Monday, February 25, 2013

Hospital Adventures

First of all, if you happen to be reading this and have not yet read my last post "Counting the Gifts," please don't read this post yet.  I'm going to write a bit about our experience in the local hospital here, and it was rough, but God was looking out for us in so many ways, and we love this place and consider it our home, so it is important to know all of that first before reading about our challenges in this experience!

A few weeks ago, my youngest son Ezekiel started to have what seemed like a cold and cough, and then quite quickly got much worse the one night.  His breathing was labored, and his cough had a terrible "bark" to it.  He had croup last winter when we were still in Los Angeles and ended up with a trip to the E.R. there, and I was pretty sure it sounded awfully similar.  When he had it that time, though, they had told us that taking them out in the cool air actually helps when it is croup, as it helps reduce the inflammation in the airways a bit.  I tried that a few times during the night, and it wasn't seeming to have much effect.  I just kept praying for him and hoping for morning.  Every once in awhile, I would have this panic of wondering if we should do something immediately and not knowing even what or how or where that would be here.  

A little aside is that I have some issues related to illness.  Illness for my kids is like my own personal hell.  I know that no parent likes having sick kids, and problems with breathing are particularly scary, I think, for any parent.  But there are some deeper things for me that get triggered, and it can be hard for me to work through them.  I grew up with a sibling who had a lot of illness and quite serious illness much of the time, and from a lot of things with that from childhood, my kids getting sick often takes on a larger than life dynamic in which I struggle to see what is happening in the present, and fears and other feelings get triggered from the past in a way that used to be nearly paralyzing.  I came face to face with it the last time we were here with Isaiah being sick a lot during those few months, and by the time we were arriving back in the States, I realized much of what was happening internally and had some amazing friends pray for me in a very powerful time that set me free from much of the power of that.  I forgot to really write about it in my post on counting the gifts in this experience, but I have to say that I am so grateful for God's work in freeing me from much of that.  It still gets triggered and can challenge my decision-making or ability to be logical, but I am conscious of it, and it has far less power over me.  Had I had this experience two years ago with one of my boys, I am not sure I would have made it through without major breakdowns.

Anyway, back to the current story...when we were all up for the morning on Wednesday, John and I made plans.  Isaiah went to work with John, and I took Ezekiel to the private clinic at Patan Hospital.  As I wrote before, there is a time on Wednesday mornings that two British doctors have set aside just for expats to come in.  I was so thankful it was a Wednesday, and I had kind of convinced myself that it was, in fact, "just croup" again.  Since we had been through that before with Zeke, I guess it scared me less, and I had seen that he responded quickly to the treatments they gave him.  Plus, I was thinking his breathing had calmed some, so I figured maybe we would be able to get some medication, possibly a breathing treatment, and head home.  When I was signing in at the counter for the clinic, the young man who works that desk said, "He is very sick.  He needs a breathing treatment."  Not a great sign.  

The nurse took his temperature, and after some Celsius/Fahrenheit conversion, I realized his fever was quite high.  One of the doctors was freed up fairly soon and called us in to the exam room.  She examined him a bit and then said she wanted to consult with the other doctor.  She said we definitely needed to go over to the E.R.  A bit of panic started to set in for me again, but thankfully, the first doctor offered to walk us over and get us settled there.  I can't really quite even describe the overwhelming feeling of walking into the emergency room there.  It is a huge open room filled with cots and people everywhere.  There are a couple of sections on the side and end that have curtains that can be pulled, though I only saw that happen once.  The rest of the room has no dividers.  Just cots that have leathery cushions on top and are spaced about three feet apart from each other.  I am fairly used to being stared at here.  It's not really abnormal culturally here, and we are obviously quite a sight that doesn't exactly blend in with the surroundings!  But, it felt a bit like a gauntlet walking between these rows of beds, cradling my sick and lethargic little guy, with people all turning and staring in this warm, dingy room that smelled like toilet.  

The smells.  Oh, my.  No one likes hospitals.  They smell funny anywhere.  But, in the States, hospitals usually smell like disinfectant and alcohol and have startling bright lights.  Throughout the time we were sitting in that room, the strong smells of human waste and some sort of sour smells kept wafting through the room in varying degrees of intensity.  A woman with a large push broom would occasionally do a round through the rows of cots, and it was unsettling to watch the literal piles of dirt get pushed around.  

