Its A Serious Seminar, So Why Are We Talking and Laughing?

It's our PDOS today or Pre-Departure Orientation Seminar but before that we need to fill out some forms first in Aureus for our OWWA documents..and the hell, I just realized I don't have a Philhealth number and a Pag-Ibig number too which is a requirement. I need to settle those things immediately!

Anyways, we were already briefed by Majoy on PDOS and sure enough what she told us is all true, it's all about the Middle East and there are lots of advertisement. And so we can't help it but to chat and talk to each other and sometimes we talked too loud I guess some people were irritated to us, but what can we do, we can't relate to the discussion, it's as if we can bring all those lectures regarding the Middle East in our destination, right?

Anyways, it's a miracle I didn't fell asleep while listening in our seminar, to think I'm from night duty and I haven't slept at all.

After the seminar, we went to Robinson's Ermita to have a halo-halo from Razon's. We took this chance to have a bonding moment with our co-workers. If last time our group was joined by the two people in Solihull, today its the people from Good Hope Hospital (Ritz and Roma).

After eating our halo-halo, we got excited and went to the nearest Netopia station to see the house of Ritz and Roma in UK. We told them that they already have a house even though they still don't have their visa. Hehe :)

After some picture taking, we then went home good thing my duty for tomorrow is 2-10, para kasi akong nagtriple shift form night, then 6-2 then 2-10...kapagod lang talaga..hehe :)

It's A Chinese Night

Yup! Yup! Its Saturday Night again and we decided to have a simple dimsum and dumpling night pero dahil sobrang init we decided to include halo-halo for the night food fest...and so we decided we will call this night, the Chowking Night. Our plan is to order some foods in Chowking fastfood chain but unfortunately they told us that they won't deliver in the night...just a weird thing dahil hindi ba mas malaki ang kita ng ganun lalo na't gabi pa!

Anyways, because they won't deliver, we decided to order in the nearby resto, Noodle King that is. Kaso as usual hndi pa rin sila nagbago, after an hour pa namin nakuha ung order namin at yung Halo-halo nila, naging juice na...

But all in all, ok naman ang food, nabusog kami...hndi rin kami na-toxic dahil walang case pero hndi rin peaceful night namin dahil tawag ng tawag yung intern dahil lang sa CD case...yun pala hindi daw tatanggap ung OR-CD ng case from 7am to 12nn dahil may power interruption sila and all their cases would be sent in our OR...e wala naman kaming memong nareceive...so ayun nagalit si Mam TJ sa OR-CD...but everything ended well naman.

And I Redeemed Myself

I know that they'll be dropping in UST today but I don't know if they'll be seeing me again, so it was a big surprise for me to see them in OR and looking for me.

Pero knusta naman ang tinawag pa nila para itanong kung asan ako e si Mam V at syempre humirit itong si Mam V, feeling ko tuloy nakahalata na siya. Anyways, to avoid the same mistake that I did last time, I decided to join them instead of joining Sir Ge and Sir Mar. But I told the latter that I'll call them or they call me when they're already done playing.

We ate some siomai, then went to Mcdo to buy some drinks and sundaes. We discussed our future and I already told them that me and Mam B might be leaving soon. They're sad and worried if there decision to come back is the right one or not and so I told them that is better to gain some experience rather than to be stuck at home doing nothing.

After, eating and chatting, we decided to go home and I accompany her in her way going home. Humirit pa tuloy siya na kelangan ko daw ba talagang sumama, sabi ko delikado ang daan. Then when I'm about to join her in crossing the street, humirit ulet sya na hindi ba sya marunong tumawid, sbi ko na lang para safe but I opted not to join her na lang baka maging awkward ang feeling namin sa isa't isa.

Anyways, kahit almost an hour ang pagsasama namin, buti na lang sila Sir Ge e hndi pa tapos sa paglalaro nila ng dinaanan ko na sila.

Love and Career

Kamusta naman ang araw na ito...after my birthday confession the people in OR suddenly realized that I'm in love again and this time it's Mam Veni who guessed who am I having a crush on.

Anyways, I think it is already in my nature not to fool or to lie to anyone. Once I promised something, I am obligated to do what I promised and so the end result Mam Veni confirmed her hunches and I'm having second thoughts if what I did was the right one or not...hopefully it won't reach the ears of some talkative people, but I doubt that considering all the personalities of the people in my workplace.

