11 years of Friendship equals One Soju Night

We are all nerds. We could talk about chemistry, physics, statistics, biology and medicine in between transvestites, taboos and dogs.

We all have boisterous laughter and we laugh at others' misfortunes and our own stupidity.

We have perfected our synchronous look when cute boys pass by and our hidden conversations about the boy in a hot black red bikini.

They could get wasted and I can get wasted just by laughing at them.

As we celebrate our 11 years of friendship, I write this post for these bunch of friends who had been there when I cried, laughed and loved.

So here's to that night of continuing traditions. (Pictures courtesy of Randelle)

The tradition of sleeping over started at one mishap hotel in Malate when they tried out different gowns using bed sheets and curtains. And after a decade,we found ourselves in one luxurious 3 star hotel along Makati Avenue.

With Jerry, Jesse and Randelle in Best Western Antel Spa Suites in Makati Avenue

We even tagged Randelle as Atty. Persida Rueda-Acosta. No more Miss Minchin or Ruby for now.

"Areglo o Asunto"- Randelle Ian as Atty. Acosta

We talked about career plans, growing up and  future escapades in the company of Jesse's Soju Concoction ( 1 Soju bottle +4 Yakult +1 lemon and 1 sprite in can).

Drowning ourselves in Jesse's Soju Concoction

We remembered our best friends slash donors in our own fun and goofy way.

Our own way of saying we miss you Edgar Dy

Remembering Suzie with her favorite food- Rice!

We love to bully her simply because we love her.

They swam and enjoyed the pool while I watched them in a bath robe.

Forgetting my swimwear in a special day like this.

We laughed and laughed- something that we always do when we see each other.

We study and work hard but we laughed harder.

10, 20, 30 or 50 years...

 I would always look back to this special night when I attempted to kicked one out in my bucket list. Though I admit that I rarely spend time with them anymore, they are one of my countless reasons why I am glued to stay.

The nth Midlife Crisis

I have been marching in and out of this desolated awareness of what should have been and where to go-s.  And unconsciously, I am creating a lost version of myself underneath the opened Word documents with nothing but a series of blinking cursors and random songs from Mayday Parade’s.

I have never realized until now that this thriving soul is seeking the stroke of a paper and that these throbbing fingers long for the touch of a pen. Indeed it had been too long and I nearly forgot how to breathe into the spaces of my own respite. I am yearning for long conversations with my pen and paper and as I strung words and meanings, I found myself in this state…

People call this a mid-life crisis.  I call this my nth mid-life crisis- the nth time where I have to re-think what I should have been and where I should have gone. As I searched for that idealist and brave self that had once stared at me in the mirror, I found nothing but this lost self pulled back on step one.

I have never realized how time would fly so fast while I am catching my own fireflies in the cheating daylight. And as they say, what matters are not the fireflies but how I caught them.What matters most are not the lost hopes and dreams but the lessons I got from the thousand failures.

Every decision in the past had struck me in whim and caprice. Right and wrong but mainly indecision had hauled me into this drowning wall and out of my once effervescence.

At 16: “Nursing is what my grandmother wants.”

At 20: “I don’t know what I want to do but going to USA is something I do not want”

At 22: “ I want this because it makes me feel good.”

At 25: “ I do not want to do this anymore. Get me out of here.”
At 27: “Is this really what I want?”

Every time I am haunted by this mid-life crisis, I go back to my purpose; I go back to His purpose- that insignificantly significant question:

 “Is this what I am made for?”; “Is this what He has called me for?”

Then it hits me. Often I found myself walking towards the deception of a midlife crisis because I was asking the wrong question of whether this is what I really want for myself.  

 I am unsure of what the future brings but one thing is certain- that there will still be nth midlife crisis in the future. And that I will be compelled to think that I should have been in a rather easier place if only I have decided otherwise.

The funny truth is “what I want” turns out not to be the compelling solution to my million and one midlife dilemmas- but “what He wants”.

A nurse is always a nurse

In 2010, 287,00 nurses in the Philippines are noted to be either unemployed and/ or underemployed. And with the recent release of those who have passed the December 2011 NLE, the statistics will surely  inflate by a hundred fold. But, if I consider the layman's definition of underemployment, I have to say I should also be counted in the statistics since I rarely use my clinical skills at ACCESS Health.

When I left my 5 year clinical work in PGH for a chance of a public health exposure in UlaanBaatar, I have left my hospital skills inside that yellow- green and orange tainted  charity ward since I cannot include "I.V insertion or Inotropes computation" in my training.Though at times I miss all the hustle of an overloaded nurse,  the thing that I am missing most is my day to day interaction with my cute patients. It had been seven years since I graduated from UPCN and each time we attend the "despedida" of one of our close friends, I can't help but think that I am way over the two year service of UPCN graduates for the country. It makes me think that I can no longer rationalize that my stay here was an obligation to the country but actually my personal choice.

Three years ago, I had exactly the same sentiments on  becoming a nurse who stays when my dear best friend  left for Abu Dhabi.  I recalled that during that year I was already burned out with what I saw in  how we  were caring for our patients in the hospital. I have seen parents who compete for hospital admissions only to found out that having their children admitted in the hospital will only cut short their lives. There were missed doses of medicines, compromises in the patient care, delayed laboratory diagnostics and apparent divisions in socio-economic status that only those who can afford will have higher chances of living. There were a million and one instances when I lay in my bed after a stressful duty that I realized that I have to look outside to feel more. I have to be outside to see more. 

Now that I am outside the four walls of the hospital, does that make me less of a nurse? Working for three months in ACCESS Health allows me to advocate for the nursing profession in small ways. Though my job position and designation is not of a clinical "nurse", I believe that it did not rob my throbbing "nursing" heart.

