3 proposals

My flatmates recently made an online reservation for their ROM date (registry of marriage). I am so happy for them. They knew each other from their Malaysian hometown, before venturing to Singapore. They have stayed together with me for 3 years now. There is the occasional couple's squabble but mostly they make a wonderful couple.

Just watched the movie "Coco avant Chanel" ("Coco before Chanel") with the titular character played by Audrey Tautou. In the movie, Étienne Balsan only proposed to his mistress Coco (Gabrielle Bonheur Chanel) after he realized that she has fallen for Arthur "Boy" Capel instead. Coco snubbed, "I never intended to marry anyone."

The above reminds me of my experience. My ex-boyfriend of that time only proposed after he knew that I had given up hope on our relationship and was moving on to a new one. The window for love to blossom had closed.

Karaoke, 3 women, 3 broken hearts

Went karaoke with my friends M and L recently. There we were, 3 women, 3 broken hearts.

M is separated from her husband whom she married in her youth. Now in her 30's, she is rebuilding her love life. However, she has not been lucky in love as yet. Men aplenty, just not the right type. She attributes it to her sub-consciously being not ready because her divorce is not finalized yet.

I wasted 7 years of my youth on each of 2 love. Am heading towards my 40's and giving up hope on building my own family from love. Perhaps if I had been more interested in the "Mills & Boons" romance paperbacks that captured the hearts of my schoolmates in my youth, I would be better prepared at the game of romantic love. However, I was bored even before I hit page 2 of the first "highly recommended" paperback that I had picked up. Being a straightforward person, I found (and still find) the dithering between "He loves me, he loves me not" a waste of time.

L is also in her 30's. She had known that she is a lesbian since she was a teen. Heterosexuals like M and I have problems looking for long-term love in Singapore. L has an even harder time given that LGBTs are often viewed with prejudice in Singapore society. To make things worse, the government policies (e.g. education and media censorship) actually reinforce these prejudicial views. This is sometimes due to the vocal politicking by the minority groups of radical evangelistic Christians.

On a personal level, I decided to be contented with the pure, innocent and sincere love I encounter daily at work. The love of children.

Pneumonia

As mentioned before, I was hospitalized at the end of March for pneumonia. A recent online article reminded me of my experience and the general state of healthcare in Singapore.

One Saturday afternoon, I was feeling dizzy and happened to test the oximetry before applying it to a patient. The oximeter indicated my SpO2 as 87% despite my deep breathing. SN LT tested it after I raised the issue to her, and her SpO2 was 98%. Although I felt dizzy, I wanted to complete my shift as the ward was very busy that day.

I must admit that for a brief period when my SpO2 was 87%, I wasn't effective at work. E.g. I was in the 4 bedded room attending to 1 patient. When I was done, another patient's NOK asked me for some items. Then the 1st patient's NOK also asked for something. Normally, I would either remember the items or write them down. I heard and understood their requests, but when I tried to write the items down on my notebook, I just couldn't think of what to write. Guess, that was the effect of short-term O2 deprivation. I turned around to ask the NOKs to repeat what they wanted. They both said something like "forget it" kindly. I don't know why. Perhaps they could see that I was struggling and I wasn't well. I was glad that they seem rather forgiving, compared to the ward staff who were working me and SN LT like slaves.

I knocked off from work late at the end of a busy shift. When I arrived home, I felt slightly feverish, drank some water, coughed with thick yellowish phlegm and rested in my room. Awhile later, the fever didn't seem to subside, thus I decided that seek treatment at a 24-hour GP clinic. Unfortunately, the 24-hour GP near my home no longer operated round-the-clock, thus I went to SGH A&E on the wee hours of a Sunday at 12+ midnight. I was having fever, cough and body ache all over. I informed the nurse at the A&E triage that I was having fever and was concerned because my oxygen levels dropped below normal earlier at work on Saturday afternoon. I also informed the A&E triage nurse that my appetite had dropped severely over the past week. From 2 bowls of porridge a day a week ago when I first felt slightly unwell, to 1/2 a piece of cake the whole of Saturday.

