Imbalance

Psychiatry is probably one of  the areas I am weak at as far as dealing with patients.

 I always thought of myself as a very empathetic person, but i feel like im one of those nurses who would rather deal with physical exhaustion than emotional/mental one. That is why (i even said this before), I can never be a Psych Nurse.

 The problem is because i connect with other people easily and i can  put myself in their shoes, and it hurts me.

Growing up in the Philippines, I have always thought that other countries make a big deal of mental health illnesses. I was raised to believe that just because someone feels depressed- doesn't mean they have depression, which is probably true in some cases. And i really hated it when people call someone "bipolar" just because that person is moody. I thought it was very offensive.

But i learned and i knew all along that our mood, emotions are all linked to our body's chemistry. Certain neurotransmitters/hormones (dopamine, serotonin etc) regulate and coordinate  the way feel. And if there's an imbalance, (just how it is for a other illnesses like Hypertension, diabetes), you're not going to feel/be normal. (what is normal, anyways? lol)

I still do feel though that there are instances in our life where we are allowed to be "imbalanced" in some way. We're humans after all. The feelings that we feel and how we react to situations makes us what we are- humans. I feel like most people falter into the deep hole of mental illness because of the combination of bad coping strategies, poor support system and a series of mishaps in life.

Don't get me wrong, i don't judge people who are diagnosed with mental health illness. Mental Health illness, just like with any other illnesses have to be going on for awhile (talking about months, years....) in order to have a proper diagnosis.

I just wish that everyone can buy that time to feel better and put get their balance back when something bad happens in their life. 

Whole point of this post i guess is:
1. Everyone comes from all walks of life and go through different types of hell, so don't judge.
2. Mental health is as important as physical health
3. It's always important to have good coping strategies and support system in life
-- and if  you have them, don't forget to seek for them when you're feeling low/sad. (This blog is my outlet. ;])

Hah, this post is random but psychiatry lectures for grad school got me to look back at my post 6 years ago about my Psych rotations when i was still in nursing school.

There's beauty in chaos

Had the craziest shift today in Cardiac ICU taking care of a really sick patient who was on ECMO. No matter how many times i say that I hated going to work, i really love the beauty in chaos that happens in the ICU. Code blue, christmas tree of IV pumps, alarms going off every second, labeled tubings, ventilators, nonstop blood transfusions, saving lives.. I have always dreamed of myself as a critical care nurse & even though im on my venture to a new career, i know i will always be one

Enough.

I am drinking my mimosa as i am writing this post.

 When i first heard of the word "burnt out", I never thought that it was something that I would actually experience as nurse..well, because I love nursing. I love being a nurse. I love my patients, I love the adrenaline, and I love the idea of caring for people and saving lives.

Last night, I almost broke down at work. I dreaded last night's shift. I felt like I carried a large elephant on my shoulder as i stepped out of my apartment. It was heavy.

The past shifts i had were rough. Rough, not in the sense that I was walking around the unit non-stop and being physically exhausted. It was mentally draining. I've had crazy patients before but I felt like everything has bottled up and it was ready to explode.

Not letting these emotions out earlier has probably made the feeling worse. I thought i could handle it.

I go to work every day with the thought that I can conquer everything, then i go home and i get slapped with the reality that i can't fix everything. I can't go home ALL the time with patients less crazy, less angry, less in pain, and less sick.

I am starting to hate work, and i hate that.

Maybe i just haven't had that one patient who truly appreciates what i do. Maybe because it's that time of the month again and i feel slightly more emotional. Maybe i am just tired. Maybe I just needed to vent about this. Maybe i just need a drink. Maybe.

Either way, writing about this makes me feel better. It's like throwing my anger and frustrations out in the universe. It brings order into my thoughts.

 I don't have to burden someone by having them listen to my ramblings about a patient who calls me a "b*tch", a patient who's moaning and in a lot of pain and I can't help, a family member who's frustrated and scared..

I had to take the day off work today, because I need to. I need some time off to recuperate, rethink, rekindle and remember why I got myself in this profession in the first place.

50 shades of crazy.

Last night, I had the craziest verbally abusive patient I have ever had in my four years of being a nurse, and although it does not affect me personally as I am used to confused/agitated patients, I can honestly say that this patient has drained the crap out of me last night.

