adventures in nursing (aka MORE prayer requests)

Well, first I'll start with updates....

Addie. still in hospital. They put in a feeding tube through her nose and into her stomach a few days ago to give her milk, supposedly only because she still has a rampant yeast infection in her mouth. I'm not really buying that as the complete story....now she has diarrhea and some sores on her head. whatever that means. I haven't been able to visit since the day after I left her as I've honestly been too busy and their "visiting hours" are 2 different 30 min blocks in the day. not very cooperatable for my schedule. I have one of our Moz doctors checking in on her tomorrow to figure out why she's not better and what they are doing (or in the more accurate case, NOT doing) for her. Please continue to pray for this little girl.

The twins (Mario and Carolina) are adjusting wonderful. I snuggle and kiss them several times a day. They are adorable and hungry little piglets. They have a potential adoptive family....a husband and wife couple that works for us...no more details, but please pray for this situation. We are doing their HIV tests on monday and there still needs to be a few court papers to be filed to make them completely eligible for adoption. Pray for their health, their growth, and for the forever family!!!

Ok, now on to a completely NEW and unrelated prayer request as well as story (for all of you that believe I only snuggle babies.....like it's a change from my OLD job in the NICU or something).

Well, if you know me (or have met me even, or perhaps just read this blog), you'd know I am a KID person. I do NOT like adults. I semi-jokingly use the cutoff at 18, but I'd love to somehow keep it below five. Not because I don't LIKE people older than 5....I just somehow relate better to under 3's and in nursing, feel the most comfortable with my knowledge here. After all, I was a neonatal intensive care nurse for 5 years before this. so I shy away from any patient that has hit puberty. I do not like taking the sick visitor on-call duty.....I do NOT like whiny adults. or patients that can affectively talk back or decide they will NOT do what I want them to do (I'm bigger than my kids, so they really have no options...what I say....goes). my compassion goes out the window the older you are. many can attest to these facts. I speak the truth. anyhow....this is just to preface my story about our missionary Heather last night (I use her name so you can pray for her by name).

I was resting from a long day, getting ready to go to our weekly home group last night when all of a sudden I heard a giant CRASH. then a loud scream. then silence. Then first responder Larry, called out, "are you okay," "do you need help" (yes, he has been trained in first-aid...and admits to knowing more than the average bear). I glance up from my solitaire game (yes, solitaire, darn you Chris) for a second, attentively listening. no response. I go back to my computer screen. then I hear first responder larry talking aloud. quick. I need towels. a chair. somewhere in this, I've assumed it's a giant rat that they have found.....but first responder larry's words don't really make sense if this was an accurate assumption....I look at my deck of hand....darn no moves....and think maybe I'll just meander out there and find out about this giant rat. what I found....was not a rat. and this is how...I poofed into adult trauma nurse.

(aside: if you are THE heather I'm talking about (sorry I slightly made the situation out to be not as serious at the time...it was for your own safety and to help me out as well).....if your name is pam and you have a daughter coming to visit me very soon.....or if you call yourself my mother.....or if you have thought about or are currently thinking about coming to visit me.....or simply you are squeamish......please skip to the last paragraph so you can simply pray.....OR click the small red X in your upper right hand corner NOW!)

