The Learning Curve

When I was still orienting as a dialysis nurse, I encountered patients who were very supportive of my training. They allowed themselves to be stuck by me. Of course, little did they know that I am not a novice at all when it comes to sticking needles on patients. My training as an anesthesiologist makes me even more experienced than the one "teaching" me. But I do not advertise this fact. I was advised by people in the office that I should not tell my patients that I have a medical degree because they may start "consulting" me and I could be charged with practicing medicine. So I was very careful about this. It pleased me when patients thanked me after the session and told me that I did well.

When I was already doing dialysis on my own, it was a different story. I had to build my confidence along the way. There were good days when everything ran smoothly, from the machine to the treatment of the patient. And there were bad days.

I remembered one particular instance when I went into a patient's room, introduced myself in a nice way (I always try to be pleasant just to establish good rapport). The patient looked at me arrogantly and started asking questions. How long will his dialysis be, how much am I taking off him, how long have I been working as a dialysis nurse. Perhaps the biggest mistake I made was admitting that I have started dialysis just a couple of months ago. He started bossing me around, demanding I take off 6 liters from him despite my better judgment. When I stuck him with the needle, he started shouting that I was sticking his nerves and it was hurting. I got pissed off and raised my voice and said, "Hey, stop panicking. It's not like I just learned doing dialysis yesterday. I know what I am doing. I am not sticking your nerves. Look at that backflow of blood. Your nerves will not show that." He stopped and calmed down. But I was already hyped up and upset. I could stick needles to his neck if I want to, I thought. If looks could kill, he would have been dead by then because I was giving him dagger looks. I guess that must have scared him, despite his huge physique because he stopped talking and allowed me to do my work.

I usually talk to my patients and give them some sort of patient education while I do the dialysis, but with him, I just sat there quietly until the end of the treatment. You just know when a patient is too full of himself, it is useless to pour information to him. It will just overflow and spill out. Why waste my energy and saliva. Of course, he did not finish the treatment because he went into seizure after one hour. That was why he was admitted to the hospital. So I stopped his treatment and rescheduled him the next day. Those are the kind of days which leaves me unfulfilled as a dialysis nurse. But I learned my lesson.

The next day, when another patient asked me how long have I been doing dialysis, I merely answered, "Oh, long enough to be bored already." She merely laughed and I started giving her patient education.

Sometimes giving too much "information" can be detrimental to a patient's health and "sanity" because it makes them paranoid. Now, when patients ask me that question again, I look them in the eye and say with all honesty, "Almost a year now." And they leave me in peace to do my work.

When I encounter bossy patients who want to manage their own dialysis treatment and order me around, I merely bombard them with pathophysiologic basis of the treatment that I plan for them. The information overload is usually enough to gain their trust and cooperation. Now I've learned how to use information, i.e. when to give too much and too little according to patient's profile and needs.

Bias Against Immigrant Nurses

Spring is my favorite season. From the dreary, colorless environment, I found the different hues of green truly captivating. The sun which I usually took for granted while I was still living in a tropical country is now embraced with much enthusiasm. But Spring is not all blue skies and colorful flowers. The sunny weather is interspersed with rain and dark clouds. And that was how I have been the past months.

One moment I feel contented and happy, the next day, my heart is filled with dissatisfaction and angst. The negative emotion usually stems from long hours at work and the feeling of receiving unjust compensation for it. I think most new immigrant nurses feel this way. I have talked to a handful of Filipino nurses working in the hospital as ward/ICU nurses and my condition is not an isolated event. We sign a job offer in the Philippines with an hourly rate which is not reflective of the ones we receive when we start working. It is not usually divulged until when you start working already. By then, you have cut all ties from your previous "life", packed up your belongings and brought your family here. It leaves you with little choice but to endure the situation until your contract is fulfilled. The employer deducts the immigration expenses from your salary for the duration of your contract. So you will end up receiving a lower rate compared to your co-workers. Personally, I think this idea is garbage.

With the high turnover of nurses in the hospitals, having a nurse for two years should already help the hospital save in terms of training new nurses. In my company, I have seen new nurses get oriented and quit just after 3 months. Actually, in the 9 months that I have been employed, I have seen 10 nurses resign! Most of them did because of the crazy hours we work. If they could get me to stay for two years, they have already saved some money. That's why I could not get the rationale for paying an immigrant nurse lower salary compared to our counterparts. I just feel like cheap labor and I know I am doing a good job. There are some nurses under orientation who could not even get out of orientation. And that means expenditure again for the company. So whoever is sitting in the financial table is not getting his numbers right by treating immigrant nurses this way. Frankly when I came here, I had all the intentions to work as a dialysis nurse for the rest of my stay. But now, having experienced this bias, I have decided to do my time and get out of the job and find something else. And I know most immigrant nurses have been thinking along that line too. And it is such a waste because if only we were treated equally, we would have stuck with the position and done a great more good for the company.

