Friday, November 9, 2012

D-41 days... surgeries

The absolute coolest thing on board is that once a year we have the chance to dress into scrubs and stand right next to the doctors in the operating room while they are doing their magic.

Today was our day! 

Darren and I signed up to be in there together. The following post is a non-medical, non-English speaker, but very enthusiastic girl's recollection of the day. Please keep in mind I cannot share any photos with you where you can see the patients and I certainly don't know all the proper medical terms (Thanks Jen P. for your spelling help). What I can tell you is how amazing this day was and how awestruck I still am. As I told Dr. Gary today; this experience really made my last 2 years worthwhile!

We reported to the OR office at 9.30 am and after we listened to the compulsory do's and don'ts list we chose our first room: ENT. Everything was covered in blue and that was our clue to stay away. All that's blue is sterile - even the circulating nurse couldn't touch any of those. Their job is to hand over half-open packs where the nurse who assists the surgery can remove the sterile instrument from inside with her gloves on. Today they were doing a parotidectomy- removing the parotid gland due to a tumor that grew under the poor guy's ear. The challenge was to cut the tumor out completely without hurting the facial nerves (that could have paralysed his whole left face.) We left after about half an hour, the doctor was still making tiny little cuts around the tumor. He said it would take about 2 hours to remove it safely.

Our second stop was Dr. Gary's Max-Fax (maxillo-facial) room. It's always a treat to go in there. Some doctors are very strict about being quiet or not standing too close, but not him. As we entered he greeted us kindly and without us asking he started to tell us what's been going on. He even pulled us closer so we could have a better look. The girl looked somewhat familiar, but I didn't want to mention it first in case I am wrong. But then Dr. Gary said that this is her third surgery; her first and second were in Sierra Leone last year! I knew I recognised her!!! She had noma, a nasty flesh-eating bacteria that left a hole on her cheek. This time Dr. Gary removed some scar tissue around her lips and nose and "just" stitched her skin together. I asked lots of questions like "will she be able to smile" (yes!) or "will it be noticeable to others that she had a problem before" (yes, slightly). The area - where the hole was - was filled by tissue from under her scalp and as such had no feelings or nerves. The few remaining blood vessels were cauterised. Dr Gary used radio waves and a transmitter (that did the burning); the patient was laying on top of a plate so the radio waves went through the patient without harming her! Is it cool or what???

We also visited the orthopedic room where Dr. Franck was about to cut a kid's hip open. Why? Because from the hip he could chip away small parts that will be implanted into his ankle - where his bone should have been. He was born with no bones in his left ankle area and apparently those small bone parts that Dr. Franck quite literally broke away (with a special hammer type of thingy) will grow into strong bones that will support his feet and thus after the casts are removed and he is done with his extensive physio therapy he will be able to WALK! :)

Our last stop before lunch was the Eye-Team. Now, this is a place I really didn't want to go. I was in their OR last year and I barely survived it. The spookiest thing is that the patients are awake, they only get local anesthetics via drops into their eye that has a cataract and then they need to lie down under the microscope. You can see it on a 22 inch TV screen what the good doc sees as he attacks the eye. The eyelids are held open with a speculum while the doc cuts into the white part. A small cut and then he can dig deep under the iris to start removing the cataract. The patient we saw today wasn't an easy one; despite his young age he apparently had some old cataract that grew together with some other nasty things in his eyes. Bottom line, the doc had to make quite a big opening before he could pull out that nasty white ball. Cataracts were supposed to be slimy layers that prevents you form seeing, but the thing he removed from his eye sounded more like a small stone when he dropped it onto the metal desk.

Darren was fascinated by all this; I had my reservations about this particular type of surgery. I still find them weird, but I did want to see it through so we stayed. You can see the picture, I was hiding behind my husband and had my eyes closed every time he had to make an actual cut. Funny thing is, out of the 4 types of surgeries we saw today, this was the most bloody!

