last days of work!

May 20, 2010

I've spent the last 2 days at the hospital. Yesterday Katie, Scottie and I were all on together which was fun!! We ended up having a full house in the ICU before we left last night. We sent a couple kids to the floor, but were over flowing unto a room across the hall for the ICU! Camilla, our little BT shunt, from last week finally made it out of here! She is feeding much better and looked great! Also the little girl who we thought needed a BT shunt but really didn't haha went out. She was sooo adorable before she left, just laying around with her big eyes open wide! Bogdyn, the little VSD boy who coded on Tuesday was obviously still here. We actually extubated him around 2pm on Thursday and he looks wonderful. Doesn't look like the downtime affected him at all. They re-echoed him and said his function is maybe a little bit better, but he possibly had some underlying cardiomyopathy, non compaction of his LV. Maybe this explains why he is so touchy. There was also a really cute little 5 year old who had a complete AV canal repair. She was previous. She just sat around all day and had her eyes glued to her portable DVD player that her Dad brought for her. She didn't like me very much when I went to take her IJ out later in the afternoon, but she didn't hold a grudge for too long. Another little boy, a partial AV canal repair from Wednesday was soooo fussy all day long and very uncomfortable. Then later in the day he started looking bad. We think he just has the normal Down's floppy airway and sounds pretty obstructed. We restarted his Milrinone and are keeping a close eye on him. It's crazy because at home we would probably be getting frequent gases on him and possibly be on CPAP or at least high flow, but here we can't do any of that! We actually only have about 7 istat cartridges left for the whole trip! Chris did a big surgery on a 29 year old man today. He had a 7cm ascending aortic aneurysm!! We placed a graft. Katie and I went up to the gallery to watch and couldn't believe how big the graft was. Swee showed us a picture of the aneurism later and it was HUGE! He is lucky to be alive! There is also a cute little girl who is PA with MAPCAS who went to the cath lab to have a stent placed. Her sats were in the 60s before and she looked bluer than a blueberry! She still looks pretty blue but at least her sats are up to the 70s and 80s now! The first pediatric case yesterday was a kid with a CoArc and a PDA ligation. He did awesome and was extubated about 30 minutes after he got back. The second case was a cute little blond haired boy who got his ASD closed. He was pretty sleepy so was still intubated when we left last night.

Last night a bunch of us went to this restaurant near the hotel that is a wine bar and has sushi. The sushi was really good, but the service was less than desirable. People only got about half there food and when they asked where it was they got the response that they were out, haha. After dinner Katie and I went to bed pretty early, we were very tired!!

This morning Katie got up super early (5AM) and went back to take a dip in the natural spring with Chris. When I woke up around 7 she was pretty much shivering in bed and got up to dry her hair she was so cold haha. I might actually break down and get in the spring tomorrow…we will see. Today I worked with Caroline and Frank. We spent the morning getting a few kids to the floor. The complete AV canal walked to the floor right while we were getting report. She had been ready to go and was just waiting for a bed. Then we took the chest drains out of the cases from yesterday, the CoArc and ASD, and they both went to the floor as well. Danya, the little ASD, was the most precious thing. He is apparently an orphan and right now had been at the local children's hospital. You can tell that all he wants is someone to love him. He just wanted you to pick him up and he held on for dear life. He just curled up to you and grabbed on to your shirt with his tiny little hands. I wish that someone could take him home and love him. The first case of the day was Alex's (surgeon/doctor from here) little girl. She is 7 months old and had her very large PDA closed. She did awesome and was to the floor by the end of the afternoon. The second case was a little down's girl who had her VSD closed and her PDA ligated. She was apparently in JET in the OR, and was really tachycardic when she got to us but could see P waves. She was also really sleepy so didn't get extubated until we were about to leave around 8. The 3rd case was an ASD that wasn't back from the OR yet when we left. When we were getting ready to get on the bus, Alex (Sasha), who's little girl had surgery earlier called us all in the breakroom. He had gotten a nice spread of food and brandy/whiskey for everyone. It is a tradition to buy expensive liquor and food at a life changing event like a birth. He gave a really nice toast talking about how he would remember this day for the rest of his life. He talked about how this really reinforced how important the work we do together is and how many lives its changing. It was really cool that we could help one of the people that we were working with here.

After leaving the hospital with a few drinks in our system we thought it was a good idea to get some food!! Katie was working with Frank tonight, but everyone else went to La Strada, the pizza place down the street. It was sooooooo good. Scottie and I shared a caprese salad, margherita pizza, and some pesto pasta. Sergey ordered us some Ukranian wine which was pretty good! It was his last night with us :( After dinner we all hung out on our floor and had some snacks and wine/vodka. Then Scottie let me download this cd that him and Katie bought at the metro stop. It was an mp3 cd of 200 songs which they thought were russian but were actually all english haha.

So overall it was a really good last 2 days of work. It is sort of bittersweet to be done. The celebration with Alex was a good way to end our last work day! Tomorrow we will all be going out to a Georgian restaraunt with the staff from the hospital.

we are true kharkivites

May 18, 2010

Katie worked yesterday and I was on night shift so I spent the day just exploring a little on my own. I slept in until about 11 which was much needed! Then I decided to just go for a walk and wander around the city until I found somewhere I wanted to chill out and read my book. I ended up walking back to where all the old churches are and found a spot near the gorgeous fountains overlooking some churches. I pretty much just spent the afternoon reading and doing some intense people watching in the beautiful weather. There are always so many people around here. You can tell it is definitely not normal to just sit at home. Everyone is always walking around and looks like just enjoying life. Sitting in near the park you could smell the bread that was being made at the monastery nearby. Smells yummy…I'll have to try it before we leave. After relaxing at the hotel and getting ready for work, Caroline and I walked down the street and got a bite to eat at La Strada which is one of the italian restaurants I went to last week. It was very good and the service there is better than anywhere we have been. You can definitely tell the service industry is a lot different than at home. Going out to eat is not meant to be a quick thing. They just bring the food out as it's ready and they don't check on your table regularly. You have to sort of flag the waiter down if you are wanting anything. And if you are ready for the bill you have to tell them, otherwise you would sit there for hours. And forgot about free refills. All the drinks are sold in bottles, even water. The US is the only place that has fountain drinks I think, haha, and free water!

