putting down my calling

a time for discernment.

(please note that as this post is published, no action as been taken yet. still discerning!)

it’s the time for me to finally say, that i am putting nursing down and aside.

it’s been 5 years since near graduation that my life change, when actually i really thought my life changed when i heard and heed God’s calling to be a nursing in 2008. it wasn’t too far apart- merely 2.5 years and it fell apart. each time i came out of the hospital as an inpatient i returned as a nursing student or staff nurse, only to fall apart. my graduation got delayed. my growth as a staff nurse got delayed. these when everything pointed to me capabilities to being otherwise. i was always doing well, most times pushed to limits others weren’t even, although they were at the same pace at me. i see that at my saving grace, but i also see that as nothing. i couldn’t survive psychologically.

caring for my patients heal me, and it is probably my Bread. but working in an environment with that much tension, i admit, that all that healing runs into negativity. there are too many to ‘please’, too many people to listen to, not good enough for all of them. and i am but only me. i am rather odd when i am nursing my patients. i am stubborn, and very stubborn at that. it can be troubling to my colleagues when i’m new and i do and decide things alone. but i do so with my own knowledge. i trust what i’ve learnt and read extensively- textbooks, journals, peer-reviewed papers etc.  i trust what i’ve experienced and what i’ve learnt not to do when i was younger as a student. but people take offense, and so take offense at me. i can’t change and lower myself to please them in that way, because i don’t want to compromise patient’s care, although i can ask more and be receptive. but it’s been imprinted. done and dusted.

i keep believing that with my recent recovery efforts, it’s enough for my psychiatrist to lift off the major depressive disorder(MDD) diagnosis. but it never seems enough no matter how severe or how minor my symptoms are. i get upset sometimes this year when he says he can’t lift it and i have to make him go through the entire diagnostic criteria to convince me. after so much of medications, ECTs and therapy, i’m still in depression. it’s sad to say with my own insight that perhaps i really am not recovered enough to handle the toxic work environment of a hospital (although i choose to work in a hospital). i want to choose happiness, finally. because of 5 years even though nursing is my lifeline, it’s made me so so so sad. it made me cry so much, and it made me hurt myself (triggered by nursing school).

it really came to light when i’m only 1.5 months into my current job and i’ve already broken down in the ward in front of my Nurse Clinician. there are too much things i cannot reconcile in this workplace and it causes me great tension. and already there are colleagues who are hating on me because i’m not picking up their (bad) practices fast enough, or for whatever immature reason it is. i have enough on my plate (health issues). and i sense that the Ward Managers/Clinician are wanting to push me too, accelerating my progress a little fast. it’s like, i already hate my job, other than my patients who sustain me.

i keep talking with God, asking Him to grant me His grace of His wisdom of what His will is of me. i know He wants me to be a nurse. but things can change, and i want to choose to be happy. 2 years ago when i was spending 6 months in the hospital, my treatment team kept asking me to change careers. they almost begged me not to return to nursing anymore. but i told them with conviction that it is my calling and that i have to follow it. i was never a staunch Catholic, but i would never understand why i would heed God’s calling so faithfully. perhaps this is it. this is my time to switch.

i don’t know where i’ll go, but i know that God has carved a path for me. i will never stop caring, because as a patient, i can never ignore what patients feel. so now, i’m sitting on Counselling, and praying as much as i can, asking for as many friends to pray for and with me as i discern where i should go.

(a little over a year ago i wanted to do Social Work. this year, i suddenly switched my mind to Counselling and i see that firstly as a sign from God. as many of my friends, colleagues and family have told me, i love to talk and i am very eloquent. with the empathy i have built across the years, i am hoping Counselling will have a place for me, if God wills.)

all’s well with rheumy!

i finally saw my rheumy again. i last saw her on 30th Sept 2014. what transpired after can be read here, herehere and here.

