Our last case was Wednesday: a male patient in his late 40s with severe aortic stenosis.  He was scheduled for an aortic valve replacement with an On-X mechanical valve.

The lines were placed, the patient was asleep, then the patient was prepped and draped.  Andrew, the anesthetist, led the time-out and Dr. White asked Daniel to pray. 

Daniel Scrubs for Cardiac Cases.  Also a Pastor 

Daniel, a scrub tech as well as the pastor of a village church, asked God to give the team wisdom, to protect the patient from any harm, and to help the replacement to be successful.  He asked God to do this, so that when this man went back to his village, it would be evident to everyone that God had done a great work through the team at Tenwek and that God would be glorified by what was about to happen in OR-2 that morning.  

The procedure went according to plan. Once we were on bypass, the heart was stopped and the aorta was open.  It was evident that this was a heavily calcified valve and the annulus, where stitches would placed to hold in the new prosthetic valve, was also heavily calcified. It took a little over 80 minutes to place the valve and close aorta before the clamp could be removed.  In every cardiac procedure, there is a moment of truth: when the cross clamp is removed and blood is allowed to perfuse the heart muscle, again. 

Andrew is an anesthetist

There is always a sigh of relief when the heart slowly begins to contract in normal sinus rhythm.  But sometimes, the heart fibrillates and it will not beat; the team must take action to re-establish a normal rhythm.  These abnormal rhythms may be a sign of something very serious; a piece of calcium could have become lodged in a coronary artery, the drug that is given to protect the heart while it is not getting blood flow (cardioplegia) may have been ineffective and the muscle may be damaged, or perhaps one of the valve stitches was inadvertently placed through a coronary artery and the heart muscle is starving for oxygen and blood flow.   These are a surgeon’s worst nightmare.  Perhaps the heart is just irritable, and administering a drug to make it less irritable and a  single counter shock will break the abnormal rhythm pattern and establish a normal rhythm.

“Charge the paddles to 40- discharge.” No change   “Again, to fifty,” no change.  “Has Lidocaine been given?  Okay, charge to seventy.”  For more than 30 minutes, a normal rhythm could not be established, and the pacing wires were not capturing.  Also of note, the blood pressure was reading a low number and then a high number, and the wave pattern was confusing.  It was very tense in the room.  Was this man’s heart damaged?  Would it never again regain function; would he die on the operating room table?  I am sure that everyone in the room was reviewing everything that had transpired and was wondering if there was possibly something they could have done better. 

Dr. White began a dialogue with Agnetta, the surgical resident assisting him, and with Andrew Bii who was giving the anesthesia, and with me.  What were our options?  Someone reached under the drape; a pulse was palpable in the patient’s foot.  It was also noted that the rhythm was improving.   It was decided that Angnetta should place a catheter in the femoral artery, to get an accurate pressure reading.  This new line revealed a blood pressure of 75, a good sign.  Over the next 40 minutes, we slowly weaned the patient from the heart lung machine.  He had a very strong heartbeat; in fact, he had a high blood pressure. The patient was on cardiopulmonary bypass nearly 4 hours, but was now stable.  His chest was closed and he was transferred to the recovery area, in stable condition. 

It is evident that God heard and answered the prayer we had prayed with Daniel. 

At the end of the day, as I reflected on this case, I was reminded of Tenwek’s mission statement:  Tenwek Hospital is a Christian community committed to excellence in compassionate health care, spiritual ministry, and training for service.  Yes, the care provided by the cardiac team at Tenwek is excellent.  I witness each member of the team brings their whole person to the cardiac operating room each day.  There is a passion in each team member to do the very best for each patient. I also noted team members acknowledge there fallibility and their dependence on one another and on Jesus to use them as instruments of His healing. 

How a team performs when the unexpected occurs defines a team’s character.  When confronted with an abnormal rhythm and blood pressure issues, this team was able to communicate and come up with the best plan to overcome the challenging obstacle.  I am very proud to have been part of this surgery team these past two weeks.   On Wednesday evening I returned to the ICU to see the patient who was quite stable and onvery little pharmacological support.  Thursday was a day of completing inventory of supplies and cleaning and storing equipment.  When I dropped by the CTICU to check in on Wednesday’s patient I was do pleased to find that he had been extubated.  He grasped my hand thanked me personally and praised God for delivering him from surgery and healing his heart.  He told me it didn’t really matter what happens to tomorrow or the next day because his life was in God’s hands.  He introduced me to his daughter.  It is humbling to witness this attitude of joy, thanksgiving and complete dependence on God in a patient still recovering from major surgery.  

Our last patient the day after surgery

Patients, A grateful father and a grateful husband, Supplies, How you can help

Patient 2 days post Mitral Valve Replacement

Their stories are all very similar- Rheumatic Heart Disease, a three or four year history of progressive shortness of breath, increasing symptoms of chest pain on exertion, and fainting spells.  Most have had one or two hospital admissions in the past year for congestive heart failure.  They are all on lasix and other drugs to optimize blood pressure and heart function, an attempt to help them to have some semblance of a normal life.  About one-third of the patients we have operated on during the past week have had a prior stroke, some of which completely resolve and some having residual deficits. Most have ranged in age from their late teen to late 20s.  

Today, we operated on a twenty-two-year-old that traveled here from Southern Sudan.

Post op transport of Patient from Southern Sudan to ICU

Dr White and team before time out

On Monday, we did two cases.  As I walked out of the surgical building at about 8pm, I was stopped by two men, one in his 20s and the other in his 40s.   One of the men approached me and said, “Excuse me, did you operate on Andrew?”  “Yes, I was there with the team,” I replied, “He did fine!  What a handsome young man.”   The man told me he was Andrew’s father; he shook my hand, thanked me, and said, “God bless you.” He had tears in his eyes.  He asked if he could take my picture.   I told him that I have 3 sons and two daughters.  The younger man then said, “Benetine is my wife.”  Benetine was the first patient we operated on, who had a mitral valve replacement.  More thank yous, more pictures together.  He told me about their daughters; then there was another handshake and a hug.  

