5.31.2011

The Pistol, The Ninja, The Saint and The Jailbait

Sometimes a patient goes into surgery screaming bloody murder, they know something fishy is up and they are not into it. They come out screaming just as loud except now we’ve really done it. They’re in pain and the last thing they recall is a bunch of strangers holding them down on a gurney in a weird room. We were probably speaking in tongues to them too. They are what we might call “A pistol.” This child is angry, doesn’t like you and is going to let you know. A 1 hour temper tantrum is headed right down that hall and into the quiet little PACU. Usually this patient has had a palate repair. Tongue stitch: Check. IV that needs to stay in over night: Check. Sensitive palate stitching: Check. Sneaky hands of an angry child: check. I usually rotate wrestling this child with the intesivist and other PACU nurse. This is why I have become incredibly buff. This is also why I have hearing loss. The poor child is so upset that I have actually seen a melt-down recur at the drop of a rupee.

Then there’s the patient who you’re terrified of pre-operatively but in love with post-operatively. These are the kids in which anesthesia flips off the crazy switch. I might refer to this patient as “A Ninja.” I see them through the PACU doors being carried back to the OT actively punching the nurse in the face whilst screaming AND simultaneously rotating their head 360 degrees all Exorcist style. For 1 1/2- 2 hours I pace the PACU in anticipation of their arrival. When I see the door to the OT slide open, I break out in a sweat. They get carried down the hall, placed in a recovery gurney and I suddenly notice that their head seems to have made it back into anatomical position quite nicely then realize I’m not being physically assaulted! They wake up a while later, those little eyes flutter open, land on you and finally, you exhale a huge sigh of relief. I scoop them up in my arms and soak in this priceless time between us. It manages to be so much sweeter when you anticipated a devil child and received an angel.  They have, in other words, ninja-d their way into your heart.

A kid who doesn’t even know they’ve had surgery is always mind blowing. This is the one that holds hands with the nurse as they walk back and I know it is going to be smooth sailing. You may hear me call this patient “The Saint.” I see those OT doors open up and my heart skips a beat. Usually these ones sleep off the anesthesia for quite sometime because they’re clearly taking the best nap of their life. Out of nowhere they pop up in their gurney. Bright eyed and bushy tailed. They don’t care about their IV, or their stitched up lip; they’re way more interested in checking out all the other screaming children. I can see them thinking “Chill out dude, you’re totally throwing your chakras out of line.” Then they eye the panee, the water. But wait, is that Tang?! Frutee? I bring them over a cup and feed them with the syringe and they gulp it down. Some even take charge of the syringe and I’m like “Wait, did you just have surgery or is this one of those Halloween make-up ‘look at me I’m all stitched up but not really’ kind of jokes?” They don’t care that their nose is oozing or that there’s a 3.0 silk suture through their tongue, they just want to blow some dang bubbles and take a wheelchair ride. They are all calm all the time.

Lastly, there are the patients (usually in the 18 months-3 year range) who give you a run for your money initially. They come in wailing, maybe kicking you in the yoni, maybe screaming blood directly onto your shirt. Before you know it you’re looking through your backpack to see what you can ditch in order to make room for the 11 kilo baby your about to try to take home. You’re looking out the windows seeing which way is the safest path to the ground so you don’t have to pass their parents in the hall on your way home with your newly abducted adopted child. I refer to this bunch as “Jailbait.” Okay, okay so I won’t be taking home any children without direct permission but seriously I can’t hold/cuddle/love on these kids enough. You know that feeling deep in your chest when you’re holding a child and they nuzzle deeper into you? Your hearts melt together in that moment. Tonight one of these kids coughed, gagged and then threw up a few ounces of bloody vomit onto my shirt and leg. We kept right on cuddling. And that, my friends, is how you know you love what you’re doing.

5.30.2011

Memory Monday v5.0



There are some things from childhood that your family just will never let you live down. I, in particular, have many of these instances. One of my favorite 'blackmail material' stories is partially shared with my older sister.

My grandparents came out to visit one summer when I was about 8 and my older sister 11. It was a southern California summer: hot, dry and worthy of a plastic pool. Do you remember those? We had the kind that was vinyl (and smelled oh so good fresh from the box,) the sides only stood up when filled with water and it was perfect for a most shallow dip. As grandma and grandpa visited with my parents and spent time with my little sister, who was an infant, Erin and I decided to go for a swim in the pool. Excitedly we set up our barbie tent right at the edge of the little pool and let our imaginations run wild. We were kids that played outside until dark and we had such good times living in our imaginations together growing up. In this particular instance the tent was our home and the pool our bath tub.

