Sunday, August 29, 2010

Trapped in Quito.

Although we arrived at the airport 2.5 hours prior to our flight, the airport gods have worked against us. Due to some technical problems we were not able to get onto our flight.

We found this out after waiting a significant time in a line that was not moving. A LAN employee stood near us and made a proclamation. With all my amazing Spanish skills I was able to pick out one word. "Cancelar" Or something like that.

We were given 2 options, as far as I could understand it anyway. We could fly instead to Lima, then Punta Cana, then Miami (arriving at 10pm). This option was not desirable to me, as I only have enough Ativan for 3 flights. The second option was a $500 voucher for LAN, a hotel, and meals until the next flight tomorrow. We obviously picked option B. This seemed like it would be simple. It was not.

Stage 1 - Get moved from giant queue to smaller queue (because we volunteered to fly tomorrow)

Stage 2 - Wait 15ish minutes to speak to an agent who tells us we can´t fly today. Thanks agent. Even though I actually really ended up liking the agent. She re-schedules our flight for tomorrow. Perfect. Now about my $500 dollars

Stage 3 - Walk to a different office/counter where we wait 30-40 minutes for our vouchers. Its no ordinary line up. It is filled with angry Spanish speakers and crying children. People keep butting in line, and we have no idea what is going on, because my idea of speaking Spanish involves adding the "o" sound to the end of English words. It was a bit frustrating, but eventually we got it sorted out. We have to sign something, which I am semi-convinced is a slavery contract. Now about my hotel. And transportation to the hotel. And what will I eat all day. Etc.

Stage 4 - We are instructed to "step aside" and wait for the magical LAN employee who bears the booklet full of vouchers for hotel stays. This takes lord knows how much longer. She writes an illegible hotel name on a voucher, ticks off a few meals, writes that we are both eligible for a 3 minute phone call and then instructs us that to arrange transport we should.... Go to the main check in counter. Again. I am skeptical.

Stage 5 - Waiting for the transportation. We do this completely out of principle because a taxi ride practically anywhere is only 3 to 6 dollars, depending on your haggling skills. But we wait anyway. We go back to the counter, where madness is ensuing. There is actually people shouting at the staff. This always seems completely retarded to me, because yelling is really going to help you out. Anyway we ask someone about the transportation and they ask us to wait. Which we do for an hour. I then employ my new tactic, which is "stand in the middle of everything and be completely in the way." Then we are actually addressed, and asked to wait in a different spot. I entertain myself by weighing myself on the luggage scale (68 KG with backpack) and commiserating with those around me. We wait and wait.

Stage 6 - The previous agent who I have come to love takes us outside to where hotel transportation should come get us. She looks like she could cry at any minute and is obviously prolonging going back into the hell that is the LAN check-in. The bus arrives! She tells us we will have to wait 30 minutes for it to leave, because we are the only ones outside and there are a bajillion people who need to get moved to this hotel. Which I am not sure exists, and think it may actually be the LAN cargo hold.

Stage 7 - The bus refuses to wait! Yay us! We travel the short distance to a VERY VERY nice hotel, which we are all awkward and weird in, wearing our dirty and torn travel clothes.

Total time for this to take place. 3 Hours.

What follows is free breakfast, a massage (that I pay for), a steam room, a sauna, a nap, a free lunch (somewhat awkward, what with my awesome Spanish) and a completely relaxing day in Quito. In a hotel in Quito anyway.

(please note: what you see is a bouquet of live roses)


Home tomorrow. Hopefully.

Friday, August 27, 2010

Otavalo: The Market

Even though I have skipped past Banos (white water rafting, and horse back riding), and Cuenca - an amazing colonial city, I will never catch up, so I might as well just move on.

We have stayed at the most amazing Hacienda (farm) every. It is about a billion years old, and the rooms are amazing, and have hot water and the piece de resistance - a fire place! Like an actual, you put wood in and light er up, fireplace. I was in heaven. We spent 2 nights there. On the second day we took advantage of a mountain biking adventure. We have never mountain biked before, so it seems like a great idea. We drove up to the highest point humans can go on Cayambe Mountain (4,800 meters). We were on the equator line and were freezing, and surrounded by blowing snow. And then we biked down 2,000 meters. Before starting we had joked about having a camera on our helmet that snapped a photo whenever we pulled on the brakes... Truth be told, it would have been more like a movie, since I pulled on the brakes the entire time. All the way down. 2,000 meters over 36 km is very steep. They fed us sandwhiches, sandwhiches that tasted like the gift of life. Then we hurtled the rest of the way down. It was on a road that was "paved" with coarse cobbled stone. Pretend you are operating a jack hammer. Now imagine doing that on a bike, because that is what it felt like. Today I can hardly move!

