Read Scripture: Acts Ch. 1-12

Fishing sunsets

Last Pfingsten, or Pentecost Sunday, I went to Ulm, a city near Munich, to go fishing.

The weather was amazing. and so was the view.

It's quite a nice feeling really, fishing. The stillness of everything. You can just sit there, and think of nothing.

The sunset was amazing!

The sky mirrored itself on the surface of the lake.

You could see the clouds reflected on the water.

were it not for the trees and the lilies, you would think that the sky was endless.

this picture somehow makes me reflect on life.

How everything seems to be balanced. nature and mankind.

this is nature's version of an artwork.

as  the sun slowly set, the insects and the frogs began their symphony.

honestly, this could pass as a ''heavenly'' scene from a movie.

we didn't really catch a lot of fish though.

still, it was a perfect afternoon. 

it makes me think of the times I spent in Escalante back in the Philippines, where we used to have sea-picnics during low tide. We would bring baskets of rice, vinegar amongst other things. We then had to search for shells and other seafood on the vast ocean floor that was then visible. I used to see lots of strange sea creatures like sea cucumbers and various clams. We usually did those picnics in the afternoon, up until sunset.  The sky would then change into wonderful colors, almost just like this in the picture.

 Ahhh... such bliss.

A take on living in Heidelberg

I know. I haven't posted in a long long while. But guess what guys! Im back in school!

Im now in my second semester in Universität Heidelberg and taking up molecular biotechnology.

I still have no Idea why they accepted me since Im really a very lazy student who always lags behind in math and chemistry ( at least the ones we now have in class) ;)

Anyway, instead of finishing up a paper I am supposed to rewrite, I now find myself procrastinating. yet again. 

I just figured, I could use my time better if I pop in a bit on my blog and share some stuff with you.

so here are some pictures of the stuff that has been ''going'' or happening since last October.

and excuse the randomness of the pictures. I am a very lazy person and do not want to rearrange them so please bear with me. ;)

this was Heidelberg, December last year.

my first time in years to step on ice again...and yes, it ended horribly. I now decided I would fare better, ice skating inside my head...since falling down wouldnt hurt as much as it did on this night.

 

this is the brightly-illuminated main street in Heidelberg, Bismarckplatz.

oh this is one of the many times I find myself taking pictures of people around me who are studying and working on something...when I should be doing the same ;)

and of course, you know, living alone in a foreign country makes me miss, miss, miss all these treats that I almost never used to mind back at home. now, since Im often homesick,  these babies have been my treasure and comfort in times  when I wish I were back home. (which happens quite oft)

look at this magnificent piece of architecture!!! can you guess what it is?....

it's the school library!  yeah, I know right. ostentatious is the word. but it a beautiful way.

and I have the best view of the sunset everyday from my room. it always takes my breath away.

i always remind myself to breathe, and stop taking pictures of the sunset everyday since the view almost never changes (it is really beautiful, mind you. but my phone cannot handle its glory. also, because I really have small memory space)

 this is a nice spot in my city, where people are free to take and leave books as they please.
an open library. sigh. I wish we had this in the philippines too.

 oh and the really cute mail box that looks like a strip from a cartoon scene. I just simply had to take a picture!

 now we come to the heart and stomach of the whole university, the place where magic happens.

this is the school Mensa or cafeteria where students get really good food for quite cheap prices
(heaven!!!)

I never quite figured out what those strange white columns with the black ovals are for. I looked, and they weren't speakers or something of the sort.
kinda makes the place look like an alien pod somehow.

this is the first picture I took of my room. the first day I moved in.. you can still see the unpacked boxes and new bed sheets!!! I love the smell of new sheets.

this was on our first week. it was a chemistry pre-course...that began the stress I call school life.

one of our early biology classes..most of the stuff mentioned in class never made sense until I got back home and consulted  our Alberts The Cell Book....

 here, ladies and gents, is my first encounter with proteins. little did I know that I would be seeing them always from that day on. (they just looked like funny blue shapes to me at first)

 the beautiful city of Heidelberg...on one of the less crowded and less tourist-infested streets ;)

our cool physics class! I sometimes share some Physics and Chemistry class stuff on my Instagram account at @laramausy

and yes, to those of you who have been wondering, I still work. But I reduced my working hours to 15% to balance it with my studies.. (I still have to live on something you know ;) )

this is a CT scan of a patient of mine who  was in prison, and who somehow managed to acquire a gun and shoot himself inside the prison cell.

Yes, he survived it, paralysed on one side of the body, and as you can see, the bullet is still there. It sits too deep within his cranial mass that it was impossible to operate on it and take it out.