Work last night was pretty good. Camilla, the BT shunt from last Thursday, is still there and doing pretty well. Just monitoring her still because she has had an iffy couple of days and may possibly need a couple more days of milrinone. She looked good throughout our shift though and will hopefully be going to the ward tomorrow or thursday. Katie already mentioned a few of the other patients. There was one adorable little girl named Tatiana, who is 4 years old and had her PDA ligated. She has these big blue eyes that just melt your heart! I have a softspot for the name because the main character in my favorite book, The Bronze Horsemen, is named Tatiana. She was sorta whiney, but you didn't really care because she was so cute. Another new patient was a little 5 month old TET who they planned on doing a BT shunt, then got in there and realized her PDA is pretty large, so they just closed her back up. I guess she had a rocky first few hours postop, but we extubated her around 9pm and she flew the rest of the night. There was also a little boy who was going to be a complete TET repair, but ended up only closing his VSD. He has a pretty chronic history of hydrocephalus and recently being in the ICU at the Children's Hospital for pneumonia. He was doing well when we left this morning, but we just talked to Chris, the surgeon, and he told us that he aspirated and arrested this afternoon. Apparently he had about a 15 minute downtime. Poor guy :( Like he hasn't had a rough enough time already! I'm anxious to see how he is doing in the morning.

Worked with Alex and Svetlana last night….Alex and Scottie bonded over Michael Jackson and grape Ukranian gum, haha. Scottie also spent a little time being a nurse last night while he was a gentleman and let Caroline and I take a nap, haha. That's right people…I said it, a nap at work. Apparently in UK and all over Europe it is common practice to take short naps at work. Caroline told us there are actually studies that say people working night shift do their best when they can get a little sleep. It was a little weird for me to actually fall asleep while working!! But I won't lie…it was kinda nice.

This morning we came back to the hotel and as soon as I knocked on the door for Katie to let me in she threw the door open and was already ready with her suit on. This meant that we were for sure going to the natural spring haha. So after having a little breakfast we made the trek over to the botanical garden. Katie, Scottie and Caroline were all very adventurous and dunked themselves in the spring. I on the other hand chose not to torture myself in freezing cold water. So I documented this little adventure by videoing Katie and trying to capture the painful faces everyone was making as soon as they hit the water!

Slept for a couple hours, not too long though because we only have a few days left here :( Then Scottie, Katie and I spent the day being true Kharkivites! We basically just got on the metro and went to the farthest away and some random stops and got out and explored. We ended up at a train station….in the probably ghetto…and then at a ginormous futbol stadium! At the stadium we had a nice lunch. While at lunch we glanced at the map we had with us and saw a little clipart of this seal holding a ball on its nose. We thought it might stand for the circus (keep in mind we can't really read the map because it's in Russian). This sounded interesting so we hopped on the Metro and went in search of Ukraine's version of the Ringling Brothers :) We ended up back in the Old City and near the flea market. We found a really nice old couple to ask directions to. Bless their hearts, the tried so hard to tell us how to get there and for such a huge language barrier they did a good job. After wandering around for awhile and stopping at an egg to check directions (no joke) we saw the circus in the distance. Even though when we got there we discovered that there wasn't a show until Saturday after we are gone, the satisfaction of actually finding the circus was enough for us. And along the way we pretty much saw the entire city!! After patting ourselves on the back for our superior navigation skills we walked to the park to get a drink and hang out. On the way we saw some kids goofing off at a skate park, breakdancers, and get ready for this…..Ukranian Karoake. I have been asking people all week if there is a karaoke bar and no one knew of any. And here we are walking through the park and just happen across a guy with a karaoke machine, charging 10 gryffindors per song. So you better believe we took advantage of it. Scottie did a smashing version of Great Balls of Fire and everyone loved him. People were dancing clapping and having a good old time. This old lady was loving him. Keep in mind that she had performed about 3 songs herself before we took the spotlight. Since Scottie was so brave and went first, Katie and I decided we couldn't pass up the change to do karaoke in a park in Ukraine. So we dragged Scottie up there with us for Sweet Caroline. Basically we are both awful singers and didn't have near as much crowd support as Scottie :( It was the most hilarious experience ever!! We were starting to get hungry so went in search of the Ukranian restaurant a lot of people went to last week, but Scottie and I missed out on cause we were at work. Katie was our navigator and after a few wrong turns we found it!! It was the best restaurant!!! We ordered soooooo much food and just all shared stuff. It was all authentic Ukrainian cuisine and our waiter helped us order. They had these outdoor tables and they even gave you blankets to wrap around yourselves if you got cold!! We all had appetizers, soup, salad, entrees, wine, and dessert and the whole bill came out to a total of an equivalent to $58. I mean this meal was so nice that it probably would have been at least $250 at home, no joke. Now our bellies are full and we are hanging out in the lobby of the hotel before we get some shuteye before our shift tomorrow. Scottie, Katie and I are all on the same shift…watch out :)

