More Than Ever

Sometimes, in the continuum of our lives, one experience – a moment or series of it – is so pivotal it changes the way we see the world.

I had my experience in my infirmity, my first real one, not only as an adult but as a practicing nurse. Sure I have had scores of flu, or flu-like illnesses before, all manifested by the classic constitutional signs and symptoms – fever of different grades, cough, colds, body malaise, vomiting, watery stool, the drill. In each of these minor illnesses, I usually combat it (and I know my practice is probably generic, too) with lots of fluids, rest, even abusing ascorbic acid (vitamin C) to dangerously liberal levels, paracetamol, the drill. And guess what, it works. Every single illness time. How could it not? After all, when our body is at its prime, it can easily cope with the stress brought about by some virulent pathogen, which, come to think of it, is not really that virulent after all. And so I always say, nothing that I, a nurse, couldn’t handle.

This is the reality of my life and of my professional practice: illness is part and parcel of the job. The moment I have consciously decided to make a living out of making other people live, I knew what I was in for – that, whatever type of disease, particularly the infectious ones, I am to handle, I am to potentially acquire. Like flying a plane and getting lost to the world of Amelia Earhart. Or closer to home, enlisting in the armed forces and possibly coming home with a limb, or two if you’re lucky enough. This is the reality, the cold bitter reality in every one’s bread and butter – the risk, or hazard if you may. One that constitutes real danger to life and limb that it reflects faithfully in every one’s payslip at the end of each month under different nomenclature but essentially the same meaning: combat pay, hazard pay, sea duty, airborne pay, danger pay, what have you. In the healthcare industry, at least in our setting, it’s called Magna Carta.

I don’t get to enjoy this. For the longest time. Or probably ever will and this is the truth. It’s a good thing though that I work in a hospital where the people are the most benevolent and generous kind. I work in a hospital where getting out of our way to check on a sick colleague is not uncommon. I work in a hospital where people with the most golden of hearts find a way to help you get through your condition relatively unscathed, at least in worry and in your pocket.

But I get sick. I get nosocomial infections. Like everyone else exposed day in and day out to virtually all kinds of virulent pathogens the world has come to know, and possibly yet to discover. No healthy individual could ever claim resistance, or even immunity to illnesses. At some point in our lives, we all succumb. Just as a pilot occasionally, well, pilots a plane with some mechanical problems, or a soldier on patrol crosses paths with the enemy and gets wounded in the crossfire. Our immunity could only do so much for us but when the pathogenecity of an organism overwhelms our system, we all bog down. Eventually, inevitably.

It all started a week ago. (I’m well on my fifth fifth day in confinement while writing this). At work, I was feeling a little funny down my throat, kind of scratchy-funny like a when a cat paws you on your neck when you try cuddle it, and my breath was a somehow a little too warm against my philtrum (this is actually just the funny little ridge between nose and mouth). Telltale signs. How could I have missed them? But then again, if I had known that it was going to get really serious, what could I have done to arrest the disease process? Overdose with vit. C? Fluid therapy until I develop dilutional hyponatremia? Abandon my post and say I needed all the rest I can get? Maybe all of the above?

I tried to dismiss the feeling, like how I selectively read only those that catches my fancy while browsing on FB (sometimes, there’s just a lot of crap you know). I told myself that the feeling is probably fleeting and anyway, the day after is my off day so if in the case that it really develops into some kind of flu, then I can just sleep in and take all the rest I can get. Simple problem, simple solution. Nothing that I, a nurse, couldn’t handle.

I woke up the next day with a pounding headache. One that is so unusual because I never had any headache after a good night’s rest. Who does? And insofar as I always attribute any feeling to a logical, rational explanation, I blamed the bottle, or three, of beer that a colleague and I shared the night before in our effort to diffuse all our tensions and stresses at work. You see, the past week has just been crazy and since it was Friday night anyway, we thanked God for it. So there, hangover! Nothing more.

When I tried moving my limbs, it wouldn’t budge. Not oh-no-i’m-paralyzed-my-muscles-wouldn’t-move kind of thing but damn-it-hurts! And it did hurt, like I’ve been through some kind of fraternity initiation the night before. I was sore, and tender, and well, very weak. Headache plus body malaise that is so deep and profound and incapacitating to a point sure doesn’t sound like purely hangover to me. The combination just isn’t right. So it must be something else, huh?

