All for the experience

Deepa Bharath

CHAPTER 7

Expecting the unexpected

For Ruth Ann Burns, the fun of being a Plasticos team member is in

secretly hoping and waiting for those twists and turns.

Things have a way of happening.

Like the volcano that became active in November when the team made

its maiden journey to the Ecuadorean Amazon. They had to land in

Guyaquil instead of Quito and take a flight from there to Macas

because the runway in Quito was blanketed by volcanic ash.

Then there was the time they got stranded in the jungle overnight

because of a broken bush plane and stayed up all night in fear of

nocturnal creatures they had heard about and seen in guide books --

spiders that ate little birds, poisonous snakes and vampire bats.

That was the trip that Ruth Ann Burns didn’t take. But her

husband, general surgeon Robert Burns, did.

“I stayed up all night worried,” Ruth Ann Burns said. “The radio

communication didn’t work, and I had no idea what had happened to

them. It was the worst night of my life.”

But as it turned out, all team members were safe, and the scary

adventure became a hearty tale that they often narrated to family and

friends.

Ruth Ann Burns makes the schedules for these trips, but she trusts

them as she trusts the little airplanes that fly in and out of Macas.

They are both unpredictable, never on time and change course with the

weather.

Their own schedules sometimes veer out of control and take wild

detours. Like their trip to neighboring Rio Bamba in November to help

people hurt in a bomb blast.

“We were waiting for our flight out of Macas,” Ruth Ann Burns

said.

But as the team waited to board their flight to Quito, they saw

the blast on television. Her husband called Ecuador’s Ministry of

Health to find out if the victims needed the team’s help.

“It turned out they needed us badly,” Ruth Ann Burns said.

So instead of vacationing in Cuenca, the team headed for more

action in Rio Bamba.

“But that’s what I love about our trips,” she said. “You never,

ever know what’s going to happen.”

IT HAPPENED ONE NIGHT,

AGAIN

Larry Nichter and Robert Burns walked out of the operation room

after more than 12 hours of surgery.

They took long strides down the corridor. Nichter leaned against

the wall and closed his eyes as he waited for the nurses and others

to finish up.

Dinner was on his mind -- and everyone else’s.

Suddenly, a door swung open, and out bolted coordinators Ruth Ann

Burns and Denise Cucurny.

“They need us in there,” an out-of-breath Cucurny told Nichter.

“You’ve got to help them.”

“What’s going on?” Nichter asked.

“We were watching a baby being born,” Cucurny said, talking like a

speed reader. “The baby can’t breathe. Something’s wrong. It’s not

why we’re here, but we have to do something. Right?”

Ruth Ann Burns nodded, tears in her eyes.

Nichter and Robert Burns rushed into the birthing room. There was

blood on the floor and on the sheets. A doctor was stitching up the

mother. All the nurses were around the baby boy, who weighed more

than seven pounds but was gagging and not breathing.

The surgeons guided the nurses. Pediatric anesthesiologist Lisette

Hernandez, who had worked with the Plasticos team all day, quickly

took over. She soon found out that the baby had swallowed meconium,

his own stool during his first bowel movement while scrunched up in

his mother’s womb. It was blocking his air passage.

“This is not good,” Nichter said, after taking one look at the

baby.

The newborn’s feet were as white as the sheet he was swaddled in.

His bare, wrinkled body was shivering uncontrollably as Hernandez

tried to give him oxygen. A yellow T-shirt with a matching hat and

booties were waiting for the little one on the side of his bed. It

didn’t look like they were going to be worn that night.

Nurses Virginia Burns, Kathleen Fodor and Jane Collins helped

Hernandez move the baby to an operating room that was not being used.

Hernandez continued to resuscitate the baby.

Collins brought in the suction machine from her recovery room.

“It’s not working,” she said.

Hernandez started suctioning the liquid out of the baby by

inserting a tube into his mouth. After more than 30 minutes of

trying, dark green swirls of meconium showed up in colorless liquid

in the tube.

