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.

Getting my eyes Czeched

For some months now, I’ve noticed my vision becoming less sharp. I finally decided to see if a bit of LASIK surgery might be a possible solution and scheduled an appointment with Prague’s premier LASIK center at a local hospital.

The appointment started off in the opposite direction I had hoped for when I was told the ophthalmologist with whom I had the appointment was not in and that his associate would see me. After a few minutes wait, a lovely young woman came in to speak with me and asked questions about my medical and visual history. I thought she was the nurse. She was the associate.

A few minutes later, I was ushered into the examination room where the young doctor did an eye exam. She quickly informed me that LASIK would not help me, and I needed to meet with her colleague. She thereupon personally walked me up to the next floor, where I met an equally young and lovely lens implantation specialist. In spite of the fact that I’m a medical provider, I can be a bit slow on the uptake. I was still of the mindset that we were talking about improving my vision which, in my mind, was a simple matter of loss of visual acuity due to aging.

The second ophthalmologist told me all about this wonderful multifocal lens that would improve my ability to read, without the Dollar Store readers I’ve used for years. “Yea!” I thought. I would love to ditch the readers. She then took me into her examination room and started with the same basic eye exam I had one floor below.

At some point, I threw out the question, “I guess LASIK would not work for me?”

“No” she said, “it will not correct the cataract.”

Cataract! What? Where did that come from? I immediately said, “I’m too young for a cataract!”

“Obviously not,” came her reply.

I was still trying to absorb this information when the young lady, now peering into my dilated right pupil, said “Oh!”

I do medical examinations and, as hard as I try, sometimes that “Oh!” just slips out. It usually isn’t good.

Now, the doctor is speaking Czech to her assistant. Next, the assistant is on the phone, and then we are moving hurriedly to another office. I asked what the “Oh!” was about. The doc tells me she thinks she sees a hole in my retina, and I’ll need retinal laser surgery.

“When?”

“Now!”

My goodness, the Czechs move quickly! This time, the retinal specialist is a rather ordinary-looking man who, though quite pleasant and reassuring, does mean things to my eyeballs as he looks for holes. After about 10 minutes of misery, he announces that my retinas are not perfect, but they are good enough and—drum roll—NO HOLES! “No laser today,” he says.

By now, I am so relieved I don’t have a hole in my retina I don’t even care that I have a cataract. Back we go to the second office, where the informed consent for cataract surgery and several bits of paperwork for pre-surgery testing are prepared. Alas, I am told that, because my retina is not perfect, I can only have the monofocal lens and will still have to rely on readers. They scheduled me for cataract surgery in three weeks, and I left the office with the typed medical report in my hand, just two hours after I arrived in the ophthalmology department.

Beat that!

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

Advanced practice nursing is an option?

In the Czech educational system, a public school student can choose to concentrate studies along a technical or professional path beginning at age 14, or what we in the United States consider high school. For instance, a student accepted to a health-career school would have a curriculum that follows a scientific and biological course, with clinical experiences in health care. After four years, the student can decide to pursue nursing, medical or allied health programs at the university level, go a completely different direction with university studies, or simply enter the workforce.

This past week, I was invited to speak at a health-career school in a neighboring community on the subject of health care in the United States. My audience was comprised of third- and fourth-year students, ages 17 to 18. The students submitted questions in advance, which gave me an idea of the type of information they were interested in.

They wanted to know a bit about me; where I went to school, where I had worked and in what section of the hospital. In fact, the assumption was that all my experience was in a hospital setting. In the Czech Republic, there are few nursing jobs outside hospitals, so, when I mentioned the many different roles nurses fill in the U.S. system, the students were quite surprised. I also identified and explained available levels of nursing education, including advanced practice possibilities, and this came as a downright shock to the students. They had never heard of an expanded nursing role, even though it exists in Europe with practitioners in the United Kingdom, the Netherlands, Sweden and Switzerland.

I had been warned that Czech students are not interactive, and I should not expect them to engage in dialog. However, the discussion about opportunities in nursing and advanced practice spurred many questions and interaction that surprised the class teacher. She admitted, once the discussion had ended, that she was amazed at the amount of interest the students had expressed and how engaged they were with questions. I hope I planted a seed of curiosity in my audience that may lead them to explore the many ways nurses can contribute to the health of their nation. The possibilities are exciting.

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

Turkey, ham or carp?

When I was growing up in Texas, our family tradition was to have turkey for Thanksgiving and ham for Christmas. That might have been related to my mother’s Ohio upbringing, since most of my friends had turkey for both holidays, except for my friend Kathy.