I was given high priority, less than 15 min wait. The SGH A&E assessment nurse took my blood pressure and oxygenation levels and they were back to normal at 12+ midnight. I was not coughing while I was at the A&E. Based on the symptoms of fever and body ache, and my information that my home was undergoing upgrading, the A&E doctor suggested a full-blood count test (FBC) as he suspected dengue. I asked for a dengue test and the doctor told me that no public hospital in Singapore offers that. The FBC results came out, the platelet count was within the normal range. I was sent home with antibiotics, lozenges, cough syrup and mouth gargle for the cough, paracetamol for the fever and MC for 3 days. The doctor focused only on the potential dengue fever, and told me to look out for bleeding under my skin (petechie). Neither the doctor nor the nurse bothered to check further on my cough. No CXR, no listening to the lungs with stethescope (auscultation). No further questions or check on my loss of appetite.

That Sunday was my day-off. I slept much of the morning, waking only for medication. That afternoon, I called my ward to inform them that I could not report for work the next day. While I was on the phone with Snr SN R, I started coughing non-stop and couldn’t get out of my bed. By evening, I managed to walk unsteadily to my kitchen. I found out that a potentially fatal complication of dengue was hypoglycemia, so I tried to drink some honeyed water. I vomited. Then I thought that perhaps honey was too strong, so I tried some plain water. I vomited the fluids on the kitchen floor and was so weak that I fell to my knees. Then I thought that perhaps I need the dextrose-saline equivalent of fluid replacement, thus I added some salt into honeyed water. It took me more than 20min to slowly sip down half a cup and I could barely retain the fluid. I sat in my room, resting, and waiting to feel better. I was still hoping that I would be well enough to continue with the SGH A&E medication.

After about an hour or 2 (at around 9+pm), I felt strong enough to walk. I debated whether to return to SGH A&E to review my condition. I decided against it since the SGH A&E doctor told me to return if I get petechie, which IMHO is a really late sign of dengue haemorrhage fever. I decided that if I could last through the night, I could visit a GP 1st thing on Monday morning for review instead. Given that I felt better after my improvised oral-rehydration drink, I went to the pharmacy to buy more oral-rehydration solutions to last me through the night. When I reached home, I opened a packet of Pedialyte ready-to-drink rehydration fluid. It took me another 20min to sip down the 62.5ml. I decided to pack my bags to be ready for hospitalization, in case my condition worsens. Once again, I sat in my room, resting, and waiting to feel better. However, this time, I found myself drifting in-and-out of consciousness and began to sense "others" around me. After an indefinite period , I drifted back to consciousness and decided to go to a hospital for my own safety. My housemates were out-of-Singapore that weekend, so no one would know if I drifted off again. While I like the peace of drifting off, I had some unfinished work to be completed, so I wasn't ready to leave my body as yet.

[30-Mar-2009 Extract of my CXR indicating LLL Pneumonia]

[15-May-2009 Extract of my CXR, for comparison]

Around midnight of the Monday morning, I arrived by taxi to my private hospital's A&E because I knew that they offered dengue tests there. I was put into the A&E isolated observation room due to my fever. The A&E triage nurse noted down my medical issues. Later, the private hospital A&E doctor auscutated my lungs and ordered for an immediate CXR, blood tests, besides my requested dengue test. Upon reviewing the CXR, the doctor told me that I need to be warded immediately. It was obvious from the CXR that I had left lower lobe pneumonia. The private hospital A&E doctor referred me to a specialist consultant. Within the hour, I was warded, given nebulizer and attended to by the referred specialist. The blood tests results followed. My week-long lost of appetite has resulted in below normal levels of potassium (2.6 mmol/L moderate hypokalemia) and sodium (133 mmol/L mild hyponatremia) in my blood and I had to be on intravenous therapy. In addition, I was also on intravenous antibiotic Avelox (moxifloxacin hydrochloride). Later in the wee hours of that morning, the dengue test report was out -- negative. All the treatment started before dawn; and by 7+ am that morning when the specialist came again for review, I was already feeling better. [Other abnormal lab results on admssion: FBC Hemoglobin 11.1g/dL, PCV 34%; Blood Differential Count Neutrophil 85%, Lymphocyte 10%; Urine Microscopy WBC 8/uL, RBC 5/uL.] The specialist gave me a capsule of nutritional supplement and reviewed my food in-take. Treatment continued. The next morning, the specialist reviewed my case and (upon my request) discharged me for a week-long recuperation at home.

The specialist consultant told me that my pneumonia did not come about suddenly, it took a period of time. Thus, I am still puzzled why the SGH A&E doctor missed it totally. I went to the public hospital to save cost. In the end, I am glad I switched to the private hospital. It may have cost my life otherwise.

