My Blogs (Writings about every day life)

[dewdrops]

A Secret

At lunch they came in to tell me.....3 flat heads mummy...we caught three flat heads...I was like wow....BB then said...it's a secret mummy....I...so what's the secret? ..hubby ...come on BB no telling...it's a secret...as BB can't keep any secrets...

I took BB aside and said it's okie...tell me...she then started to cry..asked her why? ..I don't know what to do....I love both of you...

her dad started laughing...it's okie you can tell...BB..a man gave us the fish mummy...

it turned out they didn't get any bite...so the guy fishing next to them gave them the fish...3 fish for 3 kids...hehehe...that was the secret...

[dewdrops]

Cheeky

Went in to see him...he exclaimed...another pretty one...I joked back..don't you dare fall asleep...I need to go down and grab your inhalers...and then I will be back to talk to you about them..

he laughed..you can wake me up any time my dear...if I am asleep just tap me on my shoulder and I will wake up for you...hehehe..

came out told them and J reprimanded me...what are you doing to them? this is CCU (coronary care unit) ..you can't do that to them...hehehe ..you just made his heart beat faster...hehehe

as all the patients are hooked on to a machine..a heart monitor..thus their HR (heart rate) are all on display in the nurses station.. I think she was only joking...hehehe

[dewdrops]

2.25

Thought I was going to have a nice afternoon..must have jinxed myself...

went up the ward to grab my drug charts for a medication profile (a chart that shows what tablets they are taking, when to take them) I was going to do for a discharge tomorrow..the only thing on my agenda..had 45 minutes to do it..which to me was very nice...it was going to be a nice afternoon..I will finish on time..over to OP (outpatients) by 3pm instead of being late like usual...

only to be told that Mr E was put on IV antibiotics..I looked at the dose and I thought oh no..it was a high dose..and I wasn't too familiar with the drug either..

went downstairs to try to requisition it only to find out no stock..yes there is stock but SAS stock..which means I have to find the TGA form (Therapeutic Goods Administration) similar to FDA..SAS category A form (Special Access Scheme, category A = life threatening) and since SAS it is expensive which means I have to find the High Cost Drug form...email the Director of Nursing to ask for permission...

to help the doctor I partly fill out the forms for him...then I had to ring our store lady to get her to order more in as 7 boxes of 10 ampoules would only last him 3 days..he was on 16 ampoules a day..and since today is already Wednesday...the weekend was creeping up..

she said to me you need to get the doctor to sign the form..get back to me early tomorrow for me to order..that way it will come in on Friday to see us through the weekend..

rang the doctor to ask him how best to get the forms to him....he said it was too late he will do it tomorrow..if I could leave the form on the ward for him..

walked all the way to the other hospital to grab my ampoules..thought I was done...the dose seemed high but maximum allowed dose 100mg/kg per day...so I passed it..

came back PS said did he have renal failure? went back to the ward and did some investigating..yes of course he has renal failure...his creatinine was like 400+... not only that when I checked the IV order the doctor wanted it infused over 6 hours...instead of the recommended 1.5 hours..cannot infuse it over a long time as it crystallizes...

went downstairs to check our internal program for his latest lab results so that I can work out his creatinine clearance..he had a clearance of only 10ml/min = very very very bad renal function..but then no drug his respiratory failure would kill him first..

so back to the book..usually they would give it 3 days full dose then cut it back ..can always get the doctor to do it later date..so we passed it..

as for the IV problem..can't pass it..need to know why he wants 6 hours..rang him back...lucky I did..I told him the problem thinking all he had to do was say infuse over 1.5 hours...he's quite reasonable...

no...that didn't happen... he said forget about the IV..give him oral..as he has got a nasogastric tube now..Dr D just rang me 10 minutes ago to say he has successfully inserted one...

he then said give him equivalent dose in syrup as the tablets ordered this morning..I continued..okie...I will write a phone order..please could you sign it and write a regular order in the morning?? he replied..yes I will make it official in the morning..

