Orchestroscopy, M.D. 2 comments

I have a confession to make. And it is the reason why I haven't even visited the admin page of this blog for the past five months, not to mention write and post anything online past two coherent sentences. This endeavor has pointed a sanity-draining rifle at my head and robbed me of all my remaining extra time and energy.

For reasons I will try later to expound on, long story short (and because you've probably read the title of this post already), I have insanely decided to enter the grueling and chaotic world of medicine. From being a part of healthcare in general, I am now striving rock hard to climb the oh so steep ladder of this generation's deadly Medical Hierarchy. 

I am now a "Medical Student".

And yes, as you all may have deduced by now, I am a Nurse studying to be a Doctor. 

I am a cliche.

Not that I have anything against nurses entering medical school (obviously, because I am one), it's just that recently, it has been the trend and it pains me to be considered as a part of an ongoing fad when it is a decision I have carefully and meticulously considered for months, with intensive neuron and body timeline consultations, not to mention implorations to the heavens to "Please, give me a sign!". 

So, the question is, what convinced an almost mid-20-something R.N. who is four years away from the last time she wore a toga, a funny-looking hat and accepted a blank piece of rolled paper onstage plunge back to 5-inches thick books, uniforms and head aching exams? 

Most reasons are too personal to be understood without background information so let's just put it this way. 

I have experienced the hospital. I have lived in it (mostly behind a surgical mask quietly taking it all in). I have observed countless successes and inevitable failures of various physicians. I have heard stories, the miraculous and the disastrous and everything in between. I have talked with patients and witnessed their apprehension, relief, frustrations and gratitude. 

I have been yelled upon, praised, blamed for something, and blatantly disregarded (sometimes all on the same day). And even with the chaos, the drama, the uncertainty, the culture of seniority, the never ending studying and looking stupid for things you did not study for, the inhumane workload and all the others that I have yet to discover, it is still the world I dream to be a part of.

And when you know that it is something you will regret in the future if you fail to take the chance today, you ******' take it.

%&$#@*&!!

But make no mistake, being a med student does not make me any less of an R.N. I'll be honest, I feel slightly guilty because most of the readers of this blog have commended me for being relatable as a struggling nurse here in the country and now all my posts (as rare as they will be) would be about studying and exams and more studying. Nevertheless, I hope my past posts would still be of help to R.N. colleagues and, well, for the future entries, who knows what they hold. :)

Inside the OR: On Amputations, Colossal Pimples and Bullet Trajectory 0 comments

There will always be stories that will follow us. From something we've read, watched on the news, gossiped from that overly chatty friend or witnessed with our own eyes. The thing about being an operating room nurse is that the events we witness everyday, and is considered as norm (even downright boring as I stare into my 6th Caesarian Section in an 8-hour graveyard shift) are the ones most people cringe and gasp upon. 

But then, at times, stories will come swinging through the semi-sterile double doors that even the most experienced of us will remember.

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A 20-something year old just lost his leg the day I was complaining about how I had no time to get a pedicure. A victim of a construction freak accident, his post-adolescent leg was permanently detached from his body. Now, we've seen countless of below-the-knee amputations and once we've gotten over the crude bone sawing, it was not a big deal. But the devastating and instantaneous effect of a single tragic event followed me the whole day from the moment I transferred out the patient to the ward and had to explain to the receiving nurse why a handful of relatives were crying over a BKA. The patient, himself, was in silent tears as he stared at the ceiling, waiting for his stretcher to be wheeled beside the ward bed, probably wondering the future that lays before him.

We've all been there. Thinking that something (or someone) will be with us until the end of our selfish existence, always available and conveniently at an arm's length away. Until they're not. And then the world feels like it has stopped turning as we stand, shell-shocked. I've pictured this in countless scenarios, but never one starring a body part. I guess we are all under the wrong impression that anything we are born with will stay with us to the grave.

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Burn patients. I would always cringe internally whenever I see and care for one. Not because I was repulsed by their appearance, with their scorched flaky skin that needs to be scrubbed off like a wood furniture in need of sandpaper, or the smell of burnt flesh, cloying in the air even after the procedure is done. I recoil on the inside because I could not fathom the pain, the prolonged discomfort and the life changing effects of deformity brought upon by seconds of misfortune.

Then I remember the time I looked in the mirror and saw a colossal pimple right at the center of my nose, red and angry at the world. Everyone at work noticed and made me feel like the most dermatologically ill-fated person in the country with stubborn pores rallying against me. Curse those blemish free goddesses with clear radiant skin and perfect bodies. Why can't I look like them? It turns out, luck was still on my side. Very much so.

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Running. When people inside the operating room are running, you know there are urgent matters need to be attended to. When people inside the operating room are running with a patient on a stretcher on tow, you know it's a matter of life and death.

We didn't even have time to properly set up a complete explore laparotomy / thoracotomy set when the patient came rushing in from the hospital corridor one minute after a hurried phone call from the emergency room. Middle adult male, gunshot wound through the chest. Someone continued CPR, another ran for the e-cart and ampules of Epinephrine. He was fluidly transferred to the OR table and surgery started immediately amidst the systematic chaos.

It only took less than half an hour before the surgeon proclaimed the inevitable and death certificates were arranged.

A father of children, a husband to a wife, a son to a mother. He was watching TV in their apartment's living room when hit by a stray bullet from a domestic fight near their home. Intraoperative findings revealed that the bullet tore through two of the chambers of his heart, obliterating any chances of survival.

I could hear his wife's agonized cry from outside of the operating room complex as I concentrated on the novel that was my nurse's notes. Too many thoughts poured through my mind. What a shock it must have been to find a loved one dying in the sanctuary of your own home. And what, in this world of unexplained phenomena, willed a stray bullet straight through a man's heart?

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It's a common quote: "I cried because I have no shoes, until I saw a man with no feet." We understand what it means, hell, we've read it on Facebook with matching depressing black and white photo of a pitiful looking man looking sullen. Some even clicked "Like".

And yet, do we really remember, as we whine about unreliable WiFi signal and complain about the bipolar weather? They say "Time is gold" and no one has ever really contested that fact, and yet, why are we throwing away valuable stones by the kilo by spending hours on Facebook and obsessing about how everyone's life is better than ours? Or sticking to mindless, purposeless routines because society tells us to do so, all the while forgetting to live our life, the life we truly want to live?

