WARNING!

Reader discretion is advised

The following entry is a no-holds barred record of the incident that took place on sat. I will in no way be held accountable for any premature alopecia, cardiovascular compromise or the significant alterations in proposed normal psychological behavior in the individual that follow, during and/or after the course of reading this entry.

Don't even bother to leave a comment. It doesn't matter what you think. I seriously don't give a damn.

You have been warned.

*************************************

We attended the inter-poly debates competition today. Fara and I had scooted off to town earlier in the week to purchase black jackets (at dear old G2000) simply because of the horrid nature of the supplied school blazer (That ugly, ill fitting thing reached my knees!)

In all senses, I would not want to be caught dead wearing an atrocity like that. Trust me, Calvin Klein would have spewed blood. Lagerfield would have suffered a stroke. And Versace? Well, he would be rolling in his grave.

But enough of that, back to my story.

The competition was supposed to allow us to interact with students from other institutions. The key word here would be : SUPPOSED (insert the green alien's OOooos and Ahhhhs here). It never happened. Teams pretty much kept to themselves and some, well, they came with such an elitist ideation, the thought of interactions with mere mortals like us digusted them.

We managed to win the first round easily. The second round, my teammate, Terrence had to endure some personal attacks from 2 members of the opposing team (namely, Gay Boy and Squirrel-loves-to-hide-my-walnuts Phua Chee Bye). And I didn't understand the motion well, so matter wise, I had nothing much to say. However, my team still managed to win (bless Alex's matter loaded soul and Terry's analytical skills), and because the other team did poorly.

The 3rd round saw us meeting Poly from the east side. And you know what? Their whole freaking damn bloody team (supporters and coach included - a classical example of how an apple doesn't fall very far from the tree) were such bastards. Yes, I'm including all the people present in the room here. And for the record : THEY ARE BASTARDS AND MORONS.

In a desperate attempt to win (they were on a losing streak), they used underhanded tactics, chose to forgo any form of decorum and placed personal attacks in top priority. And it got me pissed. Really pissed. Really, seriously, beyond a doubt pissed.

And everyone knows. It would not be a pretty sight.

I concede to the fact that my team did not have enough knowledge on the topic chosen. But we fought as best we could. However, turning a blind eye on basic decorum, the opposing team and their lackeys shouted in jest and banged on the tables when their team members spoke. I never denied the importance of support from the floor in competitions like this. In fact I understand the importance. But when my first speaker went up, they jeered and spat nasty, sarcastic comments - this was unneccessary. And made a circus out of the whole deal.

That in itself threw a spotlight on their lack of sportsmanship.

When it was my turn, they tried to derail me through my speech by POI-ing me incessantly and the floor threw nasty comments aloud. I held my ground. There was this bastard in the audience who stared at me and purposely laughed loudly, intending to create a diversion or break my confidence. FUCKER.

Burning with irritation, I took a brief moment to stare at the black bastard (i did not bother to engage in small talk to dig out his name - for the simple fact that he was too dirty) in the foreground to shut his faggot mouth and put him in place. He got the hint and slithered back to the hole he crawled out from. Apparently, I have eye power. Haha.You don't look so haughty now do you? LAME BASTARD.

Their debate team was no better either. Their speakers, in particular, the lame 2nd (chee bye face), started her POI with some stupid sarcastic remark, further igniting my fury. And for the record : YES, I HAD TO SHUT HER UP, pointing to the fact that her opportunity of question was wasted due to her stupidity in wasting time.

Piss-o-meter rating : on a scale of 1 - 10, they had upped the bar to 2000.

I was told that chee bye face also had a habit of undressing through the course of the debate. First, she removed her jacket. Then she unbuttoned her shirt. Next, she took off her shoes. Zul was praying that the whole debate would extend so she could strip naked and turn this whole circus into an all out, true blue strip club.

Their 3rd speaker, Mr I'm-so-blatantly-itching-for-anal-penetration, was too female for words. I too made my displeasure known by my "Throw-an-evil-eye campiagn". He also chose to tuck his dick (well, if you can even consider his taugeh sized prick that) inbetween his tighs.

Thankfully, I was brought up in civilized domestic environment, which clearly translates into : I VALUE SPORTSMANSHIP, and didn't see the necessity to stoop to their level.

It was good that these measures (of eye power and highlighting their underhanded personal attacks) managed to instill some calm to the floor. In the end, I was able to push forth some matter into the debate.

Fara said I appeared calm, passionate even, although I can assure you, it wasn't passion. I was possessed, which i hope was more alike to Joey then Adrian. My teammates said they were proud of me.

Thanks for the support guys.

We lost that round. Just as Jose predicted after he debriefed us. He commended us for our efforts and threw in strategies and matter to enlighten us. Prop won because we allowed them to get away with a vague description of their policy and definition of the terms identified.

It is a lesson learnt. This will not be repeated.

So in the end, we won 2 out of 3 debates. Wed would be the last round of the prelims. 1 last match to go. My team hopes to break into the semis, though I hope my team won't clash with the other representative from our school. It would be such a deja vu.

What is the moral of the story?
1. Ruffle my feathers, get a story.
2. Seriously anger me, get a story with your name in print.
3. This particular east-side institution's Debate club members and their coach are SICK BASTARDS AND MORONS in need of an emergency revamp in etiquette.

If you would, by any chance, like to epxress comment, even though i have explicitly cited my stance, you stubborn people can email them to : cheryldoesntgiveafuck@gmail.com
See if i care.

With such persuasive arguments highlighted to you in the abovementioned summary of this day's events, THIS MOTION MUST STAND.

I'm not particularly proud of myself today.

On my way home from debate, I met a man sitting near the edge of the sidewalk at the bus stop. He wore a scruffy looking tee shirt and plain shorts. He also had a bag hung over his neck, much like how one would wear a necklace.

Him sitting near the edge of the sidewalk with all the buses whizzing by, unnerved me.

In a single glance, I had already formed a preconceived motion that he had to be a beggar.

"Must be sent by those syndicates to cash in on the Christmas season," I reasoned.

On a second look, I noticed a huge cyst wrapping his right ankle. And within 2 minutes of seeing this man, I had condemned him to be a cheat, playing upon the sympathy of good natured bypassers.

Some people chose to ignore his presence.
Others cast sideway glances and whispered fervently to their friends.

I could not take my eyes off him.

I witnessed the people jump over him.
I saw them walk around him.
I watched as the world, so busy, disregarded him.

A lady came by. I mentioned to a friend that I liked the white bag she was carrying. I thought she would go up to him to offer him some change. Instead, she squinted at the bus guide found next to him.

The man gazed up at her as she read the bus guide and rubbed her tummy.

Not very long after, he started to move, dragging his limp lower body with his arms over the pavement. I could almost feel the harsh ground cut into my own flesh, as he inched his way towards the bus.

I saw the same woman scurry up the bus. And the man followed suit.

I observed him drag himself up the steps of the bus.
I stared as he raised his arm to plop in the coins for the bus fare.
I looked on as the bus driver leaned over the side to watch the man drag himself further into the bus.

"Is he following that woman?!" I panicked.

Suddenly, I realized how unfairly I had stereotyped this man.

What wrong had he done?

Nothing.

What did he do to deserve such disrespect?

Nothing.

Who was I to pass such judgment onto a fellow human being?

No one.

I fixed my gaze on the bus as it pulled out of the bus stop and down the road, with the crippled man and the lady with the white bag I admired.

That man did me no wrong.
I had no excuse to despise him.
Yet I did.

On the bus ride home, I sat in the chilly air-conditioned upper deck and mulled over what happened. I had morphed into just another bitch with a heart as cold as the artificially cooled bus.

I had unjustly discriminated another simply because he was different.

A beggar would have chosen a better place to beg.
A beggar would have called out for your attention.
A beggar would have stretched out his hand for alms.
A beggar would not have paid for his bus fare.

If that man ever reads this, I would like to say that I'm sorry.
Really sorry.

DESTINY VS CHOICE

Whatever happens, happens for a reason.

And whatever doesn't kill, just makes you stronger.

Do you believe in fate?
That your destiny has already been written in the book of life?
Or do you believe that one possesses the power to change the world?

I believe in a little of both.

We're all born with certain gifts. Gifts that allow us to stand out, and ultimately help define the person that we are. Besides these, the years also christen upon us, a slew of acquired qualities and a fellowship of relationships to see us to the end days.

Perhaps early on in life, being young and none-the-wiser, most decisions were made for us or even through the folly of youth. I know of friends that have unselfishly given up their dreams to live out the dreams their parents could not attain. I have friends that have entered marriage to save their family's fortunes. I have friends who have no courage to break free from the shackles of the past.

Some people may think it is the epitome of altruism.

But what good is life when that life is lived for others?

Age then brings forth wisdom and the unmistakable notion of freedom. Yet, I still see people who exhibit maturity beyond their age being chained to circumstances beyond their control.

