Una Cirugia en Guatemala ....

Saturday March 20, 2010

Today will see the completion of 2 months of my time in Guatemala.

I am in a very different place then 2 months ago: physically, mentally, and spiritually.

Physically, at the moment (well besides being in a different country) I am experiencing a whole different side to nursing: my role has switched and I am now the anxious guardian at the bedside.

Mentally, I am fighting my basic desires for independence, alone time, and my own life. Everyday I have to make the choice to not do what comes very natural to me: independently living in my own schedule and desires.

Spiritually I feel connected to the plans God has for me. I am not simply drudging through my daily tasks or floating through what comes my way. No, I am active, I am here, and I am offering my hands to be used for what work is to be done.

So here I sit (well lay for now) in a “hospital” that seems to be about the size of 2 row homes next to each other. There are 4 rooms, each with the capacity for 2 patients. I lucked out today, the kid in the bed next to my patient left an hour after we arrived – meaning I have a bed in which to sleep for the night (hallelujah!) and room to ourselves for the day/night/next morning. I’m here with Esther, from Casa Bernabe, who unfortunately broke her right clavicle while skating on Wednesday.

This past Wednesday all 160 some kids, plus guardians, piled in buses/vans and headed to “LOOPS;” a sort of amusement park type place based around go-carts/water boats. The day had passed without much more than a bloody nose (which produced enough to blood to even freak me out at first), but then after lunch it all went down hill. I was found and lead to Esther who was hunched over, balling, in pain, and unable to move her whole right side of her upper body. At 13 years old, this girl is one of the toughest, sportiest, and active girls at the orphanage. Never have I seen her cry and certainly never ask for help. My heart was wrenched when I saw her at first, and well then it broke when I examined her collar bone and discovered that it was broken.

Apparently there were more injuries that incurred that afternoon as well, however I did not learn of them till later in the day when everyone returned. Right after lunch I, and 2 other volunteers, left for the radiologist. Things are a bit funny here. If you suspect something is broken, you go have an x-ray taken. Then if a fracture is confirmed you find a Dr. who can help you out. Thankfully I have a Dr. (who volunteers at the orphanage every other week or so) in my phonebook. After one look at the x-ray, he confirmed what I had been worried about since it happened – it was not a simple or well aligned fracture and would most likely require a pin to keep the completely separated and mal-positioned collar bone in place.

This picture isn't the best, but at least you can see how broken the clavicle actually was ... a pin was totally needed

For some reason after this prognosis (and well then seeing 4 more other patients with the Dr. while he was there) my heart was a bit heavy. I went for a brief run around the compound and then came back to my room and just started to cry. Good bonding moment followed, for a bit of time I prayed for Esther with Anna Louisa – bits in Spanish, bits in English, but it was together – a step in the right direction. As I have become familiar with more of the kids here, I now know them and care for them. Because I know this girl never sits, never stops, and barely rests; my heart was heavy for her and what possibly was to come.

The toddlers woke up from a nap shortly after my emotional gush and for about an hour or so I was able to just chill with them and watch a movie – much needed. But then once they had finished with dinner, yet another girl came to me with what I immediately thought was a broken wrist. Another one, really? Up to the clinic with her, only to find 2 other “patients” who needed/wanted advice: “take some ibuprofen” – it really does cure everything. Needless to say by the time I returned to the house about 8 I was exhausted.

But we are here, she’s fine and doesn’t seem to have been overtaken by any raging infection. That however is solely to God’s credit. I watched the whole procedure. Started by walking into a dingy looking, dim lit room that had the aspects of an operating room, just all old and in need of a good scrub. The anesthesiologist started the IV, no gloves. Tubing was new – good. However the breathing tube he placed looked used to me, and I was pretty sure that the tongue depressor hadn’t been sterilized in a while. I helped apply some cricoid pressure – he did know what he was doing, that thankfully was obvious. Then the surgery started, well after she was cleaned and the Dr’s scrubbed up. They at least started off the time sterile. While nothing glared at me of an obvious disregard for sterility and infection control, just the whole atmosphere did not seem conducive to such or as though it was demanded. The incision they made was large, I just kept thinking how this poor girl is going to have a large scar on her chest forever – and is it even necessary? They dug out the 2 broken pieces of the clavicle, I could see the jagged edge of the bones – the thought of whatever germ floating around entering such a fracture made me gasp. And then they got out the drill. I hoped that it looked worn because it had been sterilized so many times … A large pin (about 6 inches long) was shoved into the inferior (bottom) side of the break – this was then drilled through the skin on the other side – this also horrified me, just kept wondering how this hadn’t cracked/fractured yet another piece of the clavicle. So then this side of the pin sticking out of the chest was connected to the drill and then drilled the opposite way into the opposing superior side of the fracture. There was still a bit of the pin sticking out thought the bottom of the skin – this was clipped with pliers that looked like they had been the old school jaws of life at one point. She was then stitched up – I wish he had been more conscious of the large scar that he was leaving on this girl’s chest. Then we were done. Everything was taken of/out and she was wheeled out to her room downstairs. Again, all of the aspects of a hospital, but somehow after spending the night here it just feels like a dingy hostel that happens to operate upstairs.

Without the mask and cap to cover my expressions throughout the operation, I’m sure my tense/horrified face would have caused quite the upset. However, she survived, is surviving, and will survive through this. No fever has popped up – although the “nurse” has not once checked. I will be giving more antibiotics throughout the week and hopefully keeping on top of the pain. So far the day has passed quietly. She was able to keep down dinner and afterwards we watched a movie and shared some tasty chocolate bread I bought at the bakery down the street. Esther is now sleeping and I believe it is time for to follow. So thankful I have a cot to stretch out on for the night. Praying that it is a peaceful night for the both of us.

Our room for the day/night ... at least I had a bed!

And that concludes my week/day. Should be heading back to the orphanage early tomorrow afternoon, doesn’t seem to be much of a rush here – I guess that’s what happens when you pay out of pocket and don’t have insurance shoving patients out onto the street. Once through this next week I will have an extra 3 days off with my weekend (so about 5 in total) for the Semana Santa. Hope to be traveling to El Salvador with Liana (who will be heading back to the states shortly after). I am looking forward to what hopefully is a relaxing and restful time away – often there is so much travel in my weekends, I return more tired than before. When I return, it will be April, and I have a feeling that mentally, the thought of hitting this mid point month will be an encouragement. That being said, there is a large part of me that doesn’t want to leave. I told a good friend this week that I could live here. Well, as long as I could live outside of the orphanage and commute in, haha and maybe with a husband? Anyway, the fact is that I have begun to settle and to feel needed. I am still trying to figure out how to best serve and live in the toddler house, but at least nursing wise, I am getting into the very unpredictable but rewarding grove of caring for others.

Adios for now, missing you all!