And In The End…….

Don’t forget to see video’s from our trip, go to:

www.aurora.org/missiontrip

New Video’s will be uploaded daily this coming week.

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You say Goodbye and I say Hola.

Dateline: Saturday October 17th, 2009

Last day in Santiago, We slept in late, 7 am, due to the festivities last night.  I think I am getting a cold because my voice is quite hoarse. It couldn’t have to do with all the singing last night.

It was very busy at Cabral hospital for a saturday morning, everyone was around to see us off on the last day.  The Tower of terror boys were on hand.

The little guy in red was the man who sat on the elevator roof and took directions from Manny.

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Manny poses with Joe Bondranko our hired gun

anesthesiologist from Tennessee.

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We hit the ICU and saw that everyone was doing fine. We pulled the last set of chest tube’s on the man who had an Aortic valve replacement from yesterday and his wires.

My woman that was an AVR/MVR from monday with nodal rhythm was now in sinus!

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There is no doubt the “Shinning Star”of the group was the first surgical patient of the trip, Dr Crouch’s AVR/MVR. She looked great and was ready to sing for us.

After rounds were done, 7 of the 10 post-op’s walked out to the waiting area for some group photo’s.

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I think the National grocery store got it right: Christmas had come early, for these 10 people. And when we all got together it was like celebrating, not like last nights festivities but a quieter more meaningful celebration of life.

And then, Our first lady the AVR/MVR from monday sang for everyone and the silence was broken, like when when the Grinch(Boris Karloff not Jim Carry) hears the Who’s singing…..it brought goosebumps.  It was a very special and touching moment.

(If you want to really see and hear her sing, got to you tube  and search: ccquinnmd or Heart 2 Heart song Cabral)

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We made many great friends in Santiago. especially with the resident doctors who helped us every step of the way. We are all very grateful!

We were all sad to leave our new friends, but the work was done (for now) and it was time to begin the trek home. All of us a little richer, on the inside!

Dr Romey and  Dr Sarah

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Dr Shayanne

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Dr Juan Carlos Geronimo

and our own Betsy Dunst RN

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No One on this trip worked harder than Mrs Joan Pascotto.

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Dr Crouch and I are very grateful to Dr Pascotto for his sage advise

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I am especially indebted to my OR/ICU team who really made it all happen.

Thank you so much!

And many thanks to our Special Guest Star;  Dr Will Szerenyi, who kept us grounded and laughing all the way!

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It is funny how even 40 years later, the Beatles still seem to have gotten it right.

“And, in the end, the love you take, is equal to the love you make.” (Abbey Road 1969)

Ain’t that the truth.

Hope you enjoyed the ride as much as I did.

Cheers and good night.

Curt Quinn, MD

Veni Vidi Vici: Mission accomplished

ULTIMA:last OR case today.

Dateline: friday Oct 16th, 2009

It was breakfast as usual this morning, power bars and Starbucks instant coffee for Joe and I. The hospital staff also prepares a nice little treat of yogurt and cookies  too. The Dominican coffee is also quite good after you get used to drinking it with room temp milk.

We are very happy to be finishing surgery today, it was a grueling monday and Tuesday, eased up wed and thur and now we are on the home stretch. As I mentioned last time the two concerns with today’s case; a 48 yo man with severe Aortic valve insufficiency are his weak heart (severely dilated  LV and EF 30%) and the fact we have no more size 21mm aortic valves to replace his with. 21 and 19mm are the most common size used down here because the size of most people is small. We have a 23mm and 19mm at our disposal. Dr Pascotto can only get valves from donations so his overall on hand stock is limited and first come, first serve is how it goes.

Mr P here is appropriately nervous today, but quite lucky so far. He actually was the 11th alternate candidate. The woman originally  picked to go with an ASD, turned out to have a more complex congenital heart defect and it s exact delineation was yet to be classified by the pediatric cardiologist. It appeared to me to  possibly be a mixed form of TAPVR.

I then check on my cabg case from yesterday and he looked fine. no major problems overnoc. My double valve case from monday was still in a nodal rhythm and could possibly need a pacemaker, which in quite a big deal down here, Though often a person’s heart rhythm can return several days post-op. Dr Bob said he ‘s got an old permanent pacer floating around the Garage  if necessary.

Walking around all day carrying so much “stuff” in the front pocket of my scrubs I felt like Dr John Reisch!

