Saturday, February 27, 2010

Collective low morale

3 incidents happened over the last 3 weeks. A place-mark to note the events. It is not the appropriate time to write more about the matters, as the storms have not settled yet.
  • 10-Feb-2010: Febrile fit case that was sent to ICU, mentioned on-the-fly here.
  • 18-Feb-2010: Strange smelling drinking water, which brought back collective unhealed memories of another water related complaint.
  • 21-25 Feb-2010: Another febrile fit case, ?UTI, that became lymphadenitis.
Add to the above, the recent low number of paediatric patients resulted in adult patients of various acuity (including one on telemetry) overflowing into the paediatric ward. The collective morale of the staff at work is low this week, especially amongst the senior SNs who had to bear the brunt of the heat. They felt that the management, as represented the comments from ADON G, is not giving staff the necessary support. This includes the nice night-shift senior SN R whose previous night nursing partner resigned with 24 hours notice just a few months back. I have personally heard all except 1 of the senior SNs verbalising plans to leave. This time around, it's not merely their venting of frustration. Some are already paving their way in that direction.

IMHO, the incidents are not caused by poor nursing. However ADON G's comments, as mentioned by the senior SNs, seem to push the blame in the nurses' direction. [Ironically, even the consultant doctors are not blaming the nurses but are fighting on our side.] As a result, the younger SNs and the ENs are worried about the what-ifs. After several near misses, what-if one day a near miss becomes a hit, and our individual nursing license is affected? The older staff are questioning why they would want to suffer so much stress when they can afford to retire and enjoy life.

As for me, I had 2 thoughts on my mind.
  1. I am not surprised by the senior SNs' reaction to ADON G's comments. My personal experience of her lecturing sucks.
  2. I hope that the senior SNs will stay around longer, at least till after I relocate to Canada. In some ways, their presence and support make ward nursing more bearable.

Sunday, February 21, 2010

One more friend in Canada

Just received news from a friend and ex-classmate. She is already in Canada!

She had mentioned to me earlier this year when she received her COPR (confirmation of PR) that she would be breaking her bond and leaving for Canada. I didn't realise then that she meant with immediate effect. She has her reasons. Her previous nursing environment was a contributing factor.

For me, my days are still of ups-and-downs. Today was a pretty good day though, 5 patients in each team. All 4 afternoon staff had the chance to eat and chat over a quick dinner, which is rare and unlikely to happen if the ward manager was in-charge. SSN R told me about a high-calcium UHT milk item on sale, that today was last day of sale. At the end of the shift, I rushed home in time to buy the milk on sale, including orders on behalf of my night colleagues. That was fun! :-)

Friday, February 19, 2010

Thoughts upon entering mid-life

A close friend asked how I was doing. My email reply captures my thoughts upon entering mid-life.


Hi [Edit: TGC],

Yes, I am recovering and my appetite is back to 2 full meals a day and a light breakfast. Full recovery would take some time. Afterall there is another wave of paediatric cold and gastro-intestinal illnesses and children cough at my face daily. [Edit: Sometimes they even spit oral medication onto my face.] :-P Wearing a surgical mask at work (unfortunately discouraged by my ward manager and ADON) reduces the chance of me spreading my pathogens to the children, but it does not protect the wearer effectively. Thus, I am usually worse-off at the end of the shift, with or without surgical mask.

> Meant to contribute something on universal healthcare thread -
> we are struggling with that here due to moral hazards it brings. Maybe too late now.

I'm not sure how the moral issue of universal healthcare can be resolved. Think I need the exposure to the other healthcare, welfare and governance schemes.

