Tuesday, May 25, 2010

Haitian Cuteness

These little guys balance out the heaviness of the last post...

Haiti, IV

For privacy reasons, I’m not going to tell much detail about specific patients, but I will for one. Pirouette. It was hard not to notice this baby. She had a condition called hydrocephalus where too much fluid is produced in your brain and it causes your head to swell. A common treatment is to put a drainage system into your brain (called a shunt), which takes the excess fluid and moves it down into your abdomen where your body can more easily process it. Well, Pirouette had a shunt but for many reasons (including other medical complications), it did not work and the excess fluid in her little head was stuck there. The size of her head was astonishing. It was easily three times what it should have been. She had so much fluid that her skull bones were not touching (babies are born with un-fused head bones to allow for squeezing down the birth canal, this is normal and the bones fuse during the first year I believe), making moving or holding her unsafe.

Children have an amazing way of accommodating many illnesses and adversaries, but eventually, Pirouette’s body was unable to fight the many pressures against it. CSF began to leak from a small wound and it became clear that she would not last much longer. I made sure to spend some time with this little princess. I massaged her legs and did some passive range-of-motion to loosen up her very contracted muscles. She didn’t like being moved with changes and her sweet face would scrunch up and break your heart. However, when you rubbed her feet or talked sweetly to her, her face would soften and you could tell she felt loved. We all did our best to make sure she felt it. Eventually Pirouette took her last breath. Neither Vivienne (she was caring for Pirouette that night and I was charge) nor I had ever done post-mortem care so Pam came to help us (immediately after doing the same for another patient of hers, I can’t begin to describe her strength). We gently cleaned her body, straightened out her new dress and placed her in the bag. We notified Cici (the logistic person on for the night) and her husband (the Chief Medical Officer that week) and the four of us escorted Vivienne (who carried Pirouette) to the morgue. As we zipped the tent back up I felt such an emptiness because that was it. We went back to work and moved on. What was missing was notifying someone. There was no one to notify. You see, Pirouette was abandoned. I can only imagine how difficult it would be to care for a normal, healthy child in such devastated conditions, but a medically fragile child? No way. Her parents probably left her in the best place they knew to and hoped for the best. Still, knowing that we were the only people to know that this little girl had gone to heaven was heavy on my heart. I asked that Jesus would hold her tightly and give her the love every child deserves.

Monday, May 24, 2010

Haiti, III

When the floor became too chaotic found respite in the NICU (Neonatal Intensive Care Unit), which was located in a corner of the PICU (Pediatric Intensive Care Unit) where most of the group I came with were working (I was one of only 3 non-ICU people in our group).
After the first night I realized they were super short in the ICU. They had 8 PICU patients and 8 NICU babies with only 3 nurses (at home one nurse takes care of 2 ICU patients max) and though they did wonderfully, they really needed an extra set of hands for the babies. I happily volunteered. Some nights I worked both the floor and NICU, other nights I did only NICU.

Ireally enjoyed working with the babies – not only because they were tiny and adorable but because I felt like I was doing something useful. They needed to be fed and I could feed them. They needed diaper changes, and I could do that (even if it was with a size 3 – have you ever tried putting a size 3 diaper on a 4 pound baby?!?).

One benefit of working with the NICU babies was watching my coworkers care for the PICU patients. I have never been more impressed and proud to be a nurse. I worked mostly with Pam, Nancy (to the right with one of our fabulous interpreters) and Joanne. Let me tell you, they worked hard. They used every skill they had to make the limited resources they had (one suction machine for 3 vented kids – what!) go so far. They knew exactly what to do in the scariest situations and did so calmly, competently and compassionately. I was so impressed and honored to be a part of the group that cared for these kiddos so well.

On the day we arrived, during our orientation, it was said that if it were not for what we were doing, these people would die. It was said to comfort us and encourage us to keep going despite frustrations that come with knowing a simple procedure or medication so widely available in the US was unavailable. Lots of kids died. I must admit that I felt so protected. The Lord knew my heart and protected me from situation in which I’d have to be a part of hard decisions like choosing to stop treatment and determining at which point continuing care became more harmful than good.

Haiti, II

Nursing in Haiti was drastically different from what I was used to. Yes, basic principles still applied, but working with limited resources and huge communication barriers was challenging. I felt that I was responding to specific situations (pain, itchiness, hunger, etc.) as opposed to using critical thinking skills to anticipate a patient’s needs or using my assessment skills for a purpose.

We were fortunate to have a lot of resources, but “a lot” is relative. Our IV fluids were limited and saline flushes were nonexistent.

