November 9th – Surgeries Day One

7:30 AM – The Day Begins

Day one hit us like jumping into the deep end of the pool.  

All of a sudden, the day was in full swing.  For those of you (like me) that don’t really know the process, it basically goes something like this.  Patients come to the unit for induction.  Then up to pre-op. (pre-operation) as they prepare to head into the operating room.  Then the operation itself.  Then to the post operation recovery area (which for us is the same staff as pre-op).  And then back to the unit for further recovery and physical therapy (which for us is the same staff that greeted them for induction).  So the process and the patient, goes full circle.

As the photographer and blogger, I have the benefit of being able to circulate to all the areas.  Sometimes I am taking photos, other times I am delivering supplies or information.

I can see all the staff working with all the patients, as they arrive to the next destination in the process.  I also have the benefit of seeing the patients.

I see patients in the induction area, that I later see on their way to the operating room.  I think they like seeing a familiar face as they travel through the steps.

Physical Logistics

Beyond the primary process of surgery and hands on patient care, there is the process of…..logistics.

Both processes run in parallel and then of course intersect at the patient.  So specifically we are taking about the process of supplies.  Both the prepackaged sterile supplies that you heard me talking about loading and unloading….but also the process of cleaning and re-sterilizing the instruments that are used during the surgical procedures.

Santo Tomas is a huge hospital.  With a huge geographic foot print.  Our main areas of focus are; the unit where our patient beds are, which we 4-1.  The pre-op and post operative areas.  They are physically in the same place, which is located near the operating room.  The operating rooms of course, and we have 4 of them, and….the supply rooms and the sterilization areas.

The patient unit is a long way from the pre and post op area, which as I said, is right near the operating rooms.  Fortunately, the supplies for the patient unit are located near 4-1.   Unfortunately, the supply storage area for the operating room is located near 4-1, which is not located near the OR.  And the sterilization machines, for the instruments used in the procedures are located a long, long……long way away from the operating rooms.

This distance not only increases the time and distance between locations, but it adds to the time necessary to complete the process, as well as hamper communications, when situations have to be discussed and decisions have to be modified.

So when you try to imagine the process, try to imagine the long, long, un-air-conditioned corridors that exists between all these places.


As I mentioned in the previous blog, the physical distance hampers communications.  However, there is one thing that hampers our communications even more.  Our inability to communicate with one another!

Of course we have interpreters, that we brought from Syracuse, primarily Dr. Castro and Linda Gonzalez.  And we have folks from Panama that can also interpret.  But if you think about it, ideally you would have a third person standing close at hand, every time a conversation takes place between one of the Americans and one of our patients.  Or between one of the Americans and a staff member from Santo Tomas.  There are 50 Operation Walk Volunteers and over 60 patients!

And yet, even with a situation that seems impossible, we are not only managing, we are thriving!  Through limited Spanish, and limited English, “informal sign language,” the use of formal interpreters, and sometimes through the connection that takes place that needs no formal interpretation, we are communicating quite well.

Is the communication always perfect?  No.  But it is amazing what key elements are able to be understood.  Sometimes I marvel as I listen to staff talk with staff or staff talk with patients, struggling to help each other be understood.  But more often I marvel at how they are able to be understood even with so little common ground.

And still other times I think, what if it was me?  Surrounded by certainly kind faces, and well intentioned people, just prior to a trip to an operating room.  And what if maybe I was not 100% certain I was understanding everything that was being told to me.  How would I feel?

On Friday morning, one of our patients, an elderly gentleman, was in the pre-op area.  He was doing fine.  Everything was medically going according to plan.  As he continued to receive his care prior to heading off to the OR, one of our staff asked him if he knew his height.  An innocent question, she just wanted to chart it in the medical record.  Well of course he started talking in centimeters, and we tried to convert it to meters, and then into yards, and one of the nurses laughed and said, “that does me no good, I normally don’t measure my patients in yards!”  Well we all started laughing, at ourselves, and maybe he wanted to join in on the fun, or maybe he was feeling a little nervous, and he turned to his interpreter, smiled and said, “Is that in case you need to build my coffin?”   

Can you imagine?

Talk about a speedy recovery, Dr. Castro said, “Absolutely not! That is for your new tuxedo, so you can go dancing!” 

As I thought about that moment, I am convinced that the patient was 99% kidding and just letting us know he had a sense of humor.  But the more I thought about it, the more I thought about all the questions that had been asked of him so far….I had to think, did he fully understand all of them?  And why we needed to ask them? Did he draw the right conclusions?  Did he draw them every time?  How many times might he have concluded, to himself, “I am not sure why they are asking me that”, but then he must have concluded, that if they are asking me, then it must be important.  And it was at that moment that I realized that he trusted us.  And of all the good and not so good communication, that was or was not taking place, the one that was, and perhaps the most important one, was trust. 

A visit from the US Ambassador

At mid day the US Ambassador Jonathan D. Farrar and his wife Terry toured the Hospital.  They knew of our visit and wanted to make a special trip to meet us and personally thank us.  The pomp and circumstance was quite exciting, and meeting the US Ambassador was very cool!  He toured with hospital officials, namely Dr. Morales, and Alfredo Maduro, a Panamanian business and philanthropist who is very involved in Operation Walk, and other humanitarian efforts.  They are both wonderfully kind men, who have made our stay here incredibly pleasant and welcoming.

The Ambassador toured all parts of our operation and was able to meet with many staff.  Of course, he stopped for several photo opportunities, and I have several photos. However, here is one I did not take!

US Ambassador and Operation Walk Team

US Ambassador and Operation Walk Team

Pictured above from left to right are…yours truly, Dr. Bret Greenky, Alfredo Maduro, Kim Murray, RN, Terry Farrar, the Ambassador’s wife, Ambassador Farrar, two members from the Department of Health and Dr. Morales.

Although my closest friends won't believe I had no intentions of getting in the photo, but it was Alfredo, who pulled me in and insisted due to his kind and generous nature.  What an experience!

Frank Panzetta