​Our first mission trip to Uganda began at LAX Friday evening November 2nd with an eventful hunt for a missing suitcase, which included essential medical supplies. Tensions were high to say the least, however, after careful scouring of the Tom Bradley International Terminal the missing supplies were found, and we successfully checked six extra-large plastic bins and multiple suitcases that were over capacity, but we were not charged—WHEW!  Breathing a sigh of relief our group of eight, which includes Dr. Tiffany Perry, Dr. Ryan Kotton, Dr. Zachary Barnard a 5th year resident, Andrea Searcy the scrub tech, Max Yue the Medtronic representative, Pamela Mikkelson our physical therapist, Cindy Litman an RN and myself Rhondine Jordan the academic assistant proceeded to our departure gate headed for Istanbul, Turkey.  Twelve hours later we landed in Istanbul followed by seven hours to Kigali Rwanda and finally arrival at Entebbe after a twenty-six-hour excursion.

​While traveling is always an endeavor, coordinating checked luggage, international visas, Ugandan medical licenses, and immunization records for a team of eight adds an additional layer of anxiety to the process. Is everyone prepared with their documents? Will we be held up at customs for any reason?  What will we do if that happens? The questions were extremely nerve-wracking, but our team was absolutely prepared, and the journey went on without a hitch. Upon arrival in Entebbe our driver Isaac stood outside the terminal with a sign that said, “Uganda Spine Camp Team, Dr. Tiffany Perry” and he ushered us into a twenty-eight-passenger bus with our luggage in tow for the four-hour bus ride to Mbarara Uganda.  After making a pit stop at the Ugandan Equator for a bathroom break and snacks our team boarded the bus once again for our destination completely exhausted but totally excited about our mission ahead of us. Exhausted, the team vacillated between periodic naps and absorbing the beauty of the country side in a country we were all experiencing for the first time except for Dr. Tiffany Perry our groups seasoned veteran on her second mission in 2017. 

​You would think that after twenty-four hours of continuous travels and lack of sleep we would embrace our hotel rooms and call it a day until Sunday, however, that assumption would be completely wrong.  Instead, this dedicated team of eight quickly dropped off our luggage and headed directly for the Mbarara hospital to unpack our multiple bins of medical supplies and survey the hospital for surgical evaluation.       

​After swift teamwork the medical supplies were unpacked and organized into groupings and ready for any surgical procedure. Did I say I was proud of our team? And I am not biased, believe me.
 One last endeavor remained before our day would be considered a complete success and that would be clinical rotation.  Our fearless leader Dr. Tiffany Perry alongside Dr. Barnard and Dr. Kisitu evaluated multiple patients experiencing a range of spinal complications, they reviewed available images and decided that two urgent cases would be on tap for Sunday morning OR.

Can I just say that today was an extremely long day but well worth it in the end, two cases will be on the docket tomorrow so stay tuned for the magic!
Our day would not be complete without delicious Indian food, and our group enjoyed every morsel. 
 
Yes, all of that happened on our very first day.  Go Team!!

​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.

​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.

​At this point, I won't bore everyone with the typical morning details of a team breakfast; It's always just us eating, chatting, and cementing the plan for the day. Reminding everyone of who's in what room, the patient we'll be operating on, and the operation.

At the hospital, Alexis and I went on rounds, accompanied by Natasha, as we checked on patients from all the days prior. Gilda and Perepeta from the previous day of operating were doing significantly better, and each was beginning to move, and had the usual complaint of discomfort and pain. Abdu, the halo, was doing well, and reported some discomfort in the chest. We explained to him it's to be expected, as the halo vest is applying some pressure, and we sent him to get some x-rays for the day. Previous patients, such as Moses from Saturday, Jacinta from Friday, and Denis from a week prior, were all going to be discharged due to their well being or significant improvement. Others remained, due to long distance to travel, then the need to return, or they simply weren't quite ready to be sent off. Julius, from one week prior, unfortunately, in addition to his TB, developed another infection, and had begun treatment via IV and had to remain a few days longer so we could see the antibiotic doing it's job.

The OR had four cases planned for the day; Three women, Allen, Gudena, and Mary all had similar operations set for lumbar decompression fusions, and we had a man by the name of Victor set for a corpectormy and cervical instrumentation and fusion. In terms of length, we had a moderate day set before us. Each case, while time consuming, went extremely smoothly, leaving us with most of the evening to plan the next day of operating. The next day of operating, however, wasn't going to be nearly as short; we were planning six separate cases for Wednesday, but things never quite work out how you expect.

