Chapter 454

Pivotal moments. When they are happening, you don’t necessarily think to yourself, “Hello, pivotal moment alert”, but as past events become distilled into that narrative entitled Life So Far, they stand out, like chapter headings in a novel. Looking back, I can instantly recall a few classics from my own story: Chapter 8: The Day Dad Bought me my First Harmonia; Chapter 17: The Day I Nearly Cut my Tongue in Half and Blamed it on the Boy Sitting Next to Me; Chapter 421: The Day Jess Walked into the Workshop at the Christmas Decorations Factory.  

At the time, the significance of such an event is often drowned out by the everyday minutiae occurring around it. When I first me Anthony, I was newly married, newly emigrated and disconcertingly jobless. Fed up with the haphazard nature of agency work, but patently unqualified for anything else, I had found Anthony’s details on my agency’s list of ‘permanent clients’. Greatly appealing was the word ‘permanent’, as was the job’s location, one suburb across from my own. Everything else about this assignment was frankly terrifying. The list of medical issues in Anthony’s care plan ran on for pages: C1 quadriplegia, total paralysis from the neck down, unable to breath independently, permanent tracheostomy, unable to regulate own temperature, one kidney etc etc… In what I now understand to be a typically pathology-focussed medical summary, barely any mention was made of Anthony’s personality, personal life…personal strengths. I was very, very close to bailing out on our meet-and-greet session, partly because I felt I would be dangerously out of my depth, and partly because, if all you saw of Anthony was his care plan, you’d be forgiven for thinking that his quality of life must be non-existent. How pivotally wrong you would be.

For Anthony, there was no doubting it when the most pivotal moment of his life came along. At the age of 6, he was hit by a car whilst walking home from school. This was more than the start of a new chapter; it was the beginning of a whole new book, for him and for his family. His is a narrative in which Bad Luck and Good Luck constantly jostle for dominance. It’s bad luck to be hit by a car and to injure your spine at the highest possible level. And yet, if this is to happen, it is remarkably fortunate that it happens to happen outside a healthcare centre and that a doctor, seeing the immediate aftermath and instantly sensing the seriousness, commences CPR straight away. With a C1 injury, you stop breathing. If deprived of oxygen for more than 3 minutes, your brain becomes permanently damaged, which is why so few survive suffering this “hangman’s” injury. From the moment of impact until this very day, more than 30 years later, Anthony has not taken a single breath unaided. In this 30-year relay-race, with that doctor firing us out of the starting blocks, one person has passed the baton of respiratory responsibility to the next in an unbroken chain, and despite some fumbles, it has never been dropped.

It is also decidedly lucky to be equipped with an innate temperament of boundless positivity, and to be born into the kind of family who will fight tooth-and-nail on your behalf, endure years of sleepless nights and endless days in court to get you the things you need to thrive, and to instil in you an extraordinary sense of self-efficacy and resilience. Victimhood is not in Anthony’s repertoire of attitudes.

When I arrived for my interview, Anthony was still being positioned in his chair, but told me to go through and wait for him in his study. Shortly afterwards he joined me and we chatted, me sitting slightly awkwardly in what I think was a child’s rocking chair, him looming above me on his magnificent mobile throne. It wasn’t the longest conversation ever, but we covered a lot of ground, jumping from one topic to the next… did I like music? Yes. Had I ever worked with a phrenic nerve pacer? No. Would I be available to come on a trip to South Africa? Huh?? 

“He’s amazing”, I said to Jess on the phone afterwards. “We’re the same age, we have a lot in common. I’m going to give it a go”.

Nearly 5 years later, gazing through the wide lens of hindsight, it’s easy to see that had I not met this man, the very idea of a career in nursing would never have occurred to me. Suddenly, I found myself working side-by-side with nurses and learning, in the most practical fashion, about anatomy and pathophysiology, ventilation and perfusion, the internal logic and special quirks of the human nervous system, as well as the fine art of Keeping Someone Alive. Before long, the clinical side of things had transitioned from being frightening to fascinating, and learning all this stuff whilst caring for someone so downright enthusiastic about life was transformative for me. As I began my formal nursing training, I continued to have lightbulb moments, as a new concept learnt in class would suddenly cast light on a previously opaque idiosyncrasy of Anth’s condition. I clearly remember, for example, the day I learnt about the meandering miracle that is the vagus nerve…

“Anth! I now know why you can’t breath, but you can digest food! It all makes sense. You’re TEXTBOOK!”

“Tell me, Henry!”

