9 January- 5 February 2011

11 Jan 11 (0045)

 

What a day! I'm so ready to fall asleep after a long day. Except for maybe 2 hours scattered here and there, we were busy from 8am to 9:30pm with a transfer (a badly controlled diabetic patient with a gangrene foot & pressure sores) & 3 trauma's (bad motorcycle accident). I can say there is good teamwork among everyone. After showering & just going to bed, I got a call that one of our trauma patients blood pressure was dropping & heart rate increasing. Hemoglobin dropped from 13.9 to 8.8, but Dr. Terri said no blood unless less than 8.0 so we wrapped a new compression dressing and elevated the leg more. The nurse seems really attentive so I think he'll be watched well. And then, I helped Marc & Orphee with a 20-month old baby who died of anemia. Somehow Marc & I are functioning more like PA's or NP's.

15 Jan 11 (2115)

I went to the January 12^th services on Wednesday. There were hundreds of people at the memorial service our hospital put on, but no outward signs of morning. I worked 12-14 hours Monday and Tuesday so I was exhausted Wednesday so I didn't work much. I'm going to have to learn how to write dressing change orders in French to incorporate the nurses doing it because it gets to be a lot. We're doing lots of much needed surgery, but it can get crazy when we have lots of patients. I have to set my boundaries because I cannot work five 12-hour shifts. I start to become ineffective because I am so mentally and physically exhausted.

But I had a wonderful nights rest, went to service, and then came to visit Elisabeth and Servilus. Servilus bought his motorcycle so we rode that for over an hour all over PaP to reach their house. Let me tell you, the motorcycle was OK in the countryside but downright scary at times in the city because other people drive crazy swerving in and out. I wanted to close my eyes because of the dust, but I wanted to keep an eye on traffic so I forced them open.

Elisabeth is looking beautiful as usual, even in her pregnancy. She taught me how to cook rice, bean sauce, and fish. We cooked outside on the ground with a charcoal grill. I just love spending time with her. I wish she lived closer so I could come more often. We watched a theater production in Kreyol that was made in the U.S. With Elisabeth help, I got the main jist, but they spoke really fast so I couldn't understand everything. The mosquitoes are really bad at their house!! So after a bath, talk with Wilshaw, I'm ready for another goodnights rest.

Side note: I wrote a letter to Orphee to help her get approved for a visitors visa. I would love to show her around Lancaster, MD, Philly, Miami, & New York. I pray that if it's Your will, she would get approved and be able to visit me. She would come back & go around with me visiting friends. And I finally visited the little Haitian boy medical patient who had told the nurse earlier in the week that he liked me. I told him I would come back and visit, but I got busy all week. His name is Reme Leonidas. It's been fun seeing a lot of patients I know come back. Especially the kids, but I haven't seen Sondy or Denise. We haven't had any long term pediatric patients, which is probably a good thing, but I miss the kids!

The results got leaked- it's the lady and Micky who won 1^st and 2^nd place. Apparently there was a lot of ballot stuffing for Jude Celestin. I guess now it's up to the Haitian government to decide if to accept these results. There were some small riots thursday, but nothing today when we drove to Servilus's place. I like how I'm starting to recognize where I am at. I still couldn't get around on my own nor would I ever want to drive here.

Brian, Marc & I have been having fun with the P90X abd workout & cooking. I'm getting used to the rice & beans, cold showers, and mosquitoes. I feel like I'm home.

16 Jan 11 (2154)

It's an interesting experience learning to cook from the basics. The food is delicious. I feel that my Kreyol is slowly but surely improving. The one Haitian American volunteer asked me this week if my boyfriend is Haitian because he said I speak it well for not being Haitian. That's a great compliment for me :) I tend to pick up on whatever accent I'm around. Robenson had to fix the motorcycle so I'm staying overnight and leaving at 5am. I pray that my devotional thought tomorrow will reach or touch at least one person.

