So I Have Shingles

Yep, I have developed shingles. Apparently it's rather uncommon for an otherwise healthy young adult to acquire this post-chicken-pox disease that normally occurs in late adulthood. Hopeully this means I will continue to have a mild case. It can crop up from stress, of course. So here's what happened; I was at my acupunture visit and I was telling Bobbi that I had had a rough day two days before when a couple had to transfer to the hospital and ended up with a "Caesar" as they call them here. This is my first transfer experience as a doula. The following day I was part of four births, three of which were pretty dramatic. Later on in our visit I mentioned that I noticed a few "spider bites" on my abdomen about two days before. She pauses and says "really? Two days ago?" 

So the ensuing week turned my spider bites into full fledged shingles along the dermatome (nerve root) in the middle of my abdomen from midline to spine on my right side. Only last night did I wince and swear with every tiny movement. It's incredible shooting, sharp and numbing nerve pain. The natural course of it is 2-3 weeks, so I'm about halfway. I will hit an infectious stage here soon, but it's short lived and only causes chicken pox in someone who has never had it, even then it's direct contact contraction. Also there are no symptoms of malaise or fever, so really it's only this bizarre nerve pain. It can turn into chronic neuralgia in a few cases, but it's not likely, and once you get it it's very rare to get shingles even one more time. So I feel like my research of it has given me an assuredly positive prognosis actually.

The clinic is pretty quiet this week too, another holiday is in the making, so we'll see about next week. I plan to still sequester myself during my active phase of the shingles. Maybe another photography excursion to the rice paddies, or maybe to a quiet beach town. Seems to me like a great way to be going through something like this I suppose.

The Midwoof

There are angry mangy dogs everywhere in Bali, and organizations called “I *heart* Bali Dogs” try and save them from their potential miserable lives. But I’ve decided I don’t love the dogs, or the monkeys who try to steel everything from you; cameras, food, sunglasses, I’ve heard about them picking up burning cigarette butts and put the wrong end in their mouths. But they chase, and bite and hiss, they are nasty. They live in the Monkey Forest Sanctuary which I walk through if I need to get to town from the village I’m staying in: Nyuh Kuning village which means “yellow coconut."

There is one dog who has decided for some reason that he needs to walk me from the clinic to the ashram if it’s during the night after a birth. I just learned that his name is Highway, and he’s considered the “midwoof” of Bumi Sehat. Ah, I love it.

***

This week there was a grand ceremony holiday called Galungan, and it's been described as the Hindu Christmas, meaning it's probably the biggest holiday of the year. It's mainly for the children and each family compound spends days building and creating a beautiful and uniquely decorated HUGE branch from the forest and sticks it upright in the ground with dyed palm strands and lanterns and flags and amazing floral and fruit arrangements hanging all over it. You can see in the photo of the street (from in front of the clinic) that it's lined with these overarching "Christmas trees." The kids eat a ton of sweets, traditional Balinese meals are made, and family's spend money they don't have to put it all on. I've been told that bellies, cupboards, and health tend to go without for a few days before and after in order to make it work financially.

What was very striking to me was that the clinic was very busy the day before the holiday, chock full of primips (first-timers) in very early labor and multips (not first-timers) who were drinking lots of young coconut water in an attempt to get labors going. There were 8 babies born the day before the big day. Then... nothing. Then a flood of births came on the day following the holiday! I think that's hilarious. It's been amazing, but exhausting. The number of volunteers has also dwindled, so my own workload has picked up. I'm doing a lot more clinical tasks than on top of the labor support, which is very good for keeping up my nursing skills, it's been great. And, I consider this kind of thing a bonus or perk to this job, I saw a baby born in the caul for the first time. This happens when the membrane of amniotic fluid never rupture during labor, and labor progresses fine without the need to have it ruptured which is soooo common to have done. So the baby is actually birthed still in the sac--face all smooshed up. It's imperative to break the sac at that point but it is considered very spiritually lucky, in many cultures. It was exciting for me.

***

Also posted is a photo of Robin Lim and her daughter Déjà. We were privleged to see the very first unofficial "premier" of Déjà's new documentary Guerilla Midwife. The film is about Robin and her incredible life's work to bring peace on earth with every gentle birth. She and her organization did a lot for the Tsunami victims in Aceh on Sumatra, the stories in the film told by survivors are horrendous and beautiful. I can't wait till the film is available for everyone, it's a "must-see."

You Can Only Get Hit By the Truck That You Don’t See Coming

I love attending births on other people's birthdays... it feels like I'm honoring that person. So here's to Sara Sage!

