M O T I V A T I O N

What is motivation? I've been asking myself that a lot lately as I try to prepare for the nursing board exams... According to the know-it-all Mr. Webster, motivation is, "a motivating force, stimulus, or influence: incentive, drive."

These last few days have been brutal. Because I spent a month in the Philippines, I didn't take the traditional NCLEX review course that my fellow classmates took, which consisted of sitting in a classroom for four 8-hour days. Instead, I opted for the online course which consists of watching the same 24 hours of lecture online. The very professional word that comes to mind is, "UGH!" It's been torture! Now don't get me wrong, I love to learn and the information truly is interesting, but watching it online for so long is brutal.

So what's motivating me? (this is for my own benefit!) Well, I need to pass the Boards...that's number one. If I don't pass, then I won't get a job, I throw away the $200 I paid to sit for the exam, and I have to do this review all over again until I can pass. On top of that, it will be very embarrassing and discouraging.

But perhaps the greatest motivating factor is not related to pride, but responsibility. As a believer in Jesus Christ, I am of the conviction that " whether you eat or drink, or whatever you do, do all to the glory of God." (1 Cor. 10:31, ESV) Of course I fall WAY short of this mark and perform half-heartedly all too often, but my goal and desire is that the more I walk this life, the more I reflect this truth. No matter what I do... change a dressing, empty a foley bag, hang an antibiotic, change a diaper, take a really big exam, take a super boring research class, or even something as mundane as scrubbing my own toilet, that I do it 100%, with a cheerful attitude, to the glory of God. He doesn't just deserve it, He demands it!

Daddy

One can always tell when I'm procrastinating, because I suddenly find lots of time to write letters and blog. :-)

Last night I was watching my first American newscast since being back and was annoyed as usual by the inane reporting. It's sad what people find newsworthy, especially to someone like me who has more of a global perspective. But the last part of the newscast really touched my heart. I don't typically see myself as an overly emotional person, but I nearly had tears in my eyes as Jenna and Barbara Bush read a letter they had written to Sasha and Malia Obama. The letter is quite long as the girls have 12 years of advice to give (from the presidencies of their grandfather and father), but it's worth reading here. However, I've copied the best parts here:

Sasha and Malia, we were seven when our beloved grandfather was sworn in as the 41st President of the United States. We stood proudly on the platform, our tiny hands icicles, as we lived history. We listened intently to the words spoken on Inauguration Day service, duty, honor. But being seven, we didn't quite understand the gravity of the position our Grandfather was committing to. We watched as the bands marched by -- the red, white, and blue streamers welcoming us to a new role: the family members of a President.

We also first saw the White House through the innocent, optimistic eyes of children. We stood on the North Lawn gazing with wonder at her grand portico. The White House was alive with devoted and loving people, many of whom had worked in her halls for decades. Three of the White House ushers, Buddy, Ramsey, and "Smiley", greeted us when we stepped into her intimidating hallway. Their laughter and embraces made us feel welcome right away. Sasha and Malia, here is some advice to you from two sisters who have stood where you will stand and who have lived where you will live:

-- Surround yourself with loyal friends. They'll protect and calm you and join in on some of the fun, and appreciate the history.

-- If you're traveling with your parents over Halloween, don't let it stop you from doing what you would normally do. Dress up in some imaginative, elaborate costume (if you are like us a pack of Juicy Fruit and a Vampiress) and trick-or-treat down the plane aisle.

-- If you ever need a hug, go find Ramsey. If you want to talk football, look for Buddy. And, if you just need a smile, look for "Smiley."

-- And, a note on White House puppies--our sweet puppy Spot was nursed on the lawn of the White House. And then of course, there's Barney, who most recently bit a reporter. Cherish your animals because sometimes you'll need the quiet comfort that only animals can provide.

-- Slide down the banister of the solarium, go to T-ball games, have swimming parties, and play Sardines on the White House lawn. Have fun and enjoy your childhood in such a magical place to live and play.

-- When your dad throws out the first pitch for the Yankees, go to the game.

-- In fact, go to anything and everything you possibly can: the Kennedy Center for theater, State Dinners, Christmas parties (the White House staff party is our favorite!), museum openings, arrival ceremonies, and walks around the monuments. Just go. Four years goes by so fast, so absorb it all, enjoy it all!

This Christmas, with the enchanting smell of the holidays encompassing her halls, we will again be saying our good-byes to the White House. Sasha and Malia, it is your turn now to fill the White House with laughter.

