I updated the pictures on my Yahoo album. You should check them out.
Here I sit writing my latest journal in the doctor’s office of the Bethesda Clinic in Xocempich, Mexico. I pull up my sleeves to allow more of the breeze from the perfectly directed fan to cool off my ever-sweaty skin and rest my left foot on the worn and rickety leather chair so as to support my elbow with my knee. A fly buzzes close to my face and is knocked to the wall nearby. I run my upper teeth over my bottom lip, thinking, pondering, processing the activities of the last couple of days. I prepare to type and idly scratch one of many red and swollen mosquito bites on my ankle from the last week. All of this occurred in the same chair in which I sat not a half hour ago writing and signing medication orders. Are you surprised? After all, I have only one year left of nursing school before taking the NCLEX and (hopefully) receiving my RN certification. What could possibly prevent me from writing medication orders??
Perhaps I should explain myself…
Every Thursday at noon Dr. Frederico Estrella (the son) returns to Merida with his family for the weekend and Dr. Jose Estrella (the father and founder of the clinic) returns from his ranchero and takes over. Today, things did not quite go as planned. There was a lot of miscommunication and Dr. Jose Estrella went to Cancun and told his son but his son failed to inform us of the schedule change. Two patients arrived in the early afternoon and we told them to wait. We again told them to wait an hour later, and an hour later, and an hour later, until we decided we should call the doctor and find out where he is. We called his cell phone and could not get through because he was out of a service area. In this area, that can mean many things including he is on his way back and between towns or having dinner with a family friend. We then called Dr. Frederico who directed us to either ask the patients to return tomorrow or allow the nurses, meaning Lina and I, to do an assessment and call him with the results he would give us medication orders over the phone. They elected to stay because of how far they travelled to reach the clinic in the first place.
Lina asked the first question of why the patient came to see the doctor. The patient responded that she was having difficulty eating and drinking due to a paralysis on the left side of her face. A lightbulb immediately lit up in my brain illuminating the medical diagnosis “Bell’s Palsy” and I looked at Lina. She clearly had no idea what the paralysis meant and did not recognize my attempt to “Spanishize” the term so I began asking the patient questions as per my nursing training. I also did a neurological, kidney, and liver assessment in response to specific patient complaints. We then called the doctor back who had me ask the patient a couple more questions. He confirmed my suspicion of Bell’s Palsy and then instructed me in what medications she needed and even described three facial exercises to teach the patient. How exhilarating! I am technically not allowed to make medical diagnosis but what an amazing experience to have my first attempt correct!! I took the orders over the phone, instructed the patient on her diagnosis, the proper use and rationale for each medication, and the three different facial exercises. Demonstrating the faces the patient was supposed to practice three times a day for 10-15 minutes had everyone in the room doubling over with laughter. It was a nice stress breaker after the assessments and occasional confusion requiring translation of Spanish into Nahuatl by Lina.
After the visit was over and the patient went to fill her prescription Lina and I burst into fits of giggles from all the tension. We merrily made our way to eat dinner nearly an hour late telling the story to another student who was passing by. After I had finished eating Lina suddenly looked at me and asked if I had signed the medication receipt. My jaw dropped and I jumped out of my chair hurrying to catch the patient before she left. It had never occurred to me at the time. After all, since when does a nursing student sign a medication receipt!! It was definitely a strange sensation signing my name and title of NNS (Northwest [University] Nursing Student) on such a valuable and inquiry ridden document.
Other than my first experience with a medical diagnosis I have seen another birth and two C-sections. I have also taken a larger role in patient care and done some hands-on teaching with the girls. I have been reading the textbooks the girls use but they have only left me feeling empty and hungry for more so I began searching for a RN maternity textbook hoping that Femia had bought one to keep herself appraised of new information. Lo and behold I found a maternity/infant textbook for RN nurses and it is even in English! Just to clarify, I do not have a problem understanding Spanish textbooks, they are much easier to understand than the spoken form, but it still makes for slower reading. I am now learning a bit more about the anatomy, physiology, and medications surrounding birth and infancy. Beyond the immediate value as I continually work with new mothers I hope to make my next year of nursing school easier by studying as much as I can over the summer.
In other news, we had our first volleyball practice yesterday! The doctor bought us a new net and ball to practice with and ordered that every student not working in the clinic in the afternoons was required to attend practice. I think they will catch on quickly. Hopefully, some donated materials from my old volleyball coach will arrive without delay so our practices will be more efficient. I have found one of the most difficult issues to deal with in a clinic is the unpredictability. If there was nothing to distract us I would be teaching English in the mornings, music theory, voice, and volleyball in the afternoons. Unfortunately, there is yet to be two days in a row where more than one of them are accomplished.
Upon further contemplation and prayer about the issues brought up in the last journal I was reminded of the rules to which I am subject at my own school. Some of the many rules seem unnecessary and overbearing on a group of young adults but, unfortunately, every one of those seemingly “authoritarian” rules has a specific rationale. Many rules have been created over time which now plague the many honest and God-fearing Christians on my campus all due to a few students’ inappropriate behaviour at some point. The rationales at this nursing school are virtually identical. One of the reasons for such innate and detailed requirements revolves around the fact that this group of young adults will be living here for two years and certain standards must be met.
As far as the authority issues, I have decided to talk with Femia, the nurse in charge and my immediate authority, and verify with her my roles and responsibilities. I intend to bring up my situation as both friend and authority to the girls in an attempt to inform her that I see certain rules are being broken and that I feel stuck in a conundrum. This approach will hopefully help her realize that I do not want to be authoritarian with the girls but a Christian example of love and proper obedience to authority so they can observe the numerous benefits of such decisions rather than only experiencing rules as authoritarian pressure to dictate every part of life. This, when taken to the extreme, only fosters resentment and a backlash of inappropriate behaviour when the person is free from the regime. I view my relationship with the girls as one of guidance, not discipline. That is the responsibility of Femia and Dr. Estrella. I only hope and pray they feel the same way.
Prayer:
For a 19 year old girl who may lose her second ovary to a very large cyst and awaits her results regarding a cancer diagnosis. She will be having laparoscopic surgery here early next week to remove the cyst. Again, the thought of never having children is a great concern to her.
For my impending conversation with Femia about my role and responsibilities.
For the girls’ understanding of the Old Testament laws and narratives. We will be doing some history review to better understand what Jesus meant when he talked to the Pharisees and why he spoke to them in the manner he did.
Praise:
The girls, though still not completely reliable about bringing their Bibles, are actively participating in devotionals, bringing up sections they think are important and asking questions which is why we are doing a history review!
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