With a different job position, I still feel as a nurse trying to resuscitate not of a patient but the morale of nurses.Though it is quite discouraging that typical Filipino nurses nowadays feel demoralized if they tell others that they are nurses. In fact, when I attended "big" meetings, even "big people" refer to "nurses" as a societal problem. The once known caring profession has evolved into an unemployment statistics that needed to respond to. 

I think I am still the same nurse who once administered oxygen and medications to hospitalized pediatric patients. Though I do not operate with surgical scissors nor carry with me patient endorsement files, I am still the same nurse who along with a few of my batch mates employed in or out of hospitals here in the country  , who still tries to find ways to stay.

Done with the visits

It's been awhile since my last post. I won't deny that I had been so busy with a lot of things and one of which was visiting all 24 khoroos in Bayanzurkh District. Ideally, as soon as a new volunteer steps into any community, he/she must conduct a needs assessment by visiting all the Family Group of Practices (FGPs) in the first two months. An FGP is the usual barangay health center in the Philippines.

My visits took at least 5 months, just in time  before the new volunteer comes in.  So, with the help of my interpreter Altai and the FGP Manager Sugar (both in their stilettos braving the steppes for hours), I finished my visits and finally realized what's in "it" for me. And I tell you, I am in a massive "it"and massive is an understatement.

To start with, this district has approximately 290,000 "registered" people- not counting the families who have put up their gers a few minutes ago and the families who have left  to move to another district (modestly explaining their culture of moving in and out). And mind you only six of these FGPs are apartment khoroos while the rest are ger khoroos. The good thing is that here they have the freedom of putting up their ger anywhere they want unlike in Manila, where people living in the squatters would have to fear for their lives because of  demolition or a rushing train. Migration is a big problem as more and more people from the countryside move to the city to find a stable job- also a situation in my country.To resolve this gap, the khoroo government is trying its best to have everyone registered for the advantage of being able to access health services but the lack of manpower in the khoroo is crippling.

During my visits, I usually interview the heads of the FGP and they were all singing the same chorus. " Not much doctors or nurses for at least 10,000 people", "doctors and nurses are overworked", "doctors and nurses are underpaid", "In a day, one doctor sees 50 patients", and the song seems to never fade. It's incredible to know that I'm new in this community but very much familiar of the song they are singing because of what I witnessed while working with much, much smaller communities in the Philippines (probably 100 times much smaller).

One of the most obvious difference though is that Mongolians usually seek consultations for injections unlike us Filipinos who would rather swallow a month of irritating tablets just to avoid those injections.In almost 80% of my visits, I  witnessed seemingly healthy people coming into the clinic with a plastic bag of IV drips and 100% of those times, I would pester my interpreter to ask what the IV drips were for. But all the time, I would be in a glorious defeat because my interpreter was too courteous to ask. After twenty minutes of IV infusion, these seemingly healthy people will resume their seemingly normal lives and will leave the seemingly busy FGP- without a single tear. One time, I tried my best to look at the IV drips but as much as I tried transposing my left and right eyeballs , I could not understand the Mongolian scripted labels and so I stopped snooping around before I got caught.

I have to say that I am quite impressed with how their FGPs are completely endowed with children's playrooms, exercise equipments, digital scales, ultrasound and echocardiogram. But during my interviews, I had found out that they don't usually use these equipments because they don't have someone in the FGP knowledgeable on how to use it. Not only do they have not enough manpower in the FGPs, they also lack the "right" manpower.

And so after five months, I finally realized how big would be the ripples of my small actions. I admit that  the communities I had worked with before was just a fraction of this district's population. I know that I am not here to give them solutions on their big problems but then now I realized how important would be the implementation of our project.

Just in case you haven't heard from me for quite some time, don't worry, I'm just too busy with my small ripples. And oh yes I might be busy hanging out with my ex-lover:

A big pat on our backs

After weeks of planning and brainstorming on how to give six days of training to the recruited 134 community health volunteers of Bayanzurkh District, we finally finished the first round of training. In order to make this six day trainings feasible, we divided the participants into two rounds with at least 25 participants in each day.

Here's the  translated training schedule that Duger ( my counterpart) did. He brilliantly thought of having these trainings conducted daily for nine days in three sites with one site preceding the others. There were 30 facilitators (specialists, trained trainers, social workers  including us, VSO volunteers and our interpreters) and grouped us according to the health topics each day.

Kara, Jo and I were responsible to do the first days of our trainings where I was tasked to give the training on Effective Communication. Such an irony though since I admit that I am not an effective communicator myself and revisiting this topic made me realize how often I take communication  lightly.

Some pictures of me doing the "Communication" training:

Day 1 ( Ambulatory 1, June 2)

Day 1 (Polyclinic, June 3)

Day 1 ( Ambulatory 2, June 4)

The succeeding days  were facilitated by different people who specializes on: Alcoholism and Smoking ( Day 2), Maternal Health (Day 3), Pediatric Health ( Day 4), Non- communicable diseases (Day 5) and Elderly Care ( Day 6).

Here are some of the "epic" pictures:

Look at the papers in their table!

I like this picture so much because the CHV on the left looks like my Lola Zoring

Dr. Ankhtuya and a CHV doing some icebreakers on "animal parts"( Day 6 at the Ambulatory 1)

The first round of trainings ended on the 13th at Ambulatory 2 and so on June 15, our community health volunteers finally had their graduation ceremony. A simple ceremony with fruits and biscuits as refreshments just to show them how we appreciated their commitment to be health volunteers. Some of the health volunteers awarded us mini- horse fiddle instruments ( Morin- Khuur) during the ceremony, after all we are also like them - people who work so hard without expecting any in return ( except probably the toilet key)

Simply said: Community Health Volunteers Graduation Ceremony

Malay skin on the stand out!

