Different bike, different city

  Spent my last day in Tel Aviv walking the beach, and streets.  Had a great lunch and chatted with some locals.  Rented a bike and managed to get back to the hotel unscathed.  It was beautiful in Tel Aviv today, probably around 70,  "typical winter" weather for them.
  The bike is a bit clunky, but it rolls.  You use your credit card at one of many docking stations where the bikes are locked up. Pay for a day or a few hours and return it to any other docking station.  One problem, all the instructions are in Hebrew.  I know less Hebrew than Arabic.  People were very helpful, but it took 3 of us to figure it out and God knows how much it will cost me in the end. 

1)  Bike on bridge over Hayarkoon  River.  Big park in background...if you look real hard.
2)  Rabin plaza.
3)  Beach side docking station.

Sunday is Tel Aviv

  Now at the Sea Side Hotel in Tel Aviv.  It is still cold here, but not raining for at least the last half of the day.  Kevin, Sarah and I walked the promenade to Jaffa, an old city on the south side of Tel Aviv.  Now a trendy cute clean place with expensive shops and galleries.  There were either several weddings going on or it is a good place for wedding pictures, stray cats, people walking with their dogs.
  I am in the bunk room which will hold 6 people, but I have it to my self so far.  It is on the roof of the building 2 blocks from the beach.  Probably a bit more enjoyable when it is warmer.  Hoping for a dry day tomorrow to rent bikes and explore Tel Aviv before we leave to the airport at 8pm.

Bridezilla at Jaffa

Saturday in Ramallah

  Kevin's friend Sarah arranged a hike for us North of Ramallah.  Suheil guided us an a nice hike through terraced olive grooves and the typical countryside.  There were about 10 of us, NGO workers, a journalist, french teachers.  Then we had a great big lunch afterwords, baked chicken and vegetables.

1) Barrels protect the young trees from goats, sheep and gazels.
2) Walking among old olive trees near Bir zeit.
3)  Take me to the airport.  Lunch at Hosh lal-aliya.

Friday night in Ramallah

   We checked on the pt.s remaining in the hospital this morning.  They look good and most will be dc home.  It was a good week of surgeries, with no major complications or mishaps.  We have a good team, I am proud to be with.
 1)  ER nurse at heart
 2)  Muhammad still has a R 6th nerve palsy but the L looks better.

 

Hemangioma dressing failure....

 

 Taim post crani pneumonia.  Out of ICU, on the floor, getting better, cute as ever.

 

Daily breakfast buffet....



   Now, we are in Ramallah staying at the City Inn Palace. The rooms are spacious and the cappuccino in the lobby is average.  We are meeting Steve for dinner at 7pm.  Many Ramallah restaurants serve wine.  I'm looking forward to a nice glass of wine with dinner.
  Ramallah is a hilly city with streets running every which way.  It seems they may come out, like spokes on a wheel from circles, anyway, we tried to walk to a restaurant and ATM in another part of town Kevin and I are familiar with. Armed with a "rubbish" map and my poor Arabic we headed out. In the end, we settled for a pastries from a small bakery, corn from a street cart, and a taxi ride home.
  One of my favorite bakeries is here.  They make bite sized chocolate croissants that melt in your mouth, for 1 shekel.  A visit to Ramallah is not complete with a stop there.  Hopefully they will be open tomorrow, my mouth is watering thinking about them.

Last work day at Rafidia

  We did rounds this am of all the pt.s. Mostly doing well, 1 with a post op pneumonia.  Then had our final "cup of tea" with the hospital director, where we get a gift and he asks for our suggestions. I asked for more nurses telling him they work too hard. 
  Dr. Samar removed a large hemangioma from a 11 month old's head.


 We left around 3 t go to Dr. Afman's family's house in the country.  Had a typical Palestinian family BBQ with kids running around, too much good food, and a wonderful walk around their property to eat green, bitter almonds called luz. There are a lot of wild flowers blooming now after all the rain.  Lupine, red poppies and shooting stars in the field with the olive and almond trees, wild asparagus.
  Oh, and we are in the local news....check the link.  See us in action.
http://www.nablustv.net/internal.asp?page=details&newsid=67934&cat=35

Land worth fighting over.

Countryside near Nablus

Lupines, red poppies, olive tree.

Cyclamen flowers.


1) Amal and I
2) Dr. Murad picking green almonds.
3) Dr. Samar, Abed, and papa Dr. Afman.

The light at the end

  We only had 2 cases today, so we were out of the hospital by 3pm.  We actually got to see some of the city including Jacob's well.  There is a beautiful church and an old well in the basement where Jesus told Jacob or some one to do something that involved the water in the well.  I was busy looking at the mosaics on the floor and the paintings on the walls and like at the check point at the Erez crossing to Gaza, taking pictures when I wasn't supposed to.
  It is a pretty place.
  We also went to Joseph's grave.....Joseph who? I don't know.  But there wasn't much to it, and you still can't take pictures.  Apparently the Jewish settlers here are very passionate about Joseph and go there nightly and cause a ruckus.
  Then, always in search of the perfect latte, we went to a rather western coffee shop and had coffee and fruit shakes.  I recommend the fruit shakes.  More shopping in the old city as the stores close and now it's dinner time.

