I’m so VERY glad we had this time together?

Cultural idiosyncrasies are some of the most entertaining aspects of living overseas, and let me assure you that we Americans are just as entertaining in our cultural habits as anyone on the face of the earth.

Recently, three colleagues of mine—a Pakistani man, a Tanzanian woman and an American woman—were in my office, and the four of us were discussing a work issue. My American colleague was explaining something to our male colleague who, because he would get frustrated by his inability to answer quickly in English, would respond instead in the local Pakistani language of Urdu and have our Tanzanian colleague translate, because she is also fluent in Urdu. As I said, the four of us were discussing a work issue, but it should be noted that I was largely ignoring the entire conversation because I was rapt with the task of clobbering a fly that was bothering me.

I don’t know what it is about flies. Mosquitoes find me boring, and fleas refuse to nibble. I don’t think I’ve ever had a tick bite; perhaps a chigger bite or two, but I am honey to a fly. A fly will travel great distances to buzz around my head and drive me out of my mind. They do it at great personal risk, because I am always intent on truncating their already limited life span.

So, as the conversation ensued, I was paying attention to my buzzing tormentor, ready for an opportunity to strike with the magazine that was rolled up in my hand. At a particularly opportune time in the conversation, the pesky fly chose to land on the edge of my desk, immediately in front of my Pakistani colleague. I reared back and slammed the rolled magazine down on the desk, at which point my friend jumped up from his chair and grabbed both of his earlobes.

There was a moment when the three of us women took in this scene. We each knew I was swatting a fly—actually, I missed—and I was momentarily miffed that my colleague would ever have thought I was aiming at him but, as we looked at him standing and holding his earlobes, we had no choice but to burst into laughter. He joined in but still tightly holding his earlobes.

After we caught our breath and wiped the tears; we had to know: Why was he holding his earlobes?

Ah, it is cultural. Because he was concentrating on the conversation and the translation that was taking place, he wasn’t paying attention to my hunt for the fly. When I slammed the rolled-up magazine down on the desk, his immediate reaction was to think he had somehow said something wrong or insulting and that I was showing my displeasure. I understood why, to get out of the way of my magazine, should it strike again, he had jumped up, but the earlobes? Turns out it is a demonstration of apology in the Sindhi culture. My friend didn’t know what he was apologizing for but his reaction was instinctive and, given the circumstances, very funny.

We have now spent several days adapting this newly learned skill to our toolkit. We’ve decided a mild insult warrants pulling on one lobe, à la Carol Burnett, and that a more serious offense should have both lobes wagging in supplication. My Pakistani friend, on the other hand, has a newfound dislike of flies. Cross-cultural assimilation at its best!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Eye witness

I have recently been on the receiving side of patient care. My cataract surgery was a complete success, and I am surprised—no, amazed—how much brighter my world looks now.

I reported to the eye clinic at a local hospital one morning last week. My ophthalmologist, who looks like she belongs in high school rather than a hospital, did a quick eye exam to determine if I was an acceptable surgery risk and then sent me off to the outpatient surgery section. There, I was met by two lovely young nurses, Petra and Jane, who explained that they each spoke a little English and that, together, would get me ready.

They were so helpful and pleasant I was sorry I caused them extra effort with my language requirements. I changed into scrubs, had my name plastered on the front of my shirt on a piece of tape so they wouldn’t forget who I was, and was led into the surgery-suite waiting area. There, one of them appeared every 10 minutes to put different medicated drops in my eye.

I’ve traveled a good bit of the world and one thing I’ve always marveled at is, no matter how friendly a society is or is not toward Americans, everyone—and I do mean everyone—likes American music. So there I am sitting in this room, surrounded by several Czechs waiting for eye surgery, and I’m listening to American country music.

After I completed several rounds of eye drops, I was transferred to the operating room, positioned for surgery and draped out. I have a bit of claustrophobia. It isn’t one of those run-screaming-out-of-the-room things but rather a nervous tension. I knew I was going to have a drape over my face, and I was a little concerned about this, but I shouldn’t have been. I only had a moment to worry about being covered up before the instruments started coming toward my eye. For the rest of the short procedure, I gave no thought to being enclosed. I was too focused on the needles and the sucker thing I was watching attack my eyeball.

I readily admit there was no pain! And, to prepare me, my ophthalmologist explained everything that was happening. The nurses were great, comforting and reassuring me, and one even held my hand. It was not a bad experience; it was a strange experience! I’ve never had eye surgery before, but I have had surgery in the United States and I can honestly say that the surgeon, staff and facility met any expectation I would have had at home. I would not hesitate to recommend them.

I’m now in the recovery phase, which has been surprisingly easy. I had no post-operative pain at all, only a patch on my eye for 24 hours. The patch came off and—voilà—bright, clear vision! I’m channeling Bob Marley lately as I sing, “I can see clearly now.”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

If you're from Georgia, I'm from Mississippi!