The three "foreigners" with our dear friend Saruul ( Kara's interpreter) during the graduation ceremony

Mini Morin- Khuur- perfect for my small fingers ( if it can be played)

Traditional Medicine in the Philippines and Mongolia

For the past two weeks, the Bayanzurkh DHU team had been selecting community health volunteers that we will be training in the upcoming months. In order to pass our selection, the applicants should at least score B's in the interview (with Avarga (Training Manager), Duger ( Public Health Manager) and Sugar ( FGP Manager)), case studies and group activities. But among the three parts in our assessment, I am really amused during the discussion in our case studies because this is when I discover about the traditional treatment of common health problems among Mongolians.

CHV applicants doing our Newspaper Activity on our 2nd Selection Day

Avarga having a headache while interviewing an applicant. 

I come from a country where Traditional Medicine is not totally rejected and knowing that there is some basis on  these healing practices makes it harder for the imposition of modern treatment. Every time I get sick when I was younger, my grandmother usually resorted to her plants as initial treatment to my ailments. Also, I experienced being one of the unfortunate followers of penicillin capsule sprinkled over  the wounds or those who had not bathed for weeks because of chicken pox or fever. My lola (grandmother) had also used “lana” or coconut oil in small bottle when I had stomach colic or the more modern version of Efficascent oil when I had pain anywhere in my body. For hiccups, we usually put red lipstick or a moist thread in the forehead of the baby which we believe are effective.

“Binat”, “Pasma” and “Hilot” are common medical terminologies in the Philippines and if we add non-medical causes of morbidity in our statistics, I am sure that “Nabati” or “Na-nuno” (a consequence of offending a spiritual entity) is one of the top leading morbidities.

Most of those that have applied to be community health volunteers in our district are probably like my lola's age and probably smelled like her. Oh Am I missing her too much? They also had the most inquisitive answers to our case studies making me so lenient on handing them As. The case studies are very helpful in determining their knowledge on common health illnesses as well as their level of critical thinking.

During the case studies discussion with our applicants

Here are some of the traditional Mongolian health practices that I have learned during our discussions:

First Aid for Burns

As an initial home remedy for burns, Mongolians usually used a solution of water, sugar and soap. There were some applicants who mentioned that they also use beer, oil or liniments, salt or black shoe polish in the burnt area.One volunteer applicant described the treatment when her daughter had accidentally incurred burns from hot coal ashes.Cow's feces and a concotion of penicillin medication and the parent's blood were put in the burnt area (Meanwhile, we Filipinos make use of toothpaste: Colgate and not Close- Up).

Cough and Colds

The mother’s early urine in the day is given to the baby to drink for cough and colds.

Rickets

In order to prevent rickets, the baby is buried in the sand because they believe that the sand is rich in Vitamin D.


Fracture

Eating a special bird's flesh can be very helpful in healing  fractured bones.

Baby's supplementary food

For breastfeeding babies, drinking boiled sheep fat can be given as a supplementary food.

Diarrhea

Drinking Mongolian yellow rice juice was reported to be effective remedy for diarrhea.

Hypertension

According to our health volunteer applicants, hypertensive events are treated by drinking one bottle of vodka and elevating your arm with the forefinger pointed up.

Low Blood Pressure

For people with low blood pressure, drinking goat’s blood is believed to raise the blood pressure.

I realize that these practices are widely used for decades and  have been found to be effective by Mongolians. This blog post does not put criticism on their way of healing diseases but in fact, hoped to provide us with more insight that traditional practices like these do actually exist everywhere in the world, may it be in the Philippines or Mongolia.

Only in Ward Eleven Part I: Communication Bloopers

From this day on, I speak nothing of bitterness just happy memories.

From this day on, as I reminisce the happy memories I had, I bring with me the genuine friendships I have with them.

This post was long overdue. Suzie and I was talking about the funny blunders that we had with our patients' watchers. This post is the same as the circulating internet email with "Phenobarbie-doll and CT skull"; only that this post contains a lot of my memories with Suzie, my co-nurses and our watchers.

Blunder 1:

Makulit na Lola: " Ma'am ubos na po iyong suwero ng pasyente namin."

Nurse: "Ano pong Bed Number po?" 

Makulit na Lola: "Ward 45."

Nurse: (correcting Makulit na Lola) Bed 45 po Lola nasa Ward Eleven po kayo. Wala po kaming extension sa likod at mas lalo pong wala kaming tunnel."

Lesson: Do not call your patients as Bed Numbers, moreso as Ward Numbers.

Blunder 2: 

Patients, especially those in the charity wards are often referred to the Medical Social Services (MSS) to augment their diagnostic and medical needs.

Nanay 1: " Ma'am, ayos na po iyong CT Scan, nahingan na po namin ng tulong."

Nurse: "Ok, sige po. Saan na iyong request para i-check natin iyong oras ng CT scan."

Nanay 1: " Ay Ma'am, iniwan ko po sa MMS." (Wagi si Nanay, high tech. Tanong naman natin iyong Wi-fi)

Blunder 3: During an IV insertion..

Nurse: "Mommy, meron po ba kayong gamit pang-suwero?"

Nanay 1: (puyat na puyat) "Ay opo Ma'am, patingnan na lang po sa supot."

Nurse: "Ok sige mommy, pahawak na ng kamay ng  bata."