Way back in college, as I learned the intricacies and beauty of the human body, and navigated through the complex and murky waters of each and every disease process, I began to develop the habit of self-diagnosis whenever I feel the slightest iota of pain or experience the faintest tingling sensation at the tip of my digits. Once, I attributed sciatica to an absurd firing sensation down my leg. Turned out, it was just some muscle strain due to excessive volleyball. Also, there was an acute right lower quadrant pain that I was so convinced to be appendicitis, which, later on just turned out to be constipation. How weird could I get? But who’ll blame me when, I know every single one who listened intently to their clinical instructors, actually, in some subtle way, practices this sick and paranoid habit of self-diagnosing? In retrospect, it’s actually child’s play but old habits die hard. Some don’t at all. And so when I felt the combination of headache and intense body malaise, I immediately thought of a myriad different diseases that could present with these cardinal signs. Meningitis? RHD? Exudative ATP? Worse, typhoid? Worst, septicemia?

I started fretting and immediately went over the cupboard to retrieve my stash of ascorbic acid and downed two tabs at once. There, it should help. I did some laundry, cleaned my shoebox of an apartment, and did pretty much all the weekend chores. I felt happy, although sore, and hit the bed after. I passed out immediately.

It was nighttime when I snapped out of what seemed to me like a thousand-year slumber. And all the body pain that I experienced when i woke up in the morning was nothing. Yes, it was nothing compared to the intensity and severity of the pain in my head and my body when I awoke that night. Everything just seemed magnified and every little nook, cavity and crevices in my body, down to the tiniest cell, and probably even my soul, was throbbing and screaming and burning. I was a burning furnace, a conflagration, and I was shivering so violently I seriously thought I wasn’t going to make it through the night. Ok, I may sound quite histrionic here but when you are in the middle of that terrible bout of fever and malaise, you’d entertain all sorts of morbid things, and yes, including the very real possibility death. On top of it, I was utterly alone. And a thousand miles away from home.

Mustering my one last ounce of strength, I reached for my medicine box and retrieved some paracetamol. I popped two in and though I know it’s not recommended, I was really afraid of getting delirious and even having convulsions. So between overdose and hyperthermic seizures, I chose the former. I got relief, albeit for an hour or two at a time, then my fever skyrockets again and I would start chilling down to the very cannaliculi of my bones. It was a vicious cycle that really, really scared the living daylight out of me.

Morning came and I felt worse. No amount of antipyretic gave me lasting relief. I was hungry, mainly because I haven’t taken anything much the previous day and the amount of paracetamol that I ingested was making my stomach churn even louder and more violently. When I tried a few crackers, I realized that I couldn’t get the damn thing past my uvula. It was an exercise in futility. One that I immediately gave up on upon trying so hard just to pacify my tummy. So being the callous and rational nurse that I am, I thought about getting more rest instead. I tried water but the pain was twice as much. I just couldn’t tolerate anything per orem. So I went on NPO (nothing per orem) and rested some more. Thinking back, I was wondering why I haven’t considered going to the hospital at once. I remembered factoring in the shame and indignity of exposing my weak self to my colleagues who knows only the vibrant, bouncy and energetic me. Also, I hated the prospect of having to use scarce and valuable resources that could be used for other patients. It was beyond my comprehension, and pride, and apparent irrationality that time. So I bode time, delusional and in denial of my apparent condition in my twisted and misplaced hope of getting better without any medications and treatment at all.

More high-grade fever and chills ensued. Near the end of the day, I awoke again and felt that my body was about to explode of fever. I was lethargic, thoroughly and bone-deep weak, and so hungry I wasn’t hungry anymore.

Then I thought I was having an aura, you know, the kind of thing that patients with seizure disorders usually experience immediately before an episode. On my part, it was some kind of an olfactory experience for I thought I was sniffing something out of order: a boiling pot of stew or something. I don’t know but it could have been coming from a neighbor’s good cooking or purely coming from my brain which was probably tricking my body to ingest something so it could continue to function. Anyhow, that sealed it for me. I gathered what few things I could think of, put on my jacket and bonnet (which made me look like a hideously coping chemo patient), popped a pill, hailed and flagged a taxi outside, and prayed.

By God, I was praying and crying inside the taxi en route to the hospital. How could I not? After all, I only go there to work, not to be in the ranks of people we serve every day. Getting sick is one thing but going through the prospect of possible admission terrified me. What scared me more was the idea of being an inpatient all by myself, no family, no immediate support-sytem, no one. Just me. And so I cried.

