The Last Mon Standing

Have you ever heard of Case Management?

The University of Oklahoma Health Sciences Center defines Case management as;

a
collaborative approach to providing and coordinating health care
services. A nurse case manager will work with you, your family,
physicians and other health care providers to ensure you or your family
member receives all the necessary services to promote your health and
oversee any illnesses or health conditions while you or your family
member continues to live at home.

 

Our fourth year head
nurse today assigned me again to my previous patient. The first thing
that student nurses usually do after establishing rapport with the
patient and her family is to look for the contraptions that is inserted
on her body, like Oxygen tank, IVF infusions (dextrose) or Foley
catheters. I noticed that my patient’s drug, Mannitol, was not inserted
on her IV line. I looked closely and saw that there were ants crawling
along its tube and some has successfully infiltrated the soluset (this
is a small cylinder connected to IV lines like dextrose for Pediatric
Patients… it minimizes the diameter of the liquid’s drop.).

I
asked her mother what happened, and she said that they found out about
the ants early this morning so the staff nurse pulled out the Mannitol.

Before
lunch, I asked the mother if she’s going to feed the baby. She said
that she doesn’t have any penny left to buy a lunch. Her bedside
neighbor who was about to go home gave her her lunch which she didn’t
touch.

When I was writing my charting on my patient’s record, my
Clinical Instructor asked me about my patient. I told her about how
much the development of her status. Her head’s circumference is
increasing (hydrocephalus) 2 cm a day. She’s a bit tolerant now to me.
I also told her that the girl had a fever last night, and her
temperature only lowered after I gave her a bed bath this morning.

My
Clinical Instructor paused for awhile then told me to ask my classmates
for a contribution for the soluset. We all gave some and we gave the
money to the mother. She thanked us of course with teary eyes and we
are more than happy to help. I really wish the child all the luck. Our
group was not the first to do it though… it is actually already a
tradition.

I really think that each patient’s story is sad, but I haven’t really sympathized with any of my or my groupmates’ patients… until today.

We are currently interning in the Pediatrics Ward of our School’s Mother Hospital. Since it is a General Hospital, we face all sorts of problems, from the common pneumonia to all types of cancers, and all imaginable and indiscernible accidents and mishaps.

My patient today is a little girl. She’s turning 3 on March 19.

She once was able to walk, move her right extremities and even talk. Sadly, she cannot do those things anymore. She can’t even cry even with the excruciating pain that her brain tumor bestows upon her tender age. She just holds her left skull and whimper.

Our first meeting was not very promising. She removed my stethoscope when I tried to listen for her Cardiac Rate. Her father suddenly ran away so I was left with her doing nothing. How would I suppose to take her vital signs if she doesn’t have anyone with her that she can trust? I stood beside her despite her disapproving look. Her squinted eyes (a complication of her left brain tumor) were maniacally mad at me… observing every little move I did. She doesn’t want to be touched by anyone. Until finally her mother came and at last I was able to get her precious Vital Signs.

I asked her mother if I can do a morning care for her child. She eagerly agreed saying that the girl has not yet taken a bath since the last two weeks of her confinement. I prepared the basin and rubbed her body. Her mom was right.

The girl caught a bronchopneumonia in the hospital so I have to suction her mouth and pharynx every now and then since she can’t cough out. This was the hardest part. I know that the girl was crying in her little moans but a tear cannot fell from her eyes. She cannot open her mouth. She only bit the tip of the suctioning tube as her way to fight me.

The mother first noticed last December about the little girl’s eyes crossing. She thought that there is something wrong with the girl’s eyes so she went to a couple of Ophthalmologists who didn’t give a concrete diagnosis of her condition. The mother noted that her child started limping last January. Until finally, she refused to eat. This was then when they went to the hospital. A CT scan was immediately ordered and it was found out that there is a 2.8 x 34 cm. of mass developing on her left parietal lobe.

The squinting of her eyes worsens. Her right leg and arm stiffened though she can still feel some stimulation.

She has not yet eaten since the time of her admission until today when her mother and I asked her. Feeding her presents another problem. The girl cannot chew nor sit. She is at risk of aspiration. It was a difficult job, but I can still see the girl struggles to swallow. She’s really strong… and also was her mother.

Her mother had a fight with her father this morning. The father was such a whiner. The mother was ranting about her husband’s laziness and the nerve to complain. The mother has to go to work while the father has to, supposedly, attend all the girl’s needs. The girl got the pneumonia because the father didn’t turn her from side to side. Whenever the girl perspires, the sweat is just left there to dry by itself… ergo BRONCHOPNEUMONIA.

The mother is doing all she can to accumulate as many financial help as possible. I saw how much she cares for her child. I was with them from 6AM to 2PM without break and nor lunch. But though I was hungry, I was very much happy to help them. The child, although is very keen to trust me, has grown in me for such a small time. I really pray for her health. The mother was miraculously met by a foundation organizer and is bound for Philippines Children’s Medical Center next week.

