Into high gear in the middle of the night.

We had all gone to bed in anticipation of a big 'tourist' day as our grand finale for this extraordinary trip. Then Gabi began calling Kevin and me - and alerting a few others that we may have a problem with our first patient of the day. Dominique and I began scribbling down supplies we might need while we were still in our hotel rooms since we had dismantled all our equipment.

Gabi and Nancy were worried that the patient may be losing blood into her abdomen, despite the fact that our surgery had been totally uneventful. We wanted to transfuse her, but there was NO O-Positive blood in Cambodia. Yes, none in Cambodia. Though it's easy to get that type in the USA, it's uncommon and hard to find in Asia. We were all asked our blood types, but none of the medical team matched.

Nary called her brother's church members, and incredibly, eight people came all the way to the hospital in the middle of the night to be tested. All our little nursing and medical students did the same, and we found three matches - but those three units would take several hours to process.

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At around 1:30am Kevin and I got dressed and called Marilyn to grab her ultrasound machine- and we were swept back to the hospital by Nary, who was in her 'Terminator Nary" mode - totally focused and efficient!. Dr. Sokchan was there to greet us when we arrived. He had sent off a blood count earlier in the evening, and while he was there, the results came back - hematocrit was only 14% (normal is more like 40%). We needed to operate. The operating rooms were locked  with enormous padlocks. We had no blood. Because our mission was over, all our instruments and anesthesia equipment  had been taken back to the clinic, broken down, and distributed all over the place.  Nothing was sterile. I had given away my laryngoscopes, endotracheal tubes and spinal needles and had NO idea where syringes and needles were anymore. Whereas one night before, all our equipment was organized and would have been fairly easy to mobilize, tonight it was a disaster.

But Nary shot me back to the clinic where I threw together the basics as quickly as I could - and returned me to the hospital to set up while the rest of the team worked on throwing together instruments, drapes, etc. etc. etc. The nursing students just appeared out of nowhere, which was extraordinary since without their amazing help we couldn't have pulled this off. Denise and Dominique somehow pulled together the bare minimum number of instruments we'd need for a laparotomy and prepared to crank up their antiquated sterilizer.

Nary and I awakened  "Mr. Ro", who found a way to get the giant padlocks off the operating room doors and helped us find a way to use the sterilizer for the instruments. In the OR itself I had no oxygen, no suction, and no EKG leads!! And I was about to do a major general anesthetic for a significant abdominal procedure. At 2am. In Cambodia. With no blood. YIKES!!!

Kevin and John helped haul in the equipment and the 'critical' bovie electrocautery unit. Kris was there to help soothe the patient just before I put her to sleep, and tuck her under her brightly colored blanket. Mindy and Nancy O were busy preparing the recovery room for what could be our most difficult case yet - and it was now 4am.

And with the help of God and a team that had worked so beautifully together all week, Cambodians and Americans side by side, we faced a really terrifying situation in a strange place, in the middle of the night, and did an AMAZING job!!!.

We had to come up with cash (John and Kevin, thanks!) to buy some albumin to give the patient until the blood arrived (two units at $57 per small 50cc bottle of 20%)- and it was so wonderful to see our little nursing students, all around us in the OR and Recovery Room, with white gauze bandages over the puncture sites used to donate their own blood.

As the sun started peaking through the window, we finished the case. Our beautiful patient was doing very well, and was stable. Dr. Davis and Dr. Sokchan worked together and did an incredible job, staying totally calm throughout.
By now we not only work well together, we trust each other. And the sense of unity and camaraderie in the OR at that moment, in Operating Room A, at Kossamak Hospital - touched me so deeply.

For a while I had thought it was such bad luck that this would all happen in the middle of the night on our last day, with no equipment left. But in many ways I think it gave us an opportunity to show our new friends and colleagues what we could really do as a team, even under the worst of circumstances. The doctors, nurses, and students there were indispensable to us in caring for this woman. I wish we could take them all home with us!

OK, enough drama!!! As we drug our tired bodies out of the recovery room, Nary told us all to go to bed and sleep for a while and forget the touristy stuff, but NOOOOOOO!! We were not, repeat NOT going to miss the Russian Market, Toul Sleng Museum, Killing Fields, OR the big end-of-trip party at the clinic scheduled for that night. So we just kept on goin' - with the help of varying amounts of caffeine! I managed to buy a ridiculous amount of stuff at the Russian Market, even semi-comatose!!

I'm writing this at the LA airport after hours of flying, so I'm going to add the rest of the last-day 'tourist' stuff when I get home. I just wanted to capture the feeling of our last real case there while it was fresh in my mind...

I'll post all my pics and short video clips and give you all the link once I get home and readjust a little!