I thought yippee...went to requisition the stock to find only 2 bottles left..lol...1 bottle =100ml..to convert to the equivalent dose I need 120ml per day for him...200ml was only going to last me 5 doses not even as you lose some every time you take a dose..which means he will run out mid tomorrow morning..

rang ordering person...please order..D said she will do it straight away..it will come in the morning if the wholesalers have stock..IF... asked her to go to store to see if there were actually 2 bottles sitting there on the shelf..as sometimes the computer can be wrong...

I was so relieved when she said there were 2 bottles...

next bit was to wait for the bottles to come through the chute ..label them..take them upstairs.. write in the notes showing my calculations.. write the phone order...talk to the nursing staff...

it was 430pm when I was done with him...took me 2 and a 1/4 hours to work that problem out..didn't help that I was tired..couldn't think clearly from lack of sleep..

here is hoping tomorrow will be a better day..now I know why no one wants to do my ward..it can easily turn your day upside down..

[dewdrops]

25
My days are from 830am to 530pm. From 830am till 3pm I service 1 and a half ward, Medical (17 beds) and half of Rehabilitation (8 beds), the rest of the day I spend helping out in Outpatients.

In theory I have 25 patients that I looked after every day. Well 25 beds that is...the number varies from 25 upwards..

Some days I get 7 discharges..thus my number would climb to 32..my highest so far is 13.. today I had 2 go and had 3 newbies which I got to see 1 so I had 26 only..the 2 would carry over to the next day. It was a quiet day for me..

My week would start as such..Mondays and Tuesdays are stocking up days..I'd see all my patients and stock them up for the week..until atleast Tuesday of the week after ..just in case Monday is a busy day and I don't get around to check their drawers...

then Wednesdays, Thursdays and Fridays are reserved for getting discharges ready..stocking up any newbies...stocking up any additions to my existing patients' orders chasing up problems and checking their medication room...ie checking their DD registers and stocking up their safe...stocking up IVs for all my patients..tidy up the cupboards..

that's in theory... anything goes...my days are non-structured thus as long as I get everything done I can start and finish as I like... I find this way works best..

[dewdrops]

830-530pm

My days start at 830am...with the exception of Tuesdays when I have to be there at 815am for the staff meeting and that goes till 9am..

In the morning I would go up and do medical first, 17 of my beds are there..this is because all my doctors are there at around that time...

My first priority is the ward's board...it's got all the admissions and discharges for the day ..the other source is J my ward clerk..she's the ward's ears..she hears everything and knows everything..

Discharges...
I have to get all their meds ready...give them atleast a few days supply...

any problems sort out with their doctors...ie how long he wants them to be on their antibiotics....warfarin doses...prednisolone reducing dose by how much? going home on their usual meds? changing back from nebules to inhalers upon discharges? clexane injections? ....

print them a medication profile..

any drug of addiction..I have to dispense and sign out of safe for them...

any websters or dosettes I have to liase with their own pharmacy to get them to pack...any nursing homes / hostels I have to ring to find out whether they need websters or not and arrange with the pharmacy that services them...

it takes forever to get one ready...thus any discharges I know of beforehand I prepare for them in advance...stock their meds up...prepare their profile and save the profile in the computer..editing only takes 5 minutes upon discharge...any DDs I dispense and write out and leave in the pharmacy safe...any problems ironed out that morning when I catch the doctors at 830-9am..

that way on the morning of the discharge it's wham bam thank you mam and they are out of the door by 1030am...I am happy because I can start on my day...the ward is happy as they can get the rooms cleaned..the doctors are happy as they can then admit more patients...and it starts all over again....

after all the discharges are out of the way...I then go and visit each of my patients..more so visit their drug charts..see if the doctors have added anything new..that I have to supply...and why? dose increased... why? deletion of one ..why? ..then I would go and read their history notes to see why or if not look at lab results...

my doctors are quite good...they are all consultants...that's one good thing with private hospitals...we don't have interns or fresh outs...the bad thing is you have to have your wits about you hehehe one asked me the other day if I could supply some Timentin as lab results are back and the patient is sensitive to it...so he has changed their antibiotic regimen...it's interesting to find out why doctors do the things they do...

