Ambulatory Trauma

After my last post, I was chastised by someone with an intense fear of needles for not including a warning that I was telling stories involving needles. So let me state that right off the bat: this post involves needles.
I also need to preface this by saying that Yvena, the only English-speaking nurse, had today off. Another nurse, Hermicia, was helping out and she is in the "first grade of English." Other than that, this was a fairly normal day at the clinic (maybe "typical" would be a better word). Around noon, a woman was carried in. She had a thermos with her which was holding vials of insulin. I took her blood pressure and temperature and then we kind of moved her off to the side (she'd had a leg amputated so we didn't make her move around a lot). She sat in the corner for close to an hour. Then things like a liter of saline and a liter of 5% dextrose started appearing on the table. I was pretty confused as to why we were going to pump her full of dextrose if we were also giving her insulin, but then after some rapid Creole, the dextrose was replaced with a liter of saline with potassium. Mind you, it is after 1pm at this point, and the clinic closes at 3. And if people have IVs running and its getting close to 3, the nurses speed them up so we can get out on time. Then a random assortment of needles is thrown onto the table. I see 18gauge first. That is a fairly big needle, considering the size of this woman. The other ones were 22g, my nemesis needle. The needle I used when I missed my first IV. The needle that doesn't show a flash of blood until its just about too late. I feel validated in this because my mom also said they can be tricky (maybe she was trying to make me feel better, but we'll go with it).
"Sarah!" The woman's veins were officially mine now. I put the tourniquet on. I can sort of see some really tiny squiggly veins in her hand, but nothing I liked, so I moved it up above her elbow. When no veins popped up at all, I broke out in a sweat. I think it was at this point that the woman started removing her clothes with the tourniquet still on her arm. I tried telling her that wasn't necessary, but to no avail. Eventually I got my tourniquet back and put it on the other arm. Nothing. Moved it again. Something that I thought might be a vein showed up on her arm, so I went for it. Me and the 18g needle. It was a miss. So I went hunting for veins again. There was a tiny one in her hand that looked like the best option. I was handed the 22g, and by this time, a crowd of nurses is gathering. So I stuck this poor woman again, and just when I was about to take it out because I just wasn't getting it, I got a flash of blood. Then starts the chaos. Another nurse takes the needle, I'm still holding the catheter in place with my hand, and yet another nurse is trying to hook up the saline with potassium (nevermind that I can practically hear instructors yelling at me for even opening the packaging without knowing the woman's labs). Then the patient starts pumping her hand like I had her do when I was looking for veins. So I'm trying to tell her to stop, hold the catheter, and get someone to give me tape. All the while, the roosters are going crazy outside. Hermicia started speaking to me in rapid Creole at this point until I ended up nearly yelling, "Hermicia! TAPE!" By that time it was too late. The catheter was bent and partially out of her hand, and no amount of adjusting could get it back in.
For some reason, they handed me another needle. This was when the head nurse showed up. Sweet woman, but just the title makes her intimidating to me. So I went back to the other arm. Found another vein and stuck her for third time, officially making her a pincushion. I missed. The head nurse tried moving it around, but we ended up taking it out. I threw in my gloves at this point, and the head nurse took over. I felt a little better about myself when she looked at the patient's arms for awhile and all she could say was, "Oh, piti! [small]". She stuck this woman twice. And yet a third nurse went to work on this woman. She stuck her three or four times before she finally got the line in. Overall, it was a mildly traumatic afternoon for me, and I wasn't even the one being repeatedly stuck. But that lady was quite the trooper.
I got home and stopped in the kitchen on my way up. Leah and I sat down at the table while I was eating my snack, and then she got a phone call. I was pretty intent on my banana and trying to fix the damage she'd done to the peanut butter by just digging into the middle of the jar and didn't really notice what she was saying. She hung up and said, "You're going to go clean wounds on a man with spinal cord injuries." Shortly after, we were picked up by Audrey (YWAM staff who was previously involved with the clinic) and taken to this man's house. Here, it was the same man who came to the clinic last week with lots of random cuts and stitches on his head and ear. It was there that I went from RN to MD. This man has intense pain in his neck and back, radiating down into his arms, and can hardly walk. I cleaned his wounds and then his wife handed me his xrays. I have no idea how to read an xray. But I didn't see anything sticking out of somewhere it shouldn't be or anything like that. I asked Leah about MRIs, but she said it's not an option in this country. So I asked what he was given at the clinic. He was a recipient of the basic package: ibuprofen, tylenol, amoxicillin, and vitamin c. So I'm prescribing him some muscle relaxants for now, which he'll get tomorrow when I go back to take his stitches out. Praise the Lord, all his lacerations are clean and nicely healed.
What I truly intended for this post to be was an update on my transportation situation, since that was the only specific prayer request I had before leaving. This morning on my way to the clinic I was trying to think of what to post about since certain members of my family get a little excited if I wait too long. And I decided transportation was the topic since nothing too exciting has happened in the last few days. (And by that I mean I've gotten used to the fact that every day is some sort of adventure). So that's the last time I'll think that I've gotten used to life here. Anyways, I pretty much have stable transportation to the clinic each day. Leah and I found these two moto drivers who are pretty reliable, fair, and safe. So one of them has been outside our house each morning to take me. This morning neither could take me, but the one was still outside to say he had someone else he knew who would. The afternoons have definitely been a lot more of an adventure. I'll spare the details for my mother's sake, but I have made it home safely (eventually) each day. It's almost more fun this way, just because God has provided something different every day, but there's always something. However, something stable would be appreciated as well. In the meantime, the nurses have taken to staying until they make sure I'm on a moto and the driver knows where my house is. I believe I've now perfected how to hold on with one hand and hold my skirt down with the other. And I think I've discovered the pecking order for street use around here. Pedestrians are at the bottom, trumped by pedestrians with wheelbarrows. Above them is bicyclists, then motos. Motos are trumped by cars, cars by trucks, and trucks by busses. The coke truck trumps all, unless there is a goat involved. Or if a fight breaks out in the street. But that's a story for when I'm on US soil again.

