August 29, 2024 • 28 mins
Have you ever felt stuck when you were trying to work through something? Saul Enriquez, a teacher to our future nurses at Rio Grande Valley Nursing School, has over 26 years of experience in caring for people with a multitude of health issues. During his work providing critical care at ICUs, trauma units, and emergency departments, he's seen patients recover from extensive injuries. All of them had one thing in common: persistence. He now teaches future nurses to have patience with their patients. Even when facing tremendous obstacles, survivors found ways to make improvement, even if it seemed insignificant at the time. Future nurses will learn with those baby steps, patients will eventually find themselves further along their path of recovery. So if you feel stuck, remember that any action is better than inaction. Keep going!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Instrumental
Carrie & Kezia (00:10):
Hi, I'm Carrie, a brain injury survivor and a
member of BIND.
And I'm Kezia, a stroke survivorand member of BIND as well.
And today is a very specialThursday and we're super excited
to welcome not only our guest,but also for it to be our very
first virtual episode.
(00:30):
So I really hope you guys areall watching us on YouTube and
can see the big differencebetween this episode and all our
other episodes.
So today we have Saul Enriquez,who is a registered nurse, uh,
in And, wait.
Rio, I can't say the right wordtoday.
Um, well, he'll introducehimself too, but he's a
(00:53):
registered nurse and he isactually a, um, professor at one
of the colleges at Rio Vale,right?
Rio Vale Grande.
Um, and we're super excited tohave him here as a guest from
Texas and teaching us a littlebit more about his point of view
as a registered nurse and hisvery, um, a lot of years, uh, in
(01:17):
neurology.
Today is not the best of my daywith words, guys, but I hope you
guys all watch the episode andenjoy it.
So welcome.
So we're so happy to have youhere.
Brian (01:30):
Welcome to BINDWAVES, the official podcast of the Brain
Injury Network of Dallas.
I'm Brian White, BIND'sExecutive Director.
On each episode, we'll beproviding insight into the brain
injury community.
We'll be talking to members andprofessionals regarding their
stories and the important roleof BIND's Clubhouse.
We work as a team to inspirehope, community, and a sense of
(01:54):
purpose to survivors,caregivers, and the public.
Thank you for tuning intoBINDWAVES.
Let's get on with the show.
Saul Enriquez (02:03):
Thank you, Kezia and Carrie, Carrie Terry.
Thank you for having me.
I'm Saul Enriquez.
I've been a registered nurse,uh, 26 years now.
I started, I got my bachelor'sdegree in Corpus Christi, Texas
A& M University, way back in thelate nineties.
It was like my second or thirdcareer, but.
(02:25):
I felt like that's where Ineeded to go immediately on my
very last day of clinicals.
I was, um, introduced to openheart massage and open heart,
um, CPR.
And so I went straight into theICU thinking, Oh my goodness,
this was an adrenaline rush.
So I've done medical ICU.
I've worked in the surgical ICU.
(02:46):
I've done neuro ICU.
I've worked in the coronary careICU, trauma unit and the burn
unit.
And then did two and a halfyears in the ER.
So I have extensive highcritical care experience, which
really has given me a broad,arena of information.
And now for the last eightyears, I've been imparting a
little bit of my knowledge andexperience to students here in
(03:08):
the Rio Grande Valley.
Uh, I'm currently teaching at aprivate college called RGV
College, uh, in Pharr, Texas.
I do reside in the Rio GrandeValley here in McAllen, Texas.
Uh, and I'm really pleased tosee that the nursing shortage
has hit us very hard, especiallyafter the pandemic.
And so I'm able to help fulfilla lot of my students dreams in
(03:30):
becoming RNs.
And so, uh, I'm excited that I'mable to be on here with you and
share some of my, some of myexperiences with you.
Uh, so thank you for that.
Carrie & Kezia (03:43):
Awesome.
That's a lot.
Open heart massaging sounds kindof scary, but I could see where
that would be a rush as well.
But so my question for you is inyour many years, let's say we're
going to focus on neuroscience.
That's kind of our little nichehere.
Um, have you always just been inICU and CCU?
(04:04):
I don't know the difference.
I know I was in CCU and ICU.
I don't know which one camefirst.
I don't know.
Really know the, I know whatthey stand for.
I know, no, I actually, youknow, I know CCU is critical
care and ICU is intensive care.
Did I get it right?
Saul Enriquez (04:17):
right, correct.
CCU involves coronary care aswell.
So one is related to the heartspace, like the open hearts.
A medical would be morepathology, disease oriented.
Then you have the neuro ICU,which is traumatic brain
injuries, whether they'reexternal or internal.
Then you have surgical intensivecare, which is after any type of
(04:38):
surgery, Um, they have a, almostlike a recovery area, make sure
that they stabilize before theygo back to the floor.
And then we have, um, the ER andthe burn unit that I've also
worked in.
And what I tell my students,Carrie, as many times as when
I'm teaching urology, Um, youknow, the urology is like the
road map of the body.
(04:58):
And so if everything iscontrolled and managed by the
brain, then everything will beaffected if the brain has
injury.
And so I've always related thatto a map of Texas, for example,
and I say there's different waysto get from the RGV all the way
to Dallas.
But you know, if there's onearea that's roadblocked or
(05:19):
damaged, or there's underconstruction, there's other
pathways that can be created toget to the final destination.
So that that's The therapy comesin, not only the allopathic
physicians or the osteopathicphysicians, but also nursing
care.
We come in and try to reestablish those alternative
pathways that can enablepatients to recover back to
(05:42):
close to where they were beforethe trauma began, uh, started,
or has happened.
Carrie & Kezia (05:48):
All right, and we call that neuroplasticity.
I know more words than I shouldknow as a stroke survivor, but
you know, that's
Saul Enriquez (05:55):
That's a
Carrie & Kezia (05:55):
good It's good to learn.
Um, I think that I like, I likethe way I've always used one of
my counselors in my day neuroprogram that used a like a
railroad station, like if, youknow, so, but I like that.
Texas roadmap better.
I think I'm going to start usingthat.
Yeah, I really liked that too.
I hadn't heard it that way, butI think it makes total sense.
