could do was make rounds, check on the staff, order supplies, request the Incident Command for more staffing help, coordinate travel nursing coverage, handle family complaints, and act as a cheerleader and emotional support for the staff. I followed up with my quarantined staff members for Covid exposure and illness. It was difficult to hear their anxiety and I feared that they could hear the quiver in my voice, so I preferred texting to phone calls.

I saw the patients come through the Triage Area, with no family members to sit by their bedside. The patients were whisked directly to the rooms with high-flow oxygen masks to aid in their breathing. I saw patients inside the isolation room as they lay with apprehensive eyes looking at their oxygen saturation numbers on the cardiac monitors.

I also remember the eyes of the ER staff beyond the masks and their face shields. Eyes that were sad and worried. Eyes haunted by the final goodbyes between the patients and their loved ones on the iPAD. Eyes filled with despair because of the unprecedented challenge wrought by the coronavirus onslaught. These were our darkest times.

I tried to be transparent with my information to the staff. But I grappled with what I could share. So, in my emails and our daily huddles, I talked about the nurse travelers coming in, the other non-clinical activities, and non-emergent procedures that were put on hold to deploy the staff to the ED and the other patient units. My news was upbeat and hopeful as I could possibly communicate to my already disheartened staff. I told them of the other surge capacity activities that the hospital leadership initiated to accommodate the influx of Covid-19 patients.

I did not share my concerns about the grim statistics and the dwindling supplies and equipment (since we compete with other hospitals for resources). I did not share that the Morgue was full and that there were Medical Examiner trailers on our campus. I did not confess that I wanted to quit nursing.

I did not want to stop and answer questions about my state of mind for fear that the tenuous hold on my fragile emotions would break. I did not want anyone to see me ugly-cry because of the sadness in my heart. So, I cried behind the doors.

My priority was that my staff would feel supported so they could take care of the patients who needed their expert help. I had to be the leader that they deserved. I learned how to look confident on the outside, although I was frazzled on the inside. I could not afford to be weak.

EPIPHANY: SELF-CARE

The staff needed mental PPE. We corroborated with the Mental Health Liaison psychologists, who offered counseling and other options for the team to de-stress, decompress, and start healing our broken hearts. My epiphany was that I had to do self-care. How could I help my staff when I was running on empty?

In my personal life, through all life’s ups and downs, I relied on my family and friends, my church, and my writing to endure. I knew I was strong enough to survive my personal travails, but I was unsure if I could remain a nurse amid the challenges that had brought down my other colleagues. I resolved to look for my joy triggers at work. I knew I had to heal myself first before I could lead others.

One day, one nurse asked to speak with me. That nurse broke down crying as soon as we got into my office. The words of pain and despair poured out, and the repressed emotions from the past months finally tumbled out. The nurse was not suicidal but was profoundly sad and depressed. We talked for a long time, but mostly, I just listened. I called one of the mental health counselors and arranged an emergency visit. Then, we hugged, and the nurse thanked me for listening, and for being there. I am glad to report that today, that nurse is now healthy and is thriving well.

FINDING MY JOY

Covid-19 would not be my downfall. Having witnessed the heroism and fortitude displayed by all healthcare personnel during these uncertain times made me realize how much I love the nursing profession. In my little way, I am privileged to have made a difference. That moment of indecision in my nursing career, that short period of burn-out, that temporary insanity is no longer. I have recovered my self-worth. I found my joy and my “why.”

What turned me around? What prevented me from leaving my profession? My healing came as I continued working as a nurse. I poured out my emotions into my daily journal, a catharsis to help me exorcise my negative feelings. My writing brought everything into perspective. Much as there were so many heartaches, I found comfort in our small triumphs. As a nurse, I was part of the army against this virus.

There were numerous things to celebrate. Let me count the reasons why we persevered:

The clapping and appreciation from the hospital neighborhood and other heroes like the firemen and the cops.
The outpouring of support from the community with unsolicited food deliveries (which both fed our bodies and our souls)
The staff working as a team and caring for each other
The staff comes in extra days so their peers will not work short-handed.
The deployed staff working in unfamiliar places and doing their very best to help
Dancing to the music “Call on Me” whenever a patient was discharged.
Getting a Thank You from a patient and his family
The staff rising to the challenge, despite the threat of Covid-19
The knowledge that every single hospital employee was doing their best under the direst of circumstances
The realization that we were doing God's work

I created a Facebook photo album of pictures from the staff to celebrate the resilient group that they are. It was a way to pay tribute and highlight this particular group on the frontlines of this war. I wanted to preserve in posterity the faces of the brave ones who came to fight the battle against Covid-19.

The FB photo album grew into a photo journal. It was to chronicle the moments of levity captured in-between moments of heartbreak; just before they rush back to the unit to save more lives. Frozen in time, the pictures showed the ED team taking a much-deserved break, a respite from the hard work. Just a little breather. There was a spirit of camaraderie, of having bonded as we worked together. As time went on, the staff started to SMIZE, they smiled with their eyes.

These healthcare workers, heroes of my time, were simply inspiring.

Covid-19 Diaries, Part 1

Covid-19 Diaries, Part 2

NURSES’ MONTH

Last May 2020, the hospital managed to celebrate the Year Of The Nurse creatively despite the constraints of social distancing and face masks. We danced on the streets, gave out cookies and cupcakes, published our virtual nursing journal, enjoyed the gifts from numerous sponsors, and were treated to an aerial display from the US Air Force and the Navy. The festivities were a harbinger of hope that we would survive. The end of the pandemic would come. And then we prayed for the vaccine, our fighting chance.

In 2022, the American Nurses Association chose the theme, “You Make A Difference.” Nurses in all disciplines and sectors truly matter as we give our patients a chance for a better life. Every Day. Our strength is rooted in determination and dedication to serving those who need help and fortified by the challenges and disruptions of the past years.

Like every single nurse standing strong despite being bruised and shaken by our pandemic ordeal, I am still here. I am proud to be a nurse.

HAPPY NURSES' MONTH!!!

The Trauma of Asian Hate

2022-04-02T20:11:00.018-07:00

About 20 years ago, a 70-year-old man was admitted as a Trauma Team to our hospital, after a brutal assault and robbery on the streets. The patient was a frail-looking Vietnamese man who was just collecting plastic bottles to help out his family. He tried to hold on to his money. His assailants pummeled him several times. They ran away with only $5.00 and left the man bruised with a leg fracture. He was forever traumatized.

According to some bystanders, two teenagers were calling him racial slurs which the old man did not understand. The family, through the interpreter, tried to get NYPD to arrest the teenagers, who were known to the community, but the police dismissed the case as a simple robbery, not a hate crime. Because they were juveniles, they got away scot-free.

Twenty years later, Asian hate still strikes fear amongst us. Microaggressions, outright harassment, and blatant racisms exist.

After the Covid-19 pandemic, Anti-Asian violence quadrupled last year. Assaults on Asians, especially the women and the elderly continue to rise. The deaths of Michelle Go, Christina Yuna Lee, Yao Pan Ma, and GuiYing Ma are senseless and horrifying.

How many more vulnerable individuals are harassed who look like me? How many times will NYPD refuse to consider or even quick to dismiss the assaults as hate crimes? How many murders have to happen before tougher measures are enforced, especially in keeping those perpetrators in jail where they belong and not released to be a menace to society again?

Many bystanders refuse to intervene for fear for their own lives. Last week, a Filipino man was assaulted in a McDonald's restaurant. The video showed another tall and burly customer just turning his back to the violence behind him.

And then there were heroes; good Samaritans. A selfless act of heroism that is commendable at this time when people choose not to defend a person in need.

Two weeks ago, the father-and-son duo of Cazim and Louie Suljovic dared to help out an Asian woman who was being assaulted and robbed outside of their pizza parlor (Louie's Pizzeria) in Elmhurst, Queens. Both men were stabbed several times but they managed to bring down two of the assailants until NYPD arrived. Both men were hospitalized at Elmhurst Hospital and fortunately, are recovering well.

The Go-Fund-Me page that was organized by a friend has raised $696,610 (as of this writing). The money will pay for their medical expenses and to support their workers while the restaurant is closed. The outpouring of support indicated the community's gratitude for the courage that almost cost them the Suljovics' lives.

https://nypost.com/2022/03/30/father-and-son-stabbed-outside-pizza-shop-slam-nyc-crime-surge/

It begs the question that many of us will probably be grappling with when faced with the same incident: what will we do? To be honest, I am not sure. If I am physically able, I know I will not be able to ignore a plea for help. I know I will call for assistance. I hope that I have a weapon with me, or maybe I can distract an assailant, and hopefully, some able-bodied men can step up and take our community back again and prevent evil-minded people from hurting innocent people whose only "mistake" is being somebody that does not look like them.

Racism, against anyone, whatever the color of their skin, is unconscionable and inhumane.

