Wednesday, March 26, 2014

Operation Walk Boston 2014: Day 6

As the sun rises in Santo Domingo and sets on our time here in the Dominican Republic, it is impossible to feel anything but grateful for the opportunity we have had over the past week to visit this beautiful country and be involved in the care of its extraordinary citizens.  In all, we were able to perform 54 total joint replacements in 39 patients.  The teamwork and planning that culminated in the ability to care for all these patients was months and years in the making, with the core group of Dr. Thornhill, Dr. Alcantara, Dr. Gomez, Dr. Concepcion, Roya Ghazinouri, and so many others coming together to find a way to give these patients the chance to get back on their feet and live their lives.  While we will be heading home today, Dr. Alcantara and Dr. Gomez will be following our patients here in the Dominican in the weeks and months to come as they return for post-operative checks and physical therapy, and we will see them next year at our post-operative clinic.

Dr. Alcantara addresses the entire team of volunteers at Operation Walk 2014.

With Dr. Alcantara and Dr. Gomez at the helm, the medical students and young Dominican doctors we met were an essential part of making this mission successful.  They cared for the patients at night and then remained in the hospital throughout the day, helping with everything from translation to dressing changes to encouraging the patients as they took their first steps with their new hips or knees.  As a small way of saying thank you, our Chief Medical Officer Carl Harper came up with the idea to present them with some short lectures about the basics of arthritis, the history of total hip and knee replacements, and complications associated with these operations yesterday morning.
Ellen lectures on complications of total joint arthroplasty to the UNIBE medical students.
UNIBE medical students in their Operation Walk gear.
Carl lectures the UNIBE medical students on arthritis.

Following these lectures, we returned to the wards for a final goodbye to all of our patients.
The patients of Operation Walk 2014.

Post-operative patients prepare to go home.

Attendings and residents from the Orthopaedic and Anesthesia teams.

Physical therapist Annie with a grateful patient.

Physical therapists Steph, Jill, and Carolyn with a happy patient.

Orthopaedic surgery team (Dr. Fitz and Dr. Dalury not shown).

Post-operative patients prepare to go home.

As much as I thought I had an understanding of the impact of total hip and knee replacements after several years as a resident and seeing our Dominican patients walk through the halls over the past week with a huge smile on their faces, many of them out of a wheelchair for the first time in years, I don't think I truly understood the magnitude of how an operation can change someone's life until I read a letter that was handed to us by a patient the day after her surgery.  The letter had been written by her son the day prior in perfect cursive on lined paper.  A copy is included below, but in case it does not project well, I have transcribed his words below.  As I don't believe I would be able to better summarize the purpose of Operation Walk and the reason we came to Santo Domingo this week, it is a privilege to close our journey with his words.


During the last two years we have struggled a lot with my mother's illness.  I wouldn't be able to describe it and sincerely, a letter doesn't mean anything compare with what you've done for my mom and my entire family.  I don't know you, and you don't know me neither but from the bottom of my heart I want to say thanks.

You have no idea of what you've done to us, you have returned to life one of the most important person in the entire family, you gave her back the ability of walk, and such a tremendous gift from someone you don't even know makes me feel confused and speechless.  Once again from the most sincere place of my heart, thanks.  And may God bless your life with everything you need.  

P.S. I feel more grateful than anything else.


Chief Operating Officer Roya and physical therapist Carolyn.
Christine and Gloria lend a hand to Dr. Burke.
Carl and Ellen at closing dinner.
Carolyn, Emily, and an UNIBE medical student help a patient with bilateral total hip replacements down the stairs.
Dr. Dalury and Lauren in the OR.
Chase reviews post-operative x-rays at our closing Grand Rounds.

Signing off for now,

Tuesday, March 25, 2014

Operation Walk Boston 2014: Day 5

In the blink of an eye, our 5 days in the operating rooms here in Santo Domingo have come to an end.  We finished up our final cases today for a total of 54 completed joint replacements over the course of this past week.

Anesthesia resident Tanya prepares a patient for spinal anesthetic while attendings Dr. Lazea and Zeballos supervise.

Dr. Thornhill, Dr. Burke, and Lauren at work on a total knee replacement.

As we walked back from the ORs and returned to the wards, we were greeted by scenes such as this one:

Paul and Sarah take a quick break in the coffee room in between cases.

The nursing staff and Physical Therapy team on the wards.

Dr. Ready and Emily take a stroll with a patient.

It certainly goes without saying that a surgical mission of this magnitude would not be possible without meticulous organization of equipment and supplies, sterilization of instruments in between cases, and distribution of medications (including the pericapsular injections given to our patients intraoperatively that have done a phenomenal job of controlling postoperative pain while also allowing for patients to walk on the same day of or after surgery).  Below are some photographs of the people who make all these things possible behind the scenes.
"Secret agent" Ashley, hard at work in the pharmacy/cargo room.

Gloria, Debbie, and Steve at mission control, readying the supplies in the cargo room.

Kesner, Steve, Anne, Franklin, and Ruddy hold down the fort.
Our pharmacist, Anne, with Ashley and Ruddy.

Drs. O'Neill, Gargarian, Concepcion, Zeballos, and Judy and Debbie get organized.

Following our final cases today, we sat down as a team to review the pre- and postoperative x-rays from each of the 54 joint replacements that were performed over the course of the week.  Led by Dr. Thornhill, each and every x-ray was closely studied and critiqued, and in addition to being a great learning experience it was truly remarkable to take in all that had been accomplished over the course of the past several days.  

The day concluded with dinner and dancing for all of the Dominican and American volunteers who participated in Operation Walk (photographs forthcoming tomorrow).  In the morning, it's back to the hospital for our final day of rounds followed by presentations by the Orthopaedic residents to the Dominican medical students on various topics regarding joint replacement.

