Jacques Update

     "Enfant a rendu son ame a Dieu." That is what I read in the nursing progress notes Tuesday morning as the porters rolled the 2 year old's body to the morgue. Translation: The child gave his soul to God. It is the most eloquent note I've ever seen written about a patient's death and it almost brought me to tears. And in seven years of ICU nursing, I don't think I've ever wanted to cry over a written note.
     The most terrible thing about Jacques is that his death might have been preventable. Had the neurological changes been identified earlier, were our CT scanner working, maybe we would have had a stronger case to transfer him to Kigali and neurosurgical intervention. It is beyond frustrating, but a lot of things I cannot change.
     What I can change is the education level of the staff here at CHUB. Please consider donating to our cause to ship over 3000 lbs of donated medical and nursing textbooks here to Rwanda. Any little bit helps. It has grown frustrating and depressing to see that over $12,000 can be raised for an injured dog in California, but I can't raise $6,000 for increasing education in East Africa.

Lessons Learned:
1) No matter how long you've been at it, there is always going to be something in nursing that makes you want to cry. It never gets easier.
2) There is a science to fundraising that I never understood before now.

Ianuarius: The Door to the Year

     The rain finally started tonight. It's been threatening for hours and the power was out earlier, but it just now started. It's been a few weeks since we had a good rain. I love the sound of the rain on the roof. It's very different than at home. Maybe because when it rains it pours here and for a long time. There is no such thing as a quick thunderstorm here. When we have thunder the entire house seems to shake. But the rain here is just big fat drops that pound onto the hard red clay and splatter everywhere. It's quite beautiful.

Knitted caps by my neighbor from home, Aunt Randy
put to good use in the NICU.

Dr. Théogène showing a new ICU nurse and GP Dr. Oscar how
to check fetal heart tones on our portable ultrasound.

     Last week was a little bit of a whirlwind. Jet lag finally subsided and I was functioning on a fairly normal level although I couldn't remember what the heck day of the week it was. Vanessa has a surgical resident from UVA here, Rhett, and we had him and Jim over for dinner one night, which was a lot of fun and a nice change from our typical weeknight routine. I also started a more serious workout schedule, where I quickly learned that two weeks at sea level completely wiped out whatever extra red blood cells I gained in my first few months here. I was huffing and puffing with just a small workout. But I went to my first yoga class here with Stacey and Jeff and I really liked the instructor. Joseph is really excited to share the practice of yoga with anyone, so it was a very refreshing environment for a yoga class. I am hoping to make it a Tuesday night regular activity.

These trees along the road to Kigali always
remind me of something out of Dr. Seuss.

     On Saturday we all made the drive up to Kigali to run errands and the most important one of all was picking up Rupert. At 15 kilos he's not much, but he's sweet, beautiful, kind, but knows to bark at strangers. Yes, we got a dog. We love him. He's pretty well trained, although terrified of the leash. We will have to work on that if we ever expect to take him for walks, but I'm sure that will come with time. Vanessa will probably stay for two years so she will keep him, but if she doesn't then we already have a good home lined up for him. We did discover the hard way that he tends to get car sick, so hopefully we won't have to take him on too many road trips to Kigali to see the vet.

So he gets car sick, but we got him safely back to Butare!

Rupert

Such funny ears!

He is very happy and healthy though, so my fingers are crossed. It's nice to come home to a furry friend, but he's so skinny sometimes I feel like I'm going to break him! Sunday was uneventful, yet productive. I went for a quick bike ride up to the market to buy some carrots and rice and was able to spend the afternoon cooking and relaxing around the house.
     Today started off with a bang. Rupert came into my room and cried about 5 am. Since I wasn't sure if he needed to go out I got up and took him out. Later I found out that he had come into all of our rooms and we each had done the same thing about ten minutes apart. Turns out he just wanted breakfast. We will have to do a little training about begging and waking up the humans when there is no intruder. Steph and I decided to be super fit and biked into work, which was a nice way to start the week. My staff always tease me though when I do this because my face stays pink for at least an hour after the fact. They find it so strange and funny at how red I get. Thank you Irish heritage. Anyway, the first thing I noticed when I walked onto the ICU this morning (this after I figured out how to access the unit as they've switched things around again due to the construction) was that all three of the patients from Friday were still there and somewhat stable! The second thing was that we had a little tyke in bed five.
     Jacques was admitted Friday afternoon just as I left. I didn't know his entire story until this morning. Here in Rwanda the mothers tie their children to their backs and go about daily life as if they didn't have an additional couple of kilos to carry. My favorite is watching the women balance baskets of fruit on their heads while they have a child on their back. I don't know why, but it's just a great image. Anyway, Jacques is two years old, and was on his mother's back when they were struck by a vehicle. His mother died instantly and he suffered from traumatic brain injury. According to the physician notes and a discussion with Vanessa, he wasn't too terribly off Friday afternoon, but Vanessa immediately filled out the transfer forms for CHUK (University Teaching Hospital of Kigali) since our CT is still not working and regardless, we don't have a neurosurgeon on staff in Butare, only in Kigali.
     Due to insurance issues he never left. He deteriorated until he respiratory arrested last night and was intubated around 10 PM. By the time I arrived on the unit at 7:30 AM, his vital signs were not looking good and I was worried, until I read the chart and examined him myself. Pupils were fixed, dilated, and there was no movement. Most likely his head injury progressed and he probably even had an intercranial hemorrhage and he was herniating, but we couldn't diagnosis it. Herniation, simply put, is when your brain swells too much. Due to our skulls the brain has no place to go during this swelling and starts to push down through the magnum foramen, or the hole where your head connects to your neck. As it goes, it compresses your brain stem, which controls your most basic functions and once this happens, you're brain dead. Jacques came into the hospital Friday awake. Now, he's brain dead. It could have been prevented were we just able to get him to Kigali. Or even have gotten a CT to make a stronger case for his immediate transfer to Kigali.
     This Monday was a little bit of a reality check. I always think how beautiful a place I live and sometimes, it's easy to forget all the hardships, hunger, and death that occurs. But often, I just need to step onto the ICU to get my head out of my dreamy state. Sadly, it sometimes leads me to not appreciate and enjoy the beauty that surrounds me in my simple life here.

