On being a nurse...

Earlier this week, I spoke to a group of high school students about my career in nursing. For a couple of weeks prior, I scrolled through tens of thousands of photos looking for apt snapshots of time spent in the various hospitals, operating rooms, and clinics throughout my career. The agony of sifting through hours of unlabeled Shutterfly and Google Photo albums inspired me to either reorganize them or hit delete altogether. Luckily, I did neither. Some messes I need to just walk away from, even digital ones. 

While preparing for the presentation, I enjoyed seeing old faces and remembering the kinds of medical care I provided. For example, I had forgotten that sometimes we'd deep freeze skull flaps for patients whose brains weren't quite ready to be re-covered. I'd forgotten how big a rigid cystoscope could be, which is a camera with a metal sheath used to look inside the bladder. All over again, I can smell the Trix cereal sweetness of the 3 liter sorbitol bags used to irrigate during prostate surgery, feel slickness of the floor when the plastic surgeon finished a liposuction case, or hear an organ donor's heart beating to silence. My nursing career started in the O.R. and while I moved onto different specialties, pieces of my heart still remain.

I had the time of my life working in urology too, but the fun was different. My job required lot of time educating, teaching, and finding appropriate resources for my patients, which meant I had to be at the ready, confident, and calm - every single day. Need to learn how to catheterize yourself because your bladder no longer works? What about giving yourself penile injections to treat erectile dysfunction? Maybe there's a cancer treatment to walk through, or you need a refill on your antibiotics because it's your 10th urinary tract infection this year. Urologic disorders are undiscerning to those with money and status, and those without. Because I lived in DC, I saw so many patients literally from all over the world. Some worked in government, others worked in the streets. Some were actual royalty while others were actual royal pains in the ass. I could recognize phone numbers calling in and knew exactly why they were calling. The urology clinic taught me to have massive patience and how to execute a professional poker face that was also empathetic, warm, and reassuring. 

Since we are getting ready to leave Uzbekistan in a few weeks, I've been thinking a lot about the events that will stick with me after four years. The spring 2021 covid vaccine rollout was notable feat. I still get goosebumps thinking about the logistical hurdles, blocks, and creative pathways we took to make it a wild success. Two colleagues and I executed an embassy wide earthquake drill that was equal parts stressful, hilarious, meaningful, and laden with lessons learned. Over 400 people were involved in the scenario including 20+ casualties with varying injuries (actors), dozens of panicked citizens (also actors) showing up to the consulate doors with their personalized "help me I'm an American" stories, the assault of hysterical colleagues, securing the premises and damage control, while maintaining the facade of calm, thoughtful responses and decision making. 

I got to visit hospitals and clinics in different regions of the country, creating medical resources for Americans living or touring in Uzbekistan. I worked with the school and other embassies on emergency planning, hosting multi-language trainings on CPR and multi-casualty management. I supported a nod worthy amount of medical evacuations. Because, sometimes lesions need a biopsy, appendixes get infected, kidney stones need removing, and someone with uncontrolled bleeding out needs a higher level of care. My boss and I like to joke that all bleeding eventually stops, but we're also not wrong. Living in a place that is medically austere means we have to be vigilant for our people, because it could be a matter of life or death. And at the same time manage the routine tasks like dispensing blood pressure meds, providing immunizations, drawing labs, performing well checks, or handling diarrhea woes. 

In the end, I don't know how much I inspired the students to go into medicine with my stories, but it was fun teaching them how to inject oranges with needles or pack wounds with gauze. Some were enthusiastic while others were anxious to get the session over with. Regardless how they might have felt, I appreciated the opportunity to think about my history with nursing, my mistakes, and victories. Now, I have so much more to look forward to at our next post in Astana and continuing my work in that health unit.

me and my bestie on UW campus
 with chunky shoes, and early 2000s flipped hairdo. 

skills lab, trying on pneumatic pants 
used for pelvic fractures 4/2023.

