Reflection

I haven't posted in quite awhile, and discovered this morning that my blog was "disabled".  It started me thinking about how I visit this site myself to reflect upon all we had experienced. 

Often I wonder what became of all those people we cared for.  My life was so dramtically changed by them, and I want to thank them.  I've become a much stronger, compassionate and wiser nurse because of their strong spirit. Those wonderful people faced devastating, life altering change with a tensile, visceral, calm strength I can only hope someday to achieve myself.  

In addition to many more volunteer efforts inspired by my experience n Indonesia, I now find myself creating opportunity for change, to find ways to promote and provide better healthcare, and to widen our horizons in how we confront our looming medical issues before they sweep over us like a tsunami.  I firmly believe there is Hope.

abandon ship drill

abandon ship drill
Originally uploaded by Donna RN.

One of the concerns on board ship is how to get non-ambulatory patients to the life boats in an emergency. Many of our ICU patients are unable to walk on their own. They are transferred to and strapped into the litters Here's one of our practice drills (just didn't include IV's and such) It's pretty hot in the ramped hallways (100 degrees) , and we are traversing two decks, moving FAST. Hard work, but the adrenalin really gets pumping, evenin practice, so it actually was fun. In this photo we'd been carrying the litter about 5 minutes, and were almost at the main deck. Whew! (and then, just for good practice, we carried her BACK!) -- no wonder I lost weight on this mission.

Banda Aceh Before & After

Banda Aceh Before & After
Originally uploaded by geena rn.

Just a little perspective...

Living Images

March 22, 2005

I've been back a few days now, and with a rare exception, I have yet to look at all the photos that I have taken and all the photos that I downloaded from all my shipmates. Ordinarily, after a vacation, I can't wait to see the photos and to smile, reliving the moments.

But this was not a vacation; this was not an occasion to be remembered solely in photos. Why am I hesitating looking at those photos?

These memories, these rare gifts of extraordinary human contact, are still alive in my mind. They are all living images, saturated in the color of sapphire seas and misty green mountains, drenched in humid equatorial stifling air, rich in sound that echoes thunderstorms, laughter, singing, and the comforting chanting of daily prayers.

They are living images that remind me of the brave smiles and eagerness of the Acehenese to embrace the people who reach out to them.

They are living images of the frightened look in the eyes of a devoted husband as he walks to the helicopter, his paraplegic wife in the litter at his side. Living images of this man as he tucks his USNS Mercy cap into his belt, and clutches to his ER TV Cast t-shirted chest 1 month's worth of supplies for PICC dressing changes and IV solutions for mixing the twice-daily dose of vancomycin he must prepare and infuse. They are living images as she bravely smiles through her tears as we tuck extra nightgowns and bed linens under her knees and transfer her from the comfort and security of the “SUB” to the hard narrow litter for her helicopter trip to land, and to the hospital bed awaiting her.

Living images of the hospital, short staffed, and ill supplied, where patients must bring their own bandages and medications. Living images of this young couple as they eventually go home, with the new wheelchair provided by HOPE and Mercy, and the extensive notes of care so carefully translated and transcribed and fervently referred to many times before they left.

My memories are living images of a grateful patient who sent gifts of thanks back to the ship. A DVD with images of the tsunami wave as it swept into the center of the city, miles from shore, carrying trees, trucks, cars and boats in a muddy raging torrent. Memories of that woman, patient and stoic, imprisoned for 14 days in isolation as she went through several surgeries in a vain attempt to save her foot. Living memories as she struggled with crutches determined to walk off the ship and face her new life. A life without 4 of her 5 children, and their children. Living memories as she and her remaining son put their hands to their hearts, their heads and then to our hands, thanking us for their care.

My memories are alive with the sound of laughter of young children as they chased bubbles in their ward; with the enthusiastic cries of “Bingo” from the mess deck, and the incredibly energetic and irrepressible singing of security forces on Karaoke nights.

They are living memories of that southern voice every morning at 7 a.m., “Attention MTF, secure the decks for flight ops. I say again, secure the decks for flight ops.”, or of the chaplain at 2200 offering his nightly prayer always soothingly ending with "God bless this ship and the people on it, God bless the people of Banda Aceh and keep them safe."

These memories are still alive in me. Palpalable, with rich scents, sounds, and rhythms that infuse my exhausted sleep. I want to integrate these living images into my consciousness, to keep their dimension rich and alive, before I begin to review the photos in their flat dimension.

I want the memories that keep those photos alive. I want that incredible daily sight of the misty, lush Sumatra landscape burned into my mind. Before I embrace and repeatedly enjoy my hundreds of photos, I want to be sure the essence of those images stay alive.

As I watch my husband playing his special Frisbee game with our dog, I look around at our home and at all he did for me. I see the vases filled with handpicked flowers placed on color-coordinated table linens. I smile at the huge welcome home poster with my image and the HOPE and Mercy logos framed and waved enthusiastically overhead as I walked out through customs. I take special note of the carefully placed mementos of our life together arranged just the way he knew I would on shelves and tabletops throughout the house.

I smile as I see the photos and letters he had snuck into my duffel before I left, and at his Marine Corps pin he gave me for good luck...to keep me safe.

These are the memories forever alive for me. And I know, I am ready. Ready to take the surreal and blend it into my family's everyday life. I'm ready to share those photos and remarkable stories with friends and family, and relish my new reality…simple and celebrated.

Courage and Faith!

Courage and Faith!
Originally uploaded by Donna RN.