(Click image to enlarge) I love it when people view my friendster account. a big deal of them are completely anonymous who are not even in my friend list.

To Cronwell, Roselle, Jerson, Jeremy and the rest of you guys thanks.

I want to extend my greetings to my sister, Chamitos Angel Acosta aka Maiah Querubin Acosta, who is celebrating her birthday today.

Just last Saturday I was urging the mother who delivered a baby girl to name her daughter after my sister but I do not think that the mother liked her name. Although this was not the case with my first ever patient inside the OB ward last June.  She asked me what name should she give her baby since she and her husband cannot think of a name. i said Maiah would be cool and my patient was really glad with it, according to her Maiah rhymes with her name, which is May.

Well I just hope that the girl would not grow up just like my sister. Yeah sure my sister was a cum laude in UP, and was ranked 11th in board exam, and was awarded  with the prestigious  "Kalabasa Award" as the "Violation Queen" in her Dorm last 2003 or 2004, but sadly, despite such achievements, she needs to take some refresher courses about Patriotism and stuff.

Last Christmas, I was setting aside all fake coins that I found so they wont be used again and brought back to the circulation, but then when I looked at the canister where I was hiding them, i was shocked because my sister gave them all to the carollers. When i told her about this she didn’t even care.

Another one, she always tells me that I should go abroad after I graduate, but that is not what I was planning. I want to serve our country (NAKS), but she would ridicule this idea then tell me that I should set aside such stupid idea.

But anyway, Happy BVirthday to you sis, you know we’re proud of you.  Kaya ichecheer kita;

One

Two

Three

Go Maiah Go

YEHEy !!!

(CLICK HERE) This is one of her gozzillions Friendster acounts BTW.

(Click Images to Enlarge) Since I only entered the bukol ward, or the lump ward, and was not able to go inside the Operating Room where the Major ORs are done, i was stationed last Saturday at the Delivery Room together with my groupmates who have the least cases of Handle or Assist in the DR.

I was really surprised and happy at the same time when the Nurse who was stationed there told me that i’ll be inserting an Intravenous Fluid Infusion (Dextrose or Swero). Even the Registered Nurses are not allowed to insert IVFs unless they have undergone a special training. And so are we, Student Nurses. That’s why I was really eager yet nervous when the Nurse told me that I’ll be inserting the bottle.Luckily I was able to insert it at the first trial. This was not my first time though, we had inserted all sorts of injection at each other in our Health Care class when we were in second year, but this was my first time to try it with a real patient, actually the first time in our group. I am really glad that I successfully inserted it in the right vein. Some registered nurses fail to do it in their first trial even if theyre doing it for years so I guess I was really lucky.

The baby was delivered, it was a baby girl.

This is by the way the photo of the cyst, which was roughly the size of a head, that my groupmates were able to extract from a man inside the OR lastThursday.

More Pics tomorrow

(This entry should have been posted last Saturday, but it was difficult for me to gather all the pictures. Thanks Lallaine!)

We finally turned our backs to the hospital that never let us set our feet in its elevator. Imagine climbing down to the ground floor from the fourth floor every time you want to pee.

According to my professor in Pediatrics and our Student

Head Nurses last week, Interns were barred from the elevator after a group from the previous batch played inside the elevator. It turned out that the whole group found an opportunity to take their photos one night inside the elevator. They barricaded the elevator and lifted it to the top floor.
Unknown to them, an emergency was happening in the third floor and an oxygen tank was ordered. The utilities were unable to bring the oxygen tank to the patient so the patient died.
What was really sad is that the patient was just 5 years old. The mother was so angry and devastated.
The Students were threatened to be dropped from the subject, but for an unkown reason they were spared and were just given an Incidental report each and were suspended for a whole week. (click images to enlarge)

And so that was the story…
… many more unfortunate events happened to some of the student nurses who had their duties there. The girl that was raped on the very first day of our internship was interning there that time. And also the girl who was robbed of with her cellphone and left with slashes on her wrist was also from that hospital. And will I ever forget the two Stdent Nurses ahead of us, who both died after acquiring Meningococcemia from their patient.

There are actually 15 of us in the group. 10 girls and 5 males (this is usually the ratio of sexes in Nursing schools) and add the two fourth year students who were with us as our Head Nurses.

Instead of having our usual duty, we had our comprehensive case study presentation last Friday. Before that, the whole group decided to meet in a nearby park, but I was unable to come… i decided not to come. Then we proceed to the rooftop were we had our case pres. so far it is the best, these are the photos of the surrounding structures.

Angelo doing the self-breast-examination

The group and our CI

while doing the case pres

views from the top.

I was assigned at the "Bukol" Room, Lumps Room, named because the Medical mission changed the Payward into an operating room for minor cases. I was very much excited when I entered the room since I know that the Doctor that would be doing the surgeries is really nice and extremely cool. She’s a Doctor for Armed Forces of the Philippines… her real name is Maricel, but her nickname is even more enchanting… Peaches. She jokes a lot. She bullies her partne,Dr. Dwayne. And she asked Neil yesterday to find her a boyfriend.

