And the Wall Comes Tumbling Down - Part 2
In Linyi, China a small town of 7 million people we were on a mission trip to help do surgeries on cleft lip and cleft palate children. I was a well established nurse by then and had formed my opinions about the rights and wrongs of the medical profession. I had been taught over the years how certain situations in medicine were handled. On this particular trip we were lucky enough to be working in an actual hospital. Every morning I did rounds on the post op patients. My first morning I asked Val, my fellow mission nurse, where the blood pressure cuff and thermometers were so I could do vital signs.
“Oh” she said “We don’t have those. We do VISUAL vital signs.”
I thought to myself is she serious? But, alas, she was. And so I went from room to room and assessed each patient; was their color good, did they feel warm, were they agitated or quiet, were they too quiet, were they breathing too fast or too slow, was their pulse strong and steady and a good rate, were they in pain? I asked where we kept the charts so I could chart my assessments.
“Oh” she said, “We don’t chart. Just let me know if there is anything you’re worried about.”
Not chart???!! How can you not chart?? How do you prove that you did your assessments?? Whoa, I’m in the twilight zone.
Next I took out an IV and was looking for a sharps containers which are standard in every hospital or clinic. Sharps containers are plastic containers, most often bright red, that are akin to religious icons as we have total respect for them and all that they hold - exposed needles contaminated with blood and disease. When we dispose of them in the sharps container a little flap opens and closes so the sharp can go in but there is no way you can get your hand in there to stick yourself.
“Oh” Val said “We don’t have sharps containers. We just throw the sharps in that bucket over there.”
In the corner stood a dirty, open bucket with a multitude of dirty needles in it, IV tubing hanging over the side. I flinched and tossed my needle in along with them, keeping my distance as if the needles would jump out and get me.
When I suspected that one of the kids had an infection and decided he needed antibiotics I went to the physician and asked about getting a physician’s order for them.
“Oh” she said “We don’t do orders, if you think anyone needs them, just give them”
And so I did.
At one point I decided I wanted to go in on one of the surgeries and observe. I put a mask and hat on and snuck into one of the rooms. There on the bed was a little boy of about 4 years of age. He was sound asleep with the anesthesiologist watching him closely. The surgeon was at the head of the bed doing a cleft lip repair. The boy was wrapped snugly in a blanket and sticking out of the bottom of the blanket were his dirty little feet still resting in his dirty little flip flops.
I asked, “You let them come in with their dirty flip flops?” The surgeon didn’t even look up from his work, “What do you think is going to happen? The germs are going to jump from his feet up to his mouth?”
No, of course they weren’t. Wow, I needed to rethink all that I had been taught in my nursing career. At first I fought it. I couldn’t wrap my head around the “irresponsibility” of this group. Once again my wall had been challenged. Everything I had ever learned in my nursing practice was up for review. So, in the few quiet moments I had in the evenings I would start to take a look at the “bricks” from my wall. What could I let go of and what did I need to hang on to? Turns out I could let go of a lot and still believe I was giving safe care. The aftershocks of my experience came to a head when I returned home and everyone else was still working in the confines of American medicine while I had reexamined everything about our practices and realized that so many of these long held beliefs were just a product of a litiginous society.
The other reason that the “building of my wall” was so important was that it gave me a foundation of values on which to make all of my decisions in life - a moral code. Decisions are much easier when you have a code of ethics that you have developed not simply from what other people have told you is right or wrong but from your own life experiences and your personal rules of conduct.
Over the years I have been able to keep an open mind and be willing to adjust my“truths” based on my own experiences. I am glad to have had the experiences where everything I have learned was thrown into disarray and I was forced to look deep into my heart to the truths and beliefs that lie there and think, really think about what they mean to me. I am happy to say that I didn’t just meander through life but have a value system that I truly believe in to the point that I don’t have to question what I should do in certain difficult situations but KNOW what I need to do, no matter how difficult, because I have a philosophy of life and values that I live by no matter what.