Okay, this week did not start off as a banner week for me. I love working in the hospital and helping patients manage the suffering they experience. But, disorganization really bothers me especially when I have no real way of effectively managing it. It seems that the staff at the hospital is ill-prepared to handle us as a group, and we often find ourselves leaving for the hospital only to leave a few hours later because there is relatively little for us to do or observe. Unfortunately, I am a nursing student who is graduating in just one more semester and will enter the nursing profession in, what I anticipate will be, early 2012. I need to know that when I enter the hospital, I am not intruding on the time and space of other health professionals who are managing their patients while, at the same time, obtain a learning experience that will aid in the development of a career caring for patients. To date, I have not received the impression that our existence at the hospital has any real organization. It’s sort of like improve. We’re playing it by ear.
However, each of us individually and as a group have worked to find some sort of organization by communicating with one another about which unit we plan to work in that is somewhat prepared to handle an intern. Unfortunately, it’s a crap shoot if any duties or shadowing of professionals conducting rounds or procedures will occur at all. Fortunately, I chose to participate two days in surgery this week and have learned a lot from the surgeons and nurses as well as observing some incredible surgeries.
Fortunately, the doctors, for the most part have English speaking skills. Though some are shy at first, once a dialog has started, it’s amazing how others will chime in. I find that with a little encouragement and reassurance of their communication skills, that the medical professionals are willing to share their expertise with me.
For example, today, I watched femoral endarterectomy, patch plasty, and varicose vein removal. Being a bit shy myself with my lack of Portuguese language skills, once the English dialog sneaked in, and started asking questions about the procedures. Not only that, the surgeons were quite enthusiastic about teaching me the intricacies of this complicated surgery once they figured out that I had a vast amount of knowledge about human anatomy, processes, and pathological conditions. We spoke as equals in the surgical unit, with me knowing full well that the professionals I was interacting with were skilled, experienced surgeons with more years of knowledge than my meager three years of medical nursing education.
Nevertheless, I learned a lot from these surgeons and nurses including what it would be like to be an experienced operating room nurse. I have a better understanding of sutures and the differing types used depending on the type and location of body tissues. I also have a greater appreciation of arteries and how both resilient and susceptible they are to disease. The patches used were artificial and were placed down the length of the femoral arteries about 3 to 4 inches long after the same length of plaque that created a 100% occlusion for these arteries. I learned that the sutures places there were not absorbable, made of silk, and different than those used to stitch the fatty tissue together, which dissolve in three months (as further opposed to the epidural stitches that dissolve in 15 days). It appears all simple, but it’s all rather complex.
I shadowed professionals during the two days on the unit for numerous surgeries. It is amazing how diversely skilled these surgeons are at mending the sick. And, I hope to shadow more next week because I want to get to know them better. Already, I chatted both professionally and personally about their career and personal lives here on the island. They are all so giving and welcoming. I have yet to encounter this degree of reception in the states.
But, as mentioned before, the other unit experiences were far less interesting and fruitful this week. Dr. Claudio did provide some extremely valuable information on resuscitation and intubation. The latter I had not learned until my day with him using the body simulator. I cannot describe how the mystery behind intubation and my lack of knowledge about it bothered me since I had not done this procedure first hand during my coursework. Now, after having done the procedure under his guidance several times, I am confident that under an emergency situation, I can perform this life saving technique under pressure.
All in all, the week turned out well given taking the initiative to make opportunity happen. I was disappointed that I did not hear from the nursing school I visited last week in an attempt to broaden the experience here in the Azores. I think the program is more focused on the medical aspect of cure rather than the nursing provision of care. Thus, I made an attempt at contacting a representative at the nursing school to hopefully help me work with more with nurses while paving the way for our only other nursing participant in session two along with, hopefully, more nursing students in the years to come. However, I am satisfied I am upholding the ethical standards of care I have learned at UNC and under the influence of some fine instructors who have taught me well about the nursing process. I have encountered some ethical nursing struggles during the four weeks here in Terceira, but I am confident I managed them well. I am indeed becoming a nurse. Being placed into a foreign environment with individual autonomy and ethical challenges made me realize just that.
On the other front, this week was not as sunny as the weeks before. Yes, we were indeed spoiled by all the sunshine and I’m hoping it returns. With overcast and rain, it’s tough to be inside the dorms all the time. I did hike by myself on Mount Brasil for 5 hours venturing out in remote areas I had not seen before, but the weather was turning for the worse, and I had to make my way quickly off the mountain before the clouds became too thick (while the sun was falling, too). Still, an amazing hike.
Ultimately, I look back at the beginning of the week as a downer. But, sometimes, starting off on one helps to motivate a person to take more initiative and get things done. When I look back on the week that has yet to end, I think it was quite productive. But, facing only two more weeks on the island, I’ll need to kick it into high gear at the hospital if I am going to gain greater knowledge from the professionals here while earning their respect enough to make certain we leave here not as a burden, but as a group that provided enlightenment. However, I am hoping we can figure out how we can give back to the hospital that opened their doors to us, however awkward our presence may be.
~ Christopher
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