Early this month, my uncle has just been diagnosed with stage 4 (final stage) lung cancer which has spread to the brain and bones. Although the life expectancy is only 3-6 months, the cost of care for this short period will be high because healthcare is "means tested". [Edit: That said, the TTSH team did a good job when breaking the life expectancy news to the family.] Both my uncle and his wife are retirees and their 2 daughters are still in tertiary education. [Edit: I think one would graduate soon but a fresh graduate's pay is unlikely to be high.] Unfortunately, they assumed that the standard government schemes of Medisave (CPF compulsory savings for medical expenses), Medishield (CPF basic hospitalization insurance) and Dependent Protection Scheme (CPF life/total-permanent-disability insurance) would be enough to minimize the out-of-pocket cash expenses, which is not the case. Thus, affordability is an issue.
[Addendum on 9-Mar-2011: This turned out to be a difficult period in my life. From events that followed, I learned of my mother's attempt to rip me off (yet again). The impact on my psyche is nonetheless significant, see my comment dated March 9, 2011 12:53 AM on StorytellERdoc's blog entry.]
Sometimes, I wonder about work and life. How long more can I stay fit for the job? Given the physically demanding nature of ward nursing and the daily close exposure to pathogens. I also wonder about the pros and cons of relocating. Moving to Canada means starting over again, almost from scratch. However, whenever I think of Singapore's stingy nanny approach to its citizens' healthcare and welfare, I feel compelled to relocate. As the Chinese saying goes, "birth, ageing, sickness and death" are events that everyone goes through. [Edit: “生老病死”是人生必經之路。]

Occasionally, I wonder what my life purpose is. Although only less than a year at work, I already don't quite feel that I am learning/growing as much as I wish at my current job. [Edit: I think it would be more precise to say that I do not feel that I am stretching myself and making the best use of my strengths and variety of interests.] Often, I feel too tired after work to pursue my personal interests and development. On some inspired moments, I dream that I would be doing research on the brain and psychology/ESP related studies. E.g. EEG and CT/MRI scans of the brain while the participant performs "ESP" tasks. I don't know if or how it will happen. Guess it's the same as years ago as a fresh graduate, I dreamt of a $50K/year salary and somehow it happened after a few years into my first career life. That said, my thoughts fluctuate between the idealism of hope (as per this paragraph) and the apathy of a recluse (preceding paragraph).

[Edit: snipped]

Best Regards


[Addendum on 24-Feb-2010] Online commentaries on migration.

Mr Wang Says So: Local & Foreigner - Little ironies in Singapore. Read the comments, they are interesting.

The Online Citizen, "Many Singaporeans want to migrate - Why?" by Leong Sze Hian

Wednesday, February 10, 2010

Loss of appetite

As mentioned before, I lost my appetite since Monday 08-Feb-2010 evening. Here's what I ate from Monday evening onwards.

Monday evening: Instead of a proper dinner, I had some clear fluids (juices, sports mineral water) and a cup of milo.

Tuesday: Besides clear fluids, I could only eat 1 slice of plain bread with a packet of milo.

Wednesday: Besides clear fluids, I managed to eat 1.5 muffins and an egg love-letter roll.

In addition, the dusty environment at work had triggered a runny nose, an itchy throat, cough and flu-like symptoms. I was somewhat worried by Tuesday night, because early symptoms I previously had of pneumonia was a week-long lost of appetite and flu-like symptoms. To assuage my concerns, I went to the hospital's A&E after my shift ended on Tuesday evening. The A&E doctor assured me that my lungs are clear and sent me home with some prescriptions.

As it turns out, I am not the only one suffering from the dust caused by our workplace renovations. On Tuesday, SEN MY was sick on MC [medical certificate in support of sick leave] for cold. Today, senior SN Y was coughing on-and-off and notably clearing her throat. Senior SN Y remarked that she associated her condition with the workplace renovations.



Thursday 11-Feb-2010: Started off well with 1 cup of miso, half a muffin, and a bottle of Yakult. Had to rush from TTSH to my hospital for the afternoon shift, and thus skipped lunch. Took over from SN J from the morning shift who practically left all orders from 1pm onwards undone [our shift ends at 2:30pm]. Thus my workday started out with several simultaneous urgent issues and the pace did not settle until 6:30pm, but picked up again at 7pm till the end of shift. Thus, I only had a chance to drink some water and eat an apricot-custard bun after work. Total intake was Poor to Fair. My throat is getting scratchy and my voice sexily hoarse. :-P

Friday 12-Feb-2010: Drank a pack of milo and ate a small red bean bun for breakfast. Snacked on 2 Chinese New Year pineapple tarts. Had a bowl of creamy of broccoli soup and 3/4 of an egg-mayonnaise sandwich for lunch. Finished the remaining 1/4 sandwich at dinner. Also managed to drink and retain lots of fluids. Although my running nose is still on a marathon, I am glad that my GIT (gastro-intestinal track) is recovering. Yeah!