Because, whatever we are doing at this very moment, what makes us so sure that a bullet is not on its way?

Top 12 Signs You Are An Operating Room (OR) Nurse 0 comments

12. You have dry hands and you fear imminent varicose veins eruption in the very near future.

11. You can sleep while standing up then snap awake at a sound of an instrument's name being called.

10. You already have glove and suture brand preferences. (Mine's Gammex 6 1/2 Powder Free for toxic cases. Catgut, most reliabe Chromic we've used!)

9. "Mayo" is not a condiment, as "Army Navy" is not a burger joint nor a specialized government unit.

8. The sequence"OS, OS, Knife, Kelly, Kelly, Army Navy, Mayo.." means something to you.

7. You like suctioning blood clots. It's fun. Seriously.

6. You have touched / poked with a gloved finger a patient's intestine at one time or another (with the surgeon's permission) just for the experience of it.

5. You have witnessed how the weirdest things get stuck in people's orifices. 

4. You know and have experienced the TRUE meaning of "an itch that can't be scratched".

3. You're used to seeing people naked and has seen private parts of all shapes, colors and sizes.

2. The phrases "tusok o patong?", "lunok laway" and "labas dila" don't sound awkward at all.

...and the top sign you are an operating room nurse:

1. You have seen both the pinnacle of human stupidity (with some of the weirdest clients you've catered to) and mortal ingenuity (from the health care providers you have worked with) with each case that has come your way. And, personally, that is one of the reasons that make this profession a cut above the rest.

The Things One Learns From Regularly Seeing Bodies Sliced Open 0 comments

I was supposed to write this deep and profound (redundancy intentional) blog series about my 1 1/2 year experience working inside the Operating Room. I planned it to be hard-hitting stuff, life-changing even, the kind of articles that would make you think about one's purpose in this world, how people tend to put much value on the wrongest of things and complain about the most insignificant details, but for some reason, I couldn't find my Paulo-Coelho-meets-Mitch-Albom voice and, after several sessions of trying, is still incapable to write my own version of Tuesdays with The Alchemist. 

Instead, what keeps popping out of my head is this sarcastic Gossip Girl style voice which likes name-dropping popular authors and makes fun of everything. So be it. I'll make use of you.

So, what did I manage to soak up after months inside a place where only few have gone inside of, half of them on the table, anesthetized, and the other half literally running around the place just to properly run the place?

Crocs are best friends. They may look fugly outside the sterile section of the OR but inside, they are your feet's closest buddy. From standing in one place for hours at a time to jogging around the facility for the whole 8 hour shift to doing the Tinikling just to get out of the way of spilling blood during bloody operations, you'd be glad to have a comfy rubber barrier protecting your feet from bodily fluids that are not yours nor from a person you're in an intimate relationship with.

Babies are not as fragile as you think. They are actually very nimble and resilient. After witnessing and assisting in hundreds of Caesarian Sections, I'm pretty much convinced I could throw one out the window and it will survive the fall. (Just a figure of speech, please don't report me to Bantay Bata.)

It's never as horrifying as macabre movies present it to be. Replace the gloomy, oil-stained walls with clean tiles and a set sterile instruments instead of chainsaws and pliers and it's pretty much the same thing, intestines and blood everywhere. The difference only lies in the anesthesia, and the fact that no one ever screams and loses their appetite after a major operation. In fact, it's all you can do to not forget to wash your hands before attacking that waiting meal in the pantry.

Nudity loses... whatever effect it has when you're surrounded by it everyday. Now I  can understand how people can go people-watching in nudist beaches and find nothing out of the ordinary. Now, seeing a pregnant mother's labia majora is just like staring at an elbow. Well, the inner part of a flexed elbow, maybe.

Surgeons are also humans. They have different personalities and techniques, they make mistakes and perform miracles, they sleep on meticulously scrubbed floors and wear crinkled scrub suits to work. They are not self-proclaimed Gods some people assume them to be nor crazy overachievers like the ones in Grey's Anatomy who have sex in the janitor's closet. Okay, I'm not sure about the latter because we do not have janitor's closets to begin with but you get the point.

You never know what you got until it's gone. Sometimes, the simplest things are the most important ones. And ironically, these are the things we most often take for granted. Like, feet, for example. I mean, I like my feet, I take them to spas and pedicures every month. But I, you, and most people, don't go around saying "God, I feel so blessed to have these feet." because they've always been there, attached to your legs.  And then the next thing you know, you're witnessing someone get theirs sawed off because of a disease or a freak accident and the unthinkable possibilities that have never entered your mind seemed all too real and plausible. And trust me, it will make you stop ingesting sugar by the kilo. 

Nurse's Notes: 1 1/2 Years Shift 9 comments

OPERATING ROOM NOTES

(August 2011 - December 2012 Shift)

> In from bum life / office work via ward with fat pads stubbornly intact on hips, belly and on subcutaneous layers covering self

> With mental, physical and parental consent to work for 8 hours a day, 5 days a week, in the most random General Reliever shiftings possible

> Transferred into Post Anesthesia Care Unit, transferred out patients

> Scrubbed and gowned aseptically

> Hooked to ongoing operations with OS and instrument count repeatedly done with complete remarks

> Operations ended, post-op care to patients rendered  instruments repeatedly washed and packed.

> Ingested 386 units of 3-in-1 coffee 350 ml type Kopiko Brown Sugar, sipping well

> Above coffees consumed followed by 1,257 cases of Caesarian Section

> Kept alive and usefull to society

> Encouraged foot and leg exercises by circulating ongoing operations

> Referred to Dimsum with orders made, paid and eaten

> Referred back to self for further evaluation and management of further plans in life

> Emotional needs perfectly attended

> Endorsed to bum life/office work with stable happiness, with memories attached at heart :)

Inside the Operating Room: The Sterile R.N. 4 comments

They stand at the end of the line, near the foot of the bed, away from the action. While everyone is looking one way, a lone entity looks at another, fussing over a table littered with blood streaked instruments. They are the quiet ones often pushed at the end of the field while a handful of assists grapple with retractors and bang each other's heads for a good view of the action. 

