Nurse... nurses

Overheard from the conversation of nursing interns:

Intern 1: How would this hospital be functional if there will be no interns?

My comment: How would you learn if not because of this hospital? Because it is a government hospital, you can try to poke and prick someone’s arm to insert an IV? Without much concern of being sued especially if you are dealing with patients in the ward. Ive been here for almost two months’ weekends and Ive seen how many times interns tried to successfully hit a vein for an IV. Can you do it in a private hospital? No. Right? It would even be better if there will be no intern so the government will be forced to hire for competent nurses and staff and not just interns and so the patient can receive what are entitled for them.

Doctor... Doctors....

You know when you are in the hospital; you can really see different faces of doctors. Il show you some of those faces:

1. Inside the ENT room:

Doctor: Listen to me (in a demanding voice). Will you listen to me? (more forceful voice)

As he was talking to an elderly woman who accompanied her grandson who accordingly did not bring the CT scan result because she thought that the doctors comment and referral was enough for the procedure to be done to her grandson.

Woman: I never though that it will be important. I thought that paper is enough. Said it in a low voice and coyly.

Doctor: Madam, I don’t care about that paper. You know what is CT scan? That is the map of your grandson brain. You know that? So, you better get it.

Why cant you not just say it in a nice manner? I thought you are different from the other doctor inside the clinic. He has also his bad side, hehe.

2. Inside the ENT room:

While my mother was secreting phlegm on her tracheo, she had difficulty in breathing because her last suction was still in the morning before we went to the hospital.

Doctor: remove the cannula. (ordering us)

My sister: How is it done doc?

Doctor: What? You were already discharged and about to remove the tracheo yet you do not know to remove the cannula?

Walking past us and twist the supposedly cannula from my mother's tracheo tube and took it off.

Doc, we did not know about it, and most probably you wont know it if you are also not an ENT doctor. Only doctors clean her tracheo tube and never had they instructed us how to do it. You cannot blame us. How dare you! (*nicely said).

In fairness to doctors, Ive seen the most compassionate doctor in the face of one of my mother's attending physicians. Everytime we asked her on the situation and prognosis of my mother, she explained to us everything and she will provide us with options. She even cared why she saw only several faces attending my mother and our expenses that might be incurred when she learned that only two of us are supporting my mother's medication. She had that compassion in the eyes attending my mother.
When we were in the OPD for the removal of NGT and tracheo tube of my mother, she met my sister in the lobby and asked how was our mother. She told my sister that she went back to the room where my mother was in but we left already that day. She just extended her warm regards to her. Thank you Doctor Narisma!

The day i said goodbye

September 22 was the day i said goodbye to NGT and tracheo tubes of my mother.

It was a beautiful day but it brought fear and apprehension to me and my sister, maybe my mother felt more than we did. It was the day that her NGT and tracheo tubes will be removed. In the morning, everything was in a rush – falling in line, looking and remembering hows that thing looks like, where is that yellow card?, dismissal slip, paying, and bringing the patient to designated clinic of the OPD (out-patient department). At the designated department time moves very slowly, the ticking of the clock seemed to drag for a lifetime. And so my mother was already tired after an hour. She wanted to lie down. We look for a stretcher because she cannot sit for long on a wheel chair. Fortunately there was one available at the hospital.

It was indeed fortunate enough because I and my sister did not think that we will be second to the last patient to leave the ENT clinic in the afternoon. In the morning we were at the Internal Medicine (IM) department after which we were referred to the ENT (Ear, Nose, Throat) department. In the IM Department, the doctor tried if she can already drink water. She did. So her NGT was removed. Next, she tried to cover the connector opening of the tracheo tube, if she can breathe. She seemed. She told us that he will refer us to the ENT Department. We were still hesitant to allow the removal of her tracheo. What if she cannot make it to remove both NGT and tracheo tube at the same time? Let us affirm this to the doctor. That was already past 12 noon.

When it was already about 5pm, my mother was already hysterical but she could not send out a voice so she just ended up crying and pounding her fist on her other palm. We pitied her for her situation. I am not sure if that was because she was tired of the day’s waiting or of prolonging the agonizing fear how this removal of tracheo would end up. Even when we entered the clinic, she continued crying covering her face with her palms. I just wiped off her watery nose and tears while giving her encouragement and assurance that it won’t be long and she'll be fine. We waited still for almost 45 minutes inside the clinic before we were entertained.