Lessons Learned:
1. Determination can save lives, but you have to be a special type of person to want to change the system.
2. Beauty is surrounded by hardship and vice versa.

Hitching a ride up the hill.

Sunset

Sunset

Coming "Home" in the New Year

     Have you ever gone back to where you spent your entire childhood and curled up on the couch with a roaring fire, your puppy dogs, and lots of down/wool blankets and gear to keep you warm and just be glad you're home? Well despite freezing my bum off, I was able to pull off the ultimate surprise as a slightly early birthday surprise for my mom and went home for a week. Now she won't admit that she had no idea... But needless to say she was surprised to find me in the family room with just a few days left in 2014.

Jean and I had a full turkey!

Christmas luncheon in Ireland

     But when I last left you, I was on my way to Ireland to celebrate Christmas. It was cold, quiet, peaceful and lovely. Jean met me at the airport and on the drive to Ballybrack updated me on everything that had happened with Himself. I was glad to learn that it was truly unexpected and quick and there was no suffering involved when he died. We did everything that he wanted me to do, even down to using the Santa themed china pattern. He spent too much money on me picking out the most thoughtful gifts, including a very useful flashlight (that I used last night), an umbrella, and some fancy new perfume that I really enjoy. We had the most fabulous Christmas luncheon, all things that Mr. O'Hara wanted me to have. It was really quite delightful. It was good to be there so that Jean could relax a little. I know she appreciated me opening the door and chatting away with friends and neighbors that continued to check in on her. I believe I was also a good excuse to decline several Christmas luncheon invitations. She told me that she was tired of being minded and how one of her daughters hadn't let her drive for almost two weeks! I told her that since I still can't drive a stick the driving wouldn't be a problem. I met their son Sean and his wife, Lisa and their four children. Even they had bought me two small presents, which made me feel bad as I had been told specifically not to get them anything. I was very grateful for my mother's presents. She mailed me some new long sleeve shirts and a scarf with matching fingerless gloves. I'm fairly certain I had them on almost the entire time I was there. I met Mr. O'Hara's nephew, Jared and his family because Himself had specifically told Jared he must come and meet me. And we all toasted him with some delicious port.

Ironically, one day we all (grandkids included) went to the Dublin zoo. It's quite a good zoo, but I must admit I found it a little amusing that I was looking at giraffes, gorillas, rhinos, hippos, and lions for the first time in several years and I live in Africa. This will hopefully be rectified next month.

     After five days Jean took me back to the Dublin airport and I hopped my flight to JFK. I spent the majority of the flight devouring book six of the Harry Potter series that I had started just a few days before... how I managed to escape the Harry Potter epidemic before, I don't know. I blame my favorite children to babysit, the Griffith Boys... particularly Morgan. All I knew of Harry Potter was random chapters in the middle of the books I would read to him and the entire time I wondered what the heck these stories were about as Morgan corrected my pronunciation of names every two minutes. Anyway, I continued to enjoy Harry Potter while I devoured a Big Mac with extra pickles as my first meal back in the US and I chipped away the hours of my almost 6 hour layover. A six hour layer for a 37 minute flight. But finally, I arrived at BWI and my neighbor Aunt Randy scooped me up and took me home.