They are the silent ones with roving eyes and reeling minds, mentally counting sponges and having that mini heart attack whenever one is nowhere to be found. They are consistently the first on the scene to set up the suite and the last one to go after the patient has been transferred to the recovery room. Then even after that, there are the myriad of instruments to be washed, dried and packed for sterilization. 

While surgeons battle their inflamed appendices, myomas, gallbladders, cysts and a variety of infected tissues, scrub nurses are in combat with a different kind of villains. Each and every one has his/her own share of "Kelly. KELLY!!!" scenario, unavailable sutures, deaf moments, missing sponges and unfamiliar instrument names of unknown origin and appearance. 

Truth is, no patient nor relative is going to thank a scrub nurse for a successful operation. In fact, they are rarely seen by those they serve. Hidden behind masks, the drowsiness of anesthetized patients, and commonly in the shadows of the operating theater lights and the egos of more important people, one could easily underestimate the utmost significance of that unassuming person scrubbed in at the end of the table, waiting to serve.

To assist selflessly as the heroes work their magic in battling the forces of internal anomalies is a trademark of all dedicated scrub nurses. Never mind the grumbling stomach, clogged nose, full bladders, aching feet and, by god, the varicose veins. Never mind the burn out of assisting in a 6-hour operation, doing post-op care to the patient and yet still have 2 trolleys full of used instruments to wash, dry and pack.

Because then, where would surgeons be without their scrub nurses? Where would Aladin be without his Genie? Bruce Wayne without his ever loyal Alfred? Frodo without Sam? Harry Potter without Ron and Hermione? Nemo without Dory? Edward Cullen without his hypoallergenic foundation and body glitter?

A successful major operation is achieved not by individual brilliance nor state of the art equipment. It is by teamwork that lives are saved and souls are once again tethered to this mortal coil. Heroes may swing and punch and flex their bulging muscles, but it is the keepers of the weapons, among others, who help them succeed in their sacred endeavor.

The clanging of swords in a mid-century war clashing for freedom or territory rings the same bell as the resounding clink of scattered steel instruments in a mayo table in battling stubborn bleeders and messed up anatomy. We are all fighting the same war, saving the same lives. And the scrub nurse plays a crucial role in the struggle, even without the spotlight. 

Inside the Operating Room: An Introduction 2 comments

Blood. There is blood everywhere. On the floor, pooling in basins, dripping from sponges and coating once glimmering stainless steel instruments. Smoke lazily floats up the room as the smell of burning flesh lingers in the air, cloying, at times suffocating. A monitor is beeping incessantly at one corner of the room, wires and cables extending from its body like a robotic creature happily entangling its prey. 

The room is filled with aliens. Or maybe not, but they sure look like extraterrestrial beings. Or maybe those specialists who cater to ones. All suited up, capped and masked, with rubberized hands. They talk with invisible mouths, their eyes being the only windows to their souls. Assuming each of them has one.

And in the middle, a body. Lying down, immobile and strapped up. A tube protruding from its mouth, and its intestine poking out from its torso. A plastic suction tube held by one of those rubber hands slurps out excess fluid as a variety of metal clamps stick out from the abdominal hole like some grotesque part of a Saw torture chamber.

Buzz. Smoke. Clamp. Tie. Suture.

Stitch, stitch, stitch.

The scene may seem like an empty mechanical show of technical procedures, but behind every needle bite is a disease and behind every disease is a person, and behind every person is a story. 

These are the stories that I would never have witnessed anywhere else. 

This familiar shiny hallway and these tiled rooms have witnessed much of people's weaknesses, but also humanity's unwavering strength, more than any other places in the world. To be a spectator a midst all the action, suspense, drama and comedy have undoubtedly shaped me more than I can explain and have made me view things in a different lense. Things may not appear brighter nor more colorful, but they do extract sense and importance in this world governed by misplaced priorities and the pursuit of temporary bliss.

Future related posts in this series will tell stories not my own, but of life's complexities that only presents itself in the most trying of times. No paper-pushing routine job, even the highest paid ones, could mirror this front-seat view on the unadulterated, barefaced truths of our existence. And this is why I wouldn't exchange this experience for the glitz of a more glamorous job.

So, who am I?

I am an OR Nurse. And I have stories to tell.

Scrub Suits and Sogo: How I Survived the "Habagat" Great Flood 5 comments

Marikina River 2 days post Habagat

Okay, so let's pretend it's still August and I haven't completely abandoned this blog for more than a month now. As you get your bearings on what month this is supposed to be, I will also pretend that I'm working on my beloved 14" Lenovo Ideapad laptop with his wonderful clicky keyboard and not on my sister's 11" netbook with horrible Asus cramped keys. See, my ever so loyal laptop have been struck down with a nasty bug that has rendered him useless especially for type-heavy functions like writing this post. No virus scan / anti-malware program have detected anything so I now have to wipe these sentimental tears off my face and reformat the entire thing and start from scratch. So help me God.

Anyway, back to the Great Flood that has yet again brought Metro Manila to a standstill. 

MONDAY

I was having my graveyard duty (10PM-6AM) at the hospital the night of August 6, 2012. There was already gutter deep flood on my way out of our subdivision but never did I expect the rain to continue like it was the biblical times all over again. Throughout the shift we could hear the relentless heavy downpour from outside and I already got the feeling that I won't be able to go home the next day since we admittedly live in the freaking flood capital of the East.

TUESDAY

Come endorsement time, our main concern was that will there be nurses to endorse to. Amazingly almost all of them made it to the hospital, wet trousers and all. C'mon, a round of applause, people. These were the ones who have braved the floods just to see to it that patients are taken care of. Not all wards were that fortunate though. I know of some nurses who had to extend their shift to 16 straight hours. All in the name of health care, of course. 

All of the elective cases in the OR have been deferred because of the rains and flooding so it was a happy day for the morning shift. Us, night shift nurses, were a different story. Numerous calls later from home and a glance at local morning news (Marikina River drowning everything in sight!), it was obvious that there was no way any of us will be able to get home without being stranded somewhere. We then decided to just stay in the hospital until our next graveyard shift and try to get home the next day.