We were taken over to an empty cot on which I sat and held Zeke in my lap.  At multiple times, the man who was with the patient in the cot next to us was actually leaning back on our cot.  Some of the sequence of things has gotten a bit blurry for me (probably for the better), but early on, after taking his temperature again, a woman (nurse, I think) told us that we needed to go out and pay at the counter and have something signed and then come back.  Charts and paperwork here are all kept by the patient as hard copy documents, and the processes often require a stamp from some other department or counter in order to move forward with a procedure or treatment.  So, I carried Zeke out of the room to the entry area of the E.R. and waited for a bit, and a woman there finally took the paper, had to look up several things and write down things and punch some numbers into a little calculator, and then she showed me the calculator with the amount to pay.  Then she marked paid, and I went back and sat on the cot with Zeke and our papers again.  

They gave me some paracetamol (acetaminophen equivalent here) to give him for the fever, which he hated!  At some point, they brought over a mask and plugged in the nebulizer.  I saw several masks in use throughout the time for various patients there.  Unfortunately, I never saw one get cleaned.  That isn't to say it didn't, but I was cringing a bit to think about it, as the machine and the mask both looked a bit dingy.  While I was holding the mask for him to have the nebulizer, I watched several people go and spit in the main hand washing sink and one woman walk barefoot into the bathroom (note the toilet smells I mentioned earlier and that these are just holes in the ground with places for your feet on either side).  

The doctor wanted him to get a chest x-ray, which I think I actually had paid for in that first trip to the counter, so they told me a room number and pointed, and I had to walk out of the E.R. and down the hall, carrying my papers and my kiddo, to the x-ray room.  The woman there looked at my papers, stamped something, and handed them back to me.  I tried to ask her if I was supposed to sit nearby and wait, but she didn't speak any English, so that is what I did.  (A side note is that I REALLY wished my Nepali was much better during this experience!)  A man came out soon from a nearby door and called us into a room that was dimly lit except for a bright light directly above the hard table in the middle of the room.  Not going to lie--it kind of reminded me of an interrogation room you see in T.V. shows in the States.  All the rooms there are cement block and, as I said before, dimly lit.  He placed the x-ray panel thing on the table, motioned for me to lay Zeke down on top of it.  Big surprise, Ezekiel seemed rather scared.  The man came back, took the lead vest thing he had given me to put on and disappeared.  I waited.  He didn't come back.  Looked around the corner.  Couldn't see him or anyone anywhere, so I took Zeke back out of that room.  I went up to try to ask the woman what we should do next, which didn't .  Thankfully, within a couple minutes, someone else handed her our x-ray, which she put in an envelope and handed to me.  I took it and walked back to our cot in the E.R.  

Another stint of waiting in the E.R.  One of the doctors from the private clinic came to check on us (which the two of them actually did several times!), and after sorting through a jumble of communication and getting some forms and numbers and such for us, I had to make another trip out of the room to the lab to get his blood drawn.  There is a narrow room with one man behind a counter that is sectioned off at the front of the lab.  There is a line of people that wait their turns to place an arm on the counter and have the man draw blood while the rest of the line watches and waits.  Then, back to the E.R., assuming somehow the results would make their way to us at some point.

We sat for quite some time there.  Occasionally, someone would pull over a movable screen in front of the cot of the person they were with so that s/he could use a bedpan.  The little girl two cots over from us had an I.V. in that they were having trouble with at several points, so there was a large pool of blood next to her cot for a good hour or so before it got cleaned up.  I kept thinking, if my little guy wasn't sick before coming in there, he surely would be after spending hours in that room.  A woman who was there with another patient came over at several points and stood right next to me or right behind me, looking at Ezekiel's chart/papers for several minutes at a time.  A group of women across the aisle from us unabashedly stared and pointed and talked about me/us/him.  People  who were there with patients often walked up to other cots of people they did not know and asked what was wrong with the person there.  At one point, there must have been something exciting happening with someone in a cot at the end section because, suddenly, there were 25-30 people gathered around watching.  I had a moment of panic in there when I looked around the room and realized that I didn't see any of the doctors or nurses that had been dealing with us and that I knew spoke English.  I wasn't sure what was happening or what we were supposed to be doing or what we were waiting for.  We were just sitting there.  I felt terribly alone and started to feel very afraid.  A verse that had been at the beginning of a story we were reading that week for school came to mind:  For God has not given us a spirit of fear, but of power and of love and of a sound mind (2 Timothy 1:7).  I prayed and prayed for God to replace my fear, as there wasn't even anything directly that I was afraid of.  I was so tired and overwhelmed, and the tears were brimming to the surface.  About that time, one of the doctors from the private clinic came in to check on us as her time was ending for the day.  She examined took a look at his chest and said he really needed to be admitted because of the "indrawing" beneath his ribs.  Despite sounding better, it seemed his little body was still working much too hard to breath.  I tried not to burst into tears on the spot, as this was definitely not what I was expecting.  She talked with the other doctors, and soon, I was seeing the doctor and nurse I had seen before, and they were talking about arranging for him to be admitted.  They said I would need a deposit first, though, so I called John and had to wait there in the E.R. until he came.  Had I known the amount, I actually could have paid from what I had on me, but they made it sound like it would be a lot, so we waited.  Total time in the E.R. was a little over 4 hours.  Well, that included the random trips out of the room, but start to finish, that's what it was.