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Click here for the aftermath of pneumonia.

Priestly matters and preceptors

We had an elderly priest as a patient recently.

The priest has a pleasant personality. His personal assistant who is a lay Catholic, however, is a different creature. Perhaps it comes from her genuine protectiveness of her boss. She demanded for single room upon arrival, even after we explained that the hospital was unfortunately fully booked for single rooms. She kicked up a fuss over the matter. My colleague in-charge Snr SN R was rather surprised by the assistant's behaviour, since she is a representative of the priest. Snr SN R remarked aside to us nurses, "By right, priests and nuns are supposed to be grateful for their lots in life."

On the discharge day, I handed out the Customer Survey form to the personal assistant as per our standard practice. She wisecracked, "Are you sure you want me to fill up this form? I will be very negative." To which I replied cheerfully, "Well, it's ok. Constructive criticisms help us to improve our service." Honestly, I meant it because if she does feedback on her perceived shortfalls in service, the management can then undertake actions to alleviate the situation if necessary.

That evening, I decided to search on the internet about the priest to find out more about this ex-patient. That's when I realize his stature in the local Catholic scene. Perhaps in their circles, people are used to reserving the best for the priest and his assistant. However, in a hospital setting, it is first-come-first-serve for room allocations. The only special considerations given are for medical and safety related issues.

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Anyway, along the same internet search, I re-stumbled upon the blog of my first preceptor at my first job after getting my first degree. As I recall, he was a supportive and instructive preceptor. He also has a sense of humour. He is now a Catholic priest. Guess I'm lucky to get good preceptors, both in my first career and my current one.

Inter-department incidents

I had 2 inter-department incidents today. One was with a medical/surgical ward and the other with the intensive care unit.

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The medical/surgical ward Sister A complained to my ward manager about linen items taken from their shelves without permission yesterday. My ward manager asked me what happened. I was the runner on-duty yesterday with Snr SN R in-charge and SN L and SN O taking teams. There were a sudden influx of adult surgical cases booked into my ward. Since my ward is really for paediatric patients, we have only a few OT gowns (all used up) and no adult pyjamas in our linen cupboard. Snr SN R instructed me to borrow a test-tube rack with test tube from Sister A's ward and SN L instructed me to borrow some OT gowns and 1 pyjamas together. When I arrived at the ward, there was only their ward admin staff on-duty together with a Snr SN B and another SN M, who was seconded to that ward for the shift. The moment I walked to Snr SN B and started saying that "I am from X ward, I would like to borrow...", she rushed away in the direction of the patients' room (without any call-bells sounding), ignoring me. Then I turned to the only other SN in sight, SN M. I told her that I'm here to borrow a test-tube rack and some linen items. SN M replied that she don't know where the items are stored. To which I replied, "I know, can I go help myself?". To which SN M acknowledged. As I was leaving the ward with the test-tubes with rack and 1 pyjamas, 3 OT gowns and 3 kimonos, Snr SN B stopped me. She claimed angrily that she only gave permission to borrow test-tubes with rack and demanded that we cannot borrow their linen. I explained to her that my colleagues have sent me up and they have already sought permission for the items. She claimed angrily that she only gave permission to borrow test-tubes with rack and not the linen items. I informed her that we have an overflow of adult patients for surgery and we have run out of gowns. I also reassured her that I have checked that their linen cupboard is well stocked before I took the items. However, she was unappeased and pressed that the pyjamas have to be billed and we should have called the linen dept for items that we want. I told her ok, I will bill the pyjamas.

After my ward manager heard my story, she laughed. She explained to me that the only billable linen item was the 1 set of pyjamas. She could not believe that the ward people would be so hung up over one billable linen item and other shared linen items. She has arranged with the linen dept to send over to Sister A's ward whatever linen they demanded as "compensation" from my ward. Fortunately I was honest to my ward manager and told her that I had previous run-ins with Sister A's ward while I was a student nurse there. Then my ward manager told me that she understand, she was a student nurse before. Haha, my ward manager was a student nurse almost 30 years ago, yet she still remembers how it was like. The ultimate irony is that when I was a student nurse at Sister A's ward, her staff would send me all over the hospital to borrow linen items without first calling in-advance to seek permission. Now, they twist over and roast me for borrowing items from them. What hypocrisy! Glad that I am at my current ward, and not under Sister A. From my experience as a student at her ward, she is easily swayed by her staff's gossips, not a leader nor a problem solver. Interestingly, Sister A has graduated from my nursing school just over a decade ago, but it seems that she has already forgotten the challenges faced by student and new nurses.

