Smile

Life is not always filled with rainbows. There are times when rains would continually shower and no trace of the sun's light would be seen. There would be days when the sky would be cloudy and you'd think that the day would perfectly go well. All of a sudden you'd be shocked to see a storm coming out of nowhere bashing everything on it's way and leaving nothing but a perfectly designed wreckage - A wreckage that may mean either two things : A sign of moving forward and keeping all your hopes up or  a sign that you're a constant mess and your life would continually be dull. How you perceive and project it in your own life would totally depend on you.

People around me would often describe me as a very strong-willed person - a person who is all the time optimistic about his life,  a person who always smiles and acts happily crazy despite adversities, a person who lives a very easy and happy life. What they mostly know about me is somehow slightly the opposite. I too have my own miseries in life. I also have my fair share of failures in life - more failures compared to success.

When I was a kid, I dreamt of being a successful person. I was a very good student at school. I continually pursued my goals in life because I knew that in the end that goal will be a reality. I kept fighting my way through - studied really hard and burned my midnight candles. I even matured early compared to my peers, always thinking critically and outcome-oriented in making  decisions. I thought life would be happier when I finish school and would land a great job that will pay-off all my hardships. I thought things would be easy along the way.  But the harsh reality of it all, life would sometimes suck. What you expect to happen may sometimes not happen. And the worst thing you'd possibly pray wont happen sometimes end up happening. All the hardships and sacrifices you've undergone would sometimes be repaid but not in full. In the long run you may have regrets - Regrets stemming from thoughts that still haunt you to this day. You'd continually question yourself, "Was it all worth it? Was it all meaningful?"

I wanted to be a rebel teen back then, but thoughts of keeping myself out of trouble and bringing added shame to my parents and family hindered me. I was different, a teen having his own world. I had a different attitude and views about life compared to my other siblings and my peers. I was always afraid to commit mistakes and would often see it coming and stop it from happening. I'm always one-step ahead and I often learned from other people's mistakes rather than experiencing it myself. I always isolated myself, kept myself apart from them all. I would often make excuses when friends invite me to parties and events and that left me being a lonely person. Slowly one after the other, friends disappear and only a few remained. Again it left me thinking, was it all worth it?

As a person, I acted rationally with a touch of a little sensitivity. Rational because that's how my father taught me to be, that one should always use his head in doing things and that there's no room for mediocrity. Sensitivity, that's what my mother taught me. She has always reminded me to use my heart in weighing things out, whether that decision would be good for the sake of others or just an action stemming out of greedy intentions. I like better what my mother taught me, because I get to see how people feel and get to be empathic. I always considered the feelings of people around me before deciding matters. I see to it that no one gets hurt or offended when I make my decisions. This is my strength as a person - being rational and sensitive. Although having this personality is good, it also serves as my vulnerable side and people would often take advantage of it when they get to know me indepthly. That's the down-side of being me. Despite of my actions and good intentions, no one seems to appreciate it. It seems that my effort was not enough. People around me would remember me for the good times, but they soon forget me when bad times happen. I wanted to be a bad person  but the good nature that my mother inculcated in me still stems out. No wonder I became a nurse. It wasn't my first choice though. I dreamt of being an accountant, an engineer, an architect and even becoming a doctor, but seeing my father having a very stressful work with no time to smile and always carrying a grumpy face at home, I decided to take a different path. A path that I wish was all worth it.

Sometimes when I'm all alone, I get to remember my past experiences and would sometimes wonder if all my sacrifices was worth it - if all my decisions was worth it. Because if they were, I sure hope that I get to reap all the fruit soon.

It pains me to say that I hate being me and that I should have been a different person - that it would have been better if I was not the person I am now. But still I believe that things happen for a reason and that God alone knows it - that each one of us has a purpose in life and it's up for us to find and discover it.

Though my life now is constantly being battered by life's uncertainties, I'm still somehow hopeful that my better days would come soon. That the dark clouds above my sky will soon disappear and that after the storm I would find a pot of gold at the end of the rainbow. I'm still looking forward to find useful stuffs from the wreckage of the storm and use it to build a better house someday.

