Cool Factor

A few days ago, two coworkers and I were discussing how many different kinds of people you meet doing international work. "You definitely meet all kinds..." I said. In light of the President's Day weekend activities at home, one of them asked if we use every part of the pig when we butcher. (I did give the correct response, but then one of them asked what the squeal was.) "What about the ears?" the other asked, "What do you do with those, wear them?" she laughed. And after I had to respond, "So, funny story...", I realized that I am actually the "all kinds."

We haven't yet discovered what makes our newest nurse unusual. He spent a few weeks working in Liberia last Fall, so his training here is a bit abbreviated. But as seems to have become the custom, I take the new person into the ward for his first admission. And it always seems to be a clown ambulance... So the other day, the new nurse joined me and my national nurse for the admission. Per the training director's orders, he was still only allowed to observe, he couldn't touch any patients.

It was a bit of a fiasco trying to triage these three patients. It seemed like they had collaborated on the ambulance ride to come up with a story. We already knew they were from a quarantined home, and the ambulance nurse told us that it was because someone died. The patients were a brother and sister and their nephew. All three looked at us with their bloodshot eyes and denied contact with any sick person. We would try to ask the child questions and the uncle would jump in and answer. "Have you had hiccups?" we asked him. He shook his head no and then hiccuped. Eventually it came out that their mother had been in another ETC and survived. Carrie was on the other side of the plexiglass and finally said, "We know someone died. Who died?!" Their father.

We walked all three patients into Suspect. We had to draw blood on all three and start lines in two of them. When we were in triage, I had washed my hands and somehow poked a hole in my outer glove when turning off the faucet on the bucket. If something happens to the outer glove but the first is still intact, you can just put a new glove on over the second. So someone threw me another pack of surgical gloves. So now we had three bloods to draw and two lines to start and I'm wearing three gloves on my dominant hand. Luckily they all had pretty good veins and my local nurse could do IVs. Our new nurse, who works in the ER at home, was still watching, much to all of our frustration.

I drew the first patient's labs and then moved on to the woman who needed labs and a line. The local nurse was going to work on her. I put the tourniquet on just to look. The patient had nice veins in her AC, so I grabbed the nurse two 18 gauges. I went to the patient's other side and told her she could squeeze my hand if she wanted to. I wasn't sure how much English she understood, but I talk to my patients anyway. (I mean, I have full conversations with Bud...) Then the nurse stuck her and I discovered that she had definitely understood me. She almost broke my hand. And that's when I looked at my nurse and saw that she had stuck the patient in the hand with my 18 gauge. "The veins are too small for this needle," she told me. Right...that's why I was aiming much higher in the arm... So we had to do the whole sticking/hand in the vice grip thing again. The nurse got the access and we drew the lab, then we started taping down the IV. Apparently "let go" was not in the patient's vocabulary, so I was reaching across the bed and trying to put the tegaderm on with one hand. The nurses here aren't experienced with tegaderms. While I was trying to be helpful, I ended up getting one of the strips on the back of the teg stuck across my three middle fingers. Really stuck. I tried to carefully pull it off, but I knew my glove would rip and there was no way I was getting a fourth glove on (oh, I mentioned that this was also on my right hand?). I soaked my hand in a bucket of 0.5% chlorine. Props to the adhesive manufacturers. And, of course, the one pair of scissors we keep in the ward was nowhere to be found. Oh hey, then we somehow lost the line. After we came out, it was pretty funny that I had taped three of my fingers together, but when my goggles were fogging and there was no end or success in sight (no pun intended), I wasn't as amused.

The next day when we finally got labs back (because it's back to taking 12-36 hours), they were all positive. A few hours ago when I was in the ward, we moved the the brother and nephew into a different pod so they wouldn't have to watch the woman die.

I had another new experience this week. While I was on R&R, a group from a University in the States stopped by to discuss a study they're doing. As a parting gift, they left us two cool vests. I finally got to wear one. We had a mandatory training this week and sent most of our nurses during the afternoon shift, so Carrie and I took the vests and went in to do afternoon meds. I've heard that it's below zero at home. Here the ambient temperature is 94. Then put on full PPE and go inside an unventilated tent. Vest with five giant ice packs in? Yes please. It was a bit unpleasant when putting it on in the pharmacy, and it's a little weird to have spots on your body that almost hurt from cold when you can feel sweat on other parts of your body.

We had fluids in two different wards, and we figured we would spend about an hour in each ward. And then two of our suspect patients pulled out their lines. At the same time. (Yes, one was the kid from the day before.) When we were getting ready to restart the first line, Carrie was inspecting my face and said my corners were getting close (you have to see all four corners of your hood/mask inside your goggles). In my frustration, I must've opened my mouth too wide a few too many times, because after I blew two of his veins, Carrie said she couldn't see my bottom corners and I had to leave.

So I only got to spend an hour in the cool vest, which was kind of pointless because I didn't even get to take advantage of the vest's purpose. However, I did notice that I did not get out of breath at all while inside, and that was really nice. I'm told that March is the hottest time of the year here, so I'm sure there will be more opportunities to use them. I hope everyone at home is enjoying the 100 degree difference.