10 October 2013

Oh Vacation...

How sweet thou art!  I was hoping to write soon after returning, before the freshness fizzled out…but we all know how efficiently work-life sucks us back in.  Oh well, my trip is still recent enough to continue enjoying its ripples…

Before I get to the highlights, I’ll say a quick word about the airport in Istanbul (which I perused 4 times in 2 weeks.)  What a wonderful convergence of people, languages & cultures!  Initially I was a little embarrassed for them, but it was truly nice to see folks waltzing about in their tight tank tops & short-shorts.  And, OMG, some of them were even holding hands & communicating with their significant others!!  I know, Crazy!  I was only briefly traumatized and resisted the urge to give them more clothing to cover up.  All jokes aside, I look forward to checking out the rest of Istanbul sometime soon…

Next quick stop – Madrid:
Keep in mind I was about 32 hrs awake (including a 12 hr shift) by the time my feet hit non-Saudi soil.  I had a six hr layover so I zombied into town.  Since I had gotten my skin-shock over with in Turkey, my first thought was how nice it was to hear a more familiar foreign language.  Despite the Spaniard’s funny lisp & extra verb tense, it was comforting to my ears.  I loved the old waiter who served me my 1st beer.  He let me stutter Spanish to him & didn’t make me feel like a complete buffoon – even when I said, “Shukran” instead of, “Gracias” – oops! J

The main attractions…

Portugal:
Gorgeous!  The friend I went to visit lives in Porto, which is where we spent most of our time.  Pictures fail at expressing the beauty & feel of the city.  A river from the mnts runs through town, shops and houses sit on the hillside, folks fish from the street & hang their colorful laundry out their windows to dry and, obviously, much of the architecture is older than America can remember.  Bakeries create little desserts that are almost too cute to eat, every restaurant serves Bacalhau (cod) and people everywhere, despite their current economic challenges, were beyond friendly.  Porto is known not only for port wine, but also for being the largest producer of cork in the world.  Since the trend for plugging wine bottles has diversified to other materials and the demand for cork has dropped, they are now making many other items – hats, shoes, bags, wallets – with the impermeable, buoyant, fire resistant stuff.  Tourists, including this one, ate it up!  Not only did we see the sights of Porto & hang with Diana’s adorable, non-English speaking family, but we hit up a port tour at a winery that was founded in 1692, took the train down to Aveiro & rode free bikes around the cute little town & drove up north to see an old castle.  Super Good Times complete with frequent, deep, appreciative breaths – Ah, the world really is continuing to go ‘round & function as we know it! J


Diana's Mom, Dad, G-ma & Uncle
Kyrgyzstan:
I have found my new dream car!  I will have a Lada – definitely one built in the 70s or 80s!  Before you google it & laugh, be sure to check out the very practical 4-wheel drive version (Lada Niva.)  Of course mine will have sturdy tires & a rack…green please.  Most important, they look Awesome!!  Also slightly relevant, they can be easily fixed from Russia to Western Europe & everywhere in between.  Anyway, Kyrgyzstan you say?  Yes!  It’s SE of Kazakhstan, west of China, they speak Russian (& Kyrgyz of course) and have incredibly stunning mountains!  Good friends who used to live across the street from me in Portland are there doing a stint with MSF.  We had grand plans for borrowing their friend’s car & venturing out to see Lake Issyk Kul, traversing the mnt range to Naryn and then bopping down to check out Osh & the world’s largest walnut forest before returning to Bishkek.  Oh, the best laid plans! 