Wednesday 17-Feb-2010: It is only today, after more than a week, that my voice returned, my nose stopped running and I am able to eat almost the normal amount for lunch and dinner. However, there is still the occasional mucus and phlegm in my nose and throat.

Tuesday, February 09, 2010

A spoilt brat and his parents

I had lost my appetite since Monday evening, and had nausea since Tuesday morning. Thus, I only had some fluids since then. Add to that, yesterday was a busy day. 13 patients in all, including 2 admissions and 2 discharges, and a couple of cases that upgraded from 4 bedded rooms to double rooms.

Amongst these up-graders was a spoilt brat. Only 3 years old but he has both his parents twisted around his little finger. The worse part is both the parents show their love by pandering to their son's every silly little preference. E.g. Nebulizer whenever he is asleep, disregarding the 4 hourly timing ordered by the doctor, i.e. bring forward or backwards by more than an hour, and even skip doses.

When the boy's neighbour was discharged, the parents wanted to switch to the window-side bed and change to a cot bed for the boy. The parents kept harassing the staff to change his bed quickly and repeatedly, even before the neighbour had left the ward. When that was settled, the child moved to the cot bed. He kept jumping around on his cot bed, but neither parent would discipline the boy for his behaviour or advise him of the risk for fall or stay close to prevent falls. It was up to me, the "nasty nurse", to warn the boy of the risk for fall since the mother insisted on not having the cot-side up.

When it came to IV antibiotics, the boy kicked me, but the mother did not do or say anything even though she saw it. So it was up to "nasty nurse" to tell the boy, "Now boy, do you know that it is rude of you to kick others? You don't kick your friends, do you?" Only then, the embarrassed mother made a half-hearted attempt to get the boy to apologize, but of course the boy refused.

Due to his active nature, the IV cannula had backflowed and was leaking. Thus we had to bring him to the treatment room to check his IV site and re-splint the arm. The mother kept telling the nurses (all 3 of us) "Don't press on him, it's painful!", "Don't hold his hands so hard!", etc. Mind you, we were only holding down her boy to re-secure the IV cannula so that her son does not have to go through another round of pain from IV re-site. We had to explain to her repeatedly why we had to hold down his hands, and that we were minimizing any discomfort. She was obviously not convinced because she started saying her prayers aloud while we were working on her son.

Come evening when I had to give the boy his medications, the boy refused and the mother did not do anything about it. Fortunately the boy's grandaunts were visiting and they were not into such nonsense. After wasting 2 sweet chewable Singulair tablets because the boy spitted them onto the floor, I crushed a 3rd one and had to force feed him using the syringe. Initially, the grandaunt was attempting to feed him while I held down his hands. Due to the boy's struggling, we swapped roles. While we were feeding the boy, the mother kept say "Don't hold his hands", "Don't hold him so hard", etc.

By then, there was already a new admission into the other bed. Someone complained about a spoilt headset and the technician came to fix the problem. Apparently, someone had pulled the headphones plug off the spoilt brat's TV and blasted the TV volume up loud enough to be heard throughout the room. I advised the mother that I had to put the headphone plug back on, so as not to disturb the neighbour's rest. The mother refused to allow me to place back the headphone plug, citing that she would lower the volume instead.

Just before the end of the shift, the mother decided that indeed the child was too active to be on the cot bed (which was high) and wanted to change back to the adult bed. SN J, as in-charge, has had enough of her requests and instructed me to inform the mother that the hospital is full and we will try to arrange tomorrow instead.

As with other young spoilt brats that I have met, one only have to look at the parents or the main-caregivers for the reason.


[Addendum on 10-Feb-2010]

I was taking the team caring for the above child again today. As per the parents' preference, I gave the nebulizer at 2:30pm while the boy is sleeping, instead of 4pm as scheduled. The boy is a sound sleeper, did not wake up at all during the nebulization.