Here's a quick Smorgasboard of Hope upon the Mercy! This is especially
meaningful to me today, as there has just been another massive earthquak 8.2 - 8.7
off the coast of Sumatra. Peole are bracing for the possibility of another
tsunami. Meanwhile, Banda Aceh, where I was only a week ago is
experieinceing widespread power loss; fear, panic, traffic jams and injuries.

These people have inordinate courage and faith in the face of penultimate
disaster.
I wish them all safety, health and happiness. I wish my patients
calm, peace and strength. I pray there will be no tsunami. I pray they will
find their lives enriched, and free from fear.

I have heard from some of my former shipmates, as they are sailing back to San Diego aboard the Mercy, providing humanitarian aid to islands along the way. They were far enough away from the earthquake to not feel or see any effects but are "on alert" in case Mercy's mission changes and they return to the Sumatran shores of Bande Aceh. I wish everyone there on sea and on land a calm night.

One small step ...

Donna with Martia-Bed
Originally uploaded by Donna RN.

3/12/05: Twelve straight days of work started to take their toll on me - I slept through breakfast, didn't get up until 7 a.m. more tired than I thought I was. But maybe there was another reason I slept in.

Martia left this morning. I don't know what time.

It's hard working PM's as we miss patient's departures. After the exhausting work last night, through our amazing interpreter, we did marathon teaching highlighting and reinforcing the information we have been sharing for two weeks: explaining drugs, doses, uses, and reactions; dressing changes; nutrition and diabetes education, I just couldn't make it to the flight deck at 6:30 a.m. to see what time Martia's “stick” was scheduled (Navy term for “group for flight”).

Martia's first efforts on crutches yesterday morning were unsuccessful, so I scheduled 3 different times last night with Physical Therapy to get her rhythm right with the crutches … a remarkable feat (pun intended!) to keep your balance with a rolling, lolling ship. (Photos show our ultimate triumph! Better than the Olympics!)

After all that, we set up an extensive calendar for the myriad doctor's appointments needed for post surgery treatments, diabetes management, medication dosage reviews, and physical therapy covering the next two months. I packed up dressing materials, labeled with detailed descriptions, color coded for wet and dry dressings, and instructions for use; I filled 1 months worth of all her prescription meds, labeled them individually with proper dose, and potential reactions; and packed a sterile suture removal kit (just in case her doctor did not have one).

With each step I kept praying to myself that they will indeed find a way to attend to these follow-up appointments…a shadow of fear dimmed my happiness at her discharge. She had come so far, what if her treatments end when her month of supplies and medications run out?

Perhaps that fear was what kept me from getting up early to see her again. We said our goodbyes last night. She and her son, Zahir, expressed such warmth and gratitude I didn't think I could handle hearing it again, it was hard to breathe when crying through my TB mask.

We had been together since I came on board this ship. Some of my identity and reason for being here is wrapped up in Martia's bandages, worn in her smile, clutched in her prayer beads.

Her laughter at my elaborate dances through isolation sustains me even now. As I dodged hanging cables, deftly avoided precariously taped needles in IV ports, balanced over anchor hooks in the floor all the while steaming my glasses, and stinging my eyes with sweat, I would hear her laughing as she reached out a hand to me.

They were excited to be leaving, and this time her laughter was of her own creation. And yet, there was something behind that twinkle in her eyes. The same thing I saw in Sara's eyes when she and her husband left. Fear, sadness and the return to the depth of loss they came from.

But we gave them hope … a chance … moments of laughter AND toys for Martia's remaining grandchildren, and a BIG bag of “equal” for her.

… I'm running now, to see if they're still here, waiting on the flight deck … I have a Mercy baseball cap for him.

Tower of Babel on CASREC

So, a quick little item highlighting the dangerous waters we tred when learning to speak another language...especially in intense situations.

For a couple of weeks now, in an attempt to be welcoming and comforting, our nurses have been greeting our patients in their native language as they come into CASREC (casualty receiving; aka admissions) with a warm "Saya parawan". "I am a nurse." This was usually met with smiles, covered grins, or outright giggles. We were glad we were able to break the tension and fears associated with coming aboard such a foreign ship, and figured they were amused by our funny accents.

Finally, one of the interpreters, upon hearing the greeting, smiled broadly himself, and gently corrected us to say "Saya parawat" ... I am a nurse.

Evidentally, we were really tickling our patients with a greeting of a very different nature: "Saya parawan" = "I am a virign".

But I suppose, in some strange way, that could also be considered welcoming or comforting?

Donna Is Home

Donna Is Home
Originally uploaded by geena rn.

Welcome back!!! We can't wait to hear more about all of your adventures! :-)

-geena

The Veranda of Mecca

In any organized event, mission, or project there is a defining moment.  A crystalized point in time that encapsulates, elevates, and  gives soul to the heart of the effort.

We experienced this in a quiet, profound and surprising way last night after one of our medical lectures.  It was time to say goodbye to all our invaluable, noble and delightful translators who were so much a part of our healing process.  They became intimately involved with our patients and their families providing not only the comfort of a familiar language in a very foreign environment, but also warmth and compassion. These intelligent people had a difficult job as sometimes, although the doctor and nurse were there at the bedside, they were the ones who had to tell a family that we cannot help them, that there is nothing more medically we can do. 

Many of these translators came from Jakarta and volunteered their time, just as we had.  So we acknowledged them last night with accolades, small gifts, many hugs and a party.  But before the party started, Tamala, a very gracious and eloquent woman from Jakarta spoke to us.  She started off thanking us all for the opportunity we gave her to act as translator and provide this gift to the Acehan people. 

Her address to us started with a paraphrase of Sir Arthur Chesterfield, "A human being is happiest when they provide service for others."  And Tamala followed this with, "this ship must be the happiest place on earth." 

