That Time I Got a Smile

When you spend the majority of your time following surgeons and visiting doctors around like a lost puppy, you pick up a few things.

Among the plethora of items on my list, I learned there’s a goodness-gracious amount of ways to stitch someone up. I had no idea. Physicians got art skills we knew nothing about. And steady hands. Oh my goodness.

Also, when you say “dehiscence” to a surgeon, you’re telling them your patient’s fascia is visible (the connective tissue fibers under the skin). Bad. If you want to tell your surgeon that the skin around the incision is simply pulling apart, just say the skin around the incision is pulling apart. Save a surgeon a panic attack.

There are certain hospitals in Angola which make our surgeons cringe. I lost track how many times I heard stories of people with un-set fractures with casts placed. Read: they left the bone broken or shattered and just put a cast over it. Unsurprisingly, those bones, which were in the wrong place, weren’t healing correctly. Some came in to CEML to be fixed up after months and months of nothing healing. 

My first encounter with one of these patients came by a 23-year old guy with a 6-month old broken femur. A FEMUR. Those definitely don't snap or heal easily. 

‘E’, our femur patient, enjoys reading Angolan poetry, has a remarkable pain tolerance,  can say “buenas noches”, “buenas tardes”, and “buenos dias”; and can count to 9—all in Spanish. Other than that, he speaks Portuguese. I have nothing else on him. He also knows I do NOT know Portuguese and that I had relatively no clue about anything he was trying to tell me during our brief acquaintence.

The OR team let me watch E’s procedure, so I got to be in the room. For someone who really likes to try and be helpful, it got a little awkward sometimes. I have no OR training. I can’t speak the language. Talk about NOT helpful. Oh, well. 

Normally, I would have introduced myself to the patient and struck up a conversation. We did this almost every week in nursing school. I loved it. I could learn their name, see if they needed anything, check anxiety level (surgery can be a little scary... and people with masks on whilst wearing weird clothes never really helped any), and answer questions (as able). In this Portuguese-speaking OR? No dice. However, I can smile. So smile I did, even though when you’re wearing a surgical mask, it doesn’t show too well. I can say “Tudo bem?” (Is everything good? At least I hope that’s what it means. Because I said it A LOT.) I can also give a thumbs-up. 

April, the finest CRNA (Nurse Anesthetist) of North Carolina, thankfully can speak Portuguese. She introduced us both to E and the surgery went underway. She did most of the question-answering and ensured he was always comfortable. And breathing. Quality people here, I'm telling you.

Occasionally, April had to leave the room. Because in a multiple-hour surgery, food is important. And nurse anesthetist-y things are important. My personal translator/teacher of all-things-anesthesia/fellow sweet tea enthisast left the room for lunch/supper at one point. I chilled by E and watched the surgeons from my chair in the corner. He’d say/ask me something every now and then. Still no clue what he was saying. Eventually, I spewed something like, “Não falo português. Falo español.” (Which I hope meant something like “I don’t speak Portuguese. I speak Spanish.”) He gave me an understanding look, but kept saying things. I’d give him a puzzling look and say something in Spanish. He would give me a puzzling look and say something in Portuguese. Eventually, I would shake my head and we would both chuckle. I have no clue what you’re saying to me, man.

After a few failed tries at successful communication, something clicked with E. That’s when I learned of his aforementioned Spanish vocabulary. He said “Good night”, “Good afternoon”, and “Good morning” to me and then counted for me. It was nice. I helped him get from 9 to 10. I congratulated him, thrilled to hear words I could finally understand.

After we got tired of not understanding each other and E’s anesthesia took more hold of him, we rested in silence. A couple of times, he’d try it back up again. After a while, I remembered my notebook. I had been carrying this small pocket-sized notebook in my…..pocket. Alex, the visiting pre-med student had one to take notes. I thought that was a pretty great idea and started lugging one around too. I grabbed a page, drew a smiley face, and showed it to E. He smiled. I can’t imagine what he must have been seeing with his anesthesia-induced hallucinations. But it got a smile. 

The procedure went longer than planned. Dr. Annelise calls orthopedic surgery “Shop class for surgeons”. Boy, do they work hard in Shop. They have all the toys too: Dewalt drills, hammers, nails, medical-equivalent of rebar—the works. They used them all. Things don't always go as planned, but the team kept going. I can’t give enough credit to this staff. This is definitely not a 9-5 job—and they give it their best even at exhaustive hours. 

During E's operation
Left to Right:
Dr. Steve, Alex, Dr. Annelise, April, and scrub tech hiding in the back
The All Star Ortho-and-Everything-Else Team

E gets a special kind of hardware for his leg. There’s a non-profit organization, Sign Fracture Care Intl, that provides necessary tools (think: nails and screws to hold healing bones in place) to hospitals in 52 developing countries. If for whatever reason, a screw or nail needs to be replaced in a bone, the organization will replace it for free. So Sign Nail guy, or E, is patched up and shipped to recover.

We visit him a few days later in the men’s ward. This is the spot I learn of his remarkable pain tolerance and his appreciation of Angolan poetry. Per Dr. Annelise’s orders, he got up on crutches and walked down the hall with the resident physical therapist. After we’ve exhausted him with walking, he gets back into bed (which in case I haven’t mentioned is in the hallway of the men’s ward, because all the other beds are filled). There’s not much there—a table (shared with another bed in the hallway adjacent to his), basin, flip flops, a bar of soap, and an Angolan poetry book. Alex and I hang out with him for a couple of minutes. All of the sudden, I remember the smiley face note in my little book. I reach in my pocket and sure enough, it’s still in its place. I pull it out and stick it in front of my face, then peak over it. Just like I did in the OR. I have no idea if E remembered my smiley face in the OR with all the anesthesia he had on board, but it got another smile. I tear the page out and hand it to him. Alex steals the show when he reaches into HIS pocket and pulls out a piece of candy. Alex gives it to him and we say our goodbyes to E.  

I added another item to my list of things learned—this time from an almost-surgeon: notebooks and candy are good to carry around in pockets. The latter being slightly better than the former. But just slightly.