D Ward Roolz & Droolz

I will take a patient assignment with vomit, diarrhea, urine, blood, or pus any day. I really dislike giving intramuscular injections known as IM injections. I think they hurt and I do not want to cause that pain for anyone else. The nurses I worked with in the ER loved that I was willing to gladly take their mental health patient assignment all shift if they would give IM antibiotic shots to my patients. A perfect swap for both of us.  Even with my extreme dislike of IM injections, I would still prefer to give an IM injection over dealing with spit, sputum, or saliva/drool. I shudder when someone clears their throat forming a glob of sticky, sometimes colored, moist, mucus from the back of their throat into a mass of salvia and phlegm that needs expectorated. My face is all cringed up even as I type describing the action of basically hawking a loogie.  If you are still with me, reading this blog post, I can only guess you might be showing some expression of 'yuck,' as well.

Tracheostomies, life saving holes in the windpipe, allowing people to breathe and live with certain medical complications, are not my thing either. The fragility of a patient after a recent trauma with a brand new tracheostomy is fascinating and frightening. I remember working with trauma patients at Dartmouth in New Hampshire as a brand new nurse. It terrified me. You had to give extra oxygen before you dared to suction their airway or they were in serious trouble, then you could not suction for more than 10 seconds, or they were in serious trouble, and then you’d have to give more oxygen after suctioning. Life is beautiful and fragile. 

Earlier this spring, through much prayer and tears, I was prompted to leave one of my nursing roles that I had for the last 3 years. Much to my own surprise, I took a private duty nursing job for pediatric/children patients that live at home with medically complex conditions. My dear friend, prayer warrior, former NICU (neonatal intensive care unit nurse), Chandra, had been trying to talk me into joining the homecare company she worked for over the last few years. Every time she asked, I had the same reply, “No way, I am not gifted in that area of nursing, I have always loved kids, but ill kids scare me and I do not do SPIT!”  These kiddos have tracheostomies, some are ventilated, some have nasal gastric (NG tubes that go from their nose directly into their stomach and that’s how they get food), some had gastric tubes (tubes surgically inserted in their bellies and that’s how they get their nutrition). My only experience with tracheostomies was the trauma unit that I worked on in New Hampshire from 2006-2008. I ended up shadowing Chandra for one of her shifts with a precious little 2 year old patient and somehow God talked me into taking this nursing role on. It was a joy! It was incredible to give the parents that are on 24/7 a break to pee, shower, eat, and sleep, in peace knowing their little one was cared for and all in the comfort of their home. It’s a fantastic nursing job I have come to love and enjoy. 

Related to many moving pieces and complexities with the “parades” out and about in my current home country, there have been major fluctuations in the surgeries we are currently able to provide. I am on an island in Africa, on a ship, but surgeons cannot just hop on a ferry to get here. I was assigned to B Ward, the pediatric surgical specialty unit, for my time aboard. I have been here 6.5 weeks now and have only worked 2 shifts on the pediatric surgical specialty unit. I worked 1 shift, on A Ward, with our goiter patients and yes, I managed to give 3 of them rides in a little plastic wagon on deck 7. We take our patients outside for fresh air each day. I called my wagon the “Mercy Ship Tuk Tuk.” The very petite ladies with steri-strips across their necks, were at first timid, refusing to ride in the wagon pulled by a ridiculous white woman.  One by one they worked up the courage to get in my “Mercy Ships Tuk Tuk” and I pulled them back and forth on deck 7. Through an interpreter, I asked the patients if they preferred riding in the motorized local Tuk Tuk in town, or if they preferred my “Mercy Ship Tuk Tuk”. 3 out of 4 voted for me. The petite women actually fit perfectly in the wagon as the average height of Malagasy women is 4 feet 11.5 inches. Smiles replaced their former skepticism.  All of my other shifts have been on D-ward with maxillofacial surgical patients.  