katie's life as an RT

May 14 and May 17

Time goes by so fast here and it seems we are always getting into something. Therefore, I have a little bit of catch-up to do on the old blog. Lindsey reminds me every day ;) I have 2 shifts at the hospital to catch you up on. I worked Friday (night shift) with Michelle. She is a really cool girl from Canada…not to mention a great nurse! We of course worked with Alex and Svetlana who always seem to work every night shift. Some how, (probably because I'm the youngest person here) a couple of the Ukrainian doctors have decided that they need to play matchmaker between Alex and I. Let me remind you Alex is an 18 year old nurse. He also wears a white lab coat unbuttoned half way with no under shift…sooooo basically my dream guy haha. I can't quite convince them that I'm too old for him so they make little comments (I don't speak Russian or Ukrainian but I'm capable of interpreting conversations in which both our names are mentioned multiple times haha). Today I got "You two can suction the patient TOGETHER" haha. Lindsey and Scottie eat it up! :) Anyways, it was a busy night at the beginning of the shift which gradually calmed down. I got to practice my extubation skills on 3 patients. Very cool to get in on all the action. I loved it and maybe got a little greedy trying to extubate everyone haha. One of the patients was a little girl around 4 that got a cath. Normally, she would not have come back to the ICU but she was still intubated (she was my first extubation :) ). She was the sweetest girl ever! She was very wild immediately after cath but once she was back to being herself she was very calm and sweet. She would politely wave me over when she wanted something. I gave her a coloring book and some stickers and she loved them. She had an uneventful night. The next patient was a 17 year old girl that had a fistula repaired. She apparently also had a cath at some point because she had the biggest hematoma I have ever seen! IT was from her groin to her knee! An ultrasound was done on it today to make sure everything looked ok. She was also very sweet. She didn't speak much english but she told me I was a "very good girl" before I left…heart warming :) Besides some emesis episodes her night was also steady. The little BT shunt pt. kept us a lot busier. She needed a few boluses along with tweaking of some meds. She didn't look good most of the night but she has been a trooper. During my day shift today she progressed nicely after we got some fluid off of her and looked the best I've seen her yet. I think she will do fine. Her mother is so cute. She sits by her side for hours watching her every move. She is very nervous. It is hard not being able to comfort your patients and families as thoroughly as normal…a thumbs up and a smile only do so much I'm sure. Another patient we had was named Elina, a PDA ligation with down's syndrome. She was the cutest thing ever! We got to extubate her as well! She did well all night and made the cutest facial expressions. She did get grumpy from time to time but when she got upset her mom would appear out of the woodwork and start breastfeeding. She calmed right down everytime haha :) The last patient Friday night was a 24 year old girl named Natasha. The surgeons did an Aortic Valve replacement on her. She was extubated soon after coming up from the OR and did well all night. She also spoke a little english and was super sweet.

Today, I worked day shift with Bonnie! Very awesome nurse from Dallas, TX. We had a steady flow of patients from the OR throughout the day so we stayed busy. We started off the day with the little BT shunt and the man that got a cabbage done so we were excited to get more patients. Today was also a great day to extubate! The first case was a pink Tet named Gobdyn (not sure that's right) who was supposed to receive a full repair. But, once in the OR he only needed his ASD closed. He also had some pulmonary Hypertension issues and hydrocephalus. He did well in the OR and because they were able to finish his case more quickly than expected they threw a third patient on the OR schedule. Post-op he was doing well when we left. The second case was a PDA ligation on a little girl name Niculina ( I think). She was also adorable of course. We extubated her as soon as she woke up. Shortly after extubation when she started to wake up more her mother brought in this training toliet and started to put her on it. The girl had a foley catheter and I couldn't believe she had to poop so of course being the expert translator that I am I asked the woman if she had to "fart noise" haha. She of course understood me bc like I said I'm an expert and she said she knew the girl had a catheter but she thought she had to poop. SHE SPOKE ENGLISH! haha. Scottie Day was cracking up and tried to tape me asking her with my sweet skills! The last patient of the day was a 4 month old little girl who they thought also needed a shunt. However, once they opened her up through a thoracotomy incision they discovered she had a very large PDA and decided not to place a shunt and to simply close her back up. (It might seem odd that the defects weren't exactly what was anticipated before the surgeons began but their echo machines are a lot older than ours and it is much more difficult to get a clear image.) She came back a little sick requiring some blood & fluid boluses and remained intubated when we finished our shift. It was very odd that she was so sick because she didn't have anything done. She started to warm up towards the end of our shift and I think she'll do better extubated. I think she'll bounce back. Lindsey and Caroline are on tonight so they will take great care of her. We have been blessed with some of the cutest patients and nicest parents. The people of Ukraine are very nice in general but the patients/families are extremely grateful. Natasha the 24 year old called the team "The doctor's with the golden hands." The local staff is also a blast to work with. I brought my cardiac defects manual and flip cards from the unit and they love them! We are definitely teaching them but they are teaching us a lot as well. Welp, I better get to bed…I have big plans of dunking myself in the spring with the locals in the morning! :)

