Angkor Wat

Should have lots to write about after tomorrow…taking a 9 hr bus ride to Angkor Wat tonight.

Groundhog day.

I keep sitting down to blog but don’t really know what to say. Obviously I should talk about my trip, my patients, the ship but it’s starting to become a bit ordinary to me. Amazing how a world so different than my daily life in the US is becoming mundane. So instead of trying to be elaborate I’m just going to describe my day.

 

Right now I am working night shift. I make the schedule so I try to make sure everyone has a few days off to rest. Mostly these days are for liberty (a day on shore) or just recovery on the boat. My day starts at 1530 when I wake up and have a snack. Usually I’m pretty hungry because I missed lunch (from 1100-1215). I teach a spin class every other day and on my off days I try to run. Unfortunately I have not seen any metric results from my daily workout…but it does help the mood. After my workout, I quickly shower. We have 2 bathrooms. The one closest to my room has about 8 showers so there is never a line in the afternoon and rarely in the morning. I have to use the shower in the back right because all the ones in front of that are way too hot. Temperature control is not something the ships engineer is overly concerned with…plus I hate hot showers most of the time. I get back to my room and try to cool off…putting on a long sleeved, two layered uniform after working out is hot. Usually there is a roomie or two taking a nap so I can’t use my hairdryer…I head back to the bathroom to dry the hair. (Side note: still trying to decide if I am going to cut the hair in Singapore. I like it short but love my pictures with long hair. Decisions, decisions.) After all this and double checking to make sure I have the right uniform pieces on (like my belt)…I head to chow. If I remember correctly its about 66 steps from berthing to the chow deck. Not sure how I manage those after working out but usually after a quick breather on the O-1 level I get there. (Seriously, you’d think I’d be used to them by now!) I love chow. Not the food but the people. The CS (culinary specialists) and FSA (food service attendants) are great. It’s the same ones everyday and I try to say hi to each of them and thank them. I’ve gotten to have a few conversations with them and hopefully will be able to get to know them better. I always ask for smaller portions because they seem to reward being nice with more food. I usually then eat dinner in the wardroom with 50 or so other officers. Then to work…

Night shift has been good to me. Most of the time all the kids are back from the OR and it’s just a matter of pain management so they can sleep well. I’ve noticed a few differences between our post-op kids in the States and the ones here…mostly that these kids are more affected by anesthesia and don’t wake up as easily. About a ¼th are nauseous constantly after waking up and almost all require little to no pain medicine. Now granted, our surgeries are not usually complex. We do a lot of inguinal hernia repairs, cleft lips, dental procedures, a few mass excisions and several other “simple” surgeries. I did have a girl the other day with a urinary catheter and a catheter coming from her right kidney, draining mostly blood into both. She went back to the OR today and will have an open removal of obstructive kidney stones. All kids that are higher acuity usually stay in our 4 bed ICU. (Have to make sure everyone earns their paycheck. J) After 2100 it’s lights out. Of course there are the list of collaterals and charge nurse responsibilities but after those are accomplished I usually can email family/friends and facebook stalk everyone. Midrats (midnight rations) are literally at midnight. They consist of leftovers from that day and sometimes a pleasant surprise, ie corndogs or chicken nuggets. Usually they are terrible. By now (0300) I can start making phone calls. Everything is still settled, most meds have been given and vital signs done…and the rest of the world is almost off work! We’re about 10hrs behind (and 1 day ahead of )the West Coast. Then I try to do a little reading or paperwork. About then everyone else starts showing up…about 0600. We muster everyday at 0630, rain, shine, day on, day off… the accountability is important on the ship because they want to make sure no one has fallen off! And in the military if you are on time, you’re late…so plan on getting there 15min early. After muster, it’s back to bed and time to do it all over again.

 

Occasionally I try to change the schedule by throwing a laundry day in (my days are Wednesday and Saturday), or a roommate movie night (which happen less now that I’m on nights). But really it’s like groundhog day around here everyday.

 

Counting up & down

67 days since I checked onto the USNS Mercy.

10 days until I check into my hotel in Singapore.