(After inserting the IV cannula...)

Nurse: "Mommy, akin na po iyong heplock natin."

Nanay 1: "Ay Ma'am wala na po kaming PADLOCK. Pa-reseta na lang po"

Blunder 4: During patient rounds, the nurse asks the watchers on the oral medications available and instruct them on time of administration.

Nurse: "Mommy, patingin po ng mga gamot po na ipapainom natin ngayong umaga."

Nanay: "Ma'am, ang meron po dito; iyong Vitamins at para sa konbulsyon, iyong Cobra po." (Cobra referring to Keppra- si Mommy nage-energy drink)

Blunder 5:

Before an EEG procedure,

Nurse: "Nanay, bago dalhin sa EEG dapat shampuhin ang pasyente ha."

After 30 minutes, the utility worker brought the patient back to the ward. The mother was so furious in the nurses' station looking for her patient's nurse.

Nanay: "Saan na iyong nurse namin? Hoy nurse,  dahil sa iyo hindi nagawa iyong EEG ng anak ko. Pinabalik kami."

Nurse: "Bakit daw po?"

Nanay: "Sabi kasi nung technician banlawan daw muna namin iyong shampoo sa buhok nung bata."

Nurse: "Eh bakit hindi niyo binanlawan kanina nung shinampoo niyo po siya."

Nanay: "Kasi sabi mo shampuhin ko, wala ka namang sinabing banlawan eh."

Nurse: "Nanay, bakit kapag nag-sha-shampoo ka hindi ka nagbabanlaw?"

Blunder 6:

During a patient rounds...

Nurse: "Kuya (referring to the watcher of another patient), nasaan po iyong pasyente dito?"

Bantay: "Ma'am dinala po siya sa autopsy?"

Nurse: (in shocked) "Kuya anong nangyari sa kanya, bago dinala sa autopsy? Nag-code ba siya" (Code- a term that hospital workers use that refers to  immediate resuscitation.")

Bantay: "Hindi naman Ma'am, hindi lang pinakain kagabi tapos sinuweruhan na siya nung nurse. Kaninang umaga inakyat sa taas para kuhanan daw po ng laman sa baga."

Nurse: 'Kuya echusero ka, baka naman ibig mong sabihin biopsy. Iyong autopsy kasi para sa patay."

Blunder 7.

After a surgical procedure, the nurse instructs the watcher of a patient...

Nurse: "Kuya, kuya, punta daw po kayo sa PACU dalhin niyo po iyong gamot ni baby na nireseta sa inyo."

Bantay:" Sige po Ma'am."

The PACU nurse was constantly calling the ward inquiring for the patient's watcher.After two hours, the watcher returned to the ward.

Nurse: "Kuya, bakit pawis na pawis kayo. Kanina pa tumatawag iyong sa PACU."

Bantay: "Eh Ma'am kanina pa nga ako naghahanap sa Paco  wala naman dun iyong pasyente ko.

Nurse: "Kuya hindi ba kayo pumunta sa 3rd floor? Doon po kasi iyong PACU."

Bantay: "Hindi Ma'am, namasahe pa nga po ako eh."

Finally, yet the most famous of all our bantay bloopers:

Blunder 8:

Bantay: "Ma'am, pa-sanction na po ng pasyente ko. Ang dami na niyang plema."

Always remember that communication is always two-way; and communication is a basic nursing skill. Failure to do so will jeopardize our relationship with our patients. However, in this case, communication bloopers will always be a part of my five year stay in Ward Eleven.

Death in her sleep

She was calling her mother for 10 times or more. The other forty three patients were irritated and agitated how her screams reverberated through the walls of the hospital ward. Doctors and nurses were all unmindful of her. She was my patient and yet I was oblivious of her pain as I was busy taking down my patient assignments and my other patients' needs. Her sister who had vigilantly watched her had left her and went outside probably to light a stick and hoped that in every exhale, her sister would once cooperate even for this night.

She was a typical uncooperative adolescent who hated being hospitalized. Every now and then, she had frequent outbursts when we force to put an oxygen mask or inject holes through her skin. She would scream on top of her lungs to communicate how she hated pain, not the physical pain but the turmoil of  feelings of hopelessness and loneliness. She had already gave up on herself as she pulled out her intravenous lines. innumerable times. Her hair was a mess, her heart was too.

I am on permanent night shift. "This night was no ordinary night", I thought to myself. I had a lot to do for tonight. Two patients on machines to prioritize,seven patients to feed every three to four hours, eight to check on their fluids and this one girl to calm every now and then.At 2 am, I changed her oxygen tank and made sure the strap fitted her comfortably. At 3 am, she was having a struggle with her father and was screaming once more. Her father who substituted the sister to watch over , was tired from the trip and dozed off  at 3:30 am as soon as her daughter slept.

She was tired as she limply settled on her side to sleep. At 4 am, I had my rounds and checked on her. She was sleeping but she was battling in her sleep. Even in her sleep she was struggling, struggling to live... struggling to breathe. At 4:30 am, I brought my ear close to her face and heard not a single faint of breathing from her. I touched her and she was already cold. Her hands were all blue, her eyes were closely shut as if she was afraid to open them once more and find herself in a prison of helplessness.

She had her death in her sleep. The doctors tried their best to revive her. But in the end, she had fought enough.

