Wow, what an interesting first day. I was almost late though, even though I left my house at six am. The bus took almost 40 minutes because they had to pack it full of all the clinic patients. I was the only nurse on board so I felt kinda special. Maybe I´ll walk tomorrow? Any how I have been placed on the ¨area medicina de mujers¨ or the women´s medical floor. The floor has three private rooms and two group rooms, each with six beds lined up side to side. There are no curtains here, privacy doesn´t really exist. We made our morning rounds stopping at each bedside and talking about the patient´s diagnosis, condition, meds, I´s & O´s all right in front of them. This will take some getting used to I think. The hospital is difficult to describe. It is a public hospital, and serves much of the poverty stricken group that can´t afford the private hospital. There were over one hundred people waiting to be seen at the clinic when I arrived, most will have to come back tomorrow.
Everything in the hospital including beds, wheelchairs, desks, bed pans... everything was manufactured sometime before 1970. All the medicine, including narcs are just kept in drawers or bins. It is such a different world it´s difficult to explain. However I think the Surgical Clinic I participated in last fall prepared me some. Generally, there is one RN on the floor and two LPNs that work together each shift. The work together to care for all of the patients and are not assigned to any number of them. Med pass is a whirlwind of mixing meds, hanging antibiotics, and passing pills. There are just little cards with the patient´s meds written on them and then you initial the chart later. (yikes). If med errors occur here, and I´m sure they do, there would be no real record.
WARNING: If you are not comfortable with death or dying, do not read the following...
On a sad note, I actually lost a patient today. The other RN and I were talking to a patient´s family today when some ladies quietly came up beside us. They were patently waiting but seemed anxious. So I asked what they needed and they asked me to come check on a patient. Ummmmm... yes, the patient´s color was terrible and she didn´t have a pulse. So I called a CORE (yelled down the hall), or as much of one that exists here. We´re not really sure what happened, or how long she had been gone. The resuscitation seemed to me more like practice for the medical students, and no one really seemed to know exactly what to do. Maybe I´m just used to the well oiled machine that works in the PVH NICU. But I was the one that grabbed the CORE cart, was heaving ET tubes, and showing them how to work the defibrillator. (It wan´t plugged in and they couldn´t put the leads on because they got caught in the cart wheel). So after three rounds of epi, and five minutes of CPR we gave up. Quite an end to the day. I think I was most saddened that the patient didn´t have any family around and it was visiting hours. She was very old, and I was okay with her death but I wanted her to have some family there, someone to cry for her.
I wan´t sure if I should include all that, and certainly wouldn´t if I was working in the states. But I wanted to share the experience. Love and miss you all. I´ll try to keep my morbid stories to myself in the future.
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