As I entered our OR room I was instantly hit with an almost solid wall of humid hot air. It seems the Machina Gods struck again and removed a cord from the AC unit and someone was looking for it?? It was as hot as hell in there.

Jim my perfusionist took matters into his own hands: unconventional but adaptability is the name of the game down here.

Above the scrub sinks were instructional signs that describe what not to do or bring into the OR’s, things like no smoking, no eating, no trash, no talking and no gun’s.

We had done a lot of teaching with the residents and Fr Bill yesterday, which dragged the case out. I was instructed from my team today to stop talking and telling jokes and just operate! While our case was going on the other team had already commenced the take down of OR #2 and moving supplies back to Dr Bob’s ” Garage Wonder Emporium”.

Dr Szerenyi was fired up, as he whipped in the lines and we were off for our last Aortic Valve replacment.As luck has it, he took a 23mm St jude Aortic valve prosthesis, Will loaded him with some of his FDA unclassified DR drugs Dobutapressin and Primalol(lack of pumps required him to mix heart drugs in the same syringe). We cautiously crept off pump(he had a huge baggy heart) and kept on going.

Because the elevator really needed to run constantly all day to move the big equipment downstairs the “Machina Boys” stationed one of the smaller guys directly on the roof of the elevator all day to hand crank as needed and we brought or guy right to the ICU with only a few jolts. Here you can see his smiling face  above through the open doorway. That’s one shitty job.

We made it up to the ICU safely and our nurses were trying to mobilize the patients as much as possible, pulling chest tube, pacing wires and getting them walking.

Everyone had been working 12-18 hour days since saturday and we were excited to possibly get out of the hospital before 4 pm today!  Maybe see some sun. Too bad he hotel pool was being repaired this week, but everything is “being repaired” down here.

Our Mitral valve replacement patient from Tuesday was walking the hallways and would have helped us move equipment if we would have let him.

We had to pack up the communal toilet paper, hand sanitizer and iPod shelf in the OR.

We did a quick tour of the hospital sterilization area. Everything was reused in some fashion, IV tubing, O2 tubes and masks. Nothing gets thrown out.

We got our Aortic Valve patient extubated in about 2 hours and with everyone looking stable left the ICU patients with the residents for a while and headed out.

A quick grocery store stop for “supplies” revealed that Xmas was in full swing here.

Some of the team wasted no time firing up some Dominican cigars.

We assembled for a nice group photo and headed to a little thank you party for us and all the residents and medical students at a local families house, set up by the supporting cardiologist Dr Lopes.

Man these Dominican people can dance! They graciously tried to teach us the “merengue” but only Bob and Joan Pascotto(seasoned professionals) looked good from our group.

Not having rehearsed in a year I was forced to lead a “Thriller” dance, It was fun but after about 2 min all the Dominicans did it better than I ever could.

We had very gracious hosts and  drank El Presidente and ate strange tasty meats.….

A well deserved rumpus. I think that was topped of by Dr Crouch leading us all via Kareokee on Springsteen’s “Born in the USA”

We headed home with one last day  left at Cabral hospital of wrapping up patient care, taking pictures and saying our goodbyes in the am.

S.P.Q.R.

Whole Blood Kicks Ass/ Deus Ex-Machina

Maybe we don’t do everything better in the USA?

Dateline: Thursday Oct 15th, 2009

It’s never a good sign when the “Machina Boys” are already trying to fix the Elevator at 7 am! I think they felt bad after all of yesterdays major delays so they came in early to try and scavenge parts from elevator #1(which never runs) to get #2 running better.

Carnie’s for the “Tower of Terror” ride

We had the late case today so first thing was am rounds in the ICU. Everyone was well.

In fact if you consider that in three days, we’ve done 4 AVR/MVR’s, 1 MVR, 1 CABG and 1 AVR/Asd Ao Aneurysm, every one is alive, extubated  and most have their chest tubes out-thats pretty freaking remarkable even in the State’s

No one had much Chest tube drainage at all, and that is after heart lung machine pump runs of considerable time??? We think it’s because of whole blood. There is no blood bank down here.

So when the final 11 are selected(10 plus a back up in case of cancellations for any reason) the family goes to the red cross and donate whole blood(not specific blood products as we use) for the surgery.

The whole blood may not have as high a HCT as packed cells, or pooled platelets, but it sure has the “right stuff”! Taking some heart surgery patients back for bleeding is happens occasionally back home no matter how careful you are. Down here it spells the potential kiss of death. We all have tried to be extra cautious in drying things up, and have given most of these patient at least 2 units of their directed whole blood. It truly has been amazing how little bleeding they have post op.