“Well, there’s this nerve…”

 

The trip to South Africa was more than just a passing comment. The practicalities (health insurance, equipment hire, 24-hour staffing etc etc) and expenses (wages, flights, accommodation, film crew (!)) involved in such a trip had taken years to iron out. Indeed, a sizeable chunk of the funding came from Anthony himself, who, a couple of years previously, had entered the TV quiz show Millionaire Hotseat and bagged himself a cool $50,000. Drop into this video at 8 minutes to see him clean up. It’s pretty epic:

https://www.youtube.com/watch?v=lKxZP8JyC_o

So I came on board at just the right time and it was during this trip – this exhausting, life-affirming trip – with myself as the only non-nurse amongst 5 staff, that the cogs really started to whirr. And now, years later, with my Masters of Nursing Science all wrapped up and a dream nursing role awaiting me in the new year, I find myself working my last few shifts with Anthony. I’ve been just one of many hundreds of carers who have passed a period of time in his company. I hope I’ve done my small part in keeping him moving on his already remarkable trajectory, but for me, Chapter 454: The Day I Met Anthony, was one that pivoted me off on a new, exciting heading, and for that, Anth, I’d like to say: thanks mate.

 

*                 *                *

 

Briefly, in other news… back to things Nepalese. Do you remember I mentioned about that 14 year old girl, Samjana, who we brought down the mountain to hospital? She had a huge necrotic wound burrowing into her heal and a worrying growth at the base of her spine. Well, thanks to the donations that have come in, she has successfully undergone surgery, with no less than three surgeons in attendance. They removed a pretty enormous and angry-looking tumour from her spine and we are currently awaiting biopsy results to learn more about it. Raj and Kushab were with her beforehand and afterwards, and they report that she is recovering well. We are hopeful at this stage that she may not have to lose the foot, which is a far more optimistic prospect than she was facing a couple of weeks ago. There is still a long road ahead for Samjana, and financial assistance is sorely needed for whatever happens next, so if you feel like helping out, you can do so here:

https://www.gofundme.com/saving-samjana

 

In less than a week now Jess and I will be jumping aboard our budget airline flight to Sri Lanka, where a wedding and other adventures, no doubt, await. I’ll be reporting back.

Thanks Legends,

 

Hen x

 

 

Nepal Week 2: Births, Deaths and the Bits In-between

In my early twenties I spent a couple of years working as an undertaker in South London. I was struck pretty early on by the contrast between the shear scale of the funeral industry (people will not stop dying) and its virtual invisibility. I had never seen a dead body before I started working there, and I don’t think this experience is particularly unusual. Funeral operatives have become masters of stealth, Men and Women in Black who slide around the peripheries of your awareness in unmarked vans, discretely ferrying the Recently-Departed from A to B, so that the Still Here can carry on their normal lives, unmolested by that most inconvenient truth of all: everybody carks it. Death really gets in the way of our plans, doesn’t it? So we don’t like to talk about it and we certainly don’t like to see it.

Things are different in Nepal. Here, death is something we’ve all been through many, many times before and each death is but a linkage point in an almost infinitely long chain of reincarnations. So death is visible, open–welcomed even–and inextricably woven into everybody’s everyday experience. It is certainly nothing to be feared, and this perhaps goes some way to explaining the atmosphere we encountered when we visited a Nepalese old folks home, at the start of our second week of placement.

The home was in Devghat, one of the holiest of Hindu sites, situated at the conflux of two holy, roiling rivers . The holiest part of this holy town is reached by crossing a wholly terrifying suspension footbridge. But vertigo aside, there was a beautifully calm feeling about this place. Everyone we passed seemed to be very old and very smiley, and all were dressed in the most optimistic shades of orange. When we arrived at our destination we were shown around to a backyard area. Plastic chairs were brought out and lined up, and hey presto!.. we had a clinic. Gradually, our bright-eyed, spritely new friends began to emerge.

And what a gang they were… sometimes, only pictures will do a thing justice, so I refer you to these, taken by my good friend Elsa, with her excellent camera and even better eye:

Interspersed between dancing, hugging, eating and bicep-flexing, we managed to do a bit of nursing. But really, apart from some general aches and pains and a few athlete’s feet, there wasn’t a whole heap wrong with this crowd. In contrast to my previous experiences of nursing homes, I was amazed to find that everybody was apparently quite happy–not to mention ambulant, self-caring and (most refreshingly), continent. In fact, the whole experience was as much of an enriching tonic for us as it was for our hosts, and I, for one, skipped out of the building at the end of our visit feeling 10 years younger. (On our way back through the town even I stocked up on orange clothing, in the rather optimistic hope that it might help me secure a long and happy life).

