OR Day 2

Today we ran three surgical rooms for three surgical teams. We started at seven and ended twelve hours later. Procedures included fistula repairs–connections between the mouth and nose–that interfere with eating and speaking.  Another case involved the removal of a hemangioma from the face with a skin graft.

We  had to be creative with medications: today instead of morphine we were given fentanyl to use for post operative pain control. Quite a lot of dimensional analysis ensued while the nurses and I crafted a dilution that we could more easily dose based on micrograms per kilogram of body weight. In US hospitals, most drugs come premixed and measured from the pharmacy as an additional safety precaution; today was a reminder that the metric system and algebra are always important.

No matter how different things are, however, they are often the same. Here, as in the United States, anemia is a problem. Some children were unable to have surgery because their hemoglobin levels were too low. Hemoglobin is the measure of red cell concentration in the blood. The red cells carry oxygen to the body tissues, and red cells need iron to make that transfer. A child with anemia can’t tolerate surgical blood loss and recouperate.  The team plans to return next year, but that’s a long wait.

We’re using the same Hemacue machine here that we have in the Walnut Creek office, and I find myself giving some of the same recommendations I give at home, only in Spanish: wean children from the bottle at one year of age, limit the amount of milk consumed, eat high iron foods: beans, meats, and green leafy vegetables like spinach, collard and kale.

After surgery, the children stay overnight, usually four children in a room. The pediatric ward is very pleasant.

About Lisa M. Asta, MD

Lisa M. Asta, M.D. is board-certified by the American Board of Pediatrics and is a Fellow of the American Academy of Pediatrics, for which she is also a Media Representative (she has been interviewed for “Kids Health” on Health Radio, and quoted in Parenting Magazine, USA Today, and the New York Times, among other publications). She is a Clinical Professor of Pediatrics at the University of California at San Francisco and past pediatric chair at John Muir Medical Center in Walnut Creek. She graduated from Temple University School of Medicine and the Johns Hopkins University. Dr. Asta is also a writer whose fiction has appeared in Inkwell, Philadelphia Stories, Schuylkill, and Zeniada. Her essays have appeared in the Journal of the American Medical Association, Hippocrates, the San Jose Mercury News, and The New Physician Magazine. She is an occasional contributor to KQED public radio’s Perspectives series, and has written articles for Bay Area Parent, Valley Parent, Parents’ Press, and Parents Express, as well as online at WebMD.com, Rx.com, and MyLifePath.com. She wrote a chapter in The Field Guide to the Normal Newborn, ed. Gary Emmet, M.D. BabyCenter.com currently has two how-to videos for parents in production which feature Dr. Asta. For more on Dr. Asta’s writing, visit www.LMAsta.com
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