I was a younger and naive ER Nurse in the U.S. before I decided to take a LOA to be a missionary nurse at a small charity hospital in the Kathmandu Valley of Nepal on the eve of my 24th birthday. Thought I knew everything with 4 years under my belt in critical care/emergency nursing...I was so wrong. During 2014-2016, civil war had broken out in the kingdom of Nepal between the monarchy and Maoists. In and around our tiny village of Banepa, suspected Maoists would disappear from their homes in the middle of the night or worst yet, their lives cut short and their bodies discovered on the trails during early morning runs in the hills. Bombing and curfews were common occurrences during my year there. It was a scary time. I complained so much about what we didn't have at our charity hospital and the frustration grew, until one beautiful spring day, we had a massive MVC happen close to our hospital campus : commuter bus vs. a taxi cab carrying a family. Having practically nothing, the entire ex-pat and local medical teams within our inky-dinky hospital pulled together everything and everyone we had to care for the injured and dying. I'll never forget my patient, a 6-year-old girl, who was found unresponsive and listless in her blood stained white party dress. She and her parents and siblings were all in the taxi cab heading to a picnic before they were hit by the bus. I was 1:1 with her, trying to maintain her faint pulse and treating her open CHI. There weren't enough doctors and none who had trained specifically for trauma. It was my day off and dressed in sari (I was at church when I got the call), I tried to "Macgyver" a make shift backboard made of plank wood, rolls of hand towels and masking tape to stabilize her. Working as fast as we could, the medical assistant, pediatrician and I worked on this little girl until she could be stable enough for the bumpy ambulance 1 hr ride to the city hospital in Kathmandu. It felt like moments but we worked on her for at least an hr before transfer, her mother screaming in Nepali above all the noise and chaos of our makeshift ER. To this day, I can still hear her mother's screams. After we had either stabilized, admitted, transferred or put in body bags the rest of the patients from the MVC, I remembered to consciously breathe. I had a tear in my sari and sweat dripping from my face. I looked over at one of the tables and I saw my 6-year-old patient's blood stained dress we had taken trauma shears to. During those hours we treated trauma patients, I had not felt anything until I saw that torn dress. I looked around the entire team with worry, exhaustion and sweat on their faces, who had pulled together through the lack of resources to do the best we could with what we had. And for the first time that day, I cried until I had no more left in me.
It's been 12 years since that day. I'm an ER Nurse manager now. I still remember that awful day in Nepal because it will always keep me humble and grateful for what I have. I'll never forget that little girl in her white party dress.
Liz Zimmerman, MPH, BSN, RN, NE-BC