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In the early afternoon, I saw an ICU staff wheeling a patient down to my ward into a room unaccompanied. It is not my ward's style to not escort patients to their rooms. I quickly rushed over as I was expecting a patient from ICU who booked that room. However, when I entered the room, I realized that the patient is not the one with the reservations. Then I instructed the ICU staff to call her dept to confirm if the patient is meant for this room while I stay with the patient in the room. She went out of the room to check. After a while, she came back into the room and apologized that it was a mistake, the patient was meant to go to Sister A's ward. About half an hour later, ICU called to complain that I did not let patient enter the room when their staff wheelchair the patient down. Fortunately for me, my in-charge Snr SN Y saw the ICU staff wheeling the patient into the room, so I have a witness. In addition, luckily the patient was nice and did not complain about the moves. In fact, he complimented me to the another ICU staff present when I had to send him back to the ICU for further monitoring as per doctor's orders.

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Fortunately my team's workload was not so busy today. In addition, I had help and support from Snr SN Y, SN O, and HCA K. Otherwise I would have been stressed out by multiple incidents near the start of my shift.

Running faster, working harder

"Running faster, working harder: repairing the care" is a 15 min video explaining health care underfunding in British Columbia, Canada. In the video, Dr Pollock mentioned education, employment, welfare, healthcare and housing are interdependent political solutions for the problems of ignorance, idleness, wants (poverty), disease and squalor.

Sadly, Singapore has gone further down the privatisation (profit-driven) road than Canada and UK. E.g. Free education (albeit with bond) for FTs but driving out Singaporeans, cheap foreign labour competing for jobs at all levels, no welfare, KPI-driven restructured hospitals, "market-subsidy" HDBs. For healthcare in Singapore, the "sustained under-investment" to orchestrate a "crisis" did happened. The show is now repeated to launch the Minister of Health's solution for elderly care.

It's so sad that the film above describes exactly how things are in Singapore. I have seen healthcare from the insides of both restructured and private hospitals. Patient care is compromised if one benchmarks against the standards set by our local nursing schools. A major contributing factor is that nurses in Singapore are overloaded. E.g. In acute medical/surgical wards, Singapore has a typical 1 RN : 12+ patients ratio, compared with the mandated maximum ratio of 1 RN : 4 patients in Australia.

Due to corporate policies, we cannot let our patients know the truth. Instead, it takes a concerned patient's kin to raise the issues. "Are Hospitals Safe?-What killed my dad?". It is a shame.

Migration thoughts on National Day

When I was in my twenties, I could not have imagined myself thinking and feeling the way I do today.

"I am happy to be filling in documents for migrating to country X on Singapore's National Day. The Singapore that I grew-up in and dreamed-of no longer exists. I have to make that leap for my long-term welfare, especially for my golden years. I am happy to be quitting Singapore."

Here is a blog entry by Lucky Singaporean that expressed very well my sentiments about being a Singapore citizen.

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[Addendum: 23-Aug-2010]

I sent in my application in November 2006. In those days, one fills up a simple summarised form at the initial application and then wait until one's form reaches the front of the queue. Then, and only then (approximately 2-4 years down the road), will one need to furnish the complete set of application forms and supporting documents.

Fun day at work

Had a good time at work today. The ward manager left work after the afternoon report handover. SN J was in-charge, I was taking the back team (7 patients, including 1 night discharge) and SEN L was taking the front team (4 patients), with 1 runner SEN MY. The mood was casual and the ward was rather peaceful. Perhaps most patients' parents were distracted by the National Day Parade broadcast. We, the nurses, had time to chat and joke amongst ourselves. SN J helped me with 1 night discharge. From around 5 pm onwards, SEN MY was somewhat whiny about her workload as the sole runner, even though SEN L and I helped with the call bells. Anyway, at the end of the shift, all of us left on time happily.

:-) Interestingly, I was the only Singapore citizen on-duty at my ward during that shift.

2 months old

I have passed the 2 months-old milestone and received my 2nd monthly paycheck, yeah! I am getting more used to the job, although I still get stressed when my team's census hits around 8 of the typical acuity for my ward.