For now, my daily prayer has been : Lord, grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference."

The Lord revealed His sentiments from Ezekiel 22:29, 31 - "The wealthy cheat and rob. They mistreat the poor and take advantage of foreigners. So I will turn my anger loose on them for what they have done." The Sovereign Lord has spoken.

An Immigrant's Woes

It's been a while since I last blogged in this site. The past few weeks have been very tiring both physically and emotionally.

When we decided to migrate here in the US, my husband and I made sure we were one in mind with our decision because we did not want to end up blaming the other should we experience hardships. Our Filipino friends who migrated were relating stories of that point in their first year in the US where they experienced the difficulty of adjusting which consequently put a strain in their relationship.

Our trial began when a couple of my co-workers started to resign from the acute dialysis team because of internal problems in the system which led to long hours of work and high job dissatisfaction. For them, it was easy to just hand in their resignation. For a migrant worker like me, you are bound to the contract that you signed. Besides, I really did not mind the internal rift going on. I simply did my work, went home and enjoyed my family.

But things started to go bad for me when I learned that a few more people handed in their resignation and we ended up working 17-18 hours a day because we were so short-staffed already. The management in turn had to hire new people for orientation to address the problem. Then I learned that I was being paid way lower than an orientee. I was burning out so fast and my morale was taking the deep plunge. I became very short-tempered at home. My kids were complaining that they hardly see me anymore. My husband had to listen to my constant complaints at work, my bodily aches and pain and whatever there was to complain about. Then I found my hope. I could transfer to a chronic facility without actually breaching my contract so I tried to arrange for this transfer to take place. Things became more frustrating when my request for transfer was delayed and a revamp of the acute dialysis program was implemented. The winter weather proved to be more of a foe than an ally as I fought to conquer the depressing state I was in. I felt I was plunged in a world of darkness where my only comfort was my husband's listening ear and understanding embrace and the peace I felt whenever I cried out in frustration to God in prayer.

Then one night, when I was once again on my endless tirrade of complaints, my husband told me to remember the time when we first arrived. He reminded me how grateful we were about all the blessings. He reminded me of all the graces we received these past few months. And I stopped and remembered. Just like that. I remembered. Then the darkness was overcome by light. All my resentment evaporated. I ceased to feel abused, exploited and victimized. God made me see that whatever they are doing to me, they are only able to do because God allowed them to. God is still in control of the situation. And I realized that this was precisely how Jesus thought of His passion and death. He went through the pain without grudge, knowing that justice and mercy will be served in the end. That realization was pure grace for me... and salvation at that instant.

Now I can talk about it, write about it and still feel peace. Because I know that God is in control. And everything has a reason and a purpose. And for some miracle, the moment I accepted the trial with an open heart and mind, things started to become better. Travel nurses were hired to replace the ones who left. Patient census dwindled that I did not have to work longer than 14 hours anymore. My kids are happier, my family is more at peace as well. And as though on cue, the winter weather lifted up to welcome the smell of spring. The sun is shining and the snow has melted. In three days, daylight saving time begins and spring will soon be here. Hopefully, by then, my situation will improve some more. I have a strong feeling it will.

Learning in a Technology-Advanced Society

As a US migrant nurse, there are a lot of things that I had to adjust to. Although I already practiced in a hospital which boasts of being hi-tech and fully equipped with state of the arts facilities, it was still different when I came here.

All nurses in the floors and ICUs have computer monitors which they just push and pull around as they do their rounds. Charting is done through this monitor. When they give medications, they scan patient's wristbands which has a barcode on it and then scans the medicine to ascertain that the right drug is given to the right patient at the right dose, time and route. I had to attend a one-day course, learning a computer software which one of the hospitals used.

As for the medicines that we give to patients, I had to get my fingerprint into the computer system called Pyxis so I can have access to the drugs. The process goes this way: the doctor writes down the order, the nurse scans the order sheet to the pharmacy, the pharmacist checks on the order to make sure that the patient is getting the right dose and has no medicine which interacts with the new drug as well as no history of allergy for that particular ordered drug. The drug is then encoded into the patient's computerized record so that it is made accessible in the system. There are drug stations for each unit which they call Pyxis. I automatically charges these medicines to the patient as soon as I get the medicines out of the Pyxis using a username and my fingerprint as "password".

