Tuesday, April 12, 2011

One of the BEST writers I've ever met.. My new roomy here in Guayaquil, BRIDGET!

by Bridget Mulrooney on Tuesday, April 12, 2011 at 10:01pm
This is the update. Thee update. The last few days have been full of changes, shocks, surprises, and your basic sheer wonder. You know the sort of wonder I mean- the kind that when you take a gingerly step backwards you feel your face grow slack and your head cock to the side.
I’ll draw on one of my favorite quotes and “Begin at the beginning,” the King said, gravely, “and go on till you come to the end; then stop.” – Alice in Wonderland.  Sometimes there is no better way than that to make an explanation.
Friday night came with a bomb; the girls (Liz, Jana & Katie) felt as thought that their time and energy would be better suited elsewhere. They announced that they’d be leaving the following morning. While this did not come as any sort of surprise to me, it did throw solvent on the side wall of MMRC’s fresh oil painted face. I do understand why the girls said they wanted to leave, from a nursing perspective. It is really hard (REALLY hard) to be idle as a nurse. It’s hard to sit still. It’s hard to feel like a filler. None of us are any good ( due to lack of experience at networking, extensive researching , long computer days) at what we are doing. This is my case in point, why I empathize with BP, why I carry on: None of us are good at what we are doing; and yet we all continue on because of the goals that we had set. Did we take on a goal that seemed impossible? Yes. Have we run into every single set back one can fathom? Yes. Have we given up? No. Will we? No.
The outside perspective is that we are going to struggle and fight, that our efforts were futile, that we are going to try to make the impossible possible until we are all broken, bruised, broken, and broke. The truth is that it might go down like that. The alternative truth is that MMRCglobal is fighting the good fight. Good fights are never the easy ones. Good fights are full of grit, sand in your eyes, bite marks on your back and the ones that leave you unsettled at the end of the day. Good fights always seem unfair and sucky for all that are involved; but good fights seem great from those that view them from afar.
Saturday morning was greeted with the settling thought that our meeting with the hospital administration/Redima/etc was coming up. We were gingerly awaiting news from them about what their agenda was so we could prepare accordingly. In order to counter-balance our presumed encounter we came up the basis of our own timeline. This was also our last group(ish) meeting. Peter, yet again, continued to take me aside – pressing me to make my voice be more proactive. It was apparent to him that I have a lot of ideas and that I am willing to share them, yet I fail in my execution of them. Situational? Schme? At times. It sucks to be called out on a character fault- but in the same breath it is inspiring to see the impact I could have with a little bit of personal growth.
The girls left in the morning on Saturday. Peter was due to go off to his next woofer farm that afternoon. The tone of the house was more than civil. MMRC has reinforced a few of my core beliefs. (I just grinned from ear to ear thinking that I used to sulk about not having any personal beliefs and seeing that I have just had some of mine reinforced- I must in fact have them!). I have always believed that people need to be where they feel they are needed, and they should never stay somewhere that they aren’t happy. I think that my many self-imposed exiles have instilled in me the elation for others when they feel so strongly about something and they aren’t afraid to jump head first into it…even when other people’s feelings are involved.
I’m going to take a brief moment to attempt to explain what side I am on. MMRC. Wow, that was probably the most concise one worded answer I have ever given. I do understand the frustrations of not doing disaster relief nursing. I do understand wanting to branch out and do outreach nursing to remote desolate areas. I do understand needing to work. I understand all of this because it is has been my state of mind for the last few (three, as of today) months. I also understand why I dug in during the months I spent in Haiti during this Jan-Feb. I committed to something: to a hope, to a possibility, to a chance, and most importantly to a cause. I understand why the girls left, and without any judgement nor ill feelings, I also understand why I stay.
We took a day off on Sunday, actually starting on Saturday night. BP, Debby, Nick and me found a nearby (2.5 hrs away) beach to go to. After Peter’s clothes had finished drying (on the new upstairs clothes line he strung up -ps thank you monoloco green string) we all squished into a compact car and headed towards the bus terminal. Once there we bid our farewells to Peter who was continuing on , on his journey. We boarded the bus and headed out to La Playas beach. We arrived there after dark and found a hotel/hostel to stay in. We got a room with two single beds and a double for a great price. To top it off the hostel had an AC unit. This made everyone but me grin. This is the one I took for the team. Ha ha. We all went out and sat in a mostly deserted night club and talked. All of us were enthused about continuing on with our program attempts. In the morning we awoke and walked a few blocks to the beach. Unlike Montanita, this beach was a family beach. It eerily resembled Jensen Beach (shout out to FLA!). We went swimming, told stories and laughed. Most of us got really sunburned. I say most liberally. I got the least amount of toxic equator sunrays witnessed the following morning by the blisters across my previously scarred forehead. I am usually proactive about protecting my face, but I must have lost my sensibilities and sense of time as me and BP played in the horrendous rip tide for more than an hour. Most of me is tan, most of Debby however is near a second degree burn. A little silvadene and aloe/cocoa butter lotion mixed with a cocktail of high fat fried foods and ibuprofen and she is managing through the days just fine. Fine with a side of sunburn.
We got back to the hospital/house on Sunday night and pretty much loafed around. BP went down to the ER (as he does every single night) and found out that the night before the noc shift RN was swamped ( 6 pts is a lot here) and requested my help. Go figure, right? BP came up to see if I was awake enough to go and work that night but I was half asleep after being up since early that am. BP went down and assisted with a little girl who had a head lac. He is so amazing when it comes to being encouraging, supportive, strong, friendly and funny. He is to me, and he was to the little girl who amazingly took her head stitches in stride and without shedding tears. You go little girl, you rock!
