Challenges, Decisions, Reflection…

July 15, 2015

After nearly a year in Saudi Arabia… it’s time for some reflection. For some serious thought about what to do next. Should I stay or should I go?

I love nursing… with everything that is in me… I can’t imagine what I’d be… or who I’d be if I wasn’t a nurse. I love the medical aspects and the science of nursing… the complexities of the human body and disease processes in the human body…

But mostly… the greatest reason why I went in to nursing was for people. To love people. To nurse them back to health… physical, mental, emotional health. To show them kindness and compassion when they’ve been dealt a heavy blow… a hard lot in life. To talk to them and get to know them and to understand their values and beliefs and how that impacts their illness experience and then to help them get through it!

“When I think about all the patients and their loved ones that I have worked with over the years,  I know most of them don’t remember me nor I them,  but I do know that I gave a little piece of myself  to each of them and they to me and those threads make up the beautiful tapestry that in my mind is my career in nursing.”     -Donna Wilk Cardillo

Working in Saudi Arabia challenges me as a nurse in infinitely more ways than I thought possible. I work with a patient population that rarely speaks the same language as me, a population that has a culture so different from my own, a religion with similarities but yet so many differences from my own.

The language barrier is one of the greatest challenges to me as a nurse. It stops me from being able to get to know my patients the way I’m used to… the way I want to! It stops me from being able to share information with them that could help them cope better with their disease and treatments. Showing kindness and compassion and loving people is something that can be done without words… but it is hard to do without words!!

So many days, I feel like I’m not nursing the way I love to, the way I should be. I’m not functioning in my full capacity. I’m just a fraction of myself as a nurse!

This is my greatest personal challenge.

But… I do my best to communicate caring and compassion… even without words!! In the words of Maya Angelou “They may forget your name but they will never forget how you made them feel.” It’s true. It doesn’t take words to make a patient feel comfortable and cared for!

Then comes the organizational challenges. Working in a hospital culture where nurses are not respected and valued the same way they are in the western world… especially in North American hospitals. Nurses are much further down in the medical hierarchy than doctors here in Saudi. We are not particularly valued. Our knowledge and input is rarely considered. We are pushed to not ask questions or consider all the options and potentially more beneficial scenarios for our patients. A doctor or a more senior staff members instructions should be taken and performed immediately without questioning it.

I was taught to provide rationale for everything I do. I was taught to question everything. Is this the right order, the right drug, the right surgery, the right treatment for my patient? The right course of action? If so… Why? What does the patient want? Is it going to potentially cause more harm for my patient? If so, does the risk outweigh the benefit? If not, what is a better option?

Here, incompleteness is a way of life. The culture is often reactive vs. proactive. There is little foresight. There is little holistic care. Quantity is often considered greater than quality. Relief of suffering has little value. Education is lacking. Education for doctors and nurses… for patients… significantly lacking! And the worst part… it doesn’t feel like many health care practitioners in this hospital even realize how much their education and skills are lacking!!

As a palliative care nurse at heart, this hurts me. I believe in holistic care. In caring for the whole person. Spiritual, mental, emotional, psychosocial distress make coping with any type of physical distress worse. We need to minister to all aspects of a person in order to ensure a successful transition through the disease process.

I believe in preventing problems before they get worse because I know what worse looks like… the very worst! Education helps with this. Education helps problems to be identified before they become particuarly problematic. Education helps people cope with problems by understanding the disease, their expected trajectory, the treatments and side effects and the best way to manage it all. Education helps doctors and nurses provide the best care for their patients and the information their patients need.

I belive in quality vs quantity always!! What is quantity if there is absolutely no quality?! Good quality often leads to a greater quantity anyways!!

Suffering does not necessarily make you stronger. How can you focus on God or Allah or on your family when you are out of your mind with blinding shards of hot white pain? Or when you can do nothing more than retch and vomit until blood vessels burst in your eyes and your abdominal muscles are distraught with discomfort from heaving? When each breath is the greatest challenge of your life and your only thought is how you can suck in the next one?

Yes it can make you more dependent on God or Allah… but it is far too often used as an excuse here to not provide appropriate analgesia or symptom management of any type… And that hurts my heart!

The challenges of life here… all the many little things that are so easy anywhere else in the world are just infinitely more challenging here… and having to fight for every little thing you need… it’s exhausting. It depletes your emotional reservoirs. As an expat, you need to know that you’re leaving at some point. Whether it is just a visit home for special events, or even just to be with family for a brief time of heartwarming solace. It makes it easier to deal with the hardships and challenges of Saudi life.