This morning I got called into the clinic to assist a labor for a woman already at 7 centimeters dilation. After three hours of back-labor progressing into a resistant second stage there was another full moon baby at Bumi Sehat. My predictions of raining babies this weekend definitely came true after a relatively quiet week. Afternoon rolled along and I was actually going to make the appointment I'd made the evening before to get my first massage here. It was a new place highly recommended by the staff at the clinic, and this month there is a grand opening 50% discount. So I went for some therapeutic pampering. And it was. I received an hour and forty-five minute massage and body scrub of rice, ginger, peanuts, oil and potato and then finishing with a bath in the first warm water I've felt (I shower under a hose of icy cold water at the ashram!) not to mention the bath was dense with frangipani buds and ginger bark. The whole experience was incredible, and it cost $7. I stopped in at the clinic on my way back and we have two primips (first-time moms) here both at 1 centimeter, and they are sisters-in-law! It's going to be a long night--good thing I feel completely mushed yet rejuvenated.

Take care of yourself, pay attention to the signs your body gives you and really listen and then don’t forget to respond. Namely; slow down and you might live a longer life--literally (hence the title of this entry.) This is reiterated to me by Dr. Bobbi, the acupuncturist at the clinic. I am going to be getting my first treatment by her this week. I have always recommended acupuncture for folks for a lot of ailments—but I have never had it! When I was freshly diagnosed with diabetes, almost nine years ago now, I was told that there was an acupuncturist who was curing newly diagnosed diabetics. I remember that my mom actually spoke with this person, and he wanted me to immediately stop taking any insulin therapy, and that I should come and stay wherever he was practicing for a proper healing, unfortunately that would mean leaving in the middle of my junior year of high school. It was not practical. So here I am years--and loads of insulin--later, finally about to receive my first treatment. I’m hoping for some boost in the circulation department, possibly a recharge of my energy overall, and any kind of kick in the pants on the old pancreas that I can get!

Speaking of health and diabetes: I have noticed a few wonderful perks to this already pretty fantastic experience. I walk everywhere like the poorer Balinese (i.e. no Motorbike) and I eat like the ex-pats (trendy macrobiotic health cafés) and so far I have been enjoying a steady stream of blood glucose levels right around 130. I’m very pleased with this. And, though unrelated, I’m also very happy to notice that my usually miserable cuticles are very healthy looking, which is helping me to grow fingernails (which for me and my nasty nail biting habit is a really big deal!)

So, my body and my soul are very happy here. 

Meet some families

A few photos of some beloved families from the clinic.

I've been working mostly with families coming in from the "fields" as they say here, with very very little, still almost everyone has a mobile phone. To announce a few generalizations here: almost every woman has experienced a pretty decent tear, the theory here is that folks are very malnourished because of an increase in white rice production thus decreasing tissue integrity. Also there are occasionally sad faces with a family having just birthed another daughter. But there are wonderful things too: dads are very involved in labor; cooing, massaging, and perpetually smiling.  Also I never know what any of the babies' names are before they leave here because there is typically a three-day naming ceremony, which sounds very fun--so I have to wait for a postnatal visit to learn all these newest little folks' names.

Contact Information and the Dirty Duck Diner

I eat gado gado everyday. My first dish was at the local Dirty Duck Diner a favorite restaurant from when I was here last with the girls in 2001. Apparently it was named for its first guests; before it was completed, a flock of ducks ran through the restaurant to the rice paddies out back and left their muddy tracks! Gado gado is a dish of sprouted grains, kale, bok choy, carrots, green beans, tofu, colorful chilis and a liberal amount of peanut sauce. It’s even better than it sounds! This meal was accompanied by a blended fresh watermelon, ginger and mint leaf drink [Raederle, Kaiulani, Corinne & Lynette, it was even better than I remembered; you have no idea how much I wish you were all here again with me!]

At the center, if not at a birth, I have been assisting in the clinic. There are prenatal visits, acupuncture, moxabustion, cupping, massage and reiki [Grammy I am doing lots of wonderful and energy rich reiki here, thank you!] and they do a pediatric clinic on Mondays. Kids with cerebral palsy can get routine acupuncture and there have been numerous improvements on body movement and stabilization of nerves apparently.

***

I can be reached by mail via the clinic at:

JANE SILVER

c/o Yayasan Bumi Sehat

Nyuh Kuning Village PO Box 116

Ubud, Bali 80571 Indonesia

and I now have a phone from the clinic to be on-call, it's free to receive calls, so if you're inclined... Forest... 

0 62* 81 353 01 2276

*please note the change!

Nafas... santai... bagus.

Breathe... relax.... good.