(06:19):
And honestly, Carrie, we learneda lot because we went through
this and we learned our recoveryand we learned through our
actions, so, um, but I likedcomparing it to a roadmap that
we just have to rebuild, uh, away to get to our, our next, our
next place.
I really liked that.
Um, and actually.
Not only are we patients, orwere we patients, um, but a lot
(06:42):
of the time between ourfamilies, our caregivers, our
supporters, it was a way forthem to also understand.
Um, so how would you be able to,the way you taught us right now,
is that the kind of vocabularyyou use with the people
explaining them what happened?
Saul Enriquez (07:00):
Well, yes, Kezia, because in down in the Rio
Grande Valley, we have a high,high amounts of immigrants
coming in.
And so we have not only the nonhigh school graduates trying to
better their life and fulfilltheir dream, but we also have
also Caribbean doctors.
(07:21):
educated in the Caribbean and inMexico, having trouble passing
their TOEFL exam and so theycannot pass their board exam.
So they, sometimes theyalternate and become nurses.
And so instead of them, um,restarting all over again, they
just go the RN route.
And so I've had three or fourmedical doctors in my classes,
(07:42):
uh, along with recent highschool graduates.
And so I find myself having tochallenge.
My, the medically trainedprofessional without losing my
high school, post high schoolgraduates.
And so it's really, it reallytough, but I also try to make
sure that, that there, it's alearning environment so that
they can be stimulated enough torealize that, uh, this is not
(08:05):
just a lot of memorization, butthis is life experiences.
And I feel like when I'mspeaking, especially about the
brain, the brain, I've been ableto not only impart.
Knowledge to the, uh, LBNprogram, but also the RN program
here.
We have a transition.
10 month program for LVNs totrans, uh, transfer or, um,
(08:27):
transition, I'm sorry, over tothe registered nurse, uh, level.
And, uh, I've been a guestlecturer in that department
three times now, and I've beenable to impart to them the, uh,
how it, what it takes from anursing perspective, uh, to help
a patient get to where they needto go.
Carrie & Kezia (08:46):
Kind of talking about the
Saul Enriquez (08:47):
very exciting.
Carrie & Kezia (08:48):
And on that, I guess one of my other questions
that I was trying to askearlier, um, I don't think I
asked it correctly, but so isbeing a nurse in neuro, ICU,
CCU, whatever it may be,different than being a neuro
nurse in the acute setting?
Saul Enriquez (09:04):
Yes, big, big, big difference in that we as
nurses, number one, the nursehas to be very therapeutic and
very understanding what's goingon.
Most of these treatment plansand recovery plans take months,
if not years.
And so if the nurse is notpatient or sets up a therapeutic
(09:26):
trust with the patient, thenit's going to be very, very
difficult The patient can getvery frustrated with themselves.
And if the nurse is pushing toofar, too fast, and too hard,
and, and, instead ofencouraging, causes frustration
in the patients, then they cancause, it can be
counterproductive.
(09:46):
So I find that, uh, in the neuroICU, you know, you would have to
be exceptionally therapeutic,very patient with them, let them
know that this is going to taketime, this is not going to be,
you know, seven days ofantibiotics and you're going
home.
Thank you.
That type of thing.
It's going to be rehab.
It's going to require relearningdifferent, uh, you know,
(10:09):
activities of daily living andthings of that nature.
So, you know, we have to makesure that and then on top of
that, we have to also make surethat our patients are going to
be safe.
The top priority, I guess, forany nurse in the neuro ICU,
especially after it's like ablunt head trauma or, um, MVC,
motor vehicle, uh, uh,collision, then you have
(10:32):
sometimes seizure activity thatcomes on after the fact.
And so then we have to make surethat our patients are not going
to end up on the floor.
They're not going to end up withan additional injury, a hip
fracture, arm fracture, because,you know, uh, they were not.
Secured properly and make surethat they didn't fall out of
bed.
So it's a vigilance,observation, meticulous detail,
(10:57):
safety, reassurance, and thingsof that nature.
Make sure that the patients aregoing to be taken care of,
watched after, and secured, makesure that they're safe.
And that's what I teach mystudents, is that in due time,
we'll see the recoveries.
Sometimes it's baby steps, butit's okay.
Baby steps are better than nosteps.
(11:19):
Hopefully that answers
Carrie & Kezia (11:21):
I think what you just said that this is.
Oh, yeah.
Yes, it does.
It does answer a lot ofquestions.
It also asks, now I have so manymore questions.
But yeah, I mean, I think it'sawesome that right now that
you're saying that you teachyour students and they have so
many different perspectiveswith, you know, where they're
from or what they've learnedbefore.
(11:41):
But I think that as a patient,that also is almost the same.
Like we.
We're also learning along theway with our injury and with our
experience, um, and also of our,our family members.
Um, so I think, I think Irelated and I'm not a nurse or a
student, um, but I think that'swhere we're at too.
(12:04):
So I love that
Saul Enriquez (12:05):
Yeah, so the internal versus external brain
injury, you know, can result inthe same type of damage.
Uh, in my personal life, both mymother had had a CVA, um, about
six years.
Years and six months ago and shesurvived and up until this past
March and she was bedridden butyou know, we did meticulous care
(12:30):
with her and she was able tohave very lucid days and some
days she didn't wake up But shethere were times where she would
ask and speak up and so we wereI was honored to have her in my
home And and take care of herbut then in 2020.
Right as soon as the pandemicwas coming into the United
States, my wife had a CVA, andso she had a stroke, and she was
(12:55):
in the hospital for 30 days, andso we found ourselves At the
time, then, you know, having todeal with this on a very, uh,
from the RN perspective and thepatient perspective, because my
wife is an RN as well, and shefound herself very impatient
because being a charge nurse,being in charge of the whole ICU
(13:16):
and the floor, she found herselfimpatient many times, wanting to
get up out of bed and wanting todo this, and then she finally
had it come to terms that as apatient, now it was having to
take the time to go back andrecalculate, re relearn and,
and, um, do the baby stepsagain.
(13:37):
Thank goodness they hit her.
Uh, it, they, she was at workwhen the CVA happened, so they
were able to immediately takeher to the CT scan and it was an
ischemic, uh, CVA, that means itwas a blood clot in the brain.