Colleagues greeted me at the entrance of the Emergency Department. Weak and still febrile, I was wheeled directly into the observation area bed #4, the farthest and most secluded area where I could have maximum privacy because only the hospital personnel who have business with me can reach there. Immediately, I was seen by the MOD (Medical on duty) and lab tests were ordered stat, IV line was started, and IV antibiotic was skin-tested. If I were on duty, these are fairly routine procedures but being on the other side, I was dazed by the abruptness of it all. Though I anticipated this, no amount of thinking really prepared me for the real thing. Here I am, finally a real-deal patient.

And so, stunned from all the things going around me and still reeling from all my body pains and fever, I placed my trust wholly in my colleagues whom I know by heart and whom I know will do their very best to make someone of their own feel better by their interventions.

My epiphany was as sharp as the skin-test of PenG that was tried in me. Right there, helpless, sick and spent on the bed and looking at the baleful bluish-gray buzz of light emanating from the flourescent bulb directly above me, hearing the resonant voices of doctor and nurses speaking and communicating in a pattern so familiar I could have been hearing myself, listening intently to the voices of my colleagues that could have been my own, all directed towards one and only one goal: to get the job done and make the patient – me – feel better at once, I finally realized the power we possess, unspoken and often unrecognized yet sublime just the same, over those who are suffering, those in pain, the destitute, the sick – the patient. It is the power to bring comfort, to alleviate pain and suffering, to restore health to its optimum, to preserve dignity, to promote well-being, to render care, and ultimately, to give oneself in order for the other to get another chance at living life to the fullest.

In nursing school, these are the fundamentals they teach us. I remember distinctly my professor who said, “Do not ever forget that as nurses, we have the power to bring healing. This is our calling, our role, our vocation”. This concept was rather too abstract for me that time but as alien as it may seem, it hit some sensitivities from within, like a stone which emanates ripples when thrown into a placid lake. It resonated into my very core and for a time it became my primary motivator to plow on the field of nursing, which before that, I had trouble incorporating into my system. Not that the lessons were hard for to be honest, they were relatively easy. But before I got into nursing, I was happy with something else. But I shall not launch into another sappy account down memory lane because it warrants another time and that story might actually be longer. Anyway, the concept of this power we have over people who are sick is something that tickled my fancy. It excited me in ways I could not entirely wrap in words. I thought I was already dead, my dreams down the drain and my hopes into oblivion. I was in that catatonic state of mind the moment I received my honorable dismissal from the other university. Then, like the unkinking of a crumpled tissue dropped in water, I slowly but surely understood – and eventually loved – this profession of healing, opening my self up to the possibility of doing wonders, giving my self, my whole self, to the beautiful world of bringing about change in this world, however minute, however insignificant, however trivial.

All our ministrations to the sick, all our goodness, all our care and compassion, even all our self at some point of doing them over and over again have the very real tendency of becoming routine. Routine. Routine that is devoid of personal touch, vacant in expression, and thoroughly mechanical and perfunctory in nature. In our line of work, this concept – indeed, state of mind – is taboo, like some allergen that is not supposed to infiltrate our system. And yet, through time and repeated practice, whatever noble ideals we espouse, whatever vigor we exercise at work, whatever joie de vivre and panache we exude, eventually level out, then wane, and then, sadly for some, die out. This is a terrible tragedy for most, if not all of us. It is like an epidemic that exacerbates in time and consumes us, and eventually making us this stoic, unemotional, uncompassionate individual completely unable to empathize with the goings on of our patients.

Fortunately, and I count myself lucky, there is remission in this kind of mind set. Unfortunately, as in my case, this realization has to come in the form of role reversal, that is, becoming the patient myself. It’s not really that I’ve become this apathetic, languid and seemingly indifferent nurse. No, far from it. But sometimes, the sheer volume of our workloads, the attitudes of our patients, the “everyday-ness” of it are just some of a host of other reasons why we lose touch with the fundamentals of care and compassion. I am guilty of this. I am not sure if I am alone in this.

But when I found myself, against all odds, lying on my sickbed, thoroughly helpless and sick and terrified, it all finally came back into me: it is precisely this helplessness, this sickness, this uncertainty that people of my chosen profession exist. And weren’t these the very reasons of our utterance “devote myself to the welfare of those committed to my care” during our oath taking? Care, such a carefree word, but one that wields much power over the other. For without it, there is no healing. Too little of it, we run the risk of complacency. Too much, there is danger of overindulgence.