Saying you're a nurse and being a nurse are two different things. I can't even name any other career job that deals with people who are sick, unwell and who takes "being called a bitch at work" lightly as a nurse would. I felt like an emotional punching bag.

What an exhausting night. Mentally.

How do you rest when you get this kind of tired?

A clean patient is a healthy patient.

Not all the time.
But i think that patients who get bed baths once in awhile recover better.
Or maybe I am just partially OCD. Haha.

I am not going to say that i give my patients full baths every single shift because that's not true. And believe me, there are days when I honestly feel lazy to bathe my patients. However, when my patients obviously smell like they haven't hit the shower for MONTHS, i think it's time to get the basin and washcloths.

I know that my main priority as a nurse is to keep my patients alive at the end of shift, but it really bothers me to see a patient so dirty when his/her nurse is out in the nurse station browsing on his/her phone.

I know and I believe that patients feel better when they are clean and taken care of physically.
I guess I just hate to follow nurses who leave their patients sitting on their wet linens or poop for hours, and I find out they sat on their butts all day.

Come fill my shoe.

This post is heart breaking, as it is a slap of reality.

Months ago, before my trip to the Philippines, I had requested vacation hours for July at work so I can celebrate my Lola (grandmother)'s 90'th birthday. It was supposed to be a big reunion on my father's side of the family.

 A couple of months before her big day, my lola fell and broke her hips.

With a family mostly working in the medical field, you would think that surgery wouldn't be an option for a frail, elderly woman like my lola. We are all aware of the complications of the hip surgery at her age, and had it been someone else's grandmother, I would've said... "it's too risky".

But she's my grandmother. She's my dad's mother. The thought of leaving her bed-ridden in pain is worse than the possible drawbacks of  the surgery.

So we went ahead with the procedure. Thankfully, she did well.

And today, we celebrated her 90th birthday in the hospital. It's one of those bittersweet moments. I am grieved to see my lola in this condition; in pain and slightly confused. But at the same time, I am  elated that most of my cousins, all coming from different parts of the world are all here, in one room, to celebrate her birthday.

Happy 90th birthday, Lola. May you have more birthdays to come!

On Working.

When i was younger, I couldn't wait to grow up and have a job. The thought of being able to financially support myself sounded so enticing when I was 14 years old. I remembered I used to pretend that I was just a renting a space at my parent's house and that my bedroom was own little abode. At that age, I just couldn't wait to do "adult activities" like driving a car, having an income, buying material things that I wanted without having to ask mom or dad for money, and having the freedom to do whatever i want.

Little did i know that being an adult is not as easy as what they make it seem like in movies or tv shows. With freedom, comes responsibility. Actually lots of it. This is the time when I actually have to start thinking about the future and what consequences I have to face with every decision I have to make.

Three years ago, I started to enter the adult world when I graduated college and got my first full time job. Last year, i fully experienced that world when I moved out of my parent's house and lived on my own.

In this world, i think it's really important that we choose a career that we enjoy. Working for a living is something that we have to do for almost the rest of our lives anyways.

Making money is one thing, but doing something that we love another.
Medical field has always been a passion of mine. It started at a young age when I used to go to my dad's (who was a physician) clinic after school. It was when i had the sight of black stethoscopes around the neck of doctors and nurses walking around the hospital and when the idea of saving lives was something i want to do for the rest of my life. I have always been fascinated with words I can't pronounce and the complications of the ever changing health system in our society.

I now work as a nurse, and although i enjoy every thing about this job, it's not always a cloudless day.. not always easy and not always fun either. There are days when I feel exhausted from constant running around the unit after 12 hours, when i have to clean up poop, vomit, sputum,and all other body fluids you can think of. When i have to take care of someone's family when a family member of mine is sick.. when i have been kicked at, spit at and called names I've never been even heard of before. There are days when I want to just call-in sick not because I am sick, but because I just don't feel like working. Some days when I have to drag myself to go to work.

But the good thing with having a job that you love is that, at the end of the day you are still content and happy. When even if you feel like you didn't touch someone's life, atleast someone touched yours. It's a forever rewarding job to take care of people who are not well and who are at the lowest moments of their lives.

According to Steve Jobs:

"Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do."