-Katie

extreme temperatures

May 17, 2010

Yesterday was an amazing day. I truly experienced some things that I never imagined that I would! We slept in which was nice and then walked around town and had lunch at an outdoor sports bar that had sushi, yum :) Igor, the director at the hospital had something fun planned for us in the afternoon, a traditional Russian banya. So we all got our suits on and waited down in the lobby not really knowing what to expect. We drove back in an old ukrainian neighborhood, down a dirt road with tons of potholes. Through my mind I was like "where are we going." We pulled into a parking lot with a big building that almost looked like a lodge from the outside built with logs. We walked in and it was only us there, Igor had rented the entire place just for our group. There was a big room with a huge table and couch and foosball! This room was where they kept the snacks and vodka and you could hang out here in between going to the sauna and dunking yourself in the pool. That's right I said sauna!! The sauna was 95 Celcius which is soooooo hot, basically like 200 Farenheit. I never imagined sitting anywhere so hot. It was what I imagine an indian sweat lodge to feel like. You sat in there for about 30 seconds before you started pouring sweat. They even gave you these caps to wear on your heads so that your hair didn't burn you where it got so hot. When you couldn't take the heat anymore there was an indoor and an outdoor plunge pool to go jump in. It was VERY cold water but felt amazing. The contrast between the heat of the sauna and the freezing temp of the pool was unbelievable. After going back and forth between the sauna and the pool for awhile a few guys that worked there came into the "lodge" with big baskets of oak leaves all tied together. This was for our massages!! One by one they took us in the sauna and had us lie on our stomachs with our head lying on a pillow of wet oak leaves. They also put another branch of leaves on our faces so we could breath in the scent and to keep us cooler. Then they proceeded to give us a type of massage using the branches. It felt amazing. They would keep dunking the branches and then basically beat you with them, haha, but it felt really good!! Then they had you go jump in the outdoor plunge pool. Then you went and sat in the sauna for about 5 more minutes before the 2nd part of your treatment. They had a massage table set up in the room with the indoor plunge pool where they gave us massages and exfoliated our skin with this sand mixture. It was awesome!!!!! After they had completely covered your body in sand you sat in the sauna for awhile longer before rinsing yourself off in the shower. Our skin felt soooooo soft afterwards. I never thought I would be getting a massage with leaves and sand by a big russian man wearing a speedo, haha. It was for sure a crazy cultural experience that I would never have had just traveling on my own. So basically we spent an afternoon of being pampered, eating dried squid and pistachios, and drinking vodka and wine :) It was glorious and so nice of Igor to treat us! On the way back to the hotel we all stopped at the English Pub (surprise surprise) and had some dinner. Everyone was exhausted after a long day of sweating.

work hard, play hard

May 16, 2010

Yesterday was a really great day!! Like I said before we have the weekend off from the hospital which is a great opportunity to see the city! Caroline and Frank went to the hospital to check on our one patient still left in the ICU (the BT shunt) and they said everything looks great! About 7 of us decided to go out and walk around the old city and try and go back to the market that was closed when Scottie and I walked there before. On our way we saw this restaurant that Alex (the 18 year old nurse) had told us about, so decided to stop in and have some lunch. It was kind of like a self service line so we could actually see what we were getting. They pretty much had any type of Ukranian food we could want. I got some sort of chicken and vegetables and then Katie and I split perogies, yum. It was a really neat restaurant, very authentic. We stopped back by the monastery so we could go in and take a look. This time we came prepared with scarves to wear over our heads. The inside was gorgeous and decorated with alot of gold, couldn't take pics in there though. Then we walked through the little outdoor park with the gorgeous views again where they sold the paintings and matrishka dolls (sp?). It was a lot more crowded with people today and there was even a little string band playing. I love hearing live music outside like that! At this point the sky was threatening rain so we tried to hurry across the river and make it to the market in time. When we finally got there they were starting to close up the outside stands but we went inside and it was soooo cool. It was a big meat and fruit/vegetable market. There were these ladies selling meat that were so happy and all they wanted was us to take there pictures haha. You wouldn't believe the type of meats they had in there…they had whole pig heads, cows hearts and lungs, and some sort of kidneys. They also had tons of fruit, so I bought an avocado to eat when it ripens later in the week. It was really a cool experience walking through the market, it was so different than anything we have at home. After we left the market it was definitely starting to rain so we decided to take the metro to a stop near this park we wanted to go to and find a cafe to wait out the rain. We found this really cool cafe with really comfy chairs and wonderful lattes :) It was all like hot pink in there, really funny. Scottie was trying to figure out how to order some sort of fruity drink so the waitress just made one she thought he would like and gave it to him. It was lit on fire hahaha. He said it was pretty good though we aren't sure what was in it. After we were done at the cafe it was perfect timing because it had stopped raining. We walked on to the park through what I am guessing was their fashion district because there were a lot of clothing stores. The park is called Gorsky park and it is also soooo kid friendly, just like the park near Freedom Square. There are carnival rides, games, cars, and much much more. We walked through the park for a while and then came to the purpose of our journey….the cable cars. I guess some people call them gandalas which I thought was just a boat on a river, haha. We all paid the equivalent of about $2 to ride on the cable car from this park to the botanical garden near our hotel. It was some really pretty views and a whole lot of fun. The baskets that we rode in were pretty small and a little bit scary. Dr.D even rode and he is scared of heights! It was definitely a cool experience. When we arrived at the botanical garden we walked down to the natural springs for the people that hadn't seen them yet. We decided to put our feet in just to see how cold it was. IT WAS COLD!!! My feet felt like they had pins poking in them our whole walk back to the hotel. I won't be dunking myself in there I don't think. Katie is still bound and determined to do it, so we will see haha. For dinner last night we went to a pizza place down the street and then to good old McDonalds for dessert haha. So overall we had a really good day of getting to know the city and sightseeing. It is nice having some time off, but I am anxious to get back to work on Monday.

barefoot in the OR...

May 15, 2010

I think the last place I had left off, Scottie and I had spent the day exploring the city. That night a few of us went to the english pub down the street which is apparently our new favorite hangout. Afterwards I went to bed early because I had to work day shift the next morning. I know weird right...when is the last time I have worked that early in the morning, haha.

Friday actually went relatively fast at the hospital. A little one month old baby girl occupied most of our time in the morning. She is a DORV with TET like physiology who got a BT shunt on Thursday evening. She looked awful when we got there!! She was super dusky and pale and freezing cold. She was also having pretty low pressures and her gas was 7.1 with a CO2 or 27 and a BE of -19!! We came to the conclusion that her shunt was probably working a little too well!! So we restarted her Epi for awhile and started her on some Milrinone, gave her some fluid and blood, paralyzed and sedated her, and increased her PEEP on the vent. After awhile she was doing much better, still a nasty color but slowly improving. Her poor mom was so sweet. Every time she came in to see her she would have tears just rolling down her face. I wish I could have talked to her, but the language barrier makes it so hard. I tried to do what I could to make her feel better, but it didn't feel like enough. You can tell that making family feel comfortable is not a priority here in the hospital. At home we would be talking her through what was going on with her child, but here it seems like they are pretty much kept in the dark.

