My Nursing Thesis Published!

September, 1998 – New England, USA

After I completed my thesis in graduate school, my advisers encouraged me to submit an article summarizing my research findings for publication. The unwieldy title of my thesis was, “Coping Strategies of Successful Caregivers of Nonambulatory Family Members”. Nonambulatory means that the person is unable to walk.

My parents and one of my patients that I had followed as a visiting nurse inspired me to do the research. After my mother had a major stroke which left her paralyzed on one side and with the mind of a ten year old, my dad stepped up to the plate and cheerfully became her full time caregiver. He had to assist her in the shower, dress her, learn to style her hair, do the grocery shopping, cooking, driving, and pay the bills. Prior to her stroke, my mother was an avid artist and gardener. She grieved that she could no longer do these hobbies. The Lord took her home to heaven to be with Him five years after her stroke. I thanked God that she was no longer suffering.

“…Death is swallowed up in victory….But thanks be to God, who giveth us the victory through our Lord Jesus Christ.” I Corinthians 15:54, 57

My parents were my inspiration for my research.

Another patient I visited at home was an elderly lady who was paralyzed from the waist down from a blood clot that went to her spine. Her husband faithfully learned how to provide all her care and purchased a van equipped with a wheel chair lift. He struggled at times with sadness over his wife’s loss of many abilities, but he did all the household tasks and driving. Other patients with similar disabilities ended up being admitted to a nursing home because their caregiver simply couldn’t cope with all the extra responsibilities.

During my research, I interviewed nine caregivers of family members who were unable to walk and then summarized their problems and coping strategies. I repeated similar research that was done with caregivers of home hospice patients to see if they had the same problems and used the same or different coping strategies. Comparison of the two groups showed they only had one problem in common (stress) and three coping strategies (social support, cognitive reformulation, and respite). I developed an educational handout for nurses to give new caregivers of family members who were unable to walk.

I submitted my research article to The Nurse Practitioner journal and was thrilled when they accepted part of it for publication.  They condensed my year of research and 48 page thesis into THREE paragraphs. Such is the world of publishing… They included it under Practice Pointers and named it Lending a hand to caregivers.

If you need to counsel a caregiver of a family member who has recently lost the ability to walk, use these suggestions to ease the load. First, tell him not to try to give care alone, but to ask for and accept help from family, friends, and health care professionals. To relieve stress, suggest that he try exercise, massage, eating out, music, prayer, reading, and napping.

Make sure he asks a physical therapist for assistance in choosing a wheelchair, if his family member can use one. Suggest using cordless and cellular phones, a lifeline necklace, and a pager to communicate with his loved ones when the caregiver is out of the house.

Finally, when traveling, recommend the caregiver pack a travel kit with a list of medications, provider phone numbers, straws, wipes, and other supplies.”

Reflection

I can’t recall the last time I saw a lay person use a pager, and cordless land lines are disappearing rapidly. Cell phones are commonplace now, but they were rare in 1998.

After I entered the full time work world as a nurse practitioner, life seemed to become too busy to continue to do research. However, I have participated in the Nurse’s Health Study 2 since 1989 conducted by the Harvard School of Public Health. Their findings collected from surveys every two years of thousands of nurses have contributed significantly to women’s health. http://nurseshealthstudy.org If you are a nurse and you were born after 1964 and live in the USA, they are looking for participants to join Nurse’s Health Study 3. I hope you will do so and continue this wonderful research that was begun in 1979!

Blog Update

Dear Readers,

I mentioned in August that I retired from nursing a year earlier than I anticipated. God has opened a wonderful door for me to learn Spanish this year in a very intense language program for missionaries. God has laid a desire on my heart to minister to Spanish speaking people during my retirement years as He gives me the strength and health. I am enjoying the program immensely, but it is a tremendous amount of work every week as I go along “poco a poco” – little by little. God has also given me several opportunities to assist the other students and my professors with their health problems, so I am still using my nursing skills unofficially.

I thought I brought all my needed journals with me to complete this blog, but I discovered that I put some of them in my storage container, so I am unable to write new material at this time. I don’t trust my memory of events nearly 20 years ago!

Since many of you are new readers, I have decided to start over from the beginning and repeat the past posts. For of those of you who have been with me from the beginning, perhaps you won’t mind reading them again. I enjoy rereading some of my favorite books and am amazed how I notice things anew because I am at a different stage in life.