Loving what you do, and doing what you love is really just the secret to living a gratifying life. :)

PS. I am writing this because I am working overtime tonight and needed the motivation. Clearly, money alone is not enough reason to get motivated to work. Haha.

Heart.

"Every heart has two parts. One that pumps and the part that loves. If you're gonna spend your life fixing broken hearts, then learn both. You can't fix one without concern for the other." 

Always my first love. The HEART. 

It's only impossible, until it's done.

Same feeling i got after i passed my NCLEX 2 years ago. 

If you are faced with the question of "Should i take it now?" Answer is yes.

Take the opportunity and if you fail, retake it!  Don't think that it's too late to take it or you don't have time to do it because you know you do. Make time.

What a great feeling to get this off my goals list this year. Finally a certified critical care nurse. 

One of those days.

Sometimes, I question why I do the things that I do or why I decided to do the things I did. 
I tend to be very impulsive sometimes, and I hate it.

A lot of people asked me WHY i moved out of my parent's house, out of a familiar place with a bunch of familiar faces.

Well, I feel like i need to venture somewhere where i can grow as a nurse and as a person.  I need to stretch out of my comfort zone. Life was becoming too routine for me there, and i needed a change.

In the end, i truly agree that we only regret the chances we didn't take. We lose on 100% of the opportunities we didn't go for.

Antidote of Death

What can one do? Go home, love your children, try not to bicker, eat well, walk in the rain, feel the sun on your face, and laugh loud and often, as much as possible, and especially at yourself. Because the antidote to death is not poetry, or miracle treatments, or a roomful of people with technical expertise and good intentions - the antidote to death is life.

Theresa Brown RN, Critical Care: A New Nurse Faces Death, Life and Everything in Between  

Alcohol pads, everywhere.

You know you’re a nurse if you have a lot of this in your car, in your bed, in your laundry, and everywhere in your room.

Sometimes you cry.

Last night was my first night on my own. I was put in the ICU w/ two patients. One of my patients was a respiratory failure old man and the other a 20 yo female w/ encephalitis secondary to teratoma. 

My old man has two peripheral IV lines. One on the right hand and the other on the left. No central line. Around 11pm last night, as I was about to draw blood from him, i noticed that his Left hand was starting to get swollen/puffy. I immediately stopped the infusion and switched his Ativan Drip and IVF tubings to the peripheral IV on the Right hand which was patent at that time. I called the doctor, told her about the situation and that WE NEED A LINE. With all these harsh medications to the vein, a central line is a MUST.

 She told me “It’s okay, just put it on the other peripheral IV”. I said, okay..so i did. she even told me to increase the infusion (which i should’ve questioned).

Around 2, i checked on my patient and he was still doing okay. I decided to do my bath early for my other patient At 3ish in the morning, as the respiratory therapists were doing their ABG blood draws, we noticed that that my old man’s right hand was swollen, purple and firm. It looked really bad. I immediately stopped the infusion, put a warm compress on it and told my charge RN.

 I called the doctor again and told her “WE NEED A LINE”, the hand was infiltrated and i did this, and that.

She said, keep trying to find one and if we can’t find one, we’ll put a line on him in the morning.

So i told our charge RN again, then one of the other older nurses said “Lemme try to find a good vein”. As she was trying to start a line, she flipped the right arm and to our shock found a pool of blisters. it was gross. and it looks like it hurts! It looked so awful. I checked the pulses and it was there. I went to the phone again and told the doctor about the worsening condition of the right arm. She came and evaluated the patient.

LONG STORY short, it was IV infiltration gone REALLY BAD. my pt developed non traumatic compartment syndrome. AND I FELT RESPONSIBLE. :( 

The thing is, he was doing good for me, we were going to extubate him that morning. His fever has gone down. His vital signs were stable. BUT Now, he’s going to the OR to get a fasciotomy.. they have to open his arms to take the fluid out. To make me feel better, the doctor said “Thanks for catching it early”. Other RNs in our unit told me “You did the right thing”. “You are a good nurse”.

All those things can be true.  but whether true or not.. It didn’t change the way i felt after seeing his poor infiltrated arm.  I felt really horrible. All i can think of is that I could’ve caught it earlier. i keep beating myself up about it. 

As nurses, we always think that we can save people. It reminded me of this quote:

"We all do our jobs with the belief that we are invincible. That is not true, of course, but being shown our inability to save every life hits hard. Eventually the belief in invincibility comes back, because how on earth could you do this job without it?”