She explained that prior to the tsunami, Indonesian people were wary of Americans, concerned about our perceived place in the world, and distrustful of our motives in global affairs.  We were feared and even despised.  Post tsunami, the Indonesian people have seen the American "war machines" (our trusty helios) bringing food, water, medical supplies, and medical personnel.  They have read about the efforts the various American organizations have made on land, and the Great White Ship Mercy's story has spread to the tiniest of mountain villages. 

According to the newspapers in Jakarta, Indonesian public opinion is now 70% favorable towards Americans, and we are viewed largely as a compassionate nation, strong, and willing to use our strength and wealth to build and save, not destroy.

Tamala said this was an extraordinary gift that we have given to Indonesia, as great a gift as the medical aid --  For we have healed the soul of two nations.

But there were more precious gems that this strong, delicate woman shared with us.  A story she said she was sure we did not know.  Most of the people that we are helping come from a conflict driven society where they are the pawns, of little perceived value, only strategic tokens.  The army will burn their homes and extort from them she said; and then the separatists will kidnap them, extort from them and burn their homes.  They are people treated as gambling pieces. 

And then the world came to their aid; and the Mercy, staffed with the feared Americans gradually became a welcome and honored fixture on their horizon. 

What we did not know, Tamala explained, is that we gave back to these people their self-respect.  Because of the extraordinary care, kindness, and respect we showed these people, she said,  we provided them a greater cure than we could imagine.  We saw people who have had limbs amputated; people with disfigurements that could only be marginally repaired, people who had successful treatments, people who were sent home to die---and yet they smiled and were happy.  They pressed their hand from their heart and forehead to our hand.  A profound gesture of humility, and gratitude. 

We had thought that with these people, expecially those we could not help, that we sent them home with no hope.  What Tamala told us was that we sent them home with dignity.  We sent them home with a renewed sense of self worth and self respect. 

As we sat spellbound by her simple elegance and eloquence, she continued to explain more.

All the patients she spoke with were saying how grateful they were for our kindness and gentleness.  However, they are so poor they will never be able to repay us, and express their gratitude appropriately.  They said that God will have to repay us for them. 

Banda Aceh, the most devastated area from the tsunami, is also one of the most religious places in Indonesia, it is considered the Veranda of Mecca, "the room before you enter the most holy room".  In the eyes of these devout and holy people, the Mercy has delivered them, their family, and their friends safely and respectfully to its door.

These people of Bande Aceh are very poor and they repeatedly express their gratitude in the only way they now how.  To tell you all that they cannot repay you for what you have done, but that God will is their most powerful and poignant compliment,  It is at the very core of their belief.

With her hand to her heart, and then to her head, she bowed slightly and said "terima kasih",

"Accept Love."  (thank you, in Acehan).

Accept Love.

And to all my family and friends, I take this gift and share it with all of you.

Terima kasih.

---This is a sad one, but again, with the triumph of human spirit soaring above it all!

A baby died.  It was a few days ago, and I have avoided writing about it for awhile.  I didn't want the raw fresh emotion coming through.  She was a sweet little 9 month old who came to us after an appendectomy had gone awry (why they did an appendectomy on a 8 month old is not known).  During the surgery there was a tear in her intestine, so intestinal fluid had been leaking into her abdominal cavity for awhile and she got sicker and sicker  ... septic by the time we got her.  Our Pedi ICU nurses were incredibly devoted to this little wonder, and our Pedi ICU doc seldom left her side.  There were several surgeries on board ship to repair the tear, to drain the fluid, to look for more tears, etc etc.  Her mother was here with her the whole time with no contact with her family, who live in a small mountain village some distance from here.  Ther one phone in that village was still not operational.  So she did not know where her family was, and they did not know the condition of the child.  IN this culture ... major decsions are made by the family, not just a single individual.  So she had many emotions to contend with.  We all became her family, as did the family members of our other patients on the unit. 

It was hard to see all the effort going into saving her .... I have rarely seen so many drips and so many different blood products being infused in one person before, and we did it for a week and a half!  She was intubated, extubated, intubated, extubated, intubated, and extubated, and that is when we had more discussion with the mother about the prognosis and decisions she would have to make.

She looked no more than a child herself, all of 85 pounds, with several more children at home.  She was stoic, then cried, and then after consulting the our onboard Muslim minister, she was made a "no code".  After so many days of intensity and emotion, the mother made a decision, and was calm.  That day she sat by the baby praying and chanting, joined periodically by the other families.  It was profound and calming to see these people quietly drift in and out by her bedside with this haunting prayer wrapping us all in a sense of calm...it became a beautiful dance, and suddenly the ventilator, the IV's, the medications, the tubes and drains faded into the background.  And we only saw her, her mother, and their new family. 

They made arrangemetns to fly her to the hosptial on shore so that she could die on her own land.  Although we all wanted to accompany her to pay her homage, it was only right that the core team (Pedi ICU nurses and the MD) took her to shore.  We took pictures with her, and made an album, signing it for the mother and the family.  The dental technicians came up and made impressions of her tiny hands (I am still not sure if this was something "western" in approach, and perhaps even a little weird to the mom, as they veiw death so differently from us) yet she accepted her gifts with calm, grace, and a almost divine dignity.  One of the nurses held the mom's hand on the chopper ride in.  They were praying the baby would last until they arrived at shore, as her respirations were increasingly shallow, and her heart rate was slowing rapidly.  They made it to shore, and to the hospital, where they discovered the father had been there just the day before looking for them, and querying about their condition.  I dont' think they were able to get to him before she died.  But she died enveloped in the embrace of a young, devoted, and dedicated mother, and surrounded by the hope and prayers of all of us ---her extended family. 

