Thursday, March 20, 2014

Operation Walk Boston 2014: Day 1

Cara takes vitals in the screening area of our pre-operative clinic.
Heather and Barb greet patients and review their medications.
As the sun goes down in Santo Domingo this evening, it's amazing to think about all that has transpired over the past 24 hours in our first full day in the Dominican Republic.  We woke up bright and early this morning (although as one of the attendings reminded us, the definition of "early morning" changes drastically after you finish residency) and headed to the Hospital Plaza de la Salud to start the mission by seeing dozens of patients in our pre-operative clinic.  Dr. Thomas Thornhill, Dr. Carl Harper, Dr. Luis Alcantara, Dr. Jeffrey Katz, and many other members of the team have been working diligently over the past months to put together the detailed medical information of the potential patients for this year's Operation Walk, and the process was incredibly streamlined.  As patients came into the clinic, our nursing team was there to greet them, take their vitals, and review their medications.  Each patient was then seen by one of several teams in an examination room, each of which consisted of an Anesthesiologist, a Physical Therapist, and an Orthopaedic surgery attending and resident.  The patients were asked to describe what ails them and how their painful hip or knee (or, in some cases, both hips and knees) affect their quality of life prior to being examined by the Orthopaedic attendings and the anesthesia team.  We reviewed the x-rays with the patients and then provided recommendations regarding a treatment plan, with the final plan to be formulated at the time of the Grand Rounds team conference that was to follow.  

Dr. Thornhill and Dr. Schumacher examine a patient with the assistance of a Dominican medical student.

Dr. Burke examines a patient with the assistance of Lyonella, a Dominican medical student who also served as translator.

Following the history and physical examinations, the entire team convened in a lecture room to discuss each patient individually, including their chief concern, medical history, and x-rays.  At that point, any issues or concerns about the care of the patient could be raised, from which medications should be temporarily discontinued in the perioperative period to which procedure the patient would most benefit from by our Op Walk team.  It was truly a collaborative effort, with everyone from the Anesthesia, Physical Therapy, Orthopaedic Surgery, OR, and nursing teams sharing their thoughts and ideas on particular patients and protocols.

Dr. Ready presents a case to the team at Grand Rounds this morning with the assistance of Emily, one of our physical therapists.
After Grand Rounds, final preparations began for the OR.  Attending Orthopaedic surgeons Dr. Thomas Thornhill, Dr. Wolfgang Fitz, Dr. John Ready, Dr. David Dalury, and Dr. Dennis Burke will each be performing a series of total hip and knee replacements over the course of the next week, and we got started with the first cases today.  I was amazed by several things, from the efficiency of our team in transporting, organizing, and readily providing the massive amount of equipment it takes to perform these operations to the kindness and graciousness of the patients to the eagerness and friendliness of the Dominican medical students and physicians who are allowing us to come to their hospital as guests. They could not have been more helpful or excited to play a role in the care of these patients, and it was a pleasure to meet them.

Tomorrow is another early day for the team, with ward rounds in the morning followed by cases all day.  Meanwhile, our physical therapists will be working with the post-operative patients from today, the nurses will be taking excellent care of the pre- and post-operative patients on the wards, and Carl, Roya, Dr. Thornhill, and many others will continue to oversee the daily workings of the entire mission. Looking forward to another great day in the Hospital Plaza de la Salud tomorrow.


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