Well, after a day like yesterday’s, no one really had too much of a problem sleeping last night, and we all wake up this morning refreshed and ready to hit the ground running. We start off with a hastily gulped breakfast of energy bars, coffee, oatmeal, etc., as we rush down to the traditional morning huddle led by our fearless leader Nathan (or should I say one-half of the fearless leader of a couple), and introduced by his warm-up act Lynne, a nurse from Loma Linda who’s here long-term. Or should we call her act the monologue? I could imagine her saying, “Well guys, we got a great team for you here today, they’ve come all the way from Minneapolis, Minnesota to fix broken bones, heal the sick, and contribute their pound of sweat … let’s give it up for Team Hennepin! And of course, the one you’ve all been waiting for … heeeeerrreee’s Nathan! Woohoo!” Alas, no. But Lynne’s awesome and she’s kind of like the glue that holds the orthopaedic service here together, the link between successive groups, the institutional memory for a hospital that runs on lots of groups of volunteers. She also maintains our inpatient census which we refer to as we make rounds on all the orthopedic patients in the hospital after breakfast.
One patient we meet on rounds is a beautiful 20-year-old woman with a large thigh mass and a pathologic hip fracture and probably has a sarcoma. It turns out no one’s told her yet that a malignant bone tumor is one of the things we’re worried about so we try to break the possibility to her as gently as possible. She doesn’t cry or even miss a beat. She might be in denial, or it might just be one more load of bad news that life’s thrown at her and everyone else here, and the only way to survive is to shrug and deal with it. In her case, dealing with it may mean nothing more than simply pain medications. There’s no adjuvant chemotherapy here (chemotherapy after you remove someone’s tumor, assuming we could even do that), no neoadjuvant chemotherapy (chemotherapy before you remove someone’s tumor), and no radiation, even for palliative purposes.
Then it’s off to clinic for me and Beth and getting the OR set up for Tom and Amy. We find out that the xray machine in orthopedic clinic is down for the week. At first it might seem it would slow you down immensely. The only way to get xrays to have them go over to the main hospital, pay 500 goudes, 125 Haitian dollars, or about 20 US dollars over in the main hospital radiology department, which almost nobody here can afford. It actually turns out not to be so bad. You quickly learn to hone in on your physical exam skills and trust your senses. Clinic actually goes faster when you don’t sweat the xrays (uh, how about when you don’t have xrays). Kind of reminds me of the Calvin ‘n Hobbes cartoon where Calvin flips through the pages of his reading assignment in about 2 seconds and proudly declares “reading goes faster if you don’t sweat comprehension.” Not necessarily the most ideal situation if you had more resources, but you do what you can. There’s one patient who actually does need an xray emergently but can’t afford it, so the only thing to do of course is just pay the hospital for the xray out of our own pockets.
In the middle of clinic of course there’s the one meal the hospital gives us a day, a lunch of – you guessed it – rice and beans! We’ve actually been looking forward to it since the last time we were here, believe it or not! This gets wolfed down among the four of us in about 3.2 seconds. Tom’s never tasted anything so good that didn’t have meat in it! We supplement this with our own snacks we’ve brought from home, including some Puffins cereal I bought last minute in a shopping spree at Kowalski’s at about ten o’clock last Saturday night, or about eight hours before our departure Sunday morning. They’re surprisingly tasty for something that looks suspiciously like cardboard and comes out of a card board box without any cartoon characters on the front panel. They do the trick and are just fine in a pinch.
By the time clinic gets done Tom and Amy have gotten the OR all set up, Lynne nurse coordinator extraordinare has pre-opped our two patients we’ve added on the schedule for this afternoon (one woman whose heel wound was looking a little worse this morning on rounds, and one woman who’s scheduled antibiotic bead removal for tomorrow we moved up to today because tomorrow’s schedule is already shaping up to be a freaking NIGHTMARE), and Jean-Joel (that’s JJ to you and me) has brought the patients down. One goes very quickly, and the other takes forever. The lady with the beads has had about a jillion previous surgeries on her hip which all began with an infection. She’s unfortunately got no hip left, just a big wad of scar tissue the size of Alaska with a small string of 17 beads encased somewhere inside like a piece of spaghetti encased in a slab of Lucite the size of a small suitcase. Because it’d been so long since they were implanted, the string has partially dissolved and to our dismay breaks apart into multiple little strands, and here we go skipping through the forest excitedly hunting for loose beads very close to large arteries and nerves as we cheerfully sing songs, which is close enough to the truth as long as you substitute “spew out” for sing, and “colorful epithets not fit for publication” for songs. The mood is tense which is an odd juxtaposition with Vampire Weekend playing on Beth's iPad in the background. After a lot of singing we eventually locate a few beads behind the femur in the region of the sciatic nerve, a few beads way out in front, and a few beads juuuust a bit inside, just like a baseball pitch. As the 17th bead is found snugly tucked away in a little safe haven of pus we break out into cheer. Fortunately, our patient does well and we finish for the day.
And so we finally get a chance to sit down and have dinner at 10:30pm, about two hours ago, and just decompress and talk about the day. Bummer that this was supposed to be the light day before the poop really hits the fan tomorrow! Oh well. Realistically we know there’s no way we’re going to get through all the cases in the schedule, but … optimism is key. And, of course, a pair of kings wouldn’t be so bad either. Cause you gotta play the hand you’re dealt, and do what you can.
