OR day 2

New day, new cases, new challenges, new successes. With every passing day things get a little bit better. The morning started out at 6 am with delicious chai tea and breakfast. We were hoping for a 7:30 start to the cases but realistically probably started at 8. Much improved from the 10 am start from the day before. Everyone started getting in routines. The hospital nurses that are assisting started understanding our techniques and processes. Efficiency is still much to be desired, but we have come leaps and bounds from the day before. The final count for the previous day was 36 surgeries and I think today we did more than 40 cases. My room today consisted of more ENT and plastics cases...1 ear reconstruction, 1 wart removal, 2 tonsillectomy's, 1 parotid rumor biopsy and drainage and a dermoid cyst removal. My room was the second to last out for the day and we finished around 6 pm. Most of the cases here are being done under spinal anesthesia with the exception of my room and the plastics room. It is more challenging to do general anesthesia because there are no ventilators, and I still don't know how much anesthesia gases the patient is receiving. It is amazing to see how much you can do without all of the abundant resources we have in the US. It is making me think more, and communicate better. You have to be an improviser and fixer to be able to survive here. One of the challenges is there is no circulation in the operating room. We have two tables in 1 room so two different cases are occurring side by side. The chemicals used to disinfect the instruments sits in the room as the fumes evaporate around us. Typically with the gases machine the excess gas the patient breathes out gets sucked away in a vacuum, however this does not exist. The type of circuit that fits on this gas machine is called a Bain circuit. So essentially all the excess gas the patient breathes out comes out of the circuit and into my face. A little gas for the patient, a little gas for me. I am pretty sure everyone in the room is partially anesthetized. There is an air conditioner in the room but then the patients are freezing so it boils down to picking your poison.

After the hospital we went wandering the streets and looking around at all the shops and people. We were supposed to have dinner on the roof of the hotel again last night but we got in trouble for bring meat up there the night before so we had to find someone to hosts us, which is not hard. Everyone here is going above and beyond to make our stay exceptional. Dinner started at 9 pm and finally finished up around 10. This dinner was a little more disappointing than the others because they served fish but there were so many little bones it was practically inedible. On the bright side there was a delicious chocolate cake. After dinner it was back to the hotel for a colder, rather than warmer, bucket washing. At least this time the water did not feel like ice. After the "shower" it's all you can do to dry off, get dressed, and get under the covers and fall asleep before you freeze. Anyway that's all for now. Will attempt pictures but it probably won't happen because of the connection.