a pebble tale

April 29th 2am... night shift

Life has become a bit routine the last couple weeks.  Work sandwiched between the rhythm of meals and sleeping.  Days off usually end up with a walk to town to a market or to visit my friend Flora and her family.  Last Saturday was a beautiful day at the beach.  Sunday, Easter, we had a scrumptious brunch with baked goods, quiche, and fruit.  The crew all put on their finest attire, fun to see all dressed in our best :)

Yesterday, not only did we celebrate Katrine's birthday, but we joined the entire country of Sierra Leone in celebrating their 50th year of independence.  Royal blue, kelly green, and white have literally been painted in the most unique places over the course of the last few weeks in preparation for yesterday's festivities... America's red, white, and blue on the fourth of July pales in comparison to the expression of pride in the land here.  Our local day volunteers that work about the ship,...many as translators came up with unique attire resembling their flag as well.  I was on the ship, but the streets were apparently full and booming with energy.

April 29th 3pm...

I was updating my blog last night on night shift... ironically and obviously commenting on the steady routine of life as of late.  I had one ICU patient, a two year old that had swallowed and aspirated a small stone eight days ago.  A local ENT surgeon and our team of doctors had spent five hours in unsuccessful attempts to remove the stone.  They left her intubated because of the risk of swelling and constricted airway after so many hours of tampering in her lower throat and lungs.

From 315am till about 430am I went through one of the most terrifying, miraculous, surreal moments in my life.  My little patient that had been quiet, sedated and resting soundly for hours.  She suddenly became restless, which happens on occasion with any patient, often with a quick resolve, but she continued to squirm and fight.  There was one other nurse nearby who came to help but as she wiggled her intubation tube became loose and I needed help, but help from another ICU nurse or someone who knew how to secure an intubation tube and give boluses of medication to sedate and how to respond to the situation.  Literally, the moment I was saying "help" internally, I looked up to see one of the three pediatric ICU nurses that work on the ship standing in the doorway in her pajamas.  Over the next 15 minutes we ended up coding this two year old.  She had coughed a plug into her intubation tube so no oxygen could pass through hence her restlessness.  We pulled her tube and used a mask to ventilate her, performed chest compressions as her heart rate subsequently dropped with her oxygenation status.  The on call anesthesiologist, also happening to be pediatric trained (also a rarity), responded to her emergent page within minutes.  I know in my heart I would not have been able to respond appropriately on my own... mainly out of inexperience with pediatrics.  

Corina, the pediatric ICU nurse and also a dear friend, had woken in the middle of the night restless and thinking about the ICU patient she had heard ended up in our unit last night.  She had gone to the dining room, drank a cup of tea and tried to watch some BBC news but her insides felt restless and she decided to "poke her head in" and see how I was doing.

I managed a few hours of sleep today.  Preparing to head to camp out for the weekend.  Feeling exceptionally thankful for a miracle last night.

a chance happening

I was just walking down the stairs to my room, the stairs are shared with the hospital traffic... as I was descending the little boy I have told you about and his mom, with baby brother in popo on her back, were coming up.  He was dressed in his normal clothes versus the familiar hospital gown.  He is headed home.  I had no idea they were leaving today and it was mere coincidence to run into them, but I got to say goodbye.  He started talking and laughing a bit the last two days I have heard, but when I am around he gets quiet and serious, so I still have not heard him talk.  I hugged him and squeezed him anyway... he will be forever on my heart and I will always wonder about the life he has before him.

Had the day off yesterday.  Relaxed on the ship most of the day.  I did walk to the market and visit my friend Flora and her family.  Katrine went with me and she showed us her few treasured photographs.  Last evening my friend Corina... a fellow nurse from the Netherlands... Katrine and I walked to "The Hope Center".  This is a building not far from the ship where the Dental Clinic is held and also a space where patients that travel from far away can stay before or after surgery.  There are quite a few of our patients there right now that don't need daily hospital/nursing care, but come to the ship for a dressing change every day or every few days or are waiting for a follow up appointment of some sort, so they have a safe and close space to be home in the interim time.  It was fun to sing and play with some of the children, many of them are getting fat!  They are not used to the nutrition and faithful heavy meals they get here so one little girl and her brother who have been at the ship for almost two months now look quite different than their arrival!