Let me break here to help you visualize our back yard situation at the time. We lived in a typical southern California home tract. The houses were close together and each neighbor had a two story home, putting the yard on display for anyone that cared to peer in. Our back fence was wrought iron, we had a large sliding glass door in addition to a large kitchen window that faced the yard. Essentially, anything that took place in that yard could be observed by a variety of folks. Go ahead, close your eyes and set the scene.

So, there we are two fairly old children playing house in our tent and little pool. Erin and I bathed together often, as many siblings do so the idea that came next didn't seem our of the ordinary. Seeing as that the pool was our 'bath tub' it didn't make much sense to 'bathe' with suits on, right? I clearly remember Erin stating to me "It's just like a real bath, but outside!" I actually felt that mom would be grateful for us getting ourselves 'clean' so that she wouldn't have to draw us a bath that night. So, at the convincing of my older and wiser sister, I stripped down and went for a skinny dip in the pool. Who really knows how long we were stark naked, but boy did I think it was the best feeling ever. Backyard bathing, no one could be too old! Next thing I know, I see my little grandma and grandpa at the sliding glass door, jaws about on the ground. Not only did we rarely see our grandparents but they were also rather conservative so I guess we, at 8 and 11, were a bit too old to be putting ourselves on display in front of them. My grandfather was especially embarrassed to have seen us in our most natural state. Sheepishly we threw on towels and my mom ushered us inside, wondering out loud what possessed us to swim naked in the backyard. Imaginary play was all we had to offer her. I don't think was a sufficient answer as whenever this story is brought up, it is never paired with a thank you for taking the burden of bathing us off of our mother. 

5.29.2011

Days off








I was directed to a four story bazaar and got a few little items for day to day stuff for the flat (plus some Nutella!) I tried to walk all the way there by gave in and hopped in a tuk tuk half way because it was wayyyy farther than I thought! I spent the afternoon napping and reading one of my books of Gandhi's writings. The highlight of the evening was sitting on the porch and hearing my Australian roommate tell the story of her rescued Wallaby that she raised when she was 10. How Australian is that?! I'm back cuddled up in bed ad reading some more before sleeping!! 

5.26.2011

Wrapping up the May mission

Heading into the last of seven surgical days for the May mission at the Guwahati Cleft Care Center better known as GC4. We'll have performed a total of 175 surgeries by the end of today!! This mission went so smoothly and safely. We couldn't have planned for a better inaugural mission in our new center! We ran 6 tables simultaneously and utilized my pretty little recovery room to its max! Everything has held up very well and there are A LOT of happy patients and families. Tomorrow the international team will leave and we'll go back to our day to day work. Many fellow nurses have asked me if I can believe that the mission is already over and all I can think is, I live the mission baby! Seriously, I am can't believe I am staying here and continuing this work. I have some goals for education with the local staff and also for stepping up the discharge education for our daily kids. Seeing how organized and consistent the discharge teaching has been this week, I definitely feel that I personally could do a better job off the mission. I am hoping to get going with a standardized discharge teaching every morning, something I have seen lacking since I have been here. Discharge teaching is pertinent to the reduction of post-surgical complications and it is our job as the nurse to empower the patients and families to do their part. End rant.

Anyhow, we received our team t-shirts today! A lovely purple! GC4!!!


5.24.2011

Something like 3 weeks in

I have been living here for a mere 3 weeks now and it has been a whirlwind. I dove right in after arriving. I worked 2 days, worked one night, opened the cleft care center on the Monday after I arrived, we worked out of the center that week, flew to Sri Lanka that Friday, came home one week ago, went straight to a meeting, started screening for mission week last Wednesday, mission team arrived Thursday, started surgeries Friday, worked the mission until yesterday, have today off and then 2.5 more days of mission surgeries.

Barely enough time to breath, right? I think I am adjusting fairly well but I am still trying to find my place here and get my two feet on the ground. I came to Guwahati's Comprehensive Cleft Care Center (also known as GC4) knowing I was walking into a challenge. The core team here has been together for months.  Living and working together, getting this center off the ground and running together. I was entering into a very tightly knit group, praying that there was room for me beyond just being a bedside nurse. The whole team welcomed me with open arms and has really made me feel at home. I am beyond thankful for that. Still though, I am struggling with finding my true purpose and role. I didn't put in the time and effort to open this center, and that is unintentionally made very apparent to me. So, I feel a little out of place and out of step with the team members that have been here for months working hard to make this happen. I am so invested in this center and its mission and am looking forward to being an invaluable member of this team. Watching the center open was a huge deal to me. I am here, I am ready to make this place sustainable. I want to educated and train these nurses and show them what it means to be a leader, a patient advocate and a nurse with global standards . I am ready.

