Today, I am finally waiting for graduation. It’s been a long journey towards where we are today, and I congratulate all of my friends from high school who are going to march during their commencement exercises this year.

In every story, there is a climax, and now I stand at the denouement. Getting here wasn’t a walk in the park, but it was worth it.

I had the privilege to be a student nurse performing primary health nursing, staff nursing, and head nursing at a tertiary level hospital for the months of January to March 2012. To just define some terms here, primary health nursing is being the all-around nurse for a client that you serve. It means that you’re in charge of providing direct care to that client, as well as coordinating everything that happens to the client. While primary health nursing is being a 24/7 nurse to a client, staff nursing is providing direct care to a client for the shift only, focusing on acute problems that you encounter during the shift. Finally, head nursing is, well, being the boss of the ward. Not only do you ensure quality patient care, you’re also responsible for ward management and personnel development’ I guess it’s the pinnacle of the clinical duty nurse. I’ll be writing about my experiences as a primary health nurse, since I think it enscapulates everything that can define my hospital experience.

I spent the first 4 weeks as a primary health nurse in the ward. A word to describe my experience during this time is “intense”. Everything I did was intense: taking life-threatening cases, planning intensely for care, executing intense care. Everything I learned for the past few years I did in a day. But what was really intense was the emotional experience of becoming close to my clients and to the families there. Being a nurse isn’t all about giving medicines and making patients comfortable; I learned that it was deeper than that. Some people say that while their nurses pass by their lives for a minute, the impact that they leave carries through eternity. The same is true for someone like me: there are clients who pass by my life who I will never forget.

I took care of a client with Ovarian Cancer that had metastasized (spread) from the primary site. She was very friendly to me, and very accommodating to my novice-ness. She said that she is happy to be part of my life as a student, and that she wished to help me learn as much as I can. I provided her with the best care that I can. During the first two weeks of caring for her, I noted edema (swelling) of her lower limbs, which was progressing upward. I studied her case, and found how ascending edema, despite all the treatment that we could give her, was not a good prognostic sign. Despite this, she was a fighter, and said that she wanted to live.

At my third week of caring for her, she had some issues with her daughter. The daughter left and never came back. I don’t know how, but that broke her will to live. The friendly woman had a blank stare on her face. When I held her hand, she did not grasp back as she usually did before. Her will was broken. I painfully saw how her condition deteriorated. When her swelling reached her neck, she was unable to speak. We had to insert a tube through her nose just to feed her. Then she would go in and out of consciousness. She was dying. She was put on a “Do Not Resuscitate” order by her relatives.

At my fifth week of caring for her, I was the student head nurse of the ward then, and I was not handling her directly. I remember it clearly: I was at the station when her caregiver approached me and said: “Sir, parang hirap huminga si ——” I quickly went to the station with my partner, who was the student staff nurse at the time, and assessed her.

Heart Sounds = very faint, barely perceptible.
Pulses = absent.
Pupillary reflex reaction = pupils were fixed, dilated.
Respiratory rate = 3 per minute.

She was gasping. I heard the “death rattle”. I knew it was the time. I told the caregivers to call the rest of the family. I referred the client to the resident on duty. I went back to her, held her hand, and I whispered: “Nandito lang po ako Tita ——. Hindi ko po kayo malilimutan. Maraming salamat po.” She passed away at 11:35 AM, February 23, 2012.

I helped my staff nurse perform post-mortem care. After all, she was my client, and though I was not her primary health nurse anymore, I felt bound to pay my last respects to this woman who touched my life.

I finished the shift professionally. After the shift, I visited my client’s room, and found her relatives there. I approached them, and expressed my condolences. I told them how much the client meant to me, and how I will never forget her. Then, I just found myself crying in front of the client’s relatives. They cried with me.

“Tsk, naiiyak din tuloy ako sa iyo!”
“Eh, sorry po, hindi ko po mapigilan.”

I guess the greatest challenge I faced then wasn’t all those papers, those long sleepless nights, nor those moments of doubt. The greatest challenge was staring Death in the eye and welcoming him as a friend. I saw patients on their deathbeds, and a passing thought comes that one day, I too will be looked upon by a student nurse.