A grateful  husband and a  grateful father 

Holly and I have been planning this trip for months. I know I told her at least once a day since January, “All of our clothes and personal items must go in our carry-on luggage.

We will each have one back- pack and a personal item.  We are allowed 2 checked bags each, not to exceed 61 linear inches. Each can weigh up to 50 pounds.  Those checked bags will only contain medical supplies.” 

"Pump room" at Tenwek where Perfusion Supplies are stored

There have been a series of emails to Tenwek team members since January, to learn what supplies are most needed.  Valve suture, chest wires, various medications, perfusion connectors, ISTAT blood test cartridges, and cardioplegia sets topped the list. One month ago, I learned about a guy from Mississippi and another from Tennessee that were on their way to Tenwek.  Both agreed to let me send supplies in one of their checked bags, which I FedExed to them before their departure. 



Holly’s and my bags totaled 197 pounds. 

Daniel preparing sterile instruments and suture 

Many items from many people:  Reed Quinn, Kathy Black, and Bob Kramer, helped me to get valve suture and chest wires from MAP International. Patti Cummings, from Sorin, gave me  donated tubing connectors.  Abbott Laboratories donated blood test cartridges. Gio Cercere lent me an ACT machine and gave me a box of test cartridges. Mike Fitzhenry provided donated connectors from Terumo. 

I have also received about 20 perfusion packs, oxygenators, and cardioplegia sets from others.  These items are currently stored in my barn, to be shipped at a later date.

Back table with donated suture 

It takes a lot of supplies to do an open-heart procedure.  Most of the basic supplies, which are needed, are supplied by Tenwek Hospital.  However, certain supplies are expensive and not available locally (such as some of the suture and supplies for cardiopulmonary bypass).

I wish that all of those that donated could have witnessed my exchange yesterday with that father and that husband.  All of us doing a little, with God’s help, can bring about a life-changing miracle for someone 8,000 miles away from our homes.

If you would like to help support Tenwek’s cardiac program, you can make a donation to the 501-C3, non-profit organization Samaritan’s Purse, to cover the costs of shipping supplies.  Please send a donation to:

Samaritan’s Purse, PO Box 3000,  Boone, NC 28607. 

Make out checks to “World Medical Missions.” 

On the memo line, please write “030230” 

I hope that you will be able to participate.  If you wish to visit the Samaritan’s Purse website to learn more about World Medical Missions, please visit http://www.samaritanspurse.org/what-we-do/medical/       Thank you.

 

Sunday, July 7th

It was an awesome day of rest, worship and fellowship.   

Exotic flowers like this grow everywhere!

At 9:30 am, I visited the CTICU; all of the patients were extubated and continuing to make good progress.  Susan was the second patient we operated on; she required high doses of cardiac drugs for several days.  It was so good to see her in a chair and extubated!

Susan extubated and eager to start walking!

The Sunday morning CTICU Nurses

Winfrida

At 9:45, we departed for the African Gospel Mission Church, which is about 2 miles from Tenwek over washed-out dirt “roads."  We were invited to the service and to lunch by Pastor Daniel Hgetich. Daniel is well know to us; he is a surgical technician who scrubs on heart cases.  We attended a wonderful service with about 150 people attending that rural church.  Those that could not give a monetary offering brought corn, sugar cane, avocados, and other produce that was auctioned off at the end of the service.

Children singing during the service:
Make a joyful noise!

Fellowship after the service

After church, we were invited to Daniel and Ann’s home for lunch.  Daniel has a cow, two calves, six goats, several sheep, and 6 chickens.  He grows bananas, avacodo, tea seedlings, and feed for the cow and calves.

Malik's son Nathan holding the Party Crasher!

We had a surprise visit from one of Daniel’s baby goats during dinner.  It was a wonderful time of fellowship.

We also met Rebecca Chumo, a retired OB nurse from Tenwek.  She trained at Tenwek and worked in OB from 1959 to 1996.  On my last trip here in October of 2012, she had a pacemaker implanted at Tenwek. An amazing, spunky woman in her mid 70’s with 7 children, 26 grandchildren and 12 great grand children so far.  Rebecca donated the land for construction of the church.

Malik with our friend Daniel

 Tomorrow we are going to step up the pace and begin doing two cases a day; so this evening I went to the OR to set up for the first case of the day. 

  

Tubing pack donated by Sorin

One of the challenges of this work is obtaining supplies to do the cases.  Over the past year, I have received donated supplies from many sources for the program here.  Shown in the photo above is a tubing pack donated by The Sorin Group.  In February, we shipped 900 pounds of supplies (three 4x4x6 ft pallets by air freight).  The supplies were donated from various sources.  Many thanks to Pete Martelle, Reed Quinn, and Bob Kramer, who gave generous donations to cover the shipping costs. Pete also contributed with packing and shrink wrap expertise.    

Giovanni Cecere donated ACT cartridges, tubing packs and cell saver sets.  He lent me the ACT II machine to use on this trip.  I promise to bring it back in one piece, Gio! It may even still work.  JK.   It was vital to the mission!  Thank you!

Please check out my post tomorrow.  I will tell you how Holly and I managed to get 200 lbs of supplies in our luggage and still have room for 3 pairs of undies and 3 paris of socks each! 

The need here is great and tomorrow I will share how you can be part of supporting the cardiac program at Tenwek.   

Until tomorrow,

Bob