This years blog has tried to capture the team 4 experience from varying perspectives of Chris (veteran neuromonitoring tech), David (college freshman volunteer), and myself – Eric (returning orthopaedic resident). Today was to be our busiest day yet. We had settled in just after midnight and fired it up at 5:30 am to get a good breakfast and get to the ORs as early as possible. The usual team gathered for our standard eggs/coffee/fruit with a side of Malerone (anti-malarial medication). I’d be lying if I didn’t see the fatigue from multiple days operating until late in the evening but everyone had their game face on, ready to make today a success. Today we had 6 operative cases, 2 operating rooms, 1 scrub tech and very little in the way of orthopaedic trauma implants. We started the day with Dr. Kayanja and I beginning a thoracic decompression and fusion for Jane, a sweet 54-year-old woman with likely infection. We continue to work and I broke to prepare for a pathologic left hip fracture while Roman (our other orthopaedic resident) scrubbed in. We had elected to place a sliding hip screw and plate (DHS) for Edward, a pleasant 44-year-old male with a history of prostate cancer. Back in the good ol’ US of A I would request the sets we need, the scrub tech would pull all the ancillary supplies (gowns, gloves, sutures, etc) and the case would take less than an hour. This case was to be a lesson in creative problem solving for me. I found myself pulling apart random unorganized sets of orthopaedic instruments and cobbling together a mix of instruments most of which dated from the Reagan administration. We also could not place the patient flat on their back (standard positioning) because the operating table could not have xrays shot through it. Chris, our neuromonitor and go-to-scrub tech joined me and lent his tireless energy and enthusiasm to the case. So with the patient laying on his side, Dr. Kayanja joined me and began an odessey of a procedure. The drilling instruments we had were about as sharp as a butter knife and we alternated cleaning the drill and spraying sterile saline across it to cool down. To complicate matters, the patient had blastic lesions from his prostate cancer to his hip, which made drilling through them equivalent to drilling through cement with a blunt tipped steel pencil. I was deeply impressed as Dr. Kayanja and I worked through the case at how cool and collected he was. Dr. Kayanja is a veteran of Uganda orthopaedic training and his skill and improvisational techniques were in full display. We successfully completed the case after 4 hours, agreed that would be the last DHS we were going to attempt to place, and drank 2 liters of water to rehydrate from the hottest OR case I have ever experienced.
In concert with our efforts, Dr. St Clair and Roman began another spine case for a hard-working 65-year-old man named Elias who required removal of the back portion of the bone of his spinal canal to relieve pressure on his nerves. This case went well and we continued the rest of the day accomplishing revision of a posterior fusion for a 70-year-old patient Ampaire as well as a above knee amputation for a severe leg infection of a sweet 5 year old girl Anne. Its hard to capture just how well we all worked this day, if ever there was a doubt as to our ability to function as a team today put it to rest. We were constantly running into obstacles and frustrations from lack of instruments to temperamental equipment to the lack of personnel. However, all these obstacles were overcome as everyone took on multiple roles to serve our patients. Drs. St Clair and Kayanja focused the team and orchestrated this complex dance of seeing additional patients in the waiting room to making sure the patients we did have actually arrived for surgery. Chris upped his game and helped us trouble shoot as a scrub tech, Sherron became the circulating scrub tech who always had a creative solution to our lack of materials/resources, David became our xray and back up scrub tech, Roman and I dug through old sets of instruments to creatively assemble our implants, and Lance literally ran from room-to-room as the ultimate jack of all trades OR staff member. We were also blessed to have Stan, the absolutely tireless Mbararra surgical resident whose indomitable positive attitude and attention to detail made this entire day a collaborative success. By the end of the day we were all running on fumes but riding high knowing what we had accomplished. We headed back for another 11 pm dinner knowing just how much we had accomplished and grateful to one another, we were all in the zone together and nothing stopped us from achieving our goals.