With Jen P. (OR Team Leader)
Around 12.10 we left for lunch. Darren had to go back to work, but I was told I could come back later if I wanted. Heck, yeah! :)

I chose Dr. Gary once again. This time he was about to remove somebody's entire bottom jaw!!!

The patient had a huge tumor growing out of his chin (i think it started in the bones), the size of my fist! The only way to save his life was to remove everything under his tongue. I couldn't believe that it's possible until I smelled again burned flesh. When I entered Dr. Gary had the skin cut open entirely under his mouth and was using some special scalpel to separate the jaw bones. Suddenly the chunk fell down and behold, half of the patient's face disappeared!

Talking about dropping your jaw! I think my jaw dropped deeper than his!!! I mean really, I was standing above a guy with his bottom face missing and the bloody skin pealed back on each side!!!

Dr. Gary (left) and his team
His tongue was held out so he wouldn't swallow it accidently. That would have been stupid as the whole point of this surgery was to save his life! The tumor was growing bigger and the poor guys only options was: slow suffocation as the tumor was pushing his tongue further back each day.

Dr. Gary was in the middle of removing some teeth (that were old and black even for Guinean standards) when suddenly the whole room went dark and silent. Apparently a seal broke somewhere in the engine room and hot oil was splashing all over the place. To prevent a potential fire the system shut itself down, which overloaded the generator and caused the entire ship to go black. 2 seconds later the back up generators kicked in, which was excellent considering the anesthesia machine was breathing for the patient. Dr. Gary never stopped his work, he just continued pulling bad teeth as if nothing has happened.

Now that the jaw was gone they had to put a tube down into his stomach so he would be able to get nutrition. For the first few trials the tube ended up in his lungs and I didn't understand why that was a problem until I was told it's not for breathing but for eating for the next week or so. :)

Me hiding behind Darren during the eye surgery :)
The next step was to get the Titanium plates. They looked like giant Lego parts in the form of a hockey stick. Dr. Gary measured the patient's jaw and started to bend the titanium plate till is was the correct size and form. He only had one tooth left on his bottom jaw and the good doc had to make sure he would be able open and close his mouth with the new jaw and would be able to chew with it properly.

As I was told the soft tissue will not be happy to connect with the titanium and to ensure a safe chemical infusion a second surgery will be necessary. They will implant some bone tissue that will grow around the titanium plate and the soft tissue and muscles will recongise it and they will live happily ever after together.

To ensure the titanium plate will stay where it should be the nurse handed over a slow drill to Dr. Gary. It looked like any ordinary drill (like an old sawing machine, it was controlled by his foot). Before I could ask why, he drilled a few holes into his remaining bottom jaw line. Soon after the screws followed. he used an ordinary looking screw driver to fasten the screws. When I mentioned that he jumped on my words: This is NOT ordinary! It's a special super-dooper surgical screwdriver. It's sterile to begin with, has an extra top part and it costs about 100 times more than your regular screwdriver! :)

While he is drilling a nurse comes in to discuss tomorrow's surgical schedule. He listens, nods and as the nurse leaves, another doctor comes in. They talk about a different patient and draw up a quick analysis. And I am just standing there, amazed at how many things he can focus on while drilling holes into somebody's jaw.

Sadly I need to leave the room soon as I have an errand to run. The nurse tells me to go, I have seen the best part already anyways. When I ask Dr. Gary what is still to come, he informs me that the rest is pretty routine. They gonna stitch the patient's tongue to the titanium plate together with the muscles. The sutures he uses will dissolve, which is good because often our patients don't show up for their follow up appointments, and here I am thinking how much easier MY life could have been had they used dissolveable sutures during my several surgeries oh so long time ago...

The last thing left will be to stitch his skin back together and off he goes. I am speechless as Dr. Gary tells me all this; his tone is so friendly, so open, so conversational as if he only described his dinner plans to me and not a complicated facial surgery.

I am telling you guys, THEY ARE THE REAL HEROES, and I just thank God I could serve together alongside them!

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