Thankfully, Isaiah was able to go to our friends' home, as I wasn't eager for both of my kids to need to experience this E.R.  John came, we paid our deposit, took our stack of papers, and walked ourselves up to the children's ward.  We went to what seemed to be the nurses' station and showed them our papers.  The pediatrician that had come to see Zeke in the E.R. was there (really nice young doctor).  A nurse took us into a room (cement block, same as the rest of the place) and showed us the "bed" (cushioned cot again) next to the window.  There were two other beds in the room with people in them (no dividers), and there was a bathroom (with a "squatty potty"), which filled the room with toilet smell every time the door blew open a smidge.  There was one leathery cushion that seemed sort of like a pillow and a sheet on the bed.  There was one thin blanket.  Apparently, you have to bring your own pillow and blankets.  Have I mentioned that winter is cold indoors here?!  Our sweet friends brought us a couple pillows and blankets from their home nearby and some homemade cookies.  He is a pediatrician, and as I mentioned in the previous post, was a gift beyond words in the whole experience.  I can honestly say we would have had a much different experience there (and not for the better!) if it hadn't been for him!  

The pediatrician had asked before we got admitted if we wanted to be in the normal children's ward or a private room.  I said it would be really great to have a private room, and he said we should really be in the children's ward.  Not sure why he asked me.  Our pediatrician friend confirmed that, until Zeke was more stable, he should stay in the regular children's ward for closer observation and treatment.  What he didn't tell me until later, which was very wise of him, was that Ezekiel was really on the verge that first night of needing to be put in the ICU!  So, while a big stretch for my Western personal space boundaries to be in an open, shared room, we stayed there.  

Nurses would come in and hand us a thermometer and then leave the room.  I actually realized the 2nd night, when we had moved to a private room, that I have never had to use a mercury thermometer for my kids and not even for myself for many, many years, and I was embarrassed to admit that I wasn't totally confident to even read it myself and had to carry it, along with a sleeping Zeke, to the nurses' station to read it, as they didn't come back to get it that time.  They had him use the nebulizer every 6 hours, and they kept wanting him to take oxygen, but he was fighting it so badly and would get himself all worked up and start gasping and coughing again.  Early on, they told us that we shouldn't fight him and get him all worked up like that, so we should just wait, and we would try to put the mask in front of his face when he slept.  Later, they would ask us why we weren't giving the oxygen to him all the time.  Zeke ended up with a secondary infections, so he had to start antibiotics.  They would ask us if he would take pills or liquid better.  Um, neither.  I think he was so on edge about the whole experience that the oral medications just were the straw that broke the camel's back, and he would just refuse and fight and spit it out.  While I understand the original hope was probably that he would be less afraid if a parent gave it to him than if a stranger did, when that proved not to be true, I was really wishing that someone else would give it to him and be the one for him to be furious at!  Given the struggle with the oral medications, that did mean he ended up with his paracetamol in suppository form several times.  At least the nurses did give him those!

By the second day, thanks to the efforts of several friends, we were able to move to a private room.  Once that had been decided, in the midst of one of the fights to give him medicine, some people opened the door to our room to watch us, left, and then came back with some more people to watch us, which pretty much cemented our determination to move to a private room.  Pretty much the same kind of room with the same toilet smell, but at least we were the only ones in it!

