A Great Time Was Had by All!!

See!  You don't have to miss the holidays when you are not living in your own country.  You find a way to celebrate wherever you are!  We had a great dinner at my apartment!  We invited several friends from work and just had a blast!  I even managed a turkey with all the trimmings.  Fifteen people came over and we ate, told stories, talked about traditions in their countries.  It was quite the spirit of Thanksgiving!

It is beautiful here now.  I didn't expect there to really be an autumn but we are having one!  The weather has cooled off nicely and it is very pleasant. Sunny sunny everyday still though it was a little cloudy once but nothing serious ;)

Well I am off to do more studying.  Next week I do my check offs and then I should have some breathing room!

Christine xx

Eid al-Adha

This is the holiday currently being celebrated by the Muslims.  It just happens to correspond this year with the American Thanksgiving.  Eid al-Adha, or Feast of Sacrifice, celebrates Abraham's (Ibriham in the Arabic spelling) willingness to sacrifice his son, Isaac, in obedience to God.   The Hajj (pilgrimage to Mekkah) occurs this week and Eid begins when the Hajj is over and lasts three days.  I have been privileged to have two very devout Muslims talk to me about their religion and what it means to them.  One man is an Arab doctor.  I really like working with him.  The other is a fellow nurse who enjoyed working with me because I would watch her patient so she could pray when the call came.  I am sure this is an important part of my education to this culture. Eid is a little like our holidays.  There are pretty lighted designs lining the streets downtown.  There are colored lights and a spirit of celebration!  The Saudi's get time off for Hajj and our employer is kind enough to give all of us Hajj days as well (which we can take anytime we want to).  My heart grows larger and filled with more understanding and love as I come to better know this people.

I am looking forward to tomorrow and celebrating my favorite holiday.  Pies are baked, preparations are made, friends are coming...good times ahead.  I have so much to be thankful for!!

Happy Thanksgiving!

Christine xx

Happy Thanksgiving

Thanksgiving has always been my favorite American holiday!  Christmas has become so frenetic and commercial, halloween..well...there is so much candy one can eat.  Thanksgiving is for remembering all that has come to you in the way of blessings.  Health, family, home, friends it is a time for remembering that a happy life does not mean being wealthy in material things.  Some of the unhappiest people I know have lots of money but have missed out on the truly meaningful things in life.  Give your life meaning!

I am cooking today and tomorrow!!  The herd of hungry expats are gathering at my apartment where I am cooking a traditional Thanksgiving dinner.  Some recipes had to be altered slightly due to unavailability of certain ingredients.  Like sage.  I could not find sage anywhere unless they are calling it something different here.  I was sure they had nutmeg but nope.  Not finding that either but did find a great cinnamon!! and ginger is easy to find!!   Cloves...well I had to trust that the spice bottle that said GLOVES would be cloves...and it was! I made my pie crusts from scratch!  I found pecans but they are not very good so they will go in to the sweet potato casserole for some crunch! 

I feel extra blessed this year!  I am living in an exotic place working in an interesting hospital.  I am learning a new language.  I have everything I need to be comfortable.  I have made great new friends.  I am thankful for technology that allows me to stay in touch with family and my friends back home.  I am thankful to God for all these blessings I have been given...even the challenging ones that teach me patience, and to have hope.  All of you who read this have touched my life and left your mark on my heart and I am grateful for you!

Happt Thanksgiving!!

Christine xx

Dheera Souks

I LOVE going to Dheera!  A couple of friends and I decided to have the full Arabian experience and go shopping in Dheera at night.  There are many little shops called souks where you can buy just about anything but the favorites are jewelry and rugs!  I bought some scarves (you cannot believe how inexpensive pashmina is here!!)  I also bought some amber and jade jewelry...also inexpensive here!  Gold is less expensive here than the rest of the world but the shop keeper said to wait because the prices are not good.  We were hungry after a while and decided to try Saudi fast food.  We had chicken sherwa (sort of a wrap with chicken, vegetables and sauce) and we sat with the women along the curbs of the souks.  We tried to blend in as much as our fair skin and light hair would let us!  At least there were no Mutawa incidents this time ;)

Tomorrow I go to the bank and do a wire transfer for the first time......as with anything having to do with business here...I am certain it will be interesting!  Fortifying myself with banana pancakes from Al Quisse before I go (they put cut up real banana in them!)

Christine xx

Language, PLEASE!!

