The Power of Cheetos

Saturday, November 3, Brooke headed to Park City for an evening out with eight girlfriends to celebrate her birthday. After a night on the town, she and her friends hailed a cab to head back to accommodations for the evening. Hungry after a night of cocktails and dancing, they asked their cab driver, Bill, if they could stop for pizza. He didn't know of anything open, but happily shared a bag of Cheetos he had with him.

A few minutes later, the group arrived at their destination. Bill got out of the cab and grabbed his cane so he could open the door for them. Brooke, a scrub tech at Salt Lake Regional Medical Center, who just returned from Operation Walk Utah in El Salvador, and Sam, an admin at Total Joint Orthopedics, were the last two out of the cab. They noticed that Bill had a cane and asked him why. He explained that he had no cartilage in his right hip but can't afford insurance to pay for surgery. Brooke and Sam immediately told him about Operation Walk USA and the national day of surgeries that was upcoming through Operation Walk Utah and Hofmann Arthritis Institute.

Sam followed up with Bill to make sure he had an appointment for the following Monday. Two days before his birthday, Bill received the call from Operation Walk Utah that his screening had gone well and he had been chosen to receive a new hip!

Bill, Brooke, and Sam in Pre-Op (bow-tie courtesy David, who made Co-ban bow-ties for the male patients and flowers for the female patients). 

This morning, Brooke (who is volunteering today for Operation Walk USA) and Sam came to Pre-op to visit with Bill before his surgery. Bill was relaxing with his girlfriend, Nancy. The two have been together since 1999, but apart for the last year and half while Nancy cares for her parents in Chicago. When she learned of the surgery, Nancy jumped on a train to be with Bill. 

"This is life-changing," Bill said. "This will bring me back to activities I have not been able to do."

"That was the best part of our evening, meeting you," said Sam. "You were the best fare I've had in a long time. I'm glad I had those Cheetos!" replied Bill.

Starting off right!

Volunteer Denise was at Salt Lake Regional Medical Center bright and early this morning to make breakfast for the team in the surgeon lounge. Apologies to the patients who were NPO and may have smelled the bacon cooking. What a wonderful treat to start off the day!

Eight surgeries are happening today. FOR FREE. Total Joint Orthopedics donated the hip implants, and Zimmer donated all the knee implants, and close to 60 people are donating their time for these Saturday surgeries.

Surgeons, anesthesiologists, nurses, PTs, aids, and many, many more have given up their time to make these eight surgeries happen today. And eight lucky patients will leave the hospital next week walking better. We can't wait to share their stories with you!

Patient Profile: Pedro

We wanted to include some before and after shots of one of our patients. Pedro lived in Utah for about 10 years, so he is near and dear to Operation Walk Utah!

Here is a video of him during screening:

As you can see, Pedro propels himself along using crutches, then drags his legs behind. He has no flexion or rotation in his hips, and came to the Operation Walk Utah screening to see if he was a candidate for total hip replacement. 

Thanks to Drs. Ponder, Jones, and Cook, and a generous implant donation from Total Joint Orthopedics, Pedro received bilateral hip replacements. 

Here's the video of him 36 hours post-op:

Pretty impressive!

Pedro with Maggie (UT) and Serena (UT) and his family just before discharge.

More pics!

A few pics from around the hospital and San Salvador:

We loved these ladies! 

Erin (UT): Are you sisters?

Purple Haired Ladies: No, we just met. Why?

Jordan (UT): Do you have the same hairdresser?

Safe travel on the highways of San Salvador

The Fanny Pack Brigade: Jason (UT), Paul (OH), Emma Angelia (UT). Don't mess with them!

Dr. Matejka (UT), Erin (UT), Becky (FL) at our final dinner.

Surgery kits. Each tote contains the items needed to set up an OR for one surgery.

Lucky enough to return home to this every night! Tip for future travelers: hotel management does not appreciate people jumping off the waterfall into the pool. 

 Sylvia (UT) and Darnell (MS)

 Angelia (UT), Darnell (MS), Brooke (UT)

 An OR Suite. 

Dr .Kennedy (MS), a patient, Darnell (MS)

 San Salvador

 Maggie (UT) with the infamous avocado tree. 

 Darby (UT) with a patient.

A Note From Serena

A note from Serena (UT), one of the floor nurses:

To work amongst a group of individuals who strive to achieve a set goal with skill, compassion, humor and teamwork is rare. To achieve this in a place which one is not use to working in is a huge accomplishment. Thank you to my team mates at Operation Walk Utah. You are all truly amazing and gifted people and I am honored to have shared this experience with you all.