I know of friends that have to support their sick parents (pertains to both mentally and physically) . I have heard of friends trapped in abusive relationships. I see some friends continuing a brave front, battling disease. I have friends doing things they do not enjoy.

Tousled between themselves and the world.

At times, we think we may have made mistakes. Or that this shitty excuse for life has left us severely shortchanged. Nothing could be further from the truth. In reality, these are opportunities to learn. We have to undergo certain phases in life before we can move on.

Like a video game, where one gains power or talents after a fight before progressing to the next level.

We can decide what we want to do with our lives. We can use these lessons learnt through heartache and suffering. We can deal with the mistakes. We can empower ourselves to right the wrongs. We can gain knowledge from the years.

And when you start to hear a irrepressable urge to answer a calling... Know that your time is now. Turn not away, but open yourself to embrace something He knows lies buried within but you're too afraid to ask.

He knows of all the stupid things that i asked for, all i wanted was happiness.

We can find hope.

We can be strong.

***********************************************

I've had my fair share of experiences.

I've gone through the mandatory teenage angst.

I'm riding the waves of adulthood.

He gives me peace.

He heard my call, and i, His.

I look at my hands often to remind myself what I am capable of.

I only turn back to see how far I have come.

I look ahead to see how far I can go.

And look around to see how blessed i am.

I question people, motives, myself

No questions are ever meaningless
And not all questions require an answer

Depending on the motive of the person asking the question
It may be used to emphasize a point
Create an awareness, or find an answer

I like to ask questions

Having too many to keep track off
Most end up being answered albeit satisfactorily
Others lay nagging
While a percentage lay dormant
Hiding in the back of my thoughts until they're ready to be resurrected

Pity you asked a question I could not answer
Or can you read my mind, and see that I simply refuse to?

The truth being stranger the fiction
And considering the consequence that may follow...
Wouldn't a defeatist stance be more comfortable?

Look at me, as I turn away, going about my usual routines

I'm joining the glitzy world of the masquerade ball

You Are Cookie Monster

Misunderstood as a primal monster, you're a true hedonist with a huge sweet tooth. You are usually feeling: Hungry. Cookies are preferred, but you'll eat anything if cookies aren't around. You are famous for: Your slightly crazy eyes and usual way of speaking How you life your life: In the moment. "Me want COOKIE!"

The Sesame Street Personality Quiz

Encounters of a strange(r) Kind

It is said that a full moon perpetuate strange events.

It's such an understatement.

It must be the changes in the phases of the moon, or the adverse effects of global warming, or even the shifting plate tectonics, that have inherently caused such a huge tidal wave of PMS across the landscape. Sheesh.

Either that, or it must be my innate ability to attract PMS-y characters. And it's this manner of bloody outflow, that repeats itself on a daily basis. Like how assured one can be that the sun rises from the east every morning.

Do i possess a mutant gene that alters my DNA thus extremely?

Sometimes i can laugh it off. Like how i did in the toilet when the staff complained we (students) were laughing too loudly in the toilet during my ED attachment.

Hello, it's a TOILET. Not a library.

Or the time when i simply could not (or refused to) comprehend the SN's instructions, leaving her to curse and roll her eyes.

Or even the time when the stupid AN insisted i was standing near the doorway, thus blocking it when i was trying to, like her, exit the door.

Hello, the door doesn't have a glass panel. I'm trying to exit. You're trying to enter. So why am i being scolded for using the door?

Othertimes, i choose to walk away and pretend it never happened. For the simple fact that i need to exercise self restraint. Cause the only thing i can be sure of is that, my words will sting. Long.

On a lighter note, i enjoyed myself at debate training on monday night. I missed the people there, having missed training for some time. Though as usual, i was lacking in either structure or content, Joey still found something positive to me. I'm brainwashing myself, I'm building confidence! More importantly, i'm having fun! And yes, Joey's still looking good.

The dates for the interpoly debate competition is out. The 2 teams have been announced. Joey chose me to be with Alex and Terrence. And a debate session with them on mon proved our team to actually work rather well together. So it's good.

Terrence's regained his confidence. Alex remains calm and collected (bless his soul.. and thanks to the bugger for getting me a rather quirky item from cambodia/laos/thailand).

You should have seen the debate senior who came! He's weird with a capital W. And when i got stuck talking to him, the rest simply scooted off, thanking their lucky stars and offering prayers. I had to entertain him while he remained unaware of how much i wanted to run off screaming under the moonlight. He wore this striped blue shirt with huge yellow stains all over. One stain was over his right clavicle, spilling over to his right shoulder; which made it look as though he had a baby puke all over him while being carried.

I would have ended up in the same state had he carried me.

I've also ended all my attachment postings for this semester =) and i'm finally able to smile again. I got to be excused very early today. And chicken and i got to roam around Bedok, buying food and making fun of people.

She likes saying the Swan Hello.
I like the Doremon mother and son combo.
She likes the leery uncle on the train.
I almost got psycho-ed by her to get the Bean carrier.

Hahaha =)

It's fun to be on attachment with her. That's cause she's lame. I hope we get to do our PRCP together too. But that means she has to choose the same disciplines as me, which roughly translates into .... hello ti ti?!

Cherlosophy's Life List

1. Go skydiving
2. Go to US to wreck havoc with Sharon Lee
3. Go to China with my PRC classmates
4. Ride the reverse bungee thingee
5. Throw a mock seizure when i'm being scolded to freak the fella so much they'd never dare do it to anyone ever again
6. To not be a doormat
7. Remind the people i love that i do
8. Wear a wig
9. Make a new friend
10. Get a merit
11. Clean my room
12. Start liking to clean the house
13. Perform in IMH with the patients
14. Work damn hard in Dec 2006
15. Upgrade my earings
16. Learn a new language and speak it well - jibberish not counted
17. Smile more
18. Get my life story published

Right now, the count stands at 18.

I've been fortunate enough to have gone through some experiences. And i'd like to add to the list. Though some experiences may not have seemed to be positive at the particular point in time, it's cumulative effect has made me what i am today.

I am Cheryl.

C-H-E-R-Y-L and damn proud to be me.

i miss this person

hahaha

and she'll most definately want this pic off the blog

i betcha she'll cry murder

HOHUM

I feel as though i'm carrying the weight of the world on my shoulders.
Nothing seems to be able to lift this low mood.

(Lights up cig)

I'm cranky.
Irritable beyond words.
Sad.
Hit by waves of hopelessness.

(Puffs away)

I'm beginning to complain non-stop about my work.
I seem to hate everyone around me.

(Lights up cig)

I hate attachment.
Too many crazy biatches.
Too many drama queens.
Too many mean assholes.
Even though incidents have lessened and the people have gotten nicer,
my interest has waned.

(puffs away)

and i'm afraid it may be beyond repair.

Someone erase my jadedness and bring back my passion.

REFLECTIONS of (no) passion

Ever felt like you questions your motives?
Ever felt lost in a jungle of pubic hair?
Ever felt so low you just feel sick to your stomach?
Ever felt like so though you're blind even with your eyes wide open?

That time is now.

It is seriously tough being a nurse. More so if that one nurse is constantly being degraded by fellow nurses. Or when that nurse feels like she's being stuck in a rut.

Dig a shallow grave and poor some shit in.

And being a nurse only by default makes it even harder to stay in this profession. I do love the bonds i've fostered with people with all walks of life. But to think that i'm shackled to a particular institution, or for the very fact, that it's not the general public, not the doctors, not the patients but our fellow nurses that despises us, makes me feel like throwing up.

True, i've witnessed and highlighted many encounters with nurses in my blog, ranging from pure stupidity to pure joy. But nothing shatters the confidence and pride in nursing more then witnessing the outpour of extreme PMS from one nurse to another.

To err is human, to forgive is divine.

Some one uttered that i'm one to prioritize my work environment above all else. And on certain aspects, that is true.

Allow me to explain.

Workplace politics really suck. I'm not very bothered by other peoples' background and private life. Thus, i don't see much of a need to ask my friends very much about what their parents do for a living, whether they're rich or poor and all the other shit. At most, i ask them what their siblings names are, and where they stay.

I view people as they are. No past, no future, everything in present tense.

And if i like you, i like you. And if i don't, i basically leave you alone.

Especially in the work setting, no matter how i may not like a person, i believe the office (or workplace) has a code of decorum that everyone understands.

No screaming.
No foul language intended to belittle.
Basically respect.
With the main goal of getting the work done.

I don't need the pretense of acting all chummy bunny.
I don't hanker after the praise and glory.

But i do need a little recognition of doing something good when it's due.

I don't feel like continuing.

I'm sick of being surrounded by PMS-sy nurses who act as though they're 100k per annum expatriates anymore.

I don't feel like being a nurse anymore.

THE STORY OF THE BEDSHEETS

Well, it all happened on the last day of my Geron posting.

It was 5 in the evening, and everyone was going about their usual routine. Suddenly, a lady was rushed into the ward on a wheelchair. She appeared to be unconscious, her head, lunging back from the velocity of the charging wheelchair. Her hapless college ran alongside, trying to keep up.

