"The Story of the Bleeding Trache"

….eeriee…

The story goes this way…

DAY 1: 

It was my second week of training…and i was assigned to this particular ward where it caters mostly to VA patients..anyway, as i was going about my business of preparing the medications for my 23 patients(that was my census at that time)…our charge nurse got a call from the ER saying that they have a patient with Severe Head Injuries caused by a vehicular accident..and that they are going to bring it up to our ward for treatment and management. When the patient arrived, he didn’t look so good. He had an endotracheal tube attached to an ambubag, a prominent head injury which was already stitched, swollen eyes, very restless, and with multiple bruises all over the body. He also had several IV fluids attached to him and his clothes were soaked in blood ( sometimes patients are transported to the wards with their street clothes still on….or am i just the one noticing this?…geez…ER people wake up.) I’d like to call him Mr. D. 

Ok..so there he was…all bloody and gasping for breath…then out of the blue, the wife appeared…crying, and near hysterical…she was raving something about him being so careless, so stupid, and how his mom just recently died and crashing his motorcycle to a concrete wall won’t bring her back( although its gonna make him see her again actually…don’t you think?..hmm)..and that they still have an 8-month old son to raise…and so on…and so forth…..i was so close to injecting her with an anxiolytic just to shut her up…sory.

After everything was done to make him comfortable and stable…the wife finally came to her senses and  calmed down. So we proceeded to go about our work for that day and finished the shift in 8 hours.

DAY 2:

The next day, my census went up to 25 patients. I was charge nurse that day so i was in charge of documentation, carrying out doctor’s orders, and making sure all procedures were done. Before starting our shift, we have to go around and make bedside endorsements. On that day, i noticed Mr. D was quite stable in the ICU section of the ward. He was a Post Craniectomy and Post Tracheostomy case and recovering steadily. He was hooked now to a mechanical ventilator making him breathe easier. He was still restless though.

I smiled to his wife and she smiled back…she was nice after all. 

The thing about ET tubes and T-Tubes is that you have to suction them regularly for secretions to avoid clogging them. That way, you’ll be able to maintain the patency andclearance of the patient’s airways. It is a not so complicated procedure yet still requires the expertise of trained personnels. Sad to say though, that due to the scarcity of hospital staff, procedures like this are sometimes delegated to the watchers of the patients(whatt???!!…yes..).

As i was teaching Mr. D’s wife how to suction his tubes, i could sense her apprehension and hesitancy in doing the the procedure. But i told her that its important that she learns to do this because his husband’s life depended on it( ok, that’s frightening…let me rephrase that)…i told her he could breathe easier if his tubes were clear (better?…good). So every now and then, i checked on her to see if she was doing it right, and she did…although there were a couple of times wherein her husband would cough and gag, i told her everything was going well….until the next day.

NEXT DAY:

Census: 26; Admission: 2; Death: 1

Where’s Mr. D?….dead.

Cause?….Cardiac Arrest.

Real Cause?…..severe hemorrhage due to improper insertion and placement of the tracheostomy tube.

FACT: The main risks associated with tracheostomy occur during surgery, or soon after. They include:the voice box or oesophagus becoming damaged during surgery, injury to a high innominate artery, jugular veins or thyroid gland. Severe bleeding may occur if the tracheostomy tube erodes through the anterior wall of the trachea into the arteries that lie there or into the thyroid gland. The bleeding may be life threatening and needs emergency surgery to control it. 

Wife?….blamed herself because she believes she suctioned him to death.

What inspired me to write this article?….we had 2 previous cases of bleeding trachs in the ward in a span of two weeks…and nobody would want to comment on it. 

..Back from the Grave…

…HI GUYS!….