Indian Living (on the lychee express)

A question I've gotten many times over this week is if it is hard to live here. My answer is no, it is not hard but it is different. I've been asked where I go shopping for groceries and I love what I get to describe. There are no grocery stores. There are little walk-up shops that sell some items like soap, toothpaste, sugar, eggs, butter, milk.



 Otherwise, we go to different out door markets for 'grocery' items. This morning I went to the fruit market and bought the most delicious fruit for breakfast.




Apparently the fruit market also is the lock market

Breakfast went a little something like this:






Fresh fruits and veggies all the time. So good!!!

5.22.2011

What would it feel like?

What would it feel like to see yourself for the first time after having your severe cleft lip repaired? Do you feel excited? How would you even recognize yourself? Do these children and adults have an identity crisis or is their self-confidence boosted immediately? Do they cry tears of joy or tears of loss of self? I personally have never experienced such a physical change in my life and I have to imagine that no amount of preparation can prepare you for the experience of looking in a mirror for the first time. How strange it must feel to open in close your mouth and have your lips close completely against one another. Do you feel a sense of relief? Is it overwhelming? Is it everything you had hoped for? Did we hold our promise to you? Is your smile all fixed?

Today Lokhi's severe bilateral cleft lip was repaired. He is fifteen years old and tears streamed down his face as he looked in the mirror for the first time. I cried right along with him as I held his hand and those questions raced through my mind. I asked him if he was paining to which he said no. I told him he was beautiful to which he nodded and it is true. Inside and out. He is a beautiful child whom I am so blessed to care for.





I worked for 16 hours today. Holding the hand of one patient, seeing the thankfulness in their eyes makes every last minute worth it. From the 10 year old who gave me the thumbs up as he was wheeled in to the OR for the second time to control the bleeding to Lokhi and his dad who couldn't stop thanking the team; I am made full and of course, here come the tears again.


5.19.2011

Sri Lanka Baby!

*I finally got to upload pictures!!!*

This past weekend I had the opportunity to fly to Sri Lanka so I took it! I know I just got here to India but I realized quite early that we work long hours most days of the week and to take time away when time away is presented to you. I actually bought  ticket then cancelled it then bought it again, that's how guilty I felt about going initially. I am glad I got over it because the weekend was amazing! I travelled with my flatmates Susie and Rosie, slightly in celebration of Rosie's birthday.

We flew into Colombo on a red eye flight and landed around 5am then went directly into a 3-4 hour drive to Ceylon. We had arranged a driver with the guest house we were staying at and he was so sweet. Not only did he wait hours for us as we missed one of our connections and landed late but he also invited us for breakfast. We arrived to his home and his wife had made a most delicious traditional Sri Lankan breakfast. It involved Indi Appas with what looked/tasted like dal and a coconut topping. It was SO good that I had seconds and even thirds. After we ate we arrived in Unawatuna and to our guest house. Immediately we threw on our bathing suits and headed to the beach which was about 50 yards away. I spent the whole day in the water or laying on the beach. For dinner we ate at a little place called Shekira, we had tuna and watched the boats sway in the harbor. It was slightly unreal in its beauty!









The next day I had banana pancakes (pancakes here are more like crepes, rolled up over a fresh banana), fresh fruit and Sri Lankan tea. Rosie and I then rented a scooter and drove around a bit then laid on the beach some more. I started a sun burn the previous day so I became very vigilant of putting on sun screen and decided to spend more time in the shade. We ate french fries, ice cream, iced coffee, grilled calamari, and sea food pasta throughout the day. I was in food heaven the whole weekend!! The three of us loaded on the scootie, shopped around Galle, and hiked down to Jungle Beach. We spent the evening in a bar that hung right over the ocean. Right as we were about to leave a group of six men walked up and insisted on buying us beers. As I don't often hang out at bars and I was feeling gross from my sun burn, I only hung around for a bit and I'm glad I stayed for a little. As turns out, these men are all employed by anti-pirate companies. They protect ships from pirates as the sail from Sri Lanka to Africa. What?!?! Pirate hunters? It was real though. I guess Sri Lanka is the best safe point so men that are too old for South African and British army are flown to Galle and then shipped out. So crazy!!









