A good weekend.

Hi, everyone! Seems like I’ve been a little wordy on my past few entries, so here are a couple pictures to make up for it. These were taken over the weekend, which was a lovely one. I had the whole weekend off, as did a few of my new companions, so we explored the island some and had a great time together. Here is some evidence of the fun. Hope you enjoy!

First, this is another view from my porch. It seems that my front yard is a playground! Incidentally, I am thinking I should try this parasailing thing, but I don't know if I am brave enough. Although, I have already been skydiving, so I would hope that I could handle parasailing.

















Welcome to Coki Beach!! Yes, this does look like heaven, but it is in fact Coki Beach. This beautiful site is really close by. As a matter of fact, I discovered today that it is right across the water from my room. Later I will post a picture of my resort from the Coki Beach side.

Thanksgiving PS

Thanks to Melanie for wishing me well in a comment posted today on the blog. (Thanks, Mel!! Love & miss you too!) It reminded me that I wanted to post a couple pictures from Thanksgiving.

This is the group of traveling nurses that I had dinner with at Molly Malone's, a local Irish restaurant that served an all-you-can-eat Thanksgiving feast with some excellent sweet potatoes. Yum!





And I found this beautiful creature near the restaurant. What a spectacular shade of green!

Island culture note – Proper Greetings

If you ever have the pleasure of visiting the islands, please note that the locals appreciate proper greetings. People are expected to use “good morning,” “good afternoon,” and “good night” when passing someone. Would you believe that a woman in the hospital, when walking by our group of five orientees, said, “ Good morning, good morning, good morning, good morning, good morning.” Unfortunately, saying hi or hello is not sufficient and can irritate an islander. Along the same lines, when stepping into an elevator it is impolite not to greet others who are also riding in the elevator.

Easy on the alcohol…

Just a word of warning to those of you who may come to visit the islands… Alcohol is cheap here. Local nurses say that the cases of alcohol poisoning they see are folks from the states who drink the same quantities they are used to at home, but don’t realize that a rum & coke, for example, contains a lot more alcohol than they are used to. The fruity tropical drinks are especially “dangerous” because it’s harder to taste the alcohol. So when you come to the islands, go easy on the drinks.

Details, details…

A little later than promised, here are the details on the hospital (pictured above).

The Basics. Schneider Regional Hospital is a government hospital that was opened in 1982 (a mere baby!) and has only had JCAHO accreditation for 5 years. It’s the only hospital on the island, so I’m not sure what they did for medical care beforehand. Patients from St. Croix and St. John’s (the other US Virgin Island islands) come via boat. There is a helicopter pad here, but no helicopter. There are 169 beds including one 8-bed ICU/telemetry unit, an 8 bed pediatric unit, labor & delivery and newborn units, hemodialysis, one medical unit, and one surgical unit. The facility has agreements with Washington Medical Center in DC and the Cleveland Clinic so that the island patients can be transported there in cases of medical necessity. (By comparison, UVa has 572+ beds and employs more than 1800 nurses.)

The Staff. The nurses on the units are primarily travelers (for example, 75% of the ED nurses are travelers). There is clearly a shortage of RN’s, as there is all over the U.S. In addition to hiring travelers, the hospital has tried to solve this problem by using a variety of personnel – LPN’s, CNA’s, and “nursing techs” who are people who have graduated from nursing school but haven’t taken their boards yet. There are seven (I think) unions at the hospital and the nurses are unionized. I have noticed that women really are running the show there. All of the presenters at our orientation were women and they were the directors of this or that department. The medical director is female. Of course, the President/CEO is male. But, he’s rumored to be nice and he knows all of the employees by name (first, middle, and last) and places a priority on being present to his staff. As does the CNO. Teamwork is huge here; we were told that not long ago a pipe burst on a Sunday afternoon flooding the dialysis unit and staff from housekeeping on through the leadership and the CEO himself worked together to mop up the water and get the unit ready to receive patients on Monday. That really impresses me.

