About a week ago, there was this nurse on an afternoon shift. The ward was a post operative. The number of patients runs to about 40, quite less compared to the previous weeks’ bloody census. He thought it would be a smooth 8 hour-shift despite him being alone in charge versus 40 pain prone patients and more or less another 40 watchers. Well, that thought just remained a thought after a not-so-fortunate event.

And the story goes like this…

One of the forty patients was in an unusual pain. In irony, it was somewhat usual and expected for a two hour post recovery room patient, he thought. The pain seemed to be not that much as it appears to be, until the nurse attended to him on the second time, much more on the third time. On all those three occasions, Vital signs were taken and were all within normal range. The standing order pain medication was given, and oxygen inhalation was started as the patient persistently claimed that he was still in pain. Sobra ka langi na pasyente, the nurse thought. The action taken seemed to be seamless and well, Isn’t it? Vital signs, Deep Breathing Exercises, Oxygen, Analgesics equals effective pain management.

On a timely instance, the resident in charge came to the nurses’ station and consequently found out about it. She immediately rushed into the patient’s room, went back to the station, and ask for some materials including a pair of sterile gloves. Nakulbaan ang nurse. Why in the world would a surgeon need a sterile gloves to mend the patient’s suffering that time? There must be something really wrong about the whole thing.

The nurse went in to the room where the patient and the doctor was. And in the scenario, was a mad doctor attending her patient. “Sir,” she told the nurse. “Tan-awa and dextrose o, wala nafollow up!”, while holding on to the almost entirely consumed IV bottle. The patient had a cystoclysis after a trans-urethral resection of the prostate. It was then she found out that the bladder distended, and the doctor had to do some of this and that to correct the whole thing. To make things more dramatic, the doctor asked for a stretcher. “Ga-i kog stretcher, ibalhin ko ning pasyente sa pikas. Didto nako magflush!” The nurse’s immediate action was to unlock the wheels of the bed and rig the bed it to where the doctor would like to bring the patient to . “Doki, wa man mi stretcher”, the nurse replied while pulling the bed towards the door.

The nurse went back to the station with a pile of left work to do, and a instant heavy heart. Soon enough, a man came into the station. He brought with him a pen and a paper. “Unsay ato sir?”, asked the nurse. “Unsay pangalan sa in-charge dire?”, replied the man. The man was the patient’s watcher/father who happens to be a barangay official as endorsed. To cut the story short, the nurse brought out his ID, the watcher copied the name. The nurse asked for the man’s purpose of copying the nurse’s name. The answer was pretty obvious though. The watcher replied “ Wa ninyo gi-atiman akong pasyente.” The nurse tried to explain. The watcher listened. Both were cordial somehow, but very unlikely to the man’s next words: “ Sige lang didto na lang pag-explain sa kung asa ka dapat mag-explain.” And the watcher ended the conversation.

Hours passed by. Back to work. Eleven o’ clock, the relievers have came. It’s the end of duty, end of the story, the nurse thought. But, like a joke, just in time, the phone rang and a certain doctor was looking for the afternoon shift nurse in charge. A surgical consultant was talking on the phone, seeking for explanation of what happened. Again, the nurse explained. But, the doctor was furious and the nurse along with the conversation just had to listen to his rants. “ Maski pag kanapulo na nimu gi-attend ang imung pasyente kung dili tama imung pag-attend, wala gyapon. Kung kaisa lang nimu giadtuan pero tama ang pagkaatend, sulbad ang problema!” And the line went out.

The nurse was me, and the patient and his pain was real. Di diay to puro linangi lang ang kay sir. The action taken by the nurse was admittedly not seamless and not well. Vital signs, Deep Breathing Exercises, Oxygen, Analgesics is not tantamount to an effective pain management. “Wala pud diay nimu giisip unsay cause sa iyang pain?” The doctor was right. It was like having a virtual suckerpunch right in my face. Nakamat-ug uroy ko sa kamatuoran. I missed out one crucial thing. It was assessment. The words said by the doctor reverberated in my mind. WE SHOULD DO THE RIGHT THING THE FIRST TIME EVERYTIME. Lisud pero mao dapat.