i made the appointment to see her again, after defaulting on her months ago. i only did so after discussing this matter with my psychiatrist, because seeing her can have grave implications. that was what happened last year, and it is quite traumatising looking back at it now, when you are at a good place in recovery. i never want to go back there again. the reassurance i had that made me go ahead to make the appointment to see my rheumy was my psychiatrist speaking to my rheumy over the phone. i made him tell her everything that transpired right after 30th Sept 2014. everything that i couldn’t tell her, he told her. every action i made which would make anyone wince, he told her. and the aftermath of what happened that stretched into the months after, he told her. i wanted him to tell her how much she was hurting me without she knowing. it was not revenge, or wanting to make my rheumy feel bad. to continue a therapeutic relationship, there has to be understanding on both ends. because it was only one-sided, making my psychiatrist talk to her would balance it out.

i told myself that i would give her and myself one last chance at this. after all, she has been my rheumy for 7 odd years. that’s a long time. she knows me very well. and i i love and respect her very much. to give up the patient-practitioner relationship would be a pity, but it would also be one i am prepared for. it has gone on for too long.

i prayed and i promised myself not to cry and not to yield, before i went into the consultation room. when i went in, i stepped in with no expectations. i didn’t want to be disappointed. my rheumy spoke to me like nothing bad ever happened. she behaved as though my psychiatrist never called her; initially. and as we went along the way, i realised she was being careful. she was listening more and avoiding certain trigger words. it made the whole consult a lot more comfortable. i had to once and yet again, convince her that since going off all DMARDs and NSAIDs, i’ve been out of control with a lot of stiffness, unpredictable flares, rheumatism, and no anti-inflammatories. she seemed to finally get why i have been so distressed. i don’t care if my stomach isn’t working well. it troubles me, yes. but it’s the lesser evil, compared to RA.

so… she engaged me again, like she always did in the past, in discussing what drug we should use to suppress the active inflammation. the first one out the door, prednisolone. she knows why. i nodded my head. then she talked about the COX-IIs, which i’ve told her before is an issue with lithium due to interactions causing prolonged QT intervals. still disputed, but she ordered some, and asked for the pharmacist to call her. next, HCQ. i told her it’s like a sugar pill for me and the need for yearly eye checks. she refuted it, citing its efficacy and changed guidelines to something like eye checks once in 5 years? i told her no. she jumped to MTX, skipping SSZ, because she thought of the pill burden. i was ok and good with MTX. once a week is great. and it works well for my disease activity. only worry is my liver. we know 15mg is sadly my threshold (i used to be able to take the max of 25mg!) so we are settling for 12.5mg. oh well!

she declined my request for shoulder injections. because of that i daren’t ask about a hip injection too. i understand steroid injections are not meant as a long term solution and there are detrimental effects to the anatomy of the joints. so i could only agree dejectedly.

out of the consultation came a resolution that i longed for, for almost a year. stopping my MTX and SSZ due to my transaminitis was understandable. but not restarting it on excuses of my GI issues, then saying i am in “clinical remission” was something that i absolutely abhorred.

and of course days when fatigue is much lighter, and flares non-existent at all. it’s a dream, and i can only hope. i was given the green light to take celecoxib(Celebrex) 200mg only on a very PRN basis, to minimise any interactions with lithium. and for that i am glad. at least i have another pain medicine.

i walked out of the hospital and made my way to my afternoon shift, a little more light-hearted. today was a good day. nothing negative came out of my rheumy visit, which i was surprised by. perhaps doctors on the same treatment team should really communicate. my psychiatrist talking sense into my rheumy did good, and for that i am grateful.

happy happy happy that i’m now back on DMARDs! yay!

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loving and learning


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photo credit: Lawrence Lim

as of now, i’ve only been SUP-ing for about 2 over months. and i’m glad to say that today, i was fortunate enough to take part in a SUP race! i joined the fun boards category, because my board of choice was only 10-feet, and also really because i didn’t think i can push myself further than 2km.

by God’s grace i was granted an off day today, so for that i am thankful.

out of the day came plenty of insights. i had my monsters, and i had my saving grace. i had terribly weak flesh, and i had some perseverance. but i think most of all, i tried to outdo myself today, which i did! and for that i feel utterly blessed.

i completed my 2km race with sluggish performance. i will not find excuses. i did not hydrate myself adequately, nor did i have a good breakfast. i did not want to compromise of all things, my heart, when i felt my chest heaving in a painful and odd way, and when i was dizzy. i basically did my 2nd km kneeling down although i had a freshly scrapped knee.

