nurse mode

deciphering key pieces of information, communicating them clearly, clarifying known/unknown information, picking up on small changes in symptoms, trying to present hard information in a loving way, asking the obvious or the really hard question, thinking creatively about solutions to problems,  holding a hand, calming quiet presence, bridging gaps of communication, willingness to say "that's a good question, let me get back to you on that,"presenting information clearly, knowing where to look for what information, knowing when to say "we don't know,"  being willing to cause pain in order to encourage/create opportunity for healing, a listening ear, gentle when helpful, firm when appropriate, providing dignity in times/places where there is little to none to be seen...

this is the stuff of nursing...behind the obvious stethescopes, the IV pumps or poles, shots, medicine cups, and bandages, this is where the essence of the job is, the stuff you don't necessarily notice, but that each nurse builds up an instinct for over the course of a career.  These aren't things you necessarily learn in school, they're the things you piece together from lessons learned from other nurses, from patients, from failures and successes, from physicians you respect and who respect you...they become part of how you approach the world.  Instinct.

Turns out after 11 years as a nurse, my instincts are pretty strong.  I don't even think about them.  I don't  think about which situations to apply them too and when not too, when is it appropriate or not, it has just become part of who I am and how I approach life and everyone in it.  Turns out, this includes my own family.  I've found myself in "nurse mode" with my mom and family with mom's new diagnosis.  Not by choice, but because it's an instinct evidently.

My dad does it as a pastor - goes into "pastor mode."  I've never been a big fan of him using that mode with us in his family, it feels a bit distancing on the receiving end, but now I understand it's not a choice he's making - it's an instinct.  It comes from years of doing something that, in time, becomes part of you.

My prayer is that my "nurse mode" instinct with my interactions with my mom in this new stage of illness doesn't feel distancing on the receiving end, that I can still be primarily her daughter first and foremost.

I've been in the US for the last 5 weeks or so.  When you come back from a place with very little access to current printed word resources, you pick them up and read them everywhere you go (at least in my experience).  In my most recent Pennsylvania Gazette (UPenn alumni magazine), I found a fascinating article with the following quote:

"Neonatologists were vigilant.  The nurses were even better, as much psychologists as highly skilled technicians.  They exuded optimism.  They never showed fear.  They became friends you could laugh with and cry with.  They offered eternal hope whether they believed in it or not..."  

- Buzz Bissinger (author of Friday Night Lights and writer for Vanity Fair and The Daily Beast from his book Father's Day)

I don't exude optimism, and I hope that I don't offer eternal hope that I don't believe exists, but I do believe there's a part of nursing, learned and honed over the course of a career, that parallels the "skilled technician" skills learned in school...the interaction with people part...one of the reasons I love what I do.

For some reason this trip home, I've had a lot of "nursing" interactions...opportunity to encourage a friend through the rough and tumble parts of nursing school, opportunity to hear from a friend on her first job as a new nurse and how she both loves it and is simultaneously terrified...I told them both that the fear is healthy :) I read the above article I found here at my parents' house and I've watched the first few episodes of the BBC show called "Call the Midwife."  Some really interesting writing, by the way.  One of my favorite quotes thus far:

"You made her feel safe. That’s the mark of a good nurse. A midwife, too. Everything else is just mechanics." - Dr. Turner to Chummy, the rookie nurse midwife who seems at first to get everything wrong

Spot on. That's it.

by and by

Farther Along (Josh Garrels)

Farther along we’ll know all about it
Farther along we’ll understand why
Cheer up my brothers, live in the sunshine
We’ll understand this, all by and by

Tempted and tried, I wondered why
The good man died, the bad man thrives
And Jesus cries because he loves em’ both
We’re all cast-aways in need of ropes
Hangin’ on by the last threads of our hope
In a house of mirrors full of smoke
Confusing illusions I’ve seen

Where did I go wrong, I sang along
To every chorus of the song
That the devil wrote like a piper at the gates
Leading mice and men down to their fates
But some will courageously escape
The seductive voice with a heart of faith
While walkin’ that line back home