My Open Letter to You

I think this is the right time for us to talk about "this" . I can't think of other ways to let you know of my side of the story, except through this, where there is no scrutiny from people who make the matter worse. I am so sorry for making your life worse than hell. You don't deserve the way I have treated you for the past months. I am so sorry for not giving you the chance to prove yourself; so sorry too for not giving myself the chance to know you more.  You have nothing to prove to me because you have proven more than what I have expected from you. The last time I had hurt you, honestly, I felt terrible about it. I don't care of what other people would think about it and my injustices, scowling glares and  pretenses.  I have no intention of bringing you down, I just want you to stand on your own feet and be accountable of your actions.You are accountable to our patients as I am accountable to you.People would think that I am bringing you down, sometimes with the way I came to you,it felt like I was actually tearing you down. But, I only intended to force you out of your cocoon and "be a butterfly".

The reason why I am writing to you publicly is for people to know that you have my respect and that you have grown tremendously in your bedside care. Maybe you have felt that I am unfair to you since my treatment to you is incommensurable to some of your friends. I am so sorry. And what happened last night was not some weird "small talk". For me, it was an answer to my prayers.

See you around.

Ward is under renovation.

The old lady was half-awake as she breathed in and out with the help of the respirator; as her husband of 50 (plus) years stood by her bedside and gripped her lifeless hands.

For the past days, I am struggling to erase this short memory from my mind; not because I feel for the old woman who does not deserve to be in her present predicament but moreso I pity for the husband who blame himself on why her wife was all oblivious, battered and black and blue. So far, the only time that the old man left her wife's side was when he hurried to their cabinet to take out some rolled tissue to wipe his own tears.

He is a young husband, around 35 I guess. When he was admitted in the bed next to our mini- station, his wife and relatives were crying incessantly. They were much aware of the reality that he may not survive, since not much has survived a gun shot wound in the head.

His wife has been the one running around for laboratory and medicine errands. She is the one who painstakingly ignored her numb muscles for running around so much. When doctors prescribed something, she without hesitance rushed to the pharmacy. Because deep down she knows if this is how second chances work, then she will not moan a single selfish complaint. For days, the husband showed no signs of improvement until the day when his eyes opened and caught the sight of her wife tired and sleepless; with her hand holding his.

Life has allowed the peculiar evolution of both rational and irrational thoughts, feelings and actions in us. And as I witness to the constant swings and shifts of these feelings and thoughts associated with morbidities and mortalities, I was reminded by a very simple life philosophy: "All we need is someone who can hold our hands in our lifeless and waking moments".

I should better be assigned back to the ward. The commotions of leaking I.V fluids, feeding tubes being pulled out, parents overly frantic about late procedures and hospital staff and students chasing after patients' charts would definitely keep my mind off these over-sentimental philosophies.

I have never dreamt of becoming just a nurse, but I wanted to be THE NURSE.

Mayna has left for U.K; Cat is adjusting well in Canada's weather; and soon Che will be off to KSA leaving a tiny proportion ofUPCN- Ow- Five behind. It is not much of a surprise having your friends pushing their luck in a different country, after all they are nurses and they are Filipinos.

But yes, we are all bound to be health exports.

While I was silently pondering and staring on a Nursing review ad( while in a pungent seat in an SM Fairview air-conditioned bus besides an equally-pungent manong), I am troubled by this tiny thought: Why is it that it is easier to enumerate the motives on why we choose to be in abroad than specifying the almost negligible reasons of choosing to stay? Even I could not elaborate my own reasons of staying (especially to my mother). In my heart, it is boldly spelled out: that maybe I'll stay FOR NOW.

When I was younger, not once did I dream of becoming a nurse. In fact, I have dreamt of being a Marine Biologist, Bank Teller, Archaeologist, Journalist, Lead Singer, Nun, Doctor, Teacher, Fashion Designer but not even a Nurse. Actually, I had formed this scary mental image of a nurse as some lady clad in a skimpy white dress, speckless stockings and a weird cap who had no other life purpose than sticking injections. Honestly, taking up a nursing course was not my idea, it was my mother's.

I remembered her coming home from Manila one night with two college applications ( UPCAT and USTET) and a bag of pancit canton calamansi. She was excited to fill up the application herself and brutally arguing with my grandparents on what course should I take. Since I had no personal disposition that time, I agreed to their every whim.

UPCAT

Campus (first choice): UP Manila

Course

First Choice: Nursing

Second Choice: Physical Therapy

Campus (second choice): UP Diliman

Course

First Choice: Tourism (They had once considered that I will grow tall when I reach college)

Second Choice: Journalism

USTET

Course

First Choice: Nursing

Second Choice: Pharmacy

When I was experiencing the long queue in UP Health Service for admission check-up , I was still very clueless. I was young and innocent when I started my nursing course and had my lessons on osmolality, Mary Leakey, id , ego and superego and self-care theory. Like my grade conscious classmates, taking up Nursing was nothing but a competition. I had never contemplated the weight of the basics of nursing until I started "feeling" the profession.

It was a bittersweet realization of falling in love with "Nursing" (bitter: because I do not want to be identified as a doctor's yaya; and sweet having to realize that finally I had a purpose). While almost one- fourth of our class was considering it as a pre-med course, I, on the other hand, was looking at my nursing duties in a different spectrum. I weirdly found myself sleepless planning for my patient care and not trying too much to understand the pathophysiology. I always caught myself daydreaming not in a skimpy white dress, stockings and cap but as someone who could put a hurting baby to sleep or comfort a teenager in his post-op.

When I was assigned to Gideon Sumaway during my Head Nursing in Ward 2, I was determined that I wanted to be a Pediatric Nurse someday ( aside from the obvious height reasons). He had treated me as her big sister and him like my own baby brother. When he was in so much pain, I grieved for not being able to eradicate his pain totally. When he bled because of a platelet deficiency, my heart bled with his family of doing nothing to stop it. When he was in high spirits early in the morning, sleepless nights seem not to matter at all. He was my realization.