91 days until I check off the USNS Mercy.

103 days until I check into my resort in Playa del Carmen.

How fast this year is going…it’s amazing. Look at all the changes that have already happened. I’m sure many more are in store.

Quy Nhon Vietnam

Liberty day in Vietnam...(see previous blog post).

A Sailor's life for me...

Our refueling friend, the USNS Amelia Earhart.

Amy Jensen, our Canadian peds nurse

Keeping a watchful eye on the helo...making sure they don't drop the mail!!

Hawaii for my birthday

Hawaii liberty with Katie and Kim.

Duke's with the roomies, Sandy and Christine!

Happy Birthday with Hula Pie!

Waikiki Beach...next time I *have* to pack the swim suit!

The girls and Duke.

My boss' boss, Max. Enjoying the Hawaiian luau with the rest of the nurse corps.

Ship Life.

Getting some fresh air before we all man the rails on our way into Pearl Harbor. Some of my corpsmen posing for the camera.

Celebrating the Nurse Corps Birthday with my boss, Shelly. And roommates, Holly and Marissa.

Second RAS with VERTREP

The day we've been waiting for! Before we hit Cambodia we were scheduled for a RAS (replenishment at sea) and a VERTREP (verticle replenishment) aka fuel and MAIL! It was fun watching the helo go back and forth between the ships... better yet knowing one of the pilots is my roommate (that makes me cool by association).

The waters were much calmer during this RAS and everyone was out for the photo op. Hoping to get the computer to play along better so I can get more photos up!

Monkeys everywhere in Cambodia

Monkeys on the side of the road, waiting for lunch. (Across the street was a vendor with bananas and other local fruit.)

At the Monkey Republic...waiting for lunch. (A nice backpackers bar with a tropical feel. They serve delicious fish amok with coconut curry as well as fabulous fried noodles with sweet chilis.)

Monkeys with full bellies. Looking for something to rinse down the bananas...

Enjoying a glass of wine after dinner. (We had all kinds of delicious seafood! Baked snapper in salt, crabs in chili, grilled prawns and a beef dish with Cambodian cheese.) L to R: Shelly, Me, Jerry and Thuong.

Cambodia Liberty Day

The monks who lived there. All the ones I saw while we were there were all young, in their teens.

One of the bigger Buddhist temples in the area.

A man at the market, sharpening his knife.

The market downtown...it was so overwhelming. The rows were barely big enough to walk down. The big aisle you see here had all kinds of food vendors and also beggars (most were handicapped in some way or another).

My daily dose of sunshine :)

I think it will work...

Worth at least a 1000 words...

My First RAS (replenishment at sea) in May. Did I ever mention how rough the water was between San Diego and Hawaii??

Halleluiah!

Now, I promise this is not something you’ve ever heard out of my mouth ever before. EVER! But I am really enjoying night shift. J I think mostly because it’s days in the US and I get a chance to catch up with people on facebook (now that our internet is working properly) and hopefully via phone (when it decides to work). It’s so much less stressful without all the politics and confusion that happens during the day. PS Kendall now I understand what you mean when you said it’s just managing chaos. Right now we don’t even have Operation Smile in our wards and it’s chaotic everyday when the boats deliver the patients at the same time we’re getting 3 post-ops. Poor translators, they are pulled in so many directions. Can I give another AMEN?! Our new translators are SO much better than the ones we had in Vietnam. At least we haven’t figured out if they are telling our pts to rub Motrin on their bellies yet… Nights are good to me here. My room is a cave with no windows so it doesn’t matter when I sleep. Meals are always a struggle (*hint hint* send easy mac and luna bars! :-D) but whats new? I’ve gotten to work out every day after my 7-8hrs of sleep and like I said, a LOT LESS stress at night. Also props to my night team…they are easy personalities to get along with too!

 

Side note: I did get one package during mail call…it was the one Jenny sent at the beginning of May! Crazy ship mail…hopefully I’ll get the rest when we go to Singapore. Not sure why some people got the packages their families sent 8 days before we had a mail call… but I can’t complain, Jenny’s package had everything I needed for these next two weeks.