I haven’t lived in the United States for almost 12 years. I can’t count the number of times a week I am asked, “Where are you from?” or some derivative of that question. I always hesitate before I answer, a habit I dislike, but it is a question that does not have a simple answer, and I’m forced to think before I reply. I have to think about the actual information the asker wants, which can vary quite a bit, depending on circumstances. I realize Americans are, more and more, a mobile society, but the question, “Where do you live?” or “Where are you from?” asked by one American to another has a limited connotation. Not so for the expat.

I spent the first 20 years of my life in Texas, followed by 17 in Tennessee and 10-plus in Mississippi, before I joined the U.S. Foreign Service. Today, I live in the Czech Republic, my legal residence is Tennessee, and I own a house in Mississippi. If I am relatively sure the intent of the question is what part of the United States I call home, and the asker is foreign, I answer “From the South” Most non-Americans have as little understanding of the geography of the United States as Americans do of other countries. I learned early on that most foreigners know New York, Chicago and Los Angeles. Any place else is just a mystery and answering “From the South” seems to satisfy them. In fact, I once spent about 10 minutes on an overseas flight trying to explain to someone that I was going to Mississippi, the state, not Mississippi, the river. He never did get it.

If I am asked the question when I begin work at a new embassy posting, I know they want to know the location of my last post. If I am traveling away from my post and someone asks the question, I always answer with the city of my current residence. About 50 percent of the time, that solves the issue. Sometimes I can have great fun with this, like the time I was in Thailand and answered the question with Pakistan. The young lady behind the counter repeated it twice with a look of amazement on her face but, since the address I had put on the registration form was indeed a Pakistan address, she didn’t argue.

If I meet people from Texas, I always tell them I am, too. I still think of myself as a Texan, even though I have spent two-thirds of my life outside of Texas. I cannot remember ever meeting someone from Mississippi overseas, but if I am introduced to a person from Alabama, Georgia or another southern state, I will counter that I am from Mississippi. And, if some stranger is pushing me about my nationality, and I am uncomfortable with giving the information, I say I am from Nova Scotia. No one knows where it is, how they talk or anything about it—shuts them right up!

Is it any wonder I’m confused?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Blow out the candle!

How, you might wonder, do I manage a patient with a medical problem that can’t be handled at my post? This is actually quite common at many embassies and not just those with poor, local medical care. Some very modern places in the world do have a medical viewpoint that is culturally different from Americans and, when necessary, we medevac to a location more in keeping with our standards or expectations. Of course, the majority of medevacs are for conditions that cannot be medically treated due to lack of appropriate local resources.

The type of medevac depends on the patient and the problem. Sometimes, the patient travels on commercial transportation alone, sometimes with a non-medical or medical attendant and, in the most severe circumstances, we call in an air ambulance. During my career, I’ve had patients who have required each kind.

You might think that the person who is able to travel alone would cause me the least angst, but that isn’t a given. Consider the mid-40s gentleman who, after six months of feeling not quite right, was evaluated by his family doctor while in the United States on leave. A chest X-ray was suspicious and a CT was ordered but, before the report was sent, he returned to post in Kabul, Afghanistan. This gentleman brought a letter into my clinic that had arrived via DHL.

The letter started with “Take this to your medical provider immediately” and, as I read, I saw the term “dissecting, ascending aortic aneurysm.” These are not words a nurse practitioner wants to read, ever, but particularly not in the middle of a war zone with limited options for emergency care. After many phone calls of consultation, the decision was made to fly the patient back to the U.S. for surgery—on regular transport. Imagine both my surprise and relief when I received a message some 30 hours later that the patient was at Duke University Hospital prepping for surgery after an uneventful flight.

The only case of Guillain-Barre I’ve ever seen occurred when I was serving in Conakry, Guinea. While my patient’s ascending paralysis was making its way up his torso, I was calling in the air ambulance. Unfortunately, air ambulance support to a remote place like Conakry can take a lot of time and, in this case, more than 24 hours. I moved the patient to the hospital nearest the airport where there were people—but precious little else—to help me take care of him. The internist overseeing the patient’s care moved the anesthesia machine into the room in case he required respiratory support, as there was no ventilator in the hospital. But, much of the time there was no electricity in the hospital either, so an Ambu bag was brought in as well!

After we settled the patient in the room, the internist brought in a candle and a tape measure. He proceeded to measure 18 inches out from the patient’s mouth, then lit the candle and asked the man to blow out the flame. He did. This, the internist said, was proof that his pulmonary function was adequate. As long as our patient could blow out the candle each hour, we would not have to intubate (put in a breathing tube). Every hour, for the next 20-plus hours, either the internist or I dutifully lit the candle and our patient dutifully blew it out. By the time the air ambulance arrived, my patient only had use of his head, neck, shoulders and upper arms, but he could still blow out the candle! I have no idea if this procedure is actually founded in good science, but I can tell you that this hourly exercise was immensely calming both to my patient and me during an otherwise very scary situation.

When the flight crew arrived and I reported off, I couldn’t help but notice the confusion on the face of the attending physician when I explained that our patient had been able to extinguish a candle flame at 18 inches throughout our wait for the air ambulance. I’ve tucked this little pearl of information into the recesses of my brain, in case I’m ever in a similar circumstance and need a rudimentary means of assessing respiratory effort. I’m happy to wait.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.