Our individual assignment sheets always have our names printed at the top and usually have some funny comment or little quote. Mine today said, "I can do all this through Him who gives me strength" (Philippians 4:13). I thought it's a fitting verse given my lack of reserves! With the exception of mornings after working a nightshift, I enjoy report here. It's often filled with humor, nearly always with encouragement, and unflagging supplication for God to fix the things I've been too doubtful to ask for. The nursing side of us knows the pathophysiologies by heart- each person is unique but bodies break down in largely common (and often predictable) ways. Sometimes the logical conclusions, borne out by experience, paint a bleak picture, and yet three times a day we ask. We huddle using whatever chairs are handy, the wheely office chair next to the tall, rigid-backed bar stool next to the little wooden toddler chair. Like some strange circular bar graph, we sit at our various heights asking for a cancer to be healed, full function to be restored, and life to be not only spared but made vibrant again.
Then after the earnest prayers, patient handoff begins. Ratty sheets full of medicine calculations, to do lists, and pertinent patient information serve as our "brains" to make sure critical information is passed on. In the afternoons and evenings, it's like calling break after a sports huddle- we fragment off to give patients to their respective oncoming nurses. In the mornings, report is given in front of everyone (I suppose to let others know the lay of the land). Two rather memorable things stick in my mind this morning.
"He's not tolerating the Ensure through his feeding tube [a diet supplement often given until regular diets can resume], so he's been getting a liquid diet through the feeding tube. The peas from the soup were a little difficult to get through, but we figured it out. He also got FanMilk last night."
First of all, whoever thought to give "regular" food through the NG tube when he kept vomiting up the Ensure (for days apparently) is genius. The thought never would have crossed my mind to put soup or ice cream down. The strangest thing I've ever put down an NG is Coke (it's great at dissolving clogs in the tube. Just think what it does to your stomach...). It still makes me laugh.
This reminds me of an interesting thing we see here. I learned that many of the infectious bugs here are resistant to antibiotics since they're used indiscriminately. It appears that prescriptions are not needed for narcotics, antibiotics, and everything else under the sun. Consequently, we use our antibiotics even more sparingly- even vanco isn't the wonderdrug that it is at home. Infections are therefore more dangerous here because so many of them are resistant to all the antibiotics (you now see another reason why vinegar and honey are used for wound care)! And yet, while this resistance to the "big guns" is going on, Tylenol (or paracetamol if you're from outside the States) is very effective in managing the various types of pain we have here. Sure we use narcotics, but Tylenol seems to go a longer way here than what I'm used to. Some theorize the Africans have a higher pain tolerance and others say their systems aren't desensitized to pain drugs. Whatever it is, it's fabulous!
"He had episodes of query syncopy. His family says it's seizures, we think it's fainting, and the patient says evil spirits knock him over. Might want to add removing evil spirits to the list today."
We all got a good laugh. Don't get me wrong, spiritual warfare is real, but something about all three causes being blamed at once in such stark contrast for these episodes struck me as funny. At home, he'd be getting worked up- blood work, heart assessments, brain assessments, etc. Here, things are a little different. Yes, knowing the cause is important, but we're rather limited in our assessment and treatment. Consequently the workups are somewhat less comprehensive. We can't treat long term seizures and we certainly can't be managing many long term cardiac issues (ie: afib), so what is the most responsible use of limited diagnostic resources**? It's an interesting line to walk, neither ignoring nor overtesting for something you can't and won't treat. On one hand it's logical but on the other, it can be discouraging. And yet we can't deny the spiritual forces at work here either. This man needs prayer regardless. So pray for this patient it is!
Somebody once told me, "you have to keep the main thing the main thing." I think that's exactly what we're trying to do here.
**Speaking of limited resources, we seem to be left with only size large exam gloves. I suppose it's better for much of the hospital staff than smalls!
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