nursing overseas

Jesus, Colonoscopies, etc

The day I was supposed to show up at the clinic for an interview, I had a panic attack.

Yes, that’s right…I was interviewing at a clinic for a nursing position—that dear, difficult profession that has brought me so much grief and so much growth. The profession I swore I never wanted to return to, at least “not as long as I can help it,” as I often quipped when asked about nursing.

Yet here I am, a year and a half into my purely non-clinical life as a nurse, and I find myself interviewing at a clinic. It started with a blog post…about what I’d learned from quitting nursing (ironic, isn’t it?). I posted a graphic on Instagram, and somehow a stranger in town stumbled upon it and direct messaged me because in many ways, she could relate to my story.

We eventually became friends (this is the beauty of social media—when screens lead to person-to-person relationships), and she’s the one who told me about this PRN job at a gastrointestinal clinic that does outpatient endoscopies and colonoscopies. The more she described the job, the more attractive it sounded: 1:1 or 1:2 patient ratios, healthy patients, 8-5 hours… She had emailed the manager, she told me. I should too, she said.

To my surprise, I did.

During the past year and a half outside the nursing world, I’ve battled thoughts of insecurity. Am I crazy for not working as a nurse? Am I going to lose my clinical skills? This one was the real kicker: Am I selfish for not using my skills to help others?

Each time these thoughts crowded my head, I came back to the moment in Cambodia I decided to quit nursing—that single, simple moment of clarity that gave me peace and confidence in my decision. I considered various PRN positions (where I could work on an as-needed basis when extra staffing was required) every once in a while, but anxiety always rose up, and I always backed down.

This time, however, anxiety sat quietly by as I emailed, called about the job, and set up an interview—that is, until the day of the interview. The reality of going back to nursing came crashing down on me, and panic rose up in my chest. I remembered the stressful days and long hours, the hurtful comments from patients and their families, the constant strain of expectations from “the people upstairs” (which is what I called the people who controlled the budget and sat in offices on the top floor of the building).

To be quite honest, the anxiety was overwhelming. I canceled my interview. A couple weeks later, with my therapist’s mantra “Exposure reduces anxiety; avoidance increases it,” ringing in my head, I rescheduled the interview simply so I could face the anxiety of walking into a nursing setting and then probably not take the job.

After praying about it, I took the job—once again to my surprise. As I began training, I was nervous, and I found all my insecurities voicing their concerns in my head. I found that my inner critic was coming out in a way I hadn’t experienced since…I had worked in nursing at the hospital. Even though the clinic setting was extraordinarily calmer and more peaceful than the hospital, in the same quiet moments of changing out a linen bag, the old, familiar voice of my inner critic showed up.

“You’re not good at this. What are you doing here? You don’t belong here. You’ll never be enough. Just give up,” the voice grumbled.

As I processed my struggles with a dear friend from nursing school, she asked two questions about this inner critic that guided me to great insight and the beginnings of peace (and grief).

First, she asked, “Do you think the inner critic has to do with your experiences at the hospital?”

“Yes,” I replied immediately. “I’ve been so stressed because all these memories of hard things from the hospital have been coming back up.”

We discussed this for a while, noting how the mindset of me being “never enough” was intertwined with my work experience at the hospital.

Then she asked the second question. “I’m pretty sure the answer to this question will be yes too, but I’ll ask it anyway,” she said. “Do you think the inner critic has to do with your experiences in Cambodia, too?”

This time I hesitated, and then replied affirmatively again. It had been a long time since I dredged up those memories from the Cambodian hospital. Quite honestly, I didn’t want to bring them back up to the surface again; I didn’t want to grieve again.

So I tried to push it back down, but I couldn’t avoid it. Each time I went to the clinic, I felt major anxiety and stress that couldn’t be explained by just starting a new job. So once again, I opened back up my memory bank; the memories come flooding back, even now:

I remember how hard volunteering in that Cambodian hospital was.

I remember how hard watching the woman with the upper GI bleed was.

And this is when it hits me. The woman with the upper GI bleed.

What broke me most about this woman was that I knew the treatment but did not have the capabilities or equipment to help.

