On the Road Again

After two very short days at home I was again traveling. This time I was heading to El Paso, Texas to start my second to last rotation. I had packed all I would need for the four months that I would be away and after many hugs I left my family again. Luckily I had a traveling companion who is one of my fellow classmates and friends, Jacob Hunsaker.  Cami dropped me off at our prearranged meeting place and we set off for the Lone Star State at 6:30am. The first six hours seemed to fly by as talked and caught up on each other’s lives. Time then began to slow down as the landscape became more monotonous. My back and legs began to ache and I felt claustrophobic crammed into the car. After 13 hours we arrived and met up with a man that my wife had put me in touch with. She had met a lady while working in the cafeteria at the Mt. Timpanogos temple and in passing had mentioned that I would be going to El Paso. This new friend told Cami that her two brothers lived there and might know of some place that we could stay. She put us in touch with her brother who arranged for Jake and I to stay at his mother-in-law’s apartment where she lived alone. So upon arriving in El Paso we met with Ruben and his mother-in-law Elia who does not speak a word of English but is more than a gracious host. We are settled in and unpacked and ready to have a new adventure. New experiences are always met with apprehension and excitement and I am looking forward to getting started so that I can get rid of the apprehension and start learning more about anesthesia.  

Peru Trip Continued

We continued to perform surgery in Lima for five days. Several unfortunate events occurred that resulted in our inability to help two individuals. The first happened to a nine year old girl that had a congenital abnormality of her jaw. The left portion of her mandible had grown normally but the right side had not which left her with an angled lower jaw and made eating difficult. We brought her in on her appointed day and put her to sleep. For sterility reasons some of the equipment we brought did not get opened until we were ready to use it. This was the case with the pediatric plate set that we needed for this young lady. Upon opening it we realized that it had been mislabeled and was in fact a duplicate adult plate set and would not work for what we needed to do. Unfortunately the only thing that we could do was wake her up without doing anything. The second event occurred on our last day in Lima. There was a young man who had been involved in a motor vehicle accident that had left his face disfigured and scarred and all previous attempts to reconstruct his face had failed. The afternoon of his surgery one of the nurses came running into the operating room and told us that there had been some miscommunication and that the patient had just eaten lunch. In surgery and anesthesia a full stomach can be deadly in the form of regurgitation and aspiration. The minimum amount of time that you can perform elective surgery after someone has eaten is six hours. We had to tell the young man that we would not be able to fix his face for another year. He was heartbroken as was his family. Other than those two instances things went quite well. We were able to do twelve surgeries some of which were quite extensive. One patient required a blood transfusion and before she could get it the blood had to be paid for and the family was required to donate as many units as the patient would need. I have no doubt that if a patient needed blood and family members were not accessible to pay and donate that the patient would bleed to death on the table. The rules are very different in foreign countries.  As we packed up our things and prepared to leave one desperate mother approached me and said, “Oh please, don’t you have time to fix my son before you go.” The desperation and pleading in her voice tore at me heart but there was nothing I could do. I put my arm around her quivering shoulders and told her that we would be back again. She gave a weak nod but her dark eyes never met mine. There is much of suffering in the world today that we who have been blessed enough to enjoy freedom and prosperity have never tasted. I have come to realize how much I take for granted and how very blessed I am.
After our last surgical day in Lima we flew to Cuzco, about 570 miles away. You have to fly there because a bus ride would take over 24 hours due to the incredible terrain you have to traverse to get there. Upon arriving in Cuzco you immediately feel the altitude (over 11000 ft). Most of our group got headaches and a bit nauseated. In the hotel everyone was given Coca tea which helped to alleviate the symptoms. Coca leaves are the main ingredient in modern day cocaine. I assure you that there was no high involved in drinking the tea but the Incans noticed that when the leaves were chewed they could work longer and were less hungry and the leaves have long been used for their medicinal properties. That being said I was not silly enough to think about attempting to bring any home least some airport narcotic hound reveal me to authorities who might not believe my purely scientific interest in the plant. We went on a quick tour of Cuzco and the next day set out for Ollantaytambo where we spent the day seeing patients. People came from all over the surrounding area to be seen by the dentists and doctors that were traveling with the group. So in that small town we met up with the rest of the group and I saw patients while some of the others translated or helped with the dental cases. It was also one of the highlights of the trip. There were many people that came to be seen that spoke only Qetchua, the native language of the Incas that has no written form.  It was very interesting to see some of the differences and the similarities that existed between these simple patients and the patients that I would see in clinics in the states.  There were some ruins in Ollantaytambo that we saw before boarding a train that would take us to Aguas Calientes, the closest city to Machu Picchu, which is only accessible by train. I sat across from one of the doctors in our group that is 6 feet 6 inches for the two and a half hour train ride. Needless to say we were great friends by the time we got to the city (the seats faced each other and were made for little Incan bodies).
The next morning was cloudy and rainy as we set out for Machu Picchu. I had been separated from my group and was put in a different hotel away from the people that I knew. We had to be on buses by 5am so I went alone. We boarded giant tour buses that were driven by crazy stunt drivers that could do unnatural things with a 80 foot long tour bus. We traveled up switchbacks to the top of the mountain were the ruins lay. The sun was just coming out and the morning mist lay like a thick blanket around all but the very peaks of the mountains. It was an awe inspiring site. I was grateful for the chance to take it in by myself. I climbed to the top of Wuana Picchu which is the tall mountain that you see in almost all of the photos of the ruins. On top I had a spectacular view of the surrounding landscape which was visible only sporadically through the clouds. The day was Sunday and so on top of that majestic mountain I listened to some conference talks and some church music on my ipod and truly felt like I was in a special place. I met up with some of the members of my group after I got off the mountain and spent the rest of the day exploring the wonder of the world that is Machu Picchu.  Pictures do not do justice to the place which can only be truly appreciated in person. We flew back to Lima the next day and then came home. Despite the incredible wonders that I had seen the greatest site that I ever saw were the faces of my family waiting for me at the airport.