…i can’t believe a hadn’t written a single entry in four months ….whew!….did you miss me?…i hope so…

anyway,…am back from the depths of the grave from which i’ve buried myelf into for the last few months…why?…i don’t know…i guess i have just been preoccupied with a lot of things…things to do, things i shouldn’t do, things am forced to do…and i guess that also includes things am not supposed to do ever but did it anyway….hehehe…i really wouldn’t want to elaborate more on that..

well, the last topic we talked about was my hospital training i did earlier this year….actually it started late last year…November exactly….and so it was…

Starting my training was a bit difficult…mainly because it was my first time ever to actually work in a tertiary hospital with a couple of thousand  bed capacity…(ok, just kidding…actually its only an 800 bed capacity hospital BUTTT….you’ll be amazed at how the hospital staff can transform it into  3x more the maximum capacity…..miracle?…nope,just plain insanity)….i remember i had this exciting-bordering-on-fear-that-i-might-kill-someone-on-my-first-day kind of emotions…but i had no choice..i had to start someplace right?….right.

Our program started with a 3 day orientation seminar…giving us a bird’s eyeview of the entire hospital set-up…rules,regulations,who’s in charge, who’s not in charge…etcetera2x…the Speakers were extra careful not to scare us  with their true to life clinical experiences but failed miserably..i remember thinking am going to hand out my resignation letter the next day…

But i didn’t of course,…i mean..who the hell gives up on the first day???!!!…certainly not me…am going to war…might as well enjoy it….so i did…and more.

 After the orientation, we proceeded to the actual clinical area….that meant real procedures, actual patients, active diseases, and not so charming doctors….we had to do everything on our own without clinical instructors to give us grades or evaluation reports(although we are evaluated at some point by the head nurses of our area)…still we had to basically perform everything on our own. 

To sum it up….it was fun…and i have a couple of interesting stories to tell…some may shock you…some maybe quite repulsive if not totally and blatantly horrific…some are unethical…some stories are inspiring(well,it inspired me)…and some can move you in more ways than one. 

…me again.

…me again.

 back from the depths of my chaotic life…

…ok stop it carien, you’re scaring them….no, am not having one of those multipersonality disorders or somethin’…am just into the habit of talking to myself sometimes…specially when i am having one of those morbid episodes.

I left you in the OR right?…well, that was a long time ago….when i was still a student nurse that is…

I have come a long way….oh well, i guess not thaat long…but i now have my fair share of experiences in the real nursing world.

After graduation, i went straight from the clasroom to……another clasroom?….yes.

I started to review for the local Nursing Board Exam…5 long months of serious…no nonsense…mind wracking…on the brink of psychosis…studying. It payed of however coz i passed the NLE with no grade below 80% in all subjects…HOOORAYYY!!!….well i worked for it so i guess i should be proud of it right?…right.

After the bliss of finally realizing that I am an RN ( tnxgiving parties, drinking sprees, food binges…etc.etc…)…me and my colleagues decided that it was time to put our well-earned knowledge into action….do some volunteer work.

I did…for a month…then i quit.

 Why?…..

Coz i wanted to push myself a little bit further…..pass the NCLEX-RN Exam.

So again, i went back to the classroom…to study…harder this time….took the exam 5 months later in Manila and as of  now, im still waiting for my results….hope it went well…im crossing my fingers here,…including my toes.(sigh)

after the NCLEX-RN exam, i applied for a 4-month training period in a tertiary hospital..that’s when my life started to change…my views of life and death…of hope and hopelessness…of holding a life in your hands…and feeling it slowly slip away… …ok im being morbid again…stop it i said.

…run over by a ten wheeler truck

My OR experience was really different….its kinda typical in a not so typical way….

…first exposure was purely observation..Do- not- touch- anything- just- watch Rule pervaded the entire OR..intended specifically for us student nurses…fine with me.

Next, we were given schedules on who to go on DR first, OR first…the rest will just have to observe…still fine with me.

I decided to observe inside the OR instead of the DR…i was more fascinated with scalpels, retractors, kelly clamps than dilating cervixes(….eww)…there was C-section going on..every one of us were tensed( students are always tensed…agree?)….when the neonate was lifted from the womb and placed on the waiting crib, my Ci was telling the one who was about to do cord dressing to bring the baby fast to the DR room to be suctioned( the DR was in the next room )..and so everyone was on their feet…..busy…busy…busy…. 