So they were able to give her,uh, that.
streptokinase medication veryquickly and dissolved the clot.
And so she regained most of, ifnot all her right sided, uh,
(14:04):
abilities to move, I guess, the,the, the, um, lack of movement
and paralysis, I should say.
Carrie & Kezia (14:09):
Yeah.
That I was
Saul Enriquez (14:10):
then, but cognitively she, she lost her
cognitive abilities to remembera lot of the information that
she, that she had learnedthrough her 20, also 25 years of
nursing.
So, she may have had short termmemory and long term memory loss
and ended up, you know, withfull disability.
But at the bottom line, she'sable to now get back to the
(14:33):
point where she can drive.
She knows where she's doing.
She makes herself daily lists ofwhat she's got, has to do that
day.
Uh, and so it's, it's veryimportant that from, you know,
we have to be a veryunderstanding as, as the nurses
and versus the patient.
Sometimes we're both.
In our situation, we were both.
And it was very frustrating forher.
(14:54):
But again, I had to be veryreassuring.
The nurses that took care of herand the rehab, uh, therapists
were amazing.
They all knew her from beforethe stroke.
So when they saw what hadhappened, they were very
therapeutic.
Bedside manners were awesome.
And so they, they were veryunderstanding as well.
So I guess it's a, it's a wholedifferent paradigm when you
(15:16):
start having to change yourmindset, going from just a nurse
taking care of somebody to beingthe patient.
And now we can understand howthe patients feel.
And again, like I said earlier,that's how I'm trying to impart
to my students that type oftherapy.
Carrie & Kezia (15:33):
Yeah.
Well, thank you so much forsharing your story.
Um, and your perspective as anurse and As a, as a husband and
as a, as a son, I think that'sreally, it's really important
because like you said, we lose,not lose our perspective, but we
kind of lose control of it to acertain extent.
(15:53):
I mean, I had a stroke and, uh,it, it's hard to be patient with
oneself.
I was 28.
I went to college.
I think, I mean, I was reallysmart.
I still am, right?
But it's really frustrating whenI didn't, I couldn't read.
So yeah, it is very, veryfrustrating.
(16:13):
Um, but it's great.
It's a great, uh, it's a greatprocess and, uh, success when
you can totally understand it.
And you're like, okay, that,that, that's what happened.
Now let's move forward.
So I think it's reallyimportant.
Yeah.
Saul Enriquez (16:30):
And we, we, we have to be very careful though,
Kezia, that as nurses we don'tpush our patients and, and
knowing that my wife was soenergetic and she was so, uh,
advanced, she was a lot smarterthan I am.
I will never be.
And I had to make sure that Ididn't push her too much too
fast and that she was also verypatient with herself and that
(16:52):
let frustration creep in.
Uh, and ultimately withdepression and whatnot.
So yes, it's very, it's babysteps.
And if we get back to 90, 95%,that is very, very important.
Awesome.
If we can get back to 75%,that's, that's awesome as well.
The bottom line is that, youknow, it's, it's just, everybody
has their own story, their ownabilities.
(17:13):
And cognitive wise, we have tomake sure that the brain heals.
Um, and that's, sometimes ittakes longer for some people,
but it ultimately will reach itsmaximum point and we have to
work with that.
Carrie & Kezia (17:27):
Okay.
Thanks.
So I'm going to take a quicklittle break and just remind all
of our listeners to go ahead andclick that like button, that
share button and that notifybutton.
Um, I guess he's clicking, um,you know that.
And so just to kind of go backto what you were saying, um, I
also, I had a hemorrhagic strokeand I also had like, I had a
blood platelet transfusion.
So maybe that's why I went toboth different ICUs or whatever.
(17:50):
Um, but I also had some of whatI feel like you're describing
what they told me.
was impulsivity.
I had a bed alarm.
I had a chair alarm.
I had all of that.
So, um, and all the differentpersonal, I mean, your family
versus, not versus, but in allthe patients that you've seen,
(18:12):
you think that's one of thegreatest challenges with a brain
injury survivor?
Or what, what do you kind of, Imean, we all have to relearn.
We all start somewhere lowerthan where we, where we wouldn't
The brain injury happened orwhatever it may be.
And again, like you said, we allrecover at a different pace at
our own pace.
Um, I was completely paralyzedon my left side.
(18:32):
It's still a little, not sogood, but I walk around, I
drive, I work, I do everything.
But
Saul Enriquez (18:38):
Right.
I reassure my patients, Carrie,that the brain recovery is
multifaceted in that not only isit physical in that we're trying
to get back to activities ofdaily living.
But it's also mental andemotional and it can even be
(18:59):
spiritual because people'semotions are affected.
Like I mentioned earlier,frustration, depression can lead
to suicide ideation.
If they're not getting back towhere they want, they thought
they should be.
And so it encompasses all theareas of our lives.
You know, the three spheres ofour being.
(19:21):
And so I, I Try to reassure mystudents that, that, uh, as a,
as a nurse, we have to be verypatient, of course, and
therapeutic.
And number one factor is safetyfor those patients.
They have to be safe.
They have to make sure that theyare not going to do something
outside of their boundaries andor push themselves that they're
(19:42):
going to fall and hurt or jumpout of bed or accidentally fall
out of bed, I should say, and,um, or develop seizure activity
and they're left alone andthey're not monitored carefully.
So yes, it's, it's the brain inthe healing process.
It encompasses all differentarenas, not just physical.
And so you have the physical andmetaphysical, the emotional,
(20:03):
and, and it's, It's veryimportant that, as nurses, we
take the time to do, to dealwith all those aspects.
If someone needs meditation, ifsomeone needs prayer, if someone
needs, um, some sort ofdifferent therapy, then, of
course, we need to be there forthem.
So again, that's very vitallyimportant as a therapeutic
(20:24):
agent, you know, promotinghealth.
Carrie & Kezia (20:28):
yeah, I just want to give everyone a heads
up.
We might have some, a little bitof, um, a disconnection for a
little bit.
Um, I hopefully not, hopefullyit's not that bad.