I remembered it all. And every little thing that my colleagues has done in order to make me feel better. Lying there, thinking of my practice thus far, I have come into a heightened sense of appreciation towards my practice in general, and my sickness in particular. I have learned how sickness can literally incapacitate you, yes, to the point of being unable to tolerate food and do activities of daily living. I have learned that to this effect, there is knowledge and skills that can help you regain your optimum health. I have learned that in order to get back to that optimum state of health, we need the power of those who are capable of doing this, that even our very own knowledge and skills will fail us in times like these. I have learned that it is a process, certainly full of pains along the way, necessary pains that we need to go through in order to achieve observable results. I have learned that in some of these processes, we need to continuously reevaluate our patients because every one reacts differently to different therapeutic milieu.

Above all, I have learned, and resolved to myself, to listen more to the needs and cries of my patients. That even the slowest IV push of PenG can and does hurt like hell, and that changing one’s shirt with an IV line on can be the most challenging of things.

I was confined for a total of six days! Six long, agonizing days. (I’m already out as I’m writing this). I spent two days at the ER OBS area thinking that a few doses of IV antibiotics will help me get back my bearing. My knowledge failed. I got worse, ate lesser, shivered more. I was, in other words, admissible. Those two days at the ER – my ER – the one place I shine the most, the one place I love the most, the one place I have most control at, are two of the longest days of my life. It was torture of the highest caliber to be so helpless in a place I feel most helpful and useful at. But long as my days have been, those were also golden days of precious learning. Learning all the things the academe will never, and ever, be able to teach its students. It is learning not from the prying eyes of each theory we learn at school but rather learning from the eyes of the subject of the theory itself – me. I learned to be a patient more than anything else. I learned how it is to be a patient. I learned how, in the face of an unknown adversary, that is my own sickness, I, a patient, and also a nurse equipped with knowledge and skills, put in a little attitude, can be all helpless and needy and well, just plain sick. I learned that the nurse in me can also cease to function at least momentarily when we are still stunned and incapacitated to fight back, and that sometimes, we all need help to deliver us from deterioration.

I have learned, most precious of all, that doctors are saints. And nurses are every day unsung heroes.

It was an eye-opener no amount of reading could have awoken in me.

Another four days up in the ward gave me more time to think about, well, things. When time is on your side, so is the temptation of the grotesque. But at the same time, the lure of the wonderful. I have chosen the latter. I wallowed and sulked and indulged in my emotions on my first night. I did this because more than ever, I felt the desolation, the reality of my situation, of my being alone, of having to go through it all without no one on my side. I cried my heart out. And then that was only so far as I allowed myself to go. My father called me up and said, “At the end of the day, we only have Him to call and He will be there”. I cried buckets. I stormed the heavens with tears and prayers. After all, my father is right. We only have Him to call when the lights turn low and we face the deepest, darkest of our nights.

But then, the darkest hour of the night is just before dawn. I held on and indeed, I did not have to look far in order to see the good and the beautiful. I realized that while we have little lapses of judgment, as in my conviction that I was utterly alone, we have them in order to learn bits of wisdom as we go along. How foolish of me to think about such thing when I was at the receiving end of torrential love and care and time and devotion from my friends, colleagues, and family? Some weren’t able to say as much as ‘get well soon’ but I could feel their love and prayers just the same. The world is still full of goodness, and I can readily attest to this insofar as I am willing to do the same for a friend in a similar predicament.

Before long, I started to get feeling better. The proverbial dawn. I had more energy and I was less tired, ate more, and never shivered again. I could even change my shirt with an IV line on in a heartbeat. I joked around that I could really get used to this but sometimes, or most of the time, when on impulse I stand up in order to answer calls of nature (which was quite often considering the amount of IV fluids my circulation was getting), I tend to forget about my existing line and almost always just go on carelessly until I feel the tugging of the IV on my arm and I am reminded once again that I am still a patient. I bide my time, allowed medications to run its course, allowed my colleagues to do what they do best at, allowed my self to rest and recuperate, allowed myself to learn, allowed my self to live. And before long, I was better.

Finally, after six days, six long, agonizing days, no, six long beautiful days of learning, I was ready to face the world again. And my first thought about this: I shall be a better nurse.

More than ever.

Photo credit: More Than Ever

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