Then Liver Cirrhosis cut his life short at 17.Because of him, I strived not to be just a nurse but to be THE NURSE. The kind that patients relate to like their own family, laugh with in their children's innocent blunders, mourn with if they had nothing to provide for their kids' medications...just the nurse that cares.

Tonight, I had a great time with Gelai at KFC. We talked on our own frustrations of being left behind by our classmates. In the middle of our conversation, a thin man approached our table, briefly introduced himself and told us that I had once cared for their daughter while they were in PGH. I was quite embarassed of not recognizing him in spite of having a good memory with faces and names. In my entire three years and so as a pedia nurse in Ward Eleven, I treated my patients not as BED NUMBERS but as somebody's child, brother, sister or grandchild, that's why I memorize their names and faces.

Bottomline is: I choose to stay because this is Nursing's true reward, being "the nurse".

(Aside from all the santol, mangga, toblerone, goldilocks that they gave me- hehehe)

Missing my college friends makes me want to eat a taco!

Last Tuesday (April 21,2009), I and some of my closest college friends had a "shoo" party for Mayna. As always, it was a blast. We all had a great time remembering every memory back in our college days. And though we had matured and changed in some ways, I am quite impressed with how everyone stayed the same ‘totoys and nenes” I have met 8 years ago.

Mayna Fel is one of my dearest friends in college ever since first year. Back then, I belonged to a clique composed of mostly the “shanangs” or the probinsiyana (Che and Au from Tuguegarao, Jomina- Nueva Vizcaya, Jayvee and Gervic-somewhere in Northern Luzon, Jo-anne- Bataan, Mayna- Catanduanes, King- Leyte and Jasper- South Cotabato). Although, we all seemed flexible and re-grouped with some true blooded Manila kids (Jerry, Suzette, Angela Hiyas,Astrid,Catrina) and some sosyal shanangs (Michelle and Cate). I think the determining factor was not the geographic origin but it was the simplicity of each one of us that glued us together. I remembered that during lunch time, we would rush to Supreme Court in Padre Faura to grab home-made meals in cheap prices because everyone’s just too home sick of their mother’s sinigang na baboy or bopis. We were all contented with banana cues and fishballs on the street. Some days we would fancy and treat ourselves with movies in Robinson Malate occupying a whole row and some days we would accessorize with five or ten peso worth of colorful earrings. During exam-free days, we would hang out at Jasper’s place and exhaust ourselves with Meteor Garden dvds. We were all carefree, bold and “loudest” in any crowd. We equated joy with simplicity and life with friendships.

Four years after college, we all stayed as good friends. We may not be as updated and available for each other more than what we were before. We may no longer enjoy the activities that we enjoyed doing during our college days. Meteor Garden may not appeal to us the same as how we all turned gaga over the four rich and pretentious lead actors. Although, we are still carefree, bold and loud like we were before.

We might not know of the specifics in each other’s lives: the uncountable times we had pissed off our supervisors and the tribulations we had faced since the last examination we had together (Nursing Boards). We may not be too available for each other in every crying moment or laugh with every time we caught ourselves in embarrassing gutters. Once or twice we may hurt each other unknowingly and selfishly, but I know that a friendship like this comes into perfection with time and distance.

I just knew that our friendship is like a taco. The friendship itself is like the tortilla that holds all the fillings (beef, tomatoes etc.) together.

Congruence

Their stories were all congruent.
(For those who had lost a child in a hospital bed and still searching for their lost hope)


In expectation, they have waited for their first born.
They were once the typical parents who adorned their babies’ small hands and feet or their velvety skin and round eyes—minutes after an arduous childbirth experience. With gentle whispers, they once assured their first born that the world is not a scary place to live even though they themselves arbitrarily believed that the world is indeed atrocious. That life, if ideal, is filled with shallow contentment but if realistic is nothing but everything.

They celebrated each night they were wide awake by their firsts’ hungry whimpers and wails or instances of his distinct chuckling on dancing lights. In the child’s eyes, they felt that for once all their flaws and mistakes were bygones. But the world is indeed harsh for those who believed that life should only be rainbows, laughter and merriment and not about bills, provision and inconsistencies. Hers was the soreness and discomfort of providing for the milk if he was not able to make the ends meet. They compromised…they sacrificed-- after all they have waited for ten years and so.

On the third month, they had not anticipated their child’s limpness and poor sucking. They miscalculated their aspirations; he wanted to teach his son how to ride a cheap second-hand bicycle on his eight and she dreamt of becoming her son’s tutor on fractions on his ten. But they only had thirty days- according to a doctor’s intelligent articulation about their son’s rare cardiac condition.

As soon as the disclosure was given, they went through the grieving process. They denied that their child’s skin was abnormally an ash grey. They were hoping for years instead of days. They kept their dreams alive but in every moment they saw their child’s closed eyes—their dreams waivered and were shattered into silhouettes. They designated their short term plans to fit into their child’s thirty days; he just wanted to be strong and man enough to stop all the tears from falling while she stopped blaming herself. In meager, they provided for all the things required from them. They were unselfish and unconditional— they sacrificed their meal for their child’s anti-pyretics and they made him secured by ignoring their own fatigue.

Not once they had faltered; they waited for their son’s recovery. Softly in his ear, they told him that together they will make fireworks last, sunsets will be paused in between the hues of orange and red, falling stars will populate every night sky and there will be no rain on happy days (if there is, it would be skipped until the rainbow part).

People around them were counting the days. They did not want them to count. They only begged for answers from them and not numbers. They counted: “twenty nine…thirty” and provided no answers.

