Oh, shit.

This patient came in from the ER to the High Dependency Unit for observation after experiencing chest pains. He asked for a bedpan, which I helped him onto. He seemed constipated, so I gave the man some privacy by turning to other work I could do while he pushed, pushed, and tried his best to let it out.

Cutting the story short, the patient's face turned a bit pale with a very faint tint of purplish-blue! I could not get a response from him, resuscitation was then commenced.

No need for too many details, he received multiple shots of adrenaline and was even intubated. And he did not make it in the end.

From today onwards, I shall be extra careful whenever I see a patient putting in extra effort to defecate.
Who knew constipation could kill?
 

One on Three

In the knowledge of how well my counterparts are coping in the general wards and the emergency department, there is nothing to boast about me taking charge of three patients in the high dependency unit today. It was a fine Sunday morning, and like most Sundays the ward was a little short on staffing, so the charge nurse from the shift before assigned me an extra patient to take care of.

At first it was quite manageable, the cases were relatively simple and I had previous experience in nursing one of the three patients. Moreover the ease of mind in having no need to worry about admitting another patient, alleviated a significant amount of stress throughout my morning shift. So I got over feeling overwhelmed by the fact that there were going to be three patients to whom I had to be responsible for, after taking over the night shift report and getting ready for the next eight hours of daytime, I felt okay as soon as the night staff clocked out. Everything went smoothly enough until the primary team doctors came; the doctors on-call from the night before were busy checking on the patients and their respective charts, before updating their assessments of the patients and drafting out the appropriate plans; then came the senior consultant, dressed in jeans and a T-shirt, looking less intimidating on a Sunday morning. He goes to the patients one at a time, discussing the cases with the doctors who were in the ward for over the past twenty-four hours.

I had three patients' plans to follow up with. And one of them was due for an urgent abdominal ultrasound. The good news was that, while preparing that patient for the scan I had time to care for my other two patients, because a doctor and a staff nurse must accompany the patient should he or she needed to be transported out of the ward. In other words, the doctors were busy, thus giving me some spare time to do other things for the other two patients. Cutting a long story short, we transferred the patient down for her scan and came back to the ward, and the day started becoming really busy. No thanks to my lack of experience, it all just never seemed to slow down. I was so caught up with tasks to performed at/before certain specific timings.

Thankfully I managed to do a presentable-enough handover to the afternoon shift nurses. Again, this was nothing to boast about; not especially since the nursing officer on duty discretely said to me, "Joel, it is okay to ask for help" at the end of the shift.

Still, it was a good shift and I look forward to working more meaningful ones. The journey has just begun and I do wish to be living the dream.
 

Low urine output

At the ICU we monitor hourly vital signs, sedation score, urine output and a few other things relevant depending on the cases. Yesterday my patient had only 2ml or urine drained over two hours. This time the staff nurse accompanying me was busy so I decided to inform the medical officer on duty.

"Doctor, doctor.. Patient so-and-so's urine output is pretty bad, only 2ml over the past two hours post surgery."
"Okay, noted. Give me a minute to come over." (Phew! I still feel a little anxious when communicating with doctors, not sure why)

 So the doctor came to check on her patient, and flushed the urinary catheter in case it was blocked. And it worked! However it did not take long for us to notice that it started leaking, and I got the stuff ready for the doctor to change the catheter.

Lo and behold, the urine just kept flowing as soon as the new catheter was in place! Poor patient, suffering from a distended bladder but was unable to express it. I felt useful as the patient's suffering was eased because I raised the issue to the doctor's attention, but what the patient probably felt was relief, which is, needless to say, more important than my feelings.


Intensive care nursing is about close monitoring of patients and judicious reporting to doctors.
 

Into the grey area

Not really crossing lines, more of like sticking my head out and risk facing possible disciplinary actions.

I am currently posted to an orthopaedic ward. It is just Day 2 and I feel like I have started this clinical posting walking along the grey.

One of the patients was just wheeled into the ward upon having undergone a shoulder surgery. Surprisingly he was awake and walking about as soon we got him changed and checked up. Another student nurse gave him his painkillers via injection, and he was advised to rest in bed as the medication might cause drowsiness. However the man insisted on walking albeit being warned not to. The staff were busy, everyone was doing their own thing and the nurse responsible for the patient who was just wheeled in instructed me to stay close to the man lest he suffered from a fall. And I did so, but he started walking towards the elevator! My patient wanted to go out for a walk. We even met his doctor on the way out. At that point of time I knew it was impossible to consult the staff nurse because her patient would have gone down and out by the time I ran back into the ward, even if I were to beg him to wait. I did not really bother asking the doctor as he would not wish to bear the responsibility had he agreed to let the patient get out of the ward this soon after surgery.