Though these people are younger, they have had real tough intra-op courses with repeat pump runs and complex surgeries. Every case seems to have some extra little medical glitch in addition to all the lack of supply and outdated equipment stuff. We are cautiously optimistic with only 3 cases to go.

Dr Couch was already underway hopping to repair a young women’s mitral valve which could spare her having her tubes tied (if he has to replace her valve she will be on coumadin for life, a known teratogenic drug)

I stopped in to see my  surgical patient for today.  He is a 53 yo man with 3 vessel coronary artery disease. I did not need a translator  for this visit, he knows who I am. We shake hands and take a photo. I touch his chest  and legs to show him where the incisions will be. I tap my watch to explain we begin in 1 hour. His smile is not as big today as usual. I understand him perfectly.

He needs a 4 vessels coronary bypass. A fairly routine case in the USA, but we’ve heard and just seen that these people have notoriously small coronary arteries and have had the poorest outcomes in past mission trips. I always hope, pray and work hard for the best outcomes for all my patients, it seems to count just a little bit more down here.

We have a much different relationship with our patients here. Even though we don’t speak their language we are all much closer. We have basically all lived at this little hospital for the past 6 days. We see them and their families everyday and they see us running around carrying boxes, eating power bars, taking video and photo’s and carrying rolls of toilet paper to the resident’s bathroom. We kind of grow on each other. The families are here about 12 hours a day and I mean the whole family. We wave and say “Ola” all day long.

As I head back down to the OR to see how John’s case is going, it looks like the Machina boys havent gotten far…….

I checked into John’s room and he is finishing up repairing his woman’s Mitral valve and sewing in the ring, so that looks good for her.

My patient is brought in and it takes about 45 min to get all his monitoring lines placed and on the ventilator. Then we heard that there was a power failure next door in Dr Crouch’s room, His Perfusionist Jim Bobby(no relation to Ricky Bobby) had to Hand crank the heart lung machine for 4 minutes until circuit breakers could be found and reset. Just a wee bit nerve raking. last time Jim had to do that was 1986.

Despite this last shot from the “gods of the machines” at Dr Crouch, his case went great and that young women went to the ICU in stable condition.

We Did a lot of teaching on my case as the residents helped open the chest, assist taking leg vein, intubate and close the leg. We only had one brief power outage not long enough to hand crank anything.

We were also on our best behavior today as we were honored with a visitor Fr . Bill Johnson S.J. the priest who blessed our mission last sunday night. He was totally cool guy and a Milwaukee native born at ST Mike’s hospital. Now believe it or not there are some occasional cuss words strewn around the OR , so most of us were pretty good. Except for my perfusionist Jim Zischler ( all perfusionist’s I believe are named Jim) who got a little upset over a political comment by Dr Szerenyi and said “Jesus Christ”! I thought I was gonna have a heart attack, but Father just rolled with it.

Here’s a view of our electrical panel.

We always pop into the other guys room to se how things are going.  Our case had gone well and i was happy. But the happiest man of the Day was clearly Dr John Crouch who had now finished his 5 cases and was home free for the next 2 days. he had the pleasure of doing 2 cases on tuesday,  so now there was only  one case left  for us to do on friday.

I do believe this picture of Dr Crouch speaks for itself! An awesome job he and his team did.

We wrapped up our case, spun the Wheel of good Karma and headed to the ICU. The Machine Gods had been satisfied for the day and allowed clear passage on the elevator.

As I finally headed to the bus at 6:30 my progress was slowed by a hospital team carrying a patient on a metal stretcher down 6 flights of stairs! It seemed the tower of terror was hungry again. This was really not a pretty sight.

Mrs Pascotto said that  only once  did the mission team have to carry a post-op up the 2 flights to the ICU. It is not recommended. That bed is damn heavy.

We hit the bus, Were handed a cold “El presadente” beer, kicked our feet up and headed home.

Oh, and by the way, I was notified by that we had used the last 21mm aortic valve wednesday. So for tomorrow’s case my options were a 19mm or 23mm, take your pick.

So it goes, in the DR

Todays Blog is dedicated to Ms Christine Schmidt and the Pleva Family of Wauksha. My thoughts are with your nice family tonight. So sorry for your loss. Curt

No hits, No runs, No errors

Dateline Oct 14th 2009: DR,  we pitched the perfect game today!