I'm still wearing that infectious smile, hiding my miseries away.^_^

Enjoying Failure

Failure is a realization of what we're not capable of doing alone. It's a realization that in everything we do, we should always walk hand in hand with God. When you do that, you won't feel depressed and useless. Instead, you'd feel blessed and inspired to keep on achieving greatness.

When your pair of shoes are undergoing wear and tear, it's a good habit to ask God for a replacement. He never fails to provide us what we need. It's a matter of admitting that we can't survive Life without Him. It's good to always walk with Him, 'cause you might never know when you need another pair of shoes. But if ever He's not around to provide one, we could always sit down and rest, stop for a while and see the wonders of His works. Slowly you would see that everything is provided around you. It's a matter of using the Will and Knowledge that He has given us to make something out of His creations.

Give room for failure, but don't make that room big enough to cloud your mind of what you are really capable of. Make that room a size of a match-box, so that you could carry it with you always. It's a reminder that nothing's perfect, and humans are prone to committing mistakes rather than doing good always. That slight imperfection is a great ingredient to one's success in Life. It's a strong motivation to keep on reaching perfection, if not near-perfection. And once you reach that goal, always look in to your pockets and see the match-box again. It's another reminder that God walked through with you during your ups and downs.

So when you get tired and feel hopeless - feeling like a failure, always remember that He's with you. You only need to look around you and feel His presence. Once you'd do that, you'd find Life worth living. You'd be enjoying every endeavor without feeling the push of negativity around you. Everything will be a breeze when you walk with God - when you live life with God.

Cheer up and Smile always!

Life as a Nurse

Life’s a breeze when you fly along with it.

Decades ago, Nursing as a career was very famous. I remember way back when I was still a fourth grader, I told myself that I’d be a nurse and would follow the footsteps of my cousins who are successful nurses working abroad. I remember changing my first dream of becoming an accountant to becoming a nurse. Filipino nurses were in demand back then, and our country continuously produced quality healthcare professionals. Being a nurse for me projected an image of success, and so as a kid I motivated myself to become one.

Years passed and the demand for nurses abroad started to decline. But that didn’t hinder me from taking up nursing as a course in college. Back in 2006, my journey to the nursing career started its course.

Life in college was a mixture of a breeze and a hurricane. I have proven that studying nursing was no joke. Indeed you have to burn your candles at night to survive it. There are many factors that would affect your survival in studying nursing: First, your family needs to be financially stable to support your study. I have a few friends who were forced to give up their dream just because their parents could not afford to. A few would get scholarships just to have the education, and some would stop for a while to get a job, work for a year, save money, and re-enroll themselves after skipping two semesters and one summer and find themselves left behind by their batch-mates. You would be spending an estimated maximum amount of one million pesos in taking the course. This at least is true in our region. If you would take the course in Metro Manila, you would likely be spending more than a million peso. The course is very expensive. You pay your internship in the hospital and end up being a catch basin for everything – that if you know what I mean. Second, you need to be intelligent, if not, hard-working and self-motivated. Studying nursing is really not a joke. You need to have good attitude, critical thinking and the skills to adapt to a continuously changing environment. You have to study different diseases, know what causes them, how they progress and the treatment needed to cure them. You need to have this knowledge so that when you practice the profession later on, you would know how to properly execute the doctor’s order and know if the treatment is really necessary for the patient or not. Nurses are molded to become patient advocates because they are the ones who constantly interact with the patients. You also need to acquire medical assessment skills and continually sharpen them. This is needed so that nurses would know if the patient is having good progress or the patient needs another referral because abnormal findings had been found. You also need to know how to distinguish when and how to execute independent nursing actions and do those actions based on your nursing diagnosis and continually assess and evaluate them and the progress of your patients.

