Saturday, January 14, 2017

Grace & Simplicity

Brase Clinic for Surgery
Day 1

My morning devotion brought me right back to the exact scripture I started this trip with: "Be strong in the Lord and His mighty Power." This was my reminder to suit up with the armor of God: the helmet of salvation, the breastplate of righteousness, the sword of the Spirit, the belt of truth, the shield of faith, and my feet fitted with the readiness of the Gospel of peace. Ephesian 6:10-18.

My success here and in everything hereafter will be determined by my reliance on God.

Bright and early we pulled into the clinic and were met with these sweet, pleasant faces seen in the below picture. The patients literally were seated outside every morning applauding us and cheering for us as we walked in. Sleeping on the hard ground with little to no water or food did not hinder their spirits. We cannot always change our circumstances, but in the midst of adversity we can most definitely change ourselves and our response to them.

 God led me to a fresh, drink of cool water; He refreshed my soul. There is still so much good here on Earth.
Those beautiful smiles. God provides. 

After walking into the clinic I asked the CRNA (Certified Registered Nurse Anesthetist), who was our team leader, what she would like for me to do and she said: "What do you mean? You're gonna go into that operating room and run a table. I'll be in and out and there will be another CRNA running the table next to you if you need anything. Your surgeon is Jerry and your first patient is getting ready in pre-op."
Whew! Alright, less than 3 months until graduation from anesthesia school and this was going to be a big test. All the mistakes, all the hard work, all that I had learned, the tears, the frustrations, the laughs was all coming to a head right here in the middle of Africa. "Be strong in the Lord and His mighty power."

The surgical schedule and cases were written on a chalk board in the hallway that we had put together the previous day: goiters/partial thyroidectomies, hernias, and lipoma excisions were all on the board for my table. Let's do this!

Making it work with less! Here was my daily set up.
We had one bottle of fentanyl to get us through the day and one oxygen tank to get us through the week. This meant hand ventilation only, no ventilators, no medium/long acting paralytics and low flow anesthesia. I had to use demerol and IV tramadol to make up for the low fentanyl and this was my first time using either one of these drugs.


New machine to learn! Thankfully my anesthesia program had us travel to a multitude of clinical sites during our training so I was confident I could figure out yet another different machine. No leaks: Check! O2 sensor: Check! ETCO2: Check! 

So in Kenya there is no formal scavenging system to dispose of anesthesia gases so umm.. we scavenged those gases right out of the window! I did not know this at first and a fellow CRNA found this hose laying at my feet and asked if I felt funny. Oops!

Never have I appreciated more the IV bags we use in America. These ones were plastic and they leaked terribly and didn't have any ports to add in and mix medication easily. Such simplicity at times we take for granted. But hey, at least we had them!

 
Off we went! And then.....

POWER OUTAGE!!!
Definitely peed my pants a little and thought my heart would beat out of my chest. 
This is why in anesthesia you have Plan A, B, C, D......Notice my blank monitors and I have an intubated, anesthetized patient undergoing surgery in front of me. Ok don't panic. Stay calm. You are trained for this. Surgeon asks how things are going and I say: "Everything is going fine." Generator does not kick in.... Ok so I deliver some IV medications to keep patient asleep, continue to hand ventilate patient, patient's color looks good, and I place my hand over their carotid and feel a wonderful pulse.
Then someone comes in and hands me this: 
Whew! A portable pulse ox! I had someone slip this on the patients finger under the drapes and I felt I could kind of breathe again. Our reliance on technology is scary but  such a good lesson to always go back to the basics. Your foundation of knowledge will never fail you.

Ok got through the first few cases just fine and now it's time for lunch! The amazing cooks from Brittney's Home of Grace brought us lunch every day and it was delicious. 






I am so thankful for my team. The instant team work and dedication was such a beautiful thing and I was honored to be here and be a part of it. 

These clinic days and all the patients I spent time with and cared for is exactly why you fight for your dreams. The calling that God has placed on your life is worth it. It's worth the fight. Two weeks before graduation from anesthesia school I sincerely wanted to quit. I was ready to throw away 2.5 years of my life along with all the sacrifice and hard work not just from me but my family and friends as well. It's always darkest just before the dawn but our greatest victories are only evident after our hardest fights and our biggest trials. You are worth it. Your dreams are worth it. 

Later that evening back at the compound, we handed out pencils and papers to all the children and gave them hugs and told them goodnight. God delivers His grace in such a big way. And when you least expect it, when you expect to give all you have away, God actually gives you back so much more. He is just so good like that.

Goodnight! Tomorrow will be another busy, busy day. 

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