Day 4: Murphy StrikesBreakfast was like the calm before the storm; no one truly knew what was going to happen, but we knew it would be a busy day. We had planned one instrumentation and fusion and one posterior lumbar instrumentation and fusion for the morning, and occiput (bone at the bottom of your skull) and C3 vertebra (the third vertebra in the neck) and anterior cervical discectomy and fusion (removal of the disc). Two long cases, and two short cases sounds ideal, but as Murphy’s Law states “anything that can go wrong, will go wrong, at the worst possible moment”. We arrive at the hospital and immediately break into our separate groups; rounds and OR. Dr. Villarreal, Dr. Kisinde, Dr. Hisey, Sydnie and I all made our way down to the surgical ward, where we saw all of the previous surgical patients. All the patients were doing fantastic, and some, such as Jecinta (who had surgery on Tuesday) was up and walking with the help of our lovely physical therapist, Michelle. Others, such as Clency (one of the two little girls who had surgery on Tuesday) was doing better than she was previously, but still wasn’t doing as well as we had all hoped she would. With a little bit of encouragement and a few painkillers to make her more comfortable and alleviate her pain from such a large surgery, we hoped to see her begin to improve. With our rounds rapidly hitting its conclusion for the day, we returned to the OR where Dr. Hisey went to the one operating room to begin, while Dr. Villarreal went to join Dr. Lieberman in the other. However, life doesn’t always intend for things to move smoothly, and always like to keep you on your toes. Once Dr. Hisey entered his operating room with everyone who was going to assist him, they noticed the anesthesia machine was not working properly, saying there was no oxygen. Now, while a patient is sedated, the machine helps them breathe by filling their lungs with oxygen, so the machine saying there isn’t any is a rather significant problem. The technicians worked as hard as they could to get the machine up and running, and after about an hour of hard work, they finally managed to fix it! Now, as they went to retrieve the patient, they couldn’t find him. It wasn’t a matter of he wasn’t in hospital, as he was here and waiting in the back for the machine to be fixed, but more a matter of he just walked off for a bit. We frantically searched for what felt like an eternity (but was more like 5 minutes) and he just came back, all ready as long as we were, so we set to work. Two cases would eventually turn to three, as Dr. Hisey finished his first case, and moved onto the second, while Dr. Lieberman and Dr. Villarreal continued work on case; a young girl named Promise in need of a large instrumentation and fusion procedure, which required caution due to the shape of her scoliosis, and the size (her T5 vertebra to her L3 vertebra). With one this size and severity, caution must be taken to prevent loss of movement in her legs, or further damage to her nerves. Cases two and three became our final case, case four. This one was on a young man named Stephano, which we knew would take a while to complete. You see, his diagnosis was an interesting one, as the bone at the base of his skull, the occiput, fused on its own to his very top vertebra, C1 (Fun fact, it’s also known as “Atlas” because it holds supports the globe of your head, after the Greek myth Atlas, who holds the world up on his shoulders). This auto-fusion, in turn, caused compression on his spinal cord and further complications, such as sudden weakness in his right side. This procedure would (as expected), turn out to be a long case, as it must be approach with extreme caution. It was planned to fuse his occiput bone to his C3 vertebra, and to decompress the spinal cord, in an attempt to have him regain motor function The night came to a late close, and we prepared to return back to the hotel for a well-earned night of sleep and rest, realizing that week 1 was slowly approaching an end. Little did we know, however, that while today was stressful, the rest of the week would hold more interesting surprises for us, never letting us relax for too long.
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Day 3: Clinic Queues
Another morning, another breakfast, another bus ride to the clinic, however, instead of our usual bus, we had a much more entertaining situation. The previous night, our normal bus driver wasn’t there, so someone else drove us to the hotel. The problem was, the bus we were taking was significantly smaller than what we needed. While it fit 12, we had to fit a grand total of 16 (including our driver). So, we piled in, got very close to each other, cracked a few clown car jokes, and made our way to the hospital to begin a multitude of surgeries and return to the penalty box, aka clinic. We arrived (we still had a few packed bags needing to be unpacked), and quickly went to work. While most of us prepped the two ORs we were going to use, Dr. Villarreal, Dr. Kisinde, and Sydnie made their way down to the ward to check on the previous day’s patient, who was doing well. After a quick peek of his incision, change of his dressing, and seeing him doing well, they quickly returned to the rest of us, where we were close to completing the final touches on the ORs for the surgeries. There was a lot of bustling around as patients were being brought in and put to sleep, x-rays were being put up and looked at, table were being prepped and steriley covered with tools placed on top, and people were beginning to scrub in. But, even through all this chaos, there was a method to the madness. People knew where to go and what to do without being asked, everyone knew what to grab, and what cases were about to happen. In the first room, we had a patient by the name of Jecinta who returned to us with two broken rods, so the plan was to exchange the broken rods. The second room had a 52 year young man named Edward who required a simple (nothing in spine Surgery is simple) 1 level fusion of his cervical (neck) vertebrae at C4 to C5. Surgeries started, and Dr. Lieberman, Dr. Kisinde, and I headed down to resume clinic from the previous day, where countless patients were still waiting from the day before. Shocked, we quickly entered the exam room, prepared ourselves, and started seeing patients. Dr. Lieberman would talk and examine them, Dr. Kisinde