Tuesday, June 28, 2011

Lows and Highs

So today our group started clinical at 9am this morning. Meg and Chelsea went on home visits while myself, Marianne and Maria went to the ER at a hospital about three blocks from the church. I was so excited to finally be putting my nursing skills in action, but once I stepped inside the adult unit of the ER my mood drastically changed. Everyone was speaking a mile a minute and in such thick accents I couldn't understand what they were asking or saying. The ER was super chaotic today as well which made everything that much worse because everyone was running around like chickens with their heads cut off. I was picking up words here and there at first but it got so overwhelming and I just couldn't keep up. I started thinking that I shouldn't be here because I can't communicate with these people and that I was just going to fail. Those who know me, I am a very independent person, I never quit and I beat myself up if I fail at something I know I can do. I was beating myself up saying that I should have studied Spanish more, regretting not taking more classes at Marquette, etc. The nervousness and defeat must have read on my face because the nurses started to talk slower and use simpler words that I could understand. I also was with Maria (who speaks fluently), and she helped translate a lot for me. After about 45 minutes of being there I was asked to take a blood pressure, I did it with ease and even though I struggled with telling them what the result was, I started to feel better about being there. Next they asked me to give an insulin shot, once they told me it was insulin, my nursing instincts kicked in and I did it with a breeze. The nurse who was showing Maria and I how to do things, began to try to explain what to do but I just did it and he was kind of shocked considering I couldn't really understand other things. That is the wonderful thing about the nursing career, it is the same in every language and can be accomplished with little communication as long as it is familiar to whomever is performing the skill.

I also got to help with an EKG and then mostly just watched other stuff like putting in IVs, assessments, etc. I also had a surgical tech pull me aside and show me how to do stitches. We watched him put some in earlier but I was kind of standing in the back so he pulled me into the trauma room and pulled out all the tools needed and just kind of showed me, but without really stitching what it all entailed. It was really cool because he didn't speak any English but we did a lot of hand motions and sounds with simple words like cabeza, sangre, and la carra to help demonstrate which type of stitches are used for certain cuts.

Most of the time this morning was spent just looking around the ER and getting familiar with the equipment or lack there of. There were 7 beds with just curtains between for the adult ER unit, most of the hospitals I have worked at in the U.S have about 20-30 private rooms all with a closing door. There was no med drawer or Pyxis unit (this is a locked machine that holds stronger drugs, for those not in the medical field) just a wooden box that had separators and the glass ampules of the medicine sitting inside. The separators had a piece of paper taped to them with the name of the drug. Anyone could just walk up, find the drug they want and then grab it and use it. Another huge difference was the fact that there were no IV machine poles. Anytime I have hung an IV bag in the U.S I just place the tubing in the machine and press buttons to determine the infusing rate and then the machine does its job. Today Maria and I both had to determine the drop rate ourselves! I remember doing it once in lab but at the time I remember thinking, "Oh I will never have to do this, all the hospital IV poles do it for you." Boy was I wrong, it was really simple to pick up, it is just a matter of counting the drops per minute and than either making it faster or slower for the desired rate. It was so interesting to see how they were still able to get so much accomplished with so little equipment and I am glad I was able to work in this setting.

After lunch the original plan was for my group to go to the orphanage and the other group to head to the nursing home. While we were waiting for the parish workers to meet us and take us to our designated places, Daisy (one of the parish nurses) said there was a change of plans and that we were going to pick up someone and take them to the hospice. So we all piled into the back of the truck (this is one of my new favorite things :]) and headed out to one of the village homes. Supposedly today while some of the missionaries were out delivering food packages they came across this home of a mother and three boys. The mother who is 42 has been sick for two years and within the past week has not eaten anything at all. The eldest boy, who is only 13 yrs old, dropped out of school when his mother got sick and has been taking care of not only his mother but the two other boys. We got to the house or what is better called a shack (the villages are made up of bamboo and tin walled shacks and roofs with dirt floors) and found a very frail, sick lady laying on a mattress. After doing some initial assessments and talking with her and I am assuming the neighbors, we helped her into the truck and drove to the hospice. There were took her to her room and then began our assessments. We took vitals, listened to lung, heart and bowel sounds and started putting two and two together. It is hard to say exactly what she has considering we don't really have any diagnostic tools, but between the five of us girls and our professor, we believe she has some kind of liver failure or hepatitis because she is very jaundiced and has ascites (fluid filling) in her stomach. We believe she doesn't have long left to live but we are happy she is at the hospice and finally getting some real care.

When we were putting Aurelia into bed at the hospice, she smiled and sighed a sigh of relief when she laid back on the bed. We did simple things like put a cool washcloth on her head and gave her some chapstick and you could just see in her eyes how comfortable she was. Even though the sadness of her dying and leaving three young sons without a mother is overwhelming and made me tear up this afternoon, the happiness that I felt when she smiled as I put the washcloth on her warm head made what we were doing worthwhile. For those who don't know, I am very interested in oncology, specifically related to hospice and palliative care. Many jaws drop and people are shocked that anyone would ever want to work in such a sad career. I am not denying that it is sad and will be emotionally difficult for me at times, but the happiness I will get knowing that one cool washcloth, sip of water, back rub or hand held makes a world of difference to the patient and helps them on their journey to the world beyond.

On a different, less serious note, we go to mass every night at 7pm, and it is all in Spanish! They clap with every song and I truly enjoy going even though I don't understand most of the readings, songs or homilies. Today, mass was longer than usual because every six weeks, they Confirm about 75 adults. Not only did they have 75 Confirmations today, they also had 15 Baptisms, it was exactly like an Easter Vigil mass that we have in the U.S.

I am being fed very well, maybe even a little too well ;) and the people here are still very welcoming and give hugs and kisses on the cheek every time they see you. It is such a happy place here and even though I had a rough morning, I feel a lot better because of the love and support I have received here not only from the other nursing students, but the missionaries and parish workers as well.

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