I am trying to figure out how to attach a powerpoint presentation I did for my family with pictures.

Lima First Surgical Day

Our first surgical day in Lima started bright and early at 6am. We got up and got dressed and had a quick breakfast of tamales and yogurt while listing to Incan pan flute christmas music. Our bus arrived and we loaded up all of our equipment and set off for the hospital. In Peru there are two tyoes of hospitals, private and public. Private hospitals are for the wealthy or for the few who have insurance. Public hospitals are discounted and partly paid for with governmental funding but they are less clean, less private, pretty much less every thing. The hospital we were working out of was of the latter variety. There were armed gaurds at the front gates and we had to move through huge crouds of people in various states of distress and discomfort. You would see gaping wounds and festering infections all waiting outside for their turn to be seen. Each different specialty had its own set of buildings. We were working out of the gynecologic building. So we arived and were issued into a small "office" to change out of our street clothes and into our scrubs. We were told that we were not allowed to arrive already dressing in hospital attire but that we needed to dress once we arrived. After dressing we got all of the equipment that we had brought and went to the operating room. To get there we had to walk through the gynecologic inpatient unit where all kinds of women were crammed into one bed right after the other with no attempt at privacy. There was a shared bathroom if you were in a position to get up yourself, but the hospital provides no essential hygiene items, your family is responsible for bringing you everything, including toilet paper. Apparently our walking through the unit caused quite a stir because they never let us do that again after the first day. The OR was located right outside the bathroom and had a very strict dress code, you could not enter without the customary mask, booties and head cover if you ever tried to enter without any one of those items you were quickly and severely chastized. Dress code aside, the ORs were pretty creepy at first with the white tiled walls and really old beds and cracked tile floors. We were offered the largest of the ORs but had been given very strict rules as to when we could use it and how we could use it. Time restrictions really put a damper on the number of patients that we would be able to see. Anyway, we prepared for the first patient and if you think about it having to bring everything you could possibly need for a surgery is pretty tough and keeping track of it all is even harder. We were allowed to use the anesthesia machine and the bed with its various attachments and some tables but we had to buy anything else that we wanted to use or ran out of or discovered that we had forgotten. It was kind of crazy when you would be in a case and need a drug that you had not brought with you and you look over at the anesthesiologist, in this case Doctora Reyes or her resident Carlos, and ask if they had it and they would say, well did you buy it? And of course we had not so either we did without our sent a runner to the pharmacy to pick it up. Some of the drugs needed to be refrigerated and so they would come in a plastic sandwich bag accompanied by an ice cube, made with contaminated tape water I am sure. At first the nurse anesthetist and I were bugged that they kept an anesthesiologist with us at all times but we soon created a symbiotic relationship in which we learned from eachother. I will go into more detail about the procedures we did in a surgical blog entry when I can upload my pictures but for now let me tell you that I have never seen this kind of surgery in any of my training so far and to me it was facinating. Some of our pictures are quite graphic but I think that you will enjoy seeing them. After a full 11 hour day we packed all of our stuff back into bags and walked them to our office and locked them up. We were all dead tierd but soon were wide awake as we cluched on to our seats for a wild bus ride back to the hotel in Lima rush hour traffic. We went to a restraunt in a strip mall on the cliffs overlooking the ocean and then headed back to the hotel for some much needed rest.