As today's workload was lighter earlier in the evening, the mother and I spent 40 minutes coaxing the child to agree to IV antibiotics. We even had to get help from the other family in the double room, to show the child that another child has the same antibiotics but did not complain of pain. As it turns out, it was worth the 40 minutes of time, winning over the mother and child.

In the evening, the child took his oral medications with minimal coaxing. Only then did he discover that all the stuff he resisted were actually sweet and yummy. I even helped the mother convince him to change his diapers by bribing him with stickers.

Just before my shift ended, there were 6 new admissions at the ward, of which 3 were under my team. 1 was a day surgery lodger, 1 was an adult male for complex migraine, and 1 was a paediatric patient. Fortunately senior SN Y was around to assist, while I took over the lodger and assist with the other team's admissions. One was an emergency case, that needed to be sent to ICU.

By the time the stuff was settled, it was already 1 hour past my knock-off time. Then I got an angry comment from the night shift HCA S that the child's parents complained of missing one dose of nebulizer. It caught me by surprise because I spent quite a long time earlier that afternoon to explain to the child's mother about his prescription and discuss alternative administration strategies. We agreed that we will not force the nebulizer on the child when it would be next due at 6:30pm, but wait for the father to arrive instead. Thus, I went to clarify with the parents. According to the parents, they only made a casual "FYI" remark, but HCA S mistook as a complaint. After clarifying with the parents, I updated senior SN R who was on night duty.

As I was leaving the ward, I saw the child's mother re-explaining to the senior SN R about the miscommunication. She even tried to talk to HCA S about it, but HCA S was too busy to attend to her. It really touches my heart that she bothered to stand up for me and clarified matters directly with the night staff.

Monday, February 08, 2010

You are wrong because

While spring-cleaning, I found an old Dilbert book "The Joy of Work - Dilbert's guide to finding happiness at the expense of your co-workers". It was a gift from my brother, who also happened to be in IT, who in-turn received the book as a gift from a couple for Christmas 1998.

Anyway, flipping through the old book before giving it away, I came across this chapter "Managing Your Co-workers", where it listed common arguments made by irrational people. Really love the humourous way it approaches meta-thinking. While reading through the list, it occurred to me how often we hear such irrational arguments from the Singaporean politicians-in-power, managers at work, etc.

[Extracted from "The Joy of Work - Dilbert's guide to finding happiness at the expense of your co-workers" by Scott Adams.]

You Are Wrong Because

For your convenience, I have circled the brain malfunction(s) that most closely resemble(s) the one(s) you recently made on the topic of (fill in topic): ______________________________

1. Amazingly bad analogy
E.g. You can train a dog to fetch a stick. Therefore, you can train a potato to dance.

2. Faulty cause and effect
E.g. On the basis of my observations, wearing huge pants makes you fat.

3. I am the world
E.g. I don't listen to country music. Therefore, country music is not popular.

4. Ignoring everything science knows about the brain
E.g. People choose to be obese/gay/alcoholic because they prefer the lifestyle.

5. The few are the same as the whole
E.g. Some Elbonians are animal rights activists. Some Elbonians wear fur coats. Therefore, Elbonians are hypocrites.

6. Generalizing from self
E.g. I'm a liar. Therefore, I don't believe what you're saying.

7. Argument by bizarre definition
E.g. He's not a criminal. He just does things that are against the law.

8. Total logical disconnect
E.g. I enjoy pasta because my house is made of bricks.

9. Judging thing without comparison to alternatives
E.g. I don't invest in U.S. Treasury bills. There's too much risk. [Note: This book was published in 1998, the world economy was different back then.]

10. Anything you don't understand is easy to do
E.g. If you have the right tools, how hard could it be to generate nuclear fission at home?

11. Ignorance of statistics
E.g. I am putting ALL of my money on the lottery this week because the jackpot is so big.

12. Ignoring the downside risk
E.g. I know that bungee jumping could kill me, but it's three seconds of great fun!

13. Substituting famous quotes for common sense
E.g. Remember, "All things come to those who wait." So don't bother looking for a job.