GoFundMe

https://www.gofundme.com/f/help-the-owners-of-louies-pizza-after-a-stabbing?utm_source=facebook&utm_medium=social&utm_campaign=p_cp%20share-sheet&fbclid=IwAR2sKYpHI04GVJRoaFygxODMDR0r7DnU2W-l29MxDqPucgFdPLDHUdSxayY

2021 Year-end Thanksgiving Reflections

2021-12-30T19:49:00.023-08:00

The past year affected all of us in immeasurable ways. What began as a promise of recovery from the horrors of 2020 with the Covid-19 vaccine fizzled out, like a New Year’s Eve sparkler dying out. In January 2021, I was hopeful that I would be able to travel soon to see my family in the Philippines. It was not to be. The US is on its 5th Covid wave with Omicron threatening to infect one and all.

As I prepared for our church’s Year-end Thanksgiving for 2021, I cleared my mind in grateful reflection. I can proudly say that I am blessed. Last Dec. 25-26, the Church of Christ (Iglesia ni Cristo) members celebrated our year-end Thanksgiving in person, instead of on Webex as we did last year.

INC Hymn #134

Oh my Father, I now deeply meditate

On the blessings, You give day by day

Truly You have never failed to care for me

And You provide my every need

It is my duty, Lord, to praise and worship You.

Ever worshipping your name faithfully;

It is my duty, Lord, to offer all to You

Oh, the very life You give to me.

Despite this year being still challenging in many other ways, there is still so much to be thankful for.

The Gift of Life
Family and friends
Work
My new book

For all these, I am thankful.

I am grateful to be an educator and a nurse leader.

When I left my previous job and started another journey, I was extremely gratified by the overwhelming support and love from my nursing staff, as well as all those who I have worked with. Their words are precious to me and have given me strength, inspiration, and determination. Their validation of my work meant to me more than I can ever express. I will forever hold them close to my heart.

I would like to share some of their thoughts:

“You have been an exemplary role model for me. Many times over the past year, I have felt overwhelmed and hapless. You were always available to listen to our complaints- even when you knew that there was nothing you could do. You displayed continuous optimism, even in the midst of what seemed like a never-ending nightmare during the COVID peak last year. You are the primary reason that I kept coming back to work and picking up extra shifts when I could. Thank you for that.

You will be the standard that I will compare others to in the future. I hope that wherever you go, you will continue to show others the light when it seems so dark.”

“Thank you for everything you have done for me and the department. You were with us every day fighting on the frontlines as we fought our first pandemic. Your encouragement and support helped me get out of bed in the morning to come to work. Although I was scared every day coming to work while pregnant, I always knew you were there to support me. For that, I will always be grateful.

You always encouraged us to be the best version of ourselves and to further our education. I always enjoyed your CEN questions in your weekly email, an email I looked forward to. I appreciated your transparency on department initiatives and staffing. I always knew you were fighting for us every day. You were an extraordinary leader and I hope one day I can strive to be a leader like you."

“I feel so lucky to have had you throughout the pandemic, We could not have done it without you.”

"Please know how grateful I am that we had you as our leader, especially this past year. I will never forget you."

New nurses: passing the torch

Today was the last day of class in 2021 for the new graduate nurses in the nursing residency program that I was consulting with. Knowing the challenges that they will be facing as they start their career as ER nurses, I shared with them how I survived the psychological land mines in a complicated but emotionally rewarding profession. In a way, I felt I was passing the torch and I felt compelled to encourage them as much as I could.

Gratitude journal. Finding my joy. Work-life balance. Self-care. Knowing that I made a difference. Sharing my love of nursing. Grateful meditation. All these fortified me and kept me standing through the years.

I asked the new nurses to reflect on what things they are grateful for. They recounted those special moments when patients thanked them for their compassionate care. Some even said that even if their patients forgot to thank them at times, they feel empowered to have made a difference in their patients' lives. It was an emotional exercise for all of us, and I tried to hold back my tears. I am proud of them.

They ALL expressed their gratitude for the opportunity to serve as a nurse, despite this Omicron threat and the short-staffing. Then they thanked all the other instructors and me for guiding them and preparing them for this career.

Hearing the words of praise from these new nurses was a gift I didn't know I needed to hear.

Here comes 2022. Happy New Year, everyone. Be safe. God bless.

Tired of Covid

2021-10-03T19:24:00.009-07:00

My nurse-friend in Florida called me in tears. She was overwhelmed.

“I am tired. I am tired of seeing so many patients die. I see the fear in their eyes as they gasp for air, as they start calling for their loved ones. And I am helpless. The Covid patients keep coming.” she said with a sigh. The sound of exhaustion.

I remember back in April last year when I heard the same words from my nursing staff in the ED. New York was the epicenter then. I could only listen as they poured their hearts out. I was helpless as my nurses broke down in tears. These were strong nurses who’ve seen them all, but how could you remain stoic when patients die in horrifying numbers?

I swallowed my own fears because my staff needed me to be strong for them. I could only offer my shoulders to cry on. I could only listen.

I have referred many of my staff to psychologists. I gave them some time off to unwind and be with their family and friends. So that they can be healthy, physically, emotionally, and mentally. In these tough times, to survive, I actively sought my moments of joy.

Somehow, through our shared grief for those we lost, we found the strength to keep moving on. The staff bonded over the feasts of donated food. We enjoyed the 7pm clapping from our community and the firemen and the police. We danced when a Covid-19 patient was discharged. We cheered when the Covid numbers started to decrease.

Last December, I felt overjoyed when I received my first dose of the Pfizer vaccine. I was hopeful that the end is in sight. I was certain that every single person who went through the nightmarish pandemic would embrace the vaccine as I did. I prayed that in a few months, I would finally be able to travel and see my mom after two years.

But the promise of freedom from masks did not come. We are in the 4th surge of Covid and who knows how many more variants will there be? Here in New York, it is not as intense as it was last year, but other states are reporting of hospitals overwhelmed by sick patients, mostly unvaccinated.

I cannot comprehend the resistance against the vaccines, I am frustrated that the other countries around the world remain in the chokehold of this pandemic because they do not get the vaccines that others have declined. I am heartbroken that I have not seen my mother in two years.

Post-traumatic Stress Disorder (PTSD) is real among healthcare workers. Every sniffle, body ache, and headache cause concern. Fever and cough trigger anxiety attacks. The angst is a visceral reaction that conjures images of intubation. For a nurse who has seen the worst, it is traumatic to envision oneself going through the same thing.

There is a staffing shortage. The healthcare staff is tired and exhausted. The vaccine mandate is divisive and controversial. How do you balance freedom of choice versus public health safety? In my honest opinion, it is necessary and maybe the only way we can get out of this torture.

Just a few days ago, I heard of a friend in the Philippines who died of Covid-19. When will this nightmare end?

Pandemic Reflection: One Year Later

2021-03-11T19:02:00.010-08:00

March 11, 2021-

Today is a moment of reflection for all of us. I wrote this in my journal, not knowing that Covid would still persist as a menace a year later. The loss of lives is still staggering and so emotional. Two more losses, one was an agency companion/sitter at work and another a church member in the prime of her life. When will this end? I did not expect to hear sad news so close to home when we're almost on the home stretch.

Today, we gathered in the Resus Room to pay respects and remember our co-worker. Although she was not an MSM employee, we claimed her as our own because she was assigned to the ED for 4 years. June was an agency employee sent to watch patients who were emotionally disturbed, suicidal or patients who are Fall and elopement risks. It was not an easy job; the patients were challenging, but she persevered and tried to help as much as they could when she was sometimes sick herself.

The room was filled with nurses, techs, and other ancillary workers. It started slow but soon the staff was sharing their memories of her. The chaplain led us in prayer. It was difficult to hold back the tears because I did not think that one year later, we would still be mourning the deaths of people we know. I didn't know that I needed the hug. The staff had a good cry then we dried our tears as we went back to work.

This second wave of Covid was not as intense as the first wave, but what is unrelenting is the slow road to recovery. Maybe it is our impatience to return back to normal. Maybe it's the frustration that people still die, despite everything we have learned.

One year later, my son is still safe and we have been indulging in our food trips, mask, and all. My 90 y/o mom is socially distanced in our home, with all her needs catered to by my family. We did her birthday celebration via Zoom on February 14th. And I had my vaccine.

In reflection, I realized that coming out of this terrible period is doable. There is light at the end of this tunnel. We have to take care of ourselves, still seek those things that give joy to our lives, hold on for those moments of triumph, celebrate the lives we have saved, give thanks for the science of the vaccine, and rejoice for the grace and blessings of having survived through it all. Simply put, just keep on hanging in there. I look forward to the future of hope.