And finally, although it's an honor and full of so many extraordinary opportunities, it isn't always easy being a member of the club you are about to join. Our dad, like yours, is a man of great integrity and love; a man who always put us first. We still see him now as we did when we were seven: as our loving daddy. Our Dad, who read to us nightly, taught us how to score tedious baseball games. He is our father, not the sketch in a paper or part of a skit on TV. Many people will think they know him, but they have no idea how he felt the day you were born, the pride he felt on your first day of school, or how much you both love being his daughters. So here is our most important piece of advice: remember who your dad really is.

I truly respect the grace and dignity of Bush's daughters. Undoubtedly they disagree with Obama's politics, but they understand and respect him for the important person he is to his daughters, and that is "Daddy."

Whether you are a missionary, a teacher, a nurse, or the president of the United States of America, there is no greater title a man can have than just "Dad." And to MY Dad, a girl could have no greater earthly father than the one I have!

I love you, Dad!

Back to Reality

The vacation is now officially over. I had an incredibly blessed month in the Philippines with just the right mix of ministry and vacation.

The flight over was filled with surprises. I got bumped up to Business class on my leg from Manila to Tokyo, sat next to 20 refugees from Burma on my flight from Tokyo to LA, and met a couple of very interesting people in the process. I love traveling; it's always filled with adventures.

But now I am back. I checked the weather tonight and found it hilarious that we are under a severe weather alert, "first showers of the year expected." Folks, this isn't even real rain...it's showers! Since when are showers considered severe?? Now I just hope that it really does rain.

I'll sign off with one of my favorite pictures of the trip. I took it under a pier on the island of Corregidor, an old World War 2 island. You can see the original pier posts beside the current ones. The original pier was bombed out during the war. You can also see a reflection of the beach in my sunglasses. :-)

Another clinic

It's been a while since I've posted... I spent a week on a gorgeous beach, soaking up the rays and doing lots of relaxing: massages, dirt-biking, scuba diving, frisbee, good food, shopping, long walks, night swims... total bliss.
Today I went up by my alma mater to help out at a free medical clinic run by two missionary doctors. I spent most of the day taking vital signs and initial assessments, but have a couple of interesting stories.

I called in a lady who looked to be very full term...and too old to be pregnant: 49. She weighed quite a bit for her stature and physical appearance. All of her vital signs were normal except for her blood pressure which was about 190/150!!! VERY high. I followed her over to the doctor because I wanted to know what was the issue with this lady. She was so sweet and didn't act like she felt ill...but her stomach was very hard and she said she wasn't pregnant. Turns out she'd been to the clinic 6 months prior with minor hemorrhage. She appeared at that time to be 5 months pregnant. When she went to the restroom to give a urine sample, she started hemorrhaging all over the floor! She was rushed to the hospital and was given 6 units of blood with orders to get a ultrasound. Of course she is very poor and couldn't afford an ultrasound. Now she's back with what appears to be a huge tumor. So very sad. The doctor said we can treat the hypertension, but the tumor will probably kill her before the hypertension does. However, they are going to get her an ultrasound and see what exactly the mass is. It might not be malignant, but in all likelihood it is.

The second story is sad also. It was a 35 y/o mother who brought in two of her seven kids. One has rubella and the other has TB. Those can be treated. But the mother cannot. She doesn't appear to be sick...and physically may not be so, but her heart is very sick. She lives with a married man and keeps getting herself pregnant because her cramps are so bad. She prefers to be pregnant. I'm sure there's also the thought that as long as she's having this guy's babies, she has some sense of security. The clinic has given her free birth control pills, but she refuses because she wants to have more babies. The kids are then sent to beg in the streets because the married man spends all his money on alcohol. The abject poverty is so sad and yet there is only so much we can do. All the medical services and medications are free and paid for by the missionary doctors' US financial donors or actual donations of products (as in a centrifuge, ultrasound machine, meds, etc...).

Each patient is prayed for before they are sent home...the lives touched are countless. The people who go to the clinic have an obvious, genuine love and affection for the doctors. It's not just a matter of gratefulness for the freebies. God is faithful, God is good.

A few more pictures

Every Tuesday, Wednesday, and Friday, a clinic is held at the birthing home for pre-natal and postpartum check-ups. Here are a few pictures from the clinics. :-)

Every mom gets her BP checked...