Anyways, I end my day by scrubbing in a heaviest case: thoracotomy, I'm perfectly fine considering I'm the scrub nurse and the surgeon is one of the nicest TCVS surgeon out there. But the thing is our anesthesiologist is not. Fortunately enough I received a text message before all this happened bearing a good news and so anything bad thing that anesthesiologist may say won't affect me anymore. Actually I'm in a bliss, knowing that there's already a future in my career abroad. :)

Happy Birthday on a Black Saturday Night Duty

It's Black Saturday, I have a night duty and it is also my birthday! Unfortunately all Catholics are in the mourning state due to Jesus Christ's death and so I decided that I'll celebrate my birthday when the midnight strikes instead. Yup! I'm moving it on the 24th this year, for the Easter celebration.

Anyways, because it is a Saturday Night, Mam Barney and I decided that we will be having a Cake Galore Night. Initially, our plan is to celebrate my birthday with the cakes that we will bake each. "Surprise each other with the cake that you'll bake for me" should be the theme unfortunately we didn't anticipate that all supermarket will be closed on Friday so we didn't have any ingredients to work with and so we decided that we'll just bought some in Red Ribbon.

Mango Cashew Roll and Mocha Chocolate courtesy of Red Ribbon and Blueberry Muffins courtesy of Benj :)

I arrived in OR and to my surprise, Jops, Sir Aldrin and Benj will be coming to celebrate my day with me, even if it is the night of Black Saturday. I'm really touched.

Good Friday and A Surprise

It's Good Friday and I'm the 6-2 HNOD today and good thing is I don't have a lot of case just one actually and it is really a minor one: laryngoscopy with biopsy and tracheostomy.

Unfortunately, all of my staff are senior staff and that means I cannot boss them around to do some stuff like making supplies, good thing I already anticipated it last night and I was able to do it with my 2-10 staff. The only thing left to do is the memo and the specimen bottle. And my staff all agreed to do the specimen bottle instead of typing the memos.

Anyways, because they knew that it is my birthday the following day, Sir Mario and Sir Jeff decided to have a little celebration by buying some pancit canton. Canton na lang daw dahil bawal ang karne as the traditions says.

Anyways, because of our little cold war, I don't know if Sir JA will go to work and will be the 2-10 HNOD or I will endorse to someone else. Around 2pm, he's still not around so Sir Ge decided to leave without me, which disappoints me because just after a few more minutes, Sir JA arrived and dismissed me early.

From Blessedness To Bitchiness

It's Maundy Thursday once again and this is the time to do our annual Visita Iglesia.

Come to think of it, I think we always do this every single year without a miss. Although I hope someday we would be able to do this in the province area. Seeing and visiting old churches to do the Visita Iglesia seems fun but of course one must never forget the real reason why we do the Visita Iglesia and that is to contemplate and meditate.

Anyways, today is also my 2-10 HNOD, I know that I have one case in the afternoon but what I didn't know is that I only have two staff. To make matters worse, our anesthesiologist is the bitchiest among them all, and saying that she's bitchy doesn't even describe her attitude.

Anyways, being able to do the Visita Iglesia, helps me to be more patient even if she started being hateful. I'm just glad that we only spent a couple of hours dealing with her.

I'm on the 2-10 Shift

Masaya sana ang 2-10 shift ngayon, dahil mga friends ko ang kasama ko, si Mam Barney at Mam Kim tapos ang HNOD namin ay si Mam TJ pero alam ko rin na imposibleng magkausap-usap kami dahil halos lahat ng kaso nasa hapon at hindi nga ako nagkamali, natapos lang ang mga kaso namin around 9:30pm na so ung bonding moments namin, ayun hindi na natuloy.

Nakakatuwa pa kasi pinaguusapan namin na baka hindi kami makapagusap ng maayos dahil si Sir JA kahit na 6-2 shift e hindi umalis at bantayan itong si Mam Kim.

Anyways, my case for today was the emergency ex-lap of a 2months old baby boy. Hindi ko nga lang alam kung ano ba talaga yung case namin pero yung ang laki kasi ng tiyan nung baby, nagkaroon ata ng intussusception tapos ang weird pa dahil yung intestines nya nakadikit pa talaga sa liver nya. Naawa nga ako sa kanya, ang bata pa pero ganun na yung nangyari sa kanya.

Anyways, okay yung case ko pati nga yugn anesthesiologist ko okay si Dr. Froi kasi ang ayoko lang yung surgeon, hindi naman kasi sya kagalingan pero kung makareklamo parang ewan lang. Ang daming demands tapos sarcastic pa kung mag-comment. Sana nga kay Dr. D or Dr. L na lang napunta yung patient e.

