Birthday Musings !!!!

I'm 26 years old.Yea right !! 26!!!  
I was painfully reminded of how old I have gotten,when a week before my birthday, it was announced in church that I would be celebrating my birthday in the upcoming week. So after church a couple of people from the youth were sitting together when one of them joked'Everyone is invited to Mani's 35th birthday'. To which I replied 'no it's the 31st'. And guess what? To my horror and dismay one of them (don't know about the others though) actually believed that I was 31 years. Dang man!! I had to spend quite some time after that in front of the mirror assessing my face from different angles.And all I could find were three lines streaked across my forehead(the after- effects of years of useless worries). Then there was this time ,a couple of years back when  one of the patients asked me how many kids I had. I literally laughed out loud. I mean granted I had an overgrown facial hair at that time and presently an invisibly receeding visible hairline but still guys we have to draw a line somewhere!!!
         I'l let you all onto a little secret. My date of birth is not the actual date. The thing is that, there was no official record of my birth. So for many years I had no exact date to celebrate. It was only when I was required to officially have a date of birth for my matriculation exams,that I was given a couple of dates to select from. I guess 8th October was easiest to remember. But that doesn't diminish it's importance as I eventually found out.
      And right from the beginning I had no special attachment to the tradition of celebrating birthday.But all that changed in college. Thanks to my friends ,my birthdays became a special event in my life. One which I could look forward to. It's mine to do what I want to do, regardless of what others have to say. So since then I give myself on this day first priority. But like they say 'excess of anything is bad' , which I found out the hard way when I was almost run over by two cars at two different places on my birthday just because I was giving myself priority or when I almost fell from the escalator being lost in my world of thoughts. But that's just me being me.                          

Anyways having celebrated my 26th birthday a couple of weeks back, made me introspect my life retrospectively. I realized my life has been one hell of a ride ,and not everyone gets to live it. It's been a life worth living,with amazing blessings from above. And I'm thankful for the good as well as the bad pages of my life,because that's what has shaped me into person I am today. But that does not mean, I'm all done with my life and I have reached where I'm supposed to reach. No!! definitely not. There's lot more to come. So life' I have a message for you', " Bring it on"!!!....

Sleep and Night Duties !!!

It's night time and the first thing that comes to your mind is the sleep. Oh yea the irresistible urge to fall into the seductively waiting arms of sleep.Most of you if not all of you will understand this allure of sleep.
Right from the start sleep had always been my Achilles heel.Nothing could pull me away from my time with her. There were times when I had slept across my bed with shoes on just because I was too lazy or tired and didn't want to waste my time with sleep.
My upbringing was in a foster home with 35 other kids. So we had a daily timetable to follow. And everyday dinner was at 8pm which was followed by a study session for around two hours usually upto 11pm and as usual my head would be deeply buried in my books, fast asleep. Time and time again being caught sleeping head down I developed the art of sleeping while sitting without nodding off. With only one drawback, I left my jaws hanging wide open . And one day I found my mouth filled with a fistfull of salt as I was caught sleeping during the study hour. Since then I might have left many habits but the jaw opening remains.
So you can understand my state of panic when as a student nurse I was posted in night duties that too for a week. Which meant 12 hours of work while the world slept. I was not prepared for this but there was no way out. And to top that our hospital had this strict 'no sleeping on night duty 'policy. At first I did all the work that was assigned to me.Then came first onslaught of sleep I resisted , then the second,I maintained a stoic appearance. Then finally the on the third onslaught I was standing there like a zombie with bloodshot eyes. I was actually standing and sleeping. Thankfully the nurses were always there to help me out.One gave me a dark corner with a table to put my heavy head down which was getting heavier by the second. And this other time I was given an empty patients bed with curtains all around.Yea as a student nurse I somehow managed the night duties thanks to the nurses.
But then came the time when I started work as a Registered Nurses. I worked in the Emergency Room along with ICU for over two years. So as long as there was work to do in the ICU or a patient in the ER, I was wide awake. Sleep was no where near ,but dang,  on a slack night I would sit on a chair fast  asleep in my old position. Yea sitting in a chair with my jaws wide open. A couple of times I have found biscuits and gauze deposited in my mouth by my fellow nurses as I wake up with a start.
One good thing though, in the night duty is the potluck dinner. The nurses on duty bring an assortment of food as we all share a sumptuous dinner in the middle of the night. It's like a mini picnic ;only the eating part.
Anyhow I just had night shift last week in paediatric oncology. And as I was taking a round around 2am I realized how peaceful everyone looked while sleeping without a care in the world.Well that's what sleep does to us. It just lulls us into a world without care full of peace and rest.
But as for me and my struggles with sleep they will continue. Though thanks to the place where I now work, I get to sleep in between for two to three hours during the night that too lying down on a nice bed. Life couldn't be better !!! Eh!! What say!!