So thank you for praying for me in my language studies as I desire to glorify the Lord here and keep my eyes and heart on Him.

I will close with this poem they found in Hudson Taylor’s journal. He was one of the early missionaries to China in the 1800’s and was used by God to found the China Inland Mission which is now Overseas Missionary Fellowship. I am enjoying translating the English flash card story (by Child Evangelism Fellowship) of his life into simple Spanish for my classmates.

“Lord Jesus, make Thyself to me,

A living, bright Reality;

More present to faith’s vision keen,

Than any outward object seen;

More dear, more intimately nigh

Than e’en the sweetest earthly tie.

Hudson Taylor flashcard story I am translating into Spanish. (CEF)

Hudson Taylor flashcard story I am translating into Spanish. (CEF)

“O God, from my youth You have taught me; and I still proclaim Your wondrous deeds. So even to old age and gray hairs, O God, do not forsake me, until I proclaim Your might to another generation, your power to all those to come.”  Psalm 71:17-18

Pamela, APRN

The Final School Year

September, 1997

I completed my one on one research course this summer with the Director of the Nurse Practitioner program, Dr. K. I learned about the different types of research broken into two broad categories of quantitative and qualitative research. Our small school does not have the staff to support doing quantitative research with labs and statistics, so I have chosen to do qualitative grounded theory research. The topic I chose is “Coping Strategies of Caregivers of Non-Ambulatory Patients”. I know it’s a mouthful!

I chose this topic largely because of my observation of how wonderfully my Dad took care of my Mom after her massive stroke. She learned to walk again slowly with a quad cane, but her left arm remained paralyzed, so he had to help her with her bath, dressing, and style her hair. I thought it was so sweet of him when he took Mom to the beautician and asked her to teach him how to use a curling iron! I don’t know of too many men who would do that. He also did all the cooking, cleaning, driving, and grocery shopping. My Mom became his full time job which he did the last five years of her life. Thankfully, he was retired and in good health. He also traveled with her by plane and in their trailer home across the country on vacation.

During my years as a visiting nurse, I took care of a dear elderly couple. Ruth had a blood clot that went to her spine and left her paralyzed from the waist down at the age of 70. Her husband, Ray, learned to do everything for her much as my dad did, and bought a van equipped with a wheelchair lift to make it easier to transport her.

Most caregivers at home are women rather than men, so I think Ray and my Dad were the exceptions. Most people would have placed people like Ruth and my Mom in a nursing home because they simply could not provide 24/7 care for them. So I asked myself, how did people cope at home with providing care for a family member who cannot walk? I noticed that when a person can’t walk, their care could become totally overwhelming.

I completed my review of literature and found an oncology nursing study with a similar theme, so I will repeat it to see if I get the same results. At the Master’s level, we are not required to do original research, but only repeat what others have done to see if we get the same results. My proposal was approved by  my two thesis advisors. My goal this semester is to find caregivers to interview and tape record them to gather all my data. Next semester, I will analyze the data and write my thesis. It was so nice to concentrate on nothing but research this summer and not have to work full time! I thank God for my Dad’s financial support to make this possible.

January, 1998

Last semester was very busy, but I really enjoyed it. My clinical assignments were so interesting as I spent two full days a week working in an Internal Medicine office with two physicians. Dr. R. established his private practice about 20 years ago. He grew up in Costa Rica, so he is fluent in Spanish. He moved to the USA when he was 16 years old, but still returns to Costa Rica annually to visit family there. He is a very kind gentleman and an excellent teacher. He just hired an associate, Dr. G., who recently completed his residency. Dr. G. likes to tell me all kinds of interesting stories about patients he saw during his residency. I see the patient first and take the history and do the physical exam. Then I present the patient privately to Dr. R. or Dr. G. and tell them the plan of care that I think would be best. We discuss it and they agree or disagree with me and tell me their reason so I learn how to treat the next patient with a similar problem. It is working out very well!

