One of the things I like most about Prague is that it surprises me! I can’t think of a month that has passed without some occasion or insight that has either surprised or delighted me. I’ve already written about many of them and, now, men in skirts!
While I’ve never been to Scotland, I have seen men in kilts before, rarely, and usually in association with a parade and bagpipes. But this past week, I noticed an abundance of men in skirts on the streets. Some were walking alone, some were in groups and, over a couple of days, the numbers grew until I thought there must be some kind of national Scottish holiday these men were honoring. Finally, I asked my buddy at the Irish pub where I frequently eat lunch, “Why all the men in kilts?”
He explained that there was a futbol—soccer to us Yanks—game in Prague between the Czechs and the Scots, and all these fine men in kilts were here to cheer on their team. A visiting friend was lucky enough to see a group of these fans as they hung out on the famous Charles Bridge—the perfect photo op!
They are gone now. The Czechs won the match 1-0 and are now second behind Spain in their group, competing toward the semifinals of the 2012 European Futbol Championship. I’m glad the Czechs won, as this is my adopted home for now, but I give a huge thumbs up to the Scots who were so supportive of their team that they outnumbered the Czechs two to one at the match. That is a terrific fan base. I will miss seeing them around.
Photo by Marianne Drain
It is influenza vaccine season, and I spend a good deal of time trying to encourage my patients to accept vaccination. I firmly believe in the benefit of any vaccination for communicable disease, and I frequently have to defend my position.
Young parents are concerned about drugs administered to their children. As a mother and grandmother, I understand their worry about risk versus benefit. Statistics are hard to find, but the National Vaccine Injury Compensation Program (U.S. Department of Health and Human Services) indicates that, on average, 100 claims of childhood deaths per annum are possibly attributable to vaccine administration. These are claims, not necessarily fact, but there is no doubt that vaccines do result in death or harm for a minuscule number of vaccine recipients each year. Of course, if one of those unfortunate persons is a member of your family, it is a tragedy of undeniable magnitude and cannot be minimized.
I am old enough to remember the advent of modern vaccines. I remember standing in line at my local elementary school with my parents, waiting to get my sugar cube with the pink medicine. That was the beginning of the polio vaccine. This memory is attached to another one, about my mother’s friend.
My mother and I would visit this lady in her home, where she lived in a round metal tube, lying on her back. A machine attached to the tube made a whoosh sound every few seconds. My mother told me this was an “iron lung,” but it would be years before I understood its significance. I knew she had polio, and she seemed remarkably normal to me as she spoke and laughed with visitors, observing them in a mirror attached to the tube above her head. I’m not sure I understood she was always in that tube.
When I was in first grade, there was a girl my age that lived on my block but, because she was blind, went to a different school. Before she was born, her mother had rubella. In the late 1980s, I made several trips with a medical team to the Caribbean island of St. Vincent. Each year, we would provide medical care to students attending a school for the blind and/or deaf, who were also victims of their mother’s rubella infections. The measles vaccine has been available in the United States since the early 1960s, and U.S. incidence of measles-caused congenital illness has been largely overcome, while the developing world is still suffering the effects that vaccine can prevent.
The risk in developed countries, while lessened, is still there. Just this month, the World Health Organization (WHO) announced that its goal of eliminating rubella and congenital rubella syndrome had been moved from 2010 to 2015, primarily because of small, vaccine-averse populations.
When parents ask for my opinion of the risk of vaccines, I don’t equivocate. I tell them about my mother’s friend in the iron lung and the other effects of vaccine-preventable disease I have witnessed firsthand. I remind them that the last case of smallpox was in 1977, the direct result of a global vaccine effort to eliminate what WHO terms “one of the most devastating diseases known to humanity.” But I also tell them the choice is theirs and that it should be an informed decision based on history and science, rather than personal apprehension. It is a serious choice.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.
It was two years ago this month on—for me—a typical Saturday night. It was about 8 p.m., and I was sitting on my sofa watching TV when the noise came and the apartment windows shook so hard I thought they would explode. I immediately ran to the radio and called the Marine on duty to tell him I was standing by, because I knew that—whatever this was—it was really bad.
Almost immediately, my cell phone rang. It was the physician I worked with at the U.S. Embassy’s health unit in Islamabad. We quickly formed a plan. I was to call the other nurse practitioner and ask her to go to one hospital while he went to another. Their goal would be to seek out injured Americans. Since I lived on the embassy compound, and was about 30 seconds away from the medical unit, I would go there, in case anyone came. Before I could get my shoes on, the Marine called to say that injured were coming through the gates, and they would be escorted to the medical unit.