Surgical Unit. The surgical unit where I work has 21 beds. I had my first day on the floor on Friday and it was labeled a slow day by the nurses. I would definitely agree; there were only six patients on the floor by the end of the day (plus two more were expected to come up to the floor from PACU). The unit handles “cruise victims” (had to smile at that one) who, in a drunken state, fall and break something, and locals (aka islanders) with their usual ailments (basic surgical needs, wounds, stabbings, broken bones, and much more that I will discover as time goes on). 75% of the population is of African descent and that means lots of hypertension and diabetes. Unfortunately, the hospital does not have a endocrinologist.

Interesting (to me, at least) tidbits.
-Security is huge here! All staff must have their ID in order to report to work. Visiting hours are strictly enforced (11AM-8PM on our unit) and visitors must surrender their driver’s license in order to obtain a pass, which clearly identifies the area of the hospital in which they are allowed to go. If they are visiting patients on two units then they must get one pass, visit the person, then go back and get the pass needed to visit the other. No children under 13 are allowed on the units. All units are locked (except one); staff enters a numeric code to gain entry and visitors must be buzzed in.
-No Smoking! I love it!! Not just inside, but outside either. Technically, they say you must be 50 feet from the facility, but given the landscape there is no real place to set up a smoking area. The joke is that you have to go to the airport if you want to smoke. Patients are told that they are not allowed to smoke and it is enforced. And they accept it! That’s the rule. Bottom line. Oh how this makes so many things easier!!
-Small island. This is a small island where they say everyone knows everyone and news travels fast. (Note that the island is 32 square miles and has about 55,000 inhabitants). When JCAHO came for a surprise visit, the inspector was welcomed on the overhead paging system before she even reached the elevators.
-Computer charting. All charting except meds are done on a Meditech computer system that has been in place for 7 years. I am amazed that they are “almost paperless,” which is more advanced than facilities I have seen. On the other hand, they are also behind in that they do not use computerized systems for physicians to place orders or nurses to chart medications.
-Very few IV pumps. When they taught us in nursing school how to calculate the rate using the drops per minute I thought it was silly and that I would never use it again. Not only do they not use IV pumps, they really don’t see the need to in the vast majority of cases. They do use pumps in the ER, ICU, and Peds. It is also interesting to note that when hospital equipment breaks, it needs to be sent off island for repairs, which can put equipment out of order for a long time.
-Breaks! Yeah! The facility recognizes that healthcare workers need breaks during their 12 hour shifts! We were told during orientation that we were entitled to a half hour lunch break and 2 fifteen minute breaks.
-Pt who are DNR are noted with a unique bracelet to help eliminate confusion in code situations. Seems like a good idea to me.
So, that’s the hospital! Let me know if I didn’t answer any of your questions!

Island Update

Part of the public transportation system are the "dollar busses" or "safaris" that are trucks/jeeps with covered benches in the back for people to sit on. Big news on the island this evening is that two of them crashed into each other. Have I mentioned how crazy the driving is around here? Most of the injured were passengers from the cruiseships and the Emergency Department was busy, busy, busy! By the way, the past few days we've had 2-4 cruiseships docking in the port here. Everyone says that Thanksgiving week tends to be one of the busiest of the year.

Back to work

Hi, hi! I hope that you are all doing well. Sorry for the long silence – I have actually been working. Can you believe it? I come to this beautiful place and they make me sit inside for hours on end listening to people talk on and on and on about hospital policy. Ugh. :)
A lot of people have been asking me about the hospital and about the job in general. I’m going to break this into two entries – one tonight with a general update and then I will write in the next day or two with more specifics about the hospital for those who might be interested. Let’s start with a picture, though. This is what I should have been doing when I was stuck indoors all that time…

