Meltdowns, Countdowns, and "Throw-downs"

It's been a busy month....both at the paying job and at One Good Deed. We've had a high census at the paying job, and also some pretty high acuity patients (that's really sick babies in layman's terms!). I've also had a capstone student with me, so besides having to behave myself :-) I've had to put my "teaching hat" on and explain a lot of what we do. All good things, but I come home pretty tired. In fact, I don't always make it home before the tired hits! A case in point was last week when I literally "dozed off" in mid-sentence while giving change of shift report!

Come on, haven't you had times when you thought it would feel really good to just close your eyes for a second? Well, that thought apparently crossed my mind and went straight to my eyes because they closed for just a few seconds. Unfortunately, I was in mid-sentence.....It was just a few seconds, but I remember thinking "something isn't quite right here" and looked up to see the on-coming nurse looking at me with a puzzled expression. What the hell, might as well be honest--there's no graceful way to come out of that one, so I said, "Oh I am so sorry. I think I almost dozed off there for a second--or, OMG was it more?!?" She burst out laughing and said it was like five seconds, tops (thank God!) and we went on. Funny, yes. Embarrassing, ABSOLUTELY! But I at least have finally admitted to myself that something has got to give and I must take care of myself and get more sleep!

Humiliating story aside, I have been having a few meltdowns lately. Things are happening very fast right now where One Good Deed is concerned....good things, but the pace is a lot when you are also trying to juggle a full-time night shift job. I mention the night shift part because it is, I think, harder to organize a busy life while trying to get enough sleep during the day. Our bodies were not meant to sleep during the daylight hours and it's hard when other tasks keep rearing their heads and demanding attention! Which brings me to the "countdown" part of this blog (and will hopefully explain the previous whining and meltdown part!)

The countdown is on for several things....namely the NANN Conference which is coming up in October and which I have to prepare both a poster presentation (not too stressful as it is almost done) and a podium presentation (meltdown!) which is started, but I'm not satisfied with the way it's going yet. I say yet because I am certain it will get there. It will, right?!?

The other countdown has to do with our upcoming trip to Rwanda in November to continue our training in the Helping Babies Breathe Program. This generally isn't too stressful for me because it is what I love, but.....a lot has been going on in the past few weeks and things have grown exponentially in this arena. My head is spinning as I try to keep up with all of the necessary work this requires while also, you know, trying to work! I just keep reminding myself that this journey I'm on was put before me for a reason, and it is the path I have chosen because I know it is right! Anyway....I plug on. And for all of the well-meaning people in my life who are giving advice like "you should cut your hours at the paying job." I would love to be able to do that.....but I have to have an income, and besides that, I love my job! And to those who say I should slow down--again, would love to, but I didn't set this pace--I just have to keep up! However, I do try to take a little time to get away from it all every so often--especially when the meltdowns seem to come one after the other--so I don't make the lives of those around me too terribly miserable! (And, yes, I am aware that a meltdown slipped into the countdown part here!)

That Someone (God) I refer to also helps out by intervening in ways that are interesting although somewhat frustrating--like the past few days when we stole away to the lake for a little quiet time before heading back into the fray. I agree to these mini vacations because I know I can still keep in touch via internet......unless there is no internet, which is what happened this time! The stress gnawed at me for a bit, but what could I do? I decided it was beyond my control and I might as well just roll with it. Thank goodness for that because I really did need the break! But, today I am back at it and trying to catch up on what I missed the last few days. I also have to remember to schedule a nap today since I am working tonight! Anyway......

On to the "throw-down" part. I think I have mentioned before about Helaina from Eos Visions and her extensive work trying to get Fidele from the Ministry of Health in Rwanda to meet with us and work with us....Well, dear Helaina has since taken a job back in the U.S.--nice job, too, at the State Department--and Katie from Canada has taken her place at Eos. Katie was warned by us all that she had her work cut out for her where Fidele is concerned. And God bless her, she took that challenge in stride and made great headway for us! Not only did Fidele make an appointment with Katie, but he kept the appointment, AND he listened and contributed to future plans for the Helping Babies Breathe training in Rwanda, AND (drum roll, please!), he said we needed to draft an MOU (memorandum of understanding--aka contract) with the Ministry from which to work on future trainings! Bravo, Katie, Bravo! Well played, indeed! She threw down the gauntlet and Fidele picked it up and ran with it! This, my friends, is HUGE!!!! It's also things like this that keep happening for us that make all the meltdowns worth it!

