Hi, I'm back. How have you all been? My little group of groupy's is continuing to grow which is pretty amazing, since this is actually the last thing I had in mind, but I'm having so much fun I can't stand it. Please continue to send emails. It's so great to hear from all of you. I get about 30 emails daily, and the number continues to increase. I believe there are over 100 people tuning in each day to hear the latest about Tenwek Hospital. In fact there may be as many as 200 people by now, and the interest from everyone is simply incredible. In fact, tonight I received an email about speaking at a local high school in Nashville when I return (I'd love to Vivian). It's midnight and we just got out of surgery. Today was exhausting, amazing, frustrating, exhilarating, satisfying, quenching, disappointing, tiring, and absolutely and completely phenomenal, all in that exact order.
I've got so much to document I feel like my brain is scrambled. We were invited to Dr. White's house last night to gather in his living room to listen to a lecture he gave at Brown University on life at a Mission Hospital. My mouth was literally on the floor the whole evening. This guy is incredible and you would not believe what kind of surgery he does (I'm not being dramatic; I have pictures to prove it. I saw this stuff with my own eyes and I still can't believe it). He does it all, literally - sometimes to the point of looking up in a medical text before he makes the incision. Anyway, that's another post and I actually took notes during his talk (I'm such a nerd) but I didn't want to miss out on a thing (and I knew this 48 y/o brain would remember only a fraction of what was discussed). So since I have notes on last night, I'll catch you up on it later when I get a free moment.
OK, back to today. I was up till 1 am posting yesterday's blog to y'all so I was a bit tired when the alarm went off at 0600. Have I told you about my room? There are mosquito nets hanging over each twin bed. We all have to take malaria prophylaxis while we're here, although there are some that say there are not many mosquito's at this altitude (6,500 ft). But like one of the surgeons said yesterday, most of his patients have malaria, and it only takes one mosquito. Apparently the antibiotic I'm taking isn't a 100% protective, so I was very careful not to open the window to my room so I could keep it mosquito-free. There are a couple of twin beds, a couple of mosquito nets a dresser and a table and chairs too small to really do anything with. The bathroom and toilet are across the hall, and I am thankful that there has been hot water every time I've gotten into the shower.
OK, the weather update for Susie... we're in the smaller of 2 rainy seasons, so it rains daily (i.e. more mosquitoes) but only for short periods. I love the rain, especially at night, and when it rains it rains with a vengeance. Very cool, very pristine, very calming, so unlike my daily life in Nashville that I am appreciating every single moment that I have here. When I leave the guest house every morning I turn into camera-guy; it's kinda like a superman thing - really. Everyone was making fun of me about it in the beginning of the trip. In fact, I didn't even take out my camera until we had landed in Amsterdam, because I really didn't know any of the team that good at first and I didn't want to seem like some kind of freak that would be running around flashing camera bulbs in their faces every 5 minutes. Then all of a sudden they started getting interested in my pictures and things changed. There started to be comments like, "If you want to download your pictures to my computer to free up space on your card, you can use my computer Tom". Of course, I initially thanked them and dismissed them politely because they didn't have faith in camera-guy from the start. Then they want to just "take a look" at my pictures, or they'll ask, "Where's Tom this is a great picture" most of the time I've already taken it days before. Now everyone just tries to guess how many pictures I'm up to. Whatever the number they come up with is about 150 to 200 behind what I actually have. In the end, I'll download to several computers to make sure I don't lose them in case my camera is stolen or something. It may as well be surgically attached to me. And I have to say, I've got some pretty incredible pictures... you'll see. Meghan, you'll be proud of me.
We are all staying in the "guest-house" which is a 5 minute walk from the hospital. There are individual rooms, somewhat like a hotel and a main kitchen area with 3 tables where everyone congregates when we're not in surgery (the morning for breakfast, lunch-if we can get out of the OR, and dinner). We have 3 cooks that take very good care of us. Livingston is the head cook (is that a cool name or what?) and 2 other ladies. I usually get scrambled eggs in the morning, either my own or someone else's left overs, there's tons of juices in the fridge, bread for toast and cereal. The cereals crack me up. They're American names (Rice Crispies, and Corn Flakes) but you should see the boxes. Actually you will, camera-guy has already taken pictures of them.
