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 Every case seems to have some extra little medical glitch in addition to all the lack of supply and outdated equipment stuff.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
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