I'm writing this at 4:15 on Tuesday morning after about four hours of very fitful sleep. I finally gave up and decided I might as well do something productive like describe my day instead of trying to rest up for day two. Much of the day yesterday I had visions of a riptide. Wikipedia, that unimpeachable source of information defines a riptide as "a tide that opposes another or other tides, causing a violent disturbance in the sea." The two opposing tides were the strong desire to get as close as possible to the Honduran Eradication Campaign's 150 patients treated goal versus the reality of the first surgical day being slow. The first case of the day always starts at least an hour late because there are inevitable last minute glitches. An oxygen fitting needs to be changed, the right sutures can't be found, decisions about which surgeon works with which anesthesiologist need to be juggled. And then each operation takes longer on the first day, or at least the first morning. It's only natural that the surgeons and their teams need to get used to operating together. Everyone knows all of this, but instead of scheduling fewer patients on the first day, the schedule always seems to be packed just as full of patients as all the other days. There is always a spirit of "we can do it-ism" when we really can't. On top of it, four more patients showed up yesterday, having heard about the mission and wanting to be seen. Two were six month old infants who needed lip surgery and are "Priority 1" meaning they can bump Priority 2 or 3 off the schedule. The other two were older and though they were not as urgent, they were also added to the schedule. In fact, three of the four were added on to yesterday, even though we were already two hours behind when they came.
OK, enough venting except to say that in the end, the surgeons were still in the OR at 10 pm and the last patient reached the ward at 11:30. I was in bed by 12:15 but so wired that sleep was marginal. Right now I'm still full of nervous energy that I hope will last until the end day two, rather than disappearing in the middle. The other inevitable outcome of this riptide was that two patients who had waited all day ended up having their surgery cancelled and rescheduled for this morning. One was a three year old boy who was scheduled for a palate repair at 4:00. He had his last solid food at 7:00 pm on Sunday and we gave him apple juice every two hours on Monday to keep him hydrated. Each time he finished his four ounces, he would give an exaggerated lip smack and fling the cup across the room. He would then dash to retrieve it, and for the next hour or so, he would entertain himself, using the cup as his soccer ball, hat, baseball, (using the long box that had housed the stack of cups as his bat,) or hiding a small car I had given him inside it. Eventually he would lose interest and abandon the cup, only to start again after the next round of juice. Around nine in the evening he got cranky and by ten he was out of patience. When the coordinator cancelled his surgery, his parents were very gracious, but those of us who had been watching him all day almost cried. The family lives in town so they slept at home. We'll see how he is when he arrives back on the ward this morning.
My day started with breakfast at 5:45, getting on the van at 6:00 with Jen, the first time pediatrician from Seattle, and three of the pre/post (ward) nurses. We paused to greet the hospital nurses with chocolates that Kara, our coordinator had managed to find for me on Sunday and spent about five minutes thanking them for hosting us and asking them to please keep an eye on us the first day to let us know if we were doing anything that should be done differently. We all made a point of stopping by their station periodically in the morning to chat for a minute or two or ask their advice, and when Kara bought us a basket of big fried buns filled with shredded pork, (mid morning snack provided by a Honduran volunteer,) we took it right over to their station to see if they would like to share. The buns disappeared, sealing our friendship with the ward nurses and solving our dilemma of not hurting the feelings of the volunteer by sending back a basket of uneaten pork buns.
The pediatric team goes to the hospital half an hour early to get the first two patients for each of the six tables ready for the OR so that surgery can start promptly at 7:00. That should happen the rest of the week. Once the first two rows are ready, we can get the rest set at a more leisurely pace. Getting them ready involves checking vital signs, exam and making sure labs, consents, and all the other pre-op details are set. In this particular hospital, the OR is not close to the wards, and the pre-op and post-op wards are not close to each other. We started out trying to communicate with cell phones, but reception was poor in the OR. We changed to walkie talkies, but static made those unworkable. What ended up happening was that Yazan, our clinical coordinator who calls to pre-op and asks for patients to be sent to the OR, would call me on the walkie talkie and say, "send patients number garble garble garble to the OR now." I would then trek down to the OR where he would tell me who to send and then I would go back to pre-op and tell the nurse who would round them up and take them down. We tried several times to get a system going using the hoard of teenage volunteers as runners, but they were a bit too much in the party mode to be relied upon. Later I learned that most are children of staff physicians and "volunteer" to get together with their friends rather than to work. I'm not sure what we'll do today.
