1. Am reaching three years in my nursing career in ED
Have been contemplating how long more I should stay further.
I am not bonded.
I am free to leave.
It has been really tiring.
I don't know if it's my luck, but I am almost always at the busiest zone in the shift.
One nurse to 15 patients is no joke when they put me at P2E.
The algorithm of P2A and D sucks and makes no sense.
Why P2A has more doctors and patients more often than not, as compared to P2D when there are lesser nurses in P2A？
This has been raised to the management and I see improvements on certain days but... still.
But can I really let go of the slightly higher pay than if I were to leave to the polyclincs?
Thought I would leave by the end of this year but... really?
When the time comes can I really pen down and shove the resignation letter/ letter of transfer in their face?
2. Grandma passed.
It has been 15 days since she passed on the 2nd day of this month.
Thought I had gotten over it, given how not-close of a relationship I share with her... but my sister made me read her descriptive blog post just now... and I cried.
Looking back...
It was the first time I'd seen my dad cry in 26 years of my life.
Not to the extent of sobbing.
But there were tears in his eyes, bloodshot.
His voice trembling and soft, very different from his usual loud and rough mannerisms.
So I did what I did.
I went over to the other side of grandma's hospital bed and hugged him.
When I had first received the news, I was having my afternoon shift dinner break, shoving bread down my throat as I read through the notes of my patients, looking at updates in plans and orders, new lab results etc., making a list in my head of what I would need to do after I got back on ground.
My dad voiced messaged me. Twice. To tell me that my grandma was in a dangerous situation, and asked if I can make it down tonight to visit her.
I made a note in my head to head down straight across the country right after work.
After which I continued scrolling through my patients' notes, and hoping that I don't get more patients.
"Fong! Ah mah already gone"
That was it.0
A single line in the whatsapp popup.
My mind was blank.
Then thousands of thoughts started racing through me.
But I quickly made a decision.
My dad needed me... or at least, someone from my immediate family.
I took a deep breath and called my nurse manager, stating the situation and asking for permission to leave.
Thankfully she had given me the green light after a long pause. If she had not, I am quite positive that I would have slapped my resignation letter on her desk after the whole ordeal.
I then called my sister. I wanted her to get there as quickly as possible too.
I booked Grab to take me quickly too. $30+ fee? Whatever. Have been grabbing from Jurong to CGH for the past few days anyway.
I still remember getting on and my driver tried to crack a joke. "Huh? You came to the wrong hospital to work ah?" (I was still in my scrubs.)
I thank my inner peace as I had replied calmly, "No, I am going there to visit family."
I thanked him internally for accepting the job of cross-country and staying quiet for the rest of the trip as well despite the 6pm traffic jams on the 1-hour ride to CGH.
During the ride, I tried to picture the situation at the hospital. What is happening over there right now? Is my little aunt crying? She was the closest to my grandma as they lived together... and since she was not married, she was all the more closer to her.
I thought about what I would say when I reached. I thought about what would be happening. I thought about what if... if we had not given in to grandma's request on Tuesday to take off her ventilator. Would things have been different?
I also thought about what if she hadn't signed the consent for the operation. Maybe if we had waited a bit longer for her pneumonia to settle? Should I have tried to talk more to the GI consultant? Actually, maybe not. He had also said then that there is no such thing as a calculated best timing for op. We knew and had a common understanding of the risks, her age, her crooked spine, her clogged up aorta, her aspiration pneumonia... but the herniation of the stomach and transverse colon could mean that the blood supply to the herniated tissues is impeded. The tissues may turn ischemic, and that could have led to further complications... and so we had to take a chance... and leave the rest to God...
But I guess God had already made plans to bring my grandma back to be with Him.
The whole thing went by quite quickly...
On the 24th May, my uncle had texted me that my grandma was having stomach pain. She was later given the diagnosis of "Gastritis" and discharged with Gastro appointment follow up.
On the 25th May, my aunt was asking me what to do as my grandma's symptoms are persisting and she was not taking well orally. I advised going back to the hospital to at least get IV meds and drip... and they brought her back and did an Xray. Which apparently, according to what my uncle said the doctors told him, "looks good". But thankfully, they decided to admit her for further monitoring. So I thought, oh well... perhaps it was a really bad gastritis.
On the 26th May, my uncle was telling me how the doctors are explaining that my grandma's aorta are clogged... and on the later part of the day... what we thought was gastritis became GI Obstruction. What my uncle had told me through msg was that "her intestines was blocked", and so I thought... maybe like my many patients in ED, small bowel obstruction. So I got a shock when the consultant told me about the herniation. Not only the intestine, the stomach too. Understanding the risks of the op, I ended the conversation with the consultant with making sure that they are giving my grandma prophylactic antibiotics already, he promised to find out (he wasn't the primary team) and to get them to order if they hadn't.