So.....I apologize for the lengthy blog with no photos to break it up, but I just had to catch you up on the chaos! It is frustrating and trying at times, but it is so very worth it! There are some other things in the works as well, so keep your fingers crossed for me as I continue my muzungu journey! But for now, I've gotta take a nap!

In New York Harbor Stands a Lady......and in East Harlem serves a Sister

Last weekend we joined Steve's family in New York for the final vow ceremony of his niece, Kensie, now better known as Sister Mary Pieta of the Divine Mercy. Not being a member of the Catholic faith, I went with a large measure of curiosity and prepared to learn a lot. I was happy to be included in this most important occasion.

While I did learn a lot about the Catholic faith,  I wasn't prepared for the emotional impact this ceremony had on me. Five young women took vows to commit themselves to their faith, and essentially, to become the brides of Christ. The ceremony was presided over by Cardinal Dolan, the Archbishop of New York, who is, in his own right, kind of a big deal in Catholic circles. I am sure he would beg to disagree, as I found him to be quite down to earth and humble.

I was raised in a protestant church, a Bible church--somewhat similar to Baptist in its beliefs, and while we had our rituals, they weren't as far-reaching as those of the Catholic Church. Later in my life, I visited various churches trying to find a home, all of them either Baptist or something very close. After my divorce, my kids and I started going to an Episcopal church down the street from where we lived. Mainly because my kids had many friends at the church and it wasn't such a struggle to get them to go to church. What I found, though, was that I rather liked the ritual and the customs. Not because I felt they were necessary to my beliefs, but because they prompted me to think about the reason for my beliefs. I am sure many of my friends in the Baptist church will disagree with me, but I have come to feel over the years that religions are very similar in their origins and actually share many commonalities. So....I no longer associate myself with one particular religion, but I do have my beliefs and I do consider myself a spiritual person.

Anyway, I digress.....back to Lady Liberty and the Sister.

Inspired by the Holy Spirit to become a Spouse of Christ
and desiring to live the Gospel more intensely
in the spirit of Saint Francis and Saint Clare, I,
Sr. Mary Pieta of the Divine Mercy,
vow and promise to Almighty God, to the Blessed Virgin Mary, to our Holy Father, Saint Francis,
 to our Holy Mother, Saint Clare,
 and to you, Your Eminence,
to observe for my entire life,
the rule of Saint Francis of Assisi,
confirmed by our lord, Pope Honorius,
as interpreted in the Constitutions
of the Franciscan Sisters of the Renewal,
living in obedience, without property,
in poverty and in chastity.

With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame.
"Keep, ancient lands, your storied pomp!" cries she
With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"

Emma Lazarus, 1883

Lady Liberty stands for freedom, the concept on which our country was founded. This past weekend I had the opportunity to lay eyes on her for the first time. It was unexpectedly emotional. I tell you this because I am making a parallel here. 

Sister Mary Pieta is another "Lady Liberty." She serves in east Harlem, New York at a convent in the "hood." She stands for Christ in her commitment to serve the poor. I am touched and moved by both of these ladies for their commitment to what is good, and right, and in Sister's case, holy. I applaud their passion and their compassion, and even today as I write this, I am moved to tears to be part of something that is bigger than myself and that touches the lives of many for the betterment of all. So God bless both of you ladies!

Choosing the Path Less Taken.....

I've been struggling some time now with thoughts of graduate school. I've researched countless Master's programs, never finding one I consider "perfect" for me. I've finally realized it's because it doesn't exist. I have no desire to take the nurse practitioner route, preferring instead to stay at the bedside doing direct patient care. That is my love, my passion, and, after all these years, I think I can say that I am fairly good at it. I like being able to sense when an infant is getting worse....or better, simply because I have been watching them closely and detect little, scarcely noticeable changes in their behavior or vital signs. So, why do I feel the pressure to advance my education? I'm fairly certain it's self-imposed. There really isn't anyone telling me I should be a practitioner, at least not to my face.