I have been so busy getting oriented to the way things are here that I haven't had a lot of time to work on my Arabic.  I plan to make a focused effort as soon as I can.  Today my patient's son told me he wanted to learn more English.  I told him I wanted to learn Arabic.  Now we have a game going (and his sister joined in as well).  He speaks to me in English and I respond in Arabic.  He says I am doing pretty well but I have a funny accent (LOL!!!).  I told him he should be glad I am not from Queens! :-)  He is doing very well speaking English!  I have a book I bought at Al Jiri bookstore that was written by an American doctor who worked here for many years.  It lists lots of medical terms and short phrases English speakers can use to explain things to patients.  it was written in Saudi Arabic which is slightly different from other Arabic.  I asked some of the Lebanese staff here if there was a large difference and they told me there is.  An Egyptian can make himself understood here as well as Lebanese but others would have trouble.

It is absolutely beautiful here!  I was a little sad I was missing autumn back home because it is my favorite season!  Well it is in the 70's and 80's here now (60's at night) and the sky is so clear I just stare at the stars as I walk home from work!  There are also a lot of flowers blooming now.  Haj is next week and even if you are not Muslim you get Haj days to add to your vacation time (we get Ramadan days as well).  I'm planning (with a little help from my friends) a big Thanksgiving day bash and since our cable has 16 sports channels I am sure we can find a football game (though it may be the English variety).  I have to work my King shift on Christmas Day but since I have worked Christmas Day ever since my children have been grown it feels like the tradition continues.  We cannot openly celebrate Christmas here but right now in the Al Quisse Center there are little kiosks with brightly colored decorations that look suspiciously like the Arab version of Christmas ornaments ;-)  Ho Ho Ho!!

Masaalama!

Christine xx

For all of my nurse friends in the United States of America......

WOW!  What a culture shock!!  At first I didn't think there would be much difference in my nursing practice but as I went farther into my orientation I found out how wrong I was!!!

First off..there are no pre-mixed drips here.  We have to mix our own inotropes!  There are formulae to be used depending on the patients weight.  There are no standard concentrations and everything is based on .01 mcg/ml.  If you are using a 50 cc bag it is .03xthe patient's weight in kilograms to get the amount of milligrams to add to the bag,  for 100 cc bag it is .06 and for a 250 cc bag it is  1.5.  Then you multiply the milligrams by 1000 to get the micrograms...then divide by the volume, divide by the patient's weight and divide by 60 and that gives you the micrograms/kg/min.  Two nurses have to do the calculations separately till both agree.

There is no unit dosing here.  Everything is in multidose vials.   Also there are no pre-filled syringes only vials.  The clinical educator and a nurse came to me yesterday with an insulin pen...no one knew how to use it but they figured I did.  They had the pen but no needle caps to put on it and they did not know at the time these pens are for single patient use.  They had been drawing the insulin out of the top with a needle (I could just imagine Carey's and Becky's looks if they saw this).

We draw ALL of our own blood sampling.  I don't consider this a problem.  All of the patients in all of the ICU's have either a PICC line or a central line.  We also do our own blood cultures and there is quite the protocol for doing them.  A couple of years back there was a huge infection control problem which is why they are so compulsive now about how we draw blood cultures, do trach care, do wound care etc.  All of the rooms in my unit are positive pressure rooms.  We have had several patients with H1N1 flu and the reason it is so serious here is because many of the patients have serious genetic diseases that make them high risk for morbid complications.  I'm telling you every night I come home and have to look up a half a dozen things I have never heard of!!

I have to do conversions all day long!  I'm sure over time it will come to me more naturally.  The hospital is run based on the American system of practice but temperatures and lab tests use the European system of measurement.  For example. a good blood glucose here is 4-5.  Multiply that number by 18 to get our equilivant.  A low hemoglobin here would be 78.  Thank goodness they put the normal range by the labs or I would never remember all that stuff!!  PT, INR and PTT is the same but the chemistrys are very different!!

I like not having to charge my patients for every little thing.  I can use as much gauze and wound care stuff as I want.  I can use all the chux in the world and not have to scan a single charge.  Communication is a problem but I am learning more Arabic and can instruct in one word requests (though they think I speak with a funny accent :) and I STILL have a lot of trouble with the gutteral click)  A lot can be communicated by gentle handling and a soft touch.  My preceptor was kind of rough with a mother who just wanted to rub her daughter's back (her daughter is 16, has leukemia and probably will not see her 17th birthday).  After the preceptor left I took some lotion and started massaging the girl's feet.  The mother saw what I was doing and was so happy there was one thing she could do to give her daughter some comfort.  So I gave her the lotion and she went at it!  I have discovered when it comes to caring for people body, mind and spirit are very much universal!

My first day on my own was yesterday and it was a great day!  There is a lot to experience here and I am embracing that!!!!