Still observing..I followed my Ci and and another student to the DR..i wanted to see the baby being suctioned and cord dressed….while in the DR, my Ci suddenly asked me to go back hurriedly to the OR to retrieve the baby’s information sheet which the student in charge forgot to bring with her…and so i went,..hurriedly..(being aware about cold stress and the desire to impress my Ci with fast moves)..i literally ran from one room to the other…then…WHAM!…as i was about to open the OR door..i hit the anesthesiologist right in the face…not fine.

No one spoke for a moment…then as i was about to blurt out my sincerest apologies….he screamed at me…ARE YOU TRYING TO KILL ME???!!!…..(fyi: I’M 5′ TALL, 42 KLS, SMALL-BONED, petite and cute)…..and he screams at me as if he has just been run over by a speeding ten wheeler truck….KILL HIM?..

I wish i had….

Didn’t apologize…

Apologies are meant for humans..

Not raving animals called over acting Anesthesiologists. 

being born

…Hi its me again…now where was i when i last left you….hmmmn…yeah…student nursing….

On my third year through nursing school, i really had a hard time starting out at first…but as time went by, i finally got the hang of it…weird schedules, unending case after after case after case after case presentations….even weirder patients, Clinical Instructors from hell and back (well not all of them i guess, some were stuck in purgatories and i hope their sins are never forgiven)…and doctors from Mars…well anyway, i would just like to tell you of an experience i had when we were about to have our OR/DR exposure…

everyone was excited…including me…that’s right…ME.

I never thought that someday i would get excited about something i really am not so fond of …but then again i guess i have finally grown to like what i do…or  is it just because i guess i have no choice but to do it anyway…whichever way you put it.

On our first day, we had our orientation on the area…it includes OR 1, OR 2, and Delivery rooms…adrenalin was rushing…it was the first time i saw neonates being born…literally seeing them come out from the wombs( or the vagina to put it more bluntly, womb is only for those who had gone C-sections)…everybody was tense except for the staff who took everything  so calmly….this was the scenario: laboring mom crying and shouting because of the pain, assisting nurse coaching her to bear down properly while doing fundal pushes, another nurse supporting her perineum so she won’t lacerate excessively, midwife waiting to catch the baby when it comes out, and us of course…jaws dropping in mid air… and so we watched and observed…some in awe…some in shock…others in disgust….even some in remorse(..i’m gonna tell my mom i love her when i get home guys)…all in all, it was truly an amazing experience..(just don’t drop those tiny, wriggling,slimy,vernix caseosa-covered neonates into the pail).

Next was the OR….

student nurse

…nursing wasn’t really my first choice in college…i wanted to be an artist..a sucessfull lawyer..an accountant..a fashion icon…a chef..hell, even a dressmaker!.. anything would do except being in the medical field…i can’t stand blood, gore, vomitus, especially mutilated limbs and communicable diseases…

…i don’t know what happened though…i ended up taking up Bachelor of Science in Nursing…God help my soul.

during my first two years in college..i had fun…that was easy..everything was so predictable…lectures, assignments, projects…typical college life…

on my third year…things started turning 360 degrees towards insanity…we were about to start our hospital duties…

but before that…we had to have proper gear…like soldiers donning their uniforms and guns for war..we had to wear stupid aprons( did nightingale wear an apron at the Crimean War?) and stethoscopes without bullets( i’d really like to shoot those toxic CI’s and head nurses if given the chance…with stethoscopes? what the hell…)….

and so came my first shooting day…er..duty day …..one word…QUIT.

…while you still can.

( to be continued………………..)????

pushed, pulled, dragged and beaten..