I went home, crying. It might seem like it’s not a big deal for someone.. He didn’t die, but the possibility of losing his right arm is there. And it hurts me. That night when i was taking the report from day shift RN, his pleasant wife and daughter was there saying hi to me and telling me how much they want to bring her husband, her dad back to LA (because they live out of town). Now, i don’t even know if i can face them when i go back to the unit tonight.  

No matter how horrible i feel, i know i can’t really do anything with situations like this. It happens. What matters is how i reacted to it.. and how this experience can make me a better nurse

. I feel like I will be an IV NAZI from now on…

There's hope.

So yesterday, I had a lady who had resp distress and severe pneumonia. We got her from the floor the other night, desatting to 60% even w/ oxygen. She had an emergent intubation and was put on a lot of drips and shizload of blood cultures/draws were done because she also screened positive for severe sepsis. We had to put her on Volumetric Diffusive Respirator or VDR(a type of ventilation which is more aggressive and delivers a higher amount of pressure to the lungs) and paralyze her so she can comply with the machine.

http://www.percussionaire.com/VDR4page.asp

I was getting report from the noc shift RN as the RTs were bagging her and trying to stabilize her. It was 645 am when i got the report and didn’t even get to sit down to do my charting until 1200. It was so busy! 

She stopped having urine output when i assumed care in the am. I even milked her foley cath but there was no urine at all. She had hx of renal transplant back in 2005 and I guess her kidney just shut down.

I talked to the doctor, and this is what he said “She’s not even gonna make it until 5pm today, putting patient on VDR is already signal that they’re at rock bottom.” 

I answered “Don’t say that!”.

He even talked to the husband of the patient, a 60 yo frail man who was crying his heart out to “prepare himself for the worst”. 

It was saddening to say such words, but we don’t want to give the family of our patients false hopes. When the husband asked me about it, I just said “Your wife is very ill, but we are doing our best to save and take care of her”. 

Miraculously, she started making urine around 1400. It made me smile.

 I am a nurse, and I believe in the power of science and medicine, but I also believe that there is such thing as hope and the peace from knowing that good unexpected things happen too. 

She started satting in the 98%-99% on the VDR. Her ABG results have improved. Her Vital Signs were more stable. I was able to titrate her Levophed drip down. I was happy. I had to sit down w/ my patient’s daughters and provide emotional support.

I looked at my phone clock and it was past 1700, I told the doctor about the improvement and told him “There’s hope”. 

Almost the end of my shift, I gave her a bath and changed her gowns and linens and cleaned her room. She looked much better than when I saw her as I was getting a report that morning. 

I went home, happy, and praying that she survive for another day or months or years. I hope so. 

Life is short.

My patient yesterday was a 16 year old male who had a GSW (gun shot wound) to the chest and abdomen. He was on versed drip, fentanyl drip, has CVP monitoring, ARTline, on mechanical ventilation via ET Tube, NG tube, foley catheter, pain pump to his Left side incision w/ Thoracotomy, Chest tubes on the right & left side. During the morning, he was extremely hypotensive. His Hematocrit and hemoglobin (lab values to know if you're bleeding or not) were so low.

 In short, he has A LOT of things going on.

But anyways, i had him yesterday and the mom visited him. 

It was so painful to see a mother see her 16 year old in a critical state like that. 

I can see the sadness in her eyes and the worry that she can lost her son. She stayed inside the room for a few mins, just quietly looking at his son.. For some people, silence is a good thing, but for this moment… It’s almost like a shattering piece of glass inside her heart. 

I always try to put myself in the shoes of my patients or my patients’ family.. and yesterday was a tough one. 

It made me realize how short our life is. We NEVER know when that day will come. It can happen any time, any day. Sometimes when least expected. For this kid, it was the other day when he was just sitting in his garage with friends eating burgers.

Before i left my shift, I talked to him (even though he was sedated) and told him to feel better because he has a mother who’s patiently waiting at home for him. I know and I am certain that he can hear me. 

Going crazie.

Going Crazie.