After spending some time in a local carinderia in front of the hospital for breakfast and some news-watching and shopping for toiletries and other essentials at the local market we went back to the hospital to get some much needed rest. Believe me when I say that the extra scrub suits in the hospital were life savers and having 2 uniforms (white and our own scrubs) were an unbelievable advantage that time. Without these extra clothes, we would be stuck with a single uniform all throughout our stranded period. Little did I know that for me, it would mean most of the rest of the week.

WEDNESDAY

Another 10-6 shift has ended. Floods have subsided in most areas and rains have stopped in the metro. All my shift-mates / stranded-mates have decided that they will take the risk of acquiring Leptospirosis just to get home. I was no exception. I disregarded the warnings from home that the main roads and more importantly, subdivision entrances were still impassable. Lagpas Tao / Hanggang Dibdib type of impassable. But I persisted.

Needless to say, I got as far as the junction in the Sta. Lucia Mall / Tropical Hut intersection. All the roads from there on were flooded. The picture above was the entrance road to Marikina. And even those going to Antipolo/Cogeo area were knee deep in water. And do I even need to mention the Waterworld that is Cainta?

With nowhere to go, I waited near the entrance of Sta. Lucia East Grand Mall hoping to be able to crash in an air-conditioned restaurant while waiting for the floods to subside. Plus, I really needed to buy a contact lense case for my lenses which I've been wearing for more than 48 hours. I wasn't able to sleep at all in the hospital because of them. I managed to soak them in sterile water for a couple of hours but since I didn't have my glasses with me, I had to put them back on because I couldn't really see anything without them.

It was already past 11 AM and the mall was still closed. They opened it a few minutes later but when I entered, there was almost no customers and half of the shops were still locked up. Thank heavens Executive Optical opened that day.

Since I already have a case and solution for my contact lenses and could finally sleep without worrying of being forever blind upon waking up, after calling home and determining that the flood was not going down any time soon, we decided that it's better if I just checked-in in the friendly neighborhood hotel standing conspicuously in front of the mall in its red and yellow glory. The Sogo Hotel.

Any concern of mine regarding the, uhm, reputation of the said hotel chain evaporated the second I stepped inside the lobby. There were people, and surprisingly, kids everywhere. Throngs of families milled around the place watching the news on the large screen at the lobby, looking up at the sky for signs of more rain and talking on cellphones asking if they could already make their way home. It was like an Upper-Middle Class Evacuation Center. With entrance fees, of course.

After a few minutes of waiting, I fortunately got the cheapest room available. To my handy dandy credit card, I'm sorry I ever doubted your usefulness. Without you I would be stuck in the streets like The Script's The Man that Can't Be Moved, although in a sleepier and less emo version. The room was not bad at all, fairly clean, although I would drop dead before I step inside the bathroom without slippers on. After 48 hours of no lasting sleep, the huge bed was heaven on earth.

I woke up at around 5PM, officially famished for being NPO (nurse's fancy way of saying no food nor drinks) since that morning's breakfast. After calling home and discovering that I had no choice but to extend my stay in the hotel to overnight since roads were still impassable, I decided to go back and shop for food and additional clothes at the mall. Good thing I went there early because minutes later, the sky was again in a grumpy mood and stores left and right were closing early in fear of another bout of heavy rains. 

I tried to look for restaurants that would accept credit card because I was already running low on cash but there was none so I had to spend my last remaining hundreds for a cheeseburger value meal and ate it back at my room. All in all, it was not a bad existence. It definitely could have been worse. I was all alone and couldn't get home but I was safely inside a hotel room with a dependable cable tv, bathroom with hot shower, a/c unit and that trademark red light which made me sleepy for some reason. This was being stranded in style.

THURSDAY

Woke up to the sound of my cellphone ringing bearing the news that the roads were still flooded but can now be treaded without drowning even if one does not know how to swim. There were also jeepneys already who were having trips up to the flooded areas so people didn't have to walk all the way, just from those places where only the most enduring of legs and Islander slippers would survive. It was time to go home.

It was 3 days after the climax of the torrential rains but still the flood in our area was still this prevalent. I came prepared with my rolled up pajama-ish scrub suit bottom, black shirt and scrunched up hair ready for battle. We in the East were so used to floods like these it was like a kamot-ulo moment instead of a devastating terrifying one to be honest.

Posh executive subdivision submerged in water.

Start of our exodus back home.

Starting from this point, we needed to embrace the Leptospirosis and feel the muddy water and unidentified floating debris enveloping our legs. Being 5'5, the water reached just below buttocks area, still unbelievably high three days after the rain. And this was on the main roads. The subdivisions were no doubt much worse.

To make the long story short, after treading thigh deep flood, getting in a dump truck full of stranded residents looking for an easier way home, walking again a short distance to our subdivision  and riding a pedicab worth 40 php per person because of the still chest deep floods, at around 12:45PM, after 4 unbelievable days, I was home.

I, literally, hugged our gate. 

DOH Terminates Nurse Volunteer Programs: A Nurse Volunteer's Point of View 8 comments

In an intelligent and thought-provoking decision, Department of Health Secretary Enrique Ona issued a memorandum terminating all "Nurse Volunteer Programs", "Volunteer Training Program for Nurses" and all similar and related programs, in all DOH-retained hospitals.

64666926 DOH Termination of Nurse Volunteer Programs

While the memorandum brings appealing images to mind (the end of nurse exploitation, employment for licensed registered nurses, respect for the nursing profession etc.), the only effects of the ordinance that is evident right now is public hospitals being grotesquely understaffed, patients suffering from inadequate care from overworked and burnt out staff nurses and entry level nursing graduates experiencing What-The-Hell-Do-I-Do-Now? syndrome.

Two-Way Street

It's not all bullying, over fatigue and slavery that envelops a nurse volunteers life. Not every registered nurse gathers used bottles in a kariton to sell at junk shops just to have money for hospital training fees. These scenarios get featured in news programs and documentary reports because it is dramatic and controversial. Truth of the matter is, nurses volunteer because they choose to practice their profession rather than apply in call centers, have fake accents and answer calls from strangers. They do it to gain leverage in this highly competitive job market.  Because let's face it, no hospital in their right mind will hire a newly licensed nurse with zero post graduate experience.