Alicia Keys’ “Good Job” By One Voice Children’s Choir

ED nursing: In the Year 2030, Not another 2020

2020-12-31T10:28:00.022-08:00

January 8, 2030- Into the Future

Nurse Jess entered the Emergency Department with her trademark walk, hopping with every other step, swinging her arms as she went straight to the Charge Nurse Station. As the Director of Nursing, she could have just looked at the dashboard on her Mango watch/minicomputer/phone to see the unit metrics. But she likes being in the middle of the action. Besides, her usually unflappable charge nurse Mae seemed a little bit frazzled as she answered her Comdevice, and mumbled something about “Remember 2020”.

Jess entered the ED where she had been a nurse for 20 years, the last two years as the much-respected nursing director. Finally, they are in the new ED wing, a state-of-the-art facility. Thanks to the generosity of the family of a prominent New York trillionaire. The 78-year-old man came in with a broken femur after a nasty fall but was so impressed by the efficiency of the ED staff before he was whisked to the OR. He lingered on just in time to say his goodbyes to his family, but he made them promise to build a new ER. And the family donated billions of dollars to create an ED well-suited to meet the demands of a new Covid19-like crisis. No more hallway patients, every patient in their own private room with some amenities like a tv, electronic patient tracker, and a nurse-call device.

Jess outfitted in the hospital-mandated IRC (Infection Repellent Clothing) for this new disease outbreak from Texas. The Tyvek 3^rd edition suit is very light with its own breathing apparatus the size of her hand. Her face shield mask is clear and does not fog nor suffocate. The plastic material covers her entire face and connects to the Tyvek suit itself. Thankfully, this new disease is not anywhere as virulent and as overwhelming as COVID-19. A shudder went through Jess’ body as she remembered the year 2020, the Year of the Nurse which nobody ever anticipated to turn out to be a nightmare year for every healthcare worker. In the year 2030, it looks like they’re in a repeat of 2020.

Last month, ten years ago was a distant memory, relegated to the hospital archives. Right after the nth ZoomstatCom meeting with the Infection Control Czar last week, the hospital leadership went into UltraPreparedness/Response Mode. The Incident Commander declared in his authoritative voice, “We are now in ICS level 2 and we expect to be in Level 3 soon.”

After the meeting, she scrolled back on her personal online blog to look for her Covid Diaries. In 2020, the ED was declared an endemic area. Ground Zero or more accurately, the war zone, for the hospital as the patients came in gasping for breath and the ED staff rushed in to fight for the patients to survive. The staff heroically stepped up to the plate, buried their emotions, and proceeded to take care of the patients. It was a whole year unlike any other that no one in his right mind would ever want to go back to. In one of the Covid-19 memes, The “Back to the Future” Emmett Brown admonished Marty McFly not to ever go to 2020 with his time travel machine.

Jess did not have to peruse the blog to relive the memories. Her heart ached in remembrance. She thinks she had some form of PTSD from that event, just like some of her colleagues. Thankfully, she was able to draw strength from her family and friends, as well as from her ED work family. Going through Covid hell proved how resilient healthcare workers are.

“Thank God, you’re here!”, Mae uttered in relief. She was still in nursing school when Covid-19 exploded. She heard terror stories from all the senior nurses, but now, her wild-eyed look resembled what Jess' 2020 nurses looked like. There were still several of those bad-ass nurses around; their eyes are calmer now, their experience during the Covid war gave them steel of nerves, and today, they serve as inspiration to their younger colleagues.

Jess swallowed her fear and made sure her smile reached her eyes above her mask. As the nursing director, she had to be a tower of strength, a source of truth, a comforting presence, and a purveyor of hope. Even if she felt a little apprehension as she saw the electronic dashboard in the Nurses' station with the throughput metrics and unit statuses highlighted in Red. It has not changed through the years, we still use the Red Surge as a common language that the ED is in crisis.

Dr. Johnson sauntered to the Nurses’ station. Like Jess, Brad experienced Covid-19. He wore his veteran status with honor, which in a way, comforted his fellow doctors. Jess and Brad are ten years older now, wiser and toughened by their experience. Jess consulted with Brad and they decided to call a unit huddle.

Mae’s voice crackled over the staff’s Communication devices that were clipped on their scrubs. Except for those currently involved in a patient’s care, most of the unit staff gathered in the 5-bedded Resuscitation room. Unable to maintain physical distancing, the nurses, doctors, techs, pharmacists, registrars, environmental services members, transporters, respiratory therapists, case managers, and even the paramedics attended the huddle.

Brad addressed the whole staff, “Ladies and gentlemen, we are at this point of declaring the ED as an endemic unit. Meaning, you will have to be in full PPE when you enter the ED door. Don’t give me this crap that you cannot breathe because our masks are a hundred times more comfortable than we have in 2020. We cannot afford to have some of you out sick. Use your PPE”.

Jess addressed the staff. Knowing that everyone is compliant with the Covid and flu vaccine, she proceeded to tell the staff that another similar mRNA vaccine is being tested by the scientists. There will be some protection from the Covid vaccine, but this new vaccine will be specifically targeting this new disease called Joslin30.

Jess reviewed the surge and escalation protocol. Although the NEDOCs score is high, all the patients are secured in their private rooms, most of which are with negative pressure. The patients have their own sophisticated TeleFam monitors to connect with their families remotely. Visiting hours were suspended except for special circumstances. The newly-reorganized CDC Fauci organization issued a much-vetted Joslin30 treatment algorithm which is immediately started in the ED. The point-of-care Joslin30 screening test is top-of-the-line accurate with a one-minute result time. Additional medical and nursing staff reinforcement from the National Medical Guard will be in the ED in two days. Supplies and equipment, and most importantly the ventilators are well-stocked. Three additional hospital units are being prepared for additional patients and will be available in a few hours.

As Jess relayed all the updates, she could see the staff visibly breathing in relief. They needed to hear the updates; needed to hear that no patients have died so far, and that patients are responding to the aggressive drug cocktail. Jess herself believed that the world is much better prepared for this new challenge. They clapped at the end of Jess’ summary of the ED status. She brought them hope and confidence that this crisis will soon pass.

“This is 2030, not a repeat of 2020. This time, we have an intelligent and responsible President who does not quarrel with her own Infection Control chief. This time, the science we trusted in 2020 is bringing us a new vaccine soon. This time, the government officials are on the same page. This time, our hospital is prepared for all eventualities. This time, we will get through this in just a month or so. Thank God, this is not 2020.”

ED Nursing Stories: Rising to the Covid-19 Challenge

2020-10-21T08:54:00.069-07:00

This is the Virtual ED Nursing Photo journal in reflection of our Covid-19 journey at Mount Sinai Morningside Emergency Department. I am certain that the sentiments will resonate with everyone on the front lines. The fears of the unknown transcend disciplines, titles, and even geography.

The ED photo album started as a collection of pictures, some submitted by those very same nurses in the direct line of fire, the ones who are at the bedside, in the front lines. I assume that these pictures were made in defiance, as well as an assurance to ourselves, that this too will pass. We were optimistic that these pictures will someday be just the chronicle of that unforgettable moment in our nursing lives. Who knows, we might just end up in the archives.

Somehow, this became a journal of our collective experience during the pandemic. I collected some of my nurses' personal reflections; I understand their need to share, to relieve their hearts of the burden.

For me, Journaling is a coping mechanism, it puts things in perspective, and it slows things down to manageable parts. It is a therapeutic activity to drain the brain of stressful recollections. Maybe, when it's written on paper, the pain loses its intensity, and it would not be as horrible. Writing eases my heartache.

While recording our anxieties, we were able to reflect on the special opportunity we have to serve those who are vulnerable. We found our joy and purpose in being valuable members of the healthcare team. So, this is also a gratitude journal. In the darkness brought by this scourge, the nurses, and of course, the rest of the healthcare team, emerge triumphant.

This is one department's journey in pictures, reflections of individual and the ED team strengths. Moments of levity are captured in-between moments of heartbreak. This photo journal captures our resilience against adversity.

In this Covid-19 crisis, ER nurses put their fears aside and placed their patients front and center. We remain resilient despite the challenges of this pandemic. On this Year of the Nurse 2020, of a time that even Florence Nightingale on her 100th birthday would have given us her seal of approval. I am never more proud to be an ER nurse.

ED Nursing Stories

COVID-19 Diary: The Heartaches and the Small Victories

2020-04-19T17:16:00.023-07:00

This is not just my story. This is also a snapshot of my department's journey through the horrors of a pandemic, with all the heartaches and the small victories. Nobody comes out of this war unscathed.

January 1, 2020

This will be a good year. This is the Year of the Nurse.

January 25-
China is far away; the danger of the coronavirus that devastated Wuhan is far away. (Or so, I thought). The hospital cautions us to prepare but there is a general sense that it’s just like the FLU. The CDC says that the Flu killed more people than the Wuhan virus. I thought we were safe here in America. Hey, even POTUS downplayed Wuhan. Life goes on.