Anyway, on my way out the door, there was mist on the foothills surrounding the hospital compound, so there I was climbing the stairs of the nearest building trying to get the best vantage point; and I did. This is a pretty amazing place. Then on to the hospital. We did 2 cardiac procedures today and they were done by the surgeon and perfusionist from Rhode Island, so I didn't have the responsibility of pumping the case, but I was in the OR all day helping out. 2 cases is a lot to do in the states at a state-of-the-art facility, let alone in a rural village in Africa where we don't really know where things are or how long they'll keep working. Everything is so much harder to do here, but that makes it so much more rewarding. For instance. We need to have ice to put in the machines that cool down the patient and cool down the medication that I pump into the heart to arrest it during bypass. At home, our machines have compressors o n them and they automatically generate ice so it's always there, and we really don't have to think about it. Here, the whole hospital only has 2 small freezers and they don't come anywhere close to being able to hold the volume of ice we need for one case, let alone 2 cases in one day. Nurses are making ice at home in their freezers and bringing it into work. Instead of putting ice in our heater-coolers, I'm putting salad bottles, soda bottles, etc filled with frozen water from peoples homes. Even the cooler pack thingys you put in your kids lunch boxes... medical staff are giving us their kids cooler pack thingy's so we have enough ice to do these cases. And that's just one of the many things that hit us square in the face every day down here. And you know what? These people are the happiest, most satisfied people I've seen in a long time, and they have absolutely nothing. Nurses make about $400 a month here, for example.
So the morning was pretty busy hauling ice in for Eric (the snorer's) case. I had some great one-on-one time with my surgeon Dr. Bichell - which never happens at home. He's too busy, I'm too busy, the world's too busy, we usually just run around in circles everyday being busy talking clinical talk before, during, after the cases ("are we going to clamp and give cardioplegia on this one?", "how cold do you want me to cool this patient", "Are you really going to do 2 Norwoods today, because I really wanted to get home before tomorrow?") then we run off to the next busy little thing we have to do so we can go home and be even busier with our busy little family's. But today, since he wasn't operating, but was scrubbed in to assist at the back table he was like my hostage and I just kept walking up to him talking to him whenever I wanted to. It was pretty cool, and it was a pretty simple thing, but I really appreciated it and was thankful for it. I really never expected all of this to happen to me on this trip. I feel like I've been lost for 48 years and I'm just now finding myself and enjoying what's going on around me. We're still busy here, but it's simpler. I can't explain it. I hope it doesn't go away when I fly out of Nairobi next week. That's what I'm trying to accomplish with these emails. Create something that I can go back to to remember what I need when I get busy again (that makes sense, you know it does!).
OK, so for those of you that have been following along, every day's subject line is about the coolest part of my day. Today it happened at lunch. I broke away from surgery to go get some lunch while Eric was finishing the first case, so I could give him a break and set up for his second case while he ate. There are several non-clinical people with us on the trip, and they go off each day on African excursions of some kind or another. One of the girls is a senior at Hunter's school (Hannah) and the other guy (Rob-special ed counselor and puppeteer) is married to one of the cardiologists on this trip from Vanderbilt. Well, today Hannah and Rob were down by the boys school that we passed by a couple days ago (remember all the pictures and the barbed wire fence?). As they were walking by the school yard all the boys came running over to the road they were walking on and asked Rob, "Are you Tom?" So Rob told them that he wasn't Tom, and all the boys started yelling in unison at him, "Where's Tom????" I guess I made an impression on my last visit. That made my heart happy. I'm going to try and go visit the school again before I leave with Rob and his video camera to see if I can get some footage of the boys yelling my name. I've found that I can now black-mail people for stuff because they want my pictures. So I'm going to give Rob my pictures if he gives me a DVD of the video footage he's shot here in Africa.
So after lunch I went back down to surgery to give Eric a break and the rest of the day was pretty much like any other day at Vanderbilt doing cases. The rooms here are very hot and humid and pretty much every day you're sweating through your scrubs to the point you could probably wring them out. I know, disgusting, but there's about 20 people in the room on every case since this is a teaching hospital and it just gets hot and gross in there. I decided that there wasn't any reason to bring my camera after lunch because I have to work and keep track of the camera and I took about 100 photos during the morning case and thought I'd reached my saturation point with pictures for the day. Boy was I ever wrong.
At about 10 pm as we were winding down on the second case, the patient was still on the table and Dr. Bichell came in the room and said that Ken (a buddy OB-GYN Doc that I've made since coming here) was delivering a C-section. My first thought was, "OMG, how cool is that?". A fraction of a second later I was thinking, "you idiot, what were you thinking by not bringing your camera?". I was almost frantic for a moment as I tried to figure out the timing of the end of my case and the beginning of the C-section hoping that I could run back to the guest house and get my camera after transporting my patient out of the room but before this mother pushed out this baby. It became apparent that the timing was not going to work out, and after confirming with Ken that it was OK for me to watch this delivery without everyone thinking I was a pervert, I settled into the room and watched him cut through each layer of skin. When he got down to the uterus it exploded as soon as he hit it with the scalpel and a pea green soup-like fluid literally sprayed out and ran down the OR table onto the floor. There was meconium (feces) in the mother's abdominal (wrong word, but I'm too tired to think of the right one) fluid. Ken asked the scrub nurse to push on the mother's fundus to help extract the baby. The next thing I knew Ken was saying, "not THAT hard", and the baby kind of flew out of the mothers abdomen. It happened in about 1 second, which was good, because I remembered thinking, "there's no way I could've gotten a picture of that". But the baby was completely limp and blue and wasn't breathing or crying.
