We are fully connected as a team now. All of us know what to expect and having worked together for 3 days, we are in rhythm together.
Dave V is our nurse who works both in recovery and on the floor to be sure patients are doing well. He and I make rounds together in the morning seeing the patients from the previous day of surgery. Dave is a fluent Spanish speaker so he can ask patients about their pain and we can decide what additional pain medicine they might need. We check the charts to determine when the have received their last dose of pain medicine. Then we ask the floor nurse to give what I prescribed. The charts are all paper and not well organized so it is difficult to see what drugs have been given. In some instances, a medication was given but not yet charted. It’s a challenge to figure out what might be the next right move but I am sure that an extra dose of very low dose Tylenol with Codeine is a merciful thing for those who have had a few ribs removed.
The big first cases are done. Now we give previous 1st stage repairs the elevation of their new ear framework that gives the ear dimension. The 2nd stage cases take about 2 hours. We have 2 cases scheduled for each of our 3 rooms. Understandably, these children are anxious. They have had a big surgery in the past with pain from the rib cartilage harvest. This next surgery is much simpler. A small piece of cartilage has been banked under the skin in the initial incision area so that it can be used to bolster the ear and give it dimension. A small skin graft is added filling the area behind the ear. The graft can come from the original skin site where the rib cartilage was taken or other sites on the body. It’s a small area that fills in behind the ear.
This year it seems that the second stage kids are more afraid of having an IV placed than the surgery. It’s easy for us to allow these patients to fall asleep using inhaled anesthesia and once they are adequately anesthetized, starting an IV is easy. It is fun to be able to change what we do and put patients to sleep by breathing anesthesia instead of using intravenous medicine. And it’s so nice to let these children know that we can let them be in control a bit.
We canceled one case for wheezing and a cough. These are elective cases that should not be done in patients who are not well.
The day ended with a challenging patient who has had numerous surgeries. He has Treacher Collins syndrome. Look it up! You can see his post operative photo. He’s a very sweet man who is smart and active but quite deformed. His airway is very challenging. We had old records to help us follow what has been done before. He had a revision of one ear. Surely he will return to have the other side done at some point.
It was a beautiful sunny day for once. Our day ended early enough that the anesthesia team all went to sit by the hotel pool. We then wandered a bit in town together until it was time for me to leave for the airport and the others to eat dinner.
I am sitting in the airport American Express lounge waiting for my 10:55 flight. It a redeye for sure. Tomorrow the operating room has 3 short cases. They will be fine with Wes who is new but very competent. As always, this has been a wonderful experience and a very positive mission for all of us.
The Adventures of Anne 