It's a good thing I got a SOLID 6 hours of sleep last night thanks to my earplugs I didn't hear the disco or street noise :) I just got back to the hotel 18 hours after I woke up here this morning but I am not complaining this is an opportunity I "signed up for & said yes to" and days like this are what it's all about - I will catch up on sleep on the flights home! I want to blog tonight because if I get a day behind then I have a hard time catching up & I'm already not so good at finishing the last day of most missions & don't want to miss journaling half of it! So I turned on some Christmas music on my Amazon music & here I go!
I started the day in the post op area - they had 3 rooms of 8 Cleft Palate patients from yesterday plus one room of 8 from Monday...the ones from Monday were getting their discharge instructions so I snapped a few photos of them & said goodbye. Tonight they will have the 24 palates from yesterday & the 24 palates from today=48 plus the 16 lips from today = 64 plus the 40 pre-ops for tomorrow = 104 - that is like the average daily census at a smaller children's hospital & we are doing it in a very antiquated "hospital" in Tangier with 8 patients in rooms that at home might have 4 and with 8 nurses at night for those 104 patients...stuff like this is what miracles look like!
After I left post op I needed to get to the OR but on my way I saw the 1st 8 babies waiting with their moms as they were the first cases on every table for the day - such cute babies. Our PACU routine in the morning is always very similar - make IV armboards out of cardboard covered in the packaging from the OR kits, make flushes & draw up pain medicine so it's all ready when the crazy happens :)
It only took until 9 am for our Primary Care Clinic to open & this one was a first for both Chris & me. A Pre/Post nurse came in saying she had been nauseous since Monday & throwing up with a slight fever. Immediately I knew she would need an IV & fluids but as we asked about her stomach pain & checked her abdomen it was very localized to her right lower quadrant with rebound tenderness which is the classis sign for an appendicitis....Chris & I looked at each other then let the clinical coordinators know our impressions....we drew her labs & they had to send her out for an ultrasound to an imaging clinic somewhere - she came back with a positive diagnosis of Appendicitis & needed surgery. She lives in Casablanca 5 hours away & putting her on a bus didn't seem like a great idea. One of the local plastic surgeons called a general surgeon friend who arranged for her to have surgery in his surgery center & tonight she is staying there overnight after having her appendix removed... and all that happened as we started to get the first round of patients in the PACU. My first patient was Sara a little 6 month old lip repair & she was MY PERFECT PATIENT - she woke up from anesthesia happy, took some juice for me, was snuggly & calm. It was hard to let her go to post op! My 2nd patient was just as good - a bilateral lip repair - one of those big clefts that disrupt the
entire face - it was a 3 1/2 hour surgery to repair her lip & nose & the transformation is absolutely incredible!!! I cant post the photos on line but I do have before & afters & one of me holding her :)
By 2 pm our 1st 8 palates were done but we had 16 more to go & at 3 pm I hit a wall & took another 20 min power nap -I am becoming a believer in power naps! At 4 we were halfway thru the palates & I estimated a 9 pm finish time which would have been close as the last patient rolled into the PACU at 9 pm & I had her recovered & awake & up on the Post Op ward just after 9:30. Unfortunately though there was a 8 year old girl who had a palate repair & some teeth pulled & about 8 she started with some bleeding on the post op ward & despite their best efforts at 9 pm she had to come back to surgery with the On Call team (who was still there & included me). The rest of the PACU team left at 8 & Samia & I finished up the last 4 patients then I had her leave at 9 while I waited for that "go back" patient to be explored & the bleeding stopped.
While I waited I ran some things up to post op & saw Sakho my 14 year old friend & her mom from Sengal West Africa. She is scheduled for surgery tomorrow - one of the last cases of the day. I spoke to her mom & she said that Op Smile helped her get a flight back after surgery so they didn't have to take the bus & she was so grateful...and I was happy to be a little part of that without her even knowing :)
A few other fun facts about this Morocco mission...they REALLY take their coffee breaks seriously & they happen at 11 am & 6 pm every day - usually with some sort of snacks & a special Moroccan green tea with mint. I don't often go in the morning - I bought some Coke Zeros & usually have that & a kind Bar in the back of the recovery room. I have gone in the afternoon though & today it was cold again & they had a traditional Moroccan soup Harira - which was very yummy. Lunch is served at 2 pm & the food at lunch has actually been pretty good - each day they serve an Tanjin which is really the tepee type pot they cook in - one day was chicken, another beef, fish & today lamb. I didn't try the fish or lamb but the other 2 were ok.
