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ADVANCING KNOWLEDGE THROUGH COLLABORATION

I knew how to take care of fish, but what about human patients?

A native of the Philippines, Mary Ann Abiado holds a doctoral degree in fish genetics and reproductive biology. But now she’s on a new career path—to become a nurse. As a graduate entry student in nursing, she reflects on the first 10 miles of her “thousand-mile journey.”

by Mary Ann G. Abiado

Mary Ann Abiado

I am 37 and starting to worry about gray hair. Recently, my adolescent daughter asked me, “Mom, why are you wearing teenager clothes when you are an old woman?” I looked at her and replied, “Honey, I am in my mid-30s and I am young!” She rolled her eyes and left.

I am a hard worker. I have a bachelor’s degree in fish biology from Central Luzon State University in the Philippines, and have master’s and doctoral degrees in fish genetics and reproductive biology from the University of Wales in Britain. I worked as a postdoctoral fellow and researcher at the University of Wisconsin in Madison (the Badgers) and The Ohio State University (OSU) in Columbus (the Buckeyes).

In 2000, I finally landed my first real job as a research associate in OSU School of Environment and Natural Resources Aquaculture (“fish culture”) Laboratory. Despite all the education, I read in my daughter’s second-grade essay, “My dad helps doctors and nurses with computers, and my mom cleans fish tanks.”

Initially, I wanted to be a professor and scientist but opportunities were not there for me. I sent about a hundred applications to several U.S. universities and colleges but received only one invitation for an interview. The chair of the search committee took me out for dinner in downtown Baton Rouge, La., and ordered deep-fried alligator nuggets. Because I wanted the job and was prepared to do anything to please the chair, I ate alligator for the first time and suffered heartburn the night before the interview. I did reasonably well in the interview but found out three months later that the position was retracted! Enough is enough, I decided. It was time for a career change!

I took two calculus classes to test my brainpower and my ability to sit in classes, complete homework and take tests. My goal was to land in a career where my skills would be in demand and where jobs would look for me. I was convinced that nursing could give me these opportunities. There has been great demand for teachers, researchers and bedside nurses, and salaries are lucrative. My dream is to become all three.

Currently, I am a graduate entry student with OSU College of Nursing and hope that, in two more years, I will be a clinical nurse specialist and a nurse practitioner, specializing in cardiopulmonary diseases or oncology. I tell you, this is a thousand-mile journey.

I want to talk about the first 10 miles. The first quarter of my program at OSU ended in December 2004. I passed the two courses successfully—fundamentals of advanced practice nursing and pathophysiology. The major obstacle was answering the multiple-choice questions that test critical-thinking skills. I’m not trying to cover up my inadequacies but, because my training in Britain usually required me to explain or elaborate upon concepts, I found it difficult to “choose the best answer.” I am, therefore, a bit scared about the NCLEX exam because it is purely multiple choice.

The most exciting part of my first quarter of training was the clinical experience of working in a nursing home. I have several friends from the Filipino-American community who work as state-tested nurse aides (STNAs) in nursing homes. However, the first time I had ever been in a nursing home was Oct. 5, 2004, the first day of clinical class. The 18 days I worked in that nursing home made me treasure every minute of my life, find joy in simple things and count my blessings. The experience convinced me that I could make a difference.

During the first week, I was anxious, uncertain whether I could do a good job as a student nurse with elderly people. I know how to take care of fish, spawn them, rear their eggs and young, draw blood, perform feeding studies and collect tissue samples for laboratory analysis. I have experience raising and nurturing two children and caring for my husband, who suffered multiple leg fractures from a motorcycle accident 13 years ago.

As I walked toward the front door of the nursing home that first day, I remembered my college years in the Philippines, when my grandmothers patiently waited for me to bring them their favorite Clint Eastwood movies. I remembered my genius boss in Tigbauan Fish Station, Iloilo, Philippines, a heavy smoker and coffee drinker who suffered from insomnia and wanted to discuss microbiology until 3 o'clock in the morning, And I remembered the older real estate broker who helped us buy our first home, and the retired gentleman who helped us buy my husband’s first truck. I went through the security doors, said good morning to my classmates and teacher, and told myself, yes, I can probably do this.

Initially, we were assigned to work with the STNAs and to familiarize ourselves with the routine of waking patients, giving them showers, passing out breakfasts and assisting with feeding. We also practiced taking vital signs. I was able to establish good rapport with the staff nurses, STNAs and patients. I noticed that there were significantly more female patients than male, and only two were African-Americans. I also noticed that the majority of the STNAs were African-Americans or African immigrants and that all staff nurses were Caucasians.

I started looking at charts and learned the differences between “full code“ (patient needs to be hospitalized in case of illness requiring prompt medical attention), “DNR-CC” (do not resuscitate, comfort care; or let the patient die comfortably) and “hospice” (patient will probably die soon). I had always felt that once a patient is placed in a nursing home, the end of life is just around the corner. Then I met Rose, who turned 100 in early 2004 and still looked gorgeous, smart and healthy.