Um, but I think right now whatyou were sharing was just, um, I
think we have talked about thata lot in some of our previous
episodes about communication andlike the importance that
(20:49):
sometimes our emotions getaffected as well.
It's not visual, but it'ssomething that happens that is
invisible, um, that it's hard toexplain, right?
Like, We have a brain injury andnow, you know, some, some people
cry more than before or somepeople laugh more than before
and have a difficulty explainingtheir emotions or their needs to
(21:11):
people that love us.
So, um, it's a very importantpart of recovery.
Um, that might take longer toheal.
Um, so I think it's veryimportant and I love that you
express that to future nurses,um, because at the end of the
day, those are the, the nursesare the people we spend the most
time with through, through ourhospitalized.
(21:33):
Um, so I love that.
Thank you so much.
Um, I do, uh, would love tohear, um, actually, if you have
any advice.
Well, right now, you weretalking about that, but also
like, if you have any, like,things, innovative.
I can't say the right wordstoday.
Um, but anything that's newthat's happening to a brain.
(21:55):
Um, I did, you did share it, uh,via email, a new, um, research,
but is there anything new thatyou think is super important to
be sharing to people that, um,are going through their new, um,
Saul Enriquez (22:08):
Well, one of the thank you.
That's an excellent questionbecause the I find myself,
especially down here in thevalley, we call ourselves a Rio
Grande Valley, and we findourselves that diet has a lot to
do with with not only predisposethe predisposed risk factors.
If there is a familiar Familialgenetic predisposition for let's
(22:30):
say Alzheimer's or Parkinson'sthat we can actually slow down
those risk factors by what we'retaking into the body.
We can also that one of the keythings in any med search class
and pharmacology class is goingto be lowering the levels of
inflammation in the body.
Number one.
Every disease that I've everstudied or come across has,
(22:53):
besides, except for trauma, hasto do with inflammatory
responses.
And so what I find is that if welower inflammation at the diet
level, at the rest, exerciselevel, reducing those radical
oxygenation species, then we canactually reduce the pathology in
our bodies.
If that, we can do that from thebrain all the way down to our
(23:16):
feet.
Number, number one.
Uh, one of the techniques thatI've actually recently started
implementing in my own lifebecause of the amyloid plaque
buildup history in my family,realizing that my mom had had
CA, a cerebral, uh, amyloidangiography and, um, amyloid,
uh, angiopathy.
(23:38):
Angiopathy, sorry.
was one of these new techniquesthat we, it is called a
photobiomodulation.
And where they use the differentnano wavelengths of the red
light spectrum to, if it's, ifit's introduced directly on top
of the cranium here, for somereason, now medical journals
are, are conclusively sayingthat the wavelengths at 810
(24:01):
nanometers penetrate way downinto the limbic system and
actually stop the development ofamyloid plaques.
And coming from a familialgenetic history of having
Alzheimer's, uh, getting upthere, you know, whatever I can
do diet wise, photo biomodulation wise, exercise,
(24:27):
things of that nature, then oneneeds to be educate ourselves.
And I bring that up in myclasses.
I said, research is now showingthis, so I'm Oh, constantly in
the NIH website looking for peerreviewed journals, double blind
studies, sometimes even tripleblind studies.
And so it's in AI today.
(24:47):
Kezia is absolutely changing theworld of neurology.
It's bringing technology intothe world.
Point.
I mean, for example, look at ournew neighbor down in
Brownsville, uh, Mr.
Mr, uh, Elon.
He is now actually working onimplementing and has already
implemented on trial basisNeuralink.
You know, and so there, thereare not only the ability to
(25:12):
bring your thoughts to reality,but now you can actually bring
your thoughts in texting forsomebody who's fully
quadriplegic or paraplegic.
And so you have medications nowthat are coming to light.
Uh, for example, Clostamine.
Clostamine is, uh, has beenrecently discovered as an anti,
it's an over the counterantihistamine.
(25:34):
And it's helping with MSpatients who have problems with
demyelination of their nerves.
And so again, the technology isso cutting edge that by the time
we get our textbooks, they'relike maybe two or three years
old, the technology is alreadyway up ahead.
And so it's a little, as aninstructor, we have to continue
to research, continue to findthings and bring them to light,
(25:57):
even though they're not in thebooks, but you know, they're
going to be at work when theyhit the road running, you know,
Carrie & Kezia (26:04):
I know, and it's so exciting because if I think
about it, like, I've read bookssince my stroke, you know, my
stroke was 15 years ago, andI've read books of people who
had strokes 40 years ago, andthey were just stuck in a
nursing home.
Um, Or, you know, an asylum andjust a, they had a stroke,
they're done, they can't go.
And now look at us today, we'vegrown so much in that, in that
(26:24):
amount of time and hopefullywe'll just keep growing quicker
because unfortunately braininjury is here to stay.
We can't, We can't, stop carwrecks, motorcycle wrecks, or
strokes.
Not yet, hopefully we can figureout how to stop strokes, but.
Saul Enriquez (26:38):
right.
Carrie & Kezia (26:39):
But I love seeing that your excitement to
tell us.
I am looking forward to thisepisode to be watched by many.
And also it was so much fun todo.
Honestly, so we can hopefullyhave you back to continue
teaching us.
Yeah, because you're really notonly teaching nurses, you're
teaching us and our listeners.
(27:00):
And there was so muchinformation.
I had so many more questions toask.
But thank you so much for beinghere.
Um, honestly, thank you so muchto our listeners to sticking
through our episode and hope youguys have learned a lot.
Thank you
Saul Enriquez (27:14):
All right.
Thanks for having me.
I appreciate it, Kezia andCarrie.
Carrie & Kezia (27:17):
Sure.
And for all of our listeners,again, if you would like to
contact us, you can email us atbindways at the bind.
org or find us on our website,the bind.
org bindwaves.
And of course on Instagram,guess what that is?
@BINDWaves.
Um, so again, if you'reinterested in becoming a member
or volunteer, go there and checkus out.
(27:40):
And obviously, like Carrie saidearlier, just don't forget to
press all of those like buttons.
And if you would like to see us,you can check it out on YouTube.
And again, don't forget everyThursday you'll find us on your
favorite platform.
So until next time.
