09 April 2025 – Wednesday – Day 3 in the Operating Room

We almost left one of the surgeons at the hotel this morning. We turned the corner and heard honking. A car saw her trying to signal us. She was running down the street waving at us. So the bus driver pulled over to let her come along. Now we have a buddy system. 

As we drove toward the hospital, we could see a statue on the top of the surrounding hills. It was the virgin of el Panecillo. It is the tallest statue in Ecuador and taller than the statue in Rio. The photo is blurry but Google has a nice one. We then passed a huge aerial bucket of KFC. It is immensely popular in the Caribbean and South America. 

Now that it’s our third day, we have a good routine. I receive our patients from the floor and put them on stretchers. Nancy gets the narcotics from the head nurse because she can speak conversational Spanish. Mine is just medical terms. We both insert IVs and then get cases started. All was going smoothly until one room had a problem with their CO2 absorption. We use soda lime to capture exhaled CO2 in the anesthesia circuit which is a mostly closed loop with oxygen flowing in along with anesthetic gas. This room’s CO2 absorber was nearly spent so that high flows of oxygen were needed to limit rebreathing. It’s a bit technical. High oxygen flow uses up more anesthetic gas which is expensive to replace here in Ecuador.   The problem is easy to fix with new soda lime but everything absolutely everything here is locked up. The anesthesia tech took a long time to come to us with his bucket of granules because there is another floor of operating rooms that is where the local doctors operate. We are guests, at best. 

Our next task was to give IV fluids to two of our recover room nurses. They had gone out yesterday morning to walk around town since our first cases come out after noon. They bought iced drinks from a cafe on the street. Any water that isn’t purified as it is in every tourist hotel, has unfamiliar bacteria that can give horrible GI distress. Street food can also be dangerous for the same reason. They both were feeling marginal yesterday. Today Nancy and I insisted that they take cipro and come in early for IV hydration and some anti nausea medicine. We don’t have extra people to fill in particularly in the postoperative area. After a few liters of fluid they were both feeling much better. 

The afternoon cases began around 2:15. It will be another long day.  The day dragged on with complex surgical issues. I passed out candy which is brought along for snacks. It makes the long afternoons tolerable. One of my rooms ended at around 7:30. We hopped in an uber and came back to the hotel. Slowly much of the group came back to the hotel we ordered drinks and snacks at the bar. It’s moments like these when we all get together after a long day that makes the mission even better. 
Time to sleep and be on a 6:30 bus again.