My professional history included more than two decades in emergency departments and intensive care units, so I was prepared for the chaos that emergencies always bring. But this night would stand out as unique in my experiences. The initial injured that were arriving had sustained minor injuries, abrasions and scratches from flying debris. People were also arriving who had not been at the location of the bomb. Some came to assist, some to look for friends, and some because they were in shell shock from the enormity of the event and weren’t sure where else to go.
The blast was from a truck bomb in front of the Marriott Hotel. The resulting explosion killed 60 people and injured nearly 300 more. The blast concussion blew out windows and doors in much of the surrounding area, and some of the people coming to the medical unit were victims of that effect.
For the first hour, until the medical unit RNs could be escorted in, I worked as the lone medical provider. Several Marines came to help and were instrumental in taking names, triaging wounds, handing out water and bringing supplies to the exam rooms. However, the atmosphere was uncannily orderly. People spoke in hushed voices and wept silently. And, as I would go to the front room to seek the next victim I could assist, those waiting had already sorted out who might need to be next and patiently waited their turns.
A gentleman I did not know, and never saw again, came to answer the phone and relay messages. When a badly injured man was brought in, and it was apparent he needed immediate critical attention, I had only to announce the need for someone to accompany him to the hospital in the embassy’s ambulance. Immediately, a serviceman volunteered.
By the second hour, the other NP and the clinic’s three RNs had come, as well as a physician’s assistant who was in the area. We all worked steadily: cleaning wounds, suturing, dressing, comforting. A second critically injured person was diagnosed and we sent him off to the hospital.
Around 11 p.m., I received a call from a consular officer that a gravely injured American had been located at a government hospital. I left with the ambulance and another military volunteer—“I can’t let you go by yourself, ma’am”—to assess the situation. The man was badly injured and in shock. He had been partially stabilized but needed a head CT, which could not be done at the present facility. I used my very best diplomatic skills to thank the staff for all they had done and moved the injured man to our ambulance so we could take him to a facility with a CT. This hospital, not equipped for trauma cases, was a terrible scene, as many injured and dead had been transported there, and the staff was doing the best they could under appalling circumstances.
At 6 a.m. the following morning, I finally went to my apartment to catch a couple hours’ sleep, then headed back to the medical unit to see victims in follow-up, or new ones with minor injuries who came to be checked out. My physician colleague had spent the entire night at the hospital and finally went home when one of the clinic RNs came to relieve him. The other NP went to the morgue to sit with deceased Americans until the air transport arrived. On Monday, we would all be in the clinic for regular work responsibilities.
I have many times reflected on that Saturday night. I still marvel at the orderliness, the compassion for one another and the solidarity of everyone who came to the health unit that evening, in spite of the horrific event that brought them there. I would not call it fate or providence, but it was one of the few times in my life that I knew, without a doubt, I was exactly where I was meant to be and doing what I was meant to do.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.
When it comes to food, I’m a consumer, not a connoisseur. I enjoy a wide variety of foods and have very few dislikes. When I was in Czech language class, the instructor asked me to list my favorite foods so she could teach me the names. I told her all I really needed to know was the word for liver. As long as I can avoid liver, I’ll be just fine.
Of course, I have learned Czech words for various foods, as I have to recognize them on the grocery shelf. But my repertoire need not be very extensive, as I refuse to cook. To clarify, yes, I do on occasion actually throw something in a pot or a pan and turn on the heat, but it is very basic cooking. No recipes, no fancy ingredients, no slicing, no dicing or extensive preparation time. When my last child flew the coop, I had been cooking for 30 years, and I decided that was long enough. My kitchen is permanently closed.
Because I like almost any food or ethnic style of cooking, I don’t get overly excited about most dishes. And, gratefully, I’ve never really been a sweets or dessert eater. My one real weakness is ice cream but, even then, I never buy it for home and seldom eat it when out. At least, that used to be true.
There is a restaurant in Prague called The Savoy. The main reason I have gone there in the past is because the ceiling of the restaurant is hand-painted and truly a beautiful sight. I’m not all that crazy about the menu, but they have a nice soup and a huge variety of teas, and I do like trying different teas. Recently, friends and I went to The Savoy for dessert. It is known for having delicious pastries but, since I don’t really like pastries, I ordered the Savoy Sundae.
A bowl was placed in front of me that contained two small scoops of rich chocolate and one scoop of vanilla laced with a hint of strawberry, all perched on a marzipan. Surrounding the ice cream was real whipped cream drizzled with a chocolate sauce and topped with cherry compote. A garnish of biscotti and a dark chocolate disk completed this unbelievable concoction.
I really don’t have the words to describe my reaction to the burst of flavors that took place in my mouth while eating the Savoy Sundae. I am hard pressed to explain why this gastronomic delight has me creating reasons to take colleagues or visiting friends to The Savoy to enjoy the beautifully painted ceiling, and oh, perhaps, a Savoy Sundae while there. I fear this may be an addiction in the making.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.