after I have settled all my old patients I do my newbies..newbies= the ones I didn't get to see from the day before......we do a profile for each new patient...what they came in for...their past history...their meds before they came in to us..why they are on them? reconciling with their past history..their local pharmacy's details..webster packs? allergies? eye drops? herbal? patches? inhalers? creams?

then after the interview I check it against the drug chart...are they all on? or did the doctor miss a few? why? intentionally or just an oversight...any items that requires special scripts I need to ring their pharmacy up to get them to post them out to me to dispense...any concession or safety net numbers I can get from them also...if the patient is a bit iffy with strengths of tablets or inhalers I can ring up the pharmacy to confirm...

this would take me till 12pm...hopefully then I can go and do rehab...my 8 beds...rehab is easy...as they are there for a few weeks so I know my patients real well...their meds don't change that much ...most time they are taken off stuff...not put on...

by 1pm I should have seen them all and that's when I can have my lunch....from 1-2pm...

after lunch I would go back to medical...see any new ones that have arrived and are occupying the empty beds from the morning's discharges..and see them...if they haven't then I would use that time to grab drug charts of any discharges I know of to prepare med profiles and jot down any problems I can see to ask the doctors when I see them next...

at 3pm I pack my back pack and walk over the road to out patients to help out till 530pm...and that is my day...

[dewdrops]

Flirting
I was being my usual extroverted self...This side of me only surfaces due to sheer necessity..I am more of an awkward shy person..

I guess it is because I feel for my patients..It must be hard to spend days surrounded by four walls not to mention the unpleasant treatments that they all go through..I can tell who will survive and who will not...survive = emotionally intact...

I admire and am inspired by those who are very sick yet still can find a smile to greet me and ask me about my day ..I love this bit of my job best..having little chats with them..If they can manage that ...here I am healthy and well ..I have to be able to do better??

Good morning...I hear you are leaving us today...

Yes...this afternoon...I don't want to go...I'll be missing you...

He then asked me...were you born here?? no...been here for 28 years...oh...that old ? you don't look a day older than 20 ..

I laughed...I am old old...approaching 40..

Are you married? ..yes...

Are you trying to chat me up or something? hehehee

Yes...hehehe

So where were you from originally ?... Viet Nam

I might have to go there for a visit...may be I can find a girl there just like you... ehhehe

[dewdrops]

My Grandma

A few weeks ago I went to visit my grandma..she's got dementia and thus she is in the high care section of the nursing home..I have not seen her for quite awhile and dread the visits..

It was a shock to the system to see her sitting there in her wheel chair..her long pants rolled up as it was hot..her top stained with food..and what looked like a hand towel around her neck..to dry her hair or to catch fallen food? I wondered..

I greeted her as I usually do ..con Ti Ti nè bà ..her pet name for me..she flickered signs of recognition then it was gone as it appeared..I brought some Viet food for her as she was only having processed food on doctor's order..she wouldn't have dentures..that's my grandma for you...she was stubborn as hell...very independent..to this in a nursing home dependent on others..luckily her memory is failing her..it is not a way to be near end of life..

I spoon fed her..asking her repeatedly if she wanted any more food..she ate most of it..then came afternoon tea..they served her tea and cake..as I turned around to wash the dishes she must have ate the cake..for it was gone by the time I came back to her..

All through my visit she would ask the same questions over and over again...how old am I ? how do you how old I am ? how old are you ? when am I going to die ? at 100 ? she had a friend that went at 100 apparently...

if she was putting up a ruse it was a good one..as she told the carer that I am her niece..she proceeded to ask me how are the kids...and how old they are..she told me she's booked her plot 10-20 years ago..I told her off..telling her it has only been a few years as she went with my dad to buy it...she then...yes..that is right...I went with him and your mum...

then she lamented..sometimes it is better to forget..remembering give me head aches..heart aches ?

when it was time to go..I bid her good bye and left..I still wonder if she's made up her mind to forget..because she doesn't want to be there in the nursing home..or is it really dementia..