Bali is exquisite.

I arrived late afternoon on Friday 8/8/8 after 24 hours of traveling. Robin Lim met me at the clinic gate with kisses. This is her baby (well, one of many I suppose), but her Yayasan Bumi Sehat clinic means Healthy Mother Earth. At the clinic there are 8 local Indonesian midwives, or bidans, and several volunteer midwives who come from all over to bring their expertise and learn the Balinese way of birth, or maybe Robin’s way of birth—which is worth learning. When I arrived I met two nurse-midwives, one from Australia, one from Italy, as well as a Canadian studying midwifery in New Zealand. There was also another doula/nurse from San Francisco; today was her first day as well. 

Robin tells me immediately that there are two women in labor right now... taking the hint, I unpacked my things in the volunteer ashram across the street, and headed back. Apparently there hasn’t been much going on all week, so of course tonight was the night there were four babies born and thunderstorms struck outside. Hmm, now that I think about it, I started menstruating as well, and last month I started on the night of the double birth mentioned in a previous posting... 

So many beautiful things happen here when someone is born. Robin does two very striking things in preparation for a birth. She asks someone to bring pusba or flowers. That night she asked her granddaughter Zhouie to go across the street to shake the tree in front of the ashram and she brought back beautiful plumeria blossoms. With these Robin drizzles them into the warm bath water where a woman is laboring, and I am crouched and bent over with my arm in the bath so that she can have the counter-pressure she needs on her lower back as her baby descends. Robin then asks all her moms what religion they practice or place their faith, and she proceeds to chant or recite a beautiful prayer with each contraction until the baby is born. This night she sang the Balinese Hindu prayer song, recited the Catholic prayer to Our Heavenly Father and sang Ave Maria, and then by morning she was saying Allah to the Muslim couple in anticipation of the father reading the full prayer to this new baby as the first words she hears. Someone asks later and she tells us that her own religion is primarily based on women and babies and "gentle births bringing peace on earth"—sounds like a good religion to me. Lastly, though Robin does a gazillion things, something very sweet she does is to scoop the plumeria blossoms and strew them around the placenta in a bowl. I think it’s a gorgeous tribute to one, if not the most amazing organs in the human body. You need one, you make one, you need another one, and you make another one! When you’re done with one it nourishes whatever it goes to; the earth if planted or the body if ingested, anyplace that is except a biohazardous waste bag in a landfill somewhere.

Of the six births during my first 24 hours I saw the above stunning posterior water birth (baby with his face up to the sky and eyes opening under water as he was born), and I walked into a room where a man kept poking his head out, his wife was laboring beautifully but he seemed so nervous. I stepped back out to get the midwife and went right back in to her room. She lifted her skirt and there was a baby’s head all the way out! The midwife came in behind me and with no time for gloves, eased out the rest of this little lady. It was a beautiful and busy number of hours. We did, unfortunately, have to send one baby to the hospital for suspected respiratory complications, a perfect birth but she just couldn’t cry that fluid out of her lungs.

This birth center and clinic is amazing how it creates so much with so little. I think my favorite so far is instead of medical supply KY lubricant for the Doppler ultrasound machine for listening to fetal heart tones, we use cheap and lovely smelling aloe vera gel!

Robin has many theories on why this world works in the ways that it does, and sometimes that involves saying things like, “I’ve never had a good feeling about this bed, tomorrow we’re getting rid of it,” after the baby who was transferred to the hospital was born in it. Getting rid of beds aside, they are definitely at capacity here, there are several beds to a room already, and so Robin is hoping to expand the clinic to accommodate the community—this is part of the One Million Mothers campaign.

And so it goes, this is birthing in Bali.

Harborview Moments: A montage..

Harborview Medical Center is the WAMI region Level 1 Trauma center, meaning Washington, Alaska, Montana and Idaho all send their critically ill and injured to HMC in downtown Seattle. This is where I have been for all of my clinical rotations as a nursing student, except for my peds rotation at Children's Regional Medical Hospital where I battled with toddlers to listen to their tummies and give them goopy sickeningly sweet smelling medications. One of my highlights at Children's was the "patient teaching" I did for my eight year old with an infected broken bone, I taught him how to play Battleship, we played for hours, it was awesome.

Anyway, Harborview is an incredible place. Let me give you a little run down of the past 9 months...