With operating done for the day, and the following day planned, we returned to the hotel, anxious to eat and get some well deserved sleep for the day, knowing we were planning many surgical cases for the following day.

Every morning is an early morning with a team breakfast. 6:30 am rolls around, and we all begin to trickle down from our rooms to eat and plan the day in more detail than we did the day before; two fusions were planned for the day on a woman by the name of Gilda, with a fusion planned from L2 (quick note: the spine is split into 3 main regions; cervical, the neck, thorassic, the middle of the back, and lumbar, the lower back. Each is abbreviated using the first letter: C, T, and L) to her pelvis, and another woman met in clinic the week prior, Perepeta, with plans to fuse her from L4 to L5. Not a difficult day, and with, both Dr. St. Clair and Dr. Huang operating at once in different rooms, it should be a short day by comparison to others. However, things are never quite what you'd expect.
We arrive at the hospital, where Dr. St. Clair and Alexis join Dr. Huang, Stanley, Natasha and I on rounds, where they escort us to the emergency ward for a consultation that had come in; a young gentleman in a boda boda (it's similar to a motorcycle) named Abdu, who had fracture located at his C1/2 vertebrae, and in addition, he was unable to move one of his arms. So, we quickly made a plan to place him in a Halo, which is supposed to keep his head still and prevent movement, so the bone can move back on it's own as much as possible, and heal on its own. A surgery is possible in this case, but would cause a severe loss of neck movement. So, we added this case to the day. The other patients were all continuing to do better; patients like Godson were going to be discharged, while others like George and Jolly were already gone and out on their own, having been discharged over the weekend due to such rapid and successful recoveries. After this patient, Dr. St. Clair and Dr. Huang left to the OR to finish getting ready for the day.
Rounds continued while surgeries were prepared for and started, with those of us on rounds arriving shortly after both incisions were started. Alexis and Stanley both went to scrub in, while Natasha and I took care of patient files and prepping the surgery schedule (as much as we could without Dr. St. Clair's approval)! Both Gilda and Perepeta were being operated on at the same time in different rooms, and with so many people wanting to learn and be a part of these surgeries, Alexis and Stanley came out for a break. We chatted over more of Sister Rose's homemade samosas, and went to go look for the halo going to be used on Abdu.
After a little bit of searching, we found a box filled with halos and halo parts, there was one problem however; we could tell which pieces went to what, and if we had everything for the halo and halo vest (it pushes down on the chest with rods, keeping the halo in the desired position). So, with each of us filling our arms, we took the parts into the doctor's room, and got to be engineers for a few minutes as attempted to build the halo and halo vest (which, was successful, by the way)!
Both surgeries went through with no difficulties; the patients were stitched up, covered, and sent to the post anesthesia care unit (abbreviated PACU), and Abdu was sent for. He arrived, and planned for the halo and vest. The halo has 4 screws used to hold it on the patient; 2 screws carefully placed above the eyebrows and slightly off center to prevent from hitting a nerve, and the other 2 screws are placed 1 above each ear; the halo is then attached via rods to the vest to maintain the desired position. Local anesthesic was injected into the pin sites, and we began to insert the screws into the halo and the patient, and quickly set up the vest on him. The whole process took maybe 30 minutes, and we sent him back to the ward.
The day was rather short, so we returned to the hotel, where we all changed, played our favorite pastime, Jenga, ate and drank, and enjoyed each other's company. Thus, ended the first day of operating with Team 2.

Saturday morning. Bittersweet as we of Team 1 share our last breakfast together before everyone leaves Dr. Huang and I behind to join Team 2 as they go to a conference in South Africa. We recall the events of the week and the one case planned for the day over our usual breakfast, and laugh as we recall Brian tearing his pants multiple times, and the severity of each tear.
We planned for rounds and a single case today, a cervical fusion on a gentleman named Moses; this would give us enough time to visit all the previous patients, the new patients from the previous day now in the ICU, participate in the surgery, and pack supplies so Team 2 has enough space for their supplies. Patients were all doing well; many were close to leaving, such as Medias, Denis, and a few others. The patients in the ICU were all reporting pain and discomfort (to be expected), but were all able to sit up and move, and thus, they could be moved later in the day from ICU to their respective wards.
The case on Moses was quick; no power outages, no surprises, nothing. A peaceful way to end our last day; Then, the packing. All our equipment needed packed up and set in another room for pick up at the end of week 2, as the incoming team has their own supplies.
Time passed, and the sad realization hit that this was it; they were leaving. We returned to the hotel, with Stanley, giving everyone departing a chance to grab their bags, have one last drink together, and take a group selfie. After some sad goodbyes, everyone piled on the bus, leaving Dr. Huang and I behind. Team 1, thanks for a fantastic week!
The rest of the day for Dr. Huang and I was filled with many much needed naps, food, drinks, and more naps before we successfully called it a night, waiting to meet all of Team 2 upon their early morning arrival during breakfast.


