.....and then we met the children

Wow!   What a day we've had!!   Our day began with the usual, but not-taken-for-granted greeting of hugs and kisses from Sister Julia, Estefan, and Dr. Reyes.    We were going to meet with Sister Julia to give her the check we brought for her, but Dr. Reyes grabbed Rose and I right away and said he needed to sedate a young patient and he actually checked his dosages with us to see if we thought they were alright!!  He explained that he ordered a 10cc bolus of Midazolam and Normal Saline to be given IV push.   Midazolam is a drug we use for sedation in health care and it works very well.    He would give the dose of Midazolam and then when she was sedated, he would order a continuous IV infusion to continue.   We accompanied him to the bedside of a young 16 year old girl dying from Leukemia.   All treatment has failed and she is very sick.   When we saw her yesterday on rounds, she was bleeding from her nose.   This morning she is bleeding from her mouth and eye, and is very anxious, thus the need for palliative sedation.    We were not at all prepared for what we would see.    Her mother was on one side of her dabbing the blood from her nose and eye, the nurse was giving the IV medication, and Dr. Reyes stood on the other side of her.   Gently, he bent down, kissed her face, and whispered in her ear, "We are all here with you.   Your mother is here.   We all love you.  Remember that."  He bent down a couple more times and kissed her as he waited for the sedation to take hold.   I held her hand, feeling for a pulse--it was rapid and weak, which indicated to me that she was getting closer to death.   After a few minutes, we took leave of the area, giving the family the privacy they deserved.   Never, in all our time here, have we been made to feel as if we were intruding or unwanted, but there is something sacred about a mother tending to her dying child that we did not want to disturb.   When we went back out in the hall, Dr. Reyes asked Rose and I to look at the orders he was writing and tell him what we thought.   We gave him the "thumbs up".   He stood up, kissed us, and hugged us as we complimented him!!   He also told us that if this sedation didn't work (we told him it probably would), he would contact a colleague at the General Hospital and ask for Propofol.   I think, but I'm not sure, he might have to purchase it himself!    After that, we asked Sister Julia to meet us in the chapel--there, we presented her with a check for $2,150.00US--money we had raised through donations to purchase narcotics.   Sister was so grateful and assured us that EVERY PENNY would be used to buy the much-needed medications!!    So much had happened already and it was only 10:00 in the morning! Remember the patient having the painful dressing changes that I mentioned yesterday?   This morning, when we walked in, she was sitting up at the side of her bed having her breakfast and smiling so beautifully!!   She was positively radiant!   We brought her a writing book and pens today, as yesterday we learned that she writes poetry.   She is 20 years old and wants to use her poetry to convince young people to always choose a life of good instead of bad.   Jane spent some time with her with the help of a young bilingual volunteer named Rebekah.  One thing we learned early on in this trip---NEVER go anywhere without a translator!!  Jane said to the young poet:  "I'm sorry I don't speak Spanish, but when I go home, I'm going to learn!"   The reply from the young patient:  "Next year when you come back you can read my poetry."    Her writing book and pens meant the world to her.  Meanwhile, Estefan was looking for Rose--he wanted her to go to the clinic area to show the nurses how SHE would change the dressing on a gentleman with an extensive head/neck wound.   Rose was AMAZING---she had only gauze and tape to work with.   That's it.   No ABD pads, no netting, no fancy dressings with fancy names infused with fancy medications or silver.  Plain old gauze, tape, and normal saline.  For the next 45 minutes we worked together on this dressing explaining every step of the way what we were doing and giving the rationale for it.   Remember---Gloria has to translate every single word back and forth!   Finally, when we had the dressing changed, instead of using gauze and tape wrapped around his head and neck to secure it, we decided to try a surgical mask secured against the side of the face and tied around his head and neck.   Our idea was met with snickers and cast glances, but we explained it was just an idea!   The patient wraps a towel around his mouth and neck area when he goes out in public anyway, so when we were done, he wrapped himself up, and was VERY happy at how comfortable it was.   We discovered quickly that there are differences in our technique and theory, and we weren't sure if the nurses were impressed or happy with us, but we did the best we could, and the patient seemed content.    I made one little mistake.   Around his dressing area, there appeared to be embedded dirt on his face.   After we packed the wound, Rose and I set to cleaning the dirt off, but when the nurse saw us, she quickly stopped us.    It turns out, the "dirt" was actually his radiation markings.   I know you can't wash radiation markings off, but I've never seem them applied with what looks like charcoal---I've only seen them tattooed.   Fortunately, we weren't too far into our good deed when we were discovered, and no harm was done.  Rose was then asked to go to the bedside of the young poet---her dressings were being changed again, and Rose was able to work with the nurse to provide some education and change the experience for the patient and the nurse, making a positive difference, as she always does.    We were finished up in the hospital for the day and it was time to leave for the orphanage.   The hospital, orphanage, and a retreat house 1.5 hours from San Salvador are the three properties owned and operated by Divina Providencia.    We had a quick drink outside with Estefan and Rebekah and then Sister Julia ushered us into the hospital transport van and her driver took us to the orphanage on the other side of the city.    