We packed up the minivan and excitedly headed towards the lake.  There were a few sputs, spurts, squeaks & other minor complaints from our trusty “Super Caravan” in route, but we were not to be dissuaded.  The gas leak we noticed under the car had slowed from a dibble to a drip…and stopped completely if we parked the car just right.  We also decided the plastic bag wrapped around the hose was normal enough.  (Keep in mind two of us have lived in the African bush & the 3rd has us both beat with crazy travel experiences.)  We spent the night in a fantastic Yurt Camp right on the lake surrounded by snow-capped peaks.  You would never guess this was probably the birthplace of the plague.  The air was fresh & cool – insert more refreshing deep breaths – and I even wore jeans & a fleece!  Day 2 found us optimistic and off to a wonderful start.  Despite our confidence (ie; denial) that all was well, we started formulating Plans B, C & D just in case the minivan refused to get us up and over the mnts.  The day progressed – complete with frequent roadside stops for reassessment, speculation & a bonus stop for apple picking.  At one point we had a repair shop take a look…the mechanic reassured us the car wouldn’t explode, but he declined to guarantee it wasn’t going to completely crap out & leave us stranded.  We carried on.  As our heroic driver was getting leg cramps trying to stay in the sweet spot – somewhere around 35 mph (60 k/h) – we began to accept the fact that this hunk of metal just wasn’t going to cooperate.  Our extremely resilient travel buddy – who happens to be 2 ½ – seemed to agree, it was time to head home.  For the record, I continue to be impressed with how well this young man tolerated our adventure – his capacity for reading (and re-reading) books is astonishing, and most adults would’ve complained more than he did.  We also figured it might not be the best plan to take his 35-wk pregnant mother over 4,000 meters…although a little pre-term labor would’ve really spiced things up!  We planned to abandon the vehicle in Karakol – where we stayed in a nice little B&B – but luck was in our favor.  The owner of the car came out from Bishkek, found s’one to tinker a bit more & we successfully made it back safe & sound the next day.  If only we’d had a Lada…

Yurt Camp
Inside the Yurt
Me n Aziz

























While in Bishkek we also toured a felting co-op where they felted carpets, shoes, scarves & small toys – very cool!  We also spent an afternoon on an Amazing hike in Ala-Archa Gorge (I think?!) – if crossing bottomless bridges, fording glacial streams & being surrounded by breath-taking mountains doesn’t recharge your batteries…you’ve got some issues.  It was just what this soul needed.  My holiday cumulated with a serene evening sharing food, wine and stories with great company.  I crashed on the couch for a few hrs before heading to the airport for my reluctant journey back to Jeddah.

Bottomless Bridge

Freeeezing Stream




















It felt a bit strange to be returning from vacation to a place that doesn’t really feel like “home”…but here I am!  Back to heat, humidity & the glorious frustrations of work J  Honestly, it was a Wonderful two weeks and, as we all know, without a touch of stress at home, vacations would lose some luster.  I want to again thank my hosts/tour guides/friends!!  Thank you for sharing your homes, meals, energy & time – I am such a fortunate gal!  Nsh’allah I will be able to offer the same hospitality one day...

10 August 2013

Ramadan Kareem!

Or Ramadan Maasalama rather…We are wrapping up the month with the 3-4 day celebration of Eid al-Fitr.  Eid marks the end of Ramadan & is the biggest Muslim holiday of the year – often compared to Christmas.  Indeed, work has been pretty quiet this past week – especially during the day when folks are sleeping.

Unfortunately I haven’t been around long enough to get much of an insider’s look or a really good feel for all the intricacies of Ramadan, but I can try & share a few things from the periphery.  Superficially, almost EveryThing is closed, or has severely reduced hours, during the day, during the entire month.  They even altered our “shopping bus” schedule to run later.  Here are a few (fuzzy – sorry!) snaps from Balad (the older district of town) at 1 am…plenty of men, women & children milling about.




As you probably know, fasting during the daylight hours is a big part of Ramadan.  It is also an important time for prayer, reading the Qur’an and for personal reflection.  It's recognized by almsgiving and, my favorite, “watching one’s tongue”…to mean “refraining from obscene & false speech.”  Feasting, visiting with family, and making trips to Mecca are also significant activities this month and during Eid – plenty of dates & delicious deserts!  Here is a snap of some families waiting for the sun to go down so they can break their fast with a picnic by the sea – nice!