Anyways, hindi pa tapos yung case ko, pinalipat na ako ni Mam TJ ng case, sa URS na daw ako dahil lahat andun na, ako na lang daw ang wala. E sa sobrang bilis ng procedure na yun, wala tuloy akong nasulat sa chart ng patient so lahat yun ginawa ko na lang sa PACU.

After that, pina-relieve na sa akin yung circulating nurse na nasa tympano-mastoidectomy case. Si Mam Kim naman ang nagrelieve dun sa scrub nurse. Buti na nga lang at wala si Sir JA kundi baka magkaroon nanaman kami ng issue.

After that, nagstay ako sa OR at dun natulog per Mam barney's request dahil supposedly iinom kami ng tea sa SB pero dhail parehas kaming dukha bumili na lang kami ng tea sa 7-Eleven.

Vacancies and Overtime

Starting today the vacancies in our area is almost half of the regular staff. Out of supposedly 40 staff, we have already 15 vacancies,4 casuals (with one year contract) and only 21 regular staff. The bad news is, even though we were lacking of staff and it's already Holy Week, the surgical cases won't stop from coming in, and so we don't have any choice but to work overtime.

Anyways, today, I was assigned to the ACL case of Dr. M. The weird thing is it will be my first time to assist in that case of Dr. M, e parang nananadya pa yung HNOD namin and she placed me in his three ACL case. So sabi ko just tell me what to do, the sequence of the things how the surgery is done and I'll be okay. The first time, I was rattled, kamusta naman kasi ang bilis ng pangyayari but the second time okay na ako and I already knew what to do, na-perfect ko na nga in a sense. Although the third time nagulo rin ang buhay ko dahil ang arte nung Ortho resident. Yung first two case kasi ibang ortho resident ang nag-assist at sa kanya simple lang, so mabilis at maayos ang buhay namin but in the third case ang arte nung nag-assist, instead of makatulong yung ginawa niya nagpahirap lang tuloy sa case namin, kahit si Dr. M na-stress.

Anyways, around 4:30pm na natapos yung case namin, and supposedly may fourth case pa dapat ako pero good thing at hindi na sa akin binigay yun. And dahil na-OT rin si Sir Ghe, sabay na kaming umuwi. Kelangan ko rin kasi ang financial assistance from him dahil super duper broke na talaga ako this week at umaasa akong sana medyo mataas naman yung sweldo ko.

Anyways, on the way home I was able to confide to Sir Ghe what happened to me this past week. The clash between me and Sir JA. The problem that my mentor is having. Of course, he also confide to me what happened to his baby. Although, I wasn't able to ask kung ano nanaman ang problem ng misis nya. Pansin ko lang kasi parati na lang sila nag-aaway. Natatakot din ako sa sinabi niyang napapagod na sya sa kakaadjust, ang nasabi ko na lang tuloy wag syang mapagod.

Closer Look: Anterior Cruciate Ligament (ACL) Reconstruction

Never in my whole stay in the operating room have I assisted in an ACL Reconstruction and Mam G knows it. I'd rather scrubbed in shoulder or knee arthroscopy because at least there I know I already mastered it, but in ACL, God knows that I don't know what to do. So when Mam G assigned me in ACL reconstruction, I didn't know what to do, so I just prayed that Dr. M (one of the best ortho surgeon in our hospital) won't be mad at me and throw me the OR instruments that I will be passing to him. And to think I need to endure all three cases of ACL.

Anyways, it's a good thing that all of my senior co-staff helped me to understand the process of ACL reconstruction and with all three cases being assigned to me, now I'm proud to say I already knew how to do it. Here's the closer look of the surgery.

ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION

Definition: Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted through a hole created by a single hole punch. The surgery is performed arthroscopically.

Procedure:

This surgical technique uses three very small incisions that are about 1/4 of an inch in length to create "portals" into the knee. A fiber-optic light source illuminates the inside of the knee and a video camera feeds an image to a monitor so that the surgeon can see inside the knee. A sterile saline solution is continuously pumped through the knee via a cannula so that the operative field is always clear.

After the surgeon inspects the knee for damage to the cartilage or the menisci, the remnants of the torn ACL are removed with a high-speed shaver. This tool is a very specialized device that is used to remove torn ligaments or torn pieces of cartilage from the knee. The surface of the intercondylar notch where the ACL normally attaches to the femur is then prepared with a high-speed burr so that the proper location for the tunnel for femoral fixation can be seen clearly. 

