Wednesday, September 28, 2011

For 1 Unit of Blood, 2 must be Donated...

foot deformity from post-polio syndrome
Today, like all Wednesdays, is clubfoot clinic day which is always a busy clinic day. In addition to clinic, we had three cases scheduled for the OR - one was a case that had been moved from last week, one was a repeat I&D for the kid with the abscess we did on Monday, and the other was a case that was on the schedule for yesterday but was pushed to today due to the family not being able to get here 2/2 living far away and having car trouble. So we planned to do the kid first but discovered on rounds that he had drank some juice that morning so we had to wait for his surgery. Our second choice was a hardware removal that had been rescheduled from last week. For whatever reason, this patient was not as ready as the patient that we had intended to do last, so we started with our originally intended third case first. It was scheduled as a triple arthrodesis for an unknown diagnosis in an 18 year-old male. We originally guessed is was most likely an untreated clubfoot, but we were wrong. It was actually a kid with post-polio syndrome that had affected the entire left side of his body. He was unable to walk due to his foot deformity and had to hobble around on one crutch. Because of his arm/wrist/hand deformity, he was unable to use two crutches. 

donating blood at the General Hospital
The whole case was fairly complicated and was still going on 4 hours after we started when I had to scrub out and leave. We have a patient in-house that had a femur fracture 8 months ago that was improperly treated and never healed. So since his fracture was so long ago, it will make the case that much more difficult to do and he will likely lose a lot of blood. Blood in Haiti is in short supply and patients have to bring their own for surgeries that require it. Typically the family members of patients will go to the Red Cross to get blood - two units have to be donated to receive one unit. Our patient, like many other patients, doesn't have any family here. So in order for him to get his surgery, he needs people to donate blood for them. In order to get to the Red Cross in time, I scrubbed out of the case and went with Pat and Ruth to the Red Cross to donate blood for our patient. I have never donated blood before, so I don't have anything to compare it to but I would imagine it is different here than in the US. For one, I was definitely hemoconcentrated due to dehydration and even with that, my hemoglobin was 12.1. Adequate for donation in Haiti. They didn't care that I had received a vaccine within the past 4 weeks. Once I finished the paperwork and had my vitals taken, I was escorted into a small room with a TV playing dubbed over soap-operas and sat into a very 1960s-esque reclining chair. The lab tech pulled out a sterile contraption with a bag and some tubing. She tightened a tourniquet and picked out her favorite vein. She uncapped the needle and I don't know that I have ever seen a needle that size be placed in any person's vein - it looked appropriately sized for an elephant's vein. Thankfully, she got my vein in one stick and so I sat waiting for my blood to fill the bag. Afterwards I sat for a while before getting up and leaving. We waited outside the Red Cross which is part of the General Hospital complex for about an hour until our ride came to pick us up. 

The final case was just being finished in the OR by the time we returned and I came to the only air conditioned room outside of the OR to sit, re-hydrate, and update you all on my new life experiences today. 

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