Guatemala Day 3: Watching a real-live operation

This little boy would let go of his dad.

The vibe on Monday was completely different from the day before. The team was focused on pre-op, surgeries and post-op and it felt like a real hospital. We were geared up and ready to work and there was no time to waste. We had planned to do 16 to 20 operations a day so the schedule was tight.

I got to wear my scrubs for the first time as I would be going into the operating room today. I thought I had picked out ones that would allow me to blend with the surgical team, but apparently I bought very fashion-forward ones (even though they were on sale) as everyone kept commenting on them. My scrubs even became the talk of the dental lab.

Oh well, I can't deny that I am a bit of a fashionista, but back to the mission.

As I walked down the hallway, every family I met looked apprehensive as they waited quietly for their surgery time, and some of the kids were hanging onto their parent’s legs, afraid of what was to come. They would still smile when I greeted them, but it faded quickly and was replaced with worry. However, they weren't the only ones apprehensive. Today would be the first day we would be working as a team and I wasn't the only one who would be in role that were far removed from what we did in back home.

Me in the operating room.

"I'm usually not in the operating room," said RN Mary Sanchez from South Carolina. "I work in intensive care so this is very different for me. I have to remember to stay clear of the sterile field and count the sponges. In intensive care, I know it so well, I can react automatically in an emergency situation. Here, it's not like that."

By 8 a.m. the first patients were being prepped in the pre-op room, but it turned out their wait was going to be a little longer than planned as all of the facets in the hospital were spewing out nothing by air.

Surprise! We had no water. Not even a drop.

“We can’t perform surgeries without water. We can’t scrub up before or wash our equipment,” Dr. Ray Maddox, our team leader said.

The team weighed our options. Should we postpone the surgeries? Should we use our limited drinking water for scrubbing? Finally, after much running around, the fire department came to our rescue and used their truck to fill up our tank. Apparently a tree had fallen and obstructed the flow of water between San Filippe and the hospital. They had to cut around the tree to free the stream.

We breathed a sigh of relief. We may have been behind schedule, but we were back to helping people.

RIGHT ON TRACK

The lack of water didn’t stop audiology from seeing their patients and they were quickly moving through their list. Each person who came in to see them had a story, including their oldest patient of the day.

Patient explaining that an animal went in his ear years ago.

“An animal went into my ear 30 years ago and, after that, I couldn’t hear,” said the 84-year-old man. “I was working at a coffee plantation at the time and it took them a long time to get it out."

He was adorable. If he heard the test beep loud and clear, he raised his hand high, but if it was quiet, he would show us the universal “little bit” sign using his thumb and forefinger.

Our CCCA, Jodi Bova, set him up with a hearing aid and you never saw a brighter smile. He thanked us over and over and gave everyone on the team a big hug.

But not all stories had a happy ending. Five-year-old Angel was born premature and had never spoken. Because he couldn’t understand the instructions, our pastor Karen Prevatt taught him to put a plastic ball into a container every time he heard the sound.

At first we thought perhaps he was hearing something as there were times when Jodi would play the sound and he would drop the ball in the container. Each time, he would make a little proud smile. But our hope was soon dashed when we placed a hearing aid on him.

“Unfortunately, in this case the hearing aid showed no improved response. We didn’t think he would benefit from it,” Jodi said.

It’s always hard to give out bad news, but the team was able to provide the parents with some other options such as the number for the local deaf school. It wasn't much, but it gave the mother some hope for her son's future.

SAVED BY THE GLOVE AND THE UTERUS THAT GREW…AND GREW…AND GREW

Meanwhile, back in surgery another obstacle had crept up.

The glove that saved us.

In the United States, the camera lens used in laposcoptic surgeries such as gallbladders comes sterilized.

It turns out that’s not the case in Guatemala, and the surgeons didn’t feel comfortable having a non-sterilized piece of equipment on the operating table. Instead of risking contamination, they needed a solution – and they needed it quickly.

CRNA Christian Cleveland-Peck came to the rescue, pulling what we fondly refer to as a “McGyver” move.

“To keep everything sterile, he cut out the finger of a rubber glove and ran the lens through it,” said Dr. Cathy Sims. “It was so simple and it worked!”

The 8 lb uterus the doctors removed. Amazing.

As the team quickly set up for their first surgery, over in Operating Room #1, Dr. Gordon Graham, Dr. Surendra Sharma, RN Pat Egerton and RN Mary Shanchez were busy pulling off their own brilliant moves. Their 39-year-old patient had come to the hospital with an enlarged uterus.

“I can’t believe the pain this woman must have been living in,” Mary said. “When he removes it, she will wake up feeling like a new person.”

Mary was right. This poor woman’s uterus had grown to the size of a small watermelon and she looked like she was 30 weeks pregnant. When removed, it weighed 8-pounds and had multiple tumors growing out of it.

“It’s one of the biggest ones I’ve removed,” said Gordon. “In the US, we would have most likely caught it much earlier so it wouldn’t have grown to such a massive size.”

It WAS the biggest one I had ever seen.  This was the first surgery I had ever witnessed and I found the whole experence amazing.  I swear, if I would have seen what I saw today when I was 17 and making career decisions, I would have been a surgeon.  I loved watching them work.

FROM DAWN TO DARK

Monday was the first of many long days. It began in the dark at 5:30 a.m. with devotion lead by Karen and continued long after the sun set. Some of us were able to get back to the hotel by 6:30 p.m., but a few members, including CRNFA Jennifer Curran in recovery, were there until 8:30 p.m. making sure all the patients spending the night were stabilized.

"One little boy asked me if I was going to stay and have a party with him. He was having so much fun at the hospital," said Jen.

All areas in the hospital were non-stop busy including the dental area where Dr. Christine Hoeplinger and a dentist from Guatemala were seeing 14 patients a day.

There was only so much they can do this week so Christine and her team are focused on cleanings, fluoride treatments, fillings and sealants.

“We don’t have all the equipment here to save the teeth. I’d love to be able to do other treatments, but I can't,” Christine said.

In total, we completed 18 surgeries on Monday. They included abdominal hysterectomies, vaginal hysterectomies, cystocele-rectocle repair, myomectomy, herniaplasty, laparoscoptic cholecystectomy, bilateral sphenoildatomy, removing tumors, frenulectomy and tonsillectomies.

These, along with the patients we met, became the talk of the day. We added them all to our list of miracles – including the massive uterus and the rubber glove. They may not be traditional miracles, but they certainly weren’t something you see every day.