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STORY OF THE WEEK WINNER

The Winner of the Readers` Choice Story of the Week
Congratulations Jeff Israel

Your Story "Jonathon's Rainbow " has been chosen as the Winner of the Readers` Choice Story of the Week.

And you have been placed into the draw to Win a Holiday Around the World for 2.

This Week's Winning Story

 

Jonathon's Rainbow
By Jeff Israel


For 25 years as a surgeon, I have worked with teams going to third world countries to take care of children with cleft lip and palate.

While I know we do great things to help these kids and their families by restoring facial features and improving speech and eating, at the back of my mind is always the question “What if something happens to one of them during the surgery or post operative time period.” In the USA, if there is a surgical challenge requiring intra and post op intense evaluation, there is a pediatric ICU, MRI and CT scanning facilities and a host of other things that we often take for granted. Not so in the third world.

We are happy to have operating room lights when they stay on during the whole case, head lamps that don’t blow out when there is a power surge, and sterilization equipment that works most of the time … not to mention running out of oxygen tanks or suture material.

eam

In February 2006, our team was operating in a small village high in the Peruvian Andes. We were working in a facility that just a few years prior had been converted from a wild animal pound to now a clinic with 2 functioning operating room’s. On a Tuesday afternoon, I performed a fairly routine cleft palate repair on an 18 month old child named Jonathon who came from a nearby town.

The case went well. The anesthesiologist and I determined it was time to awaken the child. Routine antibiotics and steroids for swelling were given as the child was taken to the recovery room. As I went to speak with the family, our recovery nurse came and whispered in my ear that Jonathon was having trouble breathing. I excused myself to rush back to recovery to find that Merle, our anesthesiologist was suctioning out Jonathon’s mouth. My headlamp evaluation revealed tongue and tonsil swelling that was starting to block the airway.

The child’s heart rate was going up, the blood pressure was still stable, but his chest was retracting signifying he wasn’t getting enough air. A three alarm fire, an F 5 tornado, just about every disaster I ever knew about was starting to play in my head. We weren’t in Portland, Oregon where there was a team of pediatric specialists ready to handle childhood airway distress.

We were in a former animal pound, in the Andes, with a child about to lose his airway.
So how does one handle airway problems in a setting like this? First, 100% oxygen was delivered by mask to buy some time while monitoring his blood oxygen level with a portable monitor we had brought from the states.

Then a discussion began with the clinic director and Merle and me. Back home, a fiberoptic scope would have been used to pass a breathing tube into the wind pipe and Jonathon would have been whisked off to the pediatric ICU for monitoring. There was no scope here and the nearest ICU was in Lima, a 24 hour harrowing car ride away.
Flights out of Cusco (40 miles away) stop at 5 PM and (you guessed it) it was nearing 5 PM. There was no problem passing the tube before surgery as there was no swelling.

Now, any manipulation could make the swelling and airway worse. While I have performed dozens of tracheotomies for airway problems over the years, doing one on an infant in this setting would be only last resort due to potential complications.

The key was getting the tongue out of the way of the airway. A thought occurred to put a heavy suture through the front part of the tongue and pull it forward. This is what was done. The chest retractions lessened and the oxygen saturation improved a bit. It was now 6 PM. The parents were notified and comforted and the night began.

cleft

It was determined that 3 of us would stay with the child overnight to take turns holding the suture and the tongue forward. We monitored his vital signs, gave IVs and steroids for swelling, and other meds for discomfort, mild sedation, and blood pressure. I can’t ever remember time moving slower. We’d break each other every 30 minutes so we could “rest”.

It seems like that wasn’t going to happen as I was running into the room every time I heard the respiratory monitor change. I became an instant expert in titrating pain (remember Jonathon had had a cleft palate repair) and vital signs with medication. Too much pain control and his respirations would depress, not enough and he would become agitated. His parents, sleeping in a makeshift bedroom, were notified every hour as to his condition. This continued until I noticed that it was 6 AM.

Beyond exhaustion with my motor running on fumes only, I sensed the clinic was coming back to life as the director Ruth and her employees and the rest of our team were returning for the next day’s surgical work. Jonathon’s tongue swelling was perhaps a bit better and his oxygen saturation was okay. Ruth came to check on us to see how we were doing. At that moment, a young volunteer named Jessie came running into the room. “Ruth, Ruth you’ve got to come outside and see this.

It’s amazing.” Ruth responded, “I can’t now Jessie, this is serious in here and we have a lot to do.” “But Ruth,” Jessie persisted, “This is unbelievable, you have to come now.” As the two left the room, I rechecked the little guy’s mouth. Was it my imagination or did the tongue and back of the throat look better? I released my endless tugging on the suture and watched. Jonathon was breathing on his own without my help. Finally, his obstruction was improving. I gave a victory yell and several of my colleagues came in to observe and rejoice with me. Jonathon was going to make it. Following these few moments of relief, Ruth and Jessie returned to the room. Ruth saw our excitement and then started shaking her head from side to side. “I don’t believe it,” she said. “In my 20 years of living in this part of the valley I have never seen this here before, a rainbow, running over the top of the clinic. We never get rainbows here.” Tears welled up in my eyes …. from fatigue, from joy, from sensing a greater presence.

When I last saw Jonathon, 2 days later, he was a happy smiling baby sucking on a milk bottle (a task he was unable to perform prior because of the cleft palate). His parents were happy and extremely thankful for the care we were able to provide. They went back to their village in the Andes to continue their indigent lives probably never knowing the impact on our lives he had made. It has been said that a greater power guides the surgeon’s hands. It is believed by most that this same power designs the future of each human being. Throughout life we are all being tested. In this case a precious child’s life was in the balance and became the ultimate test. By virtue of these tests we all grow …. hopefully with a good ending like this one …. in living color …. with Jonathon’s rainbow.

Jeff Israel
Portland
Oregon
USA


 

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