Today was the first long day of surgeries, but certainly not the last. We had one major congenital scoliosis case and a lumbar stenosis (narrowing of the spinal canal with compression of the spinal cord) case.
Our first case was a 9 year old boy name Eziekel whose about the most positive little human being you've ever met. He was a little nervous entering the OR but Joan (my Mom) helped calm his nerves with some coloring. Drs. Kip, St. Clair and Varley worked tirelessly and flaw lessly, with the support of the team, to perform a T6-L3 posterior instrumented fusion with a T10 hemi-vertebrectomy. This 7 hour surgery demanded all hands on deck. On the onset of the case we faced a C-arm (intraoperative xray machine) that is critical to determine which vertebrae to instrument. After making a substantial payment, this unit had just been fixed but now we had no idea why it wouldn't turn on. Brain Failla, our Globus Surgical Rep/ X-ray technician / circulator/ sterilization / handy man attacked this problem and discovered that someone had unplugged a cable within the storage battery likely looking for another substantial payment to fix it. A quick plug in and the C arm fired up like a dream. The case was truly a collective effort all the way through. At one point, Chris Martin, our neuro monitoring guy, caught a slip up that may have resulted in a major consequence - nerve compression resulting in a foot drop. When the patient became light on the table, due to anesthesia wearing off, he kicked his leg off and due to the drape covering him no one noticed. Chris's monitoring promptly detected this and we avoided what could have been a devastating injury to the patient. Joan, my fellow volunteer and mother, was busily filtering through the totes of medical supplies organizing the antibiotics, dressings, suture, gloves, braces, etc. in the storage room making it efficiently locate needed supplies straight away.
Sherron, our registered nurse, was expertly scrubbing with the doctors in the OR and assisting throughout the procedure. As for myself, I was given the opportunity to shadow Eric Varley, PGY 3 orthopaedic resident. I round with him in the mornings. My backpack has been functioning as a mobile medical unit stuffed with dressings, tape, antibiotics, gloves, scissors- and don't forget the hand sanitizer. Also, I kept track of all patient X rays. Eric has taught me to be methodical, accurate, and conscientious. He has driven the point home that years from now when our records are reviewed, everything must be legible, organized, and consistent-or all is lost. He is a wonderful example of all of those traits- and also a natural born teacher and now a great friend. Our team has blended naturally to become the seamless surgical machine it is.
Our second case was Musa, a 68 year old man with lumbar stenosis, epidural tumor and prostate cancer. We began the case with Dr. Kip while Dr. St Clair and Dr. Varley attended to the patella fracture we saw in the wards a day ago. Musa had multiple issues resulting from his undiagnosed prostate cancer which had spread to most of his spine. He needed a spinal tumor mass debulking, decompression of his spinal canal and instrumented fusion from T10-L1 following this ordeal the general surgeons came and performed an orchiectomy, yikes! Needless to say it was a much tougher day for Musa then any of us. Again the team came together in spectacular manner in order to overcome the obstacles that Ugandan hospitals pose and help this seriously sick man.
Our second case was Musa, a 68 year old man with lumbar stenosis, epidural tumor and prostate cancer. We began the case with Dr. Kip while Dr. St Clair and Dr. Varley attended to the patella fracture we saw in the wards a day ago. Musa had multiple issues resulting from his undiagnosed prostate cancer which had spread to most of his spine. He needed a spinal tumor mass debulking, decompression of his spinal canal and instrumented fusion from T10-L1 following this ordeal the general surgeons came and performed an orchiectomy, yikes! Needless to say it was a much tougher day for Musa then any of us. Again the team came together in spectacular manner in order to overcome the obstacles that Ugandan hospitals pose and help this seriously sick man.
Meanwhile, in OR 3, Dr. Varley and Dr. St Clair were operating on Julius, the 45 year old man who had a comminuted patellar fracture, courtesy of-you guessed it- a boda boda accident. After copious irrigation, Drs. St Clair and Varley repaired it with heavy sutures and repaired the damage to his knee joint capsule. Usually, or so I've learned, you have to keep the patients leg straight in a full leg knee immobilizer. Unfortunately, we didn't have one so as the surgeons worked I was tasked with heavily taping straight a hinged knee brace. The surgery went excellent though hot (there was on AC in this OR) and one of the Ugandan residents, our man Marvin, learned how to manage such an open injury. It was fascinating and saddening to hear that this type of injury usually requires an amputation and possibly death from a blood infection. It was again a reminder how important this work is and how gratified Marvin felt to learn how to manage such an injury.
Monday was a great day. We all really bonded as a team and were working together very well to serve the patients of lovely battered Mbarara. We left the hospital and arrived for a late night group dinner, where, Dr. St Clair reminded us of Dr. Lieberman's tradition of going around the table to hear each person share lessons they learned from the day. Each perspective was unique and insightful. We have repeated this tradition as the days have gone on and it is absolutely amazing how much has changed for us. Our investment in this place, respect for the people, and future plans to return continues to grow each day. We finished dinner just after midnight, after another rewarding, great day.
Quote of the day: He just made alittle incision, grabbed them, and pluu-mp! - Brian describing the orchiectomy he walked in on.
Monday was a great day. We all really bonded as a team and were working together very well to serve the patients of lovely battered Mbarara. We left the hospital and arrived for a late night group dinner, where, Dr. St Clair reminded us of Dr. Lieberman's tradition of going around the table to hear each person share lessons they learned from the day. Each perspective was unique and insightful. We have repeated this tradition as the days have gone on and it is absolutely amazing how much has changed for us. Our investment in this place, respect for the people, and future plans to return continues to grow each day. We finished dinner just after midnight, after another rewarding, great day.
Quote of the day: He just made alittle incision, grabbed them, and pluu-mp! - Brian describing the orchiectomy he walked in on.
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