Please do not underestimate us. We are not slaves, we know what we are doing and we are aware of the situation in these hospitals. We are not shackled to the nursing station with big metal chains, forced to administer medications under duress and monitor vital signs at gunpoint. We were not dragged into an institution to serve against our will but we do it because we want to and, so far, we see the favorable outcome of honing our crafts and sharpening our skills.

Add to that the priceless feeling of having a schedule to follow, a purpose to attend to, every day. One of the hardest things in life is to wake up at numerous mornings in a row and not be able to know what to do that day or the day after that. Plus, there is the relationship and unique bond that is formed with co-trainees, staff nurses and even patients that no bum, useless, non-"slavery" day could replace.

One thing I could completely agree with, though, is that we should not be paying thousands of pesos for these so-called trainings when we have already offered our brains, bodies and licenses for free. That long-standing custom, Secretary Ona, should be the one eternally abolished but NOT, yes you read it right, every training/volunteer program in the country.

A Dead End

So, with all due respect, DOH Secretary Ona, what do you propose we, unemployed registered nurses, do now? 

With Nurse Volunteerism / Nurse Trainings now prohibited in DOH mandated hospitals and NO ADDITIONAL BUDGET given for hiring needed nursing manpower, every one suffers. Staff nurses are reeling from the sudden influx of additional work load, patients are neglected from lack of care from the preposterous nurse-patient ratio and fresh graduates now have no opportunity to practice what they have learned in college, therefore lessening their chances of getting hired by hospitals due to inadequate experience.

Forgive me for this, but I think the memorandum is a hasty band-aid approach to a long and complicated problem of nurse shortages and exploitation in the country. It was a decision without due thought of the various elements that made the despicable nursing trade of our country what it is today. The problem is a hideous many-limbed menace and cutting of one arm will only make it bleed and stagger.

So, again, if I may ask, seriously, WHAT NOW?

How To Pay NMC Application Fee For Overseas Nurses 0 comments

Information on methods and procedure of payment of application fee of the Nursing & Midwifery Council specifically for those living outside Europe.

Payment Information 

By Cheque

If you have a UK bank account, make your cheque payable to the NMC, mark "Account payee only" (if not already printed on the cheque) and write your name, address and NMC application number on the reverse. Do not post-date cheques as we are unable to accept them. 

By Bankers Draft

Make the draft payable to the NMC, and write your name, address and NMC application number on the reverse 

BY CREDIT OR DEBIT CARD (easiest)

IF you have a credit or debit card you may pay by contacting our advice centre on 020 7333 9333 and paying the required fee over the phone.

Source: NMC Application Pack 1 

Using a IDD capable landline or a cellphone (if prepaid, make sure it has sufficient load) dial 00 44 20 7333 9333. A recorded voice will answer stating that payment of fees can now be made online via NMC's website. If you still want to pay via phone, then stay on the line. 

Payment by credit or debit card via phone:

Make sure to have your PRN number and credit card details ready. If using borrowed card, the owner of the card will be the one asked to supply the card information.

Payment by credit or debit card online: (easier)

Go to their online payments page: https://www.onlinepayments.nmc-uk.org/ , enter requested information and you're done. A confirmation email / receipt will be sent to the email address that you have provided. 

Sources:

http://www.nmc-uk.org/Registration/Staying-on-the-register/Paying-your-fees/#Online

NMC Pack 1

Nursing & Midwifery Council

23 Portland Place, London W1B 1PZ

NMC Call Center: 0207 333 6600

www.nmc-uk.org

Blood Stains, the Smell of Disinfectant and the RH Bill 36 comments

Blood stains. I saw them everyday for months during a certain period in my life. Blood on the floor, on hospitals gowns and on previously pristine white sheets. The room could almost be a set of a horror movie if not for the dozens of crying babies and nursing mothers..

For weeks it was always the same routine. Everyday, I would march the hallway armed with my medical artillery. Thermometer, stethoscope, a sphygmomanometer and a piece of paper. The whole bond paper will be filled with vital sign statistics after my round was done. Temperature, blood pressure, heart rate and respiratory rate. One column for the mother, one column for the baby. Multiplied by a hundred.

I would always brace myself upon entering the ward because I know an hour of repetitive vital signs taking will pass before I get to leave and inhale fresh air again. Imagine this: 12 single sized hospital beds, 4 mothers per bed plus baby. Sometimes we get a 2-3 pairs of mother and child per hospital bed on a good day, but 6 pairs on a toxic shift. And yes, you did the math correctly. That's a dozen people sharing one mattress. They would sleep while sitting down. Sometimes, the brazen ones would sleep on the bare floor.

I have to give credit to the hospital for doing the best they can. A few times per day, someone would wipe the floor with a heavily scented disinfectant, gather soiled hospital gowns and change the blood stained bed sheets. But with mothers and babies pouring in like giving birth is the newest craze of the nation and there is a million pesos to be won if a baby came out of your womb, there was still a lot to be done.

The odor of lochia mixed with the sharp sterile smell of industrial antiseptic would always haunt me on my way home. It stuck to my uniform and even my hair. While riding a jeepney, thoughts of these mothers cramped all together in clumps while their babies cried in discomfort occupied my mind. Furthermore, snippets of their stories would replay in my head like some eerie documentary montage about the status of women in some God-forsaken country. But this was not some African jungle miles from where I live, this was home.

I remember once overhearing a conversation, while giving medication, between my patient and her mother. A newborn baby girl was sleeping at their side. The grandmother was scolding her child because she would not stand up for herself when her husband got angry at her for giving birth, for the 3rd time, to yet another girl. He told her that he still wanted to try to have a boy, despite his meager income. I tried butting in to say that the father always determine the sex of the baby and it was not and will never be the mother's fault for giving birth to a beautiful baby girl but they looked so heated I didn't dare trespass. 

Social Services were always in our part of the hospital. It turned out, there were too many mothers who cannot pay the hospital fees to be able to go home with their child, hence, they get left behind to stay in the ward until they have the adequate finances to settle the bills, therefore occupying precious space that was supposed to be for newly arrived patients. Many of these families have more than 3 children to raise and take care of. And I wonder, if they cannot settle a less than 5,000 php hospital fee, how much harder would it be to feed, clothe and educate their existing children?