Not knowing for months and months when my next chance to leave would be made it very hard to cope with the frustrations of life in Saudi and I worry it was starting to turn me into a cynical, negative person.

I started this post on my dad’s birthday nearly a month ago… A day when I was reflecting on my family… wishing I could be home with them and especially my dad on his birthday… stressing about leave… I’d been facing a significant dilemma regarding leave. I needed leave to go home for my brothers wedding at the end of July. But it was to be right at the end of Ramadan during Eid when it is nearly impossible to get leave in my clinic due to the large amount of staff wanting off then. Also… it was to be right at the end of my contract so the only way I could get leave was to renew my contract.

I was so stressed trying to sort out what to do. I like to think I’m a relatively strong individual with pretty decent coping skills… but the last few weeks have really tested my strength and pushed me to my limits of what I can handle emotionally!!! All the cumulative challenges have made it hard for me to cope with life in Saudi Arabia. Add to that the uncertainty of not knowing whether or not I’ll be able to be with my family during a very important time in my family… and just being so far away from family during a stressful period in my life… it’s been hard. Very very hard. I thought about leaving. I thought about not signing a second year contract and leaving Saudi Arabia for good!

My leave was eventually granted… for which I was very grateful. But new issues arose…

So, I came to the decision that my best option would be to “pretend to leave”. I handed in my resignation. I will be taking terminal leave and making a final exit out of Saudi Arabia. But… with an exit/re-entry visa which will allow me to return if I want to, within the next 6 months.

I was ecstatic typing up that resignation email actually. I felt like a huge weight had been lifted off my shoulders. All the stress of the last couple months disappeared as thoughts of home, cuddles with my niece, hugs from my parents and siblings, days at the lake wakeboarding, hiking in the beautiful green forest, beautiful bottles of wine picked from the liquor store by me, motorbike rides with my dad and wine tours, my brothers wedding… and the best part, now being able to be home for the birth of my new niece or nephew. So many things I would have missed otherwise by only being able to be home for 3 weeks… I’ll now get to experience blissful, beautiful summertime weeks at home to relax and rejuvinate my soul…  surround myself with people I love more than anything in the world! People I miss every day while I’m away… People who, life here has taught me to appreciate so much more than I did before!.

It was very upsetting for my parents and for the rest of my family when I decided to move away from them and across the world to Saudi Arabia. I sincerely appreciate how supportive and understanding they’ve all been for the past year. And I know that they’re just as excited as me that I’m coming home potentially for good.

I may get home, go back to work, cuddle my new niece/nephew and decide that there’s no way I can come back to Saudi Arabia. There is a strong possibility that happen.

But, at the same time, I currently enjoy my life in Saudi Arabia ALOT. Like seriously ALOT!! My year is nearly up and it has been amazing beyond my most optimistic dreams. I’ve learned so much and had some phenomenal experiences here in Saudi and in my travels while I’ve been living in the Middle East. There are so many things I love about the people, the culture, the community, the religion, the desert, the weather, and especially the genuinely wonderful people I’ve met here in the expat community.

I’ve made some beautiful friendships here… with people just like me… people who love travel and adventure and experiencing the world and new cultures… people who understand the addiction to the expat life. And… I have plans for the next year here yet. A weekend in Sharm El-Sheikh with friends. Dubai for the Formula 1 races and the Rugby 7s. Talk of an India trip with one of my closest friends. A wedding in France and one in the UK. So much to do. And my travel list is SO far from complete. Plus, I originally came to Saudi Arabia to work at the King Abdullah Center for Oncology and Liver Disease. It hasn’t even opened yet. And I’d really like to be here when it does open. So I have a lot to do yet here in the Middle East. I’m really not done yet.

So… I’m aiming for 6-8 weeks at home… and then hope to return to Saudi Arabia, Inshallah. So… you haven’t seen the last of me yet!!!

Thank you to all of you who have supported me through this experience… championed and encouraged me… hugged me and loved me when I felt broken by the challenges of life here… and laughed and danced away not only the sadness and frustration with me, but also the sheer joy and pleasure that is life with people you love!!! I love you all more than I can ever express and my heart is so full from knowing you. I really really do hope that this is only a temporary goodbye!!!

Forever with love,

Annemarie

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