Friday began with Jameson (just like the Irish whiskey) pretending to kick ZJ in the butt with a BKA prosthesis in the chapel. Nothing like a little humor to jump start your day and kick you in the pants! Our goal after making morning rounds was to see everyone in clinic, and then try and tackle a few cases in the afternoon. And, of course, it's Friday? Which means MAC AND CHEESE for lunch! Amazing how the little things can really make a big difference. Like the light at the end of the tunnel, or the thought of a big swig of lukewarm Crystal Light after a long case, Mac and cheese on Fridays here at Adventiste motivates Tom and Amy as they do their dressing change rounds, and Beth and I as we slog through a busy morning clinc. Unfortunately the ortho clinic X-ray machine's been down all week so people either have to pay $20 to use the main hospital's X-ray machine, or we just go without, or if we absolutely need it we just pay for it ourselves. It really makes you think what X-rays you need and what you don't and it's a lesson I hope to carry home. Meanwhile, Tom and Amy spend some time with patients in the "White House" above and beyond what they're out there to do. An extra five minutes with each patient isn't really too much time to spend, but it makes a huge difference in these people's day. A smile here, a wink there, a few softly spoken words, and a clean dressing go a long way even if you don't speak Kreyol (what we'd call Haitian Creole). Amy and Tom then run over to the peds ward to do some more changes, visiting, and of course the all-important Sticker Therapy (yep, look it up, it's a valid medical treatment and it works better than 99% of the drugs we use on kids).
Lunchtime can't come soon enough. We get done with clinic and Tom and Amy get done with sticker therapy around the same time, about 2pm, and we all congregate on our cots upstairs to eat - no, inhale - our feast of mac 'n cheese. This tastes better, Tom swears, than any ribeye dinner from Manny's. We then burp contentedly and go downstairs to take care of the lady with the hip fracture who got cancelled last night. Normall this kind of fracture (called an intertrochanteric fracture) gets fixed on a fracture table back home in the States but here, our "Fracture Table" is Tom bent over the table pulling on the foot like a water skier trying to get up. Hopefully he doesn't throw out is back because then both he and the patient would be in a world of hurt! Beth graciously steps into the role of X-ray technician and does all of our C-arm pictures, and I take Dr. Francel Aleksei through the case. He does great, the patient's doing just fine, X-rays look good, and we're on to the next. This is an 82 year old woman who had a hemi-hip arthroplasty back in July. Unfortunately her would became infected post operatively. A previous surgeon placed cement beads impregnated with antibiotics in the wound, in attempts to clear up the infection. This type of procedure is commonly done back in the United States. Once Uno (Amy) performs her anesthesia wizardry, Beth (astutely) recommends we take a couple of X-rays, to make sure there are in fact beads present (this happened a few days prior, where there were supposed to beads removed from a patient, only to find out there were none...). Kudos to Beth's idea, because once we fired up those X-rays, we come to find once again...the beads, we were supposed to see them, but now we don't. PLEASE NOTE: As Pat and I are typing this, we've heard four gunshots in the past hour, and...ummm...they appear to be getting closer. So, things are back on track, however now it has come to our attention the woman's sutures had yet to be reomoved. Given the length of time since her original surgery, Beth steps up to the challenge of removing all 30 stitches from a wound that is over 10 weeks old. So, with the help of a headlamp, and some bacitracin to soften the incision scar up, Beth successfully removes all those little buggers, and our lady's wound is already looking 117% better than it had 30 minutes earlier.
Now our caseload has been completed, we decide it's in the best interest of everyone involved, that we make another trek to the Auberge de Quebec, for a tomato & onion pizza...oh yeah, and a few Prestiges too! However this time, as we stretch our weary legs, and lick our dry lips, that there is no pizza this evening...not a single one. Our hearts crushed, our stomachs screaming, we order french fries, and papaya juice (we'll get to that one later). **more gunshots** As we digress, we notice a young gentleman waling out of the interior of the restaurant carrying to pizzas to go...and five minutes later, yet another person leaves with not two but three boxes of pizza!!! We look around at one another and laugh, we've come to expect this...and it's almost an edearing quality we've learned to love about this little oasis in a desert of rubble. Let me preface this next little story by saying I "did not" order the papaya juice. After being here for the fourth time, I've gotten more wise. I watch Beth, Uno, and Pat each take a nice big pull from the straw of their juice...I look at their expressions, and all at once it's decided the papaya juice tastes like the way a room full of sweaty people would taste if you had the ability to bottle it up and drink it...we shortened it up by calling it 115/4...our own little nickname for papaya juice from here on out.
Saturday morning, today, we all wake up excited for our tradition of going back to the orphanage. We're excited to see the little kiddos, excited to give them stuff we've brought and see the smiles it brings to their faces. We're also really curious to see how they've grown and changed since we were last here in May. First we make our patient rounds in the hospital, and pack the bags for the orphanage with toys, shoes, leftover hand-me-down clothes from Tom's kid Cole, and little care packages courtesy of Jaewon Woo. As we walk into the orphanage, Tom is immediately bombarded by a horde of cute little tykes who surround him and jump all over him like football players on a fumble. We then find out that they've got a new nickname for him: Changez Movement, after the game we play with the kids every time we go, which is kind of like musical/dance version of Simon Says. Turns out the bubbles in the care packages are the hit of the party and the kids spend a lot of time blowing bubbles everywhere. After a few songs and dances, and after a lot of hugs and holding, the time to leave comes too soon and we're off. There are so many kids there each of us would love to take home if we could (think this little guy might fit into my carryon?), but we can't. The orphanage maintains a fairly steady number of 45 or so kids ... new kids come in, and older kids leave. Very few are adopted and we're not really sure where the others have ended up. One of the ones we saw back in May was a twelve-year-old boy who I played catch with, and who at the time reminded Paige of her son. He's no longer at the orphanage.
Afterwards we have lunch in Petionville at La Reserve, then it's off to Fort Jacques for some sightseeing. This is a 200-year-old fort the French built overlooking the city of Port-au-Prince from the south. You have a great view of the city to the north and on a clear day can see all the way to the beginning of the northern peninsula of the island. Off to the northeast, the massive central highlands are easily seen... one can't help but think, just beyond that is Cange where Paul Farmer and his Partners in Health have been working for decades. One can also imagine that mountains like these fading off into the distance were the same moutains that inspired the creation of the Haitian proverb "beyond mountains there are mountains."
Soon after we get back to Adventiste, Paige and Kris arrive. They're going to fill Amy's ample shoes in the role of the human painkillers - anesthesia. Tom and Amy get their things packed as they're leaving tomorrow morning. Beth and I are staying behind for another week along with Paige and Kris who've just arrived. We're all sitting around reflecting on the week that's past and the week that's coming up. All in all, it was a very rewarding week. Success isn't just measured in the number of cases done or the number of patients seen in clinic. These were tough cases that would have been hard to do under any circumstances, let alone in an OR with mosquitoes buzzing around, using batteries that die out in a few seconds, in less space than your mudroom at home, and on fractures that were sitting malreduced for days, weeks, months, and in a few cases years. Success was found in the satisfaction of a job well done no matter how tough the cirucmstances, in keeping our cool (for the most part!) despite the frustration involved, and in the poignancy of an orphan's smile when you sat down with him for a few hours, blowing bubbles, and drawing with crayons and paper.
Tom and Amy may be gone, but we hope to keep the positive vibe going for the coming week.
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