Tuesday: Hitting Our Stride

We were on a roll today! With our daily ration of plantains in our belly, we headed off to the hospital. No traffic today! The bus takes us in two rounds; the surgeons, anesthesiologists, and pre-op and circulation nurses take off, and the bus comes back for the recovery nurses, physical therapists, and other volunteers, who get to sleep in an extra half an hour.

We managed to do 21 surgeries in three OR rooms with ONE autoclave. Cat and Angelia were fast and furious in their instrument turnover, and we began anesthesia in Pre-Op instead of waiting until the patient was in the room. That means the patient hits the ground running (or sleeping, as it were) the second the room is clean. Speaking of cleaning rooms:

Dr. Kennedy (MS) and Dr. Magee (UT) mop and scrub tables, causing the Salvadorian orderlies to fear for their job. Everyone on the trip works hard, and everyone wears multiple hats!

There has been an important development in the cafeteria contest. Cafeteria 2 (also known as The One On The Right) upped the ante with a smoothie bar. This consists of a table and a lady with two and a half blenders. We will let you know tomorrow if they are still in the lead when we see how Mandi is doing after drinking hers with a raw egg. Another develop is the addition of the Banana Leaf Lady. She is making a delightful tortilla type deliciousness with cornmeal, cheese, butter, salt, and sugar. She then grills the dough pressed inside two banana leaves. A re-creation will be happening SOON at Hofmann Arthritis, so stop by for a taste! 

Surgery count to date: 45

A Few (Belated) Pics From Sunday

Maggie (PT and Translator Extraordinaire, UT), Dr. Matejka (Anesthesia, UT), and Dr. Jimenez (Orthopedic Resident, University Of Utah) during the screening conference. 

Examining a patient pre-operatively

Joanne (OK) prepping a patient

Keithe (UT) putting bone cement on a femoral component during surgery with Dr. Kennedy (MS), Jordan (UT), and Dr. Magee (UT)

Overflow waiting room for patients and their family.

Dr. Hofmann (UT) and Dr. Plaster (OK) examine a potential patient's radiographs

Pedro, a candidate for bilateral hip replacement surgery (check back for his results!)

Dr. Lavernia (FL), Dr. Shawna (OK), Dr. Cook (OH), Dr. Ponder (OK), Patrice (UT), Dr. Hofmann (UT), Jason (UT) during the screening conference

Dino (UT) and Robert (OK) look on during screening conference

Monday: Our First Full Day

Monday came with great intentions. We originally thought 21 surgeries would go, but by the time we set the schedule, the count was 19 (no one cancelled, we just changed the patient order. Everyone has to be discharged by the time we fly out Friday, so we planned the oldest and least healthy patients first, along with the patients receiving multiple surgeries, so they have some extra time to recover if needed).

We weren't off to a great start, as we got stuck in traffic on the way to the hospital, and it took us a little bit of time to hit our rhythm. We also learned that the hospital only has one working autoclave. When they ordered the second one, it arrived but didn't work, and the company's maintenance couldn't figure out how to fix it. Sterile processing has a very large, brand new, non-working autoclave. Hopefully this won't affect our rigorous schedule throughout the week. 

Our afternoon tradition seems to be passing a brand new baby around to hold. It's our good luck charm! 

Dr. Hofmann and a brand-spankin'-new baby girl

While the OR staff was more than willing to stay to do the last case, we decided as a team that it wasn't fair to the post-op and floor teams to stay until 10 pm. It's amazing how many skilled and generous people it takes to get a surgery done. Pre-op to anesthesia, then into surgery, then out of surgery into recovery, then down to the floor for care, then into PT. Dressing changes, walking, medications, repeat repeat repeat, discharge. It's a lot of work! The patient was treated to a warm meal, a hospital bed, and the promise of the first surgery slot in the morning.

As mentioned yesterday, it's earthquake season. It took us a few shakes to realize that we couldn't hear any loud trucks, and no one had seen a large herd of buffalo running through the halls. We've been told we are fine, but if we can count to six we should run for the doors. Reassuring, to say the least. 

We headed home for a quick shower. Our bus ride is 15 minutes, which happens to be the perfect amount of time to drink a cold Pilsenar from the cooler at the front of the bus. We walked three short blocks to dinner, where we met up with the newly arrived Dr. Jones and his lovely wife Susan and ate plates of calamari, octopus ceviche, and cheesy pizza, and then headed home for an early night. 21 cases for tomorrow!

Screening and Operating

Day One!

