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.