February 17-
The Novel coronavirus is here. The DOH, CDC, and WHO issued their guidelines. At triage, get the travel history, check. Ask the patient if he has a cough, fever, or upper respiratory symptoms, check. If they’re elderly, double-check. Mask yourself and mask the patient. Isolate. The Infection Control staff is overseeing our response. The algorithm was distributed to the staff. We got this.

February 28-
We received about three patients with fevers, cough, and positive travel history and they were just mildly sick. It’s not bad, I assured myself, I assured my staff. Who was I kidding? I was scared.

March 8-
What’s going on? The hospital is full-on in Incident Command mode. There is a frenzy of activities; meetings after meetings. Don and doff training. Write the standard work for Triage. Plan for Surge capacity. Look for alternate places. I requested more RN travelers and techs to help us out during the apex of the COVID patients.

The projection was that we have about 3 weeks before the patients who need the ventilators. Three more weeks to get the extra staffing and supplies. We need more N95s. I was assured that we have enough on stock but we might have to consider conserving the masks because the public is hoarding those masks. Hello? Mr. Q. Public, you are depriving the healthcare workers of the much-needed masks.

Oh, don’t forget to buy toilet paper. The Chinese factories are not manufacturing toilet paper anymore. The grocery shelves are bare while eBay sells the now-precious toilet paper at ridiculously illegal exorbitant prices. Hmmm, maybe buy a bidet?

Photographer- unknown

March 11-
The World Health Organization has declared COVID-19 a pandemic. Now reaching global proportions affecting 114 countries. The news brought a frisson of fear down my spine. I texted my family in the Philippines and instructed them to stay at home, to shelter in place, to keep my 89 y/o mother safe. I called my son who lives two towns away from me. I made him promise that he will work from home, that he should never leave without a mask, and that he should always wash his hands, He laughed at me indulgently and reminded me that he used to work in a research lab and that he, of all people, knows how to thoroughly wash his hands. He knows he has to self-distance and wear his mask every time he goes out. When we Face-timed, he jokingly rolled his eyes at me. He knows I'm just being a mom.

March 12- Fear. It is scary. Like going to the battlefield. We wonder, "Are we doing this right? Are we using the right PPE? Are we handwashing long enough?"

And yet we go to work. Every day. Despite our fears.

March 13-
It is good to step away from the hectic COVID-19 prep and planning activities (even for just a few minutes) to celebrate our Clark 8 Acute Behavioral Unit staff with a “Caught for being Great” citation from the amazing Physical Therapy team. As per the PT leaders Alicia and Helen, the Mount Sinai Morningside Clark 8 staff took the initiative to reach out to PT to borrow the patient lift device and get themselves trained on a machine that they never used in their unit before. The staff was so engaged and so receptive to learning new techniques to improve their disabled patient's experience.

March 14-
My email to the nursing staff:
I know that there is not much we can say as we go through this COVID-19 crisis together. What I know is that the ED staff continues to give their very best despite the anxiety of the unknown. The emergency department itself can be chaotic and stressful. This is the nature of our work, and right now, your minds are probably spinning with the barrage of inservice, instructions, and simply the demands of being on the frontlines in this war. I just want to thank you for your amazing hard work and resilience. Thank you, thank you. If you have any questions, please do not hesitate to e-mail or call us (Anthony, Cynthia, Lauren, and I- even if you just want to vent). FYI, all the COVID-19 testing for our admitted PUI patients came back NEGATIVE, including the last one who went to the ICU (WR, 35 y/o male).

We are trying our very best to mitigate our current circumstances and ease your workload during surges:
1. We are in the midst of finding alternate sites to move those who are Worried Well and those with mild symptoms that can be treated and released quickly. We may be using the Heal Center and Clark 9 with non-ED staff.
2. This weekend, we are piloting the use of the Ambulatory Care Clinic to refer the ESI 4-5 patients to decant the ED, thankfully with their own Ambulatory Care staff.
3. For admitted patients, more Isolation rooms were created in 7West and soon in 7E ICU for critical care surges.

What we ask of you is for you to be nice to each other. Watch each other’s back and use the buddy system when you’re donning and doffing. If you can come in for OT, please let us know, even if just to relieve for breaks. More than ever, we need you to come to work. And because we need to care for our own selves, try to Plan Your Joy. We’re in this together.

March 15-
It’s a Saturday spent at work. The ED is getting overcrowded with patients worried about their symptoms, we have the worried wells, but there are more patients coming with respiratory distress. We opened the ambulatory clinic on the second floor with the physician assistants and ambulatory clinic staff seeing those with mild-acuity symptoms. The ED leadership had a nice plan on how we will surge up. We meant to start allocating some rooms for COVID patients in the Main ED for Phase 1, then will advance to Phase 2 with additional rooms that can hold the COVID patients, then Phase 3 using Peds and Eval. It’s only Saturday and we’re already in Phase 2. Out of the 30 boarders in the ED, only two were not COVID. Now we see patients presenting with abdominal pains and testing positive for COVID.

It was a long tiring day. I ordered pizza for the staff, and they all came running to the conference room. I sat down to eat my ham with pineapple pizza pie but did not have the strength to finish the whole thing. I had the feeling that things are going to get worse, then worst before it becomes better. May God bless us all.

March 16-

Wow! A family with 4 kids from the community came to the Mount Sinai Morningside ED to thank the staff for our service during this COVID-19 pandemic. They brought several pies of pizza with handwritten Thank You cards from the kids. The ED staff works hard every single day but has been totally amazing these past weeks amidst the fear and uncertainty. Being on the front lines can be scary, but this gesture really warmed my heart. I am so glad that the staff is recognized for a job well done. I had my Joy late this afternoon after a full, exhausting day.

March 17-
I'm supposed to be off today but have been on the phone since 630am with back-to-back conference calls. Our hospital President just mentioned our ED with a special mention of my LinkedIn post about community appreciation.

March 18-
It’s my youngest sister’s birthday party but we cannot celebrate at our favorite restaurant. So, I just wrote on FB: “You are loved by everyone because you have a generous heart. Who would think that a grumpy little kid will grow up to be so lovable (a little less grumpy, hahaha)? We'll get take-out food, as everybody else shelters at home. I took the day off (although still working at home). At least, we have toilet paper, woohoo!!!”

March 19-
It was a heartbreaking day. We lost three patients in the ED today due to COVID. Their chest X-rays were horrible, "bilateral confluent diffuse airspace opacities". The doctors tried high-flow oxygen, then BiPAP. But the patients were tiring out. They needed the ventilators to give them time to marshall their immunological response to the virus. It was frightening to witness the patients gasp for breath. The nurses, the doctors, and technicians were the front-line staff who managed to conquer their fears. Equipped with their personal protective equipment (PPE) of gowns, face shields, goggles, and N95 masks, they ran towards the patients, reminiscent of how the firemen and EMS crews ran toward the World Trade Center buildings on 9/11.

The ED was full, NEDOCs score was in the 160s with 40 boarders and five waiting for ICU beds. There was a sense of urgency as we tried to arrange for transfers to the floors. I made several calls to Admitting office. Where are the beds? I was frustrated but there was not much we can do until the beds open up upstairs. The Incident Command Center was directing the storm of activities to support the hospital operations and ensure we have enough PPE. Although we are in scary times, I felt secure in the knowledge that the hospital leadership was truly responsive to our needs.

March 20-
I am the nursing director but I do not do direct bedside care like these brave men and women do. But I sure do my damn best to support them as best as I can do. I fight my own battles to secure more staff, equipment, and supplies. I spend 10-12 hours in the hospital five days a week, and then we’re expected to be on call for any emergencies. The nursing directors were just told that we have to do the Incident Management huddles at 830am even on Saturdays and Sundays. Even with all of these, it will certainly not compare with the higher risk that the bedside staff faces every single day.

I am both proud of and worried for all the direct care providers, nurses, doctors, techs, and respiratory therapists. Both the frontliners and the last recourse. They deserve all the glory and all the tributes for a job well done and for what they keep on doing. These are dark times, and the staff just keeps on rallying in the middle of the war against COVID-19. They are awesome and so inspiring.

Some of my staff were out sick on furlough; I was hoping that they were self-isolating with just fevers and a few aches and pains. I prayed, please no shortness of breath. I fought my tears as I called or texted the staff, just to check in, just to make sure that they are okay. I preferred texting because I didn't want my staff to hear the quiver of fear in my voice. I held my breath until they assured me that they were breathing fine.

I received this text from a nurse: “Today was a rough day with all the sick patients in the ED but having our EMS there was soooo helpful. They were so eager to step up and work. They were so interested in all the patients, treated them with so much respect, and helped me out tremendously. If they weren’t there, I think today easily could have been one of those days you go home and cry or bury your face in a pint of ice cream. I hope they come back every day and thank you for having them there.”