First Day in Peru

Well after my first full day in Peru I am tierd but very excited for what the next 10 days will bring. I left Salt Lake International airport at 8:30am on March 19th. I sat on my buns for 5000 miles until I arrived in Peru just after 11pm. We did not get into our hotel until after 2:30am. Customs and all that jazz hung us up. This morning I had to be up at 6 so that we could be to the hospital by 7. We arrived at the hospital and as we began unloading our stuff it became very evident that we were no longer in Kansas or any where near there. The patient that we were going to be seeing were all lined up outside sitting on something like bleachers. Many had traveled for days to get here from their remote Andean villages. It was clear from looking into their faces that they were so excited to see us and that their needs for facial reconstruction were severe. We are traveling with three maxillofacial surgeons that have been coming down here for ten years. Some of their old patients were waiting with the other patients to once again lay eyes on these men who had so eased their burdens and improved the quality of their lives. The entire group stood up and clapped as we entered the building with our equipment. We spent the entire day seeing each one of the patients that had been brought in especially for us. Our group consists of 17 people, 3 surgeons, 2 residents, 4 medcial students, me, another CRNA, a scrub tech, and three support people. We all crammed into a small exam room and brought them in one by one. It cannot have been a comfortable feeling for these simple humble people to have so much attention. The first picture is one that I took of all of us in a room interviewing a patient.Never mind, it will not let me upload any pictures so I will just have to insert them after I get back. The crazy thing about Peru is that some things are so third world and primitive but others are absolutely state of the art. The imaging that the patient's received was absolutely amazing. The Idaho Condor group that I am with pays for everything for each of the patients that we treat. The imaging that they get cost $40 US dollars. The hospitalization, medication, surgery, imaging, lab work and everything else involved in the first three cases we did totaled $300 US dollars. Certainly seems like there is room to cut back on our outrageous medical expenses don't you think? Anyway, no political stuff right now. We interviewed about 39 people in about 6 hours and picked 18 that would be good cases for the equipment we had. We had to send the other 19 people home which was extremely sad. Many of those people, as I stated earlier, had travelled long distances just to be told that they needed to wait until next year. Those who were selected were immediately placed in the hospital for preoperative workups and to be monitored. They placed all of our patients in the same ward, not the church kind of ward but the hospital kind. Each morning we would walk past the ward and all of our patients would be hanging out of the windows waiting to see us and tell us how excited they were for their turn to have surgery. We made up a tentative schedule so each one knew when they were suppose to get to go to the OR but sometimes they had to be postponed because their lab work wasn't done or for some other concern and they always cried and were hard to be consoled. For those of you who have been to South America you know that the people can be brutally honest and pretty mean to each other. If you are fat everyone calls you Fatty, if you are skinny that is what you are called. So these kids and young adults, in most cases have been ridiculed and defined by their deformities so surgery is their only chance to feel like everyone else. I was told an incredible story that illustrates this point perfectly. A couple of years ago a 19 yeat old kid came to be seen by the group. He had been playing soccer and had fallen and been kicked in the face. His nose had been severely fractured and lay completely sideways on his face. The bones healed that way and he had been living with that and the shame that came with it for years. The years of teasing had taken their toll and the young man wore a hat all of the time and did not ever look anyone in the face. His eyes were always down cast and it was evident that he truly felt like he was worthless. He arrived with his mom and was examined by our doctors. He hung his head as his case was discussed and did not make a sound. The surgeons told him that they could easily fix his nose and could make it look just like it used to, one doctor went as far as to say "we will make you look beautiful". Upon hearing those words the young man looked up and with tears in his eyes said "you can?" That same day his nose was rebroken and set correctly and a splint was used to hold his nose in its proper orientation. When the young man looked at himself in the mirror he burst into tears as did his entire family. Every morning after his surgery the young man was waiting at the gates of the hospital and followed the team around asking what he could do to help. He would not leave. He carried bags and  washed instruments and the floors, he would not leave until the expidition was over. It reminded me of the story of the savior and the healing of the ten lepers.
   After we had met with all of the patients that we would be seeing we had some time to go and see a little bit of Lima. As a group we went to an very nice restaurant near so Incan ruins. Apparently lots of famous people go there. We ate to our hearts content and I even tried guinea pig. That pretty much sums up the first day. I am going to try to post this but I want you all to know that I have not yet proofread anything and the spell checker has not been working so  . . . be kind.