The last 48 hours had pretty much been exhausting due to the acute level of care needed to get these patients through surgery. These young people are very sick and we all are worried someone is not going to make it. but today the tide was finally  changing.

Our team was up and Adam as usual for the am bus ride to Cabral Hospital, all anxious to see how our patients were doing.

We left of last noc having somehow gotten Dr Crouch’s sick heart out of the OR, and to the ICU. He and the entire team busted ass to get that guy better and it paid off! Though still critical this morning on a balloon, he was awake, making urine and had stable vitals, incredible!

Chris and Betsy had done an awesome job, as we assessed the big picture, we needed to somehow get the last two cases extubated(off the ventilator) today so we could have breathing machines for the two heart surgery cases today. Limited resources greatly increases the chances of a rapid vent wean.

We had the early case today another sweet 48 yo woman with severe Aortic and Mitral valve stenosis from rheumatic fever. As Dr Juan walked her into the room we all gave her a big hug as she willingly put her life in the hands of these strangers.

This hospital is like a small community unto itself. All the 10 candidate patients stay the whole week in 3 rooms right outside the ICU.

So every time we go back and forth from OR to ICU we see our pre-op patients standing in the hallway watching intently as the drama unfolds. They all watch as we run by with Intra-aortic balloon pumps and 6 people hurrying the post-op patient down the hall out of the “tower of terror”. They all know what day it will be their turn.

We all know what they are thinking as they bravely smile and wave to us.

This woman is about to lay down on our  table and have a double valve replacement and she hugs us all like we are her family, for today we are.

No doubt Monday and Tuesday we stressful days because the cases went long and hard. Fortunately everyone was doing ok, but for a little added good luck we whipped up the “Wheel of good Karma’ Everyone drew their picture on the cardboard pump tubing case and signed it. We then hung it on the heart lung machine.

With each spin of the wheel all of our positive energy would flow through the heart lung machine and into our patients. It may sound hokey, but I’ve used it before on tough cases. As I tell all my patients we will take everyone’s help in the OR, especially prayer.

Both our case and Dr Crouches case went without a hitch!, There was a little delay in ICU but it looked like we would have the two ventilators available for our post-op patients.

The routine when the surgery was done was to send one of the residents to secure the elevator and “test it” to see if it was running. As we sat in the OR waiting, Shyanne the resident(who refuse’s to ever ride in the elevator??) told us that the “tower of terror” was just being fixed after trapping one of our patients from yesterday in it for an hour, on her way down for an xray! oh boy.

Also we had no more EKG or transport monitors available, so we would only have O2 sat monitor for transport. Moving a fresh post op heart patient is always an anxious situation, at any hospital. Here it is another ride at Six Flags.

We finally got the go ahead from Shyanne,  scrambled on the elevator and promptly went no where. After 4 minutes and a lot of yelling up the shaft by Manny (the main elevator operator) we then descended to the first floor lobby. I was monitoring blood pressure by pulse, If you can feel it, It’s probably at least 80. After about 8 agonizing minutes and 3 trips to the first floor, we finally went up to the 6th floor, hallelujah.

Our Lady did great, without turning a hair. In the ICU we saw that everyone, including the really sick guy from last night was doing better. He was extubated and the Balloon pump coming out. The ICU team of our Nurses and the resident Doctors where all fired up.Our young patient from yesterday looked great and we were all hoping to get back to the hotel possibly before 6 pm for some R and R.

Our young man from yesterday looked good.  Thursday we have another 2 cases, Dr Crouch has a difficult Mitral valve repair on a 23 yo student and I have the other CABG case on these notoriously small coronary patients.

There’s gonna be a lot of wheel spinning tomorrow!

There is no spoon.

When Neo goes to be tested by the Oracle in ‘the Matrix” he meets a small child who can bend spoons, The real trick here explains the child is that “there is no spoon”

We are in the Matrix.

Imagine being transported with all your friends and coworkers to a strange place where you’re doing your daily job but the world and its rules have changed.Welcome to Cabral Hospital DR.

Dateline Tuesday Oct 13th: Today it was my turn to dodge the bullets.

After a real bad day and noc monday trying to get my little AVR/MVR lady through her surgery. After a good 4.5 hrs of sleep and a hot shower, we hopped on the bus and arrived at the hospital at 7am, Fortunately the resident Doc Bernice was able to wean down alot of the heart medications she was on and we we’re able to get the breathing tube out by mid morning. It looked like the worst was over for her.