Luckily today was a travel day. We moved from the Hacienda to Otavalo.

Really all we have time to do in Otavalo (we are here less than 24 hours) is the market, which is purportedly the best in South America... So in the 4 hours that we have been here we have purchased
  • Panama Hat (produced in Ecuador, EXPORTED to Panama)
  • Alpaca Blanket
  • Alpaca Socks
  • Wooden ring for my thumb
  • Rug for the kitchen
What did we need of all of this? Likely only the socks. I have just stopped myself from buying another sweater (I am up to 4 already) and a second rug, and a small model alpaca, and a little rug made of Alpaca (which, I swear to god, the cats will love). I am now wondering which of my current backpack contents will need to be left behind in order to fit in all these new family members.

Also in the market a very shrunken old lady approached us, talked to us in Spanish, and then as far as I can tell put a curse on Jen.

Other random facts. I am in an internet cafe. How do they afford to run in Ecuador? Technology is expensive, and the internet is cheap to access. In addition, I have seen my first bar of soap on a stick since Korea. Don´t think it´s about to break through to Canada anytime soon.

Monday, August 23, 2010

Ecuador - The adventure Continues

Papallacta was everything I would hope it would be and more. We spent one luxurious night in the hot pools, had delightful cheap (like all food in Ecuador) dinner, and loved our first stop on the trip. In fact, we wished it had been more than one night.

In the morning the trouble started. We started taking Malarone (the supposed best anti-malaria medication) since we would be entering the malaria zone the next day. In the morning I ate the most disgusting breakfast I have ever had in my life. I don´t know why I ate it, but I did. It was (my best description follows) eggs, sausage, bread chunks immersed in a soup of red sauce. The best way that I can describe the red sauce is to call to mind tinned spaghetti, or alphagetti.

 What follows is the most violent vomiting I have ever experienced... out the window of the bus. The roads in Ecuador are somewhat windy - you know, what with it being in the Andes mountains and all. Public transportation is great, but when I got on the bus, I didn´t have a seat. I had to stand for a while. Then I started feeling a bit sicker. Then I asked Jen what I should do if I was going to throw up. She suggested emptying out our chip bags and using those and vomit bags. I suspected the vomit volume was going to exceed 3,  50 gram bags. I was right. Instead at the last minute, I traded Jen for the window seat. We pushed the window open as far as it would go, and I proceeded to vomit as hard as I ever have while 40 Ecuadorians cheered. Thanks guys.

We arrived in Tena - which for us was essentially the gateway to the Amazon. I had to ride for 40 more minutes on a gravel road in a truck, not improving the feeling I was having really. Upon arriving, I tried to be sociable, failed, hid in my room, came out for 5 minutes at dinner, and continued to throw up... and wait for it... have explosive diarrhea AT THE SAME TIME. Thank you Ecuadorian food poisoning. Love love love.

Next day we visited a rescue zoo center - Amazoonica (which is a lovely place that you can volunteer at). I forced myself to go (45+ minutes on bumpy gravel roads, followed by 30 minuted boat (think motorized canoe) ride). Yes, great idea. I love animals. I love monkeys. I love not puking more. When we got back to the lodge there was some sort of vegatable potato soup served. As far as I am concerned it was the healing soup of the Amazon gods. That was my turn around.

Ok - so after two nights at Shangrila - the amazon jungle lodge, we moved on to a community stay. Yes, a community in the Amazon. You know, where they don´t have electricity. Let me summarize the trip, since i am running out of internet time here.
  • bamboo hut with holes in the walls big enough that when we woke up there was a stray dog under Jen´s bed
  • 6 hour trek through the jungle... in gumboots. 
  • Tilapia served whole - with the head. I called that dish "fish with a face."
  • Favorite quote from our guide on our first night, when we were going to bed at 8 pm, since it gets dark at 6.30. ¨"Might as well go to bed, nothing else to do. You can cry, you can scream - but no one can hear you."
  • 100% DEET did not even begin to deter the bugs. Not even close. You should see all the bites on my legs. The malarone continues, even though it makes me nauseous every day.
This pretty much concludes my time in the Amazon, except for I have to mention Merido, the Ecuadorian flea bitten, mutt. I loved that dog. I fed her food under the table, even though I am sure it offended everyone and probably made her sick. Loved her.