The Mutawa, or “Religious Police” who work on behalf of the “Commission for the Promotion of Virtue & Prevention of Vice” – No, I’m not kidding.  Go ahead, read that title again :)  They enforce the dress & behavior codes, crack down on public entertainment, make sure women don’t drive & check businesses to make sure they are closing 5 times a day for prayer.  They are said to be more prevalent during Ramadan & have a legitimate reputation for being verbally aggressive.  Fortunately I haven’t had the pleasure of interacting with them, but friends say they have been harassed in the mall – mostly followed around and told (unprofessionally) to cover their hair.  I don't think they can actually arrest you.

Illegal Mingling

Speaking of “watching one’s tongue” and while I’m on a down-beat, the work tid bit of the week was that one of our locum staff (3 month contract) was fired & sent home for cussing, coming clean on a med error, and having a personality conflict with one of her colleagues – obviously the wrong one.  Disturbing & concerning to be sure, but I've decided not to bitch about work in this post :)  Rumor has it the nail in the visa was the cussing…needless to say, those of us remaining with explicative tendencies are trying to come up with more appropriate words to express our frustrations – think “Fudgesicle.”  All suggestions are welcomed :)

On to more pleasant & exciting news!!  I bought my plane tickets for a much anticipated holiday in September!  I’ll be going to visit a friend I met here from Portugal for a week & then to Kyrgyzstan for a wk to see the sights & catch up with old neighbor friends there.  Both places look absolutely Gorgeous & I’m looking forward to seeing some GREEN, and red…as in wine!  Now I just need my Exit/Re-Entry Visa to go through & then it’s only 26 days to departure!  But who’s counting?

My Portuguese Habibi 
Well gang, I hope you are enjoying your August weather & bountiful gardens – Svetlana said she planted 15 tomato plants in my backyard (among many other things) and I can’t imagine it!  Maybe she ripped up part of the lawn :)  
Take care ya’ll & keep in touch – I love hearing from you!

k

17 July 2013

Just when I thought...

...they had made a day-shifter out of me.  Whew!  Welcome back to nights Nelson!  No offense to the suits, but it's so much nicer to work when only the necessary folk are wandering about - especially when you are busy.  Speaking of work, I'd like to retract a few statements from the record.  The part about ALL the pts needing to be in the ED & how most of the pts & families are grateful and awesome?  Yeah, subtract about 65% of that.  AND, if we have a few docs who are ADHD, then they have a few here who are Bipolar.  Both require a bit of duck feather, but I prefer the former.  Have I mentioned how much I miss our Pharmacists & the tube system?  Good.  While I'm at it I'd like to thank our XR/CT techs for collecting & returning our pts, Social Work & Psych for facilitating & solving sooo many important issues, Admitting & Secretaries for keeping the background running smoothly, and Techs...Oh, my dear sweet Techs, there aren't enough muscles in my fingers to type the ways in which I miss & appreciate thee!  I'll even thank the lab...well, it seems the ED/Lab - Love/Hate rel'shp is universal :)  Thanks at least for spitting out results this century.  Also, a fat SHUKRAN to our docs (regardless of your psych status) for having more than 1/2 a clue and for treating us as colleagues and respecting our judgment & opinions.  You are Wonderful!  Can't forget my peeps...again, not nearly enough ink kids!  Oh Emanuel, how I miss you!  It's probably a good thing they don't have alcohol in this country or we'd all be alcoholics!

Speaking of alcohol...had my first glass of red wine in 10 wks at an Italian Consulate dinner last wk - it was Delicious!!  I sipped & savored every grape.  There are a few other opportunities to get (bad) home-made wine and "Sid" here.  Sid reminds me of Zambian kachasu/latuku which is one smidge better for your esophagus than draino.  The Saudi vice seems to be puffing on the shisha (hookah) - it's flavored tobacco vapor (think artificial grape) - men & women alike enjoy it at home & at some open air restaurants.