So much more to life than we’ve been told
It’s full of beauty that will unfold
And shine like you struck gold my wayward son
That deadweight burden weighs a ton
Go down into the river and let it run
And wash away all the things you’ve done
Forgiveness alright

Chorus

Still I get hard pressed on every side
Between the rock and a compromise
Like the truth and pack of lies fightin’ for my soul
And I’ve got no place left go
Cause I got changed by what I’ve been shown
More glory than the world has known
Keeps me ramblin’ on

Skipping like a calf loosed from its stall
I’m free to love once and for all
And even when I fall I’ll get back up
For the joy that overflows my cup
Heaven filled me with more than enough
Broke down my levee and my bluff
Let the flood wash me

And one day when the sky rolls back on us
Some rejoice and the others fuss
Cause every knee must bow and tongue confess
That the son of god is forever blessed
His is the kingdom, we’re the guests
So put your voice up to the test
Sing Lord, come soon

Chorus

"images" of life as a city mouse

• my zip up/pop-up-tent-looking mosquito net on my bed
• the dirt floor of my tukul - which is quite nice in rainy season - no need to worry about taking your muddy shoes off outside or having a mat to wipe them off...
• showering under the stars of the african sky in our corrugated tin and blue tarp enclosed shower area
• hearing Kaya (aka. John Kaya Commando Giyafa Beautiful) shout from the shower “Eidi! Eidi!” when the water pump automatically kicks on and begins to pump new water up from the aquifer far below to supply his shower water - “new” water as in “has not been warmed in the black plastic tank by the daytime equatorial sun and is therefore freezing” water - his way of reminding me he’s there and would I please turn the pump off (switch is below the sink in the kitchen which is right next to the shower) so he can enjoy a warm-ish shower :)  Makes me chuckle every time - especially when he gets antsy when it takes me longer than he thinks is necessary to flip the switch (which may or may not be intentional on my part :)
• after a long silent pause in late evening conversation, the goings on of the day type conversation topics exhausted, or so we thought, Boya says from his sprawl on the couch- “So, for me, I don’t understand, what is it - they call it “post office”...well okay then...how about we discuss the function of what is known in most parts of the world as the postal system but people in this part of South Sudan have never had opportunity to experience or use and therefore do not understand the role and function of such a service...after our brief introduction/explanation to said service his primary concern, and that of the rest of the people who had heard such a places discussed on the radio...was what would happen, how would the people working in the post office would handle the following event: sender of letter dies before recipient receives said letter.  Would not have never ever been anywhere near my radar to consider such a question, but in this place - people die, A LOT, and it effects all parts of peoples lives, clearly also potentially one’s interface with the postal system.  Who woulda thunk it.
• my affinity for all things pus related.  Yes pus, P-U-S.  (my dad had to spell it over the phone to clarify what exactly I was talking about and had he heard me right...yes, in fact he had.)  The human body’s ability to fight infection and produce such a gross substance as a by-product of said warfare, and the procedures required to rid the body of said by-product - SO FASCINATING.  Anyways, I’ve had the honor of spending a few days per week for the last several weeks with Roda and Zebara (yes, as in - zebra) who are a cleaner (“housekeeper” of sorts) and a nurse respectively who both work in the Mundri Primary Health Care Center “minor theatre” - a very fancy name for the room with a sheet-less bed where they do dressing changes and small procedures like I&D’s (Incision and drainage to rid an infected site of pus), lipoma removals (lipectomy?) and tooth extraction and such...They are both Mother’s Union members of local parishes of the Episcopal Church of Sudan, and sassy grandma type older ladies who think I’m the best thing since sliced bread since I have a Moru name and come to hang out with and learn from them.  Roda speaks zero english, so we hobble along in arabic together - which is GREAT practice for me and so encouraging - until Zebara (who has been nursing for 48 yrs!) arrives an hour or two later for her 11am-1pm work day :)  With nothing but what seems like an endless supply of lidocaine, they render everyone from grown men to babies helpless and in tears...and I’m not quite sure how Zebara manages not to sever more large blood vessels than she does wielding a scalpel...I actually have only heard the story of one of those instances in the last month or so, thank the Lord.
• a disarming of the police by the army - think one group of powerful men with weapons trying to take away the weapons of another group of powerful men....hmmmm....could be a disaster...leaving us to get home and turn our lights off and head to bed after curfew hours - 9pm - with our S. Sudanese friends fearful of what might happen if we did anything to stand out even a bit...text messages sent between tukuls on our compound whenever I heard anything “funny”...and all because of cows...a LONG history of hostility between the agrarian Moru tribe and the Dinka/Mandari herdsman due to cattle moving into the area to graze on the grass/bush found in plenty around here during rainy season...it’s a really long story for another day but the long and the short of the story is the immense impact that tribe/tribalism has on the role of law in so many facets of life here...such that the army has to disarm the police...it’s no joke.