Key Words: ED = Emergency Department, TICU = Trauma Intensive Care Unit, BICU = Burn ICU, sedated = medication induced depressed central nervous system state in which a person is asleep and possibly without memory of experience, intubated = tube down a patient's throat to provide on airway, ventilator = machine that is hooked up to intubation device to manually or mechanically breathe for someone who is otherwise unable to breathe on their own e.g. a sedated individual, KCJ = King County Jail, CT = computed tomography, referred to sometimes as a CAT scan, FEMA = Federal Emergency Management Agency, divert = not enough beds or staff at the hospital to take any more non-critical patients--must be dispatched to other hospitals, IV = intravenous, BP = blood pressure, stridor = abnormal high-pitched breathing sound usually caused by throat blockage. Please let me know if I missed any!


One of my first weeks on the medical unit I had a patient who had a septic abdominal and pelvic infection and he needed a femur traction to stabilize the leg bone in place of the acetabulum in his pelvis. A surgical resident arrived bedside to perform the procedure, and asked if I'd be willing to help. As I'm donning sterile gloves, my first time practicing sterile field technique, he warns me that he recently had an army medic assist him in the ED and the guy passed out from the blood. The surgeon tells me it's a pretty barbaric procedure, "Ortho always is," he says. So far I think I'll be fine. I position myself to hold my patient's thigh with one hand and his knee with the other, to stabilize the femur. Andrew (as the surgeon had introduced himself) was giving lidocaine injections to the pin sites, the spots where the traction pin was to be inserted and then exit the leg on the other side. He begins to hand drill directly into the first lidocaine mark on the inside of the leg. My patient is psyching himself out to be royally in pain, I tell him to hold onto my elbow, and he grips it for dear life. Moments later, Andrew says, "Did you feel that? That vibration means we're in the bone now." After more manual drilling of this rather serious looking hardware the pin begins pushing its way out the other side. Andrew says, "Hmm, I think I missed the lidocaine wheel, but we're almost done here." As the pin emerges the skin around the site has become twisted with the manual turning, and Andrew very simply takes a scalpel and quickly slices from the pin outward about a centimeter to "unscrew" the tighly coiled skin. Now he attaches the device that will connect to the end of the bed and the rope that will be connected to each pin on the traction piece and the 15 lbs of weight that is hanging from this rope and dangling off the side of the bed, ya know to stabilize the leg.

Fast forward  a few months (to just a few weeks ago)  in the TICU where my nurse tells me to go watch a "Halo" placement on a newly admitted patient with a spine injury from a high speed motor vehicle collision. I stand in the back as a Neuro surgeon proceeds to inject lidocaine wheels into several key targets on this man's head. Then the halo contraption is placed and the pins are being screwed in. There were two of them working on either side with another surgeon holding his head, the patient here was sedated and ventilated. Once the whole procedure was finished the main surgeon turns to me and says, "Well, what did you think of that?" and I said, "Not as barbaric as a femur traction..." and he replies, "Ortho always is more barbaric..."

The day that I first shadowed in the ED was a day that folks in the community were not taking care of themselves as a general rule. I was immediately ushered into a curtained section where a man was sitting perfectly calmly as people buzzed all around him. His left hand was wrapped in gauze. He had been working in a steel cutting factory and had sliced off his fingers. The digits were in the cooler next to him. This became the main focus. The cooler was opened, the ice was dug through, a plastic biohazard bag was found and opened, rollls and rolls of gauze were unraveled and four separate dirty, but very cleanly severed fingers were revealed. You could see a creamy white round disc at the base of each finger, and when the hand was simultaneously unraveled from the gauze it also had four matching white discs of bone where his fingers had recently been. The patient was peering over the side of the bed and sneaking peaks at his own flesh. The doc said he's do his best, and that he was about to be wheeled in for a day of fine tuned surgery. The patient, very calmly, says "I just need one, just save at least one..."

The first bed in the ED is typically saved for a big trauma. So that's who showed up next. A KCJ man of 25 had jumped, he was later affectionately called the "jumper," from a two-story building and landed on his head... and never lost consciousness. He was immediately stapled and whisked into CT to scan for skull fractures and anything else. I peaked in on an x-ray and saw a couple of teeth in his stomach on the image they were collecting. When he was back out on the floor he needed to have his staples removed and proper sutchuring done to keep the swelling in check. I had been blotting his dry and cracked lips with a wet paper towel because he desparately wanted something to drink and wasn't able. As the doc was sutchuring two observing amry medics gathered and offered to help, he was obliging. First he asked for saline. The first medic grabbed a vial and handed it to the doc, and as the doc said, "that's lidocaine" I handed the assistant medic the saline flush. After a moment of trying his hardest to push the plunger on the syringe I reached over and unscrewed the cap for him. With the patients eyes covered he asked which one of these guys was helping him out with the wet paper towel... I did it one more time and then moved on to something else.