Sunday, and Team 2's arrival. There was mention of it earlier in a different day; there is no sleeping in, only early mornings with doctors. Team 2 arrived at 6:00 am, so Dr. Huang and I went down for a 6:30 am breakfast to meet and greet them. Team 2 consisted of Dr. Selvon St. Clair from ?, ?, Sherron Wilson, an RAN (resident nurse) from Florida, Alexis ?, Dr. St. Clair's personal assistant (PA), Megan ?, from?, Bogdan Popa from Safe Passage Neuromonitoring, Chris Gutman from ?, as the Medtronix representative, and of course, Dr. Huang and I. We are and chatted before deciding that some sleep would be beneficial for everyone, and parted ways.
Noon rolled around, and we all headed piled on the bus, medical supplies on board, to unpack and get situated in the hospital, in addition to prepping the surgery schedule for Monday and doing rounds to introduce patients to Dr. St. Clair. We met a few new surgical candidates while we walked, and checked on all the post op patients; each one continuing in their improvements.
Once finished we finished unloading everything, we left to reserve a table for dinner at Igongo, and then made our way to Lake Mburo national park in order to get on a boat to view hippos and crocodiles, in addition to the other animals, such as warthogs, monkies, zebras, and gazelles. But, it was in this park some of us learned a valuable lesson; when nature calls you behind a bus, make sure there are no other vehicles approaching from that direction!
Unfortunately, we missed the boat by only a few minutes, so we turned around to a small trinket shop, where most of us bought souvenirs, either for ourselves or friends and family. Following a successful shopping spree, we returned to the restaurant, where we ate and were merry.

A typical morning, as usual. A workout for some, an even earlier morning for others, and sleep for the rest of us. We discuss the plan for the day over breakfast; a challenging and long fusion on a teenage girl named Jacinta,  another fusion and decompression in the cervical region (top of the spine, below the skull) on a gentleman named Elias, and a third fusion and corpectomy (removing part or all of a vertebrael body) on a woman named Annah. Doesn't sound like a lot, but we were planning on staying late.
At the hospital, we split as we normal do at this point; Dr. Huang and I leave to do rounds, while the others all prep the operation rooms and begin. The two patients who stayed overnight from the previous night, Jolly and George were first on our list to check; Jolly wasn't doing as well as she had hoped, and told us there was a numbness in one of her arms, but after a quick exam to check her neurologically to see if there was a problem, she had great strength and no difficulty resisting or pushing us when directed to. George, however, stated he already felt like he was doing better, and his reported pain before surgery was diminishing. After directions to both patients to begin walking, we departed to check on everyone else in the surgical ward.
All of the patients in the ward were all beginning to do better; some, like Norah, were close to being allowed to leave the hospital. Others, like Julius, had smaller improvements. He was begging to move his legs, and was getting close to moving, but there was concern over a possible infection in addition to his presumed TB; it was hard to make a decisive call, as we were still waiting on cultures (some infection was removed and allowed to grow in a controlled environment to determine what it is) to be certain. After some antibiotics were given, we made our way to the OR.
The OR was already busy; Dr. Lieberman and Dr. Perry had already begun operating on Jacinta and Annah, respectively. We all expected Dr. Lieberman to take a significant amount of time due to the condition of Jacinta's back, and thus, the two other cases were given to Dr. Perry to complete. But oh boy, did it take a while.
When we started at close to 8:00 am, there were some guesses about how long the one fusion would take; 6 hours, 7 hours, 9 hours. Deep down, we all knew it'd be a while, but having it take a little over 9 hours is absolutely exhausting for all those who worked on it. With the condition of her spine, it was challenging to correct, as a sudden correction caused Kerri's equipment to repost a lose of motor function. So, slow, gradual changes are the way to go, but, after a significant amount of correction, we were all extremely thrilled. Meanwhile, Dr. Perry completed Elias with almost no difficulty, but Annah was taking longer than we all expected, due to an infection, adding a slight challenge to the case as we had to be thorough in cleaning it out. Between cases, however, for the 3rd time this week, Brian somehow managed to tear his pants once again, hopefully learning the important lesson that paper scrubs aren't very efficient when you're doing lots of manual labor and moving a lot. You think he would have learned this after the second time!
Both cases finally finished around 6:00 pm, with the each patient being closed at approximately the same time. But, after doing such long surgeries with so many small tools, both being finished at the same time, cleaning, sterilizing and preping of tools takes about twice as long. While Brian cleaned, Dr. Lieberman did a short hallway clinic, and the rest of us lounged around in the doctor's room, half asleep, waiting for a warm dinner.
As Dr. Lieberman finished the clinic, Brian was close himself to being done, the sun was gone for the day. 8:00 pm, the time we were leaving. Exhausted, worn out, satisfied with the work, and hungry for dinner. After dinner, we laughed and talked, enjoying our last night together as Team 1 before everyone left Meng and I the next day.