We had antibiotics but no directions for reconstituting them (many antibiotics are powder and need a certain amount of fluid to be added to them before they can be given intravenously).

We did a lot of improvising, reusing and repurposing. We recycled needles (only if they never came into contact with patients) and threw syringes in the trash. We used clean technique but being sterile was next to impossible. I tried to calculate drip rates, but with each move of a patients arm it would change so before long I began eyeballing it. Being exact became less of a priority, and trying to make due while still being safe became our focus.

I must admit that while I have vivid details of arriving and leaving Haiti, my time spent there blurs together much more. Each day seems to have bled into one another and instead of separate 24-hour periods it has become one long experience in my mind.

The night shift crew for the peds floor was made up of two Miami nurses (Vivienne and Juliette) and two Haitian nurses (Toussant - below left and Germaine - right) and me.

I have to say that I am so thankful to have been able to work with these four women. They were hard working, competent, kind, joyful and just plain wonderful. I was the “charge nurse” every night after day one (which didn’t mean much) and though everyone was very competent and very strong individually, I was occasionally sought out for help (I had the most peds acute care experience) and I was even asked me to help them with IVs – ha!

Working on the floor was difficult. It was chaotic.
People were everywhere. Communication was so difficult (though the translators were awesome) and I really struggled at times. I had to remind myself frequently of 1 Peter “Gird up your minds and rest your hope fully upon Jesus” and “that by your good works may you glorify God.” I often struggled and eventually needed a break.

Haiti, I

How do I put a life-changing experience into words? I’ve put off documenting my experience in Haiti simply because I don’t feel I have the ability to transpose my feelings from raw, real-life emotions into two dimensional words which will accurately describe one of hardest, most challenging and fulfilling weeks of my life. I don’t quite know what to say, but I will try. So, here goes nothing…

Let’s start with the night before. In typical Stephanie fashion, I began packing for my trip the day before I was to leave. Ben and I are similar in the sense that the rush of an impending deadline is exactly what it takes to get our butts in gear. I had spent weeks gathering supplies and waited until the day before I left to make sense of the chaos strewn over our dining table and various parts of our bedroom and living room. After a few hours I managed to cram everything into my duffle only to find myself 6 pounds over the limit (Ben blamed the four pairs of shoes I brought. He said they were unnecessary. Silly man.). I shuffled things around and wound up with the heaviest carry-on ever and finally made my way to bed well after midnight.

I woke the next morning tired yet excited and nervous. We were both quiet as we stopped by Starbucks to grab breakfast and my final latte – a last little piece of indulgence. The weight of what I was about to do was heavy on my shoulders and I held tightly to my husband’s strong hand in an attempt to burn the feel of his warm hand upon mine. I don’t know what I was more nervous about: stepping so far out of my comfort zone or doing so without my best friend. I had never challenged myself like this. I’ve never put myself in a situation in which I had to rely on my own strength. Until this time I’ve always had my family, my friends and most recently, my husband. It’s an intimidating thing to know that you are on your own. But, of course, I know that I am not alone. I was very aware that He was leading me to this place and that He would be there with me, holding my hand and protecting my heart. Yes, I was scared, nervous and weak, but I knew this was what I was supposed to do and I knew that He would make me strong.

The airport was very crowded (which is not common for our beloved PDX), but I still managed to find a few other girls I would be traveling with. It was nice to connect with some familiar faces and know that we’d all be traveling to Miami together. We flew to San Francisco and then onto Miami. We traveled all day and arrived in Florida around 10:45 pm east coast time (it’s 3 hours ahead of the west coast). By the time we got our luggage it was about 11:15 pm. I headed out to catch the shuttle to my hotel (the Days Inn – DO NOT EVER STAY THERE!). I arrived at the hotel only to find out that there was a mix-up and my reservation was at the other hotel. I thought the mistake was mine, so I took the shuttle back to the airport to catch the other shuttle to the other Days Inn. I eventually made it to the other Days Inn only to then discover that the hotel had made a mistake and I was supposed to be at the first Days Inn. It was an issue because the second hotel didn’t have a 24 hour shuttle and I’d have to take a $20 cab to the airport at 3 am. The manager at the second hotel was very nice and said he’d take care of my room and arranged for the first hotel’s shuttle to pick me up and take me back to the first hotel. Well, that never happened. After waiting for a half hour, I finally took the shuttle back to the airport. I was frustrated, tired, sweaty (it was so muggy) and smelled like cigarettes (Miami smells like one giant ashtray). I called the first Days Inn and talked to the manager. He denied just talking to the other manager and said he had no record of me having a reservation. I tried to discuss my options with him over the phone but he just kept saying, “Come down here and we’ll work it out” in his broken English. I had little faith in him, but he said he was sending a shuttle for me. So I waited. And waited. And waited. Finally, well after midnight, I gave up. I spoke with a security officer at the airport and asked where a safe place to spend the night would be. She directed me to the 24-hour subway where I got some dinner and settled in for a long night. Well, what was left of the night. You see, we were supposed to check in for our flight at 4:00 am, so at best, I would get three hours of sleep. Yeah, that didn’t happen. Try as I might, sleeping with one arm around your carry-on and your feet on your pack is not cozy and trying to tune out the group of chatty Cuban grandmas to the side of you is easier said than done.

