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.
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