We recrossed the mighty grey rivers by boat, passing the point, at the convergence of the two, where the dead are cremated and sent on their final voyage downstream. And if we follow the logic of reincarnation, then the immaterial, immutable essences that formerly animated the burning bodies set adrift here, will now, reembodied, be journeying down smaller, darker waterways as they are squeezed and coaxed into being born anew. Little did we know that the very next day, we would be lucky enough to witness this moment, not once but twice, as our adventures took us to the other end of the mortal coil…

Previously, during our stay in the mountains, we had had the pleasure of working alongside a very gentle and knowledgable obstetrician, who told us that before we left Nepal, he would love to show us around his hospital. The opportunity came the day after our visit to Devghat, and our friend was good to his word. Having placed his long queue of patients on indefinite hold, he led us off through the corridors, wards and departments of this heaving, hot and slightly oppressive public hospital, patiently answering our questions as he went. The last stop on the tour was Maternity. Here, we passed by a series of rooms, each containing women in progressively more advanced stages of labour, until, at the end of the corridor, we were ushered through a door on the left and into the Birthing Room. In this bright, concrete space, as curtains gently billowed in the warm breeze, giving passers-by a fleeting but candid view of proceedings, three women were reclined, legs in stirrups, actively, well… birthing. And so it was that before our very (wide) eyes, two new human beings popped into existence within the space of five minutes. Whilst obviously a routine occurrence for most people in this room, which typically stages around 60 births a day, for myself and some of the other uninitiated among us, this brief episode was as profound as it was unexpected. If I had hair, it would have been standing on end. I do have eyes, and to my surprise, when I blinked at last, I found they were leaking.

Having passed Monday with the Soon-to-be-Departed and Tuesday with the Newly-Hatched, we spent the rest of the week with humans who were somewhere on the road in-between. On Wednesday we were hosted by Raj and Kushab at the farmstead where they had grown up. Here, in response to the number of burns injuries we had seen in the mountains, we split into groups and had a go at making simple clay ovens; something people might be able to build in their homes instead of having open fires, into which it is all too easy to fall.

The huge diversity of experiences available within the nursing profession has always been one of its major appeals for me, but still, I never imagined that one fine day I’d be mashing up cow shit, mud and water with my bare hands, in the name of preventative healthcare. It was fun. An atmosphere of friendly–but nonetheless genuine–competitiveness pervaded proceedings as we broke off into our respective teams. I wish I could tell you that with the combined intelligence and ingenuity at their disposal, the two Melbourne Uni teams were able to revolutionise Nepalese cooking practices forever. Alas, the efforts of my team in particular, whilst admittedly more conceptual than practical, were broadly met with blank incomprehension, followed by great general amusement. We called our visionary creation the BamPoo Oven, in honour of its two chief construction materials: bamboo and poo. Despite the widespread skepticism of our colleagues, once the bamboo had burned away and the poo had hardened a little, we did manage to perch a cooking vessel on top of the oven and bring a small amount of water to the boil. But yeah, perhaps not a design classic.

On the other side of the farmyard, Raj and Kushab had teamed up with some Dutch volunteers and built this seriously impressive, fiery-eyed, double-stove topped affair:

Having come up with a design that actually works, their team won and to celebrate, we all quaffed beer and barbecued chickens under the shade of the lychee trees. I spied my chance and grabbed a quick photo with Raj and Kushab, legends that they are.

The final week was winding up, and the following morning we drove out to the next province along from Chitwan and there, in the blazing heat, we staged our last health camp with an excitable horde of 100 or so children. Standing knee-deep in a river, we went through hand-hygiene and toothbrushing, before performing an en-mass de-headlousing operation with combs, river water and a powerful brew of pulped raw mustard seeds. Here, we can see our friend Duane (another legend), gamely demonstrating the procedure and smiling throughout, despite having an excruciatingly stingy, mustard-clogged scalp.

After this was done we set up another makeshift clinic and, feeling exceedingly nursey by now, did our best to deal with whatever was presented to us. Despite being without doctors this time, we put our heads together and had a pretty good session. It was an enjoyable, confidence-boosting end to an extraordinary placement, and I’ll say now that I couldn’t imagine a finer bunch of soon-to-be nurses to have shared it with.

And so we came to our final night together, with half the team heading off trekking and the rest of us sloping back to Katmandu the following morning. There was beer, a barbecue and an appropriately flamboyant/downright-drunken dance-off of between us and our infinitely more coordinated hosts. I think I may have pulled out the Angus Young scissor-kick dance more times than was strictly necessary, but it was that kind of a night. For Kerrie, our clinical educator/surrogate mother/all round magical person, we sang a  song we had been working on- “Nursing Queen”, sung to the tune of “Dancing Queen”. It made her cry, in a good way.

Goodbyes aren’t much fun, and neither is writing about them, so we’ll just skip ahead to the present. Assignments finished, job secured for next year and another exciting trip just around the corner, I have to say that life is passing through a pretty peachy patch at the moment. Plans are already being formulated for a return to Nepal, this time with Jess, hopefully early in 2019. In the meantime, I will endeavour to keep you informed of exciting/disturbing/amusing happenings, as and when they occur.

All the very best,

 

Hen x