PASSING GAS ON THE LOVEBOAT
by Richard Busby, CRNA
I first saw the beautiful curves and sleek lines of the Anastasis through bloodshot eyes and a brain fogged by jet lag. My wife and I had responded to a last minute call from Mercy Ships and hurriedly changed our original plans to go to El Salvador with the ship, the Caribbean Mercy, and instead headed to West Africa. We tumbled out of the Land Rover and dragged our suitcases up the steep gangplank and into the reception area where we were greeted by several fresh and obviously well rested crew members. My suitcase had hardly hit the deck in our cabin when a beautiful South African took my arm and promised a private tour of the lower decks. I glanced at my beautiful wife who returned my vacant stare and fell back on the bed.
Too tired to resist, I followed as I was led through the narrow halls and down a steep staircase. I barked my shins in every doorway we came to because I was looking up at the low ceiling and completely missed the twelve inch bulkheads that we needed to step over. As we stopped before a locked door my bleary eyes focused on sign that said something about a theatre. I thought, "I'm way too tired to watch a movie." As we stepped through the door, I was met by a peculiar but vaguely familiar odor of a really clean place. I remember thinking that if this really were a clean theatre, then my feet wouldn't stick to the floor. My beautiful guide then turned and looked at me with that same gleam in her eye. She brushed past me in the narrow hallway and opened a small door and beckoned me in. What I thought was a cozy cabin was transformed into a pocket sized operating room when she hit the lights. The gleam that I had seen in her eyes had nothing to do with my masculinity. She was the resident anesthetist who had been working solo on this ship for the past week after receiving only a one week orientation herself. She was glad for the fresh meat to give her some much needed assistance with a heavy anesthesia workload. As she hurriedly went over the equipment and supplies and what the case schedule would be for tomorrow, I found myself instantly in sensory overload: the anesthesia machine was like none I had ever seen -- the buttons and dials were printed in German; the drugs were an eclectic blend from several countries and the languages and dosages were decidedly foreign. What had I gotten myself into? After our thirty minute rendezvous, I realized that my confidence was likely to be take a beating in the morning.
Six hours of fitful sleep, after being awake for twenty six and traveling halfway around the world, makes for an interesting time getting focused for morning rounds. The veterans all stayed focused and moved efficiently. I was constantly distracted by the patients I was seeing. I've seen the occasional large goiter in my practice but the first thyroid patient I saw was all of them put together. There were patients with gaping holes in their faces and some with tubes of flesh sutured from forehead to cheek in a staged facial repair and then, the final straw: one patient with a huge facial tumor ... lying next to a patient afflicted with trismus and an oral opening of 2 mm ... followed by a young boy with an all but nonexistent micrognathic lower jaw. I remember thinking "well maybe they won't turn out to be my surgical patients." I again remembered the gleam in the eye of the beautiful South African and realized that I had a fifty percent chance of managing two out of three of the most difficult airways I had ever encountered and she was delighted to share the wealth with me. We finished our rounds and I went up to begin the most exhilarating two weeks of my anesthesia career.
I got a reprieve and was asked to do the thyroid case, so I ran up the stairs and spent the next thirty minutes dragging out every airway adjunct I could possibly find. Visions of deviated tracheas danced in my head and all my fears of caring for those other cases roared to life in anticipating this one. A veteran OR nurse stood in the doorway and waited for a pause in my fevered activity and then asked if she could send for the patient. I started to say no and realized that fifteen minutes more of blind panic would not make me feel any better so I told her to go ahead. When the patient arrived, we gathered around in our tiny holding area to say a prayer for the patient. I was praying fervently as well but, I must confess, on a more selfish line. I was still unsure of which buttons and valves did what on the anesthesia machine. I thought I had the drugs figured out but started wondering if it was milligrams or micrograms written in Dutch on the vial. As I began the induction, all eyes were on me. Iím sure some were wondering what the new guy was made of and if he could perform. It was at that moment that I was transported to a new understanding of faith. In a split second I had to believe that my prayers would be answered. I had to have faith in the skills that had been poured into me over the past seventeen years in practice. I was amazed at the faith of the staff who had to believe in a practitioner that they had never worked with. And most importantly, my patient had to believe that we could improve his quality of life. As I looked down into his eyes he spoke to me in the Fulani dialect. I looked to the translator for help and he said, "he is thanking you for helping him." At that point, I knew I had no choice but to do a good job and with that I felt a peace come over me: all would be well. The induction and intubation were a bit rocky and there was a long tense moment when I passed the point of no return and was having difficulty visualizing his glottic opening but I accomplished securing his airway and the case after that was uneventful. The patient was delivered of a 5 pound bouncing baby elephant of a thyroid--and that was only the right side!
During the subsequent days, my confidence grew and I was able to enjoy the experience much more. One of the more memorable experiences was with a seven year old girl for a palatopharyngoplasty. This is a technique of closing a cleft palate in one operation. The tricky part is the emergence. We allow the patient to come back very slowly and once spontaneous respirations return, we titrate morphine to get a resp rate of 10-12/min. There is a nasogastric tube as well as a shortened uncuffed endotracheal tube sutured into opposite nostrils. The tracheal tube is then removed and replaced by a laryngeal mask airway and the patient is then maintained on a morphine infusion to prevent bucking and gagging which has the potential of disrupting the delicate repair. There is potential for swelling and airway compromise so the initial three hours are critical. We had gotten the little girl settled in recovery and I invited her mother to come back to see her. All was smooth and going as planned. Preoperatively the mother had wanted to stay with her daughter even during surgery. I was moved by her love and concern for her daughter and very surprised that on arrival in the recovery room, she sat off to the side away from her daughter and wouldnít speak to her. I looked over at her after entering some notes and saw that she was sitting in the chair at her daughterís bedside, tears streaming down her face. Alarmed, I asked the translator to ask what was the matter. The mother replied, "I am crying with gratitude that my daughter has been healed." That explained the tears but not the aloof behavior. As I was puzzling over this, Dr. Pamela, a local surgeon breezed in and I commented on the motherís behavior to her. She looked at me like I was as dumb as dirt and said, "It is not our custom to speak to someone who is sleeping." This incident and many
others changed my cultural perspective. Many people may be looking at the same thing but we donít always see the same thing.
This 'cruise' was one of the hardest experiences of my career yet one of the best. There is an incredible thrill in removing a blind boyís bandages, and then watching as he sees his father for the first time in his thirteen years. To see an orphaned sixteen year old with a huge facial neurofibroma who had been living an animal existence in a dirty hovel now, after surgery, sleeping in the arms of his adoptive crewmember. He was soaking up human contact that had been denied to him because of his grotesque affliction. These and many other stories made me realize that this investment was money well spent.
I have now changed career paths and made Mercy Ships my full time job. I am the Director of Anesthesia Support Services, dividing my time between service in the developing world and recruiting others to participate in a vacation from the ordinary. As I look back two years later I find that the Africans and the people of Central America have given me an invaluable gift. They have allowed me to participate in love as God intended. This was a romance on The Love Boat but involving a love of a higher order. I am honored to be clay in the hand of the Potter, used as an instrument of peace and healing to a hurting world.
If you would like to sign up for a 'Love Boat cruise,' Richard Busby can be contacted at:
Mercy Ships International
PO Box 2020
Garden Valley, TX 75771
Phone: 903-939-7110 FAX: 903-939-7110 e-mail: busbyb@mercy ships.org
Busbys in Honduras