• sitting in church last sunday as the lone kawaaja...struggling to understand ANY of the unbelievably fast arabic translation of the announcements and sermon - it really feels like trying to drink from a firehose - complete with the experience of feeling “drenched” at the end of the service - like I’ve been bowled over by words.  John asked me later in the day if they’d made an announcement about digging at the borehole... “well, I can tell you they made an announcement that included the words for borehole and saturday, but beyond that, I haven’t got a clue what they said”...so goes language learning :)
• you know they’re hard up when, with Bethany AND Larissa not around, people ask ME to translate for them at the team compound if I happen to be around when talking with houseworkers and such...watch out world...these are desperate times!
• Melissa comes into town on Saturday, we wander across the street to the market, buy a rolex (chapati with fried egg wrapped inside) and a cold soda treat to eat for lunch, wander around looking for treasures like a new pair of flip flops, honey and kitenge fabric, stopping to buy groceries along the way then when we get hungry and the groceries get heavy we walk back across the street to eat our street-food lunch and unload the heavy things.  We still have some time until she needs to head back home for a skype appt., and we hadn’t made it yet to peruse the used clothes piles so we walked back over and spent an hour or so laughing periodically as we found randomly funny t shirts or trucker hats...never know what you’re going to find in the market in the middle of South Sudan...perhaps a fluorescent pink polyester trucker hat that reads “ugly kid”...or a oversized XXL men’s tshirt that reads “if you tap it, they will come” below a picture of a beer keg...you just never know.
• discussions with Kaya and Boya and others about whether they would ever marry a Dinka woman (the answer was a very confident no because they would never be allowed by the Dinka men due to the number of cattle they would require as bride price), or answering their questions about how women know who is going to marry them and why it is wrong to lie to a woman when you tell her you’re going to marry her when really you just want to sleep with her and if you told her the truth - that you have no intentions of marrying her - clearly she would refuse you and clearly that would not be okay.
• praying with Boya the night before he left on Scott’s motorcycle to drive several hours into the bush where there is no cell phone reception at all, to pick his new wife from her family’s home, where it is culturally expected that he will not eat any food her family offers him.  He has paid a few thousand South Sudanese Pounds of the grand total her family asked for in bride price, and has been given permission to pick her and bring her to live in the new homes he has recently built here in Mundri...we still haven’t heard from him since he left on Monday...and the butterflies I found myself feeling in my stomach from excitement/nervousness for Boya as he left...it’s a big deal...or at least I think so.  I prayed for Bushena, his wife, who is pregnant with her first child and leaving her family’s home to go live with this new husband of hers...may peace and delight be hers.
• “it’s not normal to climb up and stand on top of your toilet when you need to use it” - Scott Will on his recent realization re. the use of our latrine (an awkwardly large concrete cube with a hole in it which was intended to be attractive to white users who “like to sit when they go” but in fact we are all grossed out by the idea of sitting on it, so we all climb up and stand on top of it and squat over the hole...TIA
• Kaya’s sincere/humorous concern for Scott and Andrew and I, that we each need to become “very serious” about finding a wife/husband.  After probing a bit in vain to find out what exactly being “very serious” in search of a spouse would look like, he did explain a bit more of his reasoning on the subject - “For me, I have no problem, but for you, ah!, your years are going!”  Thank you John Kaya for that treasured reminder :)
• the chance to go a-visiting with Melissa on tuesdays and thursday afternoons (now that this school year she only has to teach in the mornings) in search of friendly people to sit and hang out and talk with in the language of our choice...arabic for me and moru for her...we’re a good team, between the two languages we can usually hold a complete-ish basic conversation with a Moru woman or negotiate any situation we might find ourselves in a mostly satisfactory manner...whether it’s hearing the heartbreaking story of the abrupt loss of Vaida’s husband almost 20 years ago, or making arrangements to take a friend to the closest hospital with a doctor, which happens to be in Lui, about an hour’s drive away in rainy season...there may or may not be quite a few body motions involved in said conversations, but you do wha ‘cha gotta do in order to get the point across, right?