I could tell that my little aunt and uncle were worried... my grandma too, though she kept asking me to go home soon since I stayed really far away from CGH. So I made sure that she was in a comfortable position to rest before I left. That night, something in my instinct kept bugging me as I left the hospital with my sister and my dad... I remember telling my sister and dad, emphasizing the riskiness of the op. But I finally brushed it off with - oh well, I am still a relatively new nurse. My knowledge isn't enough to validate my instincts, right?
Side note, my dad somehow had an interesting thought of wanting to transfer my grandma to the hospital that I was working at and voiced it out in front of the consultant. I shot the idea down quickly. Like... I am happy that that may mean that you trust our hospital more, but excuse me?
So on that same day, somewhere in the middle of the night, my grandma was pushed to the OT.
The very next day I remembered coming down to visit my grandma in the ICU after my morning shift. She was all wired and tubed up, her eyes closed. Judging from the ventilator waveform, she was asleep. So I did not enter the room, wanting her to receive as much rest as she could. post-op day 0, she'd definitely need rest, and it's normal to be drowsy from how our body responds to pneumonia and anaesthesia right?
So for the next few days, my grandma's fever was up and down. According to my uncle, the doctor had said that my grandma's white blood cells were low. So... I guess the pneumonia is likely from a virus? The thing about viral infections... there is nothing, no treatment to precisely target the virus. Just like dengue fever, all we can do is to make sure that the patient's fever is under a relatively good control and to keep the patient well hydrated. Nothing else. ANTIBIOTICS DO NOT HELP. It's like... using a metal detector to look for a plastic bottle, you get what I mean?
On the 31st May, it has been decided to follow my grandma's request to take her off the ventilator. Prior to this, they had apparently attempted it once but obviously failed to wean - which is why my grandma was still on the ventilator. From what I understood from my aunt, my grandma did not want to put the ventilator back even if she fails again. I would assume that they have opted for partial code (no CPR/ intubation/ defib etc)...
I stood outside the ICU room with my little aunt and cousin as they started the removal of the ETT (endotracheal tube).
Everyone was relieved when we saw my grandma breathing on her own, although she was still on the NRM mask. This meant that she still required the maximum concentration of oxygen to maintain her oxygen level... which was at 92-93%. Well, my patients with lung conditions are also unable to maintain SpO2 of >95% either and most doctors don't seem too concerned... so I had thought, hopefully, my grandma's immune system can rise up to fight the lung infection and her oxygen level will - volia! and get back to normal.
At this point in time, my grandma could still respond to our questions by nodding and shaking her head although she was really drowsy. I remember staying optimistic and telling my aunt (as she was still worried and concerned with the odd-looking NRM mask) that although grandma was on full 15L O2, there is still a chance that she can get better and we can slowly wean down the oxygen level. I said that to try to convince myself too... except that I was not... especially when I look at the IV morphine that was on continuous infusion. It all started to seem like - my grandma is becoming more and more like my patients who have been put on the End-of-life pathway... when the doctors are not fully confident that the patient would make it out of the hospital alive and well...
I also had to explain to all my concerned aunts and uncle that no, IV morphine is not to let grandma "slowly go" (they had thought it to be like euthanasia and of it to be as horrifying as murder), but was actually to make grandma as comfortable as possible and lower down her respiration rate (it was on the higher range of 20s). Believe me, you'll get really tired and feel horrible to be breathing that fast after a while.
The next day (1 June) grandma was moved to the general ward, as since she was off the ventilator and partial coded, ICU care was not required. I visited her again, and she seemed to be even more drowsy... But all of us could only pray and hope for the best. I decided to brush off any unpleasant thoughts and reassured my little aunt.
And on the 2nd, God decided to end my grandma's suffering and bring her back to Him. It was after my 2nd aunt whom we lost contact with for years came to visit and as my little aunt was reading the 4th page of bible verses to my grandma by her side. According to my aunt, grandma just stopped breathing altogether... and that was when they knew she was gone.
I had rushed down in the middle of my shift like what I said at the start. I came to see the curtains of my grandma's bed drawn close. I took a deep breath and peeked in. A doctor was doing all the assessments to confirm that my grandma has indeed passed. We made eye contact and the first thing she asked was, "Are you in charge of this patient?" I don't blame her, I was in my scrubs... but I definitely had my backpack, and nurses in the wards of CGH don't wear scrubs. I replied that I was her (pointing to my grandma) granddaughter. I allowed the doctor to finish up with her assessment before going in.
