Haitan Adventist Hospital: A busy day in and out of the operating room

After dinner Monday night one of the staff asked me to start an IV on the gentleman, Pierre, who fell off a roof last Friday.  He needed blood before we operated on him on Tuesday. Jen and I tried peripheral IVs for half an hour to no avail. The blood was in his room, in a thermos, so I didn’t want to wait until morning.  I went down to the OR, found one of our few central line kits and brought it up to the ward. I was fortunate in that the light was good in his room. It was very hot and I had two of his relatives holding on to him, but even so he nearly contaminated the field. I got an external jugular catheter to thread centrally and flushed all lumina after the transfusion. We’ll see if the line stays in over night.

I slept poorly Monday night. It’s noisy and not very dark. Tuesday morning I found out I’ve been washing my hair with conditioner (vs. shampoo).  This may explain why my hair doesn’t feel too clean.  I’ve never been clear on what the difference is between the two, but it is noticeable after a day or so. I checked on Pierre before conference. His breathing seemed a bit better than Monday and His SaO2 was improved. The dressing on his CV line had come off but the catheter was still in place. I showed the nurse, who was not at all happy about the central line, how to dress it and asked one of the permanent staff who speaks Creole to give them an in-service.

We got the operating room going in a very timely fashion, under the circumstances. I helped Jen in the operating room while going back and forth with the Haitian nursing and medical staff about Pierre.  They were anxious about the central line and worried about taking him back to surgery.  I explained several times about the need to examine the wound from Friday to look for any sign of infection and that placing an external fixator on his wrist fracture would not pose any risk of further blood loss. I thought we’d come to an agreement to operate on him that day, but an hour later when I asked one of the aides to help me fetch him he told me that the case was on hold, pending consultation with ophthalmologist and neurosurgeon. At that point I decided to stop trying to get him to surgery that day. We’ll hope to work on him on Wednesday or Thursday.

There was a power failure in our common room/sleeping quarters after work. Greg and Randy were champions, tracking down the problem and putting in a fix to get us through the night. They’d both put in a full day prior to this but seemed happy as larks to have another problem to solve.

We are a little short of spinal drugs. This vial is labelled "Bupivacaine 0.5%" and I think it is in a hyperbaric solution of dextrose. I sent photos to Young Kim, the anesthetist from Columbia-Presbyterian, with whom I worked in Egypt, to ask for a translation before I shoot it into someone's back.