Day #6: Monday 11-10-2008 "A Professional First"

Day #6: Monday, November 10, 2008
Subject: “A Professional First”

Still in Africa, still not believing it, still completely fascinated with everything around me.

Before I get on about today, a few updates from prior posts...

Not only was Elvis brutally shot in the throat with a barbed arrow, but they have determined that the arrow was poisoned, which is why he went down hill so quickly (aside from the fact that he got shot in the throat at 1 am and didn't make it to the hospital for medical care until 10 am).

Also, a cool side note about my school boy friends from yesterday behind the barbed wire fence. I forgot to mention the soccer ball they were playing with. I think they intentionally kicked it over the fence so they could make contact with us by having us throw it back. The ball was made out of plastic bags rolled together and tied with rope (of course there is a picture of that Meghan).

OK, so yesterday I told you that the rest of our group arrived. What I didn't tell you was that meant I was getting a roommate in my spacious bedroom (which is smaller than my bedroom closet). So I worked late in the OR getting the pump set up for our first case today and was on the computer until 11pm sending my post from last night. When I got in the room being ever so careful not to disturb my new roommate who had been up for 48 hours traveling to Kenya only to find out that he snores like a freight train. I figured he'd roll over eventually, which he did, only to begin snoring even louder. To make a long story short, he had locked the dresser that had my "sleeping aids". At about 3 am I realized that I could put in my ear plugs from my iPOD which are noise reducing-fancy-schmancy ones that the kids got me for Father's Day. They had an amplifying effect on the snoring, it sounded closer and louder. So out of bed again to get my iPOD. The display wouldn't light up so I had no idea what songs I was selecting and I found myself listening to the Beach Boys on and off until 6 am when he woke up refreshed and ready for the first case of the day that I was pumping and he was assisting me on. I got up 15 minutes later to shower and get on with my day without a single minute of sleep all night long.

After going into surgery and realizing all the stuff that I was missing before I could do my first case I got to work to try and get everything done before they brought the patient in the room. To give you an idea of the OR's in Kenya (before you get a chance to see them first hand) there is garbage and "stuff" thrown everywhere. When I set my briefcase down to get to work dust balls went flying. There was blood everywhere, on the walls, on the OR table, the IV poles, the anesthesia machine, on the garbage containers, just everywhere (except the heart-lung machine, because it hasn't been used yet). There is also a smell that is very raunchy; kind of like dried blood and a very pungent cleaner (which they obviously don't know how to use). Add to that the very strong and distinct smell of foul body odor on most of the hospital staff. A cultural thing, I guess.

You have to expect the unexpected when going on these medical missions trips because all the supplies and capital equipment are sent from all over the United States from various hospitals, and most of it is stuff that nobody wants anymore. Add to that the fact that all the sterile supplies are wrapped in blue paper wrapping that, unless you are Superman with X-ray vision, you cannot see through it to know what is even inside. So there are boxes and boxes and boxes and boxes and boxes and boxes and boxes and boxes and boxes and boxes and boxes (OK, you get the idea) of "stuff" that you know you probably need, but aren't really sure where to start, and then the panic sets in that maybe you won't be ready by the time the patient is in the room and everyone has been planning this trip since 2003 and you don't want to be the one that messes up this great thing that has been planned for the past 5 years. OK, back to reality, get to work and get it done.

The first thing that happened was the heater cooler (that we need to cool and rewarm the patient and the solution that stops the heart and warms the blanket under the patient during surgery) burns up because it's 50 cycle current in the US and Kenya has 60 cycle current. OK, whatever, it's not working now, so figure something else out. We have another smaller one, much too small to use for all those things, so prioritize the most important one and the minor stuff will have to go by the wayside. Then where are the hand cranks for the heart-lung machine (the thingy that I run that is the life support device keeping the patient alive. In the event it burns out during bypass (refer to the heater cooler above) the patient is dead unless you put the hand crank in and turn the roller heads manually to keep the patient alive. OK, so a Phillips screw driver from the Samaritan's Purse guys will do just fine. Then the blood gas machine we need to make sure that we're actually keeping the patient alive if the heart-lung machine doesn't burn up won't let us run the sample because apparently you need an operator's ID that no one wrote down when they so graciously sent the machine in the first place. OK, so start entering random strings of numbers and letters to see if you can break the code. BINGO... 12345 did the trick (who'd of thunk that?). Then we finally got the ice to put in the heater cooler to do all the stuff above, but there were only about one bag of ice that the head nurse made at home the night before and brought into the hospital. That was so nice of her, but we actually needed about 10 times that much, but what're you going to do? As it turns out, the repair didn't require us to cool (one of the things we needed ice for) or to stop the heart (the other thing we needed the ice for). Speaking of things burning out, when the heater cooler is turned on to warm the patient, it draws so much current that it can blow the fuse. If the fuse blows in an OR where there are no windows it becomes so black you can't see your hand in front of your face, so we had to run back to the guest house to get the small flashlight I packed. Because if a fuse is going to blow or a heater cooler is going to burn up, it's most likely going to happen to me in Kenya.