As I stood by the bed looking down at my grandma's lifeless body, I stared at her chest. Hard. I didn't know what I was hoping for... a little rise in the chest to let me exclaim to everyone that my grandma was still alive?
I stood still and held her cold hands. I wanted so much to talk to her... to tell her that I am here... but it was as if someone was holding me by my throat, and I could not make a sound while I let my tears well up in my eyes. It was until my younger sister started thanking my grandma for bringing my dad into this world, that I finally manage to find my shaking and mucous-muted voice and thank her too... for taking care of me for I don't recall how long when my mother was at the hospital giving birth to my younger sister, for making me porridge with some pork floss every day during that period, for giving me random domino pieces to meddle with to pass time. I paused before I continued to apologise. To apologise on behalf of my own mother... who decided not to visit... I shall not elaborate here, or that will be another 10000-word essay.
After the nurses performed last office and moved her to the quiet room, for the first time, I combed my grandma's hair. I decided to include my aunt too, and let her put the bobby pin for grandma. My 2nd uncle asked me if I go through this often. They'd assumed that I did, for I seemed to have no fear. The truth was, I have only seen last office twice. And that was during the time when I was a student... and they weren't even under my direct care.
The whole thing afterwards went quickly and the casket service came to pick my grandma up.
And that was the first time I saw my older male cousin cry.
Throughout the whole process, I became very alert and sensitive to my older relatives' emotions, especially my dad. It was a relief that there were no overtly dramatic howling and crying like in the dramas, all just tears and sniffs here and there... I would not know how to respond. Emotions are contagious. I do not think I can confidently handle a bunch of 50s and 60-year-olds sobbing their eyes out. I am also grateful to my older female cousin for making sure things were organised and smooth-flowing, and thankful to her for taking up that role... I am no leader in this kind of situation...
So, the next day we arrived at the funeral parlour at Tampines (5A Rose room) at about 3pm and waited for grandma to arrive. We stood in two lines at the door and someone so damnned played a super slow-tempoed amazing grace... making people cry. I saw my little aunt's shuddering shoulders from the corner of my eye. Then grandma came in, in an elegant white and silver casket. After the people put down the casket and my uncle checked the 'centredness' of how it was placed, we listened to our little uncle and the lady who was in charge of the funeral service, Ms Deborah, say a few prayers. Afterwhich, I noticed my sister go outside, sniffing. I went out too, wanting to make sure she was fine.
"Is it the song? I know right? So annoying..." I tried to laugh as I blinked back tears.
I decided internally I'd boycott all Amazing grace from now. I can never listen to the song with the same inner peace and joy I had before this. Sorry, but really, nope.
The video montage played on both sides of the walls, and I guess all of us can say that we loved the part where granda was sitting and reading a verse in the bible so seriously and like a hardworking student.
“要常常喜乐， 不住地祷告， 凡事谢恩，因为这是神在基督耶稣里向你们所定的旨意。”
I kinda like this verse too, though I am no Christian.
My grandma never went to school, but she was a very curious and studious person. Every year, our angpaos will have our names personally handwritten down in Chinese.
So the rest of the day went by with our family seated down across two tables, talking in random conversations, while occasionally going over to grandma to take a look at her. It was the first time I ever saw my grandma in makeup, and she was really pretty, lips curled so ever slightly into a smile, a blue floral shawl over her shoulders and across her chest. She looked so ever peaceful...
The second day was the memorial service and friends of our relatives came over to offer their condolences. I am glad that quite a few of my dad's childhood friends had come down... Which... come to think of it, kind of led me to think now... will I have anyone? Ha. Whatever. I do not think I'll want to entertain anyone. Sorry.
The day ended with several hymns and prayers. I am not sure if it is just my uncle and grandma's church, but they sure do sound like some cult chants with the way they are shouting it out and exclaiming "AMEN!" after every short phrase to fill in the void of a breath. I have been in a catholic school for 2 years, and I have also been to 2 churches... never was the experience the same... Was it because it is in Chinese this time round? I seriously don't know man...
The third day was the cremation. I thank God and please God bless the Grab driver who took up the job of driving us all the way from Jurong to the Tampines parlour at 6am in the morning. God bless your kind soul. I was worried that we would not make it in time. Turns out we were the first to reach... besides Mr Kenny (the other person-in-charge).