Ok. That actually does not even bring me up to speed. After that we spent 2 days in Baños, and now have been in Cuenca for a day. If I could spend another day anywhere, it would Baños for sure. But more on those adventures later.

Short flight to Quito tomorrow evening. Still have Cayambe and Otovalo to go! Andean sweaters for everyone!

Sunday, August 15, 2010

Off we go to the Amazon!

Yesterday we had a self guided tour of Quito. Self guided in that we were in a taxi and the hotel guy told him where to go. $17!

We saw the Virgin of Quito. Constructed by the same guy who made the Eiffel Tower.
(Picture not my own)

We also saw the San Francisco Church (Which is the oldest church in South America) and some other churches and museums. Then the altitude kicked the crap out of us, and we had a 3 hour nap!!

We met with the group last night and they seem like a fun bunch of people. 

Today we are off to the Papallacta Hot Springs where we will be sleeping in a cabin with a hot spring outside the front door. This sounds like my kind of holiday!!



Again, I have obviously stolen this photo, since I haven´t been there yet, but I hope this is where we are staying!!!

Adios!

Friday, August 13, 2010

Quito!

We almost did not leave on the holiday. Last minute we were informed of the risks of flying to a high altitude if you suffer from epilepsy. The day before we were to depart I was told that i needed a letter signed by a doctor. I started bawling because that was not possible. Just not possible, but then they recanted and said I could sign a release of health on my own. Of course making my health insurance null and void as far as I can tell... Then Jen convinced them to let us go on a different trip. Last minute. Totally against every policy they have. And then we decided to risk it and travel as planned. 

As such, I have arrived in lovely Quito! At least it looked lovely in the dark, from the taxi cab. We had the easiest day of travel ever.

Toronto to Miami was slightly delayed, but no problems getting the bag and then rechecking through to Quito. Time to spare!

First impression of LAN airways.... Fantastic. They have a personal entertainment system, games, tv, movies, zou know - whatever.  Blankets and meals and wine oh my!

Still can not come close to beating the awesome service we received on westjet to Toronto - hello compd drinks. But I would definitely fly LAN again.

Our hotel is relatively nice. It was $80 per night compared to the average $6 to $10 all around us. I am still looking for the key to the safe. Wifi is included though, which is a nice perk. Also free breakfast, which is probably our favorite thing of life.

The worst part of the day was when the US customs man in Toronto made Jen cry.
Ativan was definitely the hero of the day, keeping me subdued on all flights and through all turbulence. Hurray!

Wednesday, August 11, 2010

Happy Holidays

I intended to get some posts ready ahead of time, but I didn't. I can't believe I am leaving tomorrow and am in a total panic!

When I get back I will just have 1 week before I am in the special care nursery taking care of little babes! :)

Back on August 31st with many tales and adventures of Ecuador !

Saturday, August 7, 2010

Done and Done

First semester of my practicum year is over! Already! I can't believe it.

I was thinking today about how much I have changed already. When I started at this hospital I couldn't find anything. I remember the first day - I sat on a chair in the atrium of the hospital, until one of my classmates showed up. And then we asked information for directions to the Respiratory Department. Yes, it was that pathetic. I stumbled through my first weeks on the wards, and eventually became comfortable doing assessments on patients, assessing their oxygen needs, doing 3 billion ECGs, administering respiratory meds, and calming panicked nurses. Some of the time. I also was able to attend traumas, conscious sedations, and cardiac arrests (to name a few) in the Emergency Department. I now know exactly what needs to be set up before we start, and I can do a conscious sedation on my own (even though it is illegal - it happened just yesterday). I don't look like a deer in the headlights when someone asks me for something in the middle of a code.

Just when I was getting comfortable with all of that, I started my rotation in the ICU - very late in the semester compared to my classmate. I was so nervous, uncomfortable, lost and just plain useless - all over again. It improved. I can independently monitor and assess the patients now. I am comfortable asking the nurses questions and they ask me questions about the ventilator, and most of the time I can answer them. When I started running ABGs on the analyzer I was a nervous mess. I couldn't even transfer a sample into a capillary tube. Now it is just a matter of routine and happens dozens of times a day. I draw gas after gas after gas. I look at it. We make ventilator changes. The doctors ask us what we think should be done - ventilation wise. I love being a part of that process. I am finally comfortable with a few of the doctors to ask questions, clarify med orders, and just plain old get my hands dirty in the ICU. Of all the places in the hospital ICU is still where I am most unsure, but I have a ton of time left to learn in the next two semester.

The best thing about the ICU is that I am actually using things that I learned in school. The therapists and nurses that work in that are are specialized and have to stay on top of those skills.