Day 5: Where’d that Patient Go?
As a premed student, there isn’t much I (Adam) can do in the operating room, but I’ve found other things to do. Taking notes on patients and keeping electronic copies of their records on a laptop, keeping track of possible surgical candidates, and probably the most important thing, keeping an up-to-date surgery schedule. Now, I’ve had no training and caught on fast on what to do, but Murphy’s Law caught me off guard, you know that line “Whatever can go wrong, will go wrong”? I made the mistake of almost forgetting it.
The day was going to be a good length; not long, not short. Four cases were planned; the removal and biopsy of a mass on a girl named Rebecca, an ACDF (Anterior Cervical Diseconomy and Fusion; it’s done remove bad disc [padding between vertebrae] and fuse the bones together) on a woman named Jolly, a decompression on a gentleman named George, and a simple injection to attempt to alleviate pain on another man by the name of Nehemiah.
Dr. Huang and I went on rounds again, visiting patients from all the days prior we had operated on. Wednesday’s patients, Bernard, Norah, and Medias K, were all feeling some post-op pain (to be expected), but doing alright. Derick, with his prior condition, could not communicate to us, but his parents stated that they saw improvement already. The patients from days prior, Denis, Medias, and now Godson, were all beginning to do even better; some saw larger improvements than others, but none the less, all were improving. Julius, however, was beginning to complain of a new pain in his hip, but his strength was okay. It was at the end of the rounds, we noticed a patient we had seen prior to the clinic, a boy with head trauma and inability to move his head side to side or forward, had returned, with the MRI we had requested to check for spinal cord damage. We spoke briefly to the boy, Antony, took the MRI and planned to look at it with Dr. Perry.
As usual at this point, we headed back to the OR, where we went our separate ways; he went to join those performing surgery, while I checked on both operating rooms, and inform Dr. Perry that the boy’s MRI was in my possession. Not long after I told her, she finished her decompression, and looked at the MRI, noting nothing unusual; the spinal cord looked perfect, and gave me directions to tell him; he could come out from the collar he was in, take muscle relaxants, do physical therapy, and no contact sports for 3 to 6 months because of a concussion as well.
I searched for Natasha, and together we went to inform Antony and his mother, as well as ask physical therapy to start working with him. They came, and feeling uncertain about working with him, asked us to take him to their neurologist, who then cleared him, saying there was no damage he could see either, but he should hold on the physical. We spoke with the family a little more and discharged them.


Natasha, who’s in charge of the surgical ward and prepping patients for surgery, and I made our way back to the OR when she informed me that prior to this, she was having difficulty finding Rebecca for her surgery. I was confident we’d locate her, no problem. I headed into the OR with Dr. Lieberman, thinking he’d be only halfway done, only to discover that, no, he was close to done. Oh boy. I checked on them and quickly left to find Dr. Stanly Kisinde, a local doctor who was very close to the team,  to see if he if had any idea where the girl was only to discover that he, too, was searching for her. He told me to wait before I told Dr. Lieberman, and quickly called the contact info we had, only to discover she wasn’t here.
Okay, okay. Now to tell Lieberman.
I head into the room I know Lieberman is in, only to see him walking out. I inform him that she wasn’t present. After a short discussion between doctors, it was determined that we’d simply move up the 4th case for the day, the epidural injection. In addition to this whole fiasco, Sherri, who was scrubbed at the time began experiencing some stomach distress. Dr. Perry quickly came to the rescue and assumed the role of scrub tech until the case was completed.
With everything under control, I went to watch the injection, but had to leave early to assist in prepping the surgery list for the following day. Natasha and I spoke again, giving each other information, and getting the status on the x-rays. She calmly informed me that one patient is unable to get their x-ray, as they can’t walk. We discussed possible ideas and parted ways. I met up with the rest of the crew at the end of an early day, and waited for Brian, who wasn’t feeling very good, (we believe he caught a cold from the draft wafting through his torn disposable scrubs). We went to finish prepping the tools for the following day. Once wrapped up, and patients tucked in, we went out to an early dinner. We again shared our lessons of the day, from which Brian and Sherrie (who was feeling better at this point) provided the back to back, quotes of the day, which caused us all to burst into laughter.
Our quotes for the day:
“There are no sick days in spine.” Brian Failla
“You’ve gotta know when to tap out.” Sherri LaCivita

