So, I just had a nice little adventure in a Nicaraguan emergency department. Two quick matters of business prior to commencing with the story: Number 1: Dear Mom and Dad- Fear not, I am not the patient in this story. Number 2: This story is written from the perspective of an ER nurse, who for all intensive purposes cannot be grossed out. I think this story is completely filtered and not disgusting in the least, but I have also heard that some people don’t find vomiting to be humorous, so I guess I will just say you’ve been warned- some components of this story may be considered to be distasteful. Alright, so here is the story. I was just about to go walking and praying with some people when someone came and got me and said that Julio had just passed out. (Julio is a friend who works here at the mission). So, I went over to Julio’s room and found him face down on the concrete floor with a nice little pool of blood around his mouth. We got him up into his bed, and about that time a doctor from the property came over. Now, normally I would be all about it if a doctor came over. This time, not so much. I am normally not critical of what doctors say or do, but I guess there’s a first time for everything. I was thinking syncope protocol in my head, but the doctor proceeded to take Julio’s blood pressure, find it to be mildly elevated, and then proceeded to try and arouse him from his semi-conscious state to give him 2 tabs of nitroglycerin (dilates blood vessels, lowers blood pressure). The following sarcastic nursing thoughts came to mind: For real, must we ruin the one thing we have going for us? Do we really want to tank his blood pressure after he just passed out? And it’s like 100 degrees outside, dude is coughing up blood and priority 1 is nitro, really? As this was occurring, I asked the doctor if there were IV supplies in the clinic, so we could give the poor dehydrated soul some fluids. Her response: no, his blood pressure is too high. Number 1: No it isn’t. It was supposedly 160/90, which is not an ideal blood pressure, but all things considered- no big deal. Number 2: It’s certainly not going to be high in a few seconds due to the excessive use of nitroglycerin that has just occurred. After a few moments, she rechecked his blood pressure, found it to be lower (shocking, I know), and reluctantly agreed to give him some IV fluids. Alright, critical sarcasm can end here- on with the story. The doctor went and found some IV supplies for me, so I popped an IV in and started giving him some IV fluids. He started coming around a little bit more, but continued to cough up blood. Where is protonix when you need it? We let him hang out and relax for a while, but he was still pretty dizzy and out of it. This especially came to light when he was trying to talk to someone on facebook chat and was like can you type for me, I can’t really see. Over the next short while things didn’t really improve much, so I and others told him that he really needed to go to the hospital. He said he was fine and did not want to go at all. Insert eye roll. They’re the same in every culture. Anyway, after much coaxing we finally got him to agree to go to the hospital. So after waiting a few moments for him to muster up the strength to stand, we helped his dizzy, staggering self to the truck and went off the hospital. Now the adventure really begins.
After a long and bumpy ride, we arrived at the tiny hospital and began to check Julio in and the power goes out, leaving the whole hospital in complete darkness. After several minutes a doctor came out to the waiting room by cell phone light and began asking Julio triage questions to see why he was there. Then some police came in with assault rifles. Then, after 15 or 20 minutes, the power came back on and Julio got to go back to a room to see another doctor. Fast forward a little bit- it was determined that Julio needed to stay overnight in the hospital. Now, in Nicaraguan hospitals I have learned that it is rather important for someone to stay with the patient because you are kind of on your own if you don’t have family with you. For example, food and water are not provided to patients. (Not that Julio was going to be able to have much to eat or drink, but you get the gist). So, I told Diego and Barb (two other awesome people from the mission who were with us) that I would be happy to stay with Julio and keep him company and make sure he didn’t die overnight. After they went back home, Julio got an x-ray and some blood drawn and then we moved to a different waiting room. Now let me paint a picture of this waiting room for you. We are sitting in old rickety wooden chairs, and Julio’s IV bag is hung up on a hook on the wall as he continues to cough up blood. An elderly woman is vomiting into a box next to us. A teenage boy is half passed out sitting up in a chair with a wash cloth over his face. An unconscious person is carried in by their hands and feet and swung up onto a gurney. A man with a