On the operating table, first the doctor tried to pull the connector holding the neck plate but it seemed that the other side of the tube was already adhering to her flesh. After some try it was successfully removed and an OS (I don’t know if I heard it right, but it’s only a sterilized gauze) was covered to her throat while an assisting intern was suctioning her mouth for saliva and secretions so not to drown her, as they said. While the doctor covered her throat she was moved to sit and she send out a grueling, terrifying growl as she tried to run after her breath and expressing her difficulty in breathing. She sounded like a slaughtered pig that is on its last breaths. After some time of that panicking moment on our part, the doctor removed the OS to be replaced with new one because blood and some phlegm or secretions dripped out from the gauze. After the blood and secretion flood out from her throat, everything, in just a click-second, a moment of stillness showed a success.

Inside of me, during the removal of the operation, I was also battling the feeling of fainting. The time I saw the blood and secretions flood out from her throat and the opening on her throat due to the tracheo tube, my visions got blurred and I felt I will be shutting out. I moved away from the table. The attending head nurse told me to keep the tubes, so I moved to collect those and got out from the room and ask for water from our helper who was waiting outside. The time I entered the room, I was already fine.

I learned that it is not good to lengthen the time of keeping the patient with tracheo tubes. It will cause a possibility that the patient will have tracheo tube for a lifetime. Maybe that can be explained by the adhering flesh to the tube when it was removed. My mother had that accessory on her throat for 2 months exactly. Her NGT was attached to her for 2 months and 1 day. Goodbye NGT and tracheo, then.

out... out.. and away

My mother was out from the hospital yesterday. Yet, she will be returning to the hospital for the removal of tube in her throat next week. Ang her NGT where she take in food will be replaced every two weeks. She is not yet advised to eat solid foods but only shakes and in liquid form. She has a diet containing 16 boiled egg white in addition to her everyday menu preparation. My sister told me that her kitchen is like a fast food stall when time after time they are preparing food for my mother.
Since my mother cannot stay with them becasue of small space, we rented a house where she can stay while waiting for the removal of her tracheo tube and her stability before we will decide that we will send her home in the province. The place is walking distance away from the place of my sister.
Yesterday, they were busy purchasing basic necessities for their stay in the house like bed, foam, cover sheet, blanket, etc.

discharged

My sister informed me just now that Nanay may be out of hospital this Monday. I was happy but I was in deep worry too because I do not know where to get money for the release of Nanay from the hospital. I am thinking where to borrow money. I can live with just a small amount out of my salary, anyway I am still single if I have to borrow again money from someone. I am looking for another P50,000 in addition to previously borrowed P100,000.

It is just disappointing to think that when you lent money to someone and now you wanted it back, they cannot give you despite they know that you badly needed money. They do not consider that they already enjoying the grace period because their debt are already due years ago, in addition to no interest at all just for them to have easy payment.

I dont think that I am abused but that surfs up sometimes in my mind. How many times I have said to myself Ive learned my lesson but evrytime people come to me and ask for help, I cannot say no to them as long as I have something.

uhh, what now? No time to regret. Look forward what will be the possible solution to that financial problem I am facing.

transfer

My mother will be transferred today to another room because she is done with tetanus treatment. This is to give way to other tetanus patient who may be in the waiting list to avail this room. So far in our search for hospital in the city that accept tetanus patient, we have not found one. It is the only tertiary hospital that has a tetanus room in the entire island, and has the capacity to manage this disease. As far i as know. Though the mortality is still high because of very low ratio of doctors and nurses to patient.

Nanay is still recuperating for her stroke problem. Thus, Nanay is not yet recommended to be discharged from hospital.

I missed her development for the past two weeks for I have not able to visit her for I am in charged in dealing some financial matters in our hometown for her medical expenses. Yet, im so glad to hear the news, though sounds not bit good, it is still a positive news because this means that she is already safe from tetanus infection. I am worry only to possible other infection due to tracheostomy tubes.

cross my finger

im happy today because my sister told me that Nanay can now try to talk but no words can came out from her because of the tracheo tubes. She can only send some hush-hush.
They are also trying to remove the oxygen if Nanay can now normally breath without the aid of tanked Oxygen. She can now sit but with assistance from somebody who will hold her back.