The Intensive Care Unit

                  PROLOGUE
Joe was running very late. He had promised his girlfriend of two years the surprise of her life. A well thought out plan to execute the perfect proposal. And with lots in his mind he was racing through the rush hour traffic at neck breaking speed nearly missing a car .

Mark was working as a nurse in the local hospital for over twelve years. Happily married with three children,Mark had chosen to settle in his hometown after marrying his childhood sweetheart,who is now a full time mother.And today just like any normal day Mark got ready to go to work the evening shift in the ICU. But today he was running slightly late and on the way he nearly had an accident as a maniac on a bike almost had a collision with his car.  
                       JOE
Where am I .And whats that beep beep sound. Why can't I move myself. Am I dead? No!!! that can't be. I can hear voices talking in hushed tones.The last thing I remember is the blinding glare of an oncoming vehicle as I was riding my bike.  And that jarring alarm again. What's that.....Am I floating....  
        
                    MARK
Patients assigned today bed 3&4. Ok let's see. Bed 4 , Joe a  25 year old male patient with history of road traffic accident on the ventilator. Oh oh a busy shift today then huh!!! There goes the ventilator alarm again. Seems the patient is awake. Inj. Midazolam 4mg stat.Sleep away...

                 JOE
What's that gurgling sound.Cough! Cough!! Oh what the hell!! What is going down my throat. Ssss!! What's that sound. Thank God it stopped. And as I  try to look at myself. Which is difficult as it is with this darn thing around my neck. I see tube coming from my nose another one in my chest and a tube for my pee.I see this machine right next to me making a slight huffing noise along with a hum as it tries to take air in and out my lungs , With tubes going from my mouth and into the machine. The gentle whirr of this thing next to my bed and the soft beep beep made me realize that I am in trouble ,deep trouble. Only the regular beat of my heart which the monitor showed in the form of sound gave me a reassurance albeit a weak one that for the time being I am alive.
                     
                       MARK
Well , let's see the orders. Hmm suction PRN(whenever necessary), sides q4h(four hourly I),IV fluids,ok on inotrops too. So blood pressure also to be maintained. I have to change his sides and giveback care too. It's definitely going to be a hectic shift. Time to  suction him. I hope this kid survives. If not hang in there my friend till my shift ends. Thankfully my other patient on bed no.3 Mr.Smith is stable. He is on some oral meds.So not much to worry about him. He will be shifted out of the ICU tomorrow anyway.

                      JOE
As I come slowly out of my drug induced slumber. I see this nurse talking softly to the patient next to my bed who seems to be in a much better shape. Oh oh there goes the alarm again from the machine which I think is the ventilator as I overheard while the nurses were talking.Darn there goes that thing down my throat.That was  uncomfortable,but I think the nurse knows what he is doing. Anyhow!! Where are my parents?How is my girlfriend taking all this in? I hope I get better. There's a lot left for me to do.

                  MARK
Another half an hour and my shift will end uneventfully . Hang in there Joe for a couple of days and you might even make it.Just then the alarm of the monitor that show  heart rate of bed 4 goes off. I think he is crashing. I see the on call doctor rushing to the bed along with a couple of other nurses. Immediately we disconnect the ventilator and connect the AMBU (it's a bag like structure which we connect to a tube that goes down a patient's throat and squeeze it as air goes in ). One of the nurse started a CPR (unlike in movies this one with both hands) . The doctor gave a series of stat orders . Inj atropine stat,inj adrenaline stat blah and blah which were immediately followed . As we all frantically made a joint effort to save the kid.One of the doctor said it's a VT (ventricular tachycardia- an abnormal heart rhythm which can be corrected by giving shock) on the ECG/EKG(It's a waveform representation of the heart beats). So we brought the paddles from the crash cart ,charged it ,shouted all clear and gave a shock of 300 joules.No effect,so the CPR continued.
 
