Mindful decisions

flow chart

This flow chart is from Cait Flanders’ book, “a year of less”.  The book wasn’t what I thought it would be about, so I don’t recommend it, but I liked the flow chart.  After coming back from Tanzania, I have been thinking about my resources.  I had this quandary with paper towels.  I was down to my last few sheets on the roll and I wondered if I needed it.  Could I use towels instead of being wasteful?  I don’t own cloth napkins.  Paper towels creates a lot of unnecessary waste and I need to rethink my use of them.  I waited two weeks before buying my resupply.  In the end, note to self, I think paper towels can be replaced if I had cloth napkins.

Here is a photo of me cutting cardboard in Tanzania.  They re-use cardboard from packaging as paper to write patient prescriptions, payment balances, and other critical information.  This experience of cutting cardboard into small pieces, reminds me to use all my available resources fully.

cutting cardboard

I am well – I have nothing to complain about except for want of a farm table and my shorts from last summer do not fit.  I must be watching too much Fixer Upper… because I really want a farm table. Not to entertain but I want a 8 ft. long table to study, like the tables at the school library.  I want to spread out my laptop, textbook, notebook, paper… all at home. This is what is missing from my life – a farm table and a bench.

As for my shorts, I was more active last summer leaving San Francisco to Durham. Can you believe that was just last summer?  I have been thinking of San Francisco lately, missing the fog and the bike ride through the Panhandle to Golden Gate Park on the way to archery practice.  I miss those experiences but have traded them in for much more.  In the first five months of this year, I have learned about maternity & pediatrics, observed births, and traveled to Guatemala and Tanzania for global health trips.

This summer, having only one class means I have time for many things like reading all about the royal wedding.  I loved that they donated the flowers from the ceremony to a local hospice.  Her bouquet, per tradition lies on the tomb of an unknown solider.  In lieu of gifts, they asked for donations to their favorite charities… the only foreign charity they choose was a non-profit in India providing menstruation pads to young girls.  This charity – the founder and director is a 2016 Duke undergraduate.  She’s 26 years old and going on to her PhD at Stanford in pubic health.  I’m not even invested in the wedding but I read all details avidly like it was my best friend’s wedding.

I go to the gym most days, working on being more active and healthy.  I have time to do  laundry, clean my house, meal prep & cook my weekly farm box share.  I’ve eaten a lot of lettuce in the last two weeks.  I read a non school related book and have been watching my Netflix queue.  If you haven’t seen the Ali Wong, Comedy Special – you need to watch it.  She’s a comic who is doing standup while pregnant – talking about all things motherhood related.  If you don’t have Netflix, you can watch her briefly on the Ellen show.

I have spent time catching up with friends (local and far), and made summer plans to see them.  I’m visiting Kris in Cleveland, meeting her fiance and seeing her home.  Marissa is visiting me for a week.  I’ll try to go up to NYC for July 4.  I’m traveling with Betty to Ireland mid-August for my first true vacation in a long time.

Class is going ok thus far, no exams yet to report back on.  I have tons of support from faculty and staff.  I meet with individual faculty twice a week, mostly for accountability.  I think everyone is afraid that I’m not going to have community or feel alone/isolated being between cohorts or forget everything, but secretly or not so secretly I am loving the downtime.  It’s really what I needed to refresh and recharge.

We are in week 3 of 12… 9 more weeks of summer class to go.  I interviewed for two summer jobs – one research oriented position and the other clinical with patients.  There was a recommendation that I needed to find community and do something in my spare time, but upon interviewing for these roles, they were full time positions and I wasn’t interested and/or able to devote 40+ hours a week to a job.  At most, I was willingly to work 2-3x/week.  The part time jobs posted were mostly admin and my time is more valuable than $10 of admin work to just fill time.  I was interested in some other clinical roles at the hospital but it would take too long for certification and the application process.  I was willingly to entertain a research or clinical position where I could practice my clinical skills.

I volunteered at an outpatient GYN clinic for women in a substance abuse recovery program last week and felt slightly traumatized by the experience.  I was expecting to triage, take vital signs, maybe observe a patient-NP exam.  I did triage, but I wasn’t expecting the hands on practice.  I was shown how to do a breast exam on a patient.  I was told you take the pads of 3 of your fingertips in a circular motion, then a press down again, in a deeper circular motion on each breast, traveling up and down the breast like a lawn mower.  I’ve never mowed a lawn before, but I think that means you press up and down systematically rather than go sideways.

I ran the speculum under warm water and put lube on the top and bottom of it for the pelvic exam.  I handed the NP other items too.  It was at this point that I felt most uncomfortable.  I was working with the NP, but I hadn’t built up any rapport with patient.  Here she was, on the scoot-scoot table, completely undressed and vulnerable and I felt so invasive.  I wish I had known that I would be going into the patient room and I would have spent more time with her before this point in the exam.  It’s not the experience I would have wanted for myself or anyone else.  I can’t do anything about this experience, but learn from it for the next time I volunteer next month.