In despair, they have grieved their first (probably their last).
They stopped hoping…they stopped living.

Slacking off and Having a Bad Temper

The best thing about having a single job and no commitments is that I have more time to sleep and slack off, and that now, my usual routine involves going to and from work, doing household chores and going to my JAM moment at alabang. With enough time- I practically finished hand stitching the five pouches I had started three months ago, invented recipes that both my brothers admittingly worshipped, did more favors for my co-staff and friends and devotedly watched every week the episodes of the recently concluded Project Runway Philippines and soon-to-be-truimphed-by-my-faves-geoff-and-tish- Amazing Race Asia.

But I never thought that by slacking off, I realized that there's just too much other people needs to know about me and consequently, there's just too much that I need to learn about myself. Aside from having a disturbing temper attitude during my duty days handling GEN PED 4 patients, I also have some little funny outward imprints. So technically, this post aims only to reveal what only few knows about me.

One thing that most people don't know about me is that every Sunday I usually have my JAM moments-- my special Jesus-and-me moments. This is a personal version of what emo, depressed people coined as their "you and me against the world moments", only that-- I am not plotting against the world and that I am not depressed at present. (The use of the word present, means that I have been depressed in the past and that in the future, I pray that I will be devoid of such animosity).

During my usual JAM days, I enjoy sleeping at the fx on my route to Alabang Hills. There were instances, although undocumented, when I over slept and was literally caught by the fx driver to be snoring and drooling. And the extremes of my sleeping, snoring and drooling included mopping my saliva on the fx windows and resting my head on the shoulders of total strangers often: "macho manongs". After my fx trips, I am grateful, that the reward of being in the church far outweighs the humiliation I received from such unreserved actions.

But enough of unimportant details about me.

Not long ago, I started adopting "forbearance" or the ability to "just" keep everything unacceptable, substandard and offensive to oneself . My discovery and adoption of the concept mostly are integrated in caring for my patients. It is a given fact that I am, at times, stubborn and difficult to relate with because of my disturbing temper. But then, as I always say, God is not yet finished with me and that I am hoping that it's not yet too late for a redemption.

In the recent weeks, I became belligerent with three previous Gen Ped 4 residents, one neuro intern, a neuro patient's mother ( who was too manipulative), a co-worker and some other patients' bantays. I was at lost, too tired, selfish and sightless of the reasons why I chose to be in Pedia and why I am called for in this profession. I am then fed up of doing everything, even out of other's and especially my own expectations. And for that I am deeply sorry...

In as much as I wanted to delve into the specifics, I think I would rather not. I would bravely end this confession abruptly, praying that for my next post: I am a changed person.

For Ian Gabriel

He died around 6 a.m last September 23; his death certificate indicated Herniation Syndrome as the cause after few weeks in a mechanical ventilator and a non-progressing GCS 3.

He was indeed one of the sweetest patients I've ever cared for ever since he was transferred from Pay ward. Not once, did he complain all the agony and discomfort from needles ( as what I remember, since he never grumbled when I was the one injecting him) nor he whined from the time he was on NPO for more than a week just for his operation to take place. I really missed him and the smile he flashed everytime I passed by his bed ( when he was still awake and the operation had not transpired yet). I missed how he would offfer me his snacks without his mother knowing and eventually putting it into my pocket alongside some empty syringes and my dirty scissors. I missed his sweetness the most, and all the countless times he had given me chocolates.

He was just nine years old. Who knows what crazy dreams he had and how he would pursue these dreams? His parents and brothers would probably know all the dreams he wanted to be-- but none of them knew that the life he had would be a life that was short-lived.

I know I was being immature and unfair then when I asked Jerry: why do kids like Ian have to be the one to experience this entire ordeal? Why not the kids on the streets who were sniffing "rugby" or those suicidals who wanted to die in the first place? They have steered their lives in their end, haven't they? I know that they too have the same shot at life but I think it would be much better if it was not Ian or Hazel or Cesar (who were all diagnosed to have Brain Tumors and who underwent brain surgeries and developed certain complications at some point). These kids deserve to have a childhood, the kind I underwent: going up in guava trees, splattering at muddy holes, running around under a rain, being chased after by dogs and playing "patintero" under a moonlight. Or just simply have a life ahead, just for them to experience falling in love, being rejected or the thrill of riding bicycles.

The day Ian died, I was assigned to Cesar. Ian's uncle had asked me earnestly not to let anything happen to Cesar. He wanted Cesar to fully recuperate so as not to waste what Ian had fought for. I could no longer hold my tears back then, but I could not cover up my transparency: that what he was asking from me was unattainable. Like Ian, Cesar too was ventilated after his craniectomy and has very poor stimuli arousability.

I am not God, I am not capable of curing them or make any of their pain stop. (If I can, I must have done it to myself a couple of times) I am not capable of making them feel numb in every stinging pain from needles. If only I can, I will. But I can't. I can only touch their hands and let them know I am there with them. I can only reassure them that miracles really do happen with God.

I missed Ian...

(It's been quite some time since I last felt this towards a patient's death. The good thing is, while I was writing this one, I was on leave and there is enough time for me to anesthetized this feeling)

On Friendships and Nursing a Sick Professor

My dearest friend, Jo-anne and I went out after our p.m shift duties last August 7. We had our usual life and philosophical updates while hungrily devouring our yang-chows. Little did we know that such uncontrollable encounter unearthed bitterness and deeper equivocal life plans. Specifically, we talked about a “missed” friend and the process that involves our friendship’s demise and a sick professor and her process towards her emotional demise.

