Tuesday, September 27, 2011

My Second Monday

So with two CRNAs and two surgeons, we thought that this week we would be able to get way more accomplished - we could run clinic and the OR at the same time. On OR days, we could run two rooms. However, with only one working anesthesia machine and the local surgeons having priority of the OR on M/W/F, it did not look like we would be as efficient and productive as we had all hoped. Appropriately, our morning meeting reflection was about just that. The idea of efficiency and productivity is very much valued in Western medicine. In Haiti, you will end up only feeling like a failure if that is all you focus on. Instead, it’s important to try to focus on the relationships you develop with your patients and the local staff and the other ways you help other than cranking out a large number of surgical cases.

The local surgeons did not have any surgical cases scheduled until the afternoon, so we had the morning to try and do our two scheduled cases of the day. Pat Yoon was in clinic and Pat Ebling did the cases. The first was (yet another) antibiotic bead removal. I was not in the room before the spinal anesthesia was administered to ensure that we took some c-arm xrays to determine if the patient actually had antibiotic beads in place. So the spinal was in and our patient was numb from the waist down when we discovered that SURPRISE! no antibiotic beads. So we didn’t actually do anything surgical and instead brought the patient to recovery until her spinal wore off. 

The second case of the morning was a pin/wire change on an external fixator that had become infected. This went smoothly. After we finished our two cases, Pat Ebling and I went to clinic to help Pat Yoon finish up. I helped remove some pins from an external fixator in a teenager with Blount’s disease. We also scheduled an evening case in a kid with fever and a posterior distal thigh abscess. After the local surgeons completed their cases, I did an I&D of the abscess and got out a large amount of pus. It was a great way to end the night. We went out to the Auberge for some pizza (which they had this time, but didn’t get our order correct on the type of pizza we ordered) and Prestige and mentally prepared for a big day in the OR on Tuesday.

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