vicious leg wound (pretty sure I saw femur) is wheeled past us with a belt in place as a tourniquet. I sat and chatted with Julio and secretly chuckled to myself at what a funny and ridiculous situation this was. I then mentioned that I was getting hungry because it was getting late and I hadn’t had dinner, but that I was also not too thrilled about the prospect of wandering around outside the hospital in the dark to find something to eat. Then a nice lady who was sitting near us (and not vomiting) offered to walk with me to get some food. So, we walked over to a street vendor and I got some delicious chicken and gallo pinto. I ate it quickly and then went back to rejoin Julio in the ever so awesome, super luxurious waiting room. (It should be noted that although it may have been a little cruel to get something to eat when Julio was not allowed to have anything, I was at least compassionate enough to not eat it in front of him). When I got back to the waiting room, I realized that I had been assuming that we were waiting for a room to be ready for Julio to stay overnight in or we were possibly waiting for him to get an endoscopy. I then however realized that that was not the case and all we were really waiting for was for him to get his blood redrawn at 5am, which at that time was still 6 hours away. Thankfully I have clocked enough hours the emergency room to know that long waits are almost always a part of the experience, so I had brought a book with me. After reading for a while I got a little sleepy, so I decided I would try to sleep. About that time, another of our waiting room compatriots started getting a breathing treatment, and when they turned on the oxygen machine/air compressor it pretty much sounded like a roaring generator. Shortly after that ended, I noticed a woman lay down on a bench to the left and a little in front of me. I then swiftly kicked my feet up over the side of my chair as to keep my feet from being vomited on. She was then provided with a box to vomit into as well. At some point I got up to go to the bathroom and the only bathroom I could find was one in a giant room full of beds and patients that was sort of sectioned off by curtains. The door to the bathroom didn’t really shut and there was no seat on the toilet. And just like food and water, toilet paper was not provided. Thankfully I knew that there was a high likelihood that this would be the case, so I just busted out my baby wipes from my cargo pocket and all was well. I went back out the waiting room and half-heartedly tried to doze, using my book as a pillow. Somewhere between 2am and 3am, we got to go back to an exam room to sleep. Some lady was asleep on one exam table and Julio got to sleep on the other, leaving a desk and chair as sleeping options for me. At first I sat in the chair and put my head down on the desk, but quickly was just like forget it- I am so tired I am just going to lay on the floor. After all it smelled reasonably clean and there weren’t too many ants crawling around. So I again used my book as a pillow and finally got to sleep for a couple of hours. Eventually Julio got his blood redrawn and we waited for the results. In the end, the results were fine I guess, there was no endoscopy, and Julio was deemed okay to go home. He was just given some prescriptions for antacids and told to change his diet and rest.
All in all, this was kind of a fun experience for me, but probably not for Julio. Not like so much fun I want to do it again experience, but I guess more interesting because I could compare the Nicaraguan emergency room to the American emergency room. Nicaraguan ER- No food. No water. Period. If you want something to eat or drink you better have someone with you who can go buy you something from a nearby store or street vendor. American ER- I pass out more cups of ice water than I put in IVs during any given shift to both patients and visitors alike. People complain about the free turkey sandwiches and all the crackers and juice they could ever want. Nicaraguan ER- You may be actively vomiting or coughing up blood, but that is certainly not emergent enough to deserve a room. And just because you are admitted for the night does not mean that you are going to get a room or even a bed for that matter. American ER- Coughing up blood and barfing all over isn’t really something that routinely gets put in the waiting room. Being admitted means a private room with an automated bed, tv, nurse call button, and private bathroom fully equipped with a toilet seat and ample toilet paper. So I guess to conclude, spending the night in the Nicaraguan ER made me very thankful and appreciative for all the provisions and luxuries that I have in the US. Not that I wasn’t already, but sometimes I think it is good to have funny, crazy experiences to remind you of just how good you have it. I am very thankful for all the blessings I have in my life and thankful for the lessons I am continuing to learn on this amazing journey.
