A Day in My Life

I guess I should feel thankful that we had water today, but I left work today feeling like “God, I hope no one dies from what I did”!
Our jobs have evolved. Anita and I get to work at 7AM. Today, that was before the coffee was ready—big mistake. It’s much easier to tolerate chaos and confusion after caffeine! We’ve had lots of problems with the ward helpers and the patient feedings. Like, they’re not doing them or when they do get done, we don’t know who because they are inconsistent about charting it. I think it all boils down to –we speak two—or maybe 3 or 4 different languages. I talk, they agree and nod their heads talk (if they look at all vague, I talk more and confuse them). I suspect they really don’t understand. Anyway, so now when we arrive, the first thing, Anita and I make rounds with the helpers, stopping at the bed of each patient who is getting a tube feeding because some patients can’t eat after some of the surgeries. We also discuss the patients who are scheduled for surgery that day and make sure everything is done and they’re NBM ( for my nurse friends, that’s NPO and all others it means “nothing by mouth”). We have different terminology for many things from the Brits and medication names are different which can be a bit challenging at times, but it works both ways. All was just perfect this morning, except they had thrown out the extra Cerelac, that they made for the 6 AM feeding. No problem, let’s just make a bit more in case someone is hungry before the porridge comes. One of us goes to a local restaurant to make porridge for the kids at 9 AM when it opens for the day so no food is available until then .

We got the first patient ready for surgery. We usually get two done, but both were admitted over the weekend and didn’t have the right paperwork. Paperwork is not something we do, so it took awhile to find all the different papers we needed. At 8 AM the surgeon, surgery nurses, day nurses and new shift of Gambian ward helpers show up with the new anesthiologist ( old one went back to England). The new anesthiologist wanted different preop medication from the last, and she wants to see ALL the patient’s charts when she comes in the AM because she doesn’t want to come back over during the day. About then, our ward “cheerleader” start the group sing of “this is the day that the Lord has made,……” It pretty much went downhill from then on.

This is a typical day.

We have 2-3 nurses that take care of the patient’s surgical wounds and medications. There are people all over the place, children crying and with interpreter’s help, we need to find out why. We scare them—some have not seen white people before and one thought Anita was a ghost and screamed everytime she came near him! I’m sure to some, we’re associated with getting stuck with needles and generally made miserable, so the screaming starts before we even touch them. Some are so stoic that they don’t make a sound no matter what we do. The Gambian parents, grandparents , and the interpreters are not very patient or compassionate with the kids, which was a total surprise to me, but most people have lots of kids and don’t seem to pay much attention to them once they can fend for themselves.

All of our supplies are 25-30 suitcases in “the Hilton”—our break room that locks when no one is present. Anything left out will disappear, so the night shift locks everything I the Hilton before they leave at 9 AM and then we take it out in the morning. It is common for one of us to run to this storeroom once or twice during an admit to get a patient gown, diaper or even a writing pen! And then you have to remember which suitcase everything is in. The mosquitoes are so thick that I’ve added “bug sprayer” to my job description. We push our work cart out, and I spray the room so that by 8AM when the rest of the team arrives, it’s bug-free-more or less. We only do 3, rarely 4, surgeries a day and it takes both of us to do the patients, help the ward nurses, make sure all the feeding are done, and admit new patients.

Yesterday, we admitted a 24 year old woman with a cleft palate. She looks fine, talks funny because of the lack of a roof to her mouth, so she is quite reticent to talk. She was blood typed and needed family to come in to have their blood typed in case she needed blood inter-op or post surgery. We couldn’t find the family members and we didn’t have the results one hr. prior to surgery. The patient didn’t know where her family was. An interpreter is supposed to go to the lab with the patients. I don’t know what happened, but the interpreter walked the family members (and non members) to the lab and left them there. The lab is probably tired of us demanding to be done right away and made this family wait almost 4 hrs to send them back. All that time, we’re looking for them. I never did get a satisfactory answer from the interpreter as to why he didn’t stay. Anita chewed him and now he’s avoiding her. Back to the blood typing story- I was told she had a father and three brothers coming in, but there were only 3 lab slips. As I tried to determine who’d been typed, I realized that one of the men wasn’t even related to her. He was an “uncle”, an endearment for a close family friend or maybe he was real uncle—his blood did not match, but since we had two matches from whoever it was that got typed, I told them all not to leave in case we needed blood during the surgery!

We all have our favorite and least favorite patients and trade their care. I don’t like working with “the cryer”, but don’t mind the “Pink Princess” who is a spoiled brat—rather unusual for a child here and especially for a girl. Her Mother is 41 and this is her 5th child, but she has been divorced and some of the kids are with a previous husband. She is the second wife of this husband and “Pink Princess” treats her mother very rudely. Yesterday she was crying because her mother wouldn’t color for her! She hits at her mother and is generally obnoxious. The mother cannot go to breakfast or lunch until the father arrives because he doesn’t want “Pink Princess” left alone. Her husband comes in daily and “Pink Princess” does whatever he wants and is very cooperative. Since her nurse has such a difficult time, I do a lot for Pink Princess. I’ve also discovered that it’s best to do it when the father is there! Today, I was able to get her to drink from her cup, rinse out her mouth, I removed her feeding tube and she drank a bit of the feeding tube “meal”—all with her father’s help. She high-fived me at the end!