Feels surreal that this is our last full week at the hospital but here it is! We continued this week caring for patients in the chemotherapy unit. One of the main patients that I cared for this week had a diagnosis of epigastric cancer with metastasis. I was told he got a positive result for HER-2 so his drug given was trastuzumab, usually given for breast cancer. There was another patient who came in to receive the same drug but she got it in as a sub-q injection. Something interesting that Nurse Ika was telling me was that that injection is made by a drug company that the hospital has a business agreement with where they get money back when they use their drugs. It’s much more expensive for the patient as well. Nurse Ika told me that if the doctor has the option, they will choose the branded injection for the patient to make money. Mia and I also got the chance to observe Dr. Parra assess a patient in the pantry room. It was a 34-year-old getting chemo for breast cancer. Her right breast was so ulcerated, that it looked almost moldy and crusty yellow. The patient had it bandaged up and almost didn’t show us because she was very shy. Then the doctor thanked the patient for showing Mia and me because he said the likelihood of us seeing someone’s breast at this state is very unlikely because of the available interventions we have in the U.S. He also noticed a new left mass on the patient’s left breast. The patient is not able to afford a CT scan, so the doctor ordered an ultrasound for the lump which is much cheaper. The patient also was not able to afford targeted treatment for bone metastasis that was going on but luckily her current chemo regimen helped the metastasis. The patient went from being wheel-chair bound to now being able to walk and not having to take any pain medications. She also told us how she lives on a different island 2 hours away but comes here to Cabrini to get treated. This conversation between the patient and doctor really was eye-opening. It shows the reality of how expensive healthcare is. But the doctor is willing to adjust the treatment to help the patient out financially, even if it means they might not get better. Dr. Parra also asked Mia and me the routine questions about where we are from and turns out he is familiar with Chicago as he often goes to oncology conferences at Northwestern. He is actually one of the best oncologists in Luzon.
We had a very fun weekend hosting our work party with the Cabrini staff that became good friends of ours. We had a great time eating good food, having some local drinks, playing party games that we showed them, making tik-toks, and listening to music all night. Sir August also brought balut for us to try before we leave because apparently no trip to the Philippines is complete without balut. Shoutout to Jake and Mia for eating it. I unfortunately could not go beyond cracking open the egg without throwing up. Other than that, a super great night and great end to our week!
This week was spent preparing for our case presentation and a sneak peek into the chemotherapy unit. We went back to Station 1, the general ward, to pick our patient and be in charge of their care for the week. We gathered all the necessary information for our presentation which will be given to a lot of the supervisors at Cabrini, other staff nurses, the dean of the nursing school that Cabrini is partnered with, and other nursing students.
On Thursday, we left Station 1 and went to the chemotherapy unit. We met Ma’am Ika, Sir Alvin, Sir Edwell, Sir Ramon, and Ma’am Zoila there. Ma’am Ika quickly took us under her wing and showed us the ins and outs of how to handle chemotherapy drugs and what the routine is like when the patients come in. The patient comes in, vitals are taken, and height and weight are recorded. Once the doctors orders are in for the medications and labs are reviewed and approved, the patient gets an IV inserted and gets fluids running. Then they get their pre-chemo medications which have included Ondansetron, Benadryl, Dexamethasone, and Diphenhydramine. Then their chemo drug is prepared. It has been a cool opportunity to be able to be a part of this as many staff in the US need chemo certification prior to handling these drugs.
This weekend was also full of fun adventures with Josh’s family who have been amazing to us and showing us around the area. We traveled to Matabungkay beach and resort here in Batangas. We swam in the ocean, snorkeled and saw so many fish and coral, spent some time in the pool, jet skied, and ate delicious food. While we jet skied, it was amazing to take in the beauty of the Philippines and just be in the moment. It was a great end to the week before starting another work week in the chemo department!
Another week done! This week was spent in the hemodialysis unit. I hadn’t even seen a hemodialysis machine before this week so there were a lot of things to learn in this unit. Patients come in batches, up to 3 batches a day with up to around 15 patients at a time. After a new batch of patients comes in, the nurses and nurse aides get ready for their “transition.” The nurse aides clean the machine, hook all the tubing up, prime the tubing, and run some tests and heat sterilization on the machine. Then once the patient is seated and ready, the nurse assesses the fistula site, takes their BP, listens to their lungs, checks for edema, and then inserts the cannula and starts the dialysis. It takes about 4 hours. During those 4 hours, the nurses document, observe the patients and the machine, and then get ready for the next batch.
Outside of the hospital this week, we traveled to Parañaque to visit our friends who are currently doing the FNRI internship. It was so great to see familiar faces and share all about our experiences with each other! We saw the new Minions movie (which I think everyone should watch) did some shopping at Greenhills, ate delicious food, and returned to Bonifacio Global City to explore the nightlife. It was a fun-filled weekend with amazing people.
