Today was the second day of surgery, and I expected that we would end the day a bit earlier than yesterday. However, it’s 8:30 in the evening and the last four patients are still on the tables. We did start on time today after a much more orderly muster, but the 30 visitors slowed things down considerably. They are from a laboratory here in Santo Domingo, and for the past seven years have done all of the blood analyses for the patients who will be having surgery at Operation Smile missions. This turns out to be a huge monetary donation as each child gets a screening panel of a complete blood count and blood type, and clotting studies. I don’t know how much this costs in commercial labs, but I know it is expensive. Multiplied by hundreds of kids over seven years, it comes to a big savings for Operation Smile. It’s sort of an indirect donation in that the money saved can then be spent on more missions to help more kids in the D.R.
When the group toured the OR’s, several wanted to see actual operations which meant getting them properly garbed and then explaining the procedures. When they came to the ward, they were very respectful of the parents’ and kids’ privacy, but had many questions for us about working on the ship versus in local hospitals. It’s clear they are really interested in and devoted to the Op Smile mission.
Otherwise, things went smoothly today. I had one boy whom I saw at screening on the 14th with chest congestion. As is typical procedure, I treated him with antibiotics for three days and saw him back today for recheck. He was no better, so I gave him a nebulizer treatment with albuterol, (an asthma medication,) and he cleared right up. After discussion with the pediatric intensivist and the team leader for anesthesia, we decided to treat the boy for 48 hours with steroids and frequent nebulizer treatments and see if he has enough improvement to have surgery. The thought process is different on these missions than it is in the US or other developed countries. The child's safety is the first priority, but you also have to take into account the child's opportunity to have the surgery done. The international team only visits the DR twice a year, and this boy is already four. His speech patterns are being adversely affected by his open palate, so he needs it fixed. His undiagnosed asthma is likely being affected by the palate as well as he aspirates when he eats. Finally, this family is from a small village, a day's travel from Santo Domingo. The father came with the boy, leaving the mother home with the five older and younger children. So, I'm keeping my fingers crossed. The next and possibly harder problem will be figuring out ongoing asthma treatment after he leaves the ship.
There were a couple of interesting stories on the ward today. A seven month old boy is here with his father; mom is home with the other six kids ages 18 months through seven years. This boy, Anderson, is breast feeding, and it doesn’t look like Dad has ever changed a diaper. However, he’s clearly very dedicated to his son and to being the parent to take on this challenge. He was doing his best today to feed Anderson juice and formula with a syringe post-op, but was clearly overjoyed when a mother in the next bed with a six month old offered to breast feed Anderson along with her own son. Both Anderson and his father were in heaven, and the other baby didn’t seem to mind sharing.
There’s an 18 month old girl here for repair of her palate. This morning when I did the pre-op exam, her mother asked if I could give the child a sedative so that she would sleep all day after surgery. I tried to tell her, gently why that wasn't a good idea, but she interrupted me to explain that her mother usually took care of the child because “nobody else can handle her.” She went on to tell me at great length that I would soon see that the child was "unbearable and out of control," would refuse to eat or drink or take medicines and that eventually I would be won over to her request. I, of course, remained polite and smiling, reminding myself in a never-ending loop that parents who seem overbearing are usually just scared. Luckily, though the mother started out her stay repeating her mantra to whoever would listen, our nurses gradually won her over. They spent lots of time at her bedside, helping her give the girl fluids, modeling calm but firm guidance, etc. She had a brief but wild regression when we needed to re-tape the IV during which she sang the ABC’s over and over at high volume and chanted, “ mommy loves you.” When we were finished, she told me that she decided to have the child's palate repaired because it was clear to her that the child was a "genius linguist." Mom says the child knows her ABC's in English, Spanish and French, all self taught, and that without the palate surgery, she was unlikely to get a job as an interpreter, the obvious choice for a child with her skills. Hmm.
Bruce the Intensivist showed me a shortcut to the PACU that cuts off the long hallway but involves using a brown-railed stairway. This may seem inconsequential, but having relied on using only red and orange rails to keep myself from getting lost, it took real courage to head up those brown-railed stairs. Still, the shorter passage drew me when I was on my 33rd trip, and on my fourth pass through the shortcut, I went up one extra floor and ended up barging into a men’s ward. It looked almost identical – just full of men. There was sort of a shocked silence, all of us staring until I turned around and walked out, gracefully!
Oh, the barging: All of the doors on the ship are extremely heavy. I'm sure it has something to do with it being a boat - ?sealing off compartments to keep the whole boat from flooding if one part is full of water? Anyway, to open a door, I have to either throw my whole body weight against it, hence the barging in, or grab the handle and use my weight to pull it open if it comes toward me. So, my workout on this boat includes cardio strength training.
I’ll end with two attack stories. The first is what I call attack laughter. There are people, usually quite nice in all other respects, whose laughter is very loud and abrupt. They often laugh when others only feel fit to let out a small giggle, and therefore, their laughter is not muted by the crowd. This laughter startles those around them, sometimes strongly, and thus the moniker, ‘attack laughter.’ There is a lovely nurse on the team who does this, and I was unfortunate enough to be sitting right in front of her on the van ride to the beach on Team Day. By the time we got there I felt like I'd been mauled.
The second attack story involves hand sanitizer. There are containers of Purell sanitizer all over the ship, six on each of our wards. They are attached to the walls, and if you walk by too close to them, they shoot out a stream of foam. Thus, I have dubbed them ‘attack sanitizers,’ and I have been sanitized more times than I can count.
Well, it’s 10:57, I’ve left the ward and am in the WIFI lounge. The rest of the week, there are fewer palate surgeries so the days should be shorter. Here’s hoping! I'll try to post more photos in the morning when the WIFI is faster. Please ignore typos.
