Friday, August 26, 2011

Arthroscopy Lessons

July 14

We finally got some blood for the man with the comminuted displaced
proximal femur fracture but we don’t have anesthesia so all surgeries
were canceled.  I took advantage of the time and went downtown with
Randy and Sam to look for a spare wheel and tire for the pickup.  I
came back with Jimmy and Joe on a tap tap.  I got a lot of
administrative work done which I hardly ever have enough time for.  I
am now working on the spine week that Dr Howard Place is setting up.
We were told that we will “probably” have anesthesia for a part of the
day tomorrow.

July 15
The week ended on a high note.  We got anesthesia for “two” cases and
wound up doing four.  For some unknown reason, the clinic was smaller
than usual.  Adeel did a hemiarthroplasty that I chiefed him on and
Francel scrubbed on.  Then I did another arthroscopy with Francel
assisting.  It was straightforward and Francel did well.  He held the
scope steady a good share of the time and was able to put in the probe
and even the shaver and do some shaving.  I am optimistic that he can
learn to be a good arthroscopist.  We’ll see how the next 4 or 5 go.
He was totally excited afterward and expressed his thanks to me very
deeply.  I told him that HAH presents a very good opportunity for him
to develop a private orthopedic practice.  I told him I would help him
to learn as much as possible and then when he is ready we can find
another young Haitian orthopedist and he and I can train him in
arthroscopy and in this way he can develop a nice group practice.  He seemed to be very
interested.  It might take some subsidizing on our parts to help him
get established.  Our patient with the proximal femur fracture and the
low hgb is still not ready for surgery.  His hemoglobin is 7.8.  Adeel was
very upbeat after we finished the cases today.  He thanked me
effusively for the great experience here.  He is really looking
forward to the time here in a couple of weeks with Scott.  I think he
could very likely decide to return here and spend significant time.
The first year med student Jonathan Mills told me this was a life
changing experience for him and he has definitely decided to take
orthopedic surgery.  I am happy that they have felt so positive about
the experience here.

Altogether, we did a total of 29 cases this week even without any
anesthesia on Thursday.  Once again, I am so happy for the arrival of
the Sabbath.  I’m looking forward to Rick Williams coming for a few
days.  He is a VP at Loma Linda University.  He is a close friend.
His son, Shane is an orthopedist who was here a couple of months ago
and was a big help.

July 16
Sabbath was once again a restful delight.  Jeannie and I went to the
English speaking church at the University up the street.  We both
rested and read and got caught up with emailing family and friends.

July 17
I went to the airport with Richard to pick up Rick.  We had to go 2 ½
hours early to drop off Brittany at the bus stop in Petionville.  I
used the time to work on my pictures.  It’s great to have Rick here.
We usually stay with he and his wife, Linda, when we are in Loma
Linda.  The last time was in March during APC.  We have so many common
interests and think a lot alike.  He thinks the taptap is pretty
awesome.  I took him out for a walk up the street to experience the
environment.  There were all of the usual street vendors as well as
guys playing dominoes and taptaps everywhere.  There were no surgeries
that need to be done and, of course, there are no anesthesia providers
anyway.  I am hoping that administration can arrange for anesthesia
help this week.  We do have several cases that should not be put off.
Adeel and Jonathan left today.  Adeel has been a really big help for
me.  He felt his time here was really worthwhile so it was mutually
beneficial.  Jonathan really blossomed here during these weeks.  He
has found what he wants to do and that is orthopedic surgery.  He was
a big help once he got in the rhythm of the situation here.  He is a
quick read and will be an outstanding ortho resident and orthopedic

July 18
The Monday clinic was big as usual.  Francel, ZJ and I worked our way
through the patients without any problems.  We didn’t see any new
patients that needed urgent surgical care.  That was good since we
still don’t know what anesthesia services will be available.  Nathan
was able to get coverage for at least part of the day tomorrow.  Rick
and I had a good time getting caught up with our respective lives.

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