Uganda, Day Five, 8/15/07

I guess it's true that the harder you work, the faster the day goes by. Well, we needed that to be true today. It was another long one. I scrubbed a few cases, and one of the nurse anesthetists actually let me intubate a patient! The off-the-wall new experiences just keep coming. If you had warned me ahead of time that I might be seeing or doing or just being in the same room as some of these events, I'd have called you crazy (among other choice words), and would mostly likely have tucked-tail and run from the trip like a present-day John Mark (an early-church missionary who left Paul and Barnabas to return home to Jerusalem, Acts 13:13). However, on this day, I'm afraid that I've been jaded by such experiences; they've stopped seeming so earth-shattering, so incredible. But, having returned home, sinking backwards into old routines, I have a hard time wrapping my mind around all that happened (and continues to happen) there.

We've all begun to experience the different approaches of those at Mulago looking for "help." ...Not medically speaking, but help nonetheless. Some come in the form of letters, others come right out and ask without inhibition. Today, I was having a snack in the "tea room" when a young man came in and started making small talk. Before I knew it, he got up, looked around, and closed the door to shut us in. I was a little aprehensive to say the least, but that's when he began to pour his heart out to me.

"Please come and meet my family! Just 10 minutes!" he said. "You could walk to my home on your break and meet my wife and son!"

I knew then what he wanted. I would end up meeting his family and becoming attached. He might be able to use this attachment in a desperate attempt to get them over to the states.

"I am a very good worker...I can clean, scrub, fix things...I work very hard."

I felt so awful. I knew there was nothing I could do to get this man and his family to America.

As for the cases, they went well. I got to scrub a spine case with Dr. Haglund: a posterior cervical decompression and fusion, C3-7. (I'd been doing mostly general neuro cases in the pediatric theatre until now). I had brought a ton of spinal fusion hardware--instruments, implants, allograft, etc.--and I was finally getting to use it in surgery. This was so weird; in the states I'm only allowed to point at things and tell the surgeons and scrub techs which instruments they needed. I end up "miming" the way the instruments are to be used with my hands. By no means could I EVER scrub in or contaminate the sterile field as an OR consultant in one of my hospitals in the US. There was a little voice in the back of my head saying, "You're not supposed to touch that drill guide!!! What are you doing?!?"

The cases went well, but we were so tired when we got back. I felt terrible for our folks in the ICU and for Senthil, our PA, and for our surgeons. They still had hours to go.

Uganda, Day Four, 8/14/07

Three more cases today. I took over Jean's circulating duties on the first and third cases and scrubbed the second. Things are starting to seem more normal, more routine.

On our second case, I found myself in a teacher role--showing the Ugandan scrub nurse how to do something I had just learned two days ago. Many of these nurses have scrubbed general surgery cases before, so a lot of this was nothing new to them. However, most had not done any neuro cases, so most of the instruments and techniques were kind of new and unfamiliar to them. They were so eager and excited about learning this new trade. I was pretty tight with my new comrades: Amina and Haba Tom.

Dr. Ali Zomorodi (theatre 1) had a remarkable case today--heroic is probably a better word. One of his patients--a young boy, maybe 4 years old--had an abscess on his brain stem causing paresis--or near paralysis--on his left side. Before surgery, he was flaccid and paretic, but after Dr. Z meticulously removed the abscess, little Nelson came out with almost full motion! When his mother came to PACU to see her son, she was beside herself!...and with good reason. She had never seen him move his left arm, and here he was, reaching to her with both!!! We all basically had to stop whatever we were doing and just absorb the moment...got some good pics of this one.

Thank goodness, we got out at a reasonable time. We hit the pool, got a nice dinner, and finally felt like we could relax and enjoy each other's company without anyone's conversation being interrupted by pagers or anesthesia alarms.

Uganda, Day Three, 8/13/07

On to the theatres! This would be our first day of cases, and my first day scrubbing--ever! I would be stationed in Dr. Stephen Parker's room along with my roommate and our fearless PA, Senthilkumar (Senthil) Radhakrishnan. Augusta Bartis and Jenny Parker (Steve's wife) would also scrub with me, and Augusta's mother, Jean, was our "circulating nurse." I doubt anyone will ever know just how much work Jean Bartis did behind the scenes in preparation for this trip--a true saint.

Our three cases for the day were all hydrocephalus patients--all very young--around 6-7 month-olds. The first two needed shunts, and the third would receive an "EVD" or an external ventricular drain to relieve the intracranial pressure caused by excess cerebrospinal fluid. I ran the table on the first two, and was "first-assist" on the third (taking Senthil's place on this one--he was needed in another room). This first assistant helps the surgeon by suctioning the wound, cauterizing bleeders with the bovie--or "hot knife"--and bayonette instruments, holding retractors, helping with sutures while closing, applying dressings (xeroform, gauze, op-sites), etc.

The pediatric theatre had no air-conditioning, but the doctors were fine with this because ped's rooms are supposed to be hot. Patients lose a lot of body heat via the open wound during surgery. Warm blankets fed by a heater can help, but with the little kids, you really need to be careful because of their tendency to lose body heat faster than adults--hence the need to "keep the heat on." I didn't realize how much of a difference it made to be scrubbed in a room like that with all the extra gowns, gloves, etc.--WOW. I had sweat pouring down my face, back, and legs...and there's nothing you can do about it for hours! You can't scratch your face without contaminating yourself! Talk about a new-found respect for our scrub nurses!

We arrived at the hospital at 8:00 that morning and didn't leave until about 10:30 that night (others--PACU nurses, ICU nurses--had to stay even later), and having missed dinner, we were all pretty beat.