That translates to "I'm inviting all of you, but each one kills their bull" . That is a phrase used here when you are talking about going out to a dinner, going out for drinks, or just in general if you are the one talking about going/doing something and are inviting other people. It's to say, I am inviting you, but you gotta cover your own bill.
Today was the hardest day of work I have had so far in my three + months of actually functioning in the role of a nurse. It was actually a night shift from 1930pm-0730am, but the nightshift was pretty calm (we had about 38 people in our ER during the night). We didn't have any true emergencies, but we did have alot of belly aches and urinary tract infections. Literally at about 07:33 am, in came the only emergency we had; unfortunately it was already too late. In the relative calm of the morning came running in a grandmother and mother combo (the mother in her teens), the grandmother holding a baby wrapped in a fleece blanket crying saying "our baby is dead, our baby is dead". I was the first to come to the patient, grabbed the baby who was flaccid, pallid, not breathing, cold, had a bit of milky whitish secretion coming from one nostril, and as we came to see once we removed the blank, had cyanotic streaks forming along the left side of the body around the pelvic/lower abdominal area. We ran into the Unidad de CrÃticos, our critical unit where the crash cart is and where supposedly all of the supplies we would need for an emergency are.
This baby, of three months, was realistically already dead and we didn't know for how long, but we began efforts to resuscitate. I grabbed the pediatric ambu bag, and the doctors began CPR. Margarita, the other nurse, and I tried to look for peripheral IV sites but were unsuccessful. By this point, the doctors/nurse from upstairs in Neo (NICU) had been called down. We probably had 10 or so people in the room by that point. I prepared a syringe of Epi diluted, and efforts to put in an IntraOsseous iv were started by one physician by using our #18 gauge introcath needles, which were too delicate to puncture the calf bone, and the efforts (4-5) were nil. #18gauge is the largest needle we use; we don't have #16 or #14 gauge needles readily available from our locked stockroom (that only 2 people have a key to). The baby had no saturation, at this point was intubated but without any IV site we couldn't pass any Epi. It was, even though probably hopeless from the start, one of the the worst codes I have seen. Very disorganized, and like always, we were running around for supplies that we just didn't have enough of in our "Critical Unit". The boss of all nurses, Lcda Maria Teresa Benavides was there to witness it all.
The saddest part about all of this, is that this same baby of three months, was in our ER the day before, and had been discharged at about 10pm with a diagnosis of pneumonia. It had literally left our ER at 10pm alive, and returned at 0730am, dead. Due to the state of the baby upon arrival, and the milk that was escaping from the nose and the whitish secretions that we removed from the lungs via suction during the code, it was evident that the baby had aspirated on his mother's milk, most likely from spitting up after feeding and breathing in the liquid without the mother knowing, and thus went into respiratory distress, respiratory arrest, to cardiac arrest. It likely had little to do with the pneumonia diagnosis, but clearly that baby was already in a compromised state of health, and who knows where the blame lies. Should that baby have been hospitalized the night before? I do not know; although I did see that baby the night before, I didn't attend to it or the family in anyway whatsoever, so I didn't know the story of the baby at all until the morning. I do know however, had that baby been hospitalized, it would be alive right now. Was it just poor timing that the baby was sick and just so happened to aspirate the morning after a hospital visit? Were they interrelated incidents? Was there something we could have done in the morning or was it really a hopeless effort?
When the young grandmother entered crying, she started saying the story how they had been there last night and he had recieved an IV and oxygen and all this treatment and now he was dead...she even pointed to me, and said "you were here last night, you know what they did to him last night!" which was true, I had been there the night before (I stood out as the gringo in a pink uniform, so clearly she recognized me), and that was when I connected the stories. It was very tough. What made it worse was after the code, we had a "meeting" with all the personnel (minus the doctors) who were there at that moment, and with Lcda Benavides, to discuss how we didn't have the supplies, we were disorganized, how everything went bad. Well Lcda Benavides, sorry to say it but this is how every code is. We are always leaving the "Critical Unit" to get other supplies. It was a blessing that she at least saw the disorganization, because at least now she knows. But, like always, that "meeting" was a circle of blame, with the subject of conversation centering back to the SAME dumb topic that we have talked about for the last three months: that we are billing patients incorrectly and therefore not having enough supplies.
Now that I am much more fluent in Spanish and have observed enough of our department and how it works, I think I have the ability to finally make my case heard. My Spanish, I believe has been accelerated by times when I am all worked up like today, after bawling in the supply closet, I went to breakfast with Margarita, the other nurse, and Diana, the technologist who I had worked that shift with. At breakfast, we discussed what happened, among other topics, and I didn't hold back anything on what I was saying; I was capable enough to express all of my thoughts without being frustrated. It was kind of like our debriefing session that we probably should have had in the ER with the rest of our employees, but I don't think the "debriefing" idea has really hit Ecuador yet. What I've realized today is that I can't continue to sit back and have problems with my boss; if she, Sandra, doesn't want to change anything then I am going to have to go above her, to Lcda Benavides directly. We are dealing with people's lives, y punto.
Three months.
The amount of time I have worked in this ER; the same amount of time that baby lived.
Two totally different perspectives on an equal amount of time.
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