Last night when she visited Nanay at the hospital, she thought that Nanay would just wanted to change position on the bed but she wanted to step down from bed. Nanay was looking for them (my two sisters)when she will be awake. Im hurt, arghhh... Hehe

Maybe she thought im still in Manila because the last time I saw her I bade her goodbye becasue I was going to Manila for the oath taking and since then, I have not seen her yet becasue I was attending some transactions in our hometown for the expenses at the hospital.

quite an improvement

Since im not in the hospital because of my work, which is 4 hours away, i usually ask for updates from my sister. Today, she told me that there is an improvement in my mother. Its almost a week already that she can send her tongue out . Her left foot can now move though its still weak. Same with her left hand. She is awake for longer time.

Her treatment at present is more focused on pulmonary infection while her problem on stroke is not so critical. She maintained only oral medication. She is really prone to pulmonary infection because our wing housed cardio-pulmonary infection cases. Though, she is isolated in a room, it does not guarantee a high percentage of security against it because of its accessibility to other rooms that do not have doors catering pneumonia, TB, and other pulmonary problems.

I should be going to the hospital this weekend but due to financial constraint that we are facing, I will be going home to transact the selling of our farm animal, and possibly look for buyer for our 1 home lot.

show me money

My sister has just called up that we need a relatively large amount of money for the antibiotic of my mother. Yes, relatively large amount of money because we are not financially stable at this time. Only I and my one sister are taking care the burden of keeping my mother in the hospital. And now that my mother is already one and half month in the hospital, we spent the supposedly reserve money for the payment of bills for the discharge of my mother from the hospital.

While I borrowed money from a friend and from the office's cooperative of P100,000. My sister spent the daily expenses which do not go below P1700, excluding the food and fare in visiting my mother in the hospital. That is acceptable for her and her husband, but when the expenses soared to P2000 and above a day, they can hardly meet it up because the income of their veterinary clinic cannot cope with their expenses and monthly payments for veterinary medicines and other supplies and it is not always everyday that there will be patient. So, we resorted to get money from the reserve.

Before, when my mother needed an albumin supplement, we think that was still fine when each bottle costs P4200 and we needed 6 bottles. We felt a little worry when an additional 6 bottles were needed week after when her protein was still below the normal, accordingly because of her being immobile and bedridden. And now, week after we were done with the albumin, we needed again an antibiotic that costs P1,300 each and should be given 4x a day for 7 days. This is aside with her maintenance for her stroke medications. This antibiotic (Piperacillin + Tazobactam) is needed for her infection acquired in the hospital because of her tracheostomy.

I was wondering, until when can we survive with this? I believed God is with us so we need not to worry.

riddle

Yes, holding her by the hand and staying by her side are not enough for a person who has lot to say but cannot express it. My mother who suffered a stroke and affected her speech, guessing what she wanted to say is the most we can do. It is more than a pantomime. More than a “pinoy-henyo” game. I can see in her eyes the disappointment in times we could not get what she wanted to say. And then withdraw the attempt to drag it further, maybe believing we cannot understand it, and better keep it to herself. Maybe when her speech returns, she would later tell it at once.

While visiting her one day at the hospital, three days after she returned from a long sleep of tetanus treatment, about a month already after admission to the hospital, she tried to lift her hand and move along her face. Holding her hand when it dropped to her tracheo tubes, I was patiently waiting her hand to drop and immediately hold it not to touch the tubes, which would bring the ventilator machine to an alarming beep because the oxygen tube will be disengaged from the plastic attachment in her throat that aids to her breathing. Thinking that it was something itchy in her nose, I scratched it. I could see there was a relief (I guess so). Though, week later we found out that her nose has already a sore because of the NGT (Naso-gastric tube). She tried to reach her nose to tell us that something is wrong in it, but we did not get it. I was just grateful that her new doctor is as compassionate with her previous doctor, who handled her for the tetanus case.

Ahh, I recalled before she was brought back to the hospital for supposedly follow-up check up, after a week of being discharged, my mother entered my room and was calling me in the door. I could see her standing through the diffused light from the street. I intentionally left my room open so I would hear whatever was happening downstairs. Quickly I jumped off from bed and turned the lights on. I asked her, “cant you sleep?” She just answered with a nod. I led her downstairs and offered to accompany her watch TV until she would be sleepy. After 20 minutes, seeing that I was so tired from work, she said we sleep now. I sent her to her room and went upstairs to get a sleep for tomorrows 5-hour travel back to the hospital. My older sister who was sleeping also at my mother’s room did not even notice that my mother passed her when she left the room.