This is a sad story, but the calm and strength that the mother showed once her decision had been made is another amazing example of human spirit, strength in the face of adversity, and the connection to the universe through profound faith.  I can't help but smile now, as I look back upon our experiences with this tiny baby and her remarkable mom.  It's a series of sweet vingettes, and gentle lullabyes, soothing and invigorating all at the same time.

Cultural Differences

Yet another discovery today highlighting the cultural differences between the Bande Achens and the Americans (or most Western countries)...and some of the "holes" in their health care system:

One of our doctors was in the laundry room (aka the Sauna from Hell) doing her wash.  Some of the translators that are aboard ship where in there also doing their laundry.  They made pleasantries with Em and then, noticing her putting her clothes into a dryer, they said, quite innocently and earnestly, "Shouldn't the nurses be doing that for you?"

'nuff said!

On a more serious note:

Fourteen days ago, I left my home, my family, my friends, and my colleagues to embark upon a grand discovery and humanitarian relief effort.   It goes without saying that this adventure would never be possible if it were not for the tremendous selflessness of those very people I have left behind.

I am so grateful for the wonderful nurses that I work with, and for the enouragement I recieved from my bosses.  People have had to cover my shifts for me, and I understand we had been pretty busy, opeing our "overflow" unit.  These wonderful colleagues have readily and happily accepted this so that I could go and do what so many of them wish they could.  I owe them so much, and think about them everyday.  Thank you all for supporting and believing in me.

I know all of you on PM's enjoyed the cookies and breads that Sandy brought to you.  If it wasn't for him, I would never have come on this mission....he has made extraordinary sacrifices so that I could make this trip, and without his continual encouragement, sage advice, and whimsical funny e-mails, I never would be accomplishing what I have.  He helps me keep my rudder in the water and my sails set and filled with the wind!

Because of you all, I have been able to do simple things in extraordinary ways in a land surreal. 

An Amazing Day

I had an amazing day today. Watched three surgeries, two of whom I would be seeing later in the day on my shift ... in fact I was actually working PACU (recovery room for you non-medical folks) for awhile, so "recovered" them and then took one of them as my patient over in ICU. A small 5 year old boy post spleenectomy ... a challenge in itself since pediatric ICU is different than adults ... Between Morphine IV, and Fentatnyl drips in this litte tiny body, I was on high alert the whole time. Especially when he started itching and spiking a temp. He had an epidural that started leaking, and I had to get the anesthesiologist up stat. We ended up putting in an artline, and a central line---for which I was grateful. His only other IV access was in his foot (that's normal for a pedi nurse, but very strange and awkward to me!) ...Flexibility is the key here (we have a saying that Sandra, one of the nurses on my unit at home will love: Sempre Gumby!) After OR I was invited to lunch with the Captain of the Ship, at his table, at his deco, in his private dining room! Table cloth! A watier! A WINDOW!!!...and the best part ....QUIET! We were actually able to have a conversation with each person at the table withoug yelling and straining to hear. I hadn't realized how noisy the ship is until I was in a quiet zone. What a treat!

Also at the table was the Chief Engineer (he's equal in rank to the Capt.) as well as the Head of OR and their chief surgeon. Also joining us was a govt representative specializing in Infection Control. It was a stimulating lunch with rapid and broad reaching exchange of ideas. We all had suggestions for the ship when it goes for retrofit...things to update some of the processes and equipment, explaining the flow we had, and what could be done to enhance it, and to enhance the care and comfort of the patients. It was a very "think tank" type of lunch discussing merits and areas of improvement for future missions. The Captain made many notes, and questioned us often to better understand the needs of the ship from a medical standpoint. I was privileged to be a part of this exchange.

Like I said, I had an amazing day.

D's Bunk

D's Bunk
Originally uploaded by geena rn.

Here's a picture of Donna's sleeping quarters :-)
Click on the picture to go to flickr and view other pictures of how she travels in style.

Sea-legs and Gimbal-hips

It's been awhile since posting, but it has been busy here, computers are hard to come by with all the folks on board, and the hookup is unreliable. If you don't save as you go, you lose everything.  I'm using a keyboard that I think was left over from the Persian Gulf Mission, when someone spilled industrial strength coffee ladened with 5 scoops of sugar and maybe some jam from the PBJ sandwich.  They must have leaned over the shift key a lot, because I really have to hammer on that key to make contact.  So, now that I have rationalized my poor typing skills, I would like you to imagine standing on a 2x4 balanced on a tennis ball---and then type. I daresay you would have as many typos.  I say stand, because right now, sitting in a wheeled chair will send you carrening across the unit and plow you right into a stretcher.  We're really rocking and rolling today ... odd because the sea looks calm. 

It was calmer yesterday, but I have definitely developed sea legs and gimbal-hips so I don't notice it much of the time.  I have one patient who has been in isolaton the whole 12 days she's been here ... she and I have suffered in the "penalty box" (as one of the doc's calls it) way too long.  Not bad for me, because I can get out of there...but she's completely cut off from everything ...with the excpetion of the large window where she can see out to the nurse's station.  So, I thought I'd give her a treat, since she was improving...put a mask on her, got her into a wheel chair, and took her and her son up to the "lido deck"  (that's what we ngo's -non government officials) call the smoking deck. It's also one of the nicest places to view the sunset.  Moving a wheel chair on the ship is no easy matter...especially when you are pushing AGAINST the roll.  Plus there are 2 inch high metal doorjams in some areas, so we have to lift the chair up and over.  It was comical, but we managed, and she was fine for the first few minutes, with the breeze in her face, in the shade shielded from that hot equatorial sun.  Then I noticed her getting a little slumped over...stoic as usual, and getting slightly green around the edges ... she was getting seasick! She was fine when she couldn't see the horizon, but a little fresh air, and a lot of wheel chair shifting (even though I was holding it locked and steady)  --- and it was all over. 