I felt feverish. My temperature was 97.8. Thank God.

March 22-

In the #YearoftheNurse2020, the COVID-19 pandemic is certainly challenging the resolve of nurses, and all the healthcare workers (doctors, PAs, techs, registrars, handlers, and ancillary staff), all over the world. The Emergency Department staff steps up to the plate as they have done time and time again. In the war against this coronavirus, the warriors choose to give their best amid the anxiety, fear, and stress. Strength, courage, and dedication are manifested in every single one of them, no matter what their job entails. These are the faces of the brave ones, those who uphold their duty above all else. Thank you, everyone, as well as the other warriors in the inpatient units and in the ICUs. I am so proud of all of the healthcare workers here and everywhere.

As you can see, the community acknowledges all our efforts. The food just keeps on coming, a gesture of appreciation from the people who depend on us for their healthcare needs. The Thank Yous certainly mean a lot; they remind us of the reason why we are doing this. We are working for the patients who need our care. This is one department's journey in pictures, chronicles of individual and the ED team strengths. I started my COVID-19 album on Facebook. I wanted to capture in posterity those moments of levity in between moments of heartbreaks. We will survive this madness.

March 24-
The nerves were getting to the staff. As the handlers were giving out the new goggles, there was a misunderstanding about the distribution. I got to the ED right when one nurse burst into tears, she was frustrated because she did not get her new goggles, and she was holding her flimsy old ones with the frayed strings. I mediated and got her the new goggles that she deserved. I know that the tears were of frustration, were of fear. I could only pat her back and stay by her side until her tears stopped. She did not want to leave her assignment. Then she took a deep breath and smiled, “I am okay.”

The RN travelers are not here yet, but at least some Procedural nurses and techs were redeployed back to the ED. They can do tasks, labs, and lines, Team Nursing we go. Then, we received some EMS techs and paramedics arrived. All hands on deck. We needed all the assistance we can get. The doctors and nurses have been rushing to the rooms to resuscitate the sick patients who come right after another. I saw one of the doctors sitting at the desk with anguish on his face. He just called the patient’s son that his father passed away. The apex came two weeks early.

March 25-
The nurse manager and educator were out on furlough, and half of my leadership team. My assistant nurse manager was busy trying to staff the unit. For the first time in all my years as an ED nurse, I felt I was drowning. The ED NEDOCs score was high in the 170s, we are seriously overcrowded with two intubations going at the same time. I kept an eye on the ventilator reports. We are low on the BiPAP but we're getting some delivered in the afternoon. The hospital converted some inpatient units to ICU beds but our patients were not going up quick enough to decant the ED. I must say that I am impressed on how the hospital converted some units into COVID-receiving units in a matter of days.

A 55-year-old COVID patient succumbed to cardiac arrest. Too young to die. It could be anyone of us. There was shock in the nurses’ eyes. After he was pronounced, the team members offered a moment of silence to pay their respects to the patient. There was no family to mourn him at the bedside. I tried to help out with the post-mortem but the nurses told me that they can handle it. One nurse said, “We cannot afford you to be sick. Who else will look out for us?” I almost bawled in front of the team. I felt a little bit useless and somewhat useful, even needed.

March 26-
My nurse’s husband was admitted to the hospital for shortness of breath related to COVID-19 and she could not stay with him. No visiting rule, even for her. It broke her heart to be so helpless. I cannot do anything. As she cried on the phone, all I could do was listen and cry along with her. I called the nurse manager in that inpatient unit to keep an eye on the husband. I visited the unit but the patient was asleep. His breathing was normal and his oxygen saturation was 96% on nasal cannula. He will be okay. At least, my nurse’s husband is not in the ICU.

March 27-
I heard two medical codes being called in the ICUs in just one hour. There were more calls for respiratory therapists throughout the day. The ED is like a warzone, we are a COVID unit after all. I saw a blur of yellow isolation gowns when a group of doctors and nurses responded to Room 22 in the ED; they have to intubate the new patient. Not even five minutes later, another call for help in Room 1 for a high-flow oxygen machine. And another patient in respiratory distress was rushed in by EMS. The charge nurse called out for another team to Room 2. I had 36 boarders in the ED, all complaints related to COVID, some confirmed, some PUIs, some PUMs. The nomenclatures and the changing guidelines from CDC are confusing. The intensity level is high in the ED.

March 28-
After an exhausting week of being the Administrator on Call in the middle of a brutal week of COVID-19 response in the hospital, I needed to do self-care in order to get re-energized for probably a more brutal week. And then reading the Thank You cards from the #mountsinaimorningside community, I see the reason "Why" we are doing this. This is our "Ikigai", our reason for being. The ED received an outpouring of love and support from the community. Food deliveries came unsolicited almost every day. And they were calling the healthcare workers their heroes.

Late at night, I received a call from my assistant nurse manager about the Visiting rules. A family member wanted to see her dying mother in the ED. The No Visitor rule was just enforced, but for end-of-life moments, visiting was allowed. The iPADs help with facilitating communication between families but nothing can take the place of an actual visit. The unit leaders all said yes. My chief nursing officer and chief medical officer approved. It was a humane decision to allow a daughter to say her final goodbye. No one should die alone.

March 29-

The news painted a terrible picture of the dire situation at my previous hospital. Suddenly, Queens is now the epicenter within the epicenter. The harrowing details of devastating deaths and inadequate staffing, PPE, and ventilators told the rest of the world that we are in deep trouble. My heart broke for what my former colleagues were going through.

I posted this on LinkedIn and FB: I just want to pay tribute to the staff at Elmhurst Hospital, my work home for 21 years. My love to the ED staff who continues to give their very best. I left a piece of my heart with you. Even as I do my own work here at Mount Sinai Morningside, I think of you on the frontlines at the 'Hurst. May you get the help you most deserve. You are all amazing. Be safe, be strong. This Thank You sign in front of the hospital should let you know how the community appreciates you all. The artist Scott LoBaido showed his gratitude to the Elmhurst warriors thru his art. As a nurse, I appreciate the sacrifice you all do. We're in this together.

March 30-

Artist unknown

This says it all. It takes courage to go where nobody else wants to go. It takes dedication to leave our families behind. It takes resilience to bounce back from a shift of heartaches and frustration to come back another day. It takes some kind of craziness to be a health care worker at this time of great stress. It takes someone special and amazing to be on the frontlines of this war. The nurse represents ALL the healthcare workers in the middle of this fight against COVID. Kudos to all the nurses, doctors, PAs, NPs, techs, registrars, resp. therapists, transports, EMS workers, Security, EVS workers, engineering, IT support, and all the administrative leadership staff who work behind the scenes to open more and more beds for us. AJA! Laban lang!

April 1-

I don’t remember who and when the 7pm clapping actually started. Suddenly, there were videos of clapping and cheering emanating from the apartment buildings around Manhattan. New Yorkers rallying to support those who cannot stay home. They were united in applauding the healthcare professionals working on the front lines of the COVID-19 pandemic. It felt good.

Then at 7pm, the sirens of the New York Fire Department provided a heart-warming surprise tribute. The New York Fire Department Engine 47 gave their respects to the staff of Mount Sinai Morningside right at the corner of Amsterdam and 113th Street. A wall of heroes applauding the new, albeit reluctant, heroes of our time. The ED staff loved returning the applause. The rousing celebration of the work we do somehow validates all the sacrifices that we make. There were air horns, somewhere distant the clanging of pots and pans. Soon the ED staff was joined by other hospital workers from the inpatient units. They hooted and cheered, for a few minutes forgetting the horrors behind the front door of the ED. In moments of crisis, we savor those moments which make sense of everything we do.

April 3
The eyes have it. As I go through the ED, I see all the staff bravely going through the day. Behind their masks and face shields, they put their thumbs up but I could feel the rising anxiety. I had to peer into their face shields to see who I was talking to. The eyes told me what they were feeling. Sad eyes from the deaths they have witnessed, more than they ever did in a single shift. Worried eyes because they needed assurance that they will not bring this virus home to their family. Haunted eyes for witnessing the final goodbyes between the patients and their loved ones on the iPAD.

But they are here, doing their job the best that they could. It's the worst of times but I see the staff stepping up. A physician assistant brought an iPAD to the room so the patient and the self-quarantined family can talk to each other. The doctors slumped in their seats as they held their phones to their ears, as they fielded questions from the worried families. The nurses and techs gowned up to prepare a patient for the morgue. At 3pm, the techs gathered around after huddle to say their prayers. They are the heroes of these uncertain times. And to survive, I see them supporting and being kind to each other, sharing the hand-made masks and surgical caps donated to them by worried friends.