It’ll be enough…

A week ago, on the drive back down to North Carolina, I listened to the Hamilton soundtrack because I ran out of podcasts.  That soundtrack carried me most of the drive.  The song, it’ll be enough…look around, look around at how lucky we are to be alive right now… rings through my ears and spirals around my head a week later.

Yesterday, I visited with the refugee family I volunteer with and they said to me, they have enough, that they do not need.  How can a family who uprooted themselves with nothing, need nothing?  I am floored by the fact, I want to go to the store to buy paper towels and Woolite and she needs nothing.  She said she needs nothing for her kids and she needs nothing.  How can she not want or need?  Is it an American custom to want vs. need?

I feel really sad too as I recently learned the news of my friend, Don.  He has lost his battle with cancer and has moved to hospice care.  After a semester of practicing difficult conversations, I find it challenging to write the right words to him.  There are no right words to express my sorrow and emptiness of a life soon to be gone.  (For those of you reading, and also know Don – you can call or text him, or send letters to his home – no email.)  I know he’s not reading my blog anymore as he does not have internet but I am writing to the universe – I am thinking of him with all my strength and courage.  I hope he is surrounded by all that he loves, all that brings him joy, and each day his needs & wants are met.

A step back is a step forward

kili.jpeg

As Duke students we are competitive and strive for perfection.  Sometimes, we do not achieve these lofty goals but it isn’t talked about and imperfection is not seen or heard.

A few weeks ago, before the end of the semester, I had what would be later known as a panic attack.  I arrived to the hospital, a regular day at clinic, however, my heart was beating incredibly fast, so much that it hurt my chest.  I felt slightly nausea, and I had shortness of breath.  Imagine, sprinting at full speed, but you are standing still.   I tried my best to slow my breathing, but after 30 minutes, I asked my clinical instructor what I should do, and she promptly walked me down to the Emergency Room.  I didn’t want to go, and if left to my own means I would have just sat it out.  She was concerned that it had already been 30 minutes and I might have a heart problem.

In the ED, I was triaged, with an electrocardiogram (EKG) machine with 10 leads to check for electrical impulses at different areas of your heart.  The EKG checks for common heart problems and the results were normal.  My blood pressure was also within normal range, but my heart was still racing.

The provider was concerned I might have a pulmonary embolism or something blocking my heart/blood flow.  I received a chest x-ray, and a V/Q scan. The ventilation-perfusion scan (V/Q) is an image looks past the chest x-ray.  You put on a face mask nebulizer for 4 minutes, breath in the radioactive material and the tech takes an x-ray while you are breathing to examine airflow (ventilation).  Then the tech reverses the airflow for 4 minutes, removing the radioactive material from your lungs.  Next, inserted into your IV (which goes straight to your blood circulation) is a chemical dye to watch the blood flow (perfusion) in the lungs while you are under the CT scan.  Both scans came back clear with no evidence of a blood clot in my lungs.  I was tachycardiac for half a day.

I was asked to follow up with school provider and the school psychiatrist.  The school provider concluded it was a severe panic attack.  I had previously thought panic attacks were brought on by a specific incidence but I am told it is accumulated stress.  Your body in a last attempt to stop the stress sent me to the ED.  The Emergency Department bill is $9,000 USD, 10% of which I am responsible for as part of my student health insurance.

The school psychiatrist, coincidentally a graduate of this ABSN program, has knowledge of what I am going through.  She told me what you learn in nursing school is not what you do in real life as a nurse.  Whatever grades you get in school, does not foreshadow who you will be and does not at all imply what kind of nurse you will become.  She said to be kind to yourself and do not be hard on what you know and don’t know in school.

She also said, I need to manage anxiety and stress better. We always talk about stress and casually say, I am so stressed but never before did I recognize what stress really means to you and your body.  She prescribed anxiety meds and suggested I take them for the duration of nursing school.  I was surprised by this recommendation.  She said they will help and when nursing school is over, I can stop taking them.  There are side effects, but we’ll start with a low dose and see how it works for me.  She says meds and psychotherapy are the best ways together to manage anxiety.  She also suggested I take it easy and try to find ways to de-stress that have previously worked for me.  I am open to trying anything that will make me feel better.

Maybe related or not related, during the same time period, I failed the pharm/patho final, which means I am retaking this course and not continuing on with my cohort.  It means I get a time out for the summer to work on me, while focusing only on one subject.  In the fall, I will continue with the next cohort, on the regular schedule of Adult and Gerontology (caring for older adults).  Following in the 4th semester, finish with the preceptorship, graduating in May, spring 2019.

This is a setback in a time line, but does not change the fact I will graduate and still be a nurse.  If anything, the bright side, I will have more down time this summer to visit friends and have them visit me.  I will be part of a new cohort and meet 70 new friends.  It wasn’t until I shared my story, others told me they also have had panic attacks and they are also on meds to manage their anxiety due to nursing school.  Classmates also called to check in, considering I hadn’t been to their first week of classes.  I am usually ok sharing but I didn’t want to advertise this story.  Now, after talking to several people, I want people to know, others have difficulty managing nursing school, it’s not just you.