So, we escorted the casket down to the van - which was really beautiful by the way, with almost full-lengthed windows at the sides and back, and then down the street in two neat rows. Side note, I think it was the 上班时间 for the foreign workers, they were streaming up and down various lorries as we went by.
We then boarded the bus which ferried us to the Mandai crematorium. I sat alone as I listened to the song playing. I can't really remember the lyrics now but it was along the line of - until we meet again and see the smile on your face. Of course, in Chinese. Kinda liked it, tear-drawing, but not as annoying as the Amazing grace.
At Mandai, we waited for the NEA person for a while - he took about 10 minutes to arrive I think. My dad was grumbling along the line about how dare they let us wait. Uhm, I guess... I don't know man.
We said prayers again and laid flowers on the casket. Visitors first, then us. Then... they sealed the casket up for good after taping the flowers in place. When they pasted (scotch-taped) grandma's photo on top, a few of us teared up again...
We then moved to this huge lecture-hall lookalike place, except that the whiteboards are replaced by a full lengthed window with grab bars in front. We all stood in a line and waited. When grandma's casket finally appeared from below, my younger male cousin started bawling. Believe me, I was - sorry I can't find a word for it. Imagine a 187 large build young man crying his eyes out till he could not even stand properly. I guess it finally dawned upon us that this, was the final goodbye...
Okay. I don't know why but suddenly Karen Mok' 这世界那么多人 is now replaying in my head.
Let's continue.
We watched the casket enter the huge doors and watched the doors close in... My heart was wrenching in pain as I tried hard to regulate my breathing, blinking away the tears that were stopping me to see my grandma clearly for the last time.
After the doors were fully shut, we were ushered down to the lobby. I felt my knees wobbling and grabbed onto the handlebars while going down the stairs. It was only after I had reached the last step that I remembered that I should take care of my dad too. I turned around with my probably red eyes and made eye contact with my little uncle who was behind me. He patted me on the shoulder lightly and I gave a little nod. No words were exchanged, but I guess we knew.
To my relief, my dad was still managing. It was my 187 cousin who had to be supported by his father and mother to get down the stairs and sit down for a while. I guess being brought up the most by my grandma amongst all the grandchildren has caused the sense of loss to be unbearable for him...
The drive back to the parlour on the bus was silent. I held my dad's hands almost throughout the trip while he tried to divert his attention by telling me all the areas that the bus was passing through that were his "territory" when he was younger.
When we reached the parlour, a few of us took my second uncle's van to Tampines Ikea which was a street down the parlour. It was still closed (opens only after 10am) so we were looking for places to sit down. My dad's feet were kind of hurting in the new shoes. He suggested going to Giant instead across the road, so the 3 of us parted ways with the rest. When we reached Giant, I quickly bought some almost smart-casual-looking slippers for him to change into. I could tell that his feet were relieved. :)
We then walked for a bit more before getting early lunch at the cafeteria on the same level.
After which we went to Ikea to later meet up with the rest, but my sister and I were mesmerised by all the comfy beds and sofas and took a seat in almost half of them. There was one velvety black one which was super comfortable and all of us agreed upon it, though not like we really are going to purchase it.
I was surprised at the number of people at Ikea - like... do you all really have so many things to buy from here?
After 1 pm we finally met up with the rest and my little aunt decided to book Grab and take the 3 of us with her while the rest took my uncle's van to Mandai again to collect the ashes.
We waited outside the area - it was their lunch time from 1-2pm, and there were other families that were there, all dressed in white. I looked at us. The vast difference made me reflect on all the different practices. It was almost as if ... Okay. Fine, I am the socially awkward one feeling out of place.
So the person helping us with the process came, dressed like he was ready for Hawaii. Kinda cool, not judging.
I had thought it would be my 187 cousin who will be carrying the ashes (he's the so-called 长孙子"eldest grandson from a son"）, but apparently not. The job landed on my dad, who was the eldest son. So I carried his shoes (the one we changed out of) for him while he carried the transparent white box into a room, where we each took a piece of the bone to place in the white urn. To be honest, I had thought that we would be seeing fully grounded whitish-grey powder like in dramas, but quite a bit of the bones were still in palm-sized chunks - just light like styrofoam, powdery like chalk.
We then followed my dad, who was carrying the sealed urn up the slopes to block Jasmine and then up to the 4th floor. The view up there was nice, it felt peaceful as well. We watched as the Hawaii guy sealed the gaps between the tablet and the cubicle with putty... and then... it was the end.
No more processes to go through, nothing else. It was a relief, followed by a sense of void.
We all then went on separate ways back home.
I reached home and decided to write myself a funeral proposal. Not the final draft though, to be further edited and confirmed.
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