Some catching up to do....

Since I last posted, I have been to Vieques, snorkeled off of Puerto Rico, and started my medical/surgical rotation...I have a lot of catching up to do.

Vieques

Over our Spring Break, we took an excursion to an island off the eastern side of Puerto Rico called Vieques. A small island, 22 miles long and 4 miles wide, sits just 7 miles off the coast. We had been hearing so much about this place. The Puerto Ricans told us that it was a 'must see' while staying here. 

After a short, bumpy ferry ride, we landed in Vieques for a couple days of fun. 

We stayed in a small bed and breakfast named the Tradewinds which was right on the water. It was cute and included breakfast, drinks and creatures of all kinds including lizards and frogs. Our reptile friends added to the "Puerto Rican" vibe, so I didn't mind sharing a room with them.:) 

If you can make friends with the animals, this was a place I would definitely recommend if you are inspired to see what Vieques has to offer. 

Red Beach - listed as one of the best beaches in the Caribbean

View from breakfast at the Tradewinds

We also tried out the famous Bioluminescent Bay that is supposed to light up when paddling through the water in your kayak...key words: SUPPOSED TO! Our tour guide said it was one of the worst nights for the BioBay that he had seen in a while. He guessed that because of the unusually warm weather, the dinoflagellates (bacteria that glows) were not lighting up. So while we got the occasional 'glow', it wasn't as bright as it should have been. :( 

Besides the disappointing turn out from the bacteria, we were still able to kayak at night through mangroves where sharks come to feed...how cool is that?!

The best kayaking team there ever was.

Culebra 

After a few short days in Vieques, we came back to Puerto Rico just to turn around and jump on that same ferry and take a day trip to Culebra. Culebra is another island just north of Vieques off the eastern side of Puerto Rico. We had heard of Culebra and the magnificent beaches there but after the weekend we just had, we didn't know if it could top our experience in Vieques. 

Flamingo Beach was just recently put at number 3 on Trip Advisor's Best Beaches in the World; it definitely did not disappoint. 

Snorkeling

We went snorkeling off the coast of Puerto Rico on a catamaran cruise. Not much more to say except that it was one of the best days thus far in PR. 

While in the water, someone yelled SHARK! It was a massive, humongous, ginormous SHARK:

Ok, fine, so it wasn't THAT big....

Start of Med/Surg

So I guess I should mention that I am also in school...

We finished up our psychiatric rotation and started our medical/surgical unit. While psych was interesting, the medical/surgical aspect of nursing is what really intrigues me. 

We jumped into our hand on experience the very first day. I was able to deep suction a patient's lungs (a tube down their throat that suctions out the secretions), change chest tube dressings, administer a MRSA test, participate in an admission and give multiple bed baths. It was definitely a day where I felt submerged in the daily routine of a nurse and I loved every second of it!

The next day at clinical was my rotation to the operation room. Life-changing doesn't even begin to describe it. 

It is exciting when walking towards the operating room as it is a chance to see parts of the body that usually are only seen in pictures in our textbooks. Going to the OR gives a new meaning to hands on experience and really puts what we learned in the classroom into real life situations.

After observing the first operation of an arthroscopic knee debridement (cleaning out years of ‘wear and tear’ in the knee from arthritis), the surgeon pulled me aside to teach me a few new things. He showed me the proper way to ‘scrub in’ which included 5-7 solid minutes of washing hands all the way up to the elbows. He presented the proper way to put on a sterile gown and gloves while still maintaining sterility. He listed off names of instruments that were meticulously lined up on the sterile tray next to the operation table. He then said, “your turn.” Yikes.

Little did I know, he had planned to test me on everything he showed me to see if I was ready to scrub in for the next orthopedic surgery. After washing my hands for 5 minutes, trying as hard as I could to remember which way to scrub the soap and how long to scrub on each finger, donning the proper gowns, gloves and mask and naming many (missing a few) of the instruments he had taught me, he said, “you passed the test!”