As a student nurse, we were required to have a minimum grade of 2.5 (80-82%) in each nursing or nursing-related subject. This was necessary in order to ensure that our school continually produces quality graduates and that the school’s product won’t have the difficulty of facing the real word of nursing as they set foot outside the portals of the college. Having a grade below the cut-off would give you two options: First, you would have to come back next year and retake the subject(s). Second, you could opt out to transfer to another nursing school. Either way, both options is a no-no; flunking a nursing subject would be a GREAT NO-NO! Again, you can’t afford to flunk and spend much again. Third, you really have to love your course or at least pretend to. Some of my friends really took nursing because it’s their childhood dream and that they belong to a family line of nurses. Some took the course as a preparation for Medicine. This bunch of people did really excel in taking the course because they love it and they have the passion for it. On the other hand, a few of my friends were forced by their parents to take nursing. They had to study nursing because they had to or else they would end up being a “tambay” in their home. At that time they had no choice because their parents won’t let them take other courses, because according to their folks nursing will provide them a bright future. That their “titos” and “titas” abroad would help them have a career. That life would be a breeze after graduation. For the first two years in college, these friends of mine had the difficulty of coping up. It was really hard for them to swallow nursing; hard for them to really love nursing. But somehow along the way, a few of them eventually learned to love the course. As for the other few, they transferred to other nursing schools. They were not able to meet the cut-off grade and they had to take the course from the start and spend much again. This is the reality surrounding the lives of student nurses and their family.

It was year 2007 when The United States of America had the recession. This event markedly affected the global market. It also affected the plight of career of nurses here and abroad. As a student nurse, we didn’t feel yet the impact of this situation in our future career. I guess we were still naïve at that time. We were reluctant that such event will have a solution soon and that there would still be an abundant career ahead of us. And so there we were, busy in our student nurses’ world. Not minding what life is after college.

It was school year 2007-2008 and I had my first exposure to the hospital as a nurse intern. Student nurses’ life for me back then was a hurricane. Hate to admit it, but before I decided to continually pursue my life in nursing, I had doubts. I was not that confident before. I even had the idea of transferring to another course and pursue my first dream of becoming an accountant just like my father. I said to myself that nursing is a pretty hard job. You really need to have patience and a very wide understanding of every situation, because if you don’t you will end up crying secretly. And I did cry secretly after duty. I even said to myself and to my mother that nursing is not for me, and that I only want to use my head for work, not my head and my hands. I had an uneasy feeling towards nursing before. But then again, my principles in life prevented me to transfer. I said to myself, “I’m already soaked in water, why not swim”? I just have to keep moving forward.

In the same year, there was a sudden turn of events in my life. My father had stroke. It was a very difficult time for our family. This event made me realize that I should really embrace my course. That in times of sickness, I would be the person to whom my family will receive comfort and care. It was really a hard time for me. I was in a dilemma, having difficulty maintaining my grades and projecting a worry-free image in school and at the same time attend to my family’s emotional need. I wanted to contribute something; I wanted to do more, but then again I still lack some skills and knowledge regarding my course. While on duty, I would constantly think about my father when doing patient care. I kept the idea that when I do good things to my patients and treat them as my family, the nurse who is taking care of my father would also do the same - that they would make him feel comfortable, that they would change his diaper properly, that they will monitor hourly his urine output because he has an indwelling catheter, that they will prevent any hospital-acquired infection from occurring. But to my dismay this didn’t happen, though he was admitted in a well-known tertiary hospital in our region. But don’t get me wrong, Filipino nurses are still the best in the world in my opinion, and I strongly believe that our region produces nurses with Tender Loving Care (TLC). There are still a lot of nurses in our country who do their job well and still with passion. Going back, the event that had transpired in my life motivated me to continually do my best and do well with my patients.

The succeeding years were slightly a breeze for me, though I still have to burn my midnight candles. Everything was going fine until I lost my scholarship. It was my fourth year in college when I lost it. I was kind of sad and worried at first, but then my family understood my situation. They knew how hard it was to maintain my grades. Losing my scholarship didn’t hinder me from giving out my best. I never lose my optimism and faith in God. I continually believed that everything happens for a reason and God has a good purpose behind it.

Year 2010, we all finally finished our degree. Some finished it by March, others by October. I’m an October graduate due to my scrubs. It was hard for me back then because I had to review for my licensure and at the same time attend to my Delivery Room (DR) scrubs. This was also true with my other batch-mates. We had to finish it all up to be officially called a Bachelor of Science in Nursing (BSN) graduate and that we could take the licensure examination on time.