(interesting how light is scattered and reflected back from the bullet, and also, notice the bullet's path from the right temporal side shown as a black streak)

and did I mention I have the best sunset views???


 :D

so that's what's new. I will try and post more in the next weeks .

ciao!

Trying to find my New Home

It's a fresh sommer morning today, August 17,2013.

I'm sitting in the main train station in Ludwigsburg, waiting patiently for my train to arrive.

Today's agenda:

Go to Heidelberg and visit 3 dorm apartements, one of which is going to be my new home in October!

The down side of traversing through all these adventures alone is that you get sad, when you see other people (most probably would-be students as well)
who are waiting next to you, all happy and excited because they're a group of 4 and they would be starting their new lives together.

It makes me long for my friends as well, makes me
reminice the most exciting, fun, beautiful times we had together during my school years, especially in college.

I sometimes wish I had a friend who's gonna be starting to study again as well in Heidelberg so that we can share our adventures together.

But well, it's not that bad. I'm excited, and terribly scared, to start this new journey in this german world.

The sun's shining, and my train's moving, I gotta go.

See you on my next updates! :)

Stay strong, everyone!!!

What Overtime is like in this side of the World

August 14, 2013. It should have been a really normal duty day like most days.
However, I had a morning shift, my fifth one in a row. That means, I am already suffering the ''lack of sleep syndrome''.
And second, It was a hectic morning shift.

For the sake of references and just pure expression, allow me to narrow down everything that happened today. It's nothing serious, mind you. But you will get an idea of how things work around here if you work as a nurse.

-------
I woke up around 5 am today. Prepared myself and waited for the bus that came around 5:35, since I was still too sleepy to walk for 20 minutes to the hospital.
I changed in to my scrubs in the locker room and went up.

I received  7 Intensive care patients today. ''Überwachungspatient''. The first one is Mrs. R.,  she's an old lady who fell down and had a terrible brain bleeding. She had to be operated in the middle of the night two weeks ago, to save her life. She's now stable, but she still has a central venous catheter for her medications and infusion. And also, she has Escherichia Coli in Urin and it's a 3-Multi-resistant strain. That means, out of the four groups of Antibiotics, she is resistant to three of them. So, we are implementing Barriere Isolation. She has the infection in her Urin.

Second patient is Mr. L. He had an intracranial bleeding after he fell down the stairs. He was already operated upon, but he retained some damages. He is awake, but he has a tracheal canula and I have to suction him almost every 30 mintues because produces a lot of tracheal and para tracheal secretion.
He was also due for a PEG (Percutaneous Endoscopic Gastrostomy) yesterday for his gastric tube placement but since he received an anti coagulant by mistake yesterday, he had it today instead.

PAtient 3 is mrs. K, she was found unconscious in her apartement on Aug. 1, in a pool of vomitus. She was operated (hemicraniectomy right sided) on Aug 1, and she had an angiography on Aug 2 to see what caused the bleeding or the unconsciousness. She also has arteriovenous malformations. She is soporous and semi-comatose. She has a tracheal canula and has occational bouts of wheezing in which I have to give her Sultanol for a long-inhalation therapy. She also has an NGT. Btw, I am amazed by all the equipments here in germany. I will try to post some pictures next time of the NGT pumps, etc. because I never saw one before in the philippines. And Mrs. K also has an infection she has Piperacillin-tazobactam Antibiotics.

Fourth Patient is Mr. S, he also had an unfortunate accident where he slipped, but he cannot remember exactly what it was. He has a chronic subdural hematomas left and right sides frontal. He was trepanated yesterday on the bedside and ca. 53 ml dark blood came out. He was trepanated again today. He also has a history of heart disease and he is known to go down with his Heart rate to up to 35 beats per minute.

PAtient 5 is Mr. B, he was walking with his walker early this morning in the Home for the Aged when he fell down and hit his head. He was born on 1927. So he is a bit old. He should have been operated, but the daughter and the family do not want this anymore. So he was in the Intensive Station, then I took him from there, and now he is comatose, he has anisocoria, right pupil is 4mm  wide and does notshow any reaction to light, and the left one is smaller, around 2,5 mm also with very little reaction. He does not have any NGT because the family still wants to decide if he should be given something to prolong his life, or not.