i was quite downtrodden when i carried my board off the water and onto land. 2nd last! oh my gosh! my monsters came out. i’m a competitive person by nature, and although i know sports will never be my thing, 2nd last wasn’t good enough for me. but though i had friends around me on the spot, they saw my FB post and the words “sluggish performance”, and J was very encouraging. it is true that all that really matters is that i completed it and i had fun!

later on, after the race was officially over, i told R i wanted to rent the board again for an hour just for a leisure paddle. i took my favourite board out, paddling leisurely with my water bottle and my handphone playing soundtracks, the hour passed quickly. in that hour i paddled about 2.8km, which is the furthest i’ve paddled (and recorded by GPS) at a go. i was surprised that i wasn’t tired. it is mind-blowing what a mindset can do. i said i was just gonna paddle to enjoy- i did, and i even surpassed myself.

so today i paddled 5km+ and walked 2km+ (to and from the beach), which is the most workout i’ve done in donkey years. (i’m not am ‘exercise’ person to begin with, and since i retired from ballet due to RA, then fell into depression, i have been severely deconditioned from hospital stays that stretched as long as 4-6 months.) i even managed to go get a prescription after that, go home, change and then go to church!

for 5 years i’ve been nagged at to pick up a sport or something i like. because of the severe depression i never got to do so. finally being able to pick up both a sport and something i like is God’s grace to me. when my treatment team told me that it would help with my mood i never believed them. that is, until i tried it. after today i learn even more about myself and how i have to find a balance between SUP-ing as something i love and as something competitive- something i was not able to do with ballet although i loved it so very much, because no matter how, then, there was an unhealthy element to it.

my SUP instructor and friend R, who also organised the race, left this comment on my FB after my photo post about the race, and i really liked it. it inspires me so much!:

Way to go, Stephanie. SUP is not only about racing, it’s about uniting souls from all corners of the world towards a common goal. It’s about pushing through your boundary, setting new ones or banish them all. The horizons are as far as you can see and paddle. Chase the rainbow at the end of it. YOUR own Rainbow! Enjoy walking on water, every single time. Jesus first walked on water, we just follow.

You did Awesome, finishing the race! Proud of you! Once stretched, you’re never the same Stephanie again.

i am just so happy right now, i can’t wait for my next off day to go for a class with R, or just go for a leisurely paddle.

i’m a little lazy to post photos here because they are all on FB. i have only a few taken myself, and the rest are by the photographers. i’ll find a way next time? this is my procrastinating again.

broken i will be no longer

the truth is, picking up the broken pieces after laying broken, can be many things all at once.

when i was broken, i was shattered into smithereens. i stayed the same for 5 years, although there were certain times when my treatment team observed that it seemed promising that i was going to start to piece myself together.

looking back, 5 years is a really long time.

when i got the ‘divine’ kick in the butt just about 1.5 to 2 months ago, it was one to get my act together. i suddenly had the  drive to do the things i ordinarily wouldn’t have done. i wanted to do do marathons to raise funds- funds for a cause like arthritis. i hated running, i hated exercising. what was i thinking??? but at that point, and even till now, i am still thinking of running a half-marathon. and then suddenly i saw something online about stand-up paddling (SUP), which was how i kickstarted my love my SUP-ing. i even bought my own paddle after my first class. i loved it that much! again, i hated the sun, i hated to tan, i hated to exercise. so what was i thinking???

after that, i signed up for the Treasure retreat (it’s a Catholic retreat; check out the tags!), and it’s by no chance i got a place. the retreat changed my life spiritually in just 4 days. and till this day, i continue to hold on to my faith and onto God.

right after the retreat, 2 days in fact, i started my new job. this is not new in a sense that i had already signed my contract. but the week before, i had chose to start on this particular day.

why i say that picking up the broken pieces can be many things at once, is because it evokes many emotions that it can be overwhelming. it gets exhilarating at times, knowing i am picking up the pieces so fast to make up for lost time. then sometimes i feel so tired and/or out of control and i just want to sit in the corner and not do anything. other times i get a little downtrodden, and so i drag my feet. the worst one has to be wanting to go back to old behaviours- dysfunctional behaviours- when i am met with difficulties. it’s devilish, the most tempting, and also the easiest way out. so… too many things at once?

