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Monday, October 21, 2013

Day 3: Heart-Stopping: Grecia Maria’s and mine!

(Becky: Tonights report on Day three and the message connie attached

I had an incredible day. Can't really sort out all of the emotions. I learned so much and was amazed by so much. I have the utmost respect for all of the people and organizations that are making this happen, despite the obvious resistance of some local forces. But at the end of the day, it's the sick babies and the worried mothers and fathers that we are here to serve. And it seems that our surgeons and leaders are determined that now we are here we are going to do it! 

I wasn't sure I could do this, and so far I've sort of impressed myself. The first lesson in Brene Brown's on-line Oprah course is: I'm imperfect and I'm enough. It fits.

Love you,
Sending some photos, too....

 As soon as we arrived at the hospital this morning, I borrowed some scrubs and wandered into the OR where my new friend Jenny, the perfusionist from Toronto, was setting up the by-pass machine. I stayed and watched the buzz as the momentum began to build. Nurses and techs kept bringing in equipment and sterilized items, moving tables, and threading electrical cords around the room. After almost two hours of set up the team was ready for the first heart surgery patient: 6 year old Grecia Maria.

Grecia was wheeled into the room, awake and scared. She was lifted onto the operating table and immediately the team began soothing her and prepping her for surgery. In a short time she was cozy and sleeping with the help of Victoria, the anesthesiologist, and some nice medication. Everything paused briefly as Nurse Sarah prayed out loud in Spanish. It took me a few seconds to realize what was happening, but the mood in the room changed briefly. I felt so moved that they were taking the time to create Sacred Space and to invoke God, the Holy Spirit, and Mary to protect and comfort Grecia, and to guide their minds and their hands during the procedure. (Of course, I couldn’t translate what was actually said, but this was the prayer in my heart. I pictured Mary walking Grecia away from the OR to a little dance studio where she danced without fatigue or pain.) As the prayer ended “Amen” came in unison. And we were ready to begin.

I stood against the wall, taking occasional photos when I got a shot between all of the doctors and nurses lined up around the operating table. When our ICHF cardiothoracic surgeon approached the operating table, after all of the prepping was over, I decided to move to the other side of the room so I could get her face in my shots. I took a few steps and three Spanish speaking nurses with scowling faces threw their hands in the air in stop-sign fashion and told me to stay there. I think they would have tackled me if I had taken one more step. What I discovered later was that I was about to breach a sterile zone. The scrub nurses had spent hours elaborately placing all of the instruments, gauze, sutures, etc on table draped in sterile cloth. I was starting to walk between the instrument table and the operating table. I quickly flattened myself back against the wall while they slid the instruments toward the end of the operating table. When everything was set up one of the nurses waved me over to the middle of the room; she had brought in a step stool and placed it about two feet below the instruments and motioned to me to step up.

The surgical team included Dr. Fenton and two Honduran surgeons (Arlette and Jorge); Scrub Nurse Sarah and her assistant; Victoria and an anesthesiologist assistant at the head of the table monitoring the equipment; and Jenny (perfusionist) and David (bio/med tech) were on the side with the bypass machine. During this time they opened Grecia’s chest and sternum, exposing her heart. Standing on the stool, I was able to follow what was happening more clearly. When the surgeons’ hands cleared away, I was able to see the top curve of Grecia’s little heart bobbing up and down as it beat!

At one point while the docs waited for medication levels to change. Dr. Fenton invited me to come to the head of the operating table where the anesthesia station was, and David carried the stool. From that vantage point I could look down over the drapes and watch little Grecia’s heart beating rhythmically. Dr. Fenton pointed to Grecia’s heart chambers and explained what she was getting ready to do. That’s when my heart stopped! And shortly after that Grecia’s heart stopped, too (for less than 30 minutes) as she went on bypass and the abnormal opening in the dividing wall between her upper heart wall chambers (atria) was repaired. Once that was over the sutures and the clean up went pretty quickly, and she was extubated right away.

I followed sleeping Grecia as she was wheeled into our makeshift ICU. (The two TB cases and the H1N1 case are still quarantined in the hospital’s ICU.) She was eagerly greeted by about 10 NICU nurses, respiratory therapists, and intensivists who have been waiting for two days to fulfill their mission. I thought a lot about Grecia’s mother, who was waiting to hear how her daughter did, but I didn’t get to see them re-united today. Although objectivity is crucial during such a serious procedure, I was completely impressed with the respect and gentleness everyone extended towards their little patient.

Baby Sebastian’s surgery has been pushed back. Today is National Armed Forces Day in Honduras, so it is a holiday. There was an issue about transportation home for the nurses if we proceeded with today’s second surgery, lasting until after 6pm. Many of the hospital staff rely on public transportation to return home at night. Since the holiday shut down the usual transportation extending the surgical schedule would make it dangerous for them to travel to some of the outlying areas after dark. So our organizers agreed to quit after only one surgery, because we wanted the nurses to be safe and to come back to assist for the rest of the 3 week mission. There was a lot of confusion about all of this. The locals knew it would be a problem but didn’t tell our team. The worst consequence was that little Sebastian had been denied food since midnight last night and his mother was anticipating his surgery all morning. They had to be told to wait two more days; the docs didn’t want to make Sebastian fast two days in a row. He will return on Wednesday. But tonight we have one little girl recovering in the ICU, surrounded by a wonderful team of nurses. I think she is dancing in her dreams!

     Gracia after surgery. Extubated and resting as the nurses are watching her numbers on the monitor.

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