                    JOE
What is happening ,I wondered as I saw a flurry of activity near my bedside. Doctors and nurses running around. Someone was loading injection into a syringe ,other was giving CPR,then there was someone I guess the doctor giving terse orders and finally the shock. It went for almost half an hour but it seemed a lifetime as I saw a bunch of people desperately trying to bring my heart back..... I stood over my lifeless body till I no longer could as I heard the doctor say 'time of death 8:15 pm' ....

                

       

Smile Please !!!

There was a time in my life as a teenager when my face in all my  photographs would be like this ('_')  , yea right! a pair of eyes looking blankly at the camera minus the smile.As a teen I was an angry guy. Just cross at the world ,at people,at circumstances, at everything in general.By principle I found it very difficult to smile. Even a 'smile please ' would elicit a forceful pulling of my cheeks backwards. I would literally say 'cheese' in my mind to bring out a smile and if there was any delay in clicking the pic I would have to start the process all over again. I had real anger issues which I was unable to express it. Anyhow I have come a long way since then and have mellowed down a bit. And as time passed by, several experiences have taught me to smile and appreciate  it's beauty and see it's presence in everyday life.Just the other day in the mall I saw this middle aged couple. Where I saw a big smile on the lady's face as she stood on the escalator while her husband held her steady. From the look of things her first ride on an escalator I guess.But the smile absolutely priceless.                             I recently did this one week experiment, in which I passed a smile to everyone that met my eye in the course of the day. Be it a pretty girl, an old man, kids or  strangers.And guess what everyone  almost 90% of the people returned a smile except the pretty girls and those characters resembling Scrooge from Charles Dickens 'The Christmas Story' ,who were perpetually nasty and angry by force of habit.(BTW a couple of pretty girls did smile back ) .So the take home point for me is smile,smile and smile,nobody gets offended when you smile.                             We all have problems, some huge and some very small. That's what life is all about , one giant roller coaster ride with its ups and down. But all that should not bog us down. A smile is what tells us that it will be all right when our world seems topsy turvy.When we see our troubles we should see it in light those having a bigger problems than ours. At my workplace I see lot of kids with cancer on a plethora of chemotherapy and countless pricks for the IV cannulas and blood tests .But despite all the pain these kids give one of the most beautiful smiles.It's an humbling experience.It happened with me as one day I was having an exceptionally bad day at work and then out of nowhere I see this small girl ,diagnosed with cancer , her hair all gone and she gave me one of the best smiles of my life almost angelic.It was as if to say there's more to life than a bad day at work.Just a gentle reminder as to how inconsequential my problems are in the whole scheme of things.                                                We all smile for different reasons.We smile to acknowledge someone we know,when we remember something funny,pleasant or memorable and for countless other reasons. Nobody teaches us to smile.It comes naturally to us.But for those who want some reason to smile.I'l give you some.So here I go.                  Firstly it's less work.I had once read somewhere that it takes more muscles to frown than to smile. So if you frown more you end up working more. So all you lazy bums who have an aversion to hard work.Here's some good new. Start smiling or else you inadvertently end up working hard.
            Secondly it's free. Yea you heard it right. It's absolutely free.It costs you nothing .You give one and you receive one back too. Now that's a good deal ain't it.You smile freely and you get one back for free. So all you cheapsters. This is something that should drive you ecstatic.  
            Thirdly it's a life saver. Many a times I was saved from a potential social embarrassment.When I smiled at my friend and he pointed a wayward cumin or a notoriously resistant piece of food stuck in between the gums and teeth.Phew! disaster averted.
            And finally its aestheticlly pleasing . We humans are very visual beings.We like something that is beautiful and easy on the eyes. Imagine seeing a body rotting and on the other hand imagine a baby smile. Yea,you see your different reactions.That's what I'm talking about.Hmmm I hope you get it. So all you people keep smiling (like my friend says) you never know who might fall in love with your smile.

New beginnings ????