Until tomorrow,

Sunday, March 23, 2014

Operation Walk Boston 2014: Day 4

Day 4 of our journey marked a significant milestone, with the first of our post-operative joint replacement patients being discharged home.  Per criteria of our Physical Therapy team, discharge home requires that patients are able to walk on their own as well as go up and down one flight of stairs. Discharge home represents the culmination of an incredible team effort and hard work on the part of both the patient and the medical team to provide patients with a better quality of life.

From start to finish, here is a look at the perioperative course of our Operation Walk patients.    

Mornings start early in the operating room, with the OR staff and anesthesia and surgical teams checking in the first patient of the day in the pre-operative area prior to heading back to the operating room.

Orthopaedic surgery residents Carl, Ellen, and Lauren get ready to scrub before cases in the OR.
An x-ray of the pelvis of one of the patients on whom a total hip replacement was performed today.  Many of our patients are younger individuals with advanced disease of the hips.

Anesthesia resident Zahra preps a patient for a spinal anesthetic prior to surgery.

Sarah, Dr. Ready, and Fiona share some smiles in between cases.

Drs. Schumacher and Thornhill perform a total knee replacement.
Our fantastic team of PACU nurses receive the patients right after they came out of the OR, making sure their vital signs are stable and their pain is well-controlled.

Julia and an UNIBE medical student welcome a post-operative patient into the PACU.

Julia, Cara, Karen and an UNIBE medical student are all smiles in the PACU.

Dr. Concepcion, one of our anesthesiologists, greets a patient in the recovery room.

On the day of surgery, the patients are encouraged to sit on the edge of the bed and start simple physical therapy exercises in bed.  By the first day after surgery, however, the expectations are high.  Patients begin walking with walkers and close supervision on the first post-operative day and tackle the stairs by the next day.

Physical therapist Steph watches closely as one of her patients begins walking.

Steph takes the same patient up and down the stairs one day later.

Physical therapist Emily accompanies a patient on a walk around the wards while Chief Medical Officer Dr. Carl Harper looks on.

Physical therapist Carolyn and her patient gives a thumbs-up as he gets ready for discharge home.

Physical therapist Jill accompanies a patient down the stairs.

Dr. Ready masters a fist bump with his patient.
Two patients get ready to head home after their knee replacements.
"Secret agent" Julia greets a patient in the afternoon.

A happy patient heads home after a hip replacement 3 days ago, with the UNIBE medical students and physicians hosting Operation Walk offering encouragement.

A special birthday wish today to Dr. Jeffrey Katz, a world-renowned rheumatologist and integral part of Operation Walk.
Happy Birthday, Dr. Katz!

Saturday, March 22, 2014

Operation Walk Boston 2014: Day 3

Another day in Santo Domingo has come to an end, concluding with 12 patients having undergone a total of 17 joint replacements today.  On account of meticulous planning by the Op Walk team (see photo of Dr. Thornhill, Carl, Paul, and Roya below), each of the 3 cases in our 4 operating rooms ran smoothly today.  Almost all of the operations here are performed under a spinal and/or epidural anesthetic by our skilled anesthesia team, and within minutes of the completion of each operation the patient is taken to the PACU (recovery room) to be cared for by our nurses prior to being transferred to the floor.

Dr. Thornhill, Paul, Carl, and Roya plan out the OR schedule for the next day.

Steve, one of our phenomenal team members who ensures that the equipment will be ready for each case, organizes supplies in the cargo room.

Our morning began on the wards by 6:30 AM, with 3 teams composed of nurses, physical therapists, American and Dominican medical students, and physicians rounding on each of our patients.  Rounds are run in much the same way that we approach them at home, with each patient being presented by the nursing team and overnight staff prior to examining the patient and coming up with a plan for the day. 

BWH Rheumatologist Dr. Jeffrey Katz presents x-ray findings on morning rounds to the team, which includes both American and Dominican physicians, medical students, nurses, and physical therapists.

Dr. John Ready and physical therapist Carolyn Beagan greet a patient on rounds.

Jill (Left) and Ellen examine a patient in the morning on ward rounds.

After rounds, the surgical team heads straight to the OR to get the day's cases started by around 7:30 AM.  Meanwhile, the physical therapy and nursing teams remain on the wards to begin the process of mobilizing the patients out of bed and getting started on walking after their total knee or hip replacements.  

OR schedule for the day.

Dr. Fitz and Carl discuss post-operative plans for a patient.

Josh from Depuy Synthes, the company responsible for donating all the knee and hip replacement implants and equipment for Operation Walk Boston, looks at the inventory for the day's cases.
Of particular excitement today was the opportunity to see how well our patients who underwent hip or knee replacement 2 days ago are now progressing with Physical Therapy.  Patients begin standing and walking on the day after surgery, and by the second day after surgery their progress is remarkable.  To see patients who came into clinic on Thursday in a wheelchair because they had been unable to walk for years due to pain now able to ambulate on their own with a walker or crutches is both fascinating and incredibly rewarding.

Physical therapists Jill and Carolyn start out with exercises in bed prior to...

...heading out for a walk through the halls with a team of encouraging onlookers.

Annie accompanies a patient through the halls after her total knee replacement.

Dr. Alcantara, who along with Dr. Gomez will care for the patients of Operation Walk Boston in the coming weeks and months, joins a patient on a walk around the wards.

Tomorrow brings with it another full day of surgery, physical therapy, and recovery for the patients of Operation Walk 2014.  We look forward to sharing some of our images and stories from the day with you, and thank you for taking the time to check in on our progress.