Transforming My Life and Practice Through Guam

It was a cold December 27, 2021, in the Chicagoland area reading at about -10 degrees Fahrenheit. The heat was broken, and it was about 50 degrees in the living room. I was back in my hometown helping take care of my mom in between work assignments curled in layers of blankets with my cat. As I was scrolling through The Gypsy Nurse Facebook page, I remembered a post about a place called Guam. I pulled out my phone and started looking up Guam. 

I thought to myself “OMG it's like a dot in the middle of the Pacific Ocean! Why have I never heard of this place!?” Guam turned out to be a US territory approximately 3,950 miles east of Hawaii. I immediately messaged the person who posted, which, in turn,  provided information quickly aapplying. I filled out the application online and then was submitted for a 13-week contract two days later. As my siblings stepped in to be caregivers for our mom, they said “Go live your life.” Well, that wasn’t going to happen as a manager in a hospital, so I took a risk leaving that job and taking a contract in Guam. Jan 21, I flew almost 24 hours through Japan to Guam to start my contract in a few days.  Many people are unaware of this little transformative gem. Guam is the westernmost point and territory of the US and is the largest Micronesian island and located in Oceania. It is a total of 212 square miles and a population of about 160,000 people. This tiny but mighty island had a huge impact on my life and nursing practice in so many ways. 
Guam helped transform and re-ignite the way I live with some amazing key life lessons. My biggest lesson learned was if not now, then when? Every time I would hear another traveler mention a trip to Saipan, Cebu, Palau, I felt every cell in my body also needed to go there. I had never heard of any of these places ever and when am I going to be on this side of the world again? But now all the sudden, I also NEEDED to swim with whale sharks that I just found out about. The girl who feared the ocean and fish. I got scuba certified while in Guam as it was very cheap and easy to schedule despite a crazy nurse schedule being released every two weeks on a Wednesday maybe. It was my biggest fear after being traumatized when I was 8 learning how to scuba dive in Mexico. But I overcame that fear. I continued to overcome it repeatedly. It is still terrifying to me but now I am advanced, and nitrox certified with about 20 dives under my belt. Prior to diving in Guam, I thought all reefs were bleached like what I have witnessed in Jamaica. It has been really depressing watching the reefs in the Caribbean bleach over the last decade or two. Diving around Guam, Palau and the Philippines helped me gain a new hope in the world as the reefs were thriving! So many colors, so many fish, so much life! It was a breath of fresh air, that not the whole world is dying. From overcoming these fears, I was able to dive in some of the best dive sites around the world, with dozens of sharks, travel the world, and continue to live my life to the fullest. “Life begins at the end of your comfort zone.”- Neale Donald Walsch
I was fortunate enough to be in Guam during Mes Chamorro. During the month of March, they celebrate their local culture. I was there during major covid restrictions so there weren’t many tourists, which allowed us to get closer to the local community and learn so much. They were super excited and grateful to be able to share their culture with us. I learned a lot about their language, food, festivities, agriculture, sports, and local healing modalities. I never really cared much for history throughout my school years, as to why I had probably never heard of Guam. This is such a tiny island with such a big impact. Living there was an amazing way to learn history. We were surrounded by it. You were able to see Japanese caves from the world war, sunken tanks, weapons around the island, and other influences. I learned how they were colonized by the Spanish, German, Japanese, then US. There was a lot of Spanish influence in the language and peoples last names as well as German and Japanese. I saw it as the Asian melting pot. We were able to eat foods from Korea, Japan, Philippines, and all over. I am going to miss the amazing authentic Asian food I got to discover and fall in love with. I was able to attend a local Chamorro BBQ where they had a whole pig and other amazing local foods like denanche, finadene, spinach and banana in coconut milk, latiya (local dessert), and venison. They also had amazing food trucks throughout the week in different locations with amazing BBQ. “Travel is not reward for working, its education for living” -Anthony Bourdain
Not only did it help me in life overall, but it had a huge positive impact on my nursing practice as well. It was eye opening to see how culture, location, and history can have an impact on your health when you are a nurse in that community. It was evident to see the effects of high carb and salt intake reflected in the prevalence of diabetes, heart disease and kidney disease. Showing the importance of public health initiatives. Since you are secluded on a tiny island in the middle of nowhere, sometimes you run out of supplies. During the time I was there we ran out of IV tubing, saline flushes, wipes, iv start kits (well any kind of kit actually), just to name a few. It helped me enjoy nursing and see it more of an art again. You get to be creative while critically thinking about how to professionally MacGyver your next task. It also made me see the importance of stewardship when it comes to supplies. The importance of not bringing too many supplies into the patient room, using everything you grab and labeling iv tubing to get the best use out of it. Using blankets or washcloths to wipe patients clean to conserve wipes if we had some. There was no scanning medications, even if the computer in the patient room was working, which was terrifying at first and really makes you return to the basics of 6 rights of medication administration every single time. Double triple checking. Many patients there were not on many medications. In fact, when in pain they almost always refused Tylenol as well. I gave out very little pain medications and that was a huge relief coming from the states where it just feels like all you do is pass out pain meds. I also noticed patients had very little allergies, if any. Another surprise to me was not having vitals machines in every room or clocks. The CNAs carried their own vitals machine and did glucose checks. Showing me the importance of carrying my own pulse ox or blood pressure kit. The culture there also seemed to believe in do everything you can, meaning there were not a lot of DNR patients that probably should have been. It was difficult for me doing CPR on people that it was mostly just harming and using up a lot of resources for a not so pleasant result. Sometimes it’s time to let people die, but I guess it was good practice, is what I had to keep reminding myself. I felt that there was good teamwork with some doctors who would consult the nurse to ask for guidance or thoughts on plan of care. I enjoyed not having a huddle and being able to get started with work at exactly 7. They use a WhatsApp chat group to share important information and to me it helped a lot having that extra time to prepare for the day and introduce myself to patients and teammates. It was sad to see almost 90% travelers with only the charge nurse as a local staff member as most their staff has left to travel as well. All these nurses were highly educated with lots of experience. I love learning from other nurses with different backgrounds. “We might not have it all together, but together we have it all.”- Author Unknown
​The transformation didn’t stop there. It carried me to many parts of southeast Asia including Palau, Philippines, Singapore, and Thailand. During these travels I did so many things I would have never even dreamed of. It shined a new light on my life back at home. First, everything is much farther than I remember it, coming from a small island. We got to eat more enculturated foods near home such as Filipino food, lechon, sisig, and a red horse (Filipino beer) of course. I work with a lot of Filipinos in Washington as well and am excited to bring them some lumpia and pancit during our shift. It has helped guide me to my dream life and goals. Stepping outside of your mundane life, helps the creative juices flow to provide you a path that was not in your site prior to travel. It helped remind me of my original passion for becoming a nurse, nursing in other countries, and providing to local communities, guiding my next career moves away from bedside nursing. This contract helped provide me with many connections in the nursing community to move forward with my future goals as a nurse. Travel nurses have a beautiful spirit full of adventure, curiosity, experience, knowledge, and passion. So, I ask you, "If not now, then when?"

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Written By: Danielle O'Brian, MedVenturist and Travel RN