Instead of the typical, calm, relaxing morning, it was a bit rushed for some of us. Since Dr. Huang, Alexis, Megan, and a few others went clubbing, they returned rather late. Most of them were able to get up, except for Dr. Huang and I. The plan was to meet around 7:00 AM to eat, take our stuff to the bus, and leave to pack everything at the hospital and do one final round of patients. However, things, as we've learned, don't always go as planned. A little past 7:40 AM, we started getting texts, and a knock at the door, as the two of us failed to wake up (and we didn't really pack, either). I don't think I've ever seen two people throw their belongings in a suitcase any faster than that morning! We went down to meet Dr. St. Clair, where we quickly ate some breakfast while waiting for the bus to load our stuff and take the three of us to the hospital (the others had already left to head there).
Our arrival was at the hospital was bittersweet, as we knew this was our final day. While Dr. Huang, Alexis, Stanley, Dr. St. Clair and I ran quick rounds, the others all remained to pack up some of the supplies, such as the instrumentation, to be sent back. The rest of the supplies were being left so the hospital could use them. Patients were doing well; many had left, we had plans to discharge others, like Gudena, Gertrude, and Wilber. A few others were going to remain a little longer to make sure they were ready to return. Once done with rounds, we regrouped with everyone, and finished moving supplies and grabbing anything we weren't leaving behind. We said our goodbyes, took one big group picture, and boarded the bus to depart. The bus ride was long, filled with naps, and had a nice stop to look at the equator (and do a little bit of shopping for souvenirs!). The break to stretch and walk was much needed, as we took a solid 30 minutes walking around, buying things, and watching the demo of the Coriolis Effect (the idea that water spins in a different direction in the northern and southern hemispheres, and on the equator line itself). After more driving, we arrived in Kampala at Khyber Pass for one last fantastic meal in Uganda, as we drove to Entebbe for our flights out. Much driving and a few hours later, we arrived at the airport in Entebbe for our flights to begin the long trek home. Knowing we'd see each other on a layover in Amsterdamn, we all boarded, knowing the long trek home was just beginning.
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The last day of operating was filled with mixed feelings. On one hand, we were all ready to begin the journey home to our families, but on the other, we were disappointed to leave those who we met for the first time and returned to. But, our focus today was still our patients, and on tap for the day, we had a moderate day planned. Four women; Judith with a tumor removal, Mary K with a lumbar decompression and fusion, Madrine with a decompression, and Mary M with a total right knee replacement, and one gentleman named Emanuel for a cervical disc fusion. In addition to these five, we added Wilber from the previous day back in, so we could adjust his halo, place him in the halo vest, and add some more traction in the desired way to continue to attempt reduction. With these cases in mind, we ate, made some plans for the evening (We have to have some fun out!), and headed towards the hospital.
With so many patients leaving from prior days, rounds became much quicker. With our first stop in the ICU to check on the previous day's patients who stayed the night (Justine left the same day), we visited Night, Deus, Gertrude, Monica, Mary, and Nataria. All of them were doing well, but per the usual complaint, told us of a significant amount of pain, to which each was given painkillers and muscle relaxants. The other patients remaining were scattered throughout the hospital; some in the ER, some in the surgical ward, and others in the private ward. We start with Wilber, telling him he'll be getting another x-ray to check the reduction, and to prep him for the afternoon when we get to him. Other patients, such as Gilda and Perepeta (from Monday) were discharged, and Julius (previous Tuesday) was transferred to the TB ward to receive more treatment and to be discharged. With the other remaining patients checked on, we returned to the OR to aid in the surgeries. While the fusion and decompression cases went by relatively simply, they still took time to complete, and the tumor removal and total knee took a significant more amount of time than we were all anticipating. We wanted to be careful and thorough in our work, and these cases were pushing us to be extra careful. Time seemed to inch past as the cases were worked on and slowly completed. The tumor was positioned in a strange way, and we had to remove all (or as much as we could); the knee is simply a procedure that takes time. Then, the ACDF (the cervical fusion) took a time due to us attempting to place certain sized screws in place. Dr. Huang took the lumbar fusion, the decompression, and ACDF, while Dr. St. Clair completed the excision and biopsy of the tumor, and the total right knee replacement. The cases ran into the late evening, and I'm talking late evening... 