Kick in the pants

It’s a bit of a strange scenario, to be aware of your own need for a kick in the pants.  If I know I’m in need of motivation, then why can’t I motivate myself?  I’m not sure why the scenario occurs but it does.  More often than I’d like to admit. 

Anyways, I’ve been in need of a kick in the pants in language learning. I think I’ve said this before, but it’s hard.  For me, it’s really hard.  The language itself, not so hard.  Juba Arabic is a pigin form of the classical Arabic spoken up north (a bit like Creole is to French as far as I understand) so it’s simplified, and the crazy swirly script is not a part of the equation either, which is definitely in my favor - the use of the roman alphabet alone is a huge bonus in the learning process.  The grammar is pretty simple.  The pronunciation is pretty simple...none of this tonal nonsense like Moru (the local tribal language which is even more daunting to me).  But the learning process?  Way hard.

Give me a concrete task and I’m good to go.  No problem.  Give me a defined role and I’m golden.  As a nurse, I approach a sick person and my role is clearly defined - we’re both aware that the sick person is sick and that I’m supposed to help them.  I can approach just about anybody in that context and say almost anything without hesitation.   But put me in a party setting where I’m just supposed to talk to people?  Forget it.  Maybe they’ll like me, maybe they won’t.  Maybe they’ll think I’m dumb, maybe they won’t.  Maybe I won’t have anything to say, maybe they won’t either.  Language learning is kinda like the party scenario...you’re just supposed to go and talk to people.  You’re just supposed to try out your new vocabulary.  So, not only are you just supposed to talk to people but you’re just supposed to talk about things like colors and numbers and parts of the body and sewing and riding a bike.  It’s murderous.  I feel totally inept.  Somebody laughs a bit (which is totally legit - I probably sound like a two year old trying to string words together) and I melt into a worthless mess.

So, maybe you're getting a better sense for the need of a good kick in the pants.  What do you do if you're me and you need a kick in the language learning pants? You move to town where you're surrounded by language more often for larger portions of the day without having to try so hard to create the scenarios - they just happen as you go about your day.  So, Tuesday, I did just that. I moved to town.  That involves moving off our team compound which is a bit outside of town, and onto the Episcopal Church of Sudan guesthouse compound in the center of Mundri town - the same compound where Scott and Andrew live - both of whom are speaking/learning Arabic.

It all came about pretty quickly, moving from a crack pot idea to reality in a week.  That's the thing about Africa.  Some things take twice as long as in the western world, and some things happen way faster than you'd ever imagine.  I packed up my trunk and my bike and got a ride down to town and moved into my home away from home away from home :)

So far, it's been a great week.  There's much more arabic around, I'm slowly by slowly becoming more and more bold in using the little bit that I have, and everyday learn a few more new words.  Scott is Mr. Hospitality and Andrew is Mr. I-want-to-learn-everything, so there are visitors in and out on/off throughout the day and evening and there's a lot of Arabic being spoken and a lot being learned.  And they've been very kind to let a girl enter their mostly boy world - looking out for me when there are drunken men around and suffering for Jesus by eating the food I cook and bake ;)  )They're quite the cooks/bakers as well, I must say.)