The ward staff ushered her into an empty examination room, where they placed her on the bed and started to try to revive her. People buzzed about the room, taking parameters, hypocount and an ECG.

The ward doctor (a foreigner) was called to the scene to insert a cannula - a precious lifeline in case IV drugs were needed. This doctor, well, you might say that she isn't exactly capable of handling high stress situations. She kept screaming for someone to anchor the lady's hand while she tried to insert the cannula.

Dr : Nurse! Nurse! Someone hold her hand!
Me : Dr, I'll do it.
Dr : Nurse! Nurse! Hold her hand! Hold her hand!
Me : (Deadpan face) Dr, I am holding her hand.
Dr : (Flustered) Oh... Ok... I insert now ah.... Hold her hand!

The lady then started to regain consciousness. It was amazing how still her arm remained (even though I didn't use any force to stabilize her arm) as she violently shook her head, screaming in pain.

Cannula one didn't work. Luckily the second was a success.

She cried out that she was a Hep B carrier and has Thalassemia B (or minor, a potentially fatal blood disorder). It became apparent that this was not her first, nor occasional admission into a healthcare institute.

I had to repeat everything she said. It was like the rest of the people in the room were deaf. They kept saying, "Huh? What did she say?"

Maybe she was speaking in tongue.

After stabilizing her, the decision was made to transfer her to an institute better equipped to render care. You see, the place I was posted to, isn't that happening a place to work in. They seldom encounter emergencies like these, preferring to jump around like ants on a frying pan and ship the elderly off to the nearest hospital at the slightest lowered glycemic level or elevated blood pressure.

I'm digressing. It's back to the story.

Ok, the decision to call an ambulance was made. And one would guess that any sane person would actually call the Civil Defence right? Well, the irony is : The ward sister blasted the SN that wanted to make that call with an eeeeeeeeeeeeeeevil, "Who gave you the authority to call the CD?" and promptly contacted a private ambulance service.

What the hell. Remember, this lady was brought in unconscious. And was screaming in pain whenever conscious.

The worst is yet to come.

I was 'assigned' to stay with the lady and her college in the room. My purpose, I presume, was to call for help if her condition took a turn for the worst. Although, the real truth in it all, was to free their staff, to continue with their usual routine. Imagine that. The sister didn't even have the decency to leave a trained, or at least their OWN staff to look after the lady.

I am but a student.

Can you seriously expect me to shoulder the responsibility for you? Or that of the reputation of your institute?

Well, things really went downhill from there.

The private ambulance took at least 25 min to get there. And the stupid, moron of a nursing manager could only smile and kept insisting that the ambulance was just around the corner, held up by evening traffic; much to the annoyance of the concerned college.

And when the ambulance finally arrived, the moron still could ask the college to chide the ambulance staff for taking such a long time (btw, she insisted that it only took them 15 min).

"You scold them lah. Aiyoh, take (stresses) 15 min you know.. haha"

You'd think that stupidity would stop there. No, it doesn't. It gets worst. Really.

While transferring the lady onto the stretcher, the sister hollered how her broken finger, which was immobilized by a pressure bandage, would not be able to take the strain of lifting the lady to the stretcher. She was compelled to repeat this statement for at least 5 more times.

I thought I was on the tip of the Andes mounts, with her voice echoing in the background, like it never meant (nor could ever) stop. Someone whould have slapped her shut. The ambulance sriver had to push her away to continue with the transfer.

After the lady was safely on the stretcher, the staff hurriedly whisked the lady into the aisle. And I was left to help clean up the room.

To my horror, the sister's next words began to make me sick. And the words would soon be seared into memory, for eternity.

"Aiyah, my bedsheets! This is my bedsheet!You can't leave with my bedsheeet!" pointing to the bedsheet under the lady on the stretcher.

"You take lah," replied the ambulance driver and proceeded to yank the bedsheet from under the lady.

"You cannot take it out like that here you know! People can see leh! Must go back into the room to take out!" she cried.

At this point, the lady's college screamed at them saying, "This is an emergency! Let's go OK!"

The ambulance driver said he'd bring the sheets back (one day), as the sister badgered him for his name and whatnots.

"Must remember to return ah! I know your name ok... haha" she said, while scouring for a name tag to read.

Although the sister was laughing a lot, i failed to see the humour in it all.

And when the driver slipped back into the room to retrieve his pillow, the sister went up to check if it was really theirs or the property of the institute.

Good grief.

Needless to say, by now, the college had transformed into some sort of panic stricken monster, yelling her head off, trying to hurry the whole process.

*************************************

The moral of the story is simple : (Chicken & Cheryl's Theory)

Never assume ALL hospitals are equipped for accident and emergencies, even though they carry the name of being a hospital.

If an accident happened to you (eg. Being run over by a car), it is better to ask the car to reverse, and then run you over AGAIN to increase the likelihood of immediate death. It is useless to admit yourself into a hospital that is ill equipped to handle situations like this.

--* The final chapter (Part One) *--

I'm running the last leg of the race now. Pretty soon, the curtain will draw to a close, and once again, I'll be off to embark on a new road. A road that will hopefully open more opportunities, revive old friendships and stir new experiences.

Though it's always painful to end some routines, I take heart in the very fact that memories can live on forever. And relationships, those that can withstand the test of time and distance, will take firm root in my life.

The years have brought not only academic qualifications, they have brought friendship in the least expected of places.

And no matter how hard I've tried to ease this transition, there appears to be a certain amount of undeniable heartache. And the fear of leaping into a whole new dimension in life.

Some friends have started a countdown to the final hour.

I have decided to express my feelings for all those near and dear to me. For there may come a time where dementia may rob me of all awareness. And the written word come so much so easier for me....

I'd like to say my thanks to the following people in particular:

1. Fara
My littlest friend, someone so dear and close to my heart.

Even though we've butt heads on many occasions, your truthful anecdotes have brought much insight. Your fearlessness to put me in place highlights not only your confidence in our friendship, but also the care you have for me.

You bring new meaning to the word fart. And sneezes.

At the same time, your inner child never fails to partake in the silly games my mind conjures. Leaving the walls and corridors to echo our shrieks and giggles.


2. Moonie
My book-burning, information-churning friend.

For as long as I can remember, you've never once gotten angry at being the butt of all my jokes. Instead, your giving nature has shown me what it means to take things in stride. Also, the courage you have shown to ride out adversities, has helped me to improve on being a better person.

Your ability to explain things calmly in a systematic manner illustrates your gift in teaching. Without you, where would I be?


3. Shidah
Though small in stature, Shid possesses the heart of a motherly lion.

One of the most forgiving persons I know. Her quiet nature has since evolved into one of confidence and her giving personality has swayed even the hardiest of hearts.

Her shopping queen instincts - Mango will not be the same without you.


4. Junaidah
Your happy giggles at anything I say, always send a smile to stretch across my face. If I get wrinkles, it must be your doing. Haha..

You have taught me the virtues of diligence and saving. And I would never have passed if not for you printing out all those e-lectures for me. Thank you.


5. Chicken Chia Suli
Attachments will never be the same without you.

Through the ice queen exterior, you have shown me what hard work and selflessness really is. Always putting the needs of the patient and your colleges before yourself. The mark of a truly wonderful nurse.

And I'll cherish all our break-time bitching and after-attachment walks to the MRT. Often ending in me reiterating the dangers of wearing your uniform out of the hospital. Heeheehee.


6. Lionel
Armed with the exterior of a hardened criminal, lies the softness of cotton. Our very own marshmallow man.

Your sometimes extreme jokes never fail to illicit laughter. And frankly, it's good that you're clear of the direction you have to life, goals and where you want yourself to be. Though at times, you try to hide the fact, I know that you have been very protective towards many in the class.

No matter how old I am, its good to know you'll always look 15-1yrs older then me =)


7. Zul
Last but not least. Our future Diplomat. The glue of the class. Under your direction, you've helped to foster bonds between the different cliques in the class.

I'm glad we managed to put our differences behind.

You have instilled in me the importance of good leadership. And the possibility of rearing a toyol in your bag. A story that I may well pass down to my children, grandchildren and great children.

This man solidifies the notion that situations can be handled with tact and grace, even though he has a knack of blowing up on me.


I'd also like to thank many others.. like Candy, who's my very own walking discount card, Evelyn, my mini pharmacist, Hoong Eng and Asyik, who have shared their knowledge selflessly, and the many others who make up the wonderful class of NR0416.

**********************

For all the times of anguish, stress and joy

For all the times of pain, sorrow and happiness

For all the faces that have been deeply etched into memory

For all the lessons I've learnt in and out of the classroom

Here stands a person renewed. Revived. Revitalized

Long live the people of NR0416

Expressive Aphasia

Some things are better plain and simple. Like language, complexity tends to distort the real meaning that one may be actually trying to put across.

