But we have this treasure in jars of clay to show that this
all-surpassing power is from God and
not from us. (2 Corinthians 4:7)

Thursday, September 16, 2010

The FIRST shift

My pharmacy assistant Siling told me these:
"If you are going back to interchange, take either bus 800 on this side or 804 on the opposite side of the road"
I was jaded after the entire thing and unknowingly, I crossed the road, waited for 804 to leave the bus stop and boarded bus 800 which came after it. It was supposed to be 2 stops away from the interchange but I ended up spending almost half an hour on the feeder bus because I boarded the wrong. Initially I felt so stupid and contemplated whether I should just alight at any stop and take a cab home. But I was just too tired to even move my butt away from the seat. So I decided to take a long ride back to the interchange.

Due to some reasons, a medication error happened today and I had to go to the patient's house to take back the medicine before things could become worse. Don't ask me why this kind of things actually happened. When your workload and patient load increased by 93% from the old days (but the number of staff remained the same and sometimes less), things do happen and you just cannot help it.

Don't worry, I didn't make that error. But I have to admit that I committed a fair share of medication errors too. When I made an error, the team supported me and helped me. So when my teammate made an error, I had to support too. The situation in the pharmacy is really bad - this is the 2nd medication error that necessitated me to go to the patient's house to explain and do service recovery. 1.5 weeks ago, a patient was discharged to a community hospital and I too made a trip to St Luke Hospital for another medication error.

But as I was taking the long bus ride just now, a tinge of blissfulness actually dawn upon me. I have a lot to tell God and I always feel as if I don't have time to talk to Him.

It felt as if so much had happened over a short span of 2 months. Have I told you lately that I have 3 major shifts in my life this year.

The first shift - My hospital had shifted from the old Alexandra Road to Yishun and is now called Khoo Teck Puat Hospital (KTPH).
Since the opening of this new hospital, I have been put in charged of 3 wards - 2 of which are Geriatric Medicine wards (老人科), the 3rd one is called Isolation ward (Infectious Disease ward).

How should I describe it? It felt as if I was running on a flat road (the old AH days) and suddenly the steepness of the road has increased tremendously and it's taking so much of me. The people that we see in Yishun are generally more sick, and the conditions are usually more acute. It felt as if God has brought me out of my comfort zone - and coincidentally, He brought me out of the comfort zone when I started turning lukewarm towards Him.

Before my principal clinical pharmacist left the hospital for PharmD, she told me something that I could never forget. She told me that I have the aptitude in clinical pharmacy and I should never give up on this path no matter how hard situations are going to be. She said there are certain things in this world is something that you can only see ONE in a decade kind, and I am one of them. Honestly, when she said that, I felt the pressure. At the same time, being a 1.5 month-old pharmacist then, I felt relieved because someone of that credentials actually validated me.

I am telling you these now not to boast about the praises she gave me, but I want to tell you that man's words can poison one's senses and numb one's direction in life.

When the hospital just started operating, the patient load was manageable and I was still managing well between these wards. As the patient load started picking up within 2 weeks of opening, the challenges that came to me also increased exponentially.

Not only myself, the whole pharmacy has practically plunged into a mess as we are understaffed and the staff-workload ratio is really an imbalance. And when there is chaos, there is also medication error. And when there is medication error, there is also complaints from both nursing and patients. When there is error and where safety is concerned, there is also a fair component of fear and people start giving up and leaving.

And you realize that you are not protecting the people you need to protect, especially the junior ones. They are living in fear - fear of making mistakes and made responsible for the harm inflicted on patients, albeit not intentional.

At the same time, I feel that coping with the ward load is a struggle. The patient conditions are so acute and sometimes it's beyond my limited knowledge and I feel fearful too. As I was reviewing the patients, I realized that there's a lot of things that I do not know and I feel that I'm so lousy, and I add no value in the care of the patient.The sense of incompetency overwhelmed me so much in the beginning that it made me quite sorrowful.

So many first time-s...

1st time facing so many mortalities within such a short time frame.

1st time feeling that I could have done something more than just accepting the things the way are, and the patient may still survive today.

1st time feeling so demoralized by certain physicians

1st time for me to experience the validation and trust from the physician and also to lose it immediately, due to some situations that is beyond my capability to prevent.

1st time hating seeing DIL (dangerously ill) and DNR (DO not resuscitate) so many times in the wards. Because I am losing them and no matter how aggressive I want to escalate the treatment, it will be a No from the physician.

1st time having my colleague's grandma admitted into my ward and she said "I know she's in safe hands because you are in charge of this ward". I feared.

1st time doing training plan to train the staff so that they can be upgraded to face the storms.

1st time feeling that I've not heard God's voice for the longest time ever and I have been so alone in this storm..

It is also the first time for having to carry the black pot and feeling so embarrassed. I was very angry with God why did I have to face such situation despite my commitment to maintain my attendance at church. What's more the black pot incidence came to me immediately after I returned from discipleship training. Such an irony - I was so spirit-filled yet the news came and I couldn't sleep the whole night. It felt as if the renewed strength that I got from DT vanished into the thin air in such a matter of seconds.

It is also the first time that I felt so powerless and sorry for not being
able to protect my pharmacy technicians and I so wanted to reverse their fear but I couldn't. I saw them losing hope and I felt sorry for the way situations are.

1st time feeling so so so weary of something that I am so fond of.

But on Monday boss talked to me and she said she wanted to rotate me to other discipline like General Surgery.

It is true that you don't know what you have had until you are about to lose it.

