Airborne

My time in Guinea has ended, and boy did it go out with a bang.

My last few shifts were...surprising - I think is the best word. 

I started working some shifts as a charge nurse this year. I was a tad apprehensive at first, but after some orientation and a couple shifts under my belt, I felt fairly comfortable about it. I had already completed the 4 charge shifts that were on my schedule, but I ended up trading to help someone out and was in charge again Tuesday evening. 

EVENING ONE - SPORTBALL 

The shift went by without much excitement until about 8:30, when a nurse asked me to look at her hernia patient. "There's a LOT more swelling than there was." In about half an hour, he had gained a softball-sized bulge that was definitely not there before. I paged the surgeon, who came down to look and wrote orders to take the patient back to the OR in the morning. He was bleeding, but it wasn't severe enough to warrant surgery that night. Page back if it gets to be football-sized. Ok, that's what we'll do, I guess. I let the OR team know, got a consent signed, and checked in with the team leader to make sure I hadn't missed anything important. 

Apparently I didn't notice that I had been sweating buckets even just sitting at the computer, because it's HOT in our ward, and a nice little dizzy spell forced me to take a breather and remember to drink water. One of the night shift nurses had made pies, so I got a piece and moved to the air-conditioned office to finish up my work. By the time I updated all the paperwork for the morning shift, I's dotted and T's crossed, I finally left - a round midnight. Slightly uneasy about the still-slowly-bleeding patient, it was even later by the time I fell asleep. No bother, I could sleep in. 

EVENING TWO - DÉJÀ VU 

Arriving on the ward, my team leader said, "Surprise! We need you in charge again!" No problem, I handled last night, and it can't be as crazy as that again. 

The bleeder from yesterday was doing fine, and everything was run of the mill until about 9; shortly after the surgeons had done their rounds. "My kid in bed 1 suddenly has all this swelling." You're kidding me. Paged the surgeon, he took one look and asked, "When did he last eat?" Great. Needs to go back to OR tonight. Once again, notified the OR team, consent, paperwork, find a translator that can explain everything to mama, and he's whisked out of the ward before shift change at 10. 

Just as I'm bringing my print-outs for the morning shift back from the office, around 11, the phone rings. "That was quick," I think as I answer, expecting the news that they're bringing him back out of recovery. 

It's the OR nurse, Melissa. "Did the day nurse say anything to you about a blistery rash?" 

"Wha...?" I double check with the night nurse who got report. "No, no one saw anything..." 

"We THINK he might have Chicken Pox." 

No freaking way. After a moment's disbelief, we discuss what to do and I jog down to D ward to make sure there's an isolation room free. The doctor on call needs to verify before we can do anything - it's a sweet English lady who usually works ashore in Capacity Building. She's never been in the OR and I help her gown up and direct her to the recovery room. "This is what I get for offering to cover the pager," she jokes. 

Sure enough, she's 99% sure it's Varicella. We have to isolate. Once again I track down a Mandingo speaker to explain everything to mum, and escort her to the iso room. It's full of extra ICU equipment which we hurriedly haul out of the way. Shortly after, her son arrives in Melissa's arms, and I help the night nurse get him settled in bed. It's after midnight by now, and our infection control nurse turns up (bless her). We all chat about the plan, no, it's not ideal, we don't have a negative pressure room, but it should be ok, it's more droplets that we need to worry about, they SHOULD be able to go home in the morning. 

Around 1 AM, at the insistance from the night nurse that she would manage (despite having this patient plus 8 more in a different ward), I went off to bed. 

EVENING THREE - MISGIVINGS 

My last shift before I head home. I'm not in charge. Phew. I'll just manage my patient load, no surprises, no problem. Right? Heh. There's some acute patients in D ward, so they've borrowed some of our staff, leaving us with 6 patients each. One of mine is our chicken pox patient. They're from upcountry, and need to stay close by until their 1 week follow-up appointment. We can't send them back to the HOPE center - he's still contagious. Mama doesn't know anyone in Conakry she can stay with, so we're going to try to put them up in a hotel. 

Going back and forth between iso and A Ward (opposite ends of the hospital), I'm trying to get myself organized and make sure I've checked on all my patients when Lizzie, the infection control nurse, tells me they've organized a place for our pox patient to stay. "I've still got to do some teaching," I tell her; she's going to come back with a chaplain who can translate for us.

After about an hour explaining the plan to mama, making sure she understands the medications and can open the stupid child-proof bottles (that is not as easy as you might think to explain in a different language), we finally started to head out. Mama stopped short outside the door and said something to the chaplain. "She wants you to pray for her," he tells me.

"Me? Are you sure? In English? Would she prefer you pray in Mandingo?"

They converse a little, and he says, "Yes, you pray, I will translate."

I don't know what that mama believes, but in that moment she knew she needed someone greater than her to get her through the week ahead. Lizzie later shared that when they reached the hotel, Mama was pleading that they not leave her there. She had lived her whole life in a remote, rural area; being in a huge city like Conakry was terrifying to her. At the HOPE center there are translators and other patients from all over the country; there's always someone you can talk to. It's safe, secure, and familiar. 

She did not want to be alone.

Lizzie and Christopher, the chaplain, were able to find a staff member at the hotel who could speak Mandingo, they helped settle mama in, reassured her that staff from the HOPE center would see her every day to bring meals, and gave her an emergency contact number. It sounds like by the time they left she was more at ease. 

~ ~ ~

Once the two of them were off in Lizzie's capable hands, I rushed back over to A Ward, where I had left a fresh post-op patient for far, far too long.  "Your vitals are done, and I gave bed 7 his paracetamol." My fellow nurses are rock stars. 

I again was in the hospital till after midnight, cleaning the iso room from floor to ceiling with my charge nurse's help. 

~ ~ ~

I don't think I'd trade those 3 crazy shifts for any one shift here at home. They were stressful, but I still walked away feeling fulfilled, effective, and oh so appreciative for the professional team who, despite being from different countries and speaking different languages, work so well together to share the load and show our patients love. 

I'll miss you Guinea,
And you too AFM - but I'll be climbing back up the gangway before long.

À la prochaine,

-D