Though it's not wrong for individuals to choose to pepper their conversation with pompous words (some out of habit, whereas others are related to their education level), the importance lies in whether the real meaning is getting through to the other party.

However, i prefer language in its simplest form.

To me, i view language as a basic form of communication, even though i have a recurrent, diseased state of incurable verbal diarrhea. Sometimes, i get carried away and allow my tongue to overide the analytical processes of my brain, ending in hurtful spats with people that mean a lot to me.

You see, like the cliche, words can hurt far worst then the deadliest wounds. Likewise, words have the power to move even the most hardened of individuals.

Language doesn't end nor start at conversation. It invloves the written, verbal word and weaves in body language.

That's why i like to read. Especially stories of fun, imaginery lands, thought provoking subjects and lives that seem to defy all odds. Emotions punctuate literally through the pages. Every turn of the page releases grief, joy, anger... such passion for life.

More often then not, people choose to repress their emotions. Preferring to drop hints instead. For one, i can't (or don't really bother to) read hints. A sideway glance, a passing remark, all seem like normal, everyday activities to me. My blunt nature makes me a poor translater, for the simple fact that i believe, one should possess the courage to say what they mean out loud, else choose to live with the option of burying what they mean, forever. Then again, Fara has reiterated the fact that some outpouring of emotion brings far more intense consequences then others.

Most people read my emotions loud and clear on my face. When i'm happy, i wear a grin stretched over my face. When i'm pissed, you can practically smell the pee. My mouth looks like i'm sucking on a ton of sour plums. When i'm sad, nothing holds back my tears. You get the idea.

And yet, as clear as my emotions go, most people will still never know me on a deeper level. Simply because some doors are better closed.

The choice of bringing some things to the grave.

Another Chapter Ends

My 2 day LSCN crash course is finally over.

And by a stroke of weird luck (and many blessings from God), i managed to scrape a pass.

It was test after test, practical after practical and drama after drama. My teammates consisted of Asyik, Hoong Eng and another lady from grp 4 - which shall remain annonymous.

That woman really sucked the life out of me. She's over-bearing, a sick, act cutesy wutsey, actress in front of the teachers and likes to act chummy bunny with me. Putting her hand over my shoulder and squeezing my arm. Yucks. And acting like th usual me, i would ever so often, have the need to violently jerk my shoulder and shrug her wandering hands away.

I basically don't like you, man.

I complained relentlessly to Asyik and Hoong Eng.
They're nice people.
They're unlike me.
Hohoho.

I felt that the woman dragged the whole team down. She's slow and unsure of her work. Especially when we're the ones being tested - she made the leader looked bad. Pity i wasn't able to choose who my partners were. I would most definately have hand-picked Asyik and Hoong Eng. Heehee...

Though during the practical, i was able to have at least one of them around. You see, in megacode, you get a scenario where the teachers tell you a little history of the patient and how a patient collapses. You (or rather, me) then assumes the role of the leader and directs how the resuscitation would be initiated.From the decision to shock or not, to the administration of medication and keeps a lookout at what the other staff (we are given 2 other helpers) are doing.

Normally, in the assessment, the other helpers are not supposed to verbalize anything and expected to do their roles well. That woman gets neither right. She's ....... lets just say she irritates me. Big time.

It was also quite confusing because some teachers insisted on us performing their way (which translates to THE ONLY WAY), while others were more flexible and allowed you to rationalize your actions.. as long as you did it the correct way, safely. Asyik concludes there isn't any form of standardization in my school. Haha. How right he is....

It was funny how i freaked them out when i dropped the paddles to the defibrillator. And how i shrieked 'it's a miracle!' when the cardiac rhythm reverted to sinus rhythm from ventricular fibrillation after applying a DC shock.

I failed my megacode the first time. Hoho. And somehow, i managed to weasel my way to a passing grade the 2nd time round. I had 'super strong man' Asyik, and someone nice the 2nd time. Heehee. My team worked well.

And so, i actually owe my grades to them =)

Sadly, not everyone got certified. But it was a really valuable learning ground for all of us. Even though my team got blasted most of the way, it strengthened not only our knowledge, but the very fact that the basis of nursing revolves around teamwork.

Tomorrow, it's back to the wards in repayment for 2 absent days. Alone.

ATTACHMENT!!

Whoever said my current posting would be super relaxing is invited to eat my shorts. Zul, you have the priviledge of being the first.

Piang eh.

I do nothing but take all the aunties and uncles to the toilet and back again for almost every minute. And if i'm not doing that, i seem to be changing every diaper in that wing.

Sit down? What sit down??? Relax? What relax man???!

Serve medicine? Once.
Read case notes? Twice, although briefly. Say 5-10 seconds?
Then it's off to send the aunties to the loo again.

But that doesn't mean my efforts are in vain. I do enjoy the time spent with the patients. Even the difficult ones.

Plus - today, we got to participate in a KTV session with the ward upstairs. Andy volunteered to sing. And once he started, he never relinquished the power brought about by the microphone.

Like the ring to gollum....

I deduced that he had masses of practice hopping from one ge tai after another during the 7th month hungry ghosts' festival. Either that or he doubles as a KTV hostess(?) EOD. That boy just sang and sang and sang.

Like an energizer bunny singing retro chinese songs.

We would have needed to pry the mic away from his cold dead fingers if they didn't off the tele.

And you should have witnessed his 'turtle dance'. Hohoho. Trust me, i would never be caught dead in a disco with a gyrating Andy. To the extent of even refuting claims that he is my classmate. I should have recorded the his whole concert. It would have brought me millions.

Wahaha... But then again, he was a blardy good sport. And it entertained the elderly and us. Heeheehee.... So cheers to you brother!

Being posted here also gives us the oppprtunity to eat out. Today, chicken, far and i got to have our break together. Even though we nearly had to tear the skin of a certain gender-altering person. But enough of ________.

Chicken and i had bak chor mee - blardy nice! And Fara had her staple 7-11 stuff. I told her that 7-11 should issue her a priviledge card from all the business she gives them. Heehee

I smell like shit at the end of the shift, though i still insist in taking public transport home. Hohoho. I need to save money. And i have no more to spend. And you have to remember, shit fertilizers a great harvest!

I'll be in school tomorrow for the LSCN course. Don't ask me what in the world it stands for. I seriously don't know myself. Don't get me started on why i look so blardy out of place with the people there. Don't ask my why i have to replace the days i am in school for the stupid course on saturdays.

All i know is that, i'm working far, far less (part time) now, but my days seem so much more packed.

It's like i don't even have any breathing space.

gasp.

Gasp.

GASP.

I hibernated for exam info-loading, finished tons of presentation after presentation and meeting after meeting of debate practice. And then attachemnt comes, and stupid case studies. Couple with more debate practice.

Debate. Shit. Debate.

Still have the interschool competition coming up in dec. I'll worry about that after my LSCN and case study/assignment k?

I'd like to order a doppleganger. Now make that 2 please.

FINGER POINTING

The news have been proclaiming the triumphant sentencing of Saddam.

Death by hanging.

Yes, the ruler of a country, whose human rights have been curtailed
even though it brought the nation and it's surroundings relative peace.
The price of peace with an iron fist?

And yes, the ruler of the country, whose borders were invaded, civilians murdered, children left orphans and starving, on the pretext of an impending nuclear holocaust.
Are nuclear weapons be invisible?

And yes, the same man, is the father whose son died trying to protect him.
While the other perpetrators stand aside and mollycoddle the real demon(s) involved.
Who is the real terror after all?

Therefore, the moral of the story is clear :
Never piss someone (or a collective group of people) that has/have/will have greater power then you.

My 2 cents worth -
I'm not on anyone's side. I just feel that this whole situation has been handled very badly. And while his mighty bushiness continues to play golf or frolick with his dogs in the mono-coloured house, there are people he has shipped off to war that WANT to return home.

As much as the people in iraq want to rebuild their lives without the annoying double-faced drama kings and queens, who are simply eyeing the profits brought about by the sale of oil.

It's freaking time to call it an end. Stop all the blame shifting, finger pointing and look into the real issues.

A country needs direction.
A people that require strength.
Leaders (more the one) that need to be brought to justice.
And a World that needs more gonads to withstand pressure.

Let this madness stop.

My prayers are with every single one of you that keeps the hope alive.

Let your conscience sing the praise for freedom

Let your heart feel the suffering

Let your eyes envision a better tomorrow

And let your hands defy the odds

LIVE ONCE. LIVE WELL. LIVE STRONG.

I'm posting some answers to the past year exam questions for all to review. Do comment should you notice any discrepancy or have anything to add. Also note that i have expanded on the explaination so i can squeeze in as much details as possible.

(A) Write short notes on the counts of sponges, sharps and instruments during surgery.