Tunnels are then drilled through the bone in the femur and the tibia so that the graft can be placed in the center of the knee in the same position as the original ACL. A separate incision that is about 2 to 3 inches long also has to be made in order to harvest the graft from either the patellar tendon or the hamstring tendons. After the graft has been harvested, it is then prepared by placing several very strong surgical sutures through the graft that are used to fix it in place. Some surgeons will also braid the graft before passing it through the tunnels.

After the graft is passed through the tunnels, it is then tensioned and fixed in place. A variety of fixation techniques have been developed to anchor the graft to the bone. Different techniques are used for different types of grafts, and today, fixation failures, though possible, are very rare.

Once the graft has been fixed in place and any additional damage has been addressed, the incisions are closed and a sterile dressing is used to cover the knee. This dressing will usually stay on for several days while the wound begins to heal.

Instruments and Supplies:

• Sharps
• Tonsil/Adson Curve Clamp
• Mixter
• Mosquito Curve
• blade 15/11
• myerding retractor
• ticron 2-0
• vicryl 0
• vicryl 2-0
• vicryl 4-0
• EB 6" # 2
• Band-aid
• Wadding sheet for pneumatic tourniquet
• pneumatic tourniquet
• camera (scope)
• light source
• water tubings
• suction tubing
• shaver
• RF
• arthroscopic hand instruments (grasper, straight biting, right biting, left biting punchers)
• drill and hose
• endobutton c/o company (as well as instruments for grafting)

Source: ACL Solutions, Wikipedia, Physio4life

Closer Look: Scoliosis Surgery

, c;lToday, I was able to assist in a Scoliosis Surgery. I was only able to assist in this surgery once and in what I remember, it's one of the long surgeries done in OR. Anyways, here's a closer look in this surgery.

SCOLIOSIS SURGERY

Definition: Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. Scoliosis surgery is designed to reduce the patients curvature and fuse the spine to prevent any further progression of the deformity.

Besides preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Usually, about a 50% correction can be obtained with surgery using modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together.

 

Procedure:

Surgery involves an incision in the posterior aspect of the spine. The child lies on their stomach as the procedure is performed. The length of the incision will be based on the location and extent of the curvature. The muscles of the spine are moved in order for the surgeon to access the spinal column. 

Surgery for scoliosis is a form of spinal fusion. Rods and screws are connected to the individual vertebrae and a wire is often used to help realign and straighten the curve. The use of Harrington rods are a common fixation device for this type of fusion.

In many cases, a bone graft is used to connect one vertebra to another to form one segment and provide additional strength to keep the bones in place. Although donor bone material may be used, the surgeon may harvest bone to be used for this bone graft from the child’s pelvis (called an autograft). Generally bone that comes from a synthetic form or donor is not as successful as the autograft. Scoliosis surgery is involved and generally takes 4 to 6 hours to perform, depending on the specific case.

Instruments and Supplies:

• Sharps
• Kelly
• ochsner straight
• freer
• wetlainer (curve)
• adson-beckman retractor
• rongeur/ gooseneck
• mallet
• harrington/cobbs
• cottonoids
• 2/3s
• rubber sheet
• bone wax
• cautery tip
• NST
• Suction tube
• curette
• sterile cover for C-arm
• PDS OCT1
• Vicryl OCT1
• Vicryl 2-0
• Prolene 4-0
• osteotome
• bone gouge

Sources: Scoliosis Surgery, Spine Health

When Jealousy Strikes!

It's Mam Barney's birthday today pero wala siya at nasa Coron.

We have a few case today and so I thought. kala ko nga hindi ako mag-oovertime today but I guess my hunches towards my work is always right. Anyways, I was supposedly on another case when Mam Mai put me together with Mam Kim. I just never thought that being with her will bring some disaster afterwards.

Anyways, among all my friends in OR, only with Sir Ge and Mam Kin that I could confide anything from my small concerns to my bigger problems but unfortunately evr since Mam Kim became the gf of Sir JA, confiding my problems with her became impossible. I wasn't allowed to be near her, text or even call her.

Today is also the first time that we had a case together. After our first case, Mam Kim approached me and told me that Sir JA saw us and got angry because of our attitude to each other. Although, I can't even remember what I did, so to avoid the misunderstanding I joked na lalayo na ako sa kanya ulet.

