For the whole month of
September I am working in Urgence/Medicine which is basically the ER. I am working the afternoon shift which
goes from 1500-2100. Compared to
Pediatrics, ER is a piece of cake.
Because the fields
have not been harvested yet, many people are low on money so this month the
hospital has been low on patients.
Well all except for Peds that always stays pretty full. The most patients I have had in
Medicine are four patients and the least amount has been zero. We usually admit at least 3-6 patients
during my shift sometimes even less than that. So I bring a book, study French, do word searches or sit
outside and people watch when there is nothing to do. One day I was quite
entertained watching a bunch of guys try and jump start a truck by pushing
it. I lost count on how many times
they tried to jump start it with no success, but I would give them an A for
determination!!
On one of those slow
days, I was sitting in Urgence by myself doing a word search (Benard the guy
that was working with me was sitting outside somewhere eating dinner) when I
hear a big commotion outside
headed my way. The next thing I
know a group of like 8 people are streaming through the door. I quickly assess the situation and
notice one of the guys is covered in blood; his shirt is soaked with it. I jump out of my shirt and yell out the
door for Benard, as I grab my headlamp and usher the bleeding guy into a exam
room. (Even though we have
electricity at the hospital, we only have one overhead light so all the exam
rooms are dark) I put on gloves,
and start to strip the guy out of his bloody shirt to get a look at what kind
of wound I am dealing with. By that
time I have at least 12 people surrounding the exam room entrance trying to see
in. No one is speaking French, so
there is no understanding what they are saying. Where is Benard!! This is
not a time to be eating dinner! I
need him! I keep working on getting the shirt off the bleeding guy; he is
speaking and crying all at once. I
grab some gauze and stick it on the wound which is high on his right side. It looks like a stab wound but I am not
able to ask. By that time Benard
is there with me. He kicks all the
observers out, and starts speaking the local language and figuring out what
happened. Apparently the guy was
drunk and got in a fight with someone else. I wonder what the
other guy he was fighting with looks like? I keep applying pressure to the
wound and the blood finally stops flowing. We do a quick set of vital on the
patient and make sure he is stable.
The doctor is notified, and all we can do is sit and wait.
Two hours later after
the patient arrives the doctor shows up.
He hands me a 10 cc syringe of lidocane and I inject it into the wound
and the doctor sticks his finger into the wound trying to tell how far the
wound goes in. The patient is
starting to show signs and symptoms of a pneumothorax and it’s decided a chest
tube needs to be put in. By that
time its almost 2130 and I should have been off shift 30 mins ago. I give my stab wound patient over to
the next nurse and head home. What
an exciting day!! And I thought Urgence was boring!!
Another time in Urgence
we had a patient come in with an enlarged prostate that was preventing him from
urinating. He was in severe pain
and very uncomfortable. We tried
putting a Foley in him to drain out the urine, but were unable to because of
his enlarged prostate.
The physician was
notified and we brought him into the ECHO room where Olen did an ultrasound on
his bladder. Then he handed me a
60cc syringe and offered me the job of draining the bladder. I was all for
sticking the guy with a giant syringe into his bladder, but I did inform Olen
that I had never done something like this in the states. Which he replied with, “And you never
will.” Great another skill learned in
Africa that I will never use back home! I stuck the needle into his bladder and had to empty the 60
syringe 11 times!! It took about
30 minutes to do. Here I was in a
dimly lit room with my head lamp on, sweat running down my back, and my left
arm shaking from the effort to pull urine out through a syringe. As I worked Olen sat at the desk
keeping me company, and telling about the upcoming vacation him and his family was
going on. As I emptied my sixth
syringe, I realized why he happily handed over the job to me, this was hard
work!! Who knew draining some guys’ bladder would be such a workout!! Once we finished our patient was much
more comfortable, and I was in desperate need of a shower. Thankfully, I was in need of a shower
from my own sweat and not my patient’s urine.
October
I enjoyed working in
Urgence/Medicine and asked to be put on same shift 1500-2100 for the month of
October. Work has picked up, and
more people are coming to the hospital now. Fields are being harvested and they are able to pay their
hospital bill. We get a lot of
malaria cases coming through Urgence, as well as hernias, dog bites/snake
bites, hydroceles the size of basketballs (collections of fluid around the
testicles usually caused by filarial worms clogging the lymphatic drainage and
the occasional motorcycle and ox cart accidents.
