Monday, April 25, 2011

Team Goethke & Chocolate Cake!

April 10

The trip back was uneventful.  I had some night sweats again last night but definitely not as bad as in the past week.  I can't eat much before feeling a bit queazy.  I hope I'm not making a mistake by going back too soon.  The warm weather feels good.

April 11 - 15

This was pretty much a week of wheel spinning for most of us.  This is the first week since the beginning of the year that I don't have an orthopedist to help me.  Not only that, but I have no anesthesiologist either.  I did my best with my limited energy to make it through the clinic on Monday but didn't quite make it.  I left the last few patients for ZJ to see.  I laid down in our room and he came and told me about the patients and I gave him instructions.  With no anesthesia provider, I had to cancel all of the patients that Steve Lovejoy had scheduled for Tuesday.  There were 6 cases.  I did one wound vac change using conscious sedation and it went well.  I spent the rest of the day just journaling and emailing and resting and getting my energy back for the big clinic on Wednesday. 

The clinic was bigger than the one on Monday.  I felt pretty good until I kind of hit a wall at about 3 pm.  I once again let ZJ see the last few patients and had him tell me about them as I lay resting.  The last thing I want is to have  a relapse of some sort.  My appetite is better and I feel like I am slowly getting my energy back. 

I was able to do a case today.  A visiting general surgeon had an anesthesia provider who was available after they finished their cases.  The case was a multiple trauma I accepted from Milot near Cap Haitien.  It is about 8 hours away by car.  He was injured in a MVA more than 2 months ago.  He has a fractured femoral neck and midshaft femur fracture on the right and an open tibial fracture on the left.  He had external fixators on both his emu and his tibia.  I had planned to remove the ex fix on the femur in anticipation of fixing it with a SIGN nail in about 10 days.  I also wanted to add more pins for stability for the tibial fracture.  It turned out, the tibial ex fix was totally loose and needed to be converted to a hybrid.  I also put on a wound vac since the wound was open with exposed bone.  It took quite a bit longer than anticipated and I felt exhausted.  It didn't help that we lost our air conditioning during the case.  I was dripping with sweat when I finished.

The Friday clinic was not very large and went well.  I was able to finish it without having to lay down.  I am definitely getting stronger and feeling better day by day.

April 16

What a treat to have a full day of rest.  I made rounds on the patients and then just spent the day resting until mid afternoon.  I felt the need to get outside so went for a walk up the street past the University.  I spotted four guys playing dominos so I watched them for a while.  They had multicolored plastic clothes pins that they would trade back and forth depending on who was the winner of the hand just played.  They would clip the clothes pins to their chin and cheeks and ear lobes.  It looked like they had huge multicolored beards.  They seemed to be having a great time.  I didn't have my camera unfortunately.  They probably wouldn't have wanted me to take their pictures anyway.  The mental image I have will last a long time, especially when I reread this part of my journal.  I continued my walk up the hill partly to see how my energy level was.  I definitely want to resume exercising again.  I miss the endorphin high.  I tried using my limited Creole with the people I met as I walked.  They all responded in one way or another.  Usually it was with a big smile.  On the way back down, I passed the domino players who were still hard at it.  They greeted me with waves and big smiles as I passed by.  When I got back, it was time for a nice long rest.

April 17

Today turned out very interesting.  The Bryce family had invited us to their home for a meal.  Stephanie had severe Blounts disease and we did bilateral TSFs with osteotomies of the tibia and fibulas two and a half months ago.  We found out today that she had had two prior surgeries by a Haitian orthopedic surgeon and had paid him a total of $16000 US.  The deformities recurred.

Emmanuel, Roosevelt and Jacque went with us to visit the Bryces.  We found a place selling fresh cut flowers so we stopped and got a nice arrangement for the family.  We had a good time getting to know each other.  Mrs Bryce made us this awesome meal.  She made 3 different kinds of pasta and a huge green salad and cooked vegetables and a huge bowl of rice as well as fried plantains.  We were totally stuffed.  It was really tasty.

When we got back to the hospital, Randy Goethke and his wife Carrie had arrived.  He is an anesthesiologist from Appleton, Wisconsin.  His wife Carrie is a family practitioner with Thedacare.  We know them very well.  Randy gives anesthesia for me regularly at Appleton Medial Center. 
Terry, Randy, Carrie, and Jeannie
He is one of the best anesthesiologists I have ever worked with.  In addition, Carrie's mom built a house on the lot immediately next to our home in Appleton.  It's good to see faces from home.  We went right to work and did a case that I had pending.

Jeannie surprised me with a great chocolate cake for my birthday. She baked it in the Prosthetika oven.  Nathan and Amy joined us and we had a good time stuffing ourselves.  Jeannie also surprised me with  a great gift.  It is a pair of cute little external speakers for our computer.  They work really well.  Now we can watch an occasional video without having to use earbuds.  I tried them out with some music and Jeannie and I demonstrated a few of our rumba moves and a bit of tango that we have been practicing.  What a kick!  It was a fun celebration even if it was for an old man's 65th birthday.

April 18

The clinic was quite large today.  I saw several more very interesting new cases.  I am happy that the $6 clinic fee hasn't seemed to slow down the good new cases.  There have been many new cases of knock knees and bowlegs.  I am sending them all to the peds clinic for a rickets workup.  A patient came in with a post op infection that required I and D.  We had a wound vac change as well as 3 other small cases.  It turned out to be a long day.  My energy level still isn't normal so I took a few breaks during the day to lay down and rest.

I got some really good news today.  It turns out that the list of charges for major and minor surgical procedures only applies to OBGYN.  I'm not sure why the list was posted on the orthopedic clinic door.  All orthopedic cases are still done for no charge unless the patient has some arrangement with the organization that brings them here.

Carrie examining a pediatric patient in the clinic
Carrie spent her day working in the pediatric clinic.  Randy helped me see patients in the clinic all morning.  It really helped since I have no one else to help this week.  He could have easily justified waiting for me to finish and then giving anesthesia for the cases.   Most anesthesiologists would have likely done that and with good reason.  Many have not done any clinic work for many years and it is well out of their comfort zone.  Randy is clearly willing pitch in and help in most any way to share the work load.  I can't express how much I appreciate what  he did.

April 19

There were 7 cases on the list today and then we added on an ankle fracture that came in last night.  We tried to get the ankle case going before 8 am and almost succeeded.  It took me considerably longer than usual.  I couldn't seem to get into "high gear."   It was almost like I was wading in molasses.  Julie was scrubbed since JJ hadn't arrived yet and that was part of the slowdown since she speaks virtually no English.  I had to get virtual all of the instruments by myself.  None of the rest of the cases were very big and they all went well. We finished before 5 pm.  Randy is such a great anesthesiologist.  Nothing fazes him and he gets cases going so quickly.   I gave the guys their Packers tee shirts and they all look good.  It will be fun to scrimmage a bit with them when we get our football.  I took Jeannie and Randy and Carrie in the pickup over to the Auberge to take a dip in the pool and get some pizza.   Randy and Carrie were surprised that such a nice little spot was so close by.  We had a really good time.  The "peekleez" was very good on the pizza.

April 20

I saw 40 patients in the clinic today.  It was a zoo as usual for a Wednesday with the clubfoot clinic at the same time.  I finished before 4 pm and then had three cases which we finished by about 6 o'clock.  I still don't have my usual level of energy but it is slowly improving.  I am so glad the night sweats are over and I have no more nausea.  My appetite is very good.  Stephanie's dad brought us a box of very nice mangos.  That family is really appreciative of the surgery that was done on her legs.


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