"Send For The Next Patient!!!"

I don't even know where to start with my blog entry this evening.  What a day, what a day!!  Much much more eventful and productive.  I didn't get too much rest last night-I woke up even more focused and determined to make up for yesterday.  I arrived to the hospital and first made sure that everyone on the service was doing ok and there were no overnight issues.  When I got up to the OR today everyone had a bit more pep in their step and seemed a bit more focused than yesterday which I certainly was pleased about.  I think some of the conversations I had yesterday reverberated back to the right ears...

First case of the day.

By 8:30am we had the first patient on the table and by 9am I was prepped and asking for the scalpel-one small win!  It was the kid from yesterday that we had to cancel-he was nervous as would be expected, this being his second time in the operating room.  I can only imagine the feeling he must have looking up and having a foreign doctor trying to comfort him through a time like this-let alone operating on him.  He was a tough little kid I could tell.  I had my hand on his shoulder while he was trying to hold back tears as the anesthesiologist was placing the spinal anesthetic, shivering on the table.  Once we were underway with surgery everything went very well and we were finished in about an hour to everyone's astonishment.  They were actually taking pictures of the surgical incision after I had finished because they were impressed with the meticulous closure!  While it's rather mundane and routine for me, it was a big deal to them so I took the time to show them how and why it's important.  That was one of my goals for the day-try to teach and engage in a way that continued to spark their curiosity and enthusiasm so that they would want to see even more and hence be more productive!!!  AND IT WORKED!!! Another small victory! "Send for the next patient!!"

The waterhose is badly 'kinked!'

The next patient came in early this morning after being struck by a car and had dislocated his knee.  He had a gross deformity and minimal pulses in his foot and needed to come up to the OR to reduce his knee back into alignment-a closed reduction.  When I told the staff that this case in particular needed to come up now and bump the others, no one seemed to understand why.  I pulled up his xray and reviewed it with them explaining how the artery behind his knee was kinked like a water hose, preventing blood flow to his leg and how popping his knee back into position would "unkink" the water hose and allow his blood to flow.  Understood!  Once the patient got to the operating room I let them feel the normal bounding pulse in his normal leg and then the significantly diminished 'kinked' pulses in the dislocated extremity.  Once we sedated and relaxed him, I showed the scrub tech how to hold and pull the leg while I guided him and let him feel the knee pop back into position which was audible for everyone to actually hear!  Then once we stabilized him in a cast I let them feel the foot so they could feel the water flow again!! 

Another small victory!  "Send for the next patient!!"

Babu came to see me on his vacation!!!

Between the next case I got another surprise.  Babu stopped by during his vacation time off!!  He was one of my favorite scrub techs who taught me so much about Liberian culture-words, food, even dance moves!  He was the one that actually gave me the name 'Balah' which was one of the first things he said to me when he saw me.  He heard that I had been asking about him since my arrival, but everyone said that he would be on vacation for one month, but was still in Monrovia.  Once he heard that I was in the country he came up to the hospital.  And get this....he wanted to scrub into the next case with me!!  I was so glad that he was there too because the next case was 2-in-1.  The 15yo kid who had both a fractured femur and tibia.  This case also went very smoothly as Babu and I worked just as well together as I remembered while we listened to my old Liberian music mix in the background that they had made for me during my last visit!  I'm looking forward to learning some of the newer dance moves before I leave!

The day moved extremely efficient and everyone was involved and learning and having fun, and most importantly doing a good service for our patients.  I ended up ordering pizza for everyone which they THOROUGHLY enjoyed.  I'm hoping that we can keep up the good work in the remaining days.

The way to a tech's heart: teach them and give them pizza!!!

I had to move the remaining cases to tomorrow's schedule because I had to run to the Liberian Medical & Dental Council for a board interview to obtain my official Liberian medical license-exciting.  Things went well during the credentialing interview and I was able to get approved which means I'll be back for sure!!

My evening ended pretty interestingly.  I got called into the ER to see a sweet young girl who had an unfortunate accident injuring her femur.  Initially she was seen by the 'country doctor' who had placed some dirt on her leg as a treatment with a wrap.  After xrays revealed a fracture that would certainly require surgery, she elected to return to the bush doctor for treatment even following a long discussion of risks and alternatives.  I'm hoping that she finds the care that's best for her.  I mentioned before some of the frustration that comes with situations like this.  I just try and do the best that I can for patients and educate them appropriately so that they can make the most informed decision they can.  You can't help everyone which sometimes is a source of consternation for me when you're so passionate about trying to do so...

As I was walking out of the ER there was a crowd gathered around a car that was carrying a man in the trunk that had just been struck by a car and was DOA.  As I walked amidst the crowd and up to trunk to see if there was anything I could do, there were silent stares and sobs as I simply genuflected and nodded my condolences-there was nothing I could do.  They took man away in the car to their family.  The hospital driver and I were driving home shortly after when we came across another unanticipated finding-a school bus rammed into the middle of a compound's concrete wall!  We stopped to check out the scene which had recently been cleared out from what bystanders were saying.  I'm sure we may have passed some people on their way to the hospital or I may hear about some new patients/injuries in the morning.  You can't make this stuff up-just as soon as you think a great day's work is done and you're riding high, the next wave of chaos is right behind it.

Hoping no one was hurt.  I may hear about this in the morning...

Despite the unexpected ending to an otherwise very efficient and productive day, my spirits remain high and invigorated because we helped some good patients and people learned new things that they were excited about.  It's great reminder that I'm not only here to help people by doing surgeries.  I can be just as, if not more effective as a teacher and inspirer...Another small victory..."Send for the next patient!!"