We woke up this morning to the din of someone outside beating on something metal with something else that was metal. Whatever it was it was probably heavy enough to make a really really loud sound but small enough to be whacked over and over fairly fast. Which, after wolfing down half a large mushroom pizza last night and falling into a food coma, is how my insides pretty much feel today.We have an ambitious surgery schedule for the next three days (T
hursday through Saturday). Perhaps overly ambitious, with five cases for today, six for Friday, and four for Saturday. We quickly find out from Brooke who pretty much is everyone's boss here that this being a Seventh Day Adventist Hospital, operating on Saturday is pretty much a no-no. We should have realized that beforehand, but what's that saying about "easier to do first and ask for forgiveness later ..."?
hursday through Saturday). Perhaps overly ambitious, with five cases for today, six for Friday, and four for Saturday. We quickly find out from Brooke who pretty much is everyone's boss here that this being a Seventh Day Adventist Hospital, operating on Saturday is pretty much a no-no. We should have realized that beforehand, but what's that saying about "easier to do first and ask for forgiveness later ..."?So after seeing some postop patients (the kid is doing just great!) we start off with clinic where there are a few patients, one of whom needs surgery, but unfortunately we're not even getting through the cases we sch
eduled from Monday's clinic, what with not having our own anesthesiologist, so all we can do is take his number and address down and tell him Jess from Hotlanta will call him sometime soon once the next team arrives. We've long ago decided that we have to be realistic and just accept that we can only do what we can do.
eduled from Monday's clinic, what with not having our own anesthesiologist, so all we can do is take his number and address down and tell him Jess from Hotlanta will call him sometime soon once the next team arrives. We've long ago decided that we have to be realistic and just accept that we can only do what we can do.We're waiting for the Haitian anesthesiologists to arrive so we can start the 5 cases scheduled for today. They roll in around 11 and we start our first case, another hip hemiarthroplasty, around noon. I can't really blame them because their Adventiste salary is around $15 a day so they do need to have a private practice on the side and hustle and work at different places to
make ends meet. Until then Tom, Liz, and I continue to familiarize ourselves with what there is available to work with. The storerooms are fairly well stocked, much better than we had expected, but there are also shortages or absences of some pretty basic things, so we - OK, who am I kidding, Tom - keeps a running list to 
send to the next doc. We find a freezer and stick our heads into it and it feels soooo good. We go up and change a VAC dressing on the patient while we're waiting, for a patient with a bad infected tibial nonunion with a big gap between the bone ends and an Ilizarov ring fixator on. Haitians have a pretty high pain tolerance and he doesn't even flinch as we shove (I mean gently place) a big bl
ack sponge into his wound down to the bone. We go back down and the hemiarthroplasty goes OK, but already the anesthesiologists are asking if we can run two rooms simultaneously to get our cases done faster. Even back home when you get offered this, it's a total windfall and you say uh, yeah of course, does the pope wear a big hat? Here, it's like winning the lottery. Unfortunately,as awesome as Tom and Liz are, we can't run two rooms cause we just don't have enough people. Note 
to self: next time I happen to be swinging through Haiti bring a second orthopaedist AND of course your own anesthetist. I hope all of our anesthesia friends back home are feeling super guilty, hahaha. We've had some pretty awesome people offer to help us out in the OR. Kenny Pettersen, who's here in country for months and starts med school at UCSF this fall, helped us out on Tuesday, and Cheri, who's hails from Milwaukee (where Liz is from) graciously helps us out today.
make ends meet. Until then Tom, Liz, and I continue to familiarize ourselves with what there is available to work with. The storerooms are fairly well stocked, much better than we had expected, but there are also shortages or absences of some pretty basic things, so we - OK, who am I kidding, Tom - keeps a running list to 
send to the next doc. We find a freezer and stick our heads into it and it feels soooo good. We go up and change a VAC dressing on the patient while we're waiting, for a patient with a bad infected tibial nonunion with a big gap between the bone ends and an Ilizarov ring fixator on. Haitians have a pretty high pain tolerance and he doesn't even flinch as we shove (I mean gently place) a big bl
ack sponge into his wound down to the bone. We go back down and the hemiarthroplasty goes OK, but already the anesthesiologists are asking if we can run two rooms simultaneously to get our cases done faster. Even back home when you get offered this, it's a total windfall and you say uh, yeah of course, does the pope wear a big hat? Here, it's like winning the lottery. Unfortunately,as awesome as Tom and Liz are, we can't run two rooms cause we just don't have enough people. Note 
to self: next time I happen to be swinging through Haiti bring a second orthopaedist AND of course your own anesthetist. I hope all of our anesthesia friends back home are feeling super guilty, hahaha. We've had some pretty awesome people offer to help us out in the OR. Kenny Pettersen, who's here in country for months and starts med school at UCSF this fall, helped us out on Tuesday, and Cheri, who's hails from Milwaukee (where Liz is from) graciously helps us out today.