what I saw.....was a very scared heather standing in utter shock with Larry and a kitchen towel applying pressure to her foot. also, as any good 2nd responder would do, I assessed the scene...and yes, I noticed that there was indeed NO danger of a large man eating rat, the broken glass coke bottle on the other side of the room and more importantly, the large puddle of blood under her foot. Dang. deep breath. silent prayer. ok, I can do this....yes, I had to pep talk myself.....go back and read the earlier paragraph puhlease!!! I grab the towel and look at first responder larry. he gives me the bullet. it's a bad cut, pretty deep, a lot of blood, not stopping. (and also....there's no help, no supplies, and you are in the middle of mozambique in heather's ROOM....oh wait...that was inferred, he didn't really say all that). so I start applying pressure and then gently try to see what the cut looks like. probably shouldn't have done that.....I have about 0.1 seconds to assess the giant gash atop her foot before the blood is shooting out at me. hmmmm.....this could be a bit of a problem. I think I flashed a concerned but it's ok you'll be just fine look at heather right about now. Then I grab a chair and practically shoved (I mean SAT) her in it so I could elevate her foot. yelling for more only partially clean kitchen towels now. applying so much pressure my hands hurt. towel getting moister. heather getting paler, less lucid, very dizzy, and nauseous. put your head in your lap please. I think I was screaming for someone to get some more nurses and supplies (real supplies from the clinic) in here.. could have just been in my head though....without luck of course. praying lots. tried applying pressure at all those nifty pressure points they show you. got a fake pressure dressing and tried to reinforce with more kitchen towels and literally tie around her foot to get better pressure. there are now 2 of us squeezing her foot. right....not working. clearly, by this point I'm thinking ARTERY. very funny God. hope you're going to give me some wisdom on this anytime now. ok. breathe. ok. heather. you're going to need to be on the floor like 2 minutes ok so I can have your foot way way higher than your heart....and so you'll not pass out. some seconds after I help her to the floor and raise her leg straight in the air and realize I STILL have no help, no supplies, and I'm in mozambique....I kinda half heartedly look around the room as if I'd see a magical blue button with the words CODE on it....and that maybe if I pressed or pulled it....I could have lots of help at my bedside. no button. a staples red easy button would do?? anywhere?.....darn. where are the buttons? I scream for someone to materialize the other 3 nurses on base now and to put a phone to my ear so I can yell the stinking supplies (besides the dish towels) that could be useful in a situation like this. insert other aside: thank you first assists fiona and rachel and also honorable mention to the administrative assistant and phone operator sharon. Then I think (heather if you are still reading or any of the aforementioned people in the first aside....please defer to the bottom paragraph now).....exactly HOW long does it take to physically exsanguinate...you know where ALL your blood flows out of the veins, onto the floor, and you cease to have more blood for you heart to pump??? wish I would have paid closer attention in nursing school....I'm sure they told me this really important decision making point sometime during those 5 semesters. I couldn't remember. what I did KNOW was that I was 99% sure it was less than the 45 minutes to the private emergency clinic in town. anytime now God would be good for something to help me out here. still no nurses. hmmm....I could use a tourniquet right about now. right, back to reality I'm in heather's room. blood pressure cuff. that could (will have to) work. I need someone to get in touch with someone that has keys to the clinic to get me a cuff and morph it here now. then it hits me that I have one thankfully in my room. I pass off the pressure applying job to someone and run to my room, grab the cough. fastened over her leg and pump it as high as it would go....then continue applying pressure to her foot. please work, please work. in walks our director (who is also a nurse). I give her the bullet. we wait a bit then slowly remove a little bit of the dressing enough to know it's mostly stopping now since I've cut off all of her blood supply. (yes she still had her foot straight up in the air). I pull ros aside to tell her the real story and how serious it is (no need to worry everyone else in the room). The other nurse solange arrives, quickly followed by the 4th nurse. oh yeah, show up when I need ya. thanks girls. I send solange for a lot of actually clean and real dressing supplies. I send jannie off to look for those cool elastic things they wrap around your arm after you give blood that stretches, hurts cause it gets so tight, and sticks to itself. she comes back emptyhanded....no worries. God prompted me to buy some while I was home in America for NO apparent reason and I kept it handy in my room for no good reason at all. Sharon had arranged transport. We throw bags together for transport. I gather a supply kit for the road....um.....just in case. I hydrate my patient (yes somewhere in the midst of all of this heather morphed into a patient), cause she's lost a little too much blood for my taste. we redress it carefully with proper supplies. I deflate the BP cuff and pray she doesn't start bleeding again. we wait awhile more. lower her leg to the floor. wait a while longer. there's a lot of hmmmss and whispering between ros and I and the other nurses at this point as to JUST how far 45 minutes is and do we think she'll start bleeding again. we help her up and into the "ambulance" (clarification a truck that has a shell on it and a foam mattress with 3 pillows in back....there's not even a light). by the time she's hopped the 25 feet to the car, her foot's bleeding through the bandaging job. I hop in the truck, praying fiercely, arm myself with my nifty cellphone flashlight (perhaps there WAS a reason my 2 previous phones just stopped working....they didn't have flashlight coincidentally), the blood pressure cuff, my "supplies" and off we go through the very dark, very bumpy night. I keep checking her foot to see if the bleeding as continued. good. it seems to have sealed itself off. we finally (a LONG 45 min later) arrive there. it takes an act of congress to get a wheelchair for her. I give the nurse the bullet and help heather into bed. he looks at the wound and grabs the doctor who discovers that there is tendon involvement as she can feel her big toe, but cannot move it. He wants to dig in her foot and find it and reattach it. at the bedside. with other patients in the room. next to the giant swinging door that leads to the street that keeps opening and shutting. without any kind of gowning, masking, or capping going on. ummmm.....thanks for playing, try again. just cause you speak english, doesn't make me that confident in your abilities or of this, ummm...clinic's. on and off the phone with Ros and passing on heather's insurance info. he doesn't listen. paternalistic medicine at his finest. administers a local anesthetic to numb her foot and start digging around for said missing tendon. there has been no paper work. no when was your last tetanus, no how much blood did she lose, no by the way do you have any allergies.....right. finally he gives up (to my silent celebratory imaginary dance) and put 4 (yes just 4) stitches in her foot to ward off infection (ha ha ha) and bandages it up and says, well you can go to SA if you want. that's what I've been trying to do.....for the last 45 min when you weren't listening to me. by this time, you've read a long story, now there's a boring part about stupid insurance companies (note to self: policy ends this month, will be changing to a more reliable tried and true and more expensive company) that ends with us begging them to admit her overnight so we can get the insurance company to agree to transport in the morning to SA to have this fixed, and some pain medicines, oh and you SURE you don't wanna give antibiotics. I was shot down on the last part. I didn't press my luck. I left the base around 5:30pm. returned a few minutes before 11pm. Heather stayed overnight without IV fluids, antibiotics, and only 1 pain shot for her insane pain. I gave her a large 1L bottle of water (or rather, made rachel give up hers) and stressed the importance of drinking LOTs and LOTS of water to replenish the blood she had lost since she was white as a piece of paper. This am, after several hours of fighting with said insurance group, we convinced them to transport her by ambulance the 3 hours through absolute bush and across the very horrible 3rd world border to the nearest South African town capable of handling her injury, but not until after I packed a bag of emergency supplies and taught her private car driver/potential life safer/fellow missionary how to apply my nifty patent pending BP cuff tourniquet and pressure dressings in case she decided to start bleeding on the way over there. An US embassy contact finally came through for us with some surgical references, and helpful hints to navigate the system.

