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18 February 2015
Sun! Glorious sun! I got up early to sit out on the roof and soak up those gorgeous rays and read and journal. The sun sets around seven here so once it went down I just went back to bed. I told the girls I was going to wait for a ride for real this time and my nap was interrupted by a man at the door who spoke no English but indicated that someone was there to pick me up.
The second heart wasn’t back yet when I got to the hospital but the first surgery was there and doing well. D. is from an Omo Valley tribe and had a mitral valve repair. She’s 12 yo, 4’7″ (140 cm) and 57 lbs (26 kg), and about the cutest thing I’ve ever seen. Four hours after open heart surgery and she was awake and alert, sitting up in bed with a teddy bear in one hand and a glass of milk in the other. I just wanted to curl up in bed beside her. While she was sleeping I snuck in quietly to strip her chest tubes but she woke up and gave me and those tubes the most bewildered looks, like “Who is this white woman and what the hell are those coming out of my chest?” Oh she made me laugh. Sitting at the nurses’ station I would look up often to find her quietly staring at me. I wanted to scoop her up, too and just run away. Ducklings, Jamie, ducklings.
The second surgery, B., came back after her On-X mitral valve replacement, only to go back to surgery fairly quickly because of bleeding from her chest. The other girls had already gone home so (after getting permission of course) I grabbed my camera and went to the OR with Tahta, Doug, and Jen. After opening her chest again Tahta found a small arterial bleed in the chest wall which he quickly cauterized. I love wounds and all things disgusting, but remind me never to be an OR nurse. I felt the darkness setting in more than once and had to take a seat. It’s not that I was grossed out; I think it’s just all that standing and breathing into a mask. I don’t like it, I hate it. Jen asked if I was comfortable extubating after they left and I told her I’d never done it, but I knew the basics- suction, deflate, pull. I was excited to try it, but when they wheeled her into the ICU she was already extubated. Wah wah.
B. is 14 yo, 4’11” (149 cm) and 90 lbs (41 kg) and gorgeous. Africans have the best skin, I swear. Iodine deficiency is common in Ethiopia and B. had a goiter on the right side of her neck. Apparently iodine-deficiency goiters only show up during puberty and goes away afterward. Isn’t that weird? After the re-op excitement she did great with minimal chest tube output and no need for pressors or more blood overnight. These kids are champs, and easy to take care of. Don’t tell the other girls, but I think I drew the lucky straw working nights.
There were four nurses on tonight, one for each patient- the three valves plus the effusion guy. 1:1 nursing, even a day out of surgery. What a life! Around midnight one of the nurses told everyone goodbye. I asked if she was leaving and another nurse said “No, she’s going to take a nap and I’m going with her.” They all take turns taking two hour naps! One of them had a room set up for me as well, which of course I took advantage of. Thanks to Sarah Godinez, I’m a huge believer in naps at work. I’ll watch your patients anytime you need to go take one. What good are you as a nurse if you can’t keep your eyes open?
After her post-op ABGs B. needed a bit of bicarb. I was thinking one amp but the cardiologist on duty gave me 20 meq. Duh- these are teeny tiny kids. I pulled out one of the pre-mixed amps of bicarb we had brought with us and the nurses were amazed. One was like “Just like that? You don’t need to mix anything? That is really nice” and she called over another nurse to check it out. These girls mix everything themselves. I didn’t have the heart to tell them about our pharmacy at home making everything for us. Boy are we spoiled.
This unit feels 1000x cleaner than the ICU at home. Maybe because it’s full of kids. Maybe because they all get bed baths before breakfast the morning after surgery. I love the open set up of this unit, too, though with four nurses chatting it gets pretty loud for the patients. Otherwise it’s great for keeping an eye on everyone and it makes it easy for all the nurses to help each other. I would love this at home if everyone weren’t in some kind of isolation. So much easier to spot trouble and assist than in our huge, divided units and a great way to keep a closer eye on rascals. I’d been reading Larry McMurtry’s ‘Dead Man’s Walk’ when not at the hospital so everyone’s a rascal, and all women are… well, you know what. The nurses paper chart and only write progress notes, and only after physical changes, nursing procedures, and a general summary of the patient’s condition at the end of the shift. Isn’t that awesome?
A lovely nap at work and a boring night, then breakfast with Solomon before my ride home. Another perfect day.