So now we're ready to go and the pump is set up with all the stuff we have, except there are no safety devices on the pump of any kind. No bubble detector to detect air bubbles and shut off the pump to keep from pumping air to the patient and stroking them out, no level sensor to shut the pump off if the blood return to the pump decreases for any reason (there are about 20 reasons it happens every day on every routine case) which would result in our pumping air to the patient and stoking them out, etc etc.

Then the surgeon announces that they're ready to begin, "Are you ready Tom". Besides the fact I've had no sleep and I'm running a pump that would be considered completely unsafe by US standards the energy in the room is incredible and I very assuredly reply that I am. We push the pump to the table after the surgeons drape the patient with 2 other people pulling extension cords and suction lines that are draped all over the floor away so we can move the pump. I hand up the lines from the pump, half of which we have to cut out and throw away to replace with something that they can actually use, and I instruct my surgeon from Vanderbilt how to assemble the lines so that it is the same as he is used to in Nashville.

Now the really shocking part of the whole day (refer to the subject line above) is that just before cutting the skin over the sternum to divide the chest and expose the heart, my surgeon from Vanderbilt says half talking to himself, "now is there anything else we need to do before we cut skin?" Not expecting any response from anyone, the Chief Surgeon from Tenwek Hospital speaks up immediately and says very pragmatically, "yes there is, we need to pray". The entire team and the 20 some people in the room immediately bowed their heads as the Chief Surgeon said the most incredible prayer for the Lord to watch over us and guide us on our maiden open heart here in Kenya. I never thought about praying for my patients until Joan (Noni) asked me if I ever did several years ago. So since then I have been, on a daily basis. But cardiac teams are generally not Christian, let alone doing a group prayer in the OR for the patient on the table. Since then Needless to say the case went off without a hitch. It was one of the shortest bypass times I've ever had and the patient did great. Go God!!

Tomorrow is a 6 pound Downs baby with a large hole in his heart (ASD with mitral cleft for you hospital folks). Say a little prayer for her and I'll check in with you tomorrow.

I had about 30 responses today from all of you. I couldn't get to most of them because the computer connection kept going down and there are a lot of people who are waiting to communicate with their loved ones, but Susie I did read yours and the food is great; prepared daily by Livingston. Tonight was lasagna with warm spinach salad and home grown pineapple, lunch was chili and corn bread, etc etc. You can forget that comment I made about losing weight while I was here because of all the gross stuff there was probably going to be to eat.

And of course, there is the ever present questions about the weather! ;) It rains daily because it's the rainy season, but it's so cool and it pours so hard and it's so calming and peaceful that it's just completely cool. Thanks for reminding me to bring the umbrella, I use it daily. But when it's not raining, it's completely beautiful.

Oh, remind me to tell you about the political unrest and the stories Dr. White told me today about the fighting between tribes. The mission’s work that the people are doing here is so incredible. There are people coming daily to work for weeks to months... we have about 20 cardiac staff here, there is a visiting OB GYN, an orthopedic surgeon showed up today, a physical therapist left yesterday, and there’s even more full time staff that live here.

Oh yah, more about the arrow. I was in Dr. White's office this morning before the case and he had an identical arrow head like the one he removed from Elvis laying on his desk. He said it wasn't the one used on Elvis, the police picked that one up today, but he had a bucket of them laying around his office somewhere. I shamelessly begged for him to please give me one to take home with me, so we'll see on that one. Anyway, the arrowhead was so detailed I asked him how they could make something like that since things here seem so barbaric. He said they fashion them out of 10 penny nails. The flat head of the nail is pounded into the arrow head and I have no idea how they barb the body of the nail. Hopefully I'll bring one home and you can all see it in person (those of you who aren't local will just have to visit).

OK, see y'all tomorrow.

PS. Sue, I couldn't add coolie-Julie to the list yet, so continue to forward to her until maybe tomorrow.