What were my choices, standing along 6 working elevators with a patient who was adamant on taking a walk outside? I decided to follow the man out despite knowing the fact that his intentions were probably for a cigarette break. So, there I was, walking a patient out of hospital grounds, to smoke, though the only smoke I inhaled was secondhand. He even took out his cigarette before stepping out of the hospital gates. Great, now I even got caught on security camera footage.

I do not regret doing what I did. What else could I have done? A fellow student nurse got the rest of my patients in the ward covered. The best chance I had of making sure the smoker patient did not fall, was to follow and stay close to him even though it meant stepping out of the hospital for a cigarette. Today, the patient is alert and walking well. He took his cigarette breaks without needing anyone to accompany him anymore. And I am getting to know him better through our conversations and my reading of his case file.

Today, a different patient asked me for a favour- to buy him lottery! He gave me a bunch of numbers and some cash. And I went to buy the 4D tickets as instructed(correctly, I hope!) after the end of my shift.

Clinical postings. New experiences, new challenges, some of them weird at times.

Borrowed and returned

A book from the library that I borrowed about a month ago. I am given 2 weeks for each loan on the book I found in the college library. Renewed my loan on the day that it was due 14 days ago and tried to do the same this morning before heading out to school. Alas, the plan failed because someone else has placed a reservation on it.

For 4 weeks, I had a resource valuable for an assignment writing, lying around in my messy room. For 4 weeks, not once did I even open the book! I remember browsing through the contents of the book in the library where I found it, and that was it. It has been 4 weeks, I wasted my loan. Now I regret.

How good is a useful resource if you do not use it?

Doing right?

All a man’s ways seem right to him, but the LORD weighs the heart. 
Proverbs 21:2 

Nobody would mind being right, am I right? Of course I am!
Well, there are times when we are aware how not right we can be. For example, beating a red light. Fair enough, anyone who believes he is always right is only deceiving himself. But at the very least we try to convince ourselves that we are not exactly wrong, blaming people and circumstances aside. The driver behind me was driving really fast and it would have been dangerous for me to step on the brakes. The white lie I told was to protect the reputation of a friend. Adam blamed Eve for giving him the forbidden fruit when they were in Eden. Need I give you more examples?

Nobody enjoys being wrong, period. What wise words from King Solomon.
But the Lord weighs the heart. How does He do it? How can we know what are in our hearts? Even the most advanced and sophisticated medical imaging technology isn't good enough to tell you the condition of a person's heart in terms of morality. Time to be frank, we all have motives and rationales behind our every action. A person seated at close proximity to me can not quite possibly read my thoughts better than another who is a thousand miles away. Only I will know why am I acting or speaking in a certain way; perhaps even I might not always understand myself.

Conscience- something that is imprinted on the soul of every man, theists and atheists alike. Some are easily pricked by their own conscience while others may be desensitized in certain areas. Anyhow, it is up to each one to live in whatever way he or she chooses to, with conscience. All of your ways seem right to you, of course. I guess deep down, we all would probably know for ourselves most of the time if what we are doing is really right or not. It is just a matter of convincing ourselves that we are somehow right.

Actions lead to consequences, a simple truth ought to be reminded of frequently lest we start living only as we please.

My actions seem logically right in my eyes, am I too stubborn to receive correction if I were sincerely wrong? I'd love to be right all the time but am I doing right? If I stand before the Lord today and He begins to audit my life, will I be among the sheep or the goats?

Tested

I remember writing this lately, "Character is about doing what is right even when no one is watching, especially when no one is watching."

Today I had a perfect opportunity to do something really wrong, well you know, the worst sins tend to be the most satisfying ones. The circumstances were just right, no one was looking and nobody would ever be aware had I done whatever I wanted to do. Probably not even the person whom I was about to victimize!

Glad to have stood firm.

Not trying to boast in my strength here though, really wish I could turn back time and correct some mistakes made in the past. There is history that I simply can not put behind, haunting me still today.
 

Bodoh

You can start enjoying your Chinese New Year's break, truly; once you stop feeling sorry about its duration. 

Learn some gratefulness lah, bodoh!

Like Clay

Jeremiah 18:6 “O house of Israel, can I not do with you as this potter does?” declares the LORD. “Like clay in the hand of the potter, so are you in my hand, O house of Israel..."

"Why are there always people better than me at literally everything I do?"
"Why am I not as good-looking as....?"
"Why must I live with the background I was born into?"
"Why can't I be this?"
"Why can't I be that?"
"If God were a gentleman, why couldn't He asked before shaping my nose this way?"

The list goes on and on forevermore. Isn't it unfair, that you couldn't choose your skin colour, hair colour, etc? Heck, isn't it unfair that you have no choice over who was going to be your sibling(s)? Or if you were going to get any, for that matter.

