It’s eight pm and the last three patients went to the OR about half an hour ago. There were only 19 patients today, down from 22 on the schedule due to two no shows at the dock and one with a fever and cough. I had a brief moment of hope for an early finish, and that was likely enough to cause the jinx that has patients still on the tables at this hour. A late start, having only one PIT(photographer who does intra-operative photos,) and some complicated cases combined to make the day move slowly.
So, the late start was due to having to learn how to do our first muster. At 6:30 we gathered in the big open area at the entrance to the OR’s and had our morning meeting. I had already been up for a few hours, trying to post photos and seeing the pre-op patients. At 6:45 the officer of the day arrived and asked us to form into three lines to facilitate the muster. At first she said she would be calling each name and asking us to respond, but then changed her mind and just went over the list with Ryan, allowing him to look over the group and say yay or nay after each name. When we were done, the Navy nurses and techs who are assisting us in the OR lined up to do their muster. They really should have gone first so we could watch them, and maybe we would have done a better job. Their lines were straight, and they stood at attention. After each name was called, there was an easily heard, “HERE, Ma’am,” and when they were done with muster they recited the Navy creed. It was very impressive. After muster, they held a mock code in the PACU for all the OR people, something OP Smile does anyway, but a bit more elaborate since it was done Navy style. The first patients didn’t get on the tables until 8:30, an hour later than planned.
The single PIT contribution to the problem is more complicated. All patients have a precise photographic record of their surgery. Usually there are two trained medical photographers who are in the OR’s and are called by the surgeons at various stages to document the surgeries. When there is only one PIT, as they are so lovingly called, the surgeons have to wait their turn. This definitely slowed the flow today. Finally, there just happened to be several kids with complicated problems. What was really impressive about the day was how good-natured the late patients were about the wait. The last three to go to the OR were a 6 year old girl, a 13 year old boy and a 30 year old man. They sat and worked puzzles, colored with crayons, played cards and raced matchbox cars for the last two hours. My patience with the delay had long since been used up, but they seemed to have a great time.
Around noon, I ate a quick lunch and then went down to the berth area and found a middle bunk on the side against the wall. It looks perfect so I’m hopeful for a good night’s sleep tonight. If the WIFI cooperates, I’ll send photos in the next day or two.
Today I’ve been counting the number of times I go up and down the stairs from deck to deck. So far I’ve made 38 trips for various reasons, a few have been from bottom to top or vice versa, but most are in a pattern between the OR and/or PACU and the wards, or from the wards to the dining (mess) hall.
So, the layout of the ship, which seems smaller every minute, is as follows:
On the top deck is the mess hall and the NGO business lounge where the so-so WIFI can be found.
Two decks down, following the stairs with the red rails and being sure to come out to the mint green walls is the deck with the OR’s and PACU.
Two decks further down but at the other end of the ship, down the stairs and following the orange rails, one finds the pre and post op wards.
To get to the berths, which are down four more decks, you must first climb up the orange stairs to the OR deck which is one of two that runs the full length of the ship, go down to the red stairway, and descend to the very bottom of the ship.
In the morning, if you are going directly to breakfast, you can climb all the way up from the berths to the mess hall. As I was up too early for breakfast this morning (5:00 – 6:30,) I climbed to the OR floor, starting at(deck 9, climb too deck 3,) then down to the wards, (deck 3 to deck 5,) then later back up to the OR deck (deck 5 up to 3,) across the ship to the red stairs and then up to the mess hall, (deck 3 to deck 1.) I’m sure they’re not called decks 1-9, but it keeps things clear to me. By the end of the week, I should be in much better shape. I don't know which other deck goes all the way across, but as I don't use it and I don't want to get lost, it's off my radar.
Tomorrow, there will be 30 visitors on board from some foundations that support Op Smile. The remaining 20 will come on Wednesday. It will definitely add to the chaos, but their support is what drives the missions. Donors generally are very respectful of the patients and our work schedule on these visits, but that many extra bodies will be interesting.
The surgical outcomes have been really beautiful today. Once again, I'm so impressed with the level of skill and artistry of the plastic surgeons on these missions.
Finally, the 30 year old man’s surgery was complete, and I went up to the PACU at 10:30 to see him before heading to bed. The surgery had been planned as a lip scar revision, but the plastic surgeon on that table was Henrique who is a highly regarded surgeon from Peru. He decided that this man deserved his best, and even though it was late at night after a long day, he did a beautiful rhinoplasty in addition. The younger brother who has been with the patient on the boat all this time, was brought to tears, as were most of us. Very cool.
While all this was going on, I began to notice that the floor was moving much more than it had been earlier. It turns out there had been big thunderstorms and heavy rain all day, and now there were big swells rocking the boat. It’s a little strange to be on a ship and totally unaware of the weather.
As an addendum, it’s 4:30 on the 18th and my new bunk is great – quiet and cozy.
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