She was temperamental; sometimes she said she loved me, sometimes that she hated me. I supposed she had another 10 more years to live. Had she been in Britain, she could have received a letter from the queen for turning 100! Once, when I was taking her blood pressure, she complained: “What are you doing with my arm? Leave me alone!” I tried to explain that I needed to take her vital signs. Finally, she shouted, “Help, this girl is killing me!” Thank God, two staff members came in the room and calmed her down.

During my first week, my instructor alerted me that a patient had recently “expired” and wondered whether I would like to see the woman. I figured that “expired” meant that the patient had died, but I asked the instructor to explain further. I proceeded to the patient’s room and saw a lady with a short physique lying in a fetal position with her mouth open. A classmate told me the patient had died within the last 30 minutes. A teary-eyed STNA, who was cleaning the body, quietly uttered, “This will be my last chance to give you a bed bath.”

She said that the patient had died of Huntington’s disease and that the family and funeral parlor had been notified. The body felt warm, not cold like I thought it would be. The STNA also told me that a dead body often releases urine and fecal matter during the first two hours following death. Experienced health professionals might think I was ignorant. Perhaps I was.

I dislike looking at dead bodies, because thoughts from my childhood tell me they come back as ghosts that will scare you in the dark. When my family attended the wake of my close friend's dad here in Columbus, I was shocked to see the dead body laid on a bench and not inside a coffin. We arrived early and my husband left my daughter and me for one full hour. I pretended I wasn’t scared and read my kid’s book about 10 times. One of the staff members came by and told me, “The person is no longer there; it’s just a body.” I looked at him and nodded.

I helped an STNA give a female patient a bed bath. The patient must have had urinary incontinence and soiled her bedding during the night. I thought I couldn’t handle the pungent odor, but my mints helped. The STNA did a good job of explaining how to give a bed bath. It felt different when I was bathing a mannequin in the laboratory. The patient’s response and reactions helped me manage the job more effectively. I enjoyed giving bed baths and felt neither embarrassed nor uncomfortable cleaning the patient’s perineal area, probably because my favorite domestic chore at home is cleaning the bathroom.

I decided I needed to familiarize myself with American slang words related to health care. I also realized I needed to speak clearly and loudly, because dealing with hearing-impaired patients is common in nursing homes. One 95-year-old gentleman said that my Filipino accent was fine—that he was able to understand me, but I needed to speak louder. By the way, just because you’re 95 years old and a nursing home resident doesn’t mean you don’t care about your appearance. When I encouraged him to get out of his room to meet other patients, he asked me to first find his hair tonic.

During my second week of clinicals, I had a chance to give my patient Imelda a shower and change her bedding. (Don't tell anybody, but I do a lousy job making our beds at home.) Imelda was cooperative during the shower; she taught me how she wanted to be cleaned and where I needed to focus more attention. I felt comfortable helping Imelda and hoped she was comfortable, too. I had the same feeling I had when giving a bath to my toddler. The only difference was I didn’t hear a plea for more bubble bath soap.

I fed a hospice patient, Mylene, breakfast in the dining room. I observed that her food portions were mashed, perhaps because of her inability to chew and swallow effectively. Throughout the feeding session, she tilted her head upward, closed her eyes and murmured sounds. She opened her mouth slightly when she felt the spoon. She ate very little of the solid food—not so solid, really—but drank all her milk and juice. I felt sad for Mylene, because she missed the joy of chewing and tasting food, and the presentation of the food was less than appealing. One of my friends believes that presentation of food is as essential as its taste. Thank goodness, he did not see Mylene’s meal. If he had, I would have heard a long lecture. Mylene was a hero. She tried her best to eat and nourish her body.

I administered medications to two patients on tube feeding, Karina and Terry. Their meds—10 to 15 kinds—needed to be administered three times a day. My instructor and I did the 11 a.m. medications. As I walked into the rooms, I thought about my lunch, stored in the refrigerator at the College of Nursing lunchroom—rice, sautéed pork and vegetables. Before eating my food, it needs to be put in a microwave oven for five minutes. Karina and Terry had their food administered continuously. I asked myself, “Don’t they miss the microwave and the burning feeling on their tongue when the food is very hot?” When I was in the Philippines, I never had the opportunity to use a microwave. Even my richest relative didn’t have one. Had these patients been Filipinos, perhaps they would not have minded their food being cool, but they are Americans and, in America, microwaves are as common as radios.

I admired the patience and interest of the STNAs in the dining room. They encouraged the patients to eat as much as they could, without rushing them. This is no longer “life in the fast lane.” My late grandmother Etang ate her meals very slowly. She started eating breakfast at 8:30 a.m. and finished 2 1/2 hours later, when we were preparing for lunch. She considered her meals a good way to rest and relax.