Foley'ing 

Teaching airway management,
Career Day 5/2024

vaccine rollout 4/2021

trying out some "panty liners" 4/2023

2006 between surgical cases.

Neurosurgery colleagues 2006

A very bad day 5/2022

T-minus 10 minutes to embassy wide drill 5/2022

Drill prep 10/2023

Southern Uzbekistan Med Field Trip

Recently, I got to take a break from wearing surgical scrubs in exchange for business casual outfits while taking a work trip around southern Uzbekistan with my doctor colleague. Our task was to visit regional hospitals and private clinics to see what resources were available for Americans living, working, and traveling around the area, and to learn about future aspirations the medical facilities had in store.

Regional hospitals function in a unified network with computerized charting, telemedicine, and blood bank resourcing. When a patient has medical needs beyond the capability of their municipal hospital, they may be relocated to a bigger one within the region, and with relative ease. Their hospital mothership, the Scientific Center of Emergency Care, is located in the capital. Interestingly, though the capital feels like its population is busting at the seams these days, with massive construction projects and mind numbing traffic, Tashkent Region is far from having the most number of hospitals (198). Overall there are 2,696 facilities in the country. Ferghana has the most with 302. We managed to visit three in the Kashkadarya and Surkhandarya Regions, which share borders with Turkmenistan, Afghanistan, and Tajikistan.

Over three days, the good doctor and I got to meet with several hospital directors, all of whom had not just their administrative day jobs, but full loads of speciality patients as well. One was a neurosurgeon, another in vascular, and a few others from intensive care, cardiology, and plastic surgery. We walked through their emergency rooms, ICUs, radiology departments, laboratories, operating rooms, and even a dialysis department. In all three hospitals, the most common reasons people end up in the ER is from car crashes involving traumatic injuries, necessitating a multidisciplinary approach to patient management - telemedicine, they said, has been a godsend. Farming equipment and tool disasters were second. 

During a lunch meeting, over plates of shashleek, salad, and naan (Uzbek style), the vascular surgeon showed me pre and post videos of a man's nearly amputated foot from a scythe injury incurred out in the field. Amazingly, he recovered all function and nearly all sensation of his foot. On other topics that surfaced, I was told a blepharoplasty* would cost me 200 dollars, a nose job for about 350, and I could get a mammogram for about 15. Plastic surgery for medical tourism is by far the most profitable and sought after enhancement. I learned that one regional hospital successfully re-introduced several organ transplant surgical cases this past year, after a country wide ban prevented them for several years. Organ trafficking and black market sales got out of control, so all transplant surgeries were shut down. Regulation in the country is tight and limited, and loaded with bureaucratic red tape, but the doc seemed hopeful a measured start become to benefit everyone in need, and that patients won't have to leave the country to find care. 

During our all of tours, not a single one of them wasn't interrupted with dozens of phone calls along the way. It offered sobering insight to how busy they were - literally everywhere in this world, patient care simply never stops and it felt so familiar. Even in my clinic with a relatively small population, I can't remember a single day where we've had downtime. Like in the US, these nurses have heavy patient loads, work 12 hour shifts, and sometimes have to get creative with limited resources. Families often hang out on the hospital campuses with picnics and blankets to manage long wait times. Uzbeks have incredible patience and resourcefulness.

Any accident requiring emergency ambulance transport is required to go to their assigned regional hospital. Care is free, including for foreigners, though the notion of integrating health insurance is starting to take hold. Private clinics focus more on speciality care, but that doesn't mean they are without heavy duty surgical capabilities. One clinic in Termez has a cardiac bypass machine and will soon conduct angiography procedures, where as another on in Qarshi touts its reputation for bariatric surgery and weight loss clinics. Every private clinic we visited have robust dentistry, ENT, and endocrine services - getting one's thyroid function tests is considered routine, as is prescribing lengthy periods of time to recuperate in semi-private rooms. Though they require countless hours of logistical planning, many private clinics enjoy the stardom of visiting specialists from countries like Russia, Turkey, India, and South Korea.

