An emergency room

Deepa Bharath

Chapter 3

Raring to go

The hospital had a smell that seemed to cling to the corridors and

to the people who walked on them.

It was not a pleasant smell. It’s hard to pinpoint what it was

exactly.

At best it could have been the cleaning agent used to mop the

floors in the mornings. At worst, it could have wafted from the grimy

bathroom floors or from the bloody sheets in the birthing room. Or it

could have been the putrid stench that oozed out of open, infected

wounds.

Whatever it was, the smell assumed a personality of its own. It

scared, dulled and tired the senses of anyone who stepped into its

domain.

The hospital in Macas has 30 beds and one operation room. A

handful of surgeons who work at the hospital, handle only a few kinds

of surgeries such as caesarian sections, gall bladder, appendicitis

and vasectomies.

This is the only hospital that even does surgeries in the Morona

Santiago area of Ecuador, which includes the jungle communities and

small towns on its outskirts.

For the Plasticos Foundation team members who are used to working

at Hoag Hospital -- which has 409 beds, a medical staff of more than

800 and modern equipment -- trying to set up a workable operation

room was a daunting challenge.

It was up to operation room nurses Kathleen Fodor and Virginia

Burns to find a way.

“It’s amazing how few resources they have here,” said Fodor,

stretching her legs, as she sat on the floor to take a break.

“You also realize how much we have back home and don’t even think

about it. We throw away so much, too.”

Fodor said she was horrified, but amazed, at how local nurses

saved bloody sheets and linen to be washed and reused the next time.

“We kept throwing them in the trash can, but they kept picking

them up,” she said. “They don’t have enough of anything and it’s

really very sad.”

The nurses had to think about issues that would never come up at

Hoag Hospital. Burns had to find a sink to wash the surgical

instruments while Fodor was trying to figure out how to unlock the

bed that was stuck in one position.

“We have to make sure they have everything, like beds and

anesthesia and suction, because they don’t do surgeries like these

all the time,” Fodor said.

When the nurses were finished, the room had two operating tables.

“We would never have two tables in the O.R. back home,” Fodor said

shaking her head, but smiling.

By the time the two Plasticos surgeons got to work, they had even

learned to ignore a couple of cockroaches that scampered across the

floor.

Most of the instruments and equipment used in the surgeries were

carted from Newport Beach in 14 large suitcases. The team carried a

portable anesthesia machine because in November, during their last

visit, the hospital had only one in working condition. But this time,

they had fixed the other one so the doctors did not have to use the

portable machine they brought.

The first few hours of surgery were fraught with some tension as

surgeons warmed up with their first couple of patients and the nurses

scurried between the operation room and a tiny storage area next to

it where they kept the instruments, gloves and supplies.

White lights illuminated the operation room and each operating

table had a set of round surgery lights. The room also had two

cabinets where the nurses stored sutures and other things they might

have needed at a moment’s notice.

Down the hall, nurse Jane Collins was setting up her “recovery

room.”

“These beds are kind of how beds were back home when I started out

as a nurse 30 years ago,” she said, eyeing the rusty legs of the

beds. “You have to manually rotate a lever to raise or lower it.”

Collins was also getting used to the idea of the oxygen masks “not

coming out of the walls.” In this hospital they came out of

5-foot-tall oxygen tanks that sat next to the patients’ beds.

But Collins knew she could try methods and techniques that she

would never dare try in the United States. She could climb on to her

patients’ beds to hold and comfort them.

“I’d never be able to do that at home,” she said. “They don’t

worry too much about name tags here or charts or paperwork. They

don’t check the vitals as often.

“Here, you do what is really important, not what lawyers think is

important.”

Coordinators Denise Cucurny and Ruth Ann Burns prepared lists of

patients selected by the surgeons. The patients lined up in a room

adjoining the recovery room and put on dark green hospital gowns.

They sat on chairs with saline solution attached to their hands,

waiting for their turn.

Most adults and even children were matter-of-fact about walking

down the hall to the operation room, holding their sachet of saline

in one hand and the long, trailing, ivy tube in the other.

The operation room’s two-table setup disturbed plastic surgeon

Larry Nichter.

“It’s scary for the patient when he or she walks in and sees this

other patient being operated on right there,” he said. “So,

sometimes, we deliberately get in the way and don’t let them see

what’s going on. It can be frightening, especially for the children.”

Fodor and Burns also set up a main table with all the instruments

needed for the day’s surgery. A “general table” like that is illegal

in the United States, said surgeon Robert Burns.

“Back home, you have to have a separate table for each surgery,”

he said. “But when we’re in the Third World, we do it this way and

the patients are fine. They leave the hospital and they recover

normally.”

Burns is a general and vascular surgeon, but he is also adept at

skin grafts, Nichter said.

“I think every surgeon is a plastic surgeon at heart,” he said as

he watched Burns operate on 13-year-old Julia Salinas, who was badly

burned on the right side from the chest down. Her left breast was

lower than her right breast and she walked with a limp because of her

injuries.

“The problem is she has a lot of scar tissue and an open wound,”

Nichter said as he marked up her wrinkled abdomen with a Sharpie pen.

The surgery, he hoped, would help the wound heal and allow her to

walk better.

Minutes after Burns completed the surgery, Julia woke up from the

anesthesia writhing.

Burns and the nurses transferred her to a gurney to be taken to

the recovery room.

“Bars up,” Nichter called out.

“They won’t go up,” Fodor said trying to push the bars upward.

“OK, just hold her down,” Nichter cautioned the nurses as they

wheeled Julia away to Collins’ recovery room. “She’s waking up.”

One down, 49 more to go.