Importance :
Loss in any of the above mentioned will result in harm to the patient

Who to count :
Scrub nurse + Circulating nurse

When to count :
(i) Before Surgery
(ii) Before closure of body cavity
(iii) Before closure of skin

How to count :
(According to standards of practice of the institution)
* Count concurrently, audibly with the circulating nurse (or qualified staff) and use of Count Chart accurately

(i) Preop
- Loosen bundles of swabs lightly
- Pick up 1 swab at a time

- Show radio-opaque thread/ intact loop of penny towel to circ nurse
- Recount if interrupted or in doubt

- Remove/discard bundle in event of discrepancy

- Ensure circ nurse records immediately + initials on Count Chart

(ii) Intra Op

- Keep count of swabs at op site
- Maintain 2 swabs at op field at any 1 time

- Use abdominal packs/penny towels/swab sticks for large/deep wounds

- Do not remove any swabs from OT til op is over

- Pass out soiled/wet swabs to circ nurse

- Count, bag up and place aside in sets of 5s/10s (according to protocol)

- Document -> strike out bundle and initial name

- Count all swabs before closure of cavity and skin
(floor count, trolley count and op field counts)

(iii) Sutures / Sharps

- Conduct preliminary/initial count

- Give 1 at a time

- Recieve intact needle

- Suture packs to tally with needles

- Additional supplies to be obtained from circ nurse

- Needles passed out are to be accounted in Count Chart

(iv) Instruments

- Conduct prelimary checks for intactness

- Account for broken/missing parts

- Observe for intactness

- Account for additional supplies in Count Chart

* The surgical team must be informed immediately of any discrepancy, and a thorough search + xray in OT + incident report must be done.

*************************************************

(B) You are an OT circulating nurse. Give a brief account on how you would handle the specimens recieved from the Scrub nurse during surgery.

* Principles revolve around :

(i) Deal promptly

(ii) Confirm nature of specimen + correct type of examination
(iii) Correct labelling + Preservation + Despatch

Interventions include :

- Use appropriate container

- Do not mix specimens

- Correct + sufficient preservatives
(Eg . fully immerse specimen in 4% Formaldenhyde)
- Multi specimens -> label in numerical order using seperate containers

- Avoid traumatizing specimen

- Double bag item prn (must be biohazard bag)

- No preservatives for specimen if C&S or frozen section

- Ensure correct patient details + type of exam required + nature of specimen

- Despatch to respective labs with correct forms STAT

- Implants/ FBs/ Stones/ Teeth are to be returned to ward nurse/pt/family

- Amputated limbs sent to mortuary for burial/disposal

I'm posting some answers to the past year exam questions for all to review. Do comment should you notice any discrepancy or have anything to add. Also note that i have expanded on the explaination so i can squeeze in as much details as possible.

Mdm Kuek, 70y, c/o inability to delay voiding and dribbling of urine whenever she coughs or sneezes too forcefully. She seldom leaves her home because she feels to embarassed to wet herself in public. During a check up, she consults the continence nurse.


(a) List the transient causes of Urinary Incontinence
(b) Briefly discuss the general urinary assessemnt for Mdm Kuek
(c) State the specific nursing management if UI the nurse clinician would render Mdm Kuek

***************************************

(a) Transient causes of UI would include:

D - Delirium (acute confusional state)
I - Infection (increases urge)
A - Atropic Vaginitis (loss of suporting structures)
P - Pharmaceutical (eg. Lasix)
P - Pyschological (eg. Dementia)
E - Endocrine Disorders (eg. DM ->polyuria)
R - Restricted Mobility (eg. Amputation)
S - Stool Impaction (presses onto bladder)

***************************************

(b) General Assessment for UI include:
(1) Medical History
- Medical, Surgical, O&G -> any problems identified?

(2) Physical Assessment
- Esp Genitalia -> Note skin condition, presence of discharges, foul smell, prolapse?
- May indicate UTI

(3) Current Medication
- On any diuretics?

(4) Fluid Intake
- Amount and type consumed
- Identify possible diuretic properties some drink possess

(5) Urinary Habits
- Note the onset, duration, severity of UI
- Eg. Frequency, Nocturia, Dysuria, Urgency, Haematuria, Obstructive symptoms

(6) Bowel Habits
- Constipated? Impacted stools -> presses on bladder

(7) Psychological State
- Depression? Delirium?

(8) Functional State
- Immobility -> leak?

(9) Environmental Factor
- Lack of toilet facilities? Too far?

(10) Age related changes
- Weak pelvic floor muscles? Atropic Vaginitis?

***************************************

(c) Nursing Management
(i) Assessment
- As abovementioned to exclude/determine factors contributing to UI

(ii) Plan
- Explain prior commencing interventions for cooperation and consent

(iii) Interventions

1. Diagnostic Investigations
   - Eg. In-Out catherization to measure Post Voided Residual (PVR) volume
   - Post void bladder scan
   - Blood Tests -> High WBC indicative of infection
   - Urine C&S + FEME to exclude UTI
   - MMSE to determine mental state
   
2. Bladder Chart/ I&O Chart
   - Useful assessment tool to describe voiding pattern
   - Provides enhanced self awareness of fluid intake and elimination pattern
   - To record findigngs for at least 3 days
   - Pt able to keep this record by themselves at home
   
3. Behavioural Techniques
   - (a) Bladder Retraining
   -> Helps pt to postpone voiding to a fixed schedule
   ->Requires pt to resist sensation of urgency to void
   -> Recommended for STRESS & URGE incontinence
   
   - (b) Habit Training
   -> Involves matching toileting schedule to pt's own voiding habits
   -> Freq, Vol, Patterns of continence & incontinence are adjusted according to pt's pattern
   
   - (c) Timed/Scheduled Training
   -> Includes techniques to trigger voiding
   -> Eg. Suprapubic tapping, Stroking inner thigh, Running a tap
   -> Recommeded for pt's who require assistance for toileting
   -> Usually 2hr intervals
   
   - (d) Prompted Voiding
   -> Asked at regualr intervals to empty bladder
   -> Form of positive reinforcement
   -> Recommeded for pt's who can respond when prompted to void
   
   - (e) Pelvic Floor Exercises
   -> Improves tone of muscles which aupport bladder neck and urethra
   -> 1st line treatment for STRESS & URGE incontinence
   -> Must be practiced daily
   
4. Introduction to External Collection Devices
   - Eg. "All-in-1 briefs", Continence pads/aids, urinals, commodes
   - Affordable, easy to apply, ranges in sizes and varies according to absorbency
   - Socially acceptable, discreet
   - Minimal skin irritation
   
5. Skin Care
   - Maintain perineum hygiene
   - Ensure right continent aids used with proper application
   - Cleanse skin well after leakage
   - Change continence pads/diaper regularly
   
6. Diet & Fluid
   - Adequate nutrition & Fluids
   - Debunk myth that low fluid intake will help incontinence
   -> Truth : Less fluid intake will result in concentrated urine, in turn irritate bladder wall and worsen incontinence
   - Encourage at least 8 glasses of plain water unless contraindicated
   - Limit drinks near bedtime
   - Reduce consumption of stimulating beverages (ie. Tea with diuretic effect)
   
7. Environmental Modification + Physical Safety
   - Convenient toilet location
   - Addition of grab bars, good lighting, non slip tiles/footwear, velco pants
   - Use of ambulating aids (eg. walking sticks)
   
8. Medication
   - Use of medication to treat Incontinence
   
   -(a) Urge :
   -> Anticholinergics (eg Propantheline Bromide) acts on bladder wall
   -> Tricyclic Antidepressants (eg. Imipramine Hydrochloride) acts on bladder muscles
   -> Bladder Relaxants (eg. Oxybutymin Chloride) acts on bladder wall
   
   - (b) Stress:
   -> Alpha-adrenergic Agonists (eg. Ephedrine) act on bladder wall and urethra
   -> Estrogen act on urethra
   
9. Address problems related to UI
   - (a) Physical
   -> Discomfort r/t dampness
   -> Unpleasane odors
   -> Skin rash/breakdown
   -> Falls
   -> Dehydration
   -> Insomnia
   
   - (b) Psycological
   -> Loss of independence (req aid for voiding)
   -> Fear of embarrassment
   -> Depression -> Suicide
   -> Loss of dignity
   -> Withdrawal
   -> Feeling of being a 'burden' to caregiver/family
   
   -(c) Social
   -> Reduced social interaction
   -> Isolation r/t embarassment/smell
   
   -(d) Sexual
   -> Avoidance of sexual contact r/t smell etc
   
   - (e) Occupational/Financial
   -> Unemployment r/t absence from work
   -> Change of job
   ->Money spent on treatment
   -> Refer to MSW/Psy/Skills traininf options
   
10. Catherization & Surgery
    - For serious cases
    

I'm posting some answers to the past year exam questions for all to review. Do comment should you notice any discrepancy or have anything to add. Also note that i have expanded on the explaination so i can squeeze in as much details as possible.

Qns :
Mrs Lim, 29y, is admitted for drug overdose. She mentioned that she has taken 60 tabs Paracetamol 1hr ago, after a quarrel with her husband. She is under considerable stress as she has recently lost her job and the family is in financial dificulties. Her husband has been unemployed for 6 months. Mrs Lim has no history of psychologicla illnesses, suicidal tendencies or any medical illness.