Thirteen. The age of the youngest post-partum mother I've ever cared for. Giving birth at thirteen was not record breaking by any means, but it was still bewildering for me to think how much different her life would be  compared to other girls her age. I witnessed an instance one time where her baby was crying and she didn't even know how to pick up her own child from the bed. Her 'bedmates', veteran mothers with 3 or more children and counting were trying to teach her how to carry her baby but all she looked was lost and defeated.

I always enjoyed watching mothers fill-out the birth certificate forms in the lying-in area. The choice of a child's name must have been an important decision for the couple that most commonly include both parties' ideas. It will be the name the baby would be forever identified with. However, I was shocked by the percentage of women who would look at their husband's / unwed father's faces in a clueless haze asking him what he wanted to name the baby and even to the point of what spelling should the name be spelled in. It was the image of absolute reliance and incapability to decide that struck me the wrong way.

See, I grew up in an environment where women held all the cards and did all the decision making that has to be done. I couldn't understand how these women could just depend everything on their spouses without having an opinion of their own. More than once, the mothers would always pass the birth certificate form to the father despite our request that they fill it up themselves. I could sense their hesitation and awkwardness in handling something important and it pained me to witness how crippled their sense of self worth were. Empowered, these women were definitely not.

She was 16, pregnant on her second trimester and was having respiratory problems. During my night shift, I went into her room almost every hour because she was having a hard time breathing despite already being administered Oxygen via nasal cannula and positioned in high Fowler's (almost sitting). I took her Vital Signs more frequently and in the process, got to know her, and the father of the child who was watching her, a little better. She was a sweet girl, well-mannered, soft spoken, with lovely eyes. I thought that she shouldn't be undergoing this kind of life-threatening condition at her age, that maybe, a little more guidance and information could have made a long way, but I do commend her strength in such adversities.

Shift ended. I endorsed the situation and went on my way. It was the last day of my stay in the ward and I felt pretty accomplished. I learned a lot and got to meet interesting people along the way. I wished the best to all the patients I've met during my stay and said a little prayer for those who may be needing a tad more help than others. I slept soundly that night. The next day, I learned that Lovely Eyes and her baby died in the delivery room due to respiratory complications.

So call me whatever names you want, threaten me with eternity in the fiery depths of hell.

These are the reasons why I support the RH Bill.




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2011 PHILIPPINE BLOG AWARDS
Special Categories - Best Single Post
WINNER, Top Post of 2011

http://www.philippineblogawards.com.ph/2011/12/05/congratulations-to-the-winners-of-the-2011-philippine-blog-awards-nationals/

December 2010 Nursing Licensure Exam (NLE) Results 2 comments

It's the time of the year once again where thousands of hopefuls in the country gather around computers screens, Googling in unision with bated breaths and pounding hearts. Hyperventilate no more, here is the result of the Nursing Licensure Exam held on December 19 & 20, 2010, released by the Philippine Regulatory Commission (PRC) this 19th of February 2011.

NLE Results December 2010    

CONGRATULATIONS to all newly passed RNs! :)

Welcome to the world of perpetual volunteerism! No, seriously, I salute each and everyone who had the nerve to face all the 500 questions without turning into a blubbering panicky mess. Now, the real challenge is about to be faced. The board exam is just for theory, now the practical exam, that is living as a nurse for the rest of your professional life, is about to begin. Good luck!

Abortion in the Philippines: Agaw-Buhay (A Documentary) 0 comments

There is clearly something erroneous about a country where ignorant teenagers put their lives in their own hands, a woman almost dies after being shunned by 5 hospitals and a pregnant mother of 4 children passed away because her doctors waited too long debating on whether to save the mother or the developing fetus inside of her.

In a place ruled by utmost faith in old men in robes, there is definitely an unclear line between religion and the state, an unfortunate circumstance which can result to the deterioration of the society in, forgive the pun, biblical proportions.

We live in an environment where when people here the word "Abortion" eyes widen, mouths gasp and terms like baby-killer, slut and evil ring in each others' thoughts. Before any one of us repeat the dire misconception, I urge everyone to give their attention and open minds to this 20 minute eye-opener.

Seldom am I touched by local docu-dramas aired on our nation's television channels, but surprisingly enough, it took something that was just uploaded on YouTube to tug at my heartstrings and opinionated views. Enter "Agaw-Buhay", a documentary created by the NGO, Likhaan, which I heard is a strong supporter of the RH Bill.

AGAW-BUHAY (A Documentary)
By: Likhaan Center for Women's Health

The real-life situations featured in the documentary are not only moving but are painfully real. The difference between the treatment of patients with money and those without are disgracefully pronounced here in our country, a thing that I witnessed first hand as a nurse who have rotated to numerous hospitals and health centers when I was in college. Add to the lack of financial support the stigma of being it known that a person had or attempted an abortion, as hard as it is to say this, I was not surprised to hear stories of mistreatment and verbal disrespect to a patient in that circumstance.

"The only problem is that in the Philippines we take the most literal the most conservative, the most restrictive interpretation."

"So long as it is considered illegal, so long as it is considered immoral by the Church, nobody's going to speak about it."

The church has made sure that all the laws and protocols of the government remain as such despite the fact that they were formulated hundreds of years ago during the Spanish reign just as the system and scriptures of the Church remain as they are now even though they were written thousands of years in the past. There is nothing wrong with tradition but there is also nothing wrong with change, and acceptance of that change and the adaptation of age-old teachings about morality with modern realities of living.

I am not Pro-Abortion nor actually think that the legalization of the act here in our country is good for the state and its people, but I believe that there should be a revision of rules about certain instances where abortion will be deemed acceptable, especially if it is to save the mother's life. Hopefully, a clear provision will free health care workers from ethical dilemmas and fear of possible legal battles regarding such matters as what happened in the third story of the documentary where a full life (one with dependents looking up to her) was lost in an attempt to save a mere developing one.

"Sa lahat na gusto na sana bumaba ang abortion, mawala ang abortion, seryosohin naten ang contraception."