Until next time.
We hope you've enjoyed listeningto BIND Waves and continue to
support BIND and our non profitmission.
(28:01):
We support brain injurysurvivors as they reconnect into
the life, the community, andtheir workplace.
And we couldn't do that withoutgreat listeners like you.
We appreciate each and every oneof you.
Continue watching.
Until next time.
Until next time.
Instrumental
Carrie & Kezia (00:10):
Hi, I'm Carrie, a brain injury survivor and a
member of BIND.
And I'm Kezia, a stroke survivorand member of BIND as well.
And today is a very specialThursday and we're super excited
to welcome not only our guest,but also for it to be our very
first virtual episode.
(00:30):
So I really hope you guys areall watching us on YouTube and
can see the big differencebetween this episode and all our
other episodes.
So today we have Saul Enriquez,who is a registered nurse, uh,
in And, wait.
Rio, I can't say the right wordtoday.
Um, well, he'll introducehimself too, but he's a
(00:53):
registered nurse and he isactually a, um, professor at one
of the colleges at Rio Vale,right?
Rio Vale Grande.
Um, and we're super excited tohave him here as a guest from
Texas and teaching us a littlebit more about his point of view
as a registered nurse and hisvery, um, a lot of years, uh, in
(01:17):
neurology.
Today is not the best of my daywith words, guys, but I hope you
guys all watch the episode andenjoy it.
So welcome.
So we're so happy to have youhere.
Brian (01:30):
Welcome to BINDWAVES, the official podcast of the Brain
Injury Network of Dallas.
I'm Brian White, BIND'sExecutive Director.
On each episode, we'll beproviding insight into the brain
injury community.
We'll be talking to members andprofessionals regarding their
stories and the important roleof BIND's Clubhouse.
We work as a team to inspirehope, community, and a sense of
(01:54):
purpose to survivors,caregivers, and the public.
Thank you for tuning intoBINDWAVES.
Let's get on with the show.
Saul Enriquez (02:03):
Thank you, Kezia and Carrie, Carrie Terry.
Thank you for having me.
I'm Saul Enriquez.
I've been a registered nurse,uh, 26 years now.
I started, I got my bachelor'sdegree in Corpus Christi, Texas
A& M University, way back in thelate nineties.
It was like my second or thirdcareer, but.
(02:25):
I felt like that's where Ineeded to go immediately on my
very last day of clinicals.
I was, um, introduced to openheart massage and open heart,
um, CPR.
And so I went straight into theICU thinking, Oh my goodness,
this was an adrenaline rush.
So I've done medical ICU.
I've worked in the surgical ICU.
(02:46):
I've done neuro ICU.
I've worked in the coronary careICU, trauma unit and the burn
unit.
And then did two and a halfyears in the ER.
So I have extensive highcritical care experience, which
really has given me a broad,arena of information.
And now for the last eightyears, I've been imparting a
little bit of my knowledge andexperience to students here in
(03:08):
the Rio Grande Valley.
Uh, I'm currently teaching at aprivate college called RGV
College, uh, in Pharr, Texas.
I do reside in the Rio GrandeValley here in McAllen, Texas.
Uh, and I'm really pleased tosee that the nursing shortage
has hit us very hard, especiallyafter the pandemic.
And so I'm able to help fulfilla lot of my students dreams in
(03:30):
becoming RNs.
And so, uh, I'm excited that I'mable to be on here with you and
share some of my, some of myexperiences with you.
Uh, so thank you for that.
Carrie & Kezia (03:43):
Awesome.
That's a lot.
Open heart massaging sounds kindof scary, but I could see where
that would be a rush as well.
But so my question for you is inyour many years, let's say we're
going to focus on neuroscience.
That's kind of our little nichehere.
Um, have you always just been inICU and CCU?
(04:04):
I don't know the difference.
I know I was in CCU and ICU.
I don't know which one camefirst.
I don't know.
Really know the, I know whatthey stand for.
I know, no, I actually, youknow, I know CCU is critical
care and ICU is intensive care.
Did I get it right?
Saul Enriquez (04:17):
right, correct.
CCU involves coronary care aswell.
So one is related to the heartspace, like the open hearts.
A medical would be morepathology, disease oriented.
Then you have the neuro ICU,which is traumatic brain
injuries, whether they'reexternal or internal.
Then you have surgical intensivecare, which is after any type of
(04:38):
surgery, Um, they have a, almostlike a recovery area, make sure
that they stabilize before theygo back to the floor.
And then we have, um, the ER andthe burn unit that I've also
worked in.
And what I tell my students,Carrie, as many times as when
I'm teaching urology, Um, youknow, the urology is like the
road map of the body.
(04:58):
And so if everything iscontrolled and managed by the
brain, then everything will beaffected if the brain has
injury.
And so I've always related thatto a map of Texas, for example,
and I say there's different waysto get from the RGV all the way
to Dallas.
But you know, if there's onearea that's roadblocked or
(05:19):
damaged, or there's underconstruction, there's other
pathways that can be created toget to the final destination.
So that that's The therapy comesin, not only the allopathic
physicians or the osteopathicphysicians, but also nursing
care.
We come in and try to reestablish those alternative
pathways that can enablepatients to recover back to
(05:42):
close to where they were beforethe trauma began, uh, started,
or has happened.
Carrie & Kezia (05:48):
All right, and we call that neuroplasticity.
I know more words than I shouldknow as a stroke survivor, but
you know, that's
Saul Enriquez (05:55):
That's a
Carrie & Kezia (05:55):
good It's good to learn.
Um, I think that I like, I likethe way I've always used one of
my counselors in my day neuroprogram that used a like a
railroad station, like if, youknow, so, but I like that.
Texas roadmap better.
I think I'm going to start usingthat.
Yeah, I really liked that too.
I hadn't heard it that way, butI think it makes total sense.
(06:19):
And honestly, Carrie, we learneda lot because we went through
this and we learned our recoveryand we learned through our
actions, so, um, but I likedcomparing it to a roadmap that
we just have to rebuild, uh, away to get to our, our next, our
next place.
I really liked that.
Um, and actually.
