This is our last full day of surgery and there were many babies with primary cleft lip repairs on the schedule. We also had many primary palates so the day has been, once again, long. It’s 7:15 in the evening and there are still five kids upstairs, four on the tables and one in recovery. It’s looking like an overall shorter day, but we shall see. Two things happened first thing in the morning to complicate the day. First, one of the surgeons from Peru woke up with a badly swollen, red painful ankle. The intensivist, who is always the designated doctor for team members, evaluated him and they decided together to use antibiotics in the hope that it’s a superficial infection and not a joint infection or the beginning of some exotic mosquito born illness. They also agreed he shouldn’t stand around all day, so we were down to three surgeons. Since we don't cancel cases for a sick surgeon, the others had to pick up the slack.
The second thing that happened was that no one was able to get an IV into a seven month old who was scheduled as the first case on one of the tables. Everyone tried including the intensivist. The problem was that the baby had not had any fluids for over 12 hours and was dry. Bruce, the intensivist, brought him back to the ward where we pushed juice and water until he was peeing well and then put in an IV to finish his hydration. Eventually he went back to the OR and had his lip repair done.
This event highlighted one of my pet peeves which is parents refusing to wake their babies for the middle of the night hydration. My orders for all the pre-op patients are clear, and include fluids for infants and toddlers around four hours before the first scheduled surgery. It's part of the whole hydration strategy to prevent just this sort of event. Once the night nurses have explained the purpose behind waking the babies and have supplied the water or juice, they have to rely on the parent’s word, about whether the the fluids are given. No one wants to wake a sleeping baby, especially not a hungry one who is likely to be fussy, so it is not unusual for parents to ignore the instructions. When I do the pre-op evaluation in the morning and ask when the child last drank fluids, parents are usually truthful and say the baby didn't want the juice. While I understand not wanting to wake a sleeping child, the result is a dry, crankier child, at risk of having surgery postponed. Our night nurses are great, but last night they were taking care of two kids with respiratory issues and two with vomiting and therefore had to rely on the parents to give the fluids. Going by pre-op questioning, I'd estimate that at least half of the patients had skipped the night time hydration. Well, I’ll hop off my soapbox now, but likely you can tell this frustrates me.
Tomorrow there are just 13 patients scheduled, all adults except for one 12 year old. They are all having scar revisions or surgery or other relatively minor procedures. Three are also have fistula surgery, operations to close small holes that have developed in previously repaired palates. These can take a fairly long time to do as there is always scar tissue to deal with. Nevertheless, the hope is to be finished with surgery after the morning and have the rest of the day to begin packing. Some if not all of the patients will go home the same day. The Navy is giving a salsa dance party on the Fantail deck tomorrow evening; don’t ask because all I know is that it’s outside. Saturday we finish packing our gear and then take the boat to shore. Saturday night is our farewell party and Sunday we fly home.
On a final note, I asked our liaison officer, April about the bunks, whether there were different sizes to accommodate all the tall men and women on the ship. She said no, all the bunks were the same size and that taller people just fold up their legs. She also said that sometimes a tall person cultivates a short friend who lets them stick their feet through the curtain at that separates the bunks at the end in order to stretch out. She also said that this ship's bunks are roomy in comparison to her previous ship. It had doorways that were more like portholes where you have to duck your head and step over the 12 inch high barrier at the bottom. She called these doorways "knee-knockers" for obvious reasons. The bunks there are four inches shorter!
Well, off to breakfast and the wards.
The second thing that happened was that no one was able to get an IV into a seven month old who was scheduled as the first case on one of the tables. Everyone tried including the intensivist. The problem was that the baby had not had any fluids for over 12 hours and was dry. Bruce, the intensivist, brought him back to the ward where we pushed juice and water until he was peeing well and then put in an IV to finish his hydration. Eventually he went back to the OR and had his lip repair done.
This event highlighted one of my pet peeves which is parents refusing to wake their babies for the middle of the night hydration. My orders for all the pre-op patients are clear, and include fluids for infants and toddlers around four hours before the first scheduled surgery. It's part of the whole hydration strategy to prevent just this sort of event. Once the night nurses have explained the purpose behind waking the babies and have supplied the water or juice, they have to rely on the parent’s word, about whether the the fluids are given. No one wants to wake a sleeping baby, especially not a hungry one who is likely to be fussy, so it is not unusual for parents to ignore the instructions. When I do the pre-op evaluation in the morning and ask when the child last drank fluids, parents are usually truthful and say the baby didn't want the juice. While I understand not wanting to wake a sleeping child, the result is a dry, crankier child, at risk of having surgery postponed. Our night nurses are great, but last night they were taking care of two kids with respiratory issues and two with vomiting and therefore had to rely on the parents to give the fluids. Going by pre-op questioning, I'd estimate that at least half of the patients had skipped the night time hydration. Well, I’ll hop off my soapbox now, but likely you can tell this frustrates me.
Tomorrow there are just 13 patients scheduled, all adults except for one 12 year old. They are all having scar revisions or surgery or other relatively minor procedures. Three are also have fistula surgery, operations to close small holes that have developed in previously repaired palates. These can take a fairly long time to do as there is always scar tissue to deal with. Nevertheless, the hope is to be finished with surgery after the morning and have the rest of the day to begin packing. Some if not all of the patients will go home the same day. The Navy is giving a salsa dance party on the Fantail deck tomorrow evening; don’t ask because all I know is that it’s outside. Saturday we finish packing our gear and then take the boat to shore. Saturday night is our farewell party and Sunday we fly home.
On a final note, I asked our liaison officer, April about the bunks, whether there were different sizes to accommodate all the tall men and women on the ship. She said no, all the bunks were the same size and that taller people just fold up their legs. She also said that sometimes a tall person cultivates a short friend who lets them stick their feet through the curtain at that separates the bunks at the end in order to stretch out. She also said that this ship's bunks are roomy in comparison to her previous ship. It had doorways that were more like portholes where you have to duck your head and step over the 12 inch high barrier at the bottom. She called these doorways "knee-knockers" for obvious reasons. The bunks there are four inches shorter!
Well, off to breakfast and the wards.
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