Monday, Monday.... Part Deux

Warning.... this is entirely unedited as it's way past my bedtime! I hope it makes even a little sense.

Today was our second Monday of our trip. It came after a very busy weekend with very little rest. As my exhaustion increases, my brainpower for blogging decreases, and I have found myself at the point of having to choose sleep versus updates. Sleep has won out almost every time! I actually took out my camera again to day and took some pictures again, but posting them will have to wait a while. I'll probably not go through them until I'm home.

Things here are continuing to be busy. Saturday we worked till, well, now I can't remember Saturday. I'm sure we worked later than we wanted to. Wow, I really can't remember Saturday now much at all. Sunday we started rounds at 6 and then started cases soon there after. We had on three easier cases and then a bigger case, but because of "island time" it still took us till 5:30 to get done. Things just don't' move with efficiency around here so a potential light day of a few easy cases still took all day, causing us to have a few hours of rest for the entire weekend rather than any substantial amount of time. It took our toll on us, working 9 days straight as today, our 10th day, we were really dragging at times. Things that should be easy, here they take more effort and more time, and just aren't that easy to get done. We can't just write an order in a patient chart for medication. We have to write the order, then find a translator, then find the nurse, then explain the order until she understands, and then check back later to make sure it got done. One of the major jobs this week has been overhauling most of the OR including the supply rooms. Well, that means that where things were on shelves yesterday are not where they are today and not labeled the same, so today I found myself running around looking to where things were moved. While the OR needs the overhaul, it just adds more time and stress to find things when we're in a hurry to grab something needed in a surgery. Yesterday, we were delayed for an hour for maintenance on the generator as we had numerous power outages yesterday. It's great fun to be operating at night and have the power go out. We all have headlights we try to keep around with us so that if the power goes out, we have some light. Of course, the ORs may or may not have functioning lights (one OR just has wiring in the ceiling, but no light) so the only light we ever have is from the fluorescents or our headlamps. I should remember to take a picture of the ceiling in there!

I have actually not been scrubbing in on many cases lately. One of the things I have really been able to help with is getting the supplies and getting the room ready for the surgery. It is certainly not as exciting as performing the surgeries, but we all find ourselves in an environment like this "dividing and conquering" the work to get through things most efficiently, and it's turned out that if I can set up a room to get Terry started on the surgery, I then can get another room ready for another surgeon and try to maximize our efficiency. We now have four Ortho surgeons here, including one resident who is in his 5th year and will graduated in June, so there are a lot of hands to get cases done, but not necessarily enough rooms to keep going at a good pace. And of course, there is only one gurney in the hospital, so we are also limited by the availability of the gurney to transport patients to and from the OR. We do break out the stretcher at times for the smaller patients if we're desperate to get going.

Last night, for our evening of rest, we went over to the hotel again for dinner and a swim in the pool. We got done early enough to catch the 6:15 taptap ride over to the hotel. It is not a far ride at all to get there so takes only about 5 minutes or so. We piled high into the tap tap with the Italian plastics team and enjoyed the ride over until we got up to the top of the hill to enter the hotel driveway and the police truck was coming out. Imagine a "road" up hill only one car width wide and literally you could reach out and touch the US Aid tents lining the street. The road has water draining down the sides and through the ruts in the dirt, and there is a fair amount of garbage lining the street. If someone comes the other direction, it's basically a standoff to see who backs down first. So, we get to the entrance to the hotel drive which is also one lane when the police come driving out. and want to go down the hill, right where we were coming up the hill. They weren't budging, and our tap tap driver wasn't budging! After about 30 seconds of no one moving, the yelling started between the drivers at which point we started ducking for cover and got out of the tap tap and walked around the "traffic jam" into the hotel and got out of the stand off! The police eventually backed up and let the tap tap into the driveway past them. The previous night, (now I am remembering Saturday a little), we also went over to the hotel but we took Scott's landrover and Terry drove us over for the evening. We had a bit of an adventure finding the right street and ended up with quite a tour of the streets around the hotel. We have really not had time to get out of the hospital much and see the area much, so these short forays into the neighborhood were very memorable. LEt's just say it was as close to off roading as I've been in an SUV and certainly would be considered off roading in the US. There is constant water flowing down the hills mixed with garbage and likely sewage. The tents line the streets and people have open fires burning for light and cooking. We ended up having to back down one street when we realized we had gone the wrong way because there was no way to turn around on the narrow road. We ended up on the right street and did get to the hotel safely and home again to the hospital without incident.

Last night, though, we did get to the hotel in time to swim before the pool closed and enjoyed a raucous game in the pool with the Italians and a beach ball. After an attempt to play waterpolo and losing the first ball down the side of the hill when someone scored a goal through the iron fence, we got out a bigger beach ball and tried to keep the ball in the air and count how many hits we could make before it hit the water. Some of the Italians speak some English, but mostly they speak Italian, making it quite entertaining at times. They are quite a rambunctious group making time around them quite entertaining and humorous. So, we enjoyed letting off some steam and playing around a bit until the stern woman at the hotel came and took our ball away. We had accidentally batted it out of the pool just as she walked up to our raucous game, and refused to give the ball back! I guess we were too noisy, but we stayed in the pool anyway and enjoyed a nice swim under the moon and stars. Sometimes when I'm far away from home I look up at the sky and marvel at the same moon and stars that I can see from my own backyard.

Today was another busy day. The added emotions of having lost a friend back at home have compounded the emotions of the trip here. It's been a challenge to stay on task at times and we are constantly pulled in many directions. Tonight, we moved patients around in rooms to create a room of patients without infections and room of those with infections. We don't need our non-infected patients literally in a cot two feet away from someone with a draining wound. So we spent an hour moving people around on their cots being interrupted by people stopping us in the hall and asking us to take care of their family member because we are in scrubs and don't understand that we cannot help every problem that people may have but have to turn them away to get help from the ER or someplace else. It is hard to not be able to help everyone who asks, but it is impossible. We have had some interesting questions asked to us in our Ortho clinic involving body parts we do not deal with and have had to refer them to Urology and General surgery for their.....ummm..... problems. Jeannie today had to keep some man from dropping his drawers right there in the hall to examine what I can only imagine is a testicular hydroceole. Terry got asked about leisure activities after hernia surgery, and I had a man come up to me to inquire about having a hernia examined. When I explained I cannot help with that and he'd have to come back to see the general surgeon, he nodded but then went on to ask me about another problem he had. So I listened and tried not to blush too much when he asked about his erectile dysfunction in layman's terms. I gently deferred the question to the general surgery clinic as well. So, we have had some laughs at times about some of the silly things, at the Italians all singing together silly songs in the OR, and some of our own jokes and occurrences (like the availability of breast implants that were donated by some hospital). Since we had a plastic surgery team, it seemed like an opportune time to joke about the crazy things donated.

Well, I can hardly see straight and rounds start in less than 8 hours. This was a longer post than anticipated. I expect I will actually blog more when I'm home and can post pictures more easily and have time to tell more stories and reflect more on what we've done and seen and experienced. I am thankful for the teams we have here this week and the help they have brought but also the laughter and fun we've had together, even with the language barriers. I have learned that I am not a piece of fig from the Italians. And I can say "piece of fig" in Italian as well! More on that another time....