I can’t believe I have been to Siberian twice now in less than six months.

I am somewhere around 26 or so hours in transit…I think this trip is going to wind up being somewhere around 30 hours total, airports and actual planes.  I am actually getting pretty skilled in sleeping upright on airplanes…a year ago I was incapable of such a feat…kind of amazing what a body can become accustomed to. 

Even more astounding to me is how far I have come from a professional standpoint in this same time frame.  When I went to Siberia on my first trip, I really had only a rudimentary knowledge of congenital heart repairs…I knew how to care for a post operative open heart child in the ICU but it was a more task oriented knowledge.  I didn’t posses a really solid grasp on the physiology; sure I understood it all when procedures and complications were explained to me on a case by case basis, but I didn’t own any of that knowledge; I would have to look up every repair and almost every anomaly that came through the door…partially in an attempt to not look like a complete idiot. 

The first time I was in Siberia, I knew that I had very little to offer the local nurses and I sure as hell didn’t have a thing to offer the local physicians.  I also realized just how much more I could know; how nice it would be to actually understand this stuff rather than trying to wrap my brain around new info every time I got a new patient. 

I made a joke to my nurse counterpart from Melbourne the other day, about one of our patients who had had a post operative complication involving a blood clot in his superior vena cava which caused his upper body to become edematous and cyanotic.  She said something about how she keeps forgetting what the child’s anomaly/repair was and thinking that he was a Glenn (which is a surgery that is  part of a staged repair that routs venous blood from the upper extremities directly into the pulmonary artery).  I said
“You keep thinking he is a Glenn because he looks like a Glenn!”  We both had a good laugh because yes, the purplish tint to his lips did indeed look very much like those of a child several days following their Glenn surgery. 

I didn’t know this last November.  Yes, I had taken care of children with this surgery but I often had to refer to bedside drawings of their anatomy or definitions in textbooks when trying to remember what the repair looked like.  Looking back, I am blown away by this and everything else I have learned over the last few months. 

I got back from Siberia with a renewed motivation to learn; I read books, I studied each of my own patients in depth.  I looked at the long strings of incoherent words listed as diagnoses in cardiology notes and tried to piece all the parts together. 

And then Iraq happened. 

I was entirely not prepared to face the degree of complexity and stress that I had to cope with there.  But I did.  And I learned volumes. 

So upon returning to Siberia, I have come a long way.  I have a different point of view.  Yes, of course there is still so much to learn.  But I saw things from a different vantage point this time….my rose colored glasses seem to have gotten lost somewhere over the Atlantic.  That is probably fodder for another entry…for some reason rehashing the petty frustrations presented on this mission does not sound appealing to me at the moment.  In short, the ICU team clearly did not want us there.  Yes, the nurses are excellent at fulfilling their bedside care roles as Russian nurses; they have little interest or incentive in learning beyond what they already need to know to complete their day to day tasks (though, I did have the opportunity to give an impromptu lecture inside the ICU one morning about the aforementioned Glenn procedure…totally at their behest).  And the ICU doctors really had little interest in input from our nurses…to the point that it was an aggravating issue.  At one point, one of the doctors went so far in excluding me from managing a patient that he instructed the interpreter to not translate for me (she was appropriately horrified).     

Like I said, it was frustrating. 

But at the same time, I feel so lucky to realize that.  I feel like I have packed so much into the last several months…the last two years in fact.  The amount I have learned and the experiences I have had, both clinically and through repeated international travel, seem to expand beyond that time frame…it feels like I have crammed five years into two. 

I ran into my ex-husband briefly while in the Valley a few weeks ago.  He was friendly, if lacking sincere warmth.  Can’t really blame the guy for that honestly…but it was suddenly so shocking to realize how long it had been…but then not really at all. 

Two years. 

The common question “What have you been up to?” makes me laugh every time. 

“Ha!  Where should I start?”