Trilingual Trifecta

Yesterday was my first day at the clinic. My understanding was that I'd be observing and kind of getting a feel for what goes on there. But they just put me to work, and that was fine because otherwise I would've been bored. I was taking temperatures and blood pressures and subsequently added the words "arm up" and "arm down" to my creole vocabulary. There is one nurse who speaks a fair amount of English and another who speaks Spanish and a tiny bit of English, so between the three of us I get some instructions and we manage to have a little bit of conversation. The Spanish speaking nurse, Stephane, works in the pharmacy, and I spent the second half of the day with her. There I learned to say "one/two/three a day."
Today was an incredibly interesting day. I was taking temps and BPs when these two kids bring their dad in with a towel over his head, looking like he is in a lot of pain. The nurse said, "Sarah, come. You clean and I hand you things." I removed bandages and gauze (which had dried to his head) to find lots of random abrasions and stitches all over one side of this man's head, including his ear. So we cleaned and rebandaged, and that's all I know. I have no idea how the injury happened, and no idea if he got any pain meds, antibiotics, etc. Then there was a boy with wounds on the bottom of his foot. While I was going through in my head what type of dressing would be best, I discovered that we have a pretty simple system used for all injuries. My choice of peroxide or saline, then betadine, then neosporin. He left in flip flops, walking on his toes.
I didn't have much time to think about that, because there was a guy in line behind him. I didn't see any wounds or bandages. Then I hear, "Sarah, IV medication." During the 90 seconds it took to get on my vinyl, non-powdered gloves in the Haitian heat, I checked this guy over and over again for any sign of a heplock. After being positive there wasn't one, but in the rational moment I had before my heart started pounding, I thought I'd double check with the nurse mixing up the anti-infective. "Sooooo you stick this...right in the vein?" "Yes, wherever you can find." Fantastic. Someone found a tourniquet, and we checked out his hand. I wasn't impressed. In fact, I was starting to freak out. Perhaps if the needle hadn't been an inch and a half long, I might've tried the one tiny little crooked vein on the side of his hand. But probably not. So we moved the tourniquet up above his elbow. A single vein popped up, but it was a good one, except for the valve. But I somehow managed to get this needle in, and then I pushed the med, torn between whether I should give it slow because I knew it probably shouldn't go in too fast and just pushing because I knew it had to hurt a whole lot. I think it's safe to say that he and I were both a little shaky afterwards. When I got back to the house, I checked my med book: Ancef - give over 30-60 minutes.
The saddest part of my day was the boy that came in next. I unwrapped his leg (it's like a surprise every time, I never know what I'll find) and found three stitches on the side of his knee. He looked mostly healed, and he said there was no pain, but the edges weren't together right. He should've had about four more stitches. They were handing me tweezers and scissors, and I asked how long the stitches had been in, hoping to stall. But he got them over a week ago. So basically, every time I cut a stitch, I was praying that the Lord will heal his knee up correctly because otherwise it won't happen. Peroxide, betadine, neosporin, and hoping the bandage was tight enough to keep him from bending his leg too much. Then he left.
Last night a cousin or someone asked me about food. I said I know for sure we won't go hungry, but we pretty much just have our daily bread. Then this morning when we were getting ready, I told Leah that it would be great to have peanut butter and jelly to take for lunch, but I grabbed my power bar and guacamole and went outside to get my taxi. Leah called me right as I was leaving the clinic to ask me something, then said, "By the way, there's three boxes in our kitchen with food in them." I ran up to the kitchen when I got back, and, of course, found jars of peanut butter and jelly in one of these boxes. And just as a bonus, another box had beef broth in it. Thank you Jesus for caring about the little things.

No Hablo Creole

We arrived safely in Haiti this afternoon, as did all our luggage. Trying to keep our luggage in our possession until we found our driver was a bit more of a challenge. I more or less ended up fighting this man for my luggage cart, even though Leah kept telling him we weren't going to pay him. So we compromised and both pushed my cart at the same time. After our two hour drive along the coast to our house, Patrick, one of Leah's friends, came and picked us up and took us to the base where there was food waiting for us. I have met my match with hot sauce. The bottle says, "One drop does it" but I failed to read that until I'd drowned my fries in it. I met some more people at the base, and some of them find it particularly amusing that I don't speak a lick of Creole. So instead, they speak to me in Spanish. That way, I can verbalize how I don't understand them.
We're headed to the market in the morning since our cupboards and fridge are bare. And morning is going to come too soon for this night owl. But I don't anticipate having too much trouble sleeping despite the music, dogs, and goats outside my windows.

Why Do Today...

I would just like it said that while I may be leaving in a little less than three hours and am not completely packed, I did bring down the suitcase and start packing this morning. Or yesterday morning. That sounds even more productive.
There is something to be said for procrastination. Certain cousins of mine (J&J, E&L) delivered their notecards to me this morning, and because these cards were assumed lost, other people wrote cards for those days, so now I have two notecards for multiple days!
Anyways, I'll be arriving in Haiti around 3pm tomorrow (4pm PA time, for those who asked about a time difference), and then who knows what. As I discussed these [non]plans with the Grosh family Monday night, Jesse commented that our family has people all over the world who have no idea what they're doing. So I should be fine. (Am I right, Jin and Kent?)