We all started reviewing for the licensure exam April of 2010. In our school, it’s a custom that all nursing graduates should take the examination December of the same graduation year. This was to ensure that everybody passes the board exam. It’s a good thing though that our school has its own affiliated review center. Unlike other review centers, our school offers its nursing graduates seventeen thousand pesos for the review. The price is not too bad considering that they provide us excellent review materials, seven months of review, plus high caliber reviewers. That was during our time. Nevertheless, I’m happy that my alma mater supports us all throughout the way. Other review centers in our region would charge a minimum of twenty five thousand pesos. Review centers in Metro Manila would charge beyond that. The maximum would be forty thousand pesos.

Just to make it brief, spending never ends upon a student nurses graduation. It increases as time goes by depending whether you’ll hit your exam only once or be repeating it unlimitedly. Even after you pass the exam, you’d still be spending more along the way. That if you know what I mean. The only time your parents won’t feel the burden of supporting you will be when you’ll be having a promising job as a nurse abroad or when you’ll be working as a Business Process Outsourcing agent in the country.

Now going back to my journey, February 2011 the Professional Regulatory Commission of the Philippines announced the successful passers of the December 2010 Nurses Licensure Examination. I was blessed and privileged to be included among those who made it through. Tears flooded my eyes because finally, I will be able to practice my profession as a nurse; that I will be able to reap the fruits of my hardships. While I was having tears of joy, a few of my friends and other batch-mates were having tears of dismay. They were so eager and motivated to pass the licensure exams, but then they still did not make it. While others are busy partying for their success, some are depressed; ashamed to go out of their house and meet people. Dreams were partially shattered. This continued for months until all of us are finally facing the reality of our future in the nursing world. At first I thought I was the only one thinking this way, but to my surprise my friends and classmates were also having the same realization. Parties ended, smiling faces looked serious, no more daily or weekly money allowance, happy parents turned to sad ones. This is the reality surrounding the lives of nursing graduates and their family.

It was October 2011 when I first had my experience as a licensed nurse. A few of my friends went with me to have our training in one of the premier tertiary hospital in our region. Others went to have theirs in district and provincial hospitals. It’s a good thing that we didn’t pay a single cent for our training. It was totally free.

So there we were experiencing first-hand what a licensed nurse is experiencing. No more Clinical Instructor to guide us around. The risk was all ours. I spent three months training as a staff nurse trainee. Since I’m no longer a student nurse, gone are the days when I get to have two to three patients. When I started practicing my profession, I started to handle seven to ten patients. The word seven may sound simple to any person, but it’s a dread actually; ten would be super dread. Seven would be a good thing if all of them don’t have a complicated case. But when you have seven, and three of them have complicated conditions, procedures or treatments, you won’t even recognize the word “Lunch” or “Break” anymore. The moment you see a new doctor’s order, you need to carry it out right away to manage your time effectively. You need to prioritize what you need to do. When a patient calls in from their room, you immediately go and see what the problem is. The moment you go out of the room, you’d find yourself having a lot of orders to carry out and procedures to do, not counting the monitoring you need to do every four hours to patients with manageable conditions and hourly monitoring of patients with complicated conditions. You also need to prepare the medications and see to it that you’d be giving the right medication with the right dosage and timing to the right patient. You also need to do your documentation for legal purposes. It was hard for me at the start. Constant adjustment was needed, but eventually I got used to it. Good thing the staff nurses were good and were freely available despite the workload to help me out and guide me. What I’ve been through was nothing compared to what my friends and batch-mates had in the district and provincial hospitals. Unlike private tertiary hospitals that have three to four staff nurses with three nurse trainees in a shift, district and provincial hospitals would have one to two staff nurses with one nurse trainee altogether handling thirty patients. According to a close-friend of mine, when he was in the district hospital he was made to handle thirty patients alone. Yes, alone without any assistance coming from the tenured or contractual staff nurse. Imagine him doing what I’ve just mentioned above to thirty patients. His staff nurse was not afraid to compromise patient safety. Good thing my friend is flexible, conscientious and God-fearing. He still managed to handle all of the patients without incurring any error.