On examination,

• She appears fearful and anxious
• Cognitive status - conscious and normal
• VS - BP : 100/65mmhg, HR : 100/min, RR : 25/min
• c/o nausea and abdominal cramps
• Vomitted 200ml of whitish fluids

Discuss the emergency management for Mrs Lim. Give rationales for the management taken.

* Note : Mrs Lim's VS is indicative of shock

***************************************

(A) Assessment

(i) Triage Priority
- Based on given scenario, vital signs, other factors (eg. age, GCS) -> Cat 2

(ii) VS + SpO2 + GCS + I&O + Physical examination
- To determine current condition for baseline comparison
- Highlight possible deterioration (Eg. renal failure, respi distress)
- Observe for subsequent vomitting

(iii) Reason for Admission
- Poisoning -> intentional, suicide
- To ensure police report is made
- To handle specimens obtained as per hospital protocol (intact police seal)
- To inform next of kin on whereabouts of individual

(iv) Severity of Poisoning
1. Drug - Amount and type. Also note TIME consumed
2. Route of Poisoning - Oral/ingestion
3. Host Susceptibility - Body weight, extent of distribution/ absorption

(v) Medical History & Medication
- Underlying medical conditions? (past and current)
- Drug/Food Allergy
- Addiction?
- Psychosis?
- Identifies factors that may worsen condition

(B) Investigations

(i) Blood Tests
- Blood for toxicolgy, Biochem studies for drug levels
- FBC, PR/PTT, LFT, GXM, U/E/Creat, Glucose, ABG

(ii) ECG
- Assess cardiac rhythm and function

(iii) CXR

(iv) Urinalysis

(v) Vomitus for toxicology/drug analysis
- Ensure intact police seal and proper despatch protocol


(c) Interventions

1. Principles of Poison Management
(i) Maintain Vital Function (ABC) + I/V Access
(ii) Clinical Evaluation
(iii) Decontamination
(iv) Neutralize Poison
(v) Enhance Elimination
(vi) Prevent Re-exposure

(i) Maintain Vital Function (ABC) + I/V Access
a. Remove from contaminated source if possible
b. Establish ABC
c. Oro-airway + O2
- Via non re-breather mask
- To flush out inhalants
d. Continous monitoring of VS + SpO2 + GCS + I&O

(ii) Clinical Evaluation
- Clear history of individual's medical condition, medication, allergies etc
- Type of poison? Mode of exposure? Time of ingestion? Specimen of poison?
- Symptoms the individual manifests (eg. drowsiness, ab cramps)
- Identification of psychosocial problems?
- Evidence of abuse?

(iii) Decontaminate
a. Topical Decontamination
- Remove from source
- Brush excess powder off skin, taking care not to break skin
- Remove contaminated clothing + others
- Flush with plenty of H2O
- Save H2O for proper disposal + testing

b. GI Decontamination
(1) Dilution (H2O)
- Aim : To decrease gastric irritation
- Child 100-200ml, Adult 200-400ml

Contraindications :
- Capsules, Tablets
- Drowsy, Coma, Seizures
- Absence of gag reflex
- Corrosive substances
Rationale : Increase risk of aspiration

(2) Emesis
- Only done when the substance is suspected to still be in the stomach (eg. under 4hrs post ingestion)
- Done when a potentially toxic dose is ingested
- Done via pharnygeal stimulation/ medication

Contraindications:
- Drowsy, coma, seizures
- No gag reflex
- Under 6months old
- Corrosives

(3) Gastric Lavage
- Indications : 1-6hr post ingestion
- Up to 12hrs for salicylates, barbiturates, carbamazepines, tricylic antidepressants
- Precaution - To insert CUFFED ETT prior to commencement to prevent aspiration (esp for comatose)

Procedure :

1. Left lateral position
2. Insert appropriate sized NGT
3. Aspirate contents til clear (and send for investigation with police seal)
4. Intro 250ml h2O (adults)
5. Wait 2min
6. Aspirate contents
7. Repeat till clear

Contraindications :
- Parraffin + Corrosive solutions, as NGT may perforate esophagus

(4) Oral Adsorbents - Activated Charcoal
- Aim : To reduce poison absorption
- Given post gastric lavage/induced emesis
- Adult : initial dose 50-100g , subsequently, 15-20g 4-8hrly x24hr (PO/NGT)
- Most effective within 1hr of poisoning (up to 12hrs for salicylate or tricyclic antidepressants)

- Indications : Paracet, Aspirin, Phenytoin, Phenobarbitones, Theophylline, Digoxin

Contraindications :
Methanol, ethanol, corrosives, heavy metal, Antidotes

(5) Catharsis
- Aim : Induce diarrhea to hasten elimination of poison from GIT (although there is controversy over efficacy)
- Currently used to neutralize constipating effects of activated charcoal

- Indications : Paraquat, Salicylates, Iron, Digoxin
- Agents used : Mg Sulfate, Na Sulphate, Sorbitol

- Precautions : F&E must be replaced as diarrhea -> low K/Na

Contraindications :
Paralytic ileus, Corrosives

(iv) Neutralize Poison - Antidotes

1. Paracetamol -> N-acetylcysteine (NAC), Methionine
2. Opiates (ie. Morphine, Pethidine) -> Naloxone, Narlophine
3. Organophosphates -> Atropine, Pralidoxime
4. Benzodiazapines (ie. Diazapam) -> Flumazenil
5. Anticholinergics (ie. Atropine) -> Physostigmine

(v) Enhance Elimination
(1) Forced Diuresis
- Aim : Increase excretion of poisons
- With or without manipulation of urine pH

Indications : Aspirin + other salicylates, Phenobarbitone
- 1 cycle = 3 x 500ml infusion in following order
- At rate of 500ml/hr

1. 500ml D5% + NaCHO3 8.4% (alkaline)
2. 500ml D5% + 30ml KCL 7.45%
3. 500ml N/S

- Number of cycles are dependent on the amount of poison in the blood
- I/V Frusemide 20mg at the end of each cycle

Nurse's Responsilibilties
- To monitor VS + GCS + CVP + output (insert IDC)
- Test urine for pH (expected to be alkaline due to bicarb infusion)
- Observe for complications : Eg. Fluid retention, electrolyte imbalance, cerebral/pulmonary edema

(2) Dialysis
- Aim : To remove high levels of poison in the bloodstream
- Types :

1. Haemodialysis
   Indications - Renal Failure, Barbiturates, Lithium, Ethylene Glycol, Methyl Alcohol, Salicylates
   
2. Charcoal Haemoperfusion
   Indications - Paraquat, Digoxin, Phenobaritone, Tricyclic Antidepressants, Theophylline

- Indications : For severe clinical intoxication, grade 4 coma, hypotension, hyper/hypothermia

(vi) Evaluation
(1) Effectiveness of intervention
- Stability of VS + GCS + SpO2

(2) Handling of specimens under appropriate protocol
- Intact police seal

(3) Prevent re-exposure
- Through education, counselling, referral to Psy to address underlying emotional issues

(4) Provide Psychogical Support + Suicide Precaution (Safety)
- Overt and Covert monitoring
- Suicide Chart
- Notify all staff of status
- Observe for signs of depression
- Medication to be taken in STAT in presence of nurse
- No isolation

(5) Accurate Documentation
- Medical legal issues

(6) Apply for transfer to ward/ICU as appropriate

***************************************

Please note that the answers provided are written with the help of open lecture notes. I have compiled most of the interventions, and management typically goes beyond the given scenario.

This was done as a revision booster for me and all those who are stuck wandering online. I hope i have been of some help. Cheers to all those who have unselfishly shared their slides =)

I'm posting some answers to the past year exam questions for all to review. Do comment should you notice any discrepancy or have anything to add. Also note that i have expanded on the explaination so i can squeeze in as much details as possible.

Qn : Mr Khoo has colo-rectal carcinoma stage III. He is admitted to your ward with wide spread metastasis. His pain is partially controlled with oral analgesics.

(a) Describe how you would assess Mr Khoo's pain.
(b) Discuss the pain management strategies for Mr Khoo.

I always thought that metastasis automatically renders the individual into stage IV. Someone please confirm. Thanks. Below are my answers with the help of an open text.