Heather was admitted to the hospital this evening, 24 hours AFTER the tendon slicing and artery nicking adventure and was waiting to see a doctor the last time I was able to have an update. They will need to probably cut up her leg and find her tendon (that retracted up her leg), pull it down, and reattach it, along with debreeding her wound. Remember she still hasn't had any antibiotics yet. They were good enough to give her a 2nd pain medicine injection before she left the Moz clinic. Please pray for Heather's peace, her health, NO infection, NO pain, a safe and successful surgery, a quick and FULL recovery. Please pray for her family that are home in England worried sick I'm sure about their 23 year old daughter in Africa having her first surgery! Pray for wisdom for the doctors and a steady hand for the surgeon. will update more as I know it. for now....get to praying for these 4!!!

UPDATE on HEATHER: she's out of surgery, it was successful, she's awake and eating! Praise God! Continue praying for NO adverse affects, NO infection, NO pain, and a quick recovery.

FRIDAY UPDATE on HEATHER: she's having a little trouble with pain control today, but now it seems better. she has a cast up to her ankle. plans for discharge today and she will stay with some missionaries in SA for a week to recover and keep her leg propped up (HEATHER-keep you leg propped up!!!). Keep praying for better pain control, NO infection, and a quick recovery with full mobility of her big toe!!! :)