We had such high hopes for today maybe an 8 or 9 pm finish
time in the Recovery room but no such luck! It started out well but finished
differently. We had 5 cute babies all cleft lips for our first round on all the
OR tables & they all had new smiles by 10 am – I took a pic of my schedule
with the first row all marked off & was thinking good thoughts for an early
finish!
Among those 5 was Naileth a cute little girl with palm tree
pony tails on her head. Her mom came in & was older (we have had SO MANY
young moms) & spoke a few words of English. They live 4 hours away &
traveled by car both the mom & dad with Naileth & all the other kids
stayed at home. I found out Naileth was the youngest of 5 & her siblings
were 21, 19, 15 & 11 years old. Mom said she was “surprised” when she found
out she was pregnant but Naileth was “sent from God to our family”. I said yes
sometimes we call them “Bonus Blessings”. She was slow to wake up so all the
other 4 babies that were in the first round were out of the recovery room
before her & a student volunteer said the dad was outside & nervous.
Typically we only let one parent in the PACU but since she was the only patient
in there I told them to let the dad in – it was a tender reunion for this
couple & Naileth & I got a few pics of them. She is totally a “Daddy’s
Girl” & once he was holding her & was comfortable that was quite
apparent. What a sweet family they are!
During the lull before the next patients would be coming off
the tables – Dani one of the OR in country volunteers here was talking to Alec
(the founder – the McGees grandson) about how she has volunteered here for the
past 12 years at all 23 Paraguay missions since she was a high school student
& her twin sister also volunteers & her sister has been to the Virginia
Beach in the USA & met the McGees but she has always “just missed him” coming
to Paraguay or Latin America & one day she hopes to meet him to thank him
for all he has done for the children of Paraguay & around the world. Alec
stepped aside for a minute after the conversation & quickly reappeared with
his phone in hand face timing Dr. McGee his grandpa & handing the phone to
Dani – she immediately burst into tears & told him how much she loved OSI –
her passion & love was palpable & she got so emotional that we all got
emotional even Alec & he stepped out & later said that never happens to
him. Again what a great kid to think of
doing that – he made her dream come true! And Dr. McGee was so kind on the
phone & genuine as we all waved to him & said hello on Facetime. Alec
is the oldest of their 14 grandchildren.
It took awhile for the 2nd round of patients (all
palates) to come off the tables but they did okay & I was still hopeful
this would be an earlier night even though we were doing 19 palates again.
About noon someone randomly brought 2 pizzas to the OR break room & they
lasted about 15 min! Pizza seems to be universal – I think I have had it in
every country I have been to on a mission!
I went to the Child Life area during the 2nd
round of surgeries to see who we would be getting in round 3. There were some
real cuties. A little blonde 3 year old who I am certain is going to be a
soccer star – he was kicking a “soccer beach ball” with great style &
coordination all across the room to the ceiling! I also me little Milagro a 5
year old & we took a photo with a white board that says “what makes you
smile”. I ended up caring for her post op & her dad was so sweet. She was a
bit restless & when I brought him in & got her in his arms she
immediately settled down. I asked if he had any questions & he said no this
was her 5th surgery. Today she had a revision of her lip repair
& a correction of a fistula or opening in her original palate repair –
hopefully this will be the last surgery she needs. When she left recovery I
gave her a doo & some frilly pink socks & she grabbed onto both of them
immediately!
By 3 pm we had done 13 of the 24 cases for the day & I
was still thinking we were doing ok. They said there was a “massage person: in
the hallway outside the OR area & encouraged the international volunteers
to go – so I did. Something was lost in translation – I was ready for a “massage”
& this was more of a Chiropractor who did adjustments & quickly took my
head in his hands & cracked my neck then back…oh well!
As I have always said the PACU is a combination of moments
of calm & chaos & we got some chaos about 4:30 pm. A palate repair was brought
in & within a few minutes was bleeding in his mouth pretty significantly we
suctioned quite a bit of blood, put pressure on it, called for a surgeon then
called for anesthesia, replaced the breathing tube & carried him back to
the operating room all in about 15 min. When there is an “emergency” things
move quickly. He was in the OR for another 2 hours as they totally undid &
redid his surgery. He got back about 6:45 pm & I barely looked at him as
one of the other nurses was going to recover him & a few minutes later
another patient came in who I helped get settled on the bed & when I put
the monitoring equipment on him he wasn’t oxygenating very well so based on the
prior patient we initially tried to suction his airway, got nothing but his
oxygen level was still low so we gave him oxygen with only minimal improvement,
I gave a breathing treatment with still little improvement & he was on 100%
oxygen. This scenario basically went on from 7-9 pm I gave a total of 8 resp
treatments, a variety of IV meds – steroids, diuretics, antibiotics etc. Unless
someone physically had an oxygen mask in place with a tight seal on his face he
wasn’t oxygenating well or breathing well & sometimes we were breathing for
him. Nathan one of the anesthesiologists & I rigged up a CPCP kind of mask
using tourniquets to hold the mask in place & that actually helped & he
also started waking up a bit. He had very diminished breath sounds on his right
side so we weren’t sure if he had aspirated something into his lungs or what.
The military hospital we are hat had not ability to do a Chest XRay? Or a blood
gas? Both very simple things…he was still requiring 100% oxygen so we decided
we needed to transfer him to a place where they could better care for him OSU
always has a PICU bed somewhere in the are & had one at a private hospital
nearby. So we prepped all the supplies for transport but here we got a semi
legit ambulance with some oxygen & supplies! (unlike Ethiopia my last
transport situation) He was also pretty stable just required the oxygen &
some tests. We brought the parents in after the physicians spoke to them &
they were doing ok. We decided that just Nicole the Intensivist & an
anesthesiologist would transport him & I would stay back in the PACU as we still
had 4 other patients coming out during this time. They were loaded up & on
their way a little after 9 & the hospital was only 15 min away. We did the
clean up from the chaos of the last 2 hours, other patients came in & by
9:30 we got most of them out but still had one on the table…that patient came
to the PACU at 9:45 & was slow to wake up. The transport group got back to
the hospital just about the time we sent that last patient to the post op ward
at 10:50 pm. The patient we transported had lots of stuff in his right lower
lobe of his lung 0 which is where we could not hear good air exchange & got
his Xray, blood gas & was put on a good oxygen BiPap system & looking
good. Had this happened about 1 or 2 in the afternoon we probably could have
waited it out & kept him but at 9 pm we just didn’t know which way he would
go & had to get him to a place with more services. It was all good & in
24-48 hours he should be fine…but that idea of getting out “earlier” was definitely
not happening. We got back to the hotel at 11 pm. I don’t think I have had consistent
late nights like I have had this week – I think it is just the large # of
palate patient & a combination of things but this is what I signed up to do
so it’s all good! A shower & bed is on my to do list & then tomorrow is
the last & a short day of surgery with only 15 cases & no palates.
Dale the student sponsor was our angel tonight – about 5 she
was leaving & said to me “you never get out of here & get to go to
dinner” (which many team members get to do/enjoy) & asked me “can I bring you
something” I said a salad would be great & that typically I am here with
Nicole & Dusty & a PC. In the midst of all the 7-9 chaos someone called
me to the door of the PACU & handed me a bag of food. About 9:30 while
waiting for the last patient we all enjoyed 4 chicken Cesar salads & she
brought us dessert too! That perhaps was one of the best “saves” of the day as
at that point we were all a little spent J
there are always so many wonderful people on these missions! I am ready for
some sleep! 
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