Kathy’s grandmother was Mexican, and their family's Christmas tradition was tamales. The grandmother, who could never say my name and always called me Beulah, would prepare a hog’s head and keep it in a big tub in the pantry. She would spend hours in the kitchen making the masa to go on the cornhusks, and then chop off meat from the hog’s head to fill the tamales. I always looked forward to Christmas visits to Kathy’s house, and tamales are still one of my favorite foods.

My mother was, at best, an adequate cook, and she passed on to me her lack of interest in spending time in the kitchen. So our Christmas ham was usually a canned ham, which, as I remember, was just a rung or two above Spam. When I married and had a family to feed on Christmas Day, I discovered spiral-cut honey hams and continued the tradition until the last little Pruett had left the nest. I don’t believe I’ve had a ham in my house since.

Czechs have a traditional Christmas meal, too. If I asked you to guess what it is, you couldn’t, unless you happen to be Czech, as it is carp soup and roasted duck. I’m not a fan of duck, but I would eat it if it were on the table. But carp? I just haven’t been brave enough to try that yet. I do like fish and I especially like catfish, and they are pretty ugly creatures, so I’ve surprised myself that my reluctance to try carp is based on how unattractive they are. That, plus I know that goldfish are carp, and it just doesn’t seem right to eat a family pet.

But Czechs are all about Christmas carp and, a few days before Christmas, you will find vendors on most streets with big vats of water and live carp swimming in them. A buyer will indicate the carp he or she wants, and the vendor catches and prepares it right there on the street. The poor carp, who was chatting with his tub buddies just a moment ago, is now on a chopping block with a cleaver aimed at beheading him. The blood literally runs in the street, and it is quite unappetizing for me.

I will be spending Christmas in Prague this year but, perhaps, it is time to look for a ham.

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

Fans, fountains and fruit

Prague is in the middle of a heat wave. The temperatures have been in the mid 80s for a week and, for a city with an average summer temperature of 74 degrees, I guess that is a bit warm. Air conditioning is virtually unknown in Prague. The few establishments that have it proudly display large, bold “Air-Conditioned!” signs to draw in wilting visitors. Fans and open windows are the methods most used to cool businesses and homes, and most restaurant dining is done alfresco, on any patch of outdoor space available.

Just across from my apartment is a very nice fountain. As I walked home from work a few nights ago, I saw many people in bathing suits—adults, not children—sitting in the fountain basin and lying around on the surrounding grass. I had to look twice to be sure I was really seeing that. Odd, I thought. The next day, same thing, and it has continued.

I can think of no water fountain that I’ve seen in the southern United States where citizens are allowed to frolic in the basin. To be fair, these Czechs weren’t frolicking, either. They were either sitting in the water, or dipping in and then going back to the grass. It was purely a method to cool down.

In thinking back over the many countries I have worked in and those that had fountains, I could only recall one other country where I’ve seen people inside a fountain. In Mexico City, the U.S. Embassy is just down Reforma Avenue from the fountain of Diana the Huntress. This is a quite large and very beautiful fountain and, for reasons I never understood, protesters for various causes would frequently come to the fountain, completely disrobe and splash around as a form of civil defiance. We would receive notices the day before these planned demonstrations and be advised to stay away from the fountain area, but there was never any violence or police action—just a bunch of nude people cavorting around Diana’s statue. Perhaps municipal fountains should be open to citizens to enjoy the cooling waters on a hot summer day, just not in the nude.

Strawberries, cherries and peaches. Oh, my! Summer has enveloped the local market with wonderful fruit. I returned to the United States in May for several weeks and left behind in Prague the sweetest, most succulent strawberries it had ever been my pleasure to enjoy. Sad was I that they would be gone on my return, as I assumed a short strawberry season as in the United States. Surprised was I when I realized there were still scads of strawberries to be had upon arriving back in Prague. So I asked, “When does the strawberry season end?” September! Because the Czech Republic has a cooler clime, strawberries grow all summer long. Yeah! I’m in paradise. The cherries are abundant right now, as are plums and peaches. Those, of course, do have a finite season, so I’m eating all I can while I can. Just one more reason to love living in Czech land!

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

Disabled doesn’t mean unable

I work with a young Czech RN who, because of an equestrian accident, is a paraplegic. She is an excellent nurse, still honing her craft, but with a zeal for knowledge and new skills that puts most professionals to shame. She is everything a nurse should be: compassionate, intelligent, skilled, astute and amiable. Her patients like her, but more importantly, they respect and trust her.