One day, I needed to take the temperature of Natalia, one of the two African-Americans in the facility. I always saw her seated in a reclining chair with her hands on her ears. She felt very ticklish when I placed the thermometer in her ears. At that time, I doubted how good a nurse I could be when I could not even take a patient’s temperature.

On my way to monitoring the vital signs of another patient, I saw Linda in the hallway, beautifully dressed and ready for her physical therapy session. I remembered giving her a bed bath during my first week. Linda suffered from urinary incontinence. I sat and chatted with her for a few minutes and asked how she felt, when she accidentally wet her bed. She replied without hesitation, “Sometimes, it’s nice to let it go.” I patted her shoulders, smiled and said goodbye.

Three weeks later, I discussed urinary incontinence with Julius, a 92-year-old patient with diabetes. He was embarrassed to talk about it and said: “I don’t think this conversation is pleasant. It will not help you with your nursing studies.” He added: “I think it is normal to ask for help from an STNA whenever I feel that my urinary pad is getting wet. I just had problems using the collection bottle last night because I urinated more frequently than normal.”

I explained that frequent urination, especially during the night, is commonly observed among diabetic patients, especially when glucose levels are elevated. Reflecting on the different responses of Linda and Julius, I thought about two things: First, maybe older women have a better sense of humor than older men, and second, men are less comfortable talking about private matters than women. Now I know why men have difficulty getting medical help for erectile dysfunction.

Once, I had to check the vital signs of two ladies, Anna and Rhea. Anna had her curlers on, and Rhea was fixing her own hair. Anna’s pulse rate was greater than 100, so I asked her, “Ma’am, are you nervous or anxious today?” She replied, “My son is picking me up at around 9:30 a.m. for a dentist appointment, and I am just so eager to get out.”

When I came to Rhea, she told me right away: “I dislike my hair these days. It’s getting thinner because of chemotherapy. I used to be pretty before.”

“You are still attractive now,” I replied.

Women have to be attractive all throughout their lives. This is what the movies and television advertisements tell us. Men often look smarter and sharper when they get older. I’ve watched several Richard Gere movies, such as “Autumn in New York” and “Pretty Woman,” and the plot is always centered on “older man meets younger woman.” I was not surprised when one of my patients, Steph, a 90-year-old woman suffering from heart failure and pulmonary fibrosis, was more focused on her 2 p.m. hair appointment than on putting her oxygen in her nose to help her breathe.

Finally, I would like to mention that the 2004 U.S. presidential election was “hot,” even among nursing home residents. A 95-year-old lady, Diana, was wholeheartedly devoted to John Kerry. She stayed up until midnight on election night to keep an eye on the returns. Diana was very sad the next day when President Bush was declared the winner. She had elevated blood pressure, showed signs of anxiety and was less friendly to me. When I asked her name before injecting insulin, she said, “You’ve been here so many times this morning, why do you have to ask my name again?”

I was silent, but my instructor saved me and explained that making sure you have the right patient is one of the “five rights” of medication administration. The patient calmed down and talked about her frustration over the defeat of her candidate. An hour later, I saw her in the activity room preparing zucchini bread for Thanksgiving celebration. Cooking certainly reduces stress, especially when you are good at it. I cook all day when I’m mad!

I have so many other things to say, but I’m running out of space. By nature, I am talkative. One time, my daughter showed me her report card. The teacher commented that she was on the honor roll, but has the tendency to be talkative. It’s probably hereditary—like mother, like daughter!

Life in the nursing home is obviously unique. Most of us will have our own time of active youth, middle age and old age. You and I may or may not end up in a nursing home. We may be lucky to be cared for by our family and die at home like my grandmother Etang.

In case you feel that your life is meaningless and nobody appreciates what you do, regardless of your efforts, drop by a nursing home in your area and spend time with the residents. You will see a fast track of your own humanity and, eventually, realize the full meaning of your life. It’s undeniable; living a long life is what we always hope for. On second thought, living a functional life probably means more.

Now, I look forward to the remaining miles of my thousand-mile journey. The first 10 miles were exciting. I will write more as I move on and reach my goals. RNL

Mary Ann G. Abiado, PhD, is enrolled in The Ohio State University College of Nursing’s graduate entry program. Designed for those who hold a non-nursing bachelor’s degree, the accelerated, three-year program leads to RN licensure and a Master of Science in Nursing.

While pursuing a nursing degree, Abiado serves as program administrator of the BioCassava Plus program at OSU. Funded by a $7.5 million grant, the interdisciplinary project is part of a $450 million program funded by the Bill and Melinda Gates Foundation to find innovative solutions to global health problems. Cassava, the primary food source of more than 250 million Africans, provides the diet of nearly 600 million people worldwide.

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