With an early dinner in our stomachs and returning to the hotel, we decided to once again play Jenga, as Dr. Perry had never played Jenga. Work hard, play hard, you know? And let me tell you, playing that game with three surgeons is the most intense way to play it. We split into teams, Girls (Sherri, Kari, and Dr. Perry) VS Boys (Dr. Lieberman, Dr. Huang, and I), and thanks to Kari “Oops” Zagar, hitting the table with her knee in the All-Or-Nothing game, boys took it 3/0. Thanks Kari!
It was after this, knowing we had a long day on Friday, that we decided to call it a night and get our rest. We knew we’d need it.

Day 4: Now Begins the Long Days
One of the simple pleasures of this trip thus far has been having breakfast together every morning; Eggs, maybe French toast, sausage, tomatoes and tea. We laugh every morning and simply enjoy everyone’s company before we begin the work we came here to do.
Wednesday. We’ve finally completed the two days of clinics, seeing everyone in the clinic, sending some for new x-rays and MRIs so we could reassess them, and setting up the surgery schedule. Wednesday is when it picked up; four cases. Fusions, decompressions, revisions, and a neurosurgery case for a brain tumor; from this day to the end of the week, long days of surgery are planned.
Dr. Huang and I go on our rounds to check on our patients, with Natasha, a local general surgery resident assisting us in locating our post-operative patients in the wards and ICU [Intensive Care Unit]. We began with the three patients who had surgery the prior day; Medius, Godson, and Julius. Medius was doing well, and was able to stand up with some assistance, and take a few steps, however, she complained of a little discomfort. Godson was doing slightly better than before, as he complained of significant discomfort and pain, and was unable to stand at the time of us doing our rounds. Julius was doing well and told us of some discomfort from his surgery as well. The discomfort from every surgery is to be expected, as these are all major surgeries, and some irritation and pain are always anticipated.


Once finished, Dr. Huang and I make our way to the OR for today’s cases, which are already in progress. By the time our arrival in the OR, Dr. Perry had already finished the decompression on a woman named Norah, and was preparing for her neurosurgical case to relieve the pressure on the brain. He would do a biopsy on a brain tumor to determine truly what the tumor is. Dr. Huang quickly went to join them, while I headed to the other operating room (We had two rooms running at once to try and help get more cases done). Inside the second room, with Dr. Lieberman, they were performing a fusion on a gentleman named Bernard, who also had TB. Both cases going on at this point, the biopsy and the fusion, took many hours to complete.
During the hours these cases took place, I rotated between the two rooms, checking on everyone, but spent most of my time in the neurosurgery case, watching how it took place, and the tools used. The thing that stood out the most from this case, excluding the fact that it was neurosurgical, was the scope used. It differed greatly from the ones used in the States, and took some time to set up, adjust and prep. The case itself, however, went smoothly. In fact, all the cases went exceptionally smoothly, they were just taxing in terms of length.
We had a short time between cases to rest and grab a bite from the food provided by Sister Rose; warm bread and samosas. It was a fast lesson to everyone that the samosas should be consumed quickly before I could get to them, as I’d easily eat six or seven (and I had!). It was during this time though, when we glanced at Brian, that we had once again noted he tore his pants. Once, we could tolerate, but twice only proves that Brian has no inhibitions!
The last case was a revision on previous instrumentation done elsewhere that had not fused to the bone on a woman named Medias K. Her case, like the others went smoothly, as anticipated the screws and rods had worked their way loose and were simply lifted out of the surgical wound. It’s important to note, that instrumentation is not often removed, and should not come out in one piece, but should be disassembled.
The day ended at close to 9:15 PM, and eight fatigued men and women all piled into the bus very satisfied with the days accomplishments. Dr. Gorlick, being the intelligent man that he is, had called ahead and ordered the buffet for us; Chicken, fish, pasta, vegetables, and potatoes. Let me tell you, there isn’t much better than arriving at the place you’re staying, and knowing there’s warm, delicious food waiting for you. We ate, laughed, shared our lessons of the day, enjoying the food and everyone’s company once more.