She drives a hand-gear vehicle, kayaks, snow skis and hand bicycles. She always was, and remains, a jock, adapting every sport she can to the constraints of her physical capacity. I know of no one at our embassy that views her as unable. Of course, she has some limitations, but don’t we all, one way or another? I think Americans have made significant progress in overcoming bias or stigma toward people who are different. The Czechs need to work on that, too.

Unfortunately for my colleague, the Czech Republic is a difficult place for people with physical limitations. To be sure, a large part of the problem is that buildings are very old here and, because of laws that prevent destruction of these precious structures, most can’t be adapted for improved handicapped access.

A law is in place that ensures adequate access for new buildings, but there just aren’t that many new buildings and the law doesn’t address problems in getting to them. Parking places for handicapped are woefully inadequate and, in many of the most popular spots, absent. Sidewalks are rough and don’t have ramps for wheelchair traffic. Bathroom doors aren’t wide enough, stalls aren’t wheelchair accessible, and there are often no elevators. The excellent public transportation system provides only minimal access for wheelchairs, making them virtually useless.

The worst insult to my very capable colleague is the prevalent public opinion that she is somehow less because she doesn’t walk. She often recounts the disbelief she gets when she meets someone new and says she is a practicing registered nurse. “But how?” they respond, as if all nursing duties require functioning legs! Yes, our clinic has made some accommodation, but truly little was required. And all those things I mentioned above that a good nurse should be are managed just fine from a sitting position.

I know that this situation will be cured with time. America started working on this issue decades ago. The Czechs will address it as well. In the meantime, my colleague is employed in an American clinic where she is treated with respect and equality and granted the opportunity to continue the work she loves.

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

Nine things I've learned since coming to the Czech Republic

I’m in my seventh month in Prague, the weather has warmed to pleasant spring perfection and I’m really enjoying this beautiful European city. I’ve been in the Foreign Service long enough to know each location has its particular culture and individual points of interest, so I’ve been reflecting on what I’ve learned since I’ve been in the Czech Republic.

1) Some people in Prague walk faster than I do. This may seem odd to you, but it is the first place I have ever lived where people on the street routinely pass me. I walk especially fast; not intentionally, it is just what I do. My 6-foot 4-inch son, who has a very long stride, doesn’t walk as fast as I do and asks me to slow down. I have been places where people look at me oddly, wondering where the fire is, I suppose, as I scoot past. Here, I am frequently outpaced, and I love it.

2) Prague is the sixth most visited city in Europe but only about 8 percent of tourists are American. I guess that means Prague is a best-kept secret from Americans but, believe me, other countries’ citizens love to come here. The CR is full of Europeans, South Americans and Asians.

3) Czechs are not friendly until after you say hello. Maybe this is a holdover from the insecure times of communism, but Czechs generally don’t make any eye contact with someone they don’t know, whether on the street or in a store. But the minute the other person says, “Dobrý den (hello),” that reserve melts away and he or she becomes open and friendly.

4) The Czech language is HARD! I think there is a reason only 11 million people speak this language, and it isn’t just because there are only 11 million Czechs! I have learned to get by in Czech when I order a meal or go to the grocery, but I will never be able to hold a simple conversation.

5) Czechs over 30 are not particularly interested in learning English. They were required to learn Russian or German—languages of occupying forces—and they are nationalistic about maintaining the Czech language. Who can blame them? I believe their thinking is, because they live in the Czech Republic and have their own language, foreigners who visit or come to live should make the accommodation to get by in the local language. I agree! We Americans think the same way. I just wish Czech wasn’t so hard.

6) Most Czech women are in the normal weight range. This is probably because almost all Czechs participate in a broad range of sports, but I have a sneaking suspicion it is also because refrigerators are tiny. Keeping the fridge stocked requires several trips a week to the market, on foot. I only feed one person, and I know my physical activity has increased just from grocery shopping. Additionally, once I’ve done the shopping and have lugged the groceries back to my apartment, I’m not too interested in eating.

7) Flowers are important. Prague is a city, but it blooms. Flower shops (květiny) are no more than two blocks away, no matter where you are in Prague. Citizens take great pride in displaying plants and flowers, and bouquets are a common gift. It really adds to the ambiance.

8) Czechs love tea! This was a total surprise to me. The CR is famous for its beer and Budweiser Budvar Brewery, home of the original Budweiser beer, is here, but tea shops with exotic teas from around the world are common. Many restaurants have a special tea menu with dozens of choices. By the way, local beer is often less expensive than tea, coffee or colas!