Chris Young, SN1 xx

Nice day in Al-Maather Cave Park

It has been a pleasant weekend.  We were all so tired we didn't try to jam pack a lot of activity this time.  We were going to Dirrah but since this is Friday we opted not to go.  Fridays are when they do the beheadings and limb removal on the square at Dirrah.  We opted to skip that.   We went to the cave park instead.  It is a lovely garden with a theater and an ancient cave site.  The information on the sign said it was part of Old Riyadh.  At first it didn't appear to be much of a cave but when we looked closer we saw though it had a small opening it goes back a long way into the hill.  They say the old Bedouins used it as a place to stay when they came for meetings or to visit.  Here are some pictures from our tour.

She has met the Mutawa!

Before I came to Kingdom of Saudi Arabia I had heard many things about the Mutawa.  I was told they carried canes and camel whips and struck men and women who were acting inappropriately.  You can be arrested if you got on the wrong side of one!  I was told you could tell who they were by they wear no ring on their head to hold the head scarf on, their thobes are shorter exposing their ankles, and they always have a beard.  Some of the books I had read told horror stories about the Mutawa.  While I am not afraid of much I really did not want to run in to one of them (but I knew I would eventually).  They seemed a little bit scary!  Today I was caring for a very sick woman who is not doing well though sh is making miniscule improvements.  I'm writing in my nurses notes, look up, AND THERE HE IS STANDING RIGHT IN FRONT OF ME!!  No ring (check), beard (check), short thobe (check).  Holy mackeral and shoot the monkey..it is the Mutawa!!  He asked if he could sing the Quran to the patient.  I said of course and since the patient was in isolation I helped him get into his gown and mask.  I listened to him sing while I was doing my notes and it was so so beautiful!!  When he came out I helped him out of the paraphernalia and disposed of it for him.  He said "thank you, sister".  I told him how much I enjoyed listening to his prayer. I think some positive attitude adjustment was made by both parties. I respected his position and he appreciated my help. The king has made a lot of changes over the years regarding the authority of the Mutawa and we were given a lot of advice on arrival.  I am glad my first real experience was a good one!

I am really quite tired.  I have worked a lot, taken lots of exams, had extra training and competency evaluations.  I haven't been out in over 10 days so I am looking forward to having a couple of days off!  I am off Thanksgiving and the bash is at my house.  The Yanks have invited the Irish, the Aussies and the Kiwi's!  Maybe some of the East Indians will come! Must go to Tamimi market and get a turkey tomorrow!!  I found canned pumpkin and sweet potatoes, stuff to make green bean casserole.  Everyone is supposed to bring something from their country to share.  I may do that pilgrim and Native American thing again.  Hmmmmmm

Christine xx

Now I Am the Expert!!

I was walking home from ordering my water cooler and internet radio when a young Canadian girl stopped me.  She had just arrived last night and her room mate hadn't made it in country yet.  She was lost and needed help finding her way back to her complex!  She had crossed the boulevard in front of the hospital to get to where we met and was terrified to try to cross it again!!  AS WELL SHE SHOULD BE!!!  I walked with her to show her "The tunnel" that goes under the street and the over road cross way that goes over the street because there is NEVER a safe time to try to cross that road otherwise (and there are many roads like that here!).  I walked her safely to her complex and answered all her questions adding words of advice that I hope will make her start a little easier.  After I left her I walked home (to my apartment....US tooo far to walk;)  I realized that after just one month (tomorrow) here I had become the "expert" and was already helping the newbies find their way around.

I am also learning a lot about power and electricity here.  Diane and I are tired of having to buy drinking water every week.  In addition we are also very aware of all the plastic trash we have been generating!!  We can buy large containers of mineral free (mostly) water but it is cumbersome unless you have a water cooler.  I found a very reasonably priced one that will give us hot or cold water but the power was 220.  Now it isn't just a matter of getting an adapter for the plug!  It also requires a transformer as well as an adapter!  Most of the residences have a combination of 220 (European) and 110 (American).  You can tell by looking at the plugs if you can't work out the Arabic ;)  My residence is all 110.  All of the appliances you can purchase are 220 so it requires extra equipment to make it work in my apartment.  It was an extra SR85 which isn't that much (between 20 and 25 dollars American) and SR 398 (nearly $100.00 American) for the cooler so I think it was a bargain!  A little info..the water here is drinkable but is very highly mineraled.  Lots of problems with kidney stones and such (I have a history of them).  It is best to find the water to drink with the least mineral content .  It is hard for me to drink enough water.  I know I haven't drank enough when I wee only 2-3 times a day and my skin gets very dry.  Because the humidity is so low here you lose a lot of water you don't realize.  You sweat but it evaporates so quickly from your skin you don't realize it!  Everyone walks around with a bottle of water in their hand!  Three liters a day is the recommended intake per person.

