Aged Care Posting

When I first saw  Mdm K, I realised, like Ah Gong (my grandfather), she had many bruises and skin breakdown on both her arms, in varying colours too! (ranging from red to different shades of purple). She looked old and frail. 

I thought she was demented because when I asked her for her name, she told me a four-syllabus name. However, I couldn't make out the exact words and spelling of what she said but I thought it was a Japanese name and since she could really be a Japanese or demented, I thought she was the latter. Moreover, she told me her age was 35 when she obviously looked much older than that.

I realised my mistake when I turned around to look at the place and saw that the name outside Room 1 was exactly what she told me! Omg! I totally didn't expect that! First, she was still lucid enough to remember her name and second, I just assumed she wasn't and that a four-syllabus name could only be a Japanese!

I have a "natural inclination" to sayang the elderly especially when they have bruises on their arms and thus, I kept sayang-ing her while talking to her. I tried feeding her lunch too but she insisted on feeding herself with no assistance needed. Afraid that she would drop her food while bringing it from her plate to her mouth, like most elderly with dementia, I tried to use her plate to follow her spoon but she became irritated after that. She scolded me for grabbing her plate and for explaining to her my reasons. Lol. She insisted that she would not drip her food and refused to let me feed her or hold her plate. Elderly can be so stubborn. She even said I was "kpo". Haha. So fierce.

After I read her case notes, I learnt two important points about her. 1) her  2 sons "disowned" her 2) she had scabies =.= the first fact was saddening especially as it was written that she still misses one of them (if she forgets then at least it is less painful for her) the second fact was =.= omg! I just sayang-ed her everywhere sia. And how does scabies spread? Via direct contact. There are no difference whether you're a healthy young girl or a frail old lady with weaker immune system. Shit! This means my stronger immune system could not even protect me! Omg!!! I became sian after that. I should have read the case notes before touching any patient. However, the only consolation was that if she really had active scabies, the staff won't touch her too, without protecting themselves and they would inform us about her. The fact that they don't and the fact that the last report about her having scabies was in September this year probably meant that she was cured (?). I was still unconvinced and quite sian about touching or even going too near her.

The next day though, I still couldn't resist myself and kept going to her. This time round, I tried to keep my hands to myself and really did touch her LESS (instead of totally not touching her like what I should actually be doing=.=). I even told myself numerous times that if I get scabies, it's ooo..kkk.. la. If I do get it, I get it lo. Bo bian. She's worth it.

Sometimes, she felt so itchy that she asked the nurses to take out the board (in front of her chair) so that she could scratch herself properly. Of course, that wasn't attended to at all. Personally, I feel that the nurses there are quite free sometimes and they can actually just take out the board, sit with the residents and ensure that they do not fall out of their chair. However, I don't think they would ever be so nice to do this. Once, she signaled to me to help her remove the board; I explained my reasons for not being able to do so and she signaled Hui Ping to help her. When Hui Ping didn't understand her, she turned to the nurses who just brushed her aside and eventually, the resident beside her to ask for help! Sadly, that resident is slightly mentally unstable and didn't even respond to her. I think it's very sad that these people, having to live there for long periods of time, only talk to the nurses (who cannot even speak their tongue) rather than make friends with their neighbours. Just picture an old lady feeling itchy all over and failing to get help to allow her to scratch herself and relieve her itchiness. She must be feeling so terrible.. Haiz.. I tried to soothe her by talking and hoping to distracting her but to little success. I even wore gloves and helped her apply moisturizer. She also asked me to help her scratch. Lol.

I liked this lady so much that I actually went to re-read her case notes again and again to find out more about her. I specifically read the part about her skin condition because I could not bear to see her keep scratching herself and complaining about being itchy..</3 I wanted to find out what condition did she suffer from to give her so much pain (I didn't manage to figure that out). However, to my relief, I found out that she was cleared of scabies during her last dermatitis appointment! I was so happy! Mainly because I could now sayang her without fears! It is her other skin conditions (and the post-scabies) that are making her feel itchy. I feel so heart-pained for her. Poor lady.

After that, I became more willing to touch her again! I helped scratch her lightly when she complained of itchiness. She even told me not to do so because helping her scratch is dirty! Omg! Didn't expect that. Haha. I continued this on my third and last day there. I even sayang-ed her head and watched her sleep on the last day. I kind of hope all these elderly whom we interacted with would not remember us because they would then keep hoping that someone else would talk to them (?). They would then miss having us around to talk to them (?). *sigh*

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Paedatrics Posting

Even before I met H, I had already heard about him. My friends were "complaining" about him, saying he had a "bad record" with the other patients and their parents. His misdeeds were also recorded in his case notes. I also heard him using swear words freely. Though this is common, to hear it coming from a 12 year old is really quite shocking for me.