17 Jan 11 (2300)

How wonderful it is to be safe, well fed, have a shower, and warm bed. But God is more than just my provider. He's love, righteousness, Holy, merciful, omega & alpha. I like the quote Marc said, "Seek God's face, not just His hands." Today was busy, but not too stressful. And I got to fit in talking with co-workers, exercise, making dinner, and talking to Wilshaw. The one nurse was telling me about a patient, but I didn't know the word I wanted to say back, so I got Mac to translate and the nurse said, "Li pale Kreyol (she speaks kreyol)". I have had a couple nurses say that if I bring a translator. But I still do have a fair amount to learn. I feel it helps me connect better to the co-workers and patients.

18 Jan 11 (2340)

Today was a testing day on my patience- a drama queen patient that was refusing to do what we ask and then refusing to leave. I had to get security involved, and guess what? They didn't leave, but stayed overnight in a cot in the hallway. I told the nurse she wasn't a patient and didn't need any nursing care. And a lot of strong emotions today. Only God knows what is best and the outcome, so I have to put it all in His hands.

20 Jan 11 (2341)

As tired as I may be, I still need to be thankful for everyday. It was a calmer work day. Even though I may not be fulfilling a floor nurse positions, I'm learning a lot of other random skills to help me as a nurse and life in general. Like coordinating care, finding beds, teaching in another language, and learning what is normal. Like tonight, we had two big surgeries that can bleed a lot, especially if not elevated, so they weren't elevated. Back in the states, I would have worried more, but I know the normal now and just compress it and elevate it.

I lift up our meeting tomorrow with Dr. Terri & Dr. Simeon to set our goals, concerns, & protocols. All in all, we can't operate in earthquake mode anymore. I pray for respect to the hospital medical director's wishes now. We have 4 ortho surgeons coming next week so it'll be busy.

21 Jan 11 (2327)

You provided me a miracle and blessings already on this sabbath. I had the nurse change the C4-C5 Quadraplegic's catheter because he had the current one in for 1 month (one not made for long term use) and he was starting to have fevers. Well, I decided to check on it (I just had a gut feeling about it not being in right), and I came in 4 hours later & noticed there was no urine in it. So I got the supplies to put in another one. I deflated the current balloon & pulled the catheter out & it started bleeding profusely. I put pressure on it, but it wouldn't stop. (The balloon had apparently been blown up in his urethra instead of bladder so it broke the lining...and he has no sensation so he couldn't feel it). I was getting nervous because it was late at night & would be hard to get urology service. Thankfully Sophie (the ER MD from England) was walking so I had her come in and try to stop it. She placed a new 18-gauge catheter and the bleeding stopped! Praise God because if it didn't, he would have needed urology surgery. I have to appreciate families here, because instead of panicking they helped as we asked. And then they got the patient (their father), all cleaned up after the mess.

I saw Sondy today and I was so glad! He didn't act like his playful self though. I gave him the picture frame and colored pencils. It seems he will be back again for a couple more cast changes. He told me our little girl patient Denise is supposed to come back March 14^th. Besides her, I've seen all the patients I've printed pictures out for. I love seeing patients again! I realized I haven't been sharing patien stories recently. I've been working long days & my brain is tired by the end. But, I shall try to start doing that again.

It's been a brand new year & way of doing things. We're not taking large short term teams & it's been better just having 1-2 ortho MD & 1-2 anesthesiologist. I've been basically functioning as his PA, bed monitor, and coordinating things. I am trying to work with the Haitians nurses & nursing directors. I definitly feel my role now and it's sure busy. Apparently, Marc brought it up to Nathan to see if I can get a stipend. I am praying about it, but I could be more effective being here for 1 year.

25 Jan 11 (2300)

I have spent way too many days without quality time with God. Sunday became a challenging & busy day. I woke up feeling sick and when we rounded on a patient she looked very sick. I had a Haitian MD look at her & he said septic shock. So he ordered some things & then we had a meeting with Dr. Simeon. The meeting went OK- still have more to compromise & collaborate.

