23 September 2024 – Monday – Day 3 in Guatemala

We ate breakfast starting at 6:15 am so that we could all get to the hospital early to be prepared for our first day. The sky was clear enough to see one volcano as we ate breakfast. The 5 minute walk to the hospital is easy as long as the traffic isn’t too aggressive. There are no stop signs or traffic lights in Antigua. Crossing the uneven cobblestone streets can be tricky. 

Patients were already in the preoperative area getting IV’s and charts checked. I went to see that everyone was ready. It turned out that the first case in one of our rooms had a toothache, possibly on both sides where his molars hurt. The surgeons looked inside his mouth to find infected teeth. They decided that the infection would jeopardize the ear graft since it was very close by. The case was cancelled. The second case in that room was already at the hospital so we did that case instead. In the meantime, they called in a patient scheduled for Wednesday to fill the empty time slot. Other rooms were ready to start making it easy to get going.  

I went to recovery to be sure they were ready. You can see that everyone in the group brings toys for the kids to have as they awaken from surgery. 

There were no surprises for a while until we found out that the case we added to fill the time slot was a child who had eaten breakfast at 6:30 because his surgery was originally scheduled for Wednesday. I agreed that by noon he was probably close enough to the 8hour NPO guideline (nothing by mouth) that we could proceed. 

The day was busy and moving well. I discussed post operative medications and orders with the recovery team. We ordered some Tylenol with codeine pills for pain from first stage rib harvests for beginning ear reconstruction. This operation is a 2 stage process. The first stage is pretty painful due mostly to the rib cartilage harvest. 

As we were ready to bring the added new case to the operating room, we were told that one of his labs was abnormal and needed to be repeated.  It took 90 minutes to get the normal results that we fully expected but had to verify.  The case finally got started at 2pm. 

We started cases, gave lunch breaks, ended cases and kept moving as best we could. Although the delayed case looked like it would take 5-6 hours, the surgeons who had completed their cases helped speed along the case and it finished in 3 hours. The OR and recovery was finally done around 6:30.  The children in recovery are incredibly brave. They don’t complain much about pain. They are brought from the OR very nearly awake so that they are ready pretty soon to get a soft toy and a few games to take to their bed on the ward…a long room filled with same sex patients. 

Many of the Rochester gang are big fans of the Buffalo Bills. They all ran off to a sports bar to watch the Bills win by a large margin once the work was done. I joined a small group going out for what was pizza and margaritas. It was a nice spot that was quiet and satisfying. 

Tomorrow is another busy day starting with early breakfast.