Isn't God fair and just to all?
I can do all the exercises in the world and eat every thing possible out there that could help me gain a little more height; but the genetic constitution in me says that I may as well give up all hope if I wanted to grow as tall as Yao Ming. Why do certain people stand out to be taller than average, without any interventions? Just because of the genetic material they inherited from their tall parents? Where is the fairness described as one of God's attributes?

"God, if you are fair to all then make every body the same lah!" Notice I write 'every body' instead of 'everybody'.

Well, aren't we His creation? Who am I to question His works? Nothing qualifies me to doubt His intelligence since He is the Creator and I am merely a creature in need of grace every moment of my life. A potter, has every authority to do as He pleases with his clay.

Lesson

The skills are fairly easy to perform lah! Comparatively lower failure rates. Not as tough as compared to the other semesters.

And I was the most relaxed student for assessment today.

And there, lo and behold, I failed a simple procedure just because I forgot one simple step.

Joel Yap, you got the results that you deserved today!

 

God is Effecient

Do you know the joy of receiving a message from a best friend? Close but living far away. I had been blessed to have received a few recently. And in that string of messages I lamented that life had become a little too peaceful for me, comparing the challenges I face today relative to that of when I first started college.

Incidentally, not long after my friend and I stopped messaging, hurdles and hurdles began showing up in my path! And the challenges seem so hard to overcome, instantly robbing me off my already weakened willpower and determination to solve problems. Life had become easy, and now it has to become much harder now just because I took notice of the risks of falling into complacency? Why me? And why now? I have to ask.

Sigh, me and my big mouth. Discuss about life lacking challenges as before, forgetting that God is omnipresent.

If God is so efficient in providing mountains for me to climb when I felt bored of walking on even terrain, surely He is good and fair to provide me the strength to conquer these mountains. And am I writing this sentence because He is omni present? Haha! Well, we are purposed for His pleasure, are we not? But the question is, why do I seem to please Him more in my periods of distresss?
 

皱眉头

在这种时刻做家务的人 应该不多吧？(2AM)

我洗衣，洗厕所，扫地，擦风扇 等等。 搞得自己满头大汗。 在忙上忙下的当儿 我发现了 自己做这些家务的时候皱眉头。

皱眉头？？ 人会皱眉大多数是因为遇到不卫生，不自在的情况是吧？ 我竟然在做家务时皱眉头。 是不是因为人为以上的活动不卫生，不自在？ 尤其是洗厕所。 但是这些打扫的工作都是每个人应该会的。 而且我已经是出外念书的半个大人了。

我庆幸自己不是娇生惯养。 来自一个小康之家，不荣华富贵。 从不歧视任何 “底层” 的行业。 可是不得不承认 妈妈比较疼我，我从小就不需要做很多家务，所以现在才会不习惯。 所以洗厕所会皱眉头。

不能看不起简简单单的打扫工作。 妈妈为我们家人服务了这么多年 没有埋怨。 我怎么能带个觉得家务又麻烦又肮脏的心理 来打扫自己居住的地方呢？ 更何况已经 很久 很久 没有扫地了！

皱眉头 的态度需要改。

To help?

What makes us human? What is so special about mankind when compared to the animal kingdom? Even the beasts and birds seem to help each other and somehow have some form of system to which they live by. They depend on instinct, to kill and to protect. However humans are far more complex than that. We have a gift called discernment, which I believe is what differentiates us from the animals.

We choose, to be good to another or the opposite.

And I think helping people is what makes us human. We help our own; we help those dependant on us; we help those who need help. A pro-social behaviour.
When not to help? When we lose interest; when in a bad mood; when our attitudes change; when we realise we've been taken advantage of? What keeps/stops us from helping others?

I just realised I might have been doing too much to help certain persons. So much so that they may develop dependance. When you want me to do something, you ask. Nothing wrong. However if you just lay back and wait for the results, why should I fulfill your responsibilities for you just because I can do a better job? It's different. Say a boy goes fishing for the first time with his dad. He doesn't know how to use a bait so the father does everything for him. But if he just waits and reap the rewards without laying a finger on the bait, he isn't going to know how to bait his rod in future. What good is it to go fishing with dad without learning anything about the activity? If the boy were to participate in setting up his fishing rod, with the help of the father, that's a different story. This boy learns.

If I helped people, their gratitude isn't important. It's more about the experience, learning and growth.
My help is wrong if it becomes unhelpful.

Doing something tough with the help of one; is different from asking him/her to do it on my behalf. I had lived a rather "easy" life before, as there were almost always people around me ready to help should I meet any difficult circumstances. People with experience, and a kind soul. It was(is) tempting to have them do my stuff for me. The easy road is always more pleasant to take. I must confess my reliance and sloth, which led to consequences.