Then, I went to look at the patient again & she was no better. So we got Dr. Simeon involved. The patient ended up being in septic shock (Tempt was 106 degrees Fahrenheit, BP= 45/35, HR 130); she had dry blood in her mouth so the guess was she was bleeding in her GI tract because her H&H= 3.3, 10%; and she was in diabetic ketoacidosis (Glucose was somewhere between 500 and 1000). She had came in with a diabetic foot ulcer that went gangrene. I believe her husband took good care of her but had no money so he couldn't take her to see the doctor. A foreign run clinic was the one who found her and brought her to our clinic. They amputated that foot, but later also had to amputate the other leg because of another sore under the knee that went down to the hamstring. She also had multiple other sores from being bed-ridden on top of other medical problems that we probably didn't even know about. So she should have been followed medically & just consulted ortho, but the family couldn't afford to be followed medically. She didn't have too many signs of problems (or they nurse never told us when she started spiking temps) so it seemed to come on quickly. So needless to say, we were running around trying to save this woman's life. I was up most of the night watching her and then worked 9 hours the next day. Marc watched her Monday morning. Her hemoglobin came up to 5.5, BP up to 75/40, but she never woke up. Her family asked us to cease treatment so they could take her home to die, but she passed away before that happened. The husband said she has been suffering for so long and maybe this was God's way of ending her suffering. I'm glad he saw it that way, but it was hard on me because I felt like she shouldn't have gotten that far advanced in a hospital. She eventually would have died of sepsis or something else in the next month or two at home if she didn't come in, but the surgery exacerbated all her medical problems.

It's a hard thing here because if patient's can't afford it, they can't get treatment. Dr. Spendie said she will see them, even if they can no pay, but that's out of her pocket & I don't want to do that often. The CBM (physical therapy techs) explained that a lot of times in Haiti people don't come to the hospital or they come too late to save them because they don't have the money (or they try voo-doo first). It's hard to understand & swallow, but there is no insurance so this private hospital can only do so much free service without going bankrupt. It's just a different challenge I face here that I don't face at home.

The new team here, 4 ortho surgeons, seem nice & cooperative. They did a lot of surgeries, but made sure we had enough beds for everyone. I got really frustrated mid-morning because we got 2 more diabetic foot ulcer patients that couldn't afford to be followed medically. I didn't want anything to happen like had happened to that other lady who died. Now that I running into this problem more frequently, do we accept these patients without a medical doctor following them. We take a risk every time in doing so. They both need amputations too. So, Marc helped me realize there are no policies yet for this situation so I can't stress myself too much but help to try to make a policy. So that's something new I will never do back home as a floor nurse. Marc said I was the "hospital wife" lol well, I'm learning. Policies & procedures when not taken to extreme are a good thing.

We have a C4-C5 quadraplegic patient here for 1 week (the one I described above with the foley issue), but he's spiking high temps too, so we changed him over to be a medical service patient. We don't want to mess around with time with him because he's so vulnerable. I loved the one patient's daughter today. She was so amused that I speak some Kreyol and wanted to play with my hair. I got her a bible study in French because she wanted a book. I forgot to mention that a lot of patient pronouce my name, "Linz", but I don't mind because I can't pronouce all of their names either.

We went out to eat the Oberge, the local hotel restaurant, the last 2 nights. It just feels good to be somewhere else but the hospital.

27 Jan 11 (0021)

I thank You so much for a calmer work day today. And for the doctors willingness to help with anything. They really helped me with writing orders, dressing changes, and whatever else. So I'm learning how to handle the day, how things work around here, and what things I can work on changing for the better. With teamwork, this hospital really is going to function well. Hopefully it will provide as much spiritual care as physical care. As challenging as it will be to be away from Wilshaw for a year, this is a wonderful opportunity for me to spend 9 more months here. The hopefully be conversational in Kreyol; to understand the system and work with everyone to change things little by little; to have time to develop better friendships; and to hopefully grow closer to God. There are very exhausting, frustrating, and challenging days but those are times I need to remember that will help build my character to be more like Christ.

