This week I spent my time back in the CCU, and for those who do not know or have not heard I have officially accepted a job at Vanderbilt University Medical Center in the CVICU. So being in the CCU is like being home for me, it is the place I love being and the place I constantly return to in this hospital. The CCU brings me much joy, and I love being able to treat and care for cardiac patients. I am very excited to start my career as a nurse, and being in Nepal has played a large role in the process.
Often times I participate in rounds and I look at monitors and assess what is happening and how to treat this patient. One day I felt like I was in a cycle of just standing there looking at monitors and listening to the rounds but I picked up on something. We were standing at the bedside of a patient and instead of a normal heartbeat on the monitor I heard a double beat with a pause and it continued this way. I was very confused as I had never heard or seen a heartbeat like that. I checked her chart and she had been diagnosed with bigeminy. After watching her heart rate, it was a regular rhythm then followed by a PVC, being diagnosed with ventricular bigeminy. She was placed on an amiodarone drip, which would help her irregular rhythm. When I returned to the unit the next day her heart beat had returned to normal sinus rhythm. Being able to see how quick a patient’s stability change is amazing. Although Nepal is low on resources and has limited access to man treatments, they have access to cardiac drugs, which in this case helped this patients bigeminy.
We had another patient come in after he had fallen of the roof of his house. He is an alcoholic currently going through alcohol withdrawal. He fractured ribs 3, 4, 5, and 6. One of the doctors approached me and asked if I had ever seen a patient with subcutaneous emphysema, I said no. So he lead me to this patient and let me feel the air throughout his arms and shoulder from the trauma this patient had endured. During rounds the doctors discussed the placement of a chest tube as you could see paradoxical breathing and the patient starting to desat quickly, the nurses applied a face mask and the patients 02 saturation went from 54% to 100%. Since this patient did not have any cardiac issues the patient was transferred to the medical ICU to continue the treatment plan. The feeling of air in parts of the body where air should no be was weird and a little concerning/scary. It was similar to pushing on bubble wrap and feeling it pop underneath your fingers but never hearing the sound of the pop. He had bruising all over his abdomen, and favored his left side.
Another patient had placental abruption at 34 weeks. She had a c-section and the baby is healthy, but since she was on warfarin due to her mitral valve replacement they had to wait so she wouldn’t bleed. She has mitral valve regurgitation and had a mitral valve replacement 12 years ago. They are constantly checking her PTT/INR to check when they can start her back on anticoagulants. Her heart rate has ranged from 75-175, she is often in tachycardia. Today was the first day where I saw her stay somewhat stable fro most of the day.
This week I was able to go to the cath lab again and watch the placement of a PCI in the left anterior descending coronary artery. They first performed an angiogram, then proceeded to put the stent into place. As we were transporting the patient to the cath lab, the family was very distraught and upset. The wife was crying as she witnessed her husband go into the cath lab, hoping to be fixed. You do not often see people cry here in Nepal, even when a family member passes away. I have only witnessed two people cry here, and one was outside the hospital setting.
It has been a great week here full of coffee dates (much needed caffeine for a very busy week) and celebrating halfway points of friends. I am taking one of my two weeks of vacation that projects abroad allows since I am here for fourteen weeks, this coming week as another volunteer and I head to Pokhara to trek for 8 days! We are very excited and are excited to take a break from the hospital routine to allow us to rest and recover. I will be sure to write and post of my vacation time in the Himalayas, sorry there are not many pictures this week!
There is a coffee shop located in the hospital and it has the best Carmel Macchiato, which provides me with some western food and comfort like I’m sitting in a local coffee shop at home 🙂