Thus, when he came over to my cubicle to find my patient, I was not too happy about it. Even when he tried to interact with me by asking me to play cards with him, I would find excuses to reject him. As I felt guilty, I agreed to play with him eventually. However, throughout the game, I was uneasy as he kept using swear words AND asking my patient to do the same. He even scolded other patients who were in the play area as well. I tried my best to steer clear of him and also hoped that he would leave my patients alone. I know I was wrong to be prejudiced against him and this is not how a nurse should behave.

Later, I found out that he is actually quite pitiful. His mother was non-existent and his father beat him frequently. This was what caused him to be hospitalized in the first place. I also heard his aunt intended to bring him overseas after he was discharged.

On my last day there, I realized that I actually cared about what happened to him. We would definitely never meet again but I hoped he would (and I told him this too) take care of himself. If no one cares for him, then all the more he should treat himself better and stay away from the "bad side"...

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Rehabilitation Posting II

When I first fed a real patient via a nasogastric tube (NGT), I was feeling a little nervous and I even dropped one of the connecting tubes right at the start! It was quite embarrassing especially with a nurse staring at a clumsy me. Other times during lab practices, I "fed" at most 50ml of plain water. However, this time round, I had to feed 200ml of thicker fluid which flowed much much slower. Thus, the entire process was quite draggy. I lost concentration and as a result, forgot to kink the tube immediately when needed. Luckily, the enrolled nurse (EN) and a fellow nursing student saw it and alerted me! Thankfully, Mr K., my patient, did not cough and appeared fine/ normal. I made a mental note never to lose focus on my task at hand again.

The second time I fed Mr K., I was constantly reminding myself to remember to kink the tube. This time, with the experience of my first NGT feeding, everything was much better and the process was smoother-- I did not drop anything and I kept my eyes constantly on Mr K., his tube and my equipment.

I learnt that besides aspiration of fluid from the NGT to test for its acidity, there are two other methods of testing the placement of the tube. They are auscultation, the pumping of air into the tube and hearing its sound in the stomach and putting the tube into a cup of water to check for presence of any air bubbles, which may mean that the tube is displaced into the lungs. However, the best method to check for tube placement is to send patient for an X-ray. Having said that though, it is not feasible to send patient for an X-ray everytime the patient is about to be fed as there are not only manpower and costs issues, exposing patient to constant radiation, no matter how low, is harmful for the patient too. Thus, the most practical and reliable method is the aspiration method.

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Obstetrics Posting

This is my most awaited posting! I love to interact with pregnant women who are anxiously waiting for the birth of their precious babies, new mothers and families who are basking in the joy of the arrival of the newborns and finally, BABIES!

However, on my first day in the obstetrics ward, what greeted my friends and I was a dismal sight. All the curtains were screened and the different patients were keeping to themselves. They certainly did not look welcoming and friendly, unlike the patients in my other postings. All my anticipation and looking forward towards this posting were dashed.

Over the next few days though, I realized drawn curtains did not mean unfriendly. It just meant that these tired women were exhausted either by their active foetus or by their crying newborns. Another reason was that many women breastfeed their babies and thus, it was more convenient to just leave the curtains drawn rather than screening and unscreening them every 2-3 hours. They were actually quite friendly and happy to share their joy with us; when they delivered, how many children they had, how pretty and handsome their newborn was, how well their child suckled when they breastfed or how much trouble they had when trying to breastfeed etc. Almost all of the mothers were very open too! They allowed us (the students) to be there with them while the breastfeeding nurse taught them breastfeeding. Without their generosity and open minds, we would not have been able to observe breastfeeding live and had to rely on watching videos. Watching the mothers breastfeed their child made me feel that breastfeeding is a natural and beautiful bonding process. THANK YOU to all the mothers who made me realize this!

The posting soon came to an end. Despite what my fellow students said about this obstetrics posting being a boring posting (as we did not have much opportunities to perform obstetrics-related skills), I felt happy and grateful for this posting. This is because I get to observe and learn stuffs too! *happy*

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Rehabilitation Posting

In this first ever posting of mine, I met the ever jovial Mr A, who had been hospitalized for quite some time already, due to a fall. As a result of that fall, Mr A had been in ICU (intensive care unit) for about a month and was recently discharged to this community hospital. He suffered a spinal injury and now only has movement neck up and some limited movement with his left finger, as a result of countless physiotherapy. Needless to say, all his ADLs (activities of daily living) had to be taken care of by the nurses and us, student nurses.