But, all in all, things I'm learning and doing, wouldn't happen in the U.S. as a one person role: Working more alongside the doctors; knowing all the staff including the medical director, working so closely together towards a change; learning how to make things work when you don't have everything you normally are used to using; learning how to deal with patient's who literally have nothing;  learning time management; bed placement; PA skills; having group exercises & meals; meetings lots of amazing people; etc! So I praise God for this opportunity. Granted we are living fairly decently here (running water & electricity). It wouldn't be safe for us to live somewhere random in PaP in tents. I wouldn't mind living in a tent, but not in PaP. It would probably be OK in the countryside.

It was interesting learning the water filter system & process to fill the water bottles. Too much clorox was put in the water, so Brian fixed it and taught us how to check the water to fill the bottles. Quite the process to get clean water- but nothing compared to what others in this world have to do to get water. The water here comes from the stream & some city water.

Our quad patient was told by me today that he wasn't going to need the surgery for the fracture to heal. I guess he thought he would have normal function again after a surgery, so I had to break the news to him. I've connected with his family and they are taking as best as care as they know. I know it will be a challenge though. He was having unknown high fevers, so they took him to the OR to debride the pressure sore. They said it was badly infected under the eschar and that if it wasn't debrided soon it would have killed him.

We have 2 new long term additions to our team. Brittany is a lab tech & Z.J. Is a social service year MD that is from America (parents are Carribean), but studied medical school in Mexico. So it's fun to have them :) I feel that we have the right combination of long term (1 year) foreign staff here and with the Haitian staff, we'll get this hospital working. We have Marc working on nurse education; Randy is an electrician & his wife is helping wherever is needed; Nathan is the assistant adminstrator & Amy is helping with whatever too (very needed!); Brian is the architect; Terry is the ortho MD & his wife Jeannie is functioning as an OR nurse; and Jamenson is working in prosthetika (where they make limbs for amputees). I don't think I missed anyone.

29 Jan 11 (1609)

It was a great week and wonderful team to work with, but I'm glad for the sabbath. The team took us out to eat. It was a good time to talk and laugh together. Today, we are heading to the beach. I was so happy for the 2 couples that never seem to get away, to get away. They all work long hours & don't have much time for themselves. We all need to work on balancing our time. Life is full of balances- work & rest; exercise & relaxing; time alone & time with others, etc. I pray that God can grant us the wisdom to know boundaries to set. The hard part is there are lots of people who need surgery (even surgeries from earthquake injuries that never resolved or the rods are malunion, etc) and not as many places that offer orthopedic service. So we're serving a large percentage population of the PaP area. Most MSF & other NGO that had orthopedic services are shutting down now.

Driving outside of PaP makes me really miss the countryside. Fresh air, less congestion & traffic, people are nicer & not so much in a rush. I think cities sometimes make people more rude, liable to sin, & puts them in over drive (constant stimulation). It would be nice to be more out of PaP/Carrefour area, but that is where God has me for now. I can live through most things for a year. We had to take an alternative route because there is some unrest & turmoil in Cite Soliel. So now we went the long way past Robenson's house, but I'll take over any disturbances.

30 Jan 11 (2350)

I am so grateful to come before You this evening. It's been a fast day! I was teaching some nursing students how to dilute the morphine 10 mg/mL into 1 mg/mL and how to give it. It took awhile to explain, but I think she understood mostly. The next day she & all the nursing students wanted a picture with me so I guess they were OK with me. Their white uniforms & hats make me giggle. So glad I never had to wear that!

