Category: Advice (that you probably shouldn’t follow)

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Holidays, Exams, and Talent Shows

It’s been a busy week out here in training-land.  3 holidays in one week, and only one day off. July 1 is Rwandan Independence Day [but it’s not celebrated].  July 4 is both American Independence Day and Rwandan Liberation Day, and for us, our only day off.  My fellow trainees and I went to the local hotel,  had pizza, fajitas, cinnamon rolls, and Fanta [or beverage of  your choice].  For me it was a welcome day off from the onslaught of language classes that the week brought.

On Saturday, we had our a mid-training language exam.  The target at this stage is Novice-high, but I have a plan.  My plan is to score Novice-Mid, get put in remedial Kinyarwanda class, get extra speaking practice, and then WOW everyone at the final exam with my Kinyarwanda prowess. But here’s the real deal, I have performance anxiety, and I have had it for years.  I almost didn’t graduate from college with my Spanish degree because I had such anxiety for my final  oral exam.  And this was with my professor who I had known for three years, and was very familiar talking to him.  So while yes, I am older and wiser, but I still have so much anxiety concerning ‘public speaking.’

On Friday, I picked up my first tailor-made shirt.  It needed a few minor adjustments so I snapped this photo of my [15 year old] tailor making the adjustments.

On Saturday, after our mid-training language exam, I went to the talent show at my host sister’s school. There was singing. And traditional dancing.  And Drumming. There was a skit [in Kinyarwanda–I didn’t understand any of it], and some kid read the news.  And then there was ‘fashion’.  Fashion consists of about 10 couples of modelling different African fashions.  And these kids are stylish.  And they have real talent… unlike most of the talent shows I have been to  in the past.

We’re fancy. We met the US Ambassador to Rwanda.
Every so often, I see beautiful tropical flowers in unexpected places.

Some people

I remember the first patient that I liked that died.  Really liked.  James was a 16 year old boy with Cystic Fibrosis.  He was surly, uncooperative, and mouthy.  He never wanted to take any medicines or do any therapy.  A lot of my co-workers would rather not have him as a patient, but whenever he was on the unit, I volunteered to take care of him.

One day, James said “you think I am sexy. . . that’s why you always want to have me.’  I replied ‘1. You’re jailbait, little boy. 2.  You’re scrawny, and you can’t even cough without getting short of breath.  Let’s do your breathing treatments and CPT.’  And he would let me.  Every.Single. Time.  For whatever reason, he responded to me not treating him like he was sick.  I always give him a choice–“do this… you know what your other options are–get intubated, put on a ventilator, and we can suck the goo out of your lungs all day long or do the CPT, take the treatments, and cough.”  He always chose to take the treatments.  He knew that if he ever went on the ventilator chances of coming off were not good.

One day, he asked me if it hurt… does being on the ventilator hurt?… does being intubated hurt?  My answer was truthful–whether it does or doesn’t, I can’t say because I’ve never been in that situation, but I do know you would be on pain meds and meds that will make you not remember.  He said OK then asked if I wanted to play chair basketball with him.  And we did.  Because that’s what you do in peds.

The next day was the Duke-UNC basketball game [James was a big Duke fan].  He asked me if I would watch it with him, and I said I would with the understanding that if I got paged, I’d have to go.  He said OK.

I got through first rounds, saving him for last, and we did his therapies while watching the game.  Duke won and after the game he told me he was ready to be intubated because it was just too much of a struggle to breathe.  I asked him if he was sure and he said he was.  I found the resident and told him what James had said.  He went to talk to him and James called his parents.  They came and it was decided that they he would be transferred to PICU and started on the ventilator later that night.

I stopped by to see him later that night.  He was still awake, had his blue, fuzzy Blue Devils blanket on his bed.  James said, “I know I can be a pain in the ass.  I know I’m probably not going to survive this, but thank you for not treating me like a kid.”  What do you say to that?  ‘You’re welcome’.  My pager went off and I was saved by the bell.  ‘I gotta run but you know you’re awesome, right?’  In typical teenage fashion he said ‘Yeah, I  know.  See you in my dreams.’  My last words to him was ‘Hush your mouth, jail-bait.’

James was right; he didn’t come off the ventilator, and died a few days later.  It sucked, but it’s life.  He knew he had a terminal disease.  He knew that most people with CF as severe as his didn’t survive much past 20.  He accepted life and a death with grace and dignity.  He may have been just a teenager, but James had a wise soul.

Nursing Lesson #1:  Some people.  The memory of some people stick with you forever.