At dahil ang tagal nung third case namin dumating, natapos na si Sir JA sa case nya. Akala ko naman kung ano yung sasabihin nya ng pinatawag nya ako yun pala e para i-confront ako sa nakita niya. I cannot forget his look, talagang galit sya with matching tremors pa yun. Ang weird pa kasi kahit sinabi niyang asawa na niya si Mam Kim at pinaghirapan niyang makuha si Mam Kim, tama bang sabihin niyang bibitawan niya si Mam Kim, sabihin lang namin na may namamagitan sa aming dalawa? Hindi ko talaga alam kung ano ba ikinaiinit ng ulo niya, e magkakaanak na nga silang dalawa e.

I felt really bothered after that incident. Naawa rin ako kay Mam Kim kasi sana kung gusto ako i-confront ni Sir JA, sana tago na lang and not with Mam Kim. It's just really weird when the green monster strikes! Ewan ko kung magkakaayos pa kami nitong si Sir JA, pero for now, dpat hindi muna kami magsama sa mga kaso. o baka magunaw ang mundo.

It's A Manic Monday

I requested a 5-1 shift not to avoid the Manic Monday, gusto ko lang talagang umuwi ng maaga hindi ko nga alam na Manic Monday pala yun. When I arrived in OR, I saw the whiteboard and I was shocked to see na iba yung format ng pagkakasulat ng mga kaso doon, instead of according to scheduled time ang list, nakaarrange by room ung mga case, nagmukha tuloy na konti lang ang case pero when I saw the clip board hala shocking dahil punong-puno sha and for sure OT to the max nanaman ang mga tao.

Anyways, I was placed in the 6am case dahil 5-1 ako, pero nagulat ako dahil ung monster anesthesiologist pala yung may hawak nung case na yun. Ok naman, carry ko na siya at dahil mabilis din yung case sandali lang niya ako nakasama pero kahit ganun, feeling ko nag15k run ako sa dami niyang pinapakuha. Anyways, after that akala ko ok na hindi pa pala, dahil after kong ma-transout yung patient sa PACU, hala nagwala ang patient, to think na intern pa siya ng hospital namin. Ang pangit ng emergence niya sa anesthesia. Sa sobrang lakas niya para kaming nagwrestling at dahil sobrang gulo niya natanggal na rin ung IV niya.

To calm him down, binigyan siya ng nalbuphine thru IM then his IV was reinserted and a propofol was given to him. Akala ko ok na ang lahat tapos umalis na ulet yung anesthesiologist, kaso after 5 minutes hala parang walang epek yung mga gamot at ayun nagwala ulet siya. Binigyan siya ng nalbuphine thru IV naman at another dose of propfol but to no effect pa rin. At dahil nagtaka na yung scrub nurse ko bakit hindi pa ako bumabalik after 30 minutes, sinundan niya ako sa PACU and siya ang pumalit sa akin para magawa ko yung mga charges ng patient. After a while napag-alamanan ko na naka-precedex at propofl drip na yung patient.

Anyways, kahit 5-1 ako na overtime pa rin ako dahil yung dalwang staff sa hapon absent so isa na lang yung 2-10 staff. Anyways ok naman yung mga naging kaso ko: 3 lap chole at isang removal of implant. Akala nga namin sobrang tagal nung removal of implant buti na lang at hindi. Kaso yung isang lap chole namin nag-open dahil sobrang lala na nung patient.

Anyways, after that day, napaisip kami paano pa kaya kami after mag end of contract yung apat na casuals namin. Siguradong patayan nanaman ito sa OT.

Saturday Night Duty and Early Sunday Trip

It's Saturday once again and our theme for tonight's duty is Street Food. And for the sake of no emergency case, Jops and I decided that each of us should bring something because we realized that if only one of us bring something, magkakaroon at magkakaroon kami ng case. Or if we don't bring any at all meron pa rin. So this time around both of us should bring something. I'm in charge of bringing the fishball, squid ball and kwek-kwek while Jops is the one responsible for the chicken and pork isaw.

Anyways, as usual late nanaman ako pero pagdating ko doon wala pa rin itong si Jops. After 40minutes dumating din siya together with Sir A and Sir P.J Hindi naman sila invited pero dahil andunna sila ininvite na rin namin sila. Yung mga inimbitahan namin, sila naman yung wala, although Benj came with mangga with bagoong.

Anyways, I realized na effective talaga ang pagdadala ng food every night dahil this time around hindi na kami nagkaroon ng case, although napull out naman itong si Jops sa DR-Pay dahil nagkaroon sila ng emergency CS.

Anyways, ambilis naubos ng food namin dahil andami ngang uninvited guests so in the end (ng umuwi na at natulog na ang mga uninvited guests) nagkwentuhan na lang kami nila Benj at Jops sa workroom at around 4:30 in the morning na ng magdecide kaming matulog dahil hindi na namin kaya.

