At Times Like These, I want My Mommy….

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Floating in space and time –

You can think of a blog as a diary from one day to the next in which case there will be an ongoing stream of small carried-over details that document the minutiae of life – what I had for breakfast, where I went and what I did. Some people find that interesting and of course, there is a time and place for such writing, for example if the daily life of the writer is so compelling that the reader wishes to be that person, then this could be a way to do it. It’s the voyeuristic aspect of People magazine or something in which we become privy to Oprah’s struggle with diet, or perhaps how Brad and Angelina’s vacation to the Caribbean was ruined by sunburn. Yes, folks, we can all identify when famous persons suffer from the same maladies as you or I …… it’s comforting. In reality though, I just don’t think there is anybody out there who fantasizes about being – me.   😉

For a moment, let us slip the surly bonds of linear time. Life happens one day at a time, but memory allows us to revisit the past and the brain is set up to visualize an alternative future, sort of like a Tibetan Thugpa, in which the stew is concocted from whatever is handy in the kitchen of the brain. When we read a book or a blog, the words on the page go into the brain, and they provoke reactions and memory which can lead down a new path, so that the final product tastes like more than just the sum of the ingredients.

The best writers know this, and they play with time, going back and forth to mimic the thoughts of the reader, dancing back and forth like the flickering lights of a fire from a fireplace, playing on the walls of the room as it burns. Furthermore, the best writers are able to come up with a unique voice, more than simply telling the story. We have lost the art of reading out loud I think, but in the days before laptop computers and television, to read out loud and try to sound like the writer, was one of the joys of sharing the printed word. Some people who read my book have told me it was the first time they ever read something by an author they knew personally, and that I wrote it the way I speak, they could just hear my actual voice jump up off every page. I take that as a compliment. Mostly. For those of you with whom I have never spoken, I have a rich baritone, confident and inspiring. Like a radio announcer.


Wednesday Class Progress

Back to the framework of time. One-foot-in-front-of-the-other time, marching forward in cadence. I have digressed a bit in these blogs, but it is time to retrace the path. The Wednesday class continues, and I realize that I have not reported on it for several weeks now. We met again yesterday, in the big green ballroom, under the chandelier. There were 55 students, which means I have had a drop off of about twenty since it started. A good teacher needs to keep a handle on how the teaching is received, and of course one indicator is to see what kind of attrition taked place  from week to week. Looking at the roster, I see that about forty of the class have been there every single session, which is a good thing – these are the core of the class. Among this group, I have my whole subgroup of teachers and the ones who are already working in ICU somewhere. This group is highly enthusiastic. This bunch tends to be better at English, and at least partly motivated by the idea that they can incorporate the materials into things they are already doing.

Twenty or so students seem to be absent from week to week. These are not necessarily the same twenty, which indicates to me that they have not simply given up. I think that life intervenes, and some of them have night duty, or other commitments. For example, two weeks ago Bir Hospital announced that there were fifteen staff nurse job openings, and that the only day for in-person application would be that Wednesday – resulting in some vacant chairs at LNC that day. The following week, Army Hospital did the same thing, holding an all-comers job interview day that competed with this class.

Yesterday, after lunch, about a dozen students left instead of sticking around to do mega-code drills, as well. Somebody said “oh they mostly have evening duty today” but then it causes me to wonder about the degree to which they are uncomfortable with the kind of public skills performance that mega-code imparts. So this presents a challenge. For those students who miss a week of class, it is not so easy to catch up on content and solidify things. Adjustments need to be made.  I have known from the beginning that the psychomotor performance of mega-code presented some cultural challenges –  I wonder as to the degree that this group of younger class participnats are simply opting out because it exceeds their comfort zone.

2012 is not far away.

File this away for next year – to capture a smaller group for a concentrated three-day short course seems to lead to better retention of students. I don’t regret doing the weekly gig – I think I have taught a cadre of people here who can bring the material to a wider audience – but given the reality of life in urban Kathmandu, this sort of indepth experience makes it difficult for everyone to attend regularly.

I have to look at how the language piece becomes a barrier or not. I routinely pause during lecture to allow the continual buzz of background discussion as the more bilingual students explain things to the less- bilingual person sitting next to them. I think I need to continue to find  ways to build that in better. For example, I did not start out with a comprehensive glossary of cardiology terms, preferring instead to define then as we went along. A short specific lexicon would be a handy thing to have. The obvious answer is, this class shoudl be taught in nepali by a Nepali expert.

My main handout was my Rhythm Strip Atlas, and I did not have a textbook per se. Oh, I brought some books on ecg analysis, and distributed them, but there were only five such books. This was a logistical limitation of the class. Then – I discovered and stepped into a brighter future.

The Himalayan Kingdom of Serendip

How this happened is a tale of serendipity for me. For a week I shared Guest House quarters with an MD from Vancouver, BC named Jason Waechter, who is an anesthesiologist, and who does critical care education for interns and residents. He is the owner of the site named above. Using my thumb drive he gave me all the materials about ecg from his website – it would have taken forever to download the documents given the internet speed of Nepal. And the materials on critical care are free. The stuff is well-written and simple, in many ways parallels the approach I take ( they are only so many ways to teach people to interpret ecg anyway). So when I realized what a gold mine of information this was, I emailed the students in the Wednesday class to bring in their thumb drive or laptop. At lunch we had a thumb drive party, in which we uploaded copies of the ecg booklet on to about thirty thumb drives. Voila. I will use this material for all future three-day courses as well.

Nepali is the lingua franca of this town

At the very beginning of class yesterday, as people filtered in, I asked one of the better students in the group to sit with some of the ones who’d missed a previous week, and to go over some of the things. I was delighted to hear how articulate she was in describing the concepts in Nepali…. And I realize I need to do even more to support this. So next week, we will build in more time to review course concepts using the expertise of class members to help those who are struggling.

Fearless Personal Inventory

And finally – had another bout of fever, chills and diarrhea. I could feel it coming on as class progressed yesterday. The weather was cool – only about eightyfive, but I was wilting, despite drinking all the water, and I started sweating more. I finished the class, but the students noticed that I was not my peppy self. To do the afternoon megacode I was joined by one of the women from the BN group I have in June, which was extremely helpful. The diarrhea started in earnest about an hour after I got home – which was good. Now, diarrhea is not always a bad thing – it is your body’s way to purge toxins out of the system – but I was alone in the Guest House. Ram, the manager stopped by on an unrelated errand and sat with me for a bit.

At times like these I want my mommy….

I am once again, doing better, but the stuffing has been knocked out of me. These episodes always cause me to conduct a fearless personal inventory – what did I eat? How did this come about? What’s in the fridge now, that I no longer trust? I think it was some mayonnaise I put into a tuna fish sandwich I made…. Now unceremoniously dumped in the trash.

The Terai beckons me once again

Saturday morning I leave for Bharatpur for my three day compressed event there. I will meet two people from there at the Kantipur bus depot at 0700, we arrive in Bharatpur by two PM, and I am told I will stay at the nicest hotel in that city. Sunday morning I meet thirty students…. And the curtain will go up – showtime!


About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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