"The best way to find yourself is to lose yourself in the service of others..."
- Mohandas Karamchand Gandhi

31.5.11

The Pistol, The Ninja, The Saint and The Jailbait

Sometimes a patient goes into surgery screaming bloody murder, they know something fishy is up and they are not into it. They come out screaming just as loud except now we’ve really done it. They’re in pain and the last thing they recall is a bunch of strangers holding them down on a gurney in a weird room. We were probably speaking in tongues to them too. They are what we might call “A pistol.” This child is angry, doesn’t like you and is going to let you know. A 1 hour temper tantrum is headed right down that hall and into the quiet little PACU. Usually this patient has had a palate repair. Tongue stitch: Check. IV that needs to stay in over night: Check. Sensitive palate stitching: Check. Sneaky hands of an angry child: check. I usually rotate wrestling this child with the intesivist and other PACU nurse. This is why I have become incredibly buff. This is also why I have hearing loss. The poor child is so upset that I have actually seen a melt-down recur at the drop of a rupee.

Then there’s the patient who you’re terrified of pre-operatively but in love with post-operatively. These are the kids in which anesthesia flips off the crazy switch. I might refer to this patient as “A Ninja.” I see them through the PACU doors being carried back to the OT actively punching the nurse in the face whilst screaming AND simultaneously rotating their head 360 degrees all Exorcist style. For 1 1/2- 2 hours I pace the PACU in anticipation of their arrival. When I see the door to the OT slide open, I break out in a sweat. They get carried down the hall, placed in a recovery gurney and I suddenly notice that their head seems to have made it back into anatomical position quite nicely then realize I’m not being physically assaulted! They wake up a while later, those little eyes flutter open, land on you and finally, you exhale a huge sigh of relief. I scoop them up in my arms and soak in this priceless time between us. It manages to be so much sweeter when you anticipated a devil child and received an angel.  They have, in other words, ninja-d their way into your heart.

A kid who doesn’t even know they’ve had surgery is always mind blowing. This is the one that holds hands with the nurse as they walk back and I know it is going to be smooth sailing. You may hear me call this patient “The Saint.” I see those OT doors open up and my heart skips a beat. Usually these ones sleep off the anesthesia for quite sometime because they’re clearly taking the best nap of their life. Out of nowhere they pop up in their gurney. Bright eyed and bushy tailed. They don’t care about their IV, or their stitched up lip; they’re way more interested in checking out all the other screaming children. I can see them thinking “Chill out dude, you’re totally throwing your chakras out of line.” Then they eye the panee, the water. But wait, is that Tang?! Frutee? I bring them over a cup and feed them with the syringe and they gulp it down. Some even take charge of the syringe and I’m like “Wait, did you just have surgery or is this one of those Halloween make-up ‘look at me I’m all stitched up but not really’ kind of jokes?” They don’t care that their nose is oozing or that there’s a 3.0 silk suture through their tongue, they just want to blow some dang bubbles and take a wheelchair ride. They are all calm all the time.

Lastly, there are the patients (usually in the 18 months-3 year range) who give you a run for your money initially. They come in wailing, maybe kicking you in the yoni, maybe screaming blood directly onto your shirt. Before you know it you’re looking through your backpack to see what you can ditch in order to make room for the 11 kilo baby your about to try to take home. You’re looking out the windows seeing which way is the safest path to the ground so you don’t have to pass their parents in the hall on your way home with your newly abducted adopted child. I refer to this bunch as “Jailbait.” Okay, okay so I won’t be taking home any children without direct permission but seriously I can’t hold/cuddle/love on these kids enough. You know that feeling deep in your chest when you’re holding a child and they nuzzle deeper into you? Your hearts melt together in that moment. Tonight one of these kids coughed, gagged and then threw up a few ounces of bloody vomit onto my shirt and leg. We kept right on cuddling. And that, my friends, is how you know you love what you’re doing.