Another patient on Friday was a 24 year old girl named Natalie who had an aortic valve replacement on Thursday. She was really sweet and spoke pretty good english. She was talking to me and Scottie and started crying when she was talking about her kid (or so we thought). Towards the end of the conversation we figured out she was actually talking about how she missed her orange and red cat, haha. Her and Julia both went to the floor otherwise known as "the ward." Yay Julia, I will miss taking care of her, she was soooo sweet and adorable. I am glad she is doing so well though!

The lunch they feed you at the hospital is sooo good. The cook is this old lady who will make you eat, I dont care if you want to or not haha. We had Ukranian Borscht which is a type of soup and sooo good. They had fresh sour cream you added to it and these pancakes that were to die for. They were so good we even came back later and had some with our tea.

The first case Friday was an older man who got a triple bipass. Luckily we weren't in charge of taking care of him cause that is a little out of my comfort zone, haha. Chris Gilbert, the surgeon who is with us likes to do one adult surgery each trip. At the same time this case was going on, Olga the surgeon from here performed a PDA ligation on a cute little 6 month old Down's kid. She came back still intubated and while they were assessing to see whether she was ready to extubate they just unhooked her ETT from the vent and just left it flopping in the breeze, basically using it as an oral airway....weird!! When it came time to extubate I got to do it!! So cool :) Igor, basically the director of the cardiac program here in Kharkiv did a cath on a 5 year old complete AV canal who previously had her PA's banded. They thought they saw some left ventricular disfunction and that it looked a little small on echo so they were cathing to check everything out. They decided that she looked good and was ready for her complete repair which will be one of our cases for next Tuesday. The last surgery was a 17 year old who had a sinus valsalva fistula. They repaired this and closed her PFO. When coming off pump they thought they heard a thrill and because they don't have a TEE here they went back on pump just to look around and make sure she didn't have a VSD or something else. Sergei the anesthesiologist who is from Belarus but now lives in Canada was telling us about this and was saying since they don't have a TEE here they have to go by just their eyes and hands. Everything looked fine and she came off pump easily!! During this case I went up to the gallery and got to watch some. It was funny seeing an OR with the doors just hanging wide open and the scrub nurse was barefoot!!! So all in all it was a successful and pretty busy day! We even got to buy icecream for some of our patients that are now on the ward...they are so cute :)

After coming back from the hospital a bunch of us went back to the English pub for dinner. I had a really good meal of grilled chicken with pineapple and vegetables, sort of like a stir fry. Everyone ordered some vodka and I figured I should try it since that is the thing to do here. I normally hate vodka but it was actually pretty smooth. Eugene, the intensivist from Minsk was leaving this morning so we all had to say goodbye to him after dinner! I found out that he actually came to Cincinnati for a month back in 2004 and spent 3 weeks as a visiting physician with Dave Nelson! I will have to ask Dave if he remembers him! When we got back from dinner everyone went down to the bar in the hotel, called the Gold Lion. I was tooo sleepy so I just went up to bed and slept like a rock until morning! Katie, Scottie, and Michelle all got back from the hospital around 9 am so I got up and ate breakfast with them. We have the weekend off to explore so when they wake up in a couple hours we are going to do just that! I think we might even take a gandala ride...no joke.

-Lindsey

May 13, 2010

As Lindsey stated in the last post we have spent a little time apart so this post is an update on my day and a half or so. Luckily after a lazy day with bad weather and dashed hopes of dunking myself in the local spring I was able to have a fun outing with the group. We went to an authentic Ukrainian restaurant. It was very interesting! Most interesting of all was the stories told by my new favorite person…Arthur. Arthur is an anesthesiologist in his 60s or 70s that has lived! I mean really really lived!!!! I hope someday I can have half as many cool stories as this guy. We were instant pals (well at least I think so haha) because we both have a love of the Masai people. Arthur spent some time with them and we both had stories to swap. Mine was my well known (at least to my family/friends) wedding proposal/free pass not to build our dung hut by the chiefs son and his was of course way better. He said that he not only tried the cow's blood/milk mixture but he loved it…had three cups hahah! He expected me to say that I also tried the blood but I had to admit I was a wimp and passed on that gourd (they use gourds as containers). Guess next time I'll have to try the delicacy of cow's blood! This guy has done it all; he even told a story that ended with him eating warm monkey brain (just a bite so he didn't get killed of course hahahaha!) from a freshly killed monkey! Sooooo cool! Anyways, I digress…basically dinner was not only delicious but filled with very colorful conversation as you can tell! Oh, Dr. D and I got the same dinner…borscht soup, veal with vegetables topped with blackberry sauce, & mashed potatoes with mushrooms. DELICIOUS!!!! My meal cost a little under 25 US $! It would have cost around $80 in the US I think. Also had a Ukrainian beer that was pretty good and was pressured to try a shot of vodka. These people love their vodka! I think Lindsey mentioned that already haha. It was super smooth tho I must say. :)

