Day 4: Trust the Process

Posted on: 03/04/2019

Author: Marian Janes

Dr. Erickson and Dr. Hamilton

12:23pm: The team is halfway through their first day of surgeries, and everyone is taking their breaks to eat a quick lunch.

On triage day, each patient was given their surgery day but no exact surgery time. Despite having rough estimates for each procedure, it’s hard for the doctors to know ahead of time how long each case will really take. Our team creates a schedule based on these estimates using four of the operating rooms at Las Obras Sociales del Santo Hermano Pedro. Two ORs are for gynecological surgeries, one is primarily used for laparoscopic surgery and the other for general surgery. Patients are brought in, after being called one by one, while their friends or family wait for them out in a small courtyard.

When you walk out to this courtyard, the Guatemalans waiting are quietly talking, laughing together or just sitting quietly. Each patient arrives the day of their surgery at 6am and waits. They wait until our team is ready to do their operation – whether that is at 8am or 2pm – and their patience is remarkable.

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8:56pm: Today, our schedule fell a little behind. The team schedules the most involved cases and patients for our first day of surgeries. That allows for more time if needed and for as many days of care as needed. Patients may need more than one surgery and may potentially need to come back in later that same week.

When the schedule gets a little behind, everyone involved with the process is asked to wait. The patients who are next wait a little longer. The families and friends who traveled to support the patient have to wait longer. What’s important to note is that these delays also leads our team to wait too. The teams in each operating room, the team in the pre-op, the teams in the PACU, the team in the ward, the pharmacists, everyone. With the unexpected nature of these difficult surgeries and situations, the team remained calm and continued on, working together to finish the case.

Towards the end of my time at the hospital today, Father Bill introduced me to a woman named Marta. Marta lives in Petén, which is in the most northern part of Guatemala towards the border with Mexico. I remember first meeting Marta when I inputted her paperwork and asking her to smile for her photo. Today, Marta shared more about her story with me. She and her husband raised their family of eight children in Rio Dulce, a beautiful and unfortunately, touristy area on the eastside of Guatamala and 15 years ago, she moved her family to Petén. From where she lives in Petén, Marta and her oldest son, Juan took a 24 hour bus ride to Antigua. His father and Marta’s husband is sick at home and was unable to make the trip.

Her son, Juan still lives in Rio Dulce with his family and took an eight-hour bus to meet his mother for this trip. The trip from Rio Dulce to Petén should really only take about half of that amount of time, he said, but the bus he takes isn’t direct and takes longer due to stops in other areas out of the way. Juan Carlos told us that in Guatemala, buses only lead directly to a city.  It’s either Petén to Antigua or Rio Dulce to Antigua, it’s either this or that. Father Bill quickly answered back – “Well, isn’t that every decision in life? You pick either this or that?” and Juan quickly agreed. “Yes, you have to choose one way or the other, but you also have to wait for the bus. Because once you’re on the bus, you also have to wait to get to where you’re going.”

While I sat with Marta today, her son and she would not stop making jokes. They joked about the size of their family. They joked about Father Bill’s head being cold because he had no hair. They even laughed as they asked us to go get some cookies from the back because Marta is hungry (The doctors instructed her not to eat or drink anything after 12am last night.)

When Father Bill told Marta that she had a beautiful sense of humor, her response was “No vivirás tanto si estás enfadado todo el tiempo.” Translated, it means “You won’t live as long if you’re angry all the time.” Unfortunately, our team was unable to do Marta’s operation today. The schedule was too behind by the afternoon, and we were not able to start her surgery process. She will stay at Casa de Fe for the night, and she’ll return tomorrow at 6am to go through the process again.

My big takeaway from today was that even though the day’s schedule didn’t go exactly as plan, everyone present was accepting of the process. The patients waiting were laughing and humbly waiting, and the nurses waiting in the PACU were smiling and enjoying themselves as they patiently waited for their next patients to arrive from the ORs. The last of our team just came back to La Quinta around 8:30pm with smiles on their faces.

Today, the process was trusted and respected, and tomorrow we’ll do it again.