Overall, the doc and I were reassured to see what kinds of care are available in this country and what has changed since the last time the health unit was able to step beyond embassy property. After the hustle of three days of hospitals tours and eight clinic tours, 2 hours of flying, and 16 hours of driving, the doc and I returned to Tashkent to complete the week seeing our own patients, writing trip reports, and catching up on hundreds of emails in our absence. I hung up my jacket and blouse and pulled out my worn, comfortable work jammies for another day of nurse life.

*eyelid lift

Medical folk hanging out in Shakhrisabz, birthplace of Temur the Great.
We're standing behind the Ak Saray Palace, builtbetween 1380 and 1404
when Temur was the man in charge.

Ak Saray Palace tree, good for sittin.

Endoscopy room, Shakhrisabz

Shakhrisabz hospital's collection of weird and unusual kidney stones.

Qarshi's Great Patriotic War (WWII) Monument at sunrise.

Red army stained glass, Great Patriotic War Monument

Nurses are the best, there's NO denying it.
Qarshi hopsital OR Nurses.

Qarshi hospital dialysis unit

Laparoscopic equipment and telemedicine towers in Qarshi.

Operating Room in Qarshi

Emergency room and head nurse in Qarshi.
This room is reserved for red triaged patients, the most serious kinds of injuries.

Endoscopy, Termez

Emergency room, reserved for trauma patients, Termez

More kick-ass nurses (and a few doctors), Termez Neuro ICU

Cardiac bypass machine, Termez

Foreign doctors with upcoming visits to private clinic in Qarshi.

Urungach Lake, Uzbekistan

Knowing what I know now, February is not best time to visit the Jade Lakes (aka Urungach Lakes) when ice, snow, and mud make for a painful and dangerous journey. A better time is in April, where landslides, boulders, livestock, and narcissists suffering from selfitis make for a painful and dangerous journey instead. Much later than April, we were told, the glacier water stops flowing which means stagnant, filmy water and hordes of mosquitos.

Sighing in resignation, we agreed to drive the gauntlet once more because a friend of ours really wanted to see what is probably Uzbekistan's most famous lake. And, we had to follow the advice we dish out to the kids, that in order to have a friend, you have to be a friend, especially when interests aren't aligned.

 

This particular weekend marked the end of Ramadan, which equaled extra days off, which equaled many people visiting the park. The upper and lower lakes were very much an Instagram versus reality: the sound of rushing glacier melt filling the nearly translucent blue-green lakes, the cool air and no bugs, versus the noisy diesel engines of the Lada 4x4 taxis, piles of trash, lines of impatient hikers, and people attempting to picnic along the rocky, narrow edge of the water. From bottom to top, the hike took us about 90 minutes, but the view was worth the effort of dodging Ladas gunning up the unstable terrain, dealing with the large amount of soda-drinking, must-disobey-all-rules kinds of visitors.

Reality: 4x4s and roaring engines. The driver was
filling the radiator with creek water.

IG: clarity

Reality: smoking, music, and nowhere to sit

IG: nothing but the sound of rushing water

IG: glossy, crisp, green

Reality: lines with nowhere to safely get off trail to avoid the pushy types.

Reality: Lada, Lada, everywhere. However, it was fun to watch them
navigate the tiny parking lot ala engine revving Tetris.

Watermelon (and Men of) in Uzbekistan

Tis nearly the end of melon season and nobody is as regretful about it than I am. Every September, I find myself in an angsty teenage phase where I am unable to appreciate the next round of late-summer fruits, like plums and figs. Though delicious, these purple-hued mini treats don't hold a candle to the mouth feel or sweetness of watermelon, and it makes me feel like Sadness.

The roadside vendors don't have the same draw either. Melon men: they cradle their giant fruits, bending over in denim jeans, stacking melons into tidy piles. Some like to knock on the rind when choosing the perfect one, others prefer to shine them with cotton towels, like Jesus Quintana before presenting them for inspection and purchase. Glistening with sweat and effort, they sell these Hulked-out pieces of sweet, chin-dripping flesh like it's going out of fashion.