I thought this was totally African. Prior to cutting the mother's uterus to deliver the baby (now picture this) the scrub nurse was standing at the foot of the bed with her hands inside what looked like a broad-woven cloth bag. Not burlap, but more refined. It was the size of a 40 gallon garbage bag, and she had her hands inside the bag all the way to the bottom so the open end of the bag was up around her neck. As soon as the baby was catapulted out of the mother, I think it actually flew across the room and landed in the nurses "bagged" arms and she literally ran out of the room with it. I was shocked that it happened so fast and that the nurse just ran out of the room when the baby needed to be resuscitated. After a second or two for it to sink in, I ran out of the room after the nurse to see where she was going with the baby that wasn't breathing. She ran down the hall on her way to our ICU, but they were bringing our bed into the cardiac OR to transport my patient, so she was completely blocked from going any further until the bed got into the cardiac OR. I felt like telling her to pass me the baby so I could run for the touch-down in the ICU but decided against it because I really don't like football and I'd probably drop the "ball".
When she got in the ICU they laid the baby on the isolette and it was lifeless, blue and completely limp as the nurse suctioned her mouth repeatedly. Another nurse was vigorously rubbing the baby to clean her off and there was not a sound coming from the baby. One of our Vanderbilt neonatal intensivists was in the ICU waiting for our cardiac patient to arrive, so he told me to go transport the cardiac patient so he could help to resuscitate the baby. When I got back in the ICU the baby was all pinked-up and crying. OK, so now I've witnessed an actual miracle and camera-guy has let himself and all his groupies down in a major way. Luckily the nurse spoke English, so I asked her if the baby would be in the ICU very long. She said no, they would take her to the nursery with the mother. Well, that was way outside my territory and I knew that I'd raise way too many eye-brows with a cameral in the Neonatal Nursery with a bunch of Mom's. Who knows, there may even be arrows involved. So I panicked and decided to run for my camera at the guest house. A good 8 minutes away. I didn't start running until I got outside the locked and guarded gate (I've been meaning to ask someone why they have guards and barbed-wire fences around the hospital, and exactly how safe is it outside the locked and guarded gate on my way home each night?) but I took off at a full sprint, arrived at the guest house where people were eating dinner. It's 6,500 ft elevation here and I literally can't speak when I'm climbing the stairs to the hospital each day (give me a break! no one else can either!). So I've been running and I try as hard as I can to control my panting and heavy breathing as I "casually" walk through the dining room to go to my room to get my camera and leisurely walk back through the dining room only to run as hard as possible back to the hospital to take a picture of the absolutely p he nominal part of my day. I get a disgusted look from the guard at the gate as he unlocks the gate for me like 4 minutes after I just ran through it and I get to the ICU only to find an empty isollete. I was really disappointed, because this blog has all of a sudden become bigger than just me. There's other people out there counting on me to document and photograph and I really wanted that picture of the little girl to take home. As I turned to leave the ICU the nurse was coming back with the baby and she was laughing at me, probably because of the look on my face. So she laid the baby down in the isollete and just left and I got some pics of my "new baby" after all. That was the completely phenomenal part of my day.
Thanks again for all your prayers. Tomorrow we are operating on my little Tetrology of Fallot boy. He's 10 years old, less than 40 pounds, and is the sweetest little boy ever. As I said yesterday, kids with his cardiac defect are operated on in the States at several months of age. Very few, if any of them ever make it to 10 years old. So this little guy has been hanging on for 10 years waiting for our cardiac team to come fix his heart. If we hadn't come to Tenwek, he would not survive. He got an exchange blood transfusion yesterday to prepare him for surgery and the procedure will be fairly risky, since we are not doing the complete repair that would be done in the States, since he will have no follow up cardiology care. Our little 2 y/o Down's baby from Monday is sitting up in bed today, and Hannah got the greatest shot of her putting her little hand in mine.
There's so much I've forgotten to report, but it's 2:00 am and camera-guy needs to go to bed.
More tomorrow...
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