Yet, Mr A not only did not despair, he still has a positive outlook on life. One would expect someone in Mr A's condition to be sulking and withdrawn but Mr A was the exact opposite. He was very glad to still be alive and to be with his family. He taught us how to not focus on the small, unhappy details in life but to celebrate the living and be more forgiving. Every time if we had nothing to do, all we had to do was to look for Mr A and he would gladly entertain and cheer us when we should be the ones making his day. Even when I was not there, I would always hear laughter coming from his cubicle as he talked to his new friends (the other patients there) about the day's events. His wife would also come daily with homemade soups and food. Though I know this must be very tiring on her; having to look after their children, work and come visit Mr A everyday without fail, she never once complained or even sighed in front of us but supported her husband through this all. How noble love is..

Anyway, kudos to Mr A. Though it has been more than one year ago, I would never forget Mr A if I ever needed hope (?). I wish him success in his physiotherapy.

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Medical-Surgical Posting (Ortho)

My impression of Mdm C was that she is a soft-spoken lady who cannot really express herself clearly. Every time when other nurses and I found her sliding or sleeping slanted, we would just inform her that we will be shifting her to an upright position and we would just shift her, sometimes even without waiting for her response, which would generally be lagged and inaudible.

Today, I was tasked with feeding Mdm C--our first "real" interaction. Throughout the whole process, she kept sliding to one side and kept her eyes closed. I thought she was just like one of the less responsive patients I sometimes see. Therefore, I did not even try to make small talk with her but just asked her to open her mouth when she stopped chewing and swallowing (ie. when she had already finished all the food in her mouth). However, from time to time, I would have to stop feeding just to drag and/or push her upright. Thus, the whole feeding process took up quite some time and became very draggy.

However, another student nurse who had been interacting with her for the past week came and talked to her. She asked Mdm C why she was eating with her eyes closed. Mdm C immediately responded by opening her eyes and smiled sheepishly! Furthermore, when that nurse asked her to sit up straight, she also responded and pushed herself upright! Oh my god! She is responsive! Had I known that or even try to talk to her in the first place, I could have saved myself all the trouble of dragging her upright by myself and that the both of us could have had a more enjoyable feeding time!

Moral of the story: Do not assume! I should talk to my patients instead of just focusing on my task. When I do that, I may just save myself some trouble and may even make my patients happier.

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Psychiatric Posting

Just as teachers would not approach students like me – quiet, do my own stuffs and never get into trouble, Mr W is someone whom I would never approach during this attachment had it not been for my clinical instructor, Mr A, who had requested an interview from him on my behalf, as part of my attachment requirements. He was a quiet person, never saying much to my questions besides the very basic. I guessed he may even be having trouble with sitting down with me and answering my endless questions. Nevertheless, he sat through the interview and did his best though he left abruptly after my interview, without even telling me.

Throughout my attachment, I tried to interact with him, firstly due to the need to write my report about his progress and gradually, just to talk to him, hoping to make his day less boring. However, not all days were smooth sailing. When he was in a good mood and not mentally disturbed, he would be able to play a few games of checkers and/or English chess. On the other hand, when his condition (schizophrenia) “striked”, mostly after dinner every day, he would feel the need to hum and pace up and down the whole ward for more than a few times. In this case, our interaction would be disrupted. Someone explained that humming may just be to block out the internal clatter (auditory hallucinations) -- Mr W's coping mechanism.

Throughout the attachment, I feel that Mr W has the potential to get well especially if his symptom of humming could be controlled. On his good days, he was willingly to play more than just a game of checkers only and answer with words, instead of sounds.

On the last day of my attachment however, his condition was bothering him and interfering with our interaction and thus, I didn’t have a chance to introduce new chess mates to him as planned (I had hoped to introduce one or two chess mates to him so that he could play and interact with more people and hone his social skills). Though all the patients in the ward would have known that day was our last day there, I still wanted to tell him personally that it was my last day and that I would not be there to disturb him anymore even if he wanted. However, I kept dragging having to tell him because I thought we would still have a lot of time for that later. I should have known that there isn’t much time actually because normally most of the patients would have been asleep by 8+pm. Mr W was no exception. He was already sleeping when I finally wanted to bade him goodbye for the last time. I wanted to leave without saying goodbye but after some internal reflection and debate, I realized I would not be able to live with not saying goodbye for at least a few days. Thus, wanting a proper closure, I went to wake him up and told him. He was half-asleep and I finally left with the feeling of not knowing whether he would wake up tomorrow thinking it was all a dream or whether he would even remember it at all.Oh well, I sincerely wish him all the best in reintegrating into our society.

Well, take-away point here is that never to leave things, especially leaving things unspoken, till the last minute because you never know how much time you are left with..?

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