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!
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