Years later, continents apart, I show up to work at a specialty clinic—a clinic that only does two things: EGDs and colonoscopies. Things that could have saved this woman’s life.

Out of all the places I could have ended up working, I wonder at the fact that I am at a GI clinic. A place where for which GI bleeds are routinely screened.

As I reflect on this, marvel at this, grieve over this (oh, the healthcare disparity!), I notice how I call this patient, “the woman in the Cambodian hospital” or “the woman with the upper GI bleed.”

The verbiage reminds me of another famous woman, one who was also acquainted with pain and suffering. One whose name I still don’t know, yet one who has taught me much about the kingdom of God. Among church-goers, she is known as “the woman at the well.

I wonder if that woman knew, if she had any idea, how others would learn of Jesus through her. I wonder if she imagined how people would read about her encounter with Jesus and be drawn to the Messiah as well.

I wonder if the woman in the Cambodian hospital had any inkling of how she would help me encounter Jesus in a new way. I wonder if she knew I would one day write about her and remember her, over and over and over, and every time return to the conclusion that Jesus is present, and Jesus is enough. I wonder if she knew her experience would live in my memory and impact every patient interaction I ever had again.

I remember her lying there. I remember her coughing up blood. I remember desperately wishing for EGD and cauterizing capabilities. I remember the desperation as I watched her suffer.

And I remember the presence of God. I remember that Jesus was with the woman in the Cambodian hospital, and I hope she’s in His presence now. I remember that He was enough then, and I remember that He is enough now.

In the hospital. In the GI clinic. In the country with EGDs and colonoscopies. In the place without any scopes at all. In the town with the woman at the well, rejected and shunned by society. In the town with the nurse at the GI clinic, plagued by an inner critic as she works. In the town with the woman in the Cambodian hospital, slowly losing blood from an upper GI bleed.

He is there, and He is enough. For my needs and for yours, He is enough.

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Beyond the Smiles (Part II)

(For Part I, click here.) 

I remember him laying there. The bare white mattress in the Emergency Ward. The blanket stained with sweat and dirt wrapped around his waist. His ribs protruding from his thin, malnourished frame.

I remember him turning onto his side, obviously in pain. I remember his mother standing at the bedside, anxiety and fear written clearly across her face.

A group of American healthcare workers, part of a medical mission team I was working with, flocked around him and hooked up an ancient ECG machine to confirm a diagnosis of pericarditis—a diagnosis for which nothing more could be done in this rural Cambodian hospital. 

As they gathered around the bed adjusting ECG leads and talking among themselves, I stood in the back. Listening, observing, and praying.

I took in a deep breath, and I let it out. This young man was dying. There was nothing we could do about it. With all our knowledge, with all our experience, with all our compassion and good intentions, there was nothing we could do to prevent this man’s suffering and death. 

There was a time when seeing a patient like this young man broke me. It led me on a journey of desperate brokenness and incredible healing. It led me to face truths concerning what I believed about God and myself. Ultimately, it led me to rest in knowing I don’t have to be enough.

This time, as I stood near the patient's bed, everything was different. Outwardly, I was surrounded by Americans, and I was grateful to be with so many whose education and experience exceeded mine. Things had shifted inwardly, too; I found I had courage to reach out to this patient in a way I was too timid to do before but was incredibly important.

When I close my eyes, I am back in the hot, humid, Cambodian Emergency Ward. I breathe in deep, and I choose to rest in this truth: I don’t have to be enough, for Christ is enough. When I stop worrying about how much I can’t do because I am not enough, I hear Jesus’ quiet invitation to sit in His presence, even in the midst of such deep suffering. And I accept. 

I sit in His presence and bring this young man to Him, praying he would know the peace of Jesus’ presence, too. I sit in His presence and bring myself and my broken heart to Him, finding space to grieve and freedom to be sad because when I’m with Jesus, the lie that “I have to be the strong one” crumbles. Jesus is the strong one. I never have to act like I have it all together—because I don’t. Jesus knows this. He's okay with this.

The Americans clear out, and it’s just my dad and me left. With the help of our friend and translator, Dad explains why the American team is there, to teach and work with the local doctors. The patient’s mother looks up tearfully and asks if her son will live.