So quickly we swooped her back over the door jam with the help of a few able bodied corpsman (more of THAT later), and off we went back into the penalty box, where she curled up thankfully and pulled the covers over her head.

So much for critical thinking on THAT matter, but you just don't learn Seaworthiness 101 in nursing school.  Come to think of it, much of what I'm doing you don't learn in nusing school!!!  And yet ...I'm doing it! 

And to the comic relief of my patient, once she peaked out from under her covers I got her laughing with my now infamous Popeye impersonation.  Isolation gown, with a mask over your face, with controlled ventilation, and little airconditioning, you tend to sweat.  As I sweat into my right eye, it stings closed and I leap around with sweat stinging, and me swaggering and squinting my way through the rest of my nursing care.   She loves it ...physical comedy is big here ... and this landlubber does it with style (if not grace).

Well, time to do the sailor's jig again!   Until next time ... Ahoy! 

No Land To Be Seen

Sunday 3/6

Back on the fantail---lots of white caps, we are cruising far out to sea, no land to be seen.  Later this afternoon, they are clearing the flight deck for us (we call it the steel beach) and they are taking a photo of the ship crew (which includes us) that will be nice...then I can hang out there for awhile before showering (again) and getting to work.

I'm starting to round with the doctors on the AM rounds...I am getting a better picture of all the patients and their maladies since we don't see the same things, necessarily, in ICU, and we certainly don't see the children (except for our one baby...very very sick).

I'm going to go down to the wards more and help out there.  The children are magnificent and resilient.  Three little boys 6, 8, and 11 all came in on the same day for inguinal hernia repairs.  They were so funny looking out for each other, and watching as one went and one came back from surgery, wide eyed and fearful at first, then comforted.  By evening they were playing together, wearing nurse scrub tops, and peeking underneath them and giggling hysterically.

Our little burn boy has us amazed.  Pre-tsunami he had been badly burned, especially his legs, which became deformed from the burn contractures.  He had little frog legs, and was unable to walk,  After his surgeries aboard ship, and lots of PT, he hobbles around the ward pushing the EKG cart!  Resilient, resilient, resilient.

The families here have had to change their lifestyle dramatically--as they have continually since 12/26/04.  There is always someone on board with the patient, sometimes several family members.

We've learned that we need to let the families know we will feed their loved one.  They panic at first at the thought of the patient being away from the family, and from their care...because the hospitals here do not provide food for the patients.  Food and bathing is a responsibility of the family.  So there has been a lot of adjusting from both perspectives. 

I'm trying to get a clearer understanding of the RN role in the hosptial.  A local physician from University Hospital came through on a tour, and I explained the neurologic and orthopedic condition of my patient.  Later our MD came back and thanked me for spending time with her and answering her questions.  Apparently she was amazed that nurses would do so much and know so much about a complicated case.  Interesting insight.

That's all from the Mercy at this time ...more to come.

Thank goodness for our translators, they have been a god send.  They are mostly from Jakarta, and berth with us.  They are smart, funny, caring, and extremely busy!

 

Project Hope In Action

Project Hope In Action
Originally uploaded by geena rn.

Of course, Sandy made these little photos into a work of art!

helo over ship

helo over ship
Originally uploaded by geena rn.

HI!

I'm having trouble downloading my camera...computers won't allow me to load the software for the canon...I"ll keep trying.  Meanwhile, these are some photos that I have downloaded from others and from the previous groups.  I don't have time for story lines, but perhpas just posting a few photos would be interesting ...don't know how many I can send, so I'll do a few at a time.  If you got the refueling one, that was cool.

So, I'm attaching files now ... enjoy!

Click on the picture in order to go to flickr and see the whole slideshow. Once there, click "prev" or "next" in the box to the upper right side of the big picture to see them all.
 

SUBs and Keys

No newspaper, no radio, and these young soldiers would rather watch a movie than CNN - so, when the internet is up, I catch pieces of news. Reading fast, as people are always waiting for the computer.  I see Martha's out today ... and that's about all I know.  Is this what is meant by Naval Intelligence?

The routine here creates seamless days, and since we work 7 days/week, it's sort of hard to know what day it is!  We're always asking each other.

The two big quesitons every day, "What day is it?" and "Whose got the keys?"  (for you non-nurses ... this is sort of an in-joke...the keys are for the narcotics cabinet, and in many facilities, there is only one set),  I guess some things don't change wherever you are!

The ship is an interesting dicotomy - we have state of the art equipment, well outfitted OR's; CT Scanner; multiple portable X-Rays, full radiology and cathlab, 20 bed isolation ward with negative air pressure, and great ventilators.  But it's total paper charting, MAR's and Card-ex AND a totally NEEDLE IV system  ...no luer locks.  It's one thing to start an IV with a needle...there is no other way ...but try doing a fentanyl push while the ship is rocking and you've tied the IV pole to the bed so the central line doesn't come out!

Speaking of beds, most of our ICU beds are actually gurneys (I can only imagine 3 - 5 days spent on those small hard beds ...we are turning our patients constantly) But we do have many Hill-ROM sport beds...I call them SUB's (sports utility beds) --with rotation and percussion capability.