26.5.11

Wrapping up the May mission

Heading into the last of seven surgical days for the May mission at the Guwahati Cleft Care Center better known as GC4. We'll have performed a total of 175 surgeries by the end of today!! This mission went so smoothly and safely. We couldn't have planned for a better inaugural mission in our new center! We ran 6 tables simultaneously and utilized my pretty little recovery room to its max! Everything has held up very well and there are A LOT of happy patients and families. Tomorrow the international team will leave and we'll go back to our day to day work. Many fellow nurses have asked me if I can believe that the mission is already over and all I can think is, I live the mission baby! Seriously, I am can't believe I am staying here and continuing this work. I have some goals for education with the local staff and also for stepping up the discharge education for our daily kids. Seeing how organized and consistent the discharge teaching has been this week, I definitely feel that I personally could do a better job off the mission. I am hoping to get going with a standardized discharge teaching every morning, something I have seen lacking since I have been here. Discharge teaching is pertinent to the reduction of post-surgical complications and it is our job as the nurse to empower the patients and families to do their part. End rant.

Anyhow, we received our team t-shirts today! A lovely purple! GC4!!!


24.5.11

Something like 3 weeks in

I have been living here for a mere 3 weeks now and it has been a whirlwind. I dove right in after arriving. I worked 2 days, worked one night, opened the cleft care center on the Monday after I arrived, we worked out of the center that week, flew to Sri Lanka that Friday, came home one week ago, went straight to a meeting, started screening for mission week last Wednesday, mission team arrived Thursday, started surgeries Friday, worked the mission until yesterday, have today off and then 2.5 more days of mission surgeries.

Barely enough time to breath, right? I think I am adjusting fairly well but I am still trying to find my place here and get my two feet on the ground. I came to Guwahati's Comprehensive Cleft Care Center (also known as GC4) knowing I was walking into a challenge. The core team here has been together for months.  Living and working together, getting this center off the ground and running together. I was entering into a very tightly knit group, praying that there was room for me beyond just being a bedside nurse. The whole team welcomed me with open arms and has really made me feel at home. I am beyond thankful for that. Still though, I am struggling with finding my true purpose and role. I didn't put in the time and effort to open this center, and that is unintentionally made very apparent to me. So, I feel a little out of place and out of step with the team members that have been here for months working hard to make this happen. I am so invested in this center and its mission and am looking forward to being an invaluable member of this team. Watching the center open was a huge deal to me. I am here, I am ready to make this place sustainable. I want to educated and train these nurses and show them what it means to be a leader, a patient advocate and a nurse with global standards . I am ready.

22.5.11

What would it feel like?

What would it feel like to see yourself for the first time after having your severe cleft lip repaired? Do you feel excited? How would you even recognize yourself? Do these children and adults have an identity crisis or is their self-confidence boosted immediately? Do they cry tears of joy or tears of loss of self? I personally have never experienced such a physical change in my life and I have to imagine that no amount of preparation can prepare you for the experience of looking in a mirror for the first time. How strange it must feel to open in close your mouth and have your lips close completely against one another. Do you feel a sense of relief? Is it overwhelming? Is it everything you had hoped for? Did we hold our promise to you? Is your smile all fixed?

Today Lokhi's severe bilateral cleft lip was repaired. He is fifteen years old and tears streamed down his face as he looked in the mirror for the first time. I cried right along with him as I held his hand and those questions raced through my mind. I asked him if he was paining to which he said no. I told him he was beautiful to which he nodded and it is true. Inside and out. He is a beautiful child whom I am so blessed to care for.





I worked for 16 hours today. Holding the hand of one patient, seeing the thankfulness in their eyes makes every last minute worth it. From the 10 year old who gave me the thumbs up as he was wheeled in to the OR for the second time to control the bleeding to Lokhi and his dad who couldn't stop thanking the team; I am made full and of course, here come the tears again.


8.5.11

Home life

Here is a little photo tour of where I live. I think the view from outside my porch is the perfect example of the way India is so beautiful and so heart breaking all in one view.









I love the lush green hills that I can see while eating my meals but just below me is shanty homes and mounds of garbage. This is something I've already become accustomed to seeing and the garbage doesn't bother me at all. You just can't get only an eyeful of beauty here. You take the good with the bad.

With that being said here are a few photos of my flat and the street I live on. There are a few little shops and restaurants right near and the fresh fruit/veggie market is just a short ride away.



