Day 7 Post - 2nd day of Surgery

Buenos días (Good morning)

**I am typing this here during the day on Tuesday in between printing out schedules and making changes in the database. It has been busy and I have had trouble finding the time to put down the thoughts. Kids are still crying everywhere – in front of me and behind me. I am in the hallway with a 6 foot desk pushed to the side of the wall and I sit at one end, different people will utilize the other end. People (Nicaraguans) think I am some kind of information person and are stopping to ask me directions and such. No hablo español (I don’t speak Spanish). I then find one of our translators to help out. There are a grunch (that is many) high school’ers that speak fluent both that have been helping us out. Some are Nicaraguans and some are English kids that live here.


Sorry for the delay in posting things but my butt has been busy. Got done with things Wednesday night and in bed at 10:30, get up at 5:30 to get something to eat in our little restaurant at the hotel and be on the bus by 6:30 to head to the hospital, which is about a 20 minute drive thru you-name-it traffic. This morning (Saturday morning) I saw it best coming up near the little bridge over this almost defunct stream. There was a horse drawn cart loaded with kindling/man and son on the seat, with a bicycle pulled cart behind, a car then a bus, two more bicycle carts and another horse drawn cart with nothing in the back and a couple bicycles strung thru there and a couple more cars. People walking on the edge or what you might call a sidewalk which is only feet away. Horns rule around here.

We needed to set up the check-in area to start screening kids (they ranged from 3 months to 30’s/40’s but most are under 10). We did 80 screenings the first day and 140 the second day. To say the least, by the end of Day 2, I had my butt kicked. I did not have all the charts done first day, as I was getting my system rolling and busy taking some pics and generally awed at the circus. There was the check in station to get the record filled out by local volunteers. Then a picture to put inside the record, then a picture of the mouth area, then they got weighed and a general check of the chest breathing. Next vital signs, then seen by a Plastic Surgeon, then the Anesthesiologist, followed by a Dentist, then Speech Therapist, then the Gatekeeper. It is his job to screen the record real quick to make sure they saw all parties, there was a diagnosis (or multiple made) and a surgery recommendation or not, that the medical waiver was signed by the parent and whatever else he was checking.

Then the record came to me to enter some of the basic information into the Electronic Medical Record. This info had name, known allergies, weight, what was diagnosed and what was proposed for surgery and once blood work came back their Hematocrit. So once we got started and there was someone at each station, the noise level got quite loud. Generally most kids were pretty cooperative. But you had some that were crying and THEN you had some that were pulling all out tantrum fits. The area we were in was not that big so the sound reverberated. At one mid afternoon the second day, there were a couple crying and throwing tantrums at the same time. Try entering data (data that different people have entered and who have different writing styles) with all that noise. We ask them to write legible, but hey. And down here, 99% of the kids have two last names and two first names. Ayyeee Carumba! Or whatever the Nicaraguan version is.

OK – back to type again. Had lots to do earlier, reconfigure tomorrow schedule and make sure all the Crits (Hematocrits) were in the computer so they would print out on my new schedule so I could then do the PICU Sheets. These sheets show the persons name and record number as well as age and weight. There are formulas built into the Excel spreadsheet so in case the child codes (quit breathing or has problems) the doc and Anesthesiologist know what drugs and how much to give quickly or how much Defibrillation they need to do.

Then had lunch (shrimp fried rice and some kind of meat – hmmmm some of those dogs weren’t running around this morning!!!!!) and went down to the Recover Ward to input Surgeon/ Anesthesiologist and what procedure was performed and if there were any implications involved. This is part of the record keeping that Op Smile is doing (a few of the many things to be inputed) to keep data for research and historical reasons.

After that, I went into the OR to watch a few cases. Part of being with these people is that you are all treated the same. We are welcome into the OR (even Kelly and Torrie came in after me and they are 16/17 years old) to see what is going on and the surgeons will explain stuff to you. I wasn’t sure what I personally would do when I saw slicing and dicing but I was fine. No queasy or falling out. Adam Kolker, a Plastic Surgeon of New York, asked me to come to the head of the table next to him and he was explaining what he was trying to do, and I was asking questions. It is hard to imagine the Cleft Lip and the big gaping hole you see in their lip and when they get done, it is closed up and looking really great. There was a bit of snipping, and dicing and slicing and he had taken one of his instruments and was kinda jamming it inside the nose towards the tip and around breaking up the excess cartilage that had built up over time.