Around 6 in the morning dumating na itong si Rain, na supposedly ka-COS ni Chia pero maya-maya biglang nagtext si Sir R na sya daw ka-COS ni Chia at parating na sya. Ayun nagulantang ang mga katauhan kung sino ba talaga, in the end ang naevict ay si Rain at dahil sobrang nabad trip si Rain dahil sayang lang ang effort niya, Jops and I decided to accompany her somewhere para hindi na sya umuwi. We decided to have a cup of tea in Tomas Morato. 

As usual kapag mga juniors lang ang magkakasama, andami naming napagkwekwentuhan, love story ng mga tao sa OR, mga experience namin from different monster surgeons atbp.

After almost two hours of sipping our teas, we decided to change location: Bannaple. Dahil sobrang aga pa at akala namin 10am nagbubukas ang establishment ayun dumating kami dun na sarado pa. After 30minutes nag-open din sila and we ordered Banoffee pie, Double CHocolate Tiramisu Cheesecake at Baked Creamy Cheesy Penne.

After that naglakad kami papuntang National Bookstore sa may Quezon Avenue. Syempre hindi pa rin naubos ang kwentuhan namin. Ito yung mga araw na gusto ko, yung tipong nag-eenjoy ka lang, walang stress at kasama mo lang ang mga taong hindi stressful. Talking anything, everything under the sun without any pressure. It's nice knowing some people like them.

This Is What You Called An Emergency?!

I'm not really a toxic person when it comes to night duty. I've been known to have the toxicity in my blood especially during the daytime but ever since I had my night duty, I realized that it is the time of the day where my toxic curse has no effect. Almost all the time, we had a peaceful night until I was partnered with Jops, our combination is the worst. 

Dalawang beses pa lang kaming nagninight duty ni Jops but during those times we always had an emergency case. The first time we had our night duty, an emergency ex-lap came, good thing the anesthesiologist and the surgeon were the kind ones. For our second night, we had an emergency cysto-RPG which is kinda weird because that kind of surgery was not an emergency at all, I mean you can do this anytime of the day pero parang for the sake of just having an emergency case for us kelangan talaga nilang gawin yun.

If the cysto-RPG emergency case is weird the weirdest of them all came last night when Jops and I had another night duty. We already accepted the fact that we are not meant to be partner in a night duty dahil nga everytime partner kami may case kami but when we arrived in the OR last night, it's a miracle na walang pending case, and so we thought until 1am came. A call from a plastic resident came scheduling an emergency debridement of right hand and she was saying that it will be a direct OR, no more stop over to the ER. I accepted it, feeling that it was really an emergency. May kanya-kanya na nga kaming theory kung ano ang nangyari. My theory nasagasaan ng kotse yung kamay nya at nalasog lasog, I forgot what Jops' theory is but our aide told us that maybe the patient was mugged and he fought tapos nasaksak yung kamay nya. Ok na sana ang lahat, okay yung surgeon pero ang tanong namin bakit naman sa dami-daming anesthesiologist yung monster anesth pa yung napili nila.

Anyways, when we received the request hala nagulat kami ni Jops. The operation in the request is as follows: Emergency debridement of 3th and 4th digit of right hand possible wire fixation. Our reaction: "ngek! daliri lang yung aayusin nila? Emergency talaga ito? Life threatening? Bakit kelangan pa nila ng anesthesiologist?" Nakakatawa lang kahit gaano ka-minor yung case for the sake of just having an emergency case for us, kelangan talagang magkaroon.

And we thought mabilis lang yung case but we were wrong, after kong masabon ng anesthesiologist for not knowing where the heck is the manual drill of OR (which I consistently saying na wala nang ganun sa OR to the surgeon, which was finally confirmed by a senior nurse), the operation which was supposedly last for an hour (if only they asked for the help of an Orthopedic surgeon) lasted for three hours. Saktong-sakto pagkatapos nila 5am na at nandun na yung mga 5am-1pm shift nurses. So kami naman (after kong i-transout sa ward yung patient) nagmadaling magopen at magset-up ng OR dahil 5am na and our earliest case for the day is 6am.

At kahit walang tulog at antok na antok, parehas pa kaming na-OT ni Jops dahil kahit na holiday, walang tawad ang mga surgeon at andami pa rin nilang cases for the day at dahil kulang sa tao, ayun kami na ang na-OT. After 3 hours of overtime work, pinauwi rin kami.