She had survived the surgery and re-exploration and our whole team was relieved.

Dr Crouch was schedualled to do 2 cases today, so he got his first one, another Avr/Mvr  and all went well.

His anesthesiologist Dr Joe (Jose’) Bodranko was busy keeping it all going but at the same time firing off the most witty retorts since Mark Twain! Those southern gentlemen are so charming…especially to the ladies. We got our case started around 10:30 by having the patient walk down from the ward as usual, Will gave him a big “my Casa, Su Casa”  welcome  hug and he was off placing lines. It is an incredibly friendly country and everyone goes by their first names, patients, nurses and doctors. Also lots of hugs and kisses for everyone. Our case today a young 34 yo man had an extremely tight and stenotic mitral valve, his Pulmonary artery pressures were 78/40 pre-op and Will and I we really worried that it would be tough to get him through. (though everyone in general is younger than our patients at home-they all have “sicker overworked hearts and other undiagnosed diseases)

Fortunately both morning cases went well without mechanical equipment error or surgical incident, hey the day was looking good……

As Dr Crouch started his 2nd case a beating heart coronary artery bypass, I got a tour of the Hospital and ER by Dr Juan  and Dr Shayanne the residents.

On our way down from surgery we encountered an bizzare site. As you may recall the elevator is less reliable than a wisconsin weatherman, we saw two men carrying a corpse down the same main stairwell that we had carried  those 67 boxes up. I watched as the poor mans body slide back and forth on the liter waiting for him to potentially slide off.

If that wasn’t shocking enough, the ER was filled with patients waiting days for any treatment, If you were not directly bleeding to death then get in line and wait.

Many people were  stuck in an ER side ward waiting for surgery like this man who had his leg fracture in water jugtraction for the last 27 days.

It made our complaining about lack of supplies and  OR equipment  sound like whining babies.

Then we got word that John’s case was having trouble, the patient  had extremely tiny coronaries and the cines(xrays of the arteries of the heart) did not show things accurately. The patient had to urgently go on the heart lung machine and was not doing well. This was now about 5pm, after two pump runs and several additional grafts and a herculean  effort by Dr Crouch and all 19 team members that man was moving out of the OR to ICU on everything we had and a faulty intra-arotic ballon pump at 10 pm. (Agent Smith is always lurking in the dominican matrix!)

Now the delema……would the bed and the pump fit in the elevator and would the elevator run.

The ‘tower of terror” as we now call the elevator, has intermittent working capability and often no lights.

As we rolled out of surgery past the 20 family members and scrambled onto the small elevator, Will and Joe Butterfield were the only ones who could ride inside. Everyone else including the patient’s family ran up the two flights of stairs to the 6th floor elevator doors while the elevator clanking noisily descended to the first freaking floor!

We could not believe the elevator went down to the first floor , sat there a while then finally meandered back up to the 6th floor, and then we cheered as the door finally opened and we could rush this critically ill patient into the ICU. Thats our rooms where we have 2 ventilators for all the ten cases we are trying to do. that means your getting the breathing tube out  the next day ready or not.

With all hands on deck, the patient was moved over to his ICU bed and Dr Crouch, Betsy and Chris took over trying to stablize this guy till 1 am, then finally took a cab back to the hotel for a few hours rest.

Just before the rest of us left at 11pm, I saw our first two heart surgery patients from yesterday, Both young women had Double Valve replacements, They had met before surgery because they shared a big room with the other preop candidates. The two women gave each other hugs and happily posed for this picture for me.

After all the hours of standing, bleeding, re-exploring, broken cable repair, extra pump runs, faulty elevators,  carrying boxes, using the same bloody sponge all day, agonizing, whining, lamenting, not having your real instruments, broken IV pumps, second guessing…………it was suddenly crystall clear why we were here!

In this pretty Island community, for 10 days we are all that stands between life and death for a handful of natives. We are their hope. In their Matrix, we are the “one’.

We rode the bus back to the hotel and collapsed. Or prep starts at 7am.

We don’t want to let them down.

The hits just keep on hitting.

There is no doubt that I need this damn blog more than you,

As I texted to my wife tonoc: Frack, frack,frack!, but not exactly with that spelling.

Dateline Oct 12th, 2009 Monday 7am,

We arrived early at the Cabral hospital to set up and do 2 cases today, Both Double valve replacements on young women. The women’s bathroom on the ground floor had overflown and flooded the entire entryway…..bad omen.