D ward is a transformative place. For those without a medical background, imagine kiwis, coconuts, cantaloupes, and honeydew melons, oh, my!  Now imagine a growth the size of a kiwi or bigger coming out of your head in front of your ear; a parotid tumor. Picture a coconut sized ball coming off your face under your eye, on the side of your nose, and protruding out of the skin;  a maxilla tumor. Picture it expanding and then starting to shift the angle of your eye to make it appear your eye is on top of the coconut and it then starts to twist your nose. Visualize your chin and a cantaloupe sized mass originating at your chin bone and growing into your lips, distorting your face so your nose turns angles looking like a pig snout and your tongue shifts and your mouth is filled with the cantaloupe and you can no longer shut your mouth. You cannot eat.  You cannot keep the saliva in your mouth; these are mandible tumors, ameloblastomas. Envision a tumor so big it’s the size of a honeydew melon and now your airway is at risk as it takes over your face. Imagine the biggest smile you have ever seen in your life, now double the size of it because there is a hole, or a cleft in the lip making it split down the middle, sometimes even all the way up into both nostrils; you have a cleft lip or bilateral complete cleft lip. Picture a tiny jaw that appears smaller than normal and offset, a grimace through clenched or missing teeth; ankylosis, which causes the jaw to be unable to open, often from untreated dental infections, the teeth were purposefully pushed out to allow the individual to be able to eat. Finally, think of a hole in the side of your face. Your teeth are exposed, you can see your tongue moving, spit and saliva run down the side of your face, because there is no cheek or skin present; noma (a Greek word in origin, meaning “devour”, a gangrene facial infection. Often starting in the mouth it eats away the facial tissue- Source Doctors Without Borders). These are a few of the medical conditions surrounding me as I show up for my shift. I glance through my patient’s charts and read 4 of their medical histories.  6 years…13 years…10 years…5 years…This is the length of time they were suffering, waiting, and praying for help.   

There’s something different in the air on D ward. It happens slowly, over a matter of days and it’s unreal to witness as the history of suffering, agony, pain, and hurt give way to allowing emotion, anticipation, and hope build in the complicated recovery process.  We gather for shift handover and there are nurses from Tasmania, Belgium, Denmark, and Holland alongside me coming on for the shift. We receive report from Swedish, Kiwi-New Zealand, Canadian, and South Korean nurses who are finishing their shifts.  I saw the patient I cared for a few nights before when he was anticipating surgery the next day. On that shift, I helped him tie a blue surgical cloth around his face, like an American child may tie a handkerchief around their face if they were playing dress up as an old west bandit. He’s not playing dress-up, he’s ashamed of his face and doesn’t want to see it, nor have anyone see the honeydew sized tumor distorting his face and overtaking his mouth, so it won’t close. He was intubated in our ICU for a few nights and has moved to the status of a high dependency unit patient and my past experience in the ER and recent care with trachs and vents, means, I am the most qualified nurse to care safely for him tonight. I am honored as I repeatedly help suction his airway from stringy clots in the back of his throat and suction salvia dripping down his face as the post operative swelling is at its peak. I prepare multiple NG feeds for him over the night. I am not bothered one bit by replacing his dressing 3 or 4 times because of the drool saturating the abdominal pad thick gauze under his pressure dressing because we need to keep his steri-strips and suture line dry to heal and prevent infection.  We removed half of his jaw in a procedure called a hemi-mandibulectomy, and we’ve replaced it with a titanium plate. Infection prevention is paramount. Nursing tasks that I once shuddered at and would hand over to anyone else, if possible, are now my joy to complete and with confidence. My patient holds a mirror in his hand many hours of the shift. He looks at himself in the mirror and I see a light in his eyes and a smile comes across his face.  I have no doubt in my mind God was preparing me for where I am now even through some of the heartache of leaving my other nursing position this past spring. I am thrilled to be a part of the D Ward team and have a sticker the team leader/manager of D-Ward gave me that reads “D Ward Droolz” and I agree wholeheartedly! D Ward Roolz & Droolz!