…haven’t heard from me since i started my training program…

well, here i am guys…still alive…pushed, pulled, dragged, beaten…but alive…

when i started this blog i said to myself i’d tell the world of my experiences…but then again i realized..who cares..the world already has a lot of problems on its own…i guess my ‘harrowing"? experiences won’t really matter…but you know what, i feel like telling it anyway….so what…

so..here’s the hard part..what would i say?…where do i start?…i don’t want to talk about my childhood…its too typical (dolls, ribbons, lollipops…ew); i also don’t want to talk about my dreams and wishes…they’re unattainable anyway ( climb Mt. Everest, win a million dollars, marry josh hartnett….sigh); and i don’t want to talk about my lovelife most especially…its uncomplicatedly complicated( what have i gotten myself into…whew)….anyway, i’ve finally decided to talk about something familiarly different…my medical life..my hospital rendevous’…my real life encounters with…life.

buckle up guys…i’m about to get you into the world of real life dramas..

world of the unknown

….have you ever ventured into the world of the unknown?….

I think i just did.

well, it's not exactly an unknown territory for me exactly…i studied it for four grueling, nerve-wracking years…read about it, familiarized it, integrated it into my system…acquired a lot of books about it…tons of case studies and researches…heck! i even wake up @ 3 am just to memorize every detail of its complicated procedures and theories…but still when i started my first real training in the field of nursing…with no clinical instructors…no classmates..just my license and me…i was totally, exhilaratingly, forgot-all-what-i-learned NERVOUS!…

…talk about paranoia and all…i really feel as if i'm not gonna make it through my four-month program…geez!

But i'm gonna show you that i can…. and by the end of this program…it will be a different ME.

…you know me better than i know myself

….who am i?…

We were once asked by our CI in Psychiatry  to write about ourselves……well….i said to myself "that's easy"…i could write a whole book about myself…my life,my passion,my dreams…my not so perfect self living in a not so perfect world..

anyway, i ended up writing just a few sentences then….nothing..

….i couldnt think of anything else to say about myself…then it dawned on me…i dont know who i am!..

okay, okay…before you freak out and start thinking that i may have a form of dissociative disorder or an early manifestation of Alzheimer's….well, i dont.

Whether we accept it or not…we dont know know ourselves as much as we would like to believe that we do…there are times that we just surprise ourselves of the things that we can do everytime we are faced with circumstances that places us at a crosspoint.

Everytime i say i cant….i end up doing the opposite and say "hey,did i just do that?"…everytime i decide to give up on something….some inner force within me says,"just get it over with"….so i do..and it surprises me in the end…i never cease to amaze myself of the things i did, can do, or will do…everyday i'm getting to know a side of me i never thought  existed.

…..you know what…the secret is to just TRY.

…get to know yourself.  

my friend

…i have this friend…an i'll call her my lithium….here's why…

i've known her even before i knew who i was..i guess she was the one who made me realize i was breathing after all…all along i thought i was just a piece of crap drifting in oblivion..living within the confines of myself, building walls instead of bridges…well, surprise! surprise!…she climbed my wall and bungeejumped right into my doorstep…my bestfriend.

i've always been manic…doing this, doing that..going there,then back here…starting something and then defies all signs of fatigue and burn out just to get things done….well, that was before i met her…cz now i've learned to stop and say…i could do this some other day…why?…coz it pays to have a lithium by your side.

patience is a virtue…so they say.

…its a very busy day…for me that is …..

tasks to be done…duties to fulfill…bridges to cross..fears to conquer.

i've always thought of myself as an achiever, a perfectionist in every way but then sometimes truth hits you in the face like a train running over doomed car…im only human…and humans..with all our weaknesses, fragility and sheer stupidity…are prone to mistakes and to put it more bluntly…failure.

but inspite of all this,ive learned to be patient with what i have, what i am and what i will be…

Patience is a virtue…so they say.

post enclex…whew!

this is my first  entry…kinda obvious..right?…well…anyway,i've finally decided to have a blog..after so many careful considerations and deep thought..which took me at least 10 minutes..here i am..sharing my vision and mission to the world…be sane everyone,whatever it takes..hold on to that sanity!…well,that's more of a plea than an advice…believe me, it's worth it….chill.

 So i just had my Nclex-RN…i survived…gudluck to the rest of you…what can i say?..whew!…ok,let me say that again…louder this time…WHEW!!!…you get the point guys…nothing more to say…

its soo not good to be a perfectionist…its more of a disease than a trait…dont you think so?…chill.