I had this experience once. There was a time when I was rotated to the Intensive Care Unit (ICU). I have this comatosed patient who was prone to seizure. He has a Nasogastric Tube (NGT) used for his feeding and for his medications. Since he was prone to seizures, his physician prescribed him Phenytoin (Dilantin). I anticipated that the drug form prescribed would be given intravenously (IV), but as I checked the order the drug form was in sustained-release capsule. Due to my training when I was still a student, I made a curious inquiry with the staff nurse that I was with. I told him politely that the doctor prescribed the wrong form and that we should notify the doctor or the resident on duty right away. I told him that the capsule form should not be crushed and not be given through the NGT and that it must not be given with the feeding. To my surprise, the staff told me that we should let it be because we must not bother the residents; because they are busy making rounds. I told him that it would be useless for us to give the capsule form because we won’t be achieving anything. The patient’s family would be spending much on the medication without achieving any positive outcome. It was not cost-effective. Again, to my surprise (I’m always surprised) he told me that situations in books doesn’t always apply in the real world; that things written in the books are theoretical. That was a stunning moment for me. A week after, the patient died. Not because of the staff nurse, but because of the complications of the patient’s illness.

In my opinion, he was so naïve. I expected too much from him. Knowing that he’s been in the practice as an ICU nurse for three years, he should have known better. What is written in nursing books is evidence-based now. Even if some parts are theoretical, these books serve as a guide for nurses to effectively manage their patients and safely do their job. If we don’t do the accepted standards of nursing care, how can we help our patients achieve a fast and cost-effective recovery? The family still opted for the treatment to continue because they still hoped for the best. The patient is in coma and is nearing death. The situation seems hopeless, but that is not a good reason for a nurse not to do his innate job description – a patient advocate. He has forgotten that nurses are patient advocates. He willingly compromised his patient’s safety. Patient safety is always a priority no matter how complicated or hard the patient’s case may be. Again, please don’t get me wrong, I strongly believe that Filipino nurses are still the best in the world. There are still a lot of nurses in our country who do their job well, still with passion and patient advocacy.

Nurses are the only workers working beyond the hour without having an overtime pay. At least for some this is true. It’s because we do what is necessary to help the patient recover at a faster yet effective way. We could not afford to risk patient safety and recovery just because our shift is over.

Nursing is not only a profession. It’s also a calling; a devotion. When you do this job without your heart in it, it would be very difficult for you to cope up along the way. You’d easily lose the privilege given to you; you’d easily lose your license. I strongly believe in the idea of reciprocity and good karma. When you do good things to others, expect that good things will also happen to you. If doing good doesn’t repay you, keep doing what you think is right. It’s the feeling of fulfillment that counts.

Going back to my journey, I finished having my contract as a nurse trainee January of 2012. I left my province to venture in the busy world of Metro Manila; hoping that my three months experience would be good enough to help me find a job. It was hard for me then to find a career in my chosen field. Nursing career in the Philippines was scarce and still is. New Registered Nurses are forced to work outside their field because they could feel the pressure of being a grown-up burden to their family. Some would work in the BPO industry, some in the Real Estate Industry, a few as private nurses. This is the reality surrounding the lives of registered nurses.

It was not easy from the start. I would look for hospitals to have my training with. But the only difference is that in the Metro, you would have to pay for your training. And paying the training won’t be a guarantee that you’d be hired after. Though I have the full support of my family financially, I could still feel the pain of being a burden. I could not afford to let them spend anything for my training. So there I was. I continually looked for hospitals that offer free training.

Hate to admit it, but whenever I see employed nurses walking in the street wearing their white uniform, I can’t help but to feel sad and unfulfilled. There’s a room in my heart that questions me why I took up nursing; that a promising career awaited me had I taken accountancy. But then everything happens for a reason. And God alone knows it. All I need to do is to be at my very best always. Not minding my progress but enjoying what I love to do most.

August of 2012, I received an email coming from a well-known hospital in the country. I was up for an interview. I was so happy that time and was also nervous. My sister encouraged me to be Optimistic and that I should always project a positive attitude. Good thing she was there to support me emotionally. I managed to pass the initial screening.

The initial screening was nerve-wracking but was worth my time. I get to gauge myself more and see the possibilities for improvement. It was no joke to be called-in for an interview. You get to meet applicants having more qualification than you do; applicants coming from well-known schools in the Metro and in the entire country. In was a humbling experience for me. Your knowledge in nursing will be tested. Not only that your personality, skills and attitude will be gauged as well.