 
Other pleasantries...a few of us had a lovely walk along the Corniche a few nights back.  It was nice to see a few stars & hear the waves crashing...and crashing again.  A powerful force beyond man & beyond rules & restrictions.  It provided a refreshing sense of normalcy...




What else?  You may have heard about our change in wkend days - they decided businesses could be more productive with other bits of the world by moving the wkend from Thurs & Fri to Fri & Sat.  Sounds simple enough, but it'd be like the U.S. saying, "Our work week will now be Sun-Thurs."  No arguing or debating - official decree from the king.  Done.  Imagine, we can't even get day-light savings time sorted out! :)

A more significant life shake up = Ramadan!  Very interesting...and tricky for those of us with tape worms (just kidding Grandma!)  I'll save Ramadan for my next post...it has barely started & I'm curious to see how the rest of the month plays out.

Well, (most of) you are probably enjoying summer weather & activities...if you need some extra sweat I'll gladly lend you my abaya & some of this humidity!  I think I'll end up being the crazy lady who wears a hoody when I go home and it's "only" 80 degrees :)  Do some camping & hiking for me - in shorts!!
Maasalama ~
k

28 June 2013

OMG

I just couldn't go to bed without posting this Immediately!

So, there I was, out for a run (cuz I will decidedly apoptose in the air-less gym), when I see some sparkly bouncing bits off in the distance....what the?!  As I get closer I could hardly believe it...SPACESUITS!! Although it was difficult to maintain my composure, I stopped, complimented them profusely, and begged them to please let me take a picture!  Of course they were thrilled.  Not quite as good as in the flesh, but please enjoy : )



23 June 2013

The Honeymoon is over...

There is really nothing more to say without going overboard :)  It's a unique unit - not really a true ED & certainly not a typical in-patient ward.  It's like a mix between an ED, a chronic medical ward (Thank You OBC for my in-pt experience!) and an ICU.  We also see a lot of transplant pts...not usually fresh ones, but no shortage of kidneys here I guess.  I do try to remind myself this is a specialist/referral hospital so our pt population will be a little distorted.  Just like at home - too many days at work made you feel like 80% of the U.S. was either heroin addicted, drunk, diabetic or wanted to jump off a bridge.  Here, you feel like all Saudi's are either borrowing a kidney, have a congenital abnormality, have had cardiac surgery, are jaundiced or diabetic...obviously not true in either country - just a skewed perspective.  And rather fascinating of course!

Which is why it's important NOT to work too much!  I'm happy to have gotten off the beach (boring!) and into a boat.  A bunch of us booked a trip out on the Red Sea - a few went diving, the rest snorkeled.  Really cool coral reefs with Amazing fish - next time I'll try & get some underwater photos.  I will probably refresh my dive cert & hope to try some wind surfing....I've heard women are "not allowed" to do the latter.  More investigation will be conducted.



Last week a Filipino friend from work took us to the fish market - much cleaner than some I've seen and always more fun than buying seafood in the grocery store :)

  





Lesson of the day - choose boy crabs instead of girl crabs...


Actually, just stick to Oregon crabs & get regular fish - Yum!  After the market we went to another co-workers house (not in a compound!) and enjoyed a lovely meal & afternoon.

On my next stretch off we plan to take a trip to Taif - it's east of Jeddah, past Mecca, and quite a few clicks away.  Apparently there are mountains to hike & camels to ride & monkeys to see!  We may even visit a "flower water"/perfume distillery (not, for the record, my preferred type of distillery!)  We'll see what actually happens.  It's a hospital organized trip so all I know is that it is from 7:30 - 11pm.  Stay tuned...

As always, I hope all is well - wish I could send ya'll some of this hot, super sunny weather!
Thanks again for your comments - just when I feel "over it" (like after Blog Post #1 :))  I read your comments & am encouraged to post again!
Until next time,
k

PS:  Warren, I am dreaming of your...gorgeously....delicious...STOUT!  You bet your rokba you are saving me some!!

02 June 2013

White Scrubs?!