Monday am was a day of regrouping. We split up the tasks in preparation for our next mornings meeting. Nick continued to shuffle computer paperwork, all accounting style. Big Props to Nicholas for he left his accounting job to once again be imposed upon to be the accountant. We are all glad that he knows what he is talking about, because at times when he dumbs down what he is working on I am still completely clueless. Better him than me ( or BP!).  I made an excel timeline sheet about our newly projected and much accelerated dates to present at the meeting. When I say “I made” you should know that means Nick was beckoned over every few minutes at first to create the formatting and when I say “to present at the meeting” I of course mean BP presented it.
BP had gone stairs to the hospital office to once again ask if we could get some sort of agenda for Tuesday’s meeting. That did not happen, although he had called up to the house with an inquiry about a 3-year-old girl who was in renal failure. The girl was tiny, only 12 kg’s and her family was very upset that she was not a candidate for dialysis. He had asked me if there was a cut off. Google agreed and said that you had to be between 12-15 kgs but some of the other things he mentioned stuck in my head.
He came up a little while longer and explained more of the girls story in detail. She had been sick since she was one years old with anemia and now she had low platelets and was in renal failure. I had been badgering him with eager questions that he thought I should just go down there and talk to the doctor/family too. I felt as thought I was imposing- but I changed into a MMRC shirt and went down anyways. She didn’t look as a child in renal falure should look, to me anyways. I had BP ask the MD for her labs and then he asked the parents some of the questions I was wondering.  Some of the words translate without interference, like when I said erythropoietin and IVIG. The family was talking about family they had in Chicago and about doing a kidney transplant. The story just wasn’t sitting right with me. This child looked as many other children I have looked like while I was working hem/onc/sct at CMH in Chicago. She was pale, bruised, but smiling. Her hair was shiny. I asked her parents how much she peed and they said usually at least six times a day. I know I am not a kidney specialist , but I have seen a bit of renal failure and normal urination usually isn’t something there. BP came back with the lab copies and sort of took me aside. One of the thoughts was that the little girl had cancer. If I wasn’t invested enough in this tired yet playful little girl I sure was now. We briefly talked to the MD in private and we pointed out the labs that seemingly indicated or in my view contraindicated a cancer diagnosis. Me and BP went back upstairs and I dove into the printed off pages, translating the parts I wasn’t sure about. I was even more certain that she didn’t have cancer- nor that she needed a kidney transplant.  Everything in her labs screamed immunodeficiency. Weird. Sometimes you just have to let things go.
Tuesday am. We all awoke ready for this meeting. Actually we all awoke very tired, and sort of assuming that the meeting was going to be delayed until the afternoon. Instead BP got a phone call saying our meeting was moved up half of an hour. I function better when I am pressed for time. I still deal with my own shortcomings of being reluctant to meet new people and to speak out in crowds, so having less time to focus in on my own trepidations and only time to focus on hurrying seems to work out well in everyone’s favor.
Dum-da-dum! We entered our  meeting and everyone sat down. We were immediately presented with a timeline that the hospital had made up for us. What a coincidence that we did exactly the same thing, right? Even though we have had nothing but setbacks and slow downs from the hospital - today they decided that we needed to kick everything into high-speed. Guess what? That is what MMRC is all about. The hospital is on track with us, but need to know that they are involved more.  In the grand scheme of things, this is actually going to save us a lot of steps when we integrate and then hand this program over to HMB.  Some of their wishes were that we do the exams at the hospital. In our minds we were going to plot out where these 50-500 cleft lip surgical candidates were and possibly travel towards them and do their initial physical exams. They also want CV’s of all our surgical teams, supply lists, etc. All of that seemed ahead of where we were on our timeline and mentally- but at the same time the things they had requested are simple and understandable things to ask. They agreed that I could do the physical exams and write for the pre-op labs and X-Rays if needed. They refused to let us do mobile clinics nor draw labs. Maybe next round that will change, but for now we are going to adhere to their guidelines. They also said that they are going to put out a television all call for candidates. Crazy, right?!
Tomorrow , at eight am, we will start evaluating our first surgical candidates for cleft lip repair. The candidates will go and be registered with HMB ( if they aren’t already) and then come to our room with their charts. We will do Pt Hx’s, ROS’s, basic vitals, and facial exams with pictures. When registering the families will sign a form allowing us to take pictures, videos, and use that media to send to potential surgical teams. This is all quite exciting. How many patients will we see tomorrow? So many that we have to tell them to come back another day? None? We just don’t know. What I do know is that we are ready.
What I also know is that we are also working on our alternative locale to house MMRC’s home base. While we all have our feet dug in, we are also not blinded by the many Ecuadorian sunsets that we all watch while perched on top of HMB’s tin roof top. Our goal is to turn this program over eventually for sustainability and empowerment of Guayaquil.
The next few weeks will be filled with communicating and setting up our partnering with LEEP and Operation Smile. Details will be shared as the next few weeks pass on. All focus needs to be on this programs launch for now, and not blurred by thoughts of ideas that are happening yet too futuristic to pay much attention to. Tonight we all will sleep wondering how tomorrow will unfold. More on that then. As for now, I am going to rest with my stomach full of tonight’s fresh green salad dinner – and smile.

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