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Day 3: Selecting Patients - An Emotionally Exhausting Day

On Friday, October 26, Niloo Edwards, MD, head of the division of cardiothoracic surgery at UW Hospital and Clinics, joined a Wisconsin delegation that journeyed to the Dominican Republic, there to spend a week providing free cardiac surgery to indigent residents in Santiago.
 
During his stay, Dr. Edwards and other surgeons operated on 11 patients, survived hurricane conditions and gained a greater perspective on health care in Latin America. The following is Dr. Edwards' blog of Day 3 of his experience. Return to Dr. Edwards' Blog: Day 1
 
Day 3: October 28, 2007
 
Today is the day we make patient selections. We start with the usual breakfast of champions, although this time we have Doritos as well as potato chips. Captain America seems to enjoy his coffee and Doritos. We spend the whole morning and most of the afternoon reviewing patient charts, echocardiograms and angiograms. The cardiology residents have spent the last few months identifying potential patients who might benefit from heart surgery; the majority is young with rheumatic valve disease. It is remarkable that some of these patients are still alive.
 
Reviewing patient cases
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PHOTO (above): Reviewing patient cases
 
I step out of the conference room into a hallway lined with people. They are all trying to make eye contact; one man step forward and asks if we are done. These are the patients' families, and they are waiting to find out if their wife, husband, or child was selected to have surgery. It is an embarrassing and humbling, and mostly heart wrenching experience. We decide to set up an impromptu clinic in the ICU. This way we can avoid having to face the families before we select the patients.
 
Impromptu clinic in the ICU
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PHOTO (above): Impromptu clinic in the ICU - This patient has a huge liver and her lung pressures are 4 times normal. She will need a high-risk triple valve replacement.
 
Next comes the patient selection. We try to pick the patients who we feel are unlikely to survive until the next mission, but it is still very difficult and they are all so sick it is hard to be sure that the ones we did not choose will survive long. Fortunately, we are spared the difficulty of telling the patients which among them have not been selected. For once I am happy my Spanish is limited, although I do run into some of the families in the hallways and I catch their accusing looks – or maybe I just feel guilty.
 
Reviewing more patient cases
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PHOTO (above): Reviewing more patient cases
 
It has been an emotionally exhausting day. By contrast yesterday was a piece of cake; at least it was just physical work. Dinner is at the ILAC (International Latin American Concerns) center. The center is run by the Jesuits, and before dinner Fr. Pat has a special mass with a blessing of the team.
 
Go to Dr. Edwards' Blog: Day 4