The grill and thrill of a granddaughter's journey of becoming a nurse

Right after taking the government licensure exam for nurses, I did not have the privilege to stay jobless at home. I was immediately "hired" as a personal nurse volunteer. At first, my expectation was to gain nothing but real life experience in providing care, until I found myself struggling everyday to preserve my patient's life. It was a month-long journey destined to be shared by the nurse-to-be-granddaughter and patient-grandmother.

My Patient's Diagnosed Disease Entities

August last year, I was made in charge of my 83-year old paternal grandmother, who was fighting six ailments:

• Osteoporosis
• End-Stage Renal Disease (ESRD)
• Congestive Heart Failure (CHF)
• Hypertension
• Rheumatoid - Osteoarthritis
• Alzheimer's disease

Her life was all work

She helped her husband raise 7 children, did household chores, and sold root crops, firewood and tilapia during the prime of her strength. When she reached the age of 60's, her posture began to deteriorate and the famous Dowager's hump became obvious. She failed to maintain proper balance most of the time, which caused her some minor wounds. As expected of said lifestyle, coupled with salty foods, she was always dehydrated which led to edema (swelling) of the lower legs and feet. She experienced shortness of breath in certain activities, needed 2-3 pillows to sleep well, and increased blood pressure.

Her condition compelled her to stay at home and manage a small store. The change in her strenuous routine was favorable considering her complaints of the joint pain worsening - hip, knees and heels, together with the fingers and toes. Years later, she manifested some signs and symptoms of Alzheimer's disease. She often forgot to turn off the stove after cooking, left her bedroom locked with the keys inside, and confused about whether she took her meds already, causing over-dosage or under-dosage. There were times when she climbed up trees to pick ripe mangoes and over fences to get herself out of the house believing that she still had to fetch her children (one of whom is my father, all grown-ups having their own families) in a nearby elementary school. She was disoriented to time, person and place and can only recall the remote past. She properly identifies and remembers her husband, my grandfather, her children, siblings and old friends within the same locale. She barely identified me and my cousins, her granddaughters and grandsons.

Pre-Confinement

Accidents which happened later aggravated her condition.

The very first one was when she bumped into the wall of their house's comfort room. She had this shuffling gate and lost her balance. She was wounded in the lateral portion of the right eyebrow, presenting a bleeding eye due to the blood that flows into her right eye if you are looking at her at a distance. I brought her into the nearest rural health center. The doctor had to do 3 small stitches to help the wound heal faster. On her way to recovery, I regularly visited her and did aseptic wound care and dressing. Then her children decided to hire a caregiver to assist me.

Because she had chronic renal failure, we maintained her with a weekly Epogen (erythropoietin) subcutaneous injection. I saw the pain that my grandmother endured, but was got used to it as time went by. The experience was enriching from my end because in the nursing school, I did not administer Epogen and some of her daily oral medicines.

My routine was administering the needed medicines, doing the wound care and dressing, maintaining hygiene and taking vital signs. Sometimes, I have to insert a suppository laxative because she had difficulty defecating due to minimal water intake and sedentary lifestyle. The twist that I did not expect myself to be doing was to remove fecal impaction (very hard stool that cannot be moved out even after inserting a laxative) through my gloved hands. It has been termed in the nursing school as digital removal of fecal impaction.

She has to sit on the bowl as I insert my index finger through her orifice and carefully removing the hardest stools I ever touched. In the process, I see her facial grimace symbolizing pain and agony. She tried to push and bear down, but I incessantly discouraged her because of her heart problem. My father and my grandfather waited from outside the comfort room. They could not imagine what could have happened had there been no nurse in the house. I finally eased up the discomfort and pain due to constipation and thanked me for helping her out, but she called me with a different name - she thought I was her cousin. She was teary eyed as I let her lay on her bed because of the relief after getting constipated.

The wound on her eyebrow healed fast, that was quite an achievement. Four days after, another accident happened. She struggled to reach the rest room again, all alone, and did not manage to sit on the toilet bowl properly. Trying to hold onto the bowl, her hand slipped out and her right chest hit the bowl. Previously diagnosed to have porous bones, she easily got fractures on her 2nd to 4th ribs, and making the situation worse, one of the fractured ribs hit some parts of her right lung and later developed into Hemothorax (blood in the lungs). That was far worse than the first accident, a case that needed immediate treatment since it involved multiple organs that could yield to multiple complications.

Hospital Confinement

Hooked in oxygen, regulated at 2-3 L/min, we rushed her into the Emergency Room. She was struggling to breath then and awkwardly positioned herself inclined onto her left side, carefully guarding the fractured right ribs. After being seen and assessed by the Resident on Duty (ROD), we anticipated that she has to be confined. In the previous confinement, it had been a problem as to who shall become a stay-in watcher to run errands. Unlike in other hospitals, the understaffing in the hospital where she was confined necessitated a stay-in watcher.

Since she cannot move in and out of the bed, I, and occasionally, together with whoever visited her, must lift her, insert the bed pan if she complains of the urge to pee and defecate. Serving a bedpan is an easy nursing job, but removing it and cleaning the perineum of the client is harder. Aside from maintaining the sheets and bed linen dry and her position straight and comfortable, the terrible smell confined in the room was an added discomfort. I hated having that early morning at first, but it became a challenging routine.

Days later, she begun to lose control over her urinary and rectal sphincters, another challenge welcomed me. Catheterization was not an option given by her doctor since that entailed a more invasive treatment and could invite infection easily. I had to out her into adult diapers and change it every 8 hours or whenever the need arose. The staff nurses almost delegated the routine nursing tasks to me. That made me even productive than just staying there all the time doing nothing while seeing her suffering. Those times where I had to do the breathing therapy (for her asthma), hook her into oxygen when she had to frequently remove the tubes, re-regulate her IV fluid, maintenance of daily hygiene, monitoring her vital signs, assisting her to eat during mealtime, inserting suppositories, administering medications and listening to the repeated stories of her childhood. The time spent at the hospital made us get closer, though she did not realize that I was her granddaughter.

Her condition got better and after almost 2 months of hospital confinement, she finally was discharged.

The Nurse-Granddaughter

I was initially motivated to take up nursing to maximize the use of my eldest sister's expensive nursing books, but as I was going on through with the BSN course, I began to love the technicalities and the in and out of nursing. I was told to stay at the hospital with grandma being the only available nursing graduate at that time. The family did not want to entrust her care to just anybody. I continued her care until I had to attend to the processing of my license after successfully passing the licensure exam.

My stay with her was not voluntary at once. Personally, I am not the typical "lola's girl". I grew up receiving less love and attention from her. She discriminated my father's family being not as well-off as the others. In family gatherings, we were given tasks to wash dishes, set the table, clean our grandparents' house, among others, while our cousins simply played, ate and enjoyed the celebration. Growing up, we felt that she favored my cousins, so as much as possible, we avoided family gatherings.

As I watched her fall asleep, I remembered the annoyance I felt towards her when I was a little child; the way she yelled at me and let me and my siblings do the dirty work. To be deprived of grandparents' affection brought a genuine heartache to me as a child. Yet, life is really full of surprises. During those critical stages of her life, it was I that she needed most. The experience made me better appreciate the importance of my profession, while gradually healing certain misunderstandings in the past.