I work evening shift all week.  Katrine's husband Ruben arrived on Sunday.  He is in the Danish army so is on leave for a couple of weeks and is a general steward on the ship.  It's nice to finally meet him and he is definitely as kind and sweet as his dear wife has painted him out to be!  :)

Photos

Thought I would give you the link to my friend Tom's blog.  He is a photographer on the ship and has many pictures of patients that I am unable to take myself and he also has the capability to upload pictures, so enjoy.  http://tombradley.wordpress.com/

I have been off all week following my stint of nights.  I stop in every day to visit my 5 year old patient from the weekend.  I don't know that I ever mentioned what he had done.  His lower jaw was significantly smaller than his upper jaw, giving him almost the look of a turtle.  It's called Pierre Robin Syndrome, or so they thought... when the surgeon actually went in and did the surgery they are actually wondering if it was trauma from a forcep delivery.  Traditionally with Pierre Robin the patient's tongue is also smaller than normal, but his tongue was normal sized which is what actually caused him significant problems.  We think for the last five years when he would fall asleep his tongue would obscure his airway so he has lived with lack of oxygen for years.  Almost like sleep apnea in overweight adults.

Anyway, he is quiet and shy and scared, yesterday he said he wanted to go home, but he doesn't speak much at all.  His mom is overjoyed and grateful for the help her son has received.

Update

Thought I would update you all on the little boy...

Yesterday, Sunday, he had a bit of a rough day.  They did a scope to look at his airway and decide if they could safely extubate him.  While sedated they were able to obtain some bloodwork they had been unable to get thus far and his blood count was low so he received a unit of blood.  Following all this his blood pressure and heart rate decided to keep everyone on their toes by hovering very low, maybe from such an eventful day, but who knows exactly why and his urine output had also tapered down to a concerning low rate. 

When I went to work at 7pm there was a lot of commotion around him making me a bit nervous to be his careprovider overnight.  All the doctors and supervisors left me their pager numbers and then were off and it was me and him.  I am HAPPY to say that he had a great night... very few issues, a couple restless periods, but all went well. 

I left at 7am and went to bed... the plan for the day was to take him to the OR, extubate him, and if he was unable to breath on his own to place a tracheotomy.  I got up around 330pm and headed to the ward with anticipation to see what transpired in my sleep.  He was awake, sitting up in bed, mom snuggled next to him... breathing fine on his own... even on room air!  No feeding tube to his nose, no IV fluids, just a little monitor for his oxygen status which was 99%... Yay!  His mom got up to attend to his fussy little brother across the room so I got to take her snuggle spot for a few minutes too :)

night shift again

We are in an emergency state on the ship.  We have lost our water supply and have very limited reserves of water.  The ship captain came across loudspeakers throughout the whole ship notifying us that there is a hold on all showers till further notice!  There are some people feeling very challenged right now!  The last few days we have known about the water situation and have been strongly encouraged to conserve in whatever ways possible.  (I think I mentioned this is the last note, so I won't repeat myself with all the details.)  I haven't showered since Wednesday myself, but I am not overly bothered.  The long curly hair is pretty forgiving and we all smell, so I don't stand out so much :)

I slept most of the day.  Got up for dinner and had an hour or so before heading back to work at 7pm.  Marianne, Katrine, and I went to the top of the ship.  The sunset was amazing... perfect circle sun that you can stare into... bright reddish orange, it's shades reflecting off the ocean water.  I think I've also already mentioned how polluted the water is around the ship where we are docked.  As we looked out the waterflow tonight was such that TONS of trash had gathered in a large moving clump right along the ship.  Most of it is plastic and one cannot think of how the western world has affected and infiltrated the rest of civilization with our "grand ideas"!  Plastic... ugh.  Staring at this I was so angry, but in some strange way the messiness was beautiful.  It was colorful... like an exhibit at the MoMA almost.  Starkly standing out was a red plastic bag, white lettering across stating "Feel Free"... The irony.