I guess I should have become a CNS (clinical nurse specialist) while those degrees still existed. Unfortunately, most of them have gone by the wayside, taken over by the practitioner role--which isn't the same at all! My frustration, I think, lies in wondering what the hell is wrong these days with wanting to be a bedside nurse?!? It seems like all of the young nurses are in such a hurry to leave the bedside and become "advanced" practitioners. I don't fault them for wanting to advance their careers, but I do fault them for trying to "hurry" the process. I can tell you one thing for sure, without some bedside experience....and I'm not talking about a mere two or three years.... you aren't going to reach your potential as an advanced practice nurse. Horrors! I said it out loud and put it on the internet for all to see! I'm sorry folks, but  a couple of years at the bedside plus a Master's and a little clinical time does not an expert make! It takes time, and unless you've worked in a unit that has one crisis after another (that you're directly involved in), you aren't going to get the kind of experience that carries you through making those tough decisions that will be yours once you get your advanced degree.

Don't get me wrong....I have a great deal of respect for my practitioner friends and colleagues. I also know that some of them could have benefited from a few more years at the bedside. This isn't about "earning your stripes," but rather about taking the time to finesse your assessment skills and spending some moments in the trenches gaining knowledge that only hands on experience can bring. A book can tell you about a sick baby, but spending hours at the bedside watching each subtle sign of illness that baby exhibits before all hell breaks loose is not something you'll master from reading a chapter!

So forgive me, my friends, if when you give me an order, I question it. I'm not trying to be difficult, and I'm not trying to challenge your position. It isn't a pissing match, it's based on an opinion, an observation that comes from years of doing what I do. I didn't get an advanced degree in it, but I certainly did get an education....at the bedside....where the changes occur and where the patients don't always read the textbooks and follow the algorithms. I will give you the courtesy of following your orders and respecting your decisions if you first give me the courtesy of listening to my opinion and realizing that maybe, just maybe, I have good reason to question you based on experience and not just for the hell of it! So for you  experienced practitioners....carry on. And for the young ones coming up with a teaspoon of experience under your belt.....listen up, you may have more alphabet soup behind your name than I do, but I bet I have seen and done more than some of you ever will. Lose the attitudes....you may need us old bedside gals in a crisis someday and it's much easier to ask someone for help when you have their respect because you've earned it. I'm not trying to offend you, and I don't envy you or discredit your choices....I just don't readily trust you....not yet.

That being said, I think I will move on down this path less traveled, content to watch over my little charges like a hawk. It may not be the position that gets the glory, but it sure does have its rewards....and they are priceless! BSN.....bedside nurse......has a nice ring to it after all!

First Run of the Season with Cap'n Steve and the Boat Dog

Yeah, I know......my life sucks! Hahahaha! After a looooong three days of work (go ahead and roll your eyes, I deserve it), we decided to spend some days off at the lake. First run of the season, and it was a great one. Bailey the boat dog would probably disagree since she fell out of the boat and had to swim for it, but hopefully she learned a valuable lesson.....when Cap'n Steve guns it at the end of the "no wake" zone, you better be hanging on! She's none the worse for wear, though, and still had a good time.

I love being at the lake during the "off" season. There are no crowds, the lake is calm and quiet, and we can RELAX! The first day, although a bit chilly, was gorgeous. We found a favorite cove and spent, we're not sure how long exactly, some time napping in the boat. Yep, we're old and dorky! Even the dog enjoyed the nap--she's old and dorky, too. We weren't so odd, though. This turtle was napping in the sun as well!

It's always good to recharge every once in awhile. Brings clarity to one's thoughts and renewed purpose for getting out there and being useful. I've finally learned....took many years.....that down time is not wasted time. I come up with some of my best work when I am doing nothing. Maybe in a few more years I'll remember to write ideas down during these times since I never remember them once I get back to "the real world." Or, maybe I'll just let them come and go and continue to escape for awhile from the chaos! What do you think?

Here's hoping this was just the beginning of many more long, lazy days at the lake this summer!

Guess I'll Have to Be a "Gig 'em" Girl Now

It's hard to believe that I've already been home from Rwanda a month. It has gone by fast, and I've been busy. We arrived back in Kansas City on Sunday evening, April 1st, and I spent much of the night (after dinner with my husband, kids and parents) doing laundry and cleaning house! We left the next morning for College Station, Texas to search for an apartment for Cait, my daughter, who will be starting grad school at Texas A&M in the fall. No rest for the weary!

Cait will be attending the Bush School at A&M. The picture above is a sculpture outside the Bush Library and School. It is horses (obviously) jumping over a section of the Berlin Wall. Beautiful piece!

