Karaikal, India: Sunday, January 25

Blackout!

A power failure last night at 7:40 pm plunged all of K-town – and the operating rooms at nearby Vinayaka Hospital - into darkness. Rotaplast surgeon Ron Gemberling bent over a patient in OR 1, working on a lip repair. Surgeons Capozzi and Spira were in OR 3 and getting read to cut a suture to complete a nasal revision. Everyone froze. Complete silence took over, punctuated by the beeping of the battery-powered monitors measuring vital signs. Biomedical Engineer Ted Leonard scrambled for his briefcase where he kept a flashlight.

“I’m feeling my way down this suture,” Capozzi said to Spira, “and I am going to cut it.” His scissors made a snipping noise. The lights blinked back on again after a long moment – Spira estimates thirty seconds, but for OR nurses Lynne Baker and Paulette McHugh it was a lifetime. With Vinayaka Hospital’s emergency generator kicking in, the doctors sewed up the day’s final patients and nurses rolled them into the Patients’ Anesthesia Recovery Unit.

“Power outage is a surgeon’s worst fear,” Spira said over 7:30 am breakfast today, “second only to an explosion and I’d been in an explosion. But I’d never been in a room so utterly black.”

The doctors recapped the night’s excitement. It was the Rotaplast team’s day off, and though a sightseeing tour was scheduled for 9:00 am, none of the doctors was sleeping in. They were heading off to the hospital to make their rounds.

Blackout notwithstanding, the second day of surgery was a winner: seventeen cases completed. Most everybody on the team felt the mission was pumping on all cylinders. Proof was waiting in the Post Op wards when the team arrived.

“Any fevers? Any bleeding?” pediatrician Al Goldberg asked the Vinayaka interns and nurses on duty as he entered the big open ward closest to the OR center. Patients not still asleep or sedated sat up and more than a few offered pinched smiles through their stitches. Parents stood and put their palms and fingertips together in the local gesture, looking a little bleary-eyed. Many had spent the night here with their children, some sleeping on the floor.

First to be examined were patients with the most recent operations. They’d be moved to smaller wards further down the hall following the order of their arrival from surgery. None would be discharged until a week from now, when they’d be examined by the Rotaplast doctors on their last day in Karaikal.

This morning the doctors were making sure that everyone they’d cut open and put back together during the past couple of days was healthy and healing normally. Normal procedure, of course, for doctors everywhere. Dr. Rajendran, the hospital’s Medical Director, was also on hand (even though it was Sunday) and she gently reassured the Americans that her own competent staff was looking after these folks.

The Americans acknowledged that fact. But beyond duty, there was something else going on, particularly among the plastic surgeons on the team as they trooped around asking questions and taking photos. They were humanitarians happy to see in the faces of the children and parents the results of their donated time and energy. They were also artists admiring their own handicraft.

The burn victim lay with his knees propped up by pillows after the five-hour operation to free his head from a thick collar of scar tissue two nights before. “My special patient,” said nurse Paula Filari. He was doing fine.

Mr. Pakirasamy from Annakuppy, the very first patient to register, was in a small ward, his five-year-old daughter being recovering nicely from the operation on her cleft palate. She was also recovering nicely, the doctors said. And by the end of the team’s morning rounds, that was the general diagnosis for all their patients.

In Thanjavur about two-and-a-half hours inland from Karaikal, the Rotaplast team toured the ancient capital of the Cholas (907 – 1310 AD) and marveled at the Brihadiswara Temple. The temple complex boasts a 190-foot pyramidal tower topped by a huge granite capstone hauled up there a long time ago on a ramp from four miles away. After, the group was feted at a lunch given by the Thanjavur Rotary Club, together with the Karaikal Rotarians hosting Rotaplast, in the air-conditioned dining room of a local hotel. The group appreciated the Rotarian fellowship, as well as the AC especially after walking barefoot over the stones of the holy site in the hot sun.

Convoying back to K-town on roads crazier than usual with holiday traffic (tomorrow is Republic Day – a nationwide blowout) a fender bender on the road nearly turned into a major dust-up.

“Our drivers were playing chicken,” said Tom Fox, “cutting each other off and tailgating.” His driver was a little too close to the car ahead and slammed on the brakes. The car behind rammed into them. “It was a good jolt,” Lynne Baker said. Her fellow passengers, in addition to Tom, were Paulette McHugh and Ambika Chada – none hurt. In minutes, the whole convoy parked by the roadside amidst a crowd watching the furious drivers argue in the dusty heat.

Meanwhile, the phone rang in number 301 at the Paris hotel – a room facing west without AC that happens to be mine. With the afternoon sun torching the hotel façade and me in my boxers compiling my notes, sipping a rum-and-coke and the ceiling fan making a galumphing knock with every pathetic rotation… I picked up the phone.

It was Dr. Rajendran, the Vinayaka Hospital’s medical director, and she sounded pretty tense. One of the kids at the hospital was suddenly running a 104-degree fever. She and her staff were really concerned over a set of complications that I couldn’t readily comprehend. It was an emergency, that was for sure. And she wanted doctors from the Rotaplast team to get over there in a hurry.

The hotel’s extremely cooperative desk manager worked the phones with me, trying to ring up the cell numbers of various Karaikal Rotarians’ gleaned from their business cards. They were all out there with the Rotaplast folks on the sightseeing tour, somewhere between K-town and Thanjavur. It was five o’clock and they were due back at three.

I finally got Bob Demuth on the line through Mr. Baraivan’s cell phone. I could hear car horns honking. He was on the road in the back of a car about a half-hour outside of town, he estimated, and he’d already spoken with the doctors on duty at Vinayaka. Demuth didn’t think it was an emergency situation, but he was going out to the hospital all the same. I called Vinayaka back and told the Medical Director to expect him in about an hour.

Demuth went first, then called Al Goldberg at the Paris to hop in a car and come over. Goldberg told his driver to step on it

The kid turned out to have a touch of pneumonia and was de-hydrated, but she was already on an IV and getting Tylenol when Demuth and Goldberg got to the hospital. The kid was going to be all right. The rest of the team extricated itself from the roadside brouhaha and convoyed back to the Paris hotel in time for a Rotary dinner and exchange of flags

But I wondered what might have happened if someone’s life had really been in the balance, and the only link was me in my boxers. Dr. Capozzi, the team’s medical director said that Rotaplast has good guidelines and safeguards, and that the Vinayaka medical staff was reliable. Even so, he said, “There’s a lesson to be learned here that provisions have to be made for immediate response by the team.” He looked thoughtful and added, “We have to always remember that this is a medical mission and that is our first allegiance.”

And tomorrow it’s back to the OR.

Rex Weiner
Wayne Schoenfeld