Day 5: 'We are all more nervous about our patients than the weather'

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 Day 5 of Dr. Edwards' blog of his experience. Return to Dr. Edwards' Blog: Day 1
Day 5: October 30, 2007
The weather is getting worse, although it appears we have been spared much of the flooding and high winds that the rest of the island has seen over the past few days. We are all more nervous about our patients than the weather.
I head up to the ICU while Fritz and his team start in the operating room. They are doing the first operation of the day, and after yesterday want to make sure everything, especially the defibrillator, works. I am delighted that our patients have done well overnight, and the lady who we had so much trouble with is awake and ready to have her breathing tube removed.

Annette and I discover where the term "order sheet" came from. There are no real charts so she writes down my medical orders on the patient's bed sheet. This way we know who the orders are for.
'Order sheets'
PHOTO (above): "Order sheets"
By the time I get down to the operating room, Fritz is already starting the bypass operation on a young farmer and Jose is wheeling our patient into the operating room. She is also a young woman who needs a mitral valve replacement. Rheumatic heart disease is a frequent problem in developing countries and the mitral valve is usually affected. In the United States, her valve could be repaired, but we do not have an echocardiogram machine for the operating room here, and so there is no way to assess the repair.
These patients only get one shot at surgery, so without a good way to evaluate the valve in the operating room I decide to replace it. We are short-handed with Fritz still scrubbed in the other room so Joel helps me close the patient. Today things go without a glitch and Fritz does his second operation of the day –a mitral valve with tricuspid valve repair.
Second operation of the day
PHOTO (above): Second operation of the day - a mitral valve with tricuspid valve repair
We find out that we don't have tricuspid repair rings, so Jody and I devise a plan, on the back of a packing crate, to create our own ring with Teflon felt.
Back-of-the-box designing
PHOTO (above): Back-of-the-box designing
This is a great team to work with; they all have a "can-do" attitude. They really live Robert Kennedy's words: "Some men see things as they are and ask 'Why?' I dream things that never were and ask, 'Why not?'"

The storm is much worse and all the restaurants are closed. So far the hospital has provided dinner at a local restaurant each night - it is their way of saying "thank you." But tonight, because of the weather they buy us Chinese food. No one wants to eat until they know where the cat is. Bonnie eventually finds him in the Christmas tree in the hospital lobby. We are all a bit more sanguine about eating dinner.

Today has been much smoother. When Fritz, Bob and I selected the patients we tried to pick the less complex operations for the first day. Unfortunately, Fritz’s lady was having chest pain while we were examining her so we moved her to the first day since we didn’t think she could wait. Despite yesterday’s difficulties she is now has her breathing tube out and is off all her medications. I am not sure she knows how close things were, but she is very grateful anyway.

I talk to my patient from yesterday about the effects of the medications. I remind him that he might get constipated from the pain medications. Annette, who is translating for me, asks, "What pain meds?" She tells me that there are only a limited amount of narcotics, so the patients only get Motrin or Tylenol, and some medications the family has to go across the street to the pharmacy to buy and bring back for us to administer. Stat (emergency) labs will only be run if the family takes the bloods to the lab and pays on the spot.
I find out later that Annette has been giving her own money to pay for the medications and labs because she hates the idea that these families have to pay. Still, despite the lack of suitable pain medications and the need to pay cash for lab tests and medications, the patients are all incredibly grateful. And all the patients smile despite the fact that their chests were opened 24 hours ago and all they have had for the pain is Motrin.
Another patient poses with Bucky Badger
PHOTO (above): Another patient poses with Bucky Badger
The families want photos of any and all team members. It seems a very false and undeserved celebrity. But the overwhelming gratitude does help make the conditions more bearable. One of the team has found a toilet with a seat in the residents’ on-call room, but our only roll of toilet paper was pinched out of the ICU last night.

The streets are deserted as we head back to the hotel. We hear of flooding and 30 deaths in the country. Apart from the rain water pouring from the ceiling on the patient care unit, we have been insulated from everything. Joel who has his Blackberry informs us that our families and co-workers have been trying to reach us, and he has reassured everyone that we are all doing well.
Go to Dr. Edwards' Blog: Day 6