The doctor (pediatrician, mind you) that checked on us first in the private room asked us, "Why won't he take the medicine?"  Um, he's two.  He afraid.  And he's two!

After his fever broke, he finally got a fairly peaceful stretch of nearly two hours of sleep that second night (MUCH longer than any stretch he had had for several nights), which was ended abruptly by a nurse coming and turning on the lights to give me a thermometer and tell me it was time for him to take his antibiotics. Thanks for that.  Pretty sure it would have been ok to wait a bit for him to take that stuff.  

We were planning that we'd be able to go home that third day, but when some doctors came in to check him, they said they thought maybe he should stay again.  I literally just started crying.  They clearly didn't know what to do, and after standing there silently for an awkward amount of time, they left.  Our friend called and even came by and checked him again himself, and while he was certainly not 100% for his breathing yet, he said he thought he was ok for us to go home.  

Apparently, the checking out process can often take several hours, but again, with our friend being there and pushing things along, we were able to get things processed relatively quickly (probably an hour and a half from the start of release papers to actually leaving).  John went to pay the bill.  Now, here it is a LOT of money, but the total amount we paid for all of it (E.R., treatments, x-ray, lab, one night in a regular room, one night in a private room) was less than our CO-PAY had been for our E.R. visit last winter.  Puts a bit of perspective on things.  We stopped at the pharmacy there before leaving to pick up more antibiotic, which the pharmacist told us to give him for 5 days, which I was pretty sure was not enough, but we got more later after verifying with our friend.  He also told us to take it three times a day--at 6:00 a.m., 2:00 p.m., and 10:00 p.m.  Yeah, pretty sure three times a day is sufficient, and we're not going to wake him up at 10:00 to space them out exactly!

Well, this has obviously gotten quite long, so I'll wrap it up.  It was a really intense and overwhelming experience--definitely the most challenging situation we've faced here.  I'm including a few photos to give a glimpse of our surroundings there.  I neither had my camera nor the presence of mind to take photos in the E.R., and it would have been awkward to even take them in our shared room, so here is our private room.

Everything had a number on it...which kind of reinforced the prison cell feel.
Imagine this same size of room with two more beds in it.  This private room actually had the second cot for someone who was staying with the patient to sleep on.  There were no other chairs or beds other than the patients' ones in the other room.  Oh, and when John asked about a crib or a rail or something--in the *children's ward*--they looked at him like he was crazy.

The private room did have this wardrobe thing and a sink as well, though it was pretty unsettling to actually look at the surfaces around the sink.  Not the color they should have been.

Weird picture, obviously, but I was trying to capture the peeling paint, shaky ceiling fan, dingy box fluorescent light view.

No, this is not a cattle chute; it is where you line up for the pharmacy window.  I can only assume the metal bar contraption is an attempt to get people to actually form a line, which is rare.

Wednesday, February 13, 2013

Counting the Gifts

It has been a really rough stretch this past week.  My boys (and I) have been sick.  We spent several days in the hospital here with our little one last week.  I have slept very little over the past 7 or 8 days.
I am tired.  I have two little guys under 5 who alternate having sleep issues and are filled with crazy levels of energy.  I have moved twice in the last 2 years--one being to the opposite side of the globe.  I don't really remember not being tired.  But, I also don't think I've been quite this tired in quite awhile.  When I get tired, it is easy for me to focus on all that is or has been wrong.  Let's be honest, I'm a bit of pessimist by default, so even when I'm not tired, it's easy for me to see life in a less than flattering light.  I have written before about Ann Voskamp and her Joy Dare challenges to be intentional about counting the gifts and even used this blog as my means of recording those for some time. God used that to really reshape my heart and mind, by His grace, to live more tuned into His gifts and cultivating a heart of gratitude.  It is still a struggle and takes a lot of discipline from me and a lot of grace from Him.

I have a lot of thoughts to process from the last week, but I decided that this is a perfect opportunity for me to be intentional about counting the gifts, both for my own sake but also so that I can share of His goodness and share the blessings before I dump out all my thoughts and fears about the challenges here.  I have had a post running around in my mind about this place truly becoming home to me, and I don't want to cloud that with laying out a whole list of the hard things from the last week.  So, before any other thoughts or details from our experiences the last week, I shall count the GIFTS!