New Sideline and Income Tax

I'm trying a new sideline today and that is being a Clinical Instructor to students who are for completion in their OR requirements.My co-staff asked me if I would like to try it, madali lang daw naman and I would be paid a thousand bucks and because I really need money right now I agreed to try it.

The work is okay, you just need to assist them in distributing their cases and re-orient them about aseptic technique and the proper way of glovings and gowning. What I really not anticipate is when a student nurse suddenly collapse while he is scrubbing in Spine Surgery. Buti na lang okay lang sya and nothing serious happened.

Today I was also able to receive the Income Tax Form...yung ififile sa BIR for your ITR. Ang weird it's my first time to accomplish such form. In my previous work kasi exempted kami dahil minimum wager lang pero now, meron na.

Anyways, umalis agad ako from my CI duty kahit na supposedly hanggang 5pm pa dapat ako, pero dahil wala naman ng cases around 3pm, sabi ko sa students ko mauuna na akong umalis. I accompanied Sir Ge to the college para kunin yung cheque nya which was his payment for doing some CI duty last January. After that we deposit all of his cheque in a nearby bank. O  db sya na ang maraming cheque...hehe :)


We went home after via Blumentritt route and nagulat ako dahil after a year lang ata ulet ako dumaan sa rutang iyon. Compared to our Fairview route, mas gusto ko pa rin sa Fairview dahil first and foremost malinis and maganda yung mga view unlike sa Blumentritt na parang andumi ng daanan. And dahil mas mura ang pamasahe papuntang Fairview. Imagine from Blumentritt to Novaliches, P40each yung FX! E dati P30 lang yun! O well sabi ko sa kanya wag na kami dumaan ulet doon. Hehe :)

"Instant Food" Saturday Night Food Fest

It's Saturday once again and as usual we have our Saturday-themed food fest duty just to avoid the toxicity of the night. Anyways, si Rain naman ang kasama ko this time around at dahil sya ang nagdala ng ice cream the night before, I promised her that I will bring some tonight.

What I didn't know is may mga kaso pa pala sa OR, good thing pagkadating ko tapos na yung mga case at magliligpit na lang kami, the other case was rescheduled the following day.

At dahil duty naman sila Jops and Benj, I told them to stay behind na lang dahil may dala akong food. So after umalis nung ibang 2-10 sabi ko may dala akong ice cream and they volunteered na bumili na rin ng ibang food, at dahil gusto nilang kumain ng noodles, bumili na sila ng yakisoba at mga noodles, habang kami ni Rain ay naglilinis ng OR.

After maglinis, we decided to eat and magkwentuhan ng mga pangyayari sa OR. The relationships na namuo sa OR and lahat ng rumors na kumakalat pinagusapan namin. This is one of those nights na hindi ko malilimutan dahil I'm with the people na hindi mga plastic at mapagkunwari. We really had fun that night, good thing nga at wala kaming emergency case ni Rain, although na pull-out sya sa DR-CD around 4am.

All Alone

Today is the last day of my 8-day straight duty and what is the best way to cap it off is to be the solo circulating nurse in the CABG. Kamusta naman unfair kung unfair ang nangyari supposedly dapat yung mga from off or double off yung ilalagay diyan pero dahil ni-request ni Sir J na ako ang circulating e d ako na nga ang napunta. But I guess ok na rin yun dahil at least ako tahimik ang buhay ko sa suite room 8 doing circulating job in the heart surgery, while other staff were being toxic to their cases. Aside from that one case lang yung napunta sa akin dahil heavy case nga yung open heart surgery while some have three or more dahil toxic nga rin nung araw na yun.

Anyways, last time second circu lang ako pero isang linggo ako namroblema so this time around, sabi ko aayusin ko ang trabaho ko lalo na sa pagccharge ng mga supplies na nagamit para hindi ako ma-question and yun nga okay naman lahat, everything went smoothly until nung bago kami mag-trans-out to PACU. Kasi naman mali rin ako, in the middle of the surgery, siyempre swabe na ako ulet unfortunately nakalimutan kong ireview yung chart nung patient so nung patapos na sila doon ko lang narealize na hindi ko pa pla nagagawa yun, buti na nga lang at mabait yung PACU nurse na naka-assign sa akin. Hindi niya ako tinoxic :) Buti rin at mabait yung anesthesiologist ko at hindi yung mga toxic na anesthesiologist kung hindi lagot talaga ako.