Strange, you come back from CT, put your patient back on a SUB and then piggyback his IV antibiotic and IV diprivan with a needle into a hep lock onto the primary line and tape the needle to the port (no secondary sets of Y tubing.)  From high tech to no tech! :-)

Hey guys! It's all new to me!  I'll have to tell my students that I feel like a new grad all over again!

The MD's round 3x's a day and I've enjoyed their approach, their teamwork and collaborative approach with the nurses.  It's a true partnership ---first name basis, and we sit shoulder to shoulder on the mess deck!  There really is a profound sense of respect.

Life At Sea

Life at sea is amazing and I marvel at human adaptability!  I see it everyday with our patients and their families.  From living in cities, and small outlying villages; to living in a ship, with no windows, no trees, none of the support system they are used to in their community.  But they create community wherever they are.  I think it is a testament to human nature.

For us American civilian landlubbers, we have a lot to adapt to also.  A military environment (albeit much more lax and flexible than on a true military ship); stringent hours for certian things, working in units unfamiliar with unfamiliar equipment, procedures, and ancillary personnel...and while well-stocked...there are many things that when you go to use them are only half there, or not working --- and once you are our of stock on the floor, the true Central Supply is 100's of miles away (or in some cases, 1000's). So you improvise, and laugh at each other.  I guess, that's really not too much different than home sometimes!

After 7 days on board ship we have become accustomed to certain things.  The first few days our cameras never left our sides and at the sound of the helos (multimisison Seahawks ...or "sky stallions") blades powerfully stirring the air around us (you can feel the percussion from the blades in the mess deck, two below flight deck ... everything reverberates ....and if you are outside...man it's invigorating!) we'd all go charging off to get a photo as they took off.  Now, though I still thrill at the sight, I am no longer scrambling for the camera...but I always stop to watch.  These dancing helos are monstrous pieces of machinery that look graceful in their powerful dance with the wind.  How they continually land onto a moving deck is beyond me. 

Refueling in the open water was fascinating.  I came up on my dinner break to watch.  Two huge tankers ships tethered by Rope only 100 feet apart for over 2 hours, with navy swift boats and German ships providing protection.  Oh! here's a real life at sea note:  We have German soldiers on board our ship for their R and R!!!!  Same ocean, different ship, different food is a TREAT for them.

This mission is really a beautiful international effort ... when we first arrived there were Austrailian and German ships out here as well as us, providing support for their land based personnel ...we are the only hospital ship here.  I'm still learning the politics about this all, but many feel there has never been a truly centralized effort, and some feel the military presence was a deterrent, (and perhaps an insult to the government).  Too bad people can't learn what I have (and this from a wild Berkeley girl) that the military CAN be a benign force of highly disciplined, intelligent individuals who understand the meaning of sacrifice, self-denial, and RESPECT.  They have the logistic knowledge to gather quickly and deploy efficiently.  The Mercy crew had 5 days notice to prepare and deploy.  The MERCY was due for drydock for upgrading, etc. and instead was outfitted, supplied and hands on deck and out to sea in less than a week. Pretty amazing. 

Back to life at sea...it's peaceful for those who don't like change or who strive on structure (hmmm, who DOESN'T that sound like?) it's a wonderful pace.  There is a set routine that is essential, but offers few options.  On board ship I've found different places to go to enjoy my time before work, and marvel at what goes on if you look past the large scale.  A small butterfly just landed on the life perserver in front of me.  What a tale his journey could tell!

Perhaps routine is beneficial to our patients and their families - for this lifestyle is extraordinarily different from their life on shore. I think routine and rules provide them structure that they can build around. 

We're sailing close to some veiled mountains and island shore.  These misty mountains contain mystery for me --- intrigue and a desire to know more.  Such veiled grandeur that a few months ago was a shroud.

Retrospect 2/28

Hi all!

I have been here a few days now (6 days on board ship  .. although it feels longer...in a good way...more of that later), so I have time to send some notes from my my journal...since e-mail wasn't available to us until 3/3. So here we go:

It's February 28:

On the flight deck at 6:30 am watching the Singapore Army with their morning manuevers.  We were briefed on our mission (HOPE's) and were processed through deportion, bags weighed (I own't even tell you how many pounds my duffel was! thank God for those wheels), and tagged, and then, the proverbial, "hurry up and wait".  At least the room was air conditioned.  I think the damp coolness (everything is damp here) helped calm the rising anticipation - after all those hours and miles of travel, our mission was about to begin (after a few more miles, and a few more hours of travel).

S'pore troops march by information as we watch in that early morning humidity.  We gather our gear and walk out onto the tarmac, passing the hanger bays, with fighter pilots assembled for pre-flight ---looked just like Top Gun!

As we stand waiting for our aircraft, the air is heavy with many morning scents and the raw power of too little sleep after too many miles and hours of flight time---and still the promise of what's about to unfold.

 It's time!

We are strapped into the webbacked, hard bench seats of a C130!  The "cabin" of the aircraft  is essentially a long dark tube with large duffels and packs in cargo webbing swinging overhead, and us sittiing knee to knee, face to face, and shoulder to shoulder.  I quickly maneuvered to an end seat next to the crew...at least I had light and room around me (not into knee knocking in tight places...just a little claustrophobic). 

Our gear is all shrink wrapped and palleted at the rear in the cargo bay 10 feet from me.  With the accompanying drone of the props as they spun up, and the booming sound of fighters taking off on the arifield in front of us, there is no other word but ... surreal.

Earplugs are passed out now, oh my God, we're moving now!  Strange with no windows to look out.  The Marines abaord are young, enthusiasatic and very accomodating, AND I daresay, amused at all of us---scared, excited and with cameras ready to flash - illuminating our path - the first of this great discovery!