I stared blankly again and thought over and over of what had happened. How could I miss that one? Years in school and even this life, in general, taught me the do’s and don’ts in problem solving. Indeed, intervening something without knowing the why’s and wherefore’s of your problem brings about a bigger problem. Ang pagsulbad sa probemang wa ka kamao nganu nimu ginaproblema kay mas gapadako ra sa problema.

Total,Quality, and Management. Three big words joined together to make a much more bigger word. Oxford College Dictionary defines it as “ a system of management based on the principle that every staff member must be committed to maintaining high standards of work in every aspect of company’s operation.”

I would like to use my personal anecdote as an analogy to this Total Quality Management. I was thinking the whole time on what to say today in front of you all. And I was a then hesitant on sharing this vulnerability, until I realized that there could be no other way a novice could convey and interpret an expert’s knowings except through the former’s personal experiences.

Like a nurse’s attempt to alleviate any patient’s pain, I was made to believe that an organization have to undergo a process of problem solving approach to attain its goal. And like a nurse, both novice and expert, an organization has to never stop learning. An organization has to never stop committing on improving itself, and consequently, improving the quality of services they give.
Blessed Mother Theresa once said, “Discipline is the bridge between goals and accomplishment.”

And in that faithful day, I believe, I failed to employ that discipline. I see wounds of different sizes and shapes almost everyday. But it’s not everyday that I see their pain. I see these wounds turn into scabs and into scars, but it’s not everytime that I see the stories behind those. I see watchers come and go our glass barriered nurses’ station and I see them cry over the sufferings of their loved ones, but it’s not always that I see their concern. It’s not always that I see how they feel.

It must be really hard mediating and meddling over the paperworks and the REAL work. But I realized, it should never be used as an excuse. After all, our clients are the patients, never the charts, and never the paperworks. But if we just practice the “discipline” we all ought to have, we are on our way to our supposed goals and vision. WE are on our way to becoming a part of the solution.

As I was reading and hearing my words, this whole thing appears to me, and maybe for some, as an oral incidental report plus a reflection paper on the sidelight. This must be something I should brave. After all, these kind of stuff are the ones that refines us individually. And these individual refinement are the very source of the whole organization’s refinement as well.

Closing this, I would again like to quote Mother Theresa; “There is always the danger that we may just do the work for the sake of the work. This is where the respect and the love and the devotion come in – that we do it to God, to Christ, and that’s why we must try to do it as beautifully as possible.”

Ladies, and Gentlemen, this I believe is what TQM is somehow about. And In behalf of Surgery East and Surgery West, it’s nurses and nurse attendants, once again, a pleasant morning!

Delivered 7/11/11

It’s Friday, and there’s this local radio dial playing 90′s song from sign in and sign off this time of the week. The song above was played, and like a reflex, my hand touched the volume panel in a compelling fashion. Beautiful lyrics. This has got be one of the most beautiful friendship song ever written.

Chorus goes like :

Kapag umuulan bumuhos ang langit sa ‘yong mga mata
Kapag mayroon unos ay aagos ang luha
Ngunit ‘di ka mag- iisa, kaibigan

Kay rami nang mga tanong sa iyong isipan
Nais mo lamang ay malaman
Bakit nagka ganoon and nangyari sa ‘yong buhay
Tanong mo man sa akin, di ko alam

Handa akong maging tanggulan
Sa tuwing sasapit sa’yo ang tag-ulan

Kapag umuulan bumubuhos ang langit sa’yong maga mata
Kapag mayroon unos ay aagos ang luha ngunit di ka mag-iisa

Ako’y naririto, naghihintay lamang sa’yo
Tumawag ka’t ako ay tatakbo sa piling mo, kaibigan!

This is no preemption. This is Faith. Mabuhay ka Manny!