Today as I was doing ward rounds with the consultant and medical officer, I felt so blessed. I realized that I learnt a lot from the team of doctors. The consultant was examining the patient and explaining to me why is he doing certain things. We discussed a lot on our patients and the medication parts and I was trying my best to help to optimize the medication part. I checked the labs and recommend the antibiotics etc and answered their queries regarding the medication according to what I know. And we moved from one patient to another patient. Just ward round, something very routine.

I noticed that we learned from each other. Sometimes when I really don't know, I told them that I don't know and will get back to them. I realized that I am no longer embarrassed by the fact that I don't know the stuff. I feel relieved when I said I don't know and will check it out.

I loved following ward rounds because we can exchange perspective. A lot of times, I do interventions based on my knowledge on the drugs and the patient. Sometimes it gets rejected. sometimes accepted. I cannot follow every team's rounds because I am doing 3 wards and all doctors review patients in the morning. I can only follow one team every day.

Everyone wants to make sure the patient gets the best care just that we are coming from different groundsBut as I follow the rounds, I tell them why I would like certain medication be dosed in certain ways, and I explained why I preferred one over another, they started to see where I am coming from and accepted my recommendation. Sometimes, after hearing the team's opinions and plan, I decided to respect the team decision and support it. It's the communication that God has slowly built over time that makes it what it is today.

I feel that I am a really silly girl. I keep seeing what I don't have, and have long forgotten what I have.

I have been really foolish. A foolish pharmacist thinking she can save the whole world and use her paper knowledge to help patients only to find herself doing more harm.

I am a stupid girl for I have been dwelling in the low self-esteem for too long and didn't realize that even the low self-esteem and inadequacy is part of God's plan in making me a better person, a greater vessel, a wiser pharmacist. I should have stopped eroding in my self-insufficiency and start discovering how He's leading me through all this while.

I forgot that I am only a 4 month-old pharmacist and God has already placed me in the best place on earth that no one could be EXCEPT ME,so that I get the best learning experience. He exposed me to the myriad of illnesses and conditions that I have not seen before and today my clinical knowledge has increased from baseline and for the things that once I didn't know, I know better now.

I realized that I can be kinder to myself and not force myself to live up to people's expectations of me. I do not need to get people's validation and it's okay that people reject my recommendations. I do not need to be fearful of rejections and therefore stop making the necessary interventions for my patients because the fact is God has given me the literature and evidence-based drug knowledge to back my interventions and whether the interventions get accepted or not, it's still part of His perfect will. I just need to face Him in all that I do, with clear conscience.

God taught me a huge lesson about myself these 2 months. To many, I appear to be a capable person but only God knows the inferiority complexes hidden beneath this brave front. But I realized that all God wants from me is to admit that I have this problem and I do not need to feel shameful about it. When I hear the voice of the enemy telling me that what He has made me to be is not enough, I just need to draw strength from God to resist it with the truth. For I have been made lukewarm, He now wants to turn up the temperature. A journey of faith He's teaching me. Learning to rely God in greater faith and not be tossed up and down like a ship in a storm. Finding the anchor in all kinds of weather and eventually found it.

All in all, I need to turn my eyes upon Jesus and not man's words, I need to tune into His words for His words is a lamp to my feet and a light for my path.

Today, I saw the doctor's entry - await pharmacist input on vancomycin monitoring.

As I was following the rounds today, I saw the patient gasping and blood pressure dropping very low. It was a DIL, DNR case and the doctor withdrew all treatment - for maximal ward comfort measures. And I realized I wasn't angry or upset. For I know exactly it's an end of life issue and I am losing the patient already - I should let her go. True enough, she passed away 2 hours later. First time realizing sometimes doing nothing is the best for the patient. First time, seeing it so physically, that the end of a man is the beginning of God in her. I can't describe exactly how I felt at that point of time - I felt that God was just telling me that how fragile human can be and as human, we are so powerless against many many things on earth. Like all we once held so dear and built our lives upon can be NOTHING in just a twinkling of an eye. Why holding onto them so tightly and burden ourselves with so much sorrows?
In the same day, the doctor whom I thought have lost trust in me called me for some other stuff. Today, my colleague needed an answer about a drug urgently and I provided it immediately.

Suddenly I felt a sense of restored justice and righteousness from God. It might not be today only, but my radar is more sensitive today I guess. I wonder when was the last time I counted my blessings and goodness in life.

Strangely, my manager wanted to meet up with me this morning, after my ward rounds.

She chatted with me for awhile and once again she said "You know, hooi ching, your seniors are singing praises about you for what you are as a young pharmacist. You have the potential and I hope you see it". Something along this line.

To hear the same thing from a different person. However, this time, the conviction is different too.

It does not matter to me anymore whether anyone thinks highly or lowly of me. It does not matter to me anymore, whether the seniors or the doctors think I have what it takes and they value my inputs. It also does not matter to me anymore if people think I make stupid interventions and get more rejections.

What matters to me most, right now, and for the rest of my life, is that God thinks highly of me and thus for every situation that He puts me in, is one that He has already overcome and I too, will overcome victoriously because He is the pillar of my strength. I should not regard it as something bad for it's an opportunity for me to grow spiritually. All I need to do is to remember this, and bite on it, chew on this promise and carve it in my heart.

I know I'm not done, He's not done with me yet.
I know the process is still on-going.

But I am no longer upset.
Neither am I happy.
I am just thankful. :)

I really hope that in future, even when my soul is heavy, God will put a song in my heart that rises out of me and sends away the dark clouds.

This is what the Lord says:
Let not the wise man boast of his wisdom
or the strong man boast of his strength
or the rich man boast of his riches,
but let him boast about this:
that he understands and knows me,
that I am the Lord, who exercises kindness,
justice and righteousness on earth,
for in these I delight,"
declares the Lord.

- Jeremiah 9:23-24-