This week was spent in the OR unit! When we first toured the unit way back in June, the charge nurse, Ma’am Anna told us we would be allowed to scrub in and assist in surgeries so this week has been long-anticipated. On the first day, we got an orientation of the unit. We walked by one of the surgical suites and the surgeon actually allowed us to walk-in mid procedure. Dr. Nazareth, one of the best urologists in Batangas, showed us the muscle layer, fascia, and subcutaneous layer. He was also one of the surgeons who was a part of the first ever kidney transplant team at Cabrini. We saw a lot of gastroscopies and colonoscopies throughout the week. There is a lot of downtime between procedures, so we got a chance to get to know the nurses and surgeons and anesthesiologists. They were all so welcoming and willing to help us to get in the flow of the OR. During one of our chats with the anesthesiologists, he told us that his daughter is actually an OBGYN back at OSF St. Joseph and Carle Bromenn in Bloomington! Such a small world! It also brought me a sense of home as someone we met knew exactly where we came from. He told us to seek her out when we have our clinical rotations next semester so that should be cool!
The most exciting day for me this week was on Friday! It was my turn to scrub in to assist a surgery and this one was going to be a TAHBSO procedure, total abdominal hysterectomy-bilateral salpingo-oopherectomy. I met the surgeon, Dr. Villadelgado, and the anesthesiologist. Got my gown on, gloves, and entered the sterile field. It was the surgeon, Joey who was the main assist, Karlene who was the person in charge of handing the instruments, me who held the retractor and instruments, and Charles the circulating nurse. It was so cool! The surgeon was keeping me in the loop after every move he made and showed me a lot of the anatomy. Saw the uterus, cervix, fallopian tubes, vaginal hole, intestines, bladder, appendix, and all the layers and probably showed me more that I don’t recall.The uterus and cervix were removed and the other tubes were tied off. There were multiple myelomas and some endometriomas with some brown liquid squirting out. This surgeon was very experienced and talented. He worked so carefully fast making sure no damage or bleeding was done. The whole procedure took about 2 hours. After the incision was sutured up, the patient was taken to PACU to recover until she got moved to Station 1, the med-surg floor.
This weekend was a much needed rest and recharge time to get ready for next week which will get spent in the hemodialysis unit and chemotherapy unit!
Another week, another hospital unit! This week was spent in the Intensive Care Unit. The patient census was definitely a lot lower than ICUs in Illinois so we got the chance to each focus on one patient but help in procedures with them all. We were able to do a lot of hands-on skills and observe many as well like NGT feedings, blood glucose tests, Foley catheter insertion, NGT insertion, and med passes. We had our first encounters with patient deaths this week too, a case of seizures after sepsis and multiple organ failure and another case of rheumatic heart disease. As emotional as these cases were, they taught me a lot about patient care and empathy and definitely made me a much stronger future nurse. Outside of the hospital this week, our preceptor Sir Jeff and his father-in-law, Kuya G, took us to hike the 1,500 steps at Mt. Makulot. It was definitely a hard challenge but the incredible views and fresh green mangoes made it all worth it. After the hike, we went to their family’s restaurant for a well-deserved lunch. For dessert, we went to their family farm property and made fresh buko juice. This was so delicious! This weekend, JAM (Jake + me + Mia) also got the opportunity to travel to Manila and explore! With our amazing tour guide once again, Ate Melissa, my best friend’s aunt who lives here, showed us some cool places! We had time to explore the SM Mega Mall and The Podium. Mall culture is definitely no joke here; they are all massive and one can spend an entire day in one. We also explored Bonifacio High Street and enjoyed the nightlife. On Sunday, we had the most delicious Korean BBQ at another mall and shopped and walked some more. A great ending to a great and eventful week! Next stop, the OR!
Another week checked off in Cabrini and in the Philippines! This week was spent in the Emergency Room. I was very shocked at how different this ER was from the ER back in the states where I volunteered. There were many instances where we had to wait outside for patients to come in. As different as it was, I am very appreciative of the many hands-on nursing activities we were given the opportunity to perform and the procedures we were able to observe. These include seeing a very deep wound being cleaned up from metal shards, taking vitals on patients of all ages, setting up the ECG machine on patients, preparing several tetanus toxoid vaccines and other medications, observing a cervical inspection on a lady in labor, and speaking with the ER doctors. We met some amazing nurses in this department who taught us new skills! Two of the nurses were actually leaving Cabrini and working abroad in Singapore and the UK. During the weekend, we had the amazing opportunity to travel to Tagaytay City with my best friend’s family who lives here in Manila. They took us to Cabana’s restaurant where we had an amazing view of the Taal volcano. Then we went to the Puzzle Mansion and got to see the largest puzzle collection owned by one lady in the entire world. We then traveled to People’s Park in the Sky and took in all of the amazing views. To end our Saturday night, we beat the rain storm right on time and ate some meriendas at the Ruined Project. Looking forward to this following week as we rotate in the ICU!
Wow! The first week in the Philippines is now complete! After long days of travel and orientation, Jake, Mia, and I, or as we call ourselves, JAM, arrived at our apartment in Santo Tomas, Batangas. On Monday, we met our preceptor, Sir Jeff. He is the head trainer nurse who will be by our side throughout these two months at St. Francis Cabrini Medical Center. This week, we stayed at Station 1 which is the equivalent of a general floor. We met so many nurses and doctors who were all very welcoming to us. It is not an understatement at all when people say Filipinos are very hospitable people. Almost every day after work, our coworkers took us around Batangas to try new things and explore new places. At the hospital, Sir Jeff has been teaching us old and new skills and I already feel like I am a more confident student nurse in the skills I am able to perform. We’ve learned medications, found and listened to fetal heartbeats, given medications to patients, drained all sorts of bodily fluids, observed IV insertions, and learned how to use their IV infusion pumps. Off to next week where we will start our ER rotation!