Before all this, I was adamant to Death not coming near any of my clients. My favorite motto for the shift was: “Itatawid ko ang pasyente.” Not on my watch, I would bright-eyedly say. My ideal. When my professor pointed out to me: “Yes, this is what you want for the patient… but is this what the patient wants?” I thought to myself, what peace can be found in being connected to all sorts of tubes and lines and being unable to move by yourself, a prisoner in your body? What peace is there in being unable to decide for yourself, as you have no way to speak or express your feelings? I realized how Death, though a bitter truth, is the bridge to peace.

Besides considerably honing my knowledge and my skills, I guess the lesson I’ve learnt from my experiences in primary health nursing is that the classroom can only teach you so much. The attitude of being a professional in dire situations… and keeping your humanity, is taught by life itself.

Insights for March 16, 2012

Today was my last day as a staff nurse in —–. Even until my last day, I did my best to grab all the opportunities presented to me to learn more about what I can do as a staff nurse in the ward. As I also had experience in head nursing, I was also able to assist in facilitating the return of excess medical supplies clients for discharge were not able to use during their stay. I was still able to provide care to 7 clients today, albeit for only half the shift. I appreciated how the staff were very supportive of Ms. Rozario and I as we were about to leave for exam today. They told us to do our best, and to make them proud. When I look back to my first day here in the ward, I am reminded on what I was before all of this, and now that I look at this final day as a staff nurse, I realize how far I’ve gone. Becoming a nurse really isn’t something that can happen overnight. If it takes a village to raise a good child, it takes a set of determined faculty, a great head nurse, and a group of excellent staff to become the best nurse that one can be. I will miss —–, and I will always treasure the experiences I have gained from my clients and my colleagues there.

Looking for inspiration, I turned up my music player, put it on shuffle, and pressed play… and hear the “Graduation March Theme”. As I listened to its familiar melody, I remember my graduation in High School, and recall how it was easier back then compared than what I’m experiencing. Is life really like a game, advancing in difficulty as we grow?

Last Friday, Reg and I ate at a burger place and talked about how we only have two weeks to go until graduation. Two weeks! I have fought tooth and nail for everyday that I woke up in the past four years, and now, I stand at the threshold of victory. During our conversation, Reg brought up the movie Click, in which the character Adam Sandler plays gets a remote that controls time. Reg asked me if I could have that remote, would I use it?

While a part of me wants all of this to be over, I wouldn’t use that remote. It is not out of pride that I do, but out of a profound sense of strength that has grown within me through these years. While within me I feel dejected, tired, weary, deep within there is a power that overrides that fear, that hopelessness. How else would Reg and I be still standing after all these years of study, if not for this strength?

I have to say, there is wisdom in the quiet patience of work. As I look back, I see what all the trials have brought out within me – the best, the worst, the strong, the weak. These two, final weeks I shall give my all. I will never give up. This is it.

I ride to battle everyday,
On my horse named Ambition,
Armed with my wits and my brain.
My armor has become shoddy,
My blade has become rusty,
My cloak is tattered-gritty.

I am hit from all sides by my foe
Fleeting as time,
Elusive as the wind
He outflanks,
He outmaneuvers,
He outlives.

I have seen his face.
His face is me.
And his horse is named Oblivion.
He is the ghost that haunts me,
The wolf that hunts me,
The one who taunts me.

I have fought you, my foe
For as long as I remember
Ever since we were born.
Tomorrow, tomorrow, and tomorrow till
I’ll ride my horse Ambition still.
On the battlefield of dreams.

Death. If life is a b****, death is the ex that you will make you love it.

I remember my first encounter with death. I was only two when my Lola Corazon died. I felt it was like a dream. During the funeral, my cousin Irene and I were running around Lola Corazon’s coffin. One of my aunts remarked: “Hoy, wag niyo gawin yan, baka mainis si Lola.” (Hey, stop being so rowdy, or else Lola will get annoyed) At that exact moment, my cousin and I fell head first onto the carpet floor.

I remember Lola Corazon as if she were only asleep. I thought that she would wake up and tease me again with her dentures. But no, Lola did not wake up, as I threw a white rose into the hole six feet under. She was covered with soil, and I never saw her again.

The finality of death came to me when my aunt, Tita Lits, died of a cardiac event when I was about 9. The pious woman who told me the story of Marcelino Pan y Vino was taken, as the child was in the story, to a place we didn’t know. Though at that time, I still hoped that she would wake up from her slumber. I remember pointing out during the wake how condensate formed on the glass cover of her casket. I thought it was a sign that she was breathing. Of course, what did a child know about death?

