Day 5: Recovery

Our bus leaves the hotel at 8:00 am each morning. We stay at the hospital all day until the bus comes back bringing the night shift about 7pm. Then we wait for the shift transition. Tonight we stopped at an Asian restaurant and ate “family style.” Doing my vegan thing, it was the first meal that really filled me up since I got here. But dinner meant we didn’t get back to our hotel until about 8:30. And then it’s time to upload pictures, label them for the ICHF DropBox, and write the blog.

When I arrived this morning I followed Dr. Nita up to the ward where Erich had spent the night. He was composed and talking on a cell phone when we entered. His mother said that he was upset when he first learned about the open heart surgery, but he was okay now. His mom looked very concerned and I just felt such a connection with her.

Erich getting ready to head to the OR

Good recovery for our first three patients. Grecia is out of the ICU and smiling again. She took a shine to Shaun of the ICHF team. I think she’ll be headed home on Thursday. Little Even was perking up a bit today, coloring and generally looking comfortable. By day’s end he was running a bit of a fever, and sleeping, but he has also moved out of the ICU. Alan, whose surgery was only a little more than 24 hours ago was awake and looking pretty good. He has asked to stay in the ICU because it has better air conditioning. Smart man. I wish all of our patients could stay under the care of the ICHF nurses and docs.

Grecia heading leaving the ICU

Grecia with her friend Shaun

Sitting up with a sticker on her forehead, coloring & enjoying a sucker!

                                               Alan recovering about 12 hours post Op

This morning little Sebastian had his surgery and he did well. By this evening he was still sleeping off his meds, and looking sweet and cute as ever.

                                            Little Sebastian 6 hours post Op - looking good!

I spent the rest of the morning in the clinic. I observed a very interesting consultation between Dr. Boston and a 19-year-old patient, Heidi. Dr. Nita translated back and forth between them. Rheumatic Fever, at 12, damaged Heidi’s heart and she needs a valve replacement. Dr. Boston was talking to her about the pros and cons of a valve replacement. The mechanical valve would last a lifetime, but would require her to take the drug Coumadin for the rest of her life, at significant cost. And the drug created concerns if she wanted to get pregnant. The second option was to receive a biological valve, not have to take the drug, knowing it would only last for 2 years. Heidi told the doctors that after having Dengue Fever during her recent pregnancy, she had a tubal ligation immediately following delivery. That made it easier for her to choose the mechanical heart. Now the challenge is for the local organizers to find the right sized valve while the team in in Honduras. Fortunately a few more physicians will be joining the team in upcoming days and may be able to procure the needed valve so that Heidi can go on the schedule before the mission winds down.

                                          Heidi's consultation with Dr. Boston and Dr. Nita.

While I was in the clinic, a nurse wheeled and incubator into the echo room. The baby, Leah Maria, was full term, but only 5 days old. She had been born at another hospital in Honduras, called Social Security, which is available to Hondurans with benefits. The doctors had detected a heart defect during the time since birth. And despite her deep skin tone, the cardiologist described her as purple. He spent a good while doing an echo on her. He asked the nurse from Social Security Hospital if they could do genetic testing on Leah, before the ICHF team talked about surgery. But later found out that the testing couldn’t be done for two weeks. Leah’s heart issues are very serious. This makes the ICHF team have to do some serious decision making. Realistically, Leah’s repairs cannot be done in one surgery. Once the ICHF team leaves in about two weeks,  Leah would not have access to the types of care that she would need. If they do surgery in the next few days, it would mean that she would need one of the beds in our ICU for the rest of the mission. And so what I gathered from the team is that Leah is not a good candidate for surgery. And that means that her life expectancy will not be very long. When the cardiologist was delivering the findings of his echo, he was having a young woman do the translation. When he explained the part about ...”and the baby will probably die” the young translator and the Social Security nurse who brought the baby fell silent and looked at her, and they proceed to explain in Spanish. The cardiologist followed up with, “Did you tell them (the parents were both in the room) what I said?” Yes. There wasn’t much time or space in the room for the parents to digest that news. Or to react to it. Perhaps they had already heard it. Perhaps when their doctors determined that Leah had such a serious heart problem they encouraged the parents to come to the experts from around the world who had set up their clinic at our hospital. It would seem like a blessing that these two events would occur simultaneously.

                                                  Five day old Leah Maria with Mom.

There aren’t any pediatric heart surgeries being done in Honduras, except what ICHF does when their teams fly in for several mission each year. In addition to saving lives, ICHF’s goal is to bring in experts to teach the local doctors how to master these complicated procedures, one by one, as the local resources eliminate the need for the missions to continue in that location. But it takes a lot of infrastructure and dedicated local physicians to make that happen.

So if a baby like Oaksie was born in Honduras, and ICHF was coming in to do surgeries, he would probably not be selected as a good use of their time and resources. They want to teach the straight-forward heart repairs with the highest prognosis for success. They want to maximize their time in country, and repair as many hearts as possible. Even if a family had good insurance, and/or money, they could not buy the surgery because there are no trained cardiothoracic surgeons available. They would either have to go to another Central American City with a better pediatric cardiac center, or take their child to a develop country, like the United States. But in Leah’s case, there might not be enough time. This is why organizations like the International Children’s Heart Foundation and Helping Hands for Honduras and MOHF are teaming together, to help fund these heart repairs that change babies lives. I am hoping that my blogging tells a story that results in some donations  to these three

worthy organizations.

I was able to observe Erich’s (13-year-old) surgery under the experienced hands of Dr. Umar Boston, St. Louis Children’s own!  When they wheeled Erich into the OR, his eyes were big with curiosity and something that looked like fear. But he had decided to be brave, so I’ll go with that. I smiled and waved and gave him a thumbs-up from my spot against the wall. He returned the slightest non, and then returned to monitoring everything that was going on around him.

                                               Brave Erich in the Operating room.

While Erich was on by-pass, the perfusionist waved me over and explained in detail how blood is diverted away from the heart though all of the tubing, and back into the system without pulsing through the heart. That gives the surgeon time to make the amazing repairs. No complications during surgery, but he was still sedated in ICU when the team left this evening.

That reminds me of a funny story that a deacon at our church told. He is a plastic surgeon. The story went something like this, an auto mechanic told a cardio-surgeon that what he did, fixing motors was basically the same as what the doctor did fixing hearts. But the doctor quipped back, “Yeah, but try fixing the motor with the engine running!