There is also one hospital which is more advanced than the rest. The medical supplies are located in a central supply room in each floor. To gain access to the room, you need an ID badge which you swipe into this machine by the door. Inside the room, there is a scanner which you use to scan into the buttons which represents patient's rooms so it gets charged to the right patient, then you scan the buttons on the boxes containing the supplies which you will be using for the patient.

Sending blood specimen to the lab is just as fast. We just put the test tubes in a canister which we dock inside a pod. We press the key (e.g. LAB) where we want the specimen sent. This goes through the wall and we call it "tubing the specimen down to the lab". One hospital would also tube blood packs for transfusion using this system as well. Request for blood therefore takes only a couple of minutes. Laboratory results are also out in the computer system within an hour.

Another thing that I noticed also is that all nurses have their own hospital phones. When I needed to endorse back the patient to the unit, I simply call the unit secretary and she connects me to the phone of the nurse who is in charge of the patient. Sometimes, the nurse would leave her phone number so I could call her directly.

There are a lot of other gadgets which I had to orient myself with, because I never got to handle these in my own country. A basic one would be figuring out how to operate a bed with all its many features and functions. It had to be demonstrated to us. And all these technological advancements are supposed to provide better quality of care to the patients.

But one thing which I am really thankful about, amidst all these technological confusions and challenges is that people here make you feel that it is alright to be a little ignorant, it is alright to ask, it is alright to admit that you do not know. And that makes a lot of difference in my adjustment as a technologically-challenged nurse. Without judgment, I was accepted and understood.

And rarely do I see patients look down on a new nurse. They were encouraging. I even had one patient apologizing to me because I had difficulty sticking a needle on her. She said she was sorry for making my job difficult, as though it was her fault! And when I finished doing the dialysis, she was very generous with her words of appreciation. Then I realize that when it comes to showing appreciation, I was stingy. I am more vocal about criticism rather than appreciation. And so I came to learn to verbalize words of gratitude as well. I learned to be more generous with kind words. I then realized that I have improved my quality of care to my patients not so much from the technology that was available to me, but more from the kindness and appreciation that I learned from them.

Winter Running

I looked out and saw the sun shining. It seemed like a nice and warm day but I know looks can be deceiving because I saw from the SUV's thermostat that the temperature outside is 27F. I won't even bother converting it to Celsius because I know that it is going to give me a negative number. And any negative number multiplied to a positive number will still give you a negative result. If you belong to my generation, you would have remembered that TV jingle "subtract 32 from degrees Fahrenheit, the result keep it in mind. When you multiply that by 5 over 9 and you'll get Celsius just fine".

I promised myself that I will not let the winter season keep me from running. I've been thinking of going to the clubhouse to try that treadmill but I never got to doing it. Now, my brother-in-law and my husband decided to run and I thought, why not join them? It's gonna be my first time to run this season. It will surely be something to write about.

I donned four layers of shirt and three layers of pants. These should keep me warm. As I stepped out of the SUV, I smiled and looked at the vast expanse of white snow before me. I covered my nose and face with a scarf to keep the the air that I breathe in warm. I am very prone to hyperreactive airway and could not stop coughing if cold air gets into my airways. I wanted to keep a slow, steady pace so I was prepared to run alone as my husband and brother-in-law also wanted to run their own paces. After 1 mile, my Running Mate was already beside me. I guess that is the value of running in solitude and that is why I do not mind running alone anymore.

I had a huge prayer intention and I discussed it with Him. In the past, I would usually offer my sufferings and sacrifices for my petitions but now I cringe at the thought of it. This was a huge one and I fear that I may have to suffer and sacrifice a great deal just to have this prayer answered. But He shook His head and told me. "I do not need your sacrifice and sufferings. I need your acts of love. And you know what I mean."

I sighed with great relief. For I saw what He meant. The memory came rushing back like a movie rerun.

