Sunday, August 28, 2011

Back in the US & DR

July 19
It hugged my sweetie goodbye this morning.  She is leaving a couple of
days before me to spend some time with her elderly mother and her two
sisters in Tennessee.  I’ll next be with her on Sunday in five days.

We had seven cases on the surgical schedule for today.  We had to
cancel one child who has an upper respiratory infection.  Two of the
cases were tentative pending clearance, including the man with the
subtrochanteric fracture.  His hemoglobin was only 8 and we had just one unit
of blood so we sent the family to look for more.  They finally were
able to obtain another unit but it wasn’t until evening.  We
rescheduled him for tomorrow.  The other patient with the ankle
fracture dislocation is also being worked up to be cleared.  We wound
up the day doing four cases and they all went well.  There is a young
anesthesiologist who first gave anesthesia at HAH last week under the
employment of a more experienced anesthesiologist.  Francel knows her
well.  She was an intern under him while he was doing his residency.
She gave the anesthesia and seems very good.  We had another
arthroscopy today that Francel had scheduled.  I let him choose and
establish the portals and put in the scope.  This was his third case
and he made some progress.  His is still quite a long ways away from
doing even simple arthroscopy by himself but I am optimistic.  The
patient had deep chondromalacia in the medial compartment with bone
exposed on the medial tibial plateau.  I helped him do the
chondroplasty.   Perhaps 3 or 4 more with me and then he can try one
by himself with me next door.  Rick came in to the OR and observed the
teaching.  He had never seen an arthroscopy.  He even helped put up an
irrigation bag when our circulator was indisposed for a bit.  One of
the cases was a patient with a high above knee amputation who has had
several attempts to cure a chronic draining sinus.  ZJ has a somewhat
personal interest in the case.  The patient is young lady who is very
pretty and has an engaging personality.  She lost her leg as a result
of an injury in the earthquake.  She has a prosthesis but has hardly
used it.  Z J thinks that some of the problem is related to the high
energy cost of ambulation associated with the short stump.  He has
done some research and wants to know if it might be possible to
lengthen her short remaining femur and try to improve her ability to
use a prosthesis.  She doesn’t have a lot to lose since she isn’t
using her prosthesis now anyway.  I ran the idea by Scott and he
thinks it could be done once she heals the chronic drainage problem.
I let ZJ do the case and we found a definite piece of dead bone where
the sinus terminated.  The end of the femur itself looked clean.  ZJ
is on cloud nine after being able to do the whole case.  I am
convinced that Z J will make an outstanding orthopedic surgeon.  I
will do everything I can to help him get a residency and perhaps even
some credit for  this year.  He has a desire to serve the underserved.
His personal lifestyle and needs are modest.  He periodically gives
worship talks and is a committed Christian.

July 20
This was kind of a bizarre day.  I am now in the DR after a 40+ minute
flight.  I was planning to come to the DR by bus so I could at last do
some more work on my project here.  It has been nine months since I
have been able to do any cases and, in particular, continue teaching
Yunior Herrera to do arthroscopy.  The bus costs only $40 one way but
it takes about 6 hours.  I had tried to find someone who would like to
come to the DR with me for a few days that would rent a car so we
could drive here.  Then they could leave me here to work at the
hospital, do some cases with Yunior then have some time with Cameron
before going on to Wisconsin.  Since no one was able to come, I
decided to ride the bus.  That plan changed.  Our patient with the
subtrochanteric femur fracture was finally ready for surgery by
Tuesday evening.  The family had obtained 2 units of blood.  Francel
wanted me to do the surgery so he arranged for anesthesia to be there
early for the case.  That meant I wouldn’t be done in time to catch
the bus to the DR.  There were flights available on Tortug’ Air so
Rick helped me make a reservation and buy a ticket for the 4 pm
flight.  The commuter service flies into La Isabela International
Airport.  It is a fairly new airport north of Santo Domingo in a
largely agricultural area.  It took about 30 minutes and $30 dollars
to get here to the hospital by taxi.  We passed by the new US embassy
which is being built.  The case went well without undue blood loss.
Francel assisted me and we were able to get a good reduction.  The
fracture was very comminuted and displaced widely.  I used the Stryker
compression screw system that the Vitales brought and donated in
January.  I added a second posterior plate and screws to help fix and
stabilize the comminuted fragments and also help prevent failure of
fixation.  These fractures are somewhat notorious for not healing.  He
will have to be kept touchdown weight bearing for at least a month or
more.  It is so great to have such good equipment to help solve
difficult fractures like these.  I set up the “hillbilly traction”
with Francel helping and learning and it worked like a charm.  We had
excellent xray visualization of the fracture in both the AP and
Lateral views.  The C-arm continues to function perfectly since Scott
did the last repairs and adjustments to the potentiometer in March.
The orthopedic program at HAH has been very blessed and continues to
provide badly needed services to the people of Haiti.

