Monday, November 11, 2013

Surgery Day #1 - 27 Patients

It has been a wonderful, long, tiring, rewarding day and I would really like to just go to bed cause the 5:30 wake up call is only 7 hours away & i still need to shower but there are so many things about this day I want to remember so here I go :)
The PACU set up this morning went well - we have ALOTof space & even expanded into 2 sides/walls of the room which was good - a is the case everywhere the gurneys are a bit old with siderails that may or may not work, the sheets not so great, not a single pillow to be found and the blankets not ones I'd ever use but it all works out. Thank goodness for the plastic Pepsi tables we used at screening as we put 4 in there for our set up as well as used boxes for tables . The hospital is doing minimal surgeries while we are here & their one nurse "Marina" is delightful & gets the kids warm blankets when she thinks they look cold. The pre op waiting area is right outside our door so that is fun to see the kids again as we go in & out.
We had a good start & got our 1st patient by 9:30 & another right after - both were cleft lips and had happy parents - the lips are external vs the palates which are internal so they have to most visible change. We pretty quickly went from calm to madness as the next 4 came out about 30-40 min later when we were sending the 1st 2 to the ward. Little Karina was the 1st one to make me get teary - her mom had tears streaming down her face as she looked at her little girl with a repaired bilateral lip - it was precious. But after that a dad named Mario got the tears flowing for all 3 of us. We have a wonderful translator Sofia a high school girl who stayed with us for 12 hours & was amazing. It was busy when the dad came in & he was standing at the edge of the gurney with tears rolling down his face - I gave him some tissues & he really got to me but I had to keep it together as we had alot of patients at that time. About 10 min later I went back & helped him hold his son & had Sofia ask if he had any ?'s & he said no but then tearfully said "I want to thank you for coming to help those who need it the most, like my son & the children of Guatemala. I heard on the radio to come here & all I could afford was bus passage for me & my son and I didn't even know if it was true but here you are earths angels. I thanks God for people like you with a pure heart. I will pray God Blesses your health to keep you helping many other children" all of that just came out of him after I asked if he had any ?'s. Rachel & Mary Laura & I were all there & he has us all in tears.  These are the moments I want to remember and would love to bottle up for those days that seem difficult in the very blessed life we live.
Since Jim the anesthesiologist broke his ankle Judith our Intensivist for this mission(who is also an anesthesiologist) covered his surgical table & he became our Recovery Room Dr. Poor guys was in a wheelchair & as his leg got more swollen we put him on a gurney elevated his leg & iced it. Doug the Team Leader for the Mission gave me the job of Drug Czar since Jim wasn't mobile. so I was Narcotic Nurse Nancy giving most all the pain meds to everyone today
One of the babies with the most profound change was Milagros - she had a HUGE bilateral Cleft & I am sure I probably took a picture of her at screening - a "Mission Guest" (aka generous donor) had followed her case & was very moved by the transformation. Her mom also was very tearful (yes there was ALOT of tears flowing today - even more to come). Her mom just kept saying "Muy Bonita Gracias"
Unfortunately one of our 1st cases a simple lip had some bleeding in the post op ward so they brought him back to us...and bleed he did no matter what we did to try to stop it. It was very unusual & the little boy also has a seizure disorder & a few other things. His poor mom was having such a hard time that the surgery didn't work & now he was bleeding & we knew he would have to go back to surgery. she was crying cause he was crying...it was bad. I tried to distract him with some of the toys I brought & a book worked for a bit, then a ball then a car. The bleeding worsened so we sped up the plan to take him back, had to restart an Iv & medicate him & the poor mom was so so sad. I went back into the OR to help them get him settled & the anesthesia started for the next surgery to find the source of the bleeding & was able to come back & with Sofia tell the mom he was settled & I was there  & it would all get fixed & I promised it would be better.
By then it was 3 pm & I hadn't gone to lunch & when I did I was less than excited to see fried fish??? Thankful for my bars & almonds. I do have to again give a shout out to pepsi - there is a full frig section like you see at 7/11 filled with water, diet pepsi, pepsi, 7 up, diet 7 up, ice tea & liquid yogurt drinks. They are a HUGE supporter of Op Smile especially in Latin America & even though I am really a diet coke fanatic here I appreciate the full access to diet pepsi products. Also I learned today thet Dunkin Donuts brings 200 donuts a day for the team  all the volunteers etc. So a donut & diet pepsi break while being a nutritional disaster was a great pick me up about 7 pm tonight
There was the sweetest couple who just clung to each other & both cried as they saw their childs intact face & smile for the 1st time - that was a tender sight I captured from behind to respect their privacy.
My little "do over" patient came back about 4:30 they thought they got all the bleeding stopped & packed his nose area where it may have originated. He was VERY SEDATED & Doug the team leader said to plan on keeping him a few hours. I had Sofia get the mom so she could see him & told her I would be with him until he went to the post op ward. she was so relieved it all was "fixed"
The last patient that really got to all of us was a 20 year old boy Steven who went to a small school in his town but didnt like to go out or talk to people as he had an unrepaired cleft that also involved his nose. He has a twin brother who is fine & it was his older sister who brought him here 6 hours from home to see about the surgery. He was a category 4 & she was worried we would not do anything for him. BUT WE DID - the amazing surgeons not only fixed his lip but basically did a full nose reconstruction using cartlidge from his ear - the difference in his before & after was incredible. His sister just cried & cried & cried & cried when we brought her in to see him & he slept the entire time. I so wished I was there when he looked in the mirror & saw himself - no need to hide any more! What a life changing day for him. I guess it touched me cause I have a 20 year old & I cant imagine a childs life being completely impacted by this simple medical issue that can be so easily corrected. It was overwelming.
A few other tidbits to remember - the post op ward was on the 1st floor - surgery & Recovery on the 2nd & NONE of the elevators worked - it made transporting pateints a challenge as does the fact that in the evening bout 50% of the lights are off???. Another patient at the end of the night was a 3 year old palate who also needed 16 dental extractions - they only did 12 but really I think we all take for granted our healthy teeth & having toothbrushes & toothpaste! Finally - I am exhausted but happy , my feet are killing me after 16 hours on cement type floors but I would still not trade this for anything.
Tomorrow we have 28 cases and 20 are Palates - that is ALOT of palates which are more complicated & more painful for the kids. Send us your good wishes, positive karma & prayers for another wonderful day for Team Guatemala

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