     My father knew I was coming, but my mother had no idea (despite what she may claim). And I wish I had captured the look on her face when I came around the doors into the family room where she was snuggled on the couch with a movie. I think it was quite the surprise ("And I usually hate surprises!") but a good one. The other part of the surprise is that I was hosting a birthday dinner for her the Saturday after New Years and her brother and his wife were coming down from Connecticut as an additional surprise. I already knew what I was going to cook, but just for good measure I thought I'd double check... sure enough I'd nailed it... surf & turf of lobster tails and steak. Aunt Sharon acted as my sous chef and made the broth for French Onion Soup while I made the crab dip and my Dad broiled the steaks while I steamed the lobster tails. It was a lovely dinner, despite seriously burning my fingers we all had a great time with family and friends who were able to join us. 

Who doesn't love lobster?

The table setting for Mom's surprise birthday dinner.

First course: French onion soup

     After dinner we all watched the Ravens play the Steelers in the wildcard playoffs. I enjoyed the first half but found myself dozing in the second half quite a bit. But it was fun to actually watch a game. I've been streaming 98 Rock (radio station) over an app on my phone the entire time I've been in Rwanda, which is pretty good. Overall there's maybe a five minute delay, but it's decent commentary and at least it's a part of home that I can have here. Unfortunately, the game tonight won't be on until 11:35 pm my time and I have tried so hard to get over my jet lag that I don't know if I'll stay up for it.

Friends since 2nd grade!

     Anyway, I was able to see many of my friends while home in Baltimore and DC and even popped up to Philadelphia for New Years to see friends whom I'd missed seeing before I left in August. It was a very relaxing week filled with junk food and good food (it's quite strange the things you crave when you live in a developing nation) and I'm glad I got home. I even got to speak to a high school class about my job when I popped in to say hi to my friend's mother. I only had one mild state of panic when my mother abandoned me in Wal-Mart. She was looking for Stevia for my dad. She went to check one area and I another... I of course found the proper aisle. This ginormously long aisle was 3/4 dedicated to sugar and sweeteners. I ended up calling my dad when my mother didn't answer her cell phone because I literally didn't know what to do there were so many options. I was completely overwhelmed.

Molly & I skating

New Years with Megan!

Drinks with Kathleen & Joe

Ice skating in Georgetown with Emily & Mark

     I was quite surprised to find approximately 3000 lbs of nursing and medical textbooks in my parents house as well. My social media campaign to gather the textbooks to bring back here for CHUB got a little out of hand, but in a good way! I am now tasked with trying to get the books shipped here to Rwanda, as my original thought of just bringing an extra suitcase back with me, clearly won't cut it. If you are interested in helping (every little bit helps) please visit my Go Fund Me page. I would really appreciate it and I know the staff who work at CHUB and the students who rotate through the hospital will really appreciate it. There is a lot of hard work that happens here and they have a thirst for knowledge unlike I've ever seen, so please help me make this happen.

Just some of the textbooks donated...

2 inches of snow before I left!

     Tuesday morning when I left Monkton the schools were closed and we had two inches of snow on the ground. It was beautiful albeit FREEZING. As my Uncle Rick kept saying, "your blood has thinned" and I wasn't tolerating the cold very well. I was impressed with myself that I had survived an hour and a half of outdoor ice skating with friends one night. Mom had me in the car obsessively early for the drive to Dulles, but this time we stopped at G & M for a crabcake lunch. 

COLD ALL THE TIME

Farewell USA lunch at G&M. Such good crabcakes.

It was perfect timing. By the time we got to the Washington Beltway, there was no traffic and we arrived at Dulles just as KLM started to accept baggage, 4 hours before my flight. Following airport tradition, mom and I grabbed some Starbucks before she said goodbye at the TSA checkpoint, the same spot where she had said goodbye in August. But this time was different. I really am not coming back for the next 8 months. I told her, "No more surprises." And of course whenever my mom starts to cry, I start to cry, to the point that when the TSA guy checked my boarding pass even he told me to make sure to call my mom when I landed. When my plane took off it felt so different this time. The excitement and novelty of moving to Africa has long since worn off and instead of being excited and scared, I just felt sad and a little lonely.

     My flights were uneventful, unless you count the screaming and therefore not so cute child who cried the entire red eye to Amsterdam. I landed in Kigali at 7:15 pm Wednesday and was welcomed by a lovely and breezey 70 degrees. My taxi driver was waiting for me and I arrived back home in Butare just before 10:30 pm. Vanessa and Julie had waited up for me and were very excited for the goodies I had brought back, which included face products, Berger Cookies, Oreos, spices, rubber cleaning gloves, new dish towels, Sirracha, and bug spray. It's the little things that matter when you live in Africa. I wasn't able to sleep until almost 4 am (perhaps because I was reading Harry Potter) so Thursday morning I slept in and got up about 10 am, where I promptly finished the final book of Harry Potter (all seven consumed in 1 month).

     I walked to work and felt odd wandering down our dirt road. I felt as though I was back where I belonged and yet felt completely out of place. I had the same sense when I was home too. Where is my home these days?

Lessons Learned:

1) True jet lag is truly terrible.

2) Even the briefest visits are well worth it.