I watch with interest at the casual grace and sincere polite manner of these young Marines. They explain what the aircraft is capable of, and help our PR person get into a jump seat so that she can video or take off ---he suggested ear phones so that she could tap into the cockpit and record it all ---my shuffle earbuds worked out nicely (hope the photo turns out, APPLE would love it).

They made us feel so comfortable that soon we went from a quiet, non-moving, frightened group into the same cabin scrambling, webclimbing monkeys they are.  We began to explore and experience...part of the grand discovery!

I smile at us, suddenly so adventurous when a mere hour ago we were worried about having to use the honey bucket (literally a plastic lined Bucket back by the payload..."pee, fling and vaporize".)

About an hour to go...I'm rocking out with my shuffle for awhile, but turn it out as the prop noise has become less an intrusion and more of an invitation.

We're landing now, PayLoad Master gets the crew to tighten the load as we land.  And then, as we are touching down the cargo doors open and the intense air of Bande Ache pours in.

It's Begun.

We're here.

We've done so much, experienced so many new things, and we are not even aboard the Mercy yet ...

   ...and the choppers are coming!

Salsa Dancing on Wednesdays??

Well, I had my first patient last night ... after all the ship and hospital orientation, it was nice to get to work ...I'm on PM's which is great for every reason, except one...we miss out on the MD lectures at 8 pm ... and Salsa dancing on Wednesday! :-)

I really felt like I was working in a MASH unit! While much of their equipment is new, and amazing, it's the little things that are missing that make you laugh, and challenge you to be creative in how you do things. The people here are so grateful for anything that we do for them...even handing them a towel brings a warm smile and grateful gesture.
These people are gracious, and gentle...and amazingly resilient. When I get back you will see some lovely pictures of how they care for each other. One of the wards actually looks like a little camp, and they all help take care of each other.
There's a little boy that we are all still trying to get to smile...and it may work yet. Thanks to you folks who donated money ...the children are enjoying little beachballs, beanie babies, and colorful stickers...and boy do they love crayons!
I am actually working in the ICU, which is mostly adults, but we do have a little 9 month old baby that we are all pulling for.
We are treating people now that have nowhere else to go for their care. The hospital is slowly recovering...SLOWLY...in case you didn't know...all the patients in that hospital and about half the staff were killed in the wave. Clean-up is extensive, and replacement of equipment is a big issue.

The international presence has been impressive. The Australians and Germans have large land based set-ups, and the UN and Red Cross tents are prevalent, especially on the flight line of the airport where we arrived.
We don't know until the night before if we are going to go on land...it all depends on what's needed where. The logisitcs are amazing. All transport of patients and their family is by helio, and those pilots are amazing, strong, gentle and compassionate. (and they have a real sense of humor watching we civilians struggle with jumpseat seatbelts, and marvelling at every little thing they take for granted. But with the patients, they are caring, compassionate, and strong.)

This is a different world out here (on land AND on sea) and the discovery for me is significant. I have become a little more introspective, and lot more patient and grateful for what my life is like. It's a true privilege to be here.
On the lighter side of ship life ... I live in the dark! Our berthing is for 100 people (only that's if all the top berths (3up!) are filled). We all work different shifts, so the lights are off to allow folks to sleep ... The lights come on at 5pm until about 8 or 9... but I'm working then! I've become adept at searching through lockers, and tiptoeing through a labrynth of bunks (trying not to trip on the shoes and duffles on the floor (there are no places to stow your bags if they don't fit in the opening under the lockers).

Haven't hurt myself yet, and have only blinded one person with my flashlight...we were both rounding the corner at the same time ... I think we woke a few folks up with that encounter...but no one knows it was us!
So, that's it for now, got to sign off before the system fails again...I'll have more news about the people as my days and nights continue to unfold. Hard to believe I've only been on board ship for 4 days...with all we have experienced, I feel I have been here a month...so much in so little time!

Donna is on her way

Click on the picture to get a larger version :-)

Donna is on her way
Originally uploaded by geena rn.

"A Great Discovery"

Hi guys!
Just wanted to send a quick I love you to you all! I'll send things to Sandy and he'll forward stuff along, as sometimes it takes awhile for the e-mails to send, and I'm not sure if multiple addresses slow anything down. We need to be careful with what we share with you...military ship and all...but I will still be able to share some great stories anyway. I got my work assignment and I start this evening in ICU. We had a lot of ship orientation, so today is our first Nursing work day. I'll be in the ICU, with nurses from Florida, Colorado, and Indiana. Great people! Fascinating ship, and wonderful people. The Indonesians are as warm, gentle and friendly as I remember when I was here before. Their spirit is amazing.

I'll sign off, now, there are people wiating to use the computers!

Hey, Matt, you were right about the food...not bad...but wrong about the sleeping arrangements ... it's bunks, 3-up and it's a hoot! :-)

As always, check with Sandy as I will be senidng him updates.

Be well, I love and miss you all...but this is a GREAT DISCOVERY (as Sandy calls it)

Love, Donna
p.s. I'm learning lots of military terms...right now, muster is one of my favorites!

And from an email she sent to Sandy:



I start my shift tonight (on PM's!!! Hurrah!) [Ed: PM's Rules!!] The nurses I will be working with are awesome, and so is our Lt. Commander in charge of our unit. It is not very busy now, but there are interesting patients, and new equipment to learn. I have lots of photos, but the system is so slow I don't think it will get through. I'll try later, just in case. The Flight from Singapore to the ship was amazing, details to follow. We flew over the beach where the wave hit ...positively sobering. I know I am here to work, but I am having a great time, meeting people, and learning alot about how Hope and Mercy are working together.