Dr Crouch had the Hot Seat and had to do the first case of the mission, A lovely 34 yo singer with severe aortic stenosis and mitral stenosis. everyone hovered as he and his team pulled off a beautiful double valve replacement, except for when the ventilator wouldn’t work for about 5min but Wil Szerenyi finally figured it out while Dr Bandranko bagged the patient.

Dr Crouch’s case went flawlessly and we were all very excited!

The Patients and their families donate “whole blood” that we give intra-operatively as needed. Here you can see dr Juan carrying this patients stash of blood into the OR

and Dr Rome’, both cardiology residents who help us all day long interpreting and navigating the hospital. We could not survive without them.

Well now it was my turn at bat. I went with Rome’ up to the ward to meet my patient again and bring here to the OR suite.

This 38 yo Woman, mother of 2 also had mitral and aortic valvular disease and a weakening heart. we  all literally walked down to the OR, she was in her best night gown and high heels.

We were all nervous, but as she entered the OR room Wil Szerenyi gave her a big hug and we all laughed. Nothing moves fast down there, especially the elevators. we heard that Dr Crouch’s case now done was awaiting elevator repair to get up to the 6th floor. Finally the team had to have a hospital  worker Hand Crank the elevator up and there was still a 1-2 foot mismatch from the elevator to the floor.

Wil got his lines in and triple checked his vent and off to sleep we went around 11am to perform our double valve replacement. Both valves were thickened and stiff, the mitral valve had the classic “fish mouth” appearance. Her heart was very hypertrophic(thickened) from years of overwork. Everything was going great until we were about to come off the heart lung machine. Wil started looking with the Echo probe and could not clearly see both mitral valve leaflets moving???

Sometimes the angle of the valve and the position of the probe can make it be difficult to see the correct plane of the valve.  I was concerned that perhaps some of the old valvular tissue may be trapped or blocking a leaflet.  We had Dr Crouch, Dr pascotto and dr Bandranko all look at the echo, and no one was sure.

It is always hard on the heart to re-arrest it, but clearly we needed to know.  We then stopped the heart again and opened the chamber to  look at the new Mechanical Mitral valve……nothing, the leaflets appeared to move unobstructed. I could not find any abnormal tissue or lesion? We then rotated the valve into a different plane just in case there was a functional problem once the heart was full or it was a visualization issue of the Echo Probe. We came off the heart lung machine and both valves looked fine, but her straining heart had been pushed too far…. Five hours later after mulitple whole blood transfusions, Heart drugs and lots of “tincture of time” we headed to the hand crank elevator, praying she would continue to improve!

Everyone from Dr Crouch’s team including himself had stayed all day long to help, it was very appreciated. We have Intra aortic ballon pump capability but Dr Bob suggested that if we could get by without it, it would be much easier to transport, so we did some recovery in the OR.

Finally it was time and we closed the chest.

Dr Juan called the elevator boys to warn them of our imminent arrival.

The resident Shayenne and I explained to her family  the serious but hopeful situation and headed to the ICU.

Our Top notch ICU team of Shari, Laurie, Betsy and Chris swarmed all over our patient as we arrived. She had been stable in transport and Wil had weaned down the Epi quite a bit, an excellent sign.

Joe and I snoozed on spare ICU beds while Laurie and Shari got her fully settled.Fortunately she awoke and moved everything, Dr Crouch’s Patient was next store sitting up in bed looking like she’d just had a manicure!

The team headed to a well deserved dinner with Joan and bob Pascotto, while Joe and I kept moral support for our ICU nurse Shari and Laurie.  The heart drug primacor that helped get her out of the OR was running low. thats all we had for her. So we cut the  dose to one quarter so that it would last the noc. About 11pm Dr Bob sent the shuttle driver back to see if we could leave. Our patient was doing well, still intubated and on EPI, Dobuta and Primacor(what was left). The 2 Cardiology fellows would watch her   so we could get some rest for tomorrow.

Orginally I was going to do an ASD Atrial septal defect repair case, Usually one of the more easy straight forward heart surgeries (sounded great to me) but we asked for a right heart cath because she had a “Snow man “appearance to her Xray and her echo at conference did not show the limits to her heart defect(we were concerned she might have PAPVR, partial anaomalous pulmonary venous return). The Residents said she had a cath done today preop by Dr Lopez and that it did show some possible Pulmonary venous abnormalities and that she also had a coronary fistula and arrested several times after the cath! Thank God we delayed her and we will do my friday Mitral valve replacement case tomorrow instead.

