Chongqing, China Surgical Volunteer Trip

Richard Siegal: Walking the Fine Line of Plastic Surgery Overseas

Each day we expect the unexpected, as working in developing countries with different cultures and levels of medical infrastructure is always a challenge.

The first case was a cleft palate.  Technically, the operation had been as perfect as possible, and the cleft palate repair had taken about an hour to complete. I held the child’s head between my hands, wished him well for a silent moment, removed the drapes and took out the gag. The surgery was now over, and the operating table needed to be repositioned for the “wake up." The senior anesthesiologist, Fred Mihm, was there, along with Sandi Walsh, the Canadian circulating nurse from the adjacent operating room. Like an airplane at takeoff and landing, there are two dangerous times during anesthesia: induction (putting to sleep) and wake-up. Now it was time to wake the patient.

The operating table needed to be turned 90 degrees, and moved back toward Jai, the anesthesiologist for this particular procedure. In a flash, Jai pulled the head of the table around and toward her, and the entire head of the operating table came off in her hands. The table had come apart, the baby no longer had any support, and the baby’s head, and then torso were rapidly falling to the floor.  (Note: the operating table is the only thing that Interplast does not bring from the central office.  We bring ¾ of a ton of medical equipment on each surgical volunteer team trip, including absolutely everything we will need to prepare, operate and care for our patients, but we simply cannot bring a full operating table due to weight and space restrictions).

I watched this from my stool, and it appeared almost in slow motion – as the endotracheal tube (still attached to the anesthesia machine) was ripped from his throat (thankfully there was no cuff) and his head was dropping like a stone toward the tile floor. 

Sandi made a lightning move and like a great baseball player, caught the child just inches from the rock hard floor.  Head and torso now supported, his feet arced down and grazed the tile gently, and Sandy quickly replaced him on the table.  Jai placed the mask over his face as if nothing at all had transpired. A Maalox heart-attack moment, a near disaster, had passed in an instant. We all took a deep breath.  Sandy immediately received my vote for MVP of the trip. A near catastrophe had been avoided by the swift reflexes of a highly trained professional. All of us surgeons, anesthesiologists and nurses have been a part of thousands of surgeries, but we never let our guard down because you just never know. 

What an amazing group. An Interplast story for a future trip. Just another day of plastic surgery in a foreign land.

Richard Talking About Anesthesia

Richard loves to talk.  Not in a bad way, he just loves to explain stuff.  Here he is talking about what our anesthesiologists go through before each case.  If you look closely, you can catch a chuckle from Fred about 2/3 of the way through. 

By the way, since there have been some problems with videos vanishing, I am going to start trying to post videos in one post and have the accompanying text in the next post.  We'll see if it doesn't cut down on some of the technical issues I have been having.