It happened two days ago, when I was giving dialysis to a difficult patient. I am usually kind and smiling to my patients, wanting to make the few hours I spend with them a very pleasant experience. But this time, it was difficult to put a smile on my face. And so I just performed my task without looking at him. He was just a patient and I was just a nurse doing my job in a functional manner. Then suddenly I stopped and looked at his face. I "saw"Jesus looking back at me on the bed, getting the dialysis. My heart softened. Now, this Man I know and I care about, this Man I can show great kindness and warm regard. And I did, without much effort. At the end of the dialysis session, when I looked at the man again and saw the patient and not Jesus anymore, he was a transformed man. His attitude towards me changed. I saw gratitude. It was a lesson taught by the Great Teacher. He taught me the easiest way to perform acts of love especially when I feel so unloving. And this is just what He is asking of me in order for Him to work on my petition... perform acts of love.

The thing about God is that He wants us to participate in His works. That is why some prayers are answered fast and some are not because some people are more willing to participate while others are more passive.

As I made my turn on the way back to the car, I passed by the huge tree which used to be clad in colorful hues of autumn. Now it was bare and naked. When you are running in solitude, it can be pretty natural to talk with nature also. So I greeted the tree (of course, just in mind) which still stood tall despite its dreary appearance. "Hi, Mr. tree. Don't worry, you will soon have your leaves back and I am looking forward to seeing your beauty again in a different form come Springtime."

Seasons change. Nothing remains the same forever. There are times when we have to shed some of our leaves, give up some things, let go of some people in our lives only to make room for new growth, new colors, new beginnings. We can easily adapt to changes if we open ourselves to it. I left the SUV and started my run clad on my blue fleece jacket with the mask on my mouth and nose. I ended my run with my fleece jacket knotted on my waist and my mask on my neck. I was breathing cold air without difficulty. I completed my 8km (5 miles) in subzero temperature. I have crossed that mysterious zone of winter running. I have discovered a new way of praying through acts of love.

Then I realized that there is still so much more to be discovered. There is still so much more that my Running Mate can teach me. I only have to run out and open myself to it, abandon my fears and embrace His ways.

Winter Adventure and Misadventure

My day started at 5:00am when the alarm clock rang. I was on duty today. I have showered the evening before so I just brushed my hair and dressed up in my 2 layers of thermal clothes before donning on my scrub suits. Breakfast for today: just coffee and Nutella sandwich. While munching on my meal, I boiled some water to cook noodles for the kids. At exactly 5:30 am the phone rang. Who could be calling this early? It was an automated phone message from the principal of the school of my 4-year-old daughter announcing that the school will be closed today due to severe weather conditions. Shortly thereafter, I received another call from the principal of my 9-year-old daughter. Another automated phone message announcing the same thing. So much for the warm breakfast noodles. Who knows what time the kids will wake up?

My husband turned on the TV to the weather channel. A snow storm will hit the city by noon according to the meteorologist. I hurriedly kissed him goodbye. Better to have an early start if I wanted to be home by noon. There was no trace of snow on my drive to the hospital but by 9am, it started to fall. I only had one patient to dialyze for the day and no add-on. By 1 pm I had already finished cleaning up and was leaving the hospital complex. When I opened my car door, I was wondering why there was a cover on my windshield. I then realized it was all covered with snow. For the first time I took hold of the brush scraper and started brushing off the snow. It was soft and feather light. I looked around and seeing that no one was around, I grabbed a handful and tasted it. It just melted in my mouth like some kind of cotton candy!

As I drove home, I made sure I was way below the speed limit. I was driving only at 40 miles per hour for the speed limit of 55. All the other cars were doing the same. I saw one car, not an uncommon sight, parked on the shoulder of the road... another casualty of the weather. I had my first taste of snow driving a day before and though it was really scary because I could not see the marks on the road, I was able to survive it without any accident.

Now, I felt the road was less dangerous because I was driving in broad daylight compared the other day. Then as I was approaching the stoplight some 500 meters ahead, it suddenly turned to yellow. Remembering my husband's advice to pump on the brakes a couple of times and not hit it hard all at one time, I did as instructed. I carefully pump on the brake. To my surprise, I felt the front wheel skidding to the left and my rearwheel skidding to the right. I released the brake immediately and turned the steering wheel to the right. Then I pumped on the brake lightly again, seeing the red traffic light looming ahead. The front wheel was now skidding to the right and the rearwheel to the left. Instinctively, I turned the wheel to the left now as adrenaline was rushing to my head. I felt myself zigzagging and was not sure if I could really make it just before the intersection. I was now holding my breath saying my prayers real hard. Just as I saw the barely visible line demarcating where to stop, I pumped on the brakes again and to my huge relief, the SUV just halted just at the margin of the line. I looked to my left. Fortunately there was no car on the middle lane. When I looked at the right, the red car behind me skidded to the shoulder and went through the intersection despite the red light. I was shocked. He could have hitted me from behind! I was still wide-eyed from shock as I fumbled for my cellphone and called my husband. I just needed to talk to someone. "I skidded! I skidded!"