For 2 weeks in July, I attended my hospital's nurses orientation. As the orientation programme was suspended during the early months of Influenza A H1N1-2009, there were many nurses (ENs and SNs) who had been at their wards for several months. During the introduction, it became apparent that many wards didn't have a culture of welcoming and supporting new staff. There is widespread existence of new staff being taken advantaged of or even bullied. Upon sharing about ward practices, it became apparent that there are non-standardised practices (sometimes even between nurses in the same ward), gaps in policy, and difficulty of applying changes (e.g. very experienced nurses who insist their existing out-dated methods still work and demanding that new staff adopt their existing methods; and foreign staff insisting on following their own countries' nursing practices). Thus, many new staff faced difficulty fitting into their wards, especially if their preceptors were not supportive. A few left the hospital even before they attended the orientation programme.

In a way, I am comparatively lucky. I did much of my student clinical training at various wards in this hospital. Thus, the problems that the new staff face did not surprise me. I faced many of them as a student. As such, I also had the opportunity to discover which wards were relatively supportive of new staff. As a result, I requested for a ward where I was more likely to fit into.

Nevertheless, I still face "people" challenges as a new staff.

• E.g. Unexpected competition from foreign trained Registered Nurses in their home countries who are downgraded to Enrolled Nurses when in Singapore.
• E.g. Returning to my ward after the 2 weeks orientation, I find myself sharing several shifts with SEN M where she was the runner assigned to my team. For some reasons, she refused to do tasks that an EN is capable of, e.g. changing IV infusion drips, flushing IV lines, and initial patient assessment upon admission. She even avoided tasks that a HCA does, e.g. answering call bells and making beds. Now that she is mostly assigned the runner's role, she claims that she found the team leader's job less stressful. She excused herself by suggesting that maybe her heavily pregnant state made a runner's job tough and tiring. Honestly, I would have accepted her excuses at face value if not for her loud insinuating questions (at the nurses' station in the presence of my preceptor who was in-charge) that I could not even manage the medications (at the end of a shift where my team was full-house with 12 patients and 1 new admission after another patient was discharged, and SEN M skived on her job as my runner). I decided to take it as a challenge to practice the Chinese philosophies of “与世無爭” ["not to fight with the world"] and that “路遙知馬力，日久知人心” ["A long journey reveals a horse's strength, a long time period reveals a person's heart"]。 As it turns out, the ward manager was in-charge the following morning and SEN M was again my assigned runner. At a busy period, she instructed me to delegate tasks to my runner, but my runner SEN M was no-where to be found. The NO was not happy that I did not know the whereabouts of my runner, but she was even more unhappy with SEN M for being missing-in-action.

Met up with some classmates for tea on Nurses' Day. We are from different job environments and face different challenges at work. In my case, I faced experienced staff under me who are still adjusting to the switch from ordering me around during my student days to me as an SN assigning them tasks. In addition, due to head-count constraints, I do not have a chance to be shadowing another staff who is in-charge of a team. A classmate in the public hospital faces difficulty of hostile foreign SN interrupting her report passing frequently with questions raised in a challenging tone. In addition, her C-class ward is almost always full-house with wait-list, and some patients have difficulty getting family support for their discharge. Another classmate in a step-down care facility faces the concern of losing her acute care nursing skills as her patients are transferred to acute care hospitals if their acuity increases. In addition, being the few staff nurses at her sub-acute hospital, there is a higher SN-to-patient ratio. She also had to deal with an agency staff not performing care according to the specified instructions. As the agency staff was well-connected to higher management, the ward manager did not dare to reject her services despite the difficulties the ward staff had with her.

After considering all the challenges faced by others and myself, I was quite happy that I had a good day today. The ward was understaffed during this shift. SSN R was in-charge, SEN L was taking team 1 (patients near the nursing station), I was taking the other team and HCA K was the sole runner for all 15 patients and she even had to help take meal orders for the 5 patients on the adjacent ward. I had 8 in-patients (of which 1 discharged in the evening) and 1 day surgery lodger for discharge in the night shift. HCA K was fantastic given her high workload. In addition, SEN L and SSN R were very supportive, helped me with the doctors' rounds, admissions and discharge. I even had breaks for tea, toilet and dinner, time to document my per-shift patient's assessment outstanding from the day before.

:-)