SO, put me in the midst of language instead of me having to seek it out, force me into the position of having to use it more often whether I'm confident or not, and there you have it - a kick in the pants.  So far so good.  And a huge thanks to Scott and Andrew who have been really kind and conscious of encouraging me to learn more, hear more, speak more...friends as teachers work pretty well :) So, with 4 days under my belt, and an initial commitment of a week long trial run, things are looking good.

So, if you're of the praying variety, please do pray that God would use this time for His glory.  Pray that I would be faithful to learn and to practice and that I wouldn't be too much of an inconvenience :)

A few shots of the new digs:

inside my tukul #1

inside my tukul #2 (note: when bed not cluttered with my junk = a place for a visitor - read teammate from the team compound - to come and stay for a night or two :)

my tukul

L-R (Scott's room - which has a small kitchen/living area, along with an outdoor shower area that we all share next to it which you cannot see,  Andrew's tukul, my tukul.  There are two other tukuls which you cannot see, to the right of mine, occupied by the guesthouse manager and a Kenyan woman, along with a piyot or mud/thatch gazebo like structure for greeting/meetings, etc )

"things that make you go hmmmmm...."

there are usually moments in life here that shock you back into remembering exactly where you are, moments that make you chuckle, some that make you cry, some that make you go hmmmm....remember that C&C Music Factory song?  ok, well, maybe you weren't listening to rap/hip-hop in the early 90's but I was and just thinking of the title line transports me back to my late elementary school/early middle school years in Pittsburgh in a instant...

anyways, back to South Sudan....and things that make one go hmmmmm....

for instance:

• the moment in church on sunday when one of the lay leaders dressed in her white dress and head scarf and sitting up front on the dais during the service leans her head back and reaches up to grab a piece of the thatch from the roof above her head and breaks it off and begins to use it to clean out her ear....hmmmmm...... :)

• the moment yesterday when in listening to a few young South Sudanese men who have been in school in the US describe their first encounter with snow....and their comparison of the looks of it falling from the sky to that of what? termites...would not have been my first thought, but they're right, snow falling from the sky looks very similar to swarms of termites flying around after a good rain....hmmmmm..... :)

• the moment yesterday as we left a funeral, which had experienced a big downpour of rain just as lunch was served, in which we were asked to pull a matatu (large minibus taxi) behind our vehicle so that they could jump start their engine....we tried but the second attempt broke the ratchet straps being used to tie one vehicle to the next.....hmmmmm.... :)

• the moment in which you're exercising (in shorts, might I add!) at 6:45am in the privacy of one of the buildings on your compound and a young man and boy who've come to borrow a bag to wrap the dead animal in that they're carrying with them and decide that what you're doing in your   piyot is far more interesting than their dead animal and decide to press their noses against the screen of the piyot and stare at you and the exercise video on the computer screen on the table...and continue to do peer and smirk after you ask them to go and tell them that you're not able to help them at the current moment...it's not until your voice gets more firm and you sound more annoyed they finally realize that you actually really do mean what you say and that they should in fact move along, that they do actually move along....hmmmmm...... :(

• the moment in which your friend in trying to describe to you the story of Noah, describes to you the "motoro boat" that he had....the moment in which you try to discern whether she is referring to the boat Noah built for the rains God sent ("motoro" means "rain" in Juba Arabic), or  if she actually really imagines Noah's ark as a motor boat....and then she goes on to describe what actually sounds like a motor boat, immitating the hum of the engine and everything....... hmmmmm..... :)