I was able to stand within the sterile field, help with mobilizing the knee, and closely watch the subsequent surgery as the two surgeons worked on the patient’s joint. As they scraped away damaged parts of the bones and ligaments, they quizzed me on the different parts of the knee that were being displayed on the large monitor via the arthroscopic camera; A learning experience I will never forget.

Other procedures I observed that day included a sigmoidectomy to take out colon cancer, surgery to reduce the intraocular pressure in the eye of a patient with glaucoma and a fistula placement in the arm for a patient who is headed for dialysis treatment.

It is amazing to think that a person was blessed with the skills to fix what is broken and transform a person’s life via medicine. The technology I observed that has allowed the medical field to progress so immensely in increasing the quality of life for so many it seriously awesome. The experience in the operating room was incredible and really made me excited that I entered the healthcare field in this quickly advancing society. 

I should learn that the longer I wait to post my adventures, the longer the blog post is. ;) 

A Day on the West Side

This past Friday, our RA took us to the western side of the island. Since we have been here, the patients at the hospital, other tourists and locals have told us about the amazing beaches on the west side. So to see it all, we went to three different beaches in one day.

Playa Jobos in Isabela 

We arrived so early that there were no other people there, so you could say that we had a private beach. :)  This is the surf spot of Puerto Rico as it hosts many surf competitions throughout the year. 

Coconuts lined the beach so naturally, we cracked them open to drink fresh coconut water, right from the source! 

There was also large cliffs that were magnificent...I don't have words for it so just take a peek at this...

Crash Boat in Aguadilla

This was the best place for us to snorkel and see the tropical fish right off the shore. We also saw dolphins frolicking in the water just outside the designated swimming area. 

Lots of boats (like the one above) lined the beach. The story is that these were used daily for fishing but are now 'touristy' decorations on the shore. There was also a long, rusted, abandoned boat dock that allowed us to jump off into crystal clear water.

Playa Sucia in Cabo Rojo

Yes, this does mean "Dirty Beach" but this beach was the farthest thing from dirty! In parts of the beach, the salt from the water evaporates to the top (don't ask me how that happens). It causes the water to become 'crusty' and red, thus it became Playa Sucia! 

The crystal clear water with an inlet to the ocean was probably my favorite location of the day. There was a yellow lighthouse at the top of the cliff that overlooks the ocean and a large drop off cliff. 

Overall, it was an AWESOME day. I am so lucky to have this experience!

Before I go off on a tangent about another amazing day of clinical work I had, I want to let you know that I am serious about HIPPA and confidentiality laws. Anything I say in these posts about patients is not personal information and cannot be linked back to their name, address, social security number, birth date, etc. and is therefore ok to post. 

Today, I went with social workers (who work with MHICM - Mental Health Intensive Case Managers) all around Puerto Rico to see patients in their homes. This included group homes, condominiums, home depot...I'll explain later.

Our first stop was at a group home for only male psychiatric patients. I was warned before getting out of the car about the attention I may receive because females are not often present in the home. Hesitantly, I exited the car and scurried into the house where we would meet with the patient. The first patient was convinced that I was his wife and would get upset if told otherwise. I am never offended by the comments that are said, but it was a little uncomfortable being told you are someone's spouse and trying to tell them differently is impossible, but I was warned. :) 

The second patient was in the same group home and before entering the room, the social worker told me that this patient was "the sweetest man you will ever meet." He entered the room with a big smile that didn't diminish throughout the conversation. His first language was English so when he found out that the interview would be in English today, his face lit up! He told us about how he was a violinist who played at Carnegie Hall, played for Johnny Carson, and was a successful musician all throughout New York City. His life took unexpected turns and he ended up needing psychiatric help. Again, even when talking about his struggles, he was still very positive about his experiences. 

He emphasized that he didn't ever want to burden anyone. He would go days and weeks without pain medication because he didn't want to ask someone to get the meds for him. After a long interview with him, the social worker (who had been working with him for a couple years) was astonished about how he opened up to us. He said that because we spoke English, he felt like he could tell us more. He didn't want to burden the social workers and ask them to speak in English in previous visits, so he would struggle with the Spanish to accommodate to them. Seriously, one of the sweetest men I have ever met.  