Mosaics at Jacobs well.....

Today is Tuesday?

  Loosing track of the days.  We started today w/ a 4 y/o girl who needed a crani for her very misshapen head.  I believe she was the one in my photo with Dandy Walker syndrome.  We started a bit late, but all went well.  During the case I went to do rounds on the pt.s from yesterday.  Taim needed more blood, he's the one in the pictures with his brain exposed, and Bailsan was still congested.  They stayed in the ICU and the rest moved out.  Luckily there were fewer pt's in the ICU today.   Our last was an emergency case, a newborn with myelomeningocele, where the part of the lower spinal cord was never closed, a kind of spina bifida.  OMG.  Smallest kid I've ever helped with in the OR.  Everyone did a great job.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002525/

 Fancy, light mounted camera to TV monitor in OR.

 First case of the day, not the brain side.

What's Next?

  Tomorrow we have 3 cases scheduled, I believe all craniectomies.  I have been doing half recovering pt.s in the PACU and in the ICU where the staff was overwhelmed going from 3 patients to 12.  All their available staff working round the clock.   So I stayed there and helped as much as  i could.  They seemed very appreciative and a large plate of pastries will be coming their way.
  There was a PALS binder on their desk.  I gave the lead RN the pocket folder of PALS meds and logarithms when I left.  Part of my involvement in the team is being out of the OR to see how this all comes together for the pt.  Like every where, you can do a brilliant case but if you have poor follow up your results may fail.   We called the hospital administrator to try to get more staff, transfer 2 pt's to the wards, and I begged an anesthesia resident to stay in the ICU to watch the kids, Dr. Ali, more pastries.  We will see how the night went in a few hours.

Waiting for ambian to take over

Front of Rafidia Hospital

 Notice it is not raining, first dry day but we still have our coats on.

Miracle of it all

  This is the same pt. 5 hours later in ICU breast feeding

The Brain

  I have taken my ambian, so this post will probably be filled with type o's. Sorry
  Monday we had 3 cases scheduled, 1 VP shunt and 2 craniectomies. This is where the skull sutures have closed prematurely causing malformed head shapes. So, basically the surgeon peels the scalp down over the patients face, cuts the skull apart, gives the brain more room to grow, "greenstick" fractures the affected skull suture line, puts in a drain and closes it up.  Pretty freakin amazing.
  Early in nursing school I thought I wanted to be an OR nurse, I have lost all that desire after the time I have been in the OR with these trips. Surgery is not for the faint at heart. No disrespect to the surgeon and the professionals in the room, it amazes me the human body can with stand it.
  Warning, this is a bloody picture.


  8 month old, scalp peeled forward, cut bone flaps....don't try this at home.

 

Rafidia Hospital

It is 2 am. I wake up each night at 2am.  I take an ambian, then next thing I know it is 7am.
  Our Internet access has been spotty, but for some reason it's good at 2am.
Dr. Samar and Kevin, our anesthesiologist arrived Sat. after noon. We went to the hospital to round on a few patients there.  A child in ICU who had a brain tumor removed some time ago, was basically in a coma because of severe hydrocephalus.  He got an emergency drain that night and a VP shunt the next day. He was awake and walking and got discharged from the ICU yesterday.
  Sunday was crazy clinic day, typical loud, fast paced day in a small office with multiple languages flying around.  A lot of cerebral palsy, and some spina bifida, but mostly misshaped heads.  Here are a couple of rare syndromes we saw;

 Apert syndrome and possible Dandy walker syndrome.

Shopping

I had to take a break from shopping due to the rain/hail/sleet/cold.  My new mohair gloves from Turkey, the complimentray coffee only helped for few hours.
Pictures from Nablus...

Hail in Nablus

Buying spices in the old city with covered streets.

Sifting corriander seeds.

Hotel Yasmeen kitchen cooks up more than hummus.

Nablus, West Bank round 2

After 3 canceled medical trips since September, I finally made it out of town.  I am with PCRF (http://www.pcrf.net )  again in Nablus, West Bank area of Palestine.  http://en.wikipedia.org/wiki/Nablus
We are staying at Hotel Al Yasmeen  http://www.alyasmeen.com/.
 Working at Rafidia Hospital.  This is a you tube video that shows the hospital with the area I will be working (PACU/ OR)  http://www.youtube.com/watch?v=vHjNtLNbFDM
Our group will work on pediatric neuosurgical patients, V-P shunts, tethered cords, canioplasties (for you medical folk).  I sure I will learn a lot.
I am in the hotel lobby with 3 layers of clothing, wishing I had more, the wind is howling but  at least the downpour from yesterday has stopped.  Breakfast of hummus, fresh yogurt, pita, boiled eggs, brewed coffee!!!  It's all good.  The rooms are fine but the ceiling mounted heater never gets the space from my head to the floor warm.
I am waiting for  my co worker,Amal to wake up, we have today to shop.