Foto Friday

It has been a rough week or two, many of my shifts had been really busy ones. Working with people under stress is stressful, and I believe I had my share of unpleasant encounters with a few colleagues this week. No need to dwell on such things that should belong in the past. Amen.

By the end of most shifts I find myself not desiring any conversations anymore.
After work I would rather not talk at all, it helps when there is no roommate; what a luxury, by the way.
On a day off I struggle between the need for meaningful fellowship and my wish for near-total silence. Hence the little dilemma of a single working man.

ICU, 4AM

I began to view myself as a real nurse only ever since I started working night shifts.
Most of the doctors and allied health professionals go back to their homes, they have lives to live too. But the patients still need to be taken care of, somebody has to be around.
Nurses on night duty are like guards watching over their patients, making sure they are well through the night. Or at least in the ICU, for, as educated to me by my preceptor, ICU nursing is very much about monitoring; you see something not right, you report it to the doctor.
Well, I like making sure my patients have quality rest, as best as they can take.  

Asystole

My husband has chronic obstructive pulmonary disease, he went to the hospital last night due to some shortness of breath but had to wait and be treated in the Emergency Department as there were no beds in the wards. I needed to sleep so I said good night to him over the phone.

This morning I got up and noticed many miss calls from an unfamiliar number a few hours ago, I was still asleep then and therefore did not answer the phone. Anyway, I decide to give my husband a call first just to check on him and the hospital admission status. If everything goes well I would get the children ready and take them to visit their grandfather before lunchtime. I dialed, and I dialed again. 

For every second he did not answer the call I began to worry more. At last the caller ring tone stopped, but the voice on the other end of the line was definitely not my husbands; somehow at that moment my heart sank.
It was a male nurse's voice, asking for my name and availability to make a trip to the hospital, and advising me to make it there as soon as possible.
"What happened to my husband?" I asked, already nearly bursting in tears.
"Sorry, madam, his heart stopped early in the morning, he was resuscitated for about thirty minutes, intubated and thereafter brought to the Intensive Care Unit," said the nurse in a deep voice.
The household and probably immediate neighbours were awaken by my crying; I broke down upon hearing the terrible news and could no longer feel my feet as my daughter had to sit me down and take over speaking to the nurse.

On arrival to the ICU I walked pass a few patients, dreading to see my husband as I may not be able to handle the sight. Alas, I recognised the man there lying unconscious, on a mechanical ventilator helping him breathe. I broke out in tears! I cannot take it! The doctors and nurses were busy around my husband's bed; I waited fifteen minutes and a medical officer comes to explain to me what had happened in the ward earlier this morning. She speaks and she speaks and all that she said did not make any sense to me as her words do not bring my husband back to breathing on his own.

I feel even more helpless and fearful as the doctor's answer fails to comfort me as I enquired, "so will he get up again?"
She can never give me a guarantee, and I cannot blame her for that. 

Just like that, my life will never be the same!

What makes a man?

What differentiates a man from a boy? How does a guy earn his right to be known as a man? Anybody can age but growth is actually a choice. I have gotten into a certain age group where I find myself at times in an awkward position not knowing if my identity should be a man or just the guy that I had been for the past decade. Of course, the latter is more natural, comfortable and convenient, but it is time to grow up and move on.

"A man takes initiative, responsibility and is not afraid of commitment," Lydia Tang.

"A man knows how to rise above his emotions," Paulus Lee. 

I agree with the above, and I know there is much more to being a man than just the above.
No intentions of undermining the roles of my female counterparts here, for life on Earth is no doubt difficult; being a man is challenging. Very challenging. To me, he is supposed to be a leader and provider to his household, in times of adversity he needs to rise up and play the role of a protector and comforter. And there is so much more aside from what I have mentioned.

To me, being a man means doing the right thing even when no one is observing.

For a guy who seems to have been challenging authority and boundaries since childhood, being a man is indeed quite a journey with plenty of obstacles ahead.
Walk with me.
 

First time deployed

To another ward, I was told to report for work this afternoon. The surgical high dependency unit was short on staff today so they required manpower from the other departments. Who knew I was worthy to be deployed to help out at other wards!

