So I’m back, spent some time back in the states and now have arrived back. Safe and sound. -1 piece of luggage that had all of the watches MGH’s Chief of Nursing gave me. Plus 2 new headphones to use for Skype, ½ of my clothes, and a bunch of other gifts for staff. I’m keeping my fingers crossed though that it is found. I’m worried though.
I have to say I was a bit nervous to return. Nervous that I wouldn’t get right back into the swing of things, but post day 3, life here is oddly familiar. My room, the landscape. Everyone around. I was surprised to feel at home. The welcome backs and hugs I have to say are great. And the ultimate compliment today was the “Lucy!” called out to me by one of the kids from the neighborhood. “Lucy! Lucy!” I heard from her, she just was so excited. And then another couple people called out my name whom I didn’t recognize, but it felt so good. I was remembered. And most importantly Tuyishime gave me a huge hug…which in truth is why I love being here…those hugs from the kids, it is the priceless bonus of this job.
So that brings me to the chemotherapy of Tuyishime. She is still here post-operatively now receiving a second round of chemotherapy. I gave her chemo today. Dactinomycin, Vincristine, and Cyclophosphamide. I’d like to say that another nurse was responsible for the whole thing and everything went flawlessly, but it was more difficult than that. Frustration level 10 on a 0-10. I left a nurse (one I really like and who is 100% competent) to find a vein. I left her side because I was helping another boy with rickets outside, and now his little 4 year old brother who came into our malnutrition ward last year has rickets too. His father wanted help. They were at our ward door wanting help so I told him to just let me get things started inside with Tuyishime and that I’d be right out. I got their x-rays, thorough histories, the rickets started in the 4.5 year old 6 months ago, I gave them the Vit.D and Calcium Dr. Sara had given me to give to them. Explained what the meds (vitamins) were. That this is caused because of malnutrition. I asked how many times the kids had milk or dairy. Once a week? I asked (trying to stretch it to something I thought wouldn’t embarrass him.) And he said, “Probably once a month” “Ok, we’ll get you some milk powder.” Gotta’ put that on my to-do list. I then got side-tracked on email, and by this time, it’s 2 hours later, the chief nurse came to tell me they still hadn’t found a vein. “You’ve been trying for the past 2 hours without stoppying?” “Yes,” was the answer. At which point I said, let’s take a break. But I was furious inside. 2 hours of a nurse trying to find a vein. To no avail. It’s very hard for me not to let my blood boil at these points. How in the world could you stick a poor kid for 2 hours straight. I went to the ward again, told the sweet nurse who was still stabbing away to stop. That we’d try again after lunch. Then we’d get the anesthesiologist to help us sedate her after lunch time (after Dr. Sara was very disappointed the job wasn't done yet - I always feel useless explaining the circumstances). And well, of course Tuyishime herself was a crying mess.
Later once again, when the anesthesiologist tried to give her an IM shot in the rear, she was once again crying, flailing, nurses trying to hold her down to give her pain medicine and diazepam. Eventually, three men picked her up and man-handled her basically to get her on her back so the shot could be given in her rear. And you know what the patients and staff were doing at this scene? Laughing. Yes laughing.
People here, Rwandan staff and Rwandan parents, laugh at this kind of thing. It is a cultural aspect of being here that until this day, I do not understand. Why would you laugh at a suffering child? I just don’t get it. I ask if they’d laugh at their own child in pain? And they say no, but then again, I think they very well may. Pain here is not something you suffer, it’s something you watch in humor, it's something you tolerate. If not, people laugh at you. I have not made any headway on this front. It is so disappointing.
To make a long story short, the morphine and diazepam didn’t stop her resisting from getting an IV. I ended up giving her 25mg Ketamine (a very strong sedation drug) which is about half to a third of what a child her weight needed, but with the Diazepam and Morphine on board, I didn’t want to overload her. That still didn’t put her to sleep. We still had to hold down her arm so she wouldn’t resist. Poor kid. Anyway, it’s post work hours now, probably about 6pm because it’s getting dark. I’ll go in there and make sure fluids are running still. Make sure documentation looks OK. 99% chance says no one has charted anything since I left. I don't know what to do about it anymore.
I have to say though, it’s frustrating to return to the nurses giving care in a way that I think is sub-optimal. I just don’t feel like they care. My battle horse cry with injections before I left was “3 strikes and your out” meaning, you can’t poke a kid any more than that without going to get another person to try. And if that second person fails. Stop. Let’s figure out another way. One of the nurses said to me today, “Here, you try until midnight if you have to.” Responding in a sentimental and empathic way to the patient’s reaction is not a part of it. At least it doesn’t seem to be to me.
Probably, the toughest part of working on the in-patient ward for me is the seeming emotional disconnect of nurses when a patient is suffering, what I would call lack of “nursing” a patient through pain and tears. When I don’t see nurses doing that…what I would call “their job” which is to be there emotionally on top of the medication administration, when I don’t see that at all…when I see worst of all, laughter (which to me is even worse than apathy) that is the toughest, most frustrating part of this job for me.
And that aspect of care doesn’t make me feel at home at all. Or like I’m making any difference in nursing care. In fact it makes me want to go into the teaching side of things, not the clinical practice of things, not work in the pediatric ward anymore, because I’d like to somehow figure out how to get nurses to care about needless suffering and do something about it, and I haven’t succeeded on this front at all. Clearly, as I saw today, they still laugh.
PS Just found out they found my luggage! Yeah! Watches for all nurses in Rwinkwavu here we come!
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