The second patient has had a bad left ankle fracture-dislocation untreated since the January 12th quake but had reasonable motion when I saw her in clinic and I didn't want to fuse her ankle, which is a common thing to do. Moreover, when we get in there, the cartilage is actually pretty good and it'd be a shame to fuse it.We struggle for awhile trying to get it back, but it just won't go ... We'd have to osteotomize (rebreak) her 3 healed fractures in that ankle and replate it, with a longer surgery and higher risk of infection here in Haiti, so we make the difficult choice of doing what's right for the situation and fusing the ankle, even though ideally what I'd want for myself would be to press on. A hard choice, and I mutter to myself "what a shame" as I scrape away perfectly good cartilage, but it's another lesson in just doing what you can. Sometimes what's ide
al and what's right aren't the same thing. By the end of this my back is feeling like Tom just beat it with a two by four because the lead aprons we're wearing under our gowns (to protect against the radiation from the xray machines we use in surgery) weigh a TON. My stomach feels worse, and I'm tired and pissed off at myself, and I'm sure Tom and Liz don't feel much better. And then the absurdity of it all hits me ... what am I complaining about, I've just finished operating on some poor lady who's been walking on a dislocated ankle since January 12th.
al and what's right aren't the same thing. By the end of this my back is feeling like Tom just beat it with a two by four because the lead aprons we're wearing under our gowns (to protect against the radiation from the xray machines we use in surgery) weigh a TON. My stomach feels worse, and I'm tired and pissed off at myself, and I'm sure Tom and Liz don't feel much better. And then the absurdity of it all hits me ... what am I complaining about, I've just finished operating on some poor lady who's been walking on a dislocated ankle since January 12th.I scrub out and talk to her family (interestingly enough, using Spanish as a common lingo - how surreal). Unfortunately there are a bunch of people whose surgeries we never got to. It's amazing how patient these people are ... they understand, it kills me to think about everything they've been through and now they're kind of waiting in lim
bo for their surgery. Jess and I figure out which ones we're realistically going to be able to do before we leave. Bummer... well, you just do what you can do. At 7pm we finally get to eat for the first time today. We're sooo tired and have absolutely no energy, but somehow it feels good in a weird way, and it helps to play with Junior, an adorable 8 year old tyke whose go
t one speed only: full speed ahead. He dances for us and sneaks up behinds us and tries to tickle us to death. You'd never know his dad just died yesterday here at Adventiste from AIDS. And at the end of a long, hard day for all of us, when Tom and I are slouched out feeling like a sack of potatoes ... Liz remembers she has another tutoring session with Michard and somehow has enough energy, dedication, and kindness to make good on her promise to help him pass his English test, and goes downstairs dutifully to tutor him one more time.
bo for their surgery. Jess and I figure out which ones we're realistically going to be able to do before we leave. Bummer... well, you just do what you can do. At 7pm we finally get to eat for the first time today. We're sooo tired and have absolutely no energy, but somehow it feels good in a weird way, and it helps to play with Junior, an adorable 8 year old tyke whose go
t one speed only: full speed ahead. He dances for us and sneaks up behinds us and tries to tickle us to death. You'd never know his dad just died yesterday here at Adventiste from AIDS. And at the end of a long, hard day for all of us, when Tom and I are slouched out feeling like a sack of potatoes ... Liz remembers she has another tutoring session with Michard and somehow has enough energy, dedication, and kindness to make good on her promise to help him pass his English test, and goes downstairs dutifully to tutor him one more time.
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