Sometimes, information from odd sources comes together at the perfect time to effect a great good. I view these as minor miracles and am always grateful for the cosmic assistance.
I had a patient who believed he was suffering from empty-nest syndrome. His last child had departed for university and he was blue, often on the verge of tears, he said. He was also finding it hard to sleep. He visited me for some advice but was not amenable to any medicinal intervention, and there isn’t much a practitioner can do about the complaint of fatigue. I offered the usual naturalistic recommendations and reassured him that tincture of time is a great healer.
I saw him frequently around the embassy and usually asked how things were going for him, since I expected, as the days turned into weeks, that his sleep and mood would improve. But they didn’t. One day, we were chatting in a hallway and he mentioned that his dogs had been acting very strange at night and were adding to his sleeplessness. He told me that, when his child left home, he began letting the family dog sleep in his room and now, several times a night, the dog would jump on the bed, bark and wake him up. As soon as he spoke, the dog would lie down and be quiet.
Immediately, an article I had read about how dogs can sense medical dangers popped into my mind. Call it a hunch or an inspiration, but I instantly asked if he snored. Yes, he said, his child often complained about how loudly he snored. Returning to my office, I sent him the Epworth Sleepiness Scale and, wow, his score was very high! That was enough to get him scheduled in the sleep lab for evaluation of possible sleep apnea.
My colleague and his dog are now having peaceful nights, thanks to the CPAP that treats his severe sleep apnea. And, perhaps because of the passage of time, or maybe because he gets adequate oxygenation at night, his blue moods and fatigue are long gone.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.
Another week has ended and, because it is summer vacation time and post transfer season, my clinic has been operating at a slower pace. I enjoy the occasional slumps, because they give me time to accomplish administrative work I’ve been putting in my “round tuit” file, catch up on journal reading and reflect a bit on what I’m doing.
Today’s reflection highlighted the virtual practice, of which I am part, and the global resources I enjoy. In my former U.S. practice, if I wished to discuss a case, I usually walked down a hall to speak with a fellow medical provider. Occasionally, I would phone a colleague about a particular patient but, almost certainly, that colleague was someone I would see face to face within a short time to continue the collaboration.
Most of my postings with the U.S. Foreign Service have been as a single provider, so when I require consultation, I pick up a phone to call medical staff people in Washington, D.C. or in another country. For example, this week I’ve collaborated by phone or e-mail with colleagues in Washington, Budapest and Kyiv. I’ve also discussed medical-supply problems with colleagues in Islamabad, Pretoria and Abu Dhabi, and worked through an administrative question with my counterpart in Bucharest. And this is a slow week!
I admit I am impressed with how truly universal and “virtual” this form of practice is. I take it for granted that the diabetes expert I rely on is in Jakarta, the neurologist is in Frankfurt and the pediatric guru is in Budapest. And, like a city toss, next year we could all be in a different location, but still readily available to each other and the patients we serve.For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.
Even though I live on the third floor of an apartment building located on one of Prague’s main streets, traffic noise is usually like white noise to me, excepting the occasional ambulance. But when I heard the successive revving engines, I immediately recognized it as something unusual. I looked out my window to see—a long line of Corvettes.
Corvettes? One after the other they came up the street and, when it continued for several minutes, I realized this was not just a quirky occurrence. Down to the street I went to see—as far as I could see in both directions—Chevrolet Corvettes!
Police had stopped the traffic so the spectacle could continue, unimpeded, to its destination, wherever that might be. People lined the sidewalks, pointing at various vehicles that impressed them and taking photos. For a full 20 minutes after I arrived at street level, they passed. There were vintage models and new ones, hardtops and convertibles, of every imaginable color, driven by men and women, some with a passenger and others alone. All the drivers and passengers looked rather serious and largely ignored the curious crowds on the sidewalks. Except for the drivers who were compelled to rev up their engines and jerk their vehicles forward by a foot or two, it was more like a funeral procession than a parade.
The scene was quite surreal. First of all, I am absolutely sure I have not seen any Corvettes traveling around Prague since I’ve been here. Secondly, the mighty Corvette, symbol of American automotive ingenuity and the most “macho” of sports cars, really stood out when contrasted to Prague’s cobble-stoned streets and ancient buildings. And, of course, despite the fact that this vehicle is distinctly American, here, in the heart of Europe, were a couple hundred of them passing.
I have since learned that the 10th International Corvette Meeting is this weekend, when proud Corvette owners from all over Europe come together to flex their engines and share their pride of ownership. I am still smiling from this unexpected treat.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.
One of the things I like most about Prague is that it surprises me! I can’t think of a month that has passed without some occasion or insight that has either surprised or delighted me. I’ve already written about many of them and, now, men in skirts!