All our knowledge, all our diagnostic powers, all our education and good intentions—it means nothing in this moment. We have nothing to offer this woman and her son. Nothing except Jesus. So we ask if we can pray, and I reach out my hand to touch this patient’s dirt-smeared blanket and lift him up to Jesus.

And I know in all our heartbreak, in all their heartbreak, Jesus is enough, and He is with us. 

His presence is so strong. It always is, if we'll just acknowledge it. If we'll just accept His invitation and stop our striving to be everything, fix everything, and know everything. Perhaps this is the most important thing I’ve learned about poverty in the past few years. Poverty and suffering highlight our sense of helplessness, and so often our response is to push this uncomfortable feeling down and ignore it or to grit our teeth and take it upon ourselves to eliminate disparities. Yet I’ve found no freedom there. 

No, freedom is found in Jesus' presence, in trust. It's found in trusting God is enough, trusting He cares and is big enough for all the hurts in the world and my grief over poverty and suffering and death, and trusting God is, indeed, good.

He is good. Even when everything around us seems to be wrong and impossible and heart-wrenching and clouded with evil. He is, indeed, good, and He is enough.

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For Nurses in Developing Countries

You know you're a nurse living in a developing country when...

1. Every time you see a body of water you think about Schistosomiasis or some other water-borne parasite.

2. You're sitting on the commode with diarrhea and as you think about your lack of water intake and proper diet during the day, you literally say out loud to yourself, "I'm losing so many electrolytes right now..."

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3. You dutifully use hand sanitizer every time soap and water isn't available, but secretly you're thinking of all the diseases only soap and water can kill.

4. You notice how dilated everyone's veins are in the hot, humid climate you're in and wish you could teleport your renal patients here for the fifteen minutes prior to starting an IV on them.

5. You're constantly telling people to change their diet to include more iron because you have a strong suspicion they're anemic after quick visual assessments, such as noting pallor in their nail beds.

6. You text your friends unashamedly about your abnormal bowel function overseas.

7. You adjust your diet according to your current bowel ailments. (More tamarind allowed today I'm constipated. More rice and less fiber when I have diarrhea.)

8. You're constantly reminding people to wear their motorbike helmets because safety always comes first, no matter the heat or discomfort. (You've seen one too many head traumas from motorbike accidents.)

9. It bothers you to the nth degree when you see people smoking on hospital grounds (considering all wards have open windows and doors and smoke can go everywhere).

10 Your heart breaks a little every time you see malnourishment. Which is pretty much every day.

11. You struggle because you have an overwhelming instinct to fix everything and make everyone feel better, but you're simply unable to. You find hope in helping one person at a time entrusting them to a Higher Power.

12. You are assessing community health needs continually, as you learn more and more about the culture, health care, and superstitions/beliefs affecting health practices.

13. Your friend in your passport country still sends you a picture of her infected eye to ask if it's pinkeye. (You reply yes, it looks like it is.)

14. Your days of running around a hospital floor getting cups of ice water so your patient will take their pills - all the while wearing a jacket because the a/c is turned up so high - seem like a distant dream.

15. Though your tolerance for super-entitled patients drops a few notches, you still respond to all with compassion and empathy because you realize in developed or developing countries, people's needs are the same: physical needs for food, water, medications, and hygiene, but also emotional and mental and spiritual needs. They just manifest in a different way. No matter if they're upset in a private American hospital room or in tears in a hot, crowded Cambodian ward, they are scared, stressed, and in need of healing and a Healer. So we respond with compassion to all. Because that's what we do. Because we are nurses.

 

To nurses in developing countries:

May your learning experiences, encounters with the sick, and poops be solid but not too hard.

May your heart, food, and water be purified and well prepared.

May the days you have the runs be blessed with plentiful access to flush toilets, toilet paper, and empathy for  patients with E. coli.

May your searches for soap and water, Lysol, deeper meaning in life, and a paradigm for suffering be fruitful and rewarding.

Most of all, may your compassion, immune system, and faith only be strengthened by your time overseas.

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