No Rest For Three Days

If you're a nurse, you work in shifts and most of the time the shifting in hospital goes by the following shift: 6am-2pm, 2pm-10pm and 10pm-6am. "Every 8" is a term used when you have only 8 hours of rest before going to work, for example you are in the night shift then the following day you have to work in the 2p-10p shift, it means you're in every 8 shift.

Anyways, since Saturday I have working in every 8 shift. I'm on the night shift last Saturday, then 2-10 shift on Sunday then 6-2 shift on Monday. In short, I have so little time to have a rest, considering that my travel time going home is almost 2 hours so that means 4 hours were wasted just going to work then going back home.

Here's the breakdown of what happened to me for the last three days:

SATURDAY

I'm on the night shift once again and this time around Jops mentioned that we will have a German Food night. I really don't have any idea what kind of food does Germans eat or what kind of food they're famous for. What I only know is that there is a food known as German sausage, and they're really heavy drinkers and they like beers. That's all, so I decided not to bring any food. But to my surprise, Jops brings food this time around, birthday kasi ng kapatid niya. Pero dahil isa lang ang nagdala ng food sa amin, we had another emergency case: emergency cysto-RPG.

SUNDAY

I'm on the 2p-10p shift andbecause I attended the mass first before going home, I was only able to get a 2 hours of sleep, so I decided that I'll just take a nap at work. Hoping that we don't have any emergency case in the afternoon.Unfortunately, when I decided to take a nap already, the nursing office called our area and asked for a pull-out in the CS case of the DR-CD, and seeing that I'm the junior in the staff, I'm the lucky one. Pero kahit papaano, I think it's a blessing in disguise dahil pagkabalik ko, meron namang emergency case sa amin which is kinda toxic buti hindi na ako doon. :)

MONDAY

I'm on the 6-2 shift this time at dahil every 8 nga ako, doon na ako sa OR natulog nung Sunday night. And dahil mukhang kawawang -kawawa ako, I requested to be placed in one of the heaviest case para stable lang ako at hindi kung san-san napupunta. At dahil heavy case siya, ni-request ko na rin na maging circulating si Sir Ge para hindi ko na siya hihintayin pauwi. Good thing they granted my request.

Yung case ko is pyelolithotomy possible anatrophic nephrolithotomy. At dahil ang swerte-swerte ko, ayun nga at naging anatrophic nephrolith ang ginawa sa patient. Good thing at si Sir Ge yung circulating ko at madaling pakiusapan kapag may kelangan ako.

After our case, sabay rin kaming nakauwi pero before going home, sinamahan ko muna siya to get yung deposit nila sa dati nilang inuupahang bahay. Dapat idedeposit na rin namin yun sa bank pero he said wag na lang muna dahil icocompute pa niya and everything kung bakit mababa lang yung nakuha nila. After that naglaro muna kami bago tuluyang umuwi sa kanya-kanyang bahay.

Closer Look: Laparoscopic Appendectomy

Today was my first time to assist in Laparoscopic Appendectomy and I'm glad that finally I was able to assist in such procedure. This kind of surgery is rarely done in our institution due to different reasons but because primarily the cost of the procedure is not that affordable compared to the open approach and secondly the incision of laparoscopic and open approach are nearly the same.

Anyways, here's the closer look of the surgery:

Laparoscopic Appendectomy

Definition:  A laparoscopic appendectomy is a surgical procedure that removes the appendix from the body through a small incision. During this procedure, small incisions are made in the abdomen so a surgeon can insert a small camera and surgical instrument. With the camera in the right place, the surgeon can watch what he is doing on a video screen, while he is removing the appendix.

Position: The patient is in supine position, arms tucked at the side. The surgeon stands on the left side of the patient with the camera holder-assistant. For maintaining co-axial alignment surgeon should stand near left shoulder and monitor should be placed near right hip facing towards surgeon.

Procedure:

A small incision will be made for insertion of the laparoscope. Additional incisions may be made so that other instruments can be used during the procedure. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the appendix and other structures can be easily visualized. The laparoscope will be inserted and the appendix will be located. The appendix will be tied off with sutures and removed. When the procedure is completed, the laparoscope will be removed.  A small tube may be placed in the incision to drain out fluids.

Instruments and Supplies: Lap Chole Set (consists of: allis #6, towel clips #6 , kelly #6 , tissue #2, thumb #1, needle holder #3) Trochars: 5mm #2, 11mm/10mm #1 Hand Instruments: grasper, dissector, needle holder, mixter/ hook, scissors, extractor, suction tip Silk 2-0 Prolene 2-0 Prolene 4-0 betadine (for betadine wash) asepto Sources: Lap AP,  World Laparoscopy Hospital