“It’s all coming out,” Hernandez said, wiping beads of sweat off

her brow.

A LIFE SAVED

Hernandez’s flushed face was now smiling under the surgical mask

and the baby was getting pinker by the minute.

“Does it look like he’s going to be OK?” Ruth Ann Burns asked, her

eyebrows raised and her eyes still teary, but hopeful.

“Yes,” Hernandez said. “For now. But we’ll have the pediatric

resident take a look at him and keep him under observation.”

The team’s timely response helped her save the baby’s life,

Hernandez said.

“This happens a lot of times in this hospital,” she said. “The

nurses help out quite a bit.”

But even two days after he was born, the child remained in the

hospital. He lay in he incubator -- nameless. A white piece of paper

stuck on the incubator had his last name scrawled out on it.

“He’s still having seizures,” hospital director Julian Cuesta said

as the team was preparing to leave.

“We’re going to suggest that the parents name the child Larry

Robert, after the two doctors who helped save his life,” Cuesta added

with a smile. “We’ll see.”

What the team did was something anyone would do in the United

States, Nichter said. But in countries such as Ecuador, philosophies

vary.

“If I wasn’t there or if Denise hadn’t been there, no one would’ve

said a word about it,” he said. “They didn’t even have a respirator

in the hospital. They don’t resuscitate. That would’ve been the end

of it.”

HE LOVES THIS WORK

Nichter thrives on surprises. He lives for those puzzles. He

yearns for a challenge.

“I love that stuff,” he said. “They say the hallmark of a surgeon

is equanimity under pressure, to make sense out of complex problems.”

Nichter picked plastic surgery because it presents questions. And

there are no ready-made answers, no books that spout solutions.

“If surgeons are like pilots and heart surgeons are like jet

pilots, plastic surgeons are test pilots,” he said. “There’s a lot of

innovation in plastic surgery.”

Nichter puts the pieces together in the operation room every

single day.

“It’s the unexpected stuff that keeps you going,” he said. “It

keeps you on your toes, keeps your skills honed.”

While the baby was an unexpected assignment for team members,

there are other things they tend to expect on such medical missions

-- things they wish don’t happen, but almost always do.

Julia Salinas, who was the very first patient in the operation

room, returned with an infection just as the team was getting ready

to pack its red suitcases. The 13-year-old hobbled into the operation

room. She had been badly burned as a small child, and surgeon Robert

Burns had performed a skin graft on her to clear up some scar tissue

in her abdomen.

Julia was clutching her stomach. Her beautiful face was contorted

in pain. Even as the surgeon lifted her turquoise dress to examine

her, the room smelled like rotten eggs. Her skin was peeling off like

an onion. The bacteria had eaten through her skin, infecting the

operated area.

Julia howled in pain, shaking her braided hair as Robert Burns

tried to clean the wound. He couldn’t give her an anesthetic. Her

parents, who were waiting in the hall, stood up from their chairs as

they heard their daughter’s plaintive cries.

Julia was one who wailed. But Robert Burns was crying inside.

“It’s never happened on one of our missions before, but a

complication from a surgery is something that can happen anywhere,

anytime,” he said. “As a surgeon, you have to expect it.”

Robert Burns held her hand.

“You’re going to be OK,” he said, comforting her.

“You really, really want to help someone,” he said later. “When it

doesn’t quite work out -- yes, I am very upset.”

Post-operative care is key and that’s something outside the

surgeon’s control, Burns said.

“We don’t know how this girl got this infection,” he said. “But

she is suffering. As if she hasn’t suffered enough from being burned

as a child. Now this.”

Julia would have to spend three weeks in the hospital before the

infection completely subsided, Burns said.

“But I’m glad this happened when we are still here,” he added with

a wan smile. “Yes, I’m definitely happy that I could take care of her

myself.”