Last week I worked 3 nights, Tuesday, Wednesday and Thursday. The first 2 nights were completely normal night shifts...busy with random tasks, but not overwhelming.
We had a patient(LC)that had been admitted for several days so we could do some more extensive testing prior to surgery. Last Thursday he had his surgery completed.
This is someone in their mid-20's with a tumor growing inside the mouth and throat. If you looked at him, you never would have guessed...his face looked completely normal.
He was the only patient scheduled for our maxilla/facial OR that day as he had an estimated 8 hour OR time. He was in for major surgery!!! Because of the extensive nature of the surgery and the post swelling that was going to happen, the first thing the surgeons did was to put in a tracheotomy just to protect his airway.
Thursday night, I was in the ICU with him. They left him on the ventilator and sedated overnight just to let his body rest. The next day (Friday) he was weaned off sedation and the ventilator. By Sunday, he was back in the ward with all the other patients.
I didn't realize how much I missed the ICU until I was back in it. It felt so good to have a vented patient with drips, (morphine and midazolam for sedation), with an a-line while managing fluids, antibiotics, I&O's, neb treatments, changing vent settings as needed, and mixing up my drugs. This may sound strange, but I think that was probably my favorite shift I've had here.
Even more than that, what I found most interesting is that throughout the night his sister would come over to the ICU just to check on him periodically. In the morning one of the day-workers (translators) told me that she was surprised/impressed that I stayed away all night taking care of her brother.
That shocked me...what I learned through asking more questions is that isn't the normal practice of nurses here. No wonder the people here have a hard time trusting us as doctors and nurses. You don't get treated unless you can pay and exorbitant amount of money first, and then it sounds like nurses here haven't been taught what to assess and look for (that's one reason we focus on education, and have local nurses that will come to education classes and shadow in the ward).
The other thing that stuck me, was that night ever so often when his sister would come in to check to see how he was doing, she would ask me some questions in French and I would answer in English...between the little English she knows, and the little French I have learned we could have simple conversations.
Language can be an interesting thing sometimes...I often joke that I've learned French sign language, or it could be Kituba sign language (the local language).
As for the LC, he is doing well and once the swelling goes down enough that his tongue isn't blocking his throat, the trach will come out and he can talk to us again. Yesterday, it looked like the swelling was starting to decrease just a little...but he still has a ways to go.
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