This bust of President George Bush was just inside the front doors of the school. I had to share it because I love the quote under it! I believe people can make a difference not only on a local and national level, but also on an international level, so this certainly resonates with me! I hope Cait is beginning a journey that will be her venue for making a difference in her world. I guess for the next two years I'll have to be a "gig 'em" girl as a Texas A&M mom! Not to fear, MIZZOU, I'll always be loyal to you, though! After all, isn't it better that I "gig 'em" instead of "rock chalking them"? ;-)

We had a whirlwind trip in Texas, but were successful in finding a perfect apartment....and one that will take Cait's "pony" AKA Aerial, the Great Dane! Everybody was so nice and quite helpful, and I am looking forward to having her a little bit closer to home! Okay, she'll still be a 12 hour drive away, but it's better than 16 hours! She'll also have family close if she needs someone. My cousin, Michelle, and her husband are just a couple of hours away in Kady (near Houston), so that gives me a measure of comfort.

After the whole Texas trip, I had to return to the reality of life...my paying job! What a culture shock after being gone for almost three weeks! It is good to be home, though, and I missed my life at KU. I do love my down time, but I find that it's always good to return to the babies I love and the coworkers who have become a second family!

Final Day in Paradise......Until Next Time!

I woke up early on our final day in Rwanda. I had a lot to think about. Last night we were joined at dinner by two nurses from Canada who had recently become HBB trainers and were in Rwanda to.....what they weren't exactly sure. Do training perhaps, but they had no idea of where to begin or who to talk to. Cathleen had found me by Googling HBB and contacted me to see if they might join us to observe our training. Unfortunately our schedules didn't work out for us to be in the same place at the same time as the training, but they were able to join us for dinner. We talked a great deal and I gave them some advice. They wanted, I think, to be given my contacts, but instead I referred them to the Ministry of Health. Hmmmm. Proof perhaps that my thinking has changed on this trip. After my meetings last Friday I realize that there absolutely has to be some kind of order to these trainings in order for them to be: 1. sustainable 2. replicable 3. monitored 4. reported to prevent duplication or missing areas entirely 5. documented in research. No end run around the homework, my friends. I got the impression that they might like to avoid all of the legwork I had done over the past four years and get right to the heart of the matter, but.....as I have learned the hard way......that legwork was crucial to my understanding of the way things work in Rwanda, and those relationships were the foundation for me to come back and speak with some authority to these friends of mine. They have seen my face repeatedly enough to realize that I am invested in them and that I want to assist in their own advancement as professionals. They trust me.

I have a necklace that I have always worn when traveling in Rwanda. It has an inscription that reads, "It's not the destination, but the journey." I have found this to be true not only of my travels, but also of my life. The journey is what it's all about.....and I will continue mine, wherever it leads, learning along the way and hopefully becoming a better person in the process.So, Cathleen and Kim, I wasn't trying to be mean, spiteful, selfish or rude....just letting you find your way, too. Here's to your own incredible journey!

And now, some photos from my last morning in Gisenyi and our farewell to Yvan at the airport:

Farewell, dear Yvan! I hope to see you next time....you are, after all, now officially family!

HBB Skills Testing at the Gisenyi District Hospital

My feeling yesterday was right.....these learners rocked their skills testing! See for yourself:

In all fairness, this wasn't these folks' first rodeo, so to speak. These were seasoned nurses and birth attendants who help women deliver babies all the time. However......the HBB program was a different approach for them. Often, in Rwanda, if a baby is born not breathing, the baby is set aside and the birth attendant tends to the mother. After all, there is the placenta to be delivered, etc. With the information and training they received over the past two days, these people realized that they might save more babies' lives if they simply spent that one minute assisting them to breathe and drying and stimulating them and keeping them warm. Simple, yes? But life changing for those babies who otherwise would be set aside to fend for themselves, to live or die by chance. These people realized that they have the power and the skills to make a difference in the lives of those babies......and that, my friends, is HUGE! It has been my experience over the course of my career that if you want to make a change in practice, you have to first make a change in the mindset of the people whose practice you want to change. Just telling them that this is the way things are going to be done now is not enough. After lunch we spent time with our learners while we waited for Dr. Emmanuel to come speak with us. We asked them questions and they asked us questions, and over those few minutes we created quite a debate among them. Many were saying that placing the infant on the mother's abdomen after birth was a change they just didn't see a reason for. There was a lot of arguing (well, it sounded like arguing, but was in Kinyarwandan so who knows?) Once Yvan translated for us, he told us that they had been arguing about the whole process of HBB because they often found themselves to be the only birth attendant with two or even three mothers delivering at the same time. How were they supposed to be three places at once?!? How indeed. They then talked about the Golden Minute and how that they  probably, even with multiple deliveries, could spend just one minute with that baby. And if the baby started crying while still on the momma's abdomen, then they could wrap it and leave it with the mom while they attended to the other delivering mommas. And that would free up their only warmer for babies who needed advanced care. It was that simple in their minds.....it made sense to them because it was practical, and because, if the baby didn't need advanced care, it allowed them to use the baby's own mother as an attendant. Who better to ensure the well-being of their baby than the momma? They said this would change their practice. So....they went from "this isn't how we've always done it"  (how many times have I heard that before--everywhere I've ever worked, and probably said it a few times myself!) to "this will change our practice." And why? Because it was explained in a way that made sense, and because they were given the evidence supporting it. Simple.