The last day it became really obvious that not only did I have the only bad sun burn I've ever had in my life but I had some slight facial swelling. I took it very easy and applied sun screen every 2 hours as well as really stayed in the shade again. I ate some more yummy breakfast, a grilled sandwich for lunch and yet more seafood pasta for dinner. I talked the night away with another British guy who was on his holiday. It started raining just before the three of us had to head back to Colombo airport. The driver picked us up at 2am and 3 hours later we were ready to leave. I got out of the van and Rosie suggested that I go look in a mirror. In her own words: "Kristin you know your face best. You should go look at it because it doesn't look right." She couldn't have been more right. The right side of my face was completely swollen. I didn't look like myself at all, I'm surprised the even believed my passport was mine. My nose and eye were the worst. I tried icing it and taking benadryl but nothing worked. We flew back home to Guwahati and went straight to a work meeting. Everyone made me painfully aware that I looked terrifying. I think a few people actually fled the room ;)



I think I am looking better as of this evening but I've also started myself on a course of Prednisone because I think this an allergic reaction to something. Yes, here in India you can just walk to the pharmacy and buy whatever drugs you please. So a short course of steroids it is.

Anyways, it is back to reality and the reality is that it is mission week! Today we screened patients. Then Friday starts seven surgery days! Ack!


5.10.2011

Picture of the day

After throwing a tantrum for 90 minutes, exhaustion hit him like a train on a track.



My apologies to the handful of you that follow both of my blogs. I am going to try and stick to day to day life here and medical/humanitarian stuff on my other blog but some stuff is just too good to not share with everyone. 

By the way! I am going to take my first weekend trip on Friday to Colombo, Sri Lanka! I am so excited! 

5.08.2011

Home life

Here is a little photo tour of where I live. I think the view from outside my porch is the perfect example of the way India is so beautiful and so heart breaking all in one view.









I love the lush green hills that I can see while eating my meals but just below me is shanty homes and mounds of garbage. This is something I've already become accustomed to seeing and the garbage doesn't bother me at all. You just can't get only an eyeful of beauty here. You take the good with the bad.

With that being said here are a few photos of my flat and the street I live on. There are a few little shops and restaurants right near and the fresh fruit/veggie market is just a short ride away.



My flat

The little market on the right is where I get milk, sugar and other little things


I've fallen in love with taking bucket showers. I have a shower head (as you can see) but it gushes out all of the warm water in under a minute. One of my roomies advised me to try the bucket method and I am in love. I can just savor my 'shower' time and the water in the bucket stays warm for quite a while. So, I love squatty potties and bucket baths. I think I'm going to survive.






My first few days

I've had my first few shifts at the cleft center and am already looking forward to what next week will bring. We are averaging 4 cases per day right now with our 2 plastic surgeons. Usually for half of the day one does surgery while the other does the follow up appointments from the previous week.

I am settling into my role and just trying to learn the ropes as of now. I will definitely be on more of a leader/nurse educator/supervisory role along with another nurse Susie. We head up the pre/post and recovery nurse staff. Susie has been here for months so she carries a huge weight of this responsibility right now but hopefully soon I will be able to really share the load with her.

We are not yet operating out of our center but we are projecting our first patient to operated on Monday there. Because of this, we prep patients for surgery, recover them and have he post op beds all in one space. It gets chaotic but I think a lot of that chaos will be settled once the center is open and we can have the recovery room on it's own as it should be.



Smushy pre/post/recovery area


Such a cutie


I've gotten to interact this week with a little 8 year old who is a World Care patient. He was born with a severe facial cleft and has had multiple operations in attempt to reconstruct his face (in the video below he has already had some repairs). He was actually flown to Virginia to be operated on by the head of Operation Smile and has since come back to India where we are further treating him. He is fighting a pretty bad infection and it looks like he may be rejecting the graft that made up his nose. He had a surgery to remove some infected parts and wash out the area two days ago. Here is a little video about him:



I don't think I can effectively convey how much this boy settles into your heart and shows us as the team why we do these surgeries. Just as it is described in the video, Nur has blossomed into such an amazing kid. He jokes around, plays, shares his food (today I was charting when a chocolate bar landed on top of my chart, he wanted me to have it). I have been praying hard for Nur and the team asking that we do the best by him and his family. I just hope that he doesn't get broken down by all of the surgeries and painful procedures. It must be so confusing to him, we are his friends but we hurt him and make him take medicine and clean his wounds. Luckily, he is forgiving and even though at midnight he was spitting his medicine at me he ended the morning playing games and drawing pictures with me. He he is so amazing.







(all photos taken by Nur)

Side note: He always draws the most detailed noses, it's so sad :( AND that's a picture of me... with a baby in my belly... not so accurate but hey! 

This week will be long but I can't wait to see what it brings!