Our entire team did an awesome job of getting two difficult cases done today and once again I am very proud and humbled to be working with these people.

SURVIVOR FOR REAL: the Toughest Day Yet!

Hey Everyone whose kindly following along,  Dateline: Sunday OCT 11th.

If you thought moving 67 heavy ass boxes and a few tons of OR equipment was hard, try picking 10 patients out of 15 for life saving surgery, and thats after you’ve personally met them and shaked their hand!

As our trustworthy OR and ICU teams finished up getting all their duck in a row in their units, Dr Crouch, Dr Pascotto and myself had the pleasure of reviewing 4 hours of in depth case presentations on 15 potential surgical candidates. Everything from 19yo   mitral prolapse to 60yo Aortic stenosis with 3V CAD and sinus of valsalva aneurysms. But mostly 30-40yo with aortic and mitral valve stenosis and regurge from Rheumatic Fever.

After the 15 case presentations we went to meet and exam each candidate. In order to even get this chance at surgery the patient and family had to pay about $3,000.00 out of pocket for labs, EKG, Echo and Cardiac Catheterization!, If you  think we’re in a recession…….these sweet folks got JACK!  Let me tell you they are all truly sweet which made our triage jobs even harder.

The Cardiology residents and fellows helped as Interpreters as Dr Crouch, Dr Pascotto and I moved from bed to bed. What made it worse was that they were still in their street clothes which makes you much more of an individual as opposed to being in the typical lose butt exposing hospital johnny.

Each person of course was nice, mostly young and had a story of progressive shortness of breath and fatigue. Because they will need a mechanical(metal/Carbon) valve and need to be on Coumadin(a drug known to cause birth defects) the women have to be sterilized. We discuss with each one all the complications and try to determine a little bit of their social status and Job situation. This is truly Military Triage medicine. The difference between getting a valve replacement or not is potentially one wrong word away!

After the exams, the 3 surgeons sat down and reviewed the rankings like a miss universe contest, but the top 10 prizes are a chance at a life saving procedure. Deal or no deal got’s nothing on us. In the 22 years since I graduated medical school this was easily the most difficult and mind bending day I have encountered. Back home its pretty simple, if there is any chance in hell grandma can make it, we lay it on the line and as a family and physician, a surgery decision is made. Here it’s just us and our conscious deciding which “10 little Indians’ are going to get in the lifeboat.

Dr Pascotto quietly sits back, observes John and I, then plays devils advocate and uses his prior expertise to push us in the direction of the “most good decision”.

So we nix the last lady whom I  just joked with and said ” we saved the best for last” because we suspect it will take longer to get her better than we have time and resources for. The 19 year old can probably wait a while before he absolutely need surgery. It is a bit Darwinian(survival of the fittest) and a bit Machiavellian(how can I get my job done and skip town in a few days).

Finally after as much debate, thought and introspection as can occur in the 45 min we are allotted, the lottery is done and the 10 finalist’s and a back up are selected. The Papal smoke blows white and a an OR schedule for the week is made. Ah-men.

This is real life, not a 7:30 am Cabgx4Lima surgery, clinic, gym and then Dinner with the wife and kids. This is I’m sorry but you’ve been given a third class bunk on the Ttitanic-tough luck, hope you live long enough to be a contestant on the next show in 4-5months.

AT this point the Face to face dirty work is left to the residents and the attending Cardiologist Dr Lopes

who brings all the patients and family into the conference room as we slither out.  He has to lay down the “word from on high” as to who stays and who goes. They know him and trust him, we are just the Northern gunslinger’s. He has a very friendly, confident, solid, mater of fact way about him that transcends any language barrier. He will do a much better job than any of us Gringo’s.

As you can see from the scratch board above we are not doing “simple cases”, lots of double valve replacements and my “ASD” probably has some degree of PAPVR, anomalous pulmonary venous return. And there is Not too much pressure on DR Crouch because if he can’t repair the 23 yo’s mitral valve on Thursday, then she will recieve a mechanical valve and need to be sterilized after surgery.

I get back to my motel room around 5pm, pop 600 of ibuprophen, look at the photo’s of my kids that Janel has emailed me and collapse in a bit of a stupor.

At 6pm We head to a local Jesuit retreat where Father Bill has arranged a special service to bless our mission and another group of ENT surgeons from Nebraska(all of whom know and love Tom Langdon!)