Realizations were understood in every sip of my iced tea and her nai-cha. Life’s purposes are made known in every chomp of our fried rice. We realized that we choose to love without being loved, we share out of no incentives at all, and that our actions existed without any thrusts.

On Friendships

When will we say friendships are moribund and dead?
Friendships, I believe, are like humans, stars or other life forms- they die a natural or accidental death. From limited reasons to infinite intentions, from numbness to efforts, all of these could trigger outcomes of a previously planted relationship. One can devote years with reminiscent memories in cultivating a friendship but mistaken selfishness, or in my case- “phrases expressing my unrequited attention” could also destroy an uninsured friendship.

I thought friendships, the most enjoying and satisfying ones, are effortless and blithe. You need not schedule, a dine-out event or acquaintance with your best friends because you always put each other on your priority list. You need not have a substantial reason to commune or meet each other, because you know that substantiality is never a standard of your friendship. That sometimes rules are bended, promises are broken and words are taken back, to heed for a friend in need.

I am a professed unbeliever of the acclaimed assertion: “Absence makes a heart grow fonder.” In fact, absence and distance will only create a large hole in your relationships. The less you know about the changes in your friends, the more you become unfamiliar of them. It doesn’t follow that your friend’s favorite color four years ago are the same as now. So, the “friend” impression you created in your mind during the first years of your friendship will now be a falsity dependent on the degree of change that you are unaware of.

By allowing the natural course of unfamiliarity and selfishness, one allows friendship be naturally eradicated.

On nursing a sick professor

She had never given me soaring remarks in her subject. In fact I was a “nobody” in her class seven years ago; I was once humiliated in her class when she mocked my answers to her essay questions reading them aloud to the class. And up until now, she does not remember me because I am indeed a”nobody” in our class. But my grade in Nursing Anthropology (which is really a mediocre) does not and did not define the extent of my maturity and totality of a person, more so my nursing skills.

We had an opportunity to know her more when we constantly visited her in her house during her recuperation from (I think) her second hospitalization. As I remembered it, we came to her house, only to enjoy her company, her wise remarks on life and practicality, her recurrent and repetitive stories, her sarcasm and her laughter. With a meager amount of money enough for our transportation and a lunch meal and free time; we became available to her-refuting our main purpose of monitoring her recovery, since we never bring any stethoscope and BP cuffs with us.

As to speak, she had her nth time of admission and discharge, Jo-anne and I had not expected her to feel any depression from a woman of her stature and dignity. She was our first nursing professor and the survival and practical skills she taught will never be paid back. So, last August 8 we surprised her with her "halo-halo", "get well soon poster and balloons", and her "bitbit pack". She asked not of these things but "tomorrows without pain" which can be purchased from nowhere.

DR with (from left) Reymund, Gelai, me, Jo-anne, Suzie and Jerry.

Uncalled Redemption: First Discovery

There's just too much in my mind right now, saturating my deepest ridges, brain furrows and inquisition. Blogging has never been a devoted routine, but now I realized the purpose it was made for. It was made to unburden those empty but heavy baggages in life for unlike Emperor Qin's belief, we are not allowed to bring all our treasures in the after life. So there's no point of building a temple and 8,000 Terra Cotta warriors to guard those crap. Not that I view those baggages as treasures.

Whoa! It has been a year since I had my last post. Much has changed since then. Admittingly, I no longer bear the same unwavering and optimistic views I have with bedside nursing. A ten day leave would do the redemption. Sorry jerry, I am going a complete 360 degrees from the things I said to you in our YM conversation regarding my confusion.


J: kasi kahit ganon yung situation, clear sa iyo yung value at essence ng pinag-aralan mo ng 4 na taon

I: kaya tinatry ko na hindi ganito... kasi nilalamon ako ng sariling sistema ng mundo

I: tulong na din na nasa pedia ako...

I: ....kaya nga gusto ko uli mag aral

J: bakit pala epi?maganda siya pero sa nakikita ko kasi, mas appropriate ang nursing sa iyo
yung insights mo malaki ang maitutulong para mabago ang nursing

J... i'm just looking at the future implications kung sakaling gawin mo nga yun at ipursue mo, malaki ang potential para mabago ang perspective sa nursing at sa magiging focus ng nursing education at practice


This conversation was just weeks old, and yet with a ten day leave, my thoughts are revolutionized, instead using these thoughts to revolutionize the distressing reputation of the Nursing profession. As what jerry said, I have or should I say "had" a deep insight with the reality of bedside nursing. It's not the skills involved, whether you are good in patient assessment and procedures, it is more of the "feeling" and "caring" which not all nurses possess. It's funny when nurses misuse and brag that nursing is a "caring" profession, when they don't care if their patients are experiencing some physical and intangible pain. When they too, are voraciosuly consumed by the brutality of our health system.I know nurses who are like that, in fact I am working with nurses like that. This is not my own way of boasting of my cleaner slate and I am, in some instances, like that.


What's more disgusting with this is that nursing has never been a selfish profession, not until now. Because of the nursing evolution nowadays, it added material gain to the realm of the profession. It's not about us in the spotlight. Its about those delicate hands being pricked with sharps, its about those surgical incisions being infected, its about those children missing the chance of a nurtured childhood and its about those parents who waited for a child for years that we hastily do not care for.

Kenneth and Marianne. It seems that they are having the time of their lives.

Call me apathetic, but honestly, I can no longer fight for these ideations. I allowed myself to be consumed because it's helpless, especially when you are working in an area where everyone has different and opposing views. I used to be that "1 against the 100" and now I can no longer change the disturbing practice in our ward. Probably in December, I will tender my resignation. THIS IS MY FIRST DISCOVERY.