July 21
I had hoped to do some arthroscopy with Dr Herrera and continue to
help him develop his skills as an arthroscopist.  Unfortunately he was
unable to get patients ready in time to do any cases today.  I’ll have
to give him more lead time when I try again.  I had plenty of
administrative work to do and was able to use the time well.  Our son,
Cameron, is now living in the Dominican Republic.  He came to the
hospital and we are going to be able to spend a couple of days
together.  It has been more than 6 months since I have been able to
spend time with him.  We plan to go east and perhaps play a round of
golf together at Casa de Campo.  I found a little hotel listed in the
Lonely Planet guidebook in the Boca Chica area.  It is modest but
clean and is close to the airport for when I leave for the US on
Saturday.  We walked down the beach into the little town.  It is a
pretty uninspiring beach town.  There were quite a number of ladies of
the night on the prowl.  Cam and I found a nice little Swiss
restaurant after a fair amount of walking and getting two very
misleading sets of directions.  It was actually only about a block
away from where we asked the first person if he knew where it was.
The salad and cheese fondue was very tasty.

July 22
We slept in late then took Cam’s van about an hour and a half drive to
Casa de Campo.  It is a high end resort on the Caribbean.  Jeannie and
I had been there for a short stay several years ago.  It has several
highly regarded golf courses designed by one of the best golf course
architects living.  The course we were able to get a tee time on is
called Dye Fore.  It is located in an area called Altos de Chavon.
This area is an artists colony that was built by the resort 3 plus
decades ago.  It looks like a Mediterranean village that is several
hundred years old.  It is very picturesque sitting on high bluffs over
the Chavon River.  I have a special picture of Jeannie at home.  I
took it of her when we were at this place more than 10 years ago.  I
cropped it and had it enlarged and framed nicely.  It hangs in a
special spot in our home.  We walked around a bit and took pictures
and had a bite of lunch before playing golf.  The golf course is a
really great layout and we were thoroughly challenged.  Afterwards we
found a nice restaurant in one of the centuries old looking buildings
and got a table on an outside area.  We had a nice soft breeze cooling
us off.  As we finished our meal, a trio of musicians appeared and
played some very pleasant music.  The older gentleman of the three
played the accordion expertly, accompanied by the others on guitars.
They also sang very well.  They came to our table and I asked them to
first do EN MI VIEJO SAN JUAN.  I sang along a bit.  That song has a
great deal of meaning for our family since we lived in Puerto Rico for
12  years and some of our best friends are Puerto Ricans.  I also
asked them to do YELLOW BIRD and MALAGUENA.   Cam and I enjoyed the
good music especially given the special spot in Altos de Chavon.
Their tip was well worth the entertainment.  It was a memorable day.
Spending it with my son made it exceptional.  Jeannie is spending
these days with her mother and two sisters so it is only right that
Cameron and I have been able to have a couple of very special days

July 23

It’s off to Wisconsin for the next two weeks.  The flight left early
this morning.  Paul and Ethyl Conner met me at the airport in Green
Bay and I am staying with them tonight.  It’s Paul’s birthday

July 24
Paul and Ethyl asked me to play golf with them to celebrate his
birthday.  It didn’t take much arm twisting on their part to get me to
agree.  My game was a bit rusty but I had fun.  I also hit some tennis
balls later in the day.

July 25
Jeannie is having a good time with her mom and sisters in Tennessee.
I wish I could be there with her.  I have very little time in my
schedule though during this year we have committed to working in
Haiti.  Clinics, elective surgeries, taking call and organizational
meetings will keep me busy for the next two weeks.  I hope to have a
bit of time to relax as well.  I’m looking forward to Jeannie coming
in two days.

No comments:

Post a Comment