It probably goes without saying, but my appreciation for our uniform is quite opposite from that of the abaya.  First, they are semi see-through (scandalous!) and probably a reason we are required to have tops that cover our bum.  Second, I know I have a big mouth, but s'times I still miss it.  Lastly, did I mention they are WHITE?  The blue color of my folder even rubbed off on the pants while it was sitting on my lap.  Also, the powers that be obviously don't know what kind of substances are flying around the ED.  Enough said.

Sooo many potential comments about my first few shifts...I'll try & stick to the ones I can express "on air."   My preceptor is Very nice & has been gracious in showing me the ropes.  She's British so there are a few too many "darling's & lovely's & brilliant's" but I suppose it beats the alternative.  I tried to explain my need for a snack every few hrs and, I'm not sure why, but I think I freaked her out a little.  Now if I mention I'm going to grab a g-bar she says, "Do you need to sit down?  You should take a little break, are you ok?  Are you sure?"  I reassure her that all is well, I'm just going to shove a bite in my face & I'll be back in 2.  Apparently "The Look" that Jamie and Mo can see from across the room is acquired :)

I don't want to bore the non-medical folks reading this, but work is a huge chunk of life here...and there are some Crazy differences:

- Patients are OFTEN held/boarded in the ED for 3-4 days.  In my 5 shifts I have only D/C'd 2 pts and have sent Zero to the floor.  Clearly the concept of "Pt Flow" has yet to cross the Atlantic.  Are you sure you don't want to come over Dr. Strear?  Plenty of time to fix our flow problem AND watch heaps of TV!

- That being said, I have yet to see a pt that doesn't need to be here.  This is a specialty hospital so there are a lot of oncology, renal, diabetic, chronically sick pts.  So far most of the pts & families have been pleasant & grateful for the care you are providing (weird, I know!)  Although communication will definitely continue to be one of the greatest frustrations, the charades that inevitably occur can be Hilarious!  Jamie, you would do wonderfully! :)   I'm almost reluctant to learn the Arabic words for vomit, diarrhea, dizzy, CT/XR, pee in the cup...because it is so fun to act them out.

- Narcotics.  Perplexing...in good & not so good ways.  In these 5 shifts I have given 2 mg of Morphine, twice, to one patient.  No joke.  I don't think they even have "...what's that one that starts with a D?" here.  Also interesting is that in order to give that snifter of MS I had to go to the med room with the charge RN who had the keys to the double-locked Narc Cabinet.  We took a vial, both of us recorded how much we were giving and wasting in 2 different spots on the paper flowsheet...and then the empty vial was returned to pharmacy for further counting and documentation.  I'm just going to pause here & let all that sink in.

I'm also going to refrain from describing the process for getting REGULAR meds from the Pharmacy...I am still baffled and you wouldn't believe it anyway.  I'll just say, Julie & Spencer & Pyxis I love you and miss you all terribly!!  And the tube system...Oh, how I miss you too!  Folks, if you ever find yourself complaining about work - ANY aspect of it (docs, colleagues/communication, "the system"), call me & I'll gladly make you feel better :)

What else...they call Vital Signs "Observations" and "Endorsing" is giving report to each other...the CBGs are in mmol/L so the normal range is 3.5 - 6.2...they love IV Tylenol...1/2 the pts are on Heparin...each lab test needs it's own tube...oh yeah.

Enough shop talk!



For FUN...we (my friends from England, NZ, Ireland, Australia, Portugal) have been to the beach a few times.  The hospital provides a free cab & you usually spend the day.  Most beaches are private & associated with a hotel so you have to pay to get in.  Once there you can take off your abaya & wear "normal" clothes, including normal swimsuits (quiet peanut gallery!)  It's a little "canned" but it's a good opp to get out & chill.  It's also nice to see men, women & children talking and interacting together - most are expats or rich Saudis.

A few of us also went to another (much nicer!) compound to watch a play.  There are 2 theater groups in Jeddah that put on productions q' few months.  It was another non-abaya event & dinner was included.  It sounds like there are occasionally "parties" at other compounds too...I'll keep you posted.



