It has been some time since I have had an overnight flight. It isn’t my favorite thing to do. I did get a bit of sleep on both the leg from LA to Miami and then again on the one to Port au Prince. Yesterday was totally quiet here. Nathan and Amy won’t be back until tomorrow. The new team arrived this evening. They are from Asheville North Carolina. Mark Hedrick is subspecialty trained in foot and ankle. He was here last year for a week and our paths crossed briefly for a day or two when I was here. He is a partner of Ken Graf who was here during my absence of the last two weeks. His PA, Jamie was here with him as was Chip a rep for Smith and Nephew. Chip knows Scott and brought a lot of replacement parts for the TSF. Our anesthesiologist is Irma Williams. She also lives in Asheville but doesn’t practice there. She had a break between stints in Texas and elsewhere.
Irma worked for several years as an Ortho PA and then studied medicine with the intention of becoming an orthopedic surgeon. At age 45 she finished her internship and discovered that she was considered “too old” to do an orthopedic residency. She decided on anesthesiology and here she is. She has been a lot of places and done a lot of interesting things.
The clinic was so big and the going was fairly slow at the start. Emanuelle asked if he could send some of the non-urgent patients home and have them return tomorrow. We had several patients that needed dressing changes and vac changes under anesthesia which limited us to just one orthopedist in the clinic for much of the day. I saw many interesting cases including a child with severe knock knees. It is probably a case of rickets. I took pictures as well as a video of her walking. I am going to have her come to have her surgery when Dror Paley and Scott are here in a couple of weeks. We scheduled about 10 cases out of the clinic. A patient with a displaced tibia fracture came in as well as another with a displaced ankle fracture. We already had a full schedule for tomorrow so we put them on for Wednesday. Our last case today was a BK amputation on a relatively young diabetic. The patient lost quite a lot of blood and we only had 500cc of plasma expander in the hospital. There was no blood available either. His pressure dropped significantly and things were tense for a bit. He then stabilized as the case finished. Mark and I both stayed with him until midnight and he seemed stable. I was pretty wired so did a few emails and checked on him again about an hour later. He was making good urine and was stable. I’m glad that these 18 hour days are not the norm.
We had several more cases that went somewhat slowly and a large clinic. Everyone is putting in a lot of work and I really appreciate Mark and his team.
The saga of the Carm continues. I turned it on to check and make sure it was ready for the cases tomorrow and the “bad iris pot” error message came up. It won’t finish the boot up. What a disappointment, especially with the cases we have with Dr Hedrick here this week and the upcoming visit of Dr Paley. Many of those cases are Carm dependent. We new the iris potentiometer wasn’t in good shape after our work on it when Scott came down that one day the end of December. The machine was working perfectly well after the calibration. JJ told me that it worked perfectly well for Ken Graf the whole time I was gone and they used it a lot. I will have Jerry Daly get a new potentiometer and Scott can bring it down when he comes in a few days.
The cases went more quickly today and we got a lot accomplished. Mark and I finished the day with a tibial SIGN nail. He hadn’t seen one before so we did it together. I had hoped to show him the perfectly done procedure, but sadly it was not to be. The fracture was several weeks old and needed to be opened to get it reduced. Everything went fine until it came time for the distal interlocking screws. I struggled to get them in and finally took a portable xray since the C-arm isn’t working. One of the locking screws was in but the other wasn’t, so I repositioned it. Dr Hedrick was very kind to indicate that he learned more from a case that required some struggling. He is an excellent surgeon and I would like very much to work more with him in the future. It is really great to have these subspecialists to learn from. I hope he and his team are able to come again.
I had an early flight out today, leaving Dr Hedrick and team. I have my 40th class reunion on Saturday night and then I have a Haiti report to give to a group on Saturday afternoon. I’ll return with Jeannie on another all night flight on Sunday. Jeannie picked me up at nearly 11pm. It was great to see her and have her in my arms again. She is so important to me and I miss her dearly when we are apart.
Mar 4, 5 and 6
APC Loma Linda California I was able to make arrangements with Jerry Daly for some needed supplies and had a good meeting with Andrew Haglund. We are staying with Rick and Linda. Shane and his family had lunch with us on Saturday. He is going to come down and help me in April. The orthopedic CME meetings were on the topic of orthopedic infections and were very good.