Not only are we patients, orwere we patients, um, but a lot
(06:42):
of the time between ourfamilies, our caregivers, our
supporters, it was a way forthem to also understand.
Um, so how would you be able to,the way you taught us right now,
is that the kind of vocabularyyou use with the people
explaining them what happened?
Saul Enriquez (07:00):
Well, yes, Kezia, because in down in the Rio
Grande Valley, we have a high,high amounts of immigrants
coming in.
And so we have not only the nonhigh school graduates trying to
better their life and fulfilltheir dream, but we also have
also Caribbean doctors.
(07:21):
educated in the Caribbean and inMexico, having trouble passing
their TOEFL exam and so theycannot pass their board exam.
So they, sometimes theyalternate and become nurses.
And so instead of them, um,restarting all over again, they
just go the RN route.
And so I've had three or fourmedical doctors in my classes,
(07:42):
uh, along with recent highschool graduates.
And so I find myself having tochallenge.
My, the medically trainedprofessional without losing my
high school, post high schoolgraduates.
And so it's really, it reallytough, but I also try to make
sure that, that there, it's alearning environment so that
they can be stimulated enough torealize that, uh, this is not
(08:05):
just a lot of memorization, butthis is life experiences.
And I feel like when I'mspeaking, especially about the
brain, the brain, I've been ableto not only impart.
Knowledge to the, uh, LBNprogram, but also the RN program
here.
We have a transition.
10 month program for LVNs totrans, uh, transfer or, um,
(08:27):
transition, I'm sorry, over tothe registered nurse, uh, level.
And, uh, I've been a guestlecturer in that department
three times now, and I've beenable to impart to them the, uh,
how it, what it takes from anursing perspective, uh, to help
a patient get to where they needto go.
Carrie & Kezia (08:46):
Kind of talking about the
Saul Enriquez (08:47):
very exciting.
Carrie & Kezia (08:48):
And on that, I guess one of my other questions
that I was trying to askearlier, um, I don't think I
asked it correctly, but so isbeing a nurse in neuro, ICU,
CCU, whatever it may be,different than being a neuro
nurse in the acute setting?
Saul Enriquez (09:04):
Yes, big, big, big difference in that we as
nurses, number one, the nursehas to be very therapeutic and
very understanding what's goingon.
Most of these treatment plansand recovery plans take months,
if not years.
And so if the nurse is notpatient or sets up a therapeutic
(09:26):
trust with the patient, thenit's going to be very, very
difficult The patient can getvery frustrated with themselves.
And if the nurse is pushing toofar, too fast, and too hard,
and, and, instead ofencouraging, causes frustration
in the patients, then they cancause, it can be
counterproductive.
(09:46):
So I find that, uh, in the neuroICU, you know, you would have to
be exceptionally therapeutic,very patient with them, let them
know that this is going to taketime, this is not going to be,
you know, seven days ofantibiotics and you're going
home.
Thank you.
That type of thing.
It's going to be rehab.
It's going to require relearningdifferent, uh, you know,
(10:09):
activities of daily living andthings of that nature.
So, you know, we have to makesure that and then on top of
that, we have to also make surethat our patients are going to
be safe.
The top priority, I guess, forany nurse in the neuro ICU,
especially after it's like ablunt head trauma or, um, MVC,
motor vehicle, uh, uh,collision, then you have
(10:32):
sometimes seizure activity thatcomes on after the fact.
And so then we have to make surethat our patients are not going
to end up on the floor.
They're not going to end up withan additional injury, a hip
fracture, arm fracture, because,you know, uh, they were not.
Secured properly and make surethat they didn't fall out of
bed.
So it's a vigilance,observation, meticulous detail,
(10:57):
safety, reassurance, and thingsof that nature.
Make sure that the patients aregoing to be taken care of,
watched after, and secured, makesure that they're safe.
And that's what I teach mystudents, is that in due time,
we'll see the recoveries.
Sometimes it's baby steps, butit's okay.
Baby steps are better than nosteps.
(11:19):
Hopefully that answers
Carrie & Kezia (11:21):
I think what you just said that this is.
Oh, yeah.
Yes, it does.
It does answer a lot ofquestions.
It also asks, now I have so manymore questions.
But yeah, I mean, I think it'sawesome that right now that
you're saying that you teachyour students and they have so
many different perspectiveswith, you know, where they're
from or what they've learnedbefore.
(11:41):
But I think that as a patient,that also is almost the same.
Like we.
We're also learning along theway with our injury and with our
experience, um, and also of our,our family members.
Um, so I think, I think Irelated and I'm not a nurse or a
student, um, but I think that'swhere we're at too.
(12:04):
So I love that
Saul Enriquez (12:05):
Yeah, so the internal versus external brain
injury, you know, can result inthe same type of damage.
Uh, in my personal life, both mymother had had a CVA, um, about
six years.
Years and six months ago and shesurvived and up until this past
March and she was bedridden butyou know, we did meticulous care
(12:30):
with her and she was able tohave very lucid days and some
days she didn't wake up But shethere were times where she would
ask and speak up and so we wereI was honored to have her in my
home And and take care of herbut then in 2020.
Right as soon as the pandemicwas coming into the United
States, my wife had a CVA, andso she had a stroke, and she was
(12:55):
in the hospital for 30 days, andso we found ourselves At the
time, then, you know, having todeal with this on a very, uh,
from the RN perspective and thepatient perspective, because my
wife is an RN as well, and shefound herself very impatient
because being a charge nurse,being in charge of the whole ICU
(13:16):
and the floor, she found herselfimpatient many times, wanting to
get up out of bed and wanting todo this, and then she finally
had it come to terms that as apatient, now it was having to
take the time to go back andrecalculate, re relearn and,
and, um, do the baby stepsagain.
(13:37):
Thank goodness they hit her.
Uh, it, they, she was at workwhen the CVA happened, so they
were able to immediately takeher to the CT scan and it was an
ischemic, uh, CVA, that means itwas a blood clot in the brain.
So they were able to give her,uh, that.
streptokinase medication veryquickly and dissolved the clot.
And so she regained most of, ifnot all her right sided, uh,
(14:04):
abilities to move, I guess, the,the, the, um, lack of movement
and paralysis, I should say.