One day, a lady who was originally from Jamaica, came to see us in near hysteria. She had coughed up a foot long worm that she put in a bottle of water to show us. I immediately recognized it as a round worm which I had learned about when I was in Dominican Republic. She last visited Jamaica two years ago, so it had been growing inside her all that time. Neither Dr. R. or Dr. G. had ever treated worms before, so I told them the medicine to prescribe and calmed the lady after telling her we could easily treat it. She thanked me and said she felt relieved to learn about it. It was fun to teach the teachers that day!

On my third clinical day, I worked several weeks in a clinic seeing adolescents with a Pediatric NP. Rich was also an excellent teacher. The other half of the semester, I shadowed a Neonatal Intensive Care NP. I was too scared to touch the premature babies who looked so tiny and fragile in the incubators on ventilators. I watched her do a lumbar puncture on one of them where she stuck a needle gently in his spine to withdraw cerebral spinal fluid. I also watched her work in a general Pediatrician’s office. I’m just not too comfortable taking care of babies because they can’t tell me what’s wrong!

I found enough caregivers to interview for my research. I tape recorded each session, then took the tapes home and played them back. Whenever the person stated a coping strategy, I stopped the tape and wrote it on an index card. After listening to all the interviews, I took all my cards and separated them into different piles of coping strategies that were repeated. I’m really enjoying doing this type of research!

Graduation, May, 1998!!!

I completed typing my thesis and both my advisors approved the final copy. It was 120 pages long! I am so glad I didn’t have to hire someone to type it, and am thankful for my high school typing teacher. We each made a poster about our research results and presented it a week ago. All my preceptors came to look at it, so I was grateful for their support. I submitted a summary of my research to the Nurse Practitioner Journal, so I will see if it is accepted.

I am amazed that I have had ten job interviews. The job I chose is to work as a Family Nurse Practitioner at a psychiatric hospital. I have never worked in psychiatry before. I will have all weekends and holidays off, and  don’t have to take call at night since a physician stays on grounds each night. The salary is excellent, so maybe I will be able to move to a one story home in the future.

 

1998 Pam MSN

I was so excited to finally receive my Master’s of Science in Nursing and become a Family Nurse Practitioner!

I thank God that my entire family came to my graduation to help me celebrate. I dedicated my thesis to my Dad and read it to them with my theme verses for graduate school:

I can do all things through Christ who strengthens me….But my God shall supply all your needs according to His riches in glory in Christ Jesus! Philippians 4:13, 19.

The school placed a copy of each graduate student’s thesis in the school library for others to read.

Reflection

How I thank God for carrying me through four long years of graduate school. I know I only had the strength to complete it because of Him. I enjoyed working as a Nurse Practitioner in a variety of roles over the next 16 years.

The Nurse Practitioner Journal published a few paragraphs about my research. As I recall, the caregivers that did best were those who used wheels to help transport the patient, took respite from care, and recruited/accepted help from others. My thesis is currently in storage, so the next time I look at it, I will see if my memory is accurate:)

 

 

 

 

Continue Graduate School or Drop Out?

April 19, 1997

Show me Thy ways, O Lord, teach me Thy paths. Psalm 25:4

I am seriously debating whether or not I should continue with graduate school. They are raising the tuition to $380 per semester credit hour, and I have 29 hours to go to complete my Master’s of Science in Nursing, so it will cost me $10,000 to finish. It will take me about three more years to complete and I have already been taking two courses each semester while working full time as a visiting nurse. I am just so weary of it all.

Psalm 25:4 was my prayer which God answered wonderfully!

Psalm 25:4 was my prayer which God answered wonderfully!

Then I read in a nursing journal that they are producing too many Nurse Practitioners (NPs), and that the new graduates are having great difficulty in finding a job. By the year 2000, there will be a glut of 30,000 NPs. I recently spent the afternoon for my clinical rotation with a school NP at the community health center. There was a middle school girl on drugs and so many other kids on antidepressants, etc. At the clinic, there were many pregnant unwed teens who have already had several abortions and sexually transmitted diseases. I don’t think I want to work with that population. A NP came and spoke to our graduate school class this semester, and she is working all kinds of strange hours in the Emergency Department of a local hospital.