So how’s the job?
The job is fine so far. I have just been on orientation, so it’s not really a true indication of what things will be like once I get on the floor. First of all, let me say that there is a group of nurses in orientation with me who are all traveling and we have banded together into a nice little support network already (more about that later). One lives in my resort and four of them live one mile down the road. Then there are three others scattered about. We are all going out for Thanksgiving. So if any of you were worried about me being alone on the holiday (or was that just me??), you can relax and chow down knowing that I am in the company of my new acquaintances.
Regarding orientation, let’s just say that this is no well-oiled machine. It’s hard (impossible?) to get a clear answer on what the schedule will be from day to day. This is not the place for type A personalities. One has to just relax and go with the flow. The hospital staff have been very nice and I am looking forward to getting to know them better. The food in the cafeteria is good. Apparently, the cafeteria is known in town to be one of the best values, so lots of islanders come there just to eat.
My first day on the floor is Friday, although I got a tour today. It’s a 21 bed surgical unit. I will be on night shift, where they “try to keep 3 nurses” on duty. Before I finished having my panic attack about trying to take care of 7 patients, I was told that “we are hardly ever full. We usually have 13-14 patients.” Amazing. At UVa we are always full & have patients literally waiting at outside hospitals for days for a bed to open up. The patients are all surgical in nature. Except for trauma patients, I don’t think the surgeries are that major (for example, no transplants, no open heart surgeries, etc.). Because we do get trauma patients who are sometimes shooting victims, stab wounds, etc, we are a locked unit. I think it will definitely be a learning experience and I will be sure to let you all know how it goes once I really get started.

Since tomorrow is Thanksgiving, I do want to take a moment to thank you very much for staying in contact. I love the email, texts, and phone calls. I am also so glad that you are checking the blog and I appreciate comments on it. I know I’ve said it before, but I’ll say it again – I am truly blessed to have you in my life. I wish you a very Happy Thanksgiving.

More Pictures

That's one heck of a big iguana, but I hear tale of larger ones. I'll keep the search going...


Some pretty flowers I found on my way back from Sugar Beach.

The view from my room as night is falling.

And the "mall." A useful find, if not very photogenic.

Saturday in review

Hello again! I am still exploring and trying to settle in. I felt rather guilty about being here since Thursday and not yet going to the beach. So I rectified that situation today by taking the short walk from my room down to Sugar Beach, which is here in Point Pleasant. The water is so beautiful - a clear blue that is just remarkable.

I also went to K Mart (one of few options) to get some household supplies and try to settle in some more. I replaced my "no-beach" guilt with "silly American" guilt as I stopped by the McDonald's for some french fries -- I just couldn't help myself.

I also set up a mailbox! Yeah! Just send me an email if you need/want to know my address. I am starting to feel a little more comfortable here, as some of the faces of those around me are looking familiar and I am learning my way around the streets a little more. I am still not used to driving on the opposite side of the road, but it is getting a little better.

Well, I am going to stop babbling at this point and post some pictures for you. Have a great day! Miss you!!

I'm here!

Hello, everyone! I just want to let you know that I have arrived safely. I am still trying to get settled in, which you can imagine is quite a process. I have lots of things to share, but don't know where to start. For now, I am just going to let you see the view from my room. I arrived in the dark last night and felt rather blue due to loneliness and the general worries about any transition. So, it was nice to get a good night's sleep (rest the brain a bit) and then wake up to this lovely view. I opened the sliding glass door & took this picture of my new front yard. Hope you enjoy!

Shout out to 5C!

For the past three years I have worked on 5 Central (5C/5W for the first 2 years) at UVa Medical Center. I want to take a moment to thank my friends there who have been so supportive of this adventure. Let’s face it, “Digestive Health” isn’t always the most glamorous line of work, and 5 Central can be a tough place (just grab a chair & ask any of us, we’ll fill your ear with plenty of stories!). But, 5 Central is composed of an amazing group of people who have created a space where I have been able to learn and mature while feeling truly cared for and respected. If you ever have the misfortune of having a digestive illness, I hope that you at least have the great fortune of finding yourself in their care.