In the staff lounge, on her break, a nurse removed her tight N95 mask as she settled down on a chair to rest, the string marks stayed on her face; red bruises under her eyes and on her nose. She closed her eyes, probably in meditation, probably just to get her bearing. Like everyone else in the healthcare world, she was exhausted. I closed the door so she can have her moment of peace.

April 6-

Here's our Mount Sinai Morningside crew. Taking a respite from the heart-breaking work to just enjoy ourselves and support each other through the hard times. Somehow, we found time to just have a little fun, and at the same time exhort the public to stay home. #stayhome #flattenthecurve #mountsinaimorningside.

April 7-
Positive news of survival should be celebrated. In our fight against COVID, we have to gather strength and hope in those things that affirm our impact on our patients' lives. We have to find the joys that will keep us moving forward. The digital board in the lobby announced that there were 137 patients who went back home to their loved ones yesterday. Today, my nurse's husband was number 138. Finding our Joy in small victories.

A staff nurse who was out on sick leave called me crying. She saw the staff video and expressed her guilt for not taking her place at the bedside with her peers. Other staff members expressed the same thing to me. I told her gently to take care of herself first, that the best thing she can do for us is to just keep us in her prayers.

A week ago, I suggested to the Incident Command Center to post the Good News of our discharges, as a kind of a morale-booster to the staff, to remind them that we are saving lives. I wondered if our city will give the healthcare workers our own ticker tape parade, maybe in the Canyon of Heroes.

April 9-

Check this out. The husband of our ANCC Diana Velazquez from the Emergency Department paid tribute to the healthcare workers of #MountSinaiMorningside. Matt Hong serenaded us with a sexy sax rendition of "When the Saints Go Marching In". Cool!

This never gets old. A much-needed boost from our friends at FDNY, heroes themselves. There are new chalk marks of appreciation on the sidewalks leading to the ED, all from the Morningside community, their own little way of appreciating the staff at Mount Sinai Morningside. This time, the firemen were joined by the NYPD officers on horses. I saw my nurses' eyes filled with tears of joy and gratitude.

April 10-
I am glad I was able to witness a patient's discharge; he is a COVID survivor. The patient broke into a wide grin as he was met with a chorus of well-wishes and boisterous applause at the #MountSinaiMorningside lobby. It is an honor and privilege to be among a group of people who cheered this patient. Much as he appreciated the warm send-off, I felt similarly blessed. It was a great feeling, a much-needed pick-me-up. There was encouraging news about the downward trending admission rates but I couldn't shake a lingering sadness earlier because of some losses of people I know. At that moment, I was energized, I felt joyful seeing the patient's grateful smile. I caught his eyes and I felt my own tears fall as he mouthed. "Thank You". I never took care of him, but he was everybody's patient at that time. Sir, Thank you.

April 11-

Pause and Applause have started at #MountSinaiMorningside.

We PAUSE to reflect on the lives lost due to COVID-19 and to strengthen our resolve to fight for the lives we can still save.
APPLAUSE is a more joyous occasion. We clap when a patient is discharged. We applaud to rejoice for the life that was saved; someone's loved one who was given a second chance.

April 12-
"Always call upon our Father
When afflictions, you may suffer;
He’ll never forsake you in your hardship.
His help He will give as long as you shall live"

This I believe. I had to believe that the pandemic will soon end. Our worship service is now on Webex. The video was grainy, and the choir hymns were canned, but the minister delivered a spiritual and uplifting sermon. My church (Church of Christ) has been doing the virtual worship service by Webex for several weeks now. I miss going to Church; I miss the brethren, the hymn-singing, just being in the House of God. This is just a bump in the road, a little test of faith. After the service, the minister beamed with relief when he saw the faces on the screen. We waved back at him. My soul needed it.

April 13-
One of the nurses relayed that she triaged one of the first COVID 19 patients she took care of last month. She recognized the eyes of the patient; those same eyes who looked at her with dread when he came in with double pneumonia and had to be intubated on his first visit. She thought he was the sickest of the sickest that horrendous day with a poor prognosis. But he was discharged two weeks later. This time he came because he was short of breath on exertion.

As he sat on the triage chair, he relaxed and even laughed when the nurse stated she recognized him. His eyes were not as frightened anymore, just concerned. He later smiled with relief when his oxygen saturation showed as 99% on room air. He acknowledged he just had to give time to feel stronger, for his lungs to go back to normal. Nurse Jovy told me that she sobbed in relief when the patient left to go home.

April 14-

After a heartbreaking loss of a church friend that had momentarily shook my world, this picture somehow eases the pain, even for just a little moment. One of our own ED staff, a registrar, was discharged after weeks of hospitalization for COVID-19. The word Social Distancing did not really enter my consciousness at that time, sorry. In defense, everyone was all masked. The lobby of the #MountSinaiMorningside was filled with thundering applause amid chants of his name. It was a celebration of a life saved, of winning one against a dreaded disease, of teamwork and unity, of survival (not just for the patient but for all those who continue to fight).

Joining this celebration was one of my nurses who survived COVID herself. She was one of the loudest cheerers. Seeing both survivors were inspiring. The moment was all-powerful, and a big morale-booster for those in the biggest battle in our professional lives. It was a joyful celebration of the men and women who fought for this patient. As I saw the numbers on the Discharge monitor continue to climb, I am hopeful that this nightmare will soon pass. It was a special Thank You that another one got away. Take that, COVID!!!

April 15-
I feel a deep, aching sadness in my heart. Yesterday, one of the most-beloved members of our church passed away. I cried for the family he left behind and for the generations of church brethren that he touched. I cried for every single one of my friends and acquaintances who died due to COVID. There is a pain of loss and the continuing fear of losing some more. Too many friends who lost family members to this pestilence. Too many precious lives gone.

April 16-
There are others in other states with a myopic understanding of how dangerous this coronavirus is and they demand to ease the lockdown. The healthcare workers continue to venture out every day to take care of the sick so that others can stay home. I feel anger that there are people who bemoan about being bored out of their minds due to staying at home. I feel disgusted at those who disregard the tragedy of lives lost just because they think that their freedom is curtailed.

The Stop-the-lockdown movement is fueled by ignorant, uneducated people who were not yet touched by this pandemic. They are just adult versions of that stupid teenager during the spring break in Miami who stated, “If I get corona, I get corona. At the end of the day, I’m not going to let it stop me from partying. What is wrong with these people?

ADDENDUM:

April 20-
I must have looked dejected as I walked through the lobby. I had my surgical cap and my N95 mask on but I was still recognizable with my ubiquitous white lab coat. Somebody asked me “How are you”. I shrugged my shoulders, squeaked a weak “I’m okay”, and quickly turned around. My tears threatened to overwhelm me and I did not want to ugly-cry in the middle of the lobby. I did not want to break down, I did not want to curl into a fetal position. A part of me wanted to say "I'm having a tough time" but I was not ready to share. I just heard of a church friend and church deacon passing from COVID-19. This is heartbreaking. In my previous hospital, five hospital workers succumbed to the complications of Covid-19. The threat of contamination looms over our heads like Damocles' sword. When is this going to end?

April 23-

This morning looks like a miracle to me. I can breathe better. I had a good night's sleep after the surprisingly calming effects of my crossword puzzles and the soothing music of Anne Murray. Earlier that day, the Mental Health Liaison met with the staff to offer some options to de-stress, to decompress. We need to do our Mental PPE. I prayed not for myself but for my own family and my work family. Then, I turned to the one thing that always calms me down: I write. I wrote what my heart spoke.

There were only 8 patients in the ED, three of which are COVID patients waiting for the med-surg beds. No ICU patient at this time. More nurses than there were patients. For the very first time ever, our NEDOCS score is -2 (negative 2). The charge nurse later texted me in the afternoon that the volume had picked up. There were now 40 patients in the ED with some trauma codes and non-COVID patients in the mix.

FaceTime eased my loneliness when I spoke with my son. He had just been working at home and he is safe. My mom is also safe in Manila, enjoying her wine now that there was no more beer to procure. It is how she relaxes at home. Everybody at home and at work is safe. That's all I needed to know.

My temperature was 97.8F. Most of my staff members who were furloughed are back to work, ready to join the fight again. Governor Andrew Cuomo said that the COVID-19 war is not over but he cautions against prematurely stopping the lockdown.

July 30-

What a year it is. It's not over yet. The tsunami of admissions had abated here in New York but there is still fear of a second wave. There are more non-COVID patients in the ED. The patient census had dramatically gone down. There are more nurses than patients. Now I can breathe better. I am sleeping better. There is light at the end of the tunnel.

Sept. 29-

To heal myself, I turn to the things that I am grateful for: my family and friends, my church, my work family, music, books, food, puzzles, and our dog. I look for my joy triggers. That is how I keep myself sane amidst all the challenges of life in the new normal. And then, I write. I write what my heart speaks.

October 4-

I hear the laughter now. I see my staff SMIZE; their eyes are smiling above their masks. They know it is not completely over yet, but they find strength in each other.