 

My favorite part of the trip

 

Boarding from London to RDU return home flight, the boarding flight attendant asked me what was my favorite part of the trip.  I said:

They call her mama Regina.  She has a vision and commitment to change the world.  She and her husband started with a mound of dirt and grew it to a village.  From nothing, came a medical clinic, a primary school, a secondary school, and a home.  The village keeps growing, as Tenzi added a sewing school, and next a trade school.  Regina’s vision of hope has changed multiple generations of lives.  She has raised hundreds of children through education by serving the grace of God.  Her children, 100+ City of Hope kids, 23+10 Mountain Mission kids, her own kids, her (sister-in-laws) adopted children, all carry the name and memory of Chacha.  They all call her mum.  She is an inspiration to us all and reminds me that one person can change the world.

Safari – journey

water buffaloSimba – actually means lion in Swahili and many animals we saw did resemble the ones seen in the Lion King.

We saw ostriches, elephants, giraffes, zebras, hippos, imapalas, eagle, baboons, lions, cubs, warthogs, wildbeast, and hyenas.

Our one day safari took us to the Tanzania side of the Serengeti National Park.  I am told it takes 5 days to see the entire park.  I learned you should not wear navy blue or black because it attracts the tsetse fly.

My favorite animal were the baby wart hogs.  The driver told us the mama warthog must be very strong, because there are so many baby wart hogs left.  Apparently, wart hogs are easy prey.  Also, easy prey is the zebra – why does it exist?  It is fat and has distinct black and white stripes – not blending in with the environment.  I think it’s only purpose must be to be eaten.

 

Tarime Hospital field trip

We had a field trip to Tarime Hospital, and associated nursing school.  Tarime is one hour from COH and it is the district hospital.  At the hospital we learned, they do sometimes have running water, but like many places, they wash there hands by taking water from the cistern (rain water) in a pitcher and washing it over a bucket.  The beds we saw were without sheets, because they are washed but due to the rainy season they cannot dry outside.  Some of the beds looked stained with stool and blood.  Outside the hospital there is a price list for every service available and how much you will be charged.

There is a special dedicated doctor for Albinos.  Albinos are considered evil to some people and their safety is in jeopardy because others also believe parts of Albino body parts might be good luck.

The nursing program has a 2 year certificate program and a 3 year diploma program.  There is a nurse shortage – with one nurse staffing an entire unit 1:20 patient ratio.

Amani Clinic

cow and manAt the clinic, Dr. Ben told us, many people keep their cows/animals under their same roof to avoid them from getting stolen.  Therefore, there is often cross contamination and infection.  Most common we saw hookworms, stomach infections, fungal infections, and UTI’s.

Cows are a sign of wealth and a dowry could be 12-16 cows.  A single cow could cost $2,000 USD.  People live on less than $1 a day.  People die over cows and the area of Ntagcha was filled with cattle wars before COH.  Many of the children are orphans because of cattle wars.  Now with the presence of COH, cattle wars are not present in the area and the local villages are at peace.

At our first day at the clinic, I helped sweep the dirt floors.  It was humbling and made me think of the skilled workers that seek refuge in the US and are unable to work in their trade.  They take up housekeeping and service jobs when they are more skilled.  Every person at the clinic helps out with sweeping and mopping every morning.

There is a strong community here in the City of Hope.  Everyone is welcoming and generous.  Each child I saw arrive at the clinic, walks with a friend.  Every child that came to the guest house for care, arrived with a friend.  Each child helps and leans on one another.

At the clinic, they use differential diagnosis to help each patient.  There are only basic tools and you must use your knowledge to find the cause of their pain and treat it.  I helped with a malaria test, which is very similar to a glucose test.  This test and a stool sample were the tests used most often with patients.  Medicine is a few cents to a few dollars and many people cannot pay the amount.  They are given a sliding scale and usually the loan comes from the community.  I was told my 1 person Duke education = 9 college student educations in Tanzania.

I observed them use every available resource.  For example, we would cut cardboard from packaging to give to patients to use as paper.  The pill bottles we use in the States, made their way to this clinic and are used to give to patients.

At the clinic, there is no running water.  There are solar panels but they do not work and there is not money to fix them.  They were installed a few years ago by a grant from the US embassy.  When we were there, they ran out of alcohol prep pads.

I watched Dr. Adam speak to the entire family about a diagnosis and prevention.  He didn’t just focus on the patient.  I watched also how they give IV injections straight into the wrist.  They do the IV injection with such precision, getting it right, finding the vein the first time. This is not a practice we do in the US, because we hang out IV medications.  In the US, inserting into the vein directly is only for emergencies.

During our time at the clinic and COH, we provided: health history and assessments of the children, wound care prevention, we taught on types of wounds and how to care for them, hand hygiene, UTI, menstruation/fertility cycle – reusable pads, and nutrition to community – mothers and babies.  I would add we were asked to speak on these topics to the children and community.  We did not come up with these topics ourselves.