This is my 13th mission with Operation Smile and therefore my 13th "first day of surgery." Usually the first day is fairly chaotic as everyone is adjusting to working in a different hospital, different operating rooms, and many languages. In addition, there are many, many things that must be done right to assure the safety of the children. Lab work, drug dosages, allergies, previous reactions to anesthetics, screening for underlying illnesses - all in just a couple of days. What's really remarkable to me is how the surgeons and anesthesiologists come together with OR nurses and technicians and spend five or six days operating all day harmoniously.
I think the norm is for a surgeon to work with a team that he or she knows and works with all the time. They can all anticipate each other's moves and work like parts of a well-oiled machine. In contrast, on an Op Smile mission, the surgeons and anesthesiologists have to set aside any personal preferences and be extremely flexible about how the OR nurses and techs do things. Most seem to do this in great good humor, perhaps because they are dedicated to the cause.
Anyway, that was a long way to say that I now have some comparison experiences, and today was an extremely smooth and enjoyable first day of surgery. It helps that many on this team have worked together on missions before, but there were also no major glitches or complications to slow things down. Mid morning, Maritsa, the Guatemalan pediatrician who is working with us asked me to see a six month old baby who had been brought over by ambulance from the government hospital. The baby had bronchiolitis, a respiratory virus, and needed to go on a ventilator, and they had been unable to intubate the baby. They had tried several times and then had brought the baby over in an ambulance, using a bag and mask to help the baby breathe. Maritsa had tried once and then asked me to try. However, after a quick look, I decided that the wiser course of action was for me to tend to the patients in our recovery room and have Igor, our Russian pediatric intensivist who is also a pediatric anesthesiologist, intubate the 6 month old. Igor gathered up some drugs and gear and went down to the ER, sedated the baby and put in a tube in about two seconds. The baby was then sent back to the government hospital because the family had no money to pay for care at the pediatric hospital. Maritsa was very unhappy about the transfer back but said this was the policy of private hospitals in Guatemala. Igor, in describing the intubation said, "How silly to try to intubate awake and kicking baby who tries to grab tube! I just knock him out and slip it in, and Finished!"
We had several young babies with cleft lips today and I put up some pre-photos and will get post ones tomorrow. They have wonderful results which will make such a difference for them. Generally, once they are drinking well, we remove the IV's, and one eight month old girl was ready about three hours after she returned from the OR. I told the mother I'd remove it as soon as she woke up, and to call me. I didn't hear from the mother for a couple of hours. and then the baby's 5 year old sister came to the desk where I was charting and put her hands on her hips and said, "No one has come to take out my baby sister's IV!!" So, I went with her to remove the IV, and while I was removing tape from the baby's arm, the older sister began flipping my hair up with her fingers. She then leaned towards her mother and in a loud stage whisper said, "Qué pelo loco!" (what crazy hair!) Heh - observant little thing. Meanwhile, the 8 month old kept up a steady crying chant of, "a casa, a casa, a casa," (go home, go home, go home.)
Kathy, the nurse who dressed in the princess dress for screening had on another wild outfit today (see photos.) She's great with the kids, letting them help take vital signs on each other and fixing the girls' hair so it fits under the OR caps they require here. (see photos.) I also posted some photos of the wards. The ones with the bunkbeds are of the pre-op wards where kids stay the night before surgery. The others are of the post-op area. There's also a photo of Sharon, another nurse, juggling, and some of the young sibling I wrote about above, standing in awe and then trying it herself. She worked for over an hour and was finally able to juggle two balls for a short time. There are also photos of some the volunteer girls from the American School who come and entertain the kids, and one of Kathy, Maritsa and me. Finally, there are some of the "Popemobile" with John Paul II's picture in the front. When he was Pope, he came to Guatemala three times and rode in this vehicle, and now it is parked permanently at the hospital. It is carefully covered each night and treated as a relic since he was made a saint.
That's it for today. Tomorrow more surgery.
I think the norm is for a surgeon to work with a team that he or she knows and works with all the time. They can all anticipate each other's moves and work like parts of a well-oiled machine. In contrast, on an Op Smile mission, the surgeons and anesthesiologists have to set aside any personal preferences and be extremely flexible about how the OR nurses and techs do things. Most seem to do this in great good humor, perhaps because they are dedicated to the cause.
Anyway, that was a long way to say that I now have some comparison experiences, and today was an extremely smooth and enjoyable first day of surgery. It helps that many on this team have worked together on missions before, but there were also no major glitches or complications to slow things down. Mid morning, Maritsa, the Guatemalan pediatrician who is working with us asked me to see a six month old baby who had been brought over by ambulance from the government hospital. The baby had bronchiolitis, a respiratory virus, and needed to go on a ventilator, and they had been unable to intubate the baby. They had tried several times and then had brought the baby over in an ambulance, using a bag and mask to help the baby breathe. Maritsa had tried once and then asked me to try. However, after a quick look, I decided that the wiser course of action was for me to tend to the patients in our recovery room and have Igor, our Russian pediatric intensivist who is also a pediatric anesthesiologist, intubate the 6 month old. Igor gathered up some drugs and gear and went down to the ER, sedated the baby and put in a tube in about two seconds. The baby was then sent back to the government hospital because the family had no money to pay for care at the pediatric hospital. Maritsa was very unhappy about the transfer back but said this was the policy of private hospitals in Guatemala. Igor, in describing the intubation said, "How silly to try to intubate awake and kicking baby who tries to grab tube! I just knock him out and slip it in, and Finished!"
We had several young babies with cleft lips today and I put up some pre-photos and will get post ones tomorrow. They have wonderful results which will make such a difference for them. Generally, once they are drinking well, we remove the IV's, and one eight month old girl was ready about three hours after she returned from the OR. I told the mother I'd remove it as soon as she woke up, and to call me. I didn't hear from the mother for a couple of hours. and then the baby's 5 year old sister came to the desk where I was charting and put her hands on her hips and said, "No one has come to take out my baby sister's IV!!" So, I went with her to remove the IV, and while I was removing tape from the baby's arm, the older sister began flipping my hair up with her fingers. She then leaned towards her mother and in a loud stage whisper said, "Qué pelo loco!" (what crazy hair!) Heh - observant little thing. Meanwhile, the 8 month old kept up a steady crying chant of, "a casa, a casa, a casa," (go home, go home, go home.)
Kathy, the nurse who dressed in the princess dress for screening had on another wild outfit today (see photos.) She's great with the kids, letting them help take vital signs on each other and fixing the girls' hair so it fits under the OR caps they require here. (see photos.) I also posted some photos of the wards. The ones with the bunkbeds are of the pre-op wards where kids stay the night before surgery. The others are of the post-op area. There's also a photo of Sharon, another nurse, juggling, and some of the young sibling I wrote about above, standing in awe and then trying it herself. She worked for over an hour and was finally able to juggle two balls for a short time. There are also photos of some the volunteer girls from the American School who come and entertain the kids, and one of Kathy, Maritsa and me. Finally, there are some of the "Popemobile" with John Paul II's picture in the front. When he was Pope, he came to Guatemala three times and rode in this vehicle, and now it is parked permanently at the hospital. It is carefully covered each night and treated as a relic since he was made a saint.
That's it for today. Tomorrow more surgery.
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