A classmate of mine also spent a day in the ED, and during report at the end of the day she says, "Jane, I thought of you down there today... we had a woman come in with contractions after dosing up with heroin that morning. This was her 8th baby and there wasn't time to take her to the UWMC where they have a Labor & Delivery unit, so we called in an on-call OBGYN doc and took her a semi-private room in the holding zone where she started pushing." This classmate says she's terrified of birth, and did not want to be there, but tried to at least slip into the background when her precepting nurse said they needed her help. She ended up holding a leg and saw very first hand her first birth. Unfortunately the baby (one of probably very few born at HMC) was born addicted to heroin.

I also had the amazing opportunity of riding with the paramedics on the Medic One rig for a day. I rode in the back of the ambulance while two paramedics were in the front (there were no medic students that day, just me). These two had impressive resumes that came up throughout the day; Carl had been with the fire department for over 30 years, and here at Harborview for 27, previously he had worked with FEMA as well--he said he quit after Katrina. Patty had also been doing this for decades and had previously worked as the medic for the swat team, she told me a story about her friend shooting a perfect shot, and that she could still save the guy.

Our first call was to 3rd avenue where a guy was having chest pain. After we assessed we called the EMTs to take him to Providence as Harborview was on divert. Next call took us across the street to the shelter where a woman was having shortness of breath, same deal happened to her. After we joked about hanging out on this block all day we got a call to hop on the freeway and out to a guy who seized and then fell and had a head injury or fell then seized, etc. CPR was on-going at the scene. When we arrived the fire department had revived him, but his blood pressure was dropping. In the back of the rig I watched as IV lines were started as the rig swerved through the streets and the equipement barely stayed put. One of the fire men came with us and helped manually bag the patient after the paramedic intubated him. The fireman was fumbling with the attachments and seemed to always have the wrong one ready. Back at Harborview the patient was taken away and the paramedics split up to do paperwork and re-stock the rig. I was given a pager and told to run to the rig if it went off. Rather soon after that, the pager went off and I found my way back to "my crew," I jumped in the back and we sped off to an address near to where I lived. The medic called back to me, "It's an assualt, we're being called along with the police." All I could think was, should I have a bullet proof vest on for this? At a local Vietnamese restaurant there was a man down on the ground, mumbling, but otherwise conscious. The medics waved the police away, if he had been assaulted, there was no one else there now. We put him in the truck, and the medic asks if I want to put in the IV, absolutely! I tried (we had just had our IV lab the week before) but I swear that 16 gauge needle was bigger than this guys' veins. The medic got it in no problem, and the patient was quicly sedated, intubated and ventilated. This time there was no extra person in the back, so I took on the role of manual ventialtor, and because I had just seen this done, I was much better at it than the fireman. Back at the ED I ran into my classmate who was down there that day, he'd been on the rigs the day before and nothing had really happened that day, he said he stuck around till about 10 pm when he finally went home. Again my two paramedics dispersed and I stayed there with the patient as he began his assessment by the ED Docs. People were shouting out questions, so I thought I would shout out answers; What was his glucose at scene? 138! What was his last BP? Systolic: 130s! What's his name? Last name: L...! Does he have a trauma number? 8....! That was fun. Next page was for a 3 year old boy/allergic reaction. We rushed down to a bus stop nearby. After barely touching a pistachio to his lips this little guy started having trouble breathing. The firemen set him down on the back of the firetruck and tried to tell him how brave he was, one of the medics brought out a teddybear from our rig which this kiddo clung to. He was showing signs of stridor, so we put him in our truck and headed off to Children's Emergency. Here was my big moment... everyone was vying for a distraction, trying to place and IV, give him a shot of epinephrine and benadryl, keep him calm, and all along he's been non-verbal, not making eye-contact and absolutely pertrified, and he looks up at me and mouths, "Wha-what's your name?"

After dropping this little guy off, the medics tell me it's time for lunch. They drive up to Capitol Hill and we all pop out to our respective meals. As I'm waiting for the guy to finish toasting my bagel the pager goes off. I tell the guy I'm actually going to need that bagel now, and I run out the door. I'm about two blocks away from the truck and hear the sirens. They bust down the road and swing into on-coming traffic blocking the street and slam on the brakes. I run around the rig and jump in the back doors. Off we go, and Patty shouts, "Did you get your bagel Jane?"

***

I've had countless experiences like this during my shifts at Harborview, an incredible place to learn, I love it. To my knowledge every one of the above stories proceeded well, with various degrees of recovery and health and survival. I may play a very small role right now, but it seems to be important nonetheless.