I'm going to post a few photos - I didn't have a chance to take many. One is of me in a funny hat. There's a tradition of Op Smile is to have a king and queen for the day, the first day chosen by the project coordinator for service of some type. The subsequent kings and queens are chosen by whoever got the first hats. I was chosen because I stepped in for the Intensivist who came late. That's it for now.
OK, enough venting except to say that in the end, the surgeons were still in the OR at 10 pm and the last patient reached the ward at 11:30. I was in bed by 12:15 but so wired that sleep was marginal. Right now I'm still full of nervous energy that I hope will last until the end day two, rather than disappearing in the middle. The other inevitable outcome of this riptide was that two patients who had waited all day ended up having their surgery cancelled and rescheduled for this morning. One was a three year old boy who was scheduled for a palate repair at 4:00. He had his last solid food at 7:00 pm on Sunday and we gave him apple juice every two hours on Monday to keep him hydrated. Each time he finished his four ounces, he would give an exaggerated lip smack and fling the cup across the room. He would then dash to retrieve it, and for the next hour or so, he would entertain himself, using the cup as his soccer ball, hat, baseball, (using the long box that had housed the stack of cups as his bat,) or hiding a small car I had given him inside it. Eventually he would lose interest and abandon the cup, only to start again after the next round of juice. Around nine in the evening he got cranky and by ten he was out of patience. When the coordinator cancelled his surgery, his parents were very gracious, but those of us who had been watching him all day almost cried. The family lives in town so they slept at home. We'll see how he is when he arrives back on the ward this morning.
My day started with breakfast at 5:45, getting on the van at 6:00 with Jen, the first time pediatrician from Seattle, and three of the pre/post (ward) nurses. We paused to greet the hospital nurses with chocolates that Kara, our coordinator had managed to find for me on Sunday and spent about five minutes thanking them for hosting us and asking them to please keep an eye on us the first day to let us know if we were doing anything that should be done differently. We all made a point of stopping by their station periodically in the morning to chat for a minute or two or ask their advice, and when Kara bought us a basket of big fried buns filled with shredded pork, (mid morning snack provided by a Honduran volunteer,) we took it right over to their station to see if they would like to share. The buns disappeared, sealing our friendship with the ward nurses and solving our dilemma of not hurting the feelings of the volunteer by sending back a basket of uneaten pork buns.
The pediatric team goes to the hospital half an hour early to get the first two patients for each of the six tables ready for the OR so that surgery can start promptly at 7:00. That should happen the rest of the week. Once the first two rows are ready, we can get the rest set at a more leisurely pace. Getting them ready involves checking vital signs, exam and making sure labs, consents, and all the other pre-op details are set. In this particular hospital, the OR is not close to the wards, and the pre-op and post-op wards are not close to each other. We started out trying to communicate with cell phones, but reception was poor in the OR. We changed to walkie talkies, but static made those unworkable. What ended up happening was that Yazan, our clinical coordinator who calls to pre-op and asks for patients to be sent to the OR, would call me on the walkie talkie and say, "send patients number garble garble garble to the OR now." I would then trek down to the OR where he would tell me who to send and then I would go back to pre-op and tell the nurse who would round them up and take them down. We tried several times to get a system going using the hoard of teenage volunteers as runners, but they were a bit too much in the party mode to be relied upon. Later I learned that most are children of staff physicians and "volunteer" to get together with their friends rather than to work. I'm not sure what we'll do today.
I'm going to post a few photos - I didn't have a chance to take many. One is of me in a funny hat. There's a tradition of Op Smile is to have a king and queen for the day, the first day chosen by the project coordinator for service of some type. The subsequent kings and queens are chosen by whoever got the first hats. I was chosen because I stepped in for the Intensivist who came late. That's it for now.
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