Well, after a day like yesterday’s, no one really had too much of a problem sleeping last night, and we all wake up this morning refreshed and ready to hit the ground running. We start off with a hastily gulped breakfast of energy bars, coffee, oatmeal, etc., as we rush down to the traditional morning huddle led by our fearless leader Nathan (or should I say one-half of the fearless leader of a couple), and introduced by his warm-up act Lynne, a nurse from Loma Linda who’s here long-term. Or should we call her act the monologue? I could imagine her saying, “Well guys, we got a great team for you here today, they’ve come all the way from Minneapolis, Minnesota to fix broken bones, heal the sick, and contribute their pound of sweat … let’s give it up for Team Hennepin! And of course, the one you’ve all been waiting for … heeeeerrreee’s Nathan! Woohoo!” Alas, no. But Lynne’s awesome and she’s kind of like the glue that holds the orthopaedic service here together, the link between successive groups, the institutional memory for a hospital that runs on lots of groups of volunteers. She also maintains our inpatient census which we refer to as we make rounds on all the orthopedic patients in the hospital after breakfast.
One patient we meet on rounds is a beautiful 20-year-old woman with a large thigh mass and a pathologic hip fracture and probably has a sarcoma. It turns out no one’s told her yet that a malignant bone tumor is one of the things we’re worried about so we try to break the possibility to her as gently as possible. She doesn’t cry or even miss a beat. She might be in denial, or it might just be one more load of bad news that life’s thrown at her and everyone else here, and the only way to survive is to shrug and deal with it. In her case, dealing with it may mean nothing more than simply pain medications. There’s no adjuvant chemotherapy here (chemotherapy after you remove someone’s tumor, assuming we could even do that), no neoadjuvant chemotherapy (chemotherapy before you remove someone’s tumor), and no radiation, even for palliative purposes.
Then it’s off to clinic for me and Beth and getting the OR set up for Tom and Amy. We find out that the xray machine in orthopedic clinic is down for the week. At first it might seem it would slow you down immensely. The only way to get xrays to have them go over to the main hospital, pay 500 goudes, 125 Haitian dollars, or about 20 US dollars over in the main hospital radiology department, which almost nobody here can afford. It actually turns out not to be so bad. You quickly learn to hone in on your physical exam skills and trust your senses. Clinic actually goes faster when you don’t sweat the xrays (uh, how about when you don’t have xrays). Kind of reminds me of the Calvin ‘n Hobbes cartoon where Calvin flips through the pages of his reading assignment in about 2 seconds and proudly declares “reading goes faster if you don’t sweat comprehension.” Not necessarily the most ideal situation if you had more resources, but you do what you can. There’s one patient who actually does need an xray emergently but can’t afford it, so the only thing to do of course is just pay the hospital for the xray out of our own pockets.
In the middle of clinic of course there’s the one meal the hospital gives us a day, a lunch of – you guessed it – rice and beans! We’ve actually been looking forward to it since the last time we were here, believe it or not! This gets wolfed down among the four of us in about 3.2 seconds. Tom’s never tasted anything so good that didn’t have meat in it! We supplement this with our own snacks we’ve brought from home, including some Puffins cereal I bought last minute in a shopping spree at Kowalski’s at about ten o’clock last Saturday night, or about eight hours before our departure Sunday morning. They’re surprisingly tasty for something that looks suspiciously like cardboard and comes out of a card board box without any cartoon characters on the front panel. They do the trick and are just fine in a pinch.
By the time clinic gets done Tom and Amy have gotten the OR all set up, Lynne nurse coordinator extraordinare has pre-opped our two patients we’ve added on the schedule for this afternoon (one woman whose heel wound was looking a little worse this morning on rounds, and one woman who’s scheduled antibiotic bead removal for tomorrow we moved up to today because tomorrow’s schedule is already shaping up to be a freaking NIGHTMARE), and Jean-Joel (that’s JJ to you and me) has brought the patients down. One goes very quickly, and the other takes forever. The lady with the beads has had about a jillion previous surgeries on her hip which all began with an infection. She’s unfortunately got no hip left, just a big wad of scar tissue the size of Alaska with a small string of 17 beads encased somewhere inside like a piece of spaghetti encased in a slab of Lucite the size of a small suitcase. Because it’d been so long since they were implanted, the string has partially dissolved and to our dismay breaks apart into multiple little strands, and here we go skipping through the forest excitedly hunting for loose beads very close to large arteries and nerves as we cheerfully sing songs, which is close enough to the truth as long as you substitute “spew out” for sing, and “colorful epithets not fit for publication” for songs. The mood is tense which is an odd juxtaposition with Vampire Weekend playing on Beth's iPad in the background. After a lot of singing we eventually locate a few beads behind the femur in the region of the sciatic nerve, a few beads way out in front, and a few beads juuuust a bit inside, just like a baseball pitch. As the 17th bead is found snugly tucked away in a little safe haven of pus we break out into cheer. Fortunately, our patient does well and we finish for the day.
And so we finally get a chance to sit down and have dinner at 10:30pm, about two hours ago, and just decompress and talk about the day. Bummer that this was supposed to be the light day before the poop really hits the fan tomorrow! Oh well. Realistically we know there’s no way we’re going to get through all the cases in the schedule, but … optimism is key. And, of course, a pair of kings wouldn’t be so bad either. Cause you gotta play the hand you’re dealt, and do what you can.
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