What happens when a chapter ends?

Last Thursday, 25th February, I spent my last morning shift in NTFGH Ward B11, a General Medicine and Geriatric discipline ward. I have spent my last 3 months as a nursing student there, struggling to adapt and to learn. Lucky enough for me, I managed to pick up rather quick, by the end of third week I was ready to have at least three patients under my care, of course with the help of the staff nurse in charge.

It became a daily routine; shuffling through the tiring shifts, waking up at five in the morning for AM shift, having a light breakfast in the staffs' room before going in for work. I have learned to have at least a cup of Milo before going into morning shift, because during my third or fourth week, I worked throughout the whole shift and only managed to have my lunch AFTER shift. I was quite proud with myself, to be honest. I still dreaded the short transition that we have when we go from PM shift to AM shift.Our PM or afternoon shift starts at 1pm, and ends at 9.30pm but of course, everybody goes home after 9.30pm. If you stay near the hospital, lucky for you but if you stay a little further, that's too bad as it would mean that you only have four to five hours of sleep and then there you go, finding yourself getting ready to return to the ward you left just seven to eight hours ago. It was only for 3 months, or 12 weeks yet I hated the shift work when I still have ten years down this road.

Going into the beginning of the past 12 weeks, I was terrified, nervous and all the stories told by our lecturers of how students failed when they were towards their end PRCP made it all worse. I was hoping that my assigned preceptor would be a great one and that the staffs in the ward would be friendly. I think I had a rough start with some of them, I'm not really the social type. As weeks went by, I started getting closer to some of them and we would talk about other things instead of just work. I had a change of preceptor as well, not that the previous one was not good but obviously I liked the later one more. A good preceptor - preceptee relationship was really important as it may affect how well I can perform.

Hours went by, weeks went by; day by day I was getting more and more familiar with the workflow. I was proficient (I dare say) in serving medications. Towards the end of week five and starting of week six, I was taking all six patients under my care with the guide of the staff nurse. Initially, I struggled because six patients would mean dozens of different orders, and tons of different medications. I gave my best in trying to remember the orders I would need to complete by the end of my shift. It was at that point where I was under tremendous stress and was at the point of breaking down. I felt that I was so close to the edge of the hill and I was about to fall off and die. It was also then that I realised why some nurses and doctors are so tasks-oriented because the workload is simply just too heavy. However, I refused to give in. I chose this path (though initially I wanted to study medicine) , and I chose this because I wanted to help those in need, to learn more about medicine and diseases. So in the midst of all the demanding tasks, I tried to give my best care to patients, by answering to their demands promptly, showering them with care and patience instead of rushing through, feeding them slowly. I guess I did it, because in between those weeks, I received my first ever official compliment from a patient's family member. It was a huge boost to my confidence, and it definitely helped pushed me through the second half of my internship.

Another few weeks went by, and I found myself making phone calls to doctors/labs/family members on my own, and receiving cases by myself. I received three transferred patients on my own during one of my afternoon shifts, something I would have not imagined myself to be capable of so soon. I was proud of myself.

 Then came the graveyard shift which probably was every student's nightmare. Being in a geriatric ward, I prepared myself to babysit my patients throughout the night. Thankfully, all my three nights went by peacefully. I even had time to sleepily make my way to the staffs' room and catch a thirty minutes nap. Long before we even get to do this graveyard shift, we were scared mostly because of the 'strange encounters' we heard from our seniors and lecturers. Unexpectedly, those did not even cross my mind at all. I was glad though. 

(photo via Facebook)

This is 99.9% the truth when you're in a geriatric ward, no joke. 

I felt responsibilities getting heavier on my shoulders as I continued my final journey as a student. I felt that I ought to get everything completed even if it means extra half an hour of work. 

Somewhere in week eight or nine, I had a patient whom suddenly went into a comatose state, probably because of his diagnosis. I did not know why but I was devastated; he was fine the day before. I was serving medications that morning and I had thought that he was still asleep but when my staff went to wake him up later on, she could not despite numerous times of calling. The patient did not even respond when she inflicted pain on him (one of the ways to check for consciousness). I had been caring for this patient for days; what happened was sort of expected but it came so sudden. I was sad, and one could only imagine how his family members felt.

Another of my first encounter, I was on morning shift the day when my patient deteriorated rapidly but thankfully, not coded. He came in for shortness of breath (SOB), but he was not on any oxygen. That morning he was fine, he was taking his medicine, he was eating his breakfast (full share). His morning vitals were great, saturation within satisfactory range. When his physiotherapist went to asses him later that morning, she took his vitals and informed me that his blood pressure was really high. So after five to ten minutes or so, I went to re-check on his vitals. He was still responding verbally to me, but I could clearly see that he was struggling to breath and his lips were turning purple (a sign of oxygen deprivation in the body). True enough, his saturation was only 70% which was really low (normal range would be >95%). And his blood pressure was really low as well, despite trying to re-take a few times. His pulse was so weak that I could not even feel it. If my staff guiding me was not there, I would have panicked. Thankfully after fluid resuscitation, and putting him on a non-rebreather mask, his condition stabilised after awhile. No words could describe the joy in me when I saw him so well a few days after that incident.
When I revisited that incident, I thought what if I did not re-check his vitals? What if I had forgot to do so or what if I waited longer? He would have died. I can only thank God for guiding me.

Honestly, I could go on with the things that I have encountered/experienced during my three months but that would be too much. I love and I hate this profession.
We are nurses, but we are also part-time babysitter, part-time cleaner, part-time translator but above all that, we are the ones who probably sometimes care most for our patients. Our patients can sometimes be mean, or their family members, but nothing beats that joy in our heart when we see our patients get discharged home healthily, or at least better. At least to me, I feel happy when I see my patient gets discharged.

I have finally completed my diploma, which means another phase in life is over. While I'm excited to start a new chapter, I'm also wondering what else that I wish to do. In a few more months, I'm going to be a 'staff nurse' or a 'registered nurse'; I pray to God that He will guide me, and give me the strength (physically and mentally) and also patience to be a great nurse.

Two amazing SN who really guided us throughout, missing them already! And two other great students.