We arrived at the locked security gate of Hogar Para Ninos Divina Providencia, and when we drove inside, we found a beautiful church at the top of a sloping driveway.  Behind it, a huge building.    We walked inside to meet the matriarch of Divina Providencia, Mother Lucita.    She is 84 years old, wheelchair-bound, and still works every day as the secretary for the orphanage!    Sister Julia introduced us, and we were shown to a living room that had windows overlooking beautiful gardens with a statue of the Virgin Mary and showing us part of the childrens' home.   For the next hour, Mother Lucita regaled us with the amazing and humerous story of how she acquired the land for the hospital, built it, ran it, and then to her surprise, one day found herself promising a dying mother that she would look after her children.   And with that promise, the orphanage was built.   Began in 1984, it is home to 40 children, ages 5-17.   Not all children are orphans, by definition, Mother Lucita explained.   Some of the children have parents, but their parents don't want them.   Those are the children with the toughest emotional and psychological issues to deal with; they struggle with resentment and anger.   Priority for admission is given to children of dying patients at Hospital Divina Providencia.   The orphanage receives no government support and the sisters want it kept that way, for then the government cannot dictate how many children will live there or how the sisters will care for them.   As does the hospital, the orphange depends on 100% donations to run, and again I was awestruck at how much can be done with the monies they are blessed to receive.   Every day, the children go out to school.   Mother Lucita explained that it is important that the children are as much a part of society as possible.   Four teachers are employed by the orphanage to help the children with their homework in the afternoon/evening.   In addition to the teachers, there are 4 staff psychologists, a dentist, and a nurse (who is one of the sisters living at the orphanage).   As were were finishing up our time together, the children arrived home from school.   As they ran by Mother Lucita's windows laughing and playing, many of them called out greetings to her.   A few of them noticed there were "foreigners" visiting, and we were greeted as well.   Two or three younger children stopped to look at us!   They were beautiful and so happy and healthy!!!!   Next, we were treated to a tour of the grounds.   They are extensive!!!   They grow their own food in gardens, raise their own livestock for slaughter, and raise their own fish (talapia) for catching!   The children are given daily chores in addition to the requirement of making their own beds and straightening their living area before they have breakfast each morning.   The home teaches them valuable life skills so when they leave at age 17, they are prepared to face the world and be productive in it.   The dormatories were beautiful--neat, tidy, and very well kept.   The children were having their lunch as we toured, so we didn't get to meet most of them, but there was a group of older girls just hanging out, and after talking to them (actually only Gloria talked to them), we all had a photo taken together.   Our tour ended back at the office, and after gifting each of us with a Divine Providence medal, Mother Lucita bid us farewell and we knew we would never forget this woman as long as we live.    We all piled into the van again to complete our final task of the day:   yesterday, before we left, we asked Sister Julia to tell us what she needed MOST for the hospital.   We said to her, "ANYTHING".    Our thoughts were that we would spend around $500 and then fundraise like crazy women when we returned.   She thought about it overnight and this is what she desired MOST:   wastebaskets in every patient's room.   That's it.   She wanted a plastic wastebasket for every patient.  She knew exactly where we could get them, and so we found ourselves downtown at a plastics factory to buy wastebaskets.   When we arrived at the store, Gloria took all our cameras from us, shoved them down into her purse and gave us one order:  NO TALKING.    We emerged from the van, and like ducklings running from a predator, we followed our two mother ducks into the store in complete silence.   We all should have remembered that we had our Divine Providence medals in our pockets, thereby having some protection, but when Gloria speaks......    Sister Julia and Gloria found the wastebaskets and Sister picked out the ones she liked.   Then came the arduent task of making her tell us how many she wanted.   It was like playing a game on "The Price is Right"!    She said 24, we said 40, she said 30, we said 40, she said nothing, we said 50, and the deal was made!!!   They cost all of $1.00 apiece.    It was difficult for her to ask for the bags to go in them---we bought her 400 for $40, and $92 later, we exited the store and got into our van.    After another trip through the city, we arrived back at the hospital, wished Sister Julia a good evening, bid Rebekah farewell, and got into our own vehicle.   Our air-conditioned van seemed happy to have us back, and took us right to Pizza Hut for supper, and then back to the beach house afterwards.    I have failed to mention the driving and traffic conditions in El Salvador.   Imagine, if you will, the most treacherous bumper card ride you could ever get on, and then multiply it by about one hundred!    First of all, those red octagonal signs that say ALTO (we call it STOP)---they mean nothing!    Secondly, there are round-abouts EVERYWHERE and seemingly, no rules.    It is survival of the fittest; drive aggressively or die.   Cars come at you from every direction and blinkers---hah!!!   Gloria drives very aggressively and very well.   She has safely delivered us to every destination we've chosen this week.   Surprisingly, we've only heard ONE swear word from her mouth, and a few gasps and shreiks from our own!!    I'll take Toronto at rush hour ANY DAY!!   And so, as we sit here, contemplating our day and enjoying another fleeting sunset on the beautiful Pacific, we are reminded that God is in control, and all the time..... He is good.