DAY 5 – Thursday August 18th:
At Case, things were running like clockwork. The surgical patient was a 50 year-old female agricultural field worker with neck and lower back pain that rendered her unable to work. She also had numbness of fingers and toes. She was disabled by spinal stenosis, or narrowing of the spinal canal where the cord sits in the neck. After rounding on the wards, the dynamic duo (Dr. Mark and Dr. Selvon) performed a C5-6 Anterior Cervical Discectomy (removal of the disc) and Fusion (locking the bones together) (ACDF) procedure. The team strategically exposed the spine, from the front, and masterfully removed the degenerated disc, a rubbery cushion between vertebrae that normally acts as a shock absorber. In this case, it was bulging out backward and compressing the cord, contributing to her stenosis. The disc was replaced by a solid implant to maintain the space between vertebrae, while screws and a plate were applied to the bones to hold them together until the fusion consolidates. The surgeons completed the procedure then came over to heckle the Mulago team, gloating about their efficiency and finesse. Sherron decided to take advantage of her early dismissal and head into town to “get her hair did” (ie. braided). So much for roughing it!
Sherron improvised in the operating room by rolling her own peanuts.
On the wards at Case, Amy “the team Florence Nightingale” was administering pain medications where needed, while Ngozi “the team Joseph Pilate” was hard at work. Her patient F.T., who had few complaints yesterday, had a very uncomfortable physio session today, but was committed to getting up and back to school in September, so he pushed through the pain.
Also pushing through the pain of the penalty box were Rocky Lieberman and his corner man Jordan, being “rope a doped” by three more patients. One was a follow-up scoliosis patient that Dr. Kris and Dr. Lieberman had operated on in 2007. She had matured into a beautiful young lady with a straight and pain-free spine. Her x-rays revealed a solid fusion, intact hardware, and a well-maintained correction with a balanced spine. The other two patients were ambitious young teens with aspirations of becoming computer engineers and businessmen, integral to Uganda’s future and who were not at all shy about sharing their ambitions. They both would eventually need surgery for their scoliosis and TB complications in the next couple of years, but wanted to finish high school first. Dr. Lieberman stayed in the center of the ring long enough to discuss all aspects of their predicament with them while displaying an incredible amount of patience, though he’d call it self-control, so as not to let the patients realize that he was rushing to get to the operating room before Siemionow and Ilalov did something he would regret (kidding of course – these guys are top notch!).
Dr. Lieberman with a patient working clinic, proving he can wear a smile even in the “penalty box.”
Unbeknownst to Dr. Lieberman, outside the ring, the surgical action at Mulago had not yet even begun. The patient still needed pre-operative X-rays and the team was waiting on 3 units of blood for transfusion. While waiting, the Mulago orthopedics residents haunted Drs. Kirill, Kris and also Jordan with articulate and detailed stories of the talented and deadly snakes found in various regions of Uganda. Later that evening the entire building heard Dr. Ilalov screaming “Black Mamba” in his Malarone-enhanced dream world.
The surgical patient P.T. was a 14 year-old girl with a spine so twisted that her ribs, over time, had pushed out and lifted her sternum (chest plate), leaving her with humps in both front and back. The multi-step surgery would require stabilization of her spine with hardware from behind, then removal of her sternum and fusion of ribs in the front, all the while maintain her ability to breathe in an already constricted rib cage. The decreased lung volume made this a particularly challenging case for our Polish pair responsible for maintaining her vitals (breathing, heart rate, and fluids) throughout the procedure. The first step took Drs. Lieberman, Siemionow and Ilalov six hours, and after review of the patient’s status Lieberman and the anesthesiologist pair decided that further surgery would subject her to unreasonable risk. She would need to recover first, and we will reevaluate when to proceed with step 2.
The entire USSM team working in the same OR during the long surgery of a 14 year old girl.
Today was also a big day for our equipment manager Brian, who, after riding the pines for hundreds of spine surgeries, got to “scrub in” and assist the scrub nurse “sister Sara”. Giddy and camera-friendly, Brian worked diligently and learned that being a scrub nurse is a LOT harder than it looks.
As with every good story there is always a silent hero. Some one behind the scenes, who quietly goes about his/her responsibilities, unassuming, barely noticeable and never getting the credit they deserve. Well this story is different. Alex was everywhere, was noticeable and performed above and beyond all expectations, especially with the team’s videography and IT needs.
After an exciting day we retired to dinner, saddened by the departure of Dr. Mark (back to residency training), Dr. Selvon and Amy (on their honeymoon), and after waiting a comfortable two hours to be served, we filled our stomachs with curried delights.
Quote of the day:
“Would you please, for the love of God, bring the check next time you come?”