After that lecture, my job as a visiting nurse with the elderly seems like an excellent place to work! I work 8 am to 4 pm Monday through Friday, ten weekends, and one holiday each year which isn’t too bad for nursing. The pay isn’t great, but I could pick up some extra Saturdays here and there to make some extra money. The VNA office is only one mile from my house and my territory is so beautiful in rural New England. I am able to come home and finish my charting in the afternoon if we don’t have any meetings at the office. Now that my knee feels better after surgery, maybe I can remain in this old three story house a while longer. I think I’ll make a few more phone calls on Monday after reviewing the job section in the Sunday newspaper. It is so good to rest in the Lord and let Him show me the way!

May 24, 1997

“In the day when I cried, Thou answered me, and strengthened me with strength in my soul.” Psalm 138:3

“For as the heavens are higher than the earth, so are My ways higher than your ways, and My thoughts than your thoughts.” Isaiah 55:9

The Lord has answered prayer in such a marvelous way concerning school since I last wrote on April 19! Last Thursday, my Dad called me and said he wanted to support me financially so I could quit my job and go to school full time and finish my degree. He asked me to send him my monthly budget to cover my expenses. I met with Dr. K., the Dean of the graduate program and she was so excited for me! We worked out my schedule so I can graduate next May. Because I missed the research course last semester, she is teaching me individually this summer for two hours weekly so I can catch up.  I thank my heavenly Father for moving the heart of my unsaved earthly father to help me out in this way, as I never asked my Dad for any financial support. I’m still in shock as to how wonderfully the Lord worked this out, way above what I could ask or think. I thank God for making my path so clear. One of my advisors at school said I definitely should not drop out as she thinks I will make a wonderful Nurse Practitioner, so her encouragement was much appreciated.

My final day as a visiting nurse is June 10. It is hard to believe that I have worked there for five years. It is tough to say goodbye to some of my monthly patients who I have known for five years. Some of them are like grandparents to me. I really hate goodbyes!

Reflection

And so the Lord made the way open for me to continue in graduate school and finish in four years rather than six years. In the fall, Dr. K. told the five of us who were full time students that the school had received a grant from the USA government that would cover our entire tuition and books for both semesters! The government says there is a shortage of NPs, so this is their way of graduating NPs more quickly. Because it was a grant, and not a loan, I graduated debt free which was a huge blessing. The tuition for the previous three years of part time courses had been reimbursed to me at the end of each semester by the Visiting Nurse Association. They did not require me to work for them as a NP after receiving my MSN as many organizations do today.

The prediction in the nursing journal of a glut of NPs never materialized as far as I recall. I never had any trouble finding a job as a NP. In fact, I have been inundated with job recruiters my entire career with a multitude of NP openings. In fact, I received a phone call earlier today from a job recruiter even though I told her last month I am not interested in a NP job at this time. Nursing is still a good career for job security in my opinion! There will always be sick people to take care of no matter what the economy is like.

Becoming a Patient

July, 1996

I completed my most difficult semester of graduate school thus far. I took pathophysiology, taught by a physician from Russia who had a heavy accent and was challenging to understand. It was a great review of physiology, but took us much deeper into what goes wrong in the body when disease occurs.

The second course was in pathopsychology which a nurse taught. We learned about the different mental illnesses and the criteria for diagnosing a person with them. We each had to choose a fictional person with a mental illness and see if they met the criteria and diagnose them with a mental illness. I chose Scarlett O’Hara, the main character in Gone With the Wind, a popular novel made into a movie about how the American civil war affected her family in the southern part of the USA. She certainly met the criteria for a Narcissistic Personality Disorder according to DSM 3. (DSM is the main book that psychiatrists use to diagnose people with mental illness.) They define Narcissism as “A pervasive pattern of grandiosity, need for admiration, and lack of empathy.” The person also has to have at least five of the listed nine characteristics. I learned there is no treatment for someone with a personality disorder. I think Scarlett had all nine of the characteristics. My classmates laughed when I read my paper out loud because most of them had seen the movie if they had not read the mammoth sized novel at some point in their life.

I also decided to go downhill skiing with the career group from church for the first time in March. I painfully discovered that it is much different than cross country skiing and requires more athletic skill than God gave me. I took quite a few falls trying to get down the icy mountain and wrenched my left knee. I was unable to walk very far without pain, so the doctor did an arthroscopy on July 8 to look inside my knee with a small scope and clean out the floating piece of torn cartilage. He said my knee was so inflamed that he was amazed I could still walk.

I painfully discovered I am NOT good at downhill skiing!