Nobody comes out of this pandemic unscathed. We have to actively and deliberately plan our joys in and outside of work. One of the nurses shared her joy when a recovered patient recognized her eyes when she cared for him in the ED.

As we all put together the pieces of our broken hearts, we march onward, stronger together.

December 13-

The second wave is here. Covid 2.0. It is a scary time. But the vaccine is here. There is HOPE and RELIEF. It is the beginning of the end. I am hoping that a few months from now, I can finally travel and hug my mom again.

For us. For our families. For you. For our country.

December 17-

I got my Covid-19 vaccine today and so did some of my ED and ICU colleagues. Finally, the Pfizer vaccine is here. I have been waiting for this. Now that we’re on the Second Wave of this horrific pandemic, I am confident that we have what it takes to fight back with a vengeance. I am joyful that this is the beginning of the end of this disease that has gripped us in a chokehold for so many months. T But now there is hope. I must confess that I was teary-eyed because I can see the light at the end of the long tunnel. The vaccine is a game-changer. This will afford all of mankind to get back to the new normal. Thank you to the scientists and the volunteer research subjects; they are heroes themselves. Maybe, a few months later, I will be able to travel and hug my mom again. #LetsBeatCOVID19 #Havefaithinthescience

December 31-

It was a heart-wrenching year. A year of profound sadness, despair, and helplessness, of fears and anxieties that continue to haunt us to this day. This disease has gripped us in a chokehold for so many months.

Somehow, the collection of pictures turned into a journal of our collective experience during the pandemic. I encouraged others to share their personal reflections; I understand the need to share, to relieve the heart of the burden of fear.

The ED staff fought together, united as we were never before. We had to work together as a team; it was the only way to survive on these darkest of days.

For me, Journaling is a coping mechanism, it puts things in perspective; it slows things down to manageable parts. It is a therapeutic activity to drain the brain of stressful recollections. It gives me time to breathe, to process my emotions.

When written on paper, the pain loses its intensity. Like a catharsis of negative emotions. Not that we can ever forget. We just need to keep our hearts from breaking into a million pieces, just need to find comfort in the small triumphs. Just so we can continue to fight and survive.

The war against Covid-19 is ongoing, but having the vaccine is a huge relief. We have a fighting chance.

As 2020 closes… HOPE. Looking forward to 2021 being a better and safer year for all of us.

Check out the Virtual ED Nursing Journal

ED Nursing Stories

Finding my Joy in Nursing: Knowing my Whys

2020-02-29T18:10:00.006-08:00

Life’s ebb and flow can sometimes sweep you into just going through the motion without the conscious enjoyment of living. The stress of work and personal lives can often leech out happiness in one or both worlds.

“Plan your joy”, Michelle Obama said. We need to care for ourselves and to take the time to invigorate and refresh ourselves. There needs to be a good work-life balance in order to survive physically, mentally, and emotionally. Self-care is being mindful of our needs so we can in turn care for others.

I actively and deliberately plan my joy outside work. Whether planning the itinerary for a vacation or just enjoying a no-stress-and-waking-up-late-week-end, I seek those things that give me comfort and happiness. Good books, funny movies, soothing music, food trips around Queens with my son and family, and indulging in my joy of writing. My guilty pleasures are to explore the things that make me uniquely interesting. Even just planning for a quiet time on my sofa with the dog snoring at my feet. There is a thoughtful consideration to enjoy my days off work in order to recharge myself. Last night, I attended a spiritual Holy Supper worship service; I am blessed.

Because I spend a lot of my wake time at work, I also plan my joy when I’m working in my hospital. Unfortunately, I have seen some co-workers who allowed their work to drain the joy in their lives and they end up burned-out and bitter, sometimes because they felt trapped in a job that no longer sustains them and sometimes because they are afraid to spread their wings and find an environment that gives them joy. I am luckier than most because I truly have enjoyed my nursing journey.

The emergency department itself can be chaotic and stressful. This is the nature of my work; there are sad times when some of our patients die but there is joy when we are able to give someone a second chance at life. In all my years of nursing, from my first job as a staff nurse at a chronic care hospital to my current role as director of nursing in a busy emergency department in Manhattan, I always make a conscious effort to enjoy these moments of joy. Being joyful is not being artificial and unrealistically pollyannaish. I would rather think of it as being Optimistic, not just a Value of the Month. It is just knowing that we can reframe our minds to find meaning and purpose and joy however stressful the work environment is.

As a nursing leader, I feel the responsibility to help my nurses re-discover the joy in their work. There are financial constraints in staffing, but there is always something to do to empower our nurses to enjoy their work, even if sometimes the trials to both body and spirit can be challenging. I would like my staff to feel that they belong that they are appreciated and that they matter. One day, a nurse stopped me to complain about the boarders in the ED, those patients take out their frustrations on the nurses because they were waiting for inpatient beds. I gently asked her if she is asking to transfer to another unit. As I actually expected, she burst out laughing and said, “Hahaha, I am just venting. I love my patients and I love my co-workers, Thanks for listening.”.

I celebrate the work of every healthcare person in the hospital. A single person can make a difference. At our leadership retreat, the testimony of a trauma survivor touched my heart. She was a pedestrian-struck patient who sustained multiple fractures and injuries. She recounted very candidly her ordeal back to recovery and gave thoughtful and honest suggestions on how we can make things better for the next patient. She was thankful for the many healthcare workers who made a difference in her care. She spoke about simple acts of kindness like the ice cream from a dietary aide and the shampoo that the trauma coordinator helped her with. She remembered the good, the bad, and the ugly, but she earnestly spoke of the things that lifted her heart.

I live for the unexpected Thank You. One elderly man thanked me for staying with his anxious wife while he parked the car. It was just a simple gesture, just a few minutes of my time. To this couple, this meant that the wife’s anxiety did not unravel into a full-blown panic attack. The elderly man didn't know that just a few minutes ago, I came from assisting in a cardiac arrest of a young man who succumbed to an overdose. The “thank yous” are our emotional rewards, Two simple words that gave me joy that day.

The comedian Michael Jr. explained, “When you know your ‘why’ then your ‘what’ has more impact because you’re working towards your purpose.” The man in the video discovered his WHY and sang Amazing Grace with his heart.

The author Simon Sinek wrote that "it is only when you understand your “why” (or your purpose) that you’ll be more capable of pursuing the things that give you fulfillment". A purpose-driven life clears your pathway and makes sense of your actions, therefore it is what gives you the reason to keep on going, to start waking up in the morning, and to stop the snooze button on the alarm clock. This happens when you find joy in your life.

My joy is in the numerous little ways that validate me as a nurse. The ways we make a difference strengthen me amidst the sadness and chaos; a reminder of why I am a nurse. The reason WHY I stay and keep on going is that it is indeed a blessing to be part of a service profession that gives patients more than just a second chance.

Moments like these give us joy in our work. Nurses appreciate the simple pleasures- a thank you from a patient or a colleague, a life saved, recognition for a job well done, and a chuckle shared with co-workers. I do not have to reflect long and hard to remember the joys in my nursing life. It is when you are successful in maintaining the right balance in your life. This is my “WHY”, my 'IKIGAI" or "my reason for being".

The Holiday Heart: Improving the Patient Experience During the Holidays

2019-12-28T15:45:00.006-08:00

Our hospital president posted a poignant holiday message for the staff this week. He talked about the melancholy in Joni Mitchell’s song “River”. He wrote that “the song paints the picture of the season, but it juxtaposes against that backdrop a sense of melancholy that is not usually associated with the end of year festivities… One of the extraordinary blessings of delivering care is that, for a period of time, we are our patients' families. We are their loved ones. We are their company when no one comes to visit. We are their comfort when the outcome of their stay with us is uncertain.”

That post resonated with me. My first job here in the United States was in a long-term facility. The patients were long abandoned by their families; left under a stranger’s care. The nursing staff held their hands and listened to the nostalgic remembrances of their loved ones. I sometimes stayed past my shift just to listen. We became their family. The nurses dried their tears just as we dried our own tears of being away from home. We were their daughters and granddaughters.

The three years I spent in that hospital shaped me to be a better nurse. I emerged to be more compassionate and empathetic to the patients. The pangs of homesickness were better dealt with when amongst the patients who needed our care. I gave my patients an extra dose of care and attention during the holidays. The staff tried to cheer up the patients and to provide distraction when their families forgot to care. I remember holding the hand of one trache-dependent ALS patient as he waited for the visit that never came. He could not verbalize his disappointment but I saw his eyes react sadly whenever the other patients in the 4-bedded room received their own visitors.

In the merriment of the season, hospitals see a lot of patients overcome with depression. Those who are medically sick sometimes spend the holidays with the staff who had to leave their families to take care of their patients. In the emergency department, we continue to get patients who choose to binge drink to fight their loneliness and ended up with Holiday Heart syndrome.