I'll conclude with a blurb about prayer time.  Most Muslims pray 5 times a day, signaled with a loud public "call to prayer" called Athan.  (Think tornado or tsunami siren but with pleasant singing instead.)  Almost q'thing stops or closes during prayer time - some grocery stores/shops let you continue shopping & just close the checkout line, some will require you to leave the store mid-shopping.  Restaurants don't make you leave, but "service" will be paused for 20-40 minutes.  At the hospital, some procedures (meds, CT, even surgery) can be delayed if the pt or family is praying.  The precise prayer times vary a little each day & they are slightly different in each city.  So far I have only been foiled by prayer time a few times.  I missed a bus while waiting in the check out line at the grocery store, I missed lunch once, and we all had to leave the 5 Riyal ($1.33) Store after 10 min d/t prayer time.  No biggie, just s'thing to be aware of...I'm totally golden now cuz I have an APP on my pod that tells me when prayer times are going to be :)

Sorry gang, that was long-winded!  I reassure myself that reading this mess is optional & I won't be offended if you don't!  I hope life is going well for everyone.  Keep me posted on the happenings & drop me a line if you get bored!
Love ya,
k

PS:  The highlight of my week, besides barely passing my blood administration exam, was Face Timing with my work peeps!  So Freaking Awesome!  Despite it's challenges, even I have to admit technology is pretty amazing!

18 May 2013

Well, there were no flying colors...

...but I survived the Dosage Calc test!  Let’s just hope I fair as well on the ECG & Blood Administration exams – apparently there is a fairly high re-do-over rate for both.  I realized today I’ve never been taught Junctional Rhythms…and have reaffirmed that I don’t care about Junctional Rhythms!! Are you having an MI? Yes, or No? Are you dying? Yes, or No? Let’s stick to the basics. :-

Other survival moments this week...the “blood extraction.”  Everyone kept asking if I had “done the blood extraction yet?”  Thankfully I was only subjected to a regular blood draw.  Plus 2 vaccinations and a PPD.  “Needles” to say (haha), not the best part of orientation.

On a more pleasant note, I bought some real, live, green plants!  Not sure if I’ll keep them alive, but for now they are a Great addition.  Speaking of…how are all my plant-sitters doing?  I didn’t give you all that free TP for nothing!  Status updates please.  Feel free to include photos :)


It also turns out that I LOVE my abaya!  The abaya is the long, black gown I have to wear every time I leave the compound (which includes all these orientation sessions.)  Cultural implications aside, it is Wonderful!  I don’t ever have to decide what to wear, I can wear the same thing q’day, I can wear very little underneath, it’s black so I can spill crap all over myself…besides being a little hot, it’s Awesome.


Also, there is something about it…In my naiveté, I feel there is some mystery behind the gown & veil. (Not all, but many women wear the full burqa.)  S’times I find myself wondering what she looks like under there. Only her husband, family and a few friends know.  According to more than one (male) Saudi instructor, they wear the gowns/veils "to protect them" from the stares & potential advances of other men.  Of course I recognize there is much more to it than that, and I’m not saying I necessarily agree, this is just a peripheral pondering.  We place so many judgments on someone’s face or body type, the way they dress or carry themselves.  They’re not all bad judgments – some are just cues to help us determine what type of person they are and what we may have in common, etc.  I guess I’m just still fascinated by it.  Intriguing thoughts to help balance all the negative things you hear…and many folks assume.

Sooooo much to learn here!  I’m anxious to see how my initial perceptions change with time & further exposure.  Hopefully I’ll make some Saudi friends and have opportunities for first-hand perspectives.  For now, I’m looking forward to getting my buns out of the sit-&-listen mode and into the ER!

Hope you are all doing well – I Love the messages, snaps, texts, email, comments here...except for trying to rotate pictures, it’s all Super Fun!  If all else weren't so different I’d hardly believe I was on the other side of the world!
Take care ya’ll,
k