Monday, April 26, 2010

A Real Tropical Vacation

I remember last year I wrote an entire entry about sending the newborn nursery babies on a tropical vaca to treat jaundice. Well, this spring break I really did go on that tropical vacation. Me and 45 other well intentioned medical personnel traveled to the Dominican Republic to help deliver medical care to poor and improvised communities.
Looking back, I'm not sure what exactly I expected. I didn't think we would be staying in a five star hotel. I was prepared to sleep on the ground. I figured I would eat bugs and gather firewood before milking our one goat. Like, whateves, it would all be in good fun and I could probably survive my spring break living like a Seattle runaway. But I hadn't thought that I wouldn't have basic medical equipment. I thought that, I don't know, the hospital would have WALLS.
We packed bags and bags of medical supplies with us into large canvas sacks and each of us was responsible for one. They weighed between 25 and 50 lbs, and every person in a 45 strong group heaved one to the Dominican on our backs. So we had a pretty intense supply of medications to prescribe and distribute at the little shack towns we visited every day. We also brought bags of surgical equipment and a few surgeons. We planned one doing GYN surgery on women with tumors and other issues that couldn't get help otherwise. The local hospital we worked with was letting us use their Operating Room. I thought we had packed enough. We were good.
It's comical how wrong I was. Alarm bells should have started to ring the first day we were there and I was approached to join the surgical team. Surprised, I said of course I would help them out, but I really had super limited experience as an OR nurse. No one cared. It was me or nothing.
Uh-oh. Could a nurse familiar with the OR work with them from the hospital?
No. It was already an issue getting an anesthesiologist. So okay.
The next morning, I dressed in my most fashionable scrubs and joined My New Surgeon Friend Laura. We rode to the hospital in the normal Dominican way, which means we were loaded into the back of a pick up truck.
When we got to the hospital we got a nice tour. It was sunny, shiny, and new.It was full of activity. It was missing a few walls and doors. A bird flew in. The nurses wore mint green polyester outfits with tiny white hats. I'm not sure why they were employed, because I basically never saw one. In the OR there were fly swatters.
We met our on-loan anesthesiologist. We said Hi and he waved back, with his one arm. Because the other arm was broken. We had a one armed anesthesiologist. During our tour, we learned that if any patient developed blood pressure higher than 210/150 to call Sue. Who Sue is or how to call her was not explained.
My New Surgeon Friend Laura reacted with amazing composure. She simply said "We are here to help. Let do the best we can with that we got." That became my motto.
I was asked to pre and post op care. We had met up with a team from Yale who were super excited to do some random surgeries with us, and they had an experienced scrub nurse. So I did vitals, medicated my patients, and put in IVs. These tasks were harder than expected for a few reasons including:
1. I had given New Medical Student Friend Caitlin my bag o trix. When I left good old america, i had packed an amazing kit with my otoscope, bp cuff, thermometer, bandages, cartoon stickers, and other VITAL things. Figuring these would all be at the hospital, I sent it to the shanty-town. It quickly became apparently all the bag o trix materials I so casually discarded were not readily available in my new situation. I was able to haggle a thermometer from a very frosty medical person whose position i never figured out (nurse? med assistant? DIRECTOR OF THE HOSPITAL?!). I was handed a mercury thermometer and a baby food jar filled with rubbing alcohol for cleaning between uses.
2. If you've never attempted IV insertion in a developing country, you should read up about it before you go. Imagine my surprise/desperation/panic when I realized that no, we hadn't packed IV insertion kits in the massive pile of other shit we brought. I once again had to haggle them from Snow Queen Hospital Lady. And they had no flushes or extension sets. I was given another baby food jar to disinfect the skin.
3. EVERYONE BLEW Their LINES. Constantly. I was having a meltdown. Giving meds is impossible when there is no access port and literally no access in the line. The Snow Queen came to help me. Her method was to literally slap the patient. I mean she slapped them left and right on both arms. I was shocked, an emotion I had basically experienced all day. She explained that slapping releases histamine and makes the vessels swell. I nodded like ooooh of course.

The day progressed with more mishaps that I;ve ever made. It was a constant comedy of awful. I quickly became known as the wasteful American because I required two sheets per bed. And the sheets were too small, so I would tuck in three corners, pull on the fourth, then another would pop out, OVER AND OVER. My translator was a great lady, but an awful translator because she would often forget I couldn't speak cereole and just stop translating for me. I'm not sure the nature of her position because I also saw her changing the drip rates on my IV lines. In American NO ONE TOUCHES MY LINES.

(Here is my JD-style internal monologue)
After, when I considered the day in the Dominican I realized why I found it so hard to adapt to this free style medical care. i mean, yes it was utterly ridiculous. But I seemed to have a more difficult time just going with the flow that everyone else. I realized it's because as a new nurse and a new student and a new EVERYTHING the one area I find comfort in is in absolutes. I relish control and knowledge and doing everything by the book. In the Dominican, I was cut off from my top of the line supplies, my piles of books, AND MY IPHONE FOR GOD'S SAKE. I had to rely on only my best efforts, and that's always scary.

Obviously I didn't bake anything there. I couldn't even drink the water.

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