Passing the initial screening won’t guarantee you to be automatically qualified for employment. You still need to pass your medical examination in order to make it to the third screening. It was a good opportunity that the hospital provided a free medical examination. I’m grateful for it because it’s rare to find such opportunity nowadays. Thanks to God, I managed to pass the second screening.

A month after, the third screening ensued. We were interviewed by the officials coming from the nursing department. It was another nerve-wracking experience for me. You’ll be asked questions relating to your previous experiences as a volunteer. The questions covered all the eleven key areas of nursing competency in the Philippines. After the interview, we were told to wait for a final call telling us if we did make it or not. It was an agony for me to wait. I had to. Such opportunity just can’t be wasted.

October 8, 2012 I received a bad news coming from the province. My mother had stroke. My big sister and I booked a flight to go back to Iloilo City. We went home by the next day. It was again a hard situation for our family. My siblings and I were in a dilemma. We were torn between keeping and telling our father and big brother the real situation that our mother was going thru. My father was in Las Piñas back then and was not aware of the situation in the province. My big brother was out of the country. Good thing that my sister-in-law is also a nurse, she and my other big sister decided to admit my mother to her department. My sister-in-law is such a devoted nurse. She painstakingly took care of my mom when I was away. She was on duty that day, but she still managed to look after my mom and her other patients. This situation inspired me more to do what I love most. Nursing is such devotion, that even when your shift is over you still act as a nurse in your home. No one could take care of your family better than you do.

October 15, 2012 I received a good news from Manila. The hospital called me and told me that I made it through and that I should prepare all the requirements for training; that training will ensue by the next year. I was happy that time. Tears of joy run into my eyes. I had to tell my mother the good news. She was so eager to get well upon hearing it and was filled with such enthusiasm to adhere to her medical treatment.

A month after, I brought my mother with me back to Manila. We all decided that it was best for her to be near me so that I could take care of her. I had to bring her with me for I know that the first three months post mild stroke is a critical period. The infarct in her brain may either heal or worsen.

December 23, 2012 my mother had stroke again. It was seven in the morning when she woke me up. She told me that she’s having difficulty in swallowing and that her tongue feels heavy. So I took her vital signs and tried to see if there’s any abnormality. She was gradually deteriorating, and I honestly didn’t know what to do. It feels more different when emergencies happen real-time in your family. You may sometimes forget your knowledge as a nurse. You may even go blank and forget you’re a nurse.

My big sisters and I went to find a hospital for our mother. We’re not yet knowledgeable of any good hospital in the vicinity. Time was running out and we need to have our mother be admitted and treated right away. We finally found a seemingly good hospital and had her admitted. She was in the ICU for two days and was transferred to a private room after. We stayed in the hospital for a week and spent our Christmas there. It was the saddest Christmas ever. This sudden turn of events in my life did make me sad. It was so much to bear, but it made me a stronger person. It made me more sensitive to the needs of the patient and his family, because I have been a patient’s family. I never lost hope and faith in God. I still believe that all of us will have our better days. And that each morning may be the start of a better day. It’s a matter of having the right mind-set and having the right people surrounding you.

My journey in life as a nurse may just be starting. But I really value every encounter. Sharing my life events as a nurse is a way for me to share optimism. It’s a way for me to let my co-nurses and future nurses know that we are not alone; that one’s struggle is also a struggle of another Pinoy RN. We all could still attain the dream that we hoped for. Even if we don’t practice our profession in the area where we really want to be, we could still touch other peoples’ lives and let people see that nursing is a dignified profession with a heart and soul.

Keep on dreaming. No one could tell you what you are not capable of. Just believe in yourself. Have faith. Have hope. Never forget where you came from or the people who had helped you reach your dreams and aspirations in life. When you stumble stand-up, learn and keep on doing what you do best. When the world tells you to give-up and makes you feel like giving up, smile back and keep moving forward. Be the good change that you can be. And as you journey along the way, remember that when you lose your purpose in life that’s the time when conflicts arise. Never forget your purpose in life; your principles. It is your guide. And finally, never forget to walk hand-in-hand with God. He is the best-friend you’ll ever have.