We’ve got 6 OR tables running. Not 6 rooms, really, because some rooms have 2 tables. All the bleep bleep of anesthesia machines can make it confusing, but generally we’ve got it down.
Yesterday I assisted Prabir, a friendly plastics man from India. We did a really really huge bilateral cleft lip - not a lot of tissue to work with, a facial cleft (Type 7) and some skin tag removals, a unilateral repair with rhinoplasty, and something else which I am forgetting at present. It was a pretty good day once we got going - don’t know what the delay code is for “Luke left the key to the OR suites back at the hotel”, but that’s what happened!
Today was much smoother. Our scrub ‘techs’ were not around for the first case, so I served as the scrub nurse. I’m pretty bad at it - didn’t know all the names of the instruments, had a hard time hearing what the surgeon asked for, and even dropped a needle driver on the floor! But, we got through and our lovely Phillipino surgeon didn’t bat an eyelash. Then I found myself next door, thinking I was just observing, when I got pulled over to intubate. Easy peesy! But - the RAE tube was a bit too small [there was a little leak] so I had to extubate and by then we had some laryngospasm; it was tough to get the 2nd tube in, so the Anesthetist handled the finishing bit thankfully.
I had fun teaching a first year med student from Tulane how to scrub, and she did a great job. Didn’t contaminate anything or piss anyone off = fantastic for a first go! Waiting in the wings to scrub on the next case - a facial cleft - there was a heck of a time getting an IV in the kid. Dehydrated and cold (thanks to cranked A/C), 4 paeds anesthetists, a paeds intensivist, and a NICU nurse tried, but all they got was a pin cushion. So, the surgeon did a venous cutdown, which seemed the definitive solution but even then, a juicy vein could not be found. We were lucky that the little girl fed vigorously in PACU because that IV flow kepts ceasing. I took out the IV in post-op recovery, since she was sucking back the Tang with no problem (and the IV was just an object to be thrashed away).
Long day. About 11 hrs on the feet, with a lunch break and a bit of loitering in between being needed. I love the variety I’m getting but I’m hoping tomorrow to scrub with Dr. Sarom and see what he can do. Sounds like he is one of the best in Cambodia and I haven’t really gotten to work with him yet.
The amount of collaboration, teaching, and learning is incredible. Surgeons from each country visit their colleagues tables to see how they are doing this flap, where they are stitching this bit, whether they are using collagen here or not. Our crack dentist rigs up prosthetics for the palate and the nurses are turning heads and taking names by being superb at their jobs. We’re all learning from one another and making things go smoothly. It’s amazing what a very-well funded, well-staffed production can do in such a short time.
On Saturday, the crew will all be heading to Siem Reap. The poor among us, and those who want to see the countryside, will take the bus. The rich Yanks will take the plane. I’ll return and have another 4-5 days with Dr. Sarom. I may splurge on the return journey so that I can squeeze in an extra day in Phnom Penh. Gotta get my evaluation sorted and I’ll be off to Saigon for 2 weeks of ER in Cho Ray Hospital!
p.s. I’ve got so many rad photos, including many of the surgeries I’ve been on, up close shots of the venous cutdown, and videos from the back of the moto… but these will have to wait for my return as I’ve yet to find a cafe with a memory card reader here.
