Saturday, June 30, 2012



Pediatrics is exactly where I need to be

Exactly, because it is so hard!

I started out with 22 patients – discharged  1 – got 4 more – and before I left – got another 2 on the next shift – 5 out of the 6 new admits needed transfusions with unbelievable Hemoglobins  in the 2’s, 3’s, etc.   

By the time I left tonight – 2 hours late – we had 27 pediatrics patients. 

The last 2 are camping out on mats on the floor – there are people crammed into every available bed, space, corner.

Gone are the beautiful days of being able to assess anyone – it’s all I can humanly possibly do to keep up with the new admits (searching for a vein on a dehydrated-fontanel-sunken-in-kid with a Hemoglobin of 3 takes time….), hanging quinine perfusion after perfusion, trying to do rounds on the quinine drips to control it (most of the IVs are positional)

Trying to control all my blood transfusions

Trying to see the sickest kids first – trying to delay the angel of death with IV ceftriaxone, dextrose, quinine, blood

People pulling on my scrubs

This drip stopped

That drip stopped

This IV infiltrated

Well, if you strap your kid to your back and walk around outside with the D5 bottle in your hand – yeah the IV is going to stop

The blood is finished

The blood is backflowing into the IV tubing

This drip is stopped

This drip is too fast

People pulling on my scrubs

Come see my child

No, come see my child

Asking again, again

My child is crying – can you give him medicine to stop crying?

My child’s stomach is “sick” we need to stop the blood

Running to the pharmacy

Running back

Trying to do more than humanly possible

But this is exactly where I need to be

Because I am getting frustrated

Because I regularly loose my cool

Because I have a tendency to snap

Because tears spring to my eyes

I have had several unfortunate altercations with male chauvinists – last night the pharmacist refused to give me another IV (the hospital is supposed to replace broken things if they are an accident de travaille)

And I’m sorry, but if you are sticking the scalp with a flimsy plastic IV – the tip of the lumen is going to crack – and when I have only 1 or 2 good veins left standing literally between this child and dying – you can better believe I’m using a brand new IV

So, he refuses

He tells me – you know, when you put in IVs, you should just do them quickly.  You shouldn’t stick people again and again

He tells me – you make children suffer more than any other nurse, you are always making children suffer

He tells me – you don’t know anything – you know less than the other nurses

And so on

And you can imagine how I took that – and how he took my not taking it

It is so hard here

Once someone asked me, do you feel like you are treated unequally here because you are a woman? – and I flippantly said – no, not at all

But I have come to realize that I misspoke

I have been noticing that I am talked down to a lot by the male staff – they must assert their dominance in every conversation and situation

They snap at me for things that are put very mildly

They get all huffy when the only thing I do is ask for things, like, oh, IVs so I can do my job.  Or when they have to come in to test blood for a transfusion

The other week the guardian of the gate refused to go call the lab tech for me.  No one had phone service and I had a child that urgently needed blood - and his reason for refusal?  Because I didn’t respect him when I asked him

As in – I didn’t say, how are you?  how is your work?  Bon travaille!! 

Because I didn’t ask how his family was first, because I didn’t ask him how his night was going

This is one of the hugest adjustments for me and one I get wrong every day

In the US – we say what we need in the workplace – we are all there to do a job and to do it rapidly and efficiently, ESPECIALLY if it’s urgent – we don’t first commence with pleasantries

So, I asked Freddie, our translator for Project 21

He himself being much down with the whole inequality, men are superior beings thing –

I said – tell me how to get along with tchadian men – because I am failing

And apparently – if a woman challenges, argues with, reprimands, or does anything that falls out of the realm of “respect,” then suddenly his value as a man is on the line – he cannot be seen to back down, or lose the argument, or allow a woman to speak to him like that – he will immediately lose all the respect that other men have for him.  He will lose his reputation.  He will lose his friends.  Men and women alike will make fun of him.

In this culture - maintaining your reputation at all costs is paramount

Relationships here trump urgency

In fact – almost nothing is urgent

And it infuriates me

And last night was also horrific – there was a little boy whose vein blew mid transfusion – he was exhausted, dehydrated, severely anemic – and so I was searching and searching – I kept getting blood flashbacks and then the veins were collapsing over and over again each time I tried to thread it. 

So I stopped.  I tried to call Hamadou or Seraphim – both geniuses at IVs – the best of the best. Usually I don’t have to call them but I would rather admit potential defeat then damage all the viable veins of someone who will die without IV products. 

But it was in a rainstorm.  No one had any cell phone service.  I couldn’t get through. I called over and over and over.   I called another girl – it kept collapsing on her too.