While I am there Joe Bondranko shows us an interesting finding. I am totally drawn to this painting of the  ”Companious redneck angel” depicting the spirit of the mountainside people who live around here.A cigar, Coffee machine and wings, now thats my kind of angel. This is very comforting to me. It allows me to take a second and realize that although life is precious, I really cannot control life and certainly not the lives of all these  wonderful people. But what I can do is take my dedicated team and try the best we can to help as many  of them as possible.

We are Surgeons and that’s what we do best.

We have joked all along this trip that we are ‘Commited to healling’ sort of a tongue in cheek saying. But when you look at it we really are.

We head out after the Blessing sermon for a nice dinner and anxiously await our first OR day.

Laughter is the best Medicine.

Cheers to all!

Welcome to Cabral Hospital, Santiago

Olay baby!

what a day, our full team moved 67 heavy boxes of OR/ICU equipment up 4 flights of stairs and set up 2 full CV heart room OR’s and an ICU. everyone was carrying stuff in high humidity 85 degree weather. The hospital as you will see is fairly basic and as you would expect kind of a free-forall.

We took totally empty operating rooms and within a day fully stocked them with OR tables, anesthesia machines, heart lung machines, air, CO2 and oxygen tanks, bovies, suture, cell savers, drugs, ETc………..It was like an Army invaded and the same thing on the 6th floor for the ICU.Finally after 3 hours the one of three elevators got fixed so we could at least transport the real heavy equipment upstairs from the “locked garage” that Dr Pascotto stores his equipment in.

After the big caravan carrying session, it turned out best to keep the heart surgeons(Crouch and Quinn) off to the side, otherwise we just screwed up things.

Overall an exhilarating and grueling day all at once, everyone working their butts off to make it safe to operate and take care off cardiac patients.

Tommorow we finish up the rooms and select 10 out of 15 possible patients for surgery next week.

This trip is all about people helping people and I am extremely proud to be working with such awesome people:

Dr John Crouch and

Norma Ramos

Norma and Joe check instruments, while Rome (santiago resident) Joan and Dr Bob pascotto, John and Roger take a break.

This is Dr Joe Bondranko an anesthesiologist from tennesee and this is his 5th trip to Santiago.

Last minute details

Dr Crouch, Norma, Roger, Evonne, Jim, Gary and myself met today with the Aurora PR team today and they Handed over 2 HD video camera’s for us to document the trip and feed daily shots up for an Aurora video blog. Should be interesting.

Gary And Curt work out some last minute technical details on the back of the Jeep as usual, trying to figure out how to hook up the auto-transfusion bags to the pleurevacs to conserve on blood products which are really not available.

First potential Mishap occured when our trusty Perfusionist Jim was getting a “pre-Trip” buzz cut from his Trusty wife Pat and she forgot to put the guard on the buzzer and gave him a little Greenskeeper Grazing……

Gearing up for the trip

Over the past year we have been stockpiling supplies for the Mission trip. At one point to due hospital inspections we had to relocate our “Depot” to Heidi’s garage. In August we had a couple of packing parties in order to organize and take inventory of what we had. It may look chaotic but thanks to the skills of Laurie, Shari and Joe we got everything fairly packaged up and labeled.

Our Perfusionist Jim, a perfectionist packaged all of the delicate Heart-lung machine equipment himself.

Joe can be seen here sorting through some surical instruments on the back of my jeep deciding what is most crucial. Many of these instruments are on loan from our good friends at St joseph’s hospital shown below.

Rita and her pals have gone well out of her way to help our cause

Wil Szerenyi our top notch anesthiologist personally supervised all alcohol consumption at our weekend meetings….

Even though Aurora St Luke’s and Community Memorial Hospitals are our main supporters, we have gotten supplies from many area hospitals like instruments from Nancy and the staff at Waukesha, Rita at St Joe’s and Pleurevac transfusion equipment from Columbia-St Mary’s. It is very nice to see how the Milwaukee CV community really has come together for this special trip.

We packaged up 6 palates of supplies and will always be grateful to Mr Dave Pelay and his perfusion Services Corp for shipping them to Tampa Florida. From there Dr Pascotto arranges to have them travel by boat over to the Domincan Republic and then the Hospital in Santiago. I would also like to Thank Mr Dennis Brown from Maquet Cardiovascular for his generous dontation of new Surgical retractors.

Dr Crouch and I would not have known about this program if it were not for Mr Joel Stevens from St Jude Medical and his continued amazing support.

With all our equipment heading south we are anxious to get on the road and begin our journey.