I painfully discovered that I am NOT good at downhill skiing!

I needed to take 2.5 weeks off work to recover rather than the predicted one week. This is the first surgery I ever had and the amount of knee pain I had after surgery was staggering. I discovered that my best pain reliever was frequent ice packs. But I guess it is good to experience surgery from a patient’s point of view rather than a nurse. So many people from church have helped me since I live alone. Their assistance and fellowship have been a great blessing to me! It also makes me realize how frail I am, and that good health is very precious.

“As a father pities His children, so the Lord pities them that fear Him. For He knows our frame; He remembers that we are dust.” Psalm 103:13-14

Reflection

That first surgery was the first of two more arthroscopies (surgery with a small scope) followed by a knee replacement at age 49. Moral of the story: DON’T try to learn to downhill ski in your forties if you are not a gifted athlete. It has always been more challenging to travel ever since I started having knee surgeries. A few years later, I sold my three story home and returned to a one level home to try and spare my knees.

I went to England on vacation with some ladies from church three weeks after that first knee surgery, and remember my 70 year old friend, Trudy, pushing ME in a wheelchair through the London airport. I exchanged my house and automatic shift car with a family in England, but their car had a clutch for shifting. I was unable to work the clutch with my left knee until the very end of the vacation because it was still healing and painful.

I also learned that I could no longer lower myself into a bathtub, kneel, squat, jump, or run. I also had to give up cross country skiing, so winters in New England aren’t too much fun anymore. After each surgery, I received treatment from numerous physical therapists, and we enjoyed talking “shop” after they found out that I was a nurse. I tried to do my post-operative exercises faithfully to get as much range of motion of my knee as possible.

I encourage my patients to do the same after surgery and to set up their house with adaptive equipment BEFORE they have surgery to make it easier when they come home. A toilet riser, reacher to pick up things off the floor, and plastic lawn chair with arms to put in the bathtub, shower hose, and bath mat are the bare minimum. A sock aide also comes in handy so you can pull on your socks without assistance. Many visiting nurse agencies have “donation closets” with equipment former patients no longer need. I tell my friends to save some money and ask if they can borrow some equipment and then return it after they have recovered from surgery.

A reacher is extremely helpful after knee surgery.

A reacher is extremely helpful after knee surgery.

Whenever one of my friends tells me that they need knee surgery, I have the utmost empathy for them and try and pass on things that have helped me over the years. Most of all, I suggest they ask God to comfort them, and He always does.

“Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort, Who comforts us IN all our tribulation, that we may be able to comfort them who are in any trouble, by the comfort with which we ourselves are comforted of God. For as the sufferings of Christ abound in us, so our consolation also abounds by Christ.” II Corinthians 1:3-5

 

 

 

Rejection and Sorrow

April, 1995

My interview for graduate school seemed to go well. I will learn next week whether or not I am accepted, so the waiting which began last September is almost over! I hope the fact that I did well in my first two courses at the State University will help with my admission. But the competition is very strong with hundreds of nurses applying for only 15 positions.

May, 1995

I received my letter today from the State University, and I was not accepted. They invited me to apply again next year, because they just don’t have room. It was quite a blow and a shock, and I feel like a total failure. It’s kind of like preparing for the big game for nine months and then being thrown off the team or having the big game cancelled. I guess I thought that since I will probably never marry, I could at least work on my career, but that door appears closed also. I haven’t had the courage to tell my parents or sister yet. I cried all day yesterday and today. I asked God to comfort me and show me what He wants me to do now.

“Make haste, O God, to deliver me; make haste to help me, O Lord.” Psalm 70:1

July, 1995

I attended a Bible seminar with ladies from church a few days after I received my rejection letter. One lady suggested I search for other MSN programs that offer the Nurse Practitioner tract. I discovered a small private college that is a shorter drive than the State University and is just starting a Family Nurse Practitioner program. I have not had any pediatric experience since I received my BSN other than volunteer camp nursing, but I guess I could learn about it again. I decided to apply and I should learn in August whether or not they accept me. If they do, they will allow me to transfer my two courses I completed at the State University, so those courses would not be wasted. I should be able to complete my Master’s of Science in Nursing degree (MSN) in three years by taking two courses in the evening each semester while continuing to work full-time as a visiting nurse. My employer will continue to reimburse me my tuition for up to two courses a semester as long as I receive an A or B grade. The price per course hour is the same as the State University. Right now, I feel like all the ambition for school has disappeared, so I really don’t care one way or the other.