 

Back to MEDCAPs… All the nurses I talked to had a very similar experience at their MEDCAPs in Vietnam. They were patient traffic control and not much more. It was nice for me because I could see some of the other stuff going on, instead of getting stuck in one place the entire day. But wasn’t very “rewarding” for my skill set. My favorite part was passing out all the stuffed animals I had brought with me that day. I left a sea bag full of them with the pediatricians and then I passed out the ones from my backpack to all the kids not seeing the peds doctors (ie optometry, Physical Therapy…). We got an extended lunch and were able to go out on the street and purchase fruit and coconut milk and other items from vendors. I attempted to eat my MRE (jambalaya) but without great success. It really didn’t taste awful, but not good enough to encourage me to fix it to make it any more edible. I did however get a coconut (which I watched carved down a bit to a cup shape, then the bottom leveled off to place on the table and the top cut off to insert a straw. J And lots of local fruit. I wish I knew all the names of the different fruits …most tasted like lychee (kind of like saying everything tastes like chicken) but they came in lots of different sizes, shapes, prickles, no prickles, huge seeds, small seeds…  

 

Tomorrow I go on liberty in Cambodia. So far I’ve been told it’s so much more fun! It sounds like this area caters more to tourists… there is a snake restaurant with snakes in the tables, an airplane restaurant (you’ll understand when I take pictures), a 5 star resort with great massages… I can’t wait.

Wrapping Up Vietnam 11.Jun.10

We’re down to 2 patients on Ward 8, our post op ward. Ward 9 is functioning as a same day surgery floor but after they patients are gone, we’ll secure it. Overall we saw some great surgeries but really weren’t that busy. Kind of scary. Cambodia should be twice as busy with half as many translators. Great!
The language barrier has been huge. It’s hard to explain to a mom why she cannot feed her crying baby. Or why a parent cannot share their meal with their kiddo postop. Also some of the procedures and effects scare the families. How do you explain the swelling is normal and the pt will feel their lips after its gone down? It’s just hard sometimes. But overall it’s awesome. Everyone seems so thankful and joyful. They have been very sweet and gracious to us as their nurses. Most go out of their way to say thank you before they leave and are affectionate.

 

SIDE NOTE: Mail Call on JUNE 13^TH!!!! J YAY!!! Finally!!! Cannot wait to see if my packages show up .

 

Internet is up and down…sometimes it’s us, sometimes it’s San Diego or Hawaii’s connection (or whoever we’re going off of). It’s hard to call back home because the timing is off during the day and I work every day so by the time I’m off I’m exhausted. Hopefully nights will be better timing and slower so I’ll have the chance to talk. Lucky me, I get to see Aaron in 20days!! He’s coming to Singapore to meet me there for my liberty. We’ve reserved a hotel with a spa and poolside bar. J Can’t wait! It’ll be a nice break after Cambodia.

 

There are several MEDCAPs in Cambodia that are very remote so they will be overnighters. I know of a 10day, 7 day and several 3 day overnight MEDCAPs. I’m hoping to go on at least 1.

My MEDCAP experience in Vietnam was interesting. They had it set up in on a school campus. Everyone waited in the courtyard area and were called by the Ministry of Health. They were then let into our patient administration area to determine what provider they would see. Options were Optometry, Dental, Medicine (Adult) or Peds. My job as a nurse wasn’t well defined since I’m unable to diagnosis and the corpsmen were assigned tasks such as vitals, I didn’t see patients but directed traffic. Really I ended up running a vital signs clinic with 4 of my corpsmen, 2 med students and a bunch of Japanese nurse volunteers. We saw all kinds of patients…monks, policemen, old men, old women, children, blind, injured...all with their hats and dressed in what sometimes looked like pajamas.

 

To be continued on my upcoming night shifts…  

 

 

 

 

 

 

Liberty day cont'd

Before I continue, please send stickers and bubbles!! They are a huge hit on the floor and I have a feeling we will be running out before we even get to Cambodia!!!