Patient 6 is Mrs. E, she was driving her car yesterday when suddenly, she lost consciousness. She was brought to the hospital and they saw a dark 'fleck' spot in her brain. Then since yesterday afternoon, she is getting worse and worse. Now she is almost comatose. She has meningitis and also gramm-negative bacilli in her spinal fluid. She has an extra centricular drainage and it's 10 cm above her nose bridge, cloudy CSP is coming out of it, most probably because of her infections. There are still a lot of unclear suspicions about her infections. She is isolated.

and lastly PAtient V, she is a woman around 40's, she tried to kill herself last month by driving in the other direction in the Autobahn. She had an accident of course, got multiple facial and cranial fractures, dislocation of acetabulum, subdural heamatomas, Sub-arachnodial bleedings, air got inside her cerebral area, etc.
She had a hemi-craniectomy right side, her right sided fronto temporal bone was taken out and 2 days ago she received a plastic one. she has a tracheal canula, she is comatose, her pupils are 4mm both sides and both do not show any reaction to light,she has her NGT in her mouth because of all her fractures.

Now you know my patients, I will quickly narrate my shift:

I got my endorsements, I checked the medications for the day.
Prepared the Antiobiotics for 6 am and 7 am.
I went to my ''Überwachung'' patients, did my usual vigilance checks,
repositioned the patients,
suctioned Mr. L (tracheal),
suctioned Mr. K (tracheal and oral)
checked blood sugars of Mrs K and Mrs E
received phone call to send Mr S to EKG
I ordered the transportation through our PC,
searched for a transport chair and prepared mr S for transportation.
WEnt to the 'Große Wache'
washed Mrs. R (using barriere isolation measures) and gave her her breakfast
ran out because of an emergency alarm,
another patient in the other 'große Wache' fell out his bett and was hanging by his arm on the bed side
I helped my colleague who was responsible for him
I helped distribute the patients breakfast (47 patients) and gave them coffee or tea to drink
came to my 'wache' and washed mr. L and prepared his bed so that he can be sent right away for his PEG if I receive a call
He was called, I ordered transport, organized  his papers and medication, and sent him down,
Mr S is back to the station, I went down and brought the EKG results to the station 3 floors lower than ours and I had to return again for the examination 'konsil'
then I went to the isolated room of MRs. E, assessed her, instered a new NGT , washed her with cold octenisept, hung 1 L Infusion and PAracetamol for her fever,
went out, spoke with the doctor about the Urinary catheter of MRs. K which had fresh blood on it,
I suggested deblocking the catheter and reinserting it and blocking it again and then flushing it with NaCl afterwards. she agreed and I tdid that
Urin was afterwards clear
I went to the main room to have breakfast with my colleagues.
I was interrupted several times by phonecalls form worried family members of my patients,
asking me how their father or sister or mother is today
it was then alright.
we had to buy our own breakfast today because it's not allowed to take part of the meals from the hospital
then after eating I went out and helped gather the breakfast tray from thw whole station
then on one room, one patient with subarachnoidal bleeding had lots of blood on her sheets and bed because she pulled out her central venous catheter.
I helped my colleague who was responsible for her
put pressure on the vein and change the whole bed. we had to drive her out of the room,. get a new bed and transfer her on the new one.
then I went to my wache, gave the morning meds,
suctioned some more.
then I started washing mrs. K, but since she's having NGT cost, she is also having diarrhea and that was quite unpleasant because I kept on cleaning and washing her again and again.
then I hung her NGT cost using the pump and the tubes.
In that time, I replaced 4 sets of perfusor injections because they were empty.
Then I prepared some sultanol inhalation for mrs K
then I went to Mrs R and changed into my disposable gown and tried to move her from the bed to the chair with the help of the physical therapist.
then I remembered the new doctors order for her which was the taking out of her central venous line.
I had to do that sterile, then cut the tip and place it in a sterile container, and send it to the laboratory.
then I received a call from our secretary . she asked me a favor to go the the hosp. laboratory and get the 2 erythroctes bag for a Mr. U who is in the other station. I told her okay, then luckily found a practicant and asked her instead to do this.
Then i received a call to get Mr. B from the intensive station. I did this, well, you know his story from above,
then I came back to the station, placed him beside mr. S, and did my check, placed him on the monitor observation , gave him O2, and prepared his documents. gave the documents to the doctor and reported of his present state. he is also tachycardic.
then I went to the big Überwachung and gave insulin to Mrs. K, and received call for a CT scan for mrs R.,
prepared her by moving her from the chair back to the bed alone., ordered transport, and went out
got call 30 mins later from CT asking me why I did not inform them that she  has an infection.
tried to explain that it was just barriere isolation, with gloves and gown if necessary.
then got another call from intensive station, I should fetch mrs. V,
i went down with O2 machine, and got her, you know her story from above as well (she tried to do suicide)
same procedure done with mr. B.,
went to the main room, saw that it was already 2 pm, hurried to empty the catheters and drainages for balancing,
doctor came in and wanted to get me to help with a cranial trepanation with Mr. S,
told her to wait a bit and tried to place Mrs.R back in the monitors coz she was back,
then saw the student/practicant that she was done with her return demonstration with teacher and asked her kindly if she can assist the doctor with the trep coz I had to do all documentation
then did my last rounds with patients,
repositioned them and assessed their vigilance and temperature.
then hung the noontime antibiotics
then removed infiltrated iv needle of mr. s

then went to main room, sat down, and began writing documentation for all patients.
I gave the endorsements to the pm shifts
then wrote down all monitoring values from 6 amd to 3 pm
by the time I was done, it was 10 minutes to 4pm