Dear Lord, Please make my heart right concerning school if You want me to continue to study for my MSN. Amen.

I also finished an intense Spanish course at the local community college with an emphasis in medical Spanish. Some folks at church are fluent in Spanish, so they let me practice talking with them which was helpful.

September 30, 1995

So much has happened since July. I was accepted at the College into the Family Nurse Practitioner program. My brother was married on August 20 which my parents were able to attend. My mother’s cancer spread to her liver last January, but her dying wish was to attend my brother’s wedding. It was sad to see her barely able to sit up in her wheelchair. It was bittersweet to say goodby to her on what is normally a happy occasion. My parents flew back to Florida where she died at home on August 28. I flew to her funeral and then started school as soon as I returned to New England. Some nights I can’t sleep and cry for several hours. These feelings are so strange with the sorrow of missing her and yet joy in knowing that she is home with the Lord, rejoicing in Him, and free of her old broken body. I miss hearing her voice and talking with her on the phone.

I was accepted into the MSN program at a small private college.

I was accepted into the MSN program at a small private college.

I started school the week after Mom died. I wasn’t sure I could concentrate enough because of my grief, but somehow, God is giving me the strength and concentration. I like it much better than the State University. I am taking graduate level statistics and have a wonderful instructor who makes it very clear. Hopefully, I won’t fall asleep in statistics class this time like I did 22 years ago when I took it for my BSN! We are also having to solve problems on the computer with a 5 inch floppy disc that corresponds to our textbook. I am thankful for my personal computer at home so I don’t have to do all my homework on campus.

January 1, 1996

“That I may know Him, and the power of His resurrection, and the fellowship of His sufferings, being made conformable unto His death…I follow after.” Philippians 3: 10,12. “Man of sorrows, and acquainted with grief.” Isaiah 53:3. “The Lord is near unto those who are of a broken heart….None of them who trust in Him shall be desolate.”  Psalm 34:18, 22

As I reflect on 1995, I believe it was my year to become acquainted with sorrow. It was one year ago yesterday that Mom found out her cancer had spread to her liver. I thank God for the work He has done in my heart this past year through my new friend, Sorrow. It is an acquaintance I would not have chosen voluntarily, but God chose this friend for me to press me closer to His heart and make me more sensitive to others who are sorrowing.

I thank God for helping me complete my two courses in graduate school with good grades. I was amazed that I received one of the highest grades in Statistics, my old foe. That was purely by the grace of God for which I praise Him!

God helped me conquer my old foe, Statistics, in graduate school!

God helped me conquer my old foe, Statistics, in graduate school!

I also met with the Dean and found out it will take me four more years of attending school part-time before I can complete my MSN degree.  I have now completed three semesters. I’m not sure I have the strength and ambition to attend eight more semesters, so I guess I will just take it one semester at a time and trust the Lord. I am claiming God’s promise in Psalm 84:11.

Psalm 84-11

Dear Lord, I commit this New Year to You. Cause me to know You better and follow You. Amen.

Reflection

So ended my year of rejection, acceptance, and sorrow. It was a challenging year, but I have learned since then that God seems to use the most difficult times in my life to cause me to lean harder on Him. I grow in His grace as I experience His loving kindness and strength in a new and deeper way. I pray you may be encouraged to draw near to Him if you are going through such a time as this today.

 

Transcultural Nursing Course – Dominican Republic – Part 3

Transcultural Nursing Course – Dominican Republic – Part 3

January 3, 1995

It seems hard to believe that our trip is half over. Today, we returned to the city hospital to work as a group so Tammy could translate for us. We made rounds in the pediatric ward and watched a skilled nurse easily start several IV’s in babies, unlike yesterday. She wore a cap with a blue velvet band, so she has a Bachelor’s degree in nursing.