*  It was a Tuesday night that Ezekiel's bad croup symptoms hit.  To make this make sense, there is a clinic at Patan Hospital every Wednesday morning at which two British doctors have set aside time just to see expats and help them.  It is the easiest and best possible scenario, in my mind, for our medical needs...and it hit exactly when I most needed it!  These two doctors and the nurse that works at it were an invaluable help to me and so very kind!  One of these doctors has worked in that hospital for many years, is a tremendous physician, and interacts with the hospital system with grace and ease.  She is the one who diagnosed what Ezekiel had and what he needed, and the two of them proceeded to escort me to the emergency room, get me settled there, and then came to check on me several times each in the hours I was there, even after their hours were over for the clinic!
*  Expat community here that looks out for each other.  I am constantly amazed and grateful for the amazing people I meet who have come here from so many places around the world.  Particularly on this side of the city, we have experienced a real sense of community among the expats.  It's like a group of soldiers in the trenches together.  We all know that there are challenges unique to being in a foreign land away from family and friends and things that are familiar.  I have received an invaluable amount of support and advice from people who have been here longer or learned things that I am eager to learn about being here.  This time was no exception.  There was a woman and her daughter in the clinic when we went in that Wednesday morning. She is someone we attend a fellowship with and helped direct me to a prayer group of moms with little ones when we were here the first time, but she isn't someone we know well.  One of the doctors told me that this woman had called back to the clinic later to check and see how I was doing with Zeke and said she could come back and be with me, if I needed someone!  Plus, my moms' prayer group here, who have become dear friends, were checking in on me and offering help and prayed for us.
*  My friend Laurel.  Laurel's husband Mark is the CEO of the company we work for here.  We both live within a few minutes of the office, so I see her most days during the week.  She has two little ones of her own at home, both of whom have had colds, but she kept Isaiah at her home Wednesday afternoon, and he felt happy and enjoyed the afternoon, which was a huge blessing at the last-minute so that he had somewhere he could be and not feel anxious!  Then, she made dinner for us that evening and checked on us multiple times throughout our time, offering help with whatever we needed.  Mark came over to the house that evening once I put Isaiah to bed so that I could go back to the hospital and trade places with John for the night.  Friday morning, Laurel brought breakfast to me at the hospital and spent the morning there with me.  And, last night in the midst of a super full day for her, she brought over an apple pie for us!
*  Steve and Becky Thorson.  I seriously cannot even begin to express the gift that they are to us and especially that they were in this experience!  They are American but have lived here in Nepal for nearly 30 years.  Steve is a brilliant pediatrician who has worked at Patan Hospital for years in various capacities.  They came to check on us the first night (in spite of Steve literally getting hit on his leg by a bus that day!), brought us homemade cookies and pillows and blankets (since they aren't provided by the hospital), and Steve examined Ezekiel and really made things happen that we needed medically throughout the time we were there.  His expertise and his stature with the staff at the hospital meant that we really got what we needed for Ezekiel and put our minds at ease so many times.
*  The office administrator at our business has become a friend of ours, and we are really thankful for her and for the opportunity to keep getting to know her.  She surprised me Friday morning by coming to the hospital with her husband to visit Ezekiel and me.  It meant so much to me!
*  The most obvious gift, perhaps, is that my little Ezekiel is fine now!  He has some cold symptoms, but he is breathing well and happy as a clam again!
*  Isaiah's run with seemingly the same virus did not result in as serious of a situation, and we never had to take him in to the clinic or hospital.
*  John and I were able to make it through the sleep deprivation and at least take care of what was necessary, and our turn with the virus waited until the boys were mostly recovered.
*  Our home and family.  I was so eager to get home from the hospital and to have our family together again in our home.  I am so thankful to not just have a house here but truly a place that feels like a home.  I'm also so very thankful that I have a husband and two kids that I love and want to be with!
*  We have the resources to get the medical care we need.  The total bills seem so small to us compared to what we would pay in the States, but I know that it would be too much for so many people.  I am so thankful for the provision we have and that it isn't a factor that causes worry or impacts our decisions about getting the care we need for our kids.
*  We have family and friends around the world who love us and pray for us.  The notes of encouragement and confirmed prayers are an absolutely amazing gift.

I am sure I am missing some in my current fog.  There have been so many gifts and such huge ones in this experience.  I'll save the challenges for another day and another post.  I choose today to focus on the gifts!