To avoid all of these, for the future's sake, please do not shun contraceptives and everything that is connected with it just because somebody else told you that it is the express highway to hell. I will not impose my beliefs in yours but before going either way, I beg you to first think, research and contemplate. There is nothing more powerful than informed decision making (which is exactly what the Reproductive Health Bill is empowering, by the way).

As for my personal insights, I unquestionably want to GIVE THE RH BILL A FIGHTING CHANCE. I cannot understand what is so scary and immoral about a bill that aims to take care of the health of its populace, especially women and children of low socioeconomic status.

I just hope the Catholic Church also cares and thinks about its followers' physical health and is not just  concerned with their spiritual well-being. Just my two cents.

SERIOUSLY, JUST NOW?: Nurse Volunteerism-For-A-Fee Finally Hits The Local News 23 comments

For most people, the explosion of feed hospital volunteerism by registered nurses all over the country is considered as news, but for thousands of professional nurses it is a lifestyle. An absurd reality where the one serving is also the one spending money for offering one's services.

It's like selling your cellphone but instead of receiving payment, you will also be the one paying the buyer in addition to giving him the gadget. Sounds absolutely insane, right?

It is. But that did not stop countless of Filipino nurses from giving in to the preposterous proposition of both government and private hospitals all around the metro for the sake of gathering experience in hopes that it will help them to finally land a paying job. Including me, my classmates in college and most probably one of your  friends, relatives or even your own child.

Now, with the explosion of this 'shocking' news, everybody's acting all concerned and affected  (politicians, the media, even our beloved PNA) when in fact, they've been turning a blind eye on the problem for YEARS now. Call me an idealist but I think that it's impossible for the media, hospital associations and even most government officials to not be aware of such injustice unless they've been living in a desolate cave without TV, radio, internet connection and cellphone signal for at least 4 years now.

And seriously, does it really have to take a physically abused and raped volunteer nurse to finally drill an opening in the thick dome of secrecy that this shameless exploitation is enveloped?

Just yesterday, a segment in GMA 7's Reporter's Notebook aired a heart-wrenching special segment about volunteer nurses paying fees just so they can practice in the hospital. So many colleagues can relate to the story that one of my friends even cried upon watching the episode.

Another video, this time from ABS-CBN regarding nurse's protest against such inhumane treatment from hospitals demanding money from would-be volunteers. (Click on the link to watch.)

http://www.abs-cbnnews.com/video/nation/01/13/11/group-protests-volunteerism-fee-scheme-nurses

Some cynics may say that none of these will happen if no one will allow such treatment. It's easy to not experience being overworked with negative salary: 

Just don't do it. Do not apply, do not pay, do not be fooled by these  well-oiled mammoth institutions looking for licensed slaves.

But then see, registered nurses took an oath. A pledge made just a few moments after passing the dreaded board exam knowing that they will be receiving their sought-after license. And for some, it is a promise they are willing to uphold no matter what. So many skilled and intelligent nurses are now in jobs not related with the path they have vowed to uphold but some are, to the point that they do it without salary or allowance, just so they can still practice the profession and help care for humanity.

It is not stupidity that brought these registered professionals to where they are now, uncompensated and begging for justice and respect. It is passion, it is the love for their profession that wakes them up every morning and takes them through the night shift. It is their concern for the sick that makes them do the unspeakable things nurses do just to get through the day because without monetary reimbursement, what else is there?

So Philippines, I am speaking to you. Start caring for your professionals, not only nurses but every under-appreciated, unrewarded job there is in the country, for when the day comes that there are already too few of them, gone from the exhaustion of being used and abused, you might by then realize your mistake way too late.

Nurse's Black-Out Campaign 2011 0 comments

Probably inspired by the recent nationwide fad of changing one's profile picture to a cartoon character to help the cause of anti child abuse and negligence, the Nurse's Black-Out Campaign aims to raise the public's awareness on the various depressing situations of Filipino nurses nationwide like paid volunteerism and unemployment. The total black-out of primary pictures on social networking sites such as Facebook and Twitter supports the online campaign in sharing the experiences and pleas of nurses all over the country.

 Title: The Nurses' Black-Out Campaign 2011

Main Objectives:

1. To utilize social media as a tool for nurses' rights awareness building;
2. To initiate social & mass mobilizations in relation to the protection of nurses' rights;
3. To garner online & non-online support from individuals, organizations and communities to end all forms of discrimination and abuse to nurses in the workplaces and communities.

Rationale:
In 2010, the Philippine Professional Regulation Commission, head agency for all the professionals in the country stated that there is already close to 200,000 unemployed and underemployed professional registered nurses in the country. And with the recently concluded December 2010 Nurse Licensure Examinations, the Philippines will be expecting more than 20,000 additional new nurses joining the unemployed sector. This rapidly growing concern of the nurses is now a crisis in the country. The Philippines is the top producer of export nurses and supplies the nursing shortage to many foreign countries but ironically lacks many skilled nurses itself.

The country's rural health units were lacking of many nurses to take care of the communities. One nurse is employed by the government to take care of 20-50,000 residents. In government hospitals, a nurse takes care of 20-50 patients in a ward. Still to some private hospitals, the nurse-patient ratio is imbalanced. Hospitals and healthcare facilities acknowledge their shortage of nurses but fails to hire more because of proclaimed budget constraints. Leaving dozens of nurses flooding in workplaces other than in the field of nursing.

Many expectant young nurses, wanting to gain hospital/clinical experience as a presumed key to international employment, offered their professional nursing services to the hospitals without getting paid. This practice led to the acceptance of hospitals to new nurses to practice in their hospitals tagging terms such as "Volunteer Nurses", "OJT Nurses" and "Nurse Trainees". However, with the overwhelming response from the new nurses, hospitals started charging training/OJT fees in exchange a certification stating that they are "trainees" of the said hospital.

Other abuses such as unfair working conditions, staffing, workplace bullying among others are being experienced by nurses who remained to be largely unreported. Other exploitation are also prevalent such as the exorbitant fees charged by Review Centers to nursing students are also rampantly unregulated.