My flat

The little market on the right is where I get milk, sugar and other little things


I've fallen in love with taking bucket showers. I have a shower head (as you can see) but it gushes out all of the warm water in under a minute. One of my roomies advised me to try the bucket method and I am in love. I can just savor my 'shower' time and the water in the bucket stays warm for quite a while. So, I love squatty potties and bucket baths. I think I'm going to survive.






My first few days

I've had my first few shifts at the cleft center and am already looking forward to what next week will bring. We are averaging 4 cases per day right now with our 2 plastic surgeons. Usually for half of the day one does surgery while the other does the follow up appointments from the previous week.

I am settling into my role and just trying to learn the ropes as of now. I will definitely be on more of a leader/nurse educator/supervisory role along with another nurse Susie. We head up the pre/post and recovery nurse staff. Susie has been here for months so she carries a huge weight of this responsibility right now but hopefully soon I will be able to really share the load with her.

We are not yet operating out of our center but we are projecting our first patient to operated on Monday there. Because of this, we prep patients for surgery, recover them and have he post op beds all in one space. It gets chaotic but I think a lot of that chaos will be settled once the center is open and we can have the recovery room on it's own as it should be.



Smushy pre/post/recovery area


Such a cutie


I've gotten to interact this week with a little 8 year old who is a World Care patient. He was born with a severe facial cleft and has had multiple operations in attempt to reconstruct his face (in the video below he has already had some repairs). He was actually flown to Virginia to be operated on by the head of Operation Smile and has since come back to India where we are further treating him. He is fighting a pretty bad infection and it looks like he may be rejecting the graft that made up his nose. He had a surgery to remove some infected parts and wash out the area two days ago. Here is a little video about him:



I don't think I can effectively convey how much this boy settles into your heart and shows us as the team why we do these surgeries. Just as it is described in the video, Nur has blossomed into such an amazing kid. He jokes around, plays, shares his food (today I was charting when a chocolate bar landed on top of my chart, he wanted me to have it). I have been praying hard for Nur and the team asking that we do the best by him and his family. I just hope that he doesn't get broken down by all of the surgeries and painful procedures. It must be so confusing to him, we are his friends but we hurt him and make him take medicine and clean his wounds. Luckily, he is forgiving and even though at midnight he was spitting his medicine at me he ended the morning playing games and drawing pictures with me. He he is so amazing.







(all photos taken by Nur)

Side note: He always draws the most detailed noses, it's so sad :( AND that's a picture of me... with a baby in my belly... not so accurate but hey! 

This week will be long but I can't wait to see what it brings!

7.5.11

A saturday in India

Today my roomie/co-worker Rosie took me on a ride through Guwahati on the scootie! First we stopped by the hospital to visit one of our favorite patients and so I could check on the discharges (I have already learned that a day off isn't a day off, you always find yourself here somehow. Projecting 60-70 hour weeks) Then we rode along the river front down into a quieter part of the city. It was much calmer and the breeze felt good on the back of the scootie. I may need to take the plunge and buy one so I have a bit of independence as opposed to relying on a driver. For the rest of the day I alternated lounging around with exploring the area immediately around my flat. So far the food has been great and the people even greater! Then I took a nap as I had to work a night shift! I woke up and was invited out to dinner before I had to head to the hospital and of course I obliged. I can't remember its name but it was traditional Indian food and just what I needed before a long night.

As I was sitting in the ward reading while our only 2 patients slept, a patient from the ward we share came over to me. He handed me packets of medicine and asked which was the one for pain (many times here the patients are responsible for going out and buying medicine for themselves while in the hospital). I looked it over and recognized 2 of the medications but the third I wasn't familiar with. The local nurse said this was pain medicine. As he walked away he handed me this note:




Because it is hard to read here is what it says:

"My Hope. 8/5/11

Sister. I go to your country with family. Please give  me a job from your country. I'm a good worker. My jobs name, pilot, painter, bricks worker, and polish and copy. ____ worker. I'm a Indian my resident is west bengal Alipurduar, newsoraganj, district Jalpaiguri. My age 36. My name is Samkar Sarkar. I love my country and others country. Sister please help me."