Then we went to the Labor and Delivery unit. When the nurses learned I had experience in labor and delivery, they assigned us to a 28 year old woman having her fourth baby who had just been admitted. The doctor examined her and said she was half way dilated and broke her water. We went on rounds and I checked her before lunch. No change. We felt her contractions and I tried to listen to the baby’s heart beat with my new stethoscope, but couldn’t hear anything. There is no fetal monitoring available here.  She looked very comfortable, so we had a leisurely lunch. When we returned at 2 p.m., she was writhing in bed in pain and looked like she was in the transition stage. I asked for a sterile glove, checked her, and she was totally dilated. I asked her to push and the baby’s head crowned, so I told her to blow so she wouldn’t have the baby in bed.  The Dominican nurse said it was time for her to go to the delivery room. We watched in amazement as the mother stood up, and walked in her sandals to the room, laid on the table, and put her feet in the stirrups.

The nurse then told me that they do all the normal deliveries rather than the physician, and motioned me to deliver the baby! It has been 13 years since I worked in labor and delivery, so I silently prayed, Dear Lord, help me! Bring this new baby into the world safely. Amen. The mother gave two pushes and the baby came out with a cord around his neck once which the Dominican nurse quickly removed so he wouldn’t strangle. The baby boy then let out a loud scream, and we all breathed a sigh of relief. It was so exciting! Then the nurse put two clamps on his cord, cut it, and motioned me to carry him to the bassinette. I rubbed him down and gave him an Apgar score of 8 at 1 minute, and 9 at 5 minutes which is totally normal. Thank you, Lord.

The nurse gave me a sterile string and motioned me to tie the cord closer to his abdomen, so I tied my best Girl Scout square knot, and asked if I did it right? She said, “Si!” (yes). Then Julie cut the cord again between the clamp and the string. They removed the 2 clamps so they could sterilize them and reuse them. We examined the cord, and it had three vessels which was normal. Julie and Paula then delivered the placenta. I handed the baby to Mom and she began to breastfeed him. After the nurse cleaned Mom, she stood up and walked to the wheelchair, and was wheeled down the hall to the postpartum area. Mom never screamed the whole time, but only grimaced. She made childbirth look so incredibly easy.

After we settled Mom in bed, she thanked us profusely, while hugging and kissing each of us.  It was so gratifying. The other students had never participated in a delivery before, so we were all thrilled. The miracle of birth never ceases to amaze me. God is so magnificent!

Lo, children are an heritage from the Lord; and the fruit of the womb is His reward. Psalm 127:3

Holding the new baby after I delivered it!

Holding the new baby after I delivered it!

Mom brought two disposable diapers with her. I saw a price tag of 3 pesos on one which equals 25 cents in the US. This is lots of money for her.  Each patient is only given one bed sheet their entire stay.

We then made rounds on the rest of the hospital. The men’s ward had 20 beds with quite a few men in traction from femur fractures from motor scooter accidents. We then went back to the ICU. The three patients we saw yesterday are about the same. The lady with high blood pressure actually had a stroke rather than a blood clot in her lung. Her right pupil was enlarged and non reactive to light. Her left arm was limp, but she could move her left leg. I checked her blood pressure, and it was back up to 196/110 and her heart rate was only 56. There was a new lady who was there with an asthma attack and was on oxygen. They had the head of her bed propped up with a chair since there is still no electricity today.

Through Tammy’s interpretation, I found out more about, Martha, the ICU nurse. She works 9 days out of 14 with two days in a row on each shift, and then she gets two days off. Dr. Elaine said nurses and doctors are not respected in the Dominican culture and the pay is very low. The head nurse makes the equivalent of $120 per month in U.S. dollars.

We then met with a lady in charge of infant feeding who has a doctorate degree from Santo Domingo. She showed us their beautiful classroom with a TV and video player. Mothers complete an 18 hour course of nine two hour classes on infant care. They have posters all over the hospital forbidding baby bottles and other posters showing a beautiful dark haired Mom breastfeeding her baby. This hospital has 190 beds for the whole region, which is not enough. They had 4000 births in 1993, and 6000 births in 1994.

At the end of the day, I rode back to the clinic Dominican style taxi, on the back of a motor scooter, hanging on to the driver for dear life and asking the Lord for safety the whole way. Then I paid him the going rate of 3 pesos – 25 cents. What a day!

Dear Lord, Thank you for the safe delivery. I pray this new baby boy and his Mom will receive you as personal Savior. Thank You for all You have taught me today and for the strength and health You have blessed me with. In Christ’s Name, Amen