Monday, September 19, 2011

No easing into a first day back...

Well friends, it has been a busy first day back at the Adventist Hospital. We started out the day with the morning meeting at 730 then proceeded to round on our hospital patients. The biggest change I have noticed from my first trip to this one is how much more organized the hospital has become. Patients are no longer being roomed in the hallways. They have started charging patients for private rooms and so unless our patients can pay, they are crammed into one of three small rooms on the main floor of the hospital. The operating room is run a little differently as well. Ortho has priority in the OR on Tuesdays and Thursdays. If we need/want to add on cases on Mondays, Wednesdays, or Fridays, they have to be in the afternoon and we do not have a recovery room available to us for our patients post-operatively. 

Some things, however, never seem to change much. Cases always take longer than anticipated and we always seem to be eating dinner at 10 pm or later at night. We end the day tired and it becomes difficult to reflect on the things we have seen and done throughout the day. I will do my best here, but I can't say that it will be too insightful since what I am really looking forward to is going to bed!

As usual, our Monday was spent in clinic and it was a fairly busy clinic (also as expected). We see some bread-and-butter ortho but also have the (unfortunate) opportunity to see disease pathology further along in its natural course than we see in the US. For example, our first patient of the day was a middle aged man who was born with bilateral clubfoot. He has been able to adapt to his deformity but not without significant cost to his mobility. He walks on the sides of his feet and has built up extremely large calluses. His legs are not in normal alignment which causes him pain elsewhere in his body. A few patients later we saw a 3 year old girl with developmental dysplasia of the hip. Her DDH was caught at a young age but due to the earthquake in Jan. 2010, she was unable to return to get it corrected until now. The years between the diagnosis and now means that she will have a much bigger operation which also corresponds with bigger surgical risk. 

We ended clinic around 3 pm and then had a couple of cases to do in the OR. The first case was an I&D of a wound. Not a terribly complicated case, but the patient happened to have the smallest veins and so a significant portion of time (and pain on the part of the patient) was spent trying to get an IV started. We finally got one started in her foot and proceeded with the case. After that, we had another I&D with a change of antibiotic beads in a hip. What complicated this case was that the woman's surgery for antibiotic bead change had been rescheduled a few times so instead of having them changed within a few weeks, it had been a few months. This meant that the beads were encased in scar tissue and buried and extremely difficult to find and remove. These factors about doubled the time our case took. So now it is 10:36, I am still working on finishing my dinner, and tomorrow we start all over again. There are 6 cases already on the surgery schedule, 4 of which are large cases. We will not get through them all and will probably be putting in 14+ hours of operating. So please send your good vibes our way! We could use a little luck :) Thanks for reading!

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