9) Finally, until 1989, every Czech baby had to be named from an official list of names. Legally, a non-Czech first name was not permitted on a birth certificate, and this tradition had been in place for centuries. Each name—male or female—had a “name” day on the calendar, and name days were celebrated rather than birth days.

No doubt, as I live here longer, I’ll learn more interesting facts about my temporary home. But I think the most important thing I’ve learned about Prague is—I’m happy living here.

Photos:

Top: Astrological clock

Bottom: Tyn Church, Old Town, Prague

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

When personal overlaps with professional

I suppose being in practice in the Foreign Service is akin to working in a small town—a very small town. While a few embassy populations are quite large, with more than a thousand staff members and families, most are well below the 500 mark. I am responsible for the occupational health needs of fewer than 200 people in Prague, plus another hundred local staff.

This means my patients are also my colleagues and friends. It is not uncommon for me to have lunch or dinner with someone I treat in the clinic the same week. Rarely are we in a situation where we provide care for people we don’t see frequently outside of the health unit, even if it is just passing in a hallway.

I have always had mixed feelings about this unusual practice environment, as having such a close relationship with one’s patients has both advantages and disadvantages. Under this system, my feeling of responsibility for a patient’s medical outcome is both professional and personal. My medical colleagues and I have to maintain clinical objectivity at the same time we have a very special interest in the people we are treating.

Recently, one of my patients has been very ill and has required advanced medical care within the Czech health system. I am thankful there is such competent care available in Prague, but the length and severity of the illness has cost me many tossing-and-turning nights. I worry and wonder if all the people making decisions in this case—myself included—are making the right decisions. From the beginning, there has been a high chance of complications, and I am acutely aware that, if things don’t go well, my embassy colleagues might look at me with a critical eye. But that isn’t the cause of my fidgety sleep. I have tremendous regard and respect for my patient, and it is that personal connection that causes the angst!

At my first post—Accra, Ghana—I was forced to hospitalize a septic 3-year old. The parents were on their initial overseas assignment and had been in country for exactly one month. The mom was a lovely young lady who stood about 5 foot 2. After admitting the baby to the hospital and initiating IV infusion of the drugs that were going to save her, the mom turned to me, literally grabbed me by the shirt and pulled my face down to hers. “Don’t let my baby die!” she cried.

That was the first time I felt the full force of the responsibility this practice can bring. Unfortunately, it hasn’t been the last time but, in that case, the child did well and left the hospital in less than a week, her mother having never left her side.

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

Interesting people

I continue to visit medical and dental clinics in Prague, as required by my Washington superiors. The purpose is to know options for care that are most in line with our American medical philosophy. This information benefits Americans who work here in an official capacity as well as visiting Americans who call the consular office for our list of medical consultants. I’ve had the opportunity to hear interesting stories along the way, and I frequently find the unexpected.

From 1948 to 1989, the Czechs were under a communist political system. One practitioner I know completed his medical education in Prague in the late 1960s and then defected to the west, eventually ending up in Canada, where he practiced for more than 20 years. He returned to Prague a few years ago to work and reclaim the home of his youth. His story is fascinating as he tells of his struggle to learn English, pass the medical examinations required in Canada and begin a life completely cut off from the rest of his family, who remained in what was then Czechoslovakia. He made huge sacrifices to live a life free of political domination.

I met a physician born in the United States to Czech parents, who defected from communism. He completed his medical education around the time the Czech Communist Party was abolished and decided to come to the Czech Republic to help build the new medical system. He has spent the last 20 years with his foot in both societies. He has a practice in Prague and maintains an attending staff position at an Ivy League teaching hospital in the United States, working at the U.S. location several times a year. Medical residents from the U.S. program have the opportunity to rotate through a linked curriculum he administers in Prague for an overseas study semester.

My young dentist in Prague is an American who married a Czech woman. They met in the United States, where they married, lived and worked but, when their child was born, they decided to move to the Czech Republic to be near her parents. His story is equally interesting because it is the reverse tale. Although he wasn’t escaping a totalitarian government, he did have to learn Czech—a very difficult language—to pass the certifying and licensing examinations. In fact, he was the first English-speaking dentist to achieve licensing in the Czech Republic. And, of course, he had to adapt to a very different medical environment. He has great stories to tell about his experiences; in fact, they all do. Meeting these interesting people and hearing their histories is one of the most interesting parts of my job.

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