Fall Funk

     Well it's official. After being out of country for just over 60 days I had my first (and I'm sure not my last) cathartic sob fest. Let me fill you in because yet again time has gotten away from me, though partially this time because I just didn't feel like writing. It's been a dark couple of weeks and I really didn't feel like bumming everyone out again.
     Two weeks ago, I walked into the ICU thinking it was just going to be like any other Monday. Granted, it would be like any other Monday here in Rwanda so never the typical Monday you're thinking of I'm sure. In fact, that particular Monday was Columbus day, so the mere fact that I was at work and some of you weren't makes it special. Anyway, it wasn't long before my tired, groggy, un-caffeinated body that hadn't slept well over the weekend, found out that our newest patient happened to be my Head of Department (medical director)'s mother. When Claude, the Senior taking over that morning found out his eyes became as big as saucers. I had an uneasy feeling.
     Tuesday morning was worse. Théogène was on his flight back from Sweden where he had been for a month working on his PhD. His mother had taken a turn for the worse and it was not looking good. I kept checking to make sure she had a pulse I was so nervous. The unit was hectic and I pushed lecture to the afternoon because otherwise I'd be lecturing to myself about the importance of calculating patient's fluid balance. The next thing I knew a different patient started to code. I don't even remember his patient story. It all happened so fast. The code ran extremely well and I was very proud of the nurses and of the doctors. We have a new General Practitioner for the ICU, Oscar, so he's still getting his feet wet, but he, Claude, and the nurses did a very good job even if in the end they were unsuccessful in reviving the man. I will say that I was able to cross another first off my list though... I thought they only used paddles on defibrillators in old tv shows (think early years of ER) and movies. Nope! They use them here too. I was the one who squirted the gel onto them. I felt as though I was in a time warp.

Claude working hard to save a life.

     Meanwhile, we were all hoping and praying that Théogène's mother would hang in there until Wednesday when he'd be back in Butare. I finally I had to leave the unit to have a bite to eat and when I came back about 25 minutes later I discovered that they had started to code her. Claude and the nurses worked tirelessly and I will admit to doing some CPR as well. But all efforts were to no avail. She died at 2:05 pm Tuesday afternoon after 30 minutes of coding. It was terrible. Théogène's brother works at the hospital as well and the rest of the family was present, but it was just awful that he wasn't there. We all felt terrible, but they had done everything that they could to save her. I went back to the cafeteria and bought everyone in the ICU a Fanta as a little pick me up. It helped a little. I didn't sleep well for the rest of the week. Nor was lecture very successful for the rest of the week. I had 11 of my 15 staff nurses come in the first week and 5 of the 15 the second.
     Friday was the funeral. Not sure if I could really handle the depression I was happy to walk up to the post office in the morning and pick up a care package. The box was almost falling apart, but it arrived, in one piece from good old Monkton, Maryland and my friend Dan and in it was a wonderful surprise... CHEERIOS! I LOVE CHEERIOS. I'm just sad that the milk here isn't fabulous, but I'll eat the entire bag dry. I don't mind. I also received more Berger cookies that at this point my housemates have fallen in love with as well and we enjoyed them very much. This prompted a super excited Facebook post, which resulted in a very funny status from my friend Kara, who is one of the sisters I met two years ago in Croatia. Unfortunately, my enjoyment of my care package was quickly brought to an end as I attended the funeral.

 

     I wasn't sure if it was appropriate for me to go initially, but everyone said that I should so I went. Out came my black dress (though I spiced it up with my red heels, color does not matter here for funerals) and I walked up to one of the churches in my neighborhood for the service with Melody. There we met Jessie and Beth (an ICU physician from Kigali) who had driven down in the morning for the service. It almost started on time and was a very nice service. The music was very beautiful. One of the things I've always appreciated about the Catholic mass is your ability to follow it no matter what language it is said in. Well... Kinyarwanda might be that exception. It was very difficult to follow, but I think I said the proper English responses where appropriate. Actually probably not. I probably said the old English responses that are reflexive and not right anymore. There were about five words of Latin that I understood for the 2.5 hour mass. When Théogène's aunt stood up to speak I got this feeling, a feeling I understood all too well. Ever since my brother died when I was 13 I get these feelings. It's of shear terror and panic revolving around death, which is an odd thing for an ICU nurse to experience I suppose. I hadn't had that feeling for a very very long time and when it hit me, I felt as though there was nothing I could do to stop it. Here I was sitting in a church and I was about to have a full blown panic attack. Fortunately, it was afternoon at this point in Rwanda so I quickly pulled out my phone and text Meredith and one of my best friends who has always known about this visceral gut aching, take your breath away feeling Luke. Dith responded as she fell asleep. Luke was able to distract me enough that I didn't end up completely freaking out. Disaster averted. But I hate that feeling.
     After the service we went to the burial. That was a very new and interesting experience. First off, the grave yard was on a beautiful hillside that overlooked rice paddies and appropriately in my opinion, the hospital is across the little valley on the opposite hillside. It was quite picturesque. However, the experience was very different than the US. First, there were prayers and singing and then they lowered the casket into the ground. That's not typically done in the US, but it didn't stop there. While we were praying and singing they started to build the gravesite. There was no dirt thrown on top of the casket, just Holy Water, but they then took boards and covered the site. Then laid down paper, and then a grid, and then concrete, and then made a headstone from brick, and then placed a cross with her name and dates on it. They entombed her. I'd never seen that done and it took me by surprise. But it certainly solidifies that she is gone. It was beautiful that her family was there until it was all said and done, but it was also immensely depressing.