No way to do a central line

Then finally – I convinced someone to take their motorcycle and go to Hamadou’s house and call him – he came and searched for an hour and a half

You could see the little boy fading

And then finally – 4 hours later – the blood already 6 hours old,  Seraphim – the best of all the staff at IVs (and that’s about where his prowess ceases) – he came and tried  for an hour or so as well.  And he failed. 

The little boy died several hours later

He was so anemic he was going to die without blood.  It was a certainty.  And one I knew the entire time. 

 - and it was in the midst of this that I had 5 new admits.

- and had 20+ drips to control.   

- and was surrounded by a cacophony of screaming children.

- and had more infiltrated IVs. 

- and was hours late on giving meds.

- and had not even assessed a single patient.

 - and had children convulsing.

 - and had children with severe dyspnea.

 - and was transfusing 4 patients.

- and was being literally pulled in different directions by anxious parents.

- and hadn’t ate or drank.

- and despite running and trying and working at top speed was not even giving what I consider to be the bare minimum of care. 

- and had the grim and heartrending fact playing over and over in my head – if you cannot figure out a way to get this IV – this little boy will die – I could see him visibly fading.

And so it was in the midst of all this that I have the pharmacist telling me that I make children suffer, and that if anyone else was in my place – the children would not be suffering. 

And so I got angry – and I didn’t handle the altercation with him well. 

And then I started crying. 

And then I snapped at the poor parents whose lives are in shambles who did a culturally courageous thing and actually brought their kid to the hospital. 

Yes – I think everyone can agree that this was frustrating. 

You may even tell me anyone would have reacted the same way.

But that’s not true. 

It’s not okay

Its not okay to get in stubborn inflammatory arguments
Its not okay to burst into tears at work
Its not okay to to be short-tempered and unkind to parents

It's not okay

because I want to do nursing in situations 2o times more extreme than this

I want to work for MSF – who goes into the worst conditions in the world at the most dangerous times, who goes where no other organization wants to go

And I sit here and dream about that?  I sit there and think I can do that? 

I’m no where close to being able to handle that. 

And it’s a harsh truth.  And not one that I like admitting. 

If I can’t handle this – what makes me think I can handle being in a war zone with bullets flying and halls overflowing with patients?  What makes me think that?  Pure chutzpah? Hubris of the young?

So, as you can see.  This is exactly where I need to be. 

    I can think of no better situation in which I can practice handling stress, diffusing arguments, developing patience,

    I can think of no better place to work through overwhelming, unfair, and difficult situations without letting it overwhelm me. 

    I can think of no better place to figure out how to work under pressure, how to keep up with impossible demands, how to hone my reactions and thoroughly expose my biggest struggles.

Being here has brought out the best that is in me.  It has allowed me to do things I didn’t think I could do and to be the kind of person I have always wanted to be.  

Being here has also brought out the worst in me.  It has showed my aspects of my character that I didn't think where there and i became the kind of person i never wanted to be.

You know there's a problem when you end up acting more like Hitler than Gandhi. 

No, I have to stay here, I have to work through this madness until I can move through with grace and patience and kindness.

I have to stay here until I can consistently treat others like human beings – no matter how much they infuriate, insult, belittle, disrespect, or annoy me.

I have to stay here until I can work through a night like tonight by focusing the best of my energy on one task at a time, one patient at a time, somehow giving myself grace to know my limitations while still pushing the boundaries of those “limitations.”

and so, this is exactly where I need to be

I truly have an unprecedented opportunity tackle my character in all its gnarly ugliness head on, go to war with it, day after day after day, and come out on the other side. 

I have a chance to become the person I want to be. 

I have a chance to prepare myself for what I want to do. 

And so I am profoundly grateful.  And I am grimly determined.   

I took a magic marker

And wrote things like ZEN and SHUT UP and PATIENCE and KINDNESS all over my arm –

I am going to beat this thing

I have an entire month of unbelievably difficult nights ahead. 

And I am excited

I am always writing about doing poetic and glorious things such as “walking through the fire.”   

Well – here is my fire. 

Right here.

Right now.

And I cannot stop walking until I can move through it without it scorching me. 

Until I can work in it without burning others.

Until I stop fanning the flames.

Until I become water.

Right here

Right now

There will never be a better boot camp

And so, this is exactly where I need to be.


*** at the time of posting - Saturday night – there were 13 new admits Thurday, 13 more on Friday – bringing up the total to an all-time high of 30 something Friday evening/Saturday morning.  Tonight I had 23 patients with 5 more on the medicine ward (which the nurse in that department graciously took over for me).  Also am pleased to report argued with no one and was in general very kind tonight – will re-magic-marker my arm in the AM. 



  1. Adelante, Janna. Keep up the good work! xo

  2. Janna - you are where God wants you - for however long, under whatever stressors --- He knows because He experienced earthly life.
    Go with Him to be what He wants you to be.
    Blessings and LOTS of hugs!!!!
    Thank you for doing what you're doing!!!