In God's own time
all things are wrought,

the rise and fall of nations,
the sweep of the tides,

the birth of a star,
the blooming of a flower.

My hemodialysis training has come to a conclusion. Like anything special, it has its bittersweetness. My four co-trainees and I will now continue with our respective journeys. We'll probably see each other again a few more times, and then that's it. We still have the wonders of e-mail and texting, but there's nothing like pure, personal interaction.

I learned a lot from these younger people, my co-trainees and the training staff, and I would like to think they learned something as well from this old fogey.

I shall miss our dialysis patients, the sweet ones and the grumpy ones; the philosophical ones and the resigned ones. They all make me grateful that I still have my good health, and they inspire me to keep it.

Caregiver's Prayer

I've always wanted to write a prayer for nurses and caregivers, and I've finally done it. Here it is:

Caregiver’s Prayer

Lord, please help me to give comfort, as I needed comfort, and You have comforted me,

To give understanding, as I needed it, and You have understood me,

To show kindness, as You have always been kind to me,

To be cautious, to be gentle, to be alert and possessed of wisdom,

To be compassionate and respectful, to always advocate for what is good and just,

Please help me to be all these each day, towards my colleagues, my patients,
and to everyone else I meet,

Help me give out all these good and virtuous things now whilst I am strong and able,
and free from the ravages of illness and disease,

For as Time passes inexorably, and Life is uncertain as ever,

My body shall become frail, ill and diseased, and I shall need, more than ever,
care and comfort from You, O Lord, and from those who will look after me.

Amen.

A Golden Milestone For A Wonderful Couple

04.16.2009

Today my folks celebrate their 50th year of togetherness in marriage. It makes me mighty proud. To stay married this long in this day and age is something of an anomaly, in this culture of "disposables"; but a wonderful anomaly nevertheless. It is something priceless, and the source of envy for those who have much materially but none in long, blissful relationships.

We love you, Mom and Dad. Thank you for making us, your children, witnesses to your love for each other. It has given us happy childhood memories. It was our refuge. It made us feel safe and secure through all these years, and up to the very last breaths we will take.

04.08.2009

I cannulated my very first AV fistula today. It was a success. About the only comment from my patient, Richard, was that he found me to be rather slow. I was quick to explain (and also honest about admitting that he was right) that I was being very careful about the entire procedure so that I would cause him minimal pain and discomfort. Which was very true.

I likewise confirmed that simplistic training videos on fistula cannulation techniques are just that, and that real-life cannulations are infinitely more "tricky" and dynamic. There really is no substitute for good (and substantial) hands-on experience with this procedure.

My learning curve, I observe, becomes steeper each day. I commit less mistakes (none in setting up the blood lines) in priming the lines and dialyzer, terminating the machine side of the session, and almost none when removing the fistula needles (there actually should be none as this is a phase fraught with risks of possible injury to the patient). I'm becoming more confident of myself with my newly-acquired skills.

I'm also increasing my interaction with the facility's patients, becoming more aware of their concerns (they're mostly about the financial and physical toll dialysis treatments place upon them); their diverse social strata (kidney disease does not distinguish between rich or poor, male or female, young or old); their behavioral idiosyncrasies (some are grouchy, some are stoic, some are full of exclamations during cannulation, some are so good-natured and good-humored that they are able to crack jokes during their treatment sessions). I see all of them as poor, unfortunate, brave souls who inspire me to be good in my craft so I would be able to give them the kind of care they want and need.

04.01.2009

This week I've started my hemodialysis hands-on at the Ospital ng Muntinlupa (Muntinlupa City Hospital), a government hospital. Its dialysis facility is majority owned and operated by B. Braun Avitum/Aesculap Academy on a percentage-sharing basis with the city hospital.

The facility is staffed by superb, very competent hemodialysis nurses and a technician, with cumulative experience in excess of 15 years, although the facility itself is less than a year old in operation. I would like to commit my trainers' names to memory, as I will forever be indebted to them for the initial nursing skills I'm acquiring in the specialized field of hemodialysis nursing:

Head Nurse - Angela Pitero
Staff Nurses - Elvis Ubas & Wency Rose Chua
Dialysis Technician - Edgar Santos

I, together with my co-trainees Mariel Jade, Mutya, Baron, and Nestor, am discovering that hemodialysis nursing is a mastery of nursing skills, machine, equipment, and the whole gamut of human interaction and emotions.

Setting up and priming blood lines and dialyzer are skills my preceptors can do with their eyes closed and under five minutes. I can do it in 30 minutes or more, with clamps and ports (believe me, there are many of them) still erroneously open or closed and with air bubbles still in the system!

In a facility with just three dialysis machines, and with a patient to machine ratio of 2:1 for a 10-hour shift, the hemodialysis nurse ought to be able to move with both swiftness and fluidity, and at the same time be able to provide adequate patient monitoring and care, and essential nursing interventions as called for.

My goal is to be able to do as such.