Admist the trash there was something not at all beautiful though... really one of the most appalling things I may have ever seen.  (Kerry Cebul I hope you read this and I would give A LOT of money to tell you the story and receive your reaction in person!)  There was floating about six feet behind this whirlwind of trash, in supine position, a large, bloated rat... I honestly did not know rats actually grew this size.  (Think The Princess Bride... ROUS's)  All four feet sticking up in the air... I actually was convinced it was a pig for a short period of time before I could see the tail.  We were then informed that these nocturnal animals are hunted by locals and provide a source of protein.  I did not get a picture, though wish I did... hopefully you all are painting an entertaining scene in your own imaginations.

I am working in the ICU.  Tonight I have three patients.  One is a fellow crew member, she is not needing ICU care, but all sick crew members come to a private room in the ICU.  One patient just needs a little extra care... we call them high dependency patients, but she is sleeping soundly and has had a good night.  Then there is my little guy... five years old, only 11 kg (24.2 lbs), intubated nasally because of swelling to his face following his surgery that could close his entire airway.  I have no pediatric nursing experience, but I am here learning and learning a lot.  It is good. 

A coworker just went to see if the baker's morning goods are coming out of the oven... one perk of night shift.  :)  Best go...

Wednesday... Hump Day :)

Snuggled on one of my "cabin mates" beds, she is packing to leave after one month of volunteering as a dental hygienist at the dental clinic.  Dusti... she is returning to Charlotte, NC, but her husbands family is from Saratoga Springs so she will be by Syracuse and the farm for a visit in the near future... :)

So the girls and I went to Sussex beach over the weekend and spent two nights at an African resort called Franco's... Italian born Franco and his wife Florence, presumably African, have created a little space often frequented by tourists that is definitely luxury for Africa, but would rate a one star hotel by our picky American standards.  It worked perfectly for us... we aren't picky!  The time away was relaxing, but it was also nice to be outside of the city and see Sierra Leone life more rural.  And of course, any venture off the ship inadvertently creates some sort of story... so two come to mind:

1.  We hired a taxi to take us from the ship about an hour and a half, with traffic, drive to the beach.  Let me explain a "taxi" though... about 80% of those that actually own a car also in turn have a taxi... it's not like there are taxi companies or businesses, people just give rides to make money.  These "taxis" range in vehicle quality from not so nice to really not so nice (scary).  Our taxi was definitely on the really not so nice end of the spectrum.  Our driver and his sidekick in the passenger seat added to the already complicated task of getting around as neither of them spoke a lick of English.  Our driver was Krio speaking only and his friend French and Krio, asking us about 15 times if we spoke French, each time we kindly answered "no".  To make a long, adventurous story short... the first alarming moment came when we stopped to get gas and it took about ten attempts turning the key to start the car.  Just as the words "do you think we should get a different taxi?", came out of my mouth, the car was moving toward our destination again and it was too late.  Though the driver quoted us a price, and pretty fair, he didn't actually know where he was taking us.  About a half hour into the trip he started pulling over asking pedestrians if he should keep going to get to Franco's at Sussex.  The farther we got from the city, the narrower and dustier the red earthen roads became.  As we headed down a slight hill toward a bridge I could see a very large construction truck heading down the adjacent hill toward us.  The bridge was a definite one laner, so I started "uh, uh, uh-ing", motioning for us to pull over while pointing vigorously at the oncoming truck, but this did not matter, we carried on.  Sweat began pouring from not only the brows of us three girls in the back, but also from our local passenger seat friend!  I am confident that 99.9% of the driving population in the world would deem that there is no way our taxi could fit past the construction truck.  I kept thinking that we would stop and back up or the truck would start backing up and I think the driver of the truck was thinking so as well... I could see him moving towards the shifter to move into reverse gear, but there was no time to make a move, we just kept moving forward.  Holding my breath I sat with awe as we passed by the right side of the truck, the driver side side-mirror was sacrificed and the side of the car scraped... Marianne staring out the window bug eyed as she was sitting on that side of the car, but we somehow astonishingly made it.  We all sighed and then started laughing till we were crying and our toothless driver turned around with the biggest smile I will never forget.  About five minutes down the road we heard a loud "pop, putt, putt, putt........" Out of the car hopped our two friends, "kick, kick, clang..." and into the trunk went the muffler!  Onward forward... and yes, about fifteen minutes later we miraculously made it to Franco's.  Our friends really wanted to come back to get us and give us a ride home on Monday, we took their numbers and found another taxi to take home.