We really are a prototype for the future, and I am so excited about it. Also, I am developing a very deep respect and gratitude for the military personnel we have encountered. Very dedicated people, and motivated. I particulalry enjoyed the marines that flew us in ... One reminded me of the young kid in "The Rock" that stayed with the Sean Connery character and protected him during the shoot-out in the mens shower room.

This Discovery is truly life altering and uplifting. I am learning so much ---and appreciate so much of what we have! By the way...wait until you see the photos of our bunks/dorm...hilarious...but it works. When I'm laying down I have about 12 inches above me...but it works! We have to do everything in the dark because so many different shifts are sleeping in there...I'm glad for all my flashlights!

She has arrived safe and sound!

As of February 28th, from Sandy:

I just got a call from Donna in Singapore, 0300 their time. Trip was great. Beat from 20+ hours of travel. Group has more Doc's than RN's. Her bag is not the largest. They will get up at 0500 for a tarmac arival at 0700 to board a C5 for a 0900 depart. They will hilo onto the ship from some where on the coast of Indo. No photos can be taken per the Sing. Gov. I will pass on what ever I get.


And from today:

I talked to Donna last night via ship phone. They get charged the same as from San Diego to here on their phone time. She will try and get onto a computer and give everyone an update. She sounds great, very happy and doing what she really wants. They have the Nurses and Docs in the same dorm area. Shades of Berkley. They stack'em three high but are using the middle and lower bunks only, someone fell out. After this tour the ship will go to San Diego. They are taking a Lottery on who will go ashore and who stays on the ship. Everyone wants to go ashore. That is where the most action is.

Donna will finish her orientation today. She said the military ride in was a Hoot. A real "E" coupon ride, web belt seating and strapped in. The military guys all want to be "Jet jockeys" and fly the transports like same. She already has some great stories to tell. This is a blast.

-Posted by your field correspondent, Geena :-)

The Day-Before-Jitters

Well,
It's the day before jitters!  I packed yesterday so that I wouldn't have to face that daunting task today, and so that Simba (our dog) wouldn't get too depressed seeing it out!

Today I've been running around getting phone cards activated, and getting emergency numbers all together for my husband, and rechecking all my lists for the millionth time!

I just found out that after 20 hours of flight time into Singapore, and a brief overnight rest, all 40 of us will  be transported to the deck of the Mercy via US Naval helicopter transport ... you know, one of those BIG choppers!!!!  Now, if that won't be a sight to behold I don't know what is.  YEE_HA!

And so, the adventure is about to begin! The people at Project HOPE have been outstanding in their support, enthusiasm and encouragement--they do great deeds everyday!

To all my family and friends, Thanks for your words of support, encouragement and humor ... and yes, Cathy, if the "Wild Thing" logo is still on the Mercy, I'll get a photo by it!!!!

Next missive should be from aboard the USNS Mercy!  I hope I will have access to the internet frequently...just know I'm thinking of you all, and will update you on our work and Mission as often as possible.

Anchors Away!!!

(ps I'm developing a relationship with the webmaster on the Mercy, so maybe I'll get on "his computer" on a farily frequent basis...we'll see!)

Before I "deploy"

Hey all!
Thanks for all the wonderful words of encouragement, it means a lot. As the day of my departure (deployment in Navy terms!) approaches, I am getting more excited and NERVOUS ...so those words really help. I'm spending as much time with Sandy as I can this week, it will be hard to leave him, but I know family and friends will be around for him.

Many have asked if I will be able to post photos while I am gone. I am not sure ... security is pretty type on-baord the ship, so I don't know if I will be able to download photos or not. But I will certainly do so when I get back!

More to come, before my adventure begins. Thanks!

Tsunami HOPE

When I was about 10 years old, I had a wonderful experience that has stayed with me all these years.

It was the day it snowed in my hometown - unheard of in over 50 years!!! While that, in and of itself, is momentous and certainly memorable for a 10 year old, it was what happened later that day that begins this tale of synergy!

My grandmother and aunt (who was a nurse at the time) took my sister and me into San Francisco for a tour of a magnificent, huge ship in dock and open for public tours. It was the Good Ship Hope, a hospital ship that travelled around the world caring for people in underdevopled countries, and providing medical training and supplies.

I remember how amazed I was at the size of the ship, and the captivating photos of the children that had been patients on that ship...many of them younger than me! It was a profoundly moving experience that I still recall frequently.

Now, years later, with my life changed as a Registered Nurse, my husband and I were compelled to find a way I could help with the tsunami relief effort. After much research and applications to different organizations, I came across a beautiful memory from my past. Project Hope!

Yes, Project Hope is still circling the globe with humanitarian aid, medical attention, and teaching--only the ship itself is USNS-Mercy. Memories flooded back, and I knew that this was where I had to be. It's taken a lot of effort, and communication, as well as support and encouragement from my husband to announce
I AM GOING TO INDONESIA WITH PROJECT HOPE for a tour of duty as a Critical Care Nurse on the hospital ship USNS-Mercy.

The synergy of this leaves me in awe. I am so grateful for this opportunity to give back to the world community, I am so grateful for the sacrifice Sandy is making; and I am so sure that this is the place I am meant to be...my childhood dream bringing hope to people awakening from a nightmare.

I'll try to update this blog while onboard ship -- not sure how often I will have access to internet computers, but I believe this will be my main source of communcation with "the outside world".

Thanks for sharing my excitement!
Donna :-)