 

So back to Liberty…

Kim (nurse), John (pharmacist), Tonya (PT), Christine (Pilot), KMac (also know as Kelly McCarthy the pediatrician J) and myself were liberty buddies. We started out liberty day surrounded by women selling small items (bracelets, postcards etc…). They all paired up with each  of us and walked from the bus all the way to the hotel asking if we want to buy anything. Their English was quite limited but they knew those phrases well..and understood the value of a dollar! It was amazing that later in the day the exact same women found us again in another part of town…KMac said it was his first real stalker. From the Saigon Hotel we walked through town trying to find a restaurant that the Aussies had recommended. We found nothing…well not nothing…but nowhere that looked like they served food. Finally we did find a café. FYI in Vietnam, they only serve beverages at café’s not food. Luckily the one we stopped at had ice J so we were able to have a cold beer and pepsi. I actually had jasmine tea and a Vietnamese coffee…delicious! From there we went to find food…we didn’t find anything near the local “mall” but did find Karaoke row. There were about 10-12 karaoke bars/places in a row!! It’s so popular with the asian culture…

Eventually after wandering through some neighborhoods we hit a jackpot! We stumbled across this little bar with a few gentlemen outside eating a noodle and beef soup. We pointed to this and tried to explain to the proprietor that is what we wanted. Immediately he grabbed the bowl from the man and starting trying to feed KMac the man’s food! We quickly got the point across we wanted our own and within 10min we each had our own bowl of noodles, beef and broth. It was delicious!! Of course us being Americans we were still hungry…they brought an amazing yeast bread that was crispy on the outside and so fluffy on the inside…fabulous! We never found the pagoda we had seen from a distance but this neighborhood ended up being the best turn ever…it led us right into a street with vendors on both sides of the road selling fruits, grains, vegetables, meat, clothing and more. It was pretty dirty and not paved but the sights were incredible. Hopefully I’ll be able to upload the pictures!  

By this time it had started raining. Keep in consideration we didn’t get off the boat till about 1pm and were walking everywhere so it was almost dinner time. We found a cab and tried to direct him to a Pagoda. We tried pagoda, temple, prayer, Buddha…apparently it didn’t work because he drove us straight to the Saigon hotel. There we were able to get a translator and were shortly on our way to the “Biggest Pagoda”. Just a side note…this cab ride was about 37,500 Dong…equivalent to about $2 dollars. So we weren’t that upset about having to drive to a nice bathroom and clear directions.

The Pagoda was beautiful! The worship areas were meticulous although the areas surrounding were not. We met a young lady studying banking mathematics (accounting) there at the temple. She gave us a quick tour and taught us a little about Buddhism. We lit incense and saw all the pictures of relatives framed in memory. We ran into a ton of people from the ship …Quy Nhon really is a small city, although it is one of the larger ones in Vietnam. There wasn’t much on the to-do list but unfortunately we only had a few hours so we didn’t get to do even those few things.

Dinner was at the Queen resort restaurant. Definitely a more touristy location, the items were more expensive but the service was good and food delicious. I imagine during the day it is an amazing view, you can see the coastline lit up at night and hear the waves hit the stone beach…  After dinner we headed back to the hotel. I attempted to find ice cream but they were all out at both the hotel bar and restaurant (even though each said the other has it). Soo we called it a night. Unfortunately from that point till we got back to the ship was way too long! We couldn’t get on the first boat back because the E4 (enlisted) and below had to go first, so we waited for the second boat…I didn’t get to bed till midnight! (Hence the need for ridiculous amounts of mountain dew, spelling and grammatical errors and nonsense in my blog.)

Almost there...

…everyone is wearing down. Working this many days with this much chaos is exhausting. I’m about to work on my 2^nd mountain dew for the day and it’s only 0930. Only a few more real surgery days, then recovery days then we’re off to Cambodia. The goal is only to do surgeries that will be able to get off the ship by the 11^th or so. Still working on a few cleft palates and lips. They really are having the most difficult time and requiring the longest stay. I am interested to see how Operation Smile functions when they come onboard in Cambodia. I’m not sure if we will incorporate them in our wards or give them their own. Last time they incorporated them due to staffing but it ended up being a great learning experience. Hopefully we can also incorporate them so we stay busy.

