Joe:
I arrived to find out I would have a GYN case to start. I looked at an anesthesia machine I had never used before, and I couldn't find the "on" switch. Opening the drawer of drugs, I was missing about half of the drugs needed for an anesthetic. I induce anesthesia and put a breathing tube in the patient. I try to turn on anesthetic gas, and the vaporizer dial will not turn, so I had to switch to a different anesthetic gas. Then I tried to put the patient on the ventilator, and the bellows of the ventilator were not going up and down. I asked someone to help out to figure out why the ventilator was not working while I had to manually hand ventilate the patient. The surgeon decided the patient should be moved down on the table, and we moved them, and their arms fell off the arm boards and dangled along the bed. I asked the person behind me to give some medicine. Noticing they were actually a tech and confused by my request, he hand ventilated the patient while I dosed the drug and hoisted the arms back up. I went to turn on the nitrous oxide, and the float wouldn't move, hence no nitrous. Okay, I will use air instead ... well the float didn't move there either. Finally, we were able to troubleshoot everything and the patient got a halothane anesthetic delivered in 100% oxygen. Not the most elegant start of a case, but everything ended well.
Brett:
I found that I had a distal humerus fracture repair to do in my room. My first thought was: "Awesome, I'll knock out a quick supraclavicular block and keep them awake. Easy Anesthesthesy." But things started to look darker as my eyes then settled on the word "Paeds" scrawled below. "Maybe it's a Swahili term for armbone?", I thought. No such luck. The OR charge nurse hands me a file on a 2 and a half year old kid. I headed back to the room to get set up. Like Joe, I had no idea where to find things or how to troubleshoot the equipment. I was able to locate basic drugs like Thiopental, Succinylcholine and Atropine, but there was only one pediatric laryngoscope blade and all the rest of the equipment was changed to a smaller size by the tech on my request. The charge nurse then brought the child into my room, kicking and screaming. For a second I imagined what he would look like when the inevitable catastrophe occurred and his bright color faded to a pale blueish-gray. I cranked up the halothane, and tried to crank up the nitrous (unsuccessfully as in Joe's case). The mask came down on his face and, despite vigorous protestation, the halothane won. I must have spend ten minutes trying to get an IV. Someone else from the surgical team was ultimately successful, but I was preoccupied with the fact that no one else in the room knew how to mask ventilate. Anyways, the IV went in, followed by the Thiopental, and then the endotracheal tube. I secured things as best I could, and turned to the machine. The tidal volume the machine reported as having delivered was over a liter (enough to burst this little kids lungs). I immediately turned off the vent and studied the chest for signs of a pneumothorax as I hand ventilated. But wait! Even with the small hand breaths I was delivering, the machine was recording up to 9 liter tidal volumes, whew! clearly a machine measurement error). If you can't rely on 30 year old equipment in the east african bush, what can you rely on? I felt okay, but only just for a minute, as the surgeons then dragged the kid to the edge of the bed, causing his torso to contort and his head to roll off the bed. Thankfully, the tube was well-taped. I held the head in place and asked the tech to draw up some fentanyl. The bad news is that he could not understand how much I wanted him to draw up. The good news is that he didn't realize that he was just drawing up air. I traded places with him, drew up the fentanyl, and pushed it into the IV (which I then realized had stopped working). By this time, the surgeons were pretty much done, so I decided to give some intranasal fentanyl and then pulled the IV. I turned off the halothane and the student anesthetist I was to be supervising for the rest of the day walked in (to my absolute relief). Unfortunately, she told me that the kid would need an IV in recovery, and we set about finding a new vein. Halothane takes forever to clear, and it seemed like we were trying to get an IV forever until the kid eventually woke up (though everyone wanted to shake the kid awake while I masked through stage 2 of anesthesia, which is incredibly dangerous for those who don't know). I decided to deal with things on an intramuscular level in the PACU, and took an the kid back to the PACU in exactly the same form I found him: Kicking and Screaming. Smokey the Bear would have been proud.
Ok.
So the rest of the day went well (after I had someone who knew how things worked around). We did a few more orthopedic cases, had some chai, then some lunch, then finished the day with a block that looked great on ultrasound, but didn't work like we thought it would in the OR. We came home, rested a bit, then went for a long walk into the bush. When we got home, we enjoyed a large dinner of butter chicken over spaghetti (that we had requested from Irene), and a post-dinner hand-made cinnamon bun (that she had made without any prompting). Without further adieu, our day in photos (most graphic one first):
This was the second case in my room. There is a fracture, they needed to fix it.
The sterile drape for the same patient. They make due with what they have.
Joe doing some tutoring for the young student anesthetists.
I was too busy taking pictures to educate anyone today.
Further tutoring as the block mentioned earlier failed to provide adequate anesthesia and general anesthesia was initiated. Sure, I could have helped, but then who would capture this rare moment on film?
Me, that's who...
Joe's token photo with the local children outside of our house.
My token photo with them. My legs hurt too much from yesterday to crouch.
A lantana bush on the start of our walk. The backdrop is the Great Rift Valley.
Certain death often waits by the trailside in the African bush.
Don't go into the tall grass.
Even the blades of grass are big here.
Looking out across the Valley just before sunset.
It's really an incredible landscape.
A lonely tree framing the setting sun.
This is one of a set of paw prints that ran across the road and disappeared into the jungle. I couldn't see any claw marks, so my guess is that it's from a leopard. Feel free to correct me if I'm wrong, but there are not a lot of feral dogs running around here (presumably because they would be eaten by leopards).
That's a small airfield behind me. I doubt it's been used much recently.
Joe's birthday cake. We spared no expense.
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