The 2 challenges are #1 the bathroom situation - as I mentioned in another post it is really not at all desirable & I have no idea why but by the afternoon the floor is pretty wet so to go in & roll up my pants & take everything out of my pockets, put on shoe covers that I change when I come out & do some serious handwashing - its quite an ordeal - The other challenge is that in the are we made into the recovery room (maybe 12x12 & then 8x8 areas) there is one 4 foot faint fluorescent light that hangs about 12 feet up in the ceiling so lighting is a challenge....it's the basics we don't ever think about 0 turning on a light or having a decent bathroom - really a porta potty would be better they way they make them these days!!!
There always are a variety of political visitors on every mission - Op Smile has positive connections & wants them to see all the resources they bring into their country...so far we had the Moroccan Minister of Health, a donor who is paying for the food & hotel & today was a TV station - yep all of us in the recovery room (& probably other areas) were interviewed & I might have been on the Moroccan news tonight - who knows? I really have expanded my skill set this mission with the lab draws, today I did a bunch of respiratory treatments on some wheezy kids, my IV solution skills & my "clinic diagnoses" - I am feeling very well rounded in my health care roles!
Anyways my night finished at the hospital at 11 - the patient Farmina came back to me at 10 & I watched her for an hour, had the surgeons & Chris clear her to go to post op then got to go pass her off to Brittany - who I now never see since she is on nights so that was fun! Hopefully she does well tonight & everything was fixed because if not I am on call & will be called back in with the on call team - that's why I wanted to be sure we all thought she was stable cause I don't want to get to the hotel, have her wake up & then have a problem in the middle of the night. He sweet little mom was waiting all by herself outside of the OR during those 2 hours so I took an Arabic interpreter who stayed too & gave her updates. After I took her on the gurney back to post op the mom gave me the biggest tightest hug & kissed both my cheeks & thanked me...those moments are priceless & worth any missed sleep. It's already 12:20 -I need to shower & be in bed by 1 am & may try to sleep in til 6 & get 5 hours of sleep. I cant believe we are over the hump on surgery days on this mission. I feel like I have managed the demands fairly easily & I absolutely KNOW it is because I have so many wonderful friends & family praying for me & our team - I am sustained by prayers of many & the blessings from a loving father in heaven who wants this good to be taking place for His children here so I am carried when I start to falter. It is such an honor to be one small piece of this big mission.
Good night from Morocco & go #lighttheworld it's a beautiful thing to do!
I started the day in the post op area - they had 3 rooms of 8 Cleft Palate patients from yesterday plus one room of 8 from Monday...the ones from Monday were getting their discharge instructions so I snapped a few photos of them & said goodbye. Tonight they will have the 24 palates from yesterday & the 24 palates from today=48 plus the 16 lips from today = 64 plus the 40 pre-ops for tomorrow = 104 - that is like the average daily census at a smaller children's hospital & we are doing it in a very antiquated "hospital" in Tangier with 8 patients in rooms that at home might have 4 and with 8 nurses at night for those 104 patients...stuff like this is what miracles look like!
After I left post op I needed to get to the OR but on my way I saw the 1st 8 babies waiting with their moms as they were the first cases on every table for the day - such cute babies. Our PACU routine in the morning is always very similar - make IV armboards out of cardboard covered in the packaging from the OR kits, make flushes & draw up pain medicine so it's all ready when the crazy happens :)
It only took until 9 am for our Primary Care Clinic to open & this one was a first for both Chris & me. A Pre/Post nurse came in saying she had been nauseous since Monday & throwing up with a slight fever. Immediately I knew she would need an IV & fluids but as we asked about her stomach pain & checked her abdomen it was very localized to her right lower quadrant with rebound tenderness which is the classis sign for an appendicitis....Chris & I looked at each other then let the clinical coordinators know our impressions....we drew her labs & they had to send her out for an ultrasound to an imaging clinic somewhere - she came back with a positive diagnosis of Appendicitis & needed surgery. She lives in Casablanca 5 hours away & putting her on a bus didn't seem like a great idea. One of the local plastic surgeons called a general surgeon friend who arranged for her to have surgery in his surgery center & tonight she is staying there overnight after having her appendix removed... and all that happened as we started to get the first round of patients in the PACU. My first patient was Sara a little 6 month old lip repair & she was MY PERFECT PATIENT - she woke up from anesthesia happy, took some juice for me, was snuggly & calm. It was hard to let her go to post op! My 2nd patient was just as good - a bilateral lip repair - one of those big clefts that disrupt the
entire face - it was a 3 1/2 hour surgery to repair her lip & nose & the transformation is absolutely incredible!!! I cant post the photos on line but I do have before & afters & one of me holding her :)
By 2 pm our 1st 8 palates were done but we had 16 more to go & at 3 pm I hit a wall & took another 20 min power nap -I am becoming a believer in power naps! At 4 we were halfway thru the palates & I estimated a 9 pm finish time which would have been close as the last patient rolled into the PACU at 9 pm & I had her recovered & awake & up on the Post Op ward just after 9:30. Unfortunately though there was a 8 year old girl who had a palate repair & some teeth pulled & about 8 she started with some bleeding on the post op ward & despite their best efforts at 9 pm she had to come back to surgery with the On Call team (who was still there & included me). The rest of the PACU team left at 8 & Samia & I finished up the last 4 patients then I had her leave at 9 while I waited for that "go back" patient to be explored & the bleeding stopped.