10:00 pm late, with a 7:30 am start time. Everyone was doing something while surgery was in progress. As Dr. Huang was finishing the ACDF, we had Wilber wheeled in for a quick adjustment to his halo and the placement of the halo vest. With the x-ray he got that day, we could see significant reduction, but we wanted more, or we'd fuse him. After many x-rays, moving him around, and placing a rolled towel under him, we got the desired x-ray, celebrated a successful reduction, and sent him back to the emergency room where he was originally. 11:00 pm rolled around, and Dr. St. Clair was still doing the knee replacement. Those of us not involved in that surgery had prepped our stuff to leave the following morning, and were waiting so we could all go eat as a team (He had the smart idea of calling ahead a reservation and our orders!). So, we came to the decision to split up; some of us would go ahead to the restaurant, and the others would go when the case was completed. Dinner had the same bittersweet feelings I've come to know; It was nice to know that we made such an impact on so many people, but sad to know that it was time to leave all those I've come to know here during the two weeks I spent. We all talked about things we've learned during our time, and our hopes for the future. Thanks were given, from everyone for accepting us, and teaching them. We took our time eating, and once we were either finishing or passing out at 1:00 am, we split into two groups once again; While three of us returned to the hotel to pass out, the others, such as Dr. Huang, Dr. St. Clair, Stanley, and others all remained behind to go to the upstairs club and enjoy their last night together. Thus ended our last day of operating. The night prior, we planned six cases for the day; Four fusions (on four women named Nataria, Mary, Monica and Gertrude), a soft tissue removal (a gentleman named Deus), and one simple decompression (a patient named Night), but none of us were quite prepared for the eight cases that actually came to be. Breakfast was, as per usual. Team all together, discussing the day, but with more focus this morning on who would be in which OR with who, what cases they'd be doing, and the time we expected each case to take. But, life is full of surprises.
At the hospital, Natasha, Alexis and I all ran rounds, and as patients were being discharged, rounds became faster. At the start of rounds, we picked up a new case in the emergency room when checking on our first Halo patient; another cervical fracture, this gentleman (named Wilber) was neurologically intact (meaning he could move all limbs and extremities, showing no spinal cord damage), and was a candidate either for a surgery or another Halo. Dr. St. Clair recommended, since he's a young patient, to attempt the Halo first to keep as much of his range of motion as intact as possible. Meanwhile, all the patients from the previous day (Allen, Victor, Gudena, and Mary) were doing significantly better, with all of them being able to stand up, and three of them were able to walk a short distance. Patients from previous days such as Annah from one of Friday's cases, and Bernard from the week prior's Wednesday, were all able to be discharged home. Other patients had to remain a few days longer, just to see continued, desired improvement. Julius started a much stronger recovery now that the antibiotics had been working for a short period. With rounds over, and all our patients checked on, the three of us made our way to the OR.There, the cases had already begun, with the cases starting in three rooms (we'd later go down to two rooms this day, which has been standard for us); We'd handle two of the fusions, while one of the local doctors handled the mass removal (which, due to the nature of the mass, resulted in an amputation of the arm). With these cases underway, the three of us from rounds parted ways to go where we were needed in the rooms. The fusions, thankfully, were small fusions, ranging from a simple one level fusion to a three level fusion. But, each fusion takes time to complete, as you don't want to rush and accidentally lead to damage. As time passed, each fusion passed, and close to mid afternoon, we'd finished all the fusions. Between the fusions and decompression, we placed another Halo on the emergency case, Wilber, in an attempt to begin a reduction (it was also an attempt to avoid surgery). With the halo quickly completed, we added some traction to aid in the natural reduction and then we moved onto the decompression, and during this, we had another case appear on us; a young woman named Justine, who had severe pain in her hip. While Dr. St. Clair took care of the decompression, Dr. Huang did a quick steroid injection in her joint. Prior to the injection, she complained of severe pain any time she walked, but once completed, she was immediately able to walk comfortably. The day came to a close late at night, and exhausted, we all headed out to eat dinner. We knew the day was going to be long, and with all the patients treated, it felt like it took a century to complete. But, we were all extremely satisfied with our all hard work... and utterly exhausted! As we called it a night, we thought about our upcoming last day of operating, and the patients we could once again make an impact on. |