Naturally, I was not thrilled when I first found out I was going to be working in an unfamiliar environment, moreover a surgical unit; I did several postings in the orthopaedics discipline and my internship at a surgical ICU, but it has been medical ICU the moment I stepped out of the nursing student uniform. Well, the shift went by and I did okay, with the help of the kind nurses in the ward.

It has been a long time since I filled up a an OT checklist.

And the learning continues.
 

Night Shift

Walking to the work place while the masses travel home after dinner, buy some supper to ease your hunger. Get changed, get ready to watch the patients through the night. Receive the handover, check on your patients, then turn off the lights. 
 
Faithfully, charting parameters and serving medications; and feeling sorry for the patients who fail to fall asleep. How can one ever rest well when an automatic door opens at least once every hour? 

Come the second half of the shift, you start struggling to stay awake. Write a report, continue watching the patients. Await the dawn of a new day. 

You may go home and rest soon enough.

Foto Friday

Mr. W, I wonder where are you.

Are you in India? 

Are you in Singapore? 

Are you in a better place? 

I really do miss you.

Why do You Never Run Out of Grace?

In moments like these when I am aware 
of the ugliness within, 
I take of my shoes and dare not face You. 

The promises left unfulfilled,
the wrongs to be corrected,
and what could be but is not yet; 
Proofs of my worth as a steward. 

In moments of facing such truths:
of realisation of my empty-handedness, 
why do You never run out of grace?

© Joel Yap

Foto Friday

The stuff I use for taking pictures are pretty much all here except for a couple of light stands and umbrellas back home in Kluang. Finally keeping these things somewhere I can feel a little more at ease with regards to worries of lenses attracting fungi growth due to low usage. Time to keep these stuff away and focus on the work I am paid to do- nursing!
By the way, however, photographer for hire! Heh!
 

33 hours awake

So a friend needed a favour, and not to boast, but I offered more than what was requested.

I had work and other commitments, janji perlu ditepati, so I did not have as much free time as I wished. For the sake of easy reading here, I shall cut a long story short; in order to fulfill my commitments over the weekend, I stayed awake for at least 33 consecutive hours. Dozing off on the wheel was really dangerous thus I ended up slapping myself multiple times while driving well below the speed limit. Struggling to stay awake at church was not a pleasant experience either. Sleep is so important that it is supposed to take up one third of the day.

This is neither me boasting nor complaining, but I remained awake gladly. All the catching up brought much joy to heart and the travelling was surely worthwhile. What are friends for?

Cheers to friendships that last!

AN flying solo?

It was a bumpy ride this morning shift. Four nurses were on sick leave, and the ward could not call back any one else to come and help out. They had no choice but to let me play the role of an assistant nurse in the intensive care unit; for the first time without direct supervision.

It is because of today that I realise how capable the nurses in this unit are, or how much harder I need to work in order to(if ever possible) be on par. The workload was reasonable but I still could not complete my tasks on time.

In the ICU, most of the patients have a tube that goes into the stomach for the purposes of feeding. Part of the care of such tubes involves checking the placement by means of aspirating stomach contents to be tested with pH papers. Since gastric juices are acidic, we know that a patient's nasogastric tube is in the right place as long as acidic contents can be withdrawn out. According to the hospital's practice, nurses are required to check the tube placements every four hours. Generally, the assistant nurses in the ICU do it; so I did it today, but my speed was far from that of any of the experienced assistant nurses. The above was only one of the tasks that I was slow in performing this morning shift.

On a whole, I kept on forgetting things and had to finish whatever I missed later than whenever I was supposed to. The distractions did not help either.

Flying solo was not easy today. Appreciating the nurses whom I "follow" even more now.
I am new, but it is not an excuse to be lousy at work!
 

Foto Friday

Life is like a roll of film; there is no turning back, and you usually get only one shot.
Receiving undesired results is a normal thing to go through.
You just need to remember to put your focus on the right things in future.

"I want to speak English"

When asked if she could have a superpower, what would it be. A Chinese first-year nursing student answered, "I want to speak English well."

And my heart broke upon hearing giggles among some others who were listening.
 

1, 2, 3, 4, Goodbye.