Carrie & Kezia (14:09):
Yeah.
That I was
Saul Enriquez (14:10):
then, but cognitively she, she lost her
cognitive abilities to remembera lot of the information that
she, that she had learnedthrough her 20, also 25 years of
nursing.
So, she may have had short termmemory and long term memory loss
and ended up, you know, withfull disability.
But at the bottom line, she'sable to now get back to the
(14:33):
point where she can drive.
She knows where she's doing.
She makes herself daily lists ofwhat she's got, has to do that
day.
Uh, and so it's, it's veryimportant that from, you know,
we have to be a veryunderstanding as, as the nurses
and versus the patient.
Sometimes we're both.
In our situation, we were both.
And it was very frustrating forher.
(14:54):
But again, I had to be veryreassuring.
The nurses that took care of herand the rehab, uh, therapists
were amazing.
They all knew her from beforethe stroke.
So when they saw what hadhappened, they were very
therapeutic.
Bedside manners were awesome.
And so they, they were veryunderstanding as well.
So I guess it's a, it's a wholedifferent paradigm when you
(15:16):
start having to change yourmindset, going from just a nurse
taking care of somebody to beingthe patient.
And now we can understand howthe patients feel.
And again, like I said earlier,that's how I'm trying to impart
to my students that type oftherapy.
Carrie & Kezia (15:33):
Yeah.
Well, thank you so much forsharing your story.
Um, and your perspective as anurse and As a, as a husband and
as a, as a son, I think that'sreally, it's really important
because like you said, we lose,not lose our perspective, but we
kind of lose control of it to acertain extent.
(15:53):
I mean, I had a stroke and, uh,it, it's hard to be patient with
oneself.
I was 28.
I went to college.
I think, I mean, I was reallysmart.
I still am, right?
But it's really frustrating whenI didn't, I couldn't read.
So yeah, it is very, veryfrustrating.
(16:13):
Um, but it's great.
It's a great, uh, it's a greatprocess and, uh, success when
you can totally understand it.
And you're like, okay, that,that, that's what happened.
Now let's move forward.
So I think it's reallyimportant.
Yeah.
Saul Enriquez (16:30):
And we, we, we have to be very careful though,
Kezia, that as nurses we don'tpush our patients and, and
knowing that my wife was soenergetic and she was so, uh,
advanced, she was a lot smarterthan I am.
I will never be.
And I had to make sure that Ididn't push her too much too
fast and that she was also verypatient with herself and that
(16:52):
let frustration creep in.
Uh, and ultimately withdepression and whatnot.
So yes, it's very, it's babysteps.
And if we get back to 90, 95%,that is very, very important.
Awesome.
If we can get back to 75%,that's, that's awesome as well.
The bottom line is that, youknow, it's, it's just, everybody
has their own story, their ownabilities.
(17:13):
And cognitive wise, we have tomake sure that the brain heals.
Um, and that's, sometimes ittakes longer for some people,
but it ultimately will reach itsmaximum point and we have to
work with that.
Carrie & Kezia (17:27):
Okay.
Thanks.
So I'm going to take a quicklittle break and just remind all
of our listeners to go ahead andclick that like button, that
share button and that notifybutton.
Um, I guess he's clicking, um,you know that.
And so just to kind of go backto what you were saying, um, I
also, I had a hemorrhagic strokeand I also had like, I had a
blood platelet transfusion.
So maybe that's why I went toboth different ICUs or whatever.
(17:50):
Um, but I also had some of whatI feel like you're describing
what they told me.
was impulsivity.
I had a bed alarm.
I had a chair alarm.
I had all of that.
So, um, and all the differentpersonal, I mean, your family
versus, not versus, but in allthe patients that you've seen,
(18:12):
you think that's one of thegreatest challenges with a brain
injury survivor?
Or what, what do you kind of, Imean, we all have to relearn.
We all start somewhere lowerthan where we, where we wouldn't
The brain injury happened orwhatever it may be.
And again, like you said, we allrecover at a different pace at
our own pace.
Um, I was completely paralyzedon my left side.
(18:32):
It's still a little, not sogood, but I walk around, I
drive, I work, I do everything.
But
Saul Enriquez (18:38):
Right.
I reassure my patients, Carrie,that the brain recovery is
multifaceted in that not only isit physical in that we're trying
to get back to activities ofdaily living.
But it's also mental andemotional and it can even be
(18:59):
spiritual because people'semotions are affected.
Like I mentioned earlier,frustration, depression can lead
to suicide ideation.
If they're not getting back towhere they want, they thought
they should be.
And so it encompasses all theareas of our lives.
You know, the three spheres ofour being.
(19:21):
And so I, I Try to reassure mystudents that, that, uh, as a,
as a nurse, we have to be verypatient, of course, and
therapeutic.
And number one factor is safetyfor those patients.
They have to be safe.
They have to make sure that theyare not going to do something
outside of their boundaries andor push themselves that they're
(19:42):
going to fall and hurt or jumpout of bed or accidentally fall
out of bed, I should say, and,um, or develop seizure activity
and they're left alone andthey're not monitored carefully.
So yes, it's, it's the brain inthe healing process.
It encompasses all differentarenas, not just physical.
And so you have the physical andmetaphysical, the emotional,
(20:03):
and, and it's, It's veryimportant that, as nurses, we
take the time to do, to dealwith all those aspects.
If someone needs meditation, ifsomeone needs prayer, if someone
needs, um, some sort ofdifferent therapy, then, of
course, we need to be there forthem.
So again, that's very vitallyimportant as a therapeutic
(20:24):
agent, you know, promotinghealth.
Carrie & Kezia (20:28):
yeah, I just want to give everyone a heads
up.
We might have some, a little bitof, um, a disconnection for a
little bit.
Um, I hopefully not, hopefullyit's not that bad.
Um, but I think right now whatyou were sharing was just, um, I
think we have talked about thata lot in some of our previous
episodes about communication andlike the importance that
(20:49):
sometimes our emotions getaffected as well.
It's not visual, but it'ssomething that happens that is
invisible, um, that it's hard toexplain, right?
Like, We have a brain injury andnow, you know, some, some people
cry more than before or somepeople laugh more than before
and have a difficulty explainingtheir emotions or their needs to
(21:11):
people that love us.