would translate and also examine them, and I would record the patient’s history and diagnosis. Of course, seeing each patient and listening to them takes time, so after the first 10 patients, Dr. Lieberman made the executive decision to see a total of 50 for the day before he heads to surgery, and more would be seen during the second week of the mission. Charts were collected, and patients continued to come in one by one; low back pain, neck pain, pain or numbness radiating into the hands and/or feet. You name it when it comes to back problems, we probably saw it. After a few breaks for our stomachs and mother nature, and the help of Dr. Hisey after his first surgery was completed, we finished seeing 58 patients, and made our way to the OR, where cases 3 and 4 were beginning to get ready. Case 3 a young girl named Clency who required a large instrumentation and fusion in her back, while case 4 was another young girl named Prima who was had a mass removed from her back. Once again, the ORs and the doctor’s room we were inhabiting started bustling with activity as we moved to prepare the next two cases; imaging, cleaning, equipment and supplies needed, people ready. Once the cases began, and those of us not directly involved in the surgeries took a short break to grab a snack, or (a crowd favorite here) sit down. While all the cases were in progress, including cases 1 and 2, Sherron and Sydnie were continuing to unpack and organize a room, so when clinic was over and those of us there returned, Sydnie proudly told us that the task Sherron had given her was “complete”, and she went to watch the surgeries. Both cases progressed smoothly and came to an end close to 7:00 PM, so we did our fantastic clown car routine, piled into the small van, and headed back to the hotel, where we ate dinner and laughed at different stories and Jason. He hypothesized that if he drinks a little bit of vodka every night, it will kill all the bacteria in his stomach and he won’t get sick from anything, and then took a drink. Needless to say, everyone became invested in his hypothesis, and we are all awaiting the results from his experiment. Then came the lessons of the day. As per usual, everyone shared what they learned, when we got to Sherron, who looked at us, chuckled, and said, “What I learned is the terminology for “complete” for millennials is different than older generations.” By this point, we all knew that Sydnie had completed the room in her eyes, but not in Sherron’s, and started cracking up. The rest of the evening was uneventful; a few of us parted ways, exhausted from the day’s work and ready for bed, while the rest continued to test Jason’s hypothesis and enjoy each other’s company. Little did we know what Wednesday would have in store for us. Day 2: Exactly how much did we pack? The morning was pretty typical to trips in the past; some got up early and worked out, some took care of emails and everything, and others slept in until the last possible minute before the standard team breakfast, where we’d discuss the tentative plan for the day. In the one year since I’ve been in Uganda, change is present, whether it be in the form of new highways and paved roads, or new buildings being built in Mbarara. But the familiarity of the hospital was pleasant as we drove down the road, ready to unpack our luggage and start a clinic. At the hospital, we unloaded what felt like countless boxes of supplies from the bus. Some unloaded them, some carried them in, and some started organizing and packing, creating a perfect system. The boxes slowly began to line the walls of the hallway and the rooms we were occupying, and when you try and fit 15 people in two rooms and a hallway with a bunch of boxes, it gets pretty cramped. As we finished up with the majority of the supplies, the truck containing more arrived, and the unpacking once again resumed in the same manner. As we unpacked, we would pass one another, with either a new box or an armful of some sort necessary supplies destined to the sorted and stored in the storage room by Sherron and Sherri, and one by one, the boxes emptied. While most of us emptied the bins, the doctors, Sydnie, Michelle and myself ran off to visit a few patients, and in viewing one gentleman, it was decided to do a surgery on him to clean an infection and perform a laminotomy (a surgery that relieves pressure in the vertebral canal). With the truck and bus now empty, we split into two main teams; Operating room (OR) prep, and a clinic team. Preparing the OR, we left Dr. Benton, Sherri, Sherron, Jason, Joel (who spent a good majority of time repairing the C-arm, which is used to take x-rays during the surgeries), Brian and Kari. For clinic, Dr. Hisey, Dr. Lieberman, and Dr. Villerreal seeing patients , Dr. Gorlick, Sydnie, Michelle, and myself (Adam) scribed for the three clinic rooms, while Dr. Kisinde, Dr. Kisitu, and Dr. Tuhumwira translated for those who could not understand. The day went by as smoothly as it can, when, you know, anything could happen at any time. Dr. Benton’s vaporizer blew a fuse upon being plugged in when testing it, so she had to adjust her plan for the rest of the week and use a different anesthetic gas than she initially planned. Other than that, OR prep went by well, with supplies being wrapped up and set to be sterilized rapidly, and everything being positioned and set up the way the teams would need them for surgery for the afternoon and following days. Time for surgery came about, and Dr. Villerreal left clinic to perform the surgery, where he left clinic and Dr. Hisey and Dr. Lieberman continued to run, with Michelle, Dr. Gorlick, Sydnie and I continuing to scribe, where an estimated 60 patients were seen through the entire day. As surgery occurred, clinic and unpacking continued for a few more hours until clinic wrapped up, unpacking was called for the day (with a lot more boxes, bags and bins still needing to be opened and emptied), and the surgery was successful. We left the hospital and returned to the hotel, where we had our team dinner before sharing lessons we learned for the day (everyday, no matter what, you should learn something). Afterwards, we split, some of us arm wrestling each other, and others passing out for the day, finally able to get a good night’s rest after so much travel and a long day of work, knowing another one was right in front of us. |