Time flies by so fast. Prior to my psych rotation this quarter, I watched "Fourth Kind" online.. It's basically a story of patients with the same sleeping disorder of seeing a white owl every night when they sleep.. then they discovered through the help of a psychiatrist who does hyponosis to them that aliens abducted them. It was kinda creepy.. but in the end, i just concluded that the psychiatrist there was mentally unstable as well. lol

I asked my mom if she thinks being with patients with mental illness will also make you mentally unstable. She said "yes". I thought so too. If you are the only one who's sane in an setting where everyone else is insane, i think you'd be one of them too.. well if you will be in that place for a loong time, then most likely. It's hard to know what is real or not especially if everyone has a different perception than yours.

Anyways, I had my first psych rotation today.. and I worked at the Psych Emergency Center. Oh Lordie! I walked right in, and saw 8 patients being evaluated by psychiatrists and nurses. I spent my whole day talking to patients.

Two things i realized after my chat with at least 4 patients:

1. Most of the patients' mental state is caused by ruptured relationships. I was kinda surprised that the main reason why most patients are in this unit is because of broken bridges of relationships. Most of them had an abusive childhood, had divorce, they lost someone they love, torn relationship with their parents, or just really weak support system in general. I feel really bad for them. I can't help but think it's not these patient's faults that they are mentally ill, but because they just had bad coping strategies. Even those who had drug induced psychosis or those who had chronic alcoholism-- their main reasons for having all these vices is because of a rough relationship with someone they care for.

2. Everyone has a story behind them. No matter who they are or where they came from. We can never judge someone just by looking at them. Everyone has a story to tell. These patients we had in the unit can be your neighbor, your classmate, the person who serves you pizza in the pub... they can be people we normally see everyday.. and we won't even know what they are going through. It really helps to really get to know the person first before judging them. :)

One day of psych rotation is already mentally exhausting.. i got home and fell asleep for 5 freaken hours. WOW. talk about being a sleepy head. I admire the nurses, doctors, case workers who take the time to make these peoples' lives better. They're really making a difference.. as for me, i don't think I want to be psych nurse in the future-- i am a good listener, but it takes more than that to be a great psych nurse.

Sent home.

I had a stomachache this morning, and my professor sent me home because of that. How lame.

Last night, i got a patient who was in a really critical condition. He came in w/ a diagnosis of cardiac arrest. Was found unconscious and he was intubated in the field. When i was taking my information from his charts, he was having seizures. It made me kinda scared.

I was excited to take care of him today.

Too bad, i had to go home and make up my hours in the sim lab! (i wanted to work with real people!)

Anyways, i went to the doctor and he told me i have gastritis. I find it really odd that I will be working in the medical field, yet i don't believe in this kind of shit. lol. He prescribed me medications that supposedly will make me feel better, but at the back of my mind-- will only make me worse.

I seriously think once you go to hospital.. get treated.. you're gonna keep on coming back no matter what.

I dont know. Maybe it's just me. Oh well.

Never say Never

..being bombarded with thick nursing books, getting my first scrubs (how excited i was!), buying my own stethoscope, first tour in hospital, first time seeing a person die, cleaning crap, seeing a person's chest opened, injecting my self with water.. and more.

WOW.

it has been a year.

I have never appreciated nurses this way ever since i got into nursing school.

I have never seen them as these selfless, compassionate individuals who's always willing to give a helping hand and ear. (well some of them)

Their work is physically, emotionally and spiritually draining. No wonder my mom gets home from work like a worker who worked for 2 days straight with no break. lol (exagge)

I looked back and remembered how i used to tell myself that i will never become a nurse... just because i was afraid of blood..( the image in my head of me working with wounded patients with bones sticking out of their flesh and passing out.) Haha. I used to find that cleaning others butts is really icky.. let alone wiping it myself.

I just wanted to heal/care people.. that's why when i was a kid, i told my parents I want to become a doctor (i think most kids say that.haha). I found myself applying to a university for Biology, not nursing when i finished highschool.

..but here i am putting all these words back to my mouth.

i survived my first year of nursing... and still striving to finally be out there.. in the hospitals.. and officially call myself an RN.

I guess you can really never say never.

I realized..

I find joy in making my patients feel comfortable/clean when they accidentally shit on themselves, from changing wound dressings infested with maggots, from dealing with patients who are suicidal and depressed, from being yelled at by patient's families..

Perhaps what i didn't want to do led me to finding who i really am and what i really want to become.