I first saw her when she exited the Operating Room at 6. She was talking with the other doctor then she put her pointer and middle fingers on her lips, her way of asking for a cigarette break. The doctor replied, “Anong sigarilyo, pag ikaw namatay…” (What cigarette, When you died…) then another doctor butt in, “…namatay ng nakangiti.” (Died smiling)… and everyone laughed. She smiled at us. The doctor later on warned her that she’ll put red peppers on her cigarette if she won’t stop.

Her partner is as cool as her, the American Doctor named Dwayne. When he saw us, he made us stand on a straight line and told us to dance Boom Tarat…  it was so funny. He really likes the show acording to him. Too bad he couldn’t say the lyrics correctly. He was instructing as to dance while he sings;

Boom Terat Terat (please sing with the usual American accent)
Boom Terat terat
Sumayath Sumyath Boom Boom Boom

Ms. Leila Busch heard him and corrected him, but he didn’t get the Tarrarat Tararat  line…  Wherever he got the Sumayath thing, I do not know. And thank goodness to the correction, we were spared from dancing.

Our first case was a guy with a lump on the Chest. Then next was a Lady with mass on her breast. That lady has previously undergone the same operation on her right breast with Dra. Peaches.  The doctor was so good in suturing, she made the cut on the Areola’s (nipple’s) and the skin’s boundary. Them she stitched them so neatly, which according to Dwayne could not meet his standard, but I think was the BEST that I’ve ever seen, that the stitch was almost invisible. I do not think I was able to help them though. I cannot find the things that they were asking and I even noticed that Dwayne was already the one who’s doing some of the things that I should have done. I was actually busy holding the curtain to cover the patient. A hairy guy at  my back kept on glancing at her breast.

Then our group had a rotation, I went back to the recovery room, this time I was not accompanied by Ms Leila but by Ms. Rosas, that’s her surname I forgot her whole name.

She, just like Ms Leila, is also a Filipina. She’s a member of Philippine Nurses Association of Greater Kansas City. There is an air of, uhmmm elegance and grace in her. She’s realy pretty and really smart. She’s smart. She explained a lot of things to me and I was able to ask her certain questions. She even showed us her Family Pictures (that’s plural) and her pets. I like her very much.

When we were about to go they gave us a stuffed toy each. I named my Panda Bear Dwayne, while Leslie named her  puppy Peaches. Angelo got a dog too, Hanzel got<br />
a pelican.

I only had an hour of sleep last night. I tried to finish my thesis. I slept at 2AM then woke up at 3. My duty is in a District Hospital and this is my first time. I didn’t know how to get there so I left the house at 4:30 (I was planning to leave at 4 but due to my grogginess, I was late). My groupmates left our redevous without me. When I got in the hospital, I was 12 minutes late but Alex insisted that it was already 15 minutes passed 6 so I am absent (Damn him.)

There is a Medical Mission being held by the Philippine Nurses Association of Greater Kansas City in that hospital. We waited for them until 8.

The Nurses were accompanied by some volunteer Doctors from the US and other nurses from the other parts of the Philipines. According to them, this was their 14th year in service. Next year they are bound for Benguet or Surigao.

One thing I and my classmates noticed about this people is how warm they are to their patient. Honestly, I have never seen a Filipino doctor cuddles a baby like his own child. You can really feel the "CARE" that they are giving even if their patients are poor. They joke a lot. One Caucasian doctor even confessed that he loves Wowowie.

I am glad that the FilAm Nurses were also this nice. I thought, if working abroad would mean that I’ll have this kind of people as my colleagues, I might as well fly to America (something that I have not planned before.).

They give gifts to get children’s trust. I was the only one who witnessed this since almost all of my groupmates were assigned with the doctors for surgeries (since I was late.).

There was one instance when the FilAm nurse, Ms. Leila Busch gave a sando to a five years old boy. The sando is white with red lining on its helm. It has the printed portrait of jollibee surrounded by floweres.

The kid noticed the flowers and insisted that flowers are only for girls. His mom had to wrestle with him just to make him wear the sando.

The kid was later on delivered to the Operating room to have his Right pinky and ringman fingers separated (he was born with his two fingers fused by skin).

Hours passed and Ms Leila came to his mother to tell her that the child was also circumcised to get a skin for the skin grafting, the operation btw is a type of plastic surgery. His mom was all trilled of the news, but when the child was brought into the room, it turned out that the doctotrs were just joking, they took the skin for the graft for the finger that doesn’t have enough skin from the abdomen.

My groupmates has more interesting stories about big cysts and small cysts… and about a guy’s, according to Aiza,  a guy’s "big Chuvaness."

Try this site http://www.pnagkc.org/ and this http://www.medicalmission.com/

PS We were dismissed as early as 12 noon.