this insight comes as deadlines for marathon registrations are nearing. do i push myself and go for it? (i have yet to even put on my running shoes, and the half marathon is in the first week of July.) or is it good enough for me to know that i have embarked on SUP at the very least, and i’m paddling 2km at least each time in the sea.

whatever it is, i know i’m picking my pieces together, bit by bit. i know i will never be whole again- bits of me have been lost since i was broken. the process of picking myself up and the pieces is very new to me, and while i celebrate a new life, i constantly have to remind myself that this is a life i have to work for.

in the meantime, i will love the seas and the paddling. i will love Lord my God. i will be the good ol’ nurse i am.

and broken i will be no longer,

be the nurse whom you want to be treated by

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having caught a URTI and laryngitis, i had a break (3 days!) from work to recover, which to me is a delight. simply because as a chronically ill patient, i don’t get sick leave from being ‘sick’. after which, i had 2 days of training.

and today i returned to work in the ward. it really tested me.

i cannot count the number of times i had to stop my eyes from welling up with tears. tears that were going to shout and berate at myself for letting my head get to me once and again. tears that were going to shred me into pieces  just because something unpleasant happened and i was going to catastrophize the whole event into a disaster.

it was hard to keep the tears back, because honestly, and very humanly, it is much easier to just cry there and then. however it would have been terribly unprofessional. i could cry at home, yes. but whatever it was, in that state of mind, i knew i could not let my colleagues see my vulnerability.

i was treated somewhat like a dispensable ‘thing’ at the start of my shift today. there was no respect given and that was something i cannot tolerate.  in fact, i was caught in between a tussle of who did NOT want to take me (i am still on probation and thus i need to be supervised). i had no say in it. later on, i was, how do you call it, scolded? scolded in a very inappropriate way by the nurse in-charge. i’m fine with scoldings if i’m wrong. but don’t push it.

in nursing, as a nurse and as a patient, respect is of utmost value to me. there are 2 things to respect.

1. Respect that i give to you and everyone (a.k.a. basic respect)
2. Respect that you have to earn yourself, regardless of whatever status you have

it’s easy. when i nurse my patients, it’s usually just Rule #1. there is no need for Rule #2.

but when i nurse my patients, and i also have to interact and handle my nursing colleagues, Rule #1 and #2 come into play. everyone gets #1. and initially, appropriately, for my managers, i have to give them their due respect until i know them better.

people talk so much about status- who ranks higher, who has higher qualifications, who has longer experience. i used to always aim to be a Nurse Clinician. but today i only had this insight, after all that has happened. i don’t care anymore. i don’t care that those nurses who were arguing about me and had the ‘privilege’ to reject me were more senior than me.

the respect i give to you, as per Rule #2, comes when i see you with a patient. how you talk to a patient, how you care for the patient. your touch. and most importantly, what you tell all of us nurses behind the patient’s back when you pass us the patient’s report. did you pass the test, even on any one that i mentioned? i am both a nurse and a patient. i can tell easily who gets respect from #2, and who doesn’t.

maybe one could argue that it is not fair for me to judge my colleagues like i’m a patient and on the receiving end. but think of it. it’s a caring trade. i don’t want to give you respect because you take good selfies, or if you cook good food, or if you are thin. if i’m in my uniform, i’m a nurse, and the same goes for my colleagues.

be the nurse whom you want to be treated by. right?

so after today, after much distress and the insurmountable urge to cry, i am telling myself…

yes, at work, i will be treated with little respect, none even. i won’t get angry, because i will tell myself that if that person behaves that way, either they are having a stinking day, or my Rule #2 doesn’t apply to them (if it can be observed). but i believe in reciprocal respect. Rule #1 will always apply, and i trust myself to never break that rule.

and at the end of the day, i shall not be angry with the nurse in-charge, because i cannot give her much of respect from Rule #2. to be angry with her, is to be silly. just think of it like… if i’m the patient, i’ll just write a complaint about her! or i’ll ask another nurse to attend to me! simple.