The night after the check-up, we crammed in the small place of my other sister with her husband, in the city. With a light dimly lit, my younger sister noticed that our mother was standing in the door looking at us sleeping soundly. She did not call anyone of us. She just stood there for a time as was later known by my sister. My sister stepped out of the room and ushered Nanay to the sala and asked her “whats up?”. The only response she uttered was “lisod” (hard). Seeing that she really had difficulty in swallowing, and was shown by her breathing, my sister raised the headboard of the folding bed and sent Nanay to sleep.

It was only when she was admitted for Tetanus that we realized what my mother wanted to say was “hard to breath” or “hard to swallow” and that she wanted to be brought to the hospital. She just cant say “hospital”. Or maybe we did not think that there was something not right. There was really something that she could not express nudging us to get some medical aid. We were not alarmed because we did not suspect of other disease or disorder aside from the stroke. We were confident that all was caused by stroke and believing that the stiffness on her jaw and hand would just subside, not just this soon, but maybe in the morrow.

I cant forgive ourselves for not looking on the other side of reality that there was something wrong going on. There is no place for regret now. It was still fortunate that Nanay was able to hang on even at the nick of time before medical aid was given.

sinful indulgence

People always have tendencies to commit errors. Even the most elect fall to err. Saints sinned. Engineers may fail to compute the right structural weight and support, chemist may mix wrong solutions, navigators may fail to interpret the right location, drivers may miscalculate their speed and distance from other vehicles – which may cost a life - so with doctors.

Recently was mother had a stroke – July 14, 2008 – with the suggestion of doctors from the Provincial hospital we proceeded to a bigger hospital - a private hospital with a name.We reached the hospital around 12:00 midnight. I do not have comments with the doctors, just that there were at least four doctors, repeating the same questions and physical examinations to my mother, one after another, who was already very tired and stressed with the 4 hours travel. They’re checking their books for conditions that will fit to their initial diagnosis calling their resident doctor or senior doctor, I guess referring the case of my mother to him/her. I bet they have difficulty or just not sure or just making sure not be wrong with their diagnosis for the consideration of the real doctors or for the consultants later.

We have four doctors attending my mother, of course with different specialization, related to stroke and heart conditions. But none of them consider on the wound/cut on my mothers right hand. That was relatively big enough that anyone can notice, especially that there was an elastic bandage wrapped around with a splint on her right arm, and a gauze on the cut. That was the second day, when the doctor even told us to take off the bandage and ask for a dressing from a nurse.

We were discharge last July 19 to recuperate fully in our home. When we went home, she had no paralysis observed - typical paralysis impression of a stroke victim. She can walk. She can eat. The only problem is her speech because of the AF type of stroke (is it right, forgive me of my terminologies). She maintained the medicines prescribed as maintenance.

Last July 25, my sister noticed that my mother had a difficulty in opening her mouth. On the 26^th, we consulted another neurologist, as referred by our attending physician at the hospital. The neurologist recommended to be injected with calcium gluconate because apparently she has low calcium based on the medical records taken during her stay at the hospital last week. Yet, day after there was no improvement. The more her looks suggested something was terribly wrong with her. So we brought her to another hospital - a government hospital.

The diagnosis was tetanus- stage III.

Should have been one of the doctors back then look on the possibility of acquiring tetanus from the wound incurred by my mother during her stroke (telling them the cut might be caused by a bolo or a steel pole because nobody really saw what happened), she should not be in her miserable condition now.

The NGT and tracheostomy set up with the ventilator beside are so morbid to look at. Should she have been given with anti-tetanus shot; she should not be attached with those plastic and looking freak. Should she have been given with anti-tetanus shot, she had been spared with this unnecessary stay at the hospital. She should have not undergone tracheotomy. I cannot contain my frustration, but we could do nothing. It happened already.

It so frustrating thinking back that she should not suffer the way she is in now. What is more so frustrating is we can overlook basic concern. It is like that we can reduce the risk of infection by sterilizing our materials, keeping sterile the needles for injection, using alcohol to a wound, etc. But we focus more on something and overlook the basic. Is it not a routinary procedure to consider tetanus infection on a cut?

If you just look in the eyes of my mother as if begging something that I bet, she knew we would not understand, your heart will be wringed with pity. All you can do is assure her that everything will be fine. And just hold her for a time and stay with her. She had undergone the tracheostomy yesterday. As I was told, she was awake already this morning. But she has still spasms.

This was originally prepared last August 13, 2008