One of the last patients we met with did not want to meet in his home but rather at Home Depot. So, naturally, we conducted the interview whilst walking through aisles of lamp shade samples and wood planks...only in Puerto Rico. :) 

This group of patients are complex medically yet very simple in nature. They teach me to be humble and positive everyday and I am oh-so grateful for that. 

My view for the day

The Hospital...

Most of the days are relaxed and seemingly calm because the patients are on medication that keep them stabilized while in the hospital. That being said, there are some eventful days, too... 

In regards to the patient population, the veterans struggle with so many more psychiatric battles than the average person. Between PTSD, Major Depressive Disorder, Bipolar Disorder and Schizophrenia, there are a spectrum of diseases that put this population at a severe risk for mental illness. I feel honored to be able to take care of such a special group of people.

One patient I will always remember is the patient I was with today. This man came in from a medical floor, where they were treating his stage 4 pressure ulcers (many of them). If you don't know what this means, let's just say that while the nurse was cleaning and dressing the wounds, she said "I think that is the bone."......ya. 

This man was also plagued with dementia and schizophrenia and was disoriented and had disorganized thinking. He had to have ankle boots on to protect his ankles from potential pressure ulcers because of his bed-bound status. He also had big, padded mittens on his hands that reminded me of the Mickey Mouse gloves you can buy as a souvenir at Disney. He was constantly "talking" to his delusions and attempting to bite his fingers through his gloves. He would swear at me and the staff when we tried to bathe him or re-position him to prevent further skin damage. He did not have any teeth so all the food we fed him was of "nectar consistency." He was skin and bones and to add to it, the staff had said he was "too aggressive to feed" so he had not eaten until we got there and had time to encourage him to eat..

Needless to say, this image broke my heart. The fear and helplessness that shown so vividly through his eyes was a big reminder for me that the people I meet everyday are not just patients, they are humans. A human who is separate from their disease. A human with a history and a battle that I will never understand. 

As devastating as it is to watch these people suffer, I am again reminded of how blessed I am to have my health and the life I do. 

Instead of making another (boring) post about the hospital, I wanted to add a little blurb on an experience I had today in the hospital. I was able to leave the psych unit and go down to the operating room to watch a procedure that seems so barbaric. It is called ECT or Electroconvulsive Therapy which is for patients who have not responded to medication. The psychiatrist, nurse and anesthesiologist were the only people in the room, so no surgeon was involved. The patient was put under general (fast acting) anesthesia and a muscle relaxant and a shock was delivered directly to their brain from a large silver "tool" that was pressed against their scalp. This induced a small, controlled seizure and the procedure was done, taking about 15 minutes in total. It is supposed to change the chemical nature of the brain, allowing for a relief of symptoms. I met with five patients who swore by the treatment and said they felt significantly better and that their depression,  schizophrenia, and other psychiatric symptoms had improved.
As barbaric and inhumane as it sounds, it seems to be working...the medical field is astounding!

Today we took a trip to La Hacienda Carabali, a horse ranch on the outskirts of El Yunque Rainforest. There, we took horses through the hills of beautiful scenery, just to the outer border of the rainforest where we were greeted by the most beautiful rainbow. 

La Hacienda Carabali with the hills of the rainforest in the background covered by the rainy clouds.

I made the "mistake" of telling the guide that I had experience with horse riding. He gave me one the the biggest horses and what I found out later to be, one of the fastest horses, too! Scary at first, but riding a horse is like riding a bike; It all comes back so quickly. Just this little time riding through the trees was enough to make me want to pick up horse back riding again when I get back to Connecticut. So, so fun! 

It was too beautiful for words, so I'll just let the pictures do the talking...

We stopped at a river, jumped off our horses and enjoyed what nature had to offer. Our tour guide made tribal face paint with the rocks in the river in which he said is a tradition of the Taino people. Unfortunately, the Tainos are almost all gone off the island because of the Spanish settlements. There is said to be less than 1% of Puerto Ricans with Taino blood. 