One 86-year-old admitted for loss of consciousness associated with low blood sugar.
Two days in the Intensive Care Unit.
Three continuous doses of inotropic agents at their respective maximum dosages.
Four limbs mottling away.

Sometimes goodbye can be a merciful thing to say.

© Joel Yap

Foto Friday

 

Remembering people like him 

reminds me of what drives me 

in striving to be the best nurse 

I can be.

Foto Friday

This picture means a lot to me.
A big shout out to all who volunteered to observe GE13!
 

133:89

Results are out for Malaysia's thirteenth general election.

Dear all, please refrain from reacting too emotionally. Try not to make yourself look like a fool by the words you use and information you share. Be more wise lah.

80% voter turnout. Well done, people. I'm sure we can do better than this come next GE.

What to do in the next three to five years? Register as a voter! Start paying attention to what is going on in the country. Stop complaining.
 

Awaiting finalised GE13 results

I write, as I now wait for the official results. At this moment, BN already gets to form the next government with a simple majority of parliamentary seats.

Many of my friends are expressing disappointments on Facebook, to the point where I wonder if I need to "unfriend" some of these people or just deactivate my account. Deliberately forgetting my password should work too. Not trying to judge my friends, but I really dare not know how many of these people are expressing grief because they have the right to. By possessing the right to grieve I mean having done all that could have been done yet the results came back unjustly. That, my friend, is having earned the right to feel angry, because of love.

If you joined the trend of expressing disbelief and/or sadness over the announcements of polling results, I urge you to keep silence as the people who earned their right to feel anger, make their feelings and thoughts be known. If you do not know what is going on, please do nothing to just follow the "trend".

Please stop showing your cheap support to causes or even peoples whom you do not know so well before.
 

Foto Friday

Foto Friday

Rethinking my principles and ideology regarding what I stand for.
Need a break after GE13.
 

Foto Friday

Taken with a film camera.

GE13: Ubah?

Went for a Pakatan Rakyat ceramah in my hometown this evening. Lots of people turned up; parking space was not easy to find, which I did not quite mind. The crowd was big and loud. And the speakers were also loud and clear about their ambition to form Federal Government.

Politicians will be politicians, they need not to only convince their voters to vote for them by mere performance in Parliament and/or Cabinet, but also have to engage with voters through speeches with good conviction about what they talk about. From experience, such speeches seem to be rather fiery and I have noticed that energy levels rise with the size of audience.

Just one observation I feel might be worth sharing, a good majority of the turnout this evening belonged the Chinese community. Not trying to imply anything here but I believe this to be a truth: Without support from the Malay population, Change can never take place.
 

My few words on GE13

We are living in exciting times as polls are nearing. I have been given hope and I have been disgusted as well; by both sides of the political divide. I believe that it is beneficial to the country and its citizens if the ruling government and its opposition counterpart were to receive near-to-even support from the voters. Therefore neither side would dare to do anything stupid due to the high risk of losing power. The fact is, people should not fear the government but the other way round, because the people who choose a government also possess the power to change it.

I have my own preferences as to which side should form government through this general election, but I would not want the other side to totally collapse. Both coalitions need to do a lot of "spring cleaning" and sort things out among themselves in order to serve the nation better and bring Malaysia to higher heights. In my humble opinion, both sides need to check and critique each other so that nobody becomes too arrogant and everything could be more transparent. It is never healthy for any government to be too strong.

Needless to say, I care about who wins in the 13th General Election but I care more about the winner winning by proper means because a fair electoral system is fundamental to any democratic society. And for a better democratic society, voters ought to stop casting their votes blindly. Time to start giving our support based on good judgment of the candidates' characters and careful review of their parties' plans for the nation.

Again I say, I do not wish to see either side of the political divide lose too badly because the truth is they need each other.

Foto Friday

These people, not unlike their counterparts on the other side of the political divide, are merely human, imperfect too.
There is hope for the nation when good people rise up against corrupted rulings; but no man is incapable of corruption himself.

Malaysians, remember that no human being is perfect as the country expects its 13th General Election soon. Look out for how the various parties campaign and get to know the candidates whom you would be voting for. Listen, observe and give your support wisely. Judge wisely those standing for election based not policies, values and past records. Watch how they speak and how they carry themselves.