Palpating baby's position

An old-school fetal scope!

The birthing mats hanging out to dry

Midwife scheduling the next appointment

When It Rains, It Pours

Dec. 29

There’s a saying I’m sure you’re all familiar with: when it rains, it POURS. We had 8 more deliveries today. One of the midwives accused me of praying that I’d see a lot of deliveries. I didn’t! I promise!
We had three more post-partum hemorrhages, which meant three more IVs. I hate starting IVs over here! They are just straight needles…no plastic catheter. Which means the needle stays in the whole time, which means it’s painful and infiltrates very easily! But, I got all three started first try and they stayed it until I took them out. Whew!
The first PPH was with a mom’s five baby. The dad asked me what the sex was and was extremely disappointed it was a girl. They have a boy but he wanted another one. When he came back 6 hours later to check on his wife, he was raging drunk. So sad.
The second PPH was secondary from horrible clots. Once we got those out, the mom was fine. BUT, this was her first baby and it was breech! They got it delivered no problems, but it sure made for another adrenaline rush. Unfortunately, I was napping during the delivery and missed it.
The last PPH of the day was with another primip. (First baby) When we went to check her, we thought she’d be 3cm because she was walking around, smiling, and silent. WRONG! She was complete and crowning. Then all the fun started. Whenever we told her to push, she started crying and trying to crawl up the table…she was terrified! She kept yelling, “Hindi ko kaya!, Hindi ko kaya!” (“I can’t do it!”) In between one of her contractions I grabbed her hand, stared her down, and said, “Kaya ko” (“I can”). I had her repeat it over and over throughout her contractions. We finally got her baby out, but she tore terribly and bled 800cc’s. In these little Filipina women, that’s a pretty big deal. Her blood pressure dipped to 60/40. As soon as I got the IV started and fluids running, she was fine.
And I can’t write about today without mentioning the cephalhematoma I saw. It was textbook. It’s all a blur now, but I think it was with the mom who was afraid to push. Because the baby was engaged for so long and was pushed against ineffectively, the skull was subjected to a lot of trauma, which caused massive swelling and bleeding between the skin and skull. Fortunately, this usually isn’t serious and goes down within a week or so.

Meconium Happens

Dec. 28
Meconium Happens

This day started out just as crazy. We had 8 total deliveries today…a near record. We had 5 moms on the floor in cots, two on beds, and more laboring outside. We got all the moms home except for the laboring ones of course. Poor Marilou had seen all these mom come and go and she was still laboring with poor progress. We knew they had no money to transfer them to the hospital and the baby’s heart-rate was fine. At around noon we put her up in stirrups to find her fully dilated. The midwife broke her membranes to find copious amounts of thick, smelly, meconium-filled amniotic fluid. (FYI: Meconium is a baby’s first BM) Terrible! We needed to get this one out pretty fast…nice thought, but it didn’t happen. The midwife tried everything: lithotomy, left side, birthing stool, all of it to no avail. (Left is the midwife playing the waiting game. Even Ming-Ming, the cat, got in on the action! see below) It just wasn’t coming. It looked like it should be a problem but for some reason Marilou just couldn’t push it out! We transferred her back to the table and into stirrups for an episiotomy. (A controlled slice to make sure the mom doesn’t tear where she shouldn’t.) Finally the baby slipped out at 1:30pm. It was extremely yellow with peeling skin from all the meconium. I suctioned it’s mouth and got out extremely thick brown mucous…meaning it had swallowed and inhaled the fluid, a very bad thing. Then it went from bad to worse. The mom continued to hemorrhage. She lost nearly 1 liter of blood. The midwife started an IV and we got fluids running in. After she was somewhat stable, we transferred her to a bed. To make a longer story short, the little boy had rapid respirations so we called out a missionary doctor and got it started on Gentamicin and Ampicillin. It threw up everything but this isn’t that unusual considering it was trying to get rip of all the goop. The mom stabilized and was able to go home the next day. The little guy now comes back twice a day for injections and check-ups. He looks great! He’s eating and keeping it down.

On a side note, I must say that for this being the father’s mistress, he was super attentive. He stayed by her side through her whole labor doing whatever she needed. He’s come to the clinic twice a day with the baby for the injections…not just sent it with someone else. He has asked lots of questions. It’s sad that he has five other kids with his wife and that this son is with a mistress, but as of now, it looks like he’ll be a good daddy. (below is mec baby cleaned up)