31 Jan 11 (2220)

Lord, life is so short & our lives can be taken away at any moment. This past week has taught me that. We had another patient die today. He was the 55 year old quadriplegic patient I explained earlier. He was in a motorcycle accident on December 25^th. He was seen by a hospital, but sent home. They brought him here January 19^th in hopes of doing surgery on his neck. They decided he didn't need surgically stabilized; that it would just heal by a brace. In the meantime, he came in with a huge pressure sore (bed sore) on his coccyx (it was all covered with eschar). We were just doing a wet-to-dry dressing, but then he started spiking temps that they couldn't find infection anywhere else & it started draining foul smelling green drainage. So they debrided it 2 times in the OR and it was fine. Today, around noon, we changed the wound vac at the bedside and the wound looked good (no signs of infection. It was deep stage IV down to the bone). But his vital signs were good that morning and for the last 3 days. I reemphasized that the patient will never walk again because his nerve had been damaged and that can't be fixed. I told him & his family no matter how the bone is fixed (by surgery or by brace), that won't make him walk again. Because they were thinking of taking him to another country to get the bone surgery, so I think this was the first time they actually understood why he could never walk again. No more than 30 minutes later, his family found me downstairs to tell me he's not breathing. I got the doctor up there & gave him an ampu bag while I ran to look for other supplies. I ran around for 10 minutes (because nothing is organized here) but the minute I got back up, the anesthesiologist pronounced him dead. They had all the intubation supplies there but it was too late. Everything just happened so fast, I didn't know what to think. I had never seen anything like that. Someone who was stable, just stop breathing. They think he either died of a pulmonary embolism (a blood clot stuck in his lung) or his neck got turned the wrong way & the nerve that controls the diaphragm was injured. I think it hit me so hard because I had just interacted with him and changed his dressing.

Some of the translators were saying that this patient had told them he couldn't live like this anymore. It was a lesson to me, when I give really bad news, that I should offer to pray with the patient after wards. We can't wait because we don't know, they could die anytime after. It was a hard lesson for me and we did pray with the family after he passed, but we never can bring back the chance to do it beforehand. When I was taking out his foley & wound vac, I had the son help me turn the body, but his son asked to leave because he didn't want to see the wound again. All I could do was give his sons a hug because I had spent time with his family & gotten to know them. After the family left with his body (it's the families responsibility in Haiti to take the body in whatever transportation they can find, including the tap-taps), I found a letter under the head of his bed. I asked Orphee to tell me what it said. She said it was a prayer, but not to God. She made me throw it away right away because I think it was some type of voo-doo saying. The patient's pastor did come & pray with them, but I've heard a lot of people practice Voo-doo while claiming to follow Christ. So, all I can do is lift up with family in prayer to God, our rock & redeemer. 

 

3 February 2011 (0630)

Yesterday, the medical team had a shorter day (in that, I mean a normal 8 hour day lol) so we cooked for them. It's nice to have a group here 2 weeks because they adjust to how we do things and it makes it easier for me. At first, we were worried because it was a big group and we weren't sure if they would try to cooperate with how we do things now. But they have been very respectful and helpful. And I've learned many things from them.

I stayed up later because a dislocated shoulder came in while I was downstairs trying to finish the census. So I got Terri & I assisted him put the shoulder back in place. The electricity went out when we were trying to insert the IV. That always makes me giggle. I also had to be the translator. I can get by if I need to. Well, time to start the day!

4 February 2011 (2200)

Starting the sabbath off right has been a blessing- finishing cooking by sunset; a vespers bible study gathering; and enjoying our meal together. I'm glad for this group of young believers! It's college roommates, only an added bonus of spiritual accountability and growing together. There is something so peaceful about spending a quiet evening with God. Tonight, I was thinking about how powerful words are. How, 30 minutes after I explained to the paralyzed man and his family that he would never walk again, he died. While he probably died of a PE, I think he also gave up on life. I told the guy I was sorry after I told him the bad news, but the better would have been to pray. I need to be in more constant talk with God throughout the day- no matter how emotionally, mentally, & physically exhausted I am. Help me to be patient even when I'm tired and frustrated. God, open my eyes to others need and not just to focus on the busy work. Help me & all of us to reach people in the truth.