Cast your vote! Vote for BN, vote for PR. Whoever you vote for, please fulfill your citizenry responsibility.

As for me, however obvious it may seem with regards to who would I be voting for, my mind is not made up yet! The people in the picture above have potential to bring about good change to the country, but they are also only human.
 

Foto Friday

So challenging, so fulfilling;

So challenging! 

To be a wedding photographer.

 

I wish to be a wedding photographer

Not to make a living out of taking pictures, but to help people remember one of the happiest days of their lives.

This is not an easy role to play, I always feel nervous whenever I'm holding the camera at an important event whether or not I were one of the main photographers because people may be counting on you to come out with good pictures, many a time under challenging circumstances. Of course, on the brighter side, there are events at which I could just show up with a camera and not feel stressed about producing good or usable photos; when the organisers(or any other parties) are not expecting anything from my memory card. In such situations, I would, in turn, totally understand if I were not given privilege or access to certain locations. Nevertheless some practice space and photos for me to take home can be better than just sitting through the whole event, depending on the nature of the occasion.

Now talk about weddings, I have been to enough church weddings that "watching" a whole ceremony from the pews might just be a little boring now that I am too old to bring toys or colouring books to a church. During such times walking around with a camera can be so much more fun! However I cannot be certain of always preferring to take pictures at every wedding I attend; there might come a day when I may have a wife seated beside me, we could then witness the coming together of younger couples, and perhaps reminisce on our own big day. There might even come a day when I may get to walk my daughter down the aisle, that will be a day when I would most certainly choose to hold her hand rather than a camera. God-willing, those days would come in His perfect timing. However when it comes to wedding dinners, I am so far, not a big fan. I would very much prefer going around shooting instead of being stuck at the dinner table! Unless, of course, there is good company. Unfortunately, such banquets have not been treating me well, maybe I have yet to celebrate marriages of peoples close to myself.  Hopefully I can have better experiences with wedding dinners when my own generation of friends starts getting married.

When you become one of the key photographers, your role at the wedding becomes different altogether. You may, at times, behave like a paparazzi; just try not to elbow the other photographers next to you, okay? From the experience(of less than five weddings) I have of being such a photographer, I never failed to feel anxious about covering the events and getting good pictures. The pressure sometimes disturbs pre-production preparations, but to overcome this I usually prepare a checklist to ease the process and make a point to meet in person and discuss details with the wedding planner(s) or newly-weds-to-be. The wedding day has proven to be most stressful, I often find myself sweating in a well air-conditioned environment. Stuff going on quickly and at times simultaneously, the number of guests, the presence of other photographers, the moments that do not wait, the limitations of my gear, etc. etc. etc. Today, I dare not claim to be worthy of shooting a wedding and charging the market rate, but with practice I do wish to be confident enough of help couples remember their big day by capturing moments of such a joyous occasion.
A good friend once made a statement,"practice doesn't make perfect, practice makes improvement, as nothing is perfect," and practise I shall.

I wish to be a wedding photographer.
 

Handwriting

Mine needs improvement.

In primary school, I remember being spoken to by numerous teachers regarding my handwriting. In Year 3, there was this teacher who even went to the lengths of summoning me to her office during recess, just to practise writing more neatly. It was only half of the recess time, she had a heart. Many years had passed now, unfortunately my handwriting remains just as terrible if it did not become more worse. Writing this, I recall a clinical instructor back in the hospital who once said to me, "you can make a good nurse, but your handwriting sucks!" Hehe! I did not argue with her but took note of her words with a smile. May God bless these good people and anyone else who warned or tried doing something about my penmanship!

This evening at this moment, I am sitting at a local cafe near where I live; here not for the food but rather access to the Internet. Do you know that in some places you just write down your order on a piece of paper, usually in codes, and the waitresses will collect that paper and key in what you want and soon bring your food to your table? Where I am practises just that; and I just received the wrong beverage because the waitress mistook what I wrote - "607" for a "601" and thereby served me white coffee instead of tea, which I had been craving for all weekend. On the brighter side, the manager agreed to replace my order and I am now awaiting to enjoy that cup of tea. As a grateful customer, of course, I intend to apologise to the waitress on my way out later. So glad for not having to suffer the consequences of not-so-good handwriting tonight.