 Boy time does fly by. It's like poof and u miss it.It's been six months since my move. My life has been a blur since I moved from  the idyllic,picturesque ,small , sleepy little excuse of a town in the Himalayas to the City Beautiful.                            Let me tell you a little about my life in this new place.  The place where I now work is a behemoth of an institution and my previous workplace is not even a fraction of it. (Though if not for financial constraints I would prefer to  work in my old place at any given time.)Here a sea of humanity comprising of doctors, nurses,paramedics ,students, technologists, security personnel, patients and relatives (the list is almost endless ) converge , each with their own purpose.The emergency rooms are never empty , corridors never silent,  OPDs teeming with people jostling for their turn. Weary , despondent, frustrated and worried people all around everyone with their own set of problems. Just reminds how apt the first few lines from the song 'sea of faces' by kutless is.I see the city lights all around me / Everyone's obscure / Ten million people each with their problems . But still I'm amazed at the sheer number of people that are treated here. From the rarest to the commonest ailments are dealt with. Sometimes people ask me how's work ? Well I don't know where to begin from ?                              Hmmm so that was a small description about my work and I might have painted a very bleak , sad, dismal picture but that's not all to my life here. I have a bunch of friends who have energy equalling a group of rambunctious school kids , who laugh out so loud as if they are without a care in the world . Be it at some random stranger's mistake of placing his foot in a dustbin while crossing a low lying fence or being the only people to laugh out loud in a full cinema theatre. They are the ones who helped me settle effortlessly with getting a gazillion paperwork done which is a must when joining a public sector and countless other ways ( thanks guys !!!). Sometimes these guys can be so mental they will drive a normal person insane.Also guess what I have become a bit deaf too. You might be wondering how . Well most of my friends if not all of them have a penchant for talking so loud as they have amplifiers attached to their larynx or voice box . But that's who my friends are. A crazy lot each with their quirks and uniqueness.  And yea other than that loads of movies, KFC , coffee and fun; reminds me of college days minus the studying and classes.                                   Anyhoo!!! Coming to a new city , new place , new people is always difficult . Whenever ever I come to a new place ( this being the third city in seven years) I come with no expectations only with the thought of an opportunity for a new beginning, a fresh start. But then believe it or not I make the same mistakes all over again. Try as I might I inadvertently end up doing the same bloopers, blunders , errors, fallacy ( or any other synonyms u might fancy ) and that's why ??? in the title . So here's me crossing my fingers, toes, heart , eyes , or whatever there is to cross and hoping against hope that this might be the beginning like never before. 

OF VEINS and CANNULAS.......

 It been over two years since I've completed my nursing training and since then I have worked in the ER or the Emergency room for over more than a year and after puncturing numerous veins over a span of two years and finally learning to put in cannula without puncturing the vein( though I do have a bad I V  days from time to time) I have developed a sort of morbid fascination with the hands and the veins that courses through them. Many a times if not mostly during a conversation with  I find my eyes wandering towards people's hands and wondering how easy or tough it might be to put in a cannula. Though for records sake the toughest ones are the infants and toddlers (And I have a personal rule of not more than two stabs for kids.) Well some people have large veins and some have barely visible vein some straight and some convoluted ...oh oh there I go again. :) ;)

PAIN AND THE EMERGENCY ROOM

Being a nurse in the ER or the casualty or ED, I come across different patients in varying stages of pain. Some come clutching abdomen, bent over accompanied with 5 relatives literally picking the patient off the floor into the ER gurney, then there are people who come howling with pain literally screaming with anxious family members worrying their minds off along with ours and they have to be forcibly be evicted out. The other patients in the ER casting curious and worried glances wondering why we aren't doing anything for the poor patient in pain.
I often am amazed at the way some people come with stoic expression hardly showing any emotion or letting out any sound to show pain, its only after the examination; palpation to be precise that they evict some sort of a sound or expression to show pain though they might be in agony.
   Well pain is synonymous to the ER.  90% of the patients that come are in some sort of a pain be it a broken bone or a dog bite or abdominal pain or chest pain anything you can think of. And then of course you have some people fake severe pain for analgesia Its not always easy to tell but then someone who comes on a regular basis with the same pain with stable vitals and gets relieved with one particular analgesia .These are some of the signs  to watch out for.Then there are some who come in the middle of the night with headache and fever and want it to be taken as a life threatening emergency. Why dont they just take a paracetamol!!!!
But , at the end of the day its always a wonderful sight to see a patient leaving all smiles and thanks form the ER