it has been a difficult day. and more is to come, i understand. i just have to trust in my Lord, and listen to my sound mind, at least till i get home (for the latter).

sick- after a code blue?

sick.

i am down with an upper respiratory tract infection (URTI) and laryngitis. basically i have no voice. i have taken medical leave from work.


i am ‘traumatised’ by my first code blue in my new work place. i didn’t know what was going on. but when everyone was confused, and our Nurse Clinician said “CPR!!!”, i jumped on the bed and compressed away like i knew how it should be done. like how i was trained and from my experience.

for the first time i actually felt with my bare hands (i forgot my gloves), ribs breaking under my hands. my heart broke. i compressed for a long time till they found someone to take over me. when i climbed down the bed, i told the doctor i will take over the bagging over the patient (pumping 100% oxygen with a rubber bag) because he was doing it so half-heartedly. c-clamped, but because the mask was too big for her face, air ws still leaking. my colleague helped with the c-clamp (so 2 c-clamps) while i bagged. i was looking at her saturation. it was dismal. my heart continue to break.

my fingers cried while i bagged. the rubber bag was still rather rigid. my finger joints couldn’t take it. but who cares. it was like when i did CPR for a good while. my wrists were crying. my joints and someone’s life. how could they compare? of course while i did my best i thought of impending flares for the next few weeks. but i looked at my patient’s opened eyes, and i really wanted her to live.

she was sent to ICU, where she coded again. she passed away. everyone, including me, were discombobulated. we haven’t even started shift.


as the shift went on, i started to lose my voice. i had my sore throat since Monday. i thought i sang too much in Church, but alas it wasn’t. at the end of the shift, i lost 3/ 4 of my voice.

i am rather sure i had gotten some pathogens from the hospital. from my colleagues or my patients. the thing is, since working since 2012, i’ve never ‘caught’ anything while working. i think psychologically, i was affected by the bad code blue. but sigh.

every single day, i’m learning. including how to fall sick, and how not to. and with code blues, i’ve been experienced with it in the cardiology ward, but really not so much in my new work place.

i’ll just take some time to rest. i feel ok actually, it’s just that neck up, it’s abit screwed. i’m taking more and more analgesia for my recalcitrant headaches. but no fear, i have ondansetron!

oh and i got some pred. yay! yay?

till then….

pain and the wait-and-see game

there really isn’t much my anaesthetist can do, really. i saw him this morning, and for the pain i suffer, perhaps what i am taking is already “too much”. i believe none of them, nor myself, would want to build a tolerance for opioids if i keep upping my dose of oxycodone. so that remains status quo.

instead for my breakthrough pain we’re gonna use tramadol 150mg (3 tablets) at a go. i told me about my struggles with nausea with tramadol if taking 100mg or more. he wanted to give me domperidone, and i said NO. that’s a pro-kinetic, can be gotten without a prescription, and just doesn’t work for my nausea which can get really bad. i thought he’d give me metoclopramide (Maxolon). but he offered ondansetron and i was over the MOON, literally. it’s a 5HT3-antagnonist and is a very strong anti-emetic. so yes i was pleased.

other than that, eperisone stays the same. pregabalin stays at 300mg, the dose which i bargained for.

and then now it’s the wait and see game. AGAIN.

i told him in fact, his pain medications don’t touch my RA flares at all, and it’s dismal. it’s not his fault. but i really just don’t understand. pain receptors??? you are really misfiring yo?

i’m finally seeing my rheumy the week after. she probably has nothing to offer me. for my flares. seriously. i have lost all hope in her. or perhaps, i have lost all hopes in my RA treatment. and until my lithium treatment from psychiatry can stop, i cannot touch NSAIDs. what is this life of pain.

i cannot comprehend this till today.

it’s always a “there’s only so much we can do” thing, or a “we’ve tried everything and there’s nothing else”, or best yet “there’s nothing i can do for you” thing that keeps happening.

what is happening? or what isn’t happening?

sigh.

i’m also sick now. i’m seldom acutely sick. the bug has been going around the staff in the ward. either that, i must have gotten something from my patients. a URTI of sorts. aargh. i’m not even on pred or MTX!!!