Urgence- Crazy Town Thursday
Last week Thursday
October 4th was the busiest I have ever seen Urgence. I barely had time to set down, people
kept coming non-stop. We also had
a combative patient in Medicine that day.
It took 6 guys to hold her down so we could put a new IV in her and give
her some much needed diazepam to calm her down. I was holding her arm as one of the nurses was trying to
find a good vein when she grabbed my arm with her other hand and started to
pull. I thought she was going to
rip my arm off!! Thankfully of the
6 guys was able to get her to let go of me, but I lost some arm hair in the
process. Later after she was
calmed down I asked Alexi (the nurse I was working with) what her deal
was. Besides being combative she
was wailing and crying like she was in severe pain before we gave her some
diazepam. He told me that she had
“traditional crying”. I don’t ever
remember learning about “traditional crying” in nursing school….. I wondered
what my teachers in school would have said if I put “traditional crying” down
as one of my nursing diagnosis!!!
We were treating her for malaria, but according to the nurse I was
working with “traditional crying” was the reason she was combative. I did a quick assessment of her to see
if there was another reason for her wailing and carrying on, but found nothing. Apparently “traditional crying” was the
reason for the way she was acting.
My nursing career has hit a high point with my diagnosis of
“traditionally crying” for one of my patients.
November
This month has been
really busy in Urgance. Most days
we are going nonstop from 1500- 2000,
Then by 2030 its time
to pass out medication on medicine, do change of shift and leave little after
2100. This last week I have been
leaving later and later because people keep coming in through Urgance nonstop. Last week every day I had 2-3 paints
come in through Urance that were unable to walk. We had to carry them into an exam room. They were either unresponsive or
combative, showing signs of dehydration, low blood sugar and classic
malaria. A couple times we had to
hold the pts down because they kept thrashing when we tried to put in an
IV. Diazepam became my new favorite
drug, helping to calm the patients down so I didn’t have to worry that they
were going to pull out there IV, hurt me or other staff, or roll off the bed.
I had another person
die on me today in Medicine. The
guy was 21 years old with heart problems.
He was admitted for treatment of malaria and was on IV quinine, which is
never good if you have heart problems.
I was passing
medication with Seraphim who I was working with when all a sudden he started
convulsing and died with in 1 minute.
There was nothing we could do.
I wish there was something I could have done. I went home that night feeling like I had let him down, that
I wasn’t able to save him.
No matter how old or young or how many times you see someone die it
still hurts.
The man in bed 8
His name is Bogael
and his 33 years old. I remember I
was working the day he was admitted into the hospital. He wore a turban wrapped around his
head and face, which is not abnormal seeing when you live in Africa. But then he took off his turban and I
understood that his head wrap was used as shield. Bogael had Burkett’s lymphoma, which is a cancer of the
lymphatic system. Bogaels face was
completely distorted by the cancer.
Bogael was my patient
in bed 8 in Medicine for 41 days.
I treated him twice for malaria while he was there getting treated for
cancer. He was always polite to me
and I always tried to talk to him in my limited French. He was always good about helping me
find my missing patients who were not in their beds but outside sitting on the
veranda. I could never pronounce
their names right so Bogael would help me call for them so I could give them
their medication.
The day Bogael was
discharged was bitter sweet.
Though he treatment for the cancer was finished I knew that he wouldn’t
live much longer. I was glad he
was finally leaving but I was going to miss seeing him laying there in bed 8
listening to Arabic music on his portable radio. The cancer might have disfigured his face but he had a
beautiful smile that could always brighten my day.
As I look back on my last month
I have had pts
admitted for snakebites, dog bites, human bites, and scorpion bites. Moto accidents, ox carts accidents,
enlarged prostates, hernias, hydrocele, TB, liver failure, and cancer tumors. I have seen wounds from stabbings,
bites from human and animals, hitting someone over the head with a stick, and dropping
a brick on the foot. I have seen malaria,
and more malaria. I have had
people come to Urgance who are combative and some who are unresponsive because
of their malaria. I have had to
help carry them into Urgence, and have had to hold others patients down as we
try and insert an IV. I have had
children come into Urgence who have developed cerebral malaria and are having
seizures. I have had both children
and adults try and bite me when assessing them (one of these days I am just
going to bite them back). I have
learned to great pts in French, Nadara (local language) and Arabic. I can understand when a pts tells me in
Nadara that they are vomiting or having diarrhea. With my limited writing ability in French I can prescribe
meds in the pts Carne, and write up their Doce (pts med sheet).