Today I worked a day shift with Caroline. A nurse from the UK with tons of experience. She goes on several ICHF trips a year! We planned on having 3 cases today but could only manage 2. The first case was a 24 year old female who needed an Aortic Valve Replacement. She had some bleeding in the OR so her case took longer than expected. But, she looked pretty good after arrival to the unit and we were able to extubate her pretty quickly once she woke up. The nurse got to extubate her…I was so jealous! But, I did get to take some pacer wires/chest tubes out today (under adult MD supervision of course ;) )! The second case was a BT shunt on a TET but they were just wrapping up in the OR when my shift came to an end so I'll meet the baby tomorrow night (back to night shift! haha). I also got to meet the kiddos from yesterday. The first was Demi who we de-lined and sent out to the unit early on. Kids walk out of the ICU here! Love it! The second was Kristina; she was feeling better than last night bc she definitely became more feisty haha. I made eye contact with her and she fake slept! The MD tried to say it was the morphine but this little girl was straight up avoiding me haha. Oh yeah speaking of vodka…Kristina got a high fever so we gave her a vodka bath! Yeap we rubbed her down with vodka and fanned her with a CXR! Gotta love a hospital that keeps vodka in the fridge at work! Classic! Anyways, it actually worked really well…perhaps we should think about stocking vodka in the pyxis? Another interesting story involving Kristina is after we got rid of most of her lines we let her go on a walk with her mom. She didn't come back for a while and then one of the russian doctors told me in a giggle that she didn't want to come back haha. So it was just in the air whether she was going to come back to the ICU or stay @ the step-down unit. Basically, a feisty 4 year old was dictating her care :) No one seemed to be concerned but me. Crazy huh haha! She ended up stopping in from time to time for a spot check and assessment haha! And last but not least, little Julia is still in the unit. She looked good today so I'm thinking she'll go to the floor tomorrow. There are 3 cases scheduled for tomorrow. Hope we get through them all. I'll let ya know :)

Thought I was done but gotta add this! Just as I finished my last sentence a wasted Russian guy came and sat next to Scottie Day and I and tried to start trouble. We are harmless individuals! Well we snuck past him and just took the stairs up 9 flights haha! Another classic Ukrainian moment! That's all for now…sure to be more! Goodnight!

-Katie

Shift work is a whole lot easier with a shot of vodka...

May 13, 2010

Last night I (Lindsey) worked another night shift and my first without Katie ;( She is working today so will probably post herself later this evening. So yesterday after I got off work I went straight to bed, was soooo tired, and slept pretty good for most of the day. Did wake up once hearing Katie trying to explain to the maid that we wanted new towels, haha, it was pretty comical. Then I caught the bus with Bonnie for my 2nd shift. The beginning of this shift was much slower than the night before, because the postops from yesterday were much more stable. The first case was a 4 year old complete TET repair who was a previous BT shunt. Her name was Christina and she was a trooper!! She went the whole night without complaining at all and keep in mind that their pain regimen is meds similar to tylenol and ibuprofen. Actually when giving morphine to patients, which is available, they don't put it on the chart because they dont like to have records of using a controlled substance, haha. Its funny because that is the most important thing to make sure is charted at home. Anyways, Christina was really sweet, she would wake up and ask for her mom and look at you with a look that was not quite so sure if she trusted you or not. She warmed up after awhile and would let me hold her hand while she went to sleep. The 2nd case was a cute little 2 and a half year old boy, Dima, who got his ASD closed. He was a sleepy head at first and didn't want to wake up postop so we ended up not extubating him until about 9pm. After extubation they pretty much give all their kids racemic epi, I haven't seen any albuterol so I'm assuming this is all they have. He had an easy night except for the fact that his mom was shoving water down his throat and then he would throw it all up, poor guy. Julia (the little TET baby from the night before) had a great night as well, during the middle of the night we noticed she had p waves, so YAY normal sinus rhythm. She is also taking a bottle and wakes up every few hours like she's never had a bite to eat in her life, haha. It's funny because the hospital doesn't supply feeds for these patients, their parents have to bring the milk for them.

One thing that has been a little difficult in the whole patient care area is that we are not supposed to change things that they already do as a standard in their hospital. So we may see things that we do differently, but if it works for them then they really want us to let it continue. I guess there are still so many things for them to learn relating to care of these pediatric cardiac patients, we don't want to overwhelm them. Also we are not there to change the way they do things (for example charting, etc.) we are just their to teach and help improve the outcomes of these patients. One of the nurses that was on last night named Victoria I thought was really wonderful. She is the first nurse that I have actually seen assess her patient. She was even trying to communicate a change she saw in Julia and was spot on. It was difficult last night because literally not one person there spoke good english. It was me, Bonnie, and Scottie on for our group so obviously none of us speaks Russian. We muddled through with a dictionary and alot of guessing, haha. Apparently it was not only nurses day in the USA yesterday, but here as well. They had some food out last night for everyone and asked us to join them. They offered a drink which you will never guess what it was....vodka, haha. That's right everyone drinking shots of vodka at the hospital. It was a huge bottle that was full...then about an hour later we walked back into their little kitchen room and there was barely any left. Can you imagine that happening at home??? NEVER!!! Don't worry we didn't accept it!! I guess people here hold their liquor better than at home though cause you didn't really notice a difference with anyone. Plus people sleep during their shifts there. The nurses take turns and leave one person in the unit at a time. Hopefully nothing goes wrong! So all in all it was a successful shift!

Today when we got back to the hotel we decided to take advantage of the free breakfast at the hotel. You have the choice between regular breakfast and russian breakfast so today we tried the russian. It was soooo good. They had these meatball looking things with rice in them served with pasta, for breakfast, haha, yummm. After breakfast we went to sleep for a few hours and then Scottie and I went exploring around the city.