3:30 am finally came and I made my way to the bathroom and whipped out my shower wipes and got ready for the day. I was really hoping to wash my hair one last time, but that was not an option. Oh well. My group slowly trickled in and we checked in with Project Medishare. They weren’t super organized, but we shrugged it off and thought nothing of it (little did we know that this was the most organized we would get). We waited the few hours before boarding the Vision flight to Port au Prince.

Flying over the sea before reaching Haiti was intense. I stretched over my neighbor to try to catch the first glimpse of this little island. I watched as bright blue waters sparkled. It seemed serene, peaceful. The large sinking ship seemed very out-of-place. I had to look twice to see if I really just saw what I think I did. I did. We flew over little of the city on our descent into Port au Prince and saw little destruction – that is not to say there was none – we simply hadn’t seen it yet. Upon disembarking the plane we were greeted with the most overwhelming burst of heat. The air was heavy with heat and I immediately began to sweat. We packed into the immigration building where hundreds of people waited in lines for entrance papers. I clung onto my passport and other papers knowing they were both my ticket in and ticket out.

After stating my purpose to the man behind the counter, our group joined together and made our way outside where we were met with a wall of faces peering in through the gates.
We finally found a Medishare representative and he sporadically lead a group of us out the gates and down the block to a waiting SUV. Though the Project Medishare field hospital was set up on the airport grounds, we had to leave the airport to get to it. It was at this point that I felt so incredibly out of place. I had never felt “white” before, but as the wall of people parted to let us through, I did. A friend of mine warned me of people who would try to grab my bags, not to steal them, but to carry them and then charge me for his services, but this didn’t happen. The men (all men, no women) simply moved out of the way and stared. I felt like Moses parting the red sea, only not as biblical or grand.

In culture shock I jumped into the first car waiting and soaked up the last little bit of air conditioning and the last second of cool I’d feel for a week.
After a short drive we arrived “home.” Our bags were being unloaded and we were instructed to go find a cot and then meet back out front for orientation. I quickly grabbed an empty cot, zipped the legs off my pants and kicked myself for throwing away the new, clean water bottle they had given me on the plane (the bottled water we were promised was used and dirty). Orientation was brief and not super informative. The director introduced himself and the Chief Nurse Officer (CNO), Jen and after the briefest “tour” imaginable, we waited as the CNO made assignments so we could get to work.

About 20 minutes later assignments were made and I was scheduled to work in day shift in the Adult tent. I was so overwhelmed. The chaos was making me crazy. I was scared, nervous, hot and way too tired (I was going on only 4 hours of sleep almost 48 hours). I began to panic. “Jen, I’m a peds nurse, I’ve never done adults!” I said. Just as an “Oh well” (she didn’t say that, but that’s about the meaning) was about to leave her mouth my hospital director saved me. She grabbed my arm and said “Steph, it’s OK, I’ll trade with you. It’s OK. You’ll be fine. Don’t worry. We’ll switch.” I’m so thankful for Ruby. I was about to lose it, but she brought me down and took the final straw off my back.

As the day shift nurses began their first shift, I tried to get myself settled for a nap. A woman from Seattle (Cici, our new logistics coordinator) helped me set up my bug hut and I laid down for a short nap that was anything but restful. There were more people than cots so they had to squeeze more in thus leaving me no room for my tent (which was awesome but very big). To make room for my tent I had to squeeze off the side of a walkway. It was an awkward spot and every time someone walked by I felt each movement. It was as though I was trying to sleep on the deck of a ship. After an hour or so I was seasick, sweaty and hotter than I had ever been in my life. I took a shower and relished in every drop of the cold water.

I never thought a palate and plywood shower with a shoddy spigot would feel luxurious, but it did. I walked out feeling refreshed and wonderful. I no longer minded my tiredness and I brushed off the new drops of sweat that beaded on my forehead. Those few minutes were what I needed to readjust my focus and gear up for a very long week.