I survived, though the patients can't all say the same

It's all unofficially over. I have most of my signatures needed from the units, minus two I have to go get tomorrow from people who weren't there today. Then on Monday I have to meet with the Head Matron (otherwise known as the Chief Nursing Officer) and get her to sign off on it all. I have nightmares that she'll find some reason to say I have to do more time, so you all can pray for that meeting!!! Then I have to go to the National Nursing Council where I'll likely sit for hours, and get them to issue me an official license (which is nothing but a stamped receipt saying I've paid for one...you would think they could have just taken my money and bypassed the whole "orientation" thing!!!)

My last week went ok. I did some time in the ER, which is just a glorified mini-surgical clinic where we inserted chest tubes, cleaned burn wounds, and cut open abscesses...none of which I handled well. I will blame it on the pregnancy, but my nursing school friends will know better--I've never had much of a stomach for pus and pain! My friend here has pointed out that here in Malawi, pain is NOT the 5th vital sign (the opposite of a common slogan in US hospitals). When people started passing out from the pain, or calling on Jesus to come and save them, I had to make fast exits and ended up spending much time in the ER parking lot trying not to pass out!

With the chest tube, a full 2 liters of pus immediately came out, overflowing the bottle meant to collect it, sending a volcano of TB-infected pus all over the floor and our shoes. None of us had masks or gowns on...Malawi is "resource challenged" (the understatement of the century!) That's what I got to do when I followed the doctors. When they put me with the nurse (the singular is not a typo) we spent the afternoon folding gauze pads and rolling cotton balls. It was much easier on my stomach, and we had to wear masks so the cotton fibers wouldn't irritate our lungs. Good thing I won't have cotton-irritation to complicate the TB I've just been exposed to!!!!!

Then I was on the medical floor, which went much better than I expected. It wasn't all that busy, though several patients died each day I was there. In fact, surgical is almost twice as busy! I concluded that here, with no CTs or MRIs and limited other 'medical studies' or drugs, it's actually easier to do surgery than treat medically! I never would have thought it! But I rounded with two British medical students (we were on our own, as the attending disappeared for 2 straight days!) with our text books and our notebooks and our nervousness about managing people's crazily complicated conditions (like fever (103), signs of sepsis (heart rate of 170, low BP), TB, anemia (Hgb of 5.3, not low enough to transfuse here...we transfuse at 8 in the US!), HIV, possible gallbladder disease, abdominal mass, heart failure with mild cardiac tampanode, and a swollen right leg...all in the same 23 year-old girl!!!! I celebrated that none of the deaths were of our patients! It's all about the minor victories, I guess.


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