Updates:

Code story from two days ago. We coded a 30 year old approximately 10 minutes after shift report. It was chaos. I got to do CPR for the first time ever. The bed was too high and the patient was too far over. My arms could have gone forever but I got the WORST leg cramps ever from being on my tippy toes and doing compressions for the longest 2 minutes of my life. There just happened to be a ton of nursing students around that day (which was nice because they were newer than me, so I felt like I knew something). The students all gloved up and got in a line up to do compressions. This resulted in me not having to do compressions again, but instead being the runner for everything my preceptor needed. Compressions continued for 25 minutes. She did not make it. Her nurse, who is always very tough, went home early that day.

Yesterday I was setting up for a conscious sedation (because my preceptor was with another apneic patient from the previous conscious sedations - lots of cardioversions happening). I had just got the oxygen mask on the patient when the nurse says, "Propofol's in." Um. WTF, I am wearing bright red, it is obvious I am not a real Respiratory Therapist. Anyway, what could I do but a jaw thrust? So I dealt with the situation at hand, and it was over a few minutes later. My precepter waltzes in and says, "Oh good, you got this all set up, when are they starting?" She was PISSED. I don't know, something about losing her license if something went awry.

And now today. Happy story first. Patient who I thought would never get off the vent, is in fact on the wards now! Hurray!

Then I got to do my first apnea test today. That is a test to assess for brain death. Essentially you disconnect the vent, and stick a suction catheter which is attached to an O2 flowmeter down the ETT. Hopefully they breathe. Our patient did, which meant he failed the apnea test, and is now back on the vent. Now I will never know what ends up happening with him. I hate that.

I'm moving out of my dorm room tomorrow. I won't miss it. I will however miss this spectacular view.

Friday, August 6, 2010

Coded

I just got back from a lovely walk in a park made up of only wilderness.

I am now too tired to write about the 25 minute code, or the conscious sedation I attended on my own (much to the chagrin of my preceptor). There was also a NICU nurse who wanted to use nasal prongs at 1/4 lpm on a blender because the 100% oxygen was too much for the baby. Ever hear about entrainment? That kid was probably only getting 22 or 23% oxygen anyway. Yes, lets add the blender, then they for sure won't get above 21%. Why do his sats suck!? Or how about the CT visit where the CT tech dropped the transport vent on the patients head, and then dropped the oxygen tank on the ground, before nearly extubating the patient. It was truly awesome. No, I am too tired to go into it into very much detail at all.




Instead I am going to read in bed. 

So far I find this to be a very good and captivating book.













Tomorrow is my last shift and I will be the only student on. I really hope this does not translate into endless ECGs. I really should be exempt since I am in the ICU, but I am working with the string of RTs who really really love to "share their workload" with the students. Truthfully I love ECGs and I love even more the freedom that I am given when working with these therapists. I feel like they really trust me to not kill anyone. Which is a good feeling.

Then tomorrow night my tasks are as follows:

  •  Update blog with more details on stories mentioned above
  •  Update blog with anything exciting that happens tomorrow
  •  Pack
  •  Read
  •  Sleep

6 days until Ecuador. I am freaking out. 


Tuesday, August 3, 2010

Life

I love Life cereal. I have nearly eaten an entire box in one weekend.

Other than that, I have been home hanging out. We went to a couple BBQ's on the weekend, endured some torrential down pours. We painted the bedroom and the office, and I have full come to terms with the fact that I hate nothing more than painting. There is still furniture and belongings strewn all about the house and I have no motivation to put it away.

I had to go to school for unbearable "debrief" day today. In the morning we sit through a few lectures, and then in the afternoon today we had a special treat. We got to tour an OR in a hospital I won't work at and have 3 different people there lecture us. One station was arterial lines, another was about an anesthesia machine, and the last was about difficult airway equipment. I tried to stay positive, but it was really really boring. I don't learn well by just listening to someone yak about something. Also they use a different anesthesia machine than my home hospital, so that was all a little irrelevant as well. And no offense to the airway lady, but you don't get into your 3rd year of RT school without seeing an OPA or an LMA. This is not news.

I found out that one of my classmates has dropped out. This is surprising and sad. I can't imagine doing this much of the program and then changing your mind (not to say I haven't thought about it daily for the past 2 years).  On the other hand it is one less person to compete for a job with later. So that's good I guess.

Back to the ICU on Thursday. 3 shifts to go and then off to ECUADOR. OMG.

In closing here is an interesting article about being below average -  Get Smarter by Realizing You're Not That Great. I'm practicing this every day now.