We woke up bright and early this morning, and the hotel had prepped a beautiful breakfast for us. We feasted on eggs, bacon, hash browns, fried plantains, and fresh fruit before boarding the bus to the Hospital Nacional General. The screening teams are made up of surgeons, nurses, PAs, anesthesiologists, and hospitalists, who have the difficult job of checking patients, reviewing charts and radiographs, and assessing general health to make sure there are no health issues that would preclude them from surgery. The screening teams rank the patients in terms of health and need, and after a group conference, the patients are chosen. As we've planned six surgeries for today, we needed to choose  those six early on. William, the Salvadorean surgeon who trained in Salt Lake for a month to prepare for our trip, was ecstatic to find a hip patient for us. After closely examining the patient's radiographs, the team determined that his deformity was too severe for the implants we have available, and we would not be able to do his surgery.

It's heartbreaking watching the potential patients with their families and knowing many of them will go home. The hospital has celebrated the occasion by decorating the doors and waiting areas with blue and white balloons. They also sprang for lunch and coffee for the families, but despite the cheery atmosphere the air is mixed with both fear and hope.

While the screening teams screened, the rest of us unpacked, and unpacked...and unpacked. The hospital staff is AMAZING, and we had a great team of helpers moving boxes, grabbing us carts, and showing us shortcuts through the hospitals. HUGE smiles from everyone. We could not have done it without them!

The rain has been on and off all day, and with the windows open on the third floor for the OR and recovery, the weather is perfect. We broke for a quick lunch in the two adjacent outdoor cafeterias despite the downpour, and enjoyed rice, chicken, veggies, and fresh tortillas under the awnings and a tree heavy with bright green avocados.

The goal going into conference was to have fewer than 50 patients (because some will have bilateral surgery). Two hours later, the team made it from 57 to 56 knee patients. KNEE. We still have our four hip patients. We are recounting supplies and planning to purchase extra anesthesia from the hospital to make them all happen. A team deadset on sticking to 51 surgeries is now doing 61, which means we are trying to knock out 21 surgeries tomorrow. 21 surgeries in 3 ORs. It will be grueling, but totally worth it.

Our six surgeries went well today, and in addition to some groggy patients, we got to see a new baby enter the world! Obstetricia is right next to the room we are using for our storage and break room, and after watching a young mother struggle through labor for most of the day, we watched her wheeled through for a C-Section. One of the nurses took the new baby on a tour of the OR so we could greet him on his way to the nursery. If he could open his eyes we`d put him to work cleaning instruments.

We`ll try to get some pictures up tomorrow. Good thing we have a 100-cup coffee maker ready to go!

On a final note, it's earthquake season. More on that tomorrow!

Arrival.

We seem to hgave overcome our technical difficulties (who knew a Google based blog site would be unsupported by a Google-based browser?), but this post was written last night. Hopefully by tomorrow we will figure out how to incorporate pictures! From Saturday:

Well, we made it! The group trickled in today from all over the US. Utah, Ohio, Mississippi, and half of Oklahoma flew through Houston, while Miami and the other half of Oklahoma arrived this morning.

Customs is little more laid back here in El Salvador. Unlike the US, travelers are allowed to roam the airport, shop, use the restroom, and eventually wander downstairs, where a customs officer collects the $10 visa fee and stamps passports.

After we claimed our bags, we stood in line to see if we would require additional screening. Here`s how it works: stand in line. Press a pedestrian crossing style button on a pole attached to a traffic light. If the light turns green, you may exit the airport. If it turns red, you walk to the side for additional screening. In the past, our group has had necessary items confiscated; we all looked nervous as we waited to see if we would get through with suture, crutches, spinal kits, and implants. Phew! We made it.

We settled into the hotel and tested the local margaritas to make sure they are up to par (they are). We enjoyed the rowdy band for what looks (and sounds, obviously) to be a great wedding. The first bus leaves at 6:30 tomorrow AM for patient screening. We'll do six surgeries tomorrow. We're recruiting hip patients to make sure we have enough, so if you happen to be in San Salvador, you may see Jordan, our Salt Lake PA, trying to pull people off the street!

Getting Ready to Leave

We had our final Salt Lake City Team meeting Monday night, where we discussed last minute items, and, more importantly, who could squeeze what extra supplies in their suitcase. Joan, our lead physical therapist, wins. She's taking seven pairs of crutches in her husband's golf bag!

Our pre-team of Sylvia, Jordan, Karen, Dr. Jimenez, and Mandi are on the red-eye to Atlanta tonight to hop the first flight to San Salvador in the morning. Along with them? William, a resident surgeon at the Hospital Nacional General who has been training at Salt Lake Regional Medical Center with Hofmann Arthritis Institute for the past month. The pre-team will begin to unpack and will determine the lay of the land before the rest of the team arrives Saturday night. 

We’ll begin screening patients bright and early Sunday morning, and start our whirlwind of surgeries Sunday afternoon. This trip is sponsored by Operation Walk Utah, but we will have volunteers joining us from Mississippi, Florida, Texas, Ohio, and Oklahoma. 

Keep an eye out for posts from our trip!