 

Yesterday was my liberty day off the ship. The liberty boats did not leave the Mercy until noon so we didn’t arrive in Quy Nhon until about 1300. Getting down to the boats was an experience!! We went up to the O1 level -first level with weatherdecks…but also 6 levels above the lowest deck (inside the ship we have from 1-5…1 being main and 2 below main, etc…). From the O1 level we had to climb down an ACOM ladder. It’s a very long ladder with rope railings and it rolls on the barge its positioned on as the ships and barge move with the water. I have a video and will try to post it…if I can, watch the bottom of the ladder to see how much it was moving while we were climbing up and down. Was almost like an amusement park ride …but for free! From there we boarded a Vietnamese Rescue boat. It has a large capacity than our band aid boats we use to transport to MEDCAPs. Whenever we go to shore, we have to use a shore pass. It is a government issued card with a designated number on it. Without it we’re not allowed past the pier and there are a ton of Vietnamese and our own security to make sure everything goes smoothly.

Club Chaos!

Working backwards a little bit…we are now up to 15 pts!! Yesterday we received 7 admissions in 2 hours. Granted that would be chaotic in any situation, especially with postops arriving at the same time and with only 4 nurses…but then throw in the language barrier, nursing students, multiple disciplines of doctors, small spaces, hard corners, paper charting, babies crying, children peeing on the floor and siblings running around…and you get a quick picture of what my day looked like yesterday. It was insane. We’re finally opening the second ward to accept the postop patients. Hopefully this will help control the mayhem a little bit. Most of our kids coming back from surgery have been doing ok. The cleft lip/palate kids are having a hard time…mostly airway issues. We have them all on monitors (which are ancient) and receiving blowby oxygen for a little while to give them a little help. I’ve had several polydactyl kids (an extra digit, either attached to another finger or toe or completely separate). We have one girl now with two uteruses, one which bleeds continuously. Not too many other diagnosis that I can think of off the top of my head but then again this is my “day off” so I’m really trying not to think.

 

My day off consists of still waking up at the butt crack of dawn to muster (mostly to make sure nobody fell off the boat). Currently they are giving report then afterwards we have a charge nurse meeting to streamline our processes a little more. Then to church, laundry, clean my room and workout all before the liberty boats start rolling at 1200p. Should be a interesting day. A lot of people that have already gone out said there isn’t much to do. But I have a whole list of places to see and things to eat…

 

 

Day 3

We got a few more patients last night…up to 5 now! The surgeons went ashore again today so no surgeries…the kiddos will stay 2 nights before they get into the OR. We have one 17yr old with a SIGNIFICANT murmur. Possible PDA (big hole) and his heart sounds are similar to washing machine sounds. His family cannot afford to fix his heart and most humanitarian missionaries don’t have the time (too short of a time period to do open heart surgery). We found out the cost of the surgery in Ho Chi Minh City is only $3400…first thought was we could write home and raise the money, but then you realize how many of these kids there will be out there. It’s overwhelming and depressing.

We also got a bunch of nursing students today. For all those at Balboa you can relate…imagine having 5 pts, 4 nurses, 4 corpsmen and 10 nursing students. Ugh…crowded and annoying! Lol I will be excited to teach when we have more to talk about then just charting and care plans.

 

 

Hot Hot Hot Hot Hot...seriously

I’ll be on land this week…probably Thursday. I may melt. Or at least lose 5lbs. Wish me luck!!

 

Day Two

We got our first patient last night! A little 30month old coming in for a repair of her cleft palate repair done last year by OpSmile. She had developed a fistula, so they went in to close it. As you can imagine, 4 eager nurses…lots of anxious corpsmen…she’s getting a ton of attention!!

A little frustrating with some of our inexperienced staff…especially since I know there are tons of qualified personnel both back at home and then even in the galley!! I am acting as charge and also teacher and nurse and runner and secretary. Oh what a day!

Should get more patients tonight…thank goodness! We need more to do!