A Trip to St. George and Zion

My oldest brother, Jeff called me midweek last week and said, "Do you know what the weather is suppose to be like in St. George this weekend?" He said that is was going to be in the mid-50s and asked if I would be interested in going down there to do a bit of mountain biking. We planned to go down after I finished my day on Friday and bike all day Saturday. We got a cheap room at the old Motel 6 and prepared to head down. When Friday arrived to my surprise and delight there were no cases at the hospital so we were able to leave early in the morning. By noon we were preparing for our first run

of the day. The weather was beautiful and warm. The first few miles of the 7 mile loop we were doing were dry and fun. However, we did not know that just the previous week St. George had had a years worth of rain in two weeks creating some huge floods and turning everything that was not rock into mud. We quickly figured this fact out as we ended up pushing and sometimes carrying our bikes about 2.5 miles. We wised up and called a local bike shop and asked which rides would be the best to take considering all the rain. The guy told us that the Church Rocks ride was pretty much the only ride the was worth doing.

On Saturday we went out to the Church Rocks which starts out with a huge drainage pipe that goes all the way under I-15. It was dry and mostly slick rock and pretty fun. Our legs were pretty shot after the previous days trudging and so about 1pm we were done. We decided to go and hike Angel's Landing in Zion National Park which was not too far away. We arrived at the park to the happy news that entrance into the park was free that day. We drove in the the nearly empty park and started to 2.5 mile rigorous hike to the top of Angel's Landing. Any of you who

have never heard of this hike need to know that it is incredible and crazy scary. Once you get to the top of the switchbacks you still have to climb a snow covered narrow trail with 1000 foot drop offs on each side of the trail. There are chain handrails along the most treacherous portions of the hike but even while hanging on it is pretty scary. We were slipping and sliding on the way up and much worse on the way down. There are many parallels that can be drawn from this hike and life and all of them pass before your mind while you hang on to a cold chain and stare 1000 feet down below your feet. It was a great hike and it was fun to hang with my brother as well.

A Journey to the Land Southward

I received an email from our program director along with the rest of our class for an opportunity to apply for a scholarship to go and perform anesthesia in Peru. The scholarship was being offered by an anesthetist that belonged to a humanitarian service organization called Idaho Condor. If we were interested in going we were to submit a one page essay on why we should be chosen to go. I submitted my essay with little hope that I would be selected. The submission date came and went without any indication as to who had been selected. I was on a break at the hospital in Payson and happened to check my email. I had been selected. I could not believe it. The email was short and succinct. He congratulated me on being selected and told me that more information was forthcoming.  He said that I should plan on working ten hours a day but promised me that the experience would change my life. I know little more now than I did then. You can look up the website for the organization at idahocondor.org. There are pictures from the 2010 trip and I think that it works the same way. There is one day that they spend in Machu Picchu and then go to Cusco and set up for surgery. I will post more information as soon as I get it.

New Clinical Schedule

Those of you that have been following my rotation schedule will assume that I am in Texas right now. Well, about the middle of last month my rotation schedule was changed. I will still be going to Texas but not until April. I am currently at Mountain View Hospital in Payson, Utah which is only 45 minutes from my house. I will be at this clinical site for three months after which I will be in Texas for four months and then finish with a final four months in Evanston, Wyoming. I just completed my first week in Payson and I am excited about being there. It is smaller than American Fork was but it is busy and will give me a good variety of cases. I am looking forward to being home for the next couple of months. I hope to be better at keeping things updated on this blog but you have heard that from me before.