Surgery

During the four surgical days on our medical mission, the entire group would have breakfast at the hotel together at 6:30 and then take shuttles to the hospital. The surgeons then made rounds on their post-operative patients while the anesthesiologists and nurses set up the operating rooms. When we were ready, we would meet the patient and parent in the pre-operative area. We adhered to standards at home; we made sure the surgeon initialed the operative site, double checked the procedure and consent, reviewed the plan with the parent. Unlike operations at home, we didn't pre-medicate the children with midazolam because we didn't have any. But surprisingly, the children tolerated the new and scary experience quite well. For the older and larger kids, we would start a pre-operative IV. For the others, we brought them back and induced inhaled anesthesia by mask. Common procedures included Achilles tenotomies, psoas muscle release, excision of extra digits, leg lengthening or shortening, osteotomies, and revision of prior surgeries. We used fentanyl and morphine as our opiates; we brought some ketorolac, acetaminophen, and ketamine as well. We were limited in our antiemetics so we only used them for older children and when necessary. Though the monitors and ventilators were old, we were able to do most of the things we needed with them. Unlike surgery at home, we didn't have good ways of warming the patient under anesthesia so the rooms were on the sweltering side. In fact, for one of the surgeries, the surgeons had rubbing alcohol poured down their back and clipped icepacks inside their gowns because it was so warm.

The post-anesthesia recovery unit was immediately outside the ORs, so close that we could stick our head outside the OR and check on our patients. We had 3 beds awaiting our patients. The PACU nurses took blood pressures manually and had a pulse ox but no EKG. Once the patient was awake, drank some jugo, and was comfortable, they were brought upstairs by orderlies to the pediatric ward.

We had anywhere from three to six cases in each room each day and operated until around 7pm. Even after the last surgery was finished, we hung around to do post-operative rounds and make sure that the last patients were discharged from PACU safely. Because everyone had to take the shuttles together back to the hotel, everyone worked together and waited around until the day's work was done. During the day, we'd have a delicious lunch provided by the hospital, and at the end of the day, we had dinner as a large group in the hotel before retiring for bed.