14. Irrelevant comparisons
E.g. A hundred dollars is a good price for a toaster, compared to buying a Ferrari.

15. Circular reasoning
E.g. I'm correct because I'm smarter than you. And I must be smarter than you because I'm correct.

16. Incompleteness as proof of defect
E.g. Your theory of gravity doesn't address the question of why there are no unicorns, so it must be wrong.

17. Ignoring the advice of experts without a good reason
E.g. Sure, the experts think you shouldn't ride a bicycle into the eye of a hurricane, but I have my own theory.

18. Following the advice of known idiots
E.g. Uncle Billy says pork makes you smarter. That's good enough for me!

19. Reaching bizarre conclusions without any information
E.g. The car won't start. I'm certain the spark plugs have been stolen by rogue clowns.

20. Faulty pattern recognition
E.g. His last six wives were murdered mysteriously. I hope to be wife number seven.

21. Failure to recognize what's important
E.g. My house is on fire! Quick, call the post office and tell them to hold my mail!

22. Unclear on the concept of sunk costs
E.g. We've spent millions developing a water-powered pogo stick. We can't stop investing now or it will all be wasted.

23. Over-application of Occam's razor (which says the simplest explanation is usually right)
E.g. The simplest explanation for the moon landings is that they were hoaxes.

24. Ignoring all anecdotal evidence
E.g. I always get hives immediately after eating strawberries. But without a scientifically controlled experiment, it's not reliable data. So I continue to eat strawberries every day, since I can't tell if they cause hives.

25. Inability to understand that some things have multiple choices
E.g. The Beatles were popular for one reason only: They were good singers.

26. Judging the whole by one of its characteristics
E.g. The sun causes sunburns. Therefore, the planet would be better off without the sun.

27. Blinding flashes of the obvious
E.g. If everyone had more money, we could eliminate poverty.

28. Blaming the tool
E.g. I bought an encyclopedia but I'm still stupid. This encyclopedia must be defective.

29. Hallucinations of reality
E.g. I got my facts from a talking tree.

30. Taking things to their illogical conclusion
E.g. If you let your barber cut your hair, the next thing you know he'll be lopping off your limbs!

31. Failure to understand why rules don't have exceptions
E.g. It should be legal to shoplift, as long as you don't take enough to hurt the company's earnings.

32. Proof by lack of evidence
E.g. I've never seen you drunk, so you must be one of those Amish people.


Have fun applying the above meta-thinking to challenge irrational statements!

Tuesday, February 02, 2010

Getting feedback

Recently, I had been told several times that so-and-so patients and their families feedback positively about me. This included a "difficult" NOK who specifically told my ADON today that he was impressed by my service and attitude.

During my student days, I would probably be over-the-moon to hear of such news. Somehow I find that my attitude to such feedback has since changed. Nowadays when I get such feedback, the randomness of chance -- to be perceived by one client/doctor as great and another as lousy -- strikes me once again. Thus, I would smile in acknowledgement to the manager(s) informing me of the feedback and highlight the involvement and contribution of my fellow colleagues instead.

For my own mental well-being, I "release" all the good, the bad, and the ugly once home.

See no evil, hear no evil, speak no evil

I met my nursing buddy for a short chat after work today.


Some days I feel like the 3 "no evil" monkeys - "see no evil", "hear no evil", and "speak no evil". There are things that happen in the wards and in the hospital that one has to be a monkey to not stick out one's neck to be chopped. E.g. Isolation policies that are "generously" bent, medication administration guidelines that are not followed, etc. Yet, once a decision is made by a higher authority, a monkey like myself can only keep my fingers crossed and hope that no incident crops up. This is because if an incident were to occur, we the new nurses are at the bottom of the "medical professionals' food chain" and may face the blame lecture, losing our license or worse.

That's where having my nursing buddy counts. We could offload the weight of such "corporate secrets" on our shoulders to each other. Things that we cannot tell anyone outside of our hospital. Yet, due to our differing schedule and other commitments, we could only manage a brief meeting once in a few months.