Speaking of skin...the local women around here have the most beautiful skin...not dry at all!  I asked the local pharmacist their secret.  He says sweet almond oil every night and use lotion with shea butter.  Those kinds of products are very inexpensive here so I have been using them.  My skin is so soft now!!!  The dryness is gone!  I remember trying to use lotion in Oklahoma and not liking it except in the winter.  I guess the humidity there is enough tht the lotion just sat on my skin rather than absorbing. 

At any rate I confess I have had more new experiences here in one month then I had in forever back home.  I miss home but I wouldn't trade this experience for anything!

Christine xx

Lost in translation?!?

I  was walking home with friends (who I managed to Tom Sawyer into carrying four boxes of stuff I had sent to myself).  Stella O'Neill, my Irish friend, noticed I had some travel brochures.  She looks at me and asks "did you get them from your man?".  I looked at her and said, "No, I got them from the travel agent".  Apparently in"Irish" that expression means I got it from the travel agent.  We looked at each other and burst out laughing!!  There are about 10 countries here divided by a common language.  We call it "the look".  Someone will say something none of the rest of us understand and we give them "the look".  It's a combination of confusion and amusement.  No one ever EVER takes offense and usually the misunderstanding results in a great laugh!!  It's great fun to share each other's English culture....or the interpretation thereof ;)

I've got a long work week ahead of me.  I work three 12 hour shifts in a row , have two days off, then work three in a row again except my clinical instructor decided I was so proficient in computer charting that he is sending me to the ISIS training on Sunday so I can help train my co-workers.  Been there a little over a week and already in the thick of things!  Means I get only one day off now....but Carlos thinks I am motivated by money and assures me I will get overtime!  That's OK.  I'm planning a trip in March for my birthday. Going to Egypt and do my best Cleopatra impersonation :)  Cairo, Alexandria, Giza and a cruise down the Nile.  Happy birthday to me!


Christine xx

Welcome to Al Rahji Bank!

I am now the proud owner of a bank account in Saudi Arabia!  Complete with ATM card!!  I am also a card carrying member of the Employee Social Club!  Yessiree I'm set up and settled in!!  I had a day off today so took care of that little bit of business and then explored more of Riyadh.  Two friends and I went to Olaya Street and found another huge mall (there are tons of malls here) but this one sold more textiles and craft items.  There was a small DMC store and we found out there was a larger one across the street!  DMC is a little like Hobby Lobby where they sell craft and artist supplies.  I was thrilled they sold beads and beading supplies as well as needlework kits.  We then went to Al Jiri Book Store.  It is more like a Office Depot than a book store.   There were lots of office supplies and computers but they did have a section that sold craft and artist supplies.  Upstairs they sold school items and some books but not many.  There were Best Sellers and a few nonfiction but not many.  I bought a book on Saudi Arabia to send to Matt's children since they seemed pretty interested in where I was going.  While we were trying to cross Olaya Street we were able to make it to the median because there was a traffic light that stopped traffic.  Getting to the other side was trickier because there is NO traffic light and the cars kept coming!  We were stuck on the median with no break in traffic!!  A man came across to us on the median and helped us make it to the other side!  I thought WOW!!  What a very kind (and brave) thing to do!  A word about driving in Riyadh...believe me when I tell you I am very very happy not to drive here!!  The traffic system makes no sense, there are no speed limits, the traffic is always very heavy and the drivers are crazy!!  The number one cause of death of children in Riyadh is traffic accidents!

My unit is interesting but not nearly as stressful as the one at CCMH.  They are using the same monitors we did before we got the new ones.  The people here did not know they could print vital signs or change colors of the waveforms or do a host of other things.  I showed them a lot of things they could do and the clinical instructor said "I can see we will be learning a lot of things from you!".  That made me feel very nice!  The drawback is they still do paper charting....and it is crazy!!  They want to move to computerized charting but some of the nurses come from areas of the world where they have very little exposure to computers.  They have to teach them basic computer skills and then try to teach them the ISIS (the charting system we will be using).  We have a very fancy PYXIS medication system that uses a bioscan after you put in a password. You have to return your empty narcotic vials and count those with the narcotics (but don't include it in the count on the PYXIS).  Returned meds do not go back into the PYXIS but get placed in a bin that says "outgoing to pharmacy". They are hoping to integrate the systems.  We are HANDWRITING the drugs out on a medication sheet!!  Modern equipment and stone age charting!

Christine xx
They use APIE charting here which I find a little hard to get used to.  It is OK for the chronic patients but not at all friendly for the acutes.  It is a very strange system but I have decided "when in Rome" and just go with it till they get the computer charting system up and running....patience.....