Trip Three: Week Four! July 13-19

 Four weeks down, nine to go! It seems like each week my blog just talks about how busy I am, but each day really just feels so full! 

On Monday, I went for a morning run before work with a few other girls from the ship. The discovery of the new road last year was one of the biggest blessings, and I so enjoy these morning runs. The sunrises are beautiful and running along the ocean is so peaceful. 

Wednesday morning, the anesthesia in-service was put on by Dr. Marian, in an anesthetist from Australia. She spoke about traumatic brain injuries and how you can accurately assess patient status when they have a brain injury, and which steps to take next. 

On Wednesday evening, there was the medical in-service put on by Dr. Erik, who spoke about craniofacial surgery and the extent of what we can do here on the ship. It was interesting! After the presentation, I went out to the dock and played volleyball with some other Crew for about an hour. It was my first time being back out at the volleyball court, and it was fun to be back! I hope to continue playing more games! I then went on a walk and called some family members before heading in to go to bed. Most mornings before work, I either try to go to the gym or for a run. It is usually the only “alone” time I can have throughout the day, even though there are still people around. There is also usually some type of community activity or group outing in the evening, if I am not on call.  

On Thursday night, I went out for dinner and karaoke with some friends! The restaurant was pretty empty, so we were able to sing quite a few songs which was fun. On Fridays and Saturdays, it is usually pretty packed and you’re lucky if you get to sing one of the songs you request. 

In the middle of the night on Thursday/Friday, there was a true emergency case. The patient was a couple days post-op from a massive MaxFax tumor removal. In order to get the appropriate people to appropriate places as fast as possible, the ship utilized the overhead announcement system. It was a little after midnight when there was an overhead announcement for required medical personnel to go to the OR. I immediately woke up and assessed whether or not I should go down to the OR, as I was not technically on call and wouldn’t want to be in the way. I quickly decided that the best choice would be to go down and be available to help if needed and assess the situation when I got there. This was one of the most emergent cases I’ve ever seen. This patient had critical bleeding coming out of his post-op facial/mouth wound, causing significant airway issues. Even though it was very, very intense and scary at times, I was beyond impressed with the skill level and ability of many of my fellow teammates. Being able to witness the expertise of the anesthesia providers, surgeons, and nurses working together to take care of this emergency was a testament to how amazing this entire mission is. Many of these team members truly are the best of the best. I helped with the case for about two hours before my manager sent me to bed around 2:00am so I could have at least six hours off work before starting my regularly scheduled cases in the general surgery room on Friday morning. I did not sleep much that night as I was worried about the patient and still had a lot of adrenaline flowing. Because I do not have much trauma experience as an operating room nurse, it was definitely a bit overwhelming. I really identified areas that I could grow in and learn more about how to deal with emergency situations. I really look up to one of the nurses who responded to the emergency call, and it was amazing seeing her expertise, professionalism, and giftedness in surgery. That patient made it through surgery and the surgeons were able to successfully stop the bleeding. He does have quite a long recovery ahead of him as his MaxFax surgery was quite intense, but the emergency case resolved well.

On Friday morning, we said farewell to members of the team were departing over the weekend, presented their certificates, and then played a game with "Lolita" before starting the surgical cases. Some points during the day were a bit of a struggle due to a few different factors, but we made it through! 

The surgeon I had worked with the past two weeks, Dr. Charlie from the USA, had his last surgical day so we wanted to go out for dinner to celebrate! He requested seafood, so we went to a new (to me) restaurant Chez Christian for a wonderful seafood meal. It was dark by the time we got there, but we were right on the beach and could hear the waves all throughout dinner. It was a special time with 11 of us OR staff in attendance, and I will miss working with Dr. Charlie in the OR! He brought a calm and sweet spirit, while also being very gifted in his work and knowledgeable about difficult cases. 

I was on call Saturday, but a kind friend offered to hold the pager for me for a couple hours in the morning so that I could go out for another massage. The cost of the massage is 50,000 Ariary which equals about $11.11. While it may seem like I am going out for dinner often and getting massages and spending so much money, the exchange rate here is about 4,500 Ariary for $1 USD. For reference, a decent restaurant meal costs about 30,000 Ariary, or about $7. Going off the ship is one of the primary ways I find relaxation or can deepen friendships with others. I find most people spend significantly less money here than when they’re at home. I typically work 10-11 hour days Monday-Friday and on-call most weekends, so I am thankful for the time off work/call to rest and recharge. 

After getting back to the ship on Saturday post-massage, I spent a couple hours at the pool reading and resting. It was one of the first days that I had been outside in the sunshine and warmer weather, so it was lovely! 

I also went down to the dock in the afternoon to say “farewell” to the departing friends. 

The on-call team did end up needing to do an urgent surgical case on Saturday evening. This patient had a massive maxillofacial tumor surgery a couple days ago. He is severely malnourished and even after nutritional support and improvement before surgery, the wound is not wanting to heal well. Unfortunately, his wound did become infected and was oozing pus. The surgeons needed to go in and open part of the incision and wash it out before applying a fresh dressing. On the weekends, there are no PACU nurses staffed, so we recover the patient in the OR. This proved to be the most challenging part of the evening. After about 1.5-2 hours of “extubation” and post-anesthetic recovery, we transferred him back to the ward/ICU. The surgical team will plan to bring him back to the OR this coming week for continuous care. Please pray for a miracle for this patient “JCR” and that his body will heal! I am thankful for a great team that worked together well on Saturday night (see below after we finished, around 10:40pm). 

On Sunday, I spent the morning at a local “park” in the sunshine, reading my Bible and having a sweet devotional time. It was another beautiful day! 

In the afternoon, the OR staff hosted a celebration on the dock to recognize the hard work that’s been done over the past couple of months! We also wanted to specifically honor the day crew and give their families an opportunity to meet other team members and see the ship. It was a wonderful afternoon filled with a lot of food, music, dancing, and games! 

OR Recap

It was another busy week in the OR, with my OR doing three or four cases a day. We primarily did hernia repairs, with a couple of hydrocelectomy cases. We removed almost 2 L of fluid from a patient who had a hydrocele! I cannot imagine how much relief he must feel. It is so great being able to restore some quality of life and provide these patients some kind of normalcy again. 

This week, the OR had 33 surgical patients across maxillofacial, general, and reconstructive plastics (started this week!). Of those 33 cases, 19 were General surgery patients. 

Thank you for your prayers and continued support! This work is difficult, exhausting, and often wearisome - but so rewarding at the same time. It can be difficult to remember that we are ultimately here to serve the Lord and be his hands and feet in Madagascar. I appreciate your continued prayers for my endurance, energy, and clarity of mind. Praise God for the miracles taking place and lives being changed in the name of Jesus!