Main Organizing Body: 
The main organizer of this online movement is the Alliance of Young Nurse Leaders and Advocates International Inc., a national registered organization of nurse leaders & advocates in the Philippines.

This project is coursed through the Alliance's network local chapters & through Ang KatipuNurse the Alliance's political arm in the following areas:
National Capital Region

1. Manila
2. Pasay
3. Makati
4. Valenzuela
5. Caloocan
6. Taguig
7. Mandaluyong
8. Las Piñas

Luzon

1. CAR Baguio-Benguet
2. Ilocos Sur
3. Pangasinan
4. Pampanga
5. Nueva Ecija
6. Nueva Vizcaya
7. Tarlac
8. Bulacan
9. Bataan
10. Camarines Sur
11. Rizal
12. Tuguegarao
13. Cavite

Visayas

1. Ilo-ilo
2. Aklan
3. Cebu
4. Negros Oriental

Mindanao

1. Davao
2. Davao Del Sur
3. Davao Del Norte
4. General Santos
5. Zamboanga

Implementing Partners: These are online communities, societies and organizations who are fully supporting the online campaign. Together, they raise awareness to their subordinates online and maintains communication with AYNLA to get materials necessary for the campaign.

Current listing of online Implementing Partners:
1. Filipino NURSES online community (base members: 197,303)
2. I am a Student Nurse online community (base members: 4,547)
3. Ateneo de Davao College of Nursing online page (base members: 1,988)

Medium of Campaign: Online resource mobilization; social networking sites (e.g. Facebook, Twitter, Tmbler, Multiply etc.)

Online Slogan: "Over 200,000 nurses are unemployed, underemployed & abused in the Philippines. Many of us are overworked but extremely underpaid. Help us gather awareness & support by changing your profile picture to pitch black from January 01-11,2011. It is time we take care of our prime care professionals! Appreciate your Nurses, take care of them - like they take care of you. Join the campaign now! [www.aynla.org]"

Campaign Period: January 01 - 11, 2011 (Initial 11 days from the start of the year)

Core Agenda:

1. Nurses' right to security of decent employment

• Demand urgent action of the Philippine Government to the ballooning unemployment rate of Filipino nurses through (A) Senate and Congressional inquiries and investigations, and (B) Formation of a multi-sectoral/agency commission or task force to oversee the Nursing Crisis.
• Implement Republic Act 9173 or otherwise known as the Philippine Nurses Act of 2002 and the Magna Carta of Public Health Nurses especially the implementation of Salary Grade 15 (SG15) for entry-level nurses and other stipulated benefits such as hazard pay, night differential pay & allowances.
• Reject internationally signed treaties such as Japan-Philippines Economic Partnership Agreement (JPEPA) where the Filipino nurses are in the losing end because of inequalities; pass Reproductive Health Bill with emphasis on trained Nurses being in the frontline of RH education and service employed by the government deployed to clinics nationwide.
• Regulate exorbitant charges made by institutions such as Review Centers to students taking the Board Exam.

2. Nurses' right to equality & to be free from all forms of discrimination

• Eliminate all forms of discrimination in the workplace such as but not limited to (A) verbal, physical and sexual abuse, (B) name calling, branding and stigmatization, and (C) LGBT nurses rights.
• Practice equal staffing in hospitals and clinics abolishing coercive 16, 18 to 24-hour duty shift and adherence to desired nurse-patient ratio of 1:20 or lesser.
• Provide avenues for alternative earning opportunities for Filipino nurses such as initial seed funding for Nursing Clinics and or loaning for interested nurses venturing on cooperatives.

Phasing:

• Phase I - Nurses Black-Out Online Campaigning through major social networking sites such as Facebook, Twitter and Multiply. Total black-out in profile photos are solicited when participating in the campaign. The online campaign will last until January 11, 2011. A probable culminating awareness activity may be set on the last day of the campaign.   
• Phase II - Nurses Rights Day After the Black-Out Campaign, we will declare every 11th of the month as the Nurses' Rights Day where we can once again go on Black-out online and do some awareness drives in localities where nurses belong. Awareness drives may be in form of pictorials, forums, seminars etc. The Nurses Rights Day shall be commemorated every 11th day of the month until we reach it's first year. Then we will evaluate each progress of the campaign. Nurses Hour is an hour allocated per working shift dedicated to Filipino nurses.
• Phase III - Physical Mobilizations will be done after we have gathered sufficient online support. Mass mobilizations such as gatherings, legislative fora, consultation meetings, benefit shows etc. can be done. International mobilizations are also expected.

Source:  http://www.aynla.org/page/nurses-blackout-campaign-2011?xg_source=activity

Facebook Page: http://www.facebook.com/event.php?eid=161884150525212

Personally, I think it is a valiant effort to utilize the Internet in spreading the word to other people who are still blissfully unaware of the standings of nurses all over the country, especially those who have just graduated in the recent years. The lack of a stable job, the myriad of trainings and seminars to undergo, the endless volunteer work, hospital experience paid BY the volunteer himself (and not the other way around, the way it should be in normal circumstances) and the work hazards in the hospitals are just a few of the things that needs to be heard by the public and even by the politicians who can actually do something about it.

Unfortunately, blacking out one's profile picture is not as fun as thinking like a child and choosing a suitable cartoon character to upload. Also, having everyone have the same black void as a thumbnail is confusing in identifying who's who in comment pages. I think those are a few of the reasons why the campaign is not as popular as compared to the one against child violence. As a graduate of nursing school, I have at least 100 friends in Facebook who are registered nurses and are experiencing the things that this campaign is trying hard to fight against, however, I have only noticed less than 5 friends who have committed to the campaign.

Blacked-out or not, I still support the advocacy and the fight that we nurses are desperately trying to win, especially since we are without help from national certified nursing organizations who all seem content on doing nothing else but hold seminars and trainings and distribute membership cards to fresh graduates. I may have not changed my profile picture to a black tile but hopefully, by writing articles and blog posts about these very topics like the one listed below, I've done my part in trying to make a better world for the graduating Filipino nurses of the future.

The Anatomy of Nurse Volunteerism

Secret Lives of Nurses

And may I just say, the injustices has been festering for too long, it's time we try to break out of our submissive cage and hit back.