One New Year’s eve several years ago, I stayed with one lonely 70 y/o patient as we watched on tv for the Times Square crystal ball to drop. She was waiting for her family to pick her up. She was teary-eyed, confused at the babble of voices in our crowded ED, unable to understand the language. But she smiled when I brought her food and counted down with her during the ball drop. As I hugged her, I was reminded of my mom, miles away in the Philippines. The patient eased my homesickness as I comforted her. Mrs. Chen bowed to me and said "Xie-xie" (Thank you in Mandarin).

During the holiday season when families spend time together, someone out there is looking for some love and attention. Like the woman from Oklahoma who posted on Craigslist, “Anybody needs a grandma for Christmas? I’ll even bring food and gifts for the kids! I have nobody and it really hurts.” This post went viral and illustrated the stark reality that many of our elderly population are isolated from their families. Actually, not just the elderly; there are many lonely people in the world.

Thank you to all of those who work during the holidays. At a time when all others celebrate the holidays in the comfort of their homes with their loved ones, it is a blessing to bring some kind of comfort and peace to those who need them the most. During the holidays, the ED is not always crowded so there is always a chance to spread some cheer around. A little touch, a little smile, and some time to just listen go a long way to ease a lonely heart.

"River" by Joni Mitchell

"River" by Sarah McLachlan

Holiday Heart Syndrome
In 1978, Philip Ettinger described "Holiday heart syndrome" (HHS) for the first time, as the occurrence, in healthy people without heart disease known to cause arrhythmia, of an acute cardiac rhythm disturbance, most frequently atrial fibrillation, after binge drinking. The name is derived from the fact that episodes were initially observed more frequently after weekends or public holidays.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998158/

When One of Our Own Is the Patient: Anna's Story

2019-11-02T20:28:00.001-07:00

“Trauma notification coming in”…

It was not just any other trauma patient, not just a stranger. The woman on the EMS gurney groaned in pain. Her face was bloodied and disfigured, her hair matted with drying blood, the face almost beyond recognition, until I saw the nurse’s uniform. Just like my own.

“Anna”, I whispered her name but it sounded loud in a room suddenly rendered quiet by the shared recognition. Anna was one of the senior nurses in the ED, and she was well-loved by all of us. Even the surgeons respected her. She was the ED’s toughest nurse, and we were all proud of her.

There was just one muffled curse then the trauma chief’s voice spurred everyone into action. We listened as we moved Anna to the stretcher. The EMS paramedic’s voice quavered with the report. “We got the call about the assault from about two streets away from the hospital. She was assaulted by her ex-husband. She’s breathing and moving all extremities. She’s awake, alert, and oriented but she cannot talk much because of her swollen face.”

The other paramedic chimed in, “And her ex was arrested by the cops. A few construction men came to her aid, but I think they beat him up too.”. I hoped that he was beaten up bad too. I was also relieved that the police did not bring that evil man to our ED.

As I cut her scrubs, I felt my eyes sting with the tears, which I had to blink away. My heart was in my throat. My hands were shaking. I locked my knees and leaned into the stretcher to prevent myself from falling. Damn it, I had to be strong because I better be the best trauma nurse there is for Anna.

I saw the fear in the staff's eyes. It was surreal to be taking care of one of our own. Anna was the trauma nurse for the day; she just went out for her lunch break and now she was lying down on the same stretcher that she just prepared.

Just like the professionals that we were, the team went to work. The other nurses looked as determined as I was as we all took our positions and did exactly what she taught us to do. Our trauma team worked in sync. The patient was one of our very own.

The ED doctors and the surgeons methodically did their assessments, Airway good, breathing on her own, no pneumothorax, vitals good. FAST was negative. As soon as the IVs were inserted, the tetanus and the antibiotics were given, we had Anna readied for the CT scans. I scooted around to her side and held her hand. Anna squeezed my hand tightly, and I said “We got you.”.

As we passed through the trauma door, several hands reached out to move the stretcher, a few “I love you" from the staff followed Anna into the CT scan. I think everybody held their breaths as we waited for the test results.

The rest of the staff had to return to their own assignments, each one held their emotions in check as they braced against the onslaught of patients demanding their pain medications and complaining about what took the staff too long to attend to their needs. One of our own was hurt, I wanted to yell at the intoxicated patient who called out for more turkey sandwiches.

The results came back. All were negative except for one broken finger when Anna punched back in defense. That’s our Anna. It seemed that the department heaved a collective sigh of relief. We admitted then to our ourselves that we feared the worst, and so we were all thankful and hugged each other.

Anna stayed out only for two weeks, but time was not enough to recover from the emotional trauma. Although she came back physically healthy, her heart was broken. After another month of showing up to work with a forced smile, she finally said her goodbyes. She relocated with her son to California, away from her husband who was in jail, to be with her mother and the rest of the family.

The last I heard, she was back to her old self, a no-nonsense nurse who intimidated the residents and the surgeons in her new hospital. Anna was back.

Making a Difference as an ED Nurse #IMakeADifference

2019-10-06T19:58:00.004-07:00

HAPPY EMERGENCY NURSES WEEK!!!!!

This could be you. This could be any nurse (ED or not) who makes a difference every single day. With humility, I acknowledge the privilege of touching somebody's life. That is why I am proud to be a nurse, more specifically an ED nurse.

As a STAFF NURSE in the Emergency Department, I made a difference when…
- I was the IV nurse to go to for the smallest and most difficult-to-access veins, long before those fancy vein-finder devices ever made it to production
- I volunteered to work another shift of overtime, even after a few hours of sleep from partying with friends
- I could last longer doing CPR than some of my co-workers who huffed and puffed after just three cycles
- I sang and danced to calm down a Down syndrome patient who was having a meltdown in the midst of a noisy ER
- I multi-tasked to cover another nurse who needed a little time to recover from a bad trauma case
- I helped out a tech who was busy elsewhere and did the EKG myself for a patient with an atypical presentation of chest pain (she had an MI)
- I intervened to prevent a fight between two intoxicated patients (I was almost hit by an errant left hook)
- I cross-checked the new nurse’s drug calculations and prevented a medication error.
- I triaged a quiet, stoic elderly man who sat patiently for his turn before a loud, obnoxious female who complained of having an asthma attack (while speaking in full sentences and clutching a bag of chips). He turned out to be in sepsis.
- I held my dying patient's hand so he didn't die alone.

And many more to mention…. I miss those good ole days.

As a NURSE EDUCATOR in the Emergency Department, I made a difference when…
- I taught the nurses how to triage, to use across-the-room-assessments, and to trust their instinct, and to not be intimidated when the doctors questioned their judgments.
- I watched like a hawk and did not let the nurses pass competency until they can demonstrate setting up chest tubes and rapid infusers to my satisfaction
- I failed a nurse’s orientation because she did not meet her milestones, but most especially, she had the nastiest attitude toward her patients.
- I patiently counseled an earnest novice nurse who had the potential to become better but just needed a little guidance to boost her self-esteem
- I “saw” the “light bulb” in my students’ eyes when I taught them how to read the EKG
- I gave feedback with respect
- I challenged the nurses' minds so they would not accept things just because they're used to doing them
- I encouraged the nurses' aides and techs to study for their nursing degree
- I engaged my students in my class to participate in robust discussions
- I prepared specialty certification materials for the nurses and pushed them to go for advanced degrees.

I felt validated when I meet former students/nurses who told me that they learned so much from me.

As a NURSE LEADER in the Emergency Department, I am making a difference when…
- I closed the vacancy gaps and improved the unit’s staffing (I must say that this is a work in progress due to increased patient admission boarders)
- I promote nurse engagement, to improve retention and satisfaction; when they feel proud of being part of the work-family
- I collaborate with the interdisciplinary staff to improve unit processes and patient workflow
- I manage my budget but will always choose patient safety over not approving overtime when the ED is in a surge
- I manage up or acknowledge the staff when they are doing great or when they do a Great Catch (catching a near-miss or potential error). I will always find a way to nominate them for a Nurse Excellence Award or for a DAISY.
- I encourage advancement in the nurses’ practice by using evidence-based care
- I practice Just Culture when staff makes unintentional errors and still hold shared accountability when needed
- I listen with an open mind and do not cast judgments until I hear all sides.
- I give honest but constructive feedback but make sure that my expectations are clear and will be followed up
- I am fair, tough but compassionate.
- I care. I only want the best for the unit, for the patients, and for the staff.
- I still intervene during difficult patient interactions.
- I do not condone workplace violence. I am an advocate for patient AND staff safety,
- I sometimes cry with the nurse, when she/he needs a shoulder to cry on.

I am still learning…. My difference may not be as exciting and full of action as when I was on the front line, but I'm hoping that I make a difference to make life easier for those in the trenches of providing care.