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i could go on for 40 days and 40 nights about my blog title and bore you to bits and pieces with 10,000 different ideas i actually had for the name of this blog but because of the 500 characters limit that is imposed upon this mechanism which, by the way, is supposed to promote free speech, i shall shorten it to just two words basically describing what the hell this is all about and who this hell belongs to. |
Saturday, October 13, 2007
project 355: God may be your CEO, but i am the nurse struggling to take care of your dying father, so come help me
back in the days of nursing school, they used to teach us this concept called the Activities of Daily Living (ADLs). it's basically a measurement of sorts, used to assess how well a patient can function in day to day living. sure, it does touch a little on the social aspects like what one does for a living and one's sexual orientation and other fillers that help encompass the human as a whole. however, the main emphasis tends to focus on stuff revolving around one's ablutions and health problems. mobility, communication, elimination (as in peeing and shitting, not people; though i'm sure that most functioning people in society can name a few they would like to), sleeping, personal hygiene. these are just some of the factors that contribute to the general assessment of a person in the ADLs. i have to say though, the ADLs are a morbidly boring module that i have always skipped since my first year at nursing school. i mean, there's only so many interesting pointers you can discuss about one's defecation, micturition and mastication capabilities. besides, as with all other subjects in the Singaporean education system, the examination material would almost always be taken directly from the course notes. all you had to do was copy the missing information from some other more hardworking soul, make a rather uneducated guess, or just google the damn thing up. after all, how hard can it be, having to guess 'Purposes of Nursing Implementation' when the answer that has been left half-blank is 'To achieve desired __________' (the answer is outcomes or goals in case you're one of those making the uneducated guesses). truth be told, the ADLs play a major role in the nurse's job scope. to put it mildly, it is the yardstick that the registered nurse uses to assess whether a patient is for for discharge. to put it perversely, it is the noisy ten inch vibrating 'yardstick' that nurses use as a choice weapon against Team Doctors. you see, every morning when the doctors are making their rounds with the consultants, they start going on a trigger-happy discharging spree (more discharges = more empty beds = more incoming patients = more revenue generated for the hospital = more cash lining my pockets). a hernia case that's able to pee a considerable amount, produce a moderate sum in the shitter, ingest a moderate amount of food, has a wound that looks moderate enough - in the doctor's opinion, that's the perfect candidate for discharge. no wonder the General Practitioner's #1 health-care advice tends to be 'Moderation is the key to a healthy lifestyle'. of course, the doctors being the busy 'i-have-a-lot-of-patients-under-my-care' health-care professionals that they are, they tend to be rushing for time whenever they see a patient. upon seeing the doctors and the flustered look on their faces, the patients feel bad about telling the doctors any other problems that's bothering them. it could be something as simple as post-surgical pain and them needing one more day to recuperate. or the fact that they can't go home yet because there's no one to take care of them. or worse still, they haven't walked a single step post-op and the doctors don't even know it. whatever the reasons, the patients always end up telling the nurses their worries. and the nurses end up conveying the patient's request for an extension of stay to the doctors. i can't help but hear the dull 'plok' of the yardstick in my mind when it comes into contact with a doctor's head. -- it's ironic that the main focus of the ADLs: Dressing, Eating, Ambulating, Toileting, Hygiene, forms a mnemonic - Death. because when one is in close proximity to the end, that would be the time when one has problems with the ADLs. the ward recently had the bad luck of accepting a difficult 'overflow' oncology patient. 'overflow' meaning when the ward that's supposed to admit their department's patient is full, they flow over to other wards that have available beds. the patients will be temporarily lodged in the other wards till there are beds available in the original wards. i used to tell an awfully crude joke to whoever was willing to listen. it's loosely paraphrased from the Dawn of the Dead tagline: 'when the colorectal wards are full, their shit will overflow to us'. without having to reveal too much medical information, let's just say that there are issues at hand that make our working lives extremely difficult. in fact, these problem can be summarized in one simple word: The Relatives (okay, so that's two words). i'll be the first to attest to the bane of relatives in the ward. in my entire nursing career, i've seen the best and worst of Singaporeans. there are the fussy ones that want things done their way despite their methods being rather medically-incorrect (solution: teach them the right way, and then compromise a bit and do it 50% their way and 50% the right way). there are the 'knowledgeable' ones who derive their information from The Mayo Clinic and wikipedia (solution: show them your nursing diploma and rub it in their faces). irritating ones who have five different relatives asking for five updates at five different times within a single shift (solution: emphasize the concept of a main spokesperson and guilt them into a corner by looking very flustered and busy). and even more irritating ones the come with sixteen other relatives, five of them being children who run amok in the hospital corridors (solution: 'you kids keep up that running and i will call the policeman' and i will go to hell for this because i still call security all the same). combine all the above and you get this particular overflow patient's relatives. they don't trust the nurses. my other colleagues are always quarrelling with them. and prolly because they are so cynical and helpless and bored of sitting and staring at their loved one dying, they try their best to find fault with the nurses. the patient has total dependency on the staff to help with his ADLs. which i would be more than willing to help if not for the fact that each ADL-associated task will come attached with a stern-looking relative sitting on the armchair, watching you do your job. they refuse to partake in the changing of diapers. they refuse to tube feed their loved one despite the fact that they have done it at home for nearly half a year to come. and worse still, they constantly criticize the nurses and 'correct' their mistakes. i can tolerate back-breaking and single-handed work. i can tolerate all the name-calling. but for some reason, i simply can't take irony. one of the 'taskmaster' relatives who sits in the armchair has been reading a book named 'God is My CEO'. and well, you know how scorned i feel about Christianity and Christians and people who don't uphold the good name of the Lord. each time i change a diaper, 'God is My CEO' stares right back at me, mocking me. i can't help but feel ashamed of having been a Christian in the past. if this is the way Christians these days are turning out, then perhaps 'till kingdom come' is really coming. and this is the straw the breaks the camel's back. we can't transfer the patient back to the original oncology ward. namely because of his infectious disease issues. the patient has a history of MRSA sputum during the previous admission (which was only last month). during this admission, he has ?MRB sputum with two positive lab results so far). the oncology ward does not have enough isolation rooms to accommodate their patient. ditto that for the infectious disease ward. we've roped in the help of the supervisors. we've tried asking the doctors to personally book a bed for the patient. falling short of a letter to the Ministry of Health, we've tried every possible solution. well, it seems that the relatives and us nurses are gonna be stuck together for quite some time. ten days into the hospital stay and we're still fighting. perhaps it's time to focus 'plok-ing' away on these relatives' heads rather than the doctors. 7 Comments:
At least your "know-it-all" are relatives whom you can rub your diploma in. Don't tell anyone but when i see a whole village of relatives swarming the wards, I tend to run. Away. this post reminded me of a pt's daughter i came into contact with a few weeks back. i'm quite sure medical school doesn't teach the doctors how to send specimens and the different blood tubes to use.... celexter: and you know what's the winning concept of this 'doctors make mistakes' brouhaha? it's always the nurses' fault. the nurses never double-check the labelled specimen when they despatch it to the labs? so they get more pay and always have scapegoats. what's not to hate about the docs? Not all doctors are bad lah. I have two pathologists in the lab, and they are quite nice. Especially the Medical Director. And oh, our Consultant Pathologist is hunky sia. Greenland is a Dutch providence for a reason::::The Netherlands is the "piss" of the Scandanavian penis clue. Greenland's melting icepacks are going to innundate our coastal cities, further fulfilling this clue. <--Home |
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