2.  It was so nice to be out of the city.  We took a couple long walks on the beach, but once the tide came in in the evening the beach was inaccessible so we walked into the local village.  I could hear birds and didn't have people bumping into every side of me.  We met a few local kids who led us around and we saw a few more views from the coastline that were stunning.  As we were walking along, just like in the city, kids would come running out to say hello and they always want to touch us.  It's sweet.  So a little girl, probably 7 or so, is smiling and saying the usual hellos... behind her is her mother holding her sister around 3.  The three year old catches a glimpse of us three white people, gets the most terrified look on her face and starts bawling.  She was frightened... I'm sure we look like crazy aliens to someone who has only seen black skin before.  The best part of the story though is the seven year olds response, she starts laughing hysterically and literally jumping up and down in place... humored to the bone by her wailing sibling.  The whole scene was so cute and fun... :)  It made my day. 

Life on the ship has been uneventful, but nice... the rhythm of meal times orders the days... we have been having difficulty getting a constant and reliable source of water to the ship and we use 92 tons of water a day, so we are in conservation mode... the laundry room is shut down, we are using disposable cutlery, plates, and cups and showers are only to be taken if absolutely necessary... when they are taken there are to be "ship showers"... two minutes long max... wet yourself turn off the water, soap up, turn the water back on to rinse.  :)  We all smell great!

Week over

I worked in the hospital most of the week.  The ward is getting busier and busier :)  Some patients stay for a few days, others a week or two depending on their procedure.  Yesterday I had my first ICU patient, though really more of a "step down" patient at home, but it was the most familiar nursing I have done since I have been here and that was very nice.  This was a young lady, we don't really know her age, but probably around 20 years old... she basically had no jaw bone resulting in TMJ, so she has been unable to open her mouth much past 3/4 inch most of her life.  Her weight is 35kg, 77lbs.  She had a reconstructed jaw with grafting from her ribs.  I took over and she was on a morphine drip, but otherwise very stable just needed some help figuring out how to swallow to get her off IV fluids and IV pain meds to oral.  She is from Guinea and only speaks a village language so we were doing three way interpretation as another girl from her village spoke their dialect and French and there is a French and English speaking man also on the unit.  By the end of my shift she was moving over to the regular ward, drinking fluid through a small 10mL syringe to the back of her throat. 

I am off over the weekend and work most of next week.  Last night a friend that works on the ship had his birthday.  He is from Ghana and quite a few of us went to a local bar and danced and danced and danced.  Two of my cabin mates, Dusti and Katie (both who sadly leave this week!), went along and they all had fun teaching us white girls how to African dance.  I believe we surprised them with our amazing moves, breaking their conception that white girls can't dance ;)

Between work shifts I have made it off ship a few times this week... I often follow a similar route through town to an open food market.  I have made friends with a girl named Flora and her family and like to go say hello and visit her.  I usually bring someone along with me and as we make our way gather a following of children, all wanting to hold our hands or give us five... huge smiles and "what your name...?" repeatedly asked.  I have pictures of the market.  It's beautiful and filthy... I stepped over a dead rat last week, but there are rows of dried chilis and dried beans, fresh kasava leaf (their green staple crop... tastes like rich grass), large bowls and bags of various rice and grain, fish with flies swarming all around, chicken feet and pig fat, palm oil for cooking... each seller of fine goods soliciting patrons to make a days end.  On the way home I look for my 90 year old friend... I don't remember his name but he sits on a bench in front of his home, his children and grandchildren and great grandchildren, of which he can not put a number to, live on the street in his home or neighboring homes.  The average life expectancy of a male in Sierra Leone is 35... this friend is a rarity... oh the stories he must have of his land, his city, his street and all that has changed over the years.