I had taken a break and gone over to the next table to watch them start a little girl with the anestheology and the beginning of the lip preparation. They would outline where they wanted to cut with a surgical marker, the doc injected a bit of (looked like a lot of local anesthetics) into the mouth and gum line and straight into the nose (ouch). I went back over to Kolker’s bed and he had him almost done up. It was looking great.

By then I needed to come out and get some work done. More schedule changes for Wednesday, needed to go back to Post Op and get some updates and sneak in some more typing in here. All along while helping out a few lost folks (remember no hablo espanol ), sweating my ass off (it gets up to 90 or so and humid) in this hallway that doesn’t always have a breeze. It is open in front of me about 50 feet away but it T’s behind me so every once in a while I can feel a breeze but mostly I sit here sweaty. Oh yeah, don’t forget crying kids in front and behind. Patients coming by on gurney’s or walking along with IV bags hanging on a cart or by their own hand. And fly’s flying around. If there are one or two, there are dozens of them. While I was in surgery, there was a fly in there they were shooing away.

Think of this place as a cross between a Mash Hospital and Gray’s Anatomy (without all the sex crap going on). Some patients scheduled for surgery come up sick so they are canx’d for the day and someone is moved up on the list and someone from another day is added and someone runs to the shelter to get them if they are there or they are called if staying somewhere in town.

Speaking of the shelter people and once they get here. Remember we feed them at the shelter. They report to the hospital the afternoon before surgery (the child and one parent) so they can pre-check in. There is a room behind me at the end of the hall where it T’s and there are 22 beds in there and we have like 25 patients tomorrow. So you double the amount because most have one parent with them. These beds are packed tighter together than you would have in a dorm room. Maybe 2 feet between some. NO A/C either. One door coming in and one door leading out and not much cross breeze. There are a couple fans trying to blow air around. But it still sucks to be in there. We feed them here as well (they need to eat). I helped for awhile, they were getting a plate of beans with some kind of white sauce and a large roll. There was some sweet milk along with some cereal dumped in for the kids as well. They ran out of food and had to go get some more so I went back to my computer.

Speaking of food, it is 7:45 right now and our peeps (the coordinators here) ordered 25 pizzas for us as we will be here to at least 9. They still have a couple surgeries to go then the docs will make rounds real quick, see their patients and sign some forms in the records so I or Karen don’t come hound them. Karen is in charge of Medical Records and we work side by side - however they are 40 feet down the hall from me. They poke their head around the corner once in a while to make sure I am alright.

We will get home, take a much needed shower – I will print out tomorrows schedule, try and get this sent out, talk shit with my roomies and lights out by 11:00. Get up tomorrow at 5:30 and ramble over to t he little restaurant to get some food, on the bus at 6:30 and do it all over again.

It sucks the workload, the heat, the noise and such. HOWEVER, as I sit here and the kids come by, they recognize me (most do) from screening and they smile at me as well as the parents. What they are getting here is thousands of dollars worth of care that will make them WAY SO MUCH BETTER in life, they won’t be ridiculed and they will be able to live a more normal life.

It is worth what I am doing and will do it again in a heartbeat. I just hope I have the same great people that are on this trip in the future. Karen and Aleisha that I am working with are great – we all get along superbly. No flare-ups, no short tempers, no losing it. Whatever happens, we help each other out and do it.

I better go down and check in with them to see what’s going on and maybe get another slice of pizza. Mushroom and Pepperoni just arrive. Two more flavors arriving next. Ham was on the first one.

p.s. my nasal condition seems to be getting a little bit better. Our team doc got me some 12 hour Afrin and put me on a extra large dose of Zythrymicin (sp), I haven’t had the sinuses running as much today.

Well helped cart a patient down the breezeway to Post Op so he can settle in for the night. Hung around waiting for the last two patients to come out of Recovery (which we go thru to get to our break room. We got out of there at 9:30 and are back in our rooms. I am waiting my turn to take a shower. It is now 10:15 so time to get this on the streets and update everyone.

I will try and write more about our party we went to Saturday night and the beach day we had Sunday.

Adios