four are no more, time flies when you’re having fun

This is the end of week four. This past week I was in nephrology like I said before, but before the week was finished I switched units to the MICU. Nephro was very very very slow and there was not a lot for me to learn.

This week I am in the MICU. When I walked into the MICU I did not know what to expect. Honestly what I saw in the MICU, I expected to see in the CCU. All the beds were full. Half the patients were on ventilators. Patients were on drips, and almost all patients had central lines. When I first walked in they had just “bagged” a patient. The patient had passed away and the way they bag patients here is they wrap them up in the sheets, tape the sheets, label the body, and leave the body on the bed until their family member can come pick them up. If no family is present the patient is sent to the government hospital where they have a morgue. Since the hospital I am volunteering at is private they do not have a morgue, and the cost of treatment is a lot more.

There are currently four patients with H1N1, three of which are on ventilators.

Patient #1: This is a young female who had dengue fever, then got H1N1, an has bilateral pneumonia. She is sedated and intubated. She is not recovering very well but they are doing the best they can here. She gets turned every two hours and gets flipped from supine to prone every other day. I was very confused as to why a ventilator patient would be laying on her stomach. I don’t recall seeing US patients ever laying on their stomach with a vent, so I did some research. Research has shown that having patient on their stomach helps increase air distribution in patients with pneumonia. It opens up alveoli that would otherwise not be open due to pneumonia, and fluid. She does not seem to be improving and has been in the hospital for 16 days now.

Patient #2: Also very young, in her twenties. She contracted H1N1, then got pneumonia, which led to ARDS from being intubated. She is on a vent and for the past two days they have done weaning trials, but she has failed. She has been on a vent for 16 days, and they are discussing a tracheostomy. She is not sedated. She apparently went into septic shock as well, and had chest tubes in place. From what I could understand from the doctors was while she was being intubated she aspirated and got pneumonia, and that led to ARDS. The other day they weaned her and took her off the ventilator but then she requested to be back on the ventilator.

Patient #3: Also in her twenties, H1N1, pneumonia, and breathing rate of 55. This patient is not vented and is doing much better. She does nebulizer treatments daily, and those have helped slow her breathing rate down. She has a respiratory rate of 40-60 per minute. After the nebulizer her breathing slowed down a little but not alot to the middle 30s.

I got to witness an intubation here. The patient came from an outlying hospital already intubated so they were changing her intubation tube/reintubating her. The doctor stuck the metal rod that helps direct the ET tube down her already existing ET tube, then he took the old ET tube out and tried to place the new ET over the rod, but it failed. He then removed everything and tried to reintubate her. He tried two or three more times but couldn’t get it. He then finally got it on the fourth try about 15 minutes after initially trying to reintubate her. During the first reintubation the patient was not sedated, but after not being able to intubate her they sedated her.

I honestly cannot imagine being intubated without sedation or a paralytic. Most patients on ventilators here are not sedated, they are wide awake and functioning. Watching the intubation without sedation was very difficult. To see how the patient was reacting to having a tube stuck down her throat between her vocal cords was a very eye opening changing experience. If I ever have to be intubated, I would want sedation and a paralytic.

Today (8/29) I took a day of rest. I am working doubles this week making up for future days i will miss, but I woke up yesterday not feeling well. I didn’t sleep at all last night, and as I type this. It is the first time that I have energy again. Today my roommate left and I will be roommate less at least for a couple of weeks, which will be nice to just have sometime to myself and a little personal space. I loved having a roommate, but after not having a roommate for two weeks and then having a roommate, it will be nice to be alone again. Today also starts the festival for the birthday of the Hindu god, Krishna. We went to the opening ceremony this morning, and the temple is right behind my house. My host father is on the committee, and has helped organize the festival. They play music, chant, and talk at all hours of the day for the next seven days. It is amazing to see how passionate they are about the celebrations here. The kids start school later to participate, people skip work, etc. It really is amazing to see how dedicated the Hindus are to what they believe. It has challenged me to be just as passionate, excited, and dedicated to my faith, as they are to theirs.

I have been sick for the past three days and each day I’m slowly getting better and better. I have had a great friend and volunteer Lilly come visit me and hang out with me every day. She has taken care of me and made sure I had enough food and drinks. She has been my life saver. I am feeling a lot better just still very congested. It has been nice to be able to rest and reflect on my past four weeks here. I cannot believe it has already been four weeks. It seems like I was just being introduce and showed around yesterday. I have been able to talk to a lot of friends over FaceTime this week which has been a blessing. The weather here has gotten a little cooler, or maybe I’m just use to it now ? Being sick and basically spending all day in bed in a foreign country is different. It’s lonely, and quite boring. But my host grandmother has made me ramen everyday for lunch and it is almost like being sick at home. I have had a lot of time to read, sleep, and rest. I have gone through three rolls of toilet paper and my nose looks like Rudolph ?

This is Lilly! My hero! And my nurse!

My Nepali ramen that I have had everyday for lunch the past three days

Thinking about my past four weeks here is a roller coaster of emotions. From arriving and having a hard time adjusting to traveling every weekend, to being sick twice in a month, to visiting foreign doctors, to being home for the next four weekends. I’m loving it. It is hard. It is the most difficult thing I have ever done, but it is so rewarding. It is rewarding in the friendships, in the laughs, and in the smiles of every day life. In trying new foods, experiencing a new culture and being submerged in a new religion. It is challenging, but I am learning so much about life, medicine, and myself. I am having to rely on the Lord more than ever to give me strength, compassion, love, and energy to make it through the tough days, and joy and peace to make it through the easier days. What a wild ride these four weeks have been can’t wait for the next 10.