Being posted to a CVM ward for my
medical posting has its perks afterall. I have a really great CI who takes the
trouble to teach us about what goes on in that particular ward and, the type of
diagnosis which are common.
Since I would be here for a full 4
weeks, I had set myself some goals. I intended to pass reports, write reports,
do drug administration and IV scheduling as well as more injections. That’s all I thought .
So, 2 weeks went by with my
classmates and I getting to slowly network with the nurses and the health
assistants. We learnt more about the heart and the various treatment or
management then we ever did during school. Somehow, in the Ward, it becomes
much more real when we read the cases and the diagnosis. Slowly, we are even
able to anticipate the type of treatment needed for the patient.
Last Saturday, I decided to sign
up for a Hospice Awareness program with the SNA. What I learnt from it has
helped to fill in the whole process of care of an individual….although I did
not know it then. We visited St Joseph’s Hospice and Dover Park Hospice. Both
places were wonderful and special in their own way.
When I stepped into St Joseph’s
Hospice, immediately I felt serene and calm. It was so peaceful and bright! I
felt like I was back in Portugal, an immediate sense of peace overcame
me.Walking through the rooms and seeing some of their residents, I get the
feeling that the residents are being well-taken care of and truly respected as
an individual. They got to wear their own clothes instead of the standard
issued pyjamas that most hospitals or homes provide. What was even more
astounding was the fact that none of their residents had any pressure sores!
The residents even had their own wheelchair parked outside their rooms to
ensure that they get out of bed at least twice or thrice a day! The nurses all
seemed really happy and sincere in their care for their residents and we even
saw one resident helping out in the laundry area.
Then we went on to Dover Park Hospice.
On our arrival, a resident had just passed away and the body was being removed.
It was noisy and a little chaotic the moment we stepped in. It can’t be helped
though because they were undergoing some repairs. What struck me about Dover
Hospice was the updated look it had. Every single room had a balcony or a
little patio which opened into a scenery of lush greenery, much like a resort.
However, unlike St Joseph’s, DPH was run almost like a hospital. It was more
structured and their residents had standard issued pyjamas. However, it must be
said that DPH has a really dedicated team of nurses and doctors as well.
So, having read about my
visits-you probably still have no idea what Hospice is about. It is a place for
the terminally ill and nursing is mostly palliative. The aim is to ease pain
and make the last passage of life as comfortable and meaningful for both the
residents and their family members.
After an insightful weekend
whereupon I also met up with some old school mates and a pal back from Canada,
I felt myself charged and ready for another week of mundane and slow nursing.
How wrong was I.
Immediately on Wednesday morning,
10-15 mins after I stepped into the ward and was preparing medications to serve
when Code Blue was activated. A patient in KG’s room had collapsed with VT. It
was the very patient who had, a day earlier, remarked to me in clear crisp
English that I was very thoughtful and sincere. I was worried. She was really
old…almost 90 years.
Unfortunately, despite emergency
resuscitation and defib (at least 23 times) she was pronounced dead-almost more
than an hour later. It was sad, three doctors… four S/Ns (of which 2 were ICU
trained) did their very best. They exhausted everything but it was useless.
It is a scary sound to hear the
ECG monitor go flat and to watch as the doctors and S/Ns leave the room leaving
everything behind. When KG, PO and I entered with our CI, it looked
like a scene from Grey’s Anatomy (the episode where Alex made fun of an obese
patient who subsequently died on the table). Strangely enough, though I knew
and spoke to the patient before, I did not feel any sadness or emotions.
It was more scary for the other
patients who could not help but ask each other what had happened and why were
we screening them off from view. The only thing that marked a death in the ward
was when we had to screen all the beds and shooed any visitors away while we
wheeled the body out to a holding area for ‘Last Office’.
Then my week ended today with,
another resuscitation case. Again, it happened when we were all busy preparing
our evening meds and again, it was from KG’s room. Her patient. And again, the
patient was someone whom I’ve nursed before during my first week in the ward
who got re-admitted again earlier this week. She needed a lot of TLC and though
it irritated the nurses, I tried to understand her needs. However, I ended up
with bruises because she loved to hit people and grab my hands without letting
go. Somehow, it was always me who got hit even when KG was the one who was rough with her whenever we changed her diapers or sponged her.
Even though her family requested
for "conservative" management, the doctors tried resuscitating her
and defibbed her at least 20 times before proceeding to CPR. They tried and, I
don’t blame them for trying because no one expected such an outcome for this
patient. The plan was to send her to a nursing home and her condition was
stable enough as well. Her youngest son had rushed over from work and his
lonely solitary figure, pacing about the ward, kept all the other visitors away
from him at least a few feet.
She was pronounced dead a little
after five, after more than an hour of resuscitation.
I will never forget the look of
pain, sadness and anguish on her son’s face when the doctor finally told him
that they had to let his mother go. Tears simply flowed out of his eyes. Her
son had always struck me as a ‘Pai- Kia’ with his fashionable hairdo and
spectacles as well as his bo-chap dressing when he first came to visit his
mother.
Today, he still had his
fashionable hairdo and spectacles but, he was in a business suit and he looked
very much like a son who had been fortunate enough to be his mother’s favoured
child and, the only son who came when we called and watched as his mother
fought for her life.
This time, it was only KG and myself
who did the ‘Last Office’.
Somehow, with all the excitement
going on, I managed to help the S/N write 2 reports and also thanks to KG and
PO, we managed to ensure the ward maintained some sense of stability.
This 2 episodes has pressed upon
me the urgency and need to really know how to do resuscitation during an
emergency and the type of drugs to use. You never know when you’re going to need to act fast and think quick. I can only now imagine what it is like in the A & E.