And then my Lola Binay died. I knew then that death is final. As I knew it, it was the cessation of bodily functions that leads to the deterioration of a person’s body. As I saw it, it was a painful truth to swallow.

Then my cousin Mojo passed away just last year because of Dengue. And now, at 9:25 PM, my cousin, Ate Pau. She had sustained irreversible brain damage due to an inborn malformation in the blood vessels in her brain. She was placed on DNR, and allowed a peaceful passing.

As of the writing, I am currently handling a patient who is on DNR. She is an 80 year old woman who has congestive heart failure. She was initially managed aggressively by her doctors, but her body could not sustain recovery. When I first saw her, she was still responsive. Now, she lies lethargic, barely hanging on. Every time I enter that room, I feel a heavy feeling that makes me sad. It is just that I find it hard to accept the futility of life in the face of death.

As I was discussing this patient’s case to my clinical instructor, she asked me what my plans are for the client. Dumbfounded, I told her: “Ma’am, itatawid ko po ang pasyente.” (“Ma’am, I will try to save the patient.”) She asked me why I thought that way. I told her that I will not allow any patient to pass away under my watch. I will fight for my patient’s life, whatever the cost. Her voice was mellow as she told me if I considered what the patient wanted. “Everyone has the right to die.” She said. With that, I cried. I remember my Lola Binay from that kind old lady, and I associated fighting for her life with fighting for Lola’s. A life for another.

Yet everyone has to die.

Oh death, you cruel master… You old friend. I wish for peace for Ate Pau’s spirit.

I sang a poem to the wind;
The wind carried my poem to the valleys;
The valleys took my poem to the mountains;
The mountains echoed my poem to the cliffs;
The cliffs passed my poem to the seas;
The seas threw my poem to the ocean;
The ocean roared my poem to the abyss;
The abyss sprung forth my poem to the continents;
But my poem was heard by none.

A continuation of the poem by Nikhil Jain:

But there was one
Filled with fun,
Who heard your words
And began to run
To find you
Got a blog
Hidden and new…

A continuation of the poem by Maria Grujicic (Malena)

She ran
Into the rain
With the poem in her hand
She held it
Strong
Because it was her song
And she sang it to the highest skies
In hope, of what may come
And Lies
Like the avoidance of passing time
The poem
It hit the torrential skies!
And brought pleasure
to coercing eyes
My poem was heard by one.

First of all, a Happy New Year to all!

My family has a lot of future health care professionals in it. I have three cousins who are nurses, a cousin who will be a pharmacist, and two future doctors. At this state, we can make a small clinic for all we want. An idea came to my father that we could establish a nursing home here for senior citizens. The thought made me think, is this possible?

Nursing homes are a lucrative business. For one, everyone is mortal, so there will never be a lack of customers for these kinds of businesses. Sure, the fixed costs of establishing the structure of the nursing home will be high, but it will pay off in the long term, given that customers pay on average five digits worth of Filipino pesos each.

Given our family of health professionals, and numerous methods for starting capital, I think it is possible to set up a nursing home in the future. However, another question comes to mind if this is feasible.

Filipinos are a family-oriented people; our families are tightly-knit in that we bear the admirable quality of upholding the adage “family first”. In all places that I’ve been here in the Philippines, I’ve always seen senior citizens living and growing with their families. That is why the thought of seemingly abandoning a family member to an institution seems alien, nay, taboo, to our liking. For families like ours, every member is a part of the body, and to leave a family member behind is akin to cutting off that part of the body.

Based on the current culture today, I do think that establishing nursing homes here is feasible. Truthfully, I do not want it to be so.

I do not want to be alone as I grow grey hairs. I do not want to eat cold soup alone. I do not want to sit on a bench all day feeding pigeons. I do not want to wither away, an old man, without a legacy. I want to teach my grandchildren how to do a roundhouse kick, if my body permits. I want to go fishing with my son. I want to go places with my wife and my family. I want to embrace my nephews and nieces and tell stories of how we were as kids. We, who learned to appreciate our past.

Will it be feasible in the future? I cannot say. Truthfully, I do not want it to be so.