My teacher and classmates

After, the ride, we went back and had a nice lunch at a restaurant near the 'hacienda'. Most of us ate the traditional meal of mufungo, a mashed and friend plantain in the shape of a bowl. You can choose chicken, pork, shrimp, lobster, etc to go on top with a choice of garlic or creole sauce. YUM!  

Mufungo with creole chicken

On the way home, the driver of our van mentioned that one of the best beaches was just down the road from where we were, so of course, we made a pit stop. This beach has a line of restaurants which have been the sites of some of Anthony Bourdain and Andrew Zimmern shows. 

Again, I just have to express how grateful I am to have this experience. I am having the time of my life and wouldn't trade it for anything. As to where my next adventure is...I think I see something over THERE!! :)

The children in their school uniforms.

As I am enjoying my time down in Puerto Rico and am so grateful for the opportunity, I am continually thinking about the children in Ghana. They started school right after we left and Patrick was able to keep working on the building because of monetary donations and volunteer support. I am always looking at their facebook page to see new pictures of the kids and I miss them more and more each day.

To donate to the orphange, please visit this website, created by a past volunteer. It will help Patrick rebuild the school and a new place for housing and provide a better means of living for the children. 

http://www.gofundme.com/417ay8

Before...

After! The school's progress!
Photos via Savior Children Foundation Facebook Page 

Our first week in Puerto Rico has been crazy! 

Last weekend was the San Sebastian Festival which is what some Puerto Ricans call, "the best weekend on the island". Juan-Carlos, our Puerto Rican residential assistant (and personal tour guide), told us that this festival started by a group of priests but turned into a large party in the streets for four days in a row. He says that Puerto Ricans will find any excuse for a party. :)

We went to Old San Juan Friday night to participate in the festival and were trapped between the crowds of people and the beautiful buildings of the city. After seeing what Old San Juan looked like at night, we couldn't wait to see it during the day.

Saturday afternoon, we took the train and a short bus ride to get to the heart of Old San Juan to see this: 

It looked like a little slice of Europe that was planted in the Caribbean. Every building has a unique history (and color). 

The San Sebastian Festival continued throughout the day and on til Monday.

San Sebastian Festival

One of the big questions people have asked me is how the food is...and shamefully, I haven't been able to try a lot of it. We had a refrigerator packed full of food when we got here so we have not had the chance to eat out a lot. Although, we were able to stop once at a restaurant in Old San Juan that served traditional Puerto Rican food, which we all learned pretty quickly, is FRIED. 

Plantain tamale, baked pork, a fried plantain, fried rice

As my parents have been saying..."Aren't you there for school or is it all vacation?!"

Thus far it has seemed like a vacation, as we are just getting back into school mode. Tuesday was our first day at the hospital, exploring the floor and touring the building. 

Our psych rotation is really interesting! The patients are all very friendly and excited to have new faces on the floor. A sweet man told me we was the ruler of the Ming Dynasty in China and later in life was an Apache Native American. They tell us a lot of things we have to take with a grain of salt...sometimes a very large grain of salt. ;) 

The second day of clinical, I was able to spend the day in the Day Clinic - a program for former inpatient psychiatric patients that do not need hospitalization but need continuing treatment which is mostly group therapy. 

As I walked in the clinic, all of the patients seemed anxious and on edge. I couldn’t tell if this was just the vibe in the clinic or if there was something different that had happened. After hearing “investigación” and “asesinato” a couple times, I figured out the reason for the extra anxiety in the air. The nurse further explained to me that the conversation was about a former participant of the day clinic that had killed his wife and himself the night before. The participants at the meeting were nervous about the risk that one day, they could just snap. It made me realize the thought process of an individual with a psychiatric illness. For example, I know I do not have the mental capability to harm another person, but people with mental illnesses can be nervous that because of the flexibility of mental cognition, they don’t know where their mind can take them. 

Humbling to say the least.