I brought my camera..but in the end I did not take any photos..I wanted to remember her on her good days..not like this...

[dewdrops]

Bargaining
Since he wasn't home for dinner I gave them dinner as usual..we played dominoes..UNO..then asked them to get ready..As it was only 9pm I told the two younger ones to write their lunch orders..and collect their snack, fruit, drink bottle...they have lunch order, lunch from the school canteen, once a week on Thursdays..

After finishing the task my son said to me..you'll have to wake me up at 740am tomorrow instead of 730am mummy..his reasoning was that because he's got his lunch order done he doesn't need the extra 10 minutes..

I told him ..no B..you will have to get up the same time..then if you are ready early you can watch TV ..it is so you don't have to rush in the morning...

[dewdrops]

Dreams..
I was in Paris...had that feeling..was on a platform..didn't know where to go...so I went back into Paris...it was a market place..

someone had said Paris was expensive..thus when I looked at what was on offer I mentally calculated in $ to see how much it was..it wasn't that expensive..except they charged for using their toilets...which I thought was not on since the toilets were all dirty..and it was expensive..like 70-80c each time..

next scene I was at Quang's place...in the country...and we were discussing about his son...but he has no son in reality..

then I was at the market place again...met up with Paul..a colleague..wanted to buy him a pressie...Jenny told me he likes this drink so off we went to buy...the guy weighed us some powder...apparently it was powerful stuff..

then she decided to buy it for him and thus I ended up buy him a boring old pink tie..as he always wear pink shirts to work...

in the next scene...I was sitting around with Chau...and Thuy ..friends from high school Thuy said something..to which I thought how true...yet I can't seem to remember it now...

and the very last scene I met the old delightful Dr M ..he was wearing a man pad..I asked him what was he doing there..in Paris? ..he said he was trying to sell his man pads to people in Europe...

I took one look at him and thought how come he doesn't look like he looked normally..he looked old...

I was giggling all through this morning...told him what I'd dreamt..and he said ..man pads= groin.. does it mean I am feeling lucky tonight ?...are you going to give me your number ??

I laughed..better ask your wife if she's got a head ache first...hehehee

have not had one this pleasant for a long time...felt happy when I woke up this morning...

[dewdrops]

Cá Sấu Và Dumplings..
Tôi thích ngắm đàn ông ..chị K bảo vì tôi mê đàn ông ..nên đi ra ngoài là liếc qua liếc lại ..cũng không phải ..thú vui của tôi là ngắm ..xong từ đó suy ra coi họ ra thế nào ..

tôi ngắm coi kiểu họ ăn mặc ..coi có chải chuốt hay bạ sao cũng được ..nhìn cách họ đi qua đi lại ..bỏ tay vô túi ..đi nhanh nhẹn ..hay đi lết lết ..nhìn mặt họ coi có tươi hay lo âu, buồn phiền ...

nghe họ nói chuyện coi họ người gì ..Nam Bắc Trung ..cách họ nói ..điềm đạm ..nhiều chuyện ..nhỏ nhẹ ..oang oang ..cách họ dùng chữ dùng câu ..có chửi thề hay không...

mới đây chị K được một người bạn tặng dumplings...thế là được tôi tặng cho ông cái tên dumplings ..chị không chịu chị bảo người ta tên Duy đẹp vậy mà em lại đặt là dumplings ..vả lại ông đâu có tròn trịa như dumplings đâu nên là tôi đã đặt sai tên

còn cá sấu cũng là một ông ..ông người xa lạ mà hôm tặng tôi bài thơ đó ..hôm đi gặp ông... trời Melbourne lạnh ...di dạo công viên mà ông chơi quần tây áo sơ mi ..áo jacket..và đôi giầy bằng da cá sấu ..mode mới ..mũi nhọn ..chắc muốn impress tôi chắc ..xịt nước hoa thơm phức nữa chứ ..thế là được chị K đặt tên là ông cá sấu .