Beth overlooking the valley

ICU nurses laying flowers at the gravesite

    Afterwards I went home extremely exhausted about six hours of funeral. I was home alone and just wanted to curl up and watch a movie. But of course, there was work to be done. Emmanuel and I needed to finish our goals for the year. So he came over and he wrote his goals out with my help and I cooked dinner. I made him stir fry. He'd never had it before and he claims he liked it. I hope so. It was a good bonding evening for us, even if I gave him too much wine to drink. I finally crawled in bed, couldn't sleep of course, and got a couple of hours of sleep before I was up and ready for a better day because I was off to Nyungwe Forest again!
     One of our pediatricians, Emily had a birthday and we decided to go hiking and then to the Forest Lodge for an evening of relaxation and fun. The hike was amazing! We climbed the highest peak in Nyungwe where at the top you can see Burundi to the south and Lake Kivu and the Congo to the west. Pretty amazing views... Ours looked more like this...

View from the top.

Yep... it was a little cloudy and mysterious so it didn't result in the best views. It did result in the spotting of some monkeys and interesting birds and some white wine with our picnic lunch and a lot of laughs as we played a game called Contact, which became infinitely more fun and difficult as we consumed wine. On the way down it started to rain. And then POUR for about 2 hours. By the time we got back to the car we were soaked, freezing, and the wine buzz had worn off.

Jared carried the white wine to the top

Mountain monkeys just hanging out

Hiking through the jungle/rainforest

By the time we got to the Lodge I also felt as though I was going to vomit. The last 30 minutes winding through the forest is gorgeous. It's also the worse part if you tend to get car sick, which I do. It was bad. I was so excited to get to my lovely room and take a very long hot bath and/or shower. You can imagine how I felt when I discovered that I had somewhat lukewarm water and that almost all of my clothes for the weekend were not only wet, but stained from my no longer waterproof day pack. So to recap, I'm soaked to the bone, freezing, feel like I might vomit, exhausted from lack of sleep for about 10 days at this point, have almost no dry clothes, and basically no hot water...

     Yep, you guessed it, cue the completely ridiculous breakdown. I could not stop crying for about an hour and a half. I FaceTimed my mom and when she asked me what had happened I even admitted that nothing had happened. I'd just had a fabulous day with my friends. And yet there was I bawling my eyes out and saying I wasn't going to go to dinner. I was being completely ridiculous. Julie and Vanessa finally were able to coax me out of my room and put me in a hot bath in Julie's room and scrounged up some dry jeans and a shirt. Fortunately, the dress I had packed for dinner was remarkably dry and unstained and I put it on and rallied for drinks and dinner and we all ended up having a really great time celebrating Emily's birthday.

The Butare Gang (L to R): Jared, Tiffany, Veronica, Emily, Julie, Jim, Vanessa, Steph

The birthday girl and her homemade cake with sparkler!

     Things have gotten a little better. The initial excitement of moving here has officially worn off though so last week was still a little rough with a lot of "I wish I'd never come here" and "Why did I leave San Francisco?" going on in my head. I was still having trouble sleeping despite Benadryl and Dramamine supplements so I worked from home on Tuesday because I just couldn't for the life of me wake up and I ended up sleeping in until 10 am. It was much needed. The end of last week I went to Kigali with Emmanuel and Cécile the In Charge of the unit and visited the three hospitals there and the ICUs to get some ideas on what we can do to improve with accreditation. I think it was very successful.

     Friday night Vanessa and Julie decided that I still needed some cheering and so I hadn't been home for five minutes before a tasty adult beverage was in my hand. We went to Chinese dinner with a group and Emmanuel joined us, which was very nice. I like treating him to dinner and such when I can. And oddly enough, Chinese has become quite the comfort food. Who would have thought. Especially since I haven't regularly ordered Chinese since I was 20. Of course it started to torrentially downpour during dinner and geniuses that we are decided to walk home... we were slightly damp by the time we reached the main drag and hopped a taxi so that we wouldn't have to slosh through the mud.

Emmanuel and I at Chinese dinner.

Vanessa, Me & Catherine in the pouring rain post dinner.

     The weekend was quiet as Julie has officially gotten me addicted to Downton Abbey and I couldn't resist watching several episodes... ok, I will admit that I managed to get through both Season 2 and 3, but it was a quiet rejuvenating weekend that I needed. We did purchase some awesome whicker furniture for our back veranda that we are all really enjoying, particularly in the morning. It's in the perfect spot to enjoy the sunrise.

The newest addition to the household

It's good to be back at work and busy. The busier I am the easier it is to keep my mind off things. Today is my 70th day in country according to the IRS. Which really means I only have 56 days to go until my Christmas vacation in Ireland with my former patient and his family. Sorry that this post is so long, but I wanted to catch everyone up. Thank you to my good friends Em & Emily who have respectively sent me a funny postcard and care package. I really appreciate how much support I am getting from back home. Keep the emails, notes, packages, texts, Facetime, and any other form of communication you can think of coming. It really really helps. Love to all!

Lessons Learned:

1) Everyone needs a cathartic breakdown session every now and then.

2) I must be one of the most truly blessed people on this planet.