Therefore I must be careful in helping. As much as I would love to help. Show me your intentions and I'll give you my help.

不爽?

原是因慢而不爽， 因为自己心急却被逼等待。 自己的脚步快却要嫌别人慢。
但想想之后， 发现自己并没被逼等待。 自愿慢下来就没资格生气。
 因几个不是理由的理由生气， 太小器了。
我便开始看见自己的幼稚。 生气自己 为什么发小孩子脾气。

没资格不爽。

Got up late

Although getting out of bed at half past 8 in the morning may be considered reasonable if not early to many, it was late for me today. I was out with a few friends from Kluang last night to celebrate two of their birthdays. Nice night out, good to keep in touch with one another(get to know new friends, for me) though each of us are busy here with our own stuff to do in Singapore. Got home rather late last night and went to bed even later.

My alarm was set to ring before 7 this morning as today's classes begin from 8AM. Little did I know I could oversleep! It usually doesn't happen to me because I'm an early waker. Gained consciousness at 8.30AM and adrenaline filled my arteries the moment I realised what time it was. Then my first thought of the day was "Oh! There goes my 100% attendance", and all the weeks of dutifully attending classes had been a waste. It's week 13, just about a month to go before Year 1 comes to an end. Why did I have to oversleep?
Well I'm thankful that it was only an hour of tutorial missed instead of some important lecture.

Nevertheless I shall continue to maintain a good attendance record. Never gonna miss another class, God willing.

Another feeling

Actually it should be "A reason to another feeling".

Delirious? recorded their final album. I feel sad.
They contributed so much to contemporary Christian music, and they play so well together as a band though I sometimes find the music too loud. Can't believe they're saying goodbye to each other. Well, I believe they each have higher callings. And their music will live on, touching lives and leading hearts upward.

Then I am reminded of a message spoken by one of my favourite speakers in church back home last week.

"The Lord's servants come and go, so don't be too attached to them." - Uncle Paul.

It was a line of words that went right into my heart that day, and it remains. Sometimes, many times we are so prone to grow attach to people who help us and speak into our lives, that we do not realise how dependant on them we have become. Only until they leave all of a sudden do we suffer great pain. But what is loss without pain anyway?

I have become so fearful of depending on another;

yet I know no man is or can be an island.

Second Best

Settling for second best 

for deserving I far less

Just follow lah

Friend go, friend invites, go loh... For fun mah....

A couple of friends were on their way to a dance audition.

.....
"Joel ah, go for the audition lah!"

....
"Erm, I don't dance"
"Hmmmmm... ok loh(so bored to be at home anyway)"


Oh I didn't expect the whole process to be nearly 4 hours! I was suffering right from the beginning, all the way through..

Friend go, friends go, just follow loh. Hahaha, suffer ah....
Well, no harm done so it's ok. At least I had a chance to sweat, so glad to have endured the whole audition. Was so so feeling like quitting during the long over-and-over practices.


Anyway, going out to wait for bus soon. It will likely be a peaceful bus ride, expecting silence in it regardless of the number of passengers aboard.

又怎样？

你敬佩老师，因此喜欢上课。
但是你上课的表现只显得出你没兴趣，喜欢又怎样？

老师帮助你很多，甚至太多太多，你很感谢。
但那又怎样？
你上课只会发呆，老师也拿你没办法，当没看到。

你早就知道向老师道谢最好的方法是把书读好，知道又怎样？

如今你要从新开始，老师还是那么照顾你。
你最好不要忘记。

对不起，谢谢您。

打球

此时下午四点四十五分。

等一下有个重要的约会，必须准时出席。 朋友邀了我在篮球场打球，本来不想运动的我竟然受不起朋友请吃雪糕的诱惑，答应了去尝试磨练磨练球艺。好久没做运动了，整个人就像未长出翅膀的蝴蝶一样，动弹不得。 其实是不想动而已，只想睡觉。昨天竟然成功睡了大约七个小时的午觉，真爽。但也很浪费时间。
毛毛虫要是不熬过一个艰难又沉闷的过程就永远不能变成蝴蝶在天空中飞舞。

不想去打球，可是一定要去。 实现承诺比纵容自己更重要。

去打篮球只是一个非常非常非常简单的比喻。 这世界上还有无数我们不想做但得做的事情。请问有哪个学生是心甘情愿念书，做功课的呢？哪个成人会希望天天有做不完的工作？

不喜欢，不愿意，不会（有时），不想  做的事情，见的人，去的地方，失去的事物，放下的东西等等，  毕竟很多都是我们所需要经历的。
地球不是天堂，万事不如意。

运动对健康有益，待会儿去做运动是对的。

朋友， 谢谢。

请别忘了冰淇淋的约定！