*************************************

(a) Assessment strategies would include the following:

(i). Accurate classfication of Pain

Acute - Sudden onset, warns of imminent tissue damage
Chronic - Prolonged, complex and more difficult to control

* Note : Cancer pain may be chronic with acute flare ups

(ii) Use of the Pain Phenomenon as a guide:

1. Physiologic
2. Sensory
3. Affective
4. Cognitive
5. Behavioural
6. Socio-cultural

1. Physiological
- Associated with direct tumor involvement (eg. tumor pressing on nerves?) or cancer therapy (eg. Side effect of RT/chemo)

2. Sensory
- To note the following : * Location - Site, diffused/localised/generalized? *Intensity - As percieved by individual (how bad?) *Quality - Ask individual to describe nature of pain (Eg. Pulsating, aching, burning)

3. Affective
- To identify psychological factors that may contribute to pain - Eg. Deteriorating condition -> depression/anxiety -> more pain - Also note the personality traits of the individual (type 1/2) as this will also affect pain perception

4. Cognitive
- Highlights how pain affects the individual's thought processes
- Eg. more pain -> more anxiety -> depression - Individuals with positive attitudes reported less severe pain

5. Behavioural
- Identifies behaviour related to pain (Eg. level of activities) or intake of analgesic

* Note : Behavioural response to pain may or may not coincide with the individual's report to pain. Eg. The patient may report of a pain score of 8, but may still be able to continue with his ADLs.

6. Socio-cultural
- Include demographic, cultural, ethnic, spiritual and other related factors that influence the perception of pain
- Eg. It may be socially acceptable in some cultures to have outward bursts of emotion when experiencing pain

(iii) Use of a Comprehensive Assessment Tool
- Includes subjective (eg. verbalization of pain) and objective (what the nurse observes) data

Onset
Location
Description
Intensity (use of pain scales)
Aggravating & Relieving Factors
Previous treatment
Effect on pain on daily activities
Vital Signs

- Pain Scales (eg. Wong-Baker's Face, Numerical)

*************************************

(b) Firstly, the Nurse must understand that pain perception is a personal and subjective evaluation. Therefore, it is important nit to impose their own personal views which will be likely to obscure the assessment process. Continual pain assessment with the following guidelines should be beneficial:

1. Pharmacotherapy
2. Complimentary Therapies
3. Other Therapies
4. Role of the nurse

1. Pharmacotherapy
- Use of the WHO's 3 step Analgesic Ladder



- Examples of Analgesics
(i) Non Opiods - Aspirin, Paracet, NSAIDs (naproxen, diclofenac, Ibuprofen)
(ii) Opiods - Weak - Codeine, Buprenorphine - Strong - Pethidine, Morphine, Fentanyl

- Examples of Adjuvants
(i) Anxiolytics - Diazepam
(ii) Antidepressants - Amitriptyline
(iii) Anticonvulsants - Sodium Valporate, Carbamezapine, Neurotin
(iv) Neuroleptics - Haloperidol

- Common Routes of Administration :
-> PO (preferred), S/C (bolus/continuous), PR, Transdermal, I/M, I/V, Epidural

* Rationale : The WHO's 3 step ladder aids in determining type & strength of analgesic required for effective pain relief.

* Nursing Responsibilities
(i) Medication must be given as presribed and on schedule (5 rights)
(ii) Dosage should be titrated to meet the individual's needs
(iii) Assess the need of adjuvant drug therapy
(iv) To observe and manage the side effects/complications of Opiods
- Eg. Constipation, N&V, Sedation, Mental CLouding, Respi depression, Urinary retention, xerostomia, pruritis, sleep disturbances

(2) Complimentary Therapy
(i) Psychological and Behavioural Therapy
- Eg. Distraction, Hypnosis, Relaxation, Guided Imagery, Music, Art, Muscle relaxation

(ii) Cutaneous Therapy
- Eg. Accupuncture, Massage, Transcutaneous Electrical Nerve Stimulation (TENS)

* Rationale : Improves coping strategies to deal with pain.

(3) Other Therapies
(i) Interventional
- Only 2-5% of Opiods direct to the CNS
- Individual may consider Nerve Blocks

(ii) Supportive Care
- Eg. Pastoral Care, Supportive Care

(iii) Anti-tumor Strategies
- Eg. Radiation, Chemotherapy, Surgery

(4) Role of the Nurse in Pain Management

(i) Believe in the patient's complaint of pain

(ii) Careful assessment
- detailed hx, physical & psychosocial assessment

(iii) Provide Psychological Support
- Encourage active participation in self care, verbalization of needs/feelings
- Include the family and social network (if possible)

(iv) Educator
- Teach effective coping strategies
- Discuss options of Pain management (safe and effective methods)

(v) Evaluation
- Individual's response to therapy, after initiation of treatment, at each new report of pain, and at suitable intervals after intervention
- Accurate documention of pain, S/E or treatment etc

* Rationale :
- Continual Assessment is important as it highlights the changes in pattern of pain, any new development or persistance in pain which will require either modification or change of current treatment.
- Failure to assess is the main cause if under treatment.

Cherlosophy's Current Playlist

1. Internal War - Unearth
2. Welcome To The Black Parade - My Chemical Romance
3. Broken - Seether Ft Amy Lee
4. Just Show Me How To Love You - Sarah Brightman & Jose Cura Ft The London Symphonic Orhestra
5. Secret Garden - Bruce Springteen
6. Secret Love - Jim Brickman
7. Through The Fire - Chaka Khan
8. Boston - Augustana
9. Yue Lao - Andy Lau (Canto Version)
10. She's No You - Jesse McCartney
11. Braveheart (End Credits) OST performed by the London Symphonic Orhestra
12. Little Girls from Annie the Musical
13. Heal Me, I'm Heartsick - No Vacancy
14. Faithfully - Journey
15. Welcome To Wherever You Are - Bon Jovi

That's all for now folks...

Here's wishing everyone a very happy Raya =)
And to my classmates, great luck for the upcomming exams.

@#*%@!# EXAMS @#*%@!#

Haha. That's all i have to say about exams.

I used to like exams.
Seriously. I know, i'm such a pervert.
But the notion of exams is less frightful
when you have the confidence of knowing a topic or topics well.

Alas, times have changed.

And i know shit about things.

Blardy hell.

Ok, i shouldn't be here in the first place.
I shouldn't be posting.
I shouldn't be checking up on people's blogs.
I shouldn't be visiting youtube.

I SHOULD be studying.

Piss ass shit.

Haha.

Bleah.

Ok, this is a senseless post.

So what??!!

It's my therapy and i't's my blog.

This is my entitlement.

I feel a story growing in my head.

Ok, that is so random.

I guess i'll leave it for a better time.

Bleah.

PUI.

out.........

I woke up early to go visit my Dad's grave today.

An event that mimics a certain undisclosed sense of familiarity.

We passed the people hawking flowers and scented water. Passed the many gravestones that dotted the plains (the surroundings made me feel as though i was in driving through some rural part of malaysia). Finally arriving at 9plus in the morning, with the weather hot and humid. The grave yard was unusually busy with activity. There were lots of people there, hoping to get the graves cleaned in time for Raya.

I was there just to say hi.

I pulled out the stray weeds. Wiped down the green tiles. Changed the white cloths. And after the usual cleansing routine, they left me alone for some private time with my Dad.

6 years have past. 6 long years.

And i sat there, going through some things in my head. Starting with small talk trying to lighten the mood (as if it was even neccessary). That didn't work. And it escalated into a full outpour of pent up emotions. I'm a little teapot, short and stout. Lalala......

Tears flow freely there.

And it sure as hell felt good. Except for the fact that a small number of people were nearby wondering what in the world this person was doing at a grave alone and weeping. Haha. I see dead people...?

So yeah. I don't really give a heck. Crying is my therapy. I'm not seriously ashamed of my tears. I cry too much and too freely. And if they wanted to stare, they should have just come straight up and asked me to audition for the media =)

I had the opportunity to spend some time with Candy and Lydia the other day. I had to wile time away during the long break on wednesday.

A long, agonizing 6hr break.

I joined them in the library to study. The lovely ladies printed out the past year exam questions for me. I'm glad to have joined them. Simply because i have never remembered having much opportunities to mingle with these people before.

And after a mind numbing (though short) session of revision, we started to talk. Candy posed a question to me - 'Eh cheryl, are you close to your patients?'

Reflecting, i can't say i am. Neither can i say i'm not. I do love them. Even though some can really get on my nerves with their drama. But i do care. And it's hard not to form bonds with someone when you're feeding them, cleaning them and spending so much of your time with them. Day after day. And i hate the goodbyes. Ask anyone that has ever worked with me.

It's like being a babysitter. You do so much, and then they leave. All that's left is an empty bed to remind me of a friendship that used to be.

Heartache Vs Happiness.

But exactly how much do they know about me? On one hand, it's a one way friendship. Superificial in a sense, simply because i'm still walled up whereas they're exposing themselves. They confide in me, i listen. I don't really divulge much about myself. We crack jokes about life, we gossip about the other nurses, we bitch about others. And sometimes, tell me their life stories, like how they met their spouses, wars they've been through, share secret recipes, how disappointing children can be, or simply how afraid of death they are.

The uncertainty of Life Vs The freedom that death brings

And on the other hand, its a deep relationship that focuses on the current day-to-day activities, with no emphasis on past or future. Only the present counts. To hell with the past. Each day is a blessing by itself.

But i guess the best judge of whether i'm liked is the patient themselves.