Addendum: It's 4:30 on the 19th, another short night. I've put up some pre and post photos. One pair (none arranged side by side) is of a 30 year old man, alone in the pre and with his brother, who accompanied him, in the post. There's also one of him with me. His nose is bandaged, but I think you can see how much he'll love the result.
When the group toured the OR’s, several wanted to see actual operations which meant getting them properly garbed and then explaining the procedures. When they came to the ward, they were very respectful of the parents’ and kids’ privacy, but had many questions for us about working on the ship versus in local hospitals. It’s clear they are really interested in and devoted to the Op Smile mission.
Otherwise, things went smoothly today. I had one boy whom I saw at screening on the 14th with chest congestion. As is typical procedure, I treated him with antibiotics for three days and saw him back today for recheck. He was no better, so I gave him a nebulizer treatment with albuterol, (an asthma medication,) and he cleared right up. After discussion with the pediatric intensivist and the team leader for anesthesia, we decided to treat the boy for 48 hours with steroids and frequent nebulizer treatments and see if he has enough improvement to have surgery. The thought process is different on these missions than it is in the US or other developed countries. The child's safety is the first priority, but you also have to take into account the child's opportunity to have the surgery done. The international team only visits the DR twice a year, and this boy is already four. His speech patterns are being adversely affected by his open palate, so he needs it fixed. His undiagnosed asthma is likely being affected by the palate as well as he aspirates when he eats. Finally, this family is from a small village, a day's travel from Santo Domingo. The father came with the boy, leaving the mother home with the five older and younger children. So, I'm keeping my fingers crossed. The next and possibly harder problem will be figuring out ongoing asthma treatment after he leaves the ship.
There were a couple of interesting stories on the ward today. A seven month old boy is here with his father; mom is home with the other six kids ages 18 months through seven years. This boy, Anderson, is breast feeding, and it doesn’t look like Dad has ever changed a diaper. However, he’s clearly very dedicated to his son and to being the parent to take on this challenge. He was doing his best today to feed Anderson juice and formula with a syringe post-op, but was clearly overjoyed when a mother in the next bed with a six month old offered to breast feed Anderson along with her own son. Both Anderson and his father were in heaven, and the other baby didn’t seem to mind sharing.
There’s an 18 month old girl here for repair of her palate. This morning when I did the pre-op exam, her mother asked if I could give the child a sedative so that she would sleep all day after surgery. I tried to tell her, gently why that wasn't a good idea, but she interrupted me to explain that her mother usually took care of the child because “nobody else can handle her.” She went on to tell me at great length that I would soon see that the child was "unbearable and out of control," would refuse to eat or drink or take medicines and that eventually I would be won over to her request. I, of course, remained polite and smiling, reminding myself in a never-ending loop that parents who seem overbearing are usually just scared. Luckily, though the mother started out her stay repeating her mantra to whoever would listen, our nurses gradually won her over. They spent lots of time at her bedside, helping her give the girl fluids, modeling calm but firm guidance, etc. She had a brief but wild regression when we needed to re-tape the IV during which she sang the ABC’s over and over at high volume and chanted, “ mommy loves you.” When we were finished, she told me that she decided to have the child's palate repaired because it was clear to her that the child was a "genius linguist." Mom says the child knows her ABC's in English, Spanish and French, all self taught, and that without the palate surgery, she was unlikely to get a job as an interpreter, the obvious choice for a child with her skills. Hmm.
Bruce the Intensivist showed me a shortcut to the PACU that cuts off the long hallway but involves using a brown-railed stairway. This may seem inconsequential, but having relied on using only red and orange rails to keep myself from getting lost, it took real courage to head up those brown-railed stairs. Still, the shorter passage drew me when I was on my 33rd trip, and on my fourth pass through the shortcut, I went up one extra floor and ended up barging into a men’s ward. It looked almost identical – just full of men. There was sort of a shocked silence, all of us staring until I turned around and walked out, gracefully!
Oh, the barging: All of the doors on the ship are extremely heavy. I'm sure it has something to do with it being a boat - ?sealing off compartments to keep the whole boat from flooding if one part is full of water? Anyway, to open a door, I have to either throw my whole body weight against it, hence the barging in, or grab the handle and use my weight to pull it open if it comes toward me. So, my workout on this boat includes cardio strength training.
I’ll end with two attack stories. The first is what I call attack laughter. There are people, usually quite nice in all other respects, whose laughter is very loud and abrupt. They often laugh when others only feel fit to let out a small giggle, and therefore, their laughter is not muted by the crowd. This laughter startles those around them, sometimes strongly, and thus the moniker, ‘attack laughter.’ There is a lovely nurse on the team who does this, and I was unfortunate enough to be sitting right in front of her on the van ride to the beach on Team Day. By the time we got there I felt like I'd been mauled.
The second attack story involves hand sanitizer. There are containers of Purell sanitizer all over the ship, six on each of our wards. They are attached to the walls, and if you walk by too close to them, they shoot out a stream of foam. Thus, I have dubbed them ‘attack sanitizers,’ and I have been sanitized more times than I can count.
Well, it’s 10:57, I’ve left the ward and am in the WIFI lounge. The rest of the week, there are fewer palate surgeries so the days should be shorter. Here’s hoping! I'll try to post more photos in the morning when the WIFI is faster. Please ignore typos.
Addendum: It's 4:30 on the 19th, another short night. I've put up some pre and post photos. One pair (none arranged side by side) is of a 30 year old man, alone in the pre and with his brother, who accompanied him, in the post. There's also one of him with me. His nose is bandaged, but I think you can see how much he'll love the result.
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