While I waited I ran some things up to post op & saw Sakho my 14 year old friend & her mom from Sengal West Africa. She is scheduled for surgery tomorrow - one of the last cases of the day. I spoke to her mom & she said that Op Smile helped her get a flight back after surgery so they didn't have to take the bus & she was so grateful...and I was happy to be a little part of that without her even knowing :)
A few other fun facts about this Morocco mission...they REALLY take their coffee breaks seriously & they happen at 11 am & 6 pm every day - usually with some sort of snacks & a special Moroccan green tea with mint. I don't often go in the morning - I bought some Coke Zeros & usually have that & a kind Bar in the back of the recovery room. I have gone in the afternoon though & today it was cold again & they had a traditional Moroccan soup Harira - which was very yummy. Lunch is served at 2 pm & the food at lunch has actually been pretty good - each day they serve an Tanjin which is really the tepee type pot they cook in - one day was chicken, another beef, fish & today lamb. I didn't try the fish or lamb but the other 2 were ok.
The 2 challenges are #1 the bathroom situation - as I mentioned in another post it is really not at all desirable & I have no idea why but by the afternoon the floor is pretty wet so to go in & roll up my pants & take everything out of my pockets, put on shoe covers that I change when I come out & do some serious handwashing - its quite an ordeal - The other challenge is that in the are we made into the recovery room (maybe 12x12 & then 8x8 areas) there is one 4 foot faint fluorescent light that hangs about 12 feet up in the ceiling so lighting is a challenge....it's the basics we don't ever think about 0 turning on a light or having a decent bathroom - really a porta potty would be better they way they make them these days!!!
There always are a variety of political visitors on every mission - Op Smile has positive connections & wants them to see all the resources they bring into their country...so far we had the Moroccan Minister of Health, a donor who is paying for the food & hotel & today was a TV station - yep all of us in the recovery room (& probably other areas) were interviewed & I might have been on the Moroccan news tonight - who knows? I really have expanded my skill set this mission with the lab draws, today I did a bunch of respiratory treatments on some wheezy kids, my IV solution skills & my "clinic diagnoses" - I am feeling very well rounded in my health care roles!
Anyways my night finished at the hospital at 11 - the patient Farmina came back to me at 10 & I watched her for an hour, had the surgeons & Chris clear her to go to post op then got to go pass her off to Brittany - who I now never see since she is on nights so that was fun! Hopefully she does well tonight & everything was fixed because if not I am on call & will be called back in with the on call team - that's why I wanted to be sure we all thought she was stable cause I don't want to get to the hotel, have her wake up & then have a problem in the middle of the night. He sweet little mom was waiting all by herself outside of the OR during those 2 hours so I took an Arabic interpreter who stayed too & gave her updates. After I took her on the gurney back to post op the mom gave me the biggest tightest hug & kissed both my cheeks & thanked me...those moments are priceless & worth any missed sleep. It's already 12:20 -I need to shower & be in bed by 1 am & may try to sleep in til 6 & get 5 hours of sleep. I cant believe we are over the hump on surgery days on this mission. I feel like I have managed the demands fairly easily & I absolutely KNOW it is because I have so many wonderful friends & family praying for me & our team - I am sustained by prayers of many & the blessings from a loving father in heaven who wants this good to be taking place for His children here so I am carried when I start to falter. It is such an honor to be one small piece of this big mission.
Good night from Morocco & go #lighttheworld it's a beautiful thing to do!
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