Dear 5C,
It was very hard for me to have to say a temporary goodbye, but I know that you understand and I can’t thank you enough for your support. I look forward to seeing you again in February (or sooner if you want to escape from the cold…). I think over time you all learned bits and pieces of my stresses of the past couple years. Even without knowing, you helped to lift me on my dark days. Your smiles, funny stories, warm hugs and kind touches helped bring me back to life. You worried about me when I wasn’t able to worry about myself. In some ways, I guess I understand a bit better how our patients feel when they are in your care and why they sometimes bond so tightly to you (sometimes more than we want, ha ha!).

With a huge grin on my face, I must also thank you for the advice and words of wisdom. Tidbits like, “Men are like buses; don’t worry if you miss one because another will be coming along soon.” :) Some of you had rather interesting/colorful suggestions on how to improve my life, health, and general happiness (special mention here must go to Sue & Cheryl – love you guys!). Thank you.

I guess there was also the occasional work going on as well. :) On the subject of my professional life, I feel like you have, in a sense, raised me. I came to you as a new grad from UNC, unsure of myself and my surroundings. You have taught me well and supported my professional growth. The nurse that I am today is a reflection of you, and I hope to make you proud. As I go out and about, I will try my best to represent you well.

With love and great thanks,
Trish

Falling?

For the past week or so I have had the precise image in my head that matches my feelings. You know the classic cartoon image of a cat falling through the air? That’s it.

Falling off a high cliff with my arms & legs outstretched, my claws spread out, desperately groping for something to cling to. Eyes wide open in terror, frantically wondering if this is really happening.

This is the unglamorous side of adventure.

Not knowing what else to do, I’m riding it out. But I can’t decide: Do I need to learn to retract the claws & just let it be, or are my feet already on the ground & I just don’t know it?
Advice, opinions, etc welcome.

Golf lessons

I am starting to get overly-stressed in handling the details of my upcoming move to the Virgin Islands. I had the pleasure of taking a break from this stress and joining my dear friend, Bob, for an afternoon of golf at Birdwood yesterday (a cool, but beautifully sunny day). This always creates great amusement as I am terrible at the game and Bob is new to the game. I have to have a little "counter" to help keep track of my shots, since I take so darn many. Just slide one bead along the string for each stroke. Once the beads run out (10 strokes), I consider the hole over. On one hole, I gave up trying to hit the ball past a little ravine and found that throwing it proved to be a much more effective strategy...

There was great amusement when we realized that we had gotten off course and had no idea that we were playing on the wrong holes. Shall I mention that it took us 3 holes to figure this out?

"Okay, it's 235 yards to the pin."

"That doesn't look like more than 2 football fields. In fact, it looks like less than one."

"Hmm... It does look short. But, that's what the scorecard says. Maybe they are counting the hills. Maybe they moved the pin. Maybe I'm not a good judge of distance."

Oh no, my dear. You're just on hole 12, not 3! :) Ugh. I hate fueling the stereotype that women don't know how to read maps...

I absolutely love the scenery at Birdwood. It is a beautiful place (as you can see in the picture above) and if you ever get a chance, you should check it out. I would be happy to just sit by the driving range for hours, especially on a spring day. The view of the mountains is spectacular and there is a nice variety of beautiful trees around the grounds. My long-time dream has been to have a nice plot of land with room for a horse and a house of my design. I planned to have weeping willows, and now I know for sure that I must, for it is a most romantic tree. After losing 4 golf balls into a lake and running out of my counting beads on the real hole 3, I decided to perch against the trunk of a weeping willow tree near the green and let Bob finish out the hole. It was so peaceful to rest there on that cool Fall day, with the wind gently brushing the long thin branches into one another and making the most soothing rustling sound. I noticed that the movement of the branches mimicked the wisps of my hair that had fallen out of my braid. Instead of pushing them back, I let them be and enjoyed the serenity of the moment as they tickled my face. I guess that one could draw a lot of lessons from this simple occasion, but here's the one I will go with: sometimes adversity can lead us to a beautiful place. If I didn't lose those golf balls and play so poorly on that hole, I never would have thought to sit down under my weeping willow. I hate to think that I could have missed that moment.