• the moment in which you're smacked in the face with the reality of abuse that women are on the receiving end of so often in war torn cultures like this one....the reality that there is no option of counseling, or talking about it openly and honestly with friends/family...no antidepressants or anti-anxiety meds to help you cope with the emotional outcroppings of such abuse....no rest from back breaking work and caring for several children that you are struggling to care and provide for on those days that are really hard....hmmmmm..... sigh..... :(

• the moment when you see a Moru woman squatting in the church's garden as she weeds around the tiny g-nut plants with little yellow flowers that are sprounting in neat and tidy little rows in the heat of the day...and looking at the rows and rows more that she has yet to do....and you're humbled by the smile on her face as you go by....hmmmmm.... :)

just of few of the moments from this week....so that you can "hmmmmmmm" along with me.

rainy days

Monday:

my first day at the health center.  ahhhhh :) sitting between Scott and the mother/sick kids and listening to his questions and their answers...asking a few of my own and recording the answers...and of course the pinching of cheeks and trying to make kids smile - with more success than I am used to from Bundibugyo...not as many shrieks and squirms of fear as I'm used to - instead of "white coat syndrome" it's more like "white skin syndrome" :)

a lot of the usual fever (which actually just translates "the body is hot"), diarrhea, vomiting, cold symptoms, etc.  and then 2 kids with marked swelling...malnutrition? kidney disease? other rheumatoid/auto-immune diseases?  what to do when the only labs you can do are a malaria test (positive or negative - no numeric parasite counts), a urine dip, and a stool culture...glad for now to be just listening :)  no solving of problems yet for me, only listening to the arabic being used and trying to use the little I have as much as I can while learning more.  It's nice, I can understand Scott's Arabic more than I can most Sudanese, so it helps me to then pick out some of the same words in their Arabic thereby improving my ability to understand their Arabic as well.  Quite a nice system if I do say so myself.

We'd said we'd leave at 1:30pm.  Around 2pm the thunder and dark clouds roll in and I grab the keys and high tail it back to Scott's hoping to pick up my bike and ride back home in time for my 2:30pm skype date with Carrie Jo...but I didn't high tail it quite fast enough and the rain caught me at Scott's.  What does one do when it starts to rain?  You sit and wait.  Wherever it is that you find yourself, you sit and wait.  I called Care and told her I was stuck in the rain and wasn't going to make it back to internet access in time.  We rescheduled.  I stole a few bites of Andrew's granola, a couple bites of Scott's cinnamon/butterscotch cake yumminess leftover from team worship/prayer the night before...plopped myself on the couch and waited.

Scott came back around 2:30pm and didn't skip a beat before jumping into "host" mode...what do you do when you're stuck in a bachelor's house during a rain storm?  You eat Ramen noodles :)  Beef was the flavor choice of the day.

What do you do when it's 3:15pm and it's still raining?  You have a cup of tea.  In this bachelor's house you're not at all stunned to find tea options like the Christmas Sugar Cookie Celestial Seasonings which happened to be my choice.  Never caught dead sitting in one place for more than a half hour at a time unless under duress, when you have Scott Will trapped in a room with little opportunity to flee, you also probe the depths of his rarely shared inner thought/emotional life and actually get some answers :)
In all seriousness though, just as the rain slows the already slow pace of African life, it also slows us Americans down and I'm really thankful for the significant conversations and pauses it gives us opportunity for.

5pm and I hear a pause in the pitter patter of the rain on the mubati roof, I decided to make the move and attempt to bike home before the next cloud moved in...and I made it.  Turned out that was the ONLY pause in the rain from 2pm until who knows when it stopped during the night...but what does 3 hours of rain mean for dirt roads?  Mud.  I was very well adorned by the time I reached home (see photo above).  And I never saw it but I could feel that my backside was pretty well mudded as well and the laughs that broke out from most every person I passed on my bike let me know I was not mistaken :)  Happy to provide everyone with a good rain pause laugh :)

a study in delight

(me & Foto)

**photos by the lovely and shutter talented Melissa Garner**