I was glad I had my bluetooth on so I was able to talk to him, debriefing myself from that "near-miss" as I drove the rest of the slippery road going home. I was now just going at 20-3o miles per hour. Then the tricky downslope came to my sight. There was a truck to my left and a couple of cars in front and behind me. I could not skid again this time or surely it will be a huge accident for all of us. As I descended slowly, I felt my car gaining momentum. He adviced me to use the manual control to shift to a lower gear. I did and then I slowly half-stepped on the brake dreading to feel the wheels skidding again. It did not. I survived the downhill alive! Finally, I arrived home and saw a couple of kids sledding on the hilly part of the compound.

I was definitely shaken badly by the driving experience that I took on the kids' invitation to play in the snow. After eating lunch, we all dressed up warmly and headed to the backyard and played to our hearts' delight. We made snow angels and threw snow balls. But the best part of it all was just lying on our backs, looking at the snowflakes falling from the white sky and catching it with our tongue. There on the soft bed of cool snow, I felt safe and embraced by God.

My Halftime

I guess the cat is out of the bag now. I wanted to become a full-pledged writer as much as my husband wants to become a full-pledged photographer. And we are both working our way towards that dream.... towards that goal. I've read that the difference between a dream and a goal is the time factor. You set a time when you will achieve a goal whereas the dream has an indefinite time as to when or if this will ever happen. We both started with our dreams but we did not stop there. We prayed about that dream everyday. And God who blesses dreams turned fantasy into reality. Because for God there is nothing impossible.

I read this book From Success to Significance by Lloyd Reeb and it described people who have lived the first half of their lives. They were financially successful but felt their lives were lacking in meaning. They were not answering to the call within. There is that sense of emptiness or that sense of restlessness, wherein you know that there is something more that you ought to be doing but are not doing right now. That was what struck me and Alvin these past two years.

Anyway, this book created a roadmap for me. It asked all the essential questions that I needed to answer for myself. My husband and I have lived the first half of our lives and we are now into the second half. It may seem too early for some that we have retired as doctors. But we have our dreams which has now started to transform into goals. And we simply needed to follow the call of our hearts, in pursuit of significance rather than success. Some people would be struck by this in their 40s or even in their 50s. I have an uncanny notion that this might be part of the midlife crisis phenomenon. However, whereas the midlife crisis would be viewed in a more negative way, this halftime tends to look at this phenomenon of "midlife crisis" in a very positive way because it gives you the time to pause, look back at your life and how you have lived it in the past and look towards the future with a sense of purpose.

Now, I am reading the ebook "48 Days to the Work You Love" and this even further puts into detail the structures that I need to achieve my goals. It helped me see all the different aspects of my life that are most essential and needed to be balanced. Work, family, financial, physical, intellectual, emotional and spiritual.

For those who are really serious about living their dreams, Bo Sanchez's Five Year Life Dreams Success Journal might be able to help in making a Personal Mission Statement. This is just a booklet or a journal of sorts where you will be asked to write down your personal mission statement and the goals for each of these aspects. There are simple questions that you need to answer. If you want a more in depth way of looking into your life's mission, then The Path by Laurie Beth Jones would be the right book for you. This may sound tedious for some, but for me, it's worth all the time and effort because it's where my dreams started to become goals and then slowly transformed into realities. And unless you really put conviction and determination in living your dreams, these dreams will only remain as dreams and you will continue asking yourself why some people are living their dreams and why you are not. It only takes one step to do that... and that is the most crucial step.... to say yes to that dream. Write it down and put a time factor when you wanted it achieved. Then start with your objectives, your mini-goals... which you can achieve in a short period of time. The year 2009 is about to end. This is the perfect time to be looking back to the years that have passed, to plan ahead and to move forward into living your dreams.

As for me, I am reviewing my Life Dreams Success Journal for 2009, checking the goals that I have met for 2009, reflecting on the ones that I have not achieved, redefining my goals for 2010 and finally, the most essential factor is offering my plans to God. Because He respects our free will and will not impose His will on us, this act of offering keeps the door open for Him to intervene in my life, revise some of my plans to create a better one, and even steer it to a completely different and more exciting direction. Then I can truly live my second half as He deemed it to be.