Turning 22 this year, if I do not die in a terrible car accident or get caught in the middle of a gunfight. Is there still a possibility to make improvements in penmanship?
 

Foto Friday

I can do big things if you don't let my size get in the way.

Short rest after Diploma

I'm kind of done with this 3-year pursuit towards obtaining a nursing diploma in Singapore. Now awaiting results though I will pass for sure. Preparing some documents to be submitted to the hospital's human resource department tomorrow, which means a day trip down to Singapore but a more relaxing one; no classes, no schedules.

THEN I can be away from the city state until work requires my presence there. To think about it, the next time I return to Singapore it will be to work and contribute to the healthcare services, working for real! No more student uniforms and limitations due to policies, no longer being sheltered under the school and its clinical instructors. Looking forward to taking on the role of a Registered Nurse although I have my share of fears and anxiety.

Now, it is time to take a short break from health sciences.
I will be living in Penang for a few weeks to volunteer at a human rights NGO, still wondering how I could help out but am quite excited about this!

Cheers to a good break.

Addicted to worrying

3 years ago, I was constantly worried about my college application being rejected.

Less than 3 years ago, upon having begun my dream course at my desired institution of education, I constantly worried about failing to attain a scholarship.

After being rewarded a scholarship by my preferred hospital, I worried about not saving up enough in order to quickly pay off my study loans upon graduating.

Today, I have the privilege of working in an intensive care unit, which was what I had been praying for since Year 2. However, throughout my posting I had been so worried about not meeting the standards required in order to be recruited by the unit; so preoccupied with such fears that my attention at work became affected.

Mankind, so faithless and forgetful of grace.
We need to learn to relax; or has it been just me?

Foto Friday

Eager to look at their own fates predicted by but only men?

Foto Friday

Cooking tomorrow!

Reunion dinner for the family.

Low urine output

At the ICU we monitor hourly vital signs, sedation score, urine output and a few other things relevant depending on the cases. Yesterday my patient had only 2ml or urine drained over two hours. This time the staff nurse accompanying me was busy so I decided to inform the medical officer on duty.

"Doctor, doctor.. Patient so-and-so's urine output is pretty bad, only 2ml over the past two hours post surgery."
"Okay, noted. Give me a minute to come over." (Phew! I still feel a little anxious when communicating with doctors, not sure why)

 So the doctor came to check on her patient, and flushed the urinary catheter in case it was blocked. And it worked! However it did not take long for us to notice that it started leaking, and I got the stuff ready for the doctor to change the catheter.

Lo and behold, the urine just kept flowing as soon as the new catheter was in place! Poor patient, suffering from a distended bladder but was unable to express it. I felt a little foolish as I forgot to palpate to check if the bladder was distended; I felt useful as the patient's suffering was eased because I raised the issue to the doctor's attention, but what the patient probably felt was relief, which is, needless to say, more important than my feelings.


Intensive care nursing is about close monitoring of patients and judicious reporting to doctors.
 

Foto Friday

I miss schooling.

I really do miss it.

Foto Friday

Brothers!

We are at different places but our memories and friendship live on.

Foto Friday

I want a shoulder to rest on too.

Say hello to 2013

It is a new year, everybody! I just got home after celebrating and counting down to year 2013 with a bang. The day exhausted by energy and camera batteries. I cannot wait to go to bed but here I am at the computer desk, writing as my hair dries up because I just took a bath.

To be glad or to be sad? Venturing into a new year. Lots of significant changes are going to take place in this year. For Malaysia, the 13th General Election is nigh. What will be changes be and how will they affect the people? We shall wait, while doing what we need to do for the benefit of the nation.
On a personal level, I am expecting to go through quite a few transitions in this very year.

Happy new year?
Phlegmatics are not big fans of change, not that change is no good. Phlegmatics prefer the status quo, in general. Just saying.
Am I looking forward to the changes that I am awaiting? Should I be happy? Can I be?

To be very frank, I would do whatever it takes to go back in time if it could ever be possible.

Pardon me if you did not feel happy after reading this; I sincerely have no intentions of dampening any spirits but I did not wish you a happy new year anyway.