So, um, it's a very importantpart of recovery.
Um, that might take longer toheal.
Um, so I think it's veryimportant and I love that you
express that to future nurses,um, because at the end of the
day, those are the, the nursesare the people we spend the most
time with through, through ourhospitalized.
(21:33):
Um, so I love that.
Thank you so much.
Um, I do, uh, would love tohear, um, actually, if you have
any advice.
Well, right now, you weretalking about that, but also
like, if you have any, like,things, innovative.
I can't say the right wordstoday.
Um, but anything that's newthat's happening to a brain.
(21:55):
Um, I did, you did share it, uh,via email, a new, um, research,
but is there anything new thatyou think is super important to
be sharing to people that, um,are going through their new, um,
Saul Enriquez (22:08):
Well, one of the thank you.
That's an excellent questionbecause the I find myself,
especially down here in thevalley, we call ourselves a Rio
Grande Valley, and we findourselves that diet has a lot to
do with with not only predisposethe predisposed risk factors.
If there is a familiar Familialgenetic predisposition for let's
(22:30):
say Alzheimer's or Parkinson'sthat we can actually slow down
those risk factors by what we'retaking into the body.
We can also that one of the keythings in any med search class
and pharmacology class is goingto be lowering the levels of
inflammation in the body.
Number one.
Every disease that I've everstudied or come across has,
(22:53):
besides, except for trauma, hasto do with inflammatory
responses.
And so what I find is that if welower inflammation at the diet
level, at the rest, exerciselevel, reducing those radical
oxygenation species, then we canactually reduce the pathology in
our bodies.
If that, we can do that from thebrain all the way down to our
(23:16):
feet.
Number, number one.
Uh, one of the techniques thatI've actually recently started
implementing in my own lifebecause of the amyloid plaque
buildup history in my family,realizing that my mom had had
CA, a cerebral, uh, amyloidangiography and, um, amyloid,
uh, angiopathy.
(23:38):
Angiopathy, sorry.
was one of these new techniquesthat we, it is called a
photobiomodulation.
And where they use the differentnano wavelengths of the red
light spectrum to, if it's, ifit's introduced directly on top
of the cranium here, for somereason, now medical journals
are, are conclusively sayingthat the wavelengths at 810
(24:01):
nanometers penetrate way downinto the limbic system and
actually stop the development ofamyloid plaques.
And coming from a familialgenetic history of having
Alzheimer's, uh, getting upthere, you know, whatever I can
do diet wise, photo biomodulation wise, exercise,
(24:27):
things of that nature, then oneneeds to be educate ourselves.
And I bring that up in myclasses.
I said, research is now showingthis, so I'm Oh, constantly in
the NIH website looking for peerreviewed journals, double blind
studies, sometimes even tripleblind studies.
And so it's in AI today.
(24:47):
Kezia is absolutely changing theworld of neurology.
It's bringing technology intothe world.
Point.
I mean, for example, look at ournew neighbor down in
Brownsville, uh, Mr.
Mr, uh, Elon.
He is now actually working onimplementing and has already
implemented on trial basisNeuralink.
You know, and so there, thereare not only the ability to
(25:12):
bring your thoughts to reality,but now you can actually bring
your thoughts in texting forsomebody who's fully
quadriplegic or paraplegic.
And so you have medications nowthat are coming to light.
Uh, for example, Clostamine.
Clostamine is, uh, has beenrecently discovered as an anti,
it's an over the counterantihistamine.
(25:34):
And it's helping with MSpatients who have problems with
demyelination of their nerves.
And so again, the technology isso cutting edge that by the time
we get our textbooks, they'relike maybe two or three years
old, the technology is alreadyway up ahead.
And so it's a little, as aninstructor, we have to continue
to research, continue to findthings and bring them to light,
(25:57):
even though they're not in thebooks, but you know, they're
going to be at work when theyhit the road running, you know,
Carrie & Kezia (26:04):
I know, and it's so exciting because if I think
about it, like, I've read bookssince my stroke, you know, my
stroke was 15 years ago, andI've read books of people who
had strokes 40 years ago, andthey were just stuck in a
nursing home.
Um, Or, you know, an asylum andjust a, they had a stroke,
they're done, they can't go.
And now look at us today, we'vegrown so much in that, in that
(26:24):
amount of time and hopefullywe'll just keep growing quicker
because unfortunately braininjury is here to stay.
We can't, We can't, stop carwrecks, motorcycle wrecks, or
strokes.
Not yet, hopefully we can figureout how to stop strokes, but.
Saul Enriquez (26:38):
right.
Carrie & Kezia (26:39):
But I love seeing that your excitement to
tell us.
I am looking forward to thisepisode to be watched by many.
And also it was so much fun todo.
Honestly, so we can hopefullyhave you back to continue
teaching us.
Yeah, because you're really notonly teaching nurses, you're
teaching us and our listeners.
(27:00):
And there was so muchinformation.
I had so many more questions toask.
But thank you so much for beinghere.
Um, honestly, thank you so muchto our listeners to sticking
through our episode and hope youguys have learned a lot.
Thank you
Saul Enriquez (27:14):
All right.
Thanks for having me.
I appreciate it, Kezia andCarrie.
Carrie & Kezia (27:17):
Sure.
And for all of our listeners,again, if you would like to
contact us, you can email us atbindways at the bind.
org or find us on our website,the bind.
org bindwaves.
And of course on Instagram,guess what that is?
@BINDWaves.
Um, so again, if you'reinterested in becoming a member
or volunteer, go there and checkus out.
(27:40):
And obviously, like Carrie saidearlier, just don't forget to
press all of those like buttons.
And if you would like to see us,you can check it out on YouTube.
And again, don't forget everyThursday you'll find us on your
favorite platform.
So until next time.
Until next time.
We hope you've enjoyed listeningto BIND Waves and continue to
support BIND and our non profitmission.
(28:01):
We support brain injurysurvivors as they reconnect into
the life, the community, andtheir workplace.
And we couldn't do that withoutgreat listeners like you.
We appreciate each and every oneof you.
Continue watching.
Until next time.
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