And for some friendships, i've allowed it to be taken out of the boundaries of the hospitals and into the real world. Some have slowly erased away, whereas others continue, their lives merging with the daily actitivies of mine.

LIVE ONCE. LIVE WELL. LIVE STRONG.

The following entry is inspired by Zul's entry in his blog where he writes about the people and situations that have helped shaped him.

Yes, the same lame fella who squirted normal saline on me after debate practice and gave me a cutting-edged look of a wet crotch. The same guy with the 'dandruff eyebrows' (a moniker lovingly bestowed by Fara). The same man who feeds his toyol living in his bag with a burger, half eaten no less. And the same person who projects an image of happiness but hides his inner most emotions.

Don't we all?

******************************

I too, am a firm believer that everything happens for a reason.

And i seek solace in the fact that there IS a God. And that God loves me. Seriously loves me. During the darkest days of my life, when all i could hear was death beckoning me. I contemplated suicide with every waking moment.

Every breath drew blood.

I was unable to envision any road other then death. And i hoped that death would stop all emotions. I pleaded for the pain to stop. Help me to ache a little less. It didn't. I hated the world. I cried. But no one heard. I vented. But all they saw was rebellion. I withdrew. But all they saw was pride. When i talked, all they heard was silence. When i called out, no one answered.

Or so i thought.

And all i was left with, were the taunted whispers. Nagging little voices that egged me to cross that line. Just die, they mocked. And i almost did.

Patrick saved my life.
Sharon Lee gave me strength to continue life.
And i gave myself up to God.

And in an instant, i saw the world from a different perspective. A dimension that was there all along. I just didn't turn the other way. I saw myself arched over the rim of the toilet bowl. My abdomen convulsing. Mouth agape, allowing a passage for the greenish secretions to escape. I pushed my fingers into the back of my throat until i could vomit no more. I could not allow myself to disappear just like that.

I wanted to live. Badly.

There was too much in life to give up. To many what-ifs and could-have-beens. Too many questions unanswered. And too many people i loved to leave behind.

I spent the next few hours in drunken stupor, slipping in and out of consciousness. And when i regained some awareness, i worried about the after-effects of my folly. The questions faded as the voices from loved ones grew stronger. I could finally see their faces. Their faces contorted, testifying the shock and horror of it all.

What the hell happened?

How did things go so terribly wrong?

I could have let myself succeed with the suicide. I didn't tell anyone. I had it all planned out. I had a cocktail of pills and booze. I fed myself the rainbow colours and textures with robotic momentum. This will help, i rationalized.

It was the easiest method to end it all.

But what would that change? Nothing. It would have made things even worse. It was a selfish act that stifled out all the people that meant something to me. And would have erased all possibilities of change.

A paradigm shift ensued. I finally had the courage to lift up my head and open my eyes. I saw people that loved me all around. Their arms out-stretched, their lips curled into a smile. I heard their voices calling out.

They were there all along.

I was the one who didn't realize it.

******************************

Zul puts it simply :
"And sometimes things happen to me at the time that may seem horrible, painful and unfair, but in reflection I realized that without overcoming those obstacles I would have never realized my potential, strength, will power or heart."

"Without these small tests, life would be like a smoothly paved, straight, flat road to nowhere. Safe and comfortable but dull and utterly pointless."

(available online: http://pui5t3r-zlack3r-z30.blogspot.com/ 2006)

******************************

This particular entry was difficult to write and even more difficult to come to a decision to publish. It exposes a side that i would rather remain dormant. And in a perverse way, it refreshes wounds that i thought had healed and become scars.

I still carry the burdens i did before, but this time, i hold no fear, for i am no longer alone.

Thousands of people brave far worse conditions every single day of their lives. I have no reason to end mine. Instead, there is an obligation for a person as fortunate as me, blessed with health and opportunities, to return to society.

And with this, i hope is a start.

I'm thankful that this episode helped awaken a need in me to seek out my religion and in turn, allowed me to find myself.

"I am all i am because of you."

******************************

Come live in me
Take over
Come breathe in me
Take over
And i will rise on eagle's wings
I will rise on eagle's wings

- Eagle's Wings -

I'm supposed to be studying. Trying to make the most out of whatever little time I have left to cram in all the theoretical components of what the semester has bestowed. Instead, I'm more like an actress now.

I'm only acting as though I'm studying.

The world continues to revolve.

I drape myself over the chair in the library. My head hangs over the books. My eyes furiously trying to comprehend the words that skip, hop and dance - mocking me as I try to chase after them.

Apathy envelopes.

I glance up and try to shake away all the madness.

People come and people go. Moving along with frenzied pace. It's as if they're heading towards the same unsaid destination.

Someone tell me where is mine.

The world continues to revolve.

For a large part of the student body, it's the 1st day of their 2nd semester. And their fresh faced, virginal enthusiasm exposing their youth. It's not a bad thing though. I've been there before. Believing I had the power to change any shit just as long as I was determined enough.

Just not so much now.

Lionel talks about friendships and his dreams in his blog.

Moonie writes of sending her aunt off.

Fara updates us with a summary of an outing we had the other day.

And Zul, he continues to explore the option of confessing his feelings towards this girl he likes. Even though it's largely known just who this protagonist actually is.

The world continues to revolve.

Everyone tangled in their own personal drama.

At this time, I realize that I'm not going anywhere just by pointing my face to my open lecture notes. My mind is in an unknown whirl with a magnitude of confusion.

I wonder why.

There's so much that needs to be done. Yet so little time left. As reality starts to burn it's way into my mind - like a farmer searing the hot iron onto the body of a lamb.

An absence of a physical scar does not mean there is an absence of pain.

I feel an emotional callousness seep in.
Pulsating deep through the veins carrying the life blood within me.

And the world continues to revolve.

Someone tell the world to stop.

Someone left me behind.

If you can't help a ten people,
Help 5.

If you can't help 5 people,
Try your damn blardy best to help 1.

And if you've no means to do anything,
At the very least, INSPIRE.

There is no reason to sit back and not do anything.

When you don't say what you mean,

Expect people not to know.

And when you do say what you mean,

Expect people not to understand.

That is what i should remember.

Cherlosophy 2006

Anger is the only thing you'll never rid yourself of, even if you lose it.

Thus far, anger is an emotion i have tried very hard to curb. A habit that's hard to break. And the week has been filled with much drama.

Too much.

Seriously so.

And when mixed with lethal doses of a nagging deadline, the stress of assesssments, failure, smart-ass comments, relentless long days at school and a lack of sleep... it blows even the minor situations into one of unparalleled holocast.

For one, i'm not particularly proud of the way that i handled the group work with Fad. I had blurted straight up that she had to get down on her hands and knees and take an active stance with the group. Afterall, we only had one and a half freaking days to prepare for the damned presentation. And i've realized that spitting (though not literally) at her in front of everyone else is simply not acceptable.

The only salvaging point is that : she did manage to see the light and come through.

A little.

But more needs to be done. And my groupies did do wonders for the presentation. Even though our work was blatantly discriminated against. I'm apologetic towards my group mates - because it's largely because of the vandetta the Black Witch harbours towards me.

Number two - I screamed the daylights out of myself (until i was dizzy with the lack of oxygen feeding my brain) to the woman who was manhandling her young child in public. Pointing and hurling threats at her to make her stop.

She didn't. Even as she climbed into the back of the cab, pulling a large wad her little girl's hair.

In retropect, i had instead, just mimicked her atrocious behaviour.

Violence begets violence.

What i should have done was to run up and speak to her calmly and hopefully, instill the virtue that things could be done in a different way.

In a manner of civilized calmness.

I'm aware of the pressures a parent faces - i should know, purely because i can reflect on how i used to treat my Dad. And how irritating children can be - same reflection, i was so damn out of hand. But shaking your child, pulling her hair and pushing her into the backseat of a vehicle is simply - damn blardy unacceptable.

There is a difference between discipline and abuse.

But before i bury my face in my hands in self pity. I will not find any excuse for regrets. Simply because i have learnt my lesson in all these.

And having witnessed the drama of battered egos of unreciprocated love, the foul moods of the hungry (yes, i'm mentioning you clearly here) and the continued torments of Lionel (who happened to turn '41' this year! Happy Birthday dude), remembering the young teen who was beaten up at the staircase by a gang a few months ago, among others...

It highlights on the ill effects of letting your emotions get the better of you.

There's a lesson to be learnt here i tell you. An a very valuable one.

I'm reliving the methods i used to manage my anger. Digging out my old cross stitch needles and thread, and engaging in repetitive distraction. Jewelry making. Reading. Blogging even.

All with a good cup of thick, sinfully rich, iced cold milo.

Though i admit there have been highlights to my week - i'm lucky enough to experience Ms Tan Chin Hong's care for her students, my supportive classmates, Joey being in a fab mood and such a gentleman (hohoho), a good week for Sharon Lee after her own mini series of drama, and my family - who's always and forever there.

It's time to allow the storm to pass through and settle into calmness again.