Friday, January 4, 2013

Day 4: Second Day of Surgeries

First Patient of the Day
We are at the Can Tho General Hospital for the second day of surgeries. I arrived with the medical team and wasn't sure what I would do today. The hospital nurses decided for me by immediately handing me scrubs and ushering me into the women's locker room to change.

That's the good thing about not setting expectations -- it's easy to go with the flow.

Going with the flow in this case equated to participating in the operating room by helping to gather supplies prior to the procedure, taking photos, and calming the patient. The patients are not completely anesthetized, but have a spinal block and some amount of medication to calm them.

OR #1
  1. 27-year-old male: metatarsophalangeal joint (MTPJ) fusion; polydactyly, cunieform;
  2. 20-year-old male: FDL tendon lengthening, possible toe repair
OR #1, First Patient: Pre-surgical view
OR #2
  1. 33-year-old male: tendon lengthening (equino cavus)
  2. 28-year-old male: bi-lateral gastroc recession
  3. 29-year-old female: gastroc recession
All of the surgeons participated in today's surgeries, either as primary, supporting, or advising roles.  Dr. Spanko and Dr. Koshimune took the lead on the first case in OR #1, but Drs Nyska, Sellers, and Lehnert were all involved as well. Dr. Ip and Dr. Mullens were focused on the first case in OR #2.

Jean Duvalsaint, Jenni Lehnert, and Susie Whipps had everything organized for each surgery and made a lot of complexity look simple. Jean and Jenni have done several missions with IEP, so they're very familiar with the particulars of the hospital. Susie seemed to be right at home after just one day in the OR yesterday.

Of the first two surgeries, the more complicated case was in the first operating room. The patient was a 27-year-old male with a deformed left foot, including extra bones and tendons. The doctors removed an extra tendon that was pulling the big toe to the inside. It looked as if his body had developed the extra tendon to support a sixth toe that did not develop.

After removing the tendon, Dr. Koshimune and Dr. Spanko worked on the great (i.e. big) toe to straighten it. This required cutting bones on either side of the joint, inserting a screw to fuse the joint, then inserting wires to position everything correctly. I noticed that his heart rate slowed when I had my hand on his shoulder, especially when the sounds of the saw and other instruments were particularly stressful.


The second operating room was a straightforward Achilles tendon lengthening (TAL procedure) so that the patient will be able to flex his foot to a right angle instead of walking on his toes. Dr. Ip made three small incisions through the skin to the Achilles' tendon, which will allow it to stretch as it heals. The patient will be in a cast with the foot in the flexed position -- possibly the first time he has ever seen his toes point upward and his ankle bend.


Our nurses, Jenni and Susie measure out the post-op medications and dosages for each of today's patients. We supply both the antibiotics and pain medication. "G," one of our translators writes the instructions on each package so that the families can dispense the meds. Because the patients and families likely do not live in Can Tho and will be going home in a day or two, the families will be doing much of the care.

Jennifer Lehnert, RN and
Diane Koshimune, DP

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