A pretty typical day

"You're doing so good!"

I put on a probably-unconvincing smile as I give a thumbs up to my patient who is halfway through the litre jug of oral contrast dye he needs to drink before his CT. I give the Day Crew helping to coax this process along a knowing glance as I check my watch again. 0945. He's supposed to have the scan at 10. It's taken over an hour to get this much in to him. Our odds don't seem favourable.

Papa E. has been on A Ward for a couple weeks now - when he arrived he urgently required a gastric tube to decompress his stomach. He came for a hernia repair, but this hernia had progressed from something inconvenient and benign to something potentially life-threatening. Part of his bowel had become incarcerated in his hernia - meaning it was pinched off, blocking circulation and the normal flow of digestion. His belly was the size of a beach ball, and tight as a drum.

Bowel obstructions are part of a normal day at work for me, but my patients aren't usually this frail. Usually they show up at the hospital within a couple days of the onset of pain, nausea, and vomiting. I suspect Papa E had been suffering for at least a few weeks before he came for his hernia appointment. He is so malnourished, but even after his hernia was repaired, the affected section of bowel removed, and all that air & fluid that had built up above the blockage removed, he's still barely eating. "I'm full!" he complains, pointing at his still-somewhat-distended stomach. What he really needs to bolster his strength and healing is TPN (IV nutrition), but unfortunately, though we've reached out to local hospitals regarding this, we can't find a reliable source. TPN is incredibly expensive, and we absolutely take it for granted at home. It's quite commonly used in complicated cases of obstructions or bowel surgery, giving the patient nearly all the nutrition they need without putting any workload on the guts.

"Nearly there!" I halfheartedly encourage papa as I fill up his cup once more. He's getting this scan because he just hasn't been progressing as he should, and his belly is still full of fluid. He glares at me like I have two heads and ignores the straw being pushed towards his mouth by the Day Crew. 

A couple hours and one failed attempt to use IV contrast dye later... Papa is back in his wheelchair beside his bed, frowning again as I now try to get him to drink some Ensure nutrition drink. He's surprisingly spry (when he actually agrees to get out of bed), considering he hasn't really eaten in weeks. As I mark down his meager intake for the morning, one of our General Surgeons rushes in to the ward. I expected him to confirm our suspicion - ascites related to liver disease.

"When was the last time he ate?" Uh oh. Those are never encouraging words. "He's just had 1/2 a cup of ensure - that's about it since the oral contrast. He refused lunch." 

"Keep him NPO. There's something...infection..." he vaguely says. "We might be taking him back to theatre."

Our hospital physician pops in a minute later. "Did you hear about the scan...looks like maybe a leak?"

"Uhh...Dr. Hank didn't mention that." 

Leaks (bowel leaks) are bad. Very bad. People can very quickly go septic. I couldn't help thinking, "that doesn't make sense - he can't be leaking. He's not nearly sick enough to have a leak." 

"Whoops. You didn't hear it from me," Dr. Sarah says as she steps back out to find the surgeons. 

After half an hour of people sticking their heads in and out of the ward with questions, trying to decide how soon they could start surgery - nope, we're doing it tomorrow - nope, now we're back on for tonight - nope, now it's ASAP. Here's some bupivicaine, we're gonna do nerve blocks again. Dr. Hank finally sat down with my charge and I to discuss the plan, and the challenges this new development posed. His biggest concern was the recovery time - we are only doing surgery for one more week, and the hospital will be closed down two weeks after that. Papa's incision would have to be left open, packed regularly, and slowly heal up from the inside. "Could we VAC it?" I piped in.

"We have VACs?" he replied, slightly surprised. "I was thinking in Africa mode. Lovely! Yes! Let's do that!"

VAC wound therapy (AKA negative-pressure therapy) can reduce wound healing that would otherwise take weeks to mere days. It's papa's best hope for a speedy recovery. 

We scrambled to get things ready as we waited for Chaplaincy to talk things over with papa. We are so fortunate to have them - when there are difficult conversations that you would otherwise have to have through a 3rd party, translating, it can feel impossible to really emotionally support your patient. Our team of chaplains, local Cameroonian day crew, take over that role for us here on board. Meanwhile, my fellow nurses were prepping some last-minute bloodwork, a type-and-screen in case papa needed a transfusion. In the midst of the chaos, I gave a rushed report to the oncoming afternoon nurse, my shift nearly over.

"Can we pray with you, papa? Before you go?"

Papa nodded, smiling weakly.

"In Pidgin, or in English?"

About 6 of us, translators, chaplains, and nurses huddled around as the half-recognizable Pidgin prayer was spoken, then the OR nurse, Carmel, helped papa shuffle down the hall. 

-----

A couple hours later, my shift over, I've showered and headed to dinner. Carmel (who's probably the most Canadian sounding Canadian on board), sits down in her scrubs for a quick dinner break. I got a quick update on how the surgery was going, but just ended up with more questions than answers. "There was so much fluid in his belly...still not sure where it's from. But he's doin' good. Just lyin' there, sleeping." She shovelled food off her plate then headed down to scrub back in. 

I went to bed early, papa constantly on my heart as I went about my nightly routine. It's weird knowing that these urgent situations are going on constantly just down the hall from my bed. At home, I very much compartmentalize my work life and my personal life. When I leave at the end of an exhausting shift, my responsibilities for those 12 hours are done. I try not to carry that stress home with me, or I would just be stressed ALL THE TIME. 

Here, though, I can pop in on my patients any time of day or night. They're so close. And I don't get stressed out here - I love being at work. My brain is still wired to close off the work sector when I'm not there, though, and it's so easy to go about my days off overlooking what's going on on the other side of that big steel door. 

-----

It's a couple days later now. Papa is recovering well, but has a long way to go still.
I was shifted to D Ward today to help with some Maxillofacial patients - a very different scene from my usual! Lots of drooling babies and patchworked faces. It was a good shift though - I got my post-op patient to smile despite suctioning up her nose. So, I'll take that as a win.

I guess the point of this whole rambling post is that there really is no such thing as a typical day on the ship. Each day is like a box of chocolates.

And that's all I have to say about that.

À la prochaine.