Today is Thursday, August 17, 2017

Operate till you drop

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The call came from my nursing friend at church. Would I consider going to Guatemala again for a surgical trip? I figured that by the first of May I would have covered most of the bases for spring activity.

Linda was romancing the wildflowers, and we would be going on wildflower walks all the month of April, the best time to catch these ephemerals. I didn't know it then, but the spring rains would inflate the creeks to allow for a float trip with my son and grandson. We would also get into some bike trips to see the early migrant birds. So by early May I was ready for a new experience.

This was till I got the pre-op surgery schedule for our trip. There were pages and pages of potential cases, most of them hernias with the list calling for 16 cases a day. I could only hope that there would be several surgeons to share the load. The list looked easy enough of what I assumed were straightforward, not previously operated patients, but anyone on the list could be a potential for an extremely large bulge complicated by scar tissue and tangled mesh.

Linda was alright with my intended absence and didn't want to come along for the ride. She was still coasting on the high from the spring new growth with the celebration spilling over into the Cedar Glade Festival and to which she was to have a small part showing off the butterfly garden and talking about the natives for which she had been continually preparing over the last two weeks. My departure day would mark the start of her involvement with the festival including possibly a wildflower walk with the wildflower afficianados.

Packing for the trip seemed less involved, or maybe I had made so many trips that I really didn't have to think much about what I would put in a suitcase. Cindy Herring, my nurse contact and neighbor, gave me a backpack containing large bottles filled with antibiotics which I thought might be confiscated at the security gate. I was pleasantly surprised when they passed the screening without incident.

A minor concern was the lack of personal scrubs I would not be taking this trip hoping that their own assets on the site would be a fit for me. New hospital policy of checking the clothes out made things more difficult to take on a trip. At launch time, I still didn't know what activity I might be pursuing in Antigua on the way back from Guatemala City. I got out the last memoirs of my previous trip to see if they might give me some ideas. So far I've done the hike to Pecaya, the zip line, the coffee plantation and the city tour. Bicycling in Antigua wasn't as much fun as I had expected mainly because of the cobblestone streets which were somewhat difficult to handle on a bicycle. I guess I could do the city tour again since I'd forgotten about all of the history of the region.

Travel to the clinic seemed easier than I remembered. The flight from Atlanta to Guatemala City was to take three hours, but it seemed like much longer since I sat between two Spanish speakers and had no view out of the window. I tried out my Spanish on the one beside me only to hear her response in perfect English. She had been in the United States for 28 years.

Customs were passed without trouble even though I was taking several bottles of medicine. The ride of two-and-a-half hours passed quickly since we were on an air-conditioned, air cushion shock-absorbing gigantic touring bus with broad windows allowing me to absorb the scenes of the countryside. It was too hazy to see the volcanoes on my side of the bus. I didn't try to take pictures since I had dozens of them from previous trips, all of which were of poor quality. What do you expect from a bus window at 50 miles an hour?

When we got to the clinic, it was good to see many familiar faces of loyal employees who would make my stay as pleasant and productive as possible. The administrator named Carlos even went into the kitchen to speed up the serving of our first evening meal when I mentioned that several of us were hungry.

With no entertainment for the night, most went to bed by 8:30 only to wake up fully rested but with the sun rising at 5:30 in the morning. The good thing about this was that at that hour you pretty much had the washroom to yourself.

Breakfast of fried plantain, black beans, cantaloupe and fried eggs was washed down with fresh-squeezed orange juice, leaving time before church for other morning rituals such as walks around the compound and exercises.

The first clinic was highlighted by a couple of impossible cases which I put the skids on by not scheduling. The first was a 60-year-old man with a basketball-sized right inguinal hernia which was unreducible and which I wasn't sure could be accommodated by his abdominal cavity even if it were reduced. I wanted the others to be in on the decision of whether or not to try this repair. The other lady of 300 pounds and an abdominal bulge so big I couldn't figure out if it was a hernia or just the "Dunlap disease," a condition where the abdomen is so big it had done lapped over the pelvis. A 73-year-old lady with an upper-abdominal incisional hernia had no symptoms and said she had been operated on twice before without relief of her bulge; I tried to discourage her from another attempt.

Ending the first day of surgery we managed to accommodate most of the patients waiting for their procedures. The man with the basketball-sized scrotal hernia was sent to another hospital because of fear of post-op complications. It turned out that the six-by-six centimeter umbilical hernia case which didn't look that bad was the most difficult because of a borderline spinal anesthetic and numerous adhesions of omentum in the two-pocket hernia pouch. Dr. Hunter Jennings from Chattanooga was kind enough to pop in and help me close the defect over a composite plug.

Monday started out with a full schedule, but by noon we had the majority of the cases done, thanks to good work by the nurses. Additional patients were called to bring the workload to last until five in the afternoon. I saw about a dozen cases for the following day and then went to prop up my legs before supper.

The afternoon rain shower came predictably at 3 p.m., cooling off the air to make for pleasant sitting on the porch. Every afternoon so far it has rained starting about the middle of the evening. Last night's thunderstorm rumbled until well into the night, which I think makes for good sleeping along with the phone call from back home where everything was going well.

It's Tuesday and already half of our operating time has passed. We made some rounds before breakfast and were able to send home most of the hernia cases. So far, knock on wood, no complications have happened in this limited time. After 19 cases, we still finished in time to watch it rain while sitting on the side porch and talking about past trips. After the rain stopped, birds came out so I rushed to the room for my binoculars and was able to see much activity while I was sitting and talking with my friends.

The white-throated magpie jay made an appearance to eat at one of the fruit trees. A dark blue-headed bird with a broad white wing bar spent enough time in the tree beside the clinic to give me a good look, but I couldn't identify him from the bird book pictures.

Interesting cases for the day were the femoral hernias, almost never seen in the United States, and a large breast enlargement and a 19-year-old male.

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Guatemala, medical mission, medicine, surgical trip
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