He wanted to go to this toy store that we saw the other day to find gifts for his kids, so we trekked on the metro (which we did very well with by the way). The toy store ended up being a bust, they just had cheaply made american toys. So we decided to look for this flea market we had heard about. While wandering around the city we came across some really beautiful places. We ended up in what is known as "Old City". After eating lunch at a great little pizza place (our 3rd since we have been here), we came across this really cool park with gorgeous fountains and some beautiful views of a few churches. Along the sidewalks some artists had their artwork set up. Scottie and I both ended up buying a really cool piece of artwork. The one I bought was of this monastery that we saw. It was so pretty with tall gold steeples. When we walked in to the courtyard this man chased after us and tied a skirt around my waste. Apparently they don't like ladies wearing capris :( We wanted to go inside and take a look but all the woman had scarves tied around their heads, so we are going to try and go back this weekend. After seeing some other great churches and having our own tour of the city, we finally found the market we were looking for. It was pretty much all closed down so we are thinking that we will try again during the weekend. It is soooo big so I'm sure will be hopping on Saturday or Sunday.

So now we are just hanging out waiting for everyone to return from the hospital. I think we are all going to the English pub again tonight!! So hope everyone is doing well at home!! Miss you!!

-Lindsey

we love you nutella :)

May 12, 2010

A lot has happened since we last wrote…seems like we've been her for a long time already! We had our first night shift which went well. The first patient was a 17 year old girl who was supposed to be an ASD repair only but ended up also having TAPVR. Luckily, the surgeons noticed this and repaired both issues! The second patient was a 3 month old baby girl that received a complete TET Repair and she was only 5 kg!! We were actually impressed by the skill level of the nursing staff with these post-ops in some regards. However, we did notice that nursing here seems to be very task oriented with not much critical thinking involved. But, both nurses were very nice about letting us make suggestions and help to take care of the patients. We were very honored during shift change when one of our MDs translated that the night nurse told the day shift nurse coming on how well we did/nice we were :) Nice to have a verbal confirmation that you are not completely annoying someone after trying to speak a language they don't understand to them constantly haha. We are supposed to be helping the nursing staff learn so it was hard for us not to dive in and do everything. It is also really hard to communicate here, especially during the night shift because we don't have a translator. Luckily the intensivist that was on, Eugene, who is from Minsk speaks Russian and English. Like we said earlier the hospital is very outdated and is lacking a lot of supplies but, after a night of witnessing the resourcefulness necessary to complete pretty much every task it became even more obvious how different our health care is from theirs. In our world it is not clean/safe/policy to reuse almost anything but in their world if you don't re-use you won't have it. Also you should see their setups for oxygen and suction, I would never be able to figure them out!! Both patients did very well throughout the night only requiring a handful of blood/fluid boluses and other medication adjustments. The TET came back from the OR in JET and we struggled throughout the night trying to get her back in Normal Sinus Rhythm. Still no success by the morning but assessment wise she looked much better. These patients will be moved out of the ICU much quicker than we are use to in our unit. We also got to get a glimpse of ICU care for adults here. There is a woman who looks to be in her 50s or 60s in the corner of the ICU that we are not really supposed to help with but we tried to here and there because it was difficult to see someone looking so hopeless. Long story short this poor woman is in a coma after having a cardiac arrest initially due to pericarditis that remains unexplained. This woman has been in their ICU ward for 2 weeks and most likely has been laying in the same position besides what appears to be a one time a day linen change. This woman does not have a depends on and is having liquid stools. We helped change her bed in the morning and could not believe the condition of her skin and that she was simply lying in her own feces. Very sad. However, hard to judge because the bed is so small with no side rails or much possibility for position change. Also, the nurses manage several patients by themselves and she requires a few hands to even provide simple care. We discussed mouth care after noting her condition and it appears that is not practiced here….we are going to try to convince them to start performing mouth care on her but again it's not like they have the convenient swabs or safe suctioning that we do. She would be likely to bite down on any make-shift swab and potentially do more harm than good. Again very sad not to have supplies necessary to provide routine care. It was a mix of being impressed with what they could do with not much and being shocked at the simple care problems they had due to lack of supplies & knowledge. We are going to teach more about infection control and simple infection prevention methods before we leave. On a lighter note, while all the patients were being good we were able to learn a couple words in Russian from a nurse named Alex. We are pretty pathetic at pronunciation but they are very excited when you try. BTW Alex has been a nurse for almost 2 years and is only 18! Pretty crazy! Alex also spoke some english so we could communicate a little that way but of course I (katie) use a little too much "flowery" language as the nurse from London puts it haha.

Besides our shift at the hospital and sleeping to prepare for it we made a quick trip to a nearby "botanical garden." There weren't any flowers haha but there is a natural spring. The locals bring water jugs to fill! Super cool! Also, there are a couple small pool-like areas where people dunk themselves in the chilly water. Mostly old men in speedos but we did see one woman in a 2 piece so we feel like it would be safe for us to give it a whirl. We plan on getting our dunk on if weather and time permit :) I had my suit on and everything today to go but it was raining again :( Another important part of our day besides sight seeing is diving into the cuisine! Pretty much my favorite part! So far everything has been really tasty, especially the salads that are made with some of the freshest vegetables I've ever tasted! There is a super market right next to us and everything is very cheap so we stock up on snacks and such for night shift…nutella is our new fav!

In fact....a salted fish compliments a beer nicely

May 10, 2010

Today was actually a holiday here in Ukraine so we had the day off to get to know our surroundings. Early in the morning we went to the hospital and got a tour from Caroline, a PICU nurse from London, she has been on three trips here before. Dr. D (preferred name :) ) was correct...the hospital is pretty outdated and it seems like it will be a make it work type of environment. There have been no updates to the hospital since the dissolution of the USSR! All of the equipment is sooo old and there is not much of it. The vents are super old and really really big. They reuse alot of equipment!! They told us that we reuse the transducers so try and not to let blood back up in them, haha. We will start surgeries tomorrow and then it is on! We will rotate doing day and night shifts with 3 or 4 other nurses so that there are 2 of us working at all times. We both are working the first night shift tomorrow night. The surgeries planned for tomorrow are most likely a ASD and a TET repair (or BT shunt).