A new spanish colleague then asked me
''lara, why dont you just leave the undone things for the pm shift?''
then I answered her,
'' I know if I leave things undone, there will be negative thinsg said afterwards, and it is my job and responsibility to do them all. Just because most of our other colleagues are doing that, leaving things undone, doesnt mean I have to do that too. You and I, we come from foreign lands, somehow, we have to show them what we're worth. We have to show them that we can stand up and live up to beyond their common expectations. Prove to them that just because we're foreigners in this land does not mean that we cannot work well. instead, show them, that mostly, we can do even better than average. Exactness and CAre. That's our motto. Always do the right thing for the patients.''

she smiled and i think she felt encouraged. she told me I was right,

then just before I went down to change in my locker,
the chamber maid ran to us and said something about someone throwing up in the elevator. I put down my bag, looked for a kidney basin and ran to the elevator, I arrived at the small ones and shouted ''where'' while holding up the basin. the people there looked surprised at me
embarassed, I went to the bigger elevators and saw my colleague with a a patient who was vomiting, gave him K.B. and assisted her to the station.
elevator accidentally closed and we were dismayed because the vomitus was still on the floor.
the we pushed the button again till it was there, and placed a metal wagon in between the doors so that the cleaning women can clean it.

then finally, I went home.


so there. long, but somehow detailed version of my morning shift today.
there may be some points left out, but you get the picture.

it's a typical day in the hospital.

My neuro-surgical patients

It's been some time since my last post. I have been busy these last 2 months with my university applications.
I got lucky and received a slot in Heidelberg for molecular biotechnology :)

I want to share some funny, touching, and interesting instances lately that happened in our station and patients.

For the sake of confidentiality, I will be using different names as references.

Instance 1:

I had a patient, Mrs. Bend, her original diagnosis was cervical stenosis. Before she was operated, she could still walk, and talk, and eat and move independently. She is also a drug abuser. It was found out that she also has Hepatitis C and liver cirrhosis.

She was operated and after that she had a problem with wound healing. Then she had operation # 2. After that, she developed tetra/paraplegia. She could not move anything anymore except her mouth and eyes, luckily, she could still talk.

She was very friendly, and nice. And it'S quite sad really, because it was found out that she had end-stage liver disease and that the internal med. station was not very willing to accept her because she was already medically ''hopeless''. She had a terrible case of ascites that her bed kept getting wet because of the fluid that was already ''leaking'' out of her peritoneum.

I saw her slowly dying every single day. And her partner visited her everyday and brought her fruits. Whenever I was with her, I saw to it that she always got what she needed. She was always thirtsy (of course) and I always gave her extra fruits in her mouth (grapes and Mirabellen coz they're bite size). Gave her comfort although I didnt have enough time because of my other patients. I know that not all nurses in my station do that. They work good, but they're only doing what ''they have to do''. They almost never bother to cross the line and go the extra distance. I am not trying to be a hypocrite, but I think that's one quality that sets Filipino nurses apart from the others.

Instance #2 :

Mrs. Conan, an asian/middle-eastern woman, was found unconscious on the floor in a pool of blood.
It turns  out, she tried to leave her husband and he got terribly mad at her.
He used an iron rod to hit her in the head until she was dead. He got her frontal, left parietal, occipital areas, with cranial fractures that caused severe brain bleeding and damage, and air got in her duras.
She also has a broken left arm and a broken right index finger (it was split into 2).

Apparently, the man thought she was already dead and stopped. But actually, she still lives.
After that incident, only a few number of family on the woman's side were allowed in.
Even her own sohns were not allowed inside by her daughter for fear of ''finishing their father's job''.

I am not prejudiced towards other nations and beliefs, but I am saddened by the fact that women are still treated horribly and unfairly even in very modern societies.

This is a sad case, but I am glad to share with you that Mrs. Conan survived and is doing well in a rehabilitation clinin to this day. Her man is facing trials.