Guh, I think my hear just broke in a thousand pieces. He doesn't ask for money or food, he asks for a job. He laid on his bed at 230am and hand wrote a resume in damn good English too. This is place fills me up in so many ways but breaks me down in many others. The people are so beautiful, kind and genuine but the poverty and desperation is deep. I came here to help change he lives of these children, to give them a better chance a a normal Indian life but I still feel so limited. I love the work I am doing but I worry that it is not enough :/







After my shift was over I headed home on a tuk tuk and ate a yummy omelette! I am trying to will myself to sleep but I'm still hungry!! 

4.5.11

I am home

I arrived in Guwahati about 20 hours ago after 30 hours of travel. My flights were very uneventful except that the airline that  I was supposed to be on for the last leg of my journey went on strike while I was over the sea heading for Dubai. Luckily, OpSmile is awesome and had already purchased me a ticket on another airline and luckily Dubai airport had free wifi so I got to check my email and find this all out! Otherwise, all my luggage made it with me and there was a driver waiting for me at the little airport.

The driver is pretty much the most aggressive driver I've experienced yet. I don't think we ever came to a full stop one time on the 20/30 minute drive to the flat. We spent a majority of the time driving on the opposite direction of traffic's lane. But I made it nice and safe, which is all that mattered! We did almost hit a few cows and I had to think, what would be the consequence if that happened? Anywho, I got the the flat and Susie and Rosie (the other 2 nurses I am living with) were at work so it was just me. Or so I thought. The apartment people offered to make me lunch and I obliged. Meanwhile, I unpacked everything and walked around the flat with a huge smile on my face. I have my own bathroom with a shower, though I have been advised to just use my water bucket for showers since there's very little hot water. I have a queen sized bed, big closet and even t.v.! While I was unpacking there was a knock on the door so I went and released the dead bolt, opened the door and found that it was the apartment people with food. The quickly told me not to lock the deadbolt so next time they could just come in and leave the food!

I finished eating and decided it was shower time. When I got out of the shower there was a little hunched over lady sweeping my floor in my bedroom. She looks as though she may not even be able to stand up straight, she has been sweeping so much. I was in my towel and just said hi and we both went on with our business. About 10 minutes later someone else came in and took out the trash then a bit later someone else came in and cleaned the bathrooms. I'm pretty sure while I was napping yet another person came in to do who knows what!

That evening Susie and Rosie got home with some dinner. I decided to just go for it and eat the chicken and fresh veggies with them, 2 whole categories of food that I didn't touch last time I was here. It's the next morning now and I still feel fine! We sat around and laughed about all the different cleaning people and they confirmed that there are about 10 different people with 10 different jobs during the day. I actually feel weird and slightly guilty that there are people that come in and do all of this stuff instead of me doing it on my own. On the other hand, I am thankful that they have a job so I guess we'll just call it even.

I slept like a rock last night and now I am off to get ready for my first day!

Notes from the air plane

445 pm
Air Emirates is amazing! They have spoiled us with a little overnight pack, a nice blanket and endless in flight entertainment

605pm
The two ladies next to me are a mom and daughter and heading to Iran. The daughter keeps pulling Kleenex out of her sleeve

623pm
Neighbor is now stuffing plane food in her purse

810pm
Chugging Water and Melatonin

1048pm
Why am I awake

1049pm
Some babies have the most angry cries.

1051pm
There are at least 2 kids with a gnarly cough and pneumonia and maybe even some pertussis?

107am
My right knee cap is throbbing. As it always does on long airplane rides.

111am
Radiohead putting me back to sleep

419am
Loud noises. Or should I say loud voices. Plus, my bum is completely numb as well as 4 of my toes on my left foot.

5am
I've used the toilet once in 12 hours. I'm the ideal window seat occupant.

528am
Movie roll: Beauty and the Beast, No Strings attached, Tangled and now going to attempt The Switch.

7am
Fell asleep twice during the switch. That's the Kristin way.

713am
Fell asleep again and dreamt that I missed breakfast. It was terrifying.

757am
Just used the bathroom and someone attempted to open the door. I yelled "occupado!" where is that from?!

759am
55 more minutes to Dubai!! I was going to watch The King's Speech but now I think i'll just read!

845am aka 745pm Dubai time
It's always weird when you land in a new country at night. For all I know, the pilot just did circles around Southern California for 16 hours. It's all city lights to me this high in the sky.

235am-Delhi time
It's currently 89 degrees out. God bless the Indian summer.