We walked back to the hotel from the hospital. It was a nice little 2 mile jaunt. It was cool to see some of the nieghborhood. It is alot of really old apartment buildings. It looks like they all cram as many apartments in as possible. There were alot of people walking around because of the holiday. We walked to Freedom Square (formerly known as Lenin Square). It is the 2nd largest square in the world! It was pretty cool, alot of open space with some statues. Surrounding it is a really awesome park. There were sooooo many people there and tons of stuff for kids to do. There were pony rides, games, rides, anything you can think of! There was even a man holding a ginormous yellow snake and a little unidentified mammal. It was adorable, a mix between a furby, a chinchilla, with a koala body and gremlin like features. We found a nice little outdoor restaraunt in the park for lunch. There was one waitress there who spoke a little english so she helped us order. We just asked her what the best thing on the menu was and ended up getting some chicken and this cold soup that had like cucumbers, chicken, egg, potatoes and dill. It was all pretty good. After we had eaten and made friends with our waitress we decided to ask her insight on the little dead fish situation. We told her that a man had handed Katie the dead fish on the bus and asked her what that meant. I mean for all we knew Katie could be engaged to this guy or something!! So apparently he didn't want her to eat the guts right away, people here actually like to eat "salted" fish with their beer. So we misunderstood about how it was like buying a beer, actually it was just to eat with a beer. Further more we saw one of these fish in the store later in the afternoon and it costs alot!! It is like 60 gryffindors (our name for the currency here) which is like $8.

After lunch we all just wandered around the city and saw some sights. We found this really cool fountain that went down like a million stairs. We also saw the world's coolest McDonalds, it was HUGE. Scottie tried to get money out of like 17 ATMs with no luck. Apparently 5th 3rd doesn't appreciate us calling ahead of time and asking them if we could use our debit cards in the Ukraine (they lied!!!). After walking around here for awhile you notice different things, like all the women here dress like they are going to the club and they are sooooo tall. There are also some sweet cars here from back in the day. We also learned a little about the language, like the word thank you is something like placebo with a spin on it, and their currency sounds like the gryffindor house in hogwarts. There is always a word you can relate to.

Tonight we all went to the English pub down the street. It was really good food and pretty cheap. Really everything here is sooo much cheaper than at home. Alot of people from the group went to and everyone is super nice. I think we will all get along really well. The last nurse, Michelle, arrived today. She had been traveling from Canada and left there on Saturday, poor girl. Now we are just hanging in the lobby watching nothing but war movies on the tv and listening to Scottie try and call the help desk at Children's so they can help him try and get on his internet in Ukraine. Sounds weird right....yeah it is.

volcanos aren't as cool as you might think....

May 9, 2010

We FINALLY have arrived in Kharkiv!!! Let's see…we left Cincinnati at 9 am on Saturday morning and we arrived in our city at 1130pm on Sunday night!! Our flights went super smooth until we boarded the plane at JFK for Kiev and ended up sitting on the runway for over 3 hours! They had to reroute our plane because the volcano in Iceland is still erupting. Not only did they have to get a new flight plan, but the winds were so strong in New York that they only had 1 runway open. Once we were finally airborne it went very smooth and we even watched 2 movies, Leap Year and Crazy Heart. We met up with Scottie, and then 2 others we hadn't met yet, Bonnie who is another nurse from Fort Worth and Dr. DiSessa who is the cardiologist from Lexington, when we left JKF. So we were on the plane for 14 hours including the time we were waiting on the runway and actual airtime which is for sure the longest I've ever been on a plane! When we arrived in Kiev we finally made it through customs and then went to check our what we should do since we missed our flight to Kharkiv. They basically told us that the other flights were full and we could all pay $70 to get on a flight tomorrow at 3pm. Luckily we found some really nice ladies from Delta who spoke great english to help us figure out what to do. They got us bus prices and we decided that it would be better to ride the bus than wait a whole day to fly. So Katie and I pretty much got it done and went ahead and bought bus tickets. So we boarded a really nice bus at 4pm where we would spend the next 7 hours, haha. These two Ukranian men sat in front of Kaite and I and really wanted to try and talk to us in English. This guy Chad who we met in the airport (he's from Alabama) had a pocket translator that we used to have conversations with the one guy who was really nice. The other guy let's just say was a little on the creepy side….He LOVED Katie haha….He loved her so much he gave her a gift of a dead fish. I am so not joking here at all! We made a pit stop to get drinks and go to the bathroom and he got back on the bus and handed her a dead fish, smiling from ear to ear with all his gold teeth haha. I'm not talking recently dead, this was like a 4 day old stinky fish that was sorta dried up still completely intact, eyes and all, and he wanted her to drink the guts out of it. Our other friend on the bus told us this was like buying her a drink, hahahaha. Needless to say she didn't eat it, she told him she had a fish allergy. Since this was only about an hour and a half into the bus ride the stinky fish rode along with us in the seat pocket and every once in a while we would get a wiff. And not only did we have a stinky fish the bus was extremely warm…so just imagine how pleasant that was! Finally at around 1130 PM we arrived at the bus station in Kharkiv where Igor (one of the guys organizing our trip) met us. It was nice to actual get somewhere and see someone who knew what was going on! We took another short bus ride to the hotel where we just checked in, It is called Hotel Myr and is really nice. Katie and I are sharing a room with 2 twin size beds. It seems like it will be really comfortable. We will have complimentary breakfasts so hopefully that will be good. Going to see the hospital in the morning which I'm really excited about. Dr.DiSessa told us it is an old rundown hospital reminiscent of the 1950s so I'm curious to see what it is really like. Well we have been up for 36 hours so I'm really looking forward to getting some shut eye!