When Dr. Emmanuel arrived we presented the certificates and then he spoke to the learners and to us. He told his staff how proud he was of them for taking this training and learning how to save more babies' lives as a result. He then told us how vital this training was to Rwanda, and to the survival of its children. What better validation could we have asked for?!?

And then, I presented him with two training kits so their new trainers could continue to train others in the district. This, as you can see, made him a very happy man indeed!

So, tomorrow I will leave Rwanda a very happy soul. I am so very proud of my colleagues who joined me. Thankful for their willingness to come and learn yet another program and then turn around and put it to immediate use, and also for their willingness to share their expertise with other nurses in this country. I think they found, as I have on many visits before, that we are really all quite similar in the areas that are important. We love our families, we love babies, and we love to laugh. And so we did......and we celebrated our similarities and sought to understand and accept our differences. It may not be world peace.....but it's a start!

HBB Training at the Gisenyi District Hospital

Today we start our first day of training at the Gisenyi District Hospital. I have visited the Gisenyi hospital on each of my trips to Rwanda, and it has become one of my favorite places. Gisenyi itself is a beautiful place, and I have always enjoyed my time in this area of Rwanda. That is not to say that I don't enjoy the other places I visit in Rwanda, but I have gotten to know many of the people at the hospital and consider them friends.

We start, as always by going over the flip chart and the action plan.

Training at Gisenyi will be a little different because not all of our learners understand English completely, so we have to readjust our training to allow Yvan to translate. This was particularly hard for me being the "wordy" person that I am..... I had to learn to be concise! (Don't get your hopes up, friends, this is a short term change! I'm an old dog....don't do well with new tricks!) Poor Yvan, he has had so much to put up with from this team of lady trainers!

After we went over the flip chart and action plan, complete with the exercises of telling the stories about the babies being born not breathing, and the one of them holding their breath as long as they could....we gave a demonstration of the scenarios.

One of the things I have come to love about my friends here in Gisenyi is their curiosity and wanting to know everything! Today was no exception.....they began firing questions at us about things way beyond the scope of this program, such as neonatal assessment, resuscitation, and on and on. Not being one to miss a teachable moment, we tried to comply with their requests. Sara came up and demonstrated, trying to keep somewhat on our original topic, how to assess an infant while you are drying, stimulating and helping them to breathe:

One thing led to another, and they were eventually asking about giving compressions and administering drugs......sigh. I finally, with Sara giggling a little in the background, had to explain the scope of the HBB program and that it was designed to work with other neonatal resuscitation programs and that it really just targeted that one minute after the baby was born. Back on track, we moved along to the rest of the training.

After the demonstrations, Yvan explained that we would break for lunch and then the afternoon would be spent with them practicing scenarios so they would be ready for the testing tomorrow.

We broke them up into three groups after lunch and began our practice scenarios. Two of the groups were placed fairly close together so Yvan could translate for those who needed it. Age comes with its privileges....Pam and I got the group that spoke pretty good English! And now the fun really began! Who knew that these folks would throw themselves so completely into this?!? We had some real actors here when it came to playing the mommas.....they did a pretty thorough job of being the birth attendant as well.

And so we spent the afternoon practicing, laughing, learning, and having fun......because we remember the things we enjoy and try to forget the things that are painful. Sorry all you former PALS instructors from a place I try to forget.....there were no tears here, just laughter, teamwork, communication, and, yes, fun! Given what we saw today, I think these people are going to rock their skills test tomorrow!