We tried twice to grow watermelon from seed in our patch of grass at home, but to no avail. We just don't have the touch, so I will impatiently wait for their return next summer and I can horrify my children again with my nightly rendition of eating the famous Great Outdoors 96-ounce steak - but with watermelon.

 

Yangiobod Flea Market

I am glad to report that both of my kids take Halloween planning very seriously. They enjoy being creepy and scary as much as I do, so when Deets asked if we could find a gas mask as part of his costume, I eagerly agreed. It gave me an excuse to return to the Yangiobod Flea Market, one of my favorite jaunts in the city. It's rowdy, dusty, and always stuffed with people on the weekends. Most of the market is divided into reasonable sections. One alley is specifically for selling only gas stoves, another for doors and windows. Rotors live in one section and wires/cables are in another. Antiques, clothing, and cell phone stalls are in between the food stalls selling drums of sunflower oil, shashleek grilled on aluminum spears, somsa, and plov. Above the melee, faded signs of good looking white people warning others to wear masks and stand 2 meters apart are totally ignored - Margo commented how this could be useful information for archeologists to discern human behaviors and value systems several hundred years from now. 

We cruised the aisles, eyes scanning for anything resembling military and found all the camouflage and lace up boots one could want. Rubber gas masks galore too. In a matter of minutes, Deets found what he was looking for. In a matter of minutes, Deets found that wearing a gas mask might not have the best "breathing material" for his Halloween costume. Braving the bargaining process on his own, he bought one anyway and opted to create a different costume for next month's holiday to avoid suffocating himself. Retro gas masks are about 5 USD these days, and he also bought an army issued aluminum canteen for the same price. He was pretty darn pleased with himself. Me too, actually.

On the way out, I stopped in my tracks to peruse the table selling surgical instruments. It was all I could do to not buy a box of expired suture, a glass syringe, metal tongue depressor, or a tenaculum clamp. You never know when you might need to perform emergency GYN surgery... for various... reasons...

Lenin items everywhere. 
EVERYWHERE.

Cable district.

Accordions, cameras, and clocks.

Antique hall.

Historic newspapers and fabrics.

Surgical delight.

Food court.

Face rugs and oil paintings.

Tashkent TV Tower

Do you own a tower with a public observation deck for tourists? Have you measured its height and included distinguishable characteristics such as King Kong traipsing around its pointy top, have elevator speeds that even Aerosmith wouldn't be able to keep up with, or hydrate with a 32 dollar G&T? If you can say yes to these questions, you too can apply to join the World Federation of Great Towers, all for a small fee of 2,000-3,500 dollars/year! (Most of the towers on this list cost millions, even billions of dollars to construct, so three grand is a drop in the bucket...)

The Tashkent TV Tower happens to be an exclusive, elite member of the WFGT, with 50 other proud members. Over 1,200 feet tall, the tower is responsible for broadcasting radio and tv throughout the province and a wee bit of Kazakhstan. There's even a hydro-meteorologic monitoring device perched on top. If the day is clear (which it usually isn't) the blue, white, and green stripes of the Uzbek flag are seen on the exterior of the observation decks/restaurants. At night, the tower lights up, shining more brilliantly than the entirety of Rod Roddy's suit collection. 

After walking through security checks, handing my Swiss army knife and surgical scissors over for safekeeping, and paying a 4 dollar entry fee, we enjoyed looking at mini tower replicas, post-Soviet decoration, and 360 degree views of the hazy city before sitting down for a snack in the rotating restaurant, 8 floors high above the world. Steve Winwood covers played while we waited 45 minutes for beers and defrosted pizza, and we practiced fixing our gazes upon non-moving objects to stave off nausea as we drifted around. We made it three quarters of the way around before the restaurant started back in reverse, making that our cue to exit. 

7th floor

 Museum and Monument of the Oppressed 

Ladies Trip!

Elevator anteroom

Fancyish restaurant with not-so-fancy food
on the 8th floor.