Their days that I
have to go into the nurses station (which is a tiny room with a desk and chair
and a curtain for a door) and have a good cry. I have seen more death in 8 months than most people see in a
lifetime. And there are day that I
have understood while I was brought to Africa.
The other day I had a
“this is Africa” moment. I was walking around medicine checking on my patients
and as I was walking by a bed I had one patient just squat on the floor next to
their bed and pee on the concrete floor.
I was so shocked I just stopped and stared. You go to be kidding me!!
Then I went and got the bleach and our mop/ broom so that the family
member could clean up the mess.
Then I had Hamadu talk to them in the local language explaining to them
about asking for a bedpan or walking to the bathroom.
Understanding Arab
I have found that I
have a talent that I didn’t know I had.
I can understand Arabic. It
came to a shock to me, because I have never taken a class in speaking
Arabic. I was working with Homadu
in Urgence when we had a patient’s father come in from Pediatrics and start
yelling at Homadu in Arabic. The
father was upset because he couldn’t find the nurse in Peds and needed someone
to look at his kids IV. So he came
to Urgeance and told Homadu that he HAD to come fix his kids IV. Homadu told him that he was working in
Urgance and that we couldn’t help him because we were in the middle of a
consultation but he could as the guard to help him find the pediatric
nurse. Well the Arab father wasn’t
happy about that and there was heated words said with angry gestures. With out realizing it had slowing
stared backing out of the room and by the time the guy left I was standing by
the door.
The crazy thing was
that this whole conversation was said in Arabic and I understood exactly what
was going on. I confirmed what I
heard with Homadu and he was shocked asking if understood Arabic. There was other instanced working in
Urgance where I would have an Arabic patient and understand what they were
saying, shocking both my Arab patient and my coworkers. Speaking Arabic back to them is not my
talent.
I am the Nurse SIT DOWN!!
I lost it at work the
other day. I yelled at a patient’s
family member and it was liberating.
I was taking care of a patient in medicine doing an IV push when the
family member decided that they new more than me. They kept telling me to slow down in French. I was going slowly so I ignored them
and kept doing my IV push. When I
was done I started to get my IV bag and medication out to start a quinine drip
for malaria when the family member decided to butt in again. They grabbed my arm and started to tell
me that it was not time for the IV bag.
That’s when I lost it. I
turned around and in French yelled at him, “ I am the nurse not you! SIT DOWN!” Needless to say it shocked the patients family member and
myself. He quickly sat down and didn’t
say another thing to me as I finished up with the patient. I couldn’t stop smiling. Patients family member are always
telling me what to do, and family member of other patients that are not even my
patient are telling me what to do.
They love to be involved in everyone’s business. I have learned to ignore them but that
night I couldn’t contain myself.
When I got back to Urgence and told Alexei (the nurse I was working
with) what had happened we both laughed.
The rest of my time working there it became our private joke. He would tell me, “Carlie you are the
nurse” which I would say, “I am the nurse, SIT DOWN!!”
Last Day
My last day of work
wasn’t all that I wanted it to be.
I started out well. I was
working with Seraphim who is always a lot of fun. It was busy but not overall busy. But then we had some parents bring in their little girl who
looked to be about 4. She had developed
cerebral malaria and was unresponsive and having seizures. We started her on IV quinine and gave
her some diazepam. But it didn’t
help. She died with in an
hour. The wailing was how I had
discovered she had died. As I
pushed back to the curtain to the Urgence admission room I knew what I would
find. As I used my stethoscope to
confirm that she was dead I couldn’t stop the tears that came to my eyes.
Later that evening at
work I developed horrible stomach pain.
It felt like a knife was been thrust into my abdomen repeatedly. I was passing meds and every time I bent
over to get into the patients medicine box under their bed I thought I was
going to puke. Finally when the
pain got so bad that I was doubling over I decided that I needed to leave work
early. I didn’t want to quite
early on my last day but I didn’t have a choice. I went and got 1 ampule of promethazine from the pharmacy
and had Seraphim give me a shot before I went home for my nausea and stomach
pain. Thinking that the medication
wouldn’t kick in for at least 15 minutes I thought it was safe to drive my
motorcycle home. That was NOT a
good idea. By the time I walked
into the house I couldn’t walk straight.
I barely made it to my bed before I passed out for the night. Thankfully the stomach pain was
gone. And I drifted off into a
drug induced sleep pain free.
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