Instance #3:

Mrs. Guerde, is a healthy woman of around 65, who is divorced and remarried a man in Africa. She has a son from her first german husband, and he visits and takes care of her everyday.

Mrs. G. originally experienced stiff necks after work and no other symptoms. Further diagnostical procedures revealed that she had an undefined and unclear mass in her occipital lobe and it needed to be operated.

She was admitted , and our surgical doctors tried to take out that mass. The problem was, upon opening, they did not find a mass, but instead, a dying, necrotic part of the brain!

Further tests after the operation revealed that she has Toxoplasmosis. It is a disease that can be carried by rhodents and cats. It can normally be fought off by our immune system and it usually remains to be asymptomatic in healthy people.

In her rare case, she got this because she incidentally has HIV. The family was of course quite shocked with the news.

With cases of immune system-depressed people, toxoplasmosis can cause severe damage.
In her case, she became blind, and disoriented and very agressive.
She kept on trying to run away and she kept on complaining why all the lights are off. She didnt recognize her family anymore but she still had her early memories.
This is also a sad case because this woman was so sick, that she could not understand why she can't see anything or why, we have to bind her in bed (otherwise she's run away, and since she's blind, this was for her own safety).

The last I heard of her, I endorsed her to another station because of her HIV,she could not stay with  us anymore since her neuro-surgical case was ''treated''.


So those are some of my day-to-day patient experiences.
I am sure that as nurses, we encounter a lot of these cases everyday. Some may even be worse than these.
The important thing is to remain professional, yet try to care for the patients with a heart and with our Filipino values.


Remember that not because the others are not going the extra mile, does not mean that we have to follow them and be ''robot'' nurses as well.

These patients are also humans like us, and like us, they also had interesting lives and they thought and moved the way we do.
Always treat people like the way we all should be treated.
There is no 'ideal' world. But at least, in your own way, even if no one sees, treat your patients in the most 'ideal' way that you can think of. in the 'ideal' world, think of what the 'ideal filipino nurses' would do.

Goodluck!

A Day in the life of a Filipino Nurse in Germany

I wake up. It's 5:30.

I get dressed and prepare to walk my normal 15-minute walk to the hospital.

I arrive around 5:45, get into the locker room, change into the hospital's blue scrub shirt and white pants, put on my shoes, and go up using the elevators to my station.

I place my bag on our cabinet, and take 1 paper with the list of all our patients' names, diagnosis, food cost, and special infos.

I grab a cup of coffee, and sit down on one of our spinnable chairs, and prepare for the endorsement.

''Do you know patient A ?'' my colleague asks me. 

'Yes, I had pm shift yesterday'

''Well, there's nothing new with him, he has to have an MRT today, his Drainage is still to be hanged 10cm üNWH, Bloodtests are prepared, you can give him 1 L of additional infusion today,  he still has his antibiotics, he had fever but we are supposed to wait till it goes down by itself. it can be something central, the doctor said.''

''how about patient B?''

''No, she's new. I dont know her yet. ''

''Patient B is an 89 yo man who fell down the stairs yesterday in his house. he has a history of  heart disease that's why he was taking Marcumar, an anticoagulant. He also has renal failure, beginning alzheimers, has no immediate relatives, lives alone, a careworker drops by him once a day,

because of the fall, he now has subdural hematomas on both sides of the brain and last night, we did a bedside trepanation that discharged 50 ml of old blood., he is awake and responsive, but he is only oriented to person, vital signs are stable, CT scan is scheduled for 10 am.''

and it goes on until I receive all my planned endorsements,

when the night shift goes,

I begin my round.

Take the temperature, control the pupils, check the monitor alarms, check the orientation of the patients ( important in the nuerosurgical dept), give oxygen if needed, suction tracheal canulas if needed, check blood sugars, hang the first NGT systems, do the first reposittioning of patients, order tranports to CT/ ORs / MRTs, write 1st documentation, prepare for the doctor's visits.

8.30- carry out doctors orders, and give the patients their breakfast if they cannot eat alone.

9:00-9:30 have our breakfast / breaktime in the nurses' room

9:30- wash the patients, reposition, give medications, send patients for examinations, prepare blood tests, assist doctor in lumbar puncture, or head trepanation

12- do the last round, temperature, pupils, vital signs, suctions, documentation, last repositioning, give i.v. antobiotics

1:00- empty drainages, Catheters for balancing, write vital signs